State-of-the-art lasers and light treatments for vascular lesions: from red faces to vascular malformations.

Notable milestones in the treatment of vascular lesions have been achieved over the past century. Many cutaneous vascular lesions can be successfully treated with lightbased devices. In this review, we will discuss the treatment of port-wine birthmarks, lymphatic malformations, infantile hemangiomas, rosacea, venous lakes, pyogenic granulomas, cherry angiomas, and angiofibromas using lasers, total reflection amplification of spontaneous emission of radiation, intense pulsed light, and photodynamic therapy. In addition, for several of these diagnoses, we will review medical therapies that can be combined with light-based devices to provide enhanced results

State-of-the-art lasers and light treatments for vascular lesions: from red faces to vascular malformations.

Notable milestones in the treatment of vascular lesions have been achieved over the past century. Many cutaneous vascular lesions can be successfully treated with lightbased devices. In this review, we will discuss the treatment of port-wine birthmarks, lymphatic malformations, infantile hemangiomas, rosacea, venous lakes, pyogenic granulomas, cherry angiomas, and angiofibromas using lasers, total reflection amplification of spontaneous emission of radiation, intense pulsed light, and photodynamic therapy. In addition, for several of these diagnoses, we will review medical therapies that can be combined with light-based devices to provide enhanced results

Simultaneous Blood Flow Measurement and Dermoscopy of Skin Lesions Using Dual-Mode Dermascope.

Dermascopes are commonly utilized for the qualitative visual inspection of skin lesions. While automated image processing techniques and varied illumination strategies have been used to aid in structural analysis of lesions, robust quantification of functional information is largely unknown. To address this knowledge gap, we have developed a compact, handheld dermascope that enables real-time blood flow measurements of skin during conventional visual inspection. In-vitro characterization demonstrated that the dermascope is capable of quantifying changes in flow across a physiologically relevant range even when used in a handheld manner with clinic lighting and dermascope LEDs on. In a small pilot clinical study, we demonstrated the dermascope's ability to detect flow differences between two distinct lesion types

Treatment-resistant prurigo nodularis: challenges and solutions

Eric H Kowalski,1 Diana Kneiber,1 Manuel Valdebran,2 Umangi Patel,1 Kyle T Amber1 1Department of Dermatology, University of Illinois at Chicago, Chicago, IL, USA; 2Department of Dermatology, University of California, Irvine, Irvine, CA, USA Abstract: Prurigo nodualris (PN) is a chronic condition with highly pruritic, hyperkeratotic papules or nodules arising in the setting of chronic pruritus. While PN may serve as a phenotypic presentation of several underlying conditions such as atopic dermatitis, chronic kidney disease-related pruritus, and neurological diseases, it represents a distinct clinical entity that may persist despite the removal of the underlying cause, if one is identified. Neuronal proliferation, eosinophils, mast cells, and small-fiber neuropathy play a role in the production of pruritus in PN, although the exact mechanism has not yet been established. Identifying an underlying cause, if present, is essential to prevent recurrence of PN. Due to often present comorbidities, treatment is typically multimodal with utilization of topical and systemic therapies. We performed a PubMed/MEDLINE search for PN and present a review of recent developments in the treatment of PN. Treatment typically relies on the use of topical or intralesional steroids, though more severe or recalcitrant cases often necessitate the use of phototherapy or systemic immunosuppressives. Thalidomide and lenalidomide can both be used in severe cases; however, their toxicity profile makes them less favorable. Opioid receptor antagonists and neurokinin-1 receptor antagonists represent two novel families of therapeutic agents which may effectively treat PN with a lower toxicity profile than thalidomide or lenalidomide. Keywords: pruritus, chronic prurigo, neurokinin 1, thalidomide, atopic dermatiti

Simultaneous Blood Flow Measurement and Dermoscopy of Skin Lesions Using Dual-Mode Dermascope.

Dermascopes are commonly utilized for the qualitative visual inspection of skin lesions. While automated image processing techniques and varied illumination strategies have been used to aid in structural analysis of lesions, robust quantification of functional information is largely unknown. To address this knowledge gap, we have developed a compact, handheld dermascope that enables real-time blood flow measurements of skin during conventional visual inspection. In-vitro characterization demonstrated that the dermascope is capable of quantifying changes in flow across a physiologically relevant range even when used in a handheld manner with clinic lighting and dermascope LEDs on. In a small pilot clinical study, we demonstrated the dermascope's ability to detect flow differences between two distinct lesion types

Distinguishing truly recalcitrant prurigo nodularis from poor treatment adherence: a response to treatment-resistant prurigo nodularis [Response to letter]

