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Treatment of keloids and hypertrophic scars with a novel polymer-based skin coating
P3011 Cryogen-induced arcuate hyperpigmentation by dynamic cooling device: A case report Dong Hyun Kim, MD, Department of Dermatology, Pochon CHA University, College of Medicine, Seongnam, South Korea; Sang Ju Lee, MD, Yonsei Star Skin & Laser Clinic, Seoul, South Korea; Sang Gun Park, MD, Yonsei Star Skin & Laser Clinic, Seoul, South Korea; Sang Ho Oh, MD, Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, South Korea Cosmetic laser surgery have some side effects, including edema, prolonged erythema, scarring, and hyperpigmentation. Among them, pigmentary changes such as hyper- and hypopigmentation are main concerns especially in Asians with darker skin type. To reduce these risks, epidermal cooling by cooling devices has been used during laser operation. Herein, we report a case of arcuate hyperpigmentation regarded as a complication of cooling device. A 34-year-old Korean female with Fitzpatrick skin type IV had been treated for acne with the non-ablative 1450nm diode laser (Smoothbeam Laser, Candela, Wayland, MA) using a 6-mm spot size at 210 ms pulse duration and 14 J/cm2 with a 40 ms cryogen spray duration with a 10ms delay. One week after the first treatment, however, she presented with numerous arcuate erythematous brown pigmented lesions on the treated area. There were no textural changes and blistering. She underwent follow-up to evaluate dyspigmentation and these hyperpigmented lesions slowly faded without specific treatment over the subsequent 3 months, but not completely resolved yet. Dynamic cooling device (DCD) is a safe and effective modality of selectively cooling the epidermis. DCD minimizes thermal injuries by aerosol spurt application of a liquid cryogen on the skin surface during or between laser pulses. However, there is a risk of pigmentary alteration following epidermal cooling in those with darker skin types, and recently developed laser treatments are no exception. It should be kept in mind that both heat and cold could make unexpected dyspigmentation. Commercial support: None identified.
WOUND HEALING AND ULCERS P3100 Diagnosing chronic wound infection: Comparison of routine cultures, quantitative microbiology, and molecular techniques Yelena Frankel, MD, MPH, Johns Hopkins University, Baltimore, MD, United States; Johan Melendez, MS, Johns Hopkins University, Balitmore, MD, United States; Lance Price, PhD, Johns Hopkins University, Baltimore, MD, United States; Jonathan Zenilman, MD, Johns Hopkins University, Baltimore, MD, United States Background: Wounds account for more than 50% of direct medical costs for skin diseases in the United States. Differentiating invasive wound infection versus colonization in chronic wounds is a major clinical challenge. Microbiology labs frequently report qualitative results (scant/moderate/heavy growth) without linkage to clinical outcome and often use a threshold of 105 organisms/gm—which is not based on carefully-controlled studies. Reliable quantification of bacterial load is critical to correlating changes in microbial population with healing rates. Objectives: We evaluated biopsies from chronic wounds and compared quantitative and qualitative results. We determined microbiology by semiquantitative cultures in a clinical lab and quantitative cultures in a research lab. Species detection was done by 2 molecular methods: real-time polymerase chain reaction (RT-PCR) and highdensity 16S microarray (Phylochip), which can identify 9000 bacterial taxa from a single sample. Methods: Fourteen patients presenting to the Johns Hopkins Wound Center with suspected chronic wound infection were enrolled. Tissue was obtained from the leading wound edge of 17 wounds using a 3-mm curette. Results: By quantitative microbiology, 16 of 17 specimens were infected at more than 105 cfu/g. Nine and seven of the bacterial organisms present were at 107 cfu/g and 108 cfu/g, respectively. In contrast, only 25% of the semiquantitative cultures showed ‘‘heavy’’ growth. RT-PCR results were comparable to quantitative culture results. Using microarray, over 300 taxa of aerobic, anaerobic, and microaerophilic bacteria were detected in a single specimen. Minimum tissue needed for reproducible measurements was 20 mg, easily obtained using a 3-mm curette with little loss of tissue or discomfort for the patient. Conclusion: Chronic wounds are highly complex ecosystems. Quantitative culture is more reproducible and reliable for determining bacterial load compared to routine semiquantitative cultures. Routine cultures greatly underestimate bacterial variety compared with 16S microarray (1-5 vs. 300 species). Modern molecular methods are promising for characterizing wound bacterial populations because they can detect difficult to culture organisms, including bacteria residing in biofilms, anaerobes, and nonviable organisms, providing insight into inflammation and healing. Commercial support: None identified.
