P6475Treatment of rosacea with photodynamic therapy: Case report and liter-ature review

Camila Ribeiro, MD, Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil;Beatrix Zink, Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil; BiancaSantos, MD, Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil; Julia Lyra-da-Silva, MD, Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil; Luana Carvalho,MD, Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil; Paulo Roberto Souza,MD, Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil

Background: Rosacea is a chronic inflammatory eruption of the face that has anintermittent course with frequent flare-ups which requires continuous or repeatedtreatments. Therefore, additional treatments options are desirable to achieve acomplete remission. In this context, photodynamic therapy, a well establishedtreatment for actinic keratoses, superficial basal cell carcinoma and Bowen disease,appears as a recent alternative treatment to inflammatory disorders, includingrosacea. For this reason, a case of severe papulopustular rosacea with satisfactoryresolution after photodynamic therapy is presented.

Case report: A 57-year-old white woman, with a previous diagnosis of rosacea, wassent to photodynamic therapy department during an exacerbation period of rosaceaand after previous unsuccessful treatments with topical medications. It wasproposed an initial preparation of the face with benzoyl peroxide (2.5%) andadapalene (0.1%) gel, daily at night during 15 days. After that, the patient wassubmitted to 1 session of photodynamic therapy with methylaminolevulate astopical photosensitizer under occlusion for 3 hours, followed by an irradiation withred LED 25 J/cm2. Another session was performed 15 days apart with a dose of 30J/cm2. The patient related only local effects. Fifteen days after the last procedure, animportant improvement was noted (Fig 1) and the sessions were suspended. After1 month, a complete remission of the acute event of rosacea was achieved (Fig 2)and, at this time, shewas reclassified as amild erythemotelangiectatic rosacea. It wasprescribed benzoyl peroxide (2.5%) and adapalene (0.1%) gel again, daily at night tobe used for a maintenance treatment. The patient remains recurrence free sevenmonths after the last session (Fig 3).

Conclusion: Before treatment, patient’s rosacea was classified as a severe papulo-pustular rosacea and after 2 sessions of photodynamic therapy with low doses asatisfactory effect was observed without using antibiotics and systemic therapy in ashort period of time. This fact suggests that photodynamic therapy could beconsidered an alternative and coadjuvant treatment for rosacea, avoiding theincreasing bacterial resistance without the use of antibiotics and without the riskof systemic effects. A future randomized controlled trial seems to be justifiable.

APRIL 20

cial support: None identified.

Commer

P6942Two children with persistent, pruritic injection site nodules after receiv-ing vaccinations which contained aluminium

Galia Ben-Zvi, MBBS, MD, Addenbrooke’s Hospital, Cambridge UniversityHospital NHS Trust, Cambridge, United Kingdom; Nigel Burrows, MBBS, MD,Addenbrooke’s Hospital, Cambridge University Hospital’s NHS Trust, Cambridge,United Kingdom

We report 2 children, both of whom, after receiving an aluminium (Al)-containingvaccination, developed persistent pruritic nodules at the vaccination site. The firstwas a 3-year-old girl who presented with an itchy lump on her left anterior thigh.This appeared 4 months after she received her third dose of Pediarix, an aluminium-containing vaccine, by intramuscular injection into this site, at 6 months of age. Onexamination, she had a 3 cm 3 1 cm, slightly hyperpigmented, hairy patch with anunderlying firmness. Patch tests were positive to aluminium at 48 hours. Othervaccine excipients were negative. The second was a 14-month-old girl whodeveloped 2 itchy nodules on her left thigh. These started approximately 8 monthsafter receiving her third IM injection of Pediacel, an aluminium-containing vaccineinto this site. On examination, there were 2 adjacent, firm nodules with overlyingexcoriations on the left lateral thigh as well as a patch of hypertrichosis andexcoriations on the lateral right thigh at the site of previous vaccinations. Patch testswere declined. In both cases, an ultrasound confirmed a change in echogenicity atthe site of the vaccination. Bergfors et al described 19 cases of persistent pruriticnodules after injection of the commonly used Al adsorbed vaccines. Hypertrichosis,excoriations, and lichenification were commonly observed. Sixteen of the 19 caseswere patch tested and all were found to have a contact allergy to Al. In some cases,the nodules persisted for up to 7 years. This side effect of vaccination is important torecognize, because further aggravation can be avoided by use of aluminium-freepreparations. Patch testing to aluminium is useful and future avoidance of alumin-ium-containing skin products, such as antiperspirants, may prevent contactdermatitis.

cial support: None identified.

