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To evaluate the use of a pinpoint irradiation technique followed by nonablative fractional technique in treatment of traumatic scars. Thirteen patients with traumatic sacrs were treated with pinpoint technique of CO2 laser using traditional headpiece activating laser at a frequency (50 Hz) to deliver pulsed mode with power of 1 W using the focusing technique followed by 3-5 passes of the nonablative 1540 nm fractional Er:glass laser. An independent physician evaluator assessed the treatment outcomes using Vancouver scar scale (VSS) and 5-point grading scale (grade 0, no improvement; grade 1, 1-25%; grade 2, 26-50%; grade 3, 51-75%; grade 4, 76-100% improvement). After the final treatment, average percentage changes of VSS were 41.5%. Improvement was evident in terms of vascularity, pigmentation, and height, while insignificant in terms of Pliability. Based on physician's global assessment, mean grade of 2.5 was achieved. Patient's subjective satisfaction scores paralleled the physician's objective evaluation. Pinpoint irradiation technique by CO2 laser followed by nonablative fractional laser is a safe and effective modality in treatment of scars.

BACKGROUND Nonmelanoma skin cancers (NMSCs) constitute the largest proportion of cancers worldwide, especially in the Western population, making it essential to develop methods to manage these cancers. Ultraviolet (UV) light being the most significant culprit in the development of NMSCs makes the sun-exposed parts of the body, such as face and extremities, the most vulnerable to develop these tumors. Early diagnosis and emphasis on cosmesis are vital while treating them especially, in patients with multiple squamous and basal cell carcinomas. Lasers seem to be a useful therapeutic modality and are being explored to develop them as a tool for treating skin cancers. OBJECTIVE To review the use of lasers in the treatment of NMSCs. METHODS We reviewed articles that involved the use of lasers in the management of NMSCs and prepared a critical analysis of the same. RESULTS AND CONCLUSIONS Lasers as a single modality, as the coherent light source in photodynamic therapy (PDT), or as an adjunct to PDT or other treatment modalities are a potential method of NMSC eradication. Superficial NMSCs and most precancerous cutaneous lesions such as Bowen's disease and actinic keratoses respond best, whereas deeper, more-aggressive NMSCs show poor outcomes with laser treatments.

Narrowband ultraviolet B phototherapy (NB-UVB) is a widely used modality in the treatment of psoriasis and is generally accepted as safe in pregnancy. Previous studies have described photodegradation of serum folate after exposure to UVA radiation but the effect of UVB is not known. We studied the effect of NB-UVB phototherapy on serum folic acid levels in patients with psoriasis and the relationship between changes in serum folate levels and the total cumulative dose of NB-UVB. Included in the study were 30 psoriatic patients between 13 and 55 years of age. Serum folate levels were measured at baseline, and after exposure to 18 and 36 sessions of NB-UVB irradiation. There were significant decreases in mean serum folate levels after NB-UVB exposure. After exposure to 18 and 36 sessions the decreases were 19% and 27%, respectively. After 18 sessions, the mean serum folate level had decreased in 18 patients (60%) from 8.64 ng/ml at baseline to 7.02 ng/ml (mean NB-UVB cumulative dose 40.02 J/cm(2); P = 0.019). After 36 sessions, the mean serum folate levels had decreased in 22 patients (73%) to 6.32 ng/ml (mean NB-UVB cumulative dose 118.16 J/cm(2); P = 0.002). The present study showed that high cumulative NB-UVB doses can induce folate photodegradation and decrease serum folate levels in patients with psoriasis and that this effect is directly related to the total cumulative dose of NB-UVB.

Acne, one of the most common dermatological diseases, is characterized by inflammatory and noninflammatory lesions that may progress to scars. Starting from pubertal age groups, it can affect adults in the age group 35-40 or more. The conventional therapies for treatment of acne are facing roadblocks because of the antibiotic resistance developing against Propionibacterium acnes. This has led to trying new therapies, of which photodynamic therapy (PDT) seems to be the one under intensive study. Promising results have been observed with PDT use in acne treatment, but it still has some more way to go to acquire the FDA approval for use in acne treatment. This is a review of the literature of use of PDT in treatment of acne, providing a starting point for dermatologists seeking to treat their patients with acne safely and effectively with this new method.

