Management of Darier disease: A review of the literature and update.

Darier disease (DD) is a rare type of inherited keratinizing disorder with no definitive therapeutic approach. The objective of this study is to provide a detailed literature review of all the available treatment modalities of Darier disease, including those that are both surgical and non surgical, to compare their efficacies and to propose a novel therapeutic approach. A complete search of the literature for all articles describing the different treatments of Darier disease, with no restrictions on patients' ages, gender or nationalities, was performed with the use of PubMed. A total of 68 articles were included in the study: 3 prospective studies, 44 case reports/case series and 21 letters/correspondences/clinical images. The treatments described were topical, oral or physical. Retinoids (isotretinoin, tazarotene and adapalene) and fluorouracil were the two most effective topical treatments. Oral retinoids were the most effective oral therapy and were prescribed in the cases of generalized Darier disease. For localized and resistant skin lesions, physical therapies including surgical excision, dermabrasion and CO2 laser ablation were the first line choices. Limitations of this article include the inability to verify the accuracy of the published data, the relatively small sample size, the absence of randomized controlled clinical trials and possible unidentified confounding factors in various studies. In every therapeutic approach to Darier disease, consideration of patient comorbidities, disease distribution, severity and treatment accessibility is essential. Large and randomized clinical trials are necessary for the comparison of the efficacy and the safety of all the treatments of Darier disease and settling a consensus for management.

O controle do câncer no Brasil na primeira metade do século XX / Cancer control in Brazil in the first half of the twentieth century

Discute as ações públicas para o controle do câncer no país, entre a década de 1920 e o final dos anos 1940. Trata da criação da Inspetoria de Profilaxia da Lepra e das Doenças Venéreas, no âmbito do Departamento Nacional de Saúde Pública, primeira ação pública relacionada à doença. Embora de pouco alcance, seu surgimento permite a compreensão do campo profissional, relacionado à doença, existente à época. Observa o papel da difusão da eletrocirurgia na ampliação do interesse médico pelo câncer e na criação do Centro de Cancerologia do Distrito Federal. Discute a criação e a primeira década de atuação do Serviço Nacional de Câncer, aproximando seu perfil inicial das questões que nortearam sua trajetória.

The article discusses public efforts to control cancer in Brazil from the 1920s to the close of the 1940s. It examines the process which brought about creation of the Inspectorship to Combat Leprosy, Venereal Diseases, and Cancer within the National Department of Public Health. Creation of the Inspectorship was the first public action to target cancer and, while it was not far-reaching, its emergence enables us to understand the professional field of cancer at that time. The text also points to the role played by the diffusion of electrosurgery in expanding medical interest about cancer and in the founding of the Cancerology Center in the Federal District. It discusses the establishment and first decade of activities of the National Cancer Service, endeavoring to link the Service's initial profile with the issues that guided its history.

O controle do câncer no Brasil na primeira metade do século XX / Cancer control in Brasil in the first half of the twentieth century

Discute as ações públicas para o controle do câncer no país, entre a década de 1920 e o final dos anos 1940. Trata da criação da Inspetoria de Profilaxia da Lepra e das Doenças Venéreas, no âmbito do Departamento Nacional de Saúde Pública, primeira ação pública relacionada à doença. Embora de pouco alcance, seu surgimento permite a compreensão do campo profissional, relacionado à doença, existente à época. Observa o papel da difusão da eletrocirurgia na ampliação do interesse médico pelo câncer e na criação do Centro de Cancerologia do Distrito Federal. Discute a criação e a primeira década de atuação do Serviço Nacional de Câncer, aproximando seu perfil inicial das questões que nortearam sua trajetória.(AU)

Medical issues and emergencies in the dermatology office

We review the medical issues and emergencies potentially encountered in the practice of general or surgical dermatology. Traditional guidelines have largely consisted of dated extrapolations from the nondermatologic literature concerning procedures that are primarily irrelevant to dermatology. This article outlines a rational approach to organizing an office emergency plan for anaphylaxis, stroke, status epilepticus, myocardial infarction, and hypertensive crisis. We discuss the literature that has influenced current office behavior regarding endocarditis prophylaxis, the use of electrosurgery with pacemakers, arrhythmogenic drug interactions, vasovagal syncope, lidocaine "allergy," and bleeding complications from oral anticoagulants. Recommendations for managing these issues in a dermatologic context are provided.