L. Rusciani MD, A. Paradisi MD, C. Alfano MD, S. Chiummariello MD, A. Rusciani MD
Background: Despite their benign nature, keloids may constitute a severe aesthetic and, in some cases, functional problem
with important repercussions on patients’ quality of life. There is no consensus on keloid treatment and no wholly
satisfactory therapy has yet emerged.
Objective: To assess the efficacy of cryotherapy in the treatment of keloids.
Methods: 135 patients with 166 keloids received cryosurgical treatment between 1990 and 2004. Freeze times and number
of sessions varied. Scar volume was measured before and after treatment. Median follow-up was 48.6 months (range 12.4-72.6
Results: Of the 166 lesions treated, 79.5% responded very well with a volume reduction of the initial mass of greater than
80% after a median of 3 treatments (range: 1-9). A good result was obtained in 14.5% of lesions, while results were unsatisfactory
in 6% of cases. The main adverse effects reported were atrophic depressed scars and residual hypopigmentation
(75% of cases). No recurrences arose during the follow-up period (12-72 months).
Conclusions: To date, cryotherapy appears to be the most effective, safe, economic, and easy-to-perform monotherapy to treat
keloid lesions and hypertrophic scars.
Joel L. Cohen MD, Steven H. Dayan MD FACS
Objective: To compare the efficacy and safety of 2 doses of botulinum toxin type A in the treatment of dermatochalasis.
Methods: Forty patients with mild to moderate dermatochalasis were randomly assigned to receive 1 of 2 doses of botulinum
toxin type A in the lateral infrabrow—4 U/brow or 6 U/brow—and followed up for 20 weeks.
Results: Investigator assessment showed the proportion of responders (?1 grade improvement in severity of dermatochalasis
on a scale of none, mild, moderate, or severe) at week 2 was 32% with 4 U and 47% with 6 U. Compared with the lower
dose group, the higher dose group also reported a greater degree of improvement, significantly higher ratings for feelings of
attractiveness and feelings of satisfaction with appearance, and a higher incidence of satisfaction.
Conclusion: Single-site injection of botulinum toxin type A in the lateral infrabrow can offer effective treatment for mild to
moderate upper eyelid dermatochalasis.
Elaine Shnitkind MD, Yaping E PhD, Susan Geen, Alan R. Shalita MD, Wei-Li Lee PhD
Background: Narrow-band blue light (420 nm) has demonstrated safety and efficacy in the treatment of acne vulgaris. It
works by exhibiting a phototoxic effect on the heme metabolism of Propionibacterium acnes. Previous studies using blue light
showed more improvement in inflammatory lesions than in comedones, as well as some improvement on the untreated side.
Cytokines have demonstrated a critical role in the development of inflammation. The expression of pro-inflammatory
cytokines such as IL-1? have been shown to result in the expression of vascular and dermal adhesion molecules, the chemoattraction
of inflammatory cells, and the stimulation of other inflammatory mediators. In addition, UVB radiation serves as a
potent modulator of cell-mediated immune responses.
Purpose: This study investigated the effect of narrow-band blue light on the inflammatory process in the presence and
absence of cytokines and UVB using IL-1? and ICAM-1 as markers for inflammation.
Methods: Two immortalized keratinocyte cell lines were compared: HaCaT, produced by spontaneous immortalization of a
genetically altered cell line, and hTERT, obtained by stable transfection of primary cell culture with human telomerase
reverse transcriptase. Cells were treated with INF-? and TNF-? and exposed to UVB (312 nm at 50 mJ/cm2) and/or blue light
(420 nm at 54 mJ/cm2 and 134 mJ/cm2). The expression of IL-1? and ICAM-1 was measured by quantitative ELISA.
Results: The results showed that blue light and low-dose UVB treatment of HaCaT and hTERT cells resulted in inhibition
of cytokine-induced production of IL-1?. The level of IL-1? decreased by 82% in HaCaT and by 75% in hTERT cells when
exposed to blue light. It decreased by 95% in HaCaT and by 91% in hTERT cells when blue light was used in combination
with UVB. ICAM-1 expression was similarly reduced in HaCaT, but not in hTERT cells.
Conclusions: This study showed that narrow-band blue light has anti-inflammatory effects on keratinocytes by decreasing
the cytokine-induced production of IL-1? and ICAM-1. In addition, blue light demonstrated synergistic effects with lowdose
UVB light. These results expand the properties of narrow-band blue light in modulating the inflammatory process and
will facilitate testing of its phototherapeutic applications in different inflammatory skin conditions.
Marcia Ramos-e-Silva MD PhD, Adriana Fernandes Ferreira DDS, Roberta Bibas MD, Sueli Carneiro MD PhD
Recurrent aphthous stomatitis is a difficult to treat and quite common chronic inflammatory disease of the oral mucosa. This
study evaluates the fluid extract from Chamomilla recutita’s safety and effectiveness in pain relief from aphthous stomatitis and
other painful ulcers of the oral mucous membrane. The analgesic effect was considered excellent by 82% and good
by 18% of the patients, as demonstrated with the Analogical Visual Scale for chronic and experimental pains after 5, 10,
and 15 minutes. Tolerance was evaluated as excellent by 97% and good by 1% of the subjects. The fluid extract from
Chamomilla recutita, due to its analgesic effect, may give these patients a better quality of life.
