PubMed Health⌕ Search

Biomedical subjects

Paul M Friedman

Publications and source records attributed to Paul M Friedman.

At least 19 recordsLinked to original sources
PubMed2006

Treatment of inflammatory facial acne vulgaris with combination 595-nm pulsed-dye laser with dynamic-cooling-device and 1,450-nm diode laser.

BACKGROUND AND OBJECTIVES: The 585-nm pulsed-dye laser and the 1,450-nm diode laser have been found effective for the treatment of mild-to-moderate inflammatory facial acne. This study was designed to evaluate the efficacy and safety of the combined treatment with the 595-nm pulsed-dye laser and the 1,450-nm diode laser for inflammatory facial acne. STUDY DESIGN/MATERIALS AND METHODS: Fifteen patients with inflammatory facial acne were treated with a combination of the 595-nm pulsed-dye laser and the 1,450-nm diode laser. Patients' subjective response to treatment was evaluated regarding improvement in acne, acne scarring, oiliness, and redness of the skin. RESULTS: All patients had reductions in acne lesion counts. Mean lesion counts decreased 52% (P < 0.01), 63% (P < 0.01), and 84% (P < 0.01) after one, two, and three treatments, respectively. Patients described moderate-to-marked improvement in acne, acne scarring, and post-inflammatory erythema. Adverse effects were limited to mild, transient erythema. CONCLUSIONS: The combination of the 595-nm pulsed-dye laser and the 1,450-nm diode laser is safe and effective for the treatment of inflammatory facial acne, acne scarring, and post-inflammatory erythema.

Acne Vulgaris↗
PubMed2006

The 1450-nm diode laser for facial inflammatory acne vulgaris: dose-response and 12-month follow-up study.

BACKGROUND: The 1450-nm diode laser has been known to thermally alter sebaceous glands and has been found to be effective for the treatment of inflammatory facial acne. OBJECTIVE: Our aim was to evaluate the dose response of a 1450-nm diode laser for treatment of facial acne, sebum production, and acne scarring utilizing two laser fluences and to determine long-term remission after laser treatment. METHODS: Twenty patients (Fitzpatrick skin phototypes II-VI) received 3 treatments using the 1450 nm diode laser (3-4 week intervals). Split face comparisons were performed by randomizing patients to one of two fluences (14 or 16 J/cm(2)) on the right or left side of the face. Clinical photographs, lesion counts, and sebum measurements were obtained at baseline and after each treatment. Investigators' and patients' subjective evaluations of response to treatment were assessed. RESULTS: Percentage reductions in mean acne lesion counts from baseline were 42.9% (14 J/cm(2)) and 33.9% (16 J/cm(2)) after one treatment and 75.1% (14 J/cm(2)) and 70.6% (16 J/cm(2)) after 3 treatments. There was persistent reduction of 76.1% (14 J/cm(2)) and 70.5% (16 J/cm(2)) at the 12-month follow-up (P < .01). Both objective and subjective improvements in acne scarring and sebum production were noted. Treatment-related pain was well tolerated, and adverse effects were limited to transient erythema and edema at treatment sites. LIMITATIONS: This was a small study and comparison was limited to two laser fluences. CONCLUSION: The 1450-nm diode laser reduced inflammatory facial acne lesions even in Fitzpatrick skin phototypes IV-VI with minimal side effects. Significant improvement in acne lesion counts were noted after the first treatment and was maintained 12 months after the third treatment, indicating significant long-term clinical remission after laser treatment.

Acne Vulgaris↗
PubMed2006

Fractional photothermolysis for the treatment of surgical scars: a case report.

BACKGROUND: Surgical scars are a challenging condition to treat. Fractional photothermolysis provides a promising new modality for treatment. CASE REPORT: A 55-year-old white female patient with a surgical scar on the chin was treated with fractional photothermolysis (1550 nm Fraxel SR laser). A single treatment session was performed at pulse energy of 8 mJ (MTZ) and a final density of 2000 MTZ/cm2. The treatment response was assessed by comparing pre- and 2-week post-treatment clinical photography. RESULTS: A greater than 75% clinical improvement of scarring was achieved at 2 weeks after a single treatment based on independent physician assessment. No significant adverse effects were noted. The improvement was persistent at 1-month follow-up. CONCLUSION: Fractional photothermolysis offers a new, effective, and safe modality for the treatment of surgical scars.

Cicatrix, Hypertrophic↗
PubMed2006

Fractional photothermolysis for treatment of poikiloderma of civatte.

