Aesthetic Dermatology

KISSIMMEE, FLA. — A second-generation erbium-doped 1550-nm laser is highly effective for fractional nonablative treatment of acne and surgical scars, and for moderate photoaging, data from a review of 877 cases revealed.

All patients had clear photographic documentation of improvement, with most achieving 70%-80% improvement, Dr. Vic A. Narurkar reported at the annual meeting of the American Society for Laser Medicine and Surgery.

Patients with Fitzpatrick skin types I-VI were treated over an 18-month period between 2005 and 2007 using the Fraxel laser (Reliant Technologies Inc.). Treatment parameters and treatment number varied based on skin type and indication. Patient charts and standardized photography were used to analyze clinical indication with efficacy, adverse effects, and skin types, said Dr. Narurkar, a dermatologist in private practice in San Francisco.

"We found that the best results were achieved with scars," he said, noting that the average improvement in his patients with acne and nonacne scars was about 80%. The next best results were seen with resurfacing on and off the face, with improvement ranging from 60% to 80%. The results were best in patients with Glogau photoaging II-III.

The most variable results were seen in patients undergoing treatment for melasma and deep rhytids; these patients had 20%-40% improvement.

The most common short-term adverse events in this study were transient edema and erythema, which occurred in all patients but resolved within 48 hours, and acne flares, which occurred in 26% of patients. The most common long-term side effect was postinflammatory hyperpigmentation, which was most common in those with type V skin, and which resolved in all patients, Dr. Narurkar said, noting that there were no permanent side effects.

Dr. Narurkar, who disclosed that he has received consulting fees and honoraria from Reliant, concluded that the second-generation erbium-doped 1550-nm laser is safe and effective for all skin types.

KISSIMMEE, FLA. — A second-generation erbium-doped 1550-nm laser is highly effective for fractional nonablative treatment of acne and surgical scars, and for moderate photoaging, data from a review of 877 cases revealed.

All patients had clear photographic documentation of improvement, with most achieving 70%-80% improvement, Dr. Vic A. Narurkar reported at the annual meeting of the American Society for Laser Medicine and Surgery.

Patients with Fitzpatrick skin types I-VI were treated over an 18-month period between 2005 and 2007 using the Fraxel laser (Reliant Technologies Inc.). Treatment parameters and treatment number varied based on skin type and indication. Patient charts and standardized photography were used to analyze clinical indication with efficacy, adverse effects, and skin types, said Dr. Narurkar, a dermatologist in private practice in San Francisco.

"We found that the best results were achieved with scars," he said, noting that the average improvement in his patients with acne and nonacne scars was about 80%. The next best results were seen with resurfacing on and off the face, with improvement ranging from 60% to 80%. The results were best in patients with Glogau photoaging II-III.

The most variable results were seen in patients undergoing treatment for melasma and deep rhytids; these patients had 20%-40% improvement.

The most common short-term adverse events in this study were transient edema and erythema, which occurred in all patients but resolved within 48 hours, and acne flares, which occurred in 26% of patients. The most common long-term side effect was postinflammatory hyperpigmentation, which was most common in those with type V skin, and which resolved in all patients, Dr. Narurkar said, noting that there were no permanent side effects.

Dr. Narurkar, who disclosed that he has received consulting fees and honoraria from Reliant, concluded that the second-generation erbium-doped 1550-nm laser is safe and effective for all skin types.

KISSIMMEE, FLA. — A second-generation erbium-doped 1550-nm laser is highly effective for fractional nonablative treatment of acne and surgical scars, and for moderate photoaging, data from a review of 877 cases revealed.

All patients had clear photographic documentation of improvement, with most achieving 70%-80% improvement, Dr. Vic A. Narurkar reported at the annual meeting of the American Society for Laser Medicine and Surgery.

Patients with Fitzpatrick skin types I-VI were treated over an 18-month period between 2005 and 2007 using the Fraxel laser (Reliant Technologies Inc.). Treatment parameters and treatment number varied based on skin type and indication. Patient charts and standardized photography were used to analyze clinical indication with efficacy, adverse effects, and skin types, said Dr. Narurkar, a dermatologist in private practice in San Francisco.

"We found that the best results were achieved with scars," he said, noting that the average improvement in his patients with acne and nonacne scars was about 80%. The next best results were seen with resurfacing on and off the face, with improvement ranging from 60% to 80%. The results were best in patients with Glogau photoaging II-III.

The most variable results were seen in patients undergoing treatment for melasma and deep rhytids; these patients had 20%-40% improvement.

The most common short-term adverse events in this study were transient edema and erythema, which occurred in all patients but resolved within 48 hours, and acne flares, which occurred in 26% of patients. The most common long-term side effect was postinflammatory hyperpigmentation, which was most common in those with type V skin, and which resolved in all patients, Dr. Narurkar said, noting that there were no permanent side effects.

Dr. Narurkar, who disclosed that he has received consulting fees and honoraria from Reliant, concluded that the second-generation erbium-doped 1550-nm laser is safe and effective for all skin types.

KISSIMMEE, FLA. — A novel fractional CO2 resurfacing device significantly and safely improved moderate to severe acne scarring in a recent study.

More than 75% of the patients studied sustained moderate to significant improvement in their acne scarring at 3 months following final treatment, Dr. Arisa Ortiz reported at the annual meeting of the American Society of Laser Medicine and Surgery.

The 15 patients, who were aged 21–60 years, had moderate to severe acne scars and had Fitzpatrick skin types I-IV. They underwent up to three treatments with the Fraxel re:pair 10,600-nm fractional CO2 laser system (Reliant Technologies Inc.), said Dr. Ortiz, who is with the University of California, Irvine.

Treatment parameters ranged from 20 to 70 mJ with 600–1,200 microthermal zones/cm

Patient evaluations were conducted using digital photographic assessment at 3 days, 1 week, 1 month, and 3 months following treatment. Specifically, skin texture, wrinkles, pigmentation, skin laxity, scarring, and overall appearance were evaluated.

Of the 15 patients, 13 were considered to have shown improvement in the appearance of scarring, with an added benefit of improved overall appearance based on physician assessment, noted Dr. Ortiz, who reported that she received equipment and honoraria from Reliant.

Of 13 who had pigmentation, 11 were improved, and of 8 with rhytids, 6 improved.

Of eight who had only one treatment, one had no improvement, five had minor improvement, and two had moderate improvement. Of two who had two treatments, both had moderate improvement. Of five who had three treatments, one had no improvement, three had moderate improvement, and one had "very significant" improvement, she said.

Smoother skin texture was an example of minor improvement, and substantial improvement in ice pick scarring was an example of moderate improvement, Dr. Ortiz pointed out, explaining that higher fluences appeared to result in greater improvements, compared with lower fluences in patients who had the same number of treatments.

In those with the greatest improvements, three treatments at fluences of 40–70 mJ were used, and those patients had the added benefit of improvements in rhytids as well as in acne scarring, Dr. Ortiz said.

All of the patients experienced transient erythema, which resolved within 3 months.

No serious patient complications occurred, and any serosanguineous oozing resolved within 48 hours of treatment.

When compared with traditional ablative resurfacing, the fractional CO2 laser treatment resulted in less patient downtime and reduced complication rates, Dr. Ortiz concluded.

KISSIMMEE, FLA. — A novel fractional CO2 resurfacing device significantly and safely improved moderate to severe acne scarring in a recent study.

More than 75% of the patients studied sustained moderate to significant improvement in their acne scarring at 3 months following final treatment, Dr. Arisa Ortiz reported at the annual meeting of the American Society of Laser Medicine and Surgery.

The 15 patients, who were aged 21–60 years, had moderate to severe acne scars and had Fitzpatrick skin types I-IV. They underwent up to three treatments with the Fraxel re:pair 10,600-nm fractional CO2 laser system (Reliant Technologies Inc.), said Dr. Ortiz, who is with the University of California, Irvine.

