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PubMed2003

Dermabrasion in dermatology.

Dermabrasion has been used for a number of years to treat a variety of dermatologic conditions, including facial skin resurfacing and scar revision. The popularity of this procedure has diminished with the advent of newer procedures including chemical exfoliation, laser resurfacing, non-ablative laser resurfacing, and microdermabrasion. Dermabrasion found its niche in treating acne and traumatic facial scars, and in cosmetic facial resurfacing. Small, portable hand-held dermabraders are the most popular units available today and are able to generate rotation speeds of 18,000-35,000 revolutions per minute. End pieces, including wire brushes, diamond fraises and serrated wheels, attach to the end of the dermabrader to allow precise resurfacing and treatment. As with all cosmetic surgical procedures, appropriate patient selection and room preparation (with appropriate lighting and monitoring equipment) are essential to assure optimal outcomes with the dermabrasion procedure. Patients must understand all of the potential risks, benefits and limitations associated with the procedure. Patients must also be aware of alternative therapies that are available. Dermabrasion is technique-dependent and the surgeon should be well versed on the technique prior to performing this therapy. Gentian violet solution is used to delineate the areas to be treated. Refrigerant topical anesthesia is used to freeze the skin prior to the procedure. Holding the skin taut, the dermabrasion procedure occurs in a routine manner, treating one anatomic unit at a time. Postoperatively, patients may have an open or closed dressing system. Postoperative medical treatment is also recommended, including the use of antiviral agents, antibacterials and corticosteroids. The re-epithelialization process is usually complete in 5-7 days and residual erythema is common for up to 4 weeks. Adequate sun protection is essential following dermabrasion. Dermabrasion has also been used in combination with other dermatologic procedures, including chemical exfoliation, soft tissue augmentation and laser procedures, to enhance the results of dermabrasion. Dermabrasion remains a useful facial skin resurfacing and scar revision technique, particularly when performed by a trained and skilled surgeon. Most dermatologic surgeons argue that pure dermabrasion is a useful modality in skilled surgical hands and should be considered when appropriate.

Dermabrasion↗
PubMed2004

Levamisole in dermatology : a review.

Levamisole, an anthelmintic agent with a wide range of immunomodulatory actions, has been used successfully as monotherapy and an adjunct to treatment in a variety of diseases. Since 1990, combination therapy of levamisole and fluorouracil has played an important role in the treatment of resected Dukes stage C adenocarcinoma of the colon. Because of its immunomodulating effects levamisole has been used in a wide range of diseases with and without success. In dermatologic disease levamisole has been successfully used in the treatment of parasitic, viral and bacterial infections including leprosy, collagen vascular diseases, inflammatory skin diseases and children with impaired immune a variety of reasons. It has also been used in combination with other drugs for treating a number of dermatologic disorders, e.g. in combination with cimetidine for treating recalcitrant warts, with prednisolone for treating lichen planus, erythema multiforme and aphthous ulcers of the mouth. Adverse affects of levamisole are mild and infrequent and include rash, nausea, abdominal cramps, taste alteration, alopecia, arthralgia, and a flu-like syndrome. It can rarely cause agranulocytosis. More studies need to be undertaken to study the full potential of levamisole in dermatologic diseases.

Adjuvants, Immunologic↗
PubMedDate not supplied

Dermatological illnesses of immigrant poultry-processing workers in North Carolina.

The authors designed this study to assess skin ailments among male Latino poultry-processing workers in one plant in North Carolina. Because conditions in poultry plants expose workers to multiple agents affecting the skin, the number of skin ailments was expected to be high. A visual skin examination was conducted by a single board-certified dermatologist for 25 male workers. Dermatological Life Quality Index scores and self-reported skin treatment data were obtained through interviews. Each worker had at least one dermatological diagnosis. Infections were most common (onychomycosis, 76%; tinea pedis, 72%), followed by inflammatory diagnoses (acne, 64%). No workers had sought medical treatment. Dermatological Life Quality Index scores indicated impaired quality of life. Worker self-reports were not strongly associated with dermatologist diagnoses. Skin diseases are common among poultry workers and impact workers' quality of life; reasons for lack of medical care should be investigated.

