Moshe Lapidoth

Cutis Marmorata Telangiectatica Congenita: Clinical Findings in 85 Patients

Abstract: Cutis marmorata telangiectatica congenita (CMTC) is an uncommon, sporadic, congenital cutaneous condition presenting with persistent cutis marmorata, telangiectasia, phlebectasia and possible ulceration of the involved skin, skin atrophy, and undergrowth of the involved extremity. To further the current understanding of this disorder, we analyzed the clinical features of a large series of patients with CMTC. The files of 85 patients with CMTC who were examined in our center over the last 20 years were reviewed. The data recorded included patient sex, age at onset, nature and distribution of the lesions, associated abnormalities, and course of disease. CMTC was characterized by early recognition of the lesions (94% at birth) and equal sex distribution. The lesion was unilateral in 65% of patients and most commonly involved the limbs (69%). Additional capillary lesions, noted in 20% of patients, may well have been an extension of the CMTC itself. Associated anomalies were found in 18.8% of patients. Almost half of the patients showed a definite improvement in the reticular vascular pattern on follow‐up. No familial cases of CMTC were noted. CMTC is more prevalent than previously recognized, affects both sexes equally, and has a mostly localized distribution; additional vascular lesions are associated with the disorder, but other anomalies occur less often. Prognosis is generally good.

The efficacy of combined treatment with prednisone and cyclosporine in patients with pemphigus: Preliminary study

BACKGROUNDnCyclosporine, a potent immunosuppressive drug, has been suggested to be beneficial in the treatment of some immune-mediated dermatoses, including pemphigus.nnnOBJECTIVEnThe aim of the present study was to evaluate the efficacy and safety of combined treatment with prednisone and cyclosporine compared with prednisone alone in patients with pemphigus.nnnMETHODSnSixteen hospitalized patients with pemphigus vulgaris received combined treatment with cyclosporine and prednisone for 12 months. Cyclosporine and prednisone were given orally at an initial dose of 5 mg/kg/day and 60 to 80 mg/day, respectively. The cyclosporine dose was adjusted to obtain plasma levels of 100 to 150 ng/L. A historical control group was composed of 15 patients with pemphigus who received prednisone at an initial dose of 120 mg/day, which was decreased according to clinical response. The clinical response, serum titer of autoantibodies, and frequency of side effects during a 1-year follow-up period were evaluated and compared.nnnRESULTSnThe 16 patients in the combined therapy group achieved clinical remission within 25 days or less, a shorter period than for the control group, although the difference was not statistically significant. New blister formation ceased after a mean of 11.1 +/- 7.9 days of onset of treatment in the combined treatment group versus 20.5 +/- 12 days in the control group (p = 0.004). Hospital stay was shorter in the combined treatment group (mean, 32.6 +/- 12.5 days) than in the control group (mean, 50.7 +/- 17.1 days; p = 0.003).(ABSTRACT TRUNCATED AT 250 WORDS)

Novel Use of Erbium:YAG (2,940-nm) Laser for Fractional Ablative Photothermolysis in the Treatment of Photodamaged Facial Skin : A Pilot Study

BACKGROUND The use of CO2 or conventional erbium laser ablation or more recent nonablative laser photothermolysis for skin rejuvenation is associated with significant disadvantages. OBJECTIVE The objective was to assess the efficacy of the erbium: YAG laser (2,940 nm) using the “ablative” fractional resurfacing mode to improve photodamaged skin. METHODS A total of 28 patients, 27 women and 1 man, aged 28 to 72 years (mean age, 54.2 years), with Fitzpatrick Skin Types II to IV, were treated for mild to moderate actinic damage using fractional erbium: YAG laser (2,940 nm) combined with Pixel technology. Sessions were scheduled at 4-week intervals. Response to treatment was evaluated by two physicians on a five-tiered scale. RESULTS Patients underwent one to four treatment sessions (mean, 3.2). The initial reaction consisted of erythema and minimal swelling. On clinical assessment 2 months after the final treatment, the results were rated excellent by 21 patients (75%) and good by 7 (25%). Nineteen of the 21 were also evaluated 6 to 9 months after final treatment without any significant change in the results. CONCLUSIONS Fractional ablative photothermolysis using erbium:YAG laser (2,940 nm) is a promising option for skin resurfacing with reduced risk and downtime compared to existing laser methods.

