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American Academy of Dermatology Acne Guidelines of Care versus Modern Skincare Trends
Get PDFAcne vulgaris remains one of the most prevalent dermatologic conditions worldwide, yet its management has become increasingly influenced by pop culture trends and consumer marketing. This review critically compares the American Academy of Dermatology (AAD) guidelines for acne treatment with the most popular skincare practices of the 2020s, including natural remedies, light therapy, and multi-step routines popularized through platforms like TikTok and Instagram. By examining the scientific evidence supporting AAD-recommended treatments, such as topical retinoids, benzoyl peroxide, and systemic therapies, and contrasting them with trending regimens that often lack clinical validation, this paper explores the widening gap between expert guidance and real-world consumer behavior. While some overlaps exist, many viral skincare trends risk overuse, irritation, or delay in effective treatment. Ultimately, this comparison underscores the need for improved dermatologic literacy among consumers and advocates for greater collaboration between dermatologists and online content creators. By bridging the divide between evidence-based care and popular culture, the dermatology community can help patients make safer, more informed decisions in managing acne
Facial Dermatoses in E-Cigarette Users and the Role of Nicotine-Induced Oxidative Stress
Get PDFFacial dermatoses in e-cigarette users arise from nicotine-induced oxidative stress, inflammatory signaling, and barrier dysfunction, contributing to an increased prevalence of acneiform eruptions, perioral dermatitis, and rosacea exacerbations. E-cigarette aerosols contain nicotine, volatile organic compounds, and reactive oxygen species (ROS) that disrupt cutaneous homeostasis by impairing antioxidant defense mechanisms and promoting lipid peroxidation in the epidermis. Nicotine exposure induces mitochondrial dysfunction in keratinocytes and sebocytes, leading to dysregulated sebum production, enhanced Cutibacterium acnes colonization, and increased susceptibility to inflammatory acne. Additionally, nicotine-mediated vasoconstriction and endothelial dysfunction reduce dermal microcirculation, compromising oxygen delivery and delaying wound healing, while heightened expression of pro-inflammatory cytokines such as IL-1β, IL-6, and TNF-α further amplifies cutaneous inflammation. Perioral dermatitis in e-cigarette users may result from a combination of vaporized chemical irritants, barrier disruption, and dysbiosis, paralleling the effects seen with traditional cigarette smoking but with unique patterns of dermal exposure. Emerging evidence also suggests an association between chronic e-cigarette use and exacerbations of rosacea, possibly linked to nicotine’s role in neurovascular dysregulation. Identifying the dermatologic consequences of e-cigarette use reinforces the need for targeted patient counseling, oxidative stress mitigation strategies, and further research into the long-term cutaneous effects of vaping
Serial Irrigation and Debridement with the Use of Kerecis in the Treatment of Necrotizing Fasciitis: A Case Report
Get PDFIntroduction: Necrotizing fasciitis is a life-threatening infection that requires emergent irrigation and radical debridement. One of the challenges surgeons often encounter is gaining adequate soft tissue coverage of the defects that remain after debridement. Kerecis SurgiClose (Coloplast, Denmark), a fish skin xenograft, is one option for wound coverage. This has demonstrated potential for fostering an environment beneficial for wound healing in various types of wounds.
Case presentation: A 39-year-old female presented to the emergency department with a one-week history of left knee pain after a fall. She had a wound on the anterior knee, which began to develop erythema. Necrotizing fasciitis was diagnosed with the patient’s Laboratory Risk Indication of Necrotizing Fasciitis (LRINEC) score of 10. She was started on antibiotics and was taken to surgery. She underwent debridements until a bed of healthy tissue was appreciated. Kerecis SurgiClose was applied over the defect which helped create a healthy tissue bed prior to placing a skin autograft. After grafting, daily dressing changes started and evident healing in the recipient site was seen.
Conclusion: This case demonstrates the importance of early diagnosis of necrotizing fasciitis, as well as the utility of fish xenografts in wound coverage once a healthy tissue environment is established. These xenografts are used for many types of wounds, however there is a paucity in the literature supporting their use in necrotizing soft tissue infections. The properties of these grafts potentiate various aspects of healing and show promising results in the healing of deep soft tissue voids
Comparative Efficacy of Dorsal Root Ganglion Versus Spinal Cord Stimulation in the Management of Complex Regional Pain Syndrome and Failed Back Surgery Syndrome: A Narrative Review
Get PDFBackground: Complex Regional Pain Syndrome (CRPS) and Failed Back Surgery Syndrome (FBSS) are challenging neuropathic pain conditions often refractory to conservative treatment. Neuromodulation offers a promising solution, particularly with spinal cord stimulation (SCS) and dorsal root ganglion stimulation (DRG-S).
Objective: This review compares DRG-S and SCS in CRPS and FBSS to evaluate their relative efficacy, safety, and clinical utility.
Methods: A narrative literature review was conducted using peer-reviewed sources focusing on the use of DRG-S and SCS in CRPS and FBSS populations.
Results: DRG-S offers enhanced targeting of focal pain areas in CRPS, while SCS provides broader coverage useful in FBSS. DRG-S demonstrates superior outcomes in CRPS regarding pain relief and functional improvement. Lead migration, a common complication in both, is reportedly lower in DRG-S.
