Sharon Worcester

ORLANDO — CO₂ laser ablation with aggressive curettage proved successful for the treatment of a patient with Darier's disease who had failed other medical therapies.

The CO₂ laser/curettage approach was initially used on one part of the patient's abdomen, and the results compared favorably with results following wire brush dermabrasion on another part of her abdomen, reported Dr. Tri H. Nguyen at the annual meeting of the Florida Society of Dermatologic Surgeons.

The areas looked similar postoperatively, with erythema appearing on the CO₂ laser-treated area at short-term follow-up, and the beginning of hypertrophic scarring in the dermabraded area (this resolved with flurandrenolide tape). The erythema resolved over time.

The patient was greatly affected by this "horrible" disease, said Dr. Nguyen, associate professor of dermatology, and director of Mohs micrographic and dermatologic surgery at the University of Texas M.D. Anderson Cancer Center, Houston. She had chronic maceration, malodor, repeat infections, and mastitis, and her daily activities were restricted by her symptoms.

After successfully treating a number of cases of Hailey-Hailey disease with the CO₂ laser/curettage approach, Dr. Nguyen thought it might prove useful in this patient since both diseases require treatment that produces lesion destruction and scarring to achieve long-lasting remission.

She had failed numerous other therapies, including systemic and topical antibiotics, topical retinoids, and laser treatments.

The CO₂ laser/curettage treatment was performed under tumescent anesthesia; the patient also received oral anxiolysis with lorazepam and oral oxycodone and acetaminophen (Percocet). The CO₂ laser was used on continuous wave mode at up to 40 W. Sometimes 15–20 W were used, but Dr. Nguyen said he never went below that setting on the first pass "because the plaques were so hyperkeratotic."

The skin was treated in a grid pattern to ensure uniformity.

Based on the initial success, the patient was treated subsequently on other areas where she experienced the most difficulties with symptoms, malodor, and infection. The resulting smooth, flat scars which fade from the initial erythema into hypo- or depigmented scars have proved to be a "much better alternative" to the hyperkeratotic Darier's lesions, he said. The patient has been extremely satisfied with the results, and has returned repeatedly for treatment of additional areas.

Dr. Nguyen had no relevant conflicts of interest to disclose.

The resulting scars have proved to be a 'much better alternative' to the hyperkeratotic Darier's lesions. DR. NGUYEN

ORLANDO — CO₂ laser ablation with aggressive curettage proved successful for the treatment of a patient with Darier's disease who had failed other medical therapies.

The CO₂ laser/curettage approach was initially used on one part of the patient's abdomen, and the results compared favorably with results following wire brush dermabrasion on another part of her abdomen, reported Dr. Tri H. Nguyen at the annual meeting of the Florida Society of Dermatologic Surgeons.

The areas looked similar postoperatively, with erythema appearing on the CO₂ laser-treated area at short-term follow-up, and the beginning of hypertrophic scarring in the dermabraded area (this resolved with flurandrenolide tape). The erythema resolved over time.

The patient was greatly affected by this "horrible" disease, said Dr. Nguyen, associate professor of dermatology, and director of Mohs micrographic and dermatologic surgery at the University of Texas M.D. Anderson Cancer Center, Houston. She had chronic maceration, malodor, repeat infections, and mastitis, and her daily activities were restricted by her symptoms.

After successfully treating a number of cases of Hailey-Hailey disease with the CO₂ laser/curettage approach, Dr. Nguyen thought it might prove useful in this patient since both diseases require treatment that produces lesion destruction and scarring to achieve long-lasting remission.

She had failed numerous other therapies, including systemic and topical antibiotics, topical retinoids, and laser treatments.

The CO₂ laser/curettage treatment was performed under tumescent anesthesia; the patient also received oral anxiolysis with lorazepam and oral oxycodone and acetaminophen (Percocet). The CO₂ laser was used on continuous wave mode at up to 40 W. Sometimes 15–20 W were used, but Dr. Nguyen said he never went below that setting on the first pass "because the plaques were so hyperkeratotic."

The skin was treated in a grid pattern to ensure uniformity.

Based on the initial success, the patient was treated subsequently on other areas where she experienced the most difficulties with symptoms, malodor, and infection. The resulting smooth, flat scars which fade from the initial erythema into hypo- or depigmented scars have proved to be a "much better alternative" to the hyperkeratotic Darier's lesions, he said. The patient has been extremely satisfied with the results, and has returned repeatedly for treatment of additional areas.

Dr. Nguyen had no relevant conflicts of interest to disclose.

The resulting scars have proved to be a 'much better alternative' to the hyperkeratotic Darier's lesions. DR. NGUYEN

ORLANDO — CO₂ laser ablation with aggressive curettage proved successful for the treatment of a patient with Darier's disease who had failed other medical therapies.

The CO₂ laser/curettage approach was initially used on one part of the patient's abdomen, and the results compared favorably with results following wire brush dermabrasion on another part of her abdomen, reported Dr. Tri H. Nguyen at the annual meeting of the Florida Society of Dermatologic Surgeons.

The areas looked similar postoperatively, with erythema appearing on the CO₂ laser-treated area at short-term follow-up, and the beginning of hypertrophic scarring in the dermabraded area (this resolved with flurandrenolide tape). The erythema resolved over time.

The patient was greatly affected by this "horrible" disease, said Dr. Nguyen, associate professor of dermatology, and director of Mohs micrographic and dermatologic surgery at the University of Texas M.D. Anderson Cancer Center, Houston. She had chronic maceration, malodor, repeat infections, and mastitis, and her daily activities were restricted by her symptoms.

After successfully treating a number of cases of Hailey-Hailey disease with the CO₂ laser/curettage approach, Dr. Nguyen thought it might prove useful in this patient since both diseases require treatment that produces lesion destruction and scarring to achieve long-lasting remission.

She had failed numerous other therapies, including systemic and topical antibiotics, topical retinoids, and laser treatments.

The CO₂ laser/curettage treatment was performed under tumescent anesthesia; the patient also received oral anxiolysis with lorazepam and oral oxycodone and acetaminophen (Percocet). The CO₂ laser was used on continuous wave mode at up to 40 W. Sometimes 15–20 W were used, but Dr. Nguyen said he never went below that setting on the first pass "because the plaques were so hyperkeratotic."

The skin was treated in a grid pattern to ensure uniformity.

Based on the initial success, the patient was treated subsequently on other areas where she experienced the most difficulties with symptoms, malodor, and infection. The resulting smooth, flat scars which fade from the initial erythema into hypo- or depigmented scars have proved to be a "much better alternative" to the hyperkeratotic Darier's lesions, he said. The patient has been extremely satisfied with the results, and has returned repeatedly for treatment of additional areas.

Dr. Nguyen had no relevant conflicts of interest to disclose.

The resulting scars have proved to be a 'much better alternative' to the hyperkeratotic Darier's lesions. DR. NGUYEN

ORLANDO — Most dermatologic surgery patients don't need perioperative antibiotics, and the routine use of antibiotics to prevent surgical site infection or infective endocarditis should be discouraged, Dr. Steve Spencer said at the annual meeting of the Florida Society of Dermatologic Surgeons.

Healthy individuals, those who undergo surgery of a clean site, and those who undergo procedures of limited duration typically do not need prophylactic antibiotics. As for determining which patients do need prophylaxis, a number of variable risk factors should be considered, including HIV-positive status, chronic immunosuppression, age, occupation, and temperature/humidity, all of which could affect infection risk, said Dr. Spencer of Port Charlotte, Fla., noting that these are gray areas that require individualized decision making.

It is clearer, however, that those who are immunocompromised; those undergoing surgery of riskier areas such as the mouth, groin, or axillae, or sites that are already infected; and those who are at high risk of infective endocarditis (see sidebar) should receive prophylaxis, he said. Dr. Spencer cited guidelines on prevention of infective endocarditis published by the American Heart Association last year (Circulation 2007;116:1736–54).

Although the guidelines mainly address dental issues, the AHA noted that infectious endocarditis is more likely to result from frequent exposure to random bacteremias associated with daily activities than from bacteremia caused by dental or medical procedures and that prophylaxis is likely to prevent a very small number of cases of infectious endocarditis, if any.

The guidelines also point out that the risks of antibiotic prophylaxis in terms of adverse events exceed the benefits, if any, from antibiotic prophylaxis and recommend that only those with the highest risk of adverse outcomes from endocarditis should undergo antibiotic prophylaxis.

As for procedures on infected skin, skin structures, or musculoskeletal tissue, the AHA noted that, while these infections are typically polymicrobial, only staphylococci and β-hemolytic streptococci are likely to cause infective endocarditis. Therefore, when antibiotic prophylaxis is needed, the drug selected should target the most likely organisms to be encountered and be given prior to the procedure.

Broad-spectrum antibiotics—most often first-generation cephalosporins—are commonly used to treat these species.

Semisynthetic penicillinase-resistant penicillins are good for gram-positive cocci, Klebsiella, Escherichia coli, and Proteus organisms. Clindamycin is an alternative option in penicillin-allergic patients. Erythromycin is almost never used because it is associated with very high staphylococcal resistance, Dr. Spencer said.

Clindamycin also is a good option for patients undergoing surgery of the oral mucosal areas, but cephalosporins may have less cross-reactivity in penicillin-allergic patients. Although trimethoprim-sulfamethoxazole coverage is similar to these, with excellent gram-positive coverage, it does not provide Pseudomonas coverage, he added.

When antibiotic prophylaxis is determined to be necessary, it should be delivered 30–60 minutes before surgery. Since surgical factors are at least as important for preventing infection, sterile techniques and proper sterilization of instruments, avoidance of excess tension on closures, avoidance of excessive suture material, and avoidance of charring also require careful attention, he said.

Conditions With Endocarditis Risk

The American Heart Association guidelines state that the following cardiac conditions have the highest risk of adverse outcomes from endocarditis:

▸ Prosthetic cardiac valve.

▸ Previous infective endocarditis.

▸ Congenital heart disease.

▸ Unrepaired cyanotic CHD, including palliative shunts and conduits.

▸ Completely repaired (with prosthetic material or device) congenital heart defect during first 6 months after the repair.

▸ Repaired CHD with residual defect (at or adjacent to the site of the prosthetic patch or device) that inhibits endothelialization.

▸ Postcardiac transplant cardiac valvulopathy.

ORLANDO — Most dermatologic surgery patients don't need perioperative antibiotics, and the routine use of antibiotics to prevent surgical site infection or infective endocarditis should be discouraged, Dr. Steve Spencer said at the annual meeting of the Florida Society of Dermatologic Surgeons.

Healthy individuals, those who undergo surgery of a clean site, and those who undergo procedures of limited duration typically do not need prophylactic antibiotics. As for determining which patients do need prophylaxis, a number of variable risk factors should be considered, including HIV-positive status, chronic immunosuppression, age, occupation, and temperature/humidity, all of which could affect infection risk, said Dr. Spencer of Port Charlotte, Fla., noting that these are gray areas that require individualized decision making.

It is clearer, however, that those who are immunocompromised; those undergoing surgery of riskier areas such as the mouth, groin, or axillae, or sites that are already infected; and those who are at high risk of infective endocarditis (see sidebar) should receive prophylaxis, he said. Dr. Spencer cited guidelines on prevention of infective endocarditis published by the American Heart Association last year (Circulation 2007;116:1736–54).

