When CO2 and Er:YAG lasers are used in a manner such that there are equivalent immediate postoperative histologic results, equivalent healing and cosmetic improvement occurs. One can use CO2 laser with one pass to mimic a moderately aggressive Er:YAG laser treatment.

A long-pulse alexandrite laser is effective in clearing solar lentigines in a single pass with minimal adverse effects.

Hair reduction can be safely and effectively achieved using a scanning 800 nm diode laser.

No abstract

Hand dermatitis is a common condition seen in the primary care setting. Occupational exposures and frequent hand washing often lead to symptoms that are irritating and may cause discomfort. Irritant dermatitis, atopic hand dermatitis and contact hand dermatitis account for at least 70% of all diagnoses. A unifying feature in most cases is an underlying disruption in the stratum corneum, altering its barrier function. Transepidermal water loss increases with barrier disruption and is exacerbated by additional exposure to water. Precise diagnosis and subsequent treatment present a considerable challenge, and hand dermatitis often becomes chronic. Initial treatment should be aimed at controlling inflammation and restoring the skin's natural barrier. Hand dermatitis represents a large proportion of occupation-associated skin disease. The prevalence among the general population has been estimated to be between 2% to 9%, 1 although one recent study cited a prevalence of 17% among a United States managed-care population, 2 whereas another found that prevalence rates may be above 50% in certain occupations. 3Risk factors for hand dermatitis include the use of latex gloves, chemical exposure, and frequent handwashing. Health care professionals, machinists, housekeepers, and beauticians are examples of individuals who are at a higher risk for developing symptoms. Other predictive factors include a history of childhood eczema and female sex. Symptoms often include irritation and discomfort that, in many cases, significantly interfere with normal daily home-or work-related activities.It is estimated that 5% to 7% of patients with hand dermatitis are characterized as having chronic or severe symptoms and 2% to 4% of severe cases are refractory to traditional topical treatment. 4 Management of refractory cases presents a significant challenge to the primary care provider and may require referral. Here I will review the pathogenesis, diagnosis, and treatment strategies for cases of hand dermatitis with a focus on irritant, atopic, and contact hand dermatitis. PathogenesisThe stratum corneum is essential in forming a barrier against the external environment and preventing water loss. This superficial layer contains epithelial cells embedded in a lipid bilayer of ceramides, fatty acids, and cholesterol with a water content between 20% and 35%. Nearly all forms of hand dermatitis involve a disruption in the stratum corneum that is usually followed, but in some cases preceded, by a local inflammatory response. 5,6 In simple terms, breeching of the stratum corneum leads to inflammatory cells being called to the scene. Inflammatory activity and transepidermal water losses lead to dryness, cracking, and inflammation. Stratum corneum lipids are mostly water soluble and water exposure from "wet work" can eliminate additional lipids. This explains the paradox regarding water making the hands drier This article was externally peer reviewed.