Fractional 1064 nm picosecond laser and skin photoaging: in vivo evaluation of treatment effects with reflectance confocal microscopy

Few studies showed the role of picosecond laser (PLS) in the treatment of skin photoaging signs. However, no studies have explored the microscopic effects of PSL in photoaging. The aim of this study is to preliminarily identify clinical variations induced by a 1,064 nm Nd:YAG PSL on the décolleté area, then to apply the treatment protocol to treat facial photoaging and estimate the clinical and microscopic outcomes. A total of 10 consecutive patients with cutaneous photoaging were enrolled. Patients were treated 3 times at monthly intervals with the fractionated 1,064 nm Nd:YAG PSL. In a preliminary phase, PSL treatment was performed on the décolleté to establish its efficacy and safety. Then, the same treatment protocol was applied to all the face and clinical and reflectance confocal microscopy (RCM) were analyzed, comparing baseline (T0) pictures and 4 months after the treatment (T1) ones. On the face, a reduction of dyschromia and wrinkles was observed at T1. Furthermore, the underlying RCM variations were revealed at different skin levels. Our results show the clinical and microscopic effectiveness and safety of the 1,064-nm Nd:YAG PSL in the treatment of skin photoaging signs.

Double phase treatment with flashlamp-pumped pulsed-dye laser and long pulsed Nd:YAG laser for resistant port wine stains in adults. Preliminary reports

BACKGROUND

Flashlamp-pumped pulsed (FLPP) dye laser still represents the standard treatment for the majority of port wine stains (PWSs), but the results on thick PWSs remain unpredictable, and many of these lesions fail to completely respond. Our aim was to report on the results obtained on unresponsive PWSs to standard laser treatments, by using a double phase laser treatment strategy using two laser passes in the same session.

METHODS

Eleven adult patients with facial PWS resistant to dye laser were enrolled. Laser sessions were scheduled every 8 weeks, and each of them consisting of two laser passes. In phase one, two different laser wavelengths (595 nm and 1064 nm) were delivered consecutively to each affected area. In the second phase, the PWS was treated using a pulse stacking technique with the 1064 nm Nd:YAG.

RESULTS

One patient was lost to follow-up. Among the remaining ten, 5 (50%) patients showed an excellent improvement (>75%), 3 (30%) patients showed a good improvement (51-75%), and 2 (20%) patients had no or minimal improvement (0-25%).

CONCLUSIONS

Our results suggest that the combination of different wavelengths in the same session can be helpful for PWSs resistant to standard laser treatments. However, in most patients two treatment phases were necessary.

Morphological features of naevoid melanoma: results of a multicentre study of the International Dermoscopy Society

BACKGROUND

Naevoid melanoma (NeM), a rare variant of melanoma, can be difficult to detect as its clinical and histopathological morphology can simulate a naevus.

OBJECTIVES

To describe the clinical and dermoscopic features associated with NeM.

METHODS

Lesions with a histopathological diagnosis of NeM were collected via an e-mail request sent to all members of the International Dermoscopy Society. All lesions were histopathologically reviewed and only lesions fulfilling a set of predefined histopathological criteria were included in the study and analysed for their clinical and dermoscopic features.

RESULTS

Twenty-seven of 58 cases (47%) fulfilled the predefined histopathological criteria for NeM and were included in the study. Clinically, 16 of the 27 NeMs presented as a nodular lesion (59%), eight (30%) as plaque type and three (11%) as papular. Analysis of the global dermoscopic pattern identified three types of NeM. The first were naevus-like tumours (n = 13, 48%), typified by a papillomatous surface resembling a dermal naevus. In these lesions local dermoscopic features included irregular dots/globules (46%), multiple milia-like cysts (38%) and atypical vascular structures (46%). The second type were amelanotic tumours (n = 8, 30%), typified by an atypical vascular pattern (75%). The third type consisted of tumours displaying a multicomponent pattern (n = 4, 15%), characterized by classical local melanoma-specific criteria. Two lesions (7%) were classified as mixed-pattern tumours as they did not manifest any of the aforementioned patterns.

