Jerome M. Garden

Treatment of cutaneous hemangiomas by the flashlamp-pumped pulsed dye laser : prospective analysis

Thirty-three cutaneous capillary and mixed hemangiomas in 24 patients were treated prospectively with the flashlamp-pumped pulsed dye laser. Patients ranged in age from 2 weeks to 7 months; the follow-up period was up to 22 months. Some patients received therapy until the lesion was almost clear or until the lesion failed to respond; others received treatment only until active capillary lesional proliferation abated. In the first group of patients, 18 of 25 lesions that were 3 mm or less in elevation lightened with therapy (93.9% +/- 4.6% in 4.1 +/- 1.6 treatment sessions) and flattened to 0.3 +/- 0.4 mm in thickness. The seven lesions that were 4 mm or more in thickness lightened 85.7% +/- 7.3% in 7.0 +/- 2.0 treatment sessions but showed less diminution in thickness (to 3.4 +/- 3.6 mm; p less than 0.01). The second group of patients, who received therapy until proliferation ceased, required just one to three therapeutic sessions. Three of the four lesions that showed residual atrophy were 4 mm or greater in thickness; the fourth lesion was ulcerated on presentation. None of the lesions had residual induration or scarring. We conclude that the flashlamp-pumped pulsed dye laser may successfully prevent enlargement and promote involution of capillary hemangiomas with minimal adverse effects. Therapy is most appropriate for patients with hemangiomas at sites of potential functional impairment, of maceration or ulceration, and of significant cosmetic disfigurement. Therapy should be initiated as early as possible, when lesions are relatively flat, for optimal results.

Tunable Pulsed Dye Laser for the Treatment of Benign Cutaneous Vascular Ectasia

A tunable pulsed dye laser emitting at 577 nm and 360 microseconds pulse width was used to treat benign cutaneous vascular ectasias other than port wine stain in 77 patients. Except for leg telangiectasias (34 patients), the overall response was excellent. Forty-two of forty-five patients with hemangiomas, spider nevi, angioma serpiginosum, venous lakes or facial telangiectasias showed excellent results after 1-4 consecutive treatments. Scarring was observed in none of the patients. These results confirm previous data on the use of the tunable dye laser in the treatment of port wine stain, and suggest that 577 nm wavelength and 360 microseconds pulse width allow the selective photothermolysis of vascular cutaneous ectasias with better clinical results than previously reported.

Treatment of resistant severe psoriasis with systemic cyclosporine

Four patients with severe psoriasis have been treated with oral cyclosporine for 6 months. Two had generalized erythroderma and two had extensive plaque-type psoriasis; all had either become unresponsive to or were unable to use other accepted treatments. All four patients responded rapidly and were completely clear of psoriasis within 3 weeks of beginning therapy. Initial doses ranged from 7.5 to 8.5 mg/kg/day. Mild reversible nephrotoxicity occurred in the one patient whose cyclosporine trough level briefly exceeded 200 ng/ml. Cyclosporine may offer an alternative therapeutic modality in the management of erythrodermic or severe resistant plaque-type psoriasis. The effectiveness of cyclosporine in psoriasis underscores the putative role of cell-mediated immune factors in the pathogenesis of psoriasis.

Bowen's disease of the distal digit. Outcome of treatment with carbon dioxide laser vaporization.

background Bowens disease (squamous cell carcinoma in situ) is an intraepithelial neoplasm that am transform into invasive squamous cell carcinoma. The preferred method of eradication for Bowens disease is surgical excision. However, when Bowens disease occurs on the digit, surgical removal can lead to scar contracture and loss of use of the finger. objective To assess the utility of carbon dioxide (CO2) laser vaporization in eradicating Bowens disease of the finger while maintaining the full range of motion and use of the digit. methods Five patients were treated with CO2 laser vaporization for Bowens disease of the digit. Patients were followed postoperatively for recurrence, clinical appearance, especially for scar formation, and function of the involved joints over a 6‐month to 3‐year period. results Four of five patients had no recurrence. Healing resulted in only modest alterations in the cosmetic appearance in comparison with the surrounding untreated skin. Posttreatment biopsy showed slight thinning of the epidermis and mild fibro‐plagia limited to the papillary dermis. Patients reported only mild postprocedure discomfort and no patients had any loss of function of the digit. conclusions CO2 laser vaporization may be a safe and effective means by which to eradicate Bowens disease of the finger without the risk of scar contracture and loss of function of the digit.

