Alexandrite Laser for the Treatment of Resistant and Hypertrophic Port Wine Stains: A Clinical, Histological and Histochemical Study / Laser de Alejandrita para el tratamiento de malformaciones capilares tipo mancha en vino de Oporto resistentes y/o hipertróficas: estudio clínico, histológico e histoquímico

BACKGROUND: Port wine stains (PWSs) are commonly treated by the pulsed dye laser. However, treatment of hypertrophic or resistant PWSs is a major therapeutic challenge. The long-pulsed Alexandrite laser could be a safe and effective treatment for resistant PWSs, due to an increase depth of penetration of 50-75% over PDL. OBJECTIVE: The aim of this study was to assess the efficacy and safety of a long-pulsed Alexandrite laser in patients with hypertrophic, dark and/or resistant PWSs. Pink pale resistant PWS were excluded from the study. METHODS: Twenty-one patients (age 20-75 years), phototypes I-IV on the Fitzpatrick scale, with PDL dark resistant PWSs were treated with long-pulsed Alexandrite laser. We excluded high phototypes and PDL pink resistant PWSs. All patients were treated with 3 laser sessions at settings of 3-ms pulse duration, 10-mm spot, 35-55J/cm2, with cooling (Dynamic Cooling Device 50 ms with delay 30 ms). Laser sessions were repeated approximately every 2 months. Three dermatologists evaluated treatment effectiveness by means of photographs of the patients before and after laser treatment (scale from 0 to 4). Adverse events were registered. Patient satisfaction was also assessed (scale from 0 to 10). RESULTS: Mean global improvement was rated as 2.28. Long-lasting side effects included minimal scarring after blistering in 1 patient. Mean patient satisfaction was 8.5. CONCLUSIONS: Our study concludes that long-pulsed Alexandrite laser was effective for treatment of resistant PWSs, although the therapeutical window is narrow with this treatment

ANTECEDENTES: Las manchas en vino de oporto (MVO) son normalmente tratadas con láser de colorante pulsado. Sin embargo, el tratamiento de MVO hipertróficas o resistentes continúa siendo un importante reto terapéutico. El láser de Alejandrita de pulso largo podría ser un método seguro y eficaz para el tratamiento de estas lesiones, debido a que la profundidad que alcanza puede superar entre un 50-75% al láser de colorante pulsado. OBJETIVO: El objetivo de este estudio fue evaluar la eficacia y la seguridad del láser de Alejandrita de pulso largo en pacientes con MVO hipertróficas y/o resistentes. Los pacientes con MVO resistentes de color rosa pálido fueron excluidos del estudio. MÉTODOS: Veintiún pacientes (Edades entre 20-75 años), fototipos I-IV en la escala Fitzpatrick, con MVO oscuras, resistentes al tratamiento con láser de colorante pulsado fueron tratados con láser de Alejandrita de pulso largo. Se excluyeron los fototipos altos y las MVO de color rosado pálido. Todos los pacientes fueron tratados con 3 sesiones de láser con los siguientes parámetros: duración de pulso de 3 ms, spot de 10 mm de diámetro, fluencias comprendidas entre 35 y 55 J/cm2, con refrigeración (Dynamic Coolong Device). El intervalo de tiempo entre sesiones fue de 2 meses aproximadamente. Tres dermatólogos evaluaron la efectividad del tratamiento a través de las fotografías de los pacientes antes y después del tratamiento con láser (escala de 0 a 4). Se registraron los eventos adversos acontecidos. La satisfacción del paciente también se evaluó (escala de 0 a 10). RESULTADOS: La mejoría global media fue de 2,28. Los efectos adversos duraderos fueron lesiones cicatriciales mínimas en un paciente. La satisfacción media de los pacientes fue de 8,5. CONCLUSIONES: Nuestro estudio concluye que el láser de Alejandrita de pulso largo puede ser eficaz en el tratamiento de MVO resistentes, aunque la ventana terapéutica es estrecha con este tratamiento

Clinical effects of non-ablative and ablative fractional lasers on various hair disorders: a case series of 17 patients.

