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According to the literature, intense pulsed light (IPL) represents a versatile tool in the treatment of some dermatological conditions (i.e., pigmentation disorders, hair removal, and acne), due to its wide range of wavelengths. The authors herein report on 58 unconventional but effective uses of IPL in several cutaneous diseases, such as rosacea (10 cases), port-wine stain (PWS) (10 cases), disseminated porokeratosis (10 cases), pilonidal cyst (3 cases), seborrheic keratosis (10 cases), hypertrophic scar (5 cases) and keloid scar (5 cases), Becker's nevus (2 cases), hidradenitis suppurativa (2 cases), and sarcoidosis (1 case). Our results should suggest that IPL could represent a valid therapeutic support and option by providing excellent outcomes and low side effects, even though it should be underlined that the use and the effectiveness of IPL are strongly related to the operator's experience (acquired by attempting at least one specific course on the use of IPL and one-year experience in a specialized centre). Moreover, the daily use of these devices will surely increase clinical experience and provide new information, thus enhancing long-term results and improving IPL effectiveness.
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Clinical Study
Unconventional Use of Intense Pulsed Light
D. Piccolo,1,2 D. Di Marcantonio,3G. Crisman,4G. Cannarozzo,2M. Sannino,2
A. Chiricozzi,3,5 and S. Chimenti3
2Italian Society of Laser Dermatology (SILD), Via Nicol`
o dall’Arca 7, 70121 Bari, Italy
3Department of Dermatology, University of Rome, Tor Vergata, Italy
4Department of Dermatology, University of Bologna, Italy
5Laboratory for Inve st ig at iv e Der matolo gy, e Rocke fe ll er Univers it y, Ne w York C it y, USA
Correspondence should be addressed to D. Piccolo;
Received  February ; Revised  June ; Accepted  June ; Published  September 
Academic Editor: Silvia Moretti
Copyright ©  D. Piccolo et al. is is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
According to the literature, intense pulsed light (IPL) represents a versatile tool in the treatment of some dermatological conditions
(i.e., pigmentation disorders, hair removal, and acne), due to its wide range of wavelengths. e authors herein report on 
unconventional but eective uses of IPL in several cutaneous diseases, such as rosacea ( cases), port-wine stain (PWS) ( cases),
disseminated porokeratosis ( cases), pilonidal cyst ( cases), seborrheic keratosis ( cases), hypertrophic scar ( cases) and keloid
scar ( cases), Becker’s nevus ( cases), hidradenitis suppurativa ( cases), and sarcoidosis ( case). Our results should suggest that
IPL could represent a valid therapeutic support and option by providing excellent outcomes and low side eects, even though
it should be underlined that the use and the eectiveness of IPL are strongly related to the operator’s experience (acquired by
attempting at least one specic course on the use of IPL and one-year experience in a specialized centre). Moreover, the daily use of
these devices will surely increase clinical experience and provide new information, thus enhancing long-term results and improving
IPL eectiveness.
1. Introduction
obtained by U.S. Food and Drug Administration (FDA)
authorization in  for the treatment of lower-limb telang-
is polychromatic, noncoherent, and broad-spectrum
pulsed light source (xenon lamp) is able to emit light of
a wavelength between  nm and  nm []. Its basic
principle consists in the absorption of photons by exoge-
nous or endogenous chromophores within the skin; this
transfer of energy to the target structures generates heat
and subsequent destruction of the target through a process
called selective photothermolysis. e wavelength should be
selected in dependence of the absorption peak of the target
chromophore and the pulse duration should last less than the
thermal relaxation time. is limits the diusion of heat and
damage to surrounding structures.
e main chromophores of the skin, such as haemo-
globin, melanin, and water, have a broad absorption spec-
trum. rough the use of a lter, available from  nm to
 nm, it is possible to select the wavelengths suitable for
the established treatment. e IPL’s pulse duration may be set
within a relatively wide range between  and  milliseconds,
depending on the selected device. In addition, a wide range
of treatment parameters, including pulse sequence and pulse
delay time, can be customized, thus giving users greater
versatility and accuracy [].
Versatility represents a signicant advantage for expe-
rienced dermatologists, but it could be a serious limit for
nonexperienced physicians and for nonmedical sta since
an erroneous selection of the setting can cause serious side
In daily practice, the application of a gel is necessary, as
well as direct contact between the handpiece and the skin,
although this hinders the local immediate response.
Hindawi Publishing Corporation
BioMed Research International
Volume 2014, Article ID 618206, 10 pages
BioMed Research International
T : Clinical data.
Number of patients Gender Mean age (range)
Rosacea   M,  F . (–)
Port wine stain   M,  F . (–)
Disseminated Porokeratosis   M,  F . (–)
Pilonidal cyst  M . (–)
Seborrheic keratosis   M,  F . (–)
Hypertrophic scar/keloids /  M,  F/ M,  F . (–)/. (–)
Becker’s nevus  M  (–)
Hidradenitis suppurativa  M,  F  (–)
Sarcoidosis  F 
Total 58 32M, 26F 42.7 (8–83)
e combination of wavelength, pulse duration, delay,
of several dermatological conditions, such as acne vulgaris,
pigmentation disorders, vascular lesions, hirsutism, photo-
damaged skin, scars and birthmarks, and melasma [].
e authors herein suggest many unconventional uses of
IPL in the treatment of dierent dermatological conditions,
such as rosacea ( cases), port-wine stain (PWS) ( cases),
disseminated porokeratosis ( cases), pilonidal cyst ( cases),
seborrheic keratosis ( cases), hypertrophic scar ( cases)
and keloid scar ( cases), Becker’s nevus ( cases), hidradeni-
tis suppurativa ( cases), and sarcoidosis ( case).
Acne rosacea or rosacea is a chronic dermatitis of
unknown aetiology, characterized by erythema, telangiec-
tasias, papules and pustules [,].
Port-wine stain is a common congenital vascular malfor-
mation occurring in up to % of infants [].
Disseminated porokeratosis is a localized alteration of ker-
atinization. Clinically, one or more atrophic mainly asymp-
tomatic and sometimes mildly itching plaques surrounded by
an hyperkeratotic border (histologically dened as a cornoid
lamella) are observed due to a rapid proliferation of atypical
keratinocytes [].
Pilonidal cyst,alsoknownaspilonidal sinus or sacrococ-
cygeal cyst (due to its frequent onset in this area), is a cyst
containing hair and skin debris [].
