Efficacy and Safety of Intense Pulsed Light With a KTP/PDLlike Filter for the Treatment of Facial Telangiectasias.

BACKGROUND: An intense pulsed light (IPL) narrowband "KTP/PDL-like" filter (525–585 nm) may combine the tolerability of the IPL with the precision of KTP and PDL lasers. This study evaluated the impact of IPL with a KTP/PDL-like filter on telangiectasias. METHODS: This was a single-center, prospective study of 17 subjects with facial telangiectasias and skin types I–III. Three monthly treatments were performed using this specific filter, with follow-up visits at 1, 3, and 6 months. Telangiectasia improvement was assessed by the investigator and subjects using a 5-point scale. Facial photographs and safety assessments were obtained at each visit. Subject discomfort was evaluated using a visual analog scale (VAS) immediately posttreatment, and subject downtime was recorded at each subsequent visit. RESULTS: All facial telangiectasias significantly improved. At 1-month follow-up, >50% lesion clearance was noted in 97.1% of facial (n=36) and 85.7% of non-facial (n=7) lesions, with 73% of subjects satisfied or very satisfied. An increase in mean social downtime (0, 2.3, and 3 days) and VAS scores (3.5, 4.5, and 4.8) with treatments 1, 2, and 3, respectively, mirrored a stepwise increase in fluence with subsequent sessions. CONCLUSIONS: The use of a novel IPL narrowband KTP/PDL-like filter can significantly improve facial and non-facial telangiectasias with minimal downtime. J Drugs Dermatol. 2020;19(9):844-850. doi:10.36849/JDD.2020.4834.

Cutis marmorata telangiectatica congenita successfully treated with intense pulsed light and pulse dyed laser therapy: a case report.

Cutis marmorata telangiectatica congenita (CMTC) is a rare vascular disorder characterized by blue-purple reticulated patches and plaques that can be localized or generalized. Associated skin atrophy and soft tissue hypoplasia is common while ulceration is relatively uncommon. As CMTC is exceedingly rare and spontaneous remission in childhood can occur in mild cases, evidence for treatment of severe, refractory disease is limited. We present the case of a four-year-old female with CMTC and associated painful, recalcitrant ulcers successfully treated with a combination of pulsed dye laser and intense pulsed light therapy.

Open-label study assessing the efficacy and tolerability of topical skin care and sun protection alone and in combination with intense pulsed light therapy.

BACKGROUND: Intense pulsed light therapy (IPL) decreases facial erythema and telangiectasias associated with rosacea. Topical skin care products decrease facial erythema by the action of active ingredients and masking effects. OBJECTIVES: To assess the efficacy and tolerability of combining a topical skin care regimen (TSCR) comprised of a multifunctional three-in-one facial cream and a mineral-based brush-on SPF50 powder sunscreen with a single IPL treatment for treating mild-to-severe facial redness associated with rosacea. METHODS: Twenty female subjects with Fitzpatrick skin types I-III received TSCR monotherapy for 12 weeks. At that time, subjects received a single IPL treatment and continued TSCR for 6 additional weeks. Subjects were evaluated at Baseline and at Weeks 4, 8, 12, and 18. RESULTS: Using a 7-point redness scale, the overall mean (SD) redness score significantly improved from 3.05 (0.97) at baseline to 2.05 (0.76) at Week 18 (P < 0.01). There was a decrease in investigator-rated erythema from baseline (bare skin) to Week 12 (bare skin, before IPL) when TSCR was used as monotherapy which did not achieve significance (P = 0.12). Most subjects (80%) were satisfied or Very satisfied with the TSCR at Week 18. All subjects (100%) agreed that it improved their baseline skin redness and most (85%) would recommend TSCR to others. TSCR was well-tolerated with no significant changes in skin dryness, scaling, or itching. Mild burning occurred immediately following the IPL treatment at Week 12. CONCLUSION: TSCR in combination with a single IPL treatment produced a significant improvement in overall facial redness in patients with rosacea. Longer-term treatment with TSCR may produce continued improvement.

PDT and BF-200 ALA: The therapy option for the treatment of Poikiloderma of Civatte.

