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Zhang J, Ge J, Chen C, Shi F, Wang Y, Zhang J, Liang W. The Effectiveness of Using CO 2 Fractional Laser and Mebo Burn Ointment Together in Treating Scars on the Face after Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5254. [PMID: 37736070 PMCID: PMC10511033 DOI: 10.1097/gox.0000000000005254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 07/21/2023] [Indexed: 09/23/2023]
Abstract
Background This study aimed to investigate the efficacy and safety of CO2 fractional laser combined with Mebo burn ointment in treating facial postoperative scars. Methods Sixty patients with facial postoperative scars in the department of plastic surgery of Sun Yat-sen Memorial Hospital from January 2020 to June 2022 were divided into a control group (30 cases) and a study group (30 cases). Both groups received CO2 fractional laser treatment, but the study group also received Mebo burn ointment application. Results The study found that both methods resulted in a significant decrease in Sawada score and a significant increase in Investigator Global Assessment score after treatment (P < 0.05), with the study group showing a more significant improvement and higher patient satisfaction (P < 0.05). All patients experienced varying degrees of bleeding, swelling, and erythema immediately after treatment, with two cases of pigmentation and two cases of persistent erythema in the control group, and one case of pigmentation and one case of persistent erythema in the study group. Adverse reactions were minimal, with the study group showing better tolerance. Conclusions The study suggests that CO2 fractional laser combined with Mebo burn ointment is an effective and safe treatment for facial postoperative scars.
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Affiliation(s)
- Jiaqi Zhang
- From the Department of Plastic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jun Ge
- From the Department of Plastic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chen Chen
- From the Department of Plastic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Fen Shi
- From the Department of Plastic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yongzhen Wang
- From the Department of Plastic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jinming Zhang
- From the Department of Plastic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Weiqiang Liang
- From the Department of Plastic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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2
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Chieffe D, Kalos S, Bunting G, Hartnick C. Blue light laser recontouring for pediatric benign fibrovascular vocal fold lesions. Int J Pediatr Otorhinolaryngol 2023; 170:111601. [PMID: 37182361 DOI: 10.1016/j.ijporl.2023.111601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/09/2023] [Accepted: 05/08/2023] [Indexed: 05/16/2023]
Abstract
INTRODUCTION Up to 40% of children with hoarseness due to benign fibrovascular vocal fold lesions do not respond to voice therapy and could benefit from further intervention to improve their communication abilities. Currently there are limited surgical options for children too young to comply with post-operative voice rest. We have begun using the 445 nm laser to recontour benign fibrovascular vocal fold lesions without post-operative voice rest in young children with hoarseness due to vocal fold nodules that is unresponsive to voice therapy. This report presents pilot data on the effect of this treatment on pediatric voice-related quality of life. METHODS Pediatric patients with benign fibrovascular lesions and severe subjective dysphonia (per parents or teachers) were given the option of undergoing surgery or continuing voice therapy. Those that opted for surgery underwent 445 nm laser recontouring of their vocal folds. They were discharged home the same day with no voice rest required. Pre- and post-demographic, acoustic measures, auditory perceptual assessments, and validated patient quality of life measures were collected. RESULTS Four patients (ages 3-8y, all male) were selected for surgery. The mean pre- and post-op PVRQOL scores were 59.4 (range: 22.5-80) and 98.1 (range: 97.5-100), respectively (low scores suggest lower voice-related QOL), and a mean change of 38.8 (previously established minimum clinically important difference: 12). Pre- and post-acoustic and aerodynamic measures similarly reflected this improvement. CONCLUSION This pilot case series addresses a commonly seen population (children with benign fibrovascular lesions and significant dysphonia despite voice therapy) where the best practice for timing and types of surgical intervention is unclear. Photoangiolytic lasers (including the 445 nm laser) are gaining popularity for the treatment of benign laryngeal pathologies, and their use may expand treatment possibilities for children with severe dysphonia due to benign vocal fold lesions that do not respond to voice therapy. Further longitudinal investigations are necessary to confirm the safety and efficacy.
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El Saftawy E, Sarhan R, Hamed A, Elhawary E, Sameh A. Lasers for cutaneous lesions: An update. Dermatol Ther 2022; 35:e15647. [PMID: 35714173 DOI: 10.1111/dth.15647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/30/2022] [Accepted: 06/14/2022] [Indexed: 11/29/2022]
Abstract
There are several types of medical settings which use lasers. Dermatologists use lasers as it is non-invasive with preferential cosmetic outcomes and finer wound healing. The types of lasers are relying on their wavelengths and delivery systems. Over time, by using several distinct devices and strategies, new lasers have been generated; as a consequence, they are manipulated in a wide range of dermatological settings. In this review, laser applications in various vascular, infectious, and hyperpigmented cutaneous lesions were framed. We aimed to represent the fitness of phototherapy for each condition as well as the overall challenges that face laser. In addition, low-level laser therapy, and laser resurfacing were noted as the marketable line of lasers in the current time for cosmetic purposes.
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Affiliation(s)
- Enas El Saftawy
- Department of Medical Parasitology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Department of Medical Parasitology, Armed Forces College of Medicine, Cairo, Egypt
| | - Rania Sarhan
- Department of Medical Parasitology, Armed Forces College of Medicine, Cairo, Egypt.,Department of Medical Parasitology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed Hamed
- Department of Medical Parasitology, Armed Forces College of Medicine, Cairo, Egypt
| | - Esraa Elhawary
- Department of Dermatology and Venereology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ahmed Sameh
- Department of Dermatology and Venereology, Armed Forces College of Medicine, Cairo, Egypt
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Abstract
SUMMARY Striae distensae, or stretch marks, are common linear lesions of atrophic skin characterized histologically by epidermal atrophy, absent rete ridges, and alterations in connective tissue architecture. Hormonal excess, mechanical stress, and genetic predisposition are all associated with striae distensae, but their exact pathogenesis remains unknown. Despite a multitude of options, no single treatment has yet proven effective. In this article, the authors describe an up-to-date overview of striae distensae in terms of their etiology, pathophysiology, and therapeutic options. Further research is required to better elucidate their pathophysiology and to develop targeted effective treatments.
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5
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Nonsurgical Management of Hypertrophic Scars: Evidence-Based Therapies, Standard Practices, and Emerging Methods. Aesthetic Plast Surg 2020; 44:1320-1344. [PMID: 32766921 DOI: 10.1007/s00266-020-01820-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2006] [Accepted: 01/05/2007] [Indexed: 12/12/2022]
Abstract
Hypertrophic scars, resulting from alterations in the normal processes of cutaneous wound healing, are characterized by proliferation of dermal tissue with excessive deposition of fibroblast-derived extracellular matrix proteins, especially collagen, over long periods, and by persistent inflammation and fibrosis. Hypertrophic scars are among the most common and frustrating problems after injury. As current aesthetic surgical techniques become more standardized and results more predictable, a fine scar may be the demarcating line between acceptable and unacceptable aesthetic results. However, hypertrophic scars remain notoriously difficult to eradicate because of the high recurrence rates and the incidence of side effects associated with available treatment methods. This review explores the various treatment methods for hypertrophic scarring described in the literature including evidence-based therapies, standard practices, and emerging methods, attempting to distinguish those with clearly proven efficiency from anecdotal reports about therapies of doubtful benefits while trying to differentiate between prophylactic measures and actual treatment methods. Unfortunately, the distinction between hypertrophic scar treatments and keloid treatments is not obvious in most reports, making it difficult to assess the efficacy of hypertrophic scar treatment.
