Shlomit Halachmi

A novel fractional micro-plasma radio-frequency technology for the treatment of facial scars and rhytids: A pilot study

Abstract Introduction: Fractional ablative and non-ablative lasers have gained popularity in the treatment of acne scars and rhytids due to their efficacy and improved tolerability. Plasma and radio frequency (RF) have also emerged as methods for ablative or non-ablative energy delivery. We report preliminary experience with a novel fractional micro-plasma RF device for the treatment of facial acne scars and rhytids. Methods: Sixteen patients with facial acne scars or rhytids were treated at 4-week intervals. Treatment parameters were titrated to an immediate end point of moderate erythema. The clinical end point for cessation of treatment was the attainment of satisfactory clinical results. Results were monitored photographically up to 3 months after treatment. Results: Acne scars showed marked improvement after two to four treatments. Facial rhytids demonstrated reduced depth after two treatments and marked improvement after four treatments. Treatment was well tolerated by all participants, with transient erythema and short downtime. These results provide initial evidence for the safety and effectiveness of fractional micro-plasma RF as a low-downtime and well-tolerated modality for the treatment of acne scars and facial rhytids.

Commentary: Safety and Tolerability of a Focused Ultrasound Device for Treatment of Adipose Tissue in Subjects Undergoing Abdominoplasty, a Placebo Control Pilot Study

The article by Shalom and colleagues, titled “Safety and tolerability of a focused ultrasound device for treatment of adipose tissue in subjects undergoing abdominoplasty, a placebo control pilot study,” describes a high-intensity focused ultrasound (HIFU) device in development, the SM-100 (Slender Medical, Herzliya, Israel). The data are from an early clinical study, predicated on preclinical and in vivo data referenced as presented at a conference but not presented or summarized in the manuscript. The study is pilot in scale, with six participants recruited for preliminary safety and histology assessments. The device development pathway follows that taken by its predecessors, the Contour I (UltraShape, Yokneam, Israel) and LipoSonix (Solta Medical, Hayward, CA).

Clinical results of skin remodeling using a novel pneumatic technology

Background  A myriad of technologies are available for the treatment of aging skin. These, however, still lack the ability to combine immediate, short‐term and long‐term aesthetic results with no downtime. Furthermore, the treatment of fine wrinkles on large surfaces remains challenging, as does the treatment of delicate regions, such as the dorsal hand, neck, and chest.

Hemangiomas of the Nasal Tip Treated with Propranolol

Background: Infantile hemangioma is the most common tumor of infancy. There are recent reports of the efficacy of propranolol in the treatment of these hemangiomas. Nasal tip hemangiomas pose a particularly sensitive concern aesthetically and functionally. The treatment of nasal tip hemangiomas is controversial. We assessed the effect of propranolol therapy in hemangiomas of the nasal tip. Objectives: To evaluate the response of nasal tip hemangiomas to systemic propranolol. Methods: During 2008-2010 ten infant with nasal tip hemangiomas presented to our tertiary care center. All underwent comprehensive evaluation by a multidisciplinary team and were then treated with oral propranolol at 2 mg/kg/day, with continuous clinical follow-up until age 14-16 months, or in older infants until the proliferative phase resolved. Results: Eight patients demonstrated good clinical improvement. Two patients had partial improvement. One patient discontinued treatment due to wheezing. Three patients had mild sleep disturbance which did not warrant discontinuation of treatment. No rebound was noticed after cessation of treatment. Limitations: Children presented by referral at variable ages. It is possible that routine initiation of propranolol in neonates at the first sign of nasal hemangioma may reduce the required treatment duration or dose. Conclusions: Early treatment of hemangiomas of the nasal tip with propranolol prevents lesion proliferation, reduces lesion volume, and prevents nasal and facial deformation. Propranolol appears to be a safe and effective treatment. Its efficacy and safety profiles, relative to other accepted therapies, suggest that it should be considered as the first-line treatment when intervention is required.

Telangiectasis in CREST syndrome and systemic sclerosis: correlation of clinical and pathological features with response to pulsed dye laser treatment

Telangiectasia are cardinal features of systemic sclerosis (SS) and calcinosis, Raynaud’s syndrome, esophageal motility, sclerodactyly, telangiectasias (CREST) syndrome. The etiology of telangiectasia in these syndromes is unknown, but vascular dysfunction has been proposed. However, the telangiectasia of CREST have anecdotally been considered relatively resistant to pulse dye laser (PDL), the treatment of choice for classic telangiectasia. The study was designed to test whether SS/CREST telangiectasia require more treatments than sporadic telangiectasia and to identify clinical and histological features that could explain such an effect. Nineteen skin biopsies from patients with SS or CREST and 10 control biopsies were examined and compared for features that may predict a differential response to PDL. Sixteen cases of SS or CREST treated with PDL between 1997 and 2007 were evaluated and response to treatment was compared with 20 patients with sporadic telangiectasis. Relative to normal skin, CREST/scleroderma telangiectasia exhibited thickened vessels in 17 out of 19 sections and thickened collagen fibers in the reticular or deep dermis in all sections. The number of treatments required to clear SS/CREST telangiectasia was approximately twofold higher. SS/CREST telangiectasia are more resistant to PDL but can be effectively cleared with more treatments.

