The management of dysplastic naevi: a survey of Australian dermatologists

Abstract

Background/Objectives

The management of dysplastic naevi based on histopathological grading is a contentious issue. Comprehensive management guidelines are lacking and the approach taken varies between clinicians. The authors sought to understand how Australian dermatologists approach the management of biopsy-proven dysplastic naevi, and the impact of grading of dysplasia upon this management.

Methods

In total, 547 Fellows of the Australasian College of Dermatologists were surveyed and 218 responses were collected (40% response rate).

Results

Although all dermatologists surveyed would re-excise an incompletely removed severely dysplastic naevus, opinion was divided over whether to treat such a lesion as an in situ melanoma or a dysplastic naevus, with 55% of respondents using a 5-mm margin and the remainder opting for narrow margin re-excision. When the same lesion was reported to be clear of margins by 1 mm after biopsy and the clinical suspicion for melanoma was high, 44% would re-excise with a 5-mm margin.

Conclusions

The approach of Australian dermatologists to the management of dysplastic naevi varies between clinicians, reflecting the problems raised by the validity of histopathological grading.

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In this issue

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Clinicopathological analysis in PTCL-NOS with CADM1 expression

Abstract

Peripheral T cell lymphoma, not otherwise specified (PTCL-NOS), is a heterogeneous disease with respect to clinicopathological features. Cell adhesion molecule 1 (CADM1) has been reported to be ectopically expressed in adult T cell leukaemia/lymphoma (ATLL). However, the frequency of CADM1 expression remains unknown in peripheral T cell lymphomas. In the current study, CADM1 expression was analysed in 88 PTCL-NOS patients. CADM1 was expressed in 14 of 88 (15.9%) PTCL-NOS cases, and its expression was associated with C-C chemokine receptor type 4 (CCR4) expression and nuclear atypia. CADM1-positive PTCL-NOS cases (10/74) had a significantly poorer prognosis than CADM1-negative cases (64/74) (P = 0.001). Multivariate analysis confirmed that CADM1 expression was an independent prognostic factor in PTCL-NOS. These findings suggest that CADM1 expression is a novel prognostic factor for PTCL-NOS.

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Specific dermatological benefits associated with quantities of lotion transferred to the skin

Summary

Background

A growing number of manufacturers are taking advantage of the ability of absorbent consumer products to deliver lotion to the skin. The lotion is included on these products to help protect the skin from adverse skin effects that can occur, including: 1) irritation, 2) over hydration of the stratum corneum, 3) dryness that can occur from extended exposure to highly absorbent consumer products and 4) changes in pH.

Objective

This manuscript presents results of a quantitative lotion transfer study of adult incontinence products. Resulting lotion transfer is compared to the results of several separate experiments in which specific skin benefits have been correlated to lotion concentrations.

Methods

The Behind-the-Knee (BTK) lotion transfer protocol was used to quantitate lotion transfer from adult incontinence (AI) test products constructed using 2 lotion formulations and two configurations of lotion application. A modified arm patch protocol, in which skin sites of a measured dimension were pre-treated with specific volumes of lotion, was used to evaluate protective effects of lotion against exposure to irritants, and over hydration from wetted absorbent products.

Results

After a 6-hr continuous exposure in the BTK the five-stripe lotion configuration products transferred (adjusted mean ± SE) 94 ± 11 μg/cm₂ to 104 ± 11 μg/cm₂ lotion. After 24 hr of wear, transfer had increased to 127 ± 22 μg/cm₂ and 149 ± 24 μg/cm₂, respectively. The single-block configuration products transferred 289 ± 10 μg/cm₂ to 316 ± 10 μg/cm₂ (P = 0.04). Transfer after 24 hr of wear was 328 ± 23 μg/cm₂ and 472 ± 21 μg/cm₂, respectively (P < 0.0001). Several protocols were used to evaluate the concentration of lotion required to provide four specific skin benefits. In studies evaluating protection against irritants, skin site pre-treated with lotion were patched with 0.5% SLS. Protective effects were assessed by visual assessment of erythema and trans-epidermal water loss (TEWL). In the first experiment, lotion pre-treatment concentrations as low as 165 μg/cm₂ exhibited significantly (P < 0.05) lower erythema and TEWL compared to the positive irritant control (i.e., no lotion pre-treatment and SLS only). In the second experiment, lotion pre-treatment concentrations of 80 μg/cm₂ (P = 0.018) exhibited significantly (P = 0.018) lower TEWL. In two studies on protection from over hydration, lotion pre-treatment sites were subsequently patched with wetted absorbent consumer products. The change in TEWL was used as a measure of over hydration. Lotion concentrations significantly reduced the increase in TEWL at 80 μg/cm2 (P = 0.007) and 70 μg/cm2 (P ≤ 0.05). A BTK study was used to evaluate the ability of lotion to prevent dryness. After 6 hours of wear, test products transferring lotion concentrations of 110 or 133 μg/cm₂ produced significantly lower scores for dryness compared to products transferring 48 or 69 μg/cm₂. Using collagen sheets to mimic the stratum corneum, an in vitro study was conducted to measure the ability of lotion to prevent passage of high pH buffer solution. Results demonstrated that the lowest concentration of lotion that was tested (110 μg/cm₂) interfered with passage of the high pH buffer through the collagen sheet, delaying the rise in pH.

