Faculty Bibliography

Importance/UNASSIGNED:Laser-assisted drug delivery (LADD) is used for various medical and cosmetic applications. However, there is insufficient evidence-based guidance to assist clinicians performing LADD. Objective/UNASSIGNED:To develop recommendations for the safe and effective use of LADD. Evidence Review/UNASSIGNED:A systematic literature review of Cochrane Central Register of Controlled Trials, Embase, and MEDLINE was conducted in December 2019 to identify publications reporting research on LADD. A multidisciplinary panel was convened to draft recommendations informed by the systematic review; they were refined through 2 rounds of Delphi survey, 2 consensus meetings, and iterative review by all panelists until unanimous consensus was achieved. Findings/UNASSIGNED:Of the 48 published studies of ablative fractional LADD that met inclusion criteria, 4 were cosmetic studies; 21, oncologic; and 23, medical (not cosmetic/oncologic), and 6 publications of nonablative fractional LADD were included at the request of the expert panel, producing a total of 54 studies. Thirty-four studies (63.0%) were deemed to have low risk of bias, 17 studies (31.5%) had moderate risk, and 3 (5.5%) had serious risk. The key findings that informed the guidelines developed by the expert panel were as follows: LADD is safe in adults and adolescents (≥12 years) with all Fitzpatrick skin types and in patients with immunosuppression; it is an effective treatment for actinic keratosis, cutaneous squamous cell carcinoma in situ, actinic cheilitis, hypertrophic scars, and keloids; it is useful for epidermal and dermal analgesia; drug delivery may be increased through the application of heat, pressure, or occlusion, or by using an aqueous drug solution; laser settings should be selected to ensure that channel diameter is greater than the delivered molecule; antibiotic prophylaxis is not recommended, except with impaired wound healing; antiviral prophylaxis is recommended when treating the face and genitalia; and antifungal prophylaxis is not recommended. The guideline's 15 recommendations address 5 areas of LADD use: (I) indications and contraindications; (II) parameters to report; (III) optimization of drug delivery; (IV) safety considerations; and (V) prophylaxis for bacterial, viral, and fungal infections. Conclusions and Relevance/UNASSIGNED:This systematic review and Delphi consensus approach culminated in an evidence-based clinical practice guideline for safe and effective use of LADD in a variety of applications. Future research will further improve our understanding of this novel treatment technique.

BACKGROUND:An increase in nonmelanoma skin cancer (NMSC) in younger patients has been reported. Many are treated with Mohs micrographic surgery (MMS). OBJECTIVE:Investigate patient and tumor characteristics in patients less than 50 years undergoing MMS for NMSC at a large, referral-based practice. METHODS & MATERIALS/METHODS:Retrospective chart review of 1,332 tumors occurring in 1,018 consecutive patients over a five-year period. RESULTS:81.7% of tumors were BCC and 55.3% occurred in women. Patients less than 30 years were more likely to be female (P equals 0.016) and women were more likely to have BCC (P equals 0.010). SCCs were more likely with increasing age (P less than 0.001). Of all tumors, 3.6% were recurrent, 2.7% had diameters ≥ 2 centimeters, and 5.5% of all BCCs had a high-risk histologic subtype. Women were more than twice as likely as men to be referred to plastic surgery for repair (P equals 0.020). CONCLUSION/CONCLUSIONS:Patients < 50 years with NMSC may represent a growing population referred for MMS, especially young women with BCC. High-risk tumor features were rare among young patients, and female gender was associated with an increased rate of referral for repair by a plastics subspecialty. Study was performed at the Laser & Skin Surgery Center of New York. IRB STATUS/UNASSIGNED:Approved by Essex Institutional Review Board, Protocol #MOHS40-65 <p><em>J Drugs Dermatol. 2018;17(5):499-505.</em></p>.

BACKGROUND: Post-procedure purpura is a major complaint of patients with port-wine stains (PWSs) treated with pulsed dye laser (PDL). OBJECTIVE: To assess the safety and efficacy of using PDL at nonpurpuric settings to treat ecchymoses that develop within PWSs after treatment with PDL. MATERIALS AND METHODS: Prospective, randomized, controlled study using 595-nm PDL for treatment of PWSs and laser-induced ecchymoses. Port-wine stains were treated in entirety at baseline. Two days later, ecchymoses on randomly selected half of the lesion were re-treated with PDL at subpurpuric settings. Treatment series was repeated 4 to 8 weeks later, and follow-up was at 1 month. Reduction in bruising and PWS clearance were assessed. Three masked evaluators graded clinical improvement using a 4-point scale (1 = 1%-25% improvement, 2 = 26%-50% improvement, 3 = 51%-75% improvement, and 4 = 76%-100% improvement). RESULTS: Twenty adults with 21 PWSs on the head, trunk, and extremities were treated. After first treatment, reduction of bruising was graded a mean value of 2.43 for the treatment side, compared with 1.93 for the control side (p = .012); after the second treatment, 2.83 compared with 2.40 (p = .021). No significant adverse events occurred. CONCLUSION: Pulsed dye laser can be used safely and effectively to reduce treatment-induced purpura in patients with PWSs.

