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PubMed1988

Anesthesia for dermatologic surgery.

The increased scope and complexity of dermatologic surgery has led to a need for greater skill in the preoperative administration of local and regional anesthesia. This article reviews the mechanism of action of local anesthetic agents, their pharmacologic properties and adverse reactions, and describes accepted techniques for safely and effectively establishing local and regional anesthesia for skin surgery. The presentation is limited to those techniques of greatest use to the office practitioner.

Anesthetics, Local↗
PubMed1988

Wound healing for the dermatologic surgeon.

An understanding of the basic science of cutaneous wound repair is essential to the dermatologic surgeon for the management of the postoperative wound. This review discusses the stages of wound healing and then applies these principles to the preoperative, intraoperative, and postoperative management of the surgical patient.

Dermatologic Surgical Procedures↗
PubMed1989

The use of live pigs in the surgical training of dermatology residents.

Refining of surgical skills requires instruction, manual repetition, and observation of results. This study demonstrates that while many dermatology residents use pig's feet or synthetic models of skin for practice, few use live animals. We describe the benefits and mechanics of utilizing anesthetized pigs for cutaneous surgical training.

Animals↗
PubMed1990

Anatomic rubber stamps of the face and body to document procedures in dermatologic surgery: one picture is worth a thousand words.

Representations of the anatomic surface location of cutaneous lesions and the surgical procedures performed on these lesions can be transferred to the medical charts using simple anatomic rubber stamps (ARS) of the body. The technique is exemplified with symbols to represent surgical excision, chemical face peel, dermabrasion, micrographic surgery, and the harvesting of flaps and grafts. ARS are also useful in liposuction surgery, punch grafts for pitted facial scars, hair transplantation, sclerotherapy, laser surgery, and other cosmetic dermatologic procedures. ARS are particularly valuable in micrographic surgery for skin cancer because they help document the depth and breadth of cancer invasion and aid in the follow-up of recurrent skin cancer, especially when defects are reconstructed.

Basal Cell Carcinoma↗
PubMed1995

An estimate of the incidence of malignant melanoma in the United States. Based on a survey of members of the American Academy of Dermatology.

BACKGROUND: The incidence of malignant melanoma (MM) in the United States (US) must be known to accurately evaluate the costs that MM imposes on the health care system and society in general. Furthermore, knowledge of the incidence is needed to determine the benefit of MM prevention programs. OBJECTIVE: To obtain an estimate of the incidence of MM in the US. METHODS: The data for this study were collected by means of a questionnaire that was sent to all members of the American Academy of Dermatology practicing in the US (N = 7412). RESULTS: Based on the mean number of MMs seen annually per dermatologist in each state and the number of dermatologists per state, the number of new in situ and invasive MMs in the US in 1992 was calculated to be 80,000. This translates to an incidence of 32 MMs per 100,000 persons. CONCLUSIONS: Our estimate of 80,000 new MMs diagnosed in 1992 in the US suggests that MM places much greater burdens on the US health care system and society than that based on current published estimates.

Dermatology↗
PubMed1995

Local anesthesia by jet-injection device in minor dermatologic surgery.

BACKGROUND: Pain and needle-phobia can be a problem during the application of local anesthesia with syringe and needle. OBJECTIVE: To evaluate a jet-injection device (without needle) to deliver local anesthesia. METHODS: Two hundred and six minor dermatological procedures using a jet-injection device for administering local anesthesia into skin tissue were performed. We comment on the technical procedures, application, usefulness in relation to areas involved and the anatomical location of lesion, and total dosage of the anesthetic agent. RESULTS: Total absence of pain during installation of anesthetic (N = 194; 94%). Good level of anesthesia in all patients. No local adverse effects. CONCLUSION: The jet-injection device is easy to handle, it is harmless, it provides good levels of anesthesia, and the dosage of anesthetic agent is smaller than the dosage administered with conventional methods.

Ambulatory Surgical Procedures↗
PubMed1997

Topical anesthetic agents in dermatologic surgery. A review.

BACKGROUND: The ideal topical anesthetic agent is one that provides 100% anesthesia in a short period of time, work on intact skin without systemic side effects, and invokes neither pain nor discomfort. The quest to find such an agent continues today. Because a topical anesthetic agent will induce anesthesia painlessly, the need for an effective agent is clear. This will serve to eliminate painful injections with lidocaine prior to many dermatologic procedures. OBJECTIVE: To provide a review of topical agents used in the past, to present products that are being used today, and to look to the future of topical anesthesia. CONCLUSIVE: During the last three decades a variety of methods have been employed to administer topical anesthesia. Presently, EMLA (eutectic mixture of local anesthetics) is the most often used method among practicing dermatologists. However, iontophoresis and the anesthetic patch are equally effective with a few notable advantages over EMLA. Liposomal agents show promise as we enter into a new millennium.

Administration, Cutaneous↗
PubMed1998

Dermatologic electrosurgery in patients with implantable cardioverter-defibrillators and pacemakers.

