Dermatologic clinics
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The use of skin substitutes to treat acute and chronic wounds should continue to increase as newer products are developed. The goals for the future are to eliminate the need for autografting, eliminate the risk for transmission of disease, improve the shelf life and simplify storage requirements, improve cosmetic outcomes, and reduce cost. A number of researchers are also looking to incorporate gene therapy into skin substitutes.
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The neck is a difficult but important area in rejuvenation of the face. Discussed are the major anatomic landmarks for neck surgery, the aging process of the neck, and the most commonly used treatments presently available for rejuvenation of the neck and their complications.
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Colored cosmetics are an important part of the dermatologic armamentarium. They can camouflage contour and pigment abnormalities, provide moisturization, enhance oil control, add sun protection, deliver barrier-enhancing agents, increase acne treatment, and create a sense of personal well-being. Familiarity with these products allows the dermatologist to provide better patient care.
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Erythroderma can be caused by a variety of underlying dermatoses, infections, and systemic diseases. Many of the findings on history, physical examination, and laboratory evaluation are nondiagnostic. Distinctive clinical and laboratory features pointing to a specific disease may be evident, however. ⋯ The prognosis of erythroderma has improved with the advent of innovative dermatologic therapies (e.g., cyclosporine and synthetic retinoids) and advances in the management of systemic manifestations. Death from sepsis, cardiac failure, adult respiratory distress syndrome, and capillary leak syndrome continue to be rarely reported. A high index of suspicion for these complications must be maintained to facilitate early medical intervention.
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Dermatologic clinics · Apr 2000
ReviewEconomic aspect of health care systems. Advantage and disadvantage incentives in different systems.
European health care delivery systems illustrate the effect of economic incentives on health care delivery. Each country faces the issue of trying to balance the desire for economic efficiency with comprehensive, quality medical care. Without careful use of economic incentives achievable with central control, one gets to pick only two of the three desired goods--high quality, low cost, and comprehensive coverage. ⋯ A further step is to give the primary care providers financial responsibility for the costs of the follow-up care provided by others to their patients. By examining the health care systems of other countries, the potential negative impact of such an approach on the use of specialists can be seen. The negative impact of these approaches on patient care is clear when dermatologists and general practitioners are compared in the delivery of dermatologic health care.