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Laser skin resurfacing
S89
Luncheon discussions
clLDl
Stimulating pediatric cases for lunch
R. Caputo, C. Gelmetti. Isfitufo I/niversitd di Milano; Milano, Italy
I.R.C.C.S.
di Scienze “Ospedale
Dertnatologiche, Maggiore”,
Pachyerythrodermic mastocytosis is one rare form of diffuse cutaneous mastocytosis that can be observed very early in the life; the other form is the urticarial one, being the difference probably due to a quantitative degree of infiltration of the skin by mast cells; in diffuse forms general symptoms can be severe and identical to those seen in anaphylaxis. Diffuse neonatal hemangiomatosis is one among the rarest types of immature capillary hemangiomas; three forms are described: pure cutaneous; associated with hepatic angiomas; associated with widespread angiomas. Juvenile self-healing mucinosis is a very rare dermatosis in childhood: a case of 8 year old boy is described. Erythema elevatum diutinum is particularly rare in childhood in which the diagnosis can be very difficult; the case described is among the youngest ever reported; dapsone is able to improve the symptoms but cannot stop the course of the disease. Juvenile Xanthogranuloma “en plaque” is uncommon but its runs a benign course as the other more common forms of JXG. Omenn syndrome is a severe immunodeficiency associated with a diffuse erytbematous scaling that is fatal if untreated; the disease can be cured with bone marrow transplant. Wells syndrome can be seldom suspected clinically; histology and response to treatment clarify the diagnosis. Olmsted syndrome, a rare disorder characterized by severe palmoplantar kentoderma, has been observed in two monozygotic twins and the prognosis and treatment are discussed.
m
Antiphospholipids
Mary Gantcheva. Dept. Sofia, Bulgaria
for dermatologists
Dermatology,
Medical
University,
Antiphospholipid antibodies are a group of closely related immunoglobulins (IgG, IgM, IgA or mixture), associated with an increased risk of thrombosis. Recently, they have been shown to be directed not against “native” anionic phospholipids (PL) but rather to modified PL, plasma-proteins (b2-Glycoprotein I, prothrombin, etc.) and complexes of these proteins with PL. The two most prominent members of aPL: lupus anticoagulant (LA) and anticardiolipin antibodies (aCL) are the serological markers for the APS. Antiphospholipid syndrome is a multisystem disease of hypercoagulation with extremely diverse and heterogeneous cutaneous manifestations. In a large number of cases, they are the first sign of the disease. Therefore, dermatologist need to recognize the main characteristics and skin lesions associated with APS.
ILD4
Laser skin resurfacing
Alina Fratila. Day surgery
clinic,
Bonn,
Germany
The 10,600 nm wavelength of the CO;! laser and the 2,940 nm wavelength of the pulsed Er:YAG laser with their high absorption in water, provide optimal characteristics for very accurate and complete ablation of the epidermis regardless of pigmentation or vascularity. The effects of CO2 laser resurfacing on wrinkles and the aesthetic outcome is more dramatic than with the Er:YAG laser. Er:YAG laser resurfacing does have its advantages, however, among them a shorter reepitbelization time, less thermal effect on the adjacent tissue and therefore less prolonged erythema than with CO2 laser. Also, this offers the possibility of treating the neck, chest and dorsum of the hands. These factors have recently increased the popularity of resurfacing with the Er:YAG laser. Differences regarding the healing period and postoperative erythema are also due to the dermatohistopathological features of the lesion and to postoperative care. In order to speed operation time and reduce side effects an appropriate fluence is essential. The fluence necessary to vaporize tissue with minimum of residual thermal damage (ablation thresholds) is estimated to be above 15 J/cm2 for Er:YAG laser and between 10 and 15 J/cm2 for CO2 laser, depending also on the pattern density used. A combination of surgical procedures may become necessary if the lesion is very thick or deep; e.g. CO2 followed by Er:YAG laser resurfacing for acne scarring or marked perioral wrinkles. Since most patients will need special skin care following resurfacing, the cooperation with a cosmetician will help both, doctor and patient, to obtain a better result. I LD5 Chemical peeling I. Ghersetich. Department of Dermatology, Florence,
University
of
Italy
Chemical peeling consists in the application on the skin of one or more exfoliating agents resulting in destruction of part of the epidermis and/or dermis with subsequent regeneration of new tissue. This techniques produces a controlled wound determining cutaneous renewal with reduction or disappearance of actinic keratoses, pigmentary dyschromias, wrinkles and superficial depressed scars. Chemical peelings induce a modification of the skin according to the wound depth through the following mechanism: (1) Epidermic growth stimulation following the removal of the stratum comeum. (2) Specific destruction of the damaged cutaneous layers and further regeneration of “normal” tissue, which is mandatory in some cutaneous alterations, as actinic keratoses or pigmentary dyschromias.
