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Calcinosis cutis describes the deposition of calcium in the dermis. A case of a 69-year-old woman with idiopathic calcinosis cutis that presented as a mobile subcutaneous nodule is described. The patient had an asymptomatic, firm, mobile subcutaneous nodule on her right lower leg of at least six months duration. The nodule could be easily moved from one location to another. An incisional biopsy was performed. Microscopic examination of the tissue specimen showed islands of basophilic calcium material in dense sclerotic dermal connective tissue establishing the diagnosis of calcinosis cutis. Mobile solitary calcification is an unusual presentation of idiopathic calcinosis cutis. In addition to idiopathic calcinosis cutis, benign mobile subcutaneous tumors have also been derived from adnexal structures of hair follicles and adipose tissue. Hence, not only idiopathic calcinosis cutis, but also subepidermal calcinosis in the ocular adnexa, proliferating trichilemmal cyst with focal calcification, and mobile encapsulated adipose tissue can present as a mobile subcutaneous nodule. The features of idiopathic calcinosis presenting as a mobile subcutaneous nodule as well as the characteristics of other benign mobile subcutaneous tumors are reviewed., Competing Interests: The authors have declared financial relationships, which are detailed in the next section., (Copyright © 2023, Osuoji et al.)

Importance: Laser-assisted drug delivery (LADD) is used for various medical and cosmetic applications. However, there is insufficient evidence-based guidance to assist clinicians performing LADD., Objective: To develop recommendations for the safe and effective use of LADD., Evidence Review: A systematic literature review of Cochrane Central Register of Controlled Trials, Embase, and MEDLINE was conducted in December 2019 to identify publications reporting research on LADD. A multidisciplinary panel was convened to draft recommendations informed by the systematic review; they were refined through 2 rounds of Delphi survey, 2 consensus meetings, and iterative review by all panelists until unanimous consensus was achieved., Findings: Of the 48 published studies of ablative fractional LADD that met inclusion criteria, 4 were cosmetic studies; 21, oncologic; and 23, medical (not cosmetic/oncologic), and 6 publications of nonablative fractional LADD were included at the request of the expert panel, producing a total of 54 studies. Thirty-four studies (63.0%) were deemed to have low risk of bias, 17 studies (31.5%) had moderate risk, and 3 (5.5%) had serious risk. The key findings that informed the guidelines developed by the expert panel were as follows: LADD is safe in adults and adolescents (≥12 years) with all Fitzpatrick skin types and in patients with immunosuppression; it is an effective treatment for actinic keratosis, cutaneous squamous cell carcinoma in situ, actinic cheilitis, hypertrophic scars, and keloids; it is useful for epidermal and dermal analgesia; drug delivery may be increased through the application of heat, pressure, or occlusion, or by using an aqueous drug solution; laser settings should be selected to ensure that channel diameter is greater than the delivered molecule; antibiotic prophylaxis is not recommended, except with impaired wound healing; antiviral prophylaxis is recommended when treating the face and genitalia; and antifungal prophylaxis is not recommended. The guideline's 15 recommendations address 5 areas of LADD use: (I) indications and contraindications; (II) parameters to report; (III) optimization of drug delivery; (IV) safety considerations; and (V) prophylaxis for bacterial, viral, and fungal infections., Conclusions and Relevance: This systematic review and Delphi consensus approach culminated in an evidence-based clinical practice guideline for safe and effective use of LADD in a variety of applications. Future research will further improve our understanding of this novel treatment technique.

A dystrophic nail is an alteration of the physical appearance and structural properties of the nail from its shape, color, and texture, which can result from multiple etiologies. Calcinosis cutis is a condition that refers to the calcium deposition in the skin and underlying tissue. A 55-year-old man who presented with a split right thumbnail associated with subungual calcinosis cutis affecting the same digit for a duration of nine years is described. He did not recall trauma to the affected area. Microscopic evaluation of the tissue specimen obtained following a biopsy of the affected digit's nail matrix showed foci of calcium in the dermis. The correlation of his clinical presentation and biopsy findings established a diagnosis of subungual calcinosis cutis. Subungual calcification has been observed in several clinical settings. In addition to subungual calcinosis cutis, it has been noted as a normal finding in elderly individuals. In addition, it has been observed in patients with scleroderma or following trauma to the site. Less commonly, subungual calcification can be associated with idiopathic conditions: calcifying aponeurotic fibroma, digital calcinosis circumscripta, subepidermal calcified nodule, and calcified subungual epidermoid inclusion., Competing Interests: The authors have declared financial relationships, which are detailed in the next section., (Copyright © 2021, Haddad et al.)

