Zakia Rahman, MD FAAD

All Publications

• 1,550 nm Erbium-Doped and 1,927 nm Thulium Nonablative Fractional Laser System: Best Practices and Treatment Setting Recommendations. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.] Friedman, P. M., Dover, J. S., Chapas, A., Rahman, Z., Ross, E. V., Kilmer, S. L., Roberts, W. E., Sodha, P., Stimmel, J. B., Moncrief, M. B., Waibel, J. S. 1800

  Abstract

  BACKGROUND: The Fraxel Dual laser system (Solta Medical, Inc., Bothell, WA) contains a 1,550 and 1,927 nm wavelength single handpiece with different indications for each wavelength.OBJECTIVE: To discuss treatment setting recommendations and best practices for select on-label and investigational applications of the 1,550 and 1,927 nm dual laser system.MATERIALS AND METHODS: Eight board-certified dermatologists with 10 or more years of experience with the 1,550 and 1,927 nm laser system completed an online survey about their clinical experience with the system and then participated in a roundtable to share clinical perspectives and best practices for using the laser system.RESULTS: For all Fitzpatrick skin types, treatment recommendations were described for selected approved indications for the 1,550 and 1,927 nm laser system, including both lasers in combination. Treatment recommendations were also reached for investigational applications with the 1,550 nm laser and 1,927 nm laser. Best practices for using the lasers during the treatment session to achieve optimal outcomes and decrease the post-treatment recovery time were compiled.CONCLUSION: The 1,550 and 1,927 nm dual laser system is effective for a wide range of aesthetic and therapeutic applications, on and off the face and across all Fitzpatrick skin types.

  View details for DOI 10.1097/DSS.0000000000003321

  View details for PubMedID 35050945

• Optimizing Outcomes With the 1550/1927 nm Dual Wavelength Non-Ablative Fractional Laser: Experienced User Recommendations JOURNAL OF DRUGS IN DERMATOLOGY Friedman, P. M., Chapas, A., Kilmer, S. L., Rahman, Z., Roberts, W., Ross, E., Waibel, J. S., Dover, J. S. 2021; 20 (11): 1150-1157

  Abstract

  Fractional laser treatment was introduced in 2004 as a non-invasive technique to treat sun-damaged and aging skin. Since then, numerous ablative and non-ablative photothermolysis technologies and devices have been introduced, increasing the options for clinicians and patients but also increasing the complexity regarding which system to use and the techniques to optimize outcomes. No two devices are the same and the user-manuals preset dosimetry does not address many clinical situations, which can create confusion for new and inexperienced users.An online survey addressing use of a 1550 nm /1927 nm dual wavelength, non-ablative, fractional laser was sent to eight (8) US board certified dermatologists with extensive experience in the use of the device. The survey included 39 questions, addressing experience, best practices and recommendations for use.The survey data suggests that the device can be used to treat patients of all ages and skin types for indications including photoaging and photodamage, periorbital wrinkles, freckles, (ephelides), solar lentigines, poikiloderma, scarring due to acne or surgery. It can be used on both facial and non-facial areas, including neck, chest, hands, arms, abdomen, legs, and buttocks. Unexpected and adverse effects were rarely reported and those that did were mild and transient.This position paper provides practical real-world guidelines resulting from a small survey of experienced users, for new and early uses of the novel 1550 nm /1927 nm dual wavelength, non-ablative, fractional laser. J Drugs Dermatol. 2021;20(11):1150-1157. doi:10.36849/JDD.6181.

  View details for DOI 10.36849/JDD.6181

  View details for Web of Science ID 000721535300001

  View details for PubMedID 34784135

• Laser-Assisted Delivery of Topical Rapamycin: mTOR Inhibition for Birt-Hogg-Dube Syndrome DERMATOLOGIC SURGERY Kim, D., Wysong, A., Teng, J. M., Rahman, Z. 2019; 45 (12): 1713–15

  View details for DOI 10.1097/DSS.0000000000001778

  View details for Web of Science ID 000509692200046

• Laser-Assisted Delivery of Topical Rapamycin: mTOR Inhibition for Birt-Hogg-Dube Syndrome. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.] Kim, D., Wysong, A., Teng, J. M., Rahman, Z. 2019

