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Supplemental Digital Content is Available in the Text. BACKGROUND: Lower eyelid aging is a complicated process, and for that reason, a comprehensive assessment of the lower eyelid is important before treatment. OBJECTIVE: This study was conducted to analyze and assess the lower eyelid aging process between different age groups of Asian women. METHODS AND MATERIALS: The authors developed the comprehensive lower eyelid age rating scale (CLEARS). The rating scale contains 3 domains and each composed of 3 items. Individuals were evaluated by the age group starting with the third decade (20–29 years) through the seventh decade (60–69 years) by 2 dermatologists working independently. RESULTS: A total of 114 cases were evaluated. The total scores of CLEARS increased significantly between each adjacent age group. The scores of the snap test and the severity of fine lines, nasojugal groove, midcheek furrow, and eye bags increased significantly from the 3rd decade. The scores of the distraction test and the severity of palpebromalar groove and malar mound begin to increase with the 4th decade. Kappa coefficients of all items achieved moderate to substantial agreement. CONCLUSION: This study describes the lower eyelid aging process among Asian women by CLEARS assessment. Lower eyelid aging becomes progressively more notable beginning with the third decade. [ABSTRACT FROM AUTHOR]

BACKGROUND The introduction of fractional photothermolysis (FP) for the treatment of atrophic acne scars has been proven to provide satisfactory results. For severe atrophic acne scarring, nonablative FP achieves fair improvement and takes multiple treatment sessions. Ablative fractional resurfacing provides an alternative modality with greater satisfaction. OBJECTIVE To evaluate the effectiveness and safety of the ablative fractional 2,940-nm erbium-doped yttrium aluminum garnet (Er:YAG) laser with coagulation mode for the treatment of atrophic facial acne scars in Asian skin. METHODS Thirty-four patients aged 19 to 44 (mean 34.2) with Fitzpatrick skin types III and IV, received one ablative fractional 2,940-nm Er:YAG laser treatment with an adjustable coagulation mode and were followed for 3 months. Physician evaluation and patient satisfaction were graded on a 4-point scale. Side effects were recorded at each follow-up visit. RESULTS Almost three-quarters of the patients rated their satisfaction as good to excellent (score of 3 or 4). All patients experienced short downtime, and the incidence of postinflammatory hyperpigmentation was low (3.0%). CONCLUSIONS The ablative fractional Er:YAG laser with coagulation mode is recommended for the treatment of moderate to severe atrophic acne scars, with acceptable downtime and high satisfaction in Asian patients. [ABSTRACT FROM AUTHOR]

BACKGROUND Atrophic facial acne scars is one of the most common problems in patients with inflammatory acne. Ablative laser resurfacing has unpleasant complications and a long recovery peroid. Nonablative therapies yield less improvement and satisfaction. The introduction of fractional photothermolysis (FP) is an alternative treatment for atrophic acne scars. OBJECTIVE To evaluate the effectiveness and safety of a nonablative 1,550-nm erbium-doped fiber laser in the FP of atrophic facial acne scars in one treatment session. METHODS Forty-five patients (skin type III-IV, mean age 29) with atrophic facial acne scars were enrolled in the study. Each patient received one treatment of FP. Comparative photographs were taken using specific complexion analysis to identify and quantify depressed scars and texture. Physician evaluations and patient satisfaction were graded on a 4-point scale. Side effects were recorded at each follow-up visit. RESULTS The improvement in atrophic scars and texture after a FP treatment were significant. Twenty-seven (60%) of the patients had good to excellent results after 1 month. CONCLUSION The FP of atrophic facial acne scars resulted in significant improvement even in a single treatment, with good satisfaction and unremarkable side effects. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is available in the text. Background: Varicose veins are a common problem worldwide. Although it was reported that varicose veins have cosmetic and symptomatic effects and can also lead to an increased risk of incident deep venous thrombosis, pulmonary embolism, and peripheral artery disease, whether varicose vein treatment prevents those serious complications is unknown. Methods: This retrospective cohort study used claims data extracted from the Chang Gung Research Database and National Health Insurance Research Database in Taiwan. The study subjects were patients aged ≥20 years who underwent endovenous thermal ablation (ETA) from 2005 to 2016 and a group of untreated subjects who were matched by sex and year of birth. All patients were followed from the index date to the earliest occurrence of peripheral artery disease, deep venous thrombosis, or pulmonary embolism or death or the end of the study. To avoid possible selection bias, 1:4 propensity score matching was implemented and a Cox proportional-hazards model was applied while controlling for potential confounders. We also collected data on complications within 28 days of ETA. Results: In total, data on 1323 ETA-treated patients with varicose veins were extracted from the Chang Gung Research Database, while data on 149 586 untreated patients with varicose veins were extracted from the National Health Insurance Research Database. Compared with the untreated group, ETA-treated patients had decreased risks of deep venous thrombosis and peripheral artery disease (adjusted hazard ratio, 0.49 [95% CI, 0.32–0.75] and 0.64 [95% CI, 0.49–0.85]). The incidence rates of deep venous thrombosis and pulmonary embolism after ETA (≤28 days) were 0.296% and 0.074%, respectively. Conclusions: ETA treatment of varicose veins was associated with a substantial decrease in the subsequent incidence of thromboembolism and peripheral artery disease compared with that in the absence of treatment. In addition, the incidence rate of postprocedural thromboembolic complications after ETA was low in the Asian population. We suggest that improved disease awareness and appropriate early treatment may help reduce the risk of serious complications. [ABSTRACT FROM AUTHOR]

Mast cells with bilobed or multilobed nuclei have only rarely been observed in the bone marrow of patients with systemic mastocytosis and in a case of subdural mast cell sarcoma. To our knowledge, they have not been reported in cutaneous mast cell disease. We report a rare occurrence of mast cells with bilobed or multilobed nuclei (atypical mast cell type II) in a nodular lesion of a 24-year-old woman with urticaria pigmentosa. The typical and atypical mast cells were confirmed by Giemsa and Leder's naphthol-AS-D-chloroacetate esterase stains and by immunohistochemical staining for tryptase and KIT protein (CD117). Although the nodular lesion with atypical mast cells did not appear to be cytologically malignant, the occurrence of atypical mast cells in a nodular lesion but not in a papular lesion might denote progression of the disease as suggested by the emergence of cells positive for p53.