Results of Photopatch and Patch Tests in 35 Korean Patients with Chronic Actinic Dermatitis and Clinical Importance of These Findings / 대한피부과학회지

BACKGROUND: Chronic actinic dermatitis (CAD) is a rare disease worldwide. It has been defined on the basis of three criteria: 1) clinical - a persistent eczematous eruption on sun- exposed area with possible extension into non-exposed areas, 2) photobiological - a reduction in the minimal erythema dose to UVB irradiation, and possibly longer wavelengths, and 3) histologic - an appearance consistent with chronic eczema, with or without the presence of lymphoma-like changes. However, only a few clinicohistopathologic and photobiological analyses of CAD have been undertaken in Korea. OBJECTIVE: To explore photoallergens and/or allergens causing or thought to be associated with CAD in Korean patients, and to compare the photopatch or patch test results in Korea with those from other countries. METHODS: Thirty-five Korean patients with CAD were enrolled for this study. Photopatch tests were carried out by applying two sets of the Scandinavian photopatch series to each patient. Two days after application, the photopatch tests were analysed, and one set of the photoallergens was irradiated with 50% of the MED-UVA. Both sets of photoallergens were examined 2 days later. A European standard series was used to assess the patch tests. At two and four days after application, patch tests were analysed. RESULT: Twenty-seven of the 35 patients (77.1%) who had photopatch tests showed positive responses; balsam of Peru, promethazine HCl, perfume mix, fentichlor, chlorhexidine digluconate, and chlorpromazine HCl were the common photoallergens that elicited a positive response. Twenty-one of the 35 patients (70%) showed allergy to nickel, chrome, and/or ammoniated mercury. Noticeably, photoallergens such as balsam of Peru, perfume mix, cobalt, and captan revealed positive reactions in the patch tests, too. CONCLUSION: In 77.1% and 74.3% of CAD patients, photoallergens and allergens were identified, respectively. Among them, 57.1% showed positive reactions including both photopatch and patch tests. After the most frequent photoallergens, perfume and spices, and phenothiazines or related antihistamines ranked next and were found to be a unique characteristic to Korea. Photopatch and patchtests are the method for detecting photoallergens and allergens as important initiating agents and are the diagnostic tool for the epidemiologic study of CAD.

A Case of Eccrine Chromhidriosis / 대한피부과학회지

Chromhidriosis or the production of colored sweat is a rare clinical finding. Several dyes, when injected intravenously, have been shown to be secreted in eccrine gland, but in most cases the sweat is colored in skin surface, resulting from the contamination by dyes, pigment from microorganisms, or other chemicals. We report a case of eccrine chromhidriosis which revealed blue-green spots on palms, soles, buttocks, and back.

Median Raphe Cyst of the Glans Penis / 대한피부과학회지

Median raphe cyst of the penis is an uncommon entity that usually presents as a cystic lesion on the ventral aspect of the penis, and which has a broad spectrum of histopathological appearances. It occurs most commonly near the glans penis, but may occur anywhere from the urethral meatus to the anus. It is solitary and measures only a few millimeters in diameter. Surgical excision is the treatment of choice. Recently we observed an 18-year-old male patient who had had a median raphe cyst since 5 years ago near the urethral orifice of the glans penis.

A Case of Subcutaneous Panniculitic T-cell Lymphoma

We herein report a case of subcutaneous panniculitic T-cell lymphoma which occurred in a 48-year-old Korean woman. Her disease presented as multiple subcutaneous nodules on the arms, legs, and abdomen, with systemic symptoms and signs. From the results of immunophenotypic studies, we suggest her disease may originate from cytotoxic T-lymphocytes. The patient had a protracted course of multiple dark-red-colored subcutaneous nodules on both arms, legs, and abdomen for 1 year, often with fever, chills, and malaise. Histopathologic findings for the subcutaneous nodule in the lower abdomen revealed diffuse infiltration of atypical lymphocytes in the subcutis, with extensive fat necrosis and karyorrhexis and a bean-bag cell appearance with engulfed lymphocytes in some histiocytes. The immunophenotypic studies showed a cytotoxic T-lymphocyte profile, i. e., LCA+, lysozyme+, UCHL1+, CD8+, CD20-, CD30-, and CD56-. In situ hybridization studies for the Epstein-Barr virus genome resulted in a negative finding. A lymphadenopathy was found in the right upper paratracheal area on the chest CT associated with pancytopenia and abnormal LFT findings. She received high-dose chemotherapy with autologous blood stem cell transplantation, but died after 6 months.

