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Biomedical subjects

Mitchel P Goldman

Publications and source records attributed to Mitchel P Goldman.

At least 19 recordsLinked to original sources
PubMed2007

Aminolevulinic acid-photodynamic therapy for photorejuvenation.

Light therapy is widely used in dermatology. An enhancement to his therapy is the use of a photosensitizing medication along with light therapy, known as photodynamic therapy (PDT). PDT is primarily used for the treatment of precancerous lesions, acne vulgaris, and nonmelonoma skin cancer, and has also been shown to improve the appearance of photodamaged skin. This article reviews the available literature for the treatment of photodamaged skin using PDT along with recent advancements in PDT for various dermatologic indications.

Adult↗
PubMed2006

A single center, randomized, comparative, prospective clinical study to determine the efficacy of the VelaSmooth system versus the Triactive system for the treatment of cellulite.

BACKGROUND AND OBJECTIVES: One area of cosmetic concern for women of all races is the unsightly appearance of cellulite in the buttocks area and lower extremities. Two modern technological advances claim to improve cellulite and provide reproducible results, TriActive and VelaSmooth. The TriActive laser is intended to reduce the appearance of cellulite through the combination of low-energy diode laser, contact cooling, suction, and massage. The VelaSmooth is based on a combination of two different ranges of electromagnetic energy: infrared light and radio frequency (RF) combined with mechanical manipulation of the skin. This single center study was designed to evaluate the efficacy of the VelaSmooth versus TriActive in the reduction of the appearance of cellulite. STUDY DESIGN/MATERIALS AND METHODS: Twenty female patients were treated twice a week for 6 weeks with the randomization of TriActive on one side and VelaSmooth on the other side. Patients were evaluated with photographs and circumferential thigh measurements before treatment and after the final treatment. RESULTS: Although there was improvement in the reduction of cellulite for each device individually, there was no significant difference between VelaSmooth or TriActive devices in the following categories: reduction of thigh circumference, photographic evaluation, and perceived change in before and after photographic grading. There was a statistically significant increase in the incidence of post-treatment bruising with the VelaSmooth compared to TriActive. CONCLUSIONS: In conclusion, both the TriActive and VelaSmooth provide improvement of cellulite. When comparing differences in efficacy, the average mean percent change calculated was roughly the same for both treatments and showed no statistical difference.

Adipose Tissue↗
PubMed2006

Improvement in the appearance of wrinkles with topical transforming growth factor beta(1) and l-ascorbic acid.

BACKGROUND AND OBJECTIVE: Facial rhytides are a common cosmetic concern. Surgical treatment effects dramatic improvement; however, the associated risk and cost may be prohibitive. Recent focus is on developing topical products containing biologically active ingredients for at-home therapy. Our study examines the effects of a topical cream containing transforming growth factor-beta(1) (TGF-beta(1)), l-ascorbic acid, and Cimicifuga racemosa extract (CRS) (Topix Pharmaceuticals, North Amityville, NY, USA). MATERIALS AND METHODS: In the first arm of the study, 12 subjects were randomized to apply CRS to the left or right side of their face and a cream containing l-ascorbic acid and C. racemosa in silicone base (vitamin C [Vit C]) to the contralateral side twice daily for 3 months. In the second arm of the study, 20 subjects were randomized to apply CRS to the left or right side of their face and Tissue Nutrient Solution Recovery Complex (TNS) (SkinMedica, Carlsbad, CA, USA), a product containing a variety of growth factors including VEGF, PDGF-A, G-CSF, HGF, IL-6, IL-8, and TGF-beta(1) (Nouricel-MD) without l-ascorbic acid, C. racemosa extract, or silicone base, to the contralateral side of their face twice daily for 3 months. Digital photographs were scored by study-blinded physicians, and self-assessments were completed by all subjects at baseline and at the conclusion of the protocol. RESULTS: CRS and TNS were well tolerated, and all subjects completed the 3-month protocol for the CRS versus Vit C arm of the study. Physicians rated success in facial wrinkling scores on the CRS-treated side of the face for 27 of 31 subjects. Responders showed, on average, 21.7% improvement in physician-rated wrinkle scores. The mean improvement in the group of 31 patients as a whole was 12%. Eighteen of 31 subjects reported a noticeable improvement on their CRS-treated side. Both CRS and TNS demonstrate significant success between baseline and 3-month scores, and both growth factor products are superior to Vit C. Patients preferred CRS over TNS. CONCLUSION: CRS is effective in minimizing the appearance of facial rhytides. The success of the CRS product is largely attributable to the incorporation of TGF-beta(1).

Adult↗
PubMed2006

Full scope of effect of facial lipoatrophy: a framework of disease understanding.

