A prospective comparison of octyl cyanoacrylate tissue adhesive (dermabond) and suture for the closure of excisional wounds in children and adolescents.

BACKGROUND: Recent studies suggest that the use of octyl cyanoacrylate tissue adhesive for closure of both traumatic lacerations and incisional surgical wounds results in a cosmetic outcome comparable to that achieved with conventional sutures. To date, no studies have looked at the use of tissue adhesive for higher-tension wounds, such as those created during cutaneous excisional procedures. OBJECTIVE: To compare the tissue adhesive octyl cyanoacrylate with standard suture for the closure of excisional wounds in children and adolescents. DESIGN: A prospective comparison with blinded assessment of cosmetic outcome. Twenty-eight wounds were closed with monofilament suture and 24 were closed with tissue adhesive. At approximately 2 months, photographs of the incisions were evaluated by 2 dermatologists blinded to the method of skin closure. SUBJECTS: Forty-two consecutive patients undergoing excisional dermatologic procedures at Children's Hospital, San Diego, Calif. These 42 patients had a total of 52 wounds that were evaluated. MAIN OUTCOME MEASURES: The cosmetic appearance of the wounds at 2 months, based on 2 validated wound scales: the Hollander Wound Evaluation Scale and a visual analog scale. RESULTS: There were no differences in early complications between the groups. The suture group scored higher on the visual analog scale (63.3 mm for suture vs 47.8 mm for tissue adhesive), and this difference was statistically significant (P =.02). The suture group also had a higher median score on the Hollander Wound Evaluation Scale, but this difference was not statistically significant (P =.09). CONCLUSION: The cosmetic outcome of cutaneous excisional surgery wounds closed with standard suturing was found to be superior to that of wounds closed with octyl cyanoacrylate.

Linkage disequilibrium narrows locus for venous malformation with glomus cells (VMGLOM) to a single 1.48 Mbp YAC.

Venous malformations with glomus cells are localised cutaneous lesions of vascular dysmorphogenesis. They are usually sporadic, but sometimes familial. Using five families, we mapped the locus, VMGLOM, to chromosome 1p21-p22. In order to refine this locus, spanning 4-6 Mbp, we then studied seven additional families. They exhibited linkage to VMGLOM and the combined lod score for all 12 families was 18.41 at theta = 0.0 for marker D1S188. We found a distinct haplotype shared by seven families, comprising seven alleles which are rare in the general population (P < 0.01). This indicates that the haplotype is identical by descent in all seven families, and hence the locus can be refined by inferring ancestral crossovers. Using this approach, we position the causative gene between two markers on the same non-chimeric YAC of 1.48 Mbp, a feasible size for positional cloning. As there is no known gene involved in vasculogenesis and/or angiogenesis in this YAC, the identification of the causative gene is likely to reveal a novel regulator or vascular development.

Telangiectasia macularis eruptiva perstans.

Telangiectasia macularis eruptiva perstans (TMEP) is a form of mastocytosis. It is an uncommon condition, particularly in children. The disorder is characterized by telangiectatic macules and generally has a good prognosis, with little tendency to urticate or cause constitutional symptoms. We report a girl who presented at age 2 with a 6-month history of erythematous macules on her arms and legs. The lesions were larger and possessed a more angular configuration than classic telangiectases. They slowly spread to her torso and face; there were no associated constitutional symptoms. Histopathologic examination showed dilated capillaries and increased numbers of mast cells, consistent with TMEP. Mastocytosis should be considered in patients presenting with telangiectatic lesions that are atypical in appearance, distribution, or onset.

Use of the cotton swab method in diagnosing Tinea capitis.

OBJECTIVE: To evaluate the accuracy of the cotton swab technique for identifying fungal infections of the scalp. The purpose of the study was: 1) to compare the cotton swab technique with the toothbrush method, a popular and reliable means for obtaining specimens; and 2) to ascertain if transport of a specimen, entailing variable transport duration and conditions, impairs the sensitivity and specificity of the technique. MATERIALS AND METHODS: Part 1 consisted of a prospective, investigator-blinded comparison analysis. Fifty children with scalp findings suspicious for tinea capitis were cultured using both techniques: the toothbrush and cotton swab. Ninety-six culture results were obtained for analysis. The second part of the study consisted of a prospective comparison analysis of cotton swab culture results obtained from samples plated immediately after collection in the physician's office as compared with samples transported to outside laboratories for processing. Thirty-one children with presumed tinea capitis were cultured twice with the cotton swab technique; one sample was immediately plated onto fungal medium and the other sent to an outside lab, the selection of which was dictated by the patient's insurance plan. A total of 62 samples were obtained; 58 sample results were used for analysis. RESULTS: In part 1 of the study, 60% of the 48 children analyzed had positive fungal cultures. Eighty percent of these were Trichophyton species. There was 100% agreement in the results obtained; all patients with positive results using the toothbrush method were also positive when the cotton swab method was used. Similarly, there was complete concordance in laboratory results from the second part of the study. Fifty percent of the 28 children analyzed had positive cultures; 86% grew Trichophyton species. All patients who had positive cultures from those samples plated in-office also had positive results from the outside laboratory samples. CONCLUSIONS: The cotton swab technique is an easy, atraumatic, inexpensive, and reliable means to evaluate patients with suspected tinea capitis. The method remains sensitive and specific even when transport of these specimens is required and processing is thus delayed. This painless technique requires little technical expertise and can be rapidly performed with a standard cotton tip applicator. It should prove an invaluable aid to practitioners in evaluating patients with possible fungal infections of the scalp.

Transillumination blisters in a neonate.

Transillumination with a high-intensity fiberoptic light source is an effective means of diagnosing pneumothoraces and localizing arteries and veins for blood sampling. It has been used for these purposes in neonatal intensive care units since the 1970s. Thermal burns were reported in association with the technique initially, but this complication now occurs infrequently because of numerous safety precautions. We present a case of thermal blisters induced by transillumination in a neonate. This entity is an important addition to the differential diagnosis of vesicobullous eruptions in the neonate.

Trauma-induced linear scleroderma.

Linear scleroderma (linear morphea) is a form of localized scleroderma characterized by sclerotic lesions distributed in a linear, band-like pattern. Despite its benign course, the disease can cause severe cosmetic, orthopedic, and psychologic problems. The cause is unknown. Many cases are preceded by a history of trauma. We describe a case in which linear scleroderma occurred following a laceration to the affected site. We review the treatment options and discuss the current theories regarding the pathogenesis of the disease.

Anogenital papillomavirus infections in children.

Over the years, our impression of human papillomavirus has changed. Once thought of as the cause of relatively insignificant skin lesions, its significant role in malignancy of epithelia and mucosa throughout the body is beginning to be understood. Also changing, although not as rapidly as we would like is our understanding of how human papillomavirus infects the body, the concept of latency, our responses to infection, and how to modify or boost those responses so as to overcome infection. Research into the specifics of how our immune systems react, or why they do not, should give us better insight into how and why treatment therapies work and how to optimize them. Further work into vaccines may provide the means to eradicate the virus from infected persons, as well as to prevent the initial infections.

Progressive eruptive histiocytomas.

We describe progressive eruptive lesions that have been appearing on a 50-year-old Filipino man for the past 9 years. They are characterized by smooth, brown, firm nodules mainly on the head and torso. Histologic examination shows dermal collections of lipid-filled histiocytes and Touton-type giant cells. A comparison with other types of previously described non-Langerhans cell histiocytoses is made.