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Rungsima Wanitphakdeedecha,1 Kristy Elleza R Evangelista,1,2 Chadakan Yan,1 Chalermkwan Apinuntham,1 Thanya Techapichetvanich,1 Sasima Eimpunth,1 Nittaya Lektrakul,3 Woraphong Manuskiatti1 1Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; 2Department of Dermatology, Research Institute for Tropical Medicine, Manila, Philippines; 3Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, ThailandCorrespondence: Rungsima Wanitphakdeedecha, Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkok Noi, 10700, Thailand, Tel +66 2 419 4333, Fax +66 2 411 9922, Email rungsima.wan@mahidol.ac.thBackground: Submental fat is a noticeable fat in the submental region that is of great concern aesthetically, especially to female patients. A 1060-nm diode laser is a clinically proven device for the laser lipolysis of subcutaneous fat cells. This study aimed to evaluate the safety and efficacy of a 1060-nm diode laser for submental fat reduction.Methods: Twenty subjects with unwanted localized submental fat were treated with a single session of a 1060-nm diode laser with an energy setting between 0.95 and 1.40 W/cm2, depending on each patient’s tolerance. Submental fat thickness measurements were documented at baseline, and 1, 3, and 6 months after treatment. Clinical photographs, ultrasound images, and adverse events were evaluated at each follow-up visit. Subjects responded to a satisfaction questionnaire at the end of the study.Results: The subjects had a mean age of 34.55 ± 6.19 years, a mean body weight of 70.66 ± 10.55 kilograms, and most (95%) were women. The average energy setting was 0.95– 1.40 W/cm2, with a pain score of 3.90 ± 1.30 on a 0-to-10 scale. A significant reduction in submental fat thickness measured by ultrasound was noted at post-treatment month 3 (falling to 0.46 ± 0.13; P = 0.013). However, there was a slight increase in the submental fat thickness at the 6-month follow-up (to 0.48 ± 0.12); the change in the thickness relative to the baseline was nonsignificant (P = 0.121). Most subjects reported an improvement 6 months after the treatment. No severe adverse events were observed throughout the study period.Conclusion: Our study demonstrated the potential role of 1060-nm Diode laser for the treatment of localized submental subcutaneous adiposities. It is a promising alternative treatment modality for patients seeking an in-office, nonsurgical procedure for fat reduction without severe complications.Keywords: 1060-nm, diode laser, lipolysis, submental fat

Rungsima Wanitphakdeedecha,1,2 Janice Natasha C Ng,1 Chadakan Yan,1 Woraphong Manuskiatti,1 Tatchalerm Sudhipongpracha,2 Tatre Jantarakolica3 1Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; 2College of Interdisciplinary Studies, Thammasat University, Bangkok, Thailand; 3Faculty of Economics, Thammasat University, Bangkok, ThailandCorrespondence: Rungsima WanitphakdeedechaDepartment of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Pran-nok Road, Bangkok, 10700, ThailandTel + 66-2419-4333Fax + 66-2411-9922Email rungsima.wan@mahidol.ac.thIntroduction: Port-wine stain (PWS) is a congenital malformation that does not resolve spontaneously and can cause a physiological or psychological burden to the patients. At present, most of the studies done on PWS are focused on the treatment rather than the quality of life and psychological effects of the disease.Material and Methods: A comprehensive literature search was done in MEDLINE using PubMed database, Embase®, and Cochrane. All observational studies were included in this review.Results: A total of 17 relevant articles with 2,135 PWS patients were included in this review. There were 36 measurement tools used to assess the quality of life and the psychological effects among PWS patients. The results showed that patients with facial PWS had a significant negative effect on their quality of life and had also suffered from psychological disabilities. The PWS lesion tends to worsen with age and may cause further adaptation problems towards the social environment, especially in children.Conclusion: Early treatment, psychological assistance, and patient support are the key management in improving the quality of life of patients with PWS. Quality of life must be regularly assessed together with the improvement of treatment.Keywords: port-wine stain, quality of life, psychological effects

BackgroundDue to a large variety in treatment outcomes reported in therapeutic trials and lacking patient-relevant outcomes, it is hard to adequately compare and improve current therapies for patients with capillary malformations (CMs). The Core Outcome Set for Capillary Malformations (COSCAM) project aims to develop a core outcome set (COS) for use in future CM trials, in which we will first develop a core outcome (sub)domain set (CDS). Here, we describe the methods for the development of a CDS and present the results of the first development stage.MethodsThe COSCAM project is carried out according to the recommendations of the Cochrane Skin Core OUtcomes Set INitiative (CS-COUSIN) and the Core Outcome Measures in Effectiveness Trials (COMET) initiative. During the first stage, we identified all potentially relevant outcome subdomains based on a systematic review, two focus group sessions and input from patient representatives of Dutch patient organizations and the COSCAM-founding group. In stage two, we will present the subdomains in a three-round e-Delphi study and online consensus meeting, in which CM patients, parents/caregivers and CM experts worldwide rate the importance of the proposed subdomains, hereby finalizing the core outcome (sub)domains of the CDS.ResultsA total of 67 potential outcome subdomains were included; sixteen were previously used in the literature, 20 were proposed by Dutch patients and their parents/caregivers (n = 13) in focus group sessions and 38 were suggested by the experts of the COSCAM-founding group. Seven were excluded because of overlap.ConclusionThe final CDS may serve as a minimum standard in future CM trials, thereby facilitating adequate comparison of treatment outcomes. After this CDS development, we will select appropriate outcome measurement instruments to measure the core outcome subdomains.

