Publications (11)26.49 Total impact
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Article: Fractional deep dermal ablation induces tissue tightening.
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ABSTRACT: Due to the significant risk profile associated with traditional ablative resurfacing, a safer and less invasive treatment approach known as fractional deep dermal ablation (FDDA) was recently developed. We report the results of the first clinical investigation of this modality for treatment of photodamaged skin. Twenty-four subjects received treatments on the inner forearm with a prototype fractional CO(2) laser device (Reliant Technologies Inc., Mountain View, CA) at settings of 5-40 mJ/MTZ and 400 MTZ/cm(2). Clinical and histological effects were assessed by study investigators 1 week, 1 month, and 3 months following treatment. Thirty subjects were then enrolled in a multi-center study for treatment of photodamage using the same device. Subjects received 1-2 treatments on the face and neck, with energies ranging from 10 to 40 mJ/MTZ and densities ranging from 400 to 1,200 MTZ/cm(2). Study investigators assessed severity of post-treatment responses during follow-up visits 48 hours, 1 week, 1 month, and 3 months following treatment. Using a standard quartile improvement scale (0-4), subjects and investigators assessed improvement in rhytides, pigmentation, texture, laxity and overall appearance 1 and 3 months post-treatment. Clinical and histologic results demonstrated that fractional delivery of a 10,600 nm CO(2) laser source offers an improved safety profile with respect to traditional ablative resurfacing, while still effectively resurfacing epidermal and dermal tissue. Forearm and facial treatments were well-tolerated with no serious adverse events observed. Eighty-three percent of subjects exhibited moderate or better overall improvement (50-100%), according to study investigator quartile scoring. FDDA treatment is a safe and promising new approach for resurfacing of epidermal and deep dermal tissue targets.Lasers in Surgery and Medicine 03/2009; 41(2):78-86. · 2.75 Impact Factor -
Article: Fractional resurfacing for the treatment of hypopigmented scars: a pilot study.
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ABSTRACT: Treatments for hypopigmented scars have shown limited efficacy and variable safety profiles. OBJECTIVE This study evaluated the safety and efficacy of fractional resurfacing (1,550-nm Fraxel SR laser, Reliant Technologies, Mountain View, CA) for the treatment of hypopigmented scars on the face in seven patients. Seven patients with hypopigmented scars on the face received between two and four successive treatments at 4-week intervals with the 1,550-nm Fraxel SR laser. Energy settings ranged from 7 to 20 mJ and a total density of 1,000 to 2,500 microthermal zones per square centimeter. Digital photographs were taken before each treatment and at 4 weeks after the last treatment. Independent physician clinical assessments were performed. Independent physician clinical assessment 4 weeks after the final Fraxel SR laser treatment revealed improvements of 51% to 75% in hypopigmentation in six of seven patients. One patient had only 26% to 50% improvement in hypopigmentation. Additionally, clinical improvements were noted in the overall texture of the treated skin. The patient's degree of satisfaction paralleled the physician's assessment of improvement. All patients reported improvement in hypopigmentation lasting greater than 3 months after the last treatment. Side effects were limited to mild pain during the treatment and mild posttreatment erythema and edema, which resolved in 2 to 4 days. Fractional resurfacing is a potentially effective modality for the treatment of hypopigmented scarring on the face. No adverse effects were observed.Dermatologic Surgery 04/2007; 33(3):289-94; discussion 293-4. · 1.80 Impact Factor -
Article: Fractional Resurfacing for the Treatment of Hypopigmented Scars: A Pilot Study
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ABSTRACT: BACKGROUND Treatments for hypopigmented scars have shown limited efficacy and variable safety profiles.OBJECTIVE This study evaluated the safety and efficacy of fractional resurfacing (1,550-nm Fraxel SR laser, Reliant Technologies, Mountain View, CA) for the treatment of hypopigmented scars on the face in seven patients.MATERIALS AND METHODS Seven patients with hypopigmented scars on the face received between two and four successive treatments at 4-week intervals with the 1,550-nm Fraxel SR laser. Energy settings ranged from 7 to 20 mJ and a total density of 1,000 to 2,500 microthermal zones per square centimeter. Digital photographs were taken before each treatment and at 4 weeks after the last treatment. Independent physician clinical assessments were performed.RESULTS Independent physician clinical assessment 4 weeks after the final Fraxel SR laser treatment revealed improvements of 51% to 75% in hypopigmentation in six of seven patients. One patient had only 26% to 50% improvement in hypopigmentation. Additionally, clinical improvements were noted in the overall texture of the treated skin. The patient's degree of satisfaction paralleled the physician's assessment of improvement. All patients reported improvement in hypopigmentation lasting greater than 3 months after the last treatment. Side effects were limited to mild pain during the treatment and mild posttreatment erythema and edema, which resolved in 2 to 4 days.CONCLUSION Fractional resurfacing is a potentially effective modality for the treatment of hypopigmented scarring on the face. No adverse effects were observed.Dermatologic Surgery 02/2007; 33(3):289 - 294. · 1.80 Impact Factor -
