Gloria F. Graham

The Acne Quality of Life Index (Acne-QOLI): development and validation of a brief instrument.

AbstractBackground: Acne affects many people and can be detrimental to affected patients’ quality of life. Assessing the impact of acne on quality of life requires well-validated and reliable measures of acne-specific quality of life that are brief and easy to administer and interpret. Objectives: This paper reports on the development and validation of the Acne Quality of Life Index (Acne-QOLI) for use in clinical care, research, and product development. Methods: Focus groups consisting of people from demographically different populations were conducted to identify the most relevant domains of functioning affected by acne; on the basis of these findings, candidate items were developed. An initial item pool of 58 items was included in a survey of 480 persons with mild to severe acne ranging in age from 12 to 62 years. Factor analysis and qualitative analysis were used to reduce the item pool to 21 items. The construct validity, concurrent validity, internal consistency, and test-retest reliability of the items were evaluated. Results: The 21-item Acne-QOLI showed excellent face validity, content validity, concurrent validity, and construct validity. High internal consistency and test-retest reliability were also found. Conclusions: Quality of life is now recognized as an important outcome in medical care. The Acne-QOLI is a brief and easily administered and interpreted measure of acne-related quality of life that can be used in clinical care, research, and product development.

Prevention and Management of Complications

Prevention of complications is important for all cryosurgeons to fully understand. Immediate reactions such as erythema, vesicle and bullae may be decreased if certain steps are followed.

Electrodesiccation and Curettage

Curettage alone or in combination with electrodesiccation has been used for the treatment of skin cancer. While the curette was developed in the 1870s, electrodesiccation was first used in 1911 by Clark when a high-voltage, low-current electrode was applied to the skin and resulted in drying of tissue. It was not until later that the combination of curettage and electrodesiccation gained acceptance for low-risk lesions such as superficial and nodular basal cell carcinomas.

Method and Equipment Selection

Main methods to deliver cryogens include the cryospray and the cryoprobe techniques. A flat cryoprobe applied with pressure can result in a deeper freeze in relation to lateral spread than obtained with the spray method. A pointed cryo probe tip produces an ice ball that is deeper than its radius on the surface whereas a round probe produces a hemisphere-shaped ice ball. Open-ended cryoprobes are devices where a central opening sprays nitrogen on center of a lesion rather than near the enclosed periphery. This is best used with a pyrometer or electrical impedance needle. When selecting a cryosurgical unit find one that is well constructed and has a good safety record. The cryogen of choice is generally LN. Solid carbon dioxide can be used for treatment of benign lesions. Nitrous oxide units are available but have disadvantages and are not recommended for treatment of malignant lesions. Fluorocarbon sprays can be used for treatment of acne pustules and cysts and for peeling of the skin surface, for acne scarring as well as treating plaques of psoriasis, actinic or seborrheic keratoses.

Patient Selection and Related Contraindications

Selecting the proper patients for cryosurgery is as important as a proper technique. Cold has the ability to reduce pigment and redness of rosacea or other vascular changes these must be given prime consideration. Consider the Fitzpatrick skin type, general health, anticoagulant medication, presence of flushing from rosacea, marked lentiginous skin and severe dispigmentation from photo damage or melasma. Problems associated with cryofibrogenemia, cryoglobulinemia and cryourticaria are important conditions to ask about in the history. While pacemakers were a reason in the past for selecting freezing, many today are solid state and are no longer prone to be altered by the electrocautery or electrolysis.

Evolution of the Cryo-lesion

Expected results after freezing are erythema, urtication, and edema which may last for several days. If freezing is superficial, vesicles or bullae developed. Bullae may become hemorrhagic. When treating malignances, a more gelatinous appearance may result. The stroma is more resistant to freezing than the cellular elements. Healing for most lesions takes place within 2 weeks for benign or premalignant lesions to 4–6 weeks for malignant lesions. Systemic steroids may be used to prevent swelling around the periorbital area.

Squamous Cell Carcinoma

Cutaneous squamous cell carcinoma (CSCC) is the second most common nonmelanoma skin cancer in the United States, with 700,000 new cases diagnosed yearly. Keratoacanthoma, squamous cell carcinoma in situ, precancerous lesions and CSCC will be discussed in this chapter. As more studies report the self-healing tendency of Keratoacanthoma (KA), cryosurgery is used frequently unless the tumor is already beginning to regress. Excision or shave biopsy, which can be followed by freezing for 30–60 s, extirpates these tumors frequently. Excisional biopsy, intralesional therapy or topical therapy and radiotherapy are other options.

Lesion Selection and Related Contraindications

Cryosurgery is used commonly to treat both benign and malignant skin lesions: the medical professional treating the condition must select the best method from among the many available today. This chapter deals with selection of lesions that are best suited for cryosurgery. Though there are hardly strict confines to what can or cannot be treated this chapter will discuss lesions commonly treated by cryosurgery and general contraindications as well as some lesions where cryosurgery is not the best recommendation.

Therapeutic Principles and Techniques

Cryosurgery is based on removing heat from a tissue by applying cold and this is accomplished by using a cryogen with a probe, spray or cotton swab. The selection depends on the depth of freeze needed to accomplish removing a lesion and a cotton swab may be used for a wart but is inadequate for a skin cancer. The size of the target is also important as lesions over 2 cm may be treated in stages or referred for excision or MOHS surgery.