Recurrent radiation recall dermatitis 40 years after radiation therapy for breast cancer.

Radiation recall dermatitis is an inflammatory reaction of the skin, which occurs at previously irradiated areas, usually following a subsequent exposure to an aggravating factor. Recall dermatitis can occur weeks to months after radiation, and the longest duration between radiation and dermatitis has been reported to be about 25 years. Here, we report a case of recurrent radiation recall dermatitis that developed spontaneously after 40 years following radiation for breast cancer. This case suggests that radiation recall dermatitis can occur much later than previously reported. In spite of this late presentation, topical anti-inflammatory agents managed the condition well.

Survival of densely packed follicular unit grafts using the lateral slit technique.

BACKGROUND: The use of densely packed follicular unit grafts (>30 grafts/cm(2)) is a highly debated issue, with some claiming decreased survival rates. Those who perform dense packing routinely do not believe they have seen any impaired survival. However, no prior study has rigorously analyzed densely packed areas to assess survival rates. OBJECTIVE: In this study, the authors assessed the survivability of densely packed (>70 grafts/cm(2)) follicular unit grafts using the lateral slit technique. METHODS: This study was a strictly observational study in one patient. Several 1-cm(2) areas tattooed on the mid scalp were grafted at densities ranging from 23 to 72 grafts/cm(2) using the lateral slit technique. The area surrounding the observation sites was transplanted at a density of 30 to 40 grafts/cm(2). RESULTS: Examination of the most densely packed area (72 grafts/cm(2)) at 8 months posttransplant revealed that the number of implanted grafts showing growth was 98.6% whereas the least densely transplanted area (23 grafts/cm(2)) revealed a growth rate of 95.6%. CONCLUSION: This is the first study that demonstrates high growth rates in densely packed follicular units using the lateral slit technique, even at densities of 72 grafts/cm(2). These data are in contradistinction to previously performed studies using older methodologies.

Algorithm for using a long-pulsed Nd:YAG laser in the treatment of deep cutaneous vascular lesions.

BACKGROUND: Conventional therapies for deep cutaneous vascular anomalies have demonstrated poor efficacy and many side effects. New laser systems offer greater potential to treat these difficult lesions, but the lack of specific treatment guidelines has restricted consistent success. OBJECTIVE: To establish a rational, user-friendly algorithm that incorporates basic components of deep vascular lesions to define the correct laser settings required for safe, effective, and reproducible treatment. METHODS: Within 18 months, 162 deep vascular lesions of various types and anatomic sites were evaluated for vessel size, depth, color, and pressure. An algorithm incorporating these characteristics was employed to determine laser parameter settings. Using a high-peak power, long-pulse 1064-nm Nd:YAG laser system, the vascular lesions were then treated. RESULTS: Within 6 months of follow-up, 80% of treated areas demonstrated a 50% or greater resolution after a single treatment session, with complete clearance shown in 19%. Only minimal and transient side effects were observed. Of note, 74% of areas on the extremities and 83% within the oral cavity showed a 50% or greater resolution after one treatment. CONCLUSION: Previously challenging deep cutaneous vascular anomalies may be safely reduced or cleared with the use of an appropriate laser system and this algorithm-directed technique. This represents a significant breakthrough in the management of vascular lesions.