Papular elastorrhexis. report of five cases

Papular elastorrhexis is a rare disorder that occurs predominantly during adolescence. We report 5 patients with asymptomatic white, nonfollicular, firm papules scattered over the trunk and extremities. Histologically, the papules demonstrate focal areas of collagen homogenization with decreased and fragmented elastic fibers. The clinical differential diagnosis includes papular acne scars, dermatofibrosis lenticularis disseminata (Buschke-Ollendorff syndrome), cutaneous collagenoma and nevus anelasticus, but histology clearly separates papular elastorrhexis from the other entities.     

Ablative Carbon Dioxide Laser Treatment for Papular Scars of Nose and Chin Due to Acne: A Case Series

Introduction:Papular scarring of the nose and chin due to acne is an under-reported,under-recognized,and under-treated condition.Ablative carbon dioxide laser t...     

Evaluation of effectiveness of erbium:yttrium–aluminum–garnet laser on atrophic facial acne scars with 22‐MHz digital ultrasonography in a Turkish population

Scar formation due to acne is a common problem among the young population and significantly affects their quality of life. The aim of this study was to evaluate the efficacy of erbium:yttrium–aluminum–garnet (Er:YAG) laser resurfacing for acne scars and to objectively demonstrate the altering of collagen density in the dermis by 22‐MHz digital ultrasonography. Twenty‐one patients, aged 19–55 years, with facial acne scars were treated with Er:YAG laser. The results of the laser resurfacing were evaluated for the degree of clinical improvement, alteration of the collagen density by 22‐MHz digital ultrasonography and any adverse effects at 3 months. At 3 months after the treatment, good (in 12 patients) and near total (in four patients) clinical improvement was noted in most of the patients compared to baseline. Overall treatment results were 76% (both near total and good) in 16 patients. By ultrasonographic evaluation, the average density of dermal collagen (total density/number of patients) of 21 patients was 32.714 (right cheek) and 32.142 (left cheek) before laser facial resurfacing. At the third month after treatment, the average density of dermal collagen of 21 patients was 36.380 (right cheek) and 38.809 (left cheek). In conclusion, Er:YAG laser skin resurfacing was found to be a safe and effective treatment modality for treatment of atrophic facial acne scars. As public demand grows for less invasive modalities to approach clinical diagnosis and evaluation, digital ultrasonography seems to provide an easy and confidential method for collagen density evaluation.     

Erbium:YAG laser skin resurfacing: a Pakistani experience

BACKGROUND AND OBJECTIVES: To evaluate the use of the erbium:YAG laser for resurfacing in type IV skin patients in Pakistan.

STUDY DESIGN/MATERIALS AND METHODS: Ten patients with skin type IV underwent laser skin resurfacing with an erbium:YAG laser to treat wrinkles, acne/chickenpox scars and hyperpigmentation. An evaluation was done by the treating physician and a photographic evaluation and grading was done by a blinded observer.

RESULTS: The treating physician's records show no erythema, pigmentary alteration, infection or scarring at the 3‐month follow‐up. The blinded observer's evaluation of the 3‐month photographs showed moderate to excellent improvement in 80% of patients in their respective underlying condition.

CONCLUSION: The erbium:YAG laser is safe and effective in treating wrinkles, acne/chickenpox scars and hyperpigmentation in skin type IV patients.     

Treatment of atrophic facial acne scars with fractional Er:YAG laser in skin phototype III–IV: A pilot study

Background: Fractional ablative lasers have recently been used for the treatment of skin scars. The objective of this study was to assess the efficacy and safety of the fractional erbium-doped yttrium aluminum garnet (Er:YAG) laser (2940 nm) in the treatment of skin scars. Materials and methods: A total of 9 patients (8 female, 1 male) with Fitzpatrick skin types III and IV suffering from atrophic facial acne scars were treated with a fractional Er:YAG laser for 2–5 (mean 3.3) sessions 4–6 weeks apart. One independent investigator assessed the efficacy, using standardized photographs, before and 1 month after the last treatment. The patients’ satisfaction rate was also evaluated. Results: The treatment was well tolerated by all patients without any anesthesia. The downtime was 2–3 days. All patients showed improvement in scars: excellent in 1, good in 1, and fair in 7 patients. Six patients were highly satisfied and 3 were satisfied with treatment. No adverse effect was noted. Conclusion: A fractional Er:YAG laser can deliver an effective and minimally invasive treatment for acne scars.     

