1/4. Solar-induced postinflammatory hyperpigmentation after laser hair removal.BACKGROUND: Postinflammatory hyperpigmentation (PIHP) is a frequently encountered problem in many cosmetic procedures. The treatment of PIHP is difficult and remains a challenge. OBJECTIVE: To treat a patient who developed multiple hyperpigmented macules on her thighs due to sun exposure after treatment of unwanted hair using a normal-mode ruby pulse laser. methods: The patient was treated daily with tretinoin (Retin A) 0.1% cream, triamcinolone 0.1% cream, and hydroquinone 4% cream with sunscreen (Solaquin forte), and was to avoid sun exposure. Several sites received monthly treatment of 40% trichloroacetic acid (TCA). The degree of clinical improvement of the hyperpigmentation was assessed by both the physician and the patient. RESULTS: Cosmetic results were fair. The amount of hair in her thighs was reduced but the PIHP responded only slightly to therapy. CONCLUSION: To our knowledge this is the first case of solar-induced PIHP following laser hair removal. The treatment of PIHP is difficult because there are few therapeutic options that are consistently successful. Avoidance of exposure to ultraviolet light should be emphasized to all patients prior to laser therapy. We demonstrated that serial TCA peels provided an additional benefit compared to medical treatment.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/4. vitamin a toxicity secondary to excessive intake of yellow-green vegetables, liver and laver.We report a case of sudden onset of vitamin a poisoning. A 20-year-old Japanese woman had been eating pumpkin and only a very limited amount of other foods on a daily basis for 2 years. She was overly concerned about weight reduction. Aurantiasis cutis and abnormal liver function tests were noted by her family doctor in 1995 when she was 18 years old. At that time, she stopped eating pumpkin. However, she secretly continued an excessive intake of other beta-carotene-rich vegetables, liver and laver for about 2 years. Two and one-half years after being seen by her family physician, she experienced sudden onset of low-grade fever, limb edema, cheilitis, dry skin, and headache. These symptoms worsened daily. A liver needle biopsy was performed, and it showed a normal portal tract along with fat-laden Ito cells in the space of Disse. A final diagnosis of vitamin a poisoning and hepatic injury secondary to an eating disorder was made. Her symptoms and serum beta-carotene levels returned to normal with successful adjustment of her diet.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/4. Along these lines...Non-melanotic discoloration of the skin can result from the accumulation of various internal agents (ingestion, inhalation, or injection), chemicals or drugs, such as heavy metals, amiodarone, tetracycline, clofazimine and others, or exogenous (topical) substances. Identifying the causative agent frequently requires a thorough investigation and clever detective work, including visits to the home and workplace. It is, however, rare that the patient presents at a clinic with the corpus delicti, and it is even more rare when neither the patient nor the treating physician are initially aware of it. "What is the hardest of all? That which you hold the most simple; seeing with your own eyes what is spread out before you."[J.W. Goethe quoted by J.P. Eckermann in Converstions with Goethe, May 18, 1824.]- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/4. Interdigital neuroma. Local cutaneous changes after corticosteroid injection.Interdigital neuroma was diagnosed in a patient who was treated subsequently with a local corticosteroid injection. Two to 3 weeks after injection, a 2.5 x 1.5-cm area of hyperpigmentation, thinning of the skin, and subcutaneous fat atrophy developed at the site of the injection. Occurrence of these side effects depends on the solubility of the steroid preparation, the dosage, and the anatomic site and depth of the injection. When using local corticosteroid injections to treat interdigital neuromas, the physician should be familiar with the properties and recommended dosage of the given steroid. The injection should be deep enough so that the cortisone solution does not leak into the subcutaneous area. The possibility of skin atrophy and altered pigmentation should be discussed with all patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |