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An Introduction to Teledermatology
No full textTeledermatologyTeledermatology (TD) encompasses the interpretation of a patient’s clinical history in conjunction with electronically transmitted images, in order to make a diagnosis and provide appropriate treatment recommendations. Three main platforms are currently being utilized: synchronous (real-time video consultation), asynchronousStore-and-forward (store-and-forward [SAF]), and hybrid. The main advantage provided by the use of telemedicineTelemedicinein dermatologyDermatology is easier access to specialized medical care, especially for underservedUnderserved patients and those limited by geographical barriers. TD can also be a useful tool for triaging patients, as well as a valuable asset in training residents and physicians. Furthermore, teledermatology consultations can be used in both the outpatient and inpatient setting, with many studies supporting its reliability and accuracy when compared to in-person consultations. Some barriers for its use to consider include the dependence on image/video quality, limited interaction between patients and physicians, medicolegal implications, and ethical concerns surrounding the shift of a patient-centered approach to a technologyTechnology-centered one
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International Perspective of Mohs Micrographic Surgery: East Asia
No full textOverall skin cancerSkin cancer rates are much lower in East Asian populations than in Caucasian populations. Pigmented basal cell carcinomaBasal cell carcinoma (BCC) is the most common type, and surgical excisionSurgical excision with wide margins is the standard treatmentTreatment for BCC in most East Asian countries. Due to differences among countries in insurance systems and surgical approaches, Mohs micrographic surgeryMohs micrographic surgery (MMS) is an uncommon procedure in most Asian countries. Surgical excisionSurgical excision is widely used in the major parts of East Asia because of its effectiveness and simplicity. MMS has been reported to be a successful treatmentTreatment by particular institutions in Korea and Taiwan. However, MMS is not routinely available in most dermatologic units in East Asia. Intraoperative histological evaluation to control surgical margins is widely used instead of MMS for high-risk skin cancerSkin cancer. Complete histological margin control using a double-bladed scalpel may be easily applied to standard intraoperative frozen sectionFrozen sections evaluation in many institutions where MMS is difficult to perform. It is far less time-consuming and can be easily used by surgeons with existing systems, even in East Asian countries
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Introduction
No full textSports can be broadly defined as physical activities requiring skill that can be performed individually or as part of a team. Sports currently provide opportunities for socialization, entertainment, cultural expression, physical fitness, and benefits to health. However, the sporting environment presents unique challenges to the dermatological health of its participants. Sports present its participants with environmental challenges, such as exposure to solar ultraviolet radiation in outdoor sports linked to skin carcinogenesis with inadequate protection, extremes of cold linked to frostbite, and marine environments linked to unique marine pathogens that can contaminate wounds. Equipment used in sports can be a source of cutaneous injury or hypersensitivity reactions, such as blisters induced by ill-fitting climbing shoes or contact dermatitis from swim goggles. Sports expose participants to unique physiological stressors that can induce dermatological conditions ranging from traction alopecia in breakdancers to talon noir caused by traumatic intraepidermal hemorrhages from shearing forces on the feet experienced by racquet sport players. The Spaniard Diego Durán described, roughly half a millennia ago, the large hematomas that Mesoamerican ball players would obtain playing their sport, that would be treated with lancing highlighting the long history of identification and treatment of cutaneous and dermatological conditions
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Skin Cancer Telemedicine
No full textSkin cancerSkin cancer treatment is an arm of dermatologyDermatology that relies on accurate diagnosis and timely intervention. TeledermatologyTeledermatology has proven useful in many stages of skin cancer care from triage to diagnosis, management, and surgical consultation. With the addition of traditional dermoscopy and store-and-forwardStore-and-forwardtechnologyTechnology, high resolution images of suspicious skin lesions can be sent to consulting dermatologists all-over for an expedited follow-up process. Both live video conference and store-and-forward telemedicineTelemedicine styles have assisted in narrowing the care access gap between dermatologic providers and geographically isolated patients. TeledermatologyTeledermatology also exhibits diagnostic accuracyDiagnostic accuracy rates that are acceptable and, in many cases, comparable to that of face-to-face encounters, augmenting its robust clinical utility. TechnologiesTechnology such as artificial intelligenceArtificial intelligenceand reflectance confocal microscopyReflectance confocal microscopy continue to improve image quality and the potential for increased diagnostic accuracy of virtual dermatologic care. Considering its many advantages, teledermatologyTeledermatology serves as more of a valuable clinical tool than a comprehensive replacement for skin cancer treatment, especially for Mohs surgeryMohs surgery and procedural interventions that must take place in-person. Nonetheless, teledermatology’s role in advancing the workup of skin malignancies is gaining recognition within the dermatologic community and acquiring high approval rates amongst patients for its practicality and timely access to careAccess to care
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Anesthetic Considerations in Mohs Micrographic Surgery
No full textLocal anesthesiaLocal anesthesia is defined as a loss in the perception of pain over a small area of the body. Regional anesthesiaRegional anesthesia is a loss in the perception of pain, but in a larger anatomical area or region. Both local and regional anesthesiaRegional anesthesia are typically induced through the topical application or injection of pharmacological local anesthetic agents There are two types of local anesthetic agents which are defined by their chemical structures: amidesAmide and estersEster. Both classes exert their effects by deactivating the sodium channels responsible for the inward flux of sodium during the depolarization phase of the action potential. The net result is an increase in the amount of stimulus required to generate an action potential, as well as decreased propagation of action potentials across the anesthetized neuron. This chapter will discuss the history, pharmacology, pharmacokinetics, metabolism, toxicities, chemical structures, as well as the clinical utility of using local anesthetics in localized and regional fashion
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Optimizing Care with Teledermatology