Adult↗
PubMed2006

LASIK in myopic patients with dermatological keloids.

PURPOSE: To evaluate the visual and refractive out come of LASIK in myopic patients with a known history of dermatological keloid scar. METHODS: This retrospective case series included 10 eyes of 5 white patients with a known history of dermatological keloids. All patients had low to moderate myopia with no corneal or limbal keloid. All underwent uneventful bilateral LASIK. Postoperatively, visual outcomes, refractive outcomes, and complications were evaluated. Minimum 1-year follow-up was indicated for all patients in this study. RESULTS: Mean preoperative uncorrected visual acuity (UCVA) was 20/320 and 1 year postoperative 20/20. Mean preoperative best spectacle-corrected visual acuity (BSCVA) was 20/25 and 1 year postoperative was 20/20. The mean preoperative spherical equivalent refraction was -5.00 +/- 2.6 diopters (D) and +0.1 +/- 0.2 D 1 year postoperative. The safety index was 1.02 and the efficacy index was 1.02. None of the included in this study underwent retreatment for correction of residual error or regression up to 1 year postoperatively. No sight-threatening complications were reported. No patient reported postoperative haze, severe dry eye syndrome, or flap-related problems. CONCLUSIONS: LASIK is a safe, effective, and predictable technique for correcting low and moderate myopia in patients with dermatological keloids.

Adult↗
PubMed1999

Dermatologic manifestations in HIV-infected patients: a primary care perspective.

OBJECTIVE: To document the prevalence of dermatologic manifestations in patients infected with the human immunodeficiency virus (HIV) on presentation to primary medical care. DESIGN: Prospective consecutive case series evaluated between June and November 1995. SETTING: The HIV intake clinic at an urban hospital. SUBJECTS AND METHODS: Ninety-five individuals initiating HIV-related primary care. RESULTS: Dermatologic manifestations were found in 82 patients (86%). The most common conditions were dermatophytosis in 32 patients (34%), oral hairy leukoplakia in 22 (23%), and folliculitis in 18 (19%). Well-described HIV-associated dermatologic manifestations such as Kaposi sarcoma, herpes zoster, and psoriasis were uncommon. CONCLUSIONS: The high prevalence of treatable skin disorders found in HIV-infected patients underscores the importance of careful and complete skin examination as a fundamental aspect of the initial clinical evaluation in this population.

Adult↗
PubMedDate not supplied

A study of mortality in dermatology.

BACKGROUND AND AIMS: Certain dermatological conditions are life-threatening and can cause mortality. The aim of this study is to find out the dermatological diseases leading to death in our indoor patients. METHODS: A record-based retrospective descriptive study of dermatology cases who died during the period of 1995 to 2001. RESULTS: The total number of cases analyzed was thirty-seven. There were 24 males and 13 females. The maximum number of deaths occurred in the age group 61-70. Vesiculobullous disorders were the commonest cause of death, found in 18 cases (48.6%), followed by drug reactions in 5 (13.5%), malignancies in 5 (13.5%) and collagen vascular disease in 2 cases ((5.40%). Pemphigus was the commonest fatal vesiculobullous disorder (13 cases - 35.13%), and toxic epidermal necrolysis the commonest drug reaction (3 cases - 8.10%). CONCLUSION: Area of skin involvement, electrolyte imbalance and septicemia were important factors leading to death in pemphigus and toxic epidermal necrolysis. We advocate that such patients should be managed in burns unit or ICU units.

Adolescent↗
PubMed1992

Comparison of muscle-derived serum carbonic anhydrase III and myoglobin in dermatological patients: effects of isotretinoin treatment.

