Combined CO2 and dye laser technique in the treatment of outcomes due to flap necrosis after surgery for basal cell carcinoma on the nose.

BACKGROUND AND OBJECTIVE: Basal cell carcinoma (BCC) is the most frequent cutaneous cancer worldwide, and the nasal area is the most commonly affected region. Skin flaps are usually performed to achieve radical results, but various adverse events often occur. The necrosis of the skin flap is one of the most frequently observed, resulting in scars and anti-aesthetic outcomes. Ablative and non-ablative lasers have been proposed to improve scars resulting from surgical failure and skin flap necrosis. STUDY DESIGN/MATERIALS AND METHODS: This study aims to evaluate a new laser protocol combining ablative CO2 -laser with flashlamp pulsed dye laser for the treatment of nasal scars resulting from the necrosis of flap that occurred after surgery. Twelve patients were enrolled in the study, and a total of five laser sessions were planned, spaced from 14 days to 1 month apart. RESULTS: Seven out of 12 patients underwent all the five laser sessions planned, while 5/12 patients achieved optimal cosmetic results within the fourth session. Eighty percent of the patients reported good/optimal cosmetic results, and no significant side effects were observed during the study. CONCLUSION: Combining fractionated CO2 laser with flashlamp pulsed dye laser represents a new effective modality for treating skin flap necrosis after BBC removal, representing a valid alternative to other surgical procedures.

Combination of Specific Vascular Lasers and Vascular Intense Pulsed Light Improves Facial Telangiectasias and Redness.

Background and objectives: Facial telangiectasias are dilated blood vessels that can represent a cosmetic issue for patients. They may be associated with other conditions, such as rosacea. Laser and light treatments are nowadays becoming a cornerstone in the management of these lesions. Materials and Methods: In total, 68 patients seeking medical treatment for facial telangiectasias were enrolled from 1 March 2019 to 1 March 2020 at the Dermatological Unit of Magna Graecia University (Catanzaro, Italy). A protocol consisting of a 1064 Nd:YAG laser for darker blue telangiectasias and 532 nm Nd:YAG for red lesions followed by intense pulsed light with an optimized spectrum for vascular lesion 3 weeks after the first procedure was proposed. A three-month follow-up visit assessed patient's satisfaction using a visual analog scale (VAS). Two dermatologists measured clinical results using a 4-point scale, comparing pictures before treatment and at follow-up. Results: A total of 68 patients (32 males and 36 females) completed the study, performing all requested treatments. No severe side effects were reported. Patient satisfaction was very high (8.15 ± 1.05 out of a 10-point VAS scale), as well as dermatologists' clinical evaluations (2.19 ± 0.74 out of 3). Conclusions: The combination of vascular lasers and Vascular Intense Pulsed Light acting specifically on small blood vessels may help to improve the aesthetic outcome, reducing side effects. A prospective study with a larger number of participants will be necessary to confirm this study's findings.

Sequential Use of CO2 Laser Prior to Nd:YAG and Dye Laser in the Management of Non-Facial Warts: A Retrospective Study.

Background and Objectives: Warts are benign lesions of viral etiology characterized by a hyperkeratotic appearance tending to spread across the skin surface. Various treatments have been proposed to manage this condition, such as acids, imiquimod, photodynamic therapy, cryotherapy, and various lasers. Materials and Methods: In this paper, we describe a combination protocol using CO2 laser prior to Nd:YAG laser for lesions interesting the palmoplantar areas or dye laser for lesions on other skin surfaces in the management of non-facial warts resistant to traditional therapies. In total, 34 patients with 103 warts suffering from wart infection resistant to traditional therapies treated from 1 January 2019 to 1 June 2020 were retrospectively enrolled at the Dermatological Unit of Magna Graecia University (Catanzaro, Italy). Two dermatologists measured clinical results, classifying lesions with complete resolution, partial resolution, or non-responding. Patients at four months follow-up were asked to evaluate their degree of satisfaction with a visual analog scale (VAS). Results: Almost all patients reported the complete resolution of lesions, with no patient reporting scarring. Five patients reported hypopigmentation in the treated areas. The mean satisfaction level was high. Only three patients experienced a relapse of the condition. Conclusions: Using a vascular laser following a CO2 superficial ablation of warts may help reduce the risk of scarring and decrease the incidence of relapses for lesions resistant to traditional therapies. Therefore, more extensive studies will be necessary to confirm the obtained results.

