A Prospective Survey of Patient Experiences After Laser Skin Resurfacing

Identifying and appraising patient-reported outcome measures on treatment satisfaction in acne: a systematic review

BACKGROUND

After dermatitis, acne is the next skin disease to contribute most to the burden of skin diseases worldwide. Recently, seven core outcome domains have been identified, which together form an Acne Core Outcome Set (ACORN). One of these was satisfaction with acne treatment.

OBJECTIVES

To identify studies that described the development of patient-reported outcome measures (PROMS), evaluated one or more measurement properties of a PROM, or evaluated the interpretability of a PROM in patients with acne regarding treatment satisfaction.

METHODS

The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) search strategy for identifying PROMS on acne treatment satisfaction was used. We searched PubMed, MEDLINE, Embase, LILACS, Web of Science, Cochrane Library, Emcare, PsycINFO and Academic Search premier (June 2020). Study selection, data extraction and assessment of methodological quality according to COSMIN guidance were carried out independently by two authors.

RESULTS

Only one study could be included, describing the development of a treatment satisfaction measure in patients with acne. The development was assessed as inadequate and data on measurement properties were lacking. Additionally, we found 188 studies reporting treatment satisfaction solely as an outcome, using a wide variety of methods, none of them standardized or validated.

CONCLUSIONS

We could not find a PROM on treatment satisfaction to recommend for a core outcome set in acne. There is an unmet need for a PROM on treatment satisfaction in acne that is robustly developed, designed and validated.

Dermatologic Laser Side Effects and Complications: Prevention and Management

The evolution of modern laser and light-based systems has mirrored the demand for clinically effective treatments and the need for safer technologies with reduced postoperative recovery, side effects, and complications. With each new generation of lasers, more selective tissue destruction can be achieved with reduced unwanted sequelae. Patient selection and preparation, operator technique, and expeditious recognition and management of post-treatment side effects are paramount in avoiding complications and patient dissatisfaction. An overview of important variables to consider for dermatologic laser treatments are presented in order to provide a framework to reduce the severity and duration of possible post-treatment side effects and complications.

The spectrum of laser skin resurfacing: nonablative, fractional, and ablative laser resurfacing

The drive to attain cosmetic facial enhancement with minimal risk and rapid recovery has inspired the field of nonsurgical skin rejuvenation. Laser resurfacing was introduced in the 1980s with continuous wave carbon dioxide (CO(2)) lasers; however, because of a high rate of side effects, including scarring, short-pulse, high-peak power, and rapidly scanned, focused-beam CO(2) lasers and normal-mode erbium-doped yttrium aluminium garnet lasers were developed, which remove skin in a precisely controlled manner. The prolonged 2-week recovery time and small but significant complication risk prompted the development of non-ablative and, more recently, fractional resurfacing in order to minimize risk and shorten recovery times. Nonablative resurfacing produces dermal thermal injury to improve rhytides and photodamage while preserving the epidermis. Fractional resurfacing thermally ablates microscopic columns of epidermal and dermal tissue in regularly spaced arrays over a fraction of the skin surface. This intermediate approach increases efficacy as compared to nonablative resurfacing, but with faster recovery as compared to ablative resurfacing. Neither nonablative nor fractional resurfacing produces results comparable to ablative laser skin resurfacing, but both have become much more popular than the latter because the risks of treatment are limited in the face of acceptable improvement.

LEARNING OBJECTIVES

At the completion of this learning activity, participants should be familiar with the spectrum of lasers and light technologies available for skin resurfacing, published studies of safety and efficacy, indications, methodologies, side effects, complications, and management.

Managing expectations: the art of finding and keeping loyal clients

EDITOR'S NOTE

Susan Keane Baker was the opening speaker of the symposium on Veterinary Teaching Hospitals and the Future of Clinical Veterinary Medical Education, held in November of 2006 in Kansas City, Missouri. A nationally known consultant on communication in human health care, Ms Baker offered a number of helpful insights on improving veterinarian–client relationships by managing the client's expectations. This article captures some of those insights and provides food for thought.

