Notes: Granuloma faciale (GF) is a rare cutaneous condition of unknown origin with characteristic clinicopathological features. It predominantly affects the face and in some causes an unacceptable cosmetic appearance. Numerous medical and surgical treatments have been used with varying degrees of success. Several single-patient case reports have demonstrated the successful use of the pulsed dye laser (PDL) in treating GF. This study assesses the results of four patients with facial GF from one dermatological laser centre that were treated with the Candela Vbeam™ PDL at 595 nm. Resolution of the GF was achieved in only two of the four patients (50%). Nevertheless this study provides further evidence that the PDL can help some patients with GF. Subsequently it is still a valuable treatment option for GF, especially as it is safe, well tolerated and quick.

Notes: Background and objectives  The excimer laser delivers high energy monochromatic ultraviolet (UV) B at 308 nm. Advantages over conventional UV sources include targeting of lesional skin, reducing cumulative dose and inducing faster clearance. Studies of the pulsed dye laser (PDL) in psoriasis report between 57% and 82% response rates; remission may extend to 15 months. To our knowledge, this is the first study assessing both excimer and PDL in psoriasis.Methods  We conducted a within-patient controlled prospective trial of treatment of localized plaque psoriasis. Twenty-two adult patients, mean Psoriasis Area and Severity Index 7·1, were recruited. Fifteen patients completed the full treatment, of which 13 were followed up to 1 year. Two selected plaques were treated with excimer twice weekly and V Beam® PDL, pretreated with salicylic acid (SA), every 4 weeks, respectively. Two additional plaques, treated with SA alone or untreated, served as controls. The primary outcome measures were: (i) changes in plaque-modified Psoriasis Activity and Severity Index (PSI) scores from baseline to end of treatment; (ii) clinical response to treatment (CRT), assessed by serial photographs; (iii) percentage of plaques clear at the end of treatment; and (iv) percentage of plaques clear at 1-year follow-up. The secondary outcome measures were: (i) number of laser treatments to clearance; (ii) time to relapse; (iii) frequency of side-effects; and (iv) qualitative observations with SIAscope®.Results  The mean improvement in PSI was 4·7 (SD 2·1) with excimer and 2·7 (SD 2·4) with PDL. PSI improvement was significantly greater in excimer than PDL (P = 0·003) or both control plaques (P 〈 0·001). CRT indicated 13 patients responded best with excimer, two patients best with PDL, and in seven patients there was no difference between the two lasers. CRT was significantly greater for excimer than PDL (P = 0·003) or both controls (P 〈 0·001). CRT was also significantly greater for PDL than SA alone (P = 0·004) or untreated control (P =0·002). Nine (41%) patients cleared with excimer, after mean 8·7, median 10 weeks treatment. Seven of these nine patients were followed up to 1 year; four remained clear, two relapsed at 1 month, and one at 6 months. Six (27%) patients cleared with PDL, after mean 3·3, median four treatments. All six patients were followed up to 1 year; four remained clear, one relapsed at 4 months and one at 9 months. Despite common side-effects including blistering and hyperpigmentation, patient satisfaction was high. Serial images obtained with the SIAscope® during treatment indicated different mechanisms of action of the two lasers.Conclusions  Excimer and V Beam® PDL are useful treatments for plaque psoriasis. Although the excimer appears to be on average more efficacious, a subset of patients may respond better to PDL. Long-term remission is achievable with both lasers.