Nodular primary localized cutaneous amyloidosis: Immunohistochemical evaluation and treatment with the carbon dioxide laser

Nodular primary localized cutaneous amyloidosis is an uncommon disorder for which there is no consistently satisfactory treatment. The amyloid fibrils are thought to have an immunoglobulin light chain derivation and systemic involvement must be excluded in all cases. We report a patient with a large scalp lesion of nodular primary localized cutaneous amyloidosis whose immunohistochemical evaluation revealed lambda light chain deposits and who thus far has no apparent systemic involvement. The lesion was treated by the carbon dioxide (CO2) laser with excellent cosmetic results and minimal morbidity.

Cryoglobulinemia and cutaneous leukocytoclastic vasculitis associated with hepatitis C virus infection

Hepatitis C virus infection is a frequent cause of non-A, non-B hepatitis worldwide. Resultant morbidity is significant; chronic liver disease develops in 50% of infected persons. Since serologic testing has become available there have been several reports of cutaneous findings in association with hepatitis C virus infection, including vasculitis, cryoglobulinemia, urticaria, and lichen planus. We describe a patient with cryoglobulinemia, chronic cutaneous leukocytoclastic vasculitis, and hepatitis C virus infection. Hepatitis C virus infection should be included in the differential diagnosis of the causes of cryoglobulinemia and leukocytoclastic vasculitis.

Psoriasis response to the pulsed dye laser

In psoriasis the blood vessels are enlarged and dilated. These vessels, the psoriatic microvasculature, have been implicated as participating in the pathogenesis of psoriasis. The purpose of this preliminary study was to use the flashlamp‐pumped pulsed dye laser, which selectively damages dermal vessels, to treat psoriatic plaques and to evaluate the role of the vasculature in the therapeutic response.

LASER TREATMENT OF PORT-WINE STAINS AND HEMANGIOMAS

Since their discovery, lasers have truly advanced and broadened our options for the treatment of port-wine stains and hemangiomas. It is a blending of many sciences and much effort that allows us the opportunity today to selectively treat these vascular processes with relative effectiveness and significant safety. Ongoing study and development continue to offer hope on increasing benefit for our patients. Laser systems with variable wavelengths, pulse durations, and delivery methods will help accommodate the diversity of various port-wine stains and hemangiomas that are encountered in medicine.

Hydroa Vacciniforme: Diagnosis by Repetitive Ultraviolet-A Phototesting

Hydroa vacciniforme is a rare disorder manifested in early childhood by recurrent photoinduced vesicles that heal with scarring. We report a case in which repetitive exposures to artificial ultraviolet light in the A range reproduced the clinical findings induced by natural sunlight. Phototesting may be viewed as an important diagnostic aid, as the induction of lesions clinically identical to hydroa vacciniforme can provide a reliable criterion for the diagnosis.

Hair removal using a combination radio-frequency and intense pulsed light source

BACKGROUND AND OBJECTIVE: The long‐term removal of unwanted hair is achieved by many laser and intense pulse light sources. One limitation is the treatment of individuals with dark skin. The light energy with the current systems has to penetrate through the epidermis before being absorbed by the hair follicle. In individuals with dark skin the high melanin concentration in the epidermis absorbs high energies that can lead to complications. The objective of our study was to study a new system that combines optical energy, intense pulsed light (IPL), with radio frequency (RF). This allows for the use of less optical energy due to the addition of RF energy. The lower optical fluence allows for safer treatment of darker skin types. STUDY DESIGN/MATERIALS AND METHODS: This was a multicenter study, in which 87 patients were enrolled. A single treatment was performed on a specified body site. Twenty‐one of the 69 subjects that completed the study had skin types IV–VI. Each subject was evaluated at 1, 7, 30, and 90 days after the treatment session. RESULTS: Hair counts were significantly reduced from baseline after one treatment by an average of 46%. Individual patient data showed that the percentage in hair count reduction achieved ranged from 0 to 100%, with 43% of the patients having a 50% or greater decrease. CONCLUSIONS: The combination of optical energy and RF when delivered simultaneously achieves effective hair reduction with the use of less optical energy, allowing for the safe treatment of all skin types.