Omid Hamid MDa and Gary Goldenberg MDb
Basal cell carcinoma (BCC) is a common skin cancer and its incidence is on the rise worldwide. Clinical presentation and histologic
examination are used for diagnosis and to stratify BCCs as either low- or high-risk for recurrence or development of advanced disease.
A number of surgical and nonsurgical options are available for BCC. BCC is most often managed with a surgical approach, but not all
tumors and patients are suitable for surgery. Vismodegib is a recently approved first-in-class hedgehog pathway inhibitor that has expanded
options for patients who have locally advanced or metastatic BCC.
J Drugs Dermatol. 2013;12(11):1246-1252.
Fan Xin MD PhD,a Liu Li-hong MD,a Macrene Alexiades-Armenakas MD PhD,b
Stefanie Luebberding PhD,b Shi Cui-ping MD,a Han Yue MD,a An Yu-xi MD,aYue Dan-xia MD,a
and Yang Rong-ya MD PhDa
OBJECTIVE: The aim of this explorative study was to investigate the histological effects of a novel micro-plasma radio-frequency technology
for skin rejuvenation the assessment of different parameters.
METHODS: Thirty guinea pigs were randomly selected and were distributed into three treatment groups: 40W/10KJ, 60W/10KJ, and
80W/10KJ. The treated skin was analyzed immediately, one week and one month post-treatment using histology and transmission
electron microscope (TEM).
RESULTS: At 40W/10KJ, the epidermis was intact and light collagen homogenization was observed in the papillary dermis. At 60W/10KJ,
the epidermis showed focal emergence of fractional shape change and obvious papillary dermal homogenization. At 80W/10KJ, the epidermis
was completely vaporized and the superficial and mid-dermal layers of collagen tissue showed a large area of homogenization.
Dermal collagen increased in density and became arranged in an orderly manner after one week and markedly thickened and arranged
in compact manner after one month. TEM showed that epidermal cells were relatively complete, intercellular structure was normal, but
the dermal collagen lost its typical structure, cell structure disappeared and showed massive apoptosis. A low level of apoptosis marker
expression was observed, with collagen structure restoration after one month.
CONCLUSION: The treatment with the novel micro-plasma radio-frequency technique has a dose-dependent effect on the skin, especially
on the dermal collagen tissue, where neocollagenesis is stimulated.
J Drugs Dermatol. 2013;12(11):1210-1214.
Lisa K. Chipps MD MS,a,b,c Jason Bentow MD,c Heidi B. Prather MD,d Jeffrey J. So MS PA-C,a
Jonathan M. Schouest BS,a and David M. Ozog MD,a,e Ronald L. Moy MDa,b
OBJECTIVE: To use 3D photography to evaluate the clinical efficacy of a novel radiofrequency delivery device used to improve the appearance
of rhytids and laxity of the face and neck.
STUDY DESIGN: Forty-nine subjects received a total of two radio-frequency treatments to the face and neck one-month apart. The novel
radio-frequency delivery device was used to heat the dermis between 41-43°C for five heat cycles. Primary outcome measures were
clinical efficacy quantified by the Global Assessment Improvement Scale (GAIS) and a patient survey that assessed treatment satisfaction.
RESULTS: Assessments of 3D photographs revealed an overall improvement in 74% of study subjects. 85% of patients noted an overall
improvement in the appearance of their skin. 81% of patients rated their post-treatment skin laxity as improved, 85% rated their skin
smoothness as improved and 62% rated their skin brightness as improved.
CONCLUSION: Subjects in this study demonstrated an overall improvement in face and neck appearance with regard to skin tightening,
wrinkles, and skin texture suggested by overall patient satisfaction (85%) and physician-rated GAIS improvement (74%). This study
suggests that radiofrequency applied with a continuous thermal treatment device is a safe and efficacious way to improve the overall
appearance of aging facial skin.
J Drugs Dermatol. 2013;12(11):1215-1218.
Laurel M. Morton MD,a Kevin C. Smith MD FRCPC,b Jeffrey S. Dover MD FRCPC,a,c,d,e Kenneth A. Arndt MDa,d,e,f
The potential for bruising is a frequent concern for patients undergoing minimally invasive procedures, particularly injection-based soft
tissue fillers and botulinum toxin type A. Decreasing the risk of this side effect with good technique and careful patient selection is
key, but interventions that quicken the resolution of bruising are also helpful. Many practitioners have employed the theory of selective
photothermolysis, using laser and light devices, to target hemoglobin and its breakdown products to speed time to bruise resolution.
