Fixed Drug Eruption in a Patient Taking Valacyclovir without Cross-Reactivity to Acyclovir.

Fixed drug eruption (FDE) is a well-defined hyperpigmented patch that recurs in a fixed location each time a particular drug is taken. Common causative agents of FDE are non-steroidal anti-inflammatory drugs, non-narcotic analgesics, sedatives, anticonvulsants, sulfonamides, and tetracycline. We report a 33-year-old male who presented with a recurrent, localized, brownish-to-erythematous macule and papules on the peri-philtrum area two hours after taking valacyclovir. Three episodes of valacyclovir ingestion for treatment of Herpes simplex virus infection provoked a similar skin rash at the same site. Histopathology results showed vacuolar degeneration in the basal layer of the epidermis, pigmentary incontinence, and perivascular inflammatory cell infiltration in the papillary dermis. Although patch test and skin prick test showed negative responses to acyclovir and valacyclovir, an intradermal test showed a positive reaction only to valacyclovir. The oral provocation test to acyclovir and valacyclovir showed a positive reaction only to valacyclovir. Through drug history, histopathological examination, patch test, intradermal test, and oral provocation test, we established a final diagnosis of FDE due to valacyclovir without cross-reactivity to acyclovir. To find alternative therapeutic drugs, we suggest diagnostic tests with not only the suspected drugs, but also other drugs in the same class.

The Beneficial Effect on Pigmentation Using Laser Epilation as an Initial Treatment Approach for Becker's Nevus in Asian Skin.

Becker's nevus (BN) clinically presents as brown patches with hypertrichosis. The risk of pigmentary changes still remains a concern when using lasers to treat Asian patients with BN. We aimed to evaluate the outcomes on reduction of hairs and pigment of BN using the long-pulsed 1064-nm Nd:YAG (LPNY) and/or 755-nm alexandrite (LP-Alex), before treating pigment in earnest. A total of 13 subjects were treated with the LPNY (n = 8), the LP-Alex (n = 4), and both (n = 1). Improvements on hair removal and pigment reduction were assessed using a 5-point global assessment scale. Patient satisfaction was also assessed. Treatment parameters were within those commonly used for the purpose of epilation. The average follow-up period was 19.5 ± 12.3 weeks, and the mean total number of sessions was 2.0. Eleven subjects reported >50% improvement in hair removal (11/13, 86.7%), and pigment reduction of >50% improvement was observed in 9 subjects (9/13, 69.2%). Patient satisfaction showed >50% lesion clearance in 84.6%. Hair removal settings of LPNY and LP-Alex were effective in both hypertrichosis and pigment reduction in the initial strategy of treatment of BN in skin of color.

Split-face comparison of the picosecond 1064-nm Nd:YAG laser using a microlens array and the quasi-long-pulsed 1064-nm Nd:YAG laser for treatment of photoaging facial wrinkles and pores in Asians.

Skin photoaging manifests deeper wrinkles and larger pore size. Various lasers have been tried for rejuvenation of photoaging skin, and the quasi-long-pulsed 1064-nm neodymium:yttrium-aluminum-garnet (Nd:YAG) laser is one promising treatment option. New types of laser device are emerging, including devices operating with picosecond pulse duration combined with a microlens array, which are regarded as a new breakthrough for skin rejuvenation. We aimed to evaluate the clinical effectiveness and safety of the picosecond 1064-nm Nd:YAG laser using a microlens array compared with the quasi-long-pulsed 1064-nm Nd:YAG laser in a split-face design. We designed a split-faced, prospective study and enrolled 25 subjects with photoaging facial wrinkles and enlarged pores. Each facial area was randomly assigned to undergo treatment with either the picosecond 1064-nm Nd:YAG laser (Pico-arm) or the quasi-long-pulsed 1064-nm Nd:YAG laser (Quasi-arm). We performed five laser sessions at 2-week intervals, and final results were assessed after 20 weeks after the initial laser session. We used a five-point global assessment scale, wrinkle and pore index derived from 3D camera analysis. We enrolled a total of 25 subjects (24 females and 1 male) with Fitzpatrick skin types III to IV and a mean age of 63.8 ± 5.7 years. After treatment, 54.2% of subjects in the Pico-arm reported at least moderate improvement in visible pores compared with 41.7% of the Quasi-arm (P = 0.001). A total of 12.5% of subjects in the Pico-arm showed moderate improvement in wrinkles versus 4.2% of the Quasi-arm (P = 0.125). There was a 41.3% reduction in the pore index in the Pico-arm compared to a 3.9% increase in the Quasi-arm (P = 0.048). There was a 16.4% reduction in the wrinkle index in the Pico-arm compared with a 0.5% reduction in the Quasi-arm (P = 0.01). Pain assessment score was higher in the Pico-arm than the Quasi-arm (3.65 ± 1.70 vs 1.28 ± 1.28, P = 0.001). No serious adverse events occurred during the study. Our findings suggest that the picosecond 1064-nm Nd:YAG laser with a microlens array is as effective as the quasi-long-pulsed 1064-nm Nd:YAG laser for treatment of photoaging wrinkles and pores.

Squamoid eccrine ductal carcinoma of the ear helix.

Chronic cutaneous ulcer on the ear helix of 80-year-old male was diagnosed with squamoid eccrine ductal carcinoma (SEDC). SEDC is characterized by both atypical squamous and ductal differentiation. SEDC frequently appears on sun-exposed areas. It could show local recurrence despite complete resection. These characteristics demand cautious attention to SEDC.

Melanogenesis inhibition in mice using a low-fluence 1064-nm Q-switched neodymium-doped yttrium aluminum garnet laser: a pilot study.

A low-fluence 1064-nm Q-switched neodymium-doped yttrium aluminum garnet laser, or laser toning, has yielded favorable outcomes in various benign pigmented disorders. However, the exact mechanism of action of laser toning has not been fully elucidated. We sought to determine the inhibitory effect of laser toning on melanogenesis and to assess how laser passes influence the outcomes. To produce perceptible pigmentation, nine HRM-2 melanin-possessing hairless mice were treated with ultraviolet (UV) B radiation on the dorsal skin. This was followed by zero, two, four, or six passes of laser toning twice in 2 weeks on each designated quadrant. The spectrophotometric values and pigmentation-related protein expressions were measured. Pigment changes were found in the mice skin using the Fontana-Masson stain for histopathological analysis. Four- and six-pass laser toning significantly improved the lightness compared to that in the unirradiated control (p < 0.002). The Fontana-Masson stain showed that melanin was considerably decreased in laser-irradiated skin. As the number of laser passes increased, the expression of tyrosinase decreased (p < 0.008). The following parameters also decreased in proportion to the number of laser passes: MITF, TRP-1, TRP-2, p-ERK, and p-Akt. In contrast, TGF-ß increased in proportion to the number of laser passes. However, the changes in these six proteins were not statistically significant. Our study demonstrates that laser toning improves skin pigmentation with increased number of passes in a dose-dependent manner. This effect is mediated by tyrosinase inhibition.