RESUMEN
BACKGROUND: The posterior flap is a conventional technique for closing a below-knee amputation (BKA) that uses the gastrocnemius and soleus muscle and relies on the popliteal and posterior compartment arteries. If the prior mentioned arterial blood supply is compromised, this flap likely relies on collateral flow. The purpose of this study is to identify and differentiate any significant associations between preoperative popliteal and tibial arterial flow and BKA outcomes and patient-reported function. METHODS: A retrospective review identified patients from a single tertiary wound care center who received BKAs and angiogram between 2010 and 2017 by a single surgeon. BKA complications, wound healing, and amputee ambulatory status at latest follow-up were all stratified for differences according to baseline tibial vessel run-off (VRO) status, popliteal artery patency, and popliteal angioplasty outcome. Chi-square, Fisher's exact, and Wilcoxon rank sum tests were used with significance defined as p ≤ 0.05. RESULTS: BKAs were performed on 313 patients, of which, 167 underwent preoperative angiography. Thirty-two were excluded due to lack of adequate follow-up leaving a total of 135 patients in the studied population. Diabetes was present in 87%, and 36% had end-stage renal disease. By the study's conclusion, 92% of BKAs had fully healed, with median time-to-healing of 79 days (range 19-1314 days). 60% of patients were ambulatory at 9.5 months. Higher VRO was associated with higher healing rates and lower complications and time-to-healing. The conversion rate of BKA to above-knee amputation (AKA) was 4%. Preoperative popliteal patency was associated with higher postoperative ambulation rates when compared to patients without popliteal flow preoperatively (patent: 71/109, 65%; occluded: 10/26, 40%; p = 0.02) and independently increased the likelihood of postoperative ambulation. CONCLUSIONS: The posterior flap design for BKA works even in the setting of popliteal occlusion. Complication rates are higher in patients with more compromised blood flow, which may ultimately lead to AKA. Given poor ambulation rates in patients who undergo AKA, the results of this study should encourage surgeons to consider a more functional BKA, even in instances when the popliteal artery is occluded.
Asunto(s)
Arteria Poplítea , Enfermedades Vasculares , Amputación Quirúrgica/métodos , Humanos , Arteria Poplítea/diagnóstico por imagen , Arteria Poplítea/cirugía , Estudios Retrospectivos , Resultado del Tratamiento , Caminata , Cicatrización de HeridasRESUMEN
OBJECTIVE: Hydrogen peroxide 40% (HP40) was approved by the US Food and Drug Administration for topical treatment of seborrheic keratosis (SK) in December 2017. This article will review phase II and III clinical trials to assess the drug's efficacy, safety, and clinical application. DATA SOURCES: A systematic literature review was performed using the terms "Eskata AND seborrheic keratosis," and "hydrogen peroxide AND seborrheic keratosis" in the OVID MEDLINE, PubMed, Cochrane Library, EMBASE, and Web of Science databases. ClinicalTrials.gov was searched to identify ongoing or nonpublished studies. STUDY SELECTION AND DATA ABSTRACTION: Articles written in English between January 2000 and mid-June 2020 discussing phase II and phase III clinical trials were evaluated. DATA SYNTHESIS: In 2 phase III clinical trials, 4% and 8% of patients treated with HP40 had a Physician Lesion Assessment score of zero for all 4 SKs, respectively, compared with 0% in both vehicle groups at the primary end point of day 106 (P < 0.01; P < 0.0001). RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE: HP40, although less effective, has a better safety profile than other treatment options. It should be especially considered for treatment of facial SKs, where it is most efficacious and where other treatment modalities, such as cryotherapy, are more challenging. CONCLUSIONS: HP40 is a new, safe alternative treatment for SKs, although it is expensive and only modestly effective, both of which somewhat limit its overall utility. HP40 is a promising topical alternative, particularly for cosmetically sensitive locations, such as the face.
Asunto(s)
Peróxido de Hidrógeno/uso terapéutico , Queratosis Seborreica/tratamiento farmacológico , Oxidantes/uso terapéutico , Administración Tópica , Ensayos Clínicos Fase II como Asunto , Ensayos Clínicos Fase III como Asunto , Femenino , Humanos , Peróxido de Hidrógeno/administración & dosificación , Peróxido de Hidrógeno/efectos adversos , Queratosis Seborreica/patología , Oxidantes/administración & dosificación , Oxidantes/efectos adversos , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del Tratamiento , Estados Unidos , United States Food and Drug AdministrationRESUMEN
Dermatologically, FGFR3 mutations can lead to acanthosis nigricans (AN), epidermal nevi, and seborrheic keratosis. A recent case report found that topical rapamycin (sirolimus) can improve FGFR3-induced epidermal nevi with AN features in children, specifically with Fitzpatrick skin type (FST) I/II, and we would like to expand these findings to skin plaques with extensive AN-like features in the FST IV/V adolescent population. An 18-year-old female with FST IV/V and FGFR3-induced hypochondroplasia presented to our clinic with extensive AN-like plaques. Significant improvement with lightening and thinning of the plaques was observed after applying 1% topical rapamycin cream twice daily. Topical rapamycin should be considered as a treatment option for AN, particularly in FST IV/V adolescents with FGFR3-induced AN.