Seborrheic keratosis is a benign skin lesion of the epider-
mis, mainly localized on seborrheic areas, in particular, the
a lesion with warty or squamous crusted surface of variable
size, coloured yellow-brown or dark-brown with blackish
specks, with so consistency [,].
Hypertrophic scars and keloids are a serious physical and
psychological dermatological condition for patients. Despite
the several studies performed on metabolisms and treatment
of wounds and scars, the exact pathogenesis of keloids
and hypertrophic scars remains unknown and this makes
therapies even more complicated [].
Becker’s nevus is a mostly male-predominant birthmark
hyperpigmentation, presenting with a unilateral (rarely bilat-
eral), benign hypermelanotic patch usually sited on the shoul-
der, chest, or lower back. Grouped brown spots with a bizarre
border are the common presentation, with hypertrichosis in
half of the cases [,].
Hidradenitis suppurativa is a common disease, also
known as acne inversa, which leads to a chronic relapsing
suppurative inammation of regions where apocrine glands
occur, that is, axilla, inguinal folds, perineum, genitalia,
and periareolar region. Several predisposing, triggering, and
etiologic factors have been encountered (androgenic dys-
function, obesity, etc.); thus, authors agree that aetiology is
still unclear. Commonly, the follicles into which the apocrine
glands open are plugged by keratin and infections, mainly
caused by anaerobic organisms which develop the following
stasis and cause cysts that are extremely painful to palpation
Sarcoidosis is both a systemic and a dermatologic syn-
drome of unknown etiology which can aect the skin as well
multiple and can range from macules to large plaques and
nodules. Cutaneous involvement is referred to in up to %
of patients with systemic sarcoidosis. Plaques, maculopapular
eruptions, subcutaneous nodules, and lupus pernio can be
observed as well as cutaneous manifestations [].
2. Material and Methods
 consecutive patients ( males and  females, mean age
.—range –) presenting with nine dierent dermato-
logical disorders were treated with IPL as an unconventional
approach (Tabl e  ). e aim of the study was to verify the
ecacy of IPL by comparing the obtained results with results
achieved through conventional treatment options (according
to the literature) using either clinical or dermoscopic pictures
before and aer each session. Notably, dermoscopy con-
ducted before treatment conrmed its usefulness in conrm-
ing diagnosis and in highlighting specic characteristics of
each condition, such as number and calibre of blood vessels,
distribution of pigment, and presence of crusts or hairs; thus,
it also represents a valid method for outcome assessments
[]. An IPL device (Deka M.E.L.A. Srl, Calenzano, Florence,
Italy) with two dierent handpieces for  nm and  nm
lters was used and set according to the skin type and clinical
characteristics of each patient. Dermoscopic images were
made in all cases before, immediately aer and at distance
from each treatment using a special lens for dermoscopy
(DermLite Foto, GEN LLC, San Juan Capistrano, CA, USA)
connected to a digital camera (Canon PowerShot A).
BioMed Research International
T : IPL setting for each o-label dermatological disease treated.
Filters Number of pulses Pulse duration Delay Fluence Number of sessions
Rosacea erythematotelangiectatic
component  – msec  msec – J/cmUp to 
Rosacea papulopustular component  – mse c  msec – J/cmUp to 
Port wine stain  – msec  msec – J/cmUp to 
Disseminated porokeratosis  – mse c  msec – J/cmUp to 
Pilonidal cyst   msec  msec –J/cmUp to 
Seborrheic keratosis  – mse c  msec – J/cm
Hypertrophic scar and keloid
pigmented component  – mse c  msec – J/cmUp to 
Hypertrophic scar and keloid
vascular component  – msec  msec – J/cmUp to 
Becker’s nevus
hair removal  -  msec – msec – J/cmUp to 
Becker’s nevus
pigmented component  – mse c  msec – J/cmUp to 
Hidradenitis suppurativa hair
removal  -  msec – msec – J/cmUp to 
Hidradenitis suppurativa
inammatory component  – msec  msec – J/cmUp to 
Sarcoidosis  – msec  msec – J/cmUp to 
A soothing cream, a gentle cleansing, and a photoprotec-
tion (SPF) solution were prescribed to each patient aer
each session.
In the following, the authors describe the IPL scheme
treatments and the results obtained for each dermatological
condition. Each patient has been informed that at least two
sessions up to six sessions, with intervals of approximately
– days, are needed to gain signicant results.
Rosacea. Ten patients ( females and  males) aged between
 and  years (average age . years) with Fitzpatrick
phototype II-III presented with rosacea,  with an erythema-
totelangiectatic form,  with papules and pustules, and only
one with rhinophyma.
e telangiectatic component was treated with the
 nm handpiece, while the papulopustular component was
subsequently treated with the  nm handpiece (Tab l e  ).
Port-Wine Stain. Ten patients ( males and  females) aged
between  and  years (average age . years) with Fitz-
patrick phototype II-III were treated for the presence of a
PWS. Lesions were sited on the malar part of the face (
cases), on the nose ( cases), on the glabella ( case), on the
upper lip ( case), on the forehead ( case), on the posterior
part of the neck ( case), and on the posterior upper-right
limb ( case), respectively. Tab l e  shows the IPL setting used
in these cases.
Disseminated Porokeratosis. Ten patients ( females and 
males) aged between  and  years (average age .
years) with Fitzpatrick phototypes II–IV were treated for
the presence of multiple disseminated, atrophic, and slightly
itchy plaques with a hyperkeratotic border. e lesions were
mainly located on the lower extremities (%), on the upper
extremities (%), and on the back (%). Protocol shown on
Tabl e  has been successfully applied to these patients.
Pilonidal Cyst.reepatients(males),,andyearsold
(average age . years) presented with a recurrent, inamed,
sore, and swollen cyst localized in the sacrococcygeal region.
e lesion of the oldest patient had already been surgically
treated. IPL action on hair follicles is well known and
we thus suggested the use of this device with the aim of
destroying hairs encapsulated within the cyst and hairs in the
surrounding area. e anti-inammatory properties of IPL
proved to be eective in reducing the risk of recurrence. We
decided to treat the lesion according to the protocol shown
on Tabl e  .