Background: Intralesional corticosteroid administration (ICA) is a first-line keloid treatment. However, it faces significant variability in current clinical and scientific practice, which hinders comparability of treatment results., Objectives: The aim of the study was to reach consensus on different aspects of ICA using hypodermic needles in keloids among an international group of dermatologists and plastic surgeons specialized in keloid treatment to provide consensus-based clinical treatment recommendations for all physicians treating keloids., Methods: The keloid expert panel of 12 dermatologists and 11 plastic surgeons rated 30 statements. Two online e-Delphi rounds were held, both with a response rate of 100%. Fifteen (65%) keloid experts participated in the final consensus meetings. Consensus was defined as ≥ 75% of the participants choosing agree or strongly agree on a 7-point Likert scale., Results: Consensus was reached on treatment goals, indication for ICA, triamcinolone acetonide (TAC) 40 mg/mL as the preferred corticosteroid administered at a maximum of 80 mg per month and at intervals of 4 weeks, minimizing pain during ICA, the use of 1 mL syringes and 25 or 27 Gauge needles, blanching as endpoint of successful infiltration, caution of not injecting subcutaneously, and the option of making multiple passes in very firm keloids prior to infiltration. Consensus could not be reached on TAC dosing, methods of prior local anesthesia, and location of injection., Conclusions: This e-Delphi study provides important clinical treatment recommendations on essential aspects of ICA in keloids. By implementing these recommendations, uniformity of ICA in keloid treatment will increase and better treatment results may be achieved., (© 2024. The Author(s).)

Background/objective: Laser therapy has emerged as a widely favored treatment option for solar lentigines (SL). However, a significant challenge associated with this treatment, particularly among individuals with darker skin tones, is the notable risk of postinflammatory hyperpigmentation (PIH) induction. In response to these concerns, the authors conducted a prospective, self-controlled study to comprehensively evaluate the safety and effectiveness of 532-nm picosecond laser, both with and without a microlens array (MLA), for the management of SL in patients with Fitzpatrick skin types (FST) III-V., Methods: Twenty-seven patients with FST III-V and bilateral SL on the face underwent randomized treatment. One side of the face was treated with a 532-nm picosecond laser coupled with an MLA, utilizing the fractional pigment toning (FPT) technique, while the other side received treatment without the MLA, following the conventional technique (CT). The FPT technique utilized a 9-mm spot size with a fluence of 0.47 J/cm 2 for two passes covering 40% of the area. In contrast, the CT used a 4.5-mm handpiece with fluence ranging from 0.3 to 0.7 J/cm 2 . Patients received a single treatment and were evaluated for pigment clearance, occurrence of PIH, and other adverse effects at 2 weeks, 1, 3, and 6 months posttreatment., Results: Twenty-seven participants completed the study protocol. Analysis of pigment clearance, measured via 3D photography, showed significant improvement from 2 weeks to 6 months posttreatment for both the FPT technique (p < 0.001) and CT (p = 0.004). PIH occurred in 64%, 80%, 96%, and 88% of cases on the CT side, compared to 8%, 32%, 36%, and 16% on the FPT technique side at 2 weeks, 1, 3, and 6 months posttreatment, respectively. The incidence of PIH was significantly lower on the FPT technique side compared to the CT side throughout the follow-up periods. Additionally, transient and mild hypopigmentation occurred in one participant (4%) on the FPT technique side and in five participants (20%) on the CT side. No other adverse effects were observed during the study., Conclusions: The 532-nm picosecond laser emerges as a safe and efficacious treatment modality for SL in individuals with FST III-V. Particularly noteworthy is the efficacy of the FPT technique, which demonstrates comparable effectiveness while significantly reducing the incidence of PIH compared to the CT., (© 2024 The Author(s). Lasers in Surgery and Medicine published by Wiley Periodicals LLC.)