Red dot basal cell carcinoma is a distinctive clinical subtype of basal cell carcinoma. It has been reported in eight individuals with a male to female ratio of 1:1; and the patients' ages ranged from 50 to 74 years. All patients had prior history of actinic keratoses and basal cell carcinoma. In addition, some patients also had prior squamous cell carcinoma, malignant melanoma, and/or dysplastic nevus. The tumor was usually of recent onset, asymptomatic, and on sun-exposed skin. It was most commonly located on the nose (five patients); other sites were the upper lip, the mid back, or thigh-each in one patient. The red dot basal cell carcinoma was solitary and small-usually 4 mm or less in diameter. It typically presented as a red macule or papule; however, it sometimes appeared as a flesh-colored or pink to light-red papule with a bright-red central area. Microscopic features showed basaloid tumor cells (arranged as either nodular aggregates or superficial buds or both). In the central portion of the lesion, there was a proliferation of erythrocyte-containing vascular spaces between the epidermis and the neoplasm. The basal cell carcinoma pathology subtype was either nodular and superficial (three patients), nodular (two patients), or superficial (one patient). The clinical differential diagnosis of red dot basal cell carcinoma included not only benign vascular lesions (such as hemangioma and telangiectasia) but also inflammatory conditions and adnexal tumors. Other basaloid cell neoplasms were in the pathologic differential diagnosis. The pathogenesis of red dot basal cell carcinoma is similar to that of other basal cell carcinoma clinical subtypes. Mohs surgery is the treatment of choice for red dot basal cell carcinomas. Red dot basal cell carcinoma has two categories of biologic behavior based on the ratio of the postoperative wound size as compared with the size of the preoperative tumor: nonaggressive (for which the ratio was 5:1 or less for three patients) and aggressive (for which the ratio was greater than 12:1 for three patients). There was no recurrence of the red dot basal cell carcinoma after treatment. In conclusion, the incidence of red dot basal cell carcinoma-a unique morphologic variant of basal cell carcinoma-may be higher than suggested by the number of reported patients with this basal cell carcinoma subtype.

Basal cell carcinoma is the most common cutaneous neoplasm. Calcinosis cutis is the deposition of calcium within the dermis. An 80-year-old man presented with a pearly nodule on his left nasal ala; a shave biopsy confirmed the diagnosis of a nodular basal cell carcinoma with calcinosis cutis, which was removed with Mohs micrographic surgery. The incidence of basal cell carcinoma with calcinosis cutis as well as the classification, identification, and potential origin of calcium deposits in basal cell carcinoma are discussed. Basal cell carcinoma can be associated with calcinosis cutis; indeed, calcifying basal cell carcinoma has a calculated incidence of 14%. There are five categories of calcification in basal cell carcinoma. In addition, calcification observed in cancer-free initial sections of a suspected basal cell carcinoma may be a diagnostic clue that a neoplasm is present in deeper sections of the tissue specimen. Although nodular basal cell carcinoma has the greatest incidence (37%) of calcium deposition, infiltrative (29%) and micronodular (27%) basal cell carcinomas are also frequently associated with calcification; therefore, the presence of calcifying basal cell carcinoma may indicate a more aggressive tumor subtype. Basal cell carcinoma may also be suspected in the differential diagnosis of a superficial breast neoplasm in which calcification is observed in the dermis; in this situation, mammography has been an effective diagnostic approach for identifying the basal cell carcinoma with calcification. The pathogenesis of calcification in basal cell carcinoma remains to be definitively established; however, calcium-binding proteins found in poorly differentiated keratinocytes may contribute to the etiology of basal cell carcinoma with calcification. The treatment of basal cell carcinomas with calcinosis cutis is similar to that of non-calcifying basal cell carcinomas; it is based upon the histologic subtype, the size, and the location of the tumor., Competing Interests: The authors have declared financial relationships, which are detailed in the next section., (Copyright © 2021, Forouzan et al.)

