Safety and Efficacy of Nano-Pulse Stimulation Treatment of Non-Genital, Cutaneous Warts (Verrucae).

BACKGROUND AND OBJECTIVES: This study describes the effects of nano-pulse stimulation (NPS) technology on the common verruca with the objectives of demonstrating efficacy and safety. NPS technology applies nanosecond pulses of non-thermal electrical energy to induce highly localized regulated cell death in the cellular structures of the targeted zone with negligible effects on surrounding non-cellular structures. Previous clinical studies applying NPS to common, benign skin lesions have demonstrated safety and efficacy in clearing seborrheic keratoses and sebaceous hyperplasia. STUDY DESIGN/MATERIALS AND METHODS: Sixty-two subjects were enrolled at a total of five sites. One hundred and ninety-five study verrucae up to 10 mm wide were treated with NPS delivered by a console-based handheld applicator (CellFX® System; Pulse Biosciences) and follow-ups occurred every 30 days with the option to retreat at 30, 60, and 90 days. There were 62 untreated controls and 46% of the treated verrucae were recalcitrant. RESULTS: Overall, 75.3% (70/93) of the common verrucae, 72.7% (8/11) of the flat verrucae, and 43.8% (14/32) of the plantar verrucae treated with NPS were completely clear by 60 days following the last treatment and did not recur within the 120-day observation period. The majority (54%) of verrucae cleared with a single NPS procedure. The most common treatment site reactions were erythema (50.5%) and eschar formation (23.4%) on Day 30 and on Day 120 mild erythema was present in 14% of the cases and hyperpigmentation in 18.5%. No serious adverse events were reported. A particle counter was used during 11 NPS procedures on verrucae and no significant plume generation was detected during these procedures. CONCLUSIONS: NPS is a safe and effective procedure for removing non-genital, cutaneous verrucae. Lasers Surg. Med. © 2021 The Authors. Lasers in Surgery and Medicine published by Wiley Periodicals LLC.

Crusted scabies and tinea corporis after treatment of presumed bullous pemphigoid.

We report a case of scabies that immunohistochemically mimicked bullous pemphigoid (BP) in an 82-year-old woman who presented with intractable pruritus. Bullous pemphigoid initially was diagnosed by direct immunofluorescence (DIF), though no blisters were clinically present. Subsequent immunosuppressive therapy for treatment of presumed BP led to the development of crusted scabies and widespread tinea corporis.

A congenital case of circumscribed acral hypokeratosis.

Circumscribed acral hypokeratosis is a disorder characterized by areas of erythematous depressed skin with distinct histopathological findings typically found on the palmar and plantar surfaces. Most patients are middle-aged women who report a multiyear history. We present an 10-year-old African American boy who had an asymptomatic, irregularly shaped erythematous lesion on his left medial foot that had been present since birth. A biopsy showed an abrupt, well-demarcated decrease in the thickness of the stratum corneum layer, with no parakeratosis, that was consistent with a diagnosis of circumscribed hypokeratosis. This represents the first pediatric and congenital case of circumscribed hypokeratosis reported. We review the literature and discuss the ramifications of a congenital case on understanding the etiology of circumscribed hypokeratosis.

Management of scalp dermatofibrosarcoma protuberans.

BACKGROUND: Dermatofibrosarcoma protuberans is a relatively rare, locally aggressive soft tissue tumor. Less than 5% of these tumors are located on the scalp; however, the recurrence rates for this region are high compared with those of more common locations, such as the trunk and proximal extremities. Standards for the management of dermatofibrosarcoma protuberans in general have been established in the literature, including wide local excision and Mohs micrographic surgery. OBJECTIVE: To describe optimum treatment options for primary and recurrent dermatofibrosarcoma protuberans of the scalp based on cases from Roswell Park Cancer Institute (RPCI) and from the literature. METHODS: Five cases from RPCI and 23 cases from the literature were reviewed. Age, sex, history, tumor size and level of invasion, treatment, reconstruction method, and follow-up were compiled from each case. RESULTS: Twenty-eight cases of scalp dermatofibrosarcoma protuberans were found; 13 were primary, 8 were recurrent, and 3 had persistent positive margins. Fifty-eight percent had classic histologic findings; seven tumors invaded beyond the periosteum. Twenty tumors were treated by surgical excision, whereas eight tumors were treated with Mohs micrographic surgery, requiring between two and four layers. Advanced surgical reconstruction was used in most cases to close the defects. Four patients experienced one tumor recurrence, whereas three other patients had several local recurrences. One patient died of his disease, and one died during surgical treatment of dermatofibrosarcoma protuberans. CONCLUSIONS: Mohs micrographic surgery or a modified version may be the best treatment option for scalp dermatofibrosarcoma protuberans to ensure complete removal of tumor and minimize recurrence. Surgeons should be prepared for advanced reconstruction following tumor removal.