Port wine stain treated with a combination of pulsed dye laser and topical rapamycin ointment.

BACKGROUND AND OBJECTIVE: A port wine stain (PWS) is a type of capillary vascular malformation composed of malformed, dilated blood vessels within the papillary and reticular dermis. Currently, pulsed dye laser (PDL) is considered the therapeutic gold standard, although greater than 90% of lesions may be refractory to treatment. Studies have shown that a delay in treatment results in a higher proportion of patients who develop hypertrophy and nodularity within lesions that become more resistant to therapy. Therapeutic resistance is multifactorial, but is believed to be largely due to revascularization after laser treatment. Oral sirolimus and topical imiquimod have shown promise as adjunctive therapies to minimize post-laser revascularization, but both have significant side effects. We wish to demonstrate the utility of adjunct topical sirolimus to reduce revascularization after PDL treatment. STUDY DESIGN/PATIENTS AND METHODS: This is a single patient case report of a 56-year-old male patient with an extensive PWS. After seeing initial improvement with PDL alone, he began to experience thickening and nodularity of his PWS necessitating surgical debulking. Since this procedure, topical sirolimus 0.5% ointment has been added to his treatment regimen as an adjunct to PDL. The patient is being treated with PDL (Vbeam Perfecta, Candela/Syneron, Wayland, MA) every 4-6 weeks at varied settings with the following laser parameters: fluence 9-11 J/cm(2), pulse duration 0.45-1.5 ms, focal spot size 7 mm, cooling 30/20. Sirolimus 0.5% ointment is applied to the area twice daily. RESULTS: The patient showed significant improvement in color and texture of his PWS. Compared to the initial therapy of PDL alone, topical sirolimus ointment in conjunction with PDL demonstrated greater improvement and maintenance of therapeutic results with fewer overall laser treatments. CONCLUSION: Topical sirolimus 0.5% ointment is a safe and effective adjunct to PDL in the treatment of PWS.

Rosacea associated with dupilumab therapy.

Background: Dupilumab is used for treatment of atopic dermatitis through blockade of IL-4 and IL-13 signaling of the Th2 pathway. Recent case reports have described alopecia, psoriasis, persistent facial dermatitis, and recall dermatitis at patch test sites after the initiation of dupilumab therapy.Case report: We describe the case of a 67-year-old female with atopic dermatitis who developed recurrent episodic flares of rosacea temporally associated with dupilumab injections that resolved after dupilumab discontinuation.Conclusion: The cause of rosacea-like reaction associated with dupilumab treatment is unknown. Th2 pathway inhibition by dupilumab may promote Demodex proliferation and increased IL-17-mediated inflammation implicated in the pathophysiology of rosacea.Abbreviations: atopic dermatitis: AD; interleukin: IL; persistent facial dermatitis: PFD; T-helper cell type 1: Th1; T-helper cell type 2: Th2; T-helper cell type 17: Th17; tumor necrosis factor-∝: TNF-∝.

Surgical and Functional Considerations of Dermatofibrosarcoma Protuberans Involving Facial Nerve Danger Zones.

Background: Dermatofibrosarcoma protuberans (DFSP) is a locally aggressive tumor, uncommonly occurring on the head and neck where these deeply infiltrating tumors might violate underlying neurovascular structures. Treatment is typically surgical, whether by Mohs micrographic surgery (MMS) or wide local excision (WLE). However, there is a paucity of literature describing functional neurologic outcomes following surgical extirpation of facial DFSP. Thus, we sought to examine the functional neurologic outcomes in patients undergoing either MMS or WLE for facial DFSP. Methods: Two patients with DFSP involving facial nerve danger zones treated by the multidisciplinary team with MMS and subsequent reconstruction were studied. Additionally, a comprehensive literature review of facial DFSP with regard to neurologic functional status was performed. Results: From our research, only 10 of 46 patients with facial DFSP had neurologic functional status reported, with four of these cases having notable facial nerve deficits. Of our cases, both patients experienced transient neurologic deficits and neither had evidence of recurrence. Conclusion: The proper assessment and reporting of postoperative functional recovery should be undertaken following facial DFSP resection and consideration should be given to a multidisciplinary treatment approach.

Prospective, randomized, controlled trial using best-selling smoking-cessation book.

Our prospective, randomized, controlled trial aimed to evaluate the efficacy of the self-help book, The Easy Way to Stop Smoking, by Allen Carr, in promoting smoking cessation in patients with head and neck cancer. We assessed active smokers for their willingness to read a smoking cessation book. Participants were randomized to either receive the book from our department or recommended to purchase the book. All patients received smoking cessation counseling at recruitment. Phone surveys were conducted at short- and long-term intervals to determine if the patients had purchased and/or read the book and whether they were still smoking. One hundred twelve patients were recruited, 52 of whom completed follow-up surveys. Those who received the book for free were more likely to read the book (p = 0.05). Reading the book did not correlate with successful smoking cessation (p = 0.81). Some 26% of the 27 patients who received the book quit smoking compared with 32% of the 25 patients who were recommended the book (p = 0.76). Patients who indicated motivation to quit smoking were more likely to succeed. In our study, smoking cessation did not appear to be influenced by reading The Easy Way to Stop Smoking. Despite 80.8% of the cohort indicating at least a readiness to quit smoking at recruitment, only 28.8% of patients managed to achieve successful smoking cessation at long-term follow-up. Patient motivation remains an important factor in achieving long-term smoking abstinence. Quitting smoking remains a daunting challenge for patients, with multiple interventions likely needed to achieve cessation.