The purpose of this study was to compare the efficacy and safety of the 532 nm long-pulsed laser (10 ms) with that of the 532 nm short-pulsed laser (10 ns) for freckle removal. Currently, the gold standard for treatment is the short-pulsed laser. Recently, several long-pulsed lasers have been introduced for both hair removal and the treatment of freckles. To our investigative team's knowledge, no controlled experiments have been performed to compare the safety and efficacy of long-pulsed versus short-pulsed lasers for the treatment of freckles. This was a 4-week trial, and all patients had three freckles that were randomly allocated to be treated with short-pulse laser, long-pulse laser, or to receive no treatment (control). All patients had three freckles that were randomly selected to be treated with short-pulse 532 nm Medlite IV laser (10 n, 1 J/cm(2)), or long-pulse 532 nm Aura laser (10 ms, 1 J/cm(2)) or to remain as a control (no treatment). The laser treatment was only performed once, followed by a 1-day and a 1-month follow-up visit. Freckle size was determined by a novel surface area measurement technique that was created by our research staff. The study included 17 sets of freckles (three in each set). All of the lesions which received the short-pulsed laser treatment had immediate whitening of the lesions, which turned into dry scabs the next day. None of the freckles treated in the long-pulsed group or control group developed immediate whitening or scabs. No blisters or ulcers developed. The average pain score in the short-pulsed laser group was 2-3 out of 10, while it was 0 out of 10 in the long-pulsed laser group. All scabs that developed in the short-pulsed laser group fell off between days 6 and 12 (average 8 days). The outcome of this study verified the appropriate treatment of freckles. The study confirmed that when the same energy settings, short-pulsed laser is the more effective laser treatment regimen (when compared with the long-pulsed laser), with high tolerability and minimal side effects for patients with skin types I to IV.

BACKGROUND Safety, pain, duration of effect, and patient satisfaction are important concerns for physicians performing dermal filler injections. OBJECTIVE This randomized, double-blind, split-face study compared the 6-month safety profile of dermal injections of calcium hydroxylapatite (CaHA) mixed with lidocaine (RDF-L) with that of CaHA alone (RDF) in nasolabial folds (NLFs). The study also assessed differences in pain perception, efficacy, and patient satisfaction of RDF-L and RDF for correction of nasolabial wrinkles. METHODS Sixteen adult subjects with moderate to deep NLFs according to the Lemperle Rating Scale were enrolled. Pain perception was recorded from patients using a validated visual analog pain scale. Efficacy judged by a blinded injector and an independent observer was evaluated up to 24 weeks. Patient satisfaction surveys were also collected. Adverse events were recorded throughout the study. RESULTS/CONCLUSIONS Neither RDF-L nor RDF led to significant adverse events. Comparable and limited local adverse events typical of dermal fillers were noted in both groups. No difference in duration of effect in the NLFs was shown between RDF-L and RDF. Much less pain was reported on the RDF-L side. In general, patients were extremely satisfied with the treatment on both sides. BioForm Medical (San Mateo, CA) provided Radiesse soft tissue filler, lidocaine, and other necessary supplies. Dr. Grunebaum has received compensation for presentations to the medical community about products manufactured by BioForm Medical.

There is growing interest in a wide range of nonablative interventions that, predictably, are claimed to rejuvenate skin and subcutaneous tissue “safely and effectively.” Although for many years surgery in its many forms has been the criterion standard treatment in aesthetic aspect of aging, nonsurg

The purpose of this study is to evaluate the efficacy of tattoo removal using topical imiquimod 5% cream in conjunction with the 1,064-nm Nd:YAG laser. This procedure for tattoo removal will be compared to laser treatment alone, which is the standard for cosmetic removal of tattoos. Previous studies have linked partial tattoo removal to imiquimod application in a guinea pig model. Methods: This was a small-sized, double-blinded, placebo-controlled trial with patients with Fitzpatrick skin types I-IV (light skin) who were 18–65 years of age. The patients were required to have had two tattoos of similar age and dark blue or black in color in areas that can be covered by clothing. There were four visits in total, with laser treatment and photography being performed on the first visit. Laser settings were with 1,064-nm Nd:YAG with a 10-ns pulse, 3-mm spot size, and 4 J of energy, a standard laser used for tattoo removal. During the second visit, tattoos were randomized and chosen to receive either the laser-imiquimod treatment course or laser-vehicle cream treatment. The patients returned 1 month after the completion of cream application (week #10) and 2 months after the completion of treatment with cream (week #14) for final evaluation and photographing. Results: Three patients were enrolled in this study. All of them are Fitzpatrick skin type IV. All of the patients were compliant with the drug application and have good tolerability with only mild pruritus without changing of vascularity or pigmentation. None of the patients had ulceration or scar development during the cream application. Conclusions: imiquimod plus laser therapy demonstrated a more favorable outcome when evaluated by the investigators or subjects. The mean scores for tattoo clearance from baseline to 2 months after completion of treatment with 5% imiquimod cream versus placebo cream were 4.3 versus 2.7 as rated by investigators and 4.7 versus 2.3 as rated by subjects. No textural changes were observed after therapy and were not shown to be different between the two groups. Further large-scale studies are important in developing a role for the use of imiqumod in laser-assisted tattoo removal.

