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Boixeda P, Carmona LP, Vano-Galvan S, Jaén P, Lanigan SW. Advances in treatment of cutaneous and subcutaneous vascular anomalies by pulsed dual wavelength 595- and 1064-nm application. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.mla.2008.04.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Beà-Ardébol S, Boixeda P, Bagazgoitia L, Santiago Sánchez-Mateos JL, Pérez-Carmona L, Jaén P. Management of superficial lymphangiectasias with laser: report of five patients. J Eur Acad Dermatol Venereol 2008; 23:450-1. [PMID: 18624841 DOI: 10.1111/j.1468-3083.2008.02894.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Boixeda P, Calvo M, Bagazgoitia L. [Recent advances in laser therapy and other technologies]. ACTAS DERMO-SIFILIOGRAFICAS 2008; 99:262-268. [PMID: 18394401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
Laser technology and other energy sources are rapidly finding a place in dermatology clinics. In the field of skin rejuvenation by fractional photothermolysis, although few controlled studies have been undertaken, several devices have emerged in recent years that appear less effective than laser ablation techniques but that are safer. The aim of this short article is to provide an introduction, though not treat in depth, the different emerging technologies in dermatology. We will focus particularly on lasers and light sources in improving applications such as the treatment of vascular lesions, acne, and encapsulated ink tattoos; light-emitting diodes; developments in the treatment of cellulitis; photodynamic therapy; suction methods; scarring; and finally the recent and doubtlessly future introduction of home devices for use in a range of dermatologic applications (depilation, rejuvenation, treatment of acne, etc).
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Boixeda P, Calvo M, Bagazgoitia L. Recent Advances in Laser Therapy and Other Technologies. ACTAS DERMO-SIFILIOGRAFICAS 2008. [DOI: 10.1016/s1578-2190(08)70249-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Aldanondo I, Boixeda P, Fernández-Lorente M, Marquet A, Calvo M, Jaén P. Selectivity of Photothermolysis in the Treatment of Port Wine Stains Using Multiple Pulses With a Pulsed Dye Laser. ACTAS DERMO-SIFILIOGRAFICAS 2008. [DOI: 10.1016/s1578-2190(08)70312-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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81
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Fernández-Guarino M, Boixeda P, de Las Heras E, Aboin S, García-Millán C, Olasolo PJ. Phakomatosis pigmentovascularis: Clinical findings in 15 patients and review of the literature. J Am Acad Dermatol 2007; 58:88-93. [PMID: 18045734 DOI: 10.1016/j.jaad.2007.08.012] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2007] [Revised: 07/31/2007] [Accepted: 08/09/2007] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Phakomatosis pigmentovascularis (PPV) is a rare syndrome characterized by the association of a vascular nevus with an extensive pigmentary nevus. OBJECTIVE We sought to study and evaluate clinical findings in patients with PPV referred to the laser department of our hospital. METHODS We revised the clinical findings of 15 patients with PPV and reclassified them according to Happle's new classification. RESULTS We studied 11 female patients and 4 male patients with a mean age of 21 years. Thirteen had phakomatosis cesioflammea, one cesiomarmorata, and one an unclassifiable form. Of 15 patients, 12 had nevus of Ota. The vascular involvement was extensive in our PPV population and 14 patients were affected in two or more areas. The mosaicism pattern in 13 patients was patchy and without a midline separation. The most frequent associations found were Sturge-Weber syndrome, Klippel-Trénaunay syndrome, and melanosis oculi. LIMITATIONS Limitations include the methods of case collection, that this is a retrospective study, and that there were a relatively small number of patients. CONCLUSIONS PPV are rare syndromes with a wide variability in their clinical expression. Most of the publications in the literature have only reported isolated cases.
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Díez E, Boixeda P. Frey's Syndrome in Childhood. ACTAS DERMO-SIFILIOGRAFICAS 2007. [DOI: 10.1016/s1578-2190(07)70389-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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83
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Díez E, Boixeda P. Síndrome de Frey en la infancia. ACTAS DERMO-SIFILIOGRAFICAS 2007; 98:45-6. [PMID: 17374333 DOI: 10.1016/s0001-7310(07)70008-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Frey's syndrome, also known as auriculotemporal syndrome is characterized by recurrent episodes of facial flushing and/or sweating along the distribution of the auriculotemporal nerve, that occurs in response to gustatory stimuli. The disorder is rare in children. We report a 4-year-old girl with flushing without hyperhidrosis in the left cheek on eating.
