Umbilical seborrheic keratosis-like lesion developing after diode laser hair removal in an 18-year-old patient.

OBJECTIVE: to report a possibly novel complication of laser hair removal. CASE REPORT: a white-skinned 18-year-old patient discovered an umbilical, brown, and raised lesion while shaving before his second diode laser hair removal session. He sought consultation before his fourth laser session since the lesion further thickened and darkened. Dermoscopy showed no pigmented network, but a few comedo-like openings within an erythematous-light brown scaly and fissured papule, "moth-eaten" borders, and a central crust due to manipulation, suggesting the diagnosis of seborrheic keratosis. We noted that the laser fluence was increased on the umbilical region where hair seemed resistant to treatment. The patient denied a recent history of local sun tanning, sunburns, inflammation, drainage, or manipulation. The lesion cleared, with no short-term relapse, after one session of cryotherapy. CONCLUSION: the development of a seborrheic keratosis-like lesion on a densely haired non-sun-exposed umbilicus of a young patient, following pre-laser shaving and high-fluence hair removal diode laser sessions, could have implicated triggering irritation and/or keratinocyte stimulation by red light-engendered reactive oxygen species (ROS) in the skin with silent epidermal mosaicism.

Adverse Events of Light-Assisted Hair Removal: An Updated Review.

BACKGROUND: With light-assisted hair removal becoming widely used, reports of adverse effects are increasing. OBJECTIVE: To review all the reported optical incidents and cutaneous complications of laser or intense pulse light-assisted hair removal. METHODS: A PubMed database systematic search was performed to identify studies reporting such adverse events before July 2022 using the Mesh terms "adverse effects" AND "hair removal" AND ("laser" OR "intense pulse light"). RESULTS: Altogether, 358 references were identified. After excluding duplicates, unrelated articles, guidelines, and conference abstracts, then adding references from studies bibliography, 104 publications were included. Ocular incidents consisted of anterior uveitis, iritis and iris atrophy, pupillary distortion, posterior synechiae, anterior chamber pigment, and cataracts in the anterior subcapsular region. Cutaneous complications consisted of pain, burns, folliculitis, leukotrichia, paradoxical hypertrichosis, pigmentary changes, changes in nevi, pili bigemini, herpes infection, hyperhidrosis, bromhidrosis, Fox-Fordyce disease, and frostbite from the cooling system. They were mostly correlated to skin type and body area as well as to light device and set parameters. Intense pulse light devices were found to be less painful than alexandrite laser, yet more painful than diode laser; Nd:YAG laser had the highest pain score. CONCLUSION: Optical incidents can be systematically avoided. Cutaneous complications are usually related to professional errors and patient characteristics. Better knowledge of laser physics and adequate training of laser operators are key recommendations to avoid undesirable side effects. Safety recommendations help prevent most of the reported complications.

Prevalence of adverse events varies with the different oral isotretinoin brands in acne treatment: a retrospective observational study.

Oral isotretinoin remains the most effective treatment for acne. The aim of this retrospective single-center cohort study was to estimate the prevalence of adverse events with the different oral isotretinoin brands used in acne treatment. The population consisted of all patients who consulted for acne between January 2015 and January 2020. The inclusion criterion was the initiation of treatment with oral isotretinoin. The exclusion criteria were the use of two or more brands during the same course of treatment and previous treatment with oral isotretinoin. Statistical analysis was carried out using Chi-square and Mann-Whitney tests. We analyzed 468 patients of whom 68.6% were female. The median age was 21 years. The median weight was 65 kg. The treatment was Roaccutane®, Curacné®, Acnotren®, Isosupra®, Contracné®, or Acnogen® in 44.2%, 28%, 14.5%, 10.5%, 1.7% and 0.4% of cases, respectively. Xerosis was the most frequently reported side effect regardless of the brand. The highest frequencies of hypercholesterolemia (25.6%) and eczema (13%) were noted with Roaccutane®; hypertriglyceridemia (16.8%), epistaxis (9.9%) and fatigue (3.1%) with Curacné®; excessive sweating (4.1%) and headache (4.1%) with Isosupra®; and abnormal liver function tests (11%) with Acnotren®. We found a significant correlation mainly between abnormal ASAT and Acnotren® (p = 0.009), hypercholesterolemia and Roaccutane® [OR = 1.652 (95% CI 1.056-2.585)], hypertriglyceridemia and higher body weight (p = 0.004). Factors related to the drug brand and to characteristics of acne patients could explain the variability in the prevalence of some adverse events.

