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Waibel JS, Waibel H, Sedaghat E. Scar Therapy of Skin. Facial Plast Surg Clin North Am 2023; 31:453-462. [PMID: 37806679 DOI: 10.1016/j.fsc.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Scar therapy is truly important in medicine. Patients experience great loss in quality of life with scars. There are many treatment modalities that help treat scars, including topical, intralesional, surgical, and energy-based devices. In addition, early intervention can help mitigate scar formation. Lasers represent a major innovation in the treatment of all types of scars. Treating scars is a multimodal and multispecialty endeavor. This article highlights the use of many therapies to treat scars and scar symptoms including pruritus, pain, and range of motion. This also highlights key literature including multiple recent consensus guidelines in treating scars.
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Affiliation(s)
| | - Hannah Waibel
- Southern Methodist University; Private Practice: Miami Dermatology and Laser Institute, 7800 Southwest 87th Avenue Suite B200, Miami, FL 33173, USA; Baptist Hospital, Miami, FL, USA; Dermatology Faculty, Miller School of Medicine, University of Miami
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Gfrerer L, Kilmer SL, Waibel JS, Geronemus RG, Biesman BS. Dermal Micro-coring for the Treatment of Moderate to Severe Facial Wrinkles. Plast Reconstr Surg Glob Open 2022; 10:e4547. [PMID: 36262685 PMCID: PMC9575956 DOI: 10.1097/gox.0000000000004547] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 08/03/2022] [Indexed: 06/16/2023]
Abstract
UNLABELLED Micro-coring technology (MCT) removes cores of skin without formation of scars, thereby tightening skin and reducing skin wrinkling. The purpose of this study was to evaluate the safety and efficacy of MCT with the dermal micro-coring device for the treatment of facial wrinkles. METHODS This prospective, multicenter clinical trial included fifty-one subjects who underwent MCT treatments of the mid to lower face. The primary study endpoint was change in the Lemperle Wrinkle Severity Scale. Secondary study endpoints were change in Global Aesthetic Improvement Scale (GAIS), participant satisfaction, and evaluation of treatment outcome by an independent review panel. All study endpoints were evaluated at 1, 7, 30, 60, and 150 or 180 days after treatment. Procedure bleeding, pain, and early healing profile were also captured. RESULTS The mean Lemperle Wrinkle Severity Scale change was 1.3 grades. Improvement in the GAIS was reported for 89.7% (87/97) of treated sites, and average improvement of GAIS was 1.5. Participants reported satisfaction with 85.6% of treatment sites. The independent review panel correctly identified 84.2% of the post-treatment photographs as post-treatment. Procedure bleeding and pain was mild with good healing responses and patient-reported average down time of 3 days. CONCLUSIONS The results of this study demonstrate the safety and efficacy of MCT with the dermal micro-coring device for the treatment of moderate to severe facial wrinkles. MCT led to significant improvement of facial wrinkles with high patient satisfaction and fast recovery time and should be considered in patients who are seeking minimally invasive treatment for wrinkles of the face.
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Affiliation(s)
- Lisa Gfrerer
- From the Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Suzanne L. Kilmer
- Laser and Skin Surgery Center of Northern California, Sacramento, Calif
| | | | | | - Brian S. Biesman
- Laser and Skin Surgery Center of Northern California, Sacramento, Calif
- Practice of Brian S. Biesman, MD, Nashville, Tenn
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Abrouk M, Gianatasio C, Li Y, Holmes J, Dong J, Quiñonez RL, Waibel JS. An Atlas of Optical Coherence Tomography (OCT): Elucidating In Vivo Differences of Scar Types Using OCT in Order to Guide Laser Treatment Parameters. J Clin Aesthet Dermatol 2022; 15:30-39. [PMID: 36213601 PMCID: PMC9529072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE When using laser therapy to effectively treat scars, the choice of treatment parameters depends on the knowledge accuracy of the underlying scar pathology, which is often difficult to judge by gross physical exam. As such, more quantitative measures are needed. In recent years, optical coherencetomography (OCT) has shown promise as a real-time imaging technolgoy of skin microstructure. A key step in developing a methodology for utilizing OCT to develop a comprehensive 'atlas' of OCT characteristics of a wide variety of scar types. This atlas may then be used as a tool for selecting the optimal treatment modality and parameters for each scar type. METHODS One hundred and fifty scars of a wide range of anatomical locations were imaged using OCT, capturing both vascular and structural data. A variety of scar etiologies (e.g. burn, surgical, traumatic) and types (e.g. hypertrophic, keloidal, atrophic) were included. Comparator scans were also taken from normal, unscarred skin. RESULTS OCT revealed morphological differences in the epidermis and dermis between scars and normal tissue, and between scar subtypes. Features affected by scar pathology included epidermal thickness, skin surface texture, dermal epidermal junction rugosity, blood vessel density, vessel shape and diameter, vessel direction and vascular network, dermis scattering intensity and non-uniformity. Each scar subtype showed consistent characteristics distinct from other scar subtypes. LIMITATIONS This was a single-site study of a patient population in South Florida. CONCLUSION OCT is a powerful new objective tool for the clinician to utilize in the pursuit of effective laser treatment parameters by enabling personalized treatment based on individual scar characteristics in order to maximize treatment capabilities.
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Affiliation(s)
- Michael Abrouk
- Dr. Abrouk, Dr. Li, and Dr. Dong are with the Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery at the University of Miami Miller School of Medicine in Miami, Florida
| | - Chloe Gianatasio
- Ms. Gianatasio, Dr. Holmes, Dr. Quinoñez, and Dr. Waibel are with the Miami Dermatology and Laser Institute in Miami, Florida
| | - Yumeng Li
- Dr. Abrouk, Dr. Li, and Dr. Dong are with the Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery at the University of Miami Miller School of Medicine in Miami, Florida
| | - Jon Holmes
- Ms. Gianatasio, Dr. Holmes, Dr. Quinoñez, and Dr. Waibel are with the Miami Dermatology and Laser Institute in Miami, Florida
| | - Joanna Dong
- Dr. Abrouk, Dr. Li, and Dr. Dong are with the Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery at the University of Miami Miller School of Medicine in Miami, Florida
| | - Rebecca L. Quiñonez
- Ms. Gianatasio, Dr. Holmes, Dr. Quinoñez, and Dr. Waibel are with the Miami Dermatology and Laser Institute in Miami, Florida
| | - Jill S. Waibel
- Ms. Gianatasio, Dr. Holmes, Dr. Quinoñez, and Dr. Waibel are with the Miami Dermatology and Laser Institute in Miami, Florida
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Friedman PM, Dover JS, Chapas A, Rahman Z, Ross EV, Kilmer SL, Roberts WE, Sodha P, Stimmel JB, Moncrief MBC, Waibel JS. 1,550 nm Erbium-Doped and 1,927 nm Thulium Nonablative Fractional Laser System: Best Practices and Treatment Setting Recommendations. Dermatol Surg 2022; 48:195-200. [PMID: 35050945 PMCID: PMC8806037 DOI: 10.1097/dss.0000000000003321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The Fraxel Dual laser system (Solta Medical, Inc., Bothell, WA) contains a 1,550 and 1,927 nm wavelength single handpiece with different indications for each wavelength. OBJECTIVE To discuss treatment setting recommendations and best practices for select on-label and investigational applications of the 1,550 and 1,927 nm dual laser system. MATERIALS AND METHODS Eight board-certified dermatologists with 10 or more years of experience with the 1,550 and 1,927 nm laser system completed an online survey about their clinical experience with the system and then participated in a roundtable to share clinical perspectives and best practices for using the laser system. RESULTS For all Fitzpatrick skin types, treatment recommendations were described for selected approved indications for the 1,550 and 1,927 nm laser system, including both lasers in combination. Treatment recommendations were also reached for investigational applications with the 1,550 nm laser and 1,927 nm laser. Best practices for using the lasers during the treatment session to achieve optimal outcomes and decrease the post-treatment recovery time were compiled. CONCLUSION The 1,550 and 1,927 nm dual laser system is effective for a wide range of aesthetic and therapeutic applications, on and off the face and across all Fitzpatrick skin types.
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Affiliation(s)
| | | | - Anne Chapas
- Union Square Laser Dermatology, New York, New York
| | - Zakia Rahman
- Stanford Department of Dermatology, Redwood City, California
| | | | | | - Wendy E. Roberts
- Generational and Cosmetic Dermatology, Rancho Mirage, California
| | - Pooja Sodha
- Department of Dermatology, George Washington University, Washington, District of Columbia
| | - Julie B. Stimmel
- Synchrony Medical Communications, LLC, West Chester, Pennsylvania
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Abrouk M, Gianatasio C, Li Y, Waibel JS. Prospective study of intense pulsed light versus pulsed dye laser with or without blue light in the activation of PDT for the treatment of actinic keratosis and photodamage. Lasers Surg Med 2022; 54:66-73. [PMID: 35043459 DOI: 10.1002/lsm.23492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 10/25/2021] [Accepted: 10/28/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Exposure to ultraviolet (UV) light from the sun is known to have a deleterious effect on the skin. Repeated insults to the dermal matrix from UV radiation result in the clinical signs of photodamage, including changes in skin elasticity, color, and texture. UV radiation also leads to the accumulation of DNA mutations and promotes tumor development, resulting in the formation of cutaneous precancerous and cancerous lesions. Continuous-wave incoherent blue light, intense pulsed light (IPL), and pulsed dye laser (PDL) are safe and efficacious light sources commonly used for aminolevulinic acid photodynamic therapy (PDT). The aim of this study was to prospectively evaluate the efficacy of PDT for the treatment of photodamage and actinic keratoses using four different combinations of light sources: PDL, PDL + blue light, IPL, and IPL + blue light. STUDY A total of 220 patients with either photodamage or actinic keratosis (AK) were recruited from the Miami Dermatology Laser Institute (Miami, FL) and were assigned prospectively to undergo one PDT treatment with one of the four light options: PDL, PDL + blue light, IPL or IPL + blue light. Of the 220 patients enrolled in treatment groups, 214 patients completed the study. Of the 214 patients, 88 received treatment for AK, and 126 received treatment for photodamage. All patients gave their consent to participate in the study and to allow their photographs to be utilized for the purpose of scientific presentations. RESULTS Treatment with IPL resulted in a 70.8% reduction of actinic keratoses at a 1-month follow-up. Treatment with IPL and blue light 84.4% reduction of actinic keratoses at 1 month follow up. Treatment with PDL 70.5% reduction of actinic keratoses at 1 month follow up. Treatment with PDL and blue light 69.3% reduction of actinic keratoses at 1 month follow up. Treatment with IPL resulted in an improvement score of 2.9. Treatment with IPL and blue light resulted in an improvement score of 3.0. Treatment PDL resulted in an improvement score of 1.5. Treatment with PDL and blue light resulted in an improvement score of 1.8. CONCLUSION Although all four treatment groups led to some improvement in signs of photoaging, IPL + blue light again demonstrated increased efficacy when compared to IPL, PDL, and PDL + blue light treatment groups. Results from our study were limited by an unequal distribution between treatment groups and a lack of follow-up beyond a 1-month period and warrant further research.