Treatment parameters ranged from 20 to 70 mJ with 600–1,200 microthermal zones/cm

Patient evaluations were conducted using digital photographic assessment at 3 days, 1 week, 1 month, and 3 months following treatment. Specifically, skin texture, wrinkles, pigmentation, skin laxity, scarring, and overall appearance were evaluated.

Of the 15 patients, 13 were considered to have shown improvement in the appearance of scarring, with an added benefit of improved overall appearance based on physician assessment, noted Dr. Ortiz, who reported that she received equipment and honoraria from Reliant.

Of 13 who had pigmentation, 11 were improved, and of 8 with rhytids, 6 improved.

Of eight who had only one treatment, one had no improvement, five had minor improvement, and two had moderate improvement. Of two who had two treatments, both had moderate improvement. Of five who had three treatments, one had no improvement, three had moderate improvement, and one had "very significant" improvement, she said.

Smoother skin texture was an example of minor improvement, and substantial improvement in ice pick scarring was an example of moderate improvement, Dr. Ortiz pointed out, explaining that higher fluences appeared to result in greater improvements, compared with lower fluences in patients who had the same number of treatments.

In those with the greatest improvements, three treatments at fluences of 40–70 mJ were used, and those patients had the added benefit of improvements in rhytids as well as in acne scarring, Dr. Ortiz said.

All of the patients experienced transient erythema, which resolved within 3 months.

No serious patient complications occurred, and any serosanguineous oozing resolved within 48 hours of treatment.

When compared with traditional ablative resurfacing, the fractional CO2 laser treatment resulted in less patient downtime and reduced complication rates, Dr. Ortiz concluded.

KISSIMMEE, FLA. — A novel fractional CO2 resurfacing device significantly and safely improved moderate to severe acne scarring in a recent study.

More than 75% of the patients studied sustained moderate to significant improvement in their acne scarring at 3 months following final treatment, Dr. Arisa Ortiz reported at the annual meeting of the American Society of Laser Medicine and Surgery.

The 15 patients, who were aged 21–60 years, had moderate to severe acne scars and had Fitzpatrick skin types I-IV. They underwent up to three treatments with the Fraxel re:pair 10,600-nm fractional CO2 laser system (Reliant Technologies Inc.), said Dr. Ortiz, who is with the University of California, Irvine.

Treatment parameters ranged from 20 to 70 mJ with 600–1,200 microthermal zones/cm

Patient evaluations were conducted using digital photographic assessment at 3 days, 1 week, 1 month, and 3 months following treatment. Specifically, skin texture, wrinkles, pigmentation, skin laxity, scarring, and overall appearance were evaluated.

Of the 15 patients, 13 were considered to have shown improvement in the appearance of scarring, with an added benefit of improved overall appearance based on physician assessment, noted Dr. Ortiz, who reported that she received equipment and honoraria from Reliant.

Of 13 who had pigmentation, 11 were improved, and of 8 with rhytids, 6 improved.

Of eight who had only one treatment, one had no improvement, five had minor improvement, and two had moderate improvement. Of two who had two treatments, both had moderate improvement. Of five who had three treatments, one had no improvement, three had moderate improvement, and one had "very significant" improvement, she said.

Smoother skin texture was an example of minor improvement, and substantial improvement in ice pick scarring was an example of moderate improvement, Dr. Ortiz pointed out, explaining that higher fluences appeared to result in greater improvements, compared with lower fluences in patients who had the same number of treatments.

In those with the greatest improvements, three treatments at fluences of 40–70 mJ were used, and those patients had the added benefit of improvements in rhytids as well as in acne scarring, Dr. Ortiz said.

All of the patients experienced transient erythema, which resolved within 3 months.

No serious patient complications occurred, and any serosanguineous oozing resolved within 48 hours of treatment.

When compared with traditional ablative resurfacing, the fractional CO2 laser treatment resulted in less patient downtime and reduced complication rates, Dr. Ortiz concluded.

KISSIMMEE, FLA. — Treatment with a fixed array fractional 1540-nm erbium laser was effective for improving acne scars, a review of 181 patients found.

At 3-month follow-up, the patients who underwent three treatments at 4-week intervals with the Lux1540 laser (Palomar Medical Technologies Inc., Burlington, Mass.) had a median improvement of 3 by Canfield blinded photographic evaluation (Canfield Scientific Inc. Omnia system), which translates to a 50%-75% improvement in scar appearance, Dr. Robert A. Weiss reported at the annual meeting of the American Society of Laser Medicine and Surgery.

Treatments were given using the 10-mm, 100-microbeam per pulse handpiece for a minimum of three passes per treatment site at 10-millisecond pulse duration. Fluence was set at 50–70 mJ/microbeam, said Dr. Weiss of the Maryland Laser, Skin, and Vein Institute, Baltimore.

Self-assessed treatment results indicated that the patients were pleased with the outcomes, with 85% rating their skin as improved. Patient self-assessment indicated that pain was minimal, with a reported average pain score of 2.75 out of 10.

Side effects were minimal and included mild erythema and edema, which resolved in all patients within 24 hours.

The findings suggest that a minimal fluence of 50 mJ/microbeam with three passes is required to achieve improvement in acne scars with this laser, Dr. Weiss noted.

The study was supported by Palomar, which provided Dr. Weiss with equipment, discounts, a research grant, and honoraria.

KISSIMMEE, FLA. — Treatment with a fixed array fractional 1540-nm erbium laser was effective for improving acne scars, a review of 181 patients found.

At 3-month follow-up, the patients who underwent three treatments at 4-week intervals with the Lux1540 laser (Palomar Medical Technologies Inc., Burlington, Mass.) had a median improvement of 3 by Canfield blinded photographic evaluation (Canfield Scientific Inc. Omnia system), which translates to a 50%-75% improvement in scar appearance, Dr. Robert A. Weiss reported at the annual meeting of the American Society of Laser Medicine and Surgery.

Treatments were given using the 10-mm, 100-microbeam per pulse handpiece for a minimum of three passes per treatment site at 10-millisecond pulse duration. Fluence was set at 50–70 mJ/microbeam, said Dr. Weiss of the Maryland Laser, Skin, and Vein Institute, Baltimore.

Self-assessed treatment results indicated that the patients were pleased with the outcomes, with 85% rating their skin as improved. Patient self-assessment indicated that pain was minimal, with a reported average pain score of 2.75 out of 10.

Side effects were minimal and included mild erythema and edema, which resolved in all patients within 24 hours.

The findings suggest that a minimal fluence of 50 mJ/microbeam with three passes is required to achieve improvement in acne scars with this laser, Dr. Weiss noted.

The study was supported by Palomar, which provided Dr. Weiss with equipment, discounts, a research grant, and honoraria.

KISSIMMEE, FLA. — Treatment with a fixed array fractional 1540-nm erbium laser was effective for improving acne scars, a review of 181 patients found.

At 3-month follow-up, the patients who underwent three treatments at 4-week intervals with the Lux1540 laser (Palomar Medical Technologies Inc., Burlington, Mass.) had a median improvement of 3 by Canfield blinded photographic evaluation (Canfield Scientific Inc. Omnia system), which translates to a 50%-75% improvement in scar appearance, Dr. Robert A. Weiss reported at the annual meeting of the American Society of Laser Medicine and Surgery.

Treatments were given using the 10-mm, 100-microbeam per pulse handpiece for a minimum of three passes per treatment site at 10-millisecond pulse duration. Fluence was set at 50–70 mJ/microbeam, said Dr. Weiss of the Maryland Laser, Skin, and Vein Institute, Baltimore.

