Blue light-emitting diodes for the treatment of localized vitiligo: A retrospective study.

BACKGROUND: Vitiligo is an autoimmune dermatological disease characterized by hypopigmented macules. Treatments include topical agents, phototherapy, and laser therapies. Different lasers should be individually chosen regarding location, extent, activity of the disease. AIMS: This article aims to demonstrate how blue LED is effective and safe, as its wavelength is very close to the UV spectrum (415 nm vs. 400 nm), but, unlike UV therapy, blue LED have not shown any long-term cancerogenic side effects. PATIENTS/METHODS: We treated 30 patients affected by vitiligo localized on different anatomical areas with blue light-emitting diodes. RESULTS: Complete repigmentation occurred in 75.33% of treated patients (22 out of 30 patients, 14 males, and 8 females). Partial repigmentation occurred in the remaining patients. CONCLUSIONS: Blue LED light may be a safe and well-tolerated way to induce repigmentation in patients affected by vitiligo.

Local Chemotherapy as an Adjuvant Treatment in Unresectable Squamous Cell Carcinoma: What Do We Know So Far?

Background: Squamous cell carcinoma (SCC) is one of the most common cancers involving skin and oral mucosa. Although this condition's gold-standard treatment is the surgical removal of the lesions, the physician must propose alternative treatments in some cases due to the patient's ineligibility for surgery. Among the available alternative therapies, local chemotherapy may represent an initial treatment in combination with radiotherapy or systemic chemotherapy due to the low frequency of side-effects and the lack of necessity for expensive devices. Methods: In this paper, we review all available literature in various databases (PubMed, Scopus-Embase, Web of Science), proposing local chemotherapy as a treatment for cutaneous and oral SCC. Exclusion criteria included ocular lesions (where topical treatments are common), non-English language, and non-human studies. Results: We included 14 studies in this review. The majority were case reports and case series describing the treatment of non-resectable localized SCC with either imiquimod or 5-fluorouracil. We also analyzed small studies proposing combination treatments. Almost all studies reported an excellent clinical outcome, with a low risk of relapses in time. Conclusions: Resection of the lesion remains the gold-standard treatment for SCC. When this approach is not feasible, local chemotherapy may represent a treatment alternative, and it may also be associated with radiotherapy or systemic chemotherapy.

Fluorescent light energy combined with systemic isotretinoin: A 52-week follow-up evaluating efficacy and safety in treatment of moderate-severe acne.

Fluorescent light energy therapy combined with low-dose isotretinoin or tetracycline show remarkable clinical effect on 12 cases of moderate-to-severe acne. Treatment was considered safe, well-tolerated, and highly efficacious.

Long-Term Follow-Up for Q-Switched Nd:YAG Treatment of Nevus of Ota: Are High Number of Treatments Really Required? A Case Report.

Objective: Q-switched laser is considered a gold standard treatment for Nevus of Ota (NO). We report how few laser sessions in long intervals of time may achieve satisfying outcomes reducing the rate of possible procedure-linked side effects such as burning, cornea injuries, or hyperpigmentation. Background: NO represents a congenital dermal melanocytosis in the trigeminal distribution majorly occurring in Asian individuals. Multiple reports have shown efficacy and safety of Q-switched laser for the treatment of this condition, but they were based on an empiric regimen, often leading to unnecessary overtreatments. At the best of our knowledge, no long-term follow-up observations of single laser sessions have been conducted to assess the proper intervals and number of treatments. Materials and methods: A 36-year-old Asian woman, Fitzpatrick skin type IV with clinical diagnosis of NO, was treated with 1064 nm 6 ns Q-switched laser one session per year for a total of two sessions. Clinical result was valued by two physicians independently using standardized and polarized light. No use of general anesthesia or sedation was needed in our experience. Corneal shields have been used. Results: After only two sessions of the Q-switched laser performed 1 year apart, the result was excellent with a 95% of clinical response. No side effect was observed. Conclusions: In our experience, Q-switched Nd:YAG laser is an effective treatment for NO with no necessity of high number of treatments. A larger population is needed to confirm this preliminary result.

Characteristic of chronic plaque psoriasis patients treated with biologics in Italy during the COVID-19 Pandemic: Risk analysis from the PSO-BIO-COVID observational study.

