调Q开关ND：YAG激光治疗太田痣16例

应用调Ｑ开关ＮＤ：ＹＡＧ激光治疗１６例太田痣。经治皮损基本消退６例,明显消退６例,部分消退４例,总有效率１００％。术后随访１年,皮损均无明显复发,且无瘢痕、色素脱失等副作用。该地优于ＣＯ２激光、削磨术、化学腐蚀剂等治疗方法。     

A retrospective analysis of the clinical efficacies and recurrence of Q-switched Nd:YAG laser treatment of nevus of Ota in 224 Chinese patients

Background: Nevus of Ota can be treated successfully using the Q-switched (QS) laser; but few studies are long-term retrospective of the efficacy and influencing factor, studies on the recurrence is even less. Purpose: Retrospective analysis of the clinical characteristics and recurrence of QS Nd:YAG laser treatment of nevus of Ota in 224 Chinese patients at Laser Cosmetology Center of Department of Dermatology, the Second Hospital, Xi’an Jiaotong University. Methods: The data of 224 patients with nevus of Ota were analyzed retrospectively, which included the correlation among lesion color, treatment sessions, gender, age, lesion types and effect, and all patients were followed up for 2–10 years. Results: Higher number of treatment sessions that were conducted using the QS Nd:YAG laser system was positively associated with better responses to treatment. 99.11% of patients acquired more than 75% improvement with an average of 3.7 sessions. Only eight patients (3.57%) who had been completely cleared developed recurrence at the same site as before. Conclusion: The treatment of nevus of Ota with QS Nd:YAG laser is safe and effective with rare recurrence.     

Successful treatment of a patient with multicolored nevus of Ota using a combination of 1064 and 532 nm Q-switched Nd:YAG lasers

ABSTRACT

Nevus of Ota (NO) is a hamartoma of dermal melanocytes usually presents as unilateral blue, gray or brown macules or patches. It can impose a high burden of cosmetic and psychological disturbances in affected individuals. Q-Switched lasers appear to be an effective treatment for this kind of dermal melanocytosis. Multicolored Ota nevus is a rare variant of this kind of nevus and its treatment may be more challenging compared with unicolor lesions. Herein we report a 21-year-old woman with a multicolored nevus of Ota (blue and brown), which showed a dramatic response to a combination of 1,064 nm and 532 nm Q-Switched Nd:YAG lasers. We also discuss different aspects of the Q-switched laser application of Ota nevus treatment. We also focus on laser combination therapy to treat the nevus of Ota.     

A randomized,split-face clinical trial of Q-switched alexandrite laser versus Q-switched Nd:YAG laser in the treatment of bilateral nevus of Ota

Different types of Q-switched (QS) lasers have been used successfully to treat nevus of Ota. The purpose of this study was to compare the clinical efficacy and complication of QS alexandrite (QS Alex) laser versus QS neodymium:yttrium aluminum garnet (Nd:YAG) (QS Nd:YAG) laser for bilateral nevus of Ota. Seventeen patients with bilateral nevus of Ota were treated randomly with QS Alex in one half of face and QS Nd:YAG in the other half with an interval of at least 3 months between each. Subjective assessment was made by both patients and dermatologists. Patients were also examined for evidence of complications. All patients experienced improvement (p < 0.05). There was no statistically significant difference between the two sides (p > 0.05). The pain after a short period of laser therapy was more severe for QS Alex than for QS Nd:YAG laser. Vesicles developed in 1 patient after QS Alex therapy. Both QS Alex laser and QS Nd:YAG laser were equally effective at improving bilateral nevus of Ota. Patients tolerate QS Nd:YAG laser better than QS Alex laser.     

Efficacy of the Q-switched Neodymium: Yttrium Aluminum Garnet Laser in the Treatment of Blue-black Amateur and Professional Tattoos

Background:

Q-switched neodymium: yttrium aluminum garnet (Nd: YAG) laser at a wavelength of 1064 nm primarily targets dermal melanin and black tattoo ink. Recent studies have shown that this laser is effective in treating black tattoos. There are few studies conducted in India for the same.

Aim:

The aim was to assess the effectiveness of Q-switched Nd: YAG laser (QSNYL) in the treatment of blue-black tattoos following 3 treatment sessions.

