Effectiveness of the Pulse Dye Laser Treatment in a Caucasian Women With Dermatosis Papulosa Nigra

Management of dermatosis papulosa nigra: a systematic review

Dermatosis papulosa nigra (DPN) is a variant of seborrheic keratosis that typically presents as hyperpigmented pedunculated papules on the face, trunk, and/or back in those with skin of color. Although benign, the lesions can cause significant discomfort and distress. Management options are limited and often unaffordable, as treatment is elective in most cases. This study was undertaken to provide an updated summary of safe and efficacious treatments for DPN. Five databases were searched to identify full-text publications reporting on treatments and outcomes in adults with DPN. Seventeen publications met inclusion criteria and were included: six cohort studies, one randomized controlled trial, five case report studies, one case series, and four pilot studies. Treatment options included simple excision, curettage, electrodesiccation, cryotherapy, topicals, and laser therapies. These modalities varied in their documented outcomes and associated potential adverse effect profiles. Postinflammatory hyperpigmentation is a common adverse effect that often leads to patient dissatisfaction. It can be mitigated with topical treatments aimed at reducing local inflammation. Study limitations included small sample size in individual studies, lack of consistent reporting of Fitzpatrick skin type, and lack of comparison to the standard treatment of electrodesiccation or curettage. Ultimately, treatment should consider the patient's Fitzpatrick type, treatment area, associated costs, and potential adverse effects.

Update of pathophysiology and treatment options of seborrheic keratosis

Seborrheic keratosis (SK) is a common, benign tumor that can occur on everybody site and can be conservatively managed. Cosmetic concerns, especially when a lesion involves the facial area, are the most common reason for excision. SK shows male gender preponderance and increasing age is an independent association with the condition. Even though more prevalent in the elderly, it has also been reported in younger age groups like adolescents and young adults. Precise pathogenesis is still obscure, but ultra-violet exposure represents a predisposing factor to SK by altering the biochemical concentration and expression of factors like Glutamine deaminases, endothelin, and stem cell factor. Moreover, the accumulation of amyloid-associated protein has also been postulated. Involvement of genitalia has been associated with human papillomavirus infection. Recently, Merkel cell polyomavirus nucleic acid was also detected in SK. Several oncogenic mutations involving FGFR-3 and FOXN1 have been identified. SKs are usually classified clinically and histologically. Dermatoscopy is a noninvasive alternative diagnostic technique widely used in differentiating SK from other benign and malignant tumors. In terms of treatment, topical agents, shave dissection, cryosurgery, electrodesiccation, laser application and curettage under local anesthesia are safe methods for eradication of SKs, mostly for cosmetic purposes. Though generally safe, the latter techniques may occasionally cause post-procedure depigmentation, scarring, and recurrence. Nanosecond-pulsed electric field technology is a promising new technique with fewer side-effects.

2940-nm erbium:YAG laser versus 980-nm diode laser in the treatment of multiple seborrheic keratoses: A prospective comparative randomized study

BACKGROUND

Seborrheic keratoses (SKs) are the most common benign epithelial tumors encountered in clinical practice. Complications associated with traditional treatments of SKs urge the scientists to seek alternative treatment modalities. Objective To compare the efficacy and safety of 2940-nm erbium-doped yttrium aluminum garnet (Er:YAG) laser versus 980-nm diode laser both clinically and dermoscopically for the treatment of seborrheic keratosis.

METHODS

Thirty subjects with multiple SKs were randomized to receive two sessions of either Er:YAG laser (n = 15) or diode laser (n = 15) and were followed up for 2 weeks after each session, and at 3 and 6 months after the second session.

RESULTS

Both lasers exhibited significant clearance of SKs with no significant difference in clinical and dermoscopic improvement between the two systems. However, Er:YAG laser showed shorter total downtime but more serious erythema, while scarring and hyperpigmentation were observed in diode laser group. No recurrence was detected in both groups at 6 months follow-up.

CONCLUSION

Er:YAG and diode lasers both are effective, non-invasive and well-tolerated techniques in treatment of SKs.

Treatment of dermatosis papulosa nigra using a carbon dioxide laser

BACKGROUND

Dermatosis papulosa nigra (DPN) is characterized by the presence of multiple, small, hyperpigmented, warty papules affecting the face, neck, and trunk that bear to histological semblance to seborrheic keratosis. Although the lesions are benign tumors, they can cause distress for cosmetic reasons.

OBJECTIVE

We, herein, report the cases of three female Japanese patients (mean age, 46 years) with DPN who were treated using a carbon dioxide (CO₂ ) laser with a computerized scanner. The patients were all suffering from an increased number of brown asymptomatic papules (size, 1-5 mm), which were located all over the trunk. Histological examinations revealed acanthosis, hyperkeratosis and horn cyst formation in the epidermis.

METHODS

We performed CO₂ laser (LASER 30C; Lumenis Inc) treatment (settings: 8-10 W; pulse duration, 0.05-seconds; rest duration, 0.36 seconds; laser spot size, 1.2 mm) for 5-10 months.

RESULTS

With CO₂ laser treatment, were could completely remove the lesions and achieve excellent cosmetic results without scar formation in all cases. The treated lesions did not relapse for more than 1 year.

CONCLUSION

In our opinion, CO₂ laser treatment with a computerized scanner is an effective therapeutic option for DPN.

Recent advances in managing and understanding seborrheic keratosis

Seborrheic keratosis (SK) is a common benign epidermal tumor with predominance in adult patients. Whereas common SKs are more frequent in Caucasians, dermatosis papulosa nigra is more prevalent in patients with a Fitzpatrick skin type of at least 3. There seems to be a link between extrinsic skin aging and the occurrence of SK. Mutations of fibroblast growth factor receptor 3 and other signaling molecules are a frequent finding in SK lesions. However, this does not translate into any malignant potential. Viral infections are particularly common in genital lesions, although their pathogenetic relevance for SK is questionable. Different histologic and clinical subtypes have been identified. The great variability of SKs raises some difficulties in diagnosis. Dermoscopy is the preferred non-invasive diagnostic method, in particular to differentiate pigmented SKs from other pigment tumors, including cutaneous melanoma. Eruptive SKs can be a paraneoplastic condition known as the Leser–Trélat sign. New targeted cancer treatments can cause a pseudo-Leser–Trélat sign. The treatment in practice is mainly minor surgery, including cryosurgery, shave excisions, and laser-assisted removal. The medical approaches have only limited effects. Recently, two formulations for topical therapy have been evaluated: a product with 40% hydrogen peroxide (HP40) and an aqueous nitric–zinc complex. Based on clinical trials, HP40 seems to be a promising alternative to surgery, in particular for facial lesions.