CONCLUSIONS

While NeMs may be clinically difficult to differentiate from naevi, any papillomatous lesion displaying dermoscopically atypical vessels and/or irregular dots/globules should prompt consideration for the possible diagnosis of NeM.

The multilayer technique: A new and fast approach for flashlamp-pumped pulsed (FLPP) dye laser treatment of port-wine stains (preliminary reports)

BACKGROUND

The 585 nm flashlamp-pumped pulsed (FLPP) dye laser is an effective and established treatment for port-wine stains (PWSs) during childhood. Unfortunately, PWSs tend to darken in color and may thicken or develop nodules as the lesions age, thereby making treatment difficult in adult patients since they may require several laser sessions producing unpredictable results. The aim of this article is to present and discuss the results obtained in four adult patients with PWS by use of a new approach in FLPP dye laser treatment.

OBJECTIVE

The goal of this technique was to damage, during the same treatment, the lesions at both deep and superficial levels and to reduce the number of laser sessions required to obtain the most effective eradication of hypertrophied PWSs.

METHODS

Four patients (two men and two women aged 54, 57, 49, and 61, respectively) were referred for treatment of congenital hypertrophied PWS of the face. Every dye laser session consisted of two laser passes. During the first pass the wavelength ranged from 590 to 600 nm with a long pulse (1.500 microseconds), while the second pass was performed utilizing the classic short pulse (450 microseconds) and wavelength (585 nm). Successive treatments were performed at 6- to 8-week intervals.

RESULTS

All four patients had a complete clearing of their PWS after a number of treatments, ranging from three to five sessions. Three of them (one man and the two women) experienced extremely mild blistering in a limited small area that healed in approximately 10 days without scarring. The laser sessions were well tolerated by all patients. None of the patients developed atrophic or hypertrophied scars or dyschromia.

CONCLUSIONS

Our results show an excellent response in all patients with just a few treatments (three to five sessions) and, in spite of two passes, only mild side effects that are probably limited due to cooling of the skin. We also observed a flattening and reduction of the nodules.

Long-term epilation with long-pulsed neodimium:YAG laser

BACKGROUND

Unwanted body hair can represent a severe cosmetic disturbance. The traditional methods used to epilate often have limitations, side effects, and unsatisfactory results. In recent years, various light sources (lasers and others) have been developed for long-term epilation of unwanted hair.

OBJECTIVE

This study evaluates, on a large number of patients, the efficiency and safety of a long-pulsed low-potency Nd-Yag laser invented specifically for long-term hair removal.

METHODS

Some 208 subjects needing epilation were divided into three groups and treated during an 11-month period. Group A included 79 patients with a normal distribution of unwanted hair; Group B 67 patients with constitutional hypertrichosis; and Group C 62 patients with hirsutism. Treatment sessions were performed with a fluence of 23-56 J/cm2 at 1-month intervals until obtaining desirable results. Follow-ups ranged from 1 to 6 months. In 3 patients 4-mm diameter punch biopsy specimens were obtained before the first session and again after 6 hours. A third biopsy was performed after 3 months.

RESULTS

Every session resulted in a 20-40% hair loss, depending on the color of hair. Complete epilation was obtained in 4 to 6 sessions. Only white hair was not receptive to laser light, and its growth was not modified. No patients, including dark-complexioned patients, had blistering, hypo-or hyperpigmentation. No pain was present during treatment except for the axillary area. In the specimen obtained after 6 hours, very extensive necrosis of the hair follicular and sebaceous gland epithelium was evident. Histologic findings of the biopsies taken after three months showed complete disappearance of hair and moderate fibrosis.

CONCLUSION

This study proves that the long-pulsed Nd:Yag laser treatment produces an excellent prolonged epilation with no relevant side effects. This laser light, having a 1064 nm wavelength, is minimally absorbed in superficial skin layers, and pronounced scattering up to 5 mm occurs targeting the deeper follicles.

Eruption resembling erythema gyratum repens in linear IgA dermatosis

We report a case of linear IgA dermatosis associated with eruptions resembling erythema gyratum repens in a 62-year-old man. The patient revealed no clinical and laboratory evidence of an underlying malignancy. The presence of eruptions similar to erythema gyratum repens during the course of bullous dermatoses has been described in only eight reports.

