Andrei I. Metelitsa

Future directions in cutaneous laser surgery.

This article presents an overview of future trends in cutaneous laser therapy and technology. To enhance efficacy and specificity of treatment, new wavelengths directed at both old and new targets are on the horizon. New applications, including the use of lasers to aid in the detection of skin cancers and to enhance drug delivery, are being used and investigated. A trend toward combining different lasers and light sources to optimize results continues. Advancements in at-home devices have been made. Future applications will include waveforms beyond those in the visible light and infrared spectrum, such as microwaves, ultrasound waves, and radiofrequency.

Home-Use Laser and Light Devices for the Skin—An Update

Over the past several years, a number of home-use laser and light skin devices have been introduced for various indications, including photorejuvenation, hair growth, hair removal and acne treatment. Although these devices allow for privacy and a significant cost advantage, they are typically underpowered and afford lower efficacy than their in-office counterparts. A number of these devices have recently received FDA clearance. Although large clinical trials are lacking, dermatologists should familiarize themselves with the various options to help patients assess their clinical value.

Picosecond lasers: the next generation of short-pulsed lasers

Selective photothermolysis, first discussed in the context of targeted microsurgery in 1983, proposed that the optimal parameters for specific thermal damage rely critically on the duration over which energy is delivered to the tissue. At that time, nonspecific thermal damage had been an intrinsic limitation of all commercially available lasers, despite efforts to mitigate this by a variety of compensatory cooling mechanisms. Fifteen years later, experimental picosecond lasers were first reported in the dermatological literature to demonstrate greater efficacy over their nanosecond predecessors in the context of targeted destruction of tattoo ink. Within the last 4 years, more than a decade after those experiments, the first commercially available cutaneous picosecond laser unit became available (Cynosure, Westford, Massachusetts), and several pilot studies have demonstrated its utility in tattoo removal. An experimental picosecond infrared laser has also recently demonstrated a nonthermal tissue ablative capability in soft tissue, bone, and dentin. In this article, we review the published data pertaining to dermatology on picosecond lasers from their initial reports to the present as well as discuss forthcoming technology.

Epidemiology of dermatofibrosarcoma protuberans in Alberta, Canada, from 1988 to 2007.

BACKGROUND There have only been a few population‐based, epidemiologic studies assessing dermatofibrosarcoma protuberans (DFSP). OBJECTIVE To assess the epidemiology of DFSP in Alberta, Canada, over a 20‐year period. METHODS A population‐based, retrospective analysis of all cases of DFSP in Alberta was conducted using data from the Alberta Cancer Registry. Sex‐, age‐, and anatomical location–specific incidence rates and trends were determined. RESULTS The overall age‐standardized incidence rate of DFSP remained stable at 0.93 per 100,000. DFSP prevalence was highest in individuals aged 20 to 39 (46.8%), followed by those aged 40 to 59 (34.0%), 60 and older (14.7%), and lastly younger than 20 (4.5%). The mean age at diagnosis was 41.1 (women) and 43.1 (men). The incidence of DFSP in men and women has shown a dramatic shift such that incidence in women has increased 3.2% per year, whereas in men it has decreased 2.7% per year. In women, DFSP incidence increased on the trunk and decreased on the upper extremities. CONCLUSION The age‐standardized incidence of DFSP observed is nearly twice as high as previously reported and has remained stable. The incidence is increasing in women and decreasing in men. DFSP primarily affects young to middle‐aged adults and most commonly presents on the trunk.

Therapeutic approaches to cellulite.

Cellulite is a condition that affects the vast majority of women. Although it is of no danger to ones overall health, cellulite can be psychosocially debilitating. Consequently, much research has been devoted to understanding cellulite and its etiopathogenesis. With additional insights into the underlying causes of its clinical presentation, therapeutic modalities have been developed that offer hope to cellulite sufferers. This review examines evidence for topical treatments, noninvasive energy-based devices, and recently developed minimally invasive interventions that may finally provide a solution.

Commentary: Are All Fractional Resurfacing Devices Equal with Regard to Induction of Fibrosis?

In the era of fractional resurfacing, new lasers have been developed using nonablative and ablative technology. Many clinical indications including scars and photoaging can be approached using either modality. Some might argue that a series of treatment sessions using a nonablative fractional device yield similar results to a single ablative procedure, whereas others prefer fractional ablation. Given that fractional ablation entails epidermal and dermal vaporization in addition to coagulation, differences in wound healing between the two types of procedures are not unexpected.

Commentary: Can 1927-nm Thulium Fractional Laser Treatment Truly Remove Seborrheic Keratoses?

Classic seborrheic keratoses (SKs) are well-recognized benign lesions that are typically treated to address patients’ cosmetic concerns. In their pilot clinical study, Polder and colleagues investigated the use of a 1927-nm thulium fiber laser in the clearance of macular SKs. Evaluation of six recruited patients who underwent 3 monthly laser sessions revealed >50% reduction in overall global SKs 1 month after treatment, with even more-pronounced improvement at 6-month follow-up.