Yoram Harth

Acne phototherapy using UV-free high-intensity narrow-band blue light: a three-center clinical study

Propionibacterium. acnes is a Gram positive, microaerophilic bacterium which takes a part in the pathogenesis of inflammatory acne. P. acnes is capable to produce high amounts endogenic porphyrins with no need of any trigger molecules. Light in the violet-blue range (407-420 nm) has been shown to exhibit a phototoxic effect on Propionibacterium acnes when irradiated in vitro. The purpose of our study was to test the clinical effects of a high intensity narrowband blue light source on papulo pustular acne. A total of 35 patients in 3 centers were treated twice a week with a high intensity metal halide lamp illuminating the entire face (20x20 cm2) or the back with visible light in the 407-420 nm range at an intensity of 90 mW/cm2 (CureLight Ltd.) for a total of 4 weeks. UV is totally cut off. In each treatment the patient was exposed to light for 8-15 minutes. After 8 treatments, 80% of the patients with mild to moderate papulo-pustular acne showed significant improvement at reducing the numbers of non- inflammatory, inflammatory and total facial lesions. Inflammatory lesion count decrease by a mean of 68%. No side effects to the treatment were noticed. In conclusion, full face or back illumination with the high intensity pure blue light we used exhibits a rapid significant decrease in acne lesions counts in 8 biweekly treatments.

In vivo animal histology and clinical evaluation of multisource fractional radiofrequency skin resurfacing (FSR) applicator

Abstract Objective. Acne scars are one of the most difficult disorders to treat in dermatology. The optimal treatment system will provide minimal downtime resurfacing for the epidermis and non-ablative deep volumetric heating for collagen remodeling in the dermis. A novel therapy system (EndyMed Ltd., Cesarea, Israel) uses phase-controlled multi-source radiofrequency (RF) to provide simultaneous one pulse microfractional resurfacing with simultaneous volumetric skin tightening. Methods. The study included 26 subjects (Fitzpatricks skin type 2–5) with moderate to severe wrinkles and 4 subjects with depressed acne scars. Treatment was repeated each month up to a total of three treatment sessions. Patients’ photographs were graded according to accepted scales by two uninvolved blinded evaluators. Results. Significant reduction in the depth of wrinkles and acne scars was noted 4 weeks after therapy with further improvement at the 3-month follow-up. Conclusion. Our data show the histological impact and clinical beneficial effects of simultaneous RF fractional microablation and volumetric deep dermal heating for the treatment of wrinkles and acne scars.

Non-invasive therapy of wrinkles and lax skin using a novel multisource phase-controlled radio frequency system

Abstract The last few years have shown an increased demand for non-invasive skin tightening to improve body contour. Since light (lasers or intense pulsed light sources) has a limited ability to penetrate deep into the tissue, radio frequency (RF) modalities were introduced for the reduction of lax skin to achieve skin tightening and body circumference reduction. This study presents the use of the novel 3DEEP™ technology for body contouring. 3DEEP is a next generation RF technology that provides targeted heating to deeper skin layers without pain or other local or systemic side effects associated with the use of the earlier generation RF systems available today. The study included 30 treatment areas on 23 healthy volunteers at two sites. The treatment protocol included four weekly and two bi-weekly (n= 6) treatments on different body areas. Results were evaluated by standardized photography and by circumference measurements at the treatment area, and were compared to changes in body weight. Significant improvement could be observed in wrinkles and skin laxity, and in the appearance of stretch marks and cellulite. Some changes appeared as early as after a single treatment. Circumference changes of up to 4.3 cm were measured.

Influence of cumulative sun exposure on the prevalence of common acquired nevi

BACKGROUND Conflicting evidence exists on the relation between sun exposure and the number of common acquired nevi. The increase in the number of common acquired nevi until early adulthood and their greater concentration on sun-exposed areas suggested that the growth of common acquired nevi is promoted by UV radiation. Nevertheless, it was noticed that although solar exposure accumulates with age, the number of common acquired nevi decreases after the third decade. OBJECTIVE Our purpose was to examine the relation between the prevalence of common acquired nevi and accumulative sun exposure. METHODS The number of common acquired nevi on 128 patients with multiple solar keratoses (SK) was compared with their number on 82 control subjects. The existence of SK served as a biologic marker for long-term solar effects. RESULTS On patients with SK we counted 1285 nevi (mean 10.0 nevi per person) and on control subjects, 1521 nevi (mean 18.5 nevi) (p = 0.0046; Kruskal-Wallis test). The finding that persons exhibiting signs of accumulating sun effects have fewer nevi was maintained irrespective to differences of gender, occupation, and complexion. CONCLUSION Our data suggest that accumulating solar effects may contribute to the natural maturation and elimination of common acquired nevi in late adulthood.