Clinical and pathological features associated with high-risk, multiple, and recurrent basal cell carcinomas: a retrospective cohort analysis from the Levantine coast of the Mediterranean Sea.

Basal cell carcinoma (BCC) data coming from the Levantine coast of the Mediterranean Sea are limited. The study aimed to primarily analyze the demographic, clinical, pathological, and prognostic characteristics of BCC in this region of the world and secondarily identify features associated with high-risk, recurrent, or multiple BCCs. Patients with at least one diagnosis of BCC registered in the pathology department between January 2015 and December 2019 were included in this analytical retrospective single-center cohort study. Patients with basal cell nevus syndrome were excluded. Patients' characteristics and pathological features were collected through file check for a first analysis. Risk factors and evolution were sought through a phone call interview for the second analysis. The first analysis included 506 BCCs corresponding to 365 patients with a mean age of 65 ± 15 years, twenty-two (6%) were less than 40 years old, 180 (49.3%) were women, and 85 (23.3%) had two or more BCCs. The second analysis included 279 BCCs corresponding to 205 patients. Periorificial and infiltrative BCCs were more frequent in men. Periorificial tumors were more frequently nodular or infiltrative and were associated with recurrence. Tumors with perineural involvement were histologically never nodular nor superficial. Recurrence was more frequent in BCCs having periorificial location, a size larger than 2 cm, or an infiltrative subtype. Multiple BCCs were more frequent in patients with light skin type or familial history of skin cancer. High-risk BCCs were more common in patients with low sun exposure.

Beneficial UVB phototherapy preceding a fractional CO2 laser-UVB protocol in refractory non-segmental vitiligo.

OBJECTIVES: To explore the short- and long-term effects of UVB phototherapy preceding a fractional CO2 laser-UVB protocol in patients with resistant nonsegmental vitiligo. MATERIALS AND METHODS: This single-center, prospective, split-face/body, evaluator-blinded study included adult patients with stable vitiligo refractory to conventional treatments. Two symmetrical lesions were selected. Phototherapy was delivered with one side covered, until minimal erythema. Within 3 days, 31-month-apart sessions of laser were performed on both sides. After each laser session, phototherapy was resumed three times weekly, with all lesions uncovered, until 8 weeks after the last laser session. At baseline, at the end of treatment, and 5 years later, a Mean Improvement Score by Physician (MISP) and a patient satisfaction 10-point visual analog score (VAS) were recorded. RESULTS: Ten patients (8 women and 2 men) were included; their mean age was 32.9 years; phototype III was predominant; the mean duration of vitiligo was 3 years. At the end of treatment and 5 years later, scores of lesions treated with UVB-CO2 -UVB (mean MISP 3.0 and 2.9, mean ΔVAS 4.5 and 3.9, respectively), were higher than those of lesions treated only with CO2 -UVB (mean MISP 2.5 and 2.4, mean ΔVAS 4.1 and 3.6, respectively). After 5 years, one patient lost his partial response and two patients developed light hyperpigmentation on both sides. CONCLUSION: Exposure to UVB before CO2 -UVB explains the higher scores as it was the only variable between the two sides. It may improve the response of resistant lesions with a constantly sustained result over 5 years.

Big toenail onychomycosis features associated with response to 1064 nm Nd: YAG laser treatment.

BACKGROUND: A few studies discussed the factors correlated to response in laser treatment of onychomycosis. OBJECTIVE: This study aimed to seek big toenail onychomycosis features that correlate with response to 1064 nm Nd: YAG laser treatment. METHODS: This single-center, retrospective study included patients who had only one big toenail onychomycosis, with a confirmed mycological diagnosis and/or a high clinical suspicion. Patients had three sessions 1 month apart. The following characteristics were collected from the patients' files: age, sex, smoking and arterial hypertension statuses, results of baseline mycological culture, Onychomycosis Severity Index (OSI) score at baseline and at the end of the 6-month follow-up, as well as the reported side effects. RESULTS: We included 105 patients, 86 women and 19 men, with a mean age of 43 years. Demographics have shown that 73.6% of patients were smokers, 17.9% had arterial hypertension, 61.9% had a culture positive for Trichophyton species, and 9.4% had a culture positive for Candida species. According to the OSI score, onychomycosis was mild in 18.9%, moderate in 39.6%, and severe in 41.5% of patients. At 6 months, clinical cure was achieved in 57.1% of patients. CONCLUSION: The OSI decrease after 3 sessions of Nd: YAG laser was significantly more important in women and in patients with positive mycology culture, smaller affected area of the nail, no subungual hyperkeratosis, and no nail matrix involvement. Age, smoking, hypertension, and side effects were not shown to significantly correlate with the decrease of the OSI score.

