Severe Papulopustular Rosacea with Demodicosis in a 47-year-old Filipino female: A case report

Introduction@# Rosacea is a chronic relapsing inflammatory facial dermatosis often characterized by flare-ups and remissions exclusively affecting the centrofacial skin.@*Case report@#This is a case of multiple symmetric intensely erythematous papules, pustules, and plaques over both cheeks in a 47-year-old Filipino female. Dermoscopy showed brown-yellowish structureless areas, straight vessels in a polygonal pattern, dilated follicles, follicular plugs, ill-defined white rosettes, and non-specific scales. Skin punch biopsy showed spongiosis of the epidermis and demodex folliculorum within the follicular infundibulum. The dermis revealed telangiectasia of blood vessels and dense inflammatory infiltrates. Hypertrophy of sebaceous lobules was also seen. The patient was initially treated with oral lymecycline 300mg twice a day for 2 weeks without improvement. Due to the persistence of centrofacial erythema, papules and pustules, the patient was given prednisone 10mg once a day for 1 month and low dose isotretinoin 10mg once a day for 8 months which resulted in significant decrease in erythema and number of existing lesions. To further decrease the inflammation con- tributed by demodex mites, permethrin 5% cream twice a day for 1 month was applied. Long-pulsed Neodymium-doped yttrium aluminum garnet (Nd:YAG) 1064 nm laser for a total of 10 sessions together with Isotretinoin 10 mg every other day effectively maintained remission for 1 year and 5 months. Gentle skin care measures, sunscreen, metronidazole 0.75% cream once a day, and desonide 0.05% cream twice a day for 1 week in cases of acute flares were maintained during the treatment course.@*Conclusion@#An armamentarium of topical and oral antibiotics, corticosteroids, isotretinoin and non-ablative long-pulsed Nd:YAG 1064 nm laser showed significant improvement in the inflammatory papules, pustules, and centrofacial erythema of rosa- cea and proves to be beneficial in the maintenance of its long-term remission.

1,064 nm Long-Pulsed Nd:YAG Laser for the Treatment of Onychomycosis / 대한의진균학회지

BACKGROUND: Onychomycosis is the most common disease of the nails. The traditional treatment of onychomycosis requires long term medication of antifungal agent that is associated with drug interaction, so many patients had been limited its use. OBJECTIVE: The aim of this study was to evaluate the treatment of onychomycosis with 1,064 nm long-pulsed Nd:YAG laser. METHODS: Between April 2012 and March 2013, we selected 18 nails (14 toenails, 4 fingernails) and treat over three to eight sessions every 4 weeks. RESULTS: For all 10 patients with 18 affected nails, 88.9% mycological (culture) clearance was observed after sixth sessions. At their final follow-up visit, 9 of 18 nails had more than 50% efficacy and the others had 30~50% clinical improvement. The overall average improvement rate was 55.5%. CONCLUSION: The results demonstrates that a 1,064 nm long-pulsed Nd:YAG laser may represent a safe and viable option for the treatment of onychomycosis. The optimal regimen for each patient needs to be determined.