Chemical peels.

For many decades, chemical peeling has played an important role in facial rejuvenation. These procedures are safe and effective in the management of photoaging, scarring, pigmentary dyschromias, and in the destruction of superficial skin lesions. Chemical peels are classified into superficial, medium, and deep according to their level of injury to the skin. It is the responsibility of the surgeon to assist the patient in choosing the resurfacing procedure that will most effectively satisfy his or her goals while maintaining a high margin of safety. With the current availability of various microdermabrasion and laser systems for facial rejuvenation, chemical peeling continues to be an integral part of a facial rejuvenation program because of its popularity with patients and minimal costs to the physician.

Deep dermatophytosis: report of 2 cases and review of the literature.

Skin infections due to dermatophytes are common and generally associated with a low degree of morbidity in normal hosts. Rare cases have been reported in which the dermatophyte invaded the deep dermis, subcutis, or even internal organs. Two patients, each of whom had clinical and histological findings of a deep or locally invasive dermatophyte infection, are described. This condition typically presents as a nodular eruption that is characterized histologically by suppurative granulomatous inflammation and deposition of organisms in the reticular dermis. Recognition of the potential of dermatophytes for local invasion in susceptible hosts will help ensure proper diagnosis and timely intervention in these cases.

HIV lipodystrophy: review of the syndrome and report of a case treated with liposuction.

BACKGROUND: A syndrome characterized by loss of fat on the face and limbs, localized fatty deposits on the trunk, and metabolic disturbances is becoming increasingly recognized in the human immunodeficiency virus (HIV) patient population. OBJECTIVE: To increase awareness of this syndrome among dermatologists and dermatologic surgeons and to review its various treatment options, including liposuction. METHODS: We present a patient with HIV lipodystrophy syndrome who underwent tumescent liposuction. We also describe our experience with liposuction in the management of this condition and review the treatment options that have been proposed in the literature. RESULTS: In the medical management of HIV lipodystrophy, various agents have been utilized but most have yielded disappointing results. Preliminary evidence on the use of tumescent liposuction in these patients suggests that significant improvement in the cosmetic disfigurement can be achieved. CONCLUSION: This syndrome is common among HIV-infected patients and remains difficult to treat. Although medical therapy may be preferable in most patients, liposuction represents a viable option in selected individuals.

The glucagonoma syndrome: a review of its features and discussion of new perspectives.

Glucagonoma syndrome is a paraneoplastic phenomenon characterized by an islet alpha-cell pancreatic tumor, necrolytic migratory erythema, diabetes mellitus, weight loss, anemia, stomatitis, thromboembolism, and gastrointestinal and neuropsychiatric disturbances. These clinical findings in association with hyperglucagonemia and demonstrable pancreatic tumor establish the diagnosis. Glucagon itself is responsible for most of the observed signs and symptoms, and its induction of hypoaminoacidemia is thought to lead to necrolytic migratory erythema. Liver disease and fatty acid and zinc deficiency states may also contribute to the pathogenesis of the eruption in some cases. Most patients are diagnosed too late in the clinical course for cure, but successful palliation of symptomatology can usually be achieved with surgical and medical intervention. This paper reviews the glucagonoma syndrome, paying particular attention to its cutaneous features, and provides new perspectives in our current understanding of this phenomenon.

Pilomatrix dysplasia in an immunosuppressed patient.

Immunosuppressive drugs have been used for many years in the prevention of graft failure in transplant recipients. Although they improve morbidity and mortality after transplantation, these medications carry a significant risk of adverse mucocutaneous and systemic effects. We describe a patient receiving 4 immunosuppressive drugs who experienced persistent facial dysmorphism along with striking follicular disturbances. On histopathologic examination, the follicular structures were dilated and hyperplastic with a peculiar dysplasia of the pilar matrix. Based on a review of the clinical, microscopic, and investigational findings of the skin previously reported in association with her immunosuppressive drugs, we conclude that cyclosporine was the most likely causative agent. Moreover, hypertrichosis, dysmorphic facies, and tissue hyperplasia have all been observed in patients during cyclosporine administration.

The "facelift" flap for reconstruction of cheek, lateral orbit, and temple defects.

BACKGROUND: Large defects of the cheek, lateral orbit, zygomatic arch, or the lower temple pose challenges for reconstruction. These defects can be elegantly reconstructed using the "facelift" flap. OBJECTIVE: The facelift flap is a large advancement flap with a rotational component based on rhytidectomy principles. METHODS: Redundant skin from the lower cheek is used as the donor tissue, which is advanced cephalad and posteriorly. Flap design varies slightly for men and women depending on characteristics of the external ear and ear lobe as well as the position and density of the preauricular hairline. Extensive undermining is critical to reduce tension on the flap and allow for complete closure. Traction provided by an assistant aids in the undermining. Specialized instruments are helpful when performing this flap. Rhytidectomy scissors, multipronged skin rakes, hand-held fiberoptic lighted retractor, and insulated forceps are particularly useful. Correct trimming of the flap and ear lobe placement without tension on the lobe are essential for a good cosmetic result. A large standing cone is excised retroauricularly such that the scar is hidden primarily behind the ear. RESULTS AND CONCLUSION: The facelift flap gives superior and elegant results for reconstruction of large cutaneous defects involving the cheek, lateral orbit, zygomatic arch, and lower temple.

Propylthiouracil hypersensitivity: report of two patients with vasculitis and review of the literature.

Two patients with a hypersensitivity vasculitis in association with propylthiouracil (PTU) administration are described. Although both patients presented with a cutaneous eruption, our first patient suffered severe systemic manifestations and the second patient's involvement was primarily limited to the skin. Patients with a vascular hypersensitivity reaction to PTU typically present with constitutional symptoms, acral purpuric skin lesions, and variable involvement of multiple organ systems. The reaction is treated by urgent withdrawal of PTU and implementation of supportive measures and immunosuppressive agents, as necessary. Prompt recognition of this condition and initiation of appropriate therapy lead to complete recovery in most cases.