Cactus skin injuries.

Cactus spine injuries to the skin are usually treated by removing the visible spines and applying a topical corticosteroid. With this approach, granulomatous inflammation usually resolves in 2 to 4 months. We describe a case of a 54-year-old Caucasian woman who presented for treatment of painful cactus spine granulomas on her right hand. Unroofing the granulomatous papules and removing the cactus spine fragments under a dissecting microscope, and subsequent soaking in an antibacterial solution, resulted in rapid resolution of the granulomatous lesions.

alpha-Hydroxy acid-based cosmetic procedures. Guidelines for patient management.

alpha-Hydroxy acid (AHA) peels and home regimens have recently been recognized as important adjunctive therapy in a variety of conditions including photodamage, actinic damage, melasma, hyperpigmentation disorders, acne, and rosacea. Overall in our experience and in the literature, AHAs have a proven level of safety and efficacy in a variety of skin types. Although their exact mechanism of action is unknown, it has been demonstrated that AHAs improve these disorders by thinning the stratum corneum, promoting epidermolysis, dispersing basal layer melanin, and increasing collagen synthesis within the dermis. In patients with photodamage, AHA peels and topical products are often combined with retinoids and other antioxidants for maximum benefit. Similarly, synergistic effects of fluorouracil and glycolic acid are observed in the treatment of diffuse actinic keratoses. For patients with melasma, AHA peels and combination products containing bleaching agents such as hydroquinone, kojic acid, and glycolic acid seem to have increased efficacy. Acne and rosacea patients can see improved results when standard regimens like antibacterials and topical retinoids are supplemented with AHA peels and lotions. However, care should always be taken prior to commencing treatment with AHA peels and topical products. By obtaining a thorough history and physical examination, the physician will identify any specific factors like medications, prior procedures and medical conditions which can affect the outcome of the peel. During the interview, there should be open discussion of patient questions and concerns so that realistic expectations can be made. Pre- and post-peel regimens should also be reviewed in full as patient compliance is essential to ensure the success of a series of AHA peels.

Mohs fixed-tissue excision of dentoalveolar bone in canines: a histologic evaluation.

Mohs surgery is a well-established surgical technique that involves conservative, microscopically guided excision of malignant lesions, thereby sparing the maximum amount of normal surrounding tissue. Current surgical therapy for oral cancer frequently involves resection with wide margins, resulting in significant cosmetic and functional deficits. This pilot study used the Mohs technique for in situ fixation and excision of maxillary and mandibular bone in mongrel dogs. Histologic examination of the excisional sites was carried out at 8 weeks to examine changes in the surrounding bone, periodontal ligament, and dental pulp of adjacent teeth. The findings suggest that zinc chloride fixative paste does not result in destruction of the dental pulp or surrounding dentoalveolar bone of teeth in the vicinity of a fixed-tissue excision. The Mohs fixed-tissue technique may allow preservation of oral structures that would otherwise be sacrificed in the presence of bony tumor involvement.

Tongue and cheek: oral lesions in pityriasis rosea.

Fifty-one consecutive patients with clinical findings and history consistent with pityriasis rosea underwent a complete oral examination to search for any concomitant oral lesions. One case was omitted from the statistical analysis because the results of a rapid plasma reagin test were positive. Of the fifty remaining cases, eight patients (16 percent) were noted to have various oral lesions, all of which were asymptomatic. These findings suggest that the actual incidence of oral lesions in pityriasis rosea may be higher than previously reported. A complete oral examination in a patient presenting with a papulosquamous eruption may be helpful in ascertaining the diagnosis of pityriasis rosea.

Tinea capitis in three adults.

Three cases of tinea capitis in healthy adults are presented. In light of the very low incidence (less than 1%) of tinea capitis in nonimmunocompromised adults and the possibility of contagion from asymptomatic dermatophyte carriers in the pediatric and adult populations, the necessity for heightened clinical suspicion and diagnostic tenacity in the evaluation of adults with scalp dermatitis and/or alopecia for possible tinea capitis is underscored.