Primary Axillary Hyperhidrosis Treatment Using High Intensity Focused Fractional Radiofrequency Microneedling.

Primary axillary hyperhidrosis (PAH), or excessive sweating limited to the axillary area, is a debilitating disease that severely and negatively impacts social and psychological well-being. Several treatment options are available for PAH; however, these options have been shown to provide varying effectiveness. Recent studies have suggested another treatment alternative offering an effective PAH treatment option with reported long-term results. High intensity focused fractional radiofrequency (HIFRF) microneedling is FDA cleared for the treatment of facial wrinkles. The system is designed with a unique technology that is safe for use on patients presenting with all skin types. Based on its unique design and the clinical trial experience reported in the literature by Kim, et al1 and others,2,5 we offer it to our patients as a beneficial treatment option for primary axillary hyperhidrosis (PAH). We present here a clinical experience summary from three US centers providing hyperhidrosis treatments using the high-intensity radio-frequency device, including treatment parameters, clinical outcomes, and pre- and post-treatment images. J Drugs Dermatol. 2018;17(7):745-748.

Chemical burn induced by cutaneous exposure to a concentrated sodium hypochlorite and alkyl sulfate solution.

BACKGROUND: Acute irritant contact dermatitis induced by cutaneous exposure to chemicals is a common dermatologic problem in the workplace. In severe cases, irritant contact responses can result in a caustic burn. Chemical burn induced by concentrated sodium hypochlorite (the active ingredient in bleach) has been reported infrequently in the literature, with no previously reported cases of chemical burn due to an alkyl sulfate (a common surfactant in cleaning fluids). Here we describe a chemical burn in a 16-year-old girl resulting from exposure to a solution of concentrated sodium hypochlorite and alkyl sulfate applied as a sanitizer to the interior of roller skates worn at work. OBSERVATIONS: The diagnosis was made on the basis of the patient's exposure history, clinical appearance, and laboratory results. On physical examination, the erythematous plaque, located at the site of chemical exposure, had intact skin lines, surrounding edema, and decreased sensitivity to touch. The peripheral white blood cell count was within normal limits and bacterial and fungal cultures from the lesion were negative. CONCLUSIONS: The irritant effect of exposure to chemicals, including those that usually are not major irritants, and the possible additive effect of simultaneous exposure to different chemicals, should be considered in the differential diagnosis of acute dermatitis of unknown etiology. Moreover, increased reporting of cases of chemical-induced acute irritant contact dermatitis will help lead to crucial early and appropriate treatment.

Generalized vasculitic exanthem following Loxosceles reclusa envenomation.

Brown recluse spider bites (BRSB) cause a myriad of reactions ranging from local necrosis to potentially lethal systemic involvement. Envenomation may induce a generalized exanthem known clinically but not described histologically. We report a 49-year-old female who developed a generalized exanthem 24 hours after BRSB. The histopathology demonstrated a necrotizing vasculitis similar to that seen at an envenomation site but without epidermal necrosis. Loxoscelism should be considered in patients residing in endemic areas who present with a vasculitic exanthem.

Four cases of dermatomycosis: superficial cutaneous infection by Alternaria or Bipolaris.

Invasive dermal infections in immunosuppressed patients by a wide variety of opportunistic fungi are well described in the literature; however, superficial infections (dermatomycosis) are more rarely described. We report 4 cases of dermatomycosis by Alternaria or Bipolaris species. All but one of the patients had predisposing conditions including topical corticosteroid use, atopic or seborrheic dermatitis, and nail dystrophy. All 4 patients were otherwise immunocompetent. These cases represent some of the very few reports of Bipolaris in a primary stratum corneum infection and the first report of Bipolaris in an otherwise healthy person. We also describe what may be the first report of Bipolaris onychomycosis. All of our patients responded to topical or oral imidazole antifungal therapy. We discuss the significance of Alternaria and Bipolaris as contaminants or irrelevant organisms grown in some cultures of skin scrapings.