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Port-wine stains (PWS) are frequently refractory to laser treatments. The aim of this study is to evaluate the role of treatment interval time. From 1990, 216 patients underwent Pulsed Dye Laser sessions. The laser sessions were scheduled at a minimum interval of 4 weeks to a maximum of 48 weeks. Clinical outcomes were assessed 8 weeks after the last laser session. Better results were obtained with 8 weeks interval time between therapy session, and high efficacies were also found for intervals of 4, 6 and 10 weeks. For greater interval instead, the effectiveness is significantly lower.

Alopecia Areata (AA) is an autoimmune disorder characterized by hair loss, due to a T-lymphocyte-mediated inflammatory response targeting anagen-phase hair follicles. Former studies have suggested that vaccination and viral infections may play a role in the onset of AA through a variety of different mechanisms. We report here two cases of AA following COVID-19 vaccination., Competing Interests: Conflict of interest: The authors declare no potential conflict of interest., (©Copyright: the Author(s).)

The level of patient satisfaction following tattoo removal often varies and frequently diverge from clinical objectivity. This study assesses how much social media can influence patient satisfaction after picosecond laser (PSL) tattoo removal, in light of the growing influence they have on consumers. Twenty-seven patients were treated with PSL for removal of professional black tattoo. Two groups of patients were identified: those who were already being treated at our institute or had been referred by other physicians (group 1) and those who found us through social media (group 2). Clinical improvement was evaluated 8 weeks after the final laser session and patients' satisfaction was assessed. In both groups, clinical results were homogeneous; however, Group 2 patients' subjective Global Aesthetic Improvement Scale scores were lower than those reported by clinicians (p=0.035), while Group 1 was globally more satisfied (p<0.001). We can affirm that the influence of social media on the perceptions and expectations of patients can affect their level of satisfaction. Particularly for people who are influenced by social media, it is essential to provide explanations prior to laser treatments, in order to clarify what may actually be expected from laser sources., Competing Interests: Conflict of interest: The authors declare no potential conflict of interest., (©Copyright: the Author(s).)

The efficacy of microneedle fractional radiofrequency (MFR) for the treatment of atrophic acne scars has been recently described, but accurate in vivo microscopic documentation of the processes occurring has never been reported. The aim of this study is to describe in vivo morphological atrophic acne scars' variations after treatment with MFR by means reflectance confocal microscopy (RCM) and three-dimensional (3D) imaging. A total of 11 patients requiring treatment for atrophic facial acne scars were treated with four monthly sessions of MFR. 3D imaging and RCM were assessed at baseline and 1 month after last session. Clinical improvement, according to Global Assessment Improvement Scale, and patients' satisfaction were evaluated. Clinical improvement was observed in all the treated patients, although better results were obtained for boxcar scars (p = 0.043). 3D imaging revealed a significant improvement in terms of mean scars' depth (p < 0.001). Otherwise, RCM highlighted collagen remodeling with restoration of a reticular structure. Our study confirms the efficacy and safety of MFR in acne scars' treatment and provides the microscopic description of the results using RCM., (© 2022 Wiley Periodicals LLC.)

(1) Background: Acne is a widespread skin disease, especially among adolescents. Following the COVID-19 pandemic and the use of masks, the problem has been affecting a greater number of people, and the attention of the skin care beauty routine cosmetics has been focused on the "Maskne", caused by the sebum excretion rate (SER) that stimulates microbial proliferation. (2) Methods: the present study was focused on the rheological characterization and quality assurance of the preservative system of an anti-acne serum. The biological effectiveness (cytotoxicity-skin and eye irritation-antimicrobial, biofilm eradication and anti-inflammatory activity) was evaluated in a monolayer cell line of keratinocytes (HaCaT) and on 3D models (reconstructed human epidermis, RHE and human reconstructed corneal epithelium, HCE). The Cutibacterium acnes , as the most relevant acne-inducing bacterium, is chosen as a pro-inflammatory stimulus and to evaluate the antimicrobial activity of the serum. (3) Results and Conclusions: Rheology allows to simulate serum behavior at rest, extrusion and application, so the serum could be defined as having a solid-like behavior and being pseudoplastic. The preservative system is in compliance with the criteria of the reference standard. Biological effectiveness evaluation shows non-cytotoxic and irritant behavior with a good antimicrobial and anti-inflammatory activity of the formulation, supporting the effectiveness of the serum for acne-prone skin treatment.

Background: Clinical outcomes of tattoo removal vary widely among different patients; it is known that tattoo-related features (such as pigments' type or quality, the use of multicolored inks, tattoo location size, location, layering, and duration) and personal habits (as smoking or skin phototype) could influence the clinical response to treatment, the possible role of nutrition in affecting the laser treatment of tattoos has never been investigated., Aims: This study aims to compare the clinical response of tattoos removal between omnivore and vegan patients treated with Q-switched laser (QSL)., Patients/methods: Twenty omnivore and twenty vegan patients treated for professional black tattoo removal with Nd:YAG QSL were enrolled in this study. The number of laser sessions and the median days required for complete healing were recorded; clinical improvement was evaluated 4 weeks after the last laser session., Results: The two groups were not different at the baseline in terms of sex, age, skin phototype, tattoos' age, location, and density. Vegans needed more laser sessions (p < 0.001) to achieve the best outcome, showed worst clinical responses (p = 0.001) and needed more days for complete healing (p = 0.006) compared to omnivores., Conclusion: The results of this study point out the influence of vegan diet on QLS removal of tattoos., (© 2021 Wiley Periodicals LLC.)