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Affiliation(s)
- Michael Abrouk
- Harvard Massachusetts General Hospital Laser & Cosmetic Dermatology, Wellman Center for Photomedicine, Boston, Massachusetts, USA
| | | | - Yumeng Li
- Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jill S Waibel
- Miami Dermatology & Laser Institute, Miami, Florida, USA
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Wang JV, Mehrabi JN, Abrouk M, Pomerantz H, Palma AM, Zachary CB, Waibel JS, Kelly KM, Geronemus RG. Analysis of port-wine birthmark vascular characteristics by location: Utility of optical coherence tomography mapping. Lasers Surg Med 2021; 54:98-104. [PMID: 34888897 DOI: 10.1002/lsm.23496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/10/2021] [Accepted: 11/10/2021] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Port-wine birthmarks (PWBs) are congenital capillary malformations that can be located on any area of the body. Vascular features include vessel size, depth, and density, which can greatly differ between patients, individual lesions, and even sites within the same lesion. Previous studies have determined that the location of PWB lesions has impacted their clinical response to laser treatment. OBJECTIVE We utilized dynamic optical coherence tomography (D-OCT) to measure in vivo vessel diameter, density, and superficial plexus depth in patients of all ages with PWB on various sites of the body. We hypothesized that these vascular characteristics would differ according to body location. MATERIALS AND METHODS Patients who had a PWB and presented to clinic at three sites for treatment with the pulsed dye laser (PDL) were enrolled into the study. A D-OCT scanner was utilized for noninvasive, in vivo imaging of PWB lesions. The depth of the top portion of the superficial vascular plexus was estimated as the depth at which the vessel density reaches 50% of the maximum. Vessel diameter and density were calculated by incorporated software algorithm. RESULTS A total of 108 patients were enrolled into the study. There was a total of 204 measurements of PWB lesions. Of all patients, 56.5% (n = 61) reported having a previous treatment with PDL. Of all D-OCT scans, 62.3% (n = 127) were located on the head, 14.2% (n = 29) the upper extremities, 8.3% (n = 17) the lower extremities, 7.8% (n = 16) the trunk, and 7.8% (n = 15) the neck. All locations were compared for each vascular characteristic. For superficial plexus depth, lesions on the head were significantly shallower than those on the upper extremities (217 vs. 284 µm; p < 0.001) and lower extremities (217 vs. 309 µm; p < 0.001). For vessel diameter, lesions on the head had significantly larger vessels than those on the upper extremities (100 vs. 72 µm; p = 0.001). For vessel density, lesions on the head had significantly denser vessels than those on the trunk (19% vs. 9.6%; p = 0.039) and upper extremities (19% vs. 9.3%; p < 0.001) CONCLUSIONS: PWB lesions have distinct vascular characteristics, which can be associated with their body location. This includes superficial vascular plexus depth as well as vessel diameter and density.
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Affiliation(s)
- Jordan V Wang
- Laser & Skin Surgery Center of New York, New York, New York, USA
| | - Joseph N Mehrabi
- Department of Dermatology, University of California, Irvine, California, USA
| | - Michael Abrouk
- Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Hyemin Pomerantz
- Laser & Skin Surgery Center of New York, New York, New York, USA
| | - Anton M Palma
- Institute for Clinical and Translational Science, University of California, Irvine, California, USA
| | | | - Jill S Waibel
- Miami Dermatology and Laser Institute, Miami, Florida, USA
| | - Kristen M Kelly
- Department of Dermatology, University of California, Irvine, California, USA.,Beckman Laser Institute and Medical Clinic, University of California, Irvine, California, USA
| | - Roy G Geronemus
- Laser & Skin Surgery Center of New York, New York, New York, USA
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Abrouk M, Waibel JS, Kilmer S, Fiala T. 28634 Robotic 1064-nm laser with a precision-controlled, motorized, arm for non-contact abdominal lipolysis: An FDA device clearance clinical trial. J Am Acad Dermatol 2021. [DOI: 10.1016/j.jaad.2021.06.821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abrouk M, Dong J, Waibel JS. Medical and aesthetic improvement of photodamaged skin by the combination of intense pulsed light and photodynamic therapy with 10% aminolevulinic acid hydrochloride gel. Lasers Surg Med 2021; 54:62-65. [PMID: 34324724 DOI: 10.1002/lsm.23460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 07/11/2021] [Accepted: 07/11/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of photodynamic therapy (PDT) with the novel 10% aminolevulinic acid (ALA) hydrochloride gel (10% ALA gel) and BF-RhodoLED® light (635 nm; 37 J/cm2 ) in combination with intense pulsed light (IPL) to augment the medical and aesthetic improvement of photodamaged skin of the décolleté. METHODS This was a single-site prospective, randomized, intraindividual split chest pilot study with 20 female subjects with moderate to severe photodamage of the décolleté. Subjects were randomized to ALA-PDT + IPL to one split-side of the chest and ALA-PDT only to the contralateral side. Three blinded raters assessed aesthetic improvement using the global aesthetic improvement scale (GAIS). RESULTS Eighteen subjects completed the study. Superior GAIS results were achieved on the ALA-PDT + IPL treatment side than on the ALA-PDT only treatment side (p < 0.001) after 24 weeks of follow-up. CONCLUSIONS ALA-PDT using 10% ALA hydrochloride gel and BF-RhodoLED® light had superior rejuvenation effects on the décolleté when combined with IPL compared to ALA-PDT alone.
