RESUMEN
We present the case of a 38-year-old male who reported to our practice with multiple newly developed halos around 26 existing nevi on his trunk. The halo nevi developed after the patient, who lived in the northeast, spent 2 months on a lake in Alabama, with intense heat and sun exposure. This case is remarkable in that it points to ultraviolet exposure as one instigating factor in the development of halo nevi, the development of which is incompletely understood. J Drugs Dermatol. 2023;22(12):e31-e32. doi:10.36849/JDD.6792e.
Asunto(s)
Nevo con Halo , Neoplasias Cutáneas , Masculino , Humanos , Adulto , Luz Solar/efectos adversos , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/etiologíaRESUMEN
BACKGROUND: Wound edge eversion has been hypothesized to improve aesthetic outcomes after cutaneous wound closure. Data supporting this assertion are sparse. OBJECTIVE: We sought to determine if wound eversion, achieved with interrupted subcuticular sutures, improves aesthetic outcome compared with planar closures. METHODS: We undertook a prospective, randomized, split-scar intervention in patients who underwent cutaneous surgery. Half of the wound was randomized to an everted or planar repair; the other side received the opposite one. At 3- and 6-month follow-up, both the patient and 2 blinded observers evaluated the wound using the Patient Observer Self-Assessment Scale (POSAS). RESULTS: The total observer POSAS score for the everted (13.59, 12.26) and planar (12.91, 12.98) sides did not differ significantly at 3 or 6 months, respectively. Similarly, there was not a significant difference in patient assessment between the everted (16.23, 12.84) and planar (15.07, 12.79) sides at 3 or 6 months, respectively. Finally, there was no significant difference between the 2 closure methods in terms of scar height or width at follow-up. LIMITATIONS: This was a single-center trial, which used a validated but still subjective scar assessment instrument. CONCLUSION: Wound eversion was not significantly associated with improved overall scar assessments by blinded observers or patient assessment.
Asunto(s)
Cicatriz/prevención & control , Procedimientos Quirúrgicos Dermatologicos/efectos adversos , Técnicas de Sutura , Anciano , Cicatriz/etiología , Cicatriz/patología , Autoevaluación Diagnóstica , Estética , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cirugía de Mohs , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Método Simple Ciego , Encuestas y Cuestionarios , Cicatrización de HeridasRESUMEN
BACKGROUND: The set-back suture, an absorbable dermal suturing technique, purportedly improves wound eversion and cosmetic outcomes. OBJECTIVE: We sought to conduct a split-wound, prospective, randomized study to compare the cosmetic outcome and wound eversion achieved with the set-back suture and the buried vertical mattress suture (BVMS). METHODS: A total of 46 surgical elliptical wounds were randomized to subcuticular closure with the set-back suture on half and the BVMS on the other. Maximum eversion height and width were measured immediately postoperatively. At 3 months, 2 blinded observers evaluated each scar using a 7-point Likert physician global scar assessment scale. Subjects and observers also completed the validated Patient and Observer Scar Assessment Scale, where a score of 6 represents normal-appearing skin and 60 represents worst imaginable scar. RESULTS: In all, 42 subjects completed the study. The set-back suture provided statistically significant wound eversion. On the Likert scale, observers rated the set-back suture side 1 point better than the BVMS side. Both patient and observer total Patient and Observer Scar Assessment Scale scores were significantly lower for the set-back suture side (subject mean 13.0 ± 8.7 vs 16.2 ± 12.0 [P = .039]; observer mean 24.5 ± 10.4 vs 27.7 ± 13.6 [P = .028], respectively). LIMITATIONS: Single institution experience and relatively short follow-up are limitations. CONCLUSION: The set-back suture provides superior wound eversion and better cosmetic outcomes than the BVMS.
Asunto(s)
Cicatriz/prevención & control , Procedimientos Quirúrgicos Dermatologicos/efectos adversos , Técnicas de Sutura , Anciano , Cicatriz/etiología , Autoevaluación Diagnóstica , Estética , Femenino , Estudios de Seguimiento , Humanos , Curva de Aprendizaje , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Aceptación de la Atención de Salud , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Método Simple Ciego , Encuestas y Cuestionarios , Técnicas de Sutura/efectos adversos , Técnicas de Sutura/educación , Suturas , Resultado del Tratamiento , Cicatrización de HeridasRESUMEN
The treatment of facial cysts often entails some thorny decision making for the dermatologist. We offer a review of several approaches for their removal or modification and examine the outcome evidence for some common techniques and some that are seen less often. Finally, we offer our recommendations based on this trial evidence.
