Expanded applications of carbon dioxide laser in facial plastic surgery.
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Facial Dermatoses↗
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Naevi spili, Café-au-lait spots and melanocytic naevi aggregated alongside Blaschko's lines, with a review of segmental melanocytic lesions.
This is the first case in the literature describing naevi spili, café-au-lait spots and melanocytic naevi aggregated along-side Blaschko's lines. The pattern of melanocytic lesions in our patient is different from the congenital pigmentary syndromes and the segmental distribution of melanocytic naevi, the quadrant distribution of dysplastic naevi or the partial unilateral lentiginosis which here are shortly reviewed. The distribution may be a result of a somatic mutation occurring at an early stage of embryogenesis when neural structures had already been formed.
Cafe-au-Lait Spots↗
Reconstructing visual manifestations of disease from archaeological human remains.
This paper reports on a study that aims to fill a niche within scientific illustration by developing a method whereby evidence of disease and trauma in archaeological human remains can be translated into a meaningful visual reconstruction of a diseased or physically impaired individual in life. A case study is presented, which involved reconstructing the rhino-maxillary effects of leprosy in an adult male. It is suggested that such reconstruction illustrations could have an important role in communicating ideas both to specialists and particularly to non-specialists, and may also be valuable as research tools in their own right.
Archaeology↗
Cutaneous anthrax associated with facial palsy: case report and literature review.
BACKGROUND: Anthrax is primarily an animal disease. Bacillus anthracis, the causal agent in anthrax, is a Gram-positive rod. Humans can acquire anthrax by industrial exposure to infected animals or animal products. METHODS: Reported here is the case of a 48-year-old male farm worker from Iran with a history of direct contact with herds. He presented after 6 days of fever with toxicity and a crusted ulcer on the face that was later confirmed bacteriologically to be cutaneous anthrax. He was treated with large doses of intravenous penicillin and corticosteroids along with multiple subcutaneous epinephrine injections that were used to control the infection and massive facial edema. RESULTS: After 14 days, he partially recovered; however, ipsilateral facial nerve palsy developed and persisted despite therapeutic efforts. CONCLUSION: It is not possible to conclude whether early diagnosis and treatment of anthrax results in a lower risk of complications. Facial palsy can be added to the list of variable complications of the cutaneous effects of anthrax.
Adrenal Cortex Hormones↗
Treatment of facial vascular lesions with intense pulsed light.
BACKGROUND: Various lasers, particularly the flashlamp-pulsed dye laser, have been proven to be effective in the treatment of facial vascular lesions. Nevertheless, the post-treatment side effects, such as pronounced purpura and changes in pigmentation, have been a matter of concern to patients. OBJECTIVE: To test the efficacy of an alternative treatment option that uses intense pulsed light to provide patients with a more tolerable post-treatment outcome. METHODS: A total of 200 patients were treated with an intense pulsed light source (PhotoDerm VL) using various treatment parameters. The patients were treated for facial veins (primarily telangiectasia), facial hemangiomas, rosacea and port wine stains. RESULTS: Of the 188 patients who returned for follow-up after 2 months, 174 achieved 75% to 100% clearance in one to four treatment sessions. The post-treatment side effects were minimal and well tolerated by the patients. There were no instances of scarring or other permanent side effects. CONCLUSION: The PhotoDerm VL provides a highly effective and safe alternative to the laser for treatment of facial vascular lesions. The device may achieve improved results for lesions that are resistant to laser therapy. The rate and degree of cosmetic side effects are considerably less than with laser treatment.
Adolescent↗
Malignant melanoma simulating schwannian differentiation.
A malignant melanoma demonstrating palisades of spindled melanocytes strikingly similar to Verocay bodies is reported. Immunohistochemical staining for S-100 protein and neuron-specific enolase revealed uniform positive staining of the neoplastic cells consistent with malignant melanoma. Immunohistochemical staining for myelin basic protein, a marker specific for Schwann cells, was negative in neoplastic cells. Ultrastructural examination revealed numerous melanosomes, confirming the melanocytic nature of this neoplasm. The differential diagnosis and possible histogenesis of this neoplasm are discussed.
Aged↗
Verruciform xanthoma of the nose in an elderly male.
