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Treatment of keloid sternotomy scars with 585-nm flashlamp-pumped pulsed-dye laser
194
LITERATURE
oped similar symptoms, including fevers, cough, dyspnea, and anorexia. Their blood eosinophil counts ranged from 10.7% to 26%. After discontinuation of the drug, symptoms resolved within days to weeks. Three of the 4 patients were rechallenged only to develop the same constellation of symptoms. Although this complication is rare, the authors wanted to increase our awareness because minocycline is a commonly used drug. Dykhuizen RS, Zaidi AM, Jegarajah S, et al: BrMedJ310:1520-1521,1995 Bruce A. Brod, MD
Treatment of Keloid Sternotomy Scars with 585~nm Flashlamp-Pumped Pulsed-Dye Laser This study explores a new treatment option for hypertrophic and keloidal scars that frequently occur after cardiothoracic surgery. Sixteen patients were chosen, and half of the scar was treated with the flashlamp-pumped pulsed-dye laser every 6 weeks for 6 months. All patients had clinical improvement in the treated half of the scars. In addition, there was decreased erythema and increased pliability of the skin. Posttreatment biopsy specimens showed a more normal pattern to the organization of the collagen fibers in the dermis in the treated scars. Although the mechanism of action of the laser on the scar is not elucidated by the study, it offers another option for treating this difficult problem. Alster TS, Williams CM: Lancet 345: 11981200,1995 Bruce A. Brad, MD
Neuropsychiatric Effects of Medications Allergic Diseases
for
The authors reviewed neuropsychiatric effects of theophylline, corticosteroids, p agonists, anticholinergics, antihistamines, and sympathomimetics. Case review studies of corticosteroids led to the following conclusions: (1) most severe psychiatric effects can be avoided if prednisone is administered in doses of <40 mg/day, (2) women may have a greater risk of psychiatric effects than men, and (3) a past psychiatric history does not predispose to steroid-induced psychiatric reactions. Controlled studies in children have shown mood and transient memory changes with steroid therapy. Hz-receptor blockers as well as HI-receptor blockers can cause central nervous system reactions; 88 cases due to Hz antihistamines have been reported
REVIEW
in the literature, and 1,296 cases have been reported to the Food and Drug Administration. Bender B, Milgrom H: J Allergy Clin Immuno1 95:523-528, 1995 Marti Jill Rothe, MD Diuision ofDermatolo0 University of Connecticut Farmington, CT
Activated Immunocompetent Cells in Human Skin Lymph Derived from Irritant Contact Dermatitis: An Immunomorphological Study Six healthy volunteers were investigated for irritant contact dermatitis to sodium lauryl sulfate. A superficial lymph vessel of the lower leg was cannulated 48 hours before sodium lauryl sulfate was applied to the skin of the medial and dorsal foot. A prominent increase in the number of Langerhans’ cells and T and B cells was shown in the afferent lymph fluid during the irritative and postirritative phases. Rosettes were detected with a central Langerhans’ cell surrounded by activated T cells. These findings indicate that immunoregulatory processes occur in irritant contact dermatitis. Brand Ch U, Hunziker Th, Schaffner Th, et al: Br J Dermatol 132:39-45, 1995 Marti Jill Rothe, MD
A Case Study of Dermatitis Based on a Collaborative Approach Between Occupational Physicians and Industrial Hygienists This case report reviews the interdisciplinary approach taken to evaluate a group of employees in an aircraft wire harness assembly line with complaints of work-related skin conditions. The industrial hygienists identified potential causes ofcontact dermatitis. The physicians performed examinations of involved workers and patch testing. Only 1 of 9 workers was found to have a work-related contact dermatitis. Other conditions diagnosed included tinea manum, acne, photodamage, dyshidrosis, and contact dermatitis unrelated to work. The authors emphasized the value of the collaborative approach and the importance of communication with both management and employees. Percival L, Tucker SB, Lamm SH, et al: Am Ind Hyg Assoc J 56: 184- 188,1995 Marti Jill Rothe, MD
