Search Results for "Disorders of the Hair and Nails"
Ife J. Rodney MD, Oge C. Onwudiwe MD, Valerie D. Callender MD, and Rebat M. Halder MD| |
J Drugs Dermatol. 2013;12(4):420-427.
Scoping Scalp Disorders: Practical Use of a Novel Dermatoscope to Diagnose Hair and Scalp Conditions
Nicole E. Rogers MD| |
OBJECTIVE: This paper will show how the Canfield DermScope can quickly and easily identify various nonscarring and scarring scalp disorders. Its open design does not change the direction of affected hairs or blanch certain features such as erythema. Features like perifollicular hyperkeratosis and loss of follicular orifices are still easily visible.
METHODS and MATERIALS: The author prospectively photographed patients with hair and scalp disorders in private practice between 2011 to 2012 using the handheld Canfield DermScope device.
RESULTS: The presence of scale, erythema, tufting, miniaturized or broken hairs, and loss of follicular orifices were quickly identified to make a diagnosis.
CONCLUSION: The diagnosis of hair and scalp disorders can be greatly facilitated by the use of the DermScope device.
J Drugs Dermatol. 2013;12(3):283-290.
Leon H. Kircik MD| |
While there are a number of products that can help healthy hair look healthier, shampoos or vitamins alone can’t truly regrow thinning hair. As dermatology providers, we realize this not only because we know the science, but because we see patients in the clinic every day who ask us how they can help to reverse hair loss and improve the quality of their hair.
New Insight Into the Pathophysiology of Hair Loss Trigger a Paradigm Shift in the Treatment Approach
Neil S. Sadick MD,a Valerie D. Callender MD,b Leon H. Kircik MD,c,d,e,f,g Sophia Kogan MDh| |
Hair loss affects millions of men and women of all ages and ethnicities, impacting appearance, social interactions, and psycho-emotional well-being. Although a number of options are available, they are limited, carry a potential risk of side effects, and none have proven to be comprehensive for treatment of hair loss. Across the spectrum of hair loss disorders, there has long been a segmentation into distinct mechanisms, driving the main trend in current therapeutics to focus on targeting single molecules or pathways. However, research points to similar dysregulation of intrinsic signaling pathways within follicle physiology that span the hair loss disorder spectrum – with a common inflammatory component identified in most hair loss pathogenesis, including that of androgenetic alopecia (AGA).
J Drugs Dermatol. 2017;16(11 Suppl):s135-140.
Erling Thom PhD| |
Amongst various treatment methods and substances, oral supplementation with a specific bioavailable proteoglycan stands out as a promising new therapeutic treatment method.
J Drugs Dermatol. 2016;15(8):1001-1004.
Jennifer V. Nguyen MD| |
J Drugs Dermatol. 2014;13(suppl 1):s12-s16.
M.E. Balañá; C. Alvarez Roger; A. V. Dugour and N. A. Kerner| |
Fiona P. Blanco MD, Richard K. Scher MD FACP| |
New Insight Into the Multifactorial Pathophysiology of Hair Loss: Inflammation, Stress, and Follicle Biology Take Front Stage
Kircik, et al.| |
As our understanding of the microenvironment of the hair follicle deepens, it is becoming increasingly clear that targeting a single pathway in this complex system is not ideal. Androgens, cortisol, and corticotropin-releasing hormone, all of which are not in balance in hair loss due to internal and external stress, and gene expression of pro-inflammatory mediators all affect the hair follicle to suppress “normal” function and negatively influence hair growth.
Excess Salt and Pepper Hair Treated with a Combination of Laser Hair Removal and Topical Eflornithine HCl
Laura K. Ganger MD, Iltefat H. Hamzavi MD| |
Joshua A. Zeichner MD| |
J Drugs Dermatol. 2015;14(suppl 10):s32-s34.
Gina R. Chacon MD, David J. Wolfson MD, Carlos Palacio MD, Animesh A. Sinha MD PhD| |
Marco Toscani MD, Giuseppe Curinga MD, Emilio Trignano MD, Giovanni Bistoni MD, Antonio Rusciani MD PhDc| |
Jennie T. Clarke MD, Harper Price MD, Shari Clarke MD, Rosalyn George MD, Jeffrey J. Miller MD| |
In Vitro Nail Penetration of Tavaborole Topical Solution, 5%, Through Nail Polish on Ex Vivo Human Fingernails
Tracey Vlahovic DPM,a Tejal Merchant MPharm,b Sanjay Chanda PhD,b Lee T. Zane MD,b and Dina Coronado BSb| |
OBJECTIVE: To evaluate the in vitro nail penetration properties of tavaborole topical solution, 5%, through nail polish using ex vivo, non-diseased human fingernails.
METHODS: In study 1, tavaborole penetration was evaluated over 20 days of dosing using the Franz finite dose technique and modified Franz diffusion cells. Nails received either 1 coat of over-the-counter (OTC) typical polish or were left unpolished (controls). In study 2, tavaborole penetration was measured over 14 days of dosing using the finite dose technique and vertical diffusion cells. Nails were polished with either 4 coats or 1 coat of salon typical polish or with 2 coats or 1 coat of OTC typical polish, or they were left unpolished.
RESULTS: In study 1, the mean ± standard deviation (SD) cumulative tavaborole penetration at day 21 was numerically higher, though not statistically significant, through polished nails (3,526 ± 1,433 μg/cm2) vs unpolished nails (2,661 ± 1,319 μg/cm2). In study 2, the mean cumulative tavaborole penetration was also numerically higher (statistical significance not assessed) through all nails that received polish vs unpolished nails. At day 15, mean ± SD cumulative tavaborole nail penetration was 1,179 ± 554 μg/cm2 through 4 coats of salon typical polish, 1,227 ± 974 μg/cm2 through 1 coat of salon typical polish, 1,493 ± 1,322 μg/cm2 through 2 coats of OTC typical polish, 1,428 ± 841 μg/cm2 through 1 coat of OTC typical polish, and 566 ± 318 μg/cm2 through unpolished nails.
CONCLUSION: Results from these in vitro studies demonstrated that tavaborole penetrated through human nails with up to 4 layers of nail polish.
J Drugs Dermatol. 2015;14(7):675-678.
Gabriella DiMarco MDa and Amy McMichael MDb| |
INTRODUCTION: Hair loss is a common complaint seen in dermatology clinics. From frustration and attempts at self-help, patients with hair loss may present to the dermatologist with false beliefs, or myths, about the causes of their condition and what treatments are effective.
METHODS: We identified 12 common myths about hair loss, categorized as myths about minoxidil treatment, vitamin and mineral supplements, natural topical treatments, and hair care practices. We performed a PubMed search to find evidence to support or refute each myth.
RESULTS: We found that there is little evidence to support many of these common hair loss myths. In some cases, randomized controlled trials have investigated the effects of particular therapies and point to the effectiveness of certain hair loss treatments.
DISCUSSION: In many cases, there have not been sufficient randomized controlled trials to evaluate the effect of different therapies and hair care practices on hair loss. It is best to guide patients toward treatments with a long track record of efficacy and away from those where little is known scientifically.
