ABSTRACT
Wound repair of the pretibial and forearm regions presents a challenge during dermatologic surgery as these areas are under significant tension and exhibit increased skin fragility. Various methodologies have been proposed for the closure and repair of such wounds, however, the use of the bilayered suture technique may be simpler and more effective than other techniques such as the pinch stitch, pully stitch, slip-knot stitch, pulley set-back dermal suture, horizontal mattress suture, pully stitch, and tandem pulley stitch. Our objective was to describe a novel method for the repair of pretibial and forearm wounds following Mohs micrographic surgery utilizing bilayered closure followed by tissue adhesive application. J Drugs Dermatol. 2024;23(5):380. doi:10.36849/JDD.7139  .
Subject(s)
Forearm , Mohs Surgery , Skin Neoplasms , Suture Techniques , Wound Healing , Humans , Mohs Surgery/adverse effects , Mohs Surgery/methods , Forearm/surgery , Skin Neoplasms/surgery , Tissue Adhesives , Leg/surgery , Male , FemaleABSTRACT
There is now a growing trend for buccal fat pad reduction in patients who desire a decrease in midface and lower face volume, refinement, sculpting, or enhancement of facial features. The buccal fat pad is connected to the temporal fat, and therefore buccal fat pad reduction can result in volume depletion of the temporal fossae. In addition, most patients undergoing this procedure already have pre-existing temporal volume depletion due to aging. We describe a technique in which we remove part of the buccal fat pad and transfer the fat to the temple to achieve aesthetically pleasing facial contouring.
Subject(s)
Adipose Tissue , Plastic Surgery Procedures , Cheek/surgery , Face/surgery , HumansABSTRACT
Risk factors associated with melanoma treatment delay (MTD) have been inadequately studied. To elucidate MTD associations based on patient and tumor characteristics, a retrospective cohort study was performed for cutaneous melanoma cases reported to the National Cancer Database (NCDB) between 2004 and 2015. We evaluated the number of days from diagnosis to treatment initiation, analyzing postponements more than 45 days as moderate MTD (mMTD) and postponements more than 90 days as severe MTD (sMTD). Greater MTD rates were independently associated with patients who are older than 50 years, female, nonwhite, not privately insured, and treated at an academic facility and who have more advanced tumor stage and head/neck primaries.
Subject(s)
Head and Neck Neoplasms , Melanoma , Skin Neoplasms , Factor Analysis, Statistical , Female , Humans , Melanoma/diagnosis , Melanoma/epidemiology , Melanoma/therapy , Middle Aged , Retrospective Studies , Risk Factors , Skin Neoplasms/diagnosis , Skin Neoplasms/epidemiology , Skin Neoplasms/therapy , Time-to-TreatmentSubject(s)
Arterial Occlusive Diseases/drug therapy , Cosmetic Techniques/adverse effects , Dermal Fillers/adverse effects , Hyaluronic Acid/adverse effects , Lip/pathology , Adult , Arterial Occlusive Diseases/etiology , Aspirin/administration & dosage , Dermal Fillers/administration & dosage , Drug Therapy, Combination/methods , Female , Humans , Hyaluronic Acid/administration & dosage , Hyaluronoglucosaminidase/administration & dosage , Lip/blood supply , Necrosis/drug therapy , Necrosis/etiology , Tadalafil/administration & dosage , Treatment OutcomeSubject(s)
Extremities , Torso , Dermatologic Surgical Procedures , Humans , Surgical Wound Infection , Suture Techniques , SuturesABSTRACT
Although there is evidence that gender-based disparities exist in salary, academic rank, and other factors in several areas in medicine, limited data exist on differences between male and female dermatologists. Existing studies have focused on academic dermatologists, not including the vast majority of dermatologists who work in solo and group private practices. A cross-sectional self-reported survey eliciting total annual income and other factors was performed in the fall of 2018 in the United States. A total of 397 board-certified dermatologists (MDs/DOs) participated in this study, including 53.63% female and 46.37% male respondents. A statistically significant difference existed within total annual income between male and female dermatologists (P<.0001). Several factors were identified that demonstrated statistically significant differences between male and female dermatologists, including productivity, practice area of focus, type of fellowship training, and faculty rank. However, despite controlling for these variations, gender remained a statistically significant predictor of income on both univariate and multivariate regression analyses (P=.0002/P<.0001), indicating that a gender-based income disparity exists in the field of dermatology that cannot be explained by other factors.
