Pulsed CO2 Laser Ablation of Superficial Basal Cell of Limbs and Trunk: A Comparative Randomized Clinical Trial With Cryotherapy and Surgical Ablation.

BACKGROUND: Pulsed CO2 laser is a treatment of superficial basal cell carcinoma (sBCC) although robust clinical evidence has not been reported so far. OBJECTIVE: The authors investigated efficacy, safety, time to wound healing, cosmetic outcome, patient satisfaction, and cost-effectiveness ratio of pulsed CO2 laser in comparison to cryotherapy and surgery. MATERIALS AND METHODS: BCCs of the trunk and extremities were randomized to one of the treatments. After 90 days, efficacy and cosmetic outcome were assessed. Patients recorded the time to complete healing of the wound and scored their overall satisfaction. RESULTS: Two hundred forty patients were randomized. After 3 months, complete remission (CR) rate with pulsed CO2 laser was 78.8%. This was significantly lower than surgery, whereas the CR rate with cryotherapy was not significantly different. Cosmetic result was better with surgery. High satisfaction was reported by 65.0% of patients treated with CO2 ablation. Time of wound healing was significantly shorter with CO2 laser. CONCLUSION: In comparison to cryotherapy, pulsed CO2 laser showed no statistically significant difference in efficacy, cosmetic outcome, and patient satisfaction. Time to healing was shorter; the cost and cost-effectiveness ratio were similar. Surgery had the greatest efficacy rate. The main limitation of this study was the short duration of follow-up (3 months).

Topical Boswellic acids for treatment of photoaged skin.

Boswellic acids (BAs) are pentacyclic triterpenes extracted from the gum resins of the tropical tree Boswellia serrata. They are orally administered in traditional Indian medicine for the treatment of several inflammatory disease and cancer because of their anti-inflammatory and immunomodulatory activities as well as stimulatory effects on fibroblasts. The present authors have investigated efficacy, tolerability, and safety of a base cream containing 0.5% BAs in the treatment of clinical manifestations of photoaging of facial skin with a randomized, double-blind, placebo-controlled, split-face study. Fifteen female volunteers applied the creams with or without BAs on the half sides of the face once daily for 30 days. Significant improvements of the Dover's global score for photoaging, tactile roughness, and fine lines, as well as, with noninvasive diagnostic techniques, an increase of elasticity, a decrease of sebum excretion, and a change of echographic parameters were observed with topical BAs in comparison with placebo. The treatment was always well tolerated without adverse effects. The present findings seem to indicate that topical application of BAs may represent a suitable treatment option for selected features of skin photoaging.

A short cycle of narrow-band UVB phototherapy in the early phase of long-term efalizumab can provide a quicker remission of moderate and severe psoriasis: a pilot study.

BACKGROUND: Efalizumab, albeit highly efficient in psoriasis treatment, displays a slower rate of clearance when compared to anti-tumor-necrosis-factor-alpha drugs. It has been suggested that a combination of treatments might accelerate efalizumab response. OBJECTIVE: To determine whether the combination of narrow-band ultraviolet B (NB-UVB) phototherapy and efalizumab could improve the therapeutic efficacy of efalizumab alone in moderate to severe psoriasis. methods: Ten patients underwent a treatment cycle with a whole-body NB-UVB phototherapy (3 sessions a week) during the first 4 weeks of a 6-month treatment with efalizumab at 1 mg/kg body weight/week. In addition, one of two similar plaques, selected for each patient, was shielded during phototherapy. RESULTS: A statistically significant reduction of the psoriasis severity index score was observed at 4 weeks in the irradiated plaque. A Psoriasis Area and Severity Index 75 was achieved by 70% of patients by week 12 as compared to 22-39% reported in the literature. CONCLUSION: This pilot study indicates that the combination with NB-UVB improves the efficacy of efalizumab monotherapy in the treatment of moderate to severe psoriasis.

Non-invasive diagnostic evaluation of phototherapeutic effects of red light phototherapy of acne vulgaris.

BACKGROUND: During the past few years, various phototherapeutic protocols with full-spectrum visible light or selected wavebands have been investigated in the treatment of acne vulgaris with variable results. METHODS: Fifteen women suffering from moderate acne vulgaris of the face were exposed to 20 J/cm(2) of broad-band red (lambda: 600-750 nm) light twice weekly for 4 weeks. In addition, with the aim to improve the present knowledge of the mechanisms of action of phototherapy, we measured skin sebum, pH, hydration and trans-epidermal water loss (TEWL). Lesions of the trunk were not irradiated and served as controls. RESULTS: A significant improvement of acne lesions and a significant decrease of skin sebum excretion and TEWL of the face were registered at the end of the therapy and at the 3-month follow-up visit. The results could be related to a reduced follicular colonization of Propionibacterium acnes, in that it was lethally damaged by photoactivated endogenous porphyrins. CONCLUSION: The present findings seem to indicate that red light phototherapy may represent an effective, well-tolerated, safe, simple and inexpensive treatment option for moderate acne vulgaris.