non surgical management of skin neoplasms

With advancement of medicine over past few decades, varieties of treatment modalities have been developed for both cancerous and precancerous lesions in skin diseases. Topical and oral medications are available. Non surgical treatment modalities include destruction with cryogens electrodessication & curettage, chemical peeling agents and medical therapy with 5 fluorouracil including retinoids.

For chemoprevention of skin malignancies systemic and topical retinoids have been used. Oral retinoids have been found to be highly effective in treatment of actinic keratoses. Due to longer half life and teratogenic effect of etretinate it is no longer available in USA. In patients with the increased risk of skin malignancies from congenital disorders, high dose of isotretinoin can be used. It has beneficial effects in xenoderma pigmentosa and nevoid basal cell carcinoma syndrome. However, toxicity may develop with its long term use.


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precipitating factors of heart failure

Heart failure is a common syndrome and major public health problem that is increasing in incidence and prevalence. Studies have shown incidence of nearly 500,000 new cases of cardiac failure patients each year with approximately 5 million patients already having heart failure in United States. It is primarily a disease of old age, with over 75% of existing and new cases occurring in individuals over 65 years of age. The prevalence of heart failure rises from < 1% in individuals below 60 years to nearly 10% in those over 80 years of age. There are multiple risk and precipitating factors for heart failure. Modifiable factors include smoking, high blood pressure, obesity and high blood cholesterol level. Surveys have shown better prognosis of heart failure in patients whom precipitating causes are identified, treated and eliminated.

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senescent skin

Physiological age related changes in skin are most pronounced in fair persons than blacks. The major stigma of aging in the skin is wrinkling, roughness, pigmentation and cancers. Skin is composed of epidermis and dermis. Outer epidermis is dead layer of stratum corneum while the inner one is viable layer composed of keratinocytes, melanocytes and Lagerhan’s cells. Dermis is composed of collagen. Loss of elastin and collagen is a contributory factor for wrinkling. Dermal thickness is reduced to more than 20% with age. The moisture content of the aged skin is less than adult skin. Regression and disorganization of blood vessels is one of prominent feature of aging. Cutaneous sensation is reduced lesser than tactile sensitivity by the age of 80 -85 years.

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