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PubMed1997

[High resolution 20 MHz ultrasound diagnosis in dermatology for noninvasive imaging of malignant melanomas].

For years, high-resolution b-scan ultrasound is a well established technique in dermatology regarding the preoperative determination of thickness of skin tumors like malignant melanoma or basal cell carcinoma. Most tumors appear as echopoor areas in high-frequency sonography. Until today, a differentiation between skin tumors by means of high-frequency ultrasound is not possible. This is also true concerning the differentiation between the tumor tissue itself and its subtumoral inflammatory infiltration. Therefore, this lack of differentiation leads to the fact that sonometric thicknesses of tumors often exceed the originally measured tumor thickness in histology. By means of three-dimensional reconstruction of serial b-scan images, it is possible to determine each tumor's volume and surface as well as the topographical arrangement of echopoor areas and sonographical structures. Besides high-frequency ultrasound, additional non-invasive techniques like MRI, ultrasound- or laser-doppler, computer-aided image analysis and epiluminescence microscopy are also available for diagnosing malignant melanoma. Epiluminescence microscopy is used today as a standard technique in the diagnosis of malignant melanoma due to the possibility of differential diagnosis. Latest techniques like OCT (optical coherence tomography) are not ready yet to be applied regularly in diagnosis of tumors in the field of dermatology.

Diagnosis, Differential↗
PubMed1997

Impact of patch testing on dermatology-specific quality of life in patients with allergic contact dermatitis.

BACKGROUND: A dermatology-specific quality-of-life instrument has been created and validated for its sensitivity, reproducibility, content, and construct validity. This instrument was used in an observational prospective study that evaluated the cost-effectiveness of patch testing in patients with contact dermatitis and suspicion of allergic component. OBJECTIVE: This multicenter, prospective, observational study was designed to study the various direct and indirect costs associated with diagnosis and treatment of suspected allergic contact dermatitis and the benefits of diagnosis with and without patch testing. The costs and benefits of various methods of diagnosis are evaluated to determine if patch testing is more cost-effective as a diagnostic method. One of the outcomes evaluated was the quality of life of the participants in the study and the impact of patch testing on this cohort. METHODS: A total of 567 subjects were enrolled to obtain evaluable data from at least 500 subjects from ten study centers; the investigators were chosen so as to obtain a mix of stratified degrees of usage of patch testing. Data were collected on demographics, physical characteristics, history of disease, visits to physicians, and, to evaluate costs, the use of resources such as drugs, nondrug substances, and services; other outcome data collected were on physician evaluation of improvement, confirmation of diagnosis, physician opinion of the disease management, and patient evaluation of dermatology-specific quality of life (DSQL), and pertinent economic factors. Only 6-month and 12-month follow-up visits were mandatorily scheduled according to the protocol; however, participants and providers were free to arrange additional visits as deemed necessary for health care. RESULTS: This report focuses on the evaluations at the 6-month follow-up. There are completely evaluable data on pharmacoeconomics and DSQL for 431 patients. About 43% were patch tested, and the rest were diagnosed using the information from history and physical examinations. There was significantly better improvement in each of the DSQL domains in patch tested subjects compared with non-patch-tested subjects. In addition, patients treated in "low" use clinics had lower quality of life at 6-month follow-up than those treated in "high" use clinics. CONCLUSION: Patch testing helps to diagnose the etiology of contact dermatitis early and treat the disease before it becomes chronic, thus reducing resources used and improving patient quality of life considerably.

Case-Control Studies↗
PubMed1998

[Laser applications in dermatology].

Over the past decades continuous wave laser systems have been used in dermatology for the photocoagulation and vaporization of vascular neoformations and malformations and to remove epithelial lesions. However, their mainly thermal effect can have negative impact on wound healing and scar formation due to thermal damage of adjacent tissue. More recent laser systems now permit more selective and more restrictive destruction of pathological tissue. They include pulsed and Q-switched lasers matched to the absorption characteristics of the target structures, which permit skin ablation and selective photothermolosysis of pigmented or vascular lesions. These technical innovations have expanded the therapeutic spectrum in dermatology and improved the quality of the results achieved. Nevertheless, these systems should be used only for carefully selected indications, in particular when corrective-aesthetic considerations are of importance. Furthermore, prior to treatment, it is mandatory for the dermatologist, to establish the proper diagnosis, especially in the case of pigmented lesions and skin changes of uncertain dignity.

