Lasers Surg Med 2018 Mar 25. Epub 2018 Mar 25.

DermaLase Training Services, 120 Queens Drive, Glasgow, G42, United Kingdom.

Introduction: Dark material has been observed embedded within glass slides following Q-switched Nd:YAG laser treatment of tattoos. It appears that these fragments are ejected at high speed from the skin during the treatment.

Method: Light microscopic analysis of the slides reveals aggregates of dark fragmented material, presumably tattoo ink, with evidence of fractured/melted glass. Read More

J Dtsch Dermatol Ges 2018 Apr 9;16(4):468-470. Epub 2018 Mar 9.

Laserklinik Karlsruhe, Karlsruhe, Germany.

J Cosmet Laser Ther 2018 Feb 28:1-4. Epub 2018 Feb 28.

a Department of Cosmetic Laser Surgery , Hospital of Dermatology, Chinese Academy of Medical Sciences, Peking Union Medical College , Nanjing , China.

Objective: To retrospectively evaluate the efficacy of an Alexandrite picosecond laser versus Nd:YAG nanosecond laser for removing blue-black eyeliner tattoos which have existed more than 10 years.

Methods: A total of 40 patients were treated with an Alexandrite picosecond laser in our department from August 2015 to July 2017, with a fluence of 1.96-6. Read More

Laser Ther 2017 Dec;26(4):274-281

Kasai Clinic for Plastic Surgery.

Background And Aims: The selective removal of tattoos and benign cutaneous pigmented lesions with laser energy evolved rapidly with the development of the nanosecond-domain Q-switched laser (ns-laser). Recently, however, a series of picosecond-domain lasers (ps-lasers) with pulsewidths less than 1 ns has become commercially available, enabling more efficient and faster removal of pigmented lesions in the field of dermatologic laser surgery.

Rationale Behind The Ps-laser: The efficacy of the ns-laser depended on the theory of selective photothermolysis, whereby an extremely short pulse width was delivered less than the thermal relaxation time (TRT) of a target. Read More

Lasers Med Sci 2018 Feb 9. Epub 2018 Feb 9.

Dermatology Department, Laser Unit, Hospital Universitario Ramón y Cajal, Ctra Colmenar Viejo Km 9,100, 28034, Madrid, Spain.

The novel picosecond lasers, initially developed for faster tattoo removal, have also shown great efficacy in endogenous pigmentary disorders. To describe the efficacy and safety profile of an alexandrite (755-nm) picosecond laser in a wide range of pigmented flat and elevated cutaneous lesions. A retrospective study was performed in which we collected all the clinical images of patients treated with the 755-nm alexandrite picosecond laser for 12 months (November 2016-November 2017). Read More

Ann Dermatol 2017 Dec 30;29(6):779-781. Epub 2017 Oct 30.

Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

The picosecond lasers have shown to effectively treat tattoo pigments that are intractable to previous multiple Q-switched (QS) laser treatments. Therefore we hypothesized that a picosecond laser would show better efficacy with minimal adverse events in the treatment of melasma and post-inflammatory hyperpigmentation (PIH) that are difficult to treat with conventional QS lasers. Two patients with melasma and one patient with PIH were treated with a Picosecond 755-nm Alexandrite Laser (Cyanosure, USA). Read More

J Cosmet Laser Ther 2018 Apr 4;20(2):71-76. Epub 2017 Dec 4.

c Department of Pharmacal Research , Hospital of Dermatology, Chinese Academy of Medical Sciences, Peking Union Medical College , Nanjing , China.

Background And Objective: Q-switched (QS) lasers are the gold standard for tattoo removal. The purpose of the present study was to gain a more comprehensive understanding of the factors that influence the efficacy of QS lasers and their associated complications in the removal of tattoos in China.

Patients And Methods: Clinical data of 266 patients were analyzed retrospectively. Read More

Biomed Opt Express 2017 Aug 20;8(8):3735-3748. Epub 2017 Jul 20.

Division of Integrative Biosciences and Biotechnology, Pohang University of Science and Technology, San 31, Hyoja-dong, Nam-gu, Pohang, Gyeongbuk 790-784, South Korea.

