Hair removal with a non-coherent filtered flashlamp intense pulsed light source

BACKGROUND AND OBJECTIVE

To evaluate the effects on disruption of hair growth of the non-coherent filtered flashlamp intense pulsed light (IPL) source.

MATERIALS AND METHODS

Twenty-eight sites on 23 patients with Fitzpatrick type I-III were enrolled using a single treatment IPL followed for three months post-treatment. Another 56 on 48 patients with Fitzpatrick skin types I-V randomly enrolled for two treatments one month apart and followed for six months.

STUDY DESIGN

Prior to beginning treatment and at each follow-up visit hair counts were obtained by averaging three 1-cm2 areas on a clear acetate template placed over the skin. Repeat hair counts and photographs were obtained at 2, 4, 8, and 12 weeks for the single treatment protocol and at additional 4, 5, and 6 months for the double treatment protocol. Parameters utilized were a 2.8-3.2 millisecond pulse duration typically for three pulses with thermal relaxation intervals of 20-30 milliseconds with a total fluence of 40-42 J/cm2.

RESULTS

For the double treatment protocol hair clearance of 64% was achieved immediately following the second treatment. By week 8 reduction of hair counts was 42%. At 6 months, hair counts were reduced by 33%.

CONCLUSIONS

Non-coherent IPL is an effective modality for long-term hair removal. IPL is safe with minimal side effects of epidermal injury or pigmentation change.

Periorbital skin resurfacing using high energy erbium:YAG laser: results in 50 patients

OBJECTIVE

To evaluate Erbium:YAG regional periorbital laser resurfacing clinically and histologically.

STUDY DESIGN/MATERIALS AND METHODS

Photographic evaluation before and after Erbium:YAG resurfacing with histologic evaluation of depth of injury.

SETTING

Group private single specialty practice.

PATIENTS

Fifty patients in the age range of 35-62 years, Fitzpatrick skin types I-III were treated using Erbium:YAG for regional resurfacing of periorbital rhytides.

OUTCOME MEASURES

Patients were seen at days 1, 2, 3, 7, 14, 28, and at six months and one year. Photographs were obtained prior to application of topical anesthesia and were utilized to judge improvement of rhytides at all time intervals. Additional photographs were taken at each follow-up visit and the results judged by an independent investigator. Results were graded into five categories at all treatment intervals: no improvement, mild (grade 1: up to 25%), moderate (grade 2: 25-50%), good (grade 3: 50-75%, or excellent (grade 4: 75-100%). For histologic evaluation of depth of ablation and thermal injury one, two, and three passes at 21.2 J/cm2 were performed on four patients.

RESULTS

Re-epithelization in the periorbital region was rapid with a mean duration of 2.65 days. Erythema ranged from a longest of six weeks to the shortest of seven days with a mean duration of 15.4 days. Evaluation of clinical results revealed that at two weeks mean improvement was 2.15 (between moderate and good). At four weeks further improvement was noted with a mean of 2.62. By six months, mean improvement score increased to 2.94. Minimal further improvement was noted between six months and one year with a mean improvement score of 3.02 (good to excellent). Histology revealed complete removal of the epidermis with one to three passes. Dermal ablation of 5-10 microns accompanied by small increases (5-10 microns) in dermal thermal injury occurred with each subsequent pass.

CONCLUSIONS

We conclude that high energy Erbium:YAG periorbital resurfacing is a safe and effective modality which achieves substantial therapeutic effect. Most patients achieve approximately 75% improvement. Erythema fades quickly, reepithelization is rapid and side effects are minimal.

Identification of pharmaceutical excipients using NIR spectroscopy and SIMCA

Soft independent modelling of class analogy (SIMCA) is applied to identify near-infrared (NIR) spectra of ten excipients used in the pharmaceutical industry. For each class at least 15 excipient samples were collected for the data base, considering different batches and occasionally various suppliers. Therefore the data of the classes are not always homogeneous. The performance of the original SIMCA method, which is usually described in the literature and also applied by the users, carried out at two confidence levels, 95 and 99%, on original data, SNV (standard normal variate transformation) and second derivative pre-processed data, is discussed. Reasons for the rejection rates are given. No objects were assigned to a wrong class using SIMCA.

Variations of the pursestring suture in skin cancer reconstruction

BACKGROUND

The pursestring suture (PSS) utilizes a circumferentially placed intradermal suture to decrease the size of a defect. Its primary application in dermatologic surgery has been to allow placement of a smaller full-thickness skin graft and to enhance secondary intention wound healing.

OBJECTIVE

To present our experience with 3 variations of the PSS.

METHODS

The oval defects resulting after surgical excision of cutaneous malignancies were managed with 3 variations of the traditional pursestring technique. These variations included (1) complete closure of the PSS-reduced defect by the placement of traditional interrupted sutures; (2) PSS with the Burow's triangle graft; (3) use of a PSS only part way around an oval defect to avoid distortion of a nearby free margin.

RESULTS

In the 7 years of performing these variations of the PSS technique, we have consistently achieved favorable results.

CONCLUSION

We report 3 simple-to-use variations of the PSS technique that have been extremely useful in the management of cutaneous malignancies.

