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At least 1,261 records · Page 70Linked to original sources
PubMed1993

Use of cotton-tipped applicators during skin examination and dermatologic surgery.

The cotton-tipped applicator is a widely available and versatile tool for the dermatologist. In addition to the common uses of this inexpensive tool there are many other ways for the dermatologist to use cotton-tipped applicators. From its usefulness in dermatologic examination and potassium hydroxide preparations to its multiple surgical applications, the cotton-tipped applicator is a valuable and underrated tool.

Adult↗
PubMed2006

Integration of basic dermatological care into primary health care services in Mali.

OBJECTIVE: To evaluate, in a developing country, the effect of a short training programme for general health care workers on the management of common skin diseases--a neglected component of primary health care in such regions. METHODS: We provided a one-day training programme on the management of the skin diseases to 400 health care workers who worked in primary health care centres in the Bamako area. We evaluated their knowledge and practice before and after training. FINDINGS: Before training, knowledge about skin diseases often was poor and practice inadequate. We found a marked improvement in both parameters after training. We analysed the registers of primary health care centres and found that the proportion of patients who presented with skin diseases who benefited from a clear diagnosis and appropriate treatment increased from 42% before the training to 81% after; this was associated with a 25% reduction in prescription costs. Improved levels of knowledge and practice persisted for up to 18 months after training. CONCLUSIONS: The training programme markedly improved the basic dermatological abilities of the health care workers targeted. Specific training may be a reasonable solution to a neglected component of primary health care in many developing countries.

Clinical Competence↗
PubMed1996

Dermatology. Positioned for health care reform.

Dermatologic services will of necessity be a fundamental part of any quality, cost-conscious health care system because (1) we treat medically necessary and economically significant diseases, (2) our area of expertise includes a distinct body of medical knowledge over which no other health professional has comparable expertise, and (3) our services are provided in a cost-effective manner.

Cost-Benefit Analysis↗
PubMed1998

Mind-body medicine. Practical applications in dermatology.

It is only recently that Western physicians are rediscovering the link between thought and health. The spectrum of causative factors in inflammatory dermatoses are often multifactorial. Stress and negative thoughts are major factors in dermatologic conditions. This article begins with some basic information on the ways that thoughts affect health. Practical methods of intervention including meditation, journal writing, affirmations, prayer, biofeedback, and hypnosis are presented.

Biofeedback, Psychology↗
PubMed1998

Off-label dermatologic therapies. Usage, risks, and mechanisms.

Off-label refers to the prescribing of Food and Drug Administration-approved drugs for a use not indicated on the package insert. The prescribing of off-label drugs may benefit patients with many dermatologic diseases including angiogenesis-related conditions. We surveyed 55 dermatologists from a single large academic program to assess their use of particular drugs for specific skin conditions, their perception of such use as being for Food and Drug Administration-approved or for off-label indications, and their attitudes towards off-label therapies. The practice of prescribing off-label drugs was common among the respondents, many of whom had misperceptions about which conditions are Food and Drug Administration-approved indications and about the legal ramifications of off-label therapies. We suggest that understanding the principles of off-label prescribing in conjunction with the mechanisms of drug action in diseases may help clinicians exercise their judgment in finding innovative therapies for their patients.

Dermatologic Agents↗
PubMed2002

Patients' attitudes regarding physical characteristics of medical care providers in dermatologic practices.

OBJECTIVE: To assess the present attitudes of patients toward physicians' physical attributes. DESIGN: Written survey offered to all patients seen during a 1-week period. SETTING: Two outpatient dermatologic clinical practices (a county hospital and a private practice). PARTICIPANTS: Of 315 patients offered the survey, 275 agreed to complete it. MAIN OUTCOME MEASURES: Opinions regarding physicians' demographic characteristics and opinions regarding desirability of 19 and 18 appearance-related characteristics in male and female physicians, respectively. RESULTS: Analysis of the responses revealed 25 characteristics that were significantly desirable or undesirable (defined as being selected desirable or undesirable by at least 25% of respondents). Further analysis revealed that patients in a private practice setting typically had more polar opinions about providers' appearances than did patients from a large county hospital. Most patients had no preference with regard to the sex, age, or race of their medical care providers. Age and sex of the patient did not independently contribute significantly to patient preferences, as determined by cross-tabulation analysis. Clinic site (private practice vs county hospital clinic) alone was the sole or most important predictor of preferences in 13 of the 25 significant characteristics. CONCLUSIONS: Several characteristics of providers' dress and grooming were important to patients. There seemed to be little attitudinal change from similar studies performed 2 decades ago. Cognizance of these preferences may facilitate better interactions between medical care providers and patients.

