Postsclerotherapy pigmentation. Is serum ferritin level an accurate indicator?

BACKGROUND: Human beings have suffered and sought treatment for disease of veins as early as the recordings of the old testament. The use of irritating sclerosing agents have been and are widely used today to treat varicose veins and telangiectasia. One of the most common and cosmetically significant side effects of sclerosing agents is varying degrees of hyperpigmentation. It has been reported that elevated serum ferritin level plays a role in this postsclerotherapy pigmentation. OBJECTIVE: To support or negate the possibility of a direct correlation between serum ferritin levels and pigmentation postsclerotherapy using for our investigation a patient with hemochromatosis. METHODS: A patient with hemochromatosis having a serum ferritin level of 1200 was treated for spider veins. Clinical and histologic studies were performed pretreatment and posttreatment. RESULTS: There was no clinically apparent hyperpigmentation noted on the patient after sclerotherapy over a 6-month period. Histology reports revealed macrophagic pigmentation both pretreatment and posttreatment. CONCLUSION: Our results do not confirm the theory that lab values of elevated serum ferritin correlate with pigmentation postsclerotherapy. Further study of the correlation between postsclerotic pigmentation and serum ferritin levels are needed. One would anticipate that if a true correlation existed, then an extreme case such as this would clearly support this theory.

Ambulatory phlebectomy using the tumescent technique for local anesthesia.

BACKGROUND: Ambulatory phlebectomy is a cosmetically elegant procedure that provides outpatient office-based surgical removal of large truncal varicose veins. The process of local anesthetic infiltration using traditional means is a time-consuming process that can be painful, and carries with it the inherent risk of accidental intravascular injection. OBJECTIVE: To introduce the tumescent technique for local anesthesia as it relates to the procedure of ambulatory phlebectomy and discuss the benefits of this form of anesthesia. METHODS: A description of the technique utilizing a dilute anesthetic solution, an injection syringe, and blunt-tipped anesthetic probe is provided. RESULTS: Using the tumescent technique for local anesthesia, large areas can be anesthetized quickly, safely, effectively, and relatively painlessly, offering multiple advantages over simple local infiltration, and eliminating the need for regional or general anesthesia. CONCLUSION: The authors consider the tumescent anesthesia technique to be highly effective and an important adjunct to the procedure of ambulatory phlebectomy.

Cutaneous lupus treated with topical tretinoin: a case report.

We present a case of hypertrophic lupus erythematosus treated with topical tretinoin. To date, we believe this is the first description of such treatment of this disease.