Semin Cutan Med Surg
· 2016 Mar · PMID 26963113
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Melanoma is the most dangerous type of skin cancer and its incidence has risen sharply in recent decades. Early detection of disease is critical for improving patient outcomes. Any pigmented lesion that is clinically con...Melanoma is the most dangerous type of skin cancer and its incidence has risen sharply in recent decades. Early detection of disease is critical for improving patient outcomes. Any pigmented lesion that is clinically concerning must be removed by biopsy for morphologic investigation on histology. However, biopsies are invasive and can cause significant morbidity, and their accuracy in detecting melanoma may be limited by sampling error. The advent of noninvasive imaging devices has allowed for assessment of intact skin, thereby minimizing the need for biopsy; and these technologies are increasingly being used in the diagnosis and management of melanoma. Reflectance confocal microscopy, optical coherence tomography, ultrasonography, and multispectral imaging are noninvasive imaging techniques that have emerged as diagnostic aids to physical exam and/or conventional dermoscopy. This review summarizes the current knowledge about these techniques and discusses their practical applications and limitations.
Semin Cutan Med Surg
· 2016 Mar · PMID 26963112
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Self-acquired patient images, also known as selfies, are increasingly utilized in the practice of dermatology; however, research on their utility is somewhat limited. While the implementation of selfies has yet to be uni...Self-acquired patient images, also known as selfies, are increasingly utilized in the practice of dermatology; however, research on their utility is somewhat limited. While the implementation of selfies has yet to be universally accepted, their role in triage appears to be especially useful. The potential for reducing office wait times, expediting referrals, and providing dermatologic services to patients with limited access to care is promising. In addition, as technology advances, the number of smartphone applications related to dermatology that are available to the general public has risen exponentially. With appropriate standardization, regulation, and confidentiality measures, these tools can be feasible adjuncts in clinical practice, dermatologic surgery, and teledermatology. Selfies likely will have a large role in dermatologic practice and delivery in the future.
Harker DB, Mollet T, Srivastava D
… +1 more, Nijhawan RI
Semin Cutan Med Surg
· 2016 Mar · PMID 26963111
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Wrong-site surgery in dermatology often results from inaccurate identification of a skin cancer biopsy site. Factors making biopsy-site identification difficult include background actinic damage, delays from biopsy to su...Wrong-site surgery in dermatology often results from inaccurate identification of a skin cancer biopsy site. Factors making biopsy-site identification difficult include background actinic damage, delays from biopsy to surgery, and lack of photographic documentation. While other methods exist for biopsy-site identification, photography is the most helpful tool available. Although modern technology has made high-quality photographic equipment ubiquitous and easy to use, photography for biopsy-site identification continues to be underutilized. The authors recommend that photographic documentation of biopsy sites become the standard of care.
Semin Cutan Med Surg
· 2016 Mar · PMID 26963110
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Medical imaging has dramatically transformed the practice of medicine, especially the field of dermatology. Imaging is used to facilitate the transfer of information between providers, document cutaneous disease, assess...Medical imaging has dramatically transformed the practice of medicine, especially the field of dermatology. Imaging is used to facilitate the transfer of information between providers, document cutaneous disease, assess response to therapy, and plays a crucial role in monitoring and diagnosing skin cancer. Advancements in imaging technology and overall improved quality of imaging have augmented the utility of photography. We provide an overview of current imaging technologies used in dermatology with a focus on their role in skin cancer diagnosis. Future technologies include three-dimensional, total-body photography, mobile smartphone applications, and computerassisted diagnostic devices. With these advancements, we are better equipped to capture and monitor skin conditions longitudinally and achieve improved diagnostic accuracy of skin cancer.
Semin Cutan Med Surg
· 2017 Dec · PMID 29659646
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Therapeutic patient education is a nascent movement in the care of atopic dermatitis, offering patients-and, for children, their caregivers-knowledge, skills, support, and coping strategies for managing what for many is...Therapeutic patient education is a nascent movement in the care of atopic dermatitis, offering patients-and, for children, their caregivers-knowledge, skills, support, and coping strategies for managing what for many is a relapsing/ remitting chronic disease that severely compromises quality of life. Interventions range from a written treatment plan provided in the office to a 6-week education program. Studies indicate that this approach yields benefits for patients and their caregivers. Most of these studies involved children and their parents or other caregivers, but reduced signs and symptoms of disease and improved quality of life also has been documented in adults. Semin Cutan Med Surg 36(supp4):S106-S107.
