Background
Lasers and intense pulsed light sources (IPLS) are proposed for the treatment of many pigmentary disorders. They are sometimes considered as magic tools able to remove any type of lesions. Although being the best option for several hyperpigmented lesions, they can also worsen some conditions and have potential side‐effects.
Objective
The aim of this review was to give evidence‐based recommendations for the use of lasers and IPLS in the treatment of hyperpigmented lesions.
Methods
These recommendations were produced for the European Society of Laser Dermatology by a consensus panel made up of experts in the field of pigment laser surgery. Recommendations on the use of lasers and light treatments were made based on the quality of evidence for efficacy, safety, tolerability, cosmetic outcome, patient satisfaction/preference and, where appropriate, on the experts' opinion.
Results
Lasers and IPLS are very effective for treating many hyperpigmented lesions such as lentigos, dermal hypermelanocytosis or heavy metal depositions. In the other hand, they have to be considered with great caution for other disorders, such as café au lait macules, melasma or postinflammatory hyperpigmentation. After making the correct diagnosis, if lasers or IPLS are indicated, the optimal wavelengths and parameters will be chosen taking into account the skin phototype, origin and depth of the target pigments.
Conclusion
Although potentially very effective, lasers and IPLS cannot be proposed for all types of hyperpigmented lesions. In all cases, precise recognition of the disorder is mandatory for choosing between these devices and other therapeutic approaches.
Atopic dermatitis (AD) and impetigo are skin conditions where bacterial colonisation and infection, especially with Staphylococcus aureus play an important role. We compared skin bacterial population, resistance patterns and choice of antimicrobial agents in patients diagnosed with AD and impetigo during 2005 and 2011 in our department. Number of positive cultures in the AD group were 40 and 53 in 2005 and 2011, with S. aureus found in 97.5% and 100%, respectively. Differences in resistance were marginal. In impetigo, S. aureus was found in all 70 patients in 2005 and all 40 patients in 2011. Antibiotic resistance to specifically fusidic acid was more common in 2005 impetigo patients (22.8%) versus 2011 (5%) (p = 0.078). The most commonly used oral antimicrobial was cefadroxil (in 57.5% and 52.8% of AD and 58.6% and 35% of impetigo patients in 2005 and 2011, respectively). Our observations confirm the high prevalence of S. aureus in both diseases and, interestingly, show a declining resistance trend in impetigo.
A 72-year-old woman was referred to the dermatology department with a one-month history of non-itching skin lesions in the groin. The rash had been initially diagnosed as impetigo as the lesions started as pustules. However, no improvement was noted on antibiotic treatment. The lesions changed to become larger, warty and vegetating (Fig. 1). Smaller lesions were seen perianally. No vesicles or bullae were noted. She denied loss of appetite or weight loss. There was no relevant drug history.Laboratory tests showed erythrocyte sedimentation rate of 80 mm/h (normal < 28 mm/h) and positive haemoglobin in one out of 3 foecal samples. A gastrointestinal investigation including endoscopy was negative.A skin biopsy was taken (Fig. 2). At the following visit, the patient developed papules and early exophytic plaques on the dorsal side of the tongue. Fig. 1. Vegetating red plaques in the left and right inter triginous regions.Fig. 2. Histological picture (H&E staining): (A) Prominent acanthosis with intraepidermal abscesses. (B) At higher magnification, suprabasal clefts, rounded acantholytic cells and eosino philic infiltrate are seen.
Acne vulgaris ranks among the most common dermatologic conditions encountered during adolescence up to adulthood. For moderate to severe cases of acne, isotretinoin is indicated as it is considered the most efficacious medication against acne. However, isotretinoin use is known to have its side effects and most importantly is the drug’s teratogenic potential. As a response, programs such as the Retinoid Pregnancy Prevention Program (PPP), System to Manage Accutane-Related Teratogenicity (SMART), and iPLEDGE were put into action as attempts to promote awareness on isotretinoin’s teratogenicity and reduce the incidence of exposed pregnancies. Such programs are lacking in Saudi Arabia. This study aimed, therefore, to evaluate the awareness of women of childbearing age in Makkah Province, Saudi Arabia, with regards to the side effects of the medication, specifically its teratogenicity. This study also intended to assess the compliance of both doctors and patients with the recommendations and precautions associated with isotretinoin. A cross-sectional study was conducted on 766 women participants using a previously validated questionnaire. Results showed that majority of the respondents (91%) are generally aware of the side effects of isotretinoin use, particularly its teratogenicity. However, lapses have been identified with regards to the compliance of both the treating physician and the patient. Three-fourths of sexually active women did not use any form of contraception while being on isotretinoin treatment. Two-thirds of the study participants responded that they were not issued approval forms indicating their understanding of the side effects of isotretinoin and the importance of compliance to the treating physician’s instructions; 11.5% claimed that their doctors did not perform any blood tests; and 67.7% claimed that no pregnancy test was performed at any time during the treatment. These findings strongly suggest a need for improvement when it comes to compliance of both doctors and patients. It is recommended that doctor-patient communication be more comprehensive and more efforts should be made to follow international guidelines in that regard.
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