Comparison of the 308-nm excimer laser and a 308-nm excimer lamp with 311-nm narrowband ultraviolet B in the treatment of psoriasis.

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.

Discoid lupus erythematosus and lupus profundus in childhood: a report of two cases.

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.

Laser surgical planning with magnetic resonance imaging-based 3-dimensional reconstructions for intralesional Nd:YAG laser therapy of a venous malformation of the neck.

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.

[Transverse nasal groove. A rare embryological error in nature]. / Die transversale Nasenlinie. Ein selten beachteter Webfehler der Natur.

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.

[Treatment of therapy-resistant verruca vulgaris with long-pulsed tunable dye laser]. / Behandlung von therapieresistenten Verrucae vulgares mit dem lang-gepulsten Farbstofflaser.

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.

[Treatment of therapy refractory verrucae vulgares with a ciclopirox-containing lacquer]. / Behandlung von therapieresistenten Verrucae vulgares mit einem Ciclopirox-haltigen Lack.

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.

[Treatment of port-wine stains with the flash lamp pumped dye laser. 5 years of clinical experience]. / Die Behandlung von Feuermalen mit dem blitzlampengepumpten gepulsten Farbstofflaser. Ergebnisse aus 5 Jahren klinischer Erfahrung.

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.

No generalized skin phototoxicity after intravesical application of 5-aminolevulinic acid for fluorescence diagnosis of superficial bladder cancer.

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.

Mixed capillary/lymphatic malformation with coexisting port-wine stain: treatment utilizing 3D MRI and CT-guided sclerotherapy.

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.

Hair removal using a 5-msec long-pulsed ruby laser.

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.

[Type I pachyonychia congenita (Jadarssohn-Lewandowsky)]. / Pachyonychia congenita Typ-I (Jadassohn-Lewandowsky).

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.

[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.

Percutaneous and combined percutaneous and intralesional Nd:YAG-laser therapy for vascular malformations.

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.