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Laser hair removal is ever increasing in popularity. Technology is fast advancing, and there are increasingly excessive commercial claims that laser hair removal in all skin types is free of side effects. The aim of this study is to review the evidence from published literature regarding the incidence of adverse effects after laser and light systems for hair removal. A review of the current published literature on the ill effects reported after laser/light-assisted depilation was conducted. Overall incidence of adverse effects after laser/light hair removal appears to be low, with very uncommon permanent sequelae. The two largest studies to date have shown that acute and transient side effects do occur. Higher incidence of pigmentary alterations is associated with the shorter wavelength lasers (up to 19%), particularly with darker skin types, compared with lower incidence using the neodymium-yttrium-aluminium-garnet laser (2-3%). Both studies did not show any long-term side effects or scarring. Laser/light hair removal, carried out by trained professionals, is a safe procedure with a very low incidence of permanent sequelae. The majority of adverse effects are transient and minor. They are more common in darker skin. Longer wavelength devices reduce the risk in darker skin.

There have been several studies published on the side effects of laser hair removal, but none specifically looked at acneform reactions. The aim of this study is to obtain an accurate assessment of the incidence of acneform reactions after laser hair removal in relation to skin type, laser type, site of treatment, polycystic ovarian syndrome history (PCOS), age, and sex of the patient. This is a multi-centre prospective study of patients presenting for laser hair removal. Data were gathered using a questionnaire completed by the staff who performed the treatment. The incidence of acneform reactions was 6%. The following variables showed a statistically significant effect on the percentage of patients with reactions: age, with younger patients more likely to develop lesions; those treated with the Nd:YAG laser type were more likely to develop lesions than those treated with the alexandrite; and the Fitzpatrick skin type V showed the highest incidence of acneform lesions, followed by skin types II and IV. History of PCOS, number of prior treatments, use of aloe vera cooling gel, and the sex of the patient had no apparent effect on the incidence of acneform lesions. Acneform reactions are relatively common after laser hair removal; however, in the majority of cases, the severity of the reaction was mild and lasted for a short duration.

Summary Rosacea is a common condition often resulting in persistent erythema and telangiectasia as well as rhinophyma in a number of patients. Over the last two decades lasers have been increasingly used in the treatment of these permanent changes. The literature is reviewed in terms of the different laser systems, side-effects and comparison with other surgical techniques. Laser studies on rosacea-associated telangiectasia and erythema are limited. Copper-bromide, krypton and KTP lasers have been used with good to excellent results. However, the most commonly applied system is the flash lamp-pumped pulsed dye laser. Rhinophyma can be treated with a variety of different surgical methods, including laser resurfacing. CO2 lasers are the most widely used lasers, others are the Er:YAG and Nd:YAG lasers. Cosmetic end results are comparable to partial excision with a scalpel or electrosurgery. There does not appear to be an increased risk of infection or scarring, but the conventional surgical methods are quicker to perform and more cost effective.

The development of lasers as a treatment for unwanted hair has led to an increased interest in this field. Laser hair removal is frequently commercially led and there are few controlled studies to demonstrate efficacy. It is important to be aware of all treatment modalities for hair removal so that patients can be counselled adequately. This review covers all methods of hair removal from physical through hormonal to laser treatment and allows the reader to understand the pros and cons of each form of therapy.

Telangiectatic leg veins (TLV) are experienced by millions of women and men. As they cause significant cosmetic embarrassment, many women seek effective treatment. Options include sclerotherapy and treatment with different lasers. We investigated the safety and efficacy of an 810-nm diode laser in the treatment of TLV. Ten females had treatment to a ≥ 2 5 cm 2 area of TLV four times at 4-weekly intervals at 25-35 W. 0.1 s duration, 0.5 S interval and a 5-mm circular spot size (fluence of 12.7-17.8 J/cm 2 ). Assessment of response was performed 4 weeks after the final treatment and patients were asked to complete a questionnaire requesting information regarding the treatment. No statistically significant clearing of the leg veins was demonstrated although some improvement was noted in individual patients. Side-effects were negligible. consisting of discomfort or mild pain. There was no scarring, purpura or pigment alteration. A visual analogue scale questionnaire (0-10) revealed that patients found the treatment acceptable (range, 4-10). Overall difference as assessed by the patients ranged from 0 to 8.4 and degree of satisfaction with the treatment from 0 to 9.8. Currently, the treatment of choice for TLV remains sclerotherapy. Our results suggest that the 810-nm diode laser is safe and well tolerated. Further research could establish whether effectiveness can be improved with higher fluences or in combination with sclerotherapy.

