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Wat H, Kawa NI, Anderson RR, Avram MM. Precise volumetric quantification using 3D stereophotogrammetry in procedural and surgical dermatology. J Am Acad Dermatol 2022; 87:e73-e75. [PMID: 33137439 DOI: 10.1016/j.jaad.2020.10.077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 10/05/2020] [Accepted: 10/22/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Heidi Wat
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Dermatology Laser and Cosmetic Center, Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts.
| | - Nisrine Imad Kawa
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - R Rox Anderson
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Dermatology Laser and Cosmetic Center, Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Mathew M Avram
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Dermatology Laser and Cosmetic Center, Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
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Wu DC, Goldman MP, Wat H, Chan HHL. A Systematic Review of Picosecond Laser in Dermatology: Evidence and Recommendations. Lasers Surg Med 2020; 53:9-49. [PMID: 32282094 DOI: 10.1002/lsm.23244] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [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: 03/08/2020] [Revised: 03/21/2020] [Accepted: 03/23/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVES The use of picosecond laser in dermatology was originally focused on optimizing the removal of unwanted tattoos. Subsequent advances in this technology have broadened its clinical indications to include treatment of benign pigmented lesions, photodamage, melasma, and scar revision. In this systematic review, evidence-based recommendations are developed for the use of picosecond laser in dermatology. STUDY DESIGN/MATERIALS AND METHODS A comprehensive search of the English language literature was performed up to and including November 2019. Relevant citations were individually evaluated, synthesized, and categorized based on the Level of Evidence. With the addition of the authors' combined clinical experience, clinical recommendations were developed. RESULTS After application of inclusion and exclusion criteria, a total of 77 unique studies were evaluated. Treatment of benign pigmented lesions was associated with level I-IV evidence; rejuvenation was associated with level II evidence; melasma was associated with level II evidence; scar revision was associated with level II-III evidence; tattoo removal was associated with level I evidence. CONCLUSION Picosecond laser is a safe and effective treatment modality for an increasing range of dermatologic indications. Further development of this technology is warranted. Lasers Surg. Med. © 2020 Wiley Periodicals, Inc.
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Affiliation(s)
- Douglas C Wu
- Cosmetic Laser Dermatology, 9339 Genesee Avenue, Suite 300, San Diego, California, 92121
| | - Mitchel P Goldman
- Cosmetic Laser Dermatology, 9339 Genesee Avenue, Suite 300, San Diego, California, 92121
| | - Heidi Wat
- Wellman Center for Photomedicine, Massachusetts General Hospital, 50 Blossom Street, Boston, Massachusetts, 02114
| | - Henry H L Chan
- Wellman Center for Photomedicine, Massachusetts General Hospital, 50 Blossom Street, Boston, Massachusetts, 02114
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Vazirnia A, Wat H, Danesh MJ, Anderson RR. Intense pulsed light for improving dry eye disease in rosacea. J Am Acad Dermatol 2019; 83:e105. [PMID: 31809814 DOI: 10.1016/j.jaad.2019.11.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 11/22/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Aria Vazirnia
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts.
| | - Heidi Wat
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Melissa J Danesh
- Harvard Combined Dermatology Residency Program, Harvard Medical School, Boston, Massachusetts
| | - R Rox Anderson
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Combined Dermatology Residency Program, Harvard Medical School, Boston, Massachusetts
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Wat H, Yee-nam Shek S, Yeung CK, Chan HHL. Efficacy and safety of picosecond 755-nm alexandrite laser with diffractive lens array for non-ablative rejuvenation in Chinese skin. Lasers Surg Med 2018; 51:8-13. [DOI: 10.1002/lsm.23014] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2018] [Indexed: 11/12/2022]
Affiliation(s)
- Heidi Wat
- Division of Dermatology, Department of Medicine; University of Alberta; Edmonton Alberta Canada
| | - Samantha Yee-nam Shek
- Division of Dermatology, Department of Medicine; The University of Hong Kong; Hong Kong SAR China
| | - Chi Keung Yeung
- Division of Dermatology, Department of Medicine; The University of Hong Kong; Hong Kong SAR China
| | - Henry Hin-lee Chan
- Division of Dermatology, Department of Medicine; The University of Hong Kong; Hong Kong SAR China
- Wellman Center for Photomedicine, Massachusetts General Hospital; Harvard Medical School; Boston Massachusetts
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Affiliation(s)
- Heidi Wat
- Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Thomas G Salopek
- Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, Canada.