Seborrheic Keratosis. Ten patients ( males and  females)
aged between  and  years (average age . years) with
Fitzpatrick phototypes I–III were treated for the presence
of multiple disseminated small seborrheic keratoses sited
BioMed Research International
F : Rosacea: signicant results with a signicant reduction in vessel number and size and a complete disappearance of papules have
been achieved aer  IPL sessions.
All lesions were treated at intervals of – days for a
total of  sessions per case according to the protocol shown
in Tabl e  .
Dermoscopic images were obtained for each case before
(also for diagnostic purpose), immediately aer, and at a
distance from each treatment using the same equipment
described above.
Hypertrophic Scars and Keloids. Ten patients,  presenting
with hypertrophic scars ( males and  females aged between
 and  years, average age . years) and  presenting
with keloids ( females and  males aged between  and 
years, average age . years), were treated with both  nm
(vascular component) and  nm (pigmented component)
wavelength handpieces. e rst sessions with the  nm
handpiece were carried out for the pigmented component
where present. Whereupon, successive treatments with the
 nm handpiece have been made for treating the vascular
component (Table ).
At least  days of rest are required before the subsequent
session and a few months are needed to obtain very positive
Becker’s Nevus. A -year-old man presented with Becker’s
nevus sited on his le shoulder blade. Clinically, a hypertri-
chotic brown patch with irregular edges of  cm ×cm in
size was observed. Successively, a -year-old man presented
with Becker’s nevus without hypertrichosis of , cm ×cm
in size and sited on his upper-right chest. In the rst case, we
decided to rst use a nm wavelength handpiece with the
aim of removing the hair components (Tabl e  ).
Aer four sessions of IPL at intervals of  days, we
performed two additional sessions with the aim of treating
the hyperpigmented component (Table ). Only the protocol
shown in Tabl e  was applied to the second patient since the
hypertrichotic component was not present.
Hidradenitis Suppurativa.One-year-oldman,previously
treated in a surgical way (clinical stage II (Hurley’s stag-
ing system) and sartorius score of ), and one -year-
old woman presented with hidradenitis suppurativa of the
axillary region, bilateral (clinical stage I (Hurley’s staging
system) and sartorius score of ).
Aer four sessions of IPL at intervals of – days,
we performed two additional sessions with pulses of  ms
and  ms separated by a delay of  ms and a uence of
2with the aim of treating the inammatory component
(Tabl e  ).
Sarcoidosis. A -year-old female presented with three
painful, rm, and vascularized nodules sited on the anterior
and posterior parts of the pinna and on the helix. rough
histopathological examination, a diagnosis of sarcoidosis was
posed. e patient had already undergone intralesional cor-
ticosteroid therapy without results. us, we suggested using
the IPL device with the aim of hitting the very prominent
(especially on dermoscopic evaluation) vascular component
within the lesions.
3. Results
In this study, we obtained good outcomes for all the treated
patients, who were aected by dierent dermatological con-
ditions. Our results are summarized as follows.
Rosacea. Patients required from  to  sessions, at intervals
of approximately – days, to gain signicant results, even
though a moderate reduction in vessel number and size and a
partial disappearance of papules were observed subsequent to
thesecondsession(Figure ). A -month follow-up revealed
the complete absence of recurrences and the persistence of
other  patients required a new treatment within the year for
the slight relapse of the papulopustular component.
Port-Wine Stain. e results were already visible aer the end
of the rst session. Dermoscopy performed before treatment
highlighted the number, calibre, and depth of the target
vessels. Supercial vessels were hit with greater accuracy
by IPL and dermoscopic examinations revealed a change in
vessel colour from red to blue immediately aer treatment.
In cases of high numbers of vessels, erosions and crusts can
follow treatment sessions for several days. e number of the
treatments required to gain signicant results depended on
the depth and site of the PWS.
ree out of  patients (%) obtained excellent results
(disappearance of PWS),  of  (%) obtained good results
(disappearance of almost % of treated vessels), and only
one (%) obtained a moderate result (disappearance of about
% of the lesion) (Figure ). e obtained results, conrmed
BioMed Research International
F : Port-wine stain: aer  IPL sessions, the patient gained excellent results.
F : Disseminated porokeratosis: aer  treatments, an important reduction of the hyperkeratotic edge and a reduction in the intensity
of melanin have been observed.
by dermoscopy, were stable aer a follow-up period ranging
from  to  years.
Disseminated Porokeratosis. All treated patients showed inter-
esting results, despite the fact that the histology conrmed the
persistence of cornoid lamella. In fact, one patient who had
shown signicant improvements aer four sessions presented
at the follow-up visit with an important reduction of the
hyperkeratotic edge and a reduction in the intensity of
melanin (Figure ); a punch biopsy was performed and the
histopathologic examination revealed the persistence of a
cornoid lamella.
Pilonidal Cyst. A complete resolution was achieved by the
third session ( days aer the rst visit) in  patients treated.
(Figure ) Aer a follow-up period of  years, for the rst
has been observed.
Seborrheic Keratosis. Supercial and small seborrheic ker-
atoses responded well to IPL, whereas larger and/or deeper
lesions may require a CO2laser or other treatment. Der-
moscopy is useful either to conrm diagnosis or to demon-
strate a change in lesion colour from brown to grey immedi-
ately aer treatment, thus predicting a good response to the
treatment. Seborrheic keratosis was usually resolved with a
mild inammation and a complete recovery within  days
aer an average of two treatments (Figure ).
Hypertrophic Scars and Keloids. Dermoscopic images reve-
aled a signicant reduction of vascular component in the
thicker areas. Scars attened and became smaller aer three
sessions. (Figures and ) All in all, good results were
achieved, even though lengthy treatment (several months) is
needed. e obtained results were stable during the follow-
growth phase.
Becker’s Nevus. A progressive hair removal and a reduction
of the hyperpigmented area were achieved to the good
satisfaction of both patients (Figure ).
Hidradenitis Suppurativa. At the end of the suggested scheme
protocol, hidradenitis suppurativa was completely removed
in both its inammatory and painful components; hair
removal was also achieved (Figure ).
Sarcoidosis. A signicant reduction of the vascular compo-
nent and in the consistency of the lesions was achieved, thus
leading to pain disappearance (Figure ).
4. Discussion
In this study, we report on our good results achieved with
almost all  patients aected by dierent dermatological
conditions. With the aim of providing more exhaustive
details, we will briey discuss each condition separately.
