Myeung Nam Kim

Fractional Photothermolysis for the Treatment of Striae Distensae in Asian Skin

AbstractBackground:Striae distensae (SD) are dermal scars characterized by linear atrophic depressions. Fractional photothermolysis (FP) is an effective modality for the treatment of cutaneous scars. Objective:To evaluate the safety and efficacy of FP for the treatment of SD in Asian skin. Methods:Six female volunteers aged between 20 and 35 years with chronic striae albae phase SD on both buttocks were enrolled. SD lesions on the right buttock were irradiated with a 1550-nm FP laser and patients were followed every 4 weeks for a total of 8 weeks. Outcome assessments included serial photographs, erythema index and melanin index tracking, skin elasticity, histologic examination, and the patients’ subjective satisfaction scores. Results:FP treatment was associated with a substantial improvement in the appearance of SD at 8 weeks post-treatment. The erythema index and melanin index of the treated SD lesions tended to converge with those of the control skin at 4-week follow-up. Skin elasticity was found to be partially normalized after FP. In addition, there was a significant increase in epidermal thickness, collagen, and elastic fiber deposition after FP as demonstrated by histologic examination. Adverse effects of FP included mild and transient pain and hyperpigmentation. Conclusion:FP can reduce SD by stimulating new collagen and elastic fiber synthesis. In addition, repetitive treatments might constitute an effective approach to improving the treatment of SD.

Multiple Pass Ultrasound Tightening of Skin Laxity of the Lower Face and Neck

BACKGROUND Skin laxity is a common complaint of patients who request skin rejuvenation. Radiofrequency and infrared light are widely used for nonablative treatment of skin laxity. Intense focused ultrasound (IFUS) has been investigated as a tool for the treatment of solid benign and malignant tumors for many decades but is only now beginning to emerge as a potential noninvasive alternative to conventional nonablative therapy. OBJECTIVES To evaluate the efficacy of IFUS for the treatment of face and neck laxity. METHODS Twelve female volunteers were enrolled in the study, and 10 were ultimately evaluated. The device under investigation was an IFUS. Areas treated included the face and neck. For treatment, the 4‐MHz, 4.5‐mm probe was used first, followed by the 7‐MHz, 3.0‐mm probe. Two blinded, experienced clinicians evaluated paired pretreatment and post‐treatment (day 90) photographs. Patient self‐assessments were also obtained. RESULTS On the first primary outcome measure, two blinded clinicians felt that 8 of 10 subjects (80%) showed clinical improvement 90 days after treatment. Nine of 10 subjects (90%) reported subjective improvement. CONCLUSIONS IFUS has many advantages for skin tightening.

The Efficacy of Autologous Platelet Rich Plasma Combined with Ablative Carbon Dioxide Fractional Resurfacing for Acne Scars: A Simultaneous Split-Face Trial

BACKGROUND Ablative carbon dioxide (CO2) fractional resurfacing is a promising therapeutic intervention for the treatment of acne scars, although this technique is associated with prolonged surgical site erythema and edema, which may affect the daily lives of patients. Autologous platelet‐rich plasma (PRP) is known to enhance wound healing and has applications in many areas of medicine. OBJECTIVES To evaluate the synergistic effects of autologous PRP with CO2 fractional resurfacing for acne scars. MATERIALS AND METHODS A split‐face trial was conducted in 14 Korean participants with acne scars. All participants received one session of ablative CO2 fractional resurfacing. Immediately after resurfacing, facial halves were randomly assigned to receive treatment with autologous PRP injections on one side (experimental side) and normal saline injections on the other side (control side). The participants were monitored for degree of recovery and resurfacing‐associated adverse events, including prolonged erythema, edema, and other effects on days 0, 2, 4, 6, 8, 15, and 30. The intensity of erythema was objectively measured using a chromometer at the same time intervals. After one additional treatment session using the same protocol, two independent dermatologists evaluated clinical improvement using a quartile grading scale. RESULTS All participants completed the study. Erythema on the experimental side improved faster than on the control side and was significantly less at day 4 (p=.01). This difference was confirmed using a chromometer (p=.049). Total duration of erythema was an average of 10.4±2.7 days on the control side and 8.6±2.0 days on the experimental side (p=.047). Edema also improved faster on the experimental side than on the control side. The total duration of edema was an average of 7.1±1.5 days on the control side and 6.1±1.1 days on the experimental side (p=.04). Participants were also assessed for duration of post‐treatment crusting, with a mean of 6.8±1.0 days on the control side and 5.9±1.1 days on the experimental side (p=.04). No other adverse effects were observed in any participant. Four months after the final treatment, overall degree of clinical improvement was significantly better on the experimental side (2.7±0.7) than on the control side (2.3±0.5) (p=.03). CONCLUSIONS Treatment with PRP after ablative CO2 fractional resurfacing enhances recovery of laser‐damaged skin and synergistically improves the clinical appearance of acne scarring. The authors have indicated no significant interest with commercial supporters.