Porokeratosis and immunosuppression

Immunosuppression may favour the development of disseminated superficial porokeratosis (DSP). We report the clinical features and the outcome of DSP in 24 patients receiving immunosuppressive treatment (group A), and compare the characteristics of the disease with those of 13 immunocompetent patients with DSP (group B). The two groups were similar with regard to age, sex, area of skin involvement and mean follow-up. There was a family history of DSP in only two patients in group A, compared with five patients in group B (P = 0.03). The skin type, based on the tanning response to sunlight, was not significantly different between the two groups. Two of the 24 patients in group A had high sun exposure, compared with five of the 13 patients in group B (P = 0.03). Moreover, 10 patients in group A and 11 in group B (P = 0.01) exhibited worsening of the disease after exposure to sunlight, usually during the summertime. These observations appear to support the hypothesis that sun exposure is not always essential for the development of porokeratosis in immunosuppressed patients. None of our patients developed skin cancer in porokeratotic lesions during the follow-up period.

Utility of topical benzoyl peroxide for prevention of surgical skin wound infection

BACKGROUND

Benzoyl peroxide is a powerful oxiding agent with broad spectrum germicidal activity and good liposolubility. Therefore, it may represent a good agent for prevention of wound infection in areas with high density of sebaceous glands.

OBJECTIVE

The aim of this study was to analyze the effectiveness of topical benzoyl peroxidase gel for prevention of surgical skin wound infections in the centrofacial area.

METHODS

A prospective study was performed on 673 patients. The patients were divided into two groups. Group A, 335 patients, was given no antibacterial prophylaxis. In group B, 338 patients, prophylactic medication with a gel containing 10% benzoyl peroxide was performed once a day for the 7 days before the surgery.

RESULTS

Thirteen of 673 patients had wound infections (1.93%). Eleven of these 13 patients were in group A (3.24%) and two were in group B (0.59%) (P < .01).

CONCLUSIONS

Topical benzoyl peroxide is an efficacious, harmless, and inexpensive agent for prevention of wound infections in seborrheic regions.

Necrolytic migratory erythema without glucagonoma in a heroin-dependent patient

We described a case of necrolytic migratory erythema without glucagonoma in a 33-year-old man. The patient had been heroin-dependent, HIV negative since the age of 23. He had no medical history of note and all the investigations revealed normal parameters. This is the first case of necrolytic migratory erythema without glucagonoma associated with heroin abuse.

Clinical features and course of Kaposi's sarcoma in kidney transplant patients: report of 13 cases

We retrospectively evaluated the prevalence of Kaposi's sarcoma (KS) in 820 kidney transplant recipients with a follow-up period of at least 6 months. Thirteen patients developed a KS (1.6%): 2 were under conventional therapy and 11 under ciclosporin A. The onset of KS was 38.7 +/- 38.3 (range 6-124) months after transplantation in the whole population and after 33.9 +/- 19.7 months in the patients treated with ciclosporin A only. Nine were men and 4 women (male/female ratio: 2.25:1). The mean age at KS occurrence was 36.8 +/- 11.1 years. The mean follow-up period since KS diagnosis was 35.9 +/- 19.5 months. Clinical manifestation and severity of KS were heterogeneous: 5 patients had a KS with cutaneous involvement only, 8 patients a KS with multiple skin and mucosal and/or visceral lesions. Only 2 patients from the second group died of peritonitis due to intestinal lesions. In these 2 patients, immunosuppressive therapy had either been increased or reintroduced after a partial regression of KS. In all other patients, therapy was promptly reduced or withdrawn. In 1 patient local radiation therapy plus intralesional bleomycin administration were started and 1 patient received intralesional vincristine. Nine patients had a complete and 2 a partial remission of lesions. After therapy reduction, 4 patients lost their kidney (these patients however, had an already ongoing chronic rejection at KS diagnosis), in 2 there was an improvement of graft function, and in the other patients it remained stable. Our experience confirms that in most cases reduction or withdrawal of immunosuppression halts the evolution of both cutaneous and visceral lesions, without compromising graft function.(ABSTRACT TRUNCATED AT 250 WORDS)