The Multifaceted Engagement of the Dermatologist in the Covid-19 Pandemic.

Dermatologists worldwide are engaged in the struggle against Covid-19. They limited their daily activity to priority cases, intending to reduce the exposure of patients in the waiting room. Teledermatology was recommended as an efficient alternative to assure patients' needs and safety. At the same time, dermatologists had to manage the skin injuries of frontline healthcare workers; to characterize the cutaneous manifestations of Covid-19; to assess the optimal treatment of patients with skin diseases, especially those taking immunomodulating and immunosuppressant molecules; and finally to promote balanced precautions in healthy persons.

Searching predictive factors of efficacy and safety in a fractional CO2 laser.

A few studies discussed short outcomes in fractional CO2 laser. This study aimed to seek factors of medium-term efficacy and safety in patients treated for facial rejuvenation or acne scars. This single-center, prospective, single-arm, evaluator-blinded cohort study included patients of 18 years and older undergoing a fractional CO2 laser for facial skin rejuvenation or atrophic acne scars. One session of ultrapulsed fractional 10 600 nm CO2 laser was performed with the Deep FX TM mode in acne scars and the Active FX TM mode in facial rejuvenation and acne scars. Follow-up was carried out for 6 months. In the end, a patient self-satisfaction assessment was obtained. A blinded physician graded improvement based on pretreatment and 6-month photography. The study included 75 patients, of whom 88% were women. Forty-five had facial rejuvenation, and 30 had atrophic acne scars treatment. Half of the patients were satisfied. The physician-blinded evaluation indicated "good to very good" improvement in 46.7% of facial rejuvenation patients, and 30% of acne scars patients. Hyperpigmentation and folliculitis were recorded in 15 and 3 patients, respectively. This study did not find statistically significant factors to predict outcomes in a fractional CO2 laser. We could however note better results in acne scar patients of thicker skin, and facial rejuvenation patients of younger age and thinner skin. We counted more hyperpigmentation events in phototypes III and IV, and it was reversible in all cases.

Sickle cell disease induces resistance to cutaneous carcinogenesis.

BACKGROUND: While skin carcinomas are reported in chronic ulcers and in patients treated with hydroxyurea (HU) for myeloproliferative neoplasms, no skin carcinoma has been reported in patients with sickle cell disease (SCD), presenting chronic skin ulcers or treated with HU. The objective was to estimate the risk of cutaneous malignant transformation in SCD patients with prolonged leg ulcers or under HU therapy. RESULTS: In this cross-sectional study, the cohort consisted of 1543 patients. In the first series, 29 patients presented a total of 53 ulcers lasting more than two years. The median age was 35 ± 8.4 years old. The median duration for a single ulcer was 9.2 ± 7 years. None of the examined ulcers showed any suspicious area of malignant transformation. In the second series, 187 patients treated with HU for more than two years were identified. The median age was 31.3 ± 9.9 years old. The median duration of treatment with HU was 6 ± 3.2 years. No skin carcinoma or actinic keratosis was recorded. CONCLUSIONS: This study showed that skin carcinogenesis did not occur in our series of SCD patients exposed to transforming events such as long term HU treatment or prolonged leg ulcers.

Triggers, clinical manifestations, and management of pediatric erythema multiforme: A systematic review.

