Dermabrasion: therapy and prophylaxis of the photoaged face

Therapeutic effect of concentrated growth factor preparation on skin photoaging in a mouse model

OBJECTIVE

To establish a nude mouse model of photoaging and study the therapeutic effect of a concentrated growth factor preparation (CGF) on skin photoaging.

METHODS

CGF was prepared from blood from Sprague-Dawley rats. A skin photoaging nude mouse model was developed using UV irradiation combined with the photosensitizer, 8-methoxypsoralen. Mice were divided randomly into seven groups (n = 6 per group): normal control, photoaging, mock treatment, saline treatment, CGF treatment, Filoca 135HA treatment, and plasma skin regeneration system irradiation (the latter two were positive controls). Body weight and skin appearance were observed and pathological changes were determined by hematoxylin and eosin staining. Fiber elasticity was evaluated by Weigert staining. Expression levels of proliferating cell nuclear antigen (PCNA) and matrix metalloproteinase 1 (MMP1) were determined by immunohistochemistry.

RESULTS

A mouse model with typical features of photoaging skin was successfully developed. CGF significantly improved the skin appearance, wrinkle scores, pathological changes, and fiber elasticity, and increased PCNA and decreased MMP1 expression levels in photoaging mice, comparable to the two positive controls.

CONCLUSION

CGF can improve the symptoms of skin photoaging in mice, suggesting that it may have applications in the treatment of skin aging in humans.

The Role of the Transcriptional Regulation of Stromal Cells in Chronic Inflammation

Chronic inflammation is a common process connecting pathologies that vary in their etiology and pathogenesis such as cancer, autoimmune diseases, and infections. The response of the immune system to tissue damage involves a carefully choreographed series of cellular interactions between immune and non-immune cells. In recent years, it has become clear that stromal resident cells have an essential role perpetuating the inflammatory environment and dictating in many cases the outcome of inflammatory based pathologies. Signal transduction pathways remain the main focus of study to understand how stimuli contribute to perpetuating the inflammatory response, mainly due to their potential role as therapeutic targets. However, molecular events orchestrated in the nucleus by transcription factors add additional levels of complexity and may be equally important for understanding the phenotypic differences of activated stromal components during the chronic inflammatory process. In this review, we focus on the contribution of transcription factors to the selective regulation of inducible proinflammatory genes, with special attention given to the regulation of the stromal fibroblastic cell function and response.

Neck skin rejuvenation

The author of this article uses the pulsed ablative CO2 laser for resurfacing of the neck and face, based on the gold standard status of the CO2 laser and a novel post-treatment plan that greatly reduces adverse effects traditionally associated with fully ablative resurfacing. The croton oil peel is an inexpensive and effective modality for rejuvenating neck skin. The use of either technique as an adjunct to neck lift surgery, with or without facelift surgery, permits surgeons to fulfill the expectations of patients who want the skin of their face and neck to be homogeneous and more attractive.

Management of acne scarring, part I: a comparative review of laser surgical approaches

Acne scarring is the result of a deviation in the orderly pattern of healing and can have profound psychosocial implications for patients. While the most effective means of addressing acne scarring is to prevent its formation through good acne control, there are a number of therapeutic interventions that improve the appearance of acne scars. Many of these procedural modalities have flaws and are limited by operator skill and experience. Laser scar revision, on the other hand, is a precise, well tolerated procedure with clinically demonstrable efficacy and minimal adverse effects that may be used alone or in combination with other scar treatments. The last 20 years has seen a dramatic evolution in laser treatment of acne scars, spanning ablative and nonablative technologies, to the current popularity of fractional laser scar revision. Determining which laser system to use depends upon the type and severity of acne scarring, the amount of recovery a patient can tolerate, and the ultimate goals and expectations of each patient. The importance of proper acne scar classification, laser scar revision techniques, and the evidence that addresses each laser system is reviewed in this article.