The use of topical anesthesia for pain control for dermatologic procedures is widespread. In addition to clinical
procedures, such as skin biopsies, lesion removal, and electrocautery, topical anesthesia is used for pain control in a
variety of cutaneous cosmetic procedures including laser procedures and injection of filler substances and/or botulism
toxin. While the use of topical anesthesia is generally regarded as safe and effective, recent concern about lidocaine
toxicity from the use of compounded mixtures of lidocaine for cosmetic procedures has been reported. This study
evaluated the potential absorption and clinical toxicity of either 30 or 60 grams of occluded topical liposomal lidocaine
(LMX4) in 8 healthy volunteers. Blood was drawn to evaluate levels of lidocaine and monoethylglycinexylidide
(MEGX) metabolites prior to application of the occluded cream at 1 hour, 2 hours, 6 hours, and 24 hours post-application.
Additionally, the volunteers were assessed for any clinical signs of lidocaine toxicity. All blood samples showed
less than 0.5 mcg/mL of serum lidocaine and MEGX metabolite. Patients reported no systemic effects and did not show
any clinical signs of lidocaine toxicity. Conclusions were that moderate amounts (30 and 60 grams—amounts used in
a variety of cosmetic procedures) of occluded 4% lidocaine cream were safe; the test subjects showed no evidence of
clinical toxicity and blood levels showed no evidence of significant lidocaine or lidocaine metabolites.
John Y. M. Koo MD, Jerry Bagel MD, Marianne T. Sweetser MD PhD, Barry S. Ticho MD PhD
Combination therapy for moderate to severe psoriasis is often used to enhance efficacy and minimize treatment-related side
effects; however, data are limited on combination therapy with the newer biologic agents. The current study examined
patients who received alefacept in combination with ultraviolet B phototherapy as part of an international, open-label study
evaluating up to 3 courses of alefacept in combination with other psoriasis therapies. Physician Global Assessment (PGA)
scores improved by 2 or more categories in 76% of patients and by 1 or more categories in 88% of patients in course A.
Corresponding response rates were 100% and 55% in course B, and 85% and 77% in course C. At week 14, a PGA of “almost
clear” or “clear” was achieved by 13%, 14%, and 8% of patients in courses A, B, and C, respectively. There was no evidence
of a cumulative effect on T cells after multiple courses of therapy. The combination of alefacept and ultraviolet B was well
tolerated and provided improvement in psoriasis.
Emmy M. Fernandez MD, Christine L. Mackley MD
The continuing quest for the ideal dermal filler has led to an abundance of injectable agents. The ideal filler should be easy
to manufacture, store, and administer. It should also be inexpensive, nontoxic, nonallergenic, natural appearing, and long
lasting. There is not yet a filler that fulfills all of these criteria; each product has its own advantages and disadvantages. This
review will examine the diverse array of fillers to date.
Daniëlle I. Kuijpers MD, Monique R. Thissen PhD, Carleine A. Thissen MD, Martino H. Neumann MD PhD
We report a case of a 34-year-old woman who received cefuroxime, a second-generation cephalosporin, as treatment for
mastitis. She subsequently developed a serum sickness-like reaction (SSLR) with a generalized pruritic rash, joint pains,
and fever. She improved upon treatment with systemic steroids. SSLR is well-described to cefaclor, a second-generation
cephalosporin. However, there is a paucity of reports of SSLR to other cephalosporins such as this case.
Boni Elewski MD, Mark R. Ling MD PhD, Tania J. Phillips MD
Background: The first gel formulation of ketoconazole has been tested in 2-week treatment courses.
Objective: To evaluate the efficacy and safety of a new, once-daily, 2-week ketoconazole 2% gel treatment in moderate to
severe seborrheic dermatitis.
Methods: Four hundred fifty-nine subjects with moderate to severe seborrheic dermatitis were randomized to receive ketoconazole
2% gel or vehicle gel once daily for 14 days. The primary efficacy was the proportion of successfully treated subjects
at day 28 (cleared and almost cleared).
Results: A significantly greater percentage of subjects were successfully treated with ketoconazole 2% gel compared with
vehicle (25.3% vs. 13.9%, P = .0014). Ketoconazole 2% gel improved erythema, scaling (P = .0022 vs. vehicle), and pruritus.
Mean overall symptom severity was reduced by 53% and 39% with ketoconazole gel and vehicle, respectively. Adverse
events were few, generally mild or moderate, and similar between treatment groups.
Conclusion: Once-daily ketoconazole 2% gel is an effective, well-tolerated, convenient, and cosmetically acceptable treatment
for moderate to severe seborrheic dermatitis.