Desquamating or blistering skin conditions may be referred to burns and plastic surgeons owing to the morphological similarity to burn injuries, given an increasing shortage of dermatology inpatient beds within the context of NHS care. Desquamating skin conditions, similar to burn injuries, carry the potential to be severe, debilitating and potentially fatal; however, they present more complexity owing to their underlying aetiologies. These conditions may present with similar physiological challenges, dressing requirements and need for extensive multidisciplinary input as burn injuries, and there is an increasing demand for burns and plastic surgery involvement in their management. In this review, the following blistering skin diseases (BSDs) are discussed: Bullous erythema multiforme, Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TENS), pyoderma gangrenosum, impetigo, Staphylococcal scalded skin syndrome, erythroderma, pemphigus vulgaris (PV), bullous lupus, pemphigus paraneoplastica, acute generalised exanthematous pustulosis (AGEP), dermatitis artefacta, linear IgA bullous dermatosis and adverse drug reaction. All patients should undergo a thorough head to toe skin examination, including the mucous membranes, their current and recent medications should be reviewed, and considered for discontinuation if clinically safe. A full panel of blood investigations, including an auto-antibody screen, should be performed to identify the underlying cause and multiorgan disfunction. A single investigation of the greatest diagnostic value is an incision or punch biopsy, which should be sent for histology and immunofluorescence analyses. Antimicrobials and steroids should be initiated by dermatology after review. General care of these patients includes treatment of the underlying cause, management of acute deterioration and symptoms, and appropriate wound care.
To investigate the therapeutic efficacy of silymarin extract on deep second-degree burns in vivo and in vitro and elucidate the underlying molecular mechanisms. A total of 126 Sprague-Dawley rats were randomized into 7 groups using a random number table method (n=18), including normal control (NC), model, vehicle control (Veh), positive control (Mepore Moist Burn Gream, 25 mg/cm2), and low-, medium-, and high-dose silymarin extract groups. All treatments were applied topically twice daily during 1st week and once daily for the subsequent 14 days. Deep second-degree burn model was established using a controlled-temperature scald device in all groups except the NC group. Therapeutic efficacy was evaluated via wound closure dynamics and tissue water content (edema). Histopathological changes, including collagen deposition and structural integrity, were examined using HE and Masson's trichrome stainings. Inflammatory and oxidative microenvironment were characterized by quantifying the levels of tumor necrosis factor (TNF)-α, interleukin (IL)-1, malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione (GSH) using commercial assay kits. Activation of the nuclear factor erythroid 2-related factor 2 (Nrf2) signaling axis [Nrf2, Kelch-like ECH-associated protein 1 (Keap1), heme oxygenase (HO)-1, and NAD(P)H:quinoneoxidoreductase 1 (NQO1)] was assessed using immunohistochemistry and Western blot, respectively. To corroborate the in vivo findings, HaCaT keratinocytes were treated with Nrf2 inhibitor ML385 to validate pathway dependency. Silymarin extract treatment significantly accelerated wound closure and attenuated tissue edema in the scalded areas (P<0.05 or P<0.01). Histopathological assessment revealed that silymarin extract augmented collagen deposition and remodeling, promoted reepithelialization and regeneration of skin appendages, mitigated inflammatory cell infiltration, and facilitated necrotic tissue resolution (P<0.01). Mechanistically, silymarin extract upregulated the Nrf2 signaling pathway by promoting Nrf2 dissociation from Keap1. This activation potentiated antioxidant defenses (HO-1, NQO1, SOD, and GSH) and suppressed MDA (P<0.05 or P<0.01). Concurrently, silymarin extract significantly downregulated pro-inflammatory cytokines IL-1 and TNF-α (P<0.05 or P<0.01). These protective effects were abrogated in vitro by the specific Nrf2 inhibitor ML385. Silymarin extract accelerates the healing of deep second-degree burns and mitigates oxidative stress-induced tissue injury by activating Nrf2 signaling axis, suggesting its potential as an effective therapeutic agent.
