Clinical evidence of 595 nm pulse dye laser treatment for viral warts on hands and feet.

BACKGROUND: Viral warts, induced by infection by different HPV genotypes, are highly frequent in the general population, particularly during infancy and among adolescents. The effectiveness of the 595 nm Pulse dye-laser in treating viral warts on the hands and feet in both adults and children was investigated in this study. MATERIALS AND METHODS: A selection of 203 patients with multiple viral warts was made. All patients underwent 4-5 treatment sessions with a 595 nm pulse Dye Laser (PDL). Treatment outcome was assessed by a quartile scale: 1 indicates no or low results (0%-25% of the lesion area cleared), 2 indicates slight clearance (25%-50% of the lesion area cleared), 3 indicates moderate-good clearance (50%-75%), and 4 indicates excellent clearance (75%-100%). Patients were asked for a subjective evaluation of the perceived overall results by means of the following score: unsatisfied (1), not very satisfied (2), satisfied (3), and very satisfied (4). Possible side effects were monitored. Results obtained were judged with a photographic evaluation, immediately and at the control visit (6 months after the last laser session). RESULTS: All patients observed global improvements. Most of the lesions were completely removed after laser therapy. A total of 95% of patients achieved excellent clearance and they were very satisfied following the laser treatment. Relevant side effects were absent in all patients. CONCLUSION: PDL treatment with the study device using a wavelength of 595 nm has proven to be a tolerable and safe therapy for viral warts management.

A Multimodal Approach to Laser Treatment of Extensive Hypertrophic Burn Scar: A Case Report.

BACKGROUND Hypertrophic scars from severe burns cause physical and psychological stress. Proper treatment, including CO2 laser systems, can alleviate these burdens by enabling skin remodeling and collagen production. This study assessed the efficacy of a new laser device with 2 wavelengths (10 600 nm/1540 nm) and 2 scanning units on hypertrophic burn scar management. CASE REPORT A 34-year-old African woman sought treatment for a large hypertrophic burn scar on her right foot. The scar, formed at age 9, was complicated by infection. She underwent 2 CO2 sessions (Scar3 scanner), followed by 3 cycles of fractional CO2 +1540 nm laser (µScan DOT scanner) once a month, combined with topical hyaluronic acid. She also had 2 maintenance sessions with a 595-nm dye laser to prevent scar reactivation. The CO2 and 1540 nm laser synergy improved laxity through volumetric thermal effects, causing contraction and stimulation. This led to a softer, smaller scar with less consistency. The patient experienced significant improvement in quality of life due to alleviation of pain and restored footwear comfort. CONCLUSIONS The hypertrophic burn scar was effectively treated using 10 600 nm and 1540 nm wavelengths, along with dye laser treatment for recurrence prevention.

Erbium Laser for Skin Surgery: A Single-Center Twenty-Five Years' Experience.

 (1) Introduction: The Erbium laser is a very versatile laser system used in dermatology. Its ability to be almost selectively absorbed by water makes it a perfect device for managing various cutaneous skin conditions. (2) Methods: In this paper, we report our twenty-five years' experience with the Erbium laser. More than three thousand patients were treated for common skin disorders such as flat warts, seborrheic keratosis, xanthelasmas, and scars. (3) Results: A complete response was observed in 89.6%, without significant side effects. Local anesthesia was used in only a tiny percentage of patients. (4) Conclusions: This study confirms that the Erbium laser is a valuable and flexible procedure for laser surgery with excellent safety and short healing times.

Nonconventional Use of Flash-Lamp Pulsed-Dye Laser in Dermatology.

Flash-lamp pulsed-dye laser (FPDL) is a nonablative technology, typically used in vascular malformation therapy due to its specificity for hemoglobin. FPDL treatments were performed in a large group of patients with persistent and/or recalcitrant different dermatological lesions with cutaneous microvessel involvement. In particular, 149 patients (73 males and 76 females) were treated. They were affected by the following dermatological disorders: angiokeratoma circumscriptum, genital and extragenital viral warts, striae rubrae, basal cell carcinoma, Kaposi's sarcoma, angiolymphoid hyperplasia, and Jessner-Kanof disease. They all underwent various laser sessions. 89 patients (59.7%) achieved excellent clearance, 32 patients (21.4%) achieved good-moderate clearance, 19 patients (12.7%) obtained slight clearance, and 9 subjects (6.1%) had low or no removal of their lesion. In all cases, FPDL was found to be a safe and effective treatment for the abovementioned dermatological lesions in which skin microvessels play a role in pathogenesis or development. Further and single-indication studies, however, are required to assess a standardized and reproducible method for applying this technology to "off-label" indications.

