Superficial radiotherapy for multiple keratoacanthomas.

We report the case of a 76-year-old Caucasian woman who attended our clinic with multiple keratoacanthomas. Radiotherapy was considered a viable and effective option in such an old patient, who could not be a good surgical candidate for number and distribution of the lesions, and for the age. After a 12-month follow-up, we observed the complete and global disappearance of the lesions; the patient was therefore very satisfied especially in view of the clinical outcome. According to our point of view, radiotherapy allows the physician to obtain a good oncological radicality and excellent cosmetic results too.

Efficacy and safety evaluation of an innovative CO2 laser/radiofrequency device in dermatology.

BACKGROUND: CO2 laser has not only become the most widely used laser in dermatological surgical practice, but it has also proved to be highly effective in treating aesthetic imperfections. OBJECTIVE: To examine the efficacy and safety of a novel fractional CO2 laser combined with a radiofrequency device in different dermatological, surgical and aesthetic fields. METHODS: A total of 79 patients were treated in our Outpatient Service with a novel fractional CO2 laser combined with a bipolar radiofrequency device for a maximum of 5 months. Group A consisted of 39 patients with lesions requiring complete excision, whereas Group B consisted of 40 subjects seeking to enhance aesthetic facial imperfections. The results were assessed by three 'blind' investigators using photographs and clinical observations; in addition, the patients had to give their own subjective assessment of the results. RESULTS: At the 6-month follow-up, the lesions of the Group A patients had been completely removed, except for one case of a large sebaceous nevus on the scalp. All the Group B patients showed global improvement in skin tightening, removal of fine lines and rhytides and correction of dilated pores and hyperpigmentation, with no significant side-effects and short downtimes. CONCLUSION: This kind of laser meets the needs of the majority of dermatologists requiring a unique, versatile tool to remove cutaneous lesions and at the same time, safely and effectively treat skin imperfections.

Laser use in infantile hemangiomas, when and how.

Infantile hemangiomas (IHs) are proliferating embrional tumors which can stem from placented tissue and are constituted by endothelial cell hyperproliferation. The management of the IHs is always challenging for all the specialists because of the heterogeneous behavior of these lesions. The factors leading to an aggressive position are essentially these: the prevention or reduction of aesthetic risks, the prevention or treatment of ulcerated hemangiomas, the prevention or impairment of functional risks and pain, and the removal of life-threatening risks. The treatment of vascular lesions is one of the mostly sought and performed cutaneous laser procedures, and in the field of IH treatments the more used laser devices certainly are pulsed dye lasers. Early laser therapy is able to reduce the possibility that the lesion will reach its full size, preventing several complications, connected to the hemangioma's growth, and providing psychological relief for pediatric patients and their parents.

Eyelid skin tightening: a novel 'Niche' for fractional CO2 rejuvenation.

BACKGROUND: The periorbital area is a barometer of chronologic and environmental age for which patients usually seek rejuvenation; fractional CO(2) laser plays a key role among the variety of available dermatologic treatments. OBJECTIVES: The purpose of this study is to evaluate the efficacy and safety of Fractional CO(2) laser in eyelid tightening and periorbital wrinkles. METHODS: Forty-five patients received a range of 2-3 treatments in the upper, lower eyelids and periorbital area with a fractional laser device. Photographs were taken before and after each treatment and 2 weeks, 4 weeks, 3 months, 6 months and 12 months after the final treatment. The results were judged by three dermatologists who had not taken part in the treatments. RESULTS: One year after the last laser session, all patients showed global improvements in eyelid skin tightening: five patients (11.1%) achieved excellent improvement, 11 patients (24.5%) marked improvement, 15 patients (33.3%) moderate improvement and 14 subjects (31.1%) slight improvement. At the 1-year follow-up, the percentage of subjects with a lift in their eyebrows and consequently a widened palpebral fissure was 82.2 (37 patients), whereas 17.8% (eight patients) showed no eyebrow elevation. CONCLUSIONS: Fractional CO(2) laser treatments allow dermatologists to achieve notable improvements in eyelid skin tightening, and eyebrow elevation safely and without significant side-effects.

