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peripheral pigmentation&#44; and white central patch&#41;&#44; more than a year since onset&#44; age over 18&#8239;years&#44; and not having undergone prior treatment in the past 3&#8239;months&#46; DF that fulfilled typical clinical and dermatoscopic criteria were chosen and a total of 23 cases were included&#46; All patients gave signed informed consent in order to take part in the study&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The Q-Switched alexandrite laser with a wavelength of 755&#8239;nm &#40;Alex Lazr&#44; Syneron Candela&#44; Boston&#44; MA&#44; USA&#41; was used&#46; The parameters used were a fluence of 7&#46;5&#8239;J&#47;cm<span class="elsevierStyleSup">2</span>&#44; a spot size of 3&#8239;mm&#44; and a pulse duration of 50&#8239;ms&#46; Local anesthetic was not required&#46; Each lesion was treated in 2 sessions&#44; with an interval of 4&#8239;weeks between sessions&#46; Post-treatment care included application of petrolatum cream twice daily for a week&#46; The V Beam pulsed dye laser &#40;Alex Lazr&#44; Syneron Candela&#44; Boston&#44; MA&#44; USA&#41;&#44; with a wavelength of 595&#8239;nm was used to improve residual erythema secondary to application of the Q-Switched alexandrite laser&#46; The parameters used were a fluence of 10-11&#8239;J&#47;cm<span class="elsevierStyleSup">2</span>&#44; a spot size of 7&#8239;mm&#44; and a pulse duration of 1&#46;5&#8239;ms&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Patients were followed up for 2&#8239;months&#46; Clinical and dermatoscopic images of the DF were taken before and after treatment&#46; Similar lighting&#44; the same camera setup&#44; the same dermatoscope &#40;Handyscope for Ipod touch&#44; Fotofinder Systems GmbH&#44; Bad Birnbach&#44; Germany&#41;&#44; and the same image-processing technique were used to ensure that the images were comparable&#46; Three different dermatologists evaluated the effectiveness and safety of the treatment &#40;comparison of interobserver agreement&#41; by assessing changes in color&#44; degree of hardening&#44; patient satisfaction &#40;0-10 points&#41;&#44; and adverse effects observed before and after treatment&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Results</span><p id="par0025" class="elsevierStylePara elsevierViewall">All patients were women aged between 25 and 67 &#8239;years &#40;mean&#44; 51&#46;2&#8239;years&#41;&#46; Time since onset of the DF varied between 2 and 40&#8239;years &#40;mean&#44; 15&#8239;years&#41;&#46; Fourteen patients had phototype&#8239;III on the Fitzpatrick scale&#44; 8 had phototype&#8239;II&#44; and 1 patient had phototype&#8239;I&#46; Twenty-one of the DF were located on the lower limbs and only 2 were located on the arms&#46; None of the patients reported associated symptoms before or after treatment&#46; Partial clearance of the brown color was observed in 9 DF&#44; whereas complete clearance was observed in 14&#46; Patients reported a high degree of satisfaction &#40;mean&#44; 8&#8239;points&#41;&#46; Furthermore&#44; after treatment&#44; 15 patients reported a reduction in the degree of hardening of the DF &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A and 1B&#41;&#46; Dermatoscopy before application of the laser revealed pigmentation in all the DF&#46; This pigmentation disappeared in all cases after treatment <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C and 1D&#41;&#46; Before application of the laser&#44; 10 of the DF revealed diverse structures with a vascular appearance&#46; After laser treatment&#44; however&#44; these structures were observed in 18 of the DF&#46; The white central patch was present in all cases of DF&#44; both before and after treatment&#46; Erythema &#40;reddish coloring of the post-laser lesion&#41; was the most frequent adverse effect and was observed in 14 of the DF&#46; The erythema disappeared after application of the V Beam pulsed dye laser &#40;595&#8239;nm&#59; 10-11&#8239;J&#47;cm<span class="elsevierStyleSup">2</span>&#59; 7&#8239;mm&#59; 1&#44;5&#8239;ms&#41; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>E&#41;&#46; Only