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Jeffrey S Dover

Publications and source records attributed to Jeffrey S Dover.

36 records · Page 2Linked to original sources
PubMed2003

Evaluation of the role of exogenous estrogen in postoperative progress after laser skin resurfacing.

BACKGROUND: Recent studies indicate that exogenous estrogens may promote wound healing. Many laser skin resurfacing (LSR) patients use hormone replacement therapy (HRT) or oral contraceptive pills (OCPs). OBJECTIVE: To evaluate the effect of exogenous estrogen on LSR postoperative healing. METHODS: This is a retrospective case control study of 44 female patients who underwent combination CO2/Er:YAG full-face LSR. Sixteen postmenopausal patients using oral HRT during procedure and follow-up were compared with 16 controls. Six premenopausal patients on estrogen-containing OCPs during the procedure and follow-up were compared with six controls. Case and control groups were matched by age, skin type, and treatment technique. Premenopausal and postmenopausal groups were compared. The variables evaluated included erythema, swelling, crusting, purpura, pain, pruritus, reepithelialization, complications, and patient assessment of outcome. RESULTS: For premenopausal and postmenopausal women, there were no significant differences in outcome measures of postoperative morbidity between groups receiving and not receiving estrogen. The incidence of complications, time until re-epithelialization, and patient assessment of outcome were similar between groups. CONCLUSION: Our findings suggest that exogenous estrogen in the form of HRT or OCPs does not clinically alter postoperative progress in combination CO2/Er:YAG LSR patients. Premenopausal women heal comparably to postmenopausal women after LSR.

Adult↗
PubMed2003

A prospective trial of fungal colonization after laser resurfacing of the face: correlation between culture positivity and symptoms of pruritus.

BACKGROUND: After full-face laser resurfacing of the face, patients often complain of pruritus, which may be intense. It has been suggested that some cases of postresurfacing pruritus may be associated with subclinical fungal infection. OBJECTIVE: To determine whether intense pruritus after laser resurfacing of the face is correlated with simultaneous fungal growth of the treated skin. METHODS: Twelve adult female patients undergoing combined full-face laser resurfacing with CO2 and erbium:YAG lasers for chronic photodamage or acne scarring were enrolled in a prospective study. Fungal cultures were obtained by swabbing the facial skin of each patient immediately before, 3 days after, and 6 days after the laser procedure. At the same points in time, investigators completed objective assessments of the patients' facial skin, and patients reported the sensations that they were experiencing. RESULTS: Six patients (50%) complained of significant pruritus (3 or greater on a scale of 0 to 5). In four of the six cases (67%), at least one of the three fungal cultures obtained grew fungal organisms, including Candida albicans (2 cultures), Candida parapsilosis, Aureobasidium pullulans, and Fusarium species. In no instances did culture positivity occur in the absence of significant pruritus. A statistically significant relationship (P=0.0143) was found to exist between at least one of the three cultures being positive and the emergence of significant posttreatment pruritus. Physician ratings of clinical signs did not correlate with patient reports of pruritus, other symptoms, or culture positivity. CONCLUSION: Colonization or subclinical infection with fungi, particularly Candida spp., may be associated with significant postlaser resurfacing pruritus. Antifungal prophylaxis may mitigate this discomfort. Further research is required to confirm and expand these results.

Adolescent↗
PubMed2003

Treatment of facial telangiectasia with variable-pulse high-fluence pulsed-dye laser: comparison of efficacy with fluences immediately above and below the purpura threshold.