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Affiliation(s)
- Michael Abrouk
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Joanna Dong
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jill S Waibel
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery (Voluntary Faculty), University of Miami, Miami, Florida, USA
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Mahar PD, Spinks AB, Cleland H, Bekhor P, Waibel JS, Lo C, Goodman G. Improvement of Burn Scars Treated With Fractional Ablative CO2 Lasers—A Systematic Review and Meta-analysis Using the Vancouver Scar Scale. J Burn Care Res 2020; 42:200-206. [DOI: 10.1093/jbcr/iraa130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Fractional ablative CO2 laser is being used increasingly to treat burn scars; however, objective measures of outcome success vary widely. This systematic review and meta-analysis extracts and pools available data to assess the outcomes of patients with burn scars treated with fractional ablative CO2 laser. A search of MEDLINE, EMBASE, and the gray literature was performed. The review included studies that reported patients with a confirmed diagnosis of scarring as a result of a burn injury, who were treated with fractional ablative CO2 laser and whose progress was recorded using the Vancouver Scar Scale (VSS). Eight studies were included in the systematic review and meta-analysis. Treatment regimens varied amongst studies, as did patient outcomes. Pooled data revealed an average VSS improvement of 29% across 282 patients following fractional CO2 ablative laser treatment. Although the heterogeneity of treatment regimens across studies limits this systematic review’s ability to provide specific treatment recommendations, the overall trend towards improvement of burns scars treated with fractional CO2 laser based on the VSS encourages further exploration of this modality as a therapeutic tool.
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Affiliation(s)
- Patrick D Mahar
- Skin Health Institute and Royal Children’s Hospital, Melbourne, Victoria, Australia
| | | | - Heather Cleland
- Victorian Adult Burns Service, The Alfred Hospital and Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - Philip Bekhor
- Department of Dermatology, Department of Dermatology, Royal Children’s Hospital and Laser Dermatology, Melbourne, Victoria, Australia
| | - Jill S Waibel
- Miami Dermatology and Laser Institute, Miami, Florida
| | - Cheng Lo
- Victorian Adult Burns Service, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Gregory Goodman
- Skin Health Institute and Dermatology Institute of Victoria, Melbourne, Australia
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Ahluwalia J, Gianastano C, Waibel JS. Incorporating Aesthetic Devices into a Dermatologic Practice. J Clin Aesthet Dermatol 2020; 13:18-21. [PMID: 32082466 PMCID: PMC7028379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background: Lasers and energy-based devices allow physicians to provide quality care to patients and achieve optimal clinical results. Objective: We sought to review the benefits and drawbacks of purchasing and leasing energy-based devices and to highlight key factors that are important to consider when incorporating these devices into a practice. Methods: A PubMed search was conducted for articles on purchasing or leasing lasers and energy-based devices in dermatology. Key reports and personal commentaries on incorporating these technologies into practice are summarized in this review. Results: Energy-based devices are clinical and financial investments and can provide outstanding results for patients and result in substantial gratification for a practice. There are a variety of factors to consider when selecting specific lasers and energy-based devices. Conclusions: Capital resources, aesthetic practice values, expertise in using the device, patient demographics, location of the practice, clinic space requirements, and regulations should be considered when buying or leasing a device.
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Affiliation(s)
- Jusleen Ahluwalia
- Dr. Ahluwalia is with the University of California, San Diego in San Diego, California
- Drs. Gianastano and Waibel are with Miami Dermatology and Laser Institute in Miami, Florida
| | - Chloe Gianastano
- Dr. Ahluwalia is with the University of California, San Diego in San Diego, California
- Drs. Gianastano and Waibel are with Miami Dermatology and Laser Institute in Miami, Florida
| | - Jill S Waibel
- Dr. Ahluwalia is with the University of California, San Diego in San Diego, California
- Drs. Gianastano and Waibel are with Miami Dermatology and Laser Institute in Miami, Florida
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Waibel JS, Rudnick A, Arheart KL, Nagrani N, Gonzalez A, Gianatasio C. Re-pigmentation of Hypopigmentation: Fractional Lasers vs Laser-Assisted Delivery of Bimatoprost vs Epidermal Melanocyte Harvesting System. J Drugs Dermatol 2019; 18:1090-1096. [PMID: 31738492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background: Hypopigmentation is a common cutaneous manifestation that frequently poses a therapeutic challenge for dermatologists. Current treatments have varying efficacies and rarely provide patients with long-term results. However, new treatments are emerging, and head-to-head studies comparing these treatments are warranted. Methods & Materials: In this prospective, Institutional Review Board (IRB)-approved, double-blinded study, 40 subjects with moderate to severe hypopigmentation were randomized into 1 of 4 treatment arms; non-ablative fractional laser, ablative fractional laser, ablative fractional laser with laser-assisted delivered bimatoprost, and an epidermal harvesting system. Results: All patients in this study showed improvement regardless of the treatment modality. The average improvement score was calculated on a 0 to 4 scale, and Group 3 (fractional ablative laser and bimatoprost) was found to have a significantly higher average improvement than all other treatments, with 76% of the patients exhibiting at least a grade 3 (over 50%) improvement over the treatment course. Group 1 (non-ablative fractional) also had a significantly higher average score compared with group 2 (fractional ablative laser). Conclusion: New and emerging therapies have shown promise in helping re-pigmentation of cutaneous hypopigmentation. In this head-to-head trial, it was shown that laser-assisted delivery of bimatoprost had a greater statistically significant improvement compared with 3 possible treatment modalities for stimulation of pigment in medical and cosmetic hypopigmentation. J Drugs Dermatol. 2019;18(11):1090-1096.