Radio frequency (RF) is electromagnetic radiation in the frequency range of 3-300GHz. The primary effects of RF energy on living tissue are considered to be thermal. The goal of the new devices based on these frequency ranges is to heat specific layers of the skin. The directed use of RF can induce dermal heating and cause collagen degeneration. Wound healing mechanisms promote the remodeling of collagen and wound contraction, which ultimately clinically enhances the appearance of mild to moderate skin laxity. Preliminary studies have reported efficacy in the treatment of laxity that involves the periorbital area and jowls. Because RF energy is not dependent on specific chromophore interaction, epidermal melanin is not at risk of destruction and treatment of all skin types is possible. As such, radiofrequency-based systems have been used successfully for nonablative skin rejuvenation, atrophic scar revision and treatment of unwanted hair, vascular lesions and inflammatory acne. The use of RF is becoming more popular, although a misunderstanding exists regarding the mechanisms and limitations of its actions. This concise review serves as an introduction and guide to many aspects of RF in the non ablative rejuvenation of skin.

Human leukocyte antigen (HLA) antigens vary considerably in different racial groups, and an analysis of results from several geographical locations suggests that vitiligo appears to be associated with different HLA antigens in different groups. The aim of this work was to assess the association of HLA-Cw with vitiligo in the Egyptian population. Forty unrelated patients with nonsegmental vitiligo and 20 matched controls were selected. A polymerase chain reaction sequence specific primer (PCR-SSP) method was used to determine HLA DNA typing. There was a statistically significant difference in the association of HLA-Cw6 with vitiligo in the 2 studied groups. A comparatively increased number of patients showed HLA-Cw2 and HLA-Cw7 (13.64%). However, there were no statistically significant differences. To the best of our knowledge, this is the first molecular study of HLA typing in Egyptian patients with vitiligo. Our findings are in agreement with earlier studies that reported statistically increased frequencies for allele of HLA-Cw6 in Northern Italian, Kuwaiti, Chinese Han, and Saudi populations (45.45%, P.05).

Background: Vitiligo is an acquired hypomelanotic skin disorder resulting from the loss of functional melanocytes from the cutaneous epidermis. Low catalase (CAT) activity and accumulation of hydrogen peroxide (H2O2) have been demonstrated in the epidermis of vitiligo patients. Some polymorphisms on catalase gene may have effect on the quantity and activity of catalase enzyme. The aim of this study was to investigate whether catalase (CAT) gene polymorphisms are associated with susceptibility to vitiligo in Egyptian population. Materials and methods: Thirty patients with vitiligo and twenty gender, age and ethnic matched controls were enrolled in the study. Genotyping was done by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Results: The CAT gene -89A>T and 389C>T genotypes and allele frequencies of vitiligo patients did not differ significantly from those of healthy controls. Conclusions: We found no association between CAT gene -89A>T and 389C>T polymorphism and vitiligo susceptibility in Egyptian vitiligo patients. Further studies with greater sample size should be performed to verify these results.

Background : In the early 1960s, Eugene Garfield and Irving Sher created the journal impact factor to help select journals for the Science Citation Index (SCI). Today it has become a widespread subject of controversy even for Garfield, the man who created it who is quoted saying Impact Factor is not a perfect tool to measure the quality of articles but there is nothing better and it has the advantage of already being in existence and is, therefore, a good technique for scientific evaluation. The use of the term impact factor has gradually evolved, especially in Europe, to include both journal and author impact. This ambiguity often causes problems. It is one thing to use impact factors to compare journals and quite another to use them to compare authors. Journal impact factors generally involve relatively large populations of articles and citations. Individual authors, on average, produce much smaller numbers of articles. Objectives: Impact factor, an index based on the frequency with which a journal's articles are cited in scientific publications, is a putative marker of journal quality. However, empiric studies on impact factor's validity as an indicator of quality are lacking. The authors try to evaluate and highlight the validity of Impact Factors and its significance as a tool of assessment for scientific publications. Methods: Analysis of the several reports in literature and from their own point of view. Conclusion: A journal's impact factor is based on 2 elements: the numerator, which is the number of citations in the current year to any items published in a journal in the previous 2 years, and the denominator, which is the number of substantive articles (source items) published in the same 2 years. The impact factor could just as easily be based on the previous year's articles alone, which would give an even greater weight to rapidly changing fields.

"Recall dermatitis" classically refers to the uncommon phenomenon of chemotherapy-induced reactivation of skin damage originally induced by radiotherapy months or years earlier. We compare this condition to ectopic flare-up reactions presenting as dermatitis at existing or previous sites by an inducing agent. Enhanced sensitization of an existent allergen by patch testing is rarely described. We describe a case of a 61-year-old man's developing localized allergic contact dermatitis at previous neomycin-treated sites following the diagnosis of neomycin sensitivity on patch testing, which we attribute to a "flare-up" phenomenon.

