Generalized keratosis pilaris induced by testosterone injections in a patient with CHARGE syndrome.

Keratosis pilaris (KP) is a common disorder of follicular keratinization characterized by keratotic follicular papules with varying degrees of perifollicular erythema. Keratosis pilaris affects up to half of normal children and up to three-quarters of children with atopic dermatitis. KP is prominent during adolescence and less common in older people, but it may occur in children and adults of all ages. In this report, we describe the case of a 13-year-old boy known to have CHARGE syndrome who developed generalized keratosis pilaris after testosterone injections. To the best of our knowledge, this is the first reported case of generalized keratosis pilaris induced by testosterone injection.

Injection Site Pain, Onset and Duration of Action of Botulinum Toxin Reconstituted in Normal Saline With and Without Sodium Bicarbonate: A Prospective, Single Center, Randomized, Double-Blind Interventional Study.

Purpose: This study was designed to investigate the effects of botulinum toxin type A injections diluted with the mixture of sodium bicarbonate and normal saline on pain reduction, onset of action, and duration of action. Methods: This is a prospective, randomized, double-blind clinical study, which included 30 female patients (age >25). The patients were randomized to receive botulinum toxin injections diluted with normal saline and sodium bicarbonate on one side of the face and saline control injections on the other side. Pain severity was assessed using visual analogue scale. The onset and duration of action were recorded according to the patients' subjective opinions after 1 week and 3 months, respectively. Results: Lower pain intensity ratings were observed when botulinum toxin was diluted with 0.05 and 0.1 mL of sodium bicarbonate as compared to saline. Regarding the onset of action, the botulinum toxin injections diluted with saline and 0.1-mL sodium bicarbonate side showed faster response in many patients than other dilutions (P < .001). Both the 0.05-mL and 0.1-mL sodium bicarbonate concentrations showed longer duration effects on patients than other concentrations. Conclusion: The use of sodium bicarbonate and saline in a mixture for the dilution of botulinum toxin can decrease patients' discomfort and provide a faster action with longer duration effects.

Objectif: Cette étude a été conçue pour étudier les effets des injections de toxine botulinique de type A diluées dans un mélange de bicarbonate de sodium et de solution physiologique salée sur l'atténuation de la douleur, ainsi que sur le début d'action et la durée d'action. Méthodologie: Il s'agissait d'une étude clinique prospective menée à répartition aléatoire et à double insu auprès de 30 patientes (âge ≥ 25 ans). Celles-ci ont été réparties aléatoirement pour recevoir des injections de toxine botulinique diluées dans une solution physiologique salée et du bicarbonate de sodium d'un côté du visage et des injections de solution physiologique salée témoins de l'autre côté du visage. L'intensité de la douleur a été évaluée à l'aide d'une échelle visuelle analogique. Le début et la durée de l'action de la toxine ont été consignées d'après la perception subjective des patientes 1 semaine et 3 mois après les injections, respectivement. Résultats: Des scores d'intensité de douleur plus faibles ont été observés lorsque la toxine botulinique était diluée dans 0,05 mL et 0,1 mL de bicarbonate de sodium, par rapport à la dilutions dans une solution physiologique salée seulement. En ce qui concerne le début d'action, les injections de toxine botulinique diluées dans une solution physiologique salée et 0,1 mL de bicarbonate de sodium ont été associées à une réponse plus rapide chez de nombreuses patientes, par rapport aux autres dilutions (p < 001). Les concentrations de bicarbonate de sodium à 0,05 mL et à 0,1 mL ont produit des effets de plus longue durée sur les patientes que les autres concentrations. Conclusion: L'utilisation du bicarbonate de sodium et d'une solution physiologique salée dans un mélange pour dilution de la toxine botulinique pourrait diminuer la gêne des patientes, ainsi qu'offrir un début d'action plus rapide et des effets de plus longue durée.

Histopathologic pitfalls of Mohs micrographic surgery and a review of tumor histology.

Mohs micrographic surgery is a specialized subset of staged surgical excisions with each subsequent stage being driven largely by the histologic findings of the previous stage. Therefore, it is imperative that histologic analysis is performed in an accurate manner. Frozen section and tissue flattening is a crucial step in Mohs surgery. Frozen sections introduce certain artifacts and these artifacts must be interpreted in the correct context. Basal and squamous cell carcinomas are the most common tumors encountered in Mohs micrographic surgery, and their histopathology is also associated with certain "pitfalls". Basal cell carcinoma should be distinguished from hair follicles, folliculocentric basaloid proliferations, poromas, nevus sebaceous, desmoplastic trichoepitheliomas, and spiradenomas, to name but a few histologic entities. Similarly, squamous cell carcinoma should be distinguished from hypertrophic actinic keratoses, pseudoepitheliomatous hyperplasia, sebaceous carcinoma, and microcystic adnexal carcinoma. In addition, there are numerous subtypes of basal cell and squamous carcinomas that the Mohs surgeon should be aware of due to differences in the biologic behavior of these tumors. This review presents a number of the common histologic pitfalls of Mohs micrographic surgery and a review of tumor histology.