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6
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Li K, Nicoli F, Xi WJ, Zhang Z, Cui C, Al-Mousawi A, Balzani A, Tong Y, Zhang Y. The 1470 nm diode laser with an intralesional fiber device: a proposed solution for the treatment of inflamed and infected keloids. BURNS & TRAUMA 2019; 7:5. [PMID: 30783604 PMCID: PMC6376646 DOI: 10.1186/s41038-019-0143-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 01/21/2019] [Indexed: 01/08/2023]
Abstract
Background Keloids are the result of abnormal wound healing and often are subject to infections and recurrent inflammation. We present a study conducted with a 1470 nm diode laser using an intralesional optical fiber device for the treatment of inflamed keloid scars. We evaluate its efficacy as a novel alternative method to decrease keloid infection and inflammation. Methods The patients who underwent 1470 nm laser treatment from February 2016 to February 2018 at the plastic and reconstructive surgery department of the Shanghai Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University with keloid accompanying serious local infection and fester were included. Patients took curative effect evaluation before and 1 year after the treatment. The test items included infection frequency in each year; pain, by visual analogue scale (VAS); itch, using VAS; quality of life (QOL), using QOL scale; and blood supply, using PeriCam PSI. Results A total of 19 patients (mean age 35.21 years, range 11–66) with history of inflamed keloids with episodes of infection or abscess were enrolled. Patients underwent to a 1470 nm laser therapy for average of 1.16 times. After treatment, infection frequency and blood supply in keloids were reduced (p < 0.001). Pain, itching, and QOL were improved (p < 0.001). Conclusion The present study shows that 1470 nm fiber laser treatment could improve inflamed keloids fairly well by decreasing inflammation, and a relative stabilization of collagen composition. Therefore, it is an effective minimally invasive scar therapy, but further studies are essential to confirm the present results.
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Affiliation(s)
- Ke Li
- 1Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhi Zao Ju Road, Shanghai, 200011 China
| | - Fabio Nicoli
- 2Department of Plastic and Reconstructive Surgery, University of Rome "Tor Vergata", Rome, Italy.,3Department of Plastic and Reconstructive Surgery, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Wen Jing Xi
- 1Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhi Zao Ju Road, Shanghai, 200011 China
| | - Zheng Zhang
- 1Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhi Zao Ju Road, Shanghai, 200011 China
| | - Chunxiao Cui
- 1Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhi Zao Ju Road, Shanghai, 200011 China
| | - Ahmed Al-Mousawi
- 3Department of Plastic and Reconstructive Surgery, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Alberto Balzani
- 2Department of Plastic and Reconstructive Surgery, University of Rome "Tor Vergata", Rome, Italy
| | - Yun Tong
- Department of Medical Cosmetology Surgery, Jinhua People's Hospital, Jinhua, China
| | - Yixin Zhang
- 1Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhi Zao Ju Road, Shanghai, 200011 China
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Aggarwal A, Ravikumar BC, Vinay KN, Raghukumar S, Yashovardhana DP. A comparative study of various modalities in the treatment of keloids. Int J Dermatol 2018; 57:1192-1200. [DOI: 10.1111/ijd.14069] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 02/21/2018] [Accepted: 05/16/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Archit Aggarwal
- Department of Dermatology; Hassan Institute of Medical Sciences; Hassan Karnataka India
| | - Banavase C. Ravikumar
- Department of Dermatology; Hassan Institute of Medical Sciences; Hassan Karnataka India
| | - K. Nirvanappa Vinay
- Department of Dermatology; Hassan Institute of Medical Sciences; Hassan Karnataka India
| | - Sonia Raghukumar
- Department of Dermatology; Hassan Institute of Medical Sciences; Hassan Karnataka India
| | - D. P. Yashovardhana
- Department of Dermatology; Hassan Institute of Medical Sciences; Hassan Karnataka India
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Choi YJ, Kim JY, Nam JH, Lee GY, Kim WS. Clinical Outcome of 1064-nm Picosecond Neodymium–Doped Yttrium Aluminium Garnet Laser for the Treatment of Hypertrophic Scars. J COSMET LASER THER 2018; 21:91-98. [DOI: 10.1080/14764172.2018.1469768] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Young-Jun Choi
- Department of Dermatology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung Yup Kim
- Department of Dermatology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae-Hui Nam
- Department of Dermatology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ga-Young Lee
- Department of Dermatology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won-Serk Kim
- Department of Dermatology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Ogawa R. Keloid and Hypertrophic Scars Are the Result of Chronic Inflammation in the Reticular Dermis. Int J Mol Sci 2017; 18:ijms18030606. [PMID: 28287424 PMCID: PMC5372622 DOI: 10.3390/ijms18030606] [Citation(s) in RCA: 462] [Impact Index Per Article: 66.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Revised: 02/23/2017] [Accepted: 03/06/2017] [Indexed: 01/08/2023] Open
Abstract
Keloids and hypertrophic scars are caused by cutaneous injury and irritation, including trauma, insect bite, burn, surgery, vaccination, skin piercing, acne, folliculitis, chicken pox, and herpes zoster infection. Notably, superficial injuries that do not reach the reticular dermis never cause keloidal and hypertrophic scarring. This suggests that these pathological scars are due to injury to this skin layer and the subsequent aberrant wound healing therein. The latter is characterized by continuous and histologically localized inflammation. As a result, the reticular layer of keloids and hypertrophic scars contains inflammatory cells, increased numbers of fibroblasts, newly formed blood vessels, and collagen deposits. Moreover, proinflammatory factors, such as interleukin (IL)-1α, IL-1β, IL-6, and tumor necrosis factor-α are upregulated in keloid tissues, which suggests that, in patients with keloids, proinflammatory genes in the skin are sensitive to trauma. This may promote chronic inflammation, which in turn may cause the invasive growth of keloids. In addition, the upregulation of proinflammatory factors in pathological scars suggests that, rather than being skin tumors, keloids and hypertrophic scars are inflammatory disorders of skin, specifically inflammatory disorders of the reticular dermis. Various external and internal post-wounding stimuli may promote reticular inflammation. The nature of these stimuli most likely shapes the characteristics, quantity, and course of keloids and hypertrophic scars. Specifically, it is likely that the intensity, frequency, and duration of these stimuli determine how quickly the scars appear, the direction and speed of growth, and the intensity of symptoms. These proinflammatory stimuli include a variety of local, systemic, and genetic factors. These observations together suggest that the clinical differences between keloids and hypertrophic scars merely reflect differences in the intensity, frequency, and duration of the inflammation of the reticular dermis. At present, physicians cannot (or at least find it very difficult to) control systemic and genetic risk factors of keloids and hypertrophic scars. However, they can use a number of treatment modalities that all, interestingly, act by reducing inflammation. They include corticosteroid injection/tape/ointment, radiotherapy, cryotherapy, compression therapy, stabilization therapy, 5-fluorouracil (5-FU) therapy, and surgical methods that reduce skin tension.
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Affiliation(s)
- Rei Ogawa
- Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School Hospital, Tokyo 113-8603, Japan.
