Faculty Bibliography

Importance/UNASSIGNED:Sturge-Weber syndrome (SWS) is a neurocutaneous syndrome involving the skin, brain, and eyes. Consensus recommendations for management are lacking. Objective/UNASSIGNED:To consolidate the current literature with expert opinion to make recommendations that will guide treatment and referral for patients with port-wine birthmarks (PWBs). Evidence Review/UNASSIGNED:In this consensus statement, 12 nationally peer-recognized experts in dermatology with experience treating patients with SWS were assembled. Key topics and questions were formulated for each group and included risk stratification, optimum treatment strategies, and recommendations regarding light-based therapies. A systematic PubMed search was performed of English-language articles published between December 1, 2008, and December 1, 2018, as well as other pertinent studies identified by the expert panel. Clinical practice guidelines were recommended. Findings/UNASSIGNED:Treatment of PWBs is indicated to minimize the psychosocial impact and diminish nodularity and potentially tissue hypertrophy. Better outcomes may be attained if treatments are started at an earlier age. In the US, pulsed dye laser is the standard for all PWBs regardless of the lesion size, location, or color. When performed by experienced physicians, laser treatment can be safe for patients of all ages. The choice of using general anesthesia in young patients is a complex decision that must be considered on a case-by-case basis. Conclusions and Relevance/UNASSIGNED:These recommendations are intended to help guide clinical practice and decision-making for patients with SWS and those with isolated PWBs and may improve patient outcomes.

BACKGROUND AND OBJECTIVES/OBJECTIVE:The objectives of this study were to evaluate the safety, tolerability, and efficacy of oxymetazoline hydrochloride cream, 1% (oxymetazoline) when used as an adjunctive treatment with energy-based therapy for patients with moderate to severe facial erythema associated with rosacea. STUDY DESIGN/MATERIALS AND METHODS/METHODS:In this Phase 4, multicenter, interventional, open-label study, eligible patients received one of four energy-based therapies (potassium titanyl phosphate laser, intense pulsed light therapy, pulsed-dye laser Vbeam Perfecta, or pulsed-dye laser Cynergy) on day 1 and day 29 and once-daily application of oxymetazoline on days 3 through 27 and days 31 through 56. Improvement from baseline in Clinician Erythema Assessment (CEA) score, patient satisfaction measures, incidence of treatment-emergent adverse events (TEAEs), and worsening from baseline on dermal tolerability assessments and the Clinician Telangiectasia Assessment (CTA) were assessed. Data were summarized using descriptive statistics. RESULTS:A total of 46 patients (mean age, 51.1 years; 78.3% female) enrolled in this study. Similar numbers of patients received each of the energy-based therapies in addition to oxymetazoline. All patients demonstrated an improvement from baseline in CEA during the study with 39 of 43 evaluable patients (90.7%) demonstrating an improvement 6 hours posttreatment on day 56. Most patients were satisfied or very satisfied with treatment at the end of the study. All TEAEs were mild or moderate in severity. Some patients experienced worsening in dermal tolerability assessment symptoms (range: 4-21 patients; 8.7-45.7%). Worsening in CEA and CTA were each reported by three patients (6.5%) at any time during the study. CONCLUSIONS:Treatment with oxymetazoline as adjunctive therapy with energy-based therapy was safe, well tolerated, and reduced facial erythema in patients with moderate to severe persistent facial erythema associated with rosacea. Lasers Surg. Med. © 2020 The Authors. Lasers in Surgery and Medicine published by Wiley Periodicals LLC.

BACKGROUND AND OBJECTIVES/OBJECTIVE:) laser has well-demonstrated safety and efficacy in resurfacing treatment of scars in the adult population and in the treatment of pediatric burn scars. However, there is a paucity of literature regarding laser resurfacing of traumatic and surgical scars for cosmetic benefit in the pediatric population, and in majority of cases previously reported, this was done under general anesthesia. STUDY DESIGN/MATERIALS AND METHODS/METHODS:laser resurfacing (FALR) of traumatic or surgical scars at a single center between 2018 and 2019, inclusive. Primary endpoints included safety and tolerance. RESULTS:A total of 31 FALR treatments were performed in 10 patients with traumatic and surgical scars located on the face (age 4-14 years, Fitzpatrick skin type [FST] I-IV, 60% female). Settings ranged from total energy per session 0.02-0.33 kJ, with a 7-mm tip and 30-50% coverage. Nine patients had two or more treatments (average 3, maximum 8) spaced at least 4 weeks apart. All resurfacing treatments were well-tolerated with local infiltration of 1% lidocaine with epinephrine (1:100,000). Six (67%) patients were treated with additional measures including pulsed dye laser, 1927-nm fractional non-ablative low-energy, low-density laser, or intralesional agents (5-fluorouracil, triamcinolone, botulinum toxin). At follow-up (of varied intervals), short-term erythema, as expected, was seen in six patients, and hyperpigmentation in one case (FST IV), both treated with aforementioned alternate devices. Although gradual, improvement in scar appearance and texture was seen with FALR treatments. No additional scarring, infection, or hypopigmentation was seen. CONCLUSIONS:Treatment with fractional ablative laser resurfacing is safe and well-tolerated in the pediatric population in an outpatient setting with local anesthesia. Traumatic scars may cause significant distress to children and parents alike. Multimodal therapy may lead to optimal cosmesis. Given the excellent tolerability, the authors recommend consideration of laser resurfacing in pediatric patients with traumatic or surgical scars when bothersome, either cosmetically or psychologically. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

