RESUMO
BACKGROUND: Psoriasis is a chronic, genetically determined inflammatory disease, characterized by an immunomediated pathogenesis, which affects approximately 1-3% of the population. Various modalities have been used for psoriasis treatment, including ultraviolet (UV) radiation. Narrowband UVB (311 nm) phototherapy is a well-established, widely used and highly efficient treatment for psoriasis, but a big disadvantage is that large areas of unaffected skin are irradiated along with the psoriatic lesions. OBJECTIVES: This investigation evaluates a 308-nm excimer laser and a 308-nm excimer lamp in comparison with 311-nm narrowband UVB in the treatment of patch psoriasis by using two different dose-increase schemes. MATERIALS AND METHODS: Fifteen patients with plaque psoriasis were enrolled in the study (first regime). Three different psoriatic lesions were treated with the 308-nm excimer laser, the 308-nm excimer lamp or 311-nm narrowband UVB three times per week. UVB doses were increased slowly and stepwise (1, 1, 2, 2, 3, 3, ...multiple MEDs). Sixteen patients were enrolled in the second regime. Two plaques were treated with the 308-nm excimer laser or with the 308-nm lamp with an accelerated scheme (2, 2, 4, 4, 6, 6, ...multiple MEDs) three times per week. We increased the UVB doses every second treatment (first and second regime) during the whole treatment. If blistering occurred, the blistered plaque was not treated on the next scheduled treatment. At every third visit and 1, 2 and 4 months after the last treatment a Psoriasis Severity Index (PSI) score was assigned in both regimes. RESULTS: Using Friedman analysis, the PSI scores did not show a statistically significant difference (P > 0.05) comparing 308-nm laser therapy, 308-nm lamp therapy and 311-nm narrowband therapy after 10 weeks in the first regime. The mean number of treatments to achieve clearance was 24. With the accelerated scheme, clearance could be achieved with fewer treatments and with half the cumulative dose of the first regime. Nevertheless, the side-effects such as blistering and crusting were also increased. CONCLUSIONS: Both 308-nm light sources can clear patch psoriasis in a similar manner to standard phototherapy, with the advantage of the ability to treat exclusively the affected skin and with a reduced cumulative dose, thus perhaps reducing the long-term risk of carcinogenicity.
Assuntos
Terapia a Laser , Psoríase/radioterapia , Terapia Ultravioleta/métodos , Adulto , Idoso , Doença Crônica , Relação Dose-Resposta à Radiação , Feminino , Humanos , Lasers/efeitos adversos , Masculino , Pessoa de Meia-Idade , Psoríase/patologia , Índice de Gravidade de Doença , Resultado do Tratamento , Terapia Ultravioleta/efeitos adversosRESUMO
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.
Assuntos
Terapia a Laser/métodos , Lasers/normas , Terapia com Luz de Baixa Intensidade/métodos , Dermatopatias/radioterapia , Dermatopatias/cirurgia , Adolescente , Adulto , Fatores Etários , Criança , Pré-Escolar , Dermatologia/métodos , Feminino , Humanos , Lactente , Terapia a Laser/efeitos adversos , Terapia com Luz de Baixa Intensidade/efeitos adversos , Masculino , Pessoa de Meia-Idade , Transtornos da Pigmentação/patologia , Transtornos da Pigmentação/terapia , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Dermatopatias/patologia , Dermatopatias Vasculares/patologia , Dermatopatias Vasculares/terapia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/terapia , Resultado do TratamentoRESUMO
Discoid lupus erythematosus (DLE) is a rare disorder in childhood, with 22 cases reported in the English-language literature. Less than 2% of patients with DLE have an onset before 10 years of age. We describe two children with DLE and lupus profundus with an onset of the disease at the ages of 11 and 15 years and focus on likely histopathologic differences between DLE in children and in adults. Histopathologic characteristics for childhood DLE might be an intense periadnexal and perivascular infiltrate extending into the interstitium and subcutaneous tissue consisting of lymphocytes, histiocytes, eosinophilic granulocytes, and plasma cells and lacking epidermal atrophy. The diagnosis of DLE in our two patients was established by clinicopathologic correlation based on clinical presentation, histologic and immunofluorescent findings in skin biopsy specimens, and the absence of clinical and laboratory evidence of systemic involvement. Therapy with antimalarials resulted in reduction of the skin lesions, but in one patient severe lipoatrophy occurred.
