Arisa E. Ortiz

Evaluation of a novel fractional resurfacing device for treatment of acne scarring

Pulsed carbon dioxide (CO2) laser devices are considered highly effective treatment options for skin resurfacing. However, the high risk for significant treatment complications following CO2 resurfacing has warranted the development of new treatment modalities. The concept of fractional photothermolysis was developed to address the shortcomings of ablative and non‐ablative device modalities. This report evaluates a fractional approach to CO2 laser resurfacing for the treatment of moderate to severe acne scarring. The primary endpoint of the study was the overall improvement in the appearance of acne scarring.

Long-term efficacy of a fractional resurfacing device†‡§

Recently, there has been much debate regarding the long‐term efficacy of fractional resurfacing devices. While pulsed CO2 laser resurfacing is considered a highly effective treatment, fractionated resurfacing is a newer modality and its long‐term efficacy has yet to be assessed. We report the long‐term outcomes of subjects previously treated with fractional CO2 resurfacing for photodamaged skin and acne scars.

Smoking and the skin

Cigarette smoking has been associated with significant morbidity affecting all systems of the body, including the integumentary system. We review the many dermatologic hazards of tobacco use. It is important to distinguish between the effects of tobacco smoke from effects of pure nicotine on the skin. All skin cells express several subtypes of the nicotinic class of acetylcholine receptors, including the α7 receptor. Many chronic dermatoses are affected by smoking either negatively or positively. Elucidation of positive associations with a particular disease can lead to improvement from smoking cessation, whereas inverse correlation may lead to development of a disease‐specific treatment with nicotinergic agonists.

Rising Concern over Cosmetic Tattoos

Background A rise in popularity of cosmetic tattoos has led to an increase in adverse reactions. Due to more pressing concerns, the Food and Drug Administration (FDA) has not traditionally enforced its authority over tattoo inks. Objective To raise awareness of the dangers of cosmetic tattoos. Materials and Methods We reviewed FDA policies regarding tattoo ink, different ink components, adverse reactions, and various treatment options for cosmetic tattoo removal. Results and Conclusion An increase in consumer complaints has prompted FDA investigation into tattoo inks and their safety. It is important that further complications be reported to the FDA to promote regulation of cosmetic tattoo inks.

Incidence of and Risk Factors for Skin Cancer in Organ Transplant Recipients in the United States

Importance Skin cancer is the most common malignancy occurring after organ transplantation. Although previous research has reported an increased risk of skin cancer in solid organ transplant recipients (OTRs), no study has estimated the posttransplant population–based incidence in the United States. Objective To determine the incidence and evaluate the risk factors for posttransplant skin cancer, including squamous cell carcinoma (SCC), melanoma (MM), and Merkel cell carcinoma (MCC) in a cohort of US OTRs receiving a primary organ transplant in 2003 or 2008. Design, Setting, and Participants This multicenter retrospective cohort study examined 10 649 adult recipients of a primary transplant performed at 26 centers across the United States in the Transplant Skin Cancer Network during 1 of 2 calendar years (either 2003 or 2008) identified through the Organ Procurement and Transplantation Network (OPTN) database. Recipients of all organs except intestine were included, and the follow-up periods were 5 and 10 years. Main Outcomes and Measures Incident skin cancer was determined through detailed medical record review. Data on predictors were obtained from the OPTN database. The incidence rates for posttransplant skin cancer overall and for SCC, MM, and MCC were calculated per 100 000 person-years. Potential risk factors for posttransplant skin cancer were tested using multivariate Cox regression analysis to yield adjusted hazard ratios (HR). Results Overall, 10 649 organ transplant recipients (mean [SD] age, 51 [12] years; 3873 women [36%] and 6776 men [64%]) contributed 59 923 years of follow-up. The incidence rates for posttransplant skin cancer was 1437 per 100 000 person-years. Specific subtype rates for SCC, MM, and MCC were 812, 75, and 2 per 100 000 person-years, respectively. Statistically significant risk factors for posttransplant skin cancer included pretransplant skin cancer (HR, 4.69; 95% CI, 3.26-6.73), male sex (HR, 1.56; 95% CI, 1.34-1.81), white race (HR, 9.04; 95% CI, 6.20-13.18), age at transplant 50 years or older (HR, 2.77; 95% CI, 2.20-3.48), and being transplanted in 2008 vs 2003 (HR, 1.53; 95% CI, 1.22-1.94). Conclusions and Relevance Posttransplant skin cancer is common, with elevated risk imparted by increased age, white race, male sex, and thoracic organ transplantation. A temporal cohort effect was present. Understanding the risk factors and trends in posttransplant skin cancer is fundamental to targeted screening and prevention in this population.

Ablative CO2 lasers for skin tightening: traditional versus fractional.

