[Rhinophyma : Successful treatment with low-dose oral isotretinoin]. / Rhinophym : Therapieerfolg mit niedrig dosiertem systemischem Isotretinoin.

Rhinophyma is a form of rosacea and is often cosmetically disfiguring. There are various therapeutic ablation modalities. Surgery is often associated with down-time and side-effects. We describe successful treatment with low-dose isotretinoin as a safe alternative with a lower risk of complications. We also discuss the advantages and disadvantages of various therapeutic modalities.

Neodymium-doped yttrium aluminium garnet (Nd:YAG) 1064-nm picosecond laser vs. Nd:YAG 1064-nm nanosecond laser in tattoo removal: a randomized controlled single-blind clinical trial.

BACKGROUND: For decades, nanosecond lasers (NSLs) have been used to remove tattoos. Since 2012, pulses of picosecond lasers (PSLs) have been available for tattoo removal. Based on a few observational studies, the claim has been made that PSLs are considerably more effective while showing fewer side-effects in comparison with NSLs. OBJECTIVES: To compare the efficacy and side-effects of a PSL side by side with an NSL for tattoo removal. METHODS: Twenty-one patients with 30 black tattoos were treated with PSL and NSL in a split-study design in two sessions at intervals of 6 weeks. The safety and efficacy of laser treatments were determined by blinded observers assessing randomized digital photographs in this prospective clinical study. The primary end point was the clearance of the tattoos ranging in quartiles from 0% to 100%; secondary end points were side-effects and pain. RESULTS: The average clearance overall as evaluated showed no statistical difference between NSL and PSL (P = 1·00). Using a visual analogue scale (0 = no pain, 10 = maximum pain), a value of 3·8 ± 1·0 was reported for the PSL, which was statistically different from NSL (7·9 ± 1·1, P < 0·001). Transient side-effects were observed, as well as hypo- and hyperpigmentation, but there was no statistically significant difference between PSL and NSL. CONCLUSIONS: After two treatments of black tattoos with a neodymium-doped yttrium aluminium garnet laser (1064 nm), the use of picosecond pulses does not provide better clearance than nanosecond pulses. However, pain is less severe when using a PSL.

[Recurrent pyogenic granuloma. Treatment at difficult anatomic sites with the long-pulsed Nd:YAG laser (1064 nm)]. / Therapieresistentes Granuloma pyogenicum. Behandlung an schwierigen anatomischen Lokalisationen mit dem lang gepulsten Nd:YAG-Laser (1064 nm).

Treatment of pyogenic granuloma is still difficult as lesions tend to recur. There are various means of treatment: surgical, cryotherapy, topical agents and various lasers. We successfully treated two recurrent pyogenic granulomas at difficult sites (on the tip of the finger and ear) using the Nd: YAG laser (1064 nm). Several treatments under local anesthesia were needed. The energy was increased until coagulation was visible. The laser treatment led to complete resolution.

[New approach to photoepilation. Diode laser with SHR (Super Hair Removal) compared to alexandrite laser]. / Ein neuer Ansatz in der Laser-Haarreduktion. Diodenlaser mit SHR ("Super Hair Removal") im Vergleich mit dem Alexandritlaser.

BACKGROUND: Photoepilation has been an essential field of application of dermatologic laser therapy for many years. The present article evaluates whether the use of a new operation mode of a long-pulsed diode laser can be effective, nearly painless, with few side effects and independent of the skin type. To this aim, its use has been compared to an established method of photoepilation. MATERIAL AND METHODS: In a controlled prospective study with 18 (♀=12, ♂=6) patients aged between 22 and 58 years, the effects of photoepilation with the long-pulsed alexandrite laser and the long-pulsed diode laser, operated in the Super Hair Removal mode (SHR), were compared. RESULTS: The alexandrite laser is slightly more effective with fair skin types; the SHR mode is clearly more effective with dark skin types. Regarding painfulness, the SHR mode is clearly superior. In terms of speed, the two systems are comparable. The alexandrite laser is more user-friendly because of its light and small handpiece. CONCLUSION: The major advantages of the SHR mode are its effectiveness in dark skin types and its lack of pain. The alexandrite laser is slightly more effective with fair skin types, slightly faster and its handling is considerably more comfortable. None of the two systems has yet brought about a breakthrough with fair hair.