Few therapies are currently available to treat keratosis pilaris atrophicans (KPA), a spectrum of disorders which includes ulerythema ophryogenes and atrophoderma vermiculata.To evaluate the response of KPA to treatment with the pulsed dye laser (PDL) with regard to improvements in erythema and skin roughness, treatment tolerability, and side effects.Treatment of all facial areas involved with KPA with the PDL at 585 nm was evaluated in 12 patients. Prior to and after each treatment skin erythema was estimated using an erythema meter, and skin roughness was analysed using micrometer evaluation of a skin surface biopsy taken from the same mapped area and analysed by computer to calculate the roughness profile.Patients received 2 to 8 treatments with the PDL with energies ranging from 6.0 to 7.5 J/cm2. Clinical improvement was noted in all patients with significant reduction in erythema scores. Pre-treatment scores ranged from 4 to 13 (mean 8.3) and post-treatment 0 to 8 (mean 3.1) (P0.05). Improvements in skin roughness were clinically apparent in all but two patients, but these were not significant on evaluation of skin surface biopsies. Treatment was generally well tolerated, and side effects other than local pain during treatment were very few.PDL treatment appears to be a safe and effective treatment for the erythema associated with KPA but does not give significant improvement in associated skin roughness.

Lasers are frequently used to treat pigmented skin lesions; however, there is little published data from routine clinical practice. We performed a retrospective review of patients treated between January 2003 and January 2004 to describe the patients, methods used and the clinical outcome. The long-term result was determined by a patient questionnaire. In total, 67 patients with 76 pigmented lesions were treated (22 males and 45 females, mean age 22 years); 27% had Fitzpatrick skin types IV-VI. The Q-switched Nd:YAG, and erbium:YAG lasers were used in 75% and 24% of cases, respectively, with an average of 5.4 treatments/patient. The physician-rated outcome at the end of treatment was 'very positive' in 45% and 'mostly positive' in 30% of cases. The patient-rated outcome at an average of 21 months post-treatment was 'excellent' in 29.5%, 'good' in 25%, and 'fair' in 22.7% of the 44 cases. About 50% of patients with the three most common lesions (congenital naevi, other/unspecified naevi and naevus of Ota) achieved good or excellent long-term results.

Background/Aims: This study aims to measure and characterize the psychological impact of a port wine stain on patients using a questionnaire and to measure psychosocial changes after pulsed dye laser therapy.Methods: Over a 5-year period, all 249 patients (192 females and 57 males) aged 15 years and older with a port wine stain (PWS) attending a laser clinic completed a psychological questionnaire at their first visit. The overall mean score (OMS) expressed as a percentage of the maximum possible score of 32 (%OMS) for all patients was 61.7%.Results: The mean score was significantly higher for females (%OMS 63.8%; OMS 20.42, SD 7.9) than for males (%0MS 54.7%; OMS 17.5, SD 7.4; P

Congenital melanocytic naevi (CMN) can cause significant psychosocial morbidity, especially if they are in visually exposed areas. The preferred treatment is surgical excision, though not all lesions are amenable to this because anatomical location may preclude aesthetic and functional reconstruction. Three children with inoperable facial CMN were treated with Er:YAG resurfacing under general anaesthetic. Two children were Fitzpatrick skin type II, and one child was skin type VI. Treatment was performed at 4-9-monthly intervals. The procedure achieved significant lightening and thinning in all three cases, without scarring or dyspigmentation. One child developed herpes simplex infection in the treated area on one occasion, which was managed with oral aciclovir, and did not lead to scarring or preclude further treatment. We conclude that Er:YAG laser resurfacing is effective for CMN, even in darker skin types. The incidence of side-effects is low, although repeated treatment is necessary.

A guide to laser treatment of port wine stains, tattoos and cutaneous pigmented disorders

Summary Hirsutism has a significant impact on the quality of life of affected patients. We report a prospective study of 45 hirsute females attending a laser clinic. Of these, 15 patients completed a pair of modified dermatology life quality index (DLQI) questionnaires, immediately before and at varying intervals (up to 6 months) after laser treatment. The mean DLQI score before treatment was 12.8 (median = 9.0, SD = 8.5). The mean DLQI score at 1–2 months was 7.0 (median = 2.5, SD = 10.0, P = 0.06), at 2–4 months it was 9.2 (median = 10.0, SD = 10.0, P = 0.48) and at 4–6 months it was 11.5 (median = 10.5, SD = 8.0, P = 0.88). There was a major improvement in DLQI score at 1–2 months but longer-term benefit was not observed. In a separate questionnaire, hirsute females (n = 45) reported a high level of patient satisfaction (71.1%) and willingness to have further treatment (77.8%) despite the fact that 97.1% had unwanted hair back at pretreatment levels at 6 months.

