Vicki J Levine, M.D.

Procedural dermatology training during dermatology residency: a survey of third-year dermatology residents
Lee, Erica H; Nehal, Kishwer S; Dusza, Stephen W; Hale, Elizabeth K; Levine, Vicki J
2011 Mar;64(3):475-83, 483.e1, Journal of the American Academy of Dermatology
BACKGROUND: Given the expanding role of multiple surgical procedures in dermatology, resident training in procedural dermatology must be continually assessed to keep pace with changes in the specialty. OBJECTIVE: We sought to assess the third-year resident experience in procedural dermatology during residency training. METHODS: This survey study was mailed to third-year dermatology residents at 107 Accreditation Council for Graduate Medical Education (ACGME)-approved dermatology residency programs in 2009. RESULTS: A total of 240 residents responded (66%), representing 89% of programs surveyed. Residents assume the role of primary surgeon most commonly in excisional surgery (95%) and flap and graft reconstruction (49%) and least often in Mohs micrographic surgery (18%). In laser and cosmetic procedures, the resident role varies greatly. Residents believed they were most prepared in excisional surgery, botulinum toxin, and laser surgery. Residents believed it was sufficient to have only knowledge of less commonly performed procedures such as hair transplantation, tumescent liposuction, and ambulatory phlebectomy. Of responding residents, 55% were very satisfied with their procedural dermatology training during residency. LIMITATIONS: Individual responses from residents may be biased. Neither residency program nor dermatologic surgery directors were surveyed. CONCLUSION: This survey confirms dermatology residents received broad training in procedural dermatology in 2009, in keeping with ACGME/Residency Review Committee program guidelines. The results provide feedback to dermatology residency programs and are an invaluable tool for assessing, modifying, and strengthening the current procedural dermatology curriculum
— id: 138289, year: 2011, vol: 64, page: 475, stat: Journal Article,

Imiquimod induced psoriasis: A case report, review of the literature, and pathophysiologic mechanism
Machler, Brian; Mark, Nicholas; Patel, Utpal; Levine, Vicki
2011 FEB ;64(2):AB148-AB148, Journal of the American Academy of Dermatology
— id: 126452, year: 2011, vol: 64, page: AB148, stat: Journal Article,

Imiquimod 5% cream induced psoriasis: a case report, summary of the literature and mechanism
Patel, U; Mark, N M; Machler, B C; Levine, V J
2011 Mar;164(3):670-672, British journal of dermatology
— id: 138288, year: 2011, vol: 164, page: 670, stat: Journal Article,

Novel PRKAR1A gene mutations in Carney Complex
Pan, Lorraine; Peng, Lan; Jean-Gilles, J; Zhang, Ximin; Wieczorek, Rosemary; Jain, Shilpa; Levine, Vicki; Osman, Iman; Prieto, Victor G; Lee, Peng
2010 ;3(5):545-548, International journal of clinical & experimental pathology
Carney complex is a syndrome that may include cardiac and mucocutaneous myxomas, spotting skin pigmentation, and endocrine lesions. Many patients with Carney complex have been shown to have a stop codon mutation in the PRKAR1A gene in the 17q22-24 region. Here we present the case of a 57 year-old man with multiple skin lesions and cardiac myxomas. Histology of the skin lesions showed lentigenous melanocytic hyperplasia and cutaneous myxomas, confirming the diagnosis of Carney complex. Lesional and control normal tissue from the patient were identified and sequenced for the PRKAR1A gene. A germline missense mutation was identified at exon 1A. This is the first report of this mutation, and one of the few reported missense mutation associated with Carney complex. This finding strengthens the argument that there are alternative ways in which the protein kinase A 1-alpha subunit plays a role in tumorigenesis
— id: 110695, year: 2010, vol: 3, page: 545, stat: Journal Article,

