Pulsed dye laser treatment of pigmented lesions: a randomized clinical pilot study comparison of 607- and 595-nm wavelength lasers.

BACKGROUND: The 595-nm pulsed dye laser has been used for the treatment of benign epidermal pigmented lesions (EPLs), but there is a risk of inducing undesirable purpura with treatment. OBJECTIVE: To compare a 607-nm laser with a commercially-available 595-nm laser for the treatment of EPLs. MATERIALS AND METHODS: Monte-Carlo simulations were performed to characterize laser interaction with skin. Ten patients with EPLs were treated with a 607-nm study prototype laser and the 595-nm pulsed dye laser twice at 2- to 4-week intervals on the left or right side on a randomized basis. Study endpoints included clearance rate of lesions, side effects immediately after treatment and at final follow-up, and patient discomfort/pain. RESULTS: Monte-Carlo simulations show that the 607-nm is absorbed more specifically by melanin than the 595-nm wavelength. Both lasers were effective in treatment of EPLs. The average degree of improvement overall was 41.2% with the 607-nm laser and 40% with the 595-nm laser. Patients reported less discomfort/pain during treatment with the 607-nm laser. CONCLUSIONS: Our findings suggest that the 607-nm laser is safe and at least as effective as the 595-nm laser in treatment of EPLs. There was less patient discomfort/pain during treatment using the 607-nm laser.

Biologic dressings: current applications and limitations in dermatologic surgery.

BACKGROUND: Various biologic dressings have been developed in an effort to find the ideal skin substitute for use in acute and chronic wounds. There are many potential uses for such dressings, but no panaceas exist. Because millions of health care dollars are spent each year on wound care, and a great deal of patient morbidity occurs from these wounds, the search for new and better dressings is likely to continue. OBJECTIVE: To review the current evidence regarding the utility, outcomes, and adverse effects of the available biologic dressings, with a particular focus on use in acute surgical wounds and applicability to dermatologic surgery. MATERIALS AND METHODS: PubMed literature search and review of data on biologic dressings with particular attention to the past 2 decades. Emphasis was placed on peer-reviewed manuscripts and larger series. CONCLUSIONS: There is extensive literature regarding the use of biologic dressings in chronic wounds, such as venous leg ulcers and burns, but studies evaluating these dressings in acute surgical wounds and dermatologic surgery have been limited. There appear to be specific surgical settings in which such dressings may be of particular use, in addition to limitations of their use. Additional studies, particularly randomized and comparative trials, would be highly desirable.

Penicillamine-induced elastosis of the mucosal lip.

Long-term penicillamine therapy has been associated with alterations in dermal elastic tissue. Well-described associated dermatoses include pseudo-pseudoxanthoma elasticum, acquired cutis laxa, elastosis perforans serpiginosa, and anetoderma. Histologically, "lumpy-bumpy"" or "bramble-bush"" morphologic changes of elastic fibers in the dermis are characteristic. Previous reports of these findings in normal-appearing skin and internal organs suggest a systemic elastolytic process. Here we report an unusual case of penicillamine-induced elastosis affecting the mucosa of the lip with characteristic histologic features.

Peroxisome proliferator-activated receptor-gamma and retinoid X receptor signaling regulate fatty acid uptake by primary human placental trophoblasts.

CONTEXT: Transplacental transfer of fatty acids from the maternal to the fetal circulation is essential for fetal development. The nuclear receptor peroxisome proliferator-activated receptor-gamma (PPARgamma) regulates fatty acid transport and storage in adipocytes and other cell types. OBJECTIVE: This study tested the hypothesis that PPARgamma and its heterodimeric nuclear receptor partner, retinoid X receptor (RXR), regulate fatty acid uptake by human trophoblasts. DESIGN: Prospective basic laboratory in vitro research was conducted using primary term human trophoblasts. SETTING: The study was performed in the perinatal biology laboratory of an academic medical center. PATIENTS OR OTHER PARTICIPANTS: Study materials were obtained from healthy pregnant women at a gestational age of 37-41 wk. INTERVENTIONS: There were no interventions. MAIN OUTCOME MEASURES: Fat uptake and accumulation in human placental trophoblasts were measured. RESULTS: We initially demonstrated that activation of PPARgamma and/or RXR with selective agonists increased the accumulation of neutral lipids in trophoblasts as well as uptake of free fatty acids. Furthermore, activation of PPARgamma and RXR enhanced the expression of the fat droplet-associated protein adipophilin along with fatty acid transport protein (FATP)4, whereas expression of FATP2 was decreased by activation of RXR. Finally, we found that inhibition of p38 MAPK, which diminishes the activity of PPARgamma in trophoblasts, inhibited fatty acid uptake and blocked the PPARgamma- and RXR-dependent increases in adipophilin and FATP4 expression, yet stimulated the expression of FATP1, FATP2, and FATP3. CONCLUSIONS: These data support a role for PPARgamma and RXR in regulation of fatty acid transport and storage in human placental trophoblasts.