one of the patients &#40;with phototype&#8239;I on the Fitzpatrick scale&#41; showed residual hypopigmentation&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">Surgical excision of DF is generally considered to be a cure and presents local recurrence of less than 2&#37;&#46; Surgery&#44; however&#44; may produce unwanted scars&#46; Nonsurgical therapeutic alternatives described include cryotherapy and intralesional injection of corticosteroids&#46; This last treatment is of limited and variable efficacy&#44; and may cause adverse effects in some cases&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> No standard approach exists to the treatment of DF and management of these lesions continues to be a therapeutic challenge&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Different types of laser have been used to treat DF&#46; Pulsed dye laser has been shown to provide clinical improvement in these lesions and to have adequate cosmetic results&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> Wang and Lee<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> reported 20&#8239;DF treated in 3 sessions with pulsed dye laser &#40;600&#8239;nm&#59; 7&#8239;J&#47;cm<span class="elsevierStyleSup">2</span>&#59; 7&#8239;mm&#59; 1&#44;5&#8239;ms&#41;&#46; In terms of reduction of lesion size&#44; 15 of the 20 DF &#40;75&#37;&#41; presented a complete clinical response&#44; whereas 5 &#40;25&#37;&#41; showed a partial response&#46; In terms of improvement in coloring&#44; 12 of the 20 DF &#40;60&#37;&#41; presented a complete and 8 &#40;40&#37;&#41; showed a partial response&#46; The authors of that study concluded that pulsed dye laser provided a better esthetic result than surgical excision&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Wang and Lee<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> reported 22&#8239;DF treated in between 1 and 3 sessions with pulsed dye laser &#40;595&#8239;nm&#59; 11&#8239;J&#47;cm<span class="elsevierStyleSup">2</span>&#59; 7&#8239;mm&#59; 2&#8239;ms&#41;&#46; Six of these cases showed clinical improvement of over 75&#37;&#44; 6 showed an improvement of between 50&#37; and 75&#37;&#44; 8 showed improvement of between 25&#37; and 50&#37;&#44; and 2 showed improvement of less than 25&#37;&#46; Dermatoscopy revealed changes in all those cases of DF&#46; Full clearance of pigmentation was found in 12 of the DF &#40;54&#37;&#41; and pigmentation was merely reduced in 9 &#40;40&#37;&#41;&#46; Postinflammatory hyperpigmentation or hypopigmentation was the only adverse effect reported and this resolved spontaneously 6&#8239;months after treatment&#46; Because the target of the pulsed dye laser is oxyhemoglobin and not melanin&#44; the mechanism of action in DF is not fully understood&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Wang et al<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> reported good results after treating DF located on the thigh with a CO<span class="elsevierStyleInf">2</span> laser &#40;450-500&#8239;nm&#59; 1-4 passes&#59; 3-5&#8239;mm&#59; 500-600&#8239;ms&#41; in 3 sessions&#44; with an interval of 5&#8239;weeks between each session&#59; a topical corticosteroid was also used in that study&#46; That treatment produced complete flattening of the lesion and disappearance of the pruritus&#46; Minimal postinflammatory hyperpigmentation was also observed&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The use of CO<span class="elsevierStyleInf">2</span> laser in multiple facial DF has also been described&#59; however&#44; details of the parameters used were not provided&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">While preliminary&#44; our study has shown that the Q-Switched alexandrite laser is an effective and safe therapeutic alternative for the treatment of DF&#46; Patients also reported a high degree of satisfaction&#44; which is closely related to the complete or partial disappearance of the brown color of the lesions&#46; Most patients choose a nonsurgical solution&#44; which avoids the risk of scarring and a poor esthetic