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Altering CO2 Laser Pulse Energy Settings Did Not Influence Differential Gene Transcription in Normal Skin in a Red Duroc Pig Model 改变二氧化碳激光脉冲能量设置不会影响红杜洛克猪模型正常皮肤的差异基因转录。
IF 2.2 3区 医学 Q2 DERMATOLOGY Pub Date : 2024-06-19 DOI: 10.1002/lsm.23813
Lou'ay K. Hussein, Taryn E. Travis, Lauren T. Moffatt, Jeffrey W. Shupp, Bonnie C. Carney

Objectives

Fractional ablative CO2 lasers are used clinically to treat cutaneous burn scars with reported varying degrees of effectiveness. It was hypothesized that different laser pulse energy settings may lead to differential gene transcription in a porcine model.

Methods

Uninjured skin from red Duroc pigs was treated with a fractional ablative CO2 laser set to 70, 100, or 120 mJ across the abdomen (n = 4 areas per treatment). Punch biopsies of both treated and untreated sites were taken before treatment (baseline), at 30 min, and at each hour for 6 h and stored in All-Protect tissue reagent. The biopsies were then used to isolate RNA, which was subsequently used in qRT-PCR for eight genes associated with wound healing and the extracellular matrix: CCL2, IL6, FGF2, TIMP1, TIMP3, COL1A2, MMP2, and DCN. RPL13a was used as a housekeeping gene to normalize the eight genes of interest. One-way ANOVA tests were used to assess for differences among laser pulse energies and two-way ANOVA tests were used to assess the differences between treated and untreated areas.

Results

While six of the eight genes were upregulated after treatment (p < 0.05), there were no significant differences in gene expression between the different laser pulse energies for any of the eight genes.

Conclusion

While laser treatment is correlated with a positive and significant upregulation for six of the eight genes 4 h after intervention, the pulse energy settings of the laser did not lead to a statistically significant difference in gene transcription among the treatment areas. Different laser pulse energies may not be required to induce similar cellular responses in a clinical setting.

目的:临床上使用点阵烧蚀二氧化碳激光器治疗皮肤烧伤疤痕,据报道效果不一。假设在猪模型中,不同的激光脉冲能量设置可能会导致不同的基因转录:方法:用设置为 70、100 或 120 mJ 的点阵烧蚀 CO2 激光治疗红色杜洛克猪腹部未受伤的皮肤(每次治疗 4 个区域)。在治疗前(基线)、治疗后 30 分钟、治疗后 6 小时内的每个小时,分别对治疗部位和未治疗部位进行冲孔活检,并将活检组织保存在 All-Protect 组织试剂中。然后用活检组织分离出 RNA,并在 qRT-PCR 中检测与伤口愈合和细胞外基质相关的八个基因:CCL2、IL6、FGF2、TIMP1、TIMP3、COL1A2、MMP2 和 DCN。RPL13a 用作看家基因,对八个相关基因进行归一化处理。用单向方差分析检验评估激光脉冲能量之间的差异,用双向方差分析检验评估处理区和未处理区之间的差异:结果:8 个基因中有 6 个在治疗后上调(P虽然激光治疗与干预 4 小时后 8 个基因中 6 个基因的正向显著上调相关,但激光的脉冲能量设置并未导致治疗区域之间基因转录的显著统计学差异。在临床环境中,诱导类似的细胞反应可能并不需要不同的激光脉冲能量。
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引用次数: 0
Postoperative Time and Anatomic Location Influence Skin Graft Reperfusion Assessed With Laser Speckle Contrast Imaging 通过激光斑点对比成像评估术后时间和解剖位置对皮肤移植再灌注的影响
IF 2.2 3区 医学 Q2 DERMATOLOGY Pub Date : 2024-06-18 DOI: 10.1002/lsm.23815
André Pinho, Ana Brinca, Joana Xará, Mariana Batista, Ricardo Vieira

Objectives

Under optimal conditions, afferent and efferent human skin graft microcirculation can be restored 8–12 days postgrafting. Still, the evidence about the reperfusion dynamics beyond this period in a dermato-oncologic setting is scant. We aimed to characterise the reperfusion of human skin grafts over 4 weeks according to the necrosis extension (less than 20%, or 20%–50%) and anatomic location using laser speckle contrast imaging (LSCI).

Methods

Over 16 months, all eligible adults undergoing skin grafts following skin cancer removal on the scalp, face and lower limb were enroled. Perfusion was assessed with LSCI on the wound margin (control skin) on day 0 and on the graft surface on days 7, 14, 21 and 28. Graft necrosis extension was determined on day 28.

Results

Forty-seven grafts of 47 participants were analysed. Regardless of necrosis extension, graft perfusion equalled the control skin by day 7, surpassed it by day 21, and stabilised onwards. Grafts with less than 20% necrosis on the scalp and lower limb shared this reperfusion pattern and had a consistently better-perfused centre than the periphery for the first 21 days. On the face, the graft perfusion did not differ from the control skin from day 7 onwards, and there were no differences in reperfusion within the graft during the study.

Conclusion

Skin graft reperfusion is a protracted process that evolves differently in the graft centre and periphery, influenced by postoperative time and anatomic location. A better knowledge of this process can potentially enhance the development of strategies to induce vessel ingrowth into tissue-engineered skin substitutes.