(1) Background: Cosmeceuticals are topical products applied to human skin to prevent skin ageing and maintain a healthy skin appearance. Their effectiveness is closely linked to the compounds present in a final formulation. In this article, we propose a panel of in vitro tests to support the efficacy assessment of an anti-ageing cream enriched with functional compounds. (2) Methods: biocompatibility and the irritant effect were evaluated on reconstructed human epidermis (RHE) and corneal epithelium (HCE) 3D models. After a preliminary MTT assay, normal human dermal fibroblasts (NHDF) and keratinocytes (HaCaT) were used to evaluate the extracellular matrix (ECM) protein synthesis, and interleukin-6 (IL-6) and metalloproteinase-1 (MMP-1) production. (3) Results: data collected showed good biocompatibility and demonstrated the absence of the irritant effect in both 3D models. Therefore, we demonstrated a statistical increase in collagen and elastin productions in NHDF cells. In HaCaT cells, we highlighted an anti-inflammatory effect through a reduction in IL-6 levels in inflammatory stimulated conditions. Moreover, the reduction of MMP-1 production after UV-B radiation was demonstrated, showing significant photo-protection. (4) Conclusion: a multiple in vitro assays approach is proposed for the valid and practical assessment of the anti-ageing protection, anti-inflammatory and biocompatible claims that can be assigned to a cosmetic product containing functional compounds.

Background and Objectives: Skin photoaging is related to extrinsic environmental exposures, mainly represented by ultraviolet radiation. One of the treatment options is laser resurfacing. As nutritional status is involved in cutaneous photodamage, we evaluated whether dietary patterns can also influence the response to facial resurfacing. Our prospective multicentric study involves three dermatologic centers specialized in laser therapy in northern Italy. The study aims to compare the outcome of a CO 2 ablative laser therapy between omnivore and vegan patients., Study Design/materials and Methods: Fifty-three omnivore and fifty-three vegan women undergoing ultrapulsed CO 2 resurfacing for photodamaged facial skin were enrolled in this study. Clinical improvement was evaluated 3 and 6 months after the treatment using the modified Dover score., Results: After laser treatment, vegans showed slower complete re-epithelialization (P < 0.001*) and disappearance of the erythema (P < 0.001*). After 3 and 6 months, vegans showed worse outcomes in terms of fine lines (P < 0.001* and P < 0.001*, respectively) and tactile roughness (P = 0.003* and ​​​​P = 0.002*, respectively) compared with omnivores, while they did not differ in mottled pigmentation., Conclusions: The present study suggests that diet influences the clinical outcome of fractioned CO 2 laser treatment. Lasers Surg. Med. © 2021 Wiley Periodicals LLC., (© 2021 Wiley Periodicals LLC.)

Background and Objectives: The efficacy of picosecond laser (PSL) in the treatment of striae distensae (SD) has been recently reported; otherwise, the base for this improvement has not been clarified yet. The aim of this study is to treat long-lasting SD with PLS and to describe their in vivo morphological variations after treatment using three-dimensional (3D) imaging and reflectance confocal microscopy (RCM)., Study Design/materials and Methods: A total of 27 patients asking for treatment for SD were treated with four monthly sessions of PLS. Clinical improvement was estimated through a blinded evaluation performed by two independent dermatologists, Global Assessment Improvement Scale (GAIS), patients' satisfaction, 3D imaging, and RCM assessments at baseline and 6 months after the last laser session., Results: Although a clinical improvement of SD was observed in 81.4% of patients according to physicians' GAIS, only 66.6% of patients reported subjective improvement and satisfaction after treatment (P = 0.04). 3D imaging revealed a significant improvement in terms of skin texture (P < 0.001) and mean SD depth (P < 0.001). Otherwise, RCM highlighted collagen remodeling and the appearance of new dermal papillae in all the treated SD compared with baseline., Conclusions: The present study confirms that PLS represents a safe treatment option for SD; herein, we report morphological documentation of skin variations after PLS treatment. Lasers Surg. Med. © 2021 Wiley Periodicals LLC., (© 2021 Wiley Periodicals LLC.)

Background: The aging of facial structures depends on genetic, anatomic, chronologic, and environmental factors that affect the skin and underlying tissues. Microfocused ultrasound with visualization (MFU-V) has emerged as a safe and effective treatment for skin laxity. As the nutritional status may contribute to skin aging, it would be interesting to evaluate whether different dietary patterns can also influence the response to MFU-V treatment for skin laxity., Aims: The aim of this study is to compare the outcome of MFU-V therapy between omnivore and vegan patients., Methods: Twenty-seven vegan and twenty-seven omnivorous women who underwent MFU-V treatment for laxity of lower face and neck were enrolled. The clinical outcome was evaluated using the FLR (Facial Laxity Rating) scale after 3 and 6 months from treatment., Results: At baseline, no significant differences were found in terms of FLR scale in both treated sites. After 3 months, reduction in FLR scale was significantly lower for vegans both on face (P = .04) and neck (P = .004). At 6 months, vegan patients had a worse clinical outcome on lower face (P = .001) and neck (P < .001)., Conclusion: The present study suggests that a vegan diet may negatively influence the outcome of a MFU-V treatment., (© 2021 Wiley Periodicals LLC.)