Antibiotic prophylaxis of wound infections in skin surgery

A controlled prospective study of 2165 outpatients undergoing skin surgery was performed to evaluate the utility and the effects of several antibiotic schedules for prophylaxis of wound infections. The patients were divided into four groups. Twenty-three of the 541 group A patients, given no antibiotics, had wound infections. Eight of the 542 group B patients, given systemic antibiotics from immediately after surgery until the third day, had wound infections. Four of the 540 group C patients, treated only with local sterile antibiotic powder sprinkled into the wound during surgery, had wound infections develop, and only one infection occurred in the 542 group D patients given systemic antibiotics from 2 days before surgery until the second day after surgery. This last schedule was the best for prophylaxis of wound infections in contamination-prone regions. Local antibiotic administration is a simple method for prevention of infections in routine skin surgery.

Effect of UVB plus tar therapy on serum levels of interleukin-2 receptors in patients with psoriasis

Baseline serum levels of interleukin-2 receptor (IL2R) were measured in 65 patients with active psoriasis. IL2R levels in psoriatic patients were significantly higher than in healthy controls (582.4 +/- 289.23 u/ml vs. 369.64 +/- 111.10 u/ml; P less than 0.05), but did not differ statistically from values found in an atopic dermatitis control group (619.88 +/- 254.27 u/ml). Sex, age and severity of the disease do not affect levels of IL2R. The same IL2R levels were measured in 26 psoriatic patients receiving UVB plus tar therapy. This therapy, continued until clinical remission, lowered IL2R levels to values comparable to controls. This decrease may be due to an immunosuppressive effect of therapy.

Skin ultrasound in dermatologic surgical planning

High-resolution ultrasonography was performed on 55 patients with palpable skin lesions, all submitted to surgical excision and to histologic diagnosis. In all the cases, the ultrasound picture was confirmed by the surgical appearance of the lesions. The sonographic structure was characteristic in the case of cysts and angiomas, lymphangiomas in particular. Ultrasonography is considered a simple and reliable technique for the pre-operative evaluation of skin nodules, as it gives a clear picture of their size, depth, and outline. However, sonography cannot substitute for the clinical dermatologic approach and the need for an histologic diagnosis.

[Chronic urticaria and allergy to Acari. Experience with a specific desensitization therapy]

Eighty-five patients affected by chronic urticaria (45 females and 40 males) were submitted to intradermal tests with house and storage mites in order to evaluate a possible sensitization to these allergens. The same allergological tests were performed in an 80-subject control group. The results showed immediate cutaneous reactivity to one or more mites in 40 patients (47%) while only 6 positivities (7.5%) were found in the control group. 27 patients, out of the 40 allergic to mites, were submitted to specific desensitizing therapy. 6 of them showed a complete recovery, 20 good results and only 1 slight improvement of clinical manifestations. These data allow us to hypothesize that the allergy to mite allergens is an important etiopathogenic factor in several chronic so called "idiopathic" urticarias.

Ultrasonography of proliferative vascular lesions of the skin

High-resolution ultrasonography with small part probes was performed on 20 proliferative vascular lesions of the skin (3 lymphangiomas, 9 hemangiomas, 8 Kaposi sarcomas). All the lesions were submitted to histological examination. The histological cuts were made in the same planes as the ultrasound scans in order to obtain a direct comparison. The sonographic pattern of each histotype is characteristic and correlated with the corresponding histological picture. Lymphangiomas appear as large anechoic communicating cavities; hemangiomas have small hypoechoic areas separated by thin hyperechoic septa. Kaposi sarcomas possess a mixed sonographic structure with ill-defined margins. Ultrasound is proposed as a simple and harmless diagnostic aid to clinical examination of proliferative vascular lesions of the skin.

Incidence of polycystic ovaries in patients with late-onset or persistent acne: hormonal reports

Forty-six women affected by late-onset or persistent acne were studied in order to investigate the frequency of hormonal abnormalities and polycystic ovaries. Hirsutism, perioral distribution of acne lesions and irregular menses were recorded. Hormonal measurements and ovarian echographies were performed. Twenty-four patients were affected with polycystic ovaries, detected by ultrasound scanning. Among the acne patients, the women with ovarian abnormalities had higher values of androstenedione, dehydroepiandrosterone, dehydroepiandrosterone sulfate and luteinizing hormone (LH), and a higher LHT/follicle-stimulating hormone ratio than those with acne and without ovarian abnormalities. This study indicates the prevalence of polycystic ovaries in women with late-onset or persistent acne. Moreover, hormonal abnormalities indicate a subgroup of acne patients defined by the presence of ovarian disorders.