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Tévar E, Calvo M, Moratinos M, Boixeda P. Láser y otras fuentes de luz en el tratamiento de manchas en vino de Oporto. ACTAS DERMO-SIFILIOGRAFICAS 2006; 97:419-27. [PMID: 16978541 DOI: 10.1016/s0001-7310(06)73434-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Laser treatment of vascular skin lesions is rapidly improving. Port wine stain (PWS) is one of the first lesions successfully treated with laser. The pulsed dye laser (PDL) has been developed on the concept of selective photothermolysis and has revolutionized PWS treatment. Even though the response is variable, substantial blanching can be obtained after several sessions. Greater selectivity and better response have been achieved by modifying PDL parameters such as longer pulse width, longer wavelength, or higher energy fluencies with cooling skin devices. It is known that thick, deep or raised lesions present poor response to conventional treatments. The aim of this study is to review the different lasers and other light sources which are developing for the treatment of PWS and other vascular lesions.
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Belmar P, Boixeda P, Baniandrés O, Fernández-Lorente M, Arrazola JM. Seguimiento a largo plazo de angiofibromas tratados con láser de CO2 en 23 pacientes con esclerosis tuberosa. ACTAS DERMO-SIFILIOGRAFICAS 2005; 96:498-503. [PMID: 16476284 DOI: 10.1016/s0001-7310(05)73121-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Tuberous sclerosis is an autosomal dominant disease in which hamartomas form in multiple organs. Cutaneous changes are one of the primary characteristics of this disease. These include angiofibromas (AF), a common form of presentation that causes significant cosmetic and medical problems. The CO2 laser has been used satisfactorily in treating these lesions, but there are few studies that evaluate its long-term results. The aim of our study is to assess the long-term response of the treatment of angiofibromas. METHODS A retrospective study was carried out on 23 patients with angiofibromas treated with CO2 laser. The patients were treated between 1991 and 2000, inclusive, with continuous or superpulsed CO2 laser. We classified the angiofibromas by size, initial treatment results and patients' ages (< 20 years and 20 years or older). RESULTS Ages ranged from 12 to 39 years, with a median age of 22.5 years. After treatment, patients were followed up for a period of six months to 10 years. In the long-term analysis, we found that 30.1 % maintained the initial result, and 60.9 % showed different degrees of recurrence, with a mean recurrence time of 3 years. When we analyzed the long-term results by the size of the angiofibromas, initial result and patients' ages, we found no statistically significant differences among the different groups. The survival analysis of the age groups, with Kaplan-Meier curves, showed that the youngest patients (< 20 years) had earlier recurrences than the older ones (logarithmic range 4.01 and p < 0.05). CONCLUSIONS CO2 laser treatment achieves good short-term results. On the other hand, one of the biggest problems is recurrence over the long term; this is probably due to the fact that, because of their nature, these lesions cannot be eliminated permanently. This work coincides with earlier studies which found no factors that would make it possible to predict the recurrence of the lesions. However, we can conclude that recurrence takes place at a later date in older patients, and therefore they have better cosmetic results over the long term.
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Baniandrés O, Boixeda P, Belmar P, Pérez A. Treatment of lupus erythematosus with pulsed dye laser. Lasers Surg Med 2003; 32:327-30. [PMID: 12696102 DOI: 10.1002/lsm.10169] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVES The treatment of cutaneous lupus erythematosus (CLE) with dye and argon laser has been evaluated in a number of articles in recent years. The improvement of telangiectasias and chronic erythema of the cutaneous lesions was based on the selective photothermolysis ablation of the dilated capillaries and venules. STUDY DESIGN/MATERIALS AND METHODS We describe the results of the treatment of cutaneous lesions of 14 patients; eight with discoid lupus erythematosus (DLE) and six with systemic lupus erythematosus (SLE). Three patients received a treatment with flashlamp pulsed dye laser (FPDL) (585 nm, 450 microseconds) with fluences in the range from 5 to 7.75 J/cm(2); the other 11 patients were treated with long pulsed dye laser (LPDL) (595 nm, 1.5-10 milliseconds) with fluences in the range from 6 to 13 J/cm(2) depending on the pulse duration. RESULTS During a median follow-up of 10 months, we observed an average improvement in over 60% of the lesions. A few side effects were observed in all patients: four had transient hyperpigmentation and one patient had light scarring. Three patients had a relapse after more than 1 year; they were then offered conventional treatment. CONCLUSIONS We confirm that pulsed dye laser is a good alternative treatment for the erythema in active cutaneous lesions of lupus erythematosus (LE).
