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The hybrid epidermoid and apocrine cyst. A combination of apocrine hidrocystoma and epidermal inclusion cyst.

We describe four cases of unusual superficial cutaneous cysts that have a lining epithelium composed of apocrine cells immediately adjacent to keratinizing squamous epithelium with an intact granular layer. Two of the cysts were on the nipple of the breast and two of the cysts were on the face. The lumina of all four cysts contained keratin. Immunoperoxidase staining for carcinoembryonic antigen in the facial cysts showed positive staining within the apocrine cells of the lining epithelium in one case. The pathogenesis of these lesions is uncertain. We suggest that these unusual cysts be called hybrid epidermoid and apocrine cysts.

Adult↗

Argon-pumped tunable dye laser.

The argon-pumped tunable dye laser (APTDL) is useful in the treatment of a wide variety of superficial vascular and melanocytic lesions. Safety is enhanced by the use of a computerized scanning device--the Hexascan. Over a 1-year period, 140 patients (33 patients under the age of 21, and 21 patients from 0 to 10 years of age) were treated. Facial rosacea/telangiectasia was the most frequently treated lesion, followed by port-wine stain. Although multiple treatments were often necessary, fading was successfully achieved in most patients without scarring or other complications.

Adolescent↗

Botulinum toxin A for hyperkinetic facial lines: results of a double-blind, placebo-controlled study.

Previous work on patients with muscular dystonia has shown that small intramuscular doses of botulinum toxin A eliminated hyperkinetic facial lines for approximately 6 months. The purpose of this study was to determine the efficacy of botulinum toxin A injections in eliminating facial wrinkles in aesthetic surgery patients who do not have muscular dystonia. Eleven healthy subjects were studied in a double-blind fashion. On both sides of the face, 0.2 cc of either normal saline or botulinum toxin A was injected into the forehead or into the periorbital wrinkles (crow's feet). Documentation of results was made by photographs taken of the patients during repose and during facial animation before and after injection. Assessment of facial wrinkles was done from a grading system in which the patient and the facial plastic surgeon were asked to judge the severity of the wrinkles on a scale from 0 to 3, with 0 reflecting no facial wrinkles and 3 reflecting severe facial wrinkling. Nine of 11 subjects injected with botulinum toxin A noted a significant improvement in the severity of their facial wrinkles in comparison with the side of the face injected with saline, with a rating improvement of 2 points. Two of 11 subjects noted a moderate improvement, with a rating improvement of 1 point. No patient injected with saline reported an improvement in the severity of the facial wrinkles on the control side. There were no serious complications. Botulinum toxin A is an efficacious method of nonsurgically eliminating facial wrinkles and may play a role in the cosmetic enhancement of the aging face.

Adult↗

Use of distortions in the treatment of skin lesions of the face: the distorting excision.

Reconstruction after excision of a cutaneous lesion of the face is done by various complex old and new flaps to avoid any distortion. The distortions following primary closure of defects in the face are given undue importance. We have observed and used the capacity of self-correction of these distortions, which is partially due to the muscular actions. We show our experience in various distorting reconstructions of the face in 36 patients. Because of our partial presence in a children's hospital, most of our patients were children.

Adaptation, Physiological↗

Measurement of the anatomic position of the corrugator supercilii.

OBJECTIVE: To standardize the location of the corrugator supercilii by using known facial landmarks. METHODS: The corrugator supercilii points of origin, insertion, and maximal muscle thickness were measured relative to the nasion and supraorbital notch in 21 cadavers. Comparisons of measurements between male and female cadavers were performed using a two-tailed t-test. RESULTS: The location of the corrugator supercilii was variable but was not significantly different between males and females. From the nasion, the mean point of origin was 4 mm lateral and 6 mm superior, the mean point of insertion was 33 mm lateral and 16 mm superior, and the mean maximal muscle thickness was 16 mm lateral and 10 mm superior. At their point of greatest thickness, most corrugators were found to lie below the upper border of the superciliary arch. CONCLUSIONS: There is variability in the location of the corrugator supercilii that is not gender dependent. When injecting botulinum toxin into the corrugator supercilii, it might be advantageous if the lower forehead skin of the brow is elevated, thus allowing for more precise injection. This may achieve weakness of the targeted muscle with lower doses of botulinum toxin, thus lessening the risk of eyelid and brow ptosis.

Cadaver↗

Trichilemmal carcinoma occurring in a lesion of solar keratosis.