J Drugs Dermatol. 2017;16(7):690-694.
The Safety and Efficacy of a Sustainable Marine Extract for the Treatment of Thinning Hair: A Summary of New Clinical Research and Results from a Panel Discussion on the Problem of Thinning Hair and Current Treatments
Identifying the causes of alopecia and thinning hair has proven especially complex in women. Current treatment options include topical formulations, prescription medications, oral supplements, and costly hair transplants; but they all have drawbacks, such that a novel therapy is needed.
This supplement presents a summary of clinical studies that have demonstrated the welcome safety and efficacy of the nutraceutical Viviscal® (Lifes2good, Inc., Chicago, IL), which contains a proprietary blend of proteins, lipids, and glycosaminoglycans of marine origin that provide essential nutrients for stimulating existing hair growth and reducing hair shedding. The summary is followed by a lively panel discussion on hair loss and current therapies amongst experts in dermatology and plastic surgery: Vivian Bucay MD (San Antonio, TX), Wendy Roberts MD (Palm Springs, CA), Heidi Waldorf MD (New York, NY), and Steven Dayan MD (Chicago, IL).
Terrence Keaney MD| |
J Drugs Dermatol. 2015;14(9):1036-1040.
Douglas N. Robins MD| |
Lidia Rudnicka MD PhD, Malgorzata Olszekska, Adriana Rakowska, Elzbieta Kowalska-Oledzka, Monika Slowinska| |
Eric S. Schweiger MD, Olga Boychenko DO, Robert M. Bernstein MD| |
Evaluation of the Appearance of Nail Polish Following Daily Treatment of Ex Vivo Human Fingernails With Topical Solutions of Tavaborole or Efinaconazole
Tracey C. Vlahovic DPM,a Dina Coronado BS,b Sanjay Chanda PhD,b Tejal Merchant MPharm,b and Lee T. Zane MDb| |
METHODS: Twelve ex vivo human cadaver fingernails were cleaned, polished with two coats of L’Oréal® Nail Color, Devil Wears Red #420, and mounted on floral foam. Nails were treated with tavaborole or efinaconazole solutions once daily for 7 days. Dropper and brush applicators were applied to white watercolor paper immediately after dosing to evaluate color transfer from polished nails. On day 7, remaining solutions were transferred to clear glass vials to evaluate color transfer from applicators to solutions. Nails, applicators, and papers were photographed daily following application; remaining solutions were photographed after 7 days of dosing.
RESULTS: Tavaborole-treated polished nails showed no polish discoloration, and tavaborole applicators did not change in appearance during treatment. No color transfer from polished nails was evident to applicator, paper, or remaining solution. Efinaconazole-treated polished nails showed substantial polish changes after the first day of treatment, with polish appearance and discoloration progressively worsening over 7 days of treatment. Color transfer from nails was evident to applicator, paper, and remaining solution.
CONCLUSIONS: Daily dropper application of tavaborole to ex vivo polished nails did not alter polish appearance. Brush application of efinaconazole produced visible changes in polish appearance and color transfer to applicators, paper, and remaining solution. Tavaborole topical solution, 5% may not alter nail polish appearance; the impact of nail polish on tavaborole clinical efficacy has not been evaluated.
J Drugs Dermatol. 2016;15(1):89-94.
Noel Prevost PA-C, Joseph C. English III MD| |
Erin Courtney RN BSN and David J. Goldberg MD JD| |
The Safety and Efficacy of a Sustainable Marine Extract for the Treatment of Thinning Hair: A Summary of New Clinical Research and Results from a Panel Discussion on the Problem of Thinning Hair and Current Treatments
Carl S. Hornfeldt PhD RPha and Mark Hollandb
Panel Discussion with Vivian W. Bucay MD,c Wendy E. Roberts MD,d Heidi A. Waldorf MD,e
and Steven H. Dayan MDf
J Drugs Dermatol. 2015;14(suppl 9):s15-s22.
Asra Ali MD and John M. Martin IV MD| |
Comparison of High-fluence, Single-pass Diode Laserto Low-fluence, Multiple-pass Diode Laser for LaserHair Reduction With 18 Months of Follow Up
Martin Braun MD| |
Vasanop Vachiramon MD,a,b Trudy Brown LEI CLS CPE,a,c Amy J. McMichael MDa| |
Objectives: To determine patient satisfaction and complications with long-pulsed Nd:YAG laser assisted hair removal in dark-complexioned skin individuals from the patient's point of view.
Patients/Methods: A survey questionnaire was administered to subjects with Fitzpatrick skin type VI between the ages of 21-70 years who had been treated with long-pulsed Nd:YAG for unwanted hair. Questions were comprised of those related to satisfaction and complications from treatment with LHR. Satisfaction was recorded on a linear analogue scale (LAS=not at all satisfied; 100=extremely satisfied).
Results: Fifty patients (female 41, male 9) completed the survey. All patients were satisfied with Nd:YAG LHR treatment with the mean satisfaction score of 84.2. All patients favor LHR treatment as compared to alternative methods. The majority of patients (79.3%) who had completed six or more LHR treatments were removing their hair less frequently than before LHR treatment. Hyperpigmentation after treatment was noted in three patients (6%), which lasted for 3-10 days. No hypopigmentation, blistering, or scarring was observed. All patients completing the study would recommend LHR for patients with unwanted hair with the mean recommendation score of 91.5.
Conclusions: Nd:YAG laser-assisted hair removal gives a high rate of patient satisfaction in terms of hair reduction with minimal complication among subjects of color.
J Drugs Dermatol. 2012;11(2):191-195.
Efficacy and Safety of Minoxidil 5% Foam in Combination With a Botanical Hair Solution in Men With Androgenic Alopecia
Terrence C. Keaney MD,a Hanh Pham MA,b Erika von Grote PhD,b and Matthew H. Meckfessel PhDc| |
J Drugs Dermatol. 2016;15(4):406-412.
Hair Depigmentation During ChemotherapyWith Dasatinib, a Dual Bcr-Abl/Src FamilyTyrosine Kinase Inhibitor
Angel Sun, Russel S. Akin, Everado Cobos,Jennifer Smith MD| |
Ahmad Ghanizadeh MD| |
Case Report: This is a report of a woman with a major depressive disorder who complained of diffuse scalp hair loss during treatment with sertraline. This case is unique because before taking sertraline and after the discontinuation of sertraline, the patient had taken fluoxetine. There was no report of hair loss during the fluoxetine therapy.
Discussion: The different impacts of sertraline and fluoxetine on dopamine reuptake inhibition were identified as a possible reason for this side effect. Therefore, this rare side effect of sertraline should be noted and further studies may show that switching from one selective serotonin reuptake inhibitor to another may prevent hair loss
Efficacy and Safety of Minoxidil 2% Solution in Combination With a Botanical Hair Solution in Women With Female Pattern Hair Loss/Androgenic Alopecia
Amy McMichael MD,a Hanh Pham MA,b Erika von Grote PhD,c and Matthew H. Meckfessel PhDc| |
J Drugs Dermatol. 2016;15(4):398-404.