Although the guidelines mainly address dental issues, the AHA noted that infectious endocarditis is more likely to result from frequent exposure to random bacteremias associated with daily activities than from bacteremia caused by dental or medical procedures and that prophylaxis is likely to prevent a very small number of cases of infectious endocarditis, if any.

The guidelines also point out that the risks of antibiotic prophylaxis in terms of adverse events exceed the benefits, if any, from antibiotic prophylaxis and recommend that only those with the highest risk of adverse outcomes from endocarditis should undergo antibiotic prophylaxis.

As for procedures on infected skin, skin structures, or musculoskeletal tissue, the AHA noted that, while these infections are typically polymicrobial, only staphylococci and β-hemolytic streptococci are likely to cause infective endocarditis. Therefore, when antibiotic prophylaxis is needed, the drug selected should target the most likely organisms to be encountered and be given prior to the procedure.

Broad-spectrum antibiotics—most often first-generation cephalosporins—are commonly used to treat these species.

Semisynthetic penicillinase-resistant penicillins are good for gram-positive cocci, Klebsiella, Escherichia coli, and Proteus organisms. Clindamycin is an alternative option in penicillin-allergic patients. Erythromycin is almost never used because it is associated with very high staphylococcal resistance, Dr. Spencer said.

Clindamycin also is a good option for patients undergoing surgery of the oral mucosal areas, but cephalosporins may have less cross-reactivity in penicillin-allergic patients. Although trimethoprim-sulfamethoxazole coverage is similar to these, with excellent gram-positive coverage, it does not provide Pseudomonas coverage, he added.

When antibiotic prophylaxis is determined to be necessary, it should be delivered 30–60 minutes before surgery. Since surgical factors are at least as important for preventing infection, sterile techniques and proper sterilization of instruments, avoidance of excess tension on closures, avoidance of excessive suture material, and avoidance of charring also require careful attention, he said.

Conditions With Endocarditis Risk

The American Heart Association guidelines state that the following cardiac conditions have the highest risk of adverse outcomes from endocarditis:

▸ Prosthetic cardiac valve.

▸ Previous infective endocarditis.

▸ Congenital heart disease.

▸ Unrepaired cyanotic CHD, including palliative shunts and conduits.

▸ Completely repaired (with prosthetic material or device) congenital heart defect during first 6 months after the repair.

▸ Repaired CHD with residual defect (at or adjacent to the site of the prosthetic patch or device) that inhibits endothelialization.

▸ Postcardiac transplant cardiac valvulopathy.

ORLANDO — Most dermatologic surgery patients don't need perioperative antibiotics, and the routine use of antibiotics to prevent surgical site infection or infective endocarditis should be discouraged, Dr. Steve Spencer said at the annual meeting of the Florida Society of Dermatologic Surgeons.

Healthy individuals, those who undergo surgery of a clean site, and those who undergo procedures of limited duration typically do not need prophylactic antibiotics. As for determining which patients do need prophylaxis, a number of variable risk factors should be considered, including HIV-positive status, chronic immunosuppression, age, occupation, and temperature/humidity, all of which could affect infection risk, said Dr. Spencer of Port Charlotte, Fla., noting that these are gray areas that require individualized decision making.

It is clearer, however, that those who are immunocompromised; those undergoing surgery of riskier areas such as the mouth, groin, or axillae, or sites that are already infected; and those who are at high risk of infective endocarditis (see sidebar) should receive prophylaxis, he said. Dr. Spencer cited guidelines on prevention of infective endocarditis published by the American Heart Association last year (Circulation 2007;116:1736–54).

Although the guidelines mainly address dental issues, the AHA noted that infectious endocarditis is more likely to result from frequent exposure to random bacteremias associated with daily activities than from bacteremia caused by dental or medical procedures and that prophylaxis is likely to prevent a very small number of cases of infectious endocarditis, if any.

The guidelines also point out that the risks of antibiotic prophylaxis in terms of adverse events exceed the benefits, if any, from antibiotic prophylaxis and recommend that only those with the highest risk of adverse outcomes from endocarditis should undergo antibiotic prophylaxis.

As for procedures on infected skin, skin structures, or musculoskeletal tissue, the AHA noted that, while these infections are typically polymicrobial, only staphylococci and β-hemolytic streptococci are likely to cause infective endocarditis. Therefore, when antibiotic prophylaxis is needed, the drug selected should target the most likely organisms to be encountered and be given prior to the procedure.

Broad-spectrum antibiotics—most often first-generation cephalosporins—are commonly used to treat these species.

Semisynthetic penicillinase-resistant penicillins are good for gram-positive cocci, Klebsiella, Escherichia coli, and Proteus organisms. Clindamycin is an alternative option in penicillin-allergic patients. Erythromycin is almost never used because it is associated with very high staphylococcal resistance, Dr. Spencer said.

Clindamycin also is a good option for patients undergoing surgery of the oral mucosal areas, but cephalosporins may have less cross-reactivity in penicillin-allergic patients. Although trimethoprim-sulfamethoxazole coverage is similar to these, with excellent gram-positive coverage, it does not provide Pseudomonas coverage, he added.

When antibiotic prophylaxis is determined to be necessary, it should be delivered 30–60 minutes before surgery. Since surgical factors are at least as important for preventing infection, sterile techniques and proper sterilization of instruments, avoidance of excess tension on closures, avoidance of excessive suture material, and avoidance of charring also require careful attention, he said.

Conditions With Endocarditis Risk

The American Heart Association guidelines state that the following cardiac conditions have the highest risk of adverse outcomes from endocarditis:

▸ Prosthetic cardiac valve.

▸ Previous infective endocarditis.

▸ Congenital heart disease.

▸ Unrepaired cyanotic CHD, including palliative shunts and conduits.

▸ Completely repaired (with prosthetic material or device) congenital heart defect during first 6 months after the repair.

▸ Repaired CHD with residual defect (at or adjacent to the site of the prosthetic patch or device) that inhibits endothelialization.

▸ Postcardiac transplant cardiac valvulopathy.

ORLANDO — Topical 5% imiquimod is an effective treatment for squamous cell carcinoma in situ and should be considered as an option for this disease, Dr. Theodore Rosen reported at the annual meeting of the Florida Society of Dermatologic Surgeons.

Imiquimod (Aldara) is approved for the treatment of superficial basal cell carcinomas, and although it has been used for Bowen's disease, data are lacking on its efficacy for this use, said Dr. Rosen, who is professor of dermatology at Baylor College of Medicine in Houston.

A review of 49 of his patients with Bowen's disease who were compliant with their treatment showed that nearly 90% had a complete response at an average follow-up of 2 years. About one-third of the cleared cases were verified on biopsy.

Importantly, five patients who were believed to be compliant had no response whatsoever. This supports the premise that about 1% of the population will fail to respond to imiquimod, Dr. Rosen noted.

An alternative approach to treatment should be used in such patients, he said.

In general, though, the response rate with imiquimod is reasonable. Findings from the three best studies of this treatment suggest that the overall response rate is about 85%, which is enough to warrant its consideration by physicians, Dr. Rosen said.

In his study, patients ranged in age from 48 to 85 years, and 96% were male.

The lesion was located on the extremities in 30% of patients, on the face in 25%, on the trunk or neck in 18%, on the genitalia in 11%, on the scalp in 9%, on the ears in 5%, and on the lips in 2%, he reported.

Lesions on the genitalia had a significantly greater risk of progressing to invasive disease (10% vs. 3% for other areas), yet all of the genital lesions in this study cleared with imiquimod treatment, he noted (Dermatol. Surg. 2007;33:427–31).

Patients were treated daily for 6–16 weeks (every other day for patients with genital lesions) until the target area was heavily crusted and eroded.

"I tend to push it a little bit," Dr. Rosen said of the therapy, adding that it is important to monitor patients.

There have been a few case reports of Bowen's disease ostensibly being cleared with imiquimod, only to have a subsequent invasive lesion develop, he noted.

Patients who undergo treatment with imiquimod for Bowen's disease are at high risk and "shouldn't be out of your grasp," Dr. Rosen said.

Although some cases of invasive squamous cell carcinoma have been treated with imiquimod and the overall treatment success rate appears to be about 70%, it is not his treatment of choice for invasive disease, as it is for Bowen's disease, he said.

Dr. Rosen disclosed that he has served on the speakers bureau for Graceway Pharmaceuticals, the maker of Aldara, and has received honoraria from the company.

ORLANDO — Topical 5% imiquimod is an effective treatment for squamous cell carcinoma in situ and should be considered as an option for this disease, Dr. Theodore Rosen reported at the annual meeting of the Florida Society of Dermatologic Surgeons.

Imiquimod (Aldara) is approved for the treatment of superficial basal cell carcinomas, and although it has been used for Bowen's disease, data are lacking on its efficacy for this use, said Dr. Rosen, who is professor of dermatology at Baylor College of Medicine in Houston.

A review of 49 of his patients with Bowen's disease who were compliant with their treatment showed that nearly 90% had a complete response at an average follow-up of 2 years. About one-third of the cleared cases were verified on biopsy.

Importantly, five patients who were believed to be compliant had no response whatsoever. This supports the premise that about 1% of the population will fail to respond to imiquimod, Dr. Rosen noted.

An alternative approach to treatment should be used in such patients, he said.

In general, though, the response rate with imiquimod is reasonable. Findings from the three best studies of this treatment suggest that the overall response rate is about 85%, which is enough to warrant its consideration by physicians, Dr. Rosen said.

In his study, patients ranged in age from 48 to 85 years, and 96% were male.

The lesion was located on the extremities in 30% of patients, on the face in 25%, on the trunk or neck in 18%, on the genitalia in 11%, on the scalp in 9%, on the ears in 5%, and on the lips in 2%, he reported.

Lesions on the genitalia had a significantly greater risk of progressing to invasive disease (10% vs. 3% for other areas), yet all of the genital lesions in this study cleared with imiquimod treatment, he noted (Dermatol. Surg. 2007;33:427–31).

Patients were treated daily for 6–16 weeks (every other day for patients with genital lesions) until the target area was heavily crusted and eroded.

"I tend to push it a little bit," Dr. Rosen said of the therapy, adding that it is important to monitor patients.

There have been a few case reports of Bowen's disease ostensibly being cleared with imiquimod, only to have a subsequent invasive lesion develop, he noted.

Patients who undergo treatment with imiquimod for Bowen's disease are at high risk and "shouldn't be out of your grasp," Dr. Rosen said.

Although some cases of invasive squamous cell carcinoma have been treated with imiquimod and the overall treatment success rate appears to be about 70%, it is not his treatment of choice for invasive disease, as it is for Bowen's disease, he said.

Dr. Rosen disclosed that he has served on the speakers bureau for Graceway Pharmaceuticals, the maker of Aldara, and has received honoraria from the company.

ORLANDO — Topical 5% imiquimod is an effective treatment for squamous cell carcinoma in situ and should be considered as an option for this disease, Dr. Theodore Rosen reported at the annual meeting of the Florida Society of Dermatologic Surgeons.