Adult↗
PubMedDate not supplied

Comparison of dermatologic diagnoses by primary care practitioners and dermatologists. A review of the literature.

BACKGROUND: Cost-containment efforts in the United States have led to a greater emphasis on health care delivery by primary care physicians as opposed to specialists, who are assumed to be more costly. With this approach, it is incumbent on the primary care physician to be able to accurately diagnose and treat common maladies, including skin disease. OBJECTIVE: To ascertain whether differences in performance were detectable between groups of physicians when presented with color slides or high-quality transparencies. DESIGN: We performed a critical review of published studies. RESULTS: Overall, dermatologists (93% correct) performed better than nondermatologists (52% correct) (P < .001). No difference was appreciable between dermatology residents (91% correct) and practicing dermatologists (96% correct) or between internal medicine residents (45% correct) and family practice residents (48% correct). In addition, family medicine attending physicians (70% correct) performed better than internal medicine attending physicians (52% correct) (P < .001). CONCLUSION: Primary care physicians should receive more training in the diagnosis of skin disease.

Clinical Competence↗
PubMed1998

Future of laser dermatology.

BACKGROUND AND OBJECTIVE: Laser dermatology, a long-time model for laser tissue interactions, will play an important part in the future of research, diagnostics, and therapeutics. STUDY DESIGN/MATERIALS AND METHODS: Laser research continues in photobiology, especially in molecular reactions, and it continues at the cellular level in melanocyte and Langerhans cells. RESULTS: Laser diagnostics in the development of opto-electronics concern new developments in imagery. Some studies include new types of microscopes for living skin and vary from the portable illuminated skin microscopes, the current dermatoscopes, to the coaxial polarizing microscope and the new scanning confocal microscope of Gmitro for living tissues. The regular confocal microscope for fixed tissue slides will revolutionize dermatopathology. The other research microscopes include the ultrasonic biomedical microscope and the IR microscope and the holographic microscope of optical phase conjugation used for living tissues. CONCLUSION: New lasers for therapy include micromedical lasers, economical junction diode lasers alone and for pumping solid-state lasers, FEL of the future, and multiwavelength laser units. These later units include seven-wavelength units of barium, copper vapor and ruby, and are available for other heavy metal laser heads, ds gold-628 nm and lead-722 nm. Copper vapor can pump also Ti sapphire. The MOPO series (200 nm in the UV to > 4,500 in the IR) is the most extensive modern multiwavelength laser box type.

Dermatology↗
PubMed2000

Evaluation of cooling methods for laser dermatology.

BACKGROUND AND OBJECTIVE: Skin cooling is used to protect the epidermis in a variety of laser dermatology procedures, including leg vein treatment, hair removal, and port wine stain removal. Spray and contact cooling are the two most popular methods, but similarities and differences of these techniques are not well understood. STUDY DESIGN/MATERIALS AND METHODS: A theoretical model of skin cooling is presented for two different regimens: "soft" cooling in which freezing of the skin is not permitted and "hard" cooling in which the skin can be frozen to a given depth. Spray and contact cooling were also compared experimentally using an in vitro model. RESULTS: For a fixed skin surface temperature, spray and contact cooling theoretically produce the same cooling profile in the skin. Anatomic depth of cooling depends on the time for which either the spray or contact is applied. In vitro experiments caused temperature at the simulated basal layer to be between -5 and +5 degrees C for both spray (tetrafluoroethane, boiling point -26 degrees C) and contact (-27 degrees C sapphire plate) cooling. The theoretical precooling analysis shows hard mode to be faster and more selective than soft mode; however, cooling time for hard mode must be carefully controlled to prevent irreversible epidermal damage caused by freezing. CONCLUSIONS: Both spray and contact cooling provide efficient skin cooling. The choice of cooling method depends on other factors such as the target depth, cost, safety, and ergonomic factors.

Cryosurgery↗
PubMed1995

Public education projects in skin cancer. Experience of the Canadian Dermatology Association.

