Seeking shade equity: Tree canopy coverage in public schools in Austin, TX.

BACKGROUND/OBJECTIVES: Tree canopies have dermatologic and environmental benefits, especially on school campuses. However, inequities likely exist, and tree planting initiatives may further exacerbate disparities. We sought to identify any relationship between tree canopy shade on public school campuses in Austin, TX and the socioeconomic makeup of the student population, as well as whether current initiatives appropriately address any inequities. METHODS: In this cross-sectional study, we used ArcGIS, a publicly available geographic information system (GIS), to calculate the percentage of tree canopy on campuses within the Austin Independent School District (AISD) for the years 2006 and 2022. We compared this with the percentage of students eligible for free and reduced meals (FRM) at each school. The percentages of FRM-eligible students were also compared for "low priority" versus "high priority" neighborhoods, as assigned by Austin's Tree Priority Map. RESULTS: Among 112 schools analyzed, schools with minority FRM-eligible students had significantly more tree canopy compared to schools with majority FRM-eligible students (19.9% vs. 12.4%, p < .001). When comparing tree priorities, there was a significant difference between the percentage of FRM-eligible students in "low priority" schools compared to "high priority" schools (23.8% vs. 62.2%, p < .001). CONCLUSIONS: Additional work is needed to rectify inequities in tree canopy access for public school students. Designations such as those used in Austin's Tree Priority Map would likely help direct such efforts. We hope this study encourages future research with GIS by both dermatologists and other health care professionals to promote interdisciplinary work with urban planners.

Blood Glucose Testing Lancet and Paper Clip as a Milia Extractor.

In low-resource settings, dermatologists may not have the preferred tools needed to evaluate a patient or perform a procedure. Commonplace affordable supplies can be substituted when needed. We describe the use of a blood glucose testing lancet and a paper clip for milia extraction.

Safety of Intradermal/Subcutaneous Lidocaine With Epinephrine Use in Dermatologic Surgery.

BACKGROUND: Recently, the safety of lidocaine plus epinephrine use in outpatient surgery has come under scrutiny despite its long history of use in outpatient dermatologic procedures and surgeries. OBJECTIVE: To assess the frequency of crash cart and other emergency interventions during Mohs micrographic surgery when lidocaine plus epinephrine is used as a local anesthetic and evaluate patient comorbidities associated with these events. MATERIALS AND METHODS: A retrospective chart review was conducted in an outpatient Mohs micrographic surgery clinic. RESULTS: One thousand one hundred twenty-seven Mohs cases were reviewed from the period of March 2015 to June 2016 with 864 meeting the inclusion criteria of patient weight, medical history, and amount of lidocaine administered recorded. No adverse events requiring emergency intervention with a crash cart or transfer to the emergency department occurred despite a patient population with advanced age and a wide range of comorbidities. CONCLUSION: No serious adverse events requiring emergency intervention were associated with lidocaine with epinephrine doses administered below the Food and Drug Administration recommended maximum. The authors did not find evidence from this study or after a literature search to support the requirement for a crash cart and other emergency equipment to be present during procedures.

A pilot study to investigate the efficacy of tobramycin-dexamethasone ointment in promoting wound healing.

INTRODUCTION: The standard postsurgical treatment of wounds after dermatologic procedures is currently limited. Topical corticosteroids have been used successfully in postoperative management of ophthalmologic surgeries that involve the skin of the eyelid. In particular, tobramycin 0.3%/dexamethasone 0.1% ophthalmic ointment is considered the "gold standard" of steroid-antibiotic fixed combinations and is marketed worldwide as an agent used to control postsurgical inflammation and prevent postsurgical infection. The purpose of this study is to evaluate both the efficacy and safety of tobramycin-dexamethasone ointment for the postsurgical management of Mohs or dermatologic surgery in comparison to white petrolatum. METHODS: The authors employed a half-scar study in which patients who underwent skin cancer removal surgery were given tobramycin-dexamethasone ointment and white petrolatum to apply to each half of their wound for 2 weeks. The study was double blinded, and physicians and the patients independently evaluated the scars for cosmetic appearance at 2 and 6 weeks postoperatively. The evaluation criteria included judging which side of the wound looked better based on color, thickness, and discomfort. RESULTS: Eighteen patients were enrolled, of which 13 patients completed the three phases of the study. After 6 weeks the wounds did not show a statistically significant difference in color, thickness, or discomfort on either side. CONCLUSION: Results obtained to date suggest that the application of tobramycin-dexamethasone ointment to wounds after dermatologic surgery does not promote better wound healing than white petrolatum. These findings indicate that a topical steroid and antibiotic ointment may not be an effective intervention in improving postoperative outcomes in dermatologic surgeries.

Acute methotrexate toxicity seen as plaque psoriasis ulceration and necrosis: A diagnostic clue.

