Treatment of sporadic port-wine stains: a retrospective review of 17 cases consecutively treated by pulsed sequential dual wavelength 595 and 1064 nm laser.

BACKGROUND: Port-wine stains (PWS) are relatively common and often cause cosmetic and psychological concerns. The pulsed dye laser is currently the treatment of choice for PWS. OBJECTIVE: To assess the effectiveness of the pulsed sequential dual wavelength 595 and 1064 nm laser as first-line treatment for PWS and to identify prognostic factors for treatment outcome in a retrospective series of 17 consecutive previously untreated patients. METHODS: The response to treatment was evaluated 2 months after treatment utilizing comparative photographs and a standard physician global assessment (PGA) grading system. Furthermore, measurement of the normalized erythema index (NEI) reduction (ΔNEI%) was carried out using an image analysis system. The subjective improvement was assessed using a patient's satisfaction questionnaire. Multiple linear regression models were finally used to identify factors associated with ΔNEI% and patients' satisfaction. RESULTS: Seventeen patients, with PWS, including 12 children were included. The average PGA assessment was 2.5 ± 1.3 corresponding to an amelioration of 50% with a high intraclass correlation coefficient among the experts. The before-after NEI showed a statistically significant mean reduction of 3.5 ± 2.6 units, corresponding to a relative reduction of 31%. Questionnaires showed that the satisfaction was very good with an average score of 6.1 points on a scale ranging from -10 to 10 points. Multiple regression analysis revealed that location in the frontotemporal area was associated with a significant reduction in ΔNEI% (38.4%; 95% CI 4.3, 72.6). Presence of PWS on the neck was associated with a lower patient satisfaction (-3.7 points; 95% CI -6.5, -0.9). There were no significant side-effects, except for transient discomfort and purpura. CONCLUSIONS: Based on the results obtained in the largest reported series so far, the pulsed sequential dual wavelength 595 and 1064 nm laser represents an effective and safe first-line therapeutic option for the treatment of PWS.

Hypertrichosis in Becker's nevus: effective low-fluence laser hair removal.

Becker's nevus is cosmetically bothersome both due to the hyperpigmentation and due to the hypertrichosis which can accompany it, particularly in males. Laser hair removal can be considered, but the pigmented background of the Becker's nevus makes the treatment more challenging. Fifteen patients with Becker's nevus underwent eight sessions of hair removal with low-fluence high-repetition-rate diode lasers (808-810 nm). All participants experienced significant hair reduction at 6 and 12 months. No adverse events were reported. The study supports the use of low fluence with high-repetition-rate diode laser hair removal as a safe and effective method for the management of hypertrichosis in Becker's nevus.

Best practice options for hair removal in patients with unwanted facial hair using combination therapy with laser: guidelines drawn up by an expert working group.

Hirsutism is a common disorder affecting between 5 and 15% of the population. One of the most devastating consequences of hirsutism is the presence of unwanted facial hair. Treatment of hirsutism involves a two-pronged approach: treating the underlying cause and reduction of visible hair. Laser hair removal is one of the most effective options for reducing visible hair, however, it may not be wholly effective in all patients and combination therapy may need to be considered. Pharmacological therapy is often used in combination with mechanical hair removal due to the time needed for the drug treatment to demonstrate visible results. Clinical data investigating the use of laser treatment in combination with other treatments has focused on laser with topical eflornithine. The expert working group reviews existing data and provides guidance on the use of eflornithine in combination with laser for resistant hirsutism.

[Mohs micrographic surgery: concept, technic and indications]. / La chirurgie micrographique selon Mohs: concept, technique et indications.

Mohs Micrographic Surgery is a technic to treat severe cutaneous carcinoma. By performing a microscopic and topographic analysis of the whole tissue excised, both a reduction of the surgical margin and margins in normal tissue is obtained. The major indications of micrographic surgery are recurrent basalcell carcinoma after surgery or radiotherapy, not fully excised or localized on the nose and the mediofacial region, some spinouscell carcinoma and dermatofibrosarcoma protuberans.

Kaposi's sarcoma following allogeneic bone marrow transplantation.

