Independent Dermatologists Research Articles

Enhancing hair growth in male androgenetic alopecia by a combination of fractional CO2 laser therapy and hair growth factors.

Laser therapy and growth factors have been used as alternative treatments for male androgenetic alopecia (MAA). The aim of this study is to determine the efficacy and safety of hair growth factors alone or combined with ablative carbon dioxide (CO2) fractional laser therapy in MAA. Twenty-eight men were enrolled in this randomized half-split study based on a left-head to right-head pattern. Fractional CO2 laser treatment was unilaterally performed; hair growth factors were bilaterally applied. Six sessions with 2-week intervals were performed. Global photographs and dermoscopy assessments were performed at the baseline and 4months after first treatment. Global photographs underwent blinded review by three independent dermatologists. Scanning electron microscopy was used to compare changes in hair-follicle phase and hair-shaft diameter. Twenty-seven participants completed the 4-month treatment schedule. One patient was lost. Mean hair density increased from 114±27 to 143±25/cm2 (P<0.001) in the combined group and from 113±24 to 134±19/cm2 in the growth factor group (P<0.001). The mean change from baseline between two groups was also compared (P=0.003). Global photographs showed improvement in 93% (25/27) patients in the combined group and 67% (18/27) patients in the growth factor group. Under scanning electron microscopy, hair follicles appeared to transition from telogen to anagen, and hair-shaft diameter increased in five randomly selected patients. Ablative fractional CO2 laser combined with hair growth factors may serve as an alternative treatment for MAA in individuals unwilling/unable to undergo medical or surgical treatment.

Clinical efficacy and safety evaluation of a novel fractional unipolar radiofrequency device on facial tightening: A preliminary report.

Previous studies have shown that radiofrequency (RF) energy is safe and effective for improving skin laxity. Unlike monopolar and bipolar devices, little has been studied with the unipolar hand piece. We sought to evaluate the safety and efficacy of a novel fractional unipolar RF device on facial tightening. This was a retrospective, single-center study of 14 subjects with age-related facial laxity who underwent five sessions of fractional unipolar RF at an interval of 2 weeks, and then followed-up for 3 months. Standardized photos were taken at baseline and at 3-months follow-up, and were assessed by two independent dermatologists using a 4-point scale (0=no improvement, 1=mild improvement, 2=moderate improvement, 3=significant improvement). Punch biopsies (2 mm) were performed and a questionnaire was used to evaluate the patient's satisfaction and the incidence of adverse reactions. Fourteen subjects with mild to moderate age-related facial laxity were included in the study. The mean age of the subjects was 49.7 years (range 32-80). 35.7% of the subjects showed significant improvement, 50% moderate improvement, and 14.3% slight improvement of facial laxity in their follow-up photos. About 85.7% of the patients replied that they were either greatly satisfied or satisfied with the results at 3-months follow-up. Skin biopsies revealed an increase in collagen in the dermis. None of the subjects experienced any serious adverse events during or after the procedure. Our findings suggest that fractional Unipolar RF can be safely performed on the face and is effective in skin tightening. It has a great advantage over other forms of RF by being entirely painless.

Treatment of vitiligo with 308-nm excimer laser: our experience from a 2-year follow-up of 979 Chinese patients.

The 308-nm excimer laser had been proved to be a time-efficient and potent therapeutic alternative for the management of vitiligo. Different results had been reported in different ethnic populations. To investigate the efficacy and related contributing factors of 308-nm excimer laser in Chinese vitiligo patients. A total of 979 Chinese patients (3478 lesions) with progressive-stage vitiligo who had received 308-nm excimer laser treatment were recruited from the vitiligo clinic of Shandong Provincial Hospital of Dermatology &Venereology from 2012 to 2014. Efficacy of treatment was evaluated at the end of session by two independent dermatologists based on the before and after images taken. Repigmentation was graded on a 4-point scale: grade 1, poor repigmentation (0-25%); grade 2, moderate repigmentation (26-50%); grade 3, good repigmentation (51-75%); grade 4, excellent repigmentation (76-100%). The mean grade of repigmentation was 2.29, 44.22% showed less than 25% repigmentation, 16.27% showed 26-50% repigmentation, 5.95% showed 51-75% repigmentation and 33.55% showed more than 76% repigmentation. The repigmentation of facial lesions was better than lesions located elsewhere (P < 0.0001), the best response was noted in the periorbital region, while lesions on hands and feet showed poor repigmentation (P < 0.0001). The degree of repigmentation was negatively correlated with disease duration (r = -0.268, P < 0.001), age (r = -0.095, P < 0.001) and shape of lesions (r = -0.114, P < 0.001), whereas it was positively correlated with treatment frequency (r = 0.270, P < 0.001). Lesions with concurrent poliosis were more likely resistant to treatments. 308-nm excimer laser appears to be an effective and safe treatment in Chinese vitiligo patients. The clinical response and treatment efficacy was affected by many factors such as age, affected anatomical area, shape of the lesion, disease duration and treatment frequencies.