result&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">DF are characterized clinically by considerable hyperpigmentation and treating the visible surface pigment using a Q-Switched alexandrite laser is therefore a logical approach&#46; The residual erythema observed in 14 of the DF 2&#8239;months after the last laser session was reduced notably after application of the V Beam pulsed dye laser&#46; We therefore believe that the combination of the V Beam pulsed dye laser and the Q-Switched alexandrite laser will improve the final cosmetic result in DF&#46; Furthermore&#44; 65&#37; of patients reported a reduction in the degree of hardening of the DF&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">To our knowledge&#44; the use of the Q-Switched alexandrite laser as a therapeutic option in DF has not been reported to date&#46; The limitations of this study include the small number of cases&#44; the lack of histologic findings&#44; the short follow-up period&#44; measurement of a subjective variable such as degree of hardening of the DF&#44; and the lack of another comparative treatment&#46; More clinical studies will be required to evaluate the efficacy&#44; safety&#44; and cosmetic results of the combination of Q-Switched alexandrite laser and pulsed dye laser in DF&#46;Although the treatment of choice in DF is surgical excision&#44; this may produce unwanted scarring&#46; We therefore believe that the combination of the Q-Switched alexandrite laser and the V Beam pulsed dye laser will be a valid therapeutic alternative for reducing the least esthetic characteristics of DF&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conflicts of Interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Pulsed dye and carbon dioxide lasers have been applied in dermatofibroma with clinical improvement&#46; We treated 23 dermatofibromas two times at a 4-week interval with Q-Switched alexandrite laser 755&#8239;nm &#40;7&#46;5&#8239;J&#47;cm<span class="elsevierStyleSup">2</span>&#44; 3&#8239;mm&#44; 50&#8239;ms&#41;&#46; V Beam pulsed dye laser with a wavelength of 595&#8239;nm was used for the residual erythema &#40;10-11&#8239;J&#47;cm<span class="elsevierStyleSup">2</span>&#44; 7&#8239;mm&#44; 1&#46;5&#8239;ms&#41;&#46; A partial attenuation of brown colour was observed in 9 patients and complete disappearance of brown colour in 14 patients&#46; Patient satisfaction was very high&#46; Fifteen patients felt a decrease in hardening of dermatofibroma after treatment&#46; A pigment network in dermoscopy was observed in all patients before treatment and no one after treatment&#46; A combined treatment using both V Beam pulsed dye laser and Q-Switched alexandrite laser may be a therapeutic option to reduce the aesthetic effect of dermatofibroma with a high patient satisfaction and good cosmetic outcomes&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">El uso de los l&#225;seres de colorante pulsado &#40;<span class="elsevierStyleItalic">pulse dye laser</span> &#91;PDL&#93;&#41; y de di&#243;xido de carbono &#40;CO<span class="elsevierStyleInf">2</span>&#41; para el tratamiento de los dermatofibromas &#40;DF&#41; ha demostrado tener buenos resultados cl&#237;nicos&#46; Un total de 23 DF fueron tratados en dos sesiones con el l&#225;ser de alejandrita Q-Switched de 755 nm &#40;7&#44;5&#8239;J&#47;cm<span class="elsevierStyleSup">2</span>&#44; 3&#8239;mm&#44; 50&#8239;ms&#41;&#44; dejando entre cada sesi&#243;n un intervalo de 4 semanas&#46; Para el eritema residual se utiliz&#243; el l&#225;ser V Beam PDL con una longitud de onda de 595 nm &#40;10-11&#8239;J&#47;cm<span class="elsevierStyleSup">2</span>&#44; 7 mm&#44; 1&#44;5&#8239;ms&#41;&#46; En 9 de las pacientes se observ&#243; una atenuaci&#243;n parcialde la coloraci&#243;n marr&#243;n y en 14 de ellas una desaparici&#243;n completa de la misma&#46; Las pacientes refirieron un grado elevado de satisfacci&#243;n despu&#233;s de haber realizado el tratamiento&#46; As&#237; mismo&#44; 15 de las pacientes notaron una disminuci&#243;n en el endurecimiento de los DF&#46; En el examen dermatosc&#243;pico previo al tratamiento&#44; en todos los