585-nm Flashlamp-pumped Pulsed Dye Laser Research Articles

Factors Associatedwith with the Development of Striae Gravidarum

Abstract Background and aim: Striae Gravidarum is one of the common skin changes during pregnancy. There are several risk factors for striae development. The aim of this study was to survey of associated factors with the development of striae gravidarum. Materials and methods: A convenience sample of 325 primiparous women were assessed during the immediate postpartum period for evidence of SG. Data were collected by a questionnaire and physical examination. The presence and and severity of striae was evaluated by Davey’s score. To determine the possible risk factors for the development of SG, characteristics of women with and without striae were compared using chi square test, independent t test and logistic Regression. Findings: In 182 (81.3%) of participants striae gravidarum was developed. Development of SG in 174 of 182 women (95.6%) was on the abdomen, 110 of 182 (60.4%) was on the thighs and in 74 of 182 (40.6%) SG was developed on the breasts during their pregnancy. Mean and SD of Davey score in breast, abdomen and thighs were (1.08 ± 1.55), (4.31 ± 2.21) and (1.76 ± 2.02) respectively. Family history of SG in mother, weight gain and body mass index during pregnancy and newborn weight, were signi fi cantly associated with the development of SG. Conclusions: This study showed that genetic factors (family history of striae gravidarum) and physical factors (weight gain and body mass index during pregnancy) may have a significant role in development of striae gravidarum. Therefore, conducting studies in the future to identify how these factors can cause striae gravidarum seem to be helpful. Keywords: Striae Gravidarum, Striae, Prevalenceو Risk Factors. REFERENCES Atwal GS ML, Griffiths CE, Polson DW (2006) Striae Gravidarum in Primipae. British Journal of Dermatology . 155(5) 965-9. Chang AL Agredano YZ Kimball AB (2004) Risk Factors Associated with Striae Gravidarum. Journal of the American Academy of Dermatology , 51(6) 881-5. Cunningham FG, Bloom SL, Leveno KJ (2010) Williams Obstetrics 23rd Ed. New York: McGraw-Hill. Davey CM(1972) Factors Associated with the Occurrence of Striae Gravidarum. An International of Journal Obstetrics and Gynecology . 79(12) 1113-4. Durmazlar SPK, Eskioglu F(2009) Striae Gravidarum: Associated Factors in Turkish Primiparae. Journal of the Turkish Academy Dermatology , 3(4) 93401a. Fitzpatrick TB(1988) The Validity and Practicality of Sun-Reactive Skin Types I Through VI. Archives of Dermatology . 124(6) 869. Gabbe S.G. NJR, Simpson J.L (2002) Obstetrics: Normal and Problem Pregnancies . 4th Ed. New York (NY): Churchill Livingstone. Ghasemi A, Gorouhi F, Rashighi Firoozabadi M, Jafarian S, Firooz A (2007) Striae Gravidarum: Associated Factors. Journal of the European Academy of Dermatology and Venereology . 21(6) 743-6. Lerdpienpitayakul R, Manusirivithaya S, Wiriyasirivaj B, Lorwatthanasirikul J(2009) Prevalence and Risk Factors of Striae Gravidarum in Primiparae. Thai Journal of Obstetrics and Gynaecology . 17(2) 70-9 Liu D(1974) Letter:Striae gravidarum. Lancet. 1(7858) 625. McDaniel DH, Ash K, Zukowski M(1996) Treatment of Stretch Marks with the 585-nm Flashlamp-Pumped Pulsed Dye Laser. Dermatologic Surgery . 22(4) 332-8. Osman H, Rubeiz N, Tamim H, Nassar AH (2007) Risk Factors for the Development of Striae Gravidarum. American Journal of Obstetrics and Gynecology . 196(1) 62 e1-5. Ratree JO, Titapant V, Chuenwattana P, Tontisirin P (2008) Prevalence and Associate Factors for Striae Gravidarum. Journal of the Medical Association of Thailand = Chotmaihet Thangphaet . 91(4) 445-51. Salter SA, Batra RS, Rohrer TE, Kohli N, Kimball AB (2006) Striae and Pelvic Relaxation: Two Disorders of Connective Tissue with a Strong Association. Journal of Investigative Dermatology . 126(8) 1745-8. Shuster S. 1979. The Cause of Striae Distensae. Acta Dermato-Venereologica Supplementum , 59(85) 161. Thomas R, Liston W(2004) Clinical Associations of Striae Gravidarum. Journal of Obstetrics & Gynecology . 24(3) 270-1. Wade TR, Wade SL, Jones HE (1978) Skin Changes and Diseases Associated with Pregnancy. Obstetrics & Gynecology .52(2) 233-42. Watson R, Parry E, Humphries J, Jones C, Polson D, Kielty C, et al (1998) Fibrillin Microfibrils Are Reduced in Skin Exhibiting Striae Distensae. British Journal of Dermatology . 138(6) 931-7. Wong RC, Ellis CN. 1984. Physiologic Skin Changes in Pregnancy. Journal of the American Academy of Dermatology , 10(6) 929-40.

