Laser-assisted blepharoplasty: An innovative safe and effective technique.

BACKGROUND: Blepharoplasty is one of the most popular esthetic procedures with an acceptable risk profile and a relatively quick procedure. METHODS: The aim was to evaluate the efficacy and safety of a new CO2 and 1540-nm laser-assisted blepharoplasty technique applied to the upper and lower eyelids. A total of 38 patients were enrolled. Photographs were taken before the treatment and at 6-month follow-up. One "blind" observer assessed the performance of this technique by ranking the results in four categories of eyelid esthetic: 1 = no or poor results (0%-25%), 2 = slight improvement (25%-50%), 3 = moderate improvement (50%-75%) and 4 = marked improvement (75%-100%). All possible complications were monitored. RESULTS: Thirty-two patients (84 %) achieved marked improvement, four patients (11%) moderate improvement, two patients (5 %) slight improvement, while zero subjects (0%) poor or no improvement. No serious adverse effects were observed. CONCLUSIONS: Our results from clinical evaluations suggest that the CO2 and 1540-nm laser assisted blepharoplasty is proved to be a sophisticate intervention efficacious in improving the treatment of patients with various degrees of eyelid and periocular aging and also in reducing downtime.

Treatment of benign hyperpigmentations and pigmented scars by 755 alexandrite laser comparing the Single Pass versus MultiPass (MoveoPL) emission in skin types I-IV.

Lasers are effective treatments for benign hyperpigmentations but may be difficult especially in darker skin type. In this randomized split-face controlled study on benign hyperpigmentations and pigmented scars, we compare the standard Single Pass (SP) emission with the MultiPass emission (MoveoPL) 755 alexandrite laser. Patients, skin types I-IV, with solar lentigines and ephelides of the face, chest, and hands and patients with pigmented scars of the legs, underwent laser treatment, by treating one side of the body or half scar using the SP and the other side using MoveoPL. Improvements according to a grading score system, side effects, and patient satisfaction were recorded. About 63 patients were enrolled. An overall improvement of benign hyperpigmentations and pigmented scars was recorded, with a grading score (±SD) of 2.8 ± 0.8 for SP and 3.6 ± 0.5 for MoveoPL (range, 0-4). SP emission showed best results in skin types I-II whereas MotusPL obtained successfully results in all the phototypes analyzed (types I-IV). Patients preferred MoveoPL as it was associated with fewer side effects. Both standard SP and MoveoPL emission are effective and safe. MoveoPL showed a higher efficacy and safety profile for the treatment of hyperpigmentations.

Combined pulsed dye laser and Q-switched Nd:YAG laser intraumatic facial tattoo removal: A case series.

Traumatic tattoos can be treated with several methods, including mechanical and chemical devices. However, they are rarely used due to the high risk of permanent side effects such as scarring and depigmentation. Recently, laser devices, especially the Q-switched (QS) laser and the pulsed dye laser (PDL), applied in combination, have achieved complete clearance of the lesions without any risk of side effects. Herein, we reported three cases of traumatic facial tattoos successfully treated with combined PDL and QS Nd:YAG laser.

Dermatosis Papulosa Nigra and 10,600-nm CO2 laser, a good choice.

Dermatosis Papulosa Nigra (DPN) is a common skin condition observed in black people and considered a benign epithelial tumor, and more specifically, a particular topographic form of seborrheic keratosis. We treated five female patients affected by DPN with 10,600-nm CO2 laser. We propose the 10,600-nm CO2 laser as a valid therapeutic option in patients affected by DPN, since the treatment is well tolerated, causes no major side effects, and is effective and long lasting.

Spectral morphological analysis of skin lesions with a polarization multispectral dermoscope.

Dermoscopy is the conventional technique used for the clinical inspection of human skin lesions. However, the identification of diagnostically relevant morphologies can become a complex task. We report on the development of a polarization multispectral dermoscope for the in vivo imaging of skin lesions. Linearly polarized illumination at three distinct spectral regions (470, 530 and 625 nm), is performed by high luminance LEDs. Processing of the acquired images, by means of spectral and polarization filtering, produces new contrast images, each one specific for melanin absorption, hemoglobin absorption, and single scattering. Analysis of such images could facilitate the identification of pathological morphologies.

A case of acne fulminans presenting with systemic symptoms resembling acute appendicitis with maculopapular purpura-like eruption exacerbated by systemic steroids.

Acne fulminans, the most severe form of acne, comprises ulcerative nodulocystic lesions with general, abdominal, and skeletal symptoms acute in onset. In our case, the patient initially had been managed as acute appendicitis. Antibiotic therapy had been administered in full doses with systemic corticosteroids, usually recommended as primary treatment. Few days later, we observed the complete palette of clinical manifestations (vasculitis-like lesions and joint pain) and the classic signs (nodules and pustules on face and chest) allowing the correct diagnosis. Our treatment was peculiar: a systemic antibiotic therapy, based on cephalosporines, proved to be effective.

