A comparison of dysphagia rates between long-segment anterior versus posterior cervical fusion.

OBJECTIVE: The goal of this study was to compare rates of dysphagia and patient-reported outcomes (PROs) following long-segment (≥ 3 levels) anterior cervical spinal fusion (ACF) and posterior cervical spinal fusion (PCF) at 3 and 12 months postoperatively. PROs were also compared for patients with dysphagia versus those without dysphagia. METHODS: A prospectively collected quality improvement database was used to identify patients who had a long-segment cervical spinal fusion. Cohorts were divided into ACF and PCF groups. Eating Assessment Tool-10 scores and PROs were obtained for all patients preoperatively and at 3 and 12 months postoperatively to compare. Multivariate analysis was also performed to evaluate risk factors for dysphagia. RESULTS: A total of 132 patients met the inclusion criteria, 77 of whom had undergone ACF and 55 of whom had undergone PCF. Dysphagia rates between ACF and PCF cohorts were similar at baseline (13.0% vs 18.2%, p = 0.4). New-onset dysphagia rates were also comparable at 3-month follow-up (39.7% vs 23.1%, p = 0.08) and 12-month follow-up (32.6% vs 32.4%, p > 0.99). Patients who underwent PCF had worse Neck Disability Index (NDI) scores at 3 months than did patients with ACF (13.67 ± 9.49 vs 10.55 ± 6.24, respectively; p = 0.03). There were significantly higher NDI scores for patients with dysphagia at 3 months in both the ACF and PCF groups and at 12 months for those in the PCF group. Analogously, EuroQol-5 Dimensions scores were worse for patients with dysphagia; however, this was only significant for patients in the ACF group at 3 months. There were no significant risk factors for the development of dysphagia found on multivariate analysis. CONCLUSIONS: Similar rates and severity of dysphagia were seen following ACF and PCF at 3- and 12-month follow-up. This suggests that long-term dysphagia following cervical fusion surgery may be due to structural changes from the fusion rather than the surgical approach. However, the ACF cohort was significantly younger, and this may have partially accounted for the findings. PROs were also compared for patients with and without dysphagia, demonstrating worsened outcomes in some domains for patients who presented with dysphagia at 3- and 12-month follow-up. This suggests that dysphagia may be associated with a decreased quality of life after cervical fusion.

Nasal reconstructive techniques following Mohs surgery or excisions: a systematic review.

Numerous reconstructive techniques for nasal defects following skin cancer removal have been described; however, the literature lacks a comprehensive systematic review. Our objective was to systematically review nasal reconstruction methods after tumor removal, correlate the use of specific techniques to the nasal subunits involved, assess the quality of the available evidence, and set the stage for future research on this topic. Eight databases were searched for studies published in English from January 2004 to December 2018 containing repair data for nasal defects following Mohs or excision for four or more subjects. Recorded data included author specialties, study design, subject number, demographics, defect characteristics, procedure type, reconstructive methods, outcome measures, and complications. One-hundred and eleven studies were included. Study types included case series (73%), observational cohort studies (25%), and clinical trials (2%). Most authors were dermatologic surgeons (61%). Resection was most commonly performed via Mohs (82%). Flaps (42%), linear closures (28%) and grafts (25%) were most utilized for reconstruction. In Zones I and II, transposition flaps were the most common followed by advancement flaps. In Zone III, full thickness skin grafts were the most common repair. Most studies were case series or small cohort studies, representing low level evidence. Flaps are the most common method described in the literature for nasal reconstruction. The overall quality of the evidence available on this topic is low.

Granuloma annulare: strengthening potential associations and pentoxifylline as a therapeutic option.

Granuloma annulare is frequently described in association with numerous systemic conditions and is often refractory to treatment. This retrospective review explored a large patient cohort to further strengthen associated comorbid conditions and assess response to different treatments in patients with granuloma annulare. This study found that patients with granuloma annulare frequently carried a diagnosis of hypothyroidism. Additionally, the highest rate of improvement in any treatment category was seen with pentoxifylline use. Thus, should be further explored as a first-line therapeutic option in the treatment of granuloma annulare.

Dermatologic Sequelae Associated with Radiation Therapy.

