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BACKGROUND Fractional ablative resurfacing is frequently used for treating atrophic and acne scars as well as for the early improvement of scars after surgery. No evidence-based clinical data on improving the appearance of skin grafts by fractional CO2 -laser resurfacing have been available so far. OBJECTIVES The primary outcome parameter was the adaptation of the skin graft to the surrounding skin 2, 6, and 12 months after the second laser treatment. Secondary outcome parameters were melanin variation, skin roughness, resizing of the skin graft, and patient satisfaction with cosmetic results. METHODS The randomized half of the skin graft was treated with the fractional CO2 -laser two times in a 4-week interval, whereby the first laser treatment was conducted 3-8 weeks after surgery. Two independent dermatologists assessed the adaptation of the treated area and the untreated control of the skin graft to the surrounding skin using follow-up pictures and an 11-point scale (0 representing no adaptation at all and 10 complete adaptation). RESULTS Adaptation to the surrounding skin was significantly improved after laser therapy. The mean investigator ratings showed poor adaptation to the surrounding skin before the first treatment (treatment: 2.24 ± 1.00; control group: 1.95 ± 1.27; P

Fractional ablative resurfacing is frequently used for treating atrophic and acne scars as well as for the early improvement of scars after surgery. No evidence-based clinical data on improving the appearance of skin grafts by fractional COThe primary outcome parameter was the adaptation of the skin graft to the surrounding skin 2, 6, and 12 months after the second laser treatment. Secondary outcome parameters were melanin variation, skin roughness, resizing of the skin graft, and patient satisfaction with cosmetic results.The randomized half of the skin graft was treated with the fractional COAdaptation to the surrounding skin was significantly improved after laser therapy. The mean investigator ratings showed poor adaptation to the surrounding skin before the first treatment (treatment: 2.24 ± 1.00; control group: 1.95 ± 1.27; P .001; n = 26) but significant improvement at the follow-up visits (8 weeks: treatment: 6.38 ± 1.47; control group 5.29 ± 1.27; P .001; 6 months: treatment: 7.31 ± 1.24; control group 6.04 ± 0.91; 12 months: treatment: 7.6 ± 1.26; control group: 6.57 ± 1.02; n = 26). After fractional ablative laser treatment, appearance of the skin grafts was significantly improved for all time points. Profilometric analysis showed significantly reduced skin roughness 1 year after laser treatment compared to control (P = .003). Pigmentary irregularities were improved. Melanin distribution was significantly more uniform 1 year after laser treatment compared to control (P = .034). Patients were reasonably satisfied with both sides of the skin graft before treatment but more satisfied with the laser-treated side at the other time points (P .001).Adaptation of the skin graft to the surrounding skin was significantly improved after ablative fractional skin resurfacing. Skin roughness and melanin variation were also improved. Patient satisfaction with the appearance of the skin graft was significantly higher after graft resurfacing. Thus, this treatment modality can be recommended for patients wishing to improve the appearance of their skin graft. Lasers Surg. Med. 50:1010-1016, 2018. © 2018 Wiley Periodicals, Inc.

When using procedures that enable complete examination of surgical margins (3D histology), microscopically controlled surgery (MCS) represents a safe and proven method to confirm R0 resection of infiltrating tumors, especially at problematic sites, while preserving the adjacent tissue. This allows for excellent or good aesthetic results that are superior (cryosurgery, short-range irradiation) or equivalent (PDT) to nonsurgical and less safe procedures (PDT).

Background: Fractional CO2-laser resurfacing is increasingly used for treating rhytides and photoaged skin because of its favorable benefit-risk ratio. A key outcome measure and treatment goal in aesthetic laser therapy is patient satisfaction. However, few data are available on patient-reported outcomes after fractional ablative skinresurfacing. Objectives: To compare patient expectations before and patient satisfaction after three fractional CO2-laser treatments and to correlate objectively measured wrinkle reduction with patient satisfaction after treatment. Methods: We investigated patient expectation and satisfaction using a 14-item questionnaire in 24 female patients. We assessed the skin-related quality of life and patient satisfaction with skin appearance. We profilometrically measured wrinkle size in four facial areas before and three months after treatment and investigated correlations between wrinkle reduction and patient satisfaction. Results: The high patient expectations before treatment (ceiling effect) were actually slightly exceeded. The average score of 14 items delineating patient satisfaction with laser treatment was higher (4.64 0.82; na 24) than the respective expectations before treatment (4.43 0.88; na 24). Skin-related quality of life and patient satisfaction with skin appearance had significantly improved after the last treatment. Patients dissatisfied with their skin appearance before treatment (mean 2.1 1.5; evaluated on a scale ranging from 0‐6) were satisfied (mean 5.1 1.2) (P< 0.001) with skin appearance at the follow-up. Patient satisfaction with skin appearance was not correlated to the profilometrically measured reduction of wrinkle size of any facial area. Conclusions: Our results show high patient satisfaction with ablative fractional skin resurfacing, also regarding improved self-esteem and self-satisfaction despite high pre-treatment expectations. Skin-specific quality of life had significantly improved. Thus, this treatment modality can be recommended for patients with photoaged skin wishing to improve skin appearance. Lasers Surg. Med.

