The dangers of human papillomavirus (HPV) laser plume and best safety practices.

Human papillomavirus (HPV) remains to be one of the most common viruses that afflicts the skin and mucosa. Direct contact with cutaneous lesions facilitates a majority of viral transmission. However, the development of laser therapy as treatment for HPV brought to attention the concern of infectious laser plume and the risk it poses to those inhaling it. We conducted a literature review using English articles in PubMed to validate this risk and propose the best safety practices dermatologists can apply when using laser therapy as treatment for HPV. Our investigation identified smoke evacuators as primary modes of mitigation, and we suggest further studies will aid in the refinement of best practice recommendations.

The risk of metastases from squamous cell carcinoma of the skin.

Cutaneous squamous cell carcinoma (cSCC) is the second most common nonmelanoma skin cancer, accounting for 20% of all skin cancers. The risk of the disease continues to rise annually with an estimated 50-200% increase in incidence within the last three decades. Although cSCC is one of the most common skin cancers, reported having 1 million cases per year in the United States, there is inconsistency with its reported metastatic rate. Research exploring cSCC metastasis found an overall rate of 1.2-5% but this range varies, and some dermatologists are finding cSCC's ability to spread more worrisome. This allows for clinical variation in the appropriate treatments and follow-up guidelines when diagnosing a patient with cSCC. Poor prognosis in patients with a high metastatic potential makes cSCC clinically problematic. Clinician emphasis should be put on risk factors, anatomical site, tumor presentation, and histological features when evaluating cSCC's metastatic potential. In this review, specific skin conditions that predispose to cSCC and discrepancies in its reported metastatic potential will be discussed.

DMSO: an aid to combat pain and pruritus.

Dimethyl sulfoxide (DMSO) is a highly reactive by-product of paper production in the form of an odorless, colorless liquid that has been studied since the 1860s. Initially it was utilized as a solvent, but more recently it is being investigated for therapeutic applications. Owing to its versatility, the use of DMSO has been proposed in many different medical fields for a variety of applications, with possibly the widest use being in the field of dermatology. The clinical interest in the use of DMSO for dermatology conditions stems from this solution's efficacy as a vehicle to deliver pharmacological agents across the stratum corneum and its ability to penetrate biological membranes. Currently there is only one FDA approval for the use of DMSO, and it is not in the dermatologic field but rather for interstitial cystitis. Outside of the FDA scope of usage, DMSO is used frequently to treat osteoarthritis in humans and animals, as well as other chronic pain conditions. This suggests the possible utility of DMSO being applicable to other inflammatory conditions such as pruritus. Further research is necessary to explore the promising utilization opportunities of DMSO in dermatology.

Sunscreen regulations and use of anti-inflammatory agents in sunscreens.

The Food and Drug Administration (FDA) has been more proactive in regulating sunscreen products. In 2011, the FDA publicized a set of new requirements for marketing over-the-counter sunscreens in the United States. The primary goal of the new FDA requirements was to provide consumers with a clear understanding of the level of protection actually provided by a sunscreen. Furthermore, information about protection against ultraviolet A radiation, associated with early aging and skin cancer, was to be clarified. With the new regulations, sunscreen products that provide protection against ultraviolet A and ultraviolet B would be allowed to be marketed as broad-spectrum sunscreen [1].

Cryosurgical treatment of warts: dimethyl ether and propane versus liquid nitrogen - case report and review of the literature.

For years, dermatologists have relied on cryotherapy with liquid nitrogen as a safe and effective treatment for warts. More recently, several over-the-counter (OTC) wart-freezing therapies have become available. Manufacturers have substituted liquid nitrogen with dimethyl ether and propane (DMEP), and marketed these new preparations to be safe and effective alternatives to in-office cryotherapy with liquid nitrogen. However, data from in vitro studies and comparative studies in humans refute manufacturers' claims that these products reproduce in-office cryotherapy.

Herpes and acoustic neuromas: is there a cause and effect to observe?

Acoustic neuromas are a result of damage to the affected nerve function and can potentially press surrounding tissues. Although some sources suggest that observation is the treatment of choice for only those over 65 years of age and those unable to tolerate undergoing surgery or radiosurgery, most affected individuals should strongly consider not doing any aggressive therapies. Herpes has already been shown to mimic acoustic neuroma clinically, but growing evidence suggests that it is likely the cause of most cases of this entity.

Use of a keratolytic agent with occlusion for topical treatment of hyperkeratotic seborrheic keratoses.

BACKGROUND: Seborrheic keratoses are the most common benign tumors in adults. Despite their negative cosmetic appearance, no topical treatment is commonly recommended for these lesions. OBJECTIVE: Our objective was to assess whether clinical benefit could be achieved by using a keratolytic topical agent and superficial scraping for this condition. METHODS: A topical 50% urea-containing product under occlusion was applied daily to large and/or thick hyperkeratotic seborrheic keratoses on the truck and extremities. The patients were instructed to digitally scrape the surface of the lesions in an attempt to reduce the thickness of the lesions. RESULTS: In a pilot nonrandomized open-label survey, patients expressed satisfaction with using this topical therapeutic technique. CONCLUSIONS: Hyperkeratotic seborrheic keratoses can be satisfactorily managed with topical agents and scraping with reasonable patient satisfaction. Further studies with various keratolytic agents using other delivery systems are warranted.

An in vitro study comparing temperatures of over-the-counter wart preparations with liquid nitrogen.

BACKGROUND: Over-the-counter (OTC) wart-freezing therapies have appeared on the market claiming that they reproduce in-office cryotherapy. OBJECTIVE: We sought to determine whether these OTC home wart removal products are as cold as liquid nitrogen. METHODS: The coldness obtained by 3 representative commercial wart products, and liquid nitrogen, was assessed using a thermometer calibrated from -100 degrees C to 50 degrees C. Temperatures of the commercial wart products used were measured and compared with those obtained with liquid nitrogen. RESULTS: None of the OTC coolants were as cold as liquid nitrogen, and they did not lower temperature as quickly as liquid nitrogen. LIMITATIONS: This study did not evaluate the clinical efficacy of any of the agents studied. CONCLUSIONS: Despite advertising messages, OTC refrigerants do not achieve freezing equivalent to liquid nitrogen.

Bacterial symbiotes, their presence in head lice, and potential treatment avenues.

BACKGROUND: Pediculus humanus capitis (head lice) belongs to the order Anoplura, which are blood-feeding ectoparasites that live on human hair. Within these insects reside symbiotic bacteria that enable the insect to flourish on dietary sources of limited nutritional value. These symbiotic bacteria are essential to the survival of the insect. OBJECTIVE: To assess the feasibility of treating head lice by altering their symbiotic bacteria. METHODS: In addition to a literature review of the expanded role of symbiotic bacteria in other organisms, the anatomic localization of their presence in human head lice and molecular characterization of the head louse symbiont were analyzed. RESULTS: Anatomically, the bacterial symbiotes are localized to the midgut mycetome in males and the ovaries in females. The 16S ribosomal ribonucleic acid phylogenetic analysis was presented. Features of this bacterial symbiote may make this symbiont accessible as a target for pediculocidal and ovicidal therapy by altering its habitat and existence. CONCLUSIONS: An understanding of the nature of bacterial symbiotes of head lice might lead to alternative strategies for eradication or inhibition of these necessary bacteria, thereby controlling head lice with less toxic agents than conventional insecticides, to which the organism continues to increase its resistance.