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It has been reported that the final outcome of laser resurfacing still depends to a large degree on the efficiency of the post laser resurfacing wound care in promoting wound healing and preventing early and late complications.The objective of this study was to evaluate and compare a new hydrocolloid dressing, H2460, with Flexzan(TM) for healing of an acute wound after laser skin resurfacing (LSR).Ten volunteers received LSR of the peri-orbital area with an erbium:YAG laser. Identical parameters were used on both sides: 2 J, 5 mm spot, 8 Hz, 300 micros pulse, two passes on the upper eyelids, four passes on the lower eyelids and six passes on the crow's feet area. Soon after the LSR, one side was covered with Flexzan dressing and the other side was covered with a new hydrocolloid dressing -- H2460. The side of the dressing was randomized by alternating both dressings. All volunteers were evaluated and digitally photographed every day for a week and at 1 month after LSR. The degree of erythema, swelling, bleeding, oozing, crusting, pigmentary changes, scarring, discomfort, itching, burning, ease of application of dressings, initial adhesion, overall adhesion, leakage of fluid, maceration of surrounding skin, ease of removal and adhesive residue upon removal were documented.In all volunteer and investigator's evaluations, the new dressing, H2460, achieved far better results than Flexzan in each category. After a 1-week follow-up all volunteers and the investigator evaluated the H2460 side as: healed better, simple to use, and caused less discomfort in 10 out of 10 volunteers. The blinded observer's assessment showed that the Flexzan side healed better in one volunteer.The new dressing, H2460, is a better and suitable alternative to Flexzan as a post LSR dressing.

We report on a 3-year-old boy with hair abnormalities and a generalized bone dysplasia. He had very short, sparse hair and craniosynotosis. His stature, growth, and limb lengths were normal, as was his neurological development. While this phenotype has some resemblance to cranioectodermal dysplasia, the radiographic and hair abnormalities are different. Histological studies showed abnormalities in the internal root sheath of the hair follicle and the hair shaft. These findings define a new ectodermal dysplasia syndrome of unknown cause. © 1993 Wiley-Liss, Inc.

Optical ranging using femtosecond laser pulses and nonlinear-optical cross correlation is demonstrated for the investigation of the microstructure of biological systems. By using pulses of 65-fsec duration generated by a colliding-pulse mode-locked ring dye laser, a spatial resolution of less than 15 μm is achieved with a detection sensitivity to remitted signals as small as 10−7 of the incident pulse energy. This technique is applied to measure the cornea in rabbit eyes in vivo as well as to investigate the epidermal structure of human skin in vitro.

Background and Design: Solar-induced cutaneous damage is mediated partly via oxidative pathways. Some evidence exists for a photoprotective role of antioxidants. In a double-blind, placebo-controlled study, we examined the effect of a long-term, orally administered antioxidant against UV-induced epidermal damage. Healthy human subjects supplemented their usual diet daily with either 400 IU of oral vitamin E (α-tocopherol acetate) or placebo over a 6-month period. Minimal erythema dose and histologic response to threefold minimal erythema dose exposure were determined at baseline, 1 month, and 6 months. Results: The minimal erythema dose did not vary substantially at the three time points within each treatment group or in the vitamin E—supplemented group vs the placebo group. The number of sunburn cells produced by a threefold minimal erythema dose exposure was also not significantly different between the two groups. Of note, however, vitamin E levels in plasma increased only modestly and in skin biopsy specimens were unchanged following 1 month and 6 months of supplementation. Conclusions: No clinical or histologic difference in the response to UVB could be detected between the placebo and vitamin E—supplemented groups. In this small study, daily ingestion of 400IU of oral α-tocopherol daily does not provide meaningful photoprotection. (Arch Dermatol. 1994;130:1257-1261)

Chancroid is a venereal disease caused by the microorganism Haemophilus ducreyi . Herein we present two cases of chancroid, with a review of the diagnostic laboratory tests, the treatment of this disease, and the differential diagnosis of genital ulcers.

Despite steady improvement in the laser treatment of port wine stains (PWS), hypertrophic scarring remains a serious side-effect in approximately 10% of patients. The tunable dye laser (577 nm) has been shown to cause selective vascular destruction in normal and PWS skin. We have treated ten patients using a tunable dye laser (577 nm, 300 mu sec) resulting in clearing of the PWS without any evidence of hypertrophic scarring. Treatment requires no anesthesia or wound care, and there were no postoperative infections.

