Favre-Racouchot syndrome: a novel two-step treatment approach using the carbon dioxide laser.

BACKGROUND: Favre-Racouchot syndrome (FRS) is both disfiguring and difficult to treat. Available medical and surgical therapies are of variable efficacy. Most treatments do not achieve complete resolution and do not show maintenance of therapeutic response. OBJECTIVES: To assess the response to a novel two-step treatment using the CO2 laser in patients with FRS. METHODS: Seven patients with FRS were treated with the CO2 laser in resurfacing mode with manual expression of comedones under infiltrative local anaesthesia. The procedure was completed in one treatment session lasting 30 min and the wound was left to heal by secondary intention. A topical antibiotic was applied to treated areas, which were covered with a nonadherent dressing. All patients were assessed 3 months postoperatively by the operating laser surgeon and a visual assessment of clinical response to treatment in comparison with pretreatment photographs was made. Patient satisfaction was also recorded. RESULTS: All patients achieved complete resolution of FRS. The follow-up duration for our cohort ranged from 8 months to 3 years. Two patients required further treatment within a 2-3-year period from initial treatment. Disease relapse was noted over 1 year after the primary treatment; both these cases were smokers and repeat treatment with similar laser parameters maintained reproducible results. Our longest disease-free follow-up duration was 3 years postprimary treatment. The laser surgeons and patients reported high levels of therapeutic benefit and satisfaction with the results. CONCLUSIONS: This two-step treatment of FRS (CO2 laser resurfacing and manual pressure-induced expression of comedones) is an effective and durable treatment for FRS with an excellent cosmetic outcome. Long-term follow-up beyond 3 years is planned to determine whether later recurrence occurs with this technique.

A study of the efficacy of carbon dioxide and pigment-specific lasers in the treatment of medium-sized congenital melanocytic naevi.

BACKGROUND: Treatment of medium-sized congenital melanocytic naevi (CMN) can be challenging. OBJECTIVES: To present the results of treatment of 55 CMN with the carbon dioxide (CO(2) ) and pigment-specific lasers. METHOD: CO(2) and Q-switched lasers (frequency-doubled Nd:YAG, Nd:YAG and alexandrite) were used to treat 55 CMN. Patients were treated at 3-month intervals until maximum clearance. Clinical response at 3-6 months after final treatment was graded as poor (< 50%), good (50-75%) or excellent (> 75%). Outcomes were evaluated on case note review and questionnaire. RESULTS: Thirty-six of the 55 CMN were macular and 19 were mammillated. Twenty-seven CMN were present on the head and neck. For macular CMN, outcomes were better for truncal CMN. Scarring and pallor were seen in three lower limb macular CMN treated with a CO(2) laser. Mammillated CMN on the head and neck showed most improvement. Pigment-specific lasers were of no additional benefit. Repigmentation occurred in 6% of macular and 21% of mammillated CMN. Partial or complete regimentation of CMN was reported by 46% of patients. CONCLUSIONS: Compared with macular CMN, mammillated CMN show a marginally better response to laser treatment. CMN on the limbs respond poorly. Pigment-specific lasers do not lighten mammillated CMN. Adverse effects can occur with CO(2) laser treatment of macular CMN on lower limbs.

Efficacy of topical tacrolimus 0.3% in clobetasol propionate 0.05% ointment in therapy-resistant cutaneous lupus erythematosus: a cohort study.

BACKGROUND: Despite a range of available topical and systemic therapies, treatment of cutaneous lupus erythematosus (CLE) can be challenging. Objectives. To evaluate the efficacy of a specially formulated preparation of tacrolimus 0.3% in clobetasol propionate 0.05% ointment (TCPO) in the treatment of CLE. METHODS: Case notes of 13 patients with treatment-resistant CLE (11 discoid LE, 1 systemic LE and 1 subacute cutaneous LE) who had used twice-daily TCPO (TCPO group) were reviewed. These were compared with five similar patients with resistant CLE who had been given 0.1% tacrolimus ointment alone (TO group). RESULTS: In the TCPO group (mean treatment duration 20 months, range 1-72), a good or excellent response was seen in five and six patients, respectively; one patient showed slight improvement. Telangiectasia and acne were observed in two patients. No systemic side-effects were noted. In the TO group (mean treatment duration 6 months, range 1-24), one patient showed good improvement and two showed slight improvement. CONCLUSION: The results of our small retrospective study suggest that TCPO may be more effective than either 0.1% tacrolimus or clobetasol propionate 0.05% ointment monotherapy in the treatment of recalcitrant CLE. Randomized controlled trials are needed to confirm these preliminary findings.