Primar zu unterscheiden ist zwischen vaskularen Fehlbildungen und echten vaskularen Neoplasien. Obwohl die Hamangiome des Sauglings- und Kindesalters echte vaskulare, proliferative Tumoren sind, sollen sie in diesem Kapitel behandelt werden, da sie ein ganz anderes biologisches Verhalten zeigen als die anderen Gefastumoren und moglicherweise – wie einige Fehlbildungen – eine genetische Basis besitzen. Im Unterschied zu den Neubildungen zeigen vaskulare Fehlbildungen primar keine Proliferation von Gefasen oder von Gefaswandbestandteilen. Bei Geburt angelegt und hier oft schon erkennbar, jedoch oft auch erst im Laufe der Kindheit oder des Erwachsenenalters klinisch manifest werdend, vergrosern sie sich mit dem Korperwachstum, ohne ein eigenstandiges Wachstum zu zeigen. Abzugrenzen ist hier das haufige Pseudowachstum durch zunehmende Gefasdilatation.

Summary Background Results of profilometric skin analyses after fractional ablative skin resurfacing are not only important for evaluating the efficacy of this therapy but are also relevant for physicians practising laser and aesthetic skin therapy. Currently, objective measurements of wrinkle reduction after fractional CO2 laser resurfacing are scarce, and it remains unclear whether the various facial areas respond differently to this therapy. Objectives To measure wrinkle parameters, the homogeneity of melanin distribution and skin roughness in four facial areas (periorbital, perioral, forehead, cheeks) before and after three fractional CO2 laser treatments. Methods Twenty-five women were analysed with regard to wrinkle parameters and mottled pigmentation on the face. We measured wrinkle size, depth and width and the homogeneity of melanin distribution and skin roughness in four facial areas before and after three fractional CO2 laser treatments. Additionally, the investigators rated clinical improvement using five-point grading scales. Results Wrinkles were significantly reduced in all facial areas, and the best results for wrinkle size and depth were found for the cheeks (−58·3%, P = 0·018 and −51·3%, P = 0·018) and the periorbital area (−35·1%, P

Summary Background Complete clearance of port-wine stains (PWS) is difficult to achieve, mainly because of the resistance of small blood vessels to laser irradiation. Indocyanine green (ICG)-augmented diode laser treatment (ICG+DL) may overcome this problem. Objectives To evaluate the feasibility of ICG+DL therapy of PWS and to compare the safety and efficacy of ICG+DL with the standard treatment, flashlamp-pumped pulsed dye laser (FPDL). Methods In a prospective randomized controlled clinical study, 31 patients with PWS were treated with FPDL (λem = 585 nm, 6 J cm−2, 0·45 ms pulse duration) and ICG+DL (λem = 810 nm, 20–50 J cm−2, 10–25 ms pulse duration, ICG-concentration: 2 mg kg−1 body weight) in a split-face modus in one single treatment setting that included histological examination (haematoxylin and eosin, CD34). Two blinded investigators and the patients assessed clearance rate, cosmetic appearance and side-effects up to 3 months after treatment. Results ICG+DL therapy induced photocoagulation of medium and large blood vessels (> 20 μm diameter) but not of small blood vessels. According to the investigators’ assessment, clearance rates and cosmetic appearance were better after ICG+DL therapy than after FPDL treatment (P = 0·114, P = 0·291, respectively), although not up to a statistically significant level, whereas patients considered these parameters superior (P = 0·003, P = 0·006, respectively). On a 10-point scale indicating pain during treatment, patients rated ICG+DL to be more painful (5·81 ± 2·12) than FPDL treatment (1·61 ± 1·84). Conclusion ICG+DL represents a new and promising treatment modality for PWS, but laser parameters and ICG concentration need to be further optimized.

In the literature, non-ablative fractionated photothermolysis (nFP) is accredited with improvement of wrinkles and scars combined with a reduced downtime. The purpose of this work was to evaluate the impact of a combination laser (1,320/1,440 nm) for nFP on hypertrophic scars, acne scars, and facial wrinkles. Thirty-six patients suffering from hypertrophic scars (n = 7), acne scars (n = 9), and wrinkles (n = 20) were treated using a combination Nd:YAG laser [λ(em) = 1,320 and 1,440 nm, pulse duration: 3-ms single pulse, fluence: 8.0-9.0 J/cm(2) (1,320 nm); 2.0-2.5 J/cm(2) (1,440 nm)]. The appearance of the treated condition was evaluated in a retrospective study by two blinded investigators based on follow-up photographs and by patient self-assessment. The frequency of side-effects was also assessed. Both patients and blinded observers rated the treatment results for hypertrophic scars and acne scars as slight improvement, and for wrinkles as equal as compared to baseline. No serious side-effects were reported. The light device used did not lead to a considerable clinical improvement of hypertrophic scars, acne scars, or wrinkles in this study.