Asunto(s)
Quistes/cirugía , Cara , Tejido Subcutáneo/cirugía , Procedimientos Quirúrgicos Operativos/métodos , Estética , Humanos , Medición de Riesgo , Procedimientos Quirúrgicos Operativos/efectos adversos , Resultado del TratamientoRESUMEN
Mitomycin C (MMC) is an antineoplastic antibiotic that has been used off-label in the treatment of hypertrophic scars and keloids. Herein we report our successful use of this agent in a patient with sternal keloids refractory to other means of therapy. We further review the literature regarding the use of MMC in the treatment of keloids.
Asunto(s)
Alquilantes/uso terapéutico , Queloide/tratamiento farmacológico , Mitomicina/uso terapéutico , Adulto , Alquilantes/administración & dosificación , Femenino , Estudios de Seguimiento , Humanos , Queloide/patología , Mitomicina/administración & dosificación , Uso Fuera de lo IndicadoRESUMEN
The techniques of noninvasive facial rejuvenation are forever being redefined and improved. This article will review historical as well as present approaches to resurfacing, discussing the nonablative tools that can complement resurfacing procedures. Current thoughts on the pre- and postoperative care of resurfacing patients are also considered.
Asunto(s)
Terapia por Láser/historia , Ritidoplastia/historia , Envejecimiento de la Piel/efectos de la radiación , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Terapia por Láser/métodos , Rejuvenecimiento , Ritidoplastia/métodosRESUMEN
Ultrasonic imaging has been used in the field of dermatology for nearly 30 years. In this review, we seek to explain the basic principles of ultrasound as they relate to the skin. Based on differences in keratin, collagen, and water content, ultrasonic waves are reflected back to a transducer and translated into a gray-scale image for interpretation. The technicalities of the process and its variations (power, continuous wave Doppler ultrasound, ultrasound elastography) are briefly reviewed, and we further highlight many of the applications for ultrasound in the treatment and diagnosis of dermatologic conditions, including melanoma and nonmelanoma skin cancer, benign tumors, inflammatory diseases, and lipoablation. Each of these entities is uniquely characterized using ultrasonic techniques. Based on published sources, we contend that although ultrasound is still being fine-tuned for application in dermatology and largely remains in experimental phases, it has potential for use in many arenas of our specialty.
Asunto(s)
Neoplasias Cutáneas/diagnóstico por imagen , Neoplasias Cutáneas/terapia , Piel/diagnóstico por imagen , Terapia por Ultrasonido , Carcinoma Basocelular/diagnóstico por imagen , Carcinoma Basocelular/terapia , Humanos , Imagenología Tridimensional , Curva de Aprendizaje , Lipectomía/métodos , Cirugía de Mohs , Ultrasonografía DopplerRESUMEN
The Muir-Torre Syndrome is characterized by the clinical constellation of sebaceous neoplasms, keratoacanthomas, and internal malignancies caused by a defect in DNA mismatch repair. Another mismatch repair defect causes Turcot syndrome, which manifests with colorectal and central nervous system neoplasms. We wish to report a case in which the manifestations of both syndromes were observed in the same patient. We further discuss the possible genetic basis for this overlap.