Imiquimod (Aldara) is approved for the treatment of superficial basal cell carcinomas, and although it has been used for Bowen's disease, data are lacking on its efficacy for this use, said Dr. Rosen, who is professor of dermatology at Baylor College of Medicine in Houston.

A review of 49 of his patients with Bowen's disease who were compliant with their treatment showed that nearly 90% had a complete response at an average follow-up of 2 years. About one-third of the cleared cases were verified on biopsy.

Importantly, five patients who were believed to be compliant had no response whatsoever. This supports the premise that about 1% of the population will fail to respond to imiquimod, Dr. Rosen noted.

An alternative approach to treatment should be used in such patients, he said.

In general, though, the response rate with imiquimod is reasonable. Findings from the three best studies of this treatment suggest that the overall response rate is about 85%, which is enough to warrant its consideration by physicians, Dr. Rosen said.

In his study, patients ranged in age from 48 to 85 years, and 96% were male.

The lesion was located on the extremities in 30% of patients, on the face in 25%, on the trunk or neck in 18%, on the genitalia in 11%, on the scalp in 9%, on the ears in 5%, and on the lips in 2%, he reported.

Lesions on the genitalia had a significantly greater risk of progressing to invasive disease (10% vs. 3% for other areas), yet all of the genital lesions in this study cleared with imiquimod treatment, he noted (Dermatol. Surg. 2007;33:427–31).

Patients were treated daily for 6–16 weeks (every other day for patients with genital lesions) until the target area was heavily crusted and eroded.

"I tend to push it a little bit," Dr. Rosen said of the therapy, adding that it is important to monitor patients.

There have been a few case reports of Bowen's disease ostensibly being cleared with imiquimod, only to have a subsequent invasive lesion develop, he noted.

Patients who undergo treatment with imiquimod for Bowen's disease are at high risk and "shouldn't be out of your grasp," Dr. Rosen said.

Although some cases of invasive squamous cell carcinoma have been treated with imiquimod and the overall treatment success rate appears to be about 70%, it is not his treatment of choice for invasive disease, as it is for Bowen's disease, he said.

Dr. Rosen disclosed that he has served on the speakers bureau for Graceway Pharmaceuticals, the maker of Aldara, and has received honoraria from the company.

The Centers for Disease Control and Prevention is launching a study to improve understanding of an unexplained and controversial dermatologic condition known as Morgellons, which is affecting an increasing number of individuals in the United States and abroad, the agency announced last month.

Little is known about the cause of the condition, which is characterized by a range of dermatologic symptoms, including rashes and sores that occur in association with abnormal crawling, biting, or stinging sensations. Patients often describe having threads, fibers, or foreign materials underneath or protruding from the skin in affected areas. Fatigue, mental confusion, memory loss, joint pain, and changes in vision have also been reported.

Some medical professionals consider Morgellons to be a manifestation of other medical or psychological conditions, including delusional parasitosis, but experts are divided on the topic.

“What is clear is that those who suffer from this condition, as well as their family members and their physicians, have questions,” Dr. Michele Pearson said during a press briefing held to announce the study's launch.

It is also clear that the symptoms and the suffering of patients are very real, said Dr. Pearson, principal investigator for the CDC, in response to questions from the media about whether Morgellons is a “real disease.”

The study will be conducted in conjunction with Kaiser Permanente Northern California, because it has a large population of members and because of its research capabilities. In addition, northern California is one of the areas in which cases have been geographically concentrated, Dr. Joe Selby, director, division of research, Kaiser Permanente Northern California said during the briefing.

Cases have also been reported in Canada, Australia, and several European countries. The CDC has received about 1,200 inquiries about the disorder, and some estimates put the number of self-reported cases at about 10,000.

The researchers aim to determine the prevalence, as well as to identify epidemiological, clinical, and histopathologic features of the condition. Patient recruitment will begin immediately. Participants will undergo a detailed general, dermatologic, and mental health evaluation; skin biopsies; and blood tests.

“[Morgellons] is complicated, and it may involve multiple factors … but we believe this study will provide useful information to the medical community, and–most importantly–to those who suffer with this disorder,” said Dr. Pearson.

Arrows point to fibers from a facial lesion that are similar to what some patients say are characteristic of Morgellons. Some physicians consider the condition a manifestation of medical or psychological conditions. Morgellons Research Foundation

The Centers for Disease Control and Prevention is launching a study to improve understanding of an unexplained and controversial dermatologic condition known as Morgellons, which is affecting an increasing number of individuals in the United States and abroad, the agency announced last month.

Little is known about the cause of the condition, which is characterized by a range of dermatologic symptoms, including rashes and sores that occur in association with abnormal crawling, biting, or stinging sensations. Patients often describe having threads, fibers, or foreign materials underneath or protruding from the skin in affected areas. Fatigue, mental confusion, memory loss, joint pain, and changes in vision have also been reported.

Some medical professionals consider Morgellons to be a manifestation of other medical or psychological conditions, including delusional parasitosis, but experts are divided on the topic.

“What is clear is that those who suffer from this condition, as well as their family members and their physicians, have questions,” Dr. Michele Pearson said during a press briefing held to announce the study's launch.

It is also clear that the symptoms and the suffering of patients are very real, said Dr. Pearson, principal investigator for the CDC, in response to questions from the media about whether Morgellons is a “real disease.”

The study will be conducted in conjunction with Kaiser Permanente Northern California, because it has a large population of members and because of its research capabilities. In addition, northern California is one of the areas in which cases have been geographically concentrated, Dr. Joe Selby, director, division of research, Kaiser Permanente Northern California said during the briefing.

Cases have also been reported in Canada, Australia, and several European countries. The CDC has received about 1,200 inquiries about the disorder, and some estimates put the number of self-reported cases at about 10,000.

The researchers aim to determine the prevalence, as well as to identify epidemiological, clinical, and histopathologic features of the condition. Patient recruitment will begin immediately. Participants will undergo a detailed general, dermatologic, and mental health evaluation; skin biopsies; and blood tests.

“[Morgellons] is complicated, and it may involve multiple factors … but we believe this study will provide useful information to the medical community, and–most importantly–to those who suffer with this disorder,” said Dr. Pearson.

Arrows point to fibers from a facial lesion that are similar to what some patients say are characteristic of Morgellons. Some physicians consider the condition a manifestation of medical or psychological conditions. Morgellons Research Foundation

The Centers for Disease Control and Prevention is launching a study to improve understanding of an unexplained and controversial dermatologic condition known as Morgellons, which is affecting an increasing number of individuals in the United States and abroad, the agency announced last month.

Little is known about the cause of the condition, which is characterized by a range of dermatologic symptoms, including rashes and sores that occur in association with abnormal crawling, biting, or stinging sensations. Patients often describe having threads, fibers, or foreign materials underneath or protruding from the skin in affected areas. Fatigue, mental confusion, memory loss, joint pain, and changes in vision have also been reported.

Some medical professionals consider Morgellons to be a manifestation of other medical or psychological conditions, including delusional parasitosis, but experts are divided on the topic.

“What is clear is that those who suffer from this condition, as well as their family members and their physicians, have questions,” Dr. Michele Pearson said during a press briefing held to announce the study's launch.

It is also clear that the symptoms and the suffering of patients are very real, said Dr. Pearson, principal investigator for the CDC, in response to questions from the media about whether Morgellons is a “real disease.”

The study will be conducted in conjunction with Kaiser Permanente Northern California, because it has a large population of members and because of its research capabilities. In addition, northern California is one of the areas in which cases have been geographically concentrated, Dr. Joe Selby, director, division of research, Kaiser Permanente Northern California said during the briefing.

Cases have also been reported in Canada, Australia, and several European countries. The CDC has received about 1,200 inquiries about the disorder, and some estimates put the number of self-reported cases at about 10,000.

The researchers aim to determine the prevalence, as well as to identify epidemiological, clinical, and histopathologic features of the condition. Patient recruitment will begin immediately. Participants will undergo a detailed general, dermatologic, and mental health evaluation; skin biopsies; and blood tests.

“[Morgellons] is complicated, and it may involve multiple factors … but we believe this study will provide useful information to the medical community, and–most importantly–to those who suffer with this disorder,” said Dr. Pearson.

Arrows point to fibers from a facial lesion that are similar to what some patients say are characteristic of Morgellons. Some physicians consider the condition a manifestation of medical or psychological conditions. Morgellons Research Foundation

Bystander-initiated cardiopulmonary resuscitation saves lives but occurs far too infrequently and is often provided inadequately, according to a new scientific statement from the American Heart Association.

The statement calls for a concerted effort by health care providers, policy makers, and community leaders to provide education and training to improve the rate and quality of bystander CPR.

“CPR is an inexpensive and readily available technique that can save lives. Therefore, the number of people trained in CPR must increase, and the quality of CPR provided must improve,” wrote Dr. Benjamin S. Abella, lead author of the statement, and his colleagues (Circulation 2008;117;704-9).

Although it has been shown that high-quality CPR provided by bystanders can improve the rates of survival to hospital discharge, in many communities only 15%−30% of victims receive bystander CPR before emergency medical services personnel arrive. With arrival times often occurring after 7-8 minutes, and a drop in survival rates of 7%−10% for each minute without CPR, the lack of bystander-initiated CPR can have a dramatic impact on patient outcome.

“In communities where widespread CPR training has been provided, survival rates from witnessed sudden cardiac arrest associated with [ventricular fibrillation] have been reportedly as high as 49% to 74% … unfortunately, on average, about 6% of out-of-hospital sudden cardiac arrest victims survive to hospital discharge in the United States,” Dr. Abella, clinical research director for the Center for Resuscitation Science at the University of Pennsylvania, Philadelphia, said in a press statement.

Study findings have shown that even when CPR by a bystander and CPR by trained health care professionals are provided, they are too often provided inadequately, with chest compressions that are too shallow or interrupted too often, and with excessive rates of rescue breathing. The authors provide a number of recommendations to improve the rate and quality of bystander CPR, including:

▸ Broadening CPR training. New approaches in training are needed to reach a larger public audience. A 22-minute, self-instructional program available through the AHA is an example of a tool that can be used outside the classroom. The statement also calls for community and corporate programs to encourage CPR education, and suggests that training be provided in high schools as a prerequisite for graduation and in hospitals for families of patients at risk for sudden cardiac arrest.

▸ Addressing common barriers to lay rescuer action. Bystanders are often reluctant to perform CPR out of fear of disease transmission, fear of legal liability, or as a result of the complexity of guidelines and instructional materials (which hampers both learning and delivery of bystander CPR). Thus, in addition to education about the value of quick action for saving lives, the public should be better informed about the very low risk of disease transmission (there have been no reported cases of HIV transmission or hepatitis via CPR, for example) and the availability of mouth-to-mouth barrier devices and gloves, which should be mandated wherever an automatic external defibrillator (AED) is stationed. Information about Good Samaritan laws that protect bystanders from liability should be included in CPR training and posted prominently near AED stations.

▸ Improving lay rescuer and emergency medical services programs. These programs can be upgraded by providing a process for continuous quality improvement. Reviews of resuscitation efforts and quality of CPR provided by bystanders and dispatchers are needed, as is monitoring (by health care systems that provide CPR services) of the quality of CPR provided during resuscitation efforts.

