Videomicroscopy of port-wine stains: correlation of location and depth of lesion.

BACKGROUND: Anatomic location and depth of ectasia of port-wine stains (PWSs) are important prognostic indicators when evaluating treatment options for patients. Videomicroscopy permits subsurface evaluation of PWSs, thereby allowing determination of the depth of the ectatic vessels. OBJECTIVE: Our purpose was to determine whether location of PWSs corresponds to the depth of the ectatic vessels. METHODS: Seventeen patients presenting for evaluation or treatment of PWSs underwent videomicroscopy with a Video Loupe 7EX microscope. Data were recorded by location of the PWS as a type 1 lesion (blobs or globular structures) corresponding to ectasia of the superficial capillary loops, a type 2 lesion (rings) corresponding to ectasia of the deeper horizontal plexus, or a mixed pattern. RESULTS: PWSs in areas that typically respond well to laser treatment (V3, neck, and trunk) were more likely to have a superficial type 1 pattern. PWSs in areas that have a poorer response to therapy (V2, distal extremities) were more likely to have a deeper type 2 pattern. CONCLUSION: We found that patients with lesions in the V3 dermatome and on the trunk and neck have more superficially ectatic vessels, whereas those lesions in dermatome V2 and on the distal extremities have more deeply placed vessels. Further studies are needed to determine whether videomicroscopy can be used to preoperatively predict treatment results.

Lupus erythematosus-like features in patients with cutaneous T-cell lymphoma.

BACKGROUND: The development of lupus erythematosus-like (LE-like) features in patients with cutaneous T-cell lymphoma (CTCL) has not been reported previously in the literature. Both diseases, however, have been etiologically linked to retroviruses. OBJECTIVE: Our purpose was to report four cases of patients with CTCL who developed LE-like features during the course of their disease, and to evaluate for evidence of antibodies to retroviruses in the sera of these patients. PATIENTS: Four patients with biopsy-proven CTCL with clinical or histologic features of systemic lupus erythematosus (SLE) were evaluated for clinical and laboratory criteria for SLE. Only one patient demonstrated four American Rheumatism Association (ARA) criteria sufficient for the diagnosis of SLE. The remaining three patients demonstrated one or two criteria for SLE. In addition, the sera of these patients were examined by Western blot analysis for evidence of human immunodeficiency virus type I (HIV-I), human T-cell lymphotrophic virus type I (HTLV-I), or human intracisternal A-type particle type I (HIAP-I) retroviral proteins. Each patient demonstrated antibodies to some of the retroviral proteins examined. The sera of two patients reacted to proteins for HIAP-I, and the sera of two patients reacted to p24 gag proteins of HIV-I. No patient reacted to HTLV-I proteins. CONCLUSIONS: Our report identifies four patients with CTCL who developed LE-like features during the course of their disease. Although the etiology of CTCL and SLE has not been well established, each has been linked to retroviruses. Evidence of antibodies to retroviral proteins was identified in each of our patients by Western blot analysis. Although the clinical and laboratory findings in these cases do not resolve the etiologic role of retroviruses in CTCL or SLE, they suggest that retroviruses may have a role in the pathogenesis of the clinical phenomenon reported in these four patients.

CTCL in patients under 20 years of age: a series of five cases.

The diagnosis of cutaneous T-cell lymphoma in patients under 20 years of age is extremely rare. We report five patients diagnosed before 20 years of age who illustrate the striking variations in clinical and histologic features as well as disease progression. We feel this information stresses the importance of multiple biopsies in young patients with chronic dermatoses.

Linear scleroderma in children.

BACKGROUND: Linear scleroderma is a cutaneous disease of unknown etiology. It most often affects children, who develop band-like lesions in an asymmetric distribution. The literature is reviewed as to the diagnosis, pathogenesis, and treatment of linear scleroderma. CASE REPORT: Six new cases of linear scleroderma in children are reported. Their ages ranged from 6 to 17 years, and five were girls. A 17-year-old girl had en coup de sabre. Multiple treatment modalities were used. All laboratory testing was negative. CONCLUSIONS: Linear scleroderma is a clinical diagnosis. The pathogenesis remains unknown. A consistently effective therapy has not been found, although diphenylhydantoin and ticlopidine hydrochloride should be evaluated in clinical trials.

Clinical usefulness of the argon laser for the 1990s.

The argon laser remains an excellent, important laser in the 1990s. Its major role in dermatology is for the treatment of mature nodular port-wine stains, telangiectasia, small vascular lesions, and superficial pigmented lesions. Technique modifications and appropriate patient selection have been developed to maximize favorable response.

Dermatologic laser surgery.

The first laser was constructed in 1959 and in only three decades lasers have achieved an important, well-established position in cutaneous surgery. The future is filled with rich opportunities for further investigation of the new laser systems and laser photobiology.

Subacute cutaneous lupus erythematosus-like drug eruption due to combination diuretic hydrochlorothiazide and triamterene.

Three patients taking a frequently prescribed diuretic combination of hydrochlorothiazide and triamterene developed eruptions resembling subacute cutaneous lupus erythematosus. Histopathology of the skin biopsies of all three patients was consistent with subacute cutaneous lupus erythematosus. On discontinuation of the diuretic drug, the cutaneous eruptions cleared.

Carbon dioxide laser treatment of verrucae vulgares.

A report is presented on the use of the carbon dioxide (CO2) laser for the removal of recalcitrant warts of hands and feet of 27 patients. Of the 27 patients 22 (81%) required only one laser treatment to eradicate warts and remain free of lesions at the 6-month follow-up visit. The other patients required up to 3 retreatments with the laser during the first 6 months to remain free of lesions at a 6-month follow-up. The CO2 laser provided a bloodless surgical field, accurate control, minimal postoperative pain, and decreased postoperative infection. The authors conclude that, while the CO2 laser is not without its disadvantages, it should be considered an important adjunct in the treatment of difficult, widespread, or recalcitrant verrucae.