Poikiloderma is a chronic skin condition affecting middle-age men and women that comprises cutaneous atrophy, telangiectasias, and changes in the pigmentation of the skin usually of mottled appearance (both hyper- and hypopigmentation). There is no specific medical treatment for Poikiloderma of Civatte (PC), but the use of photoprotector/sunscreen + SPF 50 to avoid prolonged sun exposure is highly recommended in these patients. Some authors recommend the use of topical corticoids in early stages; however, the results have not been satisfactory. Multiple topical (retinoids, dimethyl sulfoxide, or calcineurin inhibitors), systemic (cyclophosphamide), and physical (dermabrasion, phototherapy, and fractional photothermolysis) treatments have been described with unequal and inconsistent responses or unsatisfactory. This report underlies the combination of BF-200 ALA and photodynamic therapy (PDT) with positive results at the clinical level: significant improvement of pigmentary changes and telangiectasias after two PDT sessions.

A rare case of cutaneous collagenous vasculopathy.

Cutaneous collagenous vasculopathy is a rare microangiopathy first described by Salama and Rosenthal in 2000. Several cases have been reported to date, describing distinct histological findings of thick hyaline collagenous blood vessel walls in the superficial dermis. Clinical confusion can arise with generalised essential telangiectasia. We report a case occurring in a 76-year-old woman who presented with a 2-year history of a telangiectatic rash progressing from her knees upwards. The diagnosis was confirmed on skin biopsy and treatment with pulsed dye laser was later initiated at the patient's request.

Optical coherence tomography imaging of telangiectasias during intense pulsed light treatment: a potential tool for rapid outcome assessment.

Vascular malformations commonly occur in the facial region, and can be associated with significant stigma and embarrassment. Studies have shown that even recommended light-based treatments do not always result in complete clearance. This indicates the need for more accurate pre-treatment assessment of vessel morphology to optimize treatment settings and identify possible morphological predictors of the outcome. Fourteen patients (six males, eight females, and aged 37-66 years) with the diagnosis of telangiectasias were enrolled and were all scanned with OCT and digitally photographed before and minutes after IPL treatment. OCT images of the telangiectasias before treatment were displayed as hyporeflective/signal poor bands clearly demarcated from the surrounding tissue. Minutes after treatment, OCT images demonstrated two different reactions. (1) Narrow hyperreflective bands surrounding the vessels, which may indicate edema or insufficient coagulation. (2) Hyperreflective signals within the lumen of the vessels, compatible with the expected irreversible microthrombus formation in the vessels. OCT imaging is capable of real-time assessment of tissue damage during light and laser treatment, including visualization of the perivascular changes. This may offer a more dynamic, more complete understanding of the efficacy and potential outcome of the treatment process. It is hypothesized that these immediate changes may correlate to longer-term treatment outcome.

Heat-triggered reticular telangiectatic erythema induced by a spinal cord stimulator.

In recent years, cutaneous complications have been reported after implantation of medical devices as a result of their widespread use. We report a case of reticular telangiectatic erythema (RTE) after replacement of a spinal cord stimulator. To date, the pathogenesis of RTE has been poorly understood. Some reports have suggested that heat is involved, whereas others seem to contradict this observation. In our thermographic study, we found that heat can cause RTE.

Post-implantation erythema in 3 patients and a review of reticular telangiectatic erythema.

BACKGROUND: The appearance of erythematous, blanchable patches or plaques overlying an implant suggests possible reticular telangiectatic erythema (RTE). RTE is a benign reactive cutaneous manifestation that can present following the implantation of a cardiac pacemaker, defibrillator or intrathecal infusion pump in an otherwise asymptomatic, non-infectious patient. OBJECTIVE: To demonstrate the variety in clinical presentation of patients presenting with RTE or similar patch test-negative post-implantation erythema. PATIENTS/MATERIALS/METHODS: After institutional board approval had been obtained, patient information was obtained from electronic medical record files, which included surgical reports, pathology reports, and notes from outpatient encounters. RESULTS: We report post-implantation erythema following insertion of an elbow prosthesis, a knee prosthesis, and a spinal cord stimulator, which have not previously been cited as aetiologies of RTE. CONCLUSION: Owing to the delayed onset and variable recovery, RTE remains a diagnostic challenge. RTE should be included in the differential diagnosis of any patient presenting with erythema over the site of a previously implanted device.

