Serologic Abnormalities in Macular Lymphocytic Arteritis with Case Presentation.

Macular lymphocytic arteritis (MLA) is an indolent cutaneous small-medium-vessel vasculitis characterized by widespread asymptomatic livedo racemosa. A number of serologic abnormalities have been reported including an elevated erythrocyte sedimentation rate and antibodies associated with antiphospholipid antibody syndrome. We present a case of MLA with multiple serologic abnormalities, including those that have yet to be reported, such as anti-U1 ribonucleotide protein, anti-RNA polymerase III, anti-smith, and anti-proteinase 3 antibodies. We also provide a brief review of this unfamiliar entity with a focus on the appropriate workup.

Comparing demographic characteristics and adverse event rates at two dermatologic surgery practices.

BACKGROUND: Patient demographics and operative techniques may contribute to adverse events after surgeries. OBJECTIVE: To identify differences in adverse event rates between different dermatologic surgery centers and potential contributing features affecting these rates. METHODS: Data regarding demographics, procedure type, and adverse events were collected at two dermatologic surgery centers. RESULTS: The most common adverse event at both sites was infection: 2.1% at site 1 versus 0.5% at site 2 (p < .001). Using multivariate logistic regression, procedure type (Mohs surgery), geographic location (being at site 1), older age, and anatomic location of surgery were associated with a higher risk of infection. CONCLUSION: Adverse event rate appears to correlate with patient demographics, procedure type, and setting of surgery more than use of prophylactic antibiotics. Identification of differences in adverse event rates and potential contributing variables at different practices may allow for identification of opportunities to prevent adverse events.

Quantifying and characterizing adverse events in dermatologic surgery.

BACKGROUND: Although office-based dermatologic procedures are generally considered safe, there is a lack of prospective data on the rate of adverse events (AEs) associated with these procedures. OBJECTIVE: To determine the frequency of AEs after dermatologic surgery and to characterize the most commonly encountered AEs. METHODS: A web-based interface was designed to track AEs with the input of four dermatologic surgeons. Patient demographic and operative data were collected at the time of the dermatologic surgery procedure. AEs occurring at any time during the data collection period were logged according to an a priori categorization scheme. RESULTS: The AE rate was 2.0% in this series of 2,418 subjects undergoing dermatologic surgery from February 1 through December 14, 2010. The most commonly reported AEs were suspicion of infection (64%), postoperative hemorrhage (20%), and wound dehiscence (8%). Suspicion of infection was slightly less frequent in subjects who received prophylactic preoperative antibiotics (0.4%) than in those who did not (1.5%, p = .07). There were no serious AEs and no deaths. CONCLUSION: AEs are uncommon after office-based dermatologic surgery procedures. Preoperative antibiotics may further decrease the infection rate after dermatologic surgery, but the risks and benefits must be weighed given the already low AE rate.

Intramuscular triamcinolone: a safe, effective and underutilized dermatologic therapy.

Although intramuscular triamcinolone acetonide has been available as a dermatologic therapy for many years, it is used sparingly or not at all by many dermatologists because of concern about its safety, as well as a lack of understanding of its specific therapeutic benefits. This case report discusses the efficacy and safety of intramuscular triamcinolone acetonide, along with description of the specific technique employed by the author, as well as the clinical indications and side effects seen by the author in his practice over time. The report describes the positive results attained in the treatment of many chronic, recalcitrant dermatologic conditions that cannot be adequately controlled by topical therapy alone. Because of its strong safety profile and unique therapeutic efficacy, intramuscular triamcinolone should be considered as a primary therapy for many chronic, steroid responsive, dermatologic conditions requiring a systemic approach.

Case reports: alopecia universalis: hair growth following initiation of simvastatin and ezetimibe therapy.

Alopecia areata is an organ specific autoimmune disease in which hair is lost in various patterns. Its most extreme form, alopecia universalis, is the total loss of all scalp and body hair. This form of the condition is very resistant to treatment and spontaneous remission is quite rare. The following is a case of a 54-year-old male with longstanding alopecia universalis who began to grow dense hair on his scalp as well as patchy hair growth on his face, pubic and axillary areas one month after starting a course of simvastatin 40 mg and ezetimibe 10 mg daily prescribed for his hyperlipidemia. For 2 years prior to starting the combination drug, he had taken simvastatin 40 mg alone without evidence of any hair growth. The combination of simvastatin and ezetimibe has previously demonstrated synergistic immunomodulatory effects, which most likely accounts for the clinical response in this case.

Basal cell carcinoma occurring in scar tissue following excision of a parotid gland pleomorphic adenoma.

BACKGROUND: A 49-year-old patient presented with a basal cell carcinoma growing on scar tissue left following excision of a parotid gland pleomorphic adenoma. OBJECTIVE: The objective was to determine whether the basal cell carcinoma had resulted from tumor spillage at the time of the pleomorphic adenoma excision. METHODS: Substantial evidence is presented linking the two tumors. RESULTS: The basal cell carcinoma most likely occurred as the result of tumor spillage at the time of the parotid gland pleomorphic adenoma excision. CONCLUSIONS: Cutaneous connective tissue stroma plays a significant role in determining the differentiation of basal cell carcinomas.