Treatment of port wine stains with pulsed dye laser and topical timolol: a multicenter randomized controlled trial.

BACKGROUND: Neoangiogenesis occurs within days following laser treatment of port wine stains (PWS), and plays a central role in treatment failures. Topical use of timolol can significantly reduce the production of vascular endothelial growth factor in vitro, and in animal models. OBJECTIVES: The aim of this study was to assess the efficacy of topical timolol in combination with pulsed dye laser (PDL) treatment, compared with PDL alone, for treating PWS. METHODS: This was a prospective multicenter controlled trial performed in children with PWS of the face who had not previously received laser treatment. After randomization, one group was treated with PDL alone, and the other with PDL followed by twice daily applications of timolol gel. Three laser sessions were performed at 1-month intervals with fixed parameters. The evaluation was performed on standardized pictures by two independent physicians blinded to the treatment received. The primary endpoint was marked or complete improvement of the PWS [Investigator Global Assessment (IGA) 3 or 4] 1 month after the third session. RESULTS: Twenty-two children were included. Two patients were lost to follow-up. There was no difference in the success rate between the two groups (IGA 3 or 4 observed in one of 10 patients and two of 12 patients, for PDL alone, and for PDL associated with topical timolol, respectively; P = 1·0). No side-effect related to the application of topical timolol was observed. CONCLUSIONS: The addition of timolol gel for preventing neoangiogenesis failed to significantly improve the efficacy of PDL treatment of PWS.

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.

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.