Self-assessed treatment results indicated that the patients were pleased with the outcomes, with 85% rating their skin as improved. Patient self-assessment indicated that pain was minimal, with a reported average pain score of 2.75 out of 10.

Side effects were minimal and included mild erythema and edema, which resolved in all patients within 24 hours.

The findings suggest that a minimal fluence of 50 mJ/microbeam with three passes is required to achieve improvement in acne scars with this laser, Dr. Weiss noted.

The study was supported by Palomar, which provided Dr. Weiss with equipment, discounts, a research grant, and honoraria.

KISSIMMEE, FLA. — Fractional photothermolysis is a promising treatment for surgical scars, including those that have failed to fully respond to other treatments, a small study suggests.

In 13 patients with various types and ages of surgical scars, fractional resurfacing using Reliant Technologies Inc.'s 1,550-nm, erbium-doped fiber laser (Fraxel) resulted in greater than 75% improvement in nine patients and at least 51%-75% improvement in an additional two patients.

The remaining two patients achieved between 25% and 50% improvement, Dr. Joy Kunishige reported at the annual meeting of the American Society for Laser Medicine and Surgery.

The patients were treated for scars resulting from Mohs surgery, excision, trauma, or plastic surgery, and most underwent a total of three treatments (range, two to eight). Treatments were administered at energy levels of 6–70 mJ, with final densities of 312–2,500 microthermal zones per square centimeter.

Outcomes were based on physician assessment of photographs that were taken at baseline and at 2 weeks following final treatment.

"All the characteristics that we looked at improved, including atrophy, hypertrophy, hyperpigmentation, and erythema," said Dr. Kunishige of the University of Texas Health Sciences Center, Houston, noting that all outcomes scores were maintained at the 12-month follow-up.

Traditional scar treatment involves use of the pulsed dye laser, but it appears that fractional resurfacing may provide better depth of penetration, she said. "Admittedly, many of the scars were new, and were possibly still undergoing remodeling, but even older scars showed similar improvement."

Scars that had failed to respond fully to prior therapies also responded to the Fraxel laser. It appears that this laser can be used as monotherapy for treating scars, or as an adjunct to other treatments, she said.

Dr. Kunishige reported no financial conflicts related to her presentation.

KISSIMMEE, FLA. — Fractional photothermolysis is a promising treatment for surgical scars, including those that have failed to fully respond to other treatments, a small study suggests.

In 13 patients with various types and ages of surgical scars, fractional resurfacing using Reliant Technologies Inc.'s 1,550-nm, erbium-doped fiber laser (Fraxel) resulted in greater than 75% improvement in nine patients and at least 51%-75% improvement in an additional two patients.

The remaining two patients achieved between 25% and 50% improvement, Dr. Joy Kunishige reported at the annual meeting of the American Society for Laser Medicine and Surgery.

The patients were treated for scars resulting from Mohs surgery, excision, trauma, or plastic surgery, and most underwent a total of three treatments (range, two to eight). Treatments were administered at energy levels of 6–70 mJ, with final densities of 312–2,500 microthermal zones per square centimeter.

Outcomes were based on physician assessment of photographs that were taken at baseline and at 2 weeks following final treatment.

"All the characteristics that we looked at improved, including atrophy, hypertrophy, hyperpigmentation, and erythema," said Dr. Kunishige of the University of Texas Health Sciences Center, Houston, noting that all outcomes scores were maintained at the 12-month follow-up.

Traditional scar treatment involves use of the pulsed dye laser, but it appears that fractional resurfacing may provide better depth of penetration, she said. "Admittedly, many of the scars were new, and were possibly still undergoing remodeling, but even older scars showed similar improvement."

Scars that had failed to respond fully to prior therapies also responded to the Fraxel laser. It appears that this laser can be used as monotherapy for treating scars, or as an adjunct to other treatments, she said.

Dr. Kunishige reported no financial conflicts related to her presentation.

KISSIMMEE, FLA. — Fractional photothermolysis is a promising treatment for surgical scars, including those that have failed to fully respond to other treatments, a small study suggests.

In 13 patients with various types and ages of surgical scars, fractional resurfacing using Reliant Technologies Inc.'s 1,550-nm, erbium-doped fiber laser (Fraxel) resulted in greater than 75% improvement in nine patients and at least 51%-75% improvement in an additional two patients.

The remaining two patients achieved between 25% and 50% improvement, Dr. Joy Kunishige reported at the annual meeting of the American Society for Laser Medicine and Surgery.

The patients were treated for scars resulting from Mohs surgery, excision, trauma, or plastic surgery, and most underwent a total of three treatments (range, two to eight). Treatments were administered at energy levels of 6–70 mJ, with final densities of 312–2,500 microthermal zones per square centimeter.

Outcomes were based on physician assessment of photographs that were taken at baseline and at 2 weeks following final treatment.

"All the characteristics that we looked at improved, including atrophy, hypertrophy, hyperpigmentation, and erythema," said Dr. Kunishige of the University of Texas Health Sciences Center, Houston, noting that all outcomes scores were maintained at the 12-month follow-up.

Traditional scar treatment involves use of the pulsed dye laser, but it appears that fractional resurfacing may provide better depth of penetration, she said. "Admittedly, many of the scars were new, and were possibly still undergoing remodeling, but even older scars showed similar improvement."

Scars that had failed to respond fully to prior therapies also responded to the Fraxel laser. It appears that this laser can be used as monotherapy for treating scars, or as an adjunct to other treatments, she said.

Dr. Kunishige reported no financial conflicts related to her presentation.

KISSIMMEE, FLA. — Combined radiofrequency energy and indocyanine green-mediated pulsed light phototherapy proved highly effective for the treatment of acne in a study of 14 Fitzpatrick skin type IV patients with substantial facial acne.

The patients, who were aged 16–35 years (mean age 25 years), and who had at least 10 inflamed facial acne lesions, were treated with 1 mg/mL indocyanine green (ICG) cream, which was applied to the face for 30 minutes and then wiped off. This was followed by combination pulsed light at 580–980 nm, and a radiofrequency device, Syneron Medical Ltd.'s Aurora SR, at an optical energy of 18–22 J/cm

The patients, who received no topical or oral acne medications in the 2 months prior to study initiation, received three treatments at 4-week intervals. Lesion count decreased by 18%, 49%, 68%, and 76%, at 4, 8, 12, and 16 weeks, respectively, after the initial treatment, said Dr. Rho of the Leaders Clinic in Seoul, South Korea.

Follow-up at 1, 4, 7, and 14 days after each treatment showed that side effects were minimal, and included only transient stinging and slight peeling, said Dr. Rho, who reported that he had no financial disclosures associated with his presentation.

ICG-mediated near-infrared light phototherapy has received a great deal of attention for the treatment of acne because of its sebaceous gland selectivity and high penetration depth. In addition, radiofrequency energy is known to reduce sebum production. Together, these treatments can substantially reduce the number of acne lesions, he said.

A 31-year-old female patient is shown before treatment (top). Improvement is seen after one session (bottom). Photos courtesy Dr. Nark-Kyoung Rho

ELSEVIER GLOBAL MEDICAL NEWS

KISSIMMEE, FLA. — Combined radiofrequency energy and indocyanine green-mediated pulsed light phototherapy proved highly effective for the treatment of acne in a study of 14 Fitzpatrick skin type IV patients with substantial facial acne.

The patients, who were aged 16–35 years (mean age 25 years), and who had at least 10 inflamed facial acne lesions, were treated with 1 mg/mL indocyanine green (ICG) cream, which was applied to the face for 30 minutes and then wiped off. This was followed by combination pulsed light at 580–980 nm, and a radiofrequency device, Syneron Medical Ltd.'s Aurora SR, at an optical energy of 18–22 J/cm

The patients, who received no topical or oral acne medications in the 2 months prior to study initiation, received three treatments at 4-week intervals. Lesion count decreased by 18%, 49%, 68%, and 76%, at 4, 8, 12, and 16 weeks, respectively, after the initial treatment, said Dr. Rho of the Leaders Clinic in Seoul, South Korea.

