Integrated cooling-vacuum-assisted 1540-nm erbium:glass laser is effective in treating mild-to-moderate acne vulgaris.

Acne treatment by a mid-infrared laser may be unsatisfactory due to deeply situated acne-affected sebaceous glands which serve as its target. Skin manipulation by vacuum and contact cooling may improve laser-skin interaction, reduce pain sensation, and increase overall safety and efficacy. To evaluate the safety and efficacy of acne treatment using an integrated cooling-vacuum-assisted 1540-nm erbium:glass laser, a prospective interventional study was conducted. It included 12 patients (seven men and five women) suffering from mild-to-moderate acne vulgaris. The device utilizes a mid-infrared 1540-nm laser (Alma Lasers Ltd. Caesarea, Israel), which is integrated with combined cooling-vacuum-assisted technology. An acne lesion is initially manipulated upon contact by a vacuum-cooling-assisted tip, followed by three to four stacked laser pulses (500-600 mJ, 4 mm spot size, and frequency of 2 Hz). Patients underwent four to six treatment sessions with a 2-week interval and were followed-up 1 and 3 months after the last treatment. Clinical photographs were taken by high-resolution digital camera before and after treatment. Clinical evaluation was performed by two independent dermatologists, and results were graded on a scale of 0 (exacerbation) to 4 (76-100 % improvement). Patients' and physicians' satisfaction was also recorded. Pain perception and adverse effects were evaluated as well. All patients demonstrated a moderate to significant improvement (average score of 3.6 and 2.0 within 1 and 3 months, respectively, following last treatment session). No side effects, besides a transient erythema, were observed. Cooling-vacuum-assisted 1540-nm laser is safe and effective for the treatment of acne vulgaris.

Immediate and delayed effects of treatment at the Dead Sea in patients with psoriatic arthritis.

The purpose of this study was to evaluate the immediate and delayed effects of balneotherapy at the Dead Sea on patients with psoriatic arthritis (PsA). A total of 42 patients with PsA were treated at the Dead Sea for 4 weeks. Patients were randomly allocated into two groups: group 1 (23 patients) and group 2 (19 patients). Both groups received daily exposure to sun ultraviolet rays and regular bathing at the Dead Sea. Group 1 was also treated with mud packs and sulfur baths. Patients were assessed by a dermatologist and a rheumatologist 3 days before arrival, at the end of treatment, and at weeks 8, 16, and 28 from the start of treatment. The clinical indices assessed were morning stiffness, right and left hand grip, number of tender joints, number of swollen joints, Schober test, distance from finger to floor when bending forward, patient's self-assessment of disease severity, inflammatory neck and back pain and psoriasis area and severity index (PASI) score. Comparison between groups disclosed a similar statistically significant improvement for variables such as PASI, morning stiffness, patient self-assessment, right and left grip, Schober test and distance from finger to floor when bending forward. For variables such as tender and swollen joints, and inflammatory neck and back pain, improvement over time was statistically significant in group 1. Addition of mud packs and sulfur baths to sun ultraviolet exposure and Dead Sea baths seems to prolong beneficial effects and improves inflammatory back pain.

Effects of vitamin D3 on keratinocyte proliferation and differentiation in vitro: modulation by ligands for retinoic acid and retinoid X receptors.

Keratinocytes express receptors for 1,25-dihydroxyvitamin D3 [1,25(OH)2D3], all-trans-retinoic acid (all-trans-RA), 9-cis-retinoic acid (9-cis-RA) and triiodothyronine (T3). The vitamin-D receptor (VDR) can act as a transcription factor by forming homodimers or heterodimers with the retinoic-acid receptor (RAR), the retinoid X receptor (RXR) or the triiodothyronine receptor (TR). This study investigated whether the antiproliferative and prodifferentiating effects of 1,25(OH)2D3 on normal human keratinocyte cultures is modified by all-trans-RA, a ligand for RAR, by CD2809, a ligand for RXR, by 9-cis-RA, a ligand for the RAR and RXR, and T3, a ligand for the TR. Submerged, second-passage normal human keratinocytes were grown to approximately 30% confluency before incubation for 4 days with ligands in keratinocyte growth medium supplemented with 3% charcoal-stripped fetal calf serum and 0.3 mM Ca2+. Proliferation was measured by the dimethylthiazolyl-diphenyl-tetrazolium-bromide assay. Then differentiation was determined in the same culture, performing a cell ELISA for transglutaminase type 1. All-trans-RA, 9-cis-RA and CD2809 had a slight stimulatory effect on proliferation. In combination with 1,25(OH)2D3, all retinoids partially counteracted the antiproliferative effect of 1,25(OH)2D3. The differentiation was dose-dependently inhibited by all-trans-RA, 9-cis-RA and CD2809 alone. In combination with 1,25(OH)2D3, all retinoids reversed the prodifferentiating effect of 1,25(OH)2D3, resulting in a net inhibition of differentiation. T3 had no effect on proliferation of differentiation, either alone or in combination with 1,25(OH)2D3. In conclusion, retinoids with different receptor selectivities had similar effects on keratinocyte proliferation and differentiation. The effects of 1,25(OH)2D3 on proliferation and differentiation were reversed by all retinoids. Therefore ligand-dependent heterodimer formation between the VDR and retinoid receptors may not be important for the combined effects of 1,25(OH)2D3 and retinoids on keratinocyte proliferation and differentiation in vitro.