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Waibel JS, Gianatasio C, Rudnick A. Randomized, Controlled Early Intervention of Dynamic Mode Fractional Ablative CO
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Laser on Acute Burn Injuries for Prevention of Pathological Scarring. Lasers Surg Med 2019; 52:117-124. [DOI: 10.1002/lsm.23170] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Jill S. Waibel
- Department of ResearchMiami Dermatology and Laser Institute Miami Florida
| | - Chloe Gianatasio
- Department of ResearchMiami Dermatology and Laser Institute Miami Florida
| | - Ashley Rudnick
- Department of ResearchMiami Dermatology and Laser Institute Miami Florida
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Waibel JS, Gianatasio C, Rudnick A, Siegel A. Use of Lasers in Wound Healing: How to Best Utilize Laser Technology to Prevent Scar Formation. Curr Derm Rep 2018. [DOI: 10.1007/s13671-018-0240-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Waibel JS, Phuc Phan Thi K, Hoenig LJ. Laser Treatment Performed More Than 4 Decades After Napalm Burns: Healing the Scars of the "Napalm Girl". JAMA Dermatol 2018; 154:1228-1229. [PMID: 30193374 DOI: 10.1001/jamadermatol.2018.2774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jill S Waibel
- Miami Dermatology and Laser Institute, Miami, Florida
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Jaller Char JJ, Jaller JA, Waibel JS, Bhanusali DG, Bhanusali N. The Role of IL-17 in the Human Immune System and Its Blockage as a Treatment of Rheumatoid Arthritis, Ankylosing Spondylitis, and Psoriatic Arthritis. J Drugs Dermatol 2018; 17:539-542. [PMID: 29742185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Interleukin 17 (IL-17) functions as a bridge between the innate and adaptive immunity. In addition to being a crucial defense mechanism against extracellular pathogens, it plays a significant role in inflammation, therefore considered a decisive factor in inflammatory conditions; hence the importance of its understanding for the treatment of autoimmune diseases. Animal models have demonstrated that blockage of the IL-17 receptor (IL-17R) may prevent these pathologies. For instance, there is evidence that IL-17R-deficient mice may be protected against the development of collagen-induced arthritis (CIA) and experimental autoimmune encephalitis (EAE). Furthermore; inflammatory disorders such as rheumatoid arthritis (RA), psoriasis, psoriatic arthritis (PSA), and ankylosing spondylitis (AS) have been associated with IL-17, and therapeutically targeting this inflammatory pathway could improve patients' outcomes. The discovery and subsequent studies of this interleukin have aided in the understanding of the immune system, and its potential therapeutic blockage provokes optimism for the treatment of these distressing conditions. J Drugs Dermatol. 2018;17(5):539-542.
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Waibel JS, Holmes J, Rudnick A, Woods D, Kelly KM. Angiographic optical coherence tomography imaging of hemangiomas and port wine birthmarks. Lasers Surg Med 2018; 50:718-726. [PMID: 29566276 DOI: 10.1002/lsm.22816] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES A current therapeutic challenge of vascular lesions is that they do not always respond effectively to laser treatment. Information on targeted vessels could potentially be used to guide laser treatments. Optical coherence tomography (OCT) is a useful tool for the non-invasive imaging of tissues, including skin hemangiomas and port wine birthmarks. Dynamic OCT is able to rapidly characterize cutaneous blood vessels. The primary goal of this study was to demonstrate the ability of bedside OCT to image (i) overall vessel pattern; (ii) individual vessel morphology, diameter and depth; and (iii) total vessel density as a function of depth in infantile hemangiomas and port wine birthmarks (PWB). MATERIALS AND METHODS This IRB approved, observational clinical trial was performed among healthy volunteers ages 3 months-73 years old. All patients presented for laser treatment of either infantile hemangiomas or PWB with skin types ranging from Fitzpatrick I-V. OCT imaging of 49 hemangioma and PWB scans were performed pre- and post-treatment. The diameter and depth of the blood vessels making up the vascular lesions were measured. In addition, normal skin was scanned for comparison. Five datasets for infantile hemangiomas and five for PWB that were without motion artifacts were analyzed. RESULTS Scanned lesions exhibited variable and highly heterogeneous blood vessel patterns with vessel diameters ranging from 20 to 160 μm, suggesting that the laser treatment with single pulse durations may not be optimal. The largest blood vessel diameter observed (160 μm) may not be adequately treated by commonly used pulsed dye laser pulse durations. CONCLUSION OCT allowed rapid, non-invasive characterization of the diameter and depth of blood vessels in individual vascular lesions. Imaged lesions consisted of a heterogeneous population of vessel sizes, morphologies, and depth. Future studies could utilize this information to assist development of individualized treatment protocols in an effort to improve vascular birthmark removal. Lasers Surg. Med. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Jill S Waibel
- Miami Dermatology and Laser Institute, 7800 S.W 87th Ave Suite B200, Miami, Florida 33173
| | - Jon Holmes
- Michelson Diagnostics Ltd., Eclipse House, Eclipse Park, Sittingbourne Road, Maidstone, Kent, United Kingdom
| | - Ashley Rudnick
- Miami Dermatology and Laser Institute, 7800 S.W 87th Ave Suite B200, Miami, Florida 33173
| | - Daniel Woods
- Michelson Diagnostics Ltd., Eclipse House, Eclipse Park, Sittingbourne Road, Maidstone, Kent, United Kingdom
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Abstract
Ablative fractional lasers (AFXL) enhance uptake of therapeutics and this newly emerging field is called laser-assisted drug delivery (LAD). This new science has emerged over the past decade and is finding its way into clinical practice. LAD is poised to change how medicine delivers drugs. Topical and systemic application of pharmaceutical agents for therapeutic effect is an integral part of medicine. With topical therapy, the stratum corneum barrier of the skin impairs the ability of drugs to enter the body. The purpose of LAD is to alter the stratum corneum, epidermis, and dermis to facilitate increased penetration of a drug, device, or cell to its respected target. AFXL represents an innovative, non-invasive strategy to overcome the epidermal barrier. LAD employs three steps: (1) breakdown of the skin barrier with a laser, (2) optional use a laser for a therapeutic effect, (3) delivery of the medicine through laser channels to further enhance the therapeutic effect. The advantages of using lasers for drug delivery include the ease of accessibility, the non-invasive aspect, and its effectiveness. By changing the laser settings, one may use LAD to have a drug remain locally within the skin or to have systemic delivery. Many drugs are not intended for use in the dermis and so it has yet to be determined which drugs are appropriate for this technique. It appears this developing technology has the ability to be a new delivery system for both localized and systemic delivery of drugs, cells, and other molecules. With responsible development AFXL-assisted drug delivery may become a new important part of medicine.