Poikiloderma of Civatte refers to a change in the skin where there is atrophy, hyper- and hypopigmentation, and dilation of fine blood vessels (telangiectasia). These alterations often cause cosmetic disfigurement, most commonly in middle-aged or elderly women with a fair complexion. Several treatment modalities, based on the theory of selective photothermolysis, including argon lasers, KTP lasers, pulsed dye lasers, and intense pulsed light devices, have been used to treat this condition in the past. Clinical experience has shown that complete clearing is difficult to achieve. Moreover, depending on the modality used, adverse effects, such as scarring with irregular hypopigmentation, post-inflammatory hyperpigmentation, post-treatment purpura, mottled appearance, crusting, and erythema, have been reported. Multiple sessions with these treatments are usually necessary to obtain optimal clearing.

Atrophy↗
PubMed2005

A rare case of fatal primary cutaneous mucinous carcinoma of the scalp with multiple in-transit and pulmonary metastases.

BACKGROUND: Primary cutaneous mucinous carcinoma is a rare neoplasm derived from the sweat glands. It is usually located in the head and neck region, with the eyelids being the most common site of presentation. Recurrence following primary excision is common but metastasis is rare. CASE REPORT: We report a patient presenting with rapidly progressive cutaneous mucinous carcinoma on the right parietal scalp. Systemic work-up failed to reveal an occult primary source. The tumor was treated with Mohs micrographic surgery with clear margins. However, within two months, the patient developed new lesions on the scalp both adjacent to and separate from the original previously excised area, as well as metastasis to the right parotid gland. The patient received adjuvant radiation therapy both to the scalp lesions and to the parotid gland with apparent control of locoregional disease. However, two weeks after completing radiation therapy, the patient was found to have developed pulmonary metastases and died soon thereafter. CONCLUSION: Primary mucinous carcinoma arising in the skin is rare and usually follows an indolent course. We report the rare occurrence of a mucinous carcinoma of the scalp that developed multiple cutaneous tumors caused by in-transit metastases, as well as parotid gland metastases and eventual fatal pulmonary metastases.

Adenocarcinoma, Mucinous↗
PubMed2005

Curettage prior to Mohs' micrographic surgery for previously biopsied nonmelanoma skin cancers: what are we curetting? Retrospective, prospective, and comparative study.

BACKGROUND: Curettage prior to excision and Mohs' micrographic surgery for nonmelanoma skin cancer is performed based on the assumption that the curette will remove softer, more friable tumor-infiltrated dermis and leave structurally intact normal skin. This assumption, however, has not been objectively examined in the dermatologic surgery literature. OBJECTIVE: We performed a study to examine the ability of curettage to selectively remove and delineate nonmelanoma skin cancer prior to Mohs' micrographic surgery. METHODS: The study included 150 previously biopsied basal cell and squamous cell carcinomas less than 1.5 cm in size. We conducted (1) a retrospective study of 50 tumors curetted prior to Mohs' surgery by a surgeon who routinely curettes preoperatively; (2) a prospective study in which a surgeon who routinely does not curette preoperatively curetted 50 tumors prior to Mohs' surgery; and (3) a comparative historical group of 50 noncuretted tumors treated with Mohs' surgery by the latter surgeon. All curetted tissue was evaluated histologically. RESULTS: Only 50% of the curetted tissue demonstrated the presence of tumor in the curettings, but in 76% of these, the curette left residual tumor at the surgical margins. Of the other 50% in which the curette removed only non-cancer-containing skin, 34% had tumor present at the surgical margin. Overall, the curette removed tumor, leaving no residual tumor at the surgical margins in only 12% of lesions. Comparison with historical noncuretted tumors operated on by the same surgeon showed that curettage did not affect the mean number of stages or the proportion of tumors requiring more than one stage for histologic clearance. CONCLUSION: Although curettage may be helpful in debulking friable skin prior to Mohs' micrographic surgery, it does not reliably delineate the extent of a tumor.

Biopsy↗
PubMed2004

Treatment of atrophic facial acne scars with the 1064-nm Q-switched Nd:YAG laser: six-month follow-up study.