Teens and tanning knowledge and attitudes
Ashinoff, Robin; Levine, Vicki J; Steuer, Alexa B; Sedwick, Carly
2009 Feb;2(2):48-50, Journal of Clinical & Aesthetic Dermatology
Background: The incidence of skin cancer, including melanoma, continues to increase. Teenagers are especially vulnerable, as are young females. The incidence of melanoma among young women in their twenties and thirties has begun to increase again. These young people are also the population that frequent tanning salons. Objective: This voluntary, anonymous, New York University, Institutional Review Board-approved survey was given to students in grades 9 through 12 to ascertain their understanding of what causes skin cancers and the dangers of excessive sun exposure and tanning salons. Methods and materials: An Institutional Review Board-approved, 22-question survey was administered anonymously to more than 450 students with 368 returned responses. The survey was administered to students in grades 9 through 12 at two high schools in New York and New Jersey. Results: More than 80 percent of students view movie stars as tan and almost 60 percent see 'tan' people as better looking. In addition, more than 90 percent believe that a tan does not prevent further damage to the skin (as opposed to the customary belief that a 'base' tan can protect against extreme sun exposures, such as when on a tropical vacation). There appears to be a disconnect between knowledge and sun tanning behaviors. Most teenagers still believe that tans are attractive and teenage girls continue to use tanning salons and tan naturally. We need to address the connection between sun tanning in youth and skin cancers years later. Legislation to limit access of tanning salons to teenagers needs to be enacted
— id: 115879, year: 2009, vol: 2, page: 48, stat: Journal Article,

Use of Mohs surgery by the Veterans Affairs Health Care System
Karen, Julie K; Hale, Elizabeth K; Nehal, Kishwer S; Levine, Vicki J
2009 Jun;60(6):1069-1070, Journal of the American Academy of Dermatology
— id: 102284, year: 2009, vol: 60, page: 1069, stat: Journal Article,

Adverse effects of Q-switched laser treatment of tattoos
Holzer, Aton M; Burgin, Susan; Levine, Vicki J
2008 Jan;34(1):118-122, Dermatologic surgery
— id: 115880, year: 2008, vol: 34, page: 118, stat: Journal Article,

Analysis of vector alignment with the Zitelli bilobed flap for nasal defect repair: a comparison of flap dynamics in human cadavers
Zoumalan, Richard Abraham; Hazan, Carole; Levine, Vicki J; Shah, Anil R
2008 May-Jun;10(3):181-185, Archives of facial plastic surgery
OBJECTIVE: To determine whether differences of angles between the alar rim and the long axis of the secondary defect in a Zitelli bilobed flap affect alar displacement in a fresh cadaver model. METHODS: In fresh cadaver heads, identical, unilateral 1-cm circular defects were created at the superior alar margin. Three different laterally based bilobed flap templates for reconstruction were used. One template, used on 3 cadavers, had an angle of 60 degrees between the alar rim and the long axis of the secondary defect. Another template, used on 3 cadavers, had an angle of 90 degrees . The last template had an angle of 135 degrees and was used on 2 cadavers. Photographs were taken before the repair and after with the camera and cadaver heads in the same spatial relationship to each other. RESULTS: In the 3 cadavers that had repair using an angle of 60 degrees , all cadavers experienced alar retraction, with a mean displacement of 1.3 mm. This was not a statistically significant change (P = .07). In the defects that had repair using an angle of 90 degrees , there was also no significant alar displacement (P = .72). In the 2 cadavers that underwent repair using an angle of 135 degrees , both ala underwent depression by 1.0 mm. When the differences achieved between the different angles were compared, there was a significant difference in measured distortion between the cadavers that had 90 degrees and 60 degrees vector placement (P = .02). There were no measurable changes to the contralateral maximal nostril distance. CONCLUSIONS: Vector alignment can have an impact on nostril displacement. In bilobed flaps, the axis of the secondary defect may play an important role. This study suggests that secondary defects aligned perpendicular to the nostril have the least amount of alar distortion
— id: 82914, year: 2008, vol: 10, page: 181, stat: Journal Article,

The treatment of solar lentigines with the Q-switched ruby laser (QSRL) and long-pulsed Alexandrite laser (gentlelase plus): A pilot comparative study
Hazan, C; Hale, EK; Soofi, HM; Levine, V
2007 MAR ;35(1):62-62, Lasers in surgery & medicine
— id: 71468, year: 2007, vol: 35, page: 62, stat: Journal Article,

