The British journal of dermatology
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Historically, ascertainment of nonmelanoma skin cancer (NMSC) by cancer registries in the U.K. has been shown to be incomplete in several studies. However, recent evidence suggesting that almost all clinically diagnosed NMSCs are verified histologically, coupled with the increasing availability of electronic histopathology data to cancer registries, raises the possibility that this situation may have improved. ⋯ Ascertainment of NMSC has probably improved since the advent and use of electronic pathology data. Ongoing increases in age-adjusted incidence, combined with ageing of the population, will have major implications for the clinical workload associated with NMSC for the foreseeable future.
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Microvascular abnormalities (capillary elongation, widening and tortuosity) are a characteristic feature of psoriasis and form one of the pathological diagnostic criteria. However, it is still not entirely clear when these microcirculatory changes appear in the skin of psoriatic subjects. Some studies suggest that capillary dilatation and elongation are present in the clinically uninvolved skin of psoriatic patients even at sites at which psoriatic plaques rarely occur. ⋯ These findings indicate that prior to the development of clinical lesions there are no significant morphological differences between the dermal microvessels in the clinically uninvolved skin of psoriatic subjects and the dermal microvessels in the normal skin of healthy volunteers. However, during plaque formation, the superficial papillary microvessels in plaque skin undergo a striking, characteristic change, i.e. elongation, widening and tortuosity. These blood vessels must therefore, at least in part, play an important, necessary, but probably secondary role in the pathogenesis of clinical lesions in psoriasis.
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Randomized Controlled Trial
Treatment of axillary hyperhidrosis with botulinum toxin type A reconstituted in lidocaine or in normal saline: a randomized, side-by-side, double-blind study.
Botulinum toxin type A represents a safe and effective treatment for primary axillary hyperhidrosis. One of the most troublesome disadvantages associated with this therapy is pain at the injection sites. Reconstitution of botulinum toxin A in a solution of lidocaine could be an easy alternative procedure to reduce the discomfort associated with those injections. However, the current recommendations are that botulinum toxin A should be reconstituted in normal saline. ⋯ Short- and long-term results show the equal effectiveness of botulinum toxin A reconstituted in saline or in lidocaine. However, because injections of botulinum toxin A reconstituted in lidocaine are associated with significantly reduced pain, lidocaine-reconstituted botulinum toxin A may be preferable for treating axillary hyperhidrosis.
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Assessing pruritus severity is difficult because of its subjective nature. A questionnaire that takes into account how the symptom is perceived by the patient may provide a more accurate representation of the pruritus. However, recently developed questionnaires do not specifically quantify severity of the symptom. ⋯ Based on this preliminary evidence of validity and reliability, this new seven-item ISS may be useful in comparing pruritus severity among different disease populations or in assessing pruritus treatment effectiveness.
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Patients who suffer from chronic itch employ creative techniques to alleviate their itch, often using painful thermal stimuli, such as hot and very cold showers, as well as mechanical stimuli, such as scratching. ⋯ The present psychophysical study demonstrates that repetitive noxious thermal and scratching stimuli inhibit itch and do not require direct physical interaction with the area of the skin from which itch originates.