Hypnosis in dermatology.

BACKGROUND: Hypnosis is an alternative or complementary therapy that has been used since ancient times to treat medical and dermatologic problems. OBJECTIVE: To describe the various uses for hypnosis as an alternative or complementary therapy in dermatologic practice. METHODS: A MEDLINE search was conducted from January 1966 through December 1998 on key words related to hypnosis and skin disorders. RESULTS: A wide spectrum of dermatologic disorders may be improved or cured using hypnosis as an alternative or complementary therapy, including acne excoriée, alopecia areata, atopic dermatitis, congenital ichthyosiform erythroderma, dyshidrotic dermatitis, erythromelalgia, furuncles, glossodynia, herpes simplex, hyperhidrosis, ichthyosis vulgaris, lichen planus, neurodermatitis, nummular dermatitis, postherpetic neuralgia, pruritus, psoriasis, rosacea, trichotillomania, urticaria, verruca vulgaris, and vitiligo. CONCLUSION: Appropriately trained clinicians may successfully use hypnosis in selected patients as alternative or complementary therapy for many dermatologic disorders.

Keloids and hypertrophic scars.

BACKGROUND: Keloids and hypertrophic scars are benign fibrous growths that occur after trauma or wounding of the skin and present a major therapeutic dilemma to the dermatologist because of frequent recurrences. OBJECTIVE: The purpose of this study is to review the pertinent literature and provide updated information on keloids and hypertrophic scars that will enable the physician to better understand and treat these lesions. METHODS: A Medline literature search was performed for relevant publications. RESULTS: Traditional treatment methods which have been effective include a combination of surgery with intralesional steroids and/or radiotherapy, silicone gel sheeting, pressure, and cryotherapy. Recently newer modalities shown to be effective include pulsed dye laser, interferon alfa-2b, and cultured epithelial autografts. CONCLUSION: Keloids and hypertrophic scars present a major therapeutic dilemma to the dermatologist because of frequent recurrences. A better understanding of keloid pathogenesis may lead to improved therapies by which keloid growth and regrowth may be obviated. Although optimal treatment for keloids remains undefined, successful treatment can be obtained through a multimodality approach. Regardless of the technique employed, an observation period of at least 2 years is necessary to rule out recurrence.

Persistent Sweet's syndrome occurring in a child with a primary immunodeficiency.

Sweet's syndrome (SS) occurs most commonly in association with inflammatory or neoplastic disorders. Only rarely has it been associated with immunodeficiency disorders. We describe a child with a T-cell immunodeficiency who had a persistent neutrophilic dermatosis that was histologically and clinically consistent with SS. SS associated with immunodeficiencies may occur as a reaction to an underlying infection or a defect in immunoregulation. Such patients, however, may not be able to produce the classic fever and neutrophilia associated with SS. They may fail to respond to standard treatment for SS and may suffer a prolonged and persistent course.

Immunologic bullous diseases: blisters without a precipitating event.

Although the overall incidence of immunologic bullous diseases is comparatively low, they are nonetheless potentially lethal dermatologic disorders that occur most commonly in individuals age 55 and older. Thus familiarity with the signs, symptoms, and treatments will be valuable to the primary care physician. For bullous diseases in general, the challenge is to differentiate between those arising from immunologic rather than exogenous causes, such as drug-induced or drug-triggered pemphigus. Treatment goals include screening for associated malignancies, managing the lesions, and minimizing the morbidity and mortality associated with the disease. Collaboration with a dermatologist can aid in achieving these objectives.

Limits of ICD-9-CM code usefulness in epidemiological studies of contact and other types of dermatitis.

BACKGROUND: International Classification of Diseases, Version 9, Clinical Modification (ICD-9-CM) coding information used for billing is readily available in computerized form. OBJECTIVES: The purpose of this article is to determine the usefulness of ICD-9-CM codes in a descriptive dermatoepidemiological study of contact and other dermatitis. METHODS: Prospective recording of specific dermatologic diagnoses and the ICD-9-CM code assigned for each diagnosis was performed for all patient visits to the author's dermatology clinics for 6 months. RESULTS: There were 2,524 patient visits with 4,451 diagnoses, of which 789 diagnoses were dermatitis. The 10 different diagnostic categories of dermatitis had eight associated ICD-9-CM codes. Allergic contact dermatitis with 247 visits, irritant contact dermatitis with 30 visits, and nummular dermatitis with 61 visits shared one diagnostic code. Thus, 43% of visits for dermatitis were intermixed by having the same ICD-9-CM code. CONCLUSION: Lack of one-to-one correspondence of ICD-9-CM codes with dermatitis diagnostic categories creates a situation in which ICD-9-CM codes are not useful for dermatoepidemiological studies of contact and other types of dermatitis. This could be corrected by assigning additional five-digit ICD-9-CM codes to cover each type of dermatitis. Coding for specific allergens or irritants is not feasible with the current five-digit ICD-9-CM codes.