A retrospective study of 21 patients with the histopathologic diagnosis of minimal deviation melanoma (MDM; n = 18) and borderline melanoma (BM; n = 3) was undertaken to determine the prognosis for these patients compared with that for patients with other types of malignant melanoma. The findings indicate that the prognosis for these uncommon nevomelanocytic tumors is somewhat better than that for other malignant melanomas. Follow-up periods in this series ranged from 18 to 96 months (mean, 57 months). Primary lesions ranged in thickness from 1.6 to 10.4 mm. The histopathologic subtypes included the Spitz variant (nine patients), the spindle cell variant (six patients), the combined spindle and epithelioid cell type (three patients), and the small epithelioid cell type (three patients). Only two of the patients died of widespread metastatic disease. Comparison of the histologic and clinical prognostic indicators of mortality in patients who have malignant melanoma with the clinical and pathologic features seen in this series of 21 patients would appear to indicate a diminished tendency toward metastatic or recurrent disease in patients with MDM and BM.

Presentation of Case A 25-year-old woman was admitted to the hospital because of syncope. She was well until five days earlier, when she began to experience orthostatic dizziness, nausea, and sweating, accompanied by the passage of tarry stools. Crampy pain in both lower abdominal quadrants prompted the removal of an intrauterine device, which had been inserted one month earlier; there was no improvement in the symptoms. On the day of admission she lost consciousness while walking to work and was brought to the Emergency Ward. Grand-mal seizures developed when the patient was 11 years of age and were controlled with . . .

A patient with T4+ (helper-inducer) T cell chronic lymphocytic leukemia developed an erythema multiforme-like eruption, the diagnosis of which was supported by routine light microscopic findings. Immunopathologic studies using monoclonal antibodies demonstrate that despite an overwhelming majority of leukemic T4+ cells in the peripheral blood and dermal infiltrate, the predominant cells in the epidermal infiltrate are T8+ (cytotoxic-suppressor) cells. These findings are different from those seen in epidermotropic T cell leukemic infiltrates and are similar to those previously reported in erythema multiforme. Thus it is likely that the leukemic T4+ cells are participating in this cutaneous hypersensitivity reaction along with residual, normal T8+ cells.

Presentation of Case A 15-year-old boy was admitted to the hospital because of a progressive cutaneous disorder. He was born of an uneventful full-term third pregnancy and vaginal delivery and apparently developed normally as an infant. Soon after his first year of life hyperpigmented macules and hypopigmented papular lesions developed over the exposed areas of his skin and gradually spread to affect most of his body. At the age of three years he became blind in the right eye, and in more recent years vision was impaired in the left eye. He never attended school. Through the years his mother . . .

The preponderance of malignant melanomas that occur in the Japanese population affect the palmar and plantar areas, in contrast to those of whites, which occur predominantly on the head, neck, and trunk. Furthermore, a precursor lesion, the dysplastic nevus, has been well defined in nonacral white skin but not in the Japanese. In this paper, a similarity between benign and atypical acral nevomelanocytic proliferations in Japanese and whites is described. However, it appears that in the Japanese group the melanocytes in benign and atypical proliferations are less dendritic than those noted in whites, and, in both groups, extensive pigmentation was noted in both the epidermal and dermal components of benign and malignant lesions in this limited review. A practical approach to classifications of atypism is, likewise, offered, J Invest Dermatol 92:222S–226S, 1989

Local exposure of the sites of elicitation (ears) of contact hypersensitivity (CHS) in mice to relatively modest doses of ultraviolet radiation (FS40 sunlamps) daily for 4 days prior to challenge in previously immunized animals results in significant enhancement of the CHS response as measured by 24-h swelling. This effect was seen in both C3H/HeJ and A/J mice and with the use of both trinitrochlorobenzene and dinitrofluorobenzene as contact sensitizers. Doses of PUVA (parenteral administration of 8-methoxypsoralen followed by exposure to UVA, 320-400 nm, radiation) up to that which can systemically suppress the induction of CHS failed to affect the elicitation of CHS. Irritation of the sites of elicitation of CHS by applications of turpentine also failed to affect the CHS elicitation reaction. Enhancement of the CHS elicitation response by local ultraviolet radiation exposure prior to challenge appears to be a specific photobiologic event.

