Association of PDO threads and technologies-Facial treatment protocols

BACKGROUND

Aging is part of the immutable characteristics of the human being, and the search for treatments to alleviate the undesirable effects of aging is frequent in the dermatological office.

AIMS

This work proposes the technique of association of PDO threads with technologies and the description of the facial treatment protocols.

METHODS

For contextualization, two case studies of two patients subjected to the procedure are analyzed.

CONCLUSIONS

In recent years, there have been marked changes in facial rejuvenation techniques using PDO threads and these have shown satisfactory results for collagen biostimulation. Having technologies in dermatological clinics is a frequent reality, and sometimes, some doctors are in doubt about when to use them associated with PDO wires and in which sequence it should be done, ensuring patient safety and maintaining the integrity of the wires. This article aims to bring clarity about how to use technology and when is the right time. It is also intended to clarify that the PDO wire can be used in conjunction with the microfocused ultrasound technology, since the melting point of the PDO polymer is between 110° and 115°C.

The qualification and training of laser/intense pulse light hair removal operators within South Africa

BACKGROUND

Lasers and intense pulse light (IPL) sources are powerful devices that can cause skin burns, pigmentary changes, and scarring if used incorrectly. Adequate training is essential, and regulations are required to limit complications.

AIMS

The purpose was to investigate the qualifications and training obtained by laser hair removal operators in South Africa.

METHODS

Questionnaires were distributed and information gathered from owners/managers of laser clinics, suppliers of laser devices in South Africa, individuals in the workplace performing laser hair removal procedures, and accredited tertiary institutions.

RESULTS

A majority of clinic owners/managers (94.45%) felt that more emphasis should be placed on laser hair removal training at a tertiary level, and 66.67% outsource additional training provided by the manufacturer of laser devices. Based on the survey to manufacturers, 50% did not require any formal qualification as a minimum requirement, while 33.33% indicated laser hair removal training is incorporated at a NQF level 4 (National/Senior Certificate). The majority of individuals (68.89%) received training from tertiary institutions; however, they did not receive any practical training, and 60.87% felt the amount of training was insufficient. According to the survey sent to tertiary institutions in South Africa, only 27.78% offer laser hair removal training, and of these, 20% offer no practical training and 50% indicated that no practical examination is provided.

CONCLUSIONS

There is a clear lack of training in laser hair removal in South Africa. The industry should have standard requirements in terms of minimum practical and theoretical hours with regards to the therapy.

Randomized, side-by-side comparison of a topical photo-enhancer gel for hair removal: an efficacy and safety study

Background: Novel protocols are evolving to enhance hair follicle damage while preserving safety and improving efficacy. Objectives: The safety and tolerability of a 755-nm diode laser was compared to a combined laser with topical photo-enhancer gel ("combined") versus laser alone ("solo"). Methods: Twenty women (age 23-33 years old), Fitzpatrick skin type I-V, were randomized to side-by-side comparisons with a laser hair removal protocol. The combined side received reduced laser energy compared to the solo side. The laser used in-motion super hair removal technology. Subjects received up to four treatments. Subjects were assessed at baseline and at 1 and 6 months after the last treatment. Results: At the 1-month follow-up, there were no statistical differences in percent hair reduction between the combined (81 ± 16%) versus the solo (77 ± 15%) protocols (p > 0.05). Similarly, at 6-month follow-up, there are no statistical differences between the combined (71 ± 24%) versus the solo (70 ± 23%) treatment protocols (p > 0.05). The average accumulative laser energy in the combined side was half of the solo side (4.2 ± 1.6 vs. 7.6 ± 2.7 kJ, respectively). Pain during the procedure was significantly higher in the solo (5.5 ± 1.8) versus the combined (3.8 ± 1.7) protocol (p < 0.001). Conclusion: A laser hair removal paradigm that combines a 755-nm diode laser with a photo-enhancer gel (reduced kJ protocol) is clinically effective as a solo treatment protocol.

ANALYTICAL SOLUTIONS OF BIO-HEAT CONDUCTION ON SKIN IN FOURIER AND NON-FOURIER MODELS

In general, the transport of thermal energy in living tissue is a complex process. The analysis of the heat conduction of skin tissue is helpful for understanding of the bio-thermo-mechanical behavior of skin tissue. So far, three kinds of conduction law — (1) the Fourier model, (2) the C-V model and (3) dual-phase-lag (DPL) model — are often investigated in bio-thermal transfer process. In this study, the mathematical model of heat conduction of the skin tissue subjected to a general transient heating at the skin surface was established. The analytical solutions of these three conduction models are presented. In addition, the measure of thermal injury of the skin tissue subjected to a harmonic heating was investigated. It was found that the phenomenon of Fourier model is greatly different to those of the C-V and DPL models. Moreover, the effects of the phase lags, the heating frequency, and the heat quantity on the temperature variation and the index of thermal injury were significant. In sum, the analytical method can be used to solve the conduction problem of any one-layer tissue.

