Samuel J. Stegman

Abscess formation and local necrosis after treatment with Zyderm or Zyplast Collagen Implant

The incidence, clinical presentation, pathophysiology, and possible treatment of two rare but clinically meaningful complications of tissue augmentation with Zyderm and Zyplast Collagen Implant are described. Abscesses as a manifestation of hypersensitivity to bovine collagen occur rarely (4 in 10,000 cases) and may persist for days to weeks. Periods of remission and exacerbation may occur from 1 month to more than 24 months. Localized tissue necrosis also occurs rarely (9 in 10,000 cases) after implantation and is probably the result of local vascular interruption and not hypersensitivity. The incidence varies greatly between the anatomic sites of implantation; more than half the reported cases involve the glabella. Evidence strongly suggests that the increased vulnerability of the glabellar region is due to its unique vascular distribution.

Atypical keloids after dermabrasion of patients taking isotretinoin

Six patients underwent dermabrasion while on or having recently completed isotretinoin (Accutane) therapy. All patients developed keloids in atypical locations; the keloids eventually responded to topical or intralesional steroid therapy. Retinoids have a modulatory effect on connective tissue metabolism, including suppression of collagenase, which may enhance keloid formation. Dermabrasion should be delayed in those patients taking or recently on isotretinoin therapy.

Microscopic‐controlled excision of cutaneous tumors. Chemosurgery, fresh tissue technique

A modification of Mohs chemosurgery which eliminates the zinc chloride paste but follows the careful piece by piece excision, marking, and mapping has been developed for the treatment of cutaneous tumors. The technique is called Microscopic Controlled Excision (MCE). This 8‐year retrospective study reports a 97.2% cure rate for 532 determinant lesions. One hundred eighty‐five (35%) of these cases followed for 5 years or longer had a 96% cure rate. The modified technique eliminates the pain of zinc chloride fixative paste, shortens the time required to perform the surgery, removes less uninvolved, normal tissues, and the final defect is a fresh surgical wound which can be repaired immediately. These advantages become highly significant since a high 5‐year cure rate can be obtained. It is recommended that this technique be used for all tumors which recur after routine treatment by excision, radiation therapy, curettage and desiccation, or cryosurgery, for tumors with poorly defined clinical borders, for sclerosing basal cell epitheliomas, and for primary cutaneous carcinomas in areas which have a predilection for recurrence.

Basal cell carcinoma and squamous cell carcinoma. Recognition and treatment.

Although they are common, careful attention is necessary to detect basal cell carcinomas and squamous cell carcinomas early on. Suggestions for easier detection, as well as proper selection of therapy, are discussed.

Effects of phytohemagglutinin and concanavalin-A on mammalian epidermal cells

Abstract Effects of membrane activation by lectins on undifferentiated and differentiated epidermal cells of newborn rats were investigated after intradermal injection of phytohemagglutinin and concanavalin-A. Between 4 to 6 hr DNA synthesis decreased in the basal cells, the spinous cells enlarged, and protein synthesis was suppressed. By 24 hr, a decrease in the number of granular cells was observed because the superficial granular cells became cornified normally but new granular cells were not formed. Also at 24 hr, the number of cells synthesizing DNA increased and the spinous layer thickened. Glycogen deposition appeared in the basal, spinous, and granular cells between 8 hr and 24 hr. New granular cells were formed by 48 hr and both protein and DNA synthesis recovered by 72 hr. These results suggested that membrane bound lectins affect epidermal cells in a manner that resembles various types of epidermal injury.