Dexamethasone Mesotherapy: An Alternative for Keloid Treatment in Hispanic Skin.

The incidence of keloids in individuals with skin of color is as high as 16%. Intralesional steroid injection is recommended as a first-line treatment, even though the outcomes are often suboptimal. Histologically, the keloid epidermal layer is thicker than in normal skin, and the vascular density is higher in the marginal area at subepidermal level due to the elevated expression of vascular endothelial growth factor. Dexamethasone significantly suppresses this proangiogenic cytokine compared with Triamcinolone. We report the case of a 32-year-old phototype VI man with a 6-month-history of a keloid on the dorsum of his right hand that caused functional and cosmetic morbidity. We performed an intralesional injection of dexamethasone using a mesotherapy technique, that led to significant shrinking and complete recovery of range of motion after two sessions, with no regrowth at the 1-year follow-up. Mesotherapy is a safe and easy technique used in cosmetic medicine, which allows for a slower diffusion of dexamethasone and prolongs its pharmacological action, reducing the risk of local side effects. This technique has the potential to be standardized, but its main drawback is the need for proper sedation. Randomized clinical trials are required to further evaluate the clinical efficacy of dexamethasone mesotherapy.

Percutaneous Intradermal Purse-String closure for Correction of Male Tuberous Nipple-Areola Complex Deformity.

BACKGROUND: Male tuberous breast is an exceedingly rare condition that not fit properly into the majority of existing classifications of gynecomastia. This deformity has been categorized by Cordova and Moschella as gynecomastia grade III; however, they do not make any reference to the isolated tuberous deformity of the nipple-areola complex (NAC). Considering that the areolar area is the main ''esthetic unit'' in the male chest, surgical correction of the isolated tuberous NAC deformity can be challenging. There is a belief that this deformity is unsuccessfully corrected when approached through a limited periareolar incision at the lower pole. A complete periareolar incision, with a concentric excision of excess areolar skin, is usually required leaving an unnatural-looking round periareolar scar on the male thorax. METHODS: We describe a variation of a surgical technique for the correction of a male tuberous NAC deformity in a teenager who rejected a conspicuous round periareolar scar after surgery. This modification combines a conventional lower hemiareolar approach with a percutaneous intradermal purse-string suture in the superior areolar margin to reduce the areolar diameter, avoiding an evident circumareolar scar. RESULT: At the six-month follow-up, areolar widening or tuberous deformity relapse was not observed. The patient felt satisfied with the outcome. CONCLUSION: The use of percutaneous intradermal purse-string periareolar suture for correction of this rare deformity is a simple and reproducible surgical technique that could help to obtain a better cosmetic result by restoring the contour of the male chest while minimizing the visibility of the residual scar. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Empathy Levels of Dental Faculty and Students: A Survey Study at an Academic Dental Institution in Chile.

A successful health care provider may be described as a clinician capable of establishing a comprehensive diagnosis including identifying related risk factors. However, an equally important quality a clinician should possess is the ability to understand the experiences and feelings of others to allow better communication for better outcomes. It is likely that faculty empathy levels influence students' ability to demonstrate this attribute. The aim of this study was to assess the levels of empathy of dental faculty members relative to dental students at the Universidad San Sebastian in Chile. Using a cross-sectional design of survey-collected data collected with the Jefferson Scale of Empathy, the authors compared the perceptions of the dental faculty involved in teaching fourth- and fifth-year dental students (n=116) to the perceptions of basic and preclinical students (n=346) and clinical students (n=189). The data were collected in 2016-17. The results showed that the mean faculty scores were higher than that of the students in compassionate care (90.1%) and perspective adoption (89.7%); however, for putting oneself in the other's shoes, the faculty had a lower score (57.8%) than the clinical students (58.2%). Future investigations are needed to understand the impact of faculty empathy scores on students and whether pedagogical interventions can increase empathy scores.

Back to Basics: Could the Preoperative Skin Antiseptic Agent Help Prevent Biofilm-Related Capsular Contracture?

BACKGROUND: Capsular contracture (CC) has remained an unresolved issue throughout history. Strong evidence focuses on bacterial biofilm as its main source. A literature review revealed that more than 90% of bacteria found in capsules and implants removed from patients with Baker grade III-IV CC belong to the resident skin microbiome (Staphylococcus epidermidis, predominant microorganism). The use of an adequate preoperative skin antiseptic may be a critical step to minimize implant contamination and help prevent biofilm-related CC. OBJECTIVES: The authors sought to compare the effect of 2 different antiseptic skin preparations: povidone-iodine (PVP-I) vs chlorhexidine gluconate (CHG) on CC proportions after primary breast augmentation through a periareolar approach. METHODS: In June of 2014, The Society for Healthcare Epidemiology of America proposed to use CHG for preoperative skin preparation in the absence of alcohol-containing antiseptic agents as strategy to prevent surgical site infection. The clinical safety committee of a surgical center in Colombia decided to change PVP-I to CHG for surgical site preparation thereafter. The medical records of 63 patients who underwent to primary breast augmentation through a periareolar approach during 2014 were reviewed. In the first 6 months PVP-I was used in 32 patients, and later CHG was employed in 31 patients. RESULTS: Pearson's chi-squared test to compare CC proportions between subgroups showed a statistically significant difference. The CC proportion was higher for patients who had antisepsis with PVP-I. CC was absent when CHG was employed. CONCLUSIONS: CHG as preoperative skin antiseptic for primary breast augmentation surgery was more effective than PVP-I to help prevent biofilm-related CC.