Profiling and predicting help-seeking behaviour among trauma-exposed UK firefighters.

Background: Firefighters often do not avail of psychological support services within fire services. Hence, investigating help-seeking behaviour is crucial to determine viable support options. Objective: This study attempted to characterize help-seeking behaviour among UK firefighters by profiling and identifying patterns of help-seeking. Methods: An online survey was administered to 1282 UK firefighters who were asked which help-seeking options they availed of within and outside professional settings. The analysis was conducted in two linked phases. First, latent class analysis was used to identify the fewest profiles that most accurately described help-seeking behaviour. Second, multinomial logistic regression analysis was employed to describe class composition using demographic and years in service variables, while ANOVA was employed to identify variation in alcohol consumption and openness to discussing emotions across help-seeking classes. Results: Five distinct help-seeking classes were identified. Class 1 (9.2%) represented firefighters who availed of all forms of support. Class 2, the smallest class (6.9%) represented firefighters who independently sought External Professional Psychological Support. Class 3 (12.2%) represented those who mainly sought Friends Support. Class 4, the largest class (48.7%) represented those who mainly sought Spousal Support. Class 5 (23%) represented firefighters who sought all avenues of Social Support. Regression analyses indicated that the External Psychological Support class was more likely to be single with fewer years in service. Firefighters longest in service were less likely to seek Social Support, and those who relied on Spousal support had the lowest alcohol consumption. Conclusion: Variations in help-seeking behaviour among UK firefighters were found. Firefighters who sought spousal support had the lowest alcohol consumption rates, indicating a protected profile. Firefighters who only sought friends and informal colleagues' support had the highest alcohol consumption rates and the most difficulty in discussing feelings, indicating a potential at-risk profile. Recognizing these differences in help-seeking patterns is important for targeting interventions.

Antecedentes: los bomberos a menudo no hacen uso de los servicios de apoyo psicológico dentro de los servicios de bomberos. Por lo tanto, investigar el comportamiento de búsqueda de ayuda es crucial para determinar la viabilidad de las opciones de apoyo.Objetivo: Este estudio intentó caracterizar el comportamiento de búsqueda de ayuda entre los bomberos del Reino Unido mediante la elaboración de perfiles e identificación de patrones de búsqueda de ayuda.Métodos: se administró una encuesta en línea a 1282 bomberos del Reino Unido, a quienes se les preguntó qué opciones de búsqueda de ayuda tenían dentro y fuera de los entornos profesionales. El análisis se realizó en dos fases vinculadas. Primero, se utilizó el análisis de clase latente para identificar la menor cantidad de perfiles que describían con mayor precisión el comportamiento de búsqueda de ayuda. En segundo lugar, se empleó el análisis de regresión logística multinomial para describir la composición de la clase usando variables demográficas y de años en servicio, mientras que ANOVA se empleó para identificar la variación en el consumo de alcohol y la apertura para discutir las emociones a través de las clases de búsqueda de ayuda.Resultados: Se identificaron cinco clases distintas de búsqueda de ayuda. La clase 1 (9.2%) representó a los bomberos que hicieron uso de todas las formas de apoyo. La clase 2, la clase más pequeña (6.9%) representaba a los bomberos que buscaban el apoyo psicológico profesional externo de forma independiente. La clase 3 (12.2%) representaba a aquellos que buscaban principalmente apoyo de amigos y la clase 4, la clase más grande (48.7%) se caracterizaba por los bomberos que buscaban principalmente apoyo del conyugue. La clase 5 (23%) representaba a los bomberos que buscaban todas las vías de apoyo social. Los análisis de regresión indicaron que la clase de Apoyo Psicológico Externo tenía más probabilidades de ser soltero/a con menos años de servicio. Los bomberos que llevaban más tiempo en servicio tenían menos probabilidad de buscar apoyo social en comparación con aquellos en servicio durante 0-10 años.Conclusión: Se encontraron variaciones en el comportamiento de búsqueda de ayuda entre los bomberos del Reino Unido. Los bomberos que buscaron apoyo del conyugue tuvieron las tasas de consumo de alcohol más bajas, lo que indica un perfil protegido. Bomberos que solo buscaban el apoyo de amigos y el apoyo informal de los colegas tuvieron las tasas más altas de consumo de alcohol y la mayor dificultad para discutir los sentimientos, lo que indica un perfil de riesgo. Reconocer las diferencias en los patrones de búsqueda de ayuda es importante para focalizar las intervenciones.

The causes of nail apparatus pigmentation presenting to a melanoma screening clinic a prospective study.

