Hair removal with the long-pulse alexandrite and long-pulse Nd:YAG lasers is safe and well tolerated in children.

BACKGROUND: Children with excessive hair may have severe psychological consequences. Laser hair removal in adults is known to be safe and well tolerated, but this is less well established in children. OBJECTIVE: To describe our experience with laser hair removal in children, and to investigate the safety and tolerability of this procedure in children. METHODS: The case records of 24 children aged < 16 years, who had received a minimum of three treatments for hair removal were analysed retrospectively. For patients with Fitzpatrick skin phototype II-IV, the lasers used were a long-pulse alexandrite (755 nm) with either continuous chilled-air cooling at fluences of 16-27 J/cm(2) or a long-pulse alexandrite with cryogen cooling at fluences of 16-32 J/cm(2). For patients with Fitzpatrick skin phototype IV-VI, lasers used were a long-pulse Nd:YAG (1064 nm) with a chilled contact sapphire tip at fluences of 20-35 J/cm(2) or a long-pulse Nd:YAG with cryogen cooling at fluences of 16-26 J/cm(2). RESULTS: Mean age at first treatment was 12.3 years. Diagnoses were constitutional hirsutism (14 patients), polycystic ovarian syndrome (five), congenital melanocytic naevus (two), generalized hypertrichosis (two) and naevoid hypertrichosis (one). One patient required a general anaesthetic, eight required topical anaesthetic cream, and 15 did not require any form of anaesthesia. Intolerable discomfort requiring adjustment in fluence was the only recorded side-effect, affecting two cases. There were no incidences of blistering, infection, dyspigmentation or scarring. CONCLUSION: When administered appropriately, laser hair removal is safe and well tolerated in children aged < 16 years.

Er:YAG laser resurfacing for inoperable medium-sized facial congenital melanocytic naevi in children.

Congenital melanocytic naevi (CMN) can cause significant psychosocial morbidity, especially if they are in visually exposed areas. The preferred treatment is surgical excision, though not all lesions are amenable to this because anatomical location may preclude aesthetic and functional reconstruction. Three children with inoperable facial CMN were treated with Er:YAG resurfacing under general anaesthetic. Two children were Fitzpatrick skin type II, and one child was skin type VI. Treatment was performed at 4-9-monthly intervals. The procedure achieved significant lightening and thinning in all three cases, without scarring or dyspigmentation. One child developed herpes simplex infection in the treated area on one occasion, which was managed with oral aciclovir, and did not lead to scarring or preclude further treatment. We conclude that Er:YAG laser resurfacing is effective for CMN, even in darker skin types. The incidence of side-effects is low, although repeated treatment is necessary.

Cutaneous and systemic sequelae from exposure to 2-vinylpyridine.

We present the case of an employee of a chemical production factory who became sensitized to 2-vinylpyridine despite wearing full protective polyvinyl chloride clothing. He developed severe dermatitis at the site of contact, secondary eczematization over the flexures and periungual areas, as well as marked systemic upset. Pyridines are known sensitizers although this reaction pattern has not previously been described.

Imiquimod in the treatment of lentigo maligna.

BACKGROUND: Lentigo maligna (LM) is treated to prevent progression to lentigo maligna melanoma (LMM). Surgery remains the treatment of choice, although topical immunotherapy with imiquimod has recently become a popular alternative. OBJECTIVES: In this review, we have analysed the published literature relating to the use of imiquimod for LM, in order to understand better the utility of this treatment. METHODS: All English language studies relating to the use of imiquimod for LM were analysed up to January 2006. RESULTS: Eleven case reports and four open-label studies were identified, comprising a total of 67 patients who completed treatment with imiquimod for LM. There was significant variability in treatment schedules and regimens. Eight patients failed to respond, with LMM developing in two of these. In certain cases there were discrepancies between clinical and histological response with some patients clearing clinically but not histologically, and vice versa. Follow-up periods were short, exceeding 12 months in only five cases. CONCLUSIONS: Although imiquimod clearly has an effect on LM, this analysis of available studies has helped to identify concerns about its use. Without controlled evidence and prolonged follow up, the use of imiquimod for LM must still be considered experimental.

Severe adverse cutaneous reaction to insulin due to cresol sensitivity.

We present the case of an 80-year-old lady known to be sensitive to chlorocresol (4-chloro-3-methyl phenol) who developed severe erythrodermic exfoliative dermatitis with atypical features 2 weeks after commencing subcutaneous insulin. All medications except insulin were stopped, without major improvement. It was noted that the insulin contained m-cresol (m-methyl phenol) so a parabens-based insulin was substituted. There was a significant improvement in her clinical condition within 72 hr. Further patch and intradermal testing to the insulin and m-cresol was planned, but she developed a nosocomial infection and died. We hypothesize that the adverse cutaneous reaction was a systemic manifestation of cresol sensitivity, given the rapid clinical resolution on changing insulins and the previously demonstrated sensitivity to chlorocresol, particularly as cross-reactivity between different low molecular weight methyl phenols is documented. Local injection site reactions and systemic side-effects including nausea, diarrhoea and vomiting have previously been reported with cresol-containing insulins, although to our knowledge, this is the first reported case of a severe cutaneous reaction. It is important to be aware of m-cresol as a potential allergen, as it is contained in most commercially available insulins.

Study of choice between accident and emergency departments and general practice centres for out of hours primary care problems.

OBJECTIVES: To determine the reasons for choosing between primary care out of hours centres and accident and emergency (A&E) departments for patients with primary care problems. METHODS: Interviews using a semistructured approach of samples of patients attending A&E departments and general practitioner (GP) out of hours centres for primary care problems. RESULTS: 102 patient interviews were undertaken. Sixty two per cent of A&E attenders were unemployed compared with 41% of out of hours attenders. White people were more likely to attend A&E departments and Asians the out of hours centre (p<0.01) and unemployed were more likely to attend A&E departments (70% v 30%). Some 46.3% of A&E department attenders had not contacted their GP before attending; 81.3% of first time users of the out of hours centre found out about it on the day of interview. Those attending A&E thought waiting times at the out of hours centre would be 6.3 hours (median) compared with a median perceived time of 2.9 hours by those actually attending the out of hours centre. Actual time was actually much less. CONCLUSION: Once patients have used the GP out of hours centre they are more likely to use it again. Education should be targeted at young adults, the unemployed and white people. Patients should be encouraged to contact their GP before A&E department attendance for non-life threatening conditions. Waiting time perception may be an important reason for choice of service.