DF se observ&#243; la presencia de una red de pigmento&#46; Esta red de pigmento desapareci&#243; en todos los casos tras la aplicaci&#243;n del l&#225;ser&#46; La combinaci&#243;n del l&#225;ser V Beam PDL y del l&#225;ser de alejandrita Q-Switched en los DF constituye una alternativa terap&#233;utica adecuada que&#44; adem&#225;s de buenos resultados cosm&#233;ticos&#44; ha conseguido un elevado grado de satisfacci&#243;n por parte de los pacientes&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Imbern&#243;n-Moya A&#44; Bele&#241;a-C&#225;rdenas M&#44; Ruiz-Rodr&#237;guez R&#44; S&#225;nchez-Carpintero I&#46; Estudio prospectivo de la combinaci&#243;n de l&#225;ser de alejandrita Q-Switched de 755&#8239;nm y el l&#225;ser V Beam de colorante pulsado de 595&#8239;nm en dermatofibromas&#46; Actas Dermosifiliogr&#46; 2020&#59;111&#58;257&#8211;260&#46;</p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A&#44; Dermatofibroma before treatment&#59; B&#44; Dermatofibroma after treatment&#59; C&#44; Before treatment&#44; the dermatofibroma shows peripheral pigmentation accompanied by a white central patch&#59; D&#44; After treatment with the Q-Switched alexandrite laser with a wavelength of 755&#8239;nm&#44; dermatoscopy of the dermatofibroma shows vascular structures and a white central patch&#59; E&#44; After treatment with the 595-nm pulsed dye laser&#44; dermatoscopy of the dermatofibroma shows a white central patch&#46;</p>"
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E-Brief Comunications
Prospective Study of Q Switched Alexandrite Laser 755 nm and V Beam Pulsed Dye Laser 595 nm in Dermatofibroma
Estudio prospectivo de la combinación de láser de alejandrita Q-Switched de 755 nm y el láser V Beam de colorante pulsado de 595 nm en dermatofibromas
A. Imbernón-Moya
Corresponding author
dradrianimbernon@gmail.com

Corresponding author.
, M. Beleña-Cárdenas, R. Ruiz-Rodríguez, I. Sánchez-Carpintero
Clínica Dermatológica Internacional, Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Dermatofibroma &#40;DF&#41; is a benign skin tumor of fibroblastic origin&#46; Lesions are often located on the upper and lower limbs of adult patients&#46; Treatment of DF is only necessary when symptomatic or for esthetic reasons&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The aim of this study is to report our experience treating DF with a combination of Q-Switched alexandrite laser and V Beam pulsed dye laser&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Methods</span><p id="par0010" class="elsevierStylePara elsevierViewall">Inclusion criteria were the clinical and dermatoscopic findings of the DF &#40;dimpling&#44; peripheral pigmentation&#44; and white central patch&#41;&#44; more than a year since onset&#44; age over 18&#8239;years&#44; and not having undergone prior treatment in the past 3&#8239;months&#46; DF that fulfilled typical clinical and dermatoscopic criteria were chosen and a total of 23 cases were included&#46; All patients gave signed informed consent in order to take part in the study&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The Q-Switched alexandrite laser with a wavelength of 755&#8239;nm &#40;Alex Lazr&#44; Syneron Candela&#44; Boston&#44; MA&#44; USA&#41; was used&#46; The parameters used were a fluence of 7&#46;5&#8239;J&#47;cm<span class="elsevierStyleSup">2</span>&#44; a spot size of 3&#8239;mm&#44; and a pulse duration of 50&#8239;ms&#46; Local anesthetic was not required&#46; Each lesion was treated in 2 sessions&#44; with an interval of 4&#8239;weeks between sessions&#46; Post-treatment care included application of petrolatum cream twice daily for a week&#46; The V Beam pulsed dye laser &#40;Alex Lazr&#44; Syneron Candela&#44; Boston&#44; MA&#44; USA&#41;&#44; with a wavelength of 595&#8239;nm was used to improve residual erythema secondary to application of the Q-Switched alexandrite laser&#46; The parameters used were a fluence of 10-11&#8239;J&#47;cm<span class="elsevierStyleSup">2</span>&#44; a spot size of 7&#8239;mm&#44; and a pulse duration of 1&#46;5&#8239;ms&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Patients