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Intralesional Treatment for Keloids and Hypertrophic Scars: A Review

BACKGROUND Although differing in clinical presentation and prognosis, keloids and hypertrophic scars are generally characterized by abnormally proliferative scar tissue and are extremely debilitating. Several intralesional therapies have been studied in attempts to find a universally safe and effective modality, of which there are currently none. OBJECTIVE To provide a comprehensive review of current intralesional treatment modalities for keloids and hypertrophic scars. METHODS AND MATERIALS A PubMed search was performed for literature pertaining to intralesional treatment modalities for keloids and hypertrophic scars. References from retrieved articles were also considered for review. RESULTS AND CONCLUSION Many intralesional therapies for keloids and hypertrophic scars are currently available to physicians and patients. Mechanisms of action and side effect profiles vary between these agents, and new approaches to keloids and hypertrophic scars are frequently being explored. Randomized controlled trials are needed to assess these new and promising modalities fully.

Inflammatory Nodules Following Soft Tissue Filler Use: A Review of Causative Agents, Pathology and Treatment Options

Nodule development is a common complication following the use of fillers for soft tissue augmentation and is commonly categorized as inflammatory or non-inflammatory in nature. Inflammatory nodules may appear anywhere from days to years after treatment, whereas non-inflammatory nodules are typically seen immediately following implantation and are usually secondary to improper placement of the filler. Although inflammatory nodules are more common with permanent fillers such as silicone, inflammatory nodule development following administration of temporary fillers such as hyaluronic acid and collagen has also been reported. Treated many times with corticosteroids due to their anti-inflammatory properties, inflammatory nodules may be secondary to infection or biofilm formation, warranting the use of alternative agents. Appropriate and prompt diagnosis is important in avoiding delay of treatment or long-term complications for the patient. This paper addresses the etiology, development, and studied treatment options available for inflammatory nodules secondary to each of the major classes of fillers. With this knowledge, practitioners may expeditiously recognize and manage this common side effect and thus maximize functional and aesthetic benefit.

Laser and light therapy for onychomycosis: a systematic review.

More than just a cosmetic concern, onychomycosis is a prevalent and extremely difficult condition to treat. In older and diabetic populations, severe onychomycosis may possibly serve as a nidus for infection, and other more serious complications may ensue. Many treatment modalities for the treatment of onychomycosis have been studied, including topical lacquers and ointments, oral antifungals, surgical and chemical nail avulsion, and lasers. Due to their minimally invasive nature and potential to restore clear nail growth with relatively few sessions, lasers have become a popular option in the treatment of onychomycosis for both physicians and patients. Laser or light systems that have been investigated for this indication include the carbon dioxide, neodymium-doped yttrium aluminum garnet, 870/930-nm combination, and femtosecond infrared 800-nm lasers, in addition to photodynamic and ultraviolet light therapy. This systematic review will discuss each of these modalities as well as their respective currently published, peer-reviewed literature.

Pulsed dye laser-resistant port-wine stains: mechanisms of resistance and implications for treatment.

Port‐wine stains (PWS) are among the most common congenital vascular malformations. Unlike capillary haemangiomas, these lesions do not involute spontaneously but rather become progressively more disfiguring as the patient ages. While benign in nature, the cosmetic deformity and attendant psychological and emotional distress prompt the majority of those afflicted to seek treatment. The pulsed dye laser (PDL) has long been considered the treatment of choice for these vascular lesions; however, very few patients achieve total clearance with PDL therapy and a significant number of lesions fail to respond at all. In order to address these recalcitrant cases, the mechanisms that contribute to treatment resistance must be understood and novel laser and light therapies must be employed. This review will address what is currently known about lesion‐specific characteristics of PDL‐resistant PWS as well as discuss current and future treatment options.

Carbon dioxide laser for the treatment of microcystic lymphatic malformations (lymphangioma circumscriptum): a systematic review.