Primary Sjogren's syndrome manifested as multiple sclerosis and cutaneous erythematous lesions: a case report

Sjogren's syndrome is a chronic autoimmune disorder characterized by lymphocytic infiltration of the lacrimal and salivary glands, leading to dryness of eyes (kerato-conjunctivitis sicca) and mouth (xerostomia). The skin lesions in Sjogren's syndrome are usually manifested as xeroderma, but sometimes appear as annular erythema or vasculitis. Central nervous system symptoms may be presented as one of extraglandular manifestations, though rare in incidence, and need differential diagnosis from multiple sclerosis. We report a case of a 45-year-old woman diagnosed as multiple sclerosis at first but later as neurologic manifestation of primary Sjogren's syndrome, showing signs of multiple sclerosis and cutaneous erythematous lesions.

Facial Reconstruction with Local Flap after Mohs Micrographic Surgery of Basal Cell Carcinoma / 대한피부과학회지

BACKGROUND: Up to eighty percent of all basal cell carcinomas occur in the head and neck region. Mohs micrographic surgery(MMS) was known as an ideal treatment for primary or secondary basal cell carcinoma. The surgical defects after the removal of malignant skin lesions are usually reconstructed with secondary intention, primary closure, skin graft, and local flap. When we reconstruct the surgical defect, we must consider the reconstruction method, defect site or size, recurrence, patient age, general health state, and functional and cosmetic aspects. OBJECTIVE: The purpose of this study was to evaluate the cure rate and the reconstruction method(especially, local flap reconstruction) by the cosmetic unit of the face after MMS. METHODS: From March 1991 to February 1998, fifty-seven patients were diagnosed histologically with basal cell carcinoma on the face at the department of dermatology of our unit. All the tumors were removed with MMS. According to the facial cosmetic unit, we divided the face into nose, cheek, eyelid, forehead, and temple. We reviewed the local flaps after Mohs micrographic surgery of basal cell carcinoma. RESULTS: 1. 50 of the 57 patients(86%) who had been diagnosed as basal cell carcinoma visited our hospital after their tumors increased over 10mm. Only one case among the fifty seven cases having MMS showed recurrence which means cure rate is ninty eight percent. 2. The forty two patients(74%) who had basal cell carcinoma on the head and neck were treated with local flap, ten patients(17%) were treated with primary closure, and five patients(9%) were treated with skin graft to reconstruct skin defect after MMS. 3. Reconstruction of the nose after MMS of basal cell carcinoma : Of the twenty nine patients that had basal cell carcinoma on the nose twenty four were local flap. The large defects were repaired by glabella and nasolabial flap, while small defects were Banner flap, and Limberg flap. 4. Reconstruction of the the cheek after MMS of basal cell carcinoma : Of the twelve patients that had basal cell carcinoma on the cheek ten were local flap. We preferred to reconstruct the cheek with cheek rotation flap. 5. Reconstruction of the eyelid after MMS of basal cell carcinoma : Of the eight patients that had basal cell carcinoma on the eyelid five were local flap. The depth of invasion was limited to the anterior lamella. We reconstructed the eyelid with variable local flap like unipedicle flap, bipedicle Tripier flap, cheek advancement flap, and glabella flap. 6. Reconstruction of the forehead, temple, scalp, and auricle after MMS of basal cell carcinoma : Of the eight patients that had basal cell carcinoma on the temple, scalp, and auricle three were local flap. We reconstructed the defects with scalp rotation flap, glabella rotation flap, and Banner flap. CONCLUSION: MMS is an ideal method for the treatment of basal cell carcinomas in that it provides 98% cure rates and maximum preservation of normal tissue by complete surgical margin control. Because of high cure rates(98%) after MMS, we can reconstruct the head and neck, especially face with the local flap which obtained the desired result functionally and aesthetically compared with other reconstruction methods like skin graft and secondary intention.