OBJECTIVES: To quantitatively assess improvement in acne scarring after a series of nonablative laser treatments and to determine efficacy at 1-, 3-, and 6-month follow-up after treatment. DESIGN: Before-after trial of consecutively selected patients. SETTING: Private practice at the Laser and Skin Surgery Center of New York, New York. PATIENTS: Eleven patients with mild to moderate atrophic acne scarring were treated. INTERVENTIONS: A 3-dimensional optical profiling imaging system was used to assess skin topography before, during, and after treatment. Patients were treated with a 1064-nm Q-switched Nd:YAG laser and reassessed after 3 treatment sessions and at 1, 3, and 6 months after the fifth treatment session. MAIN OUTCOME MEASURES: The skin roughness analysis was quantified at baseline and at each follow-up interval. Pain, erythema, and petechiae formation were assessed on 3-point scales. RESULTS: At midtreatment (1 month after the third treatment session), an 8.9% improvement in roughness analysis was seen. This improvement increased to 23.3%, 31.6%, and 39.2% at 1, 3, and 6 months after the fifth treatment, respectively. Patients reported mild to moderate pain with treatment. The only adverse effects noted were transient erythema and mild pinpoint petechiae. CONCLUSIONS: Treatment with the nonablative 1064-nm Q-switched Nd:YAG laser results in significant quantitative improvements in skin topography in patients with mild to moderate atrophic acne scars. Continued incremental improvements were noted at 1-, 3-, and 6-month follow-up, indicating ongoing dermal collagen remodeling after the treatment.

Acne Vulgaris↗
PubMed2004

The safety and efficacy of the 308-nm excimer laser for pigment correction of hypopigmented scars and striae alba.

OBJECTIVE: To assess the safety and efficacy of the 308-nm excimer laser in pigment correction of hypopigmented scars and striae alba. DESIGN: Institutional review board-approved randomized controlled trial. SETTING: Private research center. PATIENTS: Volunteer sample of 31 adult subjects with hypopigmented scars or striae alba distributed on the face, torso, or extremities. INTERVENTIONS: Lesions were randomized to receive treatment or not, with site-matched normal control areas. Treatments were initiated with a minimal erythema dose minus 50 mJ/cm(2) to affected areas. Subsequent treatments were performed biweekly until 50% to 75% pigment correction, then every 2 weeks thereafter until a maximum of 10 treatments, 75% increase in colorimetric measurements, or 100% visual pigment correction. MAIN OUTCOME MEASURES: Pigment correction by visual and colorimetric assessments compared with untreated control lesions and site-matched normal skin before each treatment and at 1-, 2-, 4-, and 6-month follow-up intervals. Occurrence of erythema, blistering, dyspigmentation, or other adverse effects was monitored. RESULTS: The percentage pigment correction by both assessments increased in direct proportion to the number of treatments. The mean percentage pigment correction by visual assessment relative to control of 61% (95% confidence interval [CI], 55%-67%) for scars and 68% (95% CI, 62%-74%) for striae was achieved after 9 treatments. The mean percentage pigmentation by colorimetric measurements relative to control of 101% (95% CI, 99%-103%) for scars and 102% (95% CI, 99%-104%) for striae was achieved after 9 treatments. Both sets of values gradually declined toward baseline levels during the 6-month follow-up. No blistering or dyspigmentation occurred. CONCLUSIONS: Therapy with the 308-nm excimer laser is safe and effective in pigment correction of hypopigmented scars and striae alba. Mean final pigment correction rates relative to control sites of approximately 60% to 70% by visual assessment and 100% by colorimetric analysis were observed after 9 treatments administered biweekly. Maintenance treatment every 1 to 4 months is required to sustain the cosmetic benefit.

Abdomen↗
PubMed2004

60-minute application of S-Caine Peel prior to 1,064 nm long-pulsed Nd:YAG laser treatment of leg veins.

BACKGROUND AND OBJECTIVES: Advancements in laser treatment of leg veins necessitate concurrent investigations in topical anesthesia to minimize treatment-related pain. To evaluate the efficacy of the S-Caine Peel for providing topical anesthesia after a 60-minute application. STUDY DESIGN/PATIENTS AND METHODS: A randomized, double-blinded, placebo-controlled trial was performed in two centers. Sixty patients received S-Caine Peel and placebo vehicle on different treatment sites for 60 minutes prior to laser treatment of leg veins using a 1,064 nm long-pulsed Nd:YAG laser. Patients rated their level of pain using a visual analog scale. Adequacy of anesthesia and expressed pain at each site were rated by the investigator. RESULTS: The mean visual analog scale (VAS) was 27 mm for active sites compared to 43 mm for placebo (P < 0.001). Improved pain relief was noted for 67% of active versus 30% of placebo sites (P < 0.001). Anesthesia was judged adequate by the investigator for 55% of active compared with 12% of placebo sites (P < 0.001). CONCLUSIONS: The S-Caine Peel is safe and effective when applied for 60 minutes prior to laser therapy of leg veins.