Materials and Methods:

This study, a prospective interventional study included a total of 12 blue-black tattoos. Following informed consent for the procedure, as well as for photographs, a questionnaire was administered, and improvement perceived by the patient was recorded. In addition, global assessment score (GAS) by a blinded physician was also recorded. Photographs were taken at baseline and at every follow-up. Each patient underwent three treatment sessions with 1064 nm QSNYL at 4–6 weekly intervals. Fluences ranged from 1.8 to 9 J/cm². The follow-up was done monthly for 4 months from the first treatment session. The response was assessed by patient assessment (PA) and GAS by comparing photographs.

Results:

After three treatment sessions, although no patient achieved clearance, most patients showed good response with few adverse effects. An average of 64.1% (GAS) and 54.2% (PA) improvement was observed in 12 tattoos. Tattoos more than 10-year-old showed quicker clearing than those less than 10-year-old. Amateur tattoos also showed a better response in comparison to professional tattoos.

Conclusion:

Totally, 1064 nm QSNYL is safe and effective for lightening blue-black tattoos in pigmented Indian skin. All patients achieved near complete clearance following the continuation of treatment (an average of six sessions) although this was spaced at longer intervals.     

Acquired Bilateral Nevus of ota-like Macules with Mucosal Involvement: A New Variant of Hori's Nevus

Acquired bilateral nevus of Ota-like macules (ABNOM) or Hori''s nevus, a rare form of acquired dermal melanocytoses, presents as bilateral facial blue-gray macules without ocular or mucosal involvement. This condition is mostly found in women of Asian descent and usually appears in the fourth or fifth decade of life. Pathogenesis is unknown, though few theories have been proposed. Effective treatment has been found to be achieved with pigment-specific lasers. Herein, we report a case of Hori''s nevus with mucosal involvement. A 42-year-old male patient, presented to us with blue-gray discoloration on either side of his face, both eyes, and in the mouth since the age of one year. Histopathological examination showed clusters and singly dispersed pigmented melanocytes within the upper and mid-dermis regions. Special staining of melanocytes using Masson-Fontana stain was positive. Diagnosis of Hori''s nevus was made by correlating clinical and histopathological findings. Patient was informed of his treatment options, but refused treatment. A similar case of Hori''s nevus with mucosal involvement has not been reported so far.     

Limits of fine-needle aspiration cytology in diagnosing pilomatrixoma: a series of 25 cases with clinico-pathologic correlations

Background:

Pilomatrixoma (PMX) is a benign, quite uncommon, skin neoplasm, which is frequently misdiagnosed by clinicians.

Aim:

We have analyzed 25 PMX to determine the agreement between clinical diagnosis, preoperative FNA characteristics, and corresponding histopathological specimens; moreover, reliable cytologic criteria for PMX and the differential diagnosis to avoid cytological pitfalls have been emphasized.

Materials and Methods:

By fine-needle aspiration (FNA) cytology a series of consecutive cases of PMX collected during last 5 years were studied. Smears were stained by Papanicolau and May-Grünwald-Giemsa.

Results:

Patients affected by PMX were 11 males, 14 females (ratio 1:1.27); the mean age was 32.72 years with age range 3-78 years, being 72% (18/25) of patients 40 years or less. PMX was mainly distributed in the head-neck region (52%), scalp (16%), upper/lower arms (28%), and chest (4%). The observed diagnostic cytological features were represented by clusters of basaloid epithelial cells, shadow or ghost cells, inflammatory background, calcification, and giant cells. Unfortunately, not all these morphological aspects were always disclosed in smears, thus making the cytological preoperative diagnosis questionable and problematic.

Conclusions:

The experience of a well-trained cytopathologist should distinguish the relevant FNA features in terms of smear background, architecture, and cell morphology. The most dangerous mistake in FNA diagnosis of PMX regards a diagnosis of primary malignant or metastatic cutaneous lesions.     

Melasma: a clinico-epidemiological study of 312 cases

Background:

Melasma is an acquired increased pigmentation of the skin, characterized by gray-brown symmetrical patches, mostly in the sun-exposed areas of the skin. The pathogenesis is unknown, but genetic or hormonal influences with UV radiation are important.

Aims:

Our present research aims to study the clinico-epidemiological pattern and the precipitating or provocation factors in melasma.

Materials and Methods:

A total of 312 patients were enrolled for the study over a period of one year.