were followed up for 2&#8239;months&#46; Clinical and dermatoscopic images of the DF were taken before and after treatment&#46; Similar lighting&#44; the same camera setup&#44; the same dermatoscope &#40;Handyscope for Ipod touch&#44; Fotofinder Systems GmbH&#44; Bad Birnbach&#44; Germany&#41;&#44; and the same image-processing technique were used to ensure that the images were comparable&#46; Three different dermatologists evaluated the effectiveness and safety of the treatment &#40;comparison of interobserver agreement&#41; by assessing changes in color&#44; degree of hardening&#44; patient satisfaction &#40;0-10 points&#41;&#44; and adverse effects observed before and after treatment&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Results</span><p id="par0025" class="elsevierStylePara elsevierViewall">All patients were women aged between 25 and 67 &#8239;years &#40;mean&#44; 51&#46;2&#8239;years&#41;&#46; Time since onset of the DF varied between 2 and 40&#8239;years &#40;mean&#44; 15&#8239;years&#41;&#46; Fourteen patients had phototype&#8239;III on the Fitzpatrick scale&#44; 8 had phototype&#8239;II&#44; and 1 patient had phototype&#8239;I&#46; Twenty-one of the DF were located on the lower limbs and only 2 were located on the arms&#46; None of the patients reported associated symptoms before or after treatment&#46; Partial clearance of the brown color was observed in 9 DF&#44; whereas complete clearance was observed in 14&#46; Patients reported a high degree of satisfaction &#40;mean&#44; 8&#8239;points&#41;&#46; Furthermore&#44; after treatment&#44; 15 patients reported a reduction in the degree of hardening of the DF &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A and 1B&#41;&#46; Dermatoscopy before application of the laser revealed pigmentation in all the DF&#46; This pigmentation disappeared in all cases after treatment <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C and 1D&#41;&#46; Before application of the laser&#44; 10 of the DF revealed diverse structures with a vascular appearance&#46; After laser treatment&#44; however&#44; these structures were observed in 18 of the DF&#46; The white central patch was present in all cases of DF&#44; both before and after treatment&#46; Erythema &#40;reddish coloring of the post-laser lesion&#41; was the most frequent adverse effect and was observed in 14 of the DF&#46; The erythema disappeared after application of the V Beam pulsed dye laser &#40;595&#8239;nm&#59; 10-11&#8239;J&#47;cm<span class="elsevierStyleSup">2</span>&#59; 7&#8239;mm&#59; 1&#44;5&#8239;ms&#41; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>E&#41;&#46; Only one of the patients &#40;with phototype&#8239;I on the Fitzpatrick scale&#41; showed residual hypopigmentation&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">Surgical excision of DF is generally considered to be a cure and presents local recurrence of less than 2&#37;&#46; Surgery&#44; however&#44; may produce unwanted scars&#46; Nonsurgical therapeutic alternatives described include cryotherapy and intralesional injection of corticosteroids&#46; This last treatment is of limited and variable efficacy&#44; and may cause adverse effects in some cases&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> No standard approach exists to the treatment of DF and management of these lesions continues to be a therapeutic challenge&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Different types of laser have been used to treat DF&#46; Pulsed dye laser has been shown to provide clinical improvement in these lesions and to have adequate cosmetic results&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> Wang and Lee<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> reported 20&#8239;DF treated in 3 sessions with pulsed dye laser &#40;600&#8239;nm&#59; 7&#8239;J&#47;cm<span class="elsevierStyleSup">2</span>&#59; 7&#8239;mm&#59; 1&#44;5&#8239;ms&#41;&#46; In terms of reduction of lesion size&#44; 15 of the 20 DF &#40;75&#37;&#41; presented a complete clinical response&#44; whereas 5 &#40;25&#37;&#41; showed a partial response&#46; In terms of improvement in