[Psoriasis. Natural versus artificial balneophototherapy]

Artificial balneophototherapy is an imitation of the natural balneophototherapy (Dead Sea climatotherapy; DSC) using highly concentrated salt solutions (25%) and UVB radiation. In 2008 the artificial balneophototherapy was included in the German healthcare system as an effective, evidence-based therapy for patients with moderate-severe psoriasis. In contrast, natural DSC is still considered a "non-standard and off-label therapy". Therefore we analyzed all studies published in the past two decades on both artificial and natural balneophototherapy comparing them in effectiveness, length of remission and practicability. Evidence-based studies on DSC showed good clinical results and long remission periods in psoriatic patients; the two methods seem comparable in effectiveness. Patients with chronic, therapy-resistant psoriasis should have access to DSC if they fail routine measures.

Does dye laser treatment with higher fluences in combination with cold air cooling improve the results of port-wine stains?

BACKGROUND AND OBJECTIVE

The use of cold air cooling (CAC) and cryogen spray cooling during dye laser treatment of port-wine stains (PWS) has become a standard in recent years. Still unsolved is the question of which fluences are necessary in combination with CAC in order to achieve an optimum clearance and the lowest possible rate of side-effects.

STUDY DESIGN

In a prospective study, we treated 11 patients with PWS with pulsed dye laser (Photogenica V, Cynosure, lambda = 585 nm, iota(p) = 0.5 ms, spot size = 7 mm). Each PWS was partitioned into three areas: (area 1) 6 J/cm(2) without CAC, (area 2) 6 J/cm(2) with CAC (level 4), (area 3) 9 J/cm(2) with CAC (level 4).

RESULTS

Area 3 (mean, 59%) showed a slightly better clearance than area 1 (mean, 57%); in area 2, we observed a reduced clearance (mean, 45%). Compared with area 1, we achieved a reduction of pain through CAC in areas 2 and 3. The healing periods as well as the rate of side-effects were comparable in all areas.

CONCLUSION

We observed a slight but not statistically relevant increase in clearance with the use of higher fluences and CAC compared with lower fluences without CAC. Because pain is lowered significantly when using CAC, and because this makes the treatment more comfortable for the patients, we tend to recommend the use of higher fluences (9 J/cm(2)) with simultaneous CAC for treating PWS.

Pulsed dye laser: what's new in non-vascular lesions?

BACKGROUND AND OBJECTIVE

In dermatology, the pulsed dye laser (PDL) is the therapeutic instrument of choice for treating most superficial cutaneous vascular lesions. In addition, clinical experience over the last decade allowed us to treat patients with an ever increasing number of non-vascular indications. The purpose of this report is to summarize and critically appraise the scientific evidence that support the role of PDL in treating non-vascular skin lesions.

METHODS

A literature-based study has been conducted, including the review of publications over the period January 1995 to December 2006, using the Medline Database. We also included our own experience in managing non-vascular lesions with the PDL. Four sets of preoperative and postoperative photos are presented.

RESULTS

For viral skin lesions, PDL proved to be an alternative to other therapy options. This applies particularly to periungual warts and mollusca contagiosa. The mechanism of PDL with inflammatory dermatoses has not yet been elucidated. The effect seems to be better if there is a vascular component to the disease. With most of these indications (such as psoriasis and acne), PDL currently plays a rather minor or complementary role. Regarding collagen remodelling (hypertrophic scars, keloids, stretch marks, and skin rejuvenation), the question of whether a therapy makes sense or not has to be decided from case to case.

CONCLUSION

With PDL, it is possible to achieve good results with numerous, partly less well-known indications (i.e. lupus erythematosus). With other diseases, PDL has so far been considered to be a complementary therapy method or to be in an experimental state.

[Venous lakes. Treatment with a combination of diode laser (910 nm) and radio frequency]

BACKGROUND

Venous lakes of the lip are a cosmetic problem for many patients due to their exposed location, nodularity, fragility and blue color. We sought an effective and well tolerated therapy method.

PATIENTS AND METHODS

Over one year, we treated 20 patients with a combination of diode laser (910 nm) and radiofrequency.

RESULTS

In all cases, there was complete regression of the venous lake (average: 1.4 treatment sessions). Side effects were transient pain that was assessed as mild by the patients, and transient swelling. Scarring or hypo-/hyperpigmentation did not occur.

