Postinflammatory Hyper Research Articles

Formaldehyde 5% in Flexible Collodion Compared to Cryotherapy for Treatment of Female Genital Warts: A Randomized Clinical Trial.

Genital wart is a sexually transmitted disease caused by human papillomavirus (HPV) and is responsible for discomfort, and decreased quality of life and productivity in victims with a high recurrence rate after treatments. This study aimed to compare the efficacy and safety of formaldehyde 5% with cryotherapy for the treatment of female genital warts. Eighty women with at least two similar genital warts who visited the outpatient dermatology clinic of Shahid Faghihi hospital, Shiraz, Iran, were enrolled in this study. One lesion of each patient was self-treated with formaldehyde 5% in flexible collodion gel once daily for 28 days and the other matched lesion was treated by weekly repeated cryotherapy courses. The number of eradicated lesions and the mean days needed to treat, pain scores, complications and patient satisfaction were compared between the treatment methods. Complete clearance of lesions was observed in 58.7% of formaldehyde-treated lesions compared to 88.7% for cryotherapy (P value = 0.000). With formaldehyde-treated lesions, 51% complained of pain, 36.3% had pruritus, 86.3% had skin dryness, 88.8% complained of burning sensation and 93.7% showed erythema. In the cryotherapy group, 92.5% complained of pain, 15% had burning sensation, 75% showed erythema, 5% had atrophy, 80% developed post-inflammatory hyper or hypopigmentation (PIH) and 92.5% suffered from ulceration. Seventy-five (93%) found it easy to apply and (47) 58% were satisfied with their treatment results. Self-administration of formaldehyde 5% resulted in a lower clearance rate but had better cosmetic outcomes with lower pain scores compared to cryotherapy.

Characteristics of postinflammatory hyper- and hypopigmentation in patients with psoriasis: A survey study

Characteristics of postinflammatory hyper- and hypopigmentation in patients with psoriasis: A survey study

Clinical & ultrastructural evaluation of the effect of fractional CO2 laser on facial melasma

ABSTRACTMelasma represents the most obvious and disfiguring change of the face leading to psychological problems especially in females. Ablative lasers have also been used by many professionals to treat melasma, although there is few scientific data supporting this indication. The exact mechanism of action of ablative lasers in melasma is not yet clear enough. We aimed to evaluate the ultrastructural effect of fractional ablative CO2 (FrCo2) laser on facial melasma. Eleven melasma patients evaluated clinically by clinical modified area and severity index (MASI) score, treated by two sessions of fractional CO2 laser one month a part. Two punch biopsies of 2 mm diameter were obtained from all subjects one before and the other 3 months after treatment. All biopsies were analyzed by light and electron microscopy. Clinically, significant improvement of pigmentation and 48% reduction of (MASI) score were observed after two sessions of laser treatments. Light microscopic analysis of specimens revealed significant decrease in melanocyte count after treatment. Electron microscopic analysis of specimens after treatment revealed significant decrease in the number and size of melanocytes and significant decrease or complete absence of melanin granules in the surrounding keratinocytes compared to pre-treatment specimens. No scarring or post inflammatory hyper or hypopigmentation. We concluded that repeated application of Fractional CO2 laser on melasma skin may result in long lasting improvement due to its destructive effect on melanocytes.