Background So far, pulsed dye lasers have been regarded as the gold standard in the treatment of port-wine stains (PWS). Recently, intense pulsed light (IPL) has been reported to achieve more pronounced fading in some patients. Objectives To evaluate the efficacy and the side effects of IPL treatment of PWS in a direct comparison to the short-pulsed dye laser (SPDL) and the long-pulsed dye laser (LPDL). Methods Test spots (n = 158) were applied with IPL (λem = 555–950 nm, pulse duration: 8–14 milliseconds (single pulse), fluence: 11–17.3 J/cm2), the SPDL (λem = 585 nm, pulse duration: 0.45 milliseconds, fluence: 6 J/cm2), and the LPDL (λem = 585/590/595/600 nm, pulse duration: 1.5 milliseconds, fluence: 12/14/16/18 J/cm2) in a side-by-side modus in untreated (n = 11) and previously treated (n = 14) patients with PWS. Lesion clearance was evaluated by three blinded investigators based on follow-up photographs 6 weeks after treatment. Incidence of side effects was assessed. Results In previously untreated PWS as well as in pretreated PWS, IPL treatments were rated significantly (P

In dieser Arbeit soll ohne Anspruch auf Vollstandigkeit auf einige relevante Innovationen in der dermatologischen Lasertherapie eingegangen werden. Eine der wichtigsten stellt die fraktionale Lasertherapie dar. Insbesondere fur die Behandlung der Altershaut und der Aknenarben hat sich diese neue Behandlungsoption bewahrt. Bei Melasma und anderen Hyperpigmentierungen ist das Verfahren zumindest bei manchen Patienten wirksam, und auch fur andere, seltenere Indikationen gibt es Erfolg versprechende Berichte. Ein zweites Verfahren, das zunehmend Verbreitung findet, ist die Laserlipolyse, sei es zur Unterstutzung der Liposuktion oder als alleinige Therapieoption. Mittels subkutan eingefuhrter Fasern bzw. Handstucke wird das Fettgewebe durch Laserlicht lysiert und wohl auch dermales Bindegewebe erhitzt. Im Vergleich zur alleinigen Liposuktion sollen die Nebenwirkungen geringer sein, und zusatzlich soll eine Gewebestraffung induziert werden. Unklarheit besteht noch daruber, welche Wellenlangen(kombinationen) und Parameter hier als optimal einzustufen sind und ob das Verfahren klassischen Liposuktionstechniken uberlegen ist. Daruber hinaus wird noch auf einige Verbesserungen in der Therapie von vaskularen Veranderungen, insbesondere durch den Einsatz langerer Wellenlangen, und einige unkonventionelle, experimentelle Therapieansatze bei nicht klassischerweise durch Laser behandelbaren Erkrankungen eingegangen.

To confirm a local R0 resection of tumors with infiltrative growth at problem sites and for sparing of tissue, microscopically controlled surgery represents a safe and proven method, particularly when there are no gaps between the tissue taken at the incision margins.

The presented guidelines on the use of laser and intense pulsed light (IPL) systems in treating skin conditions and imperfections reflect the state of laser technology and medical knowledge of its use as of 2006. The recommendations contained herein are based on average requirements for diagnosis and treatment, which in actual practice may vary in individual patients. Recommended dosages and equipment selection may also vary according to treatment situation. These recommendations should thus be critically interpreted while keeping in mind individual patient factors.

Background: Venous malformations are common vascular anomalies which only occur sporadically. Objective: We present a series of 25 patients with extratruncular venous malformations of the skin or the neighboring mucosa that are arranged in a segmental pattern. Results: All lesions were sporadic and mostly unilateral. According to the extent of the vascular malformation, two subgroups were defined: large- to medium-sized and small localized lesions (‘acrofacial distribution’). In large- or medium-sized lesions, we noted a strict midline separation of the disorder. Thus, we assume that this segmental arrangement reflects genetic mosaicism. Conclusions: This type of venous malformation originates from a postzygotic mutation that occurs at an early developmental stage. Hence, the type of vascular disorder present in our 25 patients seems to fulfil each criterion of the term ‘nevus’. This vascular nevus should be distinguished from other forms of venous malformations such as the varicose veins associated with the Klippel-Trénaunay syndrome, the dermal nodules of the blue rubber bleb nevus syndrome and the vascular skin lesions of the Maffucci syndrome. Thus, we propose the new term ‘venous nevus’ or ‘nevus venosus’.