Keratoacanthoma arising from an excisional surgery scar
Kimyai-Asadi, Arash; Shaffer, Christy; Levine, Vicki J; Jih, Ming H
2004 Mar-Apr;3(2):193-194, Journal of drugs in dermatology : JDD
A causal relationship between keratoacanthomas and a variety of preceding traumatic events has been postulated in the literature. We report a patient who developed a keratoacanthoma at the site of a recent cutaneous excision site, demonstrating that surgical trauma can precede the development of keratoacanthomas
— id: 46176, year: 2004, vol: 3, page: 193, stat: Journal Article,

Laser treatment of congenital and acquired vascular lesions. A review
Rothfleisch, Jeremy E; Kosann, Meredith Klein; Levine, Vicki J; Ashinoff, Robin
2002 Jan;20(1):1-18, Dermatologic clinics
Several quasi-continuous-wave and pulsed lasers can effectively treat a variety of vascular lesions. The pulsed dye laser and its newer variants were specifically designed to target hemoglobin and, by increasing their wavelengths slightly, have successfully achieved greater depths of penetration. When used in to compliance with the theory of selective photothermolysis, these systems have been shown to be safe and to have a low incidence of adverse sequelae. With the concomitant use of epidermal cooling systems, side-effect profiles have been further reduced. Although great progress has been made in the laser treatment of leg telangiectasias, even the newest laser systems have failed to meet patient expectations. Continuing advances in laser technology, however, will probably lead to enhanced clinical results, decreased side-effect profiles, improved hardware, and reduced costs
— id: 32491, year: 2002, vol: 20, page: 1, stat: Journal Article,

Common benign neoplasms I
Kuperman-Beade M; Levine VJ
Current dermatologic diagnosis & treatment Philadelphia : Lippincott Williams & Wilkins, 2001,
— id: 3685, year: 2001, vol: , page: 30, stat: Chapter,

Common benign neoplasms II
Kuperman-Beade M; Levine VJ
Current dermatologic diagnosis & treatment Philadelphia : Lippincott Williams & Wilkins, 2001,
— id: 3686, year: 2001, vol: , page: 32, stat: Chapter,

Laser removal of tattoos
Kuperman-Beade M; Levine VJ; Ashinoff R
2001 ;2(1):21-25, American journal of clinical dermatology
Tattoos are placed for different reasons. A technique for tattoo removal which produces selective removal of each tattoo pigment, with minimal risk of scarring, is needed. Nonspecific methods have a high incidence of scarring, textural, and pigmentary alterations compared with the use of Q-switched lasers. With new advances in Q-switched laser technology, tattoo removal can be achieved with minimal risk of scarring and permanent pigmentary alteration. There are five types of tattoos: amateur, professional, cosmetic, medicinal, and traumatic. Amateur tattoos require less treatment sessions than professional multicolored tattoos. Other factors to consider when evaluating tattoos for removal are: location, age and the skin type of the patient. Treatment should begin by obtaining a pre-operative history. Since treatment with the Q-switched lasers is painful, use of a local injection with lidocaine or topical anaesthesia cream may be used prior to laser treatment. Topical broad-spectrum antibacterial ointment is applied immediately following the procedure. Three types of lasers are currently used for tattoo removal: Q-switched ruby laser (694 nm), Q-switched Nd:YAG laser (532 nm, 1064 nm), and Q-switched alexandrite laser (755 nm). The Q-switched ruby and alexandrite lasers are useful for removing black, blue and green pigments. The Q-switched 532 nm Nd:YAG laser can be used to remove red pigments and the 1064 nm Nd:YAG laser is used for removal of black and blue pigments. The most common adverse effects following laser tattoo treatment with the Q-switched ruby laser include textural change, scarring, and pigmentary alteration. Transient hypopigmentation and textural changes have been reported in up to 50 and 12%, respectively, of patients treated with the Q-switched alexandrite laser. Hyperpigmentation and textural changes are infrequent adverse effects of the Q-switched Nd:YAG laser and the incidence of hypopigmentary changes is much lower than with the ruby laser. The development of localized and generalized allergic reactions is an unusual complication following tattoo removal with the Q-switched ruby and Nd:YAG lasers. Since many wavelengths are needed to treat multicolored tattoos, not one laser system can be used alone to remove all the available inks and combination of inks. While laser tattoo removal is not perfect, we have come a long way since the advent of Q-switched lasers. Current research is focusing on newer picosecond lasers, which may be more successful than the Q-switched lasers in the removal of the new vibrant tattoo links
— id: 26578, year: 2001, vol: 2, page: 21, stat: Journal Article,