  View details for PubMedID 30640787

• A Practical Approach to Chemical Peels: A Review of Fundamentals and Step-by-step Algorithmic Protocol for Treatment. The Journal of clinical and aesthetic dermatology Soleymani, T., Lanoue, J., Rahman, Z. 2018; 11 (8): 21–28

  Abstract

  Background: Chemoexfoliation, also known as chemical peeling, is a method of targeted cutaneous ablation using specific caustic agents that allow for rapid, predictable, and uniform thickness of chemoablation to a desired cutaneous depth, ultimately resulting in an improved appearance of skin. Objective: In this review, we provide an up-to-date analysis of all currently available chemical peels for dermatologic use, as well as a step-by-step instructional protocol for an algorithmic approach to treatment. Methods: A comprehensive search of the Cochrane Library, MEDLINE, and PUBMED databases was performed to identify relevant literature investigating chemical peeling agents. In addition, a search of all commercially available, prescription-based peeling agents was performed to identify all products currently available in the United States market. Results and Conclusion: Chemical peels are the third most commonly performed noninvasive cosmetic procedure in the United States, with over 1,300,000 procedures performed in 2016 alone. There has been a paradigm shift in recent years, with lasers largely supplanting deep peels. Despite this shift, superficial peels have proliferated in both popularity and product diversity. When used for the appropriate indication and with proper technique, nearly all peeling agents have demonstrated excellent clinical efficacy and remain an indispensable cost-effective tool in the dermatologist's aesthetic toolbox.

  View details for PubMedID 30214663

• REVIEW OF MAUDE DATABASE ON EFFICACY AND SAFETY OF CRYOLIPOLYSIS Kuo, K., Sheu, S., Rahman, Z. WILEY. 2017: 428

  View details for Web of Science ID 000399658600073

• Mitigation of epidermal growth factor receptor inhibitor-induced side effects utilizing melanin and vascular-specific lasers: A case report series. Journal of cosmetic and laser therapy Kuo, K. Y., Kwong, B., Rahman, Z. 2017: 1-3

  Abstract

  The advent of targeted chemotherapy has led to the emergence of new dermatologic toxicities. We sought to use lasers and light devices to treat recalcitrant cutaneous adverse effects related to cancer treatment. Three stage III or IV cancer patients with cutaneous complications due to epidermal growth factor receptor (EGFR) inhibitors were treated with melanin and vascular-specific laser and light technologies. Two patients reported reduction in papulopustular eruption following pulse dye laser (PDL) treatment. Two patients noted reduction in hair growth following intense pulsed light (IPL) and/or Alexandrite laser treatments. One patient was treated with both the PDL and IPL and reported improvement of both EGFR-induced hypertrichosis and papulopustular eruption. Laser and light devices targeting melanin and hemoglobin can be utilized to mitigate the cutaneous adverse effects associated with EGFR inhibitors in patients who have failed traditional therapies. This represents a new option for the cancer patient who is suffering from chemotherapy-induced side effects.

  View details for DOI 10.1080/14764172.2017.1299187

  View details for PubMedID 28463045

• SUCCESSFUL TREATMENT OF MELASMA USING A MODIFIED KLIGMAN FORMULA COMBINED WITH A LOW FLUENCE QS Nd:YAG LASER Enamandram, M., Sheu, S., Rahman, Z. WILEY. 2017: 30

  View details for Web of Science ID 000398604500084

• VIDEODERMOSCOPY AS A NOVEL TOOL FOR THE VISUALIZATION OF LASER THERAPEUTIC ENDPOINTS Sheu, S., Enamandram, M., Rahman, Z. WILEY. 2017: 35

  View details for Web of Science ID 000398604500098

• Treatment of Surgical Scars with Laser Therapy CURRENT DERMATOLOGY REPORTS Geraghty, L., Rahman, Z. 2016; 5 (3): 143–49

  View details for DOI 10.1007/s13671-016-0152-7

  View details for Web of Science ID 000386358300001

• COMBINATION LONG PULSED 1064 Nd:YAG LASER AND BROAD BAND LIGHT MAXIMIZES OUTCOMES IN ROSACEA TREATMENT Rahman, Z., Enamandram, M. WILEY-BLACKWELL. 2016: 36–37