Fractionated laser resurfacing corrects the inappropriate UVB response in geriatric skin

Non-melanoma skin cancer is a disease primarily afflicting geriatric patients as evidenced by the fact that 80% of all non-melanoma skin cancers are diagnosed in patients over the age of 60 years. As such, geriatric skin responds to cancer-inducing UVB irradiation in a manner that allows the establishment of tumor cells. Currently, the only effective treatment for non-melanoma skin cancer is the removal of the tumors after they appear, indicating the need for a more cost-effective prophylactic therapy. Geriatric volunteers were treated with fractionated laser resurfacing therapy on either sun-protected (upper buttocks) or chronically sun-exposed (dorsal forearm) skin. Fractionated laser resurfacing therapy was demonstrated to decrease the occurrence of senescent fibroblasts in geriatric dermis, increase the dermal expression of insulin-like growth factor-1, and correct the inappropriate UVB response observed in untreated geriatric skin. These responses to fractionated laser resurfacing were equal to the effects seen previously using the more aggressive wounding following dermabrasion. Furthermore, fractionated laser resurfacing was equally effective in both sun-protected and sun-exposed skin. The ability of fractionated laser resurfacing treatment to protect against the occurrence of UVB-damaged proliferating keratinocytes indicates the potential of fractionated laser resurfacing to reduce or prevent aging-associated non-melanoma skin cancer.

5-Fluorouracil superficial peel for multiple actinic keratoses

BACKGROUND

Chronically photodamaged skin usually presents with multiple, widespread, actinic keratoses (AKs), and treatment of the entire affected area is recommended.

METHODS

We report our experience with a combination of Jessner's solution or 70% glycolic acid (GA) with 5% 5-fluorouracil (5-FU) solution for superficial pulse peeling used in the treatment of widespread AKs in 31 patients. Pulse peelings were performed at biweekly intervals. The endpoint for treatment was complete or maximum clearance of the lesions at clinical evaluation. Pre- and post-skin biopsy and histopathologic examination were performed in three patients for the purpose of demonstrating the pulse peel effects.

RESULTS

All patients achieved a satisfactory result, including the complete regression, or at least 80% clearing, of AK lesions and an overall improvement of photodamaged skin.

CONCLUSION

We consider this superficial 5-FU pulse peel to be a safe, well-tolerated, very effective, and highly inexpensive therapeutic option for the treatment of multiple, diffuse AKs. Its benefit/cost ratio will be of interest to public health services, mainly in developing countries.

Trichloroacetic acid peeling versus dermabrasion: a histometric, immunohistochemical, and ultrastructural comparison

BACKGROUND

Trichloroacetic acid (TCA) chemical peel and dermabrasion are beneficial methods for treatment of photoaged skin.

OBJECTIVE

In this study, we evaluated the changes induced by these therapies on various structures of facial skin of nine dark-skinned patients (Fitzpatrick types IV-V; TCA, five patients; dermabrasion, four patients) demonstrating different degrees of photodamage.

METHODS

Routine histopathology coupled with histometric computer-assisted image analysis was used to assess epidermal changes. Alcian blue stain was used to evaluate changes in glycosaminoglycans. Immunoperoxidase techniques with antibodies against types I and III collagen and elastin were used to evaluate quantitatively changes in collagen and elastic fibers, and their ultrastructure was examined by transmission electron microscopy.

RESULTS

Similar histologic, immunohistochemical, as well as ultrastructural changes were observed in the two groups, including epidermal and dermal rejuvenation with new collagen deposition and normalization of the elastic tissue. However, these changes were more prominent in patients treated with dermabrasion than those treated with TCA.

CONCLUSION

The results of this study suggest that beneficial effects of such modalities on facial skin were accomplished primarily by increasing the amounts of collagen I and collagen III and improving the morphologic appearance of collagen and elastic fibers.

Full face laser resurfacing: Therapy and prophylaxis for actinic keratoses and non-melanoma skin cancer

BACKGROUND

Although there are many effective treatment modalities for individual actinic keratoses (AKs), widespread lesions on the photoaged face pose a challenge due to inefficient and ineffective therapy resulting in high rates of recurrence after local destruction. Full face laser resurfacing offers an effective and efficient treatment option that successfully reduces the number of AK's on diffusely damaged skin and may show a prophylactic benefit for preventing non-melanoma skin cancers.

OBJECTIVE

To assess the efficacy of full face laser resurfacing in reducing the number of facial AK's by comparing preoperative and postoperative numbers of lesions present and to observe the incidence of non-melanoma skin cancer after full face laser resurfacing.