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10
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Jaloux C, Bertrand B, Degardin N, Casanova D, Kerfant N, Philandrianos C. Les cicatrices chéloïdes (deuxième partie) : arsenal et stratégie thérapeutique. ANN CHIR PLAST ESTH 2017; 62:87-96. [DOI: 10.1016/j.anplas.2016.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 04/10/2016] [Indexed: 10/21/2022]
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11
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Azad SM, Gerrish J, Dziewulski P. Hypertrophie Scars and Keloids: An Overview of the Aetiology and Management. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/175899830000500103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Hypertrophic scars and keloids are a common surgical problem. There is increasing knowledge of the pathology of this condition but the exact pathogenesis is yet unknown. Treatment remains difficult and is associated with high recurrence rates in certain forms. The psychological implications for the patient are enormous and have still to be fully defined. This article is a review of the current aetiology, pathology and management of hypertrophic scars and keloids. Various treatment options are discussed and psychological aspects have been emphasised.
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Affiliation(s)
- Sanjay M Azad
- St Andrew's Centre for Plastic Surgery and Burns, Chelmsford, UK
| | - John Gerrish
- St Andrew's Centre for Plastic Surgery and Burns, Chelmsford, UK
| | - Peter Dziewulski
- St Andrew's Centre for Plastic Surgery and Burns, Chelmsford, UK
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12
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Geraghty LN, Rahman Z. Treatment of Surgical Scars with Laser Therapy. CURRENT DERMATOLOGY REPORTS 2016. [DOI: 10.1007/s13671-016-0152-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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13
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Clyne SB, Halum SL, Koufman JA, Postma GN. Pulsed Dye Laser Treatment of Laryngeal Granulomas. Ann Otol Rhinol Laryngol 2016; 114:198-201. [PMID: 15825568 DOI: 10.1177/000348940511400305] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Laryngeal granulomas are effectively treated with antireflux therapy and speech therapy. Failure to respond leads to treatment with Botox or surgical excision. We report on the use of the pulsed dye laser for treating chronic granulomas that do not respond to standard therapy. We performed a retrospective review from September 2002 to September 2003. Patients identified with chronic granulomas that were not responding to standard therapy were treated in our office with the pulsed dye laser. Ten patients were identified; the mean age was 58 years. Two patients underwent more than one pulsed dye laser treatment. Five of the 10 had resolution of their lesions, and 3 had a partial response. Two were unchanged. The average follow-up was 6 months, and there were no complications. We conclude that in-office use of the pulsed dye laser is a relatively safe and effective method for treating laryngeal granulomas that do not respond to antireflux therapy and speech therapy.
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Affiliation(s)
- Stephen B Clyne
- Center for Voice and Swallowing Disorders, Department of Otolaryngology, Wake Forest University Medical Center, Winston-Salem, North Carolina 27157, USA
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14
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Franco RA, Zeitels SM, Farinelli WA, Faquin W, Anderson RR. 585-NM Pulsed Dye Laser Treatment of Glottal Dysplasia. Ann Otol Rhinol Laryngol 2016; 112:751-8. [PMID: 14535557 DOI: 10.1177/000348940311200902] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Management of glottal dysplasia can be difficult and often results in a suboptimal treatment outcome. The surgeon and patient must cooperatively balance decisions regarding the effects of possible malignancy, vocal dysfunction, and recurrences leading to multiple use of general anesthetics. A pilot study was done in 57 cases (36 patients and 97 vocal folds) without complication to evaluate the effectiveness of a 585-nm pulsed dye laser (PDL; 450-μs pulse width, 19 to 76-J/cm2 fluence, 1- to 2-mm spot size) in the treatment of vocal fold keratosis. Forty of the 57 cases had bilateral treatment. Phonomicrosurgical resection was done in 35 of the 57 cases after PDL treatment. Of this group, 10 cases were found to have hyperplasia, 21 dysplasia, 4 carcinoma in situ, and 1 carcinoma. One patient had phonomicrosurgical resection before PDL treatment. In 21 of the 57 cases, the disease was irradiated without resection (4 unilateral lesions and 17 bilateral lesions). Approximately 80% of the patients in this series had a greater than 70% reduction in the size of the lesion with the use of the PDL irrespective of whether they underwent resection. Clinical observation revealed no new anterior commissure web formation despite bilateral anterior commissure treatment in 28 of the 57 cases. The PDL enhanced the epithelial excision by improving hemostasis and by creating an optimal dissection plane between the basement membrane and the underlying superficial lamina propria. In this initial trial, the PDL provided relatively safe and effective treatment for glottal dysplasia. Analysis of patterns of recurrence will require longer follow-up.
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Affiliation(s)
- Ramon A Franco
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
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15
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Cotton AM. A Review of the Principles and Use of Lasers in Lower Limb Problems. INT J LOW EXTR WOUND 2016; 3:133-42. [PMID: 15866804 DOI: 10.1177/1534734604268596] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Lasers present a unique light source with many clinical uses including a number of applications relevant to the lower extremity. In this article, the basic principles of lasers and their interactions with tissue will be reviewed. The article examines laser applications in skin and vascular disease including wound healing. The principles of laser safety are discussed, and relevant future developments are considered.
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Affiliation(s)
- A M Cotton
- Department of Medical Physics and Bioengineering, Southampton University, Hospitals Trust NHS, Southampton, UK.
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16
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Zeitels SM, Franco RA, Dailey SH, Burns JA, Hillman RE, Anderson RR. Office-Based Treatment of Glottal Dysplasia and Papillomatosis with the 585-NM Pulsed Dye Laser and Local Anesthesia. Ann Otol Rhinol Laryngol 2016; 113:265-76. [PMID: 15112968 DOI: 10.1177/000348940411300403] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Treatment of glottal papillomatosis and dysplasia was mirror-guided and performed in surgeons' offices in the 19th century. It migrated to the operating room in the 20th century to accommodate direct laryngoscopic surgery, which required assistants to administer anesthesia and procedural support. Presently, the primary treatment goals, which are disease regression and voice restoration or maintenance, are tempered by the morbidity of general anesthesia and potential treatment-induced vocal deterioration. In fact, general anesthesia has been appropriately considered to be an acceptable source of morbidity for the promise of a precise procedure, which usually ensures airway safety and an optimal vocal outcome. However, patients with recurrent glottal papillomatosis and keratosis with dysplasia are typically monitored with various degrees of watchful waiting until there is a subjective judgment (on the part of the patient and surgeon) that the disease is more of a liability than is the procedure to treat it. Innovations in the 585-nm pulsed dye laser delivery system have allowed for its use in the clinic with local anesthesia through the working channel of a flexible fiberoptic laryngoscope. A prospective assessment was done on 51 patients in 82 cases of recurrent glottal papillomatosis (30) and dysplasia (52). All individuals had previously undergone microlaryngoscopic management with histopathologic evaluation. Five procedures could not be completed because of impaired exposure (2) or discomfort (3). Of those patients who could be treated, there was at least a 50% disease involution in 68 of 77 cases (88%) and 25% to 50% disease regression in the remaining 9 (12%). Patient self-assessment of the voice revealed that 34 of 77 were improved, 39 were unchanged, 4 were slightly worse, and none were substantially worse. These data confirm that diseased mucosa can be normalized without resection or substantial loss of vocal function. The putative mechanisms, which vary according to the fluence (energy) delivered by the laser, are photoangiolysis of sublesional microcirculation, denaturing of epithelial basement membrane linking proteins, and cellular destruction. Furthermore, this relatively safe, effective technique allowed for treatment of many patients (in a clinic setting) in whom classic surgery-related morbidity would have often delayed intervention.