Background: Balloon cell nevus (BCN) is a rare histopathological entity. It is usually represented by an asymptomatic brown smooth or polypoid lesion, but no clinical features allow differentiation from other melanocytic nevi. Moreover, dermoscopy and reflectance confocal microscopy (RCM) aspects of BCN have been described in a few single cases. This study aims to describe a wider BCN series with dermoscopic and RCM features to assess the most frequent patterns., Methods: Ten patients who underwent a BCN surgical excision with histological diagnosis were included in this study. Dermatoscopy and RCM were performed for each lesion, searching for the features described in literature., Results: Each nevus presented as an asymptomatic, smooth brownish lesion. Regarding dermoscopy, four balloon cell nevi showed yellow globules, eight white globules, eight a light-brown network at the periphery, and eight a structureless central area; moreover, we found a hyperpigmented central blotch in four cases. RCM examination highlighted aggregates of dense nests at superficial dermis level in all BCNs, characterized by the presence of a dark nucleus surrounded by vacuolized cytoplasm. Moreover, multiple melanophages were seen at the dermal-epidermal junction in one case and superficial epidermal dendritic cells in one case., Conclusions: This series of 10 BCNs improves the dermoscopic and confocal microscopic knowledge of this rare entity. We also reported a new dermoscopic aspect represented by central hyperpigmented blotch. A correct identification of BCN with noninvasive techniques allows to avoid unnecessary surgical excision., (© 2021 the International Society of Dermatology.)

Few studies showed the role of picosecond laser (PLS) in the treatment of skin photoaging signs. However, no studies have explored the microscopic effects of PSL in photoaging. The aim of this study is to preliminarily identify clinical variations induced by a 1,064 nm Nd:YAG PSL on the décolleté area, then to apply the treatment protocol to treat facial photoaging and estimate the clinical and microscopic outcomes. A total of 10 consecutive patients with cutaneous photoaging were enrolled. Patients were treated 3 times at monthly intervals with the fractionated 1,064 nm Nd:YAG PSL. In a preliminary phase, PSL treatment was performed on the décolleté to establish its efficacy and safety. Then, the same treatment protocol was applied to all the face and clinical and reflectance confocal microscopy (RCM) were analyzed, comparing baseline (T0) pictures and 4 months after the treatment (T1) ones. On the face, a reduction of dyschromia and wrinkles was observed at T1. Furthermore, the underlying RCM variations were revealed at different skin levels. Our results show the clinical and microscopic effectiveness and safety of the 1,064-nm Nd:YAG PSL in the treatment of skin photoaging signs.

Skin ageing has many manifestations such as wrinkles, dryness, hyperpigmentation, and uneven skin tone. Extrinsic and intrinsic factors, especially solar ultraviolet light (UVB), contribute to skin ageing; its main features are brown spots, alterations in melanin pigmentation, and a decrease in collagen and hyaluronic acid linked to oxidative stress. Several studies showed that topical products containing ingredients with antioxidant activity can reduce oxidative damage; to provide a maximum anti-ageing effect to the skin, topical products can combine various ingredients. C-SHOT SERUM contains a combination of two molecules with a proven anti-ageing activity: a high percentage (30%) of a more stable vitamin C derivative, 3- O -ethyl-l-ascorbic acid, and lactic acid (1%). The product showed a high biocompatibility, assessed through an MTT assay on keratinocytes and on Reconstructed Human Epidermis (RHE, SkinEthic); the anti-ageing activity was demonstrated on human dermal fibroblasts and keratinocytes by a statistically significant increase in collagen production and a reduction of a UVB-induced DNA damage marker ( γ -H2AX histone), indicating DNA protection. Moreover, a depigmenting activity, shown by a highly significant decrease in melanin content on treated Reconstructed Human Pigmented Epidermis (RHPE), was assessed. According to the data of our study, the tested product contrasts the effect of skin ageing and irregular pigmentation due to the physiological decline of the skin.

Port-wine stains (PWS) are frequently refractory to laser treatments. Although previous data highlight prognostic factors and biological events related to poor outcomes, no previous publications correlate their capillaroscopic and architectural features. The aim of the present study is to describe refractory port-wine stains performing capillaroscopy and reflectance confocal microscopy (RCM) to describe their morphological and microscopic aspects. This is a prospective cohort study. All the consecutive patients with PWS poor responsive to previous treatment were included. Clinical assessment, capillaroscopy, and reflectance confocal microscopy were performed. A total of 65 patients were included, 12 with a capillaroscopic Type II pattern patients and 53 with Type III. At RCM examination, PWS with a capillaroscopic Type III pattern showed deeper-located blood vessels (p < 0.001) with a higher diameter (p < 0.042) compared with Type II. At the dynamic evaluation, 3 RCM patterns can be distinguished: Subset A, characterized by linear vessels with reduced diameter; Subset B, formed by enlarged vessels; and Subset C, characterized by deep and large aneurysmatic dilatation connected to small vessels. We defined 3 RCM patterns of refractory PWS.