The AHA also suggests Internet-based CPR education and certification programs be developed, and that research be done to identify the best educational methods for delivering CPR training, the optimal target populations for CPR education, the value of dispatch-assisted CPR in a variety of communities, and the public perceptions that serve as barriers to CPR training and administration.

Bystander-initiated cardiopulmonary resuscitation saves lives but occurs far too infrequently and is often provided inadequately, according to a new scientific statement from the American Heart Association.

The statement calls for a concerted effort by health care providers, policy makers, and community leaders to provide education and training to improve the rate and quality of bystander CPR.

“CPR is an inexpensive and readily available technique that can save lives. Therefore, the number of people trained in CPR must increase, and the quality of CPR provided must improve,” wrote Dr. Benjamin S. Abella, lead author of the statement, and his colleagues (Circulation 2008;117;704-9).

Although it has been shown that high-quality CPR provided by bystanders can improve the rates of survival to hospital discharge, in many communities only 15%−30% of victims receive bystander CPR before emergency medical services personnel arrive. With arrival times often occurring after 7-8 minutes, and a drop in survival rates of 7%−10% for each minute without CPR, the lack of bystander-initiated CPR can have a dramatic impact on patient outcome.

“In communities where widespread CPR training has been provided, survival rates from witnessed sudden cardiac arrest associated with [ventricular fibrillation] have been reportedly as high as 49% to 74% … unfortunately, on average, about 6% of out-of-hospital sudden cardiac arrest victims survive to hospital discharge in the United States,” Dr. Abella, clinical research director for the Center for Resuscitation Science at the University of Pennsylvania, Philadelphia, said in a press statement.

Study findings have shown that even when CPR by a bystander and CPR by trained health care professionals are provided, they are too often provided inadequately, with chest compressions that are too shallow or interrupted too often, and with excessive rates of rescue breathing. The authors provide a number of recommendations to improve the rate and quality of bystander CPR, including:

▸ Broadening CPR training. New approaches in training are needed to reach a larger public audience. A 22-minute, self-instructional program available through the AHA is an example of a tool that can be used outside the classroom. The statement also calls for community and corporate programs to encourage CPR education, and suggests that training be provided in high schools as a prerequisite for graduation and in hospitals for families of patients at risk for sudden cardiac arrest.

▸ Addressing common barriers to lay rescuer action. Bystanders are often reluctant to perform CPR out of fear of disease transmission, fear of legal liability, or as a result of the complexity of guidelines and instructional materials (which hampers both learning and delivery of bystander CPR). Thus, in addition to education about the value of quick action for saving lives, the public should be better informed about the very low risk of disease transmission (there have been no reported cases of HIV transmission or hepatitis via CPR, for example) and the availability of mouth-to-mouth barrier devices and gloves, which should be mandated wherever an automatic external defibrillator (AED) is stationed. Information about Good Samaritan laws that protect bystanders from liability should be included in CPR training and posted prominently near AED stations.

▸ Improving lay rescuer and emergency medical services programs. These programs can be upgraded by providing a process for continuous quality improvement. Reviews of resuscitation efforts and quality of CPR provided by bystanders and dispatchers are needed, as is monitoring (by health care systems that provide CPR services) of the quality of CPR provided during resuscitation efforts.

The AHA also suggests Internet-based CPR education and certification programs be developed, and that research be done to identify the best educational methods for delivering CPR training, the optimal target populations for CPR education, the value of dispatch-assisted CPR in a variety of communities, and the public perceptions that serve as barriers to CPR training and administration.

Bystander-initiated cardiopulmonary resuscitation saves lives but occurs far too infrequently and is often provided inadequately, according to a new scientific statement from the American Heart Association.

The statement calls for a concerted effort by health care providers, policy makers, and community leaders to provide education and training to improve the rate and quality of bystander CPR.

“CPR is an inexpensive and readily available technique that can save lives. Therefore, the number of people trained in CPR must increase, and the quality of CPR provided must improve,” wrote Dr. Benjamin S. Abella, lead author of the statement, and his colleagues (Circulation 2008;117;704-9).

Although it has been shown that high-quality CPR provided by bystanders can improve the rates of survival to hospital discharge, in many communities only 15%−30% of victims receive bystander CPR before emergency medical services personnel arrive. With arrival times often occurring after 7-8 minutes, and a drop in survival rates of 7%−10% for each minute without CPR, the lack of bystander-initiated CPR can have a dramatic impact on patient outcome.

“In communities where widespread CPR training has been provided, survival rates from witnessed sudden cardiac arrest associated with [ventricular fibrillation] have been reportedly as high as 49% to 74% … unfortunately, on average, about 6% of out-of-hospital sudden cardiac arrest victims survive to hospital discharge in the United States,” Dr. Abella, clinical research director for the Center for Resuscitation Science at the University of Pennsylvania, Philadelphia, said in a press statement.

Study findings have shown that even when CPR by a bystander and CPR by trained health care professionals are provided, they are too often provided inadequately, with chest compressions that are too shallow or interrupted too often, and with excessive rates of rescue breathing. The authors provide a number of recommendations to improve the rate and quality of bystander CPR, including:

▸ Broadening CPR training. New approaches in training are needed to reach a larger public audience. A 22-minute, self-instructional program available through the AHA is an example of a tool that can be used outside the classroom. The statement also calls for community and corporate programs to encourage CPR education, and suggests that training be provided in high schools as a prerequisite for graduation and in hospitals for families of patients at risk for sudden cardiac arrest.

▸ Addressing common barriers to lay rescuer action. Bystanders are often reluctant to perform CPR out of fear of disease transmission, fear of legal liability, or as a result of the complexity of guidelines and instructional materials (which hampers both learning and delivery of bystander CPR). Thus, in addition to education about the value of quick action for saving lives, the public should be better informed about the very low risk of disease transmission (there have been no reported cases of HIV transmission or hepatitis via CPR, for example) and the availability of mouth-to-mouth barrier devices and gloves, which should be mandated wherever an automatic external defibrillator (AED) is stationed. Information about Good Samaritan laws that protect bystanders from liability should be included in CPR training and posted prominently near AED stations.

▸ Improving lay rescuer and emergency medical services programs. These programs can be upgraded by providing a process for continuous quality improvement. Reviews of resuscitation efforts and quality of CPR provided by bystanders and dispatchers are needed, as is monitoring (by health care systems that provide CPR services) of the quality of CPR provided during resuscitation efforts.

The AHA also suggests Internet-based CPR education and certification programs be developed, and that research be done to identify the best educational methods for delivering CPR training, the optimal target populations for CPR education, the value of dispatch-assisted CPR in a variety of communities, and the public perceptions that serve as barriers to CPR training and administration.

Bystander-initiated cardiopulmonary resuscitation saves lives but occurs far too infrequently and is often provided inadequately, according to a scientific statement from the American Heart Association.

The statement calls for a concerted effort by health care providers, policy makers, and community leaders to provide education and training to improve the rate and quality of bystander CPR (Circulation 2008 [Epub doi: 10.1161/CIRCULATIONAHA.107.188486]).

“CPR is an inexpensive and readily available technique that can save lives. Therefore, the number of people trained in CPR must increase, and the quality of CPR provided by every rescuer must improve,” Dr. Benjamin S. Abella, lead author of the statement, and his colleagues wrote.

Although high-quality CPR provided by bystanders has been shown in numerous studies to improve the rates of survival to hospital discharge, in many communities only 15%–30% of victims receive bystander CPR before emergency medical services personnel arrive at the scene. With arrival times often occurring after 7–8 minutes, and a drop in survival rates of 7%–10% for each minute without CPR, the lack of bystander-initiated CPR can have a dramatic impact on patient outcome.

“In communities where widespread CPR training has been provided, survival rates from witnessed sudden cardiac arrest associated with [ventricular fibrillation] have been reportedly as high as 49% to 74% … unfortunately, on average, approximately 6% of out-of-hospital sudden cardiac arrest victims survive to hospital discharge in the United States,” Dr. Abella, clinical research director for the Center for Resuscitation Science at the University of Pennsylvania, Philadelphia, said in a statement.

Studies show that even when CPR provided by a bystander and CPR provided by trained health care professionals are provided, they are too often provided inadequately, with chest compressions that are too shallow or interrupted too often, and with excessive rates of rescue breathing.

The authors provide a number of recommendations to improve the rate and quality of bystander CPR, including:

▸ Broadening CPR training. Creative new approaches to reach a larger public audience are needed. A 22-minute, self-instructional program available through the AHA is an example of a tool that can be used outside the classroom. The statement also calls for community and corporate programs to encourage CPR education, and suggests that training be provided in high schools as a prerequisite for graduation and in hospitals for families of patients at risk for sudden cardiac arrest. The development of dispatcher-assisted “telephone CPR” that can provide better assistance to untrained bystanders is also recommended.

▸ Addressing common barriers to lay-rescuer action. Bystanders are often reluctant to perform CPR out of fear of disease transmission, fear of legal liability, or as a result of the complexity of guidelines and instructional materials (which hampers both learning and delivery of bystander CPR). Thus, in addition to education about the value of quick action for saving lives, the public should be better informed about the very low risk of disease transmission (there have been no reported cases of HIV or hepatitis transmission via CPR, for example) and the availability of mouth-to-mouth barrier devices and gloves, which should be mandated wherever an automatic external defibrillator (AED) is stationed. Information about Good Samaritan laws that protect bystanders from liability should be included in CPR training and posted prominently near AED stations.

▸ Improving lay rescuer and emergency medical services programs. These programs can be upgraded by providing a process for continuous quality improvement. Reviews of resuscitation efforts and quality of CPR provided by bystanders and dispatchers are needed, as is monitoring (by health care systems that provide CPR services) of the quality of CPR provided during resuscitation efforts.

Additionally, the AHA statement suggests that Internet-based CPR education and certification programs be developed, and that research be conducted to identify the best educational methods for delivering the highest quality and broadest-reach CPR training, the optimal target populations for CPR education, the value of dispatch-assisted CPR in a variety of communities, and the public perceptions that serve as barriers to CPR training and administration.

“If the rate and quality of bystander CPR are increased substantially, the potential exists to save the lives of thousands of victims of [sudden cardiac arrest] each year,” the authors concluded.

'The potential exists to save the lives of thousands of victims of [sudden cardiac arrest] each year.' DR. ABELLA

Bystander-initiated cardiopulmonary resuscitation saves lives but occurs far too infrequently and is often provided inadequately, according to a scientific statement from the American Heart Association.

The statement calls for a concerted effort by health care providers, policy makers, and community leaders to provide education and training to improve the rate and quality of bystander CPR (Circulation 2008 [Epub doi: 10.1161/CIRCULATIONAHA.107.188486]).

“CPR is an inexpensive and readily available technique that can save lives. Therefore, the number of people trained in CPR must increase, and the quality of CPR provided by every rescuer must improve,” Dr. Benjamin S. Abella, lead author of the statement, and his colleagues wrote.

Although high-quality CPR provided by bystanders has been shown in numerous studies to improve the rates of survival to hospital discharge, in many communities only 15%–30% of victims receive bystander CPR before emergency medical services personnel arrive at the scene. With arrival times often occurring after 7–8 minutes, and a drop in survival rates of 7%–10% for each minute without CPR, the lack of bystander-initiated CPR can have a dramatic impact on patient outcome.