BACKGROUND AND OBJECTIVES: Both ablative and non-ablative fractional lasers have been applied to various uncommon hair disorders. The purpose of this study was to demonstrate the clinical effects of fractional laser therapy on the course of primary follicular and perifollicular pathologies and subsequent hair regrowth. MATERIALS AND METHODS: A retrospective review of 17 patients with uncommon hair disorders - including ophiasis, autosomal recessive woolly hair/hypotrichosis, various secondary cicatricial alopecias, pubic hypotrichosis, frontal fibrosing alopecia, and perifolliculitis abscedens et suffodiens - was conducted. All patients had been treated with non-ablative and/or ablative fractional laser therapies. RESULTS: The mean clinical improvement score in these 17 patients was 2.2, while the mean patient satisfaction score was 2.5. Of the 17 subjects, 12 (70.6%) demonstrated a clinical response to non-ablative and/or ablative fractional laser treatments, including individuals with ophiasis, autosomal recessive woolly hair/hypotrichosis, secondary cicatricial alopecia (scleroderma and pressure-induced alopecia), frontal fibrosing alopecia, and perifolliculitis abscedens et suffodiens. Conversely, patients with long-standing ophiasis, surgical scar-induced secondary cicatricial alopecia, and pubic hypotrichosis did not respond to fractional laser therapy. CONCLUSION: Our findings demonstrate that the use of non-ablative and/or ablative fractional lasers promoted hair growth in certain cases of uncommon hair disorders without any remarkable side effects.

Treatment of trichostasis spinulosa with 0.5-millisecond pulsed 755-nm alexandrite laser.

Trichostasis spinulosa (TS) is a follicular disorder in which multiple hairs in a keratinous sheath project above the skin surface. Current treatments provide temporary relief and side effects are common. We report the successful treatment of TS in 20 patients using a short-pulsed 755-nm alexandrite laser. The 20 patients (skin types II-V) presented with TS lesions on the tip of their nose. All patients received a single treatment (one to three passes) with the laser with cold air cooling but without anaesthesia or analgesia. Treatment parameters were as follows: pulse duration 0.5 ms, fluence 15-17 J/cm(2), and spot size 5 mm. The entire procedure required less than 5 min to perform. The patients were followed up for 3 months for any adverse effects or recurrence. In all patients the lesions disappeared immediately after treatment with minimal or no pain. Erythema was minimal and lasted 5-20 min in all patients. Patients were very satisfied. The treated areas were still clear 4 to 5 weeks later, and a second treatment was not considered necessary. There were adverse effects other than the erythema and there was no recurrence within the follow-up period of 3 months. A single treatment with a short-pulsed 755-nm alexandrite laser appears to be a rapid, minimally painful, and effective treatment for TS in patients of skin types II to V.

[Pseudofolliculitis barbae]. / Pseudofoliculitis de la barba.

Pseudofolliculitis barbae is a chronic, irritating, and potentially disfiguring condition that develops as a result of attempts to eliminate hair from the beard area, usually by shaving. It is difficult to determine the incidence of the disorder, but some studies report that it affects up to 1 of every 5 caucasian individuals and that it is much more common in black persons. Clinically it is characterized by the appearance of inflammatory papules and pustules. Once pseudofolliculitis has become established, treatment consists of avoiding shaving and the use of medical treatment similar to that used in acne. However, the long-term result is much more dependent on prevention through a correct shaving technique. In severe cases or when a definitive solution is sought, the treatment of choice is photodepilation.

Treatment of trichostasis spinulosa with a 755-nm long-pulsed alexandrite laser.

BACKGROUND: Trichostasis spinulosa (TS) is a common disorder of hair follicle, characterized by spinous plugs. Topical treatments offer temporary relief but permanent removal of the abnormal follicles using hair removal lasers may result in a definite cure. OBJECTIVE: To evaluate the safety and efficacy of 755-nm alexandrite laser for the treatment of TS lesions. PATIENTS AND METHODS: Two consecutive 755-nm alexandrite laser treatments were performed one month apart. The clinical response and adverse effects were assessed four weeks after the first and second treatments and 20 weeks after the second treatment. RESULTS: Thirty one patients with skin phototypes II to IV completed the study. At the last follow up visit, a decrease in dark-plug density of greater than 50% was noted in 16 patients (51.3%), while only three patients (9.7%) had an improvement of greater than 75%. Ten of the 21 patients (47.6%) with skin type III and six of the seven patients (85.7%) with skin type IV achieved at least 50% improvement in lesions at the last follow up visit (P = 0.1). CONCLUSION: The 755-nm alexandrite laser can safely and effectively reduce TS lesions lasting for a relatively long time in patients with skin types III-IV.

