Sebastian H. Verne

Non-invasive subcutaneous fat reduction: a review

The risks, financial costs and lengthy downtime associated with surgical procedures for fat reduction have led to the development of a number of non‐invasive techniques. Non‐invasive body contouring now represents the fastest growing area of aesthetic medicine. There are currently four leading non‐invasive techniques for reducing localized subcutaneous adipose tissue: low‐level laser therapy (LLLT), cryolipolysis, radio frequency (RF) and high‐intensity focused ultrasound (HIFU). To review and compare leading techniques and clinical outcomes of non‐invasive subcutaneous fat reduction. The terms ‘non‐invasive’, ‘low‐level laser’, ‘cryolipolysis’, ‘ultrasound’ and ‘radio frequency’ were combined with ‘lipolysis’, ‘fat reduction’ or ‘body contour’ during separate searches in the PubMed database. We identified 31 studies (27 prospective clinical studies and four retrospective chart reviews) with a total of 2937 patients that had been treated with LLLT (n = 1114), cryolipolysis (n = 706), HIFU (n = 843) or RF (n = 116) or other techniques (n = 158) for fat reduction or body contouring. A majority of these patients experienced significant and satisfying results without any serious adverse effects. The studies investigating these devices have all varied in treatment regimen, body locations, follow‐up times or outcome operationalization. Each technique differs in offered advantages and severity of adverse effects. However, multiple non‐invasive devices are safe and effective for circumferential reduction in local fat tissue by 2 cm or more across the abdomen, hips and thighs. Results are consistent and reproducible for each device and none are associated with any serious or permanent adverse effects.

Tranexamic Acid in the Treatment of Melasma: A Review of the Literature

Melasma is a common acquired pigmentary disorder marked by irregular hyperpigmented macules or patches and most commonly occurs in women of darker skin color. It is a chronic often-relapsing condition that causes negative psychosocial effects in those affected. Current treatments such as hydroquinone, kojic acid, and retinoids, among others, demonstrate variable efficacy and side-effect profiles. We conducted a comprehensive literature review examining the use of tranexamic acid (TA), a well-known anti-fibrinolytic agent, in the treatment of melasma. TA delivered orally, topically, and through physical methods works via the inhibition of ultraviolet (UV)-induced plasmin activity in keratinocytes. Predefined search terms were entered into PubMed. Articles were then independently screened by two authors to include only those written in the English language and relating to human subjects with at least mild melasma. The search identified 28 articles, 15 of which met the criteria for full review. The review revealed that TA treatment for melasma is equally effective or more effective than other standard therapies and may induce fewer side effects. Our comprehensive review suggests that TA may be a promising treatment option for melasma because of its demonstrated effectiveness alone and in combination with other modalities as well as its limited side-effect profile.

Laser treatment of granuloma annulare: a review

Granuloma annulare (GA) is a benign asymptomatic dermatosis that typically manifests in papules arrayed in annular arrangements. Many methods of treatment have been used with variable degrees of success, but finding a consistent and long‐term treatment has proven a challenge. This study was conducted in order to review and evaluate the latest published research on the use of lasers in the treatment of GA. A systematic search of the National Library of Medicines PubMed database was performed to identify relevant articles. Seven reports met the inclusion criteria for the review. Evidence for the use of pulsed dye laser, fractional photothermolysis, and excimer laser in the treatment of GA was found. Findings are limited by a lack of well‐designed clinical trials objectively evaluating the use of lasers in the treatment of GA. The literature review found a number of case reports and case series that report successful outcomes of the use of lasers in the treatment of GA. The promising results reported in the literature, coupled with the lack of a well‐designed review on this topic, reflect the importance of this article to the dermatologic literature as it emphasizes the need for larger and better‐designed studies on the use of lasers to treat GA.