Semin Cutan Med Surg
· 2017 Dec · PMID 29659645
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Until recently, systemic therapy of atopic dermatitis was limited to off-label use of immunomodulators, which can pose significant safety concerns, and treatment with systemic corticosteroids, not recommended in the most...Until recently, systemic therapy of atopic dermatitis was limited to off-label use of immunomodulators, which can pose significant safety concerns, and treatment with systemic corticosteroids, not recommended in the most recent guidelines. The introduction of dupilumab in 2017 marked a major advance in systemic therapy for atopic dermatitis. It has demonstrated long-term efficacy in adults with moderate to severe disease, and is being studied in children. Several other biologic agents and "small molecules" with varying mechanisms of action are in phase 2 or 3 development. Semin Cutan Med Surg 36(supp4):S103-S105.
Semin Cutan Med Surg
· 2017 Dec · PMID 29659644
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Recently a new class of topical medications for mild to moderate atopic dermatitis has been introduced with US Food and Drug Administration (FDA) approval of the first new prescription medication for this condition in mo...Recently a new class of topical medications for mild to moderate atopic dermatitis has been introduced with US Food and Drug Administration (FDA) approval of the first new prescription medication for this condition in more than a decade. Crisaborole, the newly approved medication, has relieved pruritus in more than one-third of patients within as little as 48 hours. It also has demonstrated efficacy in patients with skin of color. Topical therapies representing other new approaches to atopic dermatitis, with novel mechanisms of action, have shown promise in clinical development. Semin Cutan Med Surg 36(supp4):S99-S102.
Semin Cutan Med Surg
· 2017 Dec · PMID 29659643
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Many children with atopic dermatitis also have an allergy to one or more foods, but the presence of these two conditions in an individual does not necessarily indicate a causal link between them. Testing and interpretati...Many children with atopic dermatitis also have an allergy to one or more foods, but the presence of these two conditions in an individual does not necessarily indicate a causal link between them. Testing and interpretation, sometimes with specialist consultation, may be required to discern whether food allergy is present in a child with atopic dermatitis and-if it is present-whether the food is triggering or exacerbating signs and symptoms of atopic dermatitis. Recent milestone trials have demonstrated that early introduction of peanuts can reduce the development of peanut allergy in at-risk children. Parents may benefit from education about current revised guidelines that now recommend offering peanut-containing foods to most children at the time he or she is ready for solid food. Semin Cutan Med Surg 36(supp4):S95-S97.
Semin Cutan Med Surg
· 2017 Dec · PMID 29659642
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Recent studies have shed light on the nature of the burden of atopic dermatitis. Analysis of observational data has revealed the effect of atopic dermatitis in diverse areas such as work productivity, physical activity,...Recent studies have shed light on the nature of the burden of atopic dermatitis. Analysis of observational data has revealed the effect of atopic dermatitis in diverse areas such as work productivity, physical activity, mood, and risk of comorbidities beyond other atopic conditions. Studies on adults with moderate to severe disease show that the symptoms and consequences of atopic dermatitis affect many aspects of their lives. A clearer understanding of the burden for patients can inform open, sensitive discussions about goals of therapy. Semin Cutan Med Surg 36(supp4):S92-S94.
In our experience, patients tend to consider any undesirable feature on their body from the knees to the umbilicus, and even the arms, to be cellulite. It is important to educate prospective patients that Cellfina (Uithe...In our experience, patients tend to consider any undesirable feature on their body from the knees to the umbilicus, and even the arms, to be cellulite. It is important to educate prospective patients that Cellfina (Uithera, Inc, Mesa, Arizona) most effectively treats dimple-type cellulite, whereby fibrous bands inserting into the undersurface of the skin cause a puckered appearance. In this brief communication, we would like to share our experience in optimizing outcomes with Cellfina for the treatment of cellulite.
With the recent approval of Kythera Biopharmaceuticals (Westlake Village, California) submental fat injectable treatment Kybella, there comes a lot of excitement-but, also a bit of concern. The idea of having a nonsurgic...With the recent approval of Kythera Biopharmaceuticals (Westlake Village, California) submental fat injectable treatment Kybella, there comes a lot of excitement-but, also a bit of concern. The idea of having a nonsurgical, nonliposuction treatment for people who have a double chin is certainly exciting. The hope has been that this new treatment will provide opportunities for the many people out there who are focused on the appearance of their submental fullness to have access to a safe. affordable, and reliable treatment.With the approval of this product. there are several misconceptions that the authors herein discuss.