Electrosurgery in Dermatosis papulosa nigra: An effective, well-tolerated but less documented tool

&lt;p&gt;Dermatosis papulosa nigra (DPN) is a superficial, black or brown benign papule that develops mainly in dark-skinned individuals over the face and neck. Clinically seborrheic keratosis shows a stuck-on appearance that differentiates it from DPN. Histopathological examination described that both were identical. Many types of lasers are used as treatments for it. Traditional surgical procedures such as curettage, electrosurgery, and snip/shave excision are still considered as a therapeutic modality. Although electrodessication (ED) is a simple procedure, studies on ED use for DPN with a good number of cases are lacking. This paper presents the evaluation safety, efficacy and cost-effectiveness of ED for the treatment of DPN in Fitzpatrick’s skin type IV to VI. A total of 40 patients (11 male and 29 female) with DPN over the face and neck with skin type IV–VI were included. Superficial ED (monopolar, low, 2–3.5 W) was done by just touching the lesion under topical anesthesia. All preoperative photographs as well as 2-, 4- and 8-week post-procedure photographs were examined by two independent dermatologists who had no prior information concerning the procedure, (both known hereafter as “blinded observer”): one for examining efficacy in terms of poor improvement (0%–25%), fair (26%–50%), good (51%–75%), or excellent (76%–100%), by counting completely cleared lesions; and the other for examining side effects in terms of hypo/hyperpigmentation and scarring. As a result, 85% of patients showed excellent improvement (&amp;gt;75% clearance), 7.5% good (51%–75% clearance), 5% fair (26%–50% clearance) and 2% poor (0–25% clearance) as measured by the “blinded” observer. Post-inflammatory hyperpigmentation was observed in 15% cases, whereas hypo-pigmentation was documented in 7.5% cases. Only in two cases (5%) was lesional scarring noted. Those complications were cleared after eight weeks. In this study, ED was observed to be an effective, well-tolerated and cost-effective method for treatment of DPN in colored skin. Complications were few, and therapy was performed appropriately with effective postoperative measures.&lt;/p&gt;

Tightening effects of high-intensity focused ultrasound on body skin and subdermal tissue: a pilot study.

High-intensity focused ultrasound (HIFU) has been introduced as a new treatment modality for skin tightening through application mainly to the face and neck. This pilot study assessed the efficacy and safety of HIFU for body tightening in Asian females. Six Asian female adults were enrolled in this pilot study. All subjects were treated with HIFU to the both cheek, upper arm, lower abdomen, thigh and calf using the following probes: 7 MHz, 1.5 mm focal depth; 2 MHz, 3.0 mm focal depth; 2 MHz, 4.5 mm focal depth; 2 MHz, 6.0 mm focal depth and 2 MHz, 9.0 mm focal depth. Three blinded independent dermatologists assessed results using the Investigator Global Aesthetic Improvement Scale (GAIS) using paired pre- and post-treatment (week 4) standardized photographs. Also, we evaluated skin elasticity at all treated sites using a cutometer. Participants used the subject GAIS to assess their clinical improvement after treatment and rated their pain using a visual analogue scale (VAS) immediately, 1 and 4 weeks after treatment. The three blinded evaluators judged all treated sites as showing clinical improvement 4 weeks after treatment. Skin elasticity measured via cutometer was significantly improved 4 weeks after treatment at all treated sites (P < 0.05). All patients scored themselves subjectively as more than 'improved' on the GAIS. Immediately after treatment the mean VAS score was 5.17 ± 2.48, but no pain was reported at weeks 1 and 4. No permanent adverse effects were observed during the follow-up period. For body tightening, we applied HIFU using transducers with a lower frequency and deep focal depth to effectively deliver ultrasound energy to skin tissues. HIFU appears to be a safe and effective treatment modality for dermal and subdermal tightening.

