Roy G. Geronemus, M.D.

Reduction of thickened flap using fractional carbon dioxide laser
Brightman L.A.; Brauer J.A.; Anolik R.; Weiss E.T.; Karen J.; Chapas A.; Hale E.; Bernstein L.; Geronemus R.G.
2011 ;43(9):873-874, Lasers in surgery & medicine
Background and Objective The paramedian forehead flap is an excellent choice when repairing a large nasal defect. However, even when carefully thinned, the flap may develop a bulky appearance, an ill-fitting contour, or trap door deformity. When on the face, these suboptimal results can be quite distressing. Surgical and non-surgical options for improvement exist. Surgical options include additional debulking and reorientation of the flap. Non-surgical options include intralesional corticosteroids or 5-flourouracil, dermabrasion, and ablative and non-ablative laser resurfacing. Each option has limited benefit as well potential side effects. Study Design/Materials and Methods Case report. Results In this report, we present dramatic improvement of a thickened paramedian forehead flap using the Fraxel Re:pair, a fractional carbon dioxide (CO₂) laser (Solta Medical, Inc. Hayward, CA). Conclusion To our knowledge, this is the first case in the literature demonstrating successful reduction of a bulky flap using a fractional ablative laser.
— id: 141087, year: 2011, vol: 43, page: 873, stat: Journal Article,

Do lasers or topicals really work for nonmelanoma skin cancers?
Brightman, Lori; Warycha, Melanie; Anolik, Robert; Geronemus, Roy
2011 Mar;30(1):14-25, Seminars in cutaneous medicine & surgery
Novel strategies are urgently needed to address the millions of nonmelanoma skin cancers treated in the United States annually. The need is greatest for those patients who are poor surgical candidates or those prone to numerous nonmelanoma skin cancers and therefore at risk for marked disfigurement. Traditional treatment strategies include electrosurgery with curettage, radiation therapy, cryotherapy, excision, and Mohs micrographic surgery. Alternatives to traditional treatment, including topical medications and light or laser therapies, are becoming popular; however, there are various degrees of efficacy among these alternative tactics. These alternatives include topical retinoids, peels, 5-fluorouracil, imiquimod, photodynamic therapy, and lasers. The purpose of this paper is to review the available data regarding these alternative strategies and permit the reader to have a sense of which therapies are reasonable options for care
— id: 133416, year: 2011, vol: 30, page: 14, stat: Journal Article,

Letter: Light-emitting diode photomodulation and radiation dermatitis
Weiss, Robert A; Deland, Maitland M; Geronemus, Roy G; McDaniel, David H
2011 Jun;37(6):885-886, Dermatologic surgery
— id: 136460, year: 2011, vol: 37, page: 885, stat: Journal Article,

INTRALESIONAL PHOTODYNAMIC THERAPY OF NONMELANOMA SKIN CANCER
Desai, S; Warchya, M; Chapas, AM; Weiss, E; Brightman, L; Hale, E; Karen, J; Bernstein, L; Geronemus, R
2010 APR ;17(4):91-92, Lasers in surgery & medicine
— id: 109070, year: 2010, vol: 17, page: 91, stat: Journal Article,

Letter regarding early laser treatment of periorbital infantile hemangiomas may work, but is it really the best treatment option?
Geronemus, Roy G; Hunzeker, Christopher M
2010 Sep;36(9):1495-1497, Dermatologic surgery
— id: 134357, year: 2010, vol: 36, page: 1495, stat: Journal Article,

A simple solution to the common problem of ecchymosis
Karen, Julie K; Hale, Elizabeth K; Geronemus, Roy G
2010 Jan;146(1):94-95, Archives of dermatology
— id: 106217, year: 2010, vol: 146, page: 94, stat: Journal Article,

Led photomodulation I: Effects of pulsed and continuous wave modes on procollagen products of human skin fibroblasts
McDaniel D.H.; Mazur C.; Wilson S.; Geronemus R.G.; Weiss R.A.; Weiss M.
2010 ;42:55-55, Lasers in surgery & medicine
Background: The effect of exposure to various pulsed and continuous wave Treatments on human dermal fibroblasts in vitro was studied using ELISA assay procollagen I production as the endpoint measurement. The study was designed to evaluate the complex interactions that occur between the light source and the cell. Study: Human dermal fibroblasts in culture were exposed to a 590/870 nm LED array fixed at 3.8 mW/cm². In the pulsed mode, a matrix of exposure parameters was tested including: msec exposure 'on' times of 1 (single pulse), 10, 100, 250, 500, 1000; msec 'of f times of 10,100, 250, 500, 1000; and total pulse numbers of 1, 10, 100, 250, 500, 1000. In continuous wave mode, a range of fourteen exposure times from 0.5 to 106 msec were tested. Four days after exposure, supernatants from the exposed fibroblasts were collected and assayed. Results: Measuring percent change from control, the parameters tested produced a wide range of responses from 0% change to greater than 90% increase in procollagen I. Pulse duty cycles (msec 'on') of 100 and 250, and msec 'of f of 10 and 100, and number of 100 pulses produced the most procollagen, as did 100 msec and 10,000 msec in continuous wave mode. Conclusion: These experiments show that procollagen production by human dermal fibroblasts in vitro can be modulated using pulsed and continuous wave modes. Responses to pulsed modes reveal a more complex pattern of cellular response to light than continuous wave mode
— id: 132910, year: 2010, vol: 42, page: 55, stat: Journal Article,

Led photomodulation II: Effect of energy fluence on procollagen products of human skin fibroblasts
McDaniel D.H.; Mazur C.; Wilson S.; Geronemus R.G.; Weiss R.A.; Weiss M.
2010 ;42:55-55, Lasers in surgery & medicine
Background: Delivery of pulsed or continuous wave 590/870 nm LED light modulates the production of procollagen I by human dermal fibroblasts in vitro. In pulsed mode, the number of pulses and exposure or on time of the LED pulsed mode the duty cycle determines the energy fluence delivered to the target. In continuous wave mode, the cumulative exposure time determines the energy fluence delivered to the target. Study: Human dermal fibroblasts in culture were exposed to a 590/870 nm LED array with an energy density of 3.8 mW/cm².In the pulsed mode, a matrix of exposure parameters were tested including: msec 'on times of 1 (single pulse), 10, 100, 250, 500, 1000; msec with 'of f times of 10, 100, 250, 500, 1000; and total number of pulses of 1, 10, 100, 250, 500, 1000. In continuous wave mode, a range of fourteen exposure times from 0.5 to 10⁶ msec were tested. Four days after exposure, supernatants from the exposed fibroblasts were assayed by ELISA for procollagen I production. Results: For pulsed parameters, procollagen production was highest for energy fluence of 0.01-0.24 J/cm² with a peak around 0.1 J/cm² for parameters of 250/100/100 (msec on/msec/of f/# pulses). Continuous wave highest peaks were at 100 msec and 10,000 msec (0.0004 and 0.04 J/cm² respectively. Conclusion: 0.1 J/cm² using a pulsed 590/870 nm LED parameters of 250 msec 'on' 100 msec 'of f 100 pulses was selected as most effective for procollagen I production
— id: 132909, year: 2010, vol: 42, page: 55, stat: Journal Article,

Led photomodulation III: Effect of wavelengths and ratio of wavelengths on gene expressions in human skin fibroblasts
McDaniel D.H.; Mazur C.; Wilson S.; Geronemus R.G.; Weiss R.A.; Weiss M.
2010 ;42:57-57, Lasers in surgery & medicine
Background: A variety of parameters with LED photomodulation can alter cellular response in vitro. The effects of one visible and one infrared wavelength were evaluated to determine the optimal ratio to produce a net increase in dermal collagen by altering the ratio of total energy output of each wavelength. The ratio between the two wavelengths (595 nm and 870 nm) was shifted in 25% increments. Study: Human dermal fibroblasts in culture were exposed to a 595/870 nm LED array with total combined energy density fixed at 4.0 mW/cm². The ratio of 595/870 nm parameters were: 100%/ 0%; 75%/25%; 50%/50%; 25%/75%; and 0%/100%. These ratios were tested using pulsed duty cycle of exposure (250 msec 'on' time/100 msec 'of f time/100 pulses) and examined using commercially available extra cellular matrix and adhesion molecule RT PCR Arrays (SI Biosciences) for gene expression 24 hours post exposure. Results: There were different expression prof iles noticed for each of the ratios studied. Overall, there was an average (in an 80 gene array) of 6% directional expression difference. The greatest increase in Collagen I and decrease in Collagenase (MMP-1) was observed with 75%/25% ratio of 595/870 nm. The addition of increasing ratios of IR wavelengths causes an alteration in the gene expression prof ile. Even when the genes followed the same directional change, the ratios of the wavelengths caused variation in magnitude of expression. Conclusion: Varying the ratios of specific wavelength intensity in multiwavelength light therapy can alter the resulting gene expression patterns
— id: 132908, year: 2010, vol: 42, page: 57, stat: Journal Article,

Led photomodulation: Effects of different wavelengths and delivery modes on selected human cell types in vitro
McDaniel D.H.; Mazur C.; Wilson S.; Geronemus R.G.; Weiss R.A.; Weiss M.
2010 ;42:59-60, Lasers in surgery & medicine
Background: LED photomodulation effects on human dermal fibroblasts have been well documented. The effects of various wavelengths of light, on other cell types were evaluated using human dermal papillae, adipose, and retinal pigment epithelial cells. Study: Human dermal papillae (DP), adipocytes, and retinal pigment epithelial (RPE) cells were grown to near confluence in vitro and exposed to selected LED wavelengths in the visible and near IR light range. For DP cells the endpoint measurements were MTT assay, VEGF ELISA and hair growth-related gene expression using RT-PCR. Adipocyte endpoint measurements were leptin ELISA, total glycerol assay, and cytotoxicity measured by adenylate kinase. RPE cells were exposed to 425 nm or UVA1 light to cause cellular damage, post-treated with LED arrays, and stained with fluorescent Annexin V for apoptosis/ necrosis levels; VEGF and IL6 gene expression RT-PCR. Results: A variety of responses were seen in all studies. DP cells demonstrated increased clinically relevant responses in the 623-660 nm range, particularly at 660 nm using selected pulsed or continuous wave modes. Adipocytes demonstrated altered glycerol and leptin levels at 625 nm and 880 nm using pulsed mode. RPE cells showed a 30% decrease in staining and a downregulation of VEGF expression using 590/870 nm pulsed mode. Apotosis and necrosis of RPE cells was decreased from 92% untreated to 62-5% with various wavelengths. Conclusion: LED photomodulation demonstrated the ability to alter the expression of genes of known significance. Further investigation and optimization of parameters is warranted
— id: 132907, year: 2010, vol: 42, page: 59, stat: Journal Article,

Varying ratios of wavelengths in dual wavelength LED photomodulation alters gene expression profiles in human skin fibroblasts
McDaniel, D H; Weiss, R A; Geronemus, R G; Mazur, C; Wilson, S; Weiss, M A
2010 Aug;42(6):540-545, Lasers in surgery & medicine
BACKGROUND AND OBJECTIVE: LED photomodulation has been shown to profoundly influence cellular behavior. A variety of parameters with LED photomodulation can alter cellular response in vitro. The effects of one visible and one infrared wavelength were evaluated to determine the optimal ratio to produce a net increase in dermal collagen by altering the ratio of total energy output of each wavelength. The ratio between the two wavelengths (590 and 870 nm) was shifted in 25% increments. STUDY DESIGN/MATERIALS AND METHODS: Human skin fibroblasts in culture were exposed to a 590/870 nm LED array with total combined energy density fixed at 4.0 mW/cm.. The ratio of 590/870 nm tested parameters were: 100/0%, 75/25%, 50/50%, 25/75%, and 0/100%. These ratios were delivered using pulsed duty cycle of exposure (250 milliseconds 'on' time/100 milliseconds 'off' time/100 pulses) for a total energy fluence of 0.1 J/cm.. Gene expression was examined using commercially available extra cellular matrix and adhesion molecule RT PCR Arrays (SA Biosciences, Frederick, MD) at 24 hours post-exposure. RESULTS: Different expression profiles were noticed for each of the ratios studied. Overall, there was an average (in an 80 gene array) of 6% expression difference in up or downregulation between the arrays. The greatest increase in collagen I and decrease in collagenase (MMP-1) was observed with 75/25% ratio of 590/870 nm. The addition of increasing proportions of IR wavelengths causes alteration in gene expression profile. The ratios of the wavelengths caused variation in magnitude of expression. CONCLUSIONS: Cell metabolism and gene expression can be altered by simultaneous exposure to multiple wavelengths of low energy light. Varying the ratios of specific wavelength intensity in both visible and near infrared light therapy can strongly influence resulting fibroblast gene expression patterns
— id: 133776, year: 2010, vol: 42, page: 540, stat: Journal Article,

Choosing an alternate light source with a corresponding dose in photodynamic therapy (it's not rocket science, but it is quantum physics!): Determining the PpIX activiation effect
Sayre R.M.; Pariser D.; Goldberg D.J.; Geronemus R.; Gottschalk R.W.; Dowdy J.C.
2010 ;20:e74-, Melanoma research
Aim: Photodynamic therapy (PDT), a procedure approved in the US for the treatment of actinic keratoses and being investigated for treatment of other skin diseases, involves three components: a photosensitizer, light, and tissue oxygen. A photosensitizer is a chemical compound that can be excited by light at a specific wavelength. In PDT, a photosensitizer or the metabolic precursor to one is administered to the patient. Upon light exposure, the photosensitizer will become excited and energy is transferred from the excited photosensitizer to molecular oxygen in the treated tissue. The reactive oxygen species interact with nearby biomolecules resulting in cell death via apoptosis or necrosis. Methods: A study was conducted to evaluate the spectral output of several potential clinical light sources for PDT and other indications based upon the photosensitizer, protoporphyrin IX, absorption spectrum. The light sources examined included Clearlight(r), Clearlight(r) 100X, OmniLux BlueTM, Omnilux RedTM, Blu-U(r), and Aktilite(r). The spectral irradiance of these clinical sources used for PDT was measured by spectroradiometric techniques to determine specifically how well their emission overlapped with the absorption spectrum of protoporphyrin IX. Results: The results indicated that all sources examined have the potential to be useful in PDT with varying irradiances, ranging from 73 mW/cm² (Aktilite(r)) to 5 mW/cm² (Clearlight(r)). Thus the results of this study provided confirmation that there are various available light sources which could be effective when used in PDT. Conclusion: Dosage/fluence relationships from the various light sources are presented
— id: 111810, year: 2010, vol: 20, page: e74, stat: Journal Article,

Radiofrequency devices for body shaping: a review and study of 12 patients
Anolik, Robert; Chapas, Anne M; Brightman, Lori A; Geronemus, Roy G
2009 Dec;28(4):236-243, Seminars in cutaneous medicine & surgery
Radiofrequency (RF) devices such as ThermaCool TC (Solta Medical Inc., Hayward, CA) offer a nonablative and noninvasive treatment option for unwanted skin concerns of the head, neck, and body. Relatively fewer studies address RF treatment on the body when compared with the head and neck. The purpose of this report is to investigate the use of the ThermaCool TC system with the novel Thermage Multiplex Tip for the enhancement of body shape. Additionally, this report will review the literature of RF technology with a concentration on body shaping. Twelve subjects underwent ThermaCool TC treatments using the Thermage Multiplex Tip. Waist circumference, standardized photographs, skin laxity score, global aesthetic improvement score, and patient satisfaction surveys were assessed at baseline and several follow-up visits after treatment. Average waist circumference and skin laxity scores decreased after ThermaCool TC treatment, using the Thermage Multiplex Tip at follow-up visits held at 1, 2, 4, and 6 months after treatment. Global aesthetic improvement score and patient satisfaction surveys reflected these objective clinical improvements. RF devices, such as the ThermaCool TC offer a nonablative and noninvasive treatment option for unwanted skin findings of the head, neck, and body
— id: 107273, year: 2009, vol: 28, page: 236, stat: Journal Article,

Ablative and Fractional Ablative Lasers
Brightman, LA; Brauer, JA; Anolik, R; Weiss, E; Karen, J; Chapas, A; Hale, E; Bernstein, L; Geronemus, RG
2009 OCT ;27(4):479-489, Dermatologic clinics
The field of nonsurgical laser resurfacing for aesthetic enhancement continues to improve with new research and technological advances. Since its beginnings in the 1980s, the laser-resurfacing industry has produced a multitude of devices employing ablative, nonablative, and fractional ablative technologies. The three approaches largely differ in their method of thermal damage, weighing degrees of efficacy, downtime, and side effect profiles against each other. Nonablative technologies generate some interest, although only for those patient populations seeking mild improvements. Fractional technologies, however, have gained dramatic ground on fully ablative resurfacing. Fractional laser resurfacing, while exhibiting results that fall just short of the ideal outcomes of fully ablative treatments, is an increasingly attractive alternative because of its far more favorable side effect profile, reduced recovery time, and significant clinical outcome
— id: 105373, year: 2009, vol: 27, page: 479, stat: Journal Article,

A SIMPLE SOLUTION TO A COMMON PROBLEM
Hale, E; Karen, J; Hunzeker, C; Weiss, E; Bernstein, L; Brightman, L; Chapas, A; Geronemus, R
2009 JUL ;15(7):22-22, Lasers in surgery & medicine
— id: 101250, year: 2009, vol: 15, page: 22, stat: Journal Article,