Jessner-Kanof disease: two effective and sure therapeutic options.

Jassner-Kanof disease is a benign cutaneous disorder clinically characterized by recurrent asymptomatic erythematous papules and plaques sometimes grouped with an arciform disposition on the face, neck, and back. We describe a case of Jassner-Kanof disease resistant to conventional therapy, in which the lesions located on the arms were treated with 595 nm pulsed dye laser, and those on the trunk underwent a treatment with tacrolimus 0.03% ointment. We have compared the results and the potential side effects with the two treatments, and after 1 year of follow-up, no recurrence of cutaneous lesions were observed.

Inflammatory linear verrucous epidermal nevus: why a combined laser therapy.

Inflammatory linear verrucous epidermal nevus (ILVEN) is a benign cutaneous hamartoma, and more precisely an uncommon variant of the verrucous epidermal nevus. In our case report we describe an ILVEN female patient, resistant to previous treatments but responsive to a combined laser therapy, 10,600-nm CO2 laser and Fractional CO2 laser, with good and longstanding results. A complete resolution of the lesion was observed at the 9-month follow-up. The application of lasers has been reported in literature over recent years for resolving ILVEN lesions. Based on our clinical experience, 10,600-nm CO2 pulsed laser therapy seems to be the best treatment and Fractional CO2 laser treatment can be regarded as a very promising technique to combine with CO2 laser for reducing pigment modifications and endowing a more youthful appearance to the treated areas.

A case of perianal Crohn disease misdiagnosed as condylomata acuminata.

We report a case of a 30-year-old woman with vegetative lesions in the perianal area to highlight the importance of considering perianal Crohn disease in the differential diagnosis of a resistant condylomata acuminata that does not improve after treatment.

Controversial issues on melanoma.

In this chapter, we try to debate two of the most several controversial points about melanoma: the role of the ultraviolet (UV) ray exposure and the position of the sentinel node biopsy in the dermatological daily activity. It has been demonstrated as a direct relationship between UV exposure and the risk of developing melanoma, but it is also true that a chronic continuous UV ray exposure can develop a protective action. Nodal evaluation is one of the most important prognostic indicators to be considered for the patient outcome. The aims for which sentinel node biopsy is so often adopted can be summarized in three points: a detailed nodal staging, a regional disease control, and a possible overall improved survival. At present, many authors do not think that it let the overall survival grow; therefore, they suggest its use only to stage regional lymph nodes and accurately identify patients who could benefit through an early complete regional lymphadenectomy.

Highlights of thirty-year experience of CO2 laser use at the Florence (Italy) department of dermatology.

The CO(2) laser has been used extensively in dermatological surgery over the past 30 years and is now recognised as the gold standard for soft tissue vaporization. Considering that the continuous wave CO(2) laser delivery system and the newer "superpulsed" and scanned CO(2) systems have progressively changed our practice and patient satisfaction, a long range documentation can be useful. Our experience has demonstrated that the use of CO(2) laser involves a reduced healing time, an infrequent need for anaesthesia, reduced thermal damage, less bleeding, less inflammation, the possibility of intra-operative histologic and/or cytologic examination, and easy access to anatomically difficult areas. Immediate side effects have been pain, erythema, edema, typically see with older methods, using higher power. The percentage of after-treatment keloids and hypertrophic scars observed was very low (~1%) especially upon the usage of lower parameters. The recurrence of viral lesions (condylomas and warts) have been not more frequent than those due to other techniques. Tumor recurrence is minor compared with radiotherapy or surgery. This method is a valid alternative to surgery and/or diathermocoagulation for microsurgery of soft tissues. Our results are at times not consistent with those published in the literature, stressing the concept that multicentric studies that harmonization methodology and the patient selection are vital.

Photodynamic therapy for a hypertrophic scarring: a promising choice.

The case we report is about a female patient, 69 years old, who had a hypertrophic scarring on the right cheek because of a bite by her dog. She had attempted many types of topical and intralesional treatments but without success. The patient underwent photodynamic therapy (PDT), employing a methyl ester of 5-aminolevulinic acid (MAL) as topical photosensitizer and a non-coherent red light at a wavelength of 632 nm. This session was then repeated three more times at 2-week intervals. A month after the last session, the scarred area significantly softened, becoming more flexible, less erythematous, smoother and reduced in volume. The patient was greatly satisfied with the clinical and cosmetic result, she had no more than rough scarring on the cheek, and her skin in the area around the lesion was very smooth, wrinkle-free. She did not show any recurrence of her hypertrophic scarring after 1 year of follow-up. PDT revealed to be the most effective approach if compared with previous therapeutic options received by the patient, but further studies are necessary to evaluate protocols to be used for the best results in this kind of application.