Localised Kaposi's sarcoma (KS) was diagnosed 240 days after allogeneic bone marrow transplantation (BMT) in a severely immunosuppressed HIV negative patient with genetic predisposition. The tumour was of host origin, based on PCR amplification of DNA minisatellites. Treatment with radiotherapy prompted almost complete regression of the lesions. However the patient subsequently died with relapsed acute myelogenous leukaemia. Contrary to the incidence observed after organ allografts, the advent of KS appears to be exceptional after BMT, since only one case has been reported to date, following reinfusion of autologous marrow.

Targeted UVB phototherapy for psoriasis: a preliminary study.

Excimer laser treatment for psoriasis has been associated with good results at a lower cumulative dose than narrowband ultraviolet (UV)B protocols. To examine the clinical performance of a new targeted UVB lamp (290-320 nm; BClear) in the treatment of plaque-type psoriasis, 28 consecutive patients attending a dermatology service were treated twice weekly with the UVB lamp for 6-18 sessions (median 10). UV doses were based on multiples of a predetermined minimal erythema dose (MED). MEDs ranged from 150 to 350 mJ/cm2; maximal dose was 8 MED. Mean cumulative fluence until remission was 12.63 J/cm2. The Psoriasis Severity Index (PSI) was measured every 2 weeks for 16 weeks. Mean PSI improvement during treatment peaked at 73% after 6 weeks, and declined to 63% at 16 weeks. At that point, 36% of the patients had a > 75% improvement in PSI, and 21% showed complete clearance. Targeted radiation with the UVB lamp is effective for the treatment of plaque-type psoriasis, requiring as few as six sessions and achieving moderately long remission. As treatment is selectively directed toward lesioned skin, normal surrounding skin is spared unnecessary radiation exposure.

Photorejuvenation of the forearms by treating hyperpigmented lesions with intense pulsed light source: a case report.

UNLABELLED: A 55 year old Spanish patient, photo type III, wanted a cosmetic improvement of her forearms. She disliked the hyperpigmentation which made her look older. METHOD: After having tried several chemical peelings (50% glycolic acid plus 10% kojic acid followed by 15% MM TCA), there was no improvement in the patients's condition and it was decided to initiate intense pulsed light (IPL) treatment. RESULTS: Improvement was noted after the first session, with a slight pink coloration. At two months post treatment, we noted more than 90% clearance of the hyperpigmentation on the treated areas. CONCLUSION: This case report confirms that photorejuvenation, by treating hyperpigmented lesions with intense pulsed light source on extra-facial zones can be very effective and safe.

Striae treated by a novel combination treatment--sand abrasion and a patent mixture containing 15% trichloracetic acid followed by 6-24 hrs of a patent cream under plastic occlusion.

BACKGROUND: Striae are a common cosmetic problem, especially for women. Little has been published about chemical peel treatment of striae. OBJECTIVE: To recount 5 years experience of striae treated by a novel combination treatment--sand abrasion and a patent mixture containing 15% trichloracetic acid followed by 6-24 h of a patent cream under plastic occlusion. MATERIALS AND METHODS: Sixty-nine females of various phototypes, aged 14-63 years, were treated at various anatomical sites: abdomen (43), lateral thighs (11), breasts (4), back (3), waist (3) and others (5). Striae of all types: fresh, old, mild and severe, were treated. Average follow up was 18 months. RESULTS: After 1-8 treatments (median 4.2), appearance of the striae improved by 70%. Results were best in fresher and more superficial striae. CONCLUSIONS: A novel combination treatment is reported which safely, predictably and effectively improved striae in all skin types.

[Secondary wound healing with reference to anatomic subunits in operations of the mid-facial area]. / Sekundäre Wundheilung unter Berücksichtigung der anatomischen Untereinheiten bei Operationen im Mittelgesicht.

The healing of wounds by secondary intention is a simple method to close operative defects. The quality of wound healing will depend on the anatomic site on the face as well as on size and depth of the defect. Best functional and cosmetic results are obtained at locations with concave geometry and when the defect lies symmetrically at the interface of two anatomic subunits. Partial reconstruction or guiding sutures can create a symmetric defect in relation to anatomic subunits which will heal by second intention. This simple and efficient operative procedure is illustrated by two case reports.