"1927-nm Fractional resurfacing of facial actinic keratoses: A promising new therapeutic option"Weiss, Elliot T; Brauer, Jeremy A; Anolik, Robert; Reddy, Kavitha K; Karen, Julie K; Hale, Elizabeth K; Brightman, Lori A; Bernstein, Leonard; GERONEMUS, ROY G
BACKGROUND: Actinic keratoses (AK) are precancerous epidermal proliferations commonly present on chronically sun-damaged skin. These lesions are among the most often treated dermatologic conditions. OBJECTIVE: We sought to investigate the 6-month safety, tolerance, and efficacy of nonablative 1927-nm fractional resurfacing of facial AK. METHODS: This was a prospective clinical trial of 24 individuals with facial photodamage and AK receiving up to 4 treatments with the fractionated 1927-nm nonablative thulium laser. RESULTS: At 6 months, an 86.6% reduction in absolute number of lesions was noted by independent physician assessment. In addition, at this same time point, patients reported marked or noticeable improvement in overall photodamage. LIMITATIONS: This prospective study does not provide safety, tolerance, and efficacy data beyond 6 months of follow-up, nor does it identify the precise mechanism of action involved in AK clearance after 1927-nm resurfacing. CONCLUSION: The clinical and histologic findings, as well as the reported patient satisfaction and safety, suggest that the treatment of AK and photodamage with a fractionated 1927-nm nonablative thulium laser is a promising new therapeutic option..
"Investigation into optimal treatment intervals of facial port-wine stains using the pulsed dye laser"Anolik, R; Newlove, T; Weiss, ET; Brightman, L; Hale, EK; Karen, JK; Bernstein, L; GERONEMUS, RG
BACKGROUND: Port-wine stains (PWS) affect 0.3% to 0.5% of newborns and pulsed dye laser (PDL) remains the treatment of choice. Optimal treatment intervals have not been established. OBJECTIVE: We sought to validate the optimal treatment intervals for the management of facial PWS with PDL. METHODS: In all, 24 infants with facial PWS who received at least 5 treatments with the PDL at 2-, 3-, and 4-week intervals at a private laser and skin surgery center from 2009 to 2010 were identified by a retrospective chart review. Safety and efficacy were compared by blinded investigators. RESULTS: Side effects were equivalent in all interval groups and included only expected short-term erythema, edema, purpura, and mild postinflammatory hyperpigmentation. No patient developed hypopigmentation, scarring, or infection. All interval groups showed 50% to 100% clearance of their PWS after 5 treatments. Complete or near-complete clearance was seen in 6 of 8 (75%) and 7 of 8 (87.5%) patients in the 2- and 3-week interval groups, respectively, as compared with 3 of 8 (37.5%) patients in the 4-week interval group. LIMITATIONS: This was a retrospective chart review from a single institution. Long-term side effects and recurrence rates were not assessed. CONCLUSION: We conclude that PDL treatments at 2-, 3-, and 4-week intervals are effective for the management of facial PWS in infants with minimal short-term side effects. Shorter treatment intervals may allow for relatively more rapid and more effective treatment..
"Successful and rapid treatment of blue and green tattoo pigment with a novel picosecond laser"Brauer, Jeremy A; Reddy, Kavitha K; Anolik, Robert; Weiss, Elliot T; Karen, Julie K; Hale, Elizabeth K; Brightman, Lori A; Bernstein, Leonard; GERONEMUS, ROY G
BACKGROUND While the understanding and technology of laser tattoo removal has advanced much over the last 5 decades, treatments and results remain far from perfect. With currently available devices, treatment courses are often painful and prolonged with mixed results. We describe the successful and rapid treatment of 12 tattoos containing blue and/or green pigment with a novel, picosecond, 755-nm alexandrite laser. OBSERVATIONS All previously untreated multicolored tattoos as well as tattoos recalcitrant to treatment demonstrated at least 75% clearance of blue and green pigment after 1 or 2 treatments with a novel, picosecond, 755-nm alexandrite laser. More than two-thirds of these tattoos approached closer to 100% clearance. CONCLUSIONS While additional future studies are needed, we believe that this new technology is more effective in targeting blue and green pigment, resulting in expedited clearance with less collateral injury to surrounding tissue..