Verruciform xanthoma, first reported in 1971, has been thought to be primarily a lesion of oral and genital sites, the overwhelming majority occurring in the mouth. Recently a few cases have been seen in other sites in association with inflammatory linear epithelial nevus or epidermal nevus syndrome. This report is the first known example of verruciform xanthoma arising in the sun-damaged facial skin of an older patient who had no other associated cutaneous abnormalities.
Aged↗
In situ hybridization analysis of human papillomavirus in orofacial lesions using a consensus biotinylated probe.
The effectiveness of the Viratype Omniprobe in situ human papillomavirus tissue hybridization kit (Digene Diagnostics) was evaluated for the detection of HPV DNA in common orofacial lesions. Seventy mucocutaneous lesions were hybridized with a biotinylated Omniprobe that was specific for HPV types 6, 11, 16, 18, 31, 33, 35, 42, 43, 44, 45, 51, 52, and 56. Eighteen (25.7%) of the specimens analyzed had intranuclear positive signals for HPV. Probing with HPV 6/11, 16/18, and 31/33/35 to delimit the HPV genotype yielded HPV DNA 6/11 in 16 (88.9%) of the Omniprobe-positive specimens. Only squamous papilloma and condyloma acuminatum were found to harbor HPV DNA. Sites most frequently infected were the labial and buccal mucosa (21.7%) and the floor of the mouth (17.4%). These results suggest that hybridization with the Omniprobe provides appropriate sensitivity and specificity for detecting HPV in some benign proliferations of the oral cavity. However, the detection of HPV in oral squamous cell carcinoma, lichen planus, and keratoacanthoma remains problematic until more sensitive and specific molecular techniques are used.
Carcinoma, Squamous Cell↗
The hybrid epidermoid and apocrine cyst. A combination of apocrine hidrocystoma and epidermal inclusion cyst.
We describe four cases of unusual superficial cutaneous cysts that have a lining epithelium composed of apocrine cells immediately adjacent to keratinizing squamous epithelium with an intact granular layer. Two of the cysts were on the nipple of the breast and two of the cysts were on the face. The lumina of all four cysts contained keratin. Immunoperoxidase staining for carcinoembryonic antigen in the facial cysts showed positive staining within the apocrine cells of the lining epithelium in one case. The pathogenesis of these lesions is uncertain. We suggest that these unusual cysts be called hybrid epidermoid and apocrine cysts.
Adult↗
Argon-pumped tunable dye laser.
The argon-pumped tunable dye laser (APTDL) is useful in the treatment of a wide variety of superficial vascular and melanocytic lesions. Safety is enhanced by the use of a computerized scanning device--the Hexascan. Over a 1-year period, 140 patients (33 patients under the age of 21, and 21 patients from 0 to 10 years of age) were treated. Facial rosacea/telangiectasia was the most frequently treated lesion, followed by port-wine stain. Although multiple treatments were often necessary, fading was successfully achieved in most patients without scarring or other complications.
Adolescent↗
Botulinum toxin A for hyperkinetic facial lines: results of a double-blind, placebo-controlled study.
Previous work on patients with muscular dystonia has shown that small intramuscular doses of botulinum toxin A eliminated hyperkinetic facial lines for approximately 6 months. The purpose of this study was to determine the efficacy of botulinum toxin A injections in eliminating facial wrinkles in aesthetic surgery patients who do not have muscular dystonia. Eleven healthy subjects were studied in a double-blind fashion. On both sides of the face, 0.2 cc of either normal saline or botulinum toxin A was injected into the forehead or into the periorbital wrinkles (crow's feet). Documentation of results was made by photographs taken of the patients during repose and during facial animation before and after injection. Assessment of facial wrinkles was done from a grading system in which the patient and the facial plastic surgeon were asked to judge the severity of the wrinkles on a scale from 0 to 3, with 0 reflecting no facial wrinkles and 3 reflecting severe facial wrinkling. Nine of 11 subjects injected with botulinum toxin A noted a significant improvement in the severity of their facial wrinkles in comparison with the side of the face injected with saline, with a rating improvement of 2 points. Two of 11 subjects noted a moderate improvement, with a rating improvement of 1 point. No patient injected with saline reported an improvement in the severity of the facial wrinkles on the control side. There were no serious complications. Botulinum toxin A is an efficacious method of nonsurgically eliminating facial wrinkles and may play a role in the cosmetic enhancement of the aging face.