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Affiliation(s)
- Steven M Zeitels
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
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17
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Rees CJ, Halum SL, Wijewickrama RC, Koufman JA, Postma GN. Patient Tolerance of In-Office Pulsed Dye Laser Treatments to the Upper Aerodigestive Tract. Otolaryngol Head Neck Surg 2016; 134:1023-7. [PMID: 16730550 DOI: 10.1016/j.otohns.2006.01.019] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2005] [Accepted: 01/30/2006] [Indexed: 11/22/2022]
Abstract
INTRODUCTION: Recent advances in technology have facilitated a movement toward unsedated in-office treatment of laryngeal, tracheal, and esophageal lesions. The objective of this study was to determine patient tolerance of inoffice pulsed-dye laser (PDL) treatment of upper aerodigestive tract pathoses via the transnasal esophagoscope. METHODS: Three hundred twenty-eight unsedated in-office PDL cases were performed at a university-based tertiary referral center in 131 patients. These procedures were performed for various upper aerodigestive pathoses, including recurrent respiratory papillomatosis, chronic granulomas, and recurrent leukoplakia. Eighty-nine subjects completed a phone survey concerning their discomfort level after the PDL procedure. They were also asked specific questions about recovery time, pain medication, and preference of operating room versus inoffice procedures. RESULTS: The average comfort score was 7.4 (10 being minimal discomfort). Eighty-four percent did not use any pain medication; 87% stated that, if possible, they would prefer to undergo unsedated inoffice procedures rather than surgeries under general anesthesia for further treatment of their upper aerodigestive tract pathosis. CONCLUSIONS: Unsedated transnasal treatment of upper aerodigestive tract pathoses is readily accepted and well-tolerated by otolaryngology patients. Patients overwhelmingly prefer the inoffice PDL over surgeries under general anesthesia.
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Affiliation(s)
- Catherine J Rees
- Center for Voice and Swallowing Disorders, Department of Otolaryngology, Medical College of Georgia, Augusta, GA 30912-4060, USA
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18
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Tian WCBA. Savior of post-blepharoepicanthoplasty scarring: Novel use of a low-fluence 1064-nm Q-switched Nd:YAG laser. J COSMET LASER THER 2016; 18:69-71. [PMID: 26820981 DOI: 10.3109/14764172.2015.1063661] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Blepharoplasty with medial epicanthoplasty is popular in Asia. However, known complications include scarring, which can take the form of hypertrophic scars or keloids. Treatments for scars include pressure dressing, silicone gels, retinoic acids, radiotherapy, cryotherapy, triamcinolone injections, and surgical revision. These methods, however, have variable outcomes. Recently, there is an interest in post-surgical scar remodeling with lasers. Although the 1064-nm Q-switched Nd:YAG is primarily a pigment laser, it has recently been shown to be effective for treating scars. In the management of post-blepharoepicanthoplasty scarring, this is certainly unheard of. In this paper, we present a novel technique of treating a patient with post-blepharoepicanthoplasty hypertrophic scarring with a low-fluence 1064-nm Q-switched Nd:YAG laser.
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Sharobaro VI, Romanets OP, Grechishnikov MI, Baeva AA. [Optimization of treatment and prevention of scars]. Khirurgiia (Mosk) 2016:85-90. [PMID: 26762086 DOI: 10.17116/hirurgia2015985-90] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- V I Sharobaro
- A.V. Vishnevskiy Institute for Surgery, Health Ministry of the Russian Federation, Moscow, Russia
| | - O P Romanets
- A.V. Vishnevskiy Institute for Surgery, Health Ministry of the Russian Federation, Moscow, Russia
| | - M I Grechishnikov
- A.V. Vishnevskiy Institute for Surgery, Health Ministry of the Russian Federation, Moscow, Russia
| | - A A Baeva
- A.V. Vishnevskiy Institute for Surgery, Health Ministry of the Russian Federation, Moscow, Russia
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Park YM, Jo KH, Hong HJ, Choi HS. Phonatory outcome of 585nm/pulsed-dye laser in the management of glottic leukoplakia. Auris Nasus Larynx 2014; 41:459-63. [DOI: 10.1016/j.anl.2014.05.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 05/04/2014] [Accepted: 05/13/2014] [Indexed: 10/25/2022]
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Makboul M, Makboul R, Abdelhafez AHK, Hassan SS, Youssif SM. Evaluation of the effect of fractional CO2 laser on histopathological picture and TGF-β
1 expression in hypertrophic scar. J Cosmet Dermatol 2014; 13:169-79. [DOI: 10.1111/jocd.12099] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Mohamed Makboul
- Faculty of Medicine; Plastic Surgery Department; Assiut University; Assiut Egypt
| | - Rania Makboul
- Faculty of Medicine; Pathology Department; Assiut University; Assiut Egypt
| | - Assem HK Abdelhafez
- Faculty of Medicine; Plastic Surgery Department; Assiut University; Assiut Egypt
| | - Safaa Said Hassan
- Faculty of Medicine; Histology Department; Assiut University; Assiut Egypt
| | - Sherif M Youssif
- Faculty of Medicine; Plastic Surgery Department; Assiut University; Assiut Egypt
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Ablative Fractional Photothermolysis for the Treatment of Hypertrophic Burn Scars in Adult and Pediatric Patients. J Burn Care Res 2014; 35:455-63. [DOI: 10.1097/bcr.0000000000000028] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gauglitz GG, Reinholz M, Kaudewitz P, Schauber J, Ruzicka T. Treatment of striae distensae using an ablative Erbium: YAG fractional laser versus a 585-nm pulsed-dye laser. J COSMET LASER THER 2013; 16:117-9. [DOI: 10.3109/14764172.2013.854621] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Shu B, Ni GX, Zhang LY, Li XP, Jiang WL, Zhang LQ. High-power helium-neon laser irradiation inhibits the growth of traumatic scars in vitro and in vivo. Lasers Med Sci 2013; 28:693-700. [PMID: 22678421 DOI: 10.1007/s10103-012-1127-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Accepted: 05/24/2012] [Indexed: 02/08/2023]
Abstract
This study explored the inhibitory effect of the high-power helium-neon (He-Ne) laser on the growth of scars post trauma. For the in vitro study, human wound fibroblasts were exposed to the high-power He-Ne laser for 30 min, once per day with different power densities (10, 50, 100, and 150 mW/cm(2)). After 3 days of repeated irradiation with the He-Ne laser, fibroblast proliferation and collagen synthesis were evaluated. For in vivo evaluation, a wounded animal model of hypertrophic scar formation was established. At postoperative day 21, the high-power He-Ne laser irradiation (output power 120 mW, 6 mm in diameter, 30 min each session, every other day) was performed on 20 scars. At postoperative day 35, the hydroxyproline content, apoptosis rate, PCNA protein expression and FADD mRNA level were assessed. The in vitro study showed that the irradiation group that received the power densities of 100 and 150 mW/cm(2) showed decreases in the cell proliferation index, increases in the percentage of cells in the G0/G1 phase, and decreases in collagen synthesis and type I procollagen gene expression. In the in vivo animal studies, regions exposed to He-Ne irradiation showed a significant decrease in scar thickness as well as decreases in hydroxyproline levels and PCNA protein expression. Results from the in vitro and in vivo studies suggest that repeated irradiation with a He-Ne laser at certain power densities inhibits fibroblast proliferation and collagen synthesis, thereby inhibits the growth of hypertrophic scars.