Low-fluence vs. standard fluence hair removal: A contralateral control non-inferiority study

Introduction: Laser hair removal at lower fluences, delivered under certain conditions, may retain the efficacy of high-fluence lasers while improving tolerability. We performed a pilot study comparing the efficacy, safety and tolerability of laser hair removal using traditional settings compared to lower fluences, delivered from a larger handpiece and under vacuum. Material and methods: Fourteen healthy participants underwent 5 axillary hair removal treatments with an 800 nm diode laser at 1-month intervals, with follo-wup 1 and 3 months after the 5th treatment. In all patients, one side was treated with standard parameters using a 9×9 mm chilled tip and gel, while the contralateral side was treated using a 22×35 mm vacuum-assisted handpiece at fluences up to 12 J/cm2. Follow-up assessments were performed after each treatment and at each follow-up visit, and included photography and questionnaires. Results: Eleven participants completed the study and follow-up. All experienced significant hair removal in all treated areas. At the 3-month follow-up visit, the high-fluence and low-fluence treated axillae demonstrated comparable hair reduction. Participants found the lower fluence treatments to be more tolerable. No adverse events were reported. Conclusion: Lower fluence diode laser, delivered under conditions of vacuum and using larger spot sizes, can provide significant hair reduction.

Melasma and laser treatment: an evidenced-based analysis.

The use of lasers in the treatment of melasma has been addressed in case reports, but there is no consensus in the literature regarding the safety, efficacy, or durability of laser-based treatments. Furthermore, given the potential risks of laser intervention in hyperpigmented skin, the relative risks and benefit of laser must be compared to more conservative and traditional treatment approaches. English language literature in which the main intervention was a light-based therapy and the target was melasma was analyzed. The study included only prospective, controlled studies which included at least 10 participants, and which presented the data with accepted objective and quantitative study metrics. Seven studies met the inclusion criteria. Two studies reported the response to melanin-targeting lasers and five reported the response to fractional photothermolysis. The response to lasers was not consistent among the reports. Adverse events including hyperpigmentation were reported in several studies. The durability of melasma improvement was limited in all cases where laser was used as monotherapy. In studies that compared laser to topical treatments, laser-based monotherapy failed to show benefit over topical treatments. This analysis suggests that the use of lasers for the treatment of melasma cannot be recommended, due to unpredictable safety and efficacy, time-limited clinical improvement, and no clear benefit over conventional treatments.

Lasers in skin cancer prophylaxis

Skin cancer is the most common malignancy, with over 1 million cases diagnosed annually in the USA, comprising more than a third of cancers in the USA [101]. Cutaneous malignancies are amenable to early diagnosis and treatment, owing to their visual accessibility; the same advantage should facilitate preventative measures in high-risk individuals or in cases of known or suspected premalignant lesions. Topical and systemic pharmaceuticals are used in daily practice, but lasers – which have hitherto been limited to the treatment of diagnosed malignancies – provide a safe and well-controlled technology for treating focal or wide areas at high risk for cutaneous malignancy. The lasers used act by a variety of mechanisms, including selective photothermolysis, nonselective ablation or through the use of coherent light sources for photodynamic therapy. These mechanisms and the ability to apply them directly make lasers a promising tool in the dermatologist’s armamentarium in the battle against skin cancer.

Treatment of actinic keratoses and photodamage with non-contact fractional 1540-nm laser quasi-ablation: an ex vivo and clinical evaluation

The main use of non-ablative fractional photothermolysis today is for the improvement of wrinkles and scars. The purpose of this work was to evaluate the effect of a “classic” non-ablative fractional 1540nm on facial photodamaged skin and actinic keratoses. Seventeen patients with facial actinic keratoses (AKs) and photodamage underwent two or three laser treatments with fractional 1540-nm erbium glass laser at fluences of 75 mJ, 15 ms pulse duration, and 10-mm spot size in non-contact mode. Two blinded assessors and participants evaluated clinical improvement of treatment areas after 3 months, using a quartile grading scale (no improvement = 0, 1–25% improvement = 1, 26–50% = 2, 51–75% = 3, and 76–100% = 4). Three months after the last treatment, the mean level of improvement was 3.4 ± 0.72 for AK and 3.3 ± 0.54 for skin appearance. Adverse events observed after each treatment were moderate erythema, mild edema, erosions (two cases), and mild desquamation. No scarring or post-inflammatory pigmentary changes were observed. The clinical results were supported by histological changes observed in Yucatan pig studies in vivo and ex vivo. The 1540-nm fractional erbium glass laser in the non-contact mode is a safe and effective treatment for facial photodamage and AKs.

Commentary: Approach to the Rare Eccrine Tumors

The current case report describes the diagnosis and management of a little recognized cutaneous malignancy, representing 0.005% of all malignant epithelial neoplasms. It is a member of a large family of sweat gland neuroendocrine carcinomas with more than 10 subtypes, including microcystic adnexal carcinoma, mucinous adenocystic carcinoma, endocrine mucin-producing sweat gland carcinoma, sclerosing sweat duct carcinoma, eccrine ductal adenocarcinoma, mucoepidermoid carcinoma, basaloid eccrine carcinoma, eccrine spiradenoma, eccrine porocarcinoma, clear cell eccrine carcinoma, hidradenocarcinoma, aggressive digital papillary adenocarcinoma, and carcinosarcoma. It is thought that some of these subtypes may exist on a continuum representing multistage progression.