Treatment of striae distensae with needling therapy versus CO2 fractional laser

Background and objectives: Striae are atrophic dermal scars with overlying epidermal atrophy causing cosmetic concern. This study assesses and compares the efficacy and safety of needling therapy versus CO2 fractional laser in treatment of striae. Methods: Twenty Egyptian female patients with striae in the abdomen and lower limbs were involved in the study. The patients were treated with needling therapy and CO₂ laser every 1 month for 3 sessions. Follow-up by digital photography and skin biopsy was conducted at baseline and 6 months after treatment. Clinical improvement was assessed by comparing photographs and patient's satisfaction before and after treatment. Results: Nine of 10 (90%) needle-treated patients showed improvement. Among them, 3 (30%) had good, 4 (40%) had fair, and 2 (20%) had poor improvements; however, 1 (10%) did not show any improvement after the treatment. In CO₂-laser treated patients, 5 of 10 (50%) of the patients showed clinical improvement; 1 (10%) were good, 3 (30%) were fair, and 1 (10%) were poor; however, 5 (50%) did not show improvement. Conclusion: The results support the use of microneedle therapy over CO₂ lasers for striae treatment.     

Comparative study between excimer light and topical antioxidant versus excimer light alone for treatment of vitiligo

Background: Vitiligo is an acquired idiopathic cutaneous disease characterized by pearly white patches of variable shapes and sizes. Various medical and surgical therapeutic options have been proposed to achieve repigmentation; phototherapy is one of the most efficient options. Topical therapies have been a mainstay of vitiligo treatment, with or without phototherapy. Aim of the work: To compare the efficacy of combined topical antioxidant hydrogel and excimer light versus excimer light alone in treating vitiligo. Patients and Methods: Thirty patients were included in this comparative, prospective, randomized study. For each patient, at least 2–4 vitiliginous macules were randomly selected and treated while an untreated vitiliginous macule served as control. Lesions were divided into two groups: Group A received combination therapy of daily topical antioxidant plus excimer light, while Group B received only excimer light. Lesions were treated twice a week for a maximum of 24 sessions. Initial fluencies were adjusted individually according to the minimal erythema dose in vitiliginous skin. Efficacy based on repigmentation percentages were blindly evaluated by two independent physicians. Results: Group A lesions showed significant efficacy than group B (p < 0.001), specially on treating UV-sensitive lesions with no side effects. Conclusion: Topical antioxidant and excimer light represents a valuable, effective therapy for localized vitiligo.     

Microdermabrasion followed by a 5% retinoid acid chemical peel vs. a 5% retinoid acid chemical peel for the treatment of photoaging - a pilot study

Background Both retinoid acid (RA) chemical peeling and microdermabrasion are minimally invasive procedures recently developed for the treatment of photoaging. The efficacy of each procedure has been proved, but the results of the combination of these two methods have not been studied until now. Objectives To assess and compare the efficacy of microdermabrasion followed by a 5% RA chemical peel with that of a 5% RA chemical peel alone. Methods Six female patients with moderate degrees of photodamage were evaluated. Three submitted to microdermabrasion followed by the application of a 5% RA chemical peel and three submitted to a 5% RA chemical peel alone. Each patient underwent three treatment sessions, with intervals of 7–10 days. Photographs were taken, and both biopsies and histological assessments were carried out, before treatment and 7 days after the final treatment session. Results In the opinion of the patients, in both groups there was improvement in the texture, pigmentation, and appearance of the treated skin, and this was confirmed with the assessment of the pre‐ and post‐treatment photographs. The combination of microdermabrasion followed by a 5% RA peel showed slightly greater improvement in the histological alterations resulting from photoaging. Conclusion Both methods, microdermabrasion followed by a 5% RA chemical peel and a 5% RA chemical peel alone are effective in the treatment of photoaging.     