Conclusions

We can conclude that pretreatment with 110 μg/cm₂ lotion acts as a barrier to high pH fluids such as urine. Using the measurement of lotion transfer from the AI products, together with the results of studies conducted to determine the concentration of lotion required to provide specific skin benefits, we conclude that the five-stripe lotion configuration AI test products transferred enough lotion (i.e, ≥ 80 μg/cm₂) to provide skin protection with regard to: 1) irritant effects and 2) excess moisture. The single-block AI test products also transferred enough lotion to provide these skin benefits (i.e., ≥ 165 μg/cm₂), and the additional benefits of skin protection against: 3) dryness, and 4) changes in pH.

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Adult onset Kawasaki disease presenting with acute epiglottitis findings

Publication date: Available online 5 October 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Daichi Murakami, Gen Sugita, Mehmet Gunduz, Tomohiro Suenaga, Takashi Takeuchi, Hiroyuki Suzuki, Muneki Hotomi




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Risk factors of pediatric tinnitus: Systematic review and meta-analysis

Objectives/Hypothesis

Medications for pediatric tinnitus are not widely used due to a lack of evidence-based information. The modification of risk factors is essential in pediatric tinnitus; however, there is a lack of systematic reviews despite several reports on risk factors. This study performed a systematic review and meta-analysis of available literature to evaluate risk factors of pediatric tinnitus.

Methods

Studies reporting the risk factors of pediatric tinnitus were systematically reviewed by searching the MEDLINE, PubMed, and Embase databases for studies published from database inception to 2016. The selected articles included clinical or epidemiological studies conducted with at least 50 subjects and at least one risk factor, including age, gender, hearing loss, noise exposure, or smoking.

Results

Eleven studies involving a total of 28,358 individuals were identified. Increased age was not a significant risk factor with a standardized median difference of 0.16 (95% confidence interval [CI]: −0.01 to 0.33). However, there was a significant correlation between increased age and tinnitus in the adolescent population. The odds ratio (OR) was 1.37 for female gender (95% CI: 1.17 to 1.60), 2.39 for hearing loss (95% CI: 1.48 to 3.87), and 11.35 for noise exposure (95% CI: 1.87 to 68.77). Two studies in adolescents showed statistical significance for smoking as a risk factor in developing tinnitus (OR: 6.05, 95% CI: 1.81 to 20.21).

Conclusions

Older-aged adolescents, as well as those who are females and those with hearing loss may have a higher risk of tinnitus. Noise exposure in the general pediatric population and smoking in adolescents may represent especially important risk factors in pediatric tinnitus. Laryngoscope, 2017

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Adult normative data for phonatory aerodynamics in connected speech

Objectives/Hypothesis

To establish normative values for phonatory aerodynamic measurements in connected speech across adult ages and gender.

Study Design

Prospective data collection across group design.

Methods

One hundred fifty adults aged >18 years without voice complaints were stratified into three equal-age groups (group 1 [ages 18–39 years]; group 2 [ages 40–59 years], and group 3 [ages 60 + years]) and two equal-gender groups (male and female) resulting in 25 participants in each category. Participants read the first four sentences of the Rainbow Passage at comfortable pitch and loudness to obtain a connected speech sample. The following dependent variables were analyzed: breath number, reading passage duration, mean phonatory airflow, inspiratory airflow duration, and expiratory airflow duration.

Results

A gender effect was found for mean phonatory airflow, with males showing significantly greater phonatory airflow than females during connected speech (P < .001). Number of breaths was significantly greater for group 3 than group 2 (P < .001) and group 1 (P < .001). Duration, and inspiratory and expiratory airflow durations were all significantly greater for group 3 (P < .001) than group 2 (P < .001) than group 1 (P < .001).

Conclusions

This study provides normative data for phonatory aerodynamics in adult connected speech. Significant age and gender effects were observed. Laryngoscope, 2017

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