Evaluation of oral isotretinoin effects on hearing system in patients with acne vulgaris: Reversible or not?

Systemic isotretinoin is commonly used for severe acne treatment. It has many side effects, one of these is about hearing system, which has rarely been reported, also previous studies reported contradictory results about systemic isotretinoin and its association with hearing system. In this study, we aimed to investigate whether systemic isotretinoin affected on the hearing system or not. The study included 32 acne vulgaris patients (64 ears) who treated with oral isotretinoin 0.5 mg/kg body weight for at least 4 months and audiometric tests including pure‐tone, speech, bilateral acoustic reflexes, and tympanometric measurements were performed at baseline, in the first week, in the first month, and third month of treatment, and sixth month after treatment. Audiometric tests were performed for right and left ears separately. A significant difference was found in the pure‐tone thresholds (before treatment, first week, first month, third month of treatment, and sixth month after treatment) for the both ears at 8000 Hz (P < .001) and a significant decrease in the sixth month post‐treatment pure‐tone thresholds compared to pre‐treatment thresholds at 8000 Hz. Additionally, a statistically significant increase was observed in serum LDL and triglyceride levels in the third month of treatment and a significant decrease at the sixth month after treatment (P < .001). Systemic isotretinoin caused bilateral hearing threshold changes in acne patients during the therapy but the changes improved after discontinuation. Therefore, our findings may provide safety using for dermatologists about hearing effects of isotretinoin, which is quite effective on severe acne.     

A split axilla comparison study of axillary hair removal with low fluence high repetition rate 810 nm diode laser vs. high fluence low repetition rate 1064 nm Nd:YAG laser

Background A low fluence, high repetition rate 810 nm diode laser using constant motion technique has been recently introduced with advantages of less treatment discomfort and fewer side effects compared with traditional laser hair removal. Objective To compare hair reduction and side effects of low fluence high repetition rate 810 nm diode with high fluence low repetition rate 1064 nm Nd:YAG lasers. Methods Forty‐nine subjects were randomly received five monthly treatments with diode laser on one side of their axilla and long‐pulsed Nd:YAG laser on the other side. Hair count was recorded at baseline, 1‐ and 6‐month follow‐up visits. Results Percentage of axillary hair reduction at 1‐month follow‐up visit after receiving diode and Nd:YAG laser treatment were 71.0% and 82.3%, respectively, and at 6‐month follow‐up were 35.7% and 54.2%, respectively. There were significant differences in hair reduction between both laser systems at 1‐ and 6‐month follow‐ups (P < 0.001 and P < 0.001, respectively). Patients reported lower pain on the diode laser side (P < 0.001). Side effects of both laser systems were mild and transient erythema and swelling. Conclusions High fluence low repetition rate Nd:YAG laser was superior in hair reduction and provided higher patient satisfaction. However, low fluence high repetition rate diode laser was less painful.     

Treatment of ulcerated haemangiomas with a non‐coherent pulsed light source: Brief initial clinical report

Background: Ulceration is the most common complication of infantile haemangiomas and constitutes an authentic therapeutic challenge because of associated pain, infection, haemorrhage and subsequent scarring. Objective: To report our experience with an intense pulsed light (IPL) system in the treatment of ulcerated haemangiomas. Methods: Case 1: A 4‐month‐old girl, with haemangioma affecting the entire cutaneous surface of the left limb, developed four ulcerations on the inner aspect of this extremity. Two sessions with an IPL system using a triple pulse mode, a 570‐nm lower cut‐off filter and a fluence of 38?J/cm² were performed. Case 2: A 5‐month‐old girl with ulcerated labial haemangioma that previously failed to respond to intralesional corticoids was treated with an IPL system device. Three sessions using a triple pulse mode with a 570‐nm lower cut‐off filter and a fluence of 48?J/cm² were realized. Results: Good results were rapidly obtained after two and four sessions of IPL treatment, respectively. Pain was soon relieved and complete epithelization was obtained by between 1 and 2 months in both patients. Conclusion: Although our experience is rare, we believe that IPL devices may be an effective alternative treatment of ulcerated haemangiomas.     