Background: Acne vulgaris (AV) is a prevalent skin condition known for its potential to cause scarring and psychological distress, often leading to diminished self-esteem. While topical and oral treatments are commonly prescribed, some patients experience treatment failure, adverse effects, or contraindications to conventional therapies. In response to these challenges, laser and energy-based device therapies have emerged as promising alternatives for individuals who fall into these categories, showing considerable potential in the treatment of AV., Objective: This study aimed to evaluate the long-term efficacy and safety of a nonablative monopolar radiofrequency (NMRF) in treatment of moderate to severe AV., Methods: Twenty-four patients with moderate to severe AV underwent a series of two NMRF treatment sessions, spaced 4 weeks apart. To evaluate treatment outcomes, live in-person lesion counts and measurements of pore size and volume, and sebum production were quantified using Antera® 3D imaging system, and Sebumeter®, respectively. Patients' self-assessment data regarding degree of improvement and facial oiliness were gathered. Dermatology life quality index (DLQI) questionnaire was utilized to assess the impact of AV on their quality of life. All objective and subjective evaluations were conducted at the baseline, 1 month after the first treatment, and during follow-up visits 1, 3, and 6 months after the last treatment sessions. Adverse effects were also recorded during each visit., Results: Twenty out of the 24 subjects completed the study protocol. The mean inflammatory lesion counts significantly reduced by 42.86% and 45.71% from the baseline at 3 (p = 0.027) and 6 months (p = 0.032) after the second treatment. Sebum excretion likewise significantly decreased from baseline by 11.62% (p = 0.012), 13.37% (p < 0.001), and 21.51% (p = 0.004), 1 month after the first treatment, 1 and 6 months after the second treatment, respectively. The pore volume continued to decrease by 35% (p = 0.003) and 41.5% (p < 0.001) at 1 and 6 months following the final treatment, respectively. The DLQI significantly decreased from 10.00 (interquartile range [IQR]: 6.50-15.00) to 2.00 (IQR: 1.00-4.75), corresponding to 80% improvement of the index, 1 month after the last treatment and was sustained up to the last follow-up visit. Patients' self-assessments on degree of improvement and facial oiliness also significantly improved following NMRF treatments. The treatments were well-tolerated without significant adverse effects., Conclusion: NMRF appears to be an effective and safe treatment for inflammatory AV, with therapeutic outcomes persisting up to 6 months after two treatment sessions., (© 2024 The Authors. Lasers in Surgery and Medicine published by Wiley Periodicals LLC.)

Utilization of lasers and energy-based devices for surgical scar minimization has been substantially evaluated in placebo-controlled trials. The aim of this study was to compare reported measures of efficacy of lasers and energy-based devices in clinical trials in preventing surgical scar formation in a systematic review and network meta-analyses. Five electronic databases, PubMed, Scopus, Embase, ClinicalTrials.gov, and the Cochrane Library, were searched to retrieve relevant articles. The search was limited to randomized controlled trials that reported on clinical outcomes of surgical scars with treatment initiation no later than 6 months after surgery and a follow-up period of at least 3 months. A total of 18 randomized controlled trials involving 482 participants and 671 postsurgical wounds were included in the network meta-analyses. The results showed that the most efficacious treatments were achieved using low-level laser therapy) (weighted mean difference -3.78; 95% confidence interval (95% CI) -6.32, -1.24) and pulsed dye laser (weighted mean difference -2.46; 95% CI -4.53, -0.38). Nevertheless, low-level laser therapy and pulsed dye laser demonstrated comparable outcomes in surgical scar minimization (weighted mean difference -1.32, 95% CI -3.53, 0.89). The findings of this network meta-analyses suggest that low-level laser therapy and pulsed dye laser are both effective treatments for minimization of scar formation following primary closure of surgical wounds with comparable treatment outcomes.

Introduction: Port-wine stains (PWS) are congenital capillary abnormalities caused by immature, venule-like vasculature that progressively dilates due to poor endothelial cell differentiation. PWS affects between 0.3% and 0.9% of newborns, with 90% of cases occurring on the face. Individuals with facial PWS and their parents had a significant negative impairment on their quality of life (QoL) and also suffered from psychological disabilities., Methods: This was a cross-sectional questionnaire-based survey study in Thailand from July 2021 to April 2022. The questionnaires included demographic data, subjective evaluation (SE), and the Dermatology Life Quality Index (DLQI). The questionnaire was performed with a full scale and adjusted scale of validity and reliability test of DLQI using factor analysis and Cronbach's alpha. The study outcome was a subjective evaluation and DLQI in patients who received pulsed dye laser (PDL) treatment., Results: Of the 54 patients, 35.2% (19) are male, and 64.8% (35) are female. Regarding age groups, 64.8% (35) are below 5 years old, and 35.2% (19) are older than 5 years. SE results showed that males evaluated an improvement of the facial PWS lesion significantly better than females (P < 0.05). The older age group graded the percentage of improvement better than the younger age group (P < 0.01). The result of the DLQI showed no difference in DLQI between gender. Older age result resulted in a significantly different DLQI compared with younger age (P < 0.01). Parent-reported DLQI improvement was less than self-reported DLQI improvement in patients with PWS treated with PDL (P < 0.05). Concerning the instrument of the study, the validity and reliability analysis of the DLQI questionnaire using factor analysis and Cronbach's alpha have been performed. The adjusted scale with the 5-item DLQI questionnaire is more appropriate in terms validity and reliability., Conclusion: This study demonstrates that facial PWS reduces the QoL as measured by DLQI. We discovered that the QoL of patients and parents with PWS was significantly impaired. The main influencing factors were older age, the improved perception between gender, and PDL treatments. In addition, we found only five questions that are reliable for PWS. The adjusted five-item DLQI questionnaires are more appropriate regarding validity and reliability., Trial Registration Number: TCTR20230210001, COA no. si 1059/2020., (© 2023. The Author(s).)