BACKGROUND: Advanced stage primary cutaneous malignant melanoma (PCMM) has a high mortality. PCMM may affect any area of the skin, including the nail apparatus (malignant melanoma or subungual melanoma). Although nail apparatus malignant melanoma (NAMM) is rare, delayed diagnosis carries a poor prognosis. AIM: The primary aim was to study the range of nail presentations and identify key patterns to aid in differential diagnosis. A secondary aim was to quantify the number of patients requiring surgery, indications for biopsy, and the incidence and characteristics of NAMM. METHODS: This was a prospective study of all referrals with nail apparatus pigmentation to a weekly dedicated melanoma screening clinic over a 6-month period. RESULTS: In total, 2246 patients were included. Of the 38 patients referred with nail pigmentation, 1 (2.6%) was diagnosed with NAMM and involved a fungating amelanotic lesion of the right hallux. The remaining patients were diagnosed with subungual haematoma (20/38; 52.6%), viral wart (2/38; 5.4%), acral fibrokeratoma (1/38; 2.6%), myxoid cyst (3/38; 7.9%), fungal nail infection (4/38; 10.5%), Pseudomonas nail infection (1/38; 2.6%), benign linear pigmentation (2/38, 5.3%), Bowen disease (1/38, 2.6%), psoriatic nail changes (2/38; 5.3%) and matrix malalignment (1/38; 2.6%). Of the eight patients (21.1%) who required surgery, five had a biopsy taken and three underwent surgery. Only 14 cases were followed up by Dermatology. NAMM accounted for 0.7% of all melanomas diagnosed. CONCLUSION: We illustrate the wide range of diagnoses for pigmented nail presentations and highlight the late presentation of advanced disease in a patient presenting with NAMM.

Inherited pulmonary cylindromas: extending the phenotype of CYLD mutation carriers.

BACKGROUND: Germline mutations in the tumour suppressor gene CYLD are recognized to be associated with the development of multiple cutaneous cylindromas. We encountered such a patient who presented with breathlessness because of multiple pulmonary cylindromas. OBJECTIVES: To search for clinical and radiological features of multiple pulmonary cylindromas in a cohort of 16 patients with CYLD mutations. METHODS: A retrospective case-note review was carried out in a tertiary dermatogenetics clinic where CYLD mutation carriers are reviewed on an annual basis. In-depth investigation was carried out for patients with pulmonary tumours. RESULTS: Four patients had radiological imaging of their lungs, of which two had multiple pulmonary cylindromas that were confirmed histologically. Serial computed tomography monitoring allowed for pre-emptive endobronchial laser ablation, preventing major airway obstruction and pulmonary collapse. CONCLUSIONS: Pulmonary cylindromas are an unrecognized, but infrequently symptomatic, aspect of the phenotype in these patients that can have implications for patient care. They should be considered in patients with a high tumour burden that present with respiratory symptoms, and where appropriate, monitored with serial imaging.

Cutaneous manifestations of phosphate solution extravasation.

Extravasation injuries are common in patients receiving multiple intravenous infusions. Although such injuries are closely associated with the infusion of cytotoxic chemotherapy, they have also been been associated with extravasation of noncytotoxic drugs. Extravasation injuries can lead to skin ulceration and nerve and tendon damage, and therefore to permanent disability. We report three cases of phosphate solution extravasation leading to unusual cutaneous manifestations.

Successful treatment of forehead lipoma depends on knowledge of the surgical anatomy: a step-by-step guide.

We review the anatomy of the frontal scalp in relation to the clinical features and surgical management of frontalis-associated lipoma. Awareness of this entity, coupled with sound regional anatomical knowledge, is essential to achieve good outcomes.

Nasal anatomy for the dermatological surgeon.

The nose is an important site of skin pathology and skin cancer in particular, underlining the importance of the nose to the practice of dermatology. This article is intended to serve as an overview of the anatomy of the nose for dermatologists and dermatological surgeons. Areas of clinical relevance are emphasized with examples.

Motor nerves of the head and neck that are susceptible to damage during dermatological surgery.

As the incidence of non melanoma skin cancer rises, dermatologists will increasingly be called upon to perform excisions in the head and neck region. Damage to the motor nerves of the head and neck represents an important adverse event for patients, and a source of litigation for surgeons. Understanding the anatomy of this region is key to counselling patients about the possibility of motor nerve injury associated with particular skin surgical procedures. We describe the anatomy of the motor nerves of the head and neck that are most vulnerable to injury during dermatological surgery. The consequences of injury are outlined, and the surface anatomy and anatomical landmarks that may be used to identify the relevant danger zones are described.

A prospective case series of secondary intention healing for surgical wounds on the dorsum of the hand.

