Virtually painless local anesthesia: diluted lidocaine proves to be superior to buffered lidocaine for subcutaneous infiltration.

BACKGROUND: Many physicians believe that buffering local anesthetics with sodium bicarbonate is the best technique for reducing the pain and discomfort associated with subcutaneous infiltration. OBJECTIVE: To compare the level of pain and discomfort associated with subcutaneous infiltration of lidocaine diluted with normal saline to that associated with traditionally buffered lidocaine. PATIENTS/METHODS: In a prospective, double-blind trial, 31 patients were asked to use a visual analog scale to rank the level of pain and discomfort caused by two different solutions of lidocaine with epinephrine. Solution A: 3 mL of 1% lidocaine + epinephrine in 30 mL of bacteriostatic 0.9% sodium chloride in a 1:10 ratio, in which each mL contained 9 mg of sodium chloride and 9 mg of benzyl alcohol. Solution B: 5 mL of 8.4% sodium bicarbonate solution and 50 mL of 1% lidocaine + epinephrine in a 1:10 ratio. RESULTS: Twenty-eight out of 31 patients reported that the solution of lidocaine diluted with normal saline was the least painful upon injection. CONCLUSION: Pain and discomfort during subcutaneous injection of lidocaine can be reduced by diluting the anesthetic with normal saline in a 1:10 ratio.

Nail damage from gel polish manicure.

Manicures can result in nail damage via instrumentation, nail polish, nail polish removers, and artificial nails. We report nail weakness, brittleness, and thinning in five subjects after the application of a new manicure system called gel polish and removal with acetone and manual peeling. All subjects complained that the polish was very difficult to remove and that their nails became much thinner after the procedure. Pseudoleukonychia and onychoschizia lamellina were noted on examination. One subject underwent ultrasound and reflectance confocal microscopy (RCM) measurements of nail plate before and after the gel polish application, which showed thinned nail plate (0.063 vs. 0.050 cm and 0.059 vs. 0.030 cm, respectively). Overall, we call attention to the adverse effects of gel polish manicures in five subjects. In addition, our case illustrates potential utility of ultrasound and RCM in measuring nail plate thickness.

A pilot study to determine the safety and efficacy of monochromatic excimer light in the treatment of vitiligo.

BACKGROUND AND OBJECTIVE: According to a European pilot study, the 308-nanometer (nm) Excilite mu (DEKA, Florence, Italy) system may be a promising tool for patients with vitiligo by offering targeted phototherapy, a rapid onset of repigmentation, and few adverse effects. The objective of this study was to evaluate the clinical efficacy and safety of the 308-nm Excilite mu in the treatment of vitiligo. METHODS AND LIMITATIONS: Ten patients with stable vitiligo were exposed to 10 weeks of targeted phototherapy with the Excilite mu device, followed by 5 weeks of observation. Skin types 1 and 2 were not included in the cohort, and Wood's light examination was not documented. RESULTS: At 2 weeks, repigmentation was observed in 60% of the subjects, according to patient assessment, and 50% of the subjects, according to the treating physician and independent observer assessments. All patients maintained the repigmentation during the 5-week, follow-up period. CONCLUSION: The 308-nm Excilite mu is a safe and fast-acting therapeutic option in patients with stable vitiligo and skin types 3 through 6.

Predictors of skin cancer screening practice and attitudes in primary care.

BACKGROUND: Physician visits provide invaluable opportunities to screen patients for skin cancer, yielding earlier detection and improved survival. OBJECTIVE: We sought to assess frequency of skin cancer screening by full body skin examinations (FBSE) by primary care physicians, patient attitudes toward FBSE, and risk factors for cutaneous malignancy. METHODS: Questionnaires were distributed to patients at primary care and dermatology clinics. RESULTS: A total of 426 participants were surveyed. Overall, 20% of patients reported having undergone regular FBSE by their primary care physician. Sex, race, personal skin cancer history, and Fitzpatrick skin type were predictive of whether a FBSE was performed by a patient's primary care physician. Men were more likely to report having undergone a FBSE (22% vs 19%; P < .01); women were more likely to report feeling embarrassed by a FBSE (15% vs 4%; P < .01). LIMITATIONS: This study was conducted at a single site academic center. CONCLUSION: Although low rates of skin cancer screening are reported by patients, those at higher risk are being screened more frequently. Sex disparity exists, and as both male and female patients have a strong preference to undergo FBSE, unmet opportunities for skin cancer prevention should be maximized.

Neck injuries caused by automatic two-point seat belts: an analysis of four cases.

Although seat belts significantly reduce the extent and severity of injuries sustained by motor vehicle occupants, seat belts are known to be associated with chest and abdominal trauma. Less commonly understood are severe neck injuries caused by the use of two-point automatic shoulder harnesses without concurrent use of a manual lap belt. Such injuries may include cervical spine fractures, craniocervical dislocations and rarely decapitation. Recognizing patterned injuries caused by seat belts and the ability to correlate autopsy findings with the circumstances surrounding the death will allow for correct interpretation of seat-belt related trauma. The four cases described detail fatal neck injuries as a result of improper seat belt use in which an automatic two-point shoulder harness was used without a manual lap restraint. In two of the cases, the victims were decapitated.