Background: Photodynamic therapy (PDT) is an approved and effective treatment for actinic keratosis (AK). The time of complete skin healing is estimated to range between 5 and 10 days, but the role of nutrition in influencing it has never been evaluated. Objective: The aim of this study was to compare the time of skin healing and side effects in omnivores and vegans treated with PDT for AK. Materials and methods: Thirty omnivore and thirty vegan patients, treated with PDT for AK, were enrolled. Side effects, according to local skin response (LSR) score, were compared after 3, 7, and 30 days; the time of complete skin healing was recorded. Results: At day 3, day 7, and day 30 post treatment, vegan group showed higher total LSR score ( p  = .008, p  < .001, p  < .001, respectively), highlighting higher edema and vesiculation at day 3 ( p  < .001, p  = .002, respectively), erythema, desquamation, edema, and vesiculation at day 7 ( p  < .001, p  < .001, p  < .001, p  < .001, respectively) and erythema and desquamation after 30 days ( p  < .001, p  < .001, respectively). The difference of complete skin healing was statistically significant ( p  < .001). Conclusions: The present study suggests that diet may have a prognostic and predictive role on PDT outcomes in term of side effects and time of skin repair.

Background: Postsurgical skin healing can result in different scars types, ranging from a fine line to pathologic scars, in relation to patients' intrinsic and extrinsic factors. Although the role of nutrition in influencing skin healing is known, no previous studies investigated if the vegan diet may affect postsurgical wounds., Objective: The aim of this study was to compare surgical scars between omnivore and vegan patients., Methods and Materials: This is a prospective observational study. Twenty-one omnivore and 21 vegan patients who underwent surgical excision of a nonmelanoma skin cancer were enrolled. Postsurgical complications and scar quality were evaluated using the modified Scar Cosmesis Assessment and Rating (SCAR) scale., Results: Vegans showed a significantly lower mean serum iron level (p < .001) and vitamin B12 (p < .001). Wound diastasis was more frequent in vegans (p = .008). After 6 months, vegan patients had a higher modified SCAR score than omnivores (p < .001), showing the worst scar spread (p < .001), more frequent atrophic scars (p < .001), and worse overall impression (p < .001)., Conclusion: This study suggests that a vegan diet may negatively influence the outcome of surgical scars.

Purpose: A growing interest in the treatment of scars with picosecond laser (PSL) is evident, although the basis for scar improvement is poorly understood. The aim is to provide new insights into the role of PSL in scar improvement through noninvasive in vivo skin imaging., Methods: A total of 16 patients with 20 surgical scars were treated with three sessions of PSL. Efficacy was estimated through blinded evaluations performed by external dermatologists, Vancouver Scar Scale (VSS), Global Assessment Improvement Scale (GAIS), patient satisfaction, 3D imaging, and reflectance confocal microscopy (RCM) assessments at T0 (before treatment) and at T1 (6 months post-treatment). Safety was estimated through adverse events evaluation., Results: In vivo findings revealed the modulation of pigmentation, vascularization, improved texture (P = .0001; 3D imaging), and variations of collagen remodeling (at RCM) in both atrophic and hypertrophic scars. A reduced epidermal thickness (at RCM) was observed in hypertrophic scars (P < .01) after treatment., Conclusions: Our results confirm that PSL is an effective and safe technique for the treatment of atrophic and hypertrophic scars. In detail, we describe herein 3D and RCM features enabling the visualization of variations occurring in the skin after PSL treatment., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives and background: Tissue stabilized-guided subcision (TS-GS) treatment has emerged as a single session treatment for cellulite dimples. To date, studies on a few patients were reported. We present data concerning efficacy and safety of TS-GS for cellulite in a cohort of Italian patients. Patients and Methods: This is a retrospective study involving 122 patients requiring cellulite treatment, classified according to validate cellulite dimples scale at rest, at T0. TS-GS technique is assessed in terms of efficacy (masked evaluations of pre- and post-treatment pictures, satisfaction of patients and variations in cellulite dimples scale at rest), safety of results at 12 months follow-up (T1). U nivariate and multivariate analyses were carried out to evaluate variables associated with the size effect. Results: Masked evaluations of 112 patients completing the study resulted in the correct selection of pre- and post-treatment images in all cases and all patients were satisfied. The mean cellulite dimples scale at rest score improved ≥1 point at T1. We found a significant association between size effect, higher satisfaction ( p < .01), cellulite grading at T0 ( p < .01), higher BMI ( p = .037); a higher BMI was correlated to an increased cellulite grading at T0 ( p = .02). Only minor and temporary adverse events were reported. Conclusions: We confirm herein the clinical efficacy and safety of TS-GS for cellulite dimples treatment in a cohort of Italian patients assessed with the validated cellulite dimples scale at rest.

The efficacy of NAFL in the treatment of striae distensae (SD) has been demonstrated. Nevertheless, the base for this improvement has not been clarified yet. The aim of this study is to describe in vivo variations occurring in the skin after the treatment, using reflectance confocal microscopy (RCM). Ten patients asking for the treatment of SD were enrolled. Clinical and RCM images were acquired before the treatment, immediately after 1 and 6 months after the first treatment. One thousand five hundred forty-nanometer laser treatments were performed every 4 weeks for 6 sessions. Efficacy was estimated through the evaluation of pre- and post-treatment clinical pictures by two expert and independent physicians and with GAIS. Improvement of SD was observed in 80% of patients. Temporary erythema and edema were reported. RCM revealed the dissolution of collagen bundles and the appearance of new papillae, as compared to baseline. NAFL represents an effective and safe treatment modality for SD. We report herein in vivo variations occurring in SD after NAFL treatment.