Er:YAG laser for the treatment of actinic keratoses
Jiang SB; Levine VJ; Nehal KS; Baldassano M; Kamino H; Ashinoff RA
2000 May;26(5):437-440, Dermatologic surgery
BACKGROUND: There is no single optimal treatment for multiple facial actinic keratoses. The existing therapies such as topical 5-fluorouracil, chemical peels, cryotherapy, dermabrasion, and CO2 laser resurfacing can produce prolonged recovery time or are often operator dependent. OBJECTIVE: The purpose of this study was to investigate another therapeutic modality which provides a shorter recovery time with uniform results. We performed a prospective pilot study investigating the use of the Er:YAG laser for the treatment of multiple facial actinic keratoses. METHODS: Five patients with multiple facial actinic keratoses were treated with two to three passes of Er:YAG laser. Anesthesia was achieved in all cases by topical application and local infiltration when indicated. All patients were treated with 2.0 J, 5 mm spot size, and a fluence of 10 J/cm2. Clinical and histologic evaluations were performed both pre- and postoperatively. RESULTS: All patients showed a decrease in the total number of clinical actinic keratoses on the face ranging from 86 to 96%. In addition to the reversal of actinic damage in the epidermis, histologic evidence revealed increased fibroplasia and decreased superficial solar elastosis 3 months after the laser resurfacing. Reepithelialization occurred in 5-8 days, and erythema lasted for about 3-6 weeks after the procedure. There was no evidence of scarring or pigmentary changes in any of the patients during the follow-up period. CONCLUSION: Er:YAG laser skin resurfacing is a safe and effective treatment for multiple facial actinic keratoses. Histologic data suggest a new zone of collagen deposition occurs in the superficial papillary dermis. Under our current parameters, Er:YAG laser skin resurfacing has a relatively short recovery period and a low risk of scarring. Unlike the CO2 laser, Er:YAG laser skin resurfacing can be performed with topical anesthesia alone
— id: 11694, year: 2000, vol: 26, page: 437, stat: Journal Article,

Comparative study of the efficacy of four topical anesthetics
Friedman PM; Fogelman JP; Nouri K; Levine VJ; Ashinoff R
1999 Dec;25(12):950-954, Dermatologic surgery
BACKGROUND: With the emergence of new laser and dermatologic procedures, the need for more effective topical anesthesia continues to grow. There are now several topical anesthetics that are being used prior to laser and surgical procedures. OBJECTIVE: To compare the degree and duration of anesthesia produced by four commonly used topical anesthetics, we performed a prospective study investigating the efficacy of EMLA (eutectic mixture of local anesthetics), ELA-Max, 4% tetracaine gel, and betacaine-LA ointment (formerly eutectic-LA). METHODS: Equal amounts of the above topical anesthetics plus a control (eucerin cream) were applied to 10 test sites under occlusion on the volar forearms of 12 adult volunteers. After a 60-minute application time, the degree of anesthesia was assessed immediately by a Q-switched Nd:YAG laser at 1064 nm. Pain testing was also performed 30 minutes after the 60-minute application period. Volunteer responses to pain stimuli were recorded using an ordinal scale of 0 (no pain) to 4 (maximal pain). The mean scores for the time intervals were obtained. Analysis of the data was performed using analysis of variance (ANOVA), Newman-Keuls test, Friedman rank order test, and paired t-tests. RESULTS: ELA-Max, EMLA, and tetracaine were statistically superior to control after the 60-minute application period. Thirty minutes later, ELA-Max, EMLA, tetracaine, and betacaine-LA were all statistically superior to the control. Comparing individual anesthetics, ELA-Max and EMLA were the superior anesthetics at both time intervals. Although the mean pain scores for each anesthetic were lower 30 minutes after their removal, the differences did not reach statistical significance. CONCLUSION: This is the first prospective study comparing the efficacy of several new topical anesthetic agents. Using the methodology of this study, in which the anesthetics were applied under occlusion, ELA-Max and EMLA were the superior anesthetics after a 60-minute application time and 30 minutes later. In addition, there was a clinical increase in efficacy suggested with all of the anesthetics 30 minutes after their removal
— id: 11909, year: 1999, vol: 25, page: 950, stat: Journal Article,