585-595nm pulsed dye, pulsed 532nm and 1064 nm long-pulsed neodymium-doped yttrium aluminum garnet (Nd:YAG) lasers and
intense pulsed light may be utilized with best results achieved when treatment is performed 1-2 days after the appearance of purpura.
Specific therapy recommendations, side effects and contraindications will be addressed in this review.
J Drugs Dermatol. 2013;12(11):1219-1222.
BACKGROUND: Cellulite gives the skin surface an orange peel or mattress-like appearance thought to be caused by expansion of subcutaneous
fat, fibrotic septae and, dermal laxity and atrophy.
OBJECTIVE: To evaluate the safety and efficacy of a single cellulite treatment using an Nd:YAG 1440-nm laser delivered with a special
fiber delivery system and temperature control.
METHODS: Women with cellulite on their thighs and buttocks were enrolled in a prospective Institutional Review Board–approved study.
Subjects were 15 healthy females of all Fitzpatrick Skin types with cellulite (grades II-III). A single treatment was performed with an
average of seven 5 x 5 cm squares treated per leg. Evaluations with 2D and 3D imaging, patient and blinded evaluator scales as well
as skin histology were performed at baseline, 3 and 6 months post treatment.
RESULTS: In the 2D photographs, blinded evaluators were able to identify treated photographs versus baseline in 90% of cases and
the number of sites with improvement in contour irregularities was 94%. With 3D imaging, the average decrease in skin depressions
(dimples) was 49% at 6 months and 66% of patients showed improvement in overall skin contour at 6 months follow-up. Patient and
physician satisfaction scores were high and no adverse events were reported.
CONCLUSION: The Nd:YAG 1440 nm laser with a special fiber delivery system produced significant improvement in cellulite with one
treatment after 6 months of follow up. There were no adverse events.
J Drugs Dermatol. 2013;12(11):1224-1230.
Jill Waibel MD, Adam Jared Wulkan MD, and Ashley Rudnick
BACKGROUND and OBJECTIVES: Onychomycosis affects five percent of the worldwide population. Onychomycosis is a therapeutic challenge.
Current therapies on the market are either ineffective or require patient monitoring. Laser and light technologies are being investigated
as a possible treatment option for onychomycosis. The proposed mechanism of action is unknown. All infectious agents may be
killed by heat (except prions). One possible theory is the photothermal effect from water absorbing lasers creates bulk heating in the
nail plate to kill fungal hyphae. Laser technology may be a promising new treatment option for onychomycosis. This is a prospective trial
with real-time temperature feedback to evaluate efficacy and safety of laser therapy for onychomycosis.
METHODS: Twenty-one patients with PAS or culture proven fungal onychomycosis were prospectively treated with laser until target
temperature of 46 - 48 degrees Celsius was achieved using real-time infrared temperature feedback. The laser and light therapies used
were 1319nm, 1064nm and BroadBand Light. Exclusion criteria included mixed infection and no other prior therapeutic interventions.
Subjects received four treatment sessions one week apart. Assessments included PAS & cultures at one, three and six months post
treatment. Patients also were asked a pain score from 1-10 during treatment.
RESULTS: Patients tolerated the procedures well with high satisfaction. Average treatment time was 10 minutes. No adverse events
were noted. Patients reported mild-moderate transient discomfort during treatment. Six-month culture results revealed 20/21 negative
for fungal organisms.
CONCLUSION: Laser therapy offers a safe and effective new option for onychomycosis. This may be the optimal therapy for a large market
that needs alternative or adjunct to current therapies. Laser is quick, painless therapy that does not require any oral medications or
blood test for monitoring. Additional larger scientific studies are needed to confirm our pilot study results.
J Drugs Dermatol. 2013;12(11):1237-1242.