Anaplastic large cell lymphoma mimicking noduloulcerative tertiary syphilis.

Anaplastic large cell lymphoma (ALCL) is a recently described malignancy that can show heterogeneity in its clinical presentation. We report on a patient whose clinical presentation, medical history, and serologic test results were suggestive of tertiary syphilis. Histologic evaluation, however, revealed a large cell lymphoma with Ki-1 positive findings on immunostaining. We review the differential diagnosis of ALCL and add to that a pattern of ALCL clinically mimicking noduloulcerative tertiary syphilis.

Unilateral nevoid telangiectasia: occurrence in two patients with hepatitis C.

Unilateral nevoid telangiectasia, a rarely reported disorder, has been said to be related to increased estrogen receptors in involved skin. The lesions may be congenital or acquired. When acquired it arises almost exclusively during periods of relatively increased estrogen levels such as during pregnancy or puberty, or in association with alcoholic cirrhosis. We describe unilateral nevoid telangiectasia in two young men without any evidence of cirrhosis, but with serologic evidence of hepatitis C infection. Tissue specimens from these men were analyzed for estrogen and progesterone receptors, but there was no difference in involved versus uninvolved skin.

Descriptive epidemiology of contact dermatitis in a university student population.

BACKGROUND: The frequency of irritant and allergic contact dermatitis has been compared in relatively few studies. OBJECTIVE: This report describes the frequency of visits by university students to campus prepaid health plan dermatologists for irritant and allergic contact dermatitis compared with visits for other types of dermatitis and other skin problems. METHODS: Prospective recording of specific dermatologic diagnoses was performed for all visits of students to student health service dermatologists. Diagnoses were then tabulated, rank ordered, and compared. RESULTS: Irritant dermatitis represented 2.3% of all first visits and 1.6% of all total visits. Allergic contact dermatitis accounted for 3.1% of all first and 2.4% of all total visits. Other types of dermatitis were found in 12.5% of all first and 11.1% of all total visits. Contact dermatitis ranked first among types of dermatitis, being seen in 30.0% of first visits for dermatitis and in 27.0% of total visits for dermatitis. CONCLUSION: In this prospective study, contact dermatitis represented a relatively large proportion of visits for dermatitis. Slightly more allergic than irritant contact dermatitis was found. This is at variance with findings in industrial settings that irritant dermatitis generally is more common than allergic contact dermatitis.

Pyoderma gangrenosum associated with cystic acne and hidradenitis suppurativa controlled by adding minocycline and sulfasalazine to the treatment regimen.

Pyoderma gangrenosum often presents a difficult therapeutic challenge. The case is described of a 42-year-old black man with the association of cystic acne, hidradenitis suppurativa, and seronegative arthritis with pyoderma gangrenosum. The pyoderma gangrenosum ulcers remained refractory to treatment until therapies aimed in part at the associated diseases were begun. Minocycline was given for treatment of cystic acne and hidradenitis suppurativa as well as pyoderma gangrenosum. Sulfasalazine was prescribed for seronegative arthritis as well as pyoderma gangrenosum. The combination therapy permitted healing of the pyoderma gangrenosum ulcers.

Pyoderma gangrenosum in a patient with cryoglobulinemia and hepatitis C successfully treated with interferon alfa.

We describe a patient with long-standing pyoderma gangrenosum unresponsive to therapy. The patient had concomitant cryoglobulinemia and hepatitis C. When the hepatitis C was treated with interferon alfa-2a his pyoderma gangrenosum resolved. Whether this was from the interferon alfa or spontaneous resolution is not known.

Skin cancer prevention and screening.

Prevention and early detection of skin cancers are crucial to reducing morbidity and mortality. Armed with the above information and with some experience, the primary care physician can understand risk factors and recognize common benign and malignant skin tumors. This allows the primary care physician to play a key role in teaching patients about skin cancer prevention and in screening patients for skin cancers.

Aging and the skin: recognizing and managing common disorders.

Senescent changes in structure and function of the skin and chronic solar radiation damage predispose the skin of the elderly to certain inflammatory and infectious diseases. In this context, the diagnosis and treatment of senile xerosis and pruritus are discussed, as are the common types of dermatitides, infections, and infestations.