Two cases of treatment site granulomatous reaction to Zyderm Collagen Implant that occurred in spite of a negative skin test are reported. A delayed hypersensitivity reaction to ZCI is suggested by the clinical time course and the histologic findings of hypersensitivity granulomas. Humoral immunity is also implicated in the reaction since elevated anti-Zyderm serum antibodies and plasma cell infiltrates are present. Resolution of the clinical signs and symptoms occurred over several months with no treatment. The physician using ZCI should be aware of this rare adverse reaction.

Extensive Mohs surgery for carcinomas of the forehead and scalp occasionally requires the removal of periosteum. The exposed bone presents a wound management problem. One method, if healing by secondary intention is a viable option, is to chisel bone to stimulate granulation tissue and promote healing. A case is presented that describes this procedure in an elderly patient.

This review summarizes the major categories of plant dermatitis: (1) mechanical injury, (2) pharmacologic injury, (3) primary irritant phytodermatitis, (4) allergic phytodermatitis, (5) pseudophytodermatitis, (6) phytophotodermatitis, and (7) pseudophytophotodermatitis. Representative species from this classification are considered. Field characteristics, dermatitis produced, chemical constituents, and diagnosis are discussed.

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