Assuntos
Lúpus Eritematoso Discoide/patologia , Paniculite de Lúpus Eritematoso/patologia , Adolescente , Fatores Etários , Biópsia por Agulha , Criança , Quimioterapia Combinada , Feminino , Seguimentos , Humanos , Hidroxicloroquina/uso terapêutico , Imuno-Histoquímica , Lúpus Eritematoso Discoide/tratamento farmacológico , Masculino , Paniculite de Lúpus Eritematoso/tratamento farmacológico , Medição de Risco , Índice de Gravidade de Doença , Protetores Solares , Resultado do Tratamento , Vitamina ERESUMO
BACKGROUND: Three-dimensional (3-D) imaging using computed tomography or magnetic resonance imaging data is well known for surgical planning of complex lesions in neurosurgery. In dermatology, percutaneous and intralesional Nd:YAG laser therapy is well established for numerous types of vascular malformations. Diagnostic imaging using ultrasound, computed tomography, or magnetic resonance imaging is necessary to plan the laser therapy of those malformations. The therapeutic problem is to localize the venous malformation exactly before treatment on sectional 2-dimensional images. OBSERVATIONS: We describe a 27-year-old woman with a venous malformation of the neck. The data of diagnostic magnetic resonance imaging were used for a 3-D reconstruction of the venous malformation to demonstrate the anatomical extent and subcutaneous involvement for laser surgical planning. Percutaneous and intralesional laser therapy was performed at 3-month intervals with the Nd:YAG laser using the 3-D reconstruction as a road map for the Nd:YAG laser. Eight weeks after the last laser treatment, the bulky lesions of the neck showed regression. Using the 3-D reconstruction for laser surgical planning, physicians could perform intralesional laser treatment more exactly. The complex anatomy of the venous malformation could be elucidated by studying the 3-D images before and during laser surgery. CONCLUSION: The use of magnetic resonance imaging-based 3-D reconstructions for laser surgical planning can demonstrate the often unexpected extent and improve the intralesional laser therapy in the treatment of venous malformations.
Assuntos
Malformações Arteriovenosas/diagnóstico por imagem , Malformações Arteriovenosas/cirurgia , Imageamento Tridimensional/métodos , Terapia a Laser , Adulto , Malformações Arteriovenosas/patologia , Feminino , Humanos , Terapia a Laser/métodos , Imageamento por Ressonância Magnética , Pescoço , Procedimentos de Cirurgia Plástica/métodos , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Common warts are induced by human papilloma virus (HPV) types 1-4, 26-29, 38, 41, 49, 57, 63, and 65 and can be found in up to 10% of adults and children. Many treatment modalities have been used to destroy the infected viral cells. These include the use of various methods such as salicylic acids, cryosurgery, curettage, and electrocautery. PATIENTS/METHODS: The purpose of this study was to examine the efficacy of the long-pulsed tunable dye laser (LPTDL) in the treatment of verrucae vulgares. Twenty-four patients with recalcitrant warts were included in the study. Thirty-one warts were treated in these patients. RESULTS: Two patients (6.5%) were completely freed of their warts, and a reduction of > 75% was attained in 12.9%. Nine patients (29%) experienced a reduction of < 50%. CONCLUSIONS: The LPTDL represents another quick treatment modality with low side effects, but only low clearance rates could be found in this study.
Assuntos
Fotocoagulação a Laser/métodos , Verrugas/cirurgia , Humanos , Resultado do TratamentoRESUMO
Two patients presented with a transverse groove located between the lower third and upper two-thirds of the nose since birth. The alar and triangular cartilage attach themselves in a linear transverse fashion, the so called nasal line. It is important to recognize the nasal line as a localizing factor for milia, cysts and comedones. The nasal line is rather easily overlooked but awareness of its existence allows one to quickly confirm that it is not a rarity. We propose an embryological origin.
