Over 20 months, we have treated 74 patients (59 children less than 12 years of age) with port-wine stains (PWS) using a 585-nm flashlamp-pulsed dye laser (SPTL-1, Candela Corp., Wayland, Mass., USA) after topical anesthesia with Emla^TM cream. A 5-point reference color scale was used to evaluate the results. 45 patients had at least one treatment on the entire surface of the lesion. A mean of 88 impacts per session was delivered. There was a significant decrease in color in around two thirds of the cases after one complete treatment with a gradual tendency to improvement after subsequent treatments. Younger age at the beginning of treatment was not found to be predictive of a better outcome after the first treatment. In around one third of the cases, positive test site treatment was not correlated with significant improvement after one treatment. Lesions situated on the limbs were less responsive than those on the head and neck. Except for problems due to absence of general anesthesia in young children enduring repeated stressful and sometimes painful procedures, the overall impression is that early treatment of PWS is possible with very limited risks of scarring using this technique.

A living cellular allogeneic dressing made up of cultured keratinocytes adhering to a collagen film was used to treat 20 leg ulcers of various aetiologies in 16 patients. A reduction in pain was noted in 80% of cases, and promotion of granulation tissue in the ulcer bed in 70% of cases. In 10 patients, epithelialization of 71 +/- 29% of the ulcer was noted at Day 30.

Annular lipoatrophy of the ankle (ALA) is a rare acquired lipoatrophic panniculitis first reported in 1953 by Ferreira-Marques by the name lipoatrophia annularis 1 and then described by Winkelmann as connective tissue panniculitis (CTP), 2 but it would appear that ALA is a more localized form of CTP. 3 It mainly affects children who are otherwise healthy but may present with autoimmune diseases 3-5 and has a stereotyped presentation, starting with inflammatory nodules or plaques around the ankles which progress into circumferential subcutaneous atrophy within a few months. There is no consensus on treatment, and long-term outcomes are poorly documented. We present four new cases of childhood ALA, including a patient with an extended follow-up of more than 10 years. | C A S E REP ORTSFour children (two boys and two girls), aged between 5 and 9 years, were diagnosed with ALA. All were otherwise healthy. Their characteristics are presented in Table 1. ALA has a classic history starting with inflammatory nodules or plaques around the ankles and calves evolving over months to subcutaneous atrophy. Some had triggering events, such as Patient 1 (Figure 1) who reported the appearance of lesions after wearing a new pair of high-top shoes that may have caused local trauma. All had a classic history of ALA except for Patient 2, who reported no initial inflammatory stage. Only, Patient 1 reported initial debilitating symptoms (severe cramps and myalgia).The lesions were located on the lower extremities for all patients except for Patient 3 (Figure 2), who had mild lesions on the buttocks.

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