Reliable methods to evaluate the burden of actinic keratoses.

Dermatologists treat actinic keratoses to prevent non-melanoma skin cancer. Evaluation of actinic keratosis therapy depends on reliable measures of the lesions. The commonly used method of directly counting all visible lesions has been shown to be unreliable. We performed a prospective, single-blinded study to explore the reliability of body surface area involvement and direct counting of lesions measuring greater than 0.5 cm. Consecutively available subjects with >2% body surface area involvement of both upper extremities were recruited from the Albuquerque, NM Veterans Administration Dermatology Clinic upon their arrival. Blinded investigators evaluated 37 subjects during two visits, baseline and 2 weeks later, using both methods. Data were analyzed using the 26 pairs where evaluating physician was the same at both time points. Both methods correlated well when comparing the two time points. Our results did not change when we added the pairs where the evaluating physician differed in the two time points. Our study demonstrates that both methods are viable ways to evaluate actinic keratoses, even when the investigators differ at different time points, a practical matter in clinical trials. Our study provides a promising option to evaluate emerging new actinic keratoses therapies. However, given that the method was only tested on upper extremities of a veteran population, further testing must be performed in different anatomical locations and in non-veteran populations.

Self-reported flight hours vs. company records for epidemiologic studies of flight attendants.

INTRODUCTION: Although there is increased interest in health effects studies of aircrew members, the differences between self-reported work history and company records, including effects on exposure assessment, are poorly characterized. METHODS: We collected both self-reported work history and company records as part of a National Institute for Occupational Safety and Health biomonitoring study of reproductive hormones in 45 female flight attendants. These two sources of work history information were compared to identify differences which might impact the assessment of work exposures. RESULTS: There appeared to be consistent overreporting of self-reported block time and number of flight segments compared with company record-based estimates. Overreporting in turn inflated the assessment of two important exposures: cosmic ionizing radiation estimated dose and time zones crossed. Factors including domicile, block hours per year of work, and length of employment affected the amount and direction of overreporting. Comparison to compensated credit hours, including nonflight hours, did not fully account for the overreporting. DISCUSSION: Self-report of block time may or may not include compensated nonflight hours, resulting in differences when compared to company records. Exposure bias is likely to result if the complexities of self-report are not considered when writing questionnaires. Aircrew members should be asked for additional occupational information, and a comparison of self-report block time to a sample of company records should be considered prior to exposure assessment and epidemiologic analysis.

Skin rejuvenation in facial surgery.

The treatment of the aging face has evolved to increasingly incorporate minimally office-based procedures. The importance of recognizing and treating facial rhytids has always been recognized as important, but an increasing number of modalities have been developed for this purpose. Similarly, there has been an increase of emphasis in the recognition of dyschromias, solar keratoses, and other skin abnormalities. In this article, an overview of many of the minimally invasive office-based procedures that we favor in our practice will be briefly reviewed.