Epidermolysis bullosa acquisita occurring in 2 patients with hepatitis C.

We report 2 patients with documented chronic hepatitis C infection and epidermolysis bullosa acquisita (EBA). Both patients clinically represent classic EBA, exhibiting skin fragility and blistering occurring both spontaneously and secondary to trauma, which heal with milia and scar formation. EBA often is a disease of altered immune status and debility. Further work is necessary to show whether hepatitis C plays a causative role in EBA in these 2 patients and in general.

Cupric keratosis: green seborrheic keratoses secondary to external copper exposure.

Exogenous copper is a well-known cause of blue-green dyspigmentation of the hair, nails, and skin. We report the case of a patient with a blue-green discoloration of multiple seborrheic keratoses on his chest and back after swimming in a pool for rehabilitation of a back injury. Metallic analysis using atomic absorption spectrometry was performed on water samples from both the swimming pool and the hot tub the patient was using. Our dermatology clinic tap water was used as a control. Results of this analysis revealed an elevated level of copper in the swimming pool (2.750 ppm) and normal levels in the hot tub (0.502 ppm) and the control sample (0.891 ppm). The copper level in the swimming pool was more than double the recommended maximum set forth by the US Environmental Protection Agency. After the patient discontinued water exercises in the swimming pool, the green discoloration of the seborrheic keratoses disappeared rapidly. We believe this case represents the first report in the literature of the discoloration of epidermal growths secondary to exogenous heavy metal exposure.

Periorbital ablative and nonablative resurfacing.

Ablative resurfacing using laser systems for facial rejuvenation, especially in the periorbital areas, has effectively replaced chemical peels. Refined methods yield outstanding efficacy with significantly fewer side effects as compared with the prototypical lasers of decades past. Despite these technologic refinements, the trend toward minimally invasive rejuvenation techniques has placed a substantial emphasis on the many nonablative modalities available to the practitioner. Although the clinical efficacy to date has been less with the nonablative devices, the lack of substantial morbidity has made the devices marketable to a large population of patients despite their modest results at best and highly unpredictable results at worst. Numerous options, ablative and nonablative, are now available for the patient desiring improvement in periorbital rhytids.

The beveled edge technique for harvesting of full-thickness skin grafts.

BACKGROUND: Mohs surgery often uses the creation of a "beveled edge" of 45 degrees during the staged excision of skin cancers. Reconstruction of these defects frequently requires the use of full-thickness skin grafts. Because most wounds are best repaired with 90-degree edges, the beveled incision technique often used in Mohs micrographic surgery creates a wound that may need to be modified prior to reconstruction. OBJECTIVE: We present a method of harvesting the graft with a similar 45-degree angle beveled incision. METHODS: After marking, preparing, locally anesthetizing, and draping the donor site, the graft is harvested using a 45-degree angled incision. Any remaining fat is trimmed away from the base of the graft. The graft is then placed directly on the surgical defect without any "freshening" of the wound edges and is sutured into place. RESULTS: The graft takes well on the surgically created defect, leaving a cosmetically acceptable result. CONCLUSION: We have found that harvesting the graft with a beveled incision of 45 degrees, similar to taking Mohs stages, hastens the repair process. This obviates the need to remove normal tissue to create a 90-degree angle and allows for better approximation of the dermal surface area of the graft to the base of the defect.