Farid Stephan

Fractional laser for vitiligo treated by 10,600 nm ablative fractional carbon dioxide laser followed by sun exposure.

Vitiligo is an acquired disorder of the skin and mucous membranes. Many patients with vitiligo remain in the refractory state despite the availability of numerous potential treatments. To the best of our knowledge, only one trial considers ablative fractional CO2 laser in the treatment of vitiligo.

Bullous Pemphigoid Associated With Linagliptin Treatment

and dysgeusia than the continuous regimen. Similarly, the muscle cramps and dysgeusia in the present patients resolved within 1 month after interrupting the vismodegib regimen. Although pharmacokinetic studies have shown suboptimal efficacy and similar incidence and severity of adverse effects when vismodegib, 150 mg, was used once weekly or 3 times weekly, no studies to our knowledge have investigated the efficacy of continuous daily doses with drug breaks in between.3 We found a mean of 1.4 new surgically eligible BCCs per year per patient undergoing intermittent therapy, which is comparable to the 2.0 new surgically eligible BCCs per year per patient found by Tang et al1 in patients undergoing a standard continuous daily regimen. Vismodegib resistance occurs in patients who undergo continuous vismodegib dosing.4 The frequency of resistance in patients who undergo an intermittent form of treatment is largely unknown. Combination therapy with hedgehog pathway inhibitors downstream of smoothened, such as itraconazole and arsenic trioxide, provide opportunities to increase efficacy and possibly reduce the incidence of resistance.5,6

Clinical resistance to three types of botulinum toxin type A in aesthetic medicine

Botulinum toxin injections have become the most frequent noninvasive cosmetic procedure carried out worldwide. Botulinum toxin has also multiple other indications in different medical fields. However, with the repetition of injections, a new concern has emerged: clinical resistance and loss of effectiveness of the treatment. After reporting a case of primary nonresponsiveness to three types of botulinum toxin type A injections, we conducted a review about all factors leading to the primary or secondary nonresponsiveness, as well as the factors affecting the immunogenicity of this neurotoxin. Most of the reports and studies focused on secondary resistance to botulinum toxin (BT) and the neurotoxin immunogenicity; primary nonresponsiveness was rarely reported. Factors leading to primary or secondary resistance to BT injections were numerous. In the majority of the studies, development of neutralizing antibodies to botulinum toxin was considered responsible of the induced clinical resistance. Patients should be aware of this rising concern as well as clinicians who should learn how to minimize the risk of resistance development, sparing the patients more invasive treatment modalities. Further studies related to botulinum toxin resistance are needed.

Fractional CO2 laser treatment for a skin graft.

Skin grafts are widely used in reconstructive and plastic surgery, leaving an inevitable scar appearance on the body, affecting the quality of life of the patients. Fractional ablative lasers have become a leading procedure for the treatment of acne and burn scars. We report a case of a skin graft showing excellent improvement in overall appearance after three sessions of fractional CO2 laser. The undamaged tissue left between the microthermal treatment zones is responsible of collagen formation and reepithelialization. Remodeling and collagen formation are observed even 6 months after a fractional CO2 laser session.

Lamotrigine-induced hypersensitivity syndrome with histologic features of cd30+ lymphoma

Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome or drug-induced hypersensitivity syndrome (DIHS) is a severe adverse drug reaction. It can present with clinical, paraclinical, and histological findings mimicking skin and/or systemic lymphomas. We report the first case of a lamotrigine-induced DRESS with histologic features of a cutaneous CD30+ lymphoma. The patient responded well to a tapering course of oral steroids. This case highlights the atypical presentation of a lamotrigine-induced DRESS/DIHS in the presence of a cutaneous and a lymph node CD30 + lymphocytic infiltrate mimicking systemic lymphoma. Pathologists and clinicians must be aware of this “lymphomatous” presentation of drug reactions.

Hyalinosis cutis et mucosae manifests in different features in two sisters

Hyalinosis cutis et mucosae (lipoid proteinosis or Urbach– Wiethe disease) is a rare disease of autosomal recessive inheritance, which affects mainly the skin and mucous membranes of the pharyngolaryngeal tract. Some familial cases have been described in the literature. We report observations of two sisters suffering from the disease with different symptoms and highlight the potential for variance in the penetrance and expression of the disease within the same family.

