Variants of milia successfully treated with CO(2) laser vaporization

Evaluation of Meibomian Gland Function after Therapy of Eyelid Tumors at Palpebral Margin with Super Pulse CO2 Laser

Purpose

To investigate the effect on meibomian gland function of super pulse carbon dioxide (CO₂) laser excision in the treatment of eyelid tumors at palpebral margin.

Methods

36 patients with 36 eyelid tumor size ≤ 1 cm and within 1 mm to palpebral margin were recruited in this study. Of which, 16 cases with tumors in the upper eyelid and 20 cases in the lower eyelid were involved. The eyelid tumors of all the patients were treated by super pulse CO₂ laser with its power density varied between 0.6 and 21.1 W/mm² and in repeat mode. The laser spot size ranged from 120 to 200 μm. Ocular surface parameters including tear film break-up time (BUT) and meibograde, meibum expressibility, and meibum quality were evaluated at pretherapy, 1 week, 1 month, and 3 months posttherapy in all 36 patients.

Result

All the patients were satisfied with the therapy. No infective complications and recurrence occurred in any of the 36 patients at the following period. The eyelid wound recovered well with nearly normal appearing after 2 to 3 weeks. The morphology of limbi palpebralis, BUT, meibograde, meibum expressibility, and meibum quality of all the 36 patients showed no significant difference before and after the therapy.

Conclusions

Super pulse CO₂ laser had no effect on meibomian gland function and morphology in the excision of tumors at palpebral margins, which was an efficacy and well-tolerated therapy with lower complications and recurrence.

Milia En Plaque as a Distinct Follicular Hamartoma With Cystic Trichoepitheliomatous Features

Milia en plaque (MEP) is an uncommon disorder characterized by an erythematous plaque containing numerous milia. The pathogenesis of MEP is not clear. The authors report a man with an erythematous plaque on the right retroauricular area, containing numerous white-yellow cysts varying in size. Histological examination showed that multiple cystic structures at various levels of the dermis that were lined by stratified squamous epithelium and contained keratinous material-these findings were consistent with the diagnosis of multiple milia. In addition to epidermal cysts, however, the lesion consisted of a branched proliferation of pale-staining keratinocytes lined with basal keratinocytes budding from the overlying epidermis. Moreover, some cysts were formed within the branched epithelial proliferation, had thicker cyst walls than the ordinary milium, or had irregular or branched projections toward the surrounding dermis. From these findings, the authors conclude that MEP is a distinct follicular hamartoma with cystic trichoepitheliomatous features.

Laser treatment of periocular skin conditions

Advances in laser technology in recent decades have increased the options for the treatment of dermatologic conditions of the eye and eyelid. Benign tumors can be laser-ablated with relative ease, and vascular and melanocytic lesions can be precisely targeted with modern lasers. In this contribution, we review treatment of periocular pigmented lesions, including melanocytic nevi and nevus of Ota; vascular lesions including telangiectasias, port wine stains, and infantile hemangiomas; hair removal; eyeliner tattoo removal; laser ablation of common benign periocular tumors, such as syringomas, xanthelasma, milia, and seborrheic keratoses; and laser resurfacing. The recent advent of fractionated laser technology has resulted in dramatically decreased healing times for periocular skin resurfacing and fewer adverse effects. Fractionated laser resurfacing has now nearly supplanted traditional full-field laser resurfacing, and safe treatment of rhytides on the thin skin of the eyelids is possible. Proper eye protection is, of course, essential when using lasers near the eye. Patient preparation, safety precautions, and risks--intraocular and extraocular--are discussed herein. As laser technology continues to advance, we are sure to see improvements in current treatments, as well as development of new applications of cutaneous lasers.

Treatment of genital lesions with diode laser vaporization

Background

Genital warts caused by human papillomavirus (HPV) infection are the most common sexually transmitted disease leading to anogential lesions. Although the laser therapy has been shown to be effective in a number of conditions, the use of laser diode vaporization in urological applications and the understanding on its effectiveness as a treatment for various urological conditions is limited. Therefore, the aim of this study was to evaluate the efficacy of diode laser vaporization as a treatment for genital lesions.

