Efficacy of early treatment of facial port wine stains in newborns: a review of 49 cases.

BACKGROUND: Port wine stains (PWS) affect 0.3-0.5% of both sexes of newborns, usually occurring on the face. OBJECTIVE: To document safety and effectiveness of cryogen spray cooled, pulsed-dye laser at higher fluences than previously used to lighten facial PWS in infants < or =6 months, and establish that frequent treatment early in life yields better clearance than if delayed until later in life. MATERIALS AND METHODS: Forty-nine infants who had been treated with pulsed-dye laser treatments for facial PWS at < or =6 months were identified by case review of photographs, age, sex, PWS severity score prior to laser treatment, number of treatments, and improvement following laser therapy. RESULTS: Patients averaged 9.3 (range 2-16) treatments at 4-6 week intervals at 7.75-9.5 J/cm(2). Average surface area treated was 24.0% with 88.6% average clearance after 1 year. Average clearance was 90.7% for lesions covering <20% surface area and 85.6% for lesions > or =20%. Location (V1, V2, V3, eye, and/or scalp), treated surface area, treatment number, and fluence predicted clearance. Average clearance for sole involvement of V1 was highest (at 93.8%), followed by V2 (at 91.1%), V3 (at 84.3%), V1/V2 (at 83.7%), V1/V2/V3 (at 81.0%), periocular (at 88.6%), and scalp (at 89.9%). All patients tolerated the higher treatment fluences without atrophy or scarring. DISCUSSION/CONCLUSIONS: Frequent, high energy pulsed-dye laser treatments are safe and highly effective in improving facial PWS in infants < or =6 months of age. Patients with PWS should be referred for pulsed-dye laser treatment during early infancy.

Rue the herb: Ruta graveolens--associated phytophototoxicity.

We describe an unusual case of phytophototoxicity induced by an herbal plant, Ruta graveolens, from the Rutaceae family. This common herb, also called rue, can be found throughout rural settings in the United States. When psoralens from rue come in contact with human skin that is subsequently exposed to ultraviolet A light, an impressive photoirritant reaction can occur. This report both clarifies the distinguishing features of photoirritant reactions versus photoallergic reactions and reviews the pathophysiology and clinical presentation of phytophotodermatitis. R. graveolens can be associated with an impressive photoirritant reaction and should not be used as an insect repellent.

Pediatric pyogenic granuloma of the glans penis.

Pyogenic granulomas are benign vascular proliferations of the skin and mucous membranes. We present a case report of a 13-year-old uncircumcised boy with phimosis and a pyogenic granuloma of the glans penis. The relationship between these lesions, phimosis, smegma, and circumcision is discussed. When the lesion is found in conjunction with phimosis, consideration should be given for circumcision. Close follow-up to rule out recurrence is necessary.

The surgical treatment of labial adhesions in pre-pubertal girls.

STUDY OBJECTIVE: A review of our experience with the surgical treatment of labial adhesions refractory to medical treatment. DESIGN: Retrospective review. SETTING: University tertiary care hospital same-day surgery center. PARTICIPANTS: Nine prepubertal females, age 3-6 yrs, presenting with thick, symptomatic labial adhesions refractory to medical management. INTERVENTION: All patients underwent surgical lysis of labial adhesions under general anesthesia. Adhesions were incised sharply and the cut edges were reapproximated with 7-0 chromic suture by a pediatric urologist (JGB). MAIN OUTCOME MEASURES: Duration of recurrence-free follow-up. RESULTS: No patient had recurrence in an average of 8.6 months of follow-up. Surgery was well tolerated in all cases. CONCLUSION: This technique effectively treats and prevents the recurrence of moderate to severe labial adhesions that are unresponsive to medical therapy.