Granulomatous mycosis fungoides with large cell transformation misdiagnosed as leprosy.

BACKGROUND: Granulomatous mycosis fungoides is an unusual histopathological variant of cutaneous T-cell lymphoma without clinical distinction from classic mycosis fungoides. Symptoms associated with peripheral nerve involvement have rarely been reported in the literature. CASE REPORT: The authors described a case of granulomatous MF stage IIB with large cell transformation who initially presented with leprosy-like condition and chronic left peroneal neuropathy The patient received six courses ofgemcitabine with greater than 90% improvement of skin lesions. The rest of the lesions were successfully treated with local electron beam radiation. CONCLUSION: Granulomatous MF with neuropathy can be clinically misdiagnosed if there is no histopathological and immunohistochemical finding to support the diagnosis of lymphoma.

Effect of pulse width of a variable square pulse (VSP) erbium:YAG laser on the treatment outcome of periorbital wrinkles in Asians.

BACKGROUND: Uses of appropriate laser parameters are essential for an optimum outcome with minimal risks of complications. OBJECTIVE: To evaluate the effect of pulse width of a variable square pulse (VSP) Er:YAG laser on the treatment outcome. METHODS: Twenty-four Thais with periorbital wrinkles received two treatments with a low-fluence, VSP Er:YAG laser resurfacing 1 month apart. Subjects were randomly divided into two groups and treated with two different parameters including a pulse width of 0.3 ms (short pulse, SP) for one group and a pulse width of 250 ms (super-long pulse, SL) for the other group. Assessments were evaluated at baseline, 1-month and 3-month follow-up visits. RESULTS: After one treatment, 63.7% and 33.4% of the subjects in the SP and SL groups, respectively, were assessed to have obvious to marked improvement of their wrinkles. After two treatments, a higher percentage of the subjects were rated to have obvious to marked improvement including 91% and 66.7% in the SP and SL groups, respectively. There was no significant difference in therapeutic outcome between the SP and SL groups. CONCLUSIONS: There was no significant difference in efficacy and side effects, between the SP and SL groups. However, a trend toward better response with the shorter pulse width was observed.

Treatment of punched-out atrophic and rolling acne scars in skin phototypes III, IV, and V with variable square pulse erbium:yttrium-aluminum-garnet laser resurfacing.

BACKGROUND: Treatment of acne scars remains a challenge, especially in dark-skinned individuals. Treatment parameters may be optimized by selecting appropriate pulse width and laser energy that enhance tissue thermal response with limited morbidity. OBJECTIVE: To determine the efficacy and side effects of variable square pulse (VSP) erbium:yttrium-aluminum-garnet (Er:YAG) laser resurfacing for treatment of punched-out atrophic and rolling acne scars. METHODS Twenty-four subjects with acne scars were treated monthly for 2 months with four passes of VSP Er:YAG laser resurfacing using a 7-mm spot size and a fluence of 0.4 J/cm(2). Subjects were divided into two groups and treated with two different pulse widths: 300 micros (short pulse, SP) and 1,500 micros (extra-long pulse, XLP). Objective and subjective assessments were obtained at baseline and 1, 2, and 4 months after treatment. RESULTS: In the SP group, skin smoothness improved significantly (p<.01); in the XLP group, skin smoothness (p<.05) and scar volume (p<.05) improved significantly from baseline. Adverse effects consisted of transient postinflammatory hyperpigmentation (18%) and acneiform eruption (9%). CONCLUSIONS: Low-fluence VSP Er:YAG laser resurfacing is a promising treatment option for acne scars, with minimal risk of side effects. Laser pulse width and energy determine the efficacy and the risk of side effects. The authors have indicated no significant interests with commercial supporters.

Treatment of melasma using variable square pulse Er:YAG laser resurfacing.

BACKGROUND: Treatment of melasma remains a challenge. Laser treatments show limited efficacy, with a high rate of recurrence and side effects. Recently, variable-pulsed erbium:yttrium aluminum garnet (Er:YAG) lasers have shown favorable results in skin resurfacing, with minimal downtime and adverse effects. OBJECTIVE: To determine the efficacy and side effects of variable square pulsed (VSP) Er:YAG laser resurfacing for treatment of epidermal type melasma. METHODS: Twenty Thai women with epidermal-type melasma were treated with two passes of VSP Er:YAG laser resurfacing using a 7-mm spot size, pulse duration of 300 micros, and a fluence of 0.4 J/cm(2). Two treatments were given 1 month apart. Visual analog scale (VAS), Melasma Area and Severity Index (MASI) score and melanin index (MI) were measured at baseline and 1, 2, and 4 months after treatment. RESULTS: There was a significant improvement in VAS from baseline at 1-, 2-, and 4-month follow-up visits (p<.001). Significant improvement in MASI score at the 2-month visit from baseline (p=.004) was also observed. The average MI measured using melanin reflectance spectrometry measurements corresponded to MASI score rating. CONCLUSIONS: VSP Er:YAG laser resurfacing effectively but temporarily improved epidermal-type melasma. Recurrence was observed after the treatment was discontinued.