Background: Enlarged facial pores are visible topographic features of the skin that have been associated with cutaneous photoaging and increased sebum production. It has remained a common dermatologic concern, gaining a significant number of in-clinic consults. Available treatment modalities often operate on a single mode of action, consequently offering limited and short-term outcomes., Objective: This study aimed to evaluate the long-term efficacy and safety of a nonablative monopolar radiofrequency (NMRF) for pore tightening and sebum output reduction in Thai patients., Methods: Nineteen patients with enlarged pores underwent two sessions of NMRF treatments at 4-week intervals. The measurements of pore volume, skin texture, average pore size, sebum production, and skin elasticity were quantified using Antera® 3D imaging system, dermoscopic image analysis with ImageJ software, Sebumeter® and Cutometer®. Clinical evaluation by two dermatologists was done using blinded clinical photographs. All objective and subjective assessments were done at the baseline, a month after the first treatment, and during follow-up visits 1, 3, and 6 months after the last treatment. Adverse effects were also recorded during each visit., Results: Seventeen out of the 19 subjects completed the study protocol. The mean pore volume significantly reduced by 24% from the baseline at 1 month after the first treatment (p < 0.016). The pore volume continued to decrease by 34% and 38% a month (p < 0.001) and 6 months (p < 0.001) following the final treatment, respectively. Sebum excretion likewise significantly decreased from baseline by 39% (p = 0.002) and 36% (p < 0.001), 3 and 6 months after the second treatment, respectively. Skin texture and elasticity also significantly improved following two NMRF sessions. The objective assessments of the pore appearance corresponded to subjective clinical evaluations. The treatment was well-tolerated without significant side effects, such as dyspigmentation, textural alteration, and scarring., Conclusion: NMRF appears to be effective and safe for the reduction of pore size and sebum production, with therapeutic outcomes persisting up to 6 months after two treatment sessions., (© 2023 The Authors. Lasers in Surgery and Medicine published by Wiley Periodicals LLC.)

Autologous cultured fibroblast injections for soft tissue augmentation are a potential alternative to other filler materials. No studies have compared autologous fibroblast injections and hyaluronic acid (HA) fillers for treating nasolabial folds (NLFs). To compare the efficacies and safeties of autologous cultured fibroblast injections and HA fillers for treating NLFs. This prospective, evaluator-blinded, pilot study enrolled 60 Thai female adult patients diagnosed with moderate to severe NLFs. They were randomized to receive either 3 treatments of autologous fibroblasts at 2-week intervals or 1 treatment with HA fillers. The primary outcome was the clinical improvement of the NLFs graded by 2 blinded dermatologists immediately after injection and at 1-, 3-, 6-, and 12-month follow-ups. Objective measurement of the NLF volume was evaluated. Patient self-assessment scores, pain scores, and adverse reactions were recorded. Of the 60 patients, 55 (91.7%) completed the study protocol. The NLF volumes improved significantly in the autologous fibroblast group at all follow-ups relative to baseline (P = 0.000, 0.004, 0.000, 0.000, and 0.003). The patients in the autologous fibroblast group rated more noticeable NLF improvements than those in the HA filler group (3-month follow-up, 58.41% vs. 54.67%; 6-month follow-up, 52.50% vs. 46%; 12-month follow-up, 44.55% vs. 31.33%). No serious adverse reactions were recorded. Autologous fibroblast injections are safe and effective for treating NLFs. These injections also promise sustained growth of living cells, possibly leading to a greater persistence than shown by other fillers., (© 2023. The Author(s).)

Introduction: Monopolar radiofrequency (MRF) is a valuable modality for tightening and contouring mild-to-moderate facial skin laxity. Few studies have evaluated new-generation MRF devices for lower facial laxity in Asians. This study aims to evaluate the efficacy and safety of MRF for treating lower facial laxity in Asians., Methods: This prospective cohort study enrolled 30 volunteers with Fitzpatrick Skin Types III-V and mild-to-moderate skin laxity. Subjects received a single MRF treatment. Self-assessments and adverse events were recorded. Two blinded dermatologists graded improvements (6-point scale) after treatment and 1, 3, and 6 months later., Results: All subjects completed the study. Treatment energy levels ranged from 2 to 4. The average number of shots was 412 ± 49, delivered in 3-4 passes with 15-30% overlap. All patients reported improvement in lower facial laxity immediately after treatment. Most patients had mild-to-moderate improvement over the 6-month follow-up. Continuous improvement was observed at the 1-, 3-, and 6-month follow-ups (P < 0.01). Significant improvement was seen at the 6-month follow-up compared with the 1-month follow-up (P < 0.01). Subjects tolerated the procedure well: the average pain score was 3.13 out of 10, and no serious adverse events were observed., Conclusions: The new-generation MRF device we tested was effective and safe for mild-to-moderate lower facial laxity in Asian skin. The latest MRF technology offers improved safety to prevent complications. Appropriate patient selection, setting, and protocols are mandatory to achieve optimal clinical outcomes., The Trial Registration Number: TCTR20210326002., (© 2022. The Author(s).)