Effective epilation of white and blond hair using combined radiofrequency and optical energy

OBJECTIVE: The present study examined the long‐term photoepilatory effect on blond and white hair of a combined intense pulsed light (680–980?nm) device with a bipolar radiofrequency component producing electrical current at a depth of 4?mm.

MATERIALS AND METHODS: Thirty‐six adult women with white and blond hair (skin phenotypes I–V) were included in the study. The chin and upper lip were treated with four treatment sessions over 9–12 months with long‐term follow‐up performed at month 18 (6 months after the last treatment). The level of RF energy was 20?J/cm³, while optical fluences varied from 24 to 30?J/cm². Hair counts and photographic evaluation of some sites were obtained at baseline, months 1, 3 and 5 and the final treatment session.

RESULTS: An average hair removal of 48% was observed at month 18 (6 months following the final treatment session). A slightly higher photoepilatory efficiency was noted for blond hair (52%) versus white hair (44%) treatment sites.

CONCLUSION: Combined radiofrequency and optical energy technology may produce effective photoepilation of blond and white hair phenotypes.     

Treatment of terminal and vellus non‐pigmented hairs with an optical/bipolar radiofrequency energy source—with and without pre‐treatment using topical aminolevulinic acid

Objective. The present study compares the 6‐month hair removal efficacy of a combined pulsed light bipolar radiofrequency device with and without pre‐treatment using topical aminolevulinic acid.

Materials and methods. Fifteen adult females, skin phenotypes II–IV were entered into the study. Ten subjects were determined to have white terminal hairs; an additional five females presented with fine facial vellus hairs. Unwanted facial hair was treated twice at 4–6 week intervals with a combined optical bipolar radiofrequency source. At each treatment half of the treatment area was pre‐treated with topical aminolevulinic acid; the other half was not. Follow‐up visits were undertaken at 6 months after the second treatment. Hair counts were obtained before treatment and 6 months after the final treatment.

Results. An average terminal white hair removal of 35% was observed at 6 months after treatment with the combined pulsed light bipolar radiofrequency device. When pre‐treatment with topical aminolevulinic acid was provided the average hair removal of terminal white hairs was found to be 48%. None of the five subjects with vellus hair were noted to respond to either treatment.

Conclusions. Combined radiofrequency and optical light treatment leads to effective hair removal of terminal white hairs. This improvement is increased with pre‐treatment use of topical aminolevulinic acid. Vellus nonpigmented hairs did not respond to treatment     

Leg ulcer caused by Mycobacterium ulcerans ssp. shinshuense infection

Background An 81‐year‐old man presented with a skin ulcer on the left forearm caused by infection with Mycobacterium ulcerans ssp. shinshuense. The patient first noticed the subcutaneous nodule with an undermined ulcer and areola on the left forearm without any episode of trauma. Methods The rod‐shaped and acid‐fast bacteria taken from the ulcerative lesion were positive for Ziehl–Neelsen staining. The bacterial colony was cultured on Ogawa slant egg medium at 28 °C. Results A clinical diagnosis of Mycobacterium infection was made. For therapy, in addition to oral clarithromycin, topical sulfadiazine silver and hyperthermia were used. One month after starting treatment, topical treatment was changed to U‐pasta (sucrose, povidone‐iodine). Four months after the onset of the disease, bacterial colonies composed of scotochromogens were identified as Mycobacterium marinum by the DNA–DNA hybridization (DDH) method. The growth speed and characteristics of the bacterial colonies were different from those of Mycobacterium marinum. Conclusions This pathogenetic bacterium was finally identified as Mycobacterium ulcerans ssp. shinshuense by the polymerase chain reaction method and 16S rRNA gene sequencing. Nine months after the onset of the disease, the ulcer was re‐epithelialized with a residual scar.     