BACKGROUND: Erythema multiforme (EM) is an acute inflammatory mucocutaneous condition. EM is rarely described in children and infants. OBJECTIVE: To investigate the triggers, clinical manifestations, and treatment of pediatric EM. METHODS: Systematic literature review of pediatric EM. RESULTS: After full-text article review, we included 113 articles, representing 580 patients. The mean age was 5.6 years, ranging 0.1-17 years. Infectious agents were the main triggers: herpes simplex virus (HSV) in 104 patients (17.9%) and Mycoplasma pneumoniae in 91 patients (15.7%). In total, 140 cases (24.1%) were drug-related and 89 cases (15.3%) had other triggers, such as vaccines (19 patients, 3.2%). In total, 229 patients had EM major (39.5%). Treatment was supportive care only (180 patients, 31.1%), systemic corticosteroids (115 patients, 19.8%), antivirals (85 patients, 14.6%), and antibiotics (66 patients, 11.3%), mostly macrolides (45 patients, 7.7%). Long-term sequelae were rare (1.3%). Pediatric EM was reported in 19 infants (3.2%). The main trigger was vaccination (9 patients). Infantile EM was EM major in 2 cases and EM minor in 17. Infants were less prone to develop EM major than older children (P < .01). Pediatric EM was recurrent in 83 cases (14.3%), which was triggered by HSV in 36 patients (61%). Recurrence affected older children. LIMITATIONS: Potential confusion between Steven Johnson syndrome and EM major in addition to publication bias. CONCLUSION: Pediatric EM is a rare disease, mainly triggered by infections. This condition can affect all mucosal surfaces, most commonly the oral mucosae. The diagnosis is clinical, and management relies on supportive care. Vaccines are a particular trigger in infants. Recurrent cases are most commonly linked to HSV. Dermatologists and pediatricians should be aware of this potentially recurrent and severe condition.

[Skin and pregnancy]. / Peau et grossesse

Skin and pregnancy. Skin manifestations during pregnancy are common and diversified. Physiological changes are the most frequently reported. These changes mainly include hyperpigmentation, cutaneous signs of vascular proliferation or congestion, and striae distensae. Regression is spontaneous in post-partum but total clearance can be incomplete. Eventual treatment of resistant changes is reported until delivery or end of lactation. Specific dermatoses of pregnancy include polymorphic eruptions of pregnancy, atopic eczema of pregnancy, intrahepatic cholestasis and pemphigoid gestationis. It is mandatory, in any eczema-like or urticaria-like pruritic dermatose of pregnancy, to rule out pemphigoid gestationis, a rare auto-immune dermatose, by performing skin biopsy with direct immunofluorescence or an ELISA BP 180-NC16A. In case of generalized pruritis, serum bile salts levels should be tested in order to rule out intrahepatic cholestasis.

Peau et grossesse. Les manifestations cutanées au cours d'une grossesse sont fréquentes et très diverses. Les modifications physiologiques sont les plus fréquentes ; ce sont en particulier les hyperpigmentations, les signes de congestion ou de prolifération vasculaire et les vergetures. Leur régression est spontanée en post-partum mais parfois incomplète. Leur éventuel traitement se fait après l'accouchement ou mieux à la fin de l'allaitement. Les dermatoses spécifiques de la grossesse incluent les dermatoses polymorphes gravidiques, l'eczéma atopique de la grossesse, la cholestase intrahépatique gravidique et la pemphigoïde gestationnelle. Devant toute dermatose eczématiforme ou urticarienne prurigineuse il faut éliminer une pemphigoïde gestationnelle, dermatose auto-immune rare, en réalisant une biopsie avec immunofluorescence directe ou un Elisa BP 180-NC16A. Devant un prurit généralisé, un dosage des sels biliaires sériques est nécessaire afin d'éliminer une cholestase intra-hépatique.

Skin disease in pregnancy.

Skin manifestations during pregnancy are common and diversified. This review will focus on the most important entities to be recognized by obstetricians. These are, on the one hand, physiological changes, where unnecessary investigations should be avoided, and on the other, the specific dermatoses of pregnancy. These develop electively in pregnancy, and they are currently grouped into three disorders: polymorphic eruption of pregnancy, atopic eczema of pregnancy, and pemphigoid gestationis. Arguments for recognition of these are presented including detection of anti-BP180 antibodies. Follow-up and treatment depend on the precise diagnosis. Risks in fetal prognosis may occur in rare pemphigoid gestationis cases.

Reversibility of hyperhidrosis post axillary depilatory laser.

