Fire-retardant clothing-related dermatitis.

BACKGROUND: Several laborers in a refinery unit undergoing a work over noted skin eruptions. Signs and symptoms included erythema, pruritus, scaling, and perifollicular inflammation on skin contacted by fire-retardant clothing (FRC). OBJECTIVE: The purposes of this report were to show a correlation between this rash outbreak and the use of FRC, to report the investigative results as to what aspect of the FRC most likely caused the dermatitis, and to present how this outbreak was ended. METHODS: Employees received questionnaires, were examined, and received patch testing, and pH testing of FRC was performed to evaluate the causative factors. RESULTS: More than 100 workers reported a rash, and approximately a third of these individuals exhibited a unique rash. There was a trend toward Hispanic and white workers being more affected than black workers. The onset of the rash peaked from June to August. This FRC-related rash resolved with the use of manufacturer-recommended laundering procedures. CONCLUSIONS: The FRC-associated eruption was most likely a form of irritant contact dermatitis due to inadequate laundering procedures. The most effective preventative measure other than proper laundering was the use of underclothing to prevent contact of FRC with sweat-moistened skin.

Novel homozygous frameshift mutation of EVER1 gene in an epidermodysplasia verruciformis patient.

Epidermodysplasia verruciformis (EV) is a rare genetic skin disease with an autosomal recessive trait, and the patients have susceptibility to a specific group of human papillomavirus genotypes. Recently germline mutations in EVER1/2 genes have been detected in EV patients with different ethnic origins. In this study, we have applied PCR, single-stranded conformational polymorphism analysis, and sequencing as well as restriction fragment length polymorphism analysis for identifying potential mutation(s) of EVER genes in an EV patient and in the parents of Pakistani origin. A novel homozygous frameshift mutation (T base deletion at nucleotide position 968 of DNA) has been detected in the EVER1 gene of the patient. The parents carried this mutated allele in a heterozygous form. This is the third report on the presence of EVER1 mutations in an EV patient, and this result supports better understanding, diagnosis, and genetic counseling of EV patients.

Long-term follow-up of basal cell carcinomas treated with perilesional interferon alfa 2b as monotherapy.

BACKGROUND: Interferon alfa-2b (IFN) may be used to treat basal cell carcinoma (BCC) as an alternative to surgical or destructive methods. OBJECTIVE: The purpose of this study is to determine the long-term effectiveness of IFN treatment for BCC. METHODS: Fifty patients with 98 biopsy-proven primary superficial and nodular BCCs were treated perilesionally and intradermally with injections of IFN between 1985 and 1992. RESULTS: Clinical cures were noted in 95 of 98 BCCs (51 nodular and 44 superficial), with a mean follow-up period of 10.5 years (9 months to 18.5 years). Of these, 35 of the 50 patients, which would include 68 of the 98 tumors, were followed up for a minimum of 10 years, with an average follow-up of 13.5 years. The 3 lesions requiring further treatment were nodular type BCC. One of these lesions showed no response to treatment, whereas the other two responded, then recurred at 4 and 154 months. Of the 68 tumors followed up for a minimum of 10 years, cure rates were 96%. Overall data analysis using Kaplan-Meier estimates showed 98% success rates at years 5 and 10, and a 96% success rate at year 15. LIMITATIONS: Since 31% of patients could not be evaluated for more than 10-year follow-up, it is possible that the long-term cure rate is lower than that found in those available for evaluation. CONCLUSIONS: Treatment of superficial and nodular BCCs with perilesional IFN is an acceptable treatment that may provide benefits over other treatment modalities depending on patients' individual needs. In addition, on the basis of this study, results of IFN treatment for BCC are comparable to most other methods of tumor destruction.

Plantar wart treatment with combination imiquimod and salicylic acid pads.

Treatment of plantar warts is often difficult and may be painful, often employing destructive treatment modalities. We report the successful treatment of a patient with a large plantar wart using Imiquimod 5% cream under occlusion with a 40% salicylic acid pad. This combination treatment modality likely allows successful delivery of Imiquimod through the thick skin on the plantar surface. Once penetrated, an anti-viral state is created by upregulating specific cytokines to eradicate the human papilloma virus (HPV).

Plantar wart treatment with combination imiquimod and salicylic acid pads.

Treatment of plantar warts is often difficult and may be painful, often employing destructive treatment modalities. We report the successful treatment of a patient with a large plantar wart using Imiquimod 5% cream under occlusion with a 40% salicylic acid pad. This combination treatment modality likely allows successful delivery of Imiquimod through the thick skin on the plantar surface. Once penetrated, an anti-viral state is created by upregulating specific cytokines to eradicate the human papilloma virus (HPV).

Delayed staged closure with repeated directional suturing of cutaneous defects.

BACKGROUND: Postsurgical wound management is traditionally a choice between intraoperative surgical repair or healing by secondary intention. We describe a technique that combines intraoperative and postoperative surgical repair with granulation. OBJECTIVE: Delayed closure with repeated directional suturing was evaluated as an alternative closure technique for large wounds. METHODS: Sixty patients had surgical defects partially closed intraoperatively with postoperative staged closures over 2 to 4 weeks. Only those wounds that could not be closed intraoperatively without vascular compromise or anatomic disfigurement were treated. RESULTS: All wounds were closed using skin from the same anatomic unit. Complications were minimal, and the results were acceptable to both the patients and the surgeon. CONCLUSION: Delayed closure with repeated directional suturing is a reasonable alternative when primary closure is not possible or when it would cause anatomic disfigurement.