Paolo Bonan

Fractional CO2 laser: a novel therapeutic device upon photobiomodulation of tissue remodeling and cytokine pathway of tissue repair

Minimally ablative fractional laser devices have gained acceptance as a preferred method for skin resurfacing. Notable improvements in facial rhytides, photodamage, acne scarring, and skin laxity have been reported. The aim of the present work was to compare how different CO2 laser fluences, by modulating the secretory pathway of cytokines, are able to influence the wound‐healing process, and how these fluences are associated with different clinical results. Eighteen patients, all with photodamaged skin, were treated using a fractional CO2 laser (SmartXide DOT, Deka M.E.L.A., Florence, Italy) with varying laser fluences (2.07, 2.77, and 4.15 J/cm2). An immunocytochemical study was performed at defined end points in order to obtain information about specific cytokines of the microenvironment before and after treatment. The secretory pathway of cytokines changed depending on the re‐epithelization and the different laser fluences. Different but significant improvements in wrinkles, skin texture, and hyperpigmentation were definitely obtained when using 2.07, 2.77, and 4.15 J/cm2, indicating fractional CO2 laser as a valuable tool in photorejuvenation with good clinical results, rapid downtime, and an excellent safety profile.

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.

Vascular based non conventional dye laser treatment for basal cell carcinoma

ABSTRACT:  Basal cell carcinoma is the most common skin tumor in humans which can be removed in a variety of ways (depending on the type of the lesion, the affected area, and depth of the lesion). Laser therapy offers another option to the traditional methods of treatment; thus, the purpose of this work is to valuate the efficacy of dye laser in a selected group of patients affected by superficial basal cell carcinoma. We suggest that the success of pulse dye laser treatment lies in the fact that as all tumors, basal cell carcinomas contain an increased number of dilated blood vessels. Twenty patients (eight males and 12 females) with superficial basal cell carcinoma were given five treatments with a flashlamp‐pumped pulse dye laser every 20 days. The clinical follow up was 12–24 months after the fifth treatment. A complete response was obtained in 16 patients out of 20. Three recurrences and one no response was observed during the study. Pulse dye laser is effective and safe in the treatment of superficial basal cell carcinoma

Intense pulsed light in the treatment of non‐aesthetic facial and neck vascular lesions: report of 85 cases

Background  Intense pulsed light (IPL) treatment is one of the most effective procedures for patients with non‐aesthetic vascular lesions in addition to signs of skin photoageing, and it has been reported as very successful in the treatment of telangiectasias, spider nevi, erythrosis, and above all, rosacea and poikiloderma. Its use is based on the principle of selective photothermolysis, which exploits the haemoglobin absorption peak among its range of wavelengths.

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.

Eyelid skin tightening: a novel ‘Niche’ for fractional CO2 rejuvenation

Background  The periorbital area is a barometer of chronologic and environmental age for which patients usually seek rejuvenation; fractional CO2 laser plays a key role among the variety of available dermatologic treatments.

Cutaneous pseudolymphoma localized to black tattoo

may also result in extensive scarring and significant delays in diagnosis, biopsy, and treatment of melanoma, which increases the risk of malignancy recurrences from residual cancer cells. Because of the widespread availability of black salve products, physicians need to be familiar with these types of compounds and their potential dangers to educate their patients for their proper use in minor skin problems and the danger of using them for more serious problems.

Fractional CO2 laser for the treatment of acne scars

Background  Numerous reports have been published on skin rejuvenation by the so‐called fractional laser device that delivers a laser beam in a dot form over a grid pattern.

A study of fractional CO2 laser resurfacing: the best fluences through a clinical, histological, and ultrastructural evaluation

Background  Fractional resurfacing is a laser treatment modality to create numerous microscopic thermal injury zones of controlled width, depth, and density that are surrounded by a reservoir of spared epidermal and dermal tissue, allowing rapid repair of laser‐induced thermal injury.

The Role of Cyclosporine A in the Treatment of Pemphigus Erythematosus

Abstract: Steroids are effective in the autoimmune bullous disease pemphigus; however, treatment may be difficult to sustain because of severe side effects. Cyclosporine A acts mainly on helper/inducer T lymphocytes and has few side effects at few doses. We report three patients with pemphigus erythematosus who had a relapse while receiving the maintenance dose of steroid therapy. All patients who were treated with both cyclosporine A (5 mg/kg/d) and prednisone (1 mg/ kg/d) responded remarkably well to combined therapy. After clearing, prednisone was discontinued and cyclosporine A was reduced to 2 to 3 mg/kg/d. With this treatment, all patients have been virtually free of symptoms, have remained well, and have had normal laboratory values.