No full textTeledermatology Teledermatology can be implemented for use across a wide variety of dermatologic conditions with the goal of decreasing patient wait times, travel times, exposure to hospital and clinical environments, and the financial burden of dermatologic care on both patients and clinics. The field of dermatology Dermatology is especially fit for telemedicine Telemedicine because of the visual nature of the dermatologic assessment. As the utilization of teledermatology Teledermatology is on the rise and has the potential to play an essential role in patient care, it is vital to ensure that all patients are receiving optimal virtual treatment continually. Teledermatology Teledermatology visits have the capability to function as effectively as their in-person equivalents if the proper measures and strategies are implemented. Steps can be taken by both the patient and the physician to optimize the efficiency and quality of care that patients receive. These optimization strategies can be implemented before, during, and after patient visits. They include perfecting workflow, technology Technology used for meetings, room setup, security software, organization, and both patient and physician responsibilities before and after visits. These methods are outlined within this chapter and will ensure that both the patient’s and physician’s time is maximally utilized while optimizing for the patient’s understanding and satisfaction
Biopsy Techniques
No full textAbstract
This chapter will review the various types of biopsies utilized in dermatologic surgery, and the indications for the different approaches. In addition, the appropriate instruments and instructions for proper technique will be discussed
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Racket Sports and Volleyball
No full textRacket sports include tennis, racquetball, squash, pickleball, and badminton. Common environmental factors in racket sports and predispose this population to developing tinea versicolor and other tinea dermatophyte infections. Athletic accessories including the racket handle and the movements required in racketball sports, may contribute to the incidence of intertrigo among racketball players. Risk factors include poor hygiene, closed-toes or ill-fitting shoes, tight-fitting clothes, and hyperhidrosis. Repeated and prolonged exposure to irritants commonly found in tennis equipment can result in allergic contact dermatitis, also known as “racket-grip irritation.” Patients may present with well-demarcated erythematous plaques with pruritic vesicles, accompanied by edema and excoriations due to scratching Athletes are at particular risk for acne mechanica, especially those with an already existing predisposition to acne. Acne mechanica, also known as friction acne or acne traumatica, is considered a complication of acne vulgaris rather than a distinct type of acne. Subungual hematoma, more commonly known as “Tennis Toe,” is a nail bed bruise resulting from a traumatic injury. These hematomas may occur from wearing tight-fitting sneakers or from repeated trauma to the front of the shoe, as commonly seen in tennis players. Volleyball encompasses both indoor and beach disciplines, each presenting unique challenges to athletes’ skin health. The volleyball environment presents distinct challenges for skin health, with significant differences between indoor and beach settings. Solar erythema and miliaria represent significant dermatological challenges in volleyball, particularly affecting beach volleyball athletes and indoor players in warm environments
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An Introduction to Mohs Micrographic Surgery
No full textFrederic E. MohsFrederic E. Mohs, the pioneer of Mohs micrographic surgeryMohs micrographic surgery (MMS), initiated its development in the 1930s during medical school. He innovatively applied zinc chlorideZinc chloride to “fix” tumors, enabling their microscopic analysis of histological architecture. In 1936, he translated this insight into surgical practice, commencing cutaneousCutaneous tumor treatmentTreatment in humans and laying the groundwork for chemosurgeryChemosurgery, an antecedent to modern MMS. In 1941, MohsMohs documented outcomes from 440 of his patients undergoing fixed-tissue chemosurgeryChemosurgery in the Archives of Surgery. He continued to share his findings, reporting through various avenues including the American Academy of Dermatology in Chicago in 1946 and the Archives of Dermatology in 1947. In 1953, he produced video demonstrations of chemosurgeryChemosurgery, forgoing zinc chlorideZinc chloride fixation for expedited use of fresh frozen tissueFresh frozen tissue, a pivotal moment in laying the foundation for and shaping present-day MMS. In 1983, the first 1-year fellowship program was formally approved by the American College of Mohs Micrographic SurgeryMohs micrographic surgery and CutaneousCutaneous Oncology (ACMMSCO). Over fourteen years, ACMMSCO endorsed 60+ 1–2-year training programs and accredited fellowships surfaced in Australia, New Zealand, and Canada. Globally, MMS practice is on the rise, with a dedicated section in this book to chronicle its expansion
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Dance & Gymnastics
No full textDance encompasses a broad range of activities but is generally related to any form of rhythmic movement. Prolonged use of tightly fitting clothing, occlusive footwear, and exposure to excessive moisture or sweat are all factors inherent to the athletic artform of dance. These factors place dancers at an increased risk for acquiring fungal infections. Dancers across all genres of dance place an extraordinary amount of physical pressure and impact forces on their feet and toes, leaving them very susceptible to various conditions associated with repetitive nail trauma, blistering, bruising, and superficial skin tears. Dancers should be cautioned to look for signs of infection including pain, swelling, redness, and warmth, erythema or induration to the skin and should seek medical attention immediately if these signs of infection are present. Rosin has a wide range of uses, including for string instruments, but dancers use rosin on their shoes to create friction between the shoe and the floor. Typically, dancers crush the rosin–purchased in small-rock forms–into a powder and then rub it into the toes and heels of their shoes. The common acute allergic contact dermatitis reaction to rosin tends to occur within 1–3 days after exposure and is often confined to the area of contact with rosin. Gymnastics is a physically demanding sport requiring strength, flexibility, balance, and coordination. Athletes in this sport routinely perform complex maneuvers using various types of equipment such as mats, bars, beams, and vaults, often in close contact with one another and shared surfaces. Gymnasts are particularly at risk for dermatophyte infections due to their frequent use of shared facilities and the sweaty conditions that result from repeated bare-footed practice. The repetitive friction from movements such as vaulting and tumbling can create micro-abrasions that compromise the skin’s barrier, increasing susceptibility to infection
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