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Abstract
The demand for minimally invasive cosmetic procedures is rising, and the public and other physicians deem dermatologists as top providers of these services. Given these expectations, dermatologic residency training must equip resident physician trainees to care for the growing population of patients with aesthetic concerns. As stands, formal hands-on cosmetic dermatology training in residency is lacking specific structure. Educational, cultural, time, and monetary barriers exist, among others, which restrict residents from attaining proficiency in cosmetic dermatology procedures prior to graduation. This may adversely impact patient safety and deter graduates from offering aesthetic procedures. The standardization of core residency competencies in minimally invasive cosmetic procedures is fundamental to guarantee patient safety and satisfaction while ensuring practitioner competence. The balance between these elements is essential for optimal patient care. We review and debate for modifying and strengthening the current curriculum requirements while presenting means to overcome barriers.
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Affiliation(s)
- Elizabeth J Kream
- Department of Dermatology, University of Illinois at Chicago, College of Medicine, Chicago, Illinois, USA
| | - Virginia A Jones
- Department of Dermatology, University of Illinois at Chicago, College of Medicine, Chicago, Illinois, USA
| | - Maria M Tsoukas
- Department of Dermatology, University of Illinois at Chicago, College of Medicine, Chicago, Illinois, USA.
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2
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Ferreira IG, Weber MB, Bonamigo RR. History of dermatology: the study of skin diseases over the centuries. An Bras Dermatol 2021; 96:332-345. [PMID: 33814211 PMCID: PMC8178570 DOI: 10.1016/j.abd.2020.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/05/2020] [Accepted: 09/10/2020] [Indexed: 10/27/2022] Open
Abstract
The study of skin, the science of dermatology, has undergone significant transformations throughout the centuries. From the first descriptions of skin diseases in Egyptian papyri and in Hippocratic writings to the first treatises on dermatology, important individuals and discoveries have marked the specialty. In the 18th and 19th centuries, the specialty consolidated itself as a field of medical study based on the first classifications of dermatoses, diagnostic methods, and drug treatments. In the 20th century, the scientific and technological revolution transformed dermatological practice, incorporating new therapeutic resources, as well as surgical and aesthetic procedures. In the face of such a vigorous process, it is important to provide a historical synthesis for the medical community to recognize and understand the origins that supported one of the most relevant specialties in the current medical scenario.
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Affiliation(s)
- Iago Gonçalves Ferreira
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil; Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil.
| | - Magda Blessmann Weber
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil; Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
| | - Renan Rangel Bonamigo
- Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil; Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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3
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Borges J, Manela-Azulay M, Cuzzi T. Photoaging and the clinical utility of fractional laser. Clin Cosmet Investig Dermatol 2016; 9:107-14. [PMID: 27217790 PMCID: PMC4861605 DOI: 10.2147/ccid.s77996] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The description of atomic structure by Niels Bohr set the basis for the emergence of quantum physics. Based on these fundamentals, Einstein published in 1917 a paper on the amplification of energy by Stimulated Emission of Radiation as part of his quantum theories. In 1955, Townes and Gordon turned Einstein’s theories into practice, creating a coherent and amplified microwave device using ammonia gas in an optical medium. But it was at the beginning of the 1980s, that Anderson and Parrish published an article about the selective photothermolysis model which revolutionized clinical practice. The use of laser in photoaging began with CO2 (10,600 nm). In 1989, it was first used for resurfacing of a face with prominent photoaging. Ablative lasers have therefore had great popularity in the 1980s and 1990s, but prolonged postoperative time and significant risk of side effects have lowered the acceptance by patients. In 2004, the description of the fractionated radiation for the treatment of photoaging, by Mainstein, represented a great event. The stimulation of collagen occurred through fractional laser beams, which would reach the selected area while saving islands of sound skin. These islands accelerated the process of cicatrization of the treated tissue and shortened the postprocedure time. Furthermore, the fractionated radiation presented a smaller range of side effects, increasing the safety of the procedure. As mentioned earlier, as fractional lasers incise on the skin, they leave islands of healthy skin that accelerate recovery, while generating necrosis columns. Such necrosis columns remove damaged extracellular matrix material, allowing resettlement of fibroblasts. Such resettled fibroblasts, under the influence of a new tensile strength, restart to produce structures for extracellular matrix, such as collagen, elastin, and proteoglycans, in a more physiological way. Fractional lasers are considered by many dermatologists as the best choice in laser therapy for the treatment of photoaging.