Therapeutic Hotline: Facial skin rejuvenation in a patient treated with photodynamic therapy for actinic keratosis.

The aim of the most used treatments of actinic keratoses (AKs) is to avoid the conversion into invasive squamous cell carcinoma through the destruction of the lesion; a lot of therapeutic modalities (imiquimod, 5-fluorouracil, electrosurgery with curettage, cryosurgery) are effective and safe in this field, but not many can do it with excellent cosmetic results like treatment with photodynamic therapy (PDT). We have treated with this technique an old patient, whose AK was resistant to other treatments; the most interesting feature of our case comes from the esthetic effects of the PDT employing a methyl-ester of 5-aminolevulinic acid as topical photosensitizer. This kind of therapy has removed not only the lesion but also the photoaging manifestations like the wrinkles and the ugly lines, leaving a smooth skin, as we have proved with 3D-profilometry technique.

Nonconventional Use of Flash-Lamp Pulsed-Dye Laser in Dermatology.

Flash-lamp pulsed-dye laser (FPDL) is a nonablative technology, typically used in vascular malformation therapy due to its specificity for hemoglobin. FPDL treatments were performed in a large group of patients with persistent and/or recalcitrant different dermatological lesions with cutaneous microvessel involvement. In particular, 149 patients (73 males and 76 females) were treated. They were affected by the following dermatological disorders: angiokeratoma circumscriptum, genital and extragenital viral warts, striae rubrae, basal cell carcinoma, Kaposi's sarcoma, angiolymphoid hyperplasia, and Jessner-Kanof disease. They all underwent various laser sessions. 89 patients (59.7%) achieved excellent clearance, 32 patients (21.4%) achieved good-moderate clearance, 19 patients (12.7%) obtained slight clearance, and 9 subjects (6.1%) had low or no removal of their lesion. In all cases, FPDL was found to be a safe and effective treatment for the abovementioned dermatological lesions in which skin microvessels play a role in pathogenesis or development. Further and single-indication studies, however, are required to assess a standardized and reproducible method for applying this technology to "off-label" indications.

Laser surgery in rhinophyma.

BACKGROUND: Rhinophyma is a benign, disfiguring disorder, commonly referred to as the end-stage of severe rosacea and characterized by a progressive thickening and hypertrophy of the nasal skin and soft tissues. The aim of this paper was to evaluate the efficacy of CO2 laser compared to other laser techniques and surgical methods in the treatment of rhinophyma. METHODS: Twenty-four rhinophyma patients were treated with CO2 laser in our institution from 2003 to 2013. A 10,600-nm CO2 pulsed laser was used in all patients, with a 6-month, post-treatment follow-up. RESULTS: Six months after the last laser session, all patients showed global improvement of their clinical conditions: 19 (79.1%) high improvement (>75%), 4 (16.7%) moderate improvement (50-75%), and 1 (4.2%) low improvement (<25%). CONCLUSIONS: Our study demonstrates that carbon dioxide laser warrants a careful nasal surface ablation, allowing the remodeling of the hypertrophic areas, with an excellent cosmetic result, a very short healing time, and virtually no side effects.

In-vivo imaging of psoriatic lesions with polarization multispectral dermoscopy and multiphoton microscopy.

Psoriasis is a skin autoimmune disease characterized by hyperkeratosis, hyperproliferation of the epidermis and dilatation of dermal papillary blood vessels. Healthy skin (5 volunteers) and psoriatic lesions (3 patients) were visualized in vivo, with high contrast and resolution, with a Polarization Multispectral Dermoscope and a Multiphoton Microscope. Psoriatic features were identified and quantified. The effective diameter of the superficial blood vessels was measured at 35.2 ± 7.2 µm and the elongated dermal papillae had an effective diameter of 64.2 ± 22.6 µm. The methodologies developed could be employed for quantitative diagnostic purposes and furthermore serve as a monitoring method of the effect of personalized treatments.

Tattoo-associated skin reaction: the importance of an early diagnosis and proper treatment.

Tattoo is going to be a very common practice especially among young people and we are witnessing a gradual increase of numerous potential complications to tattoo placement which are often seen by physicians, but generally unknown to the public. The most common skin reactions to tattoo include a transient acute inflammatory reaction due to trauma of the skin with needles and medical complications such as superficial and deep local infections, systemic infections, allergic contact dermatitis, photodermatitis, granulomatous and lichenoid reactions, and skin diseases localized on tattooed area (eczema, psoriasis, lichen, and morphea). Next to these inflammatory skin reactions we have to consider also the possibility of the development of cutaneous conditions such as pseudolymphomatous reactions and pseudoepitheliomatous hyperplasia. The aim of this study is to underline the importance of an early diagnosis by performing a histological examination especially when we are in front of suspected papulonodular lesions arising from a tattoo, followed by a proper treatment, since cutaneous neoplastic evolution is known to be a rare but possible complication.