RESUMEN
Electronic medical records have made great advances in the provision of quality health care but have increased physician workload and often limit face-to-face time with patients. These effects are particularly felt in the academic dermatology clinic, a critical time of practice development. Time constraints from implementation of electronic medical records have resulted in low patient volume and reduced educational opportunities. A review of the literature suggests that utilizing scribes as physician aides in the academic dermatology setting may increase patient access, clinic volume, educational experience, and hospital revenue.
Asunto(s)
Dermatología , Médicos , Documentación/métodos , Eficiencia Organizacional , Registros Electrónicos de Salud , HumanosRESUMEN
Sunscreens are topical preparations containing any number of ultraviolet filters (UVFs). The first part of the review will focus on the recent Food and Drug Administration (FDA) regulations of 2019 and general use of these agents. While sunscreen products are becoming more regulated in the United States, we still lag behind other countries in our options for UVFs. Sun protection to prevent skin cancer and aging changes should be a combination of sun avoidance, protective structures, and clothing as well as use of sunscreen products. Newer and safer products are needed to help supplement and replace older agents as well as improve their cosmetic acceptability. This will be a review of ingredients, local toxicities (i.e. contact dermatitis, photocontact dermatitis), special considerations for children, and cosmesis of sunscreen preparations. Part 2 will focus on the environmental, ecological and human toxicities that have been increasingly related to UVFs.
RESUMEN
BACKGROUND: Sunscreens are topical preparations containing one or more compounds that filter, block, reflect, scatter, or absorb ultraviolet (UV) light. Part 2 of this review focuses on the environmental, ecological effects and human toxicities that have been attributed to UV filters. METHODS: Literature review using NIH databases (eg, PubMed and Medline), FDA and EPA databases, Google Scholar, the Federal Register, and the Code of Federal Regulations (CFR). LIMITATIONS: This was a retrospective literature review that involved many different types of studies across a variety of species. Comparison between reports is limited by variations in methodology and criteria for toxicity. CONCLUSIONS: In vivo and in vitro studies on the environmental and biological effects of UV filters show a wide array of unanticipated adverse effects on the environment and exposed organisms. Coral bleaching receives considerable attention from the lay press, but the scientific literature identifies potential toxicities of endocrine, neurologic, neoplastic and developmental pathways. These effects harm a vast array of aquatic and marine biota, while almost no data supports human toxicity at currently used quantities (with the exception of contact allergy). Much of these data are from experimental studies or field observations; more controlled environmental studies and long-term human use data are limited. Several jurisdictions have prohibited specific UV filters, but this does not adequately address the dichotomy of the benefits of photoprotection vs lack of eco-friendly, safe, and FDA-approved alternatives.
RESUMEN
A 63-year-old man presented with left lower extremity ischemia and pain. Left lower extremity angiography revealed calcification throughout the superficial femoral artery, prompting atherectomy and angioplasty with a drug-coated balloon. About 1 week after the procedure, he developed angulated ulcers with central eschar on the left lower extremity and was referred to the dermatology clinic. A biopsy showed cutaneous intravascular foreign material consistent with hydrophilic polymer gel. In patients who develop retiform purpura and ulcerations after endovascular procedures, the diagnosis of hydrophilic polymer embolus should be considered. Treatment consists of supportive care, making early identification vital to avoid unnecessary amputation.
RESUMEN
Lichen planus pigmentosus is a photodistributed dyschromia of unknown etiology described clinically as hyperpigmented gray-blue or brown-black macules or patches in a photodistributed pattern. Although there has been some debate, lichen planus pigmentosus is considered by many to be a separate diagnostic entity from ashy dermatosis or erythema dyschromicum perstans, which shares similar characteristics. Various treatment strategies have been applied to help resolve or improve the appearance of lichen planus pigmentosus lesions; however, an optimal treatment method is yet to be elucidated. The authors present a case of an 18-year-old Hispanic man with lichen planus pigmentosus whose skin findings responded dramatically to a combined regimen of daily topical azelaic acid foam and tretinoin cream with twice-monthly chemical peels using glycolic acid and Jessner's solution. The authors have noted a sparcity of therapeutic literature for lichen planus pigmentosus, and hope to aid clinicians in therapeutic management strategy for this patient subset.