改良连续皮内缝合在皮肤外科手术中的临床应用

目的 介绍改良连续皮内缝合闭合手术切口的方法及临床效果。 方法 选取82例手术患者,其中色素痣37例,基底细胞癌10例,皮脂腺囊肿16例,脂肪瘤6例,脂溢性角化8例,皮肤纤维瘤3例,凹陷性瘢痕2例。所有皮损均采用单纯手术切除,术后切口长度最短0.8 cm,最长12 cm。术后切口采用改良连续缝合,即将两端带有小三角针的可吸收线,分别按从一侧皮缘真皮内进、出针,然后再从对侧皮缘真皮内进、出针的顺序缝合切口。 结果 82例手术患者,术后均采用改良连续皮内缝合法闭合手术切口,80例Ι期愈合,2例术后2 d开始红肿,疼痛,经对症处理5 d后红肿消失。术后随访3 ~ 6个月,78例切口对合平整、光滑,4例出现瘢痕增生,给予糖皮质激素局部封闭后明显缓解好转。无切口裂开。 结论 改良连续皮内缝合法用于面颈、躯干、四肢皮肤缺损,术后切口对合好,美容效果满意。     

Control of head lice with a coconut-derived emulsion shampoo

Objective   To evaluate a novel coconut-derived emulsion (CDE) shampoo against head lice infestation in children.
Design   A school trial in which pupils were treated on days 0 and 7 and checked on days 8 and 15 and a family trial where product was applied by parents three times in 2 weeks or used as a cosmetic shampoo and checked on days 14 and days 70.
Setting   UK schools in Bristol and Western-super-Mare and families in Northern Somerset.
Main outcome measure   Numbers of children free from infestation after treatment.
Results   In the school trial, percentage cures at day 8 were 14% (permethrin, n  = 7) and 61% (CDE, n  = 37). In the family trial where all family members were treated, cure rate was 96% ( n  = 28), and if the shampoo was subsequently used as a cosmetic shampoo, only 1 of 12 children became re-infested after 10 weeks.
Conclusion   CDE shampoo is a novel effective method of controlling head lice and used after treatment as a cosmetic shampoo can aid in the reduction of re-infestation.     

Utilization of a high-resolution digital imaging system for the objective and quantitative assessment of hyperpigmented spots on the face

Background/aims:   The aim of this study was to quantify and confirm the efficacy of cosmetic formulations for hyperpigmented spots over a wide area of the face using a high quality digital imaging system that we developed.
Methods:   A total of 120 Japanese female volunteers aged 25–60 years with solar lentigines were treated for 6 months with a skin lightening moisturizer (SLM, thereafter) containing 3% magnesium ascorbyl phosphate on one side of the face and vehicle on the other side. During the course of the study, facial images were collected by the image analysis to measure facial skin colour and the total area of hyperpigmented spots. The evaluation was also conducted by visual grading. Measurements were made before and 1, 3, and 6 months after starting the application, and again 6 months after discontinuing the treatment. Three similar clinical studies using the same protocol were repeated for up to one-month to confirm the reproducibility of the results and to examine seasonal variation.
Results:   SLM significantly reduced the total area of hyperpigmented spots ( P  < 0.005) after one month of treatment compared to the vehicle, with no significant variation in facial skin colour tone in the areas outside the hyperpigmented spots. The results of the visual grading were consistent with those obtained by image analysis. The total area of hyperpigmented spots 6 months after discontinuing the treatment had returned to pre-treatment levels. The reproducibility of these clinical results was demonstrated in three follow-up studies.
Conclusions:   A high-resolution digital imaging method, combined with a split-face clinical protocol is sensitive enough to prove that SLM readily reduces hyperpigmented spots, while maintaining normal facial skin colour.     

先天性阴道前庭表皮样囊肿3例报告

目的:探讨先天性阴道前庭表皮样囊肿的临床特点,提高对其诊断、治疗及预后的认识。方法:回顾性分析北京燕化医院2012年1月至12月诊治的3例先天性阴道前庭表皮样囊肿的临床资料,复习相关文献,并进行随访。结果:3例先天性阴道前庭表皮样囊肿患儿均为刚出生后常规体检时由产科大夫发现,经泌尿外科大夫会诊,并在患儿出生后反复观察排尿,证实肿物与尿道无直接关系后第3天行手术完整切除,病理活检证实为表皮样囊肿。1例因表皮样囊肿较大,先去顶减除部分囊肿壁再完整剥除残余囊壁。3例患儿术后分别为1年3个月、11个月及7个月,随访中病儿伤口愈合良好,排尿正常,未发现异常现象。结论:先天性阴道前庭表皮样囊肿为良性病变,外科手术切除是唯一的治疗手段。手术应将囊肿壁完整剥离,最终确诊需依靠病理。     