Background: Physiologic lip hyperpigmentation is a common aesthetic concern, especially in Southeast Asia. There is limited data on the application of the picosecond laser for this condition., Objective: To evaluate the efficacy and safety of using a 755-nm picosecond laser in the treatment of physiologic lip hyperpigmentation., Methods: Twenty healthy patients with physiologic lip hyperpigmentation received 5 bi-weekly treatments with a 755-nm picosecond laser using a 6-mm spot size, fluence of 0.71 J/cm 2 at 5 Hz. Subjective and objective evaluation on the improvement of lip hyperpigmentation were obtained at baseline, 2 weeks after each treatment and at 1, 3, and 6 months after the final treatment. Patient self-assessment, pain score, and adverse reactions were also recorded., Results: All patients completed the study and attended all follow-ups. Most (52.6%) patients presented with moderate clinical improvement at 6-month follow-up. The average melanin index decreased significantly after the fourth treatment ( p = .048) and at 1-month follow-up ( p = .026). More than half the patients (70%) reported moderate-to-marked improvement at 6-month follow-up. Only 1 patient presented with a transient adverse reaction of lip edema., Conclusion: The 755-nm picosecond laser is safe and effective for the treatment of physiologic lip hyperpigmentation in Thai patients., (Copyright © 2022 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Background: There is limited evidence on the best available treatment options for capillary malformations (CMs), mainly due to the absence of uniform outcome measures in trials on therapies. A core outcome set (COS) enables standard reporting of trial outcomes, which facilitates comparison of treatment results., Objectives: To develop a core outcome domain set (CDS), as part of a core outcome set (COS), for clinical research on CMs., Methods: Sixty-seven potentially relevant outcome subdomains were recognized based on the literature, focus group sessions, and input from the COSCAM working group. These outcome subdomains were presented in an online Delphi study to CM experts (medical specialists and authors of relevant literature) and (parents of) patients with CM (international patient associations). During three e-Delphi study rounds, the participants repeatedly scored the importance of these outcome subdomains on a seven-point Likert scale. Participants could also propose other relevant outcome subdomains. Consensus was defined as ≥ 80% agreement as to the importance of an outcome subdomain among both stakeholder groups. The CDS was finalized during an online consensus meeting., Results: In total 269 participants from 45 countries participated in the first e-Delphi study round. Of these, 106 were CM experts from 32 countries, made up predominantly of dermatologists (59%) and plastic surgeons (18%). Moreover, 163 (parents of) patients with CM from 28 countries participated, of whom 58% had Sturge-Weber syndrome. During the two subsequent e-Delphi study rounds, 189 and 148 participants participated, respectively. After the entire consensus process, consensus was reached on 11 outcome subdomains: colour/redness, thickness, noticeability, distortion of anatomical structures, glaucoma, overall health-related quality of life, emotional functioning, social functioning, tolerability of intervention, patient satisfaction with treatment results, and recurrence., Conclusions: We recommend the CDS to be used as a minimum reporting standard in all future trials of CM therapy. Our next step will be to select suitable outcome measurement instruments to score the core outcome subdomains. What is already known about this topic? Besides physical and functional sequelae, capillary malformations (CMs) often cause emotional and social burden. The lack of uniform outcome measures obstructs proper evaluation and comparison of treatment strategies. As a result, there is limited evidence on the best available treatment options. The development of a core outcome set (COS) may improve standardized reporting of trial outcomes. What does this study add? A core outcome domain set (CDS), as part of a COS, was developed for clinical research on CMs. International consensus was reached on the recommended core outcome subdomains to be measured in CM trials: colour/redness, thickness, noticeability, distortion of anatomical structures, glaucoma, overall health-related quality of life, emotional functioning, social functioning, tolerability of intervention, patient satisfaction with treatment results, and recurrence. This CDS enables the next step in the development of a COS, namely to reach consensus on the core outcome measurement instruments to score the core outcome subdomains. What are the clinical implications of this work? The obtained CDS will facilitate standardized reporting of treatment outcomes, thereby enabling proper comparison of treatment results. This comparison is likely to provide more reliable information for patients about the best available treatment options., (© 2022 The Authors. British Journal of Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists.)

