Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.]
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The perioperative management of anticoagulation and antiplatelet therapy is a controversial topic in the field of dermatologic surgery. Dermasurgeons must weigh the risk of bleeding against the risk of thrombotic complications when deciding how to manage perioperative anticoagulation. ⋯ Dermasurgeons were more likely to continue medically necessary aspirin and warfarin in 2005 compared to 2002, with the most dramatic shift evident in the management of warfarin. They were more likely to discontinue prophylactic aspirin, NSAIDs, and vitamin E. Surgeons were concerned about bleeding with the antiplatelet agent clopidogrel. More evidence-based medicine is necessary to set guidelines for the management of anticoagulation and antiplatelet therapy perioperatively.
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Randomized Controlled Trial
Laser-assisted tattoo removal with topical 5% imiquimod cream.
Laser-assisted tattoo removal is effective but can be costly and time-consuming and can result in disfiguring scars and pigment alterations. Imiquimod, an immune response modifier, may play a role in tattoo removal. ⋯ Topical imiquimod is an ineffective adjunct to laser-assisted tattoo removal.
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The 7% lidocaine and 7% tetracaine (LT) peel is a self-occlusive, topical local anesthetic that has been proven safe and effective for use in conjunction with many dermatologic procedures, including cryotherapy, collagen injections, and various laser treatments. The product is applied directly to the skin as a cream that dries within 20 to 30 minutes of air exposure to form a flexible film membrane that is easily peeled off before surgery. ⋯ Studies comparing the LT peel with placebo or a 1:1 eutectic mixture of local anesthetics (EMLA) cream have shown the LT peel to have superior anesthetic efficacy in adult patients undergoing a variety of cutaneous procedures. The LT peel is safe and well tolerated, with side effects limited to localized, transient skin reactions that do not appear to interfere with clinical outcome. It is an effective topical anesthetic for dermatologic procedures that is convenient to use and promotes a positive patient experience.
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Hand-held dermoscopy improves the malignant/benign excision ratio for melanocytic lesions. Much has been described about its use in pigmented lesions; however, the use of dermoscopy in clinically nonpigmented lesions is less well studied. Existing studies have used a combination of traditional immersion dermoscopy and polarized light dermoscopy. This is the first study, to our knowledge, to strictly use digital polarized light dermoscopy for the evaluation of clinically nonpigmented, biopsy-proven dermal nevi. ⋯ The most common dermoscopic features (using polarized light) of clinically nonpigmented, biopsy-proven dermal nevi are brown pigment, white areas, comma-shaped vessels, and hair.