Background: The Q-switched Ruby laser (QSRL) is used for the treatment of pigmented lesions. The influence of QSRL treatment on gene expression of nontransformed primary melanocytes has not been addressed in vitro. Objective: We investigated the gene expression profile of melanocytes following QSRL irradiation. Methods: Primary melanocytes were irradiated with the QSRL (694 nm). Early and late transcriptional effects were analyzed using the Affymetrix gene array platform. Results: Laser irradiation of melanocytes had minor effects on mRNA expression. We found only 31 out of 14,500 genes which were at least twofold up- or downregulated. The differential expression of heme oxygenase 1 and galanin in QSRL-treated melanocytes was additionally confirmed by real-time RT-PCR. Analysis of a selection of 36 genes which are known to be associated with malignant melanoma development and progression revealed no significantly aberrant expression in the QSRL-treated melanocytes. Conclusion: Our study shows that QSRL treatment of primary melanocytes in vitro does not cause major alterations of global gene expression and particularly of genes associated with malignant melanoma. However, since QSRL treatment may have different effects on gene expression of melanocytic cells in vivo, further studies are required to evaluate QSRL treatment of (nevo-) melanocytic lesions.

Hereditary haemorrhagic telangiectasia (HHT) is a familial, autosomal, dominant, multi-system, vascular, dysplasia. Besides repetitive epistaxis, cutaneous eruptive macules and nodules lead to recurring bleeding and cosmetic problems. We report on a pilot study of four cases of HHT in which cutaneous lesions were treated with a pulsed neodymium:yttrium-aluminum-garnet (Nd:YAG) laser (1,064 nm). Pulsed Nd:YAG laser treatment, without anaesthesia, was performed several times on eruptive angiomas on palmar and facial skin. Lesions on fingers and face mostly showed very good, or even complete, clearing after the first laser treatment. Several macules required multiple treatment; only a few lesions showed no effect. Pulsed Nd:YAG laser therapy (1,064 nm) appears to be an effective and safe treatment option for hereditary haemorrhagic telangiectasia on the skin of face and extremities.

Fractional CO2 -laser resurfacing is increasingly used for treating rhytides and photoaged skin because of its favorable benefit-risk ratio. A key outcome measure and treatment goal in aesthetic laser therapy is patient satisfaction. However, few data are available on patient-reported outcomes after fractional ablative skin-resurfacing.To compare patient expectations before and patient satisfaction after three fractional CO2 -laser treatments and to correlate objectively measured wrinkle reduction with patient satisfaction after treatment.We investigated patient expectation and satisfaction using a 14-item questionnaire in 24 female patients. We assessed the skin-related quality of life and patient satisfaction with skin appearance. We profilometrically measured wrinkle size in four facial areas before and three months after treatment and investigated correlations between wrinkle reduction and patient satisfaction.The high patient expectations before treatment (ceiling effect) were actually slightly exceeded. The average score of 14 items delineating patient satisfaction with laser treatment was higher (4.64 ± 0.82; n = 24) than the respective expectations before treatment (4.43 ± 0.88; n = 24). Skin-related quality of life and patient satisfaction with skin appearance had significantly improved after the last treatment. Patients dissatisfied with their skin appearance before treatment (mean 2.1 ± 1.5; evaluated on a scale ranging from 0-6) were satisfied (mean 5.1 ± 1.2) (P 0.001) with skin appearance at the follow-up. Patient satisfaction with skin appearance was not correlated to the profilometrically measured reduction of wrinkle size of any facial area.Our results show high patient satisfaction with ablative fractional skin resurfacing, also regarding improved self-esteem and self-satisfaction despite high pre-treatment expectations. Skin-specific quality of life had significantly improved. Thus, this treatment modality can be recommended for patients with photoaged skin wishing to improve skin appearance.

Summary A 2-year-old girl with Moya Moya disease who had relapsing cerebrovascular strokes presented with loose skin folds, ‘chicken’ skin appearance and perforating elastosis serpiginosa-like lesions in the genitocrural region. Histologically, calcified material perforating the epidermis and adjacent short curled and mineralized elastic fibres suggested a variant of pseudoxanthoma elasticum (PXE). As PXE is known to be caused by various mutations in the transmembrane transporter ABCC6 gene, we hypothesized that a novel ABCC6 mutation may underlie this unique combination of PXE and elastopathic vascular damage. Therefore, the complete ABCC6 coding region of the patient and her parents was screened for genetic alterations. No bona fide disease-causing mutation of ABCC6 could be found in the child and in her parents. However, two novel allelic amino acid substitutions (Arg1273Lys and Glu1293Lys; exon 27) were found in the girl and her father, localized in close proximity to the region that codes for the functionally critical second nucleotide-binding fold of ABCC6. Although a causal involvement of these amino acid substitutions could not be proven based on this study, both heterozygote substitutions may possibly have interacted with other undetected recessive maternal ABCC6 changes in the child. To the best of our knowledge, this is the first report of an association between early-onset PXE and severe Moya Moya syndrome possibly related to ABCC6 changes.