STUDY DESIGN

A retrospective chart review of 24 patients with widespread facial AK's (greater than 30) treated with full face UPCO(2) and/or Er:Yag laser resurfacing was performed. All patients were a minimum of 1 year post-operative following facial laser resurfacing. The recurrence of AK's and the occurrence of facial non-melanoma skin cancers in these patients was assessed through chart analysis.

RESULTS

Widespread AK's were effectively eliminated in all patients. Twenty-one patients (87%) remained lesion free for at least 1 year. Fourteen of the 24 patients (58.3%) showed no new lesions during a 2-year follow-up. There was an overall 94% reduction in total number of AK's. Adverse effects included transient perioral scarring in one patient, S. aureus infection in two patients, and dyschromia in two patients.

CONCLUSIONS

Full face laser resurfacing provides long-term effective prophylaxis against AKs and may reduce the incidence of AK related squamous cell carcinoma.

Chemical peels: their place within the range of resurfacing techniques

The photoaging index has been developed to determine the level of skin rejuvenation required to reduce the visible signs of aging. Minor photoaging is reversed with free-radical avoidance and peeling with a topical skin care regimen consisting of buffing grains, alpha-hydroxy acid normalizing tonics and vitamin A conditioning lotions. The reversal of moderate photoaging requires the addition of light-to-moderate peels using alpha-hydroxy acids combined with microdermabrasion. For the more advanced case the Jessner/trichloroacetic acid (TCA) combination peel (Monheit peel) is used which can be repeated once to twice a year. Laser resurfacing is especially useful to shrink the collagen and produce a 'face-lift bypass'. The phenol peel remains the standard to reverse heavy lines. A new modified formula (Hetter) is used which contains less phenol and less croton oil. Dermabrasion is helpful for removing multiple actinic keratosis. With this combination of skin care, chemical peels, and dermabrasion it is possible to reverse the photoaging index.

Short-term histologic effects of nonablative resurfacing: results with a dynamically cooled millisecond-domain 1320 nm Nd:YAG laser

BACKGROUND

It is widely believed that nonablative laser techniques can lead to dermal collagen remodeling without the obvious epidermal injury and the wound created with ablative approaches. This occurs when dermal collagen injury is induced without visible injury to the overlying epidermis.

OBJECTIVE

To examine the acute histologic effects both 1 hour and several days after standardized treatment protocols of dynamically cooled millisecond domain Nd:YAG 1320 nm laser to provide further insight into the mechanism of action of nonablative resurfacing.

METHODS

Multiple adjacent sites on the preauricular area of the cheek of 10 patients were biopsied following one to three laser passes of dynamically cooled millisecond-domain Nd:YAG 1320 nm laser. Biopsies were performed at 1 hour and at 3 days following a single treatment. The number of passes was varied from one to three and Tmax (peak temperature measured by integrated radiometer) during treatment was targeted for 45-48 degree C.

RESULTS

At 1 hour after treatment, epidermal spongiosis and edema of the basal cell layer were present in all the specimens treated with three passes. At 3 days the three pass samples also showed microthrombosis, widened vessels, sclerosis of the vessel walls, and infiltration of neurophilic granulocytes. The occurrence of these histologic findings correlated well with the presence of clinical improvement (judged by photographs) at 8 weeks after treatment. Acute histologic changes and clinical improvement were not observed below treatment temperatures of Tmax 45 degree C or after one pass alone. Repeated temperatures above a Tmax of 48 degree C incurred risk of epidermal injury.

CONCLUSION

Even though longer-term histologic findings have confirmed the collagen synthesis component of 1320 nm Nd:YAG laser, our data indicate that there may be some additional factors other than dermal collagen heating with subsequent collagen repair. The concept of true "nonablative resurfacing" may involve some form of subclinical epidermal injury that improves the clinical outcome. Acute changes involving superficial blood vessel injury with cytokine release may also be implicated. Our histologic findings suggest that three passes with fluence and cooling adjusted to a Tmax of 45 degree C-48 degree C yields improved clinical results.