Asunto(s)
Astrocitoma/diagnóstico , Neoplasias Encefálicas/diagnóstico , Neoplasias del Colon/diagnóstico , Neoplasias Colorrectales/diagnóstico , Síndrome de Muir-Torre/diagnóstico , Neoplasias Primarias Múltiples/diagnóstico , Síndromes Neoplásicos Hereditarios/diagnóstico , Neoplasias de las Glándulas Sebáceas/diagnóstico , Proteínas Adaptadoras Transductoras de Señales/genética , Adenocarcinoma Sebáceo/diagnóstico , Neoplasias Encefálicas/genética , Neoplasias Colorrectales/genética , Reparación de la Incompatibilidad de ADN , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Síndrome de Muir-Torre/genética , Homólogo 1 de la Proteína MutL , Proteína 2 Homóloga a MutS/genética , Mutación , Neoplasias Primarias Múltiples/genética , Síndromes Neoplásicos Hereditarios/genética , Proteínas Nucleares/genética , LinajeRESUMEN
Amyloidosis cutis dyschromica is a rare form of cutaneous amyloidosis in which there is deposition of keratinocyte-derived amyloid with involvement of almost the entire integument, leading to diffuse dyschromia without associated systemic abnormalities. We report the case of a 40-year-old female who presented with the onset of diffuse hyperpigmentation shortly after birth, which was followed by the widespread development of numerous 2-5 mm hypopigmented macules. Biopsy of the one of these macules revealed eosinophilic globular material in the papillary dermis with Congo red birefringence which also stained positively for high-molecular weight cytokeratin. Electron microscopy confirmed the presence of 11 nm hollow fibrils, consistent with amyloid. Similar clinical changes were noted in a younger male sibling. Both patients also suffered from an unexplained neurological disorder characterized by atypical Parkinsonism, spasticity and motor weakness. This association has not been shown before and may represent a heretofore unreported contiguous gene syndrome.
Asunto(s)
Amiloidosis Familiar/complicaciones , Espasticidad Muscular/complicaciones , Enfermedades Neuromusculares/complicaciones , Enfermedad de Parkinson/complicaciones , Enfermedades de la Piel/complicaciones , Adulto , Amiloidosis Familiar/genética , Amiloidosis Familiar/patología , Biopsia , Femenino , Humanos , Masculino , Espasticidad Muscular/genética , Espasticidad Muscular/patología , Debilidad Muscular/etiología , Debilidad Muscular/patología , Enfermedades Neuromusculares/genética , Enfermedades Neuromusculares/patología , Pakistán , Enfermedad de Parkinson/genética , Enfermedad de Parkinson/patología , Enfermedades de la Piel/genética , Enfermedades de la Piel/patologíaRESUMEN
As reflected in the literature, the use of dermal filler agents has increased substantially over the last decade. Consequently, these agents are more frequently encountered on histopathologic examination. A variety of dermal fillers can be readily identified histopathologically, and the accurate identification of these agents is a critical task for dermatopathologists. Furthermore, a basic understanding of the histological features of fillers has relevance to dermatologists and dermatologic surgeons. The identification of filler substances may have important diagnostic, medico-legal and medical management considerations. This concise review aims to provide a pragmatic approach to distinguishing the agents most frequently encountered in routine practice and in the literature.
Asunto(s)
Materiales Biocompatibles/efectos adversos , Materiales Biocompatibles/análisis , Técnicas Cosméticas/efectos adversos , Piel/patología , Colágeno/efectos adversos , Colágeno/análisis , Durapatita/efectos adversos , Durapatita/análisis , Humanos , Hidrogeles/efectos adversos , Hidrogeles/análisis , Inyecciones Intradérmicas , Ácido Láctico/efectos adversos , Ácido Láctico/análisis , Parafina/efectos adversos , Parafina/análisis , Poliésteres , Polímeros/efectos adversos , Polímeros/análisis , Polimetil Metacrilato/efectos adversos , Polimetil Metacrilato/análisis , Siliconas/análisis , Piel/químicaRESUMEN
Subungual melanoma is a relatively rare variant of melanoma, accounting for 0.7-3.5% of all melanoma cases in the Caucasian population. Curiously, it occurs in 8-33% of cases in black, Asian, Native American and Hispanic populations, which generally face a substantially lower risk of melanoma. Herein the authors report the case of a 69-year-old Hispanic female with a subungual melanoma of the acral lentiginous type that directly invaded the periosteum, cortex and medulla of the distal phalanx. In addition, we review published reports of acral lentiginous melanoma with osseous invasion and discuss the evidence, on a molecular level, for this entity's aggressive pattern of invasion. The review of cases is limited to those found through the PubMed search engine.
Asunto(s)
Neoplasias Óseas/secundario , Melanoma/patología , Neoplasias Cutáneas/patología , Falanges de los Dedos del Pie/patología , Anciano , Femenino , Humanos , Invasividad Neoplásica , Periostio/patologíaRESUMEN
Acquired digital fibrokeratoma is a rare benign fibroepithelial tumor that typically presents as a solitary asymptomatic nodule on the finger or toe. Middle-aged adults are most commonly affected. Here we discuss an unusual case of acquired digital fibrokeratoma presenting as a cluster of multiple nodules on the sole of a 15-year-old boy.
