Yau-Li Huang

Treatment of melasma with mixed parameters of 1,064-nm Q-switched Nd:YAG laser toning and an enhanced effect of ultrasonic application of vitamin C: a split-face study

Melasma is an acquired pigment disorder showing symmetrical hyperpigmentation of the face characterized by light to dark brown patches with indistinct borders on both cheeks. Melasma is prevalent in middle-aged women with harmless hormone imbalances. It is also known as the mask of pregnancy and is prevalent in most child-bearing women. It fluctuates month by month, and yet, there is no promising treatment. The Q-switched neodymium-doped yttrium aluminum garnet (QS-Nd:YAG) laser (1,064-nm wavelength) was introduced in Asia years ago for both skin toning and treatment of facial pigment. This low-fluence, 1,064-nm QS-Nd: YAG laser also reportedly improved melasma. Adjunctive treatments such as vitamin C iontophoresis or chemical peels were recommended in other reports. The technique using the 1,064-nm QS-Nd:YAG laser for toning and the enhancement of adjunctive treatments need further investigation and long-term follow-up before recommendations for the ideal protocol for melasma treatment can be made. The aim of this study is to evaluate the improvement of melasma using different parameters with the 1,064-nm QS-Nd:YAG laser with ultrasonic application of topical vitamin C. Eight patients, ranging in age from 32 to 45xa0years (mean 37xa0years), with long-term melasma were studied. Most of the melasma cases were dermal or mixed-type melasma. The patients had no cosmetic treatment (laser, intense pulsed light, or chemical peel) 1xa0year prior to the study. The entire face of each patient was treated with the 1,064-nm QS-Nd:YAG laser for four sessions at 1-month intervals. The laser treatment was divided into three parts with different parameters. First, each patient underwent whole face exposure for one pass with an 8-mm spot size at a power of 2.0xa0J/cm2. Next, the spot size was shifted to 6xa0mm at a power of 3.5xa0J/cm2 for one full-face pass, and then ended with a 4-mm spot size at 3.2xa0J/cm2 for one full-face pass, with multiple passes for the main lesions. The end point was mild erythema and swelling, without petechiae. All patients applied ice packs for 5xa0min before the adjunctive treatment. We designed a split-face study with or without ultrasonic application of topical vitamin C. Only the right side of the face received ultrasonic melasma application of vitamin C for 15xa0min after ice packing. The left side of the face was covered with a moisturizing lotion. Objective evaluation was performed with visual analog score. All eight patients completed the 3-month follow-up after the four laser treatments. Statistics showed significant improvement with ultrasonic application of vitamin C compared to laser monotherapy. The improvement was more pronounced during second to fourth sessions. There was no rebound or post-inflammatory hyperpigmentation detected during the 3-month follow-up period. The combination of 1,064-nm QS-Nd:YAG laser treatment with ultrasonic application of topical vitamin C exerted more prompt response of melasma. We recommended this protocol including mixed parameters of 1,064-nm QS-Nd:YAG laser toning method combining with vitamin C ultrasonic application that can yield higher satisfaction for the difficult facial pigmentation problems such as melasma.

Combination therapy of focused ultrasound and radio-frequency for noninvasive body contouring in Asians with MRI photographic documentation

Previous studies have shown that single or multiple treatments by focused ultrasound are effective and safe. However, most include focused ultrasound only and not radio-frequency treatment. There is paucity of magnetic resonance imaging (MRI) measurements and pictures in the literature. This study aimed to assess the efficacy, safety, and pain and satisfaction levels of the combination therapy of focused ultrasound and radio-frequency for improving body contours. Thirty-two Asian patients received 3 sequential treatments every 2xa0weeks in the abdominal region. Safety parameters and adverse events were recorded. The subjects’ pain and satisfaction levels were evaluated using a five-point Likert scale. Two patients underwent MRI study randomly. There was a mean reduction in circumference of 3.91u2009±u20091.8xa0cm (pu2009≤u20090.001). In MRI measurement, the average in fat thickness reduction was 21.4 and 25xa0% on the upper and lower abdomen, respectively. There were three mild and self-limited localized adverse events. The satisfaction survey showed that 71.9xa0% was satisfied with the results, while pain level evaluation showed that 90.5xa0% felt no pain. Combination therapy of focused ultrasound and radio-frequency for noninvasive body contouring is an effective, safe, and painless procedure in Asians. Although the change is minor compared to traditional surgical procedure, it is real, definite, and effective.

