Surgery Update for General Dermatologists Session 1
April 2017
in “
Australasian Journal of Dermatology
”
Lichen planopilaris cicatricial alopecia scalp pruritus perifollicular erythema acitretin Staphylococcus aureus topical decolonization basal cell carcinoma perineural invasion Mohs surgical excisions Mohs Micrographic Surgery skin stretch bupivacaine lignocaine LPP scarring alopecia itchy scalp redness around hair follicles S. aureus BCC MMS lidocaine
TLDR Most patients with Lichen planopilaris improved with acitretin, but treatments often didn't work well; preventing infection in skin surgery is important, and bupivacaine might be a better anesthetic.
In a retrospective study of 40 cases of Lichen planopilaris (LPP) at an Australian tertiary referral hair clinic, researchers found that the condition, which is a primary lymphocytic cicatricial alopecia, showed a marked female predominance and was most commonly characterized by scalp pruritus and perifollicular erythema. The study, which reviewed medical records from 2012 to 2016, included 37 female and 3 male patients with an onset age range of 17-77 years and a mean age of 54.6 years. Despite various treatments, 75% of patients showed improvement with systemic acitretin, but overall treatment outcomes were mixed and often unsatisfactory, highlighting the need for multicenter, prospective, randomized controlled trials to identify more effective treatments. Additionally, the document discussed the latest evidence on preventing surgical site infection in dermatologic surgery, emphasizing that nasal carriage of Staphylococcus aureus is highly predictive of infection risk and that topical decolonization is more effective than oral antibiotics. A prospective series also revealed that perineural invasion (PNI) in basal cell carcinoma (BCC) may be present exclusively in the central tissue blocks of Mohs surgical excisions, which could go undetected since Mohs Micrographic Surgery (MMS) assesses marginal rather than central tissue. The document also touched on the importance of skin stretch in surgical planning and execution, and presented findings on the use of bupivacaine as an adjunct to lignocaine in dermatologic surgery, suggesting that bupivacaine may provide greater efficacy of anesthetic effect.
