595 nm pulsed dye laser for the treatment of superficial basal cell carcinoma.
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Biomedical subjects
Publications and source records attributed to P Campolmi.
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The ocular tissues can be the site of a number of malignant tumors in adults. Approximately 5% to 10% of all skin tumors occur in the eyelid. Incidence studies indicate that basal cell carcinoma is the most frequent malignant eyelid tumor (90%) followed by squamous cell carcinoma (9%). A 55-year-old man presented a squamous cell carcinoma (SCC) of 8 mm diameter, localized in the middle third of the lower eyelid, 3 mm under the eyelid margin on the eyelids. The histopathologic examination of a biopsy specimen showed the typical features of squamous cell carcinoma. Photodynamic therapy (PDT) with topical 5-aminolevulic acid (ALA) after Frost suture was employed. Very good results were obtained with rapid healing, without invasiveness, and without anesthesia. There was no evidence of scar formation and no signs of recurrence at 6 months follow-up. Many therapeutic methods have been suggested for squamous cell carcinoma of the eyelid. We consider photodynamic treatment of eyelid skin malignancies to be of great interest and it may represent an interesting future perspective for their management especially when surgical intervention cannot be tolerated by the patient.
Photodynamic therapy (PDT) is a treatment modality using a photosensitizer, light and oxygen to cause photochemically-induced selective cell death. Topical PDT is most suitable for thin lesions such as superficial basal cell carcinoma and actinic keratoses in dermatology. Results with PDT as treatment of thicker lesions such as nodular basal cell carcinoma appear to have a limited role because the photosensitizer or the light cannot penetrate deeply enough into the thicker tumor volume. In this preliminary study we use intralesional administration of 5-aminolevulinic acid to enhance the efficacy of the photosensitivity of nodular basal cell carcinomas, thus improving clinical cure.
BACKGROUND: Various types of UVB radiation source (290-320 nm) are used in treating psoriasis and their therapeutic mechanism has been attributed to immunosuppressive properties. Recently, a new UVB source generated by a 308-nm excimer laser has been introduced for the treatment of psoriasis. OBJECTIVE: In this study we investigated the immunohistochemical evaluation of T cells and the expression of various apoptosis-related molecules in the psoriatic hyperproliferative skin before and after treatment with 308-nm monochromatic excimer light (MEL). METHODS: Ten patients (three women and seven men), ranging in age from 29 to 79 years, affected by plaque-type psoriasis vulgaris, were treated with MEL. Biopsies from psoriatic lesions of MEL-treated sites were taken before, 24 h and/or 48 h after the first irradiation and analysed by the immunophosphatase alkaline technique (APAAP). RESULTS: MEL treatment was found to cause a significant decrease in the rate of proliferation of keratinocytes and a relevant depletion of T cells in all psoriatic lesions, 48 h after the first irradiation: 308 nm light eliminated T cells from the psoriatic epidermis and also from the dermis, highlighting the ability of this UVB source to penetrate the skin compared with normal UVB and establish direct cytotoxic action on T cells infiltrating skin lesions. Rapid clearing of psoriatic lesions involves potential molecular targets of UVB in T cells including p53, which is upregulated after direct irradiation with 308-nm UVB. Moreover, Bcl-2 expression in healing psoriasis epidermis after MEL treatment is significantly decreased compared with untreated skin and the TUNEL (TdT-mediated dUTP-biotin nick end labelling) technique revealed the presence of relevant apoptotic keratinocytes in the irradiated epidermis. CONCLUSIONS: These results indicate that psoriatic skin after monochromatic excimer light therapy is associated with significant T-cell depletion and alterations of apoptosis-related molecules accompanied by a decreased proliferation index and clinical remission.