Adult↗
Use of distortions in the treatment of skin lesions of the face: the distorting excision.
Reconstruction after excision of a cutaneous lesion of the face is done by various complex old and new flaps to avoid any distortion. The distortions following primary closure of defects in the face are given undue importance. We have observed and used the capacity of self-correction of these distortions, which is partially due to the muscular actions. We show our experience in various distorting reconstructions of the face in 36 patients. Because of our partial presence in a children's hospital, most of our patients were children.
Adaptation, Physiological↗
Hyperpigmented burn injuries of the face: treatment with the Q-switched ruby laser.
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Adult↗
Trichilemmal carcinoma occurring in a lesion of solar keratosis.
A case of trichilemmal carcinoma occurring in a lesion of solar keratosis was reported. A 92-year-old woman had an erythematous plaque on her face that contained a reddish nodule. Histological examination of the nodule revealed typical features of trichilemmal carcinoma accompanied by those of solar keratosis in the marginal zone. The histological features of the erythematous plaque corresponded with those of solar keratosis. However, in situ the carcinoma developed in the epithelium of a hair follicle as well as in the interfollicular epidermis in the lesion of solar keratosis. We considered it likely that bowenoid malignant transformation occurred in both interadnexal and adnexal epithelium because of actinic damage, and a trichilemmal carcinoma arose. The paper also discussed the histogenesis of trichilemmal carcinoma.
Aged↗
Solitary piloleiomyoma with an unusual clinical appearance.
We present a 66-year-old man with a solitary piloleiomyoma on the forehead. The lesion had unusual clinical features; it was a crusted and dome-shaped nodule, which exhibited rapid growth. Histology revealed the typical features of piloleiomyoma. The unusual clinical features may have been due to its unique location, in which the downward growth of the tumor was prevented by the underlying frontal bone.
Aged↗
A comparison of dermoscopic features among lentigo senilis/initial seborrheic keratosis, seborrheic keratosis, lentigo maligna and lentigo maligna melanoma on the face.
Clinical differentiation of facial lentigo senilis/initial seborrheic keratosis (LS/ISK), seborrheic keratosis (SK), lentigo maligna (LM), and lentigo maligna melanoma (LMM) can be difficult. Dermoscopy improves the diagnoses in pigmented skin lesions (PSLs), but it is not helpful for the sun-exposed face because of the flat rete ridges without network-derived features. Therefore, development of new diagnostic criteria for this particular localization is a current issue of dermatology. In this retrospective study, dermoscopic slides of facial pigmented skin lesions of 66 patients referred to two clinics in Turkey were evaluated. Our aim was to determine the reliability of dermoscopy in the differentiation of these entities. The facial PSLs of 66 patients (34 males and 32 females) (median age: 58.2) were photographed with a Dermaphot (Heine, Hersching, Germany) over a five year period from November of 1995 to May of 2000. All of the dermoscopic slides were analysed according to 27 dermoscopic criteria developed by Schiffner et al. This data set contained 22 histologically proven malignant (14 LM, 8 early LMM) and 44 benign (18 SK, 26 LS/ISK) PSLs. In general, asymmetric pigmented follicular openings, dark streaks, slate-gray streaks, dark globules, slate-gray globules, dark dots, dark rhomboidal structures, light brown rhomboidal structures, dark homogeneous areas and dark pseudonetworks were statistically significant for malignant growth. On the other hand, milia-like cysts, pseudofollicular openings, cerebriform structures, light brown globules, light brown dots, light brown homogeneous areas, yellow opaque homogeneous areas, and light brown pseudonetworks were statistically significant for benign growth. This research emphasizes that dermoscopic features on the face differ from criteria used in other locations of the body. Analysis of the data suggests that dermoscopy can be used in the differentiation of LS/ISK, SK, LM and LMM from each other.
Color↗
Complicated mycosis fungoides mimicking facial erysipelas.
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Diagnosis, Differential↗
Trichilemmomal horn: cutaneous horn overlying trichilemmoma.
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Aged↗