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Background: Human Skin Substitute (Apligraf, Organogenesis, Inc., Canton, MA) is a bi-layered tissue-engineered living biological dressing developed from neonatal foreskin. It consists of a bovine collagen matrix containing human fibroblasts with an overlying sheet of stratified human epithelium containing living human keratinocytes. Human Skin Substitute (HSS) appears to be immunologically inert, and has shown usefulness in the treatment of chronic and acute wounds., Objective: Primary objectives were to evaluate the safety and efficacy of HSS in the treatment of full-thickness wounds in a prospective case series. Secondary objectives were to determine the rate of complete wound reepithelialization, incidence of complete wound healing, pain at wound site, overall cosmetic outcome, and patient satisfaction., Methods: Fourteen patients were enrolled in the study, of which 12 were evaluable. HSS was applied in a blinded fashion to 6 of the patients immediately following Mohs or excisional surgery for skin cancer. The remaining 6 patients were allowed to heal by secondary intention. Both groups were evaluated at weekly appointments until complete reepithelialization occurred. During each evaluation, wound quality was assessed through the Vancouver Burn Scar Assessment Scale by the investigator and an independent blinded dermatologist. The investigator, blinded observer, and patient further evaluated the cosmetic outcome of the wound through the use of a Visual Analog Scale over a 6-month period., Results: HSS patients and secondary intention patients were equivalent in comorbid factors such as pain, erythema, edema, exudate, infection, or hematoma between the groups. The incidence of complete wound healing at 6 months was 100% for both groups. Both groups also appeared to heal at similar rates, as defined by the complete reepithelialization of the wound. HSS patients ultimately resulted in more pliable and less vascular wounds as defined by the Vancouver Burn Scar Assessment Scale. Patient satisfaction with cosmetic outcome in both groups was positive at 6 months., Conclusions: HSS appears to be a safe, well-tolerated biological dressing with equivalent comorbid factors to secondary intention healing. HSS, however, seems to produce a more pliable and less vascular scar than those developed through healing by secondary intention. HSS also appears to produce more satisfactory cosmetic results when compared to secondary intention healing.

In this article, the epidemiology and differential diagnosis of monosymptomatic hypochondriacal psychosis are discussed in detail. The use of pimozide is also discussed and illustrated with case reports. Delusional patients are some of the most challenging cases based in dermatologic practice. This challenge is so much easier to meet if one knows how to approach these patients and feels comfortable in the use of pimozide.

Some patients only present with a cutaneous sensory complaint such as itching, burning, stinging, or other disagreeable sensations of unknown etiology. Frequently, these patients may not have any diagnosable dermatologic, neurologic, medical, or psychiatric diagnosis. Their suffering, however, is real. This article explains a practical approach to the treatment of patients with pure cutaneous sensory disorders.

Just as psychodermatologic disorders can mimic real dermatologic conditions, real dermatologic or other bona fide physical problems such as neurologic disorders can also mimic psychodermatologic disorders. This article illustrates several cases of pseudopsychodermatologic disorders. When faced with a difficult patient or baffling case, sometimes there is a tendency to "jump to conclusions" with regard to the psychogenic origins of the case. It is important to be cognizant of the possibility that one may be missing a real organic disorder if one does not keep an open mind with regard to diagnosis of the patient's skin condition.

In the recent past, there has been great progress made in making psychopharmacologic agents both more efficacious and more user friendly. If dermatologists are to more effectively treat psychodermatologic patients who refuse to see a mental health professional, judicious and responsible use of psychopharmacology is still the most feasible way to treat many of these patients. This article illustrates the use of several commonly used psychopharmacologic agents. Even for psychiatrists, it is not realistic to try to master all psychopharmacologic agents that are on the market. Familiarity with the use of medications discussed in this article is likely to add significantly to the therapeutic armamentarium of a dermatologic practitioner.