Matthias P. Schönermark

Treatment of Essential Telangiectasias with an Intense Pulsed Light Source (PhotoDerm VL)

BACKGROUND. The flashlamp‐pumped pulsed dye laser (585 and 577 nm) has proven to be a very effective and safe treatment option in the therapy of essential telangiectasias (ETE). Never‐theless, the postoperative intracutaneous hematomata, which most patients see as cosmetically disfiguring, always has been a matter of concern. OBJECTIVE. To test the efficacy and safety of a new, large spot size, intense pulsed light source, the PhotoDerm VL, which emits noncoherent light adjustable within the 515‐1200‐nm ratige, in the treatment of ETE. METHODS. Fourteen patients were treated with the PhotoDerm VL. They suffered from ETE of the face, postoperative teleangi‐ectasis of the nose, ETE of both legs, and poikiloderma of Civatte. RESULTS. All treated lesions could be abrogated with excellent results by this neiv device. There were no unpleasant side effects of the treatment. Additionally, due to the large spot size (2.8 cm2), a larger area could be treated within one session. No anesthesia was required. CONCLUSION. The PhotoDerm VL is an innovative, highly ef‐fective, and comparably safe therapeutic alternative to the laser in the treatment of ETE. The rate of cosmetically relevant side effects is considerably smaller, the patient compliance is excel‐lent, and the method can be applied easily in an outpatient setting.

Q-switched ruby laser treatment of tattoos and benign pigmented skin lesions: a critical review.

The Q-switched ruby laser (694 nm, 25-40 nsec) is an effective and safe therapeutic device for the treatment of tattoos and well-defined, benign, pigmented epidermal and dermal lesions. Because of its selective mode of action, dermal pigments of natural and artificial origin are destroyed photothermically and removed without scar. This method is exceptionally suited for the elimination of lay and professional tattoos, traumatic tattoos, and permanent makeup. Other frequent indications include benign pigmented lesions such as lentigines, freckles, café-au-lait spots, seborrheic keratosis, and Becker nevi. As a dermal pigmented lesion, the nevus of Ota is perfectly treatable. However, chloasma can no longer be considered an indication for ruby laser treatment due to unsatisfactory results. Melanocytic nevi and congenital nevi should be treated only in clinical studies. The effectiveness of the long-term epilation of dark hair with this laser device has to be verified in future investigations. Particularly attractive is the nonproblematic and straightforward removal of pigmented lesions in precarious anatomic regions like the lips, eyelids, and genitals (e.g., benign melanosis of the lips or of the penis, seborrheic keratosis of the lid angle).

Expression of Matrix-Metalloproteinases and their Inhibitors in Human Cholesteatomas

The proteolytic erosion of the temporal bone is the key event in the pathognomonic course of cholesteatoma progression. The molecular mechanisms of bone resorption, endangering the ossicles, the inner ear, the facial nerve, large vessels or the brain, are not understood. Recently, a new family of proteolytic enzymes, the matrix-metalloproteinases (MMPs) has been described and identified, which seems to play a pivotal role in matrix- and bone homeostasis and inflammatory osteolytic diseases, e.g. osteoarthritis and periodontitis. These enzymes are sophisticatedly controlled by specific inhibitors and activation cascades. We investigated whether human cholesteatoma tissue expresses MMPs and MMP-inhibitors. By immunocytochemistry of cholesteatoma-cryosections, the expression of MMP-2 (72 kD collagenase), MMP-9 (92 kD collagenase), and MMP-3 (stromelysin-1) could be seen to be strictly confined to the basal and suprabasal cell layer of the cholesteatoma epithelium. The neutrophil collagenase (MMP-8) showed a more disseminated expression in the epithelium and the granulation tissue as well. The tissue inhibitor of metalloproteases, TIMP-1, could be detected only in very limited areas of the granulation tissue in a quite randomized manner. Therefore, a derailment in favor of proteolysis of the normally tightly controlled MMP-system might be postulated. The results indicate that members of the MMP-family could play an active role in the molecular mechanisms of cholesteatoma invasion into the temporal bone. This offers new insights into the pathophysiology of the disease and of potential therapeutic approaches.