Maximizing benefits and minimizing risk with CO2 laser resurfacing

Laser resurfacing using the high-energy, pulsed and scanned CO2 laser produces the most dramatic improvement in severe photo-induced facial rhytides and deeply atrophic scars. More recently, the use of short- and long-pulsed erbium lasers in conjunction with CO2 laser resurfacing has been shown to speed healing by removing the upper layer of thermally induced necrotic tissue. The Er:YAG lasers are more superficial ablative tools that inflict less residual thermal damage on the tissue, thus allowing healing to occur without the requisite internal clearance of excessive debris. With continued research and advances in laser surgery, cutaneous resurfacing will be further enhanced with improved outcomes and lessened morbidity.

New and emerging treatments for photoaging

It is easy to become too busy treating the sequelae of photoaging, actinic keratoses, and skin cancers to discuss prevention adequately with patients. With children, sun-protective measures and sunscreen information should be the main therapeutic intervention. In any young adult with an actinic keratosis or skin cancer, topical and resurfacing treatments should be considered. In older patients with fragile skin and solar purpura, reversal of photodamage can have a positive effect on daily functioning.

Frozen human epidermal allogeneic cultures promote rapid healing of facial dermabrasion wounds

BACKGROUND

Clinical studies have shown that cultured human epidermal allogenic sheets promote faster reepithelization of skin donor sites and deep partial-thickness wounds.

OBJECTIVE

We describe the results of a controlled, clinical study of facial dermabrasion sites treated with a single application of frozen cultured human allogenic epidermal sheets that were thawed for 5-10 minutes at room temperature before application.

METHODS

Ten patients with scars from acne or of other etiology underwent facial dermabrasion. One side of the face was treated with the frozen and thawed cultures, the other side was treated with standard dry dressing.

RESULTS

The epidermal cultures promoted faster reepithelization of the wounds, with complete reepithelization in an average time of 4.6 days, whereas controls healed in an average of 7. 9 days. The reduction in healing time was 42% (P = 4.82 x 10(-7)). Pain was reduced in sites treated with the thawed cultures.

CONCLUSION

Epidermal allogenic cultures, preserved by freezing, promoted significantly faster reepithelization and reduced pain intensity of dermabraded facial wounds, suggesting that they could be used routinely to improve the recovery from dermabrasion.

Cutaneous laser resurfacing

Cutaneous resurfacing with the new generation of carbon dioxide and erbium lasers has recently come into favor for the treatment of facial rhytides, photodamage, and scarring. The precise control of these resurfacing lasers over the extent of tissue vaporization minimizes thermal damage to the skin while maximizing therapeutic efficacy. Proper use of resurfacing lasers is contingent upon a complete understanding of their clinical, histologic, and ultrastructural effects, as well as an appreciation of the principles of laser safety. An organized approach to the preoperative, intraoperative, and postoperative management of the patient undergoing laser resurfacing will be provided, including a discussion of prevention and treatment of postoperative side effects and complications. (J Am Acad Dermatol 1999;41:365-89.)

LEARNING OBJECTIVE

At the conclusion of this learning activity, participants should be familiar with the clinical, histologic, and ultrastructural effects of resurfacing lasers and be able to discuss the preoperative, intraoperative, and postoperative management of patients undergoing laser resurfacing.

A case report of laser resurfacing as a skin cancer prophylaxis

BACKGROUND

Many patients suffer from multiple nonmelanoma skin cancers. We recently encountered two such patients who requested some form of prophylaxis against future skin cancers.

OBJECTIVE

To highlight the potential utility of laser resurfacing as a skin cancer prophylaxis.

METHODS

Two patients with histories of multiple facial skin cancers were treated with CO2 laser resurfacing for the purpose of skin cancer prophylaxis.

RESULTS

During a follow-up period of 33 and 52 months, both patients have remained free of skin cancers in the main treatment field while developing new tumors outside of this area.

CONCLUSION

Laser resurfacing should be considered as a potential method of achieving skin cancer prophylaxis in selected patients.

Long-term effectiveness and side effects of carbon dioxide laser resurfacing for photoaged facial skin

BACKGROUND

Laser resurfacing has been used for treatment of photoaged facial skin since late 1993. Very few long-term follow-up studies regarding the effectiveness and side effects of this procedure have been reported.