Optical coherence tomography for assessment of epithelialization in a human ex vivo wound model: OCT for human ex vivo wound assessment

The ex vivo human skin wound model is a widely accepted model to study wound epithelialization. Due to a lack of animal models that fully replicate human conditions, the ex vivo model is a valuable tool to study mechanisms of wound reepithelialization, as well as for preclinical testing of novel therapeutics. The current standard for assessment of wound healing in this model is histomorphometric analysis, which is labor intensive, time consuming, and requires multiple biological and technical replicates in addition to assessment of different time points. Optical coherence tomography (OCT) is an emerging noninvasive imaging technology originally developed for noninvasive retinal scans that avoids the deleterious effects of tissue processing. This study investigated OCT as a novel method for assessing reepithelialization in the human ex vivo wound model. Excisional ex vivo wounds were created, maintained at air‐liquid interface, and healing progression was assessed at days 4 and 7 with OCT and histology. OCT provided adequate resolution to identify the epidermis, the papillary and reticular dermis, and importantly, migrating epithelium in the wound bed. We have deployed OCT as a noninvasive tool to produce, longitudinal “optical biopsies” of ex vivo human wound healing process, and we established an optimal quantification method of re‐epithelialization based on en face OCT images of the total wound area. Pairwise statistical analysis of OCT and histology based quantifications for the rate of epithelialization have shown the feasibility and superiority of OCT technology for noninvasive monitoring of human wound epithelialization. Furthermore, we have utilized OCT to evaluate therapeutic potential of allogeneic adipose stem cells revealing their ability to promote reepithelialization in human ex vivo wounds. OCT technology is promising for its applications in wound healing and evaluation of novel therapeutics in both the laboratory and the clinical settings.

Optical coherence tomography image processing for in vivo 3-dimensional visualization of basal cell carcinoma

The use of optical coherence tomography (OCT) imaging of basal cell carcinoma (BCC) has been widely studied leading to the description of multiple defining features with the conclusion that this imaging modality may assist in diagnosing, subtyping, and managing BCCs. Features described include lobular structures, epidermal projections, stretching effect of dermis, increased vasculature, and 1 study specifically describes a hyporeflective central region that correlates histologically with central tumor necrosis suggesting a rapid growth.1,2 Considering the many studies describing these features, there remains a disconnect with clinical applicability.3 One study concluded that using OCT significantly improved diagnostic specificity for BCC when compared to clinical and dermoscopic assessment.4 Furthermore, the development of computer diagnostic classification of BCCs has been attempted using machine learning of multiple user measured parameters of several OCT images.5 Although a step toward improved clinical application of OCT for BCC diagnosis, there is still a gap between using OCT for research and clinical decisionmaking purposes. This study investigates a new approach for analysis of OCT images of BCC.

In vitro determination of Mexican Mestizo hair shaft diameter using optical coherence tomography

Mexican mestizo population has a pluriethnic mixture of Amerindian, European and African ancestry, predominant in most Latin American countries. Until now, there are no reports about hair characteristics in this population, necessary to define normal values, for hair diseases evaluation and comparison among other ethnic groups.

Optical coherence tomography for the investigation of frontal fibrosing alopecia

Frontal fibrosing alopecia (FFA) is a cicatricial alopecia that affects the frontotemporal hairline, eyebrows and body hair. OCT is a non‐invasive imaging technique useful in understanding skin architecture and vascularization.

Morbihan Disease Complicated by Dermatosis Neglecta: A Unique Presentation.

Morbihan disease, also referred to as solid facial edema, or rosacea lymphedema, is a rare disorder that involves chronic erythema and solid edema of the cheeks, eyelids, forehead and glabella and may arise as a complication of acne vulgaris or rosacea. Of note, it may be the only initial presenting symptom of these associated diseases. Few cases have been described in the literature, as its first description by Robert Degos in 1957. The condition is characterized by its chronicity, a typical clinical appearance and the lack of specific histopathologic or laboratory findings. The condition may wax and wane but typically does not resolve without treatment. Many cases of this condition tend to be recalcitrant to therapy, with topical and oral antibiotics regimens commonly used for rosacea generally being ineffective. The disease may easily go undiagnosed, as it mimics other more common skin conditions. We present a case of originally undiagnosed Morbihan disease mistaken for an atypical allergic rash, resistant to treatment, and complicated by dermatosis neglecta.