Ablative fractional erbium-doped yttrium aluminum garnet laser with coagulation mode for the treatment of atrophic acne scars in Asian skin.

BACKGROUND: The introduction of fractional photothermolysis (FP) for the treatment of atrophic acne scars has been proven to provide satisfactory results. For severe atrophic acne scarring, nonablative FP achieves fair improvement and takes multiple treatment sessions. Ablative fractional resurfacing provides an alternative modality with greater satisfaction. OBJECTIVE: To evaluate the effectiveness and safety of the ablative fractional 2,940-nm erbium-doped yttrium aluminum garnet (Er:YAG) laser with coagulation mode for the treatment of atrophic facial acne scars in Asian skin. METHODS: Thirty-four patients aged 19 to 44 (mean 34.2) with Fitzpatrick skin types III and IV, received one ablative fractional 2,940-nm Er:YAG laser treatment with an adjustable coagulation mode and were followed for 3 months. Physician evaluation and patient satisfaction were graded on a 4-point scale. Side effects were recorded at each follow-up visit. RESULTS: Almost three-quarters of the patients rated their satisfaction as good to excellent (score of 3 or 4). All patients experienced short downtime, and the incidence of postinflammatory hyperpigmentation was low (3.0%). CONCLUSIONS: The ablative fractional Er:YAG laser with coagulation mode is recommended for the treatment of moderate to severe atrophic acne scars, with acceptable downtime and high satisfaction in Asian patients.

A comparison of Ki-67 antigen presentation in acute generalized exanthematous pustulosis and pustular psoriasis.

Ki-67 is an established marker of cell proliferation. It is highly expressed in psoriasis and correlated with the clinical severity of psoriasis. Higher number of Ki-67 positive keratinocytes has been observed in pustular psoriasis (PP) as compared with psoriasis vulgaris. As for Acute generalized exanthematous pustulosis (AGEP), a distinct disease entity but similar in many aspects of clinicopathologic features to PP, Ki-67 immunostaining presentation has never been investigated before. This study aimed to compare Ki-67 immunostaining presentation between PP and AGEP. By immunohistochemical staining, we compared Ki-67 immunostaining presentation on skin lesions of five patients of AGEP and five age-matched patients of PP. Ki-67 positive keratinocytes were counted and mean values were determined to compare between PP and AGEP. An augmented presence of Ki-67 positive keratinocytes was found in both AGEP and PP and they distributed not only in basal cell layer but in middle or even upper part of epidermis. Statistical analysis using Mann-Whitney U test showed no difference of epidermal proliferation rate between the two groups (P = 0.222). The results showed there was no difference of Ki-67 immunostaining presentation between AGEP and PP. Besides, we found marked increase of Ki-67-positive proliferating keratinocytes in AGEP and suggested that epidermal hyperproliferation may also play an important role in the formation of AGEP. We also discussed the possible pathophysiology of AGEP, possible epidermal architecture changes in AGEP and PP, and found the similarity in pathophysiology of AGEP and PP.