Introduction: Laser lipolysis is a rapidly growing noninvasive body-contouring treatment in Asians. There is increasing demand for leg contouring, especially in areas where unwanted fat deposits are prominent despite diet and exercise. Medial fat knees are one of the esthetic concerns of women today and can be a challenging problem in terms of treatment. There are few noninvasive options to remove fat from these areas. This study aims to evaluate the safety and efficacy of a 1060-nm diode laser for medial knee fat reduction., Methods: Nineteen subjects with localized unwanted fat on the medial knees were enrolled into this study. All of them were treated with a single session of 1060-nm diode laser at a power setting of 1.0-1.4 W/cm 2 , depending on patient tolerance. Body weight, knee circumference at 3 cm above the medial epicondyle of the femur, and knee fat thickness measured by ultrasonography were recorded at baseline and 1, 3, and 6 months after treatment. Clinical photographs and ultrasound images were taken before and after treatment. Side effects were documented during follow-up visits. Subjects answered a satisfaction questionnaire at the completion of the study., Results: All subjects were female, with mean age of 32.3 ± 5.3 years and body weight of 59.8 ± 11.6 kg. The average power setting was 1.3 ± 0.1 W/cm 2 with pain score of 6.1 ± 1.0. Significant reduction in knee circumferences (p < 0.001) at 1-, 3-, and 6-month follow-up visits compared with baseline, and knee fat thickness measured by ultrasound in both axial and sagittal plane at 1 and 6 months after treatment (p = 0.036 and p < 0.001, respectively) were recorded. Side effects were mild and transient, including mild erythema and tenderness., Conclusion: The 1060-nm diode laser is effective and safe for knee circumference and medial knee fat layer thickness reduction., Trial Registration: ClinicalTrials.gov identifier, TCTR20220219002. Retrospectively registered on February 19, 2022., (© 2022. The Author(s).)

Vaginal laxity, a common cause of decreased sexual sensation, is a common problem affecting the quality of life of women worldwide. Recently, lasers and energy-based devices (EBDs) have been applied in the treatment of this condition. The aim of this study was to compare the efficacy and safety of Er:YAG laser and placebo in treating decreased sexual sensation in Asians. Forty-two patients with decreased sexual sensation were randomized into 2 groups: intervention (laser treatment) and control (placebo treatment). Both groups received two treatments, at 1-month interval. Subjective and objective evaluations were done at baseline, 1-, 3-, and 6-month follow-ups. Pain score and adverse effects were also recorded. In the laser group, there was significant improvement in the patients' vaginal tightness satisfaction at 1- and 3-month follow-ups (P = 0.002 and 0.004) and also in the patients' overall satisfaction at 1- and 3-month follow-ups (P = 0.003 and 0.001). Pelvic floor muscle contraction was significantly better in the laser group after the first treatment (P = 0.043). No serious adverse effects were noted. Er:YAG laser provides improvement of sexual sensation for an average of 3 months following treatment. Mild and transient adverse effects such as leukorrhea, dryness, dysuria, vaginal itching, and spot bleeding were noted in the laser group, and these were not significantly different from the control group., (© 2021. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

Background and Objectives: Acne scars are one of the most distressing and long-term consequences of acne vulgaris, with damaging effect on a person's physical, mental, and social well-being. Numerous treatment options are available including surgical and nonsurgical techniques, depending on the clinical presentation. Although considerable advances in the development of new treatment technologies and applications have been made in the last decade, international treatment guidelines and reimbursement schemes have not yet caught up with current knowledge and practice in many centers. The authors intend to highlight the potential utility of energy-based devices (EBDs) for acne scarring, offer recommendations for safe and efficacious treatment, and provide consensus-based EBD treatment options based on varying presentations demonstrated in a series of real-life clinical photographs., Study Design/materials and Methods: An international panel of 24 dermatologists and plastic surgeons from 12 different countries and a variety of practice backgrounds was self-assembled to develop updated consensus recommendations for the treatment of acne scars. A two-step modified Delphi method took place between March 2020 and February 2021 consisting of two rounds of emailed questionnaires. The panel members approved the final manuscript via email correspondence., Results: The manuscript includes a comprehensive discussion and panel recommendations regarding the following topics: 1. the role of EBD in mitigating and treating acne scars in a patient with active acne, 2. the use of various EBDs for the treatment of different acne scar types with special focus on commonly used laser platform such as vascular lasers, ablative fractional lasers (AFLs) and non-AFLs (NAFLs), 3. treatment combinations, and 4. acne scar treatments in skin of color. The last part comprised of 10 photos of real-life clinical cases with the panel recommendation treatment plan to achieve best aesthetic outcome., Conclusion: Panel members were unanimous in their view that EBDs have a role in the management of acne scars, with AFLs, NAFLs, vascular lasers, and RF devices preferentially selected by most of the panel experts. EBDs are considered a first-line treatment for a variety of acne scar types and patients without access to these treatments may not be receiving the best available care for optimal cosmetic results. Future high-quality research and updated international treatment guidelines and reimbursement schemes should reflect this status., (© 2021 Wiley Periodicals LLC.)

