Costal fringe.

Costal fringe consists of a bandlike pattern of venous telangiectases along the anterolateral costal margins. It is a common and easily recognized entity, usually seen in elderly men. Association with underlying disease is not well established. To assess the frequency of costal fringe in a healthy young adult population, we examined 1523 active duty Air Force personnel (1203 men and 320 women) between the ages of 17 and 34 years. All subjects were human immunodeficiency virus seronegative; none had known hyperestrogenic or other disease states. Costal fringe was present in only three individuals, all men, a frequency of 0.2%. Costal fringe is a rare finding in healthy young adults.

Enhancement of the clinical margins of Bowen's disease by acetowhitening.

Acetic acid was applied preoperatively to 12 lesions of Bowen's disease to determine if acetowhitening could more clearly define clinical margins. Acetowhitening disclosed the true margins better than unenhanced direct visualization, and subclinical extension of Bowen's disease was revealed by acetowhitening in three lesions. Acetowhitening can be a useful adjunct in the surgical management of Bowen's disease.

Coccidioidomycosis.

Although rapid population growth in the Southwestern United States and travel to and through the area are increasing the potential for exposure to Coccidioides immitis, prevalence rates have declined in some endemic areas, probably because of environmental factors. With the iatrogenic immunosuppression of organ transplantation and the immunosuppression inherent in AIDS, more opportunistic infections with this organism are to be expected. The variety of cutaneous manifestations continues to challenge the dermatologist's acumen. Spherule-derived coccidioidin is an improved epidemiologic tool, and serodiagnostic techniques are easier to perform and are useful in the management of dissemination. While amphotericin B remains the standard, ketoconazole has found a definite role in the treatment of this disease in many patients. Itraconazole, now under investigation, appears very promising. Morbidity and mortality from disseminated disease appear to be declining. With current diagnostic and therapeutic methods, the prognosis for survival in immunocompetent patients is excellent.

Treatment of multiple dermal cylindromas with the carbon dioxide laser.

The management of multiple cylindromas presents a therapeutic challenge to the clinician. The condition has significant cosmetic implications, and malignant degeneration can occur. Reported treatments include excision and repair of individual lesions, high-dose radiation, and complete scalp removal with grafting. We review the proposed histogenesis of this tumor, discuss its associations, and report the first use of the carbon dioxide laser as a successful treatment.

Cutaneous manifestations of early human immunodeficiency virus exposure.

After demonstrating antibodies to the human immunodeficiency virus (HIV), two hundred patients were interviewed and given a complete cutaneous and mucous membrane examination. By means of the Walter Reed Staging Classification System for HIV infection, 155 patients were classified as having Walter Reed stage 1A-2A (WR1A-WR2A) infection. The prevalence of seborrheic dermatitis in this group was 36%. There were no other significant cutaneous findings in the WR1A-WR2A patient population.

Treatment of angiolymphoid hyperplasia of the external ear with carbon dioxide laser.

Two women with long histories of angiolymphoid hyperplasia involving the left external ear were successfully treated with carbon dioxide laser vaporization. In one of these patients a previous treatment with argon laser photocoagulation had proved unsuccessful. Carbon dioxide laser vaporization can be advantageous in the treatment of angiolymphoid hyperplasia, especially when the patient is not a good candidate for cold steel surgery or when the disease process involves confined or convoluted structures such as those on the external ear.

Treatment of dermatofibrosarcoma protuberans with Mohs micrographic surgery.

Ten patients with dermatofibrosarcoma protuberans, all of whom had been treated previously by conventional excisional surgery without success, were treated with Mohs micrographic surgery. A team approach utilizing margin control by Mohs-trained physicians and reconstruction by surgical specialists was employed. Average follow-up exceeds 3 1/2 years, with no recurrences. Microscopically controlled excision appears to be the treatment of choice for dermatofibrosarcoma protuberans.

Argon laser treatment of angiokeratomas.

The argon laser, used in either a pulsed or continuous fashion, is highly effective for treatment of angiokeratomas. Local anesthesia is usually not required. Because energy deposition is well localized, wounds heal rapidly with excellent cosmetic results.

Superpulsed lasers: minimizing thermal damage with short duration, high irradiance pulses.

Superpulsed carbon dioxide lasers emit a controlled train of short duration, high-power pulses which minimize the protein coagulation effects of the laser. Very high irradiances can be used with superb control of vaporization without significant peripheral heating. In incisional work, superpulsing permits the surgeon to advance the hand piece as slowly and as accurately as desired, while experiencing a fraction of the necrosis attendant to conventional continuous-wave lasers. In vaporizational applications, target tissue volumes are flash vaporized before significant heat can be transferred to surrounding tissue, promoting faster wound healing and reduced scarring. The superpulse feature may significantly change the way in which the carbon dioxide laser is used in cutaneous surgery.

Electrosurgical epilation.

This article discusses alternative methods for the removal of unwanted hair, the mechanisms of action of each, and their advantages and disadvantages. Epilating needle design is discussed and epilating technique is described. Physician-patient interaction and the role of the dermatologist in electrosurgical epilation are explored.

Efficacy of minocycline compared with tetracycline in treatment of acne vulgaris.

A double-blind evaluation of the efficacy and safety of minocycline hydrochloride and tetracycline hydrochloride was conducted and completed using 49 patients with Pillsbury grade 2 or grade 3 acne. For six months, half of the patients received minocycline and half received tetracycline. Although the differences between treatment groups were not statistically significant at any evaluation, more patients treated with minocycline reached and maintained a noninflammatory acne status in less time than did patients treated with tetracycline. After six weeks, twice as many patients in the group treated with minocycline had reached noninflammatory status. Side effects reported by 7 patients were equally distributed between treatment groups. No notable abnormalities were observed in the results of blood chemistry studies, hematologic tests, quantitative serum immunoglobulin determinations, or thyroid function tests in 20 of the patients examined.