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Long-Pulsed 1064-nm Nd: YAG Laser for the Treatment of Onychomycosis
Domenico Piccolo, MD, D. Kostaki, MD, E. Del Duca, MD, G. Cannarozzo, MD, M. Sannino, MD, and S. Nisticò, MD | 0 Commenti
Photomedicine and Laser Surgery
Volume XX, Number XX, 2017
ª Mary Ann Liebert, Inc.
Pp. 1–4
DOI: 10.1089/pho.2016.4153
Domenico Piccolo, MD,1 Dimitra Kostaki, MD,2 Ester Del Duca, MD,3 Giovanni Cannarozzo, MD,4 Mario Sannino, MD,4 and Steven Nistico` , MD5
Objective: The aim of this study is to evaluate the efficacy of long-pulsed 1064-nm Nd:YAG laser in penetrating tissue and targeting the fungal overgrowth in the nail plate. Background: Onychomycosis is the most frequent nail disorder. Current treatments include oral and topical antifungal agents, photodynamic therapy, and surgical approaches such as mechanical, chemical, or surgical nail avulsion. Moreover, the use of lasers to treat nail diseases has been approved in the United States by the Food and Drug Administration (FDA). Wide literature has been produced to assess the effectiveness of these devices, but, because the opposing results emerging from current studies, more data are still needed on the long-lasting efficacy and safety of this procedure. Methods: Twenty consecutive, unselected patients were enrolled in the study and treated, at intervals of 1 week, for a total of four sessions, using a long-pulsed 1064-nm Nd:YAG laser. In each session, three passages across each nail plate were performed with 1-min pause between each passage. A special lens for dermatoscopy, connected to a digital camera, was used for dermoscopic images. Results: In fourteen patients (70%; 12F; 3M), excellent results were obtained with an important reduction of chromonychia, onycholysis, opacity, longitudinal striae, and jagged proximal edge. Better results were observed in severe cases in the 2-month follow-up visit. Conclusions: Data for treating nail onychomycosis with laser and light therapy seem to be positive. The promising results of our study identify long-pulsed 1064-nm Nd:YAG laser as a possible alternative option for the treatment of onychomycosis. However, increasing subject data, improving study methodology, and output parameters may become an important next step of study in the treatment of nail onychomycosis.
1Italian Association Outpatient Dermatologists, Pescara, Italy.
2Skin Center Dermo-Aesthetic Lasers CentresPescara, Italy.
3Division of Dermatology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
4Lasers in Dermatology, University of Rome Tor Vergata, Rome, Italy.
5Department of Health Sciences, University of Catanzaro, Catanzaro, Italy.
Fractional CO2 Laser: From Skin Rejuvenation to Vulvo-Vaginal Reshaping
M. Filippini, MD, E. Del Duca, MD, F. Negosanti, MD, D. Bonciani, MD, L. Negosanti, MD, M. Sannino, MD, G. Cannarozzo, MD and S.P. Nisticò, MD | 0 Commenti
Photomedicine and Laser Surgery
Volume XX, Number XX, 2017
ª Mary Ann Liebert, Inc.
Pp. 1–5
DOI: 10.1089/pho.2016.4173
Maurizio Filippini, MD,1 Ester Del Duca, MD,2  Francesca Negosanti, MD,3,4 Diletta Bonciani, MD,5 Luca Negosanti, MD,Mario Sannino, MD,4  Giovanni Cannarozzo, MD,4  and Steven Paul Nistico` , MD4,7


