Evaluation of an ablative and non-ablative laser procedure in the treatment of striae distensae.

BACKGROUND: Striae distensae or stretch marks are atrophic linear dermal scars with epidermal atrophy. There are many therapeutic options for management, but no consistently effective modality is available yet. OBJECTIVE: We compared the efficacy of 1064 nm long pulse (LP) Nd: YAG laser and 2940 nm variable square pulse (VSP) erbium: YAG laser in the treatment of striae distensae. METHODS: Twenty female volunteers (Fitzpatrick skin types II-V) aged between 20 and 40 years with striae (3 patients with the rubra type and 17 with the alba type) were enrolled in the study. The duration of striae ranged from 4 months to 12 years. Lesions were located on the abdomen in all patients except one patient who had striae on the arms and two patients with striae in the lumbar region. Treatments were randomly allocated to both sides of the body in each patient, one side being treated with VSP erbium: YAG laser and the opposite side with LP Nd: YAG laser. All subjects were treated monthly for a total of three treatments. Two 3-mm punch biopsies were obtained from six subjects, both of the same striae, one before the first treatment and one 4 weeks after the last session. RESULTS: Response was evaluated clinically by photographic comparison and was found to be poor in 17 subjects, both on the LP Nd: YAG laser treated side and VSP erbium YAG laser treated side. All these patients had mature lesions (striae distensae alba). Three subjects had a moderate response on both sides; these patients' striae were immature (striae distensae rubra). Histologically, elastic fibers were slightly increased in post-treatment samples compared with pretreatment skin biopsies. CONCLUSION: We observed no satisfactory clinical improvement in striae distensae alba lesions although histopathological changes were seen. We suggest that variable square pulse Er: YAG and long pulse Nd: YAG lasers are not useful in the treatment of striae distensae alba.

Removal of corns by punch incision: a retrospective analysis of 15 patients.

BACKGROUND: Hard corns are firm, small, dome-shaped papules with translucent central cores, which occur on the palmoplantar region of toes and hands due to repeated trauma. Medical management of hard corns is difficult and sometimes requires surgical excision. Punch incision is a technique which is performed using a circular blade or trephine attached to a pencil-like handle. AIM: We hypothesized that it might serve as an alternative method to surgical excision in the treatment of recalcitrant corns and performed the technique to treat 17 corns in 15 patients. The present study aimed to review these 15 patients retrospectively and evaluate the effectiveness of punch incision. METHOD: A total of 15 patients with recalcitrant corns were treated using punch incision between April 2011 and December 2012 and were evaluated by photographs and patient satisfaction questionnaires. RESULTS: Out of the 17 corns, 3 corns persisted after punch incision and the patients were referred to the orthopedic clinic for further treatment; 2 of the 17 corns partially responded and required additional topical treatment; and 12 of the 17 corns responded completely to punch incision. CONCLUSION: Punch incision is a simple and effective technique for the treatment of small corns on the palms and soles.