Arch Gerontol Geriatr. 2009 Jun 25; Robert L, Molinari J, Ravelojaona V, Andrès E, Robert AMIt could be shown using the in vitro cell culture aging model, that elastase-type endopeptidase activity is progressively upregulated with successive passages (in vitro aging). Similar results were obtained previously by determining elastase-type activity as a function of age in aorta extracts (human) and skin extracts (mouse). Among the possible mechanisms involved we tested the role of advanced glycation endproducts (AGEs) on this process. AGE-production was shown to increase with age, exemplified by the exponential age-dependent crosslinking of collagen, demonstrated by Fritz Verzár, already in 1963. Several AGEs significantly upregulated elastase-type activity when added to the culture medium of fibroblasts. This effect appears to be mediated by some AGE-receptors as shown previously, and could be inhibited by a 5kDa rhamnose-rich oligosaccharide (RROP-3) as well as by a fucose-rich oligosaccharide (FROP-3). When present in the culture media, RROP-3 and FROP-3 efficiently inhibited the passage-dependent upregulation of elastase-type activity expressed by human skin fibroblasts. The use of specific inhibitors and zymography suggested that matrix metalloproteinases (MMP)-9 activation and expression are mainly involved. A detailed discussion is proposed for the interpretation of age-dependent modifications of tissues as vascular wall and skin in the light of these and related experiments, highlighting the role of several specific receptors in the mediation of the observed reactions.
Int J Cosmet Sci. 2009 Feb; 31(1): 27-39Lee JM, Carson R, Arce C, Mahajan M, Lobst SA new abrasion tool (US patent US7087063 B2) has been developed for collecting skin epidermal samples. This device includes a central shaft that holds the probe in a split chuck. Of the variety of probe designs tested, the laser-cut hollow tube (HT) probe abraded the basal layer of the epidermis most consistently, resulting in representative epidermal skin samples. Compared with traditional clinical methods, the abrasion method allows for high-throughput epidermal skin collection with minimal invasiveness to the volunteer subjects. A large number of abrasion samples have been collected in various clinical studies with no adverse effects observed. Epidermal abrasion, when used appropriately and with the optimized probes, can yield high quality tissue samples that are representative of the epidermis. A sufficient quantity of RNA and protein can be obtained for many subsequent molecular and biochemical applications. Because of its minimal invasiveness and high-throughput nature, the abrasion method can be a valuable tool used to investigate the efficacy of topical applications of skin care products.
J Dermatolog Treat. 2008; 19(5): 300-4Karabudak O, Dogan B, Baloglu HOBJECTIVES: Non-ablative laser treatment has been used for improving dermal toning. Laser application to dermis causes new collagen formation in terms of wound healing. We aimed to study mainly histological changes in skin after the use of a Q-switched Nd:YAG laser in non-ablative treatment of wrinkles. METHODS: The laser was adjusted to a fluency of 7 J/cm2 with a spot size of 3 mm and a pulse rate of 10 Hz to treat periorbital wrinkled areas. None of the patients had received filling materials, botulinum toxin injections or any dermabrasion procedures. All laser sessions were held every 15 days for a total of six sessions and all patients were photographed before treatment and then 2 months after the last treatment. Histological examinations were performed before laser treatment and 1 month after the final treatment. RESULTS: Four of eight individuals showed clinical improvement. The histological proportion of collagen fibers was measured by using the Samba method. An increase in the mean optical densities (MOD) of collagen fibers compared with baselines was statistically significant in all patients (p
J Dermatolog Treat. 2009 Jan 1; 1-6Sadick NS, Palmisano LThis report describes a novel use of injectable poly-L-lactic acid (PLLA; Sculptra((R))) for the correction of acne scars in an adult patient. The patient, a 60-year-old white woman, had previously been treated for acne scars with CO(2) laser resurfacing, dermabrasion and trichloroacetic acid peels, as well as collagen, calcium hydroxylapatite and hyaluronic acid dermal fillers. These treatment approaches did not provide satisfactory improvement of the patient's acne scars. The latest course of therapy consisted of seven treatment sessions during which injectable PLLA was administered serially into individual scars and depressions in the patient's nasolabial folds, mid-cheeks and chin. Six months after the seventh treatment session, the patient noted an observable improvement in her acne scars. She received touch-up injections 14 months after her seventh treatment. Injectable PLLA was well tolerated, with only minimal swelling for 24-72 hours post-treatment and bruising at injection sites lasting 5-7 days. Given the well-recognized difficulty in treating acne scars, the results of this case suggest that injectable PLLA may provide an improved treatment modality for resolving acne scars.
Aesthet Surg J. 2008 Jul-Aug; 28(4): 456-62Sandel HD, Perkins SWThe authors recommend carbon dioxide (CO(2)) laser resurfacing as an excellent tool for treatment of aging skin, especially when used for moderate to severe facial rhytids, explaining that some of the commonly cited disadvantages of this modality can be avoided with proper patient selection and conservative treatment settings. They contend that the ability to control fluence, density, and pattern size provides an excellent benefit-risk ratio. In addition, using a combination of other resurfacing modalities, such as 35% trichloroacetic acid chemical peels, 88% phenol, and dermabrasion with the CO(2) laser produces outstanding results. They cite their experience in safely and effectively performing simultaneous rhytidectomy and CO(2) laser resurfacing. Although newer technologies exist with less potential complications and downtime than the CO(2) laser, the authors point out that these modalities require multiple treatments, each with its own downtime, at a higher overall cost and with results that are arguably inferior. Here, they discuss their experience and techniques using the CO(2) laser, considering efficacy when used alone and in combination resurfacing treatments, and discuss its histology, physics, and history.
Photodermatol Photoimmunol Photomed. 2008 Dec; 24(6): 322-9Anbar TS, Westerhof W, Abdel-Rahman AT, Ewis AA, El-Khayyat MABACKGROUND: NB-UVB phototherapy is a very important modality in treating vitiligo but the treatment course usually exceeds 1 year. Skin ablation with mechanical dermabrasion with 5Fluorouracil (5FU) was introduced to treat vitiligo in 1983. This was modified replacing the mechanical dermabrasion by erbium-YAG (ER:YAG) laser ablation and resulted in better prognosis in periungual vitiligo. Purpose: In the present study, we are exploring the effect of the use of ER:YAG laser skin ablation and application of 5FU on the outcome of short-term NB-UVB therapy for patients with non-segmental vitiligo (NSV). METHODS: This study included 50 adult patients with a total of 65-paired symmetrical NSV lesions in different body parts. One side was treated with ER:YAG laser ablation, followed by 5FU application before simultaneous NB-UVB therapy of both sides for a maximum period of 4 months. The outcome was then evaluated both qualitatively and quantitatively. RESULTS: The overall response to therapy was better using the combination therapy. Fifty patients (78.1%) experienced a moderate-marked repigmentation response in the combination group compared with 23.4% in the mono-therapy group. The response was significantly higher when using the combination therapy in different body parts (P value is
Ann Plast Surg. 2008 Oct; 61(4): 410-2Leyngold M, Leyngold I, Letourneau PR, Zamboni WA, Shah HRhinophyma, the end stage in the development of acne rosacea, is characterized by sebaceous hyperplasia, fibrosis, follicular plugging, and telangiectasia. Although it is commonly considered a cosmetic problem, it can result in gross distortion of soft tissue and airway obstruction. Basal cell carcinoma (BCC) is a rare finding in patients with rhinophyma. The objective of this study is to review the literature of BCC in rhinophyma and report on a case. A 70-year-old male presented with long-standing rosacea that resulted in a gross nasal deformity. The patient suffered from chronic drainage and recurrent infections that failed conservative treatment with oral and topical antibiotics. The patient decided to proceed with surgical intervention and underwent tangential excision and dermabrasion in the operating room. Since 1955 there have been 11 cases reported in the literature. In our case, the pathology report noted that the specimen had an incidental finding of a completely resected BCC. The patient did well postoperatively and at follow-up remains tumor-free. Despite the uncommon occurrence of BCC in resection specimens for rhinophyma, we recommend that all specimens be reviewed by a pathologist. If BCC is detected, re-excision may be necessary and careful follow-up is mandatory. Larger studies would be needed to determine the correlation between the 2 conditions.