BACKGROUND: Electrosurgery is frequently employed in the treatment of skin cancer and other dermatologic conditions in the elderly. Implantable cardioverter-defibrillators (ICDs) and pacemakers are most commonly seen in this older population. Potentially hazardous electrosurgical interference exists with the function of ICDs and pacemakers in this setting. OBJECTIVE: Our goal is to review the potential hazards of electrosurgery in patients with ICDs and pacemakers and to suggest a perioperative management plan. METHODS: Review of the medical literature on electrosurgical interference with ICDs and pacemakers was accomplished in addition to a case report of ventricular tachycardia during Mohs surgery on a patient with an ICD. RESULTS: Multiple case reports and reviews from the nonder-matologic literature demonstrate that a real hazard exists. CONCLUSION: Knowledge of the potential electrosurgical interference with ICDs and pacemakers is required to perform these procedures safely. A perioperative management plan is suggested.

Aged↗
PubMed2005

Vitamin E: critical review of its current use in cosmetic and clinical dermatology.

BACKGROUND AND OBJECTIVE: The lipophilic antioxidant vitamin E has been used for more than 50 years in clinical and experimental dermatology. However, although a large number of case reports were published, there is still a lack of controlled clinical studies providing a rationale for clinical indications and dosage. In contrast, advances in basic research on the physiology, mechanism of action, penetration, bioconversion, and photoprotection of vitamin E in human skin have led to the development of numerous new formulations for use in cosmetics and skin care products. RESULTS: This article reviews the basic mechanisms and possible cosmetical and clinical implications of the recent advances in cutaneous vitamin E research. Experimental evidence suggests that topical and oral vitamin E has anticarcinogenic, photoprotective, and skin barrier-stabilizing properties. CONCLUSION: Although its current use is largely limited to cosmetics, controlled clinical studies for indications such as atopic dermatitis or prevention of photocarcinogenesis are needed to evaluate the clinical benefit of vitamin E.

Administration, Oral↗
PubMed2006

Frequency of use of suturing and repair techniques preferred by dermatologic surgeons.

BACKGROUND: There are many closure techniques and suture types available to cutaneous surgeons. Evidence-based data are not available regarding the frequency of use of these techniques by experienced practitioners. OBJECTIVE: To quantify, by anatomic site, the frequency of use of common closure techniques and suture types by cutaneous surgeons. METHOD: A prospective survey of the members of the Association of Academic Dermatologic Surgeons that used length-calibrated visual-analog scales to elicit the frequency of use of specific suture techniques. RESULTS: A response rate of 60% (61/101) indicated reliability of the received data. Epidermal layers were closed most often, in descending order, by simple interrupted sutures (38-50%), simple running sutures (37-42%), and vertical mattress sutures (3-8%), with subcuticular sutures used more often on the trunk and extremities (28%). The most commonly used superficial sutures were nylon (51%) and polypropylene (44%), and the most common absorbable suture was polyglactin 910 (73%). Bilayered closures, undermining, and electrocoagulation were used, on average, in 90% or more sutured repairs. The median diameters (defined as longest extent along any axis) of most final wound defects were 1.1 to 2.0 cm (56%) or 2.1 to 3.0 cm (37%). Fifty-four percent of wounds were repaired by primary closure, 20% with local flaps, and 10% with skin grafting, with the remaining 15% left to heal by second intent (10%) or referred for repair (5%). Experience-related differences were detected in defect size and closure technique: defects less than 2 cm in diameter were seen by less experienced surgeons, and defects greater than 2 cm by more experienced surgeons (Wilcoxon's rank-sum test: p=.02). But more experienced surgeons were less likely to use bilayered closures (r=-0.28, p=.036) and undermining (r=-0.28, p=.035). CONCLUSIONS: There is widespread consensus among cutaneous surgeons regarding optimal suture selection and closure technique by anatomic location. More experienced surgeons tend to repair larger defects but, possibly because of their increased confidence and skill, rely on less complicated repairs.

Dermatology↗
PubMedDate not supplied

Creating and utilizing a multimedia dermatology medical record for a PocketPC personal digital assistant.

Personal digital assistants are lightweight computers that capture and display data via tapping on their screens with a stylus and are easily linked to desktop and network computers. They have been used in medicine for a variety of purposes, and many believe personal digital assistant use can improve the provision of medical care. The author created a multimedia dermatology electronic medical record for a PocketPC (Microsoft Corp., Redmond, WA) personal digital assistant that contains patient images, tables of phototherapy, laboratory and systemic medication data, and typed chart notes. Such a record can be created and utilized but requires more time to assemble than a handwritten note, mostly due to capturing and organizing images. Future challenges involve streamlining record assembly, integrating multimedia records with hospital and office medical records, and assessing how having multimedia data available might affect care.

Computers, Handheld↗
PubMed1975

Preventive dermatology: a point of view and a challenge.