A case of trichilemmal carcinoma occurring in a lesion of solar keratosis was reported. A 92-year-old woman had an erythematous plaque on her face that contained a reddish nodule. Histological examination of the nodule revealed typical features of trichilemmal carcinoma accompanied by those of solar keratosis in the marginal zone. The histological features of the erythematous plaque corresponded with those of solar keratosis. However, in situ the carcinoma developed in the epithelium of a hair follicle as well as in the interfollicular epidermis in the lesion of solar keratosis. We considered it likely that bowenoid malignant transformation occurred in both interadnexal and adnexal epithelium because of actinic damage, and a trichilemmal carcinoma arose. The paper also discussed the histogenesis of trichilemmal carcinoma.

Aged↗

Solitary piloleiomyoma with an unusual clinical appearance.

We present a 66-year-old man with a solitary piloleiomyoma on the forehead. The lesion had unusual clinical features; it was a crusted and dome-shaped nodule, which exhibited rapid growth. Histology revealed the typical features of piloleiomyoma. The unusual clinical features may have been due to its unique location, in which the downward growth of the tumor was prevented by the underlying frontal bone.

Aged↗

A comparison of dermoscopic features among lentigo senilis/initial seborrheic keratosis, seborrheic keratosis, lentigo maligna and lentigo maligna melanoma on the face.

Clinical differentiation of facial lentigo senilis/initial seborrheic keratosis (LS/ISK), seborrheic keratosis (SK), lentigo maligna (LM), and lentigo maligna melanoma (LMM) can be difficult. Dermoscopy improves the diagnoses in pigmented skin lesions (PSLs), but it is not helpful for the sun-exposed face because of the flat rete ridges without network-derived features. Therefore, development of new diagnostic criteria for this particular localization is a current issue of dermatology. In this retrospective study, dermoscopic slides of facial pigmented skin lesions of 66 patients referred to two clinics in Turkey were evaluated. Our aim was to determine the reliability of dermoscopy in the differentiation of these entities. The facial PSLs of 66 patients (34 males and 32 females) (median age: 58.2) were photographed with a Dermaphot (Heine, Hersching, Germany) over a five year period from November of 1995 to May of 2000. All of the dermoscopic slides were analysed according to 27 dermoscopic criteria developed by Schiffner et al. This data set contained 22 histologically proven malignant (14 LM, 8 early LMM) and 44 benign (18 SK, 26 LS/ISK) PSLs. In general, asymmetric pigmented follicular openings, dark streaks, slate-gray streaks, dark globules, slate-gray globules, dark dots, dark rhomboidal structures, light brown rhomboidal structures, dark homogeneous areas and dark pseudonetworks were statistically significant for malignant growth. On the other hand, milia-like cysts, pseudofollicular openings, cerebriform structures, light brown globules, light brown dots, light brown homogeneous areas, yellow opaque homogeneous areas, and light brown pseudonetworks were statistically significant for benign growth. This research emphasizes that dermoscopic features on the face differ from criteria used in other locations of the body. Analysis of the data suggests that dermoscopy can be used in the differentiation of LS/ISK, SK, LM and LMM from each other.

Color↗

Pemphigus vulgaris following a cutaneous thermal burn.

Pemphigus vulgaris developed in a 59-year-old man following a cutaneous thermal burn. This is an example of induced pemphigus and should be included with the small number of cases where this sequence has been reported.

Burns↗

Facial granuloma.

Explore the source record for details and available documents.

Basal Cell Carcinoma↗

Facial resurfacing using a high-energy, short-pulse carbon dioxide laser.

Facial skin resurfacing is now possible using short-pulse, high-energy carbon dioxide (CO2) lasers. The laser utilized in this particular paper is the Ultra-pulse CO2 laser. The Ultra-pulse laser represents the first CO2 laser able to vaporize tissue in a single pulse with the use of a large spot size. This laser utilizes the principles of selective photothermolysis. The high-power pulses are completed in less than the thermal relaxation time of skin, estimated to be less than 1 millisecond. This translates into rapid vaporization of tissue with little heat conduction to surrounding tissues. It also should allow a reproducibility of results between practitioners with set parameters not possible with previous CO2 lasers. Clinically, this laser is useful for the removal of skin lesions, and the resurfacing of areas of sun damage, wrinkles and scars. The immediate haemostasis and excellent visibility allows for precise vaporization of abnormal tissue. Rapid and pain-free wound healing is usual. The complication rate would appear to compare very favourably with dermabrasion and chemical peeling techniques.

Adult↗

Idiopathic multiple miliary osteomas of the face.

A case of multiple miliary osteomas of the face arising in a 45-year-old Caucasian female with no history of skin disease is reported. Spontaneous development of numerous asymptomatic, skin-coloured facial papules had occurred over a 3 year period. Originally described in association with long-standing acne vulgaris, multiple miliary osteomas of the face has recently been reported in patients without prior skin disease. The pathogenesis, classification and treatment of this rare condition are discussed.

Adult↗