Laser therapy in superficial morphea lesions – indications, limitations and therapeutic alternatives

Morphea or localized scleroderma is an uncommon autoimmune and inflammatory disease which affects patients of any age. Even if morphea lesions present systemic symptoms as myalgias or arthritis, it is distinct from systemic sclerosis because it does not associate Raynaud’s phenomena or sclerodactyly, which are encountered in systemic scleroderma. The most common form of morphea in children is `en coup de sabre`, which can alter the local anatomy by deep tissue involvement. In contrast, the most frequent form that affects adults is represented by circumscribed morphea. The initial lesions present an inflammatory phase that manifests in the form of erythematous plaques, sometimes accompanied by edema. In later stages, the inflammation decreases and the lesions become sclerotic to atrophic. Therapy is most beneficial when initiated in the inflammatory stage. Topical application of high potency steroids along with phototherapy demonstrates the best results in the active phase of the disease. Localized superficial morphea can be treated with the excimer laser (using ultraviolet type B light, in range of 308nm) if topical steroid administration shows no significant clinical improvement. Phototherapy with ultraviolet light is capable of decreasing inflammation and may also have immunomodulatory effects

Psychosocial Implications of Patients with Tracheostomy - a Suggestive Example of Interdisciplinarity

Performed urgently or out of necessity, tracheostomy is one of the most traumatic surgeries that seriously affects the patient's quality of life. It has a profound impact on the ability to communicate and on self-esteem, so that the patient can experience a storm of emotions and major changes that can affect their existence.The patient with tracheostomy is a special patient with special needs. The care of such a patient involves a constant multidisciplinary effort supported by specialists in many fields: ENT specialists, oncologists, radiotherapists, anesthetists, neurosurgeons, general surgeons, physiotherapists, speech therapists, nutritionists especially psychotherapists. Tracheostomy affects the basic needs of the individual: communication, nutrition, sexuality, social relationships.Numerous studies show that patients with tracheostomy show a high level of psychological distress. Depression, anxiety, low self-esteem, frustration, alienation, isolation, tendency to suicide are the negative consequences of this mutilating surgery.Perceived as a permanent disability, tracheostomy requires special care from a psychological point of view.Sometimes, however, it is observed that both patients and their families are not sufficiently informed about the management of tracheostomy. Due to lack of means or staff, not enough emphasis is placed on preoperative training so that the patient fully understands both the benefits  and the disadvantages of this surgical technique. Therefore, often the patient's family, which later assumes the role of caregivers of the tracheotomized, perceives it as a burden, excessive fatigue, helplessness,  abandonment from society.This paper aims to highlight the importance of pre- and postoperative psychological training of both the patient and his family and to demonstrate that tracheostomy care can be one of the most suggestive examples of interdisciplinarity that seeks to provide effective solutions in this regard.</p

Laser therapy in superficial morphea lesions – indications, limitations and therapeutic alternatives

Morphea or localized scleroderma is an uncommon autoimmune and inflammatory disease which affects patients of any age. Even if morphea lesions present systemic symptoms as myalgias or arthritis, it is distinct from systemic sclerosis because it does not associate Raynaud’s phenomena or sclerodactyly, which are encountered in systemic scleroderma. The most common form of morphea in children is `en coup de sabre`, which can alter the local anatomy by deep tissue involvement. In contrast, the most frequent form that affects adults is represented by circumscribed morphea. The initial lesions present an inflammatory phase that manifests in the form of erythematous plaques, sometimes accompanied by edema. In later stages, the inflammation decreases and the lesions become sclerotic to atrophic. Therapy is most beneficial when initiated in the inflammatory stage. Topical application of high potency steroids along with phototherapy demonstrates the best results in the active phase of the disease. Localized superficial morphea can be treated with the excimer laser (using ultraviolet type B light, in range of 308nm) if topical steroid administration shows no significant clinical improvement. Phototherapy with ultraviolet light is capable of decreasing inflammation and may also have immunomodulatory effects

Immunologic and nonimmunologic sclerodermal skin conditions - review

Scleroderma-like cutaneous lesions have been found in many pathological conditions and they have the clinical appearance of sclerotic or scleroatrophic lesions. Affected skin biopsies described histopathological changes similar to those of scleroderma located strictly on the skin or those of systemic sclerosis. These skin lesions can be found in inflammatory diseases with autoimmune substrate (generalized morphea, chronic graft versus host disease, eosinophilic fasciitis), tissue storage diseases (scleredema, scleromyxedema, nephrogenyc systemic fibrosis, systemic amyloidosis), metabolic diseases (porphyrya cutanea tarda, phenylketonuria, hypothyroidism, scleredema diabeticorum), progeroid syndromes. Given the multiple etiologies of sclerodermal lesions, a correct differential diagnosis is necessary to establish the appropriate treatment

The use of NDYAG laser combined with pulsed light in the treatment of rosacea

Rosacea is a chronic inflammatory skin disease with a complex pathogenesis that mainly affects the central part of the face, with a global incidence of 5.46%. The present study was performed on a group of 68 patients with rosacea 1 and 2 subtypes, patients between 34-63 years old. The treatments were performed using a Cutera Xeo laser, using 2 types of probes: NdYag 1064nm for telangiectasias and LimeLight 520-1100nm for diffuse facial erythema, papules, and pustules, having an 10x30mm window. For patients with diffuse facial erythema, etc., the optimal number of sessions was between 3 and 6 with or without anesthetic cream, using energies between 14-19J / cm. The average recovery time was 5 days. Registered effects included bruises, pustules, burning sensation, transient stinging, and hypopigmentation. For patients with telangiectasia, the optimal number of sessions was two, performed at an average interval of once per month/ monthly

The use of a topical compound cream product with Chitosan, Silver Sulfadiazine Bentonite hidrogel and Lactic acid for the treatment of a patient with Rosacea and ulcerated Livedoid Vasculopathy

Introduction: The aims of this study were to investigate the use of a topical compound cream product with Chitosan, Silver Sulfadiazine, Bentonite hidrogel and Lactic acid for the treatment of a patient with Rosacea and prolonged ulcerated Livedo Vasculitis. Methods: A patient with ulcerated Livedo Vasculitis applied the cream 22 months daily and was examined clinically. Results: At five months the area of the right foot ulcer decreased to a diameter of 18 mm. The pain disappeared (anamnestically) in 7 days around the ulcerated areas reticulated atrophic hipopigmented areas were seen-atrophie blanche and there ware still 4 small ulcerations. I noted also the disappearance of the livedoid area from the middle of the second toe finger. The left foot ulcer was epithelised. Wound cultures were negative. After another five months of continues use of the topical cream the situation improves, diameter of the ulcer decreased at 13 mm, the small ulcerations disappeared but continues to stay on the right foot. After another year the situation is stable at the right foot but the left ulcer was partially recurrent and it was painful. Conclusions: The topical compound formula with four active ingredients: Silver sulfadiazine, bentonite hidrogel, chitosan and lactic acid it was a cheap treatment for the patient, it was tolerated without sensitizing even it was used continuously for 22 months