Article: The effects of pulse energy variations on the dimensions of microscopic thermal treatment zones in nonablative fractional resurfacing
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ABSTRACT: Background and Objectives We examined the effects of pulse energy variations on the dimensions of microscopic thermal injury zones (MTZs) created on human skin ex vivo and in vivo using nonablative fractional resurfacing.Materials and MethodsA Fraxel® SR laser system emitting at 1,550 nm provided an array of microscopic spots at variable densities. Pulse energies ranging from 4.5 to 40mJ were tested on human abdominal skin ex vivo and in vivo. Tissue sections were stained with hematoxylin and eosin (H&E) or nitro blue tetrazolium chloride (NBTC) and MTZ dimensions were determined. Ex vivo and in vivo results were compared. Dosimetry analyses were made for the surface treatment coverage calculation as a function of pulse energy and collagen coagulation based on H&E stain or cell necrotic zone based on NBTC stain.ResultsEach MTZ was identified by histological detection of a distinct region of loss of tissue birefringence and hyalinization, representing collagen denaturation and cell necrosis within the irradiated field immediately, 1, 3, and 7days after treatment. At high pulse energies, the MTZ depth could exceed 1 mm and width approached 200 µm as assessed by H&E. NBTC staining revealed viable interlesional tissue. In general, no statistically significant difference was found between in vivo and ex vivo depth and width measurements.Conclusions The Fraxel® SR laser system delivers pulses across a wide range of density and energy levels. We determined that increases in pulse energy led to increases in MTZ depth and width without compromising the structure or viability of interlesional tissue. Lasers Surg. Med. 39:157–163, 2007. © 2007 Wiley-Liss, Inc.Lasers in Surgery and Medicine 01/2007; 39(2):145 - 155. · 2.75 Impact Factor -
Article: In vivo histological evaluation of a novel ablative fractional resurfacing device
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ABSTRACT: Background and ObjectivesA novel carbon dioxide (CO2) laser device employing ablative fractional resurfacing was tested on human skin in vivo for the first time.Study Design/Materials and Methods An investigational 30 W, 10.6 µm CO2 laser system was focused to a 1/e2 spot size of 120 µm to generate an array of microscopic treatment zones (MTZ) in human forearm skin. A range of pulse energies between 5 and 40 mJ was tested and lesion dimensions were assessed histologically using hematoxylin & eosin. Wound healing of the MTZ's was assessed immediately-, 2-day, 7-day, 1-month, and 3-month post treatment. The role of heat shock proteins was examined by immunohistochemistry.ResultsThe investigational CO2 laser system created a microscopic pattern of ablative and thermal injury in human skin. The epidermis and part of the dermis demonstrated columns of thermal coagulation that surrounded tapering ablative zones lined by a thin eschar layer. Changing the pulse energy from 5 to 30 mJ resulted in a greater than threefold increase in lesion depth and twofold increase in width. Expression of heat shock protein (hsp)72 was detected as early as 2 days post-treatment and diminished significantly by 3 months. In contrast, increased expression of hsp47 was first detected at 7 days and persisted at 3 months post-treatment.Conclusion The thermal effects of a novel investigational ablative CO2 laser system utilizing fractional resurfacing were characterized in human forearm skin. We confirmed our previous ex vivo findings and show for the first time in-vivo, that a controlled array of microscopic treatment zones of ablation and coagulation could be deposited in human skin by varying treatment pulse energy. Immunohistochemical studies of heat shock proteins revealed a persistent collagen remodeling response lasting at least 3 months. We successfully demonstrated the first in-vivo use of ablative fractional resurfacing (AFR™) treatment on human skin. Lasers Surg. Med. 39:96–107, 2007. © 2007 Wiley-Liss, Inc.Lasers in Surgery and Medicine 01/2007; 39(2):96 - 107. · 2.75 Impact Factor -
Article: Minocycline hyperpigmentation isolated to the subcutaneous fat.
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ABSTRACT: We present a 15-year-old girl with bilateral lower extremity discoloration of one-year duration while taking minocycline for acne vulgaris. The clinical characteristics best supported type II minocycline hyperpigmentation, but the histology revealed that the pigmentation was solely limited to the subcutaneous adipose tissue, completely sparing the dermis. Special stain for iron was negative. This is the first case to our knowledge with pigment exclusively located in the subcutaneous fat and with the unusual finding of a negative stain for iron.Journal of Cutaneous Pathology 09/2005; 32(7):516-9. · 1.56 Impact Factor -
Article: Actinic keratoses--surgical and physical therapeutic modalities.
