David J. Kouba

Nevus of Ota Successfully Treated by Fractional Photothermolysis Using a Fractionated 1440-nm Nd:YAG Laser

A 46-year-old man of Japanese descent presented with a pigmented patch under his right eye that had been present since birth. He had no history of ocular disease, hearing loss, or use of medications that produce pigmentation. Throughout his early life, the lesion had been significantly larger, and 25 years before he presented to our clinic, it had been partially excised, resulting in a smaller patch with some white central scarring that was visible in the center (Figure 1). Physical examination revealed a blue-gray, hyperpigmented, poorly defined patch on the right infraorbital cheek area. There was no pigmentary disturbance of either eye or the oral mucosa. Other than long-standing, bilateral tear-trough deformity–related hyperpigmentation, the patient had no other pigmented macules or patches on his head or neck.

Adverse Events Associated With Mohs Micrographic Surgery Multicenter Prospective Cohort Study of 20 821 Cases at 23 Centers

IMPORTANCE Detailed information regarding perioperative risk and adverse events associated with Mohs micrographic surgery (MMS) can guide clinical management. Much of the data regarding complications of MMS are anecdotal or report findings from single centers or single events. OBJECTIVES To quantify adverse events associated with MMS and detect differences relevant to safety. DESIGN, SETTING, AND PARTICIPANTS Multicenter prospective inception cohort study of 21 private and 2 institutional US ambulatory referral centers for MMS. Participants were a consecutive sample of patients presenting with MMS for 35 weeks at each center, with staggered start times. EXPOSURE Mohs micrographic surgery. MAIN OUTCOMES AND MEASURES Intraoperative and postoperative minor and serious adverse events. RESULTS Among 20 821 MMS procedures, 149 adverse events (0.72%), including 4 serious events (0.02%), and no deaths were reported. Common adverse events reported were infections (61.1%), dehiscence and partial or full necrosis (20.1%), and bleeding and hematoma (15.4%). Most bleeding and wound-healing complications occurred in patients receiving anticoagulation therapy. Use of some antiseptics and antibiotics and sterile gloves during MMS were associated with modest reduction of risk for adverse events. CONCLUSIONS AND RELEVANCE Mohs micrographic surgery is safe, with a very low rate of adverse events, an exceedingly low rate of serious adverse events, and an undetectable mortality rate. Common complications include infections, followed by impaired wound healing and bleeding. Bleeding and wound-healing issues are often associated with preexisting anticoagulation therapy, which is nonetheless managed safely during MMS. We are not certain whether the small effects seen with the use of sterile gloves and antiseptics and antibiotics are clinically significant and whether wide-scale practice changes would be cost-effective given the small risk reductions.

Clinicopathologic features of ulcerative-atrophic sarcoidosis.

Background  Sarcoidosis is a chronic granulomatous disease of unknown etiology. Cutaneous disease is common and includes two clinicopathologic categories: granulomatous infiltration or a reactive phenomenon. In the granulomatous infiltrative group, clinical manifestations can be variable. Ulcers in sarcoidosis are uncommonly recognized and have been categorized previously under the rubric of atrophic, necrobiosis‐like, or ulcerative sarcoidosis.

Downregulation of NDUFA1 and other oxidative phosphorylation-related genes is a consistent feature of basal cell carcinoma.

Abstract:  Basal cell carcinoma (BCC) is the most common cutaneous malignancy that, like other tumours, possesses a heterogeneous genetic composition. In order to select genes with consistent changes in expression among these tumours, we analysed BCC microarray expression data by using a novel approach, termed correlative analysis of microarrays (CAM). CAM is a nested, non‐parametric method designed to qualitatively select candidates based on their individual, similar effects upon an array‐wide closeness measure. We applied the CAM method to expression data generated by two‐channel cDNA microarray experiments, where 21 BCC and patient‐matched normal skin specimens were examined. Fifteen candidate genes were selected, with six overexpressed and nine underexpressed in BCC vs. normal skin. Five of the nine consistently downregulated genes in the tumour samples are involved in mitochondrial function and the oxidative phosphorylation (OXPHOS) pathway. One of these genes was the 7.5‐kDa subunit, NADH dehydrogenase (ubiquinone) alpha subcomplex‐1 (NDUFA1), an accessory component of OXPHOS complex‐I that is essential for respiratory activity. These findings support the hypothesis that irregularities in mitochondrial function are involved in neoplasia. Suppression of NDUFA1 expression could represent a key pathogenic mechanism in the development of BCC.

Henoch–Schönlein purpura in pregnancy

Henoch–Schönlein purpura (HSP) is an IgA‐mediated small vessel vasculitis which commonly involves the skin, gastrointestinal system and kidneys. Numerous HSP triggers have been identified, and pregnancy has been reported as an exacerbating factor. After a pregnant woman had been diagnosed as having new‐onset HSP, we reviewed all cases of immunofluorescence‐proven HSP evaluated by the Department of Dermatology at the Johns Hopkins Hospital between 1990 and 2002, and report three cases of HSP occurring during pregnancy. Two patients developed new‐onset HSP, one at 16 weeks gestation and one at 22 weeks, while the third developed a recurrence of HSP at 12 weeks gestation after 19 years of remission. We conclude that pregnancy may be a trigger for HSP onset or recurrence in susceptible individuals.

Guidelines for the use of local anesthesia in office-based dermatologic surgery

There are an increasing number and variety of dermatologic surgical procedures performed safely in the office setting. This evidence-based guideline addresses important clinical questions that arise regarding the use and safety of local anesthesia for dermatologic office-based procedures. In addition to recommendations for dermatologists, this guideline also takes into account patient preferences while optimizing their safety and quality of care. The clinical recommendations presented here are based on the best evidence available as well as expert opinion.

Office-Based Cosmetic Procedures and Techniques: FILLERS AND NEUROTOXINS

Of course, from childhood to forever, we are always thought to love reading. It is not only reading the lesson book but also reading everything good is the choice of getting new inspirations. Religion, sciences, politics, social, literature, and fictions will enrich you for not only one aspect. Having more aspects to know and understand will lead you become someone more precious. Yea, becoming precious can be situated with the presentation of how your knowledge much.