Acupuncture granulomas

Pain management in hidradenitis suppurativa and a proposed treatment algorithm

Pain contributes substantially to reduced quality of life in individuals living with hidradenitis suppurativa (HS). Although improved understanding of HS pathogenesis and treatment has resulted in improved evidence-based HS management guidelines, comprehensive pain management guidelines have yet to be developed. Few HS-specific data exist to guide pharmacologic analgesia; however, recognizing HS pain as either acute or chronic and predominantly nociceptive (aching and gnawing pain due to tissue damage) versus neuropathic (burning-type pain due to somatosensory nervous system dysfunction) provides a conceptual framework for applying outside pain management practices to HS management. This article incorporates the best available evidence from the HS and pain literature to propose an HS pain algorithm that integrates psychological, pharmacologic, and complementary and alternative treatment modalities.

GOLD: human exposure and update on toxic risks

Gold is ubiquitous in the human environment and most people are in contact with it through wearing jewelry, dental devices, implants or therapies for rheumatoid arthritis. Gold is not a nutrient but people are exposed to it as a food colorant and in food chains. The present review discusses the hazards faced in personal and domestic use of gold and the far greater risks presented through occupational exposure to the metal in mining and processing gold ores. In the last situation, regular manual contact or inhalation of toxic or carcinogenic materials like mercury or arsenic, respectively, presents far greater hazard and greatly complicates the evaluation of gold toxicity. The uses and risks presented by new technology and use of nanoparticulate gold in anti-cancer therapies and diagnostic medicine forms a major consideration in gold toxicity, where tissue uptake and distribution are determined largely by particle size and surface characteristics. Many human problems arise through the ability of metallic gold to induce allergic contact hypersensitivity. While gold in jewelry can evoke allergic reactions, other metals such as nickel, chromium and copper present in white gold or alloys exhibit more serious clinical problems. It is concluded that toxic risks associated with gold are low in relation to the vast range of potential routes of exposure to the metal in everyday life.

Non-Traditional and Non-Invasive Approaches in Facial Rejuvenation: A Brief Review

While injectables, lasers, and surgical interventions have traditionally been used to reverse the changes associated with facial aging, other alternative therapies such as facial acupuncture and facial exercises are now being studied for facial rejuvenation. In this paper, we both summarize the concepts of facial acupuncture and facial exercises, and review seven studies that evaluate the efficacy of these modalities. Data from these studies suggest that both facial acupuncture and facial exercises have the potential to improve the skin laxity, wrinkle length, muscle thickness, and pigmentary changes associated with aging. Patients frequently reported improvement and experienced very few side effects. However, further research is necessary before these modalities are widely accepted as effective by the medical community, though the results of these studies may ultimately make providers less hesitant when patients seek out these services.

Dermatoses caused by cultural practices: Therapeutic cultural practices

With globalization and widespread immigration, physicians increasingly encounter patients from varying backgrounds and diverse customs. Although certain cultural practices are widely performed, there is limited medical literature describing their dermatologic and systemic effects and complications. Population diversity and sharing of traditions make it increasingly important for dermatologists to understand the role of cultural practices and recognize physiologic and pathologic sequelae. In addition, dermatologists are often adjured to assess skin findings that may be mistaken for abuse. Child abuse misdiagnosis can be traumatizing to all those involved, and immigrant families with limited English proficiency may have difficulty explaining their traditional practices. The first article of this 2-part continuing medical education series begins with a review of therapeutic cultural practices, including traditional Chinese medicine, Ayurveda, acupuncture, cupping, moxibustion, and coining, and the clinically relevant complications that may occur. Therapeutic practices can cause a range of complications, including contact dermatitis, heavy metal toxicity, and severe cutaneous adverse reactions.

Foreign Body Granulomas

A large list of foreign substances may penetrate the skin and induce a foreign body granulomatous reaction. These particles can enter the skin by voluntary reasons or be caused by accidental inclusion of external substances secondary to cutaneous trauma. In these cases, foreign body granulomas are formed around such disparate substances as starch, cactus bristles, wood splinters, suture material, pencil lead, artificial hair, or insect mouthparts. The purpose of this article is to update dermatologists, pathologists, and other physicians on the most recent etiopathogenesis, clinical presentations, systemic associations, evaluation, and evidence-based management concerning foreign body granulomatous reactions of skin.

