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Biomedical subjects

R Ashinoff

Publications and source records attributed to R Ashinoff.

At least 37 records · Page 2Linked to original sources

Failure of the flashlamp-pumped pulsed dye laser to prevent progression to deep hemangioma.

Hemangiomas are common vascular lesions in children. The flashlamp-pumped pulsed dye laser has shown excellent results in the treatment of port-wine stains and, more recently, superficial (capillary) hemangiomas. Four patients with clinically evident superficial hemangiomas illustrate the point that early treatment with this laser may not preclude growth of a deeper component of the lesions.

Facial Neoplasms↗

Linear nevus sebaceus of Jadassohn treated with the carbon dioxide laser.

A 10-year-old boy from Guiana was born with a linear nevus sebaceus covering his entire nose from the glabella area to the tip. Cosmetic appearance, which was the major concern of the patient and his family, was greatly improved by the use of the carbon dioxide (CO2) laser. The CO2 laser has not been reported previously as a treatment modality for nevus sebaceus.

Carbon Dioxide↗

Q-switched ruby laser treatment of labial lentigos.

The Q-switched ruby laser causes selective damage to pigmented cells in the skin. This laser, which has a wavelength of 694 nm and a pulse duration of 40 nsec, has shown very promising results in the treatment of both amateur and professional tattoos. Less data are available on its ability to treat benign pigmented lesions of the skin. Three patients who had labial lentigos were treated with the Q-switched ruby laser, and dramatic clearing occurred after one or two treatments with a fluence of 10 J/cm2.

Adult↗

Anthralin decreases keratinocyte TGF-alpha expression and EGF-receptor binding in vitro.

Anthralin is an effective topical treatment for active psoriasis; however, its mechanism of action is unknown. Both TGF-alpha and its receptor, the EGF receptor, are overexpressed in active psoriatic plaques and might, therefore, play a role in psoriatic epidermal hyperplasia. In order to assess whether anthralin might act via alteration of this growth factor pathway, we examined the in vitro effects of pharmacologic concentrations of anthralin on cultured normal human keratinocytes. Keratinocyte proliferation was inhibited by 98% at an anthralin concentration of 10 ng/ml. In contrast, lymphocyte proliferation was inhibited by only 50% at an anthralin concentration of 10 micrograms/ml. Anthralin treatment did not induce cell-cycle-specific growth arrest as assessed by flow-cytometric analysis of acridine-orange-stained keratinocytes. Northern analysis of anthralin-treated keratinocytes demonstrated a marked decrease in TGF-alpha mRNA expression. Anthralin-treated keratinocytes showed decreased binding of 125I-EGF and 125I-IGF-I to their respective receptors, but EGF receptor binding was inhibited to a greater extent. Anthralin decreased ligand-binding affinity and cell-surface numbers of EGF receptors as assessed by Scatchard analysis of 125I-EGF binding to anthralin-treated keratinocytes. These results indicate that anthralin alters components of the EGF receptor pathway in cultured keratinocytes and that these effects might contribute to the clinical efficacy of anthralin in the treatment of active psoriasis.

Anthralin↗

Treatment of a port-wine stain in a black patient with the pulsed dye laser.

A black man presenting with a port-wine stain was spot-treated with a flashlamp-pumped pulsed dye laser. The 1 cm2 area was treated with the flashlamp-pumped pulsed dye laser using rhodamine in methanol as the dye, a wavelength of 585 nm, a pulse duration of 450 microseconds, and a circular spot size of 5 mm. Energy density was 7.75 J/cm2. Superficial sloughing of the skin was noted immediately posttreatment. Persistent hyperpigmentation, textural changes to the skin, and no improvement in the port-wine stain were noted at follow-ups 2-, 4-, and 8-months posttreatment.

Arteriovenous Malformations↗

Cyclosporine in psoriasis treatment. Inhibition of keratinocyte cell-cycle progression in G1 independent of effects on transforming growth factor alpha/epidermal growth factor receptor pathways.