Background: Lasers can be successfully used in the treatment of facial telangiectasias. Nevertheless, reappearance of telangiectasias after successful laser treatment is a significant problem. Risk factors involved in the reappearance have not been previously investigated., Objective: To evaluate whether personal, clinical and behavioural factors can influence the recurrence or new appearance of telangiectasias after treatment., Methods: Four hundred and fifteen women and 69 men obtaining complete clearance after laser treatment were included in the study and the role of different risk factors in the reappearance of telangiectasias was analysed. Immunocompromised patients were excluded. A statistical analysis was then performed., Results: Twenty four percent of women and 14.5% of men enrolled showed a persistent clearance after treatment. In women in whom telangiectasias reappeared, logistic regression highlighted the importance of tanning addiction, aesthetic medicine and surgery procedures as risk factors, while therapy for menopause was found to be a protective factor. Hypertension was found to be a risk factor in men., Conclusions: The efficacy of laser for treatment of telangiectasias of the face has been previously proven. Nevertheless, this is the first study presenting an analysis of risk factors involved in the new appearance of telangiectasias after the clearance induced by therapy., (© 2017 European Academy of Dermatology and Venereology.)

Background: Several therapies have been proposed for cutaneous warts without results concerning factors affecting recurrences., Objective: To determine the importance of individual characteristics and different therapy modalities in the occurrence of relapses., Methods: Observational prospective cohort study including 199 patients affected by multiple plantar warts treated as follows: 49 with keratolytics, 50 with CO 2 laser, 50 with pulsed dye laser (PDL) and 50 with cryotherapy. Personal data were evaluated through a questionnaire, and treatment information was collected. A Cox regression analysis was performed to identify independent factors for relapse occurrence., Results: Of patients, 57.8% showed a persistent clearance of warts after treatment with a higher recurrence-free interval when treated with PDL. Accordingly, the risk of recurrence was increased with CO 2 laser [hazard ratio (HR) 2.92, 95% confidence interval (CI) 1.49-5.74] and keratolytic treatment (HR 3.23, 95% CI 1.60-6.54), as compared to PDL. Furthermore, the multivariate analysis highlighted a higher risk of recurrence in patients between 26 and 35 years (HR 1.88, 95% CI 1.03-3.45), older than 35 (HR 2.23, 95% CI 1.23-4.07) and smokers (HR 4.90, 95% CI 3.09-7.78)., Conclusions: Pulsed dye laser is characterized by the lowest rate of recurrence. Furthermore, our study highlights that the risk of warts relapse is 5-fold higher in smokers compared to non-smokers, revealing the importance of the effects of smoking on inflammation and immune response., (© 2016 European Academy of Dermatology and Venereology.)

Background: Flashlamp-pumped pulsed (FLPP) dye laser still represents the standard treatment for the majority of port wine stains (PWSs), but the results on thick PWSs remain unpredictable, and many of these lesions fail to completely respond. Our aim was to report on the results obtained on unresponsive PWSs to standard laser treatments, by using a double phase laser treatment strategy using two laser passes in the same session., Methods: Eleven adult patients with facial PWS resistant to dye laser were enrolled. Laser sessions were scheduled every 8 weeks, and each of them consisting of two laser passes. In phase one, two different laser wavelengths (595 nm and 1064 nm) were delivered consecutively to each affected area. In the second phase, the PWS was treated using a pulse stacking technique with the 1064 nm Nd:YAG., Results: One patient was lost to follow-up. Among the remaining ten, 5 (50%) patients showed an excellent improvement (>75%), 3 (30%) patients showed a good improvement (51-75%), and 2 (20%) patients had no or minimal improvement (0-25%)., Conclusions: Our results suggest that the combination of different wavelengths in the same session can be helpful for PWSs resistant to standard laser treatments. However, in most patients two treatment phases were necessary.

Background: Aging of the neck skin includes poikiloderma of Civatte, skin laxity and wrinkles. While the vascular alterations of poikiloderma of Civatte can be effectively treated with lasers or intense pulsed light, a successful treatment of dyschromia, skin laxity and wrinkles is still difficult to achieve., Objective: To evaluate the safety and efficacy of non-ablative fractional 1540 erbium glass laser for the treatment of aged neck skin, also by means of in vivo reflectance confocal microscopy (RCM)., Methods: A prospective study for neck resurfacing in 18 women with aged neck skin. Six laser treatments were performed in 4-week intervals with a 1540-nm erbium-glass fiber laser., Results: By using a 6-point grading scale, the mean score (±SD; range) at baseline was 3.6 (±1.5; 1-6) for skin dyschromia, 2.9 (±1.4; 1-6) for laxity and 3.3 (±1.3; 1-5) for wrinkles. Three months after the last laser session, we found a significant clinical improvement of dyschromia (p = 0.0002; Wilcoxon test), and wrinkles (p = 0.0004; Wilcoxon test), with a mean (±SD) reduction of 2.5 (±1.0) and 1.9 (±1.1) points in the 6-point grading scale, respectively. No change was observed in laxity. These results were also supported by structural changes documented by RCM., Conclusion: Non-ablative fractional 1540 erbium glass laser was both safe and effective for the treatment of dyschromia and wrinkles, but not effective for the laxity of the neck skin.

