Kenneth Beer MD, Monica Yohn RN, Jeff Closter BS
Background: Botox has been used primarily for treating rhytids of the upper face. Its use in the lower part of the face
has been reported by several authors but there is a relative scarcity of information regarding the use of Botox in the
chin and even fewer well-controlled studies in this area. This study reports the findings from a placebo-controlled trial
of Botox for the treatment of chin rhytids.
Objective: To determine whether Botox would improve chin rhytids.
Methods: A double-blinded, placebo-controlled study utilizing injections of Botox into one half of the chin and saline
into the other half. Photography as well as objective ratings were used to rate the changes due to the injections.
Results: Physicians and patients were able to discern a difference between the mentalis rhytids treated with Botox and
the rhytids treated with placebo. This change was statistically significant and consistent across various time points and
was noted at rest as well as at maximal mentalis contraction. Of the twenty patients treated, 11 were satisfied with the
results, 7 patients were not satisfied with their results, 1 was not sure whether or not they were satisfied, 1 was very
unsatisfied with her results, and 1 was lost to follow-up. It is believed that the lower satisfaction ratings were a function
of asymmetric appearance that resulted from the design of the study rather than dissatisfaction with the improvement
of the rhytids in the treated side of the mentalis.
Conclusions: Botox cosmetic is an effective treatment for moderate rhytids of the mentalis for patients that exhibit significant, dynamic, chin wrinkles
William D. Tutrone MD, Kimberly M. Green MS, Tom Norris MD, Jeffrey M. Weinberg MD, Dick Clarke
Envenomation from the brown recluse (Loxosceles recluse) spider commonly proceed on one of three clinical pathways.
The majority of bites (90%) result in nothing more than a local reaction. They are essentially self-limiting, require little
if any attention, and resolve spontaneously. A great majority of the remaining bites will produce necrotic ulcerations
of various sizes and dimensions, with systemic sequela ranging from fever to hemolysis and kidney failure. Finally,
and in the most rare cases, the patient will succumb a fatal systemic reaction. Current therapeutic options for these
wounds remain controversial and include the following: local care, corticosteroids, dapsone, and hyperbaric oxygen
(HBO) therapy. This article will review the application of HBO therapy for patients who are envenomated by brown
recluse spiders. Information for this manuscript was derived from multiple MEDLINE searches as well as searches of the
National Baromedical Service’s hyperbaric specialty literature collection.
Pooja Khera MD, John Y. Koo MD
Retinoids, a group of compounds encompassing Vitamin A and its analogs, have been shown to inhibit tumor growth
in laboratory studies. Based on these findings, a number of clinical trials have been conducted to investigate the chemoprotective
and chemotherapeutic effects of retinoids. This paper reviews the current database regarding the use of oral
and topical retinoids in the prevention and treatment of cutaneous and internal malignancies. Clinical studies have
shown that retinoids have beneficial effects in the prevention and treatment of certain neoplasms. In view of the
heightened concern of malignancy associated with the use of biologic agents in the treatment of psoriasis, retinoids may
be an attractive option for combination therapy with the biologic agents. Future clinical investigations are needed to
precisely define how this combination will fit into the treatment algorithm for moderate-to-severe psoriasis.
Hypertrophic Surgical Scars: A Pilot Study Supriya G. Bellew MD, Margaret A. Weiss MD, Robert A. Weiss MD
Background: The short-pulsed pulsed dye laser (PDL) has been previously reported to improve the appearance of
hypertrophic scars. Prolonged purpura following treatment led to the development of the newer long-pulsed pulsed
dye laser (LPDL). Intense pulsed light (IPL) has been extensively used to improve the various components of photodamage
and to reduce the incidence of purpura, but its effect on scars has not been analyzed. The objective of
this pilot study was to prospectively determine and compare the safety and efficacy of LPDL and IPL on surgically
Methods: Breast reduction scars (N = 10 scars) and abdominoplasty scars (N = 5 scars) were treated using both
LPDL and IPL. For breast reduction scars, one side was treated with each technique. For abdominoplasty scars, one
half of the scar was treated with each device. Two treatments were performed 2 months apart. Physician global
assessment scores of improvement were determined by side-by-side comparison of preoperative and randomly presented postoperative photographs. Patient pain scores during treatment were also obtained and the presence of post-treatment purpura was assessed.
Result: Mean improvement on a 0 to 3 oint scale was 2.2(55%) after the first LPDL treatment and 3.2 (80%) after the second. Mean improvement was 1.8(45%) after the first IPL treatment and 2.6(65%) after the second. Differnces in improvement between the LPDL and IPL sides were not statisdtically significant. Patients rated IPL. as more painful thatn LPDL. The incidence of post-treatment pupura was lower with IPL.
