Laser treatment of hyperpigmented lesions: position statement of the European Society of Laser in Dermatology.

BACKGROUND: Lasers and intense pulsed light sources (IPLS) are proposed for the treatment of many pigmentary disorders. They are sometimes considered as magic tools able to remove any type of lesions. Although being the best option for several hyperpigmented lesions, they can also worsen some conditions and have potential side-effects. OBJECTIVE: The aim of this review was to give evidence-based recommendations for the use of lasers and IPLS in the treatment of hyperpigmented lesions. METHODS: These recommendations were produced for the European Society of Laser Dermatology by a consensus panel made up of experts in the field of pigment laser surgery. Recommendations on the use of lasers and light treatments were made based on the quality of evidence for efficacy, safety, tolerability, cosmetic outcome, patient satisfaction/preference and, where appropriate, on the experts' opinion. RESULTS: Lasers and IPLS are very effective for treating many hyperpigmented lesions such as lentigos, dermal hypermelanocytosis or heavy metal depositions. In the other hand, they have to be considered with great caution for other disorders, such as café au lait macules, melasma or postinflammatory hyperpigmentation. After making the correct diagnosis, if lasers or IPLS are indicated, the optimal wavelengths and parameters will be chosen taking into account the skin phototype, origin and depth of the target pigments. CONCLUSION: Although potentially very effective, lasers and IPLS cannot be proposed for all types of hyperpigmented lesions. In all cases, precise recognition of the disorder is mandatory for choosing between these devices and other therapeutic approaches.

[Congenital "kissing" lesions: Nevus or "café au lait" spot?] / Lésions congénitales périorbitaires en miroir dites « kissing ¼ : nævus ou tache café au lait ?

INTRODUCTION: "Café au lait" spots (CLS) are pigmented skin lesions principally located at the trunk and the limbs. Histologically, CLSs consist in an excessive pigmentation of the epidermis, with no risk of malignant transformation. The "kissing" nevus is a rare pigmented congenital nevus affecting both lower and upper eyelids in a mirror layout. As other nevi, it presents a theoretical risk of malignant transformation. These two pigmented lesions are responsible for aesthetic discomfort when affecting the face. OBSERVATION: Three patients presenting with a congenital pigmented lesion affecting the two eyelids in a mirror layout are presented. In two cases, the lesions, initially considered as "kissing" nevi, were classified as CLSs. The diagnosis of CLS was made on a biopsy in one patient and after surgery in the other one. DISCUSSION: Pigmented mirror layout lesions, called "kissing" lesions, are exclusively described for the nevi. We describe two cases of CLSs affecting the eyelids in a mirror layout. Difficulties in diagnostic are exposed and the possible treatments are discussed.

Treatment of granuloma annulare with the 595-nm pulsed dye laser, a multicentre retrospective study with long-term follow-up.

BACKGROUND: Granuloma annulare (GA) is limited in most cases to isolated lesions, but more widespread generalized forms can be observed. In both cases, the treatment remains highly challenging. Isolated case reports suggested the interest of treating GA with a pulsed dye laser (PDL). OBJECTIVE: To evaluate the PDL in treating GA. MATERIALS AND METHODS: Retrospective multicentre study. Each patient should have at least two lesions of GA including at least one that remained untreated to serve as a control. The evaluation was performed on an Investigator Global Assessment for each lesion as compared with baseline. RESULTS: Thirteen patients (five with localized GA and eight with generalized GA) with a total of 59 lesions have been treated with a maximum of three PDL sessions. Sixteen lesions (27.1%) achieved >50% of clearing (14% of lesions for generalized GA and 56.2% for localized GA). Transient hyperpigmentation and crusting were observed in 59% and 86% of lesions respectively. The median follow-up was 6 months (2-12) and 10 lesions (all in generalized GA) recurred after initial clearing. CONCLUSION: Generalized GA showed weak improvement after treatment with a high recurrence rate. Only localized forms showed notable improvement in a more than half of treated lesions. Thus, PDL could be proposed as an alternative approach, but only for localized forms of GA.