Treatment of a nonresponding port‐wine stain with a new pulsed light source (PhotoDerm® VL)

The pulsed dye laser is effective and safe in the treatment of port‐wine stains. It is the laser of choice for port‐wine stains and initial superficial hemangiomas in children. For the treatment of darker port‐wine stains in adults that have not responded to pulsed dye laser treatment, excellent results can be achieved using the PhotoDerm VL, a new technology based upon the emission of wide band, noncoherent intense pulsed light.

Effective treatment of hypertrichosis with pulsed light: a report of two cases.

Hypertrichosis is an often stigmatizing cosmetic problem not only for women but also for male-to-female transsexual patients. The hitherto described therapeutic measures include chemical epilation, razoring, camouflage, electrolysis and thermolysis, and waxing. All of these measures are transient, more or less painful, and may lead to severe side effects (e.g., inflammatory responses and scarring). We report the successful treatment of the perioral and mandibular area of two transsexual patients (male to female), who we treated with a recently introduced intense, pulsed light source--the PhotoDerm VL. Two days after the nearly painless treatment, hair could be epilated easily with forceps. Biopsies of the treated area show an atrophy of the follicles, which can be contributed either to direct thermal injury or to an indirect photothermolytical effect. Six months after the last treatment, there is no local recurrence and no side effects.

Treatment of xanthelasma palpebrarum with the pulsed dye laser

Treatment of xanthelasma palpebrarum may prove difficult due to its delicate location at the periorbita and its sometimes extensive dimension. During recent years, carbon dioxide and argon lasers have been used with good results. However, local anesthesia is always required, and there is a concrete risk of scarring and pigmentation changes after the treatment.

Treatment of sebaceous gland hyperplasia with the pulsed dye laser.

Sebaceous gland hyperplasia may be treated by cryotherapy, cauterization, topical chemicals, or excision. The major disadvantage of these therapeutic strategies is a considerable risk of postoperative scarring or dyspigmentation. The pulsed dye laser may be an effective and safe alternative treatment option.

Expression Pattern of the Plasminogen Activator—Plasmin System in Human Cholesteatoma

The plasminogen activator—plasmin system plays a pivotal role in the delicately regulated process of extracellular matrix remodeling. Recent studies have shown that an imbalance of proteolytic enzymes over specific inhibitors in this system may lead to an aggressive, expanding, and infiltrating cellular phenotype. As cholesteatoma resembles a tumor in many ways, we investigated the pattern of expression for members of the plasminogen activator—plasmin system in 12 human cholesteatomas, using immunohistochemistry. As controls, 3 tympanic membranes and 4 ear canal skin specimens were used. In contrast to the tympanic membranes, all cholesteatoma specimens showed a strong expression of plasminogen at the basal epithelial cell layers. In ear canal skin, only the basal surface of the most basal epithelia stained discretely positive. The urokinase-type plasminogen activator (uPA) could be detected in the basal stratum of the cholesteatoma matrix and in the surrounding granulation tissue, while tissue-type plasminogen activator (tPA) was not detectable at all. Plasminogen activator inhibitor–1 (PAI-1) was expressed in both the granulation tissue and the granular cell layer of the matrix, but not in the basal epithelial cells; PAI-2 showed a pericellular expression pattern in the sub-basal and granular cell layers. Neither uPA, tPA, nor the PAIs could be detected in tympanic membrane controls; ear canal skin showed the same staining pattern as cholesteatoma only for PAI-2. Our data demonstrate that there is a clear imbalance in favor of proteolytic activity in the basal epithelial layers of the cholesteatoma matrix, which might at least partly account for the aggressive behavior of this tumorlike lesion. Further, the pattern of expression resembles the pattern described for several epithelial malignancies.