Interest To Dermatologists Research Articles

Rate of incomplete excision of basal cell carcinomas by General Practitioners with Special Interest

Conflicts of interest: none declared. Sir, The role of General Practitioners with Special Interest (GPwSI) in dermatology is evolving and has been subject to some controversy including issues of clinical governance. Rates of incomplete excision in the treatment of basal cell carcinoma (BCC) can be used as a parameter for clinical governance. Reported rates vary widely from 3% to 25%1–7 and many of these come from specialist skin cancer services or plastic surgery departments. A retrospective audit was conducted to establish the rate of incomplete excision of BCC in a GPwSI clinic at Bognor War Memorial Hospital between 2005 and 2008. Pathology reports of 124 consecutively excised BCCs (50% head and neck, 50% trunk/limbs) treated in this clinic were examined with regard to excision margins. The rate of incomplete excision was two out of 124 or 1·6%. Both of the incompletely excised lesions were from the face. One was incomplete laterally and was re‐excised (completely) by the original surgeon. The other was reported as incomplete deeply and was referred to a plastic surgeon who re‐excised the area with no residual BCC found.

A Novel Case-Based Approach to Continuing Medical Education Using a Virtual Patient Record

Purpose: In order to meet an increasing interest in advanced dermatology continuing medical education (CME) delivered asynchronously online, the Distance Learning Initiative (DLI) was developed. Methods: Ten case-based interactive courses, each containing 7 to 14 cases, were developed using a novel, interactive, virtual patient record for online delivery. As learners navigate through the cases to completion, a minimum of 80% correct patient management choices is required to unlock the quiz password, and a minimum of 80% correct quiz answers is required to receive a Category I CME certificate issued with American Academy of Physician Assistants' (AAPA) approval. Results: As of May 1, 2009, five courses containing 49 cases have opened for enrollment, with 533 course completions logged by 207 individual learners. Of the respondents, 86.6% agreed or strongly agreed that the course content was presented at an advanced level of dermatologic expertise, and 85.9% agreed or strongly agreed that the virtual patient record was user-friendly. Eighty-six percent also agreed or strongly agreed that the content increased their knowledge, while 89.9% agreed or strongly agreed that the content met the stated objectives. Conclusions: The project represents a cost-effective opportunity for dermatology physician assistants (PAs) to receive high-quality web-based instruction in a self-paced setting, with transferability of the instructional format to other medical subject areas to meet CME needs. Any subject matter that can be presented in a case-based format could be developed similarly for CME use. The project template is available free to all as an open source document.

Peat: A natural source for dermatocosmetics and dermatotherapeutics

In recent years the interest for natural substances in dermatotherapy and cosmetics has increased. Peat is a complex natural source of humic substances that are of potential interest in both dermatology and cosmetology. Humic substances in peat have been partially characterized and pharmacologic and biologic activities have been documented. Possible clinical applications are outlined.

Neurodegenerative disorders with hair abnormalities: An emergency room consultation for dermatologists

Menke′s syndrome and Elejalde disease are the two neurodegenerative disorders of dermatological interest. These patients present with characteristic hair changes which may be of diagnostic value in resource-poor setup where facilities for specific genetic analysis are not available. Simple light microscopic examination of hair may be a helpful diagnostic tool to pick up such cases.

Supercritical fluid extraction to obtain ceramides from wool fibers

The present work is focused on the optimization of the internal wool lipid (IWL) extractive process at laboratory level using supercritical carbon dioxide (SCCO 2) as solvent. IWLs have been extracted from wool on account of their considerable dermatological interest owing to their proportion of ceramides. Selected extraction variables affecting supercritical fluid extraction (SFE) are optimized to obtain natural lipid extracts rich in ceramides. The type of modifier was first evaluated and the best results were obtained using SCCO 2 in the presence of methanol and ethanol. Subsequently, pressure, temperature and CO 2 volume were optimized by using experimental design approaches. The result highlights the small influence of the temperature in both cases. 60 °C can be considered as a good temperature to obtain high amount of ceramides, around 0.25% on wool weight with 10% methanol and 0.20% on wool weight with 10% ethanol in the SFE procedure, being in both cases important is the pressure and CO 2 volume used.

