PURPOSE:Surgical treatment remains the first-line therapy of pilonidal cyst but is associated with high levels of postoperative pain, adverse events and a recurrence rate of 30%. We report our experience with laser hair removal using the Nd-YAG laser for the treatment of pilonidal cyst. MATERIALS AND METHODS:Ten patients affected by pilonidal cyst were examined and treated from October 2011 to November 2016. Treatments were carried out using the Nd-YAG laser (Deka M.E.L.A, Calenzano, Florence, Italy) at a wavelength of 1064 nm at 30-day interval. RESULTS:Nine patients were asymptomatic after the second treatment, while in one case the symptom disappeared after the fourth session. After 4-8 treatments, the pilonidal cyst had clinically disappeared and patients subjectively felt healed. In all cases, the soft-tissue ultrasounds performed before the first and after the last session showed the disappearance of the pilonidal cyst. In the follow-up, all the patients remained asymptomatic without any disease recurrence. CONCLUSIONS:Nd-YAG laser is an effective treatment for pilonidal cysts, providing excellent results with quick healing and no risk of serious adverse side-effects. It could be a very attractive alternative to open surgery, enabling patients to prevent the frequent and severe postoperative issues associated with surgery.

BACKGROUND:CO2 laser has not only become the most widely used laser in dermatological surgical practice, but it has also proved to be highly effective in treating aesthetic imperfections.OBJECTIVE:To examine the efficacy and safety of a novel fractional CO2 laser combined with a radiofrequency device in different dermatological, surgical and aesthetic fields.METHODS:A total of 79 patients were treated in our Outpatient Service with a novel fractional CO2 laser combined with a bipolar radiofrequency device for a maximum of 5 months. Group A consisted of 39 patients with lesions requiring complete excision, whereas Group B consisted of 40 subjects seeking to enhance aesthetic facial imperfections. The results were assessed by three 'blind' investigators using photographs and clinical observations; in addition, the patients had to give their own subjective assessment of the results.RESULTS:At the 6-month follow-up, the lesions of the Group A patients had been completely removed, except for one case of a large sebaceous nevus on the scalp. All the Group B patients showed global improvement in skin tightening, removal of fine lines and rhytides and correction of dilated pores and hyperpigmentation, with no significant side-effects and short downtimes.CONCLUSION:This kind of laser meets the needs of the majority of dermatologists requiring a unique, versatile tool to remove cutaneous lesions and at the same time, safely and effectively treat skin imperfections.

We report the case of a 76-year-old Caucasian woman who attended our clinic with multiple keratoacanthomas. Radiotherapy was considered a viable and effective option in such an old patient, who could not be a good surgical candidate for number and distribution of the lesions, and for the age. After a 12-month follow-up, we observed the complete and global disappearance of the lesions; the patient was therefore very satisfied especially in view of the clinical outcome. According to our point of view, radiotherapy allows the physician to obtain a good oncological radicality and excellent cosmetic results too.

BACKGROUND:The periorbital area is a barometer of chronologic and environmental age for which patients usually seek rejuvenation; fractional CO(2) laser plays a key role among the variety of available dermatologic treatments.OBJECTIVES:The purpose of this study is to evaluate the efficacy and safety of Fractional CO(2) laser in eyelid tightening and periorbital wrinkles.METHODS:Forty-five patients received a range of 2-3 treatments in the upper, lower eyelids and periorbital area with a fractional laser device. Photographs were taken before and after each treatment and 2 weeks, 4 weeks, 3 months, 6 months and 12 months after the final treatment. The results were judged by three dermatologists who had not taken part in the treatments.RESULTS:One year after the last laser session, all patients showed global improvements in eyelid skin tightening: five patients (11.1%) achieved excellent improvement, 11 patients (24.5%) marked improvement, 15 patients (33.3%) moderate improvement and 14 subjects (31.1%) slight improvement. At the 1-year follow-up, the percentage of subjects with a lift in their eyebrows and consequently a widened palpebral fissure was 82.2 (37 patients), whereas 17.8% (eight patients) showed no eyebrow elevation.CONCLUSIONS:Fractional CO(2) laser treatments allow dermatologists to achieve notable improvements in eyelid skin tightening, and eyebrow elevation safely and without significant side-effects.

Minimally ablative or sub-ablative lasers, such as fractional CO2 lasers, have been developed in an attempt to achieve the clinical results observed with traditional ablative lasers but with minimal side effects. Despite being an ablative laser, this fractional delivery system is able to produce a fractional supply of the beam of light. Moreover, the generating of fractional ablation of the tissue through the development of microscopic vertical columns surrounded by spared areas of epidermis and dermis, ensures rapid wound healing and minimum downtime. The new PSD (Pulse Shape Design) technology allows for selecting different pulse waveforms in order to meet the needs of all skin conditions, each optimized and adapted for correct use with cold superficial fine ablation, minimally deeper thermal ablation or more volumetric thermal ablation. With this system, the deep ablation and thermal stimulation help reduce superficial erythema and oedema, lowering the operating and post-o perative pain levels and preserving the therapeutic effects in the reticular derma, thus producing rapid and high-quality results. The simultaneous synchronized delivery of a RF current to the deeper layer of the skin completes the therapeutic scenario, ensuring an effective skin tightening effect over the entire area treated. We describe the preliminary results observed in the treatment of wrinkles and acne scars using this new laser technology.