Port wine stain progression: a potential consequence of delayed and inadequate treatment?
Minkis, Kira; Geronemus, Roy G; Hale, Elizabeth K
2009 Aug;41(6):423-426, Lasers in surgery & medicine
BACKGROUND AND OBJECTIVES: Port wine stains are congenital low-flow vascular malformations of the skin. Unlike hemangiomas, PWS do not involute with time, but rather if left untreated can hypertrophy and develop nodularity. Laser therapy of PWS particularly with pulsed-dye lasers, is a safe, well-established treatment that is successful in the majority of patients, especially for younger patients. Patients that fail to receive treatment early in life may subsequent develop lesions more likely to progress. STUDY DESIGN/PATIENTS AND METHODS: A case report and review of the literature are presented. We report a 43 year-old man born with a port-wine stain on the right side of his face that extended in the V2 distribution on his face. He had undergone several sessions with a pulsed-dye laser, the sequential dual-wavelength (595 nm and 1064 nm) laser and a CO2 resurfacing laser from the age of 26 but failed to follow through with a sufficient number of treatments to prevent hypertrophy. RESULTS: Due to an insufficient number and interval of treatments (with only 7 treatments over 16 years starting at age 26) with the various lasers, the patient's port wine stain continued to progress in color and development of nodularity. CONCLUSIONS: Patients born with port wine stains should have early laser treatment to achieve optimal results. Delay in treatment, as in this patient until age 26, may result in hard to treat PWS that can continue to progress in nodularity. This case illustrates the hypertrophy and nodularity that can occur due to progression of a PWS with failure to follow through with sufficient number of laser treatments
— id: 100668, year: 2009, vol: 41, page: 423, stat: Journal Article,

What lies beneath? A lesson for the clinician. Intraoperative frozen section appearance of persistent basal cell carcinoma after apparent cure with imiquimod 5% cream
Sukal, Sean A; Mahlberg, Matthew J; Brightman, Lori; Daniel, David R; Mintzis, Medwin M; Geronemus, Roy G
2009 Nov;35(11):1831-1834, Dermatologic surgery
— id: 133744, year: 2009, vol: 35, page: 1831, stat: Journal Article,

Blepharoplasty-like results with periorbital fractional CO2 laser
Brightman, L; Sukal, S; Chapas, A; Karen, J; Hale, E; Kim, K; Bernstein, L; Geronemus, R
2008 JUL ;10(7):108-108, Lasers in surgery & medicine
— id: 86855, year: 2008, vol: 10, page: 108, stat: Journal Article,

Successful treatment of acneiform scarring with CO2 ablative fractional resurfacing
Chapas, Anne M; Brightman, Lori; Sukal, Sean; Hale, Elizabeth; Daniel, David; Bernstein, Leonard J; Geronemus, Roy G
2008 Aug;40(6):381-386, Lasers in surgery & medicine
BACKGROUND: Acneiform scarring after severe episodes of acne is a common cosmetic concern, treatable by a variety of modalities with varying degrees of success. Ablative CO(2) laser resurfacing, while effective, is associated with an undesirable side effects profile, lengthy recovery period, and risk of infection as well as potential pigmentary alterations. Newer modalities using the principles of fractional photothermolysis (FP) create patterns of tiny microscopic wounds surrounded by undamaged tissue beneath the skin with an erbium-doped 1,550 nm laser. These devices produce more modest results in many cases than traditional carbon dioxide (CO(2)) lasers but with fewer side effects and shorter recovery periods. A novel ablative 30 W CO(2) laser device uses a technique called ablative fractional resurfacing (AFR), combines CO(2) ablation with a FP system. METHODS: Thirteen subjects (skin types I-IV, aged 28-58 years) with moderate to severe acne scars underwent two or three treatments with the AFR device at 1-2 months intervals. Post-treatment erythema and edema as well as improvements in texture, atrophy, and overall satisfaction with appearance were graded on a quartile scale by subjects and investigators after each treatment and 1 and 3 months after the final treatment. Petechiae, oozing and crusting, dyschromia, and scarring were graded as present or absent 3 days, 1 week, 1 month, and 3 months following each treatment. A three-dimensional optical profiling system (Primos imaging) was used to generate a high resolution topographic representation of the acneiform scar in order to measure the depths of 10 scars from each cheek prior to the first treatment and 3 months after the last treatment. RESULTS: Post-treatment side effects were mild to moderate and transient, resolving rapidly within the study period. No delayed onset hypo-pigmentation or permanent scarring was observed. Quartile grading scores correlating to at least 26-50% improvements in texture, atrophy, and overall improvement were noted in all patients. Primos topographic analysis showed that all patients had quantifiable objective improvement in the depths of acneiform scars that ranged from 43% to 79.9% with a mean level of improvement of 66.8%. CONCLUSION: Successfully combining ablative technology with FP, AFR treatments constitute a safe and effective treatment modality for acneiform scarring
— id: 93760, year: 2008, vol: 40, page: 381, stat: Journal Article,

Reversal of laser-induced hypopigmentation with a narrow-band UV-B light source in a patient with skin type VI
Reszko, Anetta; Sukal, Sean A; Geronemus, Roy G
2008 Oct;34(10):1423-1426, Dermatologic surgery
— id: 93761, year: 2008, vol: 34, page: 1423, stat: Journal Article,

The safety and efficacy of fractional photothermolysis for the correction of striae distensae
Stotland, Mira; Chapas, Anne M; Brightman, Lori; Sukal, Sean; Hale, Elizabeth; Karen, Julie; Bernstein, Leonard; Geronemus, Roy G
2008 Sep;7(9):857-861, Journal of drugs in dermatology : JDD
BACKGROUND: Improving the appearance of striae distensae, particularly striae alba, has remained a challenge due to the limited availability of effective and low-risk treatment options. Fractional photothermolysis, a novel concept in skin rejuvenation, has been reported to be effective in the treatment of facial rhytides, acne scars, and surgical scars, but its use in the treatment of striae has not been well studied. OBJECTIVE: To determine the safety and efficacy of fractional photothermolysis treatment on striae alba and striae rubra. METHODS: Twenty female patients with striae rubra or striae alba on their abdomen, thighs, or buttocks were enrolled in the study. Lesions were randomized to receive treatment, with site-matched normal control areas. Patients received a total of 6 treatments using a 1550-nm, erbium-doped fiber laser with 2 to 3 weeks of elapsed time between treatments. Clinical response to treatment was assessed at each visit, and at 1-month, 2-month, and 3-month follow-up intervals by the patient and investigator. A comparison evaluation of 8 patients examining photographs of striae at baseline and at the 3-month follow-up evaluation which was assessed by 4 independent dermatologists using the quartile grading scale. RESULTS: The independent evaluators' assessments of improvement from photographs of 8 randomly selected patients showed an overall improvement of 26% to 50% in 63% (5/8) of patients. A less than 25% improvement in dyschromia was noted in 50% (4/8) of patients. An improvement in texture of 26% to 50% was observed in 50% (4/8) of patients. The clinical responses were independent of age, gender, and skin phototype. The treatments were tolerated well by all patients with a majority of patients experiencing transient posttreatment erythema and edema. CONCLUSION: Fractional photothermolysis can be effectively and safely used in the treatment of striae rubra and striae alba
— id: 93757, year: 2008, vol: 7, page: 857, stat: Journal Article,

Eyelid tightening and improved eyelid aperture through nonablative fractional resurfacing
Sukal, Sean A; Chapas, Anne M; Bernstein, Leonard J; Hale, Elizabeth K; Kim, Karen H; Geronemus, Roy G
2008 Nov;34(11):1454-1458, Dermatologic surgery
BACKGROUND AND OBJECTIVE: The effects of fractional resurfacing on eyelid tightening and aperture are unknown. Our purpose was to retrospectively examine the potential for eyelid tightening and eye-aperture opening in patients treated with nonablative fractional resurfacing for facial photorejuvenation. STUDY DESIGN/MATERIALS AND METHODS: Fractional laser treatments using a 1,550-nm erbium-doped fiber laser system on the upper and lower eyelids were given at a pulse energy of 17 to 20 mJ at 125 micro-thermal zones (MTZ)/cm(2) to a final density of 500 to 750 MTZ/cm(2). Each patient had 3 to 7 treatments. Standard pre- and post-treatment photographs were taken at each visit. Physicians who graded 31 preselected patient photographs using a 4-point scale evaluated eyelid tightening. Increase in eyelid aperture was also evaluated. RESULTS: All patients had some degree of eyelid tightening; 19% achieved 1% to 25% tightening, 26% achieved 25% to 50%, 26% achieved 50% to 75%, and 29% achieved 75% to 100%. Increase in eyelid aperture was seen in 55.9% of patients. Postoperative wounding, hypopigmentation, hyperpigmentation, persistent erythema, and scarring were not observed. All patients experienced mild or no edema for a few days after treatment. CONCLUSION: Fractional resurfacing tightens and increases eyelid aperture without wounding, downtime, or long-term complications
— id: 93759, year: 2008, vol: 34, page: 1454, stat: Journal Article,

Deep venous thrombosis following Mohs micrographic surgery: case report
Sukal, Sean A; Geronemus, Roy G
2008 Mar;34(3):414-417, Dermatologic surgery
— id: 93764, year: 2008, vol: 34, page: 414, stat: Journal Article,

Fractional photothermolysis
Sukal, Sean A; Geronemus, Roy G
2008 Feb;7(2):118-122, Journal of drugs in dermatology : JDD
— id: 93763, year: 2008, vol: 7, page: 118, stat: Journal Article,

Thermage: the nonablative radiofrequency for rejuvenation
Sukal, Sean A; Geronemus, Roy G
2008 Nov-Dec;26(6):602-607, Clinics in dermatology
Thermage is a noninvasive nonablative device that uses monopolar radiofrequency energy to bulk heat underlying skin while protecting the epidermis to produce skin tightening. It is used for the treatment of rhytids on the face including the periorbital region and lower face, and more recently, for off-face applications. Studies have shown that it can impart mild tightening of periorbital mid, and lower facial laxity. Other radiofrequency devices have also shown objective improvements in cellulite of the buttocks and thigh regions. Thermage is an efficacious and safe nonsurgical alternative for treating mild skin laxity
— id: 93758, year: 2008, vol: 26, page: 602, stat: Journal Article,

Basal cell carcinoma arising 57 years after interstitial radiotherapy of a nasal hemangioma
Weiss, Elliot; Sukal, Sean A; Zimbler, Marc S; Geronemus, Roy G
2008 Aug;34(8):1137-1140, Dermatologic surgery
— id: 93762, year: 2008, vol: 34, page: 1137, stat: Journal Article,

Efficacy of early treatment of facial port wine stains in newborns: a review of 49 cases
Chapas, Anne M; Eickhorst, Kimberly; Geronemus, Roy G
2007 Aug;39(7):563-568, Lasers in surgery & medicine
BACKGROUND: Port wine stains (PWS) affect 0.3-0.5% of both sexes of newborns, usually occurring on the face. OBJECTIVE: To document safety and effectiveness of cryogen spray cooled, pulsed-dye laser at higher fluences than previously used to lighten facial PWS in infants < or =6 months, and establish that frequent treatment early in life yields better clearance than if delayed until later in life. MATERIALS AND METHODS: Forty-nine infants who had been treated with pulsed-dye laser treatments for facial PWS at < or =6 months were identified by case review of photographs, age, sex, PWS severity score prior to laser treatment, number of treatments, and improvement following laser therapy. RESULTS: Patients averaged 9.3 (range 2-16) treatments at 4-6 week intervals at 7.75-9.5 J/cm(2). Average surface area treated was 24.0% with 88.6% average clearance after 1 year. Average clearance was 90.7% for lesions covering <20% surface area and 85.6% for lesions > or =20%. Location (V1, V2, V3, eye, and/or scalp), treated surface area, treatment number, and fluence predicted clearance. Average clearance for sole involvement of V1 was highest (at 93.8%), followed by V2 (at 91.1%), V3 (at 84.3%), V1/V2 (at 83.7%), V1/V2/V3 (at 81.0%), periocular (at 88.6%), and scalp (at 89.9%). All patients tolerated the higher treatment fluences without atrophy or scarring. DISCUSSION/CONCLUSIONS: Frequent, high energy pulsed-dye laser treatments are safe and highly effective in improving facial PWS in infants < or =6 months of age. Patients with PWS should be referred for pulsed-dye laser treatment during early infancy
— id: 93765, year: 2007, vol: 39, page: 563, stat: Journal Article,

Treatment of radiation-induced dermatitis with light-emitting diode (LED) photomodulation
DeLand, M Maitland; Weiss, Robert A; McDaniel, David H; Geronemus, Roy G
2007 Feb;39(2):164-168, Lasers in surgery & medicine
BACKGROUND AND OBJECTIVE: Light-emitting diode (LED) photomodulation increases dermal collagen and reduces inflammation. This study evaluated the use of LED photomodulation in the prevention of radiation-induced dermatitis in breast cancer. MATERIALS AND METHODS: Patients (n=19) were treated with LED photomodulation (Gentlewaves, Light BioScience, LLC, Virginia Beach, VA) after each of a series of intensity-modulated radiation treatments (IMRT). Skin reactions were monitored weekly with National Cancer Institute (NCI) criteria. Age-matched controls (n=28) received IMRT without LED photomodulation. RESULTS: In LED-treated patients, 18 (94.7%) had grade 0 or 1 reaction and 1 (5.3%) had grade 2 reaction. Among controls, 4 (14.3%) had a grade 1 reaction, 24 (85.7%) had a grade 2 or 3 reaction. One LED-treated patient (5.3%) and 19 controls (67.9%) had to interrupt treatment. CONCLUSION: LED photomodulation treatments immediately after IMRT reduces the incidence of NCI grades 1, 2, and 3 skin reactions in patients with breast cancer treated by radiation therapy (RT) postlumpectomy
— id: 93767, year: 2007, vol: 39, page: 164, stat: Journal Article,

Redarkening of port-wine stains 10 years after laser treatment
Nelson, J Stuart; Geronemus, Roy G
2007 Jun 28;356(26):2745-2746, New England journal of medicine
— id: 93766, year: 2007, vol: 356, page: 2745, stat: Journal Article,

A quality rating scale for aesthetic surgical procedures
Alam, Murad; DesJardin, Jean; Arndt, Kenneth A; Dover, Jeffrey S; Hodapp, Robert M; Baumann, Leslie; Brody, Harold J; Carruthers, Jean B; Coleman, William P 3rd; Garden, Jerome M; Geronemus, Roy G; Glogau, Richard G; Jacob, Carolyn I; Katz, Bruce E; Klein, Arnold William; Krauss, Madeline C; Lawrence, Naomi; Moy, Ronald L; Narins, Rhoda S; Sadick, Neil S; Kaminer, Michael S
2006 Feb;54(2):272-281, Journal of the American Academy of Dermatology
BACKGROUND: Cosmetic dermatologic procedures offer the promise of visible aesthetic enhancement with minimal risk. While in recent years the number of available procedures has proliferated, there are few objective methods for evaluating the relative quality of these procedures for particular indications or specific patients. OBJECTIVE: (A) To develop a simple, easy-to-use numerical rating scale to assess the quality of cosmetic surgical procedures on a range of parameters pertaining to clinical efficacy and patient satisfaction; (B) to statistically validate the discriminative value of this rating scale. METHODS: (A) Patient and physician interviews were performed to elicit a list of factors that may collectively characterize the clinical efficacy and patient tolerability of cosmetic dermatologic procedures. A 0-100 point rating scale was developed based on these factors, with the face-validity of this scale checked by a group of patients and physicians; (B) Statistical analysis of the questionnaire was performed by asking 15 expert cosmetic dermatologic surgeons to use it to rate 23 common cosmetic dermatologic procedures, and analyzing the results. RESULTS: (A) An easy-to-use scale was constructed to assess the quality of cosmetic dermatologic procedures by rating the associated cost, risk, time (procedure and recovery), discomfort, results, and longevity of benefit. A 'physician adjustment factor' was used to further increase the relevance of this 0-100 point scale for specific patients; (B) Repeated-measures analysis of variations (ANOVAs) performed on the data from the survey of experts demonstrated that this scale can be used to discriminate between common dermatologic procedures. The differences in mean subscores and total scores among procedures grouped by anatomic site and target lesion-type were significant at the level of P < .05. LIMITATIONS: Patient preferences exogenous to the rating scale may increase or decrease the suitability of specific procedures. CONCLUSIONS: Common cosmetic dermatologic procedures are of uniformly high quality, as per expert ratings on a systematic measure. This quality rating scale appears statistically valid and robust, given that expert raters assigned similar ratings to the same procedures but mean ratings were different across procedures. In the future, this quality rating scale can be used to assess novel interventions, and to help dermatologic surgeons faced with patient concern to optimally select among alternative procedures for a given indication
— id: 93774, year: 2006, vol: 54, page: 272, stat: Journal Article,

Fractional photothermolysis for the treatment of surgical scars: a case report
Behroozan, Daniel S; Goldberg, Leonard H; Dai, Tianhong; Geronemus, Roy G; Friedman, Paul M
2006 Apr;8(1):35-38, Journal of cosmetic & laser therapy
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
— id: 93772, year: 2006, vol: 8, page: 35, stat: Journal Article,

Rapid growth of basal cell carcinoma in a multigestational pregnancy
Fisher, Galen H; Bangash, Suleman J; Mones, Joan; Geronemus, Roy G
2006 Nov;32(11):1418-1420, Dermatologic surgery
— id: 93768, year: 2006, vol: 32, page: 1418, stat: Journal Article,

Improvement of familial benign pemphigus after treatment with pulsed-dye laser: a case report
Fisher, Galen H; Geronemus, Roy G
2006 Jul;32(7):966-968, Dermatologic surgery
— id: 93769, year: 2006, vol: 32, page: 966, stat: Journal Article,

Treatment of multiple familial trichoepitheliomas with a combination of aspirin and a neutralizing antibody to tumor necrosis factor alpha: A case report and hypothesis of mechanism
Fisher, Galen H; Geronemus, Roy G
2006 Jun;142(6):782-783, Archives of dermatology
— id: 93770, year: 2006, vol: 142, page: 782, stat: Journal Article,