Humans↗
PubMedDate not supplied

Recognition of dermatological conditions by junior doctors on general medical wards.

Although we know something about the prevalence of various dermatological conditions in the community, virtually nothing is known about the prevalence and type of skin conditions affecting general medical patients in hospital. This has important implications for both undergraduate training and the continuing education of junior doctors about common skin disorders. In this study we examine the prevalence of skin conditions in 100 in-patients on four general medical wards, and assess the awareness and diagnostic accuracy of junior doctors encountering common dermatological conditions in their patients. Forty-six patients had one or more skin conditions, excluding seborrhoeic warts, skin tags, benign pigmented naevi and Campbell De Morgan spots. The 16 junior doctors correctly diagnosed 64% of common skin conditions that should have been covered in the undergraduate curriculum but detected only 43% of the two malignant skin lesions (basal cell carcinomas) identified in the study. The presence of skin conditions was rarely recorded in the notes, even when the condition was potentially relevant to the general medical condition of the patient. This study highlights the need for greater awareness of skin disease amongst junior doctors in order to avoid unnecessary patient morbidity.

Clinical Competence↗
PubMed1998

Microbiologic evaluation of cutaneous wounds in hospitalized dermatology patients.

The purpose of this study is to identify predictability of wound flora which may be helpful in the selection of empiric antibiotic therapy of wound infections while awaiting the results of bacterial cultures. Toward this end, results of an ongoing microbiologic surveillance of skin wound flora in hospitalized dermatology patients are presented. Bacterial isolates cultured from patients with skin wounds admitted to a tertiary care dermatology inpatient unit were evaluated and comparison was made to a previous survey of the same inpatient service done in 1992. Microbiologic evaluation of superficial skin wounds, leg ulcers, and pressure ulcers showed that Staphylococcus aureus was the principal isolate in superficial wounds (77%) compared to the equal prevalence of S. aureus (43%) and Pseudomonas aeruginosa (42%) cultured from leg ulcers. Cultures from pressure ulcers grew Proteus mirabilis as the dominant isolate. These data agree with previous surveillance data from the same inpatient base performed in 1992 and support the relatively predictable wound flora cultured from skin wounds in our hospital inpatient unit over the 4 years surveillance period. This predictability can enhance empiric antibiotic selection for wound infections while awaiting the results of bacterial culture, and supports the value of local microbiologic surveillance programs in the management of wound infections.

Bacterial Infections↗
PubMed1976

Hypersensitivity as a cause of dermatologic and vaginal moniliasis resistant to topical therapy.

The finding of multiple respiratory or skin allergies together with a high rate of improvement by desensitization leads the author to conclude that allergy is a predisposing factor for the chronicity or recurrence of vaginal or dermatologic moniliasis. Desensitization with Candida albicans antigen was the mainstay in the treatment of resistant dermatologic or vaginal moniliasis and the sole form of therapy in cases of nail involvement with deep seated lesions out of the reach of topical agents.

Candidiasis, Cutaneous↗
PubMed1976

[Peculiarities of a consultative service and a psychosomatic consultation-hour at a dermatological university clinic (author's transl)].

When organizing a consultative service and a psychosomatic consultation-hour at a dermatological clinic the following (specific?) peculiarities resulted: 1) the fellow doctors at the clinic at first only sent somatically untreatable cases and 2) were afraid of a correction of their diagnosis. 3) By way of identification they were faced with their own proper problems. The patients understood themselves to be physically ill and at first could not be approached regarding to their subconscious conflicts. The actual conduct of the patients in the wards and their attitude to the physicians was used in a psychodiagnostical way (whereas analytical interpretations were dispensed with) and was used therapeutically to elucidate the psycho-genesis of their affliction. Only with some singular patients suffering from skin-diseases a proper analysis could be performed for research purposes; most of them had to be treated simultaneously dermatologically as well as psychoanalytically (in a modified way). Merely with patients suffering from andrological troubles group-therapy along analytical lines was feasible and proved to be successful.