Infantile hemangiomas (IHs) are proliferating embrional tumors which can stem from placented tissue and are constituted by endothelial cell hyperproliferation. The management of the IHs is always challenging for all the specialists because of the heterogeneous behavior of these lesions. The factors leading to an aggressive position are essentially these: the prevention or reduction of aesthetic risks, the prevention or treatment of ulcerated hemangiomas, the prevention or impairment of functional risks and pain, and the removal of life-threatening risks. The treatment of vascular lesions is one of the mostly sought and performed cutaneous laser procedures, and in the field of IH treatments the more used laser devices certainly are pulsed dye lasers. Early laser therapy is able to reduce the possibility that the lesion will reach its full size, preventing several complications, connected to the hemangioma's growth, and providing psychological relief for pediatric patients and their parents.

Eighteen female patients with the signs of photoageing underwent skin rejuvenation using a fractional CO2 laser (SmartXide DOT, DEKA M.E.L.A., Florence, Italy) with varying energy density (2.07, 2.77 and 4.15 J/cm2). Clinical efficacy of the said laser irradiation parameters was assessed in all of the subjects, and the skin cytokine profile was studied by using the immunohistochemistry technique based on skin tissue samples taken prior to the treatment, right after the treatment and in 3 and 30 days. There were significant improvements in the wrinkle and skin texture condition, and hyperpigmentation was reduced as a result of the treatment, which proves the efficacy of using the fractional CO2 laser for the skin photorejuvenation. The technique ensures good clinical results and is distinguished by a short rehabilitation period and excellent safety profile. In the course of the immunohistochemistry, a relation between the skin cytokine production, reepithelization and laser irradiation density was established.

Восемнадцати женщинам добровольцам, имевшим признаки фотостарения, проведено омоложение кожи фракционным СО2-лазером (SmartXide DOT, DEKA M.E.L.A., Флоренция, Италия) с использованием различных показателей плотности энергии (2,07, 2,77 и 4,15 Дж/см2). У всех испытуемых оценена клиническая эффективность применения указанных параметров лазерного излучения, а также иммуногистохимическим методом изучен цитокиновый профиль кожи в биоптатах, взятых до лечения, сразу после лечения и спустя 3 и 30 дней. В результате лечения значительно улучшилось состояние морщин и текстуры кожи, уменьшилась гиперпигментация, что свидетельствует о высокой эффективности применения фракционного СО2-лазера для фотоомоложения кожи. Метод позволяет получить хорошие клинические результаты, характеризуется коротким реабилитационным периодом и отличным профилем безопасности. При иммуногистохимическом исследовании выявлена связь продукции цитокинов в коже с фазой реэпителизации и плотностью энергии лазерного облучения.

Dermatological radiotherapy has used for decades in the treatment of skin diseases with very good results. The Florentine school has always played a fundamental role in the development of this technique, this is where a phototherapy institute, which was going, in the future, to be 1st one in Italy to perform contact radiotherapy regularly, started. As time went by and with the development to new therapeutical modalities, the roentgentherapy met with a decreasing consent. So far, it is still proposed as an effective therapeutically modality in dermatological oncology, if even in selected cases. Basal cell carcinomas can reach big dimensions mainly for recurrence or because the tumor was overlooked for a long time. We bring to attention the case of a 65-year-old man presenting an ulcerated, sharp-bordered, infiltrating and bleeding lesion, occupying most of the left wing of the nose, with a diameter of about 3 cm. The man hadn't received any previous treatment. The lesion was subjected to a biopsy and the istopathological analysis diagnosed an ulcus rodens. The man refused the complete surgical removal, and was thus treated with roentgentherapy, with satisfying results and without any complications in the irradiated area. The patient didn't show any relapse after one year of follow-up. Radiotherapy can still be considered as an effective therapeutical alternative both for lesion requiring a surgical approach and for those developing in patients that couldn't be subjected to any other therapies.