Malignant pilar tumor of the scalp: a case report and review of literature.

Pilar tumor is a rare neoplasm arising from the external root sheath of the hair follicle and is most commonly observed on the scalp. These tumors are largely benign, often cystic, and are characterized by trichilemmal keratinization. Wide local excision has been the standard treatment. Recent reports have described a rare malignant variant with an aggressive clinical course and a propensity for nodal and distant metastases which, therefore, merits aggressive treatment. In this report, we present a case of malignant pilar tumor of the scalp with multiple nodal metastases at presentation. Diagnostic and therapeutic considerations, in the form of adjuvant radiotherapy, are subsequently discussed.

Pilomatrix carcinoma with lymph node and pulmonary metastases.

CASE REPORT: A 72-year-old male patient developed a locally recurrent pilomatrix carcinoma (PC) of the right upper shank. Within a 2-year period he also developed bilateral pulmonary as well as inguinal, cervical and paraaortic lymph node metastases. After external-beam radiation therapy (EBRT) alone, sole interstitial high-dose-rate (HDR) brachytherapy (BRT) or postoperative EBRT with interstitial HDR-BRT boost, the patient demonstrated regressive or stable disease at the lymphatic sites. Systemic chemotherapy with intravenous paclitaxel failed to assure a substantial pulmonary response. In the course of the disease after 28 months pulmonary progression has led to continuing clinical deterioration. CONCLUSION: In accordance with literature data the hitherto course of this case corroborates that radiation therapy (RT) modalities can play an important role in the treatment of PC.

Treatment of trichostasis spinulosa in skin phototypes III, IV, and V with an 800-nm pulsed diode laser.

BACKGROUND: : Trichostasis spinulosa (TS) is a common follicular disorder that results from the retention of multiple vellus hairs within pilosebaceous follicles. A variety of treatment modalities have been used with variable but largely transient success. OBJECTIVES: : To determine whether a pulsed diode laser irradiation would provide a therapeutic response to TS for a prolonged period. METHODS: : Thirteen subjects with untreated TS and skin phototypes III, IV, and V were treated with a 800-nm pulsed diode laser at fluences ranging from 24 to 40 J/cm2 (mean, 36 J/cm2) and a 12- to 20-ms (mean 18 ms) pulse width. Two treatments were delivered at 4-week intervals. Evaluation of improvement was performed at 4 and 20 weeks after the last treatment by a blinded assessment of clinical photographs. RESULTS: : Complete clearing of the lesions was achieved for a period of 8 to 12 weeks. A decrease in dark-plug appearance of greater than 50% was noted in half of the subjects 20 weeks after the second treatment. No pigmentary changes and scarring occurred in any subjects. CONCLUSION: : Pulsed diode laser proved to be a safe and long-term effective treatment for TS in dark-skinned individuals.

Follicular mycosis fungoides.

We describe a patient with follicular mycosis fungoides (MF), a rare folliculotropic variant of cutaneous T-cell lymphoma (CTCL). Follicular involvement in CTCL usually presents clinically as alopecia mucinosa associated histologically with follicular mucinosis. Follicular MF differs from alopecia mucinosa/follicular mucinosis associated with MF with regard to its clinical presentation, histology and, presumably, prognosis. Our patient presented with the characteristic findings of follicular MF, i.e. infiltrated plaques showing numerous enlarged, comedo-like follicular infundibula; histology was dominated by exclusive folliculotropism of atypical lymphocytes sometimes forming follicular Pautrier's microabscesses, and by lack of epidermotropism and follicular mucinosis. Despite photochemotherapy and treatment with oral retinoids and interferon alpha, the patient's follicular MF rapidly developed into a progressive CTCL with large tumorous lesions, but responded to electron beam therapy. The course of our patient's disease confirms the notion that follicular MF may be associated with a worse prognosis than classical MF. However, electron beam irradiation induced remission of follicular MF that was maintained by a combination therapy consisting of extracorporeal photopheresis and interferon alfa.