Effects of microdermabrasion on skin rejuvenation

Abstract

Background: Microdermabrasion is a surface treatment, noninvasive, which uses a negative pressure and drives programmable inert microcrystals on the skin, causing an exfoliation. Objective: The aim of this study was to evaluate the effects of application of microdermabrasion in human skin rejuvenation. Methods: Eleven women who were undergoing abdominoplasty were considered. An area of 25 cm² in the umbilicus to the right was conditioned with microcrystals of Al₂O₃ in maximum flow, negative pressure of 200 mmHg and total of 8 past, the left side being used as control. The number of sessions ranged from one to five, with weekly intervals, and timing of sample collection ranged from 0 to 132 days. Samples were fixed in 10% formaldehyde in phosphate buffer and were evaluated histologically. Results: A mild to marked hyperpigmentation was observed and remained for a variable period. Histological findings suggest an improvement in the epidermal layer with increased thickness and reestablishing their interdigitations in the dermis initially observed an increase in collagen synthesis. The analysis showed a late stay of epidermal changes, which did not occur in the dermis. Conclusion: Under the conditions and parameters used in this work, the microdermabrasion had a positive skin structure, showing that a viable resource in promoting skin rejuvenation.     

A split-face,investigator-blinded comparative study on the efficacy and safety of Q-switched Nd:YAG laser plus microneedling with vitamin C versus Q-switched Nd:YAG laser for the treatment of recalcitrant melasma

Background: High recurrence has previously been reported in the treatment of melasma with low-fluence 1,064-nm Q-switched neodymium-doped yttrium aluminium garnet (QS-Nd:YAG) laser. On the other hand, the efficacy and safety of the QS-Nd:YAG laser plus microneedling with vitamin C have not been evaluated in patients with mixed-type melasma. Material and methods: Sixteen patients with recalcitrant dermal- or mixed-type melasma were included in the study. One side of patients’ face was treated with QS-Nd:YAG laser plus microneedling with vitamin C (Group A) and the other side with QS-Nd:YAG laser alone (Group B) for four sessions at four-week intervals. Melasma Area Severity Index (MASI) scores and clinician’s evaluation of clinical response were assessed monthly. Results: Group A had a significantly lower mean MASI score and better treatment response than Group B according to clinician’s evaluation. According to MASI scores, in Group B, two patients had a good response while 12 were unresponsive to treatment. Good or very good improvement was reported by 10 patients in Group A and three patients in Group B. Adverse effects and recurrence rates were similar in Groups A and B (31.3 and 43.8%, respectively). Discussion: QS-Nd:YAG increases the blood circulation in the dermis, thereby enhancing the mechanical effect of microneedling to promote the penetration of vitamin C. Conclusion: Vitamin C application with microneedling immediately after treatment with QS-Nd:YAG laser is a promising adjunctive method for the treatment of recalcitrant melasma.     

The efficacy and safety of subcision using CO2 gas combined with fractional laser for acne scars: Clinical and microscopic evaluation

Background: Various modalities have been used to treat acne scars. CO₂ fractional laser is an effective and commonly used treatment. CO₂ gas injection into the dermis by needle with high pressure can cause fibrotic collagen breakage, producing the effects of subcision. CO₂ also stimulates collagen synthesis by increasing neovascularization and releasing oxygen. Objective: This study evaluated the efficacy and the safety of the combined treatment with CO₂ gas subcision and CO₂ fractional laser for acne scars. Methods and materials: Fourteen patients with acne scars were treated with three sessions of CO₂ gas subcision at 2-week intervals and two sessions of fractional laser at 4-week interval. The clinical improvement was assessed using a 4-point scale. For histologic analysis, punch biopsy was performed before and after treatment in 10 patients. Results: All patients experienced clinical improvements. Excellent, marked, moderate, and mild response was achieved in 1 (7%), 8 (57%), 4 (29%), and 1 patient (7%), respectively. Histologic evaluation of the biopsy specimens showed increased dermal collagen with dermal thickening and elastic fiber straightening in the reticular dermis after the treatment. Conclusion: The combination therapy with CO₂ gas subcision and fractional laser was satisfactory and safe for treating acne scars.

