Fractional carbon dioxide laser resurfacing of rhytides and photoageing: a prospective study using profilometric analysis.

BACKGROUND: Results of profilometric skin analyses after fractional ablative skin resurfacing are not only important for evaluating the efficacy of this therapy but are also relevant for physicians practising laser and aesthetic skin therapy. Currently, objective measurements of wrinkle reduction after fractional CO2 laser resurfacing are scarce, and it remains unclear whether the various facial areas respond differently to this therapy. OBJECTIVES: To measure wrinkle parameters, the homogeneity of melanin distribution and skin roughness in four facial areas (periorbital, perioral, forehead, cheeks) before and after three fractional CO2 laser treatments. METHODS: Twenty-five women were analysed with regard to wrinkle parameters and mottled pigmentation on the face. We measured wrinkle size, depth and width and the homogeneity of melanin distribution and skin roughness in four facial areas before and after three fractional CO2 laser treatments. Additionally, the investigators rated clinical improvement using five-point grading scales. RESULTS: Wrinkles were significantly reduced in all facial areas, and the best results for wrinkle size and depth were found for the cheeks (-58·3%, P = 0·018 and -51·3%, P = 0·018) and the periorbital area (-35·1%, P < 0·001 and -31·1%, P = 0·001, respectively). The percentage improvements of rhytides evaluated by the investigators were mostly similar to those found from in vivo measurements. The homogeneity of melanin distribution in the skin was improved by 21·4% on the cheeks (P = 0·012) and by 24·0% in the periorbital area (P < 0·001). Clinical investigators rated the improvement of mottled pigmentation considerably higher (51-75%). CONCLUSIONS: After a serial treatment with the fractional CO2 laser, we measured considerably varying wrinkle reduction depending on the area of the face, and the best results were found for the cheeks.

[Long-term course of necrobiotic xanthogranuloma with ocular involvement]. / Langzeitverlauf bei nekrobiotischen Xanthogranulomen mit Augenbeteiligung.

The clinical features of necrobiotic xanthogranuloma (NX) have been presented in a series of case reports, but there are hardly any reports on the clinical long-term course of this rare and usually chronic entity. Therapeutic recommendations are mostly based on individual observations, lacking general therapeutic guidelines. To illustrate a typical chronic and progressive course of NX, we report the case of a 64-year-old woman with periorbital NX, ocular involvement and IgG paraproteinemia. Diagnosed with NX for the first time in 1993, the patient was already presented in this journal in 1995. Since then a series of therapeutic options including medication with dapsone, chlorambucil, interferon-alpha, clofazimine, melphalan, fumaric acid esters, surgical treatment and other physical therapies such as radiation, plasmapheresis, and photodynamic therapy have been applied. None of these therapeutic approaches, however, showed a satisfying long-term effect. At present the patient is undergoing cyclophosphamide-dexamethasone pulse therapy.

Role of laser therapy in dermatology -- clinical aspects.

BACKGROUND: Laser therapy has become an integral part of therapeutic alternatives in dermatology. Nevertheless, there are only few statistical data on the role of lasers in everyday practice of dermatological clinics. OBJECTIVE: Analysis of laser patients, indications and lasers used. METHODS: We analysed 10244 patients treated with laser therapy in the Department of Dermatology at the University of Regensburg from 1992 to 2000. This figure represents 9.6 % of all patients seen during that period. RESULTS: Vascular lesions (hemangiomas, port-wine stains, telangiectasias) represented the most common indication (more than 70%) followed by infectious disorders (mostly papillomavirus lesions) as well as the removal of hairs and tattoos. Accordingly, the most frequently used laser was the flashlamp-pumped pulsed dye laser (585 nm) followed by the argon ion, the long-pulse tunable flashlamp-pumped pulsed dye laser, the Q-switch ruby laser, and the CO(2)-laser. In recent years, the percentage of indications and lasers used has changed significantly, reflecting the development of new lasers and the introduction of new indications. CONCLUSIONS: The results confirm the important role of laser therapy in dermatology.

Long-term results in the treatment of childhood hemangioma with the flashlamp-pumped pulsed dye laser: an evaluation of 617 cases.

