-
Cutis Jan 2022Autoimmune bullous dermatoses (ABDs), such as pemphigus and bullous pemphigoid (BP), cause cutaneous lesions that are painful and disfiguring. These conditions affect a... (Review)
Review
Autoimmune bullous dermatoses (ABDs), such as pemphigus and bullous pemphigoid (BP), cause cutaneous lesions that are painful and disfiguring. These conditions affect a patient's ability to perform everyday tasks, and individual lesions can take years to heal. Multiple small studies have examined how these conditions affect a patient's lifestyle. We systematically reviewed the trials that have evaluated the mental health of patients with bullous dermatoses. Of the 13 studies assessed, 2 domains of interest were primarily evaluated: quality of life (QOL) and psychological state. Quality of life predominantly was analyzed using the Dermatology Life Quality Index (DLQI). To evaluate psychological state, the General Health Questionnaire (GHQ) primarily was utilized. This review informs providers and summarizes the various ways that ABDs affect mental health.
Topics: Autoimmune Diseases; Humans; Pemphigoid, Bullous; Pemphigus; Quality of Life; Skin Diseases, Vesiculobullous
PubMed: 35180062
DOI: 10.12788/cutis.0439 -
Journal of Plastic, Reconstructive &... Dec 2020Prominent ears are the most common congenital abnormality of the head and neck, occurring in 5% of the Caucasian population. Facial disfigurement can cause psychosocial...
BACKGROUND
Prominent ears are the most common congenital abnormality of the head and neck, occurring in 5% of the Caucasian population. Facial disfigurement can cause psychosocial distress, low self-esteem and varying levels of social isolation most notable in school-age children. Although prominent ear correction is the most frequently performed aesthetic operation in children and adolescents, to our knowledge, the relationship between prominent ears and psychological, social and educational issues has not been systematically assessed.
PURPOSE OF STUDY
To investigate the psychological, social and educational impact of prominent ears and to examine how prominent ear correction affects health-related quality of life (HRQoL).
METHODS
A systematic review was conducted using a protocol registered with PROSPERO and in line with the Preferred Reporting for Items for Systematic Reviews and Meta-Analyses statement. A comprehensive search of the literature was conducted using MEDLINE, EMBASE, PyscINFO, HMIC Health Management Information Consortium, Ovid Journals Database, NHS Wales Full-Text Journals and The Cochrane Database. The inclusion criteria stated that any study investigating the association between psychological, social or educational issues, or HRQoL and prominent ears or otoplasty should be incorporated. All studies were reviewed by two authors, with data extracted for the studies finally included.
FINDINGS
Fourteen articles were finally included, with a total of 786 patients. Thirteen out of 14 papers analysed the post-operative effect of surgical correction of prominent ears. The most common motivating factor for surgery was bullying, with young males of school age being the worst affected. Prominent ear patients report higher levels of bullying and social problems, and lower levels of physical activity than patients with more severe facial disfigurements. Every study that assessed the psychosocial impact of surgery on prominent ears found a significant benefit to HRQoL.
CONCLUSION AND RELEVANCE
Prominent ears pose severe psychological and social issues that should not be underestimated. Surgical correction has consistently been shown to significantly improve HRQoL.
Topics: Adolescent; Bullying; Child; Ear, External; Educational Status; Humans; Otologic Surgical Procedures; Self Concept; Social Adjustment; Social Isolation
PubMed: 32747182
DOI: 10.1016/j.bjps.2020.05.075 -
International Journal of Dermatology Jul 2021Discoid lupus erythematosus (DLE) may lead to disfiguring scarring and permanent hair loss. Dermoscopy may serve as a noninvasive tool useful in the preliminary... (Review)
Review
BACKGROUND
Discoid lupus erythematosus (DLE) may lead to disfiguring scarring and permanent hair loss. Dermoscopy may serve as a noninvasive tool useful in the preliminary diagnosis of hair loss and inflammatory skin diseases. The aim of the paper was to summarize and analyze the dermoscopic features of DLE lesions in various anatomical locations.