“In communities where widespread CPR training has been provided, survival rates from witnessed sudden cardiac arrest associated with [ventricular fibrillation] have been reportedly as high as 49% to 74% … unfortunately, on average, approximately 6% of out-of-hospital sudden cardiac arrest victims survive to hospital discharge in the United States,” Dr. Abella, clinical research director for the Center for Resuscitation Science at the University of Pennsylvania, Philadelphia, said in a statement.

Studies show that even when CPR provided by a bystander and CPR provided by trained health care professionals are provided, they are too often provided inadequately, with chest compressions that are too shallow or interrupted too often, and with excessive rates of rescue breathing.

The authors provide a number of recommendations to improve the rate and quality of bystander CPR, including:

▸ Broadening CPR training. Creative new approaches to reach a larger public audience are needed. A 22-minute, self-instructional program available through the AHA is an example of a tool that can be used outside the classroom. The statement also calls for community and corporate programs to encourage CPR education, and suggests that training be provided in high schools as a prerequisite for graduation and in hospitals for families of patients at risk for sudden cardiac arrest. The development of dispatcher-assisted “telephone CPR” that can provide better assistance to untrained bystanders is also recommended.

▸ Addressing common barriers to lay-rescuer action. Bystanders are often reluctant to perform CPR out of fear of disease transmission, fear of legal liability, or as a result of the complexity of guidelines and instructional materials (which hampers both learning and delivery of bystander CPR). Thus, in addition to education about the value of quick action for saving lives, the public should be better informed about the very low risk of disease transmission (there have been no reported cases of HIV or hepatitis transmission via CPR, for example) and the availability of mouth-to-mouth barrier devices and gloves, which should be mandated wherever an automatic external defibrillator (AED) is stationed. Information about Good Samaritan laws that protect bystanders from liability should be included in CPR training and posted prominently near AED stations.

▸ Improving lay rescuer and emergency medical services programs. These programs can be upgraded by providing a process for continuous quality improvement. Reviews of resuscitation efforts and quality of CPR provided by bystanders and dispatchers are needed, as is monitoring (by health care systems that provide CPR services) of the quality of CPR provided during resuscitation efforts.

Additionally, the AHA statement suggests that Internet-based CPR education and certification programs be developed, and that research be conducted to identify the best educational methods for delivering the highest quality and broadest-reach CPR training, the optimal target populations for CPR education, the value of dispatch-assisted CPR in a variety of communities, and the public perceptions that serve as barriers to CPR training and administration.

“If the rate and quality of bystander CPR are increased substantially, the potential exists to save the lives of thousands of victims of [sudden cardiac arrest] each year,” the authors concluded.

'The potential exists to save the lives of thousands of victims of [sudden cardiac arrest] each year.' DR. ABELLA

Bystander-initiated cardiopulmonary resuscitation saves lives but occurs far too infrequently and is often provided inadequately, according to a scientific statement from the American Heart Association.

The statement calls for a concerted effort by health care providers, policy makers, and community leaders to provide education and training to improve the rate and quality of bystander CPR (Circulation 2008 [Epub doi: 10.1161/CIRCULATIONAHA.107.188486]).

“CPR is an inexpensive and readily available technique that can save lives. Therefore, the number of people trained in CPR must increase, and the quality of CPR provided by every rescuer must improve,” Dr. Benjamin S. Abella, lead author of the statement, and his colleagues wrote.

Although high-quality CPR provided by bystanders has been shown in numerous studies to improve the rates of survival to hospital discharge, in many communities only 15%–30% of victims receive bystander CPR before emergency medical services personnel arrive at the scene. With arrival times often occurring after 7–8 minutes, and a drop in survival rates of 7%–10% for each minute without CPR, the lack of bystander-initiated CPR can have a dramatic impact on patient outcome.

“In communities where widespread CPR training has been provided, survival rates from witnessed sudden cardiac arrest associated with [ventricular fibrillation] have been reportedly as high as 49% to 74% … unfortunately, on average, approximately 6% of out-of-hospital sudden cardiac arrest victims survive to hospital discharge in the United States,” Dr. Abella, clinical research director for the Center for Resuscitation Science at the University of Pennsylvania, Philadelphia, said in a statement.

Studies show that even when CPR provided by a bystander and CPR provided by trained health care professionals are provided, they are too often provided inadequately, with chest compressions that are too shallow or interrupted too often, and with excessive rates of rescue breathing.

The authors provide a number of recommendations to improve the rate and quality of bystander CPR, including:

▸ Broadening CPR training. Creative new approaches to reach a larger public audience are needed. A 22-minute, self-instructional program available through the AHA is an example of a tool that can be used outside the classroom. The statement also calls for community and corporate programs to encourage CPR education, and suggests that training be provided in high schools as a prerequisite for graduation and in hospitals for families of patients at risk for sudden cardiac arrest. The development of dispatcher-assisted “telephone CPR” that can provide better assistance to untrained bystanders is also recommended.

▸ Addressing common barriers to lay-rescuer action. Bystanders are often reluctant to perform CPR out of fear of disease transmission, fear of legal liability, or as a result of the complexity of guidelines and instructional materials (which hampers both learning and delivery of bystander CPR). Thus, in addition to education about the value of quick action for saving lives, the public should be better informed about the very low risk of disease transmission (there have been no reported cases of HIV or hepatitis transmission via CPR, for example) and the availability of mouth-to-mouth barrier devices and gloves, which should be mandated wherever an automatic external defibrillator (AED) is stationed. Information about Good Samaritan laws that protect bystanders from liability should be included in CPR training and posted prominently near AED stations.

▸ Improving lay rescuer and emergency medical services programs. These programs can be upgraded by providing a process for continuous quality improvement. Reviews of resuscitation efforts and quality of CPR provided by bystanders and dispatchers are needed, as is monitoring (by health care systems that provide CPR services) of the quality of CPR provided during resuscitation efforts.

Additionally, the AHA statement suggests that Internet-based CPR education and certification programs be developed, and that research be conducted to identify the best educational methods for delivering the highest quality and broadest-reach CPR training, the optimal target populations for CPR education, the value of dispatch-assisted CPR in a variety of communities, and the public perceptions that serve as barriers to CPR training and administration.

“If the rate and quality of bystander CPR are increased substantially, the potential exists to save the lives of thousands of victims of [sudden cardiac arrest] each year,” the authors concluded.

'The potential exists to save the lives of thousands of victims of [sudden cardiac arrest] each year.' DR. ABELLA

Statin therapy is a safe and cost-effective option for reducing the risk of major vascular events in patients with diabetes and should be considered for almost all diabetics, findings from a recent meta-analysis show.

In all, 14 randomized trials of statin therapy involving 18,686 individuals with diabetes and 17,220 without diabetes were included in the meta-analysis, which was conducted by the Cholesterol Treatment Trialists' Collaborators.

During more than 4 years of follow-up, 3,247 major vascular events, which were defined as the composite outcome of myocardial infarction, coronary death, stroke, or coronary revascularization, occurred in the trial participants.

Statin therapy in the diabetic patients was associated with a 9% proportional reduction in all-cause mortality per mmol/L reduction in LDL cholesterol, and was associated with a statistically similar 13% reduction in all-cause mortality in those without diabetes. This finding was due mainly to a significant reduction in vascular mortality (rate ratio of 0.87) in those with diabetes; there was no apparent effect on nonvascular mortality (rate ratio of 0.97) in this population, the investigators reported (Lancet 2008;371:117–25).

Furthermore, both those with and without diabetes had a 21% proportional reduction in major vascular events per mmol/L reduction in LDL cholesterol. In the diabetic patients, the effects of statin therapy were similar regardless of whether they had a history of vascular disease and regardless of other baseline characteristics, including type of diabetes, age, sex, treated hypertension, body mass index, systolic or diastolic blood pressure, smoking status, and estimated glomerular filtration rate.

In addition, reductions in major coronary events, coronary revascularization, and stroke were seen in those with diabetes (rate ratios of 0.78, 0.75, and 0.79, respectively), and the effect of statins on each of these outcomes was similar in diabetic and nondiabetic patients.

At 5 years, 42 fewer diabetic patients per 1,000 treated with statins had major vascular events, the collaborators found.

Statin therapy given in moderate doses over the 5 years was not associated with an increased risk of cancer or nonvascular causes of death in the study participants.

The findings, which “show convincingly” the benefits of statin therapy for reducing the risk of major vascular events in a wide range of individuals with and without diabetes, indicate that “the cost effectiveness of treatment for a person at a specific absolute level of risk of major vascular events, irrespective of whether diabetes is present, will be much the same,” the investigators wrote.

In a previous meta-analysis of 14 statin trials involving more than 90,000 patients, the researchers showed that a generic statin regimen producing a mean reduction of about 1 mmol/L was cost effective in those with as low as 1% risk of a major vascular event—suggesting that statin treatment would be cost effective in almost all diabetic patients, they noted.

Furthermore, “standard doses of a statin reduce LDL cholesterol by about 40%, which translates into a reduction of at least 1.5 mmol/L for many people with diabetes, so our results suggest that such an absolute reduction in LDL cholesterol would prevent about a third of patients from having a major vascular event,” they wrote. They concluded that statin therapy is likely to be inappropriate only in those in whom there are safety concerns (such as in pregnant women) or when there is a low short-term absolute risk of vascular disease (such as in children with type 1 diabetes).

Because the benefit seen with statin therapy is related mainly to the absolute reduction in LDL cholesterol achieved, it may be necessary to revise guidelines on statin therapy to ensure that a regimen sufficient to reduce LDL cholesterol substantially is considered for those with diabetes, they added.

In a commentary on the findings, Dr. Bernard M.Y. Cheung of the University of Birmingham, England, calls the collaborators' findings reassuring, but notes that statins “are not a panacea, and patients on statins are liable to other causes of morbidity and mortality” (Lancet 2008;321:94–5).

Treatment decisions should be based on the reduction in absolute risk—or the number needed to treat, rather than on relative risk reduction, he states, noting that in those with a high absolute cardiovascular risk, even a modest reduction in relative risk will provide meaningful clinical benefit. But he adds that other factors, such as life expectancy, concomitant disease, and quality of life also should be taken into consideration, and he stresses the continued importance of lifestyle.

“Apart from drug treatment, one must not forget the importance of lifestyle changes, such as cessation of smoking, healthy diet, and regular exercise,” Dr. Cheung wrote.

Statin therapy is a safe and cost-effective option for reducing the risk of major vascular events in patients with diabetes and should be considered for almost all diabetics, findings from a recent meta-analysis show.

In all, 14 randomized trials of statin therapy involving 18,686 individuals with diabetes and 17,220 without diabetes were included in the meta-analysis, which was conducted by the Cholesterol Treatment Trialists' Collaborators.

During more than 4 years of follow-up, 3,247 major vascular events, which were defined as the composite outcome of myocardial infarction, coronary death, stroke, or coronary revascularization, occurred in the trial participants.

Statin therapy in the diabetic patients was associated with a 9% proportional reduction in all-cause mortality per mmol/L reduction in LDL cholesterol, and was associated with a statistically similar 13% reduction in all-cause mortality in those without diabetes. This finding was due mainly to a significant reduction in vascular mortality (rate ratio of 0.87) in those with diabetes; there was no apparent effect on nonvascular mortality (rate ratio of 0.97) in this population, the investigators reported (Lancet 2008;371:117–25).

