Varicella-zoster virus in children immunized with the varicella vaccine.

We present the case of a 4-year-old immunocompetent girl with varicella-zoster virus (VZV) that occurred 45 months after a single dose of the varicella vaccine. Varicella-zoster virus is rare in children, particularly those who have received the varicella vaccine. Our case illustrates the need for a continued high index of suspicion, even among vaccinated children with herpetiform rashes, for varicella reactivation or reinfection.

Linear IgA disease: complicated by alpha thalassemia.

Dapsone is regarded as the treatment of choice for linear immunoglobulin A disease (chronic bullous disease of childhood). It is associated with both hemolytic anemia and methemoglobinemia. The hematotoxic effects are dose related and can result in significant hemolysis. We present a case of a patient with chronic bullous disease of childhood and alpha thalassemia trait. Complete resolution occurred on a standard dose of dapsone without significant hemolysis.

Dermatology aboard the USNS COMFORT: Disaster relief operations in Haiti after the 2010 earthquake.

On the 12th of January 2010, Haiti was struck by a 7.0 Richter magnitude earthquake that devastated its already fragile capital region. Approximately 230,000 people died immediately or during ensuing weeks, mostly due to acute trauma. Countless others suffered significant life- or limb-threatening injuries. As a part of the United States' response to this tragedy, eventually named Operation Unified Response, the United States Navy deployed hundreds of physicians and other medical response individuals on a hospital ship. Operation Unified Response was a military joint task force operation augmented by governmental and nongovernmental organizations. Its mission was to bring medical and logistical support to the region.

Inoculation bartonellosis in an adult: a case report.

Cat-scratch disease (CSD) and bacillary angiomatosis (BA) are caused by a gram-negative bacilli classified under the genus Bartonella (formerly Rochalimaea). Patient history, symptoms, and histopathology often fall along a continuum; therefore, both conditions should be considered in the differential diagnosis. We report a case of an 83-year-old immunocompetent woman who presented with a pyogenic granuloma-like lesion on her dorsal left wrist. The histologic differential diagnosis included an inoculation site from a cat scratch infected with Bartonella and BA. Because the patient had only 1 lesion at the site of a prior cat scratch, the lesion was diagnosed as inoculation bartonellosis. We also review the epidemiologic, clinical, and histopathologic features of CSD and BA.

Fixed drug eruptions: a case report and review of the literature.

Fixed drug eruptions (FDEs) have been described since 1889 with continually evolving documentation of implicated agents and clinical presentations. We report a case of FDE as a reaction to naproxen sodium in a 27-year-old woman. We offer an inventory of common causes of FDEs as well as a discussion of the spectrum of clinical presentations and differential diagnoses for this peculiar drug reaction.

Diffuse xanthogranulomatous dermatitis and systemic Langerhans cell histiocytosis: A novel case that demonstrates bridging between non-Langerhans cell histiocytosis and Langerhans cell histiocytosis.

The advent of electron microscopy and immunohistochemical stains allowed for reclassification of the histiocytoses based on the predominant cell in the infiltrate. Although the current schema simplicity provides a good foundation, some patients display overlapping clinical and immunohistochemical features that defy classification. The patient herein illustrates bridging between histiocytic disorders. Through this case we review the various conditions classified under the non-Langerhans cell histiocytosis and Langerhans cell histiocytosis rubric.

Split-face treatment of facial dyschromia: pulsed dye laser with a compression handpiece versus intense pulsed light.

BACKGROUND: Many visible light lasers and intense pulsed light (IPL) devices are available to treat photodamaged skin. OBJECTIVES: The objective was to perform a multiple-treatment split-face comparison evaluating a pulsed dye laser (PDL) with a compression handpiece versus IPL for photorejuvenation. METHODS: Ten subjects were treated three times at 3- to 4-week intervals. One side of the face was treated with the PDL with compression handpiece, and the other with IPL. One month after final treatment, blinded evaluation assessed for improvements in dyschromias and texture. Patients provided self-assessment of improvement in dyschromias and texture. Time to complete final treatments and pain during all treatments were recorded for each device. RESULTS: Improvement of the PDL was (mean) 86.5, 65, 85, 38, and 40% for dark lentigines, light lentigines, vessels <0.6 mm, vessels >0.6 mm, and texture, respectively, versus 82, 62.5, 78.5, 32.5, and 32%, respectively, for the IPL side. Patient-evaluated difference in improvement for vascular lesions significantly favored the PDL (p=.011). Mean third treatment times were 7.7 minutes for PDL versus 4.6 minutes for the IPL (p=.005). Mean pain ratings were 5.8 for the PDL and 3.1 for the IPL (p=.007). Purpura-free procedures depended on proper technical use of the compression handpiece when treating lentigines with the PDL. CONCLUSIONS: The PDL with compression handpiece and IPL are highly effective for photorejuvenation.

A pulsed dye laser with a 10-mm beam diameter and a pigmented lesion window for purpura-free photorejuvenation.

BACKGROUND AND OBJECTIVES: In traditional pulsed dye lasers (PDLs), power limitations and pulse characteristics have compromised purpura-free procedures. This study evaluated a new PDL with a modified pulse structure and a 10-mm beam diameter for purpura-free photorejuvenation. A compression handpiece was used for targeting lentigines. MATERIALS AND METHODS: Twenty patients with skin types I to III were treated three times at 3- to 4-week intervals. The first pass was delivered through a 10-mm compression handpiece to target pigment dyschromias using fluences between 6.5 and 8.0 J/cm(2) with a 1.5-ms pulse duration. A second pass was then performed with a 10-mm spot with fluences between 9.5 and 10 J/cm(2), a 20-ms pulse duration, and cryogen spray enabled. Improvement was evaluated by comparing pre- and posttreatment photographs and live subjects 1 month after the third treatment. RESULTS: In the majority of patients, >90% reduction of fine telangiectasias (<0.6 mm) and dark lentigines was achieved. Pigmented dyschromias improved proportional to the degree of pigment at presentation. Avoidance of purpura with the compression handpiece was dependent on obtaining proper compression before laser emission. Mean textural improvement was 34%. CONCLUSIONS: The new 595-nm PDL is highly effective for two-pass purpura-free improvement of telangiectases, pigment dyschromias, and texture.

Update on lasers and light devices for the treatment of vascular lesions.

Patients frequently present to dermatologists for the treatment of vascular lesions, including facial telangiectases, diffuse redness, port wine stains (PWS), hemangiomas, and leg veins. There are many laser and light devices that can be used with excellent results. This article summarizes the available platforms that are commonly used for the treatment of superficial vascular lesions. Newer devices and techniques are highlighted with respect to the unique characteristics of individual lesions.