The serum levels of muscle-specific serum carbonic anhydrase III (S-CAIII) and myoglobin (S-Myo) were analyzed in various male dermatological patients of the same age. The mean levels of S-CAIII and S-Myo were essentially similar in patients with acne, psoriasis vulgaris, atopic eczema and tinea, suggesting that common dermatological diseases do not affect the serum levels of the muscle markers. Increased levels of S-CAIII, which is specific for skeletal muscle cells, were found in the acne patients who had been treated with isotretinoin. However, when S-CAIII and S-Myo were studied in 24 patients (16 males, 8 females) before and during isotretinoin treatment, no constant increases in these markers could be observed. When individual patients were followed for several months, transient increases or decreases could be observed. The changes in S-CAIII, or S-Myo, did not correlate with the dose of isotretinoin, nor with the duration of the treatment. The results suggest that systemic isotretinoin does not specifically affect skeletal or myocardial muscles. The increases in these markers observed in the course of dermatological diseases and isotretinoin treatment are obviously due to other factors, such as exercise.

Adolescent↗
PubMed2000

Dermatologic disease: twenty-two year experience at the USAF Aeromedical Consultation Service and review of other military and civilian experiences.

The Aeromedical Consultation Service (ACS) is a U.S. Air Force tertiary referral service which evaluates aviators with complex medical problems and makes recommendations for their aeromedical disposition. This study reports the experience with dermatologic disease in aviators referred to the ACS over a 22-yr period from 1975-1997. A review of other military and civilian experiences with dermatologic disease is also presented. The potential impact of skin disease on aviators and support personnel, in peacetime and wartime, can be surmised by this collective account of dermatologic experiences.

Adult↗
PubMed2000

A cost consequence study of the impact of a dermatology-trained practice nurse on the quality of life of primary care patients with eczema and psoriasis.

BACKGROUND: The practice nurse is central to the development of a primary care-led National Health Service. Skin diseases can have a major impact on patients' lives but general practitioners (GPs) lack many of the skills of practical dermatology care and support. AIM: To determine whether a primary care dermatology liaison nurse should be introduced by our health authority. We identified the resources consumed and the benefits that accrued from a practice nurse who had received training in practical dermatology care. METHOD: A cost consequence study in parallel with a randomised controlled trial was undertaken in a group of nine GPs and 109 patients between the ages of 18 and 65 years who had a diagnosis of psoriasis or eczema. RESULTS: Although there was a significant improvement in our primary outcome measure within group, when compared with the control group significance was not achieved. There was no significant change in the Euroqol measure but the clinical instrument showed a significant change when compared with control. On entry, our qualitative data identified three main themes--the embarrassment caused by these skin conditions, the wish for a cure rather than treatment, and concern over the long-term effects of steroids. On completion, 20% of patients expressed that they had received a positive benefit from the clinic. CONCLUSION: This study demonstrates the difficulties of obtaining relevant information to facilitate decisions on how resources should be allocated in primary care. Not all questions can be answered by large multi-centred trials and studies themselves have an opportunity cost consuming resources that could otherwise be spent on direct health care. Often, local resource decisions will be based on partial evidence-yielding solutions that are satisfactory rather than optimum but which are, nevertheless, better than decisions taken with no evidence at all.

Adolescent↗
PubMed2000

[Evidence-based ambulatory dermatological treatment].

The evidence base for routine therapeutic decisions in dermatological out-patients was studied in a random sample of the case-notes from 115 out-patients. The evidence base of therapy prescribed when the diagnosis was ascertained was studied in literature searches in MEDLINE and EMBASE. Evidence was structured into primary evidence consisting of randomised controlled trials, and secondary evidence consisting of follow-up studies or applying trial results from clinical analogies, e.g. atopic and seborrheic dermatitis treatment. Randomised controlled trials could be found describing 38% (95% confidence interval: 30-47) of all treatments. Secondary evidence was found for 33% (24-41), while no evidence was found for 23% (16-31) of the given treatments. Approximately 75% of dermatological out-patient therapy is founded on scientific evidence spanning from randomised controlled trials to logical deduction about a given disease from an analogous clinical situation. The proportion of evidence based medicine in dermatological therapy therefore appears comparable to that of other fields of medicine.