A new 675-nm laser device in the treatment of acne scars: an observational study.

PURPOSE: Acne scarring represents a common problem that negatively impacts patients' quality of life. Different types of treatments are currently available for this dermatological condition. This study evaluates the efficacy of a new 675-nm laser source system on acne scars with the use of established parameters that guarantee minimum pain and the absence of side effects such as hyperpigmentation, hypopigmentation, and blistering. METHODS: A total of 24 subjects (all women, aged 21-42 years), with Fitzpatrick skin types I-IV and facial acne scars, were treated with three sessions of a 675-nm laser system. Efficacy of treatment was evaluated using the Goodman and Baron's quantitative grading scale before and 3 months after the last treatment. RESULTS: All 24 patients treated with this new 675-nm laser had significant improvement of acne scars according to Goodman and Baron's Quantitative Global Acne Scarring Grading System. No side effect has been observed except some minor erythematous reactions in three patients. CONCLUSION: The 675-nm laser system we used appears to be effective and well-tolerated in patients with acne scars, and it involves a simple post-treatment management.

Emerging role of anti-IL23 in the treatment of psoriasis: When humanized is very promising.

Risankizumab is a novel anti-interleukin 23 humanized antibody developed to treat severe psoriasis. In this paper, we analyze the key information about this new drug and the results of phase 3 clinical trials already present in literature in order measure its safety and effectiveness in every day practice. Risankizumab seems to be one of the best performing drugs in the treatment of psoriasis, with a good safety profile and a dosage regimen less frequent than all other biologic agents, although head-to-head randomized clinical trials with other anti-interleukin treatments will be necessary in order to confirm these preliminary results.

Combination of Fractional CO2 Laser and Rhodamine-Intense Pulsed Light in Facial Rejuvenation: A Randomized Controlled Trial.

Objective: This randomized controlled trial aims to verify the efficacy of a combined fractional CO2 laser and rhodamine-intense pulsed-light (r-IPL) protocol in the photoaging therapy. Background: Skin aging is related to multiple environmental and genetic factors that give rise to different manifestations. In recent years many techniques have been proposed for the rejuvenation of the skin of the face such as ablative and nonablative procedures. Combination of laser or light sources with different wavelengths represents a safe and effective treatment method. r-IPL is a new pulsed-light technique capable to generate wavelengths varying from 550 to 650 nm proposed in nonablative photorejuvenation with a good efficacy and safety profile. Methods: Twenty-two patients (skin phototypes II-III, aged 46-67 years) were randomly allocated into two groups: group A was treated only with a therapeutic standard dose of the fractional CO2 laser, whereas group B was treated with a combined therapy of r-IPL and fractional CO2 laser. All patients were treated up to three times at a 2-month interval. Efficacy of the procedures was assessed thanks to the Fitzpatrick Wrinkle Severity Scale (scores 1-9) before treatment and at a 4-month follow-up from the last treatment. Results: Patients treated with the combination of r-IPL and fractional CO2 laser showed better results in terms of wrinkle reduction according to the Fitzpatrick Wrinkle Severity score (2.82 ± 0.87 vs. 3.09 ± 1.14), with a statistically significant reduction in healing times (7.82 ± 0.75 vs. 13.82 ± 1.94 days, p ≤ 0.001) and duration of post-treatment erythema (3.55 ± 0.93 vs. 8.18 ± 1.47 days, p ≤ 0.001). Patient satisfaction was higher after combined fractional CO2 laser and r-IPL treatment. Conclusions: Our data suggest that combined use of fractional CO2 laser and r-IPL may lead to excellent results in terms of skin rejuvenation with a simple post-treatment management and an optimal tolerability.