Summary Background. Children with excessive hair may have severe psychological consequences. Laser hair removal in adults is known to be safe and well tolerated, but this is less well established in children. Objective. To describe our experience with laser hair removal in children, and to investigate the safety and tolerability of this procedure in children. Methods. The case records of 24 children aged

Significant advances in the treatment of vascular naevi have occurred with developments in dermatological lasers. This review discusses these developments and includes basic laser physics, new laser technology, clinical studies and improvement in technique. It also summarises the most appropriate laser use for various patients.

Laser removal of tattoos is not generally or readily available on the National Health Service and removal in privately run clinics is expensive. For those seeking removal of their tattoo this can create significant financial hardship. We investigated the psychological, social and financial impact of tattoos on the lives of those patients requesting laser removal. Sixty-eight patients with a mean age of 36 years participated. Twenty-seven (40%) had one tattoo, whereas eight (12%) possessed 10 or more; 54% had an amateur tattoo. Only 18% had received an explanation of the procedure or side-effects. The mean age at application of the first tattoo was 16 years; 48 (71%) were tattooed below the legal age limit of 18 years. Most tattoos were applied for the sake of fashion. The median duration of regret was 14 years before seeking removal. The main reasons for removal were enhancement of self-esteem and social, domestic and family reasons. In those patients attending for removal, most tattoos are applied impulsively and inexpensively in youth. They are often regretted for decades and create significant psychological, social and financial burdens.

The argon laser was used to treat fourteen patients with port-wine stains (PWS). Two adjacent test areas were treated by the minimal-blanching technique using pulse durations of 0.2 and 1 s. The two pulse durations produced similar changes in the PWS in respect of paling, incidence of visible scarring and pigmentary change.

Terbinafine-induced acute generalized exanthematous pustulosis (AGEP) has been reported in patients without a history of psoriasis. We report the occurrence of terbinafine-induced AGEP, with certain distinctive features, in a patient with psoriasis.

Venous lakes (VLs) are common benign venous ectasias in the upper dermis. They are treated to improve cosmesis and occasionally to prevent bleeding. Numerous methods have been used, such as cryotherapy, infrared coagulation and various types of lasers. They are variable in their success and all can be complicated by scarring. We report our experiences of using the 595 nm pulsed-dye laser (PDL), which has not been previously described. Eight patients were treated but sufficient resolution was achieved in only three patients. The limited success with this laser could be attributed to insufficient thermal energy being generated to close all the blood vessels permanently. A large prospective study would provide further data regarding the efficacy of the PDL. The use of compression and longer pulse durations may improve the efficacy of the 595 nm PDL to treat VLs.

Only a few cases of extrafacial rosacea have been documented although facial rosacea is a common dermatosis. We report a case of rosacea occurring on the upper arm of a patient with established facial rosacea, responding very well to treatment with topical metronidazole. To our knowledge this is the first report of the successful use of topical metronidazole in treating extrafacial rosacea.

Summary Background Laser hair removal (LHR) is a widely used treatment for unwanted hair. Aim To determine patient satisfaction with LHR. Methods The clinic offered LHR by long pulse ruby, alexandrite and Nd:YAG. Patients attending the LHR clinic completed a patient satisfaction questionnaire. Satisfaction with LHR treatment was recorded on a linear analogue scale (LAS 0 = laser very much worse than alternative method; 10 = laser very much better than the alternative method). Results In terms of hair removal, 71% of patients were satisfied with their treatment. Laser treatment compared favourably with electrolysis and waxing. LHR scored 8.6 when compared with electrolysis and 7.7 when compared with waxing. During LHR treatments, 61% of patients used fewer ancillary methods than before. Most patients would recommend LHR to other persons with unwanted hair. Conclusions Most patients were satisfied with LHR.