Leptin, an adipocyte-derived hormone, has been shown to have several immunological effects similar to those of proinflammatory cytokines. The relationship between serum leptin, psoriasis, and obesity is still conflicted, and very few studies have investigated its role in skin diseases other than psoriasis.To evaluate the possible relationship between serum leptin in nonobese patients with psoriasis and other randomly selected skin diseases.Eighty subjects (40 patients with psoriasis, 20 patients with other randomly selected skin diseases, and 20 healthy controls) were included in the study. Fasting serum leptin levels of the study groups were examined by sandwich enzyme-linked immunosorbent assay.Elevated serum leptin levels were detected in both nonobese patients with psoriasis (P=.004) and those with other randomly selected skin diseases (P=.05). Leptin levels failed to correlate to the Psoriasis Area and Severity Index score of psoriatic patients. Both sexes demonstrated comparable levels of serum leptin in psoriatic patients, while female patients suffering from other skin diseases showed higher levels of serum leptin than did males of the same group.Leptin may play a role in the immunopathogenesis of psoriasis and other skin diseases, even in the absence of obesity as a cofactor.

Background: Angiokeratoma of the Scrotum (AKS) is thought to be associated or aggravated with varicocele. The underlying pathogenesis is thought to be due to atrophy of Dartos muscle and degeneration of elastic tissue incidental to aging which results in loss of the support of the blood vessels. Aim of the work: To investigate the relation of (AKS) with underlying varicocele and probable associated male subfertility. Subjects and method: The present study, included 11 male patients with AKS all patients were subjected to scrotal duplex ultrasonography to evaluate underlying varicocele and semen analysis to detect probable subfertility. Results: The current study included eleven adolescent males aged 27 to 46 years old with AKS. Clinical assessment revealed that nine patients (82%) had varicocele while 2 patients (18%) were clinically free. The duplex ultrsonographic findings of the studied patients proved that clinically free patients (n:2) did not full-fill CDCCDU criteria for diagnosis of varicocele. The mean sperm concentration for the studied patients was 19×106/ml ranged from 2-35 millions/ml, progressive motility was 23.2% ranged from 5-50% and mean abnormal forms was 52.7% and the range was range 30-90. Conclusion: AKS is commonly associated with varicocele and impaired semen parameters and provides a clue on subfertility potential.

Cancer evolves to exploit multiple mechanisms in order to avoid immune-cell recognition and antitumor effector functions, thereby limiting the clinical benefits of immunotherapy strategies. Antibodies that square the inhibitory receptor cytotoxic T-lymphocyte–associated antigen 4 (Ctla-4, for example ipilimumab, have been indicated to discharge one of these negative invulnerable administrative pathways, expediting tough reactions in a subgroup of patients with metastatic melanoma and a by and large survival profit in patients with metastatic melanoma. The modified cell demise 1 (Pd-1) receptor is an alternate inhibitory receptor communicated by T units specially with enduring presentation to antigens. Its essential ligand, Pd-L1 (otherwise called B7-H1 or Cd274), is regularly communicated inside the tumor microenvironment, incorporating disease units and tumor-penetrating macrophages. The Pd-1 receptor has a second ligand, Pd-L2 (otherwise called B7-Dc or Cd273), that is especially communicated by antigenputting forth units. In tumor models, Pd-1 contrarily manages the effector stage of T-unit reactions after ligation of Pd-L1 communicated inside the tumor. It has been hypothesized that antibodies that piece the face to face time between Pd-1 and Pd-L1 in tumors might specially discharge the cytotoxic capacity of tumor-particular T units with fewer systemic dangerous impacts than those that are seen with other resistant checkpoint inhibitors [1]. Nivolumab, a human immunoglobulin G4–blocking neutralizer against the T–cell customized death–1 checkpoint protein, Pd-1, has movement against metastatic melanoma. Its wellbeing, clinical viability, and correlative biomarkers were as of late evaluated with or without a peptide antibody in ipilimumab–refractory and –naive melanoma. In patients with ipilimumab–refractory or –naive melanoma, nivolumab at 3 mg/kg with or without peptide immunization was overall endured and instigated reactions enduring up to 140 weeks [2].

