Usefulness of three-dimensional digital image analysis for objective evaluation of the efficacy of non-facial port-wine stain treatment with large spot 532 nm laser.

INTRODUCTION: New devices such as the large spot KTP laser are being introduced for the treatment of port-wine stains (PWS). AIM: To assess the efficacy of the large spot 532 nm laser for non-facial PWS with 3D image analysis and compare it with subjective evaluation. MATERIAL AND METHODS: Twenty PWS were photographed with a 3D photo unit before and after 532 nm large spot KTP laser treatment. Fifteen lesions were previously treated by different devices and five were not. Objective analysis of percentage improvement based on a 3D digital assessment of combined color and area improvement was performed and rates of improvement were determined as well as subjective evaluation of before and after images by a physician on a 5-grade scale. RESULTS: Mean objective response was 57.0%. A poor response was observed in 5% with the objective method and with no patient with the subjective method. A moderate response was achieved by 25% and 30% with the objective and subjective assessment respectively. A significant response was obtained by 55% objectively and 10% subjectively. 75-100% was achieved by 15% and 60% in the objective and subjective analysis respectively. The two methods significantly correlated with each other but the average subjective improvement rates were higher than the objective rates. CONCLUSIONS: Both objective and subjective analysis indicated that the large spot 532 nm laser is highly effective in the treatment of the neck and trunk. 3D color and area objective analysis provides an accurate tool to measure the efficacy of PWS treatment.

Can evaluation of specific immunoglobulin E serum concentrations of antibodies to aeroallergens in atopic dermatitis patients replace skin prick tests method in clinical practice?

INTRODUCTION: Positive skin prick tests (SPT) results with protein allergens are the minor Hanifin and Rajka's atopic dermatitis (AD) criterion. In adults, they mainly concern aeroallergens. The inflammation of skin often prevents SPT, but does not exclude the assessment of serous specific immunoglobulin E (sIgE) concentrations. AIM: To assess usefulness of testing AD patients to aeroallergens with SPT and sIgE concentrations, and the correlation of these results and the clinical AD course. MATERIAL AND METHODS: In 286 AD patients, total IgE and sIgE (14 aeroallergens) were measured. SPTs were performed with 17 aeroallergens. The AD severity was determined depending on the concurrent co-existence of asthma, allergic rhinitis, extensive skin flares and severe itching. RESULTS: 59.1% and 66.1% of patients have had positive results of sIgE and SPT, respectively (p > 0.05). The concentration of total IgE has positively correlated with the number of positive sIgE results (rho = 0.588, p < 0.001) and their intensity (rho = 0.592, p < 0.001). Among the patients with at least one high positive sIgE score, severe AD patients have been dominant (59.8% vs. 40.2%, p < 0.04). Among the patients with positive results without any high scores, the percentages are 21.6 and 78.4, respectively (p < 0.001). CONCLUSIONS: The compatibility of SPT results and IgE concentrations indicates that the two methods equally assess aeroallergy in AD patients. The assessment of sIgE concentrations is especially advisable in patients with an elevated total IgE level. The obtained results may suggest that presence of a high specific IgE level of antibodies to aeroallergens may be the factor predicting a severe clinical AD course.

Predictive value of dermoscopy for the treatment of port-wine stains with large spot 532 nm laser.

OBJECTIVE: We wanted to evaluate dermoscopy as a tool to predict the efficacy of port-wine stain (PWS) laser treatment. STUDY DESIGN AND METHODS: Large spot 532 nm laser was used for the treatment of 67 PWS. Efficacy was assessed with an objective 3D digital imaging analysis. Dermoscopy images were taken before the treatment and analyzed semi quantitatively for features and patterns. RESULTS: The following dermoscopic features: "superficial vessels," "deep vessels," "deep lakes," "superficial lakes," and "thick vessels total" were identified as positive determinants of maximal global clearance effect (GCEmax), whereas "thin long vessels," "bright background total," "whitish veil," "white circles," and "perifollicular erythema" were found to be negative determinants. Rapid response correlated positively with "superficial vessels," "superficial lakes," and "thick vessels total" scores and showed inverse correlations with "bright-red background," "bright background total," "white circles," "peacock eyes," and "perifollicular erythema" scores. "Superficial vessels," "thick vessels total," and "pale-pink patchy background" were predictors of the lack of response. Dominance of "deep vessels" was a predictor of 75% of responses and dominance of "brown areas" feature was the predictor of clearance. Patients responded to treatment differently, depending on the dermoscopic pattern of PWS. CONCLUSION: Dermoscopy may be useful to predict the response of PWS to laser treatment: its rapidity, the risk of no response, and 75% response and clearance. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

Treatment of Previously Treated Facial Capillary Malformations: Results of Single-Center Retrospective Objective 3-Dimensional Analysis of the Efficacy of Large Spot 532 nm Lasers.

