Biomedical subjects

Paul M Friedman

Publications and source records attributed to Paul M Friedman.

29 records · Page 2Linked to original sources

PubMed2004

Basal cell carcinoma arising in a port-wine stain.

BACKGROUND: The occurrence of basal cell carcinoma within a port-wine stain or nevus flammeus is rare. Sixteen cases of basal cell carcinoma which developed in a port-wine stain or nevus flammeus have been reported. OBJECTIVE: The objective was to demonstrate a rare case of basal cell carcinoma occurring in a port-wine stain successfully treated with Mohs micrographic surgery. METHODS: This is a case report and literature review. RESULTS: An 87-year-old man presented with a basal cell carcinoma on the margin of a previously untreated port-wine stain on the left cheek. Histologic examination showed a nodular basal cell carcinoma. The basal cell carcinoma was completely excised with Mohs micrographic surgery and complex linear closure was used to repair the wound in layers. The postoperative course was complicated by a hematoma, which developed 24 hr postoperatively. The hematoma was drained and there was no further bleeding or evidence of recurrence of the tumor after 12 months. CONCLUSION: Basal cell carcinoma should be included in the differential diagnosis of a skin lesion occurring in a port-wine stain.

Aged↗

PubMed2004

Mohs micrographic surgery for elliptical excision of skin tumors: a surgical and histologic study.

BACKGROUND: Elliptical excision is a standard form of treatment for cutaneous neoplasms, but routine pathologic sectioning results in incomplete histologic control of surgical margins. OBJECTIVE: The objective was to describe a technique of complete histologic margin control for tumors removed by excision as an ellipse. METHODS: A retrospective study of 100 consecutive nonmelanoma skin cancers of the head and neck removed using elliptical excisions with complete histologic margin control was performed. The technique is described and depicted in detail. RESULTS: Seventy-one tumors were removed in one excision, and 29 required additional excisions for complete histologic tumor clearance. Linear repairs were used for 93 tumors. CONCLUSION: Elliptical excision, combined with our technique of complete histologic margin control, provides a simple, efficient, and effective method for surgical removal and repair of nonmelanoma skin cancers and provides an alternative variation of performing Mohs micrographic surgery for selected tumors.

Female↗

PubMed2003

Thirty-minute application of the S-Caine peel prior to nonablative laser treatment.

BACKGROUND: Advancements in nonablative laser technology necessitate concurrent developments in topical anesthesia, as patients have reported varying degrees of discomfort during these procedures. Although topical anesthetics have proven efficacious, they possess inherent limitations related to ease of use. OBJECTIVE: To evaluate the efficacy of the S-Caine Peel (ZARS Inc., Salt Lake City, UT), a novel topical anesthetic that dries to form a flexible membrane, for induction of anesthesia after only a 30-minute application period. METHOD: Twenty patients received concurrent 30-minute applications of both the S-Caine Peel and a placebo cream randomized to the right and left cheeks in a double-blinded manner. After one pass of the 1450-nm diode laser (Smoothbeam, Candela Corp., Wayland, MA), patients' pain levels were recorded on a visual analog scale (VAS). Both the investigator and an independent observer rated perceived discomfort and immediate skin reaction based on a numerical scale. RESULTS: Differences in VAS scores between active sites (average rating of 15 mm) and placebo sites (average rating of 47 mm) were statistically significant (P<0.001). A painless procedure was noted at 50% and 65% of active sites by the independent observer and investigator, respectively. This was statistically different (P<0.001) from the independent observer and investigator perception of pain-free procedure at the placebo site, 0% and 5%, respectively. CONCLUSION: The S-Caine Peel provided effective and safe dermal anesthesia after only a 30-minute application period for nonablative laser treatment with the 1450-nm diode laser. The unique vehicle readily delivers anesthetic to contoured regions of the body and eliminates the need for occlusion.

Administration, Topical↗

PubMed2003

Two randomized, double-blind, placebo-controlled studies evaluating the S-Caine Peel for induction of local anesthesia before long-pulsed Nd:YAG laser therapy for leg veins.

