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Systemic Sclerosis: a Case Study DERMATOLOGY OFFICE PLANNING: RADIO FREQUENCY FROM DESICCATORS TURNING ON AUTOMATIC FAUCETS AND TOWEL DISPENSERS Jonathan S. Crane, D.O., F.A.O.C.D.,* Christine Cook, BS,* David George Jackson, BS, ** Pete Buskirk, P.E.,*** Erin Griffin, DO, PGY 2**** *Atlantic Dermatology Associates, P.A., Wilmington, NC **University of North Carolina at Wilmington, Wilmington, NC ***Lee Cowper Construction, Wilmington, NC **** New Hanover Regional Medical Center, Wilmington, NC ABSTRACT In opening our brand-new, 20,000 square-foot dermatology facility, we were excited to have the latest technology. We opted for hands-free faucets and hands-free towel dispensers so as to minimize disease spread. At first we were very excited about the new technology, until we discovered that electrodessication could trigger the water faucets and towel dispensers. This in turn wasted paper and soaked both employees and other equipment. It became so frustrating that we ended up replacing over 20 faucets throughout the office, moving back to the old, hand-operated technology. We don’t want others to make this same mistake. Introduction We used hands-free faucets provided by Delta manufacturer, and the hands-free paper-towel dispensers were Tork Intuition Hand Towel Dispensers. Both the faucets and the towel dispensers work by detecting infrared radiation instead of responding to touch. The infrared detectors in the faucets are powered via the wall outlet; the dispensers are powered with three D batteries.1,2 We soon found that both of these technologies would also be turned on when we used our AARON 900 desiccators, provided by Bovie Medical. These desiccators use “disposable dermal tips,” which serve the function of limiting the spread of disease, much like the sensors do.3 The radio frequency emitted by this machine is 550 kHz (5.5x105 Hz). Discussion Radio covers a broad frequency range, from approximately 5x104 Hz to 5x108 Hz. The upper end of this range is three orders of magnitude from the range of infrared frequencies, which range from 5x1011 Hz to around 5x1013 Hz. Because the frequencies of radio waves and infrared radiation Sink prior to electro-desiccator use. Sink during electro-desiccator use. are separated by only 1000 Hz, there is some room for interference.4 Though the may interfere with infrared-activated AARON 900 desiccator has a listed output appliances. frequency of 550 kHz or 5.5x105 Hz, some of the frequencies emitted may possibly References be higher than is listed.3 Also, the infrared 1. Delta Faucet: www.deltafaucet.com/ 2. Tork: www.torkusa.com/product/309606/ detection systems used by the Delta faucets 3. Bovie Medical: www.boviemed.com/products_aaron900. asp and the Tork Intuition Hand Towel Roll 4. Vias.org: http://www.vias.org/feee/img/frequenzuebersicht. Dispensers for H1 towels may be able to png detect frequencies that are lower than infrared, allowing for the possibility of interference at the lower end of the sensors’ sensitivity range.1,2 Conclusion When designing a medical office where electrodesiccators may be used, consider the fact that electrosurgical machines 8 DERMATOLOGY OFFICE PLANNING: RADIO FREQUENCY FROM DESICATORS TURNING ON AUTOMATIC FAUCETS AND TOWEL DISPENSERS SCROTAL SYRINGOCYSTADENOMA PAPILLIFERUM: A CASE REPORT AND DISCUSSION Mounir Wassef, D.O.,* Layne Nisenbaum, D.O., FAOCD** *Second-year Dermatology Resident, Columbia Hospital, West Palm Beach, FL **Program Director, Palm Beach Center for Graduate Medical Education (PBCGME) - Columbia Hospital Dermatology Residency, West Palm Beach, FL Abstract Syringocystadenoma papilliferum (SCAP) is a benign, rare, adnexal neoplasm occurring at any stage of life. Three clinical types have been described: plaque type (presenting mostly as an area of the scalp devoid of hair); linear type (most commonly seen on the neck or face); and solitary nodular type (mostly seen on the trunk – shoulders, axillae, and genital area).1 In general, SCAP usually presents as a papular lesion or a plaque on the head and neck, or less commonly on the extremities. Characteristically, SCAP is described as being a solitary, gray or dark brown, papillary or verrucous, exophytic lesion with a moist appearance that emerges from a flat and smooth, skin-colored to brown plaque that increases in size at puberty.1-3 A third of the time, SCAP arises within a nevus sebaceous (a circumscribed hamartomatous lesion predominantly composed of sebaceous glands), while the majority of the time it arises de novo. Those lesions arising within a nevus sebaceous are at increased risk for malignant potential. Basal cell carcinoma is associated with such lesions in up to 10% of cases. Less commonly, SCAP associated with a nevus sebaceous may progress to squamous cell, verrucous, or ductal carcinoma.3 The diagnosis of SCAP involves a certain degree of clinical suspicion along with histologic confirmation. Due to the aforementioned association with malignant potential, complete surgical excision along with thorough histological examination is the treatment modality of choice.1-5 Syringocystadenoma papilliferum a child. Syringocystadenoma