Min Kyung Shin

Intense focused ultrasound tightening in Asian skin: clinical and pathologic results.

BACKGROUND Laxity and wrinkles of the aging face are common cosmetic concerns. Intense focused ultrasound (IFUS), a novel treatment modality for skin laxity, produces thermal effects at various depths while sparing overlying epidermis. OBJECTIVE To evaluate the safety and efficacy of IFUS in facial skin tightening. METHODS AND MATERIALS Twenty‐two Korean patients with facial laxity were analyzed after a single IFUS treatment. Patient assessments were recorded, and two blinded, experienced clinicians who assessed improvement of nasolabial folds and jaw tightening evaluated photographs of patients and rated skin laxity. Skin biopsies were taken from 11 patients before and 2 months after treatment. RESULTS Objectively, nasolabial folds and jaw lines were improved in all patients. Subjectively, 77% of patients reported much improvement of nasolabial folds, and 73% of patients reported much improvement at the jaw line. Histologic evaluation of skin biopsy samples using hematoxylin and eosin and Victoria blue stains showed greater dermal collagen with thickening of the dermis and straightening of elastic fibers in the reticular dermis after treatment. CONCLUSION IFUS is a safe, effective, noninvasive procedure to tighten the facial skin of Asian patients. Improvement is associated with greater production of dermal collagen and straightening of dermal elastic fibers. The authors have indicated no significant interest with commercial supporters.

Platelet‐Rich Plasma Combined with Fractional Laser Therapy for Skin Rejuvenation

Background and Objectives Platelet‐rich plasma (PRP) is an autologous concentration of human platelets contained in a small volume of plasma and has recently been shown to accelerate wound healing and rejuvenate aging skin. The current study was conducted to determine whether there are additional effects of PRP combined with fractional laser therapy. Materials and Methods Twenty‐two Korean women underwent three sessions of fractional laser; 11 were treated with topical application of PRP combined with fractional laser. Evaluations were done at baseline and 1 month after the final treatment. The outcome assessments included subjective satisfaction scale; blinded clinical assessment; and the biophysical parameters of roughness, elasticity, skin hydration, and the erythema and melanin index. Biopsies were analyzed using hematoxylin and eosin, Masson‐trichrome, and immunohistochemistry for matrix metalloproteinase‐1. Results PRP combined with fractional laser increased subject satisfaction and skin elasticity and decreased the erythema index. PRP increased the length of the dermoepidermal junction, the amount of collagen, and the number of fibroblasts. Conclusion PRP with fractional laser treatment is a good combination therapy for skin rejuvenation. Keratinocyte and fibroblast proliferation and collagen production can explain the capacity of PRP to increase dermal elasticity.

A intense-focused ultrasound tightening for the treatment of infraorbital laxity

Abstract Background: Infraorbital laxity is a common problem that increases with age. Blepharoplasty with lipectomy is a very commonly performed surgical procedure to treat this problem; however, it is invasive and is associated with the potential for re-emergence. Therefore, young patients may prefer a non-surgical procedure rather than to a surgical procedure. Intense-focused ultrasound (IFUS) has emerged as an effective, non-surgical, tissue-tightening procedure. Objective: This study assessed the safety and efficacy of IFUS (UltheraTM system, Ulthera Inc, Mesa, AZ, USA) for facial tightening in Asian patients with infraorbital laxity. Methods: We studied 15 patients who were treated with an IFUS device applied to both lower eyelids. The primary outcome measure was an objective improvement in a paired comparison of pre-treatment and post treatment (6 months) photographs. A secondary outcome measure was patient satisfaction as measured by a questionnaire. Results: The mean patient age was 50 years (range, 27–69). All patients received one to two treatments with intense-focused ultrasound. All patients in the study experienced both subjective and objective improvement. Conclusion: IFUS can be used as a non-invasive, skin-tightening procedure for infraorbital laxity. No serious, permanent, or delayed side effects were noted up to 6 months post treatment. Thus, this procedure can be effective and safe in the treatment of decreased laxity of the lower eyelids.