James M. Spencer MD| |
Topical Cyclosporine Versus Emulsion Vehicle for the Treatment of Brittle Nails: A Randomized Controlled Pilot Study
Julian Mackay-Wiggan MD MS,a Jackleen Marji MD PhD,a John G. Walt MBA,b Angela Campbell,a Carol
Coppola,a Bibhas Chakraborty PhD,c David A. Hollander MD MBA,b and Scott M. Whitcup MDb
OBJECTIVE: To assess the efficacy and safety of topical cyclosporine emulsion (CsAE) versus emulsion (vehicle) alone in the treatment of brittle nail syndrome.
RESULTS: Twenty-four patients were randomized to topical CsAE emulsion or emulsion (vehicle) for 24 weeks. Four fingernails of each patient were included; the 2 most severe brittle nails and the second most normal nail were treated with the same medication. The fourth nail, the most normal nail, remained untreated and was used to assess nail growth. The prespecified primary endpoint was change from baseline in Physician Global Assessment (PGA) score (0 to 5 scale) at each follow-up visit. Safety evaluations were conducted at each visit.
RESULTS: In the intent-to-treat population (n=12 for each treatment arm), the PGA score for treated nails improved from baseline (CsAE, 0.7 to 1.4; emulsion, 0.7 to 1.5; P<0.05 for each), with no significant between-group differences. Untreated nails did not improve in overall appearance (0.0 to 0.3 grade; P>0.05). Statistically and clinically significant improvement from baseline was reported for nail length/appearance in both CsAE and vehicle groups.
LIMITATIONS: Sample size was relatively small. The difference in PGA between treated and untreated nails was not analyzed. Baseline disease severity may have been too mild, limiting detection of efficacy.
CONCLUSIONS: Both CsAE and emulsion vehicle applied topically appeared to improve signs and symptoms of brittle nail syndrome and were well tolerated. These findings warrant corroboration in a larger population and inclusion of comparison with an inactive control and a higher concentration of CsAE, the former which may help in distinguishing the efficacy of vehicle emulsion from CsAE.
J Drugs Dermatol. 2014;13(10):1232-1239.
Adriana Rakowska MD, Monika Slowinska MD, Joanna Czuwara MD, Malgorzata Olszewska MD, Lidia Rudnicka MD| |
Topical Liposomal Rose Bengal for Photodynamic White Hair Removal: Randomized, Controlled, Double-Blind Study
Nevien Samy PhDa and Maha Fadel PhDb| |
OBJECTIVE: To investigate if repetitive sessions of photodynamic therapy (PDT) using external application of liposomal Rose bengal (RB) photosensitizer followed by intense pulsed light (IPL) exposure enables removal of gray and white hair.
MATERIALS and METHODS: Rose bengal loaded in liposomes (LRB) was constructed, prepared in hydrogel, and was studied for some pharmaceutical properties. Penetration and selective hair follicle damage in mice skin were studied. Topical gel containing LRB was used for treating fifteen adult females who were complaining of facial white terminal hair. Unwanted facial hair was treated for three sessions at intervals of 4–6 weeks using intense pulsed light (IPL). At each session, the treatment area was pre-treated with topical LRB gel, while a control group of another 15 patients applied placebo gel before IPL treatment. Evaluations included hair regrowth, which was measured 4 weeks after each treatment session and at 6 months follow-up by counting the number of terminal hair compared with baseline pretreatment values. Treatment outcomes and complications if any were also reported.
RESULTS: Average hair regrowth in the LRB group was 56% after 3 treatment cycles. After six-months follow up, average terminal hair count compared with baseline pretreatment showed 40% reduction and no recorded side effects. A significant difference (P<0.05) was seen compared with the control group; the clinical results were promising.
CONCLUSIONS: Photodynamic hair removal using rose bengal-encapsulated liposomal gel in combination with IPL treatment showed significant efficacy in the treatment of white hair compared with a control group.
J Drugs Dermatol. 2014;13(4):436-442.
The Infatuation With Biotin Supplementation: Is There Truth Behind Its Rising Popularity? A Comparative Analysis of Clinical Efficacy versus Social Popularity
Teo Soleymani MD, Kristen Lo Sicco MD, and Jerry Shapiro MD FAAD FRCPC| |
Biotin, also known as Vitamin B7 or vitamin H, is a water-soluble B vitamin that acts as an essential cofactor for several carboxylases involved in the cellular metabolism of fatty acids, amino acids, and gluconeogenesis. Although there exists an incredible amount of social media hype and market advertising touting its efficacy for the improvement of hair quantity and quality, biotin’s efficacy for hair remains largely unsubstantiated in scientific literature. We reviewed all pertinent scientific literature regarding the efficacy of biotin supplementation for hair growth and quality improvement, and we also investigated its popularity in society defined as a function of market analytics. To date, there have been no clinical trials conducted to investigate the efficacy of biotin supplementation for the treatment of alopecia of any kind, nor has there been any randomized controlled trial to study its effect on hair quality and quantity in human subjects. Because of the lack of clinical evidence, its use to improve hair quantity or quality is not routinely recommended. However, societal infatuation with biotin supplementation is not only propagated by its glamorization in popular media, its popularity is vastly disproportionate to the insufficient clinical evidence supporting it’s efficacy in hair improvement. In other words, biotin supplements are quite “in vogue”, without there being any real reason to be so.
J Drugs Dermatol. 2017;16(5):496-500.
Neil S. Sadick MD FACP FACS| |
Methods: Thirty-one subjects with Fitzpatrick skin types V and VI were consented for treatment with the system. Twenty-six subjects completed the 12-week follow-up. Safety was evaluated at each visit and efficacy was evaluated at both follow-up visits.
Results: An average hair clearance of 41.7% from 57 treatment sites was reported at the 6-week follow-up visit and a 35.5% average hair clearance was reported at the 12-week follow-up. Edema was only reported in 2 cases (7.7%) of the study population. Eleven cases of erythema were reported following treatment.
Conclusion: Treatment with the modified LHE system was safe and effective for hair removal in patients with skin types V and VI.
Hendrik Uyttendaele, MD, PhD; Adam Geyer, MD and Richard K. Scher, MD, FACP| |
Charlotte Bezzina PharmD, Emmanuelle Bondon-Guitton PharmD PhD, and Jean-Louis Montastruc MD PhD| |
J Drugs Dermatol. 2013;12(1):119-120.