Furthermore, both those with and without diabetes had a 21% proportional reduction in major vascular events per mmol/L reduction in LDL cholesterol. In the diabetic patients, the effects of statin therapy were similar regardless of whether they had a history of vascular disease and regardless of other baseline characteristics, including type of diabetes, age, sex, treated hypertension, body mass index, systolic or diastolic blood pressure, smoking status, and estimated glomerular filtration rate.

In addition, reductions in major coronary events, coronary revascularization, and stroke were seen in those with diabetes (rate ratios of 0.78, 0.75, and 0.79, respectively), and the effect of statins on each of these outcomes was similar in diabetic and nondiabetic patients.

At 5 years, 42 fewer diabetic patients per 1,000 treated with statins had major vascular events, the collaborators found.

Statin therapy given in moderate doses over the 5 years was not associated with an increased risk of cancer or nonvascular causes of death in the study participants.

The findings, which “show convincingly” the benefits of statin therapy for reducing the risk of major vascular events in a wide range of individuals with and without diabetes, indicate that “the cost effectiveness of treatment for a person at a specific absolute level of risk of major vascular events, irrespective of whether diabetes is present, will be much the same,” the investigators wrote.

In a previous meta-analysis of 14 statin trials involving more than 90,000 patients, the researchers showed that a generic statin regimen producing a mean reduction of about 1 mmol/L was cost effective in those with as low as 1% risk of a major vascular event—suggesting that statin treatment would be cost effective in almost all diabetic patients, they noted.

Furthermore, “standard doses of a statin reduce LDL cholesterol by about 40%, which translates into a reduction of at least 1.5 mmol/L for many people with diabetes, so our results suggest that such an absolute reduction in LDL cholesterol would prevent about a third of patients from having a major vascular event,” they wrote. They concluded that statin therapy is likely to be inappropriate only in those in whom there are safety concerns (such as in pregnant women) or when there is a low short-term absolute risk of vascular disease (such as in children with type 1 diabetes).

Because the benefit seen with statin therapy is related mainly to the absolute reduction in LDL cholesterol achieved, it may be necessary to revise guidelines on statin therapy to ensure that a regimen sufficient to reduce LDL cholesterol substantially is considered for those with diabetes, they added.

In a commentary on the findings, Dr. Bernard M.Y. Cheung of the University of Birmingham, England, calls the collaborators' findings reassuring, but notes that statins “are not a panacea, and patients on statins are liable to other causes of morbidity and mortality” (Lancet 2008;321:94–5).

Treatment decisions should be based on the reduction in absolute risk—or the number needed to treat, rather than on relative risk reduction, he states, noting that in those with a high absolute cardiovascular risk, even a modest reduction in relative risk will provide meaningful clinical benefit. But he adds that other factors, such as life expectancy, concomitant disease, and quality of life also should be taken into consideration, and he stresses the continued importance of lifestyle.

“Apart from drug treatment, one must not forget the importance of lifestyle changes, such as cessation of smoking, healthy diet, and regular exercise,” Dr. Cheung wrote.

Statin therapy is a safe and cost-effective option for reducing the risk of major vascular events in patients with diabetes and should be considered for almost all diabetics, findings from a recent meta-analysis show.

In all, 14 randomized trials of statin therapy involving 18,686 individuals with diabetes and 17,220 without diabetes were included in the meta-analysis, which was conducted by the Cholesterol Treatment Trialists' Collaborators.

During more than 4 years of follow-up, 3,247 major vascular events, which were defined as the composite outcome of myocardial infarction, coronary death, stroke, or coronary revascularization, occurred in the trial participants.

Statin therapy in the diabetic patients was associated with a 9% proportional reduction in all-cause mortality per mmol/L reduction in LDL cholesterol, and was associated with a statistically similar 13% reduction in all-cause mortality in those without diabetes. This finding was due mainly to a significant reduction in vascular mortality (rate ratio of 0.87) in those with diabetes; there was no apparent effect on nonvascular mortality (rate ratio of 0.97) in this population, the investigators reported (Lancet 2008;371:117–25).

Furthermore, both those with and without diabetes had a 21% proportional reduction in major vascular events per mmol/L reduction in LDL cholesterol. In the diabetic patients, the effects of statin therapy were similar regardless of whether they had a history of vascular disease and regardless of other baseline characteristics, including type of diabetes, age, sex, treated hypertension, body mass index, systolic or diastolic blood pressure, smoking status, and estimated glomerular filtration rate.

In addition, reductions in major coronary events, coronary revascularization, and stroke were seen in those with diabetes (rate ratios of 0.78, 0.75, and 0.79, respectively), and the effect of statins on each of these outcomes was similar in diabetic and nondiabetic patients.

At 5 years, 42 fewer diabetic patients per 1,000 treated with statins had major vascular events, the collaborators found.

Statin therapy given in moderate doses over the 5 years was not associated with an increased risk of cancer or nonvascular causes of death in the study participants.

The findings, which “show convincingly” the benefits of statin therapy for reducing the risk of major vascular events in a wide range of individuals with and without diabetes, indicate that “the cost effectiveness of treatment for a person at a specific absolute level of risk of major vascular events, irrespective of whether diabetes is present, will be much the same,” the investigators wrote.

In a previous meta-analysis of 14 statin trials involving more than 90,000 patients, the researchers showed that a generic statin regimen producing a mean reduction of about 1 mmol/L was cost effective in those with as low as 1% risk of a major vascular event—suggesting that statin treatment would be cost effective in almost all diabetic patients, they noted.

Furthermore, “standard doses of a statin reduce LDL cholesterol by about 40%, which translates into a reduction of at least 1.5 mmol/L for many people with diabetes, so our results suggest that such an absolute reduction in LDL cholesterol would prevent about a third of patients from having a major vascular event,” they wrote. They concluded that statin therapy is likely to be inappropriate only in those in whom there are safety concerns (such as in pregnant women) or when there is a low short-term absolute risk of vascular disease (such as in children with type 1 diabetes).

Because the benefit seen with statin therapy is related mainly to the absolute reduction in LDL cholesterol achieved, it may be necessary to revise guidelines on statin therapy to ensure that a regimen sufficient to reduce LDL cholesterol substantially is considered for those with diabetes, they added.

In a commentary on the findings, Dr. Bernard M.Y. Cheung of the University of Birmingham, England, calls the collaborators' findings reassuring, but notes that statins “are not a panacea, and patients on statins are liable to other causes of morbidity and mortality” (Lancet 2008;321:94–5).

Treatment decisions should be based on the reduction in absolute risk—or the number needed to treat, rather than on relative risk reduction, he states, noting that in those with a high absolute cardiovascular risk, even a modest reduction in relative risk will provide meaningful clinical benefit. But he adds that other factors, such as life expectancy, concomitant disease, and quality of life also should be taken into consideration, and he stresses the continued importance of lifestyle.

“Apart from drug treatment, one must not forget the importance of lifestyle changes, such as cessation of smoking, healthy diet, and regular exercise,” Dr. Cheung wrote.

The Centers for Disease Control and Prevention is launching a study to improve understanding of an unexplained and controversial dermatologic condition known as Morgellons, which is affecting an increasing number of individuals both in the United States and abroad, the agency announced.

Little is known about the cause of the condition, which is characterized by a range of dermatologic symptoms, including rashes and sores that occur in association with abnormal crawling, biting, or stinging sensations.

Patients often describe having threads, fibers, or foreign materials underneath or protruding from the skin in affected areas. Fatigue, mental confusion, memory loss, joint pain, and changes in vision have also been reported.

Some medical professionals consider Morgellons to be a manifestation of other medical or psychological conditions, including delusional parasitosis, but experts are divided on the topic.

"What is clear is that those who suffer from this condition, as well as their family members and their physicians, have questions," Dr. Michele Pearson said during a press briefing held to announce the study's launch.

It is also clear that the symptoms and the suffering of patients are very real, said Dr. Pearson, principal investigator for the CDC, in response to questions from the media about whether Morgellons is a "real disease."

Dr. Dirk Elston, director of the department of dermatology at Geisinger Medical Center in Danville, Pa., said that "So far all the patients I have seen who believed they may have Morgellon's actually appeared to suffer from delusional parasitosis."

The study will be conducted in conjunction with Kaiser Permanente Northern California, which is "uniquely positioned to assist the CDC with this study," because of the large population of members it serves, and because of the research capabilities within the organization.

Furthermore, northern California is one of the "hot spots" around the country where cases of reported Moregellons have been geographically concentrated, Dr. Joe Selby, director, division of research, Kaiser Permanente Northern California said during the briefing.

Cases have also been reported in Canada, Australia, and several European countries; however, little is known about the true prevalence of the disorder, Dr. Pearson said, noting that the CDC has received about 1,200 inquiries about the Morgellons, and by some estimates there are approximately 10,000 self-reported cases of the condition.

The investigators aim to determine the prevalence, as well as to identify epidemiological, clinical, and histopathologic features of the condition. Patient recruitment will begin immediately.

Participants will undergo a detailed general, dermatologic, and mental health evaluation; skin biopsies; and a series of blood tests.

"Those affected are very anxious for answers," she said.

Although it is hoped that this study will indeed provide some answers, Dr. Pearson added, it is likely that numerous studies will be needed to fully elucidate this condition.

"[Morgellons] is complicated, and it may involve multiple factors … but we believe this study will provide useful information to the medical community, and—most importantly—to those who suffer with this disorder," she said.

The Centers for Disease Control and Prevention is launching a study to improve understanding of an unexplained and controversial dermatologic condition known as Morgellons, which is affecting an increasing number of individuals both in the United States and abroad, the agency announced.

Little is known about the cause of the condition, which is characterized by a range of dermatologic symptoms, including rashes and sores that occur in association with abnormal crawling, biting, or stinging sensations.

Patients often describe having threads, fibers, or foreign materials underneath or protruding from the skin in affected areas. Fatigue, mental confusion, memory loss, joint pain, and changes in vision have also been reported.

Some medical professionals consider Morgellons to be a manifestation of other medical or psychological conditions, including delusional parasitosis, but experts are divided on the topic.

"What is clear is that those who suffer from this condition, as well as their family members and their physicians, have questions," Dr. Michele Pearson said during a press briefing held to announce the study's launch.

It is also clear that the symptoms and the suffering of patients are very real, said Dr. Pearson, principal investigator for the CDC, in response to questions from the media about whether Morgellons is a "real disease."

Dr. Dirk Elston, director of the department of dermatology at Geisinger Medical Center in Danville, Pa., said that "So far all the patients I have seen who believed they may have Morgellon's actually appeared to suffer from delusional parasitosis."

The study will be conducted in conjunction with Kaiser Permanente Northern California, which is "uniquely positioned to assist the CDC with this study," because of the large population of members it serves, and because of the research capabilities within the organization.

Furthermore, northern California is one of the "hot spots" around the country where cases of reported Moregellons have been geographically concentrated, Dr. Joe Selby, director, division of research, Kaiser Permanente Northern California said during the briefing.