J Drugs Dermatol. 2009 Feb; 8(2): 138-44Gotkin RH, Sarnoff DS, Cannarozzo G, Sadick NS, Alexiades-Armenakas MCarbon dioxide (CO2) laser skin resurfacing has been a mainstay of facial rejuvenation since its introduction in the mid 1990s. Recently, a new generation of fractional or microablative CO2 lasers has been introduced to the marketplace. According to the concept of fractional photothermolysis, these lasers ablate only a fraction of the epidermal and dermal architecture in the treatment area. An array of microscopic thermal wounds is created that ablates the epidermis and dermis within very tiny zones; adjacent to these areas, the epidermis and dermis are spared. This microablative process of laser skin resurfacing has proven safe and effective not only for facial rejuvenation, but elsewhere on the body as well. It is capable of improving wrinkles, acne scars, and other types of atrophic scars and benign pigmented lesions associated with elastotic, sun-damaged skin. Because of the areas of spared epidermis and dermis inherent in a procedure that employs fractional photothermolysis, healing is more rapid compared to fully ablative CO2 laser skin resurfacing and downtime is proportionately reduced. A series of 32 consecutive patients underwent a single laser resurfacing procedure with the a new microablative CO2 laser. All patients were followed for a minimum of 6 months and were asked to complete patient satisfaction questionnaires; a 6 month postoperative photographic evaluation by an independent physician, not involved in the treatment, was also performed. Both sets of data were graded and reported on a quartile scale. Results demonstrated greater than 50% improvement in almost all patients with those undergoing treatment for wrinkles, epidermal pigment or solar elastosis deriving the greatest change for the better (>75%).
Mechanical exfoliation using microdermabrasion has been used as a minimally invasive treatment of photodamage, as well as to improve absorption of topical agents.
Phonophoresis, a method of electrically assisted percutaneous delivery of macromolecules, relies on ultrasonic waves producing alterations within the stratum corneum that result in increased absorption.
OBJECTIVE:
To determine the effects on photodamaged facial skin that resulted from the ultrasound-enhanced delivery of a combined hyaluronic acid, retinol, and peptide-containing complex following microdermabrasion.
METHODS:
Seven individuals, aged 40-65, with Fitzpatrick skin types I-III and class I-III rhytids, underwent eight weekly aluminum oxide crystal microdermabrasion procedures (Parisian Peel; Aesthetic Technologies, Golden, CO, USA), followed by administration of a topical combined hyaluronic acid, retinol, and peptide-containing complex, propelled through ultrasound phonophoresis.
The participants continued manual twice-daily application of the topical complex between treatments. Clinical evaluation included digital photography, and patient and investigator assessment of changes in skin dryness, texture, brightness, tone, and rhytids.
The 3-month post-treatment histologic evaluation consisted of pre- and post-treatment biopsies evaluated for microscopic and ultrastructural changes.
RESULTS:
An overall mild clinical improvement in the skin was noted. A slight increase in vascularity within the papillary dermis, increased reticulin stain (type III collagen), and ultrastuctural evidence of increased type I collagen indicate dermal injury with resulting new collagen formation.
CONCLUSION:
Microdermabrasion followed by ultrasonic phonophoretic application of topical products represents a novel dermal delivery approach to photorejuvenation
"Evaluation of histologic and electron microscopic changes after novel treatment using combined microdermabrasion and ultrasound-induced phonophoresis of human skin"
Dudelzak J, Hussain M, Phelps RG, Gottlieb GJ, Goldberg DJ
J Cosmet Laser Ther. 2008 Dec ; 10(4): 187-92 (Hubmed.org)
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Cosmetic surgery to counteract the aging process is an evolving field. Most procedures have concentrated on the face; however, the hands are an often-neglected area. Current methods of hand rejuvenation include autologous fat injection, sclerotherapy, intense pulsed light, chemical peel, and microdermabrasion.
Only autologous fat injection restores dermal thinning. We compare the use of hyaluronic acid (Restylane, Medicis Aesthetics Inc.) versus collagen (Cosmoplast, INAMED Aesthetics) for soft tissue augmentation of the dorsal hands.
MATERIALS AND METHODS:
Ten female patients who demonstrated dermal thinning of the dorsal hands were randomized to receive 1.4 mL of hyaluronic acid or 2.0 cm(3) collagen to alternate interphalangeal spaces of dorsal hands.
Patients returned at 1 week, 1 month, 3 months, and 6 months for digital photography and completion of a patient/physician questionnaire.
RESULTS:
Hands were scored by two separate blinded physicians on scales of 1 to 5 for clearance of veins. Patients scored both tolerability and satisfaction on a scale of 1 to 5. Analysis showed a mean difference of 0.95 (0.004), median difference of 0.9 (0.008) for clearance, and a mean difference of 0.90 (0.010) with a median difference of 1.0 (0.031).
The satisfaction difference was not significant with a mean difference of 0.80 (0.070) and median difference of 1.0 (0.117).
CONCLUSION:
Aging of the hands is a common problem that is often overlooked. The use of soft tissue fillers is a viable tool in hand rejuvenation. In this study hyaluronic acid proved to be superior in efficacy to collagen.
"A double-blind, comparative study of nonanimal-stabilized hyaluronic acid versus human collagen for tissue augmentation of the dorsal hands"
Man J, Rao J, Goldman M
Dermatol Surg. 2008 Aug ; 34(8): 1026-31 (Hubmed.org)
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US News World Rep. 2009 Feb; 146(1): 73
Cells Tissues Organs. 2009 Jun 24; Macchi V, Tiengo C, Porzionato A, Stecco C, Vigato E, Parenti A, Azzena B, Weiglein A, Mazzoleni F, De Caro RThe purpose of this study was to investigate the morphology of the superficial musculoaponeurotic system (SMAS). Eight embalmed cadavers were analyzed: one side of the face was macroscopically dissected; on the other side, full-thickness samples of the parotid, zygomatic, nasolabial fold and buccal regions were taken. In all specimens, a laminar connective tissue layer (SMAS) bounding two different fibroadipose connective layers was identified. The superficial fibroadipose layer presented vertically oriented fibrous septa, connecting the dermis with the superficial aspect of the SMAS. In the deep fibroadipose connective layer, the fibrous septa were obliquely oriented, connecting the deep aspect of the SMAS to the parotid-masseteric fascia. This basic arrangement shows progressive thinning of the SMAS from the preauricular district to the nasolabial fold (p < 0.05). In the parotid region, the mean thicknesses of the superficial and deep fibroadipose connective tissues were 1.63 and 0.8 mm, respectively, whereas in the region of the nasolabial fold the superficial layer is not recognizable and the mean thickness of the deep fibroadipose connective layer was 2.9 mm. The connective subcutaneous tissue of the face forms a three-dimensional network connecting the SMAS to the dermis and deep muscles. These connective laminae connect adipose lobules of various sizes within the superficial and deep fibroadipose tissues, creating a three-dimensional network which modulates transmission of muscle contractions to the skin. Changes in the quantitative and qualitative characteristics of the fibroadipose connective system, reducing its viscoelastic properties, may contribute to ptosis of facial soft tissues during aging.