Dermal Tunneling (TD®): a therapeutic option for static glabellar wrinkles

Introduction: Despite the existence of well-established therapeutic approaches, static glabellar wrinkles arise as a challenge. The subincision is a technique commonly used for the improvement of these lesions. Objectives: The present article proposes a new methodology for the undermining of static glabellar wrinkles termed and registered by the author as Dermal Tunneling (TD®). Methods: Twelve patients who underwent dermal tunneling carried out by the same physician, according to the same methodology, were retrospectively assessed through direct observation, photographic analysis and self-assessment questionnaires. Results: All patients reported that the results were good or very good. The evaluation carried out by two independent dermatologists, based on before and after photographs, showed that two patients had regular outcomes (25% improvement), five had good outcomes (50% improvement) and five had very good outcomes (75% improvement). Conclusion: Dermal Tunneling (TD®) can be considered an effective, safe and reproducible treatment.

Pulsed dye laser in treatment of steroid‐induced atrophy

One of the important and distressing cutaneous side effects of steroid therapy is skin atrophy, which has no definite and effective treatment. To the best of our knowledge, laser therapy for steroid-induced atrophic scars has not been investigated to date. The aim of this study was to evaluate the efficacy and safety of pulsed dye laser in the treatment of steroid-induced atrophic scars. In this pilot study, 15 patients with at least one atrophic patch were treated with the 585-nm pulsed dye laser at 4-week interval sessions until achieving complete improvement or until patient were lost to follow-up. Clinical outcome was assessed via standard photographic method before each treatment session and after the final visit. An independent dermatologist evaluated the photographs. All of the patients (13 females and two males) with 25-59years of age experienced some degree of improvement, except one patient who withdrew from the treatment after three sessions. The treatment was well tolerated. The results of our study indicated that pulsed dye laser therapy could be employed as a new method in the treatment of steroid-induced atrophic scars. Pulsed dye laser might affect the lesions through inducing collagen deposition and production of more superficial dermal elastin as well as less unidirectional collagen in clusters.

Treatment of port wine stains with pulsed dye laser: a retrospective study of 848 cases in Shandong Province, People's Republic of China.

BackgroundCurrently, 595 nm pulsed dye laser (PDL) therapy is offered as one of the effective treatments of port wine stains (PWSs). However, the efficacy of PDL differs in different populations.ObjectiveThe purpose of the study was to investigate the efficacy, and related factors, of 595 nm PDL in the treatment of PWSs in Chinese patients with skin type III to IV.MethodsA total of 848 cases that were treated with PDL were enrolled and analyzed in this study. An independent dermatologist evaluated these lesions according to the before and after photographs.ResultsThe response rate (RR) of all the 848 PWS patients was 69.9%, within which the cure rate was 6.3%. The patients aged ≤1 year had the highest RR (93.9%), whereas those treated after age 50 reacted the worst (RR =25%). We analyzed the anatomical distribution of the lesion and found that the temporal region had the highest lesion clearance (RR =75.3%), while the extremities had the lowest clearance (RR =44.5%). Compared with the patients whose lesion size was larger than 80 cm2, the patients with small lesion size, of 0–20 cm2, had better clinical effect (RR =73.8% vs 53.2%). The reactions of the patients with hyperplastic lesion were worse than those with red patches (RR =36.4% vs 71.7%). As well, increasing treatment numbers could achieve higher clearance rates (P=0.005).ConclusionThe PDL had a relatively high RR but a low clearance rate in Chinese patients with PWS, although the earlier the intervention, the better was the efficacy. The response of PDL was, not only related to the anatomical area, but also, to the lesion size, type of lesion (ie, the presence of existing hyperplastic lesions), and the number of treatment, all of which are essential for the evaluation of therapeutic effect and acquisition of patients consent before treatment.