Cuttlefish Ink Melanin Encapsulated in Nanolipid Bubbles and Applied Through a Micro-Needling Procedure Easily Stains White Hair Facilitating Photoepilation
Mario A. Trelles MD PhD,a,* Patricia Almudever PhD,b,* Justo M. Alcolea MD,a
Julio Cortijo PhD,b Gabriel Serrano MD,c Inmaculada Expósito MD,c Josefina Royo MD,d
and Franck Marie Leclère MD PhDe
MATERIAL AND METHODS: Twelve patients, phototypes II-III, with white or very fair hair, were treated with a compound containing melanin encapsulated in nanosomes (Melaser®) together with a fluorescent marker. Two equal 6 cm² areas were marked on each side of the occiput of the subjects. The compound was applied to a randomly selected experimental side on each patient (area A), and a saline solution applied in the same manner to the contralateral control side (area B). Penetration of the melanin into the hair follicle was assessed using optical and fluorescence microscopy. Also, condition of hair structure was checked in vivo after standard laser settings used for epilation.
RESULTS: A slight transient erythema was observed in those areas where the compound was applied with some perifollicular edema. No such effects were noticed in those areas where saline solution was applied. No persistent complications such as scarring, hypo- or hyperpigmentation were observed in any of the experimental or control areas. Under fluorescence microscopy, the hair structures in the areas to which the compound had been applied showed a clear melanin deposit confirmed by the immunofluorescence intensity, which was highest at 2 hours after application. By optical microscopy, external melanin was deposited in hair follicles. Tests with standard settings for epilation were efficacious in damaging melanin-marked white hair.
CONCLUSION: This study strongly suggests the safety and efficacy of the application of nanosomes encapsulating melanin for the introduction of melanin into hair follicles. Changes noticed in the hair structure compromising its viability indicated potential application of this external melanin marker for white hair photoepilation.
J Drugs Dermatol. 2016;15(5):615-625.
Lauren R. Seale BS,a Ariana N. Eglini BA,b and Amy J. McMichael MDc| |
J Drugs Dermatol. 2016;15(4):414-419.
Efficacy and Safety of Once-Daily Minoxidil Foam 5% Versus Twice-Daily Minoxidil Solution 2% in Female Pattern Hair Loss: A Phase III, Randomized, Investigator-Blinded Study
Ulrike Blume-Peytavi MD,a Jerry Shapiro MD,b Andrew G. Messenger MD,c Maria K. Hordinsky MD,d Paul Zhang PhD,e Carlos Quiza MD,e Uday Doshi PhD,e and Elise A. Olsen MDf| |
OBJECTIVE: Determine noninferiority of once-daily 5% MTF versus twice-daily 2% minoxidil topical solution (MTS) based on the change from baseline in target area hair count (TAHC) at 24 weeks. METHODS: In a randomized, phase III trial, women with female pattern hair loss received once-daily 5% MTF (n=161) or twice-daily 2% MTS (n=161) for 52 weeks. Primary endpoint was change from baseline in TAHC at 24 weeks. Secondary endpoint was change from baseline in TAHC at 12 weeks. Exploratory endpoints included change in total unit area density and change in overall scalp coverage.
RESULTS: Once-daily 5% MTF increased TAHC from baseline (adjusted mean ± standard error) by 23.9 ± 2.1 hairs/cm2 at week 24. Twice-daily 2% MTS increased TAHC 24.2 ± 2.1 hairs/cm2 at week 24. The treatment difference was –0.3 hairs/cm2 (95% CI = –6.0, 5.4). Since the lower bound of the 95% CI was less than –5.0, the prespecified noninferiority goal was not met. Both treatments were well tolerated.
CONCLUSIONS: Once-daily 5% MTF and twice-daily 2% MTS induced hair regrowth in female pattern hair loss, but prespecified noninferiority criteria were not met.
ClinicalTrials.gov identifier: NCT01145625
J Drugs Dermatol. 2016;15(7):883-889.
Lawrence F. Eichenfield MD and Sheila Fallon Friedlander MD| |
Fungal infection of the nails is an increasingly recognized disease in infants and children. However, it can be difficult to distinguish clinically from other nail dystrophies. In addition, many mistakenly believe that onychomycosis does not occur in childhood. Under-recognition of this infectious disorder therefore occurs. Although many consider “nail fungus” a trivial cosmetic concern, it can lead to discomfort, risk of secondary infection, and a more significant health threat in immunocompromised or diabetic individuals. It should always be considered in the differential diagnosis of nail plate disorders in children as it is one of the more common causes.
Here we review the latest data on prevalence of the disease, reasons for its relatively low incidence compared with adults, and important predisposing factors. It is important to confirm the clinical diagnosis of onychomycosis in children, and affected individuals should be examined for concomitant tinea pedis. As familial disease often occurs, it is important to check parents and siblings as well for onychomycosis and tinea pedis.
Treatment of onychomycosis is challenging, and recurrence appears to be more common in children than in adults. Prolonged systemic antifungal therapy is commonly required. However, pediatric practitioners and parents alike hesitate when asked to treat young children with a systemic drug that requires laboratory monitoring and can have systemic toxicities. Due to their thinner, faster-growing nails, children are theoretically more likely to respond to topical monotherapy than adults, and therefore good candidates for topical antifungal therapy.
The clinical data on the use of topical antifungals in pediatric onychomycosis is scarce. We review data that exist from case reports and small clinical trials. New topical antifungals are now available that afford better nail penetration and additional delivery routes to the site of infection. Pediatric trials are now on-going, and should clarify the usefulness of these agents in children.
J Drugs Dermatol. 2017;16(2):105-109.
Eliot F. Battle Jr. MD| |
Laser hair removal, previously contraindicated in patients with ethnically dark (phototypes IV-VI) or sun-tanned skin, is now recognized as a safe and effective method of permanent hair reduction in all patients. Longer wavelengths, conservative fluences, longer pulse durations and appropriate cooling methods are necessary to minimize untoward side effects and maximize efficacy. The longer wavelength Nd:YAG laser is considered safest in treating darker skin of color. An added benefit of laser epilation is that side effects of conventional hair removal such as pseudo-folliculitis barbae and post inflammatory dyspigmentation, more commonly seen in skin of color, may also respond favorably to the laser, thus increasing the potential for patient satisfaction.
J Drugs Dermatol. 2011;10(11):1235-1239.
Ciclopirox vs Amorolfine: In Vitro Penetration Into and Permeation Through Human Healthy Nails of Commercial Nail Lacquers
Daniela Monti PhD,a Silvia Tampucci PhD,a Patrizia Chetoni PhD,a Susi Burgalassi PhD,a and Federico Mailland MDb| |
J Drugs Dermatol. 2014;13(2):143-147.
Increased Prevalence of Psychiatric Disorders and Health Care-Associated Costs Among Patients With Moderate-to-Severe Psoriasis
Methods: In a retrospective, matched case-control study, data for services from nearly 75 health care plans in the United States (U.S.) were collected from PharMetrics Patient Centric Database using International Classification of Diseases, Ninth Revision Clinical Modification codes, identifying a total of 39,855 adults with moderate-to-severe psoriasis (n=7,971) and without (controls; n=31,884). Patients with psoriasis had at least one psoriasis health care claim and received at least one medical/prescription treatment claim within two consecutive years. Psychiatric comorbidities and treatments among patients and controls were determined by claims. Annual inpatient, outpatient, emergency room, and prescription costs for those with and without psoriasis and those with and without psychiatric disorders were compared.