A New 675 nm Laser Device in the Treatment of Facial Aging: A Prospective Observational Study.

Objective: To evaluate the effectiveness and safety of a 675 nm laser device in the treatment of facial aging. Background: Wrinkles represent a major sign of aging skin and are considered a major topic in cosmetic dermatology, representing a common problem that negatively impacts patients' quality of life. Different types of treatments are currently available. The aim of this study was to assess the efficacy and safety of a new 675 nm laser source system on facial wrinkles. Methods: A total of 22 consecutive female (age 49.36 ± 8.72) patients, with Fitzpatrick skin types II-IV and facial wrinkles, were treated with three sessions of a 675 nm laser system. Efficacy of treatment was assessed using the Modified Fitzpatrick Wrinkles Scale pre and postoperatively before 3 months. Results: All 22 patients treated with the 675 nm laser had a significant improvement of facial wrinkles according to the FWS (from 1.59 ± 0.80 to 1 ± 0.64; p ≤ 0.001). No side effects occurred except a mild erythematous rash in two patients. Conclusions: This novel 675 nm laser system can be considered a promising and effective tool in patients with facial wrinkles, and it involves a simple post-treatment management.

Nanosecond Q-Switched 1064/532 nm Laser to Treat Hyperpigmentations: A Double Center Retrospective Study.

(1) Benign hyperpigmentations are a common problem in cosmetic dermatology. Melasma, solar lentigo, and other acquired hyperpigmentations represent an aesthetic issue for an increasing number of patients. The gold standard in managing this condition is currently 1064/532 nanometers (nm) Q-Switched lasers. This study reports our experience on the use of a Q-switched laser with a nanosecond pulse to treat these conditions. (2) Methods: A total of 96 patients asking for benign hyperpigmentation removal were consecutively enrolled at the Magna Graecia University of Catanzaro and Tor Vergata University of Rome. Treating parameters were the following: 1064 nm with a pulse duration of 6 nanoseconds (ns) for dermic lesions and 532 nm with 6 ns for epidermal ones. Up to five treatments with a minimum interval between laser treatments of thirty days were performed. A follow-up visit three months after the last session assessed patient satisfaction with a Visual Analogue Scale (VAS). Two blinded dermatologists assessed the cosmetic result using a five-point scale comparing pictures before treatment and at follow-up. (3) Results: 96 patients were included; 47 participants were women (49.0%) and 49 men (51.0%). The mean reported age was 50.0 ± 17.3 years. All patients reached a good to complete hyperpigmentation removal at the dermatological evaluation with a mean VAS score of 8.91 ± 1.07. (4) Conclusions: Q Switched 1064/532 nm laser may be considered the gold standard treatment for benign hyperpigmentations. Our results confirm the literature findings on the effectiveness of these devices.

Daylight photodynamic therapy with 5-aminolevulinic acid 5% gel for the treatment of mild-to-moderate inflammatory acne.

BACKGROUND: Acne vulgaris is a chronic inflammatory disease that frequently occurs in adolescence. This common condition is often treated with topical or systemic therapies according to severity. Photodynamic therapy (PDT) with topical delta-aminolaevulinic acid is a novel drug-sparing, but time-consuming approach. Recently, sunlight exposure has been considered a quicker, safer, cheaper and more agreeable alternative light source for PDT, but efficacy has only been proven in the oncological field. This study aimed to evaluate the efficacy and tolerability of daylight PDT (DL-PDT) for the treatment of inflammatory acne vulgaris of face, chest and trunk lesions. METHODS: Twenty patients with mild-to-moderate acne vulgaris were enrolled and treated with a topical gel based on 5% delta-aminolaevulinic acid, administered 4 times at 14-day intervals. Efficacy was assessed with mean lesion count, Physician Global Assessment (PGA), Investigator's Global Assessment (IGA) and patients' self-assessment (10-point scale). RESULTS: Compared to T0, mean inflammatory lesions count decreased in all patients at FU1, from 16.7±4.4 to 5.2±3.3 (P). No adverse events were reported, and no patients were lost to follow-up. PGA results of "excellent" or "good" improvement were reported in 95% at T3 and 90% at FU1. Patients' self-assessments was 7.6±1.0 (T3). Discomfort was 0.5±0.2 (T3 and FU1). CONCLUSIONS: DL-PDT seems to be an effective and tolerable therapy for the treatment of mild-to-severe inflammatory acne. This novel regimen seems to be a viable option in the panorama of acne therapies.