METHODS
A systematic review of PubMed, Scopus and Web of Science was performed using the search terms: 'lupus' OR 'discoid lupus' OR 'cutaneous lupus' combined with 'dermoscopy' OR 'dermatoscopy' OR 'videodermoscopy' OR 'videodermatoscopy' OR 'trichoscopy' OR 'mucoscopy' OR 'onychoscopy'.
RESULTS
About 29 out of 318 initially identified papers were included in the analysis. In scalp DLE (n = 166), the most common findings were: white structureless areas (62%), arborizing vessels (57.8%), white scales (54.2%), follicular keratotic plugs (47%), absent follicular openings (45.8%), perifollicular scaling (43.9%), pink-white background (40.4%), speckled brown pigmentation (38%), and fibrotic white dots (33.7%). In non-scalp DLE (n = 129), the most frequent features were: follicular keratotic plugs (66.7%), white perifollicular halo (65.9%), white scale (39.5%), speckled brown pigmentation (38.8%), white structureless areas (37.2%), and arborizing vessels (34.9%). There are scarce data in the literature on dermoscopic findings in labial (n = 8), mucosal (n = 3) and ungual DLE (n = 1).
CONCLUSIONS
DLE is characterized by a wide variety of dermoscopic findings with variable frequencies depending on the location of the lesions. Nevertheless, further studies are needed in order to reliably assess frequencies, correlation with disease stage and significance of individual dermoscopic features.
Topics: Alopecia; Dermatitis; Dermoscopy; Humans; Lupus Erythematosus, Discoid; Scalp
PubMed: 33319363
DOI: 10.1111/ijd.15365 -
Journal of Plastic, Reconstructive &... May 2024Face transplant (FT) has emerged as a groundbreaking option for patients with severe facial deformities, resulting from congenital disorders, trauma, or tumor ablation.... (Review)
Review
Face transplant (FT) has emerged as a groundbreaking option for patients with severe facial deformities, resulting from congenital disorders, trauma, or tumor ablation. Although reconstructive surgery has made significant strides, the challenges of restoring both form and function remain, particularly in centrally located defects. This review explored the long-term outcomes of FT, addressing its challenges and potential pitfalls. A systematic review following the PRISMA guidelines was conducted, encompassing articles published in English from November 2005 to January 2023, which were searched across PubMed, MEDLINE, and EMBASE databases. Keywords included "face transplant," "face transplant outcomes," and "face transplant long-term." Data on surgical teams, patient demographics, transplant specifics, rejection episodes, additional surgeries, and patient-reported outcomes were extracted and analyzed. In total, 34 articles met the inclusion criteria. Over the 2 decades, 48 FT procedures were performed, with 23 patients followed for at least 3 years. Predominantly, patients were men (80%), averaging 31 years in age. Ballistic trauma (44.6%) and burns (25.5%) were common causes of injury. Chronic rejection emerged as a significant concern, leading to graft loss and necessitating retransplantation in 2 patients. Additional surgical procedures were often required. FT offers a remarkable solution for individuals with extensive facial disfigurement. Successful outcomes depend on factors, such as patient selection, multidisciplinary collaboration, psychiatric evaluation, and post-operative care. Nevertheless, challenges persist, including the need for lifelong immunosuppression and risk of chronic rejection. Although FT has transformed lives, continued success in this evolving field hinges on the ongoing research and vigilant patient management.