The implications of "subliminal toxicology a term which has been coined by Dr. L. Goldberg, the editor of Food and Cosmetics Toxicology, are discussed and related to the practice of dermatology. It is argued that only legislation proposed by dermatologists and instituted by Government Authorities can fully protect the public against unnecessary exposure to medicinal and industrial chemicals.

Animals↗
PubMed1995

Confocal laser scanning microscopy: a new optical microscopic technique for applications in pathology and dermatology.

Confocal laser scanning microscopy (CLSM) is a new optical microscopic technique, which offers significant advantages over conventional microscopy. CLSM is microscopy of optical sections. Light, which is emitted from regions other than the focal plane, is cut off by introducing a diaphragm in the beam path. The result is an optical "slice", which shows more details because the blurring from out of focus haze disappears. It has been repeatedly used in experimental, but also in diagnostic dermatopathology. The "in vivo" confocal microscopy, applied directly to the intact skin provides details of living cells in the superficial layers comparable to that of fixed and stained tissue. While the extent of its future applications is hard to predict, its potential for applications in dermatology appears enormous, particularly for studies of fixed or living tissues, where it is desirable to obtain clear images many micrometers below the surface of the tissue under examination.

Animals↗
PubMed2005

Photodynamic therapy in dermatology--an update.

Topical photodynamic therapy (PDT) is a well-established treatment modality which has mainly shown to be effective for dermatooncologic conditions like actinic keratoses (AK), Bowen's disease, in situ squamous cell carcinoma and superficial basal cell carcinoma (BCC). However, a therapeutical benefit of PDT is also evident for inflammatory dermatoses like localized scleroderma, acne vulgaris and granuloma annulare. Recent work has been focused on the development and evaluation of topical photosensitizers like the heme precursor 5-aminolevulinic acid (5-ALA) or its methyl ester (methyl aminolevulinate) inducing photosensitizing porphyrins. These drugs do not induce strong generalized cutaneous photosensitization like the systemically applied porphyrins or their derivatives. For dermatological purposes, incoherent lamps or light-emitting diode arrays can be used for light activation. Depending on the applied light dose and the concentration of the photosensitizer either cytotoxic effects resulting in tumor destruction or immunomodulatory effects improving the inflammatory conditions occur. Treating superficial oncologic lesions (tumor thickness <2-3 mm) cure rates achieved by PDT are equal to the cure rates of the respective standard therapeutic procedure. The benefits of PDT are the low level of invasiveness and the excellent cosmetic results after treatment.

Dermatology↗
PubMed2005

[Current regulatory aspects: ambulatory surgery and dermatology].

Recently the catalogue for ambulatory surgery in hospitals has been updated presenting a successful integration into the classification of EMB 2000plus. A fundamental reconstruction resulted in changes to the specifications of health care services which are covered by the catalogue. The agreement became effective in April 2005. According to the new catalogue for ambulatory surgery, the procedure codes of the OPS classification and their transitions to a specified EBM-figure or category are relevant for the reimbursement of ambulatory services provided by a hospital or in private practice. Moreover, the regulations to avoid unnecessary bed days of hospital care and the criteria of the German appropriateness evaluation protocol (G-AEP) have to be considered carefully in terms of inpatient admissions. In the following the revised catalogue for ambulatory surgery is reviewed in detail with special relevance to dermatology.

Ambulatory Surgical Procedures↗
PubMed2004

Efficacy of cyclosporin in the treatment of atopic dermatitis in dogs--combined results from two veterinary dermatology referral centres.

OBJECTIVE: To evaluate the efficacy of cyclosporin in controlling the clinical signs associated with atopic dermatitis in dogs under Australian field conditions. DESIGN: A multicentre prospective clinical investigation of the use of cyclosporin in 41 dogs with atopic dermatitis. PROCEDURE: Dogs were treated with cyclosporin (5 mg/kg orally once daily with food) for 6 weeks. Four clinical parameters of severity of atopic dermatitis were measured on Day 0 and on Day 42 using a 0 to 4 scoring system. Individual variables were then combined to form a Global Score. Both client and clinician observed pruritus scores were combined to form a Pruritus Score. Pre- and post-treatment scores were statistically analysed. The difference in results between the two investigators was also recorded and analysed. RESULTS: All dogs showed a marked reduction in pruritus and erythema during the 6-week treatment period. All dogs showed a significant (P < 0.001) improvement in clinical lesion scores and Global Score (P < 0.001). The mean percentage improvement in Global Score from Day 0 to Day 42 was 83.9%. The mean percentage improvement in Pruritus Score from Day 0 to Day 42 was 83%. The medication was well tolerated. Side effects such as vomiting, diarrhoea and soft stools were observed in four dogs. Another four dogs developed bacterial pyoderma during the trial period. There was no significant difference in results between the two centres. CONCLUSION: Cyclosporin was well tolerated and efficacious in the symptomatic treatment of atopic dermatitis in dogs attending two veterinary dermatology referral centres in Australia, under Australian field conditions, when administered at 5 mg/kg/day for 6 weeks.

Administration, Oral↗