Subject(s)
Dermatologists , Dermatology , Cross-Sectional Studies , Efficiency , Female , Humans , Male , Salaries and Fringe Benefits , United StatesABSTRACT
BACKGROUND: Melasma is a common hyperpigmentation disorder with numerous, but often unsatisfactory treatment options. AIMS: A pilot study to evaluate the efficacy and safety of a novel topical combination of 12% hydroquinone, 6% kojic acid, and 5% vitamin C cream for melasma. PATIENTS AND METHODS: A pilot study of 6 women with melasma was conducted at an academic dermatology department and a private dermatology practice to evaluate the efficacy of a topical combination of 12% hydroquinone, 6% kojic acid, and 5% vitamin C cream, entitled the "Tam Formula." Two blinded evaluators calculated Melasma Area and Severity Index (MASI) Scores before and after treatment to evaluate change from baseline, and statistical analysis was performed. RESULTS: Treatment with this combination topical cream resulted in an average 63.77 ± 22.10 percent reduction in MASI scores. CONCLUSIONS: While there is a need for further investigation, this pilot study indicates the Tam Formula may provide an alternative treatment option for melasma.
Subject(s)
Melanosis , Ascorbic Acid/therapeutic use , Female , Humans , Hydroquinones/therapeutic use , Melanosis/drug therapy , Pilot Projects , Skin Cream , Treatment OutcomeABSTRACT
Neurofibromatosis type 1 is the most common neurocutaneous syndrome, with a frequency of 1 in 2500 persons. Diagnosis is paramount in the pretumor stage to provide proper anticipatory guidance for a number of neoplasms, both benign and malignant. Loss-of-function mutations in the NF1 gene result in truncated and nonfunctional production of neurofibromin, a tumor suppressor protein involved in downregulating the RAS signaling pathway. New therapeutic and preventive options include tyrosine kinase inhibitors, mTOR inhibitors, interferons, and radiofrequency therapy. This review summarizes recent updates in genetics, mutation analysis assays, and treatment options targeting aberrant genetic pathways. We also propose modified diagnostic criteria and provide an algorithm for surveillance of patients with neurofibromatosis type 1.
Subject(s)
Neurofibromatosis 1/diagnosis , Neurofibromin 1/genetics , Protein Kinase Inhibitors/therapeutic use , Radiofrequency Therapy/methods , Skin Neoplasms/genetics , Combined Modality Therapy/methods , DNA Mutational Analysis , Diagnosis, Differential , Humans , Loss of Function Mutation , Neurofibromatosis 1/genetics , Neurofibromatosis 1/therapy , Neurofibromin 1/metabolism , Protein Kinase Inhibitors/pharmacology , Signal Transduction/genetics , Skin Neoplasms/diagnosis , Skin Neoplasms/therapy , TOR Serine-Threonine Kinases/antagonists & inhibitors , Treatment Outcome , ras Proteins/metabolismABSTRACT
Cutis marmorata telangiectatica congenita (CMTC) is a rare congenital cutaneous vascular anomaly with a reticular marbled erythematous pattern, which can result in isolated benign skin lesions or less commonly be associated with systemic anomalies. Occasionally, the characteristic pattern of CMTC lesions is masked on initial presentation, creating a diagnostic conundrum that can result in unnecessary workups to rule out vasculopathy. We present the case of a female newborn with a red-blue ulcerated skin lesion on the right leg and foot, which initially appeared as retiform purpura but evolved to exhibit the mottled pattern of CMTC by 5 days of age. Clinicians must be made aware of this potential diagnostic trap in early CMTC to avoid invasive skin biopsies and unnecessary laboratory testing in neonates.