Reconstruction of the Nose with Local Flap ater Mohs Micrographic Surgery of Basal Cell Carcinoma / 대한피부과학회지

BACKGROUND: An aggressive skin cancer on the nose, tends to have poorly defined clinical margins, and has a higher recurrence rate. A small tumor on the nose is usually easily treated by any of the standard methods. However, removal and reconstruction with preserved cosmesis is more laborous in a basal cell carcinoma larger than 10 mm in diameter. This is because the nose has complex contoures, unique skin color and texture, and the limited availability of mobile adjacent skin. When available Mohs micrographic surgery is the preferred treatment for these large tumors. OBJECTIVE: Our purpose was to investigate the preferred reconstruction method(especially, local flap reconstruction) by the cosmetic unit of the nose after Mohs micrographic surgery. METHODS: From March 1991 to February 1997, twenty-one patients were diagnosed with basal cell carcinoma on the nose at our department. All the tumors were removed with Mohs micrographic surgery, and then the defects were reconstructed with a primary closure, skin graft, and local flap.

Clinical Study of Vitiligo / 대한피부과학회지

BACKGROUND: Vitiligo is an acquired depigmentary disorder of the skin and hair. The etiology is unknown, however an autoimmune hypothesis is favored. OBJECTIVE: We performed this study to develop a better understanding of the clinical features of vitiligo patients. METHOD: We evaluated clinical manifestations of 1203 vitiligo patients(556 males and 647 females). RESULTS AND CONCLUSIONS: 1. The mean age of onset and that of the first visits made by patients were 22.9+/-18 and 27.9+/-19 years, respectively. 2. The face(37.4%) was the most common site of initial involvement. In decreasing order of frequency, the common sites of involvement were the face and neck(65.9%), thorax and abdomen(42.9%), upper extremities(42.3%). 44.5% of the cases had the vulgaris type, 26.1% the focal type, and 21.1% the segmental type. During the three months before a visit, 44% of patients experienced progression of disease. Within one year, about 75% of patients reported that the disease had progressed. 3. Precipitating or aggravating factors such as trauma(13.1%), psychological stress(9.2%), sun light (2.8%) and pregnancy(2.5%), were found in 30.9% of patients. Thyroid disease was the most common associated disease.

A Case of Radiation-Induced Pemphigus

Radiation induced pemphigus, as an example of induced pemphigus, is a rare disease which occurs in patients receiving radiotherapy. A 56-year-old male patient with nasopharyngeal cancer received 3 cycles of chemotherapy and radiotherapy on the neck and anterior chest areas. One month after completion of radio-therapy, eroded and crusted areas developed within the irradiation site. In spite of systemic antibiotic treatment, the skin lesions persisted and spread further to the trunk and upper extremities with new crops of bullae. He was treated with a high dose of prednisolone and the skin lesions cleared. We discuss the suggestive pathogenesis of radiation-induced pemphigus with the comparative results of immunoblotting in various variants of pemphigus.

Expression of Metallothionein in the Neoplasms of Ectodermal Origin / 대한피부과학회지

BACKGROUND: Metallothioneins(MTs) are ubiquitous low molecular weight cytosolic proteins with high contents of cystein that xhibit a selective binding affinity for zinc, copper and other group II heavy metal ions. In additi~on to the sequestration function and detoxification action, MTs probably participate in the cellirlar protection against. ionizing radiation and alkylating agent cytotoxicity and in cellular pn:liferation. OBJECT: The objective of this study was to evaIuate the expression of MTs and to clarify t.heir role in carcinogenesis and/or biological behaviour in the neoplasms of ectoderrnal origin. METHODS: We performed immunohistochemical studies on the surgical specimens of rnalignant rnelanoma and squamous cell carcinoma and basal cell carcinoma. The results were compared with the normal skin and mu osa and hair t,issues and raf't-on culture tissues of skin and mucosal keratinocytes. RESULTS: 1) MTs were strongly expressed in epidermal basal cells of the normal skin and raft-on cultured artificial skin They were also rnore weakly expressed in epithelial basal cells of the normal mucosa and raft on cultured artificial mucosa and in matrix cells of the normal hair. 2) In rnalignant melanoma, MTs were meaningfully expressed, i.e., a strong expression was seen in the lesions showing a rapid vertical growth phase with fatal out,comes, but a weak expression in the cases whose precursor lesions were thought as dysplastic nevi, compared to the negative finding of norrnal melanocyt,es. The strong expression in a case of congenit.al rnelanocyt.ic nevus is considered as the activation of nevoid melanocytes. 3) MTs were weakly expressed in squarnous cell carcinoma with a diffuse aattern within the tumor mass. St,rong expression of MTs was particularly apparent in the poorl. differentiated squamous cell carcinoma and at the growing border of well differentiated squamous cell carcinoma. 4) In basal cell carcinoma, MTs were rather weakly expressed in solid cireumscribed types with a diffuse pattern and in cystic type with a patchy pattern. However they were not expressed in the solid infiltrative type. CONCLUSION: From these resuilts, we concluded that MTs were ubiquitously present in possible stem cells of various epithelial tissues except melanocytes irrespective of normal or artificial skin and/or mucosa including norrnal hair tissues. In the neoplasms of ectodermal origin, MTs might be involved in the invasive growth of tumor cells in the malignant melanoma and squamous cell carcinoma. It was implied that the role of MTs in basal cell carcinoma might be related to early events of hasal cell carcinogeresis and its down regulating tendency could be possible in its infil trative stage.