A split-face, evaluator-blind randomized study on the early effects of Q-switched Nd:YAG laser versus Er:YAG micropeel in light solar lentigines in Asians

Background: Asians are prone to develop epidermal pigmentary lesions as a result of photoaging. Solar lentigines, especially those which are light in color, show somewhat limited response to pigment lasers and intense pulsed light sources. Objectives: We sought to compare the early effects as well as side effects of Q-switched Nd:YAG and Er:YAG micropeel in treating light solar lentigines in Asians. Patient and methods: This was a split-face, evaluator-blind, randomized controlled study. A single session of treatment was performed on Asian patients with light facial lentigines. Q-switched Nd:YAG laser was allocated to one half of the face, and Er:YAG micropeel to the other half. The response to therapy was evaluated by two independent dermatologists with standardized photographs taken 2 weeks and 1 month after the laser treatment. Patients’ satisfaction and preference in treatment were also assessed. Results: Fifteen patients completed the study and were analyzed. A reduction in pigment was observed with both lasers during the study period. The degree of pigment reduction in the Q-switched Nd:YAG treated side of the face was significantly higher than that of the Er:YAG micropeel treated side at 2-week follow-up (p < 0.001). The degree of pigment reduction between the Q-switched Nd:YAG-treated side and the Er:YAG micropeel-treated side was similar at 1-month follow-up (p = 0.110). Conclusion: While there is no perfect therapy for light solar lentigines, a single session of Q-switched Nd:YAG laser and Er:YAG micropeel was shown to reduce pigmentation. The immediate effects (2-week follow-up) were better with the Q-switched Nd:YAG laser but there was no great difference between the two laser types at 1-month follow-up due to the greater degree of post-inflammatory hyperpigmentation following Q-switched Nd:YAG. Both laser types could be applied either singly in turns, or in combination for maximal efficacy in future.

A split-face, evaluator-blind randomized study on the early effects of Q-switched Nd:YAG laser plus Er:YAG micropeel (combined therapy) versus Q-switched Nd:YAG alone in light solar lentigines in Asians

Solar lentigines are a common sign of aging in Asians, who often asked for treatment. Various lasers, including Q-switched Nd:YAG and Er:YAG, have been adopted, but the results are not always satisfactory, especially for those who are relatively light in color. Our objective was to compare the early effects as well as side effects of Q-switched Nd:YAG laser plus Er:YAG micropeel (combined therapy) with those of Q-switched Nd:YAG laser (QSNY) alone in light solar lentigines in Asians. This was a split-face, evaluator-blind, randomized controlled study. A single session of treatment was performed on Asian patients with light facial lentigines. A combined treatment with QSNY and Er:YAG micropeel was allocated to one half of the face, and QSNY alone to the other half. The response to therapy was evaluated by two independent dermatologists, with standardized photographs taken 2 weeks and 1 month after the laser treatment. Patients' satisfaction and preference in treatment were also assessed. Fifteen patients completed the study and were analyzed. Overall, a reduction in pigment was observed with both treatment arms during the study period. The degree of pigment reduction following combined therapy and QSNY alone was similar at 2 weeks' follow-up ( = 0.433). However, due to the higher incidence of postinflammatory hyperpigmentation (PIH) with combined therapy (73.3 vs 40%), the degree of pigment reduction in the combined side of the face was found significantly lower than that of the QSNY-alone side at 1-month follow-up (P = 0.014). Although our study results show that both combined therapy and QSNY alone are capable of reducing pigmentation, QSNY alone is considered to have more favorable qualities than combined treatment for light solar lentigines in Asians.

Reliability assessment and validation of the postacne hyperpigmentation index (PAHPI), a new instrument to measure postinflammatory hyperpigmentation from acne vulgaris

There are no validated outcome measures for postinflammatory hyperpigmentation (PIH). We sought to determine the reliability and validity of an outcome measure for PIH after acne in patients with skin of color. A postacne hyperpigmentation index (PAHPI) was developed. Six raters scored 21 patients with PIH twice. Reliability was determined within and between raters, whereas validity was evaluated by comparing scores with severity ranking by an independent dermatologist. The pigment intensity scores were compared with the melanin index of each patient using a narrowband reflectance spectrophotometer. A quality-of-life score (Skindex-29) was also compared with PAHPI scores. Total PAHPI scores showed good reliability within and between raters and were valid when compared with clinical severity and melanin indices. Good correlation was achieved between the total PAHPI score and the emotion subscale of the Skindex-29. Generalizability of results is limited to African American females. The PAHPI shows good reliability and validity when scored on patients with PIH from acne vulgaris. The PAHPI also correlates well with the emotional impact of PIH as measured by the Skindex-29. Future studies should assess the ability of the PAHPI to change with improvement of PIH from acne after treatment.

