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R Sheehan-Dare

Publications and source records attributed to R Sheehan-Dare.

At least 19 recordsLinked to original sources
PubMed2005

A comparative study of a 595-nm with a 585-nm pulsed dye laser in refractory port wine stains.

BACKGROUND: The pulsed dye laser (PDL) is the treatment of choice for port wine stains (PWS); however, some patients' PWS become refractory to further treatments. Technological advances have enabled new machines with the advent of surface cooling devices to deliver longer wavelengths and higher fluence more safely. These advances have the potential to achieve improved response rates in refractory PWS. There are few studies comparing the efficacy of standard PDL treatments for refractory PWS with the wider choice of treatment variables available from newer PDL machines. OBJECTIVES: To determine if there is any advantage of using a longer wavelength (595 nm) and pulse widths (1.5 ms, 6 ms and 20 ms) over conventional PDL settings (wavelength 585 nm, pulse width 1.5 ms) in refractory PWS. METHODS: Eighteen consecutive consenting patients with Fitzpatrick skin types 1-4 with a mean age 35 years (range 17-59 years) with refractory PWS were treated routinely with three separate test areas using 595-nm PDL (using three different pulse width settings of 1.5 ms, 6 ms and 20 ms), compared with test areas treated with 585-nm PDL (pulse width 1.5 ms). All test areas were treated with an identical fluence (15 J cm(-2)), spot size (7 mm) and cooling setting (dynamic cooling 60 ms, delay 60 ms). RESULTS: We found a statistically significant advantage of 595-nm PDL (pulse width 1.5 ms) over 595-nm PDL (pulse width 6 ms) (P < 0.05) in the treatment of refractory PWS; however, we found no significant advantage using longer pulse widths of 20 ms compared with 1.5 ms with the 595-nm PDL. There was no statistically significant advantage in using a 595-nm PDL over a 585-nm PDL using identical pulse widths of 1.5 ms, spot size, fluence and cryogen cooling settings; however, the number of directly comparable test areas was smaller. Some individual patients in our study obtained a better response with certain 595-nm PDL settings (pulse width 1.5 ms and 6 ms) compared with 585-nm PDL (pulse width 1.5 ms). CONCLUSIONS: Our experience of high fluence PDL in the treatment of refractory PWS suggests patients treated with 585 nm (pulse width 1.5 ms) improve to a similar degree as patients treated with 595-nm PDL (pulse width 1.5 ms). However, the use of the 595-nm PDL with longer pulse widths yields no extra advantage. For those patients who have failed to improve with high-fluence 585-nm PDL (pulse width 1.5 ms), test areas using 595-nm PDL (pulse width 1.5 ms and 6 ms) should be undertaken to ascertain if individual patients may benefit from the longer pulse width 595-nm PDL.

Adolescent↗
PubMed2005

Investigation of the use of the pulsed dye laser in the treatment of Bowen's disease using 5-aminolaevulinic acid phototherapy.

BACKGROUND: The use of 5-aminolaevulinic acid photodynamic therapy (ALA-PDT) for the treatment of Bowen's disease is well established. However, treatment with a continuous light source has the disadvantage of prolonged treatment time during which patients often experience significant discomfort requiring the use of local anaesthetic. OBJECTIVES: The aim of this study was to assess the efficacy and safety of the pulsed dye laser (PDL) as the light source for photoactivation of the protoporphyrin IX to treat Bowen's disease by PDT. METHODS: Thirteen patients with a total of 17 patches of histologically proven Bowen's disease were treated with 20% 5-ALA in Unguentum M (Crookes Healthcare, Nottingham, U.K.) under occlusion for 4 h. The patches were then irradiated using a Candela SPLTL-1b (Candela Corporation, Wayland, MA, U.S.A.) PDL using a wavelength of 585 nm, with a 7-mm diameter spot at a fluence of 10 J cm(-2). The spots overlapped by 50% to cover the lesion and extend beyond the clinical margin of the patch of Bowen's disease by 0.5 cm. Patients were then followed up initially at 2 months, then at 3-monthly intervals for a period of 12 months to assess treatment success and recurrence rate. RESULTS: Subjects consisted of 10 females and three males, between 47 and 88 years. The mean area of the patches of Bowen's disease was 315.4 mm(2) (range 36-2464 mm(2)) requiring a median of 32 pulses (range 3-260). Lesions sites were hands (two), foot (one) and lower leg (14). All patients experienced varying degrees of discomfort during treatment but none required the use of local anaesthetic. At 2 months eight treatment sites could not be assessed due to loose overlying crusts and removal of these revealed superficial erosions in seven patients. Of the 17 lesions treated, on follow-up at 1 year, 14 patches (82%) demonstrated a complete clinical response, although one of these had required a second treatment. Two patients with three lesions that would have required further therapy refused a second treatment. Prolonged crusting lasting 8 weeks occurred in eight patches and prolonged discomfort lasting 6 weeks occurred in four patients. CONCLUSIONS: This study has shown that the PDL is an effective light source for ALA-PDT of Bowen's disease. Light source exposure times are shorter, although overall treatment time may not always be significantly reduced for larger lesions. The procedure was well tolerated. However, the post-treatment morbidity was relatively high compared with the more conventional treatment modalities. Further studies are needed to determine whether lower energy fluences can maintain similar efficacy while reducing post-treatment morbidity.

Aged↗
PubMed2005

Streptococcus induced pustular vasculitis affecting the hands resembling pustular vasculitis of the hands--first reported case.

