Atrophic acne scar treatment using triple combination therapy: dot peeling, subcision and fractional laser.

Atrophic scars are a common complication of acne. Many modalities are proposed but each does not yield satisfactory clinical outcomes. Thus, a new combination therapy is suggested that incorporates (i) dot peeling, the focal application and tattooing of higher trichloroacetic acid concentrations; (ii) subcision, the process by which there is separation of the acne scar from the underlying skin; and (iii) fractional laser irradiation. In this pilot study, the efficacy and safety of this method was investigated for the treatment of acne scars. Ten patients received this therapy for a year. Dot peeling and subcision were performed twice 2-3 months apart and fractional laser irradiation was performed every 3-4 weeks. Outcomes were assessed using scar severity scores and patients' subjective ratings. Acne scarring improved in all of the patients completing this study. Acne scar severity scores decreased by a mean of 55.3%. Eighty percent of the patients felt significant or marked improvement. There were no significant complications at the treatment sites. It would appear that triple combination therapy is a safe and very effective combination treatment modality for a variety of atrophic acne scars.

Histopathological features in both the eschar and erythematous lesions of Tsutsugamushi Disease: identification of CD30+ cell infiltration in Tsutsugamushi disease.

Tsutsugamushi disease is an acute febrile infectious disease caused by Rickettsia tsutsugamushi. An infection is heralded by the presence of an eschar at the site of the inoculating chigger bite and followed by the development of a disseminated erythematous macular rash. CD30 expression is found in anaplastic large cell lymphoma; however, expression in nonneoplastic cutaneous disorders, such as atopic dermatitis, drug reactions, scabies, and various infectious diseases, has also been reported. Study of the cutaneous histopathology of tsutsugamushi disease has been limited. In this study, we performed biopsies of both the eschar and erythematous lesions of 15 cases of tsutsugamushi disease to assess the histopathological changes including the CD3, CD4, CD20, CD30, and CD68 reactivity. Twelve women and 3 men were included with an age range from 21 to 73 years. The most common location of the eschar was the trunk (53.3%). The histological features showed increased leukocytoclastic vasculitis in the eschar (93.3%) compared with the erythematous lesions (33.3%); basal vacuolar changes were more common in the erythematous (100%) than in the eschar lesions (20%). The inflammatory infiltrate had a majority of CD3- and CD68-positive cells. Seven erythematous lesions and 7 eschar lesions showed atypical cells that were CD30-positive cells. Here, we report on the cutaneous histopathology and pattern of inflammatory infiltrates of tsutsugamushi disease. Leukocytoclastic vasculitis and basal vacuolar changes were the characteristic features of the eschar and the erythematous lesions, respectively. In addition, CD30-positive cell infiltration was identified for the first time in this disease.

Histopathologic features in vitiligo.

Nevus depigmentosus is a congenital disorder characterized by a nonprogressive hypopigmented lesion, which may not be apparent at birth. Thus, it is sometimes difficult to differentiate vitiligo from nevus depigmentosus only by clinical features. We postulated that the histologic changes in lesional and perilesional skin might be different in the 2 conditions. We took biopsies from both lesional and perilesional skin of 100 cases of vitiligo to assess the number of melanocytes, the amount of melanin, dermal inflammatory infiltrate, and other changes. We compared them with 30 cases of nevus depigmentosus. Histologically, lesions of vitiligo showed more basal hypopigmentation and dermal inflammation than perilesional normal skin. With Fontana-Masson staining, 16% of cases of vitiligo showed the presence of melanin. The ratio of pigmented area to epidermal area was 0.06% in vitiligo, whereas 17% in perilesional normal skin and 8.9% in nevus depigmentosus. In NKI/beteb staining, 12% of vitiligo showed the presence of melanocytes, and their average number was 7.68 per square millimeter. The number of melanocytes was also decreased in nevus depigmentosus but not as much as in vitiligo. We also confirmed the presence of melanocytes in 1 of 3 cases of vitiligo by electron microscopy. In conclusion, there are a few melanocytes and melanin in some cases of vitiligo. Therefore, the diagnosis of vitiligo should be made considering these points.