Milia-like idiopathic calcinosis cutis of the forehead in an adult without Down's syndrome successfully treated with a CO2 laser.

BACKGROUND: Idiopathic calcinosis cutis is an uncommon form of calcinosis cutis. It may present as tumoral calcinosis, subepidermal calcified nodules or scrotal calcinosis. Subepidermal calcified nodules may also present as milia-like lesions commonly seen in children with Down's syndrome in the absence of tissue damage or metabolic disorders, it has been seldom reported in adults. The treatment of choice is surgical excision. However, a surgical approach may not always be beneficial to the patient given the cosmetic outcomes. Here, we describe the successful use of a CO2 laser in the treatment of milia-like calcinosis cutis of the forehead in an adult without Down's syndrome. AIMS: To describe the treatment of Milia-like idiopathic calcinosis cutis of the forehead in an adult without Down's syndrome successfully treated with a CO2 laser. METHODS: We report a case of a 48-year-old man who presented with skin-colored hard asymptomatic papules on the forehead that started about 9 years ago, a biopsy was performed and a diagnosis of milialike calcinosis cutis was made. Surgical excision was discarded regarding the location and the number of lesions, instead, a CO2 laser was used to treat this condition. RESULTS: Successful laser excision of the lesions with appealing cosmetic results. CONCLUSIONS: CO2 laser seems to be a valuable tool to treat milia-like calcinosis cutis lesions.

Effectiveness of photopneumatic technology: a descriptive review of the literature.

Usage of photopneumatic technology has recently increased for treatment of different skin conditions such as acne, keratosis pilaris (KP), and rosacea. Photopneumatic devices combine gentle negative pressure with broad band pulsed light simultaneously to attack multiple targets in the skin for better treatment outcomes. In this literature review, we evaluate the efficacy of photopneumatic therapy on treatment of acne, keratosis pilaris (KP), and rosacea.

Keratosis lichenoides chronica: Case-based review of treatment options.

Keratosis lichenoides chronica (KLC) is a rare dermatological condition characterized by keratotic papules arranged in a parallel linear or reticular pattern and facial lesions resembling seborrheic dermatitis or rosacea. The clinical, histological and therapeutic information on 71 patients with KLC retrieved through a PubMed search plus one our new case were analyzed. KLC affects patients of all ages, with a modest male predominance. Pediatric cases represent about one quarter of patients. Diagnosis is usually delayed and histologically confirmed. All patients have thick, rough and scaly papules and plaques arranged in a linear or reticular pattern, on limbs (>80%) and trunk (about 60%). Face involvement is described in two-thirds of patients. Lesions are usually asymptomatic or mildly pruritic. Other manifestations, such as palmoplantar keratoderma, mucosal involvement, ocular manifestations, nail dystrophy, are reported in 20-30% of patients. Children present more frequently alopecia. No controlled trials are available. Results from small case series or single case reports show that the best treatment options are phototherapy and systemic retinoids, alone or in combination, with nearly half of patients reaching complete remission. Systemic corticosteroids as well as antibiotics and antimalarials are not effective.

FR - Terapia fotodinámica luz de día / Daylight Photodynamic Therapy

No disponible

Combination of 595-nm pulsed dye laser, long-pulsed 755-nm alexandrite laser, and microdermabrasion treatment for keratosis pilaris: retrospective analysis of 26 Korean patients.

Keratosis pilaris (KP) has beenpresented as small keratotic follicular papules with or without surrounding erythema. Various treatments with laser or light therapy have been used for the management of KP with various clinical outcomes. In the present study, we investigated the efficacy and safety of a combination therapy for KP. A total of 29 anatomical sites with KP in 26 patients were treated using a 595-nm pulsed dye laser (PDL) with nonpurpuragenic fluences, a long-pulsed 755-nm alexandrite laser, and microdermabrasion. Clinical improvement was assessed by comparing preand posttreatment clinical photographs and patient satisfaction rates. Evaluation of the clinical results three months after the treatments showed that 12 of the 29 anatomical sites (41.4%) demonstrated Grade 3 clinical improvement, ten (34.5%) had Grade 2 clinical improvement, four (13.8%) showed Grade 1 improvement, and three (10.3%) showed Grade 4 improvement. We observed that KP lesions improved not only in erythema and skin texture, but also in brownish dyschromias. Potential adverse events were not observed, except prolonged posttherapy scaling. Our observations demonstrate that combination therapy using a 595-nm PDL, a long-pulsed 755-nm alexandrite laser, and microdermabrasion can have a positive therapeutic effect on KP.