Defect involving both the cutaneous and the vermilion lip
Fisher, Galen H; Geronemus, Roy G; Bernstein, Leonard
2006 Feb;32(2):287-289, Dermatologic surgery
An 89-year-old white male presented for Mohs micrographic surgical extirpation of an invasive squamous cell carcinoma on his right lower lip. Extirpation required two stages of Mohs surgery and produced a 1.5 x 3.7 cm partial-thickness defect involving both the cutaneous and the vermilion lip, with little loss to the underlying orbicularis oris muscles (Figure 1). How would you repair the defect?
— id: 93775, year: 2006, vol: 32, page: 287, stat: Journal Article,

Fractional photothermolysis: current and future applications
Geronemus, Roy G
2006 Mar;38(3):169-176, Lasers in surgery & medicine
Ablative lasers (CO2 and Er:YAG) provide the greatest improvement in photoaging, but significant adverse effects limit their use. Nonablative lasers have reduced adverse effects, but limited efficacy. Fractional photothermolysis (FP) produces arrays of microscopic thermal wounds called microscopic treatment zones (MTZs) at specific depths in the skin without injuring surrounding tissue. Wounding is not apparent because the stratum corneum remains intact during treatment and acts as a natural bandage. Downtime is minimal and erythema is mild, permitting patients to apply cosmetics immediately after treatment. As with other nonablative laser modalities, multiple treatments are required. FP represents an alternative for treatment of dermatologic conditions without the adverse effects of ablative laser devices and can be used on all parts of the body. FP can be used for the treatment of facial rhytides, acne scars, surgical scars, melasma, and photodamaged skin
— id: 93773, year: 2006, vol: 38, page: 169, stat: Journal Article,

Long-pulsed neodymium:yttrium-aluminum-garnet laser treatment for port wine stains
Geronemus, Roy G
2006 May;54(5):923-923, Journal of the American Academy of Dermatology
— id: 93771, year: 2006, vol: 54, page: 923, stat: Journal Article,

Laser lipolysis using a novel 1,064 nm Nd:YAG Laser
Kim, Karen H; Geronemus, Roy G
2006 Feb;32(2):241-248, Dermatologic surgery
BACKGROUND: We studied the safety and efficacy of a 1,064 nm neodymium:yttrium-aluminum-garnet (Nd:YAG) laser with a 300-micron fiber for the reduction of small unwanted fat areas. METHODS: Thirty subjects with focal areas of fat less than 100 cc were enrolled. Ten subjects were treated with laser lipolysis and had magnetic resonance imaging (MRI) at baseline and 3 months post-treatment. Ten subjects had laser lipolysis followed by biweekly treatments with the Tri-active system. The last group of 10 subjects served as control. Patients were seen at baseline and 1-week, 1-month, and 3-month follow-up visits. RESULTS: Twenty-nine patients completed the study. Self-assessment evaluations reported an improvement of 37% at the 3-month follow-up visit. MRI demonstrated an average 17% reduction in fat volume. Smaller baseline volume areas, such as the submentum, had better results, suggesting a dose-response relationship. The most common side effects were mild bruising and swelling resolving within 2 weeks. CONCLUSION: Laser lipolysis using the 1,064 nm Nd:YAG laser with a 300-micron fiber appears to be a very promising procedure that delivers good, reproducible results safely and effectively. The advantages include excellent patient tolerance, quick recovery time, and the benefit of dermal tightening
— id: 93776, year: 2006, vol: 32, page: 241, stat: Journal Article,

The use of photodynamic therapy in dermatology: results of a consensus conference
Nestor, Mark S; Gold, Michael H; Kauvar, Arielle N B; Taub, Amy F; Geronemus, Roy G; Ritvo, Eva C; Goldman, Mitchel P; Gilbert, Dore J; Richey, Donald F; Alster, Tina S; Anderson, R Rox; Bank, David E; Carruthers, Alastair; Carruthers, Jean; Goldberg, David J; Hanke, C William; Lowe, Nicholas J; Pariser, David M; Rigel, Darrell S; Robins, Perry; Spencer, James M; Zelickson, Brian D
2006 Feb;5(2):140-154, Journal of drugs in dermatology : JDD
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
— id: 65268, year: 2006, vol: 5, page: 140, stat: Journal Article,

Mutations in the CYLD gene in Brooke-Spiegler syndrome, familial cylindromatosis, and multiple familial trichoepithelioma: lack of genotype-phenotype correlation
Bowen, Sarah; Gill, Melissa; Lee, David A; Fisher, Galen; Geronemus, Roy G; Vazquez, Marialuisa Espinel; Celebi, Julide Tok
2005 May;124(5):919-920, Journal of investigative dermatology
Brooke-Spiegler syndrome (BSS), familial cylindromatosis (FC), and multiple familial trichoepithelioma (MFT), originally described as distinct entities, share overlapping clinical findings. Patients with BSS are predisposed to multiple skin appendage tumors such as cylindroma, trichoepithelioma, and spiradenoma. FC, however, is characterized by cylindromas and MFT by trichoepitheliomas as the only tumor type. These disorders have recently been associated with mutations in the CYLD gene. In this report, we describe three families with BSS, one with FC, and two with MFT phenotypes associated with novel and recurrent mutations in CYLD. We provide evidence that these disorders represent phenotypic variation of a single entity and lack genotype-phenotype correlation
— id: 93782, year: 2005, vol: 124, page: 919, stat: Journal Article,

Our approach to pediatric dermatologic laser surgery
Chapas, Anne M; Geronemus, Roy G
2005 Oct;37(4):255-263, Lasers in surgery & medicine
BACKGROUND AND OBJECTIVES: Many pediatric dermatological conditions may be successfully treated with laser surgery. STUDY DESIGN/MATERIALS AND METHODS: The clinical approach to various pediatric dermatological conditions utilizing laser treatment options is discussed. RESULTS: Clinical uses of various modalities such as pulsed dye laser, KTP laser, Nd-YAG laser, Q-switched ruby laser, erbium-YAG laser, diode laser, non-coherent blue light sources, and fractional resurfacing are presented with successful parameters, developed over 22 years, utilized on a daily basis in a laser surgery clinic. CONCLUSION: Laser surgery can make a significant improvement in many pediatric skin lesions, thanks to the unique properties of pediatric skin and a vast array of laser technologies
— id: 72466, year: 2005, vol: 37, page: 255, stat: Journal Article,

Evaluation of the S-Caine Peel for induction of local anesthesia for laser-assisted tattoo removal: randomized, double-blind, placebo-controlled, multicenter study
Chen, John Z S; Jacobson, Laurie G; Bakus, Aboneal D; Garden, Jerome M; Yaghmai, Dina; Bernstein, Leonard J; Geronemus, Roy G
2005 Mar;31(3):281-286, Dermatologic surgery
BACKGROUND: Topical anesthetics are important tools for many dermatologic procedures. The S-Caine Peel is composed of a 1:1 (w:w) eutectic mixture composed of lidocaine base 7%, USP, and tetracaine base 7%, USP. It is applied as a cream, dries on exposure to air, and forms a flexible membrane, which can be easily peeled off. OBJECTIVE: To evaluate the effectiveness of the S-Caine Peel in providing clinically useful local dermal anesthesia for laser-assisted tattoo removal and to monitor the nature and frequency of adverse events associated with the safety of the S-Caine Peel. METHODS: Thirty adult patients undergoing laser-assisted tattoo removal were enrolled in this multicentered, randomized, double-blind, placebo-controlled study. Each subject received both the S-Caine Peel and placebo simultaneously for 60 minutes. The primary efficacy parameter was a 100 mm visual analog scale (VAS) for patient self-assessment of pain. Secondary efficacy parameters included both the investigator's and an independent observer's evaluation of subject pain (4-point categorical scale: no pain through severe pain) and the patient's and the investigator's overall impression of the local anesthetic. RESULTS: Mean VAS scores were 42 mm for the S-Caine Peel and 66 mm for placebo treatment sites (p=.001). Patients received adequate pain relief in 50% of S-Caine Peel sites versus 7% of placebo sites (p=.002). The percentage of those who would like to use the S-Caine Peel again were 43% for the S-Caine Peel compared with 7% for placebo (p=.005). Investigators' evaluations revealed that 70% of patients had less pain at S-Caine Peel treatment sites compared with 10% with less pain at placebo sites (p<.001), and 70% of the S-Caine Peel-treated sites achieved adequate anesthesia versus 10% of placebo sites (p<.001). The independent witness assessed less pain in 67% of S-Caine Peel-treated sites versus 10% of the placebo sites (p=.002). One occurrence of moderate to severe erythema was noted at both an S-Caine Peel and a placebo treatment site on removal of the S-Caine Peel after 60 minutes, which self-resolved quickly. There was no statistical difference between the two groups. Other side effects were limited to local mild, transient erythema at the application sites. CONCLUSION: Administration of the S-Caine Peel for 60 minutes prior to laser-assisted tattoo removal was effective in significantly reducing pain levels associated with the procedure
— id: 93783, year: 2005, vol: 31, page: 281, stat: Journal Article,

Short-term side effects of fractional photothermolysis
Fisher, Galen H; Geronemus, Roy G
2005 Sep;31(9 Pt 2):1245-1249, Dermatologic surgery
OBJECTIVE: To ascertain the immediate and short-term side effects of fractional photothermolysis for the treatment of a variety of skin disorders involving the face, neck, chest, and hands. METHODS: Physician-administered questionnaires were given during 60 follow-up visits for fractional photothermolysis treatment for a variety of facial skin disorders in patients with skin types ranging from I to IV. The questionnaire addressed 14 possible side effects, pain, and limitation of social activities. In addition, all patients were asked about any additional side effects not mentioned in the survey. An analysis of the data was performed once 60 surveys had been collected. RESULTS: All patients (100%) undergoing fractional photothermolysis had transient post-treatment erythema. Other frequently reported post-treatment side effects were transient and included facial edema (82%), dry skin (86.6%), flaking (60%), a few (one to three) small, superficial scratches (46.6%), pruritus (37%), and bronzing (26.6%). Other more rarely reported effects included transient increased sensitivity (10%) and acneiform eruption (10%). Most patients reported that the pain level was easily tolerated, with an average pain score of 4.6 on a scale of 10. Most patients (72%) reported limiting social engagements for an average of 2 days after treatment. There were no long-lasting adverse events noted in our survey. CONCLUSION: Fractional photothermolysis to treat dermatologic conditions on the face, neck, chest, and hands is a well-tolerated and safe procedure with several immediate, and slightly delayed, post-treatment side effects. In our experience, these side effects were transient and limited to erythema, edema, dry skin, flaking skin, superficial scratches, pruritus, increased sensitivity, and acneiform eruption. Importantly, we did not see the development of post-treatment scarring, herpetic activation, hypopigmentation, hyperpigmentation, persistent erythema, persistent edema, or infection
— id: 93778, year: 2005, vol: 31, page: 1245, stat: Journal Article,

Nonablative radiofrequency treatment of facial laxity
Fisher, Galen H; Jacobson, Laurie G; Bernstein, Leonard J; Kim, Karen H; Geronemus, Roy G
2005 Sep;31(9 Pt 2):1237-1241, Dermatologic surgery
OBJECTIVE: To share our current experience and review the current literature concerning the use of radiofrequency for the treatment of facial laxity. METHODS: We discuss our experience and review the current literature. RESULTS: Radiofrequency can impart mild tightening of mid- and lower facial laxity as well as periorbital laxity. In addition, it may help acne scars and acne. CONCLUSIONS: Radiofrequency appears to impart mild improvement to facial laxity and is a viable nonsurgical option for patients with mild facial laxity. There is, however, a need for blinded, randomized controlled studies to further validate these claims
— id: 93780, year: 2005, vol: 31, page: 1237, stat: Journal Article,

Concurrent use of a handheld forced cold air device minimizes patient discomfort during fractional photothermolysis
Fisher, Galen H; Kim, Karen H; Bernstein, Leonard J; Geronemus, Roy G
2005 Sep;31(9 Pt 2):1242-1243, Dermatologic surgery
OBJECTIVE: To assess the analgesic effect of a handheld forced cold air device during fractional photothermolysis. METHODS: Twenty patients who were being treated with full-face fractional photothermolysis were asked to rate their pain level with and without the handheld air-cooling device. Pain was rated on a scale of 1 to 10, with 10 being the worst. RESULTS: Nineteen of 20 patients noted decreased pain with the addition of handheld cooling. The mean level of pain without air-cooling was 6.95 +/- 2.0. The mean level of discomfort with air cooling was 4.0 +/- 1.8. The mean decrease in pain with the addition of air-cooling was 2.9 +/- 1.8. CONCLUSION: The addition of a handheld forced cold air device to cool the skin before and after fractional photothermolysis treatment is an effective adjunctive analgesic modality
— id: 93779, year: 2005, vol: 31, page: 1242, stat: Journal Article,

Mohs surgical extirpation of a basal cell carcinoma in a patient with familial multiple trichoepitheliomas
Fisher, Galen H; Mones, Joan; Gill, Melissa; Celebi, Julide Tok; Geronemus, Roy G
2005 Nov;31(11 Pt 1):1458-1461, Dermatologic surgery
BACKGROUND: The success of Mohs surgery relies on the ability to histologically differentiate tumor from the normal background tissue of the patient. In most cases of basal cell carcinoma and nonmelanoma skin cancer, this is a relatively straightforward process. However, in distinction, when only subtle histopathologic features differentiate the background tissue from the tumor of interest, the determination of a tumor-free margin becomes more challenging. OBJECTIVE: Our objective is to highlight the histopathologic features that we used to differentiate our patient's near-confluent background of trichoepitheliomas from the basal cell carcinoma that we were extirpating. METHODS: Case report. RESULTS: A 41-year-old white female with a history of familial multiple facial trichoepitheliomas presented for removal of a basal cell carcinoma on her right lower cutaneous lip. Mohs surgery was used to remove the tumor. The characteristic features of basal cell carcinoma and trichoepithelioma were used to differentiate the basal cell carcinoma that we were removing from the surrounding trichoepitheliomatous neoplasia. CONCLUSION: Mohs surgical extirpation of a basal cell carcinoma in a patient with multiple familial trichoepitheliomas requires a clear understanding of the histopathologic features that differentiate a trichoepithelioma from a basal cell carcinoma
— id: 93777, year: 2005, vol: 31, page: 1458, stat: Journal Article,

Clinical trial of a novel non-thermal LED array for reversal of photoaging: clinical, histologic, and surface profilometric results
Weiss, Robert A; McDaniel, David H; Geronemus, Roy G; Weiss, Margaret A
2005 Feb;36(2):85-91, Lasers in surgery & medicine
BACKGROUND AND OBJECTIVES: Photomodulation has been described as a process which modifies cell activity using light sources without thermal effect. The objective of this study was to investigate the use of a non-thermal low dose light emitting diode (LED) array for improving the appearance of photoaged subjects. STUDY DESIGN/MATERIALS AND METHODS: This prospective study investigated a random cohort of patients (N = 90) with a wide range of photoaged skin treated by LED photomodulation using a full panel 590 nm non-thermal full face LED array delivering 0.1 J/cm(2) with a specific sequence of pulsing. Subjects were evaluated at 4, 8, 12, 18 weeks and 6 and 12 months after a series of 8 treatments delivered over 4 weeks. Data collected included stereotactic digital imaging, computerized optical digital profilometry, and peri-ocular biopsy histologic evaluations for standard stains and well as collagen synthetic and degradative pathway immunofluorescent staining. RESULTS: Digital imaging data showed a reduction of signs of photoaging in 90% of subjects with smoother texture, reduction of peri-orbital rhytids, and reduction of erythema and pigmentation. Optical profilometry showed a 10% improvement by surface topographical measurements. Histologic data showed markedly increased collagen in the papillary dermis of 100% of post-treatment specimens (N = 10). Staining with anti-collagen I antibodies demonstrated a 28% (range: 10%-70%) average increase in density while staining with anti-matrixmetalloproteinase (MMP)-1 showed an average reduction of 4% (range: 2%-40%). No side effects or pain were noted. CONCLUSIONS: Photomodulation to reverse photoaging is possible with a specific array of LEDs with a specific fluence using a precise pulsing or 'code' sequence. Skin textural improvement by digital imaging and surface profilometry is accompanied by increased collagen I deposition with reduced MMP-1 (collagenase) activity in the papillary dermis. This technique is a safe and effective non-painful non-ablative modality for improvement of photoaging
— id: 49634, year: 2005, vol: 36, page: 85, stat: Journal Article,

Clinical experience with light-emitting diode (LED) photomodulation
Weiss, Robert A; McDaniel, David H; Geronemus, Roy G; Weiss, Margaret A; Beasley, Karen L; Munavalli, Girish M; Bellew, Supriya G
2005 Sep;31(9 Pt 2):1199-1205, Dermatologic surgery
BACKGROUND: Light-emitting diode (LED) photomodulation is a novel nonthermal technology used to modulate cellular activity with light. OBJECTIVE: We describe our experience over the last 2 years using 590 nm LED photomodulation within a dermatologic surgery environment. METHODS: Practical use of nonthermal light energy and emerging applications in 3,500 treatments delivered to 900 patients is detailed. RESULTS: LED photomodulation has been used alone for skin rejuvenation in over 300 patients but has been effective in augmentation of results in 600 patients receiving concomitant nonablative thermal and vascular treatments such as intense pulsed light, pulsed dye laser, KTP and infrared lasers, radiofrequency energy, and ablative lasers. CONCLUSION: LED photomodulation reverses signs of photoaging using a new nonthermal mechanism. The anti-inflammatory component of LED in combination with the cell regulatory component helps improve the outcome of other thermal-based rejuvenation treatments
— id: 93781, year: 2005, vol: 31, page: 1199, stat: Journal Article,