目的:在最佳条件下,人体皮肤移植后 8-12 天即可恢复传入和传出微循环。然而,在皮肤肿瘤环境中,关于超过这一时期的再灌注动态的证据仍然很少。我们的目的是利用激光斑点对比成像(LSCI),根据坏死范围(小于 20% 或 20%-50%)和解剖位置,描述人体皮肤移植物 4 周内再灌注的特征:在16个月的时间里,所有符合条件的成年人在头皮、面部和下肢皮肤癌切除后都接受了植皮手术。第 0 天在伤口边缘(对照皮肤),第 7、14、21 和 28 天在移植物表面,使用 LSCI 评估血流灌注情况。第 28 天确定移植物坏死范围:对 47 名参与者的 47 例移植物进行了分析。无论坏死扩展情况如何,移植物的灌注量在第 7 天与对照组皮肤持平,在第 21 天超过对照组皮肤,并保持稳定。头皮和下肢坏死率低于 20% 的移植物也有相同的再灌注模式,在最初的 21 天内,移植物中心的灌注始终好于外围。在面部,从第 7 天起,移植皮肤的灌注与对照皮肤没有差异,而且在研究期间,移植皮肤内部的再灌注也没有差异:结论:植皮再灌注是一个漫长的过程,受术后时间和解剖位置的影响,植皮中心和外围的再灌注情况各不相同。对这一过程有更深入的了解可能有助于制定策略,诱导血管向组织工程皮肤替代物中生长。
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引用次数: 0
Optical Effects of Focused Fractional Nanosecond 1064-nm Nd:YAG Laser: Techniques of Application on Human Skin 聚焦分段纳秒 1064 纳米 Nd:YAG 激光的光学效应:人体皮肤应用技术。
IF 2.2 3区 医学 Q2 DERMATOLOGY Pub Date : 2024-06-18 DOI: 10.1002/lsm.23812
Connie Liu, Hsin-Yi Huang, Yu-Yang Chang, Chi-Kuang Sun, Shih-Hsuan Chia, Yi-Hua Liao

Background and Objectives

Considering the pulse widths of picosecond and nanosecond lasers used in cutaneous laser surgery differ by approximately one order of magnitude, can nanosecond lasers produce the optical effect in human skin similar to laser-induced optical breakdown (LIOB) caused by picosecond lasers?

Methods

Cutaneous changes induced by a focused fractional nanosecond 1064-nm Nd:YAG laser were evaluated by VISIA-CR imaging, histological examination, and harmonic generation microscopy (HGM).

Results

A focused fractional nanosecond 1064-nm Nd:YAG laser can generate epidermal vacuoles or dermal cavities similar to the phenomenon of LIOB produced by picosecond lasers. The location and extent of photodisruption can be controlled by the laser fluence and focus depth. Moreover, laser-induced shock wave propagation and thermal degeneration of papillary collagen can be observed by HGM imaging.

Conclusion

Focused fractional nanosecond lasers can produce an optical effect on human skin similar to LIOB caused by picosecond lasers. With techniques of application, the treatment can induce epidermal and dermal repair mechanisms in a tunable fashion to improve skin texture, wrinkles, scars, and dyspigmentation, without disrupting the epidermal surface.

背景和目的:考虑到用于皮肤激光手术的皮秒激光和纳秒激光的脉宽相差约一个数量级,纳秒激光能否在人体皮肤中产生与皮秒激光引起的激光诱导光学击穿(LIOB)类似的光学效应?通过VISIA-CR成像、组织学检查和谐波发生显微镜(HGM)评估了聚焦部分纳秒1064纳米Nd:YAG激光诱导的皮肤变化:结果:聚焦的点阵纳秒 1064 纳米 Nd:YAG 激光可产生表皮空泡或真皮空洞,类似于皮秒激光产生的 LIOB 现象。光破坏的位置和程度可由激光能量和聚焦深度控制。此外,通过 HGM 成像还能观察到激光诱导的冲击波传播和乳头胶原的热变性:结论:聚焦点阵纳秒激光可在人体皮肤上产生类似于皮秒激光引起的 LIOB 的光学效应。通过应用技术,这种治疗方法能以可调方式诱导表皮和真皮修复机制,改善皮肤纹理、皱纹、疤痕和色素沉着,而不会破坏表皮表面。
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引用次数: 0
Evaluation of a Novel Ablative 1940 nm Pulsed Laser for Skin Rejuvenation 评估用于嫩肤的新型 1940 nm 脉冲激光烧蚀。
IF 2.2 3区 医学 Q2 DERMATOLOGY Pub Date : 2024-06-18 DOI: 10.1002/lsm.23817
Yoav Gronovich, Yaniv Raderman, Ronen Toledano, Rotem Nahear, Neria Suliman, Alon Shacham, David J. Friedman, Salman Noach

Background

Skin rejuvenation is a widely sought-after goal, prompting advancements in laser technology for noninvasive and effective treatments. Ablative lasers, in particular, have evolved to address diverse skin concerns, with fractional ablative lasers offering better-tolerated outcomes. The introduction of a novel ablative Thulium pulsed laser, based on Thulium-doped Yttrium aluminum Perovskite (Tm:YAP) crystal, delivers precise and controlled skin rejuvenation by allowing customization of ablative microcolumns.

Methods

A pilot in vivo study was conducted on the abdominal skin of a live female pig. Using the Laser Team Medical (LTM) prototype laser, treatments were administered with varying coagulation settings (minimal and maximum) and energies (32, 80, 120, and 160 mJ per microcolumn). Biopsies were harvested, fixed, and stained for subsequent analysis. The penetration depth and width of the microcolumns were evaluated.

