BackgroundLow-fluence 1,064 nm Q-switched Nd:YAG laser has been widely used for the treatment of melasma. Although new Q-switched Nd:YAG lasers with photoacoustic twin pulse (PTP) mode have been recently developed for high-efficiency, there is limited information available for the new technique.ObjectiveThis study was designed to investigate the efficacy and adverse effects after few sessions of repeated low fluence 1,064 nm Q-switched Nd:YAG laser treatment with PTP mode in Asian women with melasma.MethodsTwenty-two Korean women were treated with a total of five sessions of low-fluence PTP mode Nd:YAG laser treatment (Pastelle®) at 2 weeks interval. Responses to treatments were evaluated by using Melasma Area and Severity Index (MASI) scoring, colorimeter measurement, and the investigators' and patients' overall assessments. Adverse events were recorded at each visit.ResultsInvestigators' and patients' overall assessment showed that 'significantly improved' was assessed by 13 (59.1%) and 19 of 22 patients (86.4%), respectively. MASI scores were significantly reduced by 20.4%. The lightness, measured by using a colorimeter, was significantly increased by 1.3 point. Notable adverse events were not observed.ConclusionAfter 5 sessions of laser therapy alone, about 60% of the subjects showed significant improvement. Few sessions of repeated laser toning treatment using the PTP mode is a safe and effective way to treat facial melasma.

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A 75-year-old man presented with multiple, scaly, erythematous, grouped papules, nodules and plaques with tenderness ranging from the right forearm to hand dorsum and the right lower leg for 2-3 months. Five months prior to presentation, the patient had received an antibiotic skin test on his right forearm. Lesions appeared approximately 2-3 months after the antibiotic skin test, slowly progressing without clinical improvement. Culture for fungus on the right forearm revealed growth of Scedosporium apiospermum. The tissue acid-fast bacilli (AFB) culture for the right forearm and right leg revealed growth of non-tuberculous mycobacteria which was Mycobacterium chelonae, and subsequent tissue polymerase chain reaction of both sites reported positive signs of M. chelonae. On diastase periodic acid-Schiff stain of the biopsy specimen of the right forearm, fungal hyphae were found while rod-shaped bacilli could be seen in AFB stain for the biopsy specimen of the right leg. The patient was treated with oral clarithromycin and ciprofloxacin along with an oral antifungal agent for 13 weeks. After the treatment, the lesions subsided and left a scar. We report a rare case of co-infection of S. apiospermum and M. chelonae in an immunocompetent host.

Diseases associated with immunoglobulin A (IgA) antibody include linear IgA dermatosis, IgA nephropathy, Celiac disease, Henoch-Schönlein purpura, etc. Although usually idiopathic, IgA antibody is occasionally induced by drugs (e.g., vancomycin, carbamazepine, ceftriaxone, and cyclosporine), malignancies, infections, and other causes. So far, only a few cases of IgA bullous dermatosis coexisting with IgA nephropathy have been reported. A 64-year-old female receiving intravenous ceftriaxone and metronidazole for liver abscess had purpuric macules and papules on her extremities. One week later, she had generalized edema and skin rash with bullae and was diagnosed with concurrent linear IgA dermatosis and IgA nephropathy. After steroid treatment, the skin lesion subsided within two weeks, and kidney function slowly returned to normal. As both diseases occurred after a common possible cause, we predict their pathogeneses are associated.

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