Treatment of striae distensae combined enhanced penetration platelet-rich plasma and ultrasound after plasma fractional radiofrequency

Abstract Background: Striae distensae (striae alba) is a challenging cosmetic problem for which various treatment modalities have been applied. However, the treatment of striae distensae has not been satisfactory. Objectives: This study was done to evaluate the effectiveness and the safety of enhanced penetration of platelet rich plasma with ultrasound after plasma fractional radiofrequency for the treatment of striae distensae. Subjects and method: Eighteen participants with striae distensae were treated with a Legato system (Alma Lasers, Israel) every two weeks for a total of four sessions. Thereafter, in order to enhance platelet-rich plasma penetration, ultrasound is applied. Clinical photographs were taken before first treatment and two months after the final treatment. Objective and subjective improvement scores were evaluated to demonstrate the efficacy. Abdominal skin biopsies were obtained from three individuals and histological changes were analyzed by light microscopy. Results: During the two months after the last treatment, the average width of the widest striae had decreased from 0.75 to 0.27 mm. In the objective assessment, 71.9% of the participants reported ‘‘good” or “very good’’ overall improvement. In the subjective assessment, and 72.2% of the participants reported ‘‘very satisfied” or “extremely satisfied’’ with overall improvement. The only reported side effect was post-inflammatory hyperpigmentation (11.1%). Conclusions: The plasma fractional radiofrequency and transepidermal delivery of platelet-rich plasma using ultrasound is useful in the treatment of striae distensae.

A clinical trial of combination therapy with etanercept and low dose cyclosporine for the treatment of refractory psoriasis.

BACKGROUND Over the past decade, combination therapies have become a mainstay of dermatologic care in psoriasis. Combination therapies are often more effective and safer than large dose single-agent therapies. With the emergence of new biologic therapies, dermatologists now have a wider array of tools to treat psoriasis. Although much data exists regarding cyclosporine or biologic agents alone for psoriasis, little is known about the efficacy, safety and tolerability of combination regimens. OBJECTIVE We designed a study to evaluate the efficacy and safety of etanercept and cyclosporin combination therapy in patients with refractory psoriasis. METHODS We administered oral cyclosporine (200 mg daily) and subcutaneous etanercept 50 mg weekly injections until symptoms improved, then maintained treatment at a reduced dose. Seven patients with refractory psoriasis were evaluated 4 weekly. RESULTS All 7 patients showed rapid responses to combination therapy. Mean Psoriasis Area and Severity Index reductions following conditioning therapy (mean: 6.85 weeks) and maintenance therapy (mean: 56.5 weeks) were 94.9% and 93.2%, respectively. CONCLUSION Etanercept and low-dose cyclosporine combination therapy appears to be a safe and efficacious alternative treatment strategy for patients with refractory psoriasis. The combination induced rapid improvement in patients with refractory psoriasis and dramatically improved their quality of life. Clinical studies including larger patient cohort are required to validate the safety and efficacy of this combination therapy.

Nonablative fractional laser as a tool to facilitate skin penetration of 5-aminolaevulinic acid with minimal skin disruption: a preliminary study

Effective penetration of a photosensitizer is an essential step in photodynamic therapy (PDT). There have been trials of several methods, including laser treatment, to facilitate prompt and sufficiently deep transdermal drug delivery.

