Can an inexpensive light-emitting diode loupe magnification device be as good as an expensive dermatoscope?

BACKGROUND: Dermoscopy is an invaluable technique used in both primary and secondary care to provide clinical information for diagnosis of skin disorders. Access to dermatoscopes is limited because of their high cost that limits clinicians at early levels of training, as well as those in low-resource settings, from developing the essential skills of dermoscopy. Previous solutions that have been proposed to address this issue have failed to demonstrate sufficient evidence for their use as an alternative compared with the gold standard of a dermatoscope, making it difficult to justify adoption of such solutions. AIM: To assess the noninferiority of an inexpensive light-emitting diode (LED) loupe magnification device compared with a nonpolarized dermatoscope. METHOD: This study looked at 100 paired photographs of lesions taken with both devices and asked 26 clinicians to categorize the lesions. RESULTS: Considering the consistency of the responses, this study confirmed noninferiority of the inexpensive LED loupe magnification device. Our results showed that the LED loupe magnification device is noninferior within a 25% margin and performs 82% as well as a nonpolarized dermatoscope. CONCLUSION: Our findings encourage the implementation of use of the cheaper LED loupe magnification device both in the early stages of medical training and in settings where expensive dermatoscopes are not available.

Connective tissue disease and sarcoidosis: a true association or a secondary granulomatous reaction?

Sarcoidosis occurs much more commonly in cohorts of connective tissue disease (1%) compared to the general population (0.01-0.04%). We present a case of concomitant connective tissue disease and cutaneous sarcoidal granulomas and discuss whether the observed granulomas represent a reactive phenomenon or true sarcoidosis. Click here for the corresponding questions to this CME article.

Omphaloliths: a case series and review of 29 cases in literature.

Omphaloliths are uncommon benign umbilical lesions caused by the accumulation of sebum and keratin into a stone-like concretion. Recognition of this entity can prevent unnecessary procedures and imaging studies for uncomplicated cases. We present three cases of omphaloliths from our department and review all 26 cases previously reported in the English literature with regard to modes of presentation, potential risk factors, complications, and treatment options to guide clinicians. The mean age at presentation was 48 years. Of the 29 cases, 17 (59%) were asymptomatic. Male patients presented at a younger age and were more likely to present with complications compared to females who presented at an older age with asymptomatic lesions (P=0.006). Features of patients described included dementia, hirsutism, a deep or narrow umbilicus, multiple nevi, obesity, and poor hygiene. Two patients developed overlying pyogenic granulomas. Removal of asymptomatic lesions was uncomplicated and done using forceps or following irrigation, with no recurrence. Complications, including localized abscesses and peritonitis, were associated in 41% of patients who were treated surgically; recurrence was noted in one patient. Removal of omphaloliths is recommended, once identified, to reduce risks of complications and patients should be encouraged to improve their personal hygiene.

Seasonal cutaneous sarcoidosis: a photo-induced variant.

Sarcoidosis is a multisystem granulomatous disease, with cutaneous involvement in up to 35% of cases. Owing to its heterogeneous clinical presentation, sarcoidosis is often referred to as the 'great imitator' of dermatological disease. A rare variant of photosensitive cutaneous sarcoidosis has been infrequently reported in the literature. We describe an unusual case of recurrent, photo-distributed cutaneous sarcoidosis presenting only during the summer months.

Joint hypermobility and skin elasticity: the hereditary disorders of connective tissue.

The hereditary disorders of connective tissues (HDCTs) encompass a spectrum of conditions linked pathophysiologically by abnormalities of collagen, fibrillin, and matrix proteins. The clinical picture ranges from morbidity because of musculoskeletal, skin, ocular and visceral pathologies to mortality from acute vascular collapse. For many of the conditions, there is a considerable overlap in clinical features, although severity varies; appreciating the subtle differences in presentation is vital to the clinician in determining the diagnosis. Though conditions associated with severe vascular pathology are rare, other hereditary disorders of connective tissues such as the joint hypermobility syndrome and Stickler's disease are common and probably underrecognized. Abnormal skin elasticity and scaring, joint hypermobility, and chronic arthralgia are important clues that should trigger the clinician to search for underlying hereditary disorders of connective tissues. In this article, we discuss the spectrum of clinical findings, management, and genetic screening of the more common hereditary disorders of connective tissues, highlighting their diagnostic criteria and their differences.

Resting metabolic rate in homozygous sickle cell disease

The resting metabolic rate in 20 patients with homozygous sickle cell (SS) disease was 19 percent higher than in 20 age-and sex-matched control subjects with a normal hemoglobin genotype (AA). The difference was not accounted for by differences in lean body mass. It is postulated that this increased energy expenditure reflects the energy expenditure of erythropoietic hyperplasia and leads to a marginal nutritional state that may contribute to the abnormal growth in SS disease. (AU)

Resting metabolic rate in homozygous sickle-cell disease - abstract

Erythropoietic hyperplasia and a hyperdynamic circulation might be expected to increase the resting metabolic rate (RMR) of patients with homozygous sickle-cell (SS) disease. Therefore we used the ventilated hood technique to determine the RMRs of the representative sample of adolescents with SS disease and controls with a normal haemoglobin (AA) genotype matched for age, sex, and pubertal stage. The RMR in 19 pairs was corrected for the lean body mass which was derived from the measurement of total body water. The RMR of SS subjects expressed as kcal/kg LBM was greater than that of AA controls (median, range: 38.6, 30.7 - 45.4 and 33.2, 25.4 - 35.7, respectively, z = 3.1, p = 0.002). We postulate that the increased RMR in SS disease is not compensated for by a reduction in physical activity or increased energy intake and that this leads to a marginal nutritional state which may contribute to the abnormal growth of children with SS disease(AU)