Factors affecting medical students in formulating their specialty preferences in Jordan

BackgroundIn recent years there has been a growing appreciation of the issues of career preference in medicine as it may affect student learning and academic performance. However, no such studies have been undertaken in medical schools in Jordan. Therefore, we carried out this study to investigate the career preferences of medical students at Jordan University of Science and Technology and determine factors that might influence their career decisions.MethodsA cross-sectional questionnaire-based survey was carried out among second, fourth and sixth year medical students at the Jordan University of Science and Technology, Irbid, Jordan during the academic year 2006/2007. A total of 440 students answered the questionnaire which covered demographic characteristics, specialty preferences, and the factors that influenced these career preferences. Possible influences were selected on the basis of a literature review and discussions with groups of medical students and physicians. Students were asked to consider 14 specialty options and select the most preferred career preference.ResultsThe most preferred specialty expressed by male students was surgery, followed by internal medicine and orthopaedics, while the specialty most preferred by female students was obstetrics and gynaecology, followed by pediatrics and surgery. Students showed little interest in orthopedics, ophthalmology, and dermatology. While 3.1% of females expressed interest in anesthesiology, no male students did. Other specialties were less attractive to most students.Intellectual content of the specialty and the individual's competencies were the most influential on their preference of specialty. Other influential factors were the "reputation of the specialty", "anticipated income", and "focus on urgent care".ConclusionSurgery, internal medicine, pediatrics, and obstetrics and gynaecology were the most preferred specialty preferences of medical students at Jordan University of Science and Technology.

Botulinum toxin: Non-cosmetic indications and possible mechanisms of action

Botulinum toxin (BTX) has gained a great interest in cosmetic dermatology for its effects on hyperkinetic facial lines. Understanding the basic research and analysis of effects of this potent drug can lead to other possible indications of interest for dermatologists. The use of BTX in focal hyperhidrosis is well established, but BTX has also effects on pain perception, itch and inflammation as discussed in this review.

Late-Onset Familial Mediterranean Fever: An Atypical Presentation of Dermatologic Interest

Late-Onset Familial Mediterranean Fever: An Atypical Presentation of Dermatologic Interest

Pediatric dermatology, 3rd edition

Edited by Lawrence A Schachner and Ronald C Hansen. Published by Mosby, London, 2003, £170.00 (hardcover), pp 1340. ISBN 0-323-02611-7 ![][1] Paediatric dermatology is one of the niche specialities of our field, but a relevant one. Paediatric dermatologists, or paediatricians with an interest in dermatology, face a workload that is challenging and growing. As well as conditions such as the increasingly more common atopic disorders, new or rarely seen conditions have arisen in the context of progress in science, improved healthcare and survival, and global migration. Paediatric dermatology is a dermatological rather than a paediatric subspeciality; nevertheless, where a speciality service is not provided by an adult trained dermatologist with a paediatric interest, most paediatric patients with skin problems are actually cared for by general paediatricians. The fascination of dermatology lies within its visual and almost purely clinical approach to … [1]: /embed/graphic-1.gif

Thermal analysis of merino wool fibres without internal lipids

AbstractMerino wool is made up of cuticle and cortical cells held together by the cell membrane complex (CMC), which contains a small amount of internal lipids (IWL) (1.5% by mass). IWL have been extracted from wool on account of their considerable dermatological interest owing to their proportion of ceramides. IWL have been extracted by different methods and solvents, methanol and acetone at laboratory and pilot plant levels. Thermal analysis of these extracted wool fibers is presented using thermogravimetry (TG) and differential scanning calorimetry (DSC). TG provides a measurement of the weight loss of the sample as a function of time and temperature. DSC gives information about possible structure modification of extracted wool fibers. Thermoporometry was applied to evaluate the pore size distribution of extracted wool fibers. The results showed that the extraction process increased the pore size distribution and the cumulated pore volume, which is consistent with some changes in the extracted wool CMC. Extracted fiber becomes more hydrophilic and absorbs a large amount of water. We can conclude that the lipid extraction of wool produced no relevant changes in the crystalline fraction when extracted with acetone. However, part of the amorphous keratin material was extracted with methanol, the rest of the crystalline material becoming more stable. © 2007 Wiley Periodicals, Inc. J Appl Polym Sci 104: 545–551, 2007

Conflicts of Interest in Dermatology

Conflicts of interest exist in dermatology when professional judgement concerning a primary interest, such as research validity, may be influenced by a secondary interest, such as financial gain from a for-profit organization. Conflict of interest is a condition and not a behaviour, although there is clear evidence that gifts influence behaviour. Little has been written about conflicts of interest in dermatology. This series of papers raises awareness of the subject by exploring it in greater depth from the perspective of a dermatology researcher, an industry researcher, a dermatology journal editor, a health services researcher and a patient representative. Collectively, they illustrate the many ways in which conflicts can pervade the world of dermatology publications and patient support group activities.