Patients with large total body surface area (TBSA) burns face significantly elevated risks of morbidity and mortality. Achieving rapid, durable wound closure with minimal risk of infection or systemic compromise is critical to reducing mortality. Biodegradable Temporizing Matrix (BTM) (PolyNovo, Victoria, Australia) offers a synthetic alternative to biological dermal substitutes, providing temporal wound closure and a scaffold for neodermis generation. A 68-year-old woman presented with third-degree flame burns covering 25% TBSA across the right trunk and upper limb following a domestic syncopal episode. After initial stabilization, the patient underwent a 2-stage reconstruction. Stage I (postburn day 4) involved surgical excision to the fascia and immediate application of BTM. Stage II (postburn day 39) involved the delamination of the sealing layer and coverage of the vascularized neodermis using split-thickness skin grafts, meshed at a ratio of 1:1.5. BTM was successfully integrated within 35 days, exhibiting the characteristic uniform pink color of vascular network formation. Complete epithelialization was documented by postburn day 75, with no clinical signs of infection observed throughout the treatment course. Follow-up at postburn day 377 demonstrated satisfactory functional recovery and favorable long-term scar quality, with minimal secondary contracture. BTM provided temporal closure that was less prone to infection, which proved invaluable in managing this extensive burn in a high-risk patient. Successful neodermis regeneration improves the split-thickness skin graft coverage characteristics and supports the use of BTM as an effective reconstructive modality for deep, large-TBSA burns, where minimizing risk of infection and fluid loss is paramount, while simultaneously allowing for improved functional and aesthetic outcomes.
Burn injuries remain a major public health concern, often resulting in extensive tissue damage and life-threatening complications. Among these, burn wound infections are the leading cause of mortality in patients with extensive surface area involvement. This study aimed to compare the wound-healing efficacy of silver sulfadiazine (SSD) cream and povidone-iodine in patients with second- and third-degree burns involving 30 to 50% of total body surface area (TBSA). The primary outcome was wound healing rate (time to graft preparation), while secondary outcomes included pain intensity and the frequency of required dressing changes. In this double-blind clinical trial, 80 patients with second- or third-degree burns involving 30 to 50% TBSA were enrolled and randomly assigned to receive either SSD cream or povidone-iodine (PI). The sample size was determined using a formal power calculation (α = 0.05, power = 80%), resulting in 40 patients per group. Wound healing was assessed based on healing rate, tissue appearance, pain intensity, inflammatory response, and overall recovery, using weekly clinical examinations and photographic documentation. Among the 80 participants (51.2% female and 48.8% male; mean age, 38.1 ± 14 years), the PI group required significantly more frequent dressing changes (P = 0.001) and reported higher pain intensity (P < 0.001). Interestingly, no significant between-group differences were observed in healing rate, number of surgical interventions, or length of hospital stay (P > 0.05). Logistic regression identified pain intensity as the only variable significantly associated with treatment type (P = 0.014). SSD demonstrated superior clinical performance in reducing pain and dressing frequency among patients with moderate-to-severe burns, although overall healing rates were comparable between groups. Larger multicenter studies are recommended to validate these findings and to assess long-term outcomes.Clinical trial registration Iranian Registry of Clinical Trials (IRCT), IRCT20240126060819N1, registered on April 10, 2024.