Tattoos may be associated with medical complications including, albeit rarely, skin cancer. The features of a 46-year-old man who developed a basal cell carcinoma within a tattoo on his left scapula are described and the characteristics of the other 13 patients (7 men and 6 women) with tattoo-associated basal cell carcinoma are reviewed. The tumor usually occurs on the sun-exposed skin of individuals aged 60 years and older whose tattoo has often been present for 20 years or more. The pathogenesis of a basal cell carcinoma developing within a tattoo may merely be a coincidence. However, there is supporting evidence that the tattoo and the subsequent basal cell carcinoma may be coincident events whereby either tattoo injection-associated trauma or the tattoo pigments and dyes (in their native state or after ultraviolet radiation alteration) or both have a carcinogenic impact on the development of the basal cell carcinoma at that location., Competing Interests: P.R.C. is a paid consultant for ParaPRO. The other authors (C.P.E., N.S.U., and A.C.) have no conflicts of interest to declare., (Copyright © 2020 by S. Karger AG, Basel.)

Melanoma may occur during or after natural or in vitro fertilization-associated pregnancy. A 43-year-old woman, who had received in vitro fertilization and developed a melanoma five months postpartum is described. Some studies have not shown in vitro fertilization to increase melanoma risk; however, several investigations have observed melanoma risk to be greater in women who have had this treatment. Therefore, although a potential increased risk for melanoma has been observed in infertile women who were either pregnant before or following in vitro fertilization, whether in vitro fertilization is an etiologic risk factor in the pathogenesis of melanoma for these individuals-or is merely a coincidental event-remains to be established., Competing Interests: The authors have declared that no competing interests exist.

Background and Objectives: The development of chronic non-healing wounds is multifactorial and can lead to increased patient morbidity. When traditional wound care methods fail, alternative treatments are needed to prevent chronic ulcer complications. Ablative fractional laser resurfacing (AFR) is an emerging therapy for chronic wounds. We report the successful use of AFR to facilitate the healing of chronic wounds in two pediatric patients., Study Design/materials and Methods: This is a case series including two patients with chronic wounds within scars that were treated with a micro-fractionated carbon dioxide (CO2 ) laser in a single pass at a pulse energy of 50 mJ and a treatment density of 5%. One patient had one treatment and the other had two treatments 1 month apart., Results: AFR led to rapid healing of chronic wounds in both pediatric patients. The wounds remained epithelialized after 9 months in one patient and 4 months in the other. There were no complications., Conclusions: The combination of tolerability and efficacy observed in these cases introduces AFR as a potential promising adjunct to existing treatments for chronic, non-healing wounds in the pediatric population., (© 2015 Wiley Periodicals, Inc.)

Importance: Treating posttraumatic lower extremity wounds can be challenging, especially in elderly patients. Recently, the use of fractional carbon dioxide laser has been shown to improve wound healing in scar-related wounds. We used this treatment modality in posttraumatic wounds that were slow to heal in 3 elderly patients., Observations: Each wound underwent one fractional carbon dioxide laser treatment. The wound base was treated at 30 mJ and 5% density. The entire wound edge and 1 to 2 cm into the normal surrounding skin were treated at 50 mJ and 5% density. One pass was completed at 150 Hz per treatment. Treatments were well tolerated with only mild discomfort. Each wound healed by 60% or greater within 3 weeks. No adverse events were reported aside from mild and transient erythema at site of treatment., Conclusions and Relevance: Fractional carbon dioxide laser treatment appeared to accelerate healing in each of these posttraumatic wounds. It may be a helpful adjunct in nonhealing posttraumatic wounds.

The treatment of disfiguring and disabling scars remains a field of active study, reinvigorated with recent advances in techniques and technologies. A variety of approaches can be utilized depending on scar characteristics, location, degree of tissue loss, and associated contractures. Just as traumatic scars can be complex and heterogeneous, the corresponding paradigm for treatment must also be flexible and multimodal for optimal improvement. This report describes a 3-year-old girl with a "mixed" (atrophic/hypertrophic), violaceous, contracted facial scar from a dog bite. It was treated with a novel approach utilizing a multidisciplinary pediatric scar team to combine autologous fat grafting, ablative fractional laser resurfacing, pulsed-dye laser, and laser-assisted delivery of a corticosteroid as concurrent, multimodal therapy to optimize the outcome., (©2015 Frontline Medical Communications.)