Effects of lower fluence pulsed dye laser irradiation on production of collagen and the mRNA expression of collagen relative gene in cultured fibroblasts in vitro

Lower fluence of 585-nm flashlamp-pumped pulsed dye laser has been successfully used as a nonablative technique in the treatment of wrinkles. The objective of this study was to evaluate the effect of the pulsed dye laser (585 nm) on the production of collagen and the mRNA expression of collagen related gene in fibroblasts in vitro. Cultured fibroblasts were treated with a 585-nm flashlamp-pumped pulsed dye laser (fluence 3 J/cm(2), 4 J/cm(2), spot size 7 mm, pulse duration 450 micros). The production of collagen and the mRNA expression of transforming growth factor (TGF)-beta1, SMAD2, SMAD3, SMAD4, SMAD7 and type I procollagen alpha1, alpha2 in fibroblasts were investigated by colorimetry or real time polymerase chain reaction. The production of collagen was significantly up-regulated after treatment with a 585-nm flashlamp-pumped pulsed dye laser with a fluence of 3 J/cm(2) (P < 0.001). The mRNA expression of TGF-beta1, SMAD2, SMAD3, SMAD4, SMAD7 and procollagen I was significantly up-regulated after treatment with a 585-nm flashlamp-pumped pulsed dye laser with a fluence of 3 J/cm(2) (P < 0.001). No significant difference of mRNA expression of SMAD2, SMAD3, SMAD4, SMAD7 and type I procollagen was found between controls and fibroblasts treated with pulsed dye laser with a fluence of 4 J/cm(2) (P > 0.05). Lower fluence (3 J/cm(2)) pulsed dye laser increased the collagen production in fibroblasts by up-regulating TGF-beta1, SMAD2, SMAD3, SMAD4, SMAD7 and type I procollagen mRNA expression. These may be the reason it can be effectively used in the treatment of wrinkles.

New Combination of Triamcinolone, 5-Fluorouracil, and Pulsed-Dye Laser for Treatment of Keloid and Hypertrophic Scars

Keloids and hypertrophic scars are benign growths of dermal collagen that usually cause major physical, psychological, and cosmetic problems. In this 12-week single-blinded clinical trial, 69 patients were randomly assigned into three study groups. In Group 1, intralesional triamcinolone acetonide (TAC, 10 mg/mL) was injected at weekly intervals for a total of 8 weeks. In Group 2 [TAC+5-fluorouracil (5-FU)], 0.1 mL of 40 mg/mL TAC was added to 0.9 mL of 5-FU (50 mg/mL). This combination was injected weekly for 8 weeks. In Group 3, in addition to weekly TAC+5-FU injection for 8 weeks, lesions were irradiated by 585-nm flashlamp-pumped pulsed-dye laser (PDL, 5-7.5 J/cm2) at the 1st, 4th, and 8th weeks. Lesions were assessed for erythema, pruritus, pliability, height, length, and width. Sixty patients completed the study. At the 8- and 12-week follow-up visits, all groups showed an acceptable improvement in nearly all measures, but in comparison between groups, these were statistically more significant in the TAC+5-FU and TAC+5-FU+PDL groups (p<.05 for all). At the end of the study, the erythema score was significantly lower, and itch reduction was statistically higher in the TAC+5-FU+PDL group (p<.05 for both). Good to excellent improvements (>50% improvement) were reported by the patients as follows: 20% in Group 1, 55% in Group 2, and 75% in Group 3, all of which were significantly different (p<.05). Good to excellent responses were reported by the blinded observer as follows: 15% in Group 1, 40% in Group 2, and 70% in Group 3. Their differences were statistically significant (p<.05). Atrophy and telangiectasia were seen in 37% of patients in TAC group. Overall efficacy of TAC+5-FU was comparable with TAC+5-FU+PDL, but the TAC+5-FU+PDL combination was more acceptable by the patients and produced better results. Its effect on lightening of the lesion was promising. The TAC+5-FU+PDL combination seems to be the best approach for treatment of keloid and hypertrophic scars.