Adult↗
PubMed1963

CURRENT CONCEPTS IN DERMATOLOGY. III. THE USE OF RADIOTHERAPY AND CORTICOSTEROIDS.

The use of ionizing radiation and corticosteroids is discussed, in this third and final part of a review of diseases of the skin. Radiation is being used less extensively because superior methods of treatment are available for many conditions which formerly were frequently treated by this modality. The concept of applying the radiation at the level of the basic pathologic process has been developed into clinical practice by the use of generators which can produce very soft (or superficial) ionizing radiation. Topical or systemic corticosteroids do not cure skin diseases but produce dramatic suppression of signs and symptoms. For best results consideration must be given to the diagnosis, the natural history of the disease to be treated, the method of administration and a search for possible contraindications to the use of these steroids. Basic dermatological principles (removal of offending agents, bland soothing applications, sedation, etc.) must be adhered to. The corticosteroids are not a panacea in the treatment of skin disease.

Adrenal Cortex Hormones↗
PubMed2004

[Off-label use in dermatological practice. The conflict between professional duty and legal requirements].

When making therapeutic decisions, doctors often find themselves faced with a dilemma regarding ethical, professional, legal liability, social and service aspects of their duties. These conflicts may be enhanced when medications have to be prescribed for non-approved usages, known as off-label prescribing, because existing therapy options have been exhausted. This option become considerably more difficult since the German Federal Social Court decision of March 2002 which limited off-label use to a number of very strictly defined circumstances. In order to clarify the basis for taking decisions in a given situation, an oncology expert commission has been formed under the coordination of the Department of Health and Social Security. However, this is no solution for the great variety of uncommon dermatological diseases which often require off-label medication usage.

Clinical Trials as Topic↗
PubMed2000

Virtual reality for dermatologic surgery: virtually a reality in the 21st century.

In the 20th century, virtual reality has predominantly played a role in training pilots and in the entertainment industry. Despite much publicity, virtual reality did not live up to its perceived potential. During the past decade, it has also been applied for medical uses, particularly as training simulators, for minimally invasive surgery. Because of advances in computer technology, virtual reality is on the cusp of becoming an effective medical educational tool. At the University of Washington, we are developing a virtual reality soft tissue surgery simulator. Based on fast finite element modeling and using a personal computer, this device can simulate three-dimensional human skin deformations with real-time tactile feedback. Although there are many cutaneous biomechanical challenges to solve, it will eventually provide more realistic dermatologic surgery training for medical students and residents than the currently used models.

Computer Simulation↗
PubMed2003

Antibiotic use in dermatologic surgery.

Few situations in dermatologic surgery require prophylactic antibiotics. The AHA has decreased the dose for endocarditis prophylaxis from antibiotics before and after the procedure to only 1 hour prior to the procedure. In the 1997 guidelines, fewer procedures are listed as requiring antibiotics compared with prior guidelines. In fact, several authors have questioned the efficacy of prophylactic antibiotics. The sequela of endocarditis or an infected prosthetic joint are certainly serious and possibly life-threatening conditions, yet this should not be a justification for using a therapy that is not proven and has potential serious side effects of its own. The authors suggest not using antibiotics on clean or clean-contaminated wounds regardless of cardiac history. Patients with prosthetic joint replacements probably do not need prophylactic antibiotics in cutaneous surgery unless mucosa is invaded; in such cases the guidelines set by the ADA and the AAOS should be followed. The authors believe that antibiotics should be reserved for contaminated or infected wounds when their application is therapeutic. Table 2 contains a summary of the authors' recommendations for the use of antibiotics in cutaneous surgery. Each patient should be evaluated on an individual basis, and consultation with the patient's primary physician, cardiologist, or orthopedist should be sought when the need arises.

Anti-Bacterial Agents↗
PubMed1999

The value of an aide memoire in the dermatology clinic.

