Sonal Choudhary

Photodynamic therapy in dermatology: a review

Photodynamic therapy (PDT) is used for the prevention and treatment of non-melanoma skin cancer. Until recently, clinically approved indications have been restricted to actinic keratoses, nodular and superficial basal cell carcinoma, and, since 2006, Bowen disease. However, the range of indications has been expanding continuously. PDT is also used for the treatment of non-malignant conditions such as acne vulgaris and leishmaniasis, as well as for treating premature skin aging due to sun exposure. The production of reactive oxygen intermediates like singlet oxygen depends on the light dose applied as well as the concentration and localization of the photosensitizer in the diseased tissue. Either cytotoxic effects resulting in tumor destruction or immunomodulatory effects improving inflammatory skin conditions are induced. Treating superficial non-melanoma skin cancer, PDT has been shown to be highly efficient, despite the low level of invasiveness. The excellent cosmetic results after treatment are beneficial, too.

Lasers for tattoo removal: a review

Tattoos have existed and have been used as an expression of art by man for ages—and so have the techniques to remove them. Lasers based on the principle of selective photothermolysis are now being used to remove black as well as colorful tattoos with varying successes. The commonly used lasers for tattoo removal are the Q-switched 694-nm ruby laser, the Q-switched 755-nm alexandrite laser, the 1,064-nm Nd:YAG laser, and the 532-nm Nd:YAG laser. Newer techniques and methods are evolving in tattoo removal with lasers. Choosing the right laser for the right tattoo color is necessary for a successful outcome. Our review aims to understand the principles of laser tattoo removal and their applications for different types and colors of tattoos. The review also highlights the complications that can occur such as dyspigmentation, allergic reactions, epidermal debris, ink darkening, and so on, in this process and how to prevent them.

Surgical Treatments for Lentigo Maligna: A Review

BACKGROUND Since its initial description by Jonathan Hutchinson 120 years ago, a substantial amount of research has occurred to determine the optimum surgical therapy for lentigo maligna (LM). OBJECTIVE To summarize the literature regarding the surgical treatment of LM. METHODS We searched the National Library of Medicine using Pubmed Central and MEDLINE and included as many investigational reports regarding LM therapy that were available in an attempt to form a comprehensive review of surgical modalities. The key words “lentigo maligna,”“lentigo maligna treatment,”“lentigo maligna therapy,” and “lentigo maligna therapeutic modalities” were used. RESULTS We included 12 studies examining staged surgical excision (SSE), nine using Mohs micrographic surgery (MMS), six investigating cryosurgery, 22 investigating imiquimod, seven using lasers, nine investigating radiation therapy, and two investigating electrosurgery and curettage. CONCLUSIONS SSE and MMS are associated with the lowest recurrence rates for LM. Cryotherapy and radiation therapy may be considered the options for treatment of LM in patients who cannot tolerate surgery. Imiquimod, although not currently approved by the FDA, has shown some efficacy in limited experimental studies and may play a future role in the treatment of LM. The authors have indicated no significant interest with commercial supporters.

Nonablative radiofrequency for skin rejuvenation.

There is growing interest in a wide range of nonablative interventions that, predictably, are claimed to rejuvenate skin and subcutaneous tissue “safely and effectively.” Although for many years surgery in its many forms has been the criterion standard treatment in aesthetic aspect of aging, nonsurg

Lasers in the treatment of nonmelanoma skin cancer.

BACKGROUND Nonmelanoma skin cancers (NMSCs) constitute the largest proportion of cancers worldwide, especially in the Western population, making it essential to develop methods to manage these cancers. Ultraviolet (UV) light being the most significant culprit in the development of NMSCs makes the sun‐exposed parts of the body, such as face and extremities, the most vulnerable to develop these tumors. Early diagnosis and emphasis on cosmesis are vital while treating them especially, in patients with multiple squamous and basal cell carcinomas. Lasers seem to be a useful therapeutic modality and are being explored to develop them as a tool for treating skin cancers. OBJECTIVE To review the use of lasers in the treatment of NMSCs. METHODS We reviewed articles that involved the use of lasers in the management of NMSCs and prepared a critical analysis of the same. RESULTS AND CONCLUSIONS Lasers as a single modality, as the coherent light source in photodynamic therapy (PDT), or as an adjunct to PDT or other treatment modalities are a potential method of NMSC eradication. Superficial NMSCs and most precancerous cutaneous lesions such as Bowens disease and actinic keratoses respond best, whereas deeper, more‐aggressive NMSCs show poor outcomes with laser treatments. The authors have indicated no significant interest with commercial supporters.