Cyclosporine, an immunosuppressive drug, is effective in the treatment of recalcitrant psoriasis. Previous work suggested that keratinocyte hyperproliferation and inflammation are linked in psoriasis and that immune mechanisms participate in the pathogenesis of psoriasis. Transforming growth factor (TGF) alpha may be an important regulatory factor of epidermal growth as overproduction of TGF-alpha is associated with epidermal hyperplasia in psoriatic plaques and epidermal growth factor receptors are overexpressed in psoriatic epithelium. In this study, the effects of cyclosporine on cultured human keratinocytes were examined. Cyclosporine specifically inhibited keratinocyte cell-cycle progression in the G1 phase without causing keratinocytes to terminally differentiate. Cyclosporine did not decrease the expression of TGF-alpha or epidermal growth factor receptors. These results suggest that the effects of cyclosporine on psoriatic skin are unrelated to direct effects on autocrine growth regulation of keratinocytes via TGF-alpha production or of epidermal growth factor receptor modulation.

Chemokine CXCL10↗

Flashlamp-pumped pulsed dye laser for port-wine stains in infancy: earlier versus later treatment.

Twelve children, 6 to 30 weeks of age (average 14.9 weeks), with port-wine stains of the head and neck were treated with the flashlamp-pumped pulsed dye laser at 585 nm and 450 microsecond pulse duration. Ten of 12 patients (83%) showed more than 50% lightening of their port-wine stains after 2.9 treatment sessions (2.9 +/- 1.4 [+/- standard deviation]). Forty-five percent of the patients demonstrated 75% or more lightening of their lesions after a mean of 3.8 treatments (+/- 1.6). No lesions in this group cleared completely after a mean of 2.8 treatments. Treated skin was identical in texture to normal skin in all patients. There was no evidence of depressed scars, atrophy, hyperpigmentation, or hypopigmentation in the treated areas. These results indicate that pulsed dye laser treatment of port-wine stains can be undertaken safely in infancy.

Facial Neoplasms↗

Prolongation of anesthesia in Mohs micrographic surgery with 2% lidocaine jelly.

The authors performed a prospective, randomized trial of topical 2% lidocaine jelly in patients with basal cell or squamous cell carcinomas to test the effectiveness of the jelly in prolonging the time of anesthesia between the multiple stages of Mohs micrographic surgery. There was a 48% increase in the duration of anesthesia achieved by the use of 2% lidocaine jelly in patients given 1% lidocaine with epinephrine. In patients given 1% lidocaine without epinephrine, there was approximately a 2.5 times greater duration of anesthesia achieved by using topical 2% lidocaine jelly.

Anesthesia, Local↗

The medical necessity of evaluation and treatment of port-wine stains.

New lasers and improved laser delivery systems have allowed for the safe and effective treatment of port-wine stains in patients of all ages. The satisfactory results obtained by laser treatment have increased the number of patients seeking consultation regarding their birthmarks. It is imperative that physicians recognize the various medical syndromes and problems associated with port-wine stains. A review of 415 patients with facial port-wine stains has revealed hypertrophy and/or nodularity in 65% of patients by the fifth decade of life, which increases significantly the morbidity of these lesions. It is believed that laser treatment will minimize the medical and psychologic complications that result from the natural evolution of port-wine stains.

Adolescent↗

Detection of human papillomavirus DNA in squamous cell carcinoma of the nail bed and finger determined by polymerase chain reaction.

Increasing evidence supports the association of squamous cell carcinoma of the finger and nail bed with human papillomavirus infection. We treated 12 patients with squamous cell carcinoma of the finger and nail bed, none of whom was originally diagnosed as having a malignant lesion. Half of the patients were referred for carbon dioxide laser ablation of what was believed to be a recalcitrant verruca vulgaris. Our objective was to evaluate these lesions for the presence of human papillomavirus by in situ hybridization techniques and the polymerase chain reaction. This is the first report of use of the polymerase chain reaction to detect human papillomavirus in formalin-fixed, paraffin-embedded specimens of periungual squamous cell carcinoma. Seven of the 12 lesions were evaluated for the presence of human papillomavirus by both in situ hybridization and the polymerase chain reaction. Five of the seven periungual lesions were found to contain human papillomavirus type 16 but not type 18 DNA with use of the polymerase chain reaction technique. In situ hybridization failed to identify human papillomavirus in any of these patients' tumors. Our data confirm the association between human papillomavirus and squamous cell carcinoma of the periungual region and suggest that biopsies should be performed on chronic, isolated lesions of the finger in adults before therapy is initiated.

Adult↗

Lasers in the treatment of skin cancer.