A comparison of Ki-67 antigen presentation in acute generalized exanthematous pustulosis and pustular psoriasis

Ki-67 is an established marker of cell proliferation. It is highly expressed in psoriasis and correlated with the clinical severity of psoriasis. Higher number of Ki-67 positive keratinocytes has been observed in pustular psoriasis (PP) as compared with psoriasis vulgaris. As for Acute generalized exanthematous pustulosis (AGEP), a distinct disease entity but similar in many aspects of clinicopathologic features to PP, Ki-67 immunostaining presentation has never been investigated before. This study aimed to compare Ki-67 immunostaining presentation between PP and AGEP. By immunohistochemical staining, we compared Ki-67 immunostaining presentation on skin lesions of five patients of AGEP and five age-matched patients of PP. Ki-67 positive keratinocytes were counted and mean values were determined to compare between PP and AGEP. An augmented presence of Ki-67 positive keratinocytes was found in both AGEP and PP and they distributed not only in basal cell layer but in middle or even upper part of epidermis. Statistical analysis using Mann–Whitney U test showed no difference of epidermal proliferation rate between the two groups (Pxa0=xa00.222). The results showed there was no difference of Ki-67 immunostaining presentation between AGEP and PP. Besides, we found marked increase of Ki-67-positive proliferating keratinocytes in AGEP and suggested that epidermal hyperproliferation may also play an important role in the formation of AGEP. We also discussed the possible pathophysiology of AGEP, possible epidermal architecture changes in AGEP and PP, and found the similarity in pathophysiology of AGEP and PP.

Clinical analysis and classification of dark eye circle

Dark eye circle (DEC) is a common problem that usually lacks detailed classification in the etiology and structural variations. A newly‐developed DEC Assessment Score using Woods lamp and ultrasonogram will provide a more precise evaluation of DEC for improving treatment results.

Fractional CO2 Laser Pretreatment Facilitates Transdermal Delivery of Two Vitamin C Derivatives

Background: Topical vitamin C derivatives have been used to treat melasma and used as a skin whitener. The aim of this study was to compare skin histology and permeation of l-ascorbic acid 2-phosphate sesquimagnesium salt (MAP-1) and magnesium l-ascorbic acid-2-phosphate (MAP-2) after fractional CO2 laser pretreatment. Methods: The effect of fractional laser treatment on porcine skin was examined by scanning electron microscopy and confocal laser scanning electron microscopy. The effect of fractional CO2 laser treatment of different fluencies and pass numbers on transdermal flux of the two vitamin C derivatives through porcine skin was examined in vitro using a Franz diffusion chamber. Results: Fluxes of MAP-1 and MAP-2 across fractional CO2 laser-treated (5 W) skin were eight- to 13-fold, and 20- to 22-fold higher, respectively, than the fluxes of these compounds across intact skin. Fluxes of MAP-1 and MAP-2 across fractional CO2 laser-treated (9 W) skin were 14- to 19-fold, and 30- to 42-fold higher, respectively, than their fluxes across intact skin. Conclusion: Fractional CO2 laser treatment is an effective way of delivering vitamin C derivatives into the skin.

Long-term follow-up for noninvasive body contouring treatment in Asians

There are versatile modalities to achieve noninvasive fat reduction, and most of them have proven to be effective for circumferential reduction of local fat tissue, without any serious or permanent adverse effects. However, the follow-up time is short, ranging from 1 to 24xa0weeks. Most of the patients would like to know how long will its effect last and whether there is long-term side effect or not. The aim of this study was to assess the long-term efficacy and safety of combination therapy of focused ultrasound and radio frequency for noninvasive body contouring. Thirty-two Asian subjects received three sequential combination therapies of focused ultrasound and radio-frequency treatments every 2xa0weeks in the abdominal region and were followed up 1xa0month and 1xa0year after the last treatment. After a year, 5 patients were loss follow-up and 2 were pregnant. Finally, 25 healthy Asian subjects (18 females and 7 males) were enrolled in this study. Safety parameters and adverse events were recorded. The mean body weight change remained constant without a significant change 1xa0year after treatment and was 0.1u2009±u20091.2xa0kg (pu2009=u20090.513). The mean abdominal circumference change between 1xa0month and 1xa0year after the last treatment was 0.4u2009±u20091.2xa0cm and was not significant (pu2009=u20090.169). The relationships between weight change and circumference change of the 23 patients were tested using Spearman’s rho correlation coefficient. There was a correlation between weight change and circumference change (0.73; pu2009=u20090.000). The procedure was safe without a recordable long-term adverse event. The combination therapies of nonthermally focused ultrasound and radio-frequency treatments for body contouring in the abdominal region are effective and may show positive results for at least a year if patients can maintain their body weight. The procedure is safe without recordable long-term adverse events in this study.

