preliminary support for a causal model with implica-
tions for skin cancer prevention.
Guy Cafri, MA
J. Kevin Thompson, PhD
Paul B. Jacobsen, PhD
Correspondence: Dr Thompson, Department of Psy-
chology, PCD 4118, University of South Florida, Tampa,
FL 33620-820 (Thompson@cas.usf.edu).
Financial Disclosure: None reported.
Funding/Support: This study was supported by grant R21
CA102205-01A2 from the National Cancer Institute.
1. Jackson KM, Aiken LS. A psychosocial model of sun protection and sunbath-
ing in young women: the impact of health beliefs, attitudes, norms, and self-
efficacy for sun protection. Health Psychol. 2000;19:469-478.
2. Wichstrom L. Predictors of Norwegian adolescents’ sunbathing and use of
sunscreen. Health Psychol. 1994;13:412-414.
3. Lazovich D, Forster J, Sorensen G, et al. Characteristics associated with use
or intention to use indoor tanning among adolescents. Arch Pediatr Adolesc
Med. 2004;158:918-924.
4. Baron RM, Kenny DA. The moderator-mediator variable distinction in social
psychological research: conceptual, strategic, and statistical considerations.
J Pers Soc Psychol. 1986;51:1173-1182.
5. Thompson JK, Heinberg L, Altabe M, Tantleff-Dunn S. Exacting Beauty. Wash-
ington, DC: American Psychological Association; 1999.
6. Hillhouse JJ, Turrisi R, Holwiski F, McVeigh S. An examination of psycho-
logical variables relevant to artificial tanning tendencies. J Health Psychol. 1999;
4:507-516.
7. Stice E, Trost A, Chase A. Healthy weight control and dissonance-based eat-
ing disorder prevention programs: results from a controlled trial. Int J Eat Disord.
2003;33:10-21.
8. Jackson KM, Aiken LS. Evaluation of a multicomponent appearance-based
sun-protective intervention for young women: uncovering the mechanisms
of program efficacy. Health Psychol. 2006;25:34-46.
COMMENTS AND OPINIONS
A Unique Pattern of Hyperhidrosis and
Herpes Zoster
W e read the article by Lewis and Holt1 with great
interest. They described a patient with seg-
mental hyperhidrosis, hyporeflexia, and tonic
pupil. We agree with the diagnosis of Ross syndrome.
We would like to point out that segmental hyperhi-
drosis can also be secondary to herpes zoster.2 Chopra
et al2 reported the case of a 31-year old, human immu-
nodeficiency virus–positive man who developed herpes
zoster in his left arm in the distribution of the left eighth
cervical nerve 7 days before presentation. The herpes zos-
ter resolved after 6 weeks. Two weeks later, he devel-
oped segmental hyperhidrosis evoked with heat stimuli
in the same site as that of the herpes zoster. This isoto-
pic response3 (the occurrence of a new disorder at the
same site of an unrelated and healed skin condition) most
commonly occurs when the original condition was her-
pes zoster.3 At the 6-month follow-up, the segmental hy-
perhidrosis had resolved.
Jashin J. Wu, MD
Jenny E. Murase, MD
David B. Huang, MD, PhD, MPH
Stephen K. Tyring, MD, PhD, MBA
(REPRINTED) ARCH DERMATOL/ VOL 142, AUG 2006
1069
©2006 American Medical Association. All rights reserved.
Correspondence: Dr Wu, Department of Dermatology,
University of California–Irvine, 101 The City Drive S, Bldg
53, Room 205-D, Rte 81, Orange, CA 92868-3201 (jjwu
@uci.edu).
Financial Disclosure: None reported.
1. Lewis VJ, Holt PJ. A unique pattern of hyperhidrosis. Arch Dermatol. 2006;142:
264.
2. Chopra KF, Evans T, Severson J, Tyring SK. Acute varicella zoster with pos-
therpetic hyperhidrosis as the initial presentation of HIV infection. J Am Acad
Dermatol. 1999;41:119-121.
3. Wolf R, Brenner S, Ruocco V, Filioli FG. Isotopic response. Int J Dermatol.
1995;34:341-348.
Intralesional Lipolysis With
Phosphatidylcholine for the Treatment
of Lipomas: Pilot Study
A recent article titled “Intralesional Lipolysis With
PhosphatidylcholinefortheTreatmentofLipomas:
Pilot Study,” by Kopera et al,1 contained fascinat-
ing and promising data about the treatment of lipomas by
intralesionalapplicationofphosphatidylcholine(PTC).Based
on 3 years of experience with the described technique, we
would like to add some interesting observations.
First, in our opinion, lipolysis with PTC should not
be seen as a therapy option for every patient with a li-
poma. Rotunda et al2 recently reported that sodium de-
oxycholate, a detergent component of injectable PTC for-
mulation, causes nonspecific lysis of cell membranes.
According to their in vitro observations that PTC for-
mulas are dissolving not only fat cells but also muscle
tissue, treating lipomas located near tendons, muscles,
or nerves could potentially be dangerous, leading to pos-
sible necrosis of these vital structures. We therefore sug-
gest that intramusucular lipomas and lipomas located near
tendons and nerves represent a contraindication for this
form of therapy. Moreover, solitary lipomas on the dis-
tal aspect of the legs should be excluded, as this ana-
tomical region has a higher potential risk of liposarco-
mas, and biopsies are strongly recommended.3
Second, to facilitate comparability of future studies,
a defined volume of PTC (Lipostabil; Aventis, Strasbourg,
France) would be beneficial, depending on the lipoma
size. In our patients, the lipomas are sonographically mea-
sured before therapy; then, the largest diameter of the
lipoma is divided by 2, and the result is determined as
injection volume in milliliters.
Third, Kopera and colleagues1 were able to achieve a
median volume reduction of 44% in 13 (68%) of 19 treated
lipomas, without the complete elimination of any li-
poma. The data suggest that some patients require sur-
gical removal of the lipoma because of insufficient vol-
ume reduction. To evaluate the course of surgery of
pretreated lipomas with PTC, we questioned 2 board-
certified dermatologic surgeons about their intraopera-
tive impression of 20 pretreated lipomas. They both re-
ported a simplified preparation owing to the clear
demarcation of the lipoma and surrounding subcutane-
ous tissue. We assume that the fibrotic effect of PTC leads
to a thickened capsule, thus simplifying the prepara-
tion. With the “squeeze technique,” a shorter incision is
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