Minimal deviation melanomas are uncommon nevomelanocytic tumors of indeterminate risk that appear as pigmented or nonpigmented skin nodules and are clinically diagnosed as Spitz nevi, hemangiomas, or malignant melanomas. They are characterized histologically by expansile growth in the papillary dermis with reticular dermal infiltration (minimal deviation type) or without reticular dermal invasion (borderline type). The tumors exhibit lesser cytologic atypia in their vertical growth phase (histologic variance) than observed in common forms of melanoma. A retrospective study of outcome in 21 patients with minimal deviation melanoma (mean tumor thickness by Breslow's measurement = 3.6 mm) disclosed recurrent disease in only 3 patients after a mean observation period of 57 months, supporting the impression that these tumors are not as biologically aggressive as common malignant melanomas. The histologic subtypes of minimal deviation melanoma are reviewed along with a discussion of the concept of histologic variance.

351 nm, 20-nsec XeF excimer laser irradiation has previously been shown to selectively target and damage melanosomes in human skin. In the following studies selective targeting with melanosomal photodisruption has been demonstrated in pigmented guinea pig skin with a Q-switched 40-nsec ruby laser, and a 750-nsec pulsed dye laser but not with a 400-usec pulsed dye laser. The pulse width dependence of melanosomal disruption, occurring only at pulsewidths shorter than the thermal relaxation time of the melanosome (0.5 - 1.0 usec), is in accordance with the theory of selective photothermolysis. Possible mechanisms of melanosomal photodisruption include development of sudden thermal gradients leading to cavitation or shock wave production.

• Q-switched ruby laser pulses cause selective damage to cutaneous pigmented cells. Repair of this selective damage has not been well described. Therefore, using epilated pigmented and albino guinea pig skin, we studied the acute injury and tissue repair caused by 40-ns, Q-switched ruby laser pulses. Gross observation and light and electron microscopy were performed. No specific changes were evident in the albino guinea pigs. In pigmented animals, with radiant exposures of 0.4 J/cm 2 or greater, white spots confined to the 2.5-mm exposure sites developed immediately and faded over 20 minutes. Delayed depigmentation occurred at seven to ten days, followed by full repigmentation by four to eight weeks. Regrowing hairs in sites irradiated at and above 0.4 J/cm 2 remained white for at least four months. Histologically, vacuolation of pigment-laden cells was seen immediately in the epidermis and the follicular epithelium at exposures of 0.3 J/cm 2 and greater. Melanosomal disruption was seen immediately by electron microscopy at and above 0.3 J/cm 2 . Over the next seven days, epidermal necrosis was followed by regeneration of a depigmented epidermis. By four months, melanosomes and melanin pigmentation had returned; however, hair follicles remained depigmented and devoid of melanocytes. This study demonstrates that selective melanosomal disruption caused by Q-switched ruby laser pulses leads to transient cutaneous depigmentation and persistent follicular depigmentation. Potential exists for selective treatment of pigmented epidermal and dermal lesions with this modality. ( Arch Dermatol 1989;125:43-49)

• Although the blue-green argon laser light has been used successfully to treat port-wine stains (PWSs) for many years, it produces substantial epidermal damage. We have previously shown in normal human skin that pulsed yellow tunable dye lasers (577-nm wavelength) can cause highly selective damage to cutaneous microvessels with minimal injury to the overlying epidermis. Pulsed tunable dye lasers also produce selective vascular injury in the abnormal vessels of PWSs, with clinically apparent lightening of the lesions. Both epidermal injury and fibrosis are less severe with this laser treatment than with argon and carbon dioxide laser treatments. Clinical and histologic responses of PWSs treated by argon, CO 2 , and pulsed yellow dye lasers were compared and followed up for one month in three patients. Although larger and longer-term clinical trials are necessary to fully evaluate this new treatment modality, it appears that pulsed yellow laser radiation offers a more selective, less traumatic, and probably superior form of treatment for PWSs. ( Arch Dermatol 1986;122:1016-1022)

To the Editor.— Erythropoietic protoporphyria (EPP) is an inherited disorder of porphyrin metabolism resulting in the elevation of red blood cell, plasma, and fecal protoporphyrin levels, plus cutaneous photosensitivity. The most common symptoms are painful burning and pruritus of exposed skin, often arising within minutes of exposure to ultraviolet light. Acute skin findings may include erythema or edema. However, skin lesions following attacks may be subtle or absent.1,2 The onset of symptoms in EPP is normally in infancy or in early childhood on first exposure to sunlight; it is rare for initial symptoms to occur late in life.3The most common of the porphyrias to present in adulthood is porphyria cutanea tarda. This porphyria typically presents in middle age, and is commonly associated with alcohol abuse or diabetes mellitus. Skin manifestations include vesicles, bullae, and milia, and scarring in sun-exposed skin, as well as increased skin fragility, sclerotic