Cosmetic and functional outcomes of excisional surgical wounds healed by secondary intention: A systematic review

BackgroundData regarding short-term and long-term cosmesis and functional outcomes of excisional surgical wounds healed by secondary intention healing (SIH) are limited.ObjectiveTo conduct a systematic review and assess the cosmetic and functional acceptability of SIH for acute excisional surgical wounds.MethodsFull-text articles queried from PubMed and Embase databases between January 1964 and April 2024 with cosmetic outcome data of human subjects with acute surgical wounds healed by SIH were included. Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines were followed.ResultsA total of 1655 surgical wounds, of which 1518 (91.7%) healed by SIH, from 35 studies, were included in this review. The most frequent indication for SIH was a defect resulting from excision of nonmelanoma skin cancer (keratinocyte carcinoma), which was identified in 1439 (86%) of patients. Common sites for SIH included the nose (23.3%), periocular region (15.46%), and forehead (13.5%). The majority of wounds on the forehead, medial canthus, lower eyelid, nasal ala, cheeks, lips, postauricular area, and feet resulted in good to excellent cosmetic results, whereas those on the scalp, nasal dorsum, nasal tip, nasal sidewall, and chin yielded less acceptable cosmetic results. Given the baseline variability in cosmesis of primarily closed wounds in some anatomic locations, however, these data suggest the need for future prospective studies.SummarySIH may produce an acceptable cosmetic and functional outcome for selected defects and may be of clinical benefit in the appropriate setting. This must be weighed against the potentially improved cosmesis and more rapid healing seen with primarily closed defects

396 Characterizing inpatient hospitalizations for hidradenitis suppurativa and assessing the impact of outpatient dermatology care on hospitalizations

Introduction: Hidradenitis suppurativa (HS) is associated with a significant disease burden. The use of high-cost settings care are common among HS patients. Objective: To explore factors that may influence hospital admissions and readmissions among HS patients. Methods: Using ICD-9/10 codes (705.83 and L73.2), we extracted the medical records of adult HS patients who visited the Henry Ford Health System (HFHS) ED between 2010 and 2020. Results: Of the 100 HS patients, 52 (52%) were admitted to an inpatient service. Hypertension (OR:2.55,95% CI:1.11-5.83, p value=0.027), diabetes mellitus (OR:2.42, 95%CI:1.05-5.61, p value =0.039), cellulitis (OR: 19.28, 95%CI:4.23-87.96 p\u3c0.001), sepsis (OR:10.25, 95%CI:1.34-89.24, p value=0.025), and depression (OR:3.32, 95%CI:1.10-10.04, p value =0.002) were significant predictors of admission. Chronic kidney disease (OR:3.05, 95% CI:1.00-9.23,p value=0.049), congestive heart failure (OR:4.06, 95%CI:1.19-13.80, p value =0.025), coronary artery disease (OR:15.20, 95%CI:2.80-82.65, p value=0.002), chronic obstructive pulmonary disease (OR:8.94, 95%: 1.51-52.86, p value =0.003), cellulitis (OR:4.62, 95%CI:1.66-12.88, p=0.003), sepsis (OR:3.75, 95%CI:1.02-13.82,p value =0.047), and depression (OR:4.50, 95%CI:1.54-13.18, p value=0.006) were positively associated with readmission. Those who received outpatient dermatology care had a lower risk of being admitted (n=87, 28.7% vs n=13,100%, p \u3c0.001) and readmitted (n=10, 11.5% vs n=5, 38.5%, p value =0.0108). Discussion: In this study, we demonstrate that certain comorbidities, that are common among HS patients, are significant determinants of admission to an inpatient service. Furthermore, the increase access to outpatient dermatology care significantly reduces the likelihood of HS patients being admitted and readmitted. Conclusion: The findings of this study illuminate the pivotal role of dermatologists in improving patients’ health outcomes while minimizing the avoidable use of high-cost settings care

Towards an Analytical Habitability Grid for Heritage: the Medina of Mostaganem as a Case Study

