The long-term results of cartilage removal alone for the treatment of chondrodermatitis nodularis.

Cartilage excision alone has been demonstrated to be an effective technique in the treatment of chondrodermatitis nodularis (CDN), and in the short term is associated with an 80% cure rate. The objective of this study was to demonstrate that long-term disease control could be achieved using this surgical technique. Set in three hospital dermatology departments, 94 patients with CDN affecting the helix and antihelix were contacted by postal questionnaire at least 6 months after surgery. Replies were received from 77; 11 patients had died and six could not be traced. The main outcome measure was the identification of those patients in remission and those with disease recurrence. Sixty-two helix lesions were followed up for a mean of 52 months (range 8-99). There was recurrence in 10 patients (all men; 16%). Twenty antihelix lesions were followed up for a mean of 55 months (range 8-93). There was recurrence in five patients (all women; 25%). In conclusion, this study confirms that only cartilage needs to be excised for the long-term effective treatment of CDN. The only relevant aetiological factor identified was that all except one patient slept on the same side as the CDN. We believe that pressure on the ear during sleep causes CDN. This is most evident on the most protuberant part of the ear.

Systemic lupus erythematosus complicating complement type 2 deficiency: successful treatment with fresh frozen plasma.

We report a man who presented in 1981 at the age of 30 with cutaneous lupus erythematosus (LE), which was resistant to a range of treatments over the subsequent 11 years. In 1991 he suffered fits, dysphasia and agitated depression, and in 1992 a severe septicaemic illness. Systemic LE was diagnosed, and investigation showed homozygous complement type 2 deficiency (C2d). Over a period of 30 months he has received 6 weekly fresh frozen plasma. Since starting this treatment his cutaneous disease has resolved and his depression, verbal fluency and psychomotor scores improved. We have not observed any adverse effects to this treatment and suggest it should be considered in similar patients.

Shave excision of benign papular naevocytic naevi.

Patients frequently request removal of benign papular naevi for cosmetic or functional reasons. Shave excision plus electrocautery is probably the most widely used method of removal, but this method is said to result in retained hair or pigment if deeply pigmented or hairy naevi are treated. In a prospective study, 82 benign papular naevi of all types were treated by shave excision using hot-wire electrocautery for haemostasis. Details of the naevi were accurately recorded before treatment and reassessment of shave sites carried out at 6-8 months. At review, a scar was visible at only 63% (52/82) of shave sites and all of these were cosmetically acceptable. Only 27% (15/55) of the initially pigmented naevi retained pigment and only 24% (5/21) of the initially hairy naevi regrew hair. Shave excision and electrocautery of benign naevi, including hairy and deeply pigmented ones, produce excellent cosmetic results. The patient must be warned that there is a potential risk of a scar or pigment remaining after shave excision of any naevus and for hair regrowth after shave excision of hairy naevi.

Relation between size of skin excision, wound, and specimen.

BACKGROUND: Skin wounds differ in shape and size compared with the planned excision, and skin shrinks after excision and fixation. OBJECTIVE: This study was designed to quantify and to analyze the differences between the size and shape of the planned excision, wound, and specimen. METHODS: Eighty-six patients with 93 benign or malignant skin tumors were prospectively studied. Length and width measurements were made of the lesion, planned surgical excision, postexcision wound, and prefixation and postfixation specimens. The results were analyzed to identify the effects of patient age and sex, and lesion type and site. RESULTS: Wound size was larger than planned excision size in 90% of wounds, and this effect was greatest in young patients and at trunk and limb sites. Excision and fixation caused the specimens to shrink so that the postfixation area was on average 48% of the planned excision area; benign tumors shrank more than malignant tumors. CONCLUSION: Significant differences among planned excision, wound, and specimen sizes are influenced by patient age and by lesion site and type. These results demonstrate that wound size is not equivalent to tumor size, a conclusion often made in Mohs surgery. Furthermore, assessment of tumor clearance margins from fixed tissue does not reflect in vivo clearance margins.

Comparison of wound closure by means of dog ear repair and elliptical excision.

BACKGROUND: Elliptical excision is a standard method of skin tumor removal. The technique commits the operator to the direction and length of wound closure before lesion excision and hence before the shape and size of the resulting defect is known. OBJECTIVE: This study was designed to compare the predicted results of elliptical excision with those achieved after tumor excision and dog ear repair. METHODS: Fifty-one patients with benign and malignant skin tumors were prospectively studied. Each lesion was examined and an optimal ellipse designed and marked on the skin. Only the lesion and the required margin of adjacent skin were excised before the defect was closed in an optimal direction. Dog ears were removed if appropriate. Precise measurements were made at each step. RESULTS: Twenty-eight percent of wounds could be closed with a flat sutured wound without the need for dog ear repair, 38% required one dog ear repair, and 34% two. Overall, the sutured wound length was 21% shorter and the wound direction different from the predicted ellipse in 45% of cases. CONCLUSION: Excision with dog ear repair results in significantly shorter and potentially better oriented wounds than those achieved by elliptical excision. For excision and closure of skin tumors this technique should be considered as the method of choice.

Photoprotective action of emollients in ultraviolet therapy of psoriasis.

An in vitro technique was used to measure the monochromatic protection factors of all emollients available on prescription. The action spectra for ultraviolet erythema and erythema in psoralen-sensitized skin were used to calculate, for each emollient, erythema protection factors relevant to UVB phototherapy and psoralen photochemotherapy, respectively. Of the 40 products tested, 22 (55%) had a UVB erythema protection factor > 1.2 at an application density of 2 microliters/cm2, and 31 (78%) at an application density of 4 microliters/cm2. Fewer products, 25% at 2 microliters/cm2 and 50% at 4 microliters/cm2, had a psoralen erythema protection factor > 1.2. A protection factor of 1.2 is equivalent to a reduction in ultraviolet dose of 17%, and is thus likely to be of clinical importance. These results allow a choice of emollient products which may improve response by increasing transmission of radiation through psoriasis scale without a concomitant decrease in transmission due to a sunscreening action.