Laser tattoo removal is an effective method of eliminating tattoo particles in the skin. However, laser treatment cannot always remove the unwanted tattoo completely, and there are risks of either temporary or permanent side effects. Studies using preclinical animal models could provide detailed information on the effects of laser treatment in the skin, and might help to minimize side effects in clinical practices. Read More

Laser Ther 2017 Jun;26(2):137-144

Department of Dermatology, Keio University School of Medicine.

Background And Aim: Minocycline therapy for acne vulgaris is associated with the occasional induction of various types of unsightly and often persistent hyperpigmentation, which is frequently resistant to hydroquinone treatment. Pigment-specific lasers have achieved some success with multiple treatment sessions. Recently, the picosecond domain 755 nm alexandrite laser (ps-Alex) has attracted attention in tattoo removal. Read More

J Eur Acad Dermatol Venereol 2018 Feb 21;32(2):265-270. Epub 2017 Aug 21.

Department of Dermatology, Université Côte d'Azur, Centre Hospitalier Universitaire Nice, Nice, France.

Background: Q-switched nanosecond lasers demonstrated their efficacy in treating most types of tattoos, but complete disappearance is not always achieved even after performing numerous laser sessions. Picosecond lasers are supposed to be more efficient in clearing tattoos than nanosecond lasers, but prospective comparative data remain limited.

Objective: To compare on different types of tattoos the efficacy of a nanosecond laser with two types of picosecond lasers. Read More

Clin Cosmet Investig Dermatol 2017 25;10:205-210. Epub 2017 May 25.

Inflammation Biology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane.

An increasing number of people are getting tattoos; however, many regret the decision and seek their removal. Lasers are currently the most commonly used method for tattoo removal; however, treatment can be lengthy, costly, and sometimes ineffective, especially for certain colors. Ingenol mebutate is a licensed topical treatment for actinic keratoses. Read More

Lasers Med Sci 2017 May 17. Epub 2017 May 17.

Servicio de Dermatología, Hospital Ramón y Cajal, Madrid, Spain.

Sci Rep 2017 May 8;7(1):1533. Epub 2017 May 8.

Department of Dermatology and Cutaneous Biology Research Center, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea.

During laser treatment for tattoo removal, pigment chromophores absorb laser energy, resulting in fragmentation of the ink particles via selective photothermolysis. The present study aimed to outline macroscopic laser-tattoo interactions in tissue-mimicking (TM) phantoms treated with picosecond- and nanosecond-domain lasers. Additionally, high-speed cinematographs were captured to visualize time-dependent tattoo-tissue interactions, from laser irradiation to the formation of photothermal and photoacoustic injury zones (PIZs). Read More

J Cosmet Laser Ther 2017 Oct 10;19(5):259-265. Epub 2017 Apr 10.

a Department of Dermatology , Venereology and Leprosy, Dr Ram Manohar Lohia Hospital , New Delhi , India.

Background: Q-switched lasers are conventionally used for the treatment of black tattoo. However, they require multiple sittings, and the response may be slow due to competing epidermal pigment in dark skin.

Objective: To compare the efficacy of Q-switched Nd:YAG laser alone with its combination with ultrapulse CO for the removal of black tattoo. Read More

J Clin Aesthet Dermatol 2017 Mar 1;10(3):14-15. Epub 2017 Mar 1.

Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, New York.

Lasers Surg Med 2017 Apr 20;49(4):335-340. Epub 2017 Mar 20.

The Practice of Brian S. Biesman, M.D., Nashville, Tennessee.

Background And Objective: Laser-assisted treatment of tattoos is well recognized to produce opaque epidermal whitening that prevents multiple sequential passes during a single treatment session. The amount of epidermal whitening produced in association with the procedure can be minimized by topical application of perfluorodecalin (PFD), which is an optical clearing agent. This pivotal trial assessed the ability of a transparent PFD-infused patch used in conjunction with a Q-switched nanosecond laser in the treatment of tattoos to permit multiple laser passes during a single 5 minute treatment session in comparison to the number of passes that could be completed using conventional treatment of the tattoo with the laser alone. Read More

Curr Probl Dermatol 2017 13;52:82-93. Epub 2017 Mar 13.