A randomized study was undertaken to investigate the effectiveness of a chart as an aid to memory illustrating the topical medication most frequently prescribed both in the dermatology clinic, and in general practice. One hundred subjects, half new referrals and half follow-ups, were recruited and asked to recall all of the topical preparations that had previously been prescribed for this condition. They were then asked to consult the chart, and any additional medication recognized at this time was noted, along with any clarification of formulation and strength where possible. Despite some limitations, our chart proved to be of considerable value. Thirty-eight patients could identify between three and eight additional preparations. Overall, the mean number of additional preparations recalled per patient was two. Clarification of strength and formulation was achieved by 21 patients. Eight charts were used, and provided additional information at consultation in 87% of subjects interviewed.

Administration, Topical↗
PubMed2001

Dermatology day care treatment centres.

Day care treatment centres provide the best solution for the treatment of most patients with psoriasis. The centre is not only ideal for treatment but has other roles, such as education of patients and nurses. The specialist dermatology nurse is the key to success. Out patient treatment of psoriasis is less expensive than in patient treatment. The development of a treatment centre should be seen as an additional facility and not as a substitute for in patient beds.

Administration, Topical↗
PubMed2003

Experimental study of cryogen spray properties for application in dermatologic laser surgery.

Cryogenic sprays are used for cooling human skin during laser dermatologic surgery. In this paper, six straight-tube nozzles are characterized by photographs of cryogenic spray shapes, as well as measurements of average droplet diameter, velocity, and temperature. A single-droplet evaporation model to predict average spray droplet diameter and temperature is tested using the experimental data presented here. The results show two distinct spray patterns--sprays for 1.4-mm-diameter nozzles (wide nozzles) show significantly larger average droplet diameters and higher temperatures as a function of distance from the nozzle compared with those for 0.5-0.8-mm-diameter nozzles (narrow nozzles). These results complement and support previously reported studies, indicating that wide nozzles induce more efficient heat extraction than the narrow nozzles.

Administration, Topical↗
PubMed2005

Relevance of cosmeceuticals to the dermatologic surgeon.

BACKGROUND: The dermatologic surgeon is the dermatologist with special expertise in the surgical care of the health and beauty of the skin. OBJECTIVES, METHODS, RESULTS: There is no better arena for the use of topical regimens to preserve skin quality than in the time interval devoted to before and after care with respect to surgical procedures. CONCLUSION: Many of these regimens can be tailor devised with topical drugs and cosmeceuticals together in proper balance in the patient's best interest for affordable health care.

Cosmetic Techniques↗
PubMed1961

Systemic use of corticosteroids in dermatology.

The use of corticosteroids systemically in dermatology has benefited patients with pemphigus and systemic lupus erythematosus in that they now have a better chance to carry on a productive life. These hormones, used cautiously, can alleviate some of the tremendous suffering during the explosive exacerbations and acute crises of atopic and neurodermatitis. Corticosteroids are useful in the widespread and acute contact dermatitis and drug eruptions; they are contraindicated in the treatment of ordinary psoriasis. Every attempt should be made by history-taking, clinical examination and necessary laboratory studies to reach an accurate diagnosis before corticosteroids are used. If use of them is indicated, then total patient care is required to avoid complications, and a very careful follow-up is mandatory.

Adrenal Cortex Hormones↗
PubMed2005

Evidence-based dermatology.

Evidence-based dermatology (EBD) is the application of the principles of evidence-based medicine to the diagnosis and treatment of skin disorders. EBD does not discount the individual dermatologist's clinical judgment. In fact, EBD is based on the interaction of external evidence, the physician's clinical experience, and the patient's experience. Randomized controlled trials constitute one of the highest levels of evidence and are the gold standard for validating a therapeutic intervention. For the treatment of rosacea, oral tetracycline, topical metronidazole, topical azelaic acid, and topical sulfur/sodium sulfacetamide have been validated by more than one randomized controlled trial.

Anti-Infective Agents↗
PubMed1989

The infrared coagulator in dermatology.

The infrared coagulator was developed 10 years ago in West Germany. It shares some properties with an infrared laser but differs by virtue of its noncoherent, multispectral light source. It has evolved to become a cheap, portable instrument with a wide spectrum of applications in medicine, including dermatology. The treatment of tattoos and vascular lesions with the infrared coagulator is discussed, along with the technical considerations and limitations associated with this instrument.

Animals↗