Joseph Bikowski MD FAAD
Clinicians must evaluate a voluminous amount of information from clinical trials when choosing among the growing number
of topical acne treatments. This article describes a simple way to evaluate and broadly compare the efficacy results of
well-controlled phase III clinical trials of topical acne treatments by taking into account the placebo effect (or active control
effect). Key efficacy results are drawn from the package inserts of 7 primary topical acne treatments. To account for
placebo effect, the mean percent reduction with placebo was subtracted from that of the active treatment for each type of
lesion and also calculated as an average of these differences for all lesions. Based upon the principles of research, this method
accounts for within study variances and offers a quick assessment of product efficacy. Clinicians should be cautioned that
this method only allows for broad comparisons and does not establish definitive differences between treatments.
Justin Vujevich MD, Leonard Goldberg MD, Suzan Obagi MD
Background: Partially or completely spilt earlobes are a common reason for patient presentation to the cosmetic surgeon.
Methods: In this article, we review the different techniques of repairing both partial and complete cleft earlobes.
Results:We review and illustrate 4 methods to repair a partial cleft earlobe and 17 methods to correct a complete cleft
earlobe. In addition, preoperative, intraoperative, and follow-up photographs are shown on several examples.
Conclusions: Earlobe clefts may be repaired by various techniques. While advantages and disadvantages exist for each
method, the surgeon should be familiar with categorizing the cleft, choosing a repair, and deciding whether to repierce
the earlobe intra- or postoperatively
Abbas Zamanian MD, Mehdi Farshchian MD
Background: Immunosuppressive therapy is believed to be one of the most important risk factors in the development of
skin cancer in renal transplant recipients.
Objective: Our purpose was to determine the types of neoplastic skin lesions encountered in Iranian renal transplant recipients
and their associations with immunosuppressive regimens.
Methods: The entire bodies of renal transplant recipients attending an outpatient transplantation department were
Results: Neoplastic skin lesions were diagnosed in 13.1% of the renal transplant recipients. Actinic keratoses, squamous
cell carcinomas, and basal cell carcinomas were the most common neoplastic skin lesions observed. Transplant recipients
exposed to immunosuppressive therapy for more than 5 years have a significantly higher risk of developing skin cancers
than recipients with less than 5 years of immunosuppressive therapy.
Conclusions: Our study confirmed the relatively high prevalence of neoplastic skin lesions among renal transplant recipients in the Iranian population
Lady C. Dy MD, Larry J. Buckel MD, Robert M. Hurwitz MD
Since many studies have shown the discordant diagnoses of melanocytic lesions among pathologists despite the existence
of an established histologic criteria, we sought to refine the histologic criteria by finding an additional reliable and reproducible
objective histopathologic feature to aid in the diagnosis of melanoma in situ. We performed a retrospective
analysis of 100 cases histologically diagnosed as melanoma in situ and compared them to a study control group consisting
of junctional benign melanocytic nevi. The epidermis of all the melanocytic lesions was examined for epidermal effacement.
Examination of the epidermis in the study group revealed an absence of epidermal effacement in only 7 (10%)
cases, whereas 93 (93%) cases showed an absence of rete ridges in some foci, making this an overwhelming majority finding
in the cases examined. These results serve as a compelling adjunctive finding that can be used to increase the histologic
diagnostic accuracy of melanoma in situ.
Christopher Nelson MD, James Spencer MD, Christopher Nelson Jr MD
Objectives and Methods: This study is an evaluation of patients diagnosed with actinic keratosis (AK) lesions of the upper
and lower lip (both cutaneous and mucosal surfaces), with at least one lesion on the vermilion (mucosal) lip. Patients
were treated twice daily with a topical application of diclofenac sodium 3% gel (Solaraze® Gel, Doak Dermatologics) for
a period of 90 days with a follow-up assessment at 30 days post-treatment. The presence or absence of target and new lesions
was assessed and quantified at the initial baseline visit and at each follow-up visit. An investigator global improvement
index score assessment and an evaluation of tolerability was also performed at each follow-up visit.
Conclusion: The application of diclofenac sodium 3% gel provides an effective approach for the treatment of AK of the
lip. The cure rate reported in this study for AK of the lip was similar to that of diclofenac sodium 3% gel for AK on skin
elsewhere on the body, and has a low incidence of irritation and other adverse reactions, as well as a high rate of patient
satisfaction. The unique safety and tolerability profile of diclofenac sodium 3% gel would appear to lend itself well to treatment
of the mucosal lip and vermilion, particularly when treatment decisions involve cosmetic appearance during and
subsequent to therapy.
Leon Kircik MD, James Del Rosso DO FAOCD
Atopic dermatitis (AD) is a chronic cyclical inflammatory skin disease that is increasing in incidence. Twenty percent
of those affected with AD are infants and young children. Despite the development of newer nonsteroidal topical therapies,
such as calcineurin inhibitors, topical corticosteroids remain the gold standard for the treatment of active eczematous
disease and management of exacerbation due to established efficacy and safety with appropriate use. The xerotic,
sensitive skin of AD patients mandates the use of nonirritating and nondrying topical vehicles. Recently, phase III clinical
studies have demonstrated the safety and efficacy of a novel aqueous hydrogel vehicle for desonide delivery in mild
to moderate AD, which is free of fragrances and surfactants. Corneometry and transepidermal water loss studies have
demonstrated that this patented hydrogel vehicle alone offers advantages including moisturization and skin barrier enhancement,
both of which are significant when treating eczematous and xerotic skin. Patient and physician preference
surveys suggest that the novel properties of this vehicle may aid in patient compliance with AD therapy
Mary L. Lupo MD, Joel L. Cohen MD, Marta I. Rendon MD
Evidence of the signs associated with skin aging often first appears in the periorbital area and includes wrinkles, eyelid
bags, circles around the eye, or a “tired” look. This multicenter study aimed to investigate a novel eye cream containing
a proprietary mixture of human growth factors and cytokines in combination with caffeine, bisabolol, glycyrrhetinic acid,
and sodium hyaluronate for periorbital rejuvenation. The study, which was completed by 37 female subjects between 36
to 65 years of age, revealed that clinical signs for wrinkles, lower eyelid bags or sagging, dark circles, and skin texture show
significant improvement (average 14%-28%) after 6 weeks of twice-daily application. These clinical improvements were
confirmed by a subject questionnaire. The subjects further reported that their tired look significantly improved by 32%
in average. All subjects tolerated the eye cream well and liked the way it felt. The cream’s efficacy, excellent tolerability
in the delicate periorbital skin area, and pleasant sensory properties explain why a large majority (78%) would continue