Treatment of Facial Scarring and Ulceration Resulting from Acne Excoriée with 585-nm Pulsed Dye Laser Irradiation and Cognitive Psychotherapy

BACKGROUND Self-inflicted skin ulcers and scars are often observed in patients with compulsive skin picking. The term “neurotic excoriation” has been used to describe this condition and may or may not coexist with other true skin pathologies, such as acne. The condition poses a diagnostic and treatment challenge because patients often also have an undiagnosed underlying psychologic disorder. CASE REPORTS Two patients with numerous linear and stellate facial ulcers and hypertrophic and erythematous scars were diagnosed with acne excoriée in the setting of an obsessive-compulsive disorder linked to emotional stress and anxiety. The scars were treated with a 585-nm flashlamp-pumped pulsed dye laser using a 7-mm spot size, 1.5-msec pulse duration, and fluence range of 4.5 to 6.0 J/cm2. The patients received concomitant cognitive psychodynamic therapy to halt the cycle of impulse-driven skin picking and ulcer/scar formation. Marked clinical improvement of the scars and successful treatment of the acne excoriée were achieved with this combination approach. Relapses occurred when psychodynamic intervention was interrupted. conclusion The 585-nm flashlamp-pumped pulsed dye laser improves the appearance of hypertrophic erythematous facial scars and ulcers in patients with severe acne excoriée. Proper diagnosis of underlying impulse-control disorders and ongoing psychodynamic therapy is necessary to maintain improvement.

Energy density and numbers of treatment affect response of keloidal and hypertrophic sternotomy scars to the 585-nm flashlamp-pumped pulsed-dye laser

Background: The 585-nm flashlamp-pumped pulsed-dye laser (PDL) has proven to be the treatment of choice for certain keloids and hypertrophic scars, but the precise fluence, numbers of treatment, and treatment interval remain anecdotal. Objective: This study was performed to determine whether the therapeutic outcome of the PDL varies with the energy density (fluence) of the laser pulses and numbers of treatment. Method: Ten previously untreated, erythematous, keloidal or hypertrophic median sternotomy scars of 10 patients were divided into 4 segments and were randomly treated with a 585-nm PDL at a fluence of 3, 5, and 7 J/cm2 to 3 of 4 segments every 4 weeks for a total of 6 treatment sessions. One segment of each patient's scars was untreated and served as a control. Clinical improvement including scar height, erythema, and pliability was evaluated before treatment and every 8 weeks for a total period of 32 weeks. Self-assessment was also determined by patients on a 25% increment of improvement scale comparing week 0 and week 32. Results: A significant improvement in scar height, erythema, and pliability was noted in all laser-treated scar areas. There was no significant difference in treatment outcome versus the fluence of the laser (3, 5, and 7 J/cm2), although there was a trend for lower fluences to show more improvement. Objective clinical improvement was seen as early as week 16, after more than two treatments were given. Multiple treatments (>2) appeared to provide a greater percentage of scar resolution. Conclusions: The clinical improvement of scars after PDL treatment demonstrates no statistically significant fluence dependence in this study, but a trend toward better response with lower fluences is seen. In addition, multiple treatment sessions are suggested for achieving greater response. (J Am Acad Dermatol 2001;45:557-65.)

Time-sequence histologic imaging of laser-treated cherry angiomas with in vivo confocal microscopy

Objective: To chronicle the pathophysiologic changes that occur subsequent to laser treatment of vascular lesions, we used a confocal scanning laser microscope that yields high-resolution microscopic images of skin in vivo. Methods: Cherry angiomas were treated with the 585-nm flashlamp-pumped pulsed-dye laser (PDL) and the 568-nm continuous-wave krypton laser. Repeated confocal reflectance imaging was performed before and immediately after treatment, as well as after several hours, 1 day, 2 days, 1 week, 2 weeks, 3 weeks, and 4 weeks. Results: Before treatment, confocal images revealed dilated blood vessels ranging from 10 to 50 μm in caliber, closely spaced at 5 to 50 μm apart. After PDL treatment, amorphous cords of refractile material conformed to the shape of the original vessels, followed by dark nonrefractile spaces where the vessels once were. Inflammation and necrosis ensued, with eventual replacement after 3 weeks by normal-appearing skin. After krypton laser treatment, dark nonrefractile spaces appeared immediately, with subsequent inflammation, necrosis, and eventual healing by 4 weeks. Conclusion: Confocal laser microscopic imaging elucidates the dynamic pathophysiologic events that occur after laser treatment of vascular lesions and has added insight into the different mechanisms of vessel damage induced by the PDL and krypton laser. (J Am Acad Dermatol 2000;43:37-41.)