Targeted UVB phototherapy for psoriasis: a preliminary study

Excimer laser treatment for psoriasis has been associated with good results at a lower cumulative dose than narrowband ultraviolet (UV)B protocols. To examine the clinical performance of a new targeted UVB lamp (290–320u2003nm; BClear™) in the treatment of plaque‐type psoriasis, 28 consecutive patients attending a dermatology service were treated twice weekly with the UVB lamp for 6–18 sessions (median 10). UV doses were based on multiples of a predetermined minimal erythema dose (MED). MEDs ranged from 150 to 350 mJ/cm2; maximal dose was 8 MED. Mean cumulative fluence until remission was 12.63u2003J/cm2. The Psoriasis Severity Index (PSI) was measured every 2u2003weeks for 16u2003weeks. Mean PSI improvement during treatment peaked at 73% after 6u2003weeks, and declined to 63% at 16u2003weeks. At that point, 36% of the patients had a >u200a75% improvement in PSI, and 21% showed complete clearance. Targeted radiation with the UVB lamp is effective for the treatment of plaque‐type psoriasis, requiring as few as six sessions and achieving moderately long remission. As treatment is selectively directed toward lesioned skin, normal surrounding skin is spared unnecessary radiation exposure.

A novel fractional micro-plasma radio-frequency technology for the treatment of facial scars and rhytids: A pilot study

Abstract Introduction: Fractional ablative and non-ablative lasers have gained popularity in the treatment of acne scars and rhytids due to their efficacy and improved tolerability. Plasma and radio frequency (RF) have also emerged as methods for ablative or non-ablative energy delivery. We report preliminary experience with a novel fractional micro-plasma RF device for the treatment of facial acne scars and rhytids. Methods: Sixteen patients with facial acne scars or rhytids were treated at 4-week intervals. Treatment parameters were titrated to an immediate end point of moderate erythema. The clinical end point for cessation of treatment was the attainment of satisfactory clinical results. Results were monitored photographically up to 3 months after treatment. Results: Acne scars showed marked improvement after two to four treatments. Facial rhytids demonstrated reduced depth after two treatments and marked improvement after four treatments. Treatment was well tolerated by all participants, with transient erythema and short downtime. These results provide initial evidence for the safety and effectiveness of fractional micro-plasma RF as a low-downtime and well-tolerated modality for the treatment of acne scars and facial rhytids.

Telangiectasis in CREST syndrome and systemic sclerosis: correlation of clinical and pathological features with response to pulsed dye laser treatment

Telangiectasia are cardinal features of systemic sclerosis (SS) and calcinosis, Raynaud’s syndrome, esophageal motility, sclerodactyly, telangiectasias (CREST) syndrome. The etiology of telangiectasia in these syndromes is unknown, but vascular dysfunction has been proposed. However, the telangiectasia of CREST have anecdotally been considered relatively resistant to pulse dye laser (PDL), the treatment of choice for classic telangiectasia. The study was designed to test whether SS/CREST telangiectasia require more treatments than sporadic telangiectasia and to identify clinical and histological features that could explain such an effect. Nineteen skin biopsies from patients with SS or CREST and 10 control biopsies were examined and compared for features that may predict a differential response to PDL. Sixteen cases of SS or CREST treated with PDL between 1997 and 2007 were evaluated and response to treatment was compared with 20 patients with sporadic telangiectasis. Relative to normal skin, CREST/scleroderma telangiectasia exhibited thickened vessels in 17 out of 19 sections and thickened collagen fibers in the reticular or deep dermis in all sections. The number of treatments required to clear SS/CREST telangiectasia was approximately twofold higher. SS/CREST telangiectasia are more resistant to PDL but can be effectively cleared with more treatments.