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Affiliation(s)
- Bin Shu
- Department of Rehabilitation Medicine, Institute of Field Surgery, Daping Hospital, Third Military Medical University, No.10, Changjiangzhilu, Yuzhong District, Chongqing, 400042, China.
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Kim HK, Park MK, Kim BJ, Kim MN, Kim CW, Kim SE. The treatment of keloids with pneumatic technology: a pilot study. Int J Dermatol 2012; 51:1502-7. [DOI: 10.1111/j.1365-4632.2012.05607.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
BACKGROUND Striae gravidarum (stretch marks developing during pregnancy) occur in 50% to 90% of women. They appear as red or purple lines or streaks that fade slowly to leave pale lines or marks on the skin. The abdomen, breasts and thighs are commonly affected. The exact cause of stretch marks is unclear and no preparation has yet been shown to be effective in preventing the development of stretch marks. They are a source of significant anxiety for women, impacting on their quality of life. OBJECTIVES To assess the effects of topical preparations on the prevention of stretch marks in pregnancy. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 October 2011) and reference lists of retrieved reports. SELECTION CRITERIA We included randomised controlled trials and quasi-randomised controlled trials comparing topical preparations (with active ingredients) with other topical preparations (with active ingredients), with a placebo (that is, preparations without active ingredients) or with no treatment for the prevention of stretch marks in pregnant women. DATA COLLECTION AND ANALYSIS Three review authors independently assessed trial eligibility and trial quality, and extracted data. Data were checked for accuracy. The primary outcome was the presence of stretch marks and the secondary outcome was the severity of stretch marks. MAIN RESULTS We included six trials involving 800 women. Of the six trials, we judged the risk of bias for three as 'low risk' for random sequence generation, blinding of participants and personnel, blinding of outcome assessment, completeness of outcome data and selective reporting.There was no statistically significant average difference in the development of stretch marks in women who received topical preparations with active ingredients compared to women who received a placebo or no treatment (average risk ratio (RR) 0.74; 95% confidence interval (CI) 0.53 to 1.03; five trials, 474 women; random-effects model, Tau² = 0.09, I² = 65%) (Analysis 1.1).Results were consistent with the main effects when we performed a sensitivity analysis excluding studies judged to be at high risk of bias for random sequence generation, allocation concealment or more than 20% missing data for a given outcome (average RR 0.81; 95% CI 0.60 to 1.10; four trials, 424 women; random-effects model, Tau² = 0.05, I² = 57%).The was no statistically significant average mean difference in the severity of stretch marks (standardised mean difference (SMD) -0.31; 95% CI -1.06 to 0.44; two trials, 255 women; Tau² = 0.26, I² = 87%).There was no statistically significant difference in the development of stretch marks in women who received topical preparations with active ingredients compared to women who received other topical preparations with active ingredients (average RR 0.51; 95% CI 0.16 to 1.60; two trials, 305 women; Tau² = 0.53, I² = 74%). There was no statistically significant difference in the severity of stretch marks (mean difference (MD) -0.20; 95% CI -0.53 to 0.13; one trial, 206 women; heterogeneity not applicable). AUTHORS' CONCLUSIONS We found no high-quality evidence to support the use of any of the topical preparations in the prevention of stretch marks during pregnancy. There is a clear need for robust, methodologically rigorous randomised trials involving larger sample sizes to evaluate the effects of topical preparations on the development of stretch marks in pregnancy. In addition, it is important that preparations commonly used by women to prevent and treat stretch marks are evaluated within the context of robust, methodologically rigorous and adequately powered randomised trials.
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Affiliation(s)
- Miriam Brennan
- National University of Ireland GalwaySchool of Nursing and MidwiferyGalwayIreland
| | - Gavin Young
- Temple Sowerby Medical PracticeLinden ParkTemple SowerbyPenrithCumbriaUKCA10 1RW
| | - Declan Devane
- National University of Ireland GalwaySchool of Nursing and MidwiferyGalwayIreland
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YUN JISUP, CHOI YOUNGJUN, KIM WONSERK, LEE GAYOUNG. Prevention of Thyroidectomy Scars in Asian Adults Using a 532-nm Potassium Titanyl Phosphate Laser. Dermatol Surg 2011; 37:1747-53. [DOI: 10.1111/j.1524-4725.2011.02128.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Vrijman C, van Drooge A, Limpens J, Bos J, van der Veen J, Spuls P, Wolkerstorfer A. Laser and intense pulsed light therapy for the treatment of hypertrophic scars: a systematic review. Br J Dermatol 2011; 165:934-42. [DOI: 10.1111/j.1365-2133.2011.10492.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Abstract
PURPOSE OF REVIEW To examine the place of surgery and other modes of treating scar tissue given the plethora of measures that are advocated on the internet. RECENT FINDINGS There is good evidence to support the use of silicone sheets, pulsed dye laser (PDL), intralesional triamcinolone and dermabrasion in reducing hypertrophic scars, but each needs qualifying in terms of their timing and the type of scar tissue that they are used for. SUMMARY The surgical revision of scars should be delayed for at least 12 months unless there is webbing when redistributing skin tension forces with a Z-plasty or multiple Z-plasties or other local flaps negates the need to wait for the scar to mature. In a posttraumatic 'horse shoe' shaped, or a very oblique, cut an irregular contour is likely to occur. Under these circumstances a triamcinolone injection into any raised area can help and this needs to be re-evaluated after 6 weeks. With a less irregular contour dermabrasion can help if used 8 weeks after surgery. With hypertrophic scarring both silicone gel sheeting and PDL may help reduce the prominence of the scar. Most of all time helps scars to settle and fade and typical scar maturation takes 18-24 months. The role of stem cells, particularly from adipose tissue, warrants further study.
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Pulsed dye laser in burn scars: Current concepts and future directions. Burns 2010; 36:443-9. [DOI: 10.1016/j.burns.2009.08.015] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Accepted: 08/14/2009] [Indexed: 01/22/2023]
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Anchlia S, Rao KS, Bonanthaya K, Vohra D. Keloidoscope: in search for the ideal treatment of keloids. J Maxillofac Oral Surg 2009; 8:366-70. [PMID: 23139545 DOI: 10.1007/s12663-009-0087-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2007] [Accepted: 11/08/2009] [Indexed: 10/19/2022] Open
Abstract
Although keloids were recognised in the Smith Papyrus of ancient times, the precise definition, cause and management have remained elusive. Several forms of treatment have been used with varying success.Objectives This study assesses and compares the value of intralesional steroid (Triamcinolone acetonide 40mg/ml), cryotherapy and cryotherapy with intralesional steroid in the treatment of keloids.Methodology 33 patients were studied, 11 each in the three arms and the volume of the keloids was recorded using wax patterns of alginate impressions of the keloids to note the change in size postoperatively.Results The best average percentage response was observed is patients who received both Cryotherapy (CRY) and Intralesional Steroid (ILS) (69.02%) followed by patients who received only intralesional steroid (43.98%). Among the patients who received only cryotherapy, the average percentage response was only 39.24%. 72.73% patients who received intralesional steroid with cryotherapy showed more than 50% improvement (good response) while only 9.09% patients who received intralesional steroid alone and cryotherapy alone showed similar improvement.Conclusion In patients with keloids good response can be obtained with CRY with ILS as compared to ILS alone and CRY alone.
