ABSTRACT: Keloids are fibrous growths that occur as a result of abnormal response to dermal injury. Keloids are cosmetically disfiguring and may impair function, often resulting in decreased patient quality-of-life. Treatment of keloids remains challenging, and rate of recurrence is high. We present a case of a 39-year-old African-American man (Fitzpatrick VI) with a 10-year history of keloid, who was successfully treated with eight sessions of fractionated carbon dioxide (CO2) laser immediately followed by laser-assisted drug delivery (LADD) of topical triamcinolone acetonide (TAC) ointment and review the medical literature on fractionated CO2 laser treatment of keloids. To the best of our knowledge, this is the first report of successful treatment of a keloid using combination therapy of fractionated CO2 laser and LADD with topical TAC ointment in an African-American man (Fitzpatrick VI) with excellent cosmetic results sustained at 22 months post-treatment. We believe that this combination treatment modality may be safe and efficacious for keloids in skin of color (Fitzpatrick IV-VI) and other patients. This case highlights the ability of laser surgeons to safely use fractionated CO2 lasers in patients of all skin colors.
J Drugs Dermatol. 2017;16(9):925-927. more
ABSTRACT: Onabotulinumtoxin A (Botox) can be a safe and successful off-label treatment of vertical platysma bands of various severities. Due to risk of the botulinum toxin diffusing to the underlying anatomic structures such as the deglutition muscles, the larynx, and the neck flexors, a maximal dose of 100 units has been suggested and there have been no known reports of untoward effects with doses less than 60 units. We present a case of mild to moderate dysphagia in a patient after very low doses of Abobutulinumtoxin (60 units, equivalent to 20 units of Onabotulinumtoxin using a 3:1 conversion ratio). We speculate that the adverse effects noted may be due to several possibilities, such as diffusion, injection technique, or intravascular injection. Thus, although botulinum toxin-A is generally considered a safe off-label treatment for vertical platysma bands, readers should still be aware of the possible side-effects even with low dose use, as supported by our case report of mild to moderate dysphagia with relatively conservative doses of Abobotulinumtoxin A.
J Drugs Dermatol. 2017;16(9):929-930. more
ABSTRACT: Traditional rejuvenation techniques include chemical peels, rhytidectomy of the skin, laser resurfacing, injection of dermal fillers and neurotoxins, and invasive surgical procedures. Patients with brow ptosis, jowl formation, and deepening nasolabial folds currently seek antiaging procedures with no incisions and minimal downtime such as thread-lifting with barbed sutures. The present report describes a case in which polydioxanone threads were used to lift the lower third of a patient’s face. Fillers were used to supplement the results achieved by the thread lift because often, when tissue has been lifted, volume deficits are revealed, which can be corrected with dermal fillers. The procedure was performed in less than 30 minutes and was well tolerated. Mild swelling at the insertion points and general treatment area resolved within 7 days without intervention. Bruising was not observed. The patient showed remarkable improvement 7 months after the procedure.
J Drugs Dermatol. 2017;16(9):932-934. more