[CO2 fractional resurfacing: side effects and immediate complications]. / Lasers CO2 fractionnés: suites normales et complications post-interventionnelles.

BACKGROUND: Fractional resurfacing is a new concept in laser treatment designed to divide radiation into multiple evenly spaced microspots. The aim of our study was to analyze side effects and complications following fractional CO2 laser therapy. PATIENTS AND METHODS: This retrospective study involved the analysis of records of patients treated with ablative fractional CO2 laser. Pain, type and duration of usual side effects, and immediate complications were analysed. RESULTS: Forty-six treatments were studied. The average duration of erythema was 5.2 (±2) days while that of scabs was 4.1 (±1.9) days. Average pain was 3.3/10 (±2.5) for nine patients premedicated with Emla® and 4.1/10 (±2) for the other 14 non-premedicated patients. Complications were reported for 21.7% of the 46 treatments, as follows: 10.6% facial herpes, some of which occurred despite antiviral prophylaxis (valacyclovir 500 mg/day p.o.), 8.7% inflammatory reactions, including severe facial swelling, and 2.2% acne. All complications resolved quickly. DISCUSSION: Our study specifically examined the safety of CO2 fractional lasers and showed an acceptable per interventional pain and simple follow-ups. The frequency of complications was high compared to that described with the Fraxel®, but no severe complications were reported. Given the extent of herpes complications, our study encourages the prescription of valacyclovir prophylaxis 500 mg twice a day for all patients. Patients should also be informed of the high risk of severe inflammatory reaction.

Actinic lichen planus mimicking melasma. A clinical and histopathologic study of three cases.

Three cases of actinic lichen planus mimicking melasma are presented. Although the clinical similarity to melasma is striking, the histopathologic picture is distinctive. It is suggested that actinic lichen planus be considered in the differential diagnosis of melasma.

Sequestrated meningocele of the scalp: diagnostic value of hair anomalies.

Clinical aspects of sequestrated meningocele can be varied, causing difficulties in histopathological diagnosis. The meningeal tissue is scanty and appears as nonspecific connective tissue, therefore it may be overlooked. One classical and two unusual clinical presentations of sequestrated meningocele are described: one of the latter presenting as two atrophic midline bald patches, and the other as a tiny occipital midline hair tuft. In the unusual cases, the pathologic diagnosis was made possible only with the combination of clinical, histologic, and immunohistochemical studies. Sequestrated meningocele should be included in the differential diagnosis whenever hair abnormalities are observed in neonates and young children. We believe that there is a causal relationship between anomalies of the central nervous system and the cutaneous adnexal malformations.

Contact and photocontact allergy to oxybenzone.

The purpose of this study was to determine the frequency of contact allergy and photocontact allergy to sunscreens. A consecutive series of 54 patients with suspected clinical photosensitivity were assessed. All had the same standardized photobiological investigation from January 1989 to December 1990, including patch tests and photopatch tests with 6 sunscreen agents. Oxybenzone was found to cause 4 cases of allergic contact dermatitis (with photoaggravation in 2), and 3 cases of photocontact dermatitis (13% of patients). This is probably due to the wide distribution of oxybenzone in sunscreens and other cosmetics, 2 patients with polymorphic light eruption and persistent light reactivity, respectively, were regular sunscreen users. Photobiological investigation is necessary to ensure accurate diagnosis, since sunscreen contact or photocontact allergy may simulate other photosensitivity eruptions.

Carpal tunnel syndrome and systemic sclerosis.

Carpal tunnel syndrome (CTS) was observed in 4 cases of a consecutive series of 16 patients admitted for the initial diagnosis or follow-up of systemic scleroderma from 1986 to 1990. We also observed one case of ulnar nerve compression. Neurological involvement was confirmed by electromyogram, and motor and sensory nerve conduction studies. The neurological signs appeared at the beginning of the disease in two cases and preceded the discovery of scleroderma in two. CTS is not rare in scleroderma and must be carefully sought, both clinically and electrophysiologically. Patients with 'idiopathic' CTS might need clinical follow-up for early diagnosis of scleroderma.

Schnitzler's syndrome (urticaria and macroglobulinemia) associated with pseudoxanthoma elasticum.

Schnitzler's syndrome, first described in 1974, is defined by chronic non-pruritic urticaria, osteocondentation, and a monoclonal IgM dysproteinemia, but without criteria of lymphoproliferative disease. We report a patient with chronic urticaria and macroglobulinemia. In addition, he had double monoconal dysproteinemia IgM kappa (31.3 g/l) and IgA lambda, osteocondensation, and some cutaneous lesions of pseudoxanthoma elasticum. Only 20 cases of Schnitzler's syndrome have been reported hitherto. This is the first case associated with pseudoxanthoma elasticum, which was localized and discovered at the same time as Schnitzler's syndrome. We discuss the possible role of monoclonal immunoglobulin in the occurrence of localized elastorrexhis.