BACKGROUND: Topical anesthetics are valuable tools for many dermatologic procedures. OBJECTIVE: To evaluate the efficacy and safety of S-Caine Peel composed of 1:1 (wt:wt) mixture of 7% lidocaine and 7% tetracaine in the induction of local anesthesia before long-pulsed Nd:YAG laser therapy for leg veins. METHODS: Two randomized, double-blinded, placebo-controlled trials were performed. In study 1, 60 adults received S-Caine Peel and placebo cream for 30 or 60 minutes. Efficacy was evaluated by a patient visual analog scale and impression. The pain scale and impression were evaluated by the investigator and an independent observer. In study 2, 40 adults received 60- and 90-minute applications. RESULTS: In study 1, the 30- and 60-minute application times were grouped: Patients had adequate pain relief in 48% of S-Caine sites versus 23% of placebo sites (P<0.001). Investigators reported none-to-mild pain in 50% of active sites versus 33% of placebo sites (P=0.007), with adequate anesthesia in 65% of active sites versus 43% of placebo sites (P=0.002). The independent witness assessed none-to-mild pain in 52% of active sites versus 37% of placebo sites (P=0.067). In study 2, investigators rated none-to-mild pain in 75% of 60-minute and 85% of 90-minute S-Caine sites versus 30% and 50% of placebo sites (P=0.012 and P=0.002, respectively), with adequate anesthesia in 70% and 85% of 60- and 90-minute of active sites versus 25% and 20% of placebo sites (P=0.029 and P=0.001, respectively). The independent witness rated none to mild pain in 80% and 85% of 60 and 90 minute of S-Caine sites versus 35% and 50% of placebo sites (P=0.008 and P=0.004). CONCLUSION: The S-Caine Peel provides safe and highly effective local anesthesia when applied for at least 60 minutes for laser therapy of leg veins. Facile removal of the peel provides a unique advantage and ease in administration.

Administration, Topical↗

PubMed2002

Cooling gel improves pulsed KTP laser treatment of facial telangiectasia.

BACKGROUND AND OBJECTIVE: Pulsed KTP lasers effectively treat facial telangiectasia without purpura production. Transient side effects following treatment include erythema, edema, and vesiculation leading to crust formation. The aim of this study was to investigate the utility of an aqueous gel in reducing side effects associated with pulsed KTP laser treatment of facial telangiectasia. STUDY DESIGN/MATERIALS AND METHODS: Nineteen patients with extensive facial telangiectasias were treated with a pulsed KTP laser (Versapulse, Coherent, Palo Alto, CA). The laser was used with the water cooled handpiece chilled to 4C, a 4 mm spot size, a 10-millisecond pulse duration and a fluence of 9.5 J/cm2. One side of the face was treated with the laser using the cooling handpiece alone. The other side was treated using the cooling handpiece applied to a 2-mm film of aqueous gel spread over the treatment area. RESULTS: Treatment side effects, including pain, erythema, edema, vesiculation, and crusting were scored following treatment with and without the aqueous gel. Use of the aqueous gel in conjunction with the cooling handpiece decreased the incidence and severity of pain, erythema, edema, and crusting following pulsed KTP laser treatment of facial telangiectasia. Most patients demonstrated 50-75% clearance of their telangiectasias 1 month after one treatment session, and use of the gel did not alter the treatment efficacy. CONCLUSIONS: The application of an aqueous gel during pulsed KTP laser treatment of facial telangiectasia improves treatment associated side effects without affecting vessel clearance.

Anti-Infective Agents, Local↗

PubMed2002

Safety data of injectable nonanimal stabilized hyaluronic acid gel for soft tissue augmentation.

BACKGROUND: Nonanimal hyaluronic acid gel was recently developed for soft tissue augmentation and volume expansion and has been shown to offer several advantages in comparison to other augmentation materials. There are rare reports of adverse events believed to be secondary to trace amounts of proteins in the hyaluronic acid raw material. OBJECTIVE: To determine the safety profile of nonanimal stabilized hyaluronic acid gel (Restylane, Perlane, Restylane Fine Lines, Q-Med AB, Uppsala, Sweden) for soft tissue augmentation using a retrospective review of all adverse events data from Europe, Canada, Australia, South American, and Asia from 1999 and 2000. RESULTS: Data from an estimated 144,000 patients treated in 1999 indicated the major reaction to injectable hyaluronic acid was localized hypersensitivity reactions, occurring in approximately 1 of every 1400 patients treated. In 1999 there was an adverse event reported for 1 of every 650 patients (0.15%) treated. These were temporary events that included redness, swelling, localized granulomatous reactions, bacterial infection, as well as acneiform and cystic lesions. For 2000 there was an estimated 262,000 patients treated with hyaluronic acid gel. The total number of adverse events was 144, corresponding to one adverse event for every 1800 patients (0.06%) treated. The major adverse event was again hypersensitivity, occurring in 1 of every 5000 patients treated. CONCLUSION: According to the reported worldwide adverse events data, hypersensitivity to nonanimal hyaluronic acid gel is the major adverse event and is most likely secondary to impurities of bacterial fermentation. According to data from 2000, the incidence of hypersensitivity appears to be declining after the introduction of a more purified hyaluronic acid raw material.