Results:

The mean age of patients with melasma was 33.45 years, ranging from 14 to 54 years. There was female preponderance with a female to male ratio of approximately 4 : 1. The mean age of onset was 29.99 years, with the youngest and oldest being 11 and 49 years, respectively. The patients sought medical treatment on an average of 3.59 years after appearance of melasma. About 55.12% of our patients reported that their disease exacerbated during sun exposure. Among 250 female patients, 56 reported pregnancy and 46 reported oral contraceptive as the precipitating factors. Only 34 patients had given history of exacerbation of melasma during pregnancy. A positive family history of melasma was observed in 104 (33.33%) patients. Centrofacial was the most common pattern (55.44%) observed in the present study. Wood light examination showed the dermal type being the most common in 54.48% and epidermal and mixed were seen in 21.47% and 24.03% of the cases, respectively. We tried to find an association with endocrinal diseases and observed that 20 of them had hypothyroidism.

Conclusion:

The exact cause of melasma is unknown. However, many factors have been implicated in the etiopathogenesis of this disorder. Here we try to identify the causative factors and provocation to develop melasma.     

倍频Q开关Nd:YAG 532 nm激光治疗179例颧部褐青色痣回顾性分析

目的：评价倍频Q开关Nd:YAG 532 nm激光治疗颧部褐青色痣的临床疗效、影响因素及安全性。方法：回顾性分析2011年6月～2015年6月我院皮肤科门诊确诊为颧部褐青色痣并单独接受倍频Q开关Nd:YAG 532 nm激光治疗的患者,比较治疗次数、开始治疗的年龄、治疗后不良反应。结果：符合条件的179例患者中,治疗≥3次的患者治愈率为73.0%,显著高于治疗1次的治愈率3.7%(P<0.01)及治疗2次的治愈率16.4%(P<0.01)。入选的患者年龄范围为14～49岁,以年龄进行分组,>30岁组的患者有效率（38.1%）显著低于25～30岁组(41.7%,P<0.01)及≤25岁组(66.2%,P<0.01)。72例（40.22%）患者出现不同程度色素沉着,3～6个月自行消退;2例（1.11%）患者出现水疱,无瘢痕形成。结论：早期、多次使用倍频Q开关Nd:YAG 532 nm激光治疗颧部褐青色痣安全有效。     

Unilateral Nevus of Ota with Bilateral Nevus of Ito and Palatal Lesion: A Case Report with a Proposed Clinical Modification of Tanino's Classification

Nevus of Ota and nevus of Ito are rare dermal melanocytoses. Nevus of Ota may be very rarely associated with the nevus of Ito and other extra cutaneous features. Both nevi are similar in all respect apart from the area of distribution. Bilateral distribution of nevus of Ito is seldom reported in the literature. A 24-year-old male patient reported with nevus of Ota of the right side of his face since his infancy and nevus of Ito on both shoulder regions since early childhood. He had bluish lesions on the right side of his hard palate. Systemic examination was normal. Relevant laboratory investigations were non contributory. The histopathological examination of the skin from the affected areas showed the presence of elongated dendritic dermal melanocytes. The present case is the first report of an association of bilateral nevus of Ito with nevus of Ota and palatal lesions. Tanino classified Nevus of Ota into four groups. As both the nevi are similar in all respect except the area of distribution, a minor modification of the existing Tanino''s classification to incorporate the nevus of Ito into the classification for the Ota''s nevus may be appropriate.     

Q开关紫翠宝石激光治疗儿童太田痣180例疗效观察

目的观察Q开关紫翠宝石激光治疗儿童太田痣的疗效及不良反应。方法应用Q开关紫翠宝石激光治疗儿童太田痣180例,治疗间隔3～12个月,根据临床登记及治疗前后患者照片判断疗效,并观察不良反应。结果治疗次数1～7次,治愈123例(68.3%),总有效率85%。除个别患儿出现一过性的粟丘疹、色素沉着、色素减退和点状表浅瘢痕外,未见明显其他不良反应。结论 Q开关紫翠宝石激光治疗儿童太田痣安全有效。     

Treatment of xanthelasma palpebrarum by 1064-nm Q-switched Nd:YAG laser: a study of 11 cases

BACKGROUND: Xanthelasma palpebrarum (xanthelasma) is a common disease involving the eyelids. It consists of yellowish plaques of esterified cholesterol situated in the middle and superficial layers of the dermis. Many techniques, including laser treatments, have been proposed to destroy these lesions. A preliminary study demonstrated the efficacy of 1064-nm Q-switched Nd:YAG laser in treating xanthelasma. OBJECTIVES: To present the results of a prospective study using 1064-nm Q-switched Nd:YAG laser to treat xanthelasma. METHODS: Thirty-eight lesions in 11 patients were treated. RESULTS: The results observed after a single treatment by Q-switched Nd:YAG laser were scored as good or excellent in eight patients, i.e. for 26 of 38 lesions. CONCLUSIONS: The treatment of xanthelasma by 1064-nm Q-switched Nd:YAG laser is a valuable treatment option to eliminate lesions, with rapid and good quality healing. The absence of any associated skin destruction allows treatment to be repeated when necessary.     

