Whitney D. Tope

Hypertrophic Scarring of the Neck Following Ablative Fractional Carbon Dioxide Laser Resurfacing

Ablative fractional carbon dioxide (CO2) laser treatments have gained popularity due to their efficacy, shortened downtime, and decreased potential for scarring in comparison to traditional ablative CO2 resurfacing. To date, scarring with fractional CO2 lasers has not been reported.

Comparative Efficacy of Nonpurpuragenic Pulsed Dye Laser and Intense Pulsed Light for Erythematotelangiectatic Rosacea

BACKGROUND Erythematotelangiectatic (ET) rosacea is commonly treated with a variety of laser and light‐based systems. Although many have been used successfully, there are a limited number of comparative efficacy studies. OBJECTIVE To compare nonpurpuragenic pulsed dye laser (PDL) with intense pulsed light (IPL) treatment in the ability to reduce erythema, telangiectasia, and symptoms in patients with moderate facial ET rosacea. METHODS Twenty‐nine patients were enrolled in a randomized, controlled, single‐blind, split‐face trial with nonpurpuragenic treatment with PDL and IPL and untreated control. Three monthly treatment sessions were performed with initial PDL settings of 10‐mm spot size, 7 J/cm2, 6‐ms pulse duration and cryogen cooling, and initial IPL settings of 560‐nm filter, a pulse train of 2.4 and 6.0 ms in duration separated by a 15‐ms delay, and a starting fluence of 25 J/cm2. Evaluation measures included spectrophotometric erythema scores, blinded investigator grading, and patient assessment of severity and associated symptoms. RESULTS PDL and IPL resulted in significant reduction in cutaneous erythema, telangiectasia, and patient‐reported associated symptoms. No significant difference was noted between PDL and IPL treatment. CONCLUSION A series of nonpurpuragenic PDL and IPL treatments in ET rosacea was performed with similar efficacy and safety, and both modalities seem to be reasonable choices for the treatment of ET rosacea.

Magnetic resonance imaging and permanent cosmetics (tattoos): Survey of complications and adverse events

To use a survey to determine the incidence of complications and adverse events in individuals with permanent cosmetics (e.g., tattooed eyeliner, eyebrows, lips, cheeks, etc.) who underwent magnetic resonance (MR) imaging.

Photodynamic therapy with methyl aminolevulinate for primary nodular basal cell carcinoma: results of two randomized studies

Background  Data suggest that photodynamic therapy using topical methyl aminolevulinate (MAL PDT) may be a noninvasive alternative to excisional surgery for nodular basal cell carcinoma (BCC). In the studies described here, we investigated the histologic response, tolerability, and cosmetic outcome with MAL PDT for primary nodular BCC (≤ 5 mm in depth).

Multimodal management of diffuse neonatal hemangiomatosis

Diffuse neonatal hemangiomatosis is a rare, frequently fatal disorder. We describe the case of a neonate with numerous cutaneous and ocular hemangiomas. Hepatic hemangiomas were noted at 4 weeks of age, associated with congestive heart failure resulting from hepatic arteriovenous shunting. This condition was controlled by treatment with prednisone, interferon alfa-2b and hepatic embolization. Treatment of cutaneous hemangiomas with the tunable dye laser prevented hemorrhage, facilitated routine skin care, and allowed uninhibited intravenous access during hospitalization.

Neonatal pemphigus vulgaris in a child born to a woman in remission

We describe the tenth reported case of neonatal pemphigus that mimicked Barts syndrome and review previously published cases. Unlike previous cases, the child was born with significant blistering to a mother who was in complete remission throughout the pregnancy. High antepartum maternal titers of anti-intercellular space antibodies, increased maternal disease activity, and maternal disease that requires high doses of corticosteroids or use of combined therapy correlate with poor fetal outcome, including intrauterine death.

Overtreatment effects associated with a radiofrequency tissue-tightening device: rare, preventable, and correctable with subcision and autologous fat transfer.

Device complication rates were analyzed in the Regulatory and Quality Assurance departments of Thermage, Inc., Hayward, CA, USA, in consultation with Dr. Whitney D.Tope. Corrective treatment in the case study was performed at the Dermatology Surgery and Laser Center, White Plains, NY.

Eruptive pseudoangiomatosis: A unique childhood exanthem?

We describe three children with an acute onset and spontaneous resolution of angioma-like papules during an apparent viral illness. A biopsy specimen from one patient revealed a unique histologic appearance that consisted of dilated dermal blood vessels with plump hobnail-shaped endothelial cells. On the basis of the natural history and histopathologic features of this exanthem, we suggest the name eruptive pseudoangiomatosis.

State and territorial regulation of tattooing in the United States.

The popularity and thus the incidence of tattoos has increased dramatically within the last decade. According to a 1990 unpublished market survey of 10,000 randomly selected American households, 3% of all respondents and 5% of male respondents had a tattoo. 1 As another indicator, tattoo pigment sales have increased rapidly during the last 4 years.2 The largest supplier in the United States sells tattoo pigments and supplies to more than 37,000 regular customers (Spaulding & Rogers Manufacturing Inc., personal communication, April 1994). In addition to artistic tattoos, cosmetic tattoos are sought with increasing frequency. Although most tattoos are placed without complication, the increased number of tattoos and the existence of too-brief courses in cosmetic tattooing may have led to the increase in the number of adverse tattooing experiences recently publicized.3 In addition, the efficacy of laser tattoo removal will lead to a further increase in tattoos, particularly by impressionable persons who do not view tattoos as permanent.l The U.S. Food and Drug Administration (FDA) has considered but never implemented the inspection and regulation of tattoo pigment manufacture. Tattoo pigments are currently listed under the Food, Drug and Cosmetic Act of 1938 as “color additives” intended only for topical use. The FDA in 1976 limited concentrations of lead, arsenic, and mercury to 10, 3, and 3 parts per million, respectively.4 As yet the safety of tattoo pigments has not been rigorously established, and none is FDA approved for intradermal injection. ’ Thus no federal law exists regarding the manufacture of tattoo pigments for intradermal use or the practice of tattooing. Tattoo pigment manufacturers consider a pigment’s com-

Management of cutaneous verruciform xanthoma

Verruciform xanthoma is an uncommon mucocutaneous condition of uncertain cause that only occasionally affects the skin. The histopathology is distinctive for the presence of foamy histiocytes present within elongated dermal papillae. Although simple excision of intraoral lesions is reportedly curative, treatment of cutaneous lesions has not been previously reported. We describe a 62-year-old man with a large lesion of verruciform xanthoma affecting both inguinal folds. Immunohistochemical staining, reverse transcriptase polymerase chain reaction for human papilloma virus, and ultrastructural analysis were performed to investigate the pathogenesis of this lesion. The results of these studies support the theory that the source of lipid in dermal histiocytes is degenerating keratinocytes. Initial treatment with wire loop electrosection, pulsed dye (585 nm) laser, and x-ray therapy of this patient proved unsuccessful. Preliminary success has been achieved using wide surgical excision with primary closure.