Trigeminocardiac Reflex: A Review and Key Implications to Dermatologic Surgery.

BACKGROUND: The trigeminocardiac reflex is a common but underreported occurrence that can vary from benign to life threatening. This reflex can be elicited by placing direct pressure on the globe of the eye or from traction of the extraocular muscles, stimulating the trigeminal nerve. OBJECTIVE: To provide a review of potential stimuli for the trigeminocardiac reflex within dermatologic surgery and to discuss management options for the treatment of the trigeminocardiac reflex. METHODS: PubMed and Cochrane were used to identify articles and case reports that established scenarios in which the trigeminocardiac reflex was provoked and subsequently how the reflex was managed. RESULTS: Within the field of dermatologic surgery, the trigeminocardiac reflex can be stimulated during biopsies, cryoablations, injections, laser treatments, Mohs micrographic surgery, and oculoplastic interventions, most often occurring in an office setting. The most common presentations include significant bradycardia, hypotension, gastric hypermobility, and lightheadedness. The most definitive treatment is cessation of the inciting stimulus, monitoring, and symptomatic management. Glycopyrrolate and atropine are common treatments for severe, intractable cases of the trigeminocardiac reflex. CONCLUSION: The trigeminocardiac reflex, while underreported and underrepresented in dermatologic literature and dermatologic surgery settings, should be considered in the setting of bradycardia and hypotension during dermatologic procedures.

A primer to natural hair care practices in black patients.

Natural hairstyles have increased in popularity in the United States among individuals of African and Afro-Caribbean descent. Dermatologists should be aware of general principles of natural hair care in this patient population, including basic hair care terminology, types of natural hairstyles, methods of washing, and product selection. A basic knowledge of natural hair care practices in black patients will assist dermatologists in the management and treatment of many conditions associated with traumatic hairstyling in this patient population.

The science behind common over-the-counter remedies used in dermatology.

There are many over-the-counter products used to treat dermatological conditions. Patients are inundated with information about these products. Dermatologists often encounter questions about the usefulness of over-the-counter products as anecdotal data about such products is often adapted as common practice in the medical field. Modern dermatology training does not include pharmacological education on many of the over-the-counter products commonly used by patients. In this current age when patients have increasing interest in using "natural" remedies, it is important that dermatologists can provide guidance to patients regarding some of the most common products that they may encounter. This article is designed to provide introductory information on the common uses for several over-the-counter products as well as to display any evidence in support of these products for dermatological diseases.

The efficacy of second-intention healing in the management of defects on the dorsal surface of the hands and fingers after Mohs micrographic surgery.

BACKGROUND: The type of repair chosen to manage defects on the dorsal aspects of the hands and fingers can affect overall hand function. Preservation of manual function in these areas is critical. OBJECTIVE: To evaluate the efficacy of second-intention healing of defects on the dorsal surface of the hands and fingers after Mohs micrographic surgery and to define optimal wound parameters for choosing second-intention healing. METHODS: Fifty-nine patients who had undergone second-intention healing of a Mohs defect on the dorsum of a hand or finger were contacted and their records obtained; 48 patients completed the study. Healing by second intention was assessed according to self-evaluation and retrospective review of medical records based on six outcome variables, including functional ability, durability, sensation, and cosmetic result. RESULTS: Defects ranged in size from 0.8 to 6.0 cm. Patient records revealed no documented problems with function, durability, sensation, cosmesis, or wound infection. All patients reported excellent or good functional results and normal sensation within the scar, and most reported excellent or good scar durability and cosmesis. CONCLUSION: Second-intention healing is an effective option for repairing defects on the dorsum of the hand and fingers. Large defect size is not a contraindication for second-intention healing.