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Restored epidermal CD44 expression in lichen sclerosus et atrophicus and clinical improvement with topical application of retinaldehyde

ic neuralgia, which persisted for several weeks. Light in the violet-blue range (407–420 nm) has been shown to exhibit a phototoxic effect on Proprionibacterium acnes when irradiated in vitro. P. acnes produces protoporphyrin IX which absorbs maximally around 420 nm. It is presumed that low-fluence PDL works via a direct phototoxic effect on the P. acnes, thereby reducing inflammatory lesions of facial acne. This reflects the improvement observed by most individuals with acne after exposure to sunlight. There has been increasing interest in using PDL for acne following a recent short-term randomized controlled trial. This is the first report of any serious adverse effect following treatment with low-fluence PDL for acne vulgaris. Varicella zoster virus (VZV) becomes latent in human ganglia after primary infection. VZV reactivation occurs primarily in elderly and immunosuppressed individuals, correlating with a specific decline in cell-mediated immunity to the virus. VZV can also become reactivated after surgical stress. Reactivation of herpes zoster has been reported following laser in situ keratomileusis (LASIK) for myopia. Subclinical reactivation of VZV has also been reported in astronauts. The exact molecular mechanism for reactivation of VZV is unclear. Herpes simplex virus 1 (HSV-1) reactivation may occur in patients undergoing facial carbon dioxide (CO2) laser resurfacing and can delay healing and result in severe scarring. Low-intensity laser therapy has also been reported to be an effective treatment for recurrent herpes simplex infection. Animal models have also shown HSV-1 reactivation can be induced by laser. We therefore advise caution when administering lowfluence PDL for facial acne. The long-term efficacy of lowfluence PDL in the treatment of acne vulgaris is unknown and further studies are required to confirm its efficacy; in addition, long-term studies are also required to assess whether the benefits of short-term PDL treatments are maintained.