BACKGROUND AND OBJECTIVE: Presenting the long-term results of flashlamp-pumped pulsed dye laser treatment in 617 hemangiomas to evaluate this treatment modality. STUDY DESIGN/MATERIALS AND METHODS: In 548 children, 692 hemangiomas were treated with the flashlamp-pumped pulsed dye laser (FPDL) SPTL 1B (Candela Corporation, Wayland, MA). The objective of treatment was the inhibition of further growth or the induction of regression. The treatment results were documented by the treating physician as well as by means of a questionnaire delivered to the parents. A total of 617 treatment results could be evaluated. RESULTS: After 1--12 treatments (mean, 2.5), we could achieve our treatment objective to stop the further growth of the lesion in 96.6% of all hemangiomas. In 13.8%, the treatment resulted in a complete remission, a significant regression was seen in 14.9%, and 67.9% of the treated lesions showed a discontinuation of growth. The percentage of complete remission was especially high in small superficial (42.6%) and superficial (19%) hemangiomas. CONCLUSION: In the vast majority of the hemangiomas, it was possible to stop further progression or induce regression by FPDL treatment. Total regression could be achieved in nearly half of the small superficial hemangiomas. Because the treatment is fast, effective, and nearly without side effects, we recommend early laser treatment especially in superficial and small childhood hemangiomas.

Intradermal buried vertical mattress suture as sole skin closure: evaluation of 149 cases.

Various buried suture techniques have been reported for dermatological surgery, but in most cases, superficial non-absorbable sutures are placed additionally. The aim of this study was to evaluate whether the intradermal buried vertical mattress suture can be safely used without additional skin suturing. Following 149 procedures in 126 patients, the colour and dehiscence of the scar and the presence of hypertrophy, granulomas or keloids were analysed. The cosmetic results were excellent to good in 78.5%, satisfactory in 19.5% and poor in 2%. Single additional superficial sutures had to be placed in only 14.7%. Suture marks were absent. Hypertrophic scarring was significantly more frequent in scars sutured with polyglactine than in scars sutured with polydioxanone. Early wound dehiscence, secondary wound healing and infection due to missing superficial skin sutures did not occur. This suture technique is safe, easy and fast to perform, and achieves good cosmetic results without leaving suture marks.

[CO(2) laser vaporisation of actinic cheilitis]. / CO(2)-Laservaporisation der Cheilitis actinica.

As a premalignant condition, actinic cheilitis requires therapy, and multiple treatment modalities have been described. Although frequently reported in Angloamerican literature, CO(2) laser vaporization for the treatment of actinic cheilitis is scarcely mentioned in German journals. We report 19 cases of CO(2) laser treatment of actinic cheilitis. In only one case, the ablation proved to be too superficial after the first treatment. Except in this case we did not see any recurrences and only one case with minor scarring within a median follow up period of 16 months. In comparison with other treatment modalities, we consider the CO(2) laser ablation to be a safe and cost-saving method with excellent cosmetic results.

[Therapeutic use of lasers in dermatology]. / Therapeutische Anwendung von Lasern in der Dermatologie.

In recent years, lasers have become an indispensable part of dermatotherapy. Multiple lasers allow the treatment of the most contrasting indications. Port wine stains, childhood hemangiomas, telangiectasias as well as other vascular malformations and neoplasms represent the most significant indications for laser therapy. Furthermore, modern lasers are used not only for the removal of non-professional tattoos but also for removing solar lentigines and ephelides. In principle, laser therapy of wrinkles, rhytides and actinically damaged skin is possible, but exact diagnosing and excellent treatment techniques are vital because of the possibility of severe side effects.

[Laser skin resurfacing. Er:YAG laser and cw-CO2 laser with scanner system in direct comparison]. / Laser skin resurfacing. Er:YAG Laser und cw-CO2 Laser mit Scannersystem im Seitenvergleich.

We compared a cw carbon dioxide flash-scanning laser system to an Er:YAG laser in laser skin resurfacing of facial rhytides. In all patients, CO2 laser treatment showed a better cosmetic result whereas erythema and postinflammatory hyperpigmentation were less marked in Er:YAG laser therapy.

[Elastolysis of the mid-dermis and annular elastolytic giant cell granuloma: different stages in the clinical spectrum of dermal elastolysis? Case report and review of the literature]. / Elastolyse der mittleren Dermis und anuläres elastolytisches Riesenzellgranulom: Unterschiedliche Stadien im klinischen Spektrum der dermalen Elastolyse? Fallbericht und Literaturübersicht.

In recent years there has been increased interest in diseases showing degeneration of dermal elastic tissue. Mid dermal elastolysis is a rare dermatosis, which is histopathologically characterized by mid dermal loss of elastic tissue. Both papular and patchy forms, as well as inflammatory and non-inflammatory variants, have been described. A 70-year-old woman had annular patches. In their center the clinical and histopathological findings suggested non-inflammatory mid dermal elastolysis whereas the red and slightly elevated margins showed clinical and histopathological features of annular elastolytic giant cell granuloma. Based on our case and a review of the literature, we discuss the differential diagnosis of dermal elastolysis and hypothesize that a number of lesions histologically showing mid dermal elastolysis may represent different inflammatory or non-inflammatory stages of one disease which may overlap or change from one form into another.

