BLI Publications

Cover page of History of acne is associated with new-onset acne development in patients with alopecia areata treated with Janus kinase inhibitors

History of acne is associated with new-onset acne development in patients with alopecia areata treated with Janus kinase inhibitors

(2025)

Cover page of Advancing Bladder Health Diagnostics: The Potential of Optical Techniques for Noninvasive Assessment of Lower Urinary Tract Disorders

Advancing Bladder Health Diagnostics: The Potential of Optical Techniques for Noninvasive Assessment of Lower Urinary Tract Disorders

(2025)

Purpose: This review evaluates the clinical utility of emerging optical techniques—specifically, near-infrared spectroscopy (NIRS), optical coherence tomography (OCT), photoacoustic imaging (PAI), and fiber-optic sensors (FOSs)—as noninvasive, patient-friendly modalities for diagnosing lower urinary tract dysfunction. We assess their potential integration into wearable systems for personalized urological care and propose a novel clinical pathway for their use.Methods: We included published studies employing optical modalities to evaluate bladder function or pathology, focusing on diagnostic accuracy, feasibility, and patient-related outcomes. We also examined technical principles, diagnostic performance metrics (e.g., sensitivity, resolution, penetration), and clinical validation across optical modalities. A total of 40 articles met the final inclusion criteria.Results: NIRS demonstrates >85% sensitivity for detecting detrusor overactivity in small-scale trials, with wearable devices enabling continuous bladder monitoring. OCT has been found to improve the detection of carcinoma in situ by up to 22% compared to white-light cystoscopy, although its shallow penetration (~2 mm) limits evaluation of deeper layers. PAI visualizes microvascular structures to depths of several centimeters, suggesting strong potential for noninvasive bladder tumor diagnosis. FOSs offer continuous intravesical pressure monitoring with reduced discomfort, although semi-invasive placement remains a limitation.Conclusions: Noninvasive optical diagnostics offer a safer, more patient-friendly alternative to conventional cystoscopy and urodynamic studies. However, larger multicenter trials, cost-effectiveness analyses, and regulatory alignment are needed. Integrating these emerging modalities with telemedicine and artificial intelligence could transform bladder care into a continuous, home-based model.

Chemical Mapping of Nanoparticle-Ligand Interfaces in Optical Nanocavities.

(2025)

Understanding processes in photon-phonon scattering, absorption, and chemical reactions in optical nanocavities is important for single-molecule sensors, single-photon emitters, and photocatalysis. However, the influence of electromagnetic fields, charge transfer, and molecular geometry is challenging to probe by ensemble-averaged spectroscopic techniques over multiple nanocavities. Photoinduced force microscopy (PiFM), which measures photoinduced polarizability under infrared excitation of a sample in the nanocavity between the scanning probe microscopy tip and sample surface, is used here for simultaneous nanoscale topological and chemical characterization. First-principles density functional theory (DFT) simulations of the vibrational spectra of gold nanoparticle surfaces functionalized with benzenedithiol (Au-BDT) elucidate molecular orientation, charge transfer, and oxidation state for understanding molecular and adatom reconfiguration in optical nanocavities in response to external fields.

Consensus Statement on the Prevention and Management of Complications of Fully Ablative Laser Resurfacing of the Face

(2025)

Objectives

To achieve consensus among expert laser surgeons on standards for the prevention and management of adverse events from fully ablative laser resurfacing of the face.

Materials and methods

Delphi study with two rounds of ratings and revisions until consensus was achieved. The draft set of statements was developed by a steering committee based on expert clinical experience. This was followed by two rounds of rating and revisions completed by an expert panel, then a virtual consensus meeting. In both rounds, respondents rated the draft statements on a 9-point Likert scale (1 = strongly disagree; 9 = strongly agree) and optionally provided comments. The consensus meeting was supplemented by the results of a systematic review of the literature (from 2000 to 2023).