Keratosis pilaris atrophicans: treatment with intense pulsed light in four patients.

BACKGROUND: Keratosis pilaris atrophicans (KPA) is a group of disorders characterized by erythematous keratotic papules followed by atrophy on the face. The treatment is often unsatisfactory. METHODS: Four white women, with ages ranging from 14 to 20 years, were treated with an intense pulsed light (IPL) system with a cut filter of 570 nm. The power density was between 40 and 47 J/cm(2), divided into two pulses of 3 ms, with a delay between both of 20 ms. Patients received five to nine sessions. RESULTS: Clinical improvement was noted in all patients, with a reduction of erythema in treated areas of between 75% and 100%. Treatment was well tolerated and no adverse reactions were observed. After a follow-up of 10 months no recurrence was observed. In addition, in parallel mode to erythema improvement, a reduction of roughness was observed. CONCLUSION: Our results suggest IPL should be considered as a safe treatment option in patients with KPA.

[Keratosis lichenoides chronica in two siblings with marked response to UVB phototherapy]. / Deux cas de kératose lichénoïde chronique dans une même fratrie. Réponse favorable à la photothérapie UVB.

BACKGROUND: Keratosis lichenoides chronica (KLC) is a rare chronic keratinisation disorder. Out of almost 60 published cases of KLC, only two report its occurrence in siblings. We report a new case in which a brother and sister present KLC that improved markedly with UVB phototherapy. PATIENTS AND METHODS: A 10-year-old girl presented with hyperkeratotic papules symmetrically arranged in a reticular pattern on the face and the extremities. Onset occurred at the age of six months. For a number of years, minimum sunlight was allowed owing to a diagnosis of lupus. However, KLC was our first diagnostic assumption, confirmed by an elbow lesion biopsy sample. The patient's brother, one and a half years old, had been presenting similar lesions since the age of two months. Sibship was demonstrated by DNA analysis using short tandem repeat markers. No consanguinity was found. After one month of narrow-band UVB phototherapy, most of the papules had flattened. DISCUSSION: KLC is uncommon in childhood and familial occurrence is very rare. Clinically, thick keratotic papules arranged in parallel lines or small networks cover the dorsal aspects of the limbs symmetrically. The face may be affected by a seborrhoea-like dermatitis. Histology typically shows alternating acanthosis and atrophy, with focal parakeratosis. An extensive lichenoid lymphohistiocytic and plasmocytic infiltrate is demonstrated in the dermis. The course is chronic. Spontaneous resolution may occur. Sunlight has been shown to be effective in the few paediatric cases reported. Narrow-band UVB phototherapy appears to be an effective therapeutic option.

Treatment options for actinic keratoses.

Actinic keratoses are rough, scaly lesions that commonly occur on sun-exposed areas of the skin. The prevalence of the condition increases with age. Actinic keratoses are thought to be carcinomas in situ, which can progress to squamous cell carcinomas. The decision to treat can be based on cosmetic reasons; symptom relief; or, most importantly, the prevention of malignancy and metastasis. Treatment options include ablative (destructive) therapies such as cryosurgery, curettage with electrosurgery, and photodynamic therapy. Topical therapies are used in patients with multiple lesions. Fluorouracil has been the traditional topical treatment for actinic keratoses, although imiquimod 5% cream and diclofenac 3% gel are effective alternative therapies. There are too few controlled trials comparing treatment modalities for physicians to make sound, evidence-based treatment decisions.

Comparative benefit of two thermal spring waters after photodynamic therapy procedure.