The pulsed-dye laser as an adjuvant treatment modality in acne vulgaris: a randomized controlled single-blinded trial.

BACKGROUND: Acne vulgaris is the most common skin disease and can pose a substantial therapeutic challenge. Recently, several phototherapeutic modalities, most notably pulsed-dye laser (PDL) treatment, have been introduced, but the published results - albeit promising - are controversial. OBJECTIVES: To assess the efficacy of an adjuvant PDL treatment when combined with a proven topical treatment [fixed-combination clindamycin 1%-benzoyl peroxide 5% hydrating gel (C/BPO)]. METHODS: Eighty patients (38 males and 42 females, mean +/- SD age 19.7 +/- 5.9 years) were randomized in a 1 : 2 ratio to receive C/BPO alone or in combination with PDL treatment (wavelength 585 nm, energy fluence 3 J cm(-2), pulse duration 0.35 ms, spot size 7 mm). Patients were evaluated at baseline and at 2 and 4 weeks after initial treatment. The primary end points were the Investigator's Static Global Assessment (ISGA) score and lesion count; the secondary end point was the Dermatology Life Quality Index (DLQI). RESULTS: Both groups showed a significant improvement during observation [ISGA 27.1% (C/BPO) and 24.6% (C/BPO + laser), total lesion count 9.2% and 9.0%, inflammatory lesion count 36.3% and 36.9%, DLQI 54.5% and 42.5%], but there was no significant or otherwise appreciable difference between treatment modalities as far as the extent of improvement was concerned. Patients with more severe findings at baseline had a greater benefit from either therapy regimen. CONCLUSIONS: Our findings do not support the concept of a substantial benefit of PDL treatment in acne vulgaris.

Tattoo removal by non-professionals--medical and forensic considerations.

Tattoos are common phenomena in the western world and the demand for their removal has become widespread in the recent years. The introduction of quality-switched lasers has provided an effective removal method that is increasingly being exploited by tattoo studios themselves. Dermatologists, however, are frequently confronted with complications and side effects of tattoo removals that were performed by non-professionals. The objective of this study is to assess potential risks and pitfalls of laser tattoo removal when performed by medical laymen. The methods followed are systematic and evidence-based review of the literature. Four major problem areas were identified: rare but potentially severe allergic or toxic effects of decomposition products of the tattoo pigments; bodily harm caused by out-of-specification usage of the laser devices; malignant disease that is obscured within the area of a tattoo and requires meticulous dermatological diagnosis; and insufficient pre-operative consultation of patients about the risks, side effects and realistic expectations on the therapeutic outcome. We came to a conclusion that tattoo laser removal by medical laymen is unacceptable from the point of view of patient safety and the laws need to ban this practice swiftly.

[Fractional photothermolysis. Treatment of post-inflammatory hyperpigmentation following meadow grass dermatitis]. / Fraktionierte Photothermolyse. Behandlung der postinflammatorischen Hyperpigmentierung nach Wiesengräserdermatitis.

Postinflammatory hyperpigmentation (PIH) is a benign but cosmetically disturbing skin lesion, which is notoriously difficult to treat. Standard treatments include topical application of bleaching creams and gels. In this case report, we show that fractional photothermolysis might be a new successful option in the treatment of PIH. Its efficacy must be confirmed by further studies and balanced against possible side effects, but the initial results are promising.

[Segmental Darier disease : treatment with pulsed dye laser]. / Segmentaler Morbus Darier : Behandlung mit dem gepulsten Farbstofflaser.

Darier disease is often associated with pruritus and an unpleasant odor, causing medical and emotional problems. Ablative laser therapy has proven effective in ameliorating these symptoms. Side effects of this approach include permanent hypopigmentation and a risk of scarring. We present two cases where non-ablative therapy with pulsed dye lasers proved a safe and effective way to manage the intertriginous lesions. Although the mechanism of action is unclear, our success indicates that pulsed dye laser therapy is an option in Darier disease. Larger numbers of patients, ideally in multicenter studies, must be treated in this way to confirm our results.

[Treating papillomatous intradermal nevi: lasers - yes or no? A prospective study]. / Management papillomatöser intradermaler Nävi: Laser ja oder nein? Eine Prospektivstudie.