CONCLUSION

This combined approach is a recommended option at least equivalent to other therapy methods (argon laser, CO(2) laser, pulsed-dye-laser, and others), or even superior to them due to the low rates of side effects and low number of treatment sessions.

Electro-optical synergy (ELOS?) technology for nonablative skin rejuvenation: a preliminary prospective study

BACKGROUND AND OBJECTIVES

In this preliminary prospective study, we evaluated the efficacy and safety of nonablative wrinkle treatment using combined radiofrequency (RF) and optical energy (Polaris). The dual energy technology of Polaris, called ELOS, which stands for electro-optical synergy, uses synchronous pulses of bipolar RF current and pulsed visible light (diode laser) delivered in the same pulse.

MATERIALS AND METHODS

Twenty-four subjects with periorbital and perioral wrinkles received six treatments at 4-week intervals with the Polaris WR (Syneron, Inc., Israel, 900 nm, max. RF energy 100 J/cm(3), max. laser energy 50 J/cm(2)). Each treatment consisted of two passes over the treatment area using pulsed optical and RF parameters that were determined by the patient's skin phenotype and distribution of target chromophores. The follow-up period was 3 months after the last treatment.

RESULTS

Independent scoring of blinded photographs showed a wrinkle score improvement of at least 1 (0 = no improvement, 1 = medium, 2 = good, 3 = excellent improvement) 3 months after the last of six treatment sessions. There was no difference between periorbital and perioral wrinkle reduction. Fifty-eight per cent (14/24) of the subjects reported a notable wrinkle reduction; 16% noted mild to moderate oedema and erythema lasting for no more than 1 day. Scarring or pigmentary changes were not detected. The average pain score was 0.6 (0 = no pain, 5 = intolerable pain).

CONCLUSION

Multiple treatments with the Polaris WR produced objective and subjective reduction of periorbital and perioral wrinkles. The occurrence of side-effects and pain was very low. The clinical effect may be caused by matrix coagulation of the deep dermis by the RF and selective thermolysis of blood vessels with the 900 nm diode laser.

[CO(2) and Er:YAG lasers in dermatology and aesthetic surgery]

In the past few years, the spectrum of indications for ablative lasers in dermatology and aesthetic medicine has been expanded due to technological innovations. In the following, technical basics, laser-tissue interactions, indications for the CO(2) and Er:YAG laser and laser treatment management are described. In addition, side effects and reactions associated with the use of these laser systems are listed and compared.

The effect of cold air cooling on 585 nm pulsed dye laser treatment of port-wine stains

BACKGROUND

The use of cryogen spray cooling in the course of dye laser treatment of port-wine stains has established itself in recent years because of its good analgesic and epidermally protective effects. The disadvantages of this kind of evaporative cooling are the cost and, in the case of dichlorodifluoromethane, the effects on the ozone layer. Cold air is an innovative cooling method that costs nearly nothing to use, is environmentally friendly, and can be easily adapted to existing laser systems.

OBJECTIVE

To examine and evaluate cold air cooling as an alternative method of cooling in laser treatment.

METHODS

In a prospective study, 13 patients (9 female, 4 male) with port-wine stains were treated with a pulsed dye laser (lambda = 585 nm, tau(p) = 450 microsec). In every case, either the entire area or a sample area of the port-wine stain was treated with cold air cooling on 50% of the surface and without on the other 50%. Clearance, analgesia, and adverse and concomitant effects were assessed.

RESULTS

In nine patients (69%) there were similar results in terms of clearance. In four cases, better lightening results (in two patients) and worse lightening results (in two other patients) were achieved in the area treated with cold air. Nine of the patients (69%) felt that the laser impulses accompanied by cold air were significantly less painful. Adverse effects (purpura, erythema, edema) and concomitant effects (hypopigmentation, hyperpigmentation, scars) were much less marked in the cooled areas.

CONCLUSION

Cold air is a safe and effective alternative to cryogen spray cooling. It is easy to use, economical, and environmentally friendly. Continuing studies are necessary to determine if there are interactions which affect the tissue.

Cold air in laser therapy: first experiences with a new cooling system

BACKGROUND AND OBJECTIVE

Analgesic cooling technologies are firmly established in dermatologic laser therapy. We present cold air as a novel method of cooling and compare it with those methods that are already in use.

