595nm Pulsed Dye Laser: An Alternative to Treat Basal Cell Carcinomas

INTRODUCTION: Basal cell carcinoma (BCC) is the most common cutaneous malignancy. Proffered treatment for these lesions is surgery. Based on patient’s age, drug allergies, and place of lesions, surgery may not be the best option, and alternative treatments should be considered. Pulsed dye laser (PDL) may be a good alternative therapy. The aim of the present study was to determine the effectiveness and safety of this laser in the treatment of BCCs in Iranian patients.METHODS: Patients with definite diagnosis of BCC enrolled in the study. For each patient, one lesion proved to be superficial, or nodular BCC via histopathology was treated with PDL for four sessions and after the last session, re-biopsy was done to determine any remnant of tumor. All patients were followed for 6 to 13 months to capture any recurrence of as soon as possible.RESULTS: A total of 12 patients including eight male and four female were selected. All patients completed the study in accordance to the treatment protocol. All patients cleared clinically resulting flat hypo pigmented scar, but in pathology, two patients showed remnants of tumor and were referred for surgery. No side effects, but mild erythema and irritation were noted in all patients. No recurrences were found during the follow up period.CONCLUSION: It seems that PDL may be an effective alternative therapy for some subtypes of BCCs with acceptable safety profile. Further studies with larger sample sizes are required to support this opinion

Solar Lentigines: Evaluating Pulsed Dye Laser (PDL) as an Effective Treatment Option

INTRODUCTION: Solar lentigines are among commonest cosmetic problems. There are many topical therapies suggested to treat these lesions including cryotherapy, chemical peeling with tri chloro acetic acid (TCA) and laser therapy with q-switched lasers as well as long pulsed lasers. Considering possible treatment side effects (PIH, scar) with cryotherapy and peeling in Iranian patients (darker skin types) it seems necessary to try to find alternative measures. The aim of the present study was to evaluate effect of long pulsed dye laser (LPDL) on lentigines via an objective method (computerized dermoscopy).METHODS: Patients with pathologically confirmed lentigines were selected if they agreed to participate in the study,were not treated before, hadn’t history of psoriasis, vitiligo, scar formation and were not pregnant. Letigines were dermoscopied before and after treatment with PDL (V-beam, 595nm, Candela Corp. Wayland, USA) using fluence of 10 joules, without DCD (dynamic cooling device) via extra compress lens provided with laser system. The resulting figures were compared by two academic unrelated dermatologists as well as by computerized analysis. Post laser side effects were treated with topical antibiotics and mild topical steroids. Patients were followed for six months after the end of the study to determine the rate of recurrence via dermoscopy of sites of previous lesions and also delayed side effects.RESULTS: A total of 21 patients with the same number of lesions, were included in the study. Mean age of patients was 54.2 years (±23.3) ranging from 39 to 71 years. Included patients were 18 females and three males. From 21 treated lesions, 11 were located on the hands and 10 on the face. Comparing before and after photographs taken through dermoscopy system, revealed that approximately 57% of patients had more than 75% improvement. Mean pigment analysis score (calculated by computerized dermoscope software) was respectively 8 and 2 before and after PDL therapy, showing noticeable decrease in pigment density of lesions. Side effects were mild erythema and local irritation responding to topical mild steroids. No hypo or persistent hyper pigmentation or other delayed side effects was seen after six months follow up. One patient experienced transient hyper pigmentation of treatment site after treatment. During six months follow up, no recurrences were seen.CONCLUSION: In conclusion, PDL is a safe and effective option to treat lentigines if applied properly using compression method, especially in Iranian patients. However, further studies with larger sample size are required to confirm these results

Comparing Pulsed-dye Laser with Cryotherapy in the Treatment of Common Warts

INTRODUCTION: No modality has been identified as the treatment of chice for treating common warts. Cryothearpy and pulsed-dye laser (PDL) are among common modalities for treating these lesions. The aim of this study was to compare pulsed dye laser with cryotherapy in terms of efficacy and complications.METHODS: Of a total of 46 patients enrolled in this study, 7 patients withdrew the study, 20 patients underwent cryotherapy and 19 patients underwent PDL. Patients underwent a maximum of 4 therapeutic sessions at 3-week intervals in both groups. They were assessed for the remission rate (complete and partial),side effects and recurrence rate in each session and 1 month after termination of the treatments.RESULTS: At the end of the study complete remission was achieved in 37.8% of patients in cryotherapy group and in 52.3% of patients in PDL group. This difference wasn’t statistically significant (P=0.229), though after first and second sessions of treatment complete and excellent partial remission occurred more in PDL group with significant difference (P=0.007 and P=0.021). Pain and bulla formation occurred statistically higher in cryotherapy group (P=0.002 and P=0.001). Other complications were rare in both groups.CONCLUSION: In terms of efficacy, we couldn’t demonstrate the superiority of pulseddye laser therapy to cryotherapy in treating common warts. Both methods were safe for long-term complications but PDL was much safer for short-term complications

