Use of handheld ultrasound Doppler to prevent complications from intra‐arterial injection of dermal fillers: Clinical experience

Summary

A handheld 2 MHz ultrasound Doppler device determines the presence or absence of pulsatile arterial flow immediately beneath the selected site of entry for dermal filler injection. In combination with near infrared technology to map out superficial veins, mishaps from intravascular injections may be reduced. A total of 448 patients aged range between 21 and 74 years, with 168 out of total of 1019 treatment sites having both infrared and ultrasound Doppler assisted preinjection mapping were reviewed. The injection technique is described. Improved patient safety and reduced bruising from asthetic dermal filler injections are potential benefits.

http://bit.ly/2GeLfWT

Assessment of telomerase activity in nonsegmental vitiligo tissue: a pilot study

Summary

Background

Vitiligo is characterized by loss of melanocytes; therefore, an increased risk of photoageing and cancer are expected. However, a low incidence of cancer and sun damage in vitiliginous skin has been reported. Telomerase is a specialized cellular enzyme catalysing the synthesis of telomeres, and an increased level of the telomerase activity has been highlighted in most of human cancer cells and cancer cell lines.

Aim

To assess relative telomerase activity (RTA) among patients with nonsegmental vitiligo.

Methods

In this case–control study, skin biopsy specimens were taken from 20 patients (one from lesional and another from nonlesional skin) and from sun‐protected skin from 10 healthy age‐, sex‐ and skin phototype‐matched healthy controls. PCR ELISA was performed for assessment of RTA.

Results

RTA in lesional skin biopsies from patients with nonsegmental vitiligo was significantly decreased compared with nonlesional skin and healthy control skin samples, with no significant difference between the latter two. RTA in lesional skin was negatively correlated with Vitiligo Area Scoring Index but not correlated with Vitiligo Disease Activity score or RTA of nonlesional skin. Neither lesional nor nonlesional RTA levels showed any correlation with patient sex, age, skin phototype or with disease duration.

Conclusion

Low levels of RTA in vitiliginous skin may help to explain the lower chance of developing skin cancer and decreased incidence of actinic damage in vitiliginous skin.

http://bit.ly/2GcObDm

The mental health burden in acne vulgaris and rosacea: an analysis of the US National Inpatient Sample

Summary

Background

Little is known about the mental health (MH) hospitalization among patients with acne and rosacea.

Aims

To determine the MH disorders and cost burden associated with acne and rosacea.

Methods

Data were examined from the 2002–2012 US National Inpatient Sample, comprising a sample of ~20% of all US paediatric and adult hospitalizations (n = 87 053 155 admissions).

Results

A diagnosis of ≥ 1 MH disorder was much more common among all inpatients with vs. those without a diagnosis of acne (43.7% vs. 20.0%, respectively) and rosacea (35.1% vs. 20.0%, respectively). In multivariable logistic regression models controlling for sex, age, race/ethnicity and insurance status, acne (adjusted OR = 13.02; 95% CI 11.75–14.42) and rosacea (adjusted OR = 1.70; 95% CI 1.56–1.95) were associated with significantly higher odds of a primary admission for an MH disorder (13 and 8, respectively, of 15 MH disorders examined). Both acne and rosacea were associated with higher risk of mood, anxiety, impulse control and personality disorders, and with > $2 million of excess mean annual costs of hospitalization for MH disorders in the USA.

Conclusion

In this study, inpatients with acne or rosacea had increased odds of comorbid MH disorders. In particular, there was an increased number of hospital admissions secondary to a primary MH disorder with coexistent acne/rosacea. MH comorbidities were associated with considerable excess costs among inpatients with acne or rosacea.

http://bit.ly/2Smpue8

Topical becaplermin gel is an effective adjuvant for long‐standing ulcers of livedoid vasculopathy recalcitrant to anticoagulant therapy

http://bit.ly/2GeTS3z

The causes of nail apparatus pigmentation presenting to a melanoma screening clinic a prospective study

Summary

Background

Advanced stage primary cutaneous malignant melanoma (PCMM) has a high mortality. PCMM may affect any area of the skin, including the nail apparatus (malignant melanoma or subungual melanoma). Although nail apparatus malignant melanoma (NAMM) is rare, delayed diagnosis carries a poor prognosis.

