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Keloids: Innovative therapy
P3512 Mohs micrographic surgery for dermatofibrosarcoma protuberans Mi Ryung Roh, MD, Yonsei University College of Medicine, Seoul, South Korea; Kee Yang Chung, MD, PhD, Yonsei University College of Medicine, Seoul, South Korea Background: Dermatofibrosarcoma protuberans (DFSP) is a rare soft tissue tumor with a high local recurrence rate. Recent reports indicate more favorable cure rates with Mohs micrographic surgery (MMS). Aims: The purpose of this study was to confirm the beneficial use of MMS for DFSP in a single institution in Korea. Methods: A retrospective review was performed on pertinent demographic data, tumor data, treatment characteristics, and follow-up data of 11 patients between 1997 and 2007. Review of literature for treatment modalities, and recurrence rates of DFSP was also performed. Results: Eleven DFSPs were identified and analyzed. Of these, seven were female and four were male patients and the mean age was 26.9 years. A mean number of 1.8 Mohs layers were required to clear the tumor. All tumors were excised and reconstructed by the Mohs surgeon. During the follow-up period of average 26 months, there were no identifiable recurrences. Conclusions: Treatment of primary and recurrent DFSP by MMS results in a low recurrence rate with possible benefits of smaller defects compared to WLE. Therefore, this study provides further support for MMS as the treatment of choice for DFSP. Commercial support: None identified.
SURGERY (LASER) P3600 Treatment of port wine stain with intense pulsed light of the square pulse type Elisete Crocco, Clinic of Dermatology, Santa Casa de S~ao Paulo, S~ao Paulo, Brazil; Alexandre Abramavicus, Clinic of Dermatology, Santa Casa de S~ao Paulo, S~ao Paulo, Brazil; Carla Russo, Clinic of Dermatology, Santa Casa de S~ao Paulo, S~ao Paulo, Brazil; Clarisse Zaitz, Clinic of Dermatology, Santa Casa de S~ao Paulo, S~ao Paulo, Brazil; Karina Nunes, Clinic of Dermatology, Santa Casa de S~ao Paulo, S~ao Paulo, Brazil Introduction: Port wine stain is a congenital vascular malformation of unknown etiology, usually without regression, often affecting the patient’s quality of life. Among the available treatments, we could emphasize the use of laser and intense pulsed light. We are citing the case of the treatment of port wine stain on the left hemiface with controlled pulsed light, a viable technique not only for the results but also because of the cost effectiveness. Case report: A 12-year-old white patient presented with a port wine stain on the left zygomatic region. The treatment of choice was the use of an intense pulsed light (Square Pulse) controlled pulsed light with a filter of 530nm. After being subjected to testing to determine their ideal frequency, fortnightly sessions were made. In the first two sessions there were purple, gray markings and local edema, which regressed in approximately 10 days. From the third session there was only purple. At the end of the fifteenth session, there were no complications and there was an improvement of 70% of the stain. Discussion: The use of lasers in dermatology has expanded enormously in recent years with technological advances, and many devices are currently available, allowing effective and better therapeutic responses than ever before. In this aspect, it is the controlled pulsed light devices that have grown in popularity because of their lower cost and variety of indications. Controlled pulsed light is a pulsed light source that emits high-energy light not consistent with the continuous-wave spectrum from 500 to 1200nm. The pulses vary from 0.5 to 20 msec and can be applied in sequence with single, double, or triple pulses. Among its features are indications for vascular lesions (telangectasias, port wine stains, hemangiomas and cavernous tuberosum, and microvarizes lower limb), which is the pigment of chromophore oxyhemoglobin. This report demonstrated the efficacy and safety of the use of controlled pulsed light for treatment of port wine stain. Commercial support: None identified.
P3513 Keloids: Innovative therapy Jennifer L. Parish, MD, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA, United States; Hirak B. Rhouth, MBBS, Paddington Testing Company, Philadelphia, PA, United States; Lawrence Charles Parish, MD, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA, United States
P3601
Keloids, first described by Jean Alibert in 1806, represent abnormal scar formation. Although originally considered a malignancy by Alibert, it shows no neoplastic tendencies, despite its often devastating appearance and accompanying pruritus and even pain. Histologically, there is random orientation of type 1 and type 3 collagen fibers. The overproduction of transforming growth factorebeta (TGFbeta1) in keloid formation may be responsible for the excessive scarring. Treatment is currently limited to intralesional corticosteroids and occasionally cryosurgery. Surgical intervention may create a larger keloid, while pressure dressings and radiotherapy have limited applications. Based upon the pathophysiology of keloids, a promising agent has shown that it may be effective in the treatment of this devastating condition. Fibroblasts exposed to TGF-beta 1 produce connective tissue growth factor (CTGF) which results in excessive fibrosis. AZX100 inhibits fibroblasts from producing CTGF. Phase I studies have demonstrated safety and tolerability. Currently, phase II studies are investigating the therapeutic effect of AZX100 on keloids and other scars.
Dye laser and Rendu-Osler-Weber syndrome Leandro Martı´nez, MD, Carlos Haya Hospital, Malaga, Spain; Alicia Hiraldo, Ch Hospital, Malaga, Spain; Elisabeth Gomez, Ch Hospital, Malaga, Spain; Juan Manuel Segura, Ch Hospital, Malaga, Spain; Silvestre Martinez, Ch Hospital, Malaga, Spain Rendu-Osler-Weber syndrome (hereditary hemorrhagic telangiectasia) is a familial, autosomal, dominant, multisystem, vascular dysplasia characterized by abnormal subepithelial vessels. Besides repetitive epistaxis, cutaneous lesions are an important cosmetic problem for these patients. Various treatment modalities have been described to treat the cutaneous lesions and the epistaxis associated with this disease. We reported five patients with Rendu-Osler-Weber syndrome that treated with dye laser (595nm). We have used purpuric fluences (12-14J/cm2, 1.5 msec) and 7-mm spot, and all of our patients are free of facial lesions after two or three sesions. We have treated the telangiectasias within the anterior nasal cavity and we can say that in this area the dye laser is effective; however, we think that the Nd:YAG laser could be most effective in this area and let us treat telangiectasias in all the nasal cavity.