Luncheon discussions
clLDl
Stimulating pediatric cases for lunch
R. Caputo, C. Gelmetti. Isfitufo I/niversitd di Milano; Milano, Italy
I.R.C.C.S.
di Scienze “Ospedale
Dertnatologiche, Maggiore”,
Pachyerythrodermic mastocytosis is one rare form of diffuse cutaneous mastocytosis that can be observed very early in the life; the other form is the urticarial one, being the difference probably due to a quantitative degree of infiltration of the skin by mast cells; in diffuse forms general symptoms can be severe and identical to those seen in anaphylaxis. Diffuse neonatal hemangiomatosis is one among the rarest types of immature capillary hemangiomas; three forms are described: pure cutaneous; associated with hepatic angiomas; associated with widespread angiomas. Juvenile self-healing mucinosis is a very rare dermatosis in childhood: a case of 8 year old boy is described. Erythema elevatum diutinum is particularly rare in childhood in which the diagnosis can be very difficult; the case described is among the youngest ever reported; dapsone is able to improve the symptoms but cannot stop the course of the disease. Juvenile Xanthogranuloma “en plaque” is uncommon but its runs a benign course as the other more common forms of JXG. Omenn syndrome is a severe immunodeficiency associated with a diffuse erytbematous scaling that is fatal if untreated; the disease can be cured with bone marrow transplant. Wells syndrome can be seldom suspected clinically; histology and response to treatment clarify the diagnosis. Olmsted syndrome, a rare disorder characterized by severe palmoplantar kentoderma, has been observed in two monozygotic twins and the prognosis and treatment are discussed.
m
Antiphospholipids
Mary Gantcheva. Dept. Sofia, Bulgaria
for dermatologists
Dermatology,
Medical
University,
Antiphospholipid antibodies are a group of closely related immunoglobulins (IgG, IgM, IgA or mixture), associated with an increased risk of thrombosis. Recently, they have been shown to be directed not against “native” anionic phospholipids (PL) but rather to modified PL, plasma-proteins (b2-Glycoprotein I, prothrombin, etc.) and complexes of these proteins with PL. The two most prominent members of aPL: lupus anticoagulant (LA) and anticardiolipin antibodies (aCL) are the serological markers for the APS. Antiphospholipid syndrome is a multisystem disease of hypercoagulation with extremely diverse and heterogeneous cutaneous manifestations. In a large number of cases, they are the first sign of the disease. Therefore, dermatologist need to recognize the main characteristics and skin lesions associated with APS.
ILD4
Laser skin resurfacing
Alina Fratila. Day surgery
clinic,
Bonn,
Germany
The 10,600 nm wavelength of the CO;! laser and the 2,940 nm wavelength of the pulsed Er:YAG laser with their high absorption in water, provide optimal characteristics for very accurate and complete ablation of the epidermis regardless of pigmentation or vascularity. The effects of CO2 laser resurfacing on wrinkles and the aesthetic outcome is more dramatic than with the Er:YAG laser. Er:YAG laser resurfacing does have its advantages, however, among them a shorter reepitbelization time, less thermal effect on the adjacent tissue and therefore less prolonged erythema than with CO2 laser. Also, this offers the possibility of treating the neck, chest and dorsum of the hands. These factors have recently increased the popularity of resurfacing with the Er:YAG laser. Differences regarding the healing period and postoperative erythema are also due to the dermatohistopathological features of the lesion and to postoperative care. In order to speed operation time and reduce side effects an appropriate fluence is essential. The fluence necessary to vaporize tissue with minimum of residual thermal damage (ablation thresholds) is estimated to be above 15 J/cm2 for Er:YAG laser and between 10 and 15 J/cm2 for CO2 laser, depending also on the pattern density used. A combination of surgical procedures may become necessary if the lesion is very thick or deep; e.g. CO2 followed by Er:YAG laser resurfacing for acne scarring or marked perioral wrinkles. Since most patients will need special skin care following resurfacing, the cooperation with a cosmetician will help both, doctor and patient, to obtain a better result. I LD5 Chemical peeling I. Ghersetich. Department of Dermatology, Florence,
University
of
Italy
Chemical peeling consists in the application on the skin of one or more exfoliating agents resulting in destruction of part of the epidermis and/or dermis with subsequent regeneration of new tissue. This techniques produces a controlled wound determining cutaneous renewal with reduction or disappearance of actinic keratoses, pigmentary dyschromias, wrinkles and superficial depressed scars. Chemical peelings induce a modification of the skin according to the wound depth through the following mechanism: (1) Epidermic growth stimulation following the removal of the stratum comeum. (2) Specific destruction of the damaged cutaneous layers and further regeneration of “normal” tissue, which is mandatory in some cutaneous alterations, as actinic keratoses or pigmentary dyschromias.