Background: The susceptibility of patients with chronic plaque psoriasis and the risks or benefits related to the use of biological therapies for COVID-19 are unknown. Few data about prevalence, clinical course and outcomes of COVID-19 among psoriatic patients were reported. The aims of this study were 1) to assess the prevalence and severity of COVID-19 in psoriatic patients treated with biologic agents during the first phase of the emergency (22 February to 22 April 2020) in Italy, and 2) to report the clinical outcomes of patients who have been exposed to individuals with confirmed SARS-CoV-2 infection. Methods: Patients with moderate-to-severe chronic plaque psoriasis, aged ≥18 years and undergoing treatment with biologic agents as of 22 February 2020, were eligible to be included in PSO-BIO-COVID study. Demographic and clinical characteristics of patients using any biologic for psoriasis treatment between 22 February and 22 April 2020 were registered. Results: A total of 12,807 psoriatic patients were included in the PSO-BIO-COVID study. In this cohort 26 patients (0.2%) had a swab confirmation of SARS-CoV-2 infection. Eleven patients required hospitalization and two died. Conclusion: The incidence of COVID-19 observed in our cohort of psoriatic patients (0.2%) is similar to that seen in the general population (0.31%) in Italy. However, the course of the disease was mild in most patients. Biological therapies may likely lessen 'cytokine storm' of COVID-19, which sometimes lead to multiple organ failure, ARDS, and death.

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.

Role of Vitamins in Skin Health: a Systematic Review.

PURPOSE OF REVIEW: Skin is the main defense organ of the human body against external insults (ultraviolet radiations, infections by pathogenic microorganisms, and mechanical and chemical stress). The integrity and functions of the skin barrier are supported by an adequate supply of micronutrients, such as several vitamins. The purpose of this review was to analyze all vitamin-related skin problems. RECENT FINDINGS: The World Health Organization has estimated that more than 2 billion people worldwide experience deficiencies in the intake of essential vitamins and minerals; the percentage of adults all over the world using daily vitamin supplements, for treatment or prevention of chronic disease, has increased very rapidly in recent years. In this review, 65 studies have been selected in order to examine the role of the main vitamins and their derivatives involved in maintaining the well-being of the skin and their use as prophylactic and therapeutic agents in the management of skin disorders.

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.

CO2 laser and photodynamic therapy: Study of efficacy in periocular BCC.

Basal cell carcinoma (BCC), the most common type of skin cancer in the world, usually arises in sun-exposed areas of the skin. The therapeutic approach to periocular BCC has changed in the last few years. Currently the treatment, considering the delicate localization of the disease, must not only ensure complete recovery from the neoplastic disease, but must also satisfy functional and aesthetic criteria. In this study we tried to evaluate the efficacy of CO2 laser and photodynamic therapy in periocular BCC.

Removal of unwanted hair: efficacy, tolerability, and safety of long-pulsed 755-nm alexandrite laser equipped with a sapphire handpiece.

Due to the difference in refraction coefficients between air and the corneal epithelium, irradiation of the skin with a light source can lead to reflection of the energy and its leakage to the skin causes epidermal injury. All of which decreases the efficacy of treatment. We evaluated cooling sapphire handpieces' efficacy in decreasing pain and epidermal injuries and enhancing the treatment outcome in laser hair removal. A total of 49 patients with Fitzpatrick skin types of II to IV were treated for laser hair removal on face, limbs, inguinal, and axillary areas with pulsed 755-nm alexandrite laser equipped with a sapphire handpiece and the cooling system. Hair counts were performed by two independent observers at the baseline and 3 months after the final treatment. A marked reduction in hair regrowth was noted 3 months after the final treatment in all body locations studied. Clinical hair reduction was observed and fully assessed. There were no serious side effects with an average pain score of 4.6 out of 40. The cooled sapphire cylinder tip has been shown to minimize epidermal injury and reduce the system energy leaks to the skin.

Cost-efficacy analysis of 3% diclofenac sodium, ingenol mebutate, and 3.75% imiquimod in the treatment of actinic keratosis.

Actinic keratosis (AK) is a clinical condition characterized by keratinocytic dysplastic lesions of the epidermis, affecting individuals chronically exposed to sunlight. Topical therapies allow the treatment of a whole area of affected skin and currently include diclofenac sodium gel, 5-fluorouracil cream, 5-fluorouracil and acetylsalicylic acid solution, imiquimod cream, and ingenol mebutate gel. Due to the comparable efficacy of 3% diclofenac, ingenol mebutate, and 3.75% imiquimod in treating AK multiple lesions, a pharmacoeconomic evaluation of cost-effectiveness of the three treatments was needed. A cost-efficacy analysis comparing 3% diclofenac sodium with ingenol mebutate and 3.75% imiquimod was performed. In this analysis, efficacy data were combined with quality-of-life measurement derived from previous studies as well as the costs associated with the management of these lesions in Italy. Patients' demographics and clinical characteristics were assumed to reflect those from the clinical studies considered.

Long-Pulsed 1064-nm Nd:YAG Laser for the Treatment of Onychomycosis.

