Kenneth J. Galeckas

Split-Face Treatment of Facial Dyschromia: Pulsed Dye Laser with a Compression Handpiece versus Intense Pulsed Light

BACKGROUND Many visible light lasers and intense pulsed light (IPL) devices are available to treat photodamaged skin. OBJECTIVES The objective was to perform a multiple-treatment split-face comparison evaluating a pulsed dye laser (PDL) with a compression handpiece versus IPL for photorejuvenation. METHODS Ten subjects were treated three times at 3- to 4-week intervals. One side of the face was treated with the PDL with compression handpiece, and the other with IPL. One month after final treatment, blinded evaluation assessed for improvements in dyschromias and texture. Patients provided self-assessment of improvement in dyschromias and texture. Time to complete final treatments and pain during all treatments were recorded for each device. RESULTS Improvement of the PDL was (mean) 86.5, 65, 85, 38, and 40% for dark lentigines, light lentigines, vessels <0.6 mm, vessels >0.6 mm, and texture, respectively, versus 82, 62.5, 78.5, 32.5, and 32%, respectively, for the IPL side. Patient-evaluated difference in improvement for vascular lesions significantly favored the PDL (p=.011). Mean third treatment times were 7.7 minutes for PDL versus 4.6 minutes for the IPL (p=.005). Mean pain ratings were 5.8 for the PDL and 3.1 for the IPL (p=.007). Purpura-free procedures depended on proper technical use of the compression handpiece when treating lentigines with the PDL. CONCLUSIONS The PDL with compression handpiece and IPL are highly effective for photorejuvenation.

A Pulsed Dye Laser with a 10-mm Beam Diameter and a Pigmented Lesion Window for Purpura-Free Photorejuvenation

BACKGROUND AND OBJECTIVES In traditional pulsed dye lasers (PDLs), power limitations and pulse characteristics have compromised purpura-free procedures. This study evaluated a new PDL with a modified pulse structure and a 10-mm beam diameter for purpura-free photorejuvenation. A compression handpiece was used for targeting lentigines. MATERIALS AND METHODS Twenty patients with skin types I to III were treated three times at 3- to 4-week intervals. The first pass was delivered through a 10-mm compression handpiece to target pigment dyschromias using fluences between 6.5 and 8.0 J/cm2 with a 1.5-ms pulse duration. A second pass was then performed with a 10-mm spot with fluences between 9.5 and 10 J/cm2, a 20-ms pulse duration, and cryogen spray enabled. Improvement was evaluated by comparing pre- and posttreatment photographs and live subjects 1 month after the third treatment. RESULTS In the majority of patients, >90% reduction of fine telangiectasias (<0.6 mm) and dark lentigines was achieved. Pigmented dyschromias improved proportional to the degree of pigment at presentation. Avoidance of purpura with the compression handpiece was dependent on obtaining proper compression before laser emission. Mean textural improvement was 34%. CONCLUSIONS The new 595-nm PDL is highly effective for two-pass purpura-free improvement of telangiectases, pigment dyschromias, and texture.

Successful Treatment of Pyogenic Granuloma Using a 1,064-nm Laser Followed by Glycerin Sclerotherapy

Pyogenic granulomas, or lobular capillary hemangiomas, are benign vascular tumors of the skin and oral mucosa. Commonly employed treatment modalities include shave and electrodesiccation, excision, and chemical cautery, all of which have the potential to scar. This can be especially troubling in challenging facial locations such as the vermilion lip. Herein, we describe a pyogenic granuloma treated successfully with laser and sclerotherapy. Our patient’s pyogenic granuloma was large (8.0 mm in diameter) and was raised more than 4.0 mm above the surface of his vermilion lip. By combining modalities, our hope was to intervene in a way that would minimize scarring in this cosmetically sensitive area.

Diffuse xanthogranulomatous dermatitis and systemic Langerhans cell histiocytosis: A novel case that demonstrates bridging between non-Langerhans cell histiocytosis and Langerhans cell histiocytosis

The advent of electron microscopy and immunohistochemical stains allowed for reclassification of the histiocytoses based on the predominant cell in the infiltrate. Although the current schema simplicity provides a good foundation, some patients display overlapping clinical and immunohistochemical features that defy classification. The patient herein illustrates bridging between histiocytic disorders. Through this case we review the various conditions classified under the non-Langerhans cell histiocytosis and Langerhans cell histiocytosis rubric.

Linear IgA Disease: Complicated by Alpha Thalassemia

Abstract:  Dapsone is regarded as the treatment of choice for linear immunoglobulin A disease (chronic bullous disease of childhood). It is associated with both hemolytic anemia and methemoglobinemia. The hematotoxic effects are dose related and can result in significant hemolysis. We present a case of a patient with chronic bullous disease of childhood and alpha thalassemia trait. Complete resolution occurred on a standard dose of dapsone without significant hemolysis.

Cutaneous marginal zone B-cell lymphoma in a patient previously diagnosed with cutaneous Waldenström macroglobulinemia

The patient has remained on erlotinib for 2 years in addition to oral retinoids and surgical parings. Although she has not maintained her initial dramatic response, she continues to note significant improvement in her pain with ability to ambulate. Moreover, she has not experienced any of the side effects commonly associated with EGFR inhibitor therapy, such as xerosis, papulopustular eruptions, or paronychia. EGFR is expressed in skin, primarily in basal/ suprabasal keratinocytes, and pEGFR is correlated with increased cell proliferation. Systemic administration of EGFR inhibitors results in decreased EGFR signaling, as evidenced by decreased pEGFR and upregulation of the negative growth regulator p27. Immunohistochemical analysis of affected skin from Olmsted syndrome patients showed increased suprabasal expression of cytokeratins 5 and 14 and increased Ki-67 of both basal and suprabasal keratinocytes, in comparison with adjacent, noninvolved skin. These findings suggest aberrant keratinocyte differentiation and increased proliferation in Olmsted syndrome. Given the marked thickening of epidermis and the increased expression of Ki-67, we hypothesized that EGFR inhibition in affected palmoplantar skin might reduce thickening and symptoms. Although erlotinib therapy is costly (approximately

Fixed drug eruptions: a case report and review of the literature.

3200 for a 1-month supply) and should be used selectively, the reduction in the number of surgical procedures and improvement in patient’s quality of life could be considered compensatory. In this report, we describe the life-altering improvement by administration of erlotinib in a patient with a debilitating form of Olmsted syndrome resistant to previous therapy. This case supports the investigation of EGFR inhibitors in patients with hyperproliferative benign cutaneous disorders. Brandi M. Kenner-Bell, MD, Amy S. Paller, MD, and Mario E. Lacouture, MD Department of Dermatology, the Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois