Henry H. Chan

A control study of the cutaneous side effects of chronic lithium therapy.

BACKGROUNDnTo assess the nature and prevalence of skin disorders among psychiatric patients on chronic lithium therapy and to compare them with patients on other psychotropic medications.nnnMETHODn51 patients on lithium and 57 patients on other psychotropics were recruited. Dermatological assessment included a semi-structured questionnaire and clinical examination of the subjects by two dermatologists who were blind to the psychiatric diagnosis and treatment. Secondary cutaneous reaction was defined as skin eruption that developed or deteriorated after commencement of psychiatric medication.nnnRESULTSnLithium treated patients developed significantly more secondary cutaneous reactions than the control group. This applied particularly to acne and psoriasis. Male patients on lithium were more likely to be affected than female patients.nnnCONCLUSIONnLithium aggravates or triggers cutaneous conditions that are characterized by the pathological findings of neutrophilic infiltration. Since these cutaneous problem can be distressing to patients and may affect medication compliance, there should be heightened attention to skin problems in patients receiving lithium treatment.

In vivo trial comparing patients' tolerance of Q‐switched Alexandrite (QS Alex) and Q‐switched Neodymium:Yttrium‐Aluminum‐Garnet (QS Nd:YAG) lasers in the treatment of nevus of Ota

Different types of Q‐switched lasers have been found to be effective in the treatment of nevus of Ota. However, a clinical trial involving in vivo comparison of the use of different laser systems has not been performed. The aim of the present study was to compare the patient tolerance of Q‐switched Alexandrite (QS Alex) and Q‐switched neodymium:yttrium‐aluminum‐garnet (QS Nd:YAG) lasers in the treatment of nevus of Ota.

Comparison study of a long‐pulse pulsed dye laser and a long‐pulse pulsed alexandrite laser in the treatment of port wine stains

Background: Port wine stains (PWSs) are commonly treated by the pulsed dye laser. Recently, a long‐pulse pulsed alexandrite laser was used to treat bulky vascular malformations. Objective: In the present study, we compare the efficacy and complications of the long‐pulse pulsed dye laser (LPPDL) and the long‐pulse pulsed alexandrite laser (LPPAL) in the treatment of PWSs. Methods: Eleven patients with Fitzpatrick skin types III–IV were enrolled in this study. One section of each patients PWS was treated with LPPDL and another section was treated with LPPAL. The patients PWSs were evaluated for efficacy of elimination of erythema and for treatment‐related side effects. Results: Both LPPDL and LPPAL treatment are effective in the treatment of PWSs. Hyperpigmentation was seen in two areas treated with LPPDL and in three areas treated with LPPAL. Hypopigmentation was seen in one area treated with LPPAL, but not in any of the areas treated with LPPDL. There was no scarring. Conclusion: LPPAL works best with hypertrophic, purple PWSs, while LPPDL yields better clinical improvements with the flat, pink PWSs. Targeting of deoxyhemoglobin, deeper penetration, and higher fluence may explain the effectiveness of LPPAL in purple, hypertrophic PWSs. However, there is a risk of dyspigmentation when using the LPPAL.

Long‐pulsed neodymium:yttrium‐aluminum‐garnet laser treatment for hypertrophic port‐wine stains on the lips

Pulsed dye laser (PDL) treatment of hypertrophic port‐wine stains (PWSs) on the lips has demonstrated poor efficacy and a potential risk of dyspigmentation. PDL‐resistant hypertrophic PWS may require treatment with deeper penetrating lasers such as a 1064‐nm neodymium:yttrium‐aluminum‐garnet (Nd:YAG) laser. The objective of this clinical study was to evaluate the efficacy and safety of a Nd:YAG laser for the treatment of hypertrophic PWSs on the lips. Ten patients (four were male and six were female) with hypertrophic PWSs on the lips were recruited in this study. Eight patients showed good to excellent improvement without complications. In conclusion, the Nd:YAG laser is safe and effective for treating hypertrophic PWSs on the lips.

Comparison study of a Q-switched alexandrite laser delivered with versus without compression in the treatment of dermal pigmented lesions.

Background: The Q‐switched laser is the treatment of choice when attempting to improve dermal pigmented lesions. However, purpura and dyspigmentation are frequently observed after treatment. Objective: To compare the efficacy and complications of the Q‐switched alexandrite laser when delivered with versus without compression in the treatment of dermal pigmented lesions. Methods: Ten patients with dermal lesions were enrolled in the study. Each patient had a lesion treated with the Q‐switched alexandrite laser delivered with compression. Each patient also had a lesion treated with the Q‐switched alexandrite laser delivered without compression with the same fluence and spot size. The patients were evaluated for efficacy and treatment‐related side effects. Results: There was no significant difference in efficacy, but purpura and dyspigmentation were more likely when pigmented lesions were treated without compression. Conclusion: Purpura from Q‐switched laser treatment in darkly pigmented skin is due to mechanical injury of blood vessels. It is well known that pressure ‘diascopy’ eliminates blood from cutaneous vessels by coapting the vessel lumen. In this study, we used pressure applied by a glass window on the Q‐switched laser handpiece to remove cutaneous blood during laser exposure, making it possible to reduce purpura and dyspigmentation.