Are GPs who specialise in dermatology effective? Be wary of generalising research conclusions.
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BACKGROUND AND OBJECTIVE: Dynamics of cryogen spray deposition, water condensation and frost formation is studied in relationship to cooling rate and efficiency of cryogen spray cooling (CSC) in combination with laser dermatologic surgery. STUDY DESIGN/MATERIALS AND METHODS: A high-speed video camera was used to image the surface of human skin during and after CSC using a commercial device. The influence of ambient humidity on heat extraction dynamics was measured in an atmosphere-controlled chamber using an epoxy block with embedded thermocouples. RESULTS: A layer of liquid cryogen may remain on the skin after the spurt termination and prolong the cooling time well beyond that selected by the user. A layer of frost starts forming only after the liquid cryogen retracts. Condensation of ambient water vapor and subsequent frost formation deposit latent heat to the target site and may significantly impair the CSC cooling rate. CONCLUSIONS: Frost formation following CSC does not usually affect laser dosage delivered for therapy of subsurface targets. Moreover, frost formation may reduce the risk of cryo-injury associated with prolonged cooling. The epidermal protection during CSC assisted laser dermatologic surgery can be further improved by eliminating the adverse influence of ambient humidity.
Cardiovascular disease is common, affecting an increasing number of persons as the population ages. To combat this growing health problem, physicians use a multitude of medications in the treatment of their patients. Although pharmacologic therapy greatly enhances quality of life for a majority of patients, there is always the potential for an unfavorable reaction. For example, cardiovascular drugs can induce a vast array of adverse dermatologic responses. This article reviews the various cutaneous reaction patterns that can occur as a result of treatment with specific cardiovascular agents.
Cardiovascular disease is common, affecting an increasing number of persons as the population ages. To combat this growing health problem, physicians use a multitude of medications in the treatment of their patients. Although pharmacologic therapy greatly enhances quality of life for a majority of patients, there is always the potential for an unfavorable reaction. For example, cardiovascular drugs can induce a vast array of adverse dermatologic responses. This article reviews the various cutaneous reaction patterns that can occur as a result of treatment with Class I and II antiarrhythmic agents.
Cardiovascular disease is common, affecting an increasing number of persons as the population ages. To combat this growing health problem, physicians use a multitude of medications in the treatment of their patients. Although pharmacologic therapy greatly enhances quality of life for a majority of patients, there is always the potential for an unfavorable reaction. For example, cardiovascular drugs can induce a vast array of adverse dermatologic responses. This article reviews the various cutaneous reaction patterns that can occur as a result of treatment with class III, IV, and other antiarrhythmic agents, ACE inhibitors, Angiotensin II receptor blockers, and diuretics.
Cardiovascular disease is common, affecting an increasing number of persons as the population ages. To combat this growing health problem, physicians use a multitude of medications in the treatment of their patients. Although pharmacologic therapy greatly enhances quality of life for a majority of patients, there is always the potential for an unfavorable reaction. For example, cardiovascular drugs can induce a vast array of adverse dermatologic responses. This article reviews the various cutaneous reaction patterns that can occur as a result of treatment with vasodilators and other antihypertensive drugs, anticoagulants and antiplatelet drugs, thrombolytic agents, and lipid-lowering agents.
In seven winter seasons a young watchmaker was severely disabled by the development of swelling and reddening of the skin, blistering and paraesthesiae affecting his hands. Hospital examination led to a diagnosis of "Raynaud syndrome of undetermined origin". Treatment with corticosteroids was unsuccessful. Not until the young man changed his job did the disorder disappear for good. Investigations at his place of work revealed that the man had inhaled dichloromethane fumes (methylenchloride; CH2Cl2) while cleaning watch parts in a small room that was not ventilated during the winter months. This led to endogenous carboxyneogenesis and subsequently to chronically recurring carboxyhaemoglobinaemia (13%, 10% and 10.7% COHb in three different blood samples). The significance of dichloromethane-induced CO poisoning in the development of dermatological changes is still the subject of controversial discussion.
PURPOSE: To determine whether chronic exposure to DMBA or MNNG in combination with or without UVB exposure would induce skin carcinomas in swine. METHODS: Eight gilts were exposed to 100 mJ of UVB in their left side, allowed to recuperate, and divided into two groups. Each gilt received identical high doses (DMBA 50 microM; MNNG 250 mM), low doses (DMBA 500 nM; MNNG 2.5 mM), carrier (DMSO), or nothing added treatments in the UVB and non-UVB sides. Animals were exposed weekly for 30 weeks and skin samples collected at 10, 20, and 30 weeks from initiation of exposure. An additional sample was collected 16 weeks following cessation of exposure. All samples were scored for dermal morphology, including intracellular epidermal edema, intercellular epidermal edema, papillary dermal edema, perivascular infiltrates, pyknotic stratum basale cells, collagen necrosis, and epidermal-dermal separation, and the data were analyzed by ANOVA. MNNG and UVB light had a significant effect on epidermal thickness and the number of cell layers. The greatest increase in epidermal thickness occurred from 20 weeks to 30 weeks in the UVB plus MNNG treatment. Treatment with MNNG resulted in intracellular and intercellular epidermal edema, dermal edema, and dermal inflammation at both the low and high doses of MNNG. In contrast, all the morphological evaluations of the DMBA treatments were less severe than the MNNG. CONCLUSION: Our findings show that although chronic exposure to MNNG and DMBA, with or without UVB exposure, caused severe to mild dermatopathological changes, neither resulted in the development of skin carcinomas. These results indicate that at least with respect to responses to DMBA and MNNG, the swine model mimics more closely the responses seen in human skin.
Methods for investigating contact eczematous patients and for measuring the sensitizing potential of various substances are well known and in general, sufficiently effective. This is not true for irritant dermatitis, or for possible (skin) irritant substances; moreover, cosmetics commonly do not contain acutely harmful ingredients. The use of various instrumental measurements (insensible H2O loss, CO2 release, electrical impedance, sweat rate) as indicators of the irritant potentials of substances is advocated. At the same time it is suggested that the factory physician actively investigate the workers in his factory, since these workers are exposed to known substances in known concentrations and combinations, possibly for extensive periods. This may prove to be part of a new role for him. A cosmetic may be one of several factors increasing impairment and only beyond a certain limit may this result in overt disease. Below that limit the health reserve is only partially depleted. Whether this is harmful to a person depends on other stresses, such as medicaments, work materials, other cosmetics and environmental chemicals. The effect of these must also be quantified. A model of these cumulative stresses and reactions is presented and discussed.
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We have seen multiple cases of a characteristic skin lesion produced by smoking crack cocaine. We describe a typical case with photographs demonstrating multiple blackened hyperkeratotic lesions of the palmar aspects of the fingers and palm, some linear, some circular. These involve mostly the dominant hand and are caused by the heat of the glass cocaine pipe.
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Erythema is frequently observed in the region of contact between facial prostheses and the skin. In a large-scale study on the cutaneous tolerance of facial prosthesis materials, two prosthetic materials (glue and the solvent for the glue) were tested in the allergy test after Magnusson and Kligman (OECD). Only the solvent showed a moderately pronounced allergenic potential in the macroscopic assessment.
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