BioMed Research International
F : Pilonidal cyst: a complete resolution was achieved by the third session.
F : Hidradenitis suppurativa: complete resolution of pustular-papules progressive hair removal aer  IPL treatments, bilaterally.
Clinical stage I (Hurley’s staging) and sartorius score of .
F : Seborrheic keratosis: (a) signicant reduction of multiple seborrheic keratoses of the face aer  IPL sessions, (b) seborrheic
keratoses of the back disappeared aer  IPL sessions.
BioMed Research International
F : Hypertrophic scar: signicant reduction of vascular component in the thicker areas before and aer  IPL treatments.
F : Keloid: scar aer three sessions of IPL. Dermoscopy performed immediately aer the rst treatment showed a variation of the color
from red-blue to red.
Rosacea. Treatment of clinical manifestation of rosacea usu-
ally involves lasers such as argon, pulsed dye, Nd:YAG, CO2,
and KTP, frequently causing burns, pain, and outcomes such
as scars and signicant hyperpigmentation due to incautious
assessment of the lasers’ photophysical parameters.
e ability to choose the duration of pulses makes IPL
a versatile tool in the treatment of rosacea. e possibility
of dierent lter settings (, , , , and  nm)
system. A surface of . cm2can be treated with a single shot,
in contrast to the pulse dye laser (. cm2or . cm2)and
argon ( mm2). e larger surface oers greater eciency, in
terms of reducing treatment sessions, and less discomfort for
or three pulses with dierent delays between one pulse and
the next, IPL allows the skin to cool down with minimal side
eects [].
Since the treatment is relatively unpainful, it can be
carried out in the absence of anaesthesia. Immediate response
usually presents as a slight erythema and a purple colouring
which spontaneously resolves within – hours [].
In a pilot study conducted by Mark et al., a % reduction
of blood ow, a % reduction of telangiectasias, and a
% reduction of erythema have been observed aer ve
sessions of IPL. Taub et al. noticed a reduction of % of
erythema, a reduction of % of ushing, and an improved
skin texture [,]. A  study performed by Papageorgiou
et al. noted the eectiveness of IPL in the treatment of rosacea
disease of phase I. It showed a signicant improvement of
erythema, telangiectasias, and ushing. Severity was reduced
and persistent results at  months with minimal side eects
were obtained []. Reduction in the mechanical integrity
of connective tissue of the dermis surface, responsible for
passive dilatation of the blood vessels and thus resulting in
erythema, telangiectasia, release of inammatory mediators,
and the formation of inammatory papules and pustules,
seems to play a key role in the treatment of rosacea. Moreover,
IPL can improve rosacea through the ablation of its abnormal
vessels and through the collagen remodelling of the dermis.
Furthermore, IPL determines a signicant reduction of
inammation and in the number of active sebaceous glands,
thus blocking, with great eectiveness, the altered process of
keratinization [].
In our study, all patients achieved signicant results with
Port-Wine Stain.Laserssuchasthepulsedyelaser,Nd:YAG,
alexandrite, and the diode laser are the most used ones in the
treatment of PWS [,].
Currently, the rst-choice treatment for PWS is rep-
resented by the pulsed dye laser; unfortunately, it cannot
completely remove PWS. e energy emitted reaches only
supercial vessels, thus resulting in a decreased amount of
available light to hit the deeper ones (shadow eect). Because
of this eect, hyper- and hypopigmentation and atrophic and
hypertrophic scars may result aer treatment []. When a
PWS, especially with nodular component, is treated with an
external light source, the main goal is to reach the vessels
localized at the lower surface. IPL, thanks to its variability of
BioMed Research International
F : Becker’s nevus: a progressive hair removal and a reduction of the hyperpigmented area were achieved to the good satisfaction of
the patient.
F : Sarcoidosis: signicant reduction of the nodules with diminution of the painful sensation aer  IPL treatments.
into dierent pulses, allows an additional heating which
leads to coagulation of blood vessels of dierent diameter
and dierent depth [,]. Raulin et al. reported a –%
resolution of pink-coloured PWS aer . treatments, of red
PWS aer about . treatments, and of purple PWS aer
an average of . sessions. In a study by Ozdemir et al.,
 patients with PWS were evaluated with results of up to
% in  patients and –% in  patients. In fact, IPL
can be considered an eective treatment option. However,
IPL systems require considerable experience and should be
conducted with the aid of a good dermoscopy in order to
determine the type of vessels to treat [].
Disseminated Porokeratosis. Potential therapies include topi-
cal -uorouracil, oral retinoids, CO2laser, pulse dye laser,
Nd:YAG, cryotherapy, dermabrasion, surgical excision, and
imiquimod, or a combination of several therapies simultane-
ously [].
In cases of supercial actinic porokeratosis, IPL proves to
be a valid therapeutic option by determining a destruction
of the pigment without risk of scarring or other side
Pilonidal Cysts and Hidradenitis Suppurativa. According to
the literature, laser technology applied in such cases includes
CO2laser and Nd:YAG. For its photocoagulative action,
CO2laser treatment produces a precise wound with minimal
blood loss, leaving a surgical eld clean and dry, but it is able
to coagulate large vessels and requires a long recovery period
IPL may represent a valid option for such lesions. e
broad light spectrum is absorbed by the hair sha, generates
heat, and destroys the hair follicle. IPL acts on the melanin
of the hair follicle causing necrosis of the follicle within the
cyst. Similarly, it acts on the hairs of the surrounding area in
order to reduce recurrence. Moreover, IPL has proven to be
a powerful anti-inammatory treatment able to eliminate the
chronic inammation within the cyst []. In , Highton et
al. selected  patients aected by HS and treated one axilla,
groin, or inframammary area with intense pulsed light two
BioMed Research International
times per week for  weeks using a harmony laser, whereas
the contralateral side received no treatment and was used as a
control. A signicant improvement in the mean examination
and its persistence at  months led patients to report high
levels of satisfaction. No concurrent improvement on the
untreated control side has been observed. is small study
suggests that intense pulsed light may be an eective treat-
ment for HS. Although only a few data have been reported so
far, results suggest ecacy and safety and the absence of side
eects [].
Seborrheic Keratosis. In previous studies, lasers have been
demonstrated to be eective in the treatment of seborrheic
keratosis, such as alexandrite (nm) and diode laser [].