Histopathologic findings in the clinically uninvolved skin of patients with mycosis fungoides.

Several of the methods of treating plaque-stage mycosis fungoides (MF) advocate treatment of the whole skin, although relatively little information exists on the histo-logic appearance of clinically uninvolved MF skin. Our study was performed to elucidate the histologic appearance of the clinically uninvolved skin of plaque-stage MF patients. Biopsies were taken from the clinically uninvolved skin of 18 untreated patients with plaque-stage MF, 1 cm (near) and 5=10 cm (far) from the MF plaques, and from 23 normal, healthy controls. Eight to 12 serial sections from each specimen were examined. The most common histologic finding, which was observed in six (33%) biopsies of near skin and four (22%) biopsies of far skin compared with only one (4%) biopsy of normal control (p = 0.02 and 0.1, respectively), consisted of mono-nuclear-cell infiltrate around a blood vessel in the papillary dermis, with extension of some of these cells into the overlying epidermis. More diffuse and epidermotropic mononuclear cell infiltrates were seen in an additional three (17%) biopsies of near skin, whereas mild nonepi-dermotropic superficial perivascular or perifollicular mononuclear cell infiltrates were observed in an additional four (17%) biopsies of the normal controls. In conclusion, the most common histologic finding in our study, which was observed predominantly in the MF group, might represent an earlier stage and clinically undetect-able involvement of the normal-looking skin in MF patients.

Mucinous syringometaplasia : An immunohistochemical and ultrastructural study of a case

Mucinous syringometaplasia (MS) is an unusual skin lesion of unknown etiology, characterized histologically by epidermal invaginations lined by mucin-laden goblet-like cells and by nonkeratinized squamous cells. The present case study was performed to elucidate further the characteristics of this lesion using immunohistochemistry and electron microscopy. The mucin-laden cells in the MS lesion stained positively for carcinoembryonic antigen, epithelial membrane antigen, and low molecular weight keratins. The ultrastructural examination, which was performed on deparaffined sections, revealed two morphological variants of mucous granules. Electron-dense mucous granules predominated in the mucus-containing cells, which were situated among the keratinocytes adjacent to the epidermal invaginations, mostly in the lower parts of the epidermis. Larger, electron-lucent granules containing flocculent material were found more abundantly in the cells lining the epidermal invaginations. Also, some of the mucus-containing cells showed bundles of tonofilaments; structures that appeared to be isolated short, stubby microvilli; and attachments to adjacent mucus-containing cells and keratinocytes by desmosomes. The ultrastructural and immunohistochemical findings in our case suggest that the mucinous changes occurred as a metaplastic process in the resident epidermal cells and were accompanied by changes in cellular antigen expression resembling those of simple secretory epithelium.

Awarness to photodamage versus the actual use of sun protection methods by young adults

Objective There is accumulating evidence that in spite of the large campaigns against excessive solar exposure undertaken by dermatologists worldwide, children and adolescents are still spending long periods in the sun, and do not follow the recommended sun protection guidelines.

A 12-week clinical and instrumental study evaluating the efficacy of a multisource radiofrequency home-use device for wrinkle reduction and improvement in skin tone, skin elasticity, and dermal collagen content

This study was performed in order to evaluate the safety and efficacy of a new handheld home-use multisource radiofrequency device on facial rejuvenation. Forty-seven male and female subjects were enrolled. All subjects received a NEWA® 3DEEP™ home-use device (EndyMed Medical, Caesarea, Israel) to be used on facial skin three times per week for the first four weeks and then reduced to two times per week for the following eight weeks. Assessments included expert clinical grading for efficacy, instrumental evaluation, image analysis, and photography. Forty-five subjects completed the study; all subjects reported the treatment to be painless with only mild erythema lasting up to 15 minutes post-treatment. No other adverse events were reported. Statistically significant improvements were noted in the appearance of marionette lines, skin brightness, elasticity, firmness, lift (facial), lift (jawline), texture/smoothness, tone, and radiance/luminosity by expert visual assessment. Statistically significant improvements in skin firmness and elasticity were found using a Cutometer MPA 580, as well as in collagen and hemoglobin content of the skin using a SIAscope. The results of this study indicate that the NEWA® multisource radiofrequency home-use device is effective in self-administered skin rejuvenation.