Dermal and epidermal remodeling using botulinum toxin type A for facial, non reducible, hyperkinetic lines: two case studies

Background  Many studies confirm the safety and efficacy of botulinum toxin type A in a variety of clinical indications. Its use for treatment of hyperfunctional facial lines has become the most popular cosmetic procedure. These case studies comprise an evaluation of the long-term treatment of two subjects treated with botulinum toxin type A (BOTOX®, Allergan, Irvine, CA, USA) for hyperfunctional, nonreducible, facial lines.
Aims  This paper aims to assess the long-term effectiveness of BOTOX treatment for hyperfunctional facial lines in two subjects over 7 years.
Patients/methods  Two subjects (case 1: female aged 53 years; case 2: male age 50 years) presenting with glabelar, forehead, and periorbital facial lines were treated with BOTOX over a 7-year period. Case 1 received a total of 24 treatments at 4-monthly intervals, and case 2 received 21 treatments at 3- to 6-monthly intervals.
Results  Skin quality continued to improve over time, revealing a smoother, enhanced, yet "natural" look. In particular, nonreducible forehead lines were effaced suggesting dermal and epidermal remodeling over long-term treatment. There was no evidence of development of any new wrinkles secondary to BOTOX use, and both subjects continue to report high levels of treatment satisfaction. No safety issues were raised.
Conclusions  These case studies demonstrate that nonreducible horizontal forehead lines can show long-term reduction with BOTOX treatment and high levels of subject satisfaction.     

Intratarsal keratinous cysts of the meibomian gland (a sebaceous duct cyst): report of 2 cases

Intratarsal keratinous cyst of the meibomian gland is a recently described entity that recurs if not completely excised. Herein, we report 2 cases and discuss their diagnosis and management: (1) A 57-year-old man with a recurrent mass of the upper eyelid treated with incision and drainage as a chalazion for more than 5 years and (2) An 85-year-old man presented with a slow growing nodule of the upper eyelid. Exploration via the eyelid crease approach revealed cysts fixed to the tarsus that were completely excised with a portion of the anterior tarsus. Histologically, these cysts exhibited a keratinizing squamous epithelium without a granular layer (trichilemmal keratinization), were lined by an eosinophilic undulating cuticle, contain string-like keratin debris, and had a fibrous wall without sebaceous lobules. All epithelial components strongly expressed high-molecular weight keratins, whereas the lining, cuticle, and keratin contents strongly expressed carcinoembryonic antigen. No recurrence has occurred 7 and 12 months postoperatively. The location and clinicopathologic findings of intratarsal keratinous cysts distinguish it from sebaceous tumors, steatocystoma simplex, epidermoid cyst, and dermoid cyst. However, like steatocystomas, intratarsal keratinous cysts exhibit a sebaceous duct phenotype. The anterior lid crease approach with partial tarsectomy seems to be an effective treatment.     

Hybrid cyst: A combined epidermoid and trichilemmal cyst

Seven cases of hybrid cyst, a combined epidermoid and trichilemmal cyst, are reported. Hybrid cysts occurred in five men and two women, and involved the scalp, cheek, back, arm, elbow, and forearm. The clinical diagnosis was usually cyst or sebaceous cyst. Microscopically, the upper portion of the cyst showed epidermoid keratinization in continuity with the surface epidermis, and was indistinguishable from an epidermoid cyst. Showing sharp transition from it, the inferior portion of the lesion displayed trichilemmal keratinization and was indistinguishable from a trichilemmal cyst. Hybrid cyst is not merely a newly described pathologic curiosity; rather, it forms a meaningful link between the two most common types of follicular cysts and adds weight to the body of evidence that most epidermoid cysts are related to the follicular infundibulum, while trichilemmal cysts are related to the follicular isthmus.     