Pustular vasculitis of the hands is a distinctive clinical entity. It has recently been proposed by some authors to rename pustular vasculitis of the hands as 'neutrophilic dermatosis of the hands' to reflect its histological resemblance to the neutrophilic dermatoses. We report the case of a 66-year-old woman who presented with clinical appearances resembling pustular vasculitis of the hands associated with palmo-plantar pustulosis due to Streptococcus-induced 'pustular vasculitis'.

Aged↗
PubMed2002

Pulsed dye laser and intralesional bleomycin for treatment of resistant viol hand warts.

BACKGROUND AND OBJECTIVE: Viral warts affect 7-10% of the population and are a major burden on time and resources of dermatology departments everywhere. Some warts prove resistant to multiple therapies, and this is particularly common in the immunosuppressed patient. Numerous treatments are available, but no one treatment has emerged as the treatment of choice. Bleomycin has been shown to be effective in treating warts, but administration can be difficult with risk of local complications. To demonstrate a new technique for easily and safely administrating bleomycin into warts, we undertook an open study to assess the practicality, efficacy, and tolerability of pulsed dye laser immediately followed by intralesional bleomycin in resistant viral hand warts. STUDY DESIGN/MATERIALS AND METHODS: Ten subjects, all with resistant viral hand warts of at least 3 years duration were recruited. Four subjects were on long-term immunosuppressant drugs. Eighteen warts treated in total. Area of the wart was anaesthetized with 1% lignocaine, then treated with a pulsed dye laser (7 mm spot, fluence 10 J/cm2). Immediately following this bleomycin (0.5 IU/ml) was injected into the base of the wart. Monthly follow-up and treatment until satisfactory clearance. RESULTS: Sixteen out of eighteen warts cleared (89%). Eight out of ten warts in the immunosuppressed subjects cleared. The remaining two warts responded partially to two treatments, but the patient was happy with the result and did not wish further treatment. All warts in the immunocompetent subjects cleared. No serious side effects were seen. CONCLUSIONS: The initial treatment of the wart with pulsed dye laser serves to "prepare" the wart for the bleomycin injection, which can then be given very easily. This ensures the drug is deposited into the base of the wart where it is most needed and minimises the risk of infiltration of normal skin or the operative environment. This method of combining pulsed dye laser and intralesional bleomycin appears to be a safe, rapid, well tolerated, and successful treatment for resistant hand warts. It has proven to be effective in warts in immunosuppressed patients and at difficult sites (e.g., subungual warts). These findings need confirmation from a larger controlled study.

Adult↗
PubMed1999

Facial hirsutism treated with the normal-mode ruby laser: results of a 12-month follow-up study.

Fifty-one patients of skin type I to IV with facial hirsutism received treatment with the normal-mode ruby laser (950-micros pulse; 4-mm spot; mean fluence, 49 J/cm(2); maximum fluence, 66 J/cm(2)). For each patient, one site was treated once only, and a second site was treated 4 times at 4-week intervals. After 48 weeks, 46 patients were available for assessment. After a single treatment, hair counts were reduced to a mean of 45% at 4 weeks (pretreatment median of 63 hairs down to 26), increased to 80% (median, 51 hairs) at 12 weeks, were 65% (median, 41 hairs) at 24 weeks, and were 59% (median, 35 hairs) at 48 weeks. Four weeks after 3 treatments, the hair counts had reduced to a mean of 30% (pretreatment median of 68 hairs down to 15). Twelve weeks after 4 treatments, the hair counts had increased to 45% (median, 24 hairs) and were 39% after 36 weeks (median, 22.5 hairs). No anesthesia was needed. Treatment tolerance improved with consecutive visits, allowing higher fluences to be used. Hyperpigmentation developed in 9 patients, which had faded completely in 8 patients at the end of the study. One patient showed hypopigmentation. Depressions in the skin below the jaw line developed in 5 patients, which resolved completely within 4 to 32 weeks. We conclude that normal-mode ruby laser treatment is well tolerated and leads to significant improvement of facial hirsutism, which is maintained for at least 48 weeks. Repeated treatments result in greater clinical effects.

Adolescent↗
PubMed1998

Ruby laser treatment for hirsutism: clinical response and patient tolerance.

We report the results of a study of the ruby laser in normal mode for treatment of hirsutism in 43 patients with skin types I-IV. A pulse width of 950 microseconds, a 4 mm spot and a fluence sufficient to produce minimal whitening of the epidermis were used (mean 48 J/cm2). In each patient, one site was treated once only, and a second site received four treatments at monthly intervals. After a single treatment, hair counts had reduced to a mean of 46% (median 67, reduced to 26) of the pretreatment values at 1 month, but increased to 80% (median 42) at 3 months and were 66% (median 37) at 6 months. One month after three treatments, hair counts had reduced to a mean of 29% (median 60, reduced to 15) of pretreatment values, and 3 months after four treatments at the same site, counts had increased to 44% (median 21). Patient tolerance of the treatment was good and higher fluences tended to be tolerated at consecutive visits. The first treatment was followed by mild, short-lived erythema and swelling in 60% (25 of 42) patients. Fourteen per cent (six of 42) experienced mild blistering and 33% (14 of 42) crusting. More severe reactions were seen infrequently. These results indicate that normal mode ruby laser treatment is well tolerated. Sustained reduction in hair counts can be achieved for at least 6 months, and multiple treatments produce greater clinical effects.

Adolescent↗