A comparison of infection rates during skin cancer excisions using nonsterile vs sterile gloves: A prospective randomized pilot study.

BACKGROUND: Standard surgical skin excision is a routine outpatient procedure commonly performed in Dermatology practice to treat nonmelanoma and melanoma skin cancer. Use of sterile gloves during this procedure has been the standard of care in most Dermatology offices. OBJECTIVE: To determine whether the incidence of infection rates was affected when using nonsterile gloves (NSG) instead of sterile gloves (SG) during standard skin excisions in an outpatient Dermatology clinic setting. METHODS: This prospective, subject-blinded, single-center trial randomized 93 patients presenting for routine skin cancer excisions into two groups. In the first group, 53 excisions were performed with NSG and in the second group 53 excisions were performed with sterile gloves. Degree of wound inflammation and wound infection at 48-72 hours postprocedure was measured. RESULTS: One hundred and six total wounds were included. Zero of 53 were infected in the NSG group, and 0/53 were infected in the SG at the initial screening 48-72 hours postexcision procedure (P = 0.99). The average wound inflammation score was 0.321 for the NSG group and 0.245 for the SG group. CONCLUSIONS: Our study suggests that NSG are safe to use for simple excisions of cutaneous skin cancers in an outpatient dermatology clinic setting.

Bullous fixed drug eruption masquerading as recurrent Stevens Johnson syndrome.

BACKGROUND: Fixed drug eruptions (FDE) are peculiar drug rashes that tend to be violaceous, hyperpigmented, and round to oval-shaped plaques with dusky gray centers. The lesions tend to recur in a similar dermatologic distribution upon re-exposure to the offending medication, leading to intensified inflammation and sometimes the formation of blisters, bullae, and erosions. This bullous form of FDE can be mistaken clinically for Stevens Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN). CASE REPORT: We report two cases of patients presenting to the emergency department (ED) with characteristic blistering skin lesions and reports of similar prior episodes; both patients were initially diagnosed in the ED as "recurrent SJS" and admitted to the burn intensive care unit. Each patient was evaluated emergently by dermatology consultants, identified as cases of FDE rather than SJS, and transferred to the general medical ward with an uncomplicated hospital course and complete re-epithelialization within 7 days after removal of the inciting agent. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: We discuss distinguishing features of bullous FDE and SJS/TEN in order to highlight this entity and aid in diagnostic accuracy and appropriate management by emergency physicians. In cases identified as classic or suspected SJS/TEN, the patient warrants aggressive resuscitation and admission to a burn unit, while cases identified as obvious bullous FDE can be managed much more conservatively. Although the clinical clues outlined here may help distinguish classic cases of FDE from SJS/TEN, it is always advisable to admit to a higher level of care or obtain an urgent dermatology consult when diagnostic uncertainty remains.

Outpatient burns: prevention and care.

Most burn injuries can be managed on an outpatient basis by primary care physicians. Prevention efforts can significantly lower the incidence of burns, especially in children. Burns should be managed in the same manner as any other trauma, including a primary and secondary survey. Superficial burns can be treated with topical application of lotions, honey, aloe vera, or antibiotic ointment. Partial-thickness burns should be treated with a topical antimicrobial agent or an absorptive occlusive dressing to help reduce pain, promote healing, and prevent wound desiccation. Topical silver sulfadiazine is the standard treatment; however, newer occlusive dressings can provide faster healing and are often more cost-effective. Physicians must reevaluate patients frequently after a burn injury and be aware of the indications for referral to a burn specialist.

Evaluation of dermatologic conditions by primary care providers in deployed military settings.

Dermatologic illnesses have historically been a significant source of morbidity and resource utilization in fielded military forces. The impact of cutaneous diseases during U.S. military conflicts is reviewed, and recent data from Craig Joint Theater Hospital at Bagram Air Field in Afghanistan are presented, confirming previous experience. A discussion of the difficulties of diagnosing and treating dermatologic conditions for deployed primary care providers is provided, including recommendations to improve patient care and military unit readiness.