P3101 Treatment of keloids and hypertrophic scars with a novel polymer-based skin coating Gregg Siegel, MS, BDC, San Antonio, TX, United States; Bakul Bhatt, PhD, Biomedical Development Corporation, San Antonio, TX, United States; Scott Bangert, MD, The University of Texas Medical School-Houston, Houston, TX, United States; Adelaide Hebert, MD, The University of Texas Medical SchoolHouston, Houston, TX, United States Background: Silicone sheeting is used as a noninvasive treatment for keloids and hypertrophic scarrs. However, silicone dressings often adhere poorly, can be difficult to affix to skin, can induce irritation on adjacent noninjured skin, and have inherent cosmetic deficiencies. This study was designed to evaluate the efficacy of a polymer-based skin coating to treat hypertrophic scars and keloids. The polymer is applied directly to the skin as a liquid solution that dries in seconds to form a thin film.
Recently, various phototherapeutic modalities have been used for the treatment of acne vulgaris. The purpose of this study was to investigate the efficacy of phototherapy with a newly-developed 1450-nm diode laser in patients with mild to moderate acne. An open study was performed in acne patients who were treated with 2-week intervals up to 5 times. Acne lesions were reduced by 63%. Only one patient discontinued treatment because of vesicle formation as an adverse effect. Phototherapy using this diode laser source was effective and well tolerated in acne patients, suggesting that this phototherapy may be a new modality for the treatment of acne.
Methods: Forty volunteers having a mature ([7-month-old) keloid or hypertrophic scar met inclusion/exclusion criteria and were randomized to either silicone sheeting or polymer coating treatment groups. Study participants self-administered the polymer coating treatment twice daily for the duration of the 16-week study period, and those randomized to the silicone sheeting group used the product consistent with instructions from the manufacturer. Scar measurements and subjective evaluation by the participants were completed at baseline and weeks 4, 8, and 16. Scars were evaluated using the Vancouver Scar Scale (VSS), which provides a composite score for vascularity, pliability, and height, and an ordinal score for pigmentation. Study participants provided self-assessment of itching on a 4-point scale. Results: Seventeen subjects in the polymer-coating group and 5 subjects in the silicone-sheeting group completed the study and were considered evaluable. The high rate of dropout in the silicone-sheeting group was primarily related to complications from the treatment (skin irritation, difficulty of application, etc.), and disallowed treatment group comparisons. For the polymer coating-treated group, a statistically significant difference in VSS index score from baseline was observed at weeks 4 (P \.006), 8 (P \.001), and 16 (P \.0001), demonstrating progressive improvement over the study period. Changes in scar pigmentation approached significance at week 4 (P \ .083) and continued treatment led to significant differences observed at week 16 (P \.009). Significant and progressive improvement in itching sensation was reported at weeks 4 (P \.034), 8 (P \.017), and 16 (P \.003). Notably, all individuals reported some degree of relief, with those reporting ‘‘no itching’’ increasing from 17.6% at baseline to 58.8% at the end of the study. Conclusion: These novel polymer-based coatings are an effective treatment for keloids and hypertrophic scars.
Commercial support: None identified.
Supported by Biomedical Development Corp. and Epikeia Inc.
P3012 Acne phototherapy with a 1400-nm diode laser: An open study Tomohiko Narita, MD, Kinki University School of Medicine, Department of Dermatology, Osaka-Sayama City, Japan; Akira Kawada, MD, PhD, Kinki University School of Medicine, Department of Dermatology, Osaka-Sayama City, Japan; Natsuko Konishi, MD, Kinki University School of Medicine, Department of Dermatology, Osaka-Sayama City, Japan; Naoki Oiso, MD, PhD, Kinki University School of Medicine, Department of Dermatology, Osaka-Sayama City, Japan
AB142
J AM ACAD DERMATOL
FEBRUARY 2008
WOUND HEALING AND ULCERS P3100 Diagnosing chronic wound infection: Comparison of routine cultures, quantitative microbiology, and molecular techniques Yelena Frankel, MD, MPH, Johns Hopkins University, Baltimore, MD, United States; Johan Melendez, MS, Johns Hopkins University, Balitmore, MD, United States; Lance Price, PhD, Johns Hopkins University, Baltimore, MD, United States; Jonathan Zenilman, MD, Johns Hopkins University, Baltimore, MD, United States Background: Wounds account for more than 50% of direct medical costs for skin diseases in the United States. Differentiating invasive wound infection versus colonization in chronic wounds is a major clinical challenge. Microbiology labs frequently report qualitative results (scant/moderate/heavy growth) without linkage to clinical outcome and often use a threshold of 105 organisms/gm—which is not based on carefully-controlled studies. Reliable quantification of bacterial load is critical to correlating changes in microbial population with healing rates. Objectives: We evaluated biopsies from chronic wounds and compared quantitative and qualitative results. We determined microbiology by semiquantitative cultures in a clinical lab and quantitative cultures in a research lab. Species detection was done by 2 molecular methods: real-time polymerase chain reaction (RT-PCR) and highdensity 16S microarray (Phylochip), which can identify 9000 bacterial taxa from a single sample. Methods: Fourteen patients presenting to the Johns Hopkins Wound Center with suspected chronic wound infection were enrolled. Tissue was obtained from the leading wound edge of 17 wounds using a 3-mm curette. Results: By quantitative microbiology, 16 of 17 specimens were infected at more than 105 cfu/g. Nine and seven of the bacterial organisms present were at 107 cfu/g and 108 cfu/g, respectively. In contrast, only 25% of the semiquantitative cultures showed ‘‘heavy’’ growth. RT-PCR results were comparable to quantitative culture results. Using microarray, over 300 taxa of aerobic, anaerobic, and microaerophilic bacteria were detected in a single specimen. Minimum tissue needed for reproducible measurements was 20 mg, easily obtained using a 3-mm curette with little loss of tissue or discomfort for the patient. Conclusion: Chronic wounds are highly complex ecosystems. Quantitative culture is more reproducible and reliable for determining bacterial load compared to routine semiquantitative cultures. Routine cultures greatly underestimate bacterial variety compared with 16S microarray (1-5 vs. 300 species). Modern molecular methods are promising for characterizing wound bacterial populations because they can detect difficult to culture organisms, including bacteria residing in biofilms, anaerobes, and nonviable organisms, providing insight into inflammation and healing. Commercial support: None identified.
