Head and Neck Medicine by Alexandros G.Sfakianakis

Despite the widespread use of Mohs Micrographic Surgery (MMS) for periocular basal and squamous cell carcinoma (together called keratinocyte carcinoma (KC)), follow‐up data regarding recurrences are limited.

Objectives

To investigate the recurrence rate for periocular KCs after MMS and describe experience with interdisciplinary collaborations.

Methods

Patients with periocular KCs treated with MMS between 2006 and 2016 in a tertiary MMS referral hospital were included in this retrospective cohort study. Descriptive statistics were used to describe the MMS procedure related characteristics. By follow‐up data from the electronic patient records and linkage with the Dutch nationwide network and registry of histopathology and cytopathology (PALGA) June 30^th 2017, the recurrence rate was evaluated and calculated by using a cumulative incidence curve.

Results

In total, 683 (93·7%) periocular basal cell carcinomas (BCCs) and 46 (6·3%) squamous cell carcinomas (SCCs) were treated with MMS. Three‐quarters (n=549) were primary tumours and the majority was located at the medial canthus or lower eyelid (n=649, 89·0%). In 505 MMS procedures (69%) an oculoplastic surgeon participated and in 63 patients (8·6%) a plastic surgeon performed the reconstruction. After a median follow‐up of 46 months the recurrence rate is 3·0%, based on 22 recurrences (20 BCCs and 2 SCCs).

Conclusions

MMS is an excellent treatment option for periocular KCs with a low recurrence rate. Due to its specific location an interdisciplinary approach should pre‐eminently be considered.

https://ift.tt/2zX8zEv

Variability in the Diagnosis of Surgical Site Infections After Full‐Thickness Skin Grafting: An International Survey

Abstract

Background

Diagnosis of a surgical site infection (SSI) in dermatologic surgery can be entirely based on a subjective assessment according to the 4^th criterion of the most common definition of an SSI, which was established by the US Centers for Disease Control (CDC).

Objectives

To investigate the interobserver agreement between dermatologists in their diagnosis of SSI of dermatosurgical wounds.

Methods

An international electronic photographic survey with eight photographs of wounds 1 week after full‐thickness skin grafting (FTSG) was sent to dermatologists. All wounds were assessed in terms of visual criteria beforehand. Data collected from respondents included physician characteristics and experience, and SSI assessments of all wounds.

Results

A total of 393 dermatologists from 27 countries enrolled. Most respondents were from the United States (25%), followed by Sweden (24%) and the United Kingdom (13%). There was only a slight interobserver agreement on SSI suspicion (κ = 0·19). SSI suspicion was lower for male physicians (P = 0·03), board‐certified dermatologists (P = 0·001), physicians regularly assessing surgical wounds (P = 0·03), and physicians performing FTSG (P < 0·001). Swedish physicians diagnosed more SSIs than US physicians (P = 0·002). Erythema was more common in cases with higher SSI suspicion.

Conclusion

This study reveals a broad inter‐rater variability in the diagnosis of SSI, illustrating the need for novel objective diagnostic methods that can better capture the variables that constitute an SSI.

https://ift.tt/2PwGWHu

How often are bath emollients prescribed to children with atopic eczema in primary care in England? A cross‐sectional study

Abstract

Atopic eczema is one of the most burdensome skin diseases across the globe and affects up to 20% of children in the UK. The mainstay of treatment is regular use of emollients including leave‐on emollients, soap substitutes and emollient bath additives. However, the lack of evidence to support the use of bath additives has led some to question their role in atopic eczema management. A recently published, independent, randomised controlled trial has provided robust evidence that bath emollients provide no meaningful benefit in addition to standard care (regular use of leave‐on emollients and avoidance of soap.

https://ift.tt/2zW4LTX

Efficacy of topical dithranol (Dithrocream®) in the treatment of alopecia areata: a retrospective case series

Abstract

Topical dithranol is an alternative therapy to topical diphencyprone for extensive AA, with the advantage that it can be applied at home. It is also safe in children and has low risk for use during pregnancy. Its precise mechanism of action is unknown, but it is plausible that the local cytokine profile induced by its irritant effect "compete" with the inflammatory milieu incited during the inflammatory cell attack on hair follicles.

https://ift.tt/2PwYzGZ

ω-3 LCPUFA supplementation during pregnancy and risk of allergic outcomes or sensitisation in offspring: a systematic review and meta-analysis

In the last two decades allergic diseases have seen a rise worldwide with children suffering the highest burden of the condition(1). Food allergies, eczema and asthma are the most common allergic disorders in children(1-2). The increasing burden of allergic conditions is an important public health concern and understanding how to prevent the development of allergic diseases is a vital area of research.

https://ift.tt/2UABZB8