Journal of Cutaneous and Aesthetic Surgery
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   Table of Contents     
FROM THE LITERATURE  
Year : 2011  |  Volume : 4  |  Issue : 3  |  Page : 220-222
From the Literature


1 Skinnocence: The Skin Centre, Gurgaon, Haryana, India
2 Department of Dermatology and Venereology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India

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Date of Web Publication28-Dec-2011
 

How to cite this article:
Sonthalia S, Sarkar R. From the Literature. J Cutan Aesthet Surg 2011;4:220-2

How to cite this URL:
Sonthalia S, Sarkar R. From the Literature. J Cutan Aesthet Surg [serial online] 2011 [cited 2019 Apr 18];4:220-2. Available from: http://www.jcasonline.com/text.asp?2011/4/3/220/91261


Treatment of Acne Scars in Asian Patients Using a 2,790-nm Fractional Yttrium Scandium Gallium Garnet Laser

Kim S


Dermatol Surg 2011;37:1464-1469

Ablative fractional resurfacing is an efficacious modality for the treatment of acne scars. The two traditional devices, 10,600-nm CO 2 and 2940-nm erbium-doped yttrium aluminium garnet (Er:YAG) lasers have been effective for acne scars in Asians, though with a frequent occurrence of post-inflammatory hyperpigmentation (PIH). The recently introduced 2790-nm yttrium scandium gallium garnet (YSGG) laser has been used as a novel treatment for periorbital wrinkles. The water absorption coefficient of this laser lies between Er:YAG and CO 2 lasers and induces an equivalent ratio of ablation to coagulation in the treated skin, resulting in an enhanced ratio of cosmetic benefit to patient downtime and decreased adverse effects. This study evaluated the efficacy and safety of 2790-nm YSGG ablative fractional resurfacing laser on atrophic acne scars in Asian individuals.

Twenty patients with skin phototype IV and atrophic mild-to-severe acne scars were treated with two sessions of 2790-nm ablative fractional resurfacing laser at a 6-week interval. Full-face treatments were given, consisting of a single pass with a focused tip followed by a single pass with a defocused tip with 80-120 mJ energy per microspot. At 3 months after the last session, 70% of the participants were rated as having at least 50-89% improvement in scars. Participants maintained 88% of their overall improvement at their 3-month visits compared with their 1-month follow-up visits. The average downtime was 7 days. The most common adverse effect was mild erythema (30% cases) lasting for an average of 5 days. No patient developed PIH.

Thus, the authors used a new fractional ablative laser wavelength to treat acne scarring safely and effectively in Asian patients, a population at risk of development of PIH. They also employed the novel approach of using the laser in a defocused mode for a second pass providing total ablation and coagulation of the surface of the scars, enhancing connective tissue remodelling without increasing recovery time or side effects. Although the results of this study are promising, further studies involving a larger number of patients are warranted to evaluate the long-term efficacy of the new laser. In conclusion, the authors successfully reported on the effective and safe use of 2790-nm YSGG fractional laser in the treatment of acne scars in Asian patients.

Botulinum Toxin for the Treatment of Menopausal Hot Flushes: A Pilot Study

Odo ME, Odo LM, Farias RV, Primavera RA, Leão L, Cucé LC, Juliano Y


Dermatol Surg 2011;37:1579-1583

Hot flashes are the most common and frustrating symptom in menopausal women characterized by feeling of intense heat lasting for few seconds or minutes, often followed by profuse perspiration and flushing. The most effective treatment available at present is hormonal therapy, while other treatment options have resulted in variable responses. Botulinum toxin type A (BoNTA) is very effective in the temporary control of hyperhidrosis and can be used over extensive areas of the body. This pilot study evaluated the efficacy and duration of control of hot flashes in postmenopausal women with BoNTA injections.

Sixty menopausal patients with complaints of severe hot flashes were included and randomized into 2 groups of 30 patients each to receive injections of BoNTA (study group) or saline solution (control group). Follow-up evaluations were done 60 and 180 days after treatment session. Patients graded hot flashes into three levels depending on the extent, duration and intensity of perspiration. Objective evaluation was performed using the starch-iodine test. BoNTA was used at a concentration of 500 U, diluted in 3.2 mL of saline, and injected intradermally as 0.04-mL (6.2 U) injections at each selected point in the skin. For the control group, 0.04 mL saline was given per injection point. Certain areas were excluded for safety reasons (lower eyelids, upper lip) or due to requirement of excessive amounts of toxin (axilla, inframammary region, and groins). Forty injection points were selected per patient, based on areas with excessive perspiration, face (12), chest (8), neck (5) and scalp (15). Compared to the control group, there was a statistically significant reduction in the mean intensity of sweating and mean number of hot flashes 60 days after treatment with BoNTA. No staining was detected with the starch-iodine test at the sites in which BoNTA was injected. In addition to the improvement in hot flashes in the study group, other menopausal symptoms such as night sweats and mood changes also improved. The recurrence of perspiration was complained of at the 180-day follow-up, but it was less severe than that before treatment.

The major limitation of this study is that only regions with excessive perspiration were selected for BoNTA injection. Since they do not cover the full range of variations in excessive perspiration patterns, the problem persisted in areas in which injections were not given. In conclusion, this pilot study illustrated that BoNTA treatment results in marked but reversible improvement in menopausal hot flashes. Further studies are required to confirm the findings of this study.