Follow-up at 1, 4, 7, and 14 days after each treatment showed that side effects were minimal, and included only transient stinging and slight peeling, said Dr. Rho, who reported that he had no financial disclosures associated with his presentation.

ICG-mediated near-infrared light phototherapy has received a great deal of attention for the treatment of acne because of its sebaceous gland selectivity and high penetration depth. In addition, radiofrequency energy is known to reduce sebum production. Together, these treatments can substantially reduce the number of acne lesions, he said.

A 31-year-old female patient is shown before treatment (top). Improvement is seen after one session (bottom). Photos courtesy Dr. Nark-Kyoung Rho

ELSEVIER GLOBAL MEDICAL NEWS

KISSIMMEE, FLA. — Combined radiofrequency energy and indocyanine green-mediated pulsed light phototherapy proved highly effective for the treatment of acne in a study of 14 Fitzpatrick skin type IV patients with substantial facial acne.

The patients, who were aged 16–35 years (mean age 25 years), and who had at least 10 inflamed facial acne lesions, were treated with 1 mg/mL indocyanine green (ICG) cream, which was applied to the face for 30 minutes and then wiped off. This was followed by combination pulsed light at 580–980 nm, and a radiofrequency device, Syneron Medical Ltd.'s Aurora SR, at an optical energy of 18–22 J/cm

The patients, who received no topical or oral acne medications in the 2 months prior to study initiation, received three treatments at 4-week intervals. Lesion count decreased by 18%, 49%, 68%, and 76%, at 4, 8, 12, and 16 weeks, respectively, after the initial treatment, said Dr. Rho of the Leaders Clinic in Seoul, South Korea.

Follow-up at 1, 4, 7, and 14 days after each treatment showed that side effects were minimal, and included only transient stinging and slight peeling, said Dr. Rho, who reported that he had no financial disclosures associated with his presentation.

ICG-mediated near-infrared light phototherapy has received a great deal of attention for the treatment of acne because of its sebaceous gland selectivity and high penetration depth. In addition, radiofrequency energy is known to reduce sebum production. Together, these treatments can substantially reduce the number of acne lesions, he said.

A 31-year-old female patient is shown before treatment (top). Improvement is seen after one session (bottom). Photos courtesy Dr. Nark-Kyoung Rho

ELSEVIER GLOBAL MEDICAL NEWS

KISSIMMEE, FLA. — Focal radiofrequency ablation of the neural innervation of the glabella muscle complex provided an effective and possibly more durable alternative to botulinum toxin in a series of 10 patients with concerns about glabellar frown lines.

The procedure, which is known as glabellar frown relaxation (GFX) radiofrequency ablation, was approved by the Food and Drug Administration for tissue ablation last year and has been touted as a new and improved means of relaxing frown lines without the use of toxins.

Of the 10 patients who underwent the treatment, 6 had an immediate complete response and 4 had partial attenuation of their frown lines, as judged by the inability to frown, said Dr. Cameron Rokhsar of Albert Einstein College of Medicine, New York.

Additionally, medial brow elevation occurred in five of the patients, he noted at the annual meeting of the American Society for Laser Medicine and Surgery.

The effects remained apparent at 3-month follow-up.

All patients tolerated the procedure; side effects were limited to bruising and moderate pain during treatment.

The GFX radiofrequency ablation procedure, which is performed under local anesthesia, involves insertion of a probe at the lateral canthi on each side and the use of mild electrostimulation to identify the rami of the temporal branch of the facial nerve innervating the corrugators.

A 20-second radiofrequency pulse is applied to cause the focal nerve injury, and the probe is then advanced on the nasal sidewall to identify and ablate the branches of the angular nerve innervating the procerus.

Although both botulinum toxin and GFX radiofrequency ablation target the nerves that cause frown lines, botulinum toxin therapies block signals sent from the nerves to the muscles while GFX radiofrequency energy is used to create focal damage to effectively weaken the motor nerves, Dr. Rokhsar explained.

As a result, the duration of effect is increased with GFX radiofrequency; some reports suggest that the duration can be up to 2 years, compared with 3–4 months for botulinum toxin treatments. Studies to review long-term efficacy are underway, he said, adding that "the procedure has a learning curve."

KISSIMMEE, FLA. — Focal radiofrequency ablation of the neural innervation of the glabella muscle complex provided an effective and possibly more durable alternative to botulinum toxin in a series of 10 patients with concerns about glabellar frown lines.

The procedure, which is known as glabellar frown relaxation (GFX) radiofrequency ablation, was approved by the Food and Drug Administration for tissue ablation last year and has been touted as a new and improved means of relaxing frown lines without the use of toxins.

Of the 10 patients who underwent the treatment, 6 had an immediate complete response and 4 had partial attenuation of their frown lines, as judged by the inability to frown, said Dr. Cameron Rokhsar of Albert Einstein College of Medicine, New York.

Additionally, medial brow elevation occurred in five of the patients, he noted at the annual meeting of the American Society for Laser Medicine and Surgery.

The effects remained apparent at 3-month follow-up.

All patients tolerated the procedure; side effects were limited to bruising and moderate pain during treatment.

The GFX radiofrequency ablation procedure, which is performed under local anesthesia, involves insertion of a probe at the lateral canthi on each side and the use of mild electrostimulation to identify the rami of the temporal branch of the facial nerve innervating the corrugators.

A 20-second radiofrequency pulse is applied to cause the focal nerve injury, and the probe is then advanced on the nasal sidewall to identify and ablate the branches of the angular nerve innervating the procerus.

Although both botulinum toxin and GFX radiofrequency ablation target the nerves that cause frown lines, botulinum toxin therapies block signals sent from the nerves to the muscles while GFX radiofrequency energy is used to create focal damage to effectively weaken the motor nerves, Dr. Rokhsar explained.

As a result, the duration of effect is increased with GFX radiofrequency; some reports suggest that the duration can be up to 2 years, compared with 3–4 months for botulinum toxin treatments. Studies to review long-term efficacy are underway, he said, adding that "the procedure has a learning curve."

KISSIMMEE, FLA. — Focal radiofrequency ablation of the neural innervation of the glabella muscle complex provided an effective and possibly more durable alternative to botulinum toxin in a series of 10 patients with concerns about glabellar frown lines.

The procedure, which is known as glabellar frown relaxation (GFX) radiofrequency ablation, was approved by the Food and Drug Administration for tissue ablation last year and has been touted as a new and improved means of relaxing frown lines without the use of toxins.

Of the 10 patients who underwent the treatment, 6 had an immediate complete response and 4 had partial attenuation of their frown lines, as judged by the inability to frown, said Dr. Cameron Rokhsar of Albert Einstein College of Medicine, New York.

Additionally, medial brow elevation occurred in five of the patients, he noted at the annual meeting of the American Society for Laser Medicine and Surgery.

The effects remained apparent at 3-month follow-up.

All patients tolerated the procedure; side effects were limited to bruising and moderate pain during treatment.

The GFX radiofrequency ablation procedure, which is performed under local anesthesia, involves insertion of a probe at the lateral canthi on each side and the use of mild electrostimulation to identify the rami of the temporal branch of the facial nerve innervating the corrugators.

A 20-second radiofrequency pulse is applied to cause the focal nerve injury, and the probe is then advanced on the nasal sidewall to identify and ablate the branches of the angular nerve innervating the procerus.

Although both botulinum toxin and GFX radiofrequency ablation target the nerves that cause frown lines, botulinum toxin therapies block signals sent from the nerves to the muscles while GFX radiofrequency energy is used to create focal damage to effectively weaken the motor nerves, Dr. Rokhsar explained.

