Nasal Sesamoid Cartilages: Fact or Fiction? An Anatomical Study of the Lateral Nasal Ala.

OBJECTIVES: To evaluate the presence of cartilage in the lateral nasal ala (LNA) via histological analysis of alar Mohs surgical specimens. An accurate understanding of nasal anatomy is essential to optimize esthetic and reconstructive surgical outcomes. LNA anatomy is typically pictured to include discreet accessory and sesamoid cartilages; however, the authors debate the actual presence of these structures. METHODS: A blinded reviewer analyzed 101 lateral nasal alar histologic specimens from 362 tissue blocks using a Hematoxylin and Eosin (H&E) stain to assess for the presence of cartilage. RESULTS: Out of the 362 tissue blocks histologically analyzed, only 1 included cartilaginous components. CONCLUSIONS: We conclude that the presence of sesamoid and accessory cartilages in the LNA within our sample set is exceedingly rare.

Pemphigus vulgaris induced by electrical injury.

Pemphigus refers to a group of autoimmune blistering diseases that affect the skin and mucous membranes. Pemphigus may be induced following exposure to various exogenous agents, including thermal burns, drugs, infectious agents, and neoplasms, as well as UV, ionizing, and x-ray irradiation. We report a case of a 28-year-old man with pemphigus vulgaris (PV) induced by a severe electrical injury. Approximately one month after the electrical injury, he began to develop recurrent painful oral ulcers; one year later, he began to develop cutaneous bullae. Results of a histopathologic examination and immunofluorescence studies were diagnostic of PV The primary mechanisms of high-voltage electrical injury involve electroporation, electroconformational protein denaturation, and both joule and dielectric heating. Cutaneous electrical injury ultimately results in the destruction of cells with release of their cellular constituents. Through these mechanisms, desmoglein 3 (Dsg3) may be released and become available to the immune system, which potentially leads to an autoantibody response and the subsequent development of PV.

Pulsed dye laser treatment of rosacea improves erythema, symptomatology, and quality of life.

BACKGROUND: Persistent erythema and dysesthetic symptoms are typical manifestations of rosacea. OBJECTIVE: We sought to assess improvement in erythema, symptoms, and quality of life after pulsed dye laser treatment. METHODS: Sixteen patients with erythematotelangiectatic rosacea participated. Spectrophotometric erythema measurements were taken from the right and left malar prominence; chin; and nasal alae, dorsum, and tip. A questionnaire rating the Dermatology Life Quality Index and symptoms of flushing, burning, itching, dryness, swelling, and skin sensitivity was completed. Treatment was undertaken with the pulsed dye laser at purpuragenic fluences. Measurements and treatment were repeated at 8-week intervals for a total of two treatments. RESULTS: A statistically significant improvement was observed in symptoms, quality-of-life score, and erythema in all areas with the exception of erythema of the left nasal ala. CONCLUSIONS: Pulsed dye laser treatment at purpuragenic fluences is a safe and effective treatment for symptomatic rosacea, resulting in a significant improvement in erythema, symptoms, and quality of life.

Effectiveness of microporous polysaccharide hemospheres for achieving hemostasis in mohs micrographic surgery.

BACKGROUND: Microporous polysaccharide hemospheres consist of controlled-porosity spherical particles manufactured from bioinert plant polysaccharide. Microporous polysaccharide hemospheres facilitate hemostasis by rapidly absorbing the fluid component of blood, concentrating platelets and clotting factors to accelerate blood clotting. OBJECTIVE: The objective was to compare a microporous polysaccharide hemosphere bandage and electrocautery in achieving hemostasis. METHODS: Twenty-four patients with a total of 48 stages of Mohs micrographic surgery were included. Patients were stratified by whether or not they were taking anticoagulant medications. Within each group, patients were randomized to receive either the microporous polysaccharide hemosphere bandage or electrocautery. Outcomes included bleeding through the dressing (early time point) and active bleeding upon dressing removal (late time point). RESULTS: Nineteen patients not taking anticoagulants had 40 stages, of which 18 received the study bandage and 22 received electrocautery. The remaining 5 patients on anticoagulants had 8 stages, of which 4 received the study bandage and 4 received electrocautery. In both total and subgroup analysis, there was a higher incidence of bleeding through the dressing with the study bandage (p<0.05), but no increase in the incidence of active bleeding upon dressing removal (p>0.05). CONCLUSION: The microporous polysaccharide hemosphere study bandage had an increased incidence of bleeding through the dressing compared to electrocautery, but did not have an increased incidence of active bleeding upon dressing removal.

Effect of acitretin on wound healing in organ transplant recipients.

BACKGROUND: Systemic retinoids possess significant benefits in cutaneous malignancy chemoprevention; however, retinoids have been associated with excessive granulation tissue and hypertrophic scarring. OBJECTIVE: The objective of this study was to assess wound healing outcomes in organ transplant recipients, both with and without the concomitant use of systemic acitretin chemoprophylaxis. METHODS: Twenty-nine immunosuppressed organ transplant recipients underwent treatment of basal cell or squamous cell carcinoma by Mohs or excisional surgery, with a total of 85 wounds. Wounds were evaluated postoperatively at early (average 12.9 days) and late (average 75.8 days) time points. Endpoints for all wounds included infection, hypertrophic granulation tissue, and hypertrophic scarring. Reconstructed wounds were also evaluated for dehiscence. RESULTS: Eleven patients taking oral acitretin had 41 wounds, of which 33 were reconstructed and 8 healed by second intention. The 18 patients not taking acitretin (control group) had a total of 44 wounds, of which 33 were reconstructed and 11 healed by second intention. There were no statistically significant differences between the acitretin group and the control group in the incidences of infection, dehiscence, hypertrophic granulation tissue, or hypertrophic scarring at early or late evaluation points. CONCLUSIONS: Systemic acitretin chemoprophylaxis does not appear to increase the risk of wound healing complications in organ transplant recipients.

Long-term efficacy and quality of life in the treatment of focal hyperhidrosis with botulinum toxin A.

BACKGROUND: Botulinum toxin A has been used increasingly in the treatment of focal hyperhidrosis. OBJECTIVE: To assess the long-term efficacy of botulinum toxin A in the treatment of hyperhidrosis and the changes in quality of life and patient satisfaction with treatment. METHODS: A questionnaire was designed to assess the efficacy using visual analog scales and the quality of life both before and after treatment using a modified Dermatology Life Quality Index scale. RESULTS: There was a reduction in the hyperhidrosis and a statistically significant improvement in the quality of life scores for the axillae, palms, and forehead. CONCLUSION: Botulinum toxin A injections are safe and effective for the treatment of hyperhidrosis of the axillae, palms, and forehead, resulting in an improved quality of life for patients.