BACKGROUND: : Pulsed-dye laser treatment has been shown to be highly effective for the treatment of facial telangiectasia. Posttreatment purpura after such treatment has limited patient acceptance of the procedure. OBJECTIVE: : To determine whether purpura-free treatment with recently introduced variable-pulsed pulsed-dye lasers can effectively reduce facial telangiectasia. METHODS: : This was a prospective, randomized, controlled, nonblinded trial. Eleven patients received variable-pulse pulsed-dye laser treatment with and without induction of purpura. Telangiectasia were graded on a "telangiectasia density scale," on which a 1 signified extremely fine, sparsely distributed telangiectasia, and 5 referred to thick, ropelike telangiectasia covering the affected area. For each subject, two areas on either side of the facial midline with equivalent telangiectasia density ratings were randomized to the purpura and purpura-free treatment groups, respectively. All treatments used a 7-mm spot size and a 10-ms pulse duration. The fluence associated with the purpura threshold for each patient was determined in test areas. Purpura-free treatment entailed a fluence 1.0 J/cm2 less than the purpura threshold, and purpura-level treatment entailed a fluence 0.5 J/cm2 greater than the threshold. RESULTS: : Six weeks after a single purpura-free treatment, mean telangiectasia ratings were reduced from 2.7 to 2.4. Purpura-level treatments resulted in a decrease to 1.4 from the same baseline. Thicker, denser telangiectasia appeared to benefit more from purpura-level treatment (a mean telangiectasia density scale reduction of 1.7) than finer, sparser telangiectasia (a mean reduction of 0.8). In 81% of cases, both investigators and patients rated the side treated with purpura as undergoing a greater reduction in telangiectasia density. CONCLUSION: : Although facial telangiectasia do improve after a single purpura-free treatment with the variable-pulse pulsed-dye laser, they improve more after purpura is induced. Purpura-free and purpura-level treatments may be close to equivalent for treating fine telangiectasia, but purpura-level treatments have a distinct advantage for treating thicker telangiectasia. Significantly, the variable-pulse pulsed-dye laser offers patients the option of effective treatment of some telangiectasia without bruising.

Adult↗
PubMed2003

Clinically significant facial edema after extensive treatment with purpura-free pulsed-dye laser.

BACKGROUND: Long-pulsed pulsed-dye lasers permit treatment of facial erythema and telangiectasia with purpura-free technique, which may be more comfortable for the patient than purpura-inducing treatment. However, there are anecdotal reports of treatment-associated discomfort even when purpura is not elicited. OBJECTIVE: To determine whether patients experience clinically significant erythema, edema, and pain after purpura-free treatment with pulsed-dye laser. METHODS: In this prospective, controlled study, subjects included 15 patients who were undergoing purpura-free treatment of diffuse erythema and fine telangiectasia of at least half the facial surface area with purpura-free pulsed-dye, and it included 15 age, gender, and skin-type matched control subjects who were undergoing similar treatments but with the induction of trace to mild purpura. Patients were seen in person and were surveyed by phone regarding symptoms and signs during their postoperative courses. RESULTS: Postoperative erythema of a mean 3.3-days duration and 3.4/5.0 intensity was reported by 73% (11 of 15) of the purpura-free patients. Among purpura patients, the duration was 5.6 days. The intensity was 4.0, and again, 73% of patients reported this finding. Postoperative edema occurred among 87% of purpura-free patients, but such edema occurred in all of the purpura patients, in whom it lasted longer and was more intense. Symptomatic eye swelling and uncomfortable/painful edema were seen in 27% and 20%, respectively, of purpura-free patients, but in 40% and 53% of purpura patients. Among purpura-free patients receiving fewer than 250 laser pulses per treatment, erythema and edema lasted less than 1 day and 2.5 days, whereas the mean durations were 3.4 and 5.0 days for purpura-free patients receiving greater than 250 pulses. CONCLUSION: Extensive purpura-free treatment for erythema and telangiectasia of the face with the long-pulsed pulsed-dye laser can lead to clinically significant erythema, edema, and discomfort in patients. The duration, magnitude, and frequency of these undesired effects are markedly less with purpura-free treatment compared with purpura-inducing treatment and are also less for less extensive purpura-free treatments.

Edema↗
PubMed2003

Treatment of reticular leg veins with a 1064 nm long-pulsed Nd:YAG laser.