Subject(s)
Purpura , Skin Diseases, Vascular , Telangiectasis/congenital , Female , Humans , Infant, Newborn , Livedo Reticularis , Purpura/diagnosisABSTRACT
A fixed drug eruption (FDE) is a relatively common reaction associated with more than 100 medications. It is defined as a same-site recurrence with exposure to a particular medication. The primary approach and treatment for all types of FDEs are to identify and remove the causative agent, often accomplished by a thorough history of medication and other chemical exposures, and possibly prior episodes. The most common category of FDE, localized FDE, whether bullous or non-bullous, is self-limited. Although one can confirm the causative agent using oral challenge testing, it is not recommended due to the risk of severe exacerbation or possible generalization; patch testing is now preferred. Bullous FDE may resemble erythema multiforme. Treatment of localized FDE includes medication removal, patient counseling, and symptomatic relief. Failure to remove the causative agent in localized FDE can lead to recurrence, which is associated with increased inflammation, hyperpigmentation, and risk of a potentially lethal generalized bullous FDE (GBFDE), which may resemble Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN). Distinguishing GBFDE from SJS and TEN is salient and will be stressed: GBFDE has more rapid onset in 1-24 h rather than in weeks, less or no mucosal involvement, less or no systemic involvement, and a tendency for a more favorable prognosis; however, recent experience suggests it may be just as life-threatening. This review will provide a comprehensive update and approach to diagnosis and management.
Subject(s)
Drug Eruptions/diagnosis , Palliative Care/methods , Counseling , Diagnosis, Differential , Drug Eruptions/etiology , Drug Eruptions/mortality , Drug Eruptions/therapy , Erythema Multiforme/diagnosis , Humans , Patch Tests , Prognosis , Recurrence , Severity of Illness Index , Skin/drug effects , Skin/pathology , Time FactorsSubject(s)
Behavior, Animal/physiology , Dogs/physiology , Melanoma/diagnosis , Odorants , Skin Neoplasms/diagnosis , Smell/physiology , Adult , Animals , Dogs/psychology , Female , Humans , Melanoma/pathology , Melanoma/physiopathology , Melanoma/therapy , Skin Neoplasms/pathology , Skin Neoplasms/physiopathology , Skin Neoplasms/therapy , Volatile Organic CompoundsABSTRACT
Dermatofibrosarcoma protuberans is an uncommon low-grade malignant tumor that can invade locally and rarely metastasize. Dermatofibrosarcoma protuberans has a high rate of local recurrence due to incomplete excision, especially in deep tissues. Morbidity is often related to multiple local recurrences and removal of excessive tissue with large, complex repairs. We present a case of incompletely excised dermatofibrosarcoma protuberans after initial wide local excision. We subsequently employed a "deep" vertical Mohs micrographic surgical technique to remove the remaining tumor while creating a flap with the tumor-free superficial portion to preserve tissue and avoid a complicated repair. The patient is tumor-free for 7 years.
ABSTRACT
CONTEXT.: Histopathology is the current standard to diagnose skin disease. However, biopsy may not always be feasible, such as in patients with multiple nevi, a patient with a lesion on an aesthetically significant site, or in children. Recently, noninvasive techniques, including reflectance confocal microscopy (RCM), optical coherence tomography, and Raman spectroscopy, have enabled dermatologists to manage skin lesions in real time without the need for biopsy. OBJECTIVE.: To report the updated diagnostic accuracy of RCM for equivocal skin lesions. DESIGN.: In this study, we retrospectively reviewed our data of clinically suspicious lesions from 2010 to 2017 that were evaluated by RCM. RESULTS.: Our results showed an overall sensitivity of 98.2% and specificity of 99.8%. CONCLUSIONS.: In conclusion, RCM is a noninvasive real-time tool with the potential to diagnose skin lesions with high accuracy and without biopsy.
Subject(s)
Microscopy, Confocal/methods , Skin Diseases/diagnostic imaging , Humans , Retrospective Studies , Sensitivity and SpecificitySubject(s)
Biopsy/economics , Biopsy/standards , Skin Neoplasms/pathology , Adult , Female , Humans , Quality ControlABSTRACT
Patients with skin conditions may apply or consume a wide variety of "remedies" with a similarly wide range of effects that may alter the clinical and/or dermatologic presentations of the lesion. Dermatologists or other clinicians should probe for this and carefully document such treatment, as well as any treatment administered by a health care professional or any other person. The dermatopathologist, however, cannot assume that this has been done or done successfully, and therefore must be on constant alert to recognize the effects of such "remedies."