Tinea capitis: epidemiologia e ecologia dos casos observados entre 1983 e 2003 na Faculdade de Medicina de Botucatu, Estado de São Paulo, Brasil

FUNDAMENTOS: Tinea capitis é importante infecção fúngica de interesse dermatológico e pediátrico. No Brasil sua prevalência é desconhecida, e os agentes causais principais são o Trichophyton tonsurans nas regiões Norte-Nordeste e o Microsporum canis no Sul-Sudeste do país. Conhecimento sobre gênero e espécies mais prevalentes tem importância sanitária e terapêutica. OBJETIVOS: Identificar espécies de dermatófitos, causa de Tinea capitis, em serviço universitário que atende clientela do Sistema Único de Saúde, de procedência urbana e rural, no interior do Estado de São Paulo. MÉTODOS: Amostras de casos clínicos suspeitos de Tinea capitis, procedentes da área de abrangência da Faculdade de Medicina de Botucatu-Unesp, foram investigadas por exame direto e cultivo visando ao diagnóstico e isolamento do agente causal. RESULTADOS: De 1.055 suspeitas, 594 foram confirmadas por exame direto, em 364 (61,1%) isolou-se o agente: M. canis em 88,2%, seguindo-se T. tonsurans (4,7%), T. rubrum (3,3%), M. gypseum (1,9%), T. mentagrophytes (1,6%). O sexo masculino correspondeu a 55,7% dos casos, e a faixa etária entre 0-5 anos predominou com 62,6% (p < 0,05). CONCLUSÕES: A prevalência detectada do M. canis superou o esperado para a Região Sudeste do Brasil. A freqüência de 88,2% pode estar influenciada por pacientes procedentes da zona rural. Esse dado deve ser considerado quando de decisão terapêutica.

Pruritus ani

In the anal region, pruritus may be both idiopathic (mainly of psychological/psychiatric origin) and secondary to an underlying disorder or related to local causes (mainly of dermatologic interest). Persistent pruritus ani is, in particular, a challenging experience for the dermatologist.

How to become a GPwSI in dermatology and minor surgery

Evanthia Frangos outlines her experience as a GP specialist registrar with an interest in dermatology and minor surgery

Extent and impact of industry sponsorship conflicts of interest in dermatology research

Many published clinical trials are authored by investigators with financial conflicts of interest. The general medical literature documents the pervasive extent and sometimes problematic impact of these conflicts. Accordingly, there is renewed discussion about author disclosure and clinical trial registry to minimize publication bias from financial conflicts of interest. Despite this evolving discussion in the general medical literature, little is known about the extent or role of financial conflicts of interest in dermatology research. Our purpose was to determine the extent and impact of industry sponsorship conflicts of interest in dermatology research. We recorded potential financial conflicts of interest, study design, and study outcome in 179 clinical trials published between Oct 1, 2000 and Oct 1, 2003 in four leading dermatology journals. Forty-three percent of analyzed studies included at least one author with a reported conflict of interest. These studies were more likely to report a positive result, demonstrate higher methodological quality, and include a larger sample size. Conflict of interest in clinical investigations in dermatology appears to be prevalent and associated with potentially significant differences in study methodology and reporting.

Dermatodendrosophy

Morphology is the core of clinical dermatology, and botany played an important role in its evolution. 2 Bottoni G. The roots of dermatologic thought originated in a botanic garden. Arch Dermatol. 2000; 136: 28-29 Crossref PubMed Scopus (1) Google Scholar When hiking through parks and landscapes, one sees a wide variety of trees and their bark in plain view (Fig 1, Fig 2, Fig 3, Fig 4). Have you ever tried to recognize familiar patterns? Dermatodendrosophy is a neonym composed to denote a connection between dermatology and trees; and, I hope, it provides some pleasure, perhaps even insight. Interestingly, the ancient Greek word derma (Δερμα) was used synonymously for skin as well as for the bark of trees. This selection of pictures was taken from a large collection, published in part by the author. 3 Loeser C. Dermatodendrosophy. A visual encounter of dermatologic interest with the American forest. Nashville (TN): published by the author; 1998. Google Scholar Fig 2Red cedar (Juniperus Virginiana L.): Exfoliative dermatitis? View Large Image Figure Viewer Fig 3Yellow oak (Quercus velutina Lam.): Botryomycosis? View Large Image Figure Viewer Fig 4Mississippi Hackberry (Celtis Mississippiensis Bosc.): Pseudoxanthoma elasticum and acanthosis nigricans? View Large Image Figure Viewer

Development and evaluation of a high-frequency ultrasound-based system for in vivo strain imaging of the skin

