Biomedical subjects
Publications and source records attributed to Eric C Parlette.
Cutaneous T-cell lymphoma (CTCL) has a variable presentation and comprises a broad diagnostic group. Histologic and immunophenotypic confirmation is needed to establish a precise diagnosis. Once the categorization is determined, prognosis and therapeutic algorithms unfold. Primary cutaneous, CD-30+, anaplastic, large T-cell lymphoma represents an indolent form of CTCL that often spontaneously involutes.
BACKGROUND: Leg veins can be effectively treated with lasers. However, the optimal pulse duration for small leg veins has not been established in human studies with a Nd:YAG laser. OBJECTIVES: The purpose of this study was to investigate a range of pulse durations to determine an optimal pulse duration for clearance of leg veins. STUDY DESIGN/MATERIALS AND METHODS: After mapping and photo documentation of the leg veins to be treated, a variable pulse duration Neodymium:Yttrium Aluminum Garnet (Nd:YAG) laser (3-100 milliseconds) was used in a single test site session. Pulse durations of 3, 20, 40, 60, 80, and 100 milliseconds were used. At the 3-week follow-up, the optimal pulse duration was defined as that pulse duration which resulted in the most complete clearance of vessels with the least side effects. Up to 20 vessels were then treated using the established "optimal" pulse duration. Final evaluation was at 16 weeks after the initial visit. Three blinded observers rated the percent of vessels completely cleared based on initial and final photographs. RESULTS: Eighteen patients completed the study. Fluence thresholds for immediate vessel changes varied depending on spot size and vessel diameter, with larger fluences required for smaller spot sizes and smaller vessels. Shorter pulse durations (< or =20 milliseconds) were associated with occasional spot sized purpura and spot sized post-inflammatory hyperpigmentation. Longer pulse durations (40-60 milliseconds) achieved superior vessel elimination with less post-inflammatory hyperpigmentation. With a single laser treatment, 71% of the treated vessels cleared. CONCLUSIONS: Compared to shorter pulses (<20 milliseconds), longer pulses may provide gentler heating of the vessel and a greater ratio of contraction to thrombosis.
BACKGROUND: Variable-pulse 1,064 nm wavelength lasers have been used with good effectiveness on leg telangiectasias and reticular veins and have shown promising results on facial telangiectasias as well. OBJECTIVE: To investigate the effectiveness of a variable-pulse neodymium:yttrium-aluminum-garnet (Nd:YAG) laser using a small spot size in the treatment of facial telangiectasias. METHODS: Eight male patients (mean age 75 years) underwent a single treatment session using a variable-pulse 1.5 mm spot size Nd:YAG laser with epidermal cooling. Telangiectasia diameters were 0.3 to 2.0 mm. Test sites were performed using three pulse widths (3, 20, and 60 ms), with fluences varying depending on vessel size and response. Full treatments were performed using test parameters giving the best response. Thirteen weeks later, the patients returned for final evaluation and satisfaction rating. RESULTS: Fluences ranged from 226 to 425 J/cm2, with smaller vessels requiring larger energies. Pulse duration was equally divided between the 20 and 60 ms settings. The shortest pulse width (3 ms) was inferior in all patients. Longer pulse durations achieved superior vessel elimination with minimal immediate purpura and no postinflammatory hyperpigmentation. The average mean vessel clearance was 26 to 50% in half of the patients and 51 to 75% in the other half as evaluated by three unbiased dermatologists with extensive laser experience. CONCLUSION: A small-spot size Nd:YAG laser using a pulse width of 20 ms or higher appears to be effective in clearing a significant percentage of facial telangectasias with a single pass. The side effects were minimal.
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BACKGROUND: The scarring follicular disorders pose challenging therapeutic dilemmas. OBJECTIVE: Hair removal lasers have recently been shown to be efficacious in the management of these disorders. METHODS: We present a young, Fitzpatrick skin type VI African-American patient with recalcitrant folliculitis decalvans, whom we treated with the neodymium:yttrium aluminum garnet (Nd:YAG) laser. RESULTS: A remission of folliculitis decalvans was successfully achieved using the Nd:YAG for laser depilation. CONCLUSION: Based on the optical properties of light in skin, the Nd:YAG laser is the best for laser depilation in dark individuals.
Laser treatment of vascular lesions remains one of the more common applications of lasers in dermatology. In fact, lasers have largely become the treatment of choice for vascular birthmarks such as hemangiomas and port-wine stains and the definitive treatment of the telangiectatic form of rosacea. The range of congenital and acquired vascular lesions effectively treated with lasers continues to expand.
Diabetes attacks multiple organ systems, and the skin is not spared its detrimental effects. Pathologic consequences of diabetes, such as vasculopathy, neuropathy, immunologic disturbances, defects in collagen formation, and poor glycemic control, contribute to its numerous cutaneous manifestations. In this article, Drs Tabor and Parlette present the implications of, and treatment options for, infections and dermatoses that appear in established diabetes or that indicate new-onset disease. They also discuss diabetes medications that commonly cause cutaneous reactions.
A 21-year-old white man in otherwise excellent general health was referred for a painful, progressive, facial eruption with associated fever, malaise, and cervicofacial lymphadenopathy. The patient reported that a vesicular eruption progressed from the left side of his face to also involve the right side of his face over the 48 hours preceding his clinic visit. He also reported some lesions in his throat and the back of his mouth causing pain and difficulty swallowing. Four to 7 days before presentation to us, the patient noted exposure to his girlfriend's cold sore. Additionally, he complained of a personal history of cold sores, but had no recent outbreaks. Physical examination revealed a somewhat ill man with numerous vesicles and donut-shaped, 2-4 mm, crusted erosions predominantly on the left side of the bearded facial skin. There were fewer, but similar-appearing lesions, on the right-bearded skin. The lesions appeared folliculocentric (Figure). Cervical and submandibular lymphadenopathy was present. Oral exam showed shallow erosions on the tonsillar pillars and soft palate. Genital examination was normal. The remainder of the physical exam was unremarkable. A Tzanck smear of vesicular lesions was positive for balloon cells and many multinucleated giant cells with nuclear molding. A viral culture was performed which, in several days, came back positive for herpes simplex virus. The complete blood cell count documented a white blood cell count of 8000/mm3 with 82.6% neutrophils and 9.0% lymphocytes. Based on the clinical presentation and the positive Tzanck smear, the patient was diagnosed with herpes simplex barbae, most likely spread by shaving. The patient was started on acyclovir 200 mg p.o. five times daily for 10 days. Oxycodone 5 mg in addition to acetaminophen 325 mg (Percocet; Endo Pharmaceuticals, Chadds Ford, PA) was prescribed for pain relief. A 1:1:1 suspension of viscous lidocaine (Xylocaine; AstraZeneca Pharmaceuticals LP, Wilmington, DE), diphenhydramine (Benadryl; Pfizer Inc., New York, NY), and attapulgite (Kaopectate; Pfizer Inc., New York, NY) was given as a swish and spit to relieve the oral discomfort. Good hygiene, no skin-to-skin contact with others, and no further shaving to prevent autoinoculation were stressed. He was advised to discard his old razor.
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