FIXED DRUG ERUPTION TO FLUCONAZOLE IN A 28 YEAR OLD WOMAN WITH RECURRENT VAGINAL CANDIDIASIS

Introduction Fixed Drug eruption (FDE) is a delayed type hypersensitivity reaction to certain drugs, characterized by single or multiple round patches, which may or may not have vesicles, often healing with hyper pigmentation (1) (2). FDE to Fluconazole is not common and few cases have been reported (2) (3). Case Description 28-year old woman with past medical history of chronic urticaria, eczema and hypothyroidism presenting with recurrent rash in the same exact locations after every Fluconazole use for recurrent vaginal candidiasis. Her first episode of rash was 12 months ago. Within minutes of taking Fluconazole for a vaginal yeast infection (previously used) she developed an erythematous flat, 2×2 cm rash on her nose, upper lip, right ankle and upper leg. Within 24 hours rash developed small vesicles followed by crusting. Since then she has taken Fluconazole three separate times and every time she developed the same rash on the same exact locations. The rash is pruritic in the first few days and heals with post inflammatory hyper pigmentation. She denies lesions in the genital area or on palms or soles. At the time of examination, the rash had healed with post inflammatory hyper pigmentation. Discussion Fluconazole is often used in the treatment of vaginal or esophageal candidiasis (1). FDE with Fluconazole may be more common than previously thought and should be kept in mind when patients have recurrent, classic rashes after Fluconazole use. Fluconazole should be re-prescribed with caution, since recurrent FDE lesions can be greater in size and number on repeat exposure (3). Fixed Drug eruption (FDE) is a delayed type hypersensitivity reaction to certain drugs, characterized by single or multiple round patches, which may or may not have vesicles, often healing with hyper pigmentation (1) (2). FDE to Fluconazole is not common and few cases have been reported (2) (3). 28-year old woman with past medical history of chronic urticaria, eczema and hypothyroidism presenting with recurrent rash in the same exact locations after every Fluconazole use for recurrent vaginal candidiasis. Her first episode of rash was 12 months ago. Within minutes of taking Fluconazole for a vaginal yeast infection (previously used) she developed an erythematous flat, 2×2 cm rash on her nose, upper lip, right ankle and upper leg. Within 24 hours rash developed small vesicles followed by crusting. Since then she has taken Fluconazole three separate times and every time she developed the same rash on the same exact locations. The rash is pruritic in the first few days and heals with post inflammatory hyper pigmentation. She denies lesions in the genital area or on palms or soles. At the time of examination, the rash had healed with post inflammatory hyper pigmentation. Fluconazole is often used in the treatment of vaginal or esophageal candidiasis (1). FDE with Fluconazole may be more common than previously thought and should be kept in mind when patients have recurrent, classic rashes after Fluconazole use. Fluconazole should be re-prescribed with caution, since recurrent FDE lesions can be greater in size and number on repeat exposure (3).

A review of laser and light therapy in melasma.

Melasma is a dysregulation of the homeostatic mechanisms that control skin pigmentation and excess pigment is produced. Traditional treatment approaches with topical medications and chemical peels are commonly used but due to the refractory and recurrent nature of melasma, patients often seek alternative treatment strategies such as laser and light therapy. Several types of laser and light therapy have been studied in the treatment of melasma. Intense pulsed light, low fluence Q-switched lasers, and non-ablative fractionated lasers are the most common lasers and light treatments that are currently performed. They all appear effective but there is a high level of recurrence with time and some techniques are associated with an increased risk for postinflammatory hyper- or hypopigmentation. The number and frequency of treatments varies by device type but overall, Q-switched lasers require the greatest number of treatment applications to see a benefit. Vascular-specific lasers do not appear to be effective for the treatment of melasma. Ablative fractionated lasers should be used with caution because they have a very high risk for postinflammatory hypo- and hyperpigmentation. The use of nonablative fractionated laser treatments compared with other laser and light options may result in slightly longer remission intervals. Picosecond lasers, fractional radiofrequency, and laser-assisted drug delivery are promising future approaches to treat melasma. The goal of this review is to summarize the efficacy and safety of the most commonly used laser and light therapies to treat melasma, briefly present future laser-based treatment options for patients with melasma, and provide recommendations for treatment on the basis of the reviewed information.

Fixed drug eruption to cetirizine-role of patch testing

Antihistamines are prescribed for a wide variety of disorders like urticaria, eczema, allergies and infestations. Adverse reactions due to them is unusual and the incidence of fixed drug eruption is scarce. They are characterized by a sudden onset of edematous, erythematous plaques appearing at the same sites following an oral provocation with the drug and is proposed to be due to the epidermal CD8+ T cells resident at the sites of these residual post inflammatory hyper pigmented macules. Antihistamines sharing a similar chemical structure have an increased likelihood of showing cross reactions and a patch test based evaluation can be carried out to deduce the offending drugs, cross reactions and alternative medications. Keywords: Antihistamines, Fixed drug eruptions, Patch testing

Photodynamic Therapy with 5% δ-Aminolevulinic Acid is Safe and Effective Treatment of Acne Vulgaris in Japanese Patients.