No studies on the use of pulsed light for the treatment
of seborrheic keratosis have been published so far. anks
to its broad spectrum of action, it is possible to select the
specic wavelength to act selectively on the melanin pigment
of seborrheic keratosis. Immediately aer the treatment,
a change in colour from brown to grey is observed at
dermoscopic evaluation and this represents a sign of success
of the performed procedure []. Subsequently, keratosis
tends to disappear completely without residual erythema.
e treatment is, however, limited to supercial and small
seborrheic keratoses.
Hypertrophic Scars and Keloids.epulsedyelaserhas
been reported to produce long-term improvements in the
appearance of hypertrophic scars. A very recent pilot study
has demonstrated the eectiveness of IPL in wound heal-
fully understood but most probably an action on vascular
proliferation, essential for the growth of collagen, and on
pigmentation resulting from scar formation is involved [].
studies demonstrating its eectiveness on hypertrophic scars
have been published to date. Wavelengths around  nm
are absorbed by the water within the dermis thus triggering
a reaction that leads to cytokine stimulation of collagen
bres of types I and III and elastin. e absorption peak of
the collagen bres is found to be from nm to  nm.
e heating of the collagen bres by the IPL leads to their
contraction, with a clinically detectable improvement in the
texture. e IPL, in contrast to other treatments, is not
invasive and has very few side eects. Bellew et al. have
( nm), resulting in a greater soness of the scar. Kontoe
et al. reported an improvement of more than % in the
pigmentation of hypertrophic scars, % higher than that in
the scars from asphalt, and % reduction in the size and
thickness of hypertrophic scars. is is probably due to the
inhibition of the action of the vessel caused by IPL on scar
tissue and on the subsequent proliferation of collagen [].
Becker’s Nevus. Trelles et al. compared the eectiveness of the
Erbium:YAG laser with the Nd:YAG laser in  Becker’s nevus
patients,  for each group. Up to now, there have been no
studies on the treatment of Becker’s nevus with IPL. Such
treatment is able to produce synchronized single or multiple
pulses with the possibility of varying the pulse duration.
We can then select the appropriate wavelength, taking into
account the main absorption spectrum of the pigmented
structures (between  nm and  nm) and the right pulse
duration to act eciently on the hair follicle. We can operate
on both components with excellent results. [,].
Sarcoidosis. In his systematic review on the use of pulsed
dye laser in the treatment of inammatory skin diseases
published in , Erceg A reported on ve case reports of
PDL treatment for cutaneous sarcoidosis/lupus pernio [
]. In our experience, IPL has been proven to have a signif-
icant eect on the vascular component of granulomata. Even
though IPL could not denitely treat cutaneous sarcoidosis, a
great improvement of patients’ pain and symptoms could be
5. Conclusions
According to the literature, the eectiveness of IPL has now
been well demonstrated. Its versatility, in contrast with many
single-laser spectrums, has led to its rapid spread in dierent
clinical scenarios, while the wide range of wavelengths allows
us to use these devices for a broader range of clinical condi-
tions. However, we would like to underline how the use and
experience. Apart from facilitating excellent outcome, the
broad spectrum of wavelengths used and the high number
of parameters can aect the nal result and increase the
risk of side eects. e daily use of these devices will surely
increase clinical experience and provide new information,
thus enhancing long-term results and improving IPL eec-
Conflict of Interests
e authors declare that there is no conict of interests
regarding the publication of this paper.
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... The main clinical difference between a hypertrophic scar and a keloid is that growth reaction remains within the margins of the scar in hypertrophic scars, while in keloids, the reaction extended to the boundaries of the initial scar. Many treatment modalities which ranged from surgical intervention to laser and intralesional injections of steroids and fluorouracil have been used [2]. Flatting of the lesions could be obtained; however, the other symptoms and signs of hypertrophic scars and keloids such as itching, erythema, lack of movement, and hyperpigmentation could not be treated completely by one of these modalities alone [3]. ...
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Background Post-burn hypertrophic scar and keloid are challenging problems. Intense pulsed light (IPL) vascular filter (550–1200nm) has a similar effect to the pulsed dye laser 585nm in management of the same cutaneous applications.Methods This prospective comparative study was conducted on 34 patients with post-burn hypertrophic scars and keloid. The lesions were irradiated, using an IPL filter 550–1100 nm, 20 ms pulse duration, and fluence of 34 J/cm2. Sessions done every 2 weeks over a period of 6 months. The follow-up was scheduled for 1 month and 6 months. Evaluation methods were both subjective by the Vancouver scar scale (VSS) and objective by the skin imaging analysis system.ResultsPatients received 12 sessions. Erythema was the first sign to show improvement after the second session while itching was the first symptom which showed improvement followed by pain and finally improvement in the range of movement. The improvement of the VSS was higher in the hypertrophic scars than the keloid group (P˂ 0.001).ConclusionsIPl proved its efficacy in the treatment of post-burn hypertrophic scars and keloid. However, the improvement in the pliability and erythema in hypertrophic scar was higher than in keloids.Level of evidence: Level IV, Therapeutic
... In recent years, other types of lasers have been applied to the treatment of BN, such as IPL [27], 1550-nm erbiumdoped fber laser [28], and erbium: yttrium aluminum garnet (Er: YAG) [21,29], and they appear to be efective. However, the benefts of ablative 10600-nm fractional lasers for BN remain unknown and require more trials and data [30,31]. ...
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Background. Becker’s nevus (BN) severely affects a patient’s appearance and can lead to depression, especially when it involves the face or neck. Currently, there is no effective treatment. Laser therapy has become popular, but its efficacy has not been confirmed. We evaluated the efficacy and safety of lasers in treating BN. Methods. This retrospective study involved 49 patients exposed to different laser treatments who completed at least one treatment session and follow-up. Results. The patients treated with the 755-nm alexandrite picosecond laser and Q-switched 694-nm ruby laser gained relatively good results: 3.07 ± 1.09 and 2.87 ± 1.14 on the five-point scale and 3.47 ± 0.73 and 3.40 ± 0.85 on the GAIS, respectively. However, the results of the 755-nm alexandrite picosecond laser with a diffractive focus lens array and the fractionated 1064-nm neodymium-doped: yttrium aluminum garnet picosecond laser were poor. Furthermore, there were marked differences between the number of treatment sessions and treatment effects, both for the five-point grading score for pigment clearance (F = 15.246, p < 0.001 ) and GAIS (F = 15.469, p < 0.001 ). Concerning different lasers and efficacy, there were no marked differences between the five-point grading scale and the GAIS ( p > 0.05 ). Conclusions. Although the efficacy of various lasers for BN is not satisfactory and there are no marked differences between picosecond and Q-switched lasers, they can help in selecting an appropriate laser for slight-to -moderate pigment removal. The 755-nm alexandrite picosecond laser is a new option, whereas nonablative fractional picosecond lasers for BN are not recommended. Increasing the number of treatment sessions can improve the curative effect slightly.