Anthony Rossi MD,a,d Rebecca Lu MD,a Melissa K. Frey MD,d Takako Kubota MD,c
Lauren A. Smith MD,e and Maritza Perez MDa,b
BACKGROUND: Keloids can be quite resistant to conventional methods of treatment. A wide range of treatment modalities exists, often
with suboptimal results, recurrences, and adverse events occurring. Laser therapy with the carbon dioxide, erbium:YAG, Q switched
frequency doubled neodymium-doped yttrium aluminium garnet (Nd:YAG), and 585/595 nm pulsed dye lasers have all be purported as
potential treatment modalities however with limited efficacy and data especially in the skin of color population is limited. We report the
successful use of the 300 microsecond 1064 nm Nd:YAG laser in treating keloids in patients with skin types ranging from Fitzpatrick I
through VI with special attention in treating skin of color patients.
OBJECTIVE: We examined the use of the 300 microsecond 1064 nanometer (nm) Nd:YAG laser for the treatment keloids in patients with
skin types ranging from Fitzpatrick I through VI.
METHODS & MATERIALS: A retrospective analysis of treatment efficacy was conducted on 44 patients with keloids. Three separate
treatment groups were compared. The groups consisted of: a “control group” in which the whole keloid was only treated with intralesional
corticosteroid (triamcinolone 10mg/cc) (16 patients); a “laser only” group in which the patient’s keloid was only treated with the
1064nm Nd:YAG laser at a fluency of 13 to 18 Joules / centimeter2 (J/cm2), a fixed pulse duration of 300 microseconds, 5mm spot size,
and a total of 2000 pulses (14 patients); and a “combination group” that received both the aforementioned laser therapy and adjuvant
intralesional triamcinolone (14 patients).
RESULTS: Patients in the "combination group" treated with the 300 microsecond 1064nm Nd:YAG laser therapy plus intralesional
corticosteroid and the "laser only" group both were observed to have durable clinical reduction in the thickness and erythema of the
keloids. These results were shown to be superior to the "control group" whom were only treated with intralesional corticosteroids.
Only mild and transient post treatment erythema was noted as an adverse effect.
STATISTICAL ANALYSIS: Data analysis was performed using IBM SPSS Statistics 19.0.0 (Armonk, NY). In order to assess the statistical
significance of differences in keloid improvement among the three treatment groups, The Kruskal-Wallis test (non-parametric ANOVA
test) was applied. The level of statistical significance was set at P<0.05. A statistically significant difference in keloid improvement was
appreciated between treatment groups (P<0.0001).
LIMITATIONS: A small sample size and the retrospective nature of the analysis are limitations to the study.
CONCLUSION: The 300 microsecond 1064nm Nd:YAG laser proved effective in improving the clinical appearance of keloids. We recommended
this laser protocol in conjunction with intralesional corticosteroids as a treatment option for patients with keloids, especially
in the skin of color population. The 1064nm Nd:YAG laser did not show post inflammatory hyperpigmentation nor hypopigmenatation,
which are concerns for skin types IV to VI, and therefore is a suitable option for such patients.
J Drugs Dermatol. 2013;12(11):1256-1262.
Onychomycosis is not just a cosmetic problem. It is a common disorder that may be a reservoir of infection and lead to significant
medical problems. In addition, onychomycosis may cause a substantial decrease in quality of life. An understanding of the disorder and
updated management is important for all health care professionals. Onychomycosis is the most common nail disorder in adults.1 It is
four to seven times more frequent in toenails, where it often involves several nails.2-4 It is a progressive disease, and although not life
threatening it is inappropriately considered purely a cosmetic problem, with some physicians still believing there is no need to treat. The
fungal infection usually begins in the nail bed, and often extends to the nail plate. Onychomycosis is unsightly and can be uncomfortable;
with discoloration of the nail plate and more severe disease resulting in loss of the nail plate altogether. Onychomycosis may become a
source of more widespread fungal lesions, spreading to other nails, body sites (groin, skin, scalp), and even to family members.5, 6
J Drugs Dermatol. 2013;12(11):1263-1266.
Acne therapies that are able to show efficacious treatment of acne lesions as well as to address the issues of oiliness and shine control
may be particularly appropriate for the treatment of patients with acne vulgaris that is accompanied by oily skin and facial shine. The
microsphere delivery system (MDS), a novel delivery technology for topical therapy, can be customized to optimize product attributes,
including oil absorption. Clinical trials have clearly established the efficacy and tolerability of such MDS formulations in the treatment of
acne. In addition, studies have shown that the use of products formulated with an MDS provides a more significant reduction in facial
shine than non-MDS acne therapy, as well as a reduction in facial sebum accumulation relative to control. Future clinical research should
aim to further delineate the effect of individual topical acne treatment formulations on oiliness and shine.
