Ellen Haas

Successful Treatment of Severe Keratosis Pilaris Rubra with a 595-nm Pulsed Dye Laser

Keratosis pilaris rubra and ulerythema ophryogenes (keratosis pilaris atrophicans faciei) are keratinization disorders that have a genetic basis and are characterized by follicular hyperkeratosis on erythematous skin. Given that topical treatments using urea-based keratolytics or retinoids often fail to improve the symptoms satisfactorily, there is a need for new and effective therapeutic options. We present a patient suffering from keratosis pilaris rubra and ulerythema ophryogenes, who benefited from therapy with the 595-nm pulsed dye laser (PDL).

Successful Use of Vacuum-Assisted Closure Therapy for Leg Ulcers Caused by Occluding Vasculopathy and Inflammatory Vascular Diseases – A Case Series

Background: Leg ulcers caused by vasculitis, small vessel occlusion or other rare conditions often prove to be very difficult to treat. Despite polypragmatic, systemic and localized therapy, many of these wounds are progressive and characterized by severe pain. Methods and Results: We here portray the cases of 5 patients with ulcers resistant to systemic therapy for the underlying disease, who were treated successfully using vacuum-assisted closure (VAC) for wound management. We present the advantages and disadvantages of this method, as well as illustrating the essential and known therapeutic principles. Conclusions: Our experience shows VAC to be an excellent and effective alternative in the treatment of therapy-resistant chronic wounds caused by vasculopathy (small vessel occlusion or vasculitis). We did not observe any pathergy or proinflammatory effects caused by VAC.

Integrating static and dynamic features of melanoma: The DynaMel algorithm

BACKGROUND Sequential digital dermatoscopy identifies dynamic changes in melanocytic lesions. However, no algorithm exists that systematically weights dynamic changes regarding their association with melanoma. OBJECTIVE We sought to identify relevant dynamic changes and to integrate these into a novel diagnostic algorithm. METHODS During follow-up (mean 44.28 months) of 688 patients at high risk, 675 pigmented lesions with prospectively documented dynamic changes were excised. The association between specific changes and melanoma was assessed. RESULTS We detected 61 melanomas (38 invasive, median thickness 0.42 mm) with dynamic changes. Multivariate logistic regression analyses revealed a significant association between the diagnosis of melanoma and 5 dynamic criteria. According to the observed odds ratios we defined two dynamic major criteria (2 points each: asymmetric-multifocal enlargement and architectural change) and 3 dynamic minor criteria (1 point each: focal increase in pigmentation, focal decrease in pigmentation, and overall decrease in pigmentation when not accompanied by a lighter pigmentation of the adjacent skin). The DynaMel score was generated by addition of dynamic and 7-point checklist scores with a threshold for excision of 3 or more points. Including information about dynamic changes increased the sensitivity of the 7-point checklist from 47.5% (29 of 61 melanomas detected) to 77.1% (47 of 61 melanomas detected). The specificity slightly decreased from 99.0% to 98.1%. LIMITATIONS Before broad application the DynaMel algorithm needs to be validated using data from a different prospective study. CONCLUSIONS The DynaMel algorithm integrates a scoring system for dynamic dermatoscopic changes into the 7-point checklist for dermatoscopy and thereby increased the sensitivity of melanoma detection.

Successful treatment of a large hemangioma with propranolol

Hemangiomas are the most common vascular tumors in children. They occur in 8–12% of all infants and in 22% of premature infants (female: male = 3: 1). Hemangiomas are usually sporadic; their etiology is unknown [ 1 ].

Successful Nd:YAG Laser Therapy for Hair Removal in the Oral Cavity after Plastic Reconstruction Using Hairy Donor Sites

Background: Concepts of reconstruction of intraoral structures may often include the transfer of flaps composed of external skin with hairs. Given that intraoral hair growth following myocutaneous flaps can cause discomfort, there is a need for effective treatments to relieve cancer patients of these symptoms. Objective: To describe the successful epilation of hairy intraoral flaps using Nd:YAG laser emitting a wavelength of 1,064 nm. Methods: We performed an interdisciplinary prospective clinical study with 9 patients suffering from intraoral hair growth after plastic reconstruction of a hairy donor site due to cancer. Eight male and one female patients were treated with 1-4 sessions of Nd:YAG laser at 5-15-week intervals. Results: Laser treatment resulted in effective hair reduction in 8/9 patients regardless of flap type. In 5/9 patients a hair clearance of >90% could be achieved, whereas laser treatment was ineffective in one male with white hair. Patients were very satisfied with the outcome and no side effects could be observed. Conclusion: Nd:YAG laser therapy appears to be a successful therapeutic option for patients suffering from growth of dark hair in the oral cavity after plastic reconstruction using a hairy donor site.

Pigmented Basal Cell Carcinomas 15 Years After Orbital Radiation Therapy for Graves Ophthalmopathy

Report of a Case. A 54-year-old man of Turkish descent and skin type III observed 2 progressing lesions at his right and left temporal scalp. Fifteen years earlier he had received cobalt-60 retrobulbar radiation therapy for Graves ophthalmopathy (GO) symptoms, including diplopia, eyelid retraction, and altered ocular motility. The clinical examination revealed 2 symmetrically distributed lesions of asymmetrical shape and gray-brown color (Figure 1A-D). The lesion at the right temple had a palpable patchlike appearance with a few scales, while the lesion at the left temple showed a central ulceration and branched pigmented streaks. Dermoscopy revealed diagnostic features of pigmented basal cell carcinoma (BCC) (Figure 1E and F). After complete excision, the diagnosis of 2 pigmented nodular BCCs was confirmed by histopathologic analysis (Figure 2).

Leg ulcer progression caused by topical anesthesia with EMLA® cream

While treating a 63‐year‐old woman with leg ulcerations, we observed an unusual phenomenon. A wound débridement was planned to remove adherent necrotic material.After topical anesthesia with a lidocaine‐prilocaine mixture (EMLA® cream) a hemorrhagic,livid margin area developed around the ulcer 90 minutes after application.The area turned necrotic over days and the center was débrid‐ed.