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Background Treatments of port-wine stains with conventional pulsed dye laser yield inconsistent results. Objective We evaluated the efficacy and safety of the longer pulse duration 595-nm dye laser. Methods Sixty-six adult Japanese patients were enrolled in this prospective study. The laser treatment with a cooling device was repeated 4 times at 8-week intervals with a consistent setting of 10-ms pulse duration and an energy fluence of 12 J/cm 2 , using 7-mm spot size. Results Improvement of port-wine stains was observed after multiple treatments, and 67% of the patients achieved either good or excellent response after the fourth treatment. Transient purpura, edema, or both were noted immediately after each treatment (76%-79% and 58%-67%, respectively). Hyperpigmentation (8%-17%) and hypopigmentation (6%-14%) were also mild and their occurrence did not increase by repeating treatments. Limitations Eighty five percent of the patients were classified as having Fitzpatrick skin type IV. Conclusion Our study indicated that the 595-nm dye laser with 10-ms pulse duration may be effective and well tolerated in the treatment of port-wine stains in adult Asians.

Background: Pustulosis palmaris et plantaris (PPP) is a chronic inflammatory disease consisting of polymorphonuclear leukocyte infiltration, and is often exacerbated by focal infections such as tonsillitis. In some cases, metal allergy has been reported. Objective: The purpose of this study was to evaluate (1) the significance of metal allergy in the formation of pustules, and (2) the participation of leukotriene (LT) B 4 in the formation of pustules of PPP. Methods: Patch tests with metals were performed on 7 patients with PPP, and both pustular and plasma levels of LTB 4 were measured in these 7 patients before and 48 hours after metal patch tests. Results: Palmoplantar pustules were exacerbated after the metal patch tests in all 7 patients. The mean levels of LTB 4 in plasma and pustules of the volar surface at 48 hours after the metal patch tests were significantly higher than those before the metal patch tests. Conclusion: Metals can be important in the pathogenesis of PPP by contributing to the induction of high LTB 4 concentration in the pustules. (J Am Acad Dermatol 2000;42:1021–5.)

Multicentric Bowen's disease developed in a 73-year-old man in areas involved with disseminated porokeratosis. The porokeratotic lesions were brownish; some were small and solitary, and others were coalesced and of variable size. Some lesions were erythematous. The histologic findings of the small, solitary or brownish, coalesced lesions were those of porokeratosis without apparent dysplasia; however, the erythematous coalesced lesions revealed epidermal dysplasia. Study revealed DNA ploidy abnormalities in the epidermal cells of these porokeratotic skin lesions. The skin lesions progressed in their degree of DNA ploidy abnormality from small solitary lesions to brownish coalesced ones and further to erythematous, coalesced ones. These observations suggest the direct and sequential growth of potentially malignant neoplastic clones in the patient's porokeratotic skin lesions and explain the multicentric development of Bowen's disease.

Psoriasis vulgaris was reported to be associated with a specific alanine residue at position 73 of HLA-C alleles in Japanese patients.Our purpose was to determine the role of HLA genes in susceptibility to psoriasis vulgaris in the Israeli Jewish population.Twenty-eight Israeli patients were analyzed for their HLA class I and II specificities by means of serologic and molecular methods.All patients possessed in their HLA-C antigens an alanine residue at position 73 (p0.002). A significantly increased frequency of HLA-Cw6 and of Cw7 was also observed among the patients (p0.02).Our study clearly shows that alanine in position 73 is significantly associated with psoriasis vulgaris in Jewish patients. Cw6 and Cw7 have a unique antigen-binding pocket containing both alanine at position 73 and a negatively charged aspartic acid at position 9. These residues are most probably important in determining the conformation of the C pocket and in turn the nature of the peptide bound to it. We suggest that this combination confers the highest risk of the development of psoriasis vulgaris.