Cases have also been reported in Canada, Australia, and several European countries; however, little is known about the true prevalence of the disorder, Dr. Pearson said, noting that the CDC has received about 1,200 inquiries about the Morgellons, and by some estimates there are approximately 10,000 self-reported cases of the condition.

The investigators aim to determine the prevalence, as well as to identify epidemiological, clinical, and histopathologic features of the condition. Patient recruitment will begin immediately.

Participants will undergo a detailed general, dermatologic, and mental health evaluation; skin biopsies; and a series of blood tests.

"Those affected are very anxious for answers," she said.

Although it is hoped that this study will indeed provide some answers, Dr. Pearson added, it is likely that numerous studies will be needed to fully elucidate this condition.

"[Morgellons] is complicated, and it may involve multiple factors … but we believe this study will provide useful information to the medical community, and—most importantly—to those who suffer with this disorder," she said.

The Centers for Disease Control and Prevention is launching a study to improve understanding of an unexplained and controversial dermatologic condition known as Morgellons, which is affecting an increasing number of individuals both in the United States and abroad, the agency announced.

Little is known about the cause of the condition, which is characterized by a range of dermatologic symptoms, including rashes and sores that occur in association with abnormal crawling, biting, or stinging sensations.

Patients often describe having threads, fibers, or foreign materials underneath or protruding from the skin in affected areas. Fatigue, mental confusion, memory loss, joint pain, and changes in vision have also been reported.

Some medical professionals consider Morgellons to be a manifestation of other medical or psychological conditions, including delusional parasitosis, but experts are divided on the topic.

"What is clear is that those who suffer from this condition, as well as their family members and their physicians, have questions," Dr. Michele Pearson said during a press briefing held to announce the study's launch.

It is also clear that the symptoms and the suffering of patients are very real, said Dr. Pearson, principal investigator for the CDC, in response to questions from the media about whether Morgellons is a "real disease."

Dr. Dirk Elston, director of the department of dermatology at Geisinger Medical Center in Danville, Pa., said that "So far all the patients I have seen who believed they may have Morgellon's actually appeared to suffer from delusional parasitosis."

The study will be conducted in conjunction with Kaiser Permanente Northern California, which is "uniquely positioned to assist the CDC with this study," because of the large population of members it serves, and because of the research capabilities within the organization.

Furthermore, northern California is one of the "hot spots" around the country where cases of reported Moregellons have been geographically concentrated, Dr. Joe Selby, director, division of research, Kaiser Permanente Northern California said during the briefing.

Cases have also been reported in Canada, Australia, and several European countries; however, little is known about the true prevalence of the disorder, Dr. Pearson said, noting that the CDC has received about 1,200 inquiries about the Morgellons, and by some estimates there are approximately 10,000 self-reported cases of the condition.

The investigators aim to determine the prevalence, as well as to identify epidemiological, clinical, and histopathologic features of the condition. Patient recruitment will begin immediately.

Participants will undergo a detailed general, dermatologic, and mental health evaluation; skin biopsies; and a series of blood tests.

"Those affected are very anxious for answers," she said.

Although it is hoped that this study will indeed provide some answers, Dr. Pearson added, it is likely that numerous studies will be needed to fully elucidate this condition.

"[Morgellons] is complicated, and it may involve multiple factors … but we believe this study will provide useful information to the medical community, and—most importantly—to those who suffer with this disorder," she said.

ORLANDO — Face-lifting using "mini-face-lift" techniques is well within the purview of the dermatologic surgeon, Dr. N. Fred Eaglstein said at the annual meeting of the Florida Society of Dermatologic Surgeons.

"It's a natural progression for dermatologic surgeons to move into this area," said Dr. Eaglstein, medical director of a dermatology and laser group practice in Orange Park, Fla.

The skills required for mini-face-lifts are used often by dermatologic surgeons for procedures such as advancement flaps, and with the increasing number of cosmetic procedures being done, it makes sense for mini-face-lifts to be the next step, he said.

After trying various face-lifting approaches—including thread contouring and infrared and radiofrequency treatments—without much success, he found that the QuickLift technique, which was first described by Dr. Dominic A. Brandy (Cosmet. Dermatol. 2004;17:251–60), provided superior long-term results. He has used this approach in more than 30 patients over the past year.

"With this technique, we are getting really long-lasting, effective results that patients really would like to have," said Dr. Eaglstein, who reported no financial interest in the QuickLift or related procedures.

The approach stays above the level of the superficial musculoaponeurotic system (SMAS) and usually involves plication.

Because this is a type of procedure that dermatologic surgeons do all the time—and a type of procedure with less risk of morbidity than traditional face-lifts have—it helps in circumventing issues with insurance companies that say they cover face-lifts only by plastic surgeons, he noted.

The mini-face-lift actually is a lot like a large advancement flap, and it would be a very simple procedure if it weren't for the ears, he said.

Because of the ears, the procedure is more tedious, involving extension of the excision from the temporal hairline to the preauricular area, back behind the earlobe into the mastoid fascia and into the mastoid area of the scalp. Unlike traditional face-lifts, however, it doesn't involve cutting the SMAS and undermining and removing a portion of it.

The technique ultimately allows for tightening of the SMAS with the use of two anchored purse-string sutures that cause the SMAS to bunch up and create crevices that will form fibrosis and provide the enduring tightening result, Dr. Eaglstein explained.

The procedure is performed using tumescent local anesthesia and mild oral sedation. Incisions at the hairline should be beveled to allow the hair to regrow from follicles underneath, thus concealing the scar. Face-lift scissors are a particularly useful tool for the extensive undermining used in creating the flap, he said.

Following the procedure, a pressure dressing is applied with a garment for 1 day. Patients can expect swelling, bruising, and ecchymosis for the first day, and a fair amount of discomfort for about a week, but most patients heal adequately within a few weeks.

Complications encountered with QuickLift are similar to those seen with any large flap. If an expanding hematoma occurs, it will be necessary to go back in and open up the flap to drain the hematoma, he said.

Infection is rare but can occur, as can necrosis of the flap. The avoidance of excessive tension on the flap can reduce the risk of necrosis; most of the tension should be on the underlying connective tissue. Seroma and nerve injury can also occur, but they are rare, Dr. Eaglstein said.

Because the QuickLift technique is a procedure for tightening the neck and jowls rather than the midface region, it is typically used in conjunction with other cosmetic procedures—such as liposuction of the chin, cheek, and jowls—for a synergistic effect.

Submental tuck and platysmal plication, an extended neck lift (with undermining all the way down to the central portion of the neck to pull that area back), and lateral brow lift are among other procedures that can also be performed with the QuickLift, he noted.

Adjuvant procedures can also include Botox or filler injection, fat transfer for the midface, blepharoplasty, and forehead lift. Chemical peeling or laser resurfacing performed 4–6 weeks after the QuickLift can help reduce the appearance of the scars and provide an added cosmetic benefit.

A number of courses—including weekend courses and university-based cadaveric courses—as well as articles and books are available for those interested in learning QuickLift and other mini-face-lift techniques, said Dr. Eaglstein, who reported having no conflicts of interest.

A patient is shown before and after undergoing cosmetic surgery with the "long-lasting, effective" QuickLift technique. Photos courtesy Dr. N. Fred Eaglstein

ORLANDO — Face-lifting using "mini-face-lift" techniques is well within the purview of the dermatologic surgeon, Dr. N. Fred Eaglstein said at the annual meeting of the Florida Society of Dermatologic Surgeons.

"It's a natural progression for dermatologic surgeons to move into this area," said Dr. Eaglstein, medical director of a dermatology and laser group practice in Orange Park, Fla.

The skills required for mini-face-lifts are used often by dermatologic surgeons for procedures such as advancement flaps, and with the increasing number of cosmetic procedures being done, it makes sense for mini-face-lifts to be the next step, he said.

After trying various face-lifting approaches—including thread contouring and infrared and radiofrequency treatments—without much success, he found that the QuickLift technique, which was first described by Dr. Dominic A. Brandy (Cosmet. Dermatol. 2004;17:251–60), provided superior long-term results. He has used this approach in more than 30 patients over the past year.

"With this technique, we are getting really long-lasting, effective results that patients really would like to have," said Dr. Eaglstein, who reported no financial interest in the QuickLift or related procedures.

The approach stays above the level of the superficial musculoaponeurotic system (SMAS) and usually involves plication.

Because this is a type of procedure that dermatologic surgeons do all the time—and a type of procedure with less risk of morbidity than traditional face-lifts have—it helps in circumventing issues with insurance companies that say they cover face-lifts only by plastic surgeons, he noted.

The mini-face-lift actually is a lot like a large advancement flap, and it would be a very simple procedure if it weren't for the ears, he said.

Because of the ears, the procedure is more tedious, involving extension of the excision from the temporal hairline to the preauricular area, back behind the earlobe into the mastoid fascia and into the mastoid area of the scalp. Unlike traditional face-lifts, however, it doesn't involve cutting the SMAS and undermining and removing a portion of it.

The technique ultimately allows for tightening of the SMAS with the use of two anchored purse-string sutures that cause the SMAS to bunch up and create crevices that will form fibrosis and provide the enduring tightening result, Dr. Eaglstein explained.

The procedure is performed using tumescent local anesthesia and mild oral sedation. Incisions at the hairline should be beveled to allow the hair to regrow from follicles underneath, thus concealing the scar. Face-lift scissors are a particularly useful tool for the extensive undermining used in creating the flap, he said.

Following the procedure, a pressure dressing is applied with a garment for 1 day. Patients can expect swelling, bruising, and ecchymosis for the first day, and a fair amount of discomfort for about a week, but most patients heal adequately within a few weeks.

Complications encountered with QuickLift are similar to those seen with any large flap. If an expanding hematoma occurs, it will be necessary to go back in and open up the flap to drain the hematoma, he said.

Infection is rare but can occur, as can necrosis of the flap. The avoidance of excessive tension on the flap can reduce the risk of necrosis; most of the tension should be on the underlying connective tissue. Seroma and nerve injury can also occur, but they are rare, Dr. Eaglstein said.

Because the QuickLift technique is a procedure for tightening the neck and jowls rather than the midface region, it is typically used in conjunction with other cosmetic procedures—such as liposuction of the chin, cheek, and jowls—for a synergistic effect.

Submental tuck and platysmal plication, an extended neck lift (with undermining all the way down to the central portion of the neck to pull that area back), and lateral brow lift are among other procedures that can also be performed with the QuickLift, he noted.

Adjuvant procedures can also include Botox or filler injection, fat transfer for the midface, blepharoplasty, and forehead lift. Chemical peeling or laser resurfacing performed 4–6 weeks after the QuickLift can help reduce the appearance of the scars and provide an added cosmetic benefit.

A number of courses—including weekend courses and university-based cadaveric courses—as well as articles and books are available for those interested in learning QuickLift and other mini-face-lift techniques, said Dr. Eaglstein, who reported having no conflicts of interest.

A patient is shown before and after undergoing cosmetic surgery with the "long-lasting, effective" QuickLift technique. Photos courtesy Dr. N. Fred Eaglstein

ORLANDO — Face-lifting using "mini-face-lift" techniques is well within the purview of the dermatologic surgeon, Dr. N. Fred Eaglstein said at the annual meeting of the Florida Society of Dermatologic Surgeons.