Conclusions: This pilot study suggests that LPDL and IPL are equally effective in improving the appearance of hypertrophic surgicak scars. IPL offers a movel method of treating scars that minimizes the risk of purpura.
Snehal P. Amin MD, David J. Goldberg MD
Many effective and simple topical anesthetic products are available today and commonly used in medical and non-medical
settings. The increased use of topical anesthetics, especially by non-physicians in the medical and non-medical settings,
has resulted in increased rates of complications including ineffective anesthesia, allergy, and even potential fatalities.
This review focuses on various techniques and formulations for topical anesthesia and their appropriate applications
in cosmetic and laser dermatology. In addition, the history, pharmacology, and clinical complications of topical
anesthetics are discussed.
Clay J. Cockerell MD, James R. Wharton MD
Actinic keratoses are common, sun-induced lesions that have historically been regarded as “premalignant.” Evidence
supports their inclusion along a continuum with squamous cell carcinoma. We propose a classification analogous to that
used for cervical intraepithelial neoplasia.
J. Alcalay MD, R. Alkalay MD, E. Grossman MD
Background: A common practice is not to operate on patients with elevated blood pressure (BP) levels to avoid cardiovascular
and cerebrovascular complications. We therefore designed a study to evaluate the effect of prolonged surgery
under local anesthesia on BP levels, and to compare the outcome of patients with elevated BP to those with
Methods: We studied 121 patients (65 males) with a mean age of 60 ± 14 years (range 31-89) who were referred for
Mohs micrographic surgery (MMS) during 2 consecutive months. Forty six patients had a history of hypertension.
Blood pressure was measured in all subjects in the supine position with an automated device 5 times during surgery.
Results: Blood pressure decreased significantly during surgery from 152 ± 2/85 ± 1 mm Hg at baseline to 139 ± 2/79
±1 at the end of the surgery (p < .05). Forty two patients (34%) had elevated BP levels at baseline whereas only 18
patients had these levels at the end of the first stage. There was no difference in surgery outcomes between those
with elevated and those with normal BP levels at baseline.
Conclusions: Blood pressure levels decrease during MMS under local anesthesia and the outcome of patients with
elevated BP is good. Thus, patients with elevated BP can safely undergo surgery under local anesthesia
James Q. Del Rosso DO FAOCD, Joseph Bikowski MD
Metronidazole was the first topical agent approved by the US Food and Drug Administration for the treatment of
rosacea. Several controlled studies have confirmed the efficacy and safety of topical metronidazole 0.75% gel, lotion
and cream and 1% cream for rosacea. At present, little data exists regarding the use of combination topical therapy in
rosacea management, although anecdotal evidence and preliminary studies suggest at least some additive benefit when
topical metronidazole is used in combination with sulfacetamide 10%/sulfur 5%. In this paper, the results of observational
experience evaluating topical metronidazole 0.75% gel used in combination with other topical rosacea therapies
and/or subantimicrobial dose doxycycline are reported.
Aditya K. Gupta MD PhD FRCP(C)
This randomized, evaluator-blind, 3-arm parallel, comparator controlled, multicenter pilot study evaluated the safety
and efficacy of ciclopirox nail lacquer topical solution, 8% in combination with oral terbinafine for the treatment of
moderate to severe toenail onychomycosis (?60% disease involvement of target nail and/or lunula/matrix involvement)
(N = 73). Patients were randomized to 1 of 3 treatment arms: ciclopirox nail lacquer once daily for 48 weeks
plus 4 weeks of terbinafine 250 mg/day, followed by 4 weeks of rest (no terbinafine), then another 4 weeks of
terbinafine 250 mg/day (PL8); ciclopirox nail lacquer once daily for 48 weeks plus terbinafine 250 mg/day for 12 weeks
(PL12); or terbinafine 250 mg/day for 12 weeks (L12). At week 48, mycological cure (negative microscopy and culture)
occurred in 66.7% (14/21) (PL8), 70.4% (19/27) (PL12), and 56.0% (14/25) (L12) of patients confirmed dermatophyte
positive, respectively (P: not significant). At this time point, effective cure (simultaneous mycological cure and ?90%
reduction in the disease area) was observed in 40.0% (8/20), 33.3% (8/24), and 34.8% (8/23) of patients, respectively
(P: not significant). The PL8 regimen was well-tolerated and had high compliance. The data suggest that combination therapy (PL8) may be an alternative regimen to continuous terbinafine (L12) in the treatment of moderate to severe dermatophyte toenail onychomycosis.