Laser surgery in rhinophyma.

BACKGROUND: Rhinophyma is a benign, disfiguring disorder, commonly referred to as the end-stage of severe rosacea and characterized by a progressive thickening and hypertrophy of the nasal skin and soft tissues. The aim of this paper was to evaluate the efficacy of CO2 laser compared to other laser techniques and surgical methods in the treatment of rhinophyma. METHODS: Twenty-four rhinophyma patients were treated with CO2 laser in our institution from 2003 to 2013. A 10,600-nm CO2 pulsed laser was used in all patients, with a 6-month, post-treatment follow-up. RESULTS: Six months after the last laser session, all patients showed global improvement of their clinical conditions: 19 (79.1%) high improvement (>75%), 4 (16.7%) moderate improvement (50-75%), and 1 (4.2%) low improvement (<25%). CONCLUSIONS: Our study demonstrates that carbon dioxide laser warrants a careful nasal surface ablation, allowing the remodeling of the hypertrophic areas, with an excellent cosmetic result, a very short healing time, and virtually no side effects.

Tattoo-associated skin reaction: the importance of an early diagnosis and proper treatment.

Tattoo is going to be a very common practice especially among young people and we are witnessing a gradual increase of numerous potential complications to tattoo placement which are often seen by physicians, but generally unknown to the public. The most common skin reactions to tattoo include a transient acute inflammatory reaction due to trauma of the skin with needles and medical complications such as superficial and deep local infections, systemic infections, allergic contact dermatitis, photodermatitis, granulomatous and lichenoid reactions, and skin diseases localized on tattooed area (eczema, psoriasis, lichen, and morphea). Next to these inflammatory skin reactions we have to consider also the possibility of the development of cutaneous conditions such as pseudolymphomatous reactions and pseudoepitheliomatous hyperplasia. The aim of this study is to underline the importance of an early diagnosis by performing a histological examination especially when we are in front of suspected papulonodular lesions arising from a tattoo, followed by a proper treatment, since cutaneous neoplastic evolution is known to be a rare but possible complication.

In vivo non-invasive monitoring of collagen remodelling by two-photon microscopy after micro-ablative fractional laser resurfacing.

Non-linear optical microscopy is becoming popular as a non-invasive in vivo imaging modality in dermatology. In this study, combined TPF and SHG microscopy were used to monitor collagen remodelling in vivo after micro-ablative fractional laser resurfacing. Papillary dermis of living subjects, covering a wide age range, was imaged immediately before and forty days after treatment. A qualitative visual examination of acquired images demonstrated an age-dependent remodelling effect on collagen. Additional quantitative analysis of new collagen production was performed by means of two image analysis methods. A higher increase in SHG to TPF ratio, corresponding to a stronger treatment effectiveness, was found in older subjects, whereas the effect was found to be negligible in young, and minimal in middle age subjects. Analysis of collagen images also showed a dependence of the treatment effectiveness with age but with controversial results. While the diagnostic potential of in vivo multiphoton microscopy has already been demonstrated for skin cancer and other skin diseases, here we first successfully explore its potential use for a non-invasive follow-up of a laser-based treatment.

Dermatosis Papulosa Nigra and 10,600-nm CO2 laser, a good choice.

Dermatosis Papulosa Nigra (DPN) is a common skin condition observed in black people and considered a benign epithelial tumor, and more specifically, a particular topographic form of seborrheic keratosis. We treated five female patients affected by DPN with 10,600-nm CO2 laser. We propose the 10,600-nm CO2 laser as a valid therapeutic option in patients affected by DPN, since the treatment is well tolerated, causes no major side effects, and is effective and long lasting.

