Necrotizing fasciitis is a rare but well recognized clinical entity which most often occurs on the trunk, perineum or legs following surgery or trauma. The condition is much less common in the head and neck and it is particularly uncommon in the midface/periorbital region. In almost all the cases occurring in the neck the condition follows obvious dental or oropharyngeal sepsis and in all the cases of the scalp there is a history of previous surgery or trauma. However, necrotizing fasciitis of the midface/periorbital region may lack any obvious traumatic aetiology or may follow relatively minor trauma. The diagnosis in these cases may not be suspected and treatment may be delayed with fatal consequences. Treatment by wide excision of all affected skin can lead to disastrous cosmetic consequences in facial disease and it is suggested that disease control can be achieved by raising wide based skin flaps with excision of the underlying necrotic tissue. The flaps are then returned onto normal muscle with much improved cosmetic results. This paper discusses the diagnosis and treatment of patients with necrotizing fasciitis of the face which has arisen without significant trauma.

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Hereditary haemorrhagic telangiectasia (Osler-Weber-Rendu syndrome, Osier's disease) is an inherited abnormality of the vasculature characterized by abnormal subepithelial vessels. Treatment has included repeated intranasal cautery, intra-arterial embolization and arterial ligation.Treatment has included repeated intranasal cautery, intra-arterial embolization and arterial ligation. Historically, the operation of septodermoplasty and the use of systemic/topical oestrogens have been the most effective and lasting treatments, but over time the telangiectasias recur. There is increasing interest in the use of a variety of lasers for intranasal photocoagulation.A report of nine patients suffering from hereditary haemorrhagic telangiectasia who have undergone laser treatment with the Chromos pulsed dye laser is presented. This laser produces light energy at a wavelength of 585 nm and causes localized thermal damage to the blood vessel wall.Initially, no patient saw an improvement in their symptoms, but following an average of approximately three courses of treatment, all have reported a measurable reduction in the number of epistaxes suffered.Although no treatment completely resolves the epistaxis associated with this condition, we have found the pulsed dye laser to be effective at treating telangiectasias within the anterior nasal cavity.

We report here the use of photodynamic therapy to treat two patients with multiple lesions of Bowen's disease. A total of over 500 lesions were treated, less than 10% requiring two treatments, and at follow-up 6 months later no lesions remained in either patient. The only important side-effect of treatment was a marked photosensitivity reaction. We consider photodynamic therapy an efficient treatment for Bowen's disease; multiple lesions can be treated in a short treatment session, without local anaesthesia, and healing occurs within 2 weeks.