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1.
Int J Womens Dermatol ; 5(2): 137-139, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30997391
2.
J Am Acad Dermatol ; 81(6): 1227-1234, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30797839

RESUMO

Dermatologic diagnosis relies on vision primarily and auditory and verbal input secondarily. Accurate dermatologic diagnosis is predicated on seeing and perceiving a skin finding, categorizing and naming the finding correctly, and comparing the visual data and data obtained from the totality of the clinical encounter (ie, from other sensory modalities) with one's working mental database of dermatologic diagnoses. The baseline assumption-which is false-is that a dermatologist is an expert at each of the aforementioned steps and transitions sequentially between them seamlessly in an error-free fashion. Each of these steps has inherent challenges, and the transitions between steps can also be problematic. In part 1 of this 2-part report, we describe the pitfalls associated with visual recognition. In part 2, we discuss cognitive heuristics as they relate to the dermatologic diagnostic process and prevention of diagnostic error.


Assuntos
Cognição/fisiologia , Dermatologia/métodos , Erros de Diagnóstico/prevenção & controle , Dermatopatias/diagnóstico , Percepção Visual/fisiologia , Biópsia por Agulha , Dermatologistas/psicologia , Feminino , Heurística , Humanos , Imuno-Histoquímica , Masculino , Dermatopatias/patologia
3.
J Am Acad Dermatol ; 81(6): 1237-1245, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30797841

RESUMO

Diagnostic error in dermatology is a large practice gap that has received little attention. Diagnosis in dermatology relies heavily on a heuristic approach that is responsible for our perception of clinical findings. To improve our diagnostic accuracy, a better understanding of the strengths and limitations of heuristics (cognitive shortcuts) used in dermatology is essential. Numerous methods have been proposed to improve diagnostic accuracy, including brain training, reducing cognitive load, and getting feedback and second opinions. Becoming comfortable with the uncertainty intrinsic to medicine is essential. Ultimately, the practice of metacognition, or thinking about how we think, can offer corrective insights to improve accuracy in diagnosis.


Assuntos
Dermatologistas/psicologia , Erros de Diagnóstico/prevenção & controle , Dermatopatias/diagnóstico , Percepção Visual/fisiologia , Cognição/fisiologia , Dermatologia/métodos , Erros de Diagnóstico/psicologia , Feminino , Heurística , Humanos , Masculino , Sensibilidade e Especificidade
4.
Skinmed ; 16(4): 265-267, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30207531

RESUMO

Arsenic is a naturally occurring compound that is widely distributed in trace quantities in the environment. Levels toxic to humans have been found contaminating certain regions of the world and their groundwater, leading to deleterious effects. In fact, an estimated 150 million people are affected by arsenic contamination worldwide.1 Arsenic poisoning leads to several adverse health effects, including cancer of the lung, bladder, and kidney, neurologic disorders, cardiovascular disease, peripheral vascular disease, hypertension, pulmonary disease, and diabetes mellitus.2 Skin lesions are a common manifestation of arsenic poisoning. Early findings include diffuse or spotted melanosis, leukomelanosis, and depigmentation. Years of chronic arsenic poisoning can lead to acral keratoses and squamous cell carcinoma of the skin.3.


Assuntos
Intoxicação por Arsênico/epidemiologia , Poluição da Água/efeitos adversos , Poços de Água , Bangladesh , Humanos
5.
Skinmed ; 16(4): 281-284, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30207535

RESUMO

We present the case of a 66-year-old woman with a history of systemic lupus erythematosus, who presented with tender nodules on the forearms. The patient reported an 8-year history of pink bumps on the extensor surfaces of the forearms bilaterally that would arise episodically for a few weeks and subsequently resolve with no intervention. Her systemic lupus erythematosus was under good control with oral prednisone 10 mg daily, and the development of these lesions was not associated with concomitant flares of the systemic lupus erythematosus.