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Affiliation(s)
- Juliano Borges
- Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa de Misericórdia do Rio de Janeiro, Rio de Janeiro, Brazil; Serviço de Anatomia Patológica da Faculdade de Medicina da Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mônica Manela-Azulay
- Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa de Misericórdia do Rio de Janeiro, Rio de Janeiro, Brazil; Serviço de Anatomia Patológica da Faculdade de Medicina da Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Tullia Cuzzi
- Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa de Misericórdia do Rio de Janeiro, Rio de Janeiro, Brazil; Serviço de Anatomia Patológica da Faculdade de Medicina da Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Stylianou A, Talias MA. The 'Magic Light': A Discussion on Laser Ethics. SCIENCE AND ENGINEERING ETHICS 2015; 21:979-998. [PMID: 25027860 DOI: 10.1007/s11948-014-9566-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 05/29/2014] [Indexed: 06/03/2023]
Abstract
Innovations in technology and science form novel fields that, although beneficial, introduce new bio-ethical issues. In their short history, lasers have greatly influenced our everyday lives, especially in medicine. This paper focuses particularly on medical and para-medical laser ethics and their origins, and presents the complex relationships within laser ethics through a three-dimensional matrix model. The term 'laser' and the myth of the 'magic light' can be identified as landmarks for laser related ethical issues. These ethical issues are divided into five major groups: (1) media, marketing, and advertising; (2) economic outcomes; (3) user training; (4) the user-patient/client relationship; and (5) other issues. In addition, issues arising from two of the most common applications of lasers, laser eye surgery and laser tattoo removal, are discussed. The aim of this paper is to demonstrate that the use of medical and para-medical lasers has so greatly influenced our lives that the scientific community must initiate an earnest discussion of medical laser ethics.
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Affiliation(s)
- Andreas Stylianou
- Healthcare Management Postgraduate Program, Open University of Cyprus, Latsia, Box 12794, 2252, Nicosia, Cyprus,
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5
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Stewart N, Lim AC, Lowe PM, Goodman G. Lasers and laser-like devices: Part one. Australas J Dermatol 2013; 54:173-83. [DOI: 10.1111/ajd.12034] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 01/15/2013] [Indexed: 12/27/2022]
Affiliation(s)
- Nicholas Stewart
- Concord Repatriation and General Hospital; Sydney; New South Wales; Australia
| | - Adrian C Lim
- Department of Dermatology; Royal North Shore Hospital; Sydney; New South Wales; Australia
| | - Patricia M Lowe
- Clinical Senior Lecturer; Sydney Medical School (Central); University of Sydney; Sydney; New South Wales; Australia
| | - Greg Goodman
- Dermatology Institute of Victoria; Melbourne; Victoria; Australia
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6
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Salem A, El Harras M, Ramadan A, Gamil H, Rahman AA, El-Said K. Use of the Q-switched Nd:YAG laser for the treatment of pigmentary disorders in Egyptians. J COSMET LASER THER 2010; 12:92-100. [PMID: 20331347 DOI: 10.3109/14764171003706109] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND OBJECTIVE Laser treatment of cutaneous pigmentation is one of the most interesting areas in cutaneous surgery. Our purpose was to study the efficacy of Q-switched Nd:YAG at 1064 nm and 532 nm for the treatment of some pigmented lesions in our locality in Egypt. METHODS A total of 60 subjects were treated with the Q-switched Nd:YAG laser with fluences ranging from 8 to 10 J/cm(2) for dermal lesions and 2.5-5 J/cm(2) for epidermal lesions. The number of sessions ranged from one to six sittings for epidermal lesions, four to six sessions for dermal lesions, while the mixed group required two to three sessions. RESULTS A total of 34 patients (56.7%) showed excellent response, seven patients (11.7%) showed good response, nine patients (15%) showed fair response, and 10 (16.6%) showed poor response. Transient postinflammatory hyperpigmentation occurred in five patients (8.33%) and erythema in seven patients (11.66%). Complications were common in darker skin types V and VI. CONCLUSION The Q-switched Nd:YAG laser is an effective and safe technique for the treatment of pigmented skin lesions. Adverse hyperpigmentation can occur but is transient.
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Affiliation(s)
- Ahmed Salem
- Department of Dermatology, Laser Unit, Zagazig University, Zagazig, Egypt.
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Affiliation(s)
- Joshua A Zeichner
- From Mount Sinai Medical Center, Department of Dermatology, New York, NY (Dr Zeichner) and the Weil Medical College of Cornell University, Department of Dermatology, New York, NY (Dr Sadick)
| | - Neil Sadick
- From Mount Sinai Medical Center, Department of Dermatology, New York, NY (Dr Zeichner) and the Weil Medical College of Cornell University, Department of Dermatology, New York, NY (Dr Sadick)
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Abstract
Laser therapy is one of the fastest expanding and most exciting fields in dermatology. From its theoretical beginnings in Einstein's imagination, lasers have come to be used in treatments for conditions ranging from skin malignancy and acne to hirsutism and photoaging. We will briefly review the evolution of laser treatment, with a focus on the recent developments surrounding the new millennium.