Laser hair removal: a review

BACKGROUND

Unwanted hair growth is a common aesthetic problem. Laser hair removal has emerged as a leading treatment option for long-term depilation.

OBJECTIVES

To extensively review the literature on laser hair removal pertaining to its theoretical basis, current laser and light-based devices, and their complications. Special treatment recommendations for darker skin types were considered.

MATERIALS AND METHODS

A comprehensive literature search related to the long-pulse alexandrite (755 nm), long-pulse diode (810 nm), long-pulse neodymium-doped yttrium aluminum garnet (Nd:YAG; 1,064 nm), and intense pulsed light (IPL) system, as well as newer home-use devices, was conducted.

RESULTS

The literature supports the use of the alexandrite, diode, Nd:YAG and IPL devices for long-term hair removal. Because of its longer wavelength, the Nd:YAG is the best laser system to use for pigmented skin. Further research is needed regarding the safety and efficacy of home-use devices.

CONCLUSION

Current in-office laser hair removal devices effectively provide a durable solution for unwanted hair removal.

Reoperative soft tissue trauma

Trauma remains the leading cause of death in the first 4 decades of life and is surpassed only by cancer and atherosclerotic disease as the overall leading causes of death in the United States. Many of the injuries involve the facial region, including soft tissue trauma. This article highlights the current available modalities used in the management of unsightly scars or those scars whose location and appearance compromise function.

Photodynamic therapy of port-wine stains

OBJECTIVES

The purpose of this study was to observe the improvements of port-wine stains (PWSs) under photodynamic therapy (PDT) and to further evaluate the safety and efficacy of PDT in the dermatology clinic for the treatment of PWSs.

METHODS

Total of 75 PWS patients were treated with PDT. The PWS lesions were exposed to the copper vapor laser after intravenous injection of photosensitizer (Photocarcinorin, PsD-007). The lesions were photographed before each session and the therapeutic effects were evaluated by physicians based on the improvements in color, thickness and area of the photographed lesions. A follow-up visit was carried out after 2 months. The improvement rates were classified into 5 grades for quantitation of the therapeutic effects. A decision of termination or continuation of the treatment was then made according to lesion changes.

RESULTS

Patients with PWSs responded remarkably to PDT. The complete clinical remission rate was 57.33% and the effective rate was up to 94.67% in no more than four courses of treatment. Among the completely responded patients, 20.93% were treated with no more than two courses.

CONCLUSION

PDT is safe and highly effective for the treatment of PWSs in the dermatology clinic.

Effect of HeNe laser irradiation on extracellular matrix deposition and expression of cytokines and chemokines in paracoccidioidomycotic lesions

Paracoccidioidomycosis is the most prevalent human mycosis in Latin America. Cutaneous lesions are extremely painful and sensitive, and current treatment with antifungal drugs is lengthy and may cause side effects to patients. In this perspective, the helium-neon (HeNe) laser emerges as a novel therapy form due to its ability to heal wounds without changing cell function. In this work, we evaluate the effects of HeNe laser irradiation on extracellular matrix deposition and expression of cytokines and chemokines in cutaneous lesions caused by experimental infection of Balb/c mice. Our results showed decreased levels of pro-inflammatory interleukin (IL)-17 and tumor necrosis factor-alpha, and of anti-inflammatory IL-10 cytokines in lesions exposed to HeNe laser irradiation. Chemokines CCL3 and CXCL10 showed decreased levels in laser-treated lesions, but no significant difference was observed in relation to CCL5 expression. We also detected decreased density of fibronectin and laminin in HeNe laser-treated lesions. Data presented herein support the validity of our previous results suggesting positive effects of HeNe laser in accelerating wound healing in this experimental model. We believe that HeNe laser is a new nonharmful strategy that may be used as adjuvant and/or alternative therapy for improving treatment of paracoccidioidomycotic lesions.

Prevention and management of hypertrophic scars and keloids after burns in children

Hypertrophic scars and keloids are challenging to manage, particularly as sequelae of burns in children in whom the psychologic burden and skin characteristics differ substantially from adults. Prevention of hypertrophic scars and keloids after burns is currently the best strategy in their management to avoid permanent functional and aesthetical alterations. Several actions can be taken to prevent their occurrence, including parental and children education regarding handling sources of fire and flammable materials, among others. Combination of therapies is the mainstay of current burn scar management, including surgical reconstruction, pressure therapy, silicon gels and sheets, and temporary garments. Other adjuvant therapies such as topical imiquimod, tacrolimus, and retinoids, as well as intralesional corticosteroids, 5-fluorouracil, interferons, and bleomycin, have been used with relative success. Cryosurgery and lasers have also been reported as alternatives. Newer treatments aimed at molecular targets such as cytokines, growth factors, and gene therapy, currently in developing stages, are considered the future of the treatment of postburn hypertrophic scars and keloids in children.