Chronic, nonhealing ulcers are a frustrating therapeutic challenge and investigation of innovative therapies continues to be an important research pursuit. One unique and newly applied intervention is the use of ablative fractional lasers. This technology has recently been employed for the treatment of hypertrophic, disfiguring and function-limiting scars, and was first shown to induce healing of chronic wounds in patients with persistent ulcers and erosions within traumatic scars. Recent reports suggest it may be applicable for other types of chronic wounds as well. The mechanism of action for this modality remains to be elucidated but possible factors include laser-induced collagen remodeling, photomicrodebridement and disruption of biofilms, and induction of a proper wound healing cascade., (©2015 Frontline Medical Communications.)

Importance: Despite expert wound care and assiduous management with traditional therapy, poor cosmetic outcomes, restricted motion, and symptoms such as pain and itch are a pervasive problem of disfiguring and debilitating scars. The advent of ablative fractional photothermolysis within the past decade and its application to the treatment of traumatic scars represents a breakthrough in the restoration of function and cosmetic appearance for injured patients, but the procedure is not widely used., Objective: To provide a synthesis of our current clinical experience and available literature regarding the laser treatment of traumatic scars with an emphasis on fractional resurfacing., Evidence Review: Eight independent, self-selected academic and military dermatology and plastic surgery physicians with extensive experience in the use of lasers for scar treatment assembled for a 2-day ad hoc meeting on January 19 and 20, 2012. Consensus was based largely on expert opinion, but relevant literature was cited where it exists., Findings: After consensus was appraised, we drafted the manuscript in sections during the course of several months. The draft was then circulated among all panel members for final review and comment. Our consensus is that laser treatment, particularly ablative fractional resurfacing, deserves a prominent role in future scar treatment paradigms, with the possible inclusion of early intervention for contracture avoidance and assistance with wound healing., Conclusions and Relevance: Laser scar therapy, particularly fractional ablative laser resurfacing, represents a promising and vastly underused tool in the multidisciplinary treatment of traumatic scars. Changes to existing scar treatment paradigms should include extensive integration of fractional resurfacing and other combination therapies guided by future research.

Hidradenitis suppurativa (HS) is a chronic, relapsing, inflammatory skin condition that can have a significant psychosocial impact, both with the active disease and with residual scarring. Although a wide variety of treatment options exist for HS, to our knowledge there are no reported modalities aimed specifically at treating HS scarring. We describe the case of an adolescent female who received medical management of intramammary HS followed by successful treatment with fractionated 10,600-nm carbon dioxide laser for her residual cribriform scarring. We believe there is great potential for the use of fractionated carbon dioxide laser to improve short- and long-term psychosocial outcomes of HS, promote physical scar remodeling, and possibly alter the disease process itself.

Background: Skin compromised by traumatic scars and contractures can manifest decreased resistance to shearing and other forces, while increased tension and skin fragility contribute to chronic erosions and ulcerations. Chronic wounds possess inflammatory mediator profiles and other characteristics, such as the presence of biofilms, that can inhibit healing., Observations: Three patients with multiple traumatic scars related to blast injuries initiated a course of ablative fractional laser therapy for potential mitigation of contractures, poor pliability, and textural irregularity. Patients also had chronic focal erosions or ulcerations despite professional wound care. All patients experienced incidental rapid healing of their chronic wounds within 2 weeks of their initial ablative fractional laser treatment. Healing was sustained throughout the treatment course and beyond and was associated with gradual enhancements in scar pliability, texture, durability, and range of motion., Conclusions: The unique pattern of injury associated with ablative fractional laser treatment may have various potential wound-healing advantages. These advantages include the novel concept of photomicrodebridement, including biofilm disruption and the stimulation of de novo growth factor secretion and collagen remodeling. If confirmed, ablative fractional resurfacing could be a potent new addition to traditional wound and scar treatment paradigms.