Summary Background: Hemangiomas and vascular malformations are the most common vascular lesions of infancy. Different lasers can be used for treatment. Nd:YAG laser photocoagulation is particularly effective because of its deep penetration into tissue. Patients and methods: Thirty-one patients, aged from three months to 18 years, with voluminous hemangiomas and venous malformations were treated with a cw-neodymium:YAG laser. The quartz fibre was used in percutaneous and intralesional technique. Long-term follow-up data were acquired by clinical control or a patient questionnaire for a maximal period of eight years. Twenty patients could be evaluated. Results: In the group with hemangiomas (n = 15), three cases showed nearly complete remission (> 90 %), ten cases had a partial reduction in size (50 – 90 %), in one case there was stable disease and in one case tumor growth. In the group with venous malformations (n = 5) two cases showed an excellent response (> 90 %), one case a moderate response (25 – 50 %) and in two cases there was no improvement. Adverse effects included scars (40 %), hyper- and hypopigmentation (23 %), mild atrophy (20 %) and a wrinkled texture (17 %). After maximal reduction in size, 30 % of the patients were not satisfied with the laser treatment outcome and elected surgical excision of the residual lesion. Conclusions: The neodymium:yttrium aluminium garnet (Nd:YAG) laser with percutaneous or intralesional application technique is a valuable tool for selected patients with hemangiomas and venous malformations. Zusammenfassung Hintergrund: Hamangiome und vaskulare Malformationen sind die haufigsten Gefasfehlbildungen in der Kindheit. Eine Therapieoption stellt die Laserbehandlung dar. Der Nd:YAG-Laser ist besonders effektiv aufgrund seiner hohen Eindringtiefe ins Gewebe. Patienten und Methodik: Insgesamt wurden 31 Patienten im Alter zwischen drei Monaten und achtzehn Jahren mit voluminosen Hamangiomen und venosen Malformationen mit einem cw-Neodymium:YAG-Laser behandelt. Die Laserfaser wurde in perkutaner und intralasionaler Technik angewendet. Die Nachbeobachtung uber einen Zeitraum von maximal acht Jahren erfolgte mittels klinischer Kontrollen oder einem Patientenfragebogen. Von den insgesamt 31 Patienten konnten 20 ausgewertet werden. Ergebnisse: In der Gruppe der Patienten mit Hamangiomen zeigten drei Patienten eine fast vollstandige Ruckbildung (> 90 %), zehn Patienten eine partielle Ruckbildung (50 – 90 %), in einem Fall zeigte sich ein unveranderter Befund und bei einem Patienten beobachteten wir weiterhin Wachstum. In der Gruppe der Patienten mit venosen Malformationen zeigten zwei Patienten ein exzellentes Ansprechen (> 90 %), ein Patient ein moderates Ansprechen (25 – 50 %) und bei zwei Patienten kam es zu keiner Verbesserung. Nebenwirkungen beinhalteten Narben (40 %), Hyper- und Hypopigmentierungen (23 %), geringe Atrophie (20 %) und eine Hautfaltelung. Nach vollstandiger Ruckbildung waren 30 % der Patienten unzufrieden mit dem Ergebnis und unterzogen sich einer operativen Entfernung der Residuen. Schlusfolgerungen: Der Nd:YAG-Laser mit perkutaner und intralasionaler Applikationstechnik stellt eine wirksame Methode zur Behandlung ausgewahlter Patienten mit Hamangiomen und venosen Malformationen dar.

Summary Background Psoriasis is a chronic, genetically determined inflammatory disease, characterized by an immunomediated pathogenesis, which affects approximately 1–3% of the population. Various modalities have been used for psoriasis treatment, including ultraviolet (UV) radiation. Narrowband UVB (311 nm) phototherapy is a well-established, widely used and highly efficient treatment for psoriasis, but a big disadvantage is that large areas of unaffected skin are irradiated along with the psoriatic lesions. Objectives This investigation evaluates a 308-nm excimer laser and a 308-nm excimer lamp in comparison with 311-nm narrowband UVB in the treatment of patch psoriasis by using two different dose-increase schemes. Materials and methods Fifteen patients with plaque psoriasis were enrolled in the study (first regime). Three different psoriatic lesions were treated with the 308-nm excimer laser, the 308-nm excimer lamp or 311-nm narrowband UVB three times per week. UVB doses were increased slowly and stepwise (1, 1, 2, 2, 3, 3, …multiple MEDs). Sixteen patients were enrolled in the second regime. Two plaques were treated with the 308-nm excimer laser or with the 308-nm lamp with an accelerated scheme (2, 2, 4, 4, 6, 6, …multiple MEDs) three times per week. We increased the UVB doses every second treatment (first and second regime) during the whole treatment. If blistering occurred, the blistered plaque was not treated on the next scheduled treatment. At every third visit and 1, 2 and 4 months after the last treatment a Psoriasis Severity Index (PSI) score was assigned in both regimes. Results Using Friedman analysis, the PSI scores did not show a statistically significant difference (P > 0·05) comparing 308-nm laser therapy, 308-nm lamp therapy and 311-nm narrowband therapy after 10 weeks in the first regime. The mean number of treatments to achieve clearance was 24. With the accelerated scheme, clearance could be achieved with fewer treatments and with half the cumulative dose of the first regime. Nevertheless, the side-effects such as blistering and crusting were also increased. Conclusions Both 308-nm light sources can clear patch psoriasis in a similar manner to standard phototherapy, with the advantage of the ability to treat exclusively the affected skin and with a reduced cumulative dose, thus perhaps reducing the long-term risk of carcinogenicity.