Results: Patients had significantly higher prevalence of anxiety (6.9% versus 4.4%), depression (9.2% versus 5.3%), bipolar disorder (1.1% versus 0.5%), or delirium (0.3% versus 0.1%; P<0.05) than controls (others P<0.0001). Significantly higher proportions of patients with psoriasis received antidepressants (6.1% versus 0.9%), anxiolytics (5.0% versus 0.8%), or antipsychotics (5.9% versus 0.9%) compared with controls (each P<0.0001). Total health care costs for patients with psoriasis (US $11, 369.47) were significantly higher than for controls ($3,427.60; P<0.001). Psoriasis patients with psychiatric disorders had significantly higher health care costs ($17,637.66) than those without psychiatric disorders ($10,362.80; P<0.001).
Conclusion: The prevalence of psychiatric disorders is higher in patients with moderate-to-severe psoriasis than in controls. Annual health care costs are higher in psoriasis patients with psychiatric disorders than in those without psychiatric disorders.
J Drugs Dermatol. 2011;10(8):843-850.
Ralph C. Daniel MD| |
J Drugs Dermatol. 2013;12(11):1263-1266.
Prospective Evaluation of the Safety and Efficacy of a 1060-nm Large Spot Size, Vacuum-Assisted Hair Removal Diode Laser System in Asian/Pacific Fitzpatrick’s Skin Types IV-V Patients
Sushil T.Tahiliani MD and Harsh S.Tahiliani MD| |
Asli Aksu Çerman MD, Sezgi Sarıkaya Solak MD, İlknur Altunay MD, and Nihal Asli Küçükünal MD| |
OBJECTIVE : The aim of the study was to evaluate the efficacy and safety of topical calcipotriol for the treatment of mild-to-moderate patchy AA.
METHOD: Forty-eight patients with mild-to-moderate AA were enrolled in the retrospective, 12-week trial. Calcipotriol cream was applied to the affected areas twice a day. Severity of Alopecia Tool (SALT) score and hair regrowth rate were calculated at baseline and at 3, 6, 9, and 12 weeks.
RESULTS: At week 12, the total response was achieved in 69.2% of patients. When the mean SALT score of patients at week 12 was compared to that of patients at baseline, the value at week 12 was significantly lower (P= 0.001). A regrowth score (RGS) ≥ 3 (hair regrowth of ≥ 50%) was observed in 75% of patients, whereas a RGS ≥ 4 (hair regrowth of ≥ 75%) was observed in 62.5% of patients and the complete regrowth rate (hair regrowth= 100%) was 27.1%.
CONCLUSION: Calcipotriol may serve as a safe and effective treatment option in mild-to-moderate patchy AA, and calls for more extensive controlled studies with this treatment.
J Drugs Dermatol. 2015;14(6):616-620.
Patricia K. Farris MD,a Nicole Rogers MD,a Amy McMichael MD,b Sophia Kogan MDc| |
Hair loss is a complicated problem that causes significant concern for those who are affected. Patients seeking medical treatment have limited options that include topical minoxidil and oral finasteride. While these treatments are backed by long term clinical use and research outcomes, many patients find topical minoxidil difficult to incorporate into their daily routine and some are concerned with the side effects associated with finasteride. In the office setting, patients may be treated with more invasive procedures such as platelet-rich plasma injections (PRP) and hair transplantation, treatments that often must be repeated and can lead to a costly investment. Consumers are increasingly interested in natural treatments for hair loss. Many turn to basic supplements only to be disappointed when they fail to deliver due to lack of standardization and efficacy. In this paper we review the benefits of a nutraceutical containing a specific blend of highly purified, standardized, bio-optimized, and bioavailable botanical extracts to treat hair loss. These phytoactives were selected because of their diverse multi-modal biologic activity against inflammation, DHT, stress mediators, oxidative damage, and intermediary signaling cascades. This supplement represents a paradigm shift as it addresses not only the factors that trigger hair loss but the downstream mediators of inflammation as well. Multi-center clinical studies are currently underway to confirm the efficacy and benefits of this unique nutraceutical.
J Drugs Dermatol. 2017;16(11 Suppl):s141-148.
Faris Azzouni MD,a Nathalie Zeitouni MD PhD,b and James Mohler MDa| |
J Drugs Dermatol. 2013;12(2):e30-e35.
Navid Bouzari MD, Keyvan Nouri MD, Hossein Tabatabai MD, Zahra Abbasi MD, Alireza Firooz MD, Yahya Dowlati MD PhD| |
Methods: A retrospective study of 313 consecutive laser-assisted hair removal treatments was conducted on a total of 23 patients (22 women, 1 man) with 58 anatomic areas by means of an alexandrite laser. Skin types of III and IV were represented. The long-pulsed alexandrite system (Aphrodite, Quanta system, Italy) was used at a 755-nm wavelength to deliver fluences ranging from 17 to 25 j/cm2 through a 10 mm spot size. The patients were divided into 4 groups according to the number of treatments (group I ? 4, group II = 5, group III = 6, and group IV ? 7 treatments). Digital photographs of the patients were used for hair counting. Adverse effects (hyperpigmentation, hypopigmentation, blister, folliculitis) were questioned. The treatment was defined as successful if there was more than 50% hair reduction and an absence of the adverse effects.
Results: There was a positive correlation between hair reduction and number of treatments (r = .402, p < .005). The following side effects were observed: hyperpigmentation (two patients, both in group IV); hypopigmentation (one patient in group IV) and blister (one patient in group IV); folliculitis (two patients in group III and IV). Treatment was successful in 48.3% (28 out of 58) of the treatment sites. The success rate was 25% for ?4 treatments, and 76%, 58%, and 15% for 5, 6, and ?7 treatments respectively (p = .002).
Conclusion: Patients who undergo more treatment sessions achieve a higher rate of hair reduction; although this may be concomitant with an increase in the incidence of adverse effects. The benefit of more laser treatments should be balanced with the risk of occurrence of side effects in each patient.
Hair Regrowth Following a Wnt- and Follistatin- Containing Treatment: Safety and Efficacy in a First-in-Man Phase 1 Clinical Trial
J Drugs Dermatol. 2011;10(11):1308-1312.
João Carlos Pereira MD,a João Carlos Pereira Filho MD,b and João Pedro Cabrera Pereira MDc| |
Rebecca G. Pomerantz BA, Ezra D. Mirvish BA, Larisa J. Geskin MD| |
A Phase III, Multicenter, Parallel-Design Clinical Trial to Compare the Efficacy and Safety of 5% Minoxidil Foam Versus Vehicle in Women With Female Pattern Hair Loss
Wilma Bergfeld MD,a Ken Washenik MD PhD,b,c Valerie Callender MD,d Paul Zhang PhD,e Carlos Quiza MD,e Uday Doshi PhD,e and Ulrike Blume-Peytavi MDf| |
OBJECTIVE: To compare the efficacy and safety of once-daily 5% MTF with vehicle foam for the treatment of FPHL.
