Faculty Bibliography

BACKGROUND:Picosecond-domain laser pulses improve the photomechanical disruption of tattoos. OBJECTIVE:This study evaluates the efficacy and safety of a novel, dual-wavelength, 1,064/532-nm, picosecond-domain laser for tattoo clearance. MATERIALS AND METHODS/METHODS:This was a prospective, self-controlled, clinical study of 34 subjects with 39 tattoos treated at 2 sites with an interval of 4.8 ± 1.6 weeks and up to 10 treatments (mean, 7.5). Blinded evaluation and investigator assessment of serial digital images was performed to evaluate treatment efficacy in the 36 tattoos that received at least 3 treatments. Investigators also assessed efficacy before each treatment visit up to 10 treatments. Safety and tolerability was evaluated for all 39 tattoos that underwent at least 1 treatment. RESULTS:Blinded evaluation demonstrated that lightening of tattoos was achieved in all subjects, with 86% (31 of 36 tattoos) showing at least a 50% clearance after 3 treatments. Adverse events were few and transient in nature. Patient satisfaction and treatment tolerability were high. CONCLUSION/CONCLUSIONS:Treatment of single-colored and multicolored tattoos with this novel 1,064/532-nm picosecond laser is highly safe and effective.

BACKGROUND AND OBJECTIVE: Non-ablative fractional lasers (NAFL) generate microscopic non-contiguous columns of thermal injury in the dermis, resulting in collagen remodeling. This manuscript details our experience with a novel 1,565 nm scanned, erbium-doped fiber NAFL for the treatment of facial photodamage. STUDY DESIGN/MATERIALS AND METHODS: A prospective, open-label clinical trial was conducted at two clinical sites in the United States on 16 female subjects with a mean age of 49.6 years, Fitzpatrick skin types II to IV, and a baseline Fitzpatrick-Goldman Wrinkle and Elastosis Score (FGWES) of 3-6. Each subject received three treatments at 4-5 week intervals with follow-up assessments at 1, 3, and 6 months after the last treatment. RESULTS: The mean FGWES demonstrated a statistically significant decrease from baseline both at 3 months (-0.58 +/- 0.23, P = 0.02) and 6 months (-0.66 +/- 0.22, P = 0.008) after the last treatment. Fifty percent (95%CI [24.21%, 68.49%]) of subjects showed a significant (at least 1 grade) improvement in FGWES from baseline at 3-month follow-up. At least 72% of subjects perceived the results as "moderate" to "very good" at 3 months post-treatment, with comparable satisfaction rates. Treatments were not associated with a high level of pain or discomfort and typical downtime was less than 2 days. No unexpected adverse events or serious adverse events were reported. CONCLUSION: The 1,565 nm erbium-doped scanned NAFL is an effective treatment for facial wrinkles with a favorable recovery and side effect profile. Lasers Surg. Med. 48:174-180, 2016. (c) 2015 Wiley Periodicals, Inc.

BACKGROUND: Cutaneous squamous cell carcinoma (cSCC) is the second most common cancer in the United States. Cutaneous squamous cell carcinoma has an estimated incidence of more than 700,000 new cases per year and a 5% risk of metastasis. OBJECTIVE: To provide clinicians with guidelines for the management of cSCC based on evidence from a comprehensive literature review and consensus among the authors. MATERIALS AND METHODS: The authors conducted an extensive review of the medical literature on treatment methods for cSCC, taking into consideration cure rates, recurrence and metastatic rates, aesthetic and functional outcomes, and cost effectiveness of the procedures. RESULTS: Surgical treatments provide the best outcomes for cSCC. Mohs micrographic surgery is a cost-effective procedure that affords the highest cure rate, maximal tissue preservation, and superior cosmetic outcomes. Nonsurgical methods may be used as a primary treatment for low-risk squamous cell carcinomas, but the cure rates are lower. CONCLUSION: The cure rate remains the most important consideration in choosing the treatment method, but additional factors, such as the patient's general medical condition, psychosocial circumstances, the location of the tumor and cost effectiveness of the therapy should be considered. Mohs micrographic surgery remains the preferred treatment for high-risk tumors and tumors located in cosmetically sensitive areas.