With a continuing increase in the number of tattoos performed worldwide, the need to treat tattoo complications is growing. Earlier treatments of chronic inflammatory tattoo reactions were dominated by a medical approach, or with no active intervention. In this chapter, we will address modern surgical approaches applied to situations when medical treatment is inefficient and lasers are not applicable. Read More

Curr Probl Dermatol 2017 10;52:139-229. Epub 2017 Mar 10.

The 'Tattoo Clinic', Department of Dermatology, Bispebjerg University Hospital, Copenhagen, Denmark.

Tattoos, and tattoo complications as well, are colorful and visually flashy. A clinical outlook provides important clues to diagnosis by pattern recognition. This atlas,which is a report of 79 case illustrations, is made as a practical tool and vade mecum for the clinician. Read More

Curr Probl Dermatol 2017 10;52:132-138. Epub 2017 Mar 10.

Clinicians in the fields of general medicine, dermatology, and plastic surgery are in their work now and then confronted with tattoo complications. Recognizing the rather few important diagnostic groups and urgencies, the medical 'decision tree' of treatment becomes quite simple. Acute conditions are dominated by bacterial infections needing antibiotic treatment. Read More

Curr Probl Dermatol 2017 10;52:113-123. Epub 2017 Mar 10.

Early methods of tattoo removal ultimately resulted in unacceptable cosmetic outcomes. While the introduction of laser technology was an improvement over the existing chemical, mechanical, and surgical procedures, the use of nonselective tattoo removal with carbon dioxide and argon lasers led to scarring. Q-switched lasers with nanosecond (10-9) pulse domains were considered to have revolutionized tattoo treatment, by selectively heating the tattoo particles, while reducing the adverse sequelae to adjacent normal skin. Read More

Curr Probl Dermatol 2017 10;52:74-81. Epub 2017 Mar 10.

The 'Tattoo Clinic', Department of Dermatology, Bispebjerg University Hospital, Copenhagen, Denmark.

Tattooing is a skin trauma and involves a special vulnus punctatum (with inserted tattoo ink, a vulnus venenatum), which should heal with no infection and no local complication. Local treatment in the healing phase ideally builds on the 'moist wound' principle using plastic film, hydrocolloids, silver dressing, and compression. Bacterial infections during healing are treated with oral antibiotics, and a list of first-line antibiotics is proposed. Read More

Curr Probl Dermatol 2017 10;52:124-131. Epub 2017 Mar 10.

Studies of satisfaction with tattoo removal outcomes by laser, rated by clients themselves, including qualitative aspects, are sparse. We studied long-term results and client satisfaction with tattoo removal by Q-switched YAG laser. Client satisfaction is influenced by numerous factors: pretreatment expectations, objective observations, pretreatment information, laser treatment procedures, and outcome, including subjective experiences such as pain. Read More

Curr Probl Dermatol 2017 10;52:105-112. Epub 2017 Mar 10.

Department of Dermatology, Klinikum Darmstadt, Darmstadt, and Department of Dermatology, University Hospital Greifswald, Greifswald, Germany.

Tattoo removal by Q-switched nanosecond laser devices is generally a safe and effective method, albeit a time-consuming one. Despite the newest developments in laser treatment, it is still not possible to remove every tattoo completely and without complications. Incomplete removal remains one of the most common challenges. Read More

J Eur Acad Dermatol Venereol 2017 Jul 8;31(7):1096-1110. Epub 2017 Feb 8.

Department of Dermatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.

Pain is a common side-effect of dermatological laser procedures. Non-invasive anaesthetic drugs and anaesthetic procedures can be used to provide pain relief and increase patient satisfaction and treatment efficacy. However, it remains unclear which method provides the best pain relief. Read More

J Eur Acad Dermatol Venereol 2017 May 21;31(5):904-909. Epub 2017 Feb 21.

Department of Dermatology, The "Tattoo Clinic", Bispebjerg University Hospital, Copenhagen, Denmark.

