Nevien A. Sami PhD, Abeer T. Attia PhD, Ashraf M. Badawi
Background: Achieving an effective management of acne vulgaris with minimal complications remains a difficult challenge
for physicians. Moreover, the rise in antibiotic-resistant strains reduce the future usefulness of current mainstay therapies,
and accordingly, the need for alternative therapies is mandatory. Phototherapy has been shown to be an effective
treatment for acne, and there has been a renewed interest in photodynamic therapy as a treatment modality for this condition.
Objectives: To evaluate the effectiveness of pulsed dye laser (PDL), intense pulsed light (IPL) and light-emitting diode
(LED) phototherapy for the treatment of moderate to severe acne vulgaris.
Methods: Forty-five patients with moderate to severe acne were randomly divided into 3 equal groups. Group 1 was treated
with a PDL, group 2 was treated with IPL, and group 3 was treated with a blue-red combination LED. Treatment was continued
until a ≥90% clearance of patient lesions was achieved. Clinical assessments were conducted before starting treatment,
at 1 month as a midpoint evaluation, and after the final treatment session.
Results: Patients treated with the PDL reached a ≥90% clearance of their inflammatory lesions after a mean of 4.1±1.39
sessions, while patients treated with IPL required a mean of 6±2.05 sessions. Patients treated with the LED required a
mean of 10±3.34 sessions. At the mid-point evaluation, the percent reduction in acne lesions treated with the PDL was
90% or more, in cases of IPL and the LED, the percent reductions were 41.7% and 35.3%, respectively. Laser and light
phototherapy sessions were well tolerated with minimal adverse events experienced as being mild and usually self-limiting.
Conclusions: The encouraging results of the present study contributes evidence of phototherapy as useful therapeutic option
for treatment of moderate to severe acne, and validates further studies to evaluate treatments with a larger number
of patients and for a longer period of follow-up.
Ricardo Ruiz-Rodriguez MD PhD, Laura Lopez MD, Daniel Candelas MD, Javier Pedraz MD
Background: Photodynamic therapy has been proved to be effective in skin rejuvenation.
Objective: To evaluate clinical efficacy and side effects of photodynamic therapy using topical 5-methyl aminolevulinate
and red light for photorejuvenation.
Methods: A randomized, prospective, split-face comparison study of 10 white, adult patients with moderate photodamage,
Fitzpatrick skin types 2 or 3, and no occurrence of actinic keratosis was performed. Three treatments using topical
methyl aminolevulinate cream, applied for 1 hour on one half of the face and 3 hours on the other half before illumination
with red light. A blinded investigator prior to treatment and 2 months after the third treatment evaluated each side
of the subject’s faces.
Results: A moderate improvement in fine lines, tactile roughness, and skin tightness was observed in most of the patients,
mostly on the 3-hour time side. There were no changes in mottled pigmentation or telangiectasias. Side effects were observed
in all subjects (erythema, edema, scaling) mainly in the 3-hour incubation time side.
Limitations: The small number of patients and the lack of placebo group.
Conclusion: Methyl aminolevulinic-photodynamic therapy with red light can improve fine lines, tactile roughness and
skin tightness in patients with moderate photoaging and no occurrence of actinic keratosis.
Michael H. Gold MD, Julie Biron BS
Introduction: A novel photopneumatic platform (Isolaz, Pleasanton, CA), combining vacuum pressure with a broadband
light source device has been designed to attack multiple targets for the effective treatment of acne.
Objective: The objective of this study was to evaluate the safety and efficacy of photopneumatic technology for the treatment
of mild to moderate acne vulgaris.
Methods: Eleven subjects (7 women) aged 15 to 54 years with skin types 1 to 4 presented with mild to moderate facial
acne (defined as 15 or more facial inflammatory or noninflammatory lesions) were recruited to the study. All subjects underwent
4 photopneumatic treatments at 3-week intervals with follow-up visits at 1 and 3 months.
Results: Inflammatory lesion counts continued to decrease for at least 3 months after the final treatment. At 3 months,
reductions in lesion counts were significant for both inflammatory (P=.0137) and noninflammatory (P=.0383) lesions.
Mean scores between visits consistently dropped sharply from their immediate posttreatment values for pain, erythema,
and edema. Nine subjects (82%) were moderately satisfied to very satisfied with treatment.
Conclusion: Results suggest that the photopneumatic device is a safe and effective modality for the treatment of mild to
moderate inflammatory and comedonal acne vulgaris.
Jennifer Krejci-Manwaring MD, Martha Ann McCarty MS PA-C, Fabian Camacho MS MA, Janeen Manuel PhD,Jennifer Hartle MPH, Alan Fleischer Jr MD, Steven R. Feldman MD PhD
Background: Hand dermatitis is a chronic inflammatory skin disorder for which systemic immunosuppressive therapy is
often needed. Topical treatments could complement the use of systemic corticosteroids.
Objective: To evaluate symptoms of hand dermatitis in subjects treated with a prednisone taper combined with topical
tacrolimus 0.1% ointment versus vehicle.