BACKGROUND: Basal cell carcinoma (BCC) is the most common cancer in the US population affecting approximately 2.8 million people per year. Basal cell carcinomas are usually slow-growing and rarely metastasize, but they do cause localized tissue destruction, compromised function, and cosmetic disfigurement. OBJECTIVE: To provide clinicians with guidelines for the management of BCC based on evidence from a comprehensive literature review, and consensus among the authors. MATERIALS AND METHODS: An extensive review of the medical literature was conducted to evaluate the optimal treatment methods for cutaneous BCC, taking into consideration cure rates, recurrence rates, aesthetic and functional outcomes, and cost-effectiveness of the procedures. RESULTS: Surgical approaches provide the best outcomes for BCCs. Mohs micrographic surgery provides the highest cure rates while maximizing tissue preservation, maintenance of function, and cosmesis. CONCLUSION: Mohs micrographic surgery is an efficient and cost-effective procedure and remains the treatment of choice for high-risk BCCs and for those in cosmetically sensitive locations. Nonsurgical modalities may be used for low-risk BCCs when surgery is contraindicated or impractical, but the cure rates are lower.

An article titled "Current issues in dermatologic office-based surgery" was published in the JAAD in October 1999 (volume 41, issue 4, pp. 624-634). The article was developed by the Joint American Academy of Dermatology/American Society for Dermatologic Surgery Liaison Committee. A number of subjects were addressed in the article including surgical training program requirements for dermatology residents and selected advances in dermatologic surgery that had been pioneered by dermatologists. The article concluded with sections on credentialing, privileging, and accreditation of office-based surgical facilities. Much has changed since 1999, including more stringent requirements for surgical training during dermatology residency, and the establishment of 57 accredited Procedural Dermatology Fellowship Training Programs. All of these changes have been overseen and approved by the Residency Review Committee for Dermatology and the Accreditation Committee for Graduate Medical Education. The fertile academic environment of academic training programs with interaction between established dermatologic surgeons and fellows, as well as the inquisitive nature of many of our colleagues, has led to the numerous major advances in dermatologic surgery, which are described herein.

BACKGROUND AND OBJECTIVE: A common, disfiguring problem in women, melasma is often refractory to treatment, and long-term remissions are difficult to achieve. This study assessed the safety and effectiveness of a procedure combining microdermabrasion, a topical regimen, and low fluence Q-switched Nd:YAG laser treatment. MATERIALS AND METHODS: In this observational study of 27 female subjects, phototypes II-V, referred for treatment of mixed-type melasma refractory to previous therapies, low-fluence QS Nd:YAG laser treatment of 1.6-2 J/cm(2) with 5 or 6 mm spot was administered immediately following microdermabrasion. Daily application of a broad-spectrum sunscreen began immediately; subjects used a topical skin care regimen of hydroquinone with tretinoin or vitamin C. Treatments were repeated at 4-week intervals. Follow-up assessment was done 3-12 months after the last treatment. Adverse effects were recorded at each visit. Standardized digital photographs obtained before each treatment session and at follow-up visits were objectively assessed by blinded comparison using a quartile grading system. RESULTS: Treatment was successful in all skin types, deemed painless by all subjects, and required no anesthesia. Average number of treatments was 2.6. Twenty-two subjects (81%) had >75% clearance of melasma; 11 subjects (40%) achieved >95% clearance. Most subjects showed >50% clearance of their melasma 1 month after the first treatment. Side effects were limited to mild post-treatment erythema, which developed after the microdermabrasion and lasted approximately 30-60 minutes. Four subjects noted temporary exacerbation of melasma after inadvertent sun exposure, but this resolved within several weeks of resuming the topical skin care regime. Remission lasted at least 6 months. CONCLUSION: Microdermabrasion plus low-fluence QS Nd:YAG laser treatment is a simple, non-invasive procedure with minimal risk, no recovery time, and long-lasting remission. Treatment works on all skin phototypes in just two to three treatment sessions. Subject compliance with skin care was excellent, probably due to the dramatic improvement observed within 4 weeks. Lasers Surg. Med. 44:117-124, 2012. (c) 2012 Wiley Periodicals, Inc.