[Reticulated teleangiectatic erythema after implantation of medical devices. An increasingly occurring phenomenon?]. / Retikuläre teleangiektatische Erytheme nach Implantation von elektrischen medizinischen Geräten. Ein an Häufigkeit zunehmendes Phänomen?

Reticulated telangiectatic erythema (RTE) is a rare skin reaction to extraneous materials. We present three cases in which asymptomatic persistent erythemas developed in the area of implantation after medical devices were inserted. Topical and systemic treatment did not improve the skin changes. Patch testing including applied materials showed negative results in all cases. Histological investigation of punch biopsy specimens showed moderate dilatated vessels and a slight lymphocytic infiltrate. Due to our findings and in synopsis with the clinical impression we diagnosed RTE. As RTE is asymptomatic in most cases, the devices need not be removed.

Treatment of facial reticular veins with dynamically cooled, variable spot-sized 1064 nm Nd:YAG laser.

BACKGROUND: Facial reticular veins are often seen on the temple and periorbital areas in patients with genetic predisposition or after facial cosmetic surgery. AIM: The purpose of this study was to evaluate the efficacy and safety of dynamically cooled, variable spot sized 1064 nm Nd:YAG laser in the treatment of facial reticular veins. PATIENTS/METHODS: This is a retrospective study. Twenty patients with facial reticular veins who underwent treatment with dynamically cooled, variable spot sized 1064 nm Nd:YAG laser were evaluated. Patients were followed up 1 month to 2 years after the procedure. RESULTS: Objective and subjective improvement scores after one or two treatments of dynamically cooled, variable spot sized 1064 nm Nd:YAG laser were nearly 100% when appropriate parameters were used. CONCLUSION: Dynamically cooled, variable spot sized 1064 nm Nd:YAG laser is a safe and effective treatment for facial reticular veins. Most patients responded to one treatment and experienced no significant side effects other than tolerable pain associated with the procedure.

Úlceras acrales y fenómeno de Raynaud en un adolescente / Digital ulcerations and Raynaud´s phenomenon in an adolescent

El síndrome de Crest es una variedad de esclerodermia sistémica; concretamente, una forma limitada. Se considera una forma incompleta de la enfermedad, que presenta un curso más benigno, dado que las afectaciones renal y pulmonar no son sus principales características. Los síntomas fundamentales del síndrome de Crest, que conforman su acrónimo,son: calcinosis, fenómeno de Raynaud, dismotilidad esofágica, esclerodactilia y telangiectasias. Presentamos un caso cuyo inicio se produjo durante la adolescencia, hecho muy poco frecuente, que, sin embargo, presenta un mejor pronóstico que en la edad adulta

Crest síndrome is a type of limited systemic scleroderma. It is considered to be an incomplete form of the disease that has a more benign course, as renal and pulmonary involvement are not is principal characteristics. The major symptoms of Crest syndrome, the initials of which give it its name, are calcinosis, Raynaud´s phenomenon, esophageal dysmotility, sclerodactyly and telangiectasia. We report a case with onset during adolescence, a very uncommon circumstance which however, is associated with a better prognosis than that involving adult onset

Evaluation of different temperatures in cold air cooling with pulsed-dye laser treatment of facial telangiectasia.

BACKGROUND AND OBJECTIVES: Cold air cooling is widely used in dermatological laser therapy. We investigated the influence of cold air cooling at different skin temperatures on therapeutic outcome and side effects of pulsed dye laser treatment of facial telangiectasia. STUDY DESIGN/MATERIALS AND METHODS: From September 2002 to February 2003, 17 patients with previously untreated facial telangiectasia underwent a single treatment session with flash-lamp pulsed dye laser (3.5 J/cm(2), 585 nm, 0.45 milliseconds pulse length, 10 mm beam diameter, Cynosure V). The treatment area was divided into three sub-areas: no cooling, cold air cooling to 20 degrees C and to 17 degrees C skin temperature. The skin temperature was monitored by a prototype infrared sensor system which controlled the temperature of the cold air stream (Cryo5). In a prospective study, we collected data on purpura, pain, clearance, and patient satisfaction on numerical analog scales (NAS) from 0 (meaning "no") to 3 (meaning "high"). RESULTS: Without cooling, purpura (2.53), pain (2.41), and clearance (2.35) were rated medium to high. Cooling to 20 degrees C reduced purpura (1.12) and pain (1.06), whereas the clearance (2.12) was only slightly affected. Cooling to 17 degrees C reduced purpura (0.88) and pain (0.76) even more, the clearance (2.06) was lowered marginally. Most patients preferred cooling to 20 degrees C skin temperature. CONCLUSION: In dermatological laser therapy of facial telangiectasia, the use of cold air cooling can significantly reduce side effects and increase patient satisfaction while only slightly affecting clearance. Cooling to 20 degrees C skin temperature proved to be a well-balanced middle course. For the practical use of cold air cooling, we thus recommend cooling to a level which the patient can tolerate without problems and to try to increase the energy densities.