METHOD

Patients who received carbon dioxide laser resurfacing for facial photoaging and wrinkling from Dec 17, 1993, to Nov 30, 1996, were followed up with clinical evaluation and patient questionnaires. Histologic study was also performed in 10 representative patients who had had preoperative biopsies. All treatments were performed by 2 experienced laser surgeons (R. E. F. and M. P. G.).

RESULTS

One hundred four patients were examined and interviewed with an average 24-month postoperative follow-up (range 12 to 44 months). We observed high patient satisfaction ratings and significant persistence of wrinkle score improvement. Long-term histologic features confirmed the long-lasting nature of the clinical improvement and demonstrated continuing, progressive improvement in solar clastosis deep in the dermis for an average follow-up period of 2 years. Prolonged use of topical tretinoin (retinoic acid) postoperatively may contribute to continued improvement. The incidence of long-term side effects, including pigmentary changes and scarring, was generally very low and these side effects were usually not noticed by the patients.

CONCLUSION

Improvement from cutaneous laser resurfacing has persisted for an average 24-month postoperative period with a low incidence of side effects. Hypopigmentation is the most common long-term side effect and appears to be related to the degree of pre-existing photodamage as it contrasts with the newly healed undamaged skin.

Periorbital rejuvenation: a review of dermatologic treatments

BACKGROUND

The periorbital region serves as a barometer of chronologic and environmental age and, as such, patients often seek its cosmetic rejuvenation.

OBJECTIVE

The purpose of this article was to review the dermatologic treatments available for periorbital skin rejuvenation.

METHODS

Topical retinoic and glycolic acid preparations, chemical peels, botulinum and collagen injections, dermabrasion, and laser resurfacing procedures for periorbital skin rejuvenation were reviewed. The relative benefits and risks of each treatment were detailed.

RESULTS

Minimal photodamage with mild rhytides should be responsible to topical acid therapy and superficial peels, whereas moderate wrinkling and photodamage generally require medium-depth peels, collagen injections, or erbium:YAG laser resurfacing. Deeper rhytides and more extensive cutaneous photo-damage usually necessitate CO2 laser resurfacing and botulinum injections.

CONCLUSIONS

Proper patient selection and assessment of aging severity are critical to determine the best therapeutic option.

Comprehensive treatment of the aging face--cutaneous and structural rejuvenation

As people age, characteristic changes occur in the skin, the soft tissue envelope, and the bony skeleton of the face and result in the aging face syndrome. An understanding of the pertinent biomechanical and histologic changes is necessary for developing an appropriate treatment plan. The advent of many new techniques, including cosmetic exfoliation, laser skin resurfacing, open rhinoplasty, and endoscopic, multiplane plastic surgical procedures, has enhanced therapy for the aging face syndrome. Treatment protocols should be individualized for each patient's needs and desires. Several of these recent treatments for facial rejuvenation are reviewed herein.

Long-term results after CO2 laser skin resurfacing: a comparison of scanned and pulsed systems

BACKGROUND

New laser technology permits the use of high-energy pulsed and continuous-wave carbon dioxide (CO2) lasers with flashscanners to treat rhytides.

OBJECTIVE

We compared the efficacy and side effects of the two leading CO2 lasers used in skin resurfacing.

METHODS

A total of 28 patients with facial rhytides were treated with either the UltraPulse or SilkTouch laser systems; in five additional patients, contralateral cosmetic units were treated with one system or the other in a direct comparison of the lasers.

RESULTS

We compared photographs taken before and after treatment, and a lessening of facial wrinkling was noted in all subjects. In some subjects improvement was confirmed by optical profilometry methods. Biopsy specimens in representative patients showed that immediate thermal damage was limited to 180 microns. Long-term postoperative specimens showed changes in the papillary dermis consistent with new collagen deposition and reduction of pretreatment solar elastosis. Posttreatment facial erythema was noted in half the patients for up to 2 months; transient hyperpigmentation was observed in one third of the treated areas.

CONCLUSION

Although the SilkTouch system produced more immediate thermal damage, there were no significant differences in efficacy or adverse effects between the lasers. Our results suggest that both laser systems, used with appropriate settings, are capable of safely smoothing the skin surface.