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Affiliation(s)
- Sonal Anchlia
- Dept. of Oral and Maxillofacial Surgery, Govt Dental College and Hospital, Ahmedabad, India ; Dept. of Oral & Maxillofacial Surgery, Govt Dental College & Hospital, Ahmedabad, 380016 Gujarat India
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Hirsch R, Stier M. Complications and Their Management in Cosmetic Dermatology. Dermatol Clin 2009; 27:507-20, vii. [DOI: 10.1016/j.det.2009.08.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Nouri K, Elsaie ML, Vejjabhinanta V, Stevens M, Patel SS, Caperton C, Elgart G. Comparison of the effects of short- and long-pulse durations when using a 585-nm pulsed dye laser in the treatment of new surgical scars. Lasers Med Sci 2009; 25:121-6. [PMID: 19662486 DOI: 10.1007/s10103-009-0710-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2009] [Accepted: 06/29/2009] [Indexed: 10/20/2022]
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Abstract
The wavelength of 585nm corresponds to an absorption peak of haemoglobin. The heating effect in these skin layers triggers the release of various growth factors that stimulate collagen remodelling and tightening. We report our experience with a 585nm collagen remodelling, double flashlamp excited pumped dye laser was used (ED2000, Deka MELA, Calenzano, Italy), spot size 5 mm, energy density (fluence J/cm(2)) from 2 to 4 J/cm(2), emission modality (repetition rate) at 0.5 Hz, with a short pulse duration of 250 microsec. The efficiency of 585 nm collagen remodelling pulsed dye laser is controversial in only one session. It is probably reasonable to inform patients that 3-4 treatment sessions are necessary, and that 10% of the patients have no response to nonablative photorejuvenation. Because of its low fluence and its shorter pulse duration, the 585 nm collagen remodelling pulsed dye laser has limited efficacy for the treatment of port wine stains. However, it may offer patients with erythematous, raised or hypertrophic acne scars or striae distensae a permanent cosmetic solution. This laser is safe and effective in the treatment of surgical scars starting as soon as possible, on the day of suture removal if possible. We found that 96.3% of molluscum contagiosum healed after the first treatment, the other 3.7% after the second.
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Affiliation(s)
- Jean-Loïc Michel
- Office of Dermatology, 14 place des Grenadiers-Quartier Grouchy, 42000 Saint-Etienne, France.
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Connell PG, Harland CC. Treatment of keloid scars with pulsed dye laser and intralesional steroid. ACTA ACUST UNITED AC 2009; 2:147-50. [PMID: 11360332 DOI: 10.1080/14628830050516407] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND/OBJECTIVE Keloid scars have been treated in many ways, with varying success. A wide variety of treatments, all in current usage, indicate that no treatment has been shown to be markedly superior to the others. Following the successful treatment of scars using the pulsed dye laser, and with the more traditional intralesional steroid injection, a pilot study was undertaken using a combination of these treatments. METHODS Recalcitrant keloid scars of 10 patients were managed with a combined treatment modality of pulsed dye laser (PDL) and intralesional steroid. RESULTS Seven of the patients benefited in terms of the raised nature of the scars being improved by 60%, erythema improved by 40%, and pain/itching by 75%. Three of the patients, who had presternal scars, had no benefit. CONCLUSIONS Pretreatment with PDL facilitated steroid injection by making the scar oedematous and therefore softer. In addition, we speculate that the benefits of this combined modality are summative, not just adjunctive. This study demonstrates that this treatment is effective for the treatment of keloid scars when other treatments have been unsuccessful.
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Affiliation(s)
- P G Connell
- Laser Unit, Sutton Hospital, Epsom and St Helier NHS Trust, Cotswold Road, Sutton, Surrey, SM2 5NF, UK
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Nehal KS, Lichtenstein DA, Kamino H, Levine VJ, Ashinoff R. Treatment of mature striae with the pulsed dye laser. ACTA ACUST UNITED AC 2009; 1:41-4. [PMID: 11360424 DOI: 10.1080/14628839950517084] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Striae are a common cosmetic problem with no effective treatment options. A recent study has shown improvement in the appearance of mature striae following a single 585-nm pulsed dye laser (PDL) treatment at low fluence. OBJECTIVE To evaluate the effectiveness of treating mature striae with the 585-nm PDL. METHODS Five patients with mature striae on the abdomen were prospectively treated with the 585-nm PDL at 2-month intervals for 1-2 years. The response of the striae to laser treatment was evaluated in each patient through sequential clinical, photographic, textural, and histologic assessment. RESULTS All five patients reported a slight overall improvement in the appearance of the striae following multiple PDL treatments. Comparison of pre- and post-treatment photographs, however, failed to reveal improvement in any patients. Optical profilometry performed on striae impressions showed mild improvement in the surface texture of striae in three patients. Histologic comparison of pre- and post-treatment biopsy specimens failed to reveal normalization of skin architecture. CONCLUSIONS Serial treatment of mature striae with the PDL results in mild, subjective, clinical improvement but no significant photographic, textural or histologic improvement.
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Affiliation(s)
- K S Nehal
- Department of Dermatology, New York University Medical Center, 530 First Avenue, Suite 7R, New York, NY 10016, USA
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Sadick NS, Magro C, Hoenig A. Prospective clinical and histological study to evaluate the efficacy and safety of a targeted high‐intensity narrow band UVB/UVA1 therapy for striae alba. J COSMET LASER THER 2009; 9:79-83. [PMID: 17558757 DOI: 10.1080/14764170701313767] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the efficacy and safety of a targeted narrow band UVB/UVA1 therapy for the treatment of striae alba. METHODS Fourteen individuals with skin types II-VI were enrolled in this 22-week trial that consisted of up to 10 treatments with a combination of UVB/UVA1 (MultiClear, Curelight Ltd, Israel). Participants were treated with a maximum of 10 treatments unless 100% repigmentation of stretch was achieved prior to the tenth treatment. Biopsies were taken from willing participants at baseline, immediately after the final treatment and 12 weeks after the last treatment. RESULTS Nine participants completed all treatment visits. After the final treatment, all the participants had >51% repigmentation of the treated striae. At the 4-week follow-up visit, 67% of participants had greater than 51% improvement, and 56% had greater than 51% improvement at the 8-week and 12-week follow-ups. Hyperpigmentation of striae was seen in >50% of the participants treated. The pretreatment biopsies were confirmatory of striae. There were no diagnostic light microscopic differences in the 4-week post-treatment biopsy set available in one patient. CONCLUSION This high intensity UVB\UVA1 device is an effective and safe modality for the short-term repigmentation of hypopigmented stretch marks. Additional morphologic studies over time are needed to confirm these clinical findings.
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Affiliation(s)
- Neil S Sadick
- Weill Medical College of Cornell University, New York, NY, USA.
