Clinical and dermoscopic assessment of ablative carbon dioxide laser versus intradermal heparin sodium in xanthelasma.

BACKGROUND: Ablative carbon dioxide (CO2 ) laser is still a cornerstone in the management of xanthelasma. However, post-laser complications such as post-inflammatory hyperpigmentation or scarring have to be considered. Heparin sodium was recently suggested as an effective therapeutic modality for xanthelasma. OBJECTIVE: The aim of this work was to compare the therapeutic value of ablative CO2 laser versus intradermal heparin sodium in xanthelasma. METHODS: This study was piloted on 30 xanthelasma patients, whose lesions were randomly categorized into two groups. Group A was managed with CO2 laser ablation (2 sessions scheduled every 4 weeks), whereas Group B was managed with intradermal heparin sodium injections (10 sessions scheduled every week). Pre- and post-treatments evaluations were done both clinically and dermoscopically. RESULTS: Significant reduction of xanthelasma lesions was reported in response to both therapeutic interventions. However, the ablative CO2 laser was more significantly effective than intradermal heparin sodium. Interestingly, intradermal injection of heparin sodium was nearly as effective as ablative CO2 laser in early (<2 years duration) grade I and II xanthelasma, with a lower incidence of post-therapy side effects. CONCLUSIONS: Intradermal injection of heparin sodium could be suggested as a safe and cost-effective therapeutic technique for early mild grade I and II xanthelasma. Moreover, it could be recommended as a pre-operative management of grade III and IV xanthelasma to reduce the lesions to be easily ablated with CO2 laser.

The clinical and electron microscopic evaluation of the impact of pulsed dye laser techniques on solar lentigines (randomized clinical trial).

BACKGROUND: Solar lentigines are skin lesions manifested by benign dark pigmentation causing a cosmetic problem in many patients. Several treatment modalities used for the management of solar lentigines. Side effects and rates of recurrence may be associated with them. OBJECTIVE: Treating solar lentigines with two different techniques of pulsed dye laser (PDL) and evaluation of the results both clinically and via the examination of ultrastructural changes by electron microscopy. PATIENTS AND METHODS: This study was conducted on 22 subjects with solar lentigines and having Fitzpatrick III-IV skin types, was managed by the use of PDL after enrolling them into two groups. Group I (one stacked PDL was used) and Group II (treated by stacked PDL in two sessions, 1 month apart). At baseline and 6 months after treatment, two punch biopsies with a diameter of 2 mm were taken from all patients. All taken biopsies were prepared for light and electron microscopic examinations. RESULTS: Both PDL techniques induced significant better clinical and histological outcomes. No one demonstrated any postoperative complications such as post-inflammatory hyperpigmentation and scarring. CONCLUSIONS: The two techniques of PDL are efficient for solar lentigines treatment.

Pulsed dye laser in the treatment of basal cell carcinoma: A single session versus two sessions - a randomized controlled trial.

BACKGROUND: Basal cell carcinoma is the most common form of skin cancer worldwide. It has a specialized microvasculature system that can be targeted by the pulsed dye laser using the theory of selective photothermolysis. OBJECTIVE: To evaluate the efficacy and safety of single session versus two sessions of pulsed dye laser in the treatment of basal cell carcinoma. METHODS: A total of 22 patients with basal cell carcinoma were collected in this randomized controlled trial. The patients were divided into two groups: Group I - 11 patients were treated by one session of pulsed dye laser, and Group II - 11 patients received two sessions of pulsed dye laser 2 weeks apart. The patients were assessed clinically and histopathologically after end of the treatment. RESULTS: There was a significant improvement of basal cell carcinoma clinically and histopathologically. Maximal histological clearance rate was achieved in superficial basal cell carcinoma type, small-sized basal cell carcinoma < 0.7 cm and in cases with strong inflammatory response after laser treatment. Treatment of basal cell carcinoma with two sessions of pulsed dye laser was more effective than one session treatment. LIMITATIONS: The small sample size of patients and the limited location of the lesions on the head compared with trunk and extremities. Also, the lack of adequate study power may prevent generalization of results. CONCLUSION: Pulsed dye laser proved to be a safe, effective and noninvasive modality for the treatment of basal cell carcinoma that can be used as a monotherapy in small-sized lesions. Also, it can be used to debulk large-sized lesions before surgery.