Adolescent↗
PubMed2002

[Pain management and the use of analgesics in dermatology].

OBJECTIVE: To determine pain assessment and management, and the use of analgesics in dermatology. PATIENTS AND METHODS: Two hundred and sixty six patients hospitalised in a dermatology university department (Henri-Mondor, Créteil) between November 1999 and April 2000 were enrolled in a prospective study. Clinical evaluation of pain intensity and evolution were studied using a visual analogic scale (VAS) pain score at presentation, during hospitalisation, and at discharge. Prescription and consumption of analgesics were also studied. RESULTS: Fifty-nine percent of the patients experienced pain. Eighty-four percent of them had mild or moderate to severe pain (VAS<7/10) and were relieved with non or mild opioid analgesics (discharge VAS<4/10). Sixteen percent of them had intense pain requiring morphine (VAS score >=7/10). CONCLUSIONS: Pain management is very important in dermatology. Every physician should know its principles since dermatologists play a crucial role in the patient's care.

Analgesics↗
PubMed2003

Pimozide: use in dermatology.

Pimozide is widely used in psychiatry for chronic psychoses, schizophrenia, the syndrome of Gilles de la Tourette and to a certain extent, also in dermatology. The only dermatological indication is for delusions of parasitosis. Though there is a good rationale for using pimozide in this disease, the majority of the studies on pimozide in dermatology are uncontrolled trials and case reports.

Antipsychotic Agents↗
PubMed2003

Adverse reactions to herbal therapy in dermatology.

There are many herbal therapies available for dermatological diseases that patients have already begun to discover. Dermatologists must be educated not only in the benefits of these therapies, but must also be aware of some of the risks and adverse effects. They need information about the effects of herbal remedies in order to better serve their patients who may be using herbs to treat their dermatological conditions. This brief review summarizes some of the more common herbal therapies used by many dermatology patients for their skin diseases, and the adverse reactions and drug interactions that may occur.

Drug Interactions↗
PubMed1992

Practical approaches to pediatric dermatology.

Pediatric dermatology has evolved as a subspecialty of dermatology. The ability to recognize and adequately treat the most common pediatric dermatoses represents an important skill for all dermatology nurses.

Child↗
PubMed2003

[Public health and dermatology in developing countries].

Recently some common skin diseases (SD) (i.e. pyoderma, scabies, and superficial mycosis) received special interest in terms of public health assessing their significance in developing countries (DC). The importance of this problem has been established through several kinds of studies: studies from specialized dermatology centres, where the main reasons for consulting were common infectious skin diseases; prevalence studies in the general population pointing out very high prevalence rates for common infectious SD; and studies conducted in non-specialized health centres, where those SD represented about 10% of the total number of consultations. Classical complications of common infectious SD, such as post-streptococcic nephritis, appear rather unusual. However, the costs related to SD have been established as significant; this is partly due to the low efficiency of the health agents when trying to manage SD, and to their usual lack of training. So far, SD have been considered as having a very low priority level, due to their low lethality rate, and therefore have been ignored by health authorities. However, it seems unwise to ignore a health problem for which such a demand of the populations is expressed. Health policies aiming at the improvement of this situation have to be aware of the economic and health system context in DC, and should take into account every step of the health system. The following actions have been proposed: definition of SD priorities; training of non-specialized health agents to a basic management of SD priorities; promotion of use and availability of low-cost "essential dermatologic drugs"; education of the populations regarding measures to prevent certain SD. The feasibility and the impact of such a "public health dermatology" program remain to be evaluated.