Assuntos
Nariz/anormalidades , Idoso , Cartilagem/anormalidades , Cartilagem/embriologia , Criança , Feminino , Humanos , Masculino , Nariz/embriologiaRESUMO
BACKGROUND: At present, laser therapy of port-wine stains (PWS) using the flashlamp-pumped dye laser (FPDL) at 450 micros is accepted as the optimal approach. A few years ago, a new long-pulsed tunable dye laser (LPTDL, 1.5 ms) was introduced for the treatment of leg veins. OBJECTIVES: To investigate the efficacy and side-effects of FPDL vs. LPTDL therapy of PWS. METHODS: Sixty-two patients with untreated PWS underwent test treatments with the FPDL (585 nm; 7-mm spot size; 5.75--7.0 J cm(-2) fluence) and LPTDL (585, 590, 595, 600 nm; 5-mm spot size; 11--20 J cm(-2) fluence). With the LPTDL, the epidermis was additionally cooled (Spray cooling device). The fading was evaluated clinically 6 weeks after the test treatments. RESULTS: Optimal fading was achieved by the LPTDL (> or = 585 nm) in 30 patients and by the FPDL in 12 patients. No difference was found in 20 patients. At 585 nm, the lasers worked equally well in 12 (FPDL) and 13 (LPTDL) patients, respectively. Results were independent of the localization of the PWS and of the patient's age. In spite of the longer pulse duration, the LPTDL treatment did not result in more side-effects as long as sufficient cooling was provided. CONCLUSIONS: The results provide evidence that wavelengths longer than 585 nm can increase the efficacy of treatment in some PWS. Owing to the reduced light absorption by haemoglobin at longer wavelengths and consequently increased depth of the vascular injury, larger vessels can be damaged more adequately using an increased fluence. The LPTDL at 585 nm seemed to be slightly superior to the FPDL, while accepting that due to technical reasons the laser parameters were not directly comparable. Availability of both lasers increases the therapeutic possibilities in PWS.
Assuntos
Terapia a Laser , Mancha Vinho do Porto/radioterapia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Seguimentos , Humanos , Lactente , Lasers/efeitos adversos , Pessoa de Meia-Idade , Mancha Vinho do Porto/patologia , Resultado do TratamentoRESUMO
BACKGROUND AND OBJECTIVE: Anti-inflammatory actions of ciclopirox, an antifungal agent, have been described previously. We assessed the effectiveness of ciclopirox in the treatment of viral warts. PATIENTS/METHODS: Twenty-three immunocompetent patients (age 9-61 years) with common warts at the hands, feet and in the face resistant to conventional therapy were treated. Following keratolysis with a salicylic acid-containing patch, an 8% ciclopirox lacquer was applied 1-2 times daily. At the beginning and the end of the treatment lesions were photographed and the time span (minimum 4 weeks) until complete resolution was documented. RESULTS: In 7 patients complete remission, and in 12 patients partial remission was achieved. Only 4 patients did not show any effect under topical ciclopirox treatment (mean duration of therapy 3.2 +/- 2.1 months). The overall response rate was 82.6%. Local side effects like erythema or pruritus were not reported. CONCLUSION: Our data suggest that a ciclopirox lacquer may be helpful in the treatment of common warts. However, the data have to be confirmed in a randomized controlled trial in the future.
Assuntos
Antifúngicos/administração & dosagem , Dermatoses Faciais/tratamento farmacológico , Dermatoses do Pé/tratamento farmacológico , Dermatoses da Mão/tratamento farmacológico , Piridonas/administração & dosagem , Verrugas/tratamento farmacológico , Administração Tópica , Adolescente , Adulto , Criança , Ciclopirox , Esquema de Medicação , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
BACKGROUND AND OBJECTIVE: Portwine stains are reported to occur in 2.8% of the newborn. Depending on the location and size, portwine stains can be disfiguring and may lead to psychosocial complications. They can be safely and successfully treated with the flashlamp pumped pulsed dye laser (FPDL). Our objective was to evaluate retrospectively the efficacy of the FPDL (450 microseconds, 585 nm, 5 and 7 mm) after five years of clinical experience with this laser. PATIENTS/METHODS: Between 1993-1998 in 961 patients with port-wine stains laser treatment was performed in the department of dermatology of the university of Regensburg. RESULTS: Total clearance of the portwine stain was recorded in 6.9% of the patients. In 40.4% of the patients 75-95% clearance and in 38.5% 50-75% clearance was observed. In 14.2% response was less than 50%. Laser therapy was more effective for lesions of the neck and trunk than for lesions on the head and extremities. Better results were found after laser therapy of light-red or red portwine stains compared to dark red and violaceus portwine stains. In children (less than 3 year old), clearance of more than 75% occurred significantly more often than in older patients. CONCLUSIONS: Since laser treatment in early childhood is more effective than treatment at a later age, a smaller number of treatment sessions is necessary and lower recurrence rates can be expected, laser treatment should be started in early childhood. Side effects were rare after FPDL treatment. This study underlines that the FPDL is a safe and successful treatment for portwine stains with rare side effects. But total clearance can only be reached in a small number of patients.