Progressive ascending telangiectasia treated with the 585nm flashlamp-pumped pulsed dye laser

Progressive ascending telangiectasia (PAT) is a distinct entity with telangiectatic superficial vessels on lower extremities as its main clinical feature. A relationship with occult infections and response to antibiotic and antifungal drugs have been described, although not all cases can be successfully managed with these therapies. Our objective was to treat a woman with PAT that had failed to respond to systemic antibiotic and antifungal drugs. A 44-year-old woman with PAT was treated with the flashlamp-pumped pulsed dye laser at 585 nm, with fluences varying from 7 to 7.25 J/cm2. A successful outcome was obtained with this treatment approach, with no relevant adverse effects except for mild pigmentary changes. Although ectatic vessels on lower extremities are often resistant to dye laser therapy, superficial thin capillaries like those featuring PAT can be eliminated with the pulsed dye laser at 585 nm. Transient pigmentary changes occur on treated areas but they are expected to disappear in 6 to 12 months after treatment. Laser treatment should be considered in PAT despite the extension and location of the lesions.

Treatment of keloid sternotomy scars with 585-nm flashlamp-pumped pulsed-dye laser

Treatment of keloid sternotomy scars with 585-nm flashlamp-pumped pulsed-dye laser

Treatment of Keloid Sternotomy Scars with 585-nm Flashlamp-Pumped Pulsed-Dye Laser

Treatment of Keloid Sternotomy Scars with 585-nm Flashlamp-Pumped Pulsed-Dye Laser

Treatment of Keloid Sternotomy Scars with 585-nm Flashlamp-Pumped Pulsed-Dye Laser

Treatment of Keloid Sternotomy Scars with 585-nm Flashlamp-Pumped Pulsed-Dye Laser

Focal dermal hypoplasia (Goltz's syndrome). Treatment of cutaneous lesions with the 585-nm flashlamp-pumped pulsed dye laser

REPORT OF A CASE A 26-year-old white woman presented with widespread erythematous atrophic patches over the trunk, neck, and extremities, several of which were raised and roughened and arranged in a linear pattern ( Figure 1 ). Telangiectases were scattered over the body, and some of the erythematous patches at the neck and shoulders also appeared hyperpigmented. The patient was noted to have dystrophic and brittle fingernails. Symptoms included itching and burning of the skin lesions, especially those at the lower extremities. The clinical appearance and symptomatology of the skin lesions had noticeably worsened over the 5 years before presentation. Detailed history revealed that the cutaneous lesions had been present since birth and had unsuccessfully been treated through the years with a variety of topical emollients. A skin biopsy specimen of a typical lesion revealed dilated vessels without endothelial cell proliferation within a thinned dermis. Syndactyly of the first two toes of

Improvement of Erythematous and Hypertrophic Scars by the 585-nm Flashlamp-pumped Pulsed Dye Laser

Fourteen patients with erythematous and/or hypertrophic scars resulting from remote surgical excision or trauma were evaluated and subsequently treated with one to two flashlamp-pumped pulsed dye (585 nm) laser treatments over a 2-month period. Clinical assessments were performed before commencement and at the end of the study in all 14 patients. Skin surface texture analyses using optical profilometry were obtained from 5 of the patients before and after laser irradiation. A 57% to 83% clinical improvement was seen in the scars after one to two dye laser treatments, respectively. In addition, a change in the skin texture with return of skin markings approximating those of normal skin measured by optical profilometry was observed in the scars after the pulsed dye laser treatments. The degree of clinical improvement seen at the end of the study continued to be evident in each patient at the 6-month follow-up examination.

Lichen Sclerosus et Atrophicus Treatment With the 585-nm Flashlamp-Pumped Pulsed Dye Laser

To the Editor.— Lichen sclerosus et atrophicus has frequently been reported to occur in children, the most common sites involved being the genital areas in both girls and boys.1Although dermatologists are very familiar with this entity and its occurrence in prepubertal children, lichen sclerosus et atrophicus is often misdiagnosed by other clinicians, typically as sexual abuse,2as evidenced by this case. Symptomatology usually includes pruritus and sometimes pain, but significant bleeding has rarely been described in the literature. Topical fluorinated corticosteroids are prescribed most frequently, as topical testosterone is not indicated in prepubertal girls. This case demonstrates successful use of the 585-nm flashlamp-pumped pulsed dye laser for treating bleeding telangiectases of prepubertal lichen sclerosus et atrophicus. This form of treatment has not previously been reported for this condition. Report of a Case.— A 7-year-old girl presented in December 1990 for treatment of a vulvar hemangioma. Her parents