BACKGROUND: Facial lipoatrophy has been observed to occur in a variety of patient populations, with inherited or acquired disease, or even in aging patients as a natural progression of tissue change over time. There is currently no framework from which physicians of all medical specialties can communally discuss the manifestations, diagnoses, and management of facial lipoatrophy. OBJECTIVE: The aim of this assembly was to derive a definition of facial lipoatrophy capable of being applied to all patient populations and develop an accompanying grading system. RESULTS: The final consensus of the Facial Lipoatrophy Panel encompasses both aging and disease states: "Loss of facial fat due to aging, trauma or disease, manifested by flattening or indentation of normally convex contours." The proposed grading scale includes five gradations (Grades 1-5; 5 being the most severe), and the face is assessed according to three criteria: contour, bony prominence, and visibility of musculature. CONCLUSION: Categorizing the presentation of facial lipoatrophy is subjective and qualitative, and will need to be validated with objective measures. Furthermore, during the assembly, several topics were exposed that warrant further research, including the physiology of volume loss, age and lipoatrophy, and human immunodeficiency virus and lipoatrophy.

Atrophy↗
PubMed2006

The use of photodynamic therapy in dermatology: results of a consensus conference.

Photodynamic therapy (PDT) has significant promise in improving outcomes of patients with a variety of cutaneous conditions. A group of experts met to review the principles, indications, and clinical benefits of PDT with 5-aminolevulinic acid (ALA). They also reviewed PDT with methyl aminolevulinate. The experts established consensus statements for pretreatment, posttreatment, ALA contact time, light sources, and numbers of sessions associated with ALA PDT for actinic keratosis and superficial basal cell carcinoma, photorejuvenation and cosmetic enhancement, acne, sebaceous skin, rosacea, and rhinophyma. They based consensus recommendations on their clinical experience and the medical literature. They also suggested future applications of ALA PDT. Experts concluded that ALA PDT is a safe and effective modality for the treatment of conditions commonly encountered in dermatology. Since downtime is minimal, the technique is suitable for patients of all ages and lifestyles. Appropriate light sources are available in many dermatology offices. The expanding clinical and financial benefits of PDT justify the purchase of an appropriate light source.

Aminolevulinic Acid↗
PubMed2006

Development of a keratoacanthoma after topical photodynamic therapy with 5-aminolevulinic acid.

Since its FDA approval in 1999, photodynamic therapy (PDT) with topical 5-aminolevulinic acid has become an increasingly popular modality for the treatment of actinic keratosis (AKs). It is hoped that in addition to improving clinical signs and symptoms of AKs, PDT might prevent the development of skin cancer. We present a case of a patient developing a keratoacanthoma immediately following PDT for AKs.

Administration, Topical↗
PubMed2005

A two-center, double-blinded, randomized trial testing the tolerability and efficacy of a novel therapeutic agent for cellulite reduction.

INTRODUCTION: Cellulite is the unsightly dimpling and nodularity found on the thighs and buttocks of many postadolescent women. Unfortunately, poor understanding of its pathophysiology coupled with very few scientifically based studies have left us with limited treatment options that are tolerable and effective. PURPOSE: To review current concepts of the etiology and nature of cellulite and summarize available treatment options. To evaluate a novel, pathophysiologically based, topical agent for treatment. MATERIALS AND METHODS: A total of 40 women with a moderate degree of cellulite (20 from each of the two research centers) entered a double-blinded, randomized trial where an anticellulite cream was applied on a nightly basis to the affected sites for four continuous weeks. Each subject was randomized to receive active cream on either the right or left leg, with the contralateral side serving as placebo control. Bioceramic-coated neoprene shorts were worn overnight to enhance penetration of the topical agents by occlusion. High-quality digital photography was taken before treatment and after 4 weeks, with tangential full-spectrum lighting. Five blinded, independent physician reviewers assessed the photographs for improvement. Subject questionnaires were completed to assess tolerability and efficacy. RESULTS: Of the 34 subjects who completed the study, 62% (21/34) noticed an overall improvement in their cellulite, with 62% (13/21) reporting greater improvement in the thigh that received active product. All 34 subjects found the shorts and creams easy and pleasant to use. Overall, the average measured decrease in thigh circumference was 1.9 cm (range: 0.1-4.5) with active product, and 1.3 cm (range: 0.1-3.0) with placebo. Upon review of the pre- and poststudy photographs, dermatologist evaluators found thighs treated with active product showed greater improvement than thighs treated with placebo in 68% of subjects. CONCLUSIONS: The active topical agent used in this study was found to be effective in reducing the appearance of cellulite. All subjects tolerated the formulation well with no adverse effects. The success of this research validates the pathophysiologic concepts used to formulate the topical compound. This study both increases our understanding of the nature of cellulite and establishes a tolerable, effective product to treat it.

Journal Article↗
PubMed2005

Stability of foam in sclerotherapy: differences between sodium tetradecyl sulfate and polidocanol and the type of connector used in the double-syringe system technique.