Background: Reports describing the use of ablative fractional resurfacing (AFR) for cosmetic improvements in skin dyschromia, rhytides, and textural irregularities are becoming increasingly common in the literature. However, the is little mention of its functional impact on patients with traumatic scars and scar contractures. We present our experience treating scars with AFR, highlighting four illustrative cases and providing a review on possible mechanisms., Methods: Up to three ablative fractional carbon dioxide laser treatments were performed at 1-month to 2-month intervals on four patients with functional deficits related to refractory scar contractures. Treatments were individualized and began as early as 2 months after injury or final reconstructive surgery. Cases were performed in the outpatient clinic using topical anesthetic supplemented by forced air cooling. Postprocedure care included diluted-vinegar compresses two to three times daily and application of ointment over the treatment area for approximately 3 days after the procedure. Postprocedure pain was minimal, and all patients were allowed to resume physical therapy as early as the day of treatment., Results: AFR was well tolerated without serious complications. Durable and cumulative improvements in range of motion or overall skin functionality were noted in all patients. AFR can be surgery sparing and facilitated earlier return to full or modified activities based on associated injuries., Conclusion: AFR is a novel, well tolerated, and effective complement to traditional rehabilitative management for patients with traumatic scars and scar contractures. Potential paradigm shifts include earlier initiation of treatment and a focus on functional improvements., (Copyright © 2012 by Lippincott Williams & Wilkins)

After a decade of military conflict, thousands of wounded warriors have suffered debilitating and cosmetically disfiguring scars and scar contractures. Clearly, there is a need for effective scar treatment regimens to assist in the functional and cosmetic rehabilitation of these patients. Traditional treatments, including aggressive physical and occupational therapy and dedicated wound care, are essential. Adjunctive treatments with established laser technologies, such as vascular lasers and full-field ablative lasers, have had a somewhat limited role in scar contractures due to modest efficacy and/or an unacceptable side effect profile in compromised skin. Refractory scar contractures often require surgical revision, which can be effective, but is associated with additional surgical morbidity and a significant risk of recurrence. Furthermore, current scar treatment paradigms often dictate scar maturation for approximately a year to allow for spontaneous improvement before surgical intervention. Since 2009, the Dermatology Clinic at the Naval Medical Center San Diego has been treating scars and scar contractures in wounded warriors and others using ablative fractionated laser technology. Although traditionally associated with the rejuvenation of aged and photo-damaged skin, our clinical experience and a handful of early reports indicate that laser ablative fractional resurfacing demonstrates promising efficacy and an excellent side effect profile when applied to the functional and cosmetic enhancement of traumatic scars and contractures. This article discusses our clinical experience with ablative fractional resurfacing and its potential prominent role in rehabilitation from traumatic injuries, including a possible shift in scar treatment paradigms toward earlier procedural intervention. Potential benefits include the optimization of scar trajectory and higher levels of full or adapted function in a more favorable time course., (Copyright © 2012. Published by Elsevier Inc.)

Background and Objective: Axillary hyperhidrosis is a rather common idiopathic disorder of the eccrine sweat glands, which can interfere with daily activities and cause significant social distress. The effects of 1064 nm laser hair reduction on sweat production in a pilot study in patients with focal axillary hyperhidrosis are described., Study Design/materials and Methods: In a prospective, case-controlled, randomized pilot study, one axilla from six different subjects with axillary hyperhidrosis was treated with monthly laser hair reduction sessions using the 1064 nm Nd:YAG laser at typical settings. The contralateral axilla acted as a control. Subjects were asked to subjectively classify improvement of axillary sweating using a Global Assessment Questionnaire (GAQ) weekly after each treatment. Qualitative evaluation of sweating was also performed using a modified starch iodine test monthly after each treatment. In addition, prior to the first treatment and at one month following the final treatment, a punch biopsy was performed on the treatment axilla to assess for histologic changes to the eccrine gland and surrounding structures., Results: Statistically significant improvements in subjective ratings of sweating using the GAQ compared to baseline were observed. Objective improvements in sweating with modified starch iodine testing comparing treated versus non-treated axillae were also seen for at least nine months in selected subjects. No significant differences in pre- and post-treatment biopsies were noted on routine histology., Conclusions: Laser hair reduction using the 1064 nm Nd:YAG at laser hair removal settings provides subjective and objective improvements in patients with focal axillary hyperhidrosis.