OBJECTIVE: The aim of this study is to evaluate the efficacy of long-pulsed 1064-nm Nd:YAG laser in penetrating tissue and targeting the fungal overgrowth in the nail plate. BACKGROUND: Onychomycosis is the most frequent nail disorder. Current treatments include oral and topical antifungal agents, photodynamic therapy, and surgical approaches such as mechanical, chemical, or surgical nail avulsion. Moreover, the use of lasers to treat nail diseases has been approved in the United States by the Food and Drug Administration (FDA). Wide literature has been produced to assess the effectiveness of these devices, but, because the opposing results emerging from current studies, more data are still needed on the long-lasting efficacy and safety of this procedure. METHODS: Twenty consecutive, unselected patients were enrolled in the study and treated, at intervals of 1 week, for a total of four sessions, using a long-pulsed 1064-nm Nd:YAG laser. In each session, three passages across each nail plate were performed with 1-min pause between each passage. A special lens for dermatoscopy, connected to a digital camera, was used for dermoscopic images. RESULTS: In fourteen patients (70%; 12F; 3M), excellent results were obtained with an important reduction of chromonychia, onycholysis, opacity, longitudinal striae, and jagged proximal edge. Better results were observed in severe cases in the 2-month follow-up visit. CONCLUSIONS: Data for treating nail onychomycosis with laser and light therapy seem to be positive. The promising results of our study identify long-pulsed 1064-nm Nd:YAG laser as a possible alternative option for the treatment of onychomycosis. However, increasing subject data, improving study methodology, and output parameters may become an important next step of study in the treatment of nail onychomycosis.

Nonconventional Use of Flash-Lamp Pulsed-Dye Laser in Dermatology.

Flash-lamp pulsed-dye laser (FPDL) is a nonablative technology, typically used in vascular malformation therapy due to its specificity for hemoglobin. FPDL treatments were performed in a large group of patients with persistent and/or recalcitrant different dermatological lesions with cutaneous microvessel involvement. In particular, 149 patients (73 males and 76 females) were treated. They were affected by the following dermatological disorders: angiokeratoma circumscriptum, genital and extragenital viral warts, striae rubrae, basal cell carcinoma, Kaposi's sarcoma, angiolymphoid hyperplasia, and Jessner-Kanof disease. They all underwent various laser sessions. 89 patients (59.7%) achieved excellent clearance, 32 patients (21.4%) achieved good-moderate clearance, 19 patients (12.7%) obtained slight clearance, and 9 subjects (6.1%) had low or no removal of their lesion. In all cases, FPDL was found to be a safe and effective treatment for the abovementioned dermatological lesions in which skin microvessels play a role in pathogenesis or development. Further and single-indication studies, however, are required to assess a standardized and reproducible method for applying this technology to "off-label" indications.

UVA1 Laser in the Treatment of Vitiligo.

OBJECTIVE: The purpose of this article was to evaluate the clinical efficacy and safety of a monochromatic 355 nm ultraviolet (UVA) laser in the treatment of vitiligo. BACKGROUND DATA: Broadband and narrow-band UV phototherapy has been proposed as an effective therapeutic option in vitiligo patients. METHODS: Seventeen consecutive, unselected patients (7 men and 10 women) were enrolled in an open-label, prospective study and treated twice weekly for 8 weeks at a fixed dose of 80-140 J/cm(2). Follow-up was 12 weeks. RESULTS: Clinical repigmentation was observed in 15/17 patients (88.23%), with limited side effects (mild post-treatment erythema and itching). Results were maintained during the 12 week phototherapy-free follow-up period. CONCLUSIONS: the present report suggests that UVA1 laser could be an applicable therapeutic option in patients with vitiligo.

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.

New topical treatments for psoriasis.

INTRODUCTION: Psoriasis is a common immune-mediated disorder that in 70% of cases appears in mild or mild-to-moderate form. Psoriasis is usually treated with topical medications and/or phototherapy with variable efficacy in controlling the disease. AREAS COVERED: For the past three decades, research has been focused on systemic agents for the treatment of moderate-to-severe psoriasis, particularly with the introduction of biologic agents or 'small molecules'. In parallel, novel advances in topical antipsoriatic agents have been made, experiencing a 'new era', with the development of new formulations and the identification of new therapeutic targets. These agents, having a different spectrum of action from traditional agents, are actually being tested in pre-marketing clinical trials and they may potentially represent promising treatment options that could enlarge the therapeutic armamentarium for the treatment of psoriasis. EXPERT OPINION: Future antipsoriatic topical agents show new modality of action in blocking the pathogenic process leading to psoriatic plaque formation.

UVA-1 laser in the treatment of palmoplantar pustular psoriasis.

OBJECTIVE: The purpose of this study was to assess the efficacy of monochromatic UVA laser in the treatment of palmoplantar pustular psoriasis (PPP). BACKGROUND DATA: UVA-1 laser (355 nm) has been reported to be safe and effective in the treatment of psoriasis, but the range of potential applications has not been fully explored. METHODS: Thirty-three patients were enrolled in an open prospective study. Patients were treated from two to four times weekly at a fixed dose of 80-140 J/cm(2). Follow-up was 3 months. Clinical remission was observed in all patients who completed the study, with limited side effects (mild post-treatment erythema). CONCLUSIONS: We report for the first time that UVA-1 laser produces a therapeutic response in PPP.