Fast and effective skin ablation with an Er:YAG laser: determination of ablation rates and thermal damage zones.

BACKGROUND AND OBJECTIVE: Er:YAG lasers are known to superficially ablate skin and other tissues with minimal thermal coagulation zones. The ablation efficacy and thus the clinical applicability of these lasers, however, was limited due to small beam diameters and repetition rates. Aim of this study was to determine the ablation efficacy and the amount of thermal damage with a new high-power high-repetition-rate Er:YAG laser and to find optimal treatment parameters for skin ablation. STUDY DESIGN/MATERIALS AND METHODS: In vitro and some in vivo ablation trials on human skin were performed with the Er:YAG laser (MCL 29, Aesculap-Meditec, Heroldsberg, Germany, 2.94 microns, max. 500 mJ per pulse, 250 microseconds pulse length, 3 or 4 mm spot size, repetition rate 7-10 Hz) and evaluated microscopically. RESULTS: The ablation threshold was around 1.6 J/cm2. The ablation rates increased linearly with the fluence, and the above-threshold ablation efficacy was around 2.5 microns per pulse per J/cm2, leading to ablation velocities of 70-100 microns per second and higher. With increasing pulse numbers applied to one tissue spot, the ablation per pulse decreased significantly. The amount of thermal damage was clearly dependent on the number of pulses applied (around 25 microns with < 10 imp., up to 100 microns with 40 imp.), whereas higher fluences increased the coagulation zones only minimally. The in vivo trials confirmed these results: overlapping pulses in the 4 J/cm2-range, applied in a sweeping motion, proved optimal for an efficient skin ablation with a smooth resulting surface and a thermal damage zone not exceeding 50 microns. CONCLUSIONS: The high power and the high repetition frequency make this laser a fast and effective tool for skin ablation without increasing the thermal damage, but the ablation remains limited to the superficial dermis, since hemostasis cannot be achieved due to the absence of coagulation.

[Sugar beet pollen allergy as a rare occupational disease]. / Zuckerrübenpollenallergie als seltene Berufserkrankung.

Although there are a few isolated reports in the literature suggesting that sugar beet pollen is highly antigenic, hypersensitivity to components of sugar beet is not a common disease. We report a 29-year-old man with a history of atopic dermatitis who developed both contact dermatitis and allergic rhinitis from sugar beet pollen through his job in a seed nursery.

[Necrobiotic xanthogranuloma with eye involvement. Overview and case report]. / Nekrobiotisches Xanthogranulom mit Augenbeteiligung. Ubersicht und Fallbericht.

Necrobiotic xanthogranuloma is a rare disease marked by yellowish-brown plaques with destructive growth and a tendency to ulceration, which shows a characteristic histopathological pattern of palisading granuloma with foam cells, Touton's and foreign-body giant cells, bizarre multinuclear giant cells, cholesterol clefts and marked necrobiosis of the connective tissue. Necrobiotic xanthogranuloma is associated with IgG paraproteinaemia, and occasionally with an IgA paraproteinaemia. Ocular symptoms and visceral involvement are common. We report a case of a 53-year-old woman with periorbital necrobiotic xanthogranuloma, ocular involvement and IgG paraproteinaemia, who had undergone argon-laser treatment to no avail following a diagnosis of xanthelasma. Periorbital xanthelasma-like lesions with a tendency to ulceration in combination with unexplained ocular symptoms consisting of keratitis, scleritis, episcleritis or uveitis should suggest the diagnosis of necrobiotic xanthogranuloma, especially if they are associated with paraproteinaemia.

UV-A-provoked localized bullous pemphigoid.

A 71-year-old woman had noticed the development of blisters on her forehead 4 months before she was referred to our department. Treatment with oral corticosteroids resulted in complete healing, but new blisters subsequently developed on the face, neck and backs of the hands. After the possibility of phototoxic and photoallergic reactions, as well as an abnormal porphyrin profile, had been excluded, the diagnosis of bullous pemphigoid was made by histological and direct immunofluorescent examination. UV-A provocation on the upper arm produced lesions histologically and immunohistochemically typical of bullous pemphigoid. Of particular importance was the fact that the blisters were limited strictly to light-exposed skin areas.