Emily P. Tierney MD, Ronald L. Moy MD, David J. Kouba MD PhD
Background: While a variety of epidermal wound closure techniques are utilized, there are few evidence based studies comparing
techniques in head-to-head studies.
Objective: To compare the aesthetic outcomes and wound healing properties of 2 epidermal closure mechanisms: 2-octylethylcy-
anoacrylate adhesive and rapid absorbing gut suture in skin closures.
Methods: A total of 8 patients were enrolled in this randomized right-left comparative trial. Patients were randomized for epidermal
closure with one half of their wounds (chest [n=6] and upper extremities [n=2]) with tissue adhesive and the contralateral with rapid
absorbing gut suture.
Results: Three months following wound closure, overall cosmetic outcome was slightly greater on the half closed with rapid absorb-
ing gut suture (mean=3.56) relative to the tissue adhesive (mean=3.19, P=.05). For dyspigmentation, the half of the scar treated with
the suture had a better outcome (mean=3.50) relative to tissue adhesive (mean=2.75) (P<.05). All other variables (ie, scar thickness,
wound approximation, patient outcome, and preference) were highly equivalent.
Conclusion: Both rapid absorbing gut suture and tissue adhesive appear to be highly efﬁcacious techniques for epidermal closure. It
appears that tissue adhesive may not be as effective in achieving optimal cosmesis for defects after Mohs micrographic surgery on
the trunk and extremities in follow-up at 3 months.
A survey of people with rosacea was conducted in 2006 to gain insight into experiences with rosacea therapies and relationships
with health care providers. The survey was completed by 2946 participants, of whom 2847 had been diagnosed with rosacea. Par-
ticipants ranged in age from 20 to 81 years (mean age 50 years). Among those diagnosed with rosacea, 80% agreed that medication
prevented their rosacea from worsening. Most respondents currently using prescription medication (82%) did not plan to discontinue
its use. Among current users of medication, 46% had switched from a prior agent, usually due to the lack of improvement. Among
respondents who previously switched therapies, 84% reported using some formulation of topical metronidazole. Of those respon-
dents who discussed rosacea with their physician, 83% agreed that their physician inﬂuences their use of medication; 61% viewed
their physician—in most cases a dermatologist—as a partner in managing their rosacea.
Joseph Bikowski MD FAAD
Seborrheic dermatitis, characterized by erythema and/or ﬂaking or scaling in areas of high sebaceous activity, affects up to 5% of
the US population and often appears in conjunction with other common skin disorders, such as rosacea and acne. Despite ongoing
research, its etiology is puzzling. Increased sebaceous and hormonal (androgenic) activity is thought to play a part. Recent evidence
suggests an important role for individual susceptibility to irritant metabolites of the skin commensal Malassezia, most probably M
globosa. Current approaches thus include agents with antifungal as well as antikeratinizing, and anti-inﬂammatory activity. Azelaic
acid, which has all 3 properties, may be a useful addition to ﬁrst-line management, which now comprises of topical steroids, the
immunosuppressant agents tacrolimus and pimecrolimus, azoles and other antifungals, and keratolytic agents. A recent exploratory
study supports the efﬁcacy and safety of azelaic acid 15% gel in seborrheic dermatitis. Azelaic acid may be especially valuable in this
application because of its efﬁcacy in treating concomitant rosacea and acne.
Amy L. Gosnell BS, Susan T. Nedorost MD
Background: Lower leg edema is a common side effect of amlodipine therapy, but is often unrecognized as a contributor to stasis
Objective: To determine whether amlodipine therapy is more common among patients with stasis dermatitis than age-matched
Methods: In this retrospective chart review study, the medication lists of all subjects with stasis dermatitis from a single practice
site over the past 2 years were compared to alphabetically consecutive charts of patients with basal cell carcinoma to determine the
relative usage of amlodipine.
Results: Patients with stasis dermatitis (n = 43) are more likely to take amlodipine than are basal cell carcinoma patients (n = 117) of
similar age (19% vs. 5%, P < .02), even when controlled for the use of any antihypertensive medications (25% vs. 10%, P = .05).
Conclusion: Amlodipine therapy is associated with stasis dermatitis and discontinuing amlodipine should be considered when stasis
dermatitis is diagnosed.
Robert H. Gotkin MD, Deborah S. Sarnoff MD, Giovanni Cannarozzo MD, Neil S. Sadick MD, Macrene Alexiades-Armenakas MD PhD
Carbon dioxide (CO
2) laser skin resurfacing has been a mainstay of facial rejuvenation since its introduction in the mid 1990s. Re-
cently, a new generation of fractional or microablative CO
2 lasers has been introduced to the marketplace. According to the concept
of fractional photothermolysis, these lasers ablate only a fraction of the epidermal and dermal architecture in the treatment area. An
array of microscopic thermal wounds is created that ablates the epidermis and dermis within very tiny zones; adjacent to these areas,
the epidermis and dermis are spared. This microablative process of laser skin resurfacing has proven safe and effective not only for
facial rejuvenation, but elsewhere on the body as well. It is capable of improving wrinkles, acne scars, and other types of atrophic
scars and benign pigmented lesions associated with elastotic, sun-damaged skin. Because of the areas of spared epidermis and
dermis inherent in a procedure that employs fractional photothermolysis, healing is more rapid compared to fully ablative CO
skin resurfacing and downtime is proportionately reduced.
A series of 32 consecutive patients underwent a single laser resurfacing procedure with the a new microablative CO
2 laser. All
patients were followed for a minimum of 6 months and were asked to complete patient satisfaction questionnaires; a 6 month post-
operative photographic evaluation by an independent physician, not involved in the treatment, was also performed. Both sets of data
were graded and reported on a quartile scale. Results demonstrated greater than 50% improvement in almost all patients with those
undergoing treatment for wrinkles, epidermal pigment or solar elastosis deriving the greatest change for the better (>75%).
Jeffrey M. Sobell MD, Robert E. Kalb MD, Jeffrey M. Weinberg MD
Psoriasis is an immunologic disorder mediated by T cells and proinﬂammatory cytokines. Novel biologic therapies, targeted at key
pathogenic steps, have been developed and provide efﬁcacy without the potential end-organ toxicity induced by traditional therapies.
The biologic therapies currently approved for treatment of psoriasis are classiﬁed into 2 categories, as deﬁned by their mechanism of
action: inhibition of tumor necrosis factor (TNF) (etanercept, inﬂiximab, adalimumab) and modulation of pathogenic activated T cells
(alefacept, efalizumab). This review has been prepared in 2 parts: Part 1 focuses on anti-TNF agents and includes new data that have
become available through increased clinical experience and use in eligible patients. Part 2 will present new data on T-cell modulators,
new molecules in development, and considerations for optimal therapeutic selection for treatment of patients with psoriasis (Journal
of Drugs in Dermatology, March 2009).