Pulsed dye laser as an excellent choice of treatment for lupus tumidus: a prospective study.

BACKGROUND: Clinical manifestations of cutaneous lupus erythematosus (CLE) vary widely, and different subtypes of this autoimmune disease exist. Tumidus subtype (LT) has been recently separated from the chronic subtypes and is now considered an independent entity due to its particular clinical and histological features. Different treatments are usually prescribed for CLE. Our group has experience of CLE effectively treated with pulsed dye laser (PDL). It was our impression that better responses were achieved in the LT subtype, but no controlled prospective studies with PDL have been specifically performed. MATERIALS AND METHODS: A prospective study was performed on 10 patients with histologically confirmed LT treated with PDL. All patients were treated with 595 nm PDL using the 10 mm spot size at 0.5 ms pulse width and a fluence of 8 J/cm(2). Biopsies were taken before and 4 weeks after treatment and were stained with haematoxylin-eosin. RESULTS: Evaluation after PDL treatment showed clinical improvement in all of them without side-effects and reduction of the dermal lymphocytic infiltrate in 9/10 of the patients. Epidermal changes were absent in all patients. Mucin deposition persisted only in one patient. However, 50% of the patients developed new lesions nearby or distant to the treated zones. CONCLUSIONS: PDL therapy is an effective and fast treatment option for acute flares of LT; however, it does not prevent recurrences. A histological improvement has been confirmed in this study. Purpura seems to be necessary to achieve a good response.

Ablative fractional yttrium-scandium-gallium-garnet laser for scarring residual haemangiomas and scars secondary to their surgical treatment.

BACKGROUND: Infantile haemangiomas are benign self-involuting tumours. They have a characteristic clinical course marked by early proliferation and followed by spontaneous involution. However, residual evidence with scar formation, fibrofatty residua, atrophic wrinkling, yellowish discoloration and telangiectasias is usually seen after involution. OBJECTIVE: The aim of this study was to assess the efficacy and safety of ablative fractional yttrium-scandium-gallium-garnet (YSGG) laser in patients with residual haemangiomas or with scarring after their surgery. METHODS: Twelve patients with atrophic scar or fibrofatty tissue secondary to residual hemangiomas or with scarring after surgery of haemangioma were treated with one or two sessions of ablative fractional YSGG laser at 2.790-nm wavelength. Laser therapy was performed using a spot size of 300 µm, a pulse width of 600 ms, a fluence range between 120 and 200 mJ per microspot and a density level of 3. Treatment with PDL at 595-nm or with combined sequential 595 nm PDL and 1064 nm Nd:YAG was applied if telangiectasias or a residual vascular component were present. Three dermatologists evaluated treatment effectiveness by means of photographs of the patients before starting and 3 months after finishing the therapy; the degree of improvement was rated from 0 to 4. Parents' satisfaction was also assessed (scale from 0 to 10). RESULTS: Improvement was rated as 3 in two patients, 2 in four patients, 1 in five patients and no improvement in only one patient. Mean improvement was 1.58. Degree of parents' satisfaction ranged from 0 to 10. Mean satisfaction was 6.75. A discrete punctuate pattern was seen in three patients as the only long-lasting side-effect. CONCLUSION: We consider that ablative fractional YSGG laser could be an interesting option for the treatment of selected patients with atrophic wrinkling or scarring residual haemangiomas and scars secondary to their surgical treatment.