Background Lymphangioma circumscriptum (LC) is a rare, superficial, cutaneous lymphatic malformation. Management is difficult because of high recurrence rates, regardless of the treatment modality chosen. The carbon dioxide (CO2) laser may offer a less‐invasive option than surgery that provides satisfactory functional and cosmetic results. Objectives To systematically review the efficacy and safety of the CO2 laser for the treatment of LC. Methods The terms “lymphangioma circumscriptum” and “microcystic lymphatic malformation” were combined with “treatment,” “laser,” and “carbon dioxide” during separate searches in the PubMed database. The articles retrieved were then evaluated based on set criteria. Results We identified 16 studies (11 case reports, 5 case series) with a total of 28 separate patients who had been treated for LC using a CO2 laser. Eight patients remained disease free from 4 months to 3 years, 10 experienced partial recurrence, and two experienced complete recurrence. Various laser parameters were reported, and adverse effects were generally minor and infrequent, such as dyspigmentation and mild scarring. Conclusions Available evidence indicates that the CO2 laser is a safe and efficacious option for the treatment of LC, particularly in large lesions that may not be amenable to surgical intervention.

Lasers and lights for the treatment of striae distensae

Striae distensae (SD) or “stretch marks” are a common and well-recognized dermatologic entity affecting patients of all ages, genders, and ethnicities. The treatment of SD has long been plagued by disappointing outcomes and remains a frustrating entity for both physicians and patients. While striae may become less conspicuous over time, they rarely resolve without intervention. Inspired by the success of lasers for the treatment of scars and rhytides, these devices have been applied to the treatment of SD in the hopes of achieving similar efficacy.

Pyschodermatology: a trip through history

The interaction between the mind and diseases of the skin has been the study focus for many researchers worldwide. The field of Psychodermatology, or Psychocutaneous Medicine, is the result of the merging of two major medical specialties, psychiatry and dermatology. Although the history of Psychodermatology is rather old and interesting, the field has only recently gained popularity. Since ancient times, philosophers, surgeons, dermatologists and psychiatrists have reported the presence of psychocutaneous diseases in various scenarios. In this article, the authors describe curious and remarkable facts in the history of Psychodermatology.

From flint razors to lasers: a timeline of hair removal methods.

Today, most do not go a day without practicing or hearing about new hair removal methods. However, little is discussed about the history of hair removal and the development of most hair removal methods since the period of cavemen. Avoiding decapitation and fitting in with society are two of many reasons for the development of this now normative practice. Knowledge of the hair growth cycle is vital in understanding the efficacy of various hair removal methods as well as the difference between epilation and depilation. While laser hair removal (LHR) is one of the most common cosmetic procedures practiced in the world, according to the FDA, the only current permanent form of hair removal is electrolysis. These two methods as well as various other ones are discussed in this article. Further developments are being made every day to better treat the removal of blonde and white hair as well as to diminish the pain of hair removal. With these developments, dermatologists will better understand the advancement of hair removal methods and the reasons why patients may seek treatment.

Psychoneurocutaneous medicine: past, present and future

SummaryPsychoneurocutaneous medicine is an important and rapidly growing field. It is an integrative science created to address the interaction between the mind, nervous system and skin. Four major fields are involved: psychiatry, psychology, neurology and dermatology. The history of psychoneurocutaneous medicine is old and fascinating. Even though it is a young science only established in the last century, allusions to the nervous system and diseases of the skin can be traced back thousands of years in the literature. Characteristically, the last two centuries were of special importance for the development of this field in Europe, lately in America, with great effort placed on research and publications. More recently, the creation of associations, work groups and the merging of subspecialties dedicated exclusively to study the psychological impact of skin disorders in subpopulations of patients have helped to give momentum to psychoneurocutaneous medicine. Further development of this field will shed light on the appropriate diagnosis and treatment of psychodermatologic disorders, enhancing the functionality and quality of life of patients. This paper presents a summary of the most influential facts in the history of psychoneurocutaneous medicine, its present and future perspectives.

The history of Botulinum toxin: from poison to beauty

SummaryBotulinum toxin, also called the “miracle toxin,” is a neurotoxin produced by the bacteria Clostridium botulinum. It is known to block nerve signals that contract muscles resulting in a temporary paralysis of the muscles. Toxins type A and B have been extensively studied and utilized in the realm of beauty and cosmetology. Initially, the toxin gained popularity as a disease-causing “poison”. It was only later that it found its way to becoming a must have in modern aesthetic practice. Today, this wonder toxin has proven to be an apt and convenient option in the field of anti-aging medicine.