Efficacy of fractional CO2 laser with intralesional steroid compared with intralesional steroid alone in the treatment of keloids and hypertrophic scars.

BACKGROUND AND OBJECTIVE: Keloids and hypertrophic scars (HTS) are abnormal fibrous reactions that persist for prolonged periods, rarely regress without treatment and recur after excision. Many modalities of treatment have been advocated but the success rates of these have been variable. The present study is an attempt to evaluate and compare the efficacy of combination of fractional CO2 laser (FCL) and intralesional steroid (ILS) against ILS alone in the treatment of keloids and HTS. METHODS: Patients with keloids or HTS were divided into two groups of 25 each receiving four sessions of therapy. Group 1 (FCL + ILS) received combination of FCL and intralesional triamcinolone acetonide (TAC) 10 mg/mL. Group 2 (ILS only) received intralesional TAC 10 mg/mL alone. Pretreatment measurements and photographs were taken. Two unbiased qualified dermatologists made independent evaluation of the photographs using modified Manchester quartile score (MQS). The patient's satisfaction to treatment was graded on a scale of 1-4. Statistical analysis was done using a statistical software. RESULTS: Statistically significant improvement was seen in height and length of the lesions. Overall appearance criteria of modified MQS showed an improvement of more than 50% in 43.3% of the lesions by the end of four sessions. Degree of hypertrophy showed more than 50% improvement in 40% of the lesions treated. Dyschromia showed more than 50% improvement in 33.4%. Texture showed the least improvement, with only 30% of lesions showing an improvement of more than 50%. The improvement of these parameters in ILS only group was significantly lower than the improvement seen in the FCL + ILS group. CONCLUSION: Combination therapy with FCL and ILS was superior in efficacy when compared to ILS alone, in the treatment of keloids and HTS.

A Case of an Indolent CD8-Positive Lymphoid Proliferation of the Ear.

A lady presented with indolent slowly spreading erythematous nodule on the left external ear which on histopathology showed dense monomorphic lymphoid cells in the dermis. No epidermotropism or angioinvasion was seen. Immunohistochemistry showed that the infiltrating lymphoid cells were CD8+ but CD4-. Majority of the cases of cutaneous T-cell lymphomas have a CD4+, CD8- T-cell expression. Few cases have been reported with similar CD8-positive lymphoid proliferation with a curious ear tropism.

A Case Report of Krukenbergs Tumor with Cutaneous Seeding.

A 47-year-old female patient presented with painless skin colored and erythematous papules coalesced to form plaques over lower abdomen for 10 days. She had undergone exploratory laparotomy with hysterectomy and bilateral oophorectomy 1 month ago, and histopathology was reported as Krukenbergs tumor. She was getting evaluated for primary, when she was referred to dermatology. A clinical diagnosis of cutaneous infiltration of tumor was made, and biopsy was done from a representative lesion which showed features suggestive of metastatic poorly differentiated adenocarcinoma. In the majority of cases in the past, cutaneous metastasis is seen much later in the course of the disease. High degree of suspicion and histopathology was helpful in the diagnosis of underlying malignancy in our patient.