Rope friction injuries result from rapid, repetitive contact with coarse ropes or chains, causing combined mechanical and thermal damage. These injuries commonly affect young individuals during activities such as tug-of-war, climbing, air acrobatics, and rope handling. Although superficial and deep burns are most frequent, injuries may also involve vessels, nerves, tendons, and bone. This study presents our experience managing rope friction burns and reviews functional and aesthetic outcomes. We retrospectively reviewed 23 patients with full-thickness hand defects after rope friction injuries. Functional disability was assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Scar quality was evaluated using the Patient and Observer Scar Assessment Scale (POSAS). Seventeen patients were male and 6 were female. Six patients had bilateral defects and 17 had unilateral defects. The mean defect size was 6.8±1.5 cm². Nine patients had associated vascular, nerve, or tendon injuries. Reconstruction included debridement and primary repair (n=11), full-thickness skin grafting (n=5), local flaps (homodigital rotation-advancement and transposition flaps; n=4), and superficial circumflex iliac artery perforator free flaps (n=3). Functional outcomes improved significantly after reconstruction (mean preoperative DASH: 83.9±4.02 vs. 12-month DASH: 6.65±2.57; P<0.00001). Mean patient and observer POSAS scores were 2.8±0.19 and 2.87±0.17, respectively, with no significant difference (P=0.106845). Rope friction injuries frequently extend deeper than expected and may involve critical underlying structures. Careful evaluation is essential. Most defects can be managed with primary repair, grafting, or local flaps, while free flaps provide reliable functional and aesthetic reconstruction when local options are inadequate.
Aesthetic tattooing is widely used for decorative purposes, and medical tattooing is established in reconstructive practice. However, decorative tattooing remains an underrecognized option for scar camouflage in burn and trauma patients, with limited clinical guidance regarding patient selection and integration into scar services. We performed a retrospective evaluation of patients treated at a tertiary burns center between 2021 and 2024 who underwent aesthetic tattooing for scar camouflage. Clinical records were reviewed for scar characteristics, prior scar treatments, complications, and patient-reported satisfaction. A focused literature review was undertaken to contextualize current evidence and to inform the development of a proposed management algorithm. Four patients with mature burn or traumatic scars underwent aesthetic tattooing following prior conventional scar therapies, including laser treatment, scar revision, and skin grafting. Tattoos were used to camouflage dyschromia, grafted skin, and extensive visible scarring. All patients reported high satisfaction, improved confidence, and perceived improvement in scar appearance. No tattoo-related complications were reported in this series. Aesthetic tattooing may represent a safe and effective adjunct for selected patients with mature scars when conventional scar therapies have been optimized. It has potential psychosocial benefits and may address aesthetic concerns not fully corrected by standard interventions. We propose a practical clinical algorithm incorporating scar assessment, optimization, temporary tattoo trials, and referral pathways to support integration into multidisciplinary burn and scar services.
The rapid increase in electric bike (e-bike) use has led to a rise in lithium-ion battery fires, which present significant hazards. Beyond thermal injury, these fires emit toxic gases such as hydrogen fluoride (HF), capable of causing severe chemical inhalation injury. The pulmonary effects of inhaled hydrofluoric acid are not well characterised in the literature. Two cases of severe lung injury occurred following indoor e-bike battery fires. The first patient sustained 32% total body surface area (TBSA) burns and developed acute respiratory distress syndrome with radiological evidence of chemical pneumonitis, necessitating prolonged mechanical ventilation and resulting in persistent pulmonary impairment. The second patient sustained 44% TBSA burns and experienced rapidly progressive respiratory failure that was disproportionate to typical smoke inhalation injury. Despite maximal supportive therapy, including extracorporeal membrane oxygenation, the patient died from catastrophic pulmonary failure. Lithium-ion battery fires present both thermal and chemical hazards, especially in enclosed environments. These cases highlight the importance of maintaining a high index of suspicion for toxic inhalation injury, promptly recognising disproportionate respiratory failure, and monitoring for biochemical indicators of hydrofluoric acid exposure as the prevalence of lithium-ion battery use increases.