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Affiliation(s)
- Jill S Waibel
- Miami Dermatology and Laser Institute, Miami, FL, USA.
| | | | - Deborah R Shagalov
- Dermatology, State University of New York, Downstate Medical Center, Brooklyn, NY, USA
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Waibel JS, Rudnick AC, Wulkan AJ, Holmes JD. The Diagnostic Role of Optical Coherence Tomography (OCT) in Measuring the Depth of Burn and Traumatic Scars for More Accurate Laser Dosimetry: Pilot Study. J Drugs Dermatol 2016; 15:1375-1380. [PMID: 28095550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND In recent decades, a number of optimal diagnostic technologies have emerged to assist in tissue visualization. Real-time monitoring of skin during laser therapies will help optimize laser parameters for more ef cient therapies. One of these technologies, optimal coherence tomography (OCT), may be used to help visualize burn and traumatic scars. When lasing severe scars, lasers have tunable pulse energies, which are made proportional to the scar thickness as estimated by palpation and the physician eye. This has historically been estimated by the clinician with no objective data. OCT is an emerging non-invasive imaging technique that provides a cross-sectional image of tissue micro-architecture from a depth of 0.7 - 1.5 mm. The signal intensity is related to the tissue optical scattering properties, which in turn is related to tissue constituents such as collagen density. Thus, OCT may provide an objective non-invasive measurement of scar depth. STUDY Thirty burn and traumatic scars were imaged with quality, traceable, and veri able OCT data from burn and trauma patients both pre- and post- laser therapy. OCT was rapid and ef cient (approximately 2 minutes) to scan skin to visualize real-time scar tissue in different areas of heterogenous scars. The OCT image of the scar was compared to that of normal tissue in order to identify scar tissue and estimate its depth. Laser parameters were then dialed to treat full thickness of the scar. RESULTS Clinical and OCT correlation between atrophic versus hypertrophic scars was found. However, in most cases the clinicians underestimated the depth of the scar in the dermis. CONCLUSION The treatment of burn and traumatic scars for both civilian and wounded warriors can be challenging. As these scars are often very deep, OCT allows for non-invasive examination of the thickness of the scar allowing the physician better accuracy for laser settings in the treatment for the full thickness of the scar tissue. <em>J Drugs Dermatol. 2016;15(11):1375-1380.</em>.
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Waibel JS, Rudnick A, Nousari C, Bhanusali DG. Fractional Ablative Laser Followed by Transdermal Acoustic Pressure Wave Device to Enhance the Drug Delivery of Aminolevulinic Acid: In Vivo Fluorescence Microscopy Study. J Drugs Dermatol 2016; 15:14-21. [PMID: 26741378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Topical drug delivery is the foundation of all dermatological therapy. Laser-assisted drug delivery (LAD) using fractional ablative laser is an evolving modality that may allow for a greater precise depth of penetration by existing topical medications, as well as more efficient transcutaneous delivery of large drug molecules. Additional studies need to be performed using energy-driven methods that may enhance drug delivery in a synergistic manner. Processes such as iontophoresis, electroporation, sonophoresis, and the use of photomechanical waves aid in penetration. This study evaluated in vivo if there is increased efficacy of fractional CO2 ablative laser with immediate acoustic pressure wave device. METHODS Five patients were treated and biopsied at 4 treatment sites: 1) topically applied aminolevulinic acid (ALA) alone; 2) fractional ablative CO2 laser and topical ALA alone; 3) fractional ablative CO2 laser and transdermal acoustic pressure wave device delivery system; and 4) topical ALA with transdermal delivery system. The comparison of the difference in the magnitude of diffusion with both lateral spread of ALA and depth diffusion of ALA was measured by fluorescence microscopy. RESULTS For fractional ablative CO2 laser, ALA, and transdermal acoustic pressure wave device, the protoporphyrin IX lateral fluorescence was 0.024 mm on average vs 0.0084 mm for fractional ablative CO2 laser and ALA alone. The diffusion for the acoustic pressure wave device was an order of magnitude greater. CONCLUSION We found that our combined approach of fractional ablative CO2 laser paired with the transdermal acoustic pressure wave device increased the depth of penetration of ALA.