As a result, the duration of effect is increased with GFX radiofrequency; some reports suggest that the duration can be up to 2 years, compared with 3–4 months for botulinum toxin treatments. Studies to review long-term efficacy are underway, he said, adding that "the procedure has a learning curve."

KISSIMMEE, FLA. — A single treatment with a microfractional 2940-nm erbium:YAG laser resulted in perioral wrinkle reduction of greater than 40% and an improvement of 2–3 grades on the Fitzpatrick wrinkle assessment scale in a recent study.

In all, 23 patients with a score of 5–9 on the 9-point Fitzpatrick scale underwent full-face laser treatment. The improvements from baseline were noted after the first treatment, Dr. E. Victor Ross reported at the annual meeting of the American Society for Laser Medicine and Surgery.

The patients, who had skin types ranging from I to III, were treated with a 6- to 10-mm spot size and energy ranging from 400 to 920 microbeams/cm

Between one and three passes were used in less photodamaged areas, and three to eight passes were used in more severely damaged areas. Additionally, small areas were treated with a traditional short-pulse erbium:YAG laser at four passes and 5 J/cm

Preliminary findings suggest that the microfractional erbium:YAG treatments resulted in a similar wrinkle response to that observed with traditional short-pulse erbium:YAG laser treatments; however, healing times were reduced with the microfractional erbium:YAG, said Dr. Ross of the Scripps Clinic in San Diego.

Dr. Ross acknowledged that he has received equipment, consulting fees, and a research grant from Palomar Medical Technologies Inc.

"There was very rapid recovery, both histologically and clinically," he said, noting that the average full-face treatment time was 48 minutes. Re-epithelialization of the basal layer of the epidermis occurred within 12–24 hours, and complete re-epithelialization occurred within 4–5 days.

Bronzed skin was noted immediately after the treatments, and some patients experienced focal pinpoint hemorrhage. At 2 weeks, however, only mild erythema remained, he said.

On microscopic examination, separated columns of ablation were noted, typically with a depth of 200 microns and 20–30 microns of residual thermal damage at the periphery of the conical microwounds.

Not only did the treatment lead to smoothing of the skin and reduction of perioral wrinkles, but improvements in dyschromia were also noted, Dr. Ross said.

Although optimal treatment parameters for wrinkle reduction remain to be defined, these findings suggest that microfractional 2940-nm laser treatment is superior to traditional short-pulse erbium:YAG laser treatment for this purpose, he concluded.

KISSIMMEE, FLA. — A single treatment with a microfractional 2940-nm erbium:YAG laser resulted in perioral wrinkle reduction of greater than 40% and an improvement of 2–3 grades on the Fitzpatrick wrinkle assessment scale in a recent study.

In all, 23 patients with a score of 5–9 on the 9-point Fitzpatrick scale underwent full-face laser treatment. The improvements from baseline were noted after the first treatment, Dr. E. Victor Ross reported at the annual meeting of the American Society for Laser Medicine and Surgery.

The patients, who had skin types ranging from I to III, were treated with a 6- to 10-mm spot size and energy ranging from 400 to 920 microbeams/cm

Between one and three passes were used in less photodamaged areas, and three to eight passes were used in more severely damaged areas. Additionally, small areas were treated with a traditional short-pulse erbium:YAG laser at four passes and 5 J/cm

Preliminary findings suggest that the microfractional erbium:YAG treatments resulted in a similar wrinkle response to that observed with traditional short-pulse erbium:YAG laser treatments; however, healing times were reduced with the microfractional erbium:YAG, said Dr. Ross of the Scripps Clinic in San Diego.

Dr. Ross acknowledged that he has received equipment, consulting fees, and a research grant from Palomar Medical Technologies Inc.

"There was very rapid recovery, both histologically and clinically," he said, noting that the average full-face treatment time was 48 minutes. Re-epithelialization of the basal layer of the epidermis occurred within 12–24 hours, and complete re-epithelialization occurred within 4–5 days.

Bronzed skin was noted immediately after the treatments, and some patients experienced focal pinpoint hemorrhage. At 2 weeks, however, only mild erythema remained, he said.

On microscopic examination, separated columns of ablation were noted, typically with a depth of 200 microns and 20–30 microns of residual thermal damage at the periphery of the conical microwounds.

Not only did the treatment lead to smoothing of the skin and reduction of perioral wrinkles, but improvements in dyschromia were also noted, Dr. Ross said.

Although optimal treatment parameters for wrinkle reduction remain to be defined, these findings suggest that microfractional 2940-nm laser treatment is superior to traditional short-pulse erbium:YAG laser treatment for this purpose, he concluded.

KISSIMMEE, FLA. — A single treatment with a microfractional 2940-nm erbium:YAG laser resulted in perioral wrinkle reduction of greater than 40% and an improvement of 2–3 grades on the Fitzpatrick wrinkle assessment scale in a recent study.

In all, 23 patients with a score of 5–9 on the 9-point Fitzpatrick scale underwent full-face laser treatment. The improvements from baseline were noted after the first treatment, Dr. E. Victor Ross reported at the annual meeting of the American Society for Laser Medicine and Surgery.

The patients, who had skin types ranging from I to III, were treated with a 6- to 10-mm spot size and energy ranging from 400 to 920 microbeams/cm

Between one and three passes were used in less photodamaged areas, and three to eight passes were used in more severely damaged areas. Additionally, small areas were treated with a traditional short-pulse erbium:YAG laser at four passes and 5 J/cm

Preliminary findings suggest that the microfractional erbium:YAG treatments resulted in a similar wrinkle response to that observed with traditional short-pulse erbium:YAG laser treatments; however, healing times were reduced with the microfractional erbium:YAG, said Dr. Ross of the Scripps Clinic in San Diego.

Dr. Ross acknowledged that he has received equipment, consulting fees, and a research grant from Palomar Medical Technologies Inc.

"There was very rapid recovery, both histologically and clinically," he said, noting that the average full-face treatment time was 48 minutes. Re-epithelialization of the basal layer of the epidermis occurred within 12–24 hours, and complete re-epithelialization occurred within 4–5 days.

Bronzed skin was noted immediately after the treatments, and some patients experienced focal pinpoint hemorrhage. At 2 weeks, however, only mild erythema remained, he said.

On microscopic examination, separated columns of ablation were noted, typically with a depth of 200 microns and 20–30 microns of residual thermal damage at the periphery of the conical microwounds.

Not only did the treatment lead to smoothing of the skin and reduction of perioral wrinkles, but improvements in dyschromia were also noted, Dr. Ross said.

Although optimal treatment parameters for wrinkle reduction remain to be defined, these findings suggest that microfractional 2940-nm laser treatment is superior to traditional short-pulse erbium:YAG laser treatment for this purpose, he concluded.

KISSIMMEE, FLA. — The 1,064-nm neodymium:YAG laser is effective for treating and preventing the recurrence of hidradenitis suppurativa lesions, according to the results of a randomized, controlled study of 22 patients with the disease.

The 1,064-nm Nd:YAG laser is commonly used for laser hair removal but also seems well suited for treating hidradenitis suppurativa, which histologic studies suggest is a disease of follicular occlusion with apocrine gland involvement as a secondary event, according to Dr. Emily P. Tierney and her colleagues in the department of dermatology at Henry Ford Hospital, Detroit.

Despite the fact that medical treatments for hidradenitis suppurativa have had limited efficacy against the disease and surgical treatment is associated with high morbidity, an initial pilot study conducted by Dr. Tierney and her associates found the laser to be efficacious in treating the disease.