MATERIALS AND METHODS: This was a Phase III, randomized, double-blind, vehicle-controlled, parallel-group, international multicenter trial (17 sites) in women aged at least 18 years with FPHL (grade D3 to D6 on the Savin Density Scale), treated once daily with 5% MTF or vehicle foam for 24 weeks. The co-primary efficacy endpoints were the change from baseline at week 24 in target area hair count (TAHC) and subject assessment of scalp coverage. Also evaluated were TAHC at week 12, expert panel review of hair regrowth at week 24, and change from baseline in total unit area density (TUAD, sum of hair diameters/cm2) at weeks 12 and 24.
RESULTS: A total of 404 women were enrolled. At 12 and 24 weeks, 5% MTF treatment resulted in regrowth of 10.9 hairs/cm2 and 9.1 hairs/cm2 more than vehicle foam, respectively (both P<.0001). Improved scalp coverage at week 24 was observed by both subject self-assessment (0.69-point improvement over vehicle foam; P<.0001) and expert panel review (0.36-point improvement over the vehicle foam; P<.0001). TUAD increased by 658 μm/cm2 and 644 μm/cm2 more with 5% MTF than with vehicle foam at weeks 12 and 24, respectively (both P<.0001). MTF was well tolerated. A low incidence of scalp irritation and facial hypertrichosis was observed, with no clinically significant differences between groups.
CONCLUSION: Five percent MTF once daily for 24 weeks was well tolerated and promoted hair regrowth in women with FPHL, resulting in improved scalp coverage and increased hair density compared with vehicle foam. ClinicalTrials.gov identifier: nCT01226459
J Drugs Dermatol. 2016;15(7):874-881.
Bilateral Axilla Hair Removal Comparing a Single Wavelength Alexandrite Laser With Combined Multiplexed Alexandrite and Nd:YAG Laser Treatment From a Single Laser Platform
Methods: Subjects received four laser treatments at 4-6 week intervals. One axilla was treated with the alexandrite laser alone while the contralateral axilla was treated with multiplexed pulses delivering either a 755 nm/1064 nm pulse or a 1064 nm/755 nm pulse. Efficacy was evaluated through blinded hair counts performed on digital photographs taken two and six months following the final treatment.
Results: Mean hair clearance percentages were 83%, 81%, and 86% for the alexandrite, alexandrite/YAG sequence, and YAG/alexandrite sequence, respectively. Side effects were minimal and did not differ by treatment.
Conclusion: Muliplexed 755 nm/1064 nm and 1,064 nm/755 nm pulses compared favorably with the 755 nm pulses for efficacy and side-effect profile, all being highly efficacious. Further study of the multiplexed pulses in various clinical settings, including refractory hair removal, are indicated.
J Drugs Dermatol. 2012;11(2):185-190.
Hair Removal with the 3-msec Alexandrite Laser in Patients with Skin Types IV-VI: Efficacy, Safety, and the Role of Topical Corticosteroids in Preventing Side Effects
Mohammed S. Aldraibi MD PhD, Dany J. Touma MD, Amor Khachemoune MD CWS| |
Long-term Comparison of a Large Spot Vacuum Assisted Handpiece vs the Small Spot Size Traditional Handpiece of the 800 nm Diode Laser
Nour J.Youssef MD,a Alain G.Rizk MD,a Omar A. Ibrahimi MD PhD,b,c and Zeina S.Tannous MDa,c| |
J Drugs Dermatol. 2017;16(9):893-898.
Kelley Pagliai Redbord MD, C. William Hanke MD| |
Evren Odyakmaz Demirsoy MD,a Rebiay Kıran MD,a Selma Salman MD,a Çiğdem Çağlayan MD,b
Aysun Şikar Aktürk MD,a Dilek Bayramgurler MD,a and Nilgün Bilen MDa
AIM: We aimed to evaluate the effect of systemic antipsoriatic agents on nail findings.
METHODS: Eighty-seven psoriatis patients with fingernail involvement who required systemic treatment but had not used any systemic treatment in the previous 12 weeks were included in this study. Different systemic treatment agents were given to patients, considering factors such as age, sex, and joint involvement, but not nail involvement. The control group was recruited from psoriatis patients with nail involvement who were not receiving any systemic treatment. Baseline and week 16 Nail Psoriasis Severity Index (NAPSI) and PASI were detected in all groups. At the end of the study, effects of the agents on both PASI and NAPSI were compared statistically.
RESULTS: Patients were divided into 5 groups to receive either: 1) methotrexate, 2) narrow-band ultraviolet B phototherapy, 3) biological agents, 4) acitretin, or 5) no treatment (control group). None of the conventional treatment agents caused any significant difference on NAPSI at the end of week 16 compared with control group, although PASI decreased significantly. Rate of NAPSI changes were more prominent in the biological treatment group, and a statistically significant difference was detected when compared with the control group.
J Drugs Dermatol. 2013;12(9):1039-1043.
Jonith Y. Breadon MD, Chad A. Barnes| |
J Drugs Dermatol. 2012;11(2):247-249.
J Drugs Dermatol. 2012;11(1):106-108.
David A. Sanchez BS,a,e Joshua D. Nosanchuk MD,b,c and Adam J. Friedman MDa,d,| |
J Drugs Dermatol. 2015;14(2):127-130.
Yau-Li Huang MD,a,b Shyue-Luen Chang MD,a,b Mei-Ching Lee MD,a,b
Chih-Hsiang Chang,a,b Sindy Hu MD MS,a,b and Michael H Gold MDc
OBJECTIVE: To determine if the use of a simple, objective measurement of occipital scalp laxity could reduce scar length by allowing for adjustment of donor strip harvesting during hair transplantation.
METHODS AND MATERIALS: This retrospective study included data from 39 patients who underwent hair transplantation with >2000 follicular units: 25 patients underwent measurement of occipital scalp laxity (measurement group); the other 14 did not (control group). We measured and calculated preoperative scalp parameters for hair transplantation, including follicular unit density at occipital scalp, length and width of the donor strip, and estimated total number of grafts. All patients underwent standard follicular-unit hair transplantation, at which time the actual total number of grafts was determined.
RESULTS: Mean occipital follicular unit density in the measurement group was 74.16 follicles per cm2, which did not significantly differ from the controls (73.29; t=0.410, d.f.=37, P>0.05). The mean length of the occipital surgical wound was significantly shorter in the measurement group than in the controls (19.16 vs 27.50 cm, respectively; t=10.412, d.f.=37, P<0.05). The difference between the estimated and actual total number of grafts was significant in the measurement group (2139.44 vs 2397.64, respectively; paired t=3.095, d.f.=48, P<0.05) but not in the control group (2277.71 vs 2296.71, respectively; paired t=0.175, d.f.=26, P>0.05). Accuracy in estimating the total number of grafts was poor for the measurement group, as the number of actual grafts significantly exceeded estimates.
CONCLUSION: Use of data from a simple, objective method to measure occipital scalp laxity simplified adjustment of strip harvesting, allowed for use of wider strips, and resulted in smaller donor wounds and scars from hair transplantation; however, accuracy in estimating the total number of grafts was reduced.