Patient compliance as a major determinant of laser tattoo removal success rates: A 10-year retrospective study

Abstract

The use and success of high-energy, short-pulse, Q-switched lasers for tattoo removal has been well demonstrated. Three types of lasers are currently commercially available for tattoo removal: the Q-switched ruby laser (694 nm), the Q-switched alexandrite laser (755 nm) and the Q-switched Nd:YAG laser (532 nm and 1064 nm). Multiple parameters such as tattoo type, color, location, and patient skin type dictate which laser is optimal in each patient. Despite the demonstrated efficacy of these modalities, there are few papers that address some of the long-term issues of tattoo removal, such as patient compliance, and how these issues impact on the success rates of optimal tattoo removal treatments. In this retrospective study, 10-year data from a single center are presented. Our data include parameters such as clearance rates, number of treatments, wavelength of the utilized laser, and fluence and spot-size setting. In addition, potential complications such as scarring, hypopigmentation, and pain were analyzed. Finally, we examine the patient compliance that accompanied tattoo removal and the reasons behind the typically low success rates for total tattoo clearance.     

Leiomyoma cutis: a clinicopathological series of 37 cases

Background:

Cutaneous leiomyomas are benign smooth muscle tumors that comprise three distinct types such as piloleimyoma, angioleiomyoma, and genital leiomyoma.

Aim:

The objective of this study was to report a series of cases seen in last 8 years in a tertiary care hospital in north India and to discuss their clinicopathologic findings.

Material and Methods:

Paraffin-embedded blocks of cases reported as cutaneous leiomyoma from 1999 to 2007 were retrieved from the Institute of Pathology, New Delhi, and their clinical parameters were noted. Their histopathological features were reviewed on hematoxylin-eosin stained slides. Immunohistochemistry was performed where necessary.

Results:

Twenty-seven cases of piloleiomyoma, three cases of angioleiomyoma, five breast leiomyomas, and two scrotal leiomyomas were seen in patients ranging from 21 to 65 years of age, with an average of 38.2 years at presentation. There was a male predominance with 26 males and 11 females (M:F = 2.2:1). Solitary lesions (n = 21) were more common than multiple ( n = 16). The trunk and upper limbs were involved most commonly, comprising 23 of 37 (62.2%) cases. This was followed by lower limb, face, breast, and scrotum.

Conclusion:

Cutaneous leiomyomas are rare lesions and form an important clinical differential diagnosis of painful papulonodules. These must be biopsied in order to differentiate them from other spindle cell lesions.     

调Q-Nd:YAG染料700nm激光治疗太田痣130例临床评估

应用调Q-Nd：YAG染料700nm激光治疗大田痣130例，疗效随治疗次数增加而显著，治疗5次以上治愈率75%，显效率100%，随访未发现色素减退，治疗区未见皮肤纹理改变及瘢痕，疗效与其他类型或波长激光相近，具有安全性高，恢复快，痛苦小的优点。     

Laugier-Hunziker syndrome: complete clearance of mucosal lentigines with a single session of Q-Switched Nd:YAG laser

Background: Laugier-Hunziker (LH) syndrome is a rare condition in which melanocyte overactivity produces lentiginous lesions of the lips and buccal mucosa. Objective: Given the paucity of reports on therapeutic options in LH syndrome, this case is herein reported to show the response to treatment with the Q-Switched Nd:YAG laser in a 32-year-old man with LH Syndrome. Methods: The Q-Switched Nd:YAG laser was used to treat the lentiginous lesions on the mucosal surface of the lower lips using a single pass at 532 nm. Results: There was complete clearance of the mucosal lentiginous lesions with a single laser session, and recurrence was not observed after 12 months. Conclusion: The Q-Switched Nd:YAG laser is an effective treatment option for cosmetic benefit in LH Syndrome.     

The comparison between trichloroacetic Acid 50% and co(2) laser in the treatment of cutaneous leishmaniasis scar

Background:

The scars of the cutaneous leishmaniasis and psychological problems of this disease need different interventions for its correction.

