Elizabeth I. McBurney

Erythema Gyratum Repens

BackgroundErythema gyratum repens is a rare, clinically specific, and distinctive paraneoplastic syndrome. It is associated with internal malignancy in 82% of patients. ObjectiveA 58-year-old man with erythema gyratum repens is described. On diagnosis of his eruption, a malignancy work-up revealed a 9-mm pulmonary adenocarcinoma. Removal of the carcinoma resulted in clearing of the erythema. ResultsErythema gyratum repens is most commonly associated with bronchial, esophageal, and breast cancer. It has also rarely been reported in patients without evidence of malignancy. The histopathologic findings are nonspecific. Direct immunofluorescence has sometimes revealed C3, C4, or immunoglobulin G at the basement membrane zone. ConclusionThe etiology of erythema gyratum repens is unknown, although an immune response is postulated. Treatment involves treating the underlying malignancy.

Use of Valacyclovir for Herpes Simplex Virus‐1 (HSV‐1) Prophylaxis After Facial Resurfacing: A Randomized Clinical Trial of Dosing Regimens

Background. Reactivation of herpes simplex virus‐1 (HSV‐1) after facial resurfacing has led to severe outbreaks, delayed reepitheliazation, and scarring. Current recommendations regarding the dosing of antivirals used prophylactically are based mostly on anecdotal experience. No studies have addressed the question of when such antiviral prophylaxis should begin. Objective. The purpose of this study was to compare the efficacy of valacyclovir used as an antiviral prophylaxis when started the morning before versus the morning of facial resurfacing procedures. Methods. Eighty‐four patients who presented for facial resurfacing were enrolled. Resurfacing was performed using laser (CO2, Er:YAG), chemical peeling, dermabrasion/dermasanding, or some combination of these techniques. Patients were randomly assigned to start valacyclovir 500 mg twice daily either the morning before or the morning of the procedure. Viral cultures were performed at baseline on all patients, at any sign of infection, and at the end of the 14‐day treatment period. All patients were followed for 21 days postoperatively. Results. Valacyclovir was 100% effective in the prevention of HSV reactivation in both regimens with no adverse effects reported. Conclusion. This study demonstrates the efficacy of valacyclovir as a preventive agent against HSV outbreaks following facial resurfacing whether started the day before or the day of surgery.

Side effects and complications of laser therapy.

Laser skin surgery is not without risk and some degree of downtime in most situations. Patient satisfaction is key to the perceived success of the procedure. Therefore, the physician must fully explain all risks, potential complications, and expected morbidity associated with any laser treatment to be performed. Although many side effects can be avoided by use of appropriate intraoperative technique and adequate postoperative management, untoward effects may still occur and must be promptly identified and addressed. An informed patient is an important factor in the healing process and contributes to the success of the procedure.

Atypical cutaneous lymphocytic infiltrate and a role for quantitative immunohistochemistry and gene rearrangement studies.

Aim To help clarify the significance of the T‐cell receptor (TCR) gene rearrangement and its relationship to the immunophenotyping of histologically atypical cutaneous T‐cell lymphoid infiltrates (ACLIs).

Strategic mentoring: Growth for mentor and mentee

Mentoring is enriching for both the mentor and mentee, but often getting started can be a primary obstacle to this useful tool. This contribution focuses on how to embark on a mentoring relationship with a junior colleague. In addition to describing various approaches to being a mentor, it outlines unproductive traps to avoid, steps to establishing a successful mentoring relationship, including conversation starters, and professional skills one can continue to develop to improve mentoring outcomes.

Diagnostic Dermatologic Methods

Seven simple and straightforward diagnostic procedures are reviewed in this article, all of which can be performed in the pediatrician’s office.