BACKGROUND: Foam sclerotherapy is an increasingly popular modality in the treatment of varicose veins. Worldwide, the most popular agents used are sodium tetradecyl sulfate (STS) and polidocanol (POL). The double-syringe system technique to make foam out of a sclerosing solution and air has received wide attention for its ease and reproducibility. This study examined the possibility that the relative silicone content of various disposable connectors may affect overall foam stability. We also evaluated the differences in the stability of foam between STS and POL. MATERIALS AND METHODS: In the first part of the study, one nondisposable stainless steel connector and five disposable plastic connectors were used to create foam from STS 0.50% and air. The procedure was then repeated to produce foam from POL 0.50% and air from each of the six different connector types. As a measure of foam stability, once foam was created with each type of connector, the time required for half of the original volume of sclerosing solution to settle was recorded. In the second part of the study, foam was created with a nondisposable stainless steel connector only and various concentrations of STS and POL. Foam stability was then measured for these different concentrations of sclerosants. RESULTS: The time for sclerosing solution to settle to half of its initial volume was found to vary according to the specific sclerosant and concentration used, with no statistically significant variation based on connector type. CONCLUSIONS: The type of connector used in the double-syringe system technique to produce foam for sclerotherapy is not a factor in foam stability. Sclerosing solutions differ in their foaming stability.

Dosage Forms↗
PubMed2005

Treatment of local, persistent cutaneous atrophy following corticosteroid injection with normal saline infiltration.

BACKGROUND: Injections of corticosteroids are commonly used for a variety a dermatologic conditions but may cause local, persistent cutaneous atrophy, with few therapeutic options. OBJECTIVE: To determine the effectiveness of bacteriostatic normal saline infiltration on the improvement of corticosteroid-induced cutaneous atrophy. MATERIALS AND METHODS: Four patients with corticosteroid-induced atrophy of the skin, two caused by acneiform cysts and one from intramuscular steroid injection, were treated with weekly injections of normal saline directly into the atrophic site. The patients were seen on weekly follow-up visits, and improvement was documented. RESULTS: All four patients demonstrated complete resolution of skin atrophy and restoration of surface contour within 4 to 8 weeks of initial presentation. Injected volumes of normal saline ranged from 5 to 20 cm(3) per treatment session and three to six weekly treatments. The patients were completely satisfied with these results. CONCLUSION: Normal saline infiltration offers a safe, tolerable, relatively rapid, and effective treatment for local, persistent corticosteroid-induced atrophy.

Adrenal Cortex Hormones↗
PubMed2005

Double-blind prospective comparative trial between foamed and liquid polidocanol and sodium tetradecyl sulfate in the treatment of varicose and telangiectatic leg veins.

BACKGROUND: Twenty subjects were treated with either polidocanol (POL) or sodium tetradecyl sulfate (STS) to compare the efficacy and adverse sequelae of each agent. OBJECTIVE: To determine the safety and efficacy of two widely used sclerosing agents. METHODS: After the exclusion of saphenofemoral junction incompetency, each subject's leg veins were categorized by size (< 1, 1-3, and 3-6 mm in diameter). Each leg was then randomized to be treated with 0.5%, 1%, or 1% foam of POL or 0.25%, 0.5%, or 0.5% foam of STS according to vein size. An independent panel of four physicians, blinded to treatment, performed randomized photographic evaluations obtained pretreatment and 12 weeks post-treatment. Subject satisfaction index and overall clinical improvement assessment were also obtained. RESULTS: An average 83% improvement was noted for all vein sizes in all subjects with both POL and STS after a single treatment. Subjects were satisfied with treatment, regardless of the sclerosing agent used or the vein size treated. There was no statistically significant difference in adverse effects between each group. CONCLUSION: Both POL and STS are safe and effective sclerosing agents in the treatment of varicose and telangiectatic leg veins. Both are very tolerable and demonstrate similar post-treatment sequelae.

Double-Blind Method↗
PubMed2005

Intense pulsed light as a nonablative approach to photoaging.

BACKGROUND AND OBJECTIVE: To describe the introduction and use of intense pulsed light (IPL) to treat vascular and pigmented lesions comprising photorejuvenation and its use in photodynamic therapy. METHODS: Review of the medical literature and the authors' experience with IPL. RESULTS AND CONCLUSIONS: IPL is an excellent treatment modality for vascular and pigmented manifestations of photoaging and can be combined with photodynamic therapy for the treatment of early forms of skin cancer.

Absorption↗
PubMed2005

Clinical comparison between two hyaluronic acid-derived fillers in the treatment of nasolabial folds: hylaform versus restylane.