Permanently Retained Acupuncture Needles: Radiographic Findings and Case Report

We report a case of a female patient whose routine chest radiograph revealed numerous small, linear, radiopaque foreign bodies. These were determined to be permanently implanted acupuncture needles. We describe the imaging appearance of these wires, discuss the potential for complications and briefly review the pertinent literature.

Histopathologic patterns associated with external agents

A large number of foreign substances may penetrate the skin for both voluntary and involuntary reasons. The voluntary group includes the particulate materials used in tattoos and cosmetic fillers, whereas the involuntary group is almost always caused by accidental inclusion of external substances secondary to cutaneous trauma. This article focuses on the histopathologic findings seen in cutaneous reactions to exogenous agents, with special emphasis on the microscopic morphology of the external particles in recognizing specifically the involved substance (something that is becoming increasingly important in the event of litigation).

Dermatologic Manifestations of Complementary Therapy

The dermatologic manifestations of complementary therapy include reactions to herbs used orally and topically for treating skin disease, cutaneous reactions to drugs used orally and topically for treating other diseases, and reactions to alternative interventions. The safety of alternative medicine is in question. Unlike approved drugs, the quality, efficacy, and safety of herbal medicines is not regulated. Herbal medicines may be misidentified and contaminated with a variety of substances. The following review identifies and categorizes therapies according to their common uses with their adverse reactions.

Complications of Fillers: Overview

BACKGROUND

Avoiding complications requires thorough training and medical, anatomic, and esthetic common sense. Complications can occur as a function of anatomic location, technique deficiencies, the type of defect treated, identifiable host factors, infectious processes, and allergies as a consequence of intrinsic characteristics of any particular filler. They can also occur in the absence of any identifiable host factors and flawless technique. Complications following temporary fillers often occur soon after augmentation, may resolve spontaneously, and are usually easy to treat. Conversely, complications that occur after using permanent or semipermanent fillers can appear months to years after augmentation and prove very difficult to treat.

OBJECTIVE

To analyze and describe complications that have occurred following soft tissue augmentation and to present strategies for avoiding, recognizing, and treating them.

METHODS

Protocols and observations derived from a 24-year experience using a wide variety of soft tissue augmenting agents are presented in association with pertinent clinical literature. Characteristic complications associated with specific types of soft tissue augmenting agents are presented in tabular form.

CONCLUSION

Tissue fillers offer patients an opportunity for instant gratification with minimum downtime and, in general, an extremely favorable risk-to-benefit ratio. The best way to minimize complications in both your patients and yourself is to avoid them.

Cutaneous side effects of alternative therapy

Unconventional, complementary, and alternative therapies have become very popular forms of therapy and the predictions are that their popularity will continue to soar in the future. They are often perceived as being "natural" and therefore harmless, devoid of side effects, and without unpleasant consequences. The fact is that although their risks might be less than those of conventional drugs, side effects of this therapy can and do occur and must be considered as being a relevant factor in using such methods. It is to be expected that their numbers will increase in the future because of their growing popularity and because of continuing efforts to intensify their activity and therapeutic efficacy. Therefore, now more than ever, dermatologists should be familiar with all possible side effects, risks, and toxic, allergic, and possible mutagenic reactions. This article provides fundamental and vital information for practicing dermatologists.

Side-effects of complementary and alternative medicine

Complementary and alternative medicine are increasingly used to diagnose or treat allergic diseases, and numerous studies have reported benefits of this type of medicine. This article presents a review of the literature on risks of these methods. The potential sensitizing capacity of numerous herbal remedies may lead to allergic contact dermatitis and more rarely to IgE-mediated clinical symptoms. Mechanical injuries may be observed following acupuncture leading to pneumothorax, cardiac tamponade or spinal injury. Infectious complications after acupuncture include hepatitis and bacterial endocariditis. Organ toxicity has been observed associated with various herbal preparations involving the liver, kidneys, and the heart. Some herbs may have cancerogenic properties. Severe nutritional deficiencies can occur in infants and small children given strict alternative diets, resembling 'kwashiorkor'. Finally, among other miscellaneous adverse effects, adulteration with steroids, and herbal and drug interactions are discussed. The pattern of side-effects is similar to that observed by the use of conventional medicine. Therefore, caution may be justified using both conventional and unconventional methods. Only if the benefit is proven and the side-effects are established, should a given method be chosen.