The mandate of the Canadian Dermatology Association's Sun Awareness Program is to increase awareness of the dangers of the sun's ultraviolet (UV) rays and to provide information on prevention and early detection of skin cancer. Major projects include an annual national press campaign, which reaches an increasing number of Canadians each year, and the production and distribution of educational materials. Each year during Sun Awareness Week, screening stations have been established across the country, staffed by volunteer dermatologists and members of the Canadian Cancer Society. In Vancouver between 1991 and 1993, 1767 people were screened for skin cancer. Results indicate that these events can attract people at risk for skin cancer, even though people older than age 65 are probably underrepresented as a group. Although popular with the public, these screenings are difficult to organize and are limited by human resources. These events continue in limited numbers, because they provide an excellent venue for the dissemination of educational material. Cooperation with federal agencies has been a major focus of the program. For the past 2 years, educational material on protecting newborns and children from the sun has been made available free to every new mother in Canada, while Environment Canada's Ultraviolet index program provides daily information on UV intensity along with public health messages. With the realization that health promotion requires a sustained change in behavior of an individual, we are now embarking on a national program to evaluate the knowledge, attitudes, and behavior of Canadians concerning UV radiation. With this information, we hope to adapt our educational materials so that people will adopt and maintain healthy behavior choices while out in the sun.

Adolescent↗
PubMed2005

Skin model surface temperatures during single and multiple cryogen spurts used in laser dermatologic surgery.

BACKGROUND: Although cryogen spray cooling (CSC) is used to minimize the risk of epidermal damage during laser dermatologic surgery, concern has been expressed that CSC may induce cryo-injury. In order to address this concern, it is necessary to evaluate the effects of prolonged exposure of human skin phantoms (HSP) to CSC. OBJECTIVE: To measure the minimum surface temperature (T(min)) and the time at which it occurs (t(Tmin)) as well as determine the time the sprayed HSP surface remains below 0 degrees C (sub-zero time, Deltat(s)) and -26 degrees C (residence time, Deltat(r)) during the application of single (SCS) and multiple (MCS) cryogen spurts. Two initial HSP substrate temperatures were studied, T(i): 23 and 70 degrees C. STUDY DESIGN/MATERIALS AND METHODS: An epoxy-based HSP was constructed to measure T(min), t(Tmin), Deltat(s), and Deltat(r), for 17 spray patterns: 1 SCS with a total cryo-delivery time (Deltat(c)) of 40 milliseconds; 8 MCS patterns with identical Deltat(c), but with a total cooling time (Deltat(total)) varying from 50 to 280 milliseconds; and 8 SCS patterns that matched the Deltat(total) of the MCS patterns. RESULTS: For both T(i), our results show that it is possible to distinguish between two different cooling regimes. For Deltat(total) </= 110 milliseconds, the differences between SCS and MCS patterns with the same Deltat(total) for all variables (T(min), t(Tmin), Deltat(s), Deltat(r)) are negligible. Most importantly, all these variables show a remarkable linear dependence with Deltat(total). In the interval 110 milliseconds < Deltat(total) < 280 milliseconds, T(min) and t(Tmin) are similar for SCS and MCS, while Deltat(s) and Deltat(r) show more pronounced differences between the two spray patterns. In this interval, the values of T(min) and Deltat(s) for MCS remain invariant and similar to the corresponding values for Deltat(total) = 110 milliseconds. CONCLUSIONS: These results suggest that: (1) similar epidermal protection may be attained with SCS and MCS for Deltat(total) </= 110 milliseconds; and (2) for 110 milliseconds < Deltat(total) </= 280 milliseconds, MCS help to maintain Deltat(s) similar to that of SCS at Deltat(total) = 100 milliseconds, which may be beneficial to prevent cryo-injury.

Aerosols↗
PubMed1996

In vivo confocal microscopy of human skin: a new design for cosmetology and dermatology.

In-depth exploration of cellular structures in living human skin in situ is possible with the tandem scanning microscope (TSM). However, the rigid design of the microscope limited observations to the arms, hands, and fingers. A mobile version allowing the investigation of any parts of the body has been designed. The head containing the Nipkow disk and the optical path were the only part saved from the original TSM. This prototype can be used to observe, in real time, the different skin structures down to a depth of 200 microns and to measure the thickness of the different layers with micron precision level. The hydration of the stratum corneum (SC) could be assessed. For example, lengthy immersion of the hand in water led to an increase in SC thickness without affecting that of the living epidermis. Occlusive patch tests also showed that water and, even more so. propylene glycol, led to transient swelling of the SC. In dermatology, the example of psoriasis illustrated the value of the TSM for describing, measuring, and assessing pathologic skin changes. The availability of this noninvasive method for observing changes with time in a given skin site should prove useful for monitoring treatment efficacy. This tool opens up new insight for the investigation of cutaneous pathophysiology.

Cosmetics↗
PubMed1999

The interface between rheumatology and dermatology. Why rheumaderm?