The safety and efficacy of the 308-nm excimer laser for pigment correction of hypopigmented scars and striae alba
Alexiades-Armenakas, Macrene R; Bernstein, Leonard J; Friedman, Paul M; Geronemus, Roy G
2004 Aug;140(8):955-960, Archives of dermatology
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
— id: 49639, year: 2004, vol: 140, page: 955, stat: Journal Article,

Laser-mediated photodynamic therapy of actinic cheilitis
Alexiades-Armenakas, Macrene R; Geronemus, Roy G
2004 Sep-Oct;3(5):548-551, Journal of drugs in dermatology : JDD
Actinic cheilitis (AC) is a common precancerous condition for which a safe, effective, rapid, and cosmetically favorable treatment is needed. The objective of this study was to assess the safety and efficacy of the long-pulsed pulsed dye laser (LP PDL) (595 nm) with photodynamic therapy (PDT) for the treatment of AC. This study was designed to be a prospective, proof-of concept pilot study to assess safety and efficacy of LP PDL in conjunction with topical 20% 5-aminolevulinic acid solution PDT for the treatment of AC. Control patients received LP PDL alone. The setting was an outpatient clinical research center. A volunteer sample of 21 patients with biopsy-proven AC was enrolled (age range, 42-86 years; skin types I-III). All patients were refractory to prior therapies. Patients with a history of herpes labialis were pre-treated with famcyclovir. Nineteen patients received one-to-three treatments of topical 20% 5-aminolevulinic acid for 2-3 hours, followed by LP PDL (595 nm) at monthly intervals. Two control patients received one treatment with LP PDL alone. Patients in the ALA-LP PDL group were followed at 1, 2, 3, 6, 9, and 12 months. Clearance of AC was assessed by clinical evaluation. Control patients were followed to the one month interval. We observed none-to-mild pain; slight-to-moderate erythema; no crusting, purpura, or scarring; treatment time of less than one minute; and complete resolution of post-operative erythema by day three. Complete clearance was achieved in 13/19 (68%) of patients following a mean of 1.8 treatments (7/13 (37%) after one, 2/13 (11%) after two, and 1/13 (21%) after three treatments). Patients were followed for a mean of 4.1 (range 1-12) months. Among the remaining cases, partial clearing was achieved in two patients, recurrence during the follow-up interval was observed in one patient, and failure to follow-up occurred in three patients. Post-operative impetiginization occurred in three patients with erosive AC, which resolved with dicloxacillin therapy. Among the control patients, no clearing was observed. Treatment of AC using LP PDL (595 nm) at nonpurpuric parameters following topical application of 5-aminolevulinic acid at short incubation times is safe and effective. It may offer the advantages of rapid incubation, treatment, and recovery times, minimal discomfort, excellent cosmetic outcome, and good efficacy rates. Patients with erosive AC should receive antibacterial prophylaxis. Multiple treatments may be required for complete clearing
— id: 49636, year: 2004, vol: 3, page: 548, stat: Journal Article,

Nonphysician practice of dermatologic surgery: the Texas perspective
Friedman, Paul M; Jih, Ming H; Burns, A Jay; Geronemus, Roy G; Kimyai-Asadi, Arash; Goldberg, Leonard H
2004 Jun;30(6):857-863, Dermatologic surgery
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
— id: 49641, year: 2004, vol: 30, page: 857, stat: Journal Article,

Treatment of atrophic facial acne scars with the 1064-nm Q-switched Nd:YAG laser: six-month follow-up study
Friedman, Paul M; Jih, Ming H; Skover, Greg R; Payonk, Greg S; Kimyai-Asadi, Arash; Geronemus, Roy G
2004 Nov;140(11):1337-1341, Archives of dermatology
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
— id: 49637, year: 2004, vol: 140, page: 1337, stat: Journal Article,

Nonablative laser and light therapies for skin rejuvenation
Kim, Karen H; Geronemus, Roy G
2004 Nov-Dec;6(6):398-409, Archives of facial plastic surgery
BACKGROUND: Multiple modalities have been described for skin rejuvenation, including ablative and nonablative therapies. Because of the prolonged recovery period associated with ablative procedures that injure the epidermis, nonablative skin treatments have grown increasingly popular. Various laser- and light-based systems have been designed or applied for promoting skin remodeling without damage to the epidermis. METHODS: Studies investigating the use of nonablative procedures for facial rhytids or acne scarring with clinical, histological, and objective quantitative measurements are systematically reviewed. RESULTS: Nonablative treatments are associated with clinical and objective improvements for the treatment of facial rhytids and acne scarring. Dermal remodeling seems to occur as a result of thermal injury, leading to dermal fibrosis without epidermal disruption. CONCLUSIONS: Although results are not as impressive as those of ablative treatments, nonablative procedures are effective in the treatment of photoaging and acne scarring. As technology in nonablative therapies continues to evolve, future laser and light sources may yield even more favorable results
— id: 49638, year: 2004, vol: 6, page: 398, stat: Journal Article,

The utility of punch excisions in auricular repairs
Kim, Karen H; Geronemus, Roy G
2004 Jul;114(1):278-279, Plastic & reconstructive surgery
— id: 49640, year: 2004, vol: 114, page: 278, stat: Journal Article,

A novel non-thermal non-ablative full panel LED photomodulation device for reversal of photoaging: digital microscopic and clinical results in various skin types
Weiss, Robert A; Weiss, Margaret A; Geronemus, Roy G; McDaniel, David H
2004 Nov-Dec;3(6):605-610, Journal of drugs in dermatology : JDD
Photomodulation is a process that manipulates or regulates cell activity using light sources without thermal effect. Previous studies of LED photomodulation have shown skin textural improvement accompanied by increased collagen deposition with reduced MMP-1 (collagenase) activity in the papillary dermis. The purpose of this study was to investigate a separate cohort of patients (N =93) with a wide range of Fitzpatrick skin types treated by LED photomodulation using the Gentlewaves full panel 590 nm high energy LED array with a specific sequence or code of pulsing in the millisecond domain. Results showed improvement of signs of photoaging in 90%. The majority of patients demonstrated improvement in peri-ocular wrinkles, reduction in Fitzpatrick photoaging classification, global skin texture and background erythema, and pigmentation. No side effects were noted. LED photomodulation is a safe and effective non-painful non-ablative modality for improvement of photoaging
— id: 49635, year: 2004, vol: 3, page: 605, stat: Journal Article,

Laser-mediated photodynamic therapy of actinic keratoses
Alexiades-Armenakas, Macrene R; Geronemus, Roy G
2003 Oct;139(10):1313-1320, Archives of dermatology
OBJECTIVE: To assess the safety and efficacy of the long-pulsed pulsed dye laser (LP PDL) (595 nm) with photodynamic therapy (PDT) for treatment of actinic keratoses (AKs). DESIGN: Prospective, controlled study with 10-day and 2-, 4-,6-, and 8-month follow-ups. SETTING: Clinical research center. PATIENTS Volunteer sample of 41 patients (age range, 35-91 years; skin types I-III) with AKs. INTERVENTION: Single treatment with application of topical 20% 5-aminolevulinic acid for 3 hours or 14 to 18 hours, followed by LP PDL irradiation at 595 nm. Controls received LP PDL irradiation alone. MAIN OUTCOME MEASURES: Safety assessments, treatment and recovery times, and efficacy assessments, including patient mean percentage of lesions cleared and distribution of patients by percentage of lesions cleared for different anatomic sites. RESULTS: We observed no to slight pain; slight to moderate erythema; no purpura, crusting, or scarring; treatment time of 1 lesion per second; and resolution of erythema by 7 to 14 days. The patient mean (95% confidence interval) percentage of head lesions (2620 lesions) cleared after 1 treatment was 99.47% (99.44%-99.50%) at 10 days, 98.19% (98.15%-98.23%) at 2 months, 92.94% (92.73%-93.14%) at 4 months, 91.65% (91.15%-92.15%) at 6 months, and 90.32% (78.10%-100%) at 8 months. For extremities (949 lesions), these were 83.1% (81.4%-84.9%) at 10 days, 75.5% (73.4-77.6) at 2 months, 70.9% (68.9%-72.8%) at 4 months, 92.0% (84.0%-100%) at 6 months, and 100% at 8 months. For trunk (53 lesions), these were 85% (74%-100%) at 10 days, 85% (74%-100%), and 65% (50%-80%) at 4 months. No difference in safety or efficacy was found between the 3-hour and 14- to 18-hour incubation times. In the laser-only control group, no decrease in lesions was observed. Among 31 patients with head lesions, 28 (90%) at 10 days, 19 (70%) at 2 months, 9 (47%) at 4 months, 5 (42%) at 6 months, and 5 (56%) at 8 months were completely (100%) clear following a single treatment. Skin biopsy specimens of nonresponding lesions demonstrated a high rate of squamous cell carcinoma and other non-AK neoplasms. CONCLUSIONS: Treatment of AKs using LP PDL (595 nm) at nonpurpuric parameters following topical application of 5-aminolevulinic acid is safe and effective. The advantages may include minimal discomfort, rapid incubation treatment and recovery times, excellent posttreatment cosmesis, high efficacy rates with respect to head lesions, and practical applicability to large body surface areas
— id: 49643, year: 2003, vol: 139, page: 1313, stat: Journal Article,

Beauty versus medicine: the nonphysician practice of dermatologic surgery
Brody, Harold J; Geronemus, Roy G; Farris, Patricia K
2003 Apr;29(4):319-324, Dermatologic surgery
BACKGROUND: This investigation was initiated because of a growing concern by the American Society for Dermatologic Surgery about the proliferation of nonphysicians practicing medicine and its impact on public health, safety, and welfare. OBJECTIVE: Prompted by an alarming rise in anecdotal reports among dermatologic surgeons, the study sought to determine whether there was a significant increase in the number of patients seeking corrective treatment due to complications from laser and light-based hair removal, subsurface laser/light rejuvenation techniques, chemical peels, microdermabrasion, injectables, and other cosmetic medical/surgical procedures performed by nonphysicians without adequate training or supervision. METHODS: A survey of 2,400 American Society for Dermatologic Surgery members in July 2001 and in-depth phone interviews with eight patients who experienced complications from nonphysicians performing cosmetic dermatologic surgery procedures were conducted. RESULTS: Survey data and qualitative research results attributed patient complications primarily to 'nonphysician operators' such as cosmetic technicians, estheticians, and employees of medical/dental professionals who performed various invasive medical procedures outside of their scope of training or with inadequate or no physician supervision. CONCLUSION: The results underscore the need for improved awareness, legislation, and enforcement regarding the nonphysician practice of medicine, along with further study of this issue
— id: 49646, year: 2003, vol: 29, page: 319, stat: Journal Article,

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
Chen, John Z S; Alexiades-Armenakas, Macrene R; Bernstein, Leonard J; Jacobson, Laurie G; Friedman, Paul M; Geronemus, Roy G
2003 Oct;29(10):1012-1018, Dermatologic surgery
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
— id: 49644, year: 2003, vol: 29, page: 1012, stat: Journal Article,

First multi-center study of a new non-ablative radio frequency device to tighten facial tissue
Fitzpatrick, RE; Geronemus, R; Goldberg, D; Kaminer, M; Kilmer, S; Ruiz-Esparza, J
2003 AUG 7 ;424(6949):35-35, Lasers in surgery & medicine
— id: 37172, year: 2003, vol: 424, page: 35, stat: Journal Article,

A new non-ablative radio frequency device to tighten tissue: A randomized trial comparing a single treatment to multiple treatments
Goldberg, DJ; Koch, J; Burns, J; Geronemus, R
2003 AUG 7 ;424(6949):21-21, Lasers in surgery & medicine
— id: 37171, year: 2003, vol: 424, page: 21, stat: Journal Article,

Treatment of nasolabial folds and jowls with a noninvasive radiofrequency device
Jacobson, Laurie G S; Alexiades-Armenakas, Macrene; Bernstein, Leonard; Geronemus, Roy G
2003 Oct;139(10):1371-1372, Archives of dermatology
— id: 49642, year: 2003, vol: 139, page: 1371, stat: Journal Article,

Surgical pearl: Removal of cosmetic lip-liner tattoo with the pulsed carbon dioxide laser
Mafong, Erick A; Kauvar, Arielle N B; Geronemus, Roy G
2003 Feb;48(2):271-272, Journal of the American Academy of Dermatology
— id: 49647, year: 2003, vol: 48, page: 271, stat: Journal Article,

Review of nonablative photorejuvenation: reversal of the aging effects of the sun and environmental damage using laser and light sources
Weiss, Robert A; McDaniel, David H; Geronemus, Roy G
2003 Jun;22(2):93-106, Seminars in cutaneous medicine & surgery
This review article outlines all the latest light or electromagnetic radiation based technologies used for nonablative skin rejuvenation. While many technologies have been available for a number of years, emerging technologies are also discussed, which may play a role in treatment of photoaged skin in the very near future. The principles behind these technologies are discussed in detail
— id: 49645, year: 2003, vol: 22, page: 93, stat: Journal Article,

Lasers in facial plastic surgery
Biesman, Brian S; Dover, Jeffrey S; Arndt, Kenneth A; Geronemus, Roy G
2002 Oct-Dec;4(4):270-271, Archives of facial plastic surgery
— id: 49649, year: 2002, vol: 4, page: 270, stat: Journal Article,

Efficacy of the 308-nm excimer laser for treatment of psoriasis: results of a multicenter study
Feldman, Steven R; Mellen, Beverly G; Housman, Tamara Salam; Fitzpatrick, Richard E; Geronemus, Roy G; Friedman, Paul M; Vasily, David B; Morison, Warwick L
2002 Jun;46(6):900-906, Journal of the American Academy of Dermatology
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
— id: 49652, year: 2002, vol: 46, page: 900, stat: Journal Article,

Safety data of injectable nonanimal stabilized hyaluronic acid gel for soft tissue augmentation
Friedman, Paul M; Mafong, Erick A; Kauvar, Arielle N B; Geronemus, Roy G
2002 Jun;28(6):491-494, Dermatologic surgery
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
— id: 49651, year: 2002, vol: 28, page: 491, stat: Journal Article,

Quantitative evaluation of nonablative laser technology
Friedman, Paul M; Skover, Greg R; Payonk, Greg; Geronemus, Roy G
2002 Dec;21(4):266-273, Seminars in cutaneous medicine & surgery
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
— id: 49648, year: 2002, vol: 21, page: 266, stat: Journal Article,

3D in-vivo optical skin imaging for topographical quantitative assessment of non-ablative laser technology
Friedman, Paul M; Skover, Greg R; Payonk, Greg; Kauvar, Arielle N B; Geronemus, Roy G
2002 Mar;28(3):199-204, Dermatologic surgery
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
— id: 49653, year: 2002, vol: 28, page: 199, stat: Journal Article,

Cooling gel improves pulsed KTP laser treatment of facial telangiectasia
Kauvar, Arielle N B; Frew, Kathryn E; Friedman, Paul M; Geronemus, Roy G
2002 ;30(2):149-153, Lasers in surgery & medicine
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/cm(2). 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
— id: 25649, year: 2002, vol: 30, page: 149, stat: Journal Article,

Treatment of inverse psoriasis with the 308 nm excimer laser
Mafong, Erick A; Friedman, Paul M; Kauvar, Arielle N B; Bernstein, Leonard J; Alexiades-Armenakas, Macrene; Geronemus, Roy G
2002 Jun;28(6):530-532, Dermatologic surgery
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
— id: 49650, year: 2002, vol: 28, page: 530, stat: Journal Article,

"DFSP, Merkel-cell carcinoma, extramammary Paget's disease"
Friedman P; Geronemus R
Current dermatologic diagnosis & treatment Philadelphia : Lippincott Williams & Wilkins, 2001,
— id: 3692, year: 2001, vol: , page: 44, stat: Chapter,

Use of the 308-nm excimer laser for postresurfacing leukoderma
Friedman PM; Geronemus RG
2001 Jun;137(6):824-825, Archives of dermatology
— id: 25653, year: 2001, vol: 137, page: 824, stat: Journal Article,

Topical anesthetics update: EMLA and beyond
Friedman PM; Mafong EA; Friedman ES; Geronemus RG
2001 Dec;27(12):1019-1026, Dermatologic surgery
BACKGROUND: Topical anesthetics remain a powerful, new advance for pain relief prior to cutaneous procedures. They are frequently used by dermatologists to decrease the pain associated with laser pulses, surgical procedures, or soft tissue augmentation. EMLA is the most commonly used agent, however, several new topical anesthetic agents have been released recently that claim increased efficacy and a faster onset of action. OBJECTIVE: We review and compare the efficacy of several commonly used topical anesthetics and provide a look into the future. CONCLUSION: EMLA remains the most widely used topical anesthetic given its proven efficacy and safety by several clinical trials. There has been a recent release of several new topical anesthetic agents with some demonstrating efficacy after a 30-minute application time. A reservoir of anesthetic is located and stored in the upper skin layers during application, providing additional anesthetic benefit 30 minutes after removal. As the options for the practitioner continue to grow, the demand for faster onset, comparative efficacy, and safety trials will continue to be of paramount importance
— id: 25650, year: 2001, vol: 27, page: 1019, stat: Journal Article,

Commentary on immediate postoperative laser resurfacing improves second intention healing
Geronemus RG
2001 Mar;27(3):324-326, Dermatologic surgery
— id: 25655, year: 2001, vol: 27, page: 324, stat: Journal Article,

