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Resident's Forum
Usefulness of Pulsed Dye Laser in Cutaneous Lupus Erythematosus
FR - Utilidad del láser de colorante pulsado en el lupus eritematoso cutáneo
P. García-Monteroa,
Autor para correspondencia
garciamonteropablo@gmail.com

Corresponding author.
, R. Pérez-Mesonerob, A. Barrutia-Borquec, P. Boixedad
a Departamento de Dermatología, Hospital Costa del Sol, Marbella, Málaga, Spain
b Departamento de Dermatología, Hospital Universitario de Guadalajara, Guadalajara, Spain
c Departamento de Dermatología, Hospital Universitario de Cruces, San Vicente de Barakaldo, Vizcaya, Spain
d Departamento de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, Spain
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        "titulo" => "FR - Utilidad del l&#225;ser de colorante pulsado en el lupus eritematoso cut&#225;neo"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Cutaneous lupus erythematosus &#40;CLE&#41; is a heterogeneous autoimmune disease with highly variable clinical manifestations&#44; ranging from isolated skin lesions to severe systemic involvement&#46; Cutaneous involvement is a common feature of the several distinct subtypes of CLE&#44; each of which has well-defined clinical&#44; histological&#44; and analytical characteristics&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The 2017 CLE treatment guidelines published by the European Dermatology Forum advise against laser treatment of active CLE lesions&#44; and specify that laser treatment should be administered by an accredited dermatologist and used only as an adjunctive treatment for selected lesions &#40;telangiectasia&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">These guidelines contrast significantly with previously published recommendations&#46; Since 1986&#44; when Henderson and coworkers successfully used carbon dioxide &#40;CO<span class="elsevierStyleInf">2</span>&#41; laser to treat a patient with disfiguring discoid lupus erythematosus&#44; several case reports have described satisfactory outcomes using this modality&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> CO<span class="elsevierStyleInf">2</span> laser together with argon laser improves skin lesions&#44; but causes unwanted side effects&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">By contrast&#44; pulsed dye laser &#40;PDL&#41;&#44; the most widely used form of laser treatment for CLE&#44; produces excellent results &#40;improvement rate&#44; 60&#37;&#8211;88&#37;&#41; with minimal side effects &#40;pain and pigmentary alterations&#41;&#46; In CLE patients&#44; PDL can be used to treat the erythematous-edematous component of the disease as well as telangiectasia&#44; resulting in clinical and histological improvement and a reduction in the associated symptoms&#46; PDL has been used to successfully treat subacute and chronic forms of CLE &#40;lupus erythematosus tumidus and discoid CLE&#41;&#44; and is effective in the treatment of recalcitrant lesions that do not respond to topical or systemic treatments&#44; as well as acute lesions&#44; minimizing the risk of secondary scarring&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> Other light sources including neodymium-doped yttrium aluminum garnet laser and intense pulsed light have also shown promise for the treatment of this disease&#44; although supporting evidence remains scarce&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The safety profile of PDL treatment in lupus patients has been a topic of considerable debate&#46; The wavelength of this laser &#40;595&#160;nm&#41; is outside the ultraviolet spectrum of radiation&#44; which causes photosensitivity in patients with lupus&#46; The possibility that treatment induces the formation of new lesions as a consequence of the Koebner effect has not been confirmed to date&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The mechanism underlying the therapeutic effect of PDL is not entirely clear&#46; A majority of authors subscribe to the hypothesis that PDL selectively destroys the microvasculature of CLE lesions&#44; reducing inflammation and resulting in consequent clinical and histological improvements&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The high doses of topical and&#47;or systemic immunosuppressive drugs administered to some CLE patients result in unsatisfactory responses and marked side effects&#46; Despite its absence from clinical guidelines and algorithms&#44; dermatologists should be familiar with PDL as an alternative treatment given its therapeutic potential and favorable side effect profile&#46; Further studies of the usefulness of PDL in CLE will be necessary so that this treatment can be assigned an appropriate grade of recommendation and offered to patients&#46;</p></span>"
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