Failure of physiologic doses of pure UVA or UVB to induce lesions in photosensitive cutaneous lupus erythematosus: implications for phototesting.

BACKGROUND: Phototesting studies in cutaneous lupus erythematosus have yielded variable results, with most trials reporting photo-induction of lesions by both UVA and UVB in substantial numbers of patients. OBJECTIVES: To determine the minimal erythema dose in patients with subacute cutaneous lupus erythematosus (SCLE) and controls. PATIENTS/METHODS: We phototested nine patients with SCLE and 14 skin type-matched controls, using repetitive dosing of UVA1 and UVB, but with filters that removed most of the shorter UVC and longer infrared and visible light. In addition, DNA was isolated from anticoagulated blood to genotype the TNF-alpha 308 region in each patient and control. RESULTS: We were unable to demonstrate a difference in minimal erythema dose (MED) between patients and controls, or any correlation of MED with either TNF genotype or systemic drug therapy for SCLE. In addition, no SCLE skin lesions were induced in the nine patients with either UVA or UVB, and one patient cleared a skin lesion after low-dose UVA1 irradiation. CONCLUSIONS: The potential role of wavelengths outside the UVA and UVB range in the photo-induction of cutaneous lupus skin lesions needs to be investigated, and there is a need to standardize phototesting equipment and procedures for patients with cutaneous lupus erythematous.

The Kerf-Cut dressing: application of a woodworking technique for efficient postsurgical wound care.

BACKGROUND: Simple surgical excision is one of the most common treatment methods in the dermatologist's armamentarium. We describe a precise postsurgical dressing technique that can be used for wound care of those patients whose treatment involves removal of lesions via cutaneous surgery. OBJECTIVE: To devise a novel, precise, and effective dressing technique for postsurgical wound care. MATERIALS AND METHODS: We describe the technique using common in-office instruments. RESULTS AND CONCLUSION: Wound dressings for lesions located on curved areas such as the ears, nose, cheeks, and chin often exhibit less than adequate adherence and stability. The kerf-cut dressing technique optimizes pliability of dressing tape, and this maximizes efficient and stable application of postsurgical wound dressings to curved areas of the body.

Familial partial lipodystrophy.

The lipodystrophies are rare disorders characterized by insulin resistance and the absence or loss of body fat. The 4 subtypes of lipodystrophy are characterized by onset and distribution. Partial lipodystrophy is rare, with loss of fat from the extremities and excess fat accumulation in the face and neck; recognizing this phenotype and subsequent referral for endocrinologic care may improve outcome and reduce mortality.

Cutaneous lupus erythematosus: a review.

This article will review and update information about the pathogenesis, clinical presentation, diagnosis, and treatment of cutaneous lupus erythematosus. Lupus erythematosus (LE) can present as a skin eruption, with or without systemic disease. Cutaneous LE is subdivided into chronic cutaneous LE, subacute cutaneous LE and acute LE. The prevalence of systemic lupus erythematosus (SLE) is 17-48/100,000 population worldwide. Skin disease is one of the most frequent clinical complaints of patients suffering from SLE. It has been found to occur in up to 70% of patients during the course of the disease. The most frequent mucocutaneous manifestations of SLE are malar rash (40%), alopecia (24%), and oral ulcers (19%). It has been suggested that risk factors that are more likely to signal transition of cutaneous into systemic LE are high ANA titers (> 1:320) and the presence of arthralgias. CLE patients who exhibit these symptoms should be monitored closely, since they may be at increased risk to develop SLE.

Myxoid melanoma: immunohistochemical studies and a review of the literature.

Malignant myxoid melanoma (MMM) is a rarely reported variant of malignant melanoma, which can often be confused with other mucin-containing neoplasms. A retrospective study of 3 cases of MMM and a review of the English-language literature was performed. MMM affects an older population and is frequently misdiagnosed. The major pathologic features are atypical spindle cells embedded in a myxoid stroma. Immunohistochemistry analysis of the tumor shows uniform staining of the spindle cells with S-100. In our 3 cases, there were noticeably more mast cells that could be detected with Giemsa stain and with antibody against transforming growth factor. The prognosis appears to be equivalent to other primary melanomas. Diagnosing MMM requires a high index of suspicion. We hypothesize that mast cells and secretion of transforming growth factor beta stimulates fibroblast secretion of mucin, which contributes to the tumor's invasive potential.