Assuntos
Hamartoma/cirurgia , Terapia a Laser , Dermatopatias/cirurgia , Adolescente , Adulto , Fatores Etários , Criança , Pré-Escolar , Interpretação Estatística de Dados , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Recidiva , Estudos Retrospectivos , Fatores SexuaisRESUMO
INTRODUCTION: A prospective monocenter open study was carried out to evaluate if generalized phototoxic skin reactions occur after intravesical application of 5-aminolevulinic acid (ALA) for fluorescence diagnosis of superficial bladder carcinomas. PATIENTS AND METHODS: On 21 patients, skin phototoxicity was determined prior to as well as 4, 8 and 28 h after intravesical instillation of a 3% ALA solution by exposing small skin areas to a progressively graded series of defined UVA-light doses (n = 9; 5-80 J/cm(2)). RESULTS: Prior to ALA instillation, erythema or pigmentation as signs of cutaneous phototoxicity occurred at an UVA-light dose of 28 +/- 1.5 J/cm(2) (mean +/- SEM). A reduction of the minimal phototoxic dose (MPD) was not detected 4 (28 +/- 1.9 J/cm(2)), 8 (28 +/- 1.6 J/cm(2)) and 28 h (28 +/- 1.5 J/cm(2)) after ALA instillation. Consequently phototoxic reactions were not observed. CONCLUSIONS: A reduction of MPD for UVA was not detected. Therefore, it is not necessary to protect the skin of patients from ambient or daylight after intravesical instillation of ALA for fluorescence diagnosis.
Assuntos
Ácido Aminolevulínico/efeitos adversos , Dermatite Fototóxica/etiologia , Fármacos Fotossensibilizantes/efeitos adversos , Neoplasias da Bexiga Urinária/diagnóstico , Administração Intravesical , Adulto , Idoso , Idoso de 80 Anos ou mais , Ácido Aminolevulínico/administração & dosagem , Feminino , Fluorescência , Humanos , Masculino , Pessoa de Meia-Idade , Fármacos Fotossensibilizantes/administração & dosagem , Estudos ProspectivosRESUMO
BACKGROUND: Lymphatic malformation, a benign malformation of the skin and the subcutaneous tissues, is divided into two major groups: the classical and the localized forms. Pathologically lymphatic malformation often consists of sequestered lymphatic cisterns with thick muscle walls lying deeply in the subcutaneous tissue. Communicating via dermal lymphatic channels with superficial pseudovesicles, they can vary in size depending on the pressure transmitted by the cisterns beneath. METHODS: We present a patient with mixed capillary/lymphatic malformation and coexisting port-wine stain since birth. To demonstrate the anatomic extent and the subcutaneous involvement we performed a 3D reconstruction of a magnetic resonance imaging (MRI). The diagnostic procedures, therapeutic possibilities, and complications regarding this rare appearance are reviewed. RESULTS: Good results could be obtained with CO2 laser vaporization of the superficial lesions and computed tomography (CT)-guided transcutaneous sclerotherapy for the deeper cisterns with doxycycline. CONCLUSION: The combination of CO2 laser treatment and sclerotherapy with doxycycline seems to present a treatment option for cutaneous and subcutaneous lymphangioma circumscriptum with rare side effects.
Assuntos
Linfangioma/terapia , Imageamento por Ressonância Magnética , Mancha Vinho do Porto/terapia , Radiografia Intervencionista , Escleroterapia , Neoplasias Cutâneas/terapia , Tomografia Computadorizada por Raios X , Adulto , Terapia Combinada , Doxiciclina/administração & dosagem , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Terapia a Laser , Linfangioma/diagnóstico , Mancha Vinho do Porto/diagnóstico , Soluções Esclerosantes/administração & dosagem , Neoplasias Cutâneas/diagnósticoRESUMO
BACKGROUND: Unwanted hair is a widespread cosmetic problem. Many temporary methods of hair removal exist, with laser hair removal rapidly becoming the most widely used modality. OBJECTIVES: Our objective was to evaluate the efficacy and side effects of a long-pulsed ruby laser for epilation in patients with varying skin types and hair color 6 weeks and 6 months after treatment. METHODS: Seventy-four patients received one to four treatments with a long-pulsed ruby laser (694 nm, 5-msec pulse length, 6 mm spot size, 17.5-32 J/cm2) in different body areas. RESULTS: After a mean number of treatments of 1.98 (range 1-4) the mean clearance was 51-75% after 6 weeks and less than 25% after 6 months. A lower percentage of hair regrowth was observed in the facial region than on the trunk or legs and in dark hair compared to blond hair. CONCLUSION: Laser epilation provides a quick and relatively comfortable, but nonpermanent modality for hair removal with few side effects.
