Fox-Fordyce disease: diagnosis with transverse histologic sections

Fox-Fordyce disease (FFD) is an uncommon chronic follicular based dermatosis with distinctive clinical characteristics consisting of pruritic papules confined to apocrine gland-bearing skin. Histologic confirmation of this entity is often time-consuming and difficult with conventional histologic sectioning. We describe a case of FFD occurring in a 26-year-old woman, in which we used transverse histologic sectioning to easily demonstrate the histopathologic features of this condition. With conventional sectioning of a punch biopsy specimen of an affected area, more than 23 serial sections were required to locate a follicle with pathognomonic features of the disease. In contrast, only one transverse section of a biopsy specimen was required to confirm the diagnosis. We propose that transverse histologic sectioning of biopsy specimens of patients suspected of having FFD more effectively demonstrates the diagnostic features.

Infection and allergy incidence in ambulatory surgery patients using white petrolatum vs bacitracin ointment. A randomized controlled trial

OBJECTIVE

To assess the effect of white petrolatum vs bacitracin ointment on wound infection incidence, allergic contact dermatitis incidence, and healing characteristics.

DESIGN

Randomized, double-blind, prospective trial comparing white petrolatum with bacitracin ointment in postprocedure wound care.

SETTING

A general outpatient dermatology clinic and a tertiary referral advanced surgical procedure clinic at Walter Reed Army Medical Center, Washington, DC.

PATIENTS

A total of 922 patients who had dermatologic surgery with a total of 1249 wounds.

MAIN OUTCOME MEASURES

The incidence of infection and allergic contact dermatitis during a follow-up period of 4 weeks. Healing characteristics were secondary outcomes.

RESULTS

Of the 922 patients enrolled, 440 in the white petrolatum group and 444 in the bacitracin group were evaluable for clinical response. The 2 treatment groups had comparable baseline characteristics. Thirteen patients developed postprocedure infection (1.5%), 9 (2.0%) in the white petrolatum group vs 4 (0.9%) in the bacitracin group (95% confidence interval for difference, -0.4% to 2.7%; P=.37). Eight infections (1.8%) in the white petrolatum group were due to Staphylococcus aureus vs none in the bacitracin group (P=.004). No patient in the group using white petrolatum developed allergic contact dermatitis vs 4 patients (0.9%) in the group using bacitracin (P=.12). Additionally, there were no clinically significant differences in healing between the treatment groups on day 1 (P=.98), day 7 (P=.86), or day 28 (P=.28) after the procedure.

CONCLUSIONS

White petrolatum is a safe, effective wound care ointment for ambulatory surgery. In comparison with bacitracin, white petrolatum possesses an equally low infection rate and minimal risk for induction of allergy.