Clin Interv Aging. 2009; 4(1): 269-87Gist S, Tio-Matos I, Falzgraf S, Cameron S, Beebe MWith our aging population, chronic diseases that compromise skin integrity such as diabetes, peripheral vascular disease (venous hypertension, arterial insufficiency) are becoming increasingly common. Skin breakdown with ulcer and chronic wound formation is a frequent consequence of these diseases. Types of ulcers include pressure ulcers, vascular ulcers (arterial and venous hypertension), and neuropathic ulcers. Treatment of these ulcers involves recognizing the four stages of healing: coagulation, inflammation, proliferation, and maturation. Chronic wounds are frequently stalled in the inflammatory stage. Moving past the inflammation stage requires considering the bacterial burden, necrotic tissue, and moisture balance of the wound being treated. Bacterial overgrowth or infection needs to be treated with topical or systemic agents. In most cases, necrotic tissue needs to be debrided and moisture balance needs to be addressed by wetting dry tissue and drying wet tissue. Special dressings have been developed to accomplish these tasks. They include films, hydrocolloids, hydrogel dressings, foams, hydrofibers, composite and alginate dressings.
Medical spas' menus of services vary widely and depend greatly on the medical director or owner's experience and predilection. Core services include: microdermabrasion, mild chemical peels, medical facials, laser hair removal, photorejuvenation, botulinum toxin, and injectable fillers.
Common procedures include cellulite reduction, tissue tightening, and acne treatments. Less common procedures that are more likely to be performed in medical spas with direct on-site daily involvement of the medical director include: laser resurfacing, laser-assisted lipoplasty, sclerotherapy, photodynamic therapy, and cosmetic surgery.
Multisite spas often use multi-platform devices to assist with uniformity in menu offerings and training.
"Procedures offered in the medical spa environment"
Taub AF
Dermatol Clin. 2008 Jul ; 26(3): 341-58, v (Hubmed.org)
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Biogerontology. 2009 Jun 24; Bertrand-Vallery V, Boilan E, Ninane N, Demazy C, Friguet B, Toussaint O, Poumay Y, Debacq-Chainiaux FSkin cancers and extrinsic aging are delayed consequences of cumulative UV radiation insults. Exposure of human keratinocytes to UVB has been previously shown to trigger premature senescence. In order to explore the involvement of the cyclin-dependent kinase inhibitor p16(INK-4a) in UVB-induced premature senescence, we developed an original model of repeated sublethal exposures of human keratinocytes deficient in p16(INK-4a). We did not observe any significant increase of senescence-associated beta-galactosidase activity positive cells following UVB exposure in this cell line in contrast to primary keratinocytes, suggesting a role for p16(INK-4a) in UVB-induced senescence. However, we detected sustained DNA damage, prolonged cell cycle arrest, and induction of markers of epidermal differentiation like involucrin and filaggrin as consequences of the repeated exposures. Keratinocytes exposed to the same dose of UVB in a single exposure died. Furthermore, the abundance of the keratins 6, 16 and 17 was increased in keratinocytes exposed repeatedly to UVB suggesting an alternative differentiation. This model allows the induction of a state of differentiation observed in vivo with differentiation uncoupled from premature senescence.
J Infect Chemother. 2009 Jun; 15(3): 143-55Mori TThe specificity of the tuberculin skin test (TST) in the diagnosis of tuberculosis infection is seriously compromised because of extensive use of the bacille Calmette-Guérin (BCG) vaccination. The interferon-gamma release assay (IGRA), a new diagnostic using Mycobacterium tuberculosis-specific antigens has been introduced in response to these needs. In this review, published findings on the performance of the QuantiFERON-TB (QFT), one of the IGRA formats, are summarized and discussed. In addition to its high specificity, the QFT has considerably high sensitivity, comparable with or superior to that of the TST, if applied to patients with active tuberculosis as a surrogate of latent tuberculosis infection. When applied to patients with immunosuppression, such as aging patients, or those with HIV infection, those with immunosuppressive drug therapies, or those with renal hemodialysis, QFT is shown to be more robust than the TST. As regards the dynamics of QFT responses to chemotherapy, there are many reports showing a decrease in responses during the treatment, which indicates the possibility that QFT could be used as a tool for monitoring the progress of treatment. However, there are discordant reports that warrant further study.
Microdermabrasion (MDA) is a safe, simple, and beneficial technique for superficial skin resurfacing. Despite its popular usage, few studies have assessed the efficacy of different Microdermabrasion protocols applied at the present time.
Objectives To assess the effects of Microdermabrasion generally, as well as to compare the effects of two vs. three passes of Microdermabrasion (MDA) in each session for a total number of six therapeutic sessions on skin biophysical characteristics.
METHODS:
In this randomized, investigator-blind, split-face study, 10 patients underwent a series of six Microdermabrasion treatments with an interval of 2 weeks.
One side of the face was treated with two passes of Microdermabrasion and the other side was treated with three passes, randomly. Stratum corneum hydration, sebum secretion, and skin pH measurements were obtained before and after the procedure on all sessions and also 1 and 4 weeks after the last treatment.
RESULTS:
After six sessions of Microdermabrasion, a decrease in sebum content compared to baseline was shown at the end of treatment sessions, but no statistical difference was observed between two vs. three passes groups (-30.0 [interquartile range, IQR = 50.0] vs. -27.5 [IQR = 125.3], respectively, P = 0.58).
Comparison of two treatment groups showed significant higher values of sebum content in the first follow-up after treatment with three passes of Microdermabrasion. (64.0 [IQR = 52.0] for three passes vs. 45.0 [IQR = 46.0] for two passes, P = 0.04) A significant increase was observed in pH values at the end of treatment series, first and second follow-up after treatment with two passes of Microdermabrasion.
CONCLUSIONS:
MDA may have remarkable effects on skin barrier function changes resulting in skin clinical improvements (Cochrane Skin Group identifier: CSG No. 37).
"A randomized investigator-blind trial of different passes of microdermabrasion therapy and their effects on skin biophysical characteristics"
Davari P, Gorouhi F, Jafarian S, Dowlati Y, Firooz A
Int J Dermatol. 2008 May ; 47(5): 508-13 (Hubmed.org)
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Simple procedural treatments such as comedone extraction and intralesional steroids have been utilized for many years as adjunctive therapy for acne. In the past 5 years, new technologies and procedures have become available that present new options for the treatment of acne.
OBJECTIVES:
The objective was to review, summarize, and evaluate the key studies of procedural therapies for the treatment of acne as well as place them in perspective with current clinical practice.
METHODS:
Studies selected for evaluation had at least 10 patients and clear statements of purpose, acne severity, patient selection, follow-up evaluations, previous and concurrent medications, treatment parameters, methods for evaluating results, and adverse effects. All studies were complete and published (in English) in peer-reviewed journals.