Inflammatory linear verrucous epidermal nevus: why a combined laser therapy.

Inflammatory linear verrucous epidermal nevus (ILVEN) is a benign cutaneous hamartoma, and more precisely an uncommon variant of the verrucous epidermal nevus. In our case report we describe an ILVEN female patient, resistant to previous treatments but responsive to a combined laser therapy, 10,600-nm CO2 laser and Fractional CO2 laser, with good and longstanding results. A complete resolution of the lesion was observed at the 9-month follow-up. The application of lasers has been reported in literature over recent years for resolving ILVEN lesions. Based on our clinical experience, 10,600-nm CO2 pulsed laser therapy seems to be the best treatment and Fractional CO2 laser treatment can be regarded as a very promising technique to combine with CO2 laser for reducing pigment modifications and endowing a more youthful appearance to the treated areas.

Induction of apoptosis by fractional CO2 laser treatment.

INTRODUCTION: Fractional CO2-laser is considered a preferential method for skin resurfacing, but little is known about the molecular mechanisms underlying this surgical tool. In the present study, we investigated the possible role of apoptosis by the sequential analysis of lesional skin after laser treatment, with special attention to power. Moreover, we have analyzed if there is a correlation with clinical improvement. MATERIALS AND METHODS: We evaluated the effects of fractional CO2-laser in twelve patients with photodamage skin Fitzpatrick types I to III. Apoptosis markers were assessed by an immunohistochemical study on skin samples of foream at 24 h, 72 h and 7 days after the irradiation with 15 W or 20 W. Moreover, clinical improvement was assessed by iconography. RESULTS: Fractional CO2-laser induced an inflammatory repair process mediated by activation of apoptotic pathway that was completed in 7 days. The expression of proapototic markers, as annexin-VII and Caspases-9 was increased 24-72 hours after irradiation and decreased after 7 days. While the expression of the anti-apototic marker Bcl-2 increased progressively during 7 days after treatment. CONCLUSION: Our study suggests that the skin's appearance may be enhanced by creating skin changes through apoptosis. Apoptosis, one of the major mechanisms of cell death, might play a key role in initiating the paracrine cascades that lead to cell proliferation.

Highlights of thirty-year experience of CO2 laser use at the Florence (Italy) department of dermatology.

The CO(2) laser has been used extensively in dermatological surgery over the past 30 years and is now recognised as the gold standard for soft tissue vaporization. Considering that the continuous wave CO(2) laser delivery system and the newer "superpulsed" and scanned CO(2) systems have progressively changed our practice and patient satisfaction, a long range documentation can be useful. Our experience has demonstrated that the use of CO(2) laser involves a reduced healing time, an infrequent need for anaesthesia, reduced thermal damage, less bleeding, less inflammation, the possibility of intra-operative histologic and/or cytologic examination, and easy access to anatomically difficult areas. Immediate side effects have been pain, erythema, edema, typically see with older methods, using higher power. The percentage of after-treatment keloids and hypertrophic scars observed was very low (~1%) especially upon the usage of lower parameters. The recurrence of viral lesions (condylomas and warts) have been not more frequent than those due to other techniques. Tumor recurrence is minor compared with radiotherapy or surgery. This method is a valid alternative to surgery and/or diathermocoagulation for microsurgery of soft tissues. Our results are at times not consistent with those published in the literature, stressing the concept that multicentric studies that harmonization methodology and the patient selection are vital.

A study of fractional CO2 laser resurfacing: the best fluences through a clinical, histological, and ultrastructural evaluation.