  View details for Web of Science ID 000373105000105

• MITIGATION OF EPIDERMAL GROWTH FACTOR INHIBITOR INDUCED SIDE EFFECTS UTILIZING MELANIN AND VASCULAR SPECIFIC LASERS Kuo, K., Kwong, B., Rahman, Z. WILEY-BLACKWELL. 2016: 29–30

  View details for Web of Science ID 000373105000085

• Long-term Efficacy of Topical Fluorouracil Cream, 5%, for Treating Actinic Keratosis A Randomized Clinical Trial JAMA DERMATOLOGY Pomerantz, H., Hogan, D., Eilers, D., Swetter, S. M., Chen, S. C., Jacob, S. E., Warshaw, E. M., Stricklin, G., Dellavalle, R. P., Sidhu-Malik, N., Konnikov, N., Werth, V. P., Keri, J., Lew, R., Weinstock, M. A. 2015; 151 (9): 952-960

  Abstract

  Topical fluorouracil was demonstrated to be effective in reducing the number of actinic keratoses (AKs) for up to 6 months, but no randomized trials studied its long-term efficacy.To evaluate the long-term efficacy of a single course of fluorouracil cream, 5%, for AK treatment.The Veterans Affairs Keratinocyte Carcinoma Chemoprevention (VAKCC) trial was a randomized, double-blinded, placebo-controlled trial with patients from dermatology clinics at 12 VA medical centers recruited from 2009 to 2011 and followed up until 2013. Our study population comprised 932 veterans with 2 or more keratinocyte carcinomas in the 5 years prior to enrollment. The mean follow-up duration was 2.6 years in both treatment and control groups.Participants applied either topical fluorouracil cream, 5% (n = 468), or vehicle control cream (n = 464) to the face and ears twice daily for up to 4 weeks.This study reports on AK counts and treatments, which were secondary outcomes of the VAKCC trial. Actinic keratoses on the face and ears were counted by study dermatologists at enrollment and at study visits every 6 months. The number of spot treatments for AKs on the face and ears at semiannual study visits and in between study visits was recorded.The number of AKs on the face and ears per participant was not different between the fluorouracil and control groups at randomization (11.1 vs 10.6, P > .10). After randomization, the fluorouracil group had fewer AKs compared with the control group at 6 months (3.0 vs 8.1, P < .001) and for the overall study duration (P < .001). The fluorouracil group also had higher complete AK clearance rates (38% vs 17% at 6 months) and fewer spot treatments at 6-month intervals, at study visits, and in between study visits during the trial (P < .01 for all). The fluorouracil group took longer to require the first spot AK treatment (6.2 months) compared with the control group (6.0 months) (hazard ratio, 0.69; 95% CI, 0.60-0.79). The number of hypertrophic AKs was not different between the 2 groups overall (P = .60), although there were fewer hypertrophic AKs in the fluorouracil group at 6 months (0.23 vs 0.41) (P = .05).Our results indicate that a single course of fluorouracil cream, 5%, effectively reduces AK counts and the need for spot treatments for longer than 2 years.clinicaltrials.gov Identifier:NCT00847912.

  View details for DOI 10.1001/jamadermatol.2015.0502

  View details for PubMedID 25950503

• Rationalizing Outcome Measures in Dermatologic Surgery CURRENT DERMATOLOGY REPORTS Alam, M., Maher, I. A., Sobanko, J. F., Yoo, S. S., Avram, M. M., Gladstone, H. B., Metelitsa, A., Northington, M. E., Rahman, Z., Shin, T. M., Cartee, T. V., IMPROVED Working Grp 2015; 4 (3): 140–46

  View details for DOI 10.1007/s13671-015-0106-5

  View details for Web of Science ID 000218767100007

• FIRST REPORT OF ERBIUM LASER AS THE PREFERRED TREATMENT IN A COMPARISON OF FIVE MODALITIES FOR STEATOCYSTOMA MULTIPLEX Crispin, M., Ally, M., Hollmig, T., Aasi, S., Rahman, Z. WILEY-BLACKWELL. 2015: 51

