Step-by-Step Guide to the Punch Removal Technique for Dermal Piercing: A Surgical Pearl.

While dermal piercings have become increasingly popular, there is limited dermatologic literature detailing a standard removal technique. Dermal piercings are often removed in the emergency department using non-serrated hemostats and a rocking motion until the anchor can be pulled through the skin. Removal by these means may lead to unnecessary damage to the skin, infections, and scarring. This article describes a straightforward technique for extracting dermal piercings that does not require the patient to know the size or type of dermal anchor. A detailed description, with corresponding images, is provided as a step-by-step guide on implementing a punch removal technique for dermal piercings. Dermatologists can implement this technique to remove piercings without knowing the underlying anchor type. This punch removal technique offers a solution for removing a variety of dermal piercings and subsequent scar tissue while minimizing scar formation and leaving patients with more cosmetically appealing skin.

Effects of Plant-Derived Dietary Supplements on Skin Health: A Review.

Dietary supplements have become increasingly popular to improve facial appearance and optimize skin health. With countless supplements available online and in stores, there are unlimited options for patients to choose from. Federal law does not require the Food and Drug Administration to assess each product's efficacy before its appearance on the market. Therefore, evidence-based medicine is vital for dermatologists to provide adequate recommendations regarding the safety and efficacy of various dietary supplements. The goal of this review is to evaluate plant-derived, antioxidant oral supplements and their effects on wrinkle appearance, skin hydration, skin elasticity, and photoprotection.

The Impact of Hyperhidrosis on Quality of Life: A Review of the Literature.

Hyperhidrosis is a condition of excessive sweating, which can have profound physical and mental effects. Hyperhidrosis is a significantly impactful and distressing illness that warrants equal attention as other more well-known dermatologic conditions. However, because of a lack of awareness among the public, stigma, and difficulty with access to treatments (due to cost or insurance coverage), patients are less likely to be diagnosed and treated. In hyperhidrosis, quality-of-life surveys can be useful for determining the magnitude of symptoms and to evaluate treatment outcomes. The purpose of this study was to conduct a narrative literature review to investigate the impact of hyperhidrosis on quality of life. A total of 49 articles investigating the impact of primary hyperhidrosis on quality of life were selected for the review. Hyperhidrosis is a potentially debilitating illness that affects multiple domains of patients' lives including their psychological, physical, and social functioning. Despite the significant impacts, patients with hyperhidrosis are less likely to seek care. Here, we explore these impacts, and disparities in care, in more detail.

Hyperhidrosis: A Review of Recent Advances in Treatment with Topical Anticholinergics.

BACKGROUND: Topical anticholinergics have been reported to be effective in managing hyperhidrosis (HH) given the recent approval of glycopyrronium tosylate. OBJECTIVE: This review aimed to examine the effectiveness of emerging topical anticholinergic treatments for HH and their associated adverse effects in comparison to current treatment options. METHODS: We conducted a search within the PubMed and Embase databases for current and emerging topical anticholinergic treatments for primary HH. RESULTS: The topical anticholinergics that have been recently investigated for use in HH include glycopyrrolate, oxybutynin, sofpironium bromide, and umeclidinium. The only agent currently FDA approved is glycopyrrolate. CONCLUSION: Knowledge of topical anticholinergic treatment options is important for patient care when managing HH. This review shows that while available safety data thus far are limited, emerging topical anticholinergics pose minimal known human risks.

Pleomorphic Fibroma: A Clinicopathologic Case Series With the Review of the Literature.

BACKGROUND: Pleomorphic fibromas are rare flesh-colored benign neoplasms first described in 1989. Their histopathology is notable for nuclear pleomorphism of spindle cells and multinucleate giant cells but lacking mitoses. The cellular origin of these tumors is unknown. This case series describes an additional 18 lesions with discussion of histopathology and immunohistochemistry. METHODS: This case series of 18 pleomorphic fibromas uses immunohistochemical staining for CD34, CD68, factor XIIIa, and S-100 and general histopathologic examination under light microscopy to describe the lesions. RESULTS: Immunohistochemical stains for CD34 showed nearly universal positivity of the pleomorphic spindle cells, although some more focally. The pleomorphic cells were negative for CD68, variably positive for factor XIIIa, and universally negative for S-100. All the lesions showed characteristic nuclear pleomorphism with absent mitoses. Collagen thickening was variable, mucin was absent, and perivascular inflammation was present in all lesions. CONCLUSIONS: Pleomorphic fibromas are fibrous lesions with benign clinical course and histopathologic findings including nuclear pleomorphism. Immunohistochemical staining characteristics of the lesion, along with unique spindle cells and multinucleate giant cells help to differentiate this from other tumors.

Frailty Testing Pilot Study: Pros and Pitfalls.

BACKGROUND: Frailty can be defined as an inflammatory state with a loss of physiologic reserve in multiple systems that manifests as a decreased ability to respond to stressors that ultimately leads to an increased risk of adverse outcomes. The aim of this study was to determine the ease of frailty testing in a pre-kidney transplant clinic and the resources required to do so. A secondary goal was to better understand the utility of frailty testing when evaluating potential kidney transplant recipients. METHODS: Frailty testing was conducted at a pre-kidney transplant clinic in three phases using Fried's frailty phenotype (shrinking, exhaustion, low physical activity, slowness, and grip strength). RESULTS: A total of 132 frailty tests were completed on 128 patients. Frail patients had significantly higher rates of shrinking (26% vs. 8.5%, P < 0.05), exhaustion (82.6% vs. 27.6%, P < 0.05), low physical activity (78.2% vs. 19.0%, P < 0.05), slow walking (60.8% vs. 15.2%, P < 0.05), and grip strength (73.9% vs. 25.7%, P < 0.05). When comparing the listing of frail and non-frail patients for transplant, a significantly lower proportion of frail patients were listed compared to non-frail patients (30.4% vs. 57.6%, P < 0.05). Frailty testing was most complete when an examiner dedicated to frailty testing performed the testing. CONCLUSIONS: Frailty testing is feasible to complete in a pre-transplant clinic with an appropriate investment in personnel and resources.