Spider bites of medical significance in the Mediterranean area: misdiagnosis, clinical features and management.

Despite the disrepute spiders have had for centuries, their bite is a rare occurrence. In the Mediterranean area, only two of the numerous known species are considered of medical significance: Latrodectus tredecimguttatus and Loxosceles rufescens. Spider bites have no pathognomonic signs or symptoms, therefore most diagnoses are presumptive; a spider bite can only be diagnosed when a spider (seen at the time of the bite) is collected and identified by an expert, since most physicians and patients are unable to recognize a certain spider species or distinguish spiders from other arthropods. Skin lesions of uncertain etiology are too often attributed to spider bites. In most cases, these are actually skin and soft-tissue infections, allergic reactions, dermatoses etc. Misdiagnosing a wound as a spider bite can lead to delays in appropriate care, cause adverse or even fatal outcomes and have medical-legal implications. Concerningly, misinformation on spider bites also affects the medical literature and it appears there is lack of awareness on current therapeutic indications for verified bites.

A New 675 nm Laser Device in the Treatment of Melasma: Results of a Prospective Observational Study.

Objective: This study evaluates the efficacy and safety of a new 675 nm laser source system on melasma. Background: Melasma is an acquired circumscribed hyperpigmented disorder that has a negative impact on patients' life quality. Different treatments are currently available. This study evaluates this new 675 nm laser source system, on melasma with the use of established parameters that guarantee minimum pain, the absence of side effects, and simplifying posttreatment management. Materials and methods: A total of 25 subjects (all women, 21-50 years old), with facial melasma and Fitzpatrick skin types I-III, were treated with three sessions of a new 675 nm laser system. Efficacy of treatment was evaluated using Melasma Severity Index (MSI) score before and 3 months after the last session. The appearance of side effects has also been monitored to evaluate safety. A preclinical study was executed to evaluate laser effectiveness on sheep skin. Results: All 25 subjects treated with the 675 nm laser had significant improvement in melasma according to MSI score (mean baseline MSI 26.4 ± 19.2; mean 3-month follow-up MSI 17.3 ± 15, p: 0.003). Histology in preclinical study showed selective damage of melanin-rich areas. No side effects have been observed except some minor erythematous reactions in two patients. Conclusions: Due to its high affinity with melanin, and its minimal interaction with the vascular component, novel 675 nm laser may be considered promising when treating benign pigmented lesions with a low risk of side effects and simple posttreatment management.

New Insight in Noninvasive Rejuvenation: The Role of a Rhodamine-Intense Pulsed Light System.

Background: Rhodamine-intense pulsed light (r-IPL) is a noncoherent, noncollimated, polychromatic light energy optimized for a double-peak wavelength emission, ranging between 550-680 and 850-1200 nm. Traditional IPL works within visible and infrared spectra, targeting hemoglobin and melanin, are effective to treat rosacea and pigmentary disorders. r-IPL, a new technology in dermatology, emits high-intensity light with a wavelength peak similar to the one of the pulsed dye lasers, showing a good safety and efficacy profile in nonablative photorejuvenation. Objective: Assess efficacy and safety of r-IPL on photodamaged facial skin showing hyperpigmentation, telangiectasias, fine lines, and textural changes. Methods: Five sessions of r-IPL treatment (fluence ranged between 13.5 and 14 J/cm2) have been performed on one 75-year-old lady affected by facial photodamaged skin. Efficacy of treatment was evaluated using the Fitzpatrick Elastosis and Wrinkles Scale (FEWS) and the Global Aesthetic Improvement (GAI) Scale assessed by an investigator, compared with baseline. Treatment safety and tolerance were also evaluated using the Visual Analog Scale (VAS). Results: Photographic and multispectral evaluation demonstrated relevant improvement (vascular, pigment, and texture) of photodamaged facial skin. One month after the last treatment, significant improvement in facial wrinkle and texture was noted. FEWS scores decreased significantly from 7 to 2. According to the GAI scale, the patient had an improvement in skin texture. Immediate response included mild-to-moderate erythema and only trace-mild edema in the treatment area. Pain during the treatment was minimal with a mean VAS pain score of 3/10. No other adverse events were reported. No post-treatment downtime was recorded. Conclusions: r-IPL may represent a valid therapeutic approach in noninvasive photorejuvenation.