Characterization of the fungal microbiota (mycobiome) in healthy and dandruff-afflicted human scalps.

The human scalp harbors a vast community of microbial mutualists, the composition of which is difficult to elucidate as many of the microorganisms are not culturable using current culture techniques. Dandruff, a common scalp disorder, is known as a causative factor of a mild seborrheic dermatitis as well as pityriasis versicolor, seborrheic dermatitis, and atopic dermatitis. Lipophilic yeast Malassezia is widely accepted to play a role in dandruff, but relatively few comprehensive studies have been reported. In order to investigate fungal biota and genetic resources of dandruff, we amplified the 26S rRNA gene from samples of healthy scalps and dandruff-afflicted scalps. The sequences were analyzed by a high throughput method using a GS-FLX 454 pyrosequencer. Of the 74,811 total sequence reads, Basidiomycota (Filobasidium spp.) was the most common phylum associated with dandruff. In contrast, Ascomycota (Acremonium spp.) was common in the healthy scalps. Our results elucidate the distribution of fungal communities associated with dandruff and provide new avenues for the potential prevention and treatment of dandruff.

Prevention of thyroidectomy scar using a new 1,550-nm fractional erbium-glass laser.

BACKGROUND Surgical scars are a common cosmetic problem that occurs in various surgical fields including dermatology. Diverse trials have been made to prevent this annoying scar formation. Recently, 585‐ and 595‐nm pulsed dye laser irradiation presented satisfactory cosmetic outcome for the treatment of surgical scars. Other fractionated lasers or light devices were also applied for scar treatment. OBJECTIVE To determine the effectiveness and safety of a newly developed 1,550‐nm fractional erbium–glass laser in the prevention of scar formation after total thyroidectomy. MATERIALS AND METHODS Twenty‐seven ethnic South Korean patients with linear surgical suture lines after total thyroidectomy operation were treated with a 1,550‐nm fractional erbium–glass laser. The same surgeon performed all of the operations using the same surgical techniques. Each patient was treated four times at 1‐month intervals using the same parameters (5‐ × 10‐mm spot size, 10 mJ, 1,500 spot/cm2, static mode). Initiation of the first irradiation was made approximately 2 to 3 weeks after the thyroidectomy. The scar prevention effects were evaluated each month for 6 months after thyroidectomy. Two kinds of assessment methods were applied in this evaluation. First, the Vancouver Scar Scale (VSS) was used. Second, three independent physicians gave a global assessment valuation to the final cosmetic results: poor (1), fair (2), good (3), or excellent (4). These results were compared with the surgical scars of a control group (patients who denied laser treatments and had no other treatments during the 6 months after total thyroidectomy by the same surgeon). RESULTS The average VSS score was lower in the laser treatment group. The global assessment also presented better cosmetic outcomes in the treatment group than in the controls. CONCLUSION A new 1,550‐nm fractional erbium–glass laser may efficiently repress the formation and hypertrophy of thyroidectomy scars on the neck, and it can be safely applied in relatively dark Asian skin without noticeable adverse effects. The authors have indicated no significant interest with commercial supporters.

Clinicopathologic efficacy of copper bromide plus/yellow laser (578 nm with 511 nm) for treatment of melasma in Asian patients.