J Drugs Dermatol. 2014;13(10):1248-1252.
Anjana Ray PhD,a,* Breanne Mordorski BA,b,* Angelo Landriscina BA,b Jamie Rosen BA,b Joshua Nosanchuk MD,a,c and Adam Friedman MDd| |
J Drugs Dermatol. 2016;15(7):836-840.
As one of the most powerful and versatile features of the human face, the eyebrow informs the perception of beauty and plays a critical role in sexual dimorphism, facial recognition, and non-verbal communication. Eyebrow hair also serves many important biologic functions, including sensory transmission and protection from the elements, as well as playing an important role in cosmesis and expression.
New technologies to tighten and resurface the skin, to grow the hair of the eyelashes and eyebrows, to smooth-en and lighten the skin, and to replace volume lost from this area have created opportunities for rejuvenation that were not possible until recently. These include prostaglandin analogues that not only increase the length and width of the eyelashes but also improve the length and girth of eyebrow hair. Use of topical bimatoprost daily resulted in an improvement of eyelashes in 78.1% of subjects after 16 weeks. Using it in conjunction with botulinum toxins, light sources, topical cosmeceuticals, and fillers such as hyaluronic acid has vastly improved physicians' ability to treat the periorbital region.
C. Stanley Chan MDa and Jeffrey S. Dover MDa-c aSkinCare Physicians, Chestnut Hill, MA bDepartment of Dermatology, Yale University School of Medicine, New Haven, CT cDepartment of Surgery, Dartmouth Medical School, Hanover, NH| |
J Drugs Dermatol. 2013;12(3):366-367.
Computerized Image Analysis of Nails Affected by Fungal Infection: Evaluation Using Digital Photographs and Manually Defined Areas
Robert Baran MD, Adele Sparavigna MD, Michele Setaro, Federico Mailland MD| |
Multifocal Scalp Abscesses with Subcutaneous Fat Necrosis and Scarring Alopecia as a Complication of Scalp Mesotherapy
Razan Kadry MD, Issam Hamadah MD, Abdullah Al-issa MD, Lawrence Field MD| |
Thalidomide and Analogues: Potential for Immunomodulation of Inflammatory and Neoplastic Dermatologic Disorders
Barry Ladizinski BS, Edward J. Shannon PhD, Miguel R. Sanchez MD, William R. Levis MD| |
Treatment of Focal Axillary Hyperhidrosis Using a Long-Pulsed Nd:YAG 1064 nm Laser at Hair Reduction Settings
Study Design/Materials and Methods: In a prospective, case-controlled, randomized pilot study, one axilla from six different subjects with axillary hyperhidrosis was treated with monthly laser hair reduction sessions using the 1064 nm Nd:YAG laser at typical settings. The contralateral axilla acted as a control. Subjects were asked to subjectively classify improvement of axillary sweating using a Global Assessment Questionnaire (GAQ) weekly after each treatment. Qualitative evaluation of sweating was also performed using a modified starch iodine test monthly after each treatment. In addition, prior to the first treatment and at one month following the final treatment, a punch biopsy was performed on the treatment axilla to assess for histologic changes to the eccrine gland and surrounding structures.
Results: Statistically significant improvements in subjective ratings of sweating using the GAQ compared to baseline were observed. Objective improvements in sweating with modified starch iodine testing comparing treated versus non-treated axillae were also seen for at least nine months in selected subjects. No significant differences in pre- and post-treatment biopsies were noted on routine histology.
Conclusions: Laser hair reduction using the 1064 nm Nd:YAG at laser hair removal settings provides subjective and objective improvements in patients with focal axillary hyperhidrosis.
J Drugs Dermatol. 2012;11(1):59-63.
Kyung Hee Chang MD PhD, Salinee Rojhirunsakool MD, Lynne J. Goldberg MD| |
Observations: A review of patients with extensive alopecia areata was done. Six out of 10 patients responded to treatment with intralesional triamcinolone acetonide. In comparison to the non-responders, the responders tended to have exclamation mark hairs and a positive hair pull test at their initial physical examination, and exhibited improvement during the initial months of treatment. Complications were negligible, with mild reversible atrophy in three patients. The treatment was well tolerated and, in some patients, pain was minimized by use of a topical anesthetic agent applied under occlusion prior to the visit.
Conclusion: Intralesional triamcinolone acetonide is a safe and effective treatment for patients with extensive alopecia areata. Patients with exclamation point hairs and a positive hair pull test may be more likely to respond.
Noel M. Prevost MPAS PA-C, Joseph C. English III MD| |
J Drugs Dermatol. 2011;10(11):1328-1330.
Sandeep S. Saluja MD and Matthew Q. Hand MD| |
Yasuhiro Horiuchi MD, SangJae Bae MD, Ichiro Katayama MD| |
Leopoldo Duailibe Nogueira Santos MD and Jerry Shapiro MD FRCPC| |
Andrew F. Alexis MD MPH| |
Antifungal Activity, Experimental Infections and Nail Permeation of an InnovativeCiclopirox Nail Lacquer Based on a Water-soluble Biopolymer
Giuseppe Togni PhD and Federico Mailland MD| |
Dawn Davidson RN, Daniel Ritacca MD, Mitchel P. Goldman MD| |
Exacerbation of Paranoid Schizophrenia in a Psoriatic Patient after Treatment with Cyclosporine A, but not with Etanercept
Sergio Di Nuzzo MD, Martina Zanni MD, Giuseppe De Panfilis MD| |
Dirk M. Elston MD| |
Brooke Bair DO and David Fivenson MD| |
Objective and Methods: Sodium thiosulfate has been used to systemically treat calciphylaxis with little to no adverse effects. We report two cases of ulcerative calcinosis cutis which were refractory to multiple topical treatments and did not improve with correction of underlying electrolyte abnormalities.
Results: Both cases showed an excellent response to topical 25% sodium thiosulfate compounded in zinc oxide.
Limitations: We are limited by a small sample size (n=2) in this case series.
Conclusions:We recommend topical sodium thiosulfate 25% as an alternative treatment for dystrophic calcinosis cutis.
J Drugs Dermatol. 2011;10(9):1042-1044.
Habibollah Alamdari MD, Lauren Snitzer MD, and Nora K. Shumway MD| |
Intense Pulsed Light Pulse Configuration Manipulation Can Resolve the Classic Conflict Between Safety and Efficacy
Inna Belenky PhD, Cruzy Tagger MD, and Andrea Bingham RE| |
J Drugs Dermatol. 2015;14(11):1255-1260.
Joshua A. Zeichner MD| |
J Drugs Dermatol. 2015;14(suppl 10):s35-s41.
