Treatment of pediatric pyogenic granuloma in a functionally and cosmetically sensitive area with the 1064nm ND:Yag laser.

There has been increasing interest in minimally invasive approaches to treat pyogenic granulomas. We report successful treatment of a pyogenic granuloma in a pediatric patient on a functionally and cosmetically sensitive area using the 1064nm Nd:YAG laser.

IgM ocular cicatricial pemphigoid: a unique insight into the immune system.

A 42-year-old man with ocular erythema and scarring had a conjunctival biopsy revealing depostion of IgM and C3 without IgG at the epithelial basement membrane zone.  Treatment with doxycyline, dapsone, and mycophenolate mofetil was unsuccessful and treatment with rituximab has led to partial remission of the conjunctival inflammation. He has undergone 4 cycles of rituximab treatment at intervals of 12 to 18 months.

Analysis of incidence of bulla formation after tattoo treatment using the combination of the picosecond Alexandrite laser and fractionated CO2 ablation.

BACKGROUND: The picosecond Alexandrite laser has shown increased efficacy in tattoo removal in comparison to Q-switched lasers. However, bulla formation is a well-known and expected side effect of this novel treatment and causes patient discomfort. OBJECTIVE: To analyze the incidence of bulla formation after tattoo treatment using the combination of the picosecond Alexandrite laser and fractionated CO2 ablation. MATERIALS AND METHODS: This is a retrospective chart review to determine the incidence of bulla formation after laser tattoo removal in 95 patients who were treated with either with the picosecond Alexandrite laser alone or in combination with fractional CO2 ablation. RESULTS: Twenty-six patients (32%) treated with the picosecond laser alone experienced blistering, whereas none of the patients treated with the combination of the picosecond laser and fractionated CO2 ablation experienced blistering. The difference in incidence of bulla formation between the 2 groups was found to be statistically significant (p < .05). CONCLUSION: This study shows a significant decrease in bulla formation associated with tattoo treatment when fractionated CO2 ablation is added to the picosecond Alexandrite laser, which is consistent with observations from a previous case series. This is important because decreasing extensive blistering likely results in increased patient satisfaction and willingness to return for future treatments.

Paradoxical Induction of Psoriasis and Lichen Planus by Tumor Necrosis Factor-α Inhibitors.

Case 1. A 33-year-old white woman presented to our clinic with a new-onset psoriasiform pustular eruption involving her palms and soles 4 months after the initiation of adalimumab for Crohn's disease. Her medical history was significant for childhood atopic dermatitis and hidradenitis suppurativa, but she had no personal or family history of psoriasis. Topical corticosteroids including hydrocortisone 2.5%, triamcinolone 0.1%, fluocinonide 0.05%, and clobetasol 0.05% were used without improvement. The pustular eruption spread to her scalp, trunk, and proximal extremities, and her toenails developed onycholysis and dystrophy. Her adalimumab was withdrawn for 1 month due to suspicion of a paradoxical pustular psoriasis reaction. After 2 weeks off adalimumab, the pustular dermatosis had significantly diminished and her gastroenterologist changed her medication to methotrexate. Her eruption continued to clear over the course of the next 6 months.

Hair-thread tourniquet syndrome: a case report and review of treatment.

Hair-thread tourniquet syndrome (HTTS) is caused by circumferential constriction of an appendage, usually by hair or thread, leading to obstruction of circulation and ischemia. Although not rare, this entity is not discussed extensively in the Dermatology literature. We present a case of HTTS and discuss the demographics and etiology, and review the most current treatment methods.

Successful long-term thalidomide therapy for discoid lupus erythematosus-lichen planus overlap syndrome.

Although thalidomide is a U.S. Food and Drug Admistration (FDA) approved medication for erythema nodosum leprosum and multiple myeloma, it has many off-label uses, including for discoid lupus erythematosus (DLE), Behçet's disease, apththous ulcers in HIV patients, and prurigo nodularis. Herein, we present a patient with an overlap of discoid lupus erythematosus and lichen planus who was successfully treated with thalidomide for over 19 years without significant side effects. We propose that some of the most common side effects, including peripheral neuropathy, numbness, parasthesias, sedation, and constipation, can be avoided at lower doses, typically less than 100mg/day.

Adalimumab Induced Subcutaneous Nodular Sarcoidosis; A Rare Side Effect of Tumor Necrosis Factor-α Inhibitor.

Adalimumab and other tumor necrosis factor-α inhibitors have been shown in the recent years to successfully treat sarcoidosis refractory to systemic corticosteroids and other agents.  However, there have been an increasing number of cases of sarcoidosis paradoxically induced by these agents.  It is hypothesized that this is due to the disruption of the fine balance of cytokines involved in granuloma formation. We describe the first case of adalimumab-induced subcutaneous nodular sarcoidosis in a patient with pulmonary sarcoidosis.