Methods

Patients presenting with genital lesions at the urology outpatient clinic at Coronel Mota Hospital, between March 2008 and October 2014, were enrolled into the study. Data collected included age, gender, duration of the lesion, site of the lesion and numbers of the lesions, length of follow-up, recurrence of lesions after treatment and whether there were any complications.

Results

A total of 92 patients were enrolled in the study; 92.4% (n = 85) male; mean age (± SD) 27.92 ± 8.272 years. The patients presented with a total of 296 lesions, with a median of 3 lesions each, including penis (n = 78), urethra (n = 4) lesions, and scrotum (n = 2) lesions. Lesions ranged in size from 0.1 to 0.5 cm², most commonly 0.3 cm² (n = 38; 41.3%), 0.4 cm² (n = 21; 22.8%) or 0.5 cm² (n = 20; 21.7%). Patients most commonly reported that they had their lesions for a duration of 12 (n = 29; 31.5%) or 6 months (n = 23; 25.0%). Eighteen patients (19.6%) had a recurrence after their 1^st/conventional treatment. There were no incidences of post–operative infection or complications from the laser diode vaporization.

Conclusions

Laser diode vaporization can be considered as an alternative method for treating genital lesions in urology, with satisfactory results in terms of pain, aesthetic and minimal recurrence.

Milia en plaque of the nose: report of a case and successful treatment with topical tretinoin

Milia are benign, superficial keratinaceous cysts that present as fine, small white papules. Milia en plaque is a rare, challenging-to-treat variant most often seen in the posterior auricular region. A total of 9 cases of milia en plaque have been reported in the pediatric literature to date. We report a case of milia en plaque of the nose in a 7-year-old boy, a novel site of involvement in the pediatric population, and successful treatment with the use of topical tretinoin. Topical retinoids offer an effective treatment option for the management of milia en plaque in the pediatric population.

Eyelid milia en plaque: a treatment challenge with a new CO2 fractional laser

Milia en plaque (MEP) is an uncommon finding characterized by numerous tiny milia within an erythematous area. Despite its benign and asymptomatic nature, MEP raises cosmetic concerns; moreover, the available treatment modalities for MEP are limited. In view of the few cases described in the literature, no consensus has been reached, with respect to the optimal treatment for MEP, and the choice of therapy should be individualized. We report a case of eyelid milia en plaque successfully treated with a new CO2 fractional laser that is able to ensure superficial ablation of the epidermis remodeling tissue in-depth, with minimal thermal damage and extremely rapid recovery time. The results obtained after only two treatments were good, no scarring or dyschromic changes have been registered. At 1 year, just few recurrent milia were present.

Efficacy and safety evaluation of an innovative CO2 laser/radiofrequency device in dermatology

BACKGROUND

CO2 laser has not only become the most widely used laser in dermatological surgical practice, but it has also proved to be highly effective in treating aesthetic imperfections.

OBJECTIVE

To examine the efficacy and safety of a novel fractional CO2 laser combined with a radiofrequency device in different dermatological, surgical and aesthetic fields.

METHODS

A total of 79 patients were treated in our Outpatient Service with a novel fractional CO2 laser combined with a bipolar radiofrequency device for a maximum of 5 months. Group A consisted of 39 patients with lesions requiring complete excision, whereas Group B consisted of 40 subjects seeking to enhance aesthetic facial imperfections. The results were assessed by three 'blind' investigators using photographs and clinical observations; in addition, the patients had to give their own subjective assessment of the results.

RESULTS

At the 6-month follow-up, the lesions of the Group A patients had been completely removed, except for one case of a large sebaceous nevus on the scalp. All the Group B patients showed global improvement in skin tightening, removal of fine lines and rhytides and correction of dilated pores and hyperpigmentation, with no significant side-effects and short downtimes.

CONCLUSION

This kind of laser meets the needs of the majority of dermatologists requiring a unique, versatile tool to remove cutaneous lesions and at the same time, safely and effectively treat skin imperfections.