Comedonal Darier's Disease

Darier's disease is a well-known genodermatosis characterized by recurrent waxy, hyperkeratotic papules usually occurring over the seborrheic area. The major histopathological changes are characteristic acantholysis and dyskeratosis which are diagnostic of the disease with typical clinical features. There are less common variants including the hypertrophic, vesicobullous and linear type. However, comedonal lesions are very rare. We report an unusual case of Darier's disease, which showed prominent comedonal papules and plaques over the face, scalp and upper trunk with the typical findings of Darier's disease.

A Study of Tissue Invasion of Basal Cell Carcinoma by Mohs Micrographic Surgery / 대한피부과학회지

BACKGROUND: Mohs micrographic surgery is an ideal method for removing the BCC completely. Several studies defining proper lateral margin for excision of BCC have been reported. However, the study of invasion depth of BCC has not been specially addressed. OBJECTIVE: In our study, we evaluated the safety lateral margin as well as depth of excision of BCC and the correlation with the histopathological aspects by using Mohs micrographic surgery technique. METHODS: Fourty nine patients with BCCs(29 primary, 20 recurrent) diagnosed in the Department of Dermatology of Dong-A University Hospital from March, 1991 through February, 1997 were studied prospectively. RESUTLS: 1. Fifty five percent of tumors in our series had 2mm maxumal margins and 70% of recurrent BCC were eradicated with 4-mm more lateral margins. 2. Sixty two percent of BCC located in the cheek was eradicated with the excision within the mid-subcutaneous fat and more than 76% of the tumor in the nose required the removal of the periosteum or perichondrium. 3. In Ninety five percent of BCC, less than 14mm required a 4mm lateral margin and only 5% required a 6mm margin. However, seventy two percent of BCC was eradicated with a 4mm lateral margin and more than 36% was eradicated with a 6-mm or more lateral margin. 4. Eight percent of the micronodular type required 4mm or more lateral margins and had a tendency to invade more deeply. All nodular micronodular-infiltrative BCC had 4mm or more maximal subclinical extension and periosteum/perichondrial or deeper vertical invasion. CONCLUSION: Mohs micrographic surgery is an appropriate tool to use in proposing guidelines for treatment for BCC and clinicopathological characteristics of BCC such as anatomic location, tumor size, histopathological subtype may be helpful to plan the proper surgical margins.

p53 Protein and Skin Sulfhydryl Oxidase Expression in Squamous Cell Carcinoma and precancerosis of Skin / 대한피부과학회지

BACKGROUND: Extensive study of the p53 gene has established its role as a tumor-suppressor gene, and the mutant p53 gene is expressed in a wide spectrum of human malignancy. The conversion of sulfhydryl groups to disulfide bonds in epidermis is carried out by skin sulfhydryl oxidase(SSO) at the junction of the granular layer and horny layers. So it is of interest to investigate the localization and properties of SSO in epidermal keratinocytic neoplasms. OBJECTIVE: Our purpose is to investigate the expression pattern of the p53 protein and SSO and to gain a better understanding of biologic behavior in epidermal keratinocytic neoplasms. METHODS: We investigated the expression pattern of p53 protein and SSO by immunohistochemical method on formalin-fixed, paraffin-embedded tissue specimens in 8 cases of squamous cell carcinomas, several cases of recancerosis(1 Bowen's disease, 1 actinic keratosis, 1 arsenic keratosis) and benign keratinizing disorders(1 verruca vulgaris, 1 condyloma accuminatum and 2 cases of lichen planus). RESULTS: 1. Seven out of 8 cases of squamous cell carcinama(88%) and 1 case of 1 Bowen's disease showed p53 protein expression 2. SSO was weakly present in squamous cell carcinoma and precancerosis compared to the normal skin. In the well differentiated squamous cell carcinoma and Bowen's disease, the presence of SSO was rather diffuse than poorly differentiated squamous cell carcinoma and concentrated in dyskeratotic cells and horn pearls. 3. p53-stained cells or areas were seldom stained with SSO antibody, especially in invading borders of squamous cell carcinomas. CONCLUSION: Our results suggest that p53 mutation is a common genetic change in epidermal tumorigenesis and it can be useful marker of tumor invasion in the squamous cell carcinoma and precacerosis of skin.