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ABSTRACT: Actinic keratoses (AKs) are the most common epithelial premalignant lesions seen by dermatologists today. The vast therapeutic armamentarium for treating AKs can be roughly divided into 2 categories: topical and surgical/physical modalities. It is important for clinicians to be familiarized with the various therapeutic options for treating AKs and to deliver individualized treatments. This article will review the surgical and physical modalities available for the treatment of AKs.Cutis; cutaneous medicine for the practitioner 06/2003; 71(5):381-4. · 0.81 Impact Factor -
Article: Minocycline hypersensitivity syndrome manifesting with rhabdomyolysis.
International Journal of Dermatology 09/2002; 41(8):530-1. · 1.14 Impact Factor -
Article: Defining pseudofolliculitis barbae in 2001: a review of the literature and current trends.
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ABSTRACT: Pseudofolliculitis barbae (PFB) is a chronic inflammatory and potentially disfiguring condition most often seen in men and women of African American and Hispanic origin who have tightly curled hair and who shave or tweeze hairs frequently. The etiology is multifactorial. The shape of the hair follicle, hair cuticle, and the direction of hair growth each play a role in the inflammatory response once the hair is shaven or plucked and left to grow. This reaction often produces painful, pruritic, and sometimes hyperpigmented papules in the beard distribution. The result is an unappealing cosmetic appearance, often with emotionally distressing consequences for affected individuals. The diagnosis is made clinically. Currently, prevention and early intervention are the mainstays of therapy. Many treatment options are available; however, none has been completely curative. In this review, the history, incidence, pathogenesis, clinical manifestations, dermatopathology, prevention, and treatment of PFB, including the most current surgical options, will be discussed. In addition, new data on patients with PFB from the Skin of Color Center will be presented.Journal of the American Academy of Dermatology 03/2002; 46(2 Suppl Understanding):S113-9. · 3.99 Impact Factor -
Article: Acne vulgaris in skin of color.
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ABSTRACT: In the 21st century, individuals with skin of color, including those of Hispanic, Asian, and African American descent, will account for more than half of the US population. Consequently, those individuals will constitute a significant patient population for the dermatology community. Dermatologists in major metropolitan centers as well as those in rural communities need to meet the diagnostic and therapeutic challenges posed by these patients by becoming familiar with dermatologic disease prevalence and presentation in skin of color. Commonly occurring cutaneous diseases, such as acne vulgaris, display histological and clinical differences in people with skin of color compared with Caucasians (whites). Additionally, the response to therapeutic agents may vary in people with skin of color. This article reviews data derived from a survey of skin of color patients with acne vulgaris seen at the Skin of Color Center, Department of Dermatology, St. Luke's-Roosevelt Hospital, in New York City. This information should help clinicians in their diagnosis and treatment of acne vulgaris for these patients.Journal of the American Academy of Dermatology 03/2002; 46(2 Suppl Understanding):S98-106. · 3.99 Impact Factor -
Article: In vivo confocal imaging of epidermal cell migration and dermal changes post nonablative fractional resurfacing: study of the wound healing process with corroborated histopathologic evidence.
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ABSTRACT: In vivo wound healing response post nonablative fractional laser treatment is evaluated. Seven healthy subjects receive treatments with a Fraxel re:store laser system on the forearm with pulse energies ranging from 10 to 70 mJ. The treatment sites are imaged at 1-h increments up to 40 h using confocal microscope z-stacks using 10-mum-depth spacing. At least five individual microscopic treatment zones are imaged per subject, time point, and treatment energy. Images are analyzed for tissue structure and morphology to classify each lesion as healed or not healed, depending on epidermal re-epithelialization at each time point and treatment energy. Probit analysis is used to statistically determine the ED(50) and ED(84) probabilities for a positive dose response (healed lesion) as a function of treatment energy. Confocal observations reveal epidermal keratinocyte migration patterns confirmed with histological analysis using hematoxylin and eosin (HE) and lactate dehydrogenase (LDH) staining at 10 mJ at 0, 7, 16, and 24-h post-treatment. Results indicate that more time is required to conclude re-epithelialization with larger lesion sizes (all less than 500 mum) corresponding to higher treatment energies. For the entire pulse energy range tested, epidermal re-epithelialization concludes between 10 to 22-h post-treatment for ED(50) and 13 to 28 h for ED(84).Journal of Biomedical Optics 14(2):024018. · 3.16 Impact Factor
Top co-authors
Top Journals
Institutions
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2007–2009
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Stanford University
- Department of Dermatology
Stanford, CA, USA
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2005
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Yale-New Haven Hospital
New Haven, CT, USA
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