First experience with enteric-coated mycophenolate sodium (Myfortic®) in severe recalcitrant adult atopic dermatitis: an open label study

Background Severe atopic dermatitis (AD) is often treated successfully with oral immunosuppressive drugs such as ciclosporin (CsA) or oral corticosteroids. However, some patients develop adverse effects or are unresponsive to these first‐choice oral immunosuppressive drugs. Objectives To evaluate whether enteric‐coated mycophenolate sodium (EC‐MPS) is an effective treatment in patients with severe, recalcitrant AD. Methods Ten patients with severe, recalcitrant AD were treated with EC‐MPS 720 mg twice daily for 6 months. All patients had to discontinue other oral immunosuppressive drugs due to adverse effects (n = 8) or nonresponsiveness (n = 2). Disease activity was monitored using the Severity Scoring of Atopic Dermatitis (modified SCORAD) index and the Leicester Sign Score (LSS). Additionally, the level of serum thymus and activation‐regulated cytokine (TARC) was measured. During treatment, safety laboratory examination was performed. Total serum immunoglobulin E (IgE) was followed during treatment. Use of topical corticosteroids was recorded before and during treatment. Results Compared with baseline, the mean scores for disease activity significantly decreased during treatment with EC‐MPS [modified SCORAD (P = 0·04), LSS severity (P = 0·01), LSS extent (P = 0·01)]. In addition, serum TARC levels and total serum IgE levels significantly decreased after treatment compared with before (P = 0·03; P = 0·05). Disease activity decreased after approximately 2 months of treatment and stabilized during the 6‐month treatment period. No differences in the amount of topical corticosteroids used in the 6 months prior to treatment compared with the 6‐month treatment period were found (P = 0·4). None of the patients discontinued use of EC‐MPS and only mild adverse effects were seen. Conclusions In this study EC‐MPS at a dose of 720 mg twice daily for 6 months has proven to be an effective and well‐tolerated treatment for patients with severe, recalcitrant AD.     

Short‐term isotretinoin treatment decreases insulin‐like growth factor‐1 and insulin‐like growth factor binding protein‐3 levels: does isotretinoin affect growth hormone physiology?

Summary Background Isotretinoin is an effective treatment for acne vulgaris. However, it has numerous side‐effects. It was previously reported that serum growth hormone (GH) levels decreased with isotretinoin treament. Objectives To analyse whether isotretinoin has any effects on insulin‐like growth factor‐1 (IGF‐1), insulin‐like growth factor binding protein‐3 (IGFBP3) and GH levels. Methods Forty‐seven patients aged 21·5 ± 5·1 years (mean ± SD) with acne vulgaris were included in this study. Isotretinoin therapy was initiated at a dose of 0·5–0·75 mg kg^?1 daily and then adjusted to 0·88 mg kg^?1 daily as maintenance dosage after 1 month. Screening for biochemical and hormonal parameters was performed just before initiation and after 3 months of isotretinoin treatment. Results IGF‐1 and IGFBP3 levels decreased significantly after treatment (P < 0·01), while GH levels did not change. Post‐treatment, significant increases were seen in aspartate aminotransferase, total cholesterol, low‐density lipoprotein cholesterol, triglycerides and low‐density lipoprotein cholesterol/high‐density lipoprotein cholesterol ratio (P < 0·0001) while high‐density lipoprotein cholesterol levels were significantly decreased (P < 0·0001). Conclusions Isotretinoin therapy may have an effect on GH physiology, and further studies are needed to understand this association.     