Results

Two rounds of Delphi survey were completed by 34 participants across four countries. Represented specialties were dermatology, facial plastic surgery, plastic surgery, and oculoplastic surgery. The initial 105 statements from round 1 expanded to 112 in round 2, with 96 statements achieving consensus. These included possible adverse events (11 statements); absolute and relative contraindications to treatment (5 statements); preoperative care and antimicrobial prophylaxis precautions (16 statements); intraoperative precautions (17 statements); postoperative care (21 statements); monitoring for and management of infection (16 statements); management of pigmentation changes (6 statements); and management of scarring and incipient scarring (4 statements).

Conclusion

An international consensus statement was developed for the prevention and management of complications associated with fully ablative laser resurfacing of the face. While expert practices vary, key factors for optimizing outcomes include careful patient selection, counseling, and meticulous pre- and postoperative care. Further research will improve our understanding of this treatment technique.

Efficacy and safety of etrasimod in alopecia areata: A multicentre, randomized, double‐blind, placebo‐controlled, Phase 2 study

(2025)

Background

Etrasimod, an oral, selective sphingosine 1-phosphate 1, 4 and 5 receptor modulator approved for the treatment of ulcerative colitis, has been studied in immune-mediated inflammatory diseases, including alopecia areata (AA).

Objectives

To evaluate the efficacy and safety of etrasimod in adults with moderate to severe AA.

Methods

This Phase 2, randomized, double-blind, placebo-controlled trial included patients (aged ≥18 years) with moderate to severe AA, defined as a Severity of Alopecia Tool (SALT) score of ≥25. Patients were sequentially enrolled into two cohorts. Cohort 1 included patients (SALT score of ≥50) randomized 2:1 to etrasimod 2 mg or placebo. Cohort 2 included patients (SALT score ≥25 to <95) randomized 4:1:2 to etrasimod 3 mg, 2 mg or placebo. Patients completed a 24-week double-blind and 28-week open-label extension period. The primary endpoint was percent change from baseline (%CFB) in SALT score at Week 24. Safety was monitored throughout the trial.

Results

Eighty patients were randomized to etrasimod 2 mg (n = 31), 3 mg (n = 25) or placebo (n = 24). At Week 24, least squares mean (SE) percent changes from baseline in SALT score for the etrasimod 2 mg, 3 mg and placebo groups were -13.8 (8.6), -21.4 (6.9) and 0.35 (8.9), respectively. The least squares mean difference (95% CI; P value) in SALT score %CFB of etrasimod 2 mg and 3 mg versus placebo was -14.1 (-38.9 to 10.6; p = 0.2579) and - 21.8 (-44.4 to 0.9; p = 0.0592), respectively; statistical superiority was not achieved. The proportions of patients achieving ≥30%, ≥50% or ≥75% improvement in baseline SALT score at Week 24 were generally numerically higher in etrasimod groups versus placebo. Treatment-emergent adverse events occurred in 67.7%, 80.0% and 78.3% of patients receiving etrasimod 2 mg, 3 mg and placebo, respectively, by Week 24.

Conclusions

Etrasimod did not meet the primary and secondary efficacy endpoints, but efficacy was numerically higher with etrasimod than with placebo. The etrasimod clinical programme for AA has been discontinued. Etrasimod was well tolerated, and its safety profile was consistent with other etrasimod studies to date.

Trial registration

ClinicalTrials.gov: NCT04556734.

Structured light imaging mesoscopy: detection of embedded morphological changes in superficial tissues

(2025)

Significance

Current paradigms for the optical characterization of layered tissues involve explicit consideration of an inverse problem which is often ill-posed and whose resolution may retain significant uncertainty. Here, we present an alternative approach, structured light imaging mesoscopy (SLIM), that leverages the inherent sensitivity of raw spatial frequency domain (SFD) reflectance measurements for the detection of embedded subsurface scattering changes in tissue.

Aim

We identify wavelength-spatial frequency ( λ-fx ) combinations that provide optimal sensitivity of SFD reflectance changes originating from scattering changes in an embedded tissue layer. We specifically consider the effects of scattering changes in the superficial dermis which is a key locus of pathology for diverse skin conditions such as cancer, aging, and scleroderma.

