Alexander L. Berlin

Histologic and ultrastructural analysis of melasma after fractional resurfacing.

Fractional photothermolysis is a popular treatment option for photodamaged skin and other cutaneous conditions. Recently, successful improvement in melasma has been achieved with this laser system. We undertook this study to evaluate the ultrastructural changes associated with fractional laser treatment of melasma.

A Prospective Study of Fractional Scanned Nonsequential Carbon Dioxide Laser Resurfacing: A Clinical and Histopathologic Evaluation

BACKGROUND Although unparalleled in its efficacy, carbon dioxide (CO2) laser resurfacing has a high risk:benefit ratio. A modified device uses a novel handpiece and software to deliver nonsequential fractional ablative CO2 laser exposures. OBJECTIVE To evaluate the safety and efficacy of this fractional ablative, scanned, nonsequential CO2 laser in the treatment of photo‐damaged skin and to evaluate histologic and ultrastructural changes after the treatment. MATERIALS AND METHODS Ten subjects with Fitzpatrick skin types I to III with photo‐damaged facial skin underwent a single CO2 ablative laser treatment using a scanning handpiece in a nonsequential fractional mode. Clinical improvement and histologic and ultrastructrural changes were assessed. RESULTS All subjects completed the study with no serious or long‐term complications. Blinded evaluator and subject assessment documented improvement in cutaneous photoaging. Light microscopy revealed changes consistent with a wound repair mechanism, and electron microscopy confirmed evidence of new collagen deposition. CONCLUSION Nonsequential scanned fractional CO2 laser resurfacing can lead to improvement in photo‐damaged skin, accompanied by histologic and ultrastructural evidence of wound repair and subsequent new collagen formation. The study was supported in part by a grant from Lumenis Inc.

Calcium Hydroxylapatite Filler for Facial Rejuvenation: A Histologic and Immunohistochemical Analysis

BACKGROUND Soft-tissue augmentation using calcium hydroxylapatite (CaHA) filler has been shown to be a safe and effective filler agent. A previous study utilizing electron microscopy demonstrated deposition of collagen around filler microspheres with minimal inflammatory response. OBJECTIVE The purpose of this study was to further characterize the expression of collagen in response to injected CaHA filler material using conventional, special, and immunohistochemical (IHC) staining. MATERIALS AND METHODS Five subjects with mild to moderate nasolabial rhytids underwent a single treatment with CaHA filler. Additionally, 0.1 to 0.2 mL of the filler material was injected subdermally into the postauricular area. Six months following the treatment, all subjects underwent biopsy of the treated postauricular area. Biopsies were analyzed using hematoxylin and eosin staining, special staining with picrosirius red (PSR), and IHC staining for collagen Types I and III. RESULTS All subjects completed the study with no complications. Biopsy specimens revealed increased deposition of collagen around the filler material, which was confirmed and further characterized using PSR and IHC staining. CONCLUSION Soft tissue augmentation with CaHA filler leads to long-term deposition of new collagen surrounding filler microspheres, which may contribute to the overall improvement in the appearance of treated rhytids.

Hiccups, eructation, and other uncommon prodromal manifestations of herpes zoster ☆

Although the most frequent presentation of herpes zoster involves sensory neurons, motor and autonomic symptomatology is also known to occur in this disease. An unusual symptom of hiccups is described here. Other infrequent manifestations of this common illness, including the Ramsay Hunt syndrome, herpes zoster ophthalmicus, urinary and fecal retention, sexual dysfunction, and zoster sine herpete, are reviewed. Greater awareness of unusual presentations of herpes zoster is necessary for proper diagnosis and timely management of complications that may otherwise lead to disability and serious long-term sequelae.

Evaluation of clinical, microscopic, and ultrastructural changes after treatment with a novel Q‐switched Nd:YAG laser

Background: The Q‐switched Nd:YAG laser was among the first non‐ablative lasers to be used. High‐fluence photoacoustic Q‐switched laser treatments were shown to produce results akin to those seen with some ablative lasers. Previous low‐fluence, non‐thermal, Q‐switched Nd:YAG lasers produced almost no results. Objective: The purpose of this study was to evaluate a new combined photoacoustic/photothermal low‐fluence Q‐switched Nd:YAG laser in the treatment of facial photodamage. Methods: Ten individuals with photodamaged facial skin were enrolled in the study. Participants underwent six bi‐weekly full‐face treatments using a Q‐switched Nd:YAG laser (RevLite, HOYA ConBio, Freemont, CA, USA) at 1064 nm, with an 8‐mm spot size and fluence of 3.2 J/cm2. Clinical improvement was evaluated through blinded investigator assessment of photographs obtained before and 3 months after the last treatment. Pre‐auricular biopsies, performed before and 3 months following the last treatment, were processed for light and electron microscopy and analyzed for evidence of treatment‐related changes. Results: Eight individuals completed the study with no serious or long‐term complications. Blinded evaluator assessment documented improvement in a variety of different aspects of photodamaged skin. Biopsy specimens revealed changes consistent with wound repair under light microscopy, while electron microscopy confirmed new collagen deposition. Conclusion: A novel combined photoacoustic/photothermal Q‐switched Nd:YAG laser can be used for non‐ablative photorejuvenation. In addition to clinical improvement, histological and ultrastructural changes consistent with new collagen deposition were noted.

Cutaneous photoaging treated with a combined 595/1064 nm laser

Background and objectives: The pulsed dye laser (PDL) has been used for a variety of vascular changes associated with photoaging. The Nd:YAG laser has been shown to be effective in the treatment of deeper facial vessels, as well as to stimulate new dermal collagen deposition. This study was undertaken to evaluate the safety and efficacy of sequential dual‐wavelength PDL and Nd:YAG laser treatment of photoaged facial skin. Methods: Fifteen individuals, between the ages of 38 and 66 years old, with various stigmata of facial photoaging, were entered into the study. Five sequential combined PDL/Nd:YAG (Cynergy, Cynosure Inc., Westford, MA, USA) treatments were performed using a 10‐mm handpiece at monthly intervals. PDL parameters included a 10‐ms pulse duration and a fluence set at 1 J/cm2 below the purpura threshold. Nd:YAG parameters were set at a 50‐ms pulse duration with fluences varying between 35 and 50 J/cm2, depending on patient comfort. Improvement was determined by evaluation of photographs taken before the first treatment and at 1 and 3 months following the last treatment, as well as the individuals self‐assessment. Results: Individuals tolerated treatments well with no serious, long‐term, or permanent adverse effects. Improvement was most pronounced in telangiectasias and diffuse erythema, followed by epidermal dyspigmentation and lentigines. Some individuals were also noted to have improved smoothness, radiance, or pore size. The improvement was generally maintained at the 3‐month follow‐up. In addition, the average self‐reported improvement was 1.7 (on a 0–4 scale) at 1 month and 2.4 at 3 months following the last treatment. Conclusion: A novel combined sequential PDL/Nd:YAG laser can be used to treat a variety of cutaneous changes associated with photoaging. Further studies may determine the relative impact of each laser and whether the total effect is simply additive or synergistic.