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Boixeda P, Pérez-Rodríguez A, Fernández-Lorente M, Arrazola JM. Novedades en láser cutáneo. ACTAS DERMO-SIFILIOGRAFICAS 2003. [DOI: 10.1016/s0001-7310(03)76675-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Pérez B, Núñez M, Boixeda P, Harto A, Ledo A. Progressive ascending telangiectasia treated with the 585 nm flashlamp-pumped pulsed dye laser. Lasers Surg Med 2000; 21:413-6. [PMID: 9365950 DOI: 10.1002/(sici)1096-9101(1997)21:5<413::aid-lsm1>3.0.co;2-t] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVE Progressive ascending telangiectasia (PAT) is a distinct entity with telangiectatic superficial vessels on lower extremities as its main clinical feature. A relationship with occult infections and response to antibiotic and antifungal drugs have been described, although not all cases can be successfully managed with these therapies. Our objective was to treat a woman with PAT that had failed to respond to systemic antibiotic and antifungal drugs. STUDY DESIGN/PATIENTS AND METHODS A 44-year-old woman with PAT was treated with the flashlamp-pumped pulsed dye laser at 585 nm, with fluences varying from 7 to 7.25 J/cm2. RESULTS A successful outcome was obtained with this treatment approach, with no relevant adverse effects except for mild pigmentary changes. CONCLUSIONS Although ectatic vessels on lower extremities are often resistant to dye laser therapy, superficial thin capillaries like those featuring PAT can be eliminated with the pulsed dye laser at 585 nm. Transient pigmentary changes occur on treated areas but they are expected to disappear in 6 to 12 months after treatment. Laser treatment should be considered in PAT despite the extension and location of the lesions.
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Núñez M, Miralles ES, Boixeda P, Gómez F, Pérez B, Abraira V, Ledo A. Iontophoresis for anesthesia during pulsed dye laser treatment of port-wine stains. Pediatr Dermatol 1997; 14:397-400. [PMID: 9336816 DOI: 10.1111/j.1525-1470.1997.tb00992.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Port-wine stains (PWS) are benign, congenital vascular malformations found in approximately 0.3% of newborns. PWS may be effectively treated with the flashlamp pulsed dye laser (FPDL) at 585 nm. However, laser therapy of vascular lesions often produces pain. We performed a prospective double-blind, placebo-controlled evaluation of the iontophoresis of lidocaine 5% with epinephrine 1:50,000 and mepivacaine 2% with epinephrine 1:50,000. Thirty-six patients with facial PWS were included in the study; 13 of them were treated with lidocaine 5% with epinephrine, another 13 were treated with mepivacaine 2% with epinephrine, and the other 13 were treated with preservative-free 0.9% NaCl. The pain was graded by the patient on a visual analog scale from 0 to 10, comparing the iontophoretically treated area with an adjacent area treated without anesthesia. Pain evaluation by patients demonstrated a significant decrease in the pain of pulsed dye laser impulses using the iontophoresis of lidocaine 5% with epinephrine. No change in the efficacy of pulsed dye laser treatment of PWS or important side effects were observed in our patients. Iontophoresis of lidocaine 5% with epinephrine is a safe and effective method of local anesthesia for pulsed dye laser and it is more effective than the iontophoresis of mepivacaine 2% with epinephrine.
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Abstract
BACKGROUND Port-wine stains (PWS) are a congenital, progressive ectasia of the superficial cutaneous vascular plexus that occur in 0.3%-0.5% of children at birth. They should be considered a disease with physical and psychologic complications. Treatment with the flashlamp pulsed dye laser (FPOL) has proven to be effective. Because treatment results in selective vascular injury, the risk of complications is minimal. The purpose of this study was to determine the cutaneous side-effects and complications and their frequency in patients with PWS treated with the FPDL. Eighty-nine patients who had been treated with the FPDL for PWS were included in this study. METHODS Patients were treated at 3-month intervals using slightly overlapping pulses with fluences of 6.0-9.0 J/cm2. Treating physicians were responsible for evaluating the patients. All patients were reviewed and side-effects and complications were recorded. RESULTS Pigmentary changes were the most frequently observed complications. Hyper- and hypopigmentation appeared in 16.8% and 2.4% of patients, respectively. Cutaneous depressions occurred in 2.2% of patients. One patient developed a hypertrophic scar, and another patient presented with transient cutaneous pustulosis. All these changes usually resolved spontaneously and completely in a few months. CONCLUSIONS Most of the side-effects and complications produced by the FPDL are usually transitory, and it is essentially a very secure technique.
