Seeking shade equity: Tree canopy coverage in public schools in Austin, TX.

BACKGROUND/OBJECTIVES: Tree canopies have dermatologic and environmental benefits, especially on school campuses. However, inequities likely exist, and tree planting initiatives may further exacerbate disparities. We sought to identify any relationship between tree canopy shade on public school campuses in Austin, TX and the socioeconomic makeup of the student population, as well as whether current initiatives appropriately address any inequities. METHODS: In this cross-sectional study, we used ArcGIS, a publicly available geographic information system (GIS), to calculate the percentage of tree canopy on campuses within the Austin Independent School District (AISD) for the years 2006 and 2022. We compared this with the percentage of students eligible for free and reduced meals (FRM) at each school. The percentages of FRM-eligible students were also compared for "low priority" versus "high priority" neighborhoods, as assigned by Austin's Tree Priority Map. RESULTS: Among 112 schools analyzed, schools with minority FRM-eligible students had significantly more tree canopy compared to schools with majority FRM-eligible students (19.9% vs. 12.4%, p < .001). When comparing tree priorities, there was a significant difference between the percentage of FRM-eligible students in "low priority" schools compared to "high priority" schools (23.8% vs. 62.2%, p < .001). CONCLUSIONS: Additional work is needed to rectify inequities in tree canopy access for public school students. Designations such as those used in Austin's Tree Priority Map would likely help direct such efforts. We hope this study encourages future research with GIS by both dermatologists and other health care professionals to promote interdisciplinary work with urban planners.

Blood Glucose Testing Lancet and Paper Clip as a Milia Extractor.

In low-resource settings, dermatologists may not have the preferred tools needed to evaluate a patient or perform a procedure. Commonplace affordable supplies can be substituted when needed. We describe the use of a blood glucose testing lancet and a paper clip for milia extraction.

Safety of Intradermal/Subcutaneous Lidocaine With Epinephrine Use in Dermatologic Surgery.

BACKGROUND: Recently, the safety of lidocaine plus epinephrine use in outpatient surgery has come under scrutiny despite its long history of use in outpatient dermatologic procedures and surgeries. OBJECTIVE: To assess the frequency of crash cart and other emergency interventions during Mohs micrographic surgery when lidocaine plus epinephrine is used as a local anesthetic and evaluate patient comorbidities associated with these events. MATERIALS AND METHODS: A retrospective chart review was conducted in an outpatient Mohs micrographic surgery clinic. RESULTS: One thousand one hundred twenty-seven Mohs cases were reviewed from the period of March 2015 to June 2016 with 864 meeting the inclusion criteria of patient weight, medical history, and amount of lidocaine administered recorded. No adverse events requiring emergency intervention with a crash cart or transfer to the emergency department occurred despite a patient population with advanced age and a wide range of comorbidities. CONCLUSION: No serious adverse events requiring emergency intervention were associated with lidocaine with epinephrine doses administered below the Food and Drug Administration recommended maximum. The authors did not find evidence from this study or after a literature search to support the requirement for a crash cart and other emergency equipment to be present during procedures.

Objective measurement of erythema in psoriasis using digital color photography with color calibration.

Traditional metrics for evaluating the severity of psoriasis are highly subjective, which complicates efforts to identify effective treatments in clinical trials. We propose a method for the objective measurement of the psoriasis severity parameter of erythema (redness). This procedure is standardized for different camera systems and lighting environments through the usage of a color card with predetermined color values in order to calibrate the images. Quantitative measures based on the digital color images are shown to correlate well with subjective assessment of psoriasis severity collected using a standard numerical scale by a panel of dermatologists. Additionally, the color calibration process is shown to improve results.

A pilot study to investigate the efficacy of tobramycin-dexamethasone ointment in promoting wound healing.

