Treatment of patients following facial nerve injury can be daunting. A multitude of procedures have been developed to treat the paralyzed
face. As patients recover from facial nerve injuries, a variety of asymmetries from nerve hypofunction (paresis or paralysis) or
hyperfunction (synkinesis or spasm) often persist. Careful use of botulinum toxin type A can be very useful in improving symmetry
in acute or chronic facial nerve abnormality by treating the relatively hyperfunctional side.
Fitza Singh, BA and Jeffrey M. Weinberg, MD
Psoriasis is a chronic skin disorder that affects approximately 2% of the US and European population. Over the last several years,
one of the major focuses in psoriasis research has been the development of novel biologic therapies for this disease. The aim of these
therapies is to provide selective, immunologically directed intervention, with the hope that such specificity will result in fewer side
effects than traditional therapies. In addition to these therapies, there are also oral medications in development for psoriasis. The
goal of this article is to review oral tazarotene, a novel retinoid, and oral pimecrolimus, a novel macrolactam therapy, for the treatment
of moderate to severe psoriasis.
Jonathan S. Weiss, MD and Joel S. Savin, MD
The agents most commonly used in combination for the management of acne include topical retinoids and antibiotics. Topical
retinoids normalize desquamation of the follicular epithelium, whereas antibiotics inhibit the growth of P. acnes and the production
of free fatty acids. This therapeutic combination decreases comedogenesis, bacterial growth, and inflammation, thus targeting three
of the four pathogenic factors associated with acne. Efficacy and tolerance are maximized with combination therapy, and the degree
of skin irritation is minimized. Furthermore, adjunctive therapy with topical retinoids and antibiotics tends to produce results more
quickly than single-agent therapy.
This article will examine the individual agents used in combination for acne management, and discuss the mechanisms by which they
achieve efficacy. The rationale of utilizing topical retinoids with antibiotics will be highlighted, particularly in relation to improved tolerance
and reduced irritation.
Aditya k. Gupta, MD;, PhD, FRCP(C) and Karyn A. Nicol, HBMSc
Seborrheic dermatitis is a common chronic infection of the lipid-rich areas of skin. While seborrheic dermatitis has been a recognized
clinical entity for decades, its etiology is far from clear. Early investigators of the development of seborrheic dermatitis focused
on the role of the Malassezia (previously Pityrosporum) yeasts. These yeasts are also normal skin commensals, thus their importance
as pathogens in this disorder came to be doubted. However, it was subsequently found that treatment of seborrheic dermatitis with
an antifungal agent not only resulted in clinical improvement but also reduced the number of Malassezia yeasts on the skin. This has
resulted in a resurgence of interest in the Malassezia yeasts. It has been hypothesized that there is an immunological component to
seborrheic dermatitis, possibly representing an abnormal host response to the Malassezia yeasts. This paper will discuss the role of
Malassezia in the etiology of seborrheic dermatitis, as well as the various treatment options.
Aparche Yang, BS and John Y. Koo, MD
A significant proportion of patients seen by dermatologists have skin disease complicated by a psychiatric condition. These conditions
often give rise to social, legal, and ethical concerns which impede the proper treatment of these patients, commonly involving
the prescription of anti-psychotics for non-psychotic indications. This paper clarifies the social, legal, and ethical matters which
frustrate the treatment and recovery of patients from their complex psycho-dermatologic disease. Specifically, this paper addresses
the ethical and legal issues associated with prescribing anti-psychotics for non-psychotic indications. The presented data shows that
the internationally prevalent medical practice of prescribing anti-psychotics for non-psychotic indications is not only ethical and legal,
but also an essential treatment modality in the field of dermatology.
Corticosteroids have been combined with other agents in the treatment of melasma for years. In early studies by Kligman and Willis,
topical dexamethasone as monotherapy produced little depigmentation even after 3 months of therapy. A significant concern is that
topical corticosteroids used alone in this setting, especially on the face, may result in epidermal atrophy, telangiectasia, rosacea-like
erythemas, acne, and perioral dermatitis.
Topical corticosteroids, however, including low-potency fluocinolone acetonide, also exert an anti-metabolic effect, resulting in
decreased epidermal turnover, and, thus, may produce a mild depigmenting effect. When used in combination with tretinoin and
hydroquinone in the treatment of melasma, fluocinolone acetonide 0.01% suppresses biosynthetic and secretory functions of
melanocytes, and thus melanin production, leading to early response in melasma, synergy among the three agents, and no significant
side effects over an 8-week period.
Keyvan Nouri, MD; Christopher O'Connell, BA; Juana Alonso, HTL; Maria Patricia Rivas, MD and Yadira Alonso
High quality frozen sections are fundamental in Mohs surgery, and one of the main elements in tissue processing is the mounting of
the specimen. The Miami Special has been used for this purpose at the University of Miami for over 30 years. Since 1989 the Miami
Special has languished in the literature among a growing list of mounting instruments. Therefore, new generations of Mohs surgeons
may not be acquainted with the advantages of this instrument. This article describes the Miami Special and outlines its use for the
benefit of current practitioners.
Isotretinoin therapy for the treatment of severe nodulocystic acne has been used for the last twenty-three years. Its use has been
associated with many restrictions to the patient, with some of these based on mythology rather than on scientific evidence. The purpose
of the article is to discuss the myths associated with acne treatment with isotretinoin. This article expresses the sole opinion
Robert L. Henderson, Jr. MD; Phillip M. Williford, MD and Joseph A. Molnar, MD, PhD
While ulcerative lichen planus is a common diagnosis when involving the mucosa, it is uncommonly found on the cutaneous surface.
Cutaneous ulcerative lichen planus is usually found on the palmar or plantar surfaces1,2 and has only rarely been described elsewhere3-6.
We describe a case of cutaneous ulcerative lichen planus involving the pretibia and exhibiting pathergy, which to our knowledge has not
been previously reported. We also describe successful treatment with oral acitretin in conjunction with topical and intralesional