Cupping on ancient Greek coins: A numismatic case series and its relationship to dermatology.

Cupping is an ancient medical therapy with a modern-day resurgence. This practice has been referred to in the ancient Egyptian papyri and the writings of Hippocrates and Galen. We attempt to bridge the past with the present by showcasing a series of ancient Greek coins from different mints depicting medical cupping vessels and dating as far back as the 4th century bce. This practice has not been sufficiently studied in randomized controlled trials, and a standardized procedure does not exist. The dermatologist may see the consequences of this practice in the office, as it is a complementary medical technique supposed to treat a variety of ailments from joint pain to menstrual problems and leaves a very characteristic morphology. We have showcased three coins of historic numismatic and medical interest that depict ancient cupping vessels. This is the first time these coins have been presented together. A literature search was also performed to outline the theories of the mechanism of action of cupping and to compile a list of reported dermatologic side effects.

Low incidence of metastasis and recurrence from cutaneous squamous cell carcinoma found in a UK population: Do we need to adjust our thinking on this rare but potentially fatal event?

BACKGROUND AND METHODS: Cutaneous squamous cell carcinoma (cSCC) is the commonest skin cancer with metastatic potential, however, reported rates of metastasis varies greatly. All cases of primary cSCC on the Isle of Wight between 2005 and 2014 were identified and retrospectively followed for recurrence and/or metastasis. Primary outcome was to identify the rate of metastasis/recurrence from cSCC. Secondary outcomes included associated risk factors for metastasis/recurrence, death from cSCC, and time from diagnosis of primary cSCC to event. RESULTS: A total of 1122 patients with 1495 tumors were identified within the study period. A total of 18 metastasized and 40 recurred, an overall incidence of 1.2% and 2.7%, respectively. Eight patients died from their disease. CONCLUSIONS: Risk of metastasis from cSCC in the UK general population is likely to be in the order of 1.2%. Where metastasis occurs this is often within 2 years. Recurrence rates are higher following curette and cautery. DISCUSSION: If treated adequately both recurrence and metastasis from cSCC is a rare event. Not all cSCC cases need follow-up instead time should be spent educating patients around signs of recurrence/metastasis then discharged, relieving burden on secondary care. Multi-disciplinary teaming meetings are expensive and should be limited to complex cases.

Once, twice, or three times daily famciclovir compared with aciclovir for the oral treatment of herpes zoster in immunocompetent adults: a randomized, multicenter, double-blind clinical trial.

BACKGROUND: Famciclovir, the well absorbed oral pro-drug of penciclovir, is effective in the treatment of herpes zoster when given three times daily. Because the intracellular half-life of penciclovir triphosphate in varicella-zoster virus (VZV)-infected cells (7h) is considerably longer than that of aciclovir triphosphate (1h), it may be possible to administer famciclovir less frequently than three times daily for herpes zoster: aciclovir is administered five times daily. METHODS: 559 immunocompetent adults presenting with herpes zoster whose skin lesions were present for less than 72 h were randomized to receive famciclovir 750 mg once daily (od), 500 mg twice daily (bid), or 250 mg three times daily (tid), or aciclovir 800 mg five times daily. All treatments were given for 7 days. Participants were evaluated until complete healing or for 4 weeks, whichever occurred first. RESULTS: There were no significant differences between the four treatment groups with respect to times to full crusting; loss of vesicles, ulcers and crusts; cessation of new lesion formation; a 50% reduction in the area of affected skin; and the loss of acute pain. CONCLUSIONS: Famciclovir 750 mg once daily, 500 mg twice daily and 250 mg daily, and aciclovir 800 mg five times daily are three times comparable in efficacy with respect to the cutaneous healing of herpes zoster. The current study was not designed to assess the effects of the treatments on postherpetic neuralgia (PHN).