The development and use of various laser systems for the treatment of carcinomas of the skin constitute a relatively new therapeutic approach. Because the skin is a readily accessible organ, it is an excellent site at which to attempt different therapeutic modalities. What is truly astounding has been the development of specific lasers designed to treat certain dermatologic problems. Because the field of laser biotechnology is still rapidly emerging, it is very likely that new lasers and modifications of existing ones will improve our ability to treat skin cancer and precancerous conditions.

Dermatologic Surgical Procedures↗

Capillary hemangiomas and treatment with the flash lamp-pumped pulsed dye laser.

Strawberry, or capillary, hemangiomas are common vascular neoplasms, with an incidence of approximately 2.6% in neonates. They usually develop in the first few weeks of life, so that between 1 month and 1 year the incidence rises to between 8.7% and 10.1%. These lesions may grow quite large in the first year of life, and they may ulcerate or obstruct a vital organ or function. The great majority will spontaneously regress after the first year of life. Parents are often alarmed at the sight of these hemangiomas and need reassurance that the great majority will regress spontaneously. Treatments such as cryosurgery, irradiation, radium instillation, corticosteroid therapy, or surgical excision are often ineffective or cause significant morbidity. We describe 10 children with capillary hemangiomas treated with the flash lamp-pumped pulsed dye laser. The patients ranged in age from 7 weeks to 5.5 years at the beginning of laser therapy. The patients underwent 3.1 +/- 1 (mean +/- SD) laser treatments, with a mean regression of the lesions of 69.9% +/- 4.5%. All patients demonstrated some diminution in the size and color of their hemangiomas after the treatments, and there were no ill effects, such as ulceration, hemorrhage, infection, or scarring. There was no evidence of hyperpigmentation or hypopigmentation. Pulsed dye laser therapy should be considered as an option in the treatment of capillary hemangiomas, preferably prior to their full evolution. It is also a useful therapeutic approach in those hemangiomas that are slow to regress in older children.

Child, Preschool↗

Chronic actinic dermatitis. Study of the spectrum of chronic photosensitivity in 12 patients.

Twelve patients with photodermatitis for longer than 3 months' duration were identified: 1 patient with chronic photocontact dermatitis, 1 with persistent photosensitivity following exposure to a systemic medication, 6 with persistent light reactivity, and 4 with actinic reticuloid. There were 10 men and 2 women, ranging in age from 27 to 81 years, with a mean age of 62 years. The duration of the eruption ranged from 6 months to 20 years. Persistence of photosensitivity to quinidine, which is analogous to persistent light reactivity, was documented in 1 patient, and evolution from photocontact dermatitis to actinic reticuloid was observed in 2 others. These data, along with those reported in the literature, indicate that chronic photocontact dermatitis, persistent photosensitivity to systemic agents, persistent light reactivity, photosensitive eczema, and actinic reticuloid should be considered as entities occurring along a continuum, and the term "chronic actinic dermatitis" is suggested to refer to these entities. Eight (67%) of the 12 patients had skin type VI and 2 others (17%) had skin type V, percentages markedly higher than those of the general patient population, demonstrating that chronic actinic dermatitis is not uncommon among individuals with dark skin.

Adult↗

Effect of the topical anesthetic EMLA on the efficacy of pulsed dye laser treatment of port-wine stains.

EMLA cream (Eutectic Mixture of Local Anesthetics) is a new topical anesthetic composed of 25 mg lidocaine and 25 mg prilocaine in an oil-in-water emulsion cream. It has been found to be very effective for local anesthesia prior to venepuncture, minor surgical procedures, and pulsed dye laser (PDL) therapy for port-wine stains (PWS) in children. However, since EMLA may cause vasoconstriction of cutaneous vessels, we tried to determine whether pretreatment with EMLA decreases the efficacy of subsequent PDL treatment. We report eight patients between the ages of 4 and 32 years with PWS who received two test site treatments prior to PDL treatment. One site was pretreated with EMLA cream under occlusion for 60 minutes and then left unoccluded for 15 minutes prior to PDL test treatment. The other site, in the same area of the PWS and patient's body, was not pretreated with EMLA. The test sites were compared 6-8 weeks later to determine whether EMLA decreased the degree of lightening of the PWS compared to the non-EMLA-treated site. We conclude that EMLA is an effective topical anesthetic for PDL treatment of PWS and does not adversely affect the efficacy of the treatment.

Administration, Topical↗