Actinic keratosis: a cross-sectional study of disease characteristics and treatment patterns in Danish dermatology clinics.

OBJECTIVES: The incidence of actinic keratosis (AK) is increasing, and several treatment options are available. The aim of this study was to describe clinical characteristics and treatment patterns in patients with AK treated by Danish dermatologists. METHODS: A multicenter, non-interventional, cross-sectional study was conducted. Three dermatology hospital departments and seven private dermatology clinics enrolled eligible AK patients consecutively during one week. RESULTS: A total of 312 patients were included. Non-melanoma skin cancer (NMSC) was previously reported in 51.0% of patients and currently suspected in 9.4% of AK-affected anatomical regions. Lesions of AK were located primarily on the face (38.6%), scalp (12.8%), and hands (11.2%). Actinic keratosis commonly presented with multiple AK lesions (38.6%) and field cancerization (38.5%). The treatments used most frequently were cryotherapy (57.7%) and photodynamic therapy (PDT) with methyl aminolevulinate (17.1%) and imiquimod (11.2%). The likelihood of receiving cryotherapy was higher for men (odds ratio [OR] 1.65, 95% confidence interval [CI] 1.10-2.47) and increased with age (2.2% per year, 0.4-4.0%). PDT represented the most frequently applied treatment for severe actinic damage and was more likely to be prescribed to women (OR 4.08, 95% CI 2.22-7.47) and young patients (OR 0.97 per year, 95% CI 0.95-0.99). The prevalence of severe actinic damage (17.3% versus 9.6%) and intake of immunosuppressive medication (29.0 versus 2.0) were higher among hospital patients compared with those treated in private practices (P < 0.0001). CONCLUSIONS: The majority of AK patients in Danish dermatology clinics have a history of skin cancer, and NMSC is suspected in almost 10% of AK-affected regions. Cryotherapy is the most frequently used treatment overall, except in instances of severe actinic damage, in which PDT is the first-choice treatment.

Pain following controlled cutaneous insertion of needles with different diameters.

BACKGROUND AND AIM: Needle injections are used daily by millions of people around the world for the administration of various drugs (e.g., insulin), venepuncture, and some neurophysiological procedures. The aim of this paper was to study the influence of the outer needle diameter on the pain evoked by controlled needle insertion. METHODS: An automated needle injection system was used to perform a series of insertions where velocity, angle of insertion, and depth of injection were controlled. The frequency of pain following needle insertions (23G, 27G, 30G, 32G) was recorded together with the pain intensity (measured using the visual analogue scale--VAS) and the occurrence of bleeding. RESULTS: The outer needle diameter was positively and significantly correlated to the frequency of the insertion pain; for example, 63% of insertions with 23G needles caused pain, 53% of insertions with 27G and 31% of insertions with the thinnest (32G) needle (p < 0.0001) caused pain. The thickest needle caused most insertions associated with bleeding. Bleeding insertions were approximately 1.3 times more painful (as indicated by VAS scores) than insertions without concomitant bleedings (p = 0.004). CONCLUSION: By decreasing the outer diameter of a needle, the frequency of insertion pain can be reduced and may encourage patients to adhere to demanding injection regimens such as recurrent insulin administration.

[Free versus non-free treatments with laser and intense pulsed light in dermatology: distinguishing medical laser treatments to be provided free of charge from cosmetic self-payment treatments]. / Dermatologisk behandling med laser og intenst pulserende lys: afgraensning af medicinske vederlagsfri versus kosmetiske ikkevederlagsfri behandlinger.

Lasers and light sources are increasingly used in dermatology. Due to the limited financial resources of the public health care system, the Danish Dermatological Society has developed recommendations for distinguishing medical laser treatments to be provided free of charge from cosmetic self-payment treatments. Several considerations underlie the recommendations: present legislation; the diagnosis, etiology, severity, and anatomical location of the disease; and the availability of evidence-based treatments. It is suggested that the recommendations constitute the basis for referring patients to dermatological treatment involving laser and intense pulsed light in Denmark.

