Positive Results for ALA-PDT for Treating Photodamage Results from a multicenter, Phase II clinical study of photodynamic therapy (PDT) in the treatment of mild to moderate photodamage of the face showed statistically significant interim results from its 80 patients, according to DUSA Pharmaceuticals, Inc.The study compared aminolevulinic acid (ALA) (Levulan Kerastick) combined with blue light (BLU-U) and an intense pulsed light (IPL) or a long-pulsed pulsed dye laser (PDL) to treatment with vehicle and each light source without ALA. For this split-face study, following skin cleansing with an acetone solution and about 60 minutes of drug and/or vehicle incubation, treatment with a fixed dose was given using one of the three light sources. Patients underwent up to three treatments at 3-week intervals. Results were assessed at 9 and 12 weeks. Additional follow-ups were scheduled for weeks 26 and 52.Comparing Treatments ALA-PDT with BLU-U light. At week 12, this treatment demonstrated improvement in photodamaged skin compared to BLU-U and vehicle. Statistically significant changes from baseline scores were seen in mottled pigmentation (p=0.0348) and tactile roughness (p=0.0455). Also, improvement in a number of parameters was notably greater at week 12 than week 9, without additional ALA treatments. IPL and vehicle. At week 12, significant improvement in photodamage was seen with IPL and vehicle, especially with respect to mottled pigmentation and telangiectasia. When combined with ALA, there was a trend toward even greater improvement in all parameters of photodamage except for mottled pigmentation, although the improvements were not statistically significant. PDL and vehicle. There was significant improvement in photodamaged skin with PDL and vehicle, especially with respect to telangiectasia. However, with PDL, the addition of ALA did not lead to any discernable differences in photodamage parameters.Safety was excellent in all groups, but the frequency and severity of stinging and burning during treatment was greater with IPL and PDL (with or without ALA) compared to ALA with BLU-U and for BLU-U with vehicle.  Are Patients Satisfied with Laser Hair Removal? A Look at Data from a Retrospective Study (1998-2004)By Luigi L. Polla, M.D., and Ada Polla Tray, M.B.A. In 2005, we surveyed all of our patients who benefited from laser hair removal at Forever Laser Institut between 1998 and 2004 (the total number of patients contacted was 1,250). The purpose of this study was to analyze patient satisfaction with laser hair removal treatments, to identify potential trends in patient care and possible improvements in therapeutic protocols.Patients were sent a questionnaire with a visual scale (0-10) for overall satisfaction. Patients were also asked to include specific qualitative comments. Treatment TechnologyMale and female patients who were surveyed had undergone treatment with one or more of the following lasers, depending on the patient’s skin type and hair thickness: • Candela GentleLASE alexandrite laser, 750 nm, 3 ms, 10-30 J/cm2.• Candela GentleYAG Nd:YAG laser, 1064 nm, 3 ms, 25-40 J/cm2. The laser was chosen based on the patient’s skin type: GentleLASE was used on patients with Fitzpatrick skin types I-III, whereas GentleYAG was preferred for patients with Fitzpatrick skin types IV-VI. Furthermore, GentleYAG was sometimes used for the initial treatment, in particular if the patient had very dark, coarse and dense hair, or if the matrix of the hair was expected to be deep. After a few GentleYAG treatments, that coarse hair typically became softer and lighter, and the treatment was then finished using GentleLASE. Switching from one laser to the other was also helpful when the treatment’s progress appeared slow.The typical parameters used were the following:• For light skin types: 18-mm spot, 18-20 J/cm2, DCD set to 40-30 (alexandrite)• For skin types III: 18-mm spot, 12-16 J/cm2, DCD set to 40-30 (alexandrite)• For skin types IV and darker: 18-mm spot, 10-12 J/cm2, DCD set to 40-30 (alexandrite); 12-mm spot, 30-35 J/cm2, DCD set to 40-20 (Nd:YAG).After the treatment, patients had a soothing lotion applied to avoid inflammation. This lotion was used from 2003 on, but was not used in the bikini area or underarms; a corticosteroid-containing cream was preferred in these cases. In the 15 days immediately following each treatment, the patient was welcomed back at Forever Laser Institut for a free touch-up of the entire treated area. This appeared to be the optimal method of achieving highest patient satisfaction in terms of hair reduction after every treatment. A Look at the DataThe results of the study included responses from 349 patients. Of these: 19 patients provided comments but did not complete the visual scale. Of the remaining respondents:• 36 patients scored the results at 5.5 or below (10.3%)• 294 at 6 or above (84.2%) • 229 patients scored the results at 8 or above (65.6%). The graph below illustrates these results.  High SatisfactionOverall patient satisfaction with hair removal treatments was high, whether looking at the 84.2% of scores higher than 6, or at the 65.6% of scores higher than 8. Satisfaction seemed to be highest for hair removal of the body (whether legs or backs), and lowest for the facial areas. These results illustrate one of the limitations of the laser hair removal methodology: hair growth stimulation on some areas of the face, in particular the chin. This stimulation remains frequent and well documented, although unexplained. A second limitation of laser hair removal is that the treatment of tanned skin remains a concern. It is important to note that no tanned patient was treated, even with GentleYAG. Finally, laser hair removal remained of limited use for patients with blond hair, as is a typical complaint with hair removal. Due to these various limitations, while laser hair removal remains the treatment option of choice for patients looking for long-term hair reduction, it is optimally complemented by other treatment modalities such as electrolysis, especially for the face. Dr. Polla is with the Forever Laser Institut Hair Removal Group in Geneva, Switzerland. Ms. Polla is with Alchimie Forever in Arlington, VA. RF Safe on Skin Treated with FillersA recent study found that radiofrequency (RF) (Thermage) treatment could be safely used over human skin injected with medium-term soft-tissue fillers (Restylane and Radiesse). Results of this study were published in the March 2006 issue of Lasers in Surgery and Medicine Journal.The study examined the safety of the combined use of radiofrequency and soft-tissue fillers in six patients. All patients were injected with soft-tissue fillers on the upper inner arm. Five of the subjects were treated with RF over the filler-injected sites, while the sixth patient served as the control subject and did not receive RF treatment. Filler-injected skin was histologically examined 3 days after RF treatment. The study showed no change in the appearance of the filler substances compared with untreated filler, and there was no evidence of microscopic damage to the filler or surrounding skin. Both Thermage and soft-tissue fillers are commonly used in the lower face to soften nasolabial folds and perioral rhytids. Imiquimod May Help Improve Signs of AgingResults from a new study show that imiquimod cream 5% (Aldara) improved the structure and appearance of prematurely aged skin, including fine lines, wrinkles, dyspigmentations and texture. The findings, from researchers at S.K.I.N. Incorporated, a dermatology research facility, were presented at the Annual Meeting of the American Academy of Dermatology in San Francisco.The open-label study, led by Albert Kligman, M.D., Ph.D., Professor Emeritus of Dermatology at the University of Pennsylvania, included 10 healthy females with visible signs of photoaging. Volunteers were treated with imiquimod cream five times per week for 4 weeks. At predetermined intervals, the subjects were evaluated for both visible and microscopic-level changes to the underlying skin structures.Results showed that imiquimod corrected the structural changes associated with photodamage caused by sun exposure. Additionally, use of imiquimod visibly reduced fine lines and wrinkles, improved skin texture and resulted in more uniform skin color. At the end of the study, 80% of the subjects rated these improvements as “moderate” or “great”. According to study participants’ assessments, 90% expressed strong approval of the cosmetic benefits. Visible improvement in appearance was also documented histologically. Imiquimod was well tolerated in the study and no volunteers reported irritation with redness, stinging or discomfort.