Commer

13

P6844Unusual applications of dermatoscopy

Felipe Nazareth Carvalho, MD, Rio De Janeiro, Brazil; Andreia Sanches, MD,Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; Monica Azulay, FederalUniversity of Rio de Janeiro, Rio de Janeiro, Brazil; Simone Saintive, FederalUniversity of Rio de Janeiro, Rio de Janeiro, Brazil; Stella Ramos-e-Silva, MD,Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

Dermatoscopy is a noninvasive method that assists in clinical examination, allowingthe dermatologist to evaluate pigmented skin lesions and set up of melanocyticorigin or not. This technique allows the recognition of morphologic structures thatare not observed with the naked eye and adds new dimension to the clinicalexamination. It is also known that the use of dermatoscopy nowadays is notrestricted to melanocytic lesions having been used in other diseases, such ashemangiomas, dermatofibromas, sebaceous hyperplasia, and even viral warts. Wepresent 3 cases with an unusual applicantions of dermatoscopy: (1) A femalepatient, 72 years old, with discoid lupus erythematosus was seen in the ambulatorycomplaining of itching on the scalp, where lesions have been described previouslyin discoid lupus erythematosus. On examination, carried out carefully, no lesionswere observed on the scalp or the patients whitish hair. However, when a browishstructure was observed between the hair, we decided to use dermatoscopy. Then itwas possible to observe a Pediculus humanus humanus adult that had beenfeeding on blood. (2) A female patient, 6 years old, brought by her mother, whichdiscribed ‘‘small structures on the hair’’ of her daughter. On examination, weobserved alterations in the shaft of the hair. Using dermatoscopy, we could observeyellowish masses involving all the hair shaft, featuring a diagnostic of white piedra.(3) A female patient, 55 years old, reffered skin alterations and mild dysphagia. Onclinical examination, we observed skin thickening. The examination of the nailapparatus using a dermatoscope allowed the observation of numerous periungualtelangiectasias, suggesting the diagnosis of scleroderma. Dermatoscopy is already anestablished method for evaluation of melanocytic lesions. However, the increase inits use enabled the heeding of other aspects besides the malignant cutaneous lesionsand their differential diagnoses. It is important to note that dermatoscopy can andshould be encouraged in the centers of reference and teaching of dermatology andits use in other cases may help in diagnosing uncommon dermatoses such as thosedescribed above.

cial support: None identified.

Commer

P6099Unusual presentation of cutaneous neurofibroma: A case report

Chris Lixian Tan, MBBS, National University Hospital, Singapore; Derrick ChenWee Aw, MBBS, National University Hospital, Singapore

Cutaneous neurofibromas are benign tumors composed of cells of neuromesenchy-mal origin. Although multiple neurofibromas can occur in the setting of neurofi-bromatosis, neurofibromas usually occur as sporadic, solitary lesions in healthyadults. Such sporadic solitary lesions are not uncommon and the diagnosis can oftenbe made clinically. We present a case of a 64-year-old Malay woman with a tendernodule on her neck for the past year. It is associated with contact bleeding. Theclinical diagnosis was pyogenic granuloma. Other differentials included Spitz nevus,haemangioma and Merkel cell tumor. An excision biopsy was performed and thelesion was histologically a neurofibroma. We believe that this represents the firstreported case of a neurofibroma presenting clinically as a reddish vascular nodule.

cial support: None identified.

Commer

J AM ACAD DERMATOL AB67