Topics: Humans; Facial Transplantation; Graft Rejection; Facial Injuries; Treatment Outcome
PubMed: 38513344
DOI: 10.1016/j.bjps.2024.02.064 -
European Journal of Pediatrics Feb 2023Infantile hemangioma (IH) is the most common vascular tumor in infancy. Although IHs can regress spontaneously, some problematic IHs still need treatment. However,... (Review)
Review
Infantile hemangioma (IH) is the most common vascular tumor in infancy. Although IHs can regress spontaneously, some problematic IHs still need treatment. However, either treated or untreated IHs may leave skin sequelae which can cause permanent disfigurement. Many studies evaluated the short-term efficacy of different kinds of treatment, but now, few studies are focusing on long-term skin sequelae. The objectives of our systemic review were to identify skin sequelae of IH thoroughly, determine specific factors associated with long-term IH sequelae, and learn how to improve these sequelae. We searched the following electronic databases: PubMed, EMBASE, Cochrane Library, and Clinicaltrials.gov. Three independent authors assessed the articles, and we reported this systemic review following PRISMA guidelines. Of 4448 articles initially identified, 62 underwent full-text review, and 17 met inclusion criteria. The overall rate of sequelae ranged from 5.3 to 93.5%. Factors associated with skin sequelae included patients' demographics, hemangioma characteristics, and treatment factors. What is Known: • Infantile hemangioma is the most common vascular tumor during infancy. • Infantile hemangiomas can regress spontaneously but either treated or untreated patients may leave permanent skin sequelae. What is New: • Skin sequelae in involuted Infantile hemangiomas are very common. • It is significant to prevent, recognize, and improve skin sequelae of infantile hemangiomas.
Topics: Humans; Infant; Vascular Neoplasms; Skin Neoplasms; Skin; Hemangioma; Disease Progression
PubMed: 36434402
DOI: 10.1007/s00431-022-04688-1 -
The Journal of Craniofacial SurgeryVascularized composite allotransplantation of the face is an exceedingly complex procedure, requiring extensive planning and surgical precision in order to successfully...
Vascularized composite allotransplantation of the face is an exceedingly complex procedure, requiring extensive planning and surgical precision in order to successfully manage patients with facial disfigurements. This review aims to present an overview of the salient anatomic considerations in facial transplantation, as well as give attention to unique patient populations and special considerations.A literature review was performed in search of articles pertaining to considerations in facial transplantation using the databases PubMed, Web of Science, and Cochrane. Articles selected for further review included full-text articles with an emphasis on specific anatomic defects and how they were addressed in the transplant process, as well as management of special patient populations undergoing facial transplantation. In total, 19 articles were deemed appropriate for inclusion.The use of computer-assisted technologies for the planning portion of the procedure, as well as intraoperative efficiency, has yielded favorable results and can be considered as part of the operative plan. The ultimate outcome is dependent upon the synchronization of subunits of the allograft and the desired functional outcomes, including osseous, ocular, oral, and otologic considerations. Management of specific pathology and subgroups of patients are critical aspects. Although pediatric face transplantation has not yet been performed, it is a likely a future step in the evolution of this procedure.When performing a face transplantation, many components must be considered pre-, intra-, and post-operatively. This systematic review presents specific anatomic considerations, as well as information about special patient populations within this crosssection of multidisciplinary microsurgery, psychiatry, and transplant immunology.
Topics: Child; Facial Transplantation; Humans; Microsurgery; Transplantation, Homologous; Vascularized Composite Allotransplantation
PubMed: 35758507
DOI: 10.1097/SCS.0000000000008484 -
Dental Traumatology : Official... Apr 2021Sports-related dental injuries can cause pain, disfigurement, and broken teeth which may affect the athlete's well-being and psychological status. Such injuries may also...
BACKGROUND/AIMS
Sports-related dental injuries can cause pain, disfigurement, and broken teeth which may affect the athlete's well-being and psychological status. Such injuries may also lead to the fear of re-injury and other problems. Since a delay in adequate emergency treatment can have adverse effects, it is imperative that athletes and coaches have sufficient awareness of emergency treatment options. Hence, the aim of this systematic review was to evaluate the global status of knowledge among athletes and coaches regarding the prevention and emergency management of traumatic dental injuries.
METHODS
The protocol was designed using the PRISMA guidelines and registered in PROSPERO (CRD42020184956). A broad-based search using text words and MeSH terms was performed in established databases according to a predefined strategy without any distinction of language and year of publication. Studies without details of the questionnaire, knowledge score, validity, and reliability were excluded. Data extraction was performed and risk-of-bias assessment was done by means of the Joanna Briggs Institute's critical appraisal tool.
RESULTS
Nine studies published between 2005 and 2020 were included for qualitative synthesis. They were primarily from Asia with none from North America and Australia. Most of them were cross-sectional, used convenience sampling, and were interview-based. Less than 10% of the participants in two studies had adequate knowledge of the immediate emergency management of tooth avulsion, while only 2.4% of basketball players and coaches knew that it was necessary to collect the avulsed tooth or broken tooth fragments. The overall level of knowledge was reported as poor or insufficient in all studies, with moderate or high risk-of-bias in six studies.
CONCLUSION
The knowledge regarding emergency management of TDI was found to be low globally. Along with the choice of the sport, there was a high level of variability in the study design and sampling characteristics.
Topics: Athletic Injuries; Cross-Sectional Studies; Health Knowledge, Attitudes, Practice; Humans; Reproducibility of Results; Tooth Avulsion; Tooth Injuries
PubMed: 33220152
DOI: 10.1111/edt.12629 -
Health Policy and Planning Nov 2020The incidence of chemical assault is increasing globally. In response, a number of countries are proposing legislation. However, current legislative initiatives are...
The incidence of chemical assault is increasing globally. In response, a number of countries are proposing legislation. However, current legislative initiatives are uncoordinated and do not address the spectrum of activities to prevent and care for victims of chemical assaults. To fill this gap, we aimed to review legislation, policies and regulations relevant to chemical assault to classify and catalogue current strategies into a legislative framework. Terms related to chemical assault were used to systematically search the academic, lay and legal literatures. Chemical assault was defined as the use of acid or another caustic or corrosive substance or vitriol by one person against another with the intent to injure or disfigure. Reports that described the use of chemical weapons in warfare were excluded. A second search of national legislations of countries with reports of chemical assaults was performed to identify enacted laws and gaps in legislative approaches to chemical assault control. Data regarding relevant laws, policies and regulations were extracted. The findings were used to classify and catalogue current strategies into a legislative framework using content analysis. The search returned 3769 records. Chemical assaults were reported from 104 countries. Using legislation from those countries, a framework consisting of five legislative priorities was developed: (a) apply a public health approach; (b) adopt legal definitions specific to chemical assault; (c) control chemical supply, sales and procurement; (d) facilitate justice; and (e) support survivors. Although many countries have implemented one or more of these legislative priorities, no country has a comprehensive address to chemical assault control. Comparative policy analysis and assessments of the impacts of legislative efforts may further inform strategies to prevent, prosecute and mitigate the impact of chemical assaults. In the meantime, advocacy groups and governments might consider implementation and enforcement of one or more components of this legislative framework to control the growing epidemic of chemical assault.
Topics: Crime Victims; Humans; Internationality; Policy; Policy Making; Public Health
PubMed: 33450768
DOI: 10.1093/heapol/czaa031 -
Pediatric Hematology and Oncology Nov 2022Infantile hemangiomas (IH) are the most common benign tumors of childhood. Timely diagnosis and management of higher-risk IH is key in avoiding permanent disfigurement,...
Infantile hemangiomas (IH) are the most common benign tumors of childhood. Timely diagnosis and management of higher-risk IH is key in avoiding permanent disfigurement, visual impairment, and life-threatening airway compromise. Here, we identify and critically appraise existing clinical practice guidelines (CPGs) for IH diagnosis and management. A systematic search of MEDLINE, SCOPUS, and EMBASE was conducted until August 2021. Four independent reviewers assessed each CPG utilizing the Appraisal of Guidelines for Research and Evaluation, 2 edition (AGREE II). An scaled domain score of ≥60% demonstrated adequacy in a given domain. Intraclass correlation coefficients (ICC) assessed agreement and scoring consistency between the reviewers. Eight CPGs were eligible and included for critical appraisal. Only one CPG was classified as 'high quality', with the remaining seven guidelines being 'average' ( = 3) or 'low' ( = 4) quality. Six guidelines (75.0%) were conducted via nonsystematic literature searches. The 'Applicability' (40.4%±14.0) and 'Rigor of development' (46.9%±17.3) domains achieved the lowest scores, while the highest average scores were in 'Scope and purpose' (76.7%±11.3) and 'Editorial independence' (90.8%±13.0). We found high consistency between the four independent reviewers, with 'very good' ( = 5) or 'good' ( = 1) interrater reliability in all six AGREE II domains. Based on the AGREE II instrument, there is only one available high-quality consensus statement on the diagnosis and management of IH. Low scores in 'Rigor of development' and 'Applicability' suggest notable weaknesses in the development process and reporting quality of existing IH CPGs. Future guidelines should be backed by systematic literature searches and focus on guideline clinical translation.
Topics: Hemangioma; Humans; Infant; Practice Guidelines as Topic; Reproducibility of Results
PubMed: 35468033
DOI: 10.1080/08880018.2022.2062502 -
Plastic and Reconstructive Surgery.... Oct 2019Currently, there are more than 40 cases of facial allotransplantation performed by 13 different groups in 10 countries. Although it has become a potential option to...
BACKGROUND
Currently, there are more than 40 cases of facial allotransplantation performed by 13 different groups in 10 countries. Although it has become a potential option to reconstruct and restore the function and appearance of severely facially disfigured individuals, the ethical concerns of facial allotransplantation remain unsolved. We conducted a systematic review to better understand the ethical concerns on facial allotransplantation and the changing trends of the ethical debate over time.
METHODS
A systematic review of 3 databases was performed to identify articles related to ethical topics on facial allotransplantation. The inclusion criteria were peer-reviewed articles written since 1995 on the topics of ethics and facial allotransplantation in English, French, and Chinese languages. The ethical concerns extracted from the included articles were categorized into 4 core principles of ethics: autonomy, beneficence, nonmaleficence, and justice. The different themes under these 4 principles were extracted and subgrouped. The positions of the included articles were collected. Joinpoint regression was applied to compare the frequency of themes and positions by publication year. We presented the main topics on ethical concerns and the changing trends in ethical themes and principles of facial allotransplantation.
RESULTS
There were 889 articles identified initially. After excluding 265 duplicated articles, 624 articles were included for title/abstract review process, and 148 articles were included in final data analysis. The publication year was from 2002 to 2018 with 136 articles in English, 11 in French, and 1 in Chinese. The most addressed principle was nonmaleficence (117/148, 79.1%), followed by beneficence (116/148, 78.4%), justice (103/148, 69.6%), and autonomy (86/148, 58.1%). The themes on immunosuppression/rejection, quality of life, and identity were the top 3 addressed ethical concerns. Twelve of 13 most addressed ethical themes demonstrated a decreasing trend after 2004. The themes of identity under beneficence showed a significant decrease after 2004. Ethical concerns on the cost/financial topic were the only one showing consistently increase trends from 2002 to 2018. There was a significant increase of the papers in favor of facial allotransplantation procedure comparing to those were against or neutral before and after 2008.
CONCLUSIONS
More and more articles support facial allotransplantation as a feasible option to reconstruct and restore the function and appearance of severely facially disfigured individuals. The requirement of life-long immunosuppression therapy, quality of life, and identity center the ethical debates. Supported by favorable short-term results, 12 of 13 most addressed ethical concerns have trended down. The theme of cost/financial topic becomes more frequently addressed in recent years.
PubMed: 31772878
DOI: 10.1097/GOX.0000000000002425