Photodynamic therapy with aminolevulinic acid (ALA-PDT) is effective therapy for acne vulgaris; however, relatively strong side effects limit its wide usage. We have previously demonstrated that ALA-induced protoporphyrin IX distribution with lower concentrations and shorter contact time of ALA resulted in focused damage in sebaceous glands in vivo. We have formulated a protocol for ALA-PDT using 5% ALA with 2 hours contact time. The objective of this study was to establish the effectiveness and side effect profile of the new protocol in humans. Eleven Japanese patients (Fitzpatrick's skin type III - IV, mean age 23.7±7.2) with facial acne received topical application of 5% ALA for 2 hours with subsequent illumination by a broadband light (600 - 1100 nm, 15J/cm(2), 60 mW/cm(2)). Subjects were evaluated prior to the procedure, 1 month, and 3 months after the treatment by a blinded dermatologist using the global acne grading system (GAGS). Side effects were monitored through the treatment period. The mean GAGS score decreased from 22.1±3.8 at baseline to 19.4 at 1 month, and to 16.3 at 3 months after PDT (P<0.05). Ten of eleven patients experienced local side effects, such as erythema, which were of minimal to mild severity. However, most side effects were of minimal to mild severity, and all of them resolved within several days without post inflammatory hyper pigmentation. Our protocol was effective for acne in Japanese and did not exhibit severe side effects.

Treatment of port-wine stains with flash lamp pumped pulsed dye laser on Indian skin: a six year study.

Context:Port-wine stain (PWS) is one of the commonly encountered congenital cutaneous vascular lesions, with an equal sex distribution. Pulsed dye lasers (PDL) have revolutionized the treatment of both congential and acquired cutaneous vascular lesions. The pulsed dye lasers owing to its superior efficacy and safety profile have become the gold standard for the management of port-wine stains.Aims:To evaluate the efficacy and side effects of pulsed dye laser for the management of Port-wine stain on Indian skin.Materials and Methods:Seventy five patients of Fitzpatrick skin types IV&V with PWS underwent multiple treatments with PDL (V beam-Candela) over a period of six years at monthly intervals. Laser parameters were wavelength 595nm, spot sizes 7-10mm, fluence 6-12 j/cm2, pulse duration 0.45-10ms, along with cryogen cooling. Serial photographs were taken before and after every session. Clinical improvement scores of comparable photographs using a quartile grading (o=<20%, 1=21-40%, 2=41-60%, 3=61-80%, 4=>80%) were judged independently by two dermatologists after the series of treatment. Minimum number of treatments was 6 and maximum 17. They were followed up at six monthly intervals to observe re darkening of PWS.Results:No patient showed total clearance.Grade3 improvement was observed in 70 % of children and 50% of adults after 8-10 sessions. Children showed better and faster response than adults. Thirty percent of patients developed post inflammatory hyper pigmentation which resolved over a period of six to eight weeks. Two patients had superficial scarring due to stacking of pulses. None of the patients showed re darkening of PWS till now.Conclusion:Pulsed dye laser is an effective and safe treatment for port-wine stain in Indian skin.

Bath psoralen–UVA photochemotherapy for localized scleroderma: experience from a single institute

Localized scleroderma (LS) comprises a spectrum of sclerotic autoimmune diseases primarily affecting the dermis. Various treatment modalities have been recommended for the management of LS, but only a few studies exist regarding the efficacy of bath PUVA photochemotherapy in the treatment of LS. To evaluate the efficacy of bath PUVA photochemotherapy in the management of LS in a retrospective study. Twenty-eight patients (23 women and five men) with a diagnosis of LS, confirmed by histology, were included in the study. Patients were treated with a thrice-weekly regimen of bath immersion in 0.2 mg/1 water solution of 8-methoxypsoralen, followed by irradiation with UVA. Eleven patients (39%) showed complete remission (complete softening of the sclerotic plaques with or without postinflammatory hyper- or hypopigmentation) after a mean of 71 treatments (range 33-170) and a mean cumulative dose of 115 J/cm(2) (range 11-232). Partial softening and regression of the sclerotic plaques was observed in 14 patients (50%). Three patients (10.7%) showed no effect, and in none of the patients was worsening noted during treatment. In our experience, bath PUVA photochemotherapy is an effective and well-tolerated treatment option for LS and should be considered as one of the first-line treatment modalities.

