Kristin Noiles BSc and Ronald Vender MD FRCPC
Background: The results of long-term studies on the efficacy and safety profiles of the biologics for patients with psoriasis are starting
to appear in the literature. Not only are the results promising for the biologics as a whole, but the high number of patients remaining
in these clinical trials after extended periods of time, or retention, may also reflect additional benefits of these biologics. The aim
of this review was to manuscript aims to compare rates of attrition for the various biologic therapies in pivotal clinical trials in order to
assess and compare adherence of patients to long-term use of the different biologic agents, also known as biologic survival.
Methods: An in-depth literature review was conducted using PubMed and MEDLINE. Randomized, controlled trials utilizing biologic
agents as monotherapy for the treatment of psoriasis were analyzed for patient numbers over time. Studies which provided data on
patient retention for at least 24 weeks were selected, graphed, and compared. Reasons for discontinuation were noted.
Results: Nineteen trials were selected, graphed and charted to compare attrition rates of the various biologic therapies. Due to differences
in sample size, study design, dosing regimens, study duration and limited data with regards to patient numbers, it is difficult
to reach a definitive conclusion as to which biologic agent is associated with the lowest rate of discontinuation. However, given the
data available, etanercept appears to be the most successful therapy in terms of patient retention in studies both greater than and
less than 30 weeks. For the studies using various dosing regimens, intrastudy attrition rates are also compared.
Conclusion: While the data available thus far on patient retention for the biologic therapies are very limited, preliminary conclusions
can be drawn. Among the available biologic agents, etanercept appears to be associated with the lowest rate of discontinuation. This
may be due to greater superior effiacy and to a decreased likelihood of experiencing adverse events.
Jean Carruthers MD, Steven R Cohen MD, John H. Joseph MD, Rhoda S. Narins MD, Mark Rubin MD
Our expanding understanding of the physiological and immunological conditions of the skin and, in particular, the aging face, has
prompted a growing field of aesthetic technology. Restorative procedures are taking advantage of improved and refined biotechnology,
which continues to evolve at a rapid pace. Whereas surgical correction of skin laxity was the norm in years past, there are now
many topical options available to encourage healthy, youthful skin, and an ever-growing, increasingly perfected depot of minimally
invasive, injectable dermal volumizers and stimulators, collectively referred to as dermal fillers. The growth indicators for this market
are as striking as the science. However, successful use of dermal fillers is not only a function of the quality of science leading to improved
biocompatibility but also the "art" of client selection, filler application and vigilant follow up. Even the "ideal" filler is subject
to unique interactions with both the practitioner and the patient. This article presents a review of the safety and efficacy of the most
commonly used dermal fillers with emphasis on those approved for facial aesthetics. The subtleties of improved filler technologies
that impact tissue acceptance and reaction, measures of effectiveness and a comparison of wrinkle-reduction outcomes, the nature
and incidence of acute and chronic tissue reaction, and a discussion of recommended or preferred filler applications are presented.
Background: Use of coal tar with narrowband (NB) ultraviolet B (UVB) light (the Goeckerman regimen) is an effective treatment for
plaque psoriasis that has become impractical in outpatient care mainly due to the inconvenience and aesthetic concerns of coal tar.
Objective: This study evaluated the safety, efficacy, and convenience of adding a novel LCD (coal tar) solution to standard NB-UVB
phototherapy in adults with chronic plaque psoriasis.
Methods: Patients applied LCD solution to half-body twice daily at home and received outpatient full-body NB-UVB light therapy
3 times a week for up to 12 weeks. A blinded investigator graded psoriasis severity of body halves and bilateral target lesions and
monitored adverse reactions. Patients rated their psoriasis symptoms and LCD solution aesthetics.
Results: NB-UVB + LCD therapy reduced the median time to clearance or minimal disease in at least 50% of the population by 3 weeks
(4 weeks with NB-UVB + LCD versus 7 weeks with NB-UVB alone). A statistically superior clinical response was observed by the end of
week 4 with NB-UVB + LCD versus NB-UVB alone (P < 0.05) for: PGA, target lesions, ESI scores, and patient-reported symptoms.
Conclusion: Incorporating an at-home regimen with a novel LCD solution into outpatient NB-UVB light therapy is safe, convenient,
effective, and can improve psoriasis more quickly than NB-UVB light therapy alone.
Mohamed L. Elsaie MD MBA,a,b Mahmoud F. Abdelhamid MD PhD,b
Lotfy T. Elsaaiee MD PhD FACTM,c and Hanaa M. Emam MD PhD b
Background: Botanical extracts and preparations have been used in different pathological conditions with success. An important group
of phytochemical phenolic compounds are the catechins found in green tea. Acne is a widely occurring inflammatory condition that is
estimated to affect 40 to 50 million Americans. Finding an effective, safe, cost-effective and well-tolerated treatment is the challenge.
Objective: To determine the efficacy of 2% green tea lotion in mild-to-moderate acne vulgaris.