The pulsed-dye laser (PDL) is the treatment of choice for port-wine stains (PWS). Multiple treatments are usually necessary, with standard treatment intervals ranging between 6 and 12 weeks. However, there are no studies on the effect of treating PWS at different time intervals, and the ideal time interval between treatments has not yet been agreed. It is uncertain whether treatment is more effective if administered at shorter time intervals.To establish whether the treatment of PWS with the variable pulse width 595-nm (V-beam) PDL at 2-week intervals achieves better results, with no difference in the complication rate, than treatment given at 6-week intervals.We prospectively investigated 15 patients with PWS. Each patient had the whole PWS treated at initial visit. Half of the PWS was randomly allocated to be treated at 2 weeks and the other half at 6 weeks from initial visit. Both halves of the PWS thus were treated twice in total, once at the initial visit and the second treatment either at 2 weeks or 6 weeks from initial visit. At 12 weeks an observer blinded to treatment allocation clinically evaluated the results. The outcome measure was lightening of the PWS as measured with a reflectance spectrophotometer. Complications were recorded throughout the study period.Of the 15 patients, 13 completed the study. Three patients had two PWS each treated separately, giving a total of 16 treated PWS sites. In 11 sites (69%), the 2-week interval treatment resulted in greater reduction in reflectance than the 6-week interval treatment. Using the nonparametric Wilcoxon matched-pair signed rank test, the 2-week treatment interval site resulted in greater reduction in reflectance measurements compared with the 6-week treatment interval site (P0.01). This agreed closely with independent observer assessment judging that the 2-week treatment interval resulted in better lightening of the PWS than the 6-week treatment interval (P = 0.003). There were no adverse reactions from the treatments.Preliminary data suggest that a treatment interval of 2 weeks is well tolerated by patients and resulted in greater lightening of the PWS in the majority, compared with a standard 6-week interval. It also has the potential to reduce the total duration of a course of treatment significantly.

Granuloma faciale (GF) is a rare cutaneous condition of unknown origin with characteristic clinicopathological features. It predominantly affects the face and in some causes an unacceptable cosmetic appearance. Numerous medical and surgical treatments have been used with varying degrees of success. Several single-patient case reports have demonstrated the successful use of the pulsed dye laser (PDL) in treating GF. This study assesses the results of four patients with facial GF from one dermatological laser centre that were treated with the Candela Vbeam PDL at 595 nm. Resolution of the GF was achieved in only two of the four patients (50%). Nevertheless this study provides further evidence that the PDL can help some patients with GF. Subsequently it is still a valuable treatment option for GF, especially as it is safe, well tolerated and quick.

Topical cytokines and wound healing A digest and review of wound care issues in other journals Operating theatre practices and wound care Civilian gunshot wounds Wound treatments: old or new? Lasers in surgery

The development of lasers as a treatment for unwanted hair has led to an increased interest in this field. Laser hair removal is frequently commercially led and there are few controlled studies to demonstrate efficacy. It is important to be aware of all treatment modalities for hair removal so that patients can be counselled adequately. This review covers all methods of hair removal from physical through hormonal to laser treatment and allows the reader to understand the pros and cons of each form of therapy.

Telangiectatic leg veins (TLV) are experienced by millions of women and men. As they cause significant cosmetic embarrassment, many women seek effective treatment. Options include sclerotherapy and treatment with different lasers. We investigated the safety and efficacy of an 810-nm diode laser in the treatment of TLV. Ten females had treatment to a/= 25 cm2 area of TLV four times at 4-weekly intervals at 25-35 W, 0.1 s duration, 0.5 s interval and a 5-mm circular spot size (fluence of 12.7-17.8 J/cm2). Assessment of response was performed 4 weeks after the final treatment and patients were asked to complete a questionnaire requesting information regarding the treatment. No statistically significant clearing of the leg veins was demonstrated although some improvement was noted in individual patients. Side-effects were negligible, consisting of discomfort or mild pain. There was no scarring, purpura or pigment alteration. A visual analogue scale questionnaire (0-10) revealed that patients found the treatment acceptable (range, 4-10). Overall difference as assessed by the patients ranged from 0 to 8.4 and degree of satisfaction with the treatment from 0 to 9.8. Currently, the treatment of choice for TLV remains sclerotherapy. Our results suggest that the 810-nm diode laser is safe and well tolerated. Further research could establish whether effectiveness can be improved with higher fluences or in combination with sclerotherapy.

