Palmar and plantar hyperhidrosis (HH) is a common condition characterized by excessive sweating of the palms and soles. Botulinum neurotoxin (BTX) is a very effective and safe treatment. However, the ...associated intense injection pain is a major limiting factor deterring patients from selecting this treatment.
The aim of this study was to review the numerous techniques used to minimize pain accompanying injections for palmoplantar HH. Additionally, the advantages and limitations of each modality will be discussed.
The authors performed a comprehensive literature search in PubMed/MEDLINE, Embase, Cochrane Central, and Google Scholar on randomized controlled trials, cohort studies, and case series on techniques to relieve pain of BTX injections for treatment of palmar and plantar HH.
Current available techniques in reducing botulinum injection with merits and drawbacks are nerve blocks, Bier blocks, cryoanalgesia, needle-free anesthesia, topical anesthetics, and vibration anesthesia.
Topical anesthesia, ice, and vibration are the safest and most convenient noninvasive available methods to relieve pain associated with botulinum injection. Nerve blocks, Bier block, and needle-free anesthesia provide better anesthesia but are limited by the need for training and equipment.
Background
Immunohistochemical staining has been used as part of Mohs micrographic surgery (MMS) to improve sensitivity for the detection of subtle residual tumors. It is typically used in the ...histopathologic detection of tumors such as malignant melanoma, extramammary Paget disease, and poorly differentiated and spindle cell neoplasms.
Materials and Methods
The study involved a questionnaire link emailed by the American College of Mohs Surgery to its members. The survey sought demographic information and asked about the use of immunohistochemistry (IHC) stains during fellowship training and in current practice as well as reasons why IHC staining is not incorporated into certain practices. The data were tabulated and analyzed.
Results
A total of 84 surveys were completed. Of these, 30 (35.7%) indicated having received training in IHC during the fellowship, whereas 54 (64.3%) did not. Currently, 32 (38.1%) respondents utilize IHC in their practice, whereas 52 (61.9%) do not. Among those who trained in IHC during the fellowship, 60% (n = 18) continue to utilize IHC, whereas among those whose fellowship did not incorporate IHC, 74.1% (n = 40) do not utilize IHC. A number of different immunostains were reportedly utilized during fellowship and in current practice. Among those not utilizing IHC, the top reasons cited were lack of sufficient volume to justify use (n = 38, 70.3%), cost of implementation (n = 38, 70.3%), the stains being time‐consuming (n = 36, 66.7%), and lack of familiarity with reading immunohistochemical stains (n = 29, 53.7%).
Conclusions
The use of IHC among Mohs surgeons appears to be rising compared to previous historical studies, but significant barriers remain to widespread implementation.
Cryosnip for skin tag removal Farshchian, Mehdi; Kimyai-Asadi, Arash; Daveluy, Steven
Journal of the American Academy of Dermatology,
September 2023, 2023-09-00, 20230901, Letnik:
89, Številka:
3
Journal Article
BACKGROUND
Laser treatment for photoaging of the hands should ideally address pigmentary alteration as well as associated skin roughness and wrinkling. Fractional resurfacing has been previously ...shown to effectively treat facial rhytids and dyschromia.
OBJECTIVE
We examined the effect of fractional resurfacing for photoaging of the hands.
METHODS AND MATERIALS
Ten patients (skin phototypes II to IV) with hand photodamage were randomized to receive five treatments with a 1,550‐nm diode‐pumped erbium fiber laser (Fraxel SR, Reliant Technologies) laser on either the right or left hand. Treatments were performed at settings of 8 to 9 mJ/microscopic treatment zone and density of 2,500 microscopic treatment zones/cm2. Subjective assessments by the patients and investigator were performed for skin roughness, wrinkling, and pigmentation using a 5‐point scale. Skin biopsies were taken at baseline and at 1 and 3 months.
RESULTS
Patient subjective assessment and physician clinical assessment at 1 and 3 months revealed a mean 51% to 75% improvement in skin pigmentation and 25% to 50% improvement in skin roughness and wrinkling. Biopsies of the skin showed increased density of dermal collagen. Patients experienced transient erythema and edema and none had scarring or other adverse effects.
LIMITATIONS
This was a small study.
CONCLUSION
Fractional resurfacing appears to be an effective and safe treatment modality for correcting both the pigmentary and the textural aspects of photoaging of the hand.
Background
The incidence of basal cell carcinoma (BCC) in younger individuals has increased in recent decades. However, the characteristics of BCCs in this population, especially in Ibero‐Latin ...American countries, have not been completely defined.
Objective
To describe the demographic, clinical, and histopathological characteristics of BCCs in patients younger than 40 treated with Mohs Micrographic Surgery (MMS).
Materials and Methods
A multicenter, retrospective study conducted between January 2009 and December 2014, in five Ibero‐American countries, included biopsy‐proven BCCs in patients younger than 40 that were treated with MMS. Demographic, clinical, histopathological, and surgical characteristics were described.
Results
The study included 301 tumors in 241 patients, of whom 61% were female. The most common Fitzpatrick phototype was III. The most common histological subtypes were nodular (37.5%) and infiltrative (18.9%). Perineural invasion was encountered in 1.7%, and tumor clearance was achieved in 87.4% within two stages of MMS.
Conclusions
This is the first Ibero‐Latin American transnational study describing the characteristics of BCCs in young patients treated with MMS. Despite darker skin phototypes in this population, BCCs can occur in early ages and may present with aggressive features. Therefore, MMS may be considered an appropriate first‐line treatment option in this population.
Abstract Digital papillary adenocarcinoma (DPAc) is a rare, aggressive cutaneous malignancy of sweat gland derivation. Herein, we conduct a retrospective study of 213 DPAc patients using the 17 ...registries of the Surveillance, Epidemiology, and End Results (SEER) program. We estimate the incidence of DPAc to be 0.11 per million persons per year, with the incidence rising over the past two decades. Our study shows DPAc to most commonly afflict White males, typically in their 40s-60s. We note a 5-year disease-specific survival of 98.3% and 5-year overall survival of 95.7%. We also show advanced age to be associated with more aggressive disease and identify tumor size as an independent risk factor impacting disease-specific survival. Our results also suggest that patients with DPAc have an elevated risk of developing subsequent primary malignancies, with males being at increased risk of developing lung/bronchial neoplasms and females being at increased risk of developing breast cancer.
Cutaneous drug reactions are the most common type of adverse drug reaction. These reactions, ranging from simple pruritic eruptions to potentially life-threatening events, are a significant cause of ...iatrogenic morbidity and mortality. Stevens-Johnson syndrome (SJS) is a serious and potentially life-threatening cutaneous drug reaction. Although progress has been made in the management of SJS through early detection, prompt hospitalization, and immediate cessation of offending agents, the prevalence of permanent disabilities associated with SJS remains unchanged. Nevertheless, despite being a problem that is global in scope, government and health care agencies worldwide have yet to find a consensus on either diagnostic criteria or therapy for this disorder. Here, we provide the internist and emergency room physician with a brief review the SJS literature and summarize the latest recommended interventions with the hope of improving early recognition of this disease and prevention of permanent sequelae and mortality that frequently complicate SJS.