INTRODUCTION: Photodynamic therapy (PDT) is commonly used to treat actinic keratoses, superficial cutaneous carcinoma, photodamage, and/or acne. The aim of this study was to compare the usefulness of Avène thermal spring water (ATSW), a low mineral content spring water, to a high mineral content spring water. We evaluated post-PDT clinical symptoms and findings when used as an adjunctive therapy in postprocedure skin care. METHODS: A double-blind monocentric comparative study was conducted on 25 patients suffering from either vulgaris acne or photodamage with or without actinic keratoses. The patients were treated with 5-aminolevulinic acid (5-ALA) activated with an intense pulsed light and/or blue light source. Patients were randomized so that 12 patients treated their faces with ATSW and 13 were treated with a comparative water spray. Clinical signs were evaluated by the investigator at day 0, before and 15 min after the first spraying, at days 2, 4, and 7, and each day from day 0 to day 6 by patients. Clinical signs (erythema, stinging, pruritus, pain, and tightening) were evaluated by the use of a 4-point grading scale. RESULTS: The intragroup analysis showed that pain was significantly reduced by ATSW spraying at days 2, 4, and 7. The evaluation by patients showed that only ATSW alleviates pain from day 3 to day 6. The between-group analysis revealed that pruritus was significantly reduced by ATSW at day 7. Erythema, stinging, and tightening were not significantly reduced by both waters. Patients wished to continue using ATSW in 83% of cases. CONCLUSION: This comparative clinical trial demonstrates that ATSW, a low mineral content spring water, can be useful after ALA-PDT in reducing postprocedure cutaneous inflammation and patient discomfort better than a high mineral content spring water.

[Actinic keratosis]. / Krebsvorstufe aktinische Keratose. So erkennen Sie gefährliche Sonnenschäden.

Actinic keratosis is a precancerous lesion that is commonly seen in the elderly patient and requires treatment. It shows a predilection for areas of the skin that are exposed to the sun, and usually manifests as multiple skin-colored or discrete reddish scaly verrucous plaques. The diagnosis is usually based on the clinical appearance of the lesion. Therapeutic options include physical, immunological and chemical measures. The choice of treatment is determined by numerous factors, and can be adapted to the individual situation presenting.

[Grover's disease following hemodialysis in a patient with renal failure]. / Morbus Grover unter Hämodialy--setherapie bei Niereninsuffizienz.

A 54-year-old woman with polycystic renal disease and renal failure developed Grover's disease while undergoing renal dialysis. Grover's disease or transitory acantholytic dermatosis is characterized by intensely pruritic, hyperkeratotic, succulent papules and plaques located on the trunk. The pathogenesis is unknown; genetic factors and actinic damage have been implicated. Medications, heat or immunosuppression can worsen the disease. Associations with atopic dermatitis, contact dermatitis and asteatotic dermatitis have also been described. Differential diagnostic considerations include folliculitis, scabies and dermatitis herpetiformis. Therapeutic options include moisturizing agents and phototherapy, as well as topical and systemic retinoids. There are only few case reports in the literature describing Grover's disease occurring during hemodialysis treatment. All such previous patients have been men; ours is the first woman.

Management of actinic keratoses.

Actinic keratoses are quite common. Since they represent the initial stage in the evolution of squamous cell carcinoma, recognition and treatment are important. Recently, new treatment modalities have become available including immune modulators, photodynamic therapy, and topical nonsteroidal anti-inflammatory agents.

Actinic keratoses--surgical and physical therapeutic modalities.

Actinic keratoses (AKs) are the most common epithelial premalignant lesions seen by dermatologists today. The vast therapeutic armamentarium for treating AKs can be roughly divided into 2 categories: topical and surgical/physical modalities. It is important for clinicians to be familiarized with the various therapeutic options for treating AKs and to deliver individualized treatments. This article will review the surgical and physical modalities available for the treatment of AKs.

Keratosis lichenoides chronica in childhood.

Keratosis lichenoides chronica (KLC) is a rare chronic disorder of keratinization characterized by lichenoid hyperkeratotic papules arranged in a linear pattern, erythematosquamous plaques and seborrhea-like dermatitis on the face. We report a 2-year-old girl diagnosed with KLC whose lesions, arranged in symmetrical linear fashion, improved after sunlight exposure during the summer.

Managing solar keratoses.

Solar keratoses (actinic keratoses) are common, often multiple, epidermal lesions found mainly on the sun-exposed skin of fair-skinned middle-aged and older people. They may transform into non-melanoma skin cancers, particularly squamous cell carcinoma. Here, we review the prevention and treatment of solar keratoses.

Bullous lesions in Bazex syndrome and successful treatment with oral psoralen phototherapy.

A 59-year-old man presented with a psoriasiform dermatitis with associated bullae and destructive nail dystrophy of the hands and feet. He had lost 10 kg weight over 6 months and a mass in the neck was noted. He was provisionally diagnosed with Bazex syndrome (acrokeratosis paraneoplastica) and subsequent investigations revealed a squamous cell carcinoma in the right piriform fossa. His skin lesions were treated with oral psoralen and ultraviolet A phototherapy and this cleared the cutaneous changes, but the nail changes have persisted at 18 months follow up.