Hyperhidrosis and bromhidrosis were lately reported as novel side effects of laser-assisted removal of axillary hair. The goal of our study was to evaluate the reversibility of these two side effects. An observational, single-center cohort study included over a 30-month screening period 30 patients with newly reported hyperhidrosis and/or bromhidrosis related to axillary depilatory laser. After 26 weeks of follow-up, each patient was assessed for spontaneous reversibility. A 12-week duration treatment with topical aluminum chloride was evaluated in patients with persisting hyperhidrosis. Hyperhidrosis was assessed using the Hyperhidrosis Disease Severity Scale (HDSS). Spontaneous reversibility was observed in 20% of patients. In total, 23 out of 30 patients recovered normal axillary transpiration either spontaneously or after treatment. Mean HDSS score was significantly lower in the treated group. It appears that axillary hyperhidrosis and bromhidrosis, secondary to laser depilation, reverse either spontaneously or after using topical antiperspirant.

Nodular lesions of self-healing juvenile cutaneous mucinosis: a pitfall!

Self-healing juvenile cutaneous mucinosis (SHJCM) is a rare disorder of unknown origin, which occurs in children in good health. It is characterized by the multiplication of transient cutaneous papules and nodules, mainly located on the head and periarticular areas that spontaneously resolve. Histological features of SHJCM have been well described; therefore, the diagnosis is usually made easily when papules are biopsied. We report a series of 3 new cases of SHJCM presenting mainly with nodular lesions. Histological examination of these nodules showed either lesions consistent with nodular or proliferative fasciitis or nonspecific panniculitis. Mucinous deposits were present but often inconspicuous, so could be disregarded. We wanted to emphasize this misleading presentation because a biopsy for histological examination is always mandatory in cases of proliferating nodules to rule out malignant tumors. Therefore, the diagnosis always requires discussion between pathologists and clinicians to rapidly reassure the parents and avoid inappropriate therapy.

Low blood concentration of hydroxychloroquine in patients with refractory cutaneous lupus erythematosus: a French multicenter prospective study.

OBJECTIVE: To study the relation between blood concentration of hydroxychloroquine and the clinical efficacy of hydroxychloroquine sulfate in a series of patients with cutaneous lupus erythematosus (CLE). DESIGN: Prospective multicenter study. A staff dermatologist blinded to blood hydroxychloroquine concentrations performed a standardized review of medical records and assessment of hydroxychloroquine efficacy in the following 3 categories: complete remission, partial remission (clearing of >50% of skin lesions), or treatment failure. Whole-blood samples were collected for measurement of blood hydroxychloroquine concentration. SETTING: Fourteen French university hospitals. PATIENTS: Three hundred consecutive patients with subacute or chronic CLE who had been treated with hydroxychloroquine for at least 3 months. MAIN OUTCOME MEASURES: The statistical significance of correlation between blood hydroxychloroquine concentration and efficacy of hydroxychloroquine and the statistical associations in univariate and multivariate analyses of complete remission with several variables. RESULTS: The study included 300 patients with discoid lupus erythematosus (n = 160), subacute CLE (n = 86), lupus erythematosus tumidus (n = 52), chilblain lupus (n = 26), and lupus panniculitis (n = 16); 38 of these patients had 2 or more associated forms. Median blood hydroxychloroquine concentration was significantly higher in patients with complete remission (910 [range, <50 to 3057] ng/mL) compared with partial remission (692 [<50 to 2843] ng/mL) and treatment failure (569 [<50 to 2242] ng/mL) (P = .007). In the multivariate analysis, complete remission was associated with higher blood hydroxychloroquine concentrations (P = .005) and the absence of discoid lesions (P = .004). Thirty patients (10.0%) had very low blood hydroxychloroquine concentrations (<200 ng/mL) and may be considered nonadherent to the treatment regimen. CONCLUSION: Monitoring hydroxychloroquine blood concentrations might improve the management of refractory CLE.

Myeloproliferative disorder therapy: assessment and management of adverse events--a dermatologist's perspective.

Development of cutaneous manifestations in patients with myeloproliferative disorders can be either due to the course of the disease itself or induced by some of the treatments given. The cutaneous manifestations may reveal an unknown haemopathy and/or indicate a poor prognosis. Some of these alter quality of life. Hydroxyurea has been shown to induce a variety of cutaneous adverse reactions ranging from benign effects such as hyperpigmentation to more severe leg ulcers and squamous cell carcinomas. Herein, we discuss the importance of undertaking regular physical examinations in order to identify and treat cutaneous manifestations early in their course.