A Prospective, Randomized Controlled, Single-Blinded Study to Assess the Effect of a 33-Gauge Needle Versus a 34-Gauge Needle on Pain Experienced During Injection of Local Anesthetic on the Face.

BACKGROUND: Most pain experienced by patients during Mohs micrographic surgery is associated with the initial injection. Previous studies have shown that a smaller gauge needle (33-gauge vs 30-gauge) is associated with less patient-reported pain. OBJECTIVES: To evaluate patient-reported pain levels following injection with a 33-gauge versus a 34-gauge needle.  Methods: During this prospective, randomized, controlled, single-blinded study, 480 patients were randomized into a 33-gauge versus a 34-gauge needle group. Pain levels following needle insertion were recorded using the validated numerical rating scale (VNRS)-11 scale.  Results: Injection of local anesthetic with a 34-gauge needle is associated with significantly less pain compared to a 33-gauge needle across all subgroups (P=0.007, average pain level 0.49 [34-gauge group] vs 0.79 [33-gauge group] rated on a 0-10 pain scale). Females, first-time Mohs patients, patients under age 65, patients with basal cell carcinoma, and those with tumor locations on the nose experienced the most pain reduction with the use of a 34-gauge needle.  Limitations: This was a single-blinded study; thus, the injector was able to see which needle was being used. This knowledge could have subconsciously affected the angle, speed, or force used to insert the needle. CONCLUSIONS: Injections with a 33-gauge and a 34-gauge needle are both tolerated well and associated with minimal pain. While the pain reduction associated with using a 34-gauge needle is statistically significant, the use of a 34-gauge needle may be most clinically relevant for certain patient subgroups. J Drugs Dermatol. 2023;22(11): doi:10.36849/JDD.7689.

Infantile scrotal hemangioma with transverse testicular ectopia.

Transverse testicular ectopia is a rare structural anomaly of abnormal testicular descent. We report a case of a 3-month-old boy with hemiscrotal infantile hemangioma and contralateral transverse testicular ectopia.

Comparison of racial distribution of photodermatoses in USA academic dermatology clinics: A multicenter retrospective analysis of 1080 patients over a 10-year period.

BACKGROUND: Previous studies at single academic institutions have identified variations in the prevalence of photodermatoses among racial groups. The purpose of the study was to compare the distribution of photodermatoses between Whites and Blacks at four academic medical centers in the USA. METHODS: A retrospective chart review was performed at four institutions' general dermatology clinics using diagnoses consistent with the International Classification of Disease (ICD), Ninth and Tenth Revisions, codes related to photodermatoses between August 2006 and August 2016. A total of 9736 charts were manually reviewed and classified. Analyses were performed analyzing the frequency of photodermatoses between Whites and Blacks in the pooled data. RESULTS: There were 1,080 patients with photodermatoses identified. Statistically significant differences in the frequency of photodermatoses between Whites and Blacks were identified for polymorphous light eruption (more common in Blacks), photoallergic contact dermatitis, phototoxic drug eruption, phytophotodermatitis, porphyria, and solar urticaria (more common in Whites). The most commonly diagnosed photodermatoses were polymorphous light eruption (total 672), and photodermatitis not otherwise specified (total 189). CONCLUSION: Our study demonstrated significantly higher proportions of polymorphous light eruption in Blacks, and higher proportions of photoallergic contact dermatitis, phototoxic drug eruptions, phytophotodermatitis, porphyrias, and solar urticaria in Whites.

Impact of COVID-19 on dermatologic surgery: experience of a Midwestern academic practice.

