To the Editor.—
The Madajet is a new needleless injection instrument with several applications promoted by the manufacturer. One of these applications is the infiltration of skin with a local anesthetic prior to biopsy. Use of the Madajet is advertised to "relieve much of the psychological fear and trauma associated with traditional needle and syringe injections" (Mada Medical Products Inc, publication MJ 1281).We recently examined eight skin specimens taken by shave biopsy after injection of local anesthetic with the Madajet. The local anesthetic, lidocaine with or without epinephrine, was injected directly into the lesional skin.An unusual histologic feature was noted in all specimens. Irregularly shaped, variably sized holes resembling "swiss cheese" were noted in the papillary and midreticular dermis (Figs 1 and 2). Except for the lack of an inflammatory cell response, these findings were similar to those described in paraffin granulomas and other foreign-body granulomas.1 In
Lamm J, Niebyl P, Hood A. Histologic Artifact due to Madajet. Arch Dermatol. 1985;121(7):835–836. doi:10.1001/archderm.1985.01660070023005
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