Treatment of mature striae with the pulsed dye laser
Nehal KS; Lichtenstein DA; Kamino H; Levine VJ; Ashinoff R
1999 Jan;1(1):41-44, Journal of cutaneous laser therapy
INTRODUCTION: Striae are a common cosmetic problem with no effective treatment options. A recent study has shown improvement in the appearance of mature striae following a single 585-nm pulsed dye laser (PDL) treatment at low fluence. OBJECTIVE: To evaluate the effectiveness of treating mature striae with the 585-nm PDL. METHODS: Five patients with mature striae on the abdomen were prospectively treated with the 585-nm PDL at 2-month intervals for 1-2 years. The response of the striae to laser treatment was evaluated in each patient through sequential clinical, photographic, textural, and histologic assessment. RESULTS: All five patients reported a slight overall improvement in the appearance of the striae following multiple PDL treatments. Comparison of pre- and post-treatment photographs, however, failed to reveal improvement in any patients. Optical profilometry performed on striae impressions showed mild improvement in the surface texture of striae in three patients. Histologic comparison of pre- and post-treatment biopsy specimens failed to reveal normalization of skin architecture. CONCLUSIONS: Serial treatment of mature striae with the PDL results in mild, subjective, clinical improvement but no significant photographic, textural or histologic improvement
— id: 20657, year: 1999, vol: 1, page: 41, stat: Journal Article,

Pulsed dye laser treatment of warts: an update
Ross BS; Levine VJ; Nehal K; Tse Y; Ashinoff R
1999 May;25(5):377-380, Dermatologic surgery
BACKGROUND: Warts are a therapeutic challenge. New studies indicate that pulsed dye laser therapy may be effective, with clearance rates of 72 to 93%. OBJECTIVE: To determine clearance rate in pulsed dye laser treatment of warts and compare our rate to those of other published studies. METHODS: Thirty-three patients with 96 warts received pulsed dye laser treatment for recalcitrant plantar, digital, peri- and subungual, and body warts. RESULTS: Forty-eight percent of patients had complete wart clearance; 45% partially cleared. Sixty-nine percent of those who cleared remained wart-free for an average of 11 months. Mean fluence was 9.4 J/cm2, with an average of 3.4 treatments. Body and palmar warts responded best, digital and peri- and subungual next, and plantar lesions worst. No significant side effects were observed. CONCLUSION: Pulsed dye laser is an effective treatment option for recalcitrant warts with an excellent side effect profile. However, our response rates were not as high as those previously reported, and we feel that further studies would be useful
— id: 16099, year: 1999, vol: 25, page: 377, stat: Journal Article,

Basal cell carcinoma of the genitalia
Nehal KS; Levine VJ; Ashinoff R
1998 Dec;24(12):1361-1363, Dermatologic surgery
BACKGROUND: Basal cell carcinomas (BCC) arising on the genitalia are exceedingly rare with an unclear pathogenesis. OBJECTIVE: To better understand risk factors, tumor characteristics, and the possible role of human papillomavirus (HPV) in the development of BCC of the genitalia. METHODS: 1543 records of Mohs micrographic surgery performed during a 6-year period were reviewed to identify cases of BCC arising on the genitalia. Tumor tissue was analyzed for HPV DNA by in situ hybridization. RESULTS: Four patients with BCC of the genitalia were treated with Mohs micrographic surgery. The malignancies were located on the scrotum, perineum, and perianal areas in the three male patients and on the vulva in the female patient. The mean age was 67 years. None of the patients had prior history of skin cancers. Histologic evaluation of the tumors revealed two nodular subtypes, one superficial subtype, and one with follicular differentiation. In situ hybridization failed to reveal DNA of HPV types 6, 11, 16, 18, 30, 31, 33, 35, 45, 51, and 52. CONCLUSION: In this small series, genital BCC occurred in an older age group with no identifiable predisposing risk factors and did not show evidence of HPV infection
— id: 7412, year: 1998, vol: 24, page: 1361, stat: Journal Article,