Children infrequently are afflicted with herpes zoster (HZ). Activation of latent varicella-zoster virus (VZV) in a partially immune host results in HZ. Herpes zoster in children can be benign or with varied severity, especially in cases associated with malignancy. Because of its rarity, we report widespread multisegmental HZ primarily presenting on the right side of the body and right flank in a 11 years old immunocompetent girl. The Authors have previously described a similar observation in a 6 years old female immunocompetent girl Children infrequently are afflicted with herpes zoster (HZ). Activation of latent varicella-zoster virus (VZV) in a partially immune host results in HZ. Herpes zoster in children can be benign or with varied severity, especially in cases associated with malignancy. Defects in normal immunity and cellular immunity have been postulated as important factors in the pathogenesis of HZ. Disseminated HZ is typical HZ associated with widespread cutaneous lesions simulating chicken pox and it may be associated with immunosuppression [1].

Human health has a significant importance and it is directly affected by a number of factors like different diseases including microbial and viral infections. Up till now we have paid attention to the disease causing viruses and pathogens and less has been investigated about the usefulness of normal viral flora. One such orphan virus is Torque Teno Virus (TTV). The virus is present in healthy as well as diseased population, indicating its high prevalence. The virus is ubiquitous to human body as it is present in almost all tissues and organs and this is the property that can be utilized for targeted drug delivery. Another potentially useful property of this virus is TTV derived Apoptosis Inducing protein that can be a hope for the affectees.

Few epidemiologic surveys have been carried out to determine the prevalence of skin diseases in the population of Egypt, particularly in the Sinai Peninsula. Thus, the necessity of such research in South Sinai is pressing. This study aimed to determine the prevalence of various skin diseases among children in South Sinai.A community-based protocol was followed. The study included 2194 children of both genders, 18 years of age and younger, and in six different localities within South Sinai. Data were collected by taking a full history and by systemic and dermatologic clinical examination that included the site, severity, distribution, and extent of skin lesions if present. Subjects were surveyed at general morbidity consultations and campaign field visits. The study was conducted from August 2008 to August 2009. Data were tabulated and analyzed statistically using Pearson's chi-squared test. Differences were considered significant at a P-value of 0.05.Findings revealed that 71.4% of the studied population had one or more skin diseases. The highest rate of prevalence applied to parasitic skin infestations (pediculosis capitis, 37.6%). Eczema or dermatitis were found in 25.8% of participants. Pityriasis alba occurred at a rate of 18.3% and seborrheic dermatitis at a rate of 6.7%. Xerosis was found in 11.8% of subjects, viral warts in 4.1%, photosensitivity in 4.1%, acne vulgaris in 2.6%, and fungal skin infections in 1.0%. Other skin diseases diagnosed in low numbers in the study children included impetigo, freckles, and scabies. Prevalences of vitiligo and psoriasis were very low (0.18% and 0.05%, respectively).Infective parasitic diseases are a major health problem, particularly among younger children and in subjects of low socioeconomic status.

Children infrequently are afflicted with herpes zoster (HZ). Activation of latent varicella-zoster virus (VZV) in a partially immune host results in HZ. Herpes zoster in children can be benign or with varied severity, especially in cases associated with malignancy. Because of its rarity, we report widespread multisegmental HZ primarily presenting on the right side of the body and abdomen in a 6-year-old immunocompetent girl.

Vitiligo and other autoimmune disorders are increasingly being reported in a background of immunosuppression. Viral-induced immune activation and molecular mimicry are the proposed mechanisms for the development of autoimmune diseases in individuals infected with human immunodeficiency virus (HIV). An association of vitiligo with Kaposi sarcoma (KS) rarely has been reported. The development of vitiligo preferentially around KS lesions in a patient with AIDS is unusual. We report a case of disseminated vitiligo that developed around KS nodules in a patient with AIDS.

Background: Telogen Effluvium (TE) is the most common cause of diffuse hair loss in adult females. TE may be a squeal of various metabolic alterations such as pregnancy, malnutrition especially iron deficiency anemia in premenopausal women. Hemoglobin concentration can be used to screen for iron deficiency, whereas serum ferritin concentration can be used to confirm iron deficiency. In this study we tried to put a light spot on the role of serum ferritin level in female patients with TE. Methods: A case control study was done including 100 female patients less than 40 years (their age ranged from 18 to 40 years) divided into 2 groups. The patient group containing 80 female patients with telogen effluvium the control group containing 20 normal females without hair loss. A full history was done with full clinical examination. Blood samples were collected from all studied groups and examined for: serum ferritin level (by Ferritin ELISA -EIA- 1872 test kits), Unbound T4 (by FT4 RIA KITS) and Complete blood counts (Haemoglobin level, RBCs, HCT values, MCV, MCH, MCHC). Results: The results of this study showed normal serum ferritin level in female patients suffering from telogen effluvium as well as normal serum Hg level, HCT value, RBCs count and Blood Indices. Insignificant relation was found between control and study groups using SPSS statistical data analysis. Conclusion: There was no closely linked relationship between iron metabolism and TE.