Refractory Port Wine Stains (PWS): Long Pulsed Alexandrite Laser as an Option

INTRODUCTION: Port wine stains (PWS) are congenital vascular malformations. Pulsed dye laser (PDL) is the treatment of choice till now, although many lesions do not respond completely. One of possible options is long pulsed alexandrite laser. Some literatures confirmed its efficacy. The aim of the present study is to determine the efficacy of this laser as an option in treating refractory PWS in Iranian patients.METHODS: Patients with refractory PWS lesions that did not respond to at least six PDL sessions were included if they had no history of Isotretinoin consumption in past year, history of keloid or hypertrophic scar formation, active infection in laser site and if they were not pregnant. All patients signed an informed consent. Alexandrite laser with fluencies from 36-40J/Cm2, 12 mm spot size, 3 ms pulse duration and dynamic cooling device tuned to 50/50 ms was used in three successive sessions to treat lesions. All patients photographed before each session and after 8 weeks from the last sessions. Then, pictures were rated by two blinded dermatologist rater to determine degree of response based of visual analog scaling from score 1(below 25% response) to score 4 (more than 75% response).RESULTS: A total of 20 patients comprised of 12 males and 8 females with mean age of 23 years were included. 35% (7 patients) had score of 1, 35% (7 patients) had score of 2, 25% (5 patients) had score of 3 while one patient (5%) reached score 4. No serious side effect was observed. There was no significant relationship with age, gender and size of lesions and response rate.CONCLUSION: It seems that considering a conservative approach, long pulsed alexandrite laser may be an effective option in treating refractory PWS lesions. Although future studies with higher sample size using higher fluences are required to confirm these results

Effect of Laser-Assisted Hair Removal (LAHR) on the Quality of Life and Depression in Hirsute Females: A Single-Arm Clinical Trial

Introduction: Hirsutism, mainly due to poly cystic ovary syndrome (PCOS), causes stress, anxiety and depression in females. LAHR is currently accepted as a good treatment option for hirsutism. The goal of the current study was to ascertain how LAHR affected the degree of hirsutism, quality of life, and depression in hirsute females. Methods: A single arm before/after clinical trial was designed and performed in the Razi Hospital Laser Clinic over a 15-months period. All hirsute females visiting Razi hospital laser clinic, were enrolled and received three sessions of LAHR every 4-6 weeks if they were interested and signed an informed consent. Before the commencement of LAHR and six to eight weeks after the last session, the Ferriman-Gallwey score (hirsutism severity), Beck score (depression index) and DLQI score (quality of life index) were calculated and stored. Results: There were 80 subjects in all. The mean± (SD) of the Ferriman-Gallwey score was reduced from 7.05 ± 2.27 to 4.91 ± 2.41, p<0.001. Beck depression score’s mean± (SD) was reduced from 13.3 ± 8.7 to 10.2 ± 8.4, p<0.001 and mean± (SD) of DLQI score was decreased from 5.6 ± 5.2 to 3.5 ± 2.3, p<0.001. No significant complication were reported. Conclusion:   LAHR can improve hirsutism related depression and degradation of quality of life as well as hirsutism physical signs

BMI1 and TWIST1 Downregulated mRNA Expression in Basal Cell Carcinoma

Background: BMI1, TWIST1 and SNAI2/SLUG have been implicated in aggressive behavior of squamous cell carcinoma (SCC) and melanoma and BMI1 expression could identify subtypes of Merkel cell carcinoma (MCC). However, BMI1, TWIST1 and SNAI2 expression levels in basal cell carcinomas (BCCs) have not been elucidated. We hypothesized BCC could be a good model system to decipher mechanisms which inhibit processes that drive tumor metastasis. The aim of this study was to examine the mRNA expression level of BMI1, TWIST1, and SNAI2 in BCCs. Materials and Methods: Thirty-five fresh non-metastatic BCC tissue samples and seven fresh normal skin tissue samples were evaluated by real-time RT-PCR. Results: BMI1 and TWIST1 demonstrated marked down-regulation (p< 0.00l, p= 0.00l respectively), but SNAI2 showed no significant change (p=0.12). Conclusions: Previous literature has clearly demonstrated a positive association between BMI1 and TWIST1 expression and metastatic BCC, aggressive SCC and melanoma. Here, we demonstrated a negative association between BMI1 and TWIST1 mRNA expression level and BCC