Background: Naevoid melanoma (NeM), a rare variant of melanoma, can be difficult to detect as its clinical and histopathological morphology can simulate a naevus., Objectives: To describe the clinical and dermoscopic features associated with NeM., Methods: Lesions with a histopathological diagnosis of NeM were collected via an e-mail request sent to all members of the International Dermoscopy Society. All lesions were histopathologically reviewed and only lesions fulfilling a set of predefined histopathological criteria were included in the study and analysed for their clinical and dermoscopic features., Results: Twenty-seven of 58 cases (47%) fulfilled the predefined histopathological criteria for NeM and were included in the study. Clinically, 16 of the 27 NeMs presented as a nodular lesion (59%), eight (30%) as plaque type and three (11%) as papular. Analysis of the global dermoscopic pattern identified three types of NeM. The first were naevus-like tumours (n = 13, 48%), typified by a papillomatous surface resembling a dermal naevus. In these lesions local dermoscopic features included irregular dots/globules (46%), multiple milia-like cysts (38%) and atypical vascular structures (46%). The second type were amelanotic tumours (n = 8, 30%), typified by an atypical vascular pattern (75%). The third type consisted of tumours displaying a multicomponent pattern (n = 4, 15%), characterized by classical local melanoma-specific criteria. Two lesions (7%) were classified as mixed-pattern tumours as they did not manifest any of the aforementioned patterns., Conclusions: While NeMs may be clinically difficult to differentiate from naevi, any papillomatous lesion displaying dermoscopically atypical vessels and/or irregular dots/globules should prompt consideration for the possible diagnosis of NeM., (© 2014 British Association of Dermatologists.)

The response of port-wine stains (PWS) to conventional laser treatment in adults is difficult to predict. To assess the influence of local or systemic hemodynamic variables on the clearance of PWS by using flash lamp-pumped pulsed (FLPP) dye laser. All consecutive patients ages 18 years or older undergoing laser treatment for a facial PWS were eligible. Laser sessions were scheduled every 8 weeks. All patients were evaluated based on a standard scale with four evaluation categories, from no or minimal improvement to total or almost total clearance. Clearance was achieved by 50.1 % (95 % confidence interval 35.6-64.7) of patients after a maximum of 15 treatment sessions. In multivariate analysis, increased age, a newly described Type III capillaroscopic pattern, and presence of lesions in dermatome V2 were all associated with a reduced clinical response to treatment. In a model restricted to demographic pattern and patient characteristics, arterial hypertension was also associated with a lower clinical response. A strong association was found between arterial hypertension and the Type III capillaroscopic pattern. Age, arterial hypertension, capillaroscopic pattern, and body location should be considered when planning laser treatment of PWS.

Background: Melasma is a common melanosis often difficult to treat., Objective: The aim of this paper was to report on the safety and efficacy of non-ablative fractional photothermolysis combined with the use of triple-combination cream (TCC) on a large population with melasma resistant (i.e., with no complete/near-complete clearing) to TCC alone., Methods: Seventy-six patients with resistant melasma underwent a combined treatment protocol. The protocol consisted of a TCC (hydroquinone 4%, retinoic acid 0.03%, hydrocortisone butyrate 0.1%) applied daily for 10 days followed by four laser treatments performed in 3-week intervals with a fractional 1540-nm erbium-glass laser. During these intervals, and for 3 months after the last laser session, TCC was also applied daily following a "pulse-therapy" scheme. Improvement was assessed by the melasma-area-and-severity-index (MASI) score., Results: At 1 month, marked (>75%) and moderate (51-75%) clearing of melasma were observed in 46 of 76 (67.1%) and 12 of 76 (21%) cases, respectively. At 6 months, we noticed a marked improvement in 16 of 76 (21.1%) and no improvement in 33 of 76 (43.4%) patients., Conclusion: Our study proposes the combination of NFP/TCC as a useful therapy for patients with melasma resistant to TCC alone, but it shows that its long-term efficacy is limited.

Melasma is an acquired disorder of pigmentation for which several therapeutical options are currently available. Among them, low-energy Q-switched Nd:YAG laser (1,064 nm) has been successfully applied in case series although its long-term efficacy has yet to be proven. In vivo confocal microscopy is a novel imaging technique that permits to explore the skin tissue at a nearly histologic resolution. The aim of our study was to evaluate the laser treatment efficacy by means of confocal microscopy at different time points to elucidate the mechanism of action of the laser and its possible drawbacks. Eight women who presented with melasma on the face were subjected to low-energy Q-switched Nd:YAG laser treatment and then analyzed by means of confocal microscopy. An overall improvement of melasma was noticed clinically and microscopically by means of confocal microscopy. Four cases revealed the presence of dendritic-shaped cells upon confocal microscopy and those patients were the ones presenting with a relapse of the disease. The interpretation of these cells is that they could represent reasonably activated melanocytes. This opens the question whether laser treatment should be modulated to avoid side-effects associated with its use. Confocal microscopy has emerged as an excellent tool for a better understanding of the changes occurring during laser treatment.