The versatility of lasers has truly manifested itself in various medical and cosmetic procedures. Patients consider a number of benign pigmented cutaneous lesions objectionable because of their color, size, number, or location. These lesions include lentigines, cafe-au-lait macules, ephelides, junctional nevi, seborrheic keratoses, dermal melanosis, and tattoos [1]. Removal of these lesions involves destroying the epidermis to remove the unwanted lesion. For superficial lesions, physicians can treat these lesions with multiple modalities. In addition, almost all epidermal injuries heal without scarring. For deep dermal pigmented lesion, however, selective damaging to the lesions usually is performed by using the Q-switched laser systems.

Scars are usually classified into atrophic scars, hypertrophic scars, or keloids. A number of lasers, both with known and unknown mechanisms of action, have been investigated for improving the appearance of such scars, with variable outcomes. Currently, multiple lasers are being utilized for the treatment of scars. The 585 nm pulsed dye laser is the gold standard of laser therapy for keloid and hypertrophic scars. The ablative lasers such as the CO(2) and Er:YAG lasers are best suited for atrophic scars. Non-ablative approaches have also become popular and are being widely used to achieve reduced downtimes yet still provide excellent outcomes. This chapter discusses these lasers and their role in scar improvement.

The popularity of cutaneous laser surgery has soared, however, the use of lasers in patients with darker skin types has been quite challenging. The main obstacle with cutaneous laser surgery in darker skinned patients is epidermal melanin absorption of laser energy. The absorption spectrum of melanin ranges from 320 to 1,200 nm with the greatest absorption observed in the lower end of this spectrum. The main objective in treating patients with skin of color is to avoid epidermal melanin absorption of laser energy and resultant thermal injury. Laser surgery in darker skinned patients must be approached carefully to avoid this unwanted side effect of post inflammatory pigment alteration. In this chapter, we will review the advances in lasers for ethnic skin with special emphasis on the treatment of acne scars, photorejuvenation, skin tightening, hair removal, vascular lesions and finally tattoos.

Understanding wound healing is critical for health care ­professionals mainly because of the enormous burden of chronic wounds on society. In addition, in many medical specialties, creating wounds for diagnostic and therapeutic purposes is part of a physician’s daily practice.

Ideally, topical anesthetics should provide rapid analgesic action without causing toxic blood levels of lidocaine or other side effects. Various formulations of lidocaine as a topical anesthetic have been tested and are currently on the market. Here, the authors report on a topical lidocaine with a novel delivery system that provides a rapid onset of action without toxic plasma els of lidocaine.Study 1 assessed the time needed for a topical 4% lidocaine gel with a unique drug delivery system to produce optimal anesthetic effects. Study 2 assessed lidocaine plasma concentrations and assessed the time to maximal anesthetic effect.In both studies, subjects received six botulinum toxin type A injections for crow's feet wrinkles in six separate zones in the lateral periocular regions bilaterally. The first injection was administered in the absence of topical 4% lidocaine gel. Gel was then applied to the remaining five zones and injections were given at set time points out to 45 minutes. In study 2, blood samples were taken from baseline to 60 minutes.Significant anesthetic effect with topical 4% lidocaine gel was attained without occlusion in approximately 25-30 minutes. However, optimum effects were observed between 35-40 minutes after application. Additionally, topical 4% lidocaine, when used appropriately, did not produce lidocaine plasma levels associated with toxicity.Topical 4% lidocaine gel with a unique drug delivery system produces significant anesthesia without occlusion in approximately 25-30 minutes with optimal effects observed between 35-40 minutes after application. Topical 4% lidocaine gel can be used effectively and safely as a topical anesthetic in the physician's office.

Numerous treatment modalities are available for scar management depending upon scar characteristics, age and patient expectations. The focus of this article is to review commonly used nonsurgical methods of scar revision. These include topical applications (e.g., silicone, vitamin E, pressure dressing, herbal extracts), intralesional medication (e.g., steroids, antimitotics), soft-tissue augmentation (e.g., collagen, fat), laser applications (e.g., 585-nm flashlamp-pumped pulsed dye, CO2), cryotherapy and make-up camouflage. Nonsurgical modalities can be used as prophylactic prevention of adverse scar formation, as definitive treatment, as intervening therapy until further surgical repair can be made, or as adjunctive treatment following surgical scar revision. There are several laser systems available that permit successful treatment of various types of scars. The 585-nm PDL remains the gold standard for laser treatment of hypertrophic scars and keloids. Although atrophic scars may best be treated with ablative CO2 and Er:YAG lasers, the intense interest in procedures with reduced morbidity profiles has increased the popularity of nonablative laser procedures. This paper will focus on the use of lasers for scar revision.