Adult↗
PubMed2004

Keratoacanthoma as a postoperative complication of skin cancer excision.

BACKGROUND: Keratoacanthomas usually occur spontaneously as a single rapidly growing tumor on sun-exposed skin. Multiple keratoacanthomas are rarely seen. Keratoacanthomas may also develop after trauma, laser resurfacing, radiation therapy, and at the donor site after skin grafting. OBJECTIVE: We report 6 cases of keratoacanthomas that developed in and around healing and healed surgical sites after treatment of skin cancer. These tumors developed 1 to 3 months after surgery and were sometimes multiple. METHODS: We performed follow-up examinations of patients' wounds after the treatment of skin cancer. Histological examination of nodules developing in the margins of healing wound sites and in the scars of healed wound sites after Mohs micrographic surgery revealed keratoacanthomas. RESULTS: The tumors presented as a rapidly growing nodule or nodules, with the typical morphology and pathology of keratoacanthoma. One patient developed multiple keratoacanthomas at surgical and nonsurgical sites. These nodules were treated by a combination of excision, curettage and electrodesiccation, and oral isotretinoin, 4 mg/d. CONCLUSION: Keratoacanthoma must be considered in the differential diagnosis of a rapidly growing nodule within or around the surgical site after skin cancer surgery.

Aged↗
PubMed2004

Treatment of inflammatory facial acne vulgaris with the 1450-nm diode laser: a pilot study.

BACKGROUND: The 1450-nm diode laser has been found to damage sebaceous glands selectively and to be effective for the treatment of inflammatory acne on the back. OBJECTIVE: To evaluate the efficacy and safety of the 1450-nm diode laser in the treatment of inflammatory facial acne vulgaris. METHODS: Nineteen patients with inflammatory facial acne were treated with the 1450-nm diode laser at 4- to 6-week intervals. There was no control group. Clinical photographs and lesion counts were obtained at baseline and after each treatment. Subjective evaluation of response to treatment and pain was assessed using a questionnaire. RESULTS: All patients had a reduction in acne lesions. Lesion counts decreased 37% after one treatment (p<0.01), 58% after two treatments (p<0.01), and 83% after three treatments (p<0.01). Treatment-related pain was well tolerated, and adverse effects were limited to transient erythema and edema at treatment sites. CONCLUSION: This is the first published report documenting the safety and efficacy of laser treatment for inflammatory facial acne. In our study, clinical improvement was seen in all patients and was generally dramatic, even in those refractory to previous treatment with oral isotretinoin. Topical anesthetics should be used to minimize pain associated with treatment.

Acne Vulgaris↗
PubMed2004

Nonphysician practice of dermatologic surgery: the Texas perspective.

BACKGROUND: Increases in complications resulting from the nonphysician practice of dermatologic procedures have been reported nationally. This investigation was initiated owing to growing concern regarding the nonphysician practice of medicine in Texas. OBJECTIVE: The objective was to survey dermatologists in Texas to determine the number of patients seeking corrective treatment owing to complications from dermatologic procedures performed by nonphysicians. METHODS: A total of 488 dermatologists in Texas were surveyed and seven patients who experienced complications were interviewed by phone. RESULTS: Nearly 53% of responding physicians noted increased complications resulting from nonphysician practice of medicine. Approximately 33% of responding physicians reported that complications were known to have occurred in the absence of an on-site supervising physician. CONCLUSION: The increase in the number of complications owing to nonphysician practice of medicine in Texas mirrors the increases that have been reported nationally. The serious complications reported underscore the need for improved awareness and regulatory changes by state boards of medicine.

Clinical Competence↗
PubMed2004

Successful treatment of a chronic atrophic dog-bite scar with the 1450-nm diode laser.

BACKGROUND: Atrophic scars can be revised with surgical methods and more recently with newer ablative and nonablative laser techniques. Nonablative laser technology offers the advantage of improving the appearance of atrophic scars without the risks associated with traditional surgery or ablative lasers. METHODS: A case of a large linear atrophic dog-bite scar on the chin of greater than 2-year duration treated for three sessions at 4- to 6-week intervals with the 1450-nm diode laser is presented. RESULTS: Fifty to seventy-five percent improvement in the appearance of the scar resulted after three treatments with the 1450-nm diode laser. No adverse effects were noted from the treatment. The patient subjective rating of scar improvement was more than 50%. CONCLUSION: The 1450-nm diode laser may provide a noninvasive and effective alternative for the treatment of atrophic traumatic scars. This method appears to be potentially effective even for treatment of very mature scars and warrants additional studies.

Adult↗