Background: Tattoo removal by Q-switched yttrium aluminium garnet (YAG) lasers is golden standard; however, clients' satisfaction with treatment is little known.

Objective: To determine clients' satisfaction with tattoo removal.

Methods: One hundred and fifty-four tattoo removal clients who had attended the private clinic 'Centre for Laser Surgery', Hellerup, Denmark, from 2001 to 2013 completed a questionnaire concerning outcome expectations, level of pain experiences and satisfaction with tattoo removal. Read More

J Drugs Dermatol 2016 Nov;15(11):1448-1452

Introduction: Q-switched neodymium:YAG (Nd:YAG) lasers are reported to be gold standard for laser tattoo removal. In particular, the Q-switched Nd:YAG laser at 1064 nm is widely recognized for the removal of blue/black amateur tattoos. However, treatment modalities in Fitzpatrick Type VI skin carry a greater risk of complications including alterations in pigmentation compared to fairer skin (Fitzpatrick Type I-IV skin). Read More

Lasers Med Sci 2017 02;32(2):483

Department of Dermatology, Rabin Medical Center, Beilinson Campus, 39 Jabotinski St., Petach Tikva, Israel, 49100.

Skin Res Technol 2017 Aug 20;23(3):376-383. Epub 2016 Nov 20.

Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea.

Background: Laser therapy is the treatment of choice in tattoo removal. However, the precise mechanisms of laser-tattoo pigment interactions remain to be evaluated.

Methods: We evaluated the geometric patterns of laser-tattoo pigment particle interactions using a tattoo pigment-embedded tissue-mimicking (TM) phantom. Read More

Am J Clin Dermatol 2017 Feb;18(1):59-65

Washington Institute of Dermatologic Laser Surgery, 1430 K Street NW Suite 200, Washington, DC, 20005, USA.

Tattoo art has been around for thousands of years in every culture and is currently flourishing in all age groups, social classes, and occupations. Despite the rising popularity of tattoos, demand for their removal has also increased. While various treatments, including surgical excision, dermabrasion, and chemical destruction have historically been applied, over the past 2 decades, lasers have revolutionized the way tattoos are treated and have become the gold standard of treatment. Read More

Lasers Surg Med 2017 Jan 29;49(1):40-44. Epub 2016 Sep 29.

MD Laser Skin and Vein Institute, Baltimore, Maryland.

Introduction: Picosecond lasers have been reported to be effective for removal of tattoo pigment. This prospective study evaluated the efficacy and safety of the treatment of peri-oral and -ocular wrinkles using a novel diffractive lens array coupled with a picosecond 755 nm alexandrite laser.

Methods: Forty female subjects presenting with wrinkles from photodamage were enrolled in an IRB approved study. Read More

J Cosmet Laser Ther 2016 Dec 13;18(8):456-458. Epub 2016 Oct 13.

a Netherlands Institute for Pigment Disorders (SNIP), Department of Dermatology , Academic Medical Centre, University of Amsterdam , Amsterdam , the Netherlands.

Allergic tattoo reactions form a therapeutically difficult entity. Treatment with conventional quality-switched lasers does not completely remove the allergenic particles and may lead to generalized hypersensitivity reactions. Recently, ablative fractional laser therapy was introduced as a treatment for allergic tattoo removal. Read More

Br J Dermatol 2017 Feb 29;176(2):457-464. Epub 2017 Jan 29.

Laserklinik Karlsruhe und Medizinisches Versorgungszentrum, Karlsruhe, Germany.

Background: For decades, nanosecond lasers (NSLs) have been used to remove tattoos. Since 2012, pulses of picosecond lasers (PSLs) have been available for tattoo removal. Based on a few observational studies, the claim has been made that PSLs are considerably more effective while showing fewer side-effects in comparison with NSLs. Read More

Lasers Med Sci 2016 Sep 17;31(7):1397-405. Epub 2016 Jun 17.

Department of Dermatology, Rabin Medical Center, Beilinson Campus, 39 Jabotinski St., Petach Tikva, Israel, 49100.