Dermoscopic patterns of melanoma metastases: interobserver consistency and accuracy for metastasis recognition

Cutaneous metastases of malignant melanoma (CMMM) can be confused with other skin lesions. Dermoscopy could be helpful in the differential diagnosis. To describe distinctive dermoscopic patterns that are reproducible and accurate in the identification of CMMM. A retrospective study of 146 dermoscopic images of CMMM from 42 patients attending a melanoma unit between 2002 and 2009 was performed. Firstly, two investigators established six dermoscopic patterns for CMMM. The correlation of 73 dermoscopic images with their distinctive patterns was assessed by four independent dermatologists to evaluate the reproducibility in the identification of the patterns. Finally, 163 dermoscopic images, including CMMM and nonmetastatic lesions, were evaluated by the same four dermatologists to calculate the accuracy of the patterns in the recognition of CMMM. Five CMMM dermoscopic patterns had a good interobserver agreement (blue naevus-like, naevus-like, angioma-like, vascular and unspecific). When CMMM were classified according to these patterns, correlation between the investigators and the four dermatologists ranged from κ = 0.56 to κ = 0.7. In total, 71 CMMM, 16 angiomas, 22 blue naevi, 15 malignant melanomas, 11 seborrhoeic keratoses, 15 melanocytic naevi with a globular pattern and 13 pink lesions with a vascular pattern were evaluated according to the previously described CMMM dermoscopy patterns, showing an overall sensitivity of 67.9% (range 54.9-76%) and a specificity of 79.9% (range 68.5-93.5%) for the diagnosis of CMMM. Five dermoscopic patterns of CMMM with good interobserver agreement obtained a high sensitivity and specificity in the diagnosis of metastasis, with the accuracy varying according to the experience of the observer.

Erbium: YAG laser ablation versus 70% trichloroacetıc acid application in the treatment of xanthelasma palpebrarum

Background: Xanthelasma palpebrarum (XP) is characterized by soft, yellow plaques on the upper or lower eyelids that create aesthetic problems for patients. There are several methods in the treatment of XP, such as surgical excision, blepharoplasty, cryotherapy, electrocauterization, chemical cauterization using trichloroacetic acid (TCA) or bichloroacetic acid and laser ablation. Objective: To evaluate the efficiency and complications of 70% TCA application versus erbium: YAG laser ablation in different XP lesions on the same patient. Methods: A total of 21 patients were taken into the study—1 male and 20 females, from ages 22 to 70 years. Erbium: YAG laser ablation and 70% TCA application were performed in different XP lesions of the same patient. All patients were photographed before initiating treatment and after 4 weeks using the same digital camera. Evaluation was performed 4 weeks after the first treatment session by comparing pre-treatment and post-treatment photographs by two independent dermatologists. Results: No significant difference of the improvement scores between the erbium laser and TCA was found (p = 0.248). No significant difference between the complication scores using erbium laser and TCA was found (p = 0.739). Conclusions: Both 70% TCA application and erbium: YAG laser ablation methods have similar effectiveness and complication rates.

Long-pulsed Nd:YAG laser on periorbital wrinkles in Asian patients: randomized split face study

Background and objective: This study evaluated clinical usefulness of long-pulsed Nd:YAG laser (LPNY) for periorbital wrinkles in Asian patients. Methods: Twenty seven Korean patients were treated with several passes of LPNY (5 mm spot size, fluence: 54.7–61.8 J/cm2, pulse duration: 56.5 microseconds). Three treatment sessions were conducted every 2 weeks on the half side of face that was randomly assigned. Outcome assessments included photography, global evaluation by two blinded independent dermatologists (using Fitzpatrick Wrinkle Classification System), and objective measurements of skin elasticity. Adverse events were documented. Patients reported their degree of satisfaction on a 6-point {0–5) visual analog scale (VAS). Results: All patients showed modest improvement. The mean wrinkle score on the treated side decreased by 34.9% (p < 0.05), while it did not change significantly on the control site. Skin elasticity (R2) increased significantly on the treated site. The average VAS score was 2.85 at 2 months but it dropped down to 1.05 at 6 months follow-up. No adverse effects were noted except 2 weeks lasting erythema in one patient. Conclusion: LPNY may be considered as a safe treatment option for periorbital wrinkles in Asian patients. However, three treatment sessions are not enough for maintaining optimal clinical outcome.