Carbon dioxide laser treatment of rhinophyma: a review of 124 patients.

BACKGROUND: Rhinophyma is a progressive, localized or generalized nasal deformity resulting from hypertrophy of sebaceous and connective tissue. The CO(2) laser has been used for treatment of rhinophyma, but the long-term efficacy of the treatment is unknown. OBJECTIVES: To review the outcome of 124 patients with rhinophyma treated with the CO(2) laser between 1996 and 2008 in our centre. PATIENTS AND METHODS: Exuberant sebaceous tissue was ablated using the Sharplan 40C CO(2) laser (Sharplan Lasers UK Ltd, London, U.K.) under local anaesthesia. The technique varied with the severity of rhinophyma; the laser was used in a continuous mode to debulk the larger rhinophymas, and in a resurfacing mode (Silk Touch scanner; Sharplan, 4-7-mm spot at 20-40 W) or continuous mode (10-20 W using a defocused 2-3-mm beam) to reshape the nasal contours. Outcomes were determined by case notes, clinical review and questionnaire. RESULTS: Laser treatment was completed in a single session in 115 of 124 patients. All patients were reviewed 3 months post-treatment. Results were classified as good to excellent in 118 and poor in six patients. All patients were sent a satisfaction questionnaire in 2008 and 52 patients replied. Patients reported high levels of satisfaction following treatment. The post-treatment response at 3-month review was maintained long term. The main complications were pain associated with injection of local anaesthetic, scarring and hypopigmentation (four patients) and open pores (two patients). CONCLUSIONS: The CO(2) laser is an effective and durable treatment for rhinophyma. Treatment carries a low risk of side-effects and is associated with high patient acceptability and satisfaction.

Pulsed-dye laser treatment of angioma serpiginosum.

Angioma serpiginosum (AS) is a rare, benign, vascular disorder comprising nonblanchable punctate red to purple lesions in a gyrate or serpiginous configuration. Tunable pulsed-dye laser (PDL) therapy has been successfully used in the treatment of AS. We report our results of treatment of 12 AS sites in eight patients who were treated with PDL. After an average of 3.75 treatments, complete resolution of AS was seen in five lesions, an excellent response in four and a good response in three. Self-limiting hyperpigmentation at the test sites was noted in two patients. This study provides further evidence of the efficacy of PDL for treatment of AS.

Outcomes of treatment of nine cases of recalcitrant severe hidradenitis suppurativa with carbon dioxide laser.

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic and often a recalcitrant inflammatory skin condition. OBJECTIVES: To present the results of carbon dioxide (CO2) laser treatment of recalcitrant HS in nine patients who had failed to improve on medical and other surgical treatments. METHODS: HS lesions consisting of abscesses, sinuses and granulation tissue were completely excised using the cutting mode of a CO2 laser, leaving only healthy residual subcutaneous fat. The wounds were closed by primary intention where possible and left to granulate otherwise. Outcomes were determined by clinical review and questionnaire. RESULTS: Twenty-seven sites were treated in 19 sessions on nine patients. Seven procedures were performed under general anaesthesia and 12 under local. All patients rated their postoperative discomfort as less or equal to their preoperative state. Seven of the nine patients had complete remission for 12 months or longer after their last laser treatment and ceased all medications. High levels of patient satisfaction were reported with CO2 laser treatment. The main complication was axillary scar contracture in two patients but this was insufficient to limit limb movement. CONCLUSIONS: CO2 laser treatment should be considered as a treatment option in recalcitrant HS, where multiple medical treatments have been ineffective.

CO2 laser vaporization for disfiguring lupus pernio.

Presented in this paper are two cases of longstanding gross and disfiguring lupus pernio of the nose successfully treated by CO2 laser resurfacing Both patients were resistant to previous medical therapy and have had an excellent postoperative cosmetic result.