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Affiliation(s)
- Laura D Houk
- Department of Dermatology and Cutaneous Biology, Jefferson Medical College of Thomas Jefferson University, Thomas Jefferson University, Philadelphia, PA 19107, USA
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9
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Rashid T, Hussain I, Haider M, Haroon TS. Laser therapy of freckles and lentigines with quasi-continuous, frequency-doubled, Nd:YAG (532 nm) laser in Fitzpatrick skin type IV: a 24-month follow-up. J COSMET LASER THER 2002; 4:81-5. [PMID: 12623553 DOI: 10.1080/147641702321136246] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Newly developed lasers produce excellent results with minimal complications compared with traditional treatments for freckles and lentigines. OBJECTIVES To assess the efficacy and safety of the frequency-doubled Nd:YAG (532 nm) laser in the treatment of freckles and lentigines in type IV skin. PATIENTS AND METHODS Twenty adult patients (14 with freckles and six with lentigines) were subjected to a variable number of treatments with a minimum 4-week interval until no additional improvement occurred or > 75% improvement was obvious. Patients manifesting > 50% improvement were followed up once every 3 months for 24 months. The rest were regarded as treatment failures and not followed up. RESULTS Sixteen (80%) of 20. patients (freckles, n = 10; lentigines, n = 6) manifested more than 50% improvement. They were treat- irradiated between three and eight times with a 4-12-week interval. Complications included hypopigmentation (25%), mild textural changes (15%) and hyperpigmentation (10%). All these were mild and resolved within 2-6 months. Of 10 patients with freckles followed up for 24 months, four (40%) patients showed partial recurrence. However, all the patients maintained > 50% improvement. None of the patients with lentigines showed recurrence. CONCLUSION The quasi-continuous, frequency-doubled Nd:Y AG (532 nm) laser safely and effectively treats freckles and lentigines in Fitzpatrick skin type IV.
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Affiliation(s)
- T Rashid
- Department of Dermatology, King Edward Medical College/Mayo Hospital, Lahore, Pakistan.
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Coleman WP, Hanke CW, Orentreich N, Kurtin SB, Brody H, Bennett R. A history of dermatologic surgery in the United States. Dermatol Surg 2000; 26:5-11. [PMID: 10632679 DOI: 10.1046/j.1524-4725.2000.00401.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Dermatologic surgery has a long and distinguished history in the United States. OBJECTIVE To examine the specific contributions of American dermatologic surgeons. METHOD The medical literature on cutaneous reconstructive and cosmetic surgery for the last century and a half was researched. RESULTS Numerous American dermatologic surgeons have had a major impact on scientific and technological discoveries in cutaneous surgery. Dermatologic surgeons have been significantly involved in cutaneous surgery since the second half of the 19th century. Dermatologic surgeons have contributed many important advances to the fields of chemical peeling, cryosurgery, dermabrasion, electrosurgery, hair transplantation, soft tissue augmentation, tumescent liposuction, laser surgery, phlebology, Mohs chemosurgery, cutaneous reconstruction, wound healing, botulium toxin, blepharoplasty, and rhytidectomy. CONCLUSION Dermatologic surgeons in the United States have contributed significantly to the history of reconstructive and cosmetic surgery. Dermatologic surgeons have been leaders in advancing this field and are poised to continue in the future.
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Affiliation(s)
- W P Coleman
- Tulane University School of Medicine, New Orleans, Louisiana, USA
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Welsh JH, Schroeder TL, Levy ML. Granuloma faciale in a child successfully treated with the pulsed dye laser. J Am Acad Dermatol 1999; 41:351-3. [PMID: 10426931 DOI: 10.1016/s0190-9622(99)70386-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Granuloma faciale, a rare, chronic, cutaneous disorder, is uncommon in children. Numerous treatment modalities have been used to treat granuloma faciale but none are consistently effective. In addition, many of the previously used therapies have unwanted side effects or are not well tolerated by children. We report a case of granuloma faciale in an 11-year-old child successfully treated with the pulsed dye laser. To our knowledge, this is the first report of this treatment modality for granuloma faciale.
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Affiliation(s)
- J H Welsh
- Department of Dermatology, Baylor College of Medicine, Houston, Texas, USA
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12
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Abstract
Surgical dermatology continues to evolve rapidly. The field is blessed with a number of bright and enthusiastic young surgeons who are willing to spend to necessary time investigating new techniques. The horizon has changed dramatically over the last 5 years and promises to change even more in the years to come.
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Affiliation(s)
- W P Coleman
- Department of Dermatology, Tulane University School of Medicine, New Orleans, Louisiana, USA
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14
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Parish LC, Crissey JT, Parish JL. Bibliography of secondary sources on the history of dermatology. I. Journal articles in English supplemented through 1995. Int J Dermatol 1996; 35:430-7. [PMID: 8737880 DOI: 10.1111/j.1365-4362.1996.tb03027.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- L C Parish
- Department of Dermatology and Cutaneous Biology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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