Erbium:YAG Laser Resurfacing Using a Novel Portable Device

Laser resurfacing of facial rhytids has become a popular treatment for many patients who have wrinkles, photodamage, and acne scarring. Erbium:YAG laser resurfacing has emerged as one of the safer, more effective methods of facial rejuvenation and its increasing popularity has led to its widespread use for resurfacing. However, size and high initial and maintenance cost are among the problems with currently available laser devices. The LightPod portable Erbium:YAG laser from Aerolase offers a new paradigm for more cost effective means of performing ablative resurfacing with reduced initial and maintenance cost and the ease of portability with significantly reduced size and weight. The objective of this pilot study was to analyze the efficacy of The LightPod Erbium:YAG laser in different skin types for various indications.

Laserbrasion: The Combination of Carbon Dioxide Laser and Dermasanding

BACKGROUND

The purpose of this study was to assess the efficacy of laserbrasion (the combination of carbon dioxide laser and dermasanding) in the removal of heavy perioral wrinkles.

METHODS

Ninety patients underwent laserbrasion for treatment of heavy perioral wrinkles. They were assessed clinically by the surgeon and staff for wrinkle reduction, healing, and complications. A subset of 26 patients was followed for more than 1 year to assess long-term effects, especially hypopigmentation.

RESULTS

Laserbrasion was successful in reducing 95 percent of heavy perioral wrinkles as compared with 75 percent seen previously with laser alone. No complications were noted with laserbrasion, and there was no significant long-term hypopigmentation. Healing time was quicker for laserbrasion (9 days) than for laser alone (12 days).

CONCLUSIONS

Laserbrasion is an effective and safe method of reducing deep perioral wrinkles. The technique is easy to perform and inexpensive for the laser surgeon. Laserbrasion can yield better results than the laser alone and has the added benefit of a shorter healing time.

Postacne scarring - a quantitative global scarring grading system

BACKGROUND

There is no global quantitative grading system for assessing the disease load and global severity of disease in a patient with postacne scarring.

AIMS

The purpose of this article is to provide a quantitative grading system that would allow more objective communication between practitioners of a patient's global disease severity and between investigators, educators, and proceduralists of the efficacy of grade-specific operative interventions or therapies.

PATIENTS/METHODS

We describe a global scoring system that we have found clinically useful to assess disease load and severity of acne scarring and illustrate the reproducibility of this system in a small prospective study. Photographs of 21 patients were assessed independently by four observers, two of whom were physicians and the other two nurses.

RESULTS

A quantitative global acne scarring grading system is presented. No substantial difference among acne scarring scores was seen between observers, with inter-rater agreement within four score points in 19 of the 21 patient-photos assessed.

CONCLUSIONS

A global acne scarring grading system is presented that would allow investigators, educators, and proceduralists to compare their cases more accurately and to have a more objective discussion of the efficacy of operative interventions or therapies. This scoring system is shown to be reproducible among observers independent of medical background, suggesting that patients can be assigned scores equally by physicians and nurses.

Le rajeunissement du visage : techniques de complément ou de substitution à la chirurgie. Apport des lasers et systèmes à effets thermiques

The methods additional or substitution for the surgery of facial skin ageing are dramatically rising before 40 years. These methods are addressed more to the wrinkles and others signs of aging skin. They can constitute a door of entry in the aesthetic treatments and needs a professional approach. These noninvasive methods (within the meaning of the incision) can present complications this the more so as the tendency is with the vulgarizing and with under considerations of the initial diagnosis and the treatment itself. The devices of thermal effects consist of lasers, pulsed flashlamps and radiofrequency. The objective of this development is to consider the bonds, which link the initial diagnosis and the proposal for a treatment by considering side effects and complications of each method.