Background: Nevus of Ota is a psychologically burdensome facial pigmentation birthmark common in Asian populations. Laser therapy is currently the first-line treatment, but no guidelines on when to initiate treatment have yet been established., Objectives: Our objective was to determine the correlation between treatment efficacy and safety, risk of recurrence, and age of treatment initiation in patients receiving laser therapy for nevus of Ota., Methods: We conducted a 10-year (2008-2018) retrospective cohort study of all patients who completed a minimum of five laser treatments at Siriraj Skin Laser Center, Mahidol University, Bangkok, Thailand., Results: A total of 84 patients (aged 4 months-50 years) with nevus of Ota lesions were enrolled in the study. All patients were treated with a 1064-nm Q-switched Nd:YAG or a 755-nm or 1064-nm picosecond-domain laser (or a combination thereof). Our analysis identified that initiation of laser therapy before the age of 5 years was a significant factor in reducing the number of sessions necessary to achieve aesthetic improvement (P < 0.01; 95% confidence interval [CI] 1.06-3.21). In total, 18 patients (21.4%) initiating treatment before the age of 5 years required an average of 2, 4, and 7 treatment sessions to achieve > 25, 50, and 75% of pigment lightening, respectively, whereas 66 patients (78.6%) initiating treatment after the age of 5 years required an average of 3, 7, and 11 sessions to achieve comparable clearance. The risk of postinflammatory hyperpigmentation was significantly lower in patients starting treatment before the age of 5 years (P < 0.01; 95% CI - 43.76 to - 11.94). Recurrences were not observed in patients achieving > 95% clearance., Conclusions: In our patient cohort, initiation of laser treatment for nevus of Ota before the age of 5 years significantly improved therapeutic outcomes and reduced the risk of adverse events and recurrence., Clinical Trial Registration: ClinicalTrials.gov PRS number: NCT04481178., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: Heightened intraocular pressure resulting in glaucoma and impaired vision is treatable if detected early. It is therefore necessary to identify populations at risk for glaucoma for regular screening visits., Objective: To investigate the prevalence of glaucoma in patients with facial port-wine stains (PWSs), nevus of Ota, and phakomatosis pigmentovascularis (PPV) and to establish the association between facial vascular birthmarks and ocular complications., Methods: This study is a retrospective chart review of 166 patients with facial PWS, PPV, and nevus of Ota over a 10-year period., Results: Of the 166 cases, 76 patients were diagnosed with PWS, 83 with nevus of Ota, and 7 with PPV. The mean age of patients was 12.8 years, ranging from newborn to 63 years old. Fifteen patients were diagnosed with glaucoma. Of 15 patients, 11 presented with PWS, and 4 presented with both PWS and PPV. Of 83 patients with nevus of Ota, only 2 (2.4%) presented with increased ocular pressure., Limitations: The relatively short follow-up period is a limiting factor in this study., Conclusions: Early and periodic ophthalmic examinations in patients with PWS, PPV, and nevus of Ota are essential to minimizing the risk of developing glaucoma in these groups of patients., (Copyright © 2020 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Background and Objective: Phototherapy for acne with a combination of blue and red light-emitting diodes (LEDs) appears to have excellent potential in treating inflammatory acne. However, a standard twice-weekly protocol administered 3 days apart may not be practical for patients. This study aims to seek the efficacy of LED treatment in moderate to severe acne, comparing between once and alternating twice-weekly regimens., Study Design/materials and Methods: Thirty subjects with moderate to severe acne, as defined by Burton's grading score, were recruited in the study. The subjects were randomly divided into two groups- one group received alternating blue (470 nm) and red (640 nm) light in two visits per week for 4 consecutive weeks, while the other group got blue and red light treatments consecutively on the same visit for 4 consecutive weeks. During the study period, conventional treatments were prohibited. Clinical assessments were performed by lesion counts and blinded comparative photographs before treatment and at 1, 4, and 8 weeks after the final treatment., Results: There was no statistically significant difference between once- and alternating twice-weekly regimens. Both regimens provided marked improvement only for inflammatory lesions. The median percentage of acne reduction was significantly demonstrated for 1 week after finishing the course of treatment and was sustained until the end of the study. There were no side effects noted throughout the study period., Conclusion: LED therapy is safe and effective for treatment of inflammatory acne. The treatment outcomes of once and alternating twice-weekly regimens were comparable, hence, once-weekly treatment could be considered as an alternative choice for patient's convenience. Lasers Surg. Med. © 2021 Wiley Periodicals LLC., (© 2021 Wiley Periodicals LLC.)

