Nonablative skin remodeling: selective dermal heating with a mid-infrared laser and contact cooling combination

BACKGROUND AND OBJECTIVE

Many of the microscopic changes associated with photodamage reside in the dermis. It follows that subsurface heating of the skin might allow for cosmetic enhancement without loss of the epidermis. Accordingly, we investigated the clinical and microscopic changes produced by a mid-infrared laser coupled with a contact cooling device.

STUDY DESIGN/MATERIALS AND METHODS

Nine patients were treated with an erbium glass laser and sapphire cooling handpiece in contact with the skin. Postauricular sites were irradiated with pulse energies varying from 400-1,200 mJ and numbers of pulses from 4 to 40. Outcome measures included pain, edema, and erythema at predetermined postoperative intervals. Biopsies were performed just after treatment and 2 months postoperatively for selected pulse energy-pulse number combinations.

RESULTS

Erythema, edema, and pain increased with pulse energy and number of pulses. Likewise, immediate epidermal necrosis and subsequent scarring were observed for larger pulse energy-pulse number combinations. At sites with epidermal preservation, on biopsy, immediate dermal thermal damage was observed in a band-like pattern. The deep boundaries of this band were dependent on pulse energy and pulse number. After 8 weeks, biopsies showed dermal fibroplasia roughly correlating to the band of immediate dermal thermal damage.

CONCLUSION

Selective dermal heating can be achieved with a mid-infrared laser coupled to a contact surface cooling device. In this study, the range of fibroplasia and lack of clinically substantial cosmetic enhancement suggest that the dermal thermal damage achieved may be too deep and that the injury should be confined to more superficial levels to alter the most severely photodamaged dermis. Lasers Surg. Med. 26:186-195, 2000. Published 2000 Wiley-Liss, Inc.

Transillumination blisters in a neonate

Transillumination with a high-intensity fiberoptic light source is an effective means of diagnosing pneumothoraces and localizing arteries and veins for blood sampling. It has been used for these purposes in neonatal intensive care units since the 1970s. Thermal burns were reported in association with the technique initially, but this complication now occurs infrequently because of numerous safety precautions. We present a case of thermal blisters induced by transillumination in a neonate. This entity is an important addition to the differential diagnosis of vesicobullous eruptions in the neonate.

Fluoroscopic-induced radiation dermatitis

A case of radiation dermatitis following fluoroscopy is described. Radiation dermatitis occurs rarely after fluoroscopic procedures and may pose a diagnostic challenge. Many patients do not consider fluoroscopy to be a source of radiation exposure, and clinicians may be confused by its unusual presentation.

Intravascular angioleiomyoma

A 59-year-old man presented with a 6-year history of a 2-cm tender nodule on his left lateral elbow. Excisional biopsy led to the diagnosis of angioleiomyoma. However, unlike typical angioleiomyoma which demonstrate extravascular extension, this lesion demonstrated purely intravascular growth.

The use of the 1.0 mm handpiece in high energy, pulsed CO2 laser destruction of facial adnexal tumors

BACKGROUND

The treatment of syringoma and trichoepithelioma has included punch and shave biopsy, excision, electrodessication, as well as continuous wave and superpulsed carbon dioxide laser ablation. More recently, high-energy pulsed CO2 lasers have been reported to be effective with standard available handpieces that deliver collimated beams.

OBJECTIVE

To report our experience using a focusing handpiece (1.0 mm spot at focus) with a high energy pulsed CO2 laser.

METHODS

Four patients with syringoma and two with multiple trichoepithelioma were treated with a high energy pulsed CO2 laser using a 1 mm spot size focusing handpiece. Pulse energies ranged from 125 to 250 mJ. All patients were followed 2 weeks after treatment and then for variable periods ranging from 8 to 18 months (mean=13.3 months).

RESULTS

The 1 mm spot focusing handpiece permitted rapid tumor ablation with optimal matching of lesion size and laser spot diameter. Recurrence of tumor was associated with superficial ablation while complications such as hypopigmentation and atrophy were associated with deeper ablation.

CONCLUSION

Facial adnexal tumors such as syringoma and trichoepithelioma can be successfully treated with the 1.0 mm handpiece in tandem with high energy pulsed CO2 lasers.

Subcutaneous T-cell lymphoma: a case report and additional observations

Subcutaneous T-cell lymphoma is rare. Differentiation from several clinically similar entities such as malignant histiocytosis, histiocytic cytophagic paniculitis, Weber-Christian disease, and systemic lymphoma can be difficult. Our patient presented with plaquelike lesions on her lower extremities, fevers, hepatic dysfunction, and a laboratory-proven coagulopathy. Examination of a skin biopsy specimen revealed a benign-appearing histiolymphocytic infiltrate with panniculitis and erythrophagocytosis. Immuno-histochemical staining of the infiltrate demonstrated a predominance of T cells. At autopsy, an atypical T-cell infiltrate was noted in the skin, subcutis, and other organs. Subcutaneous T-cell lymphoma is a rare type of peripheral T-cell lymphoma whose diagnosis is problematic. Based on the initial difficulty finding the lymphomatous infiltrate in our case, it is conceivable that previously reported cases of histiocytic cytophagic panniculitis, malignant histiocytosis, and Weber-Christian disease were in fact unrecognized cases of lymphoma.