How Acne Bumps Cause the Blues: The Influence of Acne Vulgaris on Self-Esteem.

Acne vulgaris is one of the most common dermatologic complaints. Although dermatologists are skilled at treating acne, invisible psychological scars can be left by the disease. We review 13 articles that examined the effect of acne vulgaris on patients' self-esteem. Overall, these studies demonstrated that acne has a negative effect on self-esteem among patients of all age groups. These effects most strongly affect women and those with severe acne (both subjectively and objectively). Despite the impact on self-esteem, only a minority of patients seek medical treatment, and even fewer seek treatment from a dermatologist. As dermatologists, we are trained in managing acne. We can provide early and effective treatment that improves both the physical and psychological effects. It is up to us to bridge the gap between those suffering from acne and their access to medical treatment.

Expert opinion: efficacy of superficial chemical peels in active acne management--what can we learn from the literature today? Evidence-based recommendations.

BACKGROUND: Superficial chemical peels offer therapeutic results in a convenient, affordable treatment. Many clinicians use these peels in the treatment of acne and acne-prone oily skin. OBJECTIVES: This article examines the evidence base that supports the widespread use of superficial peels in this setting. METHODS: A search of the English language medical literature was performed to identify clinical trials that formally evaluated the use of chemical peeling in active acne. RESULTS: Search of the literature revealed very few clinical trials of peels in acne (N=13); a majority of these trials included small numbers of patients, were not controlled and were open label. The evidence that is available does support the use of chemical peels in acne as all trials had generally favourable results despite differences in assessments, treatment regimens and patient populations. Notably, no studies of chemical peels have used an acne medication as a comparator. As not every publication specified whether or not concomitant acne medications were allowed, it is hard to evaluate clearly how many of the studies evaluated the effect of peeling alone. This may be appropriate, however, given that few clinicians would use superficial chemical peels as the sole treatment for acne except in rare instances where a patient could not tolerate other treatment modalities. CONCLUSIONS: In the future, further study is needed to determine the best use of chemical peels in this indication.

[Current role of light-based treatments and procedures in acne]. / Place des traitements à base de lumière dans l'acné.

A range of light-based treatments in acne have been used including visible light, specific narrowband light, intense pulsed light, pulsed dye laser with or without photosensitizing agents. The clinical studies in this topic have often lacked controls and included only small numbers of patients The purpose of this presentation was to assess the level of evidence in the literature on this subject, remember the scientific rational and targets of light-based therapy and remember procedures for approving the devices in the US.

Ocular effects of oral retinoids.

Knowledge of the ocular side effects of oral retinoids is important when treating patients with these drugs. The side effects include blepharoconjunctivitis, dry eye syndrome, cutaneous photosensitivity, contact lens intolerance, refractive changes, papilledema and pseudotumor cerebri, corneal opacities, and abnormal retinal function. The signs, symptoms, and management of these ophthalmologic effects are discussed.

The diagnosis of diffuse axonal injury in routine autopsy practice.

A 40-year-old pedestrian was involved in a road traffic accident. He lost consciousness immediately and remained comatose for 6 months until he died of a bronchopneumonia. Examination of the fixed brain revealed the late results of diffuse axonal injury. Not all the features were readily visible macroscopically, but required a limited number of histological sections from readily predictable sites for demonstration. Special stains played only a confirmatory role. This case illustrates some of the problems in diagnosing one of the commoner patterns of brain damage in head injury, and shows how the problem may best be approached in practice.

A retrospective look at dysplastic nevi. What were they in 1978 and how have they fared since?

We re-examined histologic sections of 305 melanocytic lesions consecutively received for diagnosis in 1978. Of 237 lesions previously diagnosed as banal melanocytic nevi, 28% were reinterpreted to be dysplastic nevi. Clinical follow-up 5 years later of 28 incompletely removed dysplastic nevi revealed neither persistence of pigment nor development of malignant melanoma at their sites of biopsy. We conclude, therefore, that dysplastic melanocytic nevi were common melanocytic neoplasms in 1978. Furthermore, based on our findings, they may be managed safely by observation with periodic clinical follow-up. Of 61 malignant melanomas studied during the same period in 1978, none occurred in association with a dysplastic nevus. The concept that malignant melanomas commonly arise in dysplastic melanocytic nevi therefore should be re-examined.