Folliculitis decalvans treated with radiation therapy.

A 33-year-old black man presented with folliculitis decalvans resistant to multiple oral and topical therapies. The patient ultimately responded to radiation therapy.

Subsurface skin renewal by treatment with a 1450-nm laser in combination with dynamic cooling.

A new nonablative laser device, Smoothbeam, has been under evaluation for nonablative wrinkle reduction in skin with minimal side effects. This device incorporates a laser at 1450-nm wavelength to heat the dermis and cryogen spray cooling to prevent epidermal damage. The thermal injury created is internal and imperceptible. The wound-healing response to this internal injury causes improvement in the appearance of skin wrinkles. Biopsies taken immediately after treatment showed mild residual thermal damage (RTD) at a depth range of 150 to 400 microm, which is the dermal zone where most solar elastosis resides. Biopsies from two months after treatment showed fibroplasia extending over a range of depths similar to the acute RTD zones. An improvement in wrinkle severity was noted on the treated side compared with the control side.

Embryonal rhabdomyosarcoma presenting in an adult: a case report and discussion of immunohistochemical staining.

Embryonal rhabdomyosarcoma is the most common soft tissue sarcoma of childhood but is rarely seen in adults. We report an embryonal rhabdomyosarcoma of the cheek in a 21-year-old Filipino man presenting as a rapidly enlarging mass. An incisional biopsy was consistent with embryonal rhabdomyosarcoma. The patient failed to respond to one cycle of chemotherapy after initial diagnosis and workup for metastatic disease. Wide local excision of the tumor was then completed with the use of the Mohs technique to clear the glabrous cutaneous margins during surgery. A Mohs surgeon and dermatopathologist were involved in interpretation of the Mohs sections. Subsequent immunohistochemical staining revealed a poorly differentiated spindled and epithelioid cell tumor, which stained diffusely positive for vimentin, S-100, and MyoD1. Rare rhabdomyoblasts were present and stained positively for desmin, muscle-specific actin, and phosphotungstic acid hematoxylin. The patient subsequently underwent radiation therapy for a total of 6,000 cGy, followed by two cycles of chemotherapy. The patient continues to be disease-free at 22 months after his wide local excision.

Non-ablative cutaneous remodeling with a 1.45 microm mid-infrared diode laser: phase I.

BACKGROUND: Presented here is phase I of a three-part study of non-ablative cutaneous remodeling with a 1.45 microm diode laser configured with a cryogen spray cooling device. METHODS: Eight men and two women (average age of 67 years) with Fitzpatrick skin phototypes I-IV were treated at postauricular sites. Treatment consisted of one or two passes with a 4mm spot and an average power of 12 W. Heating times ranged from 150 ms to 500 ms applied over two to six treatment cycles. One treatment 'cycle' lasted for 100 ms and consisted of programmable parallel cryogen spray cooling pulses interspersed with unopposed heating. Biopsies were obtained at baseline, immediately after treatment, and at 2 months. RESULTS: Patients were assessed 1 day, 1 week, 1 month and 2 months after treatment. Treatments were well tolerated with minimal pain, with a trend towards increasing discomfort with longer heating times. Erythema and edema were also mild and short-lived. There was a direct relationship between the degree of erythema and edema, and longer unopposed heating times. Mild hyperpigmentation occurred at only three treatment sites. Epidermal burns usually presented as immediate whitening in 11 of 60 one-pass sites and four of 16 two-pass sites. Whitening was associated with longer unopposed heating times. Atrophic, pitted scars occurred at two single-pass sites and three double-pass sites. Baseline biopsies demonstrated solar elastosis in a 375 microm thick band (mean range from 100 microm to 480 microm deep in the dermis). Immediate post-treatment biopsies demonstrated thermal damage in a 333 microm thick band (mean range from 311 microm to 644 microm deep in the dermis). Finally, dermal fibrosis was observed 2 months after treatment in a 272 microm thick band (mean range from 148 microm to 420 microm deep in the dermis). CONCLUSION: The 1.45 microm diode laser is capable of targeting dermal collagen and stimulating fibrosis at depths where solar elastosis resides. Longer unopposed heating times corresponded to increased erythema, edema, and pain, which were typically mild and short-lived. Epidermal burns can result in pitted scars.

Non-ablative cutaneous remodeling with a 1.45 microm mid-infrared diode laser: phase II.

BACKGROUND: Presented here is phase II of a three-part study of non-ablative cutaneous remodeling with a 1.45 microm diode laser configured with cryogen spray cooling. In phase I, safe heating and cooling parameters were established by examining gross and microscopic changes induced by the laser. Phase II examines clinical changes and side effects in the treatment of single facial rhytids. METHODS: Two men and seven women with Fitzpatrick skin phototypes I-III were treated. Single facial rhytids were treated on three separate occasions 3 weeks apart (six periorbital and three perioral). Single, control wrinkles on the contralateral sides were treated with cryogen spray cooling alone. Subjects were treated with single passes with a 5mm spot for the first two treatments. Owing to a modification in the handpiece design, a 4mm spot was used for the third and final treatment. The average power was 12 W. At each treatment visit, heating times ranged from 200 ms to 300 ms, applied as a series of heating/cooling cycles. One treatment 'cycle' lasted for 100 ms and consisted of continuous laser heating interspersed with programmable parallel cryogen spray cooling bursts. RESULTS: Patients were assessed 1 day, 1 week, 4 months, and 6 months after treatment. Treatments were well tolerated, and no patient required pain control pre or post operatively. Mild erythema and edema were noted immediately after treatment and typically cleared within 2-3 days. Superficial, branny hyperpigmentation occurred in six patients at both treatment and control sides. This discoloration resolved within 1 week of treatment and left no residual pigment alterations. No whitening or residual scarring occurred. Rhytid scores improved from a baseline score of 2.3 to 1.8 at 6 months after treatment (p>0.05). Patient acceptance of the treatment was high, but most felt that there was little improvement of the treated rhytids. CONCLUSION: Although the 1.45 microm diode laser is capable of targeting dermal collagen and stimulating fibrosis at depths where solar elastosis resides, clinical improvement of rhytids was mild and did not correlate well with the degree of histologic changes noted in phase I.

Nonablative laser skin remodeling.

Nonablative skin remodeling has become an attractive option for patients whose lifestyles demand a noninvasive approach to skin rejuvenation. This review addresses the rationales for therapy, specific devices, and study outcomes.