In addition to the well-known signs of methotrexate toxicity, rare cutaneous side effects have been described. These cutaneous signs may provide a diagnostic clue into the diagnosis of toxicity as well as facilitate early and aggressive therapy. We describe the case of a 37-year-old male, with a diagnosis of psoriasis, who developed characteristic signs and symptoms of acute methotrexate toxicity after receiving an unknown amount of intravenous methotrexate. The patient experienced a distinct change in the morphology of his existing psoriatic plaques, which became ulcerated and necrotic in the week following the methotrexate injection. Shortly after the development of cutaneous erosions, the patient developed pancytopenia, which ultimately led to his death. Ulceration and necrosis of cutaneous psoriasis plaques may serve as a herald for the impending development of life-threatening pancytopenia in patients with acute methotrexate toxicity.

Ipsilateral areolar hyperpigmentation following unilateral application of estradiol spray.

A 48 year old postmenopausal female noted hyperpigmentation of the left areola 3 months after beginning estradiol spray to her left forearm. She then applied the spray to the right forearm instead until the areolae were the same color again and then applied 1 spray to each forearm thereafter.

Dermal scatter reduction in human skin: a method using controlled application of glycerol.

BACKGROUND AND OBJECTIVE: Previous studies in a hairless Guinea pig model showed that transdermal application of glycerol effected a temporary reduction in dermal scatter of light. This study focuses on the application of this protocol on human patients. STUDY DESIGN/MATERIALS AND METHODS: After stratum corneal removal, glycerol was applied to human subjects using a low pressure transdermal application device. Optical coherence tomography imaging showed increased intensity of radiation reaching deeper regions in the skin and photographs showed enhanced visualization of dermal structures. RESULTS/CONCLUSION: Topically applied glycerol increased light penetration of in vivo corneal-stripped skin. This minimally invasive approach to temporary dermal scatter reduction has the potential to improve the efficacy of light-based diagnostic or therapeutic devices.

Survey of antibiotic prescription use for inflamed epidermal inclusion cysts.

BACKGROUND: Symptomatic epidermal inclusion cysts (EICs) are variously called "inflamed" or "infected," and the mechanism of inflammation or suppuration is controversial. Whether physicians routinely prescribe antibiotics for inflamed EICs is of concern owing to cost and bacterial resistance. OBJECTIVES: To determine whether there is any difference in the diagnosis and treatment of EICs between primary care physicians and dermatologists and to estimate the rate and cost of antibiotic prescriptions for EICs. METHODS: One hundred twenty-five primary care physicians and 52 dermatologists were surveyed using a standard case study and a photograph. RESULTS: Sixty-seven percent of the primary care physicians used the term "infected," whereas 69% of the dermatologists used the term "inflamed" or "ruptured." Eighty-four percent of the general practitioners and 94% of the dermatologists chose antibiotics for treatment. CONCLUSION: This study shows that despite the differences between general practitioners and dermatologists in diagnosis, the majority of physicians use antibiotics for the treatment of inflamed EICs.

Molluscum contagiosum.

Molluscum contagiosum is a disease caused by a poxvirus of the Molluscipox virus genus that produces a benign self-limited papular eruption of multiple umbilicated cutaneous tumors. This common viral disease is confined to the skin and mucous membranes. Transmission requires direct contact with infected hosts or contaminated fomites. It is generally thought to infect humans exclusively, but there are a few isolated reports of Molluscum contagiosum occurring in chickens, sparrows, pigeons, chimpanzees, kangaroos, a dog, and a horse. The infection is found worldwide and has a higher incidence in children, sexually active adults, and those who are immunodeficient.

Experimental nonsurgical tattoo removal in a guinea pig model with topical imiquimod and tretinoin.

BACKGROUND: Tattoo removal is a common request in dermatologic surgery practices. Conventional tattoo removal modalities consist of mechanical, chemical, and thermal methods, but these interventions may result in undesirable dermal damage, disfiguring scars, and pigmentary changes. OBJECTIVE: To evaluate the efficacy of topical imiquimod and tretinoin for the removal of tattoos in a guinea pig model. METHODS: Five albino guinea pigs (A-E) were tattooed with black, red, green, and yellow. Beginning 6 hours after tattooing, A received no treatment, B was treated with petrolatum, C had imiquimod cream alternating with tretinoin gel, D had imiquimod cream alone, and E received tretinoin gel alone. The animals were treated for 7 days. Biopsies of the tattoos were taken at 6 hours, 7 days, and 28 days. RESULTS: Control guinea pig B had normal-appearing tattoos with consistent histopathology on day 28. Guinea pig D, treated with imiquimod cream clinically, had no visible tattoo, consistent with greatly diminished or no dye evident on histopathology. Guinea pig E, treated with tretinoin gel, and guinea pig C, treated with combination tretinoin gel and imiquimod cream, had faded tattoos and moderate clearance of pigment on histopathology. CONCLUSION: In the guinea pig, the use of imiquimod was successful as a nonsurgical method of acute-phase tattoo removal, but was associated with fibrosis and the loss of dermal appendages.