Asunto(s)
Acantosis Nigricans , Enanismo , Nevo , Neoplasias Cutáneas , Acantosis Nigricans/diagnóstico , Acantosis Nigricans/tratamiento farmacológico , Adolescente , Niño , Femenino , Humanos , Sirolimus/uso terapéuticoRESUMEN
BACKGROUND: Vitamins and their derivatives are used extensively in the field of dermatology to treat a range of conditions, both benign and malignant. Additionally, over the past decade, vitamin supplements have been heavily advertised for improving overall health. Due to the widespread use of vitamins and their derivatives for dermatologic conditions, a comprehensive review of the evidence is needed. OBJECTIVE: Here we review several of the well-established uses of vitamins A, B, C, and D in the management of dermatologic conditions ranging from acne vulgaris to malignant melanoma. Additionally, we examine the dermatologic consequences of both deficiency and excess of vitamins A, B, C, and D. Finally, we delve into newer applications for these vitamins and evaluate the evidence behind them. CONCLUSION: Vitamins, in both topical and oral forms, play a key role in treating many dermatologic conditions. Some of the newer applications of vitamins, such as the use of vitamin B3 for non-melanoma skin cancer prevention, vitamin B6 for prevention of chemotherapy-induced alopecia, and vitamin C as an adjuvant treatment for malignant melanoma, appear promising. Further data is needed to validate these findings. Additionally, many people use vitamin B7 for hair, skin, and nail health. There is evidence that supports vitamin B7 supplementation in patients with uncombable hair syndrome, brittle nail syndrome, and seborrheic dermatitis. Some studies Some studies have also demonstrated a benefit in healthy individuals, although other studies have shown a neutral effect. Further randomized controlled trials are needed. Likewise, the use of vitamin D for the treatment of atopic dermatitis has conflicting results and requires further investigation. New research continues to emerge regarding vitamin supplementation, and it is an important topic for dermatologists.
Asunto(s)
Dermatólogos , Vitaminas , Ácido Ascórbico , Suplementos Dietéticos , Humanos , Vitamina A/uso terapéutico , Vitamina D , Vitaminas/uso terapéuticoRESUMEN
Congenital Volkmann ischemic contracture (CVIC) is an exceedingly rare neonatal compartment syndrome caused by intrauterine ischemia and external compression. It presents at birth with necrotic cutaneous lesions and neurologic impairment, typically in a distal upper extremity. Diagnosis and treatment are often delayed in neonates, leading to long-term neurologic sequelae. We present a rare case of CVIC in order to raise awareness of its presentation and management in hopes of improving outcomes.
Asunto(s)
Síndromes Compartimentales , Contractura Isquémica , Enfermedades de la Piel , Humanos , Recién Nacido , Contractura Isquémica/diagnóstico , PielAsunto(s)
Biopsia , Procedimientos Quirúrgicos Dermatologicos/métodos , Cirugía de Mohs/métodos , Cuero Cabelludo/patología , Enfermedades de la Piel/diagnóstico , Enfermedades de la Piel/patología , Piel/patología , Xantomatosis/diagnóstico , Xantomatosis/patología , Anciano , Antígenos CD/análisis , Antígenos de Diferenciación Mielomonocítica/análisis , Biomarcadores/análisis , Diagnóstico Diferencial , Humanos , Antígeno Ki-67/análisis , Masculino , Cuero Cabelludo/cirugía , Enfermedades de la Piel/cirugía , Pigmentación de la Piel , Xantomatosis/cirugíaRESUMEN
Vibrio vulnificus is a motile, gram-negative, halophilic, aquatic bacterium that is part of the normal estuarine microbiome and typically is found in warm coastal waters. Infection with the pathogen typically is due to consumption of contaminated seafood or exposure to contaminated seawater. Vibrio vulnificus has a mortality rate of almost 33% in the United States and is responsible for more than 95% of seafood-related deaths in the United States. Vibrio vulnificus can cause a vast spectrum of diseases, such as gastroenteritis, cellulitis, necrotizing fasciitis, and sepsis. Gastroenteritis is self-limited, whereas septicemia often is fatal. Gastroenteritis and septicemia are caused by ingestion of contaminated shellfish, whereas wound infections and necrotizing fasciitis are caused by exposure to contaminated seawater or handling of contaminated seafood. Septicemia is the most common presentation of V vulnificus and accounts for the most fatalities from the bacteria. Prompt diagnosis and treatment are vital to prevent mortality. It is important to keep V vulnificus on the differential when a patient presents with bullae or cellulitis or has a history of raw seafood consumption or exposure to brackish water, as missing the diagnosis could lead to necrotizing fasciitis, sepsis, and death.
