Delayed Inflammatory Reaction to Bio-Alcamid Polyacrylamide Gel Used for Soft-Tissue Augmentation
Soft-tissue augmentation is useful in treating the aging face as well as lipodystrophy associated with highly active antiretroviral therapy. Bio-Alcamid is a cross-linked polyalkylamide gel filler that is not currently approved by the US Food and Drug Administration for use in the United States. In this case series, Chrastil-LaTowsky et al describe 2 cases of recurrent inflammatory reactions that occurred more than 1 year after injection of Bio-Alcamid gel. Although the permanent nature of Bio-Alcamid is often considered an advantage, these cases emphasize the risks associated with early- and late-occurring complications. Globalization of the cosmetic surgery market presents unique challenges to physicians, who must be aware of potential presentations and complications of products, even those not routinely used in local practice.
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Topical Calcipotriol for Preventive Treatment of Hypertrophic Scars
Hypertrophic scar formation seems to occur more often after delayed reepithelialization owing to deep wounding or wound infection. Although mainly described as a dermal disorder, hypertrophic scar tissue also demonstrates epidermal abnormalities that may be altered biochemically by topical calcipotriol application. In this randomized, double-blind, placebo-controlled trial, van der Veer et al demonstrated no significant difference in the prevalence of hypertrophic scars between placebo- and calcipotriol-treated mammoplasty scars, despite a strong association between keratinocyte activation and hypertrophic scar formation.
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Granulomatous Dermatitis With Pseudoxanthoma Elasticum–Like Changes
Pseudoxanthoma elasticum (PXE) is a genetic disorder that affects the skin, eyes, and cardiovascular system. It is caused by homozygous or compound heterozygous mutations in the ABCC6 gene, and recent research reveals that heterozygote carriers of the ABCC6 mutation can manifest the characteristic phenotypic abnormalities of PXE. In this case report, Tiger et al document a granulomatous dermatitis with PXE-like changes in a patient with cystic fibrosis. The gene responsible for cystic fibrosis is ABCC7, an ABC cassette transporter gene in the same family as ABCC6. The relationship between these disorders remains unclear, but greater awareness of this phenomenon may promote further investigation to elucidate its clinical and biological significance.
Elevated D-dimer Level in the Differential Diagnosis of Venous Malformations
Differential diagnosis of vascular malformations may prove challenging. Recent data reveal that localized intravascular coagulopathy, characterized by elevated D-dimer levels, is observed in 40% of patients with venous malformations. In this prospective convenience sample accrued from 2 interdisciplinary sites, Dompmartin et al demonstrated that when D-dimer levels are elevated in a patient with a vascular anomaly but no other associated abnormalities, a venous malformation was present in 96.5% of patients. Patients with glomuvenous, lymphatic, or capillary malformations or Mafucci syndrome had normal D-dimer levels. This easy and inexpensive test is useful and highly specific for the diagnosis of venous malformations.
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Text-Message Reminders to Improve Sunscreen Use
Consistent sunscreen use could prevent many cases of skin cancer each year, yet only about 20% of the adult population regularly uses sufficient sunscreen. One of the frequently cited barriers to regular sunscreen use is forgetting to do so. In this randomized controlled trial of the effect of an electronic text-message reminder system, Armstrong et al sent half of the subjects daily text-message reminders via cellular phones for 6 weeks. The adherence rate for sunscreen use was nearly twice as high in the subjects who received the text messages, a level that remained stable through the study period. Cellular text messages are a low-cost, scalable, and effective method of bridging the knowledge-action gap.
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