Various laser modalities in the treatment of cutaneous lesions.

This article discusses the various lasers used to treat cutaneous lesions on the foot sequentially along the electromagnetic spectrum, beginning with ultraviolet lasers and ending with the infrared carbon dioxide laser. Also included is a brief history of the use of lasers for cutaneous diseases.

Dermatologic care behind bars.

Providing dermatologic care in a prison setting is a challenge to the practitioner's ingenuity and patience because of cumbersome methods of transporting prisoners, poor compliance with prescribed regimens, and follow-up care that is not only inadequate but almost nonexistent. Certain prevalent infections such as tinea pedis and condyloma acuminatum probably are specifically induced by the prison environment. Alopecia areata is unexpectedly common and apparently associated with stress. Pruritus, which is common, is related to both environment and stress. Dermatologic diseases seen commonly in blacks are more prevalent because of the population demographics, yet pseudofolliculitis barbae is unusual as a complaint. In this article we review our experiences in establishing a first in-prison dermatology clinic.

Laser surgery for children.

Laser surgery can be effectively used in children with either local or general anesthesia. The laser must be used only in selected instances where other therapies have not been fruitful, such as congenital port-wine stains or recalcitrant warts. Significant scarring is a potential sequela of the second degree burns produced by argon or carbon dioxide laser surgery, and is particularly a risk for children. Elective laser surgery, therefore, should be deferred until a child would be capable of cooperating fully with postoperative wound care. Parents must be appropriately informed about expectations for cure in certain diseases which may be only partially remedied. For instance, congenital melanocytic nevi may be improved, but are incompletely removed by laser surgery. Also, dramatic improvements in dynamic diseases such as adenoma sebaceum may represent only a temporary interlude.

Cutaneous disease in black children.

Understanding cutaneous disease in the black races requires that the physician first be able to discern normal from abnormal pigmentary patterns and second be able mentally to add or subtract the patient's color, so that classic textbook descriptions of disease become applicable. Blacks tend to have four exaggerated pathologic reaction patterns: (1) pigment lability (frequent hyperpigmentation and hypopigmentation), (2) follicular responses and follicular diseases, (3) mesenchymal responses (fibroplastic and granulomatous), and (4) bullous responses. Social patterns in black communities aimed at masking hypopigmentation by use of emollients produce a wide spectrum of folliculitides rarely seen in whites. Methods of hair care commonly cause alopecias. Tinea capitis, which mimics four other varied scalp diseases, is now almost exclusively seen in blacks. Infesations, such as scabies and pediculosis capitis, are almost unheard of in American blacks.

Pseudofolliculitis barbae. Medical consequences of interracial friction in the US Army.

Pseudofolliculitis barbae (PFB) is a minor disease affecting only, and almost all, blacks who shave. Because of a continued requirement by the US Army of clean shaven faces, significant interracial turmoil and animosity has been aroused. Unclear standards of care of the disease and haphazard policing of shaving habits led to a chaotic process with effective dermatologic care almost paralyzed by the hostile parties. Randomly approached lower-ranking enlistees and draftees are much more likely to complain about their disease, even if minor, and are more likely to refuse to shave and be unkempt even without permission to grow a beard (in contravention of Army regulations). Career black enlistees are likely to under-report the severity of their disease and not seek medical help, possibly because of fear of continuous harassment and inability to be promoted by their superiors. Lotion depilatories, or hair clippers, combined with routine lifting of ingrown hairs, are the most effective treatments, although complete cessation of shaving is first required.

Bullous photoreaction to nalidixic acid.

Curtaneous blisters developed after exposure to the sun in two women who were taking nalidixic acid. Blisters continued to appear even after therapy was discontinued and there was no further exposure to the sun. Phototesting showed abnormal sensitivity to both short and long wavelength ultraviolet spectra in one patient. The low incidence of this phenomenon suggests a photoallergic mechanism, but features of both photoallergy and phototoxicity are present.