Luciano Mavilia

Monochromatic excimer light (308 nm): an immunohistochemical study of cutaneous T cells and apoptosis-related molecules in psoriasis

Background Various types of UVB radiation source (290–320 nm) are used in treating psoriasis and their therapeutic mechanism has been attributed to immunosuppressive properties. Recently, a new UVB source generated by a 308‐nm excimer laser has been introduced for the treatment of psoriasis.

Possible histopathologic correlates of dermoscopic features in pigmented melanocytic lesions identified by means of optical coherence tomography.

Abstract:  Optical coherence tomography (OCT) is a novel non‐invasive imaging technique for in vivo histologic characterization of tissues. Besides pure morphology, additional functional parameters of the tissue investigated can be evaluated at the same time, such as the refractive index and the scattering coefficient. The purpose of our study is to correlate in vivo the dermoscopic structures that first appear in the melanocytic pigmented lesion (pigment network and brown globules) using this new method, with the histopathologic correlates, in order to improve their characterization and achieve easier recognition and inter‐observer reproducibility. We concentrated in particular on the pigment network and the brown globules, as these are dermoscopic parameters of great diagnostic importance in melanocytic lesions. Moreover, as these parameters are the histopathologic equivalents of structures located at the level of the dermo‐epidermal junction, they enable a correct evaluation to be made using OCT, that at present has only a few millimetres penetration power. The results of our trial, performed using the histopathological preparation as an evaluation gold standard, show that in selected cases OCT allows an in vivo correlation to be made between surface dermoscopic parameters and histopathologic correlates, in particular the pigment network and brown globules. The resolution is not high enough to reveal the morphology of the single cells, but it is possible to evaluate the architecture of a lesion.

Nd:YAG 1064 nm laser in the treatment of facial and leg telangiectasias

Background Facial and leg telangiectasias are a frequent cosmetic concern for both females and males with various skin types and ages. To date the different treatments for these problems, in particular leg telangiectasias, have frequently failed or led to negative side‐effects.

CO2 laser therapy in a case of steatocystoma multiplex with prominent nodules on the face and neck

Background Steatocystoma multiplex is an uncommon disorder which usually begins in adolescence or early adult life. The condition can be hereditary, as an autosomal dominant trait, or nonhereditary, as in this case.

595 nm Pulsed dye laser for the treatment of superficial basal cell carcinoma

Dear Sirs, We read with interest a letter by K.P. Allison et al. concerning the treatment of superficial basal cell carcinoma (sBCC) with pulsed dye laser [1]. The Authors used a single 585-nm dye laser treatment in seven sBCCs obtaining only one sBCC out of seven effectively healed at 8 weeks follow-up. They concluded the letter by writing that ‘‘at the present this treatment is not a realistic alternative to other treatments, which yield much higher cure rates’’. In our study, 20 patients (8 Male and 12 Female; age 49–72 years, mean 63 years) with sBCCs were recruited and, about 20 days after a 3-mm punch biopsy or a cytological diagnosis, a 595-nm dye laser treatment (Dermobeam 2000, Deka M.E.L.A., Florence-Italy) was performed five times a month with the following parameters: pulse duration of 1.5 ms, energy density of 7.5 J/cm and a 7 mm diameter spot. The lesions were uniformly irradiated with the minimum of overlap including about 5 mm of apparently healthy skin at the periphery of the tumour and without using intralesional or topical anaesthetic. Dye laser was equipped with a cryogen spray cooling. The clinical follow-up was 9– 12 months (mean 10 months) after the fifth treatment (Figs. 1, 2). We obtained a complete response in 16 out of 20 sBCCs. Three recurrences (one at 3-months followup and two at 6-months follow-up) and one no response case were also observed during the study period. In our opinion, 595-nm wavelength is able to penetrate deeper into the skin [2] to the target (oxyhaemoglobin or nuclear chromatin), although the complete mechanism of damage is not perfectly elucidated (photoangiolysis of sublesional microcirculation, denaturing of epithelial basement membrane linking proteins and cellular destruction) [3]. Although our laser parameters, using 595 nm wavelength, with repeated sessions might represent the optimal protocol, further investigations into the treatment of sBCC are needed to confirm our preliminary data.

Daylight methyl-aminolevulinate photodynamic therapy versus ingenol mebutate for the treatment of actinic keratoses: an intraindividual comparative analysis.

Daylight‐photodynamic therapy (D‐PDT) and ingenol mebutate (IM) are novel therapies directed to actinic keratoses (AK). The purpose of our study was to compare effectiveness, tolerability, cosmetic outcome and patient preference of D‐PDT versus IM in the treatment of grade I and II AK. Twenty‐seven patients with AK on the face or scalp were enrolled. Each patient received, in a 25 cm2 target area, D‐PDT on right side and IM on left side. Overall 323 AK were treated. Both target areas achieved complete response in 40.47% of the cases and average AK clearance rate was similar for D‐PDT and IM (p=0.74). In D‐PDT areas mean grade II AK clearance rate was lower compared with that of grade I AK (p=0.015). In IM areas grade I and II AK average clearance rates were similar (p=0.28). At week 1 and month 1, mean local skin responses (LSR) score were higher in areas treated with IM. IM areas showed more severe pain and cosmetic sequelae. D‐PDT had similar effectiveness to IM, even if IM demonstrated higher grade II AK clearance rate. Tolerability profile was superior for D‐PDT in terms of LSR and pain. D‐PDT was more cosmetically acceptable. Patients preferred D‐PDT to IM in most cases.

Combined treatment of Favre-Racouchot syndrome with a superpulsed carbon dioxide laser: report of 50 cases

Nodular elastosis with cysts and comedones also known as Favre‐Racouchot syndrome frequently occurs on actinically damaged skin of middle‐aged or elderly Caucasian subjects. The disease usually affects simmetrically the skin mainly around the orbits. Treatment in the past has not been entirely satisfactory. Treatment of 50 patients with a superpulsed carbon dioxide laser in order to vaporize epidermis followed by extraction of cystic and comedonic material using soft pressure with a pair of forceps. Laser treatment was performed without previous topical or intralesional anesthetics because no pain was reported using the described laser parameters. Our combined therapeutic approach was safe and effective in all the patients, guaranteeing an excellent cosmetic result. The combined technique assures clinical efficacy, rapid recovery, and the possibility of repeated laser application without anesthesia. On the basis of our results, we recommend the novel combined modality in the treatment of Favre‐Racouchot syndrome.

Wide-area 308-nm phototherapy with nonlaser light in the treatment of psoriasis: results of a pilot study

gical atypia is also seen. At the sides of the lesions inward turning of the rete pegs is seen but there are no other findings supportive of human papillomavirus infection. These particular histological findings reflect the unusual clinical appearance of these rather punctate keratotic lesions which do not fit into the ordinary categories of solar keratoses or Bowen’s disease seen on sun-exposed sites. Sunbed-related NMSC has been reported but no reports have described the distinct appearance and histology of these dysplastic lesions which could be synonymous with sunbed use.

Leishmaniasis recidiva cutis: an unusual two steps recurrence

Leishmaniasis recidiva cutis (LRC) is an unusual complication of acute cutaneous leishmaniasis. A 68-year-old woman with LRC is reported. Recurrence of cutaneous leishmaniasis occurred in the same area as a previous acute lesion that apparently healed in two separate steps: the first step was following neurosurgery for cranial osteoma and the second step was following a coronary artery bypass for acute heart failure. Pathogenetic hypotheses are discussed.