Background/objective: The purpose of this study was to assess the effects of fluence, pulse stacking, and multiple passes on the depth of injury caused by a fractionated Er:YAG laser in an in vivo farm pig model. DESIGN/MATERIAL/METHODS: A fractionated 2,940 nm Er:YAG laser (Pixel, Alma Lasers, Caesarea, Israel) was applied to the flank skin of a Yorkshire cross pig. The 11 mmx11 mm handpiece was comprised of either 49 or 81 microbeams (200 microm diameter), depending on the tip configuration. There were six different parameter sets divided according to total energy per pulse (150, 285, and 500 mJ) and tip type (81 or 49 microbeams per 11 mmx11 mm macrospot). Each of these six groups was subdivided according to number of stacked pulses (1, 3, and 6) and number of passes (1, 3, and 6). This resulted in a total of 36 treatment parameters., Results: With the 49 microbeam configuration, a single pulse resulted in partial epidermal ablation at 150 mJ, complete epidermal ablation at 285 mJ and partial dermal ablation at 500 mJ to a depth of 90 microm. Stacking the pulses resulted in a significant increase in ablation with each fluence with the maximal depth of ablation measured at 140 microm after six stacked pulses at 500 mJ. Increasing the number of passes did not result in a significant increase in ablative depth, but did create a larger surface area of ablation. Residual thermal damage (RTD) was minimal and remained between 10 and 20 microm., Conclusions: The fractionated Er:YAG laser exhibited some of the same tissue interactions as its fully ablative counterparts. An increase in fluence resulted in an increase in ablative depth with minimal RTD. Additionally, RTD was unaffected by pulse stacking or by additional passes. Differences were that pulse stacking appeared to yield a more rapid decrease in ablation efficiency and additional passes did not seem to increase the depth of ablation.

Background: Several techniques designed to enhance ALA delivery into subcorneal layers of palmar skin are described., Methods: Six palms from three subjects were treated with topical ALA, iontophoresis enhanced delivery of ALA, intradermal injections of ALA solution, or fractionated CO(2) laser (with or without erbium:YAG surface ablation). The relative efficacy of each technique was determined using Wood's lamp illumination for the presence of fluorescent PpIX., Results: Palms treated with topically applied ALA alone or with iontophoresis pre-treatment failed to exhibit fluorescence. The palm treated with intradermal injections of ALA and the palms pre-treated with fractionated CO(2) laser with or without erbium:YAG laser surface ablation exhibited fluorescence at treatment areas., Conclusion: Both intradermal injections and fractionated CO(2) laser (with or without erbium:YAG laser pre-treatment) may provide an effective means for delivery of ALA into subcorneal layers of palmar skin. Numerous potential clinical applications of these techniques (including treatment of localized palmar hyperhidrosis) exist., ((c) 2010 Elsevier B.V. All rights reserved.)

To date, reports on the safe and effective treatment of severe inflammatory facial acne with the low-fluence 1064 nm Nd:YAG laser are limited.The authors report a case of treatment for severe inflammatory acne in a pregnant Asian female (Fitzpatrick skin type IV) with the low fluence 1064 nm Nd-YAG laser.These findings suggest that this modality may be a safe, effective, and well-tolerated alternative for patients with acne who have contraindications to the use of systemic anti-acne therapies.

Photodamage is one of the most common reasons that patients visit a dermatologist's office. Carbon dioxide (CO(2)) laser resurfacing has always been the gold standard for reversing photodamage. Because of the relatively high incidence of side effects and the prolonged downtime associated with CO(2) resurfacing, new technologies have emerged to address photodamage. Portrait skin regeneration (PSR) is a novel device that has been developed to treat photodamage, and this device yields fewer side effects and downtime than traditional CO(2) laser resurfacing. At our center, we have performed more than 500 high-energy PSR treatments and have developed a unique and highly effective treatment protocol. In addition, fractional CO(2) laser resurfacing has emerged as the latest technology developed to combat photoaging. This technology yields impressive results and is much safer and causes less downtime than traditional CO(2) laser resurfacing. In this article, we will review our treatment techniques and protocols as well as address patient selection, preoperative and postoperative care, and anesthesia.

Laser and light technology and their use in dermatology are rapidly advancing. Radiofrequency devices have recently integrated lasers to augment the beneficial effects of both while minimizing potential complications of each. Laser-assisted liposuction is becoming more commonplace, and new investigations into the noninvasive selective destruction of fat with lasers have been undertaken. A better understanding of photobiology has generated renewed interest in the effects of low-level laser therapy on skin and wound healing. Lasers also are being used in novel ways for the purposes of in vivo diagnosis, producing some incredible imaging that may prove useful in the early diagnosis and evaluation of cutaneous disease. Finally, more recent work in the field of photochemical tissue bonding may be bringing us closer to sutureless and scarless surgery. Although not an exhaustive review, this article explores some recent advances in laser and light technologies for dermatologic applications and diagnosis.