coloring&#44; 12 of the 20 DF &#40;60&#37;&#41; presented a complete and 8 &#40;40&#37;&#41; showed a partial response&#46; The authors of that study concluded that pulsed dye laser provided a better esthetic result than surgical excision&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Wang and Lee<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> reported 22&#8239;DF treated in between 1 and 3 sessions with pulsed dye laser &#40;595&#8239;nm&#59; 11&#8239;J&#47;cm<span class="elsevierStyleSup">2</span>&#59; 7&#8239;mm&#59; 2&#8239;ms&#41;&#46; Six of these cases showed clinical improvement of over 75&#37;&#44; 6 showed an improvement of between 50&#37; and 75&#37;&#44; 8 showed improvement of between 25&#37; and 50&#37;&#44; and 2 showed improvement of less than 25&#37;&#46; Dermatoscopy revealed changes in all those cases of DF&#46; Full clearance of pigmentation was found in 12 of the DF &#40;54&#37;&#41; and pigmentation was merely reduced in 9 &#40;40&#37;&#41;&#46; Postinflammatory hyperpigmentation or hypopigmentation was the only adverse effect reported and this resolved spontaneously 6&#8239;months after treatment&#46; Because the target of the pulsed dye laser is oxyhemoglobin and not melanin&#44; the mechanism of action in DF is not fully understood&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Wang et al<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> reported good results after treating DF located on the thigh with a CO<span class="elsevierStyleInf">2</span> laser &#40;450-500&#8239;nm&#59; 1-4 passes&#59; 3-5&#8239;mm&#59; 500-600&#8239;ms&#41; in 3 sessions&#44; with an interval of 5&#8239;weeks between each session&#59; a topical corticosteroid was also used in that study&#46; That treatment produced complete flattening of the lesion and disappearance of the pruritus&#46; Minimal postinflammatory hyperpigmentation was also observed&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The use of CO<span class="elsevierStyleInf">2</span> laser in multiple facial DF has also been described&#59; however&#44; details of the parameters used were not provided&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">While preliminary&#44; our study has shown that the Q-Switched alexandrite laser is an effective and safe therapeutic alternative for the treatment of DF&#46; Patients also reported a high degree of satisfaction&#44; which is closely related to the complete or partial disappearance of the brown color of the lesions&#46; Most patients choose a nonsurgical solution&#44; which avoids the risk of scarring and a poor esthetic result&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">DF are characterized clinically by considerable hyperpigmentation and treating the visible surface pigment using a Q-Switched alexandrite laser is therefore a logical approach&#46; The residual erythema observed in 14 of the DF 2&#8239;months after the last laser session was reduced notably after application of the V Beam pulsed dye laser&#46; We therefore believe that the combination of the V Beam pulsed dye laser and the Q-Switched alexandrite laser will improve the final cosmetic result in DF&#46; Furthermore&#44; 65&#37; of patients reported a reduction in the degree of hardening of the DF&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">To our knowledge&#44; the use of the Q-Switched alexandrite laser as a therapeutic option in DF has not been reported to date&#46; The limitations of this study include the small number of cases&#44; the lack of histologic findings&#44; the short follow-up period&#44; measurement of a subjective variable such as degree of hardening of the DF&#44; and the lack of another comparative treatment&#46; More clinical studies will be required to evaluate the efficacy&#44; safety&#44; and cosmetic results of the combination of Q-Switched alexandrite laser and pulsed dye laser in DF&#46;Although the treatment of choice in DF is surgical excision&#44; this may produce unwanted scarring&#46; We therefore believe that the combination of the Q-Switched alexandrite laser and the V Beam pulsed dye laser will be a valid therapeutic