A comparative clinical and mycological study of Nd-YAG laser versus topical terbinafine in the treatment of onychomycosis.

BACKGROUND: Topical treatment of onychomycoses is time consuming, cost-intensive and subject to relatively high failure rates. Light-based devices may be effective treatment modalities. Aim of this work: To compare the clinical and mycological efficacy of Nd-YAG laser versus topical terbinafine in the treatment of onychomycosis. PATIENTS AND METHODS: This study included 40 patients with onychomycosis randomized to receive four sessions of Nd-YAG laser (group A) or topical terbinafine twice daily for six months (group B). Follow-up was performed monthly. Mycological examination was done at third and sixth months following the start of treatment. RESULTS: After six months, all patients in group A showed marked improvement, while in group B only 50% of patients showed mild to moderate improvement. In addition, by the end of six months, 80% of the patients in group A showed mycological clearance, while all patients in group B still had positive cultures. CONCLUSION: Long pulse Nd-YAG laser therapy of onychomycosis is a safe and efficient method for treating onychomycosis. It is especially beneficial in elderly, compromised and hepatopathic patients for whom other alternative treatments could present some risks.

Immunohistochemical expression of cathepsin L in atopic dermatitis and lichen planus.

BACKGROUND: Cathepsin L is a member of papain superfamily. It seems to promote T-cell survival, selection maturation in the thymus and enhance the antigen presentation. Cathepsin L plays an important role in tumor necrosis factors (TNF-α) induced cell death. Also it degrades the tight junction between cornedesomses in the epidermis. Elevated expression of cathepsin L has been found in many inflammatory and neoplastic diseases. OBJECTIVE: The aim of this study was to determine immunohistochemical expression of cathepsin L in atopic dermatitis (AD) and lichen planus (LP) patients in order to evaluate its role in the pathogenesis of both diseases. MATERIALS AND METHODS: This study included 15 patients with AD (Group I), 15 patients with LP (Group II), in addition to 10 healthy skin specimens served as controls (Group III). Punch biopsies were taken from lesional skin of the patients and controls for immunohistochemical detection of cathepsin L expression. RESULTS: Highly significant increase was found in cathepsin L expression in AD and LP patients compared to controls [P = 0.001]. CONCLUSION: Cathepsin L could be implicated as an important protease in the pathogenesis of AD and LP. It could be a useful marker for assessing AD severity.

Autologus bone marrow stem cells in atrophic acne scars: A pilot study.

BACKGROUND: Acne scar is a very distressing and difficult problem for physicians and patients. Management of cutaneous scarring from acne can be challenging and confusing. The available modalities may be effective, having considerable morbidity and long downtime. Besides, they may not have the same efficacy in different skin types or acne scar types. OBJECTIVE: To evaluate the short-term safety and efficacy of autologous bone marrow (BM) stem cells (SCs) in treating atrophic acne scars. METHODS: Fourteen patients with moderate to severe atrophic acne scars were included. All patients were subjected to single session of autologous BMSCs therapy. Each patient received 5 µg/kg/day granulocyte colony-stimulating factor (G-CSF) as a single subcutaneous dose for 2 successive days before BM aspiration. The SC-containing solution was injected under each scar intradermally. The scars of the patients were clinically assessed both qualitatively and quantitatively before and after 6 months. The patients were given a preformed questionnaire Cardiff acne disability index (CADI) before and after treatment. RESULTS: After 6 months of the injection, there was significant improvement in the qualitative grading, quantitative grading and CADI scores. All types of scars showed significant improvement. No significant adverse effects were reported in any patient. CONCLUSION: Autologous BMSCs seem to be a safe and effective treatment option for the management of all types of atrophic facial acne scars.