Marisa Pongprutthipan

Large-particle calcium hydroxylapatite injection for correction of facial wrinkles and depressions

BACKGROUND Small-particle calcium hydroxylapatite (Radiesse, Merz, Frankfurt, Germany) is safe and effective for facial wrinkle reduction, and has medium-term persistence for this indication. There is patient demand for similar fillers that may be longer lasting. OBJECTIVE We sought to assess the safety and persistence of effect in vivo associated with use of large-particle calcium hydroxylapatite (Coaptite, Merz) for facial augmentation and wrinkle reduction. METHODS This was a case series of 3 patients injected with large-particle calcium hydroxylapatite. RESULTS Large-particle calcium hydroxylapatite appears to be effective and well tolerated for correction of facial depressions, including upper mid-cheek atrophy, nasolabial creases, and HIV-associated lipoatrophy. Adverse events included erythema and edema, and transient visibility of the injection sites. Treated patients, all of whom had received small-particle calcium hydroxylapatite correction before, noted improved persistence at 6 and 15 months with the large-particle injections as compared with prior small-particle injections. LIMITATIONS This is a small case series, and there was no direct control to compare the persistence of small-particle versus large-particle correction. CONCLUSIONS For facial wrinkle correction, large-particle calcium hydroxylapatite has a safety profile comparable with that of small-particle calcium hydroxylapatite. The large-particle variant may have longer persistence that may be useful in selected clinical circumstances.

Non-ablative fractional photothermolysis in treatment of idiopathic guttate hypomelanosis.

Idiopathic guttate hypomelanosis (IGH) is a common pigmentary disorder affecting a large number of individuals. Many patients seek medical attention due to aesthetic concern. However, no standard treatment is available.

Long-pulsed 1064-nm Nd:YAG laser significantly improves keratosis pilaris: a randomized, evaluator-blind study

Abstract Background: Keratosis pilaris (KP) is a very common disorder; yet, very few treatment options are available. Objectives: To evaluate the efficacy of long-pulsed 1064-nm Nd:YAG laser for the treatment of KP. Materials and methods: Eighteen patients with untreated KP on the upper outer arms were enrolled in a randomized clinical trial. One arm was treated with long-pulsed 1064-nm Nd:YAG laser at 30 msec pulse width and fluence of 34 J/cm2, while the contralateral arm served as control. Patients received three consecutive treatments at 4-week intervals. Three blinded dermatologists assessed digital photographs using a quartile grading system to separately rate global improvement, erythema and the number of keratotic papules. Results: Seventeen patients completed the study. There were statistically significant improvements in global assessment, erythema and the number of keratotic papules at 4 weeks after the last treatment (p < 0.05). All patients also stated that their lesions improved and were satisfied with the laser treatment. Conclusion: Long-pulsed 1064-nm Nd:YAG laser has been shown to improve KP in Thai patients compared with control after three treatment sessions.

Combination of non-ablative fractional photothermolysis and 0.1% tacrolimus ointment is efficacious for treating idiopathic guttate hypomelanosis

Abstract Background: The efficacy of fractional photothermolysis and topical use of calcineurin inhibitors as treatments of idiopathic guttate hypomelanosis (IGH) have been reported. Data on combination treatments are lacking. Objectives: To evaluate the efficacy and safety of 1550-nm ytterbium/erbium fiber laser combined with 0.1% tacrolimus ointment as a treatment of IGH. Methods: In each patient with IGH, two lesions were assigned as a treatment group, whilst two lesions on another side were chosen as control. Four treatments by fractional 1550-nm ytterbium/erbium fiber laser were delivered every four weeks combined with a twice daily topical application of 0.1% tacrolimus ointment. Lesional skin color was measured by colorimeter. Digital and dermoscopic digital photographs were taken and evaluated by three dermatologists. Results: A total of 120 lesions were treated. Combination treatment normalized the relative lightness index of IGH which reached statistical significant compared with the control at week 12, after three sessions of laser treatment (p = 0.026). Physicians’ assessment score revealed that 91.67% of the lesions on treatment side showed an improvement. Swelling and redness were the most common side effects which spontaneously resolved. Conclusion: Fractional 1550-nm ytterbium/erbium fiber laser combined with topical 0.1% tacrolimus ointment was effective for IGH.

Correlation of Inflammation in Frozen Sections With Site of Nonmelanoma Skin Cancer.