INTRODUCTION: The standard postsurgical treatment of wounds after dermatologic procedures is currently limited. Topical corticosteroids have been used successfully in postoperative management of ophthalmologic surgeries that involve the skin of the eyelid. In particular, tobramycin 0.3%/dexamethasone 0.1% ophthalmic ointment is considered the "gold standard" of steroid-antibiotic fixed combinations and is marketed worldwide as an agent used to control postsurgical inflammation and prevent postsurgical infection. The purpose of this study is to evaluate both the efficacy and safety of tobramycin-dexamethasone ointment for the postsurgical management of Mohs or dermatologic surgery in comparison to white petrolatum. METHODS: The authors employed a half-scar study in which patients who underwent skin cancer removal surgery were given tobramycin-dexamethasone ointment and white petrolatum to apply to each half of their wound for 2 weeks. The study was double blinded, and physicians and the patients independently evaluated the scars for cosmetic appearance at 2 and 6 weeks postoperatively. The evaluation criteria included judging which side of the wound looked better based on color, thickness, and discomfort. RESULTS: Eighteen patients were enrolled, of which 13 patients completed the three phases of the study. After 6 weeks the wounds did not show a statistically significant difference in color, thickness, or discomfort on either side. CONCLUSION: Results obtained to date suggest that the application of tobramycin-dexamethasone ointment to wounds after dermatologic surgery does not promote better wound healing than white petrolatum. These findings indicate that a topical steroid and antibiotic ointment may not be an effective intervention in improving postoperative outcomes in dermatologic surgeries.

Acute methotrexate toxicity seen as plaque psoriasis ulceration and necrosis: A diagnostic clue.

In addition to the well-known signs of methotrexate toxicity, rare cutaneous side effects have been described. These cutaneous signs may provide a diagnostic clue into the diagnosis of toxicity as well as facilitate early and aggressive therapy. We describe the case of a 37-year-old male, with a diagnosis of psoriasis, who developed characteristic signs and symptoms of acute methotrexate toxicity after receiving an unknown amount of intravenous methotrexate. The patient experienced a distinct change in the morphology of his existing psoriatic plaques, which became ulcerated and necrotic in the week following the methotrexate injection. Shortly after the development of cutaneous erosions, the patient developed pancytopenia, which ultimately led to his death. Ulceration and necrosis of cutaneous psoriasis plaques may serve as a herald for the impending development of life-threatening pancytopenia in patients with acute methotrexate toxicity.

Ipsilateral areolar hyperpigmentation following unilateral application of estradiol spray.

A 48 year old postmenopausal female noted hyperpigmentation of the left areola 3 months after beginning estradiol spray to her left forearm. She then applied the spray to the right forearm instead until the areolae were the same color again and then applied 1 spray to each forearm thereafter.

A review of the practices and results of the UTMB to South Pole teledermatology program over the past six years.

There is no place on earth more remote and inaccessible than Antarctica. In 2002, Raytheon Polar Services Co. (RPS) awarded The University of Texas Medical Branch (UTMB) at Galveston the contract to provide specialty medical services via telemedicine to the approximately 3,500 National Science Foundation (NSF) researchers and support personnel who rotate through Antarctica in a given year. We present the practices and results of the UTMB to the South Pole teledermatology program over the past six years, from 2003 to 2008. Issues encountered include logistics of sending out biopsies for pathologic diagnosis, limited bandwidth, and satellite availability for data transmission. The UTMB to the South Pole teledermatology program demonstrates the clinical practicality of telemedicine in providing dermatologic care to remote populations in extreme climate conditions.

Dermal scatter reduction in human skin: a method using controlled application of glycerol.

BACKGROUND AND OBJECTIVE: Previous studies in a hairless Guinea pig model showed that transdermal application of glycerol effected a temporary reduction in dermal scatter of light. This study focuses on the application of this protocol on human patients. STUDY DESIGN/MATERIALS AND METHODS: After stratum corneal removal, glycerol was applied to human subjects using a low pressure transdermal application device. Optical coherence tomography imaging showed increased intensity of radiation reaching deeper regions in the skin and photographs showed enhanced visualization of dermal structures. RESULTS/CONCLUSION: Topically applied glycerol increased light penetration of in vivo corneal-stripped skin. This minimally invasive approach to temporary dermal scatter reduction has the potential to improve the efficacy of light-based diagnostic or therapeutic devices.