alternative for reducing the least esthetic characteristics of DF&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conflicts of Interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Pulsed dye and carbon dioxide lasers have been applied in dermatofibroma with clinical improvement&#46; We treated 23 dermatofibromas two times at a 4-week interval with Q-Switched alexandrite laser 755&#8239;nm &#40;7&#46;5&#8239;J&#47;cm<span class="elsevierStyleSup">2</span>&#44; 3&#8239;mm&#44; 50&#8239;ms&#41;&#46; V Beam pulsed dye laser with a wavelength of 595&#8239;nm was used for the residual erythema &#40;10-11&#8239;J&#47;cm<span class="elsevierStyleSup">2</span>&#44; 7&#8239;mm&#44; 1&#46;5&#8239;ms&#41;&#46; A partial attenuation of brown colour was observed in 9 patients and complete disappearance of brown colour in 14 patients&#46; Patient satisfaction was very high&#46; Fifteen patients felt a decrease in hardening of dermatofibroma after treatment&#46; A pigment network in dermoscopy was observed in all patients before treatment and no one after treatment&#46; A combined treatment using both V Beam pulsed dye laser and Q-Switched alexandrite laser may be a therapeutic option to reduce the aesthetic effect of dermatofibroma with a high patient satisfaction and good cosmetic outcomes&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">El uso de los l&#225;seres de colorante pulsado &#40;<span class="elsevierStyleItalic">pulse dye laser</span> &#91;PDL&#93;&#41; y de di&#243;xido de carbono &#40;CO<span class="elsevierStyleInf">2</span>&#41; para el tratamiento de los dermatofibromas &#40;DF&#41; ha demostrado tener buenos resultados cl&#237;nicos&#46; Un total de 23 DF fueron tratados en dos sesiones con el l&#225;ser de alejandrita Q-Switched de 755 nm &#40;7&#44;5&#8239;J&#47;cm<span class="elsevierStyleSup">2</span>&#44; 3&#8239;mm&#44; 50&#8239;ms&#41;&#44; dejando entre cada sesi&#243;n un intervalo de 4 semanas&#46; Para el eritema residual se utiliz&#243; el l&#225;ser V Beam PDL con una longitud de onda de 595 nm &#40;10-11&#8239;J&#47;cm<span class="elsevierStyleSup">2</span>&#44; 7 mm&#44; 1&#44;5&#8239;ms&#41;&#46; En 9 de las pacientes se observ&#243; una atenuaci&#243;n parcialde la coloraci&#243;n marr&#243;n y en 14 de ellas una desaparici&#243;n completa de la misma&#46; Las pacientes refirieron un grado elevado de satisfacci&#243;n despu&#233;s de haber realizado el tratamiento&#46; As&#237; mismo&#44; 15 de las pacientes notaron una disminuci&#243;n en el endurecimiento de los DF&#46; En el examen dermatosc&#243;pico previo al tratamiento&#44; en todos los DF se observ&#243; la presencia de una red de pigmento&#46; Esta red de pigmento desapareci&#243; en todos los casos tras la aplicaci&#243;n del l&#225;ser&#46; La combinaci&#243;n del l&#225;ser V Beam PDL y del l&#225;ser de alejandrita Q-Switched en los DF constituye una alternativa terap&#233;utica adecuada que&#44; adem&#225;s de buenos resultados cosm&#233;ticos&#44; ha conseguido un elevado grado de satisfacci&#243;n por parte de los pacientes&#46;</p></span>"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Imbern&#243;n-Moya A&#44; Bele&#241;a-C&#225;rdenas M&#44; Ruiz-Rodr&#237;guez R&#44; S&#225;nchez-Carpintero I&#46; Estudio prospectivo de la combinaci&#243;n de l&#225;ser de alejandrita Q-Switched de 755&#8239;nm y el l&#225;ser V Beam de colorante pulsado de 595&#8239;nm en dermatofibromas&#46; Actas Dermosifiliogr&#46; 2020&#59;111&#58;257&#8211;260&#46;</p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A&#44; Dermatofibroma before treatment&#59; B&#44; Dermatofibroma after treatment&#59; C&#44; Before treatment&#44; the dermatofibroma shows peripheral pigmentation accompanied by a white central patch&#59; D&#44; After treatment with the Q-Switched alexandrite laser with a wavelength of 755&#8239;nm&#44; dermatoscopy of the dermatofibroma shows vascular structures and a white central patch&#59; E&#44; After treatment with the 595-nm pulsed dye laser&#44; dermatoscopy of the dermatofibroma shows a white central patch&#46;</p>"
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