Association of Central Nervous System Depression With Topical Brimonidine When Used for Hemostasis: A Serious Adverse Event.

Importance: Minor bleeding is the most common complication of dermatologic surgery. Topical brimonidine, 0.33%, gel has been reported for the use of hemostasis in dermatologic surgery. The safety profile and risk of systemic toxic effects when brimonidine is used topically for hemostasis is unknown. Objective: To determine the risk of systemic toxic effects of topical brimonidine, 0.33%, gel when used for hemostasis. Design, Setting, and Participants: In this case series from a private practice (Hollywood Dermatology), 2 patients presented for dermatologic procedures, complicated by persistent bleeding. Interventions: Patients were treated with 10 g of brimonidine, 0.33%, gel applied under occlusion for hemostasis. Main Outcomes and Measures: Mental status, cardiopulmonary function. Results: Both patients experienced deterioration of mental status, respiratory depression, and somnolence. Results from cardiac testing, laboratory workup, and imaging were negative for cardiac or neurologic etiology. Both patients improved in less than 24 hours. Conclusions and Relevance: Topical brimonidine, 0.33%, gel can result in systemic central nervous system toxic effects when used as a hemostatic agent. At present, it is not possible to define a quantity with which brimonidine can be used safely, nor can a safe wound size be defined. We, therefore, urge against the use of topical brimonidine as a hemostatic agent until its safety is further investigated.

Ultraviolet-Fluorescent Tattoo Facilitates Accurate Identification of Biopsy Sites.

BACKGROUND: Cutaneous biopsy sites are often difficult to discern or are frequently misidentified when patients present for the treatment of skin cancers. This frustrating situation can lead to delays in treatment and wrong site surgeries. Current methods aiming to prevent this situation are not perfect. OBJECTIVE: This study seeks to determine the efficacy of ultraviolet-fluorescent tattoos in facilitating the correct identification of suspected nonmelanoma skin cancer biopsy sites. METHODS: In this prospective cohort, 51 shave biopsy sites were tattooed with ultraviolet-fluorescent ink in a series of 31 patients suspected of having a cutaneous malignancy. At the time of follow-up, the ability of the patient and the physician to identify the correct site with and without ultraviolet illumination of the tattoo was recorded. Visibility of the tattoo was graded before and after treatment. RESULTS: Patients could not positively identify their biopsy site in 35% of cases. In 7% of cases, physicians could not confidently identify the site without the aid of ultraviolet illumination. In conjunction with tattoo illumination, physicians confidently identified the site in 100% of the cases. No adverse events occurred. CONCLUSION: Ultraviolet-fluorescent tattoos offer a safe and reliable means of accurately marking cutaneous biopsy sites.

Lichenoid drug eruption after human papillomavirus vaccination.

Lichenoid drug reactions have been linked to a long and growing list of medications, most of which are used mainly in adults, making these reactions exceedingly rare in children. To the best of our knowledge, this case report is the first of a lichenoid drug eruption in a child after human papillomavirus vaccination.

Use of lenalidomide in treating refractory prurigo nodularis.

Prurigo nodularis is a chronic, relapsing neurodermatitis that is often resistant to standard therapies with topical corticosteroids and oral antihistamines. Thalidomide, while efficacious in treating recalcitrant cases of prurigo nodularis, causes significant toxicity. Thalidomide-induced peripheral neuropathy frequently results in drug discontinuation. Lenalidomide (Revlimid; Celgene Corporation, Summit, NJ) is a derivative of thalidomide with less neurotoxicity approved for the treatment of multiple myeloma and myelodysplastic syndromes that has not been widely studied in dermatologic disorders. Here, we report a case of refractory prurigo nodularis effectively treated with lenalidomide. Given its favorable side-effect profile, lenalidomide may offer a superior alternative to thalidomide in the treatment of this condition.

Patch testing practices of American Contact Dermatitis Society members.

BACKGROUND: Patch testing is an important part of diagnosing allergic contact dermatitis although there is much variability in methodology among practitioners. OBJECTIVE: We surveyed members of the American Contact Dermatitis Society (ACDS) to quantify time spent with patients with contact dermatitis; to characterize patch testing practices, including the Thin-Layer Rapid Use Epicutaneous (T.R.U.E.) Test; and to assess utilization of the Contact Allergen Replacement Database (CARD). METHODS: An electronic survey was sent to all members of the ACDS. RESULTS: Our survey was sent to the 600 members of the ACDS; 100 members participated (a response rate of 16.6%). Respondents used patch testing trays that contained an average of 62 allergens; 68% of respondents used the North American Contact Dermatitis Group series, and only 9% used the T.R.U.E. Test. Respondents' biggest criticism of the T.R.U.E. Test was its low number of allergens, and 94% of respondents used CARD regularly. CONCLUSION: ACDS members used patch testing trays with many allergens. Despite the T.R.U.E. Test's popularity among general dermatologists and allergists, few ACDS members used it. Routine CARD usage should be encouraged.