BACKGROUND AND OBJECTIVES: The pulsed dye laser set the standard of care for the treatment of vascular lesions, and recent modifications have enabled improved efficacy with fewer side effects. An investigational high energy, variable pulse duration pulsed dye laser has been modified to treat both vascular and pigmented lesions associated with photoaging. Each laser pulse is comprised of a sequence of eight uniform micropulses, which evenly distribute the pulse energy, effectively increasing the purpura threshold at any given fluence. Pigmented lesions are treated with a compression handpiece (CHP) that removes competing vascular target from the field, and helps to prevent purpura. This pilot study was undertaken to determine the optimum laser settings, and to investigate the ability of this device to improve vascular and pigmented lesions associated with photoaging. STUDY DESIGN/MATERIALS AND METHODS: Twenty-four patients with photoaged skin and phototype I-III were enrolled in the study. Thirteen received treatment for vascular and pigmented lesions, and 11 subjects were treated for pigmented lesions alone. Subjects received one to three treatments at 3-4 weeks intervals, and underwent 3- and 12-week follow-up evaluation. The degree of improvement was assessed by subject evaluation as well as comparison of standardized digital photographs by three independent dermatologists. Background erythema was treated with a 12-mm spot size, at a fluence of 7 J/cm(2), and a pulse width of 10 ms. The cryogen cooling was set at 30 mseconds with a 30 ms delay. Individual telangiectasias were treated with a 5- or 7-mm spot size at fluences of 9-14 J/cm(2) and pulse widths of 6-20 mseconds. Pigmented lesions were treated using a 5- or 7-mm spot size, with energy of 9-15 J/cm(2) and a pulse width of 1.5-10 ms without cooling. The CHP had a 7-mm spot size, and fluences of 9-16 J/cm(2), and pulse widths of 1.5 or 3 ms were used in the treatment of pigmented lesions. RESULTS: The treatment was well tolerated without the use of topical anesthetic. All subjects noted improvement in the both vascular and pigmented lesions, and were satisfied with their outcomes. Objectively, there was moderate improvement in background erythema, telangiectasia, and pigmented lesions. Three subjects who were treated with sun tans developed transient hypopigmentation and two subjects developed a transient textural change following pulse stacking for the treatment of pigmented lesions with the conventional handpiece. Purpura was noted in all patients treated for pigment with the conventional handpiece at pulsewidths less than 6 mseconds, as compared to only one that was treated with the CHP. Three patients treated in rapid succession for vascular, and then pigmented lesions with the CHP exhibited purpura, which was prevented in future treatments with 1-2 minutes of topical ice cooling between passes. CONCLUSIONS: This novel 595-nm pulsed dye laser, with a modified pulse sequence and CHP, now has the versatility to safely treat both pigment and vascular changes associated with photoaging

Photodynamic therapy (PDT) has significant promise in improving outcomes of patients with a variety of cutaneous conditions. A group of experts met to review the principles, indications, and clinical benefits of PDT with 5-aminolevulinic acid (ALA). They also reviewed PDT with methyl aminolevulinate. The experts established consensus statements for pretreatment, posttreatment, ALA contact time, light sources, and numbers of sessions associated with ALA PDT for actinic keratosis and superficial basal cell carcinoma, photorejuvenation and cosmetic enhancement, acne, sebaceous skin, rosacea, and rhinophyma. They based consensus recommendations on their clinical experience and the medical literature. They also suggested future applications of ALA PDT. Experts concluded that ALA PDT is a safe and effective modality for the treatment of conditions commonly encountered in dermatology. Since downtime is minimal, the technique is suitable for patients of all ages and lifestyles. Appropriate light sources are available in many dermatology offices. The expanding clinical and financial benefits of PDT justify the purchase of an appropriate light source