Syndrome of inappropriate secretion of antidiuretic hormone in a patient with drug-induced hypersensitivity syndrome.

production in our case led to a pituitary hyperplasia-adenoma sequence whereby autonomous ACTH production might have accounted for ongoing hypercortisolism despite resection of the teratomas. In any case, our discovery that teratomas are capable of producing CRH suggests it may be causative in other cases. Our finding is particularly significant given the shared demographic of ovarian teratomas and endogenous hypercortisolism which predominate in young women. Whilst ectopic CRH syndrome due to ovarian teratomas has never been reported, such cases may have been overlooked. In the few reported cases of ectopic ACTH syndrome secondary to ovarian teratomas, CRH staining was not performed thus it is unknown if CRH production was contributory. Indeed, concurrent ectopic ACTH and CRH production by other tumours is an established cause of hypercortisolism. In addition to tumour immunohistochemistry, preoperative plasma CRH may be useful as this should be suppressed in primary ACTH-mediated hypercortisolism. Even in the absence of Cushing’s syndrome, CRH production by the dermoid component of ovarian teratomas may have reproductive consequences as normal ovaries express CRH and CRH-receptors which mediate proand anti-ovulatory paracrine effects. The anti-ovulatory effect is mediated by dose-dependent CRH-induced inhibition of oestrogen and progesterone production in human granulosa cell lines. Heightened local expression of CRH by ovarian teratomas may thus contribute to inhibition of steroidogenesis thereby reducing fertility. Local CRH excess might also participate in teratoma persistence and progression as in vivo studies have demonstrated accelerated tumorigenesis and increased blood vessel density in CRH-secreting human epithelial cell lines compared to clones that do not secrete CRH. Another study demonstrated CRH production to be directly proportional to the aggressiveness of skin tumours with the greatest CRH expression found in malignant melanoma cell lines and the lowest in basal cell carcinoma lines. As primary malignant melanoma has arisen within ovarian teratomas, investigation is warranted into the oncogenic properties of CRH in ovarian teratomas analogous to the preexisting skin models. Advances in our understanding of the skin biology within teratomas, as highlighted by this case, will further elucidate the role of skin as an endocrine organ. We thank Dr Peter Earls, Anatomical Pathologist at St Vincent’s Hospital, Sydney for guidance in analysis of histological material.

Efficacy and Safety of 10,600-nm Carbon Dioxide Fractional Laser on Facial Skin with Previous Volume Injections.

Background: Fractionated carbon dioxide (CO2) lasers are a new treatment modality for skin resurfacing. The cosmetic rejuvenation market abounds with various injectable devices (poly-L-lactic acid, polymethyl-methacrylate, collagens, hyaluronic acids, silicone). The objective of this study is to examine the efficacy and safety of 10,600-nm CO2 fractional laser on facial skin with previous volume injections. Materials and Methods: This is a retrospective study including 14 patients treated with fractional CO2 laser and who have had previous facial volume restoration. The indication for the laser therapy, the age of the patients, previous facial volume restoration, and side effects were all recorded from their medical files. Objective assessments were made through clinical physician global assessment records and improvement scores records. Patients’ satisfaction rates were also recorded. Results: Review of medical records of the 14 patients show that five patients had polylactic acid injection prior to the laser session. Eight patients had hyaluronic acid injection prior to the laser session. Two patients had fat injection, two had silicone injection and one patient had facial thread lift. Side effects included pain during the laser treatment, post-treatment scaling, post-treatment erythema, hyperpigmentation which spontaneously resolved within a month. Concerning the previous facial volume restoration, no granulomatous reactions were noted, no facial shape deformation and no asymmetry were encountered whatever the facial volume product was. Conclusion: CO2 fractional laser treatments do not seem to affect facial skin which had previous facial volume restoration with polylactic acid for more than 6 years, hyaluronic acid for more than 0.5 year, silicone for more than 6 years, or fat for more than 1.4 year. Prospective larger studies focusing on many other variables (skin phototype, injected device type) are required to achieve better conclusions.