Treatment of flat and elevated pigmented disorders with a 755-nm alexandrite picosecond laser: clinical and histological evaluation.

The novel picosecond lasers, initially developed for faster tattoo removal, have also shown great efficacy in endogenous pigmentary disorders. To describe the efficacy and safety profile of an alexandrite (755-nm) picosecond laser in a wide range of pigmented flat and elevated cutaneous lesions. A retrospective study was performed in which we collected all the clinical images of patients treated with the 755-nm alexandrite picosecond laser for 12 months (November 2016-November 2017). Clinical features were obtained from their medical charts. Patients treated for tattoo removal were excluded. All the images were analyzed by three blind physicians attending to a visual analogue scale (VAS) from 0 to 5 (0, no change; 1, 1-24% clearance; 2, 25-49% clearance; 3, 50-74% clearance; 4, 75-99% clearance; 5, complete clearance). Patient satisfaction was obtained from a subjective survey including four items: very satisfied, satisfied, non-satisfied, and totally dissatisfied. Thirty-seven patients were included (12 males; 25 females). The mean age of the study was 42.35 years. Twenty-five patients (68%) were treated for different pigmented flat disorders such as solar and mucosal lentigines (5), stasis dermatitis (4), or nevus of Ota (4), among other diagnoses. Twelve patients (32%) were treated for epidermal elevated lesions such as warts (5), epidermal nevi (2), and seborrheic keratosis (3), among other elevated lesions. Mean number of laser treatment was 3.02 sessions while mean follow-up after last laser treatment was 4.02 months. Mean VAS score of the three observers was 3.44 (61% of clearance) for pigmentary flat disorders and 3.60 (67%) for elevated lesions. Adverse effects reported were mild blistering in the first 2-5 days following laser treatment in some of the patients. Overall satisfaction among the patients included was high. The novel 755-nm picosecond alexandrite laser is effective not only for the resolution of pigmented flat lesions of different nature but also for the treatment of the more difficult elevated pigmented lesions.

Observational study of chondrodermatitis nodularis helicis treated with methyl aminolevulinate photodynamic therapy.

BACKGROUND: Therapies used to treat chondrodermatitis nodularis helicis (CNH), such as surgical excision, pressure relief, or topical steroids report varying degrees of success. OBJECTIVE: We evaluated the response and safety of methyl aminolevulinate (MAL) photodynamic therapy (PDT) in CNH. METHODS: This retrospective, observational study performed at the University Hospital Ramon y Cajal (Madrid, Spain) and Hospital San Jorge (Huesca, Spain) included all patients diagnosed with CNH and treated with MAL-PDT from 2008 to 2015. Treatment sites were prepared and irradiated as per the conventional MAL-PDT procedure. RESULTS: Patients underwent a mean of 2.3 sessions with between-session intervals ranging from 15 days to 1 month. A complete response to PDT was observed in 33 patients (76.7%), who experienced pain relief and resolution of the inflammatory nodule. Lesion recurrence was recorded in 10 patients (23.3%) during the mean follow-up period of 20 months. Receiving ≥2 PDT sessions was significantly associated with a good response (26/28, 93% success rate, P = .003). LIMITATIONS: Some limitations of the study are the lack of an established between-session interval, the absence of evaluation of curettage effectiveness and the limited sample size. DISCUSSION: The results support the view that PDT is a promising treatment approach for CNH.

In situ production of ROS in the skin by photodynamic therapy as a powerful tool in clinical dermatology.