One of Dr. Tierney's coinvestigators in Henry Ford's dermatology department, Dr. Iltefat Hamzavi, previously conducted a study of the Nd:YAG laser in four patients with dissecting cellulitis, a disorder analogous to hidradenitis suppurativa. In that study, 1 year after the initiation of laser treatment, patients achieved decreased pus formation, a reduced reliance on systemic treatments, and a controlled or terminated disease process without dyspigmentation (Dermatol. Surg. 2006;32:1039–44).

In a poster presentation at the annual meeting of the American Society for Laser Medicine and Surgery, Dr. Tierney and her coinvestigators reported on the effect of the laser on 22 patients with bilateral and symmetrical disease who were randomized to receive laser treatment plus topical antibiotics at affected sites on one side of the body and only topical antibiotics on affected sites on the contralateral side.

The patients had a mean age of 41 years, and 15 of them had Hurley stage II hidradenitis suppurativa, which is characterized by recurrent abscesses with tract formation and cicatrization and single or multiple widely separated lesions. The other seven patients had stage III disease, which is exemplified by diffuse or near diffuse involvement, or multiple interconnected tracts and abscesses across the entire area.

Half of the 22 patients had Fitzpatrick skin type III, followed by 4 patients with type V, 3 with type IV, 3 with type II, and 1 with type VI.

After a series of up to four laser treatment sessions conducted once per month, there was a significant improvement in clinical scoring criteria based on a modified Hidradenitis Suppurativa European Research Group (HISERG) scale at all three anatomical sites treated with the laser (groin, axilla, and inframammary sites).

Compared with control sites, laser treatment improved the modified HISERG scale by the greatest amount for inguinal lesions (68% vs. 2%). Laser treatment also significantly improved HISERG scale scores of lesions in the axilla (63% vs. −11%) and at inframammary sites (30% vs. −71%).

Dr. Tierney reported that their research was supported by a Cutting Edge Research Grant from the American Society for Dermatologic Surgery and the Shahani Fund, a private individual donor that supports research at Henry Ford Hospital. Neither Dr. Tierney nor Dr. Hamzavi had any conflicts of interest to disclose.

At 2 months after the end of treatment, the patients continued to have significantly better modified HISERG scale scores at all sites combined, compared with all control sites combined.

The differences in response to laser treatment among anatomical sites appeared to be driven by the properties and distribution of hair at the site (density, volume, thickness, and proportion of follicles in anagen phase), according to the investigators.

The inguinal lesions of a patient with a 15-year history of disease are shown.

Lesion improvement is seen 2 months after four monthly laser treatments. Photos courtesy Dr. Emily P. Tierney

KISSIMMEE, FLA. — The 1,064-nm neodymium:YAG laser is effective for treating and preventing the recurrence of hidradenitis suppurativa lesions, according to the results of a randomized, controlled study of 22 patients with the disease.

The 1,064-nm Nd:YAG laser is commonly used for laser hair removal but also seems well suited for treating hidradenitis suppurativa, which histologic studies suggest is a disease of follicular occlusion with apocrine gland involvement as a secondary event, according to Dr. Emily P. Tierney and her colleagues in the department of dermatology at Henry Ford Hospital, Detroit.

Despite the fact that medical treatments for hidradenitis suppurativa have had limited efficacy against the disease and surgical treatment is associated with high morbidity, an initial pilot study conducted by Dr. Tierney and her associates found the laser to be efficacious in treating the disease.

One of Dr. Tierney's coinvestigators in Henry Ford's dermatology department, Dr. Iltefat Hamzavi, previously conducted a study of the Nd:YAG laser in four patients with dissecting cellulitis, a disorder analogous to hidradenitis suppurativa. In that study, 1 year after the initiation of laser treatment, patients achieved decreased pus formation, a reduced reliance on systemic treatments, and a controlled or terminated disease process without dyspigmentation (Dermatol. Surg. 2006;32:1039–44).

In a poster presentation at the annual meeting of the American Society for Laser Medicine and Surgery, Dr. Tierney and her coinvestigators reported on the effect of the laser on 22 patients with bilateral and symmetrical disease who were randomized to receive laser treatment plus topical antibiotics at affected sites on one side of the body and only topical antibiotics on affected sites on the contralateral side.

The patients had a mean age of 41 years, and 15 of them had Hurley stage II hidradenitis suppurativa, which is characterized by recurrent abscesses with tract formation and cicatrization and single or multiple widely separated lesions. The other seven patients had stage III disease, which is exemplified by diffuse or near diffuse involvement, or multiple interconnected tracts and abscesses across the entire area.

Half of the 22 patients had Fitzpatrick skin type III, followed by 4 patients with type V, 3 with type IV, 3 with type II, and 1 with type VI.

After a series of up to four laser treatment sessions conducted once per month, there was a significant improvement in clinical scoring criteria based on a modified Hidradenitis Suppurativa European Research Group (HISERG) scale at all three anatomical sites treated with the laser (groin, axilla, and inframammary sites).

Compared with control sites, laser treatment improved the modified HISERG scale by the greatest amount for inguinal lesions (68% vs. 2%). Laser treatment also significantly improved HISERG scale scores of lesions in the axilla (63% vs. −11%) and at inframammary sites (30% vs. −71%).

Dr. Tierney reported that their research was supported by a Cutting Edge Research Grant from the American Society for Dermatologic Surgery and the Shahani Fund, a private individual donor that supports research at Henry Ford Hospital. Neither Dr. Tierney nor Dr. Hamzavi had any conflicts of interest to disclose.

At 2 months after the end of treatment, the patients continued to have significantly better modified HISERG scale scores at all sites combined, compared with all control sites combined.

The differences in response to laser treatment among anatomical sites appeared to be driven by the properties and distribution of hair at the site (density, volume, thickness, and proportion of follicles in anagen phase), according to the investigators.

The inguinal lesions of a patient with a 15-year history of disease are shown.

Lesion improvement is seen 2 months after four monthly laser treatments. Photos courtesy Dr. Emily P. Tierney

KISSIMMEE, FLA. — The 1,064-nm neodymium:YAG laser is effective for treating and preventing the recurrence of hidradenitis suppurativa lesions, according to the results of a randomized, controlled study of 22 patients with the disease.

The 1,064-nm Nd:YAG laser is commonly used for laser hair removal but also seems well suited for treating hidradenitis suppurativa, which histologic studies suggest is a disease of follicular occlusion with apocrine gland involvement as a secondary event, according to Dr. Emily P. Tierney and her colleagues in the department of dermatology at Henry Ford Hospital, Detroit.

Despite the fact that medical treatments for hidradenitis suppurativa have had limited efficacy against the disease and surgical treatment is associated with high morbidity, an initial pilot study conducted by Dr. Tierney and her associates found the laser to be efficacious in treating the disease.

One of Dr. Tierney's coinvestigators in Henry Ford's dermatology department, Dr. Iltefat Hamzavi, previously conducted a study of the Nd:YAG laser in four patients with dissecting cellulitis, a disorder analogous to hidradenitis suppurativa. In that study, 1 year after the initiation of laser treatment, patients achieved decreased pus formation, a reduced reliance on systemic treatments, and a controlled or terminated disease process without dyspigmentation (Dermatol. Surg. 2006;32:1039–44).

In a poster presentation at the annual meeting of the American Society for Laser Medicine and Surgery, Dr. Tierney and her coinvestigators reported on the effect of the laser on 22 patients with bilateral and symmetrical disease who were randomized to receive laser treatment plus topical antibiotics at affected sites on one side of the body and only topical antibiotics on affected sites on the contralateral side.

The patients had a mean age of 41 years, and 15 of them had Hurley stage II hidradenitis suppurativa, which is characterized by recurrent abscesses with tract formation and cicatrization and single or multiple widely separated lesions. The other seven patients had stage III disease, which is exemplified by diffuse or near diffuse involvement, or multiple interconnected tracts and abscesses across the entire area.