Background: The CO2 laser has become the gold standard treatment in dermatologic surgery for the treatment of a large number of skin and mucosal lesions. The introduction of the fractional micro-ablative technology represented an integration to the ablative resurfacing technique, reducing the healing time and the side effects.
Objective: Vaginal rejuvenation performed with this technique is a minimally invasive procedure that stimulates internal tissues of the female lower genital tract to regenerate the mucosa, improving tissue trophism and restoring the correct functionality. Methods: In our experience, 386 menopausal women affected with vulvo-vaginal atrophy (VVA)were treated with three section of fractionalmicro-ablative CO2 laser. Results: After three treatments, patients reported a complete improvement of the symptoms (59.94% dryness, 56.26% burn, sensation, 48.75% dyspareunia, 56.37% itch, 73.15% soreness, and 48.79% vaginal introitus pain). Conclusions: Fractionalmicro-ablative CO2 laser seems to reduce symptoms related to vaginal atrophy. The beneficial effects were reported just after the first session and confirmed 12 months after the last session.
1Department of Obstetric and Gynecology, Hospital State of Republic of San Marino, San Marino, Republic of San Marino.
2Department of Dermatology, University of Rome Tor Vergata, Rome, Italy.
3Dermatology Center srl, Bologna, Italy.
4‘‘Laser in Dermatology,’’ University of Rome Tor Vergata, Rome, Italy.
5Section of Dermatology, Department of Surgery and Translational Medicine, University of Florence, Ospedale ‘‘Piero Palagi,’’ Florence,
6Division of Plastic Surgery, S.Orsola-Malpighi University Hospital Bologna, Bologna, Italy.
7Dermatology Department of Health Sciences, ‘‘Magna Grecia’’ University of Catanzaro, Catanzaro, Italy.
Dye Laser Treatment for Darier Disease: Results of a Case Series
Giovanni Cannarozzo, Diletta Bonciani, Mario Sannino, Federica Tamburi, Cristiano Morini, Domenico Piccolo, Steven Paul Nistico | 0 Commenti

Photomedicine and Laser Surgery
Volume X, Number X, 2016
ª Mary Ann Liebert, Inc.
Pp. 1–3
DOI: 10.1089/pho.2015.4034


Dye Laser Treatment for Darier Disease: Results of a Case Series


Giovanni Cannarozzo, MD,1 Diletta Bonciani, MD,2 Mario Sannino, MD,1 Federica Tamburi, MD,3
Cristiano Morini, MD,1,2 Domenico Piccolo MD,4 and Steven Paul Nistico1,5


To the Editor:

DARIER DISEASE (DD) is an uncommon autosomal dominant disorder. The responsible gene, mapped in the 12q23- q24.1 chromosome region, codifies for ATP2A2, which encodes a sarcoplasmic/endoplasmic reticulum calcium-ATPase, SERCA2, involved in epidermal differentiation and intercellular communication. Structural changes in keratin polypeptides and desmosomes caused by abnormal protease regulation have been shown in lesional skin.1 DD is characterized by symmetrical hyperkeratotic papules affecting seborrheic areas and extremities. Mild forms, usually located on the trunk, neck, and folds are the most




1‘‘Laser in Dermatology,’’ University of Rome, Tor Vergata, Italy.
2Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Florence, Italy.
3Unit of Dermatology, Complesso Integrato Columbus, Catholic University, Rome, Italy.
4Italian Association Outpatient Dermatologists, University of L’ Aquila, L’ Aquila, Italy. 5Department of Health Sciences, Universiity ‘‘Magna Graecia,’’ Catanzaro, Italy.




FIG. 1 .    Before and after treatment with excellent result.



common, and are often undiagnosed; skin signs may be associated with itch and a distinct odor, which may affect social life.2 The existence of unsightly lesions could lead to discomfort and be a social handicap. Treatments for DD include topical retinoids, calcipotriene, and 5-fluorouracil; dermabrasion; photodynamic therapy; and oral retinoids, which need to be given for a long period of time.1 Ablative lasers such as CO2 and Erbium:YAG lasers have also been used to treat these conditions, with variable results and side effects.3 In 2009, Schmitt et al. described a successful treatment of two patients affected by DD using a 595 nm pulse dye laser (PDL). To their knowledge, the mechanism of action was unclear; however, no other subsequent studies have confirmed this finding.4 We herein present the results after dye laser treatment in a case series of nine patients with DD who failed traditional treatment (e.g., keratolytics, topical corticosteroids, antibiotics, retinoids). Patients’ characteristics are described in Table 1. They all signed informed consent for treatment and photographs. All patients underwent treatment with a 595 nm PDL using purpuric settings (pulse duration 0.5 ms, spot size 10 – 12 mm, fluence 6.5–7 J/cm2). Treatments were repeated every 8 weeks (total of two treatments per patient). Postprocedure care instructions included cleansing with saline (once a day) and fusidic acid ointment (one or two times a day). In two cases, herpes simplex virus (HSV) flares were reported as side effects. The time to achieve resolution ranged from 2 to 4 weeks after the second treatment. The results are reported in Table 1, established by the physician with a clinical evaluation 3 months after the last treatment, considering the response excellent, good, moderate, or poor. Only two patients relapsed after 3 months of follow up, two patients presented a few persistent lesions, and other.