Given that the pigment particles in tattoos have a relaxation time of <10 ns, picosecond lasers would be expected to be more effective than nanosecond lasers in tattoo removal. To systematically review the evidence regarding the effectiveness and safety of picosecond lasers for tattoo removal, Pubmed, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, and reference lists were searched for relevant trials. Read More

Dermatol Surg 2016 Sep;42(9):1121-3

Friedman Skin & Laser Center, Jerusalem, Israel, Department of Dermatology, Brown University, Providence, Rhode Island.

Med Devices (Auckl) 2016 2;9:63-7. Epub 2016 May 2.

Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.

Background And Objectives: The use of picosecond lasers to remove tattoos has greatly improved due to the long-standing outcomes of nanosecond lasers, both clinically and histologically. The first aesthetic picosecond laser available for this use was the PicoSure(®) laser system (755/532 nm). Now that a vast amount of research on its use has been conducted, we performed a comprehensive review of the literature to validate the continued application of the PicoSure(®) laser system for tattoo removal. Read More

Lasers Med Sci 2016 Aug 16;31(6):1069-74. Epub 2016 May 16.

Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Ta-Pei Road, Niao-Sung District, Kaohsiung, 83301, Taiwan.

Effectively managing pain is vital for the well-being and satisfaction of patients undergoing dermatologic treatments involving lasers. This study investigates the potential outcome of using muscle relaxation techniques to reduce pain among people having their tattoos removed with laser treatment. This study consists of 56 participants (mean age 18. Read More

J Cosmet Laser Ther 2016 Oct 16;18(6):345-7. Epub 2016 Jun 16.

b Dermatological Surgery & Laser Unit, St John's Institute of Dermatology, St Thomas' Hospital , London , UK.

Picosecond lasers are a novel laser with the ability to create a pulse of less than one nanosecond. They have been available in the clinical context since 2012. Dermatologists are now using picosecond lasers regularly for the treatment of blue and green pigment tattoo removal. Read More

Lasers Med Sci 2016 Nov 7;31(8):1733-1737. Epub 2016 Apr 7.

Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1475 NW 12th Ave. Suite 2175, Miami, FL, 33136, USA.

The prevalence of tattoos continues to grow as modern society's stigma towards this form of body art shifts towards greater acceptance. Approximately one third of Americans aged 18-25 and 40 % of Americans aged 26-40 are tattooed. As tattoos continue to rise in popularity, so has the demand for an effective method of tattoo removal such as lasers. Read More

Lasers Surg Med 2016 Feb;48(2):181-7

Laser and Skin Surgery Center of New York, New York City, 10016, New York.

Background And Objectives: Laser procedures in skin of color (SOC) patients are challenging due to the increased risk of dyspigmentation and scarring. A novel 755 nm alexandrite picosecond laser has demonstrated effectiveness for tattoo removal and treatment of acne scars. No studies to date have evaluated its applications in pigmentary disorders. Read More

Lasers Surg Med 2016 07 2;48(5):471-3. Epub 2016 Feb 2.

Laser & Skin Surgery Center of New York, New York, New York.

Background And Objectives: Tattoo removal can inadvertently lead to paradoxical darkening after laser procedure. We present a new laser device that may treat this unwanted outcome.

Study Design/patients And Methods: We report two cases from a clinical trial, using a novel picosecond 532 nm and 1,064 nm laser to treat unwanted red tattoos. Read More

Lasers Surg Med 2016 Apr 8;48(4):392-9. Epub 2016 Jan 8.

Interdisciplinary Program of Marine-Bio, Electrical and Mechanical Engineering, Pukyong National University, Busan, Korea.

Background And Objective: Artificial skin phantoms have been developed as an alternative tissue for human skin experiments due to convenient use and easy storage. However, fabricating both thin (∼100 μm) epidermis and relatively thick dermis is often cumbersome, and most developed phantoms have hardly reflected specific human skin types. The objective of this study was to fabricate skin phantoms with 3D printing technique to emulate various human skin types (I-VI) along with the corresponding optical and mechanical properties for laser tattoo removal. Read More

Lasers Surg Med 2016 Jan 22;48(1):23-9. Epub 2015 Dec 22.

Division of Dermatology, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China.