"Ablative Fractional Resurfacing for Involuted Hemangioma Residuum"Brightman, Lori A; Brauer, Jeremy A; Terushkin, Vitaly; Hunzeker, Christopher; Reddy, Kavitha K; Weiss, Elliot T; Karen, Julie K; Hale, Elizabeth K; Anolik, Robert; Bernstein, Leonard; GERONEMUS, ROY G
BACKGROUND Given the natural tendency for 15% to 40% of infantile hemangiomas to spontaneously involute over time, much debate surrounds the issue of treatment. Until recently, effective therapies to improve the appearance of residual textural skin changes in these patients were lacking. We suggest the use of ablative fractional resurfacing for the treatment of textural skin changes resulting from involuted hemangiomas. OBSERVATIONS All patients treated with an ablative fractional carbon dioxide laser experienced considerable flattening of the fibrofatty residual tissue, with at least 50% to 75% improvement in color, texture, and overall appearance. CONCLUSION While additional future studies are needed, we believe that ablative fractional resurfacing should be considered for the treatment of textural skin changes associated with involuted infantile hemangiomas..
"Calcium Hydroxylapatite Nodule Resolution After Fractional Carbon Dioxide Laser Therapy"Reddy, KK; Brauer, JA; Anolik, R; Bernstein, L; Brightman, LA; Hale, E; Karen, J; Weiss, E; GERONEMUS, RG
BACKGROUND: Injection of calcium hydroxylapatite filler may result in nodule formation owing to superficial placement of the filler. Calcium hydroxylapatite nodules are difficult to reverse. Previously reported therapeutic options are limited and include intralesional triamcinolone, massage, needling, and excision, each with inconsistent results or potential for scarring. Observation We have observed complete resolution of calcium hydroxylapatite nodules after a single treatment with fractional carbon dioxide laser. CONCLUSIONS: A single session of fractional carbon dioxide laser treatment may resolve selected cases of calcium hydroxylapatite nodules. The mechanism of action may involve conversion of the product into tricalcium phosphates which dissolve readily. This novel therapeutic technique may enhance treatment options for a difficult clinical problem..
"Glomuvenous Malformations (Familial generalized multiple glomangiomas)" [Case Report]Brauer, Jeremy A; Anolik, Robert; Tzu, Julia; Meehan, Shane; Lieber, Colette D; GERONEMUS, ROY G
A 15-year-old boy with a diagnosis of generalized multiple glomangiomas was referred for evaluation and treatment of enlarging and increasingly painful lesions on his right ankle. The patient underwent a series of two treatments with long-pulsed KTP 1064 nm laser that resulted in substantial improvement in appearance and decreased pain. Generalized glomuvenous malformations, or multiple glomangiomas, are the less common presentation of proliferation of glomus cells and may have extracutaneous involvement. Whereas surgical management is often employed and definitive for solitary lesions, interventions such as laser therapy, may be beneficial for improvement of functional impairment and cosmesis as was observed in our patient..
"Reduction of thickened flap using fractional carbon dioxide laser"Brightman, Lori A; Brauer, Jeremy A; Anolik, Robert; Weiss, Elliot T; Karen, Julie; Chapas, Anne; Hale, Elizabeth; Bernstein, Leonard; GERONEMUS, ROY G
BACKGROUND AND OBJECTIVE: The paramedian forehead flap is an excellent choice when repairing a large nasal defect. However, even when carefully thinned, the flap may develop a bulky appearance, an ill-fitting contour, or trap door deformity. When on the face, these suboptimal results can be quite distressing. Surgical and non-surgical options for improvement exist. Surgical options include additional debulking and reorientation of the flap. Non-surgical options include intralesional corticosteroids or 5-flourouracil, dermabrasion, and ablative and non-ablative laser resurfacing. Each option has limited benefit as well potential side effects. STUDY DESIGN/MATERIALS AND METHODS: Case report. RESULTS: In this report, we present dramatic improvement of a thickened paramedian forehead flap using the Fraxel Re:pair, a fractional carbon dioxide (CO(2) ) laser (Solta Medical, Inc. Hayward, CA). CONCLUSION: To our knowledge, this is the first case in the literature demonstrating successful reduction of a bulky flap using a fractional ablative laser..
