ALBOPAPULOID LESIONS
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I am taking care of a 13 year old girl with dominant dystrophic EB of the
Pasini type.  She has begun to get albopapuloid lesions, especially on the
shins and is very disturbed about these from a cosmetic standpoint.  They do
not itch and there is minimal inflammation on biopsy so I am less inclined to
use topical steroids as suggested in JAAD 1993;29:785 where Temovate was used
successfully in a pulse fashion.  Does anyone have any experience with this
problem?  Dermablend could be used but the patient is unenthusiastic about
cover-ups.

Howard Pride 
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Try Dovonex, with caution, on a selected area. 

Haines Ely
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Histologically albopapuloid lesions show some similarity to scars
with flattening of the epidermis, dermal collagen/elastin changes
and milia (which often associate with scars in all types of DEB
patients). Accordingly, one rational approach to treating these
lesions would be to treat them as you would hypertrophic scars. The
steroid which we locally administer to treat hypertrophic scars is
not directed at treating the accompanying inflammation but in
treating the overproduction of collagen I/III by dermal fibroblasts.
Glucocorticoids are known downregulators of collagen biosynthesis.

Albopapuloid lesions in the patients I have seen have been largely
asymptomatic and I have elected not to treat them. However, if I did
have a patient such as yours who wanted them treated, I would
consider topical corticosteroids and possibly very cautious use of
intralesional steroids. Additionally, you may want to try using
silicon sheeting employing it in the same way that we use it to
treat hypertrophic scars. The only difference would be that you
would want to avoid using tape to fasten the sheeting in place and
instead use coban or elastic self adhereing gauze (tape whould be
avoided in all EB patients as the skin often commes off with the
tape during dressing changes.

I would like to announce that the Stanford Blistering Disease Clinic
Web Page is now online. the URL is:

	http://www-leland.stanford.edu/dept/derm/blister.html

Features of the page include access to the blistering disease
chapter of the electronic textbook of dermatology, an online
discussion forum for patients, researchers and physicians, a guest
lecture series, the Epidermolysis Bullosa Southwest Registry, and
dignostic services covering all types of inherited and acquired
blistering diseases. I would be interested in any constructive
comments concerning  this page.

Peter Marinkovich, MD
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