Half of the 22 patients had Fitzpatrick skin type III, followed by 4 patients with type V, 3 with type IV, 3 with type II, and 1 with type VI.

After a series of up to four laser treatment sessions conducted once per month, there was a significant improvement in clinical scoring criteria based on a modified Hidradenitis Suppurativa European Research Group (HISERG) scale at all three anatomical sites treated with the laser (groin, axilla, and inframammary sites).

Compared with control sites, laser treatment improved the modified HISERG scale by the greatest amount for inguinal lesions (68% vs. 2%). Laser treatment also significantly improved HISERG scale scores of lesions in the axilla (63% vs. −11%) and at inframammary sites (30% vs. −71%).

Dr. Tierney reported that their research was supported by a Cutting Edge Research Grant from the American Society for Dermatologic Surgery and the Shahani Fund, a private individual donor that supports research at Henry Ford Hospital. Neither Dr. Tierney nor Dr. Hamzavi had any conflicts of interest to disclose.

At 2 months after the end of treatment, the patients continued to have significantly better modified HISERG scale scores at all sites combined, compared with all control sites combined.

The differences in response to laser treatment among anatomical sites appeared to be driven by the properties and distribution of hair at the site (density, volume, thickness, and proportion of follicles in anagen phase), according to the investigators.

The inguinal lesions of a patient with a 15-year history of disease are shown.

Lesion improvement is seen 2 months after four monthly laser treatments. Photos courtesy Dr. Emily P. Tierney

VANCOUVER, B.C. — Fractional photothermolysis is superior to pulsed dye laser treatment for improving the cosmetic appearance of Mohs surgical scars and was preferred by all patients, despite being more painful, according to the first study comparing the two modalities.

The pulsed dye laser is the standard treatment for surgical scars, but it seems to primarily improve erythema, while fractional photothermolysis seems to mainly improve scar consistency, lead author Dr. Emily P. Tierney said in an interview.

It was surprising, then, to find that fractional photothermolysis outperformed the pulsed dye laser in reducing scar erythema. "My hypothesis in doing the study was that [fractional photothermolysis] would have improvements above and beyond the pulsed dye likely in terms of scar thickness and scar texture, but that the pulsed dye would have greater improvements in terms of the red component of scars," explained Dr. Tierney, a dermatologic surgeon with the Henry Ford Health System, Detroit.

The randomized, double-blind study, presented as a poster at the annual meeting of the American College of Mohs Surgery, involved 12 patients who had undergone Mohs surgery. All 12 scars were located on the face, neck, or chest, and 8 of them were hypopigmented.

In each patient, after application of lidocaine gel, half of each scar was treated with fractional photothermolysis (Fraxel SR, Reliant Technologies Inc.) and half treated with a pulsed dye laser (V-Beam, Candela Corp.). The patients received four treatments at 2-week intervals.

Dr. Tierney reported that she had no conflicts of interest in association with the research.

The same blinded physicians assessed the scars at each treatment and 1 month after the last treatment. All assessments were done in person, which permitted better evaluation of the scars' 3-D features. The physicians rated cosmetic outcomes using a quartile scale, so a one-quartile increase corresponded to a 25% improvement.

Compared with pulsed dye laser, fractional photothermolysis resulted in significantly greater improvements in scar thickness (mean improvement, 50%-75% vs. 0–25%), scar dyspigmentation (75% vs. 25%), color and texture of the subset of hypopigmented scars (50% vs. 0), and overall cosmetic outcome (75% vs. 50%). The two treatments both yielded a 50% improvement in scar texture.

Patients experienced significantly greater pain with the fractional photothermolysis than with the pulsed dye laser, according to Dr. Tierney, but neither treatment produced any other adverse effects.

At the end of the study, patients were offered additional treatment for the half of the scar with lesser improvement, and "uniformly, all of my 12 patients wanted the entire scar treated with Fraxel, so patients could see the significant difference between the two sides as well," she said, concluding that fractional photothermolysis appears to be the superior treatment and may expand the options available to patients.

All of the study patients started treatment 2–3 months after their surgery, but the best timing is unknown.

"That is something that we are going to have to look at in future studies—just where that optimal window is for scar remodeling," she commented. "Perhaps 2 months is too late or it may even be a little bit on the early side." To better define that optimal window, she and her colleagues are planning studies in which patients will be treated at varying times after surgery.

"The frequency of treatment is also an incredibly important variable in the success of both devices," she asserted, noting that treating patients every 2 weeks is very aggressive.

"I think the results that we got in terms of the before and after photos are greater than anything I have seen where people have treated with monthly or every-other-month types of intervals," Dr. Tierney concluded.

A scar is shown before being treated with pulsed dye (1) and Fraxel (2).

The same scar is shown after treatment using the two lasers as noted above. Photos courtesy Dr. Emily P. Tierney

VANCOUVER, B.C. — Fractional photothermolysis is superior to pulsed dye laser treatment for improving the cosmetic appearance of Mohs surgical scars and was preferred by all patients, despite being more painful, according to the first study comparing the two modalities.

The pulsed dye laser is the standard treatment for surgical scars, but it seems to primarily improve erythema, while fractional photothermolysis seems to mainly improve scar consistency, lead author Dr. Emily P. Tierney said in an interview.

It was surprising, then, to find that fractional photothermolysis outperformed the pulsed dye laser in reducing scar erythema. "My hypothesis in doing the study was that [fractional photothermolysis] would have improvements above and beyond the pulsed dye likely in terms of scar thickness and scar texture, but that the pulsed dye would have greater improvements in terms of the red component of scars," explained Dr. Tierney, a dermatologic surgeon with the Henry Ford Health System, Detroit.

The randomized, double-blind study, presented as a poster at the annual meeting of the American College of Mohs Surgery, involved 12 patients who had undergone Mohs surgery. All 12 scars were located on the face, neck, or chest, and 8 of them were hypopigmented.

In each patient, after application of lidocaine gel, half of each scar was treated with fractional photothermolysis (Fraxel SR, Reliant Technologies Inc.) and half treated with a pulsed dye laser (V-Beam, Candela Corp.). The patients received four treatments at 2-week intervals.

Dr. Tierney reported that she had no conflicts of interest in association with the research.

The same blinded physicians assessed the scars at each treatment and 1 month after the last treatment. All assessments were done in person, which permitted better evaluation of the scars' 3-D features. The physicians rated cosmetic outcomes using a quartile scale, so a one-quartile increase corresponded to a 25% improvement.

Compared with pulsed dye laser, fractional photothermolysis resulted in significantly greater improvements in scar thickness (mean improvement, 50%-75% vs. 0–25%), scar dyspigmentation (75% vs. 25%), color and texture of the subset of hypopigmented scars (50% vs. 0), and overall cosmetic outcome (75% vs. 50%). The two treatments both yielded a 50% improvement in scar texture.

Patients experienced significantly greater pain with the fractional photothermolysis than with the pulsed dye laser, according to Dr. Tierney, but neither treatment produced any other adverse effects.

At the end of the study, patients were offered additional treatment for the half of the scar with lesser improvement, and "uniformly, all of my 12 patients wanted the entire scar treated with Fraxel, so patients could see the significant difference between the two sides as well," she said, concluding that fractional photothermolysis appears to be the superior treatment and may expand the options available to patients.

All of the study patients started treatment 2–3 months after their surgery, but the best timing is unknown.

"That is something that we are going to have to look at in future studies—just where that optimal window is for scar remodeling," she commented. "Perhaps 2 months is too late or it may even be a little bit on the early side." To better define that optimal window, she and her colleagues are planning studies in which patients will be treated at varying times after surgery.

"The frequency of treatment is also an incredibly important variable in the success of both devices," she asserted, noting that treating patients every 2 weeks is very aggressive.