The healing of severe infected burn wounds is impeded by a vicious cycle of bacterial biofilms, oxidative stress, immune dysregulation, and hypoxia. Existing microneedle (MN) platforms often fail to address these multifactorial barriers due to insufficient mechanical robustness, lengthy fabrication times, and limited therapeutic scope. Our goal was to develop a multifunctional, on-demand MN platform that can simultaneously overcome these challenges by systematically dismantling pathological barriers and activating endogenous regenerative pathways. We developed a multifunctional MN platform based on a semi-Interpenetrating Polymer Network (sIPN) of hyaluronic acid methacrylate (HAMA) and ethoxylated trimethylolpropane triacrylate (ETPTA). This platform was co-encapsulated with a triad of therapeutic agents: a biofilm-dismantling antisense oligonucleotide (ASO) targeting the bacterial gene yycF, nanoceria (CeO₂) for reactive oxygen species (ROS) scavenging and in-situ oxygen generation, and anthocyanin (An) as an antioxidant and anti-inflammatory agent. The therapeutic efficacy of the MN platform was evaluated in a rat model of MRSA-infected full-thickness burns. Healing was assessed through macroscopic observation, histological analysis, and immunofluorescence staining. The underlying molecular mechanisms were investigated using transcriptomic and protein analyses of wound tissues. The fabricated sIPN MNs exhibited exceptional mechanical strength, rapid fabrication time, and strong tissue adhesion. In the rat model, the MNs effectively dismantled biofilms, reduced oxidative stress, alleviated hypoxia, and shifted the immune balance towards M2 macrophage polarization. This comprehensive microenvironment remodeling led to accelerated wound closure, promoted angiogenesis, and encouraged ordered collagen deposition, resulting in higher-quality tissue regeneration compared to control groups. Transcriptomic and protein analyses revealed that this enhanced healing was driven by the significant activation of the epidermal Wnt/KLF5 signaling axis. Our study presents a mechanistically elucidated, multimodal sIPN MN platform that effectively promotes the healing of infected burn wounds. By remodeling the pathological microenvironment and activating the Wnt/KLF5 regenerative axis, this on-demand platform demonstrates significant potential for clinical translation in the management of complex wounds.
Burn injuries are known as one of the main reasons for hospitalizations across the globe. Scalds, which are considered as wet burns, are more common. Many procedures are used to manage the wound healing process; using silver sulphadiazine 1% is one of those routine ways. However, nowadays, traditional medicine findings, along with modern medications, can cooperate with each other to lead to perfect wound care. Thus, the usage of medicinal plants is suggested for this purpose; so, the aim of the present study is to investigate the beneficial effects of a quadri herb (QH) ointment based on of medicinal plants: Scrophularia striata, Artemisia aucheri, Falcaria vulgaris, and Aloe vera on second-degree burn scald. A total of 42 male Wistar rats were grouped into 7; after induction of burn scald by the use of hot water, treated groups received QH ointment in concentrations of 0.5%, 1%, 2%, and 5% with respect to herbal extracts; the wound healing process was monitored for 16 days and the results were statistically analyzed. On the final day of intervention, rats were sacrificed, and skin biopsies were used for histopathological evaluations. Significant reduction of wound percentage (p ≤ 0.05) among 2% and 5% groups showed that QH ointment performed better in wound healing compared with the control and positive control groups. Histological analysis also revealed significant increases in granulation and vascular-fibroblast density with 5% of QH ointment (p ≤ 0.01). It concludes that QH ointment has remarkable effects in the healing of second-degree burn scalds.
Charred Sanguisorbae Radix (CSR) is a well-known traditional Chinese medicine clinically used to treat conditions such as burns and bleeding, with tannins being its main active ingredients. In this study, the tannins (SDT) were isolated and purified from CSR using macroporous resin. Subsequently, SDT was loaded onto a poly(lactic acid) (PLA) nanofiber membrane using electrospinning, and its potential application value as a wound dressing was evaluated. The experimental results demonstrated that the nanofiber membrane loaded with SDT exhibited strong antioxidant activity and favorable antibacterial performance, both of which were enhanced with increasing SDT concentration. Among the tested membranes, the PLA2 membrane with 9% SDT loading (90 mg SDT per 1 g PLA, mass ratio) exhibited excellent biocompatibility and could significantly promote wound closure of L929 fibroblasts in the cell scratch assay. Furthermore, the PLA2 membrane could slowly release gallic acid to continuously exert its therapeutic effect. In summary, the novel SDT-loaded PLA nanofiber membrane shows great potential as a wound dressing, providing a scientific foundation for the further application of CSR in wound healing therapy.