Results

Low coagulation settings produced ablative microcolumns with thermal affected zones of 160 µm width, while high coagulation settings resulted in wider zones of 400–530 µm. The ablation cavities' width was estimated to be less than 100 µm in both settings. The novel 1940 nm pulsed laser demonstrated superior microcolumn properties, offering potential advantages such as shorter downtime and increased efficacy compared to existing fractional ablative lasers.

Conclusion

This study presents encouraging preliminary results regarding the efficacy and safety of the first ablative 1940 nm pulsed laser. The results show ablative microcolumns thinner than the counterpart devices, showing the device safety and potential higher efficacy along with short downtime. The LTM novel ablative 1940 nm pulsed laser holds immense potential for enhancing skin rejuvenation treatments due to its superior microcolumns properties. The versatility of this laser can open new treatment procedures and may extend to different areas of dermatology.

背景:皮肤年轻化是人们普遍追求的目标,这促使激光技术不断进步,以实现非侵入性的有效治疗。尤其是烧蚀激光,已经发展到可以解决各种皮肤问题,其中点阵烧蚀激光具有更好的耐受性。基于掺铥钇铝殒石(Tm:YAP)晶体的新型烧蚀铥脉冲激光的引入,通过定制烧蚀微柱,实现了精确可控的嫩肤效果:方法:在活体雌猪的腹部皮肤上进行了试验性活体研究。使用激光医疗团队(LTM)的激光原型,以不同的凝固设置(最小和最大)和能量(每微柱 32、80、120 和 160 mJ)进行治疗。对活检组织进行采集、固定和染色,以便进行后续分析。对微柱的穿透深度和宽度进行了评估:结果:低凝固设置产生的烧蚀微柱的热影响区宽度为 160 微米,而高凝固设置产生的烧蚀区宽度为 400-530 微米。在这两种设置下,烧蚀腔的宽度估计都小于 100 微米。与现有的点阵消融激光器相比,新型 1940 nm 脉冲激光器显示出卓越的微柱特性,具有缩短停工期和提高疗效等潜在优势:本研究就首台 1940 nm 脉冲烧蚀激光器的疗效和安全性提供了令人鼓舞的初步结果。结果显示,消融微柱比同类设备更细,这说明设备安全、潜在疗效更高且停机时间更短。LTM 1940 nm 新型脉冲激光器具有卓越的微柱特性,在加强嫩肤治疗方面潜力巨大。这种激光的多功能性可以开辟新的治疗程序,并可扩展到皮肤科的不同领域。
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引用次数: 0
Fractional Radiofrequency and Oral Isotretinoin—A Prospective Randomized Controlled Split-Face Trial Comparing Concurrent Versus Delayed Fractional Radiofrequency Treatment for Acne Scars 点阵射频和口服异维A酸--比较同时点阵射频治疗痤疮疤痕和延迟点阵射频治疗痤疮疤痕的前瞻性随机对照分面试验。
IF 2.2 3区 医学 Q2 DERMATOLOGY Pub Date : 2024-06-18 DOI: 10.1002/lsm.23811
Elisa S. Gallo, Uriel Katz, Ofir Artzi

Background

Therapeutic dogma has been to treat acne scars no less than 6 months after isotretinoin (ITN) cessation.

Objective

To evaluate the safety and efficacy of fractional radiofrequency (FRF) in patients treated concurrently with ITN.

Methods

We conducted a prospective randomized control 3-arm comparative trial to evaluate the treatment of acne scars. Patients received one of three treatment options: (A) ITN and FRF concurrent treatment, (B) ITN monotherapy, and (C) FRF 6 months post-ITN treatment. Patients in the FRF cohorts received three monthly sessions. Patients were followed for adverse effects up to 6–9 months post-FRF treatment. Final cosmesis was scored by three independent dermatologists using two scales: the Echelle d'Evaluation Clinique des Cicatrices d'Acne (ECCA) and an internal 5-point investigator's scale, indicating the percentage of improvement. Subjective analyses by patients were also assessed.

Results

Objective and subjective analyses revealed improvement in the ITN-FRF cohort, which was superior to the delayed FRF cohort and the ITN monotherapy cohort. Specifically, the concurrently treated cohort (ITN-FRF) had a significant reduction in acne scar volume from baseline mean (151.1 ± 44.7 to 97.0 ± 31.2, p < 0.005), outperforming both the delayed FRF and monotherapy ITN treatment cohorts, respectively (155.4 ± 37.8 to 122.0 ± 46.2, 144.6 ± 82.8 to 132.4 ± 62.7). Additionally, the concurrently treated cohort demonstrated improved ECCA scores (36.8 ± 15.5), significantly better than the ITN monotherapy cohort (101.5 ± 20.1, p < 0.01).

Limitations

Limited patient sample size: 38 patients completed the study; mostly Fitzpatrick Type II–III skin; photographic assessments utilized.

Conclusion

Per our prospective trial, concurrent treatment of ITN-FRF is superior to delayed FRF treatment 6 months post-ITN cessation.