RESULTS AND CONCLUSIONS:
Earlier procedural therapies were adjunctive to medical therapy, such as intralesional steroids, chemical peels, and microdermabrasion. Newer methods include radiofrequency, light or laser, and photodynamic therapy that represent treatment alternatives for systemic medications.
Still early in their development, these new procedures provide an important, novel set of options for the treatment of acne. The most developed and studied therapies are blue or blue/red light combinations, 1,450-nm diode laser, and photodynamic therapy with 5-aminolevulinic acid or indocyanine green. Review of the literature of more up-to-date physical procedures provides a starting point for physicians seeking to treat their acne patients safely and effectively with these new methods.
"Procedural treatments for acne vulgaris"
Taub AF
Dermatol Surg. 2007 Sep ; 33(9): 1005-26 (Hubmed.org)
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Basic Res Cardiol. 2009 Jun 23; Belin de Chantemèle EJ, Irfan Ali M, Mintz J, Stepp DWImpairment of vascular growth is a hallmark of diabetic complications, but the progression and mechanisms are poorly understood. To determine whether obesity and early diabetes impair endothelium-dependent vasodilatation and vascular response to ischemia, microvascular function as well as angiogenic responses to ischemia were assessed in young (C57) and 6-month-old lean mice (old C57), in obese (db-C57) mice, and in mice suffering an early (db-KsJ) and sustained type 2 diabetes (old db-KsJ). Glycemia gradually increased from the db-C57 to the old db-KsJ. Early and established type II diabetes significantly reduced the level of insulin that was significantly increased in obese mice. Endothelial function was assessed in isolated resistance arteries while the angiogenic response induced by unilateral hindlimb ischemia was analyzed, after 28 days, with a laser Doppler flowmeter and angiography. Aging (-21%), obesity (-45%), as well as early (-58%) and sustained type II diabetes (-69%) induced a progressive impairment of the endothelium-dependent relaxation of the gracilis artery. Laser Doppler measurements demonstrated that only early and sustained type II diabetes impaired skin blood flow recovery. Vascular collateralization was reduced with aging and severely impaired in older db-KsJ mice, the two strains of mice in which ischemia reduced eNOS expression. These results demonstrate that endothelial dysfunction induced by obesity is insufficient to alter the angiogenic response to ischemia. Furthermore, the development of frank type II diabetes or increasing age is required to impair the vascular response to hindlimb ischemia. We conclude that additional risk factors or severe endothelial dysfunction may be requisite to impede the angiogenic response to ischemia.
Arch Intern Med. 2009 Jun 22; 169(12): 1130-8Crum-Cianflone N, Hullsiek KH, Satter E, Marconi V, Weintrob A, Ganesan A, Barthel RV, Fraser S, Agan BKBACKGROUND: As the life expectancy of persons infected with human immunodeficiency virus (HIV) increases, cancers have become an important cause of morbidity and mortality. Although cutaneous cancers are the most common malignant neoplasms in the general population, little data exist among HIV-positive persons, especially regarding the impact of HIV-specific factors. METHODS: We evaluated the incidence rates and factors associated with the development of cutaneous malignancies among HIV-infected persons by examining data that were prospectively collected from a large HIV study that included 4490 participants (1986-2006). Poisson regression and Cox proportional hazards models were performed. RESULTS: Six percent of HIV-infected persons (n = 254) developed a cutaneous malignancy during 33 760 person-years of follow-up (mean, 7.5 years). Since the advent of highly active antiretroviral therapy (HAART), the incidence rates of cutaneous non-AIDS-defining cancers (NADCs), in particular basal cell carcinoma, have exceeded the rates of cutaneous AIDS-defining cancers such as Kaposi sarcoma. Factors associated with the development of cutaneous NADCs in the multivariate models included increasing age (hazard ratio [HR], 2.1; 95% confidence interval [CI], 1.7-2.6) and race. Compared with the white/non-Hispanic race, African Americans (HR, 0.03; 95% CI, 0.01-0.14) and other races (HR, 0.14; 95% CI, 0.03-0.57) had a lower risk of cutaneous NADCs. There were no significant associations between cutaneous NADCs and time-updated CD4 lymphocyte counts, HIV RNA levels, or receipt of HAART. CONCLUSIONS: At present, the most common cutaneous malignancies among HIV-infected persons are NADCs. Cutaneous NADCs do not appear to be significantly associated with immune function or HAART but rather are related to traditional factors such as aging and skin color.
Deep dermal partial-thickness scalds remain one of the most common types of injuries in childhood. Local treatment of those wounds, alternatively described as IIb degree, is still very controversial.
Some authors advise conservative treatment of such wounds, pointing to their ability to self-reepithelialise, which is possible but significantly prolonged. Other investigators postulate operative treatment, i.e., tangential necrectomy and split-thickness autologous skin grafting, which may shorten the time of wound healing. Arguments call for contra-arguments, and the problem still seems to be unresolved.
There is indeed a lack of acceptable standardisation of the local treatment for deep dermal partial-thickness scalds in the paediatric population. The results of both conservative and operative treatment of 114 children aged between 3 months and 17 years, treated for deep dermal partial-thickness scalds from 1997 to 2004 are presented.
The treatment of five groups of patients, divided into groups based on the extent of their burn wounds, is evaluated. The patients were treated by tangential necrectomy and skin grafting, mechanical dermabrasion, Granuflex(R) (Convatec) hydrocolloid dressings, Iruxol Mono(R) (Knoll) enzymatic dressings, or Aquacel Ag(R) (Convatec) hydrofibre dressings with silver ions. A number of parameters of wound healing were analysed.
The results of this paper encouraged us to present and discuss a proposition for the standardisation of local treatment of deep dermal partial-thickness burn wounds in the paediatric population, according to the extent of injury.
"Comparison of the results of operative and conservative treatment of deep dermal partial-thickness scalds in children"
Kaźmierski M, Mańkowski P, Jankowski A, Harasymczuk J
Eur J Pediatr Surg. 2007 Oct ; 17(5): 354-61 (Hubmed.org)
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Am J Dermatopathol. 2009 Jul; 31(5): 427-31Taungjaruwinai WM, Bhawan J, Keady M, Thiele JJRecently, the antioxidant repair enzymes methionine-S-sulfoxide reductase A (MSRA) and methionine-R-sulfoxide reductase B (MSRB) were described in human epidermal keratinocytes and melanocytes. Methionine sulfoxide reductases (MSRs) are thought to protect against reactive oxygen species-induced oxidative damage in many organs, including the most environmentally exposed organ, human skin. We sought to examine the expression and distribution of this enzyme family (MSRA, MSRB1, MSRB2, and MSRB3) within the various compartments of healthy and diseased human skin. Expression was assessed using polyclonal MSR antibodies and immunohistochemical staining of human skin biopsies from various anatomical sites. Remarkably, MSRA expression was not only found in the epidermis as previously described but also in hair follicles and eccrine glands and was most pronounced in sebaceous glands. Furthermore, MSRB2 expression was found in melanocytes while MSRB1 and MSRB3 were both expressed within vascular endothelial cells. In conclusion, MSR enzymes are differentially expressed in human skin. Thus, modulation of MSR repair antioxidants may have implications for cutaneous aging and carcinogenesis.
