Treatment of pigmented purpuric dermatosis with topical photodynamic therapy.

590 nm were used. The patient did not complain about pain and burning sensation during the treatment. After 3 sessions, the lesion showed clinical improvement other than postinflammatory hyperpigmentation. However, the patient had to discontinue treatment because hemorrhoid surgery was planned. A 40-year-old woman presented with a 3 ! 4 cm brownish patch that had first been noted 3 years previously. She had no drug history and showed no other symptoms of varicose veins and chronic venous insufficiency. The histopathological examination was consistent with the diagnosis of PPD. The findings of the routine laboratory tests were in the normal range. We attempted to treat the lesion with PDT and topical methyl-ALA (Metvix , Galderma, France). The occlusive dressing method was identical to the previous case. The lesion was illuminated with red light from a Waldman PDT 1200 lamp, at a light dose of 15 J/cm 2 and a fluence rate of 50 mW/cm 2 . The patient did not feel pain and burning sensation during the treatment. After 7 treatment sessions, the lesion showed clinical improvement, and we performed a second biopsy. The histopathology revealed decreased lymphocytic infiltration in the upper dermis and red blood cell extravasation. In addition, the telangiectasia was improved. For the immunohistopathological studies, the positive cells for CD3, CD4, CD8, CD68 and CD1a were decreased after the PDT. According to the staining against factor-VIII-related Ag, the vessel number and size were also decreased after the PDT. After 6 months, she had no recurrence but only slight postinflammatory hyperpigmentation around the treated lesion ( fig. 1 , 2 ).