Chondrodermatitis nodularis chronica helicis – a conservative therapeutic approach by decompression

Background: Chondrodermatitis nodularis chronica helicis is a rather common condition which substantially affects quality of life causing pain and sleeping disturbances. Surgical treatment is connected with a tendency to recurrence. Mechanical pressure is probably the main etiological factor. Patients and Methods: A prospective study was performed with 18 patients that were offered a non‐surgical treatment using a self‐made bandage of foam plastic which they applied during the night. Of these, 12 performed the treatment including follow‐up; 6 patients initially also consented, but they did not return after the initial visit. Results: 11 patients reported substantial reduction of pain within the first month; after an average of 1.75 months they were free of pain. All 8 patients with initial sleeping problems caused by pain reported undisturbed sleep after only one month. In 11 patients the lesions receded satisfactorily, in 9 patients completely, in 2 patients leaving small asymptomatic residual lesions. Recurrences appeared in 3 patients with 2 of them having been surgically pretreated at the same location. Conclusions: We recommend conservative treatment using protective padding as first line treatment for chondrodermatitis nodularis chronica helicis. The successful outcome achieved only by relief of pressure supports pressure as the main etiological factor in the development of the disease.     

Ultrasound imaging demonstration of the improvement of non‐ablative laser remodeling by concomitant daily topical application of 0.05% retinaldehyde

BACKGROUND: Retinaldehyde has been proven to be effective in the reduction of facial wrinkles. It has also demonstrated its usefulness when used before and after laser skin resurfacing.

OBJECTIVE: A monocentric, comparative, randomized, double‐blind study was performed to evaluate the efficacy of retinaldehyde versus excipient in combination with non‐ablative laser remodeling treatment.

METHODS: A total of 16 female patients (mean age 45 years) were enrolled for neck line and forehead rhytid treatment. They were randomly assigned into two groups. The RAL group (eight patients) was treated with a non‐ablative laser (1540?nm Er:glass, 10?J/cm² per pulse, three pulses, 2?Hz repetition rate, 4?mm spot, +5°C cooling) and daily topical application of 0.05% retinaldehyde immediately after the first laser treatment and up to 3 months after the fifth treatment. The CTRL group (eight patients) was treated under similar conditions, except with a daily application of excipient. The thickness of the skin (forehead and neck) was measured by ultrasound imaging before the first treatment, 1 month after the third treatment, 1 month after the fifth treatment and 3 months after the fifth treatment.

RESULTS: An increase of dermal thickness was observed for all patients treated by laser (groups RAL and CTRL) on the forehead and neck. However, the increase was greater for the RAL group (retinaldehyde) when compared with the CTRL group (excipient). Three months after the fifth treatment, the increase in dermal thickness (%) was, respectively, 5.27 versus 1.13 for the forehead and 10.54 versus 3.57 for the neck. The difference between groups was statistically significant in favor of the retinaldehyde group for the forehead (p<0.05) and of limited significance for the neck (p=0.08).

CONCLUSION: When considering the reduced number of patients in each group, the statistical analysis demonstrates an evident advantage of using retinaldehyde versus excipient. This study demonstrates that irradiation with a 1540?nm Er:glass laser can be potentiated with concomitant daily topical application of 0.05% retinaldehyde.     

Long‐term clinical results of IPL photorejuvenation

BACKGROUND: Non‐ablative photorejuvenation is characterized by the reduction of intrinsic and extrinsic changes in photodamaged skin. Only short‐term improvement has been documented previously.

OBJECTIVE: To evaluate quantitatively the short‐term and long‐term clinical effectiveness of multiple full‐face IPL treatments for non‐ablative facial photorejuvenation.

METHODS: A total of 47 patients with varying degrees of photodamaged skin and rosaceal dermatitis underwent a series of four to five IPL treatments with a Vasculight (Lumenis Corp). Treatments were conducted every 3–4 weeks. Photographs were taken at baseline and after the treatment series was completed at both 6 weeks and 6 months. Adverse effects and clinical improvement were documented. A patient satisfaction questionnaire was completed and reviewed at the 6‐month evaluation period.

RESULTS: Standardized evaluation of rhytids showed a statistically significant improvement in wrinkles at both evaluation endpoints. Some degradation occurred over time. Facial vascularity, dyschromia, and large pore size progressively improved from the 6‐week measurement to the 6‐month measurement.