Cancer Biother Radiopharm. 2009 Jun; 24(3): 347-52Alvarez N, Vicente V, MartÃnez CAbstract Melanoma is the most important skin cancer in terms of mortality, besides developing metastasis in about a third of the patients. Interferon-alpha (IFN-alpha), a highly toxic cytokine, tends to be one of the most important treatments for melanoma. Much effort is being directed at obtaining less-toxic antitumoral compounds, particularly natural compounds such as flavonoids. Our aim was to study the combined treatment of metastatic lung melanoma with IFN-alpha and diosmin in a murine model. In this article, we report the effect of a combined treatment of IFN-alpha and the flavonoid, diosmin, on a murine model of metastatic B16F10 melanoma, assessed both macroscopically (counting subpleural nodules) and microscopically by image analysis (calculating three indices). IFN-alpha showed a dose-dependent anti-invasive and antiproliferative activity in our study, while diosmin showed an anti-invasive activity similar to the lower dose of IFN-alpha used. However, the most relevant result was the synergistic antiproliferative effect shown by the combination of the flavonoid and the lowest dose of IFN-alpha, which was similar to that produced by the highest dose of the cytokine alone.
Parasitol Res. 2009 Jun 19; Haas W, Haeberlein SWe studied the skin invasion of Schistosoma mansoni cercariae by placing gamma-irradiated and nonirradiated cercariae onto the living human skin and timing the behavior of 53 individuals. The skin invasion of S. mansoni was less efficient compared to the bird schistosome Trichobilharzia szidati. S. mansoni cercariae crept longer on the skin after attachment until they started penetration movements (median of 43 s [range of 15 s-6.58 min]; T. szidati, median of 8 s [range of 0-80 s]). Subsequent to this longer exploratory phase, 74% penetrated into wrinkles (T. szidati 84%), 22% into the smooth skin surface (T. szidati 0%), and 4% into hair follicles (T. szidati 16%). The S. mansoni cercariae needed, on average, 6.58 min (range of 1.57-13.13 min) for full entry, while T. szidati needed 4.0 min (range of 1.38-13.34 min); the fastest S. mansoni cercaria entered the skin within 94 s, while T. szidati entered within 83 s. Sixty percent of the S. mansoni cercariae had the tails still attached when the bodies disappeared in the skin whereas all T. szidati cercariae shed their tails within 0-105 s after the onset of penetration movements. The faster invasion of T. szidati may result from the more sophisticated host-finding mechanisms of this species. Regarding S. mansoni, cercarial dermatitis, as immediate skin response, developed after a sensitization period of 19 days.
Many techniques exist for treating rhytids in the perioral region. Injectable fillers, Botox, implants, lip lifts, and lip advancements all produce lasting results. Resurfacing procedures can also be used to rejuvenate this area.
This article discusses the use of chemical peels, dermabrasion, and laser resurfacing, alone or in combination, as methods to reduce fine and vertical rhytids of the upper and lower lips and superficial scarring in the perioral region.
The authors emphasize that the best outcomes are often achieved using a combination of these modalities tailored to each patient's needs, which also allows surgeons greater flexibility in achieving maximal results. This article also discusses patient selection, counseling, planning, and techniques that have yielded consistent results with high patient satisfaction.
"Treatment of perioral rhytids"
Perkins SW, Balikian R
Facial Plast Surg Clin North Am. 2007 Nov ; 15(4): 409-14, v (Hubmed.org)
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Facial dermabrasion requires the preservation of natural mimic muscle tone, adequate spontaneous respiration, and contact with a patient. By taking into account the commercial pattern of surgical interventions, anesthesia should be as safe and comfortable as possible.
For these purposes, the standard procedure of intravenous anesthesia with spontaneous respiration being preserved is optimized on the anticipatory analgesia principle, by using analgesics having the non-opiate mechanism of action: the kininogenesis inhibitor transamine and the nonsteroidal anti-inflammatory drug ketonal.
This makes it possible to provide the adequacy of anesthesia and a good cardiovascular response with the doses of narcotic analgesics, hypnotics, and an anxiolytics, which do not cause respiratory distress, and to avoid using narcotic analgesics.
The use of the antiemetics tropisetron and dexamethasone at the induction stage of anesthesia has been ascertained to be a reliable preventive measure against postoperative nausea and vomiting, by substantially enhancing its comfortability.
"Optimization of anesthetic maintenance of a facial dermabrasion operation"
Siluianova EV
Anesteziol Reanimatol. 2007 Nov-Dec ; : 71-5 (Hubmed.org)
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Dermabrasion of the periorbital region has been traditionally contraindicated due to the fear of complications. A method for safe dermabrasion of the lateral canthal region is described. Lateral canthal dermabrasion has the demonstrated advantages of being economical and relatively free of pigmentary problems.
The results for 25 consecutive cases with a follow-up period of 12 to 16 months have shown good to excellent results in the majority of cases, with 4 cases requiring further revision. The technique is not intended to replace the gold standard, laserbrasion of the periocular region, and is not demonstrated to be safe for resurfacing of the lower lid region.
However, the technique, rapid and easy once the learning curve is completed, was not associated with significant complications in the current series of patients.
"Dermabrasion for rhytids in the lateral canthal region"
Gruber R, Miranda E, Antony A
Aesthetic Plast Surg. 2007 Nov-Dec ; 31(6): 688-91 (Hubmed.org)
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Congenital melanocytic nevi can be cosmetically disfiguring, give rise to melanoma, and suggest the presence of neurocutaneous melanocytosis.
Management decisions must be tailored for each patient and each nevus, taking into consideration the risk for developing malignancy, risk for developing symptomatic neurocutaneous melanocytosis, cosmetic implications of having the nevus, cosmetic implications of any resultant surgical scars from their removal, adverse effects that the nevus may have on psycho-social development, and the adverse effects and long-term sequelae of any surgical intervention.
The advantages and disadvantages of different modalities used in the treatment of congenital melanocytic nevi are discussed. Organizational flow diagrams are presented to help clinicians in managing patients with different sized congenital melanocytic nevi.
"Congenital melanocytic nevi: treatment modalities and management options"
Marghoob AA, Borrego JP, Halpern AC
Semin Cutan Med Surg. 2007 Dec ; 26(4): 231-40 (Hubmed.org)
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Dermabrasion is a nonchemical, superficial skin resurfacing procedure. It owes its popularity to the simplicity and safety of the technique. Studies published in peer-reviewed journals have highlighted the benefits of multiple, once-a-week treatments in improving hyperchromic discolorations, facial scarring, and facial photodamage.
The mechanism of action through which microdermabrasion ameliorates skin appearance is not fully understood. Several studies suggest that the clinical improvement is produced through a dermal remodeling/wound healing repair.
Regardless of the mechanism, patients and operators alike recognize the efficacy of this procedure. We are introducing a new method to treatment of facial wrinkles. Dermabrasion with sandpaper is not a new procedure in mechanic dermabrasion. However, we used it for the first time in treating periorbital wrinkles.
"A different and cheap method: sandpaper (manual dermasanding) in treatment of periorbital wrinkles"
Emsen IM
J Craniofac Surg. 2008 May ; 19(3): 812-6 (Hubmed.org)
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In recent years, many new products and techniques have arisen that are useful in the rejuvenation of facial skin. Most of the therapies are directed at improving the results of photoaging.
These cutaneous changes occur from chronic exposure to ultraviolet B light (290 to 320 nm) associated with sunburn, and ultraviolet AII light (320 to 340 nm), and ultraviolet AI light (340 to 400 nm) associated with photoaging.
Clinically chronic photoaging may result in fine wrinkles, texture abnormalities, pigment dyschromias, and actinic keratoses.