Histology of laser resurfacing

The development of high-peak power or scanned CO2 lasers that precisely remove layers of photodamaged skin has provided a novel method of skin rejuvenation. Clinical data suggest that laser resurfacing provides comparable or better results than conventional methods of chemical peeling and mechanical dermabrasion, with a lower risk-to-benefit ratio. Histologic studies of the effects of these lasers on tissue have been helpful in establishing guidelines for appropriate clinical use of these lasers and insights into the mechanisms whereby facial skin rejuvenation is achieved.

Improvement of facial acne scars by the 585 nm flashlamp-pumped pulsed dye laser

BACKGROUND

Hypertrophic or erythematous scars (or both) have remained notoriously difficult to treat because of their persistence or recurrence after traditional therapies. Recently, the 585 nm flashlamp-pumped pulsed dye laser has been shown to be effective in treating similar traumatic and surgical scars.

OBJECTIVE

Our purpose was to determine the effectiveness of the 585 nm flashlamp-pumped pulsed dye laser in the specific treatment of facial acne scars.

METHODS

Twenty-two patients with erythematous or hypertrophic facial acne scars were included in this Investigational Review Board-approved study. The 585 nm flashlamp-pumped pulsed-dye laser was used to treat scars on half of each patient's face, with the contralateral side used as control. Baseline, 6-week, and 6-month posttreatment photographs, erythema measurements made with reflectance spectrometry, and skin texture analyses were obtained from laser-irradiated and untreated scars. Clinical analyses were performed independently by two "blinded" observers.

RESULTS

Significant clinical improvement was observed in laser-irradiated acne scars compared with the untreated (control) scars after one or two 585 nm pulsed-dye laser treatments. Erythema measurements and skin texture analyses of laser-treated scars approximated those obtained in the adjacent normal skin.

CONCLUSION

The 585 nm flashlamp-pumped pulsed-dye laser can significantly improve the clinical appearance of erythematous or hypertrophic facial acne scars.

Dermabrasion in xeroderma pigmentosum

BACKGROUND

Dermabrasion is one choice of treatment for patients with severe actinic damage.

OBJECTIVE

To report the youngest xeroderma pigmentosum patient ot have received the benefits of this procedure.

METHODS

The dermabrasion was performed under general anesthesia using an acrotorque hand engine.

RESULTS

New tumor formation was reduced for several months after the treatment.

CONCLUSION

Dermabrasion can be considered as another therapeutic choice for young xeroderma pigmentosum patients with severe actinic damage.

A comparison of wire brush and diamond fraise superficial dermabrasion for photoaged skin. A clinical, immunohistologic, and biochemical study

BACKGROUND

Superficial dermabrasion has a proven beneficial effect on photoaged skin, but little is known about the differences between the two major modalities used in dermabrasion, the diamond fraise (DF) and the wire brush (WB).

OBJECTIVE

We compared the clinical, immunohistologic, and biochemical changes after superficial dermabrasion with DF and WB.

METHODS

Eight photoaged patients (mean age, 68 years; range, 49 to 80 years) underwent facial dermabrasion to the level of the papillary dermis. Clinical assessments were performed at baseline and at 3 and 12 weeks after dermabrasion. Biopsy specimens were taken from both dermabraded halves at the same time points and assessed by routine histologic and immunohistologic examinations, western blot analysis, and radioimmunoassay. Scoring of intracellular and extracellular transforming growth factor-beta 1 was based on a semiquantitative ordinal scale (0 = no staining to 4 = maximum staining) in half-unit increments. The score for each specimen represents the average of values obtained from four high-power fields.