Laser treatment of pediatric vascular lesions: Port wine stains and hemangiomas

Pediatric vascular lesions can be medically threatening and psychologically distressing to patients. This article reviews literature on the laser treatment of two common pediatric vascular lesions, port wine stains and hemangiomas. The purpose of this report was to distinguish the lesions from one another and to present the advantages, disadvantages, complications, and limitations of laser treatment for each lesion type. This review is not a comprehensive inventory but instead highlights the studies that best show promising results or the limitations of laser treatment for the lesions. Overall, port wine stain laser treatment promoted notable clearing with low side effects, whereas hemangioma laser treatment provided inconsistent benefits and severe side effects occasionally. Laser treatment of port wine stains is safe and effective, but laser treatment of hemangiomas remains controversial and is best for lesions without deeper components.

Selected Laser-based Therapies in Otolaryngology

This article has discussed selected applications of laser therapies in otolaryngology. Lasers are the treatment of choice for PWS lesions, but new advances are needed to achieve complete blanching in the majority of cases. Noninvasive in vivo imaging and laser therapy coupled with PDT are two areas showing promise to improve outcome. PDT has the potential to offer new, cost-effective treatment options, and possibly cure, to cancer patients who are not candidates for traditional surgery, chemotherapy, and radiotherapy.

Permanent repigmentation of piebaldism by erbium:YAG laser and autologous cultured epidermis

BACKGROUND

Several surgical techniques have been proposed for the treatment of piebaldism. These procedures, however, are poorly suited for the treatment of large leucodermal lesions, can cause scars and require multiple donor sites. Recently, it has been reported that autologous cultured epidermis induces scarless repigmentation of large vitiligo lesions, using a single small donor site.

OBJECTIVES

To induce permanent repigmentation of large achromic lesions in patients suffering from piebaldism by means of autologous cultured epidermal grafts using a rapid, simple and non-invasive surgical procedure.

METHODS

Six patients with piebaldism were enrolled in this study. Achromic epidermis was removed by means of appropriately set erbium:YAG laser and autologous cultured epidermal grafts were applied on to the recipient bed. Melanocyte content was evaluated by 3,4-dihydroxyphenylalanine reaction. The percentage of repigmentation was calculated using a semiautomatic image analysis system.

RESULTS

Autologous cultured epidermis, bearing a controlled number of melanocytes, induced repigmentation of all piebald lesions. The mean percentage repigmentation was 95.45% (2791.5 cm2 repigmented/2924.2 cm2 transplanted).

CONCLUSIONS

Autologous cultured epidermal grafts induce permanent and complete repigmentation of piebald lesions, in the absence of scars. Erbium:YAG laser surgery is a rapid and precise tool for disepithelialization, hence allowing treatment of large piebald lesions during a single surgical operation.

Lasers in dermatology: four decades of progress

Advances in laser technology have progressed so rapidly during the past decade that successful treatment of many cutaneous concerns and congenital defects, including vascular and pigmented lesions, tattoos, scars, and unwanted hair-can be achieved. The demand for laser surgery has increased substantially by patients and dermatologists alike as a result of the relative ease with which many of these lesions can be removed, combined with a low incidence of adverse postoperative sequelae. Refinements in laser technology and technique have provided patients and practitioners with more therapeutic choices and improved clinical results. In this review, the currently available laser systems with cutaneous applications are outlined, with primary focus placed on recent advancements and modifications in laser technology that have greatly expanded the cutaneous laser surgeon's armamentarium and improved overall treatment efficacy and safety.

Epidermal grafting after chemical epilation in the treatment of vitiligo

BACKGROUND

Vitiligo on hairy areas like the scalp and eyebrows is frequently associated with leukotrichia and repigmentation by photochemotherapy is usually difficult because of a deficient melanocyte reservoir. Although epidermal grafting to supply melanocytes is very effective for stable vitiligo, hair growth inhibits successful transfer of melanocytes from grafted epidermis in dense hair-bearing regions.

OBJECTIVE

To investigate the effectiveness of preoperative chemical epilation to improve the results of epidermal graft by suction blister on hairy areas.

METHODS

Two patients who had vitiligo with leukotrichia on the face and scalp were treated with epidermal grafting using suction blister after chemical epilation. Two weeks after the graft they were treated with topical psolaren plus ultraviolet A (PUVA) therapy.

RESULTS

Epidermal grafting was performed successfully, and successful repigmentation of the skin with significant improvement of leukotrichia was observed in each of two patients.

CONCLUSION

Chemical epilation followed by epidermal grafting is a safe, easy, and effective treatment for vitiligo affecting hairy regions.