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Abstract
BACKGROUND AND OBJECTIVE Fractionated photothermolysis (FP) has revolutionized modern laser technology. By creating selective columns of microthermal damage, fractionated devices allows for greater treatment depths to be achieved without the prolonged downtime and risk of complications seen in traditional fully ablative laser resurfacing. Fractional resurfacing is a proven method to treat a variety of cutaneous conditions. In the Caucasian patient, a wide range of devices and treatment settings can be utilized safely and effectively. However, ethnic skin requires special consideration due to its unique pigmentary characteristics and clinical presentations. In this review article, we detail the current indications and strategies to optimize results and mitigate complications when utilizing fractional resurfacing for the Asian patient. METHODS A review of the MEDLINE English literature was conducted on fractionated laser devices studied in the Asian population. Articles included describe non-ablative devices including fractionated erbium glass, thulium fiber, diode, and radiofrequency devices; and ablative devices including fractionated carbon dioxide (CO2 ) laser, erbium yttrium aluminum garnet and yttrium scandium gallium garnet (YSGG) laser. These data were integrated with the expert opinion of the authors. CONCLUSION Taking into account the unique characteristics and cosmetic concerns of the Asian population, fractional resurfacing can be considered a safe and effective option for the treatment of atrophic and hypertrophic scarring, and photorejuvenation in ethnic skin types. Select cases of melasma may be treated with fractionated non-ablative devices, but utilized with caution. The predominant complication associated with fractional resurfacing for these conditions is post-inflammatory hyperpigmentation (PIH) and rebound worsening of melasma. A greater number of treatments at lower density settings and wider treatment intervals typically produce the lowest risks of PIH without compromising treatment efficacy. Lasers Surg. Med. 49:45-59, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Heidi Wat
- Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada, T6G 2G3
| | - Douglas C Wu
- Goldman, Butterwick, Groff, Fabi, and Wu Cosmetic Laser Dermatology, San Diego, California, 92121
| | - Henry Hin Lee Chan
- Division of Dermatology, Department of Medicine, University of Hong Kong, Hong Kong, SAR, China.,Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Wat H, Senthilselvan A, Salopek TG. A retrospective, multicenter analysis of the predictive value of mitotic rate for sentinel lymph node (SLN) positivity in thin melanomas. J Am Acad Dermatol 2015; 74:94-101. [PMID: 26542815 DOI: 10.1016/j.jaad.2015.09.014] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [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: 07/15/2015] [Revised: 09/04/2015] [Accepted: 09/09/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is a paucity of studies to substantiate whether the presence of a single mitosis justifies sentinel lymph node (SLN) biopsy (SLNB) in thin melanomas. OBJECTIVE We sought to determine if mitotic rate is associated with SLNB outcome when taking into account other prognostic factors. METHODS All cases of melanoma that underwent SLNB in the province of Alberta, Canada, between 2007 and 2013 were reviewed through a provincial tumor database. RESULTS A total of 1072 patients fulfilled inclusion criteria. When analyzing all melanomas regardless of thickness, mitotic rate was a good predictor of SLN status. When stratified by Breslow thickness, only intermediate melanomas (1.01-2.0 mm) demonstrated a significant relationship between mitotic rate and positive SLN status (P = .010). For melanomas 1 mm or smaller, mitotic rate was not associated with SLN status. A statistically significant interaction was identified between Breslow thickness and mitotic rate such that for decreasing Breslow depth, the effect of mitotic rate on SLNB status diminished (P = .028). LIMITATIONS The study was retrospective in nature. There is underlying variability in mitotic rate reporting methods over time, and between different dermatopathologists. CONCLUSIONS Mitotic rate does not have unequivocal utility in predicting SLNB status in thin melanomas. There is a significant interaction between mitotic rate and Breslow depth, such that the predictive value of mitotic rate on SLN positivity may be dependent on Breslow thickness.