"Do lasers or topicals really work for nonmelanoma skin cancers?"Brightman, Lori; Warycha, Melanie; Anolik, Robert; GERONEMUS, ROY
Novel strategies are urgently needed to address the millions of nonmelanoma skin cancers treated in the United States annually. The need is greatest for those patients who are poor surgical candidates or those prone to numerous nonmelanoma skin cancers and therefore at risk for marked disfigurement. Traditional treatment strategies include electrosurgery with curettage, radiation therapy, cryotherapy, excision, and Mohs micrographic surgery. Alternatives to traditional treatment, including topical medications and light or laser therapies, are becoming popular; however, there are various degrees of efficacy among these alternative tactics. These alternatives include topical retinoids, peels, 5-fluorouracil, imiquimod, photodynamic therapy, and lasers. The purpose of this paper is to review the available data regarding these alternative strategies and permit the reader to have a sense of which therapies are reasonable options for care.
"Herpes zoster in the distribution of the trigeminal nerve after nonablative fractional photothermolysis of the face: report of 3 cases" [Case Report]Firoz, Bahar F; Katz, Tracy M; Goldberg, Leonard H; GERONEMUS, ROY G; Polder, Kristel D; Friedman, Paul M
"Treatment of Nevus of Ota in Fitzpatrick skin type VI with the 1064-nm QS Nd:YAG laser" [Case Report]Landau, Jennifer M; Vergilis-Kalner, Irene; Goldberg, Leonard H; GERONEMUS, ROY G; Friedman, Paul M
BACKGROUND: Nevus of Ota is a pigmented lesion that usually presents at birth. Due to a greater risk for complications, physicians have not always utilized laser therapy to treat these nevi in patients with darker skin types. OBJECTIVE: To evaluate the safety and efficacy of the 1,064-nm Q-switched neodymium-doped yttrium aluminium garnet (QS Nd:YAG) laser for the treatment of Nevus of Ota in two patients with Fitzpatrick skin type (FST) VI. RESULTS: After 4-13 treatment sessions with the 1,064-nm Q-switched Nd:YAG laser with a 4 mm spot size and fluence of 4-4.2 J/cm(2), two patients with FST VI noted substantial improvement in the appearance of the nevi. CONCLUSION: At conservative treatment settings, these two case reports have shown that the 1,064-nm QS Nd:YAG laser can be utilized to safely and effectively treat Nevus of Ota in individuals with FST IV-VI..
"Letter regarding early laser treatment of periorbital infantile hemangiomas may work, but is it really the best treatment option?" [Letter]GERONEMUS, ROY G; Hunzeker, Christopher M
"Treatment of superficial infantile hemangiomas of the eyelid using the 595-nm pulsed dye laser"Hunzeker, Christopher M; GERONEMUS, ROY G
BACKGROUND: Despite the proven effectiveness of the 595-nm pulsed dye laser (PDL) in treating superficial infantile hemangiomas, many physicians are reluctant to treat such lesions involving the eyelid. OBJECTIVE To examine the safety and efficacy of the 595-nm PDL for the treatment of superficial infantile hemangiomas of the eyelid. MATERIALS & METHODS: Records were reviewed for patients with superficial infantile hemangiomas of the eyelid treated with 595-nm PDL. Pre- and post-treatment photographs were compared. Reviewers rated the degree of improvement of the hemangioma as excellent (76-100%), good (51-75%), moderate (26-50%), or poor (0-25%) and indicated whether the hemangioma was 100% clear. Side effects of scarring, atrophy, hyperpigmentation, and hypopigmentation were assessed. RESULTS: Twenty-two patients met the study criteria. Eight (36.4%) demonstrated complete clearance of their hemangioma, 17 (77.3%) received an improvement rating of excellent, and five (22.7%) received a rating of good. No scarring, atrophy, or hypopigmentation was noted. Two patients (9.1%) were noted to have hyperpigmentation in the treated area. CONCLUSION: Early treatment with the 595-nm PDL can safely and effectively diminish proliferative growth and hasten resolution of superficial infantile hemangiomas of the eyelid..