Seminars in cutaneous medicine and surgery
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Tumors of the nail unit may be difficult to diagnose because of the screening effect of the nail plate. In longitudinal melanonychia, several new promising techniques assist with early diagnosis of melanoma (in vivo matrix dermoscopy and immunohistochemistry) as well as sparing as much of the healthy tissues as is possible (shave biopsy technique). Diagnosing nail disorders is in some instances difficult both for the clinician and the pathologist. ⋯ However, polymerase chain reaction analysis remains expensive and is not routinely used by clinicians. Scoring nail dystrophy by clinical observation remains very subjective; therefore, severity indexes have been proposed. Another emerging noninvasive technique is forensic analysis of nail clippings for detection of drug intake and abuse, as well as exposure to environmental pollution.
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Female pattern hair loss (FPHL) is a clinical problem that is becoming more common in women. Female alopecia with androgen increase is called female androgenetic alopecia (FAGA) and without androgen increase is called female pattern hair loss. The clinical picture of typical FAGA begins with a specific "diffuse loss of hair from the parietal or frontovertical areas with an intact frontal hairline." Ludwig called this process "rarefaction." In Ludwig's classification of hair loss in women, progressive type of FAGA, 3 patterns were described: grade I or minimal, grade II or moderate, and grade III or severe. ⋯ Although we do not know the reason, postmenopausal alopecia in normoandrogenic women also improves with finasteride or dutasteride at a dose of 2.5 mg per day. Dermatocosmetic concealment with a hairpiece, hair prosthesis as extensions, or partial hairpieces can be useful. Lastly, weight loss undoubtedly improves hair loss in hyperandrogenic women.
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Semin Cutan Med Surg · Dec 2008
ReviewEndovenous laser ablation and sclerotherapy for treatment of varicose veins.
Superficial venous insufficiency is a common problem associated with varicose veins. Venous insufficiency and varicose veins can be symptomatic, but more commonly they are a cosmetic concern. ⋯ Saphenofemoral junction incompetence with resultant greater saphenous vein reflux is the most common cause of varicose veins; because this condition constitutes the majority of patients encountered in practice, we will concentrate on this area. Endovenous laser ablation and sclerotherapy are covered, including patient workup and selection, procedure set-up, and anesthesia.
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Semin Cutan Med Surg · Mar 2008
Comparative StudyThe use of high definition video modules for delivery of informed consent and wound care education in the Mohs Surgery Unit.
The use of video in the informed consent process has been well documented in the literature to improve patient satisfaction, understanding, comprehension, and to decrease anxiety. At the MD Anderson Mohs Surgery Unit, we use high-definition (HD) audiovisual (AV) modules to assist with the delivery of informed consent and to educate patients on the subject of postoperative wound care. The purpose of this work was to develop HD-AV media to inform patients of the risks, benefits, and alternatives of Mohs surgery before they are asked to sign the consent form and to educate patients on basic wound care after Mohs Surgery. ⋯ An early evaluation of this quality improvement initiative was performed to measure patient satisfaction, efficiency, and efficacy of the videos followed by physician/nurse discussion compared with physician/nurse discussion alone. Early evaluation of HD-AV modules used for the delivery of informed consent and postoperative wound care in the MD Anderson Mohs surgery Unit revealed that patient satisfaction was maintained and that this medium was preferred by patients in the video group over physician/nurse discussion alone. The HD modules allowed increased efficiency and patient comprehension, which improved patient education in the Mohs Surgery Unit.
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Semin Cutan Med Surg · Sep 2007
Review Case ReportsApproach to the patient with presumed cellulitis.
Dermatologists frequently are consulted in the evaluation and management of the patient with cellulitic-appearing skin. For routine cellulitis, the clinical presentation and patient symptoms are usually sufficient for an accurate diagnosis. However, when the clinical presentation is somewhat atypical, or if the patient fails to respond to appropriate therapy for cellulitis because of routine bacterial pathogens, the differential diagnosis should be rapidly expanded. We discuss the approach to the patient with presumed cellulitis, with an emphasis on the differential diagnosis of cellulitis in both the immunocompetent and immunucompromised patient.