Non-invasive procedures for tissue tightening and elevation are new frontiers in dermasurgery. Current methods for achieving
a “nonsurgical face-lift” include radiofrequency and infrared light devices which disrupt non-covalent collagen bonds and
stimulate collagen production. This study evaluated a novel treatment protocol designed to achieve a nonsurgical face-lift
with electrical stimulation of muscle. Thirty-five women were treated with the Pan G Lift (Pan Germinal Systems,
Clearwater, Florida) to enhance skin and induce soft-tissue lifting via hypertrophy of the facial musculature. The protocol
consists of biweekly treatments for 10 weeks followed by monthly maintenance treatments. Results were evaluated by both
the investigating physician and patients for up to 12 months. Estimates of percentage improvement were based on a scale of
1 to 4 (1 = 0%-25% [mild]; 2 = 26%-50% [moderate]; 3 = 51%-75% [good]; and 4 = 76%-100% [marked]). After 10 weeks
(20 treatments), the median lifting improvement scores as assessed by patients and physician were the following: cheeks––2.0
and 2.0, jowls––2.0 and 2.0, and texture––2.0 and 2.0, respectively. Physician-evaluated eye lift and neck lift showed similar
improvement. At 12 months (32 treatments), lifting and skin texture changes (assessed by patients and physician) reached
3.0 to 4.0, respectively, while physician-evaluated eye lift and neck lift achieved at least a 3.0 at 20 and 26 treatments. At
one year (32 treatments), neck lift reached a 4.0. There was no downtime and no complications occurred. The non-invasive,
muscle-stimulating Pan G Lift is a novel procedure that yields significant 3-dimensional improvements of the face and neck
(nonsurgical face-lift), which demonstrates progressive improvement with continued monthly treatments over time.
Of the pediculicides on the market, most are not 100% ovicidal and don’t have a residual activity of more than 2 days.
Therefore, at least 2 treatments are necessary to control the entire louse population. In order for a pediculicide to be effective
it should kill all active stages of the louse after a single treatment. Otherwise remaining lice will continue laying eggs
and the following treatments will not be fully effective, at least against the eggs. However, there is no general consensus as
to when the second treatment should be conducted. Taking into consideration that head louse eggs hatch between 5 to
11 days, it is suggested that a second treatment should be administered 10 days after the beginning of the treatment. This
might also explain why most of the clinical trials that were conducted by treating the patients twice with an interval of 6,
7, or 8 days showed a poor efficacy, and clinical trials where the pediculicide was applied with an interval of 10 days showed
an efficacy level of more than 90%.
Aimee L. Leonard MD, C. William Hanke MD
Giant keratoacanthomas measure greater than 2 cm and have a predilection for the nose and eyelids. As a result, they often
present a significant therapeutic challenge. A 36-year old woman was referred for evaluation of a 4.0 x 4.0 cm giant
keratoacanthoma on the nose. The patient was treated with intralesional 5-fluorouracil, and the tumor underwent complete
regression leaving a full thickness nasal cleft. The defect was then reconstructed with a paramedian forehead flap with
Seung Yoon Lee MD, Doo Rak Lee MD, Chung Eui You MD, Mi Youn Park MD PhD, Sook Ja Son MD PhD
Propolis is a beehive product known for its anti-inflammatory properties. With its growing use, propolis-induced contact
dermatitis is increasing. While the dermatitis mostly occurs on areas directly exposed to propolis, our case
presented an additional eczema at a site distant from the primary propolis-induced contact dermatitis twice in the same
individual. We diagnosed it as an autosensitization dermatitis associated with propolis-induced allergic contact dermatitis.
M.R.T.M. Thissen MD PhD, D.I.M. Kuijpers MD, G.A.M. Krekels MD PhD
Background: Surgical excision, including Mohs micrographic surgery, is the treatment of first choice for basal cell carcinoma (BCC). Occasionally, the Mohs procedure has to be ceased prematurely for unseen reasons.
