Argon laser treatment of lentigo maligna

A 64-year-old man had an irregularly pigmented lentigo maligna over the bridge of his nose. Melanin readily absorbs argon light, and the superficial location of this pool of epidermal and appendageal chromophore suggested that laser therapy might permit relatively selective lesion destruction. Argon laser surgery was performed on Nov. 9, 1981, and the treated site had remained clear to the time of writing. Selected patients with pigmented lesions may respond well to argon laser radiation, but close posttreatment clinical and histologic assessment is essential.     

Morbidity and cost of atopic eczema in Australia

The severity, morbidity and financial costs of atopic eczema (AE) were assessed during a 1-year prospective study of a cohort of 85 people aged 14-63 years (mean 36 years) with the disease. A dermatologist examined each participant using the Six Area Six Sign Atopic Dermatitis severity scoring system to classify severity. Participants completed a Dermatology Life Quality Index (DLQI), a Nottingham Eczema Severity Score (NESS) and an ongoing diary of health-care consultations and treatment costs. Follow up by mail to each participant was conducted every 2 months and participants completed a NESS, a DLQI and a diary of costs incurred. The DLQI data revealed that 36% spent over 10 min per day applying treatments, 28% indicated that AE influenced the clothes they wore, 21% felt embarrassed by their skin and 15% reported problems with treatments. There appeared to be a relationship between increased morbidity and increased severity. The average annual out-of-pocket cost for products used for treatment was A$425, ranging from A$13.50 to over A$2000 per individual. The average out-of-pocket cost for medical consultations was A$120, ranging from zero to over A$800 per individual. Although there were concerns about the reproducibility of the severity and morbidity measures, the data showed that AE can have substantial effects both financially and from a personal perspective for those affected.     

A randomized controlled trial using instant photography to diagnose and manage dermatology referrals

BACKGROUND: Fifteen percent of GP consultations are for dermatological conditions; 4% of these are referred to a dermatologist. There are long waiting lists for dermatology appointments. This study examines the value of instant photography in managing dermatology referrals. OBJECTIVE: The purpose of our study was to compare outcomes of referral for dermatology appointments between patients whose referral letters do or do not include instant photograph(s). METHODS: Patients (136), referred to a dermatologist by GPs in two urban health centres, were randomly allocated to study and control groups. Instant photographs, taken by the GP, were included in the referral letters. Control group patients were given out-patient appointments in the usual way. The numbers of study group patients needing an appointment for diagnosis or management and with a changed diagnosis after face-to-face consultation were recorded. Waiting time from referral to appointment or management plan was recorded for both groups. RESULTS: For 63% of the study group (45/71), a diagnosis and a management plan were made without the patient requiring an appointment. This included 38% (27/71) who, after diagnosis and initial management, needed an appointment and 25% (18/71) who did not. The remainder of the study group (37%; 26/71) required a face-to-face consultation. The mean time for formulation of a management plan for patients without an appointment was 17 days (SD = 11); waiting times for appointments in study and control groups were similar (mean 55 days; SD = 40). CONCLUSIONS: Instant photography is helpful in managing dermatology referrals and offers the potential to reduce numbers requiring an out-patient appointment by 25%.     

Morbidity in patients with hidradenitis suppurativa

BACKGROUND: Although skin diseases are often immediately visible to both patients and society, the morbidity they cause is only poorly defined. It has been suggested that quality-of-life measures may be a relevant surrogate measure of skin disease. Hidradenitis suppurativa (HS) leads to painful eruptions and malodorous discharge and is assumed to cause a significant degree of morbidity. The resulting impairment of life quality has not previously been quantitatively assessed, although such an assessment may form a pertinent measure of disease severity in HS. OBJECTIVES: To measure the impairment of life quality in patients with HS. METHODS: In total, 160 patients suffering from HS were approached. The following data were gathered: quality-of-life data (Dermatology Life Quality Index, DLQI questionnaire), basic demographic data, age at onset of the condition and the average number of painful lesions per month. RESULTS: One hundred and fourteen patients participated in the study. The mean +/- SD age of the patients was 40.9 +/- 11.7 years, the mean +/- SD age at onset 21.8 +/- 9.9 years and the mean +/- SD duration of the disease 18.8 +/- 11.4 years. Patients had a mean +/- SD DLQI score of 8.9 +/- 8.3 points. The highest mean score out of the 10 DLQI questions was recorded for question 1, which measures the level of pain, soreness, stinging or itching (mean 1.55 points, median 2 points). Patients experienced a mean of 5.1 lesions per month. CONCLUSIONS: HS causes a high degree of morbidity, with the highest scores obtained for the level of pain caused by the disease. The mean DLQI score for HS was higher than for previously studied skin diseases, and correlated with disease intensity as expressed by lesions per month. This suggests that the DLQI may be a relevant outcome measure in future therapeutic trials in HS.     

Interleukin-10 in cutaneous disorders: implications for its pathophysiological importance and therapeutic use

Abstract With its antiinflammatory and immunosuppressive properties interleukin-10 (IL-10) plays a dominant role in several immune reactions including regulatory mechanisms in the skin. The overexpression of this mediator has been reported in some inflammatory dermatoses as well as in various skin tumors. These observations are of importance since they may explain the limitation of hyperinflammatory conditions as in eczemas and erythemas on the one hand and the suppression of an adequate antitumor response and thereby the progression of malignant tumors on the other hand. Moreover, elevated IL-10 expression might contribute to an enhanced risk of development of microbacterial superinfections, a frequent finding in several dermatoses, and might also be involved in the pathogenesis of connective tissue diseases. In contrast, recent studies indicate a relative IL-10 deficiency in psoriasis. Early clinical data from psoriatic patients treated with recombinant human IL-10 suggest the therapeutic potential of this cytokine and underline its impact on the regulation of the skin immune system. Received: 11 October 1999 / Accepted: 19 October 1999     

线上教学对八年制医学生皮肤科学习的影响

目的　了解线上教学对北京大学第三医院八年制学生本科阶段皮肤科学习的影响。方法　对北京大学第三医院2020年应用线上教学及2016至2019年应用线下教学的八年制学生在皮肤科理论授课和见习之前和之后分别进行问卷调查,学习后进行笔试考试,对结果进行分析。采用SPSS 21.0软件进行t检验和Mann-Whitney U检验。结果　线上教学八年制学生总数53人,问卷回收率75.5%（80/106）;线下教学八年制学生总数166人,问卷回收率99.1%（329/332）。在理论授课和见习之后,线上教学的考试成绩好于线下教学（P<0.001）;线上教学的学生对于荨麻疹诊断能力的自我评价低于线下教学（P=0.008）;线上教学的学生对于皮肤科在医院中的重要程度评价（P<0.001）和对皮肤科的兴趣（P=0.002）高于线下教学;其他如对皮炎湿疹、痤疮诊断能力的自我评价、以皮肤科为职业的意愿度及皮肤科的难易程度等差异无统计学意义。60.0%（24/40）的学生提交了开放建议,其中最多的建议是希望增加线下见习[22.5%（9/40）]。结论　皮肤科线上教学形式的理论授课和见习对于学生知识点的掌握可能优于线下教学,也更能激发学生的学习兴趣,但学生对某些皮肤科常见病的诊治信心可能略低于线下教学。线上与线下结合可能在未来皮肤科教学中能够发挥更大优势,线上教学的形式和内容也亟须在实践中进一步改进。