Needs assessment for general dermatologic surgery.

This article reviews current recommendations, strength of evidence, and areas in need of further research in the surgical treatment of melanoma and nonmelanoma skin cancers, as well as other select cutaneous neoplasms. Cryosurgery, electrosurgery, photodynamic therapy, and surgical excision are discussed. Local anesthesia, suturing technique, postsurgical dressings, and optimization of scarring are briefly reviewed. In general, large, high-quality, randomized controlled trials on which to base recommendations are lacking.

Needs assessment for cosmetic dermatologic surgery.

Cosmetic procedures have been an integral part of dermatologic surgery for over half a century, with a more recent proliferation of devices to improve skin color and texture and modify subcutaneous fat. Overall, cosmetic dermatologic procedures are extremely safe. However, detailed information about safety and effectiveness, and especially comparative effectiveness, is not available for many procedures. There are few randomized control trials of comparative effectiveness of different procedures for similar indications. Key comparative effectiveness studies are briefly reviewed, and areas of substantial deficiency in such research are highlighted.

Needs assessment for Mohs micrographic surgery.

Mohs micrographic surgery (MMS) is a unique technique that can offer the highest cure rates and maximum tissue conservation in the management of specific primary and recurrent skin cancers. However, there are many areas of controversy that surround MMS, including appropriate indications for its use, technical quandaries, and outcomes. Recent efforts in these areas need to be assessed to identify research gaps in MMS to help fuel further work. The usefulness of MMS and its methods for delivery need more stringent, evidence-based, rigorous study.

Morgellons disease and delusions of parasitosis.

Morgellons disease is a controversial and poorly defined symptom cluster of skin lesions and somatic symptoms, most notably 'fibers' in the skin. Because of widespread coverage in the media and on the Internet, there are an increasing number of patients presenting to dermatologists. We present three patients who believed that they had fibers in their skin. We offer a discussion of delusions of parasitosis to demonstrate similarities between these conditions. It has been suggested by a limited number of healthcare providers that an unknown infectious agent underlies this symptom complex yet no available evidence supports this assertion. Laboratory values that would be reflective of an infectious process (e.g. elevated white blood cells, sedimentation rate, C reactive protein) are routinely normal and biopsies often reflect only nonspecific findings such as acute and chronic inflammation with erosion or ulceration. Patients with Morgellons disease generally lack insight into their disease and reject the need for psychiatric help. The goal is to build trust and refrain from minimizing what the patient experiences. Attentive examination of the patient's skin and fragments they present is necessary to rule out a true underlying pathologic process and to establish a trusting relationship. A supportive, non-confrontational approach is ideal. The patient is best treated by a team of practitioners of several specialties, including dermatologists, psychiatrists, and counselors.

Foot care education and self management behaviors in diverse veterans with diabetes.

The objective of this study was to examine differences in self-reported diabetes foot care education, self management behaviors, and barriers to good foot care among veterans with diabetes by race and ethnicity. Data was collected using the Veterans Health Administration Footcare Survey, a validated tool that assessed demographic, general health, diabetes and foot self-care information, barriers to foot self-care, receipt of professional foot care, and satisfaction with current care. We mailed surveys to a random sample of patients with diabetes from eight VA medical centers. Study participants were 81% White; 13% African American; 4% Asian, and 2% American Indian and Pacific Islanders. The majority of respondents felt that they did not know enough about foot self-care. There were large gaps between self-reported knowledge and actual foot care practices, even among those who reported "knowing enough" on a given topic. There were significant differences in self-reported foot care behaviors and education by race and ethnicity. These findings document the need for culturally-specific self-management education to address unique cultural preferences and barriers to care.

Guideline concordant venous ulcer care predicts healing in a tertiary care Veterans Affairs Medical Center.

This study describes the impact of 80% adherence to guideline concordant care for compression therapy, moist wound-healing environment, and debridement on venous ulcer outcomes. The retrospective cohort design included patients from a tertiary care Veterans Affairs Medical Center from October 2003 to September 2007. During this 5-year interval, 155 patients with 400 venous ulcers met study inclusion. A majority of ulcers (n=362) healed, with an average time to healing of 18.1 weeks (range 2-209 weeks, median 10.4 weeks). From the multivariate Poisson regression, the likelihood of ulcer healing increased when compression therapy was provided during at least 80% of visits (relative risk [RR], 1.93; 95% confidence interval [CI], 1.27-2.92) or when a moist wound-healing environment was provided during at least 80% of visits (RR, 1.63; 95% CI, 1.09-2.42). Debridement alone was not significantly associated with ulcer healing (RR, 1.0; 95% CI, 0.61-1.64). Patients who received all three treatments during at least 80% of their visits were more likely to heal than those who received < 80% treatment (RR, 2.52; 95% CI, 1.53-4.16). Guideline concordant venous ulcer care was significantly associated with venous ulcer healing, when provided at 80% or more of patient visits.

Cutaneous manifestations of Corynebacterium jeikeium sepsis.

Corynebacterium jeikeium is a rare but increasingly important cause of septicemia in neutropenic patients that can present with characteristic cutaneous findings. A 61-year-old man with myelodysplastic syndrome developed C. jeikeium sepsis and an erythematous papular eruption while neutropenic from induction chemotherapy. A review of the English language literature shows only six reported cases of hemorrhagic or erythematous papular eruption in C. jeikeium sepsis. The case is presented with an updated literature review of the history, risk factors, and treatment.