A screening questionnaire for body dysmorphic disorder in a cosmetic dermatologic surgery practice.

BACKGROUND: Dermatologic surgeons frequently see patients with body dysmorphic disorder, a distressing or impairing preoccupation with a nonexistent or slight defect in appearance. Recognition of this disorder is essential to avoid unnecessary and generally unsatisfying surgical outcomes, but no screening tools are available for use in a dermatology setting. OBJECTIVE: To develop and validate a brief self-report questionnaire to screen for body dysmorphic disorder in dermatology settings. METHODS: A questionnaire was developed and its sensitivity and specificity determined in 46 subjects, using a reliable clinician-administered diagnostic interview for body dysmorphic disorder. The interrater reliability of a defect severity scale was also determined (n = 50). RESULTS: The self-report questionnaire had a sensitivity of 100% and a specificity of 93%. The interrater reliability (ICC) of the defect rating scale was.88. CONCLUSIONS: This brief questionnaire was a highly effective screening tool for body dysmorphic disorder in a cosmetic dermatology setting. Use of this questionnaire may help identify patients with this syndrome.

Accelerated healing of pyoderma gangrenosum treated with bioengineered skin and concomitant immunosuppression.

Pyoderma gangrenosum is a rare, destructive, neutrophilic dermatosis, the origin of which remains largely obscure. The ulcerative variant of this inflammatory disorder causes painful, necrotic, rapidly enlarging ulcers. Because of pathergy, many clinicians avoid managing these nonhealing ulcers with aggressive surgical debridement and autologous grafts. This article proposes that the application of an allogeneic cultured human skin equivalent (Graftskin) not only circumvents this problem, but also hastens re-epithelialization of the ulcer bed. An added benefit of the possible improvement of the cosmetic appearance of the final scar by preventing severe wound contracture is also postulated. We report a newly diagnosed case of ulcerative pyoderma gangrenosum; the use of bioengineered skin as an adjunct to concurrent immunosuppressive therapy with cyclosporine hastened the healing and diminished pain in a rapidly enlarging leg ulcer. Within 2 weeks, the ulcer was 30% to 40% healed, achieving 100% re-epithelialization within 6 weeks.

Rate of body dysmorphic disorder in dermatology patients.

BACKGROUND: Dermatologists appear to be the physicians most often seen by patients with the psychiatric condition body dysmorphic disorder (BDD), a distressing or impairing preoccupation with a nonexistent or slight defect in appearance. The frequency of BDD among patients seeking dermatologic treatment is unknown, however. OBJECTIVE: This study determined the percentage of patients seeking dermatologic treatment who screened positive for BDD. METHODS: A validated self-report questionnaire and a reliable defect severity scale were used to determine the rate of BDD in 268 patients seeking dermatologic treatment. RESULTS: A total of 11.9% (95% confidence interval [CI], 8.0%-15.8%) of patients screened positive for BDD. Rates were similar in a community general dermatology setting (14.4% [95% CI, 8.5%-20.3%]) and a university cosmetic surgery setting (10. 0% [95% CI, 6.1%-13.9%]). CONCLUSION: BDD appears relatively common among patients seeking dermatologic treatment. Further research is needed to confirm these findings and to assist dermatologists in identifying these potentially high-risk patients.

Systematized porokeratotic eccrine and hair follicle naevus: report of a case and review of the literature.

We report a unique case of a congenital keratinocytic naevus associated with severe alopecia, onychodysplasia and palmoplantar involvement in a 13-year-old girl. The lesions, consisting of scaly, spinous and verrucous papules and plaques, mainly followed Blaschko's lines and have remained unchanged since birth. The predominant histopathological picture was that of a column of parakeratosis overlying the eccrine ostia and hair follicles. This is the first case of a systematized keratinocytic naevus characterized by histopathology of eccrine and hair follicle porokeratosis and a widespread bilateral involvement. This may be a distinct entity to be included in the differential diagnosis of linear, hyperkeratotic dermatoses. We suggest its classification as systematized porokeratotic eccrine and hair follicle naevus.

Xylene substitutes in frozen sections.

BACKGROUND: Toxic exposure to xylene may occur during routine histopathologic staining procedures. Safer xylene substitutes have been available for over a decade, however, a 1991 survey of 25 Mohs training programs revealed that only 56% were using xylene substitutes. OBJECTIVE: The purpose of this study was to compared xylene to xylene substitutes in the histologic preparation of frozen sections with respect to staining quality, clarity, cellular detail, and tissue distortion. METHODS: Xylene and xylene substitutes were used as the final clearing agent in the routine histologic preparation of fresh frozen horizontal sections. The slides were evaluated by a dermatopathologist and a Mohs surgeon in a blinded manner. RESULTS: No difference between xylene and the xylene substitutes were noted. CONCLUSION: In light of the improved safety profile and efficacy of the xylene substitutes, they should replace xylene in the Mohs laboratory.

Cutaneous B-cell lymphoma. An unusual presentation.

A patient presented with the clinical and some of the histopathologic findings consistent with a cutaneous T-cell lymphoma. Immunophenotyping, however, clearly demonstrated the B-cell nature of the proliferation. This report emphasizes the importance of immunophenotyping in these lesions, particularly since only these studies can definitely characterize these proliferations. Of greater importance is that therapy, clinical course, and prognosis will vary according to the true nature of the lymphoma. The differential diagnosis of pseudolymphoma, B-cell lymphoma, and T-cell lymphoma is also discussed.