Diffuse Urticarial Reaction Associated with Titanium Dioxide Following Laser Tattoo Removal Treatments.

IMPORTANCE: Local and generalized allergic reactions following laser tattoo removal have been documented, but are rare. To our knowledge, this is the fourth documented case of widespread urticarial eruptions following laser tattoo removal treatment. Unlike previously documented cases, this patient's reaction was found to be associated with titanium dioxide within the tattoo and her symptoms were recalcitrant to medical therapy. OBSERVATIONS: A 46-year-old female experienced diffuse urticarial plaques, erythema, and pruritis following multiple laser tattoo removal treatments with an Nd:YAG laser. The systemic allergic reaction was recalcitrant to increasing doses of antihistamines and corticosteroids. The tattoo was finally surgically excised. The excised tissue was analyzed by scanning electron microscopy and energy-dispersive X-ray analysis and contained high levels of titanium dioxide. Two weeks following the excision, and without the use of medical therapy, the patient had complete resolution of her generalized urticaria. CONCLUSIONS: Ours is the first documented case of a diffuse urticarial reaction following laser tattoo removal treatments that shows a strong association to titanium dioxide within the tattoo pigment. Herein, we describe a novel surgical approach to treat recalcitrant generalized allergic reaction to tattoo pigment.

Evaluation of dermatologic conditions by primary care providers in deployed military settings.

Dermatologic illnesses have historically been a significant source of morbidity and resource utilization in fielded military forces. The impact of cutaneous diseases during U.S. military conflicts is reviewed, and recent data from Craig Joint Theater Hospital at Bagram Air Field in Afghanistan are presented, confirming previous experience. A discussion of the difficulties of diagnosing and treating dermatologic conditions for deployed primary care providers is provided, including recommendations to improve patient care and military unit readiness.

Delay in diagnosis of diabetes mellitus due to inaccurate use of hemoglobin A1C levels.

Testing of hemoglobin A(1C) (HbA(1C)) levels has become widespread in the management of patients with diabetes mellitus. Since the 1980s, it has proven to be an invaluable tool correlating with a patient's average blood glucose levels as well as with their disease morbidity. Clinicians often base treatment decisions and make adjustments depending on a patient's HbA(1C) level. As useful as the HbA(1C) is, it does have notable limitations. A number of conditions can lead to a falsely elevated or a falsely low HbA(1C) level. When one of these conditions is present, it is important to recognize the inaccuracy of the HbA(1C) test to prevent a delay or error in the diagnosis or care of patients with diabetes mellitus. It is also important to be aware of alternative methods of monitoring a patient's diabetes such as a fructosamine assay or home and office blood glucose measurements. Presented is the case of a patient with diabetes mellitus and hereditary spherocytosis, a condition that interfered with her HbA(1C) value and resulted in a delay in her care.