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Archives Volume 10 | Issue 1

Original Articles

Trends in the Treatment and Detection of Skin Cancer

Jason Emer MD and Orit Markowitz MD
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Novel Devices for Diagnosis and Treatment

David A. Lee MD and Daniel M. Siegel MD MS
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Cosmeceutical and Nutraceutical Horizons

Reena Rupani MD and Erin Gilbert PhD
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Medical Management of Skin Disease: Recent Advances and Future Directions

Whitney P. Bowe MD, Sharon Glick MD, Alan R. Shalita MD
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Lasers and Light Therapy— A Promising Future Awaits

Jared Jagdeo MD MS and Neil Brody MD PhD
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Cosmetic Laser Treatments for Skin of Color: A Focus on Safety and Efficacy

Eliot F. Battle Jr. MD
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Rapid Onset of Response and Patient-reported Outcomes After OnabotulinumtoxinA Treatment of Moderate-to-Severe Glabellar Lines

Kenneth R. Beer MD, Charles Boyd MD, Rina K. Patel MS, Beta Bowen MS, Steven P. James MD, Mitchell F. Brin MD
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Introduction: No previously published botulinum toxin type A cosmetic trials included both physician and subject measures of onset. Objective: Determine physician- and subject-reported onset of onabotulinumtoxinA. Methods: Two-center open-label, 14-day study in toxin-naive female patients with moderate-to-severe glabellar lines (GL) treated with 20-U onabotulinumtoxinA. Onset endpoint was categorical (physician assessed: days 2, 3, 4, 7 and 14; subject: 14-day diary). Subjects rated improvements in GL severity and completed the Facial Line Outcomes (FLO) and Self-Perception of Age (SPA) questionnaires. Results: Nearly half, 48 percent (n=45) of subjects, reported onset by day 1. Subject- and physician-reported onset rates, respectively, were 77 percent and 87 percent (day 2), 93 percent and 91 percent (day 3), 98 percent and 100 percent (day 4), and 100 percent thereafter. At all time points, FLO and SPA improved (P≤0.008 and P≤0.01, respectively). No serious adverse events occurred. Conclusion: OnabotulinumtoxinA provides rapid onset (one to two days) based on physician and subject assessment. (J Drugs Dermatol. 2011;10[1]:39-44.)

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A 52-Week Study of Safety and Efficacy of Calcium Hydroxylapatite for Rejuvenation of the Aging Hand

Neil S. Sadick MD
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Objectives: The investigator sought to determine whether calcium hydroxylapatite (CaHA) could be used as dermal filler for replacement of volume loss in aging hands. Methods: The principal investigator injected 1.3 mL of CaHA into the dorsal side of both hands (BH) of 10 female patients (57–68 years of age), for full correction. Investigator, independent evaluator and subjects assessed results at four time points. Results: Safety. Brief and minor adverse events were reported. Efficacy. Wrinkle severity, improvement and patient satisfaction were assessed. Wrinkle Severity. Less severity was noted at 12 months than at baseline. Improvement. At nine months 80 percent of BH were rated as improved or better (IOB) and at 12 months 40 percent of right and 30 percent of left hands as IOB, approximating findings of the independent evaluator but at some variance from the subjects. Patient Satisfaction. At 12 months, 60 percent of subjects rated their results as “satisfactory” or better. Conclusion: In this study, CaHA performed well, with a favorable safety and durability profile. This application expands treatment options in patients seeking rejuvenation of the aging hand and face. (J Drugs Dermatol. 2011;10[1]:47-51.)