CONCLUSION: This clinical study demonstrates that non‐ablative facial rejuvenation is associated with long‐term clinical improvement of facial rhytids, abnormal vascularity and pigmentary disorders with minimal risks and side effects to the patient.     

Effects of isotretinoin treatment on sleep in patients with severe acne: a pilot study

Background There are a few case reports in literature that isotretinoin treatment may alter sleep architecture. Also studies in mice suggest a role of retinoids in the contribution of delta oscillations to the sleep electroencephalography. Objectives The aim of this study was to investigate the effect of isotretinoin treatment on sleep architecture using polysomnography (PSG). Patients and methods Twelve severe acne vulgaris patients without any psychiatric and sleep disorders were treated with 0.5 mg/kg of isotretinoin. Clinician‐administered acne questionnaire, psychiatric examination, Epworth sleepiness scale and PSG recordings were performed after the first month of treatment. Results Sleep efficiency was increased from 83.5% (62.8–89.0%, quartiles) to 89.5% (81.5–93.5%, quartiles; P = 0.036) and sleep latency decreased from 18.0 min (11.1–36.3, quartiles) to 15.5 min (9.3–19.0, quartiles; P = 0.023) following 1‐month isotretinoin treatment. There were no significant changes in other sleep parameters of PSG and scores of Epworth sleepiness scale. Conclusions This study suggests that isotretinoin treatment slightly improves night‐time sleep without any effects on sleep stages and daytime sleepiness.     

Combination treatment by 10 600 nm ablative fractional carbon dioxide laser and narrowband ultraviolet B in refractory nonsegmental vitiligo: a prospective, randomized half-body comparative study

Background Vitiligo is a common acquired depigmentation disorder caused by the loss of melanocytes. Despite the numerous treatment modalities available for vitiligo, responses to treatment are still unsatisfactory. For this reason, new treatment modalities and approaches are needed. Objectives To investigate the effects of fractional carbon dioxide (CO₂) laser therapy followed by systemic narrowband ultraviolet B (NB‐UVB) phototherapy on nonsegmental vitiligo (NSV) as a prospective and randomized left‐right comparative study. Methods Ten patients with NSV who presented symmetrical vitiligo lesions with no further improvement despite more than 1 year of conventional treatment were enrolled. Two sessions of half‐body fractional CO₂ laser therapy were performed at a 2‐month interval. NB‐UVB phototherapy was then administered to the entire body 5 days after each fractional laser treatment twice a week, increasing the dose incrementally by 15% at each session. Objective clinical assessments were made by two blinded dermatologists using a quartile grading scale, and the patients’ overall satisfaction was evaluated using a 10‐point visual analogue scale. Results Two months after the last treatment, mean improvement scores, assessed by physicians, were significantly higher for those treated with half‐body fractional CO₂ laser therapy followed by NB‐UVB phototherapy, compared with those treated with NB‐UVB alone (P = 0·034). In addition, according to subjective assessment, the half‐body laser treatment followed by NB‐UVB showed significantly higher improvements compared with NB‐UVB treatment alone (P = 0·023). Noticeable adverse events, such as infection, scarring and Koebner phenomenon, were not found in any patient. Conclusions This study suggests that fractional CO₂ laser therapy followed by NB‐UVB phototherapy could be used effectively and safely as an alternative modality for the treatment of refractory vitiligo.     

Pilot study of intense pulsed light for the treatment of systemic sclerosis-related telangiectases

