Case and research letters
Intense Pulsed Light Therapy for Lupus Pernio
Tratamiento de lupus pernio con luz pulsada intensa
L. Rosende, J. del Pozo
, A. de Andrés, L. Pérez Varela
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Servicio de Dermatología, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
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Rosende, J. del Pozo, A. de Andrés, L. Pérez Varela" "autores" => array:4 [ 0 => array:2 [ "nombre" => "L." "apellidos" => "Rosende" ] 1 => array:4 [ "nombre" => "J." "apellidos" => "del Pozo" "email" => array:1 [ 0 => "jesus.del.pozo.losada@sergas.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 2 => array:2 [ "nombre" => "A." "apellidos" => "de Andrés" ] 3 => array:2 [ "nombre" => "L." "apellidos" => "Pérez Varela" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Dermatología, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tratamiento de lupus pernio con luz pulsada intensa" ] ] "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" => 928 "Ancho" => 950 "Tamanyo" => 109485 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Almost complete response to treatment with minimal erythema.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Sarcoidosis is a multisystem granulomatous disease of unknown etiology that affects the skin in more than 25% of patients. Lupus pernio is the most characteristic skin feature and presents as infiltrated violaceous plaques that tend to have a symmetric distribution, mainly affecting acral areas: nose, cheeks, ears, lips, and forehead.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Multiple treatment options are currently available, but there are refractory cases in which alternative treatments are needed.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 54-year-old woman with no past history of interest, diagnosed 9 years previously with cutaneous sarcoidosis based on the presence of papular, erythematous–violaceous plaques on the elbows, knees, and dorsum of the nose, with necrotizing granulomas on skin biopsy. There were no clinical manifestations in other areas and the results of additional studies were normal except for slightly elevated levels of angiotensin-converting enzyme. During the first 5 years she was treated with topical and intralesional corticosteroids and chloroquine leading to acceptable control of the lesions on the elbows and knees but with persistence of lesions on the nose.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Given recurrent outbreaks, in addition to local treatment with corticosteroids she subsequently received systemic treatments with hydroxychloroquine, methotrexate, and allopurinol, leading to transient and unsatisfactory results.</p><p id="par0020" class="elsevierStylePara elsevierViewall">After the last outbreak, which mainly affected the dorsum of the nose in the form of an erythematous–violaceous plaque (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), we decided to begin treatment with an intense pulsed light system (Photoderm-Vasculight) that provides polychromatic light in the range of 515–1200<span class="elsevierStyleHsp" style=""></span>nm, on which different cut-off filters (550, 570, 590<span class="elsevierStyleHsp" style=""></span>nm, etc.) can be mounted, in combination with a long-pulsed neodymium:yttrium-aluminum-garnet (Nd:YAG) laser (1064<span class="elsevierStyleHsp" style=""></span>nm). All sessions were conducted on an outpatient basis without the need for sedation or anesthesia. The 590-nm cutoff-filter was used and a double pulse of 37<span class="elsevierStyleHsp" style=""></span>J/cm<span class="elsevierStyleSup">2</span> (T1: 2.8<span class="elsevierStyleHsp" style=""></span>ms, T2: 2.8<span class="elsevierStyleHsp" style=""></span>ms) was delivered with 20-ms delays between pulses. The sessions were conducted between June 2006 and July 2008. In each session, the energy was slightly increased up to a fluence of 45<span class="elsevierStyleHsp" style=""></span>J/cm<span class="elsevierStyleSup">2</span>. The response to treatment was almost complete (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Two years later the patient remained asymptomatic without treatment.