Methods: Twenty patients fulfilling enrolment criteria were included. Green tea was given and applied twice daily for a period of 6
weeks. The patients were seen every 2 weeks to evaluate the lesions and any side effects. To determine efficacy on acne severity,
the authors used both total lesion count (TLC) and their devised severity index (SI). Total lesions count (TLC) was calculated as papules
+ pustules while SI was scaled with numbers (1, 2 or 3) correlating to TLC in order of increasing intensity. TLC < 10 was given
an SI of 1, TLC 10-20 was given an SI of 2 and TLC > 20 was given an SI of 3.
Results: The mean total lesion count (TLC) decreased from 24 before the treatment to 10 after 6 weeks after treatment, a reduction
of 58.33%. The difference was statistically significant (P < 0.0001, 95% confidence interval [CI] of the difference = 8.58 – 19.42).
The mean severity index (SI) decreased from 2.05 before treatment to 1.25 after 6 weeks treatment, a decrease of 39.02%. The difference
was statistically significant (P < 0.0001, confidence interval [CI] of the difference = 0.54-1.26).
Conclusion: Topical 2% green tea lotion is an effective, cost-effective treatment for mild-to-moderate acne vulgaris.
Babar Rao MD and Adriana Lombardi MS II
Background: Many developed countries, including the United States, have made it a priority to incorporate telemedicine into their
healthcare systems. Worldwide, this concept has been adopted by countries in effort to provide better healthcare for those in rural
areas where hospitals may be at a distance and specialists may be even farther. Previous studies and reports have shown that the
use of telemedicine, especially tele-dermatology, has proven to be an inexpensive method for providing care to those whose countries
face financial, social, and environmental barriers to adequate healthcare.
Objective: To assess the current status of, and address the potential for, improving healthcare by using telemedicine with emphasis
on tele-dermatology in developed and developing countries.
Methods: Current literature on telemedicine/tele-dermatology was reviewed and its efficiency critiqued in an attempt to improve
dermatological care in developing areas.
Conclusion: The U.S., while significantly incorporating telemedicine on a national basis, faces various issues from state to state
regarding reimbursement and other legality concerns. Although current efforts using telemedicine have demonstrated positive
effects in countries in need, they have not substantially reduced or compensated for a fundamental lack of healthcare. Countries
with inadequate healthcare must incorporate telemedicine into their healthcare system through volunteer efforts of doctors in
Anetta E. Reszko MD PhD, Cynthia M. Magro MD,Theodore Diktaban MD, Neil S. Sadick MD
Background: Body contouring with liposuction including laser liposuction is one of the most commonly performed cosmetic procedures.
Laser lipolysis is generally well tolerated with high patient satisfaction rates. Laser lipoplasty has been postulated to offer
the unique advantage of skin tightening following removal of subcutaneous fat. The search continues for an optimal wavelength
that would allow for: (1) efficient targeting of adipocytes while targeting dermal collagen and collagen bound water to allow for
dermal remodeling and (2) targeting hemoglobin and vessel wall collagen to decrease intra-operative bleeding and consequent
Objective: The main objective of this study was to determine the effects of 1064 nm and 1320 nm Nd:YAG lipolysis on fresh ex vivo
human abdominal fat pads.
Materials & Methods: Ipsilateral 1064 nm Nd:YAG lipolysis and contralateral 1320 nm Nd:YAG lipolysis were performed on ex vivo
human abdominal fat pads from comparable topographic areas of the body of the same patient. Biopsy specimens were assessed
for alterations of the epidermis, papillary and reticular dermis and subcutaneous fat.
Conclusion: Our histological analysis demonstrated a wavelength dependent differential dermal response. Increasing fluence led to
progressively more extensive dermal coagulation with associated epidermal thermal injury with 1320 nm Nd:YAG leading to more
extensive collagen coagulation as compared to 1064 nm Nd:YAG.
James Leyden MDa, Mitchell Wortzman PhDb, Edward K. Baldwin PhDc
Background: Newer agents and formulations seek to improve the tolerability of topical retinoid therapy. Recently, a gel containing
crystalline clindamycin 1.2% and tretinoin 0.025% (CLIN/RA) was approved by the U.S. Food and Drug Administration (FDA) for the
treatment of treating mild-to-moderate acne.
Objective: This single-center, randomized, evaluator-blind phase 1 study compared the tolerability of CLIN/RA to 0.1% tretinoin gel
or 0.1% adapalene gel.
Results: Forty-five patients applied CLIN/RA once daily to one side of their face every day for 21 days. Patients were randomized to
either tretinoin 0.1% (n=23) or adapalene 0.1% (n=22) on the contralateral side. A clinical evaluator assessed degree of erythema and
scaling; patients provided subjective evaluations of burning, stinging, and itching.
Conclusion: CLIN/RA was significantly better tolerated than was 0.1% tretinoin gel, as evidenced by significantly reduced erythema
(P<0.04), scaling (P<0.03), itching (P<0.02), burning (P<0.03) and stinging (P<0.04). A trend for greater erythema, scaling, and subjective
discomfort for 0.1% adapalene gel compared to CLIN/RA was also evident.