  View details for Web of Science ID 000352099900152

• EVALUATION OF A COMPACT HOME-USE 1440nm NON-ABLATIVE FRACTIONAL LASER TO TREAT PERIORBITAL WRINKLES Rahman, Z., Dhawan, S., Starr, J., Ostrowski, R. WILEY-BLACKWELL. 2015: 23

  View details for Web of Science ID 000352099900066

• Lack of efficacy with 1064-nm neodymium:yttrium-aluminum-garnet laser for the treatment of onychomycosis: A randomized, controlled trial. Journal of the American Academy of Dermatology Hollmig, S. T., Rahman, Z., Henderson, M. T., Rotatori, R. M., Gladstone, H., Tang, J. Y. 2014; 70 (5): 911-917

  Abstract

  Laser therapies have been Food and Drug Administration approved for temporary nail plate clearance; however, there is minimal evidence of their long-term efficacy.We sought to evaluate the clinical and mycological clearance of toenails treated with 1064-nm neodymium:yttrium-aluminum-garnet laser versus no treatment.This was a randomized, controlled, single-center trial comparing 2 treatments with 1064-nm neodymium:yttrium-aluminum-garnet laser (fluence of 5 J/cm(2), rate of 6 Hz) spaced 2 weeks apart versus no treatment in 27 patients (N = 125 affected nails) with clinical and mycological diagnosis of onychomycosis. At 3 months, patients were assessed with mycological cultures and proximal nail plate measurements. Patients treated with laser were also assessed with proximal nail plate measurements at 12 months.At 3 months, 33% of patients treated with laser achieved a negative mycological culture compared with 20% of the control group (P = .49), and had more proximal nail plate clearance compared with control subjects (0.44 vs 0.15 mm, P = .18), which was not statistically significant. At 12 months, there was no difference in nail plate clearance between laser versus control subjects (0.24 vs 0.15 mm, P = .59).Our study was limited by the small sample size and number of treatments.There was no significant mycological culture or clinical nail plate clearance with 1064-nm neodymium:yttrium-aluminum-garnet laser compared with control.

  View details for DOI 10.1016/j.jaad.2013.12.024

  View details for PubMedID 24641985

• Treatment of Poikiloderma with Fractional Resurfacing BODY REJUVENATION Rahman, Z., Alam, M., Pongprutthipan, M. 2010: 31–37

  View details for DOI 10.1007/978-1-4419-1093-6_5

  View details for Web of Science ID 000276367600005

• In vivo confocal imaging of epidermal cell migration and dermal changes post nonablative fractional resurfacing: study of the wound healing process with corroborated histopathologic evidence JOURNAL OF BIOMEDICAL OPTICS Stumpp, O. F., Bedi, V. P., Wyatt, D., Lac, D., Rahman, Z. 2009; 14 (2)

  Abstract

  In vivo wound healing response post nonablative fractional laser treatment is evaluated. Seven healthy subjects receive treatments with a Fraxel re:store laser system on the forearm with pulse energies ranging from 10 to 70 mJ. The treatment sites are imaged at 1-h increments up to 40 h using confocal microscope z-stacks using 10-mum-depth spacing. At least five individual microscopic treatment zones are imaged per subject, time point, and treatment energy. Images are analyzed for tissue structure and morphology to classify each lesion as healed or not healed, depending on epidermal re-epithelialization at each time point and treatment energy. Probit analysis is used to statistically determine the ED(50) and ED(84) probabilities for a positive dose response (healed lesion) as a function of treatment energy. Confocal observations reveal epidermal keratinocyte migration patterns confirmed with histological analysis using hematoxylin and eosin (HE) and lactate dehydrogenase (LDH) staining at 10 mJ at 0, 7, 16, and 24-h post-treatment. Results indicate that more time is required to conclude re-epithelialization with larger lesion sizes (all less than 500 mum) corresponding to higher treatment energies. For the entire pulse energy range tested, epidermal re-epithelialization concludes between 10 to 22-h post-treatment for ED(50) and 13 to 28 h for ED(84).

