Canthal Rotation Flap: Analysis of Flap Mechanics.

BACKGROUND: Surgical defects of the medial canthus lack reconstructive options that are reproducible, precise, and uncomplicated. The canthal rotation flap is a simple rotation flap that respects the geometry of this anatomic location. OBJECTIVE: To describe the authors' experience with reconstructive planning, flap mechanics, and geometric analysis of the medial canthus to achieve the best cosmetic outcome when using the canthal rotation flap. METHODS: A retrospective review of 16 cases performed at Dayton Skin Care Specialists and Skin Care Specialty Physicians between 2016 and 2018 was completed with a blinded visual analog score (VAS). RESULTS: Sixteen patients with Mohs defects in the medial canthus were reconstructed using the canthal rotation flap. Defect diameters ranged from 0.8 to 2.7 cm. Patient ages ranged from 17 to 88 years. The mean flap dimensions were 4.8 cm by 2.15 cm. No major complications were noted. The VAS scar rating at 2 to 5 months follow-up was available for 10 of 16 patients; the mean VAS was 2.1. CONCLUSION: The canthal rotation flap is a reliable, single stage repair for small defects of the medial canthus that is optimized for the unique geometry of the medial canthus. This repair technique adds to the paucity of reconstructive options for the medial canthus.

Treatment of alopecia areata with topical sensitizers.

For those with severe alopecia areata, with greater than 50% scalp involvement, topical immunotherapy with diphenylcyclopropenone or squaric acid dibutylester is considered the treatment of choice. This article not only reviews the safety and efficacy of topical sensitizers for the treatment of alopecia areata but also highlights strides that have been made in the literature concerning their use in pediatric populations, molecular mechanisms of efficacy, and improved safety through targeted delivery methods.

Quantitative skin color measurements in acanthosis nigricans patients: colorimetry and diffuse reflectance spectroscopy.

Tristimulus colorimetry and diffuse reflectance spectroscopy (DRS) are white-light skin reflectance techniques used to measure the intensity of skin pigmentation. The tristimulus colorimeter is an instrument that measures a perceived color and the DRS instrument measures biological chromophores of the skin, including oxy- and deoxyhemoglobin, melanin and scattering. Data gathered from these tools can be used to understand morphological changes induced in skin chromophores due to conditions of the skin or their treatments. The purpose of this study was to evaluate the use of these two instruments in color measurements of acanthosis nigricans (AN) lesions. Eight patients with hyperinsulinemia and clinically diagnosable AN were seen monthly. Skin pigmentation was measured at three sites: the inner forearm, the medial aspect of the posterior neck, and anterior neck unaffected by AN. Of the three, measured tristimulus L*a*b* color parameters, the luminosity parameter L* was found to most reliably distinguish lesion from normally pigmented skin. The DRS instrument was able to characterize a lesion on the basis of the calculated melanin concentration, though melanin is a weak indicator of skin change and not a reliable measure to be used independently. Calculated oxyhemoglobin and deoxyhemoglobin concentrations were not found to be reliable indicators of AN. Tristimulus colorimetry may provide reliable methods for respectively quantifying and characterizing the objective color change in AN, while DRS may be useful in characterizing changes in skin melanin content associated with this skin condition.

Ultraviolet-based therapy for vitiligo: what's new?

Vitiligo is an ancient disease in which depigmented and hypopigmented macules appear on the skin. It is a disfiguring condition that may lead to severe psychological trauma. Among the many treatment modalities available for use in vitiligo, those using light therapy, and in particular ultraviolet (UV) light, are some of the most effective treatments. UV-based therapy includes phototherapy (narrowband UVB), photochemotherapy (psoralens with UVA), and targeted phototherapy (excimer laser and excimer lamp). It is important for any practitioner of UV-based therapy to understand the efficacy of each treatment type, as well as their respective adverse effects. In order to take full advantage of UV-based therapy, location, dosing, and photoadaptation must also be taken into account. This review discusses the various UV-based therapeutic options, adjuvant therapies, optimal dosing guidelines, appropriate patient selection, future treatment options, and recommendations based upon the current evidence and the authors' experience with vitiligo.

Role of phototherapy in patients with skin of color.

