RESUMEN
BACKGROUND: There are numerous subtypes of basal cell carcinoma (BCC). Defining the histopathologic subtype is an essential element in patient management, but there is little known data regarding interobserver precision in subtyping BCC. METHODS: We studied interobserver variance between six board-certified dermatopathologists who subtyped 100 BCCs in a blinded fashion. We used kappa statistic to calculate the concordance in suggested subtype by different dermatopathologists. Provided diagnoses were then re-categorized into low-risk and high-risk phenotypes, and kappa statistic for concordance on high-risk BCC was determined. RESULTS: The overall κ statistic was 0.301, indicating fair agreement among the six observers. Superficial and fibroepithelial BCC had the highest individual kappa statistics. When subtypes were re-classified into a two-tier system of high-risk and low-risk phenotypes, there was substantial interobserver agreement on high-risk BCC with a κ statistic of 0.699. CONCLUSION: These results suggest only fair agreement among dermatopathologists on specific BCC subtypes, but substantial agreement on superficial, fibroepithelial and high-risk BCC growth patterns. A simplified classification system comprised of superficial, fibroepithelial, nodular and infiltrative subtypes would increase interobserver precision and facilitate clinical decision-making.
Asunto(s)
Carcinoma Basocelular/patología , Neoplasias Cutáneas/patología , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma Basocelular/clasificación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Reproducibilidad de los Resultados , Neoplasias Cutáneas/clasificaciónRESUMEN
The history, neurophysiology, clinical aspects and treatment of pruritus are reviewed in this article. The different forms of pruritus in dermatological and systemic diseases are described, and the various aetiologies and pathophysiology of pruritus in systemic diseases are discussed. Lack of understanding of the neurophysiology and pathophysiology of pruritus has hampered the development of adequate therapies. Nevertheless, the discovery of primary afferent neurons and, presumably, second-order neurons with typical histamine responses mediating pruritic sensations can be regarded as a breakthrough in our understanding of the mechanisms behind pruritus. The number of experimental and therapeutic studies has greatly increased during the past few years, reflecting an increased interest in this topic. However, further effort is needed to develop new therapeutic concepts and clarify some confusion arising from promising case reports and uncontrolled clinical studies. A precise work-up for evaluating patients with pruritus is proposed, which may help the physician to identify the underlying causes and thus to treat the patient appropriately.
Asunto(s)
Prurito , Femenino , Humanos , Embarazo , Complicaciones del Embarazo , Prurito/etiología , Prurito/fisiopatología , Prurito/terapiaRESUMEN
BACKGROUND: Visual perception has hindered the development of blinded, placebo-controlled ultraviolet light exposure conditions in humans. New acrylic thermoplastics that block or transmit ultraviolet light have visual properties that may provide a solution. METHODS: In a series of triangle taste tests, 60 subjects were tested for the ability to visually perceive ultraviolet light transmission by two of four types of acrylic thermoplastics. RESULTS: Forty-six of sixty (67%) subjects were unable to visually detect ultraviolet light transmitting acrylics among ultraviolet blocking acrylics in both an ambient light background condition and an ambient light background condition with ultraviolet A light supplementation. CONCLUSION: Acrylic thermoplastics allow for the production of blinded, placebo-controlled ultraviolet light exposure conditions by eliminating visual discrimination differences between active and control groups.
Asunto(s)
Resinas Acrílicas , Discriminación en Psicología , Rayos Ultravioleta , Percepción Visual , Adulto , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Irritant contact dermatitis is thought to be the leading cause of occupational skin disease in the United States. Recent reports suggest otherwise. OBJECTIVES: The purposes of this study were to determine the prevalence of allergic and irritant forms of occupational contact dermatitis in the population seen at a Midwestern dermatologic referral clinic, report professions commonly affected by occupational skin disease, and indicate which substances are frequent allergens. METHODS: A retrospective analysis of patch test data collected at the University of Kansas between 1994 and 1999 was performed. RESULTS: Of 537 patients who underwent patch testing, 135 (25%) had occupational skin disease. Allergic contact dermatitis affected 81 (60%) patients, and irritant contact dermatitis was found in 46 (34%). Health care professionals, machinists, and construction workers accounted for nearly half of all patients with occupational skin disease. Nickel sulfate, glutaraldehyde, and thiuram mix were the most common allergens. CONCLUSION: Patch tests with a wider array of allergens than those currently available in the United States are needed to prevent misdiagnosis of occupational contact dermatitis.