Utility of Dermoscopy before and after Laser Irradiation in Port Wine Stains.

BACKGROUND: Port wine stains (PWSs) are commonly treated with pulsed dye laser (PDL) as a standard therapy. However, it is not easy to predict the minimal effective dose in the first treatment session. OBJECTIVE: The aim of this study was to assess whether dermoscopic findings before and after laser irradiation corresponded with the clinical improvement of PWS in patients undergoing PDL therapy. METHODS: Seven untreated PWSs in 6 patients (a male and 5 females), who presented to our hospital between May 2008 to January 2010, were assessed in this study. The mean age was 36.3 years, ranging from 14 to 57 years. A PDL with a wavelength of 585 nm and a spot size of 7 mm was used. Before and after test irradiation, patients underwent dermoscopy and clinical photography, and we assessed whether the dermoscopic findings corresponded with clinical improvement after 3 months. RESULTS: There were no obvious differences observed in the clinical photographs between each test level immediately after irradiation. However, dermoscopic photographs showed differences as the irradiated energy increased. These changes corresponded to the clinical improvement after 3 months. CONCLUSION: Our study indicates that the minimal effective fluence can be predicted by observing dermoscopic change immediately after irradiation. We think that examining the dermoscopic findings immediately after irradiation allows the laser surgeon to predict the minimal effective fluence and this prevents adverse effects of the skin.

Intense pulsed light therapy for aberrant Mongolian spots.

BACKGROUND: Aberrant Mongolian spots (AMS) distal to the lumbosacral region are thought to be more likely to persist than typical sacral Mongolian spots. So far, Q-switched ruby laser (QSRL) has been the treatment of choice for AMS. Intense pulsed light (IPL) is obtained from flashlamp devices that emit wavelengths between 515 and 1200 nm. IPL has documented efficacy for the treatment of irregular pigmentation, telangiectasia, rough skin texture, rhytids, hair removal, and vascular lesions, with several filters being available that can be used to block shorter wavelengths from the skin. As far as we could determine, there have been no clinical and histological studies on the treatment of AMS with IPL. Accordingly, the aim of this study was to assess the clinical and histological efficacy of IPL for AMS. METHODS: Seven patients (4 males and 3 females) presenting from September 2008 to July 2009 were assessed. Their mean age was 2.0 years, ranging from 0 to 7 years. The IPL device used in this study was a Natulight (Lumenis Ltd., Tokyo, Japan). Photographs were taken of all patients with a high-resolution digital camera at baseline and 6 months after treatment. Skin biopsy specimens were taken from 1 patient (case 4) before, immediately after, and 6 months after treatment. RESULTS: According to the 7 family members of the patients, the outcome of IPL was graded as follows: excellent improvement in 1 (14%), good improvement in 4 (57%), and slight improvement in 2 (29%). All families would have liked to continue IPL treatment. Evaluation of the effect of treatment by a physician was less favorable, with excellent improvement in 1 (14%), good improvement in 2 (29%), and slight improvement in 4 (57%). Histopathologic examination of the pigmented region revealed the typical features of a Mongolian spot in the hematoxylin-eosin stained section. Immediately after IPL, there were no changes in the dermis. At 6 months after treatment, however, the number of melanocytes in the middle and upper dermis was obviously decreased. CONCLUSIONS: IPL is an effective method for the treatment of AMS.

Bilateral nevus of Ota: a rare manifestation congenital type in a boy.

BACKGROUND: The nevus of Ota is usually characterized by small, flat, unilateral, blue-black or gray-brown spots occurring on skin innervated by the first or second branch of the trigeminal nerve. It comprises dermal melanocytes, presumably arising due to the dermal arrest of cells migrating from the neural crest. Nevus of Ota is 3-5 times more common in women than men, and is classified into congenital type, appearing soon after birth, and acquired type, appearing during or after puberty. METHODS: We report on a six-year-old Japanese boy with the bilateral nevus of Ota. He was referred to our hospital because of bilateral hyperpigmentation of the face, present since birth. Our treatment consisted of Q-switched ruby laser irradiation under general anesthesia. The Q-switched ruby laser (Model IB101; Niic Co. Ltd., Tokyo, Japan), had a wavelength of 694.3 nm, a spot size of 5 mm, a 1 Hz repetition rate, a pulse duration of 20 nsec and fluence ranged from 3.0 J/cm2 to 6.0 J/cm2. RESULTS: Q-switched ruby laser irradiation improved his pigmentation, and will therefore be repeated several times. CONCLUSIONS: This case of congenital bilateral nevus of Ota in a young male patient was very rare. And Q-switched ruby laser irradiation was effective as same as another nevus of Ota.

Comparison of regional efficacy and complications in the treatment of aberrant Mongolian spots with the Q-switched ruby laser.

BACKGROUND AND OBJECTIVE: Aberrant Mongolian spots (AMS) distal from the lumbosacral region are said to be more apt to persist than the typical sacral AMS, so the Q-switched ruby laser (QSRL) has been the treatment of choice for AMS. However, so far as we could determine, there is no statistical analysis of the treatment of AMS. This paper shows statistical comparisons of the efficacy and complications in the treatment of AMS with QSRL. METHODS: Fifty-three patients (16 males and 37 females) with 57 AMS regions were treated with the QSRL from March 1999 to April 2007, and we divided the diseased areas into exposed regions that could not be concealed by clothing and non-exposed regions that could be concealed by clothing, and performed a statistical analysis. RESULTS: The results indicated that QSRL treatment of AMS in the exposed regions showed significantly improved coloration and caused less pigmentation when compared with the non-exposed regions. CONCLUSION: We concluded that QSRL treatment of AMS in the exposed regions is more effective than that of AMS in the non-exposed regions.