Ichthyosis Linearis Circumflexa

The authors present a 3-year-old boy showing generalized migratory erythema with doubleedged scaling broders since 3 month after birth, Histologic examination revealed an acanthotic epidermis with hyperkeratosis, focal parakeratosis and papillomatosis. The PAS-positive, diastase-resistant amorphous materials were found in th space of parakeratoric scales and cytoplasms of spinous cells just below the parakeraroric lesion. On clectron microscopy, we could observe the round dense bodise in the upper spinous cells and a number of lipoid granules in the horny layer. Our patient showed characteristic clinical, clinical, microscopic and ultrastructural gearures of ichthyosis linearis citcumflexa(ILC). However, he showed no hair shaft abnormalities, which is the common finding of Metherthon/sysdrome(NS) along with ILC and atopic deathesis.

A Study of Subclinical Extension of Basal Cell Carcinoma by Mohs Micrographic Surgery

BACKGROUND: Basal cell carcinoma(BCC) is the most common primary cutaneous neoplasm in Korea. Since the majority of BCCs occur on the head and neck and the goal of the BCC treatment is the complete removal of tumor, Mohs micrographic surgery is ideally suited for maximizing cure rate with minimizing tissue loss. OBJECTIVE: The purpose of this study is to evaluate the depth of excision as well as the lateral margins of BCC and to correlate these with the clinicopathologic aspects of the tumors. METHODS: Twenty patients with 21 BCCs (10 primary, 11 recurrent) diagnosed in the Department of Dermatology of Dong-A University Hospital from March, 1992 through December, 1993 were studied prospectively. RESULTS: 1. Sixty percent of tumors in primary BCCs in our series had a 2-mm maximal margin and 81.8% of recurrent BCC were eradicated with 4-mm or more lateral margin. 2. All the recurrent basal cell carcinomas (8 cases) measuring greater than 15-mm required more than 4-mm margin for the total removal. 3. More than 90% of BCC on the nose in our series required the removal of periosteum/perichondrium or the excision of whole layer. CONCLUSION: Mohs micrographic surgery is an appropriate tool to use in proposing guidelines for the treatment of skin cancer because the most accurate method of determining the actual extent of skin cancer can be achieved.

Successful Treatment of an Infant with Kasabach - Merritt Syndrome with Interferon Alfa - 2a / 대한피부과학회지

Kasabach- Merritt syndrame consists of thrombocytopenia, microangiopathic hemolytic anemia, and an acute or chronic censumptive coagulopathy in associati an with a rapidly enlarging hemangioma. Most vascular turrnrs causing Kasabach-Merritt syndon e are benign but the associated coagulopathy may be lifethreatening. Our patient, a 30-day-old female infant, was admitted after an increase in the size of a hemangioma present since birth on the right leg with extension to the lower abdomen and left inguinal area. Her herrnglobin count fell to 7.1g/dl, platelet count was 26,000/ul, prothrombin time was 26 seconds, and hypofibrinogenemia developed. The patient was treated with transfusions of platelets, fresh frozen plasma and red cells and prednisolone. for 2 weeks without improvement. We started interferon alfa-2a therapy. Over the past 6 months, he hemangioma progressively diminished in size withcut any serious complication.

Primary Cutaneous B Cell Lymphoma

We report a case of B-cell lymphoma primarily involving the skin in a 12-year-old boy. The histopathologic findings were compatible with those of small lymphocytic type of non-Hodgkin's lymphoma. A cutaneous lesion was the sole manifestation of his disease without any other organ involvement. Immunophenotypic studies and immunoglobulin gene rearrangement with Southern blot analysis determined its lineages and monoclonality with result of B-cell lineage neoplasm, i. d. CD20⁺, C1323⁺, CD35⁻ and rearranged band on JH probe. We treated him with surgical excision and CVP regimen of chemotherapy (cyclophosphamide, vincristine, prednisolone). There is no recurrence or metastasis during the last six months.