Fractionated carbon dioxide (CO2) laser resurfacing is an effective treatment of skin aging. Several studies investigated the morphologic changes due to this laser treatment by using skin biopsies or animal model. Recently, reflectance confocal microscopy (RCM) has emerged as a new tool that can "optically" scan the skin in vivo with a nearly histologic resolution and in a totally noninvasive modality. Our study aims to analyze the skin changes following the ablative fractional CO2 laser sessions by using RCM. Ten patients were subjected to ablative fractional CO2 laser sessions for skin aging. Confocal microscopic images were acquired at baseline (w0), 3 weeks (w3), 6 weeks (w6), and 12 weeks (w12) after laser session. Previously identified confocal parameters were used to assess the skin aging at baseline and after treatment. At w3, the epidermis showed a complete disappearance of the mottled pigmentation upon RCM along with the presence of few Langherans' cells. The collagen type as seen upon RCM observed at baseline was replaced by a newly formed collagen type of long, bright and straight fibers (collagen remodeling). These fibers were parallel arranged and observed throughout the entire RCM mosaic. At w6 and w12 the confocal aspects of the skin was unchanged compared to w3. RCM confirmed the presence of an intense collagen remodeling following laser resurfacing. In line with previous studies, this collagen showed a peculiar arrangement and distribution. The collagen remodeling was still present after 3 months and confirms the long-term effect of the treatment. This is the first time that the skin can be analyzed in vivo at patient's bedside. In the near future, RCM can be an essential adjunct for Clinicians to measure the effects of laser treatment and possibly to gain new insights into the development of side effects.

Although numerous papers have recently been published on ablative fractional resurfacing, there is a lack of information in literature on very long-term results. The aim of this retrospective study is to evaluate the efficacy, adverse side effects, and long-term results of a random fractional ultrapulsed CO2 laser on a large population with photodamaged facial skin. Three hundred twelve patients with facial photodamaged skin were enrolled and underwent a single full-face treatment. Six aspects of photodamaged skin were recorded using a 5 point scale at 3, 6, and 24 months after the treatment. The results were compared with a non-parametric statistical test, the Wilcoxon's exact test. Three hundred one patients completed the study. All analyzed features showed a significant statistical improvement 3 months after the procedure. Three months later all features, except for pigmentations, once again showed a significant statistical improvement. Results after 24 months were similar to those assessed 18 months before. No long-term or other serious complications were observed. From the significant number of patients analyzed, long-term results demonstrate not only how fractional ultrapulsed CO2 resurfacing can achieve good results on photodamaged facial skin but also how these results can be considered stable 2 years after the procedure.

Background: Paget's disease is an intraepidermal adenocarcinoma that is difficult to diagnose clinically as it mimics inflammatory or infectious diseases. As a consequence, it may be clinically misdiagnosed resulting in a delay in appropriate management. Reflectance confocal microscopy allows the visualization of the upper layers of the skin and mucosa at cellular resolution. Paget's disease is characterized histologically by the presence of neoplastic cells scattered throughout all layers of the epidermis in a pattern similar to that also observed in melanoma (and termed Pagetoid spread)., Objective: In vivo confocal microscopy is an excellent diagnostic tool for detecting Pagetoid spread and for diagnosing melanoma. We therefore hypothesized that it may also assist in the diagnosis of Paget's disease., Methods: In this study, we describe the confocal features of nine cases of extramammary Paget's disease and one case of mammary one., Results: Large atypical Pagetoid cells were present singly and in clusters in all 10 cases and were readily visualized on ex vivo and in vivo confocal microscopy. The presence of Pagetoid spread and other confocal features, in the appropriate clinical context, is suggestive Paget's disease and should allow distinction from other inflammatory diseases that may appear similar clinically., Conclusion: The use of confocal microscopy is likely to facilitate earlier diagnosis of Paget's disease and the instigation of appropriate management with concomitant improvement in clinical outcomes., (© 2012 The Authors. Journal of the European Academy of Dermatology and Venereology © 2012 European Academy of Dermatology and Venereology.)

OBJECTIVE To analyze variables affecting the treatment course and prognosis of Q-switched laser tattoo removal. DESIGN Observational prospective cohort study. SETTING The study was carried out in a referral center for surgery and laser surgery in Milan. PARTICIPANTS Of 397 consecutive patients initially enrolled from January 1, 1995, to December 31, 2010, 352 patients (201 men and 151 women; median age, 30 years) were included in the analysis. INTERVENTION All patients were treated by the same investigator with Q-switched 1064/532-nm Nd:YAG laser and Q-switched 755-nm alexandrite laser according to tattoo colors. Laser sessions were scheduled at 6-week or longer intervals. MAIN OUTCOME MEASURES Successful therapy was defined as removal of the tattoo, with no adverse effects other than transient hypochromia or darkening. RESULTS The cumulative rates of patients with successful tattoo removal were 47.2% (95% CI, 41.8%-52.5%) after 10 sessions and 74.8% (95% CI, 68.9%-80.7%) after 15 sessions. Smoking, the presence of colors other than black and red, a tattoo larger than 30 cm2, a tattoo located on the feet or legs or older than 36 months, high color density, treatment intervals of 8 weeks or less, and development of a darkening phenomenon were associated with a reduced clinical response to treatment. CONCLUSIONS To our knowledge, this study is the first to formally assess prognostic factors for effective tattoo removal by Q-switched laser. Several variables influence response rates and should be considered when planning tattoo removal treatments.