背景:治疗原则是在停用异维A酸(ITN)后至少6个月治疗痤疮疤痕:评估点阵射频(FRF)对同时接受 ITN 治疗的患者的安全性和有效性:我们进行了一项前瞻性随机对照三臂对比试验,以评估痤疮疤痕的治疗效果。患者接受三种治疗方案中的一种:(A) ITN 和 FRF 同时治疗,(B) ITN 单药治疗,(C) ITN 治疗后 6 个月接受 FRF 治疗。FRF 组患者每月接受三次治疗。在 FRF 治疗后的 6-9 个月内,对患者的不良反应进行随访。最终疗效由三位独立的皮肤科医生使用两种量表进行评分:痤疮临床评估量表(ECCA)和研究者内部 5 分量表,显示改善的百分比。此外,还对患者的主观分析进行了评估:结果:客观和主观分析表明,ITN-FRF治疗组患者的病情有所改善,优于延迟FRF治疗组和ITN单药治疗组。具体来说,同时接受治疗的组群(ITN-FRF)的痤疮疤痕体积从基线平均值(151.1 ± 44.7 到 97.0 ± 31.2,p 限制:患者样本量有限:38 名患者完成了研究;大部分患者为 Fitzpatrick II-III 型皮肤;采用照片评估:根据我们的前瞻性试验,ITN-FRF 同时治疗优于 ITN 停用后 6 个月的延迟 FRF 治疗。
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引用次数: 0
Comprehensive Evaluation of the BeShape One Device: Assessing Thermal Safety in Noninvasive Body Contouring Using Advanced Techniques BeShape One 设备的综合评估:使用先进技术评估无创塑身的热安全性
IF 2.2 3区 医学 Q2 DERMATOLOGY Pub Date : 2024-06-18 DOI: 10.1002/lsm.23818
Yuval Ramot, Vitaly Karakuz, Ehud P. Willenz, Tal Alon, Deniz Zilberman Barzilai, Oren Beer, Abraham Nyska

Objectives

This study aims to assess the thermal safety profile of the BeShape One Device, a noninvasive, high-intensity, non-focused ultrasound device designed for reducing waist circumference. This device possesses several features that distinguish it from other commercial ultrasound-based fat reduction devices. The study focuses on evaluating temperature-related physiological changes through thermal safety analysis and histopathology in a swine model.

Materials and Methods

The study utilized three types of applicators—active, demo, and modified—to comprehensively assess the device's impact on various skin layers. Five female Large White X Landrace swine were involved in the study, and the BeShape One Device was applied to designated treatment sites using a specific treatment protocol. The assessment included clinical observations, skin reaction evaluations, gross pathology, histopathological analyses, and advanced temperature measurement techniques, including needle thermocouples, thermal cameras, COMSOL modeling, and CEM43 analysis.

Results

Clinical observations indicated the animals’ overall well-being throughout the study. Skin reactions, including erythema, edema, bruising, and crust formation, were temporary and resolved over time. Gross pathology revealed no treatment-related pathologies, except for a discoloration related to a tattoo procedure. Histopathological analyses at 30 and 90 days posttreatment demonstrated an absence of heat-related lesions in skin layers. Needle thermocouples and thermal camera measurements supported the device's ability to maintain consistent thermal homogeneity. COMSOL modeling and CEM43 analysis predicted no thermal damage to the skin, confirming the safety of the BeShape One Device.

Conclusions

Under the experimental conditions, the BeShape One Device demonstrated a favorable safety profile. Clinically and histopathologically, no adverse effects were observed. The device's ability to achieve thermal homogeneity in skin layers was validated through advanced temperature measurement techniques. COMSOL modeling and CEM43 analysis further supported the conclusion that the device is safe, making it a promising option for noninvasive body contouring procedures.

研究目的本研究旨在评估 BeShape One 设备的热安全性,这是一种无创、高强度、非聚焦超声设备,设计用于减少腰围。该设备具有多项功能,有别于其他商用超声减脂设备。研究重点是在猪模型中通过热安全分析和组织病理学评估与温度相关的生理变化:研究使用了三种类型的涂抹器--主动式、演示式和改良式,以全面评估该设备对不同皮肤层的影响。五头雌性大白 X 陆种猪参与了这项研究,并使用特定的治疗方案将 BeShape One 设备应用于指定的治疗部位。评估包括临床观察、皮肤反应评估、大体病理学、组织病理学分析和先进的温度测量技术,包括针式热电偶、热像仪、COMSOL 建模和 CEM43 分析:临床观察结果表明,动物在整个研究过程中总体状况良好。皮肤反应,包括红斑、水肿、瘀伤和结痂,都是暂时的,随着时间的推移会逐渐消失。大体病理结果显示,除了与纹身过程有关的褪色外,没有出现与治疗有关的病变。治疗后 30 天和 90 天的组织病理学分析表明,皮肤层没有出现与热有关的病变。针式热电偶和热像仪的测量结果表明,该设备能够保持一致的热均匀性。COMSOL 建模和 CEM43 分析预测皮肤没有热损伤,证实了 BeShape One 设备的安全性:结论:在实验条件下,BeShape One 设备表现出良好的安全性。结论:在实验条件下,BeShape One 设备表现出良好的安全性,在临床和组织病理学方面均未观察到不良反应。先进的温度测量技术验证了该设备在皮肤层实现热均匀性的能力。COMSOL 建模和 CEM43 分析进一步证实了该设备的安全性,使其成为无创塑身手术的理想选择。
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引用次数: 0
Efficacy and Safety of 577-nm Yellow Laser in the Treatment of Pigmented Epidermal Lesions 577 纳米黄色激光治疗表皮色素病变的有效性和安全性。
IF 2.2 3区 医学 Q2 DERMATOLOGY Pub Date : 2024-06-18 DOI: 10.1002/lsm.23814
Essamelden M. Mohamed, Hazem L. Abd Elaleem, Mona A. H. Ahmed, Mahmoud A. Rageh

Objectives

Freckles and lentigines are common pigmented problems which not only cause substantial cosmetic morbidity but also create psychosocial concern. The available modalities for the treatment of pigmented lesions are often unsatisfactory for patients, require a long treatment period, and often cause skin irritation. With the advent of lasers, safe and effective treatment options for epidermal pigmentation have become more varied for different Fitzpatrick skin types. We aimed to evaluate the efficacy and safety of 577-nm yellow laser in the treatment of pigmented epidermal lesions.