Abbreviation and acronym:

CO₂: Carbon dioxide

GAS: Global assessment scale

H&E: hematoxylin and eosin; SD: standard deviation     

A new imaging technique for assessment of the effectiveness of long pulse Nd:YAG 532 nm laser in treatment of facial port wine stain

Background: PWS is a vascular malformation presented at birth and associated with a psychological problem to the patients. Many types of laser systems were used to solve this problem. Aim of the study: To assess the efficacy of long-pulsed Nd:YAG 532-nm laser in the treatment of port wine stain both clinically and by imaging technique. Patients and methods: This is an interventional therapeutic clinical study for the treatment of facial port-twine stain with long-pulsed, 532-nm, Nd:YAG laser. The treatment sessions were done every 4 weeks for 12 sessions and follow-up after 3 months of the last session. The assessment of the response was done before and at the end of follow-up period, both objectively (percent of improvement, photo comparison by using PSNR) and subjectively (patient satisfaction). Results: Sixteen patients completed all sessions of the treatment. The improvement score for the PWS were failure = 0%, mild = 6.25%, moderate = 12.5%, good = 31.25%, and excellent = 50%. The values of PSNR for all the patients have been recorded and were fewer than 25 which means that the response for the treated lesions was very good. Conclusion: The long-pulsed Nd:YAG laser 532 nm is an effective and safe method of treatment of facial PWSs without significant residue. The PSNR was a new, simple, cheap and noninvasive method for assessment of the response of PWSs to laser therapy.     

Cutaneous effects compared between higher fluence with fewer treatments and lower fluence with more treatments in a combined IR laser/radio frequency system

Background and aims: A combined infrared (IR) laser/radio frequency (RF) system has recently been reported to create rejuvenation‐related cutaneous effects, but was associated with high levels of pain and some complications. The present study was designed to evaluate the cutaneous effects of the same system with a lower fluence and more treatments. Methods: Twenty patients were randomly assigned into two groups of 10 individuals each: Group A was treated at 50 J/cm² / 100 J/cm³ (laser/RF), respectively, two passes, three treatment sessions 30 days apart; Group B at 30 J/cm² / 50 J/cm³, three passes, five treatment sessions 15 days apart. Objective comparisons were made at the same time points with a computer program based on the clinical photography. Results: Group A noted more improvement in wrinkles than Group B at the first assessment, but both groups showed slight and progressive deterioration at the 2‐ and 6‐month assessments. Improved skin appearance was maintained throughout in both groups. The authors recognize that the comparatively small number of subjects possibly limits the statistical power of the study. Conclusions: Lower fluences and more treatment sessions with the combined 900 nm laser/RF system were complication‐free, produced improvements in the overall skin condition and less pain during sessions, suggesting that this combination may produce better patient compliance. Further treatment sessions may improve the results with implications in skin rejuvenation.     

The assessment of the effects of the combination of microdermabrasion and cavitation peeling in the therapy of seborrhoeic skin with visible symptoms of acne punctata

Objective: The aim of this study was to assess objectively the effects of the combination of corundum microdermabrasion and cavitation peeling in the therapy of seborrheic skin with visible symptoms of acne punctata.

Material and methods: The study involved a group of nine women. A series of six treatments with the combination of microdermabrasion and cavitation peeling were performed within facial skin at 10–14 days intervals. Corneometric measurements examining skin hydration level and sebumetric measurements analyzing skin sebum level were made before the series of treatments and after second, fourth and sixth procedure in five facial areas. Clinical assessment of the efficacy of the therapy was performed on the basis of photographic documentation (Fotomedicus). Anonymous questionnaires were used in order to evaluate patients’ satisfaction rate.

Results: Statistically significant improvement in skin sebum level was observed in all examined areas (forehead p = 0.002; nose p = 0.001, chin p = 0.01, left cheek p = 0.009, right cheek p = 0.007). In case of skin hydration, significant improvement was found only in the area of chin (p = 0.03). 78% of participants estimated that the improvement was in the range of 55–70%, while 22% of participants of 75–100%. The reduction in the amount and visibility of comedones and pimples were demonstrated on the basis of questionnaire and photographic documentation.

Conclusions: Combined microdermabrasion and cavitation peeling treatments improve the condition of seborrheic skin.     

