ABSTRACT
The hypertrophic Port Wine Stain (PWS) is only partially and superficially treated with the Pulsed dye laser (PDL) because of its limited depth of penetration. We used combined PDL and fiberoptic 1444-nm Nd-YAG laser to treat a case with hypertrophic PWS. METHOD: After tumescent anesthesia, few holes were made by a 16-gauge needle on different sides of the lesion. The fiberoptic tip of 1444-nm Nd-YAG laser was inserted within the holes and was pushed forward while triggering. In a fan pattern and by a back and forth movement, the subcutaneous and deep dermal areas were coagulated. The skin and outer mucosal surfaces were then treated by PDL. The fiberoptic system used was Accusculpt 1444-nm Nd-YAG laser (Lutronic lasers, South Korea), and the PDL used was 585 nm Nlite system (Chromogenex UK). The parameters used for PDL were fluence = 9 Joules/cm2 and the spot size was 5 mm. The parameters used for fiberoptic 1444-nm Nd-YAG laser were: Pulse rate = 30 Hz, pulse energy = 300 mJ, power = 6 W, and the total energy = 4000 J for the whole face and mucosa. RESULT: Little sign of regression and moderate purpura were detected immediately after combined fiberoptic Nd-YAG and PDL therapy. The lesion gradually regressed within 4 months with satisfactory color and volume change. CONCLUSION: Combined fiberoptic Nd-YAG laser and PDL can be used for the treatment of deeper and superficial layers of hypertrophic PWS.
Subject(s)
Lasers, Solid-State/therapeutic use , Low-Level Light Therapy/methods , Port-Wine Stain/radiotherapy , Adult , Cosmetic Techniques , Female , Humans , Iraq , Lasers, Solid-State/adverse effectsABSTRACT
BACKGROUND: Immunosuppressive agents are used widely in the treatment of vitiligo. Corticosteroids are used either alone or as adjuvant therapy by many practitioners. Cyclophosphamide and cycloporine-A have also been used with variable success. Azathioprine may have the potential for the treatment of vitiligo alone or in combination with other modalities. OBJECTIVE: To compare the efficacy of combined low-dose azathioprine and oral PUVA therapy versus oral PUVA therapy alone for the treatment of vitiligo. PATIENTS AND METHODS: A total of 60 vitiligo patients were randomized to receive either azathioprine (0.6-0.75 mg/kg) and oral PUVA therapy (group 1) or oral PUVA therapy alone (group 2). Patients were followed for 4 months. A graph transparency with squares of 2.5 x 2.5 mm was used to measure the rate of repigmentation after 4 months of therapy. RESULTS: Perifollicular repigmentation started after a mean of five sessions in group 1, and eight sessions in group 2. The mean total repigmentation rate after 4 months was 58.4% for group 1 and 24.8% for group 2. No serious side effects were seen during or after treatment. CONCLUSION: Azathioprine may potentiate the repigmentary effects of PUVA therapy in vitiligo patients. A limitation of the study is the lack of validated measures for vitiligo assessment.
Subject(s)
Azathioprine/administration & dosage , Immunosuppressive Agents/administration & dosage , PUVA Therapy , Vitiligo/drug therapy , Administration, Oral , Humans , Severity of Illness Index , Treatment Outcome , Vitiligo/pathologyABSTRACT
BACKGROUND: Lasers and light sources are now used worldwide for permanent or prolonged hair removal. Patients now prefer lasers and light sources for hair removal because of their noninvasiveness and fewer reported side effects. OBJECTIVE: To study and report on leukotrichia that developed following application of intense pulsed light (IPL). METHODS: From February 9, 2001 to February 14, 2002 a total of 821 patients were treated for unwanted hair. The system used was a noncoherent IPL system, with a 650 nm flashlamp filter; the parameters used varied with different Fitzpatrick skin types. The patients were treated monthly, with the rate of hair loss, measured by hair counts, and possible side effects recorded. RESULTS: Twenty-nine of 821 patients treated developed leukotrichia. Thirteen patients had no white or gray hairs before IPL therapy; the remaining 16 patients, who had few white hairs before treatment reported accelerated development of new white hairs starting after the first or second IPL therapy. Restoration of hair color occurred in 9 patients and the remaining 20 patients had no improvement or worsening of the condition within the next 2-6 months. CONCLUSION: Temporary or permanent leukotrichia may develop following IPL and laser hair removal therapy. This finding may be explained by the difference in the thermal relaxation times of melanocytes and germinative cells. The light absorbed and the heat produced by melanin may be sufficient enough to destroy or impair the function of melanocytes but insufficient to damage the hair follicle cells.