Cutaneous lymphoid hyperplasia (pseudolymphoma) in tattoos: a case series of seven patients.

BACKGROUND: Cutaneous lymphoid hyperplasia (CLH or pseudolymphoma) is considered a rare complication occurring in tattoos. We analysed the demographics, clinical features, histological aspects, allergy tests, outcome and therapeutic data of CLH in tattoos performed by a professional in a series of patients. METHODS: We conducted a retrospective chart review of seven patients managed in private practice of dermatology all over France from 2001 to 2007. RESULTS: Reactions occurred within 2 years after tattooing, were non-specific (pruritus, swelling, infiltration) and mainly restricted to red. Photosensitivity was noted in two cases. Histology was characteristic of pseudolymphoma with a T-cell predominance in all cases. Surgery (2 cases) and laser removal (2 cases, CO2 and QS-532 nm) were efficient, while local corticosteroids were not. One patient had spontaneous clinical remission after 2 years of evolution. CONCLUSIONS: This is the largest series of CLH occurring in tattoos. This delayed hypersensitivity reaction may be underestimated and triggered by a specific immunogenic compound of the ink. Its management remains difficult.

Treatment of xanthelasma palpebrarum by 1064-nm Q-switched Nd:YAG laser: a study of 11 cases.

BACKGROUND: Xanthelasma palpebrarum (xanthelasma) is a common disease involving the eyelids. It consists of yellowish plaques of esterified cholesterol situated in the middle and superficial layers of the dermis. Many techniques, including laser treatments, have been proposed to destroy these lesions. A preliminary study demonstrated the efficacy of 1064-nm Q-switched Nd:YAG laser in treating xanthelasma. OBJECTIVES: To present the results of a prospective study using 1064-nm Q-switched Nd:YAG laser to treat xanthelasma. METHODS: Thirty-eight lesions in 11 patients were treated. RESULTS: The results observed after a single treatment by Q-switched Nd:YAG laser were scored as good or excellent in eight patients, i.e. for 26 of 38 lesions. CONCLUSIONS: The treatment of xanthelasma by 1064-nm Q-switched Nd:YAG laser is a valuable treatment option to eliminate lesions, with rapid and good quality healing. The absence of any associated skin destruction allows treatment to be repeated when necessary.

[Bowen disease treated with scanned pulsed high energy CO2 laser. Follow-up of 6 cases]. / Maladie de Bowen traitée par laser CO2 hyper pulsé scanné. Suivi évolutif de dix cas.

INTRODUCTION: Cutaneous Bowen's disease is an intra-epidermal squamous cell carcinoma. PATIENTS AND METHOD: Ten cases of cutaneous Bowen's disease diagnosed among 8 patients were treated by scanned high energy carbon dioxide laser between November 1996, and March 1998. A biopsy was performed in all patients before treatment. RESULTS: The post-treatment follow-up extended from 1 to 4 years with an average follow-up of 2 years and 11 months. Only one patient, whose lesion was located on the auricle, presented a recurrence after one year. The remaining patients did not present any recurrence during their last control: six patients were followed for two years or more and one patient for one year. We demonstrate a histological and clinical correlation between the number of carbon dioxide laser passes before a clinical endpoint and the thickness of the epidermal carcinoma treated. DISCUSSION: This new treatment has comparable efficacy to other treatments. It can be applied to extensive lesions without sequelae except for the risk of residual hypopigmentation.

Treatment of gunpowder traumatic tattoo by Q-switched Nd:YAG laser: an unusual adverse effect.

