We describe three cases of exogenous ochronosis of the malar areas due to long-term application of skin-lightening agents for melasma, effectively treated by combination of Q-switched Nd:YAG and the fractional carbon dioxide lasers. None of these lasers has been reported to be used to effectively treat ochronosis before. The Q-switched Nd:YAG laser is capable of disintegrating dermal ochronotic fibers, thereby facilitating their phagocytosis and elimination via lymphatics. The fractional carbon dioxide laser is believed to assist transepidermal elimination of the onchronotic material. We believe successful treatment of ochronosis is possible when both mechanisms are applied.
Background: Despite rare reports of persimmon anaphylaxis, the association of persimmon with natural rubber latex is low or undetermined, and latex-fruit syndrome presenting with anaphylaxis caused by persimmon has not been reported. Methods: Allergy skin testing were performed for aeroallergens, persimmon and plant foods, including those implicated in the latex-fruit syndrome and local fruits. Results: Strongly positive prick by prick and skin prick tests reactions in response to persimmon fruit, plant foods with known cross-reactivity with latex and latex were demonstrated. Conclusion: Our patient showed strongly positive allergy skin testing in response to persimmon fruit, specific plant foods with reported cross-reactivity with latex and latex. Although specific IgE for persimmon fruit and RAST inhibition latex immunoCAP are not available in our country We observed strongly positive reactions selectively towards the particular plant foods that contain class I chitinases, B-1,3-gluconase, profilin and patatin-like protein. Furthermore persimmon contains profilin, a cross reactive allergen to natural rubber latex. Total IgE was high and an IgE-mediated reaction was confirmed by immediate reactions.
Background: Purpura is a common adverse effect of dermatological procedures and can compromise the patients'appearance especially when they occur on the face. Topical vitamin K oxide has been known to be effective in treatment of purpura from vascular laser and minor surgical procedures. However its effectiveness on purpuric skin with minimal ablation produced by Q-switched Nd-YAG laser has not been studied Methods: Twenty volunteers had two areas of skin lasered on the upper inner arm using Q-switched Nd:YAG 1064nm laser at slightly purpuric settings. Vitamin K and 5% urea cream were blindly applied to the purpura twice daily as randomly allocated for 10 days. Photographs were taken on days 0, 1,2,4,8, and 10. Improvement of purpura using VAS and adverse effects were recorded. Results: Twenty volunteers with average age of 35.9 years completed the study. Evaluation by investigators showed no difference in reduction of purpura between the 2 regimens although vitamin K showed a faster onset. Interestingly subjects detected fading of the vitamin K-applied site significantly from the 2nd day after application. All lesions eventually lightened by the 6th day. Conclusion: In this study topical vitamin K oxide induced lightening of purpura faster than 5% urea cream.
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