Conservation of historic cities is limited in many countries to valorization and safeguarding which is performed utilizing several types of interventions. Many countries aware of the importance of their heritage in the development of human life, are currently concerned with their inhabitants’ participatory role in conservation. The historic cities in Algeria are not immune to this fact. Nowadays, particular attention is paid to the quality of life in historic Algerian cities which are in continuous transformation. It has become an urgent issue to inquire into the state of these medinas. The aim of this article is to design an analysis grid of habitability for these historical cities in order to interpret the quality of life, as well as the understanding of the man-made quest for ideal livability. The adopted methodology is divided into two parts: first, making the grid and second, its projection and analysis. Application of the grid requires very diverse data and a field of study. For this purpose, several tools were mobilized: a questionnaire survey, field measurements and direct diagnosis. For a positive outcome to the research, fieldwork is essential. This is the case study of the Medina of Mostaganem.La conservazione delle città storiche è limitata, in molti Paesi, alla valorizzazione e alla salvaguardia che viene eseguita utilizzando diversi tipi di interventi. Molti Paesi, consapevoli dell'importanza del loro patrimonio nello sviluppo della vita umana, sono attualmente interessati al ruolo partecipativo dei loro abitanti nella conservazione. Le città storiche in Algeria non sono immuni da questo fatto.Oggigiorno, particolare attenzione è rivolta alla qualità della vita nelle città storiche algerine che sono in continua trasformazione. Analizzare lo stato di queste città storiche è diventato un problema urgente. Lo scopo di questo articolo è di progettare una metodologia di analisi di abitabilità al fine di interpretare la qualità della vita e comprendere gli standard di vivibilità ideale.La metodologia adottata è divisa in due parti: la griglia e la sua proiezione e analisi. L'applicazione della griglia richiede dati molto diversi e un settore di studio. A tal fine, sono stati utilizzati diversi strumenti: un questionario, misurazioni sul campo e analisi diretta. Per il positivo risultato della ricerca è essenziale il lavoro sul campo: il caso studio presentato é relativo alla città di Mostaganem

Demographics and clinical presentations of 844 patients with light and dark skin types with polymorphous light eruption and chronic actinic dermatitis evaluated over 23 years

INTRODUCTION: Polymorphous light eruption (PMLE) and chronic actinic dermatitis (CAD) have been classically described in White individuals, although recent studies have reported higher prevalence in patients with dark skin types, particularly African Americans. OBJECTIVE: To evaluate for differences in demographic, and clinical features between persons with light and dark skin types who have PMLE and CAD. METHODS: Retrospective review of patients with PMLE and CAD who were diagnosed from January 1, 1998, through November 31, 2021, at a single academic dermatology center. RESULTS/DISCUSSION: A total of 844 patients (725 [85.9%] female; mean [SD] age of onset: 41.7 [16.9] years) were diagnosed with PMLE, and 60 patients (22 [36.6%] female; mean age, [SD]: 60.6 [10.6] years) of age at presentation, disease duration of 8.2 [7.3] years were diagnosed with CAD. Although just over 50% of the general clinic population was White, the prevalence of PMLE and CAD was significantly higher in dark-skinned individuals compared to light-skinned individuals (PMLE: 625 [74.0%] vs. 219 [25.9%], p value \u3c .001; CAD: 43 [71.6%] vs. 17 [28.3%], p value = .003) respectively. The pinpoint papular variant of PMLE (PP-PMLE) was predominantly seen in dark-skinned individuals. CONCLUSION: A substantial proportion of PMLE and CAD cases are present in dark-skinned individuals. PP-PMLE can be mistaken for lichen nitidus. As such, recognition of this entity is important for adequate evaluation and management of patients with PMLE

Evaluating the Impact of Exclusion Criteria on the Generalizability of Hidradenitis Suppurativa Treatment Research

Exclusion criteria can limit the generalizability and translation of research findings into clinical practice. The objective of this study is to characterize the trends of exclusion criteria and explore the impact of exclusion criteria on participant diversity, length of enrollment, and the number of enrolled participants. A detailed search was performed using PubMed and clinicaltrials.gov. Nineteen published randomized controlled trials were included, where 2,664 patients were screened, and 2,234 patients (mean age: 37.6 years, 56.6% female) were enrolled from 25 countries. On average, there were 10.1 (standard deviation: 6.14, range: 3-25) exclusion criteria per randomized controlled trial. There was a weak to moderate positive correlation between the number of exclusion criteria and the proportion of enrolled participants (R = 0.49, P value = 0.040). However, no association was seen between the number of exclusion criteria, number of enrolled Black participants (R = 0.86, p value = 0.08), and enrollment length (R = 0.083, P value = 0.74). In addition, there was no discernable trend in the number of exclusion criteria over time (R = -0.18, P value = 0.48). Although the number of exclusion criteria appeared to impact the number of enrolled participants, the lack of skin of color representation in hidradenitis suppurativa randomized controlled trials does not appear to be influenced by the number of exclusion criteria