点阵式Er：YAG激光治疗痤疮瘢痕及毛孔粗大的疗效观察

目的 探讨点阵式掺铒钇铝石榴石（Er:YAG）激光对于面部凹陷性痤疮瘢痕及毛孔粗大的疗效。方法 轻至中度凹陷性痤疮瘢痕41例,予中长脉宽、能量800 ～ 1200 mJ、定点连续发射4 ～ 8个脉冲。毛孔粗大23例,予中脉宽、能量800 ～ 1000 mJ、定点连续发射2 ～ 4个脉冲。疗程为3 ～ 5次,每次间隔1个月。由医生对治疗后皮损改善程度进行评价,由患者对疗效进行满意度评价。应用三维皮肤成像仪获取皮肤立体图像,评价治疗对皮肤粗糙度的影响。结果 医生评估痤疮瘢痕患者皮损改善程度为82.93%,毛孔粗大患者皮损改善程度为86.96%;两种皮损患者满意率分别为88.80%和91.30%;与治疗前相比,治疗后表示粗糙度的Ra值及Rz值分别下降18.74%和21.01%（P < 0.001）。结论 点阵式Er:YAG激光可有效改善面部轻中度凹陷性痤疮瘢痕及毛孔粗大。     

A cross‐sectional,multi‐center study on treatment of facial acne scars with low‐energy double‐pass 1450‐nm diode laser

Acne scars are the ultimate outcome of acne vulgaris, a prevalent skin disorder affecting the pilo‐sebaceous unit. Laser resurfacing has been demonstrated to be an efficient therapy option for acne scars. Hence, we adopted this concept and conducted a study to evaluate the safety and efficacy of low‐energy double‐pass 1450‐nm diode laser on acne scars. This study was conducted on 48 patients with acne scars, treated at 4‐week interval with low‐energy double‐pass 1450‐nm diode laser. Patients were evaluated clinically and with photographs, at day 0, first month and third month post the final treatment and during follow‐up visit. Five treatment sessions were completed by all patients. Approximately, 79.2% of patients showed around 30% improvement. At the end of third month follow‐up, 92.9% of the patients demonstrated >30% improvement. Vesicle formation was observed in two cases, with no post‐inflammatory hyperpigmentation and transient hyperpigmentation was observed in one case, which vanished within 2 months. Our study showed that 1450‐nm diode laser treatment was efficient and well endured in facial acne scars when used with double‐pass at low‐energy.     

Papular acne scars. A common cutaneous finding

One hundred thirty-three patients were examined for the presence of a cutaneous eruption consisting of small, asymptomatic, hypopigmented, follicular papules on the upper part of the trunk. The papules were present in 57% of patients who had a history of acne vulgaris and in 9% of patients who denied ever having had acne. Biopsy specimens from five patients revealed circumscribed, perifollicular or parafollicular lesions in which both elastic and collagen fibers were attenuated in comparison with those in normal adjacent dermis. These changes are consistent with scar. We conclude that the papules are a scarring process secondary to acne vulgaris and propose calling the lesions papular acne scars. They appear closely related to or identical with changes previously termed perifollicular elastolysis, postacne anetoderma-like scars, and papular elastorrhexis.     

Laser resurfacing of the skin for the improvement of facial acne scarring: a systematic review of the evidence

This review presents and evaluates the evidence of the effectiveness of laser resurfacing for facial acne scars. Primary studies of all types of design in any language were identified from MEDLINE, EMBASE, the Cochrane database, Science Citation Index and various internet sites. Studies were accepted if they included patients treated by any laser for atrophic or ice-pick acne scars. The quality of the studies was assessed and data extracted by two independent researchers. There were no controlled trials but 14 case series were found which reported the effects of either the carbon dioxide or erbium:YAG laser. All of the studies were of poor quality. The types and severity of scarring were poorly described and there was no standard scale used to measure scar improvement. There was no reliable or validated measure of patient satisfaction; most improvement was based on visual clinical judgement, in many cases without blinded assessment. The inaccurate use of ordinal scales meant that any improvement was impossible to quantify with any validity, although the evidence suggested that laser treatment had some efficacy (a range in individual patients of 25-90% for both the carbon dioxide laser and the erbium:YAG laser). Changes in pigmentation as a side-effect were common (in up to 44% of patients), although lasting only a few weeks. Laser resurfacing technology is increasingly used in clinical practice to treat acne scars. Despite the poor quality evidence, it is plausible that there is some improvement of acne scarring; there is insufficient information, however, for patients to make informed decisions on whether to opt for treatment and there is not enough evidence to compare the two types of laser. There is a particular lack of information about the psychological effects of acne scar improvement. Good quality randomized controlled trials are needed with standardized scarring scales and validated patient outcome measures in order to assess the effectiveness of laser resurfacing in this group of patients.     