Gels↗

PubMed2002

3D in-vivo optical skin imaging for topographical quantitative assessment of non-ablative laser technology.

BACKGROUND: A new method for treating facial rhytides and acne scars with nonablative laser and light source techniques has recently been introduced. Given the inherent limitations of photographic and clinical evaluation to assess subtle changes in rhytides and surface topography, a new noninvasive objective assessment is required to accurately assess the outcomes of these procedures. OBJECTIVE: The purpose of this study was to measure and objectively quantify facial skin using a novel, noninvasive, In-vivo method for assessing three-dimensional topography. This device was used to quantify the efficacy of five treatment sessions with the 1064 nm QS Nd:YAG laser for rhytides and acne scarring, for up to six months following laser treatment. METHODS: Two subjects undergoing facial rejuvenation procedures were analyzed before and after therapy using a 30-mm, three-dimensional microtopography imaging system (PRIMOS, GFM, Teltow, Germany). The imaging system projects light on to a specific surface of the skin using a Digital Micromirror Device (DMD Texas Instruments, Irving, TX) and records the image with a CCD camera. Skin Surface microtopography is reconstructed using temporal phase shift algorithms to generate three-dimensional images. Measurements were taken at baseline, at various times during the treatment protocol, and then at three and six-month follow-up visits. Silicone skin replicas (FLEXICO, Herts, England) were also made before and after the laser treatment protocol for comparison to In-vivo acquisition. RESULTS: Skin roughness decreased by 11% from baseline after three treatment sessions in the wrinkles subject, while a 26% improvement of skin roughness was recorded by 3D In-vivo assessment six months following the fifth treatment session. The subject with acne scarring demonstrated a 33% decrease in roughness analysis after three treatment sessions by 3D In-vivo assessment. A 61% improvement in surface topography was recorded 3-months following the fifth treatment session, which was maintained at the 6-month follow-up. CONCLUSION: Three-dimensional In-vivo optical skin imaging provided a rapid and quantitative assessment of surface topography and facial fine lines following multiple treatment sessions with a 1064-nm QS Nd:YAG laser, correlating with clinical and subjective responses. This imaging technique provided objective verification and technical understanding of nonablative laser technology. Wrinkle depth and skin roughness decreased at the three and six-month follow-up evaluations by 3D In-vivo assessment, indicating ongoing dermal collagen remodeling after the laser treatment protocol. Future applications may include comparison of nonablative laser technology, optimization of treatment regimens, and objective evaluation of other aesthetic procedures performed by dermatologists.

Acne Vulgaris↗

PubMed2002

Treatment of inverse psoriasis with the 308 nm excimer laser.

BACKGROUND: The treatment of inverse psoriasis can be both challenging and frustrating. Conventional topical and systemic treatments can be limited in terms of efficacy, acceptability and safety. The 308 nm excimer laser has been shown to be effective in the treatment of psoriatic plaques. METHODS: A patient with chronic inverse psoriasis was treated with 308 nm excimer laser using a 3.5 cm spot, a dosage of 2 minimal erythema doses and a pulse width of 30 ns. RESULTS: Complete clearance of the psoriatic lesions was obtained after 3 weeks of treatment. Remission duration was at least 6 months. CONCLUSION: The 308 nm excimer laser is safe and effective for the treatment of inverse psoriasis. Treatments are well tolerated with minimal side effects.

Adult↗

PubMed2002

Quantitative evaluation of nonablative laser technology.