Carbon dioxide laser combined with botulinum toxin A for patients with periorbital syringomas

Background: Although various destructive methods have been described for treating syringomas, they are often associated with significant scarring and recurrence. In 2007, multiple-drilling method using carbon dioxide (CO₂) laser was introduced as an alternative modality to gain good cosmetic results. Objective: To retrospectively evaluate the effectiveness of CO₂ laser combined with botulinum toxin A (BTXA) as treatment for syringomas. Material and methods: Forty-eight patients with periorbital syringomas were treated with topical application of BTXA immediately after CO₂ laser treatment. Forty-four patients were treated with CO₂ laser only. Results: Patients who were treated with CO₂ laser combined with BTXA required significantly (p = 0.038) fewer treatment sessions compared with those treated with CO₂ laser only. When the clinical improvements of the two treatment sessions were compared, the combined therapy (CO₂ laser and BTXA) had significantly (p = 0.044) higher rate of results showing good (disappearance of 60–80% of lesion) or excellent (80–100%) than the CO₂ laser only therapy (87.5% vs. 70.5%). Conclusions: CO₂ laser combined with BTXA showed better effect than CO₂ laser only.     

Safety and efficacy of a non-contact radiofrequency device for body contouring in Asians

Background: The non-invasive reduction of subcutaneous abdominal fat became popular. Radiofrequency, non-contact, selective-field device Vanquish® has been developed to selectively induce deep fat tissue heating to reduce waist circumference. Objective: The objective of this study was to evaluate the efficacy and safety of clinical, radiological results of the radiofrequency, non-contact, selective-field device treatment. Methods: Twelve healthy individuals with no underlying medical problem were treated with five sessions of radiofrequency treatment to reduce abdominal subcutaneous fat. 45-minute sessions were performed with an 1-week interval. For efficacy evaluation, patient’s abdominal circumferences and body weight were measured, and photographs were taken at baseline and each follow-up visit for 12 weeks. One subject was examined with computed tomography (CT) before the first session and six weeks after the first CT scan, and we measured the volume of subcutaneous fat layer. Any adverse effect was assessed during the entire study period. Results: Reduction in abdominal circumferences was noted in most participants (10 of 12 patients). No serious adverse effect was reported. Volume reduction of abdominal subcutaneous fat layer was confirmed in a subject who took CT scan. Conclusions: Our study shows that the selective-field radiofrequency treatment seems to be safe and efficient for reduction of abdominal subcutaneous fat.     

Comparison of effectiveness of 1,064-nm Nd:YAG laser and Nd:YAG laser–IPL combination treatments in hand skin rejuvenation

Objective: Evaluation of the efficacy and side effects of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser and Nd:YAG laser–intense pulsed light (IPL) combination treatments in photorejuvenations of skin of the hand, and determining their impacts on patient satisfaction. Materials and Methods: Thirty-five female patients with signs of photoaging on the skin of their hands were included in the study. Three sessions of IPL and four sessions of Nd:YAG laser treatment were applied to the right hand in total with 2-week intervals between each session, whereas six sessions of Nd:YAG laser treatment were applied to the left hand of patients with 2-week intervals between each session. Results: The patients’ ages ranged between 31 and 78, and mean age was 60.77 ± 9.48. While there was no difference in pigment distribution, fine wrinkles, coarse wrinkles, and global scores between the right and left hand prior to treatment (p > 0.05), average pigment tone score was higher in the right hand with a statistically significant difference (p < 0.05). There was greater improvement in scores of pigment distribution, fine wrinkles, sallowness, pigment tone parameters, and global score on the right hand compared to left hand, which was statistically significant (p <0.001). Conclusion: In rejuvenation of photoaged dorsal skin of the hand, IPL–Nd:YAG laser combination treatment surpasses Nd:YAG laser treatment.     

Treatment of atrophic facial acne scars with fractional Er:YAG laser in skin phototype III–IV: A pilot study

Background: Fractional ablative lasers have recently been used for the treatment of skin scars. The objective of this study was to assess the efficacy and safety of the fractional erbium-doped yttrium aluminum garnet (Er:YAG) laser (2940 nm) in the treatment of skin scars. Materials and methods: A total of 9 patients (8 female, 1 male) with Fitzpatrick skin types III and IV suffering from atrophic facial acne scars were treated with a fractional Er:YAG laser for 2–5 (mean 3.3) sessions 4–6 weeks apart. One independent investigator assessed the efficacy, using standardized photographs, before and 1 month after the last treatment. The patients’ satisfaction rate was also evaluated. Results: The treatment was well tolerated by all patients without any anesthesia. The downtime was 2–3 days. All patients showed improvement in scars: excellent in 1, good in 1, and fair in 7 patients. Six patients were highly satisfied and 3 were satisfied with treatment. No adverse effect was noted. Conclusion: A fractional Er:YAG laser can deliver an effective and minimally invasive treatment for acne scars.     