BACKGROUND: Millisecond-pulsed Nd:YAG lasers have been developed for the treatment of reticular leg veins. OBJECTIVE: We evaluated the effectiveness of a single treatment with a 50 millisecond 1064 nm Nd:YAG laser in the treatment of reticular veins of the lower extremity. METHODS: Twenty patients with reticular veins measuring 1.0 to 3.0 mm in diameter received one treatment with a 1064 nm Nd:YAG laser (Coolglide, Altus, Burlingame, Calif) at fluences of 100 J/cm(2) and 50 millisecond pulse duration. Symmetric matched areas that were left untreated served as the control. Eleven patients were pretreated with a topical anesthetic cream for 1 hour before treatment and wore compression stockings for 5 days after treatment. Nine patients were treated without topical anesthesia and did not wear compression stockings. Percent clearing and side effects were determined by 3 nontreating physicians (at each respective site) comparing projected Kodachrome images 1 month and 3 months after treatment. Patients also performed a self-assessment of their results. RESULTS: Two-thirds of vessels measuring 1 to 3 mm in diameter cleared more than 75% with one treatment. Larger vessels appeared to improve more than smaller vessels. Immediate treatment discomfort was tolerable. Side effects were minimal and included superficial thrombosis, delayed bruising, hyperpigmentation, and matting. CONCLUSION: Millisecond-pulsed Nd:YAG lasers used with 50 millisecond pulses are effective in the treatment of reticular leg veins.

Adult↗
PubMed2003

Reduction in injection pain with botulinum toxin type B further diluted using saline with preservative: a double-blind, randomized controlled trial.

BACKGROUND: Injection with botulinum A exotoxin reconstituted with preserved saline has been shown to be less uncomfortable than injection with the same toxin reconstituted with preservative-free saline. OBJECTIVE: We sought to determine whether injection with botulinum toxin type B is similarly less painful when preservative-containing saline is used to further dilute the product. METHODS: We conducted a double-blind, randomized controlled trial. A total of 15 consecutive adult patients presenting for treatment of upper face dynamic lines received treatment to one side (left or right) of the face with toxin type B further diluted with preservative-containing saline, and to the other side with toxin type B further diluted with preservative-free saline. RESULTS: Of 15 patients, 13 (87%) reported less pain in the halves of their faces treated with the preservative-containing saline (P =.0006). Pain on the preservative-containing side was on average 32% less among patients as a whole, and 39% less among patients noting some reduction. The 95% confidence interval for pain reduction associated with preservative-containing injection was -46.9% to -16.1%. Neither investigators nor patients observed any difference in clinical efficacy between the 2 treatment sides. CONCLUSIONS: Use of preservative-containing saline to further dilute botulinum toxin type B can significantly decrease patient discomfort on injection.

Botulinum Toxins↗
PubMed2002

Pain associated with injection of botulinum A exotoxin reconstituted using isotonic sodium chloride with and without preservative: a double-blind, randomized controlled trial.

CONTEXT: Botulinum A exotoxin is used for various indications, including the treatment of dynamic forehead lines. OBJECTIVE: To determine whether injection with botulinum A exotoxin reconstituted with preservative-containing normal saline (isotonic sodium chloride) is less painful than injection with exotoxin that has been reconstituted with preservative-free saline. DESIGN: Two arms: (1) retrospective study; (2) double-blind, randomized controlled trial. SETTING: A multiple-physician dermatology practice. PATIENTS: (1) Retrospective study-20 consecutive adult patients presenting for treatment of upper-face dynamic lines; (2) prospective study-15 consecutive adult patients presenting for treatment of upper-face dynamic lines. INTERVENTION: In prospective study only, one side (left or right) of the face was treated with exotoxin reconstituted with preservative-containing saline, and the other side, with exotoxin reconstituted with preservative-free saline. MAIN OUTCOME MEASURES: (1) Retrospective study-discomfort at current treatment (with preservative-containing saline) compared with discomfort with most recent prior treatment (with preservative-free saline); (2) prospective study-discomfort on the side treated with preservative-containing saline compared with discomfort on the side treated with preservative-free saline. RESULTS: (1) Retrospective study-18 (90%) of 20 patients reported that treatment with exotoxin reconstituted with preserved saline was less painful than prior treatment with exotoxin reconstituted with preservative-free saline; (2) prospective study-15 (100%) of 15 patients reported less pain in the side of their face treated with exotoxin reconstituted with preservative-containing saline (P<.001). Pain on the preservative-containing side was 54% less. No difference in treatment efficacy between the sides was observed by investigators or patients. CONCLUSION: Use of preservative-containing saline to reconstitute botulinum A exotoxin can significantly decrease patient discomfort on injection.