Emerging treatments in alopecia

Introduction: Alopecia is a common concern encountered in the medical practice. Treatment approach varies according to the type and severity of alopecia. However, available treatment options have limited efficacy and several adverse effects. Presently, there are different treatment options being studied to overcome these limitations. Additionally, cellular pathways involved in the pathophysiology of alopecia are further being clarified to potentially target pathogenic molecules. Areas covered: We searched the literature for recently published articles discussing new treatment options as well as mechanisms involved in alopecia. We discuss the use of stem cells, growth factors, cellular pathways and robotic hair transplant, among other emerging therapies used for alopecia. Expert opinion: Future looks very promising and new effective treatments such as janus kinase inhibitors could possibly be available for alopecia areata. The stem-cell technology is advancing and companies involved in hair follicle neogenesis are starting clinical trials on patients with androgenetic alopecia.

Updates on the Pathophysiology and Management of Acne Rosacea

Abstract There are many options for the treatment of acne rosacea, including topical and systemic therapies, laser and light-based therapies, and surgical procedures. A classification system for rosacea identifies 4 subtypes (ie, erythematotelangiectatic, papulopustular, phymatous, and ocular), which may help guide therapeutic decision making. Until recently, the pathophysiology of acne rosacea has been poorly understood and limited to descriptions of factors that exacerbate or improve this disorder. Recent molecular studies suggest that an altered innate immune response is involved in the pathogenesis of the vascular and inflammatory disease seen in patients with rosacea. These findings may help explain the benefits of current treatments and suggest new therapeutic strategies helpful for alleviating this disease. The goals of therapy include reduction of papules, pustules, erythema, physical discomfort, and an improvement in quality of life. Standard topical treatment agents include metronidazole, azelaic acid, and sodium sulfacetamide-sulfur. Second-line therapies include benzoyl peroxide, clindamycin, calcineurin inhibitors, and permethrin. There are also various systemic therapy options.

Coma blisters in two postoperative patients.

Coma blisters are self-limited cutaneous bullae that occur in the setting of loss of consciousness because of a drug, illness, or accident, with the most common settings being barbiturate overdose and neurological disorders. The etiology behind coma blisters is poorly understood and is not related to underlying infections or autoimmune conditions. The clinical presentation consists of bullae, erosions, and violaceous plaques usually involving sites of pressure. The skin lesions usually occur within 48-72 hours of the start of a coma and resolve within 2-4 weeks. We present one case of a 5-month-old infant with severe valvular disease who required surgical repair. He was placed on extra corporeal membrane oxygenation and developed multiple tense coma blisters during the course of therapy. Skin biopsy revealed a noninflammatory subepidermal blister with necrosis of the overlying epidermis and necrosis of the eccrine ducts. We also present a second case of an 18-year-old female patient who underwent surgical resection of a benign mandibular tumor. She subsequently developed bullae on both arms 4 days after surgery. The skin biopsy showed a necrotic epidermis, a subepidermal blister, and diffuse necrosis of the eccrine coils.

Original Contribution: Photodynamic therapy in the management of acne: an update

Acne, one of the most common dermatological diseases, is characterized by inflammatory and noninflammatory lesions that may progress to scars. Starting from pubertal age groups, it can affect adults in the age group 35–40 or more. The conventional therapies for treatment of acne are facing roadblocks because of the antibiotic resistance developing against Propionibacterium acnes. This has led to trying new therapies, of which photodynamic therapy (PDT) seems to be the one under intensive study. Promising results have been observed with PDT use in acne treatment, but it still has some more way to go to acquire the FDA approval for use in acne treatment. This is a review of the literature of use of PDT in treatment of acne, providing a starting point for dermatologists seeking to treat their patients with acne safely and effectively with this new method.

Photodynamic therapy in the management of acne: an update.

Acne, one of the most common dermatological diseases, is characterized by inflammatory and noninflammatory lesions that may progress to scars. Starting from pubertal age groups, it can affect adults in the age group 35–40 or more. The conventional therapies for treatment of acne are facing roadblocks because of the antibiotic resistance developing against Propionibacterium acnes. This has led to trying new therapies, of which photodynamic therapy (PDT) seems to be the one under intensive study. Promising results have been observed with PDT use in acne treatment, but it still has some more way to go to acquire the FDA approval for use in acne treatment. This is a review of the literature of use of PDT in treatment of acne, providing a starting point for dermatologists seeking to treat their patients with acne safely and effectively with this new method.