Approach

We used Monte Carlo simulations in a four-layer skin model to analyze the SFD reflectance changes resulting from changes in superficial dermal scattering across wavelength ( λ=471 to 851 nm) and spatial frequency ( fx=0 to 0.5/mm). Within this model, we consider different values for epidermal melanin concentration to simulate variations in skin tone.

Results

Monte Carlo simulations revealed that scattering changes within the superficial dermis produce SFD reflectance changes which are maximized at specific ( λ-fx ) pairs and vary with skin tone. For light skin tones, SFD reflectance changes due to scattering reductions in the superficial dermis are maximized at λ=621 nm and spatial frequency fx≈0.33/mm . By contrast, for darker skin tones, maximal SFD reflectance changes occur at wavelengths in the near-infrared ( λ≥811 nm ) at a spatial frequency of fx≈0.25/mm . Interestingly, the change in SFD reflectance produced by such scattering changes is most uniform across all skin tones when using the longest wavelength tested ( λ=851 nm ) and a spatial frequency of fx≈0.22/mm . Taken together, our computational model identifies specific ( λ-fx ) pairs to optimally detect embedded structural alterations in the superficial dermis.

Conclusions

The findings establish the SLIM methodology as a means to detect morphological changes in an embedded subsurface tissue layer by leveraging inherent sensitivities of spatial frequency domain reflectance. This approach promises to enable simplified clinical tracking of subsurface microstructural alterations without the explicit need to consider an inverse problem approach.

Repositioning the Posterior Septal Angle in Rhinoplasty: Methods and Outcomes

(2025)

Objective

Repositioning and fixation of the posterior septal angle (PSA) relative to the anterior nasal spine (ANS) is a well-known maneuver performed during rhinoplasty. Suture techniques through the periosteum along with transosseous drilling through the spine are the two most common fixation methods. We report on how nasal airway patency varies as a function of technique and patient demographic factors.

Methods

A retrospective analysis was performed on patients who underwent PSA repositioning and stabilization during rhinoplasty due to caudal septal deformities. Nasal Obstruction Symptom Evaluation (NOSE) scales were measured pre- and post-operation to evaluate functional outcomes.

Results

207 patients with either mobile or immobile PSA underwent ANS fixation secured with either a suture passed through the periosteum of the ANS or with the creation of a drill hole through the ANS. In all patients regardless of clinical or demographic groupings, postoperative NOSE scores were significantly decreased when compared to preoperative scores (p < 0.05). Preoperative NOSE score, fixation method, sex, functional versus cosmetic, age, follow-up period, and graft site did not independently affect the postoperative NOSE score. Though the differences between primary and revision outcomes were statistically significant, patients in both groups reported significant improvements in postoperative NOSE scores that deescalated their symptoms from "severe" to "mild."

Conclusion

Repositioning and fixation of the PSA improve patient outcomes. However, there is no significant difference between fixation methods on final NOSE scores. Septal fixation with consideration for patient anatomy allows for effective treatment.

Level of evidence

4 Laryngoscope, 135:1975-1982, 2025.

Nasal Obstruction Outcomes in Medial Flap Turbinoplasty and Inferior Turbinate Submucous Resection

(2025)

Objectives

To compare longitudinal improvement in nasal obstruction quality-of-life outcomes between medial flap turbinoplasty (MFT) and inferior turbinate submucous resection (SMR) concurrently performed with functional septorhinoplasty.

Methods

Retrospective review of a prospectively collected cohort of patients undergoing functional septorhinoplasty between 2015 and 2022 at a tertiary academic center. Outcomes were assessed using the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire preoperatively and over 12 months postoperatively.

