Comparative study of ablative fractional photothermolysis versus topical retinoid cream in the treatment of idiopathic guttate hypomelanosis.

Background: Despite various treatments attempts, no prospective studies have compared the different therapeutic modalities for treatment of idiopathic guttate hypomelanosis (IGH). This study aimed to compare the efficacy of CO2 fractional laser (CO2FL), Er:YAG fractional laser (EYFL), and 0.025% topical tretinoin for treating IGH. Materials and Methods: A total of 122 lesions were analyzed from 18 patients (mean age, 70.00 ± 20.00 years). Treatment outcome evaluations included the visual analog scale (VAS) to assess lesion severity, investigator's global assessment (IGA) to assess the extent of improvement, and patient's satisfaction score (PSS). Results: Among the 122 lesions, 42, 40, and 40 were assigned to the CO2FL, EYFL, and topical tretinoin treatment groups, respectively. The VAS score was significantly improved after the second treatment. CO2FL and EYFL therapy had superior treatment efficacy compared to topical tretinoin (p < 0.01 in VAS, IGA, and PSS). There was no significant difference between the two types of fractional lasers. Conclusions: Ablative fractional laser (AFL) was an effective treatment with a relatively short treatment time without serious adverse events. We recommended AFL to treat IGH as an active treatment strategy.

Alitretinoin treatment of lichen amyloidosis.

Lichen amyloidosis (LA) is characterized by the deposition of amyloid that may respond to chronic scratching that may be secondary to atopic dermatitis, stasis dermatitis, or interface dermatitis. Despite the development of several therapeutic strategies, including topical steroids, oral antihistamines, cyclosporine, and retinoids, an effective treatment for LA has not been established. A 49-year-old woman who has been treated irregularly for atopic dermatitis for 7 years presented with localized brownish papules on the left forearm and right elbow. They developed 3 months prior and were becoming more prominent despite of treatment with cyclosporine, oral antihistamines, and topical steroids for 5 months prior to presentation. A skin biopsy revealed amyloid deposition in the dermal papillae and the patient was diagnosed with LA associated with atopic dermatitis. A 6-month course of daily oral alitretinoin 30 mg produced marked improvement in the thickness and color of the hyperkeratotic papules without aggravation of the patient's atopic dermatitis. Histologic evaluation showed clearance of amyloid deposition and almost normalization of the epidermal changes. Herein, we report a case of LA treated with alitretinoin and suggest that it could be a potential treatment option for LA, especially in patients with inflammatory skin diseases including atopic dermatitis.