We report the case of an elderly woman who had been on hydroxyurea for long-standing widespread psoriasis. After approximately 5 years's treatment with hydroxyurea, she developed a symmetrical dermatomyositis-like eruption on her hands, together with bilateral leg ulceration. Although similar skin eruptions have been reported after long-term hydroxyurea treatment, all of the previous patients were being treated for myeloproliferative disorders. A dermatomyositis-like eruption has not previously been reported to occur as a consequence of hydroxyurea treatment for psoriasis. Its recognition is important to prevent unnecessary investigation or treatment withdrawal.

The flashlamp-pumped pulsed tunable dye laser has represented a significant advance in the treatment of port-wine stains (PWS). However, not all patients will respond. In this review, the clinical features influencing the response of PWS to the pulsed dye laser will be discussed. Theoretical and clinical data are presented to explain why not all PWS will respond to this laser. Methods to overcome the problems of non-responding PWS are suggested, including new treatment devices and techniques.

During the last 5 years, 640 patients had treatment to their port wine stains (PWS) with a flashlamp-pumped pulsed dye laser. One hundred and fifty-six patients have been discharged for varying reasons, of which 59 (38%) achieved excellent (at least 75%) lightening of their birthmark. Of the remaining patients, those who attended the clinic for the sixth and 12th time for treatment were also assessed to determine the degree of fading achieved in the port wine stain. Our findings confirm that flashlamp-pumped dye laser treatment is safe and effective for the treatment of PWS and that complications are rare. However, the degree of fading achieved is variable and often unpredictable. Fifty-two per cent of facial lesions of different colours achieved over 75% fading as against 18% of non-facial lesions. Sixty-four per cent of those over the age of 50 years had an excellent response whereas only 19% of those below the age of 5 years were able to achieve a similar result. The colour of the port wine stain was found to be of no prognostic value. A search for an accurate and non-invasive method to predict the outcome of flashlamp-pumped pulsed dye laser therapy for PWS is warranted.

Nineteen patients are presented with acquired port wine stains. Acquired port wine stains are uncommon vascular lesions with the appearance of a congenital port wine stain but onset after birth. This is the largest group of patients reported to date. The acquired port wine stain was on the head and neck in 17 patients and in six this was associated with preceding trauma. Psychological assessments in adult patients showed similar morbidity to that seen in patients with congenital port wine stains. This morbidity was improved with successful laser treatment. Pulsed dye laser therapy resulted in complete clearance of the lesion in six (46%) of 13 patients treated. Two further patients had an excellent response.

All patients with port wine stains (PWS) attending a tunable dye laser clinic were examined by one author (SWL), forming a large group which has allowed study of the demographic data of such patients. Two hundred and eighty-three patients, 217 females (median age 24 years, range 0.5-73) and 66 males (median age 20 years, range 0.75-72), were examined. The PWS were on the face in 226, neck in 69, trunk in 36, upper limb in 35 and lower limb in 29. The commonest lesional colour was purple (63 patients), while 39 naevi were pink/red, 35 pink/ purple and 35 pink. The naevus was flat in 255 patients, cobblestoned in 28, associated with hypertrophy in 31 and with scarring in 22. Seventy-two patients (25.4%) had a positive family history of birthmarks, 20 strawberry haemangiomas and 22 PWS, the family history of PWS being higher than expected for the prevalence of this naevus in the population. One hundred and forty-six patients were also examined for naevus anaemicus which was noted in 12 (8.2%), confirming an association between these two naevi. Ninety-four patients had received previous treatment, most commonly with the argon laser (56 patients), of whom only five reported a good result, and 17 of 22 patients with treatment-related scarring had been treated with this laser. Cosmetic camouflage was used in 109 (38.5%) of patients, who usually had PWS on the face (94%), of whom only 46 (16%) had received advice of its use.

Angioma serpiginosum (AS) is a rare vascular naevoid disorder due to ectatic dilation of capillaries in the papillary dermis. The condition is found almost exclusively in females who have grouped erythematous punctate lesions usually on the lower limbs or buttocks, which may be unsightly. We report five patients with AS treated using a Candela SPLT1 pulsed tunable dye laser. All patients had a good to excellent response. The lesion resolved in one patient, virtually resolved in two and is considerably improved in a further patient in whom treatment is continuing. In one patient, the angiomatous lesion improved but the patient developed hyperpigmentation at the treatment site and the treatment has been temporarily suspended. The results suggest that treatment using the pulsed dye laser is very effective for AS and, in most patients, produces an excellent cosmetic result.