Comparison of high-energy pulsed carbon dioxide laser resurfacing and dermabrasion in the revision of surgical scars
Nehal KS; Levine VJ; Ross B; Ashinoff R
1998 Jun;24(6):647-650, Dermatologic surgery
BACKGROUND: Both dermabrasion and high-energy pulsed carbon dioxide (CO2) laser resurfacing can improve the appearance of surgical scars. Although the results of these two procedures have been compared using historical data, a prospective evaluation has never been performed in humans. OBJECTIVE: To prospectively compare the clinical effects of dermabrasion and high-energy pulsed CO2 laser resurfacing in the revision of surgical scars. METHODS: Facial surgical scars in four patients were prospectively revised using a split scar model. One half of the scar was dermabraded and the other half was resurfaced with the high-energy pulsed CO2 laser. Comparisons of the two treatment modalities were performed through clinical assessment, photographic evaluation, and textural analysis of the scars. RESULTS: The high-energy pulsed CO2 laser-resurfaced halves of the scar were bloodless with less postoperative crusting in comparison with the dermabraded halves. Reepithelialization time and degree and duration of postoperative erythema were similar for both treatment halves. Photographic evaluation and textural analysis showed comparable improvement in the clinical appearance and surface texture of the scars with both treatment modalities. CONCLUSIONS: Both the high-energy pulsed CO2 laser and dermabrasion can achieve comparable clinical improvement in the revision of surgical scars. The high-energy pulsed CO2 laser offers the advantage of a bloodless field and a more precise method of tissue ablation. Postoperative erythema, however, is an expected finding with both treatment modalities
— id: 7705, year: 1998, vol: 24, page: 647, stat: Journal Article,

Squamous cell carcinoma of the penis in a circumcised man: a case for dermatology and urology, and review of the literature
Ross BS; Levine VJ; Dixon C; Ashinoff R
1998 Jan;61(1):41-43, Cutis
Squamous cell carcinoma of the penis is most frequent in uncircumcised men. Other contributing factors include human papillomavirus infection, phimosis, balanitis, and smoking. We present a patient, circumcised at birth, who showed penile squamous cell carcinoma in situ and was treated with carbon dioxide laser ablation. Squamous cell carcinoma rarely presents in patients circumcised as infants. Factors contributing to chronic inflammation may predispose to this disease. Carbon dioxide and neodymium:YAG lasers are two modalities that are successful in the treatment of in situ and probably early invasive penile carcinoma. Optimal treatment includes coordination with a urologist if urethral disease is present
— id: 57241, year: 1998, vol: 61, page: 41, stat: Journal Article,

Short-pulse carbon dioxide laser resurfacing in the treatment of rhytides and scars. A clinical and histopathological study
Shim E; Tse Y; Velazquez E; Kamino H; Levine V; Ashinoff R
1998 Jan;24(1):113-117, Dermatologic surgery
BACKGROUND: Previous studies have shown the efficacy of short-pulse carbon dioxide (CO2) lasers in the treatment of rhytides and scars. To date, there have been few studies examining the histological aspects of these treatments. OBJECTIVE: The purpose of this study was to perform a prospective clinical and histopathological study of CO2 laser resurfacing for improvement of facial rhytides and scars. METHODS: A total of 23 patients were studied. Clinical improvement was evaluated both pre- and postoperatively using photographs and optical profilometry. Skin biopsies of rhytides were also obtained. RESULTS: Postoperatively, rhytides and scars both demonstrated significant increases in clinical improvement scores. Results from optical profilometry studies reflected these results. Skin biopsies from rhytides posttreatment demonstrated increases in collagen layer thickness. Improvement was sustained as late as 1 year following treatment. CONCLUSIONS: Histopathological studies suggest improvement of rhytides and scars by CO2 laser resurfacing may be attributed to new collagen formation following treatment
— id: 7793, year: 1998, vol: 24, page: 113, stat: Journal Article,