Predominant telangiectatic erythema in linear atrophoderma of Moulin: novel variant or separate entity?

Linear atrophoderma of Moulin is a distinctive disease originally described in 1992 and characterized by acquired, mildly atrophic, non-sclerotic, slightly hyperpigmented lesions following the lines of Blaschko. Here, we describe a 15-year-old girl with a 13-year history and a 29-year-old male with a 6-year history of prominent linear telangiectatic erythema and mild atrophoderma following the lines of Blaschko that involved the right leg and hip, and both legs, the trunk and both arms, respectively. As pronounced telangiectatic erythema within lesions of atrophoderma of Moulin has not hitherto been described, we propose that the disease in our patients represents a novel variant of linear atrophoderma of Moulin. Due to considerable overlap, we do not favour the notion that our cases constitute an entity entirely separate from linear atrophoderma of Moulin.

Telangiectasia hemorrágica hereditária (doença de rendu-osler-weber): um diagnóstico otorrinolaringológico / Hereditary Hemorrhagic Telangiectasia (Osler-Weber-Rendu Disease): Otolaryngologic Diagnostic

A telangiectasia hemorrágica hereditária (doença de Rendu-Osler-Weber) é uma displasia fibrovascular sistêmica, de herança autossômica dominante, caracterizada pela tríade clássica: telangiectasias, epistaxes recorrentes e história familiar. Malformações arteriovenosas, aneurismas e telangiectasias podem ocorrer distribuídas pela vasculatura corporal apresentando degeneração da célula endotelial, defeitos nas junções endoteliais e fraqueza do tecido conjuntivo perivascular. É de prognóstico essencialmente benigno, embora complicações hepáticas, gastrointestinais, pulmonares, cardíacas e neurológicas possam ocorrer. A epistaxe é a forma mais comum de sangramento (80% dos afetados); e, geralmente, o primeiro evento hemorrágico. O diagnóstico exige história e exame físico minucioso, exames hematológicos, endoscopias, angiografias, raio X de tórax e fluoroscopia. A terapia é de suporte, com suplementação de ferro e transfusões sangüíneas, mas tratamentos hormonal e cirúrgico têm propiciado resultados relativos no controle dos distúrbios hemorrágicos. O diagnóstico da doença e a relação dos orgãos acometidos são importantes na prevenção e no tratamento adequado das complicações, assim como para orientação genética. Apresentamos 9 casos da doença e as considerações quanto a seu quadro clínico, fazendo uma revisão atualizada de sua fisiopatologia, manifestações clínicas e terapêutica clínico-cirúrgica.

Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease) is a systemic autosomal dominant fibrovascular dysplasia, characterized by classical trio: telangiectasias, recurrent epistaxis and family history. Arteriovenous malformations, aneurisms and telangiectasias can occur over all the body vessels system which will show, then, endothelial cells degeneration, defective endothelial junctions and weakness of the connective tissue. Its prognostic is essencialy benign, but hepatic, gastrointestinal, pulmonary, cardiac and neurological complications may happen. Epistaxis is the most common bleeding (80% of the affected) and generally it is the first hemorrhagic event o€ the disease. The diagnosis includes history, physical examination, hematologic tests, endoscopy, angiography, chest X ray and fluoroscopy. Theraphy is supportive, offering iron supplement and blood transfusions, but hormonal and surgical treatment have obtained substancial results in bleeding control. Its diagnostic, referring to the organs involved, is important for the prevention and adequate treatment of the complications, as well as for genetic orientation. We present 9 cases and considerations about their clinical symptoms, making a revision of the current physiopathology, clinical manifestations, clinical and surgical treatment.

Lesiones telangiectásicas de distribución uniforme / Telangiectatic lesions in uniform distribution

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