The Sharpness of Blades Used in Dermatologic Surgery.

BACKGROUND: There are numerous blades available for use in dermatologic procedures. There are different advantages that are inhere.nt to different blades due to their shape and size. One aspect of the blade that is instrumental to its performance, but is not objectively defined, is sharpness. This information could be useful when choosing a blade for a particular procedure. OBJECTIVE: This study aims to objectively define the sharpness of blades used in dermatologic surgery. METHODS AND MATERIALS: The Sharpness Tester (Cutlery and Allied Trades Research Association, Sheffield, UK) was used to test the force in Newtons a blade requires to cut through a silicone cylinder. New blades were used to determine a standard for the sharpness of new blades. Blades used for surgery were tested to determine the sharpness after use. RESULTS: The sharpest blade is the double-edged razor blade (0.395 N) followed by the dermablade (0.46 N), plastic handled #15 (0.541 N), #15c (0.575 N), #10 (0.647 N), and the #15 blade (0.664 N). CONCLUSION: The sharpness of a blade is an important factor in its ability to perform a task and should be taken into account when choosing a particular blade for a particular procedure.

Postauricular skin: an excellent donor site for split-thickness skin grafts for the head, neck, and upper chest.

BACKGROUND: Postauricular skin is one of the potential donor sites for split-thickness skin grafts (STSGs). OBJECTIVE: To objectively quantify how postauricular donor sites heal after STSG harvesting. MATERIALS AND METHODS: A cohort of 39 Mohs micrographic surgery patients repaired with STSGs (total 41 surgical defects) was established. Scars resulting from postauricular donor site harvesting were objectively quantified by applying the Vancouver Scar Scale (VSS), in which healing of scars is ranked from 0 (best possible outcome) to 13 (worst possible outcome). RESULTS: Vancouver Scar Scale scores were 1.87 for sites followed for ≥6 months (n = 16), 3 for sites followed for 3 to 6 months (n = 7), and 1.61 for sites followed for 6 to 11 weeks (n = 18). Four patients developed mild hypertrophic scarring that resolved spontaneously or with intralesional triamcinolone injections at a concentration of 10 mg/mL. CONCLUSION: The postauricular skin is an excellent donor site for small-to-moderate sized STSGs (<10 cm). The donor sites healed well, as noted by the low scores on the VSS consistent with mild changes in erythema, pigmentation, and texture. The incidence of hypertrophic scarring was low and resolved with observation or treatment.

Patterns of vitamin D analog use for the treatment of psoriasis.

BACKGROUND: Psoriasis is a chronic disease that significantly impacts patients' quality of life. It most commonly manifests as localized disease, for which there are various treatment options. OBJECTIVE: To determine the prescription patterns of topical corticosteroids and vitamin D analogs for the treatment of psoriasis in the United States and how their use has changed over time. METHODS: Data from the National Ambulatory Medical Care Survey (NAMCS) from 1994 to 2010 were queried for visits linked with a psoriasis diagnosis. Prescriptions for topical corticosteroids and vitamin D analogs were described. Vitamin D analogs usage was compared across physician specialties. For each sampled visit reported in the NAMCS, visits meeting our inclusion criteria that also mentioned the following medications were identified: topical calcipotriene, topical calcipotriene/betamethasone or any topical corticosteroid indicated for the treatment of psoriasis. RESULTS: There were an estimated 2.05 million psoriasis visits per year over the 1994-2010 interval. Dermatologists were responsible for 67% of these encounters followed by family practice (14%) and internal medicine (11%). Dermatologists prescribed a vitamin D product at 15% of psoriasis visits, followed by family physicians at 12%, and internists at 5%. Dermatologists prescribed calcipotriene, calcipotriene/betamethasone, and topical corticosteroids in 15%, 4% and 59% of psoriasis visits, respectively. Over time, there was no significant change in the use of topical steroids or vitamin D products by physicians.This study is limited by the inability to determine the severity of psoriasis from the data collected, and the lack of data on the length of treatment with different medications. CONCLUSIONS: Despite their demonstrated efficacy and safer side effect profile, vitamin D analogs are used less often than topical corticosteroids for the treatment of psoriasis. These findings suggest that vitamin D products may not be utilized to their fullest potential as effective topical therapy or adjuncts to therapy for localized plaque psoriasis.

Effective treatment of Hailey-Hailey disease with a long-pulsed (5 ms) alexandrite laser.

Familial benign pemphigus (Hailey-Hailey disease) is often resistant to conventional treatments. This report describes a 35-year-old Asian American male with a 12-year history of recalcitrant Hailey-Hailey disease who was treated with a long-pulsed alexandrite laser. Fluences ranged from 12 to 20 J/cm with a 5-ms pulse duration (spot sizes: 10-15 mm). Cold air cooling was used during the sessions. There was 50% improvement noted after the first treatment. Within 10 treatments, there was 95% clearance. Complete resolution was achieved by the thirteenth treatment. The lesions have been clear or nearly clear (greater than 95%) for the past 2 years. Once clearance was achieved, five maintenance laser treatments were initiated at 3-month intervals and eventually discontinued for 12 months without relapse.

Dermatologic disease in family medicine.

BACKGROUND AND OBJECTIVES: Because dermatologic complaints are encountered frequently in primary care, the education of family physicians about skin disorders is important. Data are needed to help define areas of dermatology that deserve the most time and emphasis. This study determined what types of skin problems and medications family physicians most commonly diagnose and prescribe. METHODS: Study researchers analyzed the National Ambulatory Medical Care Survey data from 2002 to 2005 for dermatologic diagnoses and most common prescriptions by family physicians. The data from 2002-2005 were compared to data from 1990-1994. RESULTS: Skin conditions accounted for 8% of all visits to family physicians in 2002-2005. The five most common skin disorders diagnosed by family physicians were dermatitis, pyoderma, tinea, benign neoplasms, and candida. The top 20 diagnoses accounted for 70% of the visits. The three most commonly prescribed medication classes for skin problems from 2002-2005 were antihistamines, topical anti-infectives, and adrenal corticosteroids. Between 1990-1994 and 2002-2005, family physicians increased the number of less common dermatologic diagnoses they make by 10% and have concurrently increased the prescribing of medications they use to treat these disorders. CONCLUSIONS: Family physicians diagnose a wide range of skin disorders and prescribe drugs to treat them. Family physicians make more dermatologic diagnoses and prescribe more treatments than previously.