Theodor Karamfilov

Treatment of common warts and actinic keratoses by Er:YAG laser

BACKGROUND AND OBJECTIVES: The use of ablative lasers in the treatment of common warts and precancerous actinic keratoses has been reported in the literature, showing variable response rates and relapse rates. The erbium:YAG laser (Er:YAG) with a wavelength of 2.94 w m allows precise ablation avoiding strong inflammation. The authors have evaluated the potential benefits of Er:YAG laser treatment for difficult-to-treat warts and actinic keratoses. PATIENTS AND METHODS: A total of 69 patients with difficult-to-treat warts (periungual or plantar) with a mean age of 30.1 - 16.1 years (range 11-58 years), and 29 patients with actinic keratoses with a mean age of 73.5 - 9.7 years (range 58-90 years) were treated by Er:YAG laser. Ablative therapy was performed with a spot size of 3 mm, a frequency between 8 Hz and 15 Hz, and a fluence of 5.7-11.3 J cm -2 (warts) or 5.7-7.1 J cm -2 (actinic keratoses). RESULTS: After a single laser treatment a complete response (CR) was observed in 50 patients with warts (72.5%). Plantar warts were more resistant (13.5% non-responder) compared with periungual warts (5.9% non-responder). Twelve patients with a CR showed a relapse within 3 months after treatment (24.0%). All but one suffered from plantar warts. Twenty-six patients with actinic keratoses showed a CR after a single laser treatment, and in three patients a partial response (PR) was achieved. None of the patients treated with Er:YAG laser developed pigment changes, wound infections or scarring. CONCLUSION: Treatment of common epithelial lesions such as common warts or actinic keratoses by Er:YAG laser is safe and effective. In patients with plantar warts, however, a significant rate of relapse may occur, requiring additional therapy.

Botulinum toxin A for palmar hyperhidrosis.

Objective We evaluated the efficacy and safety of intracutaneous injections of botulinum toxin A on severe palmar hyperhidrosis.

Intracutaneous botulinum toxin A versus ablative therapy of Hailey-Hailey disease--a case report.

BACKGROUND: Hailey-Hailey disease is an autosomal-dominant blistering disease affecting the intertriginous skin. Dermabrasion and ablative laser treatment are known to be curative. Sweating is a common aggravating factor. Botulinum toxin A (BTXA) has been shown to inhibit sudoriferic nerves. OBJECTIVE: To evaluate whether a treatment with BTXA induces remissions and can compete with ablative therapy. To compare dermabrasion with erbium:YAG laser therapy. METHOD: Case report with side-by-side comparison. We used intracutaneous BTXA on both sides of the submammary region. Four days later a limited area of 25 cm 2 on each side was treated with either dermabrasion or erbium:YAG laser. The follow-up was 12 months. RESULTS: Wound healing was complete within 7 days after erbium:YAG laser and two weeks after dermabrasion. Areas treated with BTXA alone also showed complete remission within two weeks. During a follow-up, no relapse occurred with either treatment. CONCLUSION: BTXA is capable of inducing remissions of Hailey-Hailey disease without abrasion for at least 12 months. Among ablative treatments, erbium: YAG laser therapy leads to a more rapid wound closure than dermabrasion, with both causing complete remissions.

Treatment of recalcitrant ulcers in pyoderma gangrenosum with mycophenolate mofetil and autologous keratinocyte transplantation on a hyaluronic acid matrix.

Pyoderma gangrenosum sometimes takes a recalcitrant course that is unresponsive to standard immunosuppression with corticosteroids and/or cyclosporin A. In these cases improvement of painful ulcerations is a therapeutic challenge. We report a 17‐year‐old boy with severe pyoderma gangrenosum treated successfully with mycophenolate mofetil and autologous keratinocyte transplantation using an esterified hyluronic acid delivery system.

Remittance spectroscopy mapping of human skin in vivo

Remittance spectroscopy of human skin may be influenced by probe application pressure and body site.

Effects of adjuvant interferon-alpha low-dose therapy in melanoma patients on serum inhibin B.

Because the primary aim of adjuvant therapy for melanoma is not curative, all the possible aspects of quality of life have to be considered. One aspect of increasing importance is fertility. The effect of adjuvant interferon α‐therapy for malignant melanoma on male fertility has not been systematically investigated. In the present study, twelve male patients with primary cutaneous melanoma (pT3, 4; N0; M0) who were taking adjuvant low‐dose interferon α2b (3 times 3 mio U/week) for one year were included. Inhibin B—an established marker of male fertility—was measured with an immunosorbent assay before and after one year of interferon α‐therapy to investigate whether this treatment has any influence on fertility. The results were compared with those from normal controls (n=40). The mean serum inhibin B concentration in melanoma patients before interferon therapy was 225.4 ± 112.5 pg/mL; after treatment the level was 229.6 ± 82.0 pg/mL. This difference was not statistically significant (p>0.05). The serum inhibin B concentration in controls was 201.5 ± 17.1 pg/mL, which was not statistically different from either untreated or interferon‐treated melanoma patients (p>0.05). We conclude that low‐dose interferon α does not have a significant (negative) effect on inhibin B or male fertility.