Inhibition of proliferation of psoriatic and healthy fibroblasts in cell culture by selected Dead-sea salts.

The effect of five selected minerals abundant in the Dead-sea brine was studied on proliferation of fibroblasts grown from psoriatic and healthy skin biopsy specimens in cell culture. The reason for carrying out this study was looking for the mechanism of the antiproliferative effect of selective Dead-sea minerals in improving the psoriatic condition. Psoriatic skin shave biopsy specimens (both from involved and uninvolved areas of the body) as well as healthy skin (obtained from amputated limbs) were incubated in tissue culture, and their outgrowing fibroblasts were used for this study. The number of cells and their cyclic AMP content were used as parameters for cell division and for proving the selective involvement of magnesium salts in the antiproliferative effect. It is shown that the inhibitory effects of magnesium bromide and magnesium chloride on cell growth were significantly stronger than those of their corresponding potassium salts or of sodium chloride. These results were obtained with both psoriatic and healthy skin fibroblasts, indicating that the inhibitory effect of the selected Dead-sea minerals is present in healthy and psoriatic skin cells.

Cutaneous blood flow abnormalities in hypertriglyceridemia.

An accelerated atherosclerosis, in particular of the coronary arteries, was documented in hypertriglyceridemia. The objective of the present study was to assess the cutaneous dynamic blood flow in hypertriglyceridemia, utilizing the optical noninvasive method of laser Doppler flowmetry. The cutaneous blood flow on the forearms was measured during the postischemic reactive hyperemia test in treated and non-treated patients with hypertriglyceridemia and healthy control subjects. The subjects were 32 patients with hypertriglyceridemia--15 untreated and 17 following 6-9 months of bezafibrate treatment--and 27 healthy control subjects. In untreated patients with hypertriglyceridemia, the peak flow was significantly lower than in both the treated group (p < 0.005) and control group (p < 0.02). Similarly, the area under the response-time curve of the untreated patients with hypertriglyceridemia was smaller (p < 0.01 and p < 0.05, respectively). These parameters were similar in the treated group and the control group. The reaction was faster in the treated group, as compared to the other two groups (p < 0.001). The control group exhibited a longer time to decay than the treated group (p < 0.01). Postischemic reactive hyperemia tests in patients with hypertriglyceridemia reveal cutaneous microcirculatory changes in the forearm. These changes may arise from several mechanisms, including functional abnormalities of the endothelium or vascular smooth muscle, or structural changes in the blood vessels that limit vasodilatation. These changes are reversible, and corrected when reducing the triglyceride levels, but other abnormalities are then present, suggesting a permanent damage. These dynamic measurements of cutaneous blood flow are sensitive indicators of atherogenesis, and can be employed for the evaluation of microvascular involvement and follow-up of patients with hypertriglyceridemia.

Psoriasiform eruption induced by anticonvulsants.

We present findings from three patients who experienced a psoriasiform eruption apparently due to the antiepileptic agents sodium valproate and carbamazepine. The causal relationship between the drug and the eruption has been based mainly on circumstantial evidence and is further strengthened by the positive result of one or two in vitro tests: the macrophage migration inhibition (MIF) test and the indirect rat mast cell degranulation (MCD) test. Sodium valproate and carbamazepine, antiepileptic drugs that are associated with a relatively low rate of adverse cutaneous reactions, should be added to the growing list of drugs that produce psoriasiform eruptions. A drug-induced psoriasiform eruption due to these drugs seems to be more common than previously reported. Physicians should be aware of this type of reaction. Early detection of these cases has practical importance since the identification and elimination of the causative drug is essential for therapy success.

Granted publications: taken for granted?

Highly respected journals now relatively rarely publish independent research which is not grant-supported. This may lead to a reduction in the publication of innovative work.

Cutaneous paraneoplastic syndromes.

A review of a variety of cutaneous paraneoplastic conditions is presented. Although the conditions discussed appear in only 7-15% of cancer patients, they are considered indicators of possible underlying malignancy.