Adult↗
PubMed2002

Laser surgery of leg veins.

The use of lasers and light sources in treating lower-extremity blood vessels has not been as successful as they are for treatment of facial telangiectasia. Several reasons for this lack of success include increased hydrostatic pressure on the lower extremities and the anatomy of lower-extremity blood vessels. These vessels are in a deeper location, have thick surrounding adventitial tissue, and have increased basal lamina when compared with facial telangiectasia. Improvements in matching pulse duration to vessel size, use of more penetrating, longer wavelengths, and the addition of sophisticated cooling methods have improved the results with leg veins during the past 2 years. Further refinements in laser technology over the next few years will probably enhance treatment efficacy of lower-extremity telangiectasias.

Esthetics↗
PubMed2002

Glycolic acid peels compared to microdermabrasion: a right-left controlled trial of efficacy and patient satisfaction.

BACKGROUND: Glycolic acid peels and microdermabrasion are widely recommended by dermatologists and others for facial skin rejuvenation, but few studies have assessed their clinical efficacy. OBJECTIVE: To compare the relative efficacy of glycolic acid peels and microdermabrasion for facial skin rejuvenation. METHODS: An unblinded, randomized controlled trial was used. Each of 10 patients received paired treatments with glycolic acid peels (20%) and microdermabrasion (mild setting) for 6 consecutive weeks. The right and left sides of the face were treated with different modalities. Once a patient was assigned to receive a particular modality to a particular side of the face, all subsequent treatments were delivered in the same manner. Patient ratings, investigator ratings, and photographs were obtained before the first treatment and 1 week after the last treatment. RESULTS: In terms of overall preference for a given type of treatment, seven patients chose glycolic acid peels, one selected microdermabrasion, and two had no favorite treatment. The relative preference for glycolic acid peels approached significance (P =.0578). Investigator ratings and photographic comparisons did not reveal treatment-specific differences or significant improvement from baseline. No serious side effects were seen with either treatment, and even mild effects were seldom reported. CONCLUSION: In this study, patients appeared to prefer low-strength glycolic acid peels to low-intensity microdermabrasion for facial rejuvenation. Differences in patient satisfaction were subtle and may be technique dependent.

Adult↗
PubMed2002

Severe, intractable headache after injection with botulinum a exotoxin: report of 5 cases.

BACKGROUND: Botulinum A exotoxin is a safe agent in common use in dermatology. Occasionally, patients receiving botulinum toxin injections report postprocedure discomfort, including headaches. OBJECTIVE: Our purpose was to estimate the rate of severe headaches occurring after injection with botulinum toxin for dermatologic indications. METHODS: We used prospective monitoring of botulinum toxin injection outcomes in a single-site, 3-dermatologist practice. There was in-office and telephone follow-up of patients experiencing severe headaches. RESULTS: Approximately 1% of patients (4/320) receiving botulinum A exotoxin injections may experience severe, debilitating headaches. These may persist at high intensity for 2 weeks to 1 month before gradually fading. CONCLUSION: Botulinum A exotoxin injection may be associated with the development of life-altering headaches. Patients should be informed of this possibility.

Adult↗
PubMedDate not supplied

Photodynamic therapy for cosmetic applications.

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.

Acne Vulgaris↗