Photodynamic therapy (PDT) is a clinical modality of photochemotherapy based on the accumulation of a photosensitizer in target cells and subsequent irradiation of the tissue with light of adequate wavelength promoting reactive oxygen species (ROS) formation and cell death. PDT is used in several medical specialties as an organ-specific therapy for different entities. In this review we focus on the current dermatological procedure of PDT. In the most widely used PDT protocol in dermatology, ROS production occurs by accumulation of the endogenous photosensitizer protoporphyrin IX after treatment with the metabolic precursors 5-methylaminolevulinic acid (MAL) or 5-aminolevulinic acid (ALA). To date, current approved dermatological indications of PDT include actinic keratoses (AK), basal cell carcinoma (BCC) and in situ squamous cell carcinoma (SCC) also known as Bowen disease (BD). With regards to AKs, PDT can also treat the cancerization field carrying an oncogenic risk. In addition, an increasing number of pathologies, such as other skin cancers, infectious, inflammatory or pilosebaceous diseases are being considered as potentially treatable entities with PDT. Besides the known therapeutic properties of PDT, there is a modality used for skin rejuvenation and aesthetic purposes defined as photodynamic photorejuvenation. This technique enables the remodelling of collagen, which in turn prevents and treats photoaging stygmata. Finally we explore a new potential treatment field for PDT determined by the activation of follicular bulge stem cells caused by in situ ROS formation.

Pulsed-Dye Laser Treatment of Port-Wine Stains in Children: Useful Tips to Avoid General Anesthesia.

Pulsed dye laser (PDL) treatment of port-wine stains (PWSs) in children is a common procedure performed in most laser units. Pain assessment in our younger patients is a major concern, especially in those with extensive PWSs. The use of general anesthesia (GA) results in pain-free treatment, but its effects on the developing brain are far from totally understood. Thus we propose some tips that avoid the use of GA in most of our young patients, including the use of topical anesthetics and cooling systems, large laser spot size and high frequencies, early and frequent treatment with parents present, and the "introduction" and "pressure" techniques, among others.

Spiky keratotic projections on the palms and fingers. Spiny keratoderma.

Spiny keratoderma is an infrequent dermatosis consisting of multiple projections located on the palms and soles, with the distinct histopathology feature of a parakeratotic column above a hypogranular epidermis. This entity has been reported under several different names, such as punctate porokeratotic keratoderma, punctate keratoderma, palmar filiform hyperkeratosis, and spiny keratoderma of the palms and soles. Most of the cases described are acquired, although there are also familial cases. Since this disease has been under-diagnosed and under-reported, it is important for dermatologists to keep spiny keratoderma of the palms and soles in mind. We present a familial case of spiny keratoderma and review the literature.

Angiolymphoid hyperplasia with eosinophilia treated with vascular laser.

BACKGROUND: Angiolymphoid hyperplasia with eosinophilia is a rare, benign disorder characterized by reddish-brown nodules and plaques in the dermis and the subcutaneous tissues, typically occurring on the neck and head. Surgical excision, corticosteroids, radiotherapy, and other therapies have been used, however, recurrences are common. Treatment with vascular lasers such as pulsed dye laser (PDL) or Nd:YAG seems to be a promising therapeutic option. OBJECTIVE: To assess the efficacy and safety of PDL and combined sequential PDL-Nd:YAG laser in patients with ALHE. METHODS: Three patients with ALHE were treated with PDL at 595-nm wavelength or with a combined sequential application of 595-nm PDL and 1,064-nm Nd:YAG wavelengths. Topical anesthetic was applied before laser treatment. RESULTS: Complete resolution of the lesions was achieved in two patients with ALHE; a partial response was seen in one patient. No significant side-effects were reported. CONCLUSIONS: We consider that PDL should be a first-line therapy for AHLE. Sequential application of PDL and Nd:YAG laser seems to show promising results, so it could be an interesting new treatment option.

Low-level light-assisted photodynamic therapy using a wearable cap-like device for the treatment of actinic keratosis of the scalp.