BACKGROUND With patients more resistant to invasive treatments and those that result in significant downtime, there has been a rise in using lasers to improve skin laxity and induce tissue tightening as an alternative to surgery. Traditional and fractional ablative resurfacing induces skin tightening through precise dermal heating and a wound-healing effect. OBJECTIVE The purpose of this review was to discuss the mechanism of action of using ablative lasers to induce skin tightening and compare traditional versus fractional technologies. MATERIALS AND METHODS A review of the literature was performed. RESULTS The authors discuss traditional and fractional ablative lasers for achieving skin tightening. CONCLUSION Neocollagenesis and dermal remodeling seen after ablative resurfacing contributes to the clinical improvement seen in tissue tightening. Fractional photothermolysis may enhance tissue tightening effects of ablative lasers because of its ability to ablate deeper into the reticular dermis without significant risk for scarring.

A 1,320-nm Nd:YAG Laser for Improving the Appearance of Onychomycosis

BACKGROUND Onychomycosis is a therapeutic challenge because of the toxicities of systemic medications. This has led to the investigation of light-based technologies for safe and effective alternative treatment modalities. OBJECTIVE The purpose of this study was to determine the safety and efficacy of 4 treatments with a 1,320-nm neodymium:yttrium aluminum garnet (Nd:YAG) laser in improving the appearance of onychomycosis. MATERIALS AND METHODS This study was a 24-week, single-center randomized placebo-controlled study. Ten subjects were enrolled with culture-proven, bilateral great toenail onychomycosis. The subjects received 4 treatments with the 1,320-nm Nd:YAG laser to the treatment toenail on Days 1, 7, 14, and 60. The control toenail received a sham treatment of cryogen cooling only. Mycologic cultures were obtained at 3-month follow-up visits. RESULTS Fifty percent of mycologic cultures were negative at the 3-month follow-up after 4 laser treatments. Toenails had improvement in subungual debris, hypertrophy, and yellowing. Patient satisfaction was upheld as assessed by the Nail Quality of Life Questionnaire. CONCLUSION The 1,320-nm Nd:YAG laser may be a safe and effective therapy for improving the appearance of onychomycosis. Additional therapy may be necessary to enhance long-term results. Further investigation needs to explore the optimal treatment settings and the most effective treatment schedule.

Rapidly growing squamous cell carcinoma from permanent makeup tattoo

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A randomized, controlled, double-blind study of light emitting diode photomodulation for the prevention of radiation dermatitis in patients with breast cancer

BACKGROUND AND OBJECTIVES Radiation dermatitis occurs in a majority of patients with breast cancer who receive radiation therapy (RT), causes significant pain, and may necessitate treatment delay. Light emitting diode (LED) photomodulation has been reported to minimize radiation dermatitis. This study sought to further evaluate the efficacy of LED photomodulation in lessening radiation dermatitis. MATERIALS & METHODS After surgery, patients with breast cancer received LED photomodulation or sham treatments in conjunction with three‐dimensional conformal RT. Reactions were evaluated using standardized photographs graded according to National Cancer Institute criteria. RESULTS In the LED treatment group (n=18), no patients had grade 0 reactions, six (33.3%) had grade 1 reactions, 12 (66.7%) had grade 2 reactions, and none had a grade 3 reaction. In the sham treatment group (n=15), one (6.6%) patient had a grade 0 reaction, four (26.7%) had grade 1 reactions, 9 (60.0%) had grade 2 reactions, and one (6.7%) had a grade 3 reaction. Two (11.1%) patients in the LED treatment group and one (6.7%) in the control group had to interrupt treatment. Differences between groups were not statistically significant. CONCLUSION LED photomodulation did not reduce the incidence of radiation‐induced skin reactions or interruptions in therapy. &NA; Funding was provided for this study through the Cutting Edge Research Grant, sponsored by the American Society for Dermatologic Surgery. The GentleWaves LED Select units were loaned for this study by Light BioScience

Evaluation of a long pulsed 1064-nm Nd:YAG laser for improvement in appearance of cellulite

Abstract Background: Cellulite is a common, unwanted condition, which is challenging to treat. Objectives: The objective of this investigation was to evaluate safety and effectiveness of a long-pulsed 1064 Nd:YAG laser as a method for improvement in cellulite appearance and to evaluate parameter selection. Materials and methods: Twenty-two female subjects with posterior leg cellulite were randomly assigned to treatment of left or right thigh with higher energy treatment with cryogen spray cooling (CSC) (10-mm spot size; 50 J/cm2; 50-ms pulse duration and CSC settings of 30-ms duration with a 20-ms delay) or lower energy treatment with no CSC (10 mm; 20 J/cm2; 50 ms). Subjects received three treatments at 4 weeks intervals. Digital photographs and circumference measurements were taken pre-treatment and up to 6 months post-treatment. Results: Nineteen subjects completed three treatments and 16 subjects completed 6-month follow-up. Circumference measurements pre- and post-treatment were not significantly different. Blinded evaluators noted mild improvement in three of seven subjects in high energy group and moderate improvement in two of nine subjects in low energy group. Conclusion: Multiple passes with a long-pulsed 1064 Nd:YAG achieved mild or moderate improvement in some subjects as rated by blinded evaluators.