Evaluation of a Therapeutic Alternative for Telogen Effluvium: A Pilot Study

Background/Aim: Telogen effluvium (TE) is a scalp disorder characterized by the thinning or shedding of hair resulting from the early entry of hair in the telogen phase. Nigella sativa (NS) is a dicotyledonous belonging to the Ranunculacae family. It has been shown that its major constituent, tymoquinon (TQ), exerts anti-oxidant and anti-inflammatory effects by inhibiting pro-inflammatory mediators, such as cyclooxygenase and prostaglandin D2. The aim of this study is to evaluate the efficacy of NS essential oil as a potential treatment for TE, a pathology characterized by a significant inflammatory component. Study Design/Methods: Twenty patients affected by TE for this double-blind, placebo controlled and randomized study were enrolled. Ten of these patients were treated with a scalp lotion containing 0.5% NS, daily for 3 months, while the other ten patients were treated with placebo daily for 3 months. Videodermatoscopic analysis (Trichoscan Dermoscope Fotofinder?) and evaluation of three independent dermatologists were performed before treatment (T0), after 3 months of treatment (T3) and at the 6 months follow-up (T6). Results: The results showed a significant improvement in 70% of patients treated with NS. Videodermatoscopic analysis showed a significant increment of hair density and hair thickness in patients treated with NS. NS was also able to reduce the inflammation observed in the majority of patients affected by TE. Conclusions: The results of this study suggest that NS can be considered potentially useful for the treatment of TE.

The effect of fractional carbon dioxide lasers on idiopathic guttate hypomelanosis: a preliminary study

Idiopathic guttate hypomelanosis (IGH) is a commonly acquired leucoderma that is characterized by discrete, round or oval porcelain-white macules ∼2-5 mm in diameter that increases in number with age. A variety of therapies with variable success rates, including cryotherapy, superficial abrasion and topical retinoids are currently being used. The effects of fractional CO(2) laser therapy on IGH were investigated in this pilot study. A total of 40 patients with IGH were enrolled. The hypopigmented lesions were treated using a 10 600-nm carbon dioxide fractional laser (CO(2) FL). Two months after a single treatment, physicians' clinical assessments were performed and the patients' overall satisfaction was evaluated. The mean age of enrolled patients was 57.5 ± 10.9 years and the gender ratio was 7 : 33. The face was the most commonly treated area, although the extremities are epidemiologically the most frequently affected areas. Two months after treatment, objective assessments performed by two independent dermatologists indicated more than 50% improvement in 36 patients (90%), compared with baseline. In addition, 33 patients (82.5%) were very satisfied or satisfied with just one session of CO(2) FL treatment. Although a few patients complained of long-standing erythema and postinflammatory hyperpigmentation, these problems spontaneously resolved within 2 months after the assessments. No other noticeable side effects were observed. CO(2) FL might be a very convenient and effective modality for treating IGH without significant side effects.

Autologous Fat Transfer for Face Rejuvenation with Tumescent Technique Fat Harvesting and Saline Washing: A Report of 215 Cases

Various materials have been used for tissue augmentation and for the treatment of rhytids. Autologous fat transfer (AFT) is considered ideal regarding biocompatibility and patient concerns. This study was performed on a series of 215 female patients for face rejuvenation with tumescent technique fat harvesting and saline washing. The study was based on two AFT procedures for each patient. Second treatment was performed at least 1 month after the first operation. Their mean age was 55.5 ± 2.1 years. High-definition photographs in five standard views, front (n = 1), side (n = 2) and oblique of 3/4 (n = 2), were taken for the preoperative morphological study. Aesthetic outcomes were evaluated by the operating surgeon, the patient and an independent dermatologist. Outcomes were evaluated by comparing the preoperative photographs with those taken 1 month after the first procedure and at the end of the 1-year follow-up period. At 12 months all the patients except one noted an improvement. Of these 85.6% (184 patients) were satisfied with the treatment. The operating surgeon and the independent observer noted respectively a sufficient correction in 88.8 and 95.3%. AFT was considered painless by 94.9% and slightly painful by 5.1% of subjects. Fat tissue harvesting by tumescent anesthesia and purification with saline washing enable adipocyte viability to be preserved throughout the procedure and to perform the treatment under local anesthesia.