BACKGROUND: Papillomatous intradermal nevi are common acquired melanocytic nevi. Although harmless, they can be - especially on the face - cosmetically disturbing. At selected sites on the trunk, they may be traumatized by clothing, so that patients often wish to have them removed with a low likelihood of recurrence. MATERIAL AND METHODS: In a prospective study with 90 (female symbol=77, male symbol=13) patients aged between 13 and 67 years, 130 intradermal nevi (female symbol=114, male symbol=16) were removed using a combined therapy with CO(2), erbium: YAG and ruby lasers. RESULTS: After therapy, 2.3% of intradermal nevi recurred as a pigmented macule, while 6.9% reappeared as a papule or nodule (volume recurrence). 88% of the patients were very satisfied with the result; 11%, satisfied; and 1%, not satisfied. 99% would undergo the therapy again. CONCLUSION: The combined laser method (CO(2), erbium: YAG and ruby lasers) for the treatment of intradermal nevi produces excellent cosmetic results, is easily performed, leads to high patient satisfaction and is safe if correctly applied.

[Fractional photothermolysis: a new option for treating melasma?]. / Fraktionierte Photothermolyse: Eine neue therapeutische Option in der Behandlung des Melasma?

Melasma or chloasma is a common acquired hypermelanosis of the face and neck that is notoriously difficult to treat. Laser treatment has been employed in patients who do not respond to conventional topical agents but has failed to achieve an acceptable compromise between efficacy and side effects. Fractional photothermolysis (FP) combines the efficacy of ablative and the tolerability of non-ablative laser treatment in some skin conditions. There are few studies on using FP in melasma and its value cannot be estimated presently. Review of the literature and the authors' own experience show a definite potential which should be further investigated in systematic studies, but we cannot at this point subscribe to the euphoria expressed in some publications.

Does dye laser treatment with higher fluences in combination with cold air cooling improve the results of port-wine stains?

BACKGROUND AND OBJECTIVE: The use of cold air cooling (CAC) and cryogen spray cooling during dye laser treatment of port-wine stains (PWS) has become a standard in recent years. Still unsolved is the question of which fluences are necessary in combination with CAC in order to achieve an optimum clearance and the lowest possible rate of side-effects. STUDY DESIGN: In a prospective study, we treated 11 patients with PWS with pulsed dye laser (Photogenica V, Cynosure, lambda = 585 nm, iota(p) = 0.5 ms, spot size = 7 mm). Each PWS was partitioned into three areas: (area 1) 6 J/cm(2) without CAC, (area 2) 6 J/cm(2) with CAC (level 4), (area 3) 9 J/cm(2) with CAC (level 4). RESULTS: Area 3 (mean, 59%) showed a slightly better clearance than area 1 (mean, 57%); in area 2, we observed a reduced clearance (mean, 45%). Compared with area 1, we achieved a reduction of pain through CAC in areas 2 and 3. The healing periods as well as the rate of side-effects were comparable in all areas. CONCLUSION: We observed a slight but not statistically relevant increase in clearance with the use of higher fluences and CAC compared with lower fluences without CAC. Because pain is lowered significantly when using CAC, and because this makes the treatment more comfortable for the patients, we tend to recommend the use of higher fluences (9 J/cm(2)) with simultaneous CAC for treating PWS.

[Venous lakes. Treatment with a combination of diode laser (910 nm) and radio frequency]. / Lippenrandangiome. Behandlung mit einer Kombination aus Diodenlaser (910 nm) und Radiofrequenzenergie.

BACKGROUND: Venous lakes of the lip are a cosmetic problem for many patients due to their exposed location, nodularity, fragility and blue color. We sought an effective and well tolerated therapy method. PATIENTS AND METHODS: Over one year, we treated 20 patients with a combination of diode laser (910 nm) and radiofrequency. RESULTS: In all cases, there was complete regression of the venous lake (average: 1.4 treatment sessions). Side effects were transient pain that was assessed as mild by the patients, and transient swelling. Scarring or hypo-/hyperpigmentation did not occur. CONCLUSION: This combined approach is a recommended option at least equivalent to other therapy methods (argon laser, CO(2) laser, pulsed-dye-laser, and others), or even superior to them due to the low rates of side effects and low number of treatment sessions.

Pulsed dye laser: what's new in non-vascular lesions?