Semin Cutan Med Surg
· 2015 Dec · PMID 26650699
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In recent years, there have been many changes in the classification scheme for squamous lesions of the vulva; this is primarily due to the assimilation of new scientific information into the diagnostic terminology. For e...In recent years, there have been many changes in the classification scheme for squamous lesions of the vulva; this is primarily due to the assimilation of new scientific information into the diagnostic terminology. For example, over the past 75 years we have realized that precancerous and cancerous lesions of the vulva may be induced by a variety of preconditions, which are typically divided into human papillomavirus (HPV) and non-HPV precursor lesions. The latter include several dermatoses, especially lichen sclerosus and lichen planus. Additionally, we have learned that HPV on extramucosal and nongenital sites does not have the same malignant potential as on mucosal or genital sites. Because of the frequent changes in nomenclature due to these discoveries, both old and new terms continue to be used in clinical practice; a summary of these terms is provided to help prevent a misunderstanding of their scope and significance. Important points for clinicians and pathologists who are involved in the care of these patients are provided.
Semin Cutan Med Surg
· 2015 Dec · PMID 26650698
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Vulvodynia is a pain syndrome affecting the vulva. It occurs in about 16% of women at some time of their lives. The etiology of vulvodynia is still enigmatic and is probably multifactorial-including physiological concern...Vulvodynia is a pain syndrome affecting the vulva. It occurs in about 16% of women at some time of their lives. The etiology of vulvodynia is still enigmatic and is probably multifactorial-including physiological concerns (eg, pelvic floor muscle dysfunction, neuropathic pain, and psychosocial) and sexual issues (eg, anxiety and sexual dysfunction). Although it is a common syndrome, most patients are neither correctly diagnosed nor treated. A diagnosis of vulvodynia is based upon patient history and lack of physical findings upon careful examination. No clinical or histological findings are present to aid in diagnosis. Most treatment options for vulvodynia are neither well studied nor have an evidence base, relying instead upon expert opinion, care provider experience, and use of data from other pain syndromes. However, many patients show marked improvement after physical therapy for the pelvic floor, medications for neuropathic pain, and psychosexual therapy.
Semin Cutan Med Surg
· 2015 Dec · PMID 26650697
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Noninfectious genital ulcers are much more common than ulcers arising from infections. Still, it is important to take a thorough history of sexual activity and a sexual abuse screen. A physical exam should include skin,...Noninfectious genital ulcers are much more common than ulcers arising from infections. Still, it is important to take a thorough history of sexual activity and a sexual abuse screen. A physical exam should include skin, oral mucosa, nails, hair, vulva, and vaginal mucosa if needed. The differential diagnosis of noninfectious genital ulcers includes: lipschütz ulcers, complex aphthosis, Behçet's syndrome, vulvar metastatic Crohn's disease, hidradenitis suppurativa, pyoderma gangrenosum, pressure ulcers, and malignancies. It is important to come to the correct diagnosis to avoid undue testing, stress, and anxiety in patients experiencing genital ulcerations.
Semin Cutan Med Surg
· 2015 Dec · PMID 26650696
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Lichen planus (LP) is an inflammatory autoimmune disease that affects both glabrous and mucosal skin. Although pathophysiology has not yet been fully defined, LP is a T-cell mediated disorder that demonstrates an increas...Lichen planus (LP) is an inflammatory autoimmune disease that affects both glabrous and mucosal skin. Although pathophysiology has not yet been fully defined, LP is a T-cell mediated disorder that demonstrates an increased Th1 cytokine expression as well as T-cell reactivity against basement membrane zone components. In males, genital LP often takes its more classic form as pink, shiny, flat-topped papules on the glans and coronal sulcus. In women, erosive disease is most common and often leads to significant scarring and sexual dysfunction. Therapeutic management is challenging, and control rather than cure is the goal. Topical corticosteroids remain first-line therapy, but some women will require systemic immunosuppressants to achieve remission. Surgery is less common for women with significant scarring who wish to resume sexual activity. Further research is needed on pathogenesis, and randomized controlled trials are necessary to better define best treatments for this chronic disease.
Semin Cutan Med Surg
· 2015 Dec · PMID 26650695
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HPV is the most common sexually transmitted disease, but the overwhelming majority of individuals clear the infection. A small percentage of individuals develop persistence of oncogenic HPV types, especially HPV-16; and...HPV is the most common sexually transmitted disease, but the overwhelming majority of individuals clear the infection. A small percentage of individuals develop persistence of oncogenic HPV types, especially HPV-16; and as a result, squamous cell carcinoma can develop in the tonsils and base of the tongue. Over 70% of oropharyngeal cancers are now thought to be associated with oncogenic HPV infection. Immunohistochemistry for p16 protein is often used as a surrogate marker for oncogenic HPV in the oropharyngeal tissues, although alternative HPV DNA testing methods are under intensive study. The clinical profile of patients with HPV-associated oropharyngeal cancer (OPC) differs quite notably from that of traditional head and neck cancer patients, and the prognosis for HPV-associated OPC is significantly better. As a result, experimental clinical trials are focused on de-intensification of therapies with the hope of preserving an improved long-term quality of life for these patients.