Cohort study on patient response to botulinum toxin cosmetic therapy

Background   Botulinum toxin (BTX) therapy is currently the most popular cosmetic procedure in the United States. However, few studies exist regarding post-procedure perceptions of the patients' BTX therapy.
Objective    The aim of this cohort study was to determine patients' responses from pre- to post-BTX treatment experience.
Methods and materials    One hundred twenty-three BTX patients of six different dermatologic cosmetic practices in various boroughs of New York and Long Island in the state of New York completed the questionnaire. Six hundred eighty-three surveys were sent out, and 123 completed surveys were obtained. Numerous questions were asked regarding how patients felt and responded towards the overall procedure of their BTX therapy.
Results    Eighty-eight percent of patients were satisfied or extremely satisfied with their dermatologists. Sixty-five percent of patients felt over 60% improvement in areas treated. Fifty-eight percent of patients anticipated making repeat visits, whereas the biggest concern for returning was due to the expensive cost of BTX.
Conclusion   Our study correlated with previous studies done on retention rate of BTX cosmetic patients and satisfaction level on areas treated. The cost of BTX remained one of the primary concerns for repeat visits. Most patients were happy with their visits to the dermatology offices for BTX procedure, although things can be done to further enhance their visits and the likelihood that they will return.     

Human papillomavirus type 6/11 identified in an epidermoid cyst of the scrotum

To date, epidermoid cysts associated with human papillomavirus (HPV) infection have been described mainly in palmoplantar locations, and have involved HPV types 60 and 57. In contrast, HPV‐6/11 is a major cause of condyloma acuminatum. Here, we report the case of a healthy 31‐year‐old man who presented to our clinic with a 1‐month history of a 1‐cm, reddish‐brown, cystic scrotal tumor with a punctum. The lesion was studied histologically, immunohistochemically and by DNA–DNAin situ hybridization. Histology revealed an epidermoid cyst with vacuolated keratinocytes with shrunken nuclei (koilocytes) in the cyst wall. Immunostaining was positive for HPV antigens and in situ hybridization revealed HPV‐6/11 DNA in the koilocytes. This is the first report of an HPV‐6/11‐associated epidermoid cyst in the anogenital skin of an immunocompetent individual.     

The frequency of scarring after genital ulcers in Behçet's syndrome: a prospective study

Background Although genital ulceration with or without scar formation is an important manifestation of Behçet's syndrome, formal data on the rate of genital scarring are lacking. Objective To study prospectively the frequency of genital scar formation after genital ulcers in patients with Behçet's syndrome. Methods One hundred and two patients (72 males and 30 females) with fresh genital ulcers presenting at a dedicated Behçet's syndrome outpatient clinic were followed for 6 weeks. The ulcer location, size, and frequency of scar formation were noted. All patients were treated with similar topical therapy. Results Two hundred and ten genital ulcers were followed in both sexes. The rate of scar formation was 66.2% (102/154) in male patients and 60.7% (34/56) in female patients. When genital ulcers were stratified as a function of size, large genital ulcers (≥ 1 cm in diameter) developed scars more frequently than did smaller ulcers (< 1 cm). The rate of scar formation in male patients with large genital ulcers was 89.4% (59/66) and with small ulcers was 48.9% (43/88) (P < 0.001). In females, all 19 large ulcers healed with scarring, and the same was true for 40.5% (15/37) of the small ulcers (χ² = 18.61, P < 0.001). Conclusion About two‐thirds of genital ulcers in Behçet's syndrome leave scars. The rate of scar formation depends on the ulcer size.     

Human papillomavirus-associated plantar epidermoid cyst related to epidermoid metaplasia of the eccrine duct epithelium: a combined histological, immunohistochemical, DNA-DNA in situ hybridization and three-dimensional reconstruction analysis

BACKGROUND: We recently proposed that certain palmoplantar epidermoid cysts may be related to eccrine ducts and that human papillomavirus (HPV) 60 may play a role in their pathomechanism. However, the origin of palmoplantar epidermoid cysts is still controversial. OBJECTIVES: To examine the contribution of eccrine ducts and HPV 60 in the development of epidermoid cysts. METHODS: Five epidermoid cysts and four ridged warts that had developed on the soles of a patient were studied histologically, immunohistochemically and by DNA-DNA in situ hybridization. Using serial sections obtained from its entire body, a three-dimensional reconstruction (3DR) analysis was performed on the smallest cyst to analyse the relationship between the epidermoid cyst, eccrine duct and the overlying epidermis. RESULTS: Histological and DNA-DNA in situ hybridization analyses demonstrated both homogeneous intracytoplasmic inclusion bodies pathognomonic for HPV 60 infection and HPV 60 DNA sequences not only in all of the epidermoid cysts and ridged warts but also in the acrosyringeal portion of an eccrine duct, with the dermal portion of which the smallest cyst had been revealed to connect by 3DR analysis. However, immunohistochemical analyses using antibodies against human carcinoembryonic antigen (CEA), involucrin and several cytokeratins (CKs) revealed that the immunoreactivity of the cyst was not identical to that of the eccrine dermal duct but was identical to that of suprabasal layers of the epidermis. CONCLUSIONS: It was clearly demonstrated that an HPV 60-associated epidermoid cyst with immunoreactivities for CEA, involucrin and CKs which were identical to those of the epidermis connected with the eccrine dermal duct, supporting the idea that certain palmoplantar epidermoid cysts may develop following the epidermoid metaplasia of eccrine ducts with HPV 60 infection.     