STUDY DESIGN/MATERIALS AND METHODS

We treated 166 patients with the diagnoses hypertrichosis, port wine stains, hemangioma, essential telangiectasias, and tattoos with different laser systems (long-pulsed alexandrite laser [LPIR], pulsed dye laser, Q-switched Nd:YAG laser, Q-switched ruby laser). In a prospective study, we collected data about the analgesia of the cooling method and the thermal protection of the epidermis (reduction of the extent and duration of erythema, purpura, blisters, hyper-/hypopigmentations, edemas, crusting), compared with the cooling method with ice gel. Additionally, we measured air and skin temperatures with an infrared thermometer at different application modalities.

RESULTS

Three percent of the treated patients refused the cold air therapy altogether. Eleven percent found that it was as good as the other cooling methods; 86% clearly preferred the cold air therapy. Leaving out the perinasal area, the percentage rises to 97%. On average, the analgesic effect was by 37% better than through cooling with ice gel. The increased thermal protection of the epidermis made it possible to use laser energy levels that were higher by 15-30% and, at the same time, to reduce the rate of side effects (in 63% of the patients erythema persisted for a shorter period, in 70% the purpura was reduced, 83% had less crusting).

CONCLUSION

In dermatologic laser therapy, the use of cold air in analgesia can be considered as an effective, inexpensive, and well-accepted (by both patients and doctors) alternative to currently applied cooling methods. Nevertheless, further prospective studies are necessary to determine whether treatment results can really be improved by using higher laser energy levels.

[Molluscum contagiosum: treatment with pulsed dye laser]

BACKGROUND AND OBJECTIVE

There is a wide variety of methods for the treatment of mollusca contagiosa. Especially with anxious children, most of them are not applicable because they are often invasive, painful, time intensive or difficult to conduct (e.g. if a stay in hospital is necessary). In order to verify the existing case reports, this paper evaluates the application of the pulsed dye laser as a possible therapy alternative in cases of mollusca contagiosa.

PATIENTS/METHODS

In a prospective study 20 patients with mollusca contagiosa were treated with the pulsed dye laser.

RESULTS

The therapy was well tolerated; no scars or pigment anomalies were observed. 95.9% of the lesions healed after the first treatment, the other 4.1% after the second. This larger study verifies the positive findings indicated in case studies.

CONCLUSIONS

For exposed sites, difficult cases or if other treatment methods have failed, the pulsed dye laser is an effective, quick, bloodless and elegant therapeutic alternative for mollusca contagiosa with a low rate of side effects.

Proteolytic digestion of the beta and gamma subunits of the receptor for immunoglobulin E at the cytoplasmic face of the plasma membrane

Cytoplasmically exposed portions of the high affinity receptor for immunoglobulin E were investigated with controlled proteolytic digestion of plasma membrane vesicles from rat basophilic leukemia cells. Hypotonic shock treatment results in vesicle inversion, thereby exposing the cytoplasmic portions of the approximately 32 kDa beta and approximately 8 kDa gamma subunits to surface labeling by lactoperoxidase-catalyzed 125I-iodination. These 125I-labeled protein segments disappeared after treating inverted vesicles with trypsin, and labeled components also disappeared when chloramine T mediated 125I-iodination was used to label receptors after inverted vesicles had been trypsin digested and solubilized. Biosynthetic labeling of receptors with 35S-methionine showed that a 17-19 kDa labeled fragment, designated beta', remains associated with alpha after trypsin digestion of inverted vesicles. This beta' fragment was confirmed to be the intramembranous portion of the beta subunit in experiments where receptors were labeled with the hydrophobic photoactivated probe 3-(trifluoro-methyl)-3-(m-[125I] iodophenyl)diazirine prior to digestion. Our experimental results are consistent with the amino acid sequence and topography of the beta subunit predicted from the recently cloned cDNA for this subunit (Kinet, J.-P., et al., Proc. Natl. Acad. Sci. 85, 6483, 1988). Since the cytoplasmically-exposed portions of the beta and gamma subunits can also be efficiently and selectively removed from solubilized receptors by trypsin, reconstitution experiments to examine the importance of these segments in mediating the delivery of the transmembrane signal are made possible.