Silicone gel enhances the efficacy of Er:YAG laser treatment for atrophic acne scars: A randomized,split-face,evaluator-blinded,placebo-controlled,comparative trial

Background: The effect of topical silicone gel has been studied to prevent scars from burn, postoperative wound and to treat hypertrophic scars. No previous studies have been done to evaluate the efficacy of topical silicone gel on atrophic acne scars. Material and methods: Nineteen patients were treated with three sessions of ablative Er:YAG laser with 1-month intervals. Following each laser treatment, the randomlyassigned silicone gel or placebo was applied in split-face manner. Objective assessments, which included roughness, smoothness, hydration, transepidermal water loss were measured at baseline and prior to each treatment. Subjective assessments by dermatologists and subjects were done at baseline and 1 month after last laser treatment. Results: The laser treatments were well tolerated and resulted in clinical improvements. Topical silicone gel treatment resulted in significantly less roughness at weeks 4 and 12 compared with placebo (p < 0.05). Conclusion: Adding topical silicone gel to ablative Er:YAG laser treatment may provide additional benefits in improving acne scars.     

Papular sarcoidosis of the knees: a clue for the diagnosis of erythema nodosum-associated sarcoidosis

BACKGROUND: In recent years we have systematically explored the skin whenever sarcoidosis was suggested and we have observed with increasing frequency the presence of granulomatous cutaneous lesions of sarcoidosis involving the knees. OBJECTIVE: We sought to evaluate the specific cutaneous lesions of sarcoidosis involving the knees. METHODS: A total of 18 patients with biopsy-proven specific cutaneous sarcoidosis predominantly involving the knees were included in the study. Biopsy specimens were evaluated under polarized light. RESULTS: Of these cases, 4 corresponded to scar-sarcoidosis, 1 to plaque-type sarcoidosis, and 13 were an admixture of papules and minute scars frequently associated with erythema nodosum (papular sarcoidosis of the knees). Foreign particles were observed in 10 of 13 patients with papular sarcoidosis. CONCLUSION: Papular sarcoidosis of the knees can be considered a frequent form of cutaneous sarcoidosis, mainly observed in acute forms of the disease, and frequently associated with erythema nodosum.     

Clinical trial of a laser device called fractional photothermolysis system for acne scars

Ablative laser resurfacing is an effective treatment for acne scars. However, edema and prolonged erythema are common. Additionally, scarring and hyperpigmentation are often induced. A new concept of laser called fractional photothermolysis has been designed to create microscopic thermal wounds to achieve skin rejuvenation without significant side-effects. We treated 10 patients with acne scars using this laser system (Reliant Fraxel SR Laser). All the patients were successfully treated with minimal adverse effects. The fractional photothermolysis system represents an optional method for the treatment of acne scars.     

Papular follicular eruptions in human immunodeficiency virus-positive patients in South Africa

BACKGROUND: Papular and follicular eruptions, such as papulopruritic eruption, eosinophilic folliculitis, and infective folliculitis, are relatively common disorders in patients infected with the human immunodeficiency virus (HIV). These conditions may show considerable clinical overlap. OBJECTIVE: To assess the relative proportion of pruritic papular cutaneous eruptions in South Africans with HIV-associated dermatoses, and to correlate the clinical and histologic features of these lesions. METHODS: The clinical and histologic features of papular follicular eruptions were correlated in 40 consecutive black HIV-positive patients who underwent skin biopsy. RESULTS: The clinical features were similar in all patients and consisted of widespread papules and pustules involving the face, limbs, and trunk. The most common histologic finding was acute suppurative folliculitis, seen in 27 patients (67.5%). In most cases, no cause was found for the suppuration. Papulopruritic eruption of HIV was diagnosed in six patients (15%), HIV-associated eosinophilic folliculitis in four (10%), Pityrosporum folliculitis in two (5%), and acne in one (2.5%). Concordance between the initial clinical diagnosis and the final histopathologic diagnosis was achieved in only 27.5% of cases. CONCLUSION: Skin biopsy remains an important adjunct to the correct diagnosis and classification of papular and follicular eruptions in HIV-positive patients.     