Laser treatment of acquired vascular lesions
Ross BS; Levine VJ; Ashinoff R
1997 Jul;15(3):385-396, Dermatologic clinics
Several quasi-continuous wave and pulsed lasers can effectively treat a variety of vascular lesions. The PDL follows the theory of selective photothermolysis, is safe for infants and children, and has a low incidence of side effects. It is successful in treating telangiectasias, spider and cherry angiomas, pyogenic granulomas, venous lakes, and poikiloderma of Civatte, as well as small leg telangiectasias. Quasi-continuous wave lasers such as the APTDL, copper vapor, krypton, and KTP lasers can be used to treat telangiectasias and other vascular lesions as well. Although they carry a higher risk of complications, they may prove more useful in treating larger caliber vessels. Although the PDL often produces superior clinical results than the quasi-continuous wave lasers, some patients may prefer these latter lasers because of the lack of post-operative purpura. Lastly, newer lasers, as well as noncoherent light sources, are being developed for the treatment of leg telangiectasias. Continuing advances in laser technology will enhance results, decrease side effects, improve equipment, and reduce costs, with great benefit to an increasing patient population
— id: 7252, year: 1997, vol: 15, page: 385, stat: Journal Article,

The treatment of benign pigmented lesions and tattoos with the Q-switched ruby laser. A comparative study using the 5.0- and 6.5-mm spot size
Nehal KS; Levine VJ; Ashinoff R
1996 Aug;22(8):683-686, Dermatologic surgery
BACKGROUND: The Q-switched ruby laser (QSRL) is useful in the treatment of benign pigmented lesions and tattoos. Two spot sizes are available in the QSRL (5 and 6.5 mm). It has not been shown if one spot size is more efficacious in the treatment of benign pigmented lesions and tattoos. OBJECTIVE: The purpose of this study is to compare the clinical lightening and side effects observed with the 5.0- and 6.5-mm spot sizes of the QSRL in the treatment of benign pigmented lesions and tattoos. METHODS: Eleven patients with 12 benign pigmented lesions or tattoos were prospectively studied with the QSRL. Half of the lesion was treated with the 5.0-mm spot size while the other half was treated with the 6.5-mm spot size. Clinical lightening of the lesion was assessed using pretreatment and posttreatment photographs. RESULTS: No significant clinical difference in the lightening of lesions or in the side effect profile was observed with either spot size. CONCLUSIONS: The 5.0- and 6.5-mm spot sizes of the QSRL are equally efficacious in the removal of benign pigmented lesions and tattoos. It seems prudent to use the 6.5-mm spot size when treating large lesions to reduce treatment time, patient discomfort, and treatment cost
— id: 7026, year: 1996, vol: 22, page: 683, stat: Journal Article,

A clinical and histologic evaluation of two medium-depth peels. Glycolic acid versus Jessner's trichloroacetic acid
Tse Y; Ostad A; Lee HS; Levine VJ; Koenig K; Kamino H; Ashinoff R
1996 Sep;22(9):781-786, Dermatologic surgery
BACKGROUND: Chemical peels using alpha hydroxy acids have become one of the most frequently requested dermatologic procedures. The use of glycolic acid in superficial chemical peels is now well established. However, the role of glycolic acid in medium-depth chemical peels has yet to be elucidated. OBJECTIVE: We performed a clinical and histologic comparison of 70% glycolic acid versus Jessner's solution as part of a medium-depth chemical peel using 35% trichloroacetic acid (TCA). METHODS: Thirteen patients with actinic keratoses, solar lentigines and fine wrinkling were evaluated prospectively. Each patient was treated with 70% glycolic acid plus 35% TCA (GA-TCA) to the right face and Jessner's solution plus 35% TCA (JS-TCA) to the left face. Clinical and histologic changes were evaluated at 7, 30, and 60 days postoperatively. RESULTS: Clinically, the GA-TCA peel was effective in treating photodamaged skin. The GA-TCA peel was slightly more efficacious in removing actinic keratoses (clinical response score = 1.5) than the JS-TCA peel (clinical response score = 1.0). Histologically, the GA-TCA peel caused the formation of a slightly thicker Grenz zone (mean = 0.053 mm) 60 days postpeel than the JS-TCA peel (mean = 0.048 mm) (not statistically significant). The GA-TCA peel caused more neoelastogenesis than the JS-TCA peel, while the JS-TCA peel resulted in more papillary dermal fibrosis and neovascularization than the GA-TCA peel. CONCLUSION: The GA-TCA peel is a new medium-depth chemical peel that is effective in treating photodamaged skin
— id: 12553, year: 1996, vol: 22, page: 781, stat: Journal Article,

