Dermatology practical & conceptual最新文献

Background: Pemphigus vulgaris (PV) is an autoimmune bullous disease that usually starts on the oral mucosa, but it can affect all mucosal surfaces. There are limited data about endoscopic otorhinolaryngological examination of patients with PV.

Objective: To assess the prevalence of nasal, pharyngeal, and laryngeal involvement in patients with PV and to determine its correlation with clinical symptoms.

Methods: Thirty-four patients with pemphigus vulgaris were questioned for rhinorrhea, epistaxis, hoarseness, and throat pain. All patients' nasal, oral, hypopharyngeal, and laryngeal mucosa were then examined endoscopically by the same otolaryngologist, and mucosal lesion localizations were noted. The association between symptoms and lesion localization was assessed using the chi-squared test.

Results: The study included 34 patients, 14 (41.2%) males and 20 (58.8%) females; 32 (94.1%) patients had oral mucosal involvement. Nasal, hypopharyngeal, and laryngeal involvement were detected in 52.9%, 58.8%, and 55.9% of cases, respectively. Endoscopic examination revealed lesions in areas other than the oral mucosa in 30 patients, with 24 (70.6%) exhibiting symptoms related to these regions. Nasal bleeding was a significant symptom of nasal involvement (P=0.006), whereas nasal obstruction was not (P=0.388). Throat pain was significantly associated with hypopharyngeal involvement (P=0.003), while hoarseness showed marginal significance (P=0.05). No significant association was found between laryngeal or tonsillar involvement and any symptom.

Conclusion: The study demonstrates that a significant proportion of pemphigus vulgaris patients have silent mucosal involvement. This suggests that symptom-based evaluations may be insufficient and that systematic endoscopic screening could play a critical role in PV management.

Introduction: Magnified dermoscopy (MD), or optical super-high magnification dermoscopy, is an emerging technique in dermatology.

Objectives: The study aimed to evaluate the distribution of conventional dermoscopy, MD, and reflectance confocal microscopy (RCM) features in dermoscopically equivocal pigmented lesions and to estimate their diagnostic accuracy.

Methods: A retrospective analysis of conventional dermoscopic (20x), MD (400x), and RCM images of dermoscopically equivocal pigmented lesions, diagnosed as either nevi or melanoma, was performed. Distribution of features, sensitivity, and specificity for dermoscopy, MD, RCM, and a combination of these last two with conventional dermoscopy was estimated.

Results: A total of 74 nevi and 20 melanomas were included in the analysis. A positive correlation was observed between seven-point checklist in conventional dermoscopy and the diagnosis of melanoma. With MD, a significant correlation between dots, non-edged papillae, and melanoma was observed, but the technique did not have a significant impact on diagnostic accuracy as compared to traditional dermoscopy. On the other hand, RCM, alone or in combination with traditional dermoscopy, proved to increase diagnostic accuracy, in particular, specificity for melanoma diagnosis.

Conclusions: RCM has a defined role in increasing diagnostic accuracy of doubtful dermoscopic lesions, while the role of MD in clinical practice has yet to be defined, and methodologic standardization as well as a revision of terminology is encouraged to improve the recognition of features.

Introduction: Infiltrative anesthesia with lidocaine plays a vital role in pain management during dermatological procedures, ensuring patient comfort throughout the process.

Objective: We aimed to investigate the correlation between three different concentrations of lidocaine (2% lidocaine with 1:100,000 epinephrine diluted at ratios of 1:2, 1:4, and 1:6) used in infiltrative anesthesia and their analgesic efficacy and adverse effects in dermatological procedures.

Methods: This study employed a randomized design, with 240 patients assigned to receive varying concentrations of lidocaine with epinephrine (2% lidocaine with 1:100,000 epinephrine diluted at ratios of 1:2, 1:4, or 1:6) during seven common dermatological procedures: punch biopsy, excisional biopsy, CO2 laser biopsy, surgical excision, CO2 laser excision, fractional CO2 laser treatment, and filler injection. Total lidocaine dosage and patient comfort assessments were recorded for each participant.

Results: All three lidocaine concentrations demonstrated comparable analgesic efficacy during the procedures, as measured by visual analog scale scores. The 1:6 dilution group required a significantly lower lidocaine dose, with a 39.3% reduction compared to the 1:4 dilution group and a 75.3% reduction compared to the 1:2 dilution group (P<0.001). The 1:6 dilution group experienced significantly less pain during injection than that of the 1:4 dilution group and the 1:2 dilution group (P<0.001).

Conclusion: Lidocaine 2% with 1:100,000 epinephrine at dilutions ranging from 1:2 to 1:6 for infiltrative anesthesia in dermatological procedures provided similar analgesic efficacy. Importantly, the 1:6 dilution significantly reduced both injection pain and total lidocaine dosage. More studies are required to confirm our results.