Aim

The primary aim was to study the range of nail presentations and identify key patterns to aid in differential diagnosis. A secondary aim was to quantify the number of patients requiring surgery, indications for biopsy, and the incidence and characteristics of NAMM.

Methods

This was a prospective study of all referrals with nail apparatus pigmentation to a weekly dedicated melanoma screening clinic over a 6‐month period.

Results

In total, 2246 patients were included. Of the 38 patients referred with nail pigmentation, 1 (2.6%) was diagnosed with NAMM and involved a fungating amelanotic lesion of the right hallux. The remaining patients were diagnosed with subungual haematoma (20/38; 52.6%), viral wart (2/38; 5.4%), acral fibrokeratoma (1/38; 2.6%), myxoid cyst (3/38; 7.9%), fungal nail infection (4/38; 10.5%), Pseudomonas nail infection (1/38; 2.6%), benign linear pigmentation (2/38, 5.3%), Bowen disease (1/38, 2.6%), psoriatic nail changes (2/38; 5.3%) and matrix malalignment (1/38; 2.6%). Of the eight patients (21.1%) who required surgery, five had a biopsy taken and three underwent surgery. Only 14 cases were followed up by Dermatology. NAMM accounted for 0.7% of all melanomas diagnosed.

Conclusion

We illustrate the wide range of diagnoses for pigmented nail presentations and highlight the late presentation of advanced disease in a patient presenting with NAMM.

http://bit.ly/2Sir1lp

What's new in atopic eczema? An analysis of systematic reviews published in 2016. Part 3: nomenclature and outcome assessment

Summary

This review forms part of a series of annual updates that summarize the evidence base for atopic eczema (AE). It presents the key findings from 11 systematic reviews published in 2016 that focus on AE outcome assessment, disease impact and nomenclature. Systematic reviews on the treatment and prevention of AE are summarized in Part 1 of this update, and systematic reviews on the epidemiology of and risk factors for AE are summarized in Part 2. Six reviews summarized what outcome measurement instruments have been used in published AE trials, or summarized validation studies for the available instruments. These reviews were used to inform consensus decisions by the Harmonising Outcome Measures for Eczema initiative. Although validated instruments exist for clinical signs and patient‐reported symptoms, there are currently no validated instruments for capturing quality of life or long‐term control. Four reviews examined the impact of AE on children and their families, but few studies were included. One birth cohort study found no association between AE and educational attainment at 11 years. AE has a moderate impact on health‐related quality of life and a substantial impact on family life. AE is a major risk factor for occupational hand dermatitis, and it is advised that young atopic individuals are informed about high‐risk occupations. Further efforts are required to standardize the nomenclature for AE, which is also commonly known as 'atopic dermatitis' or 'eczema', and preferred terms vary around the world.

http://bit.ly/2GdEuod

The Transpetrosal Approaches System in Posterior Fossa Meningiomas Surgery: Rationale and Results

Abstract

Purpose of Review

This is a retrospective review of 90 patients with a posterior fossa meningioma (PFM) treated between 1996 and 2017 in our two tertiary skull base centers. Patients underwent surgical resection via different approaches. We aimed to show how different surgical approaches may help to reach gross total resection (GTR) and low morbidity, especially on facial nerve function.

Recent Findings

PFM is a real surgical challenge with high morbidity and mortality due to the surrounding structures, their common large size at diagnosis, and their potentially invasive behavior. Total resection is the only way to cure people affected. We successfully treated 90 cases of PFM and evaluated different surgical approaches.

Summary

GTR is the aim of the surgery as the extent of resection influences the rate of recurrence, which in turn influences the prognosis. Seventy percent (p < 0.001) of surgical patients achieved a GRT with low morbidity and no mortality.

http://bit.ly/2Bc6yFm