The Effect of a 1550 nm Fractional Erbium-Glass laser in Female Pattern Hair Loss

Lee GY, Lee SJ, Kim WS


J Eur Acad Dermatol Venereol. 2011;25:1450-4

Female pattern hair loss (FPHL), the most common cause of hair loss in women, results in significant psychological distress and severe impairment of social function. Medical treatments have a variable response, being unsatisfactory in many patients. A variety of laser and light sources have been tried for treatment of hair loss in men as well as women including the low-level laser therapies (LLLT) which have shown some success in clinical studies. The principle of stimulation of hair follicle growth or acceleration of hair cycling after controlled wounding has been an active area of research. The investigators of this study have extrapolated this concept to hair growth stimulation as a therapeutic effect of controlled wounding achieved by fractional photothermolysis. The purpose of this study was to evaluate the clinical efficacy and safety of the 1550-nm fractional erbium-glass laser in women with FPHL.

Twenty-seven South Korean patients (aged 26-55 years) with varying degrees of FPHL completed the 5-month treatment protocol of this single-centre, prospective study. Patients received 10 treatments with a 1550-nm fractional Er:glass laser at 2-week intervals using identical parameters (5-10 mm tip, 6 mJ pulse energy, 800 spot⁄cm 2 density, static mode), delivered in a single pass on each visit. These parameters were determined based on a comparison of results of preliminary experiments by the investigators. The whole diffuse alopetic area, usually involving the frontovertical and parietal regions, was treated without any topical anaesthetics or analgesics and without shaving the treatment area. Definite erythema developed at all treatment sites after the procedure. Treatment efficacy was assessed by changes in hair density and diameter analyzed using a phototrichogram (usually taken over the vertex area), a blinded review of global photographs done by three independent dermatologists using a seven-point scale and the patient-reported overall satisfaction grading.

After 5 months of laser treatment, a marked and statistically significant increase was observed in the hair density (from 100 ± 14/cm 2 to 157 ± 28/cm 2 ; 57% increment) and hair thickness (58 ± 12 lm to 75 ± 13 lm; 77% increment). Global photographs showed improvement in 24 (87.5%) of the 27 patients with a remarkable improvement at the frontal hair recess in all patients. Twenty-six (92.3%) patients judged their condition as improved and 1 (3.7%) as stabilized with none reporting any worsening of hair loss. No significant adverse effects were reported except mild transient pruritus in 2 (7.4%) patients. All patients showed good tolerance for treatment-related pain.

Though the exact mechanism of action of fractional photothermolysis in hair growth stimulation is not known, authors have proposed that laser-induced increased blood flow, cytokines and growth factors change, or direct stimulation of the dermal papilla may be contributory. In conclusion, 1550-nm fractional Er-glass laser irradiation may be an effective and safe treatment option for women with FPHL with improvement achieved in a relatively short period. Combined therapy with conventional treatments, such as topical minoxidil, might have a synergistic effect. Further studies are warranted with more number of patients to prove the exact mechanism of action and to propose more suitable parameters and treatment intervals.

A Double-blind, Randomized Study Comparing Pure Chromated Glycerin With Chromated Glycerin with 1% Lidocaine and Epinephrine for Sclerotherapy of Telangiectasias and Reticular Veins

Kern P, Ramelet AA, Wutschert R, Mazzolai L


Dermatol Surg 2011;37:1590-4

Sclerotherapy is one of the main modalities of treatment of reticular leg veins and telangiectasias. Various sclerosing agents have been used including hypertonic saline, detergent sclerosants such as sodium tetradecyl sulphate (STS) and polidocanol (POL), and osmotic dehydrants such as glycerin. Chromated glycerin (CG; 72% glycerin and 0.8 chromium alum) is an effective sclerosing agent for telangiectasias and reticular leg veins. CG has been shown to be more effective than 0.25% polidocanol solution and foam, but it is significantly more painful than polidocanol. While the addition of a local anaesthetic (LA) solution to CG is expected to reduce the pain, the resultant dilution of CG could possibly reduce the overall efficacy. Despite lack of clear evidence in favour of addition of LA to CG, such a combination has been used in everyday practice by many phlebologists. This study formally compared the relative efficacy and pain level of pure CG versus CG mixed with one-third lidocaine-epinephrine 1% (CGX).

This prospective randomized, double-blind trial included 110 female patients with lateral thigh reticular or telangiectatic veins, randomized into two groups to receive either pure CG or CGX injection. Only telangiectasias located on the lateral aspect of the thigh were treated, to have comparable treated skin areas and avoid the confounding effect of a potential saphenous reflux. Injections were given using 2-mL silicone syringes and a 30 G 0.5-in. needle. A total of 60-80 injections of very small volumes of the sclerosing agent were given during the treatment session with the maximum amount of injected solution being 10 mL per patient. Post-procedure compression stockings were suggested for 1-3 weeks. Efficacy assessment was done by pre- and post-procedure lower limb photographs analyzed by blinded expert reviewers. Patients' pain score (immediately post-procedure) and satisfaction with the treatment outcome (5 weeks post-treatment) were assessed using visual analogue scales. Results from 102 patients included for final analysis showed that the treatment efficacy in terms of patient satisfaction and objective visual assessment of vessel disappearance were similar in both the groups. However, CGX was significantly less painful than CG (pain score: 23.87 with CGX vs 41.57 with CG). No serious side effects were encountered in either group.

Thus, in sclerotherapy with glycerin, adding lidocaine-epinephrine to CG almost halves the pain score of pure CG injections. Epinephrine not only reduces bleeding at the injection site making the procedure easier, it also enhances the sclerosing power of CG. In conclusion, the addition of lidocaine-epinephrine 1% to CG, in a ratio of one-third, significantly reduces sclerotherapy pain without affecting efficacy when treating telangiectasias and reticular leg veins.

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Correspondence Address:
Rashmi Sarkar
Department of Dermatology and Venereology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi
India
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Source of Support: None, Conflict of Interest: None


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