RECENT FINDINGS:
Many methods of patient assessment are available, but the most useful include the Fitzpatrick skin type classification and the Glogau photoaging scale. Although many therapies are available to reduce or even reverse many of these aging changes, patient education regarding lifestyle changes (especially smoking cessation) and sun avoidance need to be a critical foundation of treatment.
Indeed, patient participation in their own skin care regimen is important for any program to be effective. Topical therapy including tretinoins, hydroxy acids, bleaching agents, and sunscreens are discussed herein.
SUMMARY:
The physician has an important role in understanding which treatment options are appropriate for mild, moderate, and severe photoaging, and in educating patients on the risks and benefits of each. This includes resurfacing modalities with microdermabrasion, chemical peels, and laser skin resurfacing.
"Facial skin rejuvenation"
Holck DE, Ng JD
Curr Opin Ophthalmol. 2003 Oct ; 14(5): 246-52 (Hubmed.org)
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It is offered to use laser Doppler fluometry indices at the acute stage of burn disease for diagnostics of lesion depth, as a criterion for degree of shock severity and its ending, for evaluation of the surgical treatment influence on clinical course of burn disease, and also at different stages of wound closing with complex temporary pedicle flap.
Methods and criterions of microcirculation study during the period of burn shock, and also in burn re-convalescents are defined for evaluation of conservative treatment efficacy and state of microcirculation in forming scars.
Application of laser Doppler fluometry contributes to reduction of surgical operations number, duration of stay in the hospital, improvement of aesthetic treatment results. Laser Doppler fluometry indices can serve as a criterion of conservative therapy efficacy, contribute to timely correction of rehabilitation plan.
"Laser Doppler flowmetry in burn treatment
Fistal' NN, Soloshenko VV
Khirurgiia (Mosk). 2008; : 53-7 (Hubmed.org)
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This investigation was initiated because of a growing concern by the American Society for Dermatologic Surgery about the proliferation of nonphysicians practicing medicine and its impact on public health, safety, and welfare.
OBJECTIVE:
Prompted by an alarming rise in anecdotal reports among dermatologic surgeons, the study sought to determine whether there was a significant increase in the number of patients seeking corrective treatment due to complications from laser and light-based hair removal, subsurface laser/light rejuvenation techniques, chemical peels, microdermabrasion, injectables, and other cosmetic medical/surgical procedures performed by nonphysicians without adequate training or supervision.
METHODS:
A survey of 2,400 American Society for Dermatologic Surgery members in July 2001 and in-depth phone interviews with eight patients who experienced complications from nonphysicians performing cosmetic dermatologic surgery procedures were conducted.
RESULTS:
Survey data and qualitative research results attributed patient complications primarily to "nonphysician operators" such as cosmetic technicians, estheticians, and employees of medical/dental professionals who performed various invasive medical procedures outside of their scope of training or with inadequate or no physician supervision.
CONCLUSION:
The results underscore the need for improved awareness, legislation, and enforcement regarding the nonphysician practice of medicine, along with further study of this issue.
"Beauty versus medicine: the nonphysician practice of dermatologic surgery"
Brody HJ, Geronemus RG, Farris PK
Dermatol Surg. 2003 Apr ; 29(4): 319-24 (Hubmed.org)
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Non-ablative laser treatment has been used for improving dermal toning. Laser application to dermis causes new collagen formation in terms of wound healing. We aimed to study mainly histological changes in skin after the use of a Q-switched Nd:YAG laser in non-ablative treatment of wrinkles.
METHODS:
The laser was adjusted to a fluency of 7 J/cm2 with a spot size of 3 mm and a pulse rate of 10 Hz to treat periorbital wrinkled areas. None of the patients had received filling materials, botulinum toxin injections or any dermabrasion procedures.
All laser sessions were held every 15 days for a total of six sessions and all patients were photographed before treatment and then 2 months after the last treatment. Histological examinations were performed before laser treatment and 1 month after the final treatment.
RESULTS:
Four of eight individuals showed clinical improvement. The histological proportion of collagen fibers was measured by using the Samba method. An increase in the mean optical densities (MOD) of collagen fibers compared with baselines was statistically significant in all patients (p<0.05).
CONCLUSION:
The 1064-nm Q-switched Nd:YAG lasers appear to be safe and efficient for non-ablative remodeling of periorbital wrinkles.
"Histologic evidence of new collagen formation using a Q-switched Nd:YAG laser in periorbital rhytids"
Karabudak O, Dogan B, Baloglu H
J Dermatolog Treat. 2008; 19(5): 300-4 (Hubmed.org)
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Acne surgery is the use of various surgical procedures for the treatment of postacne scarring and also, as adjuvant treatment for active acne. Surgery is indicated both in active acne and post-acne scars.
PHYSICIANS' QUALIFICATIONS:
Any Dermatologist can perform most acne surgery techniques as these are usually taught during postgraduation. However, certain techniques such as dermabrasion, laser resurfacing, scar revisions need specific "hands-on" training in appropriate training centers.
FACILITY:
Most acne surgery procedures can be performed in a physician's minor procedure room. However, full-face dermabrasion and laser resurfacing need an operation theatre in a hospital setting.
ACTIVE ACNE:
Surgical treatment is only an adjunct to medical therapy, which remains the mainstay of treatment. Comedone extraction is a process of applying simple mechanical pressure with a comedone extractor, to extract the contents of the blocked pilosebaceous follicle.
Superficial chemical peel is a process of applying a chemical agent to the skin, so as to cause controlled destruction of the epidermis leading to exfoliation. Glycolic acid, salicylic acid and trichloroacetic acid are commonly used peeling agents for the treatment of active acne and superficial acne scars.
CRYOTHERAPY:
Cryoslush and cryopeel are used for the treatment of nodulocystic acne. Intralesional corticosteroids are indicated for the treatment of nodules, cysts and keloidal acne scars. Nonablative lasers and light therapy using Blue light, non ablative radiofrequency, Nd:YAG laser, IPL (Intense Pulsed Light), PDT (Photodynamic Therapy), pulse dye laser and light and heat energy machines have been used in recent years for the treatment of active inflammatory acne and superficial acne scars.
Proper counseling is very important in the treatment of acne scars. Treatment depends on the type of acne scars; a patient may need more than one type of treatment. Subcision is a treatment to break the fibrotic strands that tether the scar to the underlying subcutaneous tissue, and is useful for rolling scars.
Punch excision techniques such as punch excision, elevation and replacement are useful for depressed scars such as ice pick and boxcar scars. TCA chemical reconstruction of skin scars (CROSS) (Level C) is useful for ice pick scars.
Resurfacing techniques include ablative methods (such as dermabrasion and laser resurfacing), and nonablative methods such as microdermabrasion and nonablative lasers. Ablative methods cause significant postoperative changes in the skin, are associated with significant healing time and should be performed by dermatosurgeons trained and experienced in the procedure. Fillers are useful for depressed scars. Proper case selection is very important in ensuring satisfactory results.
"Standard guidelines of care for acne surgery"
Khunger N, IADVL Task Force
Indian J Dermatol Venereol Leprol. 2008 Jan ; 74 Suppl: S28-36 (Hubmed.org)
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Resurfacing is a treatment to remove acne and chicken pox scars, and changes in the skin due to ageing.
MACHINES:
Both ablative and nonablative lasers are available for use. CO 2 laser is the gold standard in ablative lasers. Detailed knowledge of the machines is essential.
