Prevalence of skin disease in a cohort of shelter-based homeless men

BACKGROUND

Cutaneous disease is a frequent cause of morbidity in homeless people. A variety of infectious and noninfectious conditions have been described in this population that are exacerbated by malnutrition, exposure to hazardous environment, psychiatric disease, physical injuries, and limited access to health care.

OBJECTIVE

Our purpose was to study the prevalence of skin disease in a selected group of the homeless population.

METHODS

We evaluated skin diseases in a cohort of 142 homeless men who were staying overnight in a major Boston homeless shelter for men over a period of 3 months (March-June 1992). The subjects participated in the study by volunteering for a free skin examination. Completion of a detailed questionnaire on age, race, duration of homelessness, and general medical status was followed by a thorough skin examination performed by dermatologists.

RESULTS

The most prevalent skin diseases in the examined population were tinea pedis (38%), pitted keratolysis of the feet (20.4%), traumatic injuries (19.7%), toenail onychomycosis (15.4%), acne vulgaris (18.3%), and seborrheic dermatitis (13.3%).

CONCLUSION

To our surprise the majority of patients had relatively normal findings from skin examinations with only a few pathologic findings, most often related to poor foot hygiene and long-term exposure to moisture. We attribute the relatively good condition of our cohort to the excellent care provided by the shelter with regard to clothing, cleaning facilities, and medical care. Our findings may represent the prevalence of skin diseases in shelter-based homeless but not in street homeless persons who are likely to have much poorer hygiene and perhaps more skin disease.

Keloids and hypertrophic scars: review and treatment strategies

Keloids and hypertrophic scars represent exuberant forms of scar formation that frequently are pruritic, painful, and occasionally form strictures. As well, they may result in significant cosmetic disfigurement. Recent years have seen an increased understanding in the molecular and biological mechanisms of keloidal scar formation, allowing for the development of more specific therapeutic options for these lesions. Despite these developments, keloids and hypertrophic scars remain difficult to manage. Clinical, histopathological, and biochemical features of keloids and hypertrophic scars, as well as treatment guidelines, are discussed.

Comparison of the 595 nm long-pulse (1.5 msec) and ultralong-pulse (4 msec) lasers in the treatment of leg veins

BACKGROUND

Although several lasers and light sources are now available for vascular lesions, treatment of leg veins has not been very satisfactory. Lengthening the pulse width should theoretically result in improved response rates.

OBJECTIVE

This study compared the efficacy and safety of 595 nm pulsed lasers at 1.5 msec and 4 msec in treating leg veins.

METHODS

For group A, 27 healthy adult volunteers with leg veins measuring less than 1 mm in diameter were treated with a 2 mm x 7 mm elliptical handpiece. Each patient had three areas treated. The first two areas were treated with the 4 msec pulsed dye laser with fluences of 16 and 20 J/cm2, while the last area was treated with a 1.5 msec pulsed dye laser at fluences ranging from 14 to 16 J/cm2. For group B, 13 subjects were treated. Areas 1 and 2 were treated with the 4 msec pulsed dye laser using a 3 mm x 5 mm and 5 mm handpiece, respectively, while the third site was treated with a 1.5 msec laser using a 3 mm x 5 mm handpiece. Fluences ranging from 14 to 16 J/cm2 were used. Clinical evaluations were performed and photographs taken at 4-8 week intervals.

RESULTS

Neither laser regularly induced satisfactory diminution or disappearance of these vessels after one treatment. In group A, more than 50% of patients had little to no improvement, while in group B little to no improvement was observed in 33% of patients following a single treatment. Although there was no significant difference in outcomes between the test sites, the 4 msec PDL with a 3 mm x 5 mm spot size appeared to be most effective. Transient hyperpigmentation was common following either treatment, while hypopigmentation was seen in group B subjects. No scarring was noted.

CONCLUSION

Both the 4 and 1.5 msec flashlamp-pumped pulsed dye lasers were ineffective in treating leg telangiectasia following a single treatment.

The role of lasers and light sources in the treatment of leg veins

Telangiectasia of the legs occurs in 29% to 41% of women in the United States. The variation in size, flow, depth, and type preclude the possibility of a single effective treatment modality. When a systematic approach is used where feeder vessels are first surgically removed and sclerotherapy proceeds from largest to smallest vessels, 80-90% of vessels respond to a single sclerotherapy treatment. Because of the relatively modest results demonstrated with lasers and light sources and the high rate of success and the relatively low cost of ambulatory phlebectomy, compression sclerotherapy and superficial sclerotherapy, we generally recommend using lasers and light sources only for vessels that remain after this treatment approach. Lasers and light sources should be considered prior to sclerotherapy in patients who are fearful of needles, who do not tolerate sclerotherapy, who fail to respond to sclerotherapy, or who are prone to telangiectatic matting. Carefully monitored, controlled studies are essential to better define the role of the available laser and light sources in the treatment of leg veins.

A clinical and histologic prospective controlled comparative study of the picosecond titanium:sapphire (795 nm) laser versus the Q-switched alexandrite (752 nm) laser for removing tattoo pigment

BACKGROUND

Theory predicts that picosecond lasers should be more effective than the currently available nanosecond lasers in removing tattoo ink. In addition to thermal confinement, such pulse widths cause optimal photomechanical disruption of the target.

