Port-wine stains and eczema

Meyerson-Phenomenon hides a nevus flammeus

Facial eczema is a common disease in daily dermatological practice. The cause of facial eczema is often atopic dermatitis or allergic contact dermatitis. Usually, the eczema resolves with correct topical treatment and by avoiding allergic trigger factors. A 49-year-old woman presented with persistent eczema on her forehead which recurred over decades despite correct topical therapy. A skin biopsy revealed the astonishing diagnosis of a nevus flammeus with an overlying eczema known as the Meyerson phenomenon. The Meyerson phenomenon is often described in children with nevi flammei suffering from atopic dermatitis - in adults the phenomenon is rarely recognized as a reason for eczema. We show the interesting case of an adult woman with the Meyerson phenomenon on a nevus flammeus and discuss the possible pathomechanisms.

Eczematous dermatitis after vascular laser therapy: a report of two cases

Eczematous dermatitis was found in two port wine stain (PWS) lesions in two different individuals following variable pulsed 532-nm laser therapy. Both of the individuals described in this report had received low-dose superficial X-ray several years prior to the development of the eczematous dermatitis. The eczematous dermatitis in the PWS lesions was characterized by oozing, crusting, and pruritus, which showed a tendency to expand to other sites when exacerbated. Treatment with topical corticosteroid ointments produced some temporary improvement, but the dermatitis in both cases recurred when the topical medications were stopped. The mechanism of action for the development of an eczematous dermatitis in a PWS remains unclear, but may be related to multiple factors including abnormal hemodynamic forces resulting from the malformed vessels, an abnormal production of cytokines, local pathophysiological and immunological changes resulting from either the X-ray therapy or the laser therapy, and atopic constitution inherent in these individuals. These hypotheses and ideas need further study for additional insight into this rare, but reported adverse event.

An update on lasers in children

PURPOSE OF REVIEW

A variety of new indications for laser treatment have been raised in the dermatology field recently. They offer significant opportunities to manage a large spectrum of conditions in the pediatric population. Therefore, it is necessary to know the current trends and limitations of their use for the treatment of pigmented and vascular lesions.

RECENT FINDINGS

The pulsed dye laser for port wine stain treatment remains the gold standard. However, pulsed dye laser-resistant port wine stain constitutes a difficult management problem. New therapeutic modalities such as photodynamic therapy and the application of different topical angiogenesis inhibitors promise better results in avoiding port wine stain redarkening. The potential systemic effects also require further study. Traditionally, the Q-switched pigmented laser has been used for pigmented lesions. However, the 1550 nm wavelength erbium-doped fiber laser could be a new modality of treatment for Becker's nevus.

SUMMARY

Since the development of the first laser in 1960, dermatology and dermatologic surgery have rapidly evolved over the last two decades, thanks to the numerous technological and scientific acquisitions focused on improvement in the treatment of skin conditions. A large spectrum of vascular and pigmented lesions and other conditions such as chronic inflammatory skin diseases, such as psoriasis and eczema, keloids and hypertrichosis, are now managed safely with laser treatment.

Port-wine-stain-associated dermatitis: implications for cutaneous vascular laser therapy

Port-wine stains are congenital vascular malformations affecting 0.3% to 0.5% of infants. Dermatitis occurring exclusively or most severely within port-wine stains has been described in the literature. Traditionally, topical corticosteroid therapy has been used for the treatment of dermatitis, while pulseddye laser treatment is considered a safe and effective means of lightening the appearance of congenital port-wine stains. To describe the development of port-wine stain-associated dermatitis as well as a rational treatment approach to these patients, we studied three children with facial, limb, or truncal port-wine stains who developed dermatitis within the congenital vascular malformation either prior to or during treatment with pulseddye laser. Laser therapy of dermatitis-affected areas was subsequently deferred pending resolution of the dermatitis with topical corticosteroid or topical calcineurin inhibitor treatment. While pulseddye laser therapy is an effective means of lightening port-wine stains and achieving lasting resolution of any associated dermatitis, this therapy to dermatitis-affected areas should be postponed until the inflammation resolves to minimize the risk of laser-associated adverse effects.

Recalcitrant adverse reaction to vitamin K: response to pulsed dye laser

BACKGROUND

Adverse cutaneous reaction to vitamin K manifests in sclerodermatous or erythematous plaque-like reactions. Most of the cases with erythematous plaque-like dermatitis arising at the site of intramuscular vitamin K injection were recalcitrant and did not respond to various attempts with topical and intralesional corticosteroid.

OBJECTIVE

The objective was to describe a 25-year-old woman with recalcitrant adverse reaction owing to vitamin K who was successfully treated with pulsed dye laser.

METHODS

Two consecutive pulsed dye laser treatments were performed 3 weeks apart with 450-microec pulse duration, 585-nm pulse width, and fluence of 5 and 7 J/cm(2), respectively, using a 7-mm handpiece.

RESULTS

One week after the second treatment, her skin lesion was cleared and she was followed without recurrence for 7 months.

CONCLUSION

Although the precise mechanism remains yet to be proven, we have demonstrated successful treatment of localized adverse cutaneous reaction to vitamin K in one patient with the pulsed dye laser.

Meyerson phenomenon within a nevus flammeus. The different eczematous reactions within port-wine stains

Only few reports about eczematous reactions overlying nevi flammei exist. All of them were observed in children. The description of an eczematous reaction within a congenital nevus flammeus on the left lower leg of a male adult gives reason to discuss this rare phenomenon. Eczema or inflammatory changes within a port-wine stain may mostly be a collision dermatosis with an atopic dermatitis, especially when they arise in children and are localized to the neck and face. When they are observed within a grossly visible vascular malformation, as for example in the Klippel-Trenaunay syndrome, they may have a pathogenesis similar to stasis dermatitis. In rare cases, an eczematous reaction within a nevus flammeus may be the result of genetic mosaicism and is interpreted as a variant of the so-called Meyerson phenomenon.