CO2 laser-resurfacing: increased risk of side effects after uv-exposure-an experimental animal study.

BACKGROUND AND OBJECTIVES: Carbon dioxide (CO(2)) laser resurfacing is primarily performed on photodamaged facial skin where patients are further exposed to ultraviolet radiation (UVR) postoperatively. We examined whether pre- and postoperative UVR influences the development of CO(2) laser-induced side effects. STUDY DESIGN/MATERIALS AND METHODS: Hairless mice (n = 211) were treated with a Sharplan CO(2) laser with FeatherTouch scanner. Simulated solar irradiation was administered either preoperatively or pre- and postoperatively. Skin end-points (wounds, texture changes, and pigmentary changes) were evaluated blinded by clinical evaluations, skin reflectance spectroscopy, and histological examinations. RESULTS: Pre- and postoperative UVR exposed mice obtained higher clinical scores of wounds (P < 0.02) and texture changes (P < 0.01) and developed more heavy fibrosis than mice treated with laser but no UVR. UVR exposure after CO(2) laser treatment induced significant hyperpigmentation compared to unexposed control mice (P < 0.003), whereas CO(2) laser treatment itself did not induce pigmentary changes. CONCLUSIONS: UVR increases in an animal model the occurrence of postoperative side effects from CO(2) laser resurfacing.

CO2 laser resurfacing and photocarcinogenesis: an experimental study.

BACKGROUND AND OBJECTIVES: To examine whether carbon dioxide (CO2) laser treatment has a carcinogenic potential or may influence ultraviolet (UV)-induced carcinogenesis. STUDY DESIGN/MATERIALS AND METHODS: Hairless mice (n = 211) were treated with a Sharplan CO2 laser with FeatherTouch scanner. Simulated solar irradiations were administrated either pre-operatively or pre- and post-operatively. Weekly clinical assessments of skin tumors were performed blinded during the entire observation period of 12 months. RESULTS: No tumors appeared (a) in mice just treated with CO2 laser, (b) in mice exposed to UV irradiation only before CO2 laser treatment or (c) in untreated control mice. Tumors developed in CO2 laser treated mice that were exposed to UV-irradiation both pre- and post-operatively and in UV-irradiated control mice. The time to first, second, and third tumors ranged from 18 to 20 weeks and no significant differences were demonstrated. CONCLUSIONS: CO2 laser treatment does not have a carcinogenic potential in itself, nor does CO2 laser treatment influence UV-induced carcinogenesis.

Pain and biomechanical responses to distention of the duodenum in patients with systemic sclerosis.

BACKGROUND & AIMS: Abnormalities of the small intestine have been indicated in systemic sclerosis. The aim was to use a new method to study the active-passive mechanical and sensory properties of the duodenum in these patients. METHODS: A volume-controlled ramp-distention protocol was used in the duodenum in 9 patients and 8 healthy controls. The nonpainful/painful sensations, pressure, cross-sectional area, wall tension, and strain were evaluated. Using butylscopolamine for muscle relaxation, the active (contractile muscular component) and passive (other mechanical tissue components) were computed. RESULTS: The contraction amplitude was smaller and the cross-sectional area higher in the patients (P < 0.05). Both the active and passive tension as function of strain was translated to the left in the patients, indicating a stiffer wall. The maximum active tension and the corresponding strain were 62% and 69% lower in the patients (P < 0.05). An association was found between the duration of the disease and the strain (P < 0.05). The perception score was higher as function of pressure, tension, and strain (P = 0.01, P = 0.03, and P < 0.01, respectively) in the patients than in the controls, with strain as the most sensitive variable to describe the sensory response. In 5 patients who complained of regular clinical symptoms, the referred pain area to distention was enlarged. CONCLUSIONS: Systemic sclerosis resulted in increased stiffness and impaired muscle function of the duodenum. The pain evoked by a controlled strain of the gut was increased and can explain many of the symptoms reported in the clinic.