Background Telangiectases represent microvascular changes inherent in the systemic sclerosis (SSc) disease process. Intense pulsed light (IPL) is an effective treatment for non‐SSc‐related cutaneous telangiectases. Objectives This pilot study aimed to examine the efficacy, safety and tolerability of IPL treatment in an open study of patients with SSc. Methods Patients underwent three treatments of IPL at monthly intervals and attended follow‐up examinations at 1, 6 and 12 months after final treatment. Photographs, laser Doppler imaging (LDI) and thermography were used to measure changes at each visit. Results Seventeen patients completed the study. Photographs were graded (compared with baseline) as: at 1‐month follow‐up, four ‘no change’, four ‘improved’ and eight ‘much improved’; at 6‐month follow‐up, four ‘no change’, eight ‘improved’; and four ‘much improved’; and at 12‐month follow‐up (eight images were available), three ‘no change’, two ‘improved’ and three ‘much improved’. Perfusion as measured by LDI (perfusion units) was significantly reduced, compared with baseline [median 2·66, interquartile range (1·78–3·93)], at 1 month [1·70 (1·07–2·55), P = 0·006] and 6 months [2·05 (1·42–2·36), P = 0·008] post‐treatment, but not at 12 months [1·61 (1·14–3·22), P = 0·088]. No differences were found in skin temperature between baseline and follow‐up visits. Conclusions In this pilot study (the first of IPL treatment for SSc‐related telangiectases) most patients improved after IPL treatment. However, the degree of improvement was not maintained in all patients at 6–12 months, suggesting that further treatments may be necessary. Longer term studies of this novel treatment approach are now required.     

Long‐term effects of omalizumab on peripheral blood cells and C‐reactive protein levels in patients with chronic spontaneous urticaria

Omalizumab's mechanism of action is not well‐understood yet despite its strong therapeutic efficacy in chronic spontaneous urticaria (CSU). To determine the overall effect of omalizumab on peripheral blood cell counts and serum C‐reactive protein levels (sCRP) during a 1‐year follow‐up in patients with CSU. Data of 74 patients (male/female: 20/54) were reviewed from medical charts. Leucocyte counts, percentages of peripheral blood cells(lymphocyte, monocyte, neutrophil [PPBN], eosinophil, basophil [PPBB]) and sCRP were recorded at baseline, 3rd, 6th, 12th months of omalizumab treatment. Although a dramatic increase in the mean PPBB (±SD) was observed at the 3rd month, PPBB (%) gradually decreased after the 3rd month (PPBB: 0.38 ± 0.21 [baseline] vs. 0.59 ± 0.3 [3rd month], p = .002). However, 12th month PPBB remained higher than baseline (PPBB:0.38 ± 0.21 [baseline] vs. 0.46 ± 0.27 [12th month], p = .03). A dramatic decrease in the mean PPBN (%) was noticed within the first 3 months (PPBN:62.85 ± 8.97 [baseline] vs. 58.37 ± 9.07 [3rd month], p = .04), and 12th month PPBN remained lower than baseline values (PPBN: 62.85 ± 8.97 [baseline] vs. 60.31 ± 8.02 [12th month], p = .045).Mean sCRP (mg/dL) decreased rapidly within the first 3 months (sCRP: 1.09 ± 1.53 [baseline] vs. 0.56 ± 0.45 [3rd month], p = .17) and 12th month sCRP still remained lower than baseline levels (sCRP: 1.09 ± 1.53 [baseline] vs. 0.83 ± 1.06 [12th month], p = .01). Omalizumab substantially increases PPBB,and reduces PPBN accompanied by a reduction in sCRP especially in the first 3 months; however, these effects may continue in the long‐term. The alterations in peripheral blood cell ratios and sCRP may contribute to the therapeutic effect of omalizumab in CSU.     

Intensified photodynamic therapy of actinic keratoses with fractional CO2 laser: a randomized clinical trial

