English VersionVersione Italiana
Versione stampabile

Dove Cercare:
Cerca Centri GILD
Cerca un centro accreditato nella tua città
Città o Provincia
Nome (Opzionale)
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 | 30 marzo 2016 - 10:27 | 0 Commenti

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

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



Condividi articolo con: