Surgical management of familial benign chronic pemphigus by excision and primary closure

Epidemiology and impact of scarring after burn injury: a systematic review of the literature

The purpose of this study was to perform a systematic review of the existing literature on the incidence of hypertrophic scarring and the psychosocial impact of burn scars. In a comprehensive literature review, the authors identified 48 articles published since 1965 and written in English which reported the incidence and risk factors for hypertrophic scarring or assessed outcomes related to scarring. Most studies had important methodological limitations limiting the generalizability of the findings. In particular, the absence of standardized valid measures of scarring and other outcome variables was a major barrier to drawing strong conclusions. Among studies on hypertrophic scarring, the prevalence rate varied between 32 and 72%. Identified risk factors included dark skin, female gender, young age, burn site on neck and upper limb, multiple surgical procedures, meshed skin graph, time to healing, and burn severity. With regard to psychosocial outcomes, two studies compared pediatric burn survivors with a nonburn comparison group on a body image measure; neither study found differences between groups. Across studies, burn severity and location had a modest relationship with psychosocial outcome variables. Psychosocial variables such as social comfort and perceived stigmatization were more highly associated with body image than burn characteristics. To advance our knowledge of the epidemiology of scars and the burden of scars, future studies need to implement more rigorous methodologies. In particular, standardized valid measures of scarring and other outcomes should be developed. This process could be facilitated by an international collaboration among burn centers.

Laser therapy for Hailey-Hailey disease: review of the literature and a case report

Medical therapy for Hailey-Hailey disease (HHD) generally only provides temporary suppression. Surgical intervention has been shown to prolong remission, but may lead to significant morbidity. Laser therapy is becoming the preferred method of treatment because of its successful results and lower risk of complications compared to surgical modalities. We report a case of fractional ablative carbon dioxide (CO₂) laser treatment for HHD and review the relevant literature. Fractional CO₂ laser therapy was performed in our patient with a 14-year history of HHD. No recurrence was observed 5 months after laser therapy in right inframammary and axillary regions. Symptomatic recurrence was noted after treatment of inguinal areas. In conclusion, traditional laser ablation remains the treatment of choice for prolonged remission of recalcitrant plaques in HHD.

Dermatology Life Quality Index (DLQI) Scores in Burn Victims After Revival

This study aimed to evaluate reliability and validity of the Dermatology Life Quality Index (DLQI) in Iranian burned patients and to examine this question, "Does burn severity or other demographical characteristics affect the patient's perception of his or her quality of life after burn injury?" In this study, we used the Persian version of DLQI questionnaire; its reliability and validity has been confirmed earlier in vitiligo patients. The questionnaire was administered to a group of patients with burn scars after revival. The internal consistency of the questionnaire was assessed by Cronbach's alpha coefficient. Validity was performed using convergent validity. In all, 109 patients (mean age, 28.94) enrolled in the study. The scores of DLQI ranged from 4 to 28 (mean +/- SD, 17.76 +/- 5.55). Reliability analysis showed satisfactory result (Cronbach's alpha, 0.75). Cronbach's alpha coefficient in the patients with a Burn Index >or=15% was greater than those with <15%, which is an acceptable result. The Persian version of the DLQI is a reliable and valid instrument for assessing the impacts of burn scars on quality of life. The life quality index of all the patients irrelevant to age and sex were significantly impaired.

A Survey of Current Rehabilitation Trends for Burn Injuries to the Head and Neck

Burn injuries to the face and neck present a unique challenge to the burn team and must be treated with considerable care and vigilance by the rehabilitation team to prevent potential contractures that may occur. Standard guidelines for treatment of the head and neck have not been established. This article presents the results of a comprehensive survey that examined the similarities and differences in the rehabilitation techniques used in various burn centers for the treatment of these injuries. The results obtained from the survey responses demonstrate several similarities in treatment throughout the continuum of care, revealing the potential for the development of a uniform rehabilitation protocol for the treatment of burn injuries to the face and neck.

Personal story offers insight into living with facial disfigurement

This paper looks at the long-term effects of living with facial disfigurement caused by a burns injury. It applies a psychosocial model to understand how someone with such an injury confronts and adapts to living with a changed self-image.

Botulinum toxin type A for the treatment of axillary Hailey-Hailey disease

BACKGROUND

Hailey-Hailey disease is an inherited acantholytic disorder affecting the intertriginous areas of the body which is exacerbated by sweat, moisture, and friction. The disease is frequently resistant to conventional nonsurgical treatment.

OBJECTIVE

To evaluate whether chemodenervation of sweat glands would improve the course of the disease in a patient with Hailey-Hailey.

METHODS

We used low-dose treatment of the left axilla with botulinum toxin type A, the right axilla being used as a control, followed by treatment of both axillae with the optimal dose routinely used for the treatment of axillary hyperhidrosis.

RESULTS

After one treatment with a low dose of botulinum toxin type A, we observed partial improvement of the treated axilla. With subsequent treatment of both axillae with the recommended dose for axillary hyperhidrosis, we observed a sustained complete remission of the disease in the treated axillae.

CONCLUSION

Botulinum toxin type A may be an effective and safe nonsurgical alternative for the treatment of benign familial pemphigus in intertriginous areas such as the axillae.

Treatment of Hailey-Hailey disease (or benign familial pemphigus) using short pulsed and short dwell time carbon dioxide lasers

BACKGROUND

Surgical intervention of Hailey-Hailey disease (HHD) may be required to achieve prolonged remission or cure. Excisional surgery, dermabrasion, and continuous carbon dioxide (CO2) laser therapies have been utilized with success, though patients may experience considerable morbidity.

OBJECTIVE

To evaluate the use of short pulsed and short dwell time CO2 lasers in the treatment of HHD.

METHOD

Case report and review of the relevant literature.

RESULTS

A 26-year-old woman with refractory axillary HHD was initially treated with a short dwell time CO2 laser. The right axilla was treated with two passes at a fluence of 25 J/cm2, and the left axilla with three passes at 28 J/cm2. Three years later, several foci within each axilla that periodically blistered were further treated with two passes of a short pulsed CO2 laser at a fluence of 15 J/cm2. At a 3.5-year follow-up, the patient reported continued resolution of her left axilla but disease persistence in her right axilla.

CONCLUSION

HHD can be effectively treated with a short dwell time CO2 laser if appropriate laser parameters are used.

Surgical control of Hailey-Hailey disease

Hailey-Hailey disease is a benign, chronic genodermatosis manifested by recurrent lesions with a predilection for the intertriginous areas. The malodorous, weeping sores are a source of great discomfort to the patient. Medical therapy controls most lesions adequately; however, some are refractory. Experience with excision of skin involved with Hailey-Hailey disease is reported. The best results were obtained in those patients whose wounds were resurfaced with split skin grafts. Primary suture was associated with recurrent disease and residual morbidity. The findings of other isolated reports in the literature are also summarised. The results show that surgical control of Hailey-Hailey disease is indicated in recalcitrant cases.