Gardner''s syndrome with epidermoid cysts showing features of pilomatrixomas

Two brothers are described who were affected with Gardner's syndrome. Both had epidermoid cysts scattered over their irunk and limbs. Three of four epidermoid cysts removed from one of them and examined histologically showed an unusual change in which part of the wall of each cyst was replaced by granulation tissue and contained groups of shadow cells. Histo-logical and histochemical studies established that these were epidermoid cysts and not pilomatrixomas. Gardner's syndrome is a genetically determined disorder in which multiple adenomatous polyps of the colon and rectum are associated with soft and hard tissue tumours (Gardner, 1951). Epidermoid cysts are the soft tissue tumours that occur mosl commonly in this syndrome, but on two occasions a calcifying epiihelioma of Malherbe (pilomatrixoma) has been reported (Piffaretti & Foroglou, 1965; Braillon, Chapuis & Boulanger, 1972). In the family described in this paper, the proband had three soft tissue tumours on his legs which histologically showed some features suggestive of pilomatrixomas. However, each was a typical epidermoid cyst in which part of the wall was replaced by granulation lissue and there were groups of shadow cells within the cyst. It is suggested that these lesions represent unusual epidermoid cysts rather than pilomatrixomas.     

Silver deposits in cutaneous burn scar tissue is a common phenomenon following application of a silver dressing

Background:  Silver dressings have been widely and successfully used to prevent cutaneous wounds, including burns, chronic ulcers, dermatitis and other cutaneous conditions, from infection. However, in a few cases, skin discolouration or argyria-like appearances have been reported. This study investigated the level of silver in scar tissue post-burn injury following application of Acticoat™, a silver dressing.
Methods:  A porcine deep dermal partial thickness burn model was used. Burn wounds were treated with this silver dressing until completion of re-epithelialization, and silver levels were measured in a total of 160 scars and normal tissues.
Results:  The mean level of silver in scar tissue covered with silver dressings was 136 μg/g, while the silver level in normal skin was less than 0.747 μg/g. A number of wounds had a slate-grey appearance, and dissection of the scars revealed brown-black pigment mostly in the middle and deep dermis within the scar. The level of silver and the severity of the slate-grey discolouration were correlated with the length of time of the silver dressing application.
Conclusions:  These results show that silver deposition in cutaneous scar tissue is a common phenomenon, and higher levels of silver deposits and severe skin discolouration are correlated with an increase in the duration of this silver dressing application.     

Multiple palmar epidermoid cysts

Implantation of epidermal fragments into the dermis has been pointed out as the cause of common epidermal cysts. However, some palmoplantar epidermoid cysts have been reported to be caused by human papillomavirus (HPV) infection or to be derived from eccrine ducts. A 65-year-old left-handed woman presented with extraordinary multiple epidermoid cysts on the palm and volar aspect of the fingers of her left hand. HPV infection was not detected by immunohistochemistry, in situ hybridization and polymerase chain reaction. Histological investigation revealed syringeal structures within the cyst wall and in the cyst cavity. Carcinoembryonic antigen was observed in these syringeal structures but was not specifically stained in the cyst wall cells by immunohistochemistry. The cytokeratin composition of the cyst wall cells was similar to that of the nonadnexal epidermis.     

Human papillomavirus 57 identified in a plantar epidermoid cyst

We report a 23-year-old Japanese man who had plantar warts on the right sole, beneath one of which an epidermoid cyst developed. On microscopic examination, an acanthotic epidermis markedly invaginated into the underlying dermis, resulting in an open epidermoid cyst. Not only the polymerase chain reaction but also an in situ hybridization detected HPV 57 DNA in the cyst. HPV 60 is the only type of HPV that has been identified in epidermoid cysts. To our knowledge, this is the first case report of an epidermoid cyst, in which a different type of virus from HPV 60 was identified. Histological features of the cyst were also different from those of HPV 60-associated epidermoid cysts.     