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Safety and Efficacy Comparison of Blue Versus Red Light Sources for Photodynamic Therapy Using Methyl Aminolevulinate in Photodamaged Skin

Melanie D. Palm MD MBA and Mitchel P. Goldman MD
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Background and Objective: Methyl aminolevulinate (MAL) is a recently FDA-approved molecule for photodynamic therapy (PDT) in the treatment of nonhyperkeratotic actinic keratoses (AK). In the U.S., aminolevulinic acid (ALA) has been used in an off-label manner with photodynamic therapy for the treatment of chronic photodamage. The published use of MAL-PDT for photorejuvenation is more limited. MAL-PDT is usually conducted with a red light source, ALA-PDT with a blue light source. The purpose of this study is to compare the use of red versus blue light sources in the treatment of photodamage using MAL-PDT, measuring safety and efficacy outcomes following treatment. Study Design/Material and Methods: Eighteen adult patients with moderate-to-severe photodamage of the head or upper trunk were enrolled in a prospective, single center trial of MAL-PDT for photorejuvenation. Intrapatient randomization determined split-area treatment with a blue or red light source. The majority of patients were also treated with pulsed dye laser (PDL) and/or intense pulsed light (IPL) for photoactivation. Digitial photography documented the treatment area at each visit (days 0, 2, 7 and 30). Patient and physician scoring of photodamage occurred at baseline and final visits. Side effects following MAL-PDT were evaluated. Results: No statistically significant differences in signs of photodamage following MAL-PDT were observed between blue versus red light treated sides. The greatest improvement in photodamage measures following 1 MAL-PDT were pigmentation, AK and erythema. Side effects were mild in nature and did not differ between treatment sides, and all but mild erythema resolved by day 7. Conclusion: Blue and red light have similar efficacy as the light source for MAL-PDT when combined with other light sources. Side effects following MAL-PDT with red versus blue light were similar and mild in severity. MAL-PDT is an effective treatment modality for chronic photodamage, in particular AK and pigmentation. (J Drugs Dermatol. 2011;10[1]53-60.)

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Comparison of High-fluence, Single-pass Diode Laser to Low-fluence, Multiple-pass Diode Laser for Laser Hair Reduction With 18 Months of Follow Up

Martin Braun MD
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Laser hair removal is the most popular laser procedure in the United States (U.S.), yet there has not been a prospective study demonstrating long-term efficacy of diode laser hair removal beyond six months. A prospective, single-center, bilaterally paired, blinded, randomized comparison split leg study was carried out with 22 patients comparing high-fluence, single-pass diode laser to lowfluence, multiple-pass diode laser. Hair counts were done six and 18 months following five treatment sessions and were found to be comparable t90–94 percent hair reduction. Hair counts at six months following the fifth treatment were comparable to hair counts at 18 months, indicating that sixth-month hair counts can be considered indicative of long-term results. The low-fluence, multiple-pass in-motion technique was associated with significantly less pain compared to the high-fluence, single-pass technique. Multiple passes of a diode laser at low fluences but with high average power results in permanent hair removal with less discomfort and fewer adverse effects, especially in darker skin. (J Drugs Dermatol. 2011;10[1]62-65.)

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Use of Gelatin Sponges in Mohs Micrographic Surgery Defects and Staged Melanoma Excisions: A Novel Approach to Secondary Wound Healing

Peter P. Rullan MD, Carlos Vallbona PAC, Jennifer M. Rullan MD, Jonathan N. Mansbridge PhD, Vera B. Morhenn MD
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Background/Aims: Surgical closure or reconstruction is commonly used to treat wounds generated by Mohs micrographic surgeries (MMS) and staged melanoma excisions, which may result in contractures and scarring. The authors’ objective was to determine the value of using gelatin sponges to promote secondary intention healing for surgical defects after MMS and staged melanoma excisions. Methods: Sixty-four surgeries from 54 predominantly elderly patients (median age=76 years) were treated with gelatin sponges to promote healing by secondary intention in this prospective investigation. Patients rated their satisfaction with outcomes on a scale of 1 (highly dissatisfied) to 5 (highly satisfied). Results: In all patients, the wounds healed within four to 16 weeks (median=five weeks). Forty-five patients were highly satisfied with their results (mean score=4.9). Conclusion: Healing by secondary intention using gelatin sponges was associated with improved hemostasis, excellent cosmesis and a high level of patient satisfaction. (J Drugs Dermatol. 2011;10[1]68-73.)

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Addition of Chitosan May Improve the Treatment Efficacy of Triple Bandage and Compression in the Treatment of Venous Leg Ulcers

Mauricio Sandoval MD, Claudia Albornoz RN, Sonia Muñoz RN, Mirta Fica RN, Isidora García-Huidobro MD, Renato Mertens MD, Ariel Hasson MD
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Introduction: Venous leg ulcers are an important problem in public health due to their high prevalence and treatment cost. The gold standard therapy is the compression bandage. Addition of different substances to the compression therapy in order to accelerate ulcer healing has been attempted but none of them has yielded optimal results. Objective: To describe the treatment efficacy of venous leg ulcers treated with triple compression bandage and chitosan gel. Methods: A longitudinal and descriptive study was conducted in a sample of 16 patients with 26 venous leg ulcers that were treated with triple compression bandage plus a chitosan gel every seven days during nine weeks. Ulcer surface was measured during each treatment step. Results: At the end of the treatment period, 89 percent reduction of the ulcer area was found when compared to the initial area at the beginning of the study. This value represents a reduction rate of 1.8 cm2/week. Discussion: The results obtained in ulcer healing were higher than those previously reported when the compression bandage treatment of venous leg ulcers was performed alone. The observed difference might be due to the effect of the chitosan gel. (J Drugs Dermatol. 2011;10[1]75-79.)

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Case Reports

Diffuse Large B-cell Lymphoma Associated With the Use of Biologic and Other Investigational Agents: The Importance of Long-term Postmarketing Safety Surveillance

Allison Goddard MD, Judy H. Borovicka MD, Dennis P. West PhD,Andrew M. Evens DO MS, Anne Laumann MBChB MRCP
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This case report describes a patient who developed diffuse large B-cell lymphoma (DLBCL) after receiving courses of two investigational biologic agents and cyclosporine followed by more than four years of subcutaneous efalizumab for the treatment of extensive chronic plaque psoriasis. Three years later, the patient remains free of lymphoma and his psoriasis is well controlled with thriceweekly narrow-band ultraviolet phototherapy. This case emphasizes the importance of continued long-term post-marketing safety surveillance and the early reporting of all possible serious side effects, including cancers, related This case report describes a patient who developed diffuse large B-cell lymphoma (DLBCL) after receiving courses of two investigational biologic agents and cyclosporine followed by more than four years of subcutaneous efalizumab for the treatment of extensive chronic plaque psoriasis. Three years later, the patient remains free of lymphoma and his psoriasis is well controlled with thriceweekly narrow-band ultraviolet phototherapy. This case emphasizes the importance of continued long-term post-marketing safety surveillance and the early reporting of all possible serious side effects, including cancers, related to the use of any newly available product. In particular, surveillance should focus on the immunomodulating biologic agents in order to identify possible dangerous sequelae. (J Drugs Dermatol. 2011;10[1]80-83.)

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A Case of Post-herpetic Itch Resolved With Gabapentin

Jared Jagdeo MD MS and Daniela Kroshinsky MD
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Herpes zoster is a skin disease encountered commonly in dermatologic practice. While post-herpetic neuralgia (PHN) is a familiar side effect of this condition, it is not the only neuropathic symptom that can result. Post-herpetic itch (PHI) is less well known, but should be considered when evaluating a patient after an occurrence of zoster. Gabapentin has been successfully used to treat cutaneous pain and pruritus in a variety of conditions. The authors describe a case of PHI successfully treated with a course of gabapentin and propose that this agent be considered for use in patients who present with PHI. (J Drugs Dermatol. 2011;10[1]85-88.)

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Departments

Clinical Trial Review

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Clinical Trial Review is a JDD department designed to provide physicians with information on drugs and devices undergoing clinical testing. It is our goal to inform the reader of the status of select drug and device studies relevant to the practice of dermatology before this information is available through standard channels. To participate in or learn more about these and additional trials, visit www.clinicaltrials.gov.

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Pipeline Previews

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Pipeline Previews brings to you information on the newest drugs and medical products as they become available to the dermatologic community. This department may include additional information from the manufacturers, plus reports from physicians who wish to share their clinical experience with these new products. In addition, we will inform our readers about the latest drugs receiving Food and Drug Administration (FDA) approval. We trust you will find this information beneficial to your practice and research.

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Archives Volume 10 | Issue 1

Original Articles

Case Reports

Departments

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