BACKGROUND AND OBJECTIVE: In dermatology, the pulsed dye laser (PDL) is the therapeutic instrument of choice for treating most superficial cutaneous vascular lesions. In addition, clinical experience over the last decade allowed us to treat patients with an ever increasing number of non-vascular indications. The purpose of this report is to summarize and critically appraise the scientific evidence that support the role of PDL in treating non-vascular skin lesions. METHODS: A literature-based study has been conducted, including the review of publications over the period January 1995 to December 2006, using the Medline Database. We also included our own experience in managing non-vascular lesions with the PDL. Four sets of preoperative and postoperative photos are presented. RESULTS: For viral skin lesions, PDL proved to be an alternative to other therapy options. This applies particularly to periungual warts and mollusca contagiosa. The mechanism of PDL with inflammatory dermatoses has not yet been elucidated. The effect seems to be better if there is a vascular component to the disease. With most of these indications (such as psoriasis and acne), PDL currently plays a rather minor or complementary role. Regarding collagen remodelling (hypertrophic scars, keloids, stretch marks, and skin rejuvenation), the question of whether a therapy makes sense or not has to be decided from case to case. CONCLUSION: With PDL, it is possible to achieve good results with numerous, partly less well-known indications (i.e. lupus erythematosus). With other diseases, PDL has so far been considered to be a complementary therapy method or to be in an experimental state.

[Laser therapy for vascular lesions]. / Laser- und Lichttherapie von vaskulären Hautveränderungen.

The use of lasers to treat vascular lesions began in the late 1960s with the introduction of argon laser. More recently pulsed laser and intense pulsed light techniques have further improved results and reduced side effects. Their function is based on the principle of selective photothermolysis. Simultaneous application of cooling methods (contact cooling, cold air, cryogen spray) has become standard procedure for these types of therapy, whose most important indications are port-wine stain, hemangioma, and telangiectasia. A persistent difficulty is their limited penetration, resulting in limited or no effect on deeper dermal layers. New approaches therefore include combinations with bipolar radio frequency or the use of two different laser systems, e.g., dye and Nd:YAG lasers. The different lasers are described along with their effectivity, limitations and indications.

[Excimer laser. Treatment of iatrogenic hypopigmentation following skin resurfacing]. / Excimerlaser. Behandlung von iatrogenen Hypopigmentierungen nach Skin-Resurfacing.

As skin resurfacing has become more common, the number of patients developing post-treatment hypopigmentation has increased. No effective treatment for this complication has been developed. Some hypopigmented disorders, including vitiligo, have been treated with the excimer laser. We used the XeCl excimer laser to successfully treat a 78-year-old woman with perioral leukoderma following CO(2) laser skin resurfacing. The repigmentation was stable for at least 16 months. Larger prospective studies of this new therapeutic intervention are recommended to evaluate its efficacy and long-term stability.

[Reticulohistiocytoma. Treatment with pulsed-dye laser]. / Retikulohistiozytom. Behandlung durch gepulsten Farbstofflaser.

Reticulohistiocytoma is a rare non-Langerhans-cell histiocytosis. On exposed skin areas it is a cosmetic problem and can cause mechanical irritation due to its prominent nature. We successfully treated a histologically confirmed reticulohistiocytoma on the back of a 60 year old woman with a pulsed dye-laser (wavelength 585 nm, pulse 0.45 msec). The lesion regressed significantly after the first treatment (spot size: 7 mm, fluence 7.8 J/cm(2)). After another laser treatment, the lesion completely disappeared. At 28 month follow-up, no recurrence was seen. Permanent side effects were not observed. In our case report the use of the pumped pulsed dye-laser has proven to be an elegant and low risk treatment option for reticulohistiocytoma. The mechanism of action remains unknown.

[Repigmentation of persistent laser-induced hypopigmentation after tattoo ablation with the excimer laser]. / Repigmentierung persistierender laserinduzierter Hypopigmentierungen nach Tätowierungsentfernung mit dem Excimerlaser.

Hypopigmented skin developed following tattoo removal with the Q-switched Nd:YAG laser. The hypopigmented area remained unchanged for over 4 years, until the use of the 308-nm xenon-chloride excimer laser induced a significant repigmentation in 40 sessions over 14 months. The excimer laser has the potential to influence the reduced activity of the melanocytes, as demonstrated with electron microscopy.