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Wong CSM, Chan MWM, Shek SYN, Yeung CK, Chan HHL. Evaluation of a Novel Dermal Cooling System for the Treatment of Benign Pigmented Lesions in Asians. Lasers Surg Med 2024; 56:541-550. [PMID: 38922979 DOI: 10.1002/lsm.23809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 04/22/2024] [Accepted: 05/19/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE Our study aimed to evaluate the efficacy of this novel dermal cooling system (DCS) in reducing pigmentation in benign pigmented lesions in Asian patients and its potential side effects. METHODS It was a prospective open-label single-center study. Asian patients, with the presence of benign pigmented lesions mainly including lentigines, melasma, nevus spilus, ephelides, café au lait, and seborrheic keratosis were recruited for a novel DCS. The DCS provided localized cooling of the epidermal layer below freezing but was less intense than cryotherapy. Each patient received DCS at Week 0 and repeated at 4-week intervals up to 10 sessions. Global aesthetic improvement scores (GAIS) by blinded physicians and subjects were recorded at 2, 6, and 12 months posttreatment follow-up. RESULTS Eighty-one patients were recruited with a total of 305 sessions performed and 1716 lesion sites treated. At 2-month posttreatment, 76.5% and 58.6% treatment sites showed obvious to marked improvement respectively and the improvement sustained at 6 and 12 months. Only minor adverse events were reported. Erythema and edema were the most commonly anticipated effects immediately after treatment. The pain was minimal. Postinflammatory hyperpigmentation was only reported in 2.2% (38/1716) treated sites. CONCLUSION To our knowledge, this study was the first study to demonstrate that this novel DCS was an effective, safe, and well-tolerated treatment for benign pigmented lesions in Asians.
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Affiliation(s)
- Christina S M Wong
- Division of Dermatology, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Mandy W M Chan
- Division of Dermatology, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Samantha Y N Shek
- Division of Dermatology, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Chi Keung Yeung
- Division of Dermatology, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Henry H L Chan
- Division of Dermatology, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Pekmezci E. The use of radio‐wave surgery, an underestimated method, for small hyperpigmented flat or macular lesions on face. J Cosmet Dermatol 2022; 21:4691-4696. [DOI: 10.1111/jocd.14995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/13/2022] [Accepted: 04/11/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Erkin Pekmezci
- Istanbul Medipol University International Faculty of Medicine Department of Dermatology Istanbul Turkey
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Wamsley CE, Vingan N, Barillas J, Culver A, Turer DM, Kenkel JM. A Single-Center Pilot Study to Classify Signs of Dorsal Hand Aging Using 3 Grading Scales. Aesthet Surg J Open Forum 2022; 4:ojab059. [PMID: 35211668 PMCID: PMC8862723 DOI: 10.1093/asjof/ojab059] [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] [Indexed: 11/23/2022] Open
Abstract
Background While validated scales must be created in order to systemically evaluate patients and quantify outcomes of aesthetic hand treatments, scales currently available are limited to the analysis of volume loss alone. Objectives The purpose of this study was to develop 3 validated scales for the assessment of dorsal hand aging that also take into consideration wrinkling and pigmentation. Methods Fifty (50) healthy volunteers (40 females and 10 males) with Fitzpatrick skin types I-IV were recruited, and standard photographs of their left and right dorsal hands were taken with a Nikon D7100 (Nikon; Minato, Tokyo, Japan) camera. Using 25 randomized photographs, 11 plastic surgery physicians (3 chief residents, 6 senior residents, and 2 aesthetic surgery fellows) were trained on the 3 scales under investigation as well as the already-validated Merz Hand Grading Scale (MHGS). The evaluators then viewed the remaining 75 photographs independently and assigned a grade for each of the 4 scales to each photograph. Inter-rater variability was calculated for each scale. Results The Kappa score for the MHGS was 0.25, indicating fair agreement; 0.40 for wrinkle scale, indicating fair agreement; and 0.48 and 0.46 for the pigmentation density and intensity scales, respectively, indicating moderate agreement (P < 0.001). Conclusions The results show that after receiving training, the inter-rater agreement for the 3 scales under investigation was similar or slightly higher than that for the MHGS. These 3 photographic classification systems can be used consistently and reliably to characterize multiple signs of dorsal hand aging. Level of Evidence: 2
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Affiliation(s)
- Christine E Wamsley
- Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Nicole Vingan
- Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jennifer Barillas
- Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Abby Culver
- Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - David M Turer
- Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jeffrey M Kenkel
- Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
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Arginelli F, Greco M, Ciardo S, Josse G, Rossi AB, Le Digabel J, Questel E, Chester J, Pellacani G. Efficacy of D-pigment dermocosmetic lightening product for solar lentigo lesions of the hand: A randomized controlled trial. PLoS One 2019; 14:e0214714. [PMID: 31042723 PMCID: PMC6493707 DOI: 10.1371/journal.pone.0214714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 02/19/2019] [Indexed: 11/18/2022] Open
Abstract
Solar lentigo, benign lesions which mostly appear on chronically, sun-exposed surfaces, are associated with ageing. Patients are increasingly requesting a more uniform skin texture, especially for hands. Treatment options include dermoabrasion, intense pulsed light, cryotherapy, peelings, and laser therapy. Topical compounds can be employed, in alternative or associated with dermatologic procedures. The current study was designed to evaluate solar lentigo hyperpigmentation, skin architecture and clinician and patient assessments comparing a dermocosmetic lightening product (active) with a moisturizing product (control) according to clinical, digital and subjective analyses in 72 lesions over 12-month follow up period. Statistically significant differences were observed between the lesions treated with the active compared to the control in terms of papillary brightness (p = 0.03) and contrast (p = 0.03), and in the limitation of dermal-epidermal junction destructuring (p = 0.03) according to dermal-epidermal junction destructuring score at Reflectance Confocal Microscopy. Luminance (p = 0.04) and redness (p = 0.03) were improved at color analysis, and physician and patient evaluations favored the active in efficacy and patient satisfaction investigations. The dermocosmetic lightening product utilized in the current study proved to be more effective, according to clinical, digital and subjective analyses in reducing lesion hyperpigmentation, stabilizing the lesion skin architecture and increasing patient satisfaction compared to the control in a cohort of 36 subjects, over a 12-month period. Beside demonstrating the efficacy of this topical lightening product, we propose a “destructuring score”, which improves the robustness of solar lentigo’s evaluation, and can be used in future studies to standardize the quantitative comparisons of different treatment options.
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Affiliation(s)
- Federica Arginelli
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Maurizio Greco
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Silvana Ciardo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Gwendal Josse
- Pierre Fabre Dermo-Cosmétique, Clinical Skin Research Center, Toulouse, France
| | - Ana Beatris Rossi
- Pierre Fabre Dermo-Cosmétique, Clinical Skin Research Center, Toulouse, France.,Dermatology Department, Larrey University Hospital, Toulouse, France
| | - Jimmy Le Digabel
- Pierre Fabre Dermo-Cosmétique, Clinical Skin Research Center, Toulouse, France
| | - Emmanuel Questel
- Pierre Fabre Dermo-Cosmétique, Clinical Skin Research Center, Toulouse, France
| | - Johanna Chester
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
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Huang CM, Lu EY, Kirchhof MG. Cellulitis Secondary to Liquid Nitrogen Cryotherapy: Case Report and Literature Review. J Cutan Med Surg 2017; 21:334-338. [PMID: 28358590 DOI: 10.1177/1203475417702152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Liquid nitrogen cryotherapy is a commonly used technique to treat a wide variety of dermatologic conditions including actinic keratoses, non-melanoma skin cancers, verrucae, and seborrheic keratoses. The risks associated with liquid nitrogen cryotherapy are important to know and discuss with patients prior to treatment. OBJECTIVE We report a case of cellulitis secondary to liquid nitrogen cryotherapy for actinic keratosis. We sought to review the literature for an estimate of secondary infection rates following cryotherapy treatment. METHODS We searched Pubmed using the terms cryotherapy and infection or cellulitis. We then looked at articles classified as clinical trials where cryotherapy was used to treat skin conditions. We then selected clinical trials that listed cellulitis or infection as an adverse event. RESULTS AND CONCLUSION There were no case reports, case series, or review articles detailing the risk of infection from liquid nitrogen cryotherapy. We found 8 articles classified as clinical trials on Pubmed that did list infection as an adverse event. The risk of infection from these studies varied from approximately 2% to 30%. There was a great degree of heterogeneity in treatment sites, length of treatment, and treatment targets. While it is difficult to determine the true incidence of infection from liquid nitrogen cryotherapy, clinicians should endeavor to inform patients of this potential risk.
