Hotline to Helpline: Reducing On-call Demands.

Background: There is a growing societal trend in plastic surgery patients of viewing their medical care as a commodity product rather than as a healthcare service. Our four-provider private plastic surgery practice noticed this phenomenon through our patients' trend of overusing the emergency after-hours service call line. To affect this behavior, we designed a study educating patients on the emergency service call line's purpose and how to handle nonurgent issues independently.

Low-fluence treatment with a novel fractionated 2,910-nm fiber laser improves photodamage.

Background: Facial rejuvenation by lasers that target water has been a mainstay of esthetic laser treatments for decades. Modern lasers more commonly treat a fraction of the skin surface using ablative, semi-ablative, or nonablative pulses.

Methods: Twenty subjects with visible evidence of chronic photoaging on the face were enrolled in this study.

Lyme Disease Risk of Exposure to Blacklegged Ticks (Acari: Ixodidae) Infected with Borrelia burgdorferi (Spirochaetales: Spirochaetaceae) in Pittsburgh Regional Parks.

Lyme disease is the most commonly reported vector-borne illness and sixth most commonly reported notifiable infectious disease in the United States. The majority of cases occur in the Northeast and upper-Midwest, and the number and geographic distribution of cases is steadily increasing. The blacklegged tick (Ixodes scapularis Say) is the principal vector of the Lyme disease spirochete (Borrelia burgdorferi sensu stricto) in eastern North America.

Incidental granular parakeratotic cornification in carcinomas.

Granular parakeratosis is histopathologically recognized by the presence of parakeratotic corneocytes housing keratohyaline granules. Similar to acantholytic dyskeratosis and epidermolytic hyperkeratosis, it may histopathologically represent a diagnostic finding in a specific dermatosis, one of the diagnostic features in a solitary keratosis or an incidental finding. Granular parakeratosis as an incidental finding has been reported in association with various dermatoses.

Clinically occult cutaneous metastases.

Cutaneous metastases present themselves in a variety of clinical patterns and tend to be manifested as indurated papules/nodules/tumors. Some of those clinical expressions are unique for certain types of metastases. This report describes an entirely different phenomenon of clinically incognito cutaneous metastases that were only apparent histopathologically as an incidental finding.

Circumscribed palmar hypokeratosis: new observations.

Circumscribed hypokeratosis is a characteristic depression both clinically and histopathologically that was originally described as representing a distinctive acquired epidermal malformation of volar skin. To date, 16 patients with this entity have been reported. On the basis of clinical features and histopathologic findings in 4 new patients, coupled with information about some of the previously reported patients, there is evidence to suggest that this dermatosis could be secondary to trauma.

Granular parakeratotic acanthoma.

Granular parakeratosis was originally described as a dermatosis confined to the axillae that histopathologically shows characteristic findings in the cornified layer consisting of parakeratotic corneocytes housing keratohyaline granules. Since the original description of this entity, non-intertriginous examples and even incidental foci of granular parakeratotic corneocytes in association with other dermatoses have been recognized. This report details the findings of a previously unreported entity that we are naming granular parakeratotic acanthoma, which is fundamentally akin to acantholytic dyskeratotic acanthoma and epidermolytic acanthoma (ie, a solitary keratosis that histopathologically displays features indicated in its name).

Epithelial remnants of isthmus-catagen cysts.

The histopathologic diagnosis of isthmus-catagen cysts is typically rendered with ease at scanning magnification. Episodically, diagnostic problems may arise when the outermost epithelial portion of the cyst wall separates from the remainder of the cyst. If a histopathologist is unaware of this phenomenon, the findings may be misinterpreted.

Dermatophyte-related granular parakeratosis.

A patient presented with a two-month history of an annular eruption on her back. Biopsies of this process revealed dermatophytosis and concurrent granular parakeratosis. This patient's eruption resolved completely with antifungal therapy suggesting that the fungal organisms caused the granular parakeratosis.

Pedunculated presentation of dermatofibrosarcoma protuberans.

A 26-year-old patient had a dermatofibrosarcoma protuberans that clinically was considered to represent either a skin tag or neurofibroma. Histopathologically, this lesion could easily have been misinterpreted as a neurofibroma, particularly in the context of the clinical findings.

Follicular granular parakeratosis.

An 83-year-old patient presented herself with a ten-year history of keratotic papules on her trunk. A biopsy of this process revealed granular parakeratosis confined to the infundibulum of a follicle. Exclusive follicular involvement in granular parakeratosis has not been previously described.

Histopathologic findings in cutaneous cytomegalovirus infection.

When cytomegalovirus (CMV) involves the skin, viral inclusions are typically present within mesenchymal cells, e.g., endothelial cells, fibrocytes, and sometimes within inflammatory cells, e.

Herpes incognito.

Can a microscopist suspect that telltale histopathologic changes of infection by herpesvirus (varicella, zoster, or simplex) are nearby even when no diagnostic epithelial changes are present in the sections being studied? Punch-biopsy specimens from three patients are presented; in two of those cases herpesvirus infection was not even a clinical consideration. The initial histopathologic sections from these patients did not show changes of herpesvirus infection, but step sections revealed focal diagnostic changes. Atypical lymphocytes were present in each of these cases.

Major suppression of pro-alpha1(I) type I collagen gene expression in the dermis after keloid excision and immediate intrawound injection of triamcinolone acetonide.

Background: A keloid is a benign tumor that contains excess collagen, primarily type I collagen. A common therapy is intralesional injection of a glucocorticosteroid, such as triamcinolone acetonide (TA). Surgical excision is also common; often a glucocorticosteroid is injected weeks after excision when wound repair has already begun.

Silicone lymphadenopathy. A case report and review of the literature.

A case of silicone lymphadenopathy secondary to silicone mammary implantation is reported. With the recent publicity regarding possible adverse effects of silicone, pathologists need to be aware of this rare complication of silicone implantation.