Eric H Kowalski,1 Diana Kneiber,1 Manuel Valdebran,2 Umangi Patel,1 Kyle T Amber11Department of Dermatology, University of Illinois at Chicago, Chicago, IL, USA; 2Department of Dermatology, University of California-Irvine, Irvine, CA, USAKolli et al shed light on a pertinent issue of poor adherence to therapy in the treatment of prurigo nodularis (PN).1 While our intention was to cover recalcitrance in the sense of medical failure, Kolli et al bring up an extremely valuable point: adherence to therapy is dismal.2 Escalation of therapy as a result of poor compliance may result in unintended adverse effects from the more potent systemic therapies delineated in the treatment of PN. Thus, ensuring compliance with the treatment protocol should be a priority.In our view, PN is most often a phenotypic manifestation of chronic pruritus secondary to a host of diseases. Presumably, the relative adherence to treatment for the underlying cause of the PN, in cases where there is one, has a large role to play in the recalcitrance of the PN. This is perhaps most glaring in the case of atopic dermatitis (AD). AD has been identified to contribute to PN development in nearly 50% of PN patients.3 Assessment of nonadherence, as well as steroid phobia has been well documented in the AD population and almost certainly contributes to the development of clinically deemed recalcitrant PN in this population.4,5 Because of the well-established efficacy of topical corticosteroids in the treatment of atopic dermatitis, it is likely that atopic PN would prove more responsive. Thus, “treatment resistant” atopic PN, requires serious con- sideration of nonadherence. Clinical data on nonadherence in nonatopic PN patients, however, remains undetermined.Regardless of the primary underlying cause, patients receiving supervised phototherapy in the outpatient setting offer insight into truly recalcitrant PN due to complete adherence. A recent review on phototherapy in treatment of PN showed that in 5 out of 11 studies, patients experienced recalcitrant disease.6 Thus, even in a supervised setting where adherence could be monitored, numerous cases were recalcitrant.Innovation in adherence strategies across a wide spectrum of therapies ideally will result in fewer “treatment-resistant” cases.7–9 We agree with Kolli et al, that it remains vital to distinguish between poor adherence and medical failure.This is in response to the Letter to the Edito

Blood flow quantification of biopsied skin lesions using a laser speckle imaging dermatoscope (Conference Presentation)

Dermatoscopes are commonly utilized by medical professionals for the qualitative visual inspection of skin lesions. While automated image processing techniques and varied illumination strategies can aid in structural analysis of lesions, robust quantification of functional information is largely unknown. To address this knowledge gap, we have developed a compact, handheld dermatoscope that enables real-time blood flow measurements of skin using coherent illumination and laser speckle imaging (LSI). A second color camera attached to the dermatoscope helps with the simultaneous real-time observation of the skin lesions and allows the user to acquire and save color images via a custom Graphical User Interface. In-vitro characterization utilizing a blood flow phantom demonstrated that the dermatoscope is capable of quantifying changes in blood flow across a physiologically relevant range even when used in a handheld manner with ambient lighting. We also demonstrated that the dermatoscope can quantify blood flow in skin lesions in human subjects and that significant differences in blood flow are present among lesion types. There was significantly increased blood flow relative to the surrounding skin in cherry angiomas compared to solar lentigos (p<0.05), which was expected based on the vascular and pigment compositions of the two lesion types. Furthermore, we have compared blood flow maps collected from potentially cancerous lesions prior to histological analysis to determine whether blood flow measurements can help in the diagnosis of benign and malignant skin lesions. Information provided by the LSI dermatoscope may help with earlier and more accurate diagnoses of pigmented skin lesions

Blood flow quantification of biopsied skin lesions using a laser speckle imaging dermatoscope (Conference Presentation)

Dermatoscopes are commonly utilized by medical professionals for the qualitative visual inspection of skin lesions. While automated image processing techniques and varied illumination strategies can aid in structural analysis of lesions, robust quantification of functional information is largely unknown. To address this knowledge gap, we have developed a compact, handheld dermatoscope that enables real-time blood flow measurements of skin using coherent illumination and laser speckle imaging (LSI). A second color camera attached to the dermatoscope helps with the simultaneous real-time observation of the skin lesions and allows the user to acquire and save color images via a custom Graphical User Interface. In-vitro characterization utilizing a blood flow phantom demonstrated that the dermatoscope is capable of quantifying changes in blood flow across a physiologically relevant range even when used in a handheld manner with ambient lighting. We also demonstrated that the dermatoscope can quantify blood flow in skin lesions in human subjects and that significant differences in blood flow are present among lesion types. There was significantly increased blood flow relative to the surrounding skin in cherry angiomas compared to solar lentigos (p<0.05), which was expected based on the vascular and pigment compositions of the two lesion types. Furthermore, we have compared blood flow maps collected from potentially cancerous lesions prior to histological analysis to determine whether blood flow measurements can help in the diagnosis of benign and malignant skin lesions. Information provided by the LSI dermatoscope may help with earlier and more accurate diagnoses of pigmented skin lesions