Genital angiokeratomas of Fordyce 595-nm variable-pulse pulsed dye laser treatment.

BACKGROUND: Angiokeratoma of Fordyce (AF) represents dark red or blue-black papules with a scaly surface located on scrotum, labia majora, and penis. Though usually asymptomatic, bleeding after mechanical trauma and sexual intercourse may occur. AF should be differentiated from malignant melanoma, angiosarcoma, and other pigmented lesions. The treatment, usually asked from patients as the result of anxiety and social embarrassment, should be performed in a non-aggressive manner. OBJECTIVES: To determine the safety and effectiveness of 595-nm variable-pulse pulsed dye laser (VPPDL) with a Dynamic Cooling Device (DCD) in the treatment of AF. METHODS: Twenty-four patients (22 men and two women) aged 40.88 ± 12.48 years with AF were included in the retrospective study. Lesions located on scrotum, labia majora, and penis were treated with 595-nm VPPDL in the intervals of one to three months. Variable spot, fluence, and pulse-width parameters were used with and/or without DCD skin cooling. RESULTS: AF were successfully removed in all patients in one to seven (mean ± SD = 3.38 ± 2.16) treatment sessions with no permanent side effects or complications such as dyspigmentations or scarring. Recidives were observed in four patients after 0.5-1 year intervals. CONCLUSIONS: 595-nm VPPDL with DCD represents an efficient and safe method for the removal of multiple lesions of AF in genital localization.

Extensive angiokeratoma circumscriptum - successful treatment with 595-nm variable-pulse pulsed dye laser and 755-nm long-pulse pulsed alexandrite laser.

Angiokeratomas are rare vascular mucocutaneous lesions characterized by small-vessel ectasias in the upper dermis with reactive epidermal changes. Angiokeratoma circumscriptum (AC) is the rarest among the five types in the current classification of angiokeratoma. We present a case of an extensive AC in 19-year-old women with Fitzpatrick skin type I of the left lower extremity, characterized by a significant morphological heterogeneity of the lesions, intermittent bleeding, and negative psychological impact. Histopathological examination after deep biopsy was consistent with that of angiokeratoma. The association with metabolic diseases (Fabry disease) was excluded by ophthalmological, biochemical, and genetic examinations. Nuclear magnetic resonance imaging has not detected deep vascular hyperplasia pathognomic for verrucous hemangioma. The combined treatment with 595-nm variable-pulse pulsed dye laser (VPPDL) and 755-nm long-pulse pulsed alexandrite laser (LPPAL) with dynamic cooling device led to significant removal of the pathological vascular tissue of AC. Only a slight degree of secondary reactions (dyspigmentations and texture changes) occurred. No recurrence was observed after postoperative interval of 9 months. We recommend VPPDL and LPPAL for the treatment of extensive AC.

A case of linear porokeratosis treated with photodynamic therapy with confocal microscopy surveillance.

Linear porokeratosis (LP) is a rare clinical porokeratosis variant, which typically presents at birth, but can also develop in adulthood. Differential diagnosis includes linear lichen planus, lichen striatus, linear verrucous epidermal nevus, incontinentia pigmenti and linear Darier's disease. An LP lesion has an increased risk of transformation into a squamous cell carcinoma or basal cell carcinoma. The treatment of LP is contradictory and disappointing in general. We present a case of a 16-year-old girl with multiple reddish-brown macules and depressions on the medial aspect of her right arm, localized from the palmar joint up to shoulder region in a linear pattern. We performed confocal microscopy (CLSM) of multiple lesions and a punch biopsy after receiving informed consent to confirm the diagnosis. After diagnosis confirmation, we performed Photodynamic therapy (PDT). Methyl aminolevulinate cream in a 160 mg/g concentration (Metvix crm) was applied under occlusion on the previously cleaned surface of every single lesion for 3 hours. The lesions were subsequently illuminated with a dose of 37 J/cm(2) (Aktilite, PhotoCure ASA, Norway). Two months after the first PDT treatment, the patient came for a third PDT session. Treatment follow-up was performed 6 months after the initial PDT session. A CLSM image proved an increase in the width of the stratum spinosum to 42-48 µm, mild post-inflammatory changes were also present. Cosmetic and clinical response up to date at the time of last follow-up (1 year) was satisfactory. No progression was observed.

Footwear contact dermatitis from dimethyl fumarate.

BACKGROUND: Dimethyl fumarate (DMF) is an effective inhibitor of mold growth. In very low concentrations, DMF is a potent sensitizer that can cause severe allergic contact dermatitis (ACD). It has been identified as the agent responsible for furniture contact dermatitis in Europe. The aim of this study was to evaluate patients in Slovakia with footwear ACD associated with DMF, with regard to clinical manifestations, patch test results, and results of chemical analysis of their footwear. METHODS: Nine patients with suspected footwear contact dermatitis underwent patch testing with the following allergens: samples of their own footwear, commercial DMF, the European baseline, shoe screening, textile and leather dye screening, and industrial biocides series. The results were recorded according to international guidelines. The content of DMF in footwear and anti-mold sachets was analyzed using gas chromatography and mass spectrometry. RESULTS: Acute ACD was observed in nine Caucasian female patients. All patients developed delayed sensitization, as demonstrated by positive patch testing using textile footwear lining. Seven patients were patch tested with 0.1% DMF, and all seven were positive. Chemical analysis of available footwear showed that DMF was present in very high concentrations (25-80 mg/Kg). CONCLUSIONS: Dimethyl fumarate is a new footwear allergen and was responsible for severe ACD in our patients. To avoid an increase in the number of cases, the already approved European preventive measures should be accepted and commonly employed.

Comparison of hair reduction with three lasers and light sources: prospective, blinded and controlled study.

OBJECTIVE: The main goal of this study was to compare the hair removal efficacy of three methods: intense pulsed light (IPL), a combination of IPL and radio frequency (RF) and diode laser (810 nm). METHODS: Forty participants were treated within three standardized squares on lateral sites on their legs. Each of these squares was treated twice with an interval of 4-6 weeks. The fourth square was left as a control. A blinded physician counted the hairs in each square before the first treatment and 8 months after the second treatment. Immediate and delayed side effects as well as pain scores were recorded. RESULTS: The mean hair count reduction achieved by the diode laser, IPL and IPL+RF was 49.90%, 39.16% and 47.15%, respectively. This study did not show any serious side effects and the number of side effects was minimal. The mean pain scores for the first and second treatments by diode laser, IPL and IPL+RF were 4.65 and 4.58, 2.43 and 2.53, and 3.95 and 4.03, respectively. At the end of the study, a free hair removal treatment for both legs was chosen by patients in the proportion 20 diode laser, 10 IPL and eight IPL+RF. CONCLUSIONS: The combination of RF and optical energies proved its safety and efficacy for hair removal, which is comparable with diode lasers and approximately 20% more efficient than 'pure' IPL.