INDICATIONS FOR CO 2 LASER:
Therapeutic indications: Actinic and seborrheic keratosis, warts, moles, skin tags, epidermal and dermal nevi, vitiligo blister and punch grafting, rhinophyma, sebaceous hyperplasia, xanthelasma, syringomas, actinic cheilitis angiofibroma, scar treatment, keloid, skin cancer, neurofibroma and diffuse actinic keratoses. CO 2 laser is not recommended for the removal of tattoos.
AESTHETIC INDICATIONS:
Resurfacing for acne, chicken pox and surgical scars, periorbital and perioral wrinkles, photo ageing changes, facial resurfacing.
PHYSICIANS' QUALIFICATIONS:
Any qualified dermatologist (DVD or MD) may practice CO 2 laser. The dermatologist should possess postgraduate qualification in dermatology and should have had specific hands-on training in lasers either during postgraduation or later at a facility which routinely performs laser procedures under a competent dermatologist/plastic surgeon, who has experience and training in using lasers.
For the use of CO 2 lasers for benign growths, a full day workshop is adequate. As parameters may vary in different machines, specific training with the available machine at either the manufacturer's facility or at another centre using the machine is recommended.
FACILITY:
CO 2 lasers can be used in the dermatologist's minor procedure room for the above indications. However, when used for full-face resurfacing, the hospital operation theatre or day care facility with immediate access to emergency medical care is essential. Smoke evacuator is mandatory.
PREOPERATIVE COUNSELING AND INFORMED CONSENT:
Detailed counseling with respect to the treatment, desired effects, possible postoperative complications, should be discussed with the patient.
The patient should be provided brochures to study and also given adequate opportunity to seek information. Detailed consent forms need to be completed by the patients. Consent forms should include information on the machine used; possible postoperative course expected and postoperative complications.
Preoperative photography should be carried out in all cases of resurfacing. Choice of the machine and the parameters depends on the site, type of lesion, result needed, and the physician's experience.
ANESTHESIA:
Localized lesions can be treated under eutectic mixture of local anesthesia (EMLA) cream anesthesia or local infiltration anesthesia. Full-face resurfacing can be performed under general anesthesia. Proper postoperative care is important to avoid complications.
"Standard guidelines of care: CO2 laser for removal of benign skin lesions and resurfacing"
Krupashankar DS, IADVL Dermatosurgery Task Force
Indian J Dermatol Venereol Leprol. 2008 Jan ; 74 Suppl: S61-7 (Hubmed.org)
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Laser skin resurfacing procedures can be classed into two categories - invasive and non-invasive. The last several decades have witnessed a host of advancements in ablative laser therapy and other ablative modalities for the rejuvenation of skin, including the CO(2) laser, the erbium : yttrium aluminum garnet laser, chemical peels, and dermabrasion.
Despite the excellent results that can result from the practice of these techniques by experienced surgeons, the invasive nature of these devices is associated with inherent risks and patient discomfort.
Therefore, much of the focus has been on non-ablative lasers and intense-pulsed light devices. We evaluated the efficacy and safety of treatment with the new infrared light device (1100-1800 nm), Titan, and assessed the degree of improvement associated with two-time laser treatments, as compared to one-time laser treatment.
"Effect of a new infrared light device (1100-1800 nm) on facial lifting.
Ahn JY, Han TY, Lee CK, Seo SJ, Hong CK
Photodermatol Photoimmunol Photomed. 2008 Feb ; 24(1): 49-51 (Hubmed.org)
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The prevalence of allergic contact dermatitis in patients who have previously undergone skin peeling has been rarely studied.
OBJECTIVES:
We compared the frequency of positive patch test (PT) reactions in a patient group with a history of peeling, to that of a control group with no history of peeling.
PATIENTS/METHODS:
The Korean standard series and cosmetic series were performed on a total of 262 patients. 62 patients had previously undergone peeling and 200 patients did not.
RESULTS:
The frequency of positive PT reactions on Korean standard series was significantly higher in the peeling group compared with that of the control group (P < 0.05, chi-square test). However, the most commonly identified allergens were mostly cosmetic-unrelated allergens.
The frequency of positive PT reactions on cosmetic series in the peeling group was higher than that of the control group, but lacked statistical significance. The frequency (%) of positive PT reactions on cosmetic series in the high-frequency peel group was higher than that of the low-frequency group, but lacked statistical significance.
CONCLUSION:
It appears peeling may not generally affect the development of contact sensitization. Further work is required focusing on the large-scale prospective studies by performing a PT before and after peeling.
"Influence of skin peeling procedure in allergic contact dermatitis"
Kim JE, Park HJ, Cho BK, Lee JY
Contact Dermatitis. 2008 Mar ; 58(3): 142-6 (Hubmed.org)
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Acne surgery is the use of various surgical procedures for the treatment of postacne scarring and also, as adjuvant treatment for active acne. Surgery is indicated both in active acne and post-acne scars.
PHYSICIANS' QUALIFICATIONS:
Any Dermatologist can perform most acne surgery techniques as these are usually taught during postgraduation. However, certain techniques such as dermabrasion, laser resurfacing, scar revisions need specific "hands-on" training in appropriate training centers.
FACILITY:
Most acne surgery procedures can be performed in a physician's minor procedure room. However, full-face dermabrasion and laser resurfacing need an operation theatre in a hospital setting.
ACTIVE ACNE:
Surgical treatment is only an adjunct to medical therapy, which remains the mainstay of treatment. Comedone extraction is a process of applying simple mechanical pressure with a comedone extractor, to extract the contents of the blocked pilosebaceous follicle.
Superficial chemical peel is a process of applying a chemical agent to the skin, so as to cause controlled destruction of the epidermis leading to exfoliation. Glycolic acid, salicylic acid and trichloroacetic acid are commonly used peeling agents for the treatment of active acne and superficial acne scars.
CRYOTHERAPY:
Cryoslush and cryopeel are used for the treatment of nodulocystic acne. Intralesional corticosteroids are indicated for the treatment of nodules, cysts and keloidal acne scars.
Nonablative lasers and light therapy using Blue light, non ablative radiofrequency, Nd:YAG laser, IPL (Intense Pulsed Light), PDT (Photodynamic Therapy), pulse dye laser and light and heat energy machines have been used in recent years for the treatment of active inflammatory acne and superficial acne scars.
Proper counseling is very important in the treatment of acne scars. Treatment depends on the type of acne scars; a patient may need more than one type of treatment. Subcision is a treatment to break the fibrotic strands that tether the scar to the underlying subcutaneous tissue, and is useful for rolling scars.
Punch excision techniques such as punch excision, elevation and replacement are useful for depressed scars such as ice pick and boxcar scars. TCA chemical reconstruction of skin scars (CROSS) (Level C) is useful for ice pick scars.
Resurfacing techniques include ablative methods (such as dermabrasion and laser resurfacing), and nonablative methods such as microdermabrasion and nonablative lasers. Ablative methods cause significant postoperative changes in the skin, are associated with significant healing time and should be performed by dermatosurgeons trained and experienced in the procedure. Fillers are useful for depressed scars. Proper case selection is very important in ensuring satisfactory results.
"Standard guidelines of care for acne surgery"
Khunger N, IADVL Task Force
Indian J Dermatol Venereol Leprol. 2008 Jan ; 74 Suppl: S28-36 (Hubmed.org)
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Topical 5-aminolevulinic acid (ALA) and various light sources have been used to treat actinic keratoses and acne. Many of these regimens have required long incubation times due to the penetration qualities of ALA.