Background and Objective Nonablative resurfacing has proven its efficacy in vascular and pigmented lesions, while its capacity of substantial wrinkle reduction is still discussed controversially. We present the treatment results of a 1,450 nm diode laser for facial rhytides. Methods Thirty facial regions were treated with a 1,450 nm diode laser. Pre- and post treatment pictures were compared by the treating physician and two blinded observers. Results Even if mild improvement was rated in up to 35% of the post treatment pictures, a discrepancy shows up in the assessments of the three observers, presenting almost no congruency in the rating of improvement. Conclusions Our study failed to provide convincing data on the efficacy of nonablative treatment of rhytides with the 1,450 nm diode laser. In this respect, we challenge objective judgment in the assessment of subtle changes in nonablative wrinkle reduction. Lasers Surg. Med. © 2005 Wiley-Liss, Inc.

The aim of this study was to find the recurrence rates of basal cell carcinomas treated with micrographic surgery in the Department of Dermatology, University of Regensburg. From 1992 to 1997, 261 basal cell carcinomas (178 primary and 83 recurrent) have been treated. The mean duration of follow-up was 5 years (range 1-9). Data were analysed by life-table analysis. Eleven basal cell carcinomas (6 primary and 5 recurrent) recurred. The 5-year recurrence rates were 3.3% for primary and 7.3% for recurrent basal cell carcinomas. Our results are comparable with previously published data from Europe but seem higher than those reported in the USA. Use of different statistical methods to report the recurrence rates mainly accounts for the discrepancy among studies. For a better comparison among studies on recurrence rates, a standard statistical method should be used, and we support the idea that life-table analysis provides the best approximation of the true recurrence rates.

Patienten mit schwerer Beeintrachtigung der Nierenfunktion leiden haufig unter einer Reihe von dermatologischen Begleiterkrankungen. So weisen 50–100% aller Patienten mit terminaler Niereninsuffizienz wenigstens eine Hautveranderung auf. Die chronisch bestehende Uramie fuhrt an Haut und Hautanhangsgebilden zu einer Vielzahl von strukturellen und funktionellen Veranderungen. Einige uramiebedingte Veranderungen und Erkrankungen konnen durch die Dialyse und v. a. durch eine nachfolgende Nierentransplantation gebessert werden; andere sind irreversibel.

The porokeratotic eccrine ostial and dermal duct naevus or PEODDN represents a very rare hamartoma of the eccrine sweat glands. A 16-year old boy had developed subtle hyperkeratotic skin lesions on his right hallux at six months of age. When he was eight years old, he developed similar lesions on his right palm. Clinically the lesions were coniform hyperkeratoses. The histopathological examination confirmed the diagnosis of a PEODDN showing typical cornoid lamella where the eccrine secretory ducts penetrated the epidermis. Although porokeratotic eccrine ostial and dermal duct naevi are generally considered as unresponsive to conservative treatment, in our patient topical treatment with tazarotene gel 0.1% resulted in a significant improvement within three weeks.

For several years the flashlamp-pumped pulsed dye laser (FPDL) has been the favoured method for the treatment of port-wine stains (PWS). The therapeutic outcome of FPDL laser therapy depends on the anatomical location of the PWS and is mainly attributed to morphological parameters such as size and depth of the PWS blood vessels. The aim of this study was to show a correlation between the therapeutic outcome following FPDL therapy and the optical properties of the skin overlying the PWS vessels. For this purpose the therapeutic outcome following FPDL treatment (585 nm; 0.45 ms) of 884 PWS situated on different body sites was evaluated by judging the grade of fading of PWS colour. On the other hand the light penetration into 123 skin samples (thickness 0.10-1.35 mm) was determined between 450 nm and 1030 nm and compared with the PWS laser therapy outcome for equal locations by statistical analysis. PWS on the neck, trunk, arms or legs yielded a higher mean grade of fading as compared to PWS on the head. Within the face, a wide range of fading was evident. The light penetration into skin increased linearly with increasing wavelength and location-dependent differences were found. The attenuation coefficient was 22.8+/-5.3 mm(-1) at 585 nm. No significant or strong correlation was observed between the therapeutic outcome of PWS laser therapy and the light penetration into skin. However, a correlation was obvious by plotting the respective profile plots. Therefore, among other effects, in particular morphological parameters of PWS vessels, the optical properties of the skin contribute to a small extent to the clinical outcome of PWS laser therapy.