Ichthyosis is a disorder of keratinization characterized by diffuse uniform and persistent scales resulting from abnormal epidermal differentiation or metabolism. The identification of steroid sulfatase (STS) as the cause of X-linked ichthyosis (XLI) points to the importance of this enzyme in skin desquamation. Fluorescent in situ hybridization (FISH) analysis is a good diagnostic technique with which to detect a common deletion of the STS gene.In this study, the authors set out to detect the X-linked type of ichthyosis, diagnosed by detection of STS gene deletions among Egyptian males.Egyptian males complaining of X-linked ichthyosis were clinically examined, evaluating pedigree analysis of the family, cytogenetic studies using G-banding technique and FISH using locus specific probe for steroid sulfatase (STS) gene which is located at chromosome Xp22.3.Of patients, 11.11 percent had nocturnal enuresis and 33.33 percent showed STS gene deletion by FISH analysis.This study underlines a difficulty in diagnosing X-linked ichthyosis on the clinical features or familial pedigree analysis in Egypt and the importance of cytogenetic and molecular cytogenetic studies for diagnosis. FISH analysis is a good, reliable and rapid diagnostic tool with which to detect STS gene deletion. Since FISH will not detect partial deletion or point mutations, the authors recommend further molecular studies to reach the proper diagnosis of X-linked ichthyosis.

Acne, one of the most common dermatological diseases, is characterized by inflammatory and noninflammatory lesions that may progress to scars. Starting from pubertal age groups, it can affect adults in the age group 35-40 or more. The conventional therapies for treatment of acne are facing roadblocks because of the antibiotic resistance developing against Propionibacterium acnes. This has led to trying new therapies, of which photodynamic therapy (PDT) seems to be the one under intensive study. Promising results have been observed with PDT use in acne treatment, but it still has some more way to go to acquire the FDA approval for use in acne treatment. This is a review of the literature of use of PDT in treatment of acne, providing a starting point for dermatologists seeking to treat their patients with acne safely and effectively with this new method.

Knowledge and skills are required to deal with certain skin disorders and their corresponding cosmetic complaints. The field of cosmetic dermatology is growing as an overlap between the medical treatment of skin diseases and traditional cosmetology. This poses problems for dermatologists and other professionals, including regulation agencies. Dermatology should enable patients to benefit from all that is necessary for their care, whether that is surgery, drugs or cosmetics. There is no need to modify current regulations. A patient-orientated approach is advocated. The author tries to address fellow Dermatologists and those dealing with cosmetology on how to optimally maximize the outcome of their results by simple advices on how to deal with their patients.

Tattoos have existed and have been used as an expression of art by man for ages—and so have the techniques to remove them. Lasers based on the principle of selective photothermolysis are now being used to remove black as well as colorful tattoos with varying successes. The commonly used lasers for tattoo removal are the Q-switched 694-nm ruby laser, the Q-switched 755-nm alexandrite laser, the 1,064-nm Nd:YAG laser, and the 532-nm Nd:YAG laser. Newer techniques and methods are evolving in tattoo removal with lasers. Choosing the right laser for the right tattoo color is necessary for a successful outcome. Our review aims to understand the principles of laser tattoo removal and their applications for different types and colors of tattoos. The review also highlights the complications that can occur such as dyspigmentation, allergic reactions, epidermal debris, ink darkening, and so on, in this process and how to prevent them.

Poikiloderma of Civatte (PC) is a condition of the middle aged fair-skinned women and men. It is characterized by a triad of superficial skin atrophy, telangiectasia, and reticulate pattern of pigmentary alterations (both hyperpigmentation and hypopigmentation). Discoloration is usually profound at the lateral aspects of the cheeks, the lower anterior and lateral aspects of the neck, and V shape of the upper chest. The submental area, shaded by the shin, is spared (Fig. 7.1).1–14 Lesions are usually asymptomatic, although patients occasionally report itching, mild burning, and flushing.

As the population continues to age, understanding the differences between aged and young skin becomes more important to the clinician. Contact dermatitis is just one of the clinical entities that presents differently in the geriatric population. Reactions can be delayed in onset, and prolonged in duration. These altered presentations are the direct result of the pathophysiologic changes that occur in aging skin. It is especially important to recognize contact dermatitis in this age group, and to treat in a timely fashion.

There are many options for the treatment of acne rosacea, including topical and systemic therapies, laser and light-based therapies, and surgical procedures. A classification system for rosacea identifies 4 subtypes (ie, erythematotelangiectatic, papulopustular, phymatous, and ocular), which may help guide therapeutic decision making. Until recently, the pathophysiology of acne rosacea has been poorly understood and limited to descriptions of factors that exacerbate or improve this disorder. Recent molecular studies suggest that an altered innate immune response is involved in the pathogenesis of the vascular and inflammatory disease seen in patients with rosacea. These findings may help explain the benefits of current treatments and suggest new therapeutic strategies helpful for alleviating this disease. The goals of therapy include reduction of papules, pustules, erythema, physical discomfort, and an improvement in quality of life. Standard topical treatment agents include metronidazole, azelaic acid, and sodium sulfacetamide-sulfur. Second-line therapies include benzoyl peroxide, clindamycin, calcineurin inhibitors, and permethrin. There are also various systemic therapy options.

