Marie Caucanas

Recent trends in specular light reflectance beyond clinical fluorescence diagnosis.

Under specific light illumination, particularly ultraviolet (UV) and near-UV light stimulation, the skin produces both specular light reflectance and, possibly, specific fluorescent emission. These properties offer diagnostic clues and disclose some peculiar functions of the skin. A series of superficial infections (erythrasma, some tinea capitis types, tinea/pityriasis versicolor, dermatophytoses, etc.) and pilosebaceous follicles enriched in Propionibacterium spp show fluorescence. This latter characteristic is downgraded or lost while on some anti-acne treatments. A quenching effect of fluorescence is observed following the application of sunscreens. The (pre)neoplastic areas prepared for methylaminolevulinate photodynamic therapy (MAL-PDT) show reddish fluorescence following drug metabolisation producing porphyrins by the abnormal activated cells. Of note, when using a recording sensitive CCD camera instead of casual visual observation, skin fluorescence may be superimposed on the specular reflectance of the incident light. With the current technology, these situations are not distinguished with confidence. Any harsh and scaly lesion appears brighter following yellowish specular light reflectance. Stratum corneum samplings collected on clear self-adhesive discs or cyanoacrylate skin surface strippings are conveniently examined ex vivo, taking advantage of the same optical properties.

Photodynamic therapy for multi-resistant cutaneous Langerhans cell histiocytosis

Langerhans cell histiocytosis is a rare group of proliferative disorders. Beside cutaneous involvement, other internal organs can be affected. The treatment of cutaneous lesions is difficult and relies on topical corticosteroids, carmustine, nitrogen mustard, and photochemotherapy. Systemic steroids and vinblastine are used for recalcitrant skin lesions. However, some cases fail to respond. An 18-month old boy presented a CD1a+, S100a+ Langerhans cell histocytosis with cutaneous and severe scalp involvement. Topical corticosteroids and nitrogen mustard failed to improve the skin lesions. Systemic corticosteroids and vinblastine improved the truncal involvement but had no effect on the scalp lesions. Methylaminolevulinate (MAL) based photodynamic therapy (PDT) resulted in a significant regression of the scalp lesions. Control histology revealed an almost complete clearance of the tumor infiltrate. Clinical follow-up after six months showed no recurrence. Although spontaneous regression of cutaneous Langerhans cell histiocytosis is observed, the rapid effect of photodynamic therapy after several failures of other treatment suggests that photodynamic therapy was successful. As far as we know this is the first report of photodynamic therapy for refractory skin lesions. Larger series are needed to determine whether photodynamic therapy deserves a place in the treatment of multiresistant cutaneous Langerhans cell histiocytosis.

Intense Pulsed-Light Therapy for Proliferative Haemangiomas of Infancy

Infantile haemangioma therapy has long been a wait-and-see policy. Since recent development of laser and light therapy, pulsed dye laser has been successfully used for treating superficial haemangiomas. Few studies have been published about treatment with intense pulsed light (IPL) to assess the risk/benefit of IPL in the treatment of infantile haemangiomas during their early proliferative phase. In the present retrospective cohort study, we retrieved data about a series of 14 Caucasian children (median age: 4.8 months) with infantile haemangiomas treated with Photoderm Vasculight flash lamp. All patients experienced a rapid regression of the haemangiomas after 3 treatments on average. Few adverse events were noted, including ulceration and crusts. No residual scarring and cosmetic damages were noticed. Fast growing haemangiomas should be treated with light therapy as soon as possible. This technology is safe, efficient, inducing regression, and preventing any further functional and aesthetic complications. The benefit-risk ratio favours the treatment of most types of haemangiomas which are out of the scope of betablocker administration.

Dynamics of skin barrier repair following preconditioning by a biotechnology-driven extract from samphire (Crithmum maritimum) stem cells

Background  With aging, the barrier repair kinetics following any weakening of the epidermal permeability barrier function is commonly slowed down.

Intense Pulsed Light in Infantile Hemangiomas

For more than 70 years, the watchful-waiting management of infantile strawberry hemangiomas still prevails in a number of clinical settings. This concept appears now outdated since the introduction of well-suited beta-blockers, as well as noncoherent light and laser therapies. The aim of this work was to revisit the effect of intense pulsed light (IPL) therapy on infantile hemangioma. Information was collected from the peer-reviewed literature and illustrated by personal cases. When applied early in the evolution of infantile hemangiomas, IPL treatment stops the growth phase and induces regression with minimal cosmetic adverse effects and psychological damage. Initiating an adequate treatment is important because damage due to hemangiomas can be diminished by a timely and adequate approach. Beta-blockers have revolutionized the therapeutic strategy of infantile hemangiomas. The flash light therapy (IPL) represents an alternative therapy for some patients.

Epidemiology of Nail Psoriasis

Few relevant studies of the epidemiology of nail psoriasis have been published to date. A literature search collected 32 papers. The prevalence of nail psoriasis still varies from study to study, even in the same country. Some papers show a correlation with the duration of skin psoriasis, some with the severity of skin psoriasis and some an association with psoriatic arthritis. Most of the studies detail the most common clinical features of nail psoriasis. Determining the prevalence of nail psoriasis seems utopian.

Herpes Simplex Virus Infections of the Nipple

The usual sites of herpes simplex virus (HSV) type 1 and 2 infections are orolabial and anogenital, respectively. HSV infection of the nipple and periareolar area is exceptional but probably underrecognized. Typical features include severe pain and erosive or ulcerated erythematous confluent clusters of lesions of the nipple and periareolar area. It is usually unilateral and not recurring. HSV infection of the nipple is originating from autoinoculation, sexual transmission or breastfeeding. Diagnosis is often delayed. The Tzanck smear is the most rapid and adequate method of diagnosis. Immunohistochemistry enables viral identification. The treatment relies on topical disinfection and oral antiviral therapy, such as aciclovir, famciclovir or valaciclovir. Scarring is uncommon.

Chronicle of a pigmented superficial Basal cell carcinoma.

Dermoscopic patterns of basal cell carcinoma (BCC) are well defined, but the dynamics of dermoscopic changes in time were apparently never described so far. In this paper, prominent changes were observed over a 8-week period, allowing to establish a close connection between spoke wheel areas and maple leaf-like aspects, through progressive thickening of the former ones. A chronobiological phenomenon ruling synchronous apoptosis in some of the most superficial BCC nests is suggested, leading to a wax and wane process of millimetric crusts, taking part in the spontaneous BCC regression/progression process.

Management of ingrowing nails: Treatment scenarios and practical tips

This book discusses all therapeutic options regarding ingrowing toenails, from conservative to surgery. No single technique is promoted, but a rational approach according to the clinical presentation is proposed. The authors have a wide experience in nail surgery and master all published procedures. In this book they offer to the reader an algorithm of the management of ingrowing nails, as there is no “cure-all” procedure.

Definition – Pathogenesis Risk Factors – Classification – Scoring

There is still a debate about the cause of ingrowing toenails: is it the nail plate itself, the soft tissues or both that are at fault? There are few real risk factors that may promote ingrowing toenails, mainly nail abnormalities like too wide or transverse overcurved nails. Ingrowing is precipitated by improper nail cutting in most instances. The best way to classify ingrowing nails is from their location: lateral, distal or proximal. Each of these categories has different subtypes. Several severity index scoring may help the clinician to find the best treatment plan.