A Case of Toxic Pustuloderma / 대한피부과학회지

Generalized sterile pustular eruptions occur in various dermatoses including pustular psoriasis, erythema multiforme, Sneddon-Wilkinsan disease and others. Recentlr, acute eruptions of disseminated sterile pustules have been reported. The etiology is not related to a gepetic predisposition to psoriasis but to drug ingestion or viral infections, thus termed toxic pustuloderm; (T. P.). In this report, we present a typical case of T. P. observed iu our department. Our patient, an 18-year-old male, with no personal or family history of psoriasis, was given drug medication including amoxicillin for fever and chilling sensation. Pustilar eruptions first, appeared on his face about two days aft.er the medication and gradually spread to the trunk and limbs. The skin examination revealed numerous small pustules on an erythematous base. Laboratory examination revealed neutrophilic leukocytosis and an elevated sedimentation rate skin biopsy showed subeorneal and spongiform neutrophilic pustules Upon interruption of the amoxicillin, the pustules cleared rapidly in 3 days and there has been ri.o recui rence of any rash over a 7-month follow-up period.

Allergic Contact Dermatitis due to Befunolol Hydrochloride in 0 . 5 % BentosR Eyedrops / 대한피부과학회지

Befunolol hydrochloride is a B-adrenergic receptor antagonist cornnory used topically in treatment of glaucoma because of a satisfactory intraocular pressure lowering apcity without relevant topical or systemic side effects. We repart herein a case of allergic contact dermatit.is due to befunc ol nydrochloride in 0.5% Bentos eyedrops, A 52-year-old Korean woman had suffered from erythemanedema with itching sensation on her left eye since Novembeir 18, 1992. She had used various ophtalrnic preparations including Bentos eyedrops containing befinolol hydrochloride 0,5% as its activ cinstituent since October, 1992 for treatment of glaucoma of her left eye. Patch test with the European standard series, rubber series, the patiants eyedrops and their individual constituents showed positive. reactions only to 0.5% Bentos eyedrops(as is) and to befunolol hydrochloride. We noted rapid improvement of skin lesions and syipsms after the withdrawal of Bentos eyedrops and applicatior of another B-blocker(carteolol hydrocilcide).

A Study of the Therapeutic Effect of Rosacea by the Flashlamp - Pumped Pulsed Dye Laser ( SPTL - 1 ) / 대한피부과학회지

BACKGROUND: Persistent facial elangiectssia, erythema, and flushing are the major cosmetic problems in patients with rosacea, However various therapeutic modalities for roacea papules and pustules, including topical antibiotics, systemic antibiotics, isotretinoin, and systernic and topical metronidazole, are not effective in reducing telangiectasia and flushing reactions present inrosacea patients. The flashlamp-pumped pulsed dye laser has been deacribed as a succqssful treatment for port wine stains with telangiectasia as part of their abnomalities. A clinical study was therefore undertaken in a group of rosacea patients, who recieves this laser to areas of facial taieous lesions. OBJECTIVE: The purpose of the study was to evaluate the therapeutic effect of the flashlamp-pumped pulsed dye laser(SPTL-1) for osacea, especially telangiectasia and flusing reactions. METHODS: Forty-eight. patient with rosacea were studied to evaluatic the therapeutic effects of the SPTL-1 flashlamp-pumped pulsed dye laser (Candela corp.Wayland Mass.) at the Department of Dermatology in Dong-A University Hospital for 20 months from Januarg 1991 to August 1992. RESULTS: 1. Total therapeutic effects of this SPTL-1 laser showed excellent re:ults in 22.9%, good in 62.5%, fair in 8.3%, and poor in 6.3%. 2. Therapeutic effects of rosacea-associated lesions showed exeellerit or good results in 85.4% of patient,s with erythema and telangiectasia, 84% patients with papules, 100% patients with pustules, and 93.7% of patients with facial flushing. 3. Complications included trarsient hyperpigmentation (14.6%), section lary bacterial infection(6.3%), hypopigmentation(2.1%), and atropic scar(2.1%). 4. The recurrence rat.e was 2,9,%. CONCLUSION: The flashlamp-pumped pulsed dye laser (SPTL-1) is a dry effective mode of treatment for rosacea, including persistent telangiectasia and facial flushing ri.actions which were intractable to previous other therapeutic modalities.