OBJECTIVE

This study compared the efficacy of the picosecond titanium:sapphire (795 nm, 500 psec) laser and the Q-switched alexandrite (752 nm, 50 nsec) laser in the treatment of tattooed guinea pigs.

METHODS

Six albino guinea pigs, each with 6 uniformly 1 cm circular black tattoos, were treated. Three of the tattoos were divided into 2; one half was treated with the titanium:sapphire laser and the other half with the alexandrite laser. Fluences used for both lasers were 6.11, 4.24, and 2.39 J/cm2 with spot sizes of 1.25, 1.5, and 2 mm, respectively. The remaining spots served as control. Clinical evaluation and biopsies were performed at baseline and at 11 and 16 weeks after a single laser treatment.

RESULTS

Greater clearance of tattoo was observed in titanium:sapphire laser-treated areas in 2 of the 4 surviving guinea pigs. In some areas total clearing was observed after the single titanium:sapphire laser treatment. Clearing improved with higher fluences. No scarring was present. Histologic results showed similar findings.

CONCLUSION

Our findings suggest that the picosecond titanium:sapphire laser is more effective than the Q-switched alexandrite laser in removing tattoo pigment and may be of significant clinical utility.

A clinical overview of hair removal using lasers and light sources

The tremendous demand for removal of unwanted hair has led to the development of a wide range of noninvasive, user-friendly laser and light source systems; however, despite considerable advances in this field, these devices still have the potential to cause injury when used improperly. It is important to follow precise treatment guidelines in order to attain optimal results. This article gives an overview of the currently available lasers and light sources. It focuses on the practical aspect of laser hair removal by discussing patient selection, safety precautions, techniques using the different systems, pre- and post-laser treatment care, proper treatment endpoints, expected outcome, and possible side-effects and complications.

Lasers for vascular lesions

Recent developments in laser technology have revolutionized the treatment of various cutaneous disorders. Lasers provide effective and safe treatment of many conditions for which previous therapy was either unavailable, ineffective, or unacceptable. Basic laser principles, laser safety, available laser systems for treatment vascular lesions, clinical applications, preoperative considerations, anesthesia, postoperative changes, side effects/complications, nursing measures, and patient education are described.

Lichen planus localized to the nails

BACKGROUND

Lichen planus may rarely be localized to the nails.

OBJECTIVE

A case of ungual lichen planus is reported that was misdiagnosed as onychomycosis.

METHODS

A 52-year-old woman had progressive nail dystrophy for 13 months that was unresponsive to oral terbinafine. A nail biopsy was performed.

RESULTS

Histopathologic findings were consistent with lichen planus.

CONCLUSION

Onychomycosis may be confused clinically with other causes of nail dystrophy. It is important to confirm the diagnosis of onychomycosis with appropriate laboratory or histologic analysis.

Basic laser principles

Skin diseases have been treated with lasers since the early 1960s. The three principal chromophores in the skin--hemoglobin, melanin, and water--have different absorption spectra that selectively absorb certain wavelengths of electromagnetic radiation. A given wavelength and pulse duration will selectively treat a target containing a chromophore. The wide variety of lasers and their applications are discussed.

Laser skin resurfacing

There has always been interest in looking younger, but recently there seems to have been an explosion of public interest in facial rejuvenation. Physicians have been treating photodamaged skin for many years by removing the epidermis and a variable thickness of dermis with dermabrasion or chemical peels, with the expectation that reepithialization and collagen remodeling will result in a more youthful appearance. With the recent development of short-pulsed high-peak power and rapidly scanned carbon dioxide (CO2) lasers, the ability to remove photodamaged skin in a precise and reproducible manner while leaving behind a narrow zone of thermal damage has been achieved. This development has generated tremendous interest in laser skin resurfacing as a technique to reverse photoaging.

Are all 585 nm pulsed dye lasers equivalent? A prospective, comparative, photometric, and histologic study

BACKGROUND

Flashlamp-pumped pulsed dye lasers (585 nm) are used to treat port-wine stains and other cutaneous vascular lesions. Strikingly different tissue effects were seen after two apparently similar 585 nm pulsed dye lasers at equivalent fluences were used.

OBJECTIVE

We compared the photometric and histologic effects of two apparently similar 585 nm flashlamp-pumped pulsed dye laser systems.

METHODS

The burn pattern and beam profile analysis of two Candela SPTL-1 lasers and two Cynosure Photogenica V lasers were compared. Various fluences and spot sizes of the Cynosure laser were placed on normal skin and evaluated for histologic change.

RESULTS

Variation between the stated area of the spot and the actual measured area of the spot was found in all lasers studied. The area of the 5 mm spot of the two Candela lasers studied was 35% and 31% larger, respectively, than the stated area. The Cynosure lasers had areas that were 8% and 4% smaller than the stated area. Neither beam profile was uniform. The Candela laser maintained a gaussian-like distribution of energy, whereas the Cynosure laser beam profile resembled a top hat with a more even distribution of energy. Histologic studies confirmed the maintenance of vascular specificity without nonspecific thermal damage.

CONCLUSION

When changing from one 585 nm pulsed dye laser to another and using supposedly equivalent fluences, one cannot guarantee that clinical results will be equivalent. In an effort to achieve consistent treatments when moving between lasers manufactured by different companies, it would be prudent to place a single spot of energy onto burn paper and measure the diameter of the spot.