Assuntos
Remoção de Cabelo , Terapia a Laser , Feminino , Humanos , MasculinoRESUMO
BACKGROUND: Pachyonychia congenita is considered to be a genodermatosis of autosomal inheritance. It is characterized by nail hypertrophy, shortly present after birth. Later on follicular keratosis of the extremities and hyperkeratosis of palms and soles can be found. HISTORY AND CLINICAL FINDINGS: We report a child with pachyonychia congenita type-I (Jadassohn-Lewandowsky). Shortly after birth nail hypertrophy of all finger- and toenails and leukoplakia of the palate and tongue were found. At the age of 3 years follicular keratosis of the extremities and plantar bullae could be found additionally. CONCLUSION: The underlying disturbance is a mutation within genes for keratin 6, 16 and 17 which leads to formation of abnormal tonofilaments. In adult patients retinoids can be used for symptomatic treatment especially of the palmoplantar keratosis.
Assuntos
Displasia Ectodérmica/genética , Leucoplasia Oral/genética , Unhas Malformadas/genética , Adulto , Pré-Escolar , Aberrações Cromossômicas/genética , Transtornos Cromossômicos , Doença de Darier/diagnóstico , Doença de Darier/genética , Displasia Ectodérmica/diagnóstico , Humanos , Lactente , Recém-Nascido , Queratinas/genética , Leucoplasia Oral/diagnóstico , Masculino , Mutação , Unhas Malformadas/diagnósticoRESUMO
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.
Assuntos
Técnicas Cosméticas/instrumentação , Terapia a Laser/instrumentação , Dermatopatias/terapia , Neoplasias Cutâneas/terapia , Humanos , Envelhecimento da PeleRESUMO
The numerous types of vascular abnormality are classified in groups according to their pathological and anatomical features. We present case histories of 2 patients who had vascular malformations of the face since birth or early childhood. Application methods, side-effects and complications of percutaneous and intra-lesional Nd:YAG-laser therapy are reviewed for these patients. A 54-year-old woman was treated percutaneously with the Nd: YAG-laser at 1064 nm, with 20 30 W, cw 1-5 s pulses and 2 - 3 mm spot size. A 59-year-old woman was treated with the combined percutaneous and intralesional laser therapy with 30 W, cw 1-5 s pulses and 2-3 mm spot size. In both cases, percutaneous or combined percutaneous and intra-lesional Nd: YAG-laser application resulted in a significant shrinking of the lesion. The Nd:YAG-laser radiation at 1064 nm presents an effective treatment of vascular malformations due to its deep penetration into the tissue. No standardized guidelines for Nd: YAG-laser therapy exist and the treatment parameters should be chosen individually according to the type of vascular malformation.
Assuntos
Malformações Arteriovenosas/cirurgia , Terapia a Laser , Dermatopatias Vasculares/cirurgia , Procedimentos Cirúrgicos Dermatológicos , Face , Feminino , Humanos , Pessoa de Meia-Idade , Pele/irrigação sanguínea , Pele/patologiaRESUMO
Photoelastic stress analyses were done with nine prefabricated endodontic posts under axial and diagonal (26 degrees) burden with 5, 10, 15, 20, 25 kg. Stress presented itself in form of interference fringes, which became visible under polarized light. The tapered, grooved pins (Mooser and Unimetric) caused fringes along the shaft and apical as well. They worked at higher stress like a wedge. Cylindrical pins (Para Post Unity 5, Radix-anchor) showed relative strong fringes predominantly at the top. Cylindrically tapered pins (Tenax, CM, Pivomatic) and a conical pin with flat thread and grooves (Exatec-S) caused a more favourable stress distribution and the fringes at the top were clearly slighter.