BACKGROUND AND OBJECTIVE Portwine stains are reported to occur in 2.8% of the newborn. Depending on the location and size, portwine stains can be disfiguring and may lead to psychosocial complications. They can be safely and successfully treated with the flashlamp pumped pulsed dye laser (FPDL). Our objective was to evaluate retrospectively the efficacy of the FPDL (450 microseconds, 585 nm, 5 and 7 mm) after five years of clinical experience with this laser. PATIENTS/METHODS Between 1993-1998 in 961 patients with port-wine stains laser treatment was performed in the department of dermatology of the university of Regensburg. RESULTS Total clearance of the portwine stain was recorded in 6.9% of the patients. In 40.4% of the patients 75-95% clearance and in 38.5% 50-75% clearance was observed. In 14.2% response was less than 50%. Laser therapy was more effective for lesions of the neck and trunk than for lesions on the head and extremities. Better results were found after laser therapy of light-red or red portwine stains compared to dark red and violaceus portwine stains. In children (less than 3 year old), clearance of more than 75% occurred significantly more often than in older patients. CONCLUSIONS Since laser treatment in early childhood is more effective than treatment at a later age, a smaller number of treatment sessions is necessary and lower recurrence rates can be expected, laser treatment should be started in early childhood. Side effects were rare after FPDL treatment. This study underlines that the FPDL is a safe and successful treatment for portwine stains with rare side effects. But total clearance can only be reached in a small number of patients.

Hintergrund und Fragestellung. Vulgare Warzen werden durch humane Papillomviren (Typen 1–4, 26–29, 38, 41, 49, 57, 63, 65) hervorgerufen und finden sich in bis zu 10% bei Erwachsenen und Kindern. Derzeit werden viele verschiedene Therapiemodalitaten zur Zerstorung der virusbefallenen Zellen eingesetzt (Kurettage, Warzenlacke, salicylsaurehaltige Pflaster, Kryotherapie, cignolinhaltige Externa, Imiquimod). Patienten/Methodik. In dieser Studie sollte die Effektivitat des lang-gepulsten Farbstofflasers (long pulsed tunable dye laser LPTDL) in der Behandlung therapieresistenter Warzen untersucht werden. 24 Patienten mit therapieresistenten Warzen wurden in die Studie eingeschlossen. Bei diesen 24 Patienten wurden 31 Warzen behandelt. Ergebnisse. Eine komplette Abheilung der Warzen konnte nur in 6,5% der Falle erreicht werden, eine Besserung >75% in 12,9% der Falle. In 29% der Falle zeigte sich lediglich eine Verbesserung des Befundes

Summary The growing experience with laser devices, whose wave length is partially absorbed in melanin, as well as with longer pulse lengths and higher fluences has resulted in the necessity of concurrent epidermal cooling. Based on own experience as well as the current literature our review article describes every cooling device available, i.e. ice cubes, gel pads, spray cooling with nitrogen or tetrafluoroethane (HFC-134a), sapphire-glass window, “cold tip”, and cold air. The cooling systems are compared with regard to cooling method, efficacy, patient's comfort, user friendliness, and cost. In summary, a suitable cooling device is required for each indication and each individual laser.

Background and Objective Presenting the long-term results of flashlamp-pumped pulsed dye laser treatment in 617 hemangiomas to evaluate this treatment modality. Study Design/Materials and Methods In 548 children, 692 hemangiomas were treated with the flashlamp-pumped pulsed dye laser (FPDL) SPTL 1B (Candela Corporation, Wayland, MA). The objective of treatment was the inhibition of further growth or the induction of regression. The treatment results were documented by the treating physician as well as by means of a questionnaire delivered to the parents. A total of 617 treatment results could be evaluated. Results After 1–12 treatments (mean, 2.5), we could achieve our treatment objective to stop the further growth of the lesion in 96.6% of all hemangiomas. In 13.8%, the treatment resulted in a complete remission, a significant regression was seen in 14.9%, and 67.9% of the treated lesions showed a discontinuation of growth. The percentage of complete remission was especially high in small superficial (42.6%) and superficial (19%) hemangiomas. Conclusion In the vast majority of the hemangiomas, it was possible to stop further progression or induce regression by FPDL treatment. Total regression could be achieved in nearly half of the small superficial hemangiomas. Because the treatment is fast, effective, and nearly without side effects, we recommend early laser treatment especially in superficial and small childhood hemangiomas. Lasers Surg. Med. 28:273–277, 2001. © 2001 Wiley-Liss, Inc.

Various buried suture techniques have been reported for dermatological surgery, but in most cases, superficial non-absorbable sutures are placed additionally. The aim of this study was to evaluate whether the intradermal buried vertical mattress suture can be safely used without additional skin suturing. Following 149 procedures in 126 patients, the colour and dehiscence of the scar and the presence of hypertrophy, granulomas or keloids were analysed. The cosmetic results were excellent to good in 78.5%, satisfactory in 19.5% and poor in 2%. Single additional superficial sutures had to be placed in only 14.7%. Suture marks were absent. Hypertrophic scarring was significantly more frequent in scars sutured with polyglactine than in scars sutured with polydioxanone. Early wound dehiscence, secondary wound healing and infection due to missing superficial skin sutures did not occur. This suture technique is safe, easy and fast to perform, and achieves good cosmetic results without leaving suture marks.

