Yong-Kwang Tay

Minimally Ablative Erbium:YAG Laser Resurfacing of Facial Atrophic Acne Scars in Asian Skin: A Pilot Study

BACKGROUND Atrophic scars are dermal depressions caused by collagen damage most commonly occurring after inflammatory acne vulgaris. There are little published data regarding the effectiveness and safety of minimally invasive lasers in the treatment of atrophic acne scars in darker skin types. OBJECTIVE The purpose was to evaluate the efficacy and safety of a low-fluence 2,940-nm erbium:YAG laser in the treatment of atrophic acne scars in Asian patients. MATERIALS AND METHODS Nine patients aged 19 to 45 years with mild to moderate atrophic facial scars and Skin Types IV and V were treated with topical anesthesia and one to two passes with an erbium:YAG laser two times at 1-month intervals. Treatment parameters were 6-mm spot size, fluence of 400 mJ, pulse duration of 300 μs, and repetition rate of 2 Hz. RESULTS At 2 months after the last treatment, mild to moderate clinical improvement was noted in all patients compared to baseline. Treatment was well tolerated. Side effects consisted of posttreatment erythema, peeling, and crusting, which resolved within 1 to 2 weeks. There was no postinflammatory hyper- or hypopigmentation, blistering, or hypertrophic scarring. CONCLUSION Low-fluence erbium:YAG facial resurfacing was effective and safe in patients with mild to moderately severe atrophic acne scarring.

Treatment of infantile hemangiomas with the 595-nm pulsed dye laser using different pulse widths in an Asian population.

The pulsed dye laser (PDL) using varying fluences and pulse durations have been used to treat hemangiomas. This study aims to examine the efficacy and safety of the 595‐nm PDL for the treatment of infantile hemangiomas using short (1.5–3 milliseconds) versus long (10 milliseconds) pulse durations and high fluences.

Long pulsed dye laser treatment of facial wrinkles

BACKGROUND: The flashlamp pulsed dye laser has been used in the treatment of rhytids. OBJECTIVE: To evaluate the efficacy of the long pulsed dye laser in the treatment of mild to moderate wrinkles in Asian patients. METHODS: Wrinkles on one half of the face in 10 subjects were treated with the long pulsed dye laser (595 nm, 10 mm spot size, 10 ms, 7 J/cm2, 40 ms spray, 40 ms delay, single-pass, 30% overlap) with the other side serving as a control. A total of three treatments were given at 2 monthly intervals. The following sites were treated: periorbital area, six patients; forehead, two patients; cheek, two patients. No preoperative anesthesia or postoperative treatment were used. Clinical photographs were taken before and after each treatment, and analysis was undertaken through photographic evaluation by non-treating physicians. RESULTS: At 2 months after the last treatment, the clinical improvement of rhytids was noted in all patients compared with baseline. Four subjects had mild improvement (≤⃒ 25%), five had moderate improvement (26-50%) and one had marked improvement (51-75%). The periorbital area was more responsive to treatment compared with the other sites. No clinical changes were noted in the control areas. No adverse effects were reported except for transient mild erythema in two patients which lasted for up to an hour. Nine patients were somewhat satisfied with the treatment and one was highly satisfied. All wanted the other half of the face to be treated. CONCLUSION: Treatment with a non-ablative 595 nm flashlamp pulsed dye laser can lead to mild to moderate clinical improvement in class I-II rhytids with minimal to no side effects in patients with darker skin types.

Inflammatory morphea mimicking an acquired port-wine stain initially treated with pulsed-dye laser

Abstract The early inflammatory lesions of morphea may present with erythema or violaceous patches and plaques before evolving into areas of sclerosis. They have been misdiagnosed as acquired port-wine stains (PWSs). We report a previously well 7-year-old Chinese girl presenting with early facial morphea mimicking an acquired PWS with unusual histologic features of perineural inflammation. The presence of cutaneous perineural inflammation may be seen in a small percentage of cases of morphea and appears to be a feature of early inflammatory morphea. We report this case to highlight the importance in recognizing this entity and summarize the reported cases of inflammatory morphea mimicking acquired PWSs.