OBJECTIVE: Nevus of Ota represents congenital dermal melanocytosis in a trigeminal distribution, most commonly occurring in Asian individuals and other individuals with skin of color. Evidence suggests early treatment is beneficial. Multiple reports have shown efficacy and safety of Q-switched laser treatment in adults. There is little data on children and in non-Asian skin types. This series was done to demonstrate safe and effective use of Q-switched laser therapy in children of multiple skin types. STUDY DESIGN: Retrospective case series. METHODS: This was a chart review of patients under 18 years old who presented to our practice from 2002 to 2015 with a clinical diagnosis of nevus of Ota who were treated with Q-switched lasers (694 and 1,064 nm). Patients were treated without the use of general anesthesia or sedation, and corneal shields were used in appropriate cases. Percentage of improvement as well as side effects were rated by five physicians independently. Improvement, when present, was rated in quartiles (1-25%, 26-50%, 51-75%, and 76-100% improvement). RESULTS: Twenty-four children were included. The average age at the start of treatment was 3.9 years old (range of 3 months to 12.4 years), and patients had Fitzpatrick skin types IV through VI. The mean number of treatments was 9.3. Assessment revealed excellent response (76-100% improvement) in 70% of patients and good to excellent response (51-100% improvement) in 86%. Two patients (8%) had post-inflammatory hyperpigmentation, one of whom also had focal hypopigmentation. CONCLUSION: Treatment of nevus of Ota with Q-switched lasers in children with skin of color, without general anesthesia or sedation, is safe and effective. Early intervention should be encouraged for better efficacy and to prevent psychosocial distress in later childhood and adulthood. Lasers Surg. Med. (c) 2017 Wiley Periodicals, Inc.

INTRODUCTION/BACKGROUND:Acne vulgaris is common dermatologic condition with an estimated prevalence of 70 to 87%. Acne has been shown to have a significant impact on patient quality of life and mental health, especially as inflammatory lesions typically occur on cosmetically sensitive areas with the potential for permanent scarring. There have been numerous advances in the treatment of inflammatory acne with light-based and laser devices. OBJECTIVE:To review the current evidence for light-based and laser treatments in the management of inflammatory acne. METHODS:An analysis was conducted of PubMed indexed English language literature regarding management of inflammatory acne using light-based and laser treatments. RESULTS:Evidence for the utilization of laser and light-based therapy for acne was summarized in a comprehensive review. Laser and light-based treatment holds the advantages of improved patient compliance and safety profiles in comparison to pharmacologic therapy. Efficacy of device based treatment varied in comparison to standard topical treatment regimens, often more effective when used in combination therapy. Adverse effects reported were generally self-limited. DISCUSSION/CONCLUSIONS:These treatments do and will continue to play an important and enlarging role in the management of acne. Larger scale studies with standardization of treatment protocols are warranted. <p><em>J Drugs Dermatol. 2017;16(11):1095-1102.</em></p>.

Importance: The notion that systemic isotretinoin taken within 6 to 12 months of cutaneous surgery contributes to abnormal scarring or delayed wound healing is widely taught and practiced; however, it is based on 3 small case series from the mid-1980s. Objective: To evaluate the body of literature to provide evidence-based recommendations regarding the safety of procedural interventions performed either concurrently with, or immediately following the cessation of systemic isotretinoin therapy. Evidence Review: A panel of national experts in pediatric dermatology, procedural/cosmetic dermatology, plastic surgery, scars, wound healing, acne, and isotretinoin was convened. A systematic PubMed review of English-language articles published from 1982 to 2017 was performed using the following search terms: isotretinoin, 13-cis-retinoic acid, Accutane, retinoids, acitretin, surgery, surgical, laser, ablative laser, nonablative laser, laser hair removal, chemical peel, dermabrasion, wound healing, safety, scarring, hypertrophic scar, and keloid. Evidence was graded, and expert consensus was obtained. Findings: Thirty-two relevant publications reported 1485 procedures. There was insufficient evidence to support delaying manual dermabrasion, superficial chemical peels, cutaneous surgery, laser hair removal, and fractional ablative and nonablative laser procedures for patients currently receiving or having recently completed isotretinoin therapy. Based on the available literature, mechanical dermabrasion and fully ablative laser are not recommended in the setting of systemic isotretinoin treatment. Conclusions and Relevance: Physicians and patients may have an evidence-based discussion regarding the known risk of cutaneous surgical procedures in the setting of systemic isotretinoin therapy. For some patients and some conditions, an informed decision may lead to earlier and potentially more effective interventions.