  View details for DOI 10.1117/1.3103316

  View details for Web of Science ID 000266868500042

  View details for PubMedID 19405748

• Fractional Deep Dermal Ablation Induces Tissue Tightening LASERS IN SURGERY AND MEDICINE Rahman, Z., MacFalls, H., Jiang, K., Chan, K. F., Kelly, K., Tournas, J., Stumpp, O. F., Bedi, V., Zachary, C. 2009; 41 (2): 78-86

  Abstract

  Due to the significant risk profile associated with traditional ablative resurfacing, a safer and less invasive treatment approach known as fractional deep dermal ablation (FDDA) was recently developed. We report the results of the first clinical investigation of this modality for treatment of photodamaged skin.Twenty-four subjects received treatments on the inner forearm with a prototype fractional CO(2) laser device (Reliant Technologies Inc., Mountain View, CA) at settings of 5-40 mJ/MTZ and 400 MTZ/cm(2). Clinical and histological effects were assessed by study investigators 1 week, 1 month, and 3 months following treatment. Thirty subjects were then enrolled in a multi-center study for treatment of photodamage using the same device. Subjects received 1-2 treatments on the face and neck, with energies ranging from 10 to 40 mJ/MTZ and densities ranging from 400 to 1,200 MTZ/cm(2). Study investigators assessed severity of post-treatment responses during follow-up visits 48 hours, 1 week, 1 month, and 3 months following treatment. Using a standard quartile improvement scale (0-4), subjects and investigators assessed improvement in rhytides, pigmentation, texture, laxity and overall appearance 1 and 3 months post-treatment.Clinical and histologic results demonstrated that fractional delivery of a 10,600 nm CO(2) laser source offers an improved safety profile with respect to traditional ablative resurfacing, while still effectively resurfacing epidermal and dermal tissue. Forearm and facial treatments were well-tolerated with no serious adverse events observed. Eighty-three percent of subjects exhibited moderate or better overall improvement (50-100%), according to study investigator quartile scoring.FDDA treatment is a safe and promising new approach for resurfacing of epidermal and deep dermal tissue targets.

  View details for DOI 10.1002/lsm.20715

  View details for PubMedID 19226572

• Fractional resurfacing for the treatment of hypopigmented scars: A pilot study DERMATOLOGIC SURGERY Glaich, A. S., Rahman, Z., Goldberg, L. H., Friedman, P. M. 2007; 33 (3): 289-293

  Abstract

  Treatments for hypopigmented scars have shown limited efficacy and variable safety profiles. OBJECTIVE This study evaluated the safety and efficacy of fractional resurfacing (1,550-nm Fraxel SR laser, Reliant Technologies, Mountain View, CA) for the treatment of hypopigmented scars on the face in seven patients.Seven patients with hypopigmented scars on the face received between two and four successive treatments at 4-week intervals with the 1,550-nm Fraxel SR laser. Energy settings ranged from 7 to 20 mJ and a total density of 1,000 to 2,500 microthermal zones per square centimeter. Digital photographs were taken before each treatment and at 4 weeks after the last treatment. Independent physician clinical assessments were performed.Independent physician clinical assessment 4 weeks after the final Fraxel SR laser treatment revealed improvements of 51% to 75% in hypopigmentation in six of seven patients. One patient had only 26% to 50% improvement in hypopigmentation. Additionally, clinical improvements were noted in the overall texture of the treated skin. The patient's degree of satisfaction paralleled the physician's assessment of improvement. All patients reported improvement in hypopigmentation lasting greater than 3 months after the last treatment. Side effects were limited to mild pain during the treatment and mild posttreatment erythema and edema, which resolved in 2 to 4 days.Fractional resurfacing is a potentially effective modality for the treatment of hypopigmented scarring on the face. No adverse effects were observed.

  View details for DOI 10.1111/j.1524-4725.2007.33058.x

  View details for Web of Science ID 000244518000008

  View details for PubMedID 17338685

• In vivo histological evaluation of a novel ablative fractional resurfacing device LASERS IN SURGERY AND MEDICINE Hantash, B. M., Bedi, V. P., Kapadia, B., Rahman, Z., Jiang, K., Tanner, H., Chan, K. F., Zachary, C. B. 2007; 39 (2): 96-107

