Robert A. Weiss

Treatment of poikiloderma of Civatte with an intense pulsed light source.

Background. Effective treatment of poikiloderma of Civatte combines elimination of both the vascular and pigmented components simultaneously. A broad spectrum, noncoherent, intense pulsed light (IPL) source delivers multiple wavelengths with software controlled pulse durations and sequencing, which permits treatment of both vascular and pigmented lesions simultaneously. Objective. To determine response and side effects of poikiloderma of Civatte of the neck and chest when treated by IPL. Methods. One hundred and thirty‐five patients randomly selected with typical changes of poikiloderma of Civatte on the neck and/or upper chest were treated with one to five treatments using IPL. Results. Clearance of more than 75% of telangiectasias and hyperpigmentation comprising poikiloderma was observed. The incidence of side effects was 5%, including pigment changes. In many cases, improved skin texture was noted both by physician and patient. Conclusion. IPL is an effective mode of therapy for poikiloderma of Civatte. It offers a reduction of pigment and telangiectasias with a low risk profile. Additional benefits include subjective changes of improvement in skin texture.

Hair removal with a non-coherent filtered flashlamp intense pulsed light source†

To evaluate the effects on disruption of hair growth of the non‐coherent filtered flashlamp intense pulsed light (IPL) source.

Treatment of Essential Telangiectasias with an Intense Pulsed Light Source (PhotoDerm VL)

BACKGROUND. The flashlamp‐pumped pulsed dye laser (585 and 577 nm) has proven to be a very effective and safe treatment option in the therapy of essential telangiectasias (ETE). Never‐theless, the postoperative intracutaneous hematomata, which most patients see as cosmetically disfiguring, always has been a matter of concern. OBJECTIVE. To test the efficacy and safety of a new, large spot size, intense pulsed light source, the PhotoDerm VL, which emits noncoherent light adjustable within the 515‐1200‐nm ratige, in the treatment of ETE. METHODS. Fourteen patients were treated with the PhotoDerm VL. They suffered from ETE of the face, postoperative teleangi‐ectasis of the nose, ETE of both legs, and poikiloderma of Civatte. RESULTS. All treated lesions could be abrogated with excellent results by this neiv device. There were no unpleasant side effects of the treatment. Additionally, due to the large spot size (2.8 cm2), a larger area could be treated within one session. No anesthesia was required. CONCLUSION. The PhotoDerm VL is an innovative, highly ef‐fective, and comparably safe therapeutic alternative to the laser in the treatment of ETE. The rate of cosmetically relevant side effects is considerably smaller, the patient compliance is excel‐lent, and the method can be applied easily in an outpatient setting.

Cutaneous necrosis, telangiectatic matting, and hyperpigmentation following sclerotherapy : etiology, prevention, and treatment

BACKGROUND Telangíectatíc mattíng and hyperpígmentation are some of the most commonly observed side effects of sclerotherapy. Cutaneous necrosis is relatively rare and often of limited sequelae but most commonly related to extravasation of sclerosant. Physicians treating varicosities and telangiectasia by sclerotherapy must be familiar with causes and means for minimization of all three side effects. OBJECTIVE This review article discusses the proposed etiology, risk factors, approach for minimizing, and suggested treatment for the three side effects of cutaneous necrosis, telangiectatic matting, and hyperpigmentation. RESULTS Cutaneous necrosis may occur with the injection of any sclerosing agent even under ideal circumstances and does not necessarily represent physician error. When sclerosant extravasation occurs, dilution must occur immediately. Telangiectatic matting is a recognized complication occurring in approximately 15–20% of patients treated by sclerotherapy. Although the exact mechanism of the phenomena remains unknown, reactive inflammatory and/or angiogenic mechanisms are felt to play a role. Patients are advised that telangiectatic matting is usually not permanent and usually resolves spontaneously in 3–12 months. Postsclerosis pigmentation is defined as the appearance of persistent, increased pigmentation running the course of an ectatic blood vessel treated by sclerotherapy. The general incidence of hyperpigmentation ranges from 10 to 30%. Although hyperpigmentation may persist for months, its presence rarely deters patients from continuing treatment. Spontaneous resolution occurs in 70% at 6 months with 99% resolution occurring within 1 year. CONCLUSIONS With understanding the etiology, risk factors, and ways to minimize these side effects our goal is to reduce their incidence. Attempting prevention may ultimately be the most effective means of treatment. LEARNING OBJECTIVES After studying the following article, participant should be able to:Understand the definition and potential causes of cutaneous necrosis, telangiectatic matting, and hyperpigmentation following sclerotherapy.Advise patients prior to treatment on the common risks involved in sclerotherapy and to advise them on the relative incidence.Understand the concept of minimal sclerosant concentration and how it can help the physician to choose sclerosing solution concentrations to minimize risks.

Diagnosis and treatment of varicose veins: A review

Varicose veins are superficial vessels that are abnormally twisted, lengthened, or dilated and are usually caused by inefficient or defective valves within the vein. They represent a medical condition accompanied by symptoms deserving treatment. Varicose veins are a manifestation of venous disease that may precede later severe complications. Varicosities cause cutaneous disease in addition to complications specific to the venous system. This article reviews the epidemiology, adverse sequelae, anatomy, pathophysiology, evaluation, and treatment of varicose veins.