BACKGROUND: The dorsum of the hand is a common site for squamous cell carcinoma, and excision with appropriate margins often results in surgical defects that cannot be repaired by primary side-to-side closure. AIM: To assess healing time, complications and resulting scars when surgical wounds on the dorsum of the hand were allowed to heal by secondary intention. METHODS: This was a prospective study of 28 surgical defects on the dorsum of the hand, which were allowed to heal by secondary intention. Patients were followed up on days 2, 7 and 14, and then every 2 weeks until the wounds healed. Wound dressings were changed 2-3 times per week. Patients' tolerance of this treatment and their degree of satisfaction with the final results was determined. RESULTS: The defect diameters ranged from 15 to 46 mm (median 24 mm). The time to heal was determined in 24 patients, and ranged from 22 to 63 days (median 44 days). There were no cases of postoperative bleeding. Two patients developed erythema of the wound edge; wound swabs for culture were negative in both cases. Overgranulation developed in 12 of 28 wounds, which settled with the application of a potent topical steroid and discontinuation of the hydrocolloid dressing. Patients were either 'very satisfied' (12/18) or 'satisfied' (6/18) with the resulting scar. CONCLUSIONS: Secondary intention healing of surgical wounds on the dorsum of the hand is a useful management option, which is well tolerated by patients, has a low rate of complications, and gives good cosmetic results.

Direct primary closure without undermining in the repair of vermilionectomy defects of the lower lip.

BACKGROUND: Vermilionectomy is an excisional technique for the treatment of lower lip squamous cell carcinoma and actinic cheilitis. The vermilionectomy defect is usually repaired by a labial mucosal advancement flap. Traditionally, the mucosal wound margins are widely undermined but this can be associated with significant postoperative morbidity. OBJECTIVES: We describe our experience with a modified technique whereby lower lip vermilionectomy defects were repaired by direct primary closure without undermining and present the subsequent cosmetic, functional and sensory results. METHODS AND MATERIALS: This is a retrospective case series of 21 patients who underwent vermilionectomy repair by direct closure without undermining. Combined data regarding the presence of any postoperative sensory, functional or cosmetic disturbance are presented. RESULTS: Complete data were available for 17 patients. Minimal sensory disturbance was noted in 10·5% of our patients 6 months postoperatively, which is less than previous studies. Similarly, labial scar tension was less frequent in our series; 94% of the patients were satisfied with cosmesis. CONCLUSIONS: Direct closure without undermining is a simple, reproducible technique for repair of lower lip vermilionectomy defects and leads to excellent cosmetic, functional and sensory results in the majority of patients.

Dysregulated TRK signalling is a therapeutic target in CYLD defective tumours.

Individuals with germline mutations in the tumour-suppressor gene CYLD are at high risk of developing disfiguring cutaneous appendageal tumours, the defining tumour being the highly organised cylindroma. Here, we analysed CYLD mutant tumour genomes by array comparative genomic hybridisation and gene expression microarray analysis. CYLD mutant tumours were characterised by an absence of copy-number aberrations apart from LOH chromosome 16q, the genomic location of the CYLD gene. Gene expression profiling of CYLD mutant tumours showed dysregulated tropomyosin kinase (TRK) signalling, with overexpression of TRKB and TRKC in tumours when compared with perilesional skin. Immunohistochemical analysis of a tumour microarray showed strong membranous TRKB and TRKC staining in cylindromas, as well as elevated levels of ERK phosphorylation and BCL2 expression. Membranous TRKC overexpression was also observed in 70% of sporadic BCCs. RNA interference-mediated silencing of TRKB and TRKC, as well as treatment with the small-molecule TRK inhibitor lestaurtinib, reduced colony formation and proliferation in 3D primary cell cultures established from CYLD mutant tumours. These results suggest that TRK inhibition could be used as a strategy to treat tumours with loss of functional CYLD.

Cutaneous features of intravascular lymphoma.

Intravascular lymphoma (IVL) is a subset of extranodal non-Hodgkin lymphoma, with an estimated incidence of <1 case per million people. It is characterised by extensive proliferation of lymphoma cells within small to medium-sized blood vessels. Most IVLs are B-cell tumours. IVL can present primarily in any organ system, including the skin. The disease is often disseminated at diagnosis. The overall mortality rate is thought to be >80%, and >50% of patients are diagnosed at postmortem examination. There is wide variability in the clinical appearance of cutaneous lesions, which may simulate inflammatory skin disease. Therefore, awareness by dermatologists is important to enable early diagnosis when cutaneous signs are present. We report two patients with unexplained systemic disease and a skin eruption, leading to the diagnosis of IVL, and outline the range of cutaneous features reported.

Clopidogrel: mechanisms of action and review of the evidence relating to use during skin surgery procedures.

Patients who have skin surgery may be taking medication that increases the likelihood of bleeding, such as clopidogrel, aspirin, warfarin, heparin and nonsteroidal anti-inflammatory drugs (NSAIDS). All of these may increase the risk of perioperative and postoperative bleeding. This article examines the mechanism of action of clopidogrel, current practice, and evidence for or against continuing its use during skin surgery. The mechanisms of action of aspirin, warfarin, heparin and NSAIDS will also be briefly discussed.