Postoperative Pain Management in Dermatologic Surgery: A Systematic Review.

Given the opposing pressures placed on dermatologists and dermatologic surgeons by the need for adequate postoperative analgesia and the current US opioid epidemic, a systematic review was performed to analyze postoperative pain management in outpatient dermatologic surgery. Dermatologic procedures are generally associated with minor postoperative pain of short duration. Anxiety reduction may lead to less postoperative pain. Studies vary on which anatomic locations and repair types are more or less associated with pain. Evidence supports the use of acetaminophen and ibuprofen for first-line postoperative analgesia in dermatologic surgery. Opioids, if given, should only be prescribed in small quantities.

Approach to the Mature Cosmetic Patient: Aging Gracefully.

Aging gracefully has taken on a whole new meaning over the past few decades as new aesthetic treatments have been developed and are becoming more sophisticated by the day. The aging process, which is exacerbated by chronic UV exposure, results in dyspigmentation, loss of skin laxity, precancerous and cancerous skin lesions, fat loss and redistribution, and bone resorption. Laser and light devices can be used to treat dyspigmentation, while neuromodulators and soft tissue fillers can be used for rhytides and revolumization. Newer procedures include using resorbable polyglycolide/L-lactide suspension sutures with bidirectional cones for mid face revolumization, deoxycholic acid injections for submental fat reduction, and radiofrequency energy. Certain over-the-counter products can increase the risk of postprocedure bruising, while arnica and bromelain may help decrease this risk. Dermatologists continue to be at the forefront of aesthetic treatments, ready and willing to help the aging population look and feel their best.

J Drugs Dermatol. 2017;16(6 Suppl):s84-86.

Comparing the efficacies of alginate, foam, hydrocolloid, hydrofiber, and hydrogel dressings in the management of diabetic foot ulcers and venous leg ulcers: a systematic review and meta-analysis examining how to dress for success.

Diabetic foot ulcers and venous leg ulcers are chronic wounds frequently encountered by dermatologists. Choosing appropriate wound dressings can effectively promote wound healing and potentially reduce morbidity and financial burden experienced by patients. The objective of our systematic review and meta-analysis was to evaluate wound healing efficacies of synthetic active dressings in diabetic foot ulcer and venous leg ulcer management. For data collection, PubMed, Embase, Cochrane Library, CINAHL, and clinicaltrials.gov online databases were searched from database inception to 10 May 2015. Fixed and random effects modeling were used to calculate pooled risk ratios for complete ulcer healing from pairwise dressing comparisons. The results of our review showed moderate-quality level evidence that hydrogels were more effective in healing diabetic foot ulcers than basic wound contact dressings (RR 1.80 [95% CI, 1.27-2.56]). The other dressing comparisons showed no statistically significant differences between the interventions examined in terms of achieving complete diabetic foot ulcer healing. Non-adherent dressings were more cost-effective than hydrofiber dressings for diabetic foot ulcers in terms of mean total cost per patient of the dressings themselves. All venous leg ulcer pairwise dressing comparisons showed equivalent dressing efficacies in terms of promoting complete ulcer healing. Overall, most synthetic active dressings and traditional wound dressings are equally efficacious in treating diabetic foot ulcers and venous leg ulcers. For treating diabetic foot ulcers, hydrogels are more efficacious than basic wound contact dressings, and non-adherent dressings are more cost-effective than hydrofiber dressings. Ultimately, dressing choice should be tailored to the wound and the patient.

Prurigo nodularis: Picking the right treatment.

Most patients with localized nodules should receive topical treatment first. But disappointing results or specific findings described here could necessitate additional or alternative options.

Topical antibiotic prophylaxis for prevention of surgical wound infections from dermatologic procedures: a systematic review and meta-analysis.

IMPORTANCE: Topical antibiotics are not indicated for postsurgical wound infection prophylaxis in clean and clean-contaminated dermatologic surgeries, yet many dermatologists continue to prescribe them. The objective of our systematic review and meta-analysis was to critically assess the efficacy of topical antibiotics in terms of preventing postsurgical wound infections in the dermatology outpatient setting. METHODS: PubMed, Embase, MD Consult, Science Direct, Springer Link, DynaMed and Cochrane online medical databases were searched from 1980 to 2013. RESULTS: Using random effects modeling, the pooled odds ratio of developing a postsurgical wound infection was 0.71 (95% CI, 0.42-1.19). DISCUSSION: Pooled data of the four trials in the meta-analysis did not show a statistically significant difference in incidence of postsurgical wound infections between topical antibiotics and petrolatum/paraffin. In the setting of moist occlusive dressings, there is no statistically significant difference in prophylactic efficacy between applying and not applying ointment to surgical wounds. Wounds at increased risk of developing surgical site infections include wounds in diabetics, wounds located in certain anatomic regions, and wounds created by some surgical procedures. CONCLUSIONS: Petrolatum should be used instead of topical antibiotics as a prophylactic measure to prevent postsurgical wound infections in the outpatient dermatologic setting.

A retrospective comparison between preoperative and postoperative Breslow depth in primary cutaneous melanoma: how preoperative shave biopsies affect surgical management.

BACKGROUND: Accurate histopathologic staging of preoperative biopsy specimens is critical for determining optimal surgical management for patients with primary cutaneous melanoma. The American Academy of Dermatology (AAD) and National Comprehensive Cancer Network (NCCN) currently list narrow excisional biopsy (fusiform excision) as the preferred technique for biopsying lesions suspicious for melanoma. However, preoperative shave biopsies are routinely performed on lesions concerning for melanoma in many medical centers out of convenience. OBJECTIVE: The current retrospective chart review was performed to determine whether preoperative shave biopsies are acceptable for evaluating lesions suspicious for melanoma and whether shave biopsies lead to underestimation of Breslow depth great enough to require additional surgeries. METHODS: A consecutive sample of 242 primary cutaneous melanoma cases surgically excised between January 1, 2004 and December 31, 2010 in a private practice setting was analyzed for this study. RESULTS: Breslow depth underestimation occurred in 8 of 226 shave biopsy cases (3.5%). Differences in preoperative and postoperative Breslow depths in shave biopsy cases were not statistically significant (P=0.48). Underestimation of Breslow depth, melanoma transection, positive deep biopsy margins, and tumor upstaging did not lead to statistically significant changes in surgical management. CONCLUSIONS: Based on the results from the current study and available literature, the authors posit that preoperative deep excisional shave biopsies performed by dermatologists are accurate for determining Breslow depth and for planning surgical management of melanomas.

Adenoid cystic carcinoma of the base of the tongue metastasizing to the scalp.

Adenoid cystic carcinoma is a rare neoplasm that originates from secretory glands, most commonly from the salivary glands. We present a 76 year-old white man with a history of adenoid cystic carcinoma from the base of the tongue diagnosed 15 years prior to the development of the metastatic lesion on his mid-posterior scalp. The present case represents the second reported instance of an extracutaneous adenoid cystic carcinoma metastasizing to the scalp. Differentiating between a primary cutaneous adenoid cystic carcinoma and an extracutaneous adenoid cystic carcinoma metastasizing to cutaneous structures is crucial in determining prognosis and management.