Assuntos
Dermatite/etiologia , Dermatite/patologia , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/patologia , Idoso , Feminino , Humanos , Recidiva
9.
Dermatol Online J ; 23(9)2017 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-29469722

RESUMO

Elastomas are connective tissue nevi or hamartomas. They may occur in isolation or can be associated with familial syndromes such as Buschke-Ollendorff syndrome. Elastomas typically present in childhood as small ivory papules or firm skin-colored nodules that can coalesce into larger yellow plaques. These lesions are typically distributed over the extremities, abdomen, and back. Herein, we report an unusual case of a renal transplant recipient who presented with an acquired subungual papule with associated koilonychia and distal nail plate dystrophy. Histopathologic findings were consistent with subungual elastoma.


Assuntos
Neoplasias do Ânus/complicações , Carcinoma de Células Escamosas/complicações , Doenças da Unha/complicações , Nevo/complicações , Humanos , Imunossupressão , Falência Renal Crônica/complicações , Falência Renal Crônica/cirurgia , Transplante de Rim , Masculino , Pessoa de Meia-Idade , Doenças da Unha/patologia , Unhas Malformadas/complicações , Nevo/patologia
10.
Skinmed ; 14(6): 437-439, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-28031130

RESUMO

Eucerit, now more commonly known as Eucerin, was a revolutionary emulsion developed more than 100 years ago that is still popular and in common use today. The initial formulation is still the basis for a relevant global product line that holds significant market share today. The concept for Eucerin was originally developed in Germany by Dr Isaac Lifschütz, who helped develop Eucerin, meaning "beautiful wax," in 1898. The ointment was very smooth, allowing Eucerin to develop as a stable emulsion. Eucerin was revolutionary and outperformed all of its predecessors in emulsion stability, moisturizing ability, its ability to resist degradation, and its cost-effectiveness.1.


Assuntos
Emolientes/química , Emolientes/história , Emolientes/uso terapêutico , Alemanha , História do Século XIX , Humanos , Lipídeos/química , Lipídeos/história , Lipídeos/uso terapêutico , Bases para Pomadas/química , Bases para Pomadas/história , Bases para Pomadas/uso terapêutico
11.
Skinmed ; 14(4): 287-289, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27784519

RESUMO

While arsenic has been used medicinally and as a poison for thousands of years, Fowler's solution, an arsenic compound, has had a fascinating history in medicine during the past 200 years. The use of Fowler's solution was first described and published as a treatment for malaria and syphilis in the late 1700s. Many clinical applications for Fowler's solutions have been studied and utilized over the years, but toxicities have limited its utility. Even so, arsenic trioxide, chemically related to Fowler's solution, was approved by the US Food and Drug Administration for treating acute promyelocytic leukemia. The history of Fowler's solution, its applications and uses, and benefits and risks are discussed.


Assuntos
Arsenicais/uso terapêutico , Arsenitos , Óxidos/uso terapêutico , Compostos de Potássio , Trióxido de Arsênio , Arsenicais/história , Arsenitos/história , Arsenitos/envenenamento , Arsenitos/uso terapêutico , História do Século XVIII , História do Século XIX , História do Século XX , História do Século XXI , Humanos , Leucemia Promielocítica Aguda/tratamento farmacológico , Malária/tratamento farmacológico , Malária/história , Óxidos/história , Óxidos/envenenamento , Compostos de Potássio/história , Compostos de Potássio/envenenamento , Compostos de Potássio/uso terapêutico , Sífilis/tratamento farmacológico , Sífilis/história , Estados Unidos
12.
Skinmed ; 14(4): 311-313, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27784526

