Targeted phototherapy using 308 nm Xecl monochromatic excimer laser for psoriasis at difficult to treat sites.

Psoriasis is a chronic inflammatory multisystem disease involving skin and joints affecting 1-3 % of the world population. The 308-nm excimer laser has been recently used in the treatment of psoriasis, especially localized psoriasis of scalp and palm and soles. The objective of the study is to evaluate the therapeutic efficacy and safety of a 308-nm excimer laser for the treatment of scalp and palmoplantar psoriasis. A total of 41 adult patients (25 males and 16 females) were enrolled in this study, of which 26 patients had lesions localized to scalp, and 15 patients had involvement of palm and soles. The mean age was 44.5 years (range 18-73). And, the mean duration of psoriasis in our patients was 15 years. They were treated with a 308-nm excimer laser. The initial dose was based on multiples of a predetermined minimal erythema dose, twice weekly for a maximum 12 weeks. Twenty-two of the 23 patients with scalp psoriasis showed improvement, while one patient showed no change; none experienced worsening of symptoms. The mean minimal erythema dose (MED) was found to be 383 mJ/cm(2) (range 180-650 mJ/cm(2)). The cumulative dose of irradiation was 1,841 mJ/cm(2) (range 600-2,500). The percentage improvement from baseline in PSSI score was 78.57 %. Side effects were seen in 20 patients (86.96 %) mainly in the form of erythema. Four patients developed mild relapse at the end of 6 months after the therapy. In 15 patients with palmoplantar psoriasis, the mean MED was found to be 415 mJ/cm(2) (range 200-950 mJ/cm(2)). The cumulative dose of irradiation was 28.4-115.5 J cm(2) (mean 59.1 J cm(2)). The mean number of treatments to achieve clearance (equal to 90 % reduction of PSI score) was 16. Two patients relapsed at the end of 6 months after the therapy. The 308-nm excimer laser is an effective, safe, easy, and relatively quicker method for the treatment of psoriasis at difficult to treat sites, with good results in a somewhat short time.

Changing demography of leprosy: Kuwait needs to be vigilant.

INTRODUCTION: Leprosy is an ancient, chronic, communicable disease. It is claimed that it has been 'eliminated' as a public health problem at the global level. However, sporadic new cases are increasingly being encountered, even in non-endemic countries such as ours. A more disturbing fact is the increase in the number of cases in the indigenous population. OBJECTIVES: The aim of this study was to analyze the magnitude of the leprosy problem in the region of Farwaniya, in which most of the immigrants in Kuwait live, based on detection and prevalence rates over the last 6 years, in addition to a clinico-pathological analysis of the collected data. PATIENTS AND METHODS: All clinically diagnosed cases of leprosy seen over a period of 6 years, from January 2003 to December 2008, were included in the study. Socio-demographic details and clinical features were recorded on a proforma. The results were compared to similar previous data from Kuwait, and to that from other countries in the region. RESULTS: Forty-six patients (38 male and eight female) aged 22-48 years (average 33.6 years), clinically diagnosed with leprosy, were enrolled. Of the enrolled patients, 89.1% were expatriates, while 10.9% were Kuwaiti citizens. The majority of patients (n=24) were from India, followed by Bangladesh (n=6), Egypt (n=5), Pakistan (n=3), and Indonesia, Philippines and Sri Lanka (n=1 each). The duration of signs and symptoms ranged from 1 to 24 months (average 4.7 months). A total of 58.5% of expatriate patients developed their symptoms 2-5 years after entry into Kuwait. Delayed diagnosis (after 12 weeks) was observed in 70.8%. Thirty-one patients (67.4%) had multibacillary leprosy (borderline lepromatous n=15, borderline type n=7, borderline tuberculoid n=5, and lepromatous leprosy n=4), while 15 patients (32.6%) had the paucibacillary form of leprosy (tuberculoid type n=8, borderline tuberculoid n=7). The detection of lepra bacilli in tissue sections was the most common diagnostic tool (67.4%), while nasal smears showed positive results in 28.3% of cases and the slit skin smear in 17.4%. CONCLUSIONS: This study shows that leprosy in the region of Farwaniya, Kuwait, which has predominantly been a disease of immigrants, has started to infect the Kuwaiti population; such cases may just represent the tip of the iceberg. Careful examination of immigrants on arrival and subsequent periodic regular check-ups are required to prevent the spread of the disease. Furthermore, early referral of suspected cases and screening of contacts, with initiation of treatment as early as possible, are essential to control the spread of leprosy in Kuwait.

Long-term results of split-skin grafting in combination with excimer laser for stable vitiligo.

BACKGROUND: Some cases of focal or segmental vitiligo are refractory to medical treatment, and surgical management is the treatment of choice. Postsurgical exposure to ultraviolet B rays can lead to faster and better cosmetic results. OBJECTIVE: To determine the long-term results of combination therapy with split-skin-thickness grafting and 308-nm excimer laser for the management of stable focal or segmental vitiligo. PATIENTS AND METHODS: Seventeen patients (8 female, 9 male) with stable focal or segmental vitiligo not responding to nonsurgical modalities were treated with split-skin-thickness grafting and postgrafting with 32 sessions of 308-nm excimer laser, beginning 2 weeks after surgery. The patients were followed up every year for evaluation of results. RESULTS: All seventeen (100%) patients showed repigmentation, and overall results were graded as excellent in 12 patients and good in the other five at the end of excimer laser therapy. Final evaluation done at the end of 1 year revealed excellent results in all 17 patients. Two patients developed new vitiligo lesion on other parts of the body during follow-up. None of the patients developed depigmentation of the transplanted skin. CONCLUSION: Combination treatment with split-skin-thickness grafting and postsurgical exposure to 308-nm excimer laser in patients with stable focal or segmental vitiligo can lead to fast, cosmetically good, long-lasting results.

Comparative study on the efficacy, safety, and acceptability of imiquimod 5% cream versus cryotherapy for molluscum contagiosum in children.

To compare the efficacy, safety and acceptability of imiquimod (IMQ) 5% cream with cryotherapy for the treatment of molluscum contagiosum (MC) in children. Prospective, randomized, comparative, observer blinded study. A total of 74 children, with MC were divided randomly to receive treatment with either IMQ 5% cream (group A) 5 days a week or cryotherapy (group B) once a week until clinical cure or up to a maximum of 16 weeks. All the patients were followed up weekly during active treatment. The patients were followed-up for 6 months after clinical cure to look for recurrence. In the IMQ group (group A), the overall complete cure rate was 91.8% (34 of 37), 22 of the 37 patients cleared by the end of 6 weeks and 12 more patients cleared by the end of 12 weeks, while the remaining three patients (8.1%) did not clear even after 16 weeks. Whereas, in the cryotherapy group, all 37 patients achieved complete cure, 26 of 37 (70.27%) patients cleared after 3 weeks, and the remaining 11 (29.72%) cleared by the end of 6 weeks. No statistically significant difference was found between the overall complete cure rate in both groups at the end of maximum treatment period (16 weeks). Pain, bullae formation, pigmentary changes, and superficial scarring were more significantly common in the cryotherapy group compared with the IMQ group. Imiqimod 5% cream seems to be slow acting but an effective agent for the treatment of MC in children. IMQ appears to be practically painless and more cosmetically accepted treatment when compared with cryotherapy, and may be the preferred treatment of MC in children especially with numerous small lesions. Cryotherapy has the advantage of being rapidly effective, and is less expensive than IMQ and may be the preferred treatment for large solitary or few lesions.