Pulsed-dye laser versus conventional therapy in the treatment of warts
Kauvar AN; Geronemus RG
2001 Jul;45(1):151-152, Journal of the American Academy of Dermatology
— id: 25652, year: 2001, vol: 45, page: 151, stat: Journal Article,

Treatment of port-wine stains by variable pulse width pulsed dye laser with cryogen spray: a preliminary study
Lou WW; Geronemus RG
2001 Nov;27(11):963-965, Dermatologic surgery
— id: 25651, year: 2001, vol: 27, page: 963, stat: Journal Article,

Antibiotic prophylaxes in laser resurfacing patients
Friedman PM; Geronemus RG
2000 Jul;26(7):695-697, Dermatologic surgery
— id: 9143, year: 2000, vol: 26, page: 695, stat: Journal Article,

Current issues in dermatologic office-based surgery: correction
Geronemus RG
2000 May;42(5 Pt 1):847-847, Journal of the American Academy of Dermatology
— id: 16421, year: 2000, vol: 42, page: 847, stat: Journal Article,

Regarding current issues in dermatologic office based surgery
Geronemus RG
2000 May;26(5):508-508, Dermatologic surgery
— id: 9145, year: 2000, vol: 26, page: 508, stat: Journal Article,

High-fluence modified pulsed dye laser photocoagulation with dynamic cooling of port-wine stains in infancy
Geronemus RG; Quintana AT; Lou WW; Kauvar AN
2000 Jul;136(7):942-943, Archives of dermatology
— id: 9144, year: 2000, vol: 136, page: 942, stat: Journal Article,

Prospective study of hair reduction by diode laser (800 nm) with long-term follow-up
Lou WW; Quintana AT; Geronemus RG; Grossman MC
2000 May;26(5):428-432, Dermatologic surgery
BACKGROUND: Multiple laser systems are available for the purpose of hair removal. OBJECTIVE: The purpose of this study was to determine the safety and long-term efficacy of the 800 nm, pulsed diode laser at reducing hair count. METHODS: Fifty volunteers, primarily Fitzpatrick skin types II and III, with dark brown or black hair, were treated with a diode laser (800 nm, 10-40 J/cm2, 5-30 msec, 9 mm 9 mm, 5 degrees C chilled handpiece). Each subject had eight treatment sites at varying fluences and pulse durations, as well as a varying number of treatments and pulses. Hair counts were obtained at each site at baseline, 1, 3, 6, 9, and an average of 20 months after treatment. RESULTS: After one treatment, hair regrowths ranged from 22 to 31% at the 1-month follow-up visit, then remained stable between 65 and 75% from the 3-month to the averaged 20-month follow-up. After two treatments there were relatively longer growth delays, with hair regrowths plateauing beginning at 6 months after treatment and ranging from 47 to 66% for the remainder of the follow-up evaluations. Side effects were limited to pigmentary changes, transient in subjects with skin types II and III. CONCLUSIONS: This 800 nm diode laser with a chilled sapphire tip and variable pulse duration is safe and effective for long-term hair reduction in individuals with skin types II and III
— id: 9146, year: 2000, vol: 26, page: 428, stat: Journal Article,

The Role of Dermatologists in the Evolution of Laser Surgery
Wheeland RG; McBurney E; Geronemus RG
2000 Sep;26(9):815-822, Dermatologic surgery
— id: 9142, year: 2000, vol: 26, page: 815, stat: Journal Article,

Risk of hair ignition
Geronemus RG
1999 Sep;1(3):189-189, Journal of cutaneous laser therapy
— id: 25654, year: 1999, vol: 1, page: 189, stat: Journal Article,

Cryogen spray cooling in combination with nonablative laser treatment of facial rhytides
Kelly KM; Nelson JS; Lask GP; Geronemus RG; Bernstein LJ
1999 Jun;135(6):691-694, Archives of dermatology
BACKGROUND: Cryogen spray cooling can be used to provide epidermal protection while still achieving spatially selective photocoagulation in the upper dermis. The objective of this study is to determine the efficacy and safety of cryogen spray cooling in combination with a nonablative Nd:YAG (lambda = 1320 nm) laser treatment of facial rhytides in human volunteers. OBSERVATIONS: Thirty-five adults with bilateral periorbital rhytides were treated with cryogen spray cooling in combination with 3 nonablative laser treatments performed sequentially at intervals of 2 weeks. Small but statistically significant improvements were noted in the mild, moderate, and severe rhytid groups 12 weeks after the final laser treatment. A final assessment performed 24 weeks after the last treatment showed statistically significant improvement only in the severe rhytid group. The procedure was found to be safe; 4 sites (5.6%) developed transient hyperpigmentation. Two sites (2.8%) subsequently developed barely perceptible pinpoint pitted scars. CONCLUSIONS: Cryogen spray cooling is a safe and effective method for protecting the epidermis during nonablative laser treatment of facial rhytides thereby avoiding much of the morbidity associated with other resurfacing procedures. Minor improvements in rhytides can be achieved with the current technology. Optimization of treatment parameters may further improve these results
— id: 9148, year: 1999, vol: 135, page: 691, stat: Journal Article,

Effects of topical vitamin K and retinol on laser-induced purpura on nonlesional skin
Lou WW; Quintana AT; Geronemus RG; Grossman MC
1999 Dec;25(12):942-944, Dermatologic surgery
BACKGROUND: Pulsed dye laser treatments usually result in purpura. Any topical application that eliminates or shortens the duration of purpura would be extremely useful. OBJECTIVE: The purpose of this prospective study was to determine the safety and efficacy of topical vitamin K cream in shortening the duration of laser-induced purpura. METHODS: Twenty adult subjects were enrolled. Each subject had five 1.5 cm sites treated with a pulsed dye laser at 585 nm, 450 nsec, 7 mm spot size at each subject's respective threshold fluence. Each subject had a control site where no topical application was used and four other sites where a different formulation was applied to each for 2 weeks before and for 2 weeks after laser irradiation. Five vitamin K formulations with or without retinol were studied: 3% vitamin K in acrylates copolymer cream, 5% vitamin K in acrylates copolymer cream, 1% vitamin K and 0.3% retinol in acrylates copolymer cream, 1% vitamin K and 0.15% retinol in acrylates copolymer cream, 1% free vitamin K cream. Purpuric discoloration at each site was rated on days 0, 1, 3, 7, 10, and 14 after laser treatment on a quartile scale. Each site was assigned 100% discoloration on day 0 after laser irradiation. RESULTS: Laser-induced purpuric discoloration resolved faster with 1% vitamin K and 0.3% retinol in acrylates copolymer cream than with no topical application. The difference is statistically significant from day 3 onward. CONCLUSION: A combination of 1% vitamin K and 0.3% retinol in acrylates copolymer cream hastened the resolution of laser-induced purpura
— id: 9147, year: 1999, vol: 25, page: 942, stat: Journal Article,

Stress and family satisfaction in parents of children with facial port-wine stains
Miller AC; Pit-Ten Cate IM; Watson HS; Geronemus RG
1999 May-Jun;16(3):190-197, Pediatric dermatology
A cross-sectional survey was employed to assess parenting stress, family satisfaction, and parental concerns and to determine predictors of stress in parents of children with port-wine stains (PWSs). The participants were 46 parents of 24 children receiving treatment with pulsed dye laser photocoagulation for facial PWS at an outpatient dermatology clinic based at a university medical center. Outcome measures used were self-report instruments assessing psychosocial adjustment (Parenting Stress Index, Family Satisfaction Scale, and Parental Concerns Questionnaire). As a group, parents scored in the average range on the stress and family satisfaction measures when compared with a normative sample; five parents (11%) scored in the clinical range for stress. Forty-nine percent of the variance in parenting stress was accounted for by four variables: the child's age (beta = 0.34; p = 0.031), the parents' degree of family satisfaction (beta = -0.27; p = 0.077), the level of parental concern regarding the child's facial PWS (beta = 0.45; p = 0.005), and the parents' satisfaction with staff communication (beta = -0. 51; p = 0.002). The data suggest that while, as a group, parents of children with a facial PWS report to be in the average range for psychological stress, some do not fare as well as others. Factors associated with lower stress include younger children, more family cohesion and adaptation, fewer parental concerns, and greater satisfaction with parent-staff communication. The potential for the development of medical complications and psychological problems over time suggests the need for treatment of the PWS at an early age. Health care providers should be prepared to screen for clinical levels of distress and to refer parents for psychological intervention when needed
— id: 6148, year: 1999, vol: 16, page: 190, stat: Journal Article,

Treatment of spider veins with the 595 nm pulsed-dye laser [see comments]
Bernstein EF; Lee J; Lowery J; Brown DB; Geronemus R; Lask G; Hsia J
1998 Nov;39(5 Pt 1):746-750, Journal of the American Academy of Dermatology
BACKGROUND: Previous attempts to treat spider veins with the conventional 585 nm pulsed-dye laser with a 0.5-ms pulse duration have been relatively ineffective. Recently, a new pulsed-dye laser that is tunable from 585 to 600 nm with a pulse duration 3 times longer than previously available lasers has preliminarily been shown to be effective for treatment of spider veins. OBJECTIVE: Our purpose was to evaluate the effectiveness of multiple treatments with the tunable long-pulse dye laser in treatment of spider veins of the lower extremity. METHODS: Ten female volunteers were treated in two separate areas containing blue or red linear spider veins less than 1.5 mm in diameter. Treatments were administered with the pulsed-dye laser with a 1.5-ms pulse duration and 595-nm light at fluences of 15 and 20 J/cm2, and each subject received a total of 3 treatments at each site, administered at 6-week intervals. Photographs were taken before and 6 weeks after the last treatment. RESULTS: Computer-based image analysis showed clearing of more than three fourths of veins after 3 treatments with 15 or 20 J/cm2. Side effects were minimal and the treatments were well tolerated. CONCLUSION: The 595 nm, 1.5 ms pulse duration, pulsed-dye laser is safe and effective for treating blue or red spider veins of the lower extremities less than 1.5 mm in diameter in nontanned patients with Fitzpatrick skin types I and II. Multiple treatments improve on the results obtained after a single treatment
— id: 9149, year: 1998, vol: 39, page: 746, stat: Journal Article,

Scar resurfacing with high-energy, short-pulsed and flashscanning carbon dioxide lasers [see comments]
Bernstein LJ; Kauvar AN; Grossman MC; Geronemus RG
1998 Jan;24(1):101-107, Dermatologic surgery
BACKGROUND: Scars have a significant effect on a person's physical and social being. Many treatment modalities for scar improvement such as surgical scar revision, electrosurgical planing, chemical peeling, filler substance implantation, and dermabrasion have been developed. Recently, the resurfacing carbon dioxide (CO2) laser systems have proven to be a useful and safe treatment in the treatment of facial rhytides and acne scarring. OBJECTIVE: The purpose of this study was to evaluate the resurfacing CO2 lasers in the treatment of various surgical, traumatic, acne, and varicella scars. METHODS: Thirty subjects, aging between 14 and 84 years, with surgical, traumatic, acne, or varicella scars were evaluated. Two types of resurfacing laser systems were utilized in this study, a high-energy, short-pulsed CO2 laser and a continuous wave CO2 laser with an optico-mechanical computer flash-scanner. Post-surgical scars were treated with laser resurfacing between 4 and 6 weeks after scar formation. Traumatic, acne, and varicella scars were treated after scar maturation (range, 1-10 years). Scar improvement was evaluated by photographic analysis of before and after images by four independent health care workers using a quartile scale of improvement (< 25%, 25-49%, 50-74%, > 75%) as well as optical profilometry using silicone surface impressions in 12 scars. RESULTS: Twenty of 24 surgical scars had greater than 75% improvement, and 24 of 24 had greater than 50% improvement by photographic analysis. All six traumatic, acne and varicella scars had greater than 50% improvement. Optical profilometry and surface topography maps reveal a significant flattening of related and depressed scars. CONCLUSION: The high-energy, short-pulsed CO2 laser and the continuous wave CO2 laser with flash-scanning attachment are safe and effective as a treatment modality for scar revision. In general, elevated scars improve more dramatically than depressed scars
— id: 9152, year: 1998, vol: 24, page: 101, stat: Journal Article,

Treatment of recalcitrant verrucae with both the ultrapulse CO2 and PLDL pulsed dye lasers
Geronemus RG; Kauvar AN; McDaniel DH
1998 Jun;101(7):2010-2010, Plastic & reconstructive surgery
— id: 9151, year: 1998, vol: 101, page: 2010, stat: Journal Article,

Treatment of port-wine stains
Kauvar AN; Geronemus RG
1998 Aug 27;339(9):635-636, New England journal of medicine
— id: 9150, year: 1998, vol: 339, page: 635, stat: Journal Article,

Keloid formation with the 585-nm pulsed dye laser during isotretinoin treatment
Bernestein LJ; Geronemus RG
1997 Jan;133(1):111-112, Archives of dermatology
— id: 9157, year: 1997, vol: 133, page: 111, stat: Journal Article,

The short- and long-term side effects of carbon dioxide laser resurfacing [see comments]
Bernstein LJ; Kauvar AN; Grossman MC; Geronemus RG
1997 Jul;23(7):519-525, Dermatologic surgery
BACKGROUND: Carbon dioxide (CO2) laser resurfacing has become a very popular method of rhytide and scar removal in the recent past. Preliminary studies have been published describing the method, histology, and clinical results of CO2 laser resurfacing. However, none of these studies has dealt with long-term follow-up results. OBJECTIVE: To review all side effects resulting from CO2 laser resurfacing with regard to both short- and long-term effects. METHOD: Retrospective analysis of 104 patients who have undergone CO2 laser resurfacing for either facial rhytides and/or scarring with follow-up periods of 4-23 months (average, 8.2 months). RESULTS: The incidence of side effects are generally very low for CO2 laser resurfacing, including scarring, postinflammatory hyperpigmentation, and infection. However, there is a significant and previously unreported risk of hypopigmentation in an area of the population who often seek improvement in the appearance. CONCLUSIONS: CO2 laser resurfacing of facial rhytides and acne scars can be a very safe procedure by an experienced laser operator. However, careful patient selection, thorough patient instruction, and proper aesthetic analysis of treatment sites must be followed to insure the most favorable outcomes with CO2 laser resurfacing
— id: 9155, year: 1997, vol: 23, page: 519, stat: Journal Article,

Multimodal management of diffuse neonatal hemangiomatosis
Blei F; Orlow SJ; Geronemus R
1997 Dec;37(6):1019-1021, Journal of the American Academy of Dermatology
— id: 57104, year: 1997, vol: 37, page: 1019, stat: Journal Article,

Guidelines of care for hemangiomas of infancy. American Academy of Dermatology Guidelines/Outcomes Committee [see comments]
Frieden IJ; Eichenfield LF; Esterly NB; Geronemus R; Mallory SB
1997 Oct;37(4):631-637, Journal of the American Academy of Dermatology
— id: 9153, year: 1997, vol: 37, page: 631, stat: Journal Article,

Histology of laser resurfacing
Kauvar AN; Geronemus RG
1997 Jul;15(3):459-467, Dermatologic clinics
The development of high-peak power or scanned CO2 lasers that precisely remove layers of photodamaged skin has provided a novel method of skin rejuvenation. Clinical data suggest that laser resurfacing provides comparable or better results than conventional methods of chemical peeling and mechanical dermabrasion, with a lower risk-to-benefit ratio. Histologic studies of the effects of these lasers on tissue have been helpful in establishing guidelines for appropriate clinical use of these lasers and insights into the mechanisms whereby facial skin rejuvenation is achieved
— id: 9156, year: 1997, vol: 15, page: 459, stat: Journal Article,

Effect of dynamic cooling on 585-nm pulsed dye laser treatment of port-wine stain birthmarks [see comments]
Waldorf HA; Alster TS; McMillan K; Kauvar AN; Geronemus RG; Nelson JS
1997 Aug;23(8):657-662, Dermatologic surgery
BACKGROUND AND OBJECTIVE: The objective of this study was to determine the effectiveness of a dynamic cooling device (DCD), spraying the skin with a brief spurt of cryogen prior to the laser pulse, in reducing transient pain associated with 585-nm pulsed dye laser (PDL) treatment of port-wine stains (PWS), and reducing epidermal damage (hypo/hyperpigmentation) caused by this laser during PWS treatment. MATERIALS AND METHODS: Matched treatment sites were compared with and without the use of the cryogen spray in 47 patients at two investigational sites. Pain ratings, clearance of the PWS, and pigmentation changes were assessed. The results were analyzed by skin type and patient age. RESULTS: A statistically significant reduction in pain ratings was found in all patient groups using the DCD without changing the efficacy of PWS clearance. Pain reduction was most remarkable in patients with darker skin types. Dynamic cooling prevented the occurrence of epidermal damage or pigmentation change in most cases. CONCLUSIONS: This study suggests that dynamic cooling can dramatically diminish pain during PWS treatment with the 585-nm PDL without reducing treatment efficacy. The absence of epidermal damage in most patients suggests that precooling with the DCD may allow the use of higher laser fluences to expedite clearance without inducing epidermal change. Dynamic cooling has potential use with other lasers and different lesions where discomfort and epidermal effects limit therapy
— id: 9154, year: 1997, vol: 23, page: 657, stat: Journal Article,

Histology of high-energy pulsed CO2 laser resurfacing
Alster TS; Kauvar AN; Geronemus RG
1996 Sep;15(3):189-193, Seminars in cutaneous medicine & surgery
Cutaneous laser resurfacing is already proving to be a highly effective tool for improving photodamaged or scarred skin. The clinical and histological effects of the new high-energy, pulsed carbon dioxide (CO2) systems compare favorably with other treatments such as dermabrasion and chemical peels. The tissue-tightening effect noted after laser treatment may account for the claims of superior clinical improvement and needs further investigation
— id: 9159, year: 1996, vol: 15, page: 189, stat: Journal Article,