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Bloemen MC, van der Veer WM, Ulrich MM, van Zuijlen PP, Niessen FB, Middelkoop E. Prevention and curative management of hypertrophic scar formation. Burns 2009; 35:463-75. [DOI: 10.1016/j.burns.2008.07.016] [Citation(s) in RCA: 185] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2008] [Accepted: 07/08/2008] [Indexed: 12/26/2022]
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Elsaie ML, Baumann LS, Elsaaiee LT. Striae distensae (stretch marks) and different modalities of therapy: an update. Dermatol Surg 2009; 35:563-73. [PMID: 19400881 DOI: 10.1111/j.1524-4725.2009.01094.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Striae distensea (SD; stretch marks) are a well-recognized, common skin condition that rarely causes any significant medical problems but are often a significant source of distress to those affected. The origins of SD are poorly understood, and a number of treatment modalities are available for their treatment, yet none of them is consistently effective, and no single therapy is considered to be pivotal for this problem. With a high incidence and unsatisfactory treatments, stretch marks remain an important target of research for an optimum consensus of treatment. OBJECTIVE To identify the current treatment modalities and their effectiveness in the treatment of stretch marks. MATERIALS AND METHODS Review of the recent literature regarding clinical treatment of stretch marks with emphasis on the safety and efficacy of the newer optical devices and laser applications. RESULTS No current therapeutic option offers complete treatment, although there are a number of emerging new modalities that are encouraging. CONCLUSION The therapeutic strategies are numerous, and no single modality has been far more consistent than the rest. The long-term future of treatment strategies is encouraging with the advance in laser technologies.
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Affiliation(s)
- Mohamed L Elsaie
- Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida 33140, USA.
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Wolfram D, Tzankov A, Pülzl P, Piza-Katzer H. Hypertrophic scars and keloids--a review of their pathophysiology, risk factors, and therapeutic management. Dermatol Surg 2009; 35:171-81. [PMID: 19215252 DOI: 10.1111/j.1524-4725.2008.34406.x] [Citation(s) in RCA: 393] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hypertrophic scars and keloids result from an abnormal fibrous wound healing process in which tissue repair and regeneration-regulating mechanism control is lost. These abnormal fibrous growths present a major therapeutic dilemma and challenge to the plastic surgeon because they are disfiguring and frequently recur. OBJECTIVE To provide updated clinical and experimental information on hypertrophic scars and keloids so that physicians can better understand and properly treat such lesions. METHODS A Medline literature search was performed for relevant publications and for diverse strategies for management of hypertrophic scars and keloids. CONCLUSION The growing understanding of the molecular processes of normal and abnormal wound healing is promising for discovery of novel approaches for the management of hypertrophic scars and keloids. Although optimal treatment of these lesions remains undefined, successful healing can be achieved only with combined multidisciplinary therapeutic regimens.
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Affiliation(s)
- Dolores Wolfram
- Department of Plastic and Reconstructive Surgery, Innsbruck Medical University, Innsbruck, Austria.
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Choe JH, Park YL, Kim BJ, Kim MN, Rho NK, Park BS, Choi YJ, Kim KJ, Kim WS. Prevention of thyroidectomy scar using a new 1,550-nm fractional erbium-glass laser. Dermatol Surg 2009; 35:1199-205. [PMID: 19175371 DOI: 10.1111/j.1524-4725.2008.34428.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Surgical scars are a common cosmetic problem that occurs in various surgical fields including dermatology. Diverse trials have been made to prevent this annoying scar formation. Recently, 585- and 595-nm pulsed dye laser irradiation presented satisfactory cosmetic outcome for the treatment of surgical scars. Other fractionated lasers or light devices were also applied for scar treatment. OBJECTIVE To determine the effectiveness and safety of a newly developed 1,550-nm fractional erbium-glass laser in the prevention of scar formation after total thyroidectomy. MATERIALS AND METHODS Twenty-seven ethnic South Korean patients with linear surgical suture lines after total thyroidectomy operation were treated with a 1,550-nm fractional erbium-glass laser. The same surgeon performed all of the operations using the same surgical techniques. Each patient was treated four times at 1-month intervals using the same parameters (5- x 10-mm spot size, 10 mJ, 1,500 spot/cm(2), static mode). Initiation of the first irradiation was made approximately 2 to 3 weeks after the thyroidectomy. The scar prevention effects were evaluated each month for 6 months after thyroidectomy. Two kinds of assessment methods were applied in this evaluation. First, the Vancouver Scar Scale (VSS) was used. Second, three independent physicians gave a global assessment valuation to the final cosmetic results: poor (1), fair (2), good (3), or excellent (4). These results were compared with the surgical scars of a control group (patients who denied laser treatments and had no other treatments during the 6 months after total thyroidectomy by the same surgeon). RESULTS The average VSS score was lower in the laser treatment group. The global assessment also presented better cosmetic outcomes in the treatment group than in the controls. CONCLUSION A new 1,550-nm fractional erbium-glass laser may efficiently repress the formation and hypertrophy of thyroidectomy scars on the neck, and it can be safely applied in relatively dark Asian skin without noticeable adverse effects.
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Affiliation(s)
- Jun-Ho Choe
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Jongno-Ku, Seoul, Korea
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Treatment of hypertrophic scars and keloids using intense pulsed light (IPL). Aesthetic Plast Surg 2008; 32:902-9. [PMID: 18560927 DOI: 10.1007/s00266-008-9161-7] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2008] [Accepted: 04/02/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Keloids and hypertrophic scars are extremely disturbing to patients, both physically and psychologically. This study prospectively assessed the safety and efficacy of intense pulsed light (IPL) on scars originating from burns, trauma, surgery, and acne. METHODS Hypertrophic scars in 109 patients, originating from surgical incisions (n = 55), traumatic cuts (traffic accidents) (n = 24), acne scars (n = 6), keloids (n = 5), and burns (n = 19), were treated using an IPL Quantum device. Treatment was administered at 2-4-week intervals, and patients received an average of 8 treatments (range = 6-24). Using digital photographs, Changes in scar appearance were assessed by two physicians who were blinded to the study patients and treatments. The photographs were graded on a scale of 0 to 4 (none, minimal, moderate, good, excellent) for improvement in overall clinical appearance and reduction in height, erythema, and hardness. RESULTS An overall clinical improvement in the appearance of scars and reductions in height, erythema, and hardness were seen in the majority of the patients (92.5%). Improvement was excellent in 31.2% of the patients, good in 25.7%, moderate in 34%, and minimal in 9.1%. Over half the patients had good or excellent improvement. In the preventive IPL treatment group, 65% had good to excellent improvement in clinical appearance. Patient satisfaction was very high. CONCLUSION This study suggests that IPL is effective not only in improving the appearance of hypertrophic scars and keloids regardless of their origin, but also in reducing the height, redness, and hardness of scars.
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Rogge FJ, Cambier B. Safe and effective treatment of problem scars with the purely thermal non-ablative Er:YAG laser scar mode. J COSMET LASER THER 2008; 10:143-7. [PMID: 18608705 DOI: 10.1080/14764170802132694] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Traumatic events as well as surgery can cause a large variety of scars, which are often a major psychological concern to patients. Moreover, patients often report itching or burning sensations as well as pain. We investigated the efficacy of purely non-ablative laser therapy in order to improve the appearance and quality of these scars. METHODS A total of 62 patients with problem scars were enrolled in the study. The purely thermal, non-ablative scar mode of an Er:YAG laser (BURANE XL; Wavelight AG, Erlangen, Germany) was used. One to six treatment sessions were performed. The improvement of scar redness, scar flatness, scar quality, itching and burning sensations as well as pain and patient satisfaction were evaluated. RESULTS The overall scar quality improved in 93% of patients. Similarly, the flatness improved in 89% of scars, itching sensation in 79% and burning sensation in 86% of patients. In 91% of scars a decrease of scar redness was seen and all painful scars showed a pain reduction. Average patient satisfaction was 7.4 on a 10-point scale. Sixty-one patients would recommend the therapy to another person. Side effects were limited to transient erythema and oedema. CONCLUSION The high success rate combined with the low side-effects resulted in high patient satisfaction. Post-traumatic or post-surgical scars can safely and effectively be treated by the thermal scar mode of the Er:YAG laser used.