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Affiliation(s)
- Heidi Wat
- Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Thomas G Salopek
- Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
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Dytoc M, Wat H, Cheung-Lee M, Sawyer D, Ackerman T, Fiorillo L. Evaluation of the efficacy and safety of topical imiquimod 5% for plaque-type morphea: a multicenter, prospective, vehicle-controlled trial. J Cutan Med Surg 2015; 19:132-9. [PMID: 25775634 DOI: 10.2310/7750.2014.14072] [Citation(s) in RCA: 16] [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: 11/18/2022]
Abstract
BACKGROUND There is currently a lack of evidence-based therapies that are safe and effective for plaque-type morphea. We aimed to evaluate the therapeutic potential and safety profile of imiquimod 5% cream in plaque-type morphea. METHODS We enrolled 25 adult patients from two Canadian centers with histologically confirmed plaque-type morphea. Imiquimod 5% was applied to a representative plaque, and vehicle was applied to a control plaque for 9 months. Treatment efficacy was assessed with the Dyspigmentation, Induration, Erythema, and Telangiectasias (DIET) score, histology, and ultrasound evaluation. RESULTS AND CONCLUSIONS Twenty-two patients completed the entire length of the study. Imiquimod 5% was superior to vehicle in reducing DIET scores at 3, 6, 9, and 12 months (p < .05). Induration demonstrated the greatest response. Histologic evaluation showed significant improvement or resolution of disease. However, no ultrasonographic differences were found in dermal and hypodermal thicknesses between the treatment and vehicle groups (p > .05). Adverse effects were minimal and well tolerated.
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Affiliation(s)
- Marlene Dytoc
- Divisions of Dermatology and Cutaneous Sciences and Pediatric Dermatology and Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, ABDivision of Anatomical Pathology, University of British Columbia, Victoria, BC
| | - Heidi Wat
- Divisions of Dermatology and Cutaneous Sciences and Pediatric Dermatology and Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, ABDivision of Anatomical Pathology, University of British Columbia, Victoria, BC
| | - Melody Cheung-Lee
- Divisions of Dermatology and Cutaneous Sciences and Pediatric Dermatology and Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, ABDivision of Anatomical Pathology, University of British Columbia, Victoria, BC
| | - Douglas Sawyer
- Divisions of Dermatology and Cutaneous Sciences and Pediatric Dermatology and Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, ABDivision of Anatomical Pathology, University of British Columbia, Victoria, BC
| | - Thomas Ackerman
- Divisions of Dermatology and Cutaneous Sciences and Pediatric Dermatology and Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, ABDivision of Anatomical Pathology, University of British Columbia, Victoria, BC
| | - Loretta Fiorillo
- Divisions of Dermatology and Cutaneous Sciences and Pediatric Dermatology and Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, ABDivision of Anatomical Pathology, University of British Columbia, Victoria, BC
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Wat H, Haber RM. Trends in the Association between Pyoderma Gangrenosum and Autoimmune Hepatitis: Case Report and Review of the Literature. J Cutan Med Surg 2014; 18:345-52. [DOI: 10.2310/7750.2013.13177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Pyoderma gangrenosum (PG) is a neutrophilic dermatosis commonly associated with underlying systemic illness, typically of autoimmune origin. The association of PG with autoimmune hepatitis (AIH) has been reported but remains poorly recognized. Observations: We describe a case of PG manifesting 5 years following the diagnosis of AIH and conduct a literature review to determine the significance of this association. We identified a predisposition for young females and a tendency for PG to arise 4 to 12 years after the diagnosis of AIH during a period of disease quiescence. Additionally, fulminant hepatitis as the initial presentation of AIH appears to be a risk factor in the subsequent development of PG. Conclusions: These observations may provide important clues for the pathogenesis of PG in the context of AIH. Recognition of this association has important implications for dermatologists in the evaluation, workup, and management of patients with a history of AIH and suspected PG.