Tattoo formation from absorbable synthetic suture and successful removal with Q-switched ruby laser [see comments]
Bernstein LJ; Palaia DA; Bank D; Geronemus RG
1996 Dec;22(12):1040-1042, Dermatologic surgery
BACKGROUND: Traumatic tattoos result from accidental or unintentional deposition of exogenous pigment within injured skin. Pigments may consist of heavy metals, vegetable matter, or commercial dyes. OBJECTIVE: The clinical and histologic description of a traumatic tattoo resulting from a surgical procedure using undyed, braided, synthetic, absorbable suture material and its removal with the Q-switched ruby laser (694 nm, 28 nsec). METHODS: The pigmented linear lesion was biopsied and processed using standard histological methods. Subsequently, the area was treated on two occasions with the Q-switched ruby laser. RESULTS: The pigmented lesion was completely removed with the Q-switched laser treatments. CONCLUSION: We report on the occurrence of a traumatic tattoo resulting from synthetic suture material and complete removal with the Q-switched ruby laser
— id: 9158, year: 1996, vol: 22, page: 1040, stat: Journal Article,

Surgical pearl: Q-switched Nd:YAG laser removal of eyeliner tattoo
Geronemus RG
1996 Jul;35(1):101-102, Journal of the American Academy of Dermatology
— id: 9160, year: 1996, vol: 35, page: 101, stat: Journal Article,

Treatment of the cutaneous vascular component of the Rothmund-Thomson syndrome
Geronemus RG
1996 Mar-Apr;13(2):175-175, Pediatric dermatology
— id: 9163, year: 1996, vol: 13, page: 175, stat: Journal Article,

The pulsed-dye laser for infantile hemangiomas
Geronemus RG; Kauvar AN
1996 May;97(6):1302-1303, Plastic & reconstructive surgery
— id: 9161, year: 1996, vol: 97, page: 1302, stat: Journal Article,

A histopathological comparison of "char-free" carbon dioxide lasers
Kauvar AN; Waldorf HA; Geronemus RG
1996 Apr;22(4):343-348, Dermatologic surgery
BACKGROUND. New 'char-free' carbon dioxide lasers are capable of precise tissue vaporization with minimal residual thermal damage. These lasers operate either by producing high energy, rapid pulses or by scanning a highly focused continuous mode beam. OBJECTIVE. To determine the depth of ablation and the depth of residual thermal injury produced with one to three passes of the pulsed and scanned systems. METHODS. The distal ends of preauricular donor skin from 12 patients requiring full-thickness skin grafts following Mohs micrographic surgery were treated with zero to three passes of each of the lasers, and fixed for histopathological analysis. RESULTS. The three lasers tested produced vaporization of thin (20-50 microns) layers of tissue and narrow (20-150 microns) zones of thermal injury following one, two, or three passes on intact skin. CONCLUSION. The pulsed and scanned technologies are capable of producing 'char-free' tissue ablation with minimal residual thermal damage
— id: 9162, year: 1996, vol: 22, page: 343, stat: Journal Article,

Treatment of small and medium congenital nevi with the Q-switched ruby laser
Waldorf HA; Kauvar AN; Geronemus RG
1996 Mar;132(3):301-304, Archives of dermatology
BACKGROUND: The Q-switched ruby laser has been used successfully to treat a variety of benign pigmented lesions. In this study, congenital nevi (diameter, < or = 5 cm) in 18 prepubertal children were treated with the Q-switched ruby laser. OBSERVATIONS: Photographic evaluation revealed an average of 57% clearance of pigmentation in all treated nevi by the fourth treatment session and an average maximum clearance of 76% after approximately eight sessions. Greater than 90% clearance of pigment was attained in five patients. Partial repigmentation was seen in all patients who were followed up after discontinuation of therapy. Findings from histopathologic studies, obtained from one patient, revealed reduction of nevus cells in papillary dermis and upper reticular dermis that correlated with clinical lightening. There was no such reduction in the lower reticular dermis. side effects were limited to transient erythema and hypopigmentation. CONCLUSIONS: The Q-switched ruby laser effectively lightens and may clear pigmentation and eliminate superficial nevus cells from small and medium congenital nevi safely without scarring. However, these results are not permanent. The Q-switched ruby laser may be a viable alternative for providing cosmetic improvement for unresectable lesions, but it should not be considered definitive treatment. Additional studies are needed to address the long-term results of this therapy
— id: 9165, year: 1996, vol: 132, page: 301, stat: Journal Article,

Remote fire with the pulsed dye laser: risk and prevention
Waldorf HA; Kauvar NB; Geronemus RG; Leffel DJ
1996 Mar;34(3):503-506, Journal of the American Academy of Dermatology
— id: 9164, year: 1996, vol: 34, page: 503, stat: Journal Article,

Dye laser treatment of port-wine stains: comparison of the continuous-wave dye laser with a robotized scanning device and the pulsed dye laser
Dover JS; Geronemus R; Stern RS; O'Hare D; Arndt KA
1995 Feb;32(2 Pt 1):237-240, Journal of the American Academy of Dermatology
BACKGROUND: Despite good results in the treatment of most port-wine stains (PWS) with continuous-wave visible-light lasers, light PWS and those in certain locations respond less favorably and have a higher risk of scarring. Robotized scanning devices such as the Hexascan device have been developed for continuous-wave laser sources to produce greater target specificity, to increase reproducibility of results, and to decrease the incidence of adverse effects. OBJECTIVE: The purpose of this study was to compare the effects of the same wavelength of light (585 nm) on test sites within PWS with the flashlamp-pumped pulsed dye laser and a continuous-wave tunable dye laser scanned through a Hexascan robotized scanning device. METHODS: Two adjacent, noncontiguous sites within PWS were treated in 29 patients, one site with the flashlamp-pumped pulsed dye laser and the other with an argon-pumped continuous-wave tunable dye laser affixed to a Hexascan device. RESULTS: Twenty-eight patients completed the study. The pulsed dye laser was found to be superior to the continuous-wave dye laser with the Hexascan device in 45% of patients, whereas the continuous-wave tunable dye laser with the Hexascan device was considered superior in 15%. There was no difference in the remaining 40%. Undesirable side effects were infrequent with both treatments. There was no significant difference in hypopigmentation or atrophic and hypertrophic scarring, but hyperpigmentation was more frequent with the continuous-wave dye laser with the Hexascan device. CONCLUSION: Both the pulsed dye laser and continuous tunable-wave dye laser with the Hexascan device produce slight lightening after one treatment. The pulsed dye laser produces slightly greater lightening than the continuous-wave tunable dye laser with the Hexascan device 6 weeks after treatment of test areas within PWS in 40% of those treated. It also produced slightly less hypopigmentation and hyperpigmentation
— id: 9171, year: 1995, vol: 32, page: 237, stat: Journal Article,

Argon laser for the treatment of cutaneous lesions
Geronemus RG
1995 Jan-Feb;13(1):55-58, Clinics in dermatology
— id: 9172, year: 1995, vol: 13, page: 55, stat: Journal Article,

Laser surgery 1995
Geronemus RG
1995 May;21(5):399-403, Dermatologic surgery
— id: 9169, year: 1995, vol: 21, page: 399, stat: Journal Article,

Repetitive pulsed dye laser treatments improve persistent port-wine stains
Kauvar AN; Geronemus RG
1995 Jun;21(6):515-521, Dermatologic surgery
BACKGROUND. Approximately 50-75% lightening of port-wine stains is achieved within two to three treatments with pulsed dye laser therapy, but the incidence of complete clearing is variable. OBJECTIVE. This study was designed to: 1) assess the ability of continued repetitive pulsed dye laser treatments to further lighten persistent port-wine stains; 2) evaluate the factors contributing to the resistance of port-wine stains to laser therapy; and 3) determine the relative risk of adverse effects following repetitive treatments to the same area. METHODS. A retrospective photographic analysis was performed of 69 patients that failed to achieve greater than 75% lesional lightening within nine treatment sessions. The percentage improvement was assessed by comparing the degree of lightening at the last treatment to that of the midway point of treatment. RESULTS. Significant improvement in port-wine stain lightening, from the midway to last treatment, was seen in patients who had 10-25 repetitive treatments. CONCLUSION. Repetitive treatments with the pulsed dye laser can lead to improvement in the overall lightening of persistent port-wine stains without an increased risk of adverse effects
— id: 9168, year: 1995, vol: 21, page: 515, stat: Journal Article,

Pulsed dye laser treatment of warts
Kauvar AN; McDaniel DH; Geronemus RG
1995 Dec;4(12):1035-1040, Archives of family medicine
OBJECTIVE: To determine the safety and efficacy of the flashlamp-pumped pulsed dye laser for the treatment of uncomplicated and recalcitrant warts. DESIGN: Observational study. PATIENTS: A total of 142 patients with 703 recalcitrant and 25 previously untreated warts consecutively referred to two tertiary care laser centers from July 1993 through January 1994. INTERVENTION: Photocoagulation with the flashlamp-pumped pulsed dye laser. MAIN OUTCOME MEASURES: Complete resolution of treated warts after a follow-up ranging from 3 to 9 months. RESULTS: The overall response rates were 99% for body, limb, and anogenital warts; 95% for hand warts; 84% for plantar warts; and 83% for periungual warts. Side effects were limited and infrequent. CONCLUSION: Pulsed dye laser therapy is a highly effective and safe method used to selectively destroy warts without damaging the surrounding skin
— id: 9166, year: 1995, vol: 4, page: 1035, stat: Journal Article,

Adverse effects associated with the 577- and 585-nanometer pulsed dye laser in the treatment of cutaneous vascular lesions: a study of 500 patients
Levine VJ; Geronemus RG
1995 Apr;32(4):613-617, Journal of the American Academy of Dermatology
BACKGROUND: The flashlamp-pumped pulsed dye laser has been used in the treatment of cutaneous vascular disorders since 1986. Although this laser is now widely used for the treatment of port-wine stains, telangiectases, and hemangiomas, the incidence of adverse reactions has not been clearly defined in a large series of patients. OBJECTIVE: We assessed the incidence of adverse effects associated with the use of the pulsed dye laser in the treatment of vascular lesions. METHODS: We studied 500 patients undergoing pulsed dye laser treatments for port-wine stains, telangiectases, and hemangiomas. All patients were examined during the course of their treatment to assess the incidence of adverse effects associated with the use of the pulsed dye laser. RESULTS: There were no cases of hypertrophic scarring. The incidence of atrophic scarring was less than 0.1%. A spongiotic dermatitis was seen in 11 of 297 patients (0.04%) after multiple treatments of port-wine stains. Hyperpigmentation was seen in five of 500 patients (1%), whereas transient hypopigmentation was seen in 13 (2.6%). CONCLUSION: These findings demonstrate that the flashlamp-pumped pulsed dye laser is safe for the treatment of port-wine stains, telangiectases, and hemangiomas in children and adults
— id: 9170, year: 1995, vol: 32, page: 613, stat: Journal Article,

Tattoo removal with the Q-switched ruby laser and the Q-switched Nd:YAGlaser: a comparative study
Levine VJ; Geronemus RG
1995 May;55(5):291-296, Cutis
The Q-switched ruby and the Q-switched neodymium YAG lasers are both widely used in the treatment of amateur and professional tattoos. Comparative evaluation of these two laser systems has not previously been performed; thus, the advantages of each laser have not been delineated. Forty-eight amateur and professional tattoos were treated with both the Q-switched ruby and Q-switched Nd:YAG lasers. The tattoos were divided in half and one side of the tattoo was treated with each laser. After one treatment, the patients returned for evaluation to assess the degree of lightening achieved by each laser. The Q-switched ruby laser was found to be superior in lightening black dye in both professional and amateur tattoos. A significant advantage was noted for the ruby laser in the removal of green tattoo pigment. The differences with the Q-switched ruby laser and the 1064 nm option of the Q-switched YAG laser were not clinically significant in the lightening or removal of other colors. The 532 nm option of the Q-switched YAG laser was superior to the Q-switched ruby and the 1064 nm option of the YAG laser in the removal of red tattoo colors in professional tattoos. Hypopigmentation was found more commonly with the Q-switched ruby laser, while textural change was noted more commonly with the Q-switched Nd:YAG laser. One of the patients treated with the Nd:YAG laser at 1064 nm showed a hypertrophic scar
— id: 56771, year: 1995, vol: 55, page: 291, stat: Journal Article,

Skin resurfacing of fine to deep rhytides using a char-free carbon dioxide laser in 47 patients [see comments]
Waldorf HA; Kauvar AN; Geronemus RG
1995 Nov;21(11):940-946, Dermatologic surgery
BACKGROUND. Recent advances in carbon dioxide (CO2) laser technology have resulted in the development of lasers that can precisely remove thin layers of skin with minimal thermal damage to the surrounding tissue. These lasers rely on rapid pulsing or scanning of the laser beam. The effects of these lasers are predictable and reproducible, making them ideal for skin resurfacing. Clinical results have been promising, however, to date, no published series exist. OBJECTIVE. To evaluate the effectiveness and side effect profile of laser resurfacing utilizing a CO2 laser with a scanning device, and make recommendations for patient selection and treatment protocol. METHODS. Patients with perioral, periorbital, and glabellar rhytides were treated with a CO2 laser with a scanning device. Utilizing chart review and photographic evaluation, patients treated between November 1994 and April 1995 were retrospectively evaluated for effectiveness of therapy, healing time, and complication rates. RESULTS. A total of 47 patients were evaluated. Photographic evaluation or chart review revealed good to excellent cosmetic results in all anatomic areas studied. All patients experienced posttreatment erythema lasting 1-6 months. Other minor complications were limited to contact dermatitis to topical preparations, transient postinflammatory hyperpigmentation, and milia formation. One patient experienced a primary herpes simplex virus infection during reepithelialization and required intravenous therapy. Minor focal atrophy was seen in one patient. No hypertrophic scarring or permanent pigmentation changes were seen. CONCLUSIONS. A CO2 laser system with a scanning beam can effectively and safely improve or remove glabellar, perioral, and periorbital rhytides
— id: 9167, year: 1995, vol: 21, page: 940, stat: Journal Article,

Cosmetic tattoo ink darkening. A complication of Q-switched and pulsed-laser treatment
Anderson RR; Geronemus R; Kilmer SL; Farinelli W; Fitzpatrick RE
1993 Aug;129(8):1010-1014, Archives of dermatology
BACKGROUND: High-energy, short-pulse lasers, eg, Q-switched lasers, emitting visible and near-infrared light have recently been developed for removing tattoos, with little risk of scarring. The mechanisms of action, and possible adverse effects other than scarring and hypopigmentation, are not fully understood. OBSERVATIONS: We describe five cases of pulsed-laser-induced, immediate, irreversible darkening of cosmetic, white, flesh (skin-color), and pink-red colored tattoos. Irreversible ink darkening can be an insidious complication, because immediate whitening of the skin temporarily obscures the subsequently impressive color change. Among these cases, irreversible ink darkening occurred with Q-switched ruby (694 nm), Q-switched neodymium (Nd):YAG (1064 nm/532 nm), and pulsed green dye (510 nm) lasers. Attempts to remove the darkened ink with further laser treatment failed in two cases, and surgical excision was necessary. In the other three cases, subsequent laser treatments successfully removed the darkened ink. The red cosmetic tattoo ink used in one of the cases was placed in agar in vitro and was converted to a black compound immediately on Q-switched ruby laser exposure. Ferric oxide, a brown-red ingredient commonly used in cosmetic tattoos, was similarly tested and blackened in vitro by Q-switched ruby laser exposures. CONCLUSIONS: Although most tattoos are not darkened by laser treatment, short-pulsed lasers over a wide spectrum can cause immediate darkening of some tattoo inks. Patients should be warned of the potential for irreversible cosmetic tattoo darkening, and test-site exposures should be performed prior to treatment. In some cases, subsequent laser treatments may remove the blackened ink. The mechanism probably involves, at least for some tattoos, reduction of ferric oxide (Fe2O3, 'rust') to ferrous oxide (FeO, jet black), but the chemical reaction that is involved remains unknown
— id: 9174, year: 1993, vol: 129, page: 1010, stat: Journal Article,

Failure of the flashlamp-pumped pulsed dye laser to prevent progression to deep hemangioma
Ashinoff R; Geronemus RG
1993 Mar;10(1):77-80, Pediatric dermatology
Hemangiomas are common vascular lesions in children. The flashlamp-pumped pulsed dye laser has shown excellent results in the treatment of port-wine stains and, more recently, superficial (capillary) hemangiomas. Four patients with clinically evident superficial hemangiomas illustrate the point that early treatment with this laser may not preclude growth of a deeper component of the lesions
— id: 9177, year: 1993, vol: 10, page: 77, stat: Journal Article,

Rapid response of traumatic and medical tattoos to treatment with the Q-switched ruby laser
Ashinoff R; Geronemus RG
1993 Apr;91(5):841-845, Plastic & reconstructive surgery
Traumatic tattoos can be very difficult to remove. Excision is often not possible because of the extent of the tattoo, and dermabrasion may not be able to reach the area of pigment without significant scarring. Six patients with traumatic (n = 5) or medical (n = 11) tattoos were treated with the Q-switched ruby laser with complete or nearly complete resolution after one to six treatments without cutaneous scarring or permanent pigmentary alteration
— id: 9176, year: 1993, vol: 91, page: 841, stat: Journal Article,

Interferon alfa-2a therapy for extensive perianal and lower extremity hemangioma
Blei F; Orlow SJ; Geronemus RG
1993 Jul;29(1):98-99, Journal of the American Academy of Dermatology
— id: 8235, year: 1993, vol: 29, page: 98, stat: Journal Article,