Background Photodynamic therapy (PDT) with methyl aminolaevulinate (MAL) is effective for thin actinic keratoses (AKs) in field‐cancerized skin. Ablative fractional laser resurfacing (AFXL) creates vertical channels that facilitate MAL uptake and may improve PDT efficacy. Objectives To evaluate efficacy and safety of AFXL‐assisted PDT (AFXL‐PDT) compared with conventional PDT in field‐directed treatment of AK. Methods Fifteen patients with a total of 212 AKs (severity grade I–III) in field‐cancerized skin of the face and scalp were randomized to one treatment with PDT and one treatment with AFXL‐PDT in two symmetrical areas. Following curettage of both treatment areas, AFXL was applied to one area using 10 mJ per pulse, 0·12 mm spot, 5% density, single pulse (UltraPulse^®, DeepFx handpiece; Lumenis Inc., Santa Clara, CA, U.S.A.). MAL cream was then applied under occlusion for 3 h and illuminated with red light‐emitting diode light at 37 J cm^?2. Fluorescence photography quantified protoporphyrin IX (PpIX) before and after illumination. Results At 3‐month follow‐up, AFXL‐PDT was significantly more effective than PDT for all AK grades. Complete lesion response of grade II–III AK was 88% after AFXL‐PDT compared with 59% after PDT (P = 0·02). In grade I AK, 100% of lesions cleared after AFXL‐PDT compared with 80% after PDT (P = 0·04). AFXL‐PDT‐treated skin responded with significantly fewer new AK lesions (AFXL‐PDT n = 3, PDT n = 11; P = 0·04) and more improved photoageing (moderate vs. minor improvement, P = 0·007) than PDT‐treated skin. Pain scores during illumination (6·5 vs. 5·4; P = 0·02), erythema and crusting were more intense, and long‐term pigmentary changes more frequent from AFXL‐PDT than PDT (P = not significant). PpIX fluorescence was higher in AFXL‐pretreated skin [7528 vs. 12 816 arbitrary units (AU); P = 0·003] and photobleached to equal intensities after illumination (AFXL‐PDT 595 AU, PDT 454 AU; P = 0·59). Conclusions AFXL‐PDT is more effective than conventional PDT for treatment of AK in field‐cancerized skin.     

CO2 laser desiccation of urethral hair post‐penoscrotal hypospadias repair

Background: Proximal urethral defects account for approximately 20% of hypospadiac urethras. Previous surgical interventions involved hair‐bearing genital skin which consequently resulted in a hairy urethra, which is seen mainly in older patients. Objective: To evaluate the safety and effectiveness of the CO₂ laser for urethra hair elimination. Methods: Four men aged 18–20 years with hairy urethras, who failed electrolysis treatment, were treated with CO₂ laser desiccation at low fluences (2–5?watts). The treatments were performed at 1‐month intervals. Treatment was continued until no hair was seen. Visual assessment of the hair reduction was recorded. Results: Patients received two to four treatment sessions (average 3.2). On clinical assessment 3 months after the last treatment, outcome was rated excellent (no hair) in all patients. Conclusions: CO₂ laser desiccation should be considered as a therapeutic modality for a hairy urethra, especially after the failure of electrolysis.     

The metabolism and pharmacokinetics of isotretinoin in patients with acne and rosacea are not influenced by ethanol

Background Isotretinoin is effective in the treatment of severe acne and rosacea. Both parent drug and its main metabolite 4‐oxo‐isotretinoin are potentially teratogenic compounds and contain a carboxylic acid moiety. In the presence of ethanol, naturally occurring as well as synthetic retinoids also containing a carboxylic acid moiety are capable of undergoing an ethyl esterification with the metabolic formation of more lipophilic compounds with a much longer terminal half‐life. Objectives To determine if isotretinoin (13‐cis‐RA), its main metabolite 4‐oxo‐isotretinoin (4‐oxo‐13‐cis‐RA), and other possible metabolites in the presence or absence of ethanol are converted to their corresponding ethyl derivatives in patients with severe acne or rosacea after multiple isotretinoin dosing. In addition, pharmacokinetic parameters of the parent drug and its 4‐oxo metabolite were determined. Patients/methods Eleven patients with severe acne or rosacea were treated with isotretinoin daily for 3 months and investigated pharmacokinetically during 24 h after 1 month of treatment and for up to 28 days after discontinuation of therapy. A possible influence of ethanol was evaluated using a simple self‐administered questionnaire and by measuring serum ethanol levels during treatment. The concentrations of isotretinoin, 4‐oxo‐isotretinoin and possible ethylated and nonethylated metabolites were measured by reverse‐phase high‐performance liquid chromatography. Results Although seven of 11 patients had a considerable weekly alcohol intake, no endogenous synthesis of ethyl derivatives of isotretinoin, the main 4‐oxo metabolite or the all‐trans compounds was chromatographically detectable in any of the patients’ plasma samples during the treatment period. Multiple dose pharmacokinetic data for the parent drug and its main metabolite were comparable to previous studies. Conclusions The metabolism and pharmacokinetics of isotretinoin and its main metabolites are not influenced by ethanol during long‐term isotretinoin treatment. After ceasing long‐term isotretinoin therapy the recommended period of 1 month for using anticonceptive measures in fertile women seems adequate.     