LITERATURE
oped similar symptoms, including fevers, cough, dyspnea, and anorexia. Their blood eosinophil counts ranged from 10.7% to 26%. After discontinuation of the drug, symptoms resolved within days to weeks. Three of the 4 patients were rechallenged only to develop the same constellation of symptoms. Although this complication is rare, the authors wanted to increase our awareness because minocycline is a commonly used drug. Dykhuizen RS, Zaidi AM, Jegarajah S, et al: BrMedJ310:1520-1521,1995 Bruce A. Brod, MD
Treatment of Keloid Sternotomy Scars with 585~nm Flashlamp-Pumped Pulsed-Dye Laser This study explores a new treatment option for hypertrophic and keloidal scars that frequently occur after cardiothoracic surgery. Sixteen patients were chosen, and half of the scar was treated with the flashlamp-pumped pulsed-dye laser every 6 weeks for 6 months. All patients had clinical improvement in the treated half of the scars. In addition, there was decreased erythema and increased pliability of the skin. Posttreatment biopsy specimens showed a more normal pattern to the organization of the collagen fibers in the dermis in the treated scars. Although the mechanism of action of the laser on the scar is not elucidated by the study, it offers another option for treating this difficult problem. Alster TS, Williams CM: Lancet 345: 11981200,1995 Bruce A. Brad, MD
Neuropsychiatric Effects of Medications Allergic Diseases
for
The authors reviewed neuropsychiatric effects of theophylline, corticosteroids, p agonists, anticholinergics, antihistamines, and sympathomimetics. Case review studies of corticosteroids led to the following conclusions: (1) most severe psychiatric effects can be avoided if prednisone is administered in doses of <40 mg/day, (2) women may have a greater risk of psychiatric effects than men, and (3) a past psychiatric history does not predispose to steroid-induced psychiatric reactions. Controlled studies in children have shown mood and transient memory changes with steroid therapy. Hz-receptor blockers as well as HI-receptor blockers can cause central nervous system reactions; 88 cases due to Hz antihistamines have been reported
REVIEW
in the literature, and 1,296 cases have been reported to the Food and Drug Administration. Bender B, Milgrom H: J Allergy Clin Immuno1 95:523-528, 1995 Marti Jill Rothe, MD Diuision ofDermatolo0 University of Connecticut Farmington, CT
Activated Immunocompetent Cells in Human Skin Lymph Derived from Irritant Contact Dermatitis: An Immunomorphological Study Six healthy volunteers were investigated for irritant contact dermatitis to sodium lauryl sulfate. A superficial lymph vessel of the lower leg was cannulated 48 hours before sodium lauryl sulfate was applied to the skin of the medial and dorsal foot. A prominent increase in the number of Langerhans’ cells and T and B cells was shown in the afferent lymph fluid during the irritative and postirritative phases. Rosettes were detected with a central Langerhans’ cell surrounded by activated T cells. These findings indicate that immunoregulatory processes occur in irritant contact dermatitis. Brand Ch U, Hunziker Th, Schaffner Th, et al: Br J Dermatol 132:39-45, 1995 Marti Jill Rothe, MD
A Case Study of Dermatitis Based on a Collaborative Approach Between Occupational Physicians and Industrial Hygienists This case report reviews the interdisciplinary approach taken to evaluate a group of employees in an aircraft wire harness assembly line with complaints of work-related skin conditions. The industrial hygienists identified potential causes ofcontact dermatitis. The physicians performed examinations of involved workers and patch testing. Only 1 of 9 workers was found to have a work-related contact dermatitis. Other conditions diagnosed included tinea manum, acne, photodamage, dyshidrosis, and contact dermatitis unrelated to work. The authors emphasized the value of the collaborative approach and the importance of communication with both management and employees. Percival L, Tucker SB, Lamm SH, et al: Am Ind Hyg Assoc J 56: 184- 188,1995 Marti Jill Rothe, MD