injections of soft-tissue fillers have rapidly become accessible and essential. When dealing with facial aging, it is logical to compensate for the loss of volume, but the optimisation of a younger face involves a 3D strategy as well. (c) 2008 Elsevier Masson SAS. Tous droits reserves.
This case study is a collage of case studies regarding CA-MRSA in the athletic setting and is based on CA-MRSA cases observed by one of the authors while working as a school nurse in the high school setting. It is also based on multiple case studies of high school and college athletic teams documented in the literature. While CA-MRSA has been long been associated with superficial skin infections, the pathogenic capacity of CA-MRSA is now being well documented in the literature. Since 1994, there have been several cases documented where otherwise healthy children have contracted CA-MRSA infections that quickly progressed to bacteremia, sepsis, and death. Athletes, including those on high school teams, have been the subject of an increasing number of reported CA-MRSA cases (Patel, Fischer, Calfee, Plante, & Fadale, 2007). The purpose of this article is to show the importance of prevention and early treatment for suspected CA-MRSA infections. The ethical principle of justice supports nursing and public attention to prevention rather than tertiary care. In this situation, school and professional attention to hygiene would have prompted different behaviors, and this outcome might have been avoided. The cost of good hygiene practices in the locker room would have cost the school $41.45 and a little time for education. The combined estimated cost of secondary, tertiary, and rehabilitative care is $208,079 (see Table 7). The cost for permanent disability in a young person cannot be fully captured fiscally, nor should it be.
Acne is a chronic disease of the pilosebaceous follicle that affects mainly adolescents. It causes polymorph cutaneous lesions that may leave scars after regression. It is characterized by alternation of periods of exacerbation and stability. Spontaneous regression usually occurs after age 20, but some patients may continue suffering during adult life. Diagnosis is clinical and based on the patient's age at the time that the lesions first appear, and on its polymorphism and type of lesions and location. Some patients also need a hormonal and, sometimes, psychological evaluation. The right treatment for the right patient is key to treating acne safely.
Acne affects individuals of all races and ethnicities. Patients with skin of color present a unique challenge, particularly due to the potential for post-inflammatory hyperpigmentation. Concomitant therapy is an appropriate strategy for this population, as demonstrated in the following case.
In general, skin cancer is uncommon in people of color when compared to Caucasians. When it does occur, it is often associated with increased morbidity and mortality. Differences in survival rates may be attributed to skin cancers being diagnosed at a more advanced stage, and socioeconomic factors such as lack of adequate insurance coverage and lack of transportation can function as barriers to timely diagnosis and early treatment. In addition to advanced stage at presentation, malignant skin lesions in skin of color often present in an atypical fashion. Because skin cancer prevention and screening practices historically have been lower among Hispanics, Blacks, and Asians, and given the changing demographics in the United States, interventions that are tailored to each of these groups will be needed. Public educational campaigns should be expanded to educate people of all skin types with emphasis on skin cancers occurring in areas not exposed to the sun (Byrd-Miles et al., 2007), since sunlight is not as important an etiologic factor in the pathogenesis of skin cancer in people of color. Dermatologists and primary care physicians should instruct their darker-skinned patients on how to perform routine skin self-examinations. Physicians should also encourage patients to ask their specialists such as their gynecologist, dentist, and ophthalmologist to look for abnormal pigmentation during routine exams. To reduce the burden of skin cancer, several prevention methods for all people have been strongly encouraged, including monthly self-examinations, daily use of SPF 30 or greater sunscreen, sunglasses with UV-absorbing lenses, and avoiding tanning booths (American Cancer Society, 2008) (see Table 7). In addition, recommendations for clinicians to promote the prevention of skin cancer in skin of color have also been made, including closely monitoring changing pigmented lesions on the palms and soles and hyperkeratotic or poorly healing ulcers in immunosuppressed patients (Halder & Bridgeman-Shah, 1995) (see Table 7).
Nurses should encourage leaders in their health care systems to provide effective tobacco-use treatment and follow up. Nurses also need to support the policy and community interventions that motivate tobacco users to try to quit, create a supportive environment, and provide more intensive interventions for those needing them.
While many have suggested that prevention is key regarding sun over exposure, individuals (including children) still frequently experience sunburn. The Skin Cancer Foundation (2008) reported that 42% of individuals polled endured at least one sunburn per year. Furthermore, the Centers for Disease Control and Prevention (CDC) reports indicate that the incidence of sunburn rose from 31.8% in 1999 to 33.7% in 2004 (CDC, 2007). Children are more susceptible to skin damage because their skin is more sensitive than the skin of adults and it burns more easily (The Skin Cancer Foundation, 2008). Other risk factors include a fair complexion, found commonly in people with blueor green eyes, freckles, and light-colored hair (The Skin Cancer Foundation, 2008).
The precursor to leadership success is the ability to learn about and utilize the social identity of the group as it has evolved. The most successful have expertise in assessing the social identity of groups and developing a commonality of a shared vision that represents the best work of the group and of the leader.
Interest in all aspects of vitamin D seems to be surging due to perhaps the increased number of diverse positive studies suggesting it could prevent a variety of chronic diseases. However, before patients and health care professionals are educated on the preventive aspects of this vitamin that acts more like a hormone, a basic rapid review of vitamin D is needed. There are multiple reasons for the high rate of vitamin D deficiency around the world, including an aging population, obesity, protective skin care measures, skin pigmentation, increased awareness, more utilized diagnostic assays, and perhaps even the lack of natural and fortified food and beverage sources. Various benefits and limitations of vitamin D2 and vitamin D3 supplementation are discussed. The proper use of the vitamin D blood test, also known as "25-OH vitamin D," is important, and changing the normal range of this test may allow for a slightly higher cutoff value based on parathyroid hormone reductions and experience from clinical trials of osteoporosis prevention. The vitamin D doses needed to adequately increase blood levels are provided. Finally, increasing the recommended daily allowance of this vitamin to 800 to 1,000 IU per day may be beneficial for most age groups.
Malassezia are common lipid-dependent fungi that grow on the sebaceous areas of human skin, including the face, scalp, and upper trunk. Although Malassezia are a part of the normal human skin flora, they may also cause or exacerbate several skin diseases, including tinea versicolor, Pityrosporum folliculitis, and seborrheic dermatitis. Topical antifungals are the mainstay of treating Malassezia-related diseases. Chronic prophylaxis is often required to prevent recurrences.
What does evidence-based practice mean to the dermatology nurse? Specifically, what does the evidence reveal about skin cancer screening? These questions are addressed to help clarify some of the misunderstandings regarding evidence-based practice.
