The chronicle of headache treatment throughout human history from trepanation to perisutural botulinum toxin injections.

To provide a historic snapshot as regards the evolution of headache treatment throughout the human history, i.e. starting from trepanation to perisutural botulinum toxin (BoNT) injections. Ancient surgeons had aimed to reach the cranium with trepanation (a surgical operation) for headache. As BoNT inhibits the release of nociceptive and pro-inflammatory neuropeptides, it has been recently suggested as an effective alternative in the prophylactic treatment of chronic migraine headache. Chronic migraine is a complex neurological disorder for which the underlying pathophysiology is yet not totally explained. According to the generally accepted hypotheses, peripheral neurogenic activation and central trigeminal sensitization are the two main mechanisms through which its pain develops. Since the headache most commonly occurs around the perisutural areas, and as the primary pathogenesis stem from the meningeal nerve fibers; collateral sensorial branches of the meningeal nerves can be optimal paths to transport BoNT inside the cranium. Concerning the therapeutic efficacy, we anticipate that perisutural injections would be technically challenging with blind techniques and actually possible only if performed under an imaging guidance, e.g. very conveniently with high frequency ultrasound.

Treatment of cutaneous warts: an evidence-based review.

Cutaneous warts are common skin lesions caused by human papillomavirus infection. Treatment is aimed at relieving the patient's physical and psychological discomfort and at preventing the spread of infection by autoinoculation. Among the available medical and destructive therapeutic options for cutaneous warts, none is uniformly effective or virucidal. Moreover, in most cases their safety and efficacy has not been assessed in double-blind, controlled clinical trials, so that the reproducibility of many of the listed treatments is difficult to evaluate and a possible placebo effect cannot be ruled out. The aim of this article is to describe the outcome of current therapies for each clinical wart type according to evidence-based medicine studies published in the literature. For each clinical form, the existing treatments are classified as first-, second-, and third-line therapy. First-line therapy includes medical treatments (salicylic acid, silver nitrate, glutaraldehyde) that are useful to treat a single wart or a few and/or small common warts of short duration (less than 1 year). If these treatments have failed or are contraindicated, cryotherapy may be considered as second-line therapy. For recurrent or difficult-to-treat lesions, third-line therapy includes a variety of alternative therapeutic options (topical, intralesional, systemic, and physical destruction) that are generally off-label (not US FDA approved), and whose use is limited by drawbacks or adverse effects. From pooled evidence-based medicine data, it is possible to conclude that significantly higher remission rates may be expected only with cryotherapy and salicylic acid used in combination.

Use of dermatoscopy and videodermatoscopy in therapeutic follow-up: a review.

Dermatoscopy (DE) is a noninvasive technique that allows a rapid and magnified in vivo observation of the skin surface with the visualization of morphologic features invisible to the naked eye. It is performed using manual devices without computer assistance, which generally allows ×10 magnifications. Videodermatoscopy (VD) represents the evolution of DE and is performed using a video camera equipped with optic fibers and lenses that currently allow magnifications ranging from ×10 to ×1000. Both DE and VD have been demonstrated to have further applications in dermatology apart from their use in differential diagnosis of pigmented skin lesions. In several disorders, they may be useful in differential diagnosis, prognostic evaluation, and in evaluating the response to treatment. This article focuses on the use of DE and VD in therapeutic follow-up. Although VD systems using high magnifications may not be cost-effective in all cases, VD represents a more reliable noninvasive and easy-to-use tool in therapeutic follow-up both for in-office dermatology as well as for clinical investigations.