Background: Many visible light lasers and intense pulsed light (IPL) devices are available to treat photodamaged skin., Objectives: The objective was to perform a multiple-treatment split-face comparison evaluating a pulsed dye laser (PDL) with a compression handpiece versus IPL for photorejuvenation., Methods: Ten subjects were treated three times at 3- to 4-week intervals. One side of the face was treated with the PDL with compression handpiece, and the other with IPL. One month after final treatment, blinded evaluation assessed for improvements in dyschromias and texture. Patients provided self-assessment of improvement in dyschromias and texture. Time to complete final treatments and pain during all treatments were recorded for each device., Results: Improvement of the PDL was (mean) 86.5, 65, 85, 38, and 40% for dark lentigines, light lentigines, vessels <0.6 mm, vessels >0.6 mm, and texture, respectively, versus 82, 62.5, 78.5, 32.5, and 32%, respectively, for the IPL side. Patient-evaluated difference in improvement for vascular lesions significantly favored the PDL (p=.011). Mean third treatment times were 7.7 minutes for PDL versus 4.6 minutes for the IPL (p=.005). Mean pain ratings were 5.8 for the PDL and 3.1 for the IPL (p=.007). Purpura-free procedures depended on proper technical use of the compression handpiece when treating lentigines with the PDL., Conclusions: The PDL with compression handpiece and IPL are highly effective for photorejuvenation.

Background and Objectives: In traditional pulsed dye lasers (PDLs), power limitations and pulse characteristics have compromised purpura-free procedures. This study evaluated a new PDL with a modified pulse structure and a 10-mm beam diameter for purpura-free photorejuvenation. A compression handpiece was used for targeting lentigines., Materials and Methods: Twenty patients with skin types I to III were treated three times at 3- to 4-week intervals. The first pass was delivered through a 10-mm compression handpiece to target pigment dyschromias using fluences between 6.5 and 8.0 J/cm(2) with a 1.5-ms pulse duration. A second pass was then performed with a 10-mm spot with fluences between 9.5 and 10 J/cm(2), a 20-ms pulse duration, and cryogen spray enabled. Improvement was evaluated by comparing pre- and posttreatment photographs and live subjects 1 month after the third treatment., Results: In the majority of patients, >90% reduction of fine telangiectasias (<0.6 mm) and dark lentigines was achieved. Pigmented dyschromias improved proportional to the degree of pigment at presentation. Avoidance of purpura with the compression handpiece was dependent on obtaining proper compression before laser emission. Mean textural improvement was 34%., Conclusions: The new 595-nm PDL is highly effective for two-pass purpura-free improvement of telangiectases, pigment dyschromias, and texture.

Background and Objectives: Acne scarring is a common and difficult to treat condition. The plasma skin regeneration (PSR) system is a novel device that causes delayed ablation of the epidermis and controlled thermal modification to the underlying dermis. PSR has previously been shown to be a safe and effective treatment for facial rhytides and benign skin lesions. In this study, we investigated the safety and efficacy of single-treatment, high-energy, double-pass PSR for the treatment of acne scarring., Study Design/materials and Methods: Ten patients with acne scarring and Fitzpatrick skin types I-III were included in the study. All patients underwent a single PSR treatment with two high-energy passes (3.5-4.0 J). Treatments were performed in an outpatient clinic setting. Nine patients completed 6 months of follow-up. Improvement was determined by patient questionnaires and physician evaluation of digital photographs taken prior to treatment and at 3 and 6 months post-treatment., Results: On average, patients reported 34% improvement in their acne scarring at 3 months and 33% improvement at 6 months. Blinded physician ratings of patient photos demonstrated 19% improvement at 3 months and 34% at 6 months. Re-epithelialization was complete by 4-6 days after treatment, and no serious adverse events were encountered., Conclusion: PSR appears to provide a safe and effective single treatment, minimal downtime alternative for the treatment of acne scarring. Additional studies are warranted to further demonstrate the safety and efficacy of this device.