Efficacy of monopolar radiofrequency on skin collagen remodeling: a veterinary study

The aesthetic market offers various radiofrequency treatments for the reduction of wrinkles and rhytids. Even though this not an uncommon aesthetic therapy, there is considerable lack of clinical evidence on the various energy delivery systems available (unipolar, bipolar, tripolar, multipolar, etc.). The purpose of this study was to demonstrate the efficacy of a monopolar radiofrequency device (Exilis Elite, BTL Industries Inc., Boston, MA, USA) on the skin collagen in an animal model. The study treatment was done on the abdominal area of the potbellied Vietnamese mini pigs in the Veterinary Research Institute facility. All pigs were treated once per week for 4 weeks. The treatment area was sized 20 × 10cm. The surface temperature was kept in the therapeutic interval from 39°C to 43°C and the therapy lasted for 10 minutes after reaching the therapeutic temperature. Biopsy samples were taken before the therapy and at the 3‐month follow‐up. The histology samples were stained and magnified (×400) before computer processing. The collagen volume was calculated using the stereological analysis and the data were statistically processed (using the nonparametric two‐sample t‐test). The collagen content tissue increased from average of 9.0% before the therapy up to 25.9% after the 3‐month follow‐up period. The statistical comparison of 54 samples taken before and after the treatment acknowledged the significant difference (p = 0.018). The stereological analysis proved large‐scale improvement of collagen in the treated area. We have observed that the monopolar radiofrequency therapy significantly increases collagen remodeling.     

Efficacy of amorolfine nail lacquer for the prophylaxis of onychomycosis over 3 years

Background Standard treatment for onychomycosis often results in less than half of subjects achieving disease‐free nails. Onychomycosis is even more challenging to treat as relapses and re‐infections are common. Objective To determine if a prophylactic effect exists when a treatment with amorolfine nail lacquer (ANL), with half the frequency of the standard regimen, is instituted following successful treatment of dermatophytic toenail onychomycosis with matrix involvement. Methods Efficacy and safety of a group treated with ANL (once every 2 weeks) were compared with that of an untreated group in a 36‐month (3 years), single‐centre, randomized, open‐label, comparison study. Subjects to be included in the study were required to be cured of confirmed onychomycosis with matrix involvement after an initial treatment with either ANL + oral terbinafine or oral terbinafine alone in a previous study. Prophylaxis of onychomycosis was assessed by global recurrence rate, confirmed onychomycosis, clinical recurrence and mycological recurrence. Results A total of 52 subjects were enrolled (26 in each group) in the study. Throughout the study, recurrences occurred more quickly in the untreated group compared with that in the ANL group. Statistically significant differences were observed at month 12 (ANL, 8.3%; untreated, 31.8%; P = 0.047). At endpoint, 70.8% of the subjects treated with ANL remained cured compared to 50% in the untreated group (P = 0.153). Recurrence was delayed by nearly 200 days for the ANL group compared with that of the untreated group. Amorolfine was safe and well tolerated during the study, with no treatment‐related adverse events. Conclusion These results suggest that amorolfine nail lacquer may be effective and is safe for use as a prophylactic treatment for the recurrence of onychomycosis.