Pediatric burns in Saudi Arabia are predominantly household scalds in young children, causing long-term disability from scarring, contractures, pain/itch, psychosocial distress, and disrupted schooling. This thematic narrative review (2010-2025) synthesizes global and regional evidence, appraises outcome measures with attention to Arabic availability, and translates findings into Vision 2030-aligned policy actions. Evidence supports early, multidisciplinary care anchored in standardized outcome tracking. Pressure-garment therapy remains inconclusive, whereas virtual reality reduces procedural pain and telerehabilitation serves families distant from tertiary centers. A minimum national outcome set is proposed spanning scar quality (VSS, POSAS), joint range of motion, age-appropriate pain and itch scales (FLACC/FPS-R/NRS), HRQoL (PedsQL, PROMIS), and school reintegration. Embedding these indicators in electronic records and registries-with risk adjustment and linkage to utilization and cost-would enable benchmarking, value-based purchasing, and equitable service planning and access. Implemented at scale, this framework can deliver measurable gains in function, participation, and family well-being across the Kingdom.
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Diabetic neuropathy is a prevalent and debilitating complication of poorly controlled diabetes mellitus, primarily affecting peripheral nerves. Patients commonly present with symptoms such as burning sensation, numbness, tingling, and pain in the extremities, often associated with sensory deficits. Current conventional management provides limited symptomatic relief, highlighting the need for complementary approaches. In Ayurveda, this condition can be considered an Upadrava (complication) of Prameha (diabetes mellitus) and is managed through a combination of internal medications, external therapies, and detoxification procedures. A 65-year-old male patient with a 15-year history of uncontrolled diabetes mellitus presented with a severe burning sensation in both lower limbs. The patient was managed with Ayurvedic interventions, including internal medications for 1 month followed by 21 days of inpatient Panchakarma therapy. Clinical assessment using the visual analog scale (VAS), Neuropathy Disability Score (NDS), and neuropathy grading showed significant improvement following the intervention. The patient, who initially presented with moderate neuropathy, showed marked clinical improvement after 2 months of treatment. This case suggests that Ayurvedic interventions may offer a beneficial complementary approach in the management of diabetic peripheral neuropathy. Further systematic studies are required to substantiate these findings.
Post-burn itching is an important symptom that negatively affects patients during both the treatment and rehabilitation processes. Understanding patients' lived experiences regarding post-burn itching is essential to improving patient care. This qualitative study was conducted using a phenomenological approach. In-depth, face-to-face interviews were held with 10 patients who experienced itching after burn injuries. Data collection occurred between January and May 2024. Thematic analysis was employed to evaluate the data. Analysis of the data revealed four main themes and 13 sub-themes. The main themes identified were: (1) the psychological burden of itching, (2) the bodily experience of itching, (3) difficulties in daily life, and (4) coping strategies. The study findings provide detailed insights into the experiences of patients suffering from post-burn itching. These results enhance current knowledge in this area and may inform the development of holistic, patient-centred, and community-based care strategies tailored to patient needs.