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The guidelines remain unclear regarding the treatment of cutaneous sarcoidosis, since no randomized controlled studies have been conducted with sufficient numbers of patients by which to establish them,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> thus we have to tailor treatment to each patient based on severity, associated comorbidities, and possible adverse effects. Regarding the treatment of localized lesions, Badgwell and Rosen<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> suggest that although topical and intralesional corticosteroids are the treatment of choice, laser therapy is an approach that should be considered in persistent lesions.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The first type of laser used to treat lupus pernio was the flashlamp pulsed dye laser in 1992 with good results, although relapses occurred after 6–10 months.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Subsequently, other cases with a good clinical response to treatment were published,<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> one of which demonstrated the persistence of granulomas on histologic study after treatment.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Regarding carbon dioxide laser, we highlight the article by O’Donoghue and Barlow<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> on 3 patients. The first patient received concomitant low-dose oral corticosteroids for systemic disease and remained asymptomatic for 6 years. The other 2 patients, treated with carbon dioxide laser alone, presented relapses at 9 months and 14 months, respectively.</p><p id="par0040" class="elsevierStylePara elsevierViewall">There are 2 references in the literature to treatment with the Nd:YAG laser. The first was in 2005, in which the Versapulse system (532<span class="elsevierStyleHsp" style=""></span>nm) was used in a patient who had previously been treated with a dye laser with limited results; Versapulse laser treatment produced significant clearance of the erythema and there was no recurrence after 3 years of follow-up.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> The second report described 2 cases with a good response to potassium titanyl phosphate laser; one of the patients was receiving concomitant methotrexate therapy.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Complications have been minimal, the most frequent being hypopigmentation and hyperpigmentation. Green et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> presented a patient who developed ulcerative sarcoidosis in treated and untreated lesions after dye laser therapy.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Regarding the mechanism of action, it appears reasonable to assume that if we destroy the blood vessels through which the inflammatory mediators reach the focus, the sarcoidosis lesions, as well as those of other inflammatory processes such as lupus erythematosus, will disappear, at least temporarily.</p><p id="par0055" class="elsevierStylePara elsevierViewall">In our opinion, treatments with pulsed light and with laser are associated with a good safety profile, are generally well tolerated, and should be considered in patients with localized cutaneous sarcoidosis refractory to conventional treatments. However, large controlled studies are needed in order for these to be considered first-line treatments.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Rosende L, del Pozo J, de Andrés A, Pérez Varela L. Tratamiento de lupus pernio con luz pulsada intensa. Actas Dermosifiliogr. 2012;103:71–73.</p>" ] ] "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" => 991 "Ancho" => 948 "Tamanyo" => 121243 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythematous–violaceous plaque on the dorsum of the nose.</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" => 928 "Ancho" => 950 "Tamanyo" => 109485 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Almost complete response to treatment with minimal erythema.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sarcoidosis cutánea" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Y. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 5 | 4 | 9 |
| 2024 Octubre | 129 | 77 | 206 |
| 2024 Septiembre | 137 | 49 | 186 |
| 2024 Agosto | 154 | 86 | 240 |
| 2024 Julio | 183 | 58 | 241 |
| 2024 Junio | 167 | 86 | 253 |
| 2024 Mayo | 121 | 68 | 189 |
| 2024 Abril | 159 | 36 | 195 |