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Affiliation(s)
- Heidi Wat
- From the Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, and Division of Dermatology, Department of Medicine, University of Calgary, Calgary, AB
| | - Richard M. Haber
- From the Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, and Division of Dermatology, Department of Medicine, University of Calgary, Calgary, AB
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Abstract
BACKGROUND Topical vitamin D is approved by the US Food and Drug Administration for the treatment of psoriasis but is also used off-label in the treatment of a variety of cutaneous diseases despite a lack of evidence-based guidelines. OBJECTIVE The objective of this study was to provide evidence-based clinical guidelines for the off-label use of topical vitamin D in the treatment of dermatologic disease. METHODS A systematic literature review was conducted via the MEDLINE, Embase, and CENTRAL databases for off-label uses of topical vitamin D analogues in the treatment of dermatologic disease other than psoriasis. The data were synthesized, and evidence-based recommendations were rendered according to the highest level of evidence available. RESULTS A total of 165 articles met the inclusion criteria. A moderate to strong recommendation was given for the use of topical vitamin D in combination with corticosteroids and phototherapy in vitiligo and as monotherapy for various ichthyoses, morphea, pityriasis alba, prurigo nodularis, and polymorphous light eruption. There is evidence showing that topical vitamin D is ineffective in the treatment of actinic keratosis, seborrheic keratosis, lichen planus, seborrheic dermatitis, alopecia areata, chemotherapy-induced alopecia, and hypertrophic scars. CONCLUSION Topical vitamin D analogues have an important role in the off-label treatment of dermatologic disease, but higher quality studies are still required.
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Wat H, Wu DC, Mahmood MN, Brassard A. Primary systemic (amyloid light-chain) amyloidosis masquerading as pseudoxanthoma elasticum: recognizing a novel clinicopathological pattern. JAMA Dermatol 2014; 150:1091-4. [PMID: 24898161 DOI: 10.1001/jamadermatol.2014.61] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Primary systemic (amyloid light-chain [AL]) amyloidosis has a variety of cutaneous manifestations. In this case, we present a novel clinicopathological pattern of AL amyloidosis. OBSERVATIONS A woman in her 50s with a history of AL amyloidosis manifesting as macroglossia and bilateral carpal tunnel syndrome presented with skin-colored to yellow cobblestoned plaques to the neck and bilateral antecubital fossa. Although clinical similar to pseudoxanthoma elasticum (PXE), the skin changes were found to be due to amyloid deposition primarily around the pilosebaceous unit but also within the papillary and reticular dermis. Previous reports of PXE-like plaques in AL amyloidosis have been reported as part of a very rare entity termed amyloid elastosis. However, our case demonstrates several important clinical and pathological differences from this entity. Most notably, there was no dermal elastic fiber involvement, limited cutaneous and systemic involvement, and a fairly indolent course with better response to treatment. CONCLUSIONS AND RELEVANCE Identification of this atypical presentation of AL amyloidosis has important implications for early detection and rapid treatment. The lack of elastic fiber involvement establishes the uniqueness of this case, and further study may be required to determine if this histological finding has prognostic significance.
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Affiliation(s)
- Heidi Wat
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Douglas C Wu
- Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Muhammad N Mahmood
- Division of Anatomical Pathology, Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Alain Brassard
- Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Wat H, Wu DC, Rao J, Goldman MP. Application of Intense Pulsed Light in the Treatment of Dermatologic Disease: A Systematic Review. Dermatol Surg 2014; 40:359-77. [DOI: 10.1111/dsu.12424] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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