Case and Research Letter
Combined Laser Therapy in a Mpox Scar
Laserterapia Combinada en una cicatriz de Mpox
B. Pimentel
, A. Palmeiro, G. Catorze
Corresponding author
Serviço de Dermatologia do Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
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Well-defined, predominantly cystic, 15-mm lesion. It is anechoic in the periphery with heterogeneous content and internal focal echoic areas suggestive of keratin (A). Lesion appears avascular, without evident internal vessels (B).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Pérez-Wilson, G. Coulon, C. Whittle, A. Castro" "autores" => array:4 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Pérez-Wilson" ] 1 => array:2 [ "nombre" => "G." "apellidos" => "Coulon" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Whittle" ] 3 => array:2 [ "nombre" => "A." 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Note the improvement of the lesions after 6 months of treatment with apremilast 30<span class="elsevierStyleHsp" style=""></span>mg twice a day (C and D).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Mansilla-Polo, C. Abril-Pérez, M.Á. Navarro-Mira, R. Botella-Estrada" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Mansilla-Polo" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Abril-Pérez" ] 2 => array:2 [ "nombre" => "M.Á." "apellidos" => "Navarro-Mira" ] 3 => array:2 [ "nombre" => "R." "apellidos" => "Botella-Estrada" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731023004908?idApp=UINPBA000044" "url" => "/00017310/unassign/S0001731023004908/v1_202307180913/en/main.assets" ] "asociados" => array:1 [ 0 => array:17 [ "pii" => "S0001731024008019" "issn" => "00017310" "doi" => "10.1016/j.ad.2024.10.027" "estado" => "S100" "fechaPublicacion" => "2024-10-25" "aid" => "4118" "copyright" => "AEDV" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "crp" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta científico-clínica</span>" "titulo" => " Laserterapia combinada en una cicatriz de Mpox" "tienePdf" => "es" "tieneTextoCompleto" => "es" "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Combined Laser Therapy in a Mpox Scar" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1005 "Ancho" => 755 "Tamanyo" => 113282 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Sitio de la lesión transcurridos dos meses de la terapia de láser combinada.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "B. Pimentel, A. Palmeiro, G. Catorze" "autores" => array:3 [ 0 => array:2 [ "nombre" => "B." "apellidos" => "Pimentel" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Palmeiro" ] 2 => array:2 [ "nombre" => "G." "apellidos" => "Catorze" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731024008019?idApp=UINPBA000044" "url" => "/00017310/unassign/S0001731024008019/v1_202410250439/es/main.assets" ] ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>" "titulo" => "Combined Laser Therapy in a Mpox Scar" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the Editor</span>," "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "B. Pimentel, A. Palmeiro, G. Catorze" "autores" => array:3 [ 0 => array:4 [ "nombre" => "B." "apellidos" => "Pimentel" "email" => array:1 [ 0 => "pimentel233@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Palmeiro" ] 2 => array:2 [ "nombre" => "G." "apellidos" => "Catorze" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Serviço de Dermatologia do Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Laserterapia Combinada en una cicatriz de Mpox" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1005 "Ancho" => 755 "Tamanyo" => 113282 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Lesion site two months after combined laser therapy.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 27-year-old man with no significant medical history presented to the dermatology office with a five-month-old history of a dermatosis that involved the ventral surface of his penis, the back and abdomen. Further questioning revealed a self-limited flu-like syndrome with fever and myalgias that preceded the appearance of the skin lesions, approximately 2 weeks after an unprotected sexual intercourse with another male. The dermatosis first appeared as pruriginous vesicles, evolving into an umbilicated papules that later formed a scab that fell shortly after. At that time the patient came out positive in a swab for Mpox. Physical examination found an erythematous ulcerated scar with 3<span class="elsevierStyleHsp" style=""></span>mm of larger axis with associated cutaneous retraction on the ventral aspect of the penis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The patient referred pruritus and pain due to retraction at this site asking for therapy. This scar scored 8 points in the Modified Vancouver Scar Scale (mVSS). The other lesions on the body left only post inflammatory hyperpigmentation at most.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Clinical course and treatment</span><p id="par0010" class="elsevierStylePara elsevierViewall">A combined laser therapy session was scheduled and performed around 5 months after resolution of the active lesions. Anesthesia with lidocaine 4% gel was used. The patient underwent treatment with pulsed dye laser (PDL) – (Candela's V-Beam Perfecta) associated with 1550<span class="elsevierStyleHsp" style=""></span>nm ErbGlass (Frax1550<span class="elsevierStyleHsp" style=""></span>nm by Candela), parameterized 0.45<span class="elsevierStyleHsp" style=""></span>ms 6<span class="elsevierStyleHsp" style=""></span>J 7<span class="elsevierStyleHsp" style=""></span>mm 1 pass (PDL) and 10<span class="elsevierStyleHsp" style=""></span>mm 3.2<span class="elsevierStyleHsp" style=""></span>ms 40.0<span class="elsevierStyleHsp" style=""></span>J 3 passes (1550<span class="elsevierStyleHsp" style=""></span>nm ErbGlass), both lasers used in the same session sequentially (first PDL and ErbGlass after). The treatment lasted 10<span class="elsevierStyleHsp" style=""></span>min and was well-tolerated by the patient. The only side effects reported were pain 4/10 on the moment of treatment and swelling that lasted less than 24<span class="elsevierStyleHsp" style=""></span>h, managed with oral non-steroidal anti-inflammatory drugs.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Two months after the laser therapy, the erythema and ulceration had disappeared, leaving only a slight skin retraction in the scar location (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) with a mVSS score of 2. The patient reported high levels of satisfaction with the cosmetic and functional results.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Comment</span><p id="par0020" class="elsevierStylePara elsevierViewall">Mpox skin lesions can cause scarring in up to 13% of affected patients<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> and can lead to both atrophic and hyperpigmented scars.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> Scarring may cause functional impairment and cosmetic concerns, which both may have an impact on physical and psychological health and social life (considering the stigmatization and discrimination associated with Mpox infection).<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">General recommendations for Mpox scar prevention exist, such as skin washing with mild soap and water, avoidance of scratching and unroofing of lesion and scabs, sun protection and the use of silicone-based gels or sheeting.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> However, the literature regarding genital scarring of any etiology and its treatment is scarce, particularly in the case of Mpox scars.</p><p id="par0030" class="elsevierStylePara elsevierViewall">PDL use has shown results in scar treatment, with improvement in erythema, texture, pliability and pain.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> It has also shown result in hypertrophic scarring.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> The combined treatment with PDL and 1550<span class="elsevierStyleHsp" style=""></span>nm ErbGlass has shown good results in traumatic scars.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> However, their use in Mpox scars has not been published yet. By showing promising results in scar improvement, cosmetic and functional results and patient satisfaction with minimal side effects, this case report pretends to demonstrate the potential role of combined laser therapy in Mpox scars treatment.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflict of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Clinical course and treatment" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Comment" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflict of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1005 "Ancho" => 755 "Tamanyo" => 126624 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Patient's scar on the penis’ ventral surface.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1005 "Ancho" => 755 "Tamanyo" => 113282 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Lesion site two months after combined laser therapy.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A dermatologic assessment of 101 mpox (monkeypox) cases from 13 countries during the 2022 outbreak: skin lesion morphology, clinical course, and scarring" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. 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