FIG. 2 .  Before and after treatment with excellent result. 



Four patients showed good and long-lasting improvement without any new lesions appearing. The definitive mechanism for improvement in DD treated with PDL has not yet been clarified; but we propose herein a hypothesis that may be a starting point for further research. Laser therapy is generally based on the concept of selective photothermolysis. PDL is a 595 nm laser used for the therapy of vascular lesions because of their high absorbion by oxyhemoglobin, although it has been used for many inflammatory diseases (i.e., cutaneous lupus erythematosus, psoriasis, eczema). It elicits mild capillary damage and edema of endothelial cells in dermal connective tissue. This damage may produce and release cytokines and growth factors, eventually leading to the stimulation of new collagen replenishment.5 Omi et al. demonstrated an increased of inflammatory cells (neutrophils, monocytes, mast cells, lymphocytes) after 3 h even to 5 weeks after irradiation. Therefore, taking these data all together, we can state that PDL may stimulate cutaneous immunological response.6 In conclusion, we speculate that the efficacy of PDL in an inflammatory disease, such as DD, could be the result of both the vascular components of the lesions, and of its immunomodulatory properties. As the treatment is moderately painful, nonablative, and with few potential complications, PDL can be considered a safe and effective alternative to other therapies for DD, despite the cost of the device. In order to minimize side effects, antiviral and topical antibiotic may be added. Further studies with wider casuistics are obviously required to better understand the exact mechanism of PDL action in this and other inflammatory diseases.


Author Disclosure Statement

No competing financial interests exist.

References 1. Milobratovic´ D, Vukic´evic´ J. Localized Darier’s disease. Acta Dermatovenerol Alp Pannonica Adriat 2011;20:213–215.

2. Sehgal VN, Srivastava G. Darier’s disease/keratosis follicularis. Int J Dermatol 2005;44:184–192

3. Benmously R, Litaiem N, Hammami H, Badri T, Fenniche S. Significant alleviation of Darier’s disease with fractional CO2 laser. J Cosmet Laser Ther 2015;17:77–79.

4. SchmittL,Roos S,Raulin C, Karsai S. SegmentalDarier disease : treatment with pulsed dye laser. Hautarzt 2009;60:995–998.

5. Cannarozzo G, Sannino M, Tamburi F, Morini C, Nistico` SP. Flash-lamp pulsed-dye laser treatment of keloids: results of an observational study. Photomed Laser Surg 2015;33: 274–277.

6. Omi T, Kawana S, Sato S, et al. Cutaneous immunological activation elicited by a low–fluence pulsed dye laser. Br J Dermatol 2005;153:57–62.


Address correspondence to:

Steven Paul Nistico

Coordinator of Master Degree Course ‘

‘Lasers in Dermatology’’

University of Rome

Tor Vergata


Department of Health Sciences

University of Catanzaro


E-mail: steven.nistico@gmail.com

Flash-Lamp Pulsed-Dye Laser Treatment of Keloids: Results of an Observational Study
| 0 Commenti
Giovanni Cannarozzo, MD,1  Mario Sannino, MD,1  Federica Tamburi, MD,2
Cristiano Morini, MD,1 and Steven Paul Nistico', MD3
1Lasers in Dermatology, University of Rome, Tor Vergata, Italy.
2Unit of Dermatology, Complesso Integrato Columbus, Catholic University, Rome, Italy.
3Department of Health Sciences, University ‘‘Magna Graecia,’’ Catanzaro, Italy.
Objective: Flash lamp pulsed dye laser (FPDL) was used in a selected group of patients with hypertrophic scars and keloids. Objective of the study was to assess the efficacy on a large number of cases. Background data: FPDL is a nonablative technology, typically used in vascular malformation therapy because of its specificity for hemoglobin. Methods: A total of 59 patients (33 males and 26 females, mean age 37.5 years) affected by hypertrophic postsurgical scars and keloids, underwent from four to six treatment sessions with a flash lamp pumped pulsed dye laser. Clinical follow-up was performed 6 months after the last treatment. Results were judged by blind observers. Results: A total of 29 patients out of 59 (49.1%) achieved excellent clearance, 15 patients (25.4%) achieved good to moderate clearance, and 12 patients (20.4%) obtained slight improvement. Only three subjects (5%) had little or no removal of their lesion. Treatment was well tolerated with minor and transient side effects. Conclusions: FPDL is known as a safe and effective treatment for different dermatological lesions in which skin microvessels play a key role in pathogenesis or development. This laser was effective when applied to hypertrophic scars and keloids. Further studies in a larger set of patients, however, are required to assess a standardized and reproducible method for treating these lesions.
Photomedicine and Laser Surgery
Volume 33, Number 5, 2015
© Mary Ann Liebert, Inc.
Pp. 274–277
DOI: 10.1089/pho.2015.3895
308 nm UV excimer light in monotherapy or combined to topical khellin 4% and/or tacrolimus 0.1% in the treatment of vitiligo
Global Dermatology | 0 Commenti