Fractional photothermolysis has been shown to improve various types of scarring, including atrophic acne scars. The aim of the present authors was to assess the efficacy and safety of the nonablative fractional photothermolysis in the treatment of moderate and severe acne scars. Eighty-seven patients with moderate or severe acne scarring were treated with six sessions with a 1540-nm Erbium glass fiber laser at 3-week intervals. Six months after the final session, 7/87 (8%) patients showed a moderate improvement, whereas 80/87 (92%) patients had a marked improvement. In a subset of patients, the present authors also applied in vivo reflectance confocal microscopy to highlight the relevant microscopic changes. Hence, early and late posttreatment findings, most importantly the replacement of a coarser collagen with a new one, similar to the collagen seen in healthy skin, were observed. In accordance to previous studies, the present authors conclude that nonablative fractional photothermolysis is a safe and effective treatment for moderate or severe acne scarring., (© 2012 Wiley Periodicals, Inc.)

In 1983, selective photothermolysis dramatically transformed vascular surgery, reducing the adverse effects and increasing its efficacy. As a result, laser surgery is now considered the gold standard treatment for many congenital and acquired skin vascular disorders. In this paper, the authors analyze the main laser sources for vascular surgery, the general parameters regarding laser-tissue interactions that can influence the treatment (such as hemodynamic features, anatomical areas, vessel depth, and diameters), and other aspects important for a good laser practice. Afterward, the main indications for laser treatment in vascular cutaneous disorders are discussed, with particular reference to port-wine stain, hemangioma, facial telangiectasia, rosacea, spider angioma, venous lake, varicose leg veins, and leg telangiectasias., (© 2012 Wiley Periodicals, Inc.)

Vascular skin lesions comprise a wide and heterogeneous group of malformations and tumors that can be correctly diagnosed based on natural history and physical examination. However, considering the high incidence of such lesions, a great number of them can be misdiagnosed. In addition, it is not so rare that an aggressive amelanotic melanoma can be misdiagnosed as a vascular lesion. In this regard, dermoscopy and confocal laser microscopy examination can play a central role in increasing the specificity of the diagnosis of such lesions. In fact, the superiority of these tools over clinical examination has encouraged dermatologists to adopt these devices for routine clinical practice, with a progressive spread of their use. In this review, we will go through the dermoscopic and the confocal laser microscopy of diagnosis of most frequent vascular lesions (i.e., hemangiomas angiokeratoma, pyogenic granuloma, angiosarcoma) taking into particular consideration the differential diagnosis with amelanotic melanoma., (© 2012 Wiley Periodicals, Inc.)

Nonneoplastic mucocutaneous lesions are frequent in organ transplant recipients. Many of them are caused by a direct toxicity of immunosuppressive drugs, in particular glucocorticoids and cyclosporine. The effects of these agents are dose- and time-dependent. Glucocorticoids can cause acne, Cushingoid appearance, irregular purpuric areas, friable skin, and wide and violaceous stripes. Cyclosporine can cause hypertrichosis, pilosebaceous lesions, and gum hypertrophy. Patients with esthetic changes may show poor adherence to treatment with these immunosuppressive agents that may lead to progressive graft dysfunction. Apart from this direct toxicity, vigorous immunosuppression may render the transplant recipients more susceptible to mucocutaneous infections. Fungal infection, viral warts, and bacterial folliculitis are the most frequent types of mucocutaneous infection. Some fungal infections, such as oral candidiasis and pityriasis versicolor, are relatively trivial, but other mycotic infections can cause severe or disfigurating lesions. Among viral infections, warts and condylomata caused by human papilloma virus are frequent and may favor the development of nonmelanoma skin cancer. Bacterial infections are usually trivial in the early period after transplantation, being represented almost exclusively by folliculitis. However, subcutaneous infections may cause a necrotizing fasciculitis which is a life-threatening disorder, usually sustained by polymicrobial pathogens., (© 2011 The Authors. Transplant International © 2011 European Society for Organ Transplantation.)

Background: Unwanted body hair can represent a severe cosmetic disturbance. The traditional methods used to epilate often have limitations, side effects, and unsatisfactory results. In recent years, various light sources (lasers and others) have been developed for long-term epilation of unwanted hair., Objective: This study evaluates, on a large number of patients, the efficiency and safety of a long-pulsed low-potency Nd-Yag laser invented specifically for long-term hair removal., Methods: Some 208 subjects needing epilation were divided into three groups and treated during an 11-month period. Group A included 79 patients with a normal distribution of unwanted hair; Group B 67 patients with constitutional hypertrichosis; and Group C 62 patients with hirsutism. Treatment sessions were performed with a fluence of 23-56 J/cm2 at 1-month intervals until obtaining desirable results. Follow-ups ranged from 1 to 6 months. In 3 patients 4-mm diameter punch biopsy specimens were obtained before the first session and again after 6 hours. A third biopsy was performed after 3 months., Results: Every session resulted in a 20-40% hair loss, depending on the color of hair. Complete epilation was obtained in 4 to 6 sessions. Only white hair was not receptive to laser light, and its growth was not modified. No patients, including dark-complexioned patients, had blistering, hypo-or hyperpigmentation. No pain was present during treatment except for the axillary area. In the specimen obtained after 6 hours, very extensive necrosis of the hair follicular and sebaceous gland epithelium was evident. Histologic findings of the biopsies taken after three months showed complete disappearance of hair and moderate fibrosis., Conclusion: This study proves that the long-pulsed Nd:Yag laser treatment produces an excellent prolonged epilation with no relevant side effects. This laser light, having a 1064 nm wavelength, is minimally absorbed in superficial skin layers, and pronounced scattering up to 5 mm occurs targeting the deeper follicles.