Behcet’s disease (BD) is a multisystemic inflammatory vasculitic disorder which diagnosed by clinical criteria because of the lack of specific laboratory test and/or pathognomonic histopathological findings. The most frequent diagnostic criteria of this disease are mucocutaneous lesions, appearing at the disease onset or during the course, usually begin before significant organ dysfunction. According to BD International Study Group Criteria, one of the five criteria is dermatologic findings including pseudofolliculitis, acneiform nodules or papulopustular lesions (PPL) diagnosed by clinician in postadolescent patients. In some case reports and clinical studies, the PPL of BD are also denoted as Behcet’s pustulosis, folliculitis, acneiform eruptions and pseudofolliculitis. Owing to implementation of follicular lesions in these criteria, there may be difficulties in the distinction between most of the PPL of BD and the other acneiform eruptions/nonspecific follicular lesions (e.g., acne vulgaris, bacterial folliculitis, steroid acne). Certainly, clinicians should distinguish these patterns for accurate diagnosis. Although earlier studies involve numerous quandaries regarding the diagnostic histopathologic pattern of BD (e.g., whether to include vasculitis or nonspecific folliculitis), it was reported recently that the determination of vasculitic changes in histopathological and direct immunofluorescence results might be useful in the differential diagnosis of patients suspected to have BD.
Part of the book: Acne and Acneiform Eruptions
Cryotherapy, also known as cryosurgery or cryoablation, is a common dermatological treatment that is an expanded area from benign to malignant lesions. The system has been designed as a localized freezing cold that causes the destruction of cell integrity. The treatment has been also used for all ages, which is not required to have a condition of wellness. It is convenient, fast, and easy to apply in clinics, and there is no need for anesthesia. Additionally, multiple lesions are also cured in the same sessions. After the treatment, recovery period has not taken much longer and also has simple adverse effects, which are tolerable. Lastly, cryotherapy has gained excellent cosmetic results. It is highly effective for actinic keratosis and is the treatment of choice for most old patients who show poor cooperation and recurrent multiple lesions. Additionally, due to increasing premalignant lesions all over the world associated with increasing age, it is a considerable choice for lentigo maligna and Bowen’s disease. In non-melanoma skin cancers, it is also the most important option in patients who do not undergo surgery and when other options are not appropriate. In this chapter, the use of cryotherapy for premalignant and malignant cutaneous disorders has been mainly focused.
Part of the book: Dermatologic Surgery and Procedures
Vitiligo is an acquired cutaneous hypopigmentary disorder characterized by multiple depigmented macules and patches. There are numerous therapy modalities consist of topical corticosteroids and calcineurin inhibitors, phototherapy, surgical interventions and laser treatments are evaluated. Last 10 years, firstly excimer laser treatment has showed good results in repigmentation rates. “Excited dimers” produces a 308-nm ultraviolet (UV) monochromatic coherent wavelength, which lies within the UVB spectrum that absorb DNA as a chromophore to breakage DNA chain that causes a decrease in T-lymphocyte proliferation. Some articles have shown different responses depends on the type of vitiligo, number of sessions, interval periods and localisation. Researchers have also compared efficacy and also side effects of excimer laser between other methods. Combination therapies with excimer laser will be also treatment of choice via topical steroids or topical calcineurin inhibitors. Some of the patients developed delayed-onset permanent hypopigmentation need resurfacing methods such as CO2 or Er:YAG laser which mainly aims to ablate the epidermis in specific coagulation columns to promote the penetration of externally applied agent. As an alternative treatment modality in vitiligo, lasers may help to raise patient compliance and reduce potential risk for skin cancer. Its convenience is limited by high cost and accessibility.
Part of the book: Depigmentation