"I think the results that we got in terms of the before and after photos are greater than anything I have seen where people have treated with monthly or every-other-month types of intervals," Dr. Tierney concluded.

A scar is shown before being treated with pulsed dye (1) and Fraxel (2).

The same scar is shown after treatment using the two lasers as noted above. Photos courtesy Dr. Emily P. Tierney

VANCOUVER, B.C. — Fractional photothermolysis is superior to pulsed dye laser treatment for improving the cosmetic appearance of Mohs surgical scars and was preferred by all patients, despite being more painful, according to the first study comparing the two modalities.

The pulsed dye laser is the standard treatment for surgical scars, but it seems to primarily improve erythema, while fractional photothermolysis seems to mainly improve scar consistency, lead author Dr. Emily P. Tierney said in an interview.

It was surprising, then, to find that fractional photothermolysis outperformed the pulsed dye laser in reducing scar erythema. "My hypothesis in doing the study was that [fractional photothermolysis] would have improvements above and beyond the pulsed dye likely in terms of scar thickness and scar texture, but that the pulsed dye would have greater improvements in terms of the red component of scars," explained Dr. Tierney, a dermatologic surgeon with the Henry Ford Health System, Detroit.

The randomized, double-blind study, presented as a poster at the annual meeting of the American College of Mohs Surgery, involved 12 patients who had undergone Mohs surgery. All 12 scars were located on the face, neck, or chest, and 8 of them were hypopigmented.

In each patient, after application of lidocaine gel, half of each scar was treated with fractional photothermolysis (Fraxel SR, Reliant Technologies Inc.) and half treated with a pulsed dye laser (V-Beam, Candela Corp.). The patients received four treatments at 2-week intervals.

Dr. Tierney reported that she had no conflicts of interest in association with the research.

The same blinded physicians assessed the scars at each treatment and 1 month after the last treatment. All assessments were done in person, which permitted better evaluation of the scars' 3-D features. The physicians rated cosmetic outcomes using a quartile scale, so a one-quartile increase corresponded to a 25% improvement.

Compared with pulsed dye laser, fractional photothermolysis resulted in significantly greater improvements in scar thickness (mean improvement, 50%-75% vs. 0–25%), scar dyspigmentation (75% vs. 25%), color and texture of the subset of hypopigmented scars (50% vs. 0), and overall cosmetic outcome (75% vs. 50%). The two treatments both yielded a 50% improvement in scar texture.

Patients experienced significantly greater pain with the fractional photothermolysis than with the pulsed dye laser, according to Dr. Tierney, but neither treatment produced any other adverse effects.

At the end of the study, patients were offered additional treatment for the half of the scar with lesser improvement, and "uniformly, all of my 12 patients wanted the entire scar treated with Fraxel, so patients could see the significant difference between the two sides as well," she said, concluding that fractional photothermolysis appears to be the superior treatment and may expand the options available to patients.

All of the study patients started treatment 2–3 months after their surgery, but the best timing is unknown.

"That is something that we are going to have to look at in future studies—just where that optimal window is for scar remodeling," she commented. "Perhaps 2 months is too late or it may even be a little bit on the early side." To better define that optimal window, she and her colleagues are planning studies in which patients will be treated at varying times after surgery.

"The frequency of treatment is also an incredibly important variable in the success of both devices," she asserted, noting that treating patients every 2 weeks is very aggressive.

"I think the results that we got in terms of the before and after photos are greater than anything I have seen where people have treated with monthly or every-other-month types of intervals," Dr. Tierney concluded.

A scar is shown before being treated with pulsed dye (1) and Fraxel (2).

The same scar is shown after treatment using the two lasers as noted above. Photos courtesy Dr. Emily P. Tierney

KISSIMMEE, FLA. — Dark-skinned patients who undergo hair removal with a 1,064-nm Nd:YAG laser while taking isotretinoin do not appear to experience any long-term complications, according to a retrospective study of 11 patients.

The near-infrared wavelength of the Nd:YAG laser is absorbed less efficiently by epidermal melanin than with some other lasers, Dr. Khalil A. Khatri said in a poster presented at the annual meeting of the American Society for Laser Medicine and Surgery.

The patients in the study underwent Nd:YAG laser (Cutera CoolGlide) treatments with a pulse duration of 10–30 milliseconds, a spot size of 10 mm, and a repetition rate of 2 Hz. Laser fluence ranged from 30 to 55 J/cm

The patients stopped taking isotretinoin for 3 days before and after each laser hair removal treatment to reduce the severity of retinoid dermatitis. After 131 laser hair removal treatments, the patients—all of whom were taking isotretinoin for severe acne—had moderate erythema and perifollicular edema. No patients experienced vesiculation, scarring, or permanent pigmentary changes during follow-up visits, which occurred at intervals of 4, 10, or 12 weeks, he reported.

Only one patient with Fitzpatrick type V skin developed discrete crusting, which resulted in a slight hyperpigmentation that spontaneously resolved in 3 months, after the last and most intense treatment with the highest fluence used, noted Dr. Khatri, who has no financial interest in the products used in the study.

KISSIMMEE, FLA. — Dark-skinned patients who undergo hair removal with a 1,064-nm Nd:YAG laser while taking isotretinoin do not appear to experience any long-term complications, according to a retrospective study of 11 patients.

The near-infrared wavelength of the Nd:YAG laser is absorbed less efficiently by epidermal melanin than with some other lasers, Dr. Khalil A. Khatri said in a poster presented at the annual meeting of the American Society for Laser Medicine and Surgery.

The patients in the study underwent Nd:YAG laser (Cutera CoolGlide) treatments with a pulse duration of 10–30 milliseconds, a spot size of 10 mm, and a repetition rate of 2 Hz. Laser fluence ranged from 30 to 55 J/cm

The patients stopped taking isotretinoin for 3 days before and after each laser hair removal treatment to reduce the severity of retinoid dermatitis. After 131 laser hair removal treatments, the patients—all of whom were taking isotretinoin for severe acne—had moderate erythema and perifollicular edema. No patients experienced vesiculation, scarring, or permanent pigmentary changes during follow-up visits, which occurred at intervals of 4, 10, or 12 weeks, he reported.

Only one patient with Fitzpatrick type V skin developed discrete crusting, which resulted in a slight hyperpigmentation that spontaneously resolved in 3 months, after the last and most intense treatment with the highest fluence used, noted Dr. Khatri, who has no financial interest in the products used in the study.

KISSIMMEE, FLA. — Dark-skinned patients who undergo hair removal with a 1,064-nm Nd:YAG laser while taking isotretinoin do not appear to experience any long-term complications, according to a retrospective study of 11 patients.

The near-infrared wavelength of the Nd:YAG laser is absorbed less efficiently by epidermal melanin than with some other lasers, Dr. Khalil A. Khatri said in a poster presented at the annual meeting of the American Society for Laser Medicine and Surgery.

The patients in the study underwent Nd:YAG laser (Cutera CoolGlide) treatments with a pulse duration of 10–30 milliseconds, a spot size of 10 mm, and a repetition rate of 2 Hz. Laser fluence ranged from 30 to 55 J/cm

The patients stopped taking isotretinoin for 3 days before and after each laser hair removal treatment to reduce the severity of retinoid dermatitis. After 131 laser hair removal treatments, the patients—all of whom were taking isotretinoin for severe acne—had moderate erythema and perifollicular edema. No patients experienced vesiculation, scarring, or permanent pigmentary changes during follow-up visits, which occurred at intervals of 4, 10, or 12 weeks, he reported.

Only one patient with Fitzpatrick type V skin developed discrete crusting, which resulted in a slight hyperpigmentation that spontaneously resolved in 3 months, after the last and most intense treatment with the highest fluence used, noted Dr. Khatri, who has no financial interest in the products used in the study.