BACKGROUND: Fractional resurfacing is a laser treatment modality to create numerous microscopic thermal injury zones of controlled width, depth, and density that are surrounded by a reservoir of spared epidermal and dermal tissue, allowing rapid repair of laser-induced thermal injury. OBJECTIVE: To evaluate the safety and efficacy of a fractional CO(2) laser system in the treatment of photo-damaged skin with clinical, histological, and ultrastructural evaluation, with special attention to one of the parameters of this laser system: the fluences. MATERIALS AND METHODS: Twelve patients with Fitzpatrick skin types II to III with photo-damage skin underwent fractional laser treatment with one single-pass superficial on the face and forearm. Clinical outcome and histological and ultrastructural changes were assessed. RESULTS: Light microscopy of biopsies gave important information about skin changes at three different times after fractional treatment, especially revealing some differences between the fluences used in the three groups of patients. CONCLUSION: Fractional resurfacing offers significant surgical advantages allowing to achieve excellent esthetic results in balance with the biological structure. Besides, our study shows already that with 2.07 and 2.77 J/cm(2) , instead of 4.15 J/cm(2) , it is possible to reach a biological response without scar formation.

Combined treatment of Favre-Racouchot syndrome with a superpulsed carbon dioxide laser: report of 50 cases.

Nodular elastosis with cysts and comedones also known as Favre-Racouchot syndrome frequently occurs on actinically damaged skin of middle-aged or elderly Caucasian subjects. The disease usually affects simmetrically the skin mainly around the orbits. Treatment in the past has not been entirely satisfactory. Treatment of 50 patients with a superpulsed carbon dioxide laser in order to vaporize epidermis followed by extraction of cystic and comedonic material using soft pressure with a pair of forceps. Laser treatment was performed without previous topical or intralesional anesthetics because no pain was reported using the described laser parameters. Our combined therapeutic approach was safe and effective in all the patients, guaranteeing an excellent cosmetic result. The combined technique assures clinical efficacy, rapid recovery, and the possibility of repeated laser application without anesthesia. On the basis of our results, we recommend the novel combined modality in the treatment of Favre-Racouchot syndrome.

Topical photodynamic therapy for primary cutaneous B-cell lymphoma: a pilot study.

Photodynamic therapy (PDT) is a treatment based on the accumulation of a photosensitizer in the target cells and their selective destruction by irradiation with visible light. In the past 10 years, several patients with cutaneous T cell lymphoma have been successfully treated. The use of PDT in cutaneous B cell lymphoma has not been reported to date. We report the successful PDT treatment of 3 patients with early primary cutaneous B cell lymphoma.

Monochromatic excimer light (308 nm) in patch-stage IA mycosis fungoides.

Recently, numerous studies have been reported concerning the treatment of early-stage mycosis fungoides (MF) with narrowband (311-nm) UVB, claiming a beneficial response. We have used for the first time a 308-nm monochromatic excimer light, a new kind of xenon-chloride lamp, in the treatment of patch stage IA MF. We treated 7 patch lesions in 4 patients with unequivocal clinicopathologic diagnosis of MF. All lesions achieved clinical and histologic complete remission. The number of weekly sessions varied from 4 to 11 (mean 6.5; median 5.5). The total UVB 308-nm irradiation dose ranged from 5 to 9.3 J/cm(2) (mean 7.1 J/cm(2); median 7 J/cm(2)). All lesions remained in stable complete remission after a follow-up of 3 to 28 months. No remarkable side effects were reported. Our preliminary results suggest that monochromatic excimer light phototherapy is a possibly very useful treatment modality in patch stage IA MF.

CO2 laser therapy in a case of steatocystoma multiplex with prominent nodules on the face and neck.

BACKGROUND: Steatocystoma multiplex is an uncommon disorder which usually begins in adolescence or early adult life. The condition can be hereditary, as an autosomal dominant trait, or nonhereditary, as in this case. METHODS: A 40-year-old woman presented with a history of asymptomatic nodules that began around puberty on the face. There was no family history of similar lesions. Clinical examination revealed multiple nodules distributed on the face and neck. The histopathologic examination of a biopsy specimen showed the typical features of steatocystoma multiplex. CO2 laser therapy without anesthesia was employed, and the contents were evacuated by squeezing the cysts with a pair of forceps. RESULTS: Very good results were obtained with rapid healing, minimal invasiveness, and without anesthesia. There was no evidence of scar formation and no signs of recurrence at 2-year follow-up. CONCLUSIONS: Different treatments have been reported for steatocystoma multiplex. We consider CO2 laser therapy to be an ideal technique for the treatment of steatocystoma multiplex, especially when the lesions are localized in aesthetically important areas.