Background And Objectives: Photo-aging in Chinese often presents with benign pigmentary lesions. Q-switched lasers for pigmentary lesions in Asians had reported a risk of post-inflammatory hyperpigmentation (PIH) up to 25%. Longer pulse widths in the millisecond domains were advocated with reduced risk of PIH. Read More

Lasers Surg Med 2015 Oct 12;47(8):613-8. Epub 2015 Aug 12.

Nashville Centre for Laser and Facial Surgery, 345 23rd Ave N, Nashville, TN 37203.

Background And Objectives: Perfluorodecalin (PFD) has previously been shown to rapidly dissipate the opaque, white micro-bubble layer formed after exposure of tattoos to Q-switched lasers [1]. The current pilot study was conducted to qualitatively determine if the use of a transparent PFD-infused silicone patch would result in more rapid clearance of tattoos than conventional through-air techniques.

Materials And Methods: Black or dark blue tattoos were divided into two halves in a single-site IRB-approved study with 17 subjects with Fitzpatrick skin types I-III. Read More

Dermatol Surg 2015 Sep;41(9):1091-3

Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada.

Sci Rep 2015 Aug 5;5:12915. Epub 2015 Aug 5.

German Federal Institute for Risk Assessment (BfR), Department of Chemical and Product Safety, Max-Dohrn-Strasse 8-10, 10589 Berlin, Germany.

Since laser treatment of tattoos is the favored method for the removing of no longer wanted permanent skin paintings, analytical, biokinetics and toxicological data on the fragmentation pattern of commonly used pigments are urgently required for health safety reasons. Applying dynamic headspace-gas chromatography with mass spectrometric detection (DHS-GC/MS) and comprehensive two-dimensional gas chromatography coupled to time-of-flight mass spectrometry (GCxGC-ToF-MS), we identified 1,2-benzene dicarbonitrile, benzonitrile, benzene, and the poisonous gas hydrogen cyanide (HCN) as main fragmentation products emerging dose-dependently upon ruby laser irradiation of the popular blue pigment copper phthalocyanine in suspension. Skin cell viability was found to be significantly compromised at cyanide levels of ≥1 mM liberated during ruby laser irradiation of >1. Read More

Lasers Surg Med 2015 Jul 14. Epub 2015 Jul 14.

Syneron-Candela Corporation, 530 Boston Post Road, Wayland, Massachusetts, 01778.

Background And Objectives: Although nanosecond-domain lasers have been the mainstay of laser tattoo removal for decades, recent disruptive innovations in laser design have introduced a new class of commercial Q-switched lasers that generate picosecond-domain pulses.

Study: A picosecond-domain, Nd:YAG laser with a KTP frequency-doubling crystal was used to treat 31 decorative tattoos in 21 subjects. Safety and effectiveness were determined by blinded evaluation of digital images in this prospective clinical study. Read More

J Cosmet Dermatol 2015 Dec 2;14(4):302-9. Epub 2015 Jul 2.

Department and Clinic of Dermatology, Poznan University of Medical Sciences, Poznan, Poland.

Objective: The aim of the study was to evaluate the efficacy of tattoo removal treatments using the 1064-nm Q-switched (QS) Nd:YAG laser.

Background Data: Today, QS lasers appear to be the most common, effective, and safest methods to treat unwanted markings.

Material And Methods: A total of 64 patients with 75 unwanted tattoos were enrolled in the study. Read More

Wien Med Wochenschr 2015 May 12;165(9-10):195-8. Epub 2015 May 12.

Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Friedrichstrasse 41, 01067, Dresden, Germany,

Background: Tattoo removal is often requested by patients. The gold standard is laser tattoo removal that can be time- and cost-intensive. Therefore, safe alternatives without lasers, pain, and scars would be desirable. Read More

J Cutan Aesthet Surg 2015 Jan-Mar;8(1):30-6

Department of Dermatology, Maulana Azad Medical College, LN Hospital, New Delhi, India.

Tattooing is a process of implantation of permanent pigment granules in the skin. Tattoos can be decorative, medical or accidental. There has been a exponential increase in decorative tattooing as a body art in teenagers and young adults. Read More