| 2024 Marzo | 177 | 43 | 220 |
| 2024 Febrero | 155 | 38 | 193 |
| 2024 Enero | 132 | 47 | 179 |
| 2023 Diciembre | 271 | 27 | 298 |
| 2023 Noviembre | 297 | 31 | 328 |
| 2023 Octubre | 280 | 44 | 324 |
| 2023 Septiembre | 287 | 41 | 328 |
| 2023 Agosto | 184 | 28 | 212 |
| 2023 Julio | 175 | 75 | 250 |
| 2023 Junio | 193 | 54 | 247 |
| 2023 Mayo | 250 | 95 | 345 |
| 2023 Abril | 227 | 50 | 277 |
| 2023 Marzo | 198 | 35 | 233 |
| 2023 Febrero | 165 | 30 | 195 |
| 2023 Enero | 171 | 30 | 201 |
| 2022 Diciembre | 116 | 54 | 170 |
| 2022 Noviembre | 92 | 38 | 130 |
| 2022 Octubre | 77 | 40 | 117 |
| 2022 Septiembre | 141 | 50 | 191 |
| 2022 Agosto | 122 | 39 | 161 |
| 2022 Julio | 74 | 46 | 120 |
| 2022 Junio | 139 | 31 | 170 |
| 2022 Mayo | 156 | 56 | 212 |
| 2022 Abril | 180 | 43 | 223 |
| 2022 Marzo | 165 | 60 | 225 |
| 2022 Febrero | 131 | 37 | 168 |
| 2022 Enero | 164 | 43 | 207 |
| 2021 Diciembre | 95 | 27 | 122 |
| 2021 Noviembre | 104 | 54 | 158 |
| 2021 Octubre | 106 | 49 | 155 |
| 2021 Septiembre | 74 | 34 | 108 |
| 2021 Agosto | 110 | 39 | 149 |
| 2021 Julio | 107 | 22 | 129 |
| 2021 Junio | 130 | 30 | 160 |
| 2021 Mayo | 174 | 55 | 229 |
| 2021 Abril | 341 | 96 | 437 |
| 2021 Marzo | 159 | 39 | 198 |
| 2021 Febrero | 174 | 35 | 209 |
| 2021 Enero | 87 | 20 | 107 |
| 2020 Diciembre | 81 | 20 | 101 |
| 2020 Noviembre | 51 | 18 | 69 |
| 2020 Octubre | 44 | 24 | 68 |
| 2020 Septiembre | 61 | 12 | 73 |
| 2020 Agosto | 40 | 19 | 59 |
| 2020 Julio | 45 | 19 | 64 |
| 2020 Junio | 48 | 33 | 81 |
| 2020 Mayo | 30 | 21 | 51 |
| 2020 Abril | 29 | 21 | 50 |
| 2020 Marzo | 35 | 19 | 54 |
| 2020 Febrero | 6 | 10 | 16 |
| 2020 Enero | 4 | 7 | 11 |
| 2019 Diciembre | 8 | 4 | 12 |
| 2019 Noviembre | 4 | 2 | 6 |
| 2019 Octubre | 0 | 1 | 1 |
| 2019 Septiembre | 4 | 3 | 7 |
| 2019 Agosto | 4 | 0 | 4 |
| 2019 Julio | 4 | 5 | 9 |
| 2019 Junio | 6 | 13 | 19 |
| 2019 Mayo | 4 | 23 | 27 |
| 2019 Abril | 2 | 18 | 20 |
| 2019 Marzo | 4 | 14 | 18 |
| 2019 Febrero | 0 | 7 | 7 |
| 2019 Enero | 4 | 0 | 4 |
| 2018 Diciembre | 3 | 0 | 3 |
| 2018 Noviembre | 2 | 1 | 3 |
| 2018 Octubre | 4 | 0 | 4 |
| 2018 Septiembre | 3 | 0 | 3 |
| 2018 Agosto | 0 | 1 | 1 |
| 2018 Abril | 0 | 1 | 1 |
| 2018 Marzo | 2 | 2 | 4 |
| 2018 Febrero | 66 | 6 | 72 |
| 2018 Enero | 70 | 11 | 81 |
| 2017 Diciembre | 81 | 12 | 93 |
| 2017 Noviembre | 80 | 6 | 86 |
| 2017 Octubre | 56 | 12 | 68 |
| 2017 Septiembre | 103 | 11 | 114 |
| 2017 Agosto | 140 | 21 | 161 |
| 2017 Julio | 116 | 8 | 124 |
| 2017 Junio | 119 | 16 | 135 |
| 2017 Mayo | 130 | 4 | 134 |
| 2017 Abril | 153 | 9 | 162 |
| 2017 Marzo | 140 | 56 | 196 |
| 2017 Febrero | 116 | 16 | 132 |
| 2017 Enero | 88 | 8 | 96 |
| 2016 Diciembre | 86 | 12 | 98 |
| 2016 Noviembre | 104 | 2 | 106 |
| 2016 Octubre | 148 | 26 | 174 |
| 2016 Septiembre | 231 | 3 | 234 |
| 2016 Agosto | 113 | 7 | 120 |
| 2016 Julio | 78 | 18 | 96 |
| 2016 Junio | 10 | 15 | 25 |
| 2016 Mayo | 9 | 13 | 22 |
| 2016 Abril | 9 | 6 | 15 |
| 2016 Marzo | 10 | 2 | 12 |
| 2016 Febrero | 7 | 2 | 9 |
| 2016 Enero | 12 | 11 | 23 |
| 2015 Diciembre | 12 | 2 | 14 |
| 2015 Noviembre | 27 | 2 | 29 |
| 2015 Octubre | 30 | 5 | 35 |
| 2015 Septiembre | 20 | 5 | 25 |
| 2015 Agosto | 17 | 3 | 20 |
| 2015 Julio | 72 | 14 | 86 |
| 2015 Junio | 71 | 14 | 85 |
| 2015 Mayo | 121 | 19 | 140 |
| 2015 Abril | 122 | 21 | 143 |
| 2015 Marzo | 60 | 19 | 79 |
| 2015 Febrero | 51 | 11 | 62 |
| 2015 Enero | 64 | 14 | 78 |
| 2014 Diciembre | 60 | 9 | 69 |
| 2014 Noviembre | 52 | 19 | 71 |
| 2014 Octubre | 84 | 29 | 113 |
| 2014 Septiembre | 65 | 21 | 86 |
| 2014 Agosto | 81 | 15 | 96 |
| 2014 Julio | 57 | 24 | 81 |
| 2014 Junio | 71 | 19 | 90 |
| 2014 Mayo | 82 | 20 | 102 |
| 2014 Abril | 74 | 14 | 88 |
| 2014 Marzo | 82 | 25 | 107 |
| 2014 Febrero | 60 | 21 | 81 |
| 2014 Enero | 67 | 26 | 93 |
| 2013 Diciembre | 22 | 4 | 26 |
| 2013 Noviembre | 18 | 11 | 29 |
| 2013 Octubre | 16 | 14 | 30 |
| 2013 Septiembre | 13 | 16 | 29 |
| 2013 Agosto | 12 | 10 | 22 |
| 2013 Julio | 13 | 22 | 35 |
| 2013 Junio | 10 | 23 | 33 |
| 2013 Mayo | 12 | 35 | 47 |
| 2013 Abril | 21 | 22 | 43 |
| 2013 Marzo | 24 | 14 | 38 |
| 2013 Febrero | 37 | 5 | 42 |
| 2013 Enero | 55 | 16 | 71 |
| 2012 Diciembre | 42 | 9 | 51 |
| 2012 Noviembre | 3 | 7 | 10 |
| 2012 Octubre | 3 | 4 | 7 |
| 2012 Septiembre | 0 | 2 | 2 |
| 2012 Julio | 1 | 0 | 1 |
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