Acinic cell carcinoma presenting as an upper lip mass

BACKGROUND

Acinic cell carcinoma (ACC) is a rare tumor generally involving the parotid gland and infrequently the minor salivary glands.

OBJECTIVE

Clinical and histopathological characteristics of a case of ACC of the minor salivary glands, and brief review of the literature.

METHODS

Routine stains with H&E, PAS, iron, and mucicarmine; immunohistochemistry with cytokeratin, CEA, S-100, and leu-M1.

RESULTS

The ACC was removed by wide local excision. Histopathology revealed papillary cystic, solid, and ductal architectural features. The mucinous material within the lumina of the cystic and ductal structures was PAS and mucicarmine positive, and diastase resistant. All tested immunohistochemical reagents reacted with the epithelial cells. There were no mitoses, necrosis, cellular pleomorphism, or infiltration.

CONCLUSIONS

ACC is a rare tumor of salivary glands characterized by an indolent clinical course with the potential for both local recurrence and metastatic spread when tracked for decades. Published mortality rates vary from 6 to 50%. Histopathologic features do not reliably predict biologic behavior.

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.

Effect of work station design on sitting posture in young children

The purpose of the study was to compare muscular activity levels and sitting posture displayed by 10 children (mean age = 4.7 years) when performing tracing tasks while seated at a traditional work station (level desk top, 5 degrees backward sloping seat) and at an ergonomically designed work station (15 degrees sloping desk top, 15 degrees forward sloping seat). EMG profiles of latissimus dorsi (LD), erector spine (ES), and superior trapezius (ST) were sampled using Medi-trace disposable surface electrodes for 10 min on the non-dominant side. Muscle activity was sampled (1000 Hz) every 2 min for 5000 ms while the subjects performed the tracing tasks at each station. Raw EMG signals of the five trials for each muscle were processed by removing signal offset, full-wave rectification, and integration. The subjects' posture was monitored from a lateral view using a Panasonic VHS video camera while the children were seated at each work station. Neck flexion angle and the angle between the torso and thigh (hip angle) were manually sampled from the video images each 1 min as an indication of the posture adopted by the subjects during the tracing tasks. Use of t-tests for dependent means indicated that there was no significant difference in either mean ES or ST muscle activity as a function of work station design. However, subjects demonstrated significantly less LD activity when seated at the ergonomic work station (mean = 20.9 V ms) compared with the traditional work station (mean = 24.4 V ms, t = -2.88, p = 0.018).(ABSTRACT TRUNCATED AT 250 WORDS)

Radiation-induced adiposis of the parotid gland

Radiation-induced changes to the parotid gland may complicate later surgery for new or recurrent tumors of the area. Radiation commonly causes the replacement of parotid parenchyma by adipose cells as well as fibrosis and glandular atrophy. If the Mohs micrographic surgeon is not prepared for the gross and microscopic changes which may be present in the parotid gland, neighboring structures such as the facial nerve may be inadvertently encountered and tumor depth and extent may be poorly estimated. By discussing and illustrating this situation, we hope to make other surgeons aware of the difficulties which may be present after radiation to the parotid gland.

Cutaneous sarcoidal granulomas in a patient with primary biliary cirrhosis

We report here the case of a fifty-year-old Japanese woman with a history of primary biliary cirrhosis who presented with a sarcoidal granulomatous plaque on the face. Although the occurrence of extra-hepatic granulomas and primary biliary cirrhosis has been documented, this is the first case report of cutaneous sarcoidal granulomas in the absence of demonstrable sarcoidosis occurring in a patient with primary biliary cirrhosis. Because primary biliary cirrhosis and sarcoidosis are systemic granulomatous diseases of unknown cause, the coexistence of findings compatible with both entities has led to speculation that they are related. We provide a brief review of these two diseases to help examine this hypothesis.

Clinical significance and treatment of xanthomas

Xanthomas are important clinical manifestations of a variety of disorders, including lipoprotein abnormalities, hypothyroidism, diabetes and certain forms of cancer. Many patients with these lesions are also at risk for premature atherosclerosis. Family physicians are often the first to recognize xanthomas. Early detection and identification of the lesions leads to appropriate diagnosis and treatment of the related diseases.

Applications of the crescentic advancement flap

Repair of defects of the lateral nose, perialar, and nasolabial region are often challenging. Maintaining the normal anatomic boundary lines and if possible placing the sutures within these lines are important considerations when designing a closure. The crescentic advancement flap has proved to be a versatile closure for skin cancer defects in these regions. A brief historic perspective on this flap along with important concepts in its utilization for defects of the lateral nose, perialar region, and nasolabial fold are discussed.

Infiltrating lipomas of the upper extremities

The typical lipoma is an encapsulated subdermal tumor, usually easily removed if necessary. We recently encountered two lipomas that infiltrated muscles of the forearm. Excision of infiltrating lipomas may be complicated by their deep location and potential involvement of vascular and neural structures. This paper should increase dermatologists' awareness of this uncommon variant and facilitate appropriate referral for definitive treatment. We believe that this is the first report in the dermatologic literature of infiltrating lipoma of the upper extremity.