Application of dermal regenerative template in reconstructing skin defects after plantar malignant melanoma excision.

PURPOSE: The excision of plantar malignant melanoma frequently leads to wide skin defects on the plantar surface. This study aimed to investigate the advantages and feasibility of dermal regenerative template reconstructing plantar blemishes caused by malignant melanoma. METHODS: 28 patients identified with plantar malignant melanoma were included in this retrospective article. Eighteen patients received immediate skin grafts after wide excision skin graft (SG) group), whereas the remaining 10 patients were treated with dermal regenerative template (DRT) (Lando ®, Shenzhen TsingCare Medical Co. Ltd) 14 days before skin grafts (DRT group) and the postoperative survival rate in the two groups was analyzed. During the 6-month follow-up, we compared the scar index, plantar pain, and recurrent skin graft ulcer incidence on the skin grafts area. RESULTS: Postoperative survival rate in the DRT group (91.75% ± 7.64%) was higher than in the SG group (80.51% ± 7.17%). The DRT group showed less scar formation on Vancouver scar scale (VSS index): 3.40 ± 1.07 than the SG group (VSS index: 6.33 ± 0.68). The dermal regenerative template alleviated plantar pain and decreased the incidence of ulcer on the skin grafts area. CONCLUSIONS: The dermal regenerative template not only improves the survival rate of skin grafts but also alleviates scar condition, plantar pain and recurrent skin graft ulcer. This study provides a new reconstructive strategy in plantar skin defects after the excision of malignant melanoma.

Exéresis de papiloma interdigital en atención primaria / Interdigital papilloma exeresis in Primary Care

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Electrosurgical debulking of pretibial myxedema of the foot.

Pretibial myxedema or thyroid dermopathy constitutes dermal deposition of mucin, primarily hyaluronic acid and chondroitin sulfate. It is a manifestation of autoimmune thyroiditis, seen more in Graves disease than in Hashimoto thyroiditis. The time delay from treatment of hyperthyroidism to appearance of localized myxedema varies from one month to 16 years (mean 5.13 years). Despite a variety of therapeutic options, failure and relapse rates are high. Therapeutic options reported in the literature include compression, topical and intralesional corticosteroids, oral pentoxifylline, octreotide, rituximab, plasmapheresis, and high-dose intravenous immunoglobulin. We share our experience in two patients who were treated with electrosurgical debulking of selected longstanding myxedematous lesions, with one positive result and one negative result.

Efficacy of combination therapy with efinaconazole 10% solution and 1064 nm Nd:YAG laser for treatment of toenail onychomycosis.

BACKGROUND: Onychomycosis is a common but difficult to treat nail disorder. Treatment strategies thus far have included oral and topical antifungals, surgical treatment and recently lasers have emerged as a therapeutic modality. OBJECTIVE: The objective of this study was to assess whether efinaconazole together with laser would result in greater clinical and mycologic cure and lower rate of relapse compared to efinaconazole alone. METHODS: Thirty subjects were randomized to either self-apply efinaconazole 10% once daily for 48 weeks, or follow the same treatment plan but also receive six treatments with a 1064 nm Nd: YAG laser every 4 weeks. The primary endpoint was to assess the proportion of subjects who achieved complete cure at week 52. RESULTS: The combination therapy group showed significantly quicker mycological cure at the 48- and 52-week follow-up. CONCLUSION: Both efinaconazole and combination with laser were efficacious treatment, but the combination therapy leads to quicker resolution with fewer rate of relapse.

Pedal Fungal Mass in the Midwest.

Mycetoma cases are predominantly found in tropical regions and are a rare finding in the United States. These masses that are fungal or bacterial in origin can result in significant destruction of soft tissue and bone. We present a case of a patient who emigrated from Mexico to Indianapolis. He presented with a soft-tissue mass that was excised and ultimately found to be a eumycetoma of the hallux of his left foot. Successful treatment included surgical resection in combination with postoperative terbinafine, which was pulse dosed to decrease its impact on hepatic function.

[Contribution of histopathology in the diagnosis of mycetoma in a Cameroonian trader and possibility of an urban contamination]. / Mycétome : apport de l'histopathologie au diagnostic chez un commerçant camerounais, et possibilité d'une contamination urbaine.

BACKGROUND: Mycetoma are rare cutaneous affections caused by pathogens such as fungi or bacteria. They settle preferentially on limb extremities. We are going to talk about an original case of mycetoma in a young Cameroonian trader. OBSERVATION: A cutaneous mass with multiple draining sinuses was received at the anatomy and cytopathology laboratory. That mass was from a 30-year-old male trader, with no particular medical history and living in Yaounde, who was received for a lesion at the sole of the foot, which appeared some months before. This lesion started like a tough and painless nodule, which later showed draining sinuses to the skin. The surgical resection of the tissue mass was performed. The histopathological analysis with special staining procedures, which was later on performed, revealed mycetoma caused by fungi. DISCUSSION: This observation describes an original case of fungal mycetoma, which occured in a Cameroonian trader living in an urban milieu away from any mycetoma endemic zone. This case confirms the undeniable or undisputable contribution of histopathology in diagnosis of certainty. To our knowledge and according to available data, it is a premiere to find a case of mycetoma described in an urban milieu in Cameroon.

