Rhinophyma is a slowly progressive, benign dermatological disorder of the nose. The most widely accepted theory is that rhinophyma is the end stage of chronic rosacea. The primary reason for its excision is cosmetic deformity. Many treatment modalities have been described, including CO(2) laser. This method provides a very dry surgical field, which allows the sculpting of the hypertrophic areas. Pulsed dye laser (PDL) is a safe and effective treatment, resulting in a significant improvement in erythema, telangiectases, symptoms and quality of life. We report the case of a 63-year-old Caucasian man with a 2-year history of rapid progression rhinophyma. The patient was submitted to five CO(2) laser sessions, followed by three PDL sessions. Favourable re-epithelization of the surfaces treated with CO(2) laser was achieved within a very short period of time. PDL post-treatment purpura lasted a medium of 12 days. After 12 months of follow-up the patient remains without evidence of relapse. To our knowledge, this is the first case described of treatment using a combination of the CO(2) laser and PDL.

We propose to identify patients at risk of missed appointments and suggest interventions to overcome this pitfall and improve patient outcomes.

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Necrobiosis lipoidica is a rare granulomatous and inflammatory disease. Its management is particularly difficult when ulceration is present. The authors describe the clinical case of a 65-year-old female patient with necrobiosis lipoidica, who had been submitted in the past to several topical and systemic treatments with little or no improvement. She started treatment with subcutaneous etanercept and showed significant improvement without adverse events until today. The aim of this article is to report a valid and efficient alternative treatment to recalcitrant cases.

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