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Transforming mucous membrane grafts into skin grafts: Author reply
Ophthalmology Volume 108, Number 11, November 2001 with mucous membrane grafts in ichthyosis. The purpose of our article was not to discuss surgical techniques to lengthen the anterior lamella, and the statement “with free skin grafts” was used, because skin grafting is a “gold standard” procedure in oculoplastics.1 The use of mucous membrane graft in ichthyosis is really very interesting, because it is not always easy to obtain skin in these patients. This problem has already been recognized, and some authors have even suggested that in male patients, the penile foreskin would be the best donor site.2 It was said that “mucous membrane grafts do not appear to desquamate or contract as much as skin grafts.” A study comparing skin grafts and mucous membrane grafts with respect to the long-term stability of the ectropion correction in ichthyosis would certainly be useful. ANTONIO A. V. CRUZ, MD, PHD Sao Paolo, Brazil References 1. Tanenbaum M. Skin and tissues techniques. In: McCord CD Jr, Tanenbaum M, Nunery WR, eds. Oculoplastic Surgery, 3rd ed. New York: Raven Press, 1995; chap. 1. 2. Uthoff D, Gorney M, Teichmann C. Cicatricial ectropion in ichthyosis: a novel approach to treatment. Ophthal Plast Reconst Surg 1994;10:92–5.
Cut and Paste Figure 2. A 14-year-old male with spontaneous metaplasia of the ocular surface after Stevens-Johnson syndrome.
Miami, Florida, who corroborates the family’s assertion that no skin grafts were ever performed. CHARLES N.S. SOPARKAR, MD, PHD JAMES R. PATRINELY, MD MICHAEL G. HUNT, MD SALEH M. SHENAQ, MD Houston, Texas References 1. Cruz AA, Menezes FA, Chaves R, et al. Eyelid abnormalities in lamellar ichthyoses. Ophthalmology 2000;107:1895– 8. 2. Akiyama M. The pathogenesis of severe congenital ichthyosis of the neonate [review]. J Dermatol Sci 1999;21:96 –104. 3. Shwayder T. Ichthyosis in a nutshell. Pediatr Rev 1999;20:5– 12. 4. Tsubota K, Shimazaki J. Surgical treatment of children blinded by Stevens-Johnson Syndrome. Am J Ophthalmol 1999;128: 573– 81.
Author reply Dear Editor: It was with great satisfaction that I learned our article, “Eyelid Abnormalities in Lamellar Ichthyosis” (Ophthalmology 2000;107:1895– 8), provided an opportunity for Dr. Soparkar and associates to share their exciting experience
1934
Dear Editor: In the recent article by Zamir et al entitled, “Self-inflicted Anterior Scleritis,”1 self-inflicted illnesses can certainly be difficult to sort out at times.2 There are two terms introduced in the article, “malingering and factitious disorder,” that require clarification. I have concerns with the authors’ statement that the term factitious disorder “is also used in a broader sense to describe self-inflicted conditions produced by a deceptive patient to gain financial or other secondary gains (malingering).” This is confusing to the readership. The Diagnostic and Statistical Manual of Mental Disorders describes a factitious disorder as characterized by physical or psychologic symptoms that are intentionally produced or feigned to assume the sick role.3 The motivation is a psychologic need to assume the sick role, as evidenced by an absence of external incentives for the behavior.3 Factitious disorders are distinguished from acts of malingering.3 In malingering, the individual also produces the symptoms intentionally but has an external incentive for the behavior (economic gain, avoiding work, avoiding military duty, etc.).3 Thus, malingering differs from factitious disorder in that the motivation for the symptom production in malingering is an external incentive, whereas in factitious disorder, external incentives are absent. The authors’ case 1 clearly had an external incentive present (disability pension) and should therefore be classified as an act of malingering. Case 2 has no obvious external incentive and therefore represents a factitious disorder. Both, however, have “self-inflicted” diseases.
Cut and Paste Figure 2. A 14-year-old male with spontaneous metaplasia of the ocular surface after Stevens-Johnson syndrome.
Miami, Florida, who corroborates the family’s assertion that no skin grafts were ever performed. CHARLES N.S. SOPARKAR, MD, PHD JAMES R. PATRINELY, MD MICHAEL G. HUNT, MD SALEH M. SHENAQ, MD Houston, Texas References 1. Cruz AA, Menezes FA, Chaves R, et al. Eyelid abnormalities in lamellar ichthyoses. Ophthalmology 2000;107:1895– 8. 2. Akiyama M. The pathogenesis of severe congenital ichthyosis of the neonate [review]. J Dermatol Sci 1999;21:96 –104. 3. Shwayder T. Ichthyosis in a nutshell. Pediatr Rev 1999;20:5– 12. 4. Tsubota K, Shimazaki J. Surgical treatment of children blinded by Stevens-Johnson Syndrome. Am J Ophthalmol 1999;128: 573– 81.
Author reply Dear Editor: It was with great satisfaction that I learned our article, “Eyelid Abnormalities in Lamellar Ichthyosis” (Ophthalmology 2000;107:1895– 8), provided an opportunity for Dr. Soparkar and associates to share their exciting experience
1934
Dear Editor: In the recent article by Zamir et al entitled, “Self-inflicted Anterior Scleritis,”1 self-inflicted illnesses can certainly be difficult to sort out at times.2 There are two terms introduced in the article, “malingering and factitious disorder,” that require clarification. I have concerns with the authors’ statement that the term factitious disorder “is also used in a broader sense to describe self-inflicted conditions produced by a deceptive patient to gain financial or other secondary gains (malingering).” This is confusing to the readership. The Diagnostic and Statistical Manual of Mental Disorders describes a factitious disorder as characterized by physical or psychologic symptoms that are intentionally produced or feigned to assume the sick role.3 The motivation is a psychologic need to assume the sick role, as evidenced by an absence of external incentives for the behavior.3 Factitious disorders are distinguished from acts of malingering.3 In malingering, the individual also produces the symptoms intentionally but has an external incentive for the behavior (economic gain, avoiding work, avoiding military duty, etc.).3 Thus, malingering differs from factitious disorder in that the motivation for the symptom production in malingering is an external incentive, whereas in factitious disorder, external incentives are absent. The authors’ case 1 clearly had an external incentive present (disability pension) and should therefore be classified as an act of malingering. Case 2 has no obvious external incentive and therefore represents a factitious disorder. Both, however, have “self-inflicted” diseases.