[Leg ulcers in chronic venous insufficiency]

The incidence of the various types of ulcer is assessed in 180 subjects suffering from chronic ulcer of the legs and various syndrome. It emerges that about 10% of ulcers are not due to chronic venous insufficiency but to other pathologies.

[Skin diseases and primarily dermatologic cutaneous manifestations of venous disorders. Clinical elements and differential diagnosis]

The paper describes the most common dermatoses having a venous pathogenesis, with particular reference, because of their incidence, to the cutaneous manifestations of varicose syndrome. The pathophysiological basis, clinical picture and diagnostic investigations of dermatoses in venous diseases are discussed and compared with other cutaneous manifestations of non-venous diseases with which they are easily confused. The great importance of a specialised multidisciplinary approach for the correct management of a patient with these dermatological problems is emphasised.

[Seborrheic keratoses studied using scanning electron microscopy]

Ten seborrheic keratosis of acanthotic type have been observed by S.E.M. The morphological study could confirm the existence of two processes in the origin of the horny cysts which are peculiar to this affection. a) an extrafollicular process causes the involvement of groups of keratinocytes which, by assuming a vortex disposition, produce a concentric keratinization; b) a follicular process which causes an accentuated keratinization of the cells surrounding the epithelial sheath. This process was associated to the presence of multiple hairs a single follicle. Moreover, with higher magnification, it was possible to observe a great number of bacteria, yeasts and of particular alteration of the membrane which could be compared to changes in the tone filaments.

Kaposi's sarcoma in kidney transplant recipients treated with cyclosporin

We report the clinical and histological features and the course of Kaposi's sarcoma in three transplant patients treated with cyclosporin. Four months after cyclosporin treatment was stopped the lesions in all three patients had completely healed.

Self-healing pseudoangiosarcoma. Unusual vascular proliferation resembling a vascular malignancy of the skin

Pseudomalignant vascular lesions are increasingly recognized by dermatologists and may be present in several disorders affecting vessels. We describe a 58-year-old obese woman who developed vascular papulonodular lesions in the left inguinocrural area, clinically and histologically resembling a malignant vascular proliferation, that spontaneously regressed within a few months, after bed rest and weight reduction. Therefore, our patient's vascular lesions appear to have been pseudomalignancies. There are no other similar conditions reported in the literature. This kind of disorder demonstrates that vascular tissue can be involved in very bizarre cell and tissue reactions to several stimuli and can mimic malignant neoplasms. We stress the importance of constant surveillance of this kind of lesion to collect adequate clinical data, because histologic findings alone may cause misdiagnosis and lead to treatment hazardous to the patient.

Porokeratosis: immunosuppression and exposure to sunlight

Four cases of disseminated superficial actinic porokeratosis are described, all in patients who had been given immunosuppressive treatment, which might have been a contributing factor in the development of the condition. The possible relationship of immunosuppressive actinic porokeratosis to viral infection is also discussed.

Cutaneous lesions in 67 cyclosporin-treated renal transplant recipients

Sixty-seven out of 100 kidney transplant recipients treated with cyclosporin and methylprednisolone were evaluated for the presence of dermatological manifestations. Only 2 patients had no dermatological lesions; 80% had iatrogenic lesions, 38% infectious, 13% miscellaneous, 3% cancerous lesions, while 28% had cutaneous manifestations related to previous uremic state. Most of the lesions concerned the pilosebaceous unit: hypertrichosis (60%), epidermal cysts (28%), pilar keratosis (21%), acne (15%), folliculitis (12%) and sebaceous hyperplasia (10%). Among infectious manifestations, viral lesions were the most frequent and were very severe in the first month after transplantation. Two patients developed a squamous-cell epithelioma and a probable cutaneous lymphoma, respectively.