Using a topical anaesthetic cream to reduce pain during sharp debridement of chronic leg ulcers.

This multicentre, double-blind, placebo-controlled, parallel-group study assessed the efficacy and safety of using Emla (lignocaine/prilocaine) anaesthetic cream to achieve pain control during sharp debridement of chronic leg ulcers of arterial, venous or arteriovenous aetiology. A total of 101 patients (51 Emla, 50 placebo), aged 29-99 years, who had experienced pain associated with previous debridement were included. Patients with an amide anaesthetic allergy, anaesthetic diabetic ulcers, or ulcers > 50 cm2 were excluded. Debridement was initiated approximately 30 minutes after the application of a thick layer of Emla or placebo cream to an ulcer occluded with a plastic wrap. The patient and investigator assessed the pain associated with debridement on a 100 mm visual analogue scale (VAS). The median patient VAS scores were 18 mm and 53.5 mm in the Emla and placebo groups, respectively (p < 0.0001). The corresponding investigator values in the two groups were 20 mm and 49.5 mm, respectively (p = 0.004). Local reactions were mainly transient and mild, and were observed in roughly the same percentage of placebo and Emla-treated patients. After a 30-minute application Emla cream significantly reduced the pain of debridement compared with the placebo.

EMLA. A new and effective topical anesthetic.

A eutectic mixture of local anesthetics (EMLA) contains 2.5% lidocaine and 2.5% prilocaine in an oil and water emulsion and has been found to give effective, safe analgesia on normal and diseased skin, making it useful for numerous medical and surgical procedures, such as anesthesia for superficial surgery, split-thickness skin grafts, venipuncture, argon laser treatment, epilation, and debridement of infected ulcers. Other indications have included use in postherpetic neuralgia, hyperhidrosis, painful ulcers, and inhibition of itching and burning. To be effective, EMLA should ideally be applied to the desired area for at least 1 hour under an occlusive dressing. The medication has been approved since May 1991 in Canada for use on intact skin and has been available in Europe for many years. This study discusses the background, efficacy, and current and potential uses of EMLA.

Using Lasers to Treat Dermatological Disorders: A better way to treat lesions.

With the recent shift in dermatology toward complete care of the skin both medically and surgically, the dermatologist can now use advanced technological procedures, such as lasers, that offer new and better means to treat dermatological problems.

Mohs' Micrographic Surgery: An advanced form of skin cancer removal.

Mohs' micrographic surgery is a method for removing cutaneous carcinomas. Its success depends on the fact that many tumors spread contiguously. Basal cell carcinoma is the prototype of tumors treated in this way, but the list is growing. Some physicians include melanoma in the list of tumors suitable for this surgical technique.

Abnormal nevoblast migration mimicking neurofibromatosis.

A patient appeared to have von Recklinghausen type I neurofibromatosis, but her numerous cutaneous tumors were intradermal nevi and not neurofibromas. The patient had hundreds of 1- to 3-cm firm, flesh-colored, dome-shaped papules and pedunculated nodules on her buccal mucosa, eyelids, face, extremities, and trunk as well as a large, confluent, cerebriform tumor extending from the 12th thoracic vertebra to the sacrum. No cafe au lait macules, freckles, or Lisch nodules were present. Several hundred lesions were removed using the carbon dioxide laser. Histopathologic examination of all of the lesions revealed all of them to be intradermal nevi. Our patient's skin disease was clinically very similar to neurofibromatosis. We suggest our patient represents a distinct clinical entity that is related to environmental factors or a mutation that affected nevoblasts or melanoblasts and their derivatives during early embryo development.

Postherpetic neuralgia and systemic corticosteroid therapy. Efficacy and safety.

Corticosteroids are frequently advocated for use in prevention of postherpetic neuralgia (PHN), although their use is replete with controversy. The present study is a meta-analysis of the four well-controlled clinical studies conducted on this issue. The results indicated there is a statistically significant decrease in proportions affected at 6 and 12 weeks. Standard difference scores were -2.0559 and -4.1442, respectively, and 95% confidence intervals were -3.98% to -31.80% and -14.16% to -43.84%, respectively. At 24 weeks, no differences were detectable between placebo- and corticosteroid-treated groups (SD = 0.6603, p greater than 0.05, 95% confidence intervals of -6.78% to 24.67%). Side effects of treatment were rare and mild, affecting only 2.5% of patients treated with corticosteroids. No patients had dissemination of disease. Systemic corticosteroid treatment decreases the proportion of patients affected by PHN, especially when it is defined as pain occurring at 6 or 12 weeks after the acute event.

Meta-analysis for dermatologists.

Meta-analysis is a relatively new statistical technique that is attracting a great deal of attention in the medical and social science literature. This technique is discussed in terms of its tenants, advantages, rudiments, and controversies.

Bowen's disease and internal malignancy. A meta-analysis.

Bowen's disease frequently has been reported to be associated with internal malignancy, although this association has been extremely controversial. The present study uses the technique of meta-analysis to address this issue by pooling the results of the 12 studies published in the English-language literature that previously have attempted to study this issue. The results indicated no significant association between the two conditions (chi square, 1 d.f., = 0.128, p greater than 0.05, 95% confidence interval = 0.105-0.1503). Clearly, no extensive investigation in patients having Bowen's disease is warranted.