With the use of the so-called "selective" lasers, it is possible to operate specifically on the melanin as the absorbing target of undesirable hair. The optimal pulse duration for laser epilation should be found between the TRT of the epidermis (1-2 msec) and the TRT of the follicle (10-50 msec). For the thermal destruction of the follicle containing melanin, the ideal laser energy should (1) be absorbed in a selective manner with respect to other chromophores; (2) have a wavelength capable of penetrating in depth and reaching the target to be treated; and (3) be sufficient to destroy tissue targets (in the hair the papilla, the follicular epithelium, the so-called "bulge" and also the vascular support). With this method the melanin and the follicular structures are "heated" in a preferential manner while still safeguarding the adjacent skin structures. Numerous laser systems are employed in the treatment of undesirable hair with varying results according to the source, procedures, phototype, and pigmentation of the hair to be treated. The most frequent side effects may be discomfort or a slight burning sensation and un-aesthetic pigment changes or scarring. We report here our experience based on the treatment of 94 subjects over a 12 month period using the Nd:YAG laser (SMARTEPIL 2, Deka M.E.L.A., Italy). Our results indicate that a wavelength of 1064 nm is efficacious in obtaining a greater penetration and reaching the deeper follicles, with a greater respect for the skin due to the lower absorption by the melanin, and consequently a lower incidence of side effects.
Basal cell carcinomas may attain giant proportions due primarily to recurrence or because the tumour is neglected. We report the case of a 66-year-old man who presented with a bleeding, polypoid, cutaneous tumour located on the left shoulder region of 13 years duration. The man had not received any previous treatment. The lesion was biopsied and histopathologically diagnosed as a solid type basal cell carcinoma with focal areas of squamous differentiation and keratinization. The man refused complete surgical removal and therefore was treated with roentgentherapy, with satisfactory results and no complications in the irradiated area. No recurrences had manifested after 1 year follow-up.
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BACKGROUND: Facial and leg telangiectasias are a frequent cosmetic concern for both females and males with various skin types and ages. To date the different treatments for these problems, in particular leg telangiectasias, have frequently failed or led to negative side-effects. OBJECTIVE: This study examines the clinical effects and safety of applications with a 1064-nm Nd:YAG laser system (SmartEpil II, DEKA M.e.l.a., Florence, Italy) to treat vessels on the face and legs. MATERIALS AND METHODS: Twenty-five subjects with facial telangiectasias underwent one treatment at 100 J/cm2, 10 ms and 2 Hz repetition rate. Thirty-two subjects with leg telangiectasias, measuring 0.1-3 mm in diameter, were treated at 125-200 J/cm2, 10-30 ms and 2 Hz repetition rate. Subjects in this group underwent one to five treatment sessions at 8 week intervals. RESULTS: All subjects showed visible improvement, with 95-100% clearing of the face telangiectasias after only one treatment, and 50-100% clearing of the lower extremity vessels after three to five treatments. Transitory hypopigmentation was seen in two cases subjected to leg vessel treatment. CONCLUSIONS: Treatment of facial and leg telangectasias using a true long pulse 1064 nm Nd:YAG laser is an effective and safe method. The relative lack of discomfort combined with a high degree of individual satisfaction should play a part in the fairly high level of acceptance of this new form of therapy for the treatment of leg and face telangiectasias.
Photodynamic therapy (PDT) is a treatment modality using a photosensitizer, light and oxygen to cause photochemically induced selective cell death. When exposed to light with the proper wavelength, the topically applied photosensitizer or photosensitizer precursor can activate a biomolecule through electron transfer to yield free radicals or produce singlet oxygen from energy transferred from the excited sensitizer to molecular oxygen. The tissue damage is the result of the activation of reactive singlet oxygen or free radical production. Photodynamic therapy with topical application of 5-aminolevulinic acid (ALA) is a new technique and although it remains largely experimental, it has potential application for treatment of malignant skin tumors, various precancerous and selected benign skin diseases. This technique yields not only a high percentage of good therapeutic results but also excellent cosmetic outcome. This paper reviews the recently published data on clinical ALA-based PDT in dermatology.
Steroids are effective in the autoimmune bullous disease pemphigus; however, treatment may be difficult to sustain because of severe side effects. Cyclosporine A acts mainly on helper/inducer T lymphocytes and has few side effects at low doses. We report three patients with pemphigus erythematosus who had a relapse while receiving the maintenance dose of steroid therapy. All patients who were treated with both cyclosporine A (5 mg/kg/d) and prednisone (1 mg/kg/d) responded remarkably well to combined therapy. After clearing, prednisone was discontinued and cyclosporine A was reduced to 2 to 3 mg/kg/d. With this treatment, all patients have been virtually free of symptoms, have remained well, and have had normal laboratory values.
We studied the therapeutic action of CO2 Laser on leg ulcers due to chronic venous hypertension in 30 subjects. Our findings show good results in reducing pain and leg oedema and wound healing.
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