BACKGROUND Melasma is a common pigmentary disorder in Asians. Although the pathogenesis of melasma is not yet fully understood, there are several hypotheses supporting angiogenetic factors related to some types of melasma. OBJECTIVE To test the efficacy of copper bromide laser in the treatment of Korean women with melasma. MATERIALS AND METHODS Clinical parameters included physician and patient assessment and Melasma Area and Severity Index score. The intensity of pigmentation and erythema was measured using a chromometer. To evaluate histopathologic changes, punch biopsies from melasma were obtained from four patients. Immunohistochemical staining for Melan‐A, endothelin 1, CD34, and vascular endothelial growth factor (VEGF) antigen of the melasma lesions was observed. RESULTS Mean MASI score decreased dramatically after treatment. Patients exhibited telangiectatic erythema within the melasma lesion. The values of L* reflecting intensity of pigmentation increased, and the values of a* as the measurement of redness decreased after the treatments. Expression of Melan‐A, CD34, endothelin‐1, and VEGF decreased after treatment. CONCLUSION The potential application of an antiangiogenetic laser for the treatment of melasma specially accompanied by pronounced telangiectasia in Asian skin is a possible treatment option. The authors have indicated no significant interest with commercial supporters.

Treatment of Striae Distensae Using Needling Therapy: A Pilot Study

BACKGROUND Striae distensae are dermal scars characterized by flattening and atrophy of the epidermis. Although many treatment modalities have been attempted with variable results, there is no criterion standard treatment modality for striae distensae. OBJECTIVES To evaluate the effectiveness and safety of a disk microneedle therapy system (DTS) in the treatment of striae distensae. MATERIALS AND METHODS Sixteen Korean volunteers with striae distensae alba or rubra were enrolled. Patients received three treatments using a DTS at 4‐week intervals. Clinical response to treatment was assessed by comparing pre‐ and post‐treatment clinical photographs, skin biopsies, and patient satisfaction scores. Clinical improvement was assessed using the quartile grading scale. RESULTS Marked to excellent improvement was noted in seven (43.8%) patients, with minimal to moderate improvement in the remaining nine. Patient satisfaction scores showed that six (37.5%) patients were highly satisfied, eight (50.0%) were somewhat satisfied, and two (12.5%) were unsatisfied. There were no significant side effects except mild pain, erythema, and spotty bleeding. CONCLUSION Disk microneedle therapy system (DTS) can be effectively and safely used in the treatment of striae distensae.

Photodynamic therapy: New treatment for recalcitrant Malassezia folliculitis

Malassezia folliculitis commonly has been treated with oral antifungal medications. However, it has many therapeutic weaknesses such as infection relapse, drug resistance, or adverse effects like hepatotoxicity and gastrointestinal discomfort. Hence, there remains an ongoing need for alternative treatments for recalcitrant Malassezia folliculitis. Recently, many dermatologists suggest photodynamic therapy (PDT) as an alternative therapeutic option for its antimicrobial effect.

Efficacy of intradermal radiofrequency combined with autologous platelet‐rich plasma in striae distensae: a pilot study

Background  Different types of laser have recently been reported as effective tools of treatment in striae distensae. Although fractional photothermolysis is effective for striae distensae, post‐inflammatory hyperpigmentation is a major concern and common complication. There are no reports of the effects of using an intradermal radiofrequency (RF) device in striae distensae. Autologous platelet‐rich plasma (PRP) is an effective treatment known for its wound‐healing effects.

Distribution of Malassezia Species on the Scalp in Korean Seborrheic Dermatitis Patients

BACKGROUND Malassezia species play an important role in the pathogenesis of seborrheic dermatitis. In particular, M. restricta and M. globosa are considered to be the predominant organisms in seborrheic dermatitis of Western countries. However, species distribution of Malassezia in seborrheic dermatitis has not been clearly determined yet in Asia. OBJECTIVE To identify the distribution of Malassezia species on the scalp of seborrheic dermatitis patients in Korea using 26S rDNA PCR-RFLP analysis. METHODS A total of 40 seborrheic dermatitis patients and 100 normal healthy volunteers were included in this study. For the identification of Malassezia species, the scalp scales of the subjects were analyzed by 26S rDNA PCR-RFLP analysis. RESULTS The most commonly identified Malassezia species were M. restricta in the seborrheic dermatitis patients, and M. globosa in the normal controls. In the seborrheic dermatitis group, M. restricta was identified in 47.5%, M. globosa in 27.5%, M. furfur in 7.5%, and M. sympodialis in 2.5% of patients. In the healthy control group, M. globosa was identified in 32.0%, M. restricta in 25.0%, M. furfur in 8.0%, M. obtusa in 6.0%, M. slooffiae in 6.0%, and M. sympodialis in 4.0% of subjects. CONCLUSION M. restricta is considered to be the most important Malassezia species in Korean seborrheic dermatitis patients.