Prospective, single-blind, randomized, controlled study to assess the efficacy of the 585-nm flashlamp-pumped pulsed-dye laser and silicone gel sheeting in hypertrophic scar treatment.

OBJECTIVE: To determine the efficacy of the 585-nm flashlamp-pumped pulsed-dye laser and silicone gel sheeting in the treatment of hypertrophic scars in lighter- and darker-skinned patients. DESIGN: Prospective, single-blind, randomized, internally controlled, comparison investigation. SETTING: Large academic dermatology department. PATIENTS: Twenty patients with hypertrophic scars (19 completed the laser treatments and 18 completed the silicone gel sheeting treatments). MAIN OUTCOME MEASURES: Clinical measurements included hypertrophic scar blood flow, elasticity, and volume. Patients' subjective complaints of pruritus, pain, and burning were also monitored. Histological assessment of fibrosis, number of telangiectasias, and number of mast cells was performed. Statistically significant improvements in clinical measurements and patients' subjective complaints determined treatment success. RESULTS: Mean scar duration was 32 months (range, 4 months to 20 years). There was an overall reduction in blood flow, volume, and pruritus over time (P = .001, .02, and .005, respectively). However, no differences were detected among treatment and control groups. There was no reduction in pain or burning (0-40 weeks), elasticity (8-40 weeks), or fibrosis (0-40 weeks, n = 5 biopsies) in the treated or control sections of the scars. Unlike in a previous study, the number of mast cells in the scars was similar to the number of mast cells in healthy skin. CONCLUSION: Clinical results demonstrate that the improvements in scar sections treated with silicone gel sheeting and pulsed-dye laser were no different than in control sections.

Peanut allergy.

Peanut allergy is acute and severe with symptoms of immediate hypersensitivity. This allergy is very common, affecting 1% of preschoolers. The incidence has increased with succeeding generations, and is possibly due to the increasing exposure of children to peanuts at a young age. Diagnosis is via history, skin prick test, and serum IgE level. The mainstay of therapy is avoidance. Treatment of anaphylaxis includes epinephrine and antihistamines. Children usually will not outgrow this food allergy. Novel treatment with rush immunotherapy and enzyme-potentiated desensitization is not currently acceptable. We describe a 27-month-old Asian boy with a typical presentation of peanut hypersensitivity. A good understanding of the epidemiology of this illness is necessary for treatment and prevention.