Results

373 patients were analyzed with longitudinal NOSE questionnaires. Of these, 298 underwent SMR and 75 underwent MFT. The proportion of concurrent intraoperative techniques including rim graft, spreader graft, auto-spreader graft, intradomal sutures, interdomal sutures, and alar spanning sutures were not significantly different between the two cohorts. Patients in all surgical groups had a statistically and clinically significant improvement in NOSE scores between their preoperative and postoperative follow-up visits (p < 0.001). MFT patients had higher NOSE scores 1 month postoperatively (40.0 ± 30.5 vs. 31.0 ± 27.97; p = 0.017), but lower scores after 10 months (15.2 ± 13.3 vs. 25.4 ± 23.5; p = 0.036). Similarly, patients in the MFT cohort in primary rhinoplasty procedures reported higher scores initially but lower after 10 months (p = 0.024). Men in the MFT cohort reported significantly better NOSE outcomes than the SMR cohort as early as 4 months post-surgery and sustained this improvement longitudinally throughout the follow-up period (10.6 ± 12.3 vs. 22.6 ± 21.4; p = 0.012).

Conclusion

MFT and SMR offer beneficial long-term nasal breathing outcomes among patients undergoing functional rhinoplasty, though further study in appropriate patient selection is indicated.

Level of evidence

3 Laryngoscope, 135:1983-1988, 2025.

Adding to Your Tool Box: Laser Therapy for Vascular Anomalies

(2025)

Adjuvant laser therapy of vascular anomalies is based on the principle of selective photo-thermolysis, through targeted destruction of selected chromophores with minimal injury to surrounding tissue. Choice of laser wavelength, treatment parameters, and predicted response to therapy are dependent on the dominant chromophore within the vascular anomaly, lesional location, and target depth, with relatively superficial and mucosal lesions producing the best response to therapy. Lasers can be safely combined with multi-modal approaches for vascular anomalies, including sclerotherapy, surgical excision, and systemic therapy. In this manuscript, we review the laser literature on a range of vascular anomalies, and provide indications, appropriate therapeutic and warning endpoints in the skin, pearls/pitfalls, and multi-disciplinary approaches for pediatric dermatologists pursuing laser as adjuvant therapy for vascular anomalies.

Effect of Pulse Modulation on Diode-Pumped Laser Lithotripsy

(2025)

Introduction: This study addresses pulse modulation for kidney stone lithotripsy using diode-pumped thulium yttrium aluminum garnet (Tm:YAG, λ = 2.02 µm) and thulium fiber lasers (TFLs, λ = 1.94 µm). Three research questions were investigated: (1) What are the effects of varying pulse duration and energy of the first pulse and varying the interpulse delay in a pulse modulation sequence to increase energy transfer across saline to a stone? (2) Does an optimal pulse modulation profile exist in a single-pulse sequence to provide highest percent radiant energy transfer? (3) Does a higher effective energy transfer to the stone using pulse modulation produce greater stone volumetric removal? Materials and Methods: We measured radiant energy transmission efficiency (RETE) and ablation volumes in phantom and human stones. RETE was utilized to compare the pulse energy transmission through air and saline media. We recorded fast camera traces and vapor bubble collapse pressures. Craters were created at fiber standoff distances (SDs) of 0.0 mm, 0.5 mm, and 1.0 mm, and volumes were measured using optical coherence tomography. Results: For Tm:YAG laser irradiation, dual-pulse mode significantly increased RETE by as much as 75% at 1 mm SD compared with single-pulse mode. With the Tm:YAG laser, an optimal "dual-pulse" modulation resulted in greater volumetric removal compared with a "single-pulse" across all stone cohorts (p < 0.05) except for calcium oxalate monohydrate stones (p = 0.38) at a 1 mm SD. TFL yielded similar results, but showed heterogeneity across stone compositions. Conclusions: Pulse-modulated diode-pumped Tm:YAG and TFL can deliver higher photon count through a saline layer if the first pulse is optimized. An optimal pulse modulation profile where the second pulse is synchronized with the vapor bubble dynamics of the first pulse results in the highest percent RETE and increased stone volumetric removal.

Beckman Laser Institute & Medical Clinic