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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.

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.

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.

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.

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.

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 (p0.001). 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.

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...

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...

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 COFifty-three omnivore and fifty-three vegan women undergoing ultrapulsed COAfter 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.The present study suggests that diet influences the clinical outcome of fractioned CO

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

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

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 Conclusion The present study suggests that a vegan diet may negatively influence the outcome of a MFU-V treatment.

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 CO2 ablative laser therapy between omnivore and vegan patients. STUDY DESIGN/MATERIALS AND METHODS Fifty-three omnivore and fifty-three vegan women undergoing ultrapulsed CO2 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

The request for skin rejuvenating techniques is increasing. The concept of nonsurgical skin rejuvenation has been developed through the introduction of laser skin resurfacing. Laser resurfacing for skin rejuvenation was first introduced in the 1980s through the ablative carbon dioxide (CO2) laser. However, first devices showed an imbalanced risk-benefit ratio was for the high rate of adverse events and downtime. Therefore, technological evolution has led to the development of new devices, optimizing results with a reduced downtime. In detail, non-ablative and ablative fractional lasers, based on the fractional photothermolysis principle, have been introduced. The concept is based on fractional thermal damage of the skin while the undamaged surrounding tissue allows tissue repair, thus optimizing results and reducing downtime. An analysis of the main sources for laser resurfacing is herein presented as well as perioperative management advices and specific indications.

In 1983, the introduction of the concept of selective photothermolysis has dramatically transformed vascular surgery. Accordingly, this concept enabled the development of technologies reducing the adverse effects and increasing the efficacy. As a matter of fact, laser surgery is now considered the gold standard treatment for many congenital and acquired skin vascular disorders.

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.

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

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.

The treatment of pigmented lesions includes several approaches depending on the nature of the cutaneous lesion to be treated. When considering melanocytic lesions, a balance between therapeutic aspects and cosmetic concerns for aesthetic sites have to be taken into account, with particular attention for the differential diagnosis between benign and malignant.1-3 In particular, the increasing awareness for good cosmetic results lead to the development of less invasive techniques, although they hamper the histological assessment, which is the gold standard for the diagnosis of melanocytic lesions. This article is protected by copyright. All rights reserved.

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 CO2 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 CO2 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.

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 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.

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.

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.

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.

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.

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.

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. What's already known about this topic? Naevoid melanoma is a rare variant of melanoma, and can be difficult to detect as its clinical and histopathological morphology can simulate a naevus. What does this study add? This study provides new insights into the clinical and dermoscopic morphology of naevoid melanoma, facilitating its clinical recognition.

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.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).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.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.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.

Melasma is a common melanosis often difficult to treat.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.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.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.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.

Immunosuppression may favour the development of disseminated superficial porokeratosis (DSP). We report the clinical features and the outcome of DSP in 24 patients receiving immunosuppressive treatment (group A), and compare the characteristics of the disease with those of 13 immunocompetent patients with DSP (group B). The two groups were similar with regard to age, sex, area of skin involvement and mean follow-up. There was a family history of DSP in only two patients in group A, compared with five patients in group B (P = 0.03). The skin type, based on the tanning response to sunlight, was not significantly different between the two groups. Two of the 24 patients in group A had high sun exposure, compared with five of the 13 patients in group B (P = 0.03). Moreover, 10 patients in group A and 11 in group B (P = 0.01) exhibited worsening of the disease after exposure to sunlight, usually during the summertime. These observations appear to support the hypothesis that sun exposure is not always essential for the development of porokeratosis in immunosuppressed patients. None of our patients developed skin cancer in porokeratotic lesions during the follow-up period.

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 cm 2 , 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.

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.

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.

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.

We described a case of necrolytic migratory erythema without glucagonoma in a 33-year-old man. The patient had been heroin-dependent, HIV negative since the age of 23. He had no medical history of note and all the investigations revealed normal parameters. This is the first case of necrolytic migratory erythema without glucagonoma associated with heroin abuse.