The pulsed tunable dye laser is the established treatment for facial port wine stains (PWSs), particularly in children. There have been very few studies specifically addressing the efficacy of this laser in the treatment of lower limb PWSs. Twenty-seven patients with lower limb PWSs have been treated with the Candela pulsed tunable dye laser. Seventeen patients have been discharged; one patient had greater than 95% clearance of the naevus and three others had a good response to treatment. Ten patients who are continuing treatment have had an average of 9.4 treatments. Only one patient has achieved a good result, and none an excellent result. These results are disappointing compared with published figures for outcome following pulsed tunable dye laser treatment to facial PWSs, and confirm the clinical impression that PWSs on the lower limb do not respond well to pulsed dye laser therapy.

Although it is well known that stress can trigger and exacerbate psoriasis, the exact mechanism is unknown. An explanation is presented based on recent findings in psychoneuroimmunology. The number of cutaneous sensory nerves known to release neuropeptides, such as substance P, is increased in patients with psoriasis. Preliminary data indicate altered concentrations in psoriatic lesions of the same neuropeptides known to be altered in the brain during stress. An anatomical pathway is suggested to explain how descending information from the brain could cause release of neuropeptides in the skin, which would then induce psoriasis. Biochemical and clinical evidence is presented to support the relationship between stress and psoriasis.

A brief questionnaire was constructed to sample patients' factual knowledge of the nature of psoriasis. The study demonstrated that many patients with psoriasis have gaps in their knowledge of the disease or misconceptions that could be obstacles to effective treatment and disease prevention. The results of the questionnaire study are discussed as well as the need for patients to be aware of factors to improve self-care and extrinsic conditions that can exacerbate this disease.

EML A (eutectic mixture of local anaesthetics) cream is an effective analgesic in the treatment of port-wine stains. A placebo-controlled study was designed to assess whether EMLA cream altered the purpuric response of blood vessels in normal skin treated by a pulsed dye laser and to assess the analgesic effectiveness of EMLA compared with placebo. There was a significantly greater purpuric response in EMLA-treated skin than in placebo-treated skin (P < 0.05) and EMLA was confirmed as being superior to placebo as an analgesic (P < 0.01).

COMPARING DRESSINGS FOR DIABETIC FOOT ULCERS HYDROGEL AND NAPPY RASH ADVANCES IN THE USE OF LASERS IN DERMATOLOGY

Summary To investigate the association of chronic urticaria and autoimmune thyroid disease, a population of patients with thyroid autoimmunity as measured by thyroid autoantibody positivity was compared with a population of patients with thyroid disease without antibodies and an in-patient control group for the incidence and prevalence of skin disorders in particular chronic urticaria and angioedema.

SUMMARY The carbon dioxide laser was used in the treatment of 51 patients with decorative tattoos. Sixtyeight treatments were performed under local anaesthesia. Morbidity from treatment was low. Results 6 months after treatment in 44 patients revealed excellent or good results in 24 patients and hypertrophic scarring in three patients. These results confirm the value of this laser in the treatment of tattoos and demonstrate the advantages of this therapy over other treatments currently employed.

A eutectic mixture of two local anaesthetics—prilocaine and lignocaine (EMLA cream)—has been investigated for its usefulness as an analgesic in the treatment of facial port-wine stains with the tunable dye laser. The cream provided adequate analgesia in eight of 10 patients assessed and was well tolerated. The results of treatment after use of EMLA cream were no different from those where conventional analgesia had been used, and EMLA cream can be recommended for analgesia during laser treatment of port-wine stains.

Summary Twenty-seven patients with 35 dermatofibromas were treated with liquid nitrogen cryotherapy. The results were good or excellent in over 90% of cases. The addition of aspirin and clobetasol propionate to the regimen appeared to reduce side-effects. Dermatofibromas or histiocytomas are common, benign, skin tumours. They present as firm, well-defined dermal nodules on the extremities, particularly on the anterior surface of the lower leg. They occur 25 times more commonly in women than men. Treatment is usually requested on cosmetic grounds, although they are occasionally pruritic. Most authors advocate excision of the lesion when required1,2 despite reports of successful therapy with liquid nitrogen.3,4 Elton5, in reviewing the use of cryotherapy in dermatofibromas, advised personally against it. Excision of tumours on the leg, particularly on the anterior skin, can result in wide atrophic scarring, and may produce a result which is cosmetically less acceptable than the lesion being treated. We have treated 27 patients who had 35 dermatofibromas, all diagnosed clinically by cryosurgery, and assessed the results.