BACKGROUND: Current treatment of facial capillary malformations (CM) has limited efficacy. OBJECTIVE: To assess the efficacy of large spot 532 nm lasers for the treatment of previously treated facial CM with the use of 3-dimensional (3D) image analysis. PATIENTS AND METHODS: Forty-three white patients aged 6 to 59 were included in this study. Patients had 3D photography performed before and after treatment with a 532 nm Nd:YAG laser with large spot and contact cooling. Objective analysis of percentage improvement based on 3D digital assessment of combined color and area improvement (global clearance effect [GCE]) were performed. RESULTS: The median maximal improvement achieved during the treatment (GCE) was 59.1%. The mean number of laser procedures required to achieve this improvement was 6.2 (range 1-16). Improvement of minimum 25% (GCE25) was achieved by 88.4% of patients, a minimum of 50% (GCE50) by 61.1%, a minimum of 75% (GCE75) by 25.6%, and a minimum of 90% (GCE90) by 4.6%. Patients previously treated with pulsed dye lasers had a significantly less response than those treated with other modalities (GCE 37.3% vs 61.8%, respectively). CONCLUSION: A large spot 532 nm laser is effective in previously treated patients with facial CM.

Retrospective single center study of the efficacy of large spot 532 nm laser for the treatment of facial capillary malformations in 44 patients with the use of three-dimensional image analysis.

OBJECTIVE: We wanted to asses the efficacy of large spot 532 nm laser for the treatment of facial capillary malformations with the use of three-dimensional (3D) image analysis. STUDY DESIGN AND METHODS: Retrospective single center study on previously non-treated patients with facial capillary malformations (CM) was performed. A total of 44 consecutive Caucasian patients aged 5-66 were included. Patients had 3D photography performed before and after and had at least one single session of treatment with 532 nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser with contact cooling, fluencies ranging from 8 to 11.5 J/cm2 , pulse duration ranging from 5 to 9 milliseconds and spot size ranging from 5 to 10 mm. Objective analysis of percentage improvement based on 3D digital assessment of combined color and area improvement (global clearance effect [GCE]) were performed. RESULTS: Median maximal improvement achieved during the treatment (GCEmax ) was 70.4%. Mean number of laser procedures required to achieve this improvement was 7.1 (ranging from 2 to 14)). Improvement of minimum 25% (GCE 25) was achieved by all patients, of minimum 50% (GCE 50) by 77.3%, of minimum 75% (GCE 75) by 38.6%, and of minimum 90% (GCE 90) by 13.64. CONCLUSION: Large spot 532 nm laser is highly effective in the treatment of facial CM. 3D color and area image analysis provides an objective method to compare different methods of facial CM treatment in future studies. Lasers Surg. Med. 49:743-749, 2017. © 2017 Wiley Periodicals, Inc.

Atopic and Non-atopic Eczema.

Atopic dermatitis is a common term used in the medical literature, but according to The Nomenclature Review Committee Of The World Allergy Organization the name which should be used is eczema. Eczema is divided into two subtypes: atopic and non-atopic. These subtypes differ in the level of total immunoglobulin E (IgE) in serum, response to allergens in skin prick tests, and detection of specific IgE antibodies. Non-atopic eczema is characterized by a low level of total IgE, negative skin prick tests, and undetectable specific IgE antibodies. It is estimated that 10-45% cases of eczema are non-atopic ones. In recent studies, other features differentiating these two subtypes have been identified, such as female predominance in non-atopic eczema. A more severe course, damage of the epidermal barrier, predominance of Th2 (T helper cells 2) response, and a lower positive reaction to metal patch tests are the characteristics of the atopic subtype. In our opinion, new diagnostic criteria taking into account the non-atopic subtype of eczema need to be established.

MiRNA in atopic dermatitis.

MicroRNAs are relatively new molecules that have been widely studied in recent years as to determine their exact function in the human body. It is suggested that microRNAs control approx. 30% of all genes, making them one of the largest groups that control the expression of proteins. Various functions of miRNAs have already been described. In skin diseases, there are more and more studies describing an altered expression of microRNAs in the skin or serum. Relatively little is known about the function of these molecules in atopic dermatitis, which prompted us to gather current reports on this subject.