Use of a punch tool for paring plantar warts in an "awl-like" manner.

Paring is useful for both diagnosis and treatment of plantar warts. Paring techniques generally involve scalpel blades, abrasive tools, or curettes. However, these tools do not permit the use of an "awl-like" carving technique of the wart afforded by using a punch biopsy tool. We have found this technique to be associated with greater precision and safety, as well as potentially increased efficacy compared to traditional methods.

Pulsed Dye Laser Therapy in the Treatment of Warts: A Review of the Literature.

BACKGROUND: Warts or verrucae vulgaris are common cutaneous infections with currently no definitive curative treatments available. OBJECTIVE: To determine the efficacy of pulsed dye laser (PDL) in the treatment of warts. MATERIALS AND METHODS: A literature search was performed using the PubMed and MEDLINE databases. A search using {(Wart[s], verruca or condylomata)} AND [(Pulsed dye laser)] was used. Forty-four articles were identified as relevant to this review. RESULTS: Simple warts were very responsive to PDL, being treated successfully in over 95% of patients. Facial and anogenital warts also demonstrated excellent outcomes. Recalcitrant warts, displayed significant variability in their response, ranging between 50% and 100% across all articles. The response rates seen in peripheral warts (involving the hands and feet) were also very variable, ranging between 48% and 95%. Recurrence rates at 4 months of follow-up were documented as 0% to 15%. Complications have been described as very few and rare, the main ones being topical discomfort and erythema. CONCLUSION: Pulsed dye laser is a safe and effective modality in the treatment of warts that can be applied to most body parts. Cost and availability remain a limitation to the use of PDL; however, this modality can be used when other more traditional and accessible treatments have failed.

A pedunculated lesion on the foot: acquired fibrokeratoma.

Acquired fibrokeratomas are benign and uncommon lesions consisting of collagenous papules and nodules covered by hyperkeratotic epidermis. These tumors occur mainly on the fingers and toes and infrequently on the palms and soles. They may possibly be triggered by a reaction to a trauma and presents as small and solitary dome-shaped lesions with a collarete of slightly raised skin at the base. Several case reports have been published of this rare lesion, with only a few investigators describing lesions of the feet.

Novel Treatment Approach for Deep Palmoplantar Warts Using Long-Pulsed 1064-nm Nd:YAG Laser and a Moisturizing Cream Without Prior Paring of the Wart Surface.

OBJECTIVE: The present study aimed to assess the safety and efficacy of palmoplantar wart removal using long-pulsed 1064-nm Nd:YAG laser after application of a moisturizing cream. BACKGROUND: Previously described laser treatments for wart removal are associated with negative side effects and need to pare the warts before laser treatment. PATIENTS/METHODS: Two hundred forty patients (142 males, 98 females) were treated for 1-40 palmoplantar warts by long-pulsed 1064-nm Nd:YAG laser (spot size 4-6 mm, pulse duration 20 msec, fluence 200 J/cm2) after covering the wart surface with a thin film of a moisturizing cream. The endpoint was lesion graying or whitening with or without development of a hemorrhagic bulla beneath the treated wart. Color photographs were taken before and immediately after each laser session and at 1, 4, and 16 weeks after the last session. RESULTS: The overall clearance rate was 97%, with 90% of treated patients cured after one session, 4% after two, and 3% after three. Clearance rate after three laser sessions decreased linearly with the number of warts from 100% to 95%. Less accessible wart location in interdigital spaces also decreased the cure rate after three sessions from 100% to 95%. Additionally, warts became more difficult to eradicate as they aged. Remission lasted up to 6 years, and complications were mild and infrequent (17.5%). CONCLUSIONS: This novel method is effective in removing palmoplantar warts. It is easier, time-saving, and safer than other methods described in previous studies conducted with ablative or nonablative lasers.

Dermatologic Manifestations of the Lower Extremity: Nail Surgery.

Nail surgery is a fundamental component of podiatric surgery. Nail disorders are common and may cause significant morbidity and occasionally mortality. Diagnosis of inflammatory and infectious conditions, and of benign or malignant tumors, often requires a biopsy of the nail unit. Excisional surgery may also be curative for certain tumors. This article reviews key elements of nail anatomy, surgical preparation, local anesthesia, and methods to achieve and maintain a bloodless field. A familiarity with these concepts should allow clinicians to develop a surgical plan and approach when patients present with a nail disorder requiring biopsy or surgical treatment.