Commercial support: Capstone Therapeutics.
Commercial support: None identified.
MARCH 2010
J AM ACAD DERMATOL
AB147
SURGERY (LASER) P3600 Treatment of port wine stain with intense pulsed light of the square pulse type Elisete Crocco, Clinic of Dermatology, Santa Casa de S~ao Paulo, S~ao Paulo, Brazil; Alexandre Abramavicus, Clinic of Dermatology, Santa Casa de S~ao Paulo, S~ao Paulo, Brazil; Carla Russo, Clinic of Dermatology, Santa Casa de S~ao Paulo, S~ao Paulo, Brazil; Clarisse Zaitz, Clinic of Dermatology, Santa Casa de S~ao Paulo, S~ao Paulo, Brazil; Karina Nunes, Clinic of Dermatology, Santa Casa de S~ao Paulo, S~ao Paulo, Brazil Introduction: Port wine stain is a congenital vascular malformation of unknown etiology, usually without regression, often affecting the patient’s quality of life. Among the available treatments, we could emphasize the use of laser and intense pulsed light. We are citing the case of the treatment of port wine stain on the left hemiface with controlled pulsed light, a viable technique not only for the results but also because of the cost effectiveness. Case report: A 12-year-old white patient presented with a port wine stain on the left zygomatic region. The treatment of choice was the use of an intense pulsed light (Square Pulse) controlled pulsed light with a filter of 530nm. After being subjected to testing to determine their ideal frequency, fortnightly sessions were made. In the first two sessions there were purple, gray markings and local edema, which regressed in approximately 10 days. From the third session there was only purple. At the end of the fifteenth session, there were no complications and there was an improvement of 70% of the stain. Discussion: The use of lasers in dermatology has expanded enormously in recent years with technological advances, and many devices are currently available, allowing effective and better therapeutic responses than ever before. In this aspect, it is the controlled pulsed light devices that have grown in popularity because of their lower cost and variety of indications. Controlled pulsed light is a pulsed light source that emits high-energy light not consistent with the continuous-wave spectrum from 500 to 1200nm. The pulses vary from 0.5 to 20 msec and can be applied in sequence with single, double, or triple pulses. Among its features are indications for vascular lesions (telangectasias, port wine stains, hemangiomas and cavernous tuberosum, and microvarizes lower limb), which is the pigment of chromophore oxyhemoglobin. This report demonstrated the efficacy and safety of the use of controlled pulsed light for treatment of port wine stain. Commercial support: None identified.
P3513 Keloids: Innovative therapy Jennifer L. Parish, MD, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA, United States; Hirak B. Rhouth, MBBS, Paddington Testing Company, Philadelphia, PA, United States; Lawrence Charles Parish, MD, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA, United States
P3601
Keloids, first described by Jean Alibert in 1806, represent abnormal scar formation. Although originally considered a malignancy by Alibert, it shows no neoplastic tendencies, despite its often devastating appearance and accompanying pruritus and even pain. Histologically, there is random orientation of type 1 and type 3 collagen fibers. The overproduction of transforming growth factorebeta (TGFbeta1) in keloid formation may be responsible for the excessive scarring. Treatment is currently limited to intralesional corticosteroids and occasionally cryosurgery. Surgical intervention may create a larger keloid, while pressure dressings and radiotherapy have limited applications. Based upon the pathophysiology of keloids, a promising agent has shown that it may be effective in the treatment of this devastating condition. Fibroblasts exposed to TGF-beta 1 produce connective tissue growth factor (CTGF) which results in excessive fibrosis. AZX100 inhibits fibroblasts from producing CTGF. Phase I studies have demonstrated safety and tolerability. Currently, phase II studies are investigating the therapeutic effect of AZX100 on keloids and other scars.
Dye laser and Rendu-Osler-Weber syndrome Leandro Martı´nez, MD, Carlos Haya Hospital, Malaga, Spain; Alicia Hiraldo, Ch Hospital, Malaga, Spain; Elisabeth Gomez, Ch Hospital, Malaga, Spain; Juan Manuel Segura, Ch Hospital, Malaga, Spain; Silvestre Martinez, Ch Hospital, Malaga, Spain Rendu-Osler-Weber syndrome (hereditary hemorrhagic telangiectasia) is a familial, autosomal, dominant, multisystem, vascular dysplasia characterized by abnormal subepithelial vessels. Besides repetitive epistaxis, cutaneous lesions are an important cosmetic problem for these patients. Various treatment modalities have been described to treat the cutaneous lesions and the epistaxis associated with this disease. We reported five patients with Rendu-Osler-Weber syndrome that treated with dye laser (595nm). We have used purpuric fluences (12-14J/cm2, 1.5 msec) and 7-mm spot, and all of our patients are free of facial lesions after two or three sesions. We have treated the telangiectasias within the anterior nasal cavity and we can say that in this area the dye laser is effective; however, we think that the Nd:YAG laser could be most effective in this area and let us treat telangiectasias in all the nasal cavity.
Commercial support: Capstone Therapeutics.
Commercial support: None identified.
MARCH 2010
J AM ACAD DERMATOL
AB147