The Role of Ultrasound in Diagnosis of the Causes of Low Back Pain: a Review of the Literature

Context: Low back pain (LBP) is among the most prevalent musculoskeletal conditions in the developed countries. It is a common problem causing disability and imposing a huge economic burden to individuals and state organizations. Imaging plays an important role in diagnosis of the etiology of LBP. Evidence Acquisition: The electronic databases included: PubMed (1950 to present), Ovid SP Medline (1950 to present) and ISI (1982 to present) and Google Scholar. In every search engine another search was performed using various permutations of the following keywords: ultrasonography, ultrasound imaging, low back pain, back muscles, paraspinal muscles, multifidus, transverse abdominis, muscle size, spinal canal, sacroiliac joint and spondylolisthesis. Results: Magnetic resonance imaging (MRI) is widely used in evaluation of patients with LBP; however, high costs, limited availability and contraindications for its use have restricted MRI utilization. In a quest for a less expensive and readily available tool to investigate LBP, clinicians and researchers found ultrasonography (US) as an alternative. In this review we discuss the US application in diagnosis of some common causes of non-specific chronic LBP. Discussed topics include evaluation of spinal canal diameter, paraspinal and transabdominal muscles, sacroiliac joint laxity, pregnancy related LBP, sacroiliitis, and spondylolisthesis using US in patients with LBP. Conclusions: While the first researches on employing ultrasound in diagnosis of patients with LBP had been focused on spinal canal diameter, recent studies have been mostly performed to evaluate the role of transabdominal and paraspinal muscles on core stability and thereby LBP occurrence. On the other side, Doppler ultrasonography has recently played an important role in objective measurement of joint laxity as a common etiology for LBP. Doppler imaging also in pregnant patients with LBP has been recommended as a safe and sensitive method. As conclusion, according to recent and most prestigious studies, focusing more on transabdominal muscle thickness can be considered as future approach in investigations

Rituximab administration in a patient with pemphigus vulgaris following reactivation of occult hepatitis B virus infection

Immunosuppressive drugs are the milestone of treatment of autoimmune diseases, but they can lead to serious complications, including hepatitis B virus reactivation in HBV carriers as well as in patients with occult HBV infection (OBI). A 36-year-old man with OBI was diagnosed with pemphigus vulgaris. He was prescribed prednisolone and his hepatitis B surface antigen turned positive. Viral replication was successfully controlled by lamivudine and adefovir. Mycophenolate mofetil and intravenous immunoglobulin  were not effective in controlling the pemphigus vulgaris. The patient received rituximab 500 mg weekly for four weeks and went into remission without any adverse effect. He safely received another course of rituximab after a relapse one year later. In conclusion, testing for hepatitis B core antibody should be considered mandatory, in addition to HBsAg, for the screening of pemphigus patients to detect rare cases of OBI before starting therapy. Furthermore, rituximab may in some cases be safely used in HBV carriers using antivirals concomitantly

Rituximab administration in a patient with pemphigus vulgaris following reactivation of occult hepatitis B virus infection

Immunosuppressive drugs are the milestone of treatment of autoimmune diseases, but they can lead to serious complications, including hepatitis B virus reactivation in HBV carriers as well as in patients with occult HBV infection (OBI). A 36-year-old man with OBI was diagnosed with pemphigus vulgaris. He was prescribed prednisolone and his hepatitis B surface antigen turned positive. Viral replication was successfully controlled by lamivudine and adefovir. Mycophenolate mofetil and intravenous immunoglobulin  were not effective in controlling the pemphigus vulgaris. The patient received rituximab 500 mg weekly for four weeks and went into remission without any adverse effect. He safely received another course of rituximab after a relapse one year later. In conclusion, testing for hepatitis B core antibody should be considered mandatory, in addition to HBsAg, for the screening of pemphigus patients to detect rare cases of OBI before starting therapy. Furthermore, rituximab may in some cases be safely used in HBV carriers using antivirals concomitantly