Aim:

Our objective in this study was to compare the efficacy of 50% trichloroacetic acid (TCA) solution and CO₂ laser for treatment of the atrophic scars due to leishmaniasis.

Materials and Methods:

This was a randomized clinical trial performed in 92 patients. Patients were randomized into two groups: the first group was treated with 50% TCA solution, once monthly and for a maximum of 5 months, and the second group was treated with CO₂ laser which was performed for only one time. Patients were followed-up at 3 and 6 months after starting the treatment. The improvement of scar was graded by a 6-point scale using digital camera and the collected data were analyzed using SPSS software.

Results:

In this study, 74 females and 18 males were enrolled. The improvement of scar was 48.13% in the TCA group and 44.87% in the CO₂ laser group. This difference was not statically significant (P = 0.55). There was also no significant difference regarding side effects between these two groups.

Conclusion:

The results of our study showed that efficacy of focal with 50% TCA solution is compared with CO₂ laser in treatment of leishmaniasis scar. Because of the low cost and simple application of TCA solution in comparison with CO₂ laser, we suggest use of this treatment for correction of leishmaniasis scar or the atrophic scars.     

Secondary lymphangioma of vulva: a report of two cases

Secondary lymphangiomas or acquired lymphangiomas of vulva represent dilatation of upper dermal lymphatics following damage to previously normal deep lymphatics. They have been reported to occur following various infections, surgeries and radiotherapy which can cause damage to deep lymphatics.Treatment options in the management of secondary lymphangiomas include surgical resection, carbon dioxide laser vaporisation, sclerosing agents etc. We report two cases of secondary lymphangioma of vulva that followed radiotherapy for carcinoma of cervix. Both the patients were treated successfully by surgery.     

Combination of CO2 and Q-switched Nd:YAG lasers is more effective than Q-switched Nd:YAG laser alone for eyebrow tattoo removal

Background: The eyebrow tattoo removal using Q-switched lasers is usually prolonged. Other modalities may be required to enhance the efficacy and shorten the treatment course. Objective: To compare the efficacy of Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) laser alone versus combination of Q-switched Nd:YAG and Ultrapulse CO₂ lasers for eyebrow tattoo removal after a single session. Patients and methods: After local anesthesia, the right eyebrow of 20 patients was treated with Ultrapulse CO₂ laser with the parameters of 4 J/cm² and 3.2 J/cm² for the first and the second passes. Both eyebrows were then treated with 1064-nm and 532-nm Q-switched Nd:YAG laser. The spot size and pulse duration were 3 mm and 5 nanoseconds for both wavelengths, and the fluence was 7 J/cm² for 1064 nm and 3 J/cm ² for 532 nm. Results: The side treated with combination of Q-switched Nd:YAG and CO₂ lasers improved 75–100% in 6 of 20 patients versus only 1 of 20 in the side treated with Q-switched Nd:YAG alone. Similarly, the right side in 13 of 20 patients showed more than 50% improvement with combination therapy versus the left side (the monotherapy side), where only 6 of 20 cases showed more than 50% improvement. The Mann–Whitney test was 2.85 for the right side and 1.95 for the left side (P value = 0.007). Conclusion: Using Ultra pulse CO₂ laser enhances the efficacy of Q-switched Nd:YAG laser in eyebrow tattoo removal.     

Lewandowsky and lutz dysplasia: report of two cases in a family

Lewandowsky and Lutz dysplasia, also known as epidermodysplasia verruciformis (EV), is an inherited disorder in which there is widespread and persistent infection with human papilloma virus, defect in cell-mediated immunity and propensity for malignant transformation. Differential clinical and histopathologic evolutions of lesions in two cases of familial EV are compared and discussed in detail. Cases were followed up for 7 years. Detailed history, clinical features and investigations, including skin biopsy from different sites at different times, were examined. Generalized pityriasis versicolor like hypopigmented lesions in both the cases, together with variable pigmented nodular actinic keratosis like lesions on sun-exposed areas, were present. Multiple skin biopsies done from various sites on different occasions revealed features typical of EV along with lesions, i.e., actinic keratosis, Bowen's disease, basal and squamous cell carcinoma, in the elder sibling. However, skin biopsy of the other sibling showed features of EV and seborrheic keratosis only till date. This study reveals that the disease progression is variable among two individuals of the same family. Malignant lesions were seen only on sun-exposed areas and may be associated with other skin lesions or infections such as angiokeratoma of Fordyce and tinea cruris, as seen in this report.