BACKGROUND:Melasma can be associated with immense psychosocial stress, which can impact quality of life. One theory suggests that ultraviolet light can increase plasmin activity in keratinocytes, which has led to the investigation of tranexamic acid for treating melasma, since it possesses anti-plasmin properties. The use of laser-assisted drug delivery can also increase the uptake of topical medications. AIMS/OBJECTIVE:A prospective pilot study was performed to assess the utility of combination treatment with low-energy, low-density 1927 nm fractional thulium fiber laser and topical tranexamic acid for melasma. PATIENTS/METHODS/METHODS:A total of 10 subjects were enrolled. Each received 5 treatments to the full face with a low-energy, low-density 1927 nm fractional thulium fiber laser. Immediately following treatment, topical tranexamic acid was applied, and subjects were instructed to apply it twice daily for 7 days. Clinical measures, quality of life, and patient satisfaction were assessed. RESULTS:Mean improvements in Melasma Area and Severity Index (MASI) scores were 1.1 (P = .0899), 3.5 (P = .0395), and 2.5 (P = .2429) at 30-, 90-, and 180-day follow-up, respectively. Maximum improvement occurred at 90-day follow-up. The mean improvement of Melasma Quality of Life Scale (MELASQOL) score was 9.6 (P = .0024) at 30-day follow-up. In addition to changes in pigmentation, subjects also believed their skin felt better, looked more radiant, and had improvements in skin texture and tone. CONCLUSION/CONCLUSIONS:Combination of low-energy, low-density 1927 nm fractional thulium fiber laser and topical tranexamic acid improved clinical outcomes and quality of life associated with melasma. This combination treatment was safe, well-tolerated, and well-liked by subjects.

PURPOSE/OBJECTIVE:We aim to demonstrate an initial proof of concept for the presence of addictive behaviors in cosmetic procedure utilization . METHOD/METHODS:ology Adult subjects visiting a cosmetic dermatology practice with history of at least one cosmetic procedure and consideration of at least one cosmetic procedure in the past 12 months were included. Two previously validated instruments in the detection of alcohol use disorder (AUD), the CAGE (Cut down, Annoyed, Guilty, Eye-opener) questionnaire and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria were modified to evaluate subjects for a substance-related disorder (SRD) in cosmetic procedure. RESULTS:Of 153 adults, 34 (22.2%) met modified CAGE criteria and 40 (26.1%) met modified DSM-V criteria. Results from both instruments were significantly associated (P < 0.0002). Significant differences in consideration and utilization of cosmetic treatments were found in SRD positive versus negative groups (P<0.0001; P=0.009). CONCLUSIONS:and Relevance A type of SRD involving cosmetic procedures may exist and qualifying individuals may have increased cosmetic treatment utilization. Future efforts to rigorously validate an instrument for SRD detection in cosmetic procedure use are warranted for future research and clinical application.

BACKGROUND:Topical adjuncts have been investigated to improve clinical outcomes associated with laser resurfacing for photodamage and cutaneous aging. One such product is a tripeptide/hexapeptide serum, which has been shown to increase dermal collagen and elastin as well as improve post-procedural recovery following treatments. OBJECTIVE:A randomized, blinded, split-face, comparative trial was performed to assess the utility of a tripeptide/hexapeptide serum as a peri-procedural adjunct to non-ablative fractional laser resurfacing. MATERIALS AND METHODS/METHODS:A total of 20 subjects were enrolled. Each hemiface was randomized to either tripeptide/hexapeptide serum or bland moisturizer for twice daily application starting 14 days prior to first laser treatment and continuing until 60 days after. All subjects received 2 treatments to entire face approximately 1 month apart with 1927nm thulium non-ablative fractional laser. Clinical measures and immediate post-procedural recovery were assessed. RESULTS:For each hemiface, scores improved for all measures, including global photodamage, lentigines, pores, radiance, texture, and tone at 30 and 60 days. The tripeptide/hexapeptide serum had greater improvements for all measures at both time points, except for radiance at 60 days, which was equal. In cases where clinical ratings differed between sides, tripeptide/hexapeptide serum more frequently had the superior outcome. Overall, subjects were satisfied with tripeptide/hexapeptide serum. No significant adverse events were observed. CONCLUSION/CONCLUSIONS:Addition of tripeptide/hexapeptide serum as a peri-procedural adjunct to non-ablative fractional laser resurfacing improved various clinical measures of photodamage and cutaneous aging and the immediate post-procedural recovery. The tripeptide/hexapeptide serum was demonstrated to be safe, well-tolerated, and well-liked by subjects.

Recent demand for minimally and non-invasive cosmetic procedures has been rising. According to the American Society for Dermatologic Surgery (ASDS), the numbers of injectable neuromodulator and soft-tissue filler procedures have increased by 42% and 78%, respectively, since 2012.¹ Similarly, laser, light, and energy-based treatments have increased by 74%. Although it has been anecdotally reported that the popularity of dermatologic procedures may peak during specific times of the year, available data on consumer behavior is limited.^2,3 Understanding seasonal trends can offer insights to better forecast patient demand and optimize practice management. In order to fill this gap in the literature, we performed a temporal analysis of various procedures in a busy dermatology clinic.

Minimally and non-invasive cosmetic procedures are on the rise. With the advent of social media, improvements in technology, and the increased visibility of cosmetic dermatologists and plastic surgeons, consumers now have greater access to information about aesthetic procedures.

This commentary examines the recent general movement in the field of cosmetic dermatology toward imitation and reproduction. The issues of medical spas, nonphysician operators, and counterfeit products have recently garnered interest in aesthetic dermatology. As physicians, it is our professional and bioethical responsibility to ensure that our patients are educated on the presence of medical spas, nonphysician operators, and counterfeit products in our field, especially given the discrepancies in patient safety and outcomes. There are also actions that dermatologists can take in order to help differentiate themselves in this current market. This will not only protect our field, but also our patients, who we are obligated to provide high-quality care for as physicians.