"It's a natural progression for dermatologic surgeons to move into this area," said Dr. Eaglstein, medical director of a dermatology and laser group practice in Orange Park, Fla.

The skills required for mini-face-lifts are used often by dermatologic surgeons for procedures such as advancement flaps, and with the increasing number of cosmetic procedures being done, it makes sense for mini-face-lifts to be the next step, he said.

After trying various face-lifting approaches—including thread contouring and infrared and radiofrequency treatments—without much success, he found that the QuickLift technique, which was first described by Dr. Dominic A. Brandy (Cosmet. Dermatol. 2004;17:251–60), provided superior long-term results. He has used this approach in more than 30 patients over the past year.

"With this technique, we are getting really long-lasting, effective results that patients really would like to have," said Dr. Eaglstein, who reported no financial interest in the QuickLift or related procedures.

The approach stays above the level of the superficial musculoaponeurotic system (SMAS) and usually involves plication.

Because this is a type of procedure that dermatologic surgeons do all the time—and a type of procedure with less risk of morbidity than traditional face-lifts have—it helps in circumventing issues with insurance companies that say they cover face-lifts only by plastic surgeons, he noted.

The mini-face-lift actually is a lot like a large advancement flap, and it would be a very simple procedure if it weren't for the ears, he said.

Because of the ears, the procedure is more tedious, involving extension of the excision from the temporal hairline to the preauricular area, back behind the earlobe into the mastoid fascia and into the mastoid area of the scalp. Unlike traditional face-lifts, however, it doesn't involve cutting the SMAS and undermining and removing a portion of it.

The technique ultimately allows for tightening of the SMAS with the use of two anchored purse-string sutures that cause the SMAS to bunch up and create crevices that will form fibrosis and provide the enduring tightening result, Dr. Eaglstein explained.

The procedure is performed using tumescent local anesthesia and mild oral sedation. Incisions at the hairline should be beveled to allow the hair to regrow from follicles underneath, thus concealing the scar. Face-lift scissors are a particularly useful tool for the extensive undermining used in creating the flap, he said.

Following the procedure, a pressure dressing is applied with a garment for 1 day. Patients can expect swelling, bruising, and ecchymosis for the first day, and a fair amount of discomfort for about a week, but most patients heal adequately within a few weeks.

Complications encountered with QuickLift are similar to those seen with any large flap. If an expanding hematoma occurs, it will be necessary to go back in and open up the flap to drain the hematoma, he said.

Infection is rare but can occur, as can necrosis of the flap. The avoidance of excessive tension on the flap can reduce the risk of necrosis; most of the tension should be on the underlying connective tissue. Seroma and nerve injury can also occur, but they are rare, Dr. Eaglstein said.

Because the QuickLift technique is a procedure for tightening the neck and jowls rather than the midface region, it is typically used in conjunction with other cosmetic procedures—such as liposuction of the chin, cheek, and jowls—for a synergistic effect.

Submental tuck and platysmal plication, an extended neck lift (with undermining all the way down to the central portion of the neck to pull that area back), and lateral brow lift are among other procedures that can also be performed with the QuickLift, he noted.

Adjuvant procedures can also include Botox or filler injection, fat transfer for the midface, blepharoplasty, and forehead lift. Chemical peeling or laser resurfacing performed 4–6 weeks after the QuickLift can help reduce the appearance of the scars and provide an added cosmetic benefit.

A number of courses—including weekend courses and university-based cadaveric courses—as well as articles and books are available for those interested in learning QuickLift and other mini-face-lift techniques, said Dr. Eaglstein, who reported having no conflicts of interest.

A patient is shown before and after undergoing cosmetic surgery with the "long-lasting, effective" QuickLift technique. Photos courtesy Dr. N. Fred Eaglstein

ORLANDO — Ablation with a CO₂ laser caused no side effects, scarring, or recurrence in a small study of patients with actinic cheilitis, according to Dr. Keyvan Nouri.

In the study, 25 patients with this precancerous condition of the lips were treated at the University of Miami with Lumenis Ltd.'s UltraPulse CO₂ laser, said Dr. Nouri at the annual meeting of the Florida Society of Dermatologic Surgeons.

Study subjects were initially treated conservatively, at the device's proprietary density setting of 6, but Dr. Nouri now uses a density of 7 because it allows him to achieve better ablation and a similar side effect profile.

After the first pass over the suspicious and surrounding areas, the treated area was wiped. A second pass was then made at 300 mJ over the suspicious area at a density of 5. The area was then allowed to granulate, said Dr. Nouri, who is professor of dermatology at the University of Miami and director of the university's laser center.

A variety of other actinic cheilitis treatments have been used, including surgical and nonsurgical approaches, but the CO₂ laser appears to be a good treatment option, said Dr. Nouri, who owns the UltraPulse laser that was used for the treatment but disclosed having no financial interest in the company that makes the device.

This laser is easier to use than many other modalities, and may be safer as well, he said, noting that other treatments include topical agents (such as 5-fluorouracil, which can be very irritating), chemexfoliation, systemic retinoids, interferon-α, curettage and electrodesiccation, and cryosurgery.

Other advantages of the CO₂ laser, he noted, are a minimal risk of transferring precancerous cells and a low risk of infection from the procedure itself. (Most patients are premedicated with antivirals and sometimes with antibiotics.)

"I'm not saying this is a panacea, because even with the UltraPulse there can be a high recurrence rate, but it is a pretty good option," he said.

Most cases of actinic cheilitis (about 97%) occur on the lower lip. Exposure to ultraviolet radiation is a risk factor for the condition, and thus it is particularly common in those with outdoor occupations and hobbies, said Dr. Nouri. Tobacco exposure has also been linked with this condition. Men in the fifth and sixth decades of life are most often affected.

Actinic cheilitis presents as whitish or reddish lesions that are ulcerated, erosive unulcerated, or erosive ulcerated. Histologically, they present as mild epithelial dysplasia with thickening of the keratin and spinous layer.

Connective tissue and perivascular inflammation can also be seen, but basophilic changes within the connective tissue are a universal finding.

A patient with actinic cheilitis is shown before the laser ablation was performed.

The same patient is shown 1 month after treatment with the UltraPulse CO₂ laser. Photos courtesy Dr. Keyvan Nouri

ORLANDO — Ablation with a CO₂ laser caused no side effects, scarring, or recurrence in a small study of patients with actinic cheilitis, according to Dr. Keyvan Nouri.

In the study, 25 patients with this precancerous condition of the lips were treated at the University of Miami with Lumenis Ltd.'s UltraPulse CO₂ laser, said Dr. Nouri at the annual meeting of the Florida Society of Dermatologic Surgeons.

Study subjects were initially treated conservatively, at the device's proprietary density setting of 6, but Dr. Nouri now uses a density of 7 because it allows him to achieve better ablation and a similar side effect profile.

After the first pass over the suspicious and surrounding areas, the treated area was wiped. A second pass was then made at 300 mJ over the suspicious area at a density of 5. The area was then allowed to granulate, said Dr. Nouri, who is professor of dermatology at the University of Miami and director of the university's laser center.

A variety of other actinic cheilitis treatments have been used, including surgical and nonsurgical approaches, but the CO₂ laser appears to be a good treatment option, said Dr. Nouri, who owns the UltraPulse laser that was used for the treatment but disclosed having no financial interest in the company that makes the device.

This laser is easier to use than many other modalities, and may be safer as well, he said, noting that other treatments include topical agents (such as 5-fluorouracil, which can be very irritating), chemexfoliation, systemic retinoids, interferon-α, curettage and electrodesiccation, and cryosurgery.

Other advantages of the CO₂ laser, he noted, are a minimal risk of transferring precancerous cells and a low risk of infection from the procedure itself. (Most patients are premedicated with antivirals and sometimes with antibiotics.)

"I'm not saying this is a panacea, because even with the UltraPulse there can be a high recurrence rate, but it is a pretty good option," he said.

Most cases of actinic cheilitis (about 97%) occur on the lower lip. Exposure to ultraviolet radiation is a risk factor for the condition, and thus it is particularly common in those with outdoor occupations and hobbies, said Dr. Nouri. Tobacco exposure has also been linked with this condition. Men in the fifth and sixth decades of life are most often affected.

Actinic cheilitis presents as whitish or reddish lesions that are ulcerated, erosive unulcerated, or erosive ulcerated. Histologically, they present as mild epithelial dysplasia with thickening of the keratin and spinous layer.

Connective tissue and perivascular inflammation can also be seen, but basophilic changes within the connective tissue are a universal finding.

A patient with actinic cheilitis is shown before the laser ablation was performed.

The same patient is shown 1 month after treatment with the UltraPulse CO₂ laser. Photos courtesy Dr. Keyvan Nouri

ORLANDO — Ablation with a CO₂ laser caused no side effects, scarring, or recurrence in a small study of patients with actinic cheilitis, according to Dr. Keyvan Nouri.

In the study, 25 patients with this precancerous condition of the lips were treated at the University of Miami with Lumenis Ltd.'s UltraPulse CO₂ laser, said Dr. Nouri at the annual meeting of the Florida Society of Dermatologic Surgeons.

Study subjects were initially treated conservatively, at the device's proprietary density setting of 6, but Dr. Nouri now uses a density of 7 because it allows him to achieve better ablation and a similar side effect profile.

After the first pass over the suspicious and surrounding areas, the treated area was wiped. A second pass was then made at 300 mJ over the suspicious area at a density of 5. The area was then allowed to granulate, said Dr. Nouri, who is professor of dermatology at the University of Miami and director of the university's laser center.

A variety of other actinic cheilitis treatments have been used, including surgical and nonsurgical approaches, but the CO₂ laser appears to be a good treatment option, said Dr. Nouri, who owns the UltraPulse laser that was used for the treatment but disclosed having no financial interest in the company that makes the device.

This laser is easier to use than many other modalities, and may be safer as well, he said, noting that other treatments include topical agents (such as 5-fluorouracil, which can be very irritating), chemexfoliation, systemic retinoids, interferon-α, curettage and electrodesiccation, and cryosurgery.

Other advantages of the CO₂ laser, he noted, are a minimal risk of transferring precancerous cells and a low risk of infection from the procedure itself. (Most patients are premedicated with antivirals and sometimes with antibiotics.)

"I'm not saying this is a panacea, because even with the UltraPulse there can be a high recurrence rate, but it is a pretty good option," he said.

Most cases of actinic cheilitis (about 97%) occur on the lower lip. Exposure to ultraviolet radiation is a risk factor for the condition, and thus it is particularly common in those with outdoor occupations and hobbies, said Dr. Nouri. Tobacco exposure has also been linked with this condition. Men in the fifth and sixth decades of life are most often affected.

Actinic cheilitis presents as whitish or reddish lesions that are ulcerated, erosive unulcerated, or erosive ulcerated. Histologically, they present as mild epithelial dysplasia with thickening of the keratin and spinous layer.

Connective tissue and perivascular inflammation can also be seen, but basophilic changes within the connective tissue are a universal finding.

A patient with actinic cheilitis is shown before the laser ablation was performed.

The same patient is shown 1 month after treatment with the UltraPulse CO₂ laser. Photos courtesy Dr. Keyvan Nouri