Pulsed alexandrite laser for treatment of melasma in Asian patients

ABSTRACT Background: Melasma is a common acquired facial hypermelanosis with irregular brownish macules and patches. The clinical course is often fluctuated and refractory to treatment. The present study was conducted to evaluate the efficacy and safety of pulsed alexandrite laser for the treatment of melasma. Materials and methods: In the present study, we enrolled Asian patients with melasma. All the patients received four monthly treatments with a pulsed alexandrite laser. The severity of melasma was evaluated by a blinded dermatologist, using the Modified Melasma Area and Severity Index (MMASI), and by patient assessment, using a visual analogue scale, at baseline, before each treatment, and at the 1-month and 3-month follow-up visits after the last treatment. Results: Twenty-three patients completed all treatments and follow-up visits. The MMASI scores decreased significantly from 8.71 ± 5.83 at baseline to 6.07 ± 4.65 after four sessions of treatment (P < 0.05) and 6.91 ± 4.97 at 3 months after the last laser treatment (P < 0.05). After 4 sessions of treatment, 10 patients (43.5%) described their improvement as marked and excellent (>60% improvement). The treatments were well tolerated with only mild skin reaction. Conclusion: In the present study, we demonstrated that the pulsed alexandrite laser is safe and effective to treat melasma in Asian skin.

A split-face study: comparison of picosecond alexandrite laser and Q-switched Nd:YAG laser in the treatment of melasma in Asians

To evaluate efficacy and safety of picosecond 755xa0nm alexandrite laser as compared to 1064xa0nm QS-Nd:YAG laser for melasma treatment in Asians. Twelve patients received 4 sessions of treatments at 1-month interval in a split-face manner. The right side of each patient’s face received 755xa0nm picosecond laser, and the other side received 1064xa0nm QS-Nd:YAG laser. Zoom handpiece of 755xa0nm picosecond laser at fluence of 0.88–1.18xa0J/cm2 was applied. The treatment protocol used for 1064xa0nm QS-Nd:YAG laser was 8xa0mm spot size at fluence of 2.0xa0J/cm2 initially followed by 6xa0mm spot size at fluence of 3.5xa0J/cm2, and finishing with 4xa0mm spot size at 3.2xa0J/cm2. For both 755xa0nm picosecond laser and 1064xa0nm QS-Nd:YAG laser, the endpoint was mild erythema and swelling without petechiae. Objective evaluation with visual analogue score was conducted by two independent physicians. Subject self-assessment for each patient was conducted as well. Statistical results showed that higher pigmentation clearance rate was achieved at the 755xa0nm picosecond laser side after the second treatment. At the 3xa0months follow-up, greater clearance was observed at the 755xa0nm picosecond laser side compared to the 1064xa0nm QS-Nd:YAG side. 755xa0nm alexandrite picosecond laser has been observed to achieve a faster and better clearance rate for melasma compared to 1064xa0nm QS-Nd:YAG laser. We conclude that the 755xa0nm picosecond laser could be a safe and effective modality for melasma treatment in Asians.

Harvested vs estimated follicular units in hair transplantation

The follicular unit transplantation strip harvesting surgery is one of the gold standard methods of hair transplantation; the counting follicular unit ratio and hair density is a major step in donor site evaluation.

Dermoscopic Features of Cutaneous Lymphoepithelioma-like Carcinoma.

dard excision with wide surgical margins for the treatment of local high-risk SCC. In addition, the literature is lacking prospective studies regarding survival and recurrence rates of lentigo maligna melanoma treated with Mohs surgery compared with the semi-Mohs technique. Even though the reconstructive aspect of Mohs surgery is of very high value, it is very difficult to perform high-level evidence-based studies on the technique; this is why the authors believe that prospective studies in this area need to be focused on cure rate and complications and stratified for the different histologic tumor subtypes, sizes, location, and age groups. This study emphasizes the unmet need for multicenter prospective controlled studies in those fields.