Asunto(s)
Dermatosis del Pie/patología , Queratosis/patología , Neoplasias Cutáneas/patología , Adolescente , Dermatosis del Pie/cirugía , Humanos , Queratosis/cirugía , Masculino , Neoplasias Cutáneas/cirugíaRESUMEN
The hedgehog family of morphogens (sonic [Shh], Indian, and desert hedgehog) are central regulators of embryologic growth and tissue patterning. Although recent work implicates Shh in postnatal tissue repair and development, conclusive evidence is lacking. Here, we demonstrated the importance of Shh in wound repair, by examining the effects of cyclopamine, a specific inhibitor of the Shh signaling cascade, on tissue repair. Using a murine-splinted excisional wound model, which attenuates wound contraction in this loose-skinned rodent, we established that, by all measures (wound closure, epithelialization, granulation formation, vascularity, and proliferation), wound healing was profoundly impaired when Shh signaling was disrupted. Because embryonic disruption of Shh is associated with distinct phenotypic defects, our findings invite investigation of the potential role of Shh signaling under postnatal conditions associated with disregulated wound healing.
Asunto(s)
Proteínas Hedgehog/fisiología , Cicatrización de Heridas/fisiología , Animales , Proteínas Hedgehog/antagonistas & inhibidores , Ratones , Ratones Endogámicos C57BL , Transducción de Señal , Alcaloides de Veratrum/farmacologíaAsunto(s)
Técnicas Cosméticas/efectos adversos , Ácido Hialurónico/administración & dosificación , Inyecciones Intradérmicas/efectos adversos , Rinitis Vasomotora/etiología , Adulto , Femenino , Humanos , Ácido Hialurónico/efectos adversos , Rinitis Vasomotora/inducido químicamente , Rinitis Vasomotora/diagnóstico , Rinitis Vasomotora/terapiaRESUMEN
This case report seeks to alert the reader to the possibility that the keratoacanthoma (KA) may develop in tattoo sites, specifically in red tattoo sites. We further wish to describe the senior author's treatment of such a lesion using Mohs micrographic surgery and a rotation flap to preserve the integrity of the original tattoo design in an area of minimal skin laxity. We briefly discuss the etiology of the KA and review potential tattoo reactions as presented in the literature.
Asunto(s)
Queratoacantoma/cirugía , Cirugía de Mohs/métodos , Tatuaje/efectos adversos , Adulto , Femenino , Humanos , Queratoacantoma/etiología , Queratoacantoma/patología , Colgajos Quirúrgicos , Tatuaje/métodos , Factores de TiempoRESUMEN
BACKGROUND: In the United States, breast reductions based upon a Wise pattern incision remain common. However, dissatisfaction with this procedure, on the part of the patient and the surgeon alike because of unsightly scars and long-term "bottoming out" of the breast, has promoted the search for alternative methods of breast reduction. The purpose of this study was to analyze patient outcomes after vertical reduction mammaplasty utilizing prospectively collected data. METHODS: All patients were given a custom-designed questionnaire designed to evaluate their macromastia-related symptoms and other macromastia-related quality-of-life issues. Patients were then provided the same questionnaire at their final postoperative visit between 3 and 6 months after surgery. RESULTS: A total of 63 patients underwent vertical reduction mammaplasty and 40 patients underwent Wise pattern inferior pedicle reduction mammaplasty. Vertical reduction mammaplasty resulted in significant decreases in all macromastia-related symptoms analyzed, including upper back pain, lower back pain, neck pain, arm pain, shoulder pain, hand pain, breast pain, headaches, rashes and/or itching, and painful brassiere strap grooving (all, p < 0.00001). Furthermore, vertical reduction mammaplasty resulted in significant improvement in all quality-of-life factors analyzed, including difficulty buying clothes and brassieres, difficulty playing sports, and difficulty running (all, p < 0.00001). Minor complications (superficial infection, seroma, or delayed wound healing) occurred in 16 patients (25 percent) in the vertical reduction mammaplasty group. Minor office revisions (scar revision or excision) were performed in four patients (6 percent) in the vertical reduction mammaplasty group. CONCLUSION: The authors' method of vertical reduction mammaplasty offers substantial relief of macromastia-associated symptoms with a low complication/revision rate.