BACKGROUND: Hyaluronic acid-derived injectible fillers are ideal to reduce the appearance of nasolabial folding because their effect is relatively long-lasting, the material is malleable and easy to use, and there is a very low incidence of allergic reaction. OBJECTIVE: To compare the tolerability and efficacy of two commercially available hyaluronic acid-based fillers, Hylaform (INAMED Aesthetics, Inc., Santa Barbara, CA, USA) and Restylane (Medicis Pharmaceutical Corporation, Scottsdale, AZ, USA), in the treatment of nasolabial folds. METHODS: Eight healthy adult female subjects underwent filler injection therapy for tissue augmentation of their nasolabial folds. Each subject was randomized to receive Restylane 0.7 mL to either the right or the left nasolabial fold and Hylaform 1.0 mL to the contralateral side. High-quality digital photography was performed both at baseline and at 12 weeks post-treatment. These photographs were assessed by four blinded, independent dermatologist reviewers for improvement. Subjects completed questionnaires to document tolerability and satisfaction. RESULTS: All subjects found the procedure to be tolerable and completely pain free after the use of oral infraorbital regional anesthesia blocks. The average subject satisfaction score was 3.00 of 5 for Hylaform and 3.78 of 5 for Restylane. The blinded, independent reviewer panel attributed an average improvement score of 2.86 of 5 for Hylaform and 3.78 of 5 for Restylane. CONCLUSION: Both Hylaform and Restylane are effective fillers for tissue augmentation of the nasolabial folds. Restylane demonstrated higher efficacy and subject satisfaction than Hylaform. With regional nerve blocks prior to injection, both agents are completely painless.

Adult↗
PubMed2005

Prospective, comparative evaluation of three laser systems used individually and in combination for axillary hair removal.

BACKGROUND: Using the concept of selective photothermolysis, a variety of laser systems have been developed to remove unwanted hair. OBJECTIVE: To evaluate the relative efficacy, tolerability, and subject satisfaction of three different laser systems used individually and in rotation for axillary hair removal. METHODS: Twenty female patients (17 with dark-colored hair, 3 with red or light-colored hair) with Fitzpatrick phototype II skin received three treatments performed at 6- to 8-week intervals. Each axilla was divided in half to yield four distinct areas that were treated by the following lasers: (1) three sessions with a long-pulse 755 nm alexandrite laser, (2) three sessions with a long-pulse 810 nm diode laser, (3) three sessions with a long-pulse 1,064 nm neodymium:yttrium-aluminum-garnet (Nd:YAG) laser, and (4) rotational treatment consisting of a single session by each of the three laser systems. Percent hair reduction and acute and long-term side effects were evaluated after treatment. Subjects completed questionnaires assessing tolerability and satisfaction. RESULTS: All subjects tolerated the treatments well, with only local, transient side effects seen. At the 3-month follow-up, the greatest average hair reduction was comparably similarly seen after the alexandrite laser at 59.3 +/- 9.7% and the 810 nm diode laser at 58.7 +/- 7.7%. The Nd:YAG laser and rotational regimens were less efficacious, with 31.9 +/- 11.1% and 39.8 +/- 10.1% hair reduction, respectively. Subjects with red or light-colored hair experienced 5 to 15% reduced efficacy with any laser system used. Subjects found the alexandrite and diode lasers to be equally tolerable, with only slight discomfort, and the Nd:YAG laser to be the least comfortable of the three systems. Overall, subject satisfaction of each treated site, in decreasing order, was (1) the 810 nm diode laser, (2) the alexandrite laser, (3) rotational therapy, and (4) the Nd:YAG laser. CONCLUSION: At the 3-month follow-up, the long-pulse alexandrite and 810 nm diode lasers demonstrated no statistically significant differences in efficacy, comparable efficacy and tolerability, and highest subject satisfaction. Rotational therapy with the three laser systems is not as effective as treatment with the alexandrite laser or diode laser alone but is statistically more effective than use of the long-pulse Nd:YAG system alone. Individuals with red or light-colored hair and Fitzpatrick phototype II skin have decreased efficacy of laser treatment than those with dark-colored hair and the same phototype.

Adult↗
PubMed2004

A systemic type I 5 alpha-reductase inhibitor is ineffective in the treatment of acne vulgaris.

Excessive sebum production is a central aspect of the pathophysiology of acne vulgaris. Sebaceous gland function is under androgen control and it is hypothesized that dihydrotestosterone is formed by the action of 5 alpha-reductase. Type I is the controlling isoenzyme. This study describes a 3-month, multicenter, randomized, placebo-controlled clinical trial with a potent, selective inhibitor of type I 5 alpha-reductase used alone and in combination with systemic minocycline. Inhibition of type I 5 alpha-reductase was not associated with clinical improvement of acne when used alone and did not enhance the clinical benefit of systemic minocycline. These results indicate the need for further work at the molecular level to better understand the action of androgens on sebaceous gland function.

Acne Vulgaris↗