Methods: Thirty-two subjects with moderate to severe hand dermatitis were enrolled in a randomized double-blind controlled
trial. Subjects received a 3-week taper of prednisone and was randomized 2:1 to apply topical tacrolimus or its vehicle
twice daily for 12 weeks. Disease severity was evaluated at baseline and at 5 follow-up visits (weeks 1-14). Any
occurrence of relapse was recorded by patients.
Results: Twenty-two of the 32 subjects (69%) had relapse of their disease. The mean time to recurrence for tacrolimus
versus vehicle was 48 versus 39 days, respectively (P=.78). A greater improvement of induration (P=.003) and scaling
(P=.003) for patients with tacrolimus compared to vehicle was detected, as well as subjective improvement (%) from week
1 to week 12 (P=.04) compared to vehicle. Improvement in erythema (P<.0001), fissuring (P=.0003), pruritus (P=.06),
and investigator’s global assessment (P<.0001) with tacrolimus was not found to exceed improvement with vehicle.
Limitations: Small sample size provides limited power to detect differences in response.
Conclusions: Topical tacrolimus improves induration and scaling, and there is a trend suggesting it prolongs the time to
Lidia Rudnicka MD PhD, Malgorzata Olszekska, Adriana Rakowska, Elzbieta Kowalska-Oledzka, Monika Slowinska
Videodermoscopy of hair and scalp (trichoscopy) is gaining popularity as a valuable tool in differential diagnosis of hair
loss. This method allows viewing of the hair and scalp at X20 to X160 magnifications. Structures which may be visualized
by trichoscopy include hair shafts of different types: vellus, terminal, micro-exclamation mark type, monilethrix,
Netherton type, and pili annulati hairs. The number of hairs in one pilosebaceous unit may be assessed. It may be distinguished
whether hair follicles are normal, empty, fibrotic (“white dots”), filled with hyperkeratotic plugs (“yellow dots”)
or containing cadaverized hair (“black dots”). Abnormalities of scalp skin color or structure which may be visualized by
trichoscopy include honeycomb-type hyperpigmentation, perifollicular discoloration (hyperpigmentation), and scaling.
Cindy Berthelot MD, Allison Rivera MD, Madeleine Duvic MD
Mycosis fungoides (MF) is a rare neoplasm of epidermotropic CD4+ lymphocytes and represents a majority of all cutaneous
T cell lymphomas. Early stage MF is limited to cutaneous patches and plaques that can be treated with topical modalities
with high response rates. More aggressive systemic treatment of early disease does not alter survival or cure the disease
and could accelerate progression by causing immunosuppression. Topical corticosteroids, mechlorethamine, and carmustine
have been the mainstays of early treatment of MF for more than 30 years. More recently, topical formulations of
retinoids, novel rexinoids, methotrexate, immunomodulators, and photodynamic compounds have been investigated for
their potential roles in treating early MF. The future of topical treatments for MF is promising both as primary and adjunctive
Joshua M. Berlin MD FAAD, Darrell S. Rigel MD FAAD
Background: Actinic keratoses are increasingly common skin lesions that are evaluated and treated by dermatologists
on a daily basis. It is estimated that more than 90% of actinic keratoses in the US are treated by destructive therapies,
such as cryosurgery. The purpose of this study was to evaluate the efficacy of sequential therapy of cryosurgery followed
by diclofenac sodium 3% gel.
Methods: This prospective, double-arm, multicenter, open-label, phase 4 study was performed at 82 community dermatology
centers in the US. A total of 714 subjects who had a clinical diagnosis of actinic keratosis with between 5 and 15
lesions contained in a target area such as the forehead, scalp, and hands were enrolled in the study. These subjects were
randomized into 2 arms of the study: cryosurgery alone and cryosurgery followed by diclofenac sodium 3% gel for a period
of 90 days. Lesion counts were assessed at baseline, and 45, 75, 105, and 135 days after cryosurgery.
Results: Of the 521 patients enrolled in the study who successfully completed all of the visits concluding on day 135,
277 were in the cryosurgery alone arm and 244 were in the cryosurgery followed by diclofenac sodium 3% gel arm. At
the conclusion of the study, 46% of the subjects in the cryosurgery followed by the use of diclofenac sodium 3% gel arm
achieved 100% cumulative (target plus new lesions) lesion clearance compared to 21% in the cryosurgery alone arm
(P<.0001). One hundred percent target lesion clearance was achieved in 64% of the subjects in the active arm compared
to 32% in the cryosurgery alone arm (P<.0001).
Conclusions: With the increased prevalence of actinic keratoses, it is important to consider and evaluate emerging therapeutic
options. The sequential treatment with cryosurgery followed by diclofenac sodium 3% gel for 90 days is well tolerated
and can provide a therapeutic modality that may provide patients with actinic keratoses a more successful
outcome than monotherapy with cryosurgery by effectively treating clinical and subclinical lesions.