Steven Nistico1*, Giovanni Cannarozzo2, Mario Sannino2, Ester Del Duca1 and Ugo Bottoni1
1Department of Health Sciences; University of Catanzaro “Magna Graecia”, Italy
2Master Degree Lasers in Dermatology; University of Rome Tor Vergata

Many therapeutic options have been suggested for the treatment of vitiligo including non-surgical and surgical modalities. Non-surgical modalities, considered the first line therapy, include topical, intra-lesional and systemic corticosteroids, topical and oral psoralen plus ultraviolet A (PUVA), topical khellin 3%-4%-5%, broadband and narrow-band UVB (311 nm UVB phototherapy), and recently, topical immunomodulators (TIMs. e.g. tacrolimus, pimecrolimus), 308 nm excimer laser and light (MEL, monocheromatic excimer light). Thirtytwo patients affected by vitiligo were selected in this open comparative study: they were subdivided into 4 groups of 8 patients each: Group I (Control Group) included 4 man and 4 women, aged 16-70 years (mean age: 41.2 years), treated with MEL; Group II included 3 man and 5 women, aged 13-70 years (mean age: 37.7 years), treated with MEL associated with topical khellin 4%; Group III included 5 men and 3 women, aged 31-61 years (mean age: 44 years) treated with MEL associated with topical tacrolimus 0.1%; Group IV included 4 men and 4 women, aged 10-72 years (mean age. 45 years) treated with MEL associated with topical khellin 4% and tacrolimus 0.1%. Results seemed more favourable towards Group III which included patients treated with MEL and topical tacrolimus 0.1% presented an overall best response rate if compared to the other groups. In fact, the results of Group IV-patients treated with MEL combined to topical khellin 4% and tacrolimus 0.1% were not up to the authors higher expectations, taking into account the novel association not yet described in literature.

Deep Pulse Fractional CO2 Laser Combined with a Radiofrequency System: Results of a Case Series
Cannarozzo G., MD,¹ Sannino M., MD,¹ Tamburi F., MD,³ Chiricozzi A., MD,¹ Saraceno R., MD,¹ Morini C., MD,¹ Nisticò S., MD¹³ | 0 Commenti
Objective: The purpose of this study was evaluation of the safety and efficacy of this new combined technology that adds deep ablation to thermal stimulation. Background data: Minimally ablative or subablative lasers, such as fractionalCO2 lasers, have been developed in an attempt to achieve the same clinical results observedwith traditional ablative lasers, but with fewer side effects. Despite being an ablative laser, the system used in this study is able to produce a fractional supply of the beam of light. Fractional ablation of skin is performed through the development of microscopic vertical columns surrounded by spared areas of epidermis and dermis, ensuring rapidwound healing and minimum down time. Simultaneous synchronized delivery of a radiofrequency (RF) current to the deeper layers of the skin completes the therapeutic scenario, ensuring an effective skin tightening effect over the entire treated area. Methods:.Nine adult patients were treated for wrinkles and acne scars using this new laser technology. An independent observer evaluated the improvement using a five point scale. Results: All patients had good results in terms of improvement of skin texture, with mild and transitory side effects. Conclusions: This novel combined system produced improvement in wrinkles and acne scars, with progressive enhancement of skin tone and elasticity.