Laser therapy for refractory discoid lupus erythematosus when everything else has failed

Background: Discoid lupus erythematosus (DLE) is restricted to the skin, mostly the face, often chronic and disfiguring. Standard medical therapies include topical corticosteroids and antimalarials. This is a retrospective long-term follow-up of refractory DLE treated with different lasers and intense pulsed light (IPL). Methods and materials: Sixteen patients with histologically confirmed DLE participated in this study. Two men and fourteen women, aged 28–69 years, mean age 54 years, were treated at the laser units of the Departments of Dermatology at the University Hospital of Örebro from 2001 and at Skåne University Hospital in Malmö, Sweden from 1999. Several therapies, including first- and second-line treatments and even cryotherapy, had been used without response. Many patients had marked scarring. Pulsed dye laser (PDL) and IPL were used with low fluencies. Results: Of 16 patients, 14 were improved regarding itching, erythema, scaling, scarring and pain. There was no scarring as a side effect of laser therapy or IPL. Two patients were not satisfied: one because of long healing time, and the other because of post inflammatory hyper pigmentation. Conclusion: IPL and PDL is a safe adjunctive therapy to conventional treatment of DLE. In the effort to prevent severe scarring and disfigurement it should be used as early as possible.

The Association Between Melasma and Postinflammatory Hyperpigmentation in Acne Patients

BackgroundAlthough, melasma is most prevalent among Asian young women, and also darkly pigmented individuals are particularly prone to developing post inflammatory hyperpigmentation, to the best of our knowledge, there are rare or no studies about the association of melasma and Post inflammatory hyperpigmentation.ObjectivesThe aim of this study was to investigate how likely is a melasma patient to developed post inflammatory hyperpigmentation when compared to patients with inflammatory acne lesions who do not have melasma.Patients and MethodsThis comparative study was conducted on 400 participants, 200 subjects involved with pigmented lesions of melasma and inflammatory acne lesions and200 involved only with inflammatory Acne lesions without melasma. Melasma, acne and post inflammatory hyper pigmentation, if existed, were assessed by a dermatologist, and pigmentation depth was assessed by wood's lamp. Multivariate logistic regression analysis suitable for study design was used to assess the association between melasma and post-acne pigmentation.ResultsWe found out that 24.1% of patients without melasma had post-acne pigmentation compared to 66.8% in melasma group (P < 0.001). The likelihood of observing post-acne pigmentation was found to be nearly six times more in melasma patients versus those without melasma. Association existed after controlling for possible confounders such as melanin score and time length of self-reported sun exposure, and acne severity score.ConclusionsMelasma appears to increase the likelihood of post-acne pigmentation.

The Evolution of Melasma Therapy: Targeting Melanosomes Using Low-Fluence Q-Switched Neodymium-Doped Yttrium Aluminium Garnet Lasers

Melasma is an acquired disorder of pigmentation that commonly affects women with phototypes III-V, and it has a negative impact on the quality of life in affected individuals. It presents clinically as symmetric tan or brown patches on the face, most often involving the forehead, cheeks, perioral region, and periorbital region. On histologic examination, there is increased melanin in the epidermis and/or an increased number of melanosomes in the dermis, with a normal number of highly melanized and dendritic melanocytes. The mainstay of treatment is the use of sunscreen along with topical medications that suppress melanogenesis. Clearance is usually incomplete and recurrences or exacerbations are frequent, probably because of the poor efficacy in clearing dermal melanosomes. Treatment with high-energy pigment-specific lasers, ablative resurfacing lasers, and fractional lasers results in an unacceptably high rate of postinflammatory hyper- and hypopigmentation and rebound melasma. Recently, promising results have been achieved with low-fluence Q-switched neodymium-doped yttrium aluminium garnet laser treatment, which can selectively target dermal melanosomes without producing inflammation or epidermal damage, in all skin phototypes. This article reviews the current treatment modalities for melasma, the rationale for using and the clinical results of combination therapy with low-fluence Q-switched neodymium-doped yttrium aluminium garnet lasers.

