Products containing antibacterial and antimicrobial activity are heavily and increasingly marketed to American consumers, yet this report demonstrates that there are few available data to suggest efficacy or benefit in the home environment. Increasing use of these products may foster a growing acquired resistance to these antimicrobial agents. Even more troubling are the implications for the potential to select bacterial strains that are resistant to therapeutic antibiotics.
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This retrospective study of 47 patients with advanced cutaneous T-cell lymphoma (CTCL) examines the experience at the University of Pennsylvania with extracorporeal photopheresis, focusing on monotherapy or combination therapy with a wide variety of immunostimulatory agents such as interferon alfa, interferon gamma, sargramostim, and retinoids. Although the group of 31 who received multimodality therapy had worse prognostic factors at baseline, they demonstrated better response rates and overall survival than those receiving photopheresis alone. Suchin et al suggest that photopheresis in combination with immunomodulatory agents may be considered first-line therapy for patients with advanced-stage CTCL and multiple poor prognostic variables.
Residual tumor left after surgical therapy for nonmelanoma skin cancer increases the likelihood of recurrence, emphasizing the need for Mohs micrographic control of excision margins for those tumors in which the clinically visible portion of a tumor may represent only a fraction of the microscopic tumor spread. In this retrospective analysis of more than 1000 cases, Batra and Kelley identify the most predictive clinical risk factors for extensive subclinical spread, demonstrating more specifically than previous studies that certain histologic subtypes are especially problematic at some anatomic locations and that some "low-risk" locations may in fact have a greater risk of subclinical spread for men. Quantifying these risks may better prepare patients for the potential extent of surgery and enable surgeons to better plan for multiple stages or more extensive repair.
Odds ratios for important predictors of extensive subclinical spread in nonmelanoma skin cancer.
Bilayered skin substitute (BSS) is approved by the Food and Drug Administration for the treatment of venous and diabetic ulcers, but the mechanisms by which this agent promotes wound healing remain unclear. In this small group of 10 patients, allogeneic DNA from BSS could not be detected at 2 months after grafting, suggesting that BSS does not survive permanently within the wound bed. The BSS may simply provide immediate wound coverage and a barrier to injury, infection, or desiccation. Alternatively, the BSS fibroblasts and keratinocytes may release stimulatory cytokines and growth factors, or BSS matrix components may act as a scaffold to allow recruitment of cells into the wound and further matrix biosynthesis.
Conventional diamond fraise spot dermabrasion improves the appearance of surgical scars but has the associated disadvantages of potential aerosolization of infectious particles, blood spatter, and expense. Gillard et al demonstrate that manual dermabrasion using medium-grade drywall sanding screen in a back-and-forth or circular motion is equally effective as conventional dermabrasion in improving the appearance of surgical scars but with less expense. The meshed porosity of the sanding screen prevents clogging and minimizes blood spatter and aerosolized particles.
This Month in Archives of Dermatology. Arch Dermatol. 2002;138(8):1011. doi:10.1001/archderm.138.8.1011