Perioperative pain perception in patients undergoing dermatologic surgery with local anesthesia - A prospective observational study.

BACKGROUND: Dermatosurgical procedures are predominantly performed under local anesthesia, yet there are few studies on perioperative pain management for extensive or staged procedures under local anesthesia. The purpose of this study was to assess pain during dermatologic surgery, describe perioperative pain management, and identify factors that influence pain perception. PATIENTS AND METHODS: This prospective, monocentric study included inpatients undergoing dermatologic surgery under local anesthesia from April to December 2021. Preoperative demographic data, a pain questionnaire, and four psychometric questionnaires (PCS, LOT-R, SFQ, PHQ-9) were collected. Postoperative pain and analgesic use during the first 24 hours were recorded. RESULTS: A total of 120 patients (with a total of 191 interventions) were included in the study. Mean postoperative pain was reported to be very low (NRS < 2). Preoperative pain and expected postoperative pain were found to be predictive of postoperative pain. There was a strong correlation between catastrophizing and preoperative anxiety (r = 0.65) and a moderate correlation between depression and preoperative anxiety (r = 0.46). CONCLUSIONS: Dermatologic surgery under local anesthesia is generally considered painless. During preoperative counseling and assessment, attention should be paid to patients who fear surgery, report pain, or anticipate postoperative pain, as they have an increased risk of experiencing postoperative pain.

[Treatment of atopic dermatitis with dupilumab : A retrospective cohort analysis from dermatological practice]. / Therapie der atopischen Dermatitis mit Dupilumab : Eine retrospektive Kohortenanalyse aus der dermatologischen Praxis.

We present the results of a retrospective data analysis of a practice cohort of 44 patients with atopic dermatitis treated with the IL-4/13 receptor antibody dupilumab for up to 3 years. Patients were followed up over a period of 21 months during specialized consultation hours named Immunodermatology, which was established to guarantee comprehensive documentation. The patient's characteristics regarding age and sex distribution, severity and duration of disease were comparable with the patient collectives in large, pivotal studies. The therapeutic efficiency however was high (percentage of patients with EASI50, -75, -90 after 16 weeks: 94, 84, 60%, respectively) and long lasting (86% EASI90 after 52 weeks on therapy) under everyday conditions in the clinical setting. Approximately half of the patients had facial skin or eye involvement either in their history or at the start of treatment. This group of patients proved to need more and intense care because facial dermatitis and periocular dermatitis, which often involved conjunctivitis, took longer to heal, relapses occurred, and an additional topical treatment was often required. We did not observe any severe side effects during the 48 patient-years analyzed in this study. Dupilumab proved to be a safe and efficient treatment for atopic dermatitis in dermatological practice.

[Treatment of simultaneously occurring urticaria and atopic dermatitis with dupilumab]. / Therapie von Urtikaria und atopischer Dermatitis bei einer Patientin mit Dupilumab.

Our 21-year-old woman presented with symptoms of chronic spontaneous urticaria with angioedema and of cholinergic urticaria as well as of atopic dermatitis. Treatment with the IgE antibody omalizumab resulted in an improvement of urticaria; however, relapses of the atopic dermatitis occurred. The use of the monoclonal IL-4/13 receptor antibody dupilumab resulted in complete healing of the atopic dermatitis, complete remission of the chronic spontaneous urticaria with angioedema, and the satisfactory control of cholinergic flare ups over a follow-up period of 26 weeks.

[Anti-IgE-directed treatment of urticaria in a dermatological practice]. / Anti-IgE-gerichtete Therapie der Urtikaria in der dermatologischen Praxis.

We conducted a retrospective data analysis of 26 patients with chronic spontaneous urticaria (CSU), 12 of whom had been treated with anti-IgE therapy (omalizumab). The subcohort of patients treated with omalizumab displayed more severe and prolonged courses of disease. In addition, they had often undergone various inpatient therapies, frequently presenting with concomitant angioedema. Collecting the Urticaria Activity Scores from the seven daily values for wheals and itching (UAS7) proved an important and suitable instrument for the determination and assessment of the course of therapy in the dermatological office. Elaborate laboratory screenings, however, seem far less indicative of the severity, prognosis and course of the disease. Omalizumab proved to be a viable and well-tolerated treatment option. One third of the patients were completely free of all symptoms, another third showed very good improvement, whereas the last third showed no improvement at all, even when omalizumab and/or concomitant therapies were escalated.