Diode Laser Surgery as a Conservative Management of Hairy Tongue Lesion Resistance to Treatment

Hairy tongue is a furry appearance on the dorsum surface of the tongue with variable colors. This lesion is due to defective shedding of filiform papillae. Various treatments are proposed for this condition like keratolytic agents, surgical procedure with a scalpel, or laser application. In this case study, we reported successful treatment of hairy tongue with a diode laser. The diode laser with wavelength 810 nm, power of 4 watts, a pulse width of 20 milliseconds, and an interval of 20 milliseconds by a 400-micron optical fiber was selected for treatment of this lesion. There was no bleeding during this minimally invasive surgery, and the patient experienced a low level of pain. Loss of taste function was completely resolved. Based on the result of this study, a diode laser can be a good alternative for minimally invasive surgical treatment of hairy tongue.

Recalibrated Scales: The Use of Low-dose Isotretinoin in a Case of Epidermolytic Ichthyosis-NPS1 in a Filipino Child

Epidermolytic Ichthyosis (EI) is a rare non-syndromic keratinopathic ichthyosis without definitive treatment. This is a case of EI in a 5-year-old Filipino female who presented with hyperkeratotic scales sparing the palms and soles. Histopathology revealed epidermolytic hyperkeratosis. A trial of treatment with isotretinoin 0.3 mg/kg/day, together with keratolytic agents, urea lotion and lactic acid lotion, resulted in a marked decrease in the thickness of the scales and odor. Interestingly, rebound effects were noted at 0.6 mg/kg/day. Taking into account that EI presents with more skin fragility compared to non-EHK ichthyosis, the authors surmise that there may be a smaller treatment window for patients with EI, which is notably lower than recommended for ichthyosis in general.

Epidermal Proliferation and Differentiation in Ichthyosis Vulgaris

A B S T R A C TEpidermal proliferation and differentiation is a physiological process which playscrucial role in protecting human body from external environment. Ichthyosisvulgaris is a disease caused by disruption of epidermal differentiation process.Disrupted of profilaggrin conversion to filaggrin caused by mutations from thefilaggrin gene (FLG) located on chromosome 1q21. Recently, caused of ichthyosisvulgaris is mutation of the CASP14 gene on chromosome 19p13.12 which producescaspase-14, is involved in the proteolytic degradation of filaggrin. Clinicalmanifestations of ichthyosis vulgaris are hyperlinear palmar and plantar, keratosispilaris, xerosis, and localized or generalized scaling of the skin. Application ofemollients, humectants and keratolytic agents are the main treatment of ichthyosisvulgaris. Further research on caspase-14 as a therapeutic target is needed in thetreatment of ichthyosis vulgaris.

Novel NSDHL gene variant for congenital hemidysplasia with ichthyosiform erythroderma and limb defects (CHILD) syndrome

We report a case of a 1-year and 2-month-old girl with clinical features consistent with congenital hemidysplasia with ichthyosis and limb defects syndrome. Sterol analysis from skin flakes revealed increased levels of a mono 4-alpha methyl sterol also seen in plasma as well as the presence of 4-alpha-carboxy-4-methyl-cholest-8(9)-en-3beta-ol and several keto-sterols, which are usually below the limit of detection. This sterol pattern is consistent with abnormal function of the 4-alpha-methylsterol-4-demethylase complex. NSDHL gene testing revealed the presence of a variant of uncertain significance, c.130G>A (p.Gly44Ser). This missense mutation currently is not included in population databases (ExAC no frequency) and has not been reported in individuals with an NSDHL-related condition. Parental studies showed that neither parent carries the NSDHL variant. On this basis, this variant has been reclassified as likely pathogenic. Symptomatic treatment with keratolytic agents, emollients and ketoconazole was initiated.

Bilateral Tinea Nigra Plantaris with Good Response to Isoconazole Cream: A Case Report

Tinea nigra is a superficial fungal infection caused by Hortaea werneckii. It typically affects young individuals as an asymptomatic unilateral macule, from light brown to black on the palms and soles, mainly in tropical and subtropical regions. In 1997, Gupta et al. [Br J Dermatol 1997;137:483-484] described the dermoscopic characteristics of tinea nigra. Topical antifungals with or without keratolytic agents can be used for the treatment. The authors report a case of a 47-year-old man with asymptomatic light brown macules bilaterally on the plantar regions. Dermoscopic examination revealed brownish spicules consistent with the pattern described in the literature. Treatment with isoconazole cream was effective with complete resolution.