... An early publication in 2008 by Papageorgiou reported a significant improvement of 46% erythema and 55% telangiectasia with 4 sessions of IPL in 34 UK rosacea patients, and the improvements were sustained for 6 months [25]. In 2014, Piccolo demonstrated that 2-5 sessions of IPL can be used to reduce vessel number and size in 10 Italian rosacea patients, and maintenance of achieved outcomes was observed in 70% of patients at 12-month follow-up [26]. Recently, we published a 10-year retrospective study of light/laser (including IPL) on rosacea. ...
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Rosacea is difficult to treat. Therefore, new alternative modalities are necessary to demonstrate. The present study was conducted to assess the efficacy and safety of the combined therapy of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) and intense pulsed light (IPL) for rosacea to provide a new treatment option for rosacea. The study was conducted from November 2017 to April 2019 at the Department of Dermatology, The First Hospital of China Medical University. Patients aged 18–65 years and diagnosed clinically as erythematotelangiectatic (ET) or papulopustular (PP) rosacea were enrolled. Three times of ALA-PDT at 10 days interval followed by 3 times of IPL at 3–4 weeks interval were defined as 1 session and applied to the whole face of each patient. ALA-PDT: 5% ALA, red light (fluency dose 60–100 mW/cm2, 20 min); IPL: 560/590/640 nm, double/triple-pulse mode, pulse width 3.0 to 4.5 ms, delay time 30–40 ms, energy fluency 14–17 J/cm2. Ten patients were enrolled in the study. Among them, 4 patients received only 1 session, while 6 patients received 2 sessions. After all treatments, 50% of patients achieved 75–100% improvement, and 30% achieved 50–75% improvement. Forty percent of patients were graded very satisfaction and 30% graded moderate satisfaction. All noninvasive measurements showed no significant differences among all time points (p > 0.05). The side effects were pain, burning sensation, itching, erythema, desquamation, slight edema, slight exudation, and hyperpigmentation. All of which were tolerable and recovered in a few days. The combined therapy of ALA-PDT and IPL showed an effective option for rosacea with a safety profile.
... After an average of two treatments, seborrheic keratoses typically disappeared with a slight inflammatory reaction and a full recovery within 30 days. Keratosis typically vanishes entirely, leaving no erythema behind.60 4.pulsed-dye laser (case report) The patient experienced little erythema, edema, and pain during the procedure, each of which subsided within 24 to 48 h. ...
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Seborrheic keratosis (SK) is a common, benign tumor that can occur on every body site and can be conservatively managed. Cosmetic concerns, especially when a lesion involves the facial area, is the most common reason for excision. SK shows male gender preponderance and increasing age is an independent association with the condition. Even though more prevalent in the elderly, it has also been reported in younger age groups like adolescents and young adults. Precise pathogenesis is still obscure, but ultra-violet exposure represents a predisposing factor to seborrheic keratosis by altering the biochemical concentration and expression of factors like Glutamine deaminases, endothelin, and stem cell factor. Moreover, the accumulation of amyloid-associated protein has also been postulated. Involvement of genitalia has been associated with human papillomavirus infection. Recently, Merkel cell polyomavirus nucleic acid was also detected in seborrheic keratosis. Several oncogenic mutations involving FGFR-3 and FOXN1 have been identified. SKs are usually classified clinically and histologically. Dermatoscopy is a non-invasive alternative diagnostic technique widely used in differentiating SK from other benign and malignant tumours. In terms of treatment, topical agents, shave dissection, cryosurgery, electrodesiccation, laser application and curettage under local anesthesia are safe methods for eradication of SKs, mostly for cosmetic purposes. Though generally safe, the latter techniques may occasionally cause post-procedure depigmentation, scarring, and recurrence. Nanosecond pulsed electric field technology is a promising new technique with fewer side-effects. This article is protected by copyright. All rights reserved.
Importance: The management of pilonidal disease continues to be a challenge due to high rates of recurrence and treatment-associated morbidity. Observations: There is a heterogeneous repertoire of treatment modalities used in the management of pilonidal disease and wide practice variation among clinicians. Available treatment options vary considerably in their level of invasiveness, associated morbidity and disability, risks of complications, and effectiveness at preventing disease recurrence. Conservative nonoperative management strategies, including persistent improved hygiene, depilation, and lifestyle modification, focus on disease prevention and minimization of disease activity. Epilation techniques using both laser and intense pulse light therapy are also used as primary and adjunct treatment modalities. Other nonoperative treatment modalities include phenol and fibrin injection to promote closure of pilonidal sinuses. The traditional operative management strategy for pilonidal disease involves excision of affected tissue paired with a variety of closure types including primary midline closure, primary off-midline closure techniques (ie, Karydakis flap, Limberg flap, Bascom cleft lift), and healing by secondary intention. There has been a recent shift toward more minimally invasive operative approaches including sinusectomy (ie, trephination or Gips procedure) and endoscopic approaches. Overall, the current evidence supporting the different treatment options is limited by study quality with inconsistent characterization of disease severity and use of variable definitions and reporting of treatment-associated outcomes across studies. Conclusions and relevance: Pilonidal disease is associated with significant physical and psychosocial morbidity. Optimal treatments will minimize disease and treatment-associated morbidity. There is a need for standardization of definitions used to characterize pilonidal disease and its outcomes to develop evidence-based treatment algorithms.