Combination of fractional QSRL and IPL for melasma treatment in Chinese population

Background: Melasma is the most common and distressing pigmentary disorder presenting to dermatology clinics. Various treatment protocols for melasma have been suggested in the previous literature and applied in various clinical settings. However, no satisfactory therapy has been widely accepted. Objective: To evaluate the efficiency and safety of a combination treatment with fractional Q-switched ruby laser (QSRL) and intense pulsed light (IPL) for melasma in Chinese population. Methods: Fifty-three Chinese melasma patients were enrolled in this study. Each patient underwent 2 courses of treatments at 2-week interval. One course was composed of 3 successive sessions of 694-nm fractional QSRL at intervals of two weeks followed by one IPL. The efficacy was evaluated by non-invasive measurements and subjective assessments. The adverse effects were recorded. Results: Mean melanin index (MI) and erythema index (EI) significantly decreased from 216.1 and 381.8 pre-treatment to 167.8 and 310.3 post-treatment, respectively. Mean melasma area and severity index (MASI) decreased dramatically from 14.66 before treatment to 5.70 after the final treatment. These values remained at low levels at 3-month follow-up. The percentage of patients who achieved moderate or significant improvements was 73.6%. Adverse effects of QSRL and IPL were minimal. Conclusion: The combination treatment of fractional QSRL and IPL would be a promising modality for managing melasma in Chinese patients.     

Randomized controlled trial comparing photodynamic therapy based on methylene blue dye and fluconazole for toenail onychomycosis

Photodynamic therapy (PDT) is a medical modality that uses a combination of visible light and a photosensitive compound in the presence of oxygen. It is widely used to treat non‐melanoma skin cancer; other indications are being investigated, especially onychomycosis. Eighty patients with toenail onychomycosis were enrolled and completed this randomized, parallel, placebo‐controlled study. For 24 weeks, 40 patients (Group A) were treated with one placebo capsule per week and sessions of 2% methylene blue aqueous solution irradiated with light emission diode device (MBLED/PDT) with 18 J/cm²; and another 40 patients (Group B) were treated with 300 mg oral fluconazole per week and sessions of placebo PDT (haematoxylin‐diluted 1 : 10). The use of MBLED/PDT consisted of sessions with an interval of 15 days between each session for 6 months. Microbiological and clinical cure was assessed at 1 and 12 months posttreatment. Group A (MBLED/PDT) patients showed a significant response (p < 0.002) compared with Group B (fluconazole), especially in patients who required nail abrasion (p < 0.001). The MBLED/PDT is safe, effective, and well tolerated; it promotes a favorable outcome with good patient adherence and may be considered as a practical and feasible treatment option for toenail onychomycosis.     

Combination of 595-nm pulsed dye laser,long-pulsed 755-nm alexandrite laser,and microdermabrasion treatment for keratosis pilaris: retrospective analysis of 26 Korean patients

Abstract

Keratosis pilaris (KP) has beenpresented as small keratotic follicular papules with or without surrounding erythema. Various treatments with laser or light therapy have been used for the management of KP with various clinical outcomes. In the present study, we investigated the efficacy and safety of a combination therapy for KP. A total of 29 anatomical sites with KP in 26 patients were treated using a 595-nm pulsed dye laser (PDL) with nonpurpuragenic fluences, a long-pulsed 755-nm alexandrite laser, and microdermabrasion. Clinical improvement was assessed by comparing preand posttreatment clinical photographs and patient satisfaction rates. Evaluation of the clinical results three months after the treatments showed that 12 of the 29 anatomical sites (41.4%) demonstrated Grade 3 clinical improvement, ten (34.5%) had Grade 2 clinical improvement, four (13.8%) showed Grade 1 improvement, and three (10.3%) showed Grade 4 improvement. We observed that KP lesions improved not only in erythema and skin texture, but also in brownish dyschromias. Potential adverse events were not observed, except prolonged posttherapy scaling. Our observations demonstrate that combination therapy using a 595-nm PDL, a long-pulsed 755-nm alexandrite laser, and microdermabrasion can have a positive therapeutic effect on KP.     