Lp-PLA2, a new biomarker of vascular disorders in metabolic diseases.

Metabolic diseases are chronic disorders correlated to a greater risk of cardiovascular event and death. Recently, many data have sustained the biological link between microvascular dysfunction, oxidative stress, vascular inflammation, and metabolic diseases. The determination of new and specific blood biomarkers of vascular inflammation associated with obesity-related metabolic syndrome (MetS) and diabetes such as lipoprotein-associated phospholipase A2 (Lp-PLA2) could be useful to identify subject with high risk of cardiovascular events. Lp-PLA2 participates by a crucial role in microvascular dysfunction and oxidative stress showing positive association with metabolic disorders. In this review, we will argue the evolving role of Lp-PLA2 in predicting cardiovascular events in metabolic disease patients.

Flash-lamp pulsed-dye laser treatment of keloids: results of an observational study.

OBJECTIVE: Flash lamp pulsed dye laser (FPDL) was used in a selected group of patients with hypertrophic scars and keloids. Objective of the study was to assess the efficacy on a large number of cases. BACKGROUND DATA: FPDL is a nonablative technology, typically used in vascular malformation therapy because of its specificity for hemoglobin. METHODS: A total of 59 patients (33 males and 26 females, mean age 37.5 years) affected by hypertrophic postsurgical scars and keloids, underwent from four to six treatment sessions with a flash lamp pumped pulsed dye laser. Clinical follow-up was performed 6 months after the last treatment. Results were judged by blind observers. RESULTS: A total of 29 patients out of 59 (49.1%) achieved excellent clearance, 15 patients (25.4%) achieved good to moderate clearance, and 12 patients (20.4%) obtained slight improvement. Only three subjects (5%) had little or no removal of their lesion. Treatment was well tolerated with minor and transient side effects. CONCLUSIONS: FPDL is known as a safe and effective treatment for different dermatological lesions in which skin microvessels play a key role in pathogenesis or development. This laser was effective when applied to hypertrophic scars and keloids. Further studies in a larger set of patients, however, are required to assess a standardized and reproducible method for treating these lesions.

Deep pulse fractional CO2 laser combined with a radiofrequency system: results of a case series.

OBJECTIVE: The purpose of this study was evaluation of the safety and efficacy of this new combined technology that adds deep ablation to thermal stimulation. BACKGROUND DATA: Minimally ablative or subablative lasers, such as fractional CO2 lasers, have been developed in an attempt to achieve the same clinical results observed with traditional ablative lasers, but with fewer side effects. Despite being an ablative laser, the system used in this study is able to produce a fractional supply of the beam of light. Fractional ablation of skin is performed through the development of microscopic vertical columns surrounded by spared areas of epidermis and dermis, ensuring rapid wound healing and minimum down time. Simultaneous synchronized delivery of a radiofrequency (RF) current to the deeper layers of the skin completes the therapeutic scenario, ensuring an effective skin tightening effect over the entire treated area. METHODS: Nine adult patients were treated for wrinkles and acne scars using this new laser technology. An independent observer evaluated the improvement using a five point scale. RESULTS: All patients had good results in terms of improvement of skin texture, with mild and transitory side effects. CONCLUSIONS: This novel combined system produced improvement in wrinkles and acne scars, with progressive enhancement of skin tone and elasticity.