Objective: We sought for possibilities to adjuvantly treat patients in which superficial basal cell carcinoma remained after incomplete Mohs sugery.
Mehtods: We report 3 cases of patients in which Mohs micrographic surgery for their large basal cell carcinomas was ceased for different unforseen reasons, with remainin superficial fields of BCC after the aggressive and deeply localized part had imiquimod 5% crea was given for 6 weeks, covering at least 1 centimeter around the surgically treated area.
Results: The treatment was well accepted with no serious side effects and a good cosmetic result. No recurrences were seen
after a follow-up period of 20 to 34 months.
Conclusion: A combination of surgical intervention for the central deeper part of the BCC and topical imiquimod 5% cream
for the superficial part at the border might be a therapeutic option for those patients with multiple facial BCCs, severe sun
damage, and extensive surgery in the past, in whom completion of the Mohs surgical procedure for the entire tumor is not
possible for different reasons.
According to American Society for Aesthetic Plastic Surgery (ASAPS), 200,924 people had rhinoplasties in 2005.1 Patients
typically have surgical rhinoplasty to correct unsightly noses resulting from trauma, surgery, or heredity. Several alternatives
presently exist for patients considering surgical rhinoplasty. These include injections of botulinum toxins to correct the
shape of the nasal tip and the use of various fillers to correct contour and profile defects. This article presents a simple and
effective alternative using hyaluronic acid for some patients requiring nasal recontouring. The procedure offers patients the
opportunity to avoid the risks and expense associated with surgical correction.
Noah Scheinfeld JD MD, Sripal Bangalore MD
Isotretinoin (13-cis-retinoic acid) is a retinoid that is used to treat cystic acne, comedonal acne, and other diseases. For the
treatment of acne, isotretinoin is dosed at 0.5 to 2 mg/kg daily for 5 months with a target total dose of ~120 mg/kg. Its most
common side effects are mucocutaneous and ocular in nature (ie, cheilitis, ocular sicca, and decreased dark adaptation).
It can also cause xerosis. Patients should be made aware of these side effects before taking isotretinoin and also that utilization of moisturizers and eye drops can help to mitigate such side effects. Sometimes, however, the dose of isotretinoin needs to be decreased to reduce the induction of side effects.
Isotretinoins most significnt side effect is the induction of birth defects if a fetus is exposed to isotretinoin, which is pregnancy category X. Isotretinoin should be used with 2 forms of birth control by fecund women. It can rarely increase serum levels of triglycerides, which can, if very elevated, be related to the development of pancratitis and xanthomas. Isotretinoins well-documented but rarer side effects include intracranial hypertnesion. It can induce bony changes. A review of the literature demonsteates that isotrtinoin is not linked to depression ans suicide.
Facial swelling has been linked to isotretinoin use in 3 previous case reports. We note herein the first case of facial swelling that occurred in an acne patient being treated with isotretinoin who at the time the selling developed has no cysts, comedones, pustules, or evidence of bacterial infection. Possible reasons for the patients facial swelling include some type of retinoid induced angioedema, exacerbation of inflammation by isotretinoin, and istretinoin induced capillary leak syndrome.
Fiona P. Blanco MD, Richard K. Scher MD FACP
Trachyonychia is the term used to describe nail plate roughness, pitting, and ridging that may affect 1 to 20 nails. Alopecia
areata, psoriasis, lichen planus, atopic dermatitis, ichthyosis vulgaris, as well as other skin conditions have been associated
with trachyonychia, but the causal relationship is often challenging to demonstrate histologically. Clinical evidence of these
cutaneous disorders in conjunction with a nail matrix biopsy may help elucidate an etiology of trachyonychia, but many
cases often remain idiopathic. Nail biopsy findings may match skin histology, but more commonly show spongiotic or nonspecific
changes. We present an interesting case of a female with progressive development of trachyonychia in all 20 nails
coinciding with a new diagnosis of sarcoidosis.