ABSTRACT
Among the variables associated with surgical outcomes, cosmesis is important to patients and challenging to the early-learning resident. We offer a technique that allows alignment of wound edges by intraoperatively using a suture to determine where to place the next needle bite. This technique can be used to correct for variation in surface angle and malalignment with altered skin tension that is encountered during routine surgery and can be applied to intermediate and complex closures.
Subject(s)
Suture Techniques , Sutures , Humans , SkinABSTRACT
An 83-year-old Caucasian male presented with a pruritic erythematous patch to his right inguinal region, which he had contracted five months ago. After months of topical antifungal and steroid therapies, the patient was referred to dermatology due to a lack of lesion improvement. A 5.0 mm punch biopsy with immunohistochemical staining revealed the presence of pleomorphic nuclei with cytoplasm replete with mucin, suggestive of superficial extramammary Paget's disease (EMPD). As he was reluctant to undergo a surgical assessment, the patient underwent consultation and management with 30 sessions of superficial electron beam radiotherapy. A week after the completion of radiation therapy, the patient's skin exhibited minimal erythema with surrounding hyperpigmentation to the affected inguinal skin, suggesting clearance of the disease. This case highlights the importance of an accurate diagnosis in a timely manner as neoplastic cases have a metastatic risk with potentially devastating results.
ABSTRACT
In the sport of fishing, barbed fishhooks often are used for their effectiveness in maintaining the fish on the hook once it is caught. However, if a fishhook is implanted in the skin of a fisherman or fisherwoman, a barb can pose problems in removing the fishhook without exacerbating internal injury, a common fear among outpatient physicians. We describe the case of a patient who presented to the dermatology clinic with a barbed fishhook injury and discuss several simple methods for barbed fishhook removal that can be easily utilized in the outpatient setting. Because failing to treat the patient may lead to further discomfort and increased risk for complications, practitioners should be familiar with the removal methods described here, as they are not time consuming and do not require complex equipment. Furthermore, these techniques may be useful for removal of other foreign bodies embedded in cutaneous tissue (eg, splinters).
Subject(s)
Finger Injuries/therapy , Foreign Bodies/therapy , Wounds, Penetrating/therapy , Aged , Humans , Male , RecreationABSTRACT
Myiasis is a tropical infection most often caused by Dermatotobia hominis, also known as the botfly. It is rarely seen in the United States. The infection has a slow evolution and often presents with painful lesions that mimic furunculosis, boils, and infected cysts. The mechanism of infection is based on the deposition of botfly eggs onto an arthropod, which acts as a vector of transmission. The arthropod infects various hosts and botfly eggs are concomitantly deposited on the host. The Dermatobia eggs transform into their larval form and penetrate the skin through adjacent adnexal structures or through the arthropod-based site of inoculation itself. Growth of the organisms within the tissues causes painful cystlike lesions. This article describes cutaneous furuncular myiasis and discusses patterns of recognition and treatment modalities, with a case presentation of an individual diagnosed with the condition attained from a visit to Belize.
ABSTRACT
Paederus dermatitis is a peculiar, irritant contact dermatitis characterized by a sudden onset of erythematobullous lesions on exposed areas of the body. The disease is provoked by an insect belonging to the genus Paederus. This beetle does not bite or sting, but accidental brushing against or crushing the beetle over the skin provokes the release of its coelomic fluid, which contains paederin, a potent vesicant agent. This article describes this dermatitis, which occurred in three healthcare personnel aboard a medical mission boat on the Amazon River. The epidemiology and pathogenesis of paederus dermatitis is reviewed as well its treatment and prevention.