Allergic reactions to tattoo pigment after laser treatment
Ashinoff R; Levine VJ; Soter NA
1995 Apr;21(4):291-294, Dermatologic surgery
BACKGROUND. Cutaneous allergic reactions to pigments found in tattoos are not infrequent. Cinnabar (mercuric sulfide) is the most common cause of allergic reactions in tattoos and is probably related to a cell-mediated (delayed) hypersensitivity reaction. OBJECTIVE. The purpose of these case presentations is to describe a previously unreported complication of tattoo removal with two Q-switched lasers. RESULTS. Two patients without prior histories of skin disease experienced localized as well as widespread allergic reactions after treatment of their tattoos with two Q-switched lasers. CONCLUSION. The Q-switched ruby and neodymium:yttrium-aluminum-garnet lasers target intracellular tattoo pigment, causing rapid thermal expansion that fragments pigment-containing cells and causes the pigment to become extracellular. This extracellular pigment is then recognized by the immune system as foreign
— id: 12788, year: 1995, vol: 21, page: 291, 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,

The removal of cutaneous pigmented lesions with the Q-switched ruby laser and the Q-switched neodymium: yttrium-aluminum-garnet laser. A comparative study [see comments]
Tse Y; Levine VJ; McClain SA; Ashinoff R
1994 Dec;20(12):795-800, Journal of dermatologic surgery & oncology
BACKGROUND. The Q-switched ruby laser (QSRL) (694 nm) has been used successfully in the removal of tattoos and a variety of cutaneous pigmented lesions. The frequency-doubled Q-switched neodymium:yttrium-aluminum-garnet laser (QSNd:YAG) (1064 and 532 nm) has also been shown to be effective in the treatment of tattoos, however, little has been published regarding the QSNd:YAG laser in the removal of cutaneous pigmented lesions. OBJECTIVE. The purpose of this study is to compare the efficacy and side effect profile of the QSRL and the frequency-doubled QSNd:YAG lasers in the removal of cutaneous pigmented lesions, including lentigines, cafe-au-lait macules, nevus of Ota, nevus spilus, Becker's nevus, postinflammatory hyperpigmentation, and melasma. METHODS. Twenty patients with pigmented lesions were treated with the QSRL and the frequency-doubled QSNd:YAG lasers. Clinical lightening of the lesion was assessed 1 month after a single treatment. Side effects and patient satisfaction were also evaluated. RESULTS. A minimum of 30% lightening was achieved in all patients after only one treatment with either the QSRL or the frequency-doubled QSNd:YAG laser. The QSRL seems to provide a slightly better treatment response than the QSNd:YAG laser. Neither laser caused scarring or textural change of the skin. Most patients found the QSRL to be more painful during treatment, but the QSNd:YAG laser caused more postoperative discomfort. CONCLUSION. Both the QSRL and the frequency-doubled QSND:YAG laser are safe and effective methods of treatment of epidermal and dermal pigmented lesions
— id: 11477, year: 1994, vol: 20, page: 795, stat: Journal Article,

Localized vulvar pemphigoid in a child misdiagnosed as sexual abuse [see comments]
Levine V; Sanchez M; Nestor M
1992 Jun;128(6):804-806, Archives of dermatology
BACKGROUND--Various primary dermatoses can affect the vulva of children and be misdiagnosed as child abuse, with devastating social consequences. OBSERVATION--A 3-year-old girl with vulvar erosions was removed from her parent's care after a pediatrician and gynecologist diagnosed child abuse. Histopathologic and immunofluorescence studies were consistent with vulvar pemphigoid. CONCLUSION--Localized pemphigoid should be added to the differential diagnosis of vulvar lesions. Dermatologists, pediatricians, and gynecologists should be familiar with nonvenereal diseases that can exclusively affect this area. The dermatologist's expertise is particularly valuable in differentiating between primary diseases and sexual abuse
— id: 13570, year: 1992, vol: 128, page: 804, stat: Journal Article,