Skin tolerance, efficacy, and quality of life of patients with red facial skin using a skin care regimen containing Licochalcone A.

BACKGROUND: Patients with rosacea and red facial skin often show sensitivity to skin care products which can exacerbate inflammation and subjective irritation. Besides pharmacologic management, special skin care is prudent to avoid cosmetically induced irritation and address cosmetic concerns. Appropriate skin care should provide gentle cleansing, UVA/UVB protection, effective moisturization, and concealing pigments to neutralize the appearance of redness. AIMS: To evaluate skin compatibility and efficacy of a skin care regimen containing licochalcone A (Lic A), an anti-irritant from the licorice plant Glycyrrhiza inflata, for subjects with mild to moderate facial redness. PATIENTS/METHODS: Sixty-two patients with mild to moderate red facial skin used a four-product skin care regimen for 8 weeks. Clinical assessments of erythema and subjective irritation, cross-polarized photography, and self-assessment questionnaires were completed at baseline, and after 4 and 8 weeks of use. A quality of life questionnaire was given at baseline and week 8. RESULTS: Clinical evaluations, subject response, and photography confirmed very good tolerability of the regimen and effective neutralization of redness by the pigmented products. Significant improvements in average erythema scores were observed at 4 and 8 weeks (P < 0.05), and an improvement in quality of life was confirmed by the patient questionnaires. DISCUSSION: The skin care regimen containing Lic A was found to be compatible with the sensitive facial skin of patients with rosacea and improved the appearance of persistent facial redness. The products were also observed to be compatible with daily metronidazole treatment.

Disability awareness: a checklist for the medical practice.

Although Congress passed the Americans with Disabilities Act (ADA) of 1990, our nation's 54 million people with disabilities continue to face many challenges when seeking health care. Physicians and their staffs can heighten their awareness and sensitivity to disability and provide better communication plus an organized system of care for patients with disabilities.

Perichondrial cutaneous grafts for reconstruction of skin cancer excision defects.

BACKGROUND: Perichondrial cutaneous grafts (PCCGs) are composite grafts comprised of skin and subjacent perichondrium. Animal models and preliminary clinical reports have shown that PCCGs are thicker, survive better and contract less than full-thickness skin grafts, and are simpler to perform that alternative reconstructive methods such as two-stage flaps. OBJECTIVE: The applicability of PCCGs to surgical defects following Mohs surgery was investigated. METHODS: PCCGs were used to reconstruct patients with surgical defects following Mohs excision of skin cancers from facial sites near free anatomic margins and in defects with exposed cartilage. RESULTS: A series of cases is described, all with good to excellent cosmesis and function. CONCLUSION: PCCGs are useful in reconstruction of defects following Mohs excision of skin cancers.

Matricectomy.

Removal of the nail matrix is indicated in a variety of recalcitrant conditions in which the growth of the nail plate causes mechanical problems such as recurrent onychocryptosis or pain due to pinching or pressure. Before performing a matricectomy, the physician must consider the use of nonsurgical methods and the possible contraindications to surgery. Once the decision for matricectomy is made, the physician should then utilize the modality with the least morbidity and greatest convenience for the patient. A wide repertoire of methods of matricectomy is available for use; all methods, when performed properly, have similar high rates of cure.

Delayed skin grafting.

The use of skin grafts on granulating wounds is an established practice. Delaying the application of a full- or split-thickness skin graft may be an advantageous alternative method of surgical reconstruction in selected cases. Partial healing by secondary intention is useful for filling in deeper defects and usually produces a wound that is much smaller and of more normal contour than the original defect. Contraction of the graft bed is markedly influenced by location, tissue laxity, surface tension lines, motion, and wound geometry. Proper wound care, correct surgical preparation of the defect, and timing of the graft procedure are all important considerations in maximizing the overall result. Through-and-through defects and wounds produced over areas with little underlying support (eyelids and lip) often need flap reconstruction or immediate grafting to prevent undesirable functional and cosmetic results. By combining delayed healing and conventional reconstructive techniques, major tissue loss can often be restored while minimizing patient morbidity.

Delayed skin grafting in facial reconstruction. When to use and how to do.

To assess the effectiveness of delayed skin grafting for the reconstruction of facial defects following Mohs excision of cutaneous malignant neoplasms, an analysis was done on 40 patients. All grafts in this series survived. Satisfactory results were obtained in 95% of the patients. Complications were minor and uncommon. Results of this study demonstrate indications for the use of delayed skin grafting to include recurrent or aggressive primary lesions and defects that are large, deep, and favorably located. Advantages of delayed skin grafting are as follows: improved recipient bed vascularity providing high survival of a thicker graft; provision of additional tissue bulk; reduced length of time for healing; less contracture than with granulation healing; and elimination of additional scarring adjacent to the defect. In properly selected patients, this technique offers an additional method of reconstruction of facial defects.

Auricular malignant neoplasms. Identification of high-risk lesions and selection of method of reconstruction.

A prospective study of 17 auricular malignant neoplasms was conducted comparing recommended margins for conventional surgical excision to the actual margins obtained after microscopically controlled excision (Mohs' chemosurgery technique) to identify lesions at high risk for inadequate excision with conventional excision. High-risk lesions included all tumors larger than 1 cm, morpheaform basal cell carcinoma, and multiply recurrent lesions of any size. Successful excision by conventional surgery would have resulted in a defect notably larger than the actual Mohs' defect in all cases. The excess tissue excised by conventional surgery averaged 180% larger than the actual defect in primary lesions and 347% larger in recurrent lesions. Methods of reconstruction used include the following: secondary intention (granulation), primary closure, skin grafts, local flaps, and meatoplasty. The incidence, indications, and usual results obtained are discussed in detail. Mohs' chemosurgery technique provides substantial benefit and should be considered in all recurrent lesions and primary lesions larger than 1 cm to reduce recurrence and minimize the resultant deformity.

Auricular malignant neoplasms. When is chemotherapy (Mohs' technique) necessary?

A prospective study of 71 auricular malignant neoplasms was performed to identify lesions with a high risk of recurrence. Previously recommended margins for conventional surgical excision were marked. Then, all lesions were excised by the Mohs' technique. The Mohs' defect was compared with previously marked margins for conventional excision. Conventional excision would have been inadequate in 13% of primary and initially recurrent lesions smaller than 1 cm (clinical examination) and in 27% of primary lesions and 33% of recurrent lesions larger than 1 cm. All cases successfully excised by conventional excision would have resulted in a larger defect than the actual Mohs' defect. Morpheaform basal cell carcinoma was the most common lesion inadequately excised. Either cases of this histologic type or lesions larger than 1 cm or both require consideration for the use of the Mohs' technique.

Complications of fiber implantation for baldness.

Several methods of fiber implantation have been used to reduce pattern baldness, and similar results have been reported: fiber breakage, foreign-body reaction, infection and scarring. Since one method or another tends to predominate in different geographic areas, the physician often is unable to compare the results of the various methods. The two patients described in this article underwent different methods of fiber implantation; serious complications occurred in both. Fiber implantation is an unsafe technique and must be discouraged.