J Drugs Dermatol. 2013;12(11):1268-1270.
David O. Schairer MD,a Jason S. Chouake MD,a Allison J. Kutner,a Joy Makdisi,a
Josh D. NosanchukMD,b,c and Adam J. Friedman MDd,e
Skin and soft tissue infections (SSTIs) are growing in prevalence in both the outpatient and inpatient settings and are some of the
most common diseases seen by dermatologists, who are often the first point of care for these patients. Microbial resistance to
antibiotics continues to rise as more virulent strains evolve, and strains predominantly found in the hospital setting are now being
seen in the community. Therefore, innovative approaches to combat this trend are needed. Glutathione (GSH) is a well-described
and established antioxidant. It participates in detoxification of xenobiotics, regulation of cellular growth, modulation of immune response,
and maintenance of the thiol status of proteins and cellular cysteine levels. GSH is also known to have a regulatory effect
on immune cells and even inherent antibacterial properties have been reported. To this end, the value of GSH as an antibiotic was
evaluated by growing methicillin resistant S. aureus, E. coli, K. pneumoniae and P. aeruginosa strains isolated from human skin and
soft tissue infection in the presence of GSH. At a physiologic concentration of 10mM, GSH had no effect on bacterial growth. At
concentrations above 50 mM, which created acidic conditions (pH < 4), bacterial growth was completely inhibited. When adjusted
to physiologic pH, GSH exhibited a bacteriostatic effect in a concentration-dependent manner. Additionally, the cytotoxicity of GSH
was evaluated in a murine cell line. GSH was relatively non-toxic to murine macrophages, even at the highest concentration tested
(160 mM). These results suggest the potential utility of GSH for the prevention and/or as adjunctive treatment of infection, most
significantly in disease states associated with GSH deficiency.
J Drugs Dermatol. 2013;12(11):1272-1277.
Neil Swanson MDa, Christina Cognata Smith MDb, Mandeep Kaur MDb, and Gary Goldenberg Mc
BACKGROUND: Imiquimod 3.75% and 2.5% creams were studied for the treatment of actinic keratosis (AK) of the full face or balding
scalp, to determine comparable efficacy and tolerability to imiquimod 5% cream.
METHODS: In two identical multicenter, randomized, double-blind, placebo controlled studies. Adult subjects with 5 to 20 visible lesions,
or palpable AKs in an area that exceeded 25cm2 on either the face or balding scalp were randomized to imiquimod 3.75%, 2.5% or
vehicle cream (1:1:1) applied once daily for two 2-week treatment cycles, with a 2-week, no-treatment interval between cycles. Efficacy
was assessed 8 weeks posttreatment (End of Study Visit [EOS]). Primary efficacy was rate of complete clearance of AK lesions. Secondary
efficacy endpoints were rate of partial clearance at EOS (≥ 75% reduction in number of AK lesions compared to baseline) and
median percent decrease from baseline lesion count. Safety assessments included visual assessment of local skin reactions (LSRs),
number and duration of study treatment rest periods required due to intolerant LSRs, adverse events (AEs) and clinical laboratory tests.
RESULTS: Overall 479 patients were randomized to imiquimod 3.75%, 2.5%, or vehicle. Complete clearance rates were 35.6%, 30.6%,
and 6.3% respectively (both P<.001 versus vehicle). The difference in complete clearance rates (imiquimod minus vehicle) was 29.3%
and 24.3%, respectively. Partial clearance rates were 59.4%, 48.1%, and 22.6% respectively (both P<.001 versus vehicle). Median %
reductions in AK lesions were 81.8%, 71.8%, and 25.0% respectively (-<.001 versus vehicle). All primary and secondary efficacy endpoints
were greater in Study 1. Photodamage in the treatment area was 'much improved' with imiquimod 3.75%. Both active creams
were well tolerated with few treatment-related discontinuations.
CONCLUSIONS: In two well-controlled Phase 3 studies, both imiquimod 3.75% and 2.5% creams were more effective than vehicle and
well tolerated when administered daily as a 2-week on/off/on regimen to treat AK. Reduction in AK lesions was comparable to that
reported with imiquimod 5% with fewer local AEs.
J Drugs Dermatol. 2013;12(11):1278-1282.