A new method for treating facial rhytides and acne scars with nonablative laser and light source techniques has recently been introduced. Given the inherent limitations of photographic and clinical evaluation to assess subtle changes in rhytides and surface topography, new noninvasive, objective instruments were used to accurately assess the outcome of these procedures. This study measures and objectively quantifies facial skin by using 2 novel, noninvasive measuring systems after 3 to 5 treatment sessions with the 1,064 nm QS Nd:YAG laser in patients with photodamage and acne scarring. One system measures the skin surface topography and the other characterizes the biomechanical properties of the skin. Patients undergoing facial rejuvenation procedures were analyzed before and after therapy with a 32 x 32 mm in vivo three-dimensional microtopography imaging system (PRIMOS, GFM, Teltow, Germany). The imaging system projects light on to a specific surface of the skin with a Digital Micromirror Device (DMD; Texas Instruments, Irving, TX) and records the image with a CCD camera. Skin Surface microtopography is reconstructed using temporal phase shift algorithms to generate three-dimensional images. Measurements were taken at baseline, at various times during the treatment protocol, and then at 3 and 6 month follow-up visits. Silicone skin replicas (FLEXICO, Herts, England) were also made before and after the laser treatment protocol for comparison to in vivo acquisition. Skin stiffness and compliance were measured with the BTC-2000 (BTC 2000, S.R.L.I. Inc. Nashville, TN). This instrument measures the response of the skin during dynamic stress created by suction. An infrared targeting laser measures the vertical displacement of the skin during the cycle. Pressure and deformation are graphically displayed on the monitor and embedded biomechanical algorithms determine the aforementioned parameters based on the average of 3 repetitive cycles. Four sites on the face were analyzed and compared including the right and left cheek and the right and left forehead. Measurements were taken at baseline and then at 1-, 3- and 6-month follow-up visits. Skin roughness decreased 11% from baseline in the patient with photodamaged skin, while the patients with acne scarring showed a 33% improvement from baseline after 3 treatment sessions. Six-months after the fifth treatment session, a 26% improvement in skin smoothness was documented in the patients with photodamaged skin, while a 61% improvement was recorded in the subject with acne scarring. Biomechanical analysis of the skin showed a 23% decrease in skin stiffness and a 30% increase in skin compliance at the 6-month follow-up in the patients with photodamage. Alternatively, the patient with acne scarring showed a 50% increase in skin stiffness, and a 30% decrease in skin compliance at the 6-month follow-up. Three-dimensional in vivo optical skin imaging provided a rapid and quantitative assessment of surface topography and facial fine lines after multiple treatment sessions with a 1064-nm QS Nd:YAG laser, correlating with clinical and subjective responses. Biomechanical analysis provided technical understanding of structural changes in photodamaged skin and acne scarring following nonablative laser treatment. Future applications of these devices may include comparison of nonablative laser technology, optimization of treatment regimens, and objective evaluation of other aesthetic procedures performed by dermatologists.

Cicatrix↗

PubMed2002

Allergic contact dermatitis to topical minoxidil solution: etiology and treatment.

After more than a decade of use, topical minoxidil solution has proven to be a safe and effective treatment for androgenetic alopecia. However, some patients present with complaints of pruritus and scaling of the scalp. The most common causes of these symptoms include irritant contact dermatitis, allergic contact dermatitis, or an exacerbation of seborrheic dermatitis. Patients suffering from allergic contact dermatitis may benefit from patch testing to determine the causative allergen. Among the patients we patch tested, propylene glycol was found to be the contactant in a majority of cases, not the minoxidil itself. Many of these patients may be candidates for treatment with alternative formulations using other solvents, such as butylene glycol, polysorbate, or glycerol. Although predictive, patch testing results do not ensure that the compounded preparations will be tolerated. Unfortunately, patients found to be allergic to minoxidil are no longer candidates for topical treatment of their alopecia with any preparations of minoxidil.

Administration, Topical↗

PubMed2002

Efficacy of the 308-nm excimer laser for treatment of psoriasis: results of a multicenter study.

OBJECTIVE: Our purpose was to demonstrate the efficacy of the 308-nm excimer laser for treatment of psoriasis. METHODS: This study was a multicenter open trial from 5 dermatology practices (one university-based and 4 private practices). Up to 30 patients per center with stable mild to moderate plaque-type psoriasis constituted the study population. Patients received 308-nm ultraviolet B doses to affected areas. The initial dose was based on multiples of a predetermined minimal erythema dose. Subsequent doses were based on the response to treatment. Treatments were scheduled twice weekly for a total of 10 treatments. The main outcome measure was 75% clearing of the target plaque. Time to clearing was analyzed by Kaplan-Meier methods, accounting for truncated observations. RESULTS: One hundred twenty-four patients were enrolled in the study, and 80 completed the entire protocol. The most common reason for exiting from the study was noncompliance. Of the patients who met the protocol requirements of 10 treatments or clearing, 72% (66/92) achieved at least 75% clearing in an average of 6.2 treatments. Eighty-four percent of patients (95% confidence interval [CI], 79%-87%) reached improvement of 75% or better after 10 or fewer treatments. Fifty percent of patients (95% CI, 35%-61%) reached improvement of 90% or better after 10 or fewer treatments. Common side effects included erythema, blisters, hyperpigmentation, and erosions, but they were well tolerated. CONCLUSIONS: Monochromatic 308-nm excimer laser treatment appears to be effective and safe for psoriasis. It requires fewer patient visits than conventional phototherapy, and, unlike those treatments, the laser targets only the affected areas of the skin, sparing the surrounding uninvolved skin.

Adolescent↗