Inexpensive digital photography in clinical dermatology and dermatologic surgery

Digital photography can be used to follow clinical improvement in a variety of dermatoses, document pre and postoperative results, and document histologic findings from skin biopsies. Images may be printed as part of text documents and can be filed in conventional medical charts. Images can be transmitted via electronic mail rapidly and to any location. We have found digital photography to be relatively inexpensive and a powerful tool to enhance dermatologic practice.     

皮肤科设置皮肤外科主诊医师的探讨

皮肤外科在国内迅速发展,探讨通过皮肤科设置皮肤外科主诊医师和主诊医师负责制来规范和完善科室管理,促进皮肤外科的专业化发展。     

Antimicrobials in dermatologic surgery: Facts and controversies

The two main uses of antimicrobials in dermatologic surgery include prophylaxis for bacteremia and prevention of localized surgical skin infection (LSSI). Bacteremia can result in hematogenous surgical infections such as infective endocarditis and prosthetic joint infection. Comprehensive guidelines from the American Heart Society (AHA), American Dental Association (ADA), and the American Academy of Orthopedic Surgeons (AAOS) have significantly reduced the number of patients in which prophylaxis is indicated for hematogenous surgical infection. The use of antimicrobials for localized surgical skin infection in dermatology is controversial. Although the overall trend in the literature supports the decreased use of antimicrobials in dermatologic surgery as a whole, it is important to know which situations still warrant antibiotics. This contribution will address the updated guidelines of the AHA, ADA, and AAOS, evidence-based techniques to decrease localized surgical skin infections, and situations in which antibiotics should be considered during dermatologic surgery.     

Pregnancy and dermatologic surgery

The physiologic changes of pregnancy and risks to the fetus require attention during dermatologic surgery. Elective surgery should be performed in the second trimester or the postpartum period. Cosmetic work should occur after delivery to avoid hypertrophic or hyperpigmented scars. Skin preparatory agents and anesthetics may have fetal implications and should be chosen with care. Antibiotic selection for any infections must take into account possible maternal and fetal risks. Attention to detail and awareness of the changes in pregnancy should lead to safe surgery in the pregnant patient.     

Psychosomatic medicine in dermatologic education

Ten years' experience in handling psychosomatic aspects as part of dermatology courses in G?ttingen have revealed an unexpected need for such courses among students. Our program includes lectures as well as work in small groups.     

Anti-aging medicine in dermatologic practice

In the future, the increasing number of older individuals will play an even greater social and medicopolitical role. One challenge for dermatology is to incorporate preventive or anti-aging measures into daily practice. Solid understanding of the mechanisms of aging is required. An organized approach to such patients with emphasis on history, physical examination, imaging and skin physiology studies, and laboratory diagnosis is presented. Topical and systemic interventions should be based on the results of this complete evaluation.     

Cosmetic dermatologic surgery

This article deals with the office treatment of several common cosmetic problems. The topic of benign lesions is discussed, which includes the management of lentigines, milia, spider nevi, telangiectasis, xanthelasma, and keloids. The use of several modalities for the treatment of acne scarring is advocated; these include dermabrasion, punch-transplant replacement techniques, and collagen implants. Chemical face peels for actinic damage and premature wrinkling are described, and the use of hair transplants, scalp-reduction techniques, and scale flaps to surgically correct male-pattern alopecia are discussed.     

Accreditation and certification in dermatologic surgery

The Accreditation Council for Graduate Medical Education (ACGME) is an agency that accredits residency-training programs, thus assuring the public of the highest-quality medical education in the United States. Only those residents who complete ACGME-accredited programs qualify for certification by an American Board of Medical Specialties (ABMS)-sponsored board. Certification by the ABMS assures the public that a physician has become competent in a defined body of medical knowledge. Because medicine continuously evolves, the ACGME and the ABMS sponsor a process by which new specialties or subspecialties can be defined, programs accredited, and physicians certified. Procedural dermatology is a surgical subspecialty of dermatology that includes cutaneous oncology (along with Mohs micrographic surgery), cutaneous reconstructive surgery, and cosmetic surgery of the skin. The recent approval by the ACGME to accredit procedural dermatology fellowships establishes the specialty of dermatology as an organ-based body of knowledge that includes medical, pathologic, and surgical skills.     

Evidence-based medicine in dermatology

EBM is the use of the best current evidence in making decisions about the care of individual patients. Practicing EBM requires five steps: (1) formulating well-built clinical questions, (2) finding the best evidence to answer the questions, (3) critically appraising the evidence, (4) applying the evidence to specific patients, and (5) saving the critically appraised evidence. The Cochrane Library is the best source for finding the best evidence about treatment. The second best method for finding evidence about treatment and the best source for finding most other types of best evidence in dermatology is by searching the MEDLINE database using the PubMed Clinical search engine of the National Library of Medicine (http://++www.ncbi.nlm.nih.gov/PubMed/clin ica l.html). MEDLINE searches have inherent software and operator limitations that make their reliability quite variable. The quality (strength) of evidence is based on a hierarchy of evidence: results of systematic reviews of well-designed clinical studies, results of one or more well-designed clinical studies, results of large case series, and expert opinion. Once the best evidence has been found, the EBM approach involves critically appraising the quality of the evidence, determining its magnitude and precision, and applying it to the specific patient. Guidelines to appraise critically and apply evidence are available. The clinical question, best evidence, and its critical appraisal should be saved in a format that can be easily retrieved for future use.     

精准医学与皮肤病

精准医学研究是指在大样本研究获得疾病分子机制的知识体系基础上,以生物医学特别是组学数据为依据,根据“患者个体”在基因型、表型、环境和生活方式等各方面的特异性,应用现代遗传学、生物信息学和临床医学等方法与手段,制定个性化精准预防、精准诊断和精准治疗方案的一种新的医疗模式。本文根据近年来基因组学等方面的研究成果,结合具体皮肤疾病,介绍精准医学及其在皮肤病领域中应用所面临的挑战……     

Ethical dilemmas in dermatologic surgery

Dermatologic surgery presents a unique set of ethical dilemmas not frequently discussed within the medical literature. This contribution presents a few cases commonly encountered by dermatologic surgeons. The case-based discussion follows a principles-based framework for analysis and seeks to identify the central moral conflict and exemplify the development of sound reasoning for subsequent decision making through the consideration of multiple viewpoints and the weighing of potential consequences. Additional cases are provided in concise format to encourage further analysis and discourse on the distinct ethical dilemmas encountered within dermatologic surgery.     

Disparities in dermatology educational resources

Patients with dark skin can present with morphologic variants, subtle disease presentations, and disease manifestations requiring unique management and therapies. With African Americans, Asians, and Hispanic Americans becoming a significant portion of the population, dermatologists must be able to diagnose and manage skin conditions in people of color. In this study, core dermatology educational sources were examined to determine if they provide dermatologists and trainees with the knowledge base necessary to diagnose and treat skin disease in the ethnic patient. Overall, the coverage of dark skin at national meetings and in photographs in the major dermatology resources is limited and variable. More consistent photographic coverage and textual information describing common and serious skin diseases in people of color should be incorporated into educational resources.