A pilot study of the efficacy of the POLARGEN® ultrahigh-frequency electric field (40.68 MHz) radiofrequency device in the treatment of facial contouring

Background: Various radiofrequency (RF) devices are used to treat skin laxity and face contouring, but few studies have examined ultrahigh-frequency (UHF) electric field (40.68 MHz) RF devices. Objective: To evaluate the efficacy and safety of a UHF electric field (40.68 MHz) RF device for skin tightening and face contouring. Methods: Ten patients each underwent four sessions of UHF electric field RF device treatment at 2-week intervals. Clinical improvement was evaluated with the patient satisfaction score using a six-point scale, and clinical photographs taken at every visit and 2 months after the RF treatment were assessed. Skin biopsies were obtained from one patient before the first treatment and immediately after the last treatment. Adverse reactions were recorded at every follow-up visit. Results: All patients were women with a mean age of 51.7 ± 7.2 years. The mean satisfaction score was 4.5 ± 0.9 immediately after the last treatment session. Cheek, jawline, and neck enhancement and tightening were apparent in all patients. Side effects were minimal, and there were no burns or major complications. Conclusions: The UHF electric field RF device was effective for skin tightening and facial contouring, without significant adverse reactions.     

Efficacy of multipolar radiofrequency with pulsed magnetic field therapy for the treatment of abdominal cellulite

Introduction: Cellulite is a metabolic condition, predominately seen in females, that affects the subcutaneous tissue of the posterolateral thighs, buttocks, pelvic region, and abdomen. It is characterized by skin dimpling and lumpiness resembling an orange peel. Despite the wide range of treatment options for patients with cellulite, there is a paucity of empirical data supporting their efficacy. The objective of this study was to evaluate the efficacy of a new-generation multipolar radiofrequency (RF) device for the treatment of cellulite. Methods: A multipolar RF device with pulsed magnetic fields was used to treat abdominal cellulite. Twenty-five healthy adult females with stage II or stage III abdominal cellulite underwent 8 weekly treatments. Assessments were performed at baseline and at weeks 1, 4, and 12 following the final treatment. Results: Reduction in subcutaneous thickness in the axial and sagittal plane of the abdomen was observed at 1 week following treatment initiation. Results from self-reported questionnaires revealed a significantly high level of patient satisfaction (60%). Assessments by a blinded investigator at one, four, and twelve weeks after the final treatment demonstrated a significant improvement in cellulite appearance. No adverse effects were reported and the treatment was well tolerated. Conclusion: This study demonstrates the safety, efficacy, and subject satisfaction of multipolar RF with pulsed magnetic field therapy in the treatment of abdominal cellulite.     

Efficacy of platelet-rich plasma in the treatment of androgenetic (male-patterned) alopecia: A pilot randomized controlled trial

Background: Platelet-rich plasma (PRP) has been proposed as an effective treatment for different diseases. Objective: The aim of this study is to evaluate the efficacy of PRP in the treatment of androgenetic alopecia (AGA). Material and methods: In this study, 19 men with AGA were recruited among whom 17 men completed the trial. At the beginning, 2 square-shaped areas of 2.5 × 2.5 centimeters, at least 3 cm apart from each other were selected on the scalp of each patient as case and control sites. Then, 1.5 ml of PRP was injected in the case site, while in the control site the same amount of normal saline was injected. These were injected in 2 sessions, 1 month apart. The terminal and vellus hairs were counted in each square at the beginning of the study, and then 1, 3, and 6 months after the first injection. Results: In the case squares, the mean number of terminal and vellus hairs was 87 and 43 at the beginning and 85 and 42, respectively, at the end of six months. Conclusions: Our study showed that the PRP was not effective in treating AGA of grade 4–6.