Adrienne S. Glaich

Treatment of melasma using fractional photothermolysis: a report of eight cases with long-term follow-up.

BACKGROUND Melasma on the face is difficult to treat and is often refractory to multiple treatment modalities. OBJECTIVES To investigate the safety and efficacy of fractional photothermolysis (FP) for the treatment of melasma and to determine recurrence rates with this treatment method. MATERIALS AND METHODS Eight female patients (Fitzpatrick skin type II–IV) with clinically diagnosed melasma on the face were treated using FP (1,550 nm Fraxel SR laser). Two to seven treatments were performed at 3‐ to 8‐week intervals. Treatment levels ranged from 3 to 10, corresponding to 9% to 29% surface area coverage (8–10 passes per treatment). Energies used ranged from 6 to 40 mJ. Physician and patient assessments were recorded at each visit and at a follow‐up visit 7 to 36 months (mean 13.5 months) after the last treatment session. RESULTS At the last treatment, assessments revealed greater than 50% clinical improvement in melasma in five of eight patients. Follow‐up assessments by the evaluating physician revealed sustained efficacy in five patients. Recurrence was reported in three patients. No significant adverse effects were noted. CONCLUSIONS FP is a safe and effective treatment for refractory melasma, with long‐term remission. The authors have indicated no significant interest with commercial supporters.

Fractional photothermolysis for the treatment of telangiectatic matting: A case report

Background: Recent reports have demonstrated clinical and histologic evidence of the potential benefit of fractional photothermolysis (1550 nm Fraxel SR™ laser) for the treatment of dermal vascular lesions. This report evaluated the potential efficacy of fractional photothermolysis for the treatment of matted telangiectasias. Methods: A 62‐year‐old female, Fitzpatrick skin type III, with matted telangiectasias on her right medial thigh underwent five successive treatments at monthly intervals with the 1550 nm Fraxel SR laser. Digital photographs were taken prior to each treatment and at 6 months after the last treatment. Clinical assessments were performed by a non‐treating physician. Results: Clinical assessment 6 months after the last treatment with the Fraxel SR laser revealed marked improvement in the clinical appearance of the matted telangiectasias. The patients degree of satisfaction paralleled the physicians assessment of improvement. Side effects were limited to mild pain during treatment and mild, transient post‐treatment erythema and edema. Conclusion: Fractional photothermolysis is a potentially effective modality for the treatment of matted telangiectasias and warrants further studies. No long‐term adverse events were noted and the safety profile appears to be fairly broad.

595-nm long pulsed dye laser and 1450-nm diode laser in combination with intralesional triamcinolone/5-fluorouracil for hypertrophic scarring following a phenol peel

Hypertrophic scars and keloids are a therapeutic challenge because of the low response to treatment and recurrences after treatment. A variety of treatment regimens have been used with different degrees of success, with no universally accepted treatment protocol resulting in their complete and permanent resolution. We offer this case to demonstrate a combination approach for the treatment of hypertrophic scarring. A 75-year-old woman (with Fitzpatrick skin type II) presented with a 4-month history of scarring, which had developed following a phenol peel for perioral rhytides. The patient underwent 10 treatment sessions with the 595-nm long-pulsed dye laser followed immediately by the 1450-nm diode laser in combination with intralesional triamcinolone and 5-fluorouracil. After the fifth treatment session, about 90% improvement was noted; at the last treatment session, greater than 95% overall improvement was noted. Two and a half years after the last treatment session, the patient and treating physician noted no regression. A limitation of this therapy is that the combination approach makes it difficult to determine what individual contributions each treatment modality had on the final result. We have illustrated a successful multifaceted treatment regimen for hypertrophic scars and keloids using a combination approach.

Necrotic, ulcerated papules on a newborn male

BIBLIOGRAPHY Feldmeyer L, Mevorah B, Grzeschik KH, Huber M, Hohl D. Clinical variation in X-linked dominant chondrodysplasia punctata (X-linked dominant ichthyosis). Br J Dermatol 2006;154:766-9. Happle R. X-linked dominant chondrodysplasia punctata. Hum Genet 1979;53:65-73. Happle R. Cataracts as a marker of genetic heterogeneity in chondrodysplasia punctata. Clin Genet 1981;19:64-6. Kolb-Maurer A, Grzeschik KH, Haas D, Brocker D, Brocker EB, Hamm H. Conradi-Hunerman-Happle syndrome (X-linked dominant condrodyspasia punctata) confirmed by plasma sterol and mutation analysis. Acta Derm Venereol 2008;88:47-51. Steijlen PM, van Geel M, Vreeburg M, Marcus-Soekarman D, Spaapen LJM, Castelijns FCM, et al. Novel EBP gene mutations in Conrad-Hunermann-Happle syndrome. Br J Dermatol 2007; 157:1225-9. J AM ACAD DERMATOL SEPTEMBER 2009 544 JAAD grand rounds

Double rotation flap to repair two cheek defects in close proximity.

© 2005 by the American Society for Dermatologic Surgery, Inc. • Published by BC Decker Inc ISSN: 1076–0512 • Dermatol Surg 2005;31:1717–1719. A 65-YEAR-OLD man was referred for Mohs micrographic surgery of two basal cell carcinomas on the left cheek. Both the superior and the inferior sites were free of tumor after two stages. The superior basal cell carcinoma resulted in a defect measuring 2.2 1.1 cm. The inferior basal cell carcinoma left a resultant defect of 2.4 1.1 cm (Figure 1). How would you reconstruct this surgical defect?