Asunto(s)
Fascitis Necrotizante , Sepsis , Vibriosis , Vibrio vulnificus , Celulitis (Flemón)/diagnóstico , Celulitis (Flemón)/terapia , Fascitis Necrotizante/diagnóstico , Fascitis Necrotizante/epidemiología , Fascitis Necrotizante/terapia , Humanos , Vibriosis/diagnóstico , Vibriosis/epidemiología , Vibriosis/terapiaRESUMEN
BACKGROUND: Human coronaviruses (HCoVs) are one of the most common causes of the "common cold". Some HCoV strains, however, can cause fatal respiratory disease. Some examples of these diseases are severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and Coronavirus Disease 19 (COVID-19). This article will review the etiology, clinical features, diagnosis, and management of HCoVs. METHODS: A systematic literature review was performed using the terms "human coronaviruses", "MERS-CoV", "SARSCoV", "SARS-CoV2", "COVID-19", and "common cold" in OVID MEDLINE, PubMed, and Cochrane Library. FINDINGS: Most HCoVs cause mild upper respiratory infections which resolve with supportive care and no sequelae. In recent decades, however, there have been outbreaks of novel HCoVs that cause more severe disease. This is largely due to HCoVs having large genomes which undergo frequent recombination events, leading to the emergence of novel and more virulent strains of the virus. These severe respiratory illnesses can lead to acute respiratory distress requiring invasive intervention, such as mechanical ventilation. These severe infections can lead to long-lasting sequelae in patients. Scientists continue to investigate potential treatments for these viruses, though supportive care remains the gold standard. Scientists have succeeded in developing numerous vaccines for the SARS-CoV-2 virus, and ongoing data collection and analysis will shed even more light on the next steps in fighting the COVID-19 pandemic. CONCLUSION: Due to the frequency of recombination events and the subsequent emergence of novel strains, HCoVs are becoming more prevalent, making them a global health concern as they can lead to epidemics and pandemics. Understanding the epidemiology, etiology, clinical features, diagnosis, and management of HCoVs is important, especially during this worldwide pandemic.
Asunto(s)
COVID-19 , Coronavirus , COVID-19/diagnóstico , COVID-19/epidemiología , Resfriado Común , Brotes de Enfermedades , Humanos , Pandemias , SARS-CoV-2RESUMEN
OBJECTIVES: Absolute risk and cost-benefit analyses are necessary to guide clinical decision making. The purpose of this study was to evaluate whether clinical recommendations in dermatology publications were supported by adequate evidence. We also assessed whether dermatology residents report sufficient evidence when they author publications. METHODS: We analyzed the clinical cohort, case-control, and case series studies published in JAMA Dermatology and the Journal of American Academy of Dermatology from January 2018 to December 2018 for statistical significance, absolute associations, diagnostic and therapeutic clinical recommendations, and risk-benefit analysis. We also identified articles with a U.S. dermatology resident as first or second author. RESULTS: We found that the majority of articles reported statistical significance, but only 3% included absolute risk analyses and none had risk-benefit analysis. Furthermore, 42% of studies with a dermatology resident as a primary author reported statistical significance, but none provided absolute risk or risk-benefit analyses. CONCLUSIONS: Reviewers need to be more aware of the evidentiary needs required for clinical recommendations, and dermatology residents may benefit from additional statistics training.
Asunto(s)
Dermatología , Estudios de Casos y Controles , Análisis Costo-Beneficio , Humanos , Estados UnidosRESUMEN
Mucormycosis is an invasive, rapidly progressive, life-threatening fungal infection, with a propensity for diabetic, immunosuppressed, and trauma patients. The classic rhinocerebral variation is most common in diabetic patients. While the cutaneous form is usually caused by direct inoculation in immunocompetent patients. Cutaneous mucormycosis manifests in soft tissue and risks involvement of underlying structures. Tibial osteomyelitis can also occur secondary to cutaneous mucormycosis but is rare. Limb salvage is typically successful after lower extremity cutaneous mucormycosis even when the bone is involved. Herein, we report two cases of lower extremity cutaneous mucormycosis in diabetic patients that presented as acute worsening of chronic pretibial ulcers. Despite aggressive antifungal therapy and surgical debridement, both ultimately required amputation. Such aggressive presentation has not been reported in the absence of major penetrating trauma, recent surgery, or burns.