Conclusion: DRG-S is particularly effective in CRPS due to precise anatomic targeting, while SCS remains valuable in FBSS. Further randomized studies are needed to confirm long-term comparative efficacy
A Series of Successful Emergency Department Thoracotomies With Expeditious Recovery
Get PDFResuscitative thoracotomy is an invasive, morbid procedure indicated in the emergent management of blunt or penetrating trauma to the chest. It allows for rapid access to the thoracic cavity and treatment of the underlying pathology. Survival following traumatic cardiac injury relies on a near-impeccable combination of rapid assessment by properly trained emergency medical services personnel, rapid transport to a capable emergency center, accelerated access to the thoracic cavity within 10 min of cardiopulmonary resuscitation initiation, and excellent perioperative resuscitation. Overall survival rate following resuscitative thoracotomy in the United States is 9.6%. In addition, not all who survive make an acceptable neurocognitive recovery, with one large meta-analysis quoting only 92.4%. We report on two patients who survived and made a complete neurocognitive recovery following emergency department thoracotomy secondary to penetrating cardiac trauma. Both patients were discharged from the hospital within 16 days of their emergency department thoracotomy
Cognitive Workload During a Sustained Visual Attention Task in Middle-Aged and Older Adults With Persistent Symptoms After a Mild Traumatic Brain Injury
No full textBackground
Individuals with prolonged symptoms after a mild traumatic brain injury (mTBI) report requiring more effort to complete complex and sustained activities. However, the relationship between cognitive workload and patient-reported symptoms is unclear.
Objective
To compare the cognitive workload between middle-aged and older adults with persistent symptoms after mTBI and controls during a sustained visual attention task and to examine the relationship between workload and patient-reported symptoms.
Methods
In this cross-sectional study, 48 adults (24 with persistent symptoms after mTBI (mean age = 54.92 ± 9.1 years) and 24 age-matched controls (mean age = 55.00 ± 8.7 years) completed the Dot Cancellation (DC) test. Outcome measures included performance measured by time to completion and number of errors on the test, objective workload measured by the Index of Cognitive Activity (ICA), subjective workload measured by the National Aeronautics and Space Administration Task Load Index (NASA-TLX), and patient-reported outcomes of symptom severity measured by the Post-Concussion Symptom Scale (PCSS), and mental fatigue measured by the Mental Fatigue Scale (MFS).
Results
Individuals with mTBI symptoms took longer to complete the DC test (P = .002) and had higher scores on the NASA-TLX (mTBI = 37.5 [20.4, 50.8] compared to controls 10.4 [5, 27.5], P \u3c .001). No differences in ICA were noted between the groups after accounting for DC time. Moderate correlations were observed between NASA-TLX and PCSS (ρ = .58, P \u3c .001) and NASA-TLX and MFS (ρ = .58, P \u3c .001).
Conclusions
Individuals with persistent symptoms following mTBI exhibit greater subjective cognitive workload and take longer to complete a sustained visual attention task compared to age-matched controls. However, objective measures of cognitive workload did not differ significantly once task duration was controlled. Perceived cognitive workload experienced by this population is influenced by symptom severity and mental fatigue
Epidemiology of Hip Dislocations in the United States From 1990 to 2019: A Temporal Study Using the Global Burden of Disease Database
Get PDFIntroduction
Hip dislocations are devastating injuries that require urgent intervention to minimize the development of severe complications. This study aimed to evaluate the epidemiology of hip dislocations in the United States (U.S.) from 1990 to 2019.
Methods
This study is a descriptive retrospective epidemiological study. The Global Burden of Disease (GBD) database was used to collect epidemiological data on hip dislocation in the U.S. from 1990 to 2019. Data included years lived with disability (YLDs), prevalence, and incidence rates per 100,000 people. Data were regionally stratified into Northeast, Midwest, South, and West by the U.S. Census definition. Bartlett’s test was used to assess equal variance. Welch’s ANOVA was performed to assess regional differences to compare the means of different groups without assuming equal variances or equal sample sizes. The Games-Howell post hoc test was used to compare regions. Independent t-tests were performed to compare the means of each measure between males and females. Statistical significance was defined as p\u3c 0.05, and analyses were performed using IBM SPSS Statistics software, version 29.0.2.0 (IBM Corp., Armonk, NY).
Results
From 1990 to 2019, the U.S. saw a 1.67% decrease in the mean rate of YLDs, a 0.32% decrease in the mean prevalence rate, and a 4.74% decrease in the mean incidence rate of hip dislocations over the 29 years. Nationally, men experienced higher mean rates of YLDs, incidence, and prevalence compared to women, though only incidence was statistically significant (p\u3c 0.001). The Western region had the highest mean rates of YLDs, prevalence, and incidence rates of hip dislocation, while the Northeastern region experienced the lowest. Men had higher mean rates of YLDs in the Midwest (p=0.001), South (p\u3c 0.001), and West (p=0.004) regions. Men had a higher mean prevalence rate in the South (p=0.007), but not in other regions.
Conclusions
From 1990 to 2019, the U.S. experienced an overall drop in mean incidence, prevalence, and disease burden of hip dislocations, with men consistently showing higher rates across all measures compared to women. Regionally, the Western U.S. had the highest mean rates, while the Northeastern U.S. had the lowest. Our overall findings on the regional and sex-based disparities highlight the need for further targeted prevention strategies