Supraumbilical midabdominal raphe, sternal atresia, and hemangioma in an infant: response of hemangioma to laser and interferon alfa-2a [see comments]
Blei F; Orlow SJ; Geronemus RG
1993 Mar;10(1):71-76, Pediatric dermatology
We cared for an infant girl with the clinical constellation of supraumbilical midabdominal raphe, sternal atresia, and cutaneous facial and upper trunk hemangioma. This is the first report of this clinical association in the dermatologic literature. The vascular component of the disorder responded to flashlamp-pumped pulsed dye laser therapy and to systemic interferon alfa-2a (Roferon-A)
— id: 9178, year: 1993, vol: 10, page: 71, stat: Journal Article,

HEMANGIOMAS ASSOCIATED WITH MAJOR MORBIDITY SUCCESSFULLY TREATED WITH INTERFERON ALFA-2A THERAPY
BLEI, F; GERONEMUS, RG
1993 APR ;41(2):A314-A314, Clinical research
— id: 54277, year: 1993, vol: 41, page: A314, stat: Journal Article,

Pulsed dye laser treatment of vascular lesions in children
Geronemus RG
1993 Apr;19(4):303-310, Journal of dermatologic surgery & oncology
BACKGROUND. The flashlamp-pumped pulsed dye laser (577,585 nm) with 300 to 450 microseconds pulsewidths has been demonstrated to effectively and safely treat port-wine stains, telangiectases, and superficial hemangiomas in children. OBJECTIVE. The objective of this manuscript is to review the indications of the pulsed dye laser in the treatment of vascular lesions in children. CONCLUSION. Pulsed dye laser treatment of port-wine stains can remove or lighten the lesions with multiple treatment sessions. Spider telangiectases respond with complete resolution, usually within one to two treatment sessions. Superficial hemangiomas respond quite easily and effectively with the pulsed dye laser, while a more variable response is noted in deeper hemangiomas, early proliferative lesions, and ulcerated hemangiomas. This procedure is safe with a low incidence of scarring and pigmentary alteration
— id: 9175, year: 1993, vol: 19, page: 303, stat: Journal Article,

Lasers in dermatology--1993
Hruza GJ; Geronemus RG; Dover JS; Arndt KA
1993 Aug;129(8):1026-1035, Archives of dermatology
— id: 9173, year: 1993, vol: 129, page: 1026, stat: Journal Article,

Anatomical differences of port-wine stains in response to treatment with the pulsed dye laser
Renfro L; Geronemus RG
1993 Feb;129(2):182-188, Archives of dermatology
BACKGROUND AND DESIGN--Anecdotal reports and clinical observations have suggested that the response of port-wine stains to treatment with the pulsed dye laser is variable and dependent on the anatomical location of the lesion. To investigate anatomical variation in response to treatment, a retrospective study of 259 adults and children with port-wine stains of the head and neck treated with the pulsed dye laser was undertaken. Evaluation was performed by comparing simultaneously projected pretreatment and completion-treatment photographs. Anatomical differences in response were evaluated in three ways: (1) by anatomical subdivision of the head and neck into regions, (2) by dermatomal distribution, and (3) by response for midline lesions. The head and neck was subdivided into eight anatomical regions, which were independently evaluated for response. In addition, response for individual dermatomes and for midline lesions was evaluated. Response in all cases was assessed by determining the percentage of lightening from 0% to 100% (where 100% represents complete response) at the completion of treatment. Response grades were also assigned, using grades poor (0% to 25% lightening), fair (26% to 50% lightening), good (51% to 75% lightening), or excellent (76% to 100% lightening). RESULTS--One hundred thirty-seven adults and 122 children were included in the study. Evaluation by subdivision of the head and neck into regions revealed that in adults and children the centrofacial regions (medial aspect of the cheek, upper cutaneous lip, and nose) responded less favorably than the other grouped regions (periorbital, forehead/temple, lateral aspect of the cheek, neck, and chin); the centrofacial regions showed a good response (mean lightening, 70.7%) while the other grouped regions of the head and neck showed an excellent response (mean lightening, 82.3%). Evaluation by dermatomal distribution revealed that dermatome V2 showed a good response (mean lightening of 73.8%), while combined dermatomes V1, V3, and C2/C3 showed an excellent response (mean lightening of 82.4%). Evaluation of midline lesions revealed excellent responses in adults and children (mean lightening, 92.4%). CONCLUSIONS--Port-wine stains of the head and neck in adults and children demonstrate differences in response to treatment with the pulsed dye laser according to their anatomical location. Centrofacial lesions and lesions involving dermatome V2 in adults and children respond less favorably than lesions located elsewhere on the head and neck. Midline lesions respond very favorably in adults and children
— id: 9179, year: 1993, vol: 129, page: 182, stat: Journal Article,

Q-switched ruby laser treatment of labial lentigos
Ashinoff R; Geronemus RG
1992 Nov;27(5 Pt 2):809-811, Journal of the American Academy of Dermatology
The Q-switched ruby laser causes selective damage to pigmented cells in the skin. This laser, which has a wavelength of 694 nm and a pulse duration of 40 nsec, has shown very promising results in the treatment of both amateur and professional tattoos. Less data are available on its ability to treat benign pigmented lesions of the skin. Three patients who had labial lentigos were treated with the Q-switched ruby laser, and dramatic clearing occurred after one or two treatments with a fluence of 10 J/cm2
— id: 9181, year: 1992, vol: 27, page: 809, stat: Journal Article,

Treatment of a port-wine stain in a black patient with the pulsed dye laser
Ashinoff R; Geronemus RG
1992 Feb;18(2):147-148, Journal of dermatologic surgery & oncology
A black man presenting with a port-wine stain was spot-treated with a flashlamp-pumped pulsed dye laser. The 1 cm2 area was treated with the flashlamp-pumped pulsed dye laser using rhodamine in methanol as the dye, a wavelength of 585 nm, a pulse duration of 450 microseconds, and a circular spot size of 5 mm. Energy density was 7.75 J/cm2. Superficial sloughing of the skin was noted immediately posttreatment. Persistent hyperpigmentation, textural changes to the skin, and no improvement in the port-wine stain were noted at follow-ups 2-, 4-, and 8-months posttreatment
— id: 9186, year: 1992, vol: 18, page: 147, stat: Journal Article,

Lasers in the treatment of skin cancer
Geronemus R; Ashinoff R
1992 Jul;9(3):599-615, Clinics in podiatric medicine & surgery
— id: 9183, year: 1992, vol: 9, page: 599, stat: Journal Article,

Laser surgery of the nail unit
Geronemus RG
1992 Aug;18(8):735-743, Journal of dermatologic surgery & oncology
The past decade has seen a dramatic increase in the use of lasers for the treatment of dermatologic disorders. A variety of laser systems has been found to be useful in the treatment of numerous conditions found in the nail unit. The vascular lesions of the nail unit have been treated with the pulsed dye, tunable dye, copper vapor, argon, and carbon dioxide (CO2) lasers. Pigmented lesions noted in the nail unit have been effectively treated with the Q-switched ruby, copper vapor, argon, and pulsed dye lasers. The CO2 laser has been widely used for the treatment of benign and premalignant neoplasms of the nail unit as well as inflammatory processes. Investigational lasers, such as the gold vapor and excimer lasers, may provide clinical benefits for diseases of the nail unit in the near future. The potential advantages of laser surgery of the nail unit include the selective destruction of vascular and pigmented tissue as well as precise tissue destruction
— id: 9182, year: 1992, vol: 18, page: 735, stat: Journal Article,

Q-switched ruby laser therapy of nevus of Ota
Geronemus RG
1992 Dec;128(12):1618-1622, Archives of dermatology
BACKGROUND--The Q-switched ruby laser has been demonstrated to provide selective photothermolysis of pigmented tissue at a wavelength of 694 nm and a pulse width of 40 ns with dermal penetration. It was used to treat 15 patients with nevus of Ota involving the face with an age range of 6 to 52 years. Other methods of treatment for the nevus of Ota have either left scarring or were ineffective. The clinical efficacy of this laser treatment was evaluated in a comparative photographic analysis. OBSERVATIONS--Complete clearing was noted in four of the 15 patients and a minimum of 50% lightening of the original color in the remaining 11. Ten of the 15 patients were Asian, two were white, two were Hispanic, and one was Indian. The energy fluence used varied between 6 and 10 J/cm2, and the number of treatments ranged from 1 to 7. Significant lightening or clearing was found at the higher energy ranges of 9 to 10 J/cm2 with significantly less lightening noted at the lower energy range of 6 to 8.5 J/cm2. No scarring was noted in any of the 15 patients, and some isolated hypopigmentation was noted in one of the subjects. Transient postinflammatory hyperpigmentation of 2 months' duration was noted in only one patient. CONCLUSION--Q-switched ruby selective photothermolysis appears to be an effective and safe method of lightening or removing nevus of Ota
— id: 9180, year: 1992, vol: 128, page: 1618, stat: Journal Article,

Laser therapy in vascular lesions and tattoo removal
Geronemus, Roy
Secaucus, N.J. : Network for Continuing Medical Education, c1992,
— id: 423, year: 1992, vol: , page: , stat: ,

Treatment of periorbital port-wine stains with the flashlamp-pumped pulsed dye laser
Holy A; Geronemus RG
1992 Jun;110(6):793-797, Archives of ophthalmology
Sixty-seven patients with periorbital port-wine stains were treated with the flashlamp-pumped pulsed dye laser at a wavelength of 577 or 585 nm and a pulse-width of 450 microseconds. A retrospective analysis of the efficacy of this treatment was performed by qualitative and quantitative comparison of simultaneously projected pretreatment and post-treatment photographs and by comparison of photographs with a visual analog scale. These periorbital port-wine stains were treated with good-to-excellent results in 95% of the patients. As a result of treatment, macular (ie, nonhypertrophic) lesions, were lightened by an average of 80%. Neither scarring nor permanent pigmentary alteration was noted. Children of all ages were treated without adverse consequences, and the results were comparable to those of adults. The flashlamp-pumped pulsed dye laser treatment of periorbital port-wine stains is effective and safe in patients of all ages and should be considered the treatment of choice for flat and mildly hypertrophic lesions
— id: 9184, year: 1992, vol: 110, page: 793, stat: Journal Article,

Lack of efficacy of the Q-switched ruby laser in the treatment of vitiligo
Renfro L; Geronemus RG
1992 Feb;128(2):277-278, Archives of dermatology
— id: 9185, year: 1992, vol: 128, page: 277, stat: Journal Article,

Arteriovenous malformation treated with embolization and laser therapy
Ashinoff R; Berenstein A; Geronemus RG
1991 Nov;127(11):1642-1644, Archives of dermatology
— id: 9189, year: 1991, vol: 127, page: 1642, stat: Journal Article,

Capillary hemangiomas and treatment with the flash lamp-pumped pulsed dye laser [see comments]
Ashinoff R; Geronemus RG
1991 Feb;127(2):202-205, Archives of dermatology
Strawberry, or capillary, hemangiomas are common vascular neoplasms, with an incidence of approximately 2.6% in neonates. They usually develop in the first few weeks of life, so that between 1 month and 1 year the incidence rises to between 8.7% and 10.1%. These lesions may grow quite large in the first year of life, and they may ulcerate or obstruct a vital organ or function. The great majority will spontaneously regress after the first year of life. Parents are often alarmed at the sight of these hemangiomas and need reassurance that the great majority will regress spontaneously. Treatments such as cryosurgery, irradiation, radium instillation, corticosteroid therapy, or surgical excision are often ineffective or cause significant morbidity. We describe 10 children with capillary hemangiomas treated with the flash lamp-pumped pulsed dye laser. The patients ranged in age from 7 weeks to 5.5 years at the beginning of laser therapy. The patients underwent 3.1 +/- 1 (mean +/- SD) laser treatments, with a mean regression of the lesions of 69.9% +/- 4.5%. All patients demonstrated some diminution in the size and color of their hemangiomas after the treatments, and there were no ill effects, such as ulceration, hemorrhage, infection, or scarring. There was no evidence of hyperpigmentation or hypopigmentation. Pulsed dye laser therapy should be considered as an option in the treatment of capillary hemangiomas, preferably prior to their full evolution. It is also a useful therapeutic approach in those hemangiomas that are slow to regress in older children
— id: 9196, year: 1991, vol: 127, page: 202, stat: Journal Article,

Flashlamp-pumped pulsed dye laser for port-wine stains in infancy: earlier versus later treatment
Ashinoff R; Geronemus RG
1991 Mar;24(3):467-472, Journal of the American Academy of Dermatology
Twelve children, 6 to 30 weeks of age (average 14.9 weeks), with port-wine stains of the head and neck were treated with the flashlamp-pumped pulsed dye laser at 585 nm and 450 microsecond pulse duration. Ten of 12 patients (83%) showed more than 50% lightening of their port-wine stains after 2.9 treatment sessions (2.9 +/- 1.4 [+/- standard deviation]). Forty-five percent of the patients demonstrated 75% or more lightening of their lesions after a mean of 3.8 treatments (+/- 1.6). No lesions in this group cleared completely after a mean of 2.8 treatments. Treated skin was identical in texture to normal skin in all patients. There was no evidence of depressed scars, atrophy, hyperpigmentation, or hypopigmentation in the treated areas. These results indicate that pulsed dye laser treatment of port-wine stains can be undertaken safely in infancy
— id: 9192, year: 1991, vol: 24, page: 467, stat: Journal Article,

Detection of human papillomavirus DNA in squamous cell carcinoma of the nail bed and finger determined by polymerase chain reaction
Ashinoff R; Li JJ; Jacobson M; Friedman-Kien AE; Geronemus RG
1991 Dec;127(12):1813-1818, Archives of dermatology
Increasing evidence supports the association of squamous cell carcinoma of the finger and nail bed with human papillomavirus infection. We treated 12 patients with squamous cell carcinoma of the finger and nail bed, none of whom was originally diagnosed as having a malignant lesion. Half of the patients were referred for carbon dioxide laser ablation of what was believed to be a recalcitrant verruca vulgaris. Our objective was to evaluate these lesions for the presence of human papillomavirus by in situ hybridization techniques and the polymerase chain reaction. This is the first report of use of the polymerase chain reaction to detect human papillomavirus in formalin-fixed, paraffin-embedded specimens of periungual squamous cell carcinoma. Seven of the 12 lesions were evaluated for the presence of human papillomavirus by both in situ hybridization and the polymerase chain reaction. Five of the seven periungual lesions were found to contain human papillomavirus type 16 but not type 18 DNA with use of the polymerase chain reaction technique. In situ hybridization failed to identify human papillomavirus in any of these patients' tumors. Our data confirm the association between human papillomavirus and squamous cell carcinoma of the periungual region and suggest that biopsies should be performed on chronic, isolated lesions of the finger in adults before therapy is initiated
— id: 9188, year: 1991, vol: 127, page: 1813, stat: Journal Article,

Invasive squamous cell carcinoma in a patient with epidermodysplasia verruciformis
Dhillon I; Zouzias D; Geronemus R
1991 Mar;17(3):300-302, Journal of dermatologic surgery & oncology
A patient with epidermodysplasia verruciformis died of intracranial invasion by squamous cell carcinoma (SCC). A biopsy of clinically normal skin had revealed perineural invasion by malignant keratinocytes. Because SCCs arising in patients with epidermodysplasia verruciformis may be biologically aggressive, it is best to excise them with careful control of the surgical tissue margins
— id: 9193, year: 1991, vol: 17, page: 300, stat: Journal Article,

Ethics and the academic-corporate relationship
Geronemus R
1991 Feb;24(2 Pt 1):319-321, Journal of the American Academy of Dermatology
— id: 9195, year: 1991, vol: 24, page: 319, stat: Journal Article,

Lasers in the treatment of skin cancer
Geronemus R; Ashinoff R
1991 Oct;9(4):765-776, Dermatologic clinics
The development and use of various laser systems for the treatment of carcinomas of the skin constitute a relatively new therapeutic approach. Because the skin is a readily accessible organ, it is an excellent site at which to attempt different therapeutic modalities. What is truly astounding has been the development of specific lasers designed to treat certain dermatologic problems. Because the field of laser biotechnology is still rapidly emerging, it is very likely that new lasers and modifications of existing ones will improve our ability to treat skin cancer and precancerous conditions
— id: 9190, year: 1991, vol: 9, page: 765, stat: Journal Article,

Argon laser surgery in children under 13 years of age
Geronemus RG
1991 Dec;88(6):1105-1106, Plastic & reconstructive surgery
— id: 9187, year: 1991, vol: 88, page: 1105, stat: Journal Article,

Treatment of spider telangiectases in children using the flashlamp-pumped pulsed dye laser
Geronemus RG
1991 Mar;8(1):61-63, Pediatric dermatology
Twelve children 2 to 10 years of age with spider telangiectases of the face were treated with a flashlamp-pumped pulsed dye laser at a wavelength of 585 nm and a pulse width of 450 microsec. Complete resolution of the telangiectases was noted in all 12 patients, without scarring or permanent pigmentary alteration of the skin
— id: 9194, year: 1991, vol: 8, page: 61, stat: Journal Article,

The medical necessity of evaluation and treatment of port-wine stains
Geronemus RG; Ashinoff R
1991 Jan;17(1):76-79, Journal of dermatologic surgery & oncology
New lasers and improved laser delivery systems have allowed for the safe and effective treatment of port-wine stains in patients of all ages. The satisfactory results obtained by laser treatment have increased the number of patients seeking consultation regarding their birthmarks. It is imperative that physicians recognize the various medical syndromes and problems associated with port-wine stains. A review of 415 patients with facial port-wine stains has revealed hypertrophy and/or nodularity in 65% of patients by the fifth decade of life, which increases significantly the morbidity of these lesions. It is believed that laser treatment will minimize the medical and psychologic complications that result from the natural evolution of port-wine stains
— id: 9197, year: 1991, vol: 17, page: 76, stat: Journal Article,

