Robert Baran MD, Adele Sparavigna MD, Michele Setaro, Federico Mailland MD
Despite the relevant increase in clinical trials on the efficacy of various systemic and/or topical antifungal agents in onychomycosis
therapy, the evaluation of the results is largely subjective. The aim of this study was to set up and ensure an objective, reproducible
and reliable method to measure nail plate involvement in onychomycosis. In order to validate a specifically designed software for the
computerized image analysis of affected areas of the nail, standardized clinical pictures of onychomycosis were prepared by six different
clinicians using a sample of 11 affected nails. Diseased areas and total nail plates were measured both on the clinical pictures and
on their drawings traced by the different clinicians on transparent tapes adhering to sample nails. The computerized procedure was
undertaken by a trained operator who was not a dermatologist. The variation coefficients of measurements on clinical pictures (automatically
detected) and on drawings were compared. In addition, the agreement between automatic evaluation and drawing was evaluated
by means of Bland-Altman analysis. To consider the effect of possible variations linked to different operators using the computerized
method, 11 clinical pictures (one for each clinical case considered) were selected and submitted to computerized image
analysis by six different trained operators. The computerized detection of affected nail areas showed a coefficient of variation
(vc=8.5%) lower than that observed on drawings (vc=14.7%). The two methods showed appreciable agreement, as demonstrated by
Bland-Altman plot. The coefficient of variation of image analysis conducted by six different operators was very low for the total area
calculation (vc=0.9%) and acceptable for pathological area detection (vc=4.8%). Based on the results obtained, we conclude that automatic
evaluation is a reliable and helpful method for the measurement of the clinical involvement of the nail plate in onychomycosis
and for the evaluation of therapies, since it can increase the objectivity and reproducibility of data. However, in a minority of difficult
cases, expert dermatological evaluation is needed.
Evan Jones MD, Adam Korzenko BS, David Kriegel MD
The clinical uses of oral isotretinoin (13-cis-retinoic acid) are many. They include treatment of acneiform eruptions, diseases of cornification,
inflammatory disorders, and neoplastic processes. Isotretinoin has shown greater efficacy in the chemoprevention of squamous
cell carcinoma, rather than in the treatment. High-dose isotretinoin has mainly been utilized in those patients at high-risk for
multiple new skin cancers where the risk of morbidity from side effects is overshadowed by the benefit to the patient.
Varee N Poochareon BS, Daniel G Federman MD, Robert S Kirsner MD
No abstract details for the moment.
James M Spencer MD MS, Suhail M Hadi MD MPhil
The excimer lasers are a group of lasers that have found wide application in a variety of medical fields including dermatology, cardiology,
ophthalmology, and orthopedics. The word excimer refers to excited dimer. These lasers operate in the ultraviolet range, and
examples include the 193 nm argon-fluroide, 248 nm krypton-fluoride, 351 nm xenon-fluoride, and of particular interest to dermatology,
the 308 nm xenon-chloride. These lasers utilize a mixture of a noble gas and a halogen as a lasing material. They were first used
in medicine for their ability to produce cold tissue ablation, but more recently have been used in dermatology as a method of nonablative
Adriana M Villa and MD, Brian Berman MD PhD
Therapeutic interventions to augment tumor antigenicity or increase the host’s immune response against cancer cells include recombinant
cytokines, immune modulators, vaccination with tumor antigens, T cell-based immunotherapy, and gene therapy. We describe
the current role of the immunomodulators (up-regulators of the immune response) in the therapy of skin cancer (non melanoma skin
cancer, melanoma, lymphoma, Kaposi sarcoma, and extramammary Paget’s disease).
By Danny Vleggaar MD, and Ute Bauer MD
The primary reason patients seek aesthetic treatments is to combat the signs of aging. However, the majority of facial treatments
and procedures fill specific wrinkles or pull-taught sagging skin, without returning the volume and contours of a youthful face.
Injectable poly-L-lactic acid (Sculptra™) is a synthetic, biodegradable polymer, popular in Europe for the correction of lipoatrophy.
The novel technique and mechanism of action of this product require physicians to adjust their practice of treating a specific line to
returning volume to a facial area. Sculptra™ has been used successfully for the correction of nasolabial folds, mid and lower facial volume
loss, jaw line laxity, and other signs of facial aging. Sculptra™ treatment provides a minimally invasive, effective, and prolonged
(18-24 months) facial enhancement correction with a low frequency of side effects and no need for allergy testing.
Macrene R Alexiades-Armenakas MD PhD, Roy G Geronemus MD
Actinic cheilitis (AC) is a common precancerous condition for which a safe, effective, rapid, and cosmetically favorable treatment is
needed. The objective of this study was to assess the safety and efficacy of the long-pulsed pulsed dye laser (LP PDL) (595 nm) with
photodynamic therapy (PDT) for the treatment of AC. This study was designed to be a prospective, proof-of concept pilot study to
assess safety and efficacy of LP PDL in conjunction with topical 20% 5-aminolevulinic acid solution PDT for the treatment of AC.
Control patients received LP PDL alone. The setting was an outpatient clinical research center. A volunteer sample of 21 patients
with biopsy-proven AC was enrolled (age range, 42-86 years; skin types I-III). All patients were refractory to prior therapies.
Patients with a history of herpes labialis were pre-treated with famcyclovir. Nineteen patients received one-to-three treatments of
topical 20% 5-aminolevulinic acid for 2-3 hours, followed by LP PDL (595 nm) at monthly intervals. Two control patients received
one treatment with LP PDL alone. Patients in the ALA-LP PDL group were followed at 1, 2, 3, 6, 9, and 12 months. Clearance of
AC was assessed by clinical evaluation. Control patients were followed to the one month interval.
We observed none-to-mild pain; slight-to-moderate erythema; no crusting, purpura, or scarring; treatment time of less than one
minute; and complete resolution of post-operative erythema by day three. Complete clearance was achieved in 13/19 (68%) of patients
following a mean of 1.8 treatments (7/13 (37%) after one, 2/13 (11%) after two, and 1/13 (21%) after three treatments). Patients were followed
for a mean of 4.1 (range 1-12) months. Among the remaining cases, partial clearing was achieved in two patients, recurrence during
the follow-up interval was observed in one patient, and failure to follow-up occurred in three patients. Post-operative impetiginization
occurred in three patients with erosive AC, which resolved with dicloxacillin therapy. Among the control patients, no clearing
Treatment of AC using LP PDL (595 nm) at nonpurpuric parameters following topical application of 5-aminolevulinic acid at short
incubation times is safe and effective. It may offer the advantages of rapid incubation, treatment, and recovery times, minimal discomfort,
excellent cosmetic outcome, and good efficacy rates. Patients with erosive AC should receive antibacterial prophylaxis.
Multiple treatments may be required for complete clearing.
Aditya K. Gupta MD PhD FRCP (C), Melody Chow HBSc
Prednicarbate is a non-halogenated, double-ester derivative of prednisolone that has become of interest for the treatment of inflammatory
skin diseases, for example atopic dermatitis. In the past, topical steroids have been a popular choice for treating these diseases;
however, the potential for significant local and systemic adverse events, such as skin atrophy and hypothalamic-pituitary-adrenal
(HPA) axis suppression have limited their use. Prednicarbate has been found to have a favorable benefit-risk ratio, with low skin
atrophy potential, and a high anti-inflammatory action. Prednicarbate may be particularly advantageous when used intermittently in
pediatric and elderly patients.