Methods

This study was carried out on 50 patients presented with pigmented epidermal lesions (25 presented with freckles and 25 presented with lentigines). Each patient received four treatment sessions with a 577-nm diode laser at 2-week intervals.

Results

There was significant improvement in freckles and lentigines, as 23 out of 50 patients showed marked improvement, 11 patients showed moderate improvement, 10 patients showed mild improvement, and only six patients had no changes. Moreover, 23 patients were very satisfied, 18 patients were satisfied, and nine patients were not satisfied. As regards the safety of the 577-nm yellow laser, there was no significant adverse effect among patients except pain, erythema, and hyperpigmentation, which resolved within one month after treatment.

Conclusions

This study showed that the 577-nm yellow laser is an effective, safe, and well-tolerated device in the treatment of freckles and lentigines.

目的:雀斑和色斑是常见的色素沉着问题,不仅严重影响美观,还会造成社会心理问题。现有的治疗色素病变的方法往往不能令患者满意,需要较长的治疗时间,而且常常会刺激皮肤。随着激光的出现,针对不同菲茨帕特里克皮肤类型的表皮色素沉着,安全有效的治疗方法也变得更加多样化。我们旨在评估 577 纳米黄色激光治疗表皮色素病变的有效性和安全性:这项研究针对 50 名表皮色素病变患者(25 名雀斑患者和 25 名雀斑患者)。每位患者接受四次 577 纳米二极管激光治疗,每次间隔两周:结果:50 名患者中,23 名患者的雀斑和色斑有明显改善,11 名患者有中度改善,10 名患者有轻度改善,只有 6 名患者没有变化。此外,23 名患者非常满意,18 名患者满意,9 名患者不满意。至于 577-nm 黄色激光的安全性,除了疼痛、红斑和色素沉着在治疗后一个月内消失外,患者没有明显的不良反应:这项研究表明,577 纳米黄色激光是治疗雀斑和色斑的一种有效、安全且耐受性良好的设备。
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引用次数: 0
Jet-injection assisted photodynamic therapy for superficial and nodular basal cell carcinoma: A pilot study 浅表和结节性基底细胞癌的喷射注射辅助光动力疗法:一项试点研究。
IF 2.4 3区 医学 Q1 Medicine Pub Date : 2024-05-28 DOI: 10.1002/lsm.23793
Leore Lavin, Andrés M. Erlendsson, Saud Aleissa, Abdullah Aleisa, Christian Menzer, Stephen Dusza, Miguel Cordova, Hesham Alshaikh, Rohan Shah, Alexander Pan, Kwami Ketosugbo, Sharif Hosein, Erica Lee, Kishwer Nehal, Katrine Togsverd-Bo, Merete Haedersdal, Anthony Rossi

Background

Photodynamic therapy (PDT) with topical δ-Aminolevulinic acid (ALA) has efficacy in treating basal cell carcinoma (BCC) but is limited by incomplete penetration of ALA into the deeper dermis. This prospective open-label pilot trial investigated the safety and efficacy of photosensitizer jet injection for PDT (JI-PDT) for BCC treatment. It was performed with 15 patients (n = 15) with histologically confirmed, untreated, low-risk nodular BCCs at a single institution.

Methods

For the intervention, JI-PDT patients (n = 11) received two sessions of jet-injected ALA with PDT separated by four to 6 weeks. To further understand treatment technique, another group of patients (n = 4) received jet-injected ALA followed by tumor excision and fluorescence microscopy (JI-E). Treatment tolerability was assessed by local skin responses (LSR) score at five distinct time intervals. Fluorescence microscopy assessed protoporphyrin IX penetration depth and biodistribution within the tumor. At the primary endpoint, tumor clearance was evaluated via visual inspection, dermoscopy and reflectance confocal microscopy. Postinjection and postillumination pain levels, and patient satisfaction, were scored on a 0−10 scale.

Results

Fifteen participants with mean age of 58.3, who were 15/15 White, non-Hispanic enrolled. The median composite LSR score immediately after JI-PDT was 5 (interquartile range [IQR] = 3) which decreased to 0.5 (IQR = 1) at primary endpoint (p < 0.01). Immunofluorescence of excised BCC tumors with jet-injected ALA showed photosensitizer penetration into papillary and reticular dermis. Of the 13 JI-PDT tumors, 11 had tumor clearance confirmed, 1 recurred, and 1 was lost to follow-up. 1/11 patients experienced a serious adverse event of cellulitis. 70% of patients had local scarring at 3 months. Patients reported an average pain level of 5.6 (standard deviation [SD] = 2.3) during jet injection and 3.7 (SD = 1.8) during light illumination.

Conclusions

Jet injection of ALA for PDT treatment of nodular low-risk BCC is tolerable and feasible and may represent a novel modality to improve PDT.