Localization of a gene (MCUL1) for multiple cutaneous leiomyomata and uterine fibroids to chromosome 1q42.3-q43.

Dominant transmission of multiple uterine and cutaneous smooth-muscle tumors is seen in the disorder multiple leiomyomatosis (ML). We undertook a genomewide screen of 11 families segregating ML and found evidence for linkage to chromosome 1q42.3-q43 (maximum multipoint LOD score 5.40). Haplotype construction and analysis of recombinations permitted the minimal interval containing the locus, which we have designated "MCUL1," to be refined to an approximately 14-cM region flanked by markers D1S517 and D1S2842. Allelic-loss studies of tumors indicated that MCUL1 may act as a tumor suppressor. Identification of MCUL1 should have wide interest, since this gene may harbor low-penetrance variants predisposing to the common form of uterine fibroids and/or may undergo somatic mutation in sporadic leiomyomata.

The Q-switched neodymium:YAG laser and tattoos: a microscopic analysis of laser-tattoo interactions.

The Nd:YAG laser effectively removes or lightens amateur and professional tattoos. The biomechanics of the removal of tattoo particles at the cellular level are incompletely understood. We examined biopsies obtained from 35 amateur and professional tattoos (including coloured tattoos), treated on three or more occasions with the Nd:YAG laser. Biopsies taken immediately after laser treatment showed vacuolation with complete clearance of tattoo particles in the most superficial layers of the dermis, as assessed by light and electron microscopy. We propose that the 'disappearance' of the tattoo particle arises from the formation of atomic species and gaseous products, which are rapidly dissolved in the extracellular fluid. Residual fragmented particles that are commonly found in the mid- and lower dermis are rephagocytosed. The interaction between the Nd:YAG laser and black tattoo particles at 1064 nm, and red tattoo particles at 532 nm, appears to be specific, as there was little evidence of thermal damage to adjacent cells or stromal collagen.

Evaluation of the Nd/YAG laser for treatment of amateur and professional tattoos.

Two hundred and twenty-one amateur tattoos and 27 professional tattoos were treated with a Nd/YAG laser (lambda 1064 nm and 532 nm). The response was expressed as the percentage area cleared of tattoo. Seventy-nine per cent of amateur black tattoos were > or = 75% clear after one to five treatments (mean 2) at 1064 nm. The response of professional tattoos was slower and less complete. Seventy-four per cent of black professional tattoos were > or = 75% clear after one to 11 treatments (mean 6.3) at 1064 nm. Red tattoos responded well to 532 nm and were > or = 75% clear after one to five treatments. Yellow, orange, blue and green tattoos were resistant to treatment. Side-effects included minor scarring in 1.2% of tattoos and transient pigmentary changes in 77% of patients.

Aquagenic pruritus associated with metastatic squamous cell carcinoma of the cervix.

Aquagenic pruritus has been reported in association with a variety of underlying disorders including polycythaemia rubra vera, myelodysplastic syndrome, the hypereosinophilic syndrome and juvenile xanthogranuloma. However, in most cases the aetiology is unknown. The onset of intractable aquagenic pruritus is reported in a fit 71-year-old lady; however, 10 months later she was found to have hepatic metastases arising from a squamous cell carcinoma of the cervix treated 15 years previously. The occurrence of these two relatively rare conditions is likely to be coincidental. None the less, the close temporal relationship between the onset of aquagenic pruritus and the hepatic metastases raises the possibility of a true association. Aquagenic pruritus may be associated with a wider variety of underlying disorders than previously reported. Intractable symptoms of recent onset in a patient with a past history of cancer should be investigated.

Exacerbation of psoriasis precipitated by an oestradiol-testosterone implant.

A 47-year-old woman developed widespread psoriasis following insertion of a combined oestradiol-testosterone implant into her anterior abdominal wall for post-oophorectomy symptoms. The rash did not resolve until the effects of the implant had worn off and recurred following insertion of a second oestradiol-testosterone implant. Implants containing oestradiol alone were tolerated. We have found no previous reports suggesting a relationship between testosterone implants and psoriasis.