Complications of 585-nm pulsed dye laser therapy.

BACKGROUND: Port-wine stains (PWS) are a congenital, progressive ectasia of the superficial cutaneous vascular plexus that occur in 0.3%-0.5% of children at birth. They should be considered a disease with physical and psychologic complications. Treatment with the flashlamp pulsed dye laser (FPOL) has proven to be effective. Because treatment results in selective vascular injury, the risk of complications is minimal. The purpose of this study was to determine the cutaneous side-effects and complications and their frequency in patients with PWS treated with the FPDL. Eighty-nine patients who had been treated with the FPDL for PWS were included in this study. METHODS: Patients were treated at 3-month intervals using slightly overlapping pulses with fluences of 6.0-9.0 J/cm2. Treating physicians were responsible for evaluating the patients. All patients were reviewed and side-effects and complications were recorded. RESULTS: Pigmentary changes were the most frequently observed complications. Hyper- and hypopigmentation appeared in 16.8% and 2.4% of patients, respectively. Cutaneous depressions occurred in 2.2% of patients. One patient developed a hypertrophic scar, and another patient presented with transient cutaneous pustulosis. All these changes usually resolved spontaneously and completely in a few months. CONCLUSIONS: Most of the side-effects and complications produced by the FPDL are usually transitory, and it is essentially a very secure technique.

Angina bullosa hemorrhagica.

Angina bullosa hemorrhagica is characterized by acute blood blisters, mainly on the soft palate. Elderly patients are usually affected and lesions heal spontaneously without scarring. The pathogenesis is unknown, although it may be a multifactorial phenomenon. Trauma seems to be the major provoking factor and long term use of steroid inhalers has also been implicated in the disease. No underlying hematologic or immunopathogenic disorder has been found. Treatment is symptomatic. We present a 67-year-old patient with recurrent oral blood blisters which were diagnosed as angina bullosa hemorrhagica. Trauma by dental injections and use of steroid inhalers were identified as etiologic factors in this case. Erosions healed with a week. Although this is a benign condition, it may result in acute airway obstruction. Recognition is, therefore, of great importance for dermatologists.

Self-healing cutaneous mucinosis.

Self-healing juvenile cutaneous mucinosis is a new entity distinct from previously described forms of cutaneous mucinosis. We present a new case in a 26-year-old female patient who began abruptly with a papular eruption, involving the scalp, face, neck and trunk, accompanied by periarticular papules on the hands and arthralgias. No associated disease could be detected and the lesions resolved spontaneously within a few months. This is the first case described in an adult patient.

Pityriasis rubra pilaris and human immunodeficiency virus infection.

Recently, the occurrence of pityriasis rubra pilaris (PRP) has been reported in patients with HIV infection. It presents different clinical features, and has a poorer prognosis, than the classical adult type of PRP. We report the occurrence of severe PRP in an HIV-infected patient, and review the previously reported cases of this association. We propose the designation of a new category of PRP (type 6), characterized by the presence of HIV infection, usually without immunosuppression, a poor prognosis and response to treatment, and the development of nodulocystic and lichen spinulosus lesions.

Bilateral basal cell carcinoma of the breasts in a woman.

Basal cell carcinomas (BCC) on covered sites of the body are rare (1). A case of a young woman with superficial basal cell carcinoma of both breasts is described. No history of sun bathing, X-ray, or arsenical exposure was reported. Simple excision of both lesions was performed without recurrence.