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Sclerotherapy with polidocanol microfoam injection has been considered the treatment of choice for venous malformations in Klippel-Trenaunay syndrome (KTS). However, concern has been raised regarding the safety of this treatment, particularly in patients with patent foramen ovale (PFO). In this case report, Redondo et al describe a young woman with KTS who was treated with polidocanol microfoam sclerotherapy under ultrasonographic guidance. Although she did well, a subsequent migraine headache prompted a workup that revealed a PFO. Transcranial Doppler examination performed during a second sclerotherapy session revealed bubbles in the middle cerebral artery but no neurologic damage. The authors suggest that this technique may be safe even in the setting of PFO, particularly if multidetector-row computed tomography venography is used first to define the venous anatomy.
Microdermabrasion is a technique associated with minimal morbidity that may improve the appearance of photoaged skin through remodeling of the dermis with elaboration of new collagen and other matrix components. However, significant neocollagenesis has never been demonstrated following microdermabrasion. In this biochemical analysis, Karimipour et al demonstrate that aggressive coarse-grit microdermabrasion elicits a wound-healing response associated with dermal remodeling and type I and II procollagen induction. These data suggest that aggressive microdermabrasion may result in significant cosmetic improvement while minimizing patient morbidity.
IgA pemphigus is a rare autoimmune blistering disease characterized by epidermal IgA immunoglobulin deposits. The subcorneal pustular dermatosis (SPD) subtype shows subcorneal acantholysis and pustules with intercellular IgA deposits in the upper epidermis. Desmocollin 1 has been demonstrated to be a target antigen. In this case report, Düker et al describe a 94-year-old woman with SPD that showed reactivity not only to desmocollin 1 but also to isoforms 2 and 3. These findings further emphasize the complex and heterogeneous nature of pemphigus.
Sentinel lymph node (SLN) mapping avoids routine elective lymph node dissection and offers prognostic information in patients with melanoma. However, almost 20% of patients with SLN-negative disease experience recurrence. More sensitive micrometastasis detection could allow more accurate staging. In this preliminary prognostic study, Vitoux et al establish a highly sensitive quantitative assessment of melanocytic differentiation antigens that has prognostic value for patients with melanoma who undergo SLN biopsy. When performed in addition to histologic examination, quantitative assessment of melanocytic differentiation antigens predicted relapse-free survival more accurately.
Nephrogenic systemic fibrosis (NSF) may occur in the setting of renal disease and is associated with gadolinium-based contrast agents (GBCAs). The precise risks associated with GBCAs in the setting of renal disease have been difficult to determine owing to a lack of rigorous documentation of GBCA exposure, renal status metrics prior to GBCA administration, and confounding comorbidities. In this cohort study, Lee et al demonstrate a 1% risk of NSF among hemodialysis patients, 0.8% risk for renal transplantation patients, and a 0% risk for liver transplantation patients. Because GBCAs add important diagnostic information to patient examinations, the authors suggest that the ALARA (As Low As Reasonably Achievable) for radiation exposure be implemented in GBCA administration for all patients.
This Month in Archives of Dermatology. Arch Dermatol. 2009;145(10):1086. doi:10.1001/archdermatol.2009.251