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Affiliation(s)
- Fabrice Jacques Rogge
- Department of Plastic, Reconstructive and Aesthetic Surgery, Academic Hospital Sint-Blasius Dendermonde, Belgium.
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Atiyeh BS. Nonsurgical management of hypertrophic scars: evidence-based therapies, standard practices, and emerging methods. Aesthetic Plast Surg 2007; 31:468-92; discussion 493-4. [PMID: 17576505 DOI: 10.1007/s00266-006-0253-y] [Citation(s) in RCA: 166] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2006] [Accepted: 01/05/2007] [Indexed: 01/10/2023]
Abstract
Hypertrophic scars, resulting from alterations in the normal processes of cutaneous wound healing, are characterized by proliferation of dermal tissue with excessive deposition of fibroblast-derived extracellular matrix proteins, especially collagen, over long periods, and by persistent inflammation and fibrosis. Hypertrophic scars are among the most common and frustrating problems after injury. As current aesthetic surgical techniques become more standardized and results more predictable, a fine scar may be the demarcating line between acceptable and unacceptable aesthetic results. However, hypertrophic scars remain notoriously difficult to eradicate because of the high recurrence rates and the incidence of side effects associated with available treatment methods. This review explores the various treatment methods for hypertrophic scarring described in the literature including evidence-based therapies, standard practices, and emerging methods, attempting to distinguish those with clearly proven efficiency from anecdotal reports about therapies of doubtful benefits while trying to differentiate between prophylactic measures and actual treatment methods. Unfortunately, the distinction between hypertrophic scar treatments and keloid treatments is not obvious in most reports, making it difficult to assess the efficacy of hypertrophic scar treatment.
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Affiliation(s)
- Bishara S Atiyeh
- Division Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
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Karsai S, Roos S, Hammes S, Raulin C. Pulsed dye laser: what's new in non-vascular lesions? J Eur Acad Dermatol Venereol 2007; 21:877-90. [PMID: 17658995 DOI: 10.1111/j.1468-3083.2007.02297.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE In dermatology, the pulsed dye laser (PDL) is the therapeutic instrument of choice for treating most superficial cutaneous vascular lesions. In addition, clinical experience over the last decade allowed us to treat patients with an ever increasing number of non-vascular indications. The purpose of this report is to summarize and critically appraise the scientific evidence that support the role of PDL in treating non-vascular skin lesions. METHODS A literature-based study has been conducted, including the review of publications over the period January 1995 to December 2006, using the Medline Database. We also included our own experience in managing non-vascular lesions with the PDL. Four sets of preoperative and postoperative photos are presented. RESULTS For viral skin lesions, PDL proved to be an alternative to other therapy options. This applies particularly to periungual warts and mollusca contagiosa. The mechanism of PDL with inflammatory dermatoses has not yet been elucidated. The effect seems to be better if there is a vascular component to the disease. With most of these indications (such as psoriasis and acne), PDL currently plays a rather minor or complementary role. Regarding collagen remodelling (hypertrophic scars, keloids, stretch marks, and skin rejuvenation), the question of whether a therapy makes sense or not has to be decided from case to case. CONCLUSION With PDL, it is possible to achieve good results with numerous, partly less well-known indications (i.e. lupus erythematosus). With other diseases, PDL has so far been considered to be a complementary therapy method or to be in an experimental state.
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Affiliation(s)
- S Karsai
- Laserklinik Karlsruhe, Karlsruhe, Germany.
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Glaich AS, Goldberg LH, Friedman RH, Friedman PM. Fractional Photothermolysis for the Treatment of Postinflammatory Erythema Resulting from Acne Vulgaris. Dermatol Surg 2007; 33:842-6. [PMID: 17598852 DOI: 10.1111/j.1524-4725.2007.33180.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Fractional Photothermolysis for the Treatment of Postinflammatory Erythema Resulting from Acne Vulgaris. Dermatol Surg 2007. [DOI: 10.1097/00042728-200707000-00011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bailey JNR, Waite AE, Clayton WJ, Rustin MHA. Application of topical mitomycin C to the base of shave-removed keloid scars to prevent their recurrence. Br J Dermatol 2007; 156:682-6. [PMID: 17263819 DOI: 10.1111/j.1365-2133.2006.07714.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Keloid scars are formed by over-activity of fibroblasts producing collagen and they cause significant morbidity both from their appearance and from their symptoms. Existing treatments are often unsatisfactory. Topical mitomycin C is known to inhibit fibroblast proliferation. OBJECTIVES To determine whether application of mitomycin C to the base of shave-removed keloids would prevent their recurrence. METHODS Ten patients had all or part of their keloid shave-removed. After haemostasis topical mitomycin C 1 mg mL(-1) was applied for 3 min. This application was repeated after 3 weeks. The keloids were photographed before treatment and the patients were reviewed every 2 months for a total of 6 months when a final photograph of the keloid site was taken. The patients and the Clinical Trials Unit staff scored the outcome on a linear analogue scale of 0-10, where 0 = disappointed and 10 = delighted. The pretreatment and 6-month post-treatment photographs were also assessed by two dermatologists who were not involved in the clinical trial. RESULTS Four of the 10 patients were delighted with the outcome of treatment and only one was disappointed. On average there was an 80% satisfied outcome. CONCLUSIONS This new treatment of keloids has been shown to be effective in the majority of patients but further studies are required to confirm this benefit.
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Affiliation(s)
- J N R Bailey
- Department of Dermatology, The Royal Free Hospital, London NW3 2QG, UK.
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Suh DH, Chang KY, Son HC, Ryu JH, Lee SJ, Song KY. Radiofrequency and 585-nm Pulsed Dye Laser Treatment of Striae Distensae: A Report of 37 Asian Patients. Dermatol Surg 2007; 33:29-34. [PMID: 17214676 DOI: 10.1111/j.1524-4725.2007.33004.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Various lasers have recently been reported as effective treatment modalities for striae distensae, but pigmentary alterations are a major concern to the darker skin type. The Thermage (Therma Cool TC; Thermage Inc, Hayward, CA) is a radiofrequency device for the lifting of face and neck, and there is no report of using it for striae distensae. OBJECTIVE The purpose was to evaluate the effectiveness of the Thermage in combination with pulsed dye laser. MATERIALS AND METHODS Thirty-seven patients with abdominal striae distensae were treated with the Thermage and 585-nm pulsed dye laser in the first session at baseline. An additional two sessions of pulsed dye laser were performed at Weeks 4 and 8. Thermage was used at fluences of 53 to 97 J/cm2 and pulsed dye laser at fluences of 3.0 J/cm2 with 10-mm spot. Skin biopsies were taken of nine patients. RESULTS In the subjective assessment, 89.2% of the patients showed "good and very good" to overall improvement, and 59.4% were graded as "good and very good" in elasticity. All of the nine specimens showed an increase in the amount of collagen fibers, and increased elastic fibers were found in six specimens. CONCLUSION The Thermage and pulsed dye laser appear to be an effective treatment for striae distansae.
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Affiliation(s)
- Dong-Hye Suh
- Anacli Dermatologic Clinic, Department of Pathology, College of Medicine, Chung-Ang University, Seoul, Korea.
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