Faculty Bibliography

BACKGROUND:Although the stratum corneum limits transdermal absorption of topicals, laser devices can enhance topical uptake by disrupting the skin barrier. Nonablative lasers are commonly used, but their effects on topical uptake should be quantified to optimize outcomes. OBJECTIVE:The objective of this study is to analyze transdermal uptake of 4 topicals after nonablative fractional diode laser pretreatment. METHODS AND MATERIALS/METHODS:Human donor tissue was pretreated ex vivo with a nonablative fractional diode laser (1,927 nm or 1,440 nm, at varying treatment densities, powers, and peak energies) followed by application of either 2% salicylic acid, 10% ascorbic acid, over-the-counter mineral eye serum, or 4% hydroquinone. Topical uptake was quantified over 24 hours. RESULTS:Despite lower power settings, pretreatment with the 1,927 nm wavelength was associated with greater uptake of 10% ascorbic acid, mineral eye serum, and 4% hydroquinone than the 1,440 nm wavelength. In addition, 1,440-nm laser pretreatment with higher density (320 microscopic treatment zones [MTZ]/cm2) and peak power (3 W) was associated with similar uptake but greater retention of 2% salicylic acid and greater uptake of 10% ascorbic acid than that with lower density (80 MTZ/cm2) and peak power (1.2 W). CONCLUSION/CONCLUSIONS:When using laser pretreatment, device settings should be adjusted to balance outcomes with potential side effects.

Importance/UNASSIGNED:It has been suggested that Mohs surgery for skin cancer among individuals with limited life expectancy may be associated with needless risk and discomfort, along with increased health care costs. Objective/UNASSIGNED:To investigate patient- and tumor-specific indications considered by clinicians for treatment of nonmelanoma skin cancer in older individuals. Design, Setting, and Participants/UNASSIGNED:This multicenter, prospective cohort study was conducted using data from US private practice and academic centers. Included patients were those older than age 85 years presenting for skin cancer surgery and referred for Mohs surgery, with reference groups of those younger than age 85 years receiving Mohs surgery and those older than age 85 years not receiving Mohs surgery. Data were analyzed from November 2018 through January 2019. Exposures/UNASSIGNED:Mohs surgery for nonmelanoma skin cancer. Main Outcomes and Measures/UNASSIGNED:Reason for treatment selection. Results/UNASSIGNED:Among 1181 patients older than age 85 years referred for Mohs surgery (724 [61.9%] men among 1169 patients with sex data; 681 individuals aged >85 to 88 years [57.9%] among 1176 patients with age data) treated at 22 sites, 1078 patients (91.3%) were treated by Mohs surgery, and 103 patients (8.7%) received alternate treatment. Patients receiving Mohs surgery were more likely to have tumors on the face (738 patients [68.5%] vs 26 patients [25.2%]; P < .001) and nearly 4-fold more likely to have high functional status (614 patients [57.0%] vs 16 patients [15.5%]; P < .001). Of 15 distinct reasons provided by surgeons for opting to proceed with Mohs surgery, the most common were patient desire for treatment with a high cure rate (712 patients [66.0%]), good or excellent patient functional status for age (614 patients [57.0%]), and high risk associated with the tumor based on histology (433 patients [40.2%]). Conclusions and Relevance/UNASSIGNED:This study found that older patients who received Mohs surgery often had high functional status, high-risk tumors, and tumors located on the face. These findings suggest that timely surgical treatment may be appropriate in older patients given that their tumors may be aggressive, painful, disfiguring, and anxiety provoking.

A port-wine stain (PWS) is a vascular birthmark present in 0.3% to 0.5% of newborns. If untreated, this erythematous patch will grow proportionally with the child to thicken and darken with age. PWSs have implications for the child's quality of life for many years, with cosmetic, medical, and psychosocial disability. Controversy exists in many aspects surrounding laser treatment of these birthmarks in the pediatric population. We have reviewed the clinical features as well as the historic and current laser treatment of PWS. We have also examined the current hot topics of debate surrounding the treatment of PWS in the pediatric population. These controversies include the patient age of treatment initiation, the long-term psychologic impact, the use of general anesthesia, the application of eye shields, and alternative treatments for recalcitrant PWS. We have concluded with a discussion on the future directions of management and treatment.

BACKGROUND:Ultrasound energy has been used for cutaneous rejuvenation, including treatment of fine lines and wrinkles. Ultrasound waves of high intensity can induce thermal injury in the dermis, which causes tissue coagulation and remodeling. OBJECTIVE:To examine the safety and utility of a novel ultrasound device that uses high-intensity, high-frequency, parallel ultrasound beams to improve fine lines and wrinkles of the face and neck. MATERIALS AND METHODS:A prospective, multicenter, clinical study investigated the utility of this novel ultrasound device to improve fine lines and wrinkles. Sixty subjects were enrolled for single treatment to the face and neck. RESULTS:Fifty-eight subjects completed the study. The mean age was 58 years, and 87.9% were women. Fitzpatrick skin Types I to VI were represented. Assessments compared 12-week follow-up with baseline. Two blinded reviewers agreed in identifying pretreatment and post-treatment photographs for 78% of subjects. There was significant improvement of 1 to 3 Fitzpatrick Wrinkle and Elastosis Scale units in 86% of subjects. For investigator global improvement scores, 88% of subjects had improvement. Overall, 72% of subjects noted improvement, and the majority were satisfied. There were no device-related adverse events. CONCLUSION:Treatment with a novel ultrasound device that uses high-intensity, high-frequency, parallel ultrasound beams safely improved the clinical appearance of fine lines and wrinkles of the face and neck.