Developing Countries↗
PubMed2004

The compilation and edition of the first color atlas of dermatology by Robert Willan (1757-1812), Thomas Bateman (1778-1821), and Ashby Smith (?-1831) from 1790 to 1817.

An account is given of the development of early dermatologic iconography, mostly in watercolors and copper prints, as a consequence of late Enlightenment perspectives and the development of a visually-dependent concept in a text-dominated discipline of dermatology. The first great atlases in the field of dermatology by Robert Willan (1757-1812) and Jean-Louis Alibert (1768-1837), and by M. N. Devergie (1784-1842) in venereology, are addressed and Willan's work is elaborated in detail.

Anatomy, Artistic↗
PubMed2004

[Identification of Langerhans cells in dermatology].

This paper describes our own findings on the role of Langerhans' cells in dermatology and discusses literature data on their detection in seven different dermatoses. The skin is an integral part of immune system. During the past 30 years, increasing evidence has been accumulated that the skin contains cellular elements which are needed for the initiation and expression of immune response. Langerhans' cells (LCs) are dendritic cells originating in the bone marrow. They reside mainly within stratified squamous epithelia and constitute approximately 2-4% of epithelial cells. LCs are epidermal antigen presenting cells which play a crucial role in allergic contact hypersensitivity, viral diseases, graft versus host disease and elimination of neo-plastic cell clones. They express antigens conjugated with major histocompatibility complex (MHC) class II positive molecules on their surfaces for presentation to T-helper lymphocytes. LCs cannot be identified in routinely prepared histologic testing but can be visualised at the light microscope level by histochemical and immunologic techniques. Appropriate methods for the detection of Langerhans' cells in dermatology (also shown by our own experience) are histoenzymatic methods of adenosintriphosphatase (ATP-ase), acid phosphatase (AP), alpha-naphthylacetatesterase (ANAE and peroxidase-antiperoxidase immunohistochemistry method with polyclonal S-100 protein antibody (PAP). LCs are the only cells in normal skin with ATP-ase activity. Histoenzymatic methods used in patients with atopic dermatitis, vitiligo, mycosis fungoides, Behcet's disease, lichen ruber planus, psoriasis vulgaris, irritant dermatitis and allergic contact dermatitis demonstrated LSs in epidermis and dermis. ANAE and AP showed concordance and were suitable histochemical markers for LC distribution and macrophages in the dermis in mycosis fungoides, atopic dermatitis, psoriasis vulgaris, irritant chronic dermatitis and Bechet's disease. Our experience of the human skin showed a strong activity of calcium-activated adenosine triphosphatase in LCs. LCs in the guinea pig skin can be demonstrated by Mg++ and Ca++ activated adenosine triphosphatase, but a stronger activity of Ca++ activated adenosine triphosphatase in LCs after irritation. Ca++ ATP-ase as an indicator of energy-dependent pump is the reflection of intracellular calcium level, which is a significant factor for regulating the growth and metabolism of the cells. LCs are found as target cells during the efferent phase of contact allergic reaction. Immunohistochemical methods, define the role of LCs in dermatology more precisely and allow complete immunologic recognition within the epidermis.

Dermatitis, Allergic Contact↗
PubMed2004

[Measures for osteoporosis in the dermatological field--vitamin D3 and bisphosphonate].

Steroid-induced osteoporosis is the most common form of osteoporosis in the dermatological diseases, but there have been only few data concerning the treatment based on clinical evidences. For management of osteoporosis, the efficacy of vitamin D(3) and bisphosphonate had been demonstrated by meta-analytic approach. Ten dermatological patients in our clinic who had received long-term oral steroids and showed bone loss were treated with 5 mg/day of alendronate for one year, and showed significant increase in the bone mineral density of the lumbar spine. In dermatological patients requiring long-term systemic steroids, administration of drugs such as vitamin D(3) or bisphosphonate should be started earlier.

Aged↗