Minimally invasive techniques in the treatment of saphenous varicose veins

Lower extremity venous insufficiency is common and increases with age. In addition to classical symptoms, it may result in skin changes and venous ulcers. Chronic venous insufficiency has a great impact on patients health-related quality of life and is associated with considerable health care costs. Surgical ligation of the junction with or without stripping has been the standard of care in the treatment of insufficient great and small saphenous veins. However, the recurrence rates are relatively high and surgery may be associated with serious adverse events and considerable down time; it is also cosmetically suboptimal. To improve efficacy, patients health-related quality of life and treatment satisfaction and to reduce serious side effects, costs, and postoperative pain, several minimally invasive techniques have been introduced in the last decade. Dermatologists have played an important role in the development of these new therapies of truncal varicose veins. Of the new therapies, ultrasound-guided foam sclerotherapy, endovenous laser therapy, and radiofrequency ablation are the most common and challenge surgery as the gold standard of care for patients with varicose veins. The objective of this review is to inform clinicians about these 3 therapeutic options for truncal varicose veins and to describe and compare the procedures, indications, efficacy, and safety profile.

Extensive Tissue Necrosis Following High‐Concentration Sclerotherapy for Varicose Veins

Background. Tissue necrosis after sclerotherapy has been observed, but is unexplained. Objective. To present the complication of extensive tissue necrosis following high‐concentration sclerotherapy for varicose veins. Methods. Cases coming to the attention of the authors are presented briefly with commentary and discussion to explain the mechanisms of tissue destruction. Results. Although the complication of extensive tissue necrosis has been ascribed to intra‐arterial injection, in fact, careful study of the cases described here shows that intravenous injection was present in each case. A theory of distribution of the sclerosant into the arterial arborization is proposed. This theory would explain the distribution of sclerosant into the arterial tree and would also explain the causation of extensive tissue necrosis. Mention is made of experimental work in which intra‐arterial injection was not the mechanism of causation of tissue necrosis. Conclusion. Extensive tissue necrosis following high‐concentration sclerotherapy may be rare, but its occurrence is serious and its treatment may be incomplete.

Randomized sham-controlled trial to evaluate the safety and effectiveness of a high-intensity focused ultrasound device for noninvasive body sculpting.

Background: High-intensity focused ultrasound presents a noninvasive approach to body sculpting for nonobese patients. The purpose of this study was to evaluate the safety and effectiveness of a high-intensity focused ultrasound device for sculpting of the abdomen and flanks. Methods: Adults (aged 18 to 65 years) with subcutaneous abdominal fat greater than or equal to 2.5 cm thick who met screening criteria were randomized to receive high-intensity focused ultrasound treatment of the anterior abdomen and flanks at energy levels (a total of three passes each) of 47 J/cm2 (141 J/cm2 total), 59 J/cm2 (177 J/cm2), or 0 J/cm2 (no energy applied, sham control). The primary endpoint was change from baseline waist circumference at the iliac crest level at posttreatment week 12. Subjective aesthetic assessments included the Global Aesthetic Improvement Scale and a patient satisfaction questionnaire. Safety assessments included adverse events, laboratory values, and physical examinations. Results: For the primary endpoint, in the intent-to-treat population, statistical significance versus sham was achieved for the 59-J/cm2 (–2.44; p = 0.01) but not the 47-J/cm2 treatment group (–2.06 cm; p = 0.13). In a per-protocol population, statistical significance versus sham was achieved for both the 59-J/cm2 (–2.52 cm; p = 0.002) and the 47-J/cm2 treatment groups (–2.10 cm; p = 0.04). Investigator subjective measures of global aesthetic improvement and patient satisfaction also favored each active treatment versus sham. Adverse events included mild to moderate discomfort, bruising, and edema. Laboratory values and physical examinations were unremarkable. Conclusions: Treatment with this high-intensity focused ultrasound device reduced waist circumference and was generally well tolerated for noninvasive body sculpting. Reduction in waist circumference was statistically significant with both active treatments (per protocol). CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II. Figure. No caption available.

Treatment of poikiloderma of Civatte on the neck with an intense pulsed light source.

Effective treatment of poikiloderma of Civatte is difficult. The ideal treatment combines elimination of both the vascular and pigmented components simultaneously. Treatment with a broad‐spectrum noncoherent intense pulsed light source delivers multiple wavelengths with software‐controlled pulse durations and sequencing that permit treatment of both vascular and pigmented lesions simultaneously. The objective of this study was to determine the response and side effects of treating this condition with intense pulsed light. In the study, 66 patients with typical changes of poikiloderma of Civatte on the neck were treated with intense pulsed light at various settings every 4 weeks until the desired improvement occurred. A 50 to 75 percent improvement in the extent of telangiectasias and hyperpigmentation was observed after an average of 2.8 treatments. The incidence of hypopigmentation was 5 percent. It was concluded that intense pulsed light is an effective mode of therapy for poikiloderma of Civatte. It seems to offer a reduction in both pigmentation and telangiectasia‐associated erythema, with minimal side effects. (Plast. Reconstr. Surg. 107: 1376, 2001.)

Complications of sclerotherapy.

Sclerotherapy is the systematic, targeted elimination of intracutaneous and subcutaneous varicose, reticular, telangiectasias by the injection of a locally irritating chemical substance, called a sclerosant. The endpoint of this process is functionally analogous to surgical removal of a vein. However, regardless of the best of intentions, complications can and will occur with enough sclerotherapy treatments. Complications resulting from sclerotherapy can be divided into the following categories for ease of explanation: (1) frequent but transient, (2) rare but self-limited, and (3) rare but major. This article will focus on select complications in sclerotherapy, review the most common complications observed, and discuss how to minimize these in daily practice.