Acne keloidalis nuchae in the armed forces.

Acne keloidalis nuchae (AKN) is a chronic inflammatory skin disease characterized by the development of keloidlike papules, pustules, and plaques on the occipital scalp and posterior neck following mechanical trauma and irritation. First-line therapy involves avoidance of aggravating factors including short and frequent haircuts. Medical treatments-from topical and intralesional steroids, oral antibiotics, and UV light to laser and surgical excision-have demonstrated varying degrees of efficacy. The active-duty military population faces unique challenges in the treatment of AKN because personal appearance and grooming standards restrict avoidance of the very factors that promote this disease process. In this population, early identification and treatment are critical to reducing overall patient morbidity and ensuring continued operational and medical readiness. This article reviews the clinical features, epidemiology, and treatments available in the management of AKN, with a special focus on the active-duty military population.

Pseudoxanthoma Elasticum: report of a case with a novel gene mutation.

Pseudoxanthoma Elasticum (PXE) is a rare autosomal recessive disorder characterized by progressive calcification and fragmentation of elastic fibers in the skin, eyes, and cardiovascular system. PXE is caused by mutations in the ABCC6 gene but the specific pathophysiology of this condition remains unknown. We present a case of a patient who was diagnosed with PXE after experiencing vision loss following minor ocular trauma. Our patient had angioid streaks in her right eye, skin laxity of the bilateral dorsal hands, and yellow papules coalescing on the posterior neck. The diagnosis of PXE was confirmed by histopathological examination. PCR amplification of the patient's ABCC6 gene demonstrated a novel gene mutation that is believed to be pathogenic. Patients with PXE are at an increased risk of visual and potentially life-threatening cardiovascular complications. Early diagnosis provides the patient a greater chance of reducing associated morbidity and mortality.

Mohs surgery - a new approach with a mould and glass discs: review of the literature and comparative study.

OBJECTIVE: Mohs surgery is a frozen section-guided surgical excision that is the treatment of choice for aggressive cutaneous malignancy. But it is labour intensive, particularly because numerous levels are needed on each specimen to obtain a complete histologic section. Three different techniques to Mohs surgery are compared. Our new approach with moulds and glass discs is explained and discussed. DESIGN: Review of the literature and comparative study using skin specimens of fresh cadavers. SETTING: Regional care centre. METHOD: First, we evaluate, for each of the three different techniques, the number of 10 micron-thick frozen sections required to obtain a macroscopically complete cross section of the specimen. Second, we examine microscopically the quality of these first complete sections. Finally, once we have obtained a macroscopically complete cross section, we evaluate the number of deeper levels required to obtain an adequate microscopic section. RESULTS: In the first experiment, with the modern method, 90.1 sections were needed to obtain a full macroscopic section, 36.8 sections with the heat extractor method, and 10.6 sections with the new mould. The quality of the histologic glass slides was superior with the new mould. The number of deeper levels required to obtain an adequate microscopic section was 5.9 for the modern method, 4.4 for the heat extractor method, and 2.3 for the new approach (new mould). CONCLUSION: Our new approach with moulds and glass discs is simple and allows us to flatten the specimen (to obtain a complete tissue section) more reliably and efficiently compared with both the modern and the heat extractor methods. The new approach allows us to obtain these results in less time and with fewer histologic glass slides. Some other aspects are discussed.