P3101 Treatment of keloids and hypertrophic scars with a novel polymer-based skin coating Gregg Siegel, MS, BDC, San Antonio, TX, United States; Bakul Bhatt, PhD, Biomedical Development Corporation, San Antonio, TX, United States; Scott Bangert, MD, The University of Texas Medical School-Houston, Houston, TX, United States; Adelaide Hebert, MD, The University of Texas Medical SchoolHouston, Houston, TX, United States Background: Silicone sheeting is used as a noninvasive treatment for keloids and hypertrophic scarrs. However, silicone dressings often adhere poorly, can be difficult to affix to skin, can induce irritation on adjacent noninjured skin, and have inherent cosmetic deficiencies. This study was designed to evaluate the efficacy of a polymer-based skin coating to treat hypertrophic scars and keloids. The polymer is applied directly to the skin as a liquid solution that dries in seconds to form a thin film.
Recently, various phototherapeutic modalities have been used for the treatment of acne vulgaris. The purpose of this study was to investigate the efficacy of phototherapy with a newly-developed 1450-nm diode laser in patients with mild to moderate acne. An open study was performed in acne patients who were treated with 2-week intervals up to 5 times. Acne lesions were reduced by 63%. Only one patient discontinued treatment because of vesicle formation as an adverse effect. Phototherapy using this diode laser source was effective and well tolerated in acne patients, suggesting that this phototherapy may be a new modality for the treatment of acne.
Methods: Forty volunteers having a mature ([7-month-old) keloid or hypertrophic scar met inclusion/exclusion criteria and were randomized to either silicone sheeting or polymer coating treatment groups. Study participants self-administered the polymer coating treatment twice daily for the duration of the 16-week study period, and those randomized to the silicone sheeting group used the product consistent with instructions from the manufacturer. Scar measurements and subjective evaluation by the participants were completed at baseline and weeks 4, 8, and 16. Scars were evaluated using the Vancouver Scar Scale (VSS), which provides a composite score for vascularity, pliability, and height, and an ordinal score for pigmentation. Study participants provided self-assessment of itching on a 4-point scale. Results: Seventeen subjects in the polymer-coating group and 5 subjects in the silicone-sheeting group completed the study and were considered evaluable. The high rate of dropout in the silicone-sheeting group was primarily related to complications from the treatment (skin irritation, difficulty of application, etc.), and disallowed treatment group comparisons. For the polymer coating-treated group, a statistically significant difference in VSS index score from baseline was observed at weeks 4 (P \.006), 8 (P \.001), and 16 (P \.0001), demonstrating progressive improvement over the study period. Changes in scar pigmentation approached significance at week 4 (P \ .083) and continued treatment led to significant differences observed at week 16 (P \.009). Significant and progressive improvement in itching sensation was reported at weeks 4 (P \.034), 8 (P \.017), and 16 (P \.003). Notably, all individuals reported some degree of relief, with those reporting ‘‘no itching’’ increasing from 17.6% at baseline to 58.8% at the end of the study. Conclusion: These novel polymer-based coatings are an effective treatment for keloids and hypertrophic scars.
Commercial support: None identified.
Supported by Biomedical Development Corp. and Epikeia Inc.
P3012 Acne phototherapy with a 1400-nm diode laser: An open study Tomohiko Narita, MD, Kinki University School of Medicine, Department of Dermatology, Osaka-Sayama City, Japan; Akira Kawada, MD, PhD, Kinki University School of Medicine, Department of Dermatology, Osaka-Sayama City, Japan; Natsuko Konishi, MD, Kinki University School of Medicine, Department of Dermatology, Osaka-Sayama City, Japan; Naoki Oiso, MD, PhD, Kinki University School of Medicine, Department of Dermatology, Osaka-Sayama City, Japan
AB142
J AM ACAD DERMATOL
FEBRUARY 2008