  Abstract

  A novel carbon dioxide (CO(2)) laser device employing ablative fractional resurfacing was tested on human skin in vivo for the first time.An investigational 30 W, 10.6 microm CO(2) laser system was focused to a 1/e(2) spot size of 120 microm to generate an array of microscopic treatment zones (MTZ) in human forearm skin. A range of pulse energies between 5 and 40 mJ was tested and lesion dimensions were assessed histologically using hematoxylin and eosin. Wound healing of the MTZ's was assessed immediately-, 2-day, 7-day, 1-month, and 3-month post treatment. The role of heat shock proteins was examined by immunohistochemistry.The investigational CO(2) laser system created a microscopic pattern of ablative and thermal injury in human skin. The epidermis and part of the dermis demonstrated columns of thermal coagulation that surrounded tapering ablative zones lined by a thin eschar layer. Changing the pulse energy from 5 to 30 mJ resulted in a greater than threefold increase in lesion depth and twofold increase in width. Expression of heat shock protein (hsp)72 was detected as early as 2 days post-treatment and diminished significantly by 3 months. In contrast, increased expression of hsp47 was first detected at 7 days and persisted at 3 months post-treatment.The thermal effects of a novel investigational ablative CO(2) laser system utilizing fractional resurfacing were characterized in human forearm skin. We confirmed our previous ex vivo findings and show for the first time in-vivo, that a controlled array of microscopic treatment zones of ablation and coagulation could be deposited in human skin by varying treatment pulse energy. Immunohistochemical studies of heat shock proteins revealed a persistent collagen remodeling response lasting at least 3 months. We successfully demonstrated the first in-vivo use of ablative fractional resurfacing (AFR) treatment on human skin.

  View details for DOI 10.1002/lsm.20468

  View details for Web of Science ID 000244609500003

  View details for PubMedID 17311274

• The effects of pulse energy variations on the dimensions of microscopic thermal treatment zones in nonablative fractional resurfacing LASERS IN SURGERY AND MEDICINE Bedi, V. P., Chan, K. F., Sink, R. K., Hantash, B. M., Herron, G. S., Rahman, Z., Struck, S. K., Zachary, C. B. 2007; 39 (2): 145-155

  Abstract

  We examined the effects of pulse energy variations on the dimensions of microscopic thermal injury zones (MTZs) created on human skin ex vivo and in vivo using nonablative fractional resurfacing.A Fraxel SR laser system emitting at 1,550 nm provided an array of microscopic spots at variable densities. Pulse energies ranging from 4.5 to 40 mJ were tested on human abdominal skin ex vivo and in vivo. Tissue sections were stained with hematoxylin and eosin (H&E) or nitro blue tetrazolium chloride (NBTC) and MTZ dimensions were determined. Ex vivo and in vivo results were compared. Dosimetry analyses were made for the surface treatment coverage calculation as a function of pulse energy and collagen coagulation based on H&E stain or cell necrotic zone based on NBTC stain.Each MTZ was identified by histological detection of a distinct region of loss of tissue birefringence and hyalinization, representing collagen denaturation and cell necrosis within the irradiated field immediately, 1, 3, and 7 days after treatment. At high pulse energies, the MTZ depth could exceed 1 mm and width approached 200 microm as assessed by H&E. NBTC staining revealed viable interlesional tissue. In general, no statistically significant difference was found between in vivo and ex vivo depth and width measurements.The Fraxel SR laser system delivers pulses across a wide range of density and energy levels. We determined that increases in pulse energy led to increases in MTZ depth and width without compromising the structure or viability of interlesional tissue.

  View details for DOI 10.1002/lsm.20406

  View details for Web of Science ID 000244609500009

  View details for PubMedID 17096412

• Fractional Laser treatment for pigmentation and texture improvement. Skin therapy letter Rahman, Z., Alam, M., Dover, J. S. 2006; 11 (9): 7-11

  Abstract

  Fractional laser treatment with the 1,550 nm erbium fiber laser (Fraxel Laser, Reliant Technologies) has bridged the gap between the ablative and nonablative laser modalities used to treat the epidermal and dermal signs of skin aging. By targeting water as its chromophore, the laser induces a dense array of microscopic, columnar thermal zones of tissue injury that do not perforate or impair the function of the epidermis. The significant skin remodeling that ensues can be used to treat, with limited downtime, epidermal pigmentation, melasma, and rhytides, as well as textural abnormalities that include acne-related and surgical scars.

  View details for PubMedID 17075654