Gynecomastia: etiologies, clinical presentations, diagnosis, and management.

Gynecomastia is a common finding that is present in up to 57% of men. It is caused by proliferation of the mammary glands, which leads to the development of dense subareolar tissue. The condition results from both physiologic (eg, hypogonadism, altered estrogen-to-androgen ratio) and nonphysiologic (eg, drugs, herbal products) causes. Most cases are benign and resolve spontaneously. Treatment is usually unnecessary, although there are specific signs and symptoms that warrant further workup. Psychosocial effects also are of concern, particularly among adolescents. Knowledge of the possible causes of gynecomastia and a thoughtful approach to the patient presenting with this condition can lead to improved outcomes and patient satisfaction. This concise review of the common presentation, etiologies, diagnosis, and treatment of gynecomastia should aid healthcare professionals who may encounter these patients in their practices.

Mucocutaneous complications of smoking cessation therapies.

Despite widespread knowledge of the morbidity and mortality associated with smoking, this addictive practice continues to be quite prevalent throughout the United States, as about one-fifth of the population smokes cigarettes. Because of the financial burden, and the significant psychosocial and health implications of smoking, many individuals are now attempting to quit, and often using some type of pharmacotherapy for assistance. Given that dermatologists will likely encounter patients using smoking cessation aids, it is important to be aware of their potential mucocutaneous adverse effects. We present a brief review of the dermatologic complications associated with smoking cessation therapies. Hopefully, this article will also remind dermatologists to encourage smoking cessation at every visit.

Pesquisa de opinião sobre eficácia, custos e cicatrização de procedimentos de resurfacing para rugas estáticas faciais / Expert survey on the efficacy, costs and healing of resurfacing procedures for facial static wrinkles

Foi realizada uma pesquisa de opinião entre especialistas em "resurfacing" cutâneo com a finalidade de compararem-se custos e benefícios entre as técnicas de laser de CO2 totalmente ablativo, lasers fracionados ablativos, lasers fracionados não ablativos, radiofrequência fracionada ablativa, microagulhamento, dermabrasão, peelings médios e peelings de fenol- -óleo de cróton. A opção mais eficaz para tratamento de rugas estáticas faciais foi peeling de fenol-óleo de cróton, ranqueado em primeiro lugar por 71,4% dos experts, seguido de laser de CO2 totalmente ablativo, por 28,6%. Sobre "downtime", os procedimentos elencados com recuperação mais rápida foram microagulhamento e laser fracionado não ablativo, com 42,9% cada um, seguidos por radiofrequência fracionada ablativa, com 14,3%. O período para recuperação completa dos efeitos colaterais e adversos foi percebido como mais curto no microagulhamento por 50% dos experts. Sobre os custos operacionais, o procedimento menos custoso foram peelings médios, de acordo com a opinião de 71,4% dos especialistas. Tais resultados apontam para melhor custo/benefício de procedimentos como peelings químicos e microagulhamento, de acordo com a opinião dos 14 especialistas brasileiros que responderam ao questionário.

A survey on the opinion of specialists regarding skin resurfacing was performed, with the objective of comparing costs and benefits between the techniques: totally ablative CO2 laser, fractional ablative lasers, fractional non-ablative lasers, ablative fractional radiofrequency, microneedling, dermabrasion, medium peels, phenol-croton oil peels. The most effective option for the treatment of static wrinkles was the phenol-croton oil peel, in first place by 71.4% of the experts, followed by totally ablative CO2 laser, by 28.6%. Regarding downtime, procedures ranked as fastest recovery were microneedling and fractional non-ablative lasers, with 42.9% each, followed by ablative fractional radiofrequency, with 14.3%. Complete recovery period for side and adverse effects was perceived as shorter with microneedling by 50% of the experts. Regarding operating costs. The less costly procedure was medium peels, according to the opinion of 71.4% of the experts. Such results point towards a better cost/benefit of procedures such as chemical peels and micro-needling, according to the opinion of 14 Brazilian specialists who answered the questionnaire.

Effectiveness of acupressure on pruritus and lichenification associated with atopic dermatitis: a pilot trial.

BACKGROUND: Pruritus is a debilitating aspect of atopic dermatitis (AD). Acupuncture has been reported to diminish pruritus, but self-administered acupressure has not been previously evaluated. OBJECTIVES: To evaluate the effectiveness of acupressure on the severity of eczema in a pilot trial. METHODS: Adult patients with AD were randomised to an intervention group (acupressure with standard of care) or a control group (standard of care alone). Subjects in the intervention group performed acupressure using a 1.2 mm acupellet at the LI11 point, applying pressure for 3 min three times per week for 4 weeks. The severity of itching and AD at baseline and at 4 weeks were measured on a visual analogue scale (VAS), the Investigator's Global Assessment (IGA) and the Eczema Area and Severity Index (EASI). RESULTS: Fifteen subjects were enrolled, 12 of whom completed the study between November 2009 and May 2011. There was no significant change between baseline and follow-up survey scores within the control group. In the investigation group there was a decrease in the VAS score (p=0.05) and EASI lichenification (p=0.03), although without significant change in the overall EASI score. Comparison of the scores between groups showed a greater decrease in VAS in the experimental group than in the control group (p=0.04), and a decrease in the IGA (p=0.03) and EASI lichenification score (p=0.03). The overall EASI scores were unchanged. CONCLUSION: Subjects using acupressure at LI11 for 4 weeks had improvement in pruritus and lichenification. Acupressure may prove to be an easily administered alternative treatment, but larger-scale studies are needed to confirm these preliminary findings.