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Arch Dermatol. 2003;139:1251.

Mechanisms Underlying Imiquimod-Induced Regression of Basal Cell Carcinoma In Vivo
Imiquimod is a local immune response modifier that has demonstrated potent antiviral and antitumor activity. In this pilot, open-label, nonrandomized study, Urosevic et al seek to define the mechanisms by which topical imiquimod leads to destruction of superficial basal cell carcinomas (sBCCs). Daily application of 5% imiquimod cream 5 times weekly was prescribed for 6 weeks to histologically documented sBCCs, after which the tumor was excised. Tumor cells demonstrated decreased Bcl-2 expression, making them more susceptible to apoptosis. Tumor clearance may be the result of its increased susceptibility to apoptosis as well as a consequence of an increase in peritumoral and intratumoral infiltrating cells.

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Laser-Mediated Photodynamic Therapy of Actinic Keratoses
Actinic keratoses (AKs) are extremely prevalent cutaneous neoplasms. Many ablative and medical therapies for AKs exist, but each has disadvantages that include scarring, hypopigmentation, prolonged erythema, difficulty with patient compliance, long recovery periods, and lower cure rates with topical treatments. Alexiades-Armenakas and Geronemus demonstrate that photodynamic therapy of AKs using long-pulsed pulsed-dye laser at nonpurpuric parameters following topical 5-aminolevulinic acid is safe and effective. The advantages may include minimal discomfort, rapid treatment and recovery times, excellent posttreatment cosmesis, high efficacy rates with respect to head lesions, and practical applicability to large body surface areas.

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Erythromelalgia: Vasculopathy, Neuropathy, or Both? A Prospective Study of Vascular and Neurophysiologic Studies in Erythromelalgia
Erythromelalgia is a clinical syndrome characterized by intermittent local heat, erythema, and pain affecting the bilateral lower extremities symmetrically, significantly diminishing patient quality of life. In this prospective study of 67 patients with erythromelalgia, Davis et al performed autonomic reflex screening and vascular function studies in patients prior to symptom onset and then once more after symptom provocation. Almost 60% of patients had abnormal nerve conduction study results, confirming previous observations that erythromelalgia is associated with a small-fiber neuropathy.

Characteristic redness of the toes in a patient with erythromelalgia.

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Laser-Assisted Penetration of Topical Anesthetic in Adults
Lidocaine is one of the most commonly used local anesthetic agents. The stratum corneum, however, prevents adequate penetration of topically applied lidocaine. Lidocaine formulations with enhanced penetration are helpful but not ideal owing to the required prolonged contact time of 30 to 60 minutes. The erbium:YAG (Er:YAG) laser has ablative properties such that a single pulse can remove an area of the stratum corneum, leading to enhanced uptake of topical agents such as lidocaine and epinephrine while leaving the entire viable epidermis intact. In this randomized controlled trial, Baron et al demonstrate that pretreatment of skin with an Er:YAG laser facilitates penetration of lidocaine cream, providing anesthesia after just 5 minutes.

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Erbium:YAG Laser and Cultured Epidermis in the Surgical Therapy of Stable Vitiligo
Autologous cultured epidermis can induce a steady and complete repigmentation of "stable" vitiligo. Disepithelialization of the recipient site has been most commonly achieved with programmed diathermosurgery, a time-consuming process that limits the width of the area that can be treated during a single procedure. Erbium:YAG lasers are capable of precise tissue ablation, and this study demonstrates the usefulness of the Er:YAG laser in preparing the recipient site with speed and minimal trauma. Removing the epidermis in such a fast and safe manner allows larger vitiligo lesions to be treated during a single surgical operation.

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SECTION EDITOR: ROBIN L. TRAVERS, MD

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