背景:局部使用δ-氨基酮戊酸(ALA)的光动力疗法(PDT)对治疗基底细胞癌(BCC)有一定疗效,但由于ALA不能完全渗透到真皮深层而受到限制。这项前瞻性开放标签试验研究了光敏剂喷射注射光导疗法(JI-PDT)治疗 BCC 的安全性和有效性。试验在一家医疗机构进行,15 名患者(n = 15)经组织学证实患有未经治疗的低风险结节性 BCC:在干预过程中,JI-PDT 患者(n = 11)接受了两次喷射注射 ALA 和 PDT 治疗,每次间隔 4 到 6 周。为进一步了解治疗技术,另一组患者(n = 4)在接受喷射注射 ALA 后进行肿瘤切除和荧光显微镜检查(JI-E)。治疗耐受性通过五个不同时间间隔的局部皮肤反应(LSR)评分进行评估。荧光显微镜评估原卟啉 IX 在肿瘤内的穿透深度和生物分布。在主要终点,通过目测、皮肤镜和反射共聚焦显微镜评估肿瘤清除情况。注射后和照射后疼痛程度以及患者满意度按0-10级评分:15名参与者的平均年龄为58.3岁,其中15/15为白人,非西班牙裔。JI-PDT治疗后的LSR综合评分中位数为5(四分位间距[IQR] = 3),在主要终点时降至0.5(IQR = 1)(P 结论:JI-PDT治疗后的LSR综合评分中位数为5(四分位间距[IQR] = 3),在主要终点时降至0.5(IQR = 1喷射注射 ALA 用于 PDT 治疗结节性低风险 BCC 是可耐受和可行的,可能是一种改进 PDT 的新方法。
{"title":"Jet-injection assisted photodynamic therapy for superficial and nodular basal cell carcinoma: A pilot study","authors":"Leore Lavin,&nbsp;Andrés M. Erlendsson,&nbsp;Saud Aleissa,&nbsp;Abdullah Aleisa,&nbsp;Christian Menzer,&nbsp;Stephen Dusza,&nbsp;Miguel Cordova,&nbsp;Hesham Alshaikh,&nbsp;Rohan Shah,&nbsp;Alexander Pan,&nbsp;Kwami Ketosugbo,&nbsp;Sharif Hosein,&nbsp;Erica Lee,&nbsp;Kishwer Nehal,&nbsp;Katrine Togsverd-Bo,&nbsp;Merete Haedersdal,&nbsp;Anthony Rossi","doi":"10.1002/lsm.23793","DOIUrl":"10.1002/lsm.23793","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Photodynamic therapy (PDT) with topical δ-Aminolevulinic acid (ALA) has efficacy in treating basal cell carcinoma (BCC) but is limited by incomplete penetration of ALA into the deeper dermis. This prospective open-label pilot trial investigated the safety and efficacy of photosensitizer jet injection for PDT (JI-PDT) for BCC treatment. It was performed with 15 patients (<i>n</i> = 15) with histologically confirmed, untreated, low-risk nodular BCCs at a single institution.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>For the intervention, JI-PDT patients (<i>n</i> = 11) received two sessions of jet-injected ALA with PDT separated by four to 6 weeks. To further understand treatment technique, another group of patients (<i>n</i> = 4) received jet-injected ALA followed by tumor excision and fluorescence microscopy (JI-E). Treatment tolerability was assessed by local skin responses (LSR) score at five distinct time intervals. Fluorescence microscopy assessed protoporphyrin IX penetration depth and biodistribution within the tumor. At the primary endpoint, tumor clearance was evaluated via visual inspection, dermoscopy and reflectance confocal microscopy. Postinjection and postillumination pain levels, and patient satisfaction, were scored on a 0−10 scale.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifteen participants with mean age of 58.3, who were 15/15 White, non-Hispanic enrolled. The median composite LSR score immediately after JI-PDT was 5 (interquartile range [IQR] = 3) which decreased to 0.5 (IQR = 1) at primary endpoint (<i>p</i> &lt; 0.01). Immunofluorescence of excised BCC tumors with jet-injected ALA showed photosensitizer penetration into papillary and reticular dermis. Of the 13 JI-PDT tumors, 11 had tumor clearance confirmed, 1 recurred, and 1 was lost to follow-up. 1/11 patients experienced a serious adverse event of cellulitis. 70% of patients had local scarring at 3 months. Patients reported an average pain level of 5.6 (standard deviation [SD] = 2.3) during jet injection and 3.7 (SD = 1.8) during light illumination.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Jet injection of ALA for PDT treatment of nodular low-risk BCC is tolerable and feasible and may represent a novel modality to improve PDT.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141158543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Efficacy of laser hair removal in hidradenitis suppurativa: A systematic review and meta-analysis 激光脱毛对化脓性扁桃体炎的疗效:系统回顾与荟萃分析。
IF 2.4 3区 医学 Q1 Medicine Pub Date : 2024-05-20 DOI: 10.1002/lsm.23796
William D. Shipman III MD, PhD, Monica N. Williams MD, Kathleen C. Suozzi MD, Anna S. Eisenstein MD, PhD, Jeffrey S. Dover MD

Objectives

Hidradenitis suppurativa (HS) is a chronic inflammatory condition characterized by painful nodules, draining tunnels, and fibrotic scarring in intertriginous, hair-bearing areas. The pathogenesis involves follicular occlusion and subsequent rupture, leading to uncontrolled inflammation. Treatment options for HS are limited and lack universal effectiveness. Laser hair removal (LHR) has been explored as a potential treatment; however, the efficacy and appropriate laser modalities remain unclear. This systematic review examined the efficacy and adverse effects of LHR in HS.