RESUMO

Case 1 A 60-year-old African American man presented with a medical history of morbid obesity (weighing more than 550 lb), benign prostatic hyperplasia, hyperlipidemia, gynecomastia, atrial fibrillation, hypertension, chronic obstructive pulmonary disease, psoriasis, sleep apnea, and cardiomegaly. His size has limited his ability to clean himself properly. He experiences chronic and recurrent skin irritation and cellulitis possibly secondary to intertriginous superinfection, lymphedema, and venous stasis. On examination, his abdomen showed heavy skinfolding with hyperpigmentation, cobblestone and velvety changes, thickening and fibrotic induration of the skin, focal areas of redness, and tenderness on palpation (Figure 1A and 1B). These findings are consistent with a clinical picture of chronic elephantiasis nostras verrucosa (ENV) and lipodermatosclerosis (LDS). He has had numerous hospitalizations for recurrent cellulitis in the abdomen and lower limbs during the past 8 years. He is currently residing in a weight-loss facility and is managing skin care using topical nystatin powder and periodic topical triamcinolone ointment.


Assuntos
Parede Abdominal/patologia , Elefantíase/patologia , Dermatoses da Perna/patologia , Linfedema/complicações , Obesidade Mórbida/complicações , Dermatopatias/patologia , Celulite (Flegmão)/etiologia , Doença Crônica , Elefantíase/etiologia , Humanos , Dermatoses da Perna/etiologia , Masculino , Pessoa de Meia-Idade , Multimorbidade , Dermatopatias/etiologia
13.
Skinmed ; 14(3): 213-4, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27502261
16.
Skinmed ; 13(5): 389-91, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26790511
17.
Skinmed ; 12(2): 84-8, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24933845

RESUMO

Several studies have described a wide spectrum of hyperandrogenism diseases, many of which are difficult to distinguish from each other. In order to better understand diseases of hyperandrogenism, the authors performed a retrospective study of the cutaneous features and metabolic findings in women with hyperandrogenism. A retrospective chart analysis compiled by three dermatologists in both academic and private settings was performed, including patients presenting with > or = 2 manifestations of hyperandrogenism. Relevant dermatologic and associated manifestations and laboratory and imaging study findings were reviewed. Moderate to severe acne was the most common manifestation. Other common manifestations that patients first presented with include hirsutism, acanthosis nigricans, androgenic alopecia, and skin tags. Oligomenorrhea was the most common systemic presenting sign. Statistical analysis of various clinical markers revealed correlations with hyperandrogenemia. Acanthosis nigricans and hirsutism were found to be useful clinical markers for hyperandrogenism, whereas androgenic alopecia was not. This study provides some insights into the presentation and diverse manifestations seen in hyperandrogenism.


Assuntos
Hiperandrogenismo/complicações , Dermatopatias/etiologia , Acantose Nigricans/etiologia , Acne Vulgar/etiologia , Adulto , Feminino , Hirsutismo/etiologia , Humanos , Oligomenorreia/complicações , Sobrepeso/complicações , Síndrome do Ovário Policístico/complicações , Síndrome do Ovário Policístico/diagnóstico , Estudos Retrospectivos
19.
Skinmed ; 9(5): 279-80, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-22165041

RESUMO

Although studies have yet to prove definitively a causal relationship between diet and acne, the lay public has traditionally held that such causality exists. The authors' study aims to determine which nutritional elements are thought to be related to acne, both positively and negatively. YouTube, a popular video-sharing Web site, was used to survey the views of the lay public. The keywords "acne," "acne diet," and "acne food" were searched in YouTube in July and August of 2009, and 87 videos were included in the study. More than 85% of videos suggest at least a moderate correlation between diet and acne. Dairy products and oily and greasy foods were viewed as aggravating factors, while fruits, vegetables, and supplements were regarded as alleviating factors. Generally regarded "truths" can affect patient compliance with treatment regimens, and a knowledgeable physician is better able to address these issues with his or her patients.


Assuntos
Acne Vulgar/etiologia , Atitude Frente a Saúde , Dieta/efeitos adversos , Coleta de Dados , Humanos , Internet , Percepção , Opinião Pública , Gravação em Vídeo
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