Transient improvement in chronic psoriasis after treatment of TNF-α blocker induced disseminated M. tuberculosis infection.

Improvement in psoriasis after treatment of reactivated latent tuberculosis following initiation of TNF-α inhibitor therapy has yet to be described in the literature. The authors present a case of transient, yet significant, improvement in chronic plaque psoriasis after antibiotic therapy for reactivated TB.

Treatment of focal axillary hyperhidrosis using a long-pulsed Nd:YAG 1064 nm laser at hair reduction settings.

BACKGROUND AND OBJECTIVE: Axillary hyperhidrosis is a rather common idiopathic disorder of the eccrine sweat glands, which can interfere with daily activities and cause significant social distress. The effects of 1064 nm laser hair reduction on sweat production in a pilot study in patients with focal axillary hyperhidrosis are described. STUDY DESIGN/MATERIALS AND METHODS: In a prospective, case-controlled, randomized pilot study, one axilla from six different subjects with axillary hyperhidrosis was treated with monthly laser hair reduction sessions using the 1064 nm Nd:YAG laser at typical settings. The contralateral axilla acted as a control. Subjects were asked to subjectively classify improvement of axillary sweating using a Global Assessment Questionnaire (GAQ) weekly after each treatment. Qualitative evaluation of sweating was also performed using a modified starch iodine test monthly after each treatment. In addition, prior to the first treatment and at one month following the final treatment, a punch biopsy was performed on the treatment axilla to assess for histologic changes to the eccrine gland and surrounding structures. RESULTS: Statistically significant improvements in subjective ratings of sweating using the GAQ compared to baseline were observed. Objective improvements in sweating with modified starch iodine testing comparing treated versus non-treated axillae were also seen for at least nine months in selected subjects. No significant differences in pre- and post-treatment biopsies were noted on routine histology. CONCLUSIONS: Laser hair reduction using the 1064 nm Nd:YAG at laser hair removal settings provides subjective and objective improvements in patients with focal axillary hyperhidrosis.

Imiquimod in the treatment of alopecia universalis.

Imiquimod is used topically in the treatment of numerous dermatologic conditions. Imiquimod modifies the immune response through cytokine induction of the T-cell helper subset, correlating with the expression of interferon alpha, tumor necrosis factor alpha, interferon gamma, and interleukins (ILs) 1 and 12. Reciprocal inhibition of TH2 immune response occurs via up-regulation of interferon gamma and down-regulation of TH2-associated cytokines, including IL-4, IL-5, IL-6, IL-10, and IL-13. Alopecia universalis is a severe form of alopecia thought to arise from T-cell mediated autoimmune disease of the hair follicle. There have been no case reports noting a beneficial effect of topical imiquimod in the treatment of alopecia universalis. We present a case of a 15-year-old adolescent girl with alopecia universalis since age 8 who experienced transient hair growth after topical application of imiquimod.

Demonstration of protoporphyrin IX (PpIX) localized to areas of palmar skin injected with 5-aminolevulinic acid (ALA) and pre-treated with a fractionated CO2 laser prior to topically applied ALA.

BACKGROUND: Several techniques designed to enhance ALA delivery into subcorneal layers of palmar skin are described. METHODS: Six palms from three subjects were treated with topical ALA, iontophoresis enhanced delivery of ALA, intradermal injections of ALA solution, or fractionated CO(2) laser (with or without erbium:YAG surface ablation). The relative efficacy of each technique was determined using Wood's lamp illumination for the presence of fluorescent PpIX. RESULTS: Palms treated with topically applied ALA alone or with iontophoresis pre-treatment failed to exhibit fluorescence. The palm treated with intradermal injections of ALA and the palms pre-treated with fractionated CO(2) laser with or without erbium:YAG laser surface ablation exhibited fluorescence at treatment areas. CONCLUSION: Both intradermal injections and fractionated CO(2) laser (with or without erbium:YAG laser pre-treatment) may provide an effective means for delivery of ALA into subcorneal layers of palmar skin. Numerous potential clinical applications of these techniques (including treatment of localized palmar hyperhidrosis) exist.