Adam J. Wulkan

Treatment of Hypertrophic Scars Using Laser and Laser Assisted Corticosteroid Delivery

Hypertrophic scars and contractures are common following various types of trauma and procedures despite skilled surgical and wound care. Following ample time for healing and scar maturation, many millions of patients are burdened with persistent symptoms and functional impairments. Cutaneous scars can be complex and thus the approach to therapy is often multimodal. Intralesional corticosteroids have long been a staple in the treatment of hypertrophic and restrictive scars. Recent advances in laser technology and applications now provide additional options for improvements in function, symptoms, and cosmesis. Fractional ablative lasers create zones of ablation at variable depths of the skin with the subsequent induction of a wound healing and collagen remodeling response. Recent reports suggest these ablative zones may also be used in the immediate post‐operative period to enhance delivery of drugs and other substances. We present a case series evaluating the efficacy of a novel combination therapy that incorporates the use of an ablative fractional laser with topically applied triamcinolone acetonide suspension in the immediate post‐operative period.

Treatment of Burn Scars With the 1,550 nm Nonablative Fractional Erbium Laser

Scarring is a major source of morbidity in patients with burns. Burn scars are difficult to treat and are among the worst scars seen in clinical medicine. Fractional laser resurfacing is a promising treatment option because of its unique wound healing response and depth of penetration.

Pediatric nail conditions

Pediatric nail findings are plentiful and can range from benign processes to the initial signs of a systemic condition. The examination of the nail is an essential part of the pediatric physical examination. The nail unit consists of the nail plate, the nail matrix, the hyponychium, the nail bed, and the surrounding nail folds. Conditions that affect the nail unit have a variety of etiologies; these include inflammatory, congenital, and hereditary conditions as well as tumors and trauma. This review describes many of the nail conditions that are seen in the pediatric population.

Microfocused Ultrasound for Facial Photorejuvenation: A Review.

Microfocused ultrasound is a unique technology to treat skin laxity of the brow, lower face, and the rhytides of the décolletage. Over the past several years, the efficacy and safety of this device has been well documented and its adoption widespread. By delivering focused acoustic energy, which is converted to heat, this device creates predictable and reproducible microcoagulative zones that initiate a concentrated inflammatory wound response. By targeting the deep reticular dermis and superficial muscle and fascial planes, such as the superficial musculoaponeurotic system, platysma, and pectoralis muscle fascia, this nonablative technology increases neocollagenesis and neoelastogenesis in a novel fashion, while avoiding many of the complications related to epidermal heating observed in several other nonablative devices. Although the results are not equivalent to those of a rhytidectomy, microfocused ultrasound provides an excellent noninvasive means to achieve a regenerative effect on the face, neck, and décolletage when performed in the appropriate patient population.

Successful Treatment of Becker's Nevus With Long-Pulsed 1064nm Nd:YAG and 755nm Alexandrite Laser and Review of the Literature.

ABSTRACT Background: Becker’s Nevus is an aesthetically troublesome condition secondary to hyperpigmentation and hypertrichosis. Although several lasers have been employed with varying degrees of success, the exact devices and treatment parameters have yet to be elucidated. Objective: To assess the combination Nd:YAG and alexandrite laser as a safe and efficacious treatment for Becker’s Nevus. Methods: In a 20-year-old Fitzpatrick Skin Type IV male, a Becker’s Nevus was treated with six sessions of long-pulsed 1064 nm Nd:YAG laser at six-week intervals followed by five sessions of long-pulsed 755 nm alexandrite laser at three-month intervals. Results: This patient experienced a significant reduction in both hyperpigmentation and hypertrichosis after these treatment sessions. No serious adverse events were reported. Conclusion: This case supports the use of combination long-pulsed 1064 nm laser and 755 nm laser as a safe and efficacious treatment for Becker’s Nevus.

Nodular Cutaneous Amyloidoma of the Extremity Secondary to Chronic Granulomatous Inflammation in Setting of Sarcoidosis

Soft tissue amyloidoma is a rare condition that presents primarily in the abdomen and/or mediastinum and more uncommonly on the extremities. Soft tissue amyloidomas on the extremities have been associated with chronic inflammation, particularly when accompanied by AA‐type amyloid deposition as seen in local trauma, surgery, hypertension and diabetes. To our knowledge, this is the first reported case of nodular cutaneous amyloidoma in the setting of systemic and cutaneous sarcoidosis. A 65‐year‐old woman presented with an asymptomatic subcutaneous nodule above her left lateral malleolus. Histopathology of the lesion showed an inconspicuous epidermis with amorphous eosinophilic material deposited in masses within the entire dermis. Congo red and crystal violet stains were positive. Based on the clinical and pathologic findings she was diagnosed with nodular cutaneous amyloidoma. We hypothesize that this process developed secondary to the chronic granulomatous inflammation of sarcoidosis.

Nail Alterations in Cutaneous T-Cell Lymphoma: A Case Series and Review of Nail Manifestations.

Background: Cutaneous T-cell lymphoma (CTCL) encompasses a broad range of lymphoproliferative diseases affecting the skin and can be clinically misleading due to its variable presentation. Nail alterations commonly appear in advanced-stage mycosis fungoides and true Sézary syndrome; however, they may be present in any stage of the disease. Although proper recognition of nail involvement in CTCL has both clinical and therapeutic value, specific nail findings have been infrequently described in the current literature. Observations: We describe 4 patients with CTCL who presented with clinically significant nail alterations. The most common findings were nail discoloration, thickening, crumbling, onycholysis, and onychomadesis. Other notable findings included splinter hemorrhages, subungual hyperkeratosis, and anonychia. Conclusions and Message: The described cases illustrate many of the documented nail findings associated with CTCL and emphasize the variable nature of nail manifestations. The presence of specific nail alterations should increase the clinical suspicion of CTCL - especially in patients with concomitant systemic and/or cutaneous manifestations - and early biopsy specimens should be taken for diagnosis. Nail alterations should also be accurately described and monitored in all patients with biopsy-confirmed CTCL to help identify treatment response and detect disease recurrence.