Dermabrasion.

This article provides an overview of the resurfacing technique of dermabrasion. Preoperative consultation, perioperative medications, postoperative management, common complications, and reasonable outcome expectations are all described in detail. A description of proper technique, intraoperative equipment, and an approach to full-face procedures is also described.

Detection of circulating T cells with CD4+CD7- immunophenotype in patients with benign and malignant lymphoproliferative dermatoses.

BACKGROUND: Cutaneous T-cell lymphomas (CTCLs) are malignancies of CD4+ T cells that involve the skin. CD4+CD7- cells may represent a malignant population in CTCL. OBJECTIVE: Our purpose was to compare the percentage of CD4+CD7- cells and the expression of pan-T-cell antigens in blood lymphocytes from 31 patients with benign dermatoses with 35 patients who had CTCL. METHODS: The patients with CTCL were classified as follows: 10 with mycosis fungoides (MF), seven with pre-Sézary syndrome (pre-SS), and 18 with Sézary syndrome (SS). Flow cytometry was used to determine the percentage of CD4+CD7- cells and the CD4/CD8 ratio and to detect aberrant expression of the pan-T-cell antigens CD2, CD3, and CD5. RESULTS: We found a mean of 5.8% CD4+CD7- cells for the 16 normal control subjects and 9.3% for the benign cases (p = 0.13). The patients with pre-SS and SS had a higher percentage of CD4+CD7- cells (22.4% and 35.5%, respectively) than patients with benign dermatoses (p < 0.01); no difference was found between patients with benign dermatoses and those with MF (p = 0.80). The mean CD4/CD8 ratio was 3.1 for the normal control subjects compared with 7.4 for the patients with benign dermatoses (p < 0.01). Patients with SS had a ratio of 49, which was higher than the ratio for those with benign dermatoses (p < 0.01); however, the ratio for patients with MF and pre-SS did not differ from that of the group with benign dermatoses (p = 0.71 and 0.55, respectively). Aberrant CD2, CD3, or CD5 expression was observed in 66% of patients with SS, 29% with pre-SS, 30% with MF, but in none of the patients with a benign dermatosis. CONCLUSION: Small numbers of CD4+CD7- cells can be found by flow cytometry in patients with a benign dermatosis and in normal control subjects. This T-cell subset is expanded in pre-SS and SS but not in MF. Aberrant pan-T-cell antigen expression is commonly observed in patients with SS but not in patients with a benign dermatosis.

Dermabrasive scar revision. Immunohistochemical and ultrastructural evaluation.

BACKGROUND: Dermabrasion of facial scars 4-8 weeks after injury frequently completely eliminates visible evidence of scar formation. However, efforts to define the cellular and structural mechanisms by which this phenomenon occurs have been limited in their success. OBJECTIVE: We investigated wound healing after dermabrasive scar revision. METHODS: The surgical scars of seven patients were abraded 6-8 weeks after injury. Comparative electron microscopic and immunohistochemical studies were performed on punch biopsy specimens taken before and after the dermabrasion. Ultrastructural changes in the basement membrane components and dermal structures were evaluated. Monoclonal antibody staining techniques were used to observe the presence, location, and temporal expression of tenascin, epiligrin, cadherins, and integrin subunits. RESULTS: We observed: 1) an increase in collagen bundle density and size with a tendency toward unidirectional orientation of fibers parallel to the epidermal surface, 2) an upregulation of tenascin expression throughout the papillary dermis, and 3) expression of alpha-6/beta-4 integrin subunit on the keratinocytes throughout the stratum spinosum. CONCLUSIONS: The mechanisms by which dermabrasive scar revision alters the events of primary cicatrix formation include modification of extracellular ligand expression, thereby influencing epithelial cell-cell interaction, and reorganization of connective tissue.

Condom-related allergic contact dermatitis.

After 25 years of wearing a condom catheter, recurrent blisters and epidermal sloughing of the penile shaft developed in a patient. Patch testing revealed hypersensitivities to several allergenic components of the condom catheter (that is thiram and mercaptobenzothiazole). After immediate treatment with topically applied steroids, the condition improved and the patient successfully switched to a silicone condom without further irritation.

Ultrastructural evaluation of mid-dermal elastolysis.

Mid-dermal elastolysis is a well-defined clinical and histopathologic entity manifested by fine wrinkling of the skin and a mid-dermal loss of elastic fibers. Ultrastructural and histologic studies were performed in an attempt to better define the cause of the elastolytic process. Biopsy specimens from the lesions of 3 patients with mid-dermal elastolysis were studied at light and electron microscopic levels. Ultrastructural evidence of normal elastic fiber engulfment by activated macrophages was observed; however, some fields also demonstrated envelopment of abnormally degenerated elastic tissue. Although there are many potential causes of this degeneration, photodistribution of the lesions suggests that ultraviolet damage is a primary inciting factor.