Effective treatment for hypertrophic scar with dual-wave-length PDL and Nd:YAG in Chinese patients

There are several ways to prevent and treat hypertrophic scars. In recent years, lasers have been quite extensively used in treating scars. For example, Pulsed Dye Laser (PDL) and Intense Pulsed Light (IPL) can accelerate mutation of scar, whereas non-ablative and ablative fractional laser can improvescar texture. Dual-wave-length laser treatment is extensively used for blood vessel diseases but is rarely used and less reported for treatment of hypertrophic scars. Our study focuses on the efficacy and safety of dual-wave-length PDL and Nd:YAG in treatment of hypertrophic scars. Twenty-five patients in our study complaining of hypertrophic scars were treated with combined PDL/Nd:YAG laser at 4-6 weeks intervals. Following this, the patients and observers assessed these scars by using Patient Scar Assessment Scale (PSAS) and Observer Scar Assessment Scale (OSAS). The resultsshowed that hypertrophic scar was significantly improved after several laser treatments, and no severe adverse effects were observed. Considering the safety and satisfactory effects of dual-wave-length laser treatment, it can be regarded as a good method for treating hypertrophic scars. This study clearly demonstrates that combined PDL/Nd:YAG laser treatment is an effective, safe and well-tolerated treatment option for hypertrophic scars.     

Treatment of periorbital syringoma by the pinhole method using a carbon dioxide laser in 29 Asian patients

Background: Pinhole method has been used to treat various types of scars and dermal tumors by making multiple small holes in target tissues of the deep dermis using an ablative 10,600-nm carbon dioxide (CO₂) laser. Objectives: We prospectively investigated the efficacy and safety of using a CO₂ laser to treat periorbital syringomas via the pinhole method. Methods: A total of 29 patients with periorbital syringomas were treated with two sessions of CO₂ laser treatment using the pinhole method at two-month intervals. Laser fluences were delivered under the following settings: pulse duration of 200 μs, frequency of 50 Hz, on time of 0.04, and an off time of 0.01. Results: Among the 29 patients, 13 patients (44.8%) presented with small discrete papular syringomas, 10 (34.5%) had plaque-type lesions, and six (20.7%) had mixed lesions. Evaluation of the clinical results at 2 months after the second treatment session revealed marked clinical improvement (51–75%) in 10 of the 29 patients (34.5%), moderate clinical improvement (26–50%) in eight (27.6%), near-total improvement (≥ 75%) in seven (24.1%), and minimal improvement (0–25%) in four patients (13.8%). Conclusions: Our observations indicated that application of the pinhole method using a CO₂ laser exerts positive therapeutic effects in Asian patients with periorbital syringomas.     

The microsecond 1064 nm Nd:YAG laser as an adjunct to improving surgical scars following Mohs micrographic surgery

Background: Scarring following skin surgery is an unavoidable certainty. Scars resulting from Mohs Micrographic Surgery (MMS) can cause both cosmetic and functional problems. Various lasers have been used to treat scars, but the role of the microsecond pulsed 1064 nanometer neodymium-doped yttrium aluminum garnet (1064 nm Nd:YAG) in treating surgical scars is not well-defined. Objective: We aim to examine the clinical application of the 1064 nm Nd:YAG laser in improving surgical scars. Methods: Ten patients who were unhappy with cosmetic or functional outcomes of their surgical scars following MMS were treated with 1–3 sessions of the 1064 nm Nd:YAG laser to improve their scars. Therapy completion was determined by patient satisfaction with the appearance of their scars and/or resolution of any contractures that formed following surgery. Results: All ten patients were pleased with the improved appearance of their scars. Four patients saw complete resolution of an ectropion or eclabium that formed secondary to scar contractures from MMS. The side effects of laser treatments were limited to 1–2 hours of erythema, and there were no incidences of adverse effects or recurrence of contractures. Conclusion: Our clinical experience with the 1064 nm Nd:YAG laser provides promising data on improving appearance of and functionality from post-surgical scars.     