Methods

A comprehensive literature search was conducted from inception to September 2023 in Ovid MEDLINE, Ovid Embase, and The Cochrane Library (Wiley) with predefined inclusion and exclusion criteria, and a meta-analysis was conducted.

Results

Ten studies were selected (n = 227 total patients) and included six randomized controlled trials, two nonrandomized experimental studies, and two case series. Various laser modalities, including long-pulsed neodymium-doped yttrium aluminum garnet (Nd:YAG) (n = 115), intense pulsed light (n = 18), Alexandrite (n = 54), intralesional 1064 nm diode (n = 20), and combined fractional CO2 and long-pulsed Nd:YAG laser (n = 20), consistently demonstrated significant improvement in HS disease severity, irrespective of the disease scoring method used. Minimal adverse effects (primarily mild pain and erythema) were reported. A meta-analysis of three studies utilizing long-pulsed Nd:YAG laser demonstrated a standardized mean difference in disease severity of −1.68 (95% confidence interval: −2.99; −0.37), favoring treatment with LHR for HS.

Conclusions

Hair follicles are key in HS pathogenesis and all included studies showed a significant improvement in HS disease severity after LHR regardless of the laser device used, likely related to hair follicle unit destruction. HS is a complex and heterogenous condition, and multiple disease scoring methods complicate outcome comparisons across studies. However, LHR, utilizing various techniques, is an effective treatment option for HS with minimal adverse effects.

目的:化脓性扁平湿疹(HS)是一种慢性炎症,其特征是在生发区的三叉神经间出现疼痛结节、引流隧道和纤维化瘢痕。发病机制包括毛囊闭塞和随后的破裂,导致炎症失控。HS 的治疗方法有限,而且缺乏普遍的有效性。激光脱毛(LHR)已被视为一种潜在的治疗方法,但其疗效和适当的激光模式仍不明确。本系统性综述研究了激光脱毛对 HS 的疗效和不良反应:方法:在 Ovid MEDLINE、Ovid Embase 和 Cochrane Library (Wiley) 中按照预定义的纳入和排除标准进行了从开始到 2023 年 9 月的全面文献检索,并进行了荟萃分析:共筛选出 10 项研究(n = 227 名患者),包括 6 项随机对照试验、2 项非随机实验研究和 2 项病例系列研究。各种激光模式,包括长脉冲掺钕钇铝石榴石(Nd:YAG)(n = 115)、强脉冲光(n = 18)、亚历山大激光(n = 54)、1064 nm 二极管(n = 20)以及点阵 CO2 和长脉冲 Nd:YAG 激光联合疗法(n = 20),无论采用哪种疾病评分方法,都能显著改善 HS 的疾病严重程度。据报道,不良反应极少(主要是轻微疼痛和红斑)。对使用长脉冲 Nd:YAG 激光的三项研究进行的荟萃分析表明,疾病严重程度的标准化平均差异为-1.68(95% 置信区间:-2.99;-0.37),LHR 治疗 HS 更受青睐:结论:毛囊是HS发病的关键,所有纳入的研究都显示,无论使用哪种激光设备,LHR治疗后HS疾病严重程度都有显著改善,这可能与毛囊单位破坏有关。HS 是一种复杂的异质性疾病,多种疾病评分方法使不同研究的结果比较变得复杂。不过,采用不同技术的 LHR 是治疗 HS 的有效方法,且不良反应极小。
{"title":"Efficacy of laser hair removal in hidradenitis suppurativa: A systematic review and meta-analysis","authors":"William D. Shipman III MD, PhD,&nbsp;Monica N. Williams MD,&nbsp;Kathleen C. Suozzi MD,&nbsp;Anna S. Eisenstein MD, PhD,&nbsp;Jeffrey S. Dover MD","doi":"10.1002/lsm.23796","DOIUrl":"10.1002/lsm.23796","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Hidradenitis suppurativa (HS) is a chronic inflammatory condition characterized by painful nodules, draining tunnels, and fibrotic scarring in intertriginous, hair-bearing areas. The pathogenesis involves follicular occlusion and subsequent rupture, leading to uncontrolled inflammation. Treatment options for HS are limited and lack universal effectiveness. Laser hair removal (LHR) has been explored as a potential treatment; however, the efficacy and appropriate laser modalities remain unclear. This systematic review examined the efficacy and adverse effects of LHR in HS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A comprehensive literature search was conducted from inception to September 2023 in Ovid MEDLINE, Ovid Embase, and The Cochrane Library (Wiley) with predefined inclusion and exclusion criteria, and a meta-analysis was conducted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ten studies were selected (<i>n</i> = 227 total patients) and included six randomized controlled trials, two nonrandomized experimental studies, and two case series. Various laser modalities, including long-pulsed neodymium-doped yttrium aluminum garnet (Nd:YAG) (<i>n</i> = 115), intense pulsed light (<i>n</i> = 18), Alexandrite (<i>n</i> = 54), intralesional 1064 nm diode (<i>n</i> = 20), and combined fractional CO<sub>2</sub> and long-pulsed Nd:YAG laser (<i>n</i> = 20), consistently demonstrated significant improvement in HS disease severity, irrespective of the disease scoring method used. Minimal adverse effects (primarily mild pain and erythema) were reported. A meta-analysis of three studies utilizing long-pulsed Nd:YAG laser demonstrated a standardized mean difference in disease severity of −1.68 (95% confidence interval: −2.99; −0.37), favoring treatment with LHR for HS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Hair follicles are key in HS pathogenesis and all included studies showed a significant improvement in HS disease severity after LHR regardless of the laser device used, likely related to hair follicle unit destruction. HS is a complex and heterogenous condition, and multiple disease scoring methods complicate outcome comparisons across studies. However, LHR, utilizing various techniques, is an effective treatment option for HS with minimal adverse effects.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141071344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Intraoral laser hair removal: A scoping review 口内激光脱毛:范围综述。
IF 2.2 3区 医学 Q2 DERMATOLOGY Pub Date : 2024-05-13 DOI: 10.1002/lsm.23797
Abigail Katz BA, Ryan Rivera-Oyola MD, Carrie Levinson MSLIS, Jessica G. Labadie MD