BackgroundIntense pulsed light (IPL) treatment is one of the most effective procedures for patients with non-aesthetic vascular lesions in addition to signs of skin photoageing, and it has been reported as very successful in the treatment of telangiectasias, spider nevi, erythrosis, and above all, rosacea and poikiloderma. Its use is based on the principle of selective photothermolysis, which exploits the haemoglobin absorption peak among its range of wavelengths.ObjectiveThe aim of this study is to assess the efficacy and safety of intense pulsed light in treating non-aesthetic vascular skin lesions, especially with regard to poikiloderma of Civatte and rosacea.MethodsA total of eighty-five patients, 64 women and 21 men, with 63 non-aesthetic vascular lesions (28 Poikiloderma of Civatte and 35 rosacea), 22 pigmented lesions (UV-related hyperpigmentation of solar lentigo-type) and four precancerous lesions (actinic keratosis, AKs), were treated repeatedly with IPL for 2 years. The patients received a mean of five treatments (range 4-6) at 3-weekly intervals. They were evaluated via clinical observations and professional photographs were taken before each treatment and after 2 weeks, 4 weeks, 3 months, 6 months and 12 months. The outcome of the IPL treatments was evaluated by four independent dermatologists, who were not informed about the study protocol, and who assessed the performance of IPL by dividing the results into four categories: no results, slight improvement, moderate improvement and marked improvement.ResultsAll the patients showed improvements in their overall lesions: 72 lesions (80.9%) achieved a marked improvement, 14 lesions (15.7%) achieved a moderate improvement and three lesions (3.4%) achieved a slight improvement. The results of the 63 non-aesthetic vascular lesions in Rosacea and Poikiloderma of Civatte were: 51 with a marked improvement, 10 with moderate improvement, whereas only two lesions achieved a slight improvement. The improvement of all four actinic keratoses was marked whereas the 22 pigmented lesions obtained a marked improvement in 17 cases, a moderate improvement in four cases and a slight improvement in one case. No undesirable effects were observed.ConclusionsOur study confirms how by minimizing side-effects, time and costs, IPL can be effective and safe for the treatment of non-aesthetic facial and neck vascular lesions.

Basal cell carcinoma is a common skin tumour with a benign course. The purpose of this work is to evaluate the efficiency of a flash-lamp pumped pulsed dye laser for the treatment of superficial basal cell carcinomas.

Minimally ablative fractional laser devices have gained acceptance as a preferred method for skin resurfacing. Notable improvements in facial rhytides, photodamage, acne scarring, and skin laxity have been reported. The aim of the present work was to compare how different CO(2) laser fluences, by modulating the secretory pathway of cytokines, are able to influence the wound-healing process, and how these fluences are associated with different clinical results. Eighteen patients, all with photodamaged skin, were treated using a fractional CO(2) laser (SmartXide DOT, Deka M.E.L.A., Florence, Italy) with varying laser fluences (2.07, 2.77, and 4.15 J/cm(2)). An immunocytochemical study was performed at defined end points in order to obtain information about specific cytokines of the microenvironment before and after treatment. The secretory pathway of cytokines changed depending on the re-epithelization and the different laser fluences. Different but significant improvements in wrinkles, skin texture, and hyperpigmentation were definitely obtained when using 2.07, 2.77, and 4.15 J/cm(2), indicating fractional CO(2) laser as a valuable tool in photorejuvenation with good clinical results, rapid downtime, and an excellent safety profile.

Basal cell carcinoma is the most common skin tumor in humans which can be removed in a variety of ways (depending on the type of the lesion, the affected area, and depth of the lesion). Laser therapy offers another option to the traditional methods of treatment; thus, the purpose of this work is to valuate the efficacy of dye laser in a selected group of patients affected by superficial basal cell carcinoma. We suggest that the success of pulse dye laser treatment lies in the fact that as all tumors, basal cell carcinomas contain an increased number of dilated blood vessels. Twenty patients (eight males and 12 females) with superficial basal cell carcinoma were given five treatments with a flashlamp-pumped pulse dye laser every 20 days. The clinical follow up was 12-24 months after the fifth treatment. A complete response was obtained in 16 patients out of 20. Three recurrences and one no response was observed during the study. Pulse dye laser is effective and safe in the treatment of superficial basal cell carcinoma

RESULTSFor over five years, we have been using a new ultraviolet B ray source, a Xenon-Chloride lamp emitting non-coherent, monochromatic 308-nm light that represents the natural evolution of the excimer laser. A source of monochromatic excimer light (MEL) produces 50 mW/cm(2) power density at a distance of 15 cm from the source and has a maximum irradiating area of 504 cm(2), this feature representing the greatest therapeutic advantage offered by 308 nm sources. On the other hand, the benefits offered by the MEL compared to traditional phototherapies are essentially correlated to the fact that there is no need to administer oral psoralens (PUVA therapy) and that sessions need to be repeated only every 7-15 days, an important condition for the improvement of the patient's quality of life (since at least 2-3 weekly sessions are required with the traditional UVB therapy). Using MEL, UV B light can be applied on the entire body, with partial subintrant skin irradiations, or on one or just a few individual patches, taking care to accurately protect the healthy surrounding skin and allowing for a phototherapy exclusively targeted onto the lesion to be treated. Clinical indications and the reasons for choosing MEL for the treatment of photosensitive skin disorders are virtually identical to those stated for PUVA therapy or narrowband UV B light. Due to the absence of photosensitizing substances and drug-induced toxicity, patients who work in the open air, pregnant women and patients suffering from liver or kidney failure can also be treated. Furthermore, the short time required for sessions, the duration of cycles and the selective exposure of the skin areas to be treated undoubtedly represent significant benefits for patients in terms of safety and efficacy. In addition to psoriasis, the use of MEL can also be extended to other pathologies such as vitiligo, alopecia areata, atopic dermatitis and patch-stage IA mycosis fungoides with encouraging