Topical review: skin infections in the foot and ankle patient.

There are numerous cutaneous disorders that affect the foot, but of these conditions skin infections have the most significant impact on overall patient morbidity and clinical outcome. Skin infections in foot and ankle patients are common, with often devastating consequences if left unrecognized and untreated in both surgical and nonsurgical cases. There is a diverse array of infectious dermatoses that afflict the foot and ankle patient including tinea pedis, onychomycosis, paronychia, pitted keratolysis, verruca, folliculitis, and erysipelas. Prompt diagnosis, treatment, and surveillance of these common infectious conditions are critical in managing these dermatoses that can potentially progress to form deep abscesses and osteomyelitis. Infections can be managed with a combination of ventilated shoewear and synthetic substances to keep the feet dry, topical and oral antimicrobial agents, and patient education regarding preventative hygiene measures. The purpose of this review is to aid foot and ankle surgeons and other physicians in the diagnosis and treatment of infectious dermatoses affecting the foot.

Pediatric "STUMP" lesions: evaluation and management of difficult atypical Spitzoid lesions in children.

Spitz nevi represent a distinct type of melanocytic nevi more commonly seen in childhood. Although typically benign, a subset of Spitz lesions raise concern and create a diagnostic dilemma as a result of confusing histology that involves characteristics of classic Spitz nevi intermixed with features of cutaneous melanoma. Such atypical Spitz lesions, or Spitzoid tumors of uncertain malignant potential, are difficult to classify and their biologic potential is uncertain. Nonetheless, these are critical tasks for both prognosis and clinical management. New tools, such as immunohistochemical stains, comparative genomic hybridization, and fluorescence in situ hybridization, have been used to provide further insight into these controversial lesions and to aid in their evaluation. In this review, we present our experience managing 6 cases of Spitzoid tumor of uncertain malignant potential and discuss the potential use of various diagnostic modalities, including sentinel lymph node biopsy, immunostaining, and molecular analysis.

Nickel allergy: localized, id, and systemic manifestations in children.

Nickel is the most common allergen causing allergic contact dermatitis in patch-tested children, especially in female children. Allergy to this metal can manifest in a variety of ways. In this case series, we present four children to illustrate the different presentations of nickel allergy confirmed by patch testing. Localized, id, and systemic nickel reactions are reviewed, as well as the diagnosis and management of nickel allergic contact dermatitis. While localized dermatitis in areas of direct contact to the allergen is the most common and easiest form of nickel allergy to identify, recognition of varying presentations is critical as these can result in more chronic and severe symptoms, and can be misdiagnosed as atopic dermatitis.

Omphalomesenteric duct remnants: umbilical versus umbilical cord lesions.

The omphalomesenteric duct is an embryologic connection between the digestive tract and yolk sac, which typically involutes by the time of birth. Failure of the obliteration process can result in omphalomesenteric duct remnants. We present two cases of children with such remnants, one with an umbilical polyp requiring traditional excisional therapy and one more unusual case of an umbilical cord cyst resolving spontaneously without intervention. The differential diagnosis, which includes urachal remnants and umbilical pyogenic granulomas, is discussed, along with management and special considerations that practioners should be aware of when treating pediatric umbilical and umbilical cord lesions.

Reactions to Aquaphor: is bisabolol the culprit?

Bisabolol is a sesquiterpene alcohol compound derived from the German chamomile plant, a member of the Compositae family. Only two case reports of adults with allergic contact dermatitis to this chemical exist in the literature, and we describe three more cases of children with recalcitrant atopic dermatitis found to have potential allergic contact dermatitis to bisabolol- a component of the Aquaphor emollient they were using to treat their atopic dermatitis. Of note, Compositae dermatitis has been shown to have a higher prevalence in children with atopic dermatitis, so it is important for physicians to be aware of the potential allergens (like bisabolol) in products they are recommending as first line treatments.

Autologous fat transfer: an in-depth look at varying concepts and techniques.

Fat augmentation is safe, relatively inexpensive, and readily available. Now that cosmetic surgeons are recognizing that facial aging is not simply due to gravity but also to atrophy of tissues, the use of fat for volume restoration is becoming even more popular. Newer techniques of Lipostructure, facial fat rebalancing, and fat autograft muscle injection (FAMI) are targeted to achieve true full-face three-dimensional rejuvenation; however, practical means of objectively measuring outcome are lacking. Basic questions remain regarding the optimal harvesting site, processing technique, and most effective injection technique. Scientific research is emerging th address these issues.