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Waibel JS, Mi Q, Ozog D, Qu L, Zhou L, Rudnick A, Al‐Niaimi F, Woodward J, Campos V, Mordon S. Laser‐assisted delivery of vitamin C, vitamin E, and ferulic acid formula serum decreases fractional laser postoperative recovery by increased beta fibroblast growth factor expression. Lasers Surg Med 2015; 48:238-44. [DOI: 10.1002/lsm.22448] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2015] [Indexed: 01/01/2023]
Affiliation(s)
- Jill S. Waibel
- Miami Dermatology and Laser Institute7800 SW 87th AvenueSuite B200MiamiFlorida33173
| | - Qing‐Sheng Mi
- Henry Ford Immunology ProgramDepartments of Dermatology and Internal MedicineHenry Ford Hospital1 Ford PlaceDetroitMichigan48202
| | - David Ozog
- Henry Ford Immunology ProgramHenry Ford Hospital3031 W Grand Blvd.DetroitMichigan48202
| | - Le Qu
- Henry Ford Immunology ProgramDepartment of DermatologyHenry Ford Hospital1 Ford PlaceDetroitMichigan48202
| | - Li Zhou
- Henry Ford Immunology ProgramDepartments of Dermatology and Internal MedicineHenry Ford Hospital1 Ford PlaceDetroitMichigan48202
| | - Ashley Rudnick
- Miami Dermatology and Laser Institute7800 SW 87th AvenueSuite B200MiamiFlorida33173
| | | | - Julie Woodward
- Duke University2351 Erwin Rd., Suite 3802DurhamNorth Carolina27705
| | | | - Serge Mordon
- INSERM U1189INSERM1 Avenue Oscar LambretLilleFrance
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Rkein A, Ozog D, Waibel JS. Treatment of atrophic scars with fractionated CO2 laser facilitating delivery of topically applied poly-L-lactic acid. Dermatol Surg 2014; 40:624-31. [PMID: 24852466 DOI: 10.1111/dsu.0000000000000010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Atrophic scars represent a loss of collagen and a challenging reconstructive dilemma with disappointing traditional treatments. OBJECTIVE To study the safety and efficacy of the treatment of atrophic scars using an ablative fractionated CO2 laser and topical poly-L-lactic acid (PLLA) immediately after to improve atrophic scars. MATERIALS AND METHODS This was an uncontrolled, institutional review board-approved, prospective study evaluating the treatment of atrophic scars. Four blinded dermatologists evaluated a total of 20 photographs taken at baseline and 3 months after the laser and PLLA treatments using the Modified Manchester Scar Scale. Four criteria were evaluated: (1) overall improvement, (2) improvement in scar atrophy, (3) improvement in scar color/dyschromia mismatch, and (4) improvement in scar contour. RESULTS All 4 observers accurately identified 76 of the 80 "before" and "after" photographs. Therefore, the blinded evaluating physicians agreed that at the 3-month follow-up visit, 95% of the scars had improved. Each criterion demonstrated an average improvement of at least 33%. CONCLUSION The combination of using an ablative fractional CO2 laser and PLLA in the treatment of atrophic scars has a synergistic effect on their inherent properties in up-regulating new collagen synthesis to improve atrophic scars.
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Affiliation(s)
- Ali Rkein
- *Department of Dermatology, Henry Ford Hospital; †Miami Dermatology and Laser Institute, Miami, Florida
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Sklar LR, Burnett CT, Waibel JS, Moy RL, Ozog DM. Laser assisted drug delivery: a review of an evolving technology. Lasers Surg Med 2014; 46:249-62. [PMID: 24664987 DOI: 10.1002/lsm.22227] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Topically applied drugs have a relatively low cutaneous bioavailability. OBJECTIVE This article reviews the existing applications of laser assisted drug delivery, a means by which the permeation of topically applied agents can be enhanced into the skin. RESULTS The existing literature suggests that lasers are a safe and effective means of enhancing the delivery of topically applied agents through the skin. The types of lasers most commonly studied in regards to drug delivery are the carbon dioxide (CO2 ) and erbium:yttrium-aluminum-garnet (Er:YAG) lasers. Both conventional ablative and fractional ablative modalities have been utilized and are summarized herein. LIMITATIONS The majority of the existing studies on laser assisted drug delivery have been performed on animal models and additional human studies are needed. CONCLUSIONS Laser assisted drug delivery is an evolving technology with potentially broad clinical applications. Multiple studies demonstrate that laser pretreatment of the skin can increase the permeability and depth of penetration of topically applied drug molecules for both local cutaneous and systemic applications.
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Affiliation(s)
- Lindsay R Sklar
- Department of Dermatology, Henry Ford Hospital, 3013 West Grand Blvd, Suite 800, Detroit, Michigan, 48202
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Minokadeh A, Wulkan AJ, Beer K, Waibel JS. Merkel cell carcinoma. Skinmed 2014; 12:120-121. [PMID: 24933855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A 92-year-old man presented for evaluation with a 1-month history of a rapidly growing asymptomatic pink nodule on his forearm. Biopsy results of the lesion demonstrated pathology consistent with Merkel cell carcinoma (MCC). Immunohistochemical studies displayed positive cytoplasmic staining for cytokeratin AE1/AE3, positive dot-like perinuclear staining for cytokeratin-20, diffuse cytoplasmic staining for neuron specific enolase, and no significant staining for S-100. Subsequent positron emission tomography did not reveal evidence of metastatic disease. Wide excision of the lesion was performed along with a sentinel node biopsy of his left axilla. The sentinel nodes were negative for MCC. Adjuvant radiation treatment of the tumor site was provided because the pathologist noted MCC within 2 mm of the deep margin.