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Pérez B, Abraira V, Núñez M, Boixeda P, Perez Corral F, Ledo A. Evaluation of agreement among dermatologists in the assessment of the color of port wine stains and their clearance after treatment with the flashlamp-pumped dye laser. Dermatology 1997; 194:127-30. [PMID: 9094459 DOI: 10.1159/000246079] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Color classification and its subjective clearance evaluation in response to treatment are essential in the management of patients with port wine stains (PWS). But color perception by physicians is not an objective measurement so that it can change among observers. Agreement among physicians is essential for the reliability of the color classification and the clinical assessment of the response to laser treatment. OBJECTIVE The purpose of our study was to determine the reliability of the clinical color classification of port wine stains and of their color change or clearance in response to laser treatment. The study was not designed to evaluate the outcome of laser treatment in PWS or the factors that could predict the final response. METHODS We used the kappa index to evaluate the proportion of agreement in color and clearance perception among dermatologists. Six dermatologists classified the initial color of PWS in 80 patients. Three of them also assessed the amount of clearance achieved after treatment with the flashlamp-pumped dye laser. These three dermatologists were usually dedicated to treat patients with PWS, while the other three were not. RESULTS The kappa index showed a substantial agreement in both cases. No difference in the initial color perception was observed between the group of dermatologists specialized in PWS and the other three dermatologists. CONCLUSION These results favor the reliability of the clinical method in the assessment of PWS before and after laser treatment. So, although subjective, color perception by physicians can be used in the study of laser treatment outcome in PWS and its related factors, and the results of different authors can be compared.
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Boixeda P. Pulsed Dye Laser Treatment of Telangiectatic Chronic Erythema of Cutaneous Lupus Erythematosus. ACTA ACUST UNITED AC 1996. [DOI: 10.1001/archderm.1996.03890270132027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Núñez M, Boixeda P, Miralles ES, de Misa RF, Ledo A. Pulsed dye laser treatment of telangiectatic chronic erythema of cutaneous lupus erythematosus. ARCHIVES OF DERMATOLOGY 1996; 132:354-5. [PMID: 8607651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Miralles ES, Núñez M, Boixeda P, Moreno R, Bellas C, Ledo A. Transformed cutaneous T cell lymphoma and biclonal gammopathy. Int J Dermatol 1996; 35:196-8. [PMID: 8655237 DOI: 10.1111/j.1365-4362.1996.tb01639.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Núñez M, Boixeda P, Miralles ES, de Misa RF, Ledo A. Pulsed dye laser treatment in lupus erythematosus telangiectoides. Br J Dermatol 1995; 133:1010-1. [PMID: 8547022 DOI: 10.1111/j.1365-2133.1995.tb06945.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Boixeda P, Sánchez-Miralles E, Azaña JM, Arrazola JM, Moreno R, Ledo A. CO2, argon, and pulsed dye laser treatment of angiofibromas. THE JOURNAL OF DERMATOLOGIC SURGERY AND ONCOLOGY 1994; 20:808-12. [PMID: 7798412 DOI: 10.1111/j.1524-4725.1994.tb03709.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Tuberous sclerosis is a complex disorder of hamartoma formation in many organs, particularly the skin, brain, eye, kidney, and heart. The characteristic skin lesions are angiofibromas (AF), the shagreen patch, periungual fibromas, and "ash-leaf" white macules. Treatment for AF has previously included electrocoagulation, electrodesiccation and curettage, dermabrasion, excision, cryosurgery, and oral 13-cis retinoic acid. Both argon and CO2 lasers have been used in isolated cases to treat AF. OBJECTIVE The purpose of this work is the study of the application of three different lasers in the treatment of facial AF. METHODS Ten patients with facial AF were treated with CO2, argon, and pulsed dye lasers. Patients' AF were graded with regard to the size and color of the lesions. A 2-3-cm2 test was assayed on the face of all patients with each laser before performing a complete treatment and in order to choose the best laser. RESULTS Results were considered excellent in seven patients and good in three patients, with decrease of erythema and flattening of the AF. Minimal scarring was noted in two patients. Transient erythema was observed in patients treated with the CO2 laser. All patients or their parents considered the treatment cosmetically satisfactory. CONCLUSION We found the CO2 laser to be a better therapeutic tool than the argon laser to treat AF, especially in those patients with multiple and protuberant AF. The argon laser would be more useful in those patients with very red AF and light complexion, and the pulsed dye laser in those with very red and flat AF.
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de Misa RF, Azaña JM, Harto A, Boixeda P, Moreno R, Ledo A. Psoriatic arthritis: one year of treatment with extracorporeal photochemotherapy. J Am Acad Dermatol 1994; 30:1037-8. [PMID: 8188874 DOI: 10.1016/s0190-9622(09)80154-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Núñez M, Miralles ES, Boixeda P, Arrazola JM, Ledo A. Pulsed dye laser treatment of cutaneous vascular lesions in CREST syndrome. J DERMATOL TREAT 1994. [DOI: 10.3109/09546639409080572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Martínez J, de Misa RF, Boixeda P, Arrazola JM, Ledo A. Long-term results of intralesional interferon alpha-2B in discoid lupus erythematosus. J Dermatol 1993; 20:444-6. [PMID: 8408929 DOI: 10.1111/j.1346-8138.1993.tb01316.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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