This study tested the effectiveness of ALA in producing erythema when applied for 10 minutes after 2 passes of microdermabrasion versus an incubation time of one hour without microdermabrasion.
The areas were treated with a 595-nm pulsed dye laser at 15 J/cm2 or 22.5 J/cm2. Photographs were taken at 24 and 48 hours after the treatment. The data indicated consistent superior results with the use of microdermabrasion prior to the application of ALA for 10 minutes.
It appears that incubation of ALA with microdermabrasion for 10 minutes is as effective as, or more so than, ALA applied alone for one hour in producing erythema.
"Efficacy of microdermabrasion preceding ALA application in reducing the incubation time of ALA in laser PDT"
Katz BE, Truong S, Maiwald DC, Frew KE, George D
J Drugs Dermatol. 2007 Feb ; 6(2): 140-2 (Hubmed.org)
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Microdermabrasion and superficial glycolic acid peels are common aesthetic procedures. Microdermabrasion alone provides the benefits of exfoliation but may provide faster results and increased patient satisfaction when combined with superficial glycolic acid (alpha-hydroxy acid) peels because of the significant antiaging effects of glycolic acid peels.
A roundtable discussion was held with dermatologists to review methods of combining these procedures. The first method included alternating glycolic acid peels and microdermabrasion treatments every 2 weeks, enabling the patient to receive both a peel and microdermabrasion in the same month.
With the second method, microdermabrasion may be used prior to the superficial glycolic acid peel to increase the exfoliation and antiaging effects of both treatments within the same visit. This second method is considered to be a more aggressive approach and usually is reserved for patients with a history of procedures.
Lastly, combining treatments can be used to maintain a patient's skin after the initial treatment stage, usually performed every other month or seasonally, depending on the patient. As with all combination treatments, safety precautions and monitoring the patient's skin throughout treatment are crucial to success
"Combining superficial glycolic acid (alpha-hydroxy acid) peels with microdermabrasion to maximize treatment results and patient satisfaction"
Briden E, Jacobsen E, Johnson C
Cutis. 2007 Jan ; 79(1 Suppl Combining): 13-6 (Hubmed.org)
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Dermabrasion has been used for a number of years to treat a variety of dermatologic conditions, including facial skin resurfacing and scar revision. The popularity of this procedure has diminished with the advent of newer procedures including chemical exfoliation, laser resurfacing, non-ablative laser resurfacing, and microdermabrasion.
Dermabrasion found its niche in treating acne and traumatic facial scars, and in cosmetic facial resurfacing. Small, portable hand-held dermabraders are the most popular units available today and are able to generate rotation speeds of 18,000-35,000 revolutions per minute.
End pieces, including wire brushes, diamond fraises and serrated wheels, attach to the end of the dermabrader to allow precise resurfacing and treatment. As with all cosmetic surgical procedures, appropriate patient selection and room preparation (with appropriate lighting and monitoring equipment) are essential to assure optimal outcomes with the dermabrasion procedure.
Patients must understand all of the potential risks, benefits and limitations associated with the procedure. Patients must also be aware of alternative therapies that are available. Dermabrasion is technique-dependent and the surgeon should be well versed on the technique prior to performing this therapy.
Gentian violet solution is used to delineate the areas to be treated. Refrigerant topical anesthesia is used to freeze the skin prior to the procedure. Holding the skin taut, the dermabrasion procedure occurs in a routine manner, treating one anatomic unit at a time.
Postoperatively, patients may have an open or closed dressing system. Postoperative medical treatment is also recommended, including the use of antiviral agents, antibacterials and corticosteroids. The re-epithelialization process is usually complete in 5-7 days and residual erythema is common for up to 4 weeks.
Adequate sun protection is essential following dermabrasion. Dermabrasion has also been used in combination with other dermatologic procedures, including chemical exfoliation, soft tissue augmentation and laser procedures, to enhance the results of dermabrasion.
Dermabrasion remains a useful facial skin resurfacing and scar revision technique, particularly when performed by a trained and skilled surgeon. Most dermatologic surgeons argue that pure dermabrasion is a useful modality in skilled surgical hands and should be considered when appropriate
"Dermabrasion in dermatology"
Gold MH
Am J Clin Dermatol. 2003; 4(7): 467-71 (Hubmed.org)
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Lasers Surg Med. 2009 Jun 16; 41(5): 327-336Bjerring P, Christiansen K, Troilius A, Bekhor P, de Leeuw JBACKGROUND: Identical skin fluorescence can be obtained after one hour spraying with 0.5% liposome-encapsulated 5-ALA and after 0.5 hour application of 20% 5-ALA in a cream base. In this study the clinical outcome and side effects using the 0.5% 5-ALA in Caucasian skin are investigated and compared to earlier reported non-ablative treatments for wrinkles and improvements of skin texture using 20% ALA photodynamic photorejuvenation. METHODS AND MATERIALS: 37 healthy Caucasian female patients participated in a randomized, prospective split face study. Two different intense pulsed light (IPL) treatment modalities were investigated; both employed a pre-treatment of approximately one hour of spraying with 0.5% liposome encapsulated 5-ALA. One modality combined type I photorejuvenation with wrinkle reduction (C-PDT) using a waveband from 530 to 750 nm and short pulse durations (7 J/cm(2), 2 x 2.5 ms, delay 10 ms). The other modality (PDT alone) emitted a band of wavelengths from 400 to 720 nm, three passes were performed (3.5 J/cm(2), 30 ms pulse duration). RESULTS: After a series of three C-PDT or PDT-alone treatments, the patients obtained statistically significant (P< 5 x 10-5) reductions in periorbital and perioral wrinkles. Using the Fitzpatrick wrinkle scale, periorbital wrinkles were reduced by 1.2 grades (SD: 1.1) and 1.1 (SD: 1.1), respectively and perioral wrinkles were reduced by 0.8 grades (SD: 1.0) and 0.7 (SD: 0.9) respectively. The difference in treatment efficacy between. C-PDT and PDT alone treated sides was not statistically significant (P = 0.224). CONCLUSION: The present study shows that statistically significant improvements in wrinkle reduction and skin texture, equivalent to previously reported results obtained with 20% ALA, can be obtained with 0.5% liposome encapsulated 5-ALA. Only minor and infrequent side effects were registered at the 0.5% 5-ALA treated areas. Skin fluorescence monitoring during pre-treatrnent with 5-ALA may improve clinical efficacy, reduce time consumption and increase safety of the treatment. Lasers Surg. Med. 41:327-336, 2009. (c) 2009 Wiley-Liss, Inc.
According to the American Society for Aesthetic Plastic Surgery, in the year 2000 over 5.7 million cosmetic surgical and nonsurgical procedures were performed in the United States. This was a 25% increase above the total number performed in 1999.
The most popular of these procedures was botulinum toxin injection, followed by chemical peels and microdermabrasion. As the field of plastic and reconstructive surgery changes, so does the scope of the oculoplastic surgeon.
This review article summarizes those developments in aesthetic surgery that are recent additions to the practice of aesthetic oculoplastic surgery. It highlights the most recent literature discussing brow and midface lifts, skin lasers, microdermabrasion, upper and lower blepharoplasty, chemical peels, botulinum toxin, and fat sculpturing.
"Advances in cosmetic oculoplastic surgery"
Morgenstern KE, Foster JA
Curr Opin Ophthalmol. 2002 Oct ; 13(5): 324-30 (Hubmed.org)
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