Understanding the response mechanisms of vegetation characteristics and soil enzyme activities to climatic factors in desertified regions is crucial. However, the relationships between vegetation, soil enzyme activities, and climatic factors in dune ecosystems under different anthropogenic disturbances remain unclear. This study, based on in situ observations conducted from 2020 to 2023 in the Horqin Sand Land, systematically elucidates the response mechanisms of vegetation characteristics and soil enzyme activities to precipitation and temperature across different types of sand dunes under enclosure (control), mowing, burning, and grazing treatments. The results indicate that the effects of mowing and burning on vegetation and soil enzyme activities are strongly water-dependent. In sand dunes located in the moisture-rich dune-meadow ecotone, these treatments exhibited compensatory effects, whereas in moisture-limited semi-mobile dunes, they led to inhibitory effects. Grazing, on the other hand, significantly reduced dune vegetation biomass and soil enzyme activities by 9-45%, but markedly increased plant species richness. Correlation analysis revealed that, following mowing and burning, Poaceae species in ecotone dunes were able to rapidly utilize precipitation, exhibiting high sensitivity to rainfall. In semi-mobile dunes where shrubs and herbaceous plants coexist, species with different life forms enhanced their relationships with precipitation through stratified water use. In contrast, grazing damaged vegetation via herbivory and trampling, overall weakening the response of vegetation to both temperature and precipitation. Structural equation modeling revealed that in ecotone dunes, precipitation significantly promoted sucrose enzyme activity only under burning and grazing treatments. In fixed dunes, however, due to the low palatability of Asteraceae species, livestock trampling facilitated litter decomposition and increased fecal inputs, thereby enhancing nutrient availability, and precipitation significantly promoted vegetation growth. Overall, different disturbances modulated the responses of vegetation and soil enzyme activities to climatic factors by regulating soil hydrothermal conditions and resource use efficiency, highlighting the critical role of water availability in controlling ecological processes in desertified regions. This study provides a theoretical basis and technical support for the conservation and restoration of sandy ecosystems.
Diabetic kidney disease (DKD) is a serious condition associated with diabetes, and the role of uric acid (UA) in its development remains debated. This study used a Mendelian randomization (MR) analysis, epidemiological validation, transcriptome data mining and animal study to assess the causal relationship between high serum uric acid (HUA) and DKD. Meanwhile, differential expression analysis of lactate-related genes were conducted. Besides, the suggested lactylation associated genes was verified in vivo and vitro. MR shows that gene-predicted serum uric acid level was positively correlated with the risk of DKD (OR = 1.25, 95% CI: 1.01-1.54, P = 0.0396). The finding was further supported by US National Health and Nutrition Survey data. Lactylation associated transcriptome analysis identified associated genes, HMOX1, OGDH, and SPP1. In type 1 and type 2 diabetes HUA mouse model, the expression of HMOX1, OGDH, and SPP1 was significantly enhanced and HUA treatment significantly aggravated renal injury. In podocyte cell line, inhibition of the expression of HMOX1, OGDH, and SPP1 significantly improve the podocyte function. This study provides evidence that high serum uric acid is associated with DKD, and indicates HMOX1, OGDH, and SPP1 as possible important molecules linked to disease progression. These findings offer new biomarkers and potential therapeutic targets for early diagnosis and intervention of DKD.
Verbal fluency is a behavioral task that requires the generation of words from a semantic category (category fluency) or words beginning with a specific letter (letter fluency). Although word production engages a frontal-temporal-parietal network, no studies have tested how lesions to temporal and parietal lobe areas that represent semantic and phonological knowledge dampen neural responses in the left pars triangularis and the left pars opercularis, two adjacent regions in the left inferior frontal gyrus implicated in word search and retrieval. Here, 52 patients with temporal lobe lesions underwent clinical functional MRI while performing the category and letter fluency tasks. We investigated where lesion presence was inversely related to the magnitude of task-specific neural responses in pars triangularis and pars opercularis using a technique referred to as voxel-based lesion activity mapping (VLAM). We found that lesions to the left anterior superior temporal gyrus, left temporal pole, left hippocampus, left insula, and underlying inferior fronto-occipital fasciculus were associated with reduced neural responses in the left pars triangularis during the category fluency task. Lesion damage to the right hippocampus was associated with reduced neural responses in the left pars opercularis during category fluency. By contrast, lesions to the left posterior superior temporal gyrus, left supramarginal gyrus, left parietal operculum, and the inferior fronto-occipital fasciculus and left arcuate fasciculus were associated with reduced neural responses in the left pars triangularis and the left pars opercularis during the letter fluency task. These results suggest that anatomically dissociable brain networks interact with the left inferior frontal gyrus when different search strategies constrain the retrieval of word representations.