Treatment of infraorbital dark circles by autologous fat transplantation: a pilot study

Background  Infraorbital dark circles are a cosmetic concern for a large number of individuals. However, the exact definition and precise cause has not been elucidated clearly. In our experience infraorbital dark circles due to thin and translucent lower eyelid skin overlying the orbicularis oculi muscle can be treated successfully with autologous fat transplantation.
Objectives  This study was conducted to clarify the nature of dark circles under the eyes and determine the efficacy of autologous fat transplantation.
Patients and methods  Ten patients with dark circles due to increased vascularity and translucency of the skin were included. They received at least one autologous fat transplantation and follow-up evaluations were conducted at least 3 months after the last treatment.
Results  An average of 1·6 autologous fat transplantations were done in both infraorbital areas. Patients showed an average of 78% improvement (average grading scale: 2·6 out of 4). Most of the patients showed improvement in the infraorbital darkening and contour of the lower eyelids.
Conclusions  Autologous fat transplantation is an effective method for the treatment of infraorbital dark circles due to thin and translucent lower eyelid skin overlying the orbicularis oculi muscle.     

Photodynamic therapy with methyl aminolevulinate for primary nodular basal cell carcinoma: results of two randomized studies

Background  Data suggest that photodynamic therapy using topical methyl aminolevulinate (MAL PDT) may be a noninvasive alternative to excisional surgery for nodular basal cell carcinoma (BCC). In the studies described here, we investigated the histologic response, tolerability, and cosmetic outcome with MAL PDT for primary nodular BCC (≤ 5 mm in depth).
Methods  Two multicenter, randomized, double-blind studies with similar design and procedures were conducted. After surface debridement and minor tumor debulking, MAL cream 160 mg/g (66 patients with 75 lesions) or placebo cream (65 patients with 75 lesions) was applied for 3 h, followed by illumination with broad-spectrum red light (75 J/cm², 570–670 nm). This was repeated 7 days later. Lesions with a partial response (≥ 50% reduction in greatest diameter) at 3 months were re-treated (21%). Treatment sites were excised at 3 months (clinical nonresponders) or 6 months (clinical responders) after the last treatment.
Results  Histologically verified lesion complete response rates were higher with MAL PDT than with placebo [73% (55/75) vs. 27% (20/75)]. Treatment was most effective for facial lesions (89% complete response). Cosmetic outcome was good or excellent in 98% of evaluable, completely responding lesions treated with MAL PDT.
Conclusion  Although longer follow-up studies are required, these promising data indicate the potential of topical MAL PDT as a noninvasive treatment alternative for nodular BCC.     

The use of silicone gel in the treatment of fresh surgical scars: a randomized study

Aim.  To evaluate the effectiveness of a silicone gel in treating surgical wounds compared with a control group of the same phenotype and same scar site for which a placebo was advised.
Methods.  This was a randomized controlled trial, carried out in a dermatology department of a university hospital. In total, we studied 110 patients (55 men, 55 women) who had undergone outpatient surgery at the Department of Dermatology, University of Florence, between May and July 2005. The patients were divided into two groups: a treatment group (group A) and a control group (group B). Subjects ( n  = 65) in group A were prescribed silicone gel to be applied to the wound twice a day for 60 days after the removal of stitches. Subjects ( n  = 45) in group B were prescribed the use of zinc oxide cream. All subjects, in both study and control groups, were examined by the same dermatologists every month for 3 months after surgery, then every 2 months for a total follow-up of 8 months from the date of surgery.
Results.  In the treatment group, only 18 patients (27%) had formation of a nonphysiological scar: diastasic scar in 10 patients (15%), hypertrophic scar in 6 (9%) and atrophic scar in 2 (3%). No keloid scars were recorded. In the control group, 25 (55%) had an altered scar: keloid scars in 5 patients (11%), hypertrophic scar in 10 (22%), diastasic scar in 8 (18%) and atrophic scar in 2 (4%).
Conclusions.  The results of this study indicate that silicone gel is able to reduce the formation of keloid and hypertrophic scars and the signs/symptoms associated with the healing process (paraesthesia, pulling sensation, alterations in colour).     

Hereditary trichilemmal cysts

One hundred and fifteen individuals from 60 families are described who had trichilemmal cysts. These were solitary or multiple intradermal cysts and occurred most frequently on the scalp. A punctum leading from the skin surface to the cyst was not seen in any patient. Because they are encapsulated they are easily removed. Histologicaily they resemble the external root sheath in the region of the follicular isthmus and are quite different from epidermoid cysts. They are not associated with Gardner's syndrome or any other diseases. In 46 of the 60 families an autosomal dominant mode of inheritance was demonstrated.