Silica granuloma: scanning electron microscopy and energy dispersive X-ray microanalysis

Dermatoses caused by cultural practices: Therapeutic cultural practices

With globalization and widespread immigration, physicians increasingly encounter patients from varying backgrounds and diverse customs. Although certain cultural practices are widely performed, there is limited medical literature describing their dermatologic and systemic effects and complications. Population diversity and sharing of traditions make it increasingly important for dermatologists to understand the role of cultural practices and recognize physiologic and pathologic sequelae. In addition, dermatologists are often adjured to assess skin findings that may be mistaken for abuse. Child abuse misdiagnosis can be traumatizing to all those involved, and immigrant families with limited English proficiency may have difficulty explaining their traditional practices. The first article of this 2-part continuing medical education series begins with a review of therapeutic cultural practices, including traditional Chinese medicine, Ayurveda, acupuncture, cupping, moxibustion, and coining, and the clinically relevant complications that may occur. Therapeutic practices can cause a range of complications, including contact dermatitis, heavy metal toxicity, and severe cutaneous adverse reactions.

Complications of Acupuncture

Acupuncture as a treatment modality is now more widely used by the medical profession. It behoves both practitioners and patients to be aware of possible complications, the majority of which can be avoided with cautious and prudent use of this ancient therapy.

There have been many isolated reports of complications of acupuncture in the literature. We surveyed the literature identifying all articles referring to complications of acupuncture. Our findings are presented and discussed.

Cutaneous silica granuloma in a child

A 12-year-old girl had a 4-year history of two asymptomatic, sharply demarcated, granulomatous lesions on her face. The lesions did not respond to topical steroids and histopathologic examination of biopsy specimens showed granulomatous inflammation. Since cutaneous leishmaniasis is endemic where the patient lived, she was diagnosed as chronic cutaneous leishmaniasis but did not respond to meglumine antimoniate treatment. Reexamination of the biopsy specimens under polarized light revealed numerous birefringent crystalline particles, and cutaneous silica granuloma was the final diagnosis. The lesions were treated with intralesional triamcinolone acetonide and completely disappeared. We report this case of cutaneous silica granuloma, which is unusual in children, and emphasize the importance of polarized light microscopic examination of granulomatous skin diseases.

Acupuncture granulomas

Silicone compounds have recently been a source of controversy with regard to their potential role in the genesis of collagen vascular diseases. Foreign body reactions to injectable silicone were noted early in its cosmetic use and led to subsequent abandonment of this procedure. Here we report the first documented case of silicone granulomas to occur after acupuncture.

Foreign body gingivitis: clinical and microscopic features of 61 cases

Gingival inflammation associated with foreign bodies in connective tissue is termed foreign body gingivitis. It is not recognized commonly by clinicians and has not been described fully in the literature. This study examined the clinical and microscopic features of 61 cases of foreign body gingivitis. It was more common in women and occurred at a mean age of 48 years. It presented most frequently as a red or red and white painful chronic lesion that had been present for less than 1 year. Often it was diagnosed clinically as lichen planus. There was no gingival site predilection. Microscopically, foreign bodies, usually less than 5 microns in diameter, were found in an area of moderate to severe inflammation composed of lymphocytes, histiocytes, and plasma cells. The inflammation frequently was granulomatous and sometimes lichenoid.