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Affiliation(s)
- Christina M Huang
- 1 Queen's School of Medicine, Queen's University, Kingston, ON, Canada
| | - Emily Y Lu
- 1 Queen's School of Medicine, Queen's University, Kingston, ON, Canada
| | - Mark G Kirchhof
- 2 Division of Dermatology, Department of Medicine, Queen's University, Kingston, ON, Canada
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Vachiramon V, Panmanee W, Techapichetvanich T, Chanprapaph K. Comparison of Q-switched Nd: YAG laser and fractional carbon dioxide laser for the treatment of solar lentigines in Asians. Lasers Surg Med 2016; 48:354-9. [DOI: 10.1002/lsm.22472] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Vasanop Vachiramon
- Division of Dermatology; Faculty of Medicine Ramathibodi Hospital; Mahidol University; Bangkok Thailand
| | - Wikanda Panmanee
- Division of Dermatology; Faculty of Medicine Ramathibodi Hospital; Mahidol University; Bangkok Thailand
| | - Thanya Techapichetvanich
- Division of Dermatology; Faculty of Medicine Ramathibodi Hospital; Mahidol University; Bangkok Thailand
| | - Kumutnart Chanprapaph
- Division of Dermatology; Faculty of Medicine Ramathibodi Hospital; Mahidol University; Bangkok Thailand
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Seirafi H, Fateh S, Farnaghi F, Ehsani AH, Noormohammadpour P. Efficacy and safety of long-pulse pulsed dye laser delivered with compression versus cryotherapy for treatment of solar lentigines. Indian J Dermatol 2011; 56:48-51. [PMID: 21572792 PMCID: PMC3088935 DOI: 10.4103/0019-5154.77552] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Although cryotherapy is still the first-line therapy for solar lentigines, because of the side effects such as post-inflammatory hyperpigmentation (PIH), especially in patients with darker skin types, pigment-specific lasers should be considered as a therapy for initial treatment. Aim: The aim of this study is to evaluate the efficacy and safety of cryotherapy compared with 595-nm pulsed dye laser (PDL) with cutaneous compression in the treatment of solar lentigines. Materials and Methods: Twenty-two patients (skin type II–IV) with facial or hand lentigines participated in this study. Lesions of one side of the face or each hand were randomly assigned and treated with either cryotherapy or PDL. Treatments were performed with radiant exposures of 10 J/cm2 , 7-mm spot size and 1.5 ms pulse duration with no epidermal cooling. Photographs were taken before treatment and 1-month later. The response rate and side effects were compared. Results: PDL was more likely to produce substantial lightening of the solar lentigines than cryotherapy, especially in skin type III and IV (n = 8, n = 9; P < 0.05), but might be no difference in type II (n = 5; P > 0.05). PIH was seen only in cryotherapy group. PDL group had only minimal erythema. No purpura was observed. Conclusion: PDL with compression is superior to cryotherapy in the treatment of solar lentigines in darker skin types.
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Affiliation(s)
- Hassan Seirafi
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
BACKGROUND The aging of the hands is typically characterized by wrinkles, skin thinning, and solar lentigines. The search for effective treatments has led to the use of laser and intense pulsed light (IPL) technologies. OBJECTIVE To assess the effectiveness of an IPL device for the improvement of dyspigmentation and overall skin quality on the dorsa of the hands. METHODS Twenty-three patients with sun damage and solar lentigines on the dorsal hands were treated with four IPL sessions at 3- to 4-week intervals. Prior to treatment, photographs were taken and informed consent was obtained. Pre- and post-treatment photography and investigator clinical assessment and patient questionnaires were collected for data analysis. RESULTS After four treatment sessions, good to excellent results in the improvement in solar lentigines and skin quality were assessed by investigators in 100% of the cases and in 86.94% (20 of 23 subjects) by patient self-assessments. No significant side effects were observed. CONCLUSION IPL is an effective and safe treatment option to improve solar lentigines and skin texture for hand rejuvenation.
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Affiliation(s)
- Alberto Goldman
- Department of Dermatology, Laser and Plastic Surgery, Clinica Goldman, Porto Alegre, RS, Brazil.
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Raziee M, Balighi K, Shabanzadeh-Dehkordi H, Robati RM. Efficacy and safety of cryotherapy vs. trichloroacetic acid in the treatment of solar lentigo. J Eur Acad Dermatol Venereol 2008; 22:316-9. [DOI: 10.1111/j.1468-3083.2007.02409.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Therapy for solar lentigines is diverse but can be divided into two broad categories: physical therapy and topical therapy. Physical therapies are frequently used with excellent clinical success rates, but this has to be balanced against associated side effects and recurrence rates with certain therapies. A range of topical therapies have been used and, more recently, fixed combinations of topical agents have been investigated. The Pigmentary Disorders Academy undertook to evaluate the clinical efficacy of the different treatments of solar lentigines in order to generate a consensus statement on their management. Clinical papers published during the past 20 years were identified through MEDLINE searches and methodology and outcome were assessed according to guidelines adapted from the US Preventive Services Task Force (USPSTF) on health care. The consensus of the group was that first-line therapy for solar lentigines was ablative therapy with cryotherapy. Although no large-scale studies have been completed, there is also good evidence to suggest that lasers are an effective treatment. An alternative to ablative therapy is topical therapy and there is good evidence to support the use of a fixed double combination, as well as retinoids, such as adapalene and tretinoin. Topical therapy can also be considered as maintenance therapy after the primary therapy has been applied. Because of the diversity of scoring systems used in the assessment of treatment outcome, the group recommends the development of treatment guidelines.
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Affiliation(s)
- Jean-Paul Ortonne
- Department of Dermatology, University of Nice-Sophia Antipolis, Nice, France
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