Treatment of the poikilodermatous component of the Rothmund-Thomson syndrome with the flashlamp-pumped pulsed dye laser: a case report
Potozkin JR; Geronemus RG
1991 Jun;8(2):162-165, Pediatric dermatology
The Rothmund-Thomson syndrome is a rare disorder characterized by poikiloderma, juvenile cataracts, bone abnormalities, short stature, sparse hair, hypogonadism, defective dentition, nail dystrophy, hyperkeratosis, and mental retardation. A 12-year-old boy with the syndrome was referred to us for evaluation and treatment of poikiloderma. This component of the disease was markedly improved with the use of pulsed dye laser photocoagulation
— id: 9191, year: 1991, vol: 8, page: 162, stat: Journal Article,

Effect of the topical anesthetic EMLA on the efficacy of pulsed dye laser treatment of port-wine stains
Ashinoff R; Geronemus RG
1990 Nov;16(11):1008-1011, Journal of dermatologic surgery & oncology
EMLA cream (Eutectic Mixture of Local Anesthetics) is a new topical anesthetic composed of 25 mg lidocaine and 25 mg prilocaine in an oil-in-water emulsion cream. It has been found to be very effective for local anesthesia prior to venepuncture, minor surgical procedures, and pulsed dye laser (PDL) therapy for port-wine stains (PWS) in children. However, since EMLA may cause vasoconstriction of cutaneous vessels, we tried to determine whether pretreatment with EMLA decreases the efficacy of subsequent PDL treatment. We report eight patients between the ages of 4 and 32 years with PWS who received two test site treatments prior to PDL treatment. One site was pretreated with EMLA cream under occlusion for 60 minutes and then left unoccluded for 15 minutes prior to PDL test treatment. The other site, in the same area of the PWS and patient's body, was not pretreated with EMLA. The test sites were compared 6-8 weeks later to determine whether EMLA decreased the degree of lightening of the PWS compared to the non-EMLA-treated site. We conclude that EMLA is an effective topical anesthetic for PDL treatment of PWS and does not adversely affect the efficacy of the treatment
— id: 9200, year: 1990, vol: 16, page: 1008, stat: Journal Article,

Porokeratosis of Mibelli with underlying hemangioma treated by the flashlamp-pumped pulsed dye laser
Ashinoff R; Geronemus RG
1990 Nov;46(5):410-412, Cutis
Porokeratosis of Mibelli is a disorder of epidermal proliferation in which an abnormal clone of cells expands in a centrifugal manner. We present a case of porokeratosis of Mibelli with an underlying hemangioma that was treated with a 585 nm flashlamp-pumped pulsed dye laser. The underlying hemangioma responded well to laser therapy while the porokeratosis remained unchanged. The implications of this for the pathogenesis of porokeratosis and the specificity of the pulsed dye laser are discussed
— id: 9199, year: 1990, vol: 46, page: 410, stat: Journal Article,

Thrombocytopenia-absent radii syndrome and lack of response to the pulsed dye laser
Ashinoff R; Geronemus RG
1990 Nov;126(11):1520-1521, Archives of dermatology
— id: 9201, year: 1990, vol: 126, page: 1520, stat: Journal Article,

Dermatologic laser surgery
Garden JM; Geronemus RG
1990 Feb;16(2):156-168, Journal of dermatologic surgery & oncology
The laser is becoming an increasingly important surgical and medical instrument in the field of dermatology. Developments in the areas of laser technology and application have significantly broadened its clinical use over the past several years. These rapid changes and advances in the use of the laser for cutaneous processes may make it difficult for the physician to maintain a current base of knowledge in this area. Relevant laser systems and their clinical applications are presented and discussed, as are investigational laser systems, which may be of importance for the future. This will allow the dermatologic surgeon the opportunity to update concepts and evaluate the various laser systems and their cutaneous applications
— id: 9204, year: 1990, vol: 16, page: 156, stat: Journal Article,

Poikiloderma of civatte
Geronemus R
1990 Apr;126(4):547-548, Archives of dermatology
— id: 9203, year: 1990, vol: 126, page: 547, stat: Journal Article,

Presuturing in alopecia reductions
Meirson D; Reyes BA; Geronemus R
1990 Sep;16(9):818-820, Journal of dermatologic surgery & oncology
The technique of presuturing for alopecia reductions is described. With this procedure, the area of potential reduction is sutured 12-24 hours prior to surgery to enhance the laxity of the scalp
— id: 9202, year: 1990, vol: 16, page: 818, stat: Journal Article,

Treatment of port-wine stains during childhood with the flashlamp-pumped pulsed dye laser
Reyes BA; Geronemus R
1990 Dec;23(6 Pt 1):1142-1148, Journal of the American Academy of Dermatology
Seventy-three patients between the ages of 3 months to 14 years (average age 6 years 2 months) with port-wine stains were treated with the flashlamp-pumped pulsed dye laser. More than 75% lightening was achieved with an average of 2.5 treatments in 33 patients (45%), 50% to 74% lightening after an average of 1.7 treatments in 31 (42%), 26% to 49% lightening after 2 treatments in 5 (7%), and less than 25% lightening after 1 treatment in 4 (5%). The overall average lightening after one treatment was 53%. The percentage of lightening increased as the number of treatments increased. Three patients had 100% clearance of the port-wine stain. Patients aged between 3 months and 6 years (44 patients) had a better response after the first treatment (55% lightening) than did patients aged between 7 and 14 years (29 patients with a 48% lightening; p = 0.027). Complications included cutaneous depressions in four patients, hyperpigmentation in 16 patients, and hypopigmentation in three patients. All complications were transient and disappeared completely
— id: 9198, year: 1990, vol: 23, page: 1142, stat: Journal Article,

The association of lichen planus of the penis with squamous cell carcinoma in situ and with verrucous squamous carcinoma
Bain L; Geronemus R
1989 Apr;15(4):413-417, Journal of dermatologic surgery & oncology
Two cases of squamous cell carcinoma (SCC) of the penis, one verrucous type and one in situ, arising in association with an inflammatory dermatosis most consistent with lichen planus, are described. Although SCC has previously been reported to have arisen from lichen planus of the oral mucosa, these are the first reported cases of the coexistence of these processes on the penis
— id: 9207, year: 1989, vol: 15, page: 413, stat: Journal Article,

The treatment of Zoon's balanitis with the carbon dioxide laser
Baldwin HE; Geronemus RG
1989 May;15(5):491-494, Journal of dermatologic surgery & oncology
Zoon's balanitis, or plasma cell balanitis, is a chronic erosive process of the uncircumcised penis. The lesions are often refractory to conservative topical and surgical therapy and frequently require circumcision as a curative measure. This case report describes the first reported successful use of the carbon dioxide laser in the defocused mode to vaporize the chronic penile erosions of Zoon's balanitis
— id: 9206, year: 1989, vol: 15, page: 491, stat: Journal Article,

Microcystic adnexal carcinoma of the scalp
Chow WC; Cockerell CJ; Geronemus RG
1989 Jul;15(7):768-771, Journal of dermatologic surgery & oncology
Microcystic adnexal carcinoma (MAC) is a recently described rare adnexal neoplasm showing benign histologic features but a locally aggressive behavior. It has most commonly been reported to occur on the face but it has also been noted in the axilla and buttock. We describe a 41-year-old white male with a 5-year history of MAC on the scalp and treatment by Mohs micrographic surgery. To our knowledge, this is the first case of MAC reported to occur on the scalp
— id: 9205, year: 1989, vol: 15, page: 768, stat: Journal Article,

Continuous arteriovenous hemofiltration for acute renal failure
Bartlett RH; Bosch J; Geronemus R; Paganini E; Ronco C; Swartz R
1988 Jan-Mar;34(1):67-77, ASAIO transactions (American Society of Artificial Internal Organs)
— id: 9208, year: 1988, vol: 34, page: 67, stat: Journal Article,

Ultraviolet laser ablation of skin: healing studies and a thermal model
Lane RJ; Wynne JJ; Geronemus RG
1987 ;6(6):504-513, Lasers in surgery & medicine
We have followed the course of healing of incisions made with the krypton-fluoride excimer laser. Incisions were made in guinea pig skin, in vivo, under identical conditions of irradiation. The progressive healing of these incisions was followed over the course of 3 weeks. We noted excellent healing with re-epithelialization, and the re-formation of collagen fibers with minimal fibrosis. We present a simple thermal model for ablation of tissue by a short pulse of strongly absorbed laser radiation.
— id: 9209, year: 1987, vol: 6, page: 504, stat: Journal Article,

DERM/RX. A computer aid to the management of diseases of the skin
Kopf AW; Geronemus R; Sanchez M; Natow A; Grossman D; Goldberg D
1986 Oct;4(4):589-598, Dermatologic clinics
DERM/RX (dermatologic therapy) is a computerized data base representing a compendium of therapeutic management options for over 600 diseases of the skin. This data base is housed in the National Headquarters of the American Academy of Dermatology in Evanston, Illinois. It is accessible via DERM/INFONET to members of the American Academy of Dermatology via telephonic communication lines that blanket the United States. The data base is constantly updated by the Task Force on DERM/RX of the Committee on Biomedical Communications of the American Academy of Dermatology.
— id: 9210, year: 1986, vol: 4, page: 589, stat: Journal Article,

Ultraviolet-laser ablation of skin
Lane RJ; Linsker R; Wynne JJ; Torres A; Geronemus RG
1985 May;121(5):609-617, Archives of dermatology
We report on the use of pulsed ultraviolet-laser irradiation at 193 nm from an argon-fluoride laser and at 248 nm from a krypton-fluoride laser to ablate skin. In vitro, both wavelengths performed comparably, removing tissue precisely and cleanly, and leaving minimal thermal damage to the surrounding tissue. In vivo, the 193-nm laser radiation failed to remove tissue after bleeding began. The 248-nm radiation, however, continued to remove tissue despite bleeding and left a clean incision with only minimal thermal damage. The krypton-fluoride excimer laser beam at 248 nm, which should be deliverable through a quartz optical fiber, has great potential as a surgical instrument.
— id: 9211, year: 1985, vol: 121, page: 609, stat: Journal Article,

Continuous arteriovenous hemodialysis: a new modality for treatment of acute renal failure
Geronemus R; Schneider N
1984 ;30:610-613, Transactions (American Society for Artificial Internal Organs)
— id: 9212, year: 1984, vol: 30, page: 610, stat: Journal Article,

ULTRAVIOLET-LASER ABLATION OF SKIN AND OTHER TISSUES
LANE, RJ; LINSKER, R; WYNNE, JJ; TORRES, A; GERONEMUS, RG
1984 ;32(2):A597-A597, Clinical research
— id: 40989, year: 1984, vol: 32, page: A597, stat: Journal Article,

Surgical gem. modification of surgical gloves to prevent exposure to hepatitis during hair transplantation surgery
Rigel DS; Albom MJ; Geronemus RG; Freedberg IM
1983 Feb;9(2):114-115, Journal of dermatologic surgery & oncology
— id: 9213, year: 1983, vol: 9, page: 114, stat: Journal Article,

Studies of carbohydrate metabolism after hemodialysis and hemofiltration in uremic patients
Geronemus R; Bosch JP; Thornton J; Rayfield EJ
1982 Apr;142(4):707-710, Archives of internal medicine
To assess the effects of dialysis or hemofiltration on carbohydrate metabolism in uremia, we performed intravenous (IV) glucose tolerance tests (IV GTTs) after an overnight fast 48 hours following the last treatment in ten patients with chronic renal failure. Samples were obtained for plasma glucose, insulin, glucagon, and growth hormone levels throughout the GTTs in addition to basal samples for levels of plasma potassium and bicarbonate. The IV GTTs were performed at the end of a four-month period of standard hemodialysis (period 1) and then at the end of a four-month period of hemofiltration (period 2). Patients had mild glucose intolerance that did not change after hemofiltration, although the exaggerated insulin responses to glucose administration did significantly decrease in period 2. The fasting hyperglucagonemia did not decrease after hemofiltration but exhibited normal suppression with IV glucose. Levels of basal plasma bicarbonate and basal plasma potassium did not change significantly in period 2. Further studies investigating the beneficial metabolic effect of hemofiltration would seem to be indicated based on the data reported herein.
— id: 9217, year: 1982, vol: 142, page: 707, stat: Journal Article,

Liver biopsies upsilon liver scans in methotrexate-treated patients with psoriasis
Geronemus RG; Auerbach R; Tobias H
1982 Sep;118(9):649-651, Archives of dermatology
The possibility of hepatotoxic reactions in 24 patients receiving long-term methotrexate therapy for psoriasis was evaluated by both liver biopsies and technetium TC 99 m sulfur-colloid liver scans. The two diagnostic methods were compared in a retrospective analysis. Six of 17 patients with clinically normal liver biopsy interpretations were found to have abnormal liver scans, while three of five patients with histologically proved fibrosis had completely normal liver scans. We conclude that hepatotoxic reactions from long-term methotrexate use in psoriasis cannot be reliably evaluated by the technetium Tc 99m sulfur colloid liver scan.
— id: 9216, year: 1982, vol: 118, page: 649, stat: Journal Article,

The effect of two new dressings on epidermal wound healing
Geronemus RG; Robins P
1982 Oct;8(10):850-852, Journal of dermatologic surgery & oncology
The effects of a Polyethylene oxide hydrogel dressing and a co-polymer starch hydrogel dressing upon the rate of re-epithelization were evaluated in a study using Yorkshire pigs. The polyethylene oxide hydrogel dressing significantly promoted re-epithelization by 44% as compared to untreated control wounds, while the copolymer starch hydrogel dressing significantly promoted epidermal healing by 24%. A possible mechanism of action is presented for the quicker healing induced by these dressings.
— id: 9215, year: 1982, vol: 8, page: 850, stat: Journal Article,

Use of a biopsy punch for removal of epithelial cysts
Lieblich LM; Geronemus RG; Gibbs RC
1982 Dec;8(12):1059-1062, Journal of dermatologic surgery & oncology
— id: 9214, year: 1982, vol: 8, page: 1059, stat: Journal Article,

High flux hemofiltration: further reduction in treatment time
Geronemus R; von Albertini B; Glabman S; Bosch JP
1979 ;9:125-127, Proceedings of the Clinical Dialysis & Transplant Forum
— id: 9219, year: 1979, vol: 9, page: 125, stat: Journal Article,

Glucose tolerance in patients on haemodialysis, sequential ultrafiltration and dialysis and haemofiltration
Geronemus R; von Albertini B; Glabman S; Kahn T; Rayfield E; Bosch JP
1979 ;16:698-699, Proceedings of the European Dialysis & Transplant Association
— id: 9220, year: 1979, vol: 16, page: 698, stat: Journal Article,

Wound healing. The effects of topical antimicrobial agents
Geronemus RG; Mertz PM; Eaglstein WH
1979 Nov;115(11):1311-1314, Archives of dermatology
The effect of four commonly used topical antimicrobial agents on the rate of reepithelialization of clean wounds was evaluated in white domestic pigs. Neosporin Ointment was found to significantly increase the rate of reepithelialization by 25%, while Furacin significantly retarded the healing rate by 24%. Pharmadine, a preparation containing povidone-iodine, did not affect the rate of healing. Both Silvadene and its vehicle significantly increased the rate of reepithelialization by 28% and 21%, respectively. The effects of these agents cannot be explained on the basis of their antimicrobial activity.
— id: 9218, year: 1979, vol: 115, page: 1311, stat: Journal Article,

Clinical trial of maintenance sequential ultrafiltration and dialysis (UFD)
Glabman S; Geronemus R; von Albertini B; Kahn T; Moutoussis G; Bosch JP
1979 ;25:394-397, Transactions (American Society for Artificial Internal Organs)
Because of its better tolerance, sequential ultrafiltration and dialysis may be useful for intermittent fluid removal in dialysis patients. It offers no major clinical benefits as a chronic form of therapy and may be deleterious for some parameters
— id: 9221, year: 1979, vol: 25, page: 394, stat: Journal Article,

High flux hemofiltration
Bosch JP; Geronemus R; Glabman S; Lysaght M; Kahn T; von Albertini B
1978 Nov;2(4):339-342, Artificial organs
Experiments were performed using a new hollow fiber hemofilter. Ultrafiltration rates and whole blood urea clearances were measured in post-dilution hemofiltration. High ultrafiltration rates were obtained with the new hemofilter. No adverse effects were detected despite filtration fractions above 45%. These experiments suggest that it is possible in post-dilution hemofiltration to obtain small solute clearances comparable to those of hemodialysis without apparent deleterious effects.
— id: 9224, year: 1978, vol: 2, page: 339, stat: Journal Article,

Urea kinetics in hemodialysis, hemofiltration, and sequential ultrafiltration and dialysis
Bosch JP; Geronemus R; von Albertini B; Miller T; Kahn T; Glabman S
1978 Nov 18-20;8:142-146, Proceedings of the Clinical Dialysis & Transplant Forum
— id: 9223, year: 1978, vol: 8, page: 142, stat: Journal Article,

Enhanced small molecular clearance in hemofiltration
Geronemus R; von Albertini B; Glabman S; Lysaght M; Kahn T; Bosch JP
1978 Nov 18-20;8:147-151, Proceedings of the Clinical Dialysis & Transplant Forum
— id: 9222, year: 1978, vol: 8, page: 147, stat: Journal Article,

Streptokinase clot lysis time in patients with ruptured intracranial aneurysms
Geronemus R; Herz DA; Shulman K
1974 Apr;40(4):499-503, Journal of neurosurgery
— id: 9225, year: 1974, vol: 40, page: 499, stat: Journal Article,