RESUMEN
BACKGROUND: The association between pyoderma gangrenosum (PG) and arthritis is well established. We have observed a refractory population of patients with arthritis-associated PG (PGA). We, therefore, tested the hypothesis that differences exist in response to treatment in patients with PGA compared with patients with PG without arthritis. OBSERVATIONS: We performed a review of patients with PG during a 2-year period. Patients had noninfectious chronic ulcerations clinically typical for PG, exclusion of relevant differential diagnoses, and consistent histopathological features. Outcomes compared between patients with arthritis (PGA) and without arthritis (PG) included complete healing, percentage change in wound size, and duration of therapy. Of 10 PG ulcers, 7 healed, compared with 2 of 8 PGA ulcers. There was a greater mean percentage decrease in wound size in the PG vs the PGA ulcers (78.9% vs 23.4%; P =.10) and a shorter mean duration of treatment (8.7 vs 14.8 months; P =.18). CONCLUSIONS: The ulcers of patients with PGA seem more refractory to treatment than the ulcers of patients with PG alone. Those with PGA ulcers represent a refractory subset of patients, and the ulcers are possibly secondary to unique pathophysiological features.
Asunto(s)
Artritis/tratamiento farmacológico , Artritis/epidemiología , Piodermia Gangrenosa/tratamiento farmacológico , Piodermia Gangrenosa/epidemiología , Adulto , Artritis/complicaciones , Femenino , Florida/epidemiología , Humanos , Masculino , Registros Médicos , Persona de Mediana Edad , Pronóstico , Piodermia Gangrenosa/complicaciones , Estudios Retrospectivos , Resultado del Tratamiento , Cicatrización de HeridasRESUMEN
OBJECTIVE: To compare the cost and margin adequacy of Mohs micrographic surgery (Mohs) and traditional surgical excision (TSE) for the treatment of facial and auricular nonmelanoma skin cancer (NMSC). DESIGN: Prospective cost analysis with each patient serving as his or her own control. SETTING: Study was performed from 1999 to 2001 at the University of Connecticut dermatology clinic, a tertiary care referral center. PATIENTS: A total of 98 consecutive patients with a primary diagnosis of NMSC on the face and ears. MAIN OUTCOME MEASURES: The average cost of Mohs and TSE per patient for the treatment and repair of NMSC; adequacy of TSE margins after the initial procedure(because this outcome affects overall cost). RESULTS: Mohs was cost comparable to TSE when the subsequent procedure for inadequate TSE margins after permanent section was Mohs (937 vs 1029 US dollars; P =.16) or a subsequent TSE (937 vs 944 US dollars; P =.53). When facility-based frozen sections were requested for TSE, Mohs was significantly less costly (956 vs 1399 US dollars; P<.001). The cost difference between Mohs and TSE was sensitive to the type of repair chosen. CONCLUSIONS: If the end point is clear margins, Mohs is cost comparable to TSE performed by otolaryngologic surgeons. Some caution is needed when evaluating the cost of facial and auricular NMSC treatment because the choice of repair can significantly affect the cost conclusions.
Asunto(s)
Costos de Hospital , Cirugía de Mohs/economía , Recurrencia Local de Neoplasia/cirugía , Servicio Ambulatorio en Hospital/economía , Neoplasias Cutáneas/cirugía , Procedimientos Quirúrgicos Operativos/economía , Anciano , Carcinoma Basocelular/economía , Carcinoma Basocelular/patología , Carcinoma Basocelular/cirugía , Carcinoma de Células Escamosas/economía , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/cirugía , Connecticut , Análisis Costo-Beneficio , Oído/patología , Oído/cirugía , Cara/patología , Cara/cirugía , Femenino , Humanos , Masculino , Recurrencia Local de Neoplasia/economía , Recurrencia Local de Neoplasia/patología , Pautas de la Práctica en Medicina/economía , Estudios Prospectivos , Neoplasias Cutáneas/economía , Neoplasias Cutáneas/patología , Resultado del TratamientoRESUMEN
BACKGROUND: The endogenous antioxidant system of the skin scavenges reactive oxygen species and combats ultraviolet induced oxidative skin damage. Supporting this cutaneous defense system with topical or oral antioxidants may provide a successful strategy for the treatment and prevention of skin cancer. OBJECTIVE: Review evidence regarding treatment and prevention of melanoma and nonmelanoma skin cancers through dietary and topical antioxidants, vitamins, and herbal supplements. METHODS: Literature review. RESULTS: Review of the literature demonstrates that the administration of synthetic retinoids has not proved beneficial for otherwise healthy patients with nonmelanoma skin cancer. Selenium supplementation has reduced the incidence of several internal malignancies but not of nonmelanoma skin cancer. Synergistic use of beta-carotene with vitamins C and E has demonstrated prophylaxis against reactive oxygen radicals involved in nonmelanoma skin cancer and reduced sunburn reactions significantly. 1,25-dihydroxyvitamin D3 analog CB1093 has demonstrated promise as a therapeutic agent in the regression of the early stages of melanoma in specific cell lines. CONCLUSION: Delivery of exogenous antioxidants in combination appears to be a more successful strategy for enhancing the cutaneous antioxidant system than the administration of isolated antioxidants alone. Vitamin D analogs may have a role in the medical therapy of melanoma. However, avoiding exposure to ultraviolet light appears to be the only true panacea against the development of melanoma and NMSC.