Background: Purpura-free elimination of telangiectases with a single pass of a pulsed dye laser with a large spot has proved difficult., Objective: The purpose of this report was to define parameters that achieve single-pass purpura-free telangiectasia reduction., Materials: Thirty patients between the ages of 23 and 78 years were treated with a pulsed dye laser with a 10-mm spot and fluences ranging from 9 to 10 J/cm2. The macropulse width was 20 ms. Each macropulse was composed of eight pulselets. Treatments were carried out over facial areas with discrete telangiectases., Results: Smaller telangiectases (<600 microm) showed transient bluing followed by stenosis. Larger vessels (600-10,000 microm) showed bluing but inconsistent closure. A second pass typically resulted in closure., Conclusion: A modified pulsed dye laser was capable of single-pass purpura-free reduction with a 10-mm spot size.

Background: Although effective as a monotherapy for the treatment of inflammatory acne, the 1,450-nm diode laser is associated with considerable pain at higher fluences., Materials and Methods: Eleven subjects were treated with a 1,450-nm diode laser in a split-face bilateral paired acne study. One-half of the face received a single-pass consisting of stacked double pulses. The other side received a double-pass treatment of single pulses. Settings were 11 J/cm(2) or lower as tolerated with appropriate dynamic cooling device (range 25-35)., Results: The mean pain rating was 5.33 on a 0 to 10 scale on the stacked-pulse treatment side and 5.12 on the double-pass side. Blinded reduction in mean acne lesion counts were 57.6% and 49.8% reduction, respectively. An overall acne scar improvement was seen in 83% of subjects with acne scarring. Transient hyperpigmentation occurred in two patients on the stacked pulse side and completely resolved without sequelae., Conclusions: The pulsed 1,450-nm diode laser can be used at lower fluences that elicit less discomfort yet effectively improve inflammatory acne. Stacking pulses appears to render a slightly higher efficacy than the multipass technique. Single-pulse, multiple-pass treatments may have a lower risk of cryogen-induced transient hyperpigmentation compared to standard high fluence techniques.

Background and Objectives: Pulsed 595 nm and 532 nm lasers can effectively diminish or eliminate facial telangiectasia. We performed a split-face, single-blind, controlled, comparison study in an effort to determine their individual and comparative efficacy., Study Design/materials and Methods: Fifteen patients were treated using a 595-nm PDL on one side of the face and a pulsed 532-nm potassium-titanyl-phosphate (KTP) laser on the other. Each subject was evaluated at 3 weeks after three treatments., Results: Both devices improved telangiectasia. The 532-nm device, however, was at least as effective or more effective than the 595-nm laser in all subjects. On average, the KTP laser achieved 62% clearing after the first treatment and 85% clearing 3 weeks after the third treatment, compared to 49% and 75% for the PDL, respectively. Seventy-nine percent of KTP laser-treated patients continued to have swelling for greater than 1 day versus 71% of PDL-treated patients. Of those patients who noted persistent erythema for at least 1 day after treatment, 58% noted more erythema on the KTP laser-treated side compared to 8% on the PDL-treated side., Conclusions: Both the 595-nm and the 532-nm pulsed lasers are highly effective in the treatment of facial telangiectasia and redness. The 532-nm KTP laser appears to be more effective but causes more swelling and erythema.

Laser treatment of vascular lesions remains one of the more common applications of lasers in dermatology. In fact, lasers have largely become the treatment of choice for vascular birthmarks such as hemangiomas and port-wine stains and the definitive treatment of the telangiectatic form of rosacea. The range of congenital and acquired vascular lesions effectively treated with lasers continues to expand.

With the advent of short contact and pulsed light techniques, topical 5-aminolevulinic acid photodynamic therapy (5-ALA PDT) has become a viable clinical modality. Intense pulsed light, the pulsed dye laser, and blue light-emitting lamps have become the most commonly used devices in inducing a cosmetic PDT effect. More recently, by combining the photothermal effects of pulsed light with the photochemical effects of PDT, an enhanced cosmetic effect has been demonstrated in a variety of dermatologic conditions. In addition, the use of shorter 5-ALA incubation times allows for improved patient tolerance during treatment and subsequently fewer adverse effects in the postoperative period. A review of the current literature on cosmetic uses of PDT as well as our personal techniques are discussed in detail.