Although the division of medicine into specialties according to different systems is convenient, it is also artificial: the different systems interact and many diseases overlap both in their pathological features as well as their clinical expression. Many examples of such interactions are seen in the connective tissue disorders, where rheumatological and dermatological manifestations may be prominent features. In some of them the skin rash may be a diagnostic marker (e.g., systemic lupus erythematosus, dermatomyositis). Joint involvement can also be found in "primary" skin disorders such as psoriasis; certain infections can produce both skin and joint manifestations including a number of fairly common viral disorders as well as Lyme borelliosis and the acquired immune deficiency syndrome (A.I.D.S.) The skin may also be the major target of toxicity from a number of drugs, particularly those that are used in the management of rheumatic disorders.

Anti-Bacterial Agents↗
PubMed2003

[From Einstein's Quantum Theory to modern laser therapy. The history of lasers in dermatology and aesthetic medicine].

Laser technology has considerably expanded therapeutic modalities in dermatology and aesthetic medicine. In addition, lasers have broadened the spectrum of diagnostic and therapeutic options in many other medical fields. Dermatologists, especially Dr. Leon Goldman, played an important role in the evolution and use of medical lasers. There was a long way from the concept of stimulated emission as the fundamental idea of laser technology by Albert Einstein in 1917 to the practical use of the laser today. We review the development of laser technology from the early days through the latest advances.

Animals↗
PubMed2003

[Miracles in dermatology? An overview of miraculous cures of skin diseases in the Catholic Church].

Miracles which can be observed in different religions are often closely connected to medicine. These miraculous cures, considered to be inexplicable by medical science, have been documented in Christian religion and in occidental culture for more than 2000 years. These miraculous healings are also reported in the field of dermatology. The miraculous bulletins documented by the Catholic Church take their beginning in the Old Testament and extend to the miraculous cures of Lourdes in present time. We provide an overview of miraculous healings of skin diseases, whereby accounts documented in the Bible, reports during the Middle Ages, and cases documented throughout the last century are discussed. In view of modern medicine, most of the miraculous healings do not meet modern demands of science, but remain important as milestones in medical and religious history.

Adult↗
PubMed2004

[Special emergencies in dermatology].

Emergency cases in dermatology are rare but potentially life-threatening conditions. They comprise a broad spectrum of diseases which require immediate hospitalization or even intensive care. A rapid diagnosis and appropriate therapy is necessary since some of these emergency cases are associated with a high mortality and with severe disabling complications. Typical examples are: the bacterial infections Waterhouse-Friderichsen syndrome, necrotizing erysipelas and necrotizing fasciitis, as well as staphylococcal and streptococcal toxic shock syndromes. Another special emergency situation is venomous snake bites.

Dermatology↗
PubMed2004

[Inpatient treatment costs of skin diseases. Diagnosis-based cost calculation in a university dermatology clinic].

BACKGROUND AND OBJECTIVE: With the advent of the DRG system, German hospitals are being forced to improve cost transparency and to uncover inefficient structures. METHODS: Diagnosis-based costs were calculated in the Department of Dermatology in the University Hospital of Freiburg for ten samples, each containing 20 cases. By using in-patient files, cost and productivity information for the fiscal year 2000 was attributed to each single case in a bottom-up-approach. The resulting total costs per case were contrasted to their remuneration under the DRG system. RESULTS: Average case costs were determined between EUR 1,339.83 and EUR 5,714.73. With 19.3% to 28.4% of total costs, nursing costs were the biggest single cost factor. Prolonging the length of stay incurred average extra costs of EUR 144.26 to EUR 199.98 per case and day. The correlation of case costs and their corresponding DRG cost weights was modest with r=0,48. There was considerable cost variance within individual DRGs. CONCLUSIONS: The diagnosis-related cost calculation reveals striking cost differences relating to specific diagnoses. This method is more suitable for cost calculations in the hospital than more general approaches.

Academic Medical Centers↗
PubMed2005

[Pharmacogenetics: Important aspects for dermatology].

Pharmacogenetics, pharmacogenomics or metabonomics are terms reflecting a new trend in pharmacology taking into consideration individual factors which influence the effects of drugs. Examples in dermatology include glucose-6-phosphate dehydrogenase-polymorphism (DADPS), dihydropyrimidine dehydrogenase-deficiency (5-Fluoruracil), thiopurine-S-methyltransferase-deficiency (azathioprine), cytochrome P450 isoenzymes and transferases (drug allergy and allergic contact dermatitis), and intolerant reactions to NSAIDs.

Anti-Inflammatory Agents, Non-Steroidal↗