Radiation therapy is a mainstay for the treatment of primary malignancies and metastatic disease and is associated with several dermatological adverse events that are underreported in the literature. The objective of this paper was to review the literature regarding cutaneous manifestations associated with radiation therapy in order to promote awareness of the cutaneous radiation therapy-associated adverse effects. This extensive literature review was performed using the Pubmed and Embase databases. Studies were reviewed for relevance and critical evidence pertaining to cutaneous manifestations of radiation therapy. The most commonly reported cutaneous sequelae associated with radiation therapy include radiation dermatitis, non-melanoma skin cancer, radiation-associated angiosarcoma, morphea, bullous pemphigoid, lymphangioma circumscriptum, and pseudosclerodermatous panniculitis. For many of these conditions, only case reports or case series exist and there is an absence of large-scale cohort studies. Despite these limitations, this review describes the wide range of dermatological adverse events associated with radiation therapy.

Statin-induced dermatomyositis for the practicing dermatologist: a review of the literature.

Statins cause a spectrum of muscle-related adverse events, including autoimmune myopathies such as dermatomyositis (DM). This review aims to describe the events of statin-induced DM and amyopathic dermatomyositis (ADM) to increase awareness for practicing dermatologists about harmful interactions with the most commonly prescribed lipid-lowering medication. PubMed was searched for relevant literature related to statin-induced DM and ADM. Numerous cases of statin-induced DM have been reported in individuals with no history of DM or other autoimmune conditions. Statins also cause ADM, although this is a rare association. Because of the widespread use of statins worldwide for atherosclerotic disease prevention, it may be of benefit to practicing dermatologists and all clinicians to assess for a history of DM when prescribing statins and inquire if patients with a DM-like presentation are taking or have taken a statin medication.

Transcutaneous electrical nerve stimulation (TENS): a review of applications in dermatology.

Background: A transcutaneous electrical nerve stimulation (TENS) unit is an inexpensive, accessible therapeutic device with multiple dermatology-related uses.Objective: This review aims to describe the dermatological applications of TENS.Methods: PubMed was searched for literature related to TENS in dermatology. Articles describing this association were reviewed for evidence.Results: TENS offered pain relief during photodynamic therapy for the treatment of actinic keratoses, with a reduction in visual analog scale (VAS) scores for patients using TENS during photodynamic therapy compared to those using no intervention. In the treatment of refractory postherpetic neuralgia pain, patients received greater pain relief when given pregabalin along with TENS therapy compared to pregabalin and no TENS therapy. TENS was the most effective therapy in reducing the incidence of PHN when compared to antiviral agents or combination therapy. The administration of TENS three times per week for four weeks improved VAS scores for pruritus associated with atopic dermatitis and lichen simplex chronicus. This benefit extended into the treatment of other conditions, resulting in improvement of pruritus measured by VAS and Dermatology Life Quality Index scores for macular amyloidosis and lichen planus.Conclusions: TENS is beneficial in the field of dermatology, particularly involving the relief of chronic pruritus.

The rise in subscription skin care services.

Subscription skin care services are a rising niche of direct-to-consumer telehealth models. The explosion of such services may be a reflection of the increasing demand by patients to have accessible, affordable dermatological care. These models come with both benefits and risks to patients. A thorough understanding of how subscription skin care services work may benefit dermatologists in addressing patients' questions regarding alternative care options.

Dermatologic manifestations associated with electronic cigarette use.

BACKGROUND: Electronic cigarette use continues to rise, yet there are no reviews summarizing dermatologic manifestations associated with electronic cigarettes in the literature. OBJECTIVE: To review the literature regarding cutaneous manifestations associated with electronic cigarette use and increase awareness of side effects associated with this rapidly developing public health epidemic. METHODS: The PubMed database was searched for related literature. All studies involving the effects of electronic cigarette use on the skin or mucosa were obtained and reviewed for evidence. RESULTS: Contact dermatitis, thermal injuries, and oral mucosal lesions have been reported with the use of electronic cigarettes. LIMITATIONS: The conclusions presented in individual case reports or series are not based on randomized controlled trials. CONCLUSION: Electronic cigarettes can present with harmful dermatologic manifestations.