This chapter thoroughly examines various IPL and laser scar revision and treatment technologies. Furthermore, it is divided into two sections: atrophic scars and hypertrophic scars. The chapter provides practitioners with useful assessment tools for differentiating scars based on their depth, shape, texture, and origin. Furthermore, it assists readers by recommending the best treatment based on scar type using various light IPL, 532 nm KTP, 1064 nm Nd:YAG, with a special emphasis on 1550 nm Er:Glass, a 1927 nm thulium, 2940 nm Er:YAG, and 10,600 nm CO2 lasers.KeywordAtrophic scarsAcne scarsFractional non-ablative lasersFractional ablative lasersHypertrophic scarsKeloids
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This study reviewed the efficacy and safety of intense pulsed light (IPL) for the treatment of dry eye disease (DED). The PubMed database was used to conduct the literature search, which used the keywords "intense pulsed light" and "dry eye disease". After the authors evaluated the articles for relevancy, 49 articles were reviewed. In general, all treatment modalities were proven to be clinically effective in reducing dry eye (DE) signs and symptoms; however, the level of improvement and persistence of outcomes differed amongst them. Meta-analysis indicated significant improvement in the Ocular Surface Disease Index (OSDI) scores post-treatment with a standardized mean difference (SMD) = −1.63; confidence interval (CI): −2.42 to −0.84. Moreover, a meta-analysis indicated a significant improvement in tear break-up time (TBUT) test values with SMD = 1.77; CI: 0.49 to 3.05. Research suggests that additive therapies, such as meibomian gland expression (MGX), sodium hyaluronate eye drops, heated eye mask, warm compress, lid hygiene, lid margin scrub, eyelid massage, antibiotic drops, cyclosporine drops, omega-3 supplements, steroid drops, and warm compresses along with IPL, have been found to work in tandem for greater effectiveness; however, in clinical practice, its feasibility and cost-effectiveness have to be taken into consideration.
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Becker's nevus (BN) is a benign hamartoma that may present as a distressing cosmetic problem. The treatment of BN poses a significant challenge as current therapeutic modalities are suboptimal and have an increased risk of adverse effects, such as scarring and dyspigmentation. We present the use of non-ablative fractional laser therapy combined with Q-switched Nd:YAG laser as a possible therapeutic option for BN treatment and review relevant literature to discuss its efficacy and limitations.
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Purpose of Review This article reviews the history, indications, therapeutic safety/efficacy, and suspected mechanisms of action of intense pulse light therapy (IPL) in treating meibomian gland dysfunction (MGD) and related conditions. Recent Findings IPL has been used by dermatologists since the 1980s. Today, through reduction of meibum viscosity, photocoagulation, photobiomodulation, photorejuvenation, and antimicrobial effects, IPL is becoming more widely employed as a novel approach for MGD in ophthalmology. Recent literature supports IPL as a safe and effective approach to managing the symptoms and signs of MGD, though patient selection and treatment duration/protocol vary. Summary MGD is a common ophthalmologic condition that significantly impacts a patient’s quality of life. Oftentimes, MGD can be managed with conventional treatments. In more refractory cases of MGD, IPL represents an innovative, in-office, procedural-based therapeutic approach with promising efficacy and safety.
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Dermoscopy (synonyms include dermatoscopy, epiluminescence microscopy, surface light microscopy and reflected light microscopy) is a non-invasive instrumental method for the invivo study of pigmented skin lesions. This technique allows for viewing the parameters that would otherwise be invisible to the naked eye. The term “dermoscopy” was introduced for the first time in 1920 by Saphier. This method was initially used to study the capillaries of normal and diseased skin. Subsequently, in 1951, Goldman was the first to use monocular instruments to study nevi and melanomas via epiluminescence. The following year he also invented the first portable dermatoscope. Modern dermoscopy probably stems from authors Pehamberger et al. who introduced a pattern analysis for diagnosing pigmented skin lesions in 1987. The first Consensus Meeting on dermoscopy was held in Hamburg in November 1989, during which the first common terminology for dermoscopic criteria was established. The first semi-quantitative diagnostic algorithm was proposed in 1994 by Stolz et al., known as “the ABCD rule of dermatoscopy”. In 1998, Argenziano et al. introduced a semi-quantitative diagnostic system with 7 points known as the “seven-point checklist”, based on a simplified pattern analysis. The first interactive atlas of dermoscopy was published on CD-ROM in 2000 by Argenziano et al. which defined the main demoscopic criteria. In 2005, Chimenti et al. published the Italian guidelines for dermoscopy, while, in 2007, Bowling et al. reported the recommendations of the “International Dermoscopy Society”. Over recent years dermoscopy has proved to be extremely useful even on dermatological pathologies of an inflammatory origin and skin parasitosis. Over the last decade, the rapid development of new laser technologies has brought radical changes to clinical practice in dermatology, with huge increases in the treatment potential of pathologies that were very difficult to cure until several years ago, reducing to a minimum any scarring of the tissues around the lesions. While the surgical use of laser, in particular CO2 laser, has produced excellent results over the last few years, the new technologies have recently improved the therapeutic possibilities in the field of: . Pigmentary disorders . Vascular pathologies . Photorejuvenation . Hair removal . Hypertrophic scars and keloids . Tattoo removal At the present time, laser is able to resolve often disfiguring skin problems, with excellent patient compliance and shorter recovery times, thus replacing conventional surgical therapies which are not able to guarantee the same results. Intense pulsed light (IPL) was introduced at the end of the 90’s especially for treatment of superficial telangiectasias, pigmented lesions and hair removal. This procedure avails of a pulsating luminous energy source which, unlike laser, is incoherent and has a wide spectrum. Although not really a laser, IPL has indications for use similar to those of dermatological lasers, since it covers a broad spectrum of wavelengths and can be widely used in treating vascular lesions of the skin, pigmentation disorders, hirsutism and hypertrichosis. The purpose of this study is to demonstrate the validity of dermoscopy before, during and after treatment with laser and IPL. All cases presented in this book were treated during my laser and IPL experience from 2001 onwards and all concern Italian patients with phototypes varying between II and III (according to Fitzpatrick’s classification scale). The results obtained therefore pertain to this kind of population. However, I am extremely confident that it will be possible to achieve similar results with appropriate adjustments to suit the phototypes and skin types of different populations worldwide.