The Efficacy and Safety of Long-term Oral Cyclosporine Treatment for Patients with Atopic Dermatitis

BACKGROUND Steroids are used in conventional treatment of atopic dermatitis (AD) and they are very effective for improving the symptoms, but they also have several complications. Many studies have reported that short-term use of cyclosporine (CsA) is effective for severe AD as a substitute for steroid. However, there are very few studies on the long-term use of CsA for AD in the Korean population. OBJECTIVE The purpose of this study was to investigate whether long-term CsA therapy is effective and safe for treating AD. METHODS We performed a retrospective study of the patients with AD and who were treated with CsA at Kyung Hee Medical Center between January 2001 and February 2008. Among 147 patients, 61 received CsA treatment for more than 6 months. To evaluate the efficacy of CsA treatment, the objective SCORAD was checked for all 61 patients at every visit. Extensive laboratory tests were performed every two months to assess the safety of treatment. RESULTS The mean duration of CsA treatment was 13.5+/-8.4 months and the mean initial dose of CsA was 2.7+/-0.9 mg/kg/day. The mean objective SCORAD values significantly decreased from 34.1+/-11.2 at baseline to 11.4+/-10.7 after 6-month of CsA treatment (p<0.05). A significant decline of the SCORAD score was observed starting from 1-month of CsA treatment. The mean duration of remission was 4.5+/-2.9 months. A total of 13 adverse events in 10 patients were recorded during the study period. One patient dropped out due to renal dysfunction. Elevation of peripheral blood pressure was noted in 8 patients. Three patients complained of gastrointestinal troubles, and one patient had hypertrichosis, but the problems of these 4 patients were mild and easily treated. CONCLUSION We suggest that long-term, low-dose CsA treatment is safe and effective for patients who suffer from AD.

Comparative histometric analysis of the effects of high-intensity focused ultrasound and radiofrequency on skin

Abstract Introduction: High-intensity focused ultrasound (HIFU) and radiofrequency (RF) are used for non-invasive skin tightening. Neocollagenesis and neoelastogenesis have been reported to have a mechanism of controlled thermal injury. Objective: To compare neocollagenesis and neoelastogenesis in each layer of the dermis after each session of HIFU and monopolar RF. Methods: We analyzed the area fraction of collagen and elastic fibers using the Massons Trichrome and Victoria blue special stains, respectively, before and after 2 months of treatments. Histometric analyses were performed in each layer of the dermis, including the papillary dermis, and upper, mid, and deep reticular dermis. Results: Monopolar RF led to neocollagenesis in the papillary dermis, and upper, mid, and deep reticular dermis, and neoelastogenesis in the papillary dermis, and upper and mid reticular dermis. HIFU led to neocollagenesis in the mid and deep reticular dermis and neoelastogenesis in the deep reticular dermis. Among these treatment methods, HIFU showed the highest level of neocollagenesis and neoelastogenesis in the deep reticular dermis. Conclusions: HIFU affects deep tissues and impacts focal regions. Monopolar RF also affects deep tissues, but impacts diffuse regions. We believe these data provide further insight into effective skin tightening.

Case of isolated benign primary cutaneous plasmacytosis in a child.

A collection of plasma cells in the skin can represent a broad spectrum of disease entities. Secondary syphilis, primary cutaneous plasmacytoma, primary cutaneous plasmacytosis, cutaneous lymphoid hyperplasia and nodular amyloidosis are considered possible differential diagnoses. We present a case of a 7‐year‐old girl with an erythematous scaly plaque on her right buttock that had been present for approximately 5 years. Prior to her visit to our department she had been treated at a local dermatology clinic with topical methylprednisolone acetate and topical calcitriol without significant improvement. Histopathological examination revealed psoriasiform hyperplasia, hyperkeratosis, parakeratosis and a band‐like or dense perivascular infiltration of plasma cells with a few lymphocytes and histiocytes. Other laboratory tests were within the reference ranges. At our department, the patient was given oral prednisolone along with an intralesional injection of triamcinolone and application of topical methylprednisolone acetate and tacrolimus hydrate to the affected area. The lesion improved significantly but recurred 3 months later. We present a rare case of isolated benign primary cutaneous plasmacytosis in a female pre‐adolescent child.

Association of UVRAG polymorphisms with susceptibility to non-segmental vitiligo in a Korean sample.

Please cite this paper as: Association of UVRAG polymorphisms with susceptibility to non‐segmental vitiligo in a Korean sample. Experimental Dermatology 2010; 19: e323–e325.