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Introduction: Patient information leaflets (PILs) are an important source of information for patients postoperatively. There are currently no nationally agreed standards by dermatologists for postoperative advice following skin surgery., Aim: To assess the common themes and areas of variation in advice given in PILs after skin surgery across all National Health Service (NHS) hospitals in England and Wales., Methods: All acute trusts in England (n = 159) and local health boards in Wales (n = 7) were requested to provide their postoperative dermatological PILs for general sutured wound care or excision biopsy. Eight preselected parameters were assessed: minimum dressing duration, duration of pressing on a bleeding wound, postoperative analgesia, explanation of infection signs, application of petroleum jelly, scarring, whom to contact if there is a problem, and the recommended postoperative time for abstaining from active exercise., Results: PILs were received from 137 different dermatology departments belonging to 127/166 (76.5%) organisations across England and Wales. Of these, 102 PILs gave a specific duration for dressings: 45/102 (44.1%) advised a minimum of 48 h, but 28/102 (27.5%) recommended leaving dressings in place until suture removal. Regarding duration of pressing on a bleeding wound, 117 PILs gave advice, with the most common recommendation being 15 min (30/117, 25.6%), followed closely by 10 min (26/117, 22.2%). Of the 137 PILs received, 125 gave advice regarding postoperative analgesia, with paracetamol alone being the most common recommendation (24/125, 19.2%). For the remaining parameters, 111/137 (81.0%) PILs described ≥ 2 signs of infection, 42/137 (30.7%) recommended the application of petroleum jelly, 65/137 (47.4%) mentioned scarring, 137/137 (100%) highlighted whom to contact if there were postoperative problems and 87/137 (63.5%) PILs gave advice regarding postoperative abstinence from active exercise., Conclusions: The advice given in dermatology postoperative PILs across England and Wales is highly variable. A nationally agreed template or set of postoperative advice should be considered to improve consistency., (© 2015 British Association of Dermatologists.)

Background: Isotretinoin is an efficacious treatment for acne, but has been controversially linked with depression., Objectives: This study aimed to examine the effects of isotretinoin on quality of life(QoL) and depression using a prospective design., Methods: The WHOQOL-BREF QoL measure and Centre for Epidemiological Studies Depression Scale were administered to consecutive outpatients with acne who were prescribed either isotretinoin (n = 65) or antibiotic treatment (n = 31).Patients and physicians rated acne severity independently. Groups were compared at baseline with a matched community sample (n = 94) and measurements repeated at 3 months for treatment groups., Results: There were no differences between the three groups at baseline in terms of age, gender, depression or overall QoL. Acne was more severe in the treatment groups (P < 0·001). Depression was negatively correlated with QoL (P < 0·001)and hence was included as a covariate in repeated-measures analyses of QoL.Acne improved over time in both treatment groups (F = 48·2, P < 0·001). There was no detectable deterioration in depression score in either group (F = 1·1, not significant). QoL in the physical and social domains improved (P < 0·001) while psychological and environmental QoL was unchanged over time. The improvement in social QoL was greater in the isotretinoin group (P < 0·05). Those patients with higher baseline depression scores showed greater improvements in physical, psychological and social QoL (P < 0·001)., Conclusions: Treatment of acne improves QoL, particularly in those with more depressive symptoms at the outset. Mood deterioration was not detected, but the possibility of subtle or rare mood effects of isotretinoin cannot be ruled out.

Background: Postoperative wound oedema causing increased suture tension is thought to be a possible cause of scars known as suture marks. Quantification of such oedema has not previously been reported in the literature. Measures to accommodate wound oedema may include the adoption of alternative suture techniques and the use of more elastic suture materials., Objectives: To quantify wound expansion after skin surgery and to identify any contributory factors, and to determine the ability of eight commonly used skin suture materials to stretch under increasing tension., Methods: Forty consecutive adult patients attending a dermatology department for routine skin surgery in December 2002 were recruited. Details including body site, nature of the lesion excised and dimensions of the open wound were recorded. The distance between entry and exit points of an untied suture at the time of skin surgery was measured and then repeated 24 h postoperatively. The ability of eight different suture materials to stretch when an increasing force was applied was measured by hanging standard weights from the sutures and measuring the suture length for each force applied., Results: Thirty-nine patients completed the study. All wounds expanded postoperatively, with a mean lateral expansion of 1.0 mm. There was a strong association between the width of the unsutured wound after excision and the subsequent wound expansion. Commonly used sutures in skin surgery were found to be relatively inelastic at forces under 0.2 kg. The monofilament Novofil (Davis & Geck, Danbury, CT, U.S.A.) exhibited the greatest degree of stretch of those tested., Conclusions: There is considerable oedema in the first 24 h after skin surgery, particularly with wider excisions. This needs to be considered when choosing suturing materials and techniques to avoid excessive suture tension.