Post-herpetic neuralgia (PHN) is primarily a disease of the elderly and often refractory to treatment. Randomized and controlled
trials have yielded several significant advances in the treatment and prevention of this disease. Treatment advances
include the lidocaine patch, opioid analgesics, nortriptyline, amitriptyline, and gabapentin. However, no treatment regimen
fully eliminates the pain. Improvements in prevention include prompt recognition and treatment of high-risk herpes zoster
(HZ) patients with antiviral and analgesic therapies. Even with these advances, PHN remains a debilitating and painful disease.
Vaccines offer the greatest promise of relief. The childhood vaccine against varicella zoster virus offers long-lasting
immunity, largely preventing HZ and PHN. But most adults have already had varicella and are at risk for HZ and PHN as
they age. Therefore, a more potent vaccine against varicella has been developed for use in adults. This vaccine offers a new
and significant advance in the prevention of HZ and its most noteworthy complication, PHN.
Joseph Bikowski MD, Radhakrishnan Pillai PhD, Braham Shroot PhD
Multivesicular emulsion systems are a new patented technology for topical delivery of pharmaceutical and over-the-counter
actives. This novel technology involves the creation of a 2-phase, oil-in-water emulsion system that produces concentric
multilamellar spheres of oil and water. Active ingredients can be released from their respective layers upon application to the
skin. In addition to a controlled-release of active agents, the multivesicular emulsion base improves the biophysical properties
of the skin by reducing transepidermal water loss and enhancing skin hydration. This technology has been applied to 6%
salicylic acid formulations that in clinical experience show efficacy with high tolerance in several hyperkeratotic disorders.
Subjects’ self-assessment was clearly indicative of the excellent cosmetic elegance of the multivesicular emulsion system.
D. Vleggaar MD, R. Forte MD
An ever increasing number of devices and procedures designed to rejuvenate the aging face are available to dermatologists
and plastic surgeons. These devices include products consisting of autologous materials, natural polymers, and synthetic compounds.
The diversity of these materials is reflected by the wide variety of techniques used to administer them. Differences
in terms of injection technique and the equipment used for each device are usually a consequence of the nature of the material.
The depth at which a substance is deposited is also very important as device-related adverse events are often a result of
improper placement. The techniques used to inject the commonly encountered soft tissue fillers and volume enhancers are
compared here, with special reference to the degree with which injection technique causes device-related adverse events.
Jean Carruthers MD, Alastair Carruthers MD
Hyaluronans have become the most popular agents used for soft tissue augmentation in the entire facial area. They are biodegradeable,
nonpermanent and have a remarkable safety profile. Their natural biocompatibility means that no pretreatment
skin test is necessary. The soft pliable enhancement of natural tissue turgor and contour makes them very acceptable in the
lips and perioral and periocular regions. The more viscous agents are very helpful in the treatment of facial lipoatrophy particularly
in the region of the cheeks and chin.
Sody Abby Naimer MD, Amnon Biton MD, Morris Topaz MD
Background: Removal of subcutaneous skin masses and certain deep skin injuries results in defects, which demand immediate
closure. Although primary closure of these defects in 2 layers is an acceptable solution, this technique has a number of
drawbacks, such as extended time consumption upon performance, demand for additional suture material and occasional tissue
response or foreign body reaction to retained absorbable stitches leading to infection and its sequelae.
Objective: We describe an approach intended to furnish a satisfactory solution to the needs of tissue closure in such cases.
The significant innovation of this technique is the closure of both deep and superficial layers of skin in one single suture.
Materials and Methods: Our suture combines the advantages of the classic mattress suture together with those of the buried
subcutaneous suture. We performed the vertical mattress suture with 3/0 polypropylene or monofilament suture and added a
subcutaneous loop to achieve sufficient approximation of deep tissue surfaces. This suture technique was applied in our first
50 cases. The defects were closed without adverse sequelae. No tissue infections were observed. Wound dehiscence occurred
in one case after premature suture removal. The stitches were slightly more difficult to remove than regular sutures. Review
of the resulting scars exhibited acceptable results similar to those of parallel closure techniques.
Conclusions: This easily performed technique yields the benefits of reducing suture cost, annulling foreign body reaction, and
resulting in both a functional and aesthetically pleasing outcome. The subcutaneous loop technique has become our standard closure of choice for wounds demanding cutanwous and subcutanwous repair.
Stacy Smith MD, Vera Morhenn MD, Guy Webster MD
Topical drugs use a variety of ingredients to control the properties of the final product. Solid phase porous microspheres
(SPPM, Microsponge®) have been incorporated into several topical prescription products in an effort to improve performance
or tolerability. SPPMs provide a reservoir effect allowing more prolonged skin exposure to the active ingredient. They are used
in products for acne vulgaris, actinic keratoses, and pigmentary changes. The differences in clinical performance between existing
formulations of these common active ingredients and the formulations using SPPMs are compared and contrasted.
Skin is the most commonly affected organ in patients with HIV, and the incidence of cutaneous adverse reactions in persons
infected with HIV versus those who are not infected is significantly higher. Cutaneous drug reactions contribute to increased
morbidity and are often the cause of treatment nonadherence. Undoubtedly, the widespread use of highly active antiretroviral
therapy has had a positive effect on the natural course of the disease; however, advances in HIV therapy will continue to
increase the potential for cutaneous eruptions, further complicating the evaluation of skin manifestations that are so common
in this disease. Distinguishing between cutaneous drug reactions and other cutaneous diseases associated with HIV
infection can be challenging. Nevertheless, it is important for clinicians to be knowledgeable about the clinical characteristics
and presentations of these reactions and to determine whether drug discontinuation is indicated.
Sabine Laquieze MD, Janusz Czernielewski MD, Marie-José Rueda MD
Despite their beneficial effects on the treatment of acne vulgaris, topical and oral retinoids may cause severe local irritation
(retinoid dermatitis) due to their mechanism of action, thereby jeopardizing patient adherence, and thus compromising treatment
efficacy. Alleviating dryness and improving skin comfort by using a moisturizer concomitantly to retinoids could
enhance efficacy. In the present study, 30 subjects receiving either oral isotretinoin for at least 2 months or topical tretinoin
for at least one month applied a moisturizing cream (Cetaphil® Moisturizing Cream) twice daily for 15 days on one half of
the face while the other side remained untreated. Clinical assessments, confirmed by biophysical measurements, showed that
the moisturizer provided a significant improvement in skin dryness, roughness, and desquamation. Skin properties and skin
discomfort were also greatly improved and subjects were very satisfied with the product. Retinoid-induced skin irritation can
be relieved by the regular use of a gentle moisturizing cream as an adjunctive treatment.