Low-fluence treatment with a novel fractionated 2,910-nm fiber laser improves photodamage.

BACKGROUND: Facial rejuvenation by lasers that target water has been a mainstay of esthetic laser treatments for decades. Modern lasers more commonly treat a fraction of the skin surface using ablative, semi-ablative, or nonablative pulses. METHODS: Twenty subjects with visible evidence of chronic photoaging on the face were enrolled in this study. All subjects received two full-face, single-pass treatments spaced 2 months apart with the superficial mode of a 2910 nm fiber laser with an estimated penetration depth of 10 µm, 25% coverage, delivered in a 15 mm × 15 mm square microbeam pattern. A blinded comparison of pretreatment and 3-month post-treatment images was performed. Evaluation of biopsy samples for laser-tissue effects was performed on three separate subjects and biopsies were harvested 1-day post-treatment, 1-week post-treatment, and 2-weeks post-treatment. RESULTS: Blinded evaluation of digital images revealed an average improvement score of 25.1 ± 14.5 (mean ± SEM) or 25.1%, using an 11-point scale evaluating overall improvement in photoaging (p < 0.001). Post-treatment effects were limited to mild-to-moderate erythema and edema, and the pain was rated a 1.9 out of a maximum of 10. Histology demonstrated superficial changes in the stratum corneum and epidermis with dermal inflammation present at 1-day post-treatment and 1-week post-treatment, with a return to baseline at 2 weeks. CONCLUSIONS: The 2910 nm fiber laser is safe and effective for improving mild photodamage, with minimal discomfort and downtime. Dermal inflammation results from very superficial epidermal injury and may contribute to clinical improvement.

Incidental granular parakeratotic cornification in carcinomas.

Granular parakeratosis is histopathologically recognized by the presence of parakeratotic corneocytes housing keratohyaline granules. Similar to acantholytic dyskeratosis and epidermolytic hyperkeratosis, it may histopathologically represent a diagnostic finding in a specific dermatosis, one of the diagnostic features in a solitary keratosis or an incidental finding. Granular parakeratosis as an incidental finding has been reported in association with various dermatoses. This report expands the concept of granular parakeratosis as an incidental histopathologic feature by describing it in carcinomas. In addition, we also present the phenomenon of retained keratohyaline granules unaccompanied by a nucleus within corneocytes, ie, granular orthokeratotic cornification.

Clinically occult cutaneous metastases.

Cutaneous metastases present themselves in a variety of clinical patterns and tend to be manifested as indurated papules/nodules/tumors. Some of those clinical expressions are unique for certain types of metastases. This report describes an entirely different phenomenon of clinically incognito cutaneous metastases that were only apparent histopathologically as an incidental finding.

Circumscribed palmar hypokeratosis: new observations.

Circumscribed hypokeratosis is a characteristic depression both clinically and histopathologically that was originally described as representing a distinctive acquired epidermal malformation of volar skin. To date, 16 patients with this entity have been reported. On the basis of clinical features and histopathologic findings in 4 new patients, coupled with information about some of the previously reported patients, there is evidence to suggest that this dermatosis could be secondary to trauma.

Granular parakeratotic acanthoma.

Granular parakeratosis was originally described as a dermatosis confined to the axillae that histopathologically shows characteristic findings in the cornified layer consisting of parakeratotic corneocytes housing keratohyaline granules. Since the original description of this entity, non-intertriginous examples and even incidental foci of granular parakeratotic corneocytes in association with other dermatoses have been recognized. This report details the findings of a previously unreported entity that we are naming granular parakeratotic acanthoma, which is fundamentally akin to acantholytic dyskeratotic acanthoma and epidermolytic acanthoma (ie, a solitary keratosis that histopathologically displays features indicated in its name).

Epithelial remnants of isthmus-catagen cysts.

The histopathologic diagnosis of isthmus-catagen cysts is typically rendered with ease at scanning magnification. Episodically, diagnostic problems may arise when the outermost epithelial portion of the cyst wall separates from the remainder of the cyst. If a histopathologist is unaware of this phenomenon, the findings may be misinterpreted.

Dermatophyte-related granular parakeratosis.

A patient presented with a two-month history of an annular eruption on her back. Biopsies of this process revealed dermatophytosis and concurrent granular parakeratosis. This patient's eruption resolved completely with antifungal therapy suggesting that the fungal organisms caused the granular parakeratosis.

Pedunculated presentation of dermatofibrosarcoma protuberans.

A 26-year-old patient had a dermatofibrosarcoma protuberans that clinically was considered to represent either a skin tag or neurofibroma. Histopathologically, this lesion could easily have been misinterpreted as a neurofibroma, particularly in the context of the clinical findings.

Follicular granular parakeratosis.

An 83-year-old patient presented herself with a ten-year history of keratotic papules on her trunk. A biopsy of this process revealed granular parakeratosis confined to the infundibulum of a follicle. Exclusive follicular involvement in granular parakeratosis has not been previously described.