Contact dermatitis to para‐phenylenediamine in hair dye following sensitization to black henna tattoos – an ongoing problem

The increased frequency of case reports of allergic contact dermatitis from non-permanent black henna tattoos in recent years shows the popularity of this form of body painting. Seven patients presented with allergic contact dermatitis after initial hair or eyelash dyeing. They all had a history of a previous reaction from a black henna tattoo. All were patch tested with the European standard patch test series and the standard supplemental series, as well as special series for dyes and hairdressers. All seven patients showed a positive reaction in patch testing with para-phenylenediamine (PPD) (0.3 % and/or 1.0 % in pet.). Five patients also had positive reactions to other dyes such as aminophenol, para-toluene diamine, disperse orange and yellow and four patients reacted to benzocaine. These were interpreted as cross-reactions. The time from sensitization by the black henna tattoo to the onset of allergic contact dermatitis after hair dyeing was an average of 6.2 years. The most common cause of allergic contact dermatitis after black henna tattoos is PPD. Both the long skin contact and the high concentrations of PPD increase the risk of sensitization. Allergic contact dermatitis may be followed by post-inflammatory hyper- or hypopigmentation, scarring and lifelong sensitization, which can have occupational impact, especially for hair dressers and cosmeticians.

Treatment of Melasma Using a Novel 1,927-nm Fractional Thulium Fiber Laser: A Pilot Study

A 1,927-nm wavelength was recently added to the 1,550-nm erbium-doped fiber laser. This wavelength possesses a higher absorption coefficient for water than the 1,550-nm, conferring greater ability to target epidermal processes such as dyschromia. To evaluate the efficacy and safety of a novel 1,927-nm fractional thulium fiber laser in the treatment of melasma. Fourteen patients underwent three to four laser treatments (at 4-week intervals) at pulse energies of 10 to 20 mJ and total densities of 252 to 784 microscopic treatment zones per cm(2) (6-8 passes) using a 1,927-nm thulium fiber laser. Three blinded assessors and the patients evaluated clinical improvement of treatment areas at 1-, 3-, and 6-month follow-ups. Side effects were assessed, and pain was scored using a visual analog scale (0-10). A statistically significant 51% reduction in MASI score was observed at 1-month post 3 to 4 laser treatments. A 33% (p = .06) and 34% (p = .07) reduction in Melasma Area and Severity Index score was observed at the 3- and 6-month follow-up visits, respectively. Skin responses observed after treatment were moderate erythema and mild edema. No scarring or postinflammatory hyper- or hypopigmentation was observed. The 1,927-nm fractional thulium fiber laser is a safe, effective treatment for melasma.

Fractionated Carbon Dioxide Laser Treatment of Photoaging: Prospective Study in 45 Patients and Review of the Literature

Ablative fractional photothermolysis (AFP) has been reported to be effective for photoaging. To perform a clinical trial in 45 patients with moderate to severe skin photoaging to quantify improvement with AFP. A prospective, single-blind study in 45 patients who presented for desired treatment of photoaging. Patients received a series of two to three treatments with AFP. Thirty-nine women (86.7%) and six men (13.3%) were enrolled. Patients received two or three treatment sessions (mean 2.4). There were no incidence of adverse events of scarring, prolonged erythema (lasting more than 7 days), postinflammatory hyper- or hypopigmentation, or infection in the 108 treatment sessions given during this study. Mean improvement was 48.5% (95% confidence interval (CI)=44.6-52.4%) for skin texture, 50.3% (95% CI=46.1-54.5%) for skin laxity, 53.9% (95% CI=49.5-58.5%) for dyschromia, and 52.4% (95% CI=47.9-56.9%) for overall cosmetic outcome (all p<.05). Significant improvement in photoaging of the face can be achieved using an AFP device with skin types I to III after a series of two to three treatments.