Picosecond lasers for tattoo removal: a systematic review

Given that the pigment particles in tattoos have a relaxation time of <10xa0ns, picosecond lasers would be expected to be more effective than nanosecond lasers in tattoo removal. To systematically review the evidence regarding the effectiveness and safety of picosecond lasers for tattoo removal, Pubmed, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, and reference lists were searched for relevant trials. The primary outcome was >70xa0% clearance of tattoo pigment. Secondary outcomes were 90–100xa0% clearance of tattoo pigment, number of laser sessions required, and adverse effects. Eight trials were included, six with human participants (160 participants) and 2 with animal models. Seven of the eight trials explored the usage of either 755, 758, 795, 1064, or 1064/532-nm picosecond lasers for black and blue ink tattoos. In the human trials, 69–100xa0% of tattoos showed over 70xa0% clearance of pigment after 1–10 laser treatments. Reported side effects included pain, hyperpigmentation and hypopigmentation, blister formation and transient erythema, edema, and pinpoint bleeding. Included articles varied in type of laser investigated, mostly non-comparative studies and with a medium to high risk of bias. There is sparse evidence that picosecond lasers are more effective than their nanosecond counterparts for mainly black and blue ink tattoo removal, with minor side effects.

Treatment of the skin manifestations of hereditary hemorrhagic telangiectasia with pulsed dye laser

Hereditary hemorrhagic telangiectasia (HHT) is a familial disorder, in which variably sized arteriovenous malformations develop in the skin, respiratory tract, central nervous system, and gastrointestinal and urogenital tracts. Bleeding is a major problem in the abnormal vessels, primarily in the nose and internal lesions. Skin lesions, in contrast, do not generally bleed spontaneously but pose a significant cosmetic concern. The lesions are characteristically small caliber vessels located in the dermis. As such, they are ideal targets for vascular lesions. Eight patients with cutaneous facial lesions of HHT were treated by pulsed dye laser. All patients exhibited excellent (75–100xa0%) clearance after a mean of 2.6 treatments (range 1–8). In comparison, a control group of patients with non-HHT facial telangiectasia required a mean of 1.9 (range 1–5; pu2009<u20090.05) treatments. No adverse events were reported in either group. The study confirms the safety and efficacy of PDL in the management of the cutaneous lesions of HHT.

Basal cell carcinoma arising over facial port wine stain: a single-centre experience.

Backgroundu2002 A growing number of reports point to a possible connection between basal cell carcinoma (BCC) and port wine stain (PWS). Researchers suggest that either the elevated temperature induced by the increased dermal vasculature or an oncogenic factor produced by the ectatic vessels makes the overlying epidermis more susceptible to ultraviolet or ionizing radiation.

Melasma and laser treatment: an evidenced-based analysis.

The use of lasers in the treatment of melasma has been addressed in case reports, but there is no consensus in the literature regarding the safety, efficacy, or durability of laser-based treatments. Furthermore, given the potential risks of laser intervention in hyperpigmented skin, the relative risks and benefit of laser must be compared to more conservative and traditional treatment approaches. English language literature in which the main intervention was a light-based therapy and the target was melasma was analyzed. The study included only prospective, controlled studies which included at least 10 participants, and which presented the data with accepted objective and quantitative study metrics. Seven studies met the inclusion criteria. Two studies reported the response to melanin-targeting lasers and five reported the response to fractional photothermolysis. The response to lasers was not consistent among the reports. Adverse events including hyperpigmentation were reported in several studies. The durability of melasma improvement was limited in all cases where laser was used as monotherapy. In studies that compared laser to topical treatments, laser-based monotherapy failed to show benefit over topical treatments. This analysis suggests that the use of lasers for the treatment of melasma cannot be recommended, due to unpredictable safety and efficacy, time-limited clinical improvement, and no clear benefit over conventional treatments.