Background and Objective: Fractional 1064-nm picosecond-domain laser has recently been utilized for the treatment of atrophic acne scars and showed promising results. However, data on the safety and efficacy of this procedure in dark-skinned patients are limited. This prospective, self-controlled study was conducted to objectively evaluate the safety and efficacy of a 1064-nm picosecond laser coupled with a microlens array (MLA) for the treatment of atrophic acne scars on Asian skin., Study Design/materials and Methods: Twenty-six subjects of Fitzpatrick skin types (FSTs) III and IV with atrophic acne scars were enrolled. All subjects were treated with a 1064-nm picosecond laser (spot size of 8 mm, fluence of 1.0 J/cm 2 , a repetition rate of 10 Hz) in combination with the MLA handpiece for an average of three passes, for 6 monthly sessions. Objective (measurement of scar volume using three-dimensional (3D) photography and skin roughness analysis using ultraviolet A-light video camera) and subjective (clinical evaluation by two blinded dermatologists) assessments were obtained at baseline and at 1, 3, and 6 months after the final treatment., Results: Statistically significant reduction of the scar volume from baseline at 1, 3, and 6 months after the final treatment were observed by 3D photography and ultraviolet A-light video camera. At the 6-month follow-up, 50% (13 of 26) of the subjects were rated as having at least 50% improvement of the scars. The rate of improvement significantly increased from the 1-month follow-up to the 6-month follow-up (P = 0.013). Similarly, at the 6-month follow-up, the scar volume (P = 0.024) and skin roughness (P = 0.001) also significantly improved, in comparison with the baseline. Mild postinflammatory hyperpigmentation (PIH) was observed to develop in approximately 18% of all the treatment sessions. All cases of PIH were temporary and resolved within 4 weeks on average., Conclusions: The 1064-nm picosecond laser with MLA is a safe therapeutic alternative for the treatment of atrophic acne scars in dark-skinned individuals. Lasers Surg. Med. © 2020 Wiley Periodicals LLC., (© 2020 Wiley Periodicals LLC.)

Background: Reapplication of sunscreen every 2 hours is recommended, especially after swimming, sweating, or working outdoors. However, the sustainability of sunscreen during the workday among outdoor workers is still unclear., Objective: To evaluate the course of facial sunscreen coverage and sustainability over an 8-hour workday among outdoor workers., Materials and Methods: This open-label trial included 20 healthy subjects who spend at least 80% of their workday outdoors. All volunteers applied 2 mg/cm 2 of provided broad-spectrum sunscreen mixed with the invisible blue fluorescent agent to all parts of their face in the morning. A VISIA-CR camera was used to capture facial fluorescence intensity every 2 hours, and digital image analysis software was used to quantify fluorescence intensity at six areas of the face at each time point for 8 hours., Results: Sunscreen coverage declined most rapidly during the first 2 hours with a mean reduction of 18.31%. By the end of the 8-hour study workday, the mean decrease in sunscreen coverage was 31.63% (range: 17.39%-45.29%)., Conclusion: Reapplication of sunscreen is essential among outdoor workers. After 4 hours, the amount of sunscreen remaining on the face may not be sufficient for protecting the skin from harmful ultraviolet radiation., Competing Interests: All authors declare no personal or professional conflicts of interest, and no financial support from the companies that produce and/or distribute the drugs, devices, or materials described in this report., (© 2021 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

Background and Objectives: Enlarged pores are one of the most common causes of skin surface irregularities. Existing studies supporting the benefit of lasers and energy-based devices (EBD) for this condition are limited, with a short duration of follow-up period. We aimed to evaluate the efficacy and adverse effects of Er:YAG laser for treatment of enlarged pores in dark-skinned patients., Study Design/materials and Methods: Nineteen subjects (aged 26-47 years) with skin phototypes III (21.1%) and IV (78.9%) and enlarged pores were treated with 4 monthly sessions of Erbium:YAG laser. Objective (ultraviolet light A video camera) and subjective (clinical evaluation by two blinded dermatologists) assessments were obtained at baseline, 1-month after each treatment and at 1, 3, and 6 months after the final treatment., Results: The weighted mean score of quartile grading scales showed significant improvement in pore size from baseline starting at 1-month after the third treatment and continued until 3 months after the fourth (final) treatment (P < 0.001). However, the improvement dropped significantly at 6 months after the final treatment. Objective measurements of the improvements in skin surface smoothness and wrinkles corresponded with the physician raters' clinical evaluation., Conclusions: Erbium:YAG laser is a safe and effective treatment for enlarged pores in dark-skinned individuals. Maintenance treatments are recommended to achieve a longer-lasting outcome. Lasers Surg. Med. © 2020 Wiley Periodicals LLC., (© 2020 Wiley Periodicals LLC.)

Background: Picosecond lasers are increasingly being investigated in treating pigmentation disorders because they may provide better treatment efficacy and comfort compared with nanosecond lasers., Objective: This study aims to evaluate the efficacy and side effect of a novel 670-nm picosecond laser in the removal of benign pigmented lesions (BPLs) in individuals with Fitzpatrick skin types (FST) III and IV., Materials and Methods: Fifteen subjects with solar lentigines and 7 subjects with ABNOMs received a single treatment with a 670-nm picosecond laser. Blinded physicians assessed the pigment clearance using a 5-category grading system scale. All subjects were evaluated at 1 month, 3 month, and 6 month after a single treatment. Adverse events were recorded at every follow-up visit., Results: All subjects with lentigines had complete clearance (95%-100%) of lesions during 3-month follow-up after a single treatment session of 670-nm picosecond laser, whereas 75% of the subjects with ABNOMs noted fair lightning (25%-49%) of lesions. Mild hypopigmentation and hyperpigmentation were observed in 9% and 14% of the subjects, respectively, which resolved within 3 months after the treatment., Conclusion: The novel 670-nm picosecond laser is a safe and effective treatment for BPLs in subjects with FST III and IV with low rates of transient adverse effects., (Copyright © 2020 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.)