Treatment of atrophic facial acne scars with the 1064-nm Q-switched Nd:YAG laser: six-month follow-up study

OBJECTIVES: To quantitatively assess improvement in acne scarring after a series of nonablative laser treatments and to determine efficacy at 1-, 3-, and 6-month follow-up after treatment. DESIGN: Before-after trial of consecutively selected patients. SETTING: Private practice at the Laser and Skin Surgery Center of New York, New York. PATIENTS: Eleven patients with mild to moderate atrophic acne scarring were treated. INTERVENTIONS: A 3-dimensional optical profiling imaging system was used to assess skin topography before, during, and after treatment. Patients were treated with a 1064-nm Q-switched Nd:YAG laser and reassessed after 3 treatment sessions and at 1, 3, and 6 months after the fifth treatment session. MAIN OUTCOME MEASURES: The skin roughness analysis was quantified at baseline and at each follow-up interval. Pain, erythema, and petechiae formation were assessed on 3-point scales. RESULTS: At midtreatment (1 month after the third treatment session), an 8.9% improvement in roughness analysis was seen. This improvement increased to 23.3%, 31.6%, and 39.2% at 1, 3, and 6 months after the fifth treatment, respectively. Patients reported mild to moderate pain with treatment. The only adverse effects noted were transient erythema and mild pinpoint petechiae. CONCLUSIONS: Treatment with the nonablative 1064-nm Q-switched Nd:YAG laser results in significant quantitative improvements in skin topography in patients with mild to moderate atrophic acne scars. Continued incremental improvements were noted at 1-, 3-, and 6-month follow-up, indicating ongoing dermal collagen remodeling after the treatment.     

Efficacy and safety of 1064‐nm Q‐switched Nd:YAG laser with low fluence for keloids and hypertrophic scars

Background Several treatment modalities using laser devices have been used for the treatment of keloids and hypertrophic scars with various therapeutic outcomes. Objective The purpose of this study was to describe the efficacy and safety of 1064‐nm Q‐switched (QS) Nd:YAG laser with low fluence on keloids and hypertrophic scars. Methods Keloids and hypertrophic scars located at 21 anatomic sites in 12 Korean patients (10 men and 2 women; mean age 23.8 years, range 21–33) were treated using 1064‐nm QS Nd:YAG laser with low fluence at 1–2 week intervals. Treatment settings were 1.8–2.2 J/cm², 7‐mm spot size and 5–6 passes with appropriate overlapping. Results Follow‐up data collected 3 months after the final treatment revealed decreases in the mean score for the following lesion characteristics: pigmentation from 1.8 to 1.2; vascularity from 1.4 to 1.0; pliability from 3.0 to 2.0 and height from 2.3 to 1.8. The modified Vancouver General Hospital Burn Scar Assessment score decreased from 8.6 to 5.9 (P < 0.0001). Observed side‐effects were a mild prickling sensation during treatment, and mild post‐treatment erythema, both of which resolved within few hours. Conclusion Our results demonstrate that QS Nd:YAG laser with low fluence may be used for the treatment of keloids and hypertrophic scars.     

Q开关1064nm Nd:YAG激光碳膜术治疗中重度痤疮疗效与安全性评价

目的:评价Q开关1064 nm Nd:YAG激光碳膜术治疗寻常痤疮的疗效与安全性。方法:中重度痤疮患者166例随机分为实验组(83例)和对照组(83例)。对照组给予米诺环素胶囊100 mg,1天2次口服;克林霉素甲硝唑搽剂外用,1天3次。实验组在对照组治疗的基础上行Q开关1064 nm Nd:YAG激光碳膜术,10天治疗一次。结果:治疗40天后实验组有效率为87.76%,明显高于对照组的65.31%,差异有显著性(P0.05)。两组均未见明显不良反应发生。结论:Q开关1064 nm Nd:YAG激光碳膜术可提高药物治疗痤疮的疗效。