Hintergrund und Fragestellung. Fur den deutschsprachigen Raum existiert keine umfassende Studie uber die Haufigkeit und Verteilung von Hautveranderungen bei Neugeborenen. Ziel der Studie war es, diese zu erfassen. Patienten/Methodik. Im Rahmen einer prospektiven Studie wurden 1000 Neugeborene innerhalb der ersten 120 Lebensstunden untersucht. Ergebnisse. Eine oder mehrere z. T. transiente Hautveranderungen zeigten 59,7% der Kinder. Unterschiede des untersuchten Kollektivs zu bisherigen Studien zeigten sich in einem haufigeren Vorkommen von kongenitalen melanozytaren Navi (6%) und Naevi flammei (2,8%). Bei den Naevi flammei wurde anstelle der ublichen Verteilung von 2 Jungen zu 1 Madchen eine Verteilung von 1:1 festgestellt. Das Erythema toxicum neonatorum und Milien kamen seltener vor. Schlussfolgerungen. Vaskulare Hautveranderungen wie Naevus flammeus und Hamangiom mit zusammen 37,2% stellen den Hauptanteil der Hautveranderungen bei Neugeborenen dar. Kongenitale melanozytare Navi traten haufiger als bisher beschrieben auf. Zusammenhange zwischen einem gehauften Auftreten von Hautveranderungen beim Kind und Nikotinkonsum in der Schwangerschaft konnten nicht gezeigt werden.

Unwanted hair is a widespread cosmetic problem. Many temporary methods of hair removal exist, with laser hair removal rapidly becoming the most widely used modality.Our objective was to evaluate the efficacy and side effects of a long-pulsed ruby laser for epilation in patients with varying skin types and hair color 6 weeks and 6 months after treatment.Seventy-four patients received one to four treatments with a long-pulsed ruby laser (694 nm, 5-msec pulse length, 6 mm spot size, 17.5-32 J/cm2) in different body areas.After a mean number of treatments of 1.98 (range 1-4) the mean clearance was 51-75% after 6 weeks and less than 25% after 6 months. A lower percentage of hair regrowth was observed in the facial region than on the trunk or legs and in dark hair compared to blond hair.Laser epilation provides a quick and relatively comfortable, but nonpermanent modality for hair removal with few side effects.

Fur die Cheilitis actinica gilt wegen ihrer Zugehorigkeit zu den fakultativen Prakanzerosen eine obligate Behandlungsindikation, wobei verschiedenste, mehr oder weniger invasive Therapieverfahren zur Anwendung kommen. In dieser Arbeit soll speziell auf die Moglichkeit der CO2-Laservaporisation hingewiesen werden, die, im Gegensatz zur englischsprachigen, in der deutschsprachigen Fachliteratur bislang keine nennenswerte Beachtung gefunden hat. Wir berichten uber eigene Behandlungsergebnisse bei 19 CO2-Laserbehandlungen bei Cheilitis actinica. In nur einem Fall erwies sich die erste Behandlung als zu oberflachlich fur eine vollstandige Abheilung. Bei einer mittleren Nachbeobachtungszeit von 16 Monaten konnten keine weiteren Rezidive und in nur einem Fall eine unauffallige Narbenbildung beobachtet werden. Im Vergleich zu anderen Behandlungsmoglichkeiten, die kurz dargestellt werden, kann die CO2-Laserablation als sicheres und kostengunstiges Verfahren mit exzellentem kosmetischen Ergebnis angesehen werden.

Die Porokeratosis Mibelli ist eine seltene, hereditare epidermale Verhornungsstorung mit verschiedenen Sonderformen und bis heute unklarer Pathogenese. Sie ist klinisch durch erythematose Plaques mit typisch hyperkeratotischem Randwall und histologisch durch die kornoide Lamelle gekennzeichnet. Berichtet wird uber eine Porokeratosis gigantea, eine morphologische Variante der klassischen Porokeratosis Mibelli. Die Pathogenese der Porokeratosis wird unter besonderer Berucksichtigung der klonalen Hypothese und der Potenz zur malignen Transformation diskutiert.

Laser sind ein fester Bestandteil der Dermatotherapie geworden und es stehen zahlreiche Geräte zur Verfügung, die bei unterschiedlichsten Indikationen eingesetzt werden können. Wichtigste Indikationen sind Feuermale, kindliche Hämangiome, erweiterte Äderchen und andere vaskuläre Fehl- und Neubildungen. Die Entfernung von Tuschetätowierungen ist mit modernen Lasergeräten ebenso möglich wie die Entfernung von solaren Lentigines und Epheliden. Die Lasertherapie von faltenreicher, aktinisch geschädigter Haut ist prinzipiell möglich, erfordert aber exakte Indikationsstellung und Behandlungstechniken, da erhebliche Nebenwirkungen möglich sind.