The novel coronavirus disease 2019 (COVID-19) pandemic has disrupted clinical practice everywhere. The aim of this study was to quantify the specific impact of COVID-19 on skin cancer treatment at an academic dermatologic surgery practice. We conducted a retrospective chart review to compare metrics such as patient visits, histological upgrading, and Mohs stages per tumor between 60-day periods immediately before and after COVID-19 was declared a pandemic. Out of 1138 total encounters, decreases of 58% in total in-person visits and 38% in Mohs surgeries performed were observed following declaration of the pandemic. More squamous cell carcinoma and squamous cell carcinoma in situ (SCC/SCCIS) and less basal cell carcinoma (BCC) tumors were treated post-declaration compared to pre-declaration. There was a significantly higher histological upgrade rate for total tumors, as well as for the BCC subgroup, but not the SCC/SCCIS subgroup. While the overall number of dermatologic surgeries decreased after declaration of the pandemic, the higher histological upgrade rate reflects an appropriate triage of higher risk skin cancers. These findings may be useful both to assess the effectiveness of protocols for COVID-19 and to prepare for future resource-limited scenarios.

Oral Low-Dose Naltrexone in the Treatment of Frontal Fibrosing Alopecia and Lichen Planopilaris: An Uncontrolled Open-Label Prospective Study.

Background Frontal fibrosing alopecia (FFA) and lichen planopilaris (LPP) is scarring alopecias with limited evidence supporting their treatment options. We investigated the use of low-dose naltrexone (3 mg oral daily) as adjunctive therapy in the treatment of FFA and LPP. Methods A single-center, uncontrolled open-label prospective study was performed, with 26 patients who took low-dose naltrexone for one year included in the per-protocol analysis. Both patient-reported (pruritus and burning/pain) and physician-assessed (erythema, scale, and scalp involvement) outcomes were analyzed. Results There were decreases in erythema and scale for the overall longitudinal outcomes using linear mixed effects model analysis. However, only erythema had a significant decrease at 12 months compared with baseline. Mean erythema decreased by 0.93 at 12 months compared with baseline on a 0-3-point scale (p<0.0001, 95% mean CI [-1.32, -0.53]). There was no statistically significant difference comparing 12 months to baseline for the other outcomes including pruritus, burning/pain, and scalp involvement. Limitations include the possibility of spontaneous stabilization, concurrent medications, a small sample size with limited racial diversity, and mild subjective symptoms at baseline. Conclusion Our study supports further investigation of oral low-dose naltrexone as adjunctive therapy in the treatment of FFA and LPP if there is prominent erythema, and possibly scale.

Operative expectations for Mohs surgery in patients with chronic lymphocytic leukemia: A multicenter retrospective cohort study.

Background: Patients with chronic lymphocytic leukemia (CLL) are immunocompromised and have both a higher incidence of and more aggressive skin cancers, often requiring treatment with Mohs micrographic surgery. Objective: Characterize operative expectations for Mohs surgery in patients with CLL. Methods: Multicenter retrospective cohort study. Results: One hundred fifty-nine tumors from 99 patients with CLL were matched 1:4 with controls. Cases had higher odds for requiring at least 3 stages during Mohs surgery compared to controls (odds ratio = 1.91; 95% CI [1.21-3.02]; P = .01). The mean number of Mohs stages in cases was 1.97 (±0.92) compared with 1.67 (±0.87) in controls (P = .0001). A regression analysis showed that cases had larger postoperative tumor areas (cm2) versus controls (mean = 5.57 vs 4.47; estimate difference Δß = 1.10 cm2; 95% CI [0.18-2.03]; P = .02). In logistic regression, cases were twice as likely to receive a flap repair compared to controls (odds ratio = 2.45; 95% CI [1.58-3.8]). Limitations: Retrospective cohort study and lack of histologic subtyping of tumors. Conclusion: Patients with CLL require more Mohs stages to attain clear surgical margins, have larger postoperative defect areas, and require more advanced repair techniques compared to a control population without CLL. These findings are essential for preoperative planning and patient counseling and further support the use of Mohs surgery in patients with CLL.

The Universal Dermatology Bandage Kit: A Succinct Collection of Supplies.

Biopsies, excisions, and other invasive cutaneous procedures are daily occurrences in dermatology clinics. Each procedure requires subsequent placement of a bandage; physicians can be left with an overwhelming choice of supplies for this purpose. We present a universal bandage kit as a resource for physicians in search of a concise guide for purchasing materials and educating nursing staff. These few supplies meet all bandaging needs that arise in a dermatology clinic.