1,927-nm Fractional Thulium Fiber Laser for the Treatment of Nonfacial Photodamage: A Pilot Study

A 1,927-nm wavelength was recently added to the 1,550-nm erbium-doped fiber laser. This wavelength possesses a higher absorption coefficient for water than the 1,550-nm, conferring greater ability to target epidermal processes. To evaluate the efficacy and safety of a novel 1,927-nm fractional thulium fiber laser in the treatment of nonfacial photodamage. Nine participants with nonfacial photodamage underwent three laser treatments (at 3- to 4-week intervals) at pulse energies of 10 to 20 mJ and 30% to 55% surface area coverage (4-8 passes) with a 1,927-nm thulium fiber laser. A blinded assessor and participants evaluated clinical improvement of treatment areas at 1-month follow-up using a quartile grading scale (0-4). Nine participants with a total of 12 treatment areas completed three treatments and the 1-month follow-up visit. At follow-up, a blinded assessor rated mean improvement in photodamage as 3.25 ± 1.0 and lentigines as 3.33 ± 0.9 on a scale of 0 to 4 (0=none, 1=1-25%, 2=26-50%, 3=51-75%, and 4=76-100% improvement). Skin responses observed after treatment were moderate erythema, mild edema, itching, and desquamation. No scarring or postinflammatory hyper- or hypopigmentation was observed. The 1,927-nm fractional thulium fiber laser is a safe, effective treatment for nonfacial photodamage. Dr. Polder is a principal investigator and Dr. Suzanne Bruce is a consultant for Solta Medical.

Dermatitis cruris pustulosa et atrophicans

Dermatitis cruris pustulosa et atrophicans (DCPA) is a distinctive type of chronic superficial folliculitis, primarily affecting the lower limbs. It is characterized by symmetrical follicular pustules of both legs, with cutaneous edema, resulting in alopecia, atrophy and scarring. It was first described by Clarke, from West Nigeria, in 1952 and well illustrated in his book "Skin diseases in the African," under the initial label of "Nigerian shin disease." Subsequently, it was described in India as well, in 1964, and continues to be a problem in dermatology clinics across the country. It is predominantly a disease of men and has a high prevalence in some geographical regions; up to 3-4% in Madras, South India. Some unique features that distinguish DCPA from banal pustular folliculitis include its peculiar localization to the legs, extreme chronicity, resistance to therapy and inevitable alopecia and atrophy of the involved skin, with little postinflammatory hyper- or hypopigmentation. Further, even in the presence of extensive lesions, there are no systemic features. Coagulase-positive Staphylococcus aureus is known to have a role in the etiology of DCPA, but the exact etiopathogenesis still needs to be elucidated. Immunological postulates such as hypergammaglobulinemia have been put forward to explain the chronicity of the condition. A number of therapeutic agents have been tried in various studies, including cotrimoxazole, psoralen with ultraviolet A (PUVA) therapy, ciprofloxacin, pentoxifylline, rifampicin, dapsone, minocycline and mupirocin (topical) with variable success rates. Although a well-recognized entity in dermatology clinics in tropical countries, DCPA has received little attention in the dermatological literature and has only a few studies to its credit. Its unique clinical picture, unclear etiopathogenesis and resistance to therapy afford a vast scope for further investigation and study.

Minimally Ablative Erbium:YAG Laser Resurfacing of Facial Atrophic Acne Scars in Asian Skin: A Pilot Study

Atrophic scars are dermal depressions caused by collagen damage most commonly occurring after inflammatory acne vulgaris. There are little published data regarding the effectiveness and safety of minimally invasive lasers in the treatment of atrophic acne scars in darker skin types. The purpose was to evaluate the efficacy and safety of a low-fluence 2,940-nm erbium:YAG laser in the treatment of atrophic acne scars in Asian patients. Nine patients aged 19 to 45 years with mild to moderate atrophic facial scars and Skin Types IV and V were treated with topical anesthesia and one to two passes with an erbium:YAG laser two times at 1-month intervals. Treatment parameters were 6-mm spot size, fluence of 400 mJ, pulse duration of 300 micros, and repetition rate of 2 Hz. At 2 months after the last treatment, mild to moderate clinical improvement was noted in all patients compared to baseline. Treatment was well tolerated. Side effects consisted of posttreatment erythema, peeling, and crusting, which resolved within 1 to 2 weeks. There was no postinflammatory hyper- or hypopigmentation, blistering, or hypertrophic scarring. Low-fluence erbium:YAG facial resurfacing was effective and safe in patients with mild to moderately severe atrophic acne scarring.