Cannabinoids for the Treatment of Dermatologic Conditions

In recent years, cannabinoid (CB) products have gained popularity among the public. The anti-inflammatory properties of CBs have piqued the interest of researchers and clinicians because they represent promising avenues for the treatment of autoimmune and inflammatory skin disorders that may be refractory to conventional therapy. The objective of this study was to review the existing literature regarding CBs for dermatologic conditions. A primary literature search was conducted in October 2020, using the PubMed and Embase databases, for all articles published from 1965 to October 2020. Review articles, studies using animal models, and nondermatologic and pharmacologic studies were excluded. From 248 nonduplicated studies, 26 articles were included. There were 13 articles on systemic CBs and 14 reports on topical CBs. Selective CB receptor type 2 agonists were found to be effective in treating diffuse cutaneous systemic sclerosis and dermatomyositis. Dronabinol showed efficacy for trichotillomania. Sublingual cannabidiol and Δ-9-tetrahydrocannabinol were successful in treating the pain associated with epidermolysis bullosa. Available evidence suggests that CBs may be effective for the treatment of various inflammatory skin disorders. Although promising, additional research is necessary to evaluate efficacy and to determine dosing, safety, and long-term treatment guidelines

Tolerability profile of topical cannabidiol and palmitoylethanolamide: a compilation of single-centre randomized evaluator-blinded clinical and in vitro studies in normal skin.

BACKGROUND: An increasing number of studies have investigated the adverse effect profile of oral cannabinoids; however, few studies have provided sufficient data on the tolerability of topical cannabinoids in human participants. AIM: To assess the tolerability profile of several commercial topical formulations containing cannabidiol (CBD) and palmitoylethanolamide (PEA) on the skin of healthy human participants. METHODS: Three human clinical trials and one in vitro study were conducted. The potential for skin irritation, sensitization and phototoxicity of several products, were assessed via patch testing on healthy human skin. The products assessed included two formulations containing CBD and PEA, one containing hemp seed oil and four concentrations of CBD alone. Ocular toxicity was tested using a traditional hen\u27s egg chorioallantoic membrane model with three CBD, PEA and hemp seed oil formulations. RESULTS: There was no irritation or sensitization of the products evident via patch testing on healthy participants. Additionally, mild phototoxicity of a hemp seed oil product was found at the 48-h time point compared with the negative control. The in vitro experiment demonstrated comparable effects of cannabinoid products with historically nonirritating products. CONCLUSION: These specific formulations of CBD- and PEA-containing products are nonirritating and nonsensitizing in healthy adults, and further encourage similar research assessing their long-term safety and efficacy in human participants with dermatological diseases. There are some limitations to the study: (i) external validity may be limited as formulations from a single manufacturer were used for this study, while vast heterogeneity exists across unregulated, commercial CBD products on the market; and (ii) products were assessed only on normal, nondiseased human skin, and therefore extrapolation to those with dermatological diseases cannot be assumed

Evidence-Based Consensus on the clinical application of Photobiomodulation

BackgroundThere is a lack of evidence-based consensus to assist clinicians in using photobiomodulation (PBM).ObjectiveTo create a consensus on the safe and effective use of PBM.MethodsA systematic literature review of Embase and MEDLINE was conducted in June 2022 to identify publications reporting research on PBM. An international multidisciplinary panel was convened to draft recommendations informed by the systematic search; they were refined through 2 rounds of Delphi survey, 2 consensus meetings, and iterative review by all panelists until unanimous consensus was achieved.ResultsA multidisciplinary panel of experts (n = 21) was assembled based on publication history. The key findings that informed the consensus developed by the expert panel were as follows: PBM is a safe treatment modality for adult patients and red light PBM does not induce DNA damage. PBM is an effective treatment option for peripheral neuropathy, androgenic alopecia, wound ulcers due to multiple etiologies, decubitus ulcers, pain attributed to diabetic foot ulcers, and acute radiation dermatitis.ConclusionThe systematic literature search and structured Delphi consensus approach culminated in an evidence-based clinical practice guideline for safe and effective use of PBM in medical and aesthetic applications. Future research will further bolster our understanding of this evolving noninvasive technique

Apport à court terme de l’électrothérapie antalgique (TENS) dans le traitement conservateur des lésions de la coiffe des rotateurs non opérées.

Objectif :Evaluer l’apport à court terme de l’électrothérapie antalgique type TENS en cas de lésions de la coiffe des rotateurs non opérées, et ce sur les plans douloureux, articulaire et musculaire en vue de confirmer ou infirmer l’efficacité de la technique.   Les résultats de l’étude vont ainsi contribuer l’utilisation argumentée des techniques de physiothérapie utilisées dans le traitement conservateur de ce type de lésions.Méthodes :Il s’agit d’un essai clinique randomisé contrôlé en double aveugle mené au niveau du service de rhumatologie P43 du CHU IBN ROCHD de Casablanca. La population à l’étude est de 30 patients souffrant de lésions non opérées  de la coiffe des rotateurs répartis en deux séries : Série A  (n=15), groupe dont les patients bénéficient de l’application du TENS en plus du traitement kinésithérapique de référence et Série B (n=15),  groupe de référence; pour une durée de six séances. Le score d’évaluation scapulaire de Constant est l’outil d’évaluation utilisé en début et en fin de traitement