Phototherapy has proven to be one of the most versatile and effective treatment options for a variety of inflammatory and pigmentary skin diseases. However, the use of these treatment modalities in patients of color requires some special considerations. The modality chosen, the dosing of the treatment and duration of treatment are all issues to be considered for patients of color treated with ultraviolet phototherapy. In addition, there are some diseases which are more commonly seen in patients of color. These diseases may have better treatment outcomes using newer phototherapeutic options such as the long pulsed Nd:YAG laser or UVA1. As our population in the United States becomes more diverse it would behoove all dermatologists to acquaint themselves with the special circumstances of treating ethnic patients with phototherapy.

Mechanism of injury predicts case fatality and functional outcomes in pediatric trauma patients: the case for its use in trauma outcomes studies.

BACKGROUND/PURPOSE: The mechanism of injury (MOI) may serve as a useful adjunct to injury scoring systems in pediatric trauma outcomes research. The objective is to determine the independent effect of MOI on case fatality and functional outcomes in pediatric trauma patients. METHODS: Retrospective review of pediatric patients ages 2 to 18 years in the National Trauma Data Bank from 2002 through 2006 was done. Mechanism of injury was classified by the International Classification of Diseases, Ninth Revision, E codes. The main outcome measures were mortality, discharge disposition (home vs rehabilitation setting), and functional impairment at hospital discharge. Multiple logistic regression was used to adjust for injury severity (using the Injury Severity Score and the presence of shock upon admission in the emergency department), age, sex, and severe head or extremity injury. RESULTS: Thirty-five thousand ninety-seven pediatric patients in the National Trauma Data Bank met inclusion criteria. Each MOI had differences in the adjusted odds of death or functional disabilities as compared with the reference group (fall). The MOI with the greatest risk of death was gunshot wounds (odds ratio [OR], 3.52; 95% confidence interval [CI], 2.23-5.54 95). Pediatric pedestrians struck by a motor vehicle have the highest risk of locomotion (OR, 3.30; 95% CI, 2.89-3.77) and expression (OR, 1.65; 95% CI, 1.22-2.23) disabilities. CONCLUSION: Mechanism of injury is a significant predictor of clinical and functional outcomes at discharge for equivalently injured patients. These findings have implications for injury prevention, staging, and prognosis of traumatic injury and posttreatment planning.

Critical comparison of diffuse reflectance spectroscopy and colorimetry as dermatological diagnostic tools for acanthosis nigricans: a chemometric approach.

Quantification of skin changes due to acanthosis nigricans (AN), a disorder common among insulin-resistant diabetic and obese individuals, was investigated using two optical techniques: diffuse reflectance spectroscopy (DRS) and colorimetry. Measurements were obtained from AN lesions on the neck and two control sites of eight AN patients. A principal component/discriminant function analysis successfully differentiated between AN lesion and normal skin with 87.7% sensitivity and 94.8% specificity in DRS measurements and 97.2% sensitivity and 96.4% specificity in colorimetry measurements.

Photomedicine and phototherapy considerations for patients with skin of color.

BACKGROUND/PURPOSE: Patients with skin of color present unique challenges and opportunities for dermatologists in their disease states as well as their response to treatment. There are differences in dosing for patients with skin of color using standard phototherapeutic approaches as well as unique disease states that may respond to newer phototherapeutic options. Lastly, there are optical diagnostic options that allow investigators to differentiate erythema and pigmentation in a quantitative manner for clinical research purposes. METHODS: Review of the current literature with regard to vitiligo, hidradenitis suppurativa and optical diagnostic methods. CONCLUSIONS: Practitioners need to be aware of the various phototherapy and laser therapy options for patients with skin of color. New discoveries for the use of visible light as a form of treatment are on the horizon, and optical diagnostic techniques such as diffuse reflectance spectroscopy and colorimetry may add value clinically and within the research realm as objective measures of pigmentation and erythema.

Inverse psoriasis: case presentation and review.

Inverse psoriasis is a rare form of psoriasis that affects between 3% and 7% of psoriasis patients. Its appearance and distribution in the flexural skin folds makes it a difficult disease to diagnose, and because it is thought of as a variant of psoriasis, there are very few studies that deal with it exclusively. We present a short case report of inverse psoriasis and a review of the literature on various facets of this disease: epidemiology, histology, clinical presentation, differential diagnosis, and treatment.