Susanne Astner

Utilizing fractional resurfacing in the treatment of therapy-resistant melasma

Background. Multiple treatment modalities have been employed for the management of melasma with minimal to no success. Objective. We propose fractional resurfacing as a new treatment modality for melasma. Methods. A 31‐year‐old Caucasian female with facial epidermal and dermal melasma, resistant to multiple courses of topical therapies, was treated with two sessions of full‐face fractional resurfacing (FraxelTM Laser; Reliant technologies, San Diego, CA), separated by a three‐week interval. Clinical improvement was assessed by Woods Lamp examination as well as parallel and cross‐polarized comparative photography at baseline and 6 months later. Results. Marked reduction in epidermal and dermal facial pigmentation was observed at the six‐month follow‐up visit. Conclusion. Fractional resurfacing may prove to be an effective and safe treatment modality for lightening of the epidermal and dermal pigmentation of melasma. Further studies with long‐term follow‐up periods and multiple patients with diverse skin phototypes and different variants of melasma are warranted

Noninvasive evaluation of allergic and irritant contact dermatitis by in vivo reflectance confocal microscopy.

Background: The clinical differentiation of allergic contact dermatitis (ACD) and irritant contact dermatitis (ICD) is often difficult to accomplish. Reflectance‐mode confocal microscopy (RCM) is an imaging technique that has previously been used to examine ACD and ICD noninvasively in vivo. Objective: To determine characteristic features of ACD and ICD and their kinetic evolution over time. Ethnic susceptibility to contact irritants such as sodium lauryl sulfate and Ivory dishwashing liquid was evaluated noninvasively, and the sensitivity and specificity of RCM parameters were analyzed in a clinical context and in reference to patch testing. Methods: Subjects were patch‐tested with allergens, irritants, and controls. Clinical scoring and RCM evaluation were performed at various time points, assessing stratum corneum (SC) disruption, spongiosis, exocytosis, vesicle formation, and epidermal thickness. Results: RCM features of both ACD and ICD include spongiosis, exocytosis, vesicle formation, and blood vessel dilatation. SC disruption, epidermal necrosis, and hyperproliferation are hallmarks of ICD whereas ACD more typically presents with vesicle formation. Patients with ICD showed a more rapid recovery than those with ACD. When tested with Ivory soap at selected concentrations, Caucasians, when compared to African Americans, showed significantly lower clinical thresholds for ICD and features that were more severe. Conclusions: RCM may be a promising new technology for longitudinal noninvasive studies of contact dermatitis (CD). Using a diagnostic algorithm and those parameters with high sensitivity for CD, RCM may facilitate the differentiation of acute ACD and ICD. RCM can reliably visualize cutaneous changes at subclinical degrees of CD, which suggests a possible role for RCM as an adjunctive tool in CD diagnosis. The results of this pilot study also indicate ethnic differences in the response to contact irritants. However, further studies are needed to substantiate the relevance and clinical applicability of our findings.

Treating vascular lesions

ABSTRACT:  The treatment of acquired vascular lesions is one of the most commonly requested and performed cutaneous laser procedures. Furthermore, every year, 40,000 children are born in the United States each with congenital vascular lesions and malformations. Laser treatment of vascular lesion is based on the principle of selective photothermolysis, conceived in the 1980s. A variety of different lasers and light sources have since been used in the treatment of vascular lesions: lasers with wavelengths between green and yellow, near infrared lasers, and broadband light sources. Despite limitations, this remains the treatment of choice today. This publication addresses acquired and congenital vascular lesions as different entities and proposes a separation of vascular lesions into those that can easily be treated from those where clearance is difficult. Different treatment modalities and the various endpoints of individual vascular lesions will be discussed.

In vivo assessment of pigmentary and vascular compartments changes in UVA exposed skin by reflectance-mode confocal microscopy.

Abstract:  Exposure of the skin to ultraviolet A (UVA) results in various biological responses, skin‐colour changes being among the major ones. Although intense research has been performed on UVA‐induced pigmentation and vascular changes, the process of skin‐colour changes after UVA irradiation remains unclear. For a better understanding of the UVA tanning mechanism, we here performed a human study in 27 healthy volunteers with skin phototype (SPT) II to VI. After a single UVA exposure to inner forearm, the skin sites were imaged using reflectance‐mode confocal microscopy (RCM), for analysis of melanin and vascular changes. Punch biopsies were also taken from the UVA‐exposed or non‐exposed sites for histological examination. Skin sections were stained with Fontana‐Masson and evaluated by a sensitive tyrosinase assay for comparison with RCM images. Furthermore, the effect of blood flow on skin‐colour changes was evaluated visually after administration of an intradermal anesthesia of lidocaine with or without epinephrine. Our RCM analysis showed dendritic melanocytes and a different melanin distribution in the epidermal layer, clearly visible 1 week after the UVA exposure in subjects of SPT V which were supported by histological examination. However, no melanin distribution pattern changes were apparent immediately after the exposure, while RCM images showed accelerated capillary flow patterns. The restriction of this UVA induced‐accelerated blood flow by epinephrine inhibited partially or completely the immediate pigment darkening and delayed tanning. These in vivo studies confirmed that vascular change is an important factor for the development of the immediate pigment darkening and delayed tanning.

Effects of a 1,450 nm diode laser on facial sebum excretion.

Laser therapy with a 1,450 nm diode laser is a clinically effective treatment for acne vulgaris, although the mechanism of action is unknown. To investigate this, we conducted a small, prospective, controlled clinical trial to assess this lasers effects on the facial sebum excretion rate (SER).

Clinical Evaluation of a 1,450‐nm Diode Laser as Adjunctive Treatment for Refractory Facial Acne Vulgaris

BACKGROUND Despite aggressive multitreatment medical acne regimens, many patients demonstrate modest benefit. The 1,450-nm diode laser has been shown to improve acne in a study setting. OBJECTIVE Herein we evaluate the use of this laser as an adjunctive tool in the management of refractory facial acne vulgaris. MATERIALS AND METHODS Thirteen patients were treated. Lesion counts, clinical evaluation, and digital photography were performed at baseline and at all follow-up visits. Patients received an average of three treatments. Acne severity index and patient satisfaction were assessed. Patients continued their medical acne regimen where applicable. RESULTS Mean total lesion and inflammatory lesion counts decreased from 66 ± 14 and 23 ± 5 at baseline to 34 ± 12.9 and 14 ± 7 after three treatments (p<.05). Side effects were mild, including erythema lasting up to 24 hours. CONCLUSION The 1,450-nm diode laser provides moderate improvement of refractory acne vulgaris. Our findings support the use of this device as an adjunctive treatment for acne management.