Validation of a claims‐based diagnostic code for Stevens–Johnson syndrome in a commercially insured population

PURPOSE: To validate the administrative claims identification of a diagnosis of Stevens-Johnson syndrome (SJS) using medical records as the "gold standard" in a large, commercially insured US population. METHODS: Patients with >1 medical claim with the International Classification of Diseases, Ninth Revision, Clinical Modification code 695.1x between 1 July 2000 and 31 May 2007 were queried in the HealthCore Integrated Research Database(SM) , which contains administrative claims data for 14 commercial health insurance plans. Trained nurses and pharmacists abstracted pertinent information from the identified patients' medical records, which were then reviewed by two independent dermatologists to identify criteria to determine SJS diagnosis. Positive predictive values (PPVs) based on the claims and chart data were computed for all the cases. RESULTS: Medical charts for 200 claims-identified cases, with the International Classification of Diseases, Ninth Revision, Clinical Modification code 695.1x, were abstracted and reviewed by the dermatologists. A total of five cases (PPV = 2.50%, 95%CI = 0.8%-5.7%) were determined to be SJS with clinical certainty. PPVs varied with data stratification: PPV for inpatient claims only (PPV = 2.00%, 95%CI = 0.24%-7.04%), inpatient claims with 695.1x in first diagnosis field (PPV = 4.11%, 95%CI = 0.86%-11.54%), and final decisions of either clinical certainty or probable cases of SJS (PPV = 6.00%, 95%CI = 3.14%-10.25%). CONCLUSION: These findings demonstrate the difficulties associated with identifying rare disorders, which lack specific diagnostic criteria, within administrative claims databases. They underscore the challenges of using claims data to monitor ill-defined clinical conditions as well as the need to validate claims-identified cases with information from other sources, such as medical charts. Copyright © 2012 John Wiley & Sons, Ltd.

Excimer light photototherapy of segmental and non‐segmental vitiligo: experience in Taiwan

To determine the efficacy of excimer light in the treatment vitiligo and to assess parameters affecting therapeutic results. This retrospective study analyzed 227 patches of vitiligo in 142 patients. Treatment was performed twice weekly and treatment efficacy was assessed by two independent dermatologists. Patients who received less than 24 treatment sessions were excluded from the analysis of predictive factors for response. Sixty-eight (30.0%) patches achieved more than 50% repigmentation, and 42 (18.5%) achieved more than 75% repigmentation. The mean treatment numbers to achieve any repigmentation and more than 50% repigmentation were 19.41 and 34.93, respectively. Fewer treatment sessions number, segmental lesions and absence of melasma were significant predictors for poor treatment response in multivariate analysis. Lesions on the hands/feet needed the highest dose and scalp lesions needed the highest number of treatment sessions to produce initial repigmentation. Excimer light is a valuable treatment modality for both segmental and non-segmental vitiligo even in patients who have failed previous treatments. The number of treatment sessions needed to produce initial pigmentation may be higher than 30 for scalp lesions. There is a need to find other combination methods, both medical and surgical, to enhance its therapeutic efficacy.

Organisation du suivi conjoint ville–hôpital

Systemic therapy of psoriasis with biologics or cyclosporine requires combined follow-up of patients by hospitals and dermatologists in private practice. Initiation of therapy and the laboratory examinations required before starting treatment are carried out in a hospital setting, and subsequent follow-up may be carried out by a dermatologist in private practice. Successful combined follow-up depends on certain key points, chiefly good knowledge by the independent dermatologist of the systemic therapies available for psoriasis, and smooth working of the hospital-dermatologist interface. It is essential to develop training and information tools in order to optimise joint therapy. This may also be formalised by the creation of a healthcare network as provided for in French legislation (law of 4 March 2002).