A novel radiofrequency device for the treatment of rhytides and lax skin: A pilot study

Background: Radiofrequency devices generate electromagnetic energy to induce dermal heating to a critical temperature of about 65°C, causing collagen to shrink and contract, and this provides a non‐ablative means to improve rhytides and lax skin. Objective: To evaluate the efficacy and safety of a novel radiofrequency device (Photo Bio Care, Thailand) operating at a frequency of 1.75u2005MHz for the treatment of rhytides and lax skin in Asian patients. Methods: Six female patients (age range, 30–60 years; mean age 48 years) with class I and II facial rhytides and Fitzpatrick skin types III and IV were treated six times at intervals of 2–3 weeks. The forehead, periorbital area, cheeks and nasolabial folds were treated using the following parameters: monopolar mode, pulse duration of 5u2005s, frequency of 18u2005Hz, and power of 100u2005W. No preoperative anesthesia or postoperative treatment were used. The handpiece was applied to the skin in a continuous sweeping motion until the baseline skin temperature was elevated to 40°C, as monitored with a laser thermometer, and this was maintained for 3 minutes. Clinical photographs were taken before, after the sixth treatment and 2 months after the last treatment. Analysis was undertaken through photographic evaluation by non‐treating physicians. Results: At 2 months after the last treatment, mild to moderate (25–50%) clinical improvement was noted in all patients compared to baseline, and all patients were somewhat satisfied with the treatment. The procedure was well tolerated with no unexpected side effects. Discomfort was rated as mild and post‐treatment erythema resolved within 1–2 hours. Conclusion: Treatment with the radiofrequency device can result in mild to moderate clinical improvement of age‐related rhytides and lax skin. The system is safe and inexpensive with no consumables required.

Retrospective analysis of earlobe keloids treated with the carbon dioxide laser ablation or cold steel debulking surgery

Abstract Background: Treatment of keloids is a therapeutic challenge. Objectives: To determine the outcome and the risk of recurrence after debulking cold steel surgery or carbon dioxide (CO2) laser ablation of earlobe keloids. Material and methods: The case records of 16 patients with earlobe keloids managed at Changi General Hospital, Singapore, from 2003 to 2009 were reviewed retrospectively. Results: Fourteen patients were females, and the mean age at presentation was 20 years. Eight patients underwent CO2 laser ablation, six patients underwent cold steel surgery, one patient underwent both surgery and CO2 laser ablation, and one patient received only 40 mg/ml of intralesional triamcinolone acetonide. Fourteen patients were followed up for 1–24 months post procedure, and two patients defaulted. Both modalities were equally effective in debulking the earlobe keloids. All 13 patients who had either CO2 laser ablation or cold steel surgery had recurrence of keloid growth at 2–18 weeks post procedure. The patient who received intralesional triamcinolone acetonide therapy alone had only partial response to the therapy. Conclusions: Both the CO2 laser ablation and cold steel surgery were equally useful in reducing the size of the earlobe keloids, but were not effective in preventing regrowth of the keloids, even with adjunctive intralesional steroids. Patients should be clearly counselled regarding this.

Trousseau syndrome presenting with penile gangrene

NSAID: nonsteroidal anti-inflammatory drugs PSA: prostate-specific antigen INTRODUCTION Trousseau syndrome is a hypercoagulable state in association with an underlying malignancy. It is associated with myriad arterial and venous thrombotic events such as superior vena cava obstruction, noninfectious endocarditis, and myocardial infarction. Here we describe an unusual presentation of Trousseau syndrome in a patient with underlying prostate adenocarcinoma.

Linear atrophoderma of Moulin

Linear atrophoderma of Moulin (LAM) is a rare and distinct clinical entity characterized by acquired unilateral, hyperpigmented, and atrophic bandlike skin lesions following the lines of Blaschko. We report a rare and interesting case of LAM.

A Study Comparing the Efficacy and Risk of Adverse Events Using Two Techniques of Electrocautery for the Treatment of Seborrheic Keratoses

Seborrheic keratoses are among the most common skin tumors. They usually appear in the fifth decade in temperate countries but may develop earlier in tropical countries. Various theories exist for the etiology of seborrheic keratoses, including ultraviolet exposure. Also, a French working group has shown that the somatic fibroblast growth factor receptor 3 (FGFR3) mutation plays an important role in the development of seborrheic keratoses.