RESULTS

Both methods of dermabrasion resulted in significant resolution of actinic keratoses, lentigines, and wrinkling. No statistical significance was noted between the two methods in regard to clinical efficacy. Significantly fewer milia occurred after DF than after WB. Solar elastosis decreased with both the WB and DF. Immunohistologic examination demonstrated a highly significant increase in papillary dermal fibroblast staining for amino terminal procollagen I (type I pN-collagen) at 3 weeks for both DF and WB compared to baseline. Staining at 12 weeks had decreased from the peak noted at week 3, but was still significantly increased from baseline. Western blotting of type I pN-collagen demonstrated a 5.4-fold (p = 0.01) increase from baseline at 3 weeks and a 4.9-fold (p = 0.002) increase at 12 weeks after dermabrasion with the WB. Similarly, the DF produced a 4.9-fold (p = 0.006) increase at 3 weeks and a 5.1-fold (p = 0.008) increase at 12 weeks after dermabrasion. Western blotting of amino terminal procollagen III (type III pN-collagen) showed a 6.1-fold (p = 0.07) increase from baseline at 3 weeks and a 3.9-fold (p = 0.04) increase at 12 weeks after dermabrasion with the DF. The WB showed a 3.8-fold (p = 0.07) increase from baseline at 3 weeks and a 5.1-fold (p = 0.05) increase at 12 weeks. Transforming growth factor-beta 1 demonstrated a significant increase in extracellular staining with DF (3.3 +/- 0.2) and WB (3.7 +/- 0.2) from baseline (1.2 +/- 0.2, p < 0.001) at 3 weeks.

CONCLUSION

Superficial dermabrasion with DF and WP appears to be similarly efficacious in the treatment of photoaged skin. Significant increases in type I pN-collagen, type III pN-collagen, and TGF-beta 1 occurred in the papillary dermis after both types of dermabrasion. These results suggest that increased fibroblast activity and consequent collagen I and III synthesis underlie the clinical improvement.

Dermabrasion for prophylaxis and treatment of actinic keratoses

BACKGROUND

After dermabrasion, patients with actinic keratoses remain free of new lesions for many years. This clinical effect has been alluded to for 40 years in the dermatologic literature. However, there has been no consensus on how long this clinical benefit actually lasts.

OBJECTIVE

To ascertain the longevity of the beneficial effect of dermabrasion, clinical records of patients who underwent this procedure for treatment of actinic keratosis were reviewed.

METHOD

Retrospective review.

RESULTS

A total of 23 such patients with at least 2 years good clinical follow-up were identified. Their ages ranged from 33 to 76 years. One year after dermabrasion, 96% remained free of new actinic keratoses. The benefits of dermabrasion gradually diminished with 83% clear at 2 years, 79% at 3 years, 64% at 4 years, and 54% at 5 years. The average time after dermabrasion before the appearance of one actinic keratoses was 4 years (median, 4.5 years). Dermabrasion, however did not prevent the appearance of basal cell carcinomas in the perinasal area.

CONCLUSION

Dermabrasion provides long-term effective prophylaxis against actinic keratoses and presumably squamous cell carcinomas. The benefits last for an average of 4 years before even one new actinic keratosis reappears. Cryosurgery, 5-Fluorouracil, and chemical peels result in much shorter prophylaxis. Dermabrasion is the most effective modality for prevention of new actinic keratoses.

The role of dermabrasion and chemical peels in the treatment of patients with xeroderma pigmentosum

We describe our experience with two patients with xeroderma pigmentosum who underwent periodic trichloroacetic acid chemical peels. One also received a full-face dermabrasion. The effect of chemical peeling was more transient than dermabrasion but was associated with less morbidity. Both chemical peeling and dermabrasion provided a prophylactic effect against the development of skin malignancies; the latter had a more pronounced effect.

Combining manual dermasanding with low strength trichloroacetic acid to improve actinically injured skin

BACKGROUND

Motor-driven dermabrasion or deeper chemosurgical peeling improves photodamaged facial skin. However, these procedures each pose disadvantages that we felt could be largely ameliorated by combining manual dermasanding with low strength trichloroacetic acid peeling.

OBJECTIVE

To evaluate the effectiveness, safety, and reproducibility of a technique combining manual dermasanding and light peeling in treating actinically injured facial skin.

METHODS

Manual abrasion with moistened silicone-carbide sandpaper followed by application of a 25% trichloroacetic acid solution was performed on over 300 patients followed as long as 7 years.

RESULTS

Improvement was uniformly noted in luster, brightness, dyschromia, and rhytids. The procedure was easily mastered and results were reproducible. Postoperative pigmentary problems and scarring were extremely rare.

CONCLUSIONS

The technique demands minimal skill and experience, while providing pleasing results. There is no splatter or sharp lines of demarcation, and results suggest distinct advantages over motor-driven dermabrasion or deep peeling procedures.