The following study reviews the recent literature pertaining to allergic contact dermatitis (ACD) in the pediatric population. This study also provides an overview of the most common allergens and discusses various therapeutic modalities.The pathophysiology of ACD is intricate and multifaceted, resulting in a characteristic, delayed inflammatory response. Although commonly recognized in adults, its existence in the pediatric population was questioned. Recent literature suggests that pediatric ACD exists and is more common than previously recognized. The diagnosis relies on the clinical presentation combined with appropriate use and interpretation of a patch test. Although many studies have investigated ACD in children, few have documented the relevance of positive patch test reactions until recently. The most current prevalence estimates of positive patch test reactions range from 14 to 70% of children patch tested. Although that range is broad, these studies have demonstrated the relevance of positive reactions and confirmed ACD as a disease entity in children.ACD is a previously underrecognized disease process in the pediatric population that can manifest as a serious dermatologic challenge for both patients and physicians. This review will address the prevalence, diagnostic methods, frequent allergens and treatment options in pediatric ACD.

Photodynamic therapy (PDT) is used for the prevention and treatment of non-melanoma skin cancer. Until recently, clinically approved indications have been restricted to actinic keratoses, nodular and superficial basal cell carcinoma, and, since 2006, Bowen disease. However, the range of indications has been expanding continuously. PDT is also used for the treatment of non-malignant conditions such as acne vulgaris and leishmaniasis, as well as for treating premature skin aging due to sun exposure. The production of reactive oxygen intermediates like singlet oxygen depends on the light dose applied as well as the concentration and localization of the photosensitizer in the diseased tissue. Either cytotoxic effects resulting in tumor destruction or immunomodulatory effects improving inflammatory skin conditions are induced. Treating superficial non-melanoma skin cancer, PDT has been shown to be highly efficient, despite the low level of invasiveness. The excellent cosmetic results after treatment are beneficial, too.

BACKGROUND Striae distensea (SD; stretch marks) are a well-recognized, common skin condition that rarely causes any significant medical problems but are often a significant source of distress to those affected. The origins of SD are poorly understood, and a number of treatment modalities are available for their treatment, yet none of them is consistently effective, and no single therapy is considered to be pivotal for this problem. With a high incidence and unsatisfactory treatments, stretch marks remain an important target of research for an optimum consensus of treatment. OBJECTIVE To identify the current treatment modalities and their effectiveness in the treatment of stretch marks. MATERIALS AND METHODS Review of the recent literature regarding clinical treatment of stretch marks with emphasis on the safety and efficacy of the newer optical devices and laser applications. RESULTS No current therapeutic option offers complete treatment, although there are a number of emerging new modalities that are encouraging. CONCLUSION The therapeutic strategies are numerous, and no single modality has been far more consistent than the rest. The long-term future of treatment strategies is encouraging with the advance in laser technologies.

Botanical extracts and preparations have been used in different pathological conditions with success. An important group of phytochemical phenolic compounds are the catechins found in green tea. Acne is a widely occurring inflammatory condition that is estimated to affect 40 to 50 million Americans. Finding an effective, safe, cost-effective and well-tolerated treatment is the challenge.To determine the efficacy of 2% green tea lotion in mild-to-moderate acne vulgaris.Twenty patients fulfilling enrolment criteria were included. Green tea was given and applied twice daily for a period of 6 weeks. The patients were seen every 2 weeks to evaluate the lesions and any side effects. To determine efficacy on acne severity, the authors used both total lesion count (TLC) and their devised severity index (SI). Total lesions count (TLC) was calculated as papules + pustules while SI was scaled with numbers (1, 2 or 3) correlating to TLC in order of increasing intensity. TLC10 was given an SI of 1, TLC 10-20 was given an SI of 2 and TLC20 was given an SI of 3.The mean total lesion count (TLC) decreased from 24 before the treatment to 10 after 6 weeks after treatment, a reduction of 58.33%. The difference was statistically significant (P0.0001, 95% confidence interval [CI] of the difference = 8.58 - 19.42). The mean severity index (SI) decreased from 2.05 before treatment to 1.25 after 6 weeks treatment, a decrease of 39.02%. The difference was statistically significant (P0.0001, confidence interval [CI] of the difference = 0.54-1.26).Topical 2% green tea lotion is an effective, cost-effective treatment for mild-to-moderate acne vulgaris.