BACKGROUND: Daylight photodynamic therapy (dlPDT) is a painless and increasingly cost-effective treatment for actinic keratosis (AK). New protocols avoid incubation, minimizing pain and adverse events. However, it is time-consuming and dependent on specific weather conditions. In patients with AK of the scalp, we evaluated the efficacy of indoor photodynamic therapy (PDT) using a wearable low-level light therapy (LLLT) device, without pre-incubation with a photosensitizing agent. METHODS: In this pilot study, 27 patients with thin and moderately thick AK (Olsen Grades I-II) underwent a single 15-minute session of LLLT using a wearable cap-like device immediately after application of methyl-aminolevulinate (MAL) cream, with no prior preparation of the affected area. Treatment efficacy was quantified by measuring the reduction in AK lesion number and the AK quality of life (AKQoL) score. All AK lesions were mapped at baseline for follow-up 2 months later. Paired pre/post scalp biopsies from 5 patients were analysed using histological and immunohistochemical techniques (p53, p27, cyclin D1, p63, and Ki67 expression). Data were analysed using the Wilcoxon signed-rank test. RESULTS: In all patients we observed a global reduction in the number of AK lesions (71%; p < 0.0001) and AKQoL score (from 5.6 to 4.4; p = 0.034) 2 months after treatment. Histology and immunohistochemistry of skin biopsies from 5 patients also revealed marked improvements after LLLT. No patients reported any pain during treatment. CONCLUSION: PDT using LLLT is a rapid, painless, and efficacious modality for the treatment of AK.

Experience with photodynamic therapy in Hailey-Hailey disease.

Hailey-Hailey disease (HHD) is a rare genodermatosis that is often difficult to treat. This paper reports three patients with HHD treated with one session of photodynamic therapy (PDT) using topical methyl aminolevulinic acid applied under occlusion for 3 hours and red light at 37 J/cm2 for 7.5 minutes. Our results are not successful: all of the patients suffered discomfort during the 3-4 weeks following PDT and only one patient experienced clinical improvement. None of the patients would like to repeat the treatment. PDT is at an exploratory stage; further studies are necessary to determine whether PDT is useful in the treatment of HHD.

[Gefitinib-induced perforating dermatosis]. / Dermatosis perforante por gefitinib.

Gefitinib (Iressa) is a new antineoplastic agent that acts by selectively inhibiting epidermal growth factor receptor tyrosine kinase (EGFR-TK). It has shown activity against several solid tumors. Because of their action mechanism, gefitinib and other tyrosine kinase inhibitors have been associated with multiple cutaneous effects, most of which are mild and well tolerated. We present a case of perforating dermatosis after treatment with gefitinib.

[Treatment of acneiform rash by epidermal growth factor inhibitors with oral tetracyclines]. / Tratamiento de la erupción acneiforme por inhibidores del factor de crecimiento epidérmico con tetraciclinas orales.

INTRODUCTION: Epidermal growth factor inhibitors (EGFR) are new antineoplastic agents that are increasingly being developed. They are basically used as second line treatment in advanced stage tumors. Appearance of a facial acneiform rash in patients treated with these drugs is common and characteristic. The literature proposes multiple topical and systemic treatment options. Up to now, there is no clear evidence on any of them. PATIENTS AND METHODS: A descriptive study of 6 patients who were treated with 100 mg daily dose of doxycycline for 3 weeks was conducted. Clinical characteristics of the patients and treatment efficacy were analyzed. RESULTS: Five of the six patients achieved total resolution of the acneiform rash with this treatment. One patient achieved partial response. After long follow-up periods and in spite of following treatment with the EGFR inhibitors, no relapse was observed. CONCLUSIONS: Doxycycline is suggested as an effective treatment in this disease. Even though it is a short series, the results in our patients support this efficacy.

Dermatosis perforante por gefitinib / Gefitinib-induced perforating dermatosis

El gefitinib (Iressa®) es un nuevo agente antineoplásico que actúa inhibiendo selectivamente la tirosina cinasa del factor de crecimiento epidérmico (EGFR-TK). Ha demostrado actividad frente a varios tumores sólidos. Por su mecanismo de acción, el gefitinib y otros inhibidores de tirosina cinasa se han asociado a múltiples efectos cutáneos dermatológicos, la mayoría de ellos leves y bien tolerados. Se presenta un caso de dermatosis perforante tras tratamiento con gefitinib

Gefitinib (Iressa®) is a new antineoplastic agent that acts by selectively inhibiting epidermal growth factor receptor tyrosine kinase (EGFR-TK). It has shown activity against several solid tumors. Because of their action mechanism, gefitinib and other tyrosine kinase inhibitors have been associated with multiple cutaneous effects, most of which are mild and well tolerated. We present a case of perforating dermatosis after treatment with gefitinib