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Anderson RR, Donelan MB, Hivnor C, Greeson E, Ross EV, Shumaker PR, Uebelhoer NS, Waibel JS. Laser Treatment of Traumatic Scars With an Emphasis on Ablative Fractional Laser Resurfacing. JAMA Dermatol 2014; 150:187-93. [DOI: 10.1001/jamadermatol.2013.7761] [Citation(s) in RCA: 176] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- R. Rox Anderson
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston
| | - Matthias B. Donelan
- Department of Plastic Surgery, Shriner’s Hospital for Children, Boston, Massachusetts
| | - Chad Hivnor
- San Antonio Uniformed Health Education Consortium, Lackland Air Force Base, Texas
| | - Eric Greeson
- San Antonio Uniformed Health Education Consortium, Lackland Air Force Base, Texas
| | - E. Victor Ross
- Scripps Clinic Laser and Cosmetic Dermatology Center, San Diego, California
| | - Peter R. Shumaker
- Department of Dermatology, Naval Medical Center, San Diego, California
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Waibel JS, Wulkan AJ, Shumaker PR. Treatment of hypertrophic scars using laser and laser assisted corticosteroid delivery. Lasers Surg Med 2013; 45:135-40. [PMID: 23460557 DOI: 10.1002/lsm.22120] [Citation(s) in RCA: 142] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVES Hypertrophic scars and contractures are common following various types of trauma and procedures despite skilled surgical and wound care. Following ample time for healing and scar maturation, many millions of patients are burdened with persistent symptoms and functional impairments. Cutaneous scars can be complex and thus the approach to therapy is often multimodal. Intralesional corticosteroids have long been a staple in the treatment of hypertrophic and restrictive scars. Recent advances in laser technology and applications now provide additional options for improvements in function, symptoms, and cosmesis. Fractional ablative lasers create zones of ablation at variable depths of the skin with the subsequent induction of a wound healing and collagen remodeling response. Recent reports suggest these ablative zones may also be used in the immediate post-operative period to enhance delivery of drugs and other substances. We present a case series evaluating the efficacy of a novel combination therapy that incorporates the use of an ablative fractional laser with topically applied triamcinolone acetonide suspension in the immediate post-operative period. METHODS This is a prospective case series including 15 consecutive subjects with hypertrophic scars resulting from burns, surgery or traumatic injuries. Subjects were treated according to typical institutional protocol with three to five treatment sessions at 2- to 3-month intervals consisting of fractional ablative laser treatment and immediate post-operative topical application of triamcinolone acetonide suspension at a concentration of 10 or 20 mg/ml. Three blinded observers evaluated photographs taken at baseline and six months after the final treatment session. Scores were assigned using a modified Manchester quartile score to evaluate enhancements in dyschromia, hypertrophy, texture, and overall improvement. LIMITATIONS Small sample size and lack of a control arm. RESULTS Combination same session laser therapy and immediate post-operative corticosteroid delivery resulted in average overall improvement of 2.73/3.0. Dyschromia showed the least amount of improvement while texture showed the most improvement. CONCLUSION Combination same-session therapy with ablative fractional laser-assisted delivery of triamcinolone acetonide potentially offers an efficient, safe and effective combination therapy for challenging hypertrophic and restrictive cutaneous scars.
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Affiliation(s)
- Jill S Waibel
- Miami Dermatology, Laser Institute, Miami, Florida 33173, USA
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Abstract
A 28-year-old white man presented to the Emergency Department with a 24-hour history of an eruption on his extremities, trunk, and face. The patient was known to be HIV positive with a CD4 count of 527 and a viral load of 20,300. He denied fever, chills, malaise, and headache. His social history was significant for the fact that he was in a monogamous homosexual relationship. He had no recent travel, pet exposures, or sick contacts. Physical examination revealed stable vital signs and no documented fever. A maculopapular eruption was present on his face, trunk, and extremities (Figures 1 and 2). There was no palmar or plantar involvement. He was treated with diphenhydramine and topical 2.5% hydrocortisone and advised to return if his condition did not improve. Twelve days after the initial evaluation, the patient consulted us again due to progression of his dermatitis. He had no additional complaints other than an eruption on both palms but neither sole. (Figure 3). The eruption now demonstrated erythematous pink-red oval macules and papules 1-2 cm in size distributed on his scalp, face, trunk, and arms. A few papules contained fine collarettes of scale. Further questioning revealed that the patient had experienced a tender rectal ulcer 2 months previously. A punch biopsy and rapid plasma reagin were performed. The histopathologic examination revealed interface dermatitis with lymphocytes, plasma cells, occasional neutrophils, and a prominent lymphoplasmacytic perivascular dermatitis with infiltration of the vessel walls. Warthrin-Starry and Steiner methods demonstrated spirochetes at the dermal-epidermal junction and in vessel walls, consistent with Treponema pallidum (Figure 4). Rapid plasma reagin and fluorescent Treponema antibody were both reactive with a Venereal Disease Research Laboratory (VDRL) of 1:16. The patient was diagnosed as having secondary syphilis and treated with 2.4 million units of IM benzathine penicillin for 3 weeks. His eruption resolved after the initial treatment and he did not experience a Jarisch-Herxheimer reaction.
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Affiliation(s)
- Steven D Burdette
- Division of Dermatology, Department of Medicine, Wright State University School of Medicine, Dayton, OH 45428, USA
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Kumar G, Bernstein JM, Waibel JS, Baumann MA. Sweet's syndrome associated with sargramostim (granulocyte-macrophage colony stimulating factor) treatment. Am J Hematol 2004; 76:283-5. [PMID: 15224368 DOI: 10.1002/ajh.20112] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Sweet's syndrome is an acute febrile neutrophilic dermatosis that is a known complication of the administration of filgrastim, a drug that causes increased neutrophil proliferation and differentiation. This complication has not previously been reported during treatment with sargramostim, a hematopoietic cytokine with activity that overlaps filgrastim. We report a case of Sweet's syndrome in association with sargramostim treatment following chemotherapy for acute myelogenous leukemia. A suspected second episode occurred after subsequent chemotherapy and sargramostim treatment. Physicians should be aware of this possible association because the signs and symptoms of Sweet's syndrome are easily mistaken as being due to infection.
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Affiliation(s)
- Geetika Kumar
- Department of Medicine, Wright State University School of Medicine, 4100 West Third Street, Dayton, OH 45428, USA
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Abstract
White lesions are frequently found during the examination of the oral cavity. Although some benign physiologic entities may present as white lesions, systemic conditions, infections, and malignancies may also present as white oral lesions. An appreciation of the many clinical entities that white lesions may represent is necessary if a differential diagnosis of white lesions is to be elucidated. The appreciation of subtle clinical findings associated with white lesions of the oral cavity permits clinicians to better care for their patients.
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Affiliation(s)
- Diana V Messadi
- Section of Oral Medicine, Division of Oral Biology and Medicine, School of Dentistry, University of California Los Angeles, Box 951668, Los Angeles, CA 90095-1668, USA
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