John Louis Ratz

Treatment of dermatofibrosarcoma protuberans with Mohs micrographic surgery.

Ten patients with dermatofibrosarcoma protuberans, all of whom had been treated previously by conventional excisional surgery without success, were treated with Mohs micrographic surgery. A team approach utilizing margin control by Mohstrained physicians and reconstruction by surgical specialists was employed. Average follow-up exceeds 3 1/2 years, with no recurrences. Microscopically controlled excision appears to be the treatment of choice for dermatofibrosarcoma protuberans.

Treatment of hidradenitis suppurativa with carbon dioxide laser excision and second-intention healing.

BACKGROUND Hidradenitis suppurativa is a disabling disease. Although medical management can at times control the disease, the treatment of choice is surgical excision. Surgical defects have been managed by second-intention healing, simple surgical closure, or complex surgical repairs. OBJECTIVE Our purpose was to determine the benefit of carbon dioxide laser excision with healing by second intention to treat lesions of hidradenitis suppurativa. METHODS We treated seven patients who had axillary and inguinoperineal hidradenitis suppurativa with carbon dioxide laser excision followed by second-intention healing. A total of 12 procedures were performed (five bilateral and two unilateral). Follow-up periods were 10 to 27 months. RESULTS After a healing time of 4 to 8 weeks, scars were flat and linear. Only one recurrence of hidradenitis suppurativa has been observed; this occurred along the margin of the surgical scar in a previously treated area. Some patients, however, had continued disease activity in untreated areas. All subjects were satisfied with the results of the procedure, and complications were minimal. CONCLUSION Carbon dioxide laser excision with second-intention healing is safe and effective for hidradenitis suppurativa.

Carbon dioxide laser treatment of chronic actinic cheilitis

The carbon dioxide laser in both conventional and superpulsed modes was used to treat 13 patients with chronic actinic cheilitis. The procedure was well tolerated. Focal, but not functionally restricting, scarring developed in three patients. The cosmetic result was otherwise excellent. No recurrences have been noted.

Treatment of essential telangiectasia: Effects of increasing concentrations of polidocanol†‡

A double-blind, double-paired comparison study was performed to evaluate the effects of increasing concentrations of polidocanol in the sclerotherapy of essential telangiectasias of the legs. Polidocanol 0.25%, 0.50%, 0.75%, and 1.0% were compared with regard to clinical effectiveness, safety, and patient acceptance. All dosages were well tolerated by the patients. There were no allergic reactions to polidocanol and no cases of superficial ulceration nor necrosis. Among those whose veins cleared, there was little difference in time to clearing for the four concentrations, which averaged three to four treatment sessions. No statistically significant differences existed among the four dosages with respect to level of improvement, itching, or neovascularization. Polidocanol 0.75% and 1.0%, however, caused more side effects noted by patients and induced more hyperpigmentation than did the lower concentrations. Polidocanol 0.25% yielded the lowest percentage of patients whose veins cleared. The 0.50% solution was the most effective concentration for total overall clearing of the types of vessels treated in this study. From this information it appears that 0.50% polidocanol may be the sclerosing agent of choice.

Treatment of acne keloidalis nuchae with carbon dioxide laser.

The chronic stage of acne keloidalis nuchae is characterized by symptomatic keloidal papules and plaques on the occipital scalp and posterior neck. We describe our results with the use of the carbon dioxide laser in eight patients with treatment-refractory acne keloidalis nuchae.

Multiple symmetric lipomatosis: Treatment with liposuction

Multiple symmetric lipomatosis is a fascinating disease of uncertain etiology that manifests as massive lipomatous deposits in specific areas of the body. The clinical syndrome and possible pathogenesis are discussed. Classic surgical lipectomy has been the only treatment thus far reported; we report a patient successfully treated with liposuction.

Plasmapheresis, a treatment modality for necrobiotic xanthogranuloma

A case of necrobiotic xanthogranuloma treated with plasmapheresis is reported. This entity is characterized by multiple inflammatory, ulcerative nodules and atrophic plaques with a xanthomatous quality that develop in conjunction with a paraproteinemia. Successful healing of ulcerated lesions and lowering of the paraproteinemia was achieved by plasmapheresis in our patient with necrobiotic xanthogranuloma when cytotoxic therapy failed.

Treatment of angiolymphoid hyperplasia of the external ear with carbon dioxide laser

Two women with long histories of angiolymphoid hyperplasia involving the left external ear were successfully treated with carbon dioxide laser vaporization. In one of these patients a previous treatment with argon laser photocoagulation had proved unsuccessful. Carbon dioxide laser vaporization can be advantageous in the treatment of angiolymphoid hyperplasia, especially when the patient is not a good candidate for cold steel surgery or when the disease process involves confined or convoluted structures such as those on the external ear.

Acute allergic contact dermatitis from diazolidinyl urea (Germall II) in a hair gel

Diazolidinyl urea (Germall II) is a preservative recently used in cosmetics. It is effective against most contaminating microorganisms, especially Pseudomonas. We report the first case of an acute allergic contact dermatitis from diazolidinyl urea that was contained in a hair gel.

Cutaneous amyloidosis: A case report of the tumefactive variant and a review of the spectrum of clinical presentations

A case of primary localized cutaneous amyloidosis is presented to illustrate the spectrum of cutaneous amyloidosis. The clinical, pathologic, and pathogenic characteristics of amyloidosis syndromes are briefly reviewed and summarized.