papilliferum. Arch Dermatol Case Report 1985;121(9):1198. can exhibit both apocrine and eccrine 11. de Bliek JP, Starink TM. Multiple linear A 55-year-old male with no significant differentiation. For example, positive syringocystadenoma papilliferum. J Eur Acad Dermatol previous medical history reported changes Venereol 1999;12(1):74–76 immunoreactivity for gross cystic disease 12. Mazoujian G. Immunohistochemistry of GCDFP-24 and in a skin lesion on the scrotum. The skin zinc alpha2 glycoprotein in benign sweat gland tumors. fluid proteins 15 and 24 and zinc alpha-2 lesion had been present for over 25 years Am J Dermatopathol 1990;12(5):452–457 glycoprotein demonstrates evidence of 13. Mazoujian G, Margolis R. Immunohistochemistry of and had been gradually increasing in size gross cystic disease fluid protein (GCDFP-15) apocrine differentiation.10,11 On the other over the past two years. The lesion was a in 65 benign sweat gland tumors of the skin. Am J hand, immunohistochemical analysis Dermatopathol 1988;10(1):28–35 gray-white cystic structure filled with soft, 14. Noda Y, Kumasa S, Higashiyama H, et al. of cytokeratins in SCAP demonstrates Immunolocalization of keratin proteins in sweat gland yellow-grey material. It was located on the similarities to eccrine poromas and the tumours by the use of monoclonal antibody. Pathol Res inferior pole of the right hemi scrotum, 4 Pract 1988;183(3):284–291. ductal component of eccrine glands.12 In 15. Hashimoto K, Lever WF. Appendage tumors of the skin , mm x 4 mm in size, with a well-defined Vol. 47. Springfield, IL:Charles C Thomas, 1968 addition, light and electron microscopic margin. The patient denied any bleeding or 16. Boni R, Xin H, Hohl D, et al. Syringocystadenoma features of some lesions show evidence papilliferum: a study of potential tumor suppressor discharge from the lesion. On microscopic genes. Am J Dermatopathol 2001;23 (2):87–89. of eccrine differentiation.13 It is probable examination, the epidermis showed varying that syringocystadenoma papilliferum degrees of papillomatosis. One or several arises from undifferentiated cells with the cystic invaginations extended downward potential to exhibit both apocrine and from the epidermis. The upper portion of eccrine modes of epithelial secretion. Of the invaginations and, in some instances, interest, the view expressed by Pinkus large segments of the cystic invaginations probably is correct: Most lesions of were lined by squamous, keratinizing cells syringocystadenoma papilliferum exhibit similar to those of the surface epidermis apocrine differentiation; however, some (Fig. 1). The papillary projections and demonstrate eccrine features.5 Studies the lower portion of the invaginations have demonstrated loss of heterozygosity were lined by glandular epithelium often for Patched and p16, a negative regulator consisting of two rows of cells. The luminal of the cell cycle, in syringocystade- row of cells consisted of high columnar cells noma papilliferum, suggesting that with oval nuclei and faintly eosinophilic these molecules may play a role in the cytoplasm (Fig. 2). pathogenesis of these lesions.14 Discussion References 1. Katoulis AC, Bozi E. Syringocystadenoma papilliferum. Syringocystadenoma papilliferum occurs In: Orphanet Encyclopedia. Paris: BioMed Central; 2004; most commonly on the scalp or the face; 2. http://www.orpha.net/data/patho/GB/ Figure 1 uk-syringocystadenoma-papilliferum.pdf however, in about one fourth of the cases, 3. Mammino JJ, Vidmar DA. Syringocystadenoma it is seen elsewhere.6-9 It is usually first Papilliferum. Int J Dermatol 1991; 30(11); 763-766 4. Helwig EB, Hackney VC, Syringocystadenoma noted at birth or in early childhood and Papilliferum; lesions with and without nevus sebaceous and basal cell carcinoma. Arch Dermatol Syphilol presents as a papule or several papules in 1955;71(4);361-372 a linear arrangement or as a plaque. The 5. Goshima J, Hara H, Okada T, Suzuki H. Syringocystadenoma Papilliferum arising on the lesion increases in size at puberty, becoming scrotum. Eur J Dermatol 2003; 13(3): 271 – 273 papillomatous and often crusted.5 On the 6. Pinkus H. Life history of nevus syringocystadenomatosus papilliferus. Arch Dermatol scalp, syringocystadenoma papilliferum Syphilol 1954;63(3): 305 – frequently arises around puberty within a 7. 322 8. Rostan SE, Waller JD. Syringocystadenoma papilliferum nevus sebaceus that has been present since in an unusual location. Report of a case. Arch Dermatol 1976;112(6):835–836. birth. SCAP arising on the scrotum is 9. Helwig EB, Hackney VC. Syringocystadenoma exceedingly rare. papilliferum. Arch Dermatol1955;71:361 Figure 2 10. Goldberg NS, Esterly NB. Linear papules on the neck of W ASSEF, NISENBAUM 9 APLASIA CUTIS CONGENITA ASSOCIATED WITH FETUS PAPYRACEUS- A CASE REPORT AND REVIEW Donna D. Tran, MSIII,* Patrick Keehan, D.O.** *3rd-year Medical Student, University of North Texas Health Science Center, Fort Worth, TX **Board-certified Dermatologist, Premier Dermatology, Fort Worth, TX Introduction abnormalities or malformation life.6,9 6 Aplasia cutis congenita (ACC) is a rare syndromes.
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