BACKGROUND: The Q-switched Nd:YAG laser can completely eliminate traumatic tattoos. OBJECTIVE: We report the results of the unsuccessful removal of traumatic tattoos among three patients with dermal inclusions of gunpowder who were shot at close range. METHODS: Treatment was tried in each patient with a Q-switched Nd:YAG laser at a medium fluence (4-6 J/cm2). RESULTS: During treatment of our patients, each pulse provoked sparks and the immediate formation of bleeding trans- epidermal pits. After the healing process was completed, we observed poxlike scars and the spreading of pigments in the skin around the initial points of the tattoo. CONCLUSION: We hypothesize that the rapid transfer of high-energy pulses to powder particles creates microexplosions of these fragments resulting in cavitation and provoking transepidermal holes and subsequent scars. This adverse effect was only produced if the tattoo resulted from gun powder being shot at a short distance from the skin.

[Langerhans-cell histiocytosis in twin sisters]. / Histiocytose langerhansienne chez deux soeurs jumelles.

BACKGROUND--Histiocytosis of Langerhans cells includes a range of clinical manifestations that have been described as bone eosinophilic granuloma, Hand-Schüller-Christian syndrome, Letterer-Siwe syndrome and Hashimoto-Pritzker histiocytosis. These syndromes represent a spectrum of severity and prognosis of the same underlying disorder which is usually sporadic. It has occurred in monozygotic twins and in a familial pattern. This report describes monozygotic twins who developed the disease a few months after their father was found to be suffering from Hodgkin's disease. Case n. 1.--A 4 month-old girl was admitted because of fever, disseminated lymphadenopathy and hepatomegaly. She also had interstitial pneumonia. Infiltrating abnormal histiocytes were demonstrated in lymph node and bone marrow biopsies. X-rays showed lytic areas in the skull. Serology for EBV infection was negative. Special studies with immune markers of lymph node histiocytes confirmed the diagnosis of Langerhans cell histiocytosis, and more precisely, Letterer-Siwe syndrome. The patient was given prednisolone followed by vinblastine without success. She was given etoposide 11 weeks later, which induced remission. This treatment was replaced by vinblastine when the patient was aged 2 years 9 months. Case n. 2.--The monozygotic twin of the case n. 1 was also admitted at 4 months of age because of the same manifestations. Laboratory findings were identical to those of her sister, as was her response to the same drugs. The father was diagnosed as having Hodgkin's disease 3 months before the first manifestation of Langerhans cell histiocytosis in his daughters. His maternal uncle had also been treated for Hodgkin's disease. Immunologic studies of the twin were negative. CONCLUSION--These cases of Langerhans cell histiocytosis in monozygotic twins have no apparent relationship with the Hodgkin's disease of their father. Etoposide seems to be useful for treating such severe forms of the disease.

Subcutaneous changes in dermatomyositis.

We report the case of a 42-year-old woman with concomitant panniculitis and dermatomyositis. Painful, indurated lesions on the buttocks, thighs, arms, abdomen and breasts were associated with proximal muscle weakness. Skin biopsy revealed lobular panniculitis, and vacuolar degeneration of epidermal basal cells. Direct immunofluorescence was negative. Serum muscle enzyme (creatinine-phosphokinase) levels were elevated, and electromyography demonstrated a myositic process. Muscle biopsy showed an inflammatory myositis. These results were consistent with dermatomyositis associated with panniculitis. Only five cases of this association have been reported previously. The relationship between these two conditions is discussed.

[Metastatic basal cell carcinoma]. / Carcinome basocellulaire métastatique.

A case of basal cell carcinoma in a 17-year old male patient complicated, 5 years later, by inguinal and pulmonary metastases is reported. This clinical case raises two problems: the reality of the entity and the long-term follow-up of this type of tumours.

[Cutaneous and nail infections caused by Hendersonula toruloidea]. / Infection cutanéo-phanérienne par Hendersonula toruloidea.

A case of cutaneous and nail infection due to Hendersonula toruloidea (HT), in a Senegalese woman who had been living in France for 7 years is reported. This patient presented with keratotic lesions of the palms and distal and lateral onycholysis. Culture of clinical specimens on Sabouraud's medium without cycloheximide resulted in the isolation of HT. This rare fungal infection is often misdiagnosed.