Purpose

Intraoral hair growth is a debilitating side effect of flap or graft-based oropharyngeal reconstruction. There is no standardized treatment, but groups have successfully eradicated unwanted hair growth with intraoral laser hair removal. This scoping review assesses the utility of laser therapy in managing this condition.

Methods

This scoping review followed PRISMA-ScR guidelines. Ovid Medline, Embase (Ovid) and Scopus were queried using index terms and keywords. Resulting articles were reviewed for inclusion by two independent reviewers against inclusion criteria and relevant data were extracted.

Results

The literature search yielded 297 articles, 22 of which met inclusion criteria. In total, 77 patients were treated: 38 patients with an Alexandrite laser, 19 with an Nd:YAG laser, 18 with a diode laser, and two with a CO2 laser. Complete response defined as 80% or more reduction in hair count was achieved in 70 patients (90%) and six patients (8%) achieved a partial response (10%–79% reduction in hair count). One patient (1%) with gray hair saw less than a 10% reduction in hair count. On average, 3.84 treatment sessions were needed, spaced 5.4 weeks apart. Treatments were well tolerated without major side effects.

Conclusions

This is the first scoping review assessing the utility of intraoral laser hair therapy and suggests it may be a safe and effective treatment. However, surgeons should advise preoperative hair removal when clinically feasible to mitigate this side effect as much as possible.

目的:口内毛发生长是皮瓣或移植物口咽部重建术的一个令人沮丧的副作用。目前还没有标准化的治疗方法,但有研究小组通过口内激光脱毛成功根除了多余的毛发生长。本范围界定综述评估了激光疗法在控制这种情况方面的效用:本范围界定综述遵循 PRISMA-ScR 指南。使用索引词和关键词查询了 Ovid Medline、Embase (Ovid) 和 Scopus。由两名独立审稿人根据纳入标准对检索到的文章进行审查,并提取相关数据:文献检索共获得 297 篇文章,其中 22 篇符合纳入标准。共有 77 名患者接受了治疗:38名患者接受了亚历山大激光治疗,19名患者接受了Nd:YAG激光治疗,18名患者接受了二极管激光治疗,2名患者接受了CO2激光治疗。70名患者(90%)获得了完全应答,即毛发数量减少80%或以上,6名患者(8%)获得了部分应答(毛发数量减少10%-79%)。一名白发患者(1%)的毛发数量减少不到 10%。平均需要 3.84 次治疗,每次间隔 5.4 周。治疗耐受性良好,无重大副作用:这是首次对口内激光毛发治疗的效用进行评估的范围界定审查,表明它可能是一种安全有效的治疗方法。不过,外科医生应在临床可行的情况下建议术前脱毛,以尽可能减轻这种副作用。
{"title":"Intraoral laser hair removal: A scoping review","authors":"Abigail Katz BA,&nbsp;Ryan Rivera-Oyola MD,&nbsp;Carrie Levinson MSLIS,&nbsp;Jessica G. Labadie MD","doi":"10.1002/lsm.23797","DOIUrl":"10.1002/lsm.23797","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Intraoral hair growth is a debilitating side effect of flap or graft-based oropharyngeal reconstruction. There is no standardized treatment, but groups have successfully eradicated unwanted hair growth with intraoral laser hair removal. This scoping review assesses the utility of laser therapy in managing this condition.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This scoping review followed PRISMA-ScR guidelines. Ovid Medline, Embase (Ovid) and Scopus were queried using index terms and keywords. Resulting articles were reviewed for inclusion by two independent reviewers against inclusion criteria and relevant data were extracted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The literature search yielded 297 articles, 22 of which met inclusion criteria. In total, 77 patients were treated: 38 patients with an Alexandrite laser, 19 with an Nd:YAG laser, 18 with a diode laser, and two with a CO<sub>2</sub> laser. Complete response defined as 80% or more reduction in hair count was achieved in 70 patients (90%) and six patients (8%) achieved a partial response (10%–79% reduction in hair count). One patient (1%) with gray hair saw less than a 10% reduction in hair count. On average, 3.84 treatment sessions were needed, spaced 5.4 weeks apart. Treatments were well tolerated without major side effects.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This is the first scoping review assessing the utility of intraoral laser hair therapy and suggests it may be a safe and effective treatment. However, surgeons should advise preoperative hair removal when clinically feasible to mitigate this side effect as much as possible.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140916728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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