The elastic properties of skin are of great interest in dermatology because they are affected by many pathological conditions. In this paper, a technique for in vivo mechanical strain imaging of the skin based on high-frequency ultrasound (HFUS) is presented. Elastic skin properties are assessed applying suction to the skin surface with a stepwise increased vacuum and estimating the resulting displacements in a spatially resolved manner. Acquired radio frequency (RF) echo signals and their envelope are analyzed for this purpose. A computer-controlled vacuum system with a digital pressure control loop was developed for precise and reproducible deformation. In a first processing step, the skin surface is segmented. Local axial strains inside the skin are estimated from axial displacements, which are estimated from consecutive echo signal frames analyzing the phase of the complex cross correlation function of analytical echo signals. Furthermore, speckle tracking is applied to estimate axial and lateral displacements and to quantify axial and lateral strains. The correlation coefficient of windowed echo signals compensated for displacements are used as a measure to validate the estimated strains, which is essential to accomplish reliable in vivo measurements. Phantom experiments were performed to validate the proposed technique. Results of in vivo measurements are presented, showing the potential for mechanical strain imaging in the skin in vivo.

P‐22 Mites of interest in canine and feline dermatology: evaluation of their survival and structural integrity in oil preparations for microscopy

Diagnostic dilemmas often arise when veterinary practitioners suspect a parasitic skin disease but direct microscopy of collected samples are negative. It has been suggested that the delay between collection of the sample in the veterinary practice and evaluation at the referral laboratory results in parasite lysis. This study was performed to determine if delay in processing the samples may lead to negative results. A further aim was to determine if using other oil media (when mineral oil was not available) would result in parasite modification. One‐hundred samples of skin scrapings and otic smears in several oil media from dogs and cats diagnosed as positive for several mites of dermatological importance were kept under room conditions and evaluated over a 21‐day period for mite survival and retention of recognizable structural features. Mineral oil, kitchen grade olive oil, pharmaceutical grade baby oil and glycerin were used as oily media to process the samples. At the end of the study, mite survival rate was established between 2 and 5 days. Sarcoptes and Otodectes mites survived the longest. After 21 days of observation, all parasites and their eggs still remained recognizable, no matter which oil medium was used. It was concluded that a delay in the submission of samples does not result in negative findings. Funding: Self‐funded.

Heat shock protein 47 expression in aged normal human fibroblasts: modulation by Salix alba extract.

Heat shock protein (HSP) 47 is a specific chaperone of procollagen. This heat shock protein is responsible for the correct three-dimensional organization of procollagen and its control-quality prior secretion. The aim of the study is to evaluate the level of HSP 47 in aged, photoaged, and senescent fibroblasts and its modulation by a plant extract (Salix alba). The level of HSP 47 and/or procollagen expression in fibroblasts was measured by real-time RT-PCR (mRNA transcripts) and by flow cytometry (immunochemistry technique for measurement of arbitrary fluorescence intensity). Immunochemistry techniques and confocal microscopy were used to visualize the cellular localization of HSP 47 and procollagen. These parameters were compared with different age donors, nonsenescent, and senescent fibroblasts. Fibroblasts were irradiated by a noncytotoxic dose of UVA (6 J/cm(2)), and HSP 47 level was evaluated. S. alba extract was tested for its capacity to modulate HSP 47 expression. Colocalization of HSP 47 and procollagen was shown by confocal microscopy, indicating that HSP 47 could play a role of procollagen molecular chaperone in the cellular model. It was also shown that the HSP 47 level is decreased in old-donor cells, senescent, and irradiated cells. This decrease can be modulated by a S. alba extract (polyphenols rich) in a dose-dependent manner. The evaluation of HSP 47 expression in the experimental conditions can lead to a new approach of aging and photoaging, pointing out the implication of this chaperone in these pathophysiologic phenomena. Modulation of HSP 47 expression by this family of molecules could be of cosmetic and/or dermatologic interest.

Internal lipid content and viscoelastic behavior of wool fibers

AbstractWool is a natural keratin fiber made up of cuticle and cortical cells held together by the cell membrane complex (CMC), which contains few internal lipids (IWLs) (1.5% by mass). IWL arouse considerable cosmetic and dermatological interest because of its high proportion of ceramides. In this work, IWLs were extracted with acetone, methanol, and dichloromethane/acetone solvents, and the possible alteration of the extracted fibers with respect to their textile feasibility was analyzed. Parameters of yield, fibril, and matrix viscoelastic behavior, deformation work, and breaking elongation were useful in highlighting the effect of internal wool lipids on the mechanical properties of the fibers. The extraction with acetone and methanol solvents supplied good yields of IWL. Although extraction with methanol achieved the richest extracts, the fibers were chemically modified. By contrast, although acetone‐extracted fibers had similar properties after treatment, alkaline solubility was lower and fiber length and barb were superior. In the mechanical analysis, a prior extraction of IWL increased yield tenacity and decreased the elongation at break of the fibers, maintaining the feasibility of extracted wool for textile purposes. © 2004 Wiley Periodicals, Inc. J Appl Polym Sci 92: 3252–3259, 2004