Outdoors and Active.

In brief Summer's onset means physicians will see many skin conditions they don't usually see at other times of the year. Heat, humidity, and exposure to outdoor elements combine to make skin vulnerable to sunburn, parasite contact, infection, insect bites, and allergic reactions to noxious plants. Most conditions are easy to diagnose and treat, but others are less common and require greater effort to determine the etiology. Rapid recognition along with prevention tips can help keep patients active.

Punctate keratoses of the palms and soles and keratotic pits of the palmar creases.

Punctate keratoses of the palms and soles and keratotic pits of the palmar creases are frequently confused. A prospective study of 283 patients revealed a prevalence of 11% and 3%, respectively, in a metropolitan county hospital dermatology clinic. Punctate keratoses of the palms and soles and keratotic pits of the palmar creases are similar in size, number of lesions per palm, aggravation by trauma, and predominance in blacks and in men. These entities are different in appearance, distribution, age at onset, prevalence, symptoms, and prognosis. Punctate keratosis of the palms and soles and keratotic pits of the palmar creases should be considered independent entities. To help eliminate confusion, we propose that punctate keratoses refer only to the hyperkeratotic papules scattered diffusely in the palms and occasionally in the soles and that keratotic pits of the palmar creases refer only the hyperkeratotic, conical depressions confined to the palmar creases.

Postfixation of cryostat sections improves tumor definition in Mohs surgery.

Precise identification and localization of tumor is the key to success in Mohs micrographic surgery. In a pilot study, we demonstrated improvement in tumor definition and staining characteristics after formalin fixation of cryostat sections (postfixation) when compared with unfixed specimens. We further investigated the benefits of postfixation with a series of tissue fixatives and with varying fixation times. In all cases, postfixation was found to be beneficial. No improvement was noted by extending the postfixation time beyond 1 minute.

Pyogenic granuloma following laser treatment of a port-wine stain.

A pyogenic granuloma occurred in a port-wine stain treated with first an argon, and subsequently a carbon dioxide, laser. Although reports of this phenomenon are infrequent in the literature, our review suggests that this is not a rare complication. The pathogenetic implications are discussed.