Daylight photodynamic therapy: the Southern California experience.

BACKGROUND: Photodynamic therapy (PDT) is a safe and effective treatment for actinic keratoses (AKs) and photoactinic damage. Three elements are needed for PDT: a photosensitizer, oxygen, and a light source. Conventional PDT is performed with a variety of different laser and light sources including blue, yellow and red in addition to filtered intense pulsed lights (IPL). Daylight PDT, using ambient visible light has been reported as safe, time- and cost-efficient, and more comfortable than with other light sources. We report our experience with daylight PDT in 80 patients. MATERIAL AND METHODS: Eighty patients with multiple actinic keratoses related to chronic photodamage underwent one or two sessions with daylight PDT. Anatomic locations treated included face, chest, arms, and legs. Aminolevulinic acid (ALA, Levulan, Kerastick Dusa USA) was applied one hour prior to light exposure. Thick actinic keratoses were gently curetted prior to ALA application. A chemical sunscreen was applied thirty minutes into the incubation and subsequently patients sat outside in the shade for 2.5 hours. The following day, patients applied a chemical sunscreen and went into either shaded or direct sunlight for 15-30 extra minutes depending on sensitivity. Significant pain associated with this second day exposure was an indication to return indoors immediately. After the second exposure they were instructed to stay inside for the remainder of the 48 hour post treatment period. RESULTS: All patients tolerated the procedure well. Patients denied any pain during the first two and half hour exposure. The second day exposure elicited a mild burning sensation that patients rated as a 2-3/10 though some patients elected to go outside protocol and 'tough it out' despite more significant discomfort. Patients and physicians noted significant reduction in photoactinic damage and actinic keratoses. Patients appreciated the convenience of the treatment. There were no significant adverse events, and no patients reported scarring. CONCLUSION: In this case series, daylight PDT achieved obvious improvement in photodamage, specifically precancerous lesions, and in photoaging with a reduction in lentigenes and other signs of aging. Patients reported significantly less pain than with conventional PDT and enjoyed the convenience of treatment generally in their backyard. It was noted to be a safe procedure with no significant adverse events such as scarring. Additionally, the cost of the procedure was significantly reduced, with ALA and its application being the only expenses.

Metastatic Squamous Cell Carcinoma Presenting as Symptom of AIDS.

The development of metastatic cutaneous squamous cell carcinoma in an otherwise healthy and young individual should prompt physicians to investigate for an underlying cause of immunosuppression. The following case presents an individual who underwent Mohs surgery of a poorly differentiated squamous cell carcinoma. Four months following Mohs surgery, the patient presented with lymphadenopathy and new skin nodules. Metastatic disease or infection were included in the differential diagnosis. An immunosuppression work-up was completed and the patient was diagnosed with human immunodeficiency virus (HIV). Treatment with antiretroviral therapy was initiated 1 month prior to treatment of the metastatic disease with an immunomodulator, cemimplimab-rwlc. This contribution highlights the importance of determining the immunological status of a patient who presents with metastatic disease following a complete tumor clearance.

Laser treatment of superficial leg veins: a review.

BACKGROUND: Superficial leg veins affect millions of people worldwide, and treatment of these vessels is a common dermatologic request. The advance of lasers in recent years has led to numerous laser and light devices intended to treat these superficial vessels. OBJECTIVE AND METHOD: A review of the literature on the laser and light devices available for the treatment of superficial leg vessels with historical and recent trends is presented. RESULTS AND CONCLUSIONS: The appropriate choice of light system to treat telangiectases, venulectases, and reticular veins varies depending on anatomical, physiological, and biological differences in the vessels. Safe and efficacious treatment of superficial leg vessels can be achieved with multiple lasers by taking advantage of the oxyhemoglobin absorption peaks. The authors have indicated no significant interest with commercial supporters.

Laser hair reduction and removal.

Hair removal by any means is unlikely to decrease in popularity, especially with the advent of laser technology allowing for effective treatment of hypertrichosis and hirsutism. There are many effective laser and intense light sources. Although virtually all skin types can be treated, the ideal target is a dark hair on light colored skin, and treatment of nonpigmented or vellus hairs has been disappointing with this method. The physical hair removal methods will continue to be popular options. The practice of aesthetic medicine should include consideration of offering hair reduction using lasers or light sources.