Betty Bellman

Cosmetic Use of Botulinum A Exotoxin for the Aging Neck

background. The use of botulinum toxin for facial rhytides has become more popular. In the past, plastic surgery was the only choice for rejuvenation of the aging neck. We discuss the cosmetic use of botulinum toxin for the rejuvenation of the neck and review the anatomy. objectives. We will review the four age‐related neck degeneration categories and discuss how to inject botulinum A exotoxin into the platysmal neck bands. result. We will discuss how botulinum can tighten neck jowls, eliminate horizontal neck rhytides, and improve skin laxity. conclusion. Botulinum A exotoxin is a safe, effective, alternative treatment for rejuvenation of the aging neck and lower face. Patients are uniformly satisfied and complications are minimal.

Cutaneous disseminated histoplasmosis in AIDS patients in south Florida

Background Histoplasma capsulatum is a dimorphic pathogenic fungus endemic to the Mississippi and Ohio river valleys. In the immunocompetent it causes a self‐limited disease, but in the immunocompromised may lead to disseminated disease (disseminated histoplasmosis (DH)). It is one of the opportunistic infections which defines the acquired immunodeficiency syndrome (AIDS) and is rarely encountered outside endemic regions.

Infection with Methicillin-resistant Staphylococcus aureus after Carbon Dioxide Resurfacing of the Face: Successful Treatment with Minocycline, Rifampin, and Mupiricin Ointment

background. The incidence of cutaneous bacterial infection after carbon dioxide (CO2 laser resurfacing is increasing. Patients with staphylococcal colonization of their anterior nares may be at greater risk for postoperative cutaneous colonization and/or infection, which can potentially cause scarring. objective. We present a case report of methicillin‐resistant Staphylococcus aureus secondary infection of the skin after CO2 laser resurfacing. We discuss the possible etiologies of this patients infection, her postoperative management, and preoperative suggestions for possibly preventing infection. methods. A 49‐year‐old woman was treated with CO2 laser resurfacing for moderate actinic damage and facial rhytides. She developed a cutaneous infection with methicillin‐resistant S. aureus, which caused diffuse linear scarring on her cheeks and upper lip. results. The patient was successfully treated with oral minocycline, rifampin, and topical mupiricin ointment to her cutaneous erosions. conclusions. We propose that it would be helpful for patients undergoing CO2 laser resurfacing to have their nares cultured to see if they are staphylococcal carriers. If a patient is found to be a carrier, mupiricin ointment can be used preoperatively treat to the nares, to help decrease the risk of infection of the skin from this potential source.

Immediate and Delayed Hypersensitivity Reactions to Restylane

We report two cases of hypersensitivity reactions to Restylane. In the first case, edema developed in a 57-year-old Hispanic woman 10 minutes after injection of 0.7 mL of Perlane around her upper commissures and Botox in her upper face. The patient had been skin tested for Restylane several months earlier and showed no positive reaction. In the second case, intermittent swelling and induration developed in a 77-year-old Caucasian woman 3 weeks after she received Restylane injections limited to the nasolabial folds. Currently, skin testing prior to hyaluronic acid treatment is not required. Our experience and reports in the literature suggest that while skin testing is unlikely to predict acute reactions to HA, it would be helpful in identifying patients at risk for delayed, long-term reactions.

Prostate cancer metastatic to skin

Cutaneous metastases from adenocarcinoma of the prostate are uncommon despite prostate cancer being the second most common malignancy in the American male population. We report bright red “berry‐like” cutaneous metastases in a dermatomal distribution from adenocarcinoma of the prostate. The prostate origin of the adenocarcinoma was confirmed by immunohistochemical staining for prostate‐specific antigen.

Contact Dermatitis to Polysporin® Masquerading as a Delayed-Type Hypersensitivity Response to Dye Pigment

Background: A 15-year-old Hispanic adolescent with multiple amateur India ink tattoos developed a recurrent, eczematous pruritic eruption several weeks after each treatment with the Q-switched ruby laser. Objective: To determine if the patient was having an allergic reaction to tattoo dye pigment or an allergic contact dermatitis. Methods: Open- and closed-patch testing was performed to Polysporin® ointment, which revealed a 2+ vesicular reaction. Conclusion: Delayed-type hypersensitivity responses to contact allergens can very closely mimic the less common allergic reactions to dye pigment from tattoos. Open- and closed-patch testing to topical medications should be performed on any patient suspected of having an allergic reaction to tattoo dye pigment.