Section on dermatology. (Abstracts of Scientific Posters).

DEBM1-D. THE ECONOMIC IMPACT OF ACUTE SUNBURN. Molly Warthan, BA, Mandy Warthan, MD, Dan Sewell, MD, and Richard F. Wagner, MD. The University of Texas Medical Branch at Galveston, Galveston, TX.

The beach is a high-risk environment for sunburn injury, due to the interaction of natural environmental conditions that intensify natural ultraviolet light exposure and the behavioral characteristics of beach-goers. Long-term consequences of sunburn injury to the skin, such as premature aging, premalignant skin changes, cutaneous melanoma, and nonmelamoma skin cancer, are well known, but less attention has been directed to understanding the costs associated with acute sunburn injury. The purpose of this project was to estimate the economic impact of acute sunburn in a beach-going population during the summer. A 2-mile-long area of public beachfront in Galveston, Texas, was monitored and a population-based analysis of sunburn in beach-goers was conducted throughout the summer by use of baseline beachfront surveys. Sunburn risk factors, severity, and the cost of the acute sunburn injury were evaluated with a series of questions asked by the interviewer. Of the 57 beach-goers interviewed, 35 (61%) used sunscree n. Of the 35 individuals who used sunscreen, 31 (89%) reported erythema and sunburn in sun-exposed areas (31/57; 54.4%). Of the 31 sunscreen-users who reported sunburn, 22 (71%) described the sunburn as painful. Of the 19 men interviewed, 5 (26.3%) missed a total of 9 days of work during the previous year due to sunburn. Of the 38 women interviewed, 4 reported a total of 7 days work missed during the prior year because of sunburn. Based on these findings, statistical studies showed that 227,520 workdays were lost by beachgoers in Galveston each year. The total economic impact for lost work by these individuals exceeded $26 million. Intensive education and awareness of the public, physicians, employers, and insurers about the short- and long-term effects of sunburn injury, as well as its adverse economic impact, is needed to reduce the economic burden of the acute sunburn. Documentation of sunburns' short- and long-term costs should help persuade public and private institutions, as well as employers and insura nce companies, to commit financial resources necessary to support educational preventive sunburn interventions.

DERM2-D. BLASTOMYCOSIS-LIKE PYODERMA. David Carey, MD. Albuquerque, NM.

A 32-year-old, diabetic woman presented with an 18-month history of a slowly expanding, painful lesion on her right lower leg. She had seen several primary care physicians during this interval and had been prescribed several short courses of systemic antibiotics, including cephalexin, dicloxacillin and doxycycline. These regimens had resulted in partial improvement, followed by prompt relapse when the antibiotics were discontinued. The patient denied antecedent injury to the region, specifically denying injury by vegetable matter. Additionally, she denied ingestion of any systemic medications, bromides, or iodides. Physical examination revealed an 8 x 5-cm tender, boggy, suppurative, cicatrized plaque on the right anterior lower leg. A deep fungal infection, specifically blastomycosis, was the suspected diagnosis. Histology revealed epidermal hyperplasia with sinus tracts containing purulent material. PAS, GMS and AFB were negative. Tissue cultures for fungus and mycobacteria were negative. Tissue cultures gr ew Staphylococcus aureus. A diagnosis of blastomycosis-like pyoderma was rendered. Though poorly understood, blastomycosis-like pyoderma is thought to represent an aberrant and exaggerated response to cutaneous infection with Staphylococcus aureus in the setting of nonspecific immunosuppression. In addition to long-term systemic antibiotic therapy, other published treatment options include destructive modalities such as electrodessication and curettage, excision, and carbon dioxide laser vaporization. After several failed attempts with long-term oral antibiotic therapy, the patient has been steadily improving on a regimen of monthly intralesional injections of triamcinolone and cephalexin.