A comparison of 3 lasers and liquid nitrogen in the treatment of solar lentigines: a randomized, controlled, comparative trial.

OBJECTIVE: To determine if laser therapy is superior to liquid nitrogen for the treatment of solar lentigines and if so, to determine if one laser is superior to the other lasers that were tested. DESIGN: Randomized, controlled, comparative study with blinded observers. SETTING: University-based dermatology clinic. PARTICIPANTS: Twenty-seven patients with multiple solar lentigines on the backs of both hands. INTERVENTIONS: Liquid nitrogen cryotherapy, the Medlite II frequency-doubled Q-switched Nd:YAG laser (Continuum Biomedical, Livermore, Calif), the HGM K1 krypton laser (HGM Medical Laser Systems Inc, Salt Lake City, Utah), and the DioLite 532-nm diode-pumped vanadate laser (Iridex Corp, Mountain View, Calif). MAIN OUTCOME MEASURES: Photographs of the hands were taken prior to and 6 and 12 weeks following treatment. Blinded observers and patients evaluated each treatment on its ability to lighten pigmented lesions without causing unwanted adverse effects. RESULTS: Many new laser systems claim an advantage for treating pigmented lesions by selectively destroying melanin. In this study, the frequency-doubled Q-switched Nd:YAG laser was most likely to provide significant lightening (P<.05), followed by the HGM K1 krypton laser, the 532-nm diode-pumped vanadate laser, and liquid nitrogen. The frequency-doubled Q-switched Nd:YAG laser also had the fewest adverse effects (P<.05), while the HGM K1 krypton laser had the most (P<.05). Of the 27 patients, 25 preferred laser therapy to cryotherapy, with the frequency-doubled Q-switched Nd:YAG laser being the most popular. CONCLUSIONS: Laser therapy is superior to liquid nitrogen for the treatment of solar lentigines. Of the laser systems tested in this study, the frequency-doubled Q-switched Nd:YAG laser is the most effective.

Acute generalized varicella zoster in the setting of preexisting generalized erythema.

We report a 5-year-old girl who initially had generalized erythema from scarlet fever. Four days later she developed sheets of monomorphous vesicles in the areas of erythema. A Tzanck smear of a vesicle base showed multinucleated giant cells, and viral culture grew varicella zoster virus, confirming a clinical diagnosis of varicella. This case illustrates that, with a background of preexisting erythema, varicella may present in an atypical manner.

Low-dose oral methotrexate treatment for recalcitrant palmoplantar pompholyx.

We describe 5 patients with severe pompholyx who did not respond to conventional therapy or who had debilitating side effects from corticosteroids. Low-dose methotrexate was added to their treatment regimens and led to significant improvement or clearing with a favorable side-effect profile. In all 5 patients the need for oral corticosteroid therapy was substantially decreased or eliminated, thus decreasing potential corticosteroid-induced morbidity. In this uncontrolled series of patients with recalcitrant palmoplantar pompholyx, methotrexate was an effective treatment and acted as a steroid-sparing agent.

Expression of c-fos in cultured human nevus cells: an increase over melanocytes and melanoma cells.

Nevus cells exhibit growth characteristics in culture which differentiate them from melanocytes and melanoma cells. We examined the expression of c-jun, c-fos and jun-B mRNA levels in cultures of different melanocytic cell types to determine if biologic differences among these cells was due to their level of proto-oncogene expression. Because cell growth and differentiation are also known to be affected by serum conditions, the expression of c-jun, c-fos and jun-B was examined under normal serum conditions and serum starved and repleted conditions which stimulates proto-oncogene expression. Expression of c-jun and jun-B was not significantly different among the cell types studied under normal serum conditions, or serum starved and refed conditions and c-fos was not detectable in any of the unstimulated cell types. In contrast, when the cells were serum starved and refed, the level of c-fos expression was uniformly increased (2-10 fold) in 3 different nevus cell lines. This increase was not seen in normal melanocyte cultures or 2 melanoma cell lines. With serum deprivation and repletion, c-fos was also elevated in 1 melanoma cell line. We conclude that the regulation of the proto-oncogene c-fos is different in nevus cells than in normal melanocytes, which may contribute to the different growth characteristics seen with nevus cells.

Resolution of recalcitrant molluscum contagiosum virus lesions in human immunodeficiency virus-infected patients treated with cidofovir.

BACKGROUND: Molluscum contagiosum virus (MCV) causes cutaneous skin growths that mainly affect children, sexually active adults, and immunocompromised individuals. Lesions of MCV in patients infected with human immunodeficiency virus can be large and numerous, and response to available treatments is often unsatisfactory. OBSERVATIONS: We describe 3 men infected with human immunodeficiency virus who presented with extensive MCV lesions that were not responsive to various treatments. Patient 1 demonstrated dramatic clearing of his MCV lesions when intravenous cidofovir therapy was started for his treatment-resistant bilateral CMV retinitis and because of cidofovir's possible activity against MCV. In case 2, cidofovir was compounded as a 3% cream in a combination vehicle (Dermovan) for extensive facial involvement, and complete resolution of MCV was seen after 1 month of therapy. In case 3, intravenous cidofovir therapy was started both for CMV retinitis and in an attempt to clear 90% facial MCV involvement; after 1 month of treatment, all clinical evidence of MCV had resolved. All 3 patients remain clear of recurrence. CONCLUSIONS: Cidofovir, a nucleotide analog of deoxycytidine monophosphate, appears to have contributed to clearing of advanced MCV lesions in these 3 patients, thus providing suggestive evidence of clinical activity against MCV. Controlled trials of cidofovir therapy for MCV in persons infected with human immunodeficiency virus are warranted.

Differentiation of involved and uninvolved psoriatic skin from healthy skin using noninvasive visual, colorimeter and evaporimeter methods.

BACKGROUND/AIMS: Uninvolved skin of psoriasis may not be entirely normal. The object was to characterize healthy, uninvolved psoriatic skin and lesional skin by biophysical methods. METHODS: Involved and uninvolved psoriatic and age-gender matched healthy skin was measured objectively with a colorimeter and evaporimeter and subjectively with visual assessment in 14 subjects. METHODS: Visual assessment of erythema (E), scaling (S) and induration (I) as well as the target lesion score at the involved psoriatic skin sites were significantly elevated (p<0.05) above uninvolved psoriatic or healthy skin sites. No difference between uninvolved psoriatic and healthy skin was measured visually. Transepidermal water loss at involved psoriatic skin >uninvolved psoriatic skin >healthy skin (p<0.05). Objective assessment of skin color in 3 color scales, L*, a*, and b*, differentiated involved and uninvolved psoriatic skin from healthy skin sites. Involved psoriatic skin demonstrated higher (p<0.01) a-scale values and lower (p<0.01) L* and b* scale values than uninvolved psoriatic skin. Further, colorimeter L* and a* scale values at uninvolved psoriatic skin sites were lower and higher (p<0.05), respectively, than healthy skin. The individual chromameter parameters (L*, a*, b*) correlated well with the visual parameters (E, S and I). Composite colorimeter description (L*× b*)/a* significantly differentiated healthy skin from both involved and uninvolved psoriatic skin. CONCLUSIONS: These collective data highlight that even visually appearing uninvolved psoriatic skin is compromised compared with healthy skin. These objective, noninvasive but differential capabilities of the colorimeter and evaporimeter will aid in the mechanistic quantification of new psoriatic drug therapies and in conjuction with biochemical studies, add to understanding of the multifactorial pathogenesis of psoriasis.