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Hidradinitis suppurativa (HS) and pilonidal sinus (PNS) are chronic inflamatory skin diseases, often refractory to treatment and search for a new treatment is on. We tried deroofing with the help of carbon dioxide laser in patients of HS and PNS, however there was recurrence. To evaluate a technique combining the use of CO(2) laser and long pulse 1064 nm Neodymium-doped Yttrium Aluminium Garnet (Nd:YAG) laser for the treatment of HS and PNS. In 4 patients with HS and 5 patients with PNS, we performed procedure in two steps: first destroying the hair follicles with long pulse Nd yag 1064 laserfollowed by deroofing with carbon di oxide laser. Follow up was done upto 3 years. All patients with HS were females in the age group of 30-40 years. In PNS, 2 male patients were of age less than 20, two male patients of age more than 20 and one females of age less than 20. None of the HS or PNS patients showed recurrence. The deroofing with CO(2) laser along with hair follicle removal with long pulse Nd:YAG laser is an effective minimally invasive tissue saving surgical intervention for the treatment of refractory HS and PNS lesions.
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Hypermelanosis includes a diverse group of genetic and acquired skin anomalies that appear as darker, hyperpigmented areas. Melasma, in particular, is a hypermelanotic condition that affects sun-exposed skin in females. Whether this condition is acquired or genetic is still controversial. However, it clearly correlates with exposure to UV light, a genetic predisposition, and hormonal variations (from pregnancy or oral contraceptives). Between October 2006 and March 2008, 38 patients with melasma were treated with intense pulsed light (IPL) at the LASER Center of the Department of Health Science, Plastic and Reconstructive Surgery Session, University of L'Aquila. Diagnosis was based on medical history, physical examination, and video microscopy. Results were graded as excellent, good, moderate, or poor. Grades were given according to outcome scale and reported complications. All 38 patients had follow-up checks at 30 days, 3 months, and 6 months and someone at more than 1 year. Results were excellent in 18 patients (47.37%), good in 11 (28.95%), moderate in 5 (13.16%), and poor in 4 cases (10.52%). From a careful review of the scientific literature and according to our personal clinical experience, IPL stands out as an effective tool in the treatment and healing of a high percentage of hypermelanosis and melasma, with a very low risk of complications and an excellent satisfaction rate among patients.
BACKGROUND: The position of the pulsed dye laser (PDL) in the treatment of inflammatory skin diseases is still unclear. Evidence-based recommendations are lacking. OBJECTIVES: We sought to systematically review all available literature concerning PDL treatment for inflammatory skin diseases and to propose a recommendation. METHODS: We searched for publications dated between January 1992 and August 2011 in the database PubMed. All studies reporting on PDL treatment for an inflammatory skin disease were obtained and a level of evidence was determined. RESULTS: Literature search revealed 52 articles that could be included in this study. The inflammatory skin diseases treated with PDL consisted of: psoriasis, acne vulgaris, lupus erythematodes, granuloma faciale, sarcoidosis, eczematous lesions, papulopustular rosacea, lichen sclerosis, granuloma annulare, Jessner lymphocytic infiltration of the skin, and reticular erythematous mucinosis. The efficacy of PDL laser treatment for these inflammatory skin diseases was described and evaluated. LIMITATIONS: Most conclusions formulated are not based on randomized controlled trials. CONCLUSIONS: PDL treatment can be recommended as an effective and safe treatment for localized plaque psoriasis and acne vulgaris (recommendation grade B). For all other described inflammatory skin diseases, PDL seems to be promising, although the level of recommendation did not exceed level C.
Hidradenitis suppurativa is a chronic skin condition characterized by recurrent inflammation and infection of skin in intertriginous areas containing apocrine glands. Intense pulsed light uses high-energy broad-spectrum light. Current applications include hair removal and the treatment of acne vulgaris, which has a pathogenesis similar to that of hidradenitis suppurativa. The authors conducted a study to determine whether intense pulsed light is an effective treatment for hidradenitis suppurativa. Eighteen patients were randomized to treatment of one axilla, groin, or inframammary area with intense pulsed light two times per week for 4 weeks using a Harmony Laser. The contralateral side received no treatment and acted as a control. The response to treatment was assessed using a validated examination and clinical photographs, and by measuring patient satisfaction on a Likert scale. After treatment, there was a significant improvement in the mean examination score that was maintained at 12 months (p < 0.001, logistical regression analysis). The improvement was confirmed by independent assessment of clinical photographs (interrater reliability, 0.79; p < 0.001). Patients reported high levels of satisfaction with the treatment. There was no concurrent improvement on the untreated control side. This small study suggests that intense pulsed light may be an effective treatment for hidradenitis suppurativa. It could be added to treatments used for this condition, particularly for patients keen on avoiding surgery and those with groin and inframammary disease. Further studies are required to confirm the efficacy and mechanism of action of intense pulsed light in hidradenitis suppurativa.
Laser applications have revolutionized the treatment of many cutaneous vascular anomalies. Because most of these lesions are congenital, the pediatric population has benefited primarily. In this article, the authors focus primarily on laser treatment options, realizing that this modality is but one part of an overall comprehensive plan of management options for these affected children. The literature was reviewed and interjected into the authors' 20 years of experience in the use of lasers in the pediatric population. The use of different therapy modalities, such as the neodymium:yttrium-aluminum-garnet laser, pulsed dye laser, erbium:yttrium-aluminum-garnet laser, and intense pulsed light systems, is discussed. Outcomes, risks, benefits, and treatment protocols vary for each entity and for each laser. The authors' results and those of others are presented. Lasers play a vital role as an adjunctive therapy or definitive therapy in many of the authors' pediatric patients. Anyone treating such patients should be well aware of lasers as a valuable tool.
Porokeratosis of Mibelli (PM) is a clonal disorder of keratinization. It clinically presents with one or more annular plaques with central atrophy and elevated keratotic borders. With a 7.5 percent risk of malignancy, PM should be treated to prevent transformation into squamous cell carcinoma, Bowen disease, or basal cell carcinoma. Multiple treatment options are available, however, there is not one universally effective treatment. We describe the successful treatment of porokeratosis of Mibelli of the left calf in an 83-year-old man with topical 5 percent imiquimod and topical 5 percent 5-fluorouracil.
We describe a 73-year-old woman with a long-standing history of annular, hyperkeratotic papules that began on the palms and soles and gradually spread to her trunk, extremities, and face. The clinical presentation and biopsy findings were consistent with PPPD, which is a rare subtype of porokeratosis that begins on the palms and soles and gradually spreads to the trunk and extremities. Owing to the risk of malignant degeneration in porokeratosis, patients should be closely monitored with total body skin examinations. There is no definitive treatment for PPPD. Oral retinoids are sometimes helpful although relapses are common after discontinuation of therapy.