Treatment of Acne Keloidalis Nuchae by Simply Combining Two Conventionally Available Modalities: Ablation with Carbon Dioxide Laser and Intralesional Triamcinolone Acetonide.

Acne keloidalis nuchae is a chronic inflammatory condition affecting the occipital area or nape of the neck characterized by fibrotic papules, firm pustules, and nodules that coalesce into keloid like mass or plaques. It was first described by Kaposi in 1969. It is also known as lichen keloidalis nuchae, dermatitis papillaris capillitia, and folliculitis nuchae scleroticans. If not treated in the early stages of the disease it tends to be refractory to conventional methods like topical, intralesional steroids with antibiotics or retinoids. Surgical interventions remain the only choice in such cases. Various surgical modalities including surgical excision with primary or secondary closure, split-thickness skin grafts, and laser-assisted treatments have been tried. Most surgical methods have longer downtime with a higher chance of relapse. We studied the results of a combined treatment option carbon dioxide laser ablation followed by intralesional triamcinolone injection in the same sitting. This outpatient procedure has shown good results with no relapse and less downtime.

Use of Intralesional Deoxycholic Acid for Antiretroviral Treatment Associated Lipohypertrophy: A Qualitative Open-Label Study of an Innovative Indication.

Background: With the advent of antiretroviral treatment (ART), human immunodeficiency virus/AIDS has become a chronic manageable disease. Though life expectancy has improved, it brings alongside effects of long-term medical treatment. One of the major side effects is body dysmorphism, which leads to esthetic problems. Problems of lipodystrophy (LDS), especially facial lipoatrophy as well as facial and upper back lipohypertrophy are perceived by patients as highly stigmatizing manifestations of their human immunodeficiency virus infection. It has been reported to affect mood and quality of life, as well as reduced adherence to antiretroviral medications. Patients feel discomfort while sleeping, dressing, and during day-to-day activities. Aim: The aim of this study was to test a relatively cost-effective and efficacious treatment modality for long-standing ART-associated lipohypertrophy of the submental fat and dorsocervical fat. Materials and Methods: This was a prospective open-label clinical study, in which 21 patients on regular ART with associated lipohypertrophy were enrolled in this open-label study. Deoxycholic acid (DCA) was given intralesionally once every 4-6 weeks. Patients were assessed for response, any adverse events, and patient satisfaction during every visit. Results: Intralesional DCA seems to be a promising treatment modality for long-standing ART-induced LDS with better cost-benefit in comparison with surgical interventions. Limitations: It was a small-sized sample that was studied. The lag time between starting the treatment and optimum results was long in comparison with liposuction. The result is better appreciated at the end of treatment rather than after every session implying that it has a cumulative effect. Neither pre- and post-ultrasonography nor metric documentation was done. Conclusions: Intralesional DCA seems to be a promising treatment modality for long-standing ART-induced LDS with better cost-benefit in comparison with surgical interventions.

Old Wine in New Bottle: Lentigo Transplant for Beauty Spot Creation.

Melanocytic nevi especially on the face, neck, and chest are considered a sign of beauty since historic times. Since historic times and in various cultures, these nevi are associated with beauty and attractiveness, thus called beauty spots. Artificial beauty marks have been fashionable since the medieval era. it requires repetitive use easily making it a cumbersome process. Tattooed beauty marks by medical professionals or tattoo artists are commonly done but require frequent touch-ups with a risk of complications. So we came up with a very innovative technique of tissue grafting of an existing lentigines/melanocyte nevus to the desired site which gave a natural and permanent solution.

Localized Follicular Mucinosis in a Child Treated Successfully with Pimecrolimus and Targeted Phototherapy.

Follicular mucinosis (FM)/alopecia mucinosa is not commonly seen in children. There are a limited number of case reports, and its prognosis and long-term outcome are unpredictable. We describe a case of FM in a 3-year-old child, which was confirmed on histopathology. The lesion resolved with topical pimecrolimus cream and targeted phototherapy with an excimer lamp and has not recurred.