IMPORTANCE During Mohs micrographic surgery of nonmelanoma skin cancer (NMSC), inflammation in histologic frozen sections has been found to occasionally presage the detection of tumors in frozen sections of adjacent excision specimens. OBJECTIVE To quantify the correlation between the location of inflammation without visible tumor in histologic frozen sections and the location of subsequently detected NMSC. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study of 3148 cases pertaining to frozen sections associated with the staged excision of NMSC was performed from September 8, 2008, to September 18, 2009, at an urban academic medical center, with the collected data analyzed on May 9, 2013. EXPOSURES Consecutive cases of Mohs micrographic surgery performed at an academic medical center. MAIN OUTCOMES AND MEASURES For each wedge-shaped tissue segment corresponding with 1 hour of time on a clock face, the proportion of patients with inflammation at the source location of the segment who subsequently had a tumor at this same location; the proportion of patients who had neither inflammation nor subsequent tumor at the source location of the segment; the probability of subsequent tumor at this location given the prior finding of inflammation at the same location; and the probability that a location was without tumor in the absence of preexisting inflammation at that location. RESULTS Of the medical records of 3148 cases of NMSC that were reviewed, 60 showed inflammation in histologic frozen sections from an excision specimen that was followed by tumor in the subsequent excision specimen. Of these 60, 39 (65%) were b asal cel carcinoma and 21 (35%) were squamous cell carcinomas; 53 (88%) were Mohs stage 1. In 7 of 12 segments, a significant positive correlation was found between the presence of inflammation and the presence of nearby tumor with correlation coefficients ranging from 0.196 to 0.384 (P < .05) . The probability that tumor was absent when inflammation was not seen at a particular location (ie, clock-face segment) in preceding sections from that location was 91%, with segment-specific probability values ranging from 82% to 96%. CONCLUSIONS AND RELEVANCE During Mohs micrographic surgery of NMSC with the examination of frozen sections, histologic inflammation is modestly predictive of adjacent tumor whereas lack of inflammation strongly predicts that no additional tumor will be found.

Subcutaneous infiltration of carbon dioxide (carboxytherapy) for abdominal fat reduction: A randomized clinical trial

Background Noninvasive fat removal is preferred because of decreased downtime and lower perceived risk. It is important to seek new noninvasive fat removal treatments that are both safe and efficacious. Objective To assess the extent to which carboxytherapy, which is the insufflation of carbon dioxide gas into subcutaneous fat, results in reduction of fat volume. Methods In this randomized, sham‐controlled, split‐body study, adults (body mass index, 22‐29 kg/m2) were randomized to receive 5 weekly infusions of 1000 cm3 of CO2 to 1 side of the abdomen, and 5 sham treatments to the contralateral side. The primary outcome measures were ultrasound measurement of fat layer thickness and total circumference before and after treatment. Results A total of 16 participants completed the study. Ultrasound measurement indicated less fat volume on the side treated with carboxytherapy 1 week after the last treatment (P = .011), but the lower fat volume was not maintained at 28 weeks. Total circumference decreased nominally but not significantly at week 5 compared with baseline (P = .0697). Participant body weights did not change over the entire course of the study (P = 1.00). Limitations Limitations included modest sample size and some sources of error in the measurement of circumference and fat layer. Conclusion Carboxytherapy provides a transient decrease in subcutaneous fat that may not persist. Treatment is well tolerated.

Sun protection behavior and knowledge of patients attending laser clinic to prevent adverse events of laser: A cross-sectional, single-center, tertiary care study

Limited data of sun protection knowledge in laser treatment patients exists therefore, preventative information should be provided by dermatologists to minimize harmful effects.

Endovenous Laser and Radiofrequency Treatment of Leg Veins

Superficial varicosity is a common medical condition that is symptomatic in 20-30% of the US population. Classic symptoms of venous insufficiency are ankle edema, leg fatigue, aching, discomfort, and muscle cramps. Some patients develop associated complications, including stasis dermatitis, lipodermatosclerosis, skin atrophy, superficial thrombophlebitis, and venous ulcers. The treatment of varicose veins reduces symptoms and complications of chronic venous insufficiency and improves quality of life. Superficial varicose veins are often due to failure of the valves in the saphenous vein and at the saphenofemoral junction (SFJ), causing venous reflux. Until recently, traditional ligation and stripping has been the standard of care in the treatment of truncal varicosities. But there are some disadvantages, including a 20% recurrence rate in 5 years, requirement of 2-6 weeks of downtime, associated risks of general anesthesia, scars, and possible neurovascular and lymphatic vessel damage. As an alternative, there are currently available endovenous treatment options for superficial varicose veins: ultrasound guided foam sclerotherapy, endovenous radiofrequency, and endovenous laser treatment. These are minimally invasive in-office procedures with less pain, early ambulation, and less recovery time. In this chapter, we review techniques for endovenous laser and endovenous radiofrequency treatments.