Intense pulsed light in the treatment of non-aesthetic facial and neck vascular lesions: report of 85 cases.

BACKGROUND: Intense pulsed light (IPL) treatment is one of the most effective procedures for patients with non-aesthetic vascular lesions in addition to signs of skin photoageing, and it has been reported as very successful in the treatment of telangiectasias, spider nevi, erythrosis, and above all, rosacea and poikiloderma. Its use is based on the principle of selective photothermolysis, which exploits the haemoglobin absorption peak among its range of wavelengths. OBJECTIVE: The aim of this study is to assess the efficacy and safety of intense pulsed light in treating non-aesthetic vascular skin lesions, especially with regard to poikiloderma of Civatte and rosacea. METHODS: A total of eighty-five patients, 64 women and 21 men, with 63 non-aesthetic vascular lesions (28 Poikiloderma of Civatte and 35 rosacea), 22 pigmented lesions (UV-related hyperpigmentation of solar lentigo-type) and four precancerous lesions (actinic keratosis, AKs), were treated repeatedly with IPL for 2 years. The patients received a mean of five treatments (range 4-6) at 3-weekly intervals. They were evaluated via clinical observations and professional photographs were taken before each treatment and after 2 weeks, 4 weeks, 3 months, 6 months and 12 months. The outcome of the IPL treatments was evaluated by four independent dermatologists, who were not informed about the study protocol, and who assessed the performance of IPL by dividing the results into four categories: no results, slight improvement, moderate improvement and marked improvement. RESULTS: All the patients showed improvements in their overall lesions: 72 lesions (80.9%) achieved a marked improvement, 14 lesions (15.7%) achieved a moderate improvement and three lesions (3.4%) achieved a slight improvement. The results of the 63 non-aesthetic vascular lesions in Rosacea and Poikiloderma of Civatte were: 51 with a marked improvement, 10 with moderate improvement, whereas only two lesions achieved a slight improvement. The improvement of all four actinic keratoses was marked whereas the 22 pigmented lesions obtained a marked improvement in 17 cases, a moderate improvement in four cases and a slight improvement in one case. No undesirable effects were observed. CONCLUSIONS: Our study confirms how by minimizing side-effects, time and costs, IPL can be effective and safe for the treatment of non-aesthetic facial and neck vascular lesions.

Prevalence and distribution of solitary oral pigmented lesions: a prospective study.

Solitary pigmented lesions are uncommon in the oral mucosa. A review of the literature reveals no information regarding the relative frequency of these lesions. The purpose of this study is to determine the relative prevalence of solitary oral pigmented lesions in a selected population of patients. This study includes 265 consecutive patients who accessed the dermatology out-patients' surgery of the Department of Dermatology, University of Florence between March 2006 and July 2007. The sample we studied presented 5.7% of oral pigmented lesions; the most frequent being vascular lesions. Despite the various methods used, the differential diagnosis for these particular lesions is not always easy. There is some difficulty in distinguishing between a benign pigmented lesion and a growing melanoma which, though rare (1% of all oral malignancies), is a serious and often fatal disease. Therefore, biopsy with histological exam represents the diagnostic gold standard.

Photodynamic treatment for viral infections of the skin.

Photodynamic therapy (ALA/MAL-PDT) is indicated for the treatment of actinic keratoses, for superficial, nodular basal cell carcinoma and for Bowen's disease; there is evidence that PDT can be active also against bacteria, viruses and fungi. The new indications for PDT include many types of viral skin infections human papilloma virus (HPV)-related as verrucae of feet and hands, Condylomata acuminata, periungueal warts, epidermodysplasia verruciformis, but also viral skin lesions non HPV related as molluscum contagiosum and herpes simplex can be successfully treated. The use of PDT in HPV infections is due to its anti-inflammatory and antiproliferative skills: in the lesions treated there is a release of cytotoxic radicals which damage keratinocytes infected by HPV, inducing their selective apoptosis and necrosis. The PDT application in this field of lesions is safe and successful; in comparison with the other techniques it has less side-effects and less recurrences, but the most important property is that it is not-invasive: it means a reduced risk of infections and excellent cosmetic results.