Middle-aged and older adults with type 2 diabetes mellitus (T2DM) often experience insufficient physical activity (PA) and reduced quality of life (QOL). Understanding how psychosocial factors are associated with this relationship is important for developing effective nursing interventions. Therefore, this study aimed to investigate the mediating roles of psychological resilience and exercise self-efficacy in the association between PA and QOL among community-dwelling populations. A cross-sectional survey was conducted among 328 middle-aged and older adults (≥ 45 years old) with T2DM in Changsha, China. Data were collected using validated instruments, including the International Physical Activity Questionnaire (IPAQ-SF), Connor-Davidson Resilience Scale (CD-RISC), Exercise Self-Efficacy Scale, and the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36). Structural equation modeling and 5,000-bootstrap resampling were used to test mediation effects. Given the high collinearity observed between physical activity and exercise self-efficacy in the partial mediation model, a full mediation model was retained as the final model. PA was indirectly and positively associated with QOL primarily through exercise self-efficacy (standardized indirect effect = 0.195, 95% CI [0.103, 0.287]). The sequential pathway through psychological resilience and exercise self-efficacy was also significant (standardized indirect effect = 0.009, 95% CI [0.002, 0.017]), whereas psychological resilience alone was not a significant mediator. The final model demonstrated acceptable fit (χ²/df = 3.26, RMSEA = 0.083, CFI = 0.960, NFI = 0.944, IFI = 0.961, TLI = 0.920). This study tested a chain mediation model suggesting that the observed association between PA and QOL may be partly explained by a sequential psychosocial pathway involving psychological resilience and exercise self-efficacy. These findings highlight the potential value of integrating psychological empowerment and behavioral strategies in future interventions aimed at supporting better QOL among middle-aged and older adults with T2DM.
Dissipation of body heat, essential to human life, is largely achieved through sweating. If sweating does not occur normally-as in patients with hypohidrosis (reduced sweating) or anhidrosis (lack of sweating)-the ability to dissipate heat via evaporative mechanisms is overwhelmed. Body temperature may rise, leading to heat-related illness, including heat intolerance, hyperthermia, heat exhaustion, heat stroke, and even death. In patients seen by a dermatologist, anhidrosis may underly and contribute to their symptoms and signs but may be difficult to detect given a limited availability of tools to measure anhidrosis. An association between anhidrosis and skin symptoms including flushing syndromes (eg, facial flushing and erythromelalgia) and widespread skin symptoms (eg, itching, burning, numbness, or tingling, and paresthesias) has recently been described. This review explores the existing dermatologic literature on anhidrosis including clues to the pathophysiology of these disorders, its relationship to skin diseases and symptoms, the tests currently available, and approaches to management. Recognition of an underlying anhidrosis by dermatologists may be important for providing optimal management for patients with heat-related symptoms.
Angiosarcoma is a rare, aggressive malignancy that accounts for less than 1% of sarcomas of bone. Epithelioid angiosarcoma, a subtype, is characterized by pleomorphic cells with vascular differentiation and commonly arises in deep soft tissues of the extremities. Angiosarcoma associated with orthopedic implants or retained foreign bodies, such as ballistic debris, is exceedingly rare. Here, the authors present the case of epithelioid angiosarcoma in a 54-year-old male with a history of a prior proximal femur ballistic injury and intramedullary nail fixation who was initially misdiagnosed with chronic osteomyelitis.