Alopecia Areata Treated With Efalizumab: A Case With Significant HairRe-Growth After Long-Term Therapy
Jeffrey R. Smith MPH, Russell S. Akin MD, Michael J. Wells MD| |
Resident Rounds. Part II: Distinguishing Porphyria Disorders: Biochemical Markers and Associated Findings
James L. Griffith Jr. MS and Robert Bacigalupi MD| |
Jennifer Hayes BAa and John Koo MDb| |
The potential relationship between systemic retinoids used in dermatology and affective disorders is controversial. Acitretin, which is widely used in the treatment of psoriasis is part of this controversy secondary to its chemical relation to isotretinoin, a drug which has been associated with a large number of anecdotal case reports of depression and suicidal ideation. Moreover, an FDA package insert precaution regarding acitretin's association with depression and suicide has elevated the level of concern for patient safety. The objective of this article is to review the evidence in the literature regarding acitretin's association with affective disorders. After 12 years of worldwide use only two cases involving acitretin have been reported in the literature. In addition, despite many anecdotal cases involving isotretinoin, there have been no clinical studies that have proven a causal relationship between isotretinoin and depression or suicidal ideation. For acitretin there have been no systematic clinical studies that examine such a relationship. Moreover, it is notable that the FDA precaution regarding depression and suicide on the package insert of acitretin predates the publication of the aforementioned two cases. This suggests that a relationship between acitretin and affective disorders is a class labeling rather than a scientifically proven association.
J Drugs Dermatol. 2011;10(4):409-412.
Evidence-Based Skincare: The Importance of Offering Moisturization, Relief, and Protection in Common Skin Disorders
Leon H. Kircik MD| |
Anne Chapas MD FAAD and Kendra Gail Bergstrom MD FAAD| |
Bexarotene and Its Potential Role in the Treatment of Neurological Disorders: Beyond Its Role as an Anti-Cancer Agent
Shailendra Kapoor MD| |
Transungual Delivery of Efinaconazole: Its Deposition in the Nail of Onychomycosis Patients and In Vitro Fungicidal Activity in Human Nails
Misao Sakamoto MS,a Noriaki Sugimoto MS,b Hideki Kawabata MS,a Eiko Yamakawa MS,a
Nobuyuki Kodera MS,a Radhakrishnan Pillai PhD,c and Yoshiyuki Tatsumi PhDd
OBJECTIVE: To investigate the transungual delivery of efinaconazole in onychomycosis patients and its fungicidal activity in the toenail.
METHODS: Concentrations of efinaconazole were determined as part of a multi-center, open label study in forty onychomycosis patients following repeated application of efinaconazole topical solution, 5% and 10% to the toenails over 28 days, with a 2-week follow-up. Fungicidal activity against T. rubrum in the ventral layer of human nails was determined using an in vitro human nail infection model (ChubTur®).
RESULTS: Efinaconazole concentrations in the nail were four orders of magnitude higher than MIC values of efinaconazole against dermatophytes. Further, nail drug concentrations were not influenced by the presence of disease or nail thickness, and maintained at high antifungal levels post-treatment. Efinaconazole was effective in reducing fungal viability, suggesting that sufficient amounts of efinaconazole were being delivered into the ventral layer of the nail plate.
CONCLUSIONS: Effective transungual delivery of efinaconazole was demonstrated. The high efinaconazole concentrations in patient toenails and fungicidal activity in vitro potentially contribute to the clinical efficacy reported in phase 3 studies.
J Drugs Dermatol. 2014;13(11)1388-1392.
Ronald B. Vender MD FRCPC, Orli Goldberg MD| |
Vitamin and Mineral Deficiencies in Patients With Telogen Effluvium: A Retrospective Cross-Sectional Study
Evelyn J. Cheung MD, Jacquelyn R. Sink MD, and Joseph C. English III MD| |
J Drugs Dermatol. 2016;15(10):1235-1237.
E. Victor Ross MDa and James Childs PhDb| |
STUDY DESIGN/MATERIALS AND METHODS: Porcine skin and fat tissue were prepared and separated to form a 2mm skin layer above a 1 cm thick fat layer. A 50μm thermocouple was placed between the layers and centered beneath a 23 x 38 mm treatment window of an 805 nm diode laser device (Vectus, Cynosure, Westford, MA). Apertures provided various incident beam spot sizes and the temperature rise of the thermocouple was measured for a fixed fluence.
RESULTS: The 2mm deep target's temperature rise versus treatment area showed two regimes with different positive slopes. The first regime up to approximately 1 cm2 area has a greater temperature rise versus area than that for the regime greater than 1 cm2. The slope in the second regime is nonetheless appreciable and provides a fluence reduction factor for skin safety. The same temperature rise in a target at 2 mm depth (typical hair bulb depth in some areas) is realized by increasing the area from 1 to 4 cm2 while reducing the fluence by half.
CONCLUSIONS: The role of spot size and in situ beam divergence is an important consideration to determine optimum fluence settings that increase skin safety when treating deeper targets.
J Drugs Dermatol. 2015;14(12):1437-1442.
Robert A. Swerlick MD aand Caren F. Campbell MD b| |
J Drugs Dermatol. 2013;12(1):99-102.
Background: South Asians represent a rapidly growing part of the U.S. population, increasing 188 percent from 1990 to 2000 (0.27% to 0.78%). Studies investigating the epidemiology of skin disorders in South Asian Americans are lacking.
Objective: We sought to determine common skin conditions and concerns among this population.
Methods: This was a community-based survey study. The IRB-approved survey tool was distributed to South Asians adults in the New York City area. All data was self-reported.
Results: 190 surveys were completed. 54 percent of responders were female and 46 percent were male. The age of participants ranged from 18-74 years. The respondents were predominantly foreign born (76%), but a large minority (32%) reported living in the U.S. for over 20 years. Nearly half (49%) of the study population reported having visited a dermatologist in the past. The five most common dermatologic diagnoses included: acne (37%), eczema (22%), fungal infection (11%), warts (8%) and moles (8%). The five most common concerns included: dry skin (25%), hair loss (22%), uneven tone (21%), dark spots (18%) and acne (17%).
Conclusions: Our results suggest that the leading skin conditions and concerns in South Asian Americans are similar to those reported in other populations with skin of color.
J Drugs Dermatol. 2011;10(5):524-528.
Pollution as a Risk Factor for the Development of Melasma and Other Skin Disorders of Facial Hyperpigmentation ‑ Is There a Case to Be Made?
Wendy E. Roberts MD FAAD| |
J Drugs Dermatol. 2015;14(4):337-341.
Evidence-Based Skincare: The Importance of Offering Moisturization, Relief, and Protection in Common Skin Disorders
Joy Makdisi BS and Adam Friedman MD FAAD| |
Punctate Palmoplantar Keratoderma (Buschke-Fischer-Brauer Disease) with Psoriasis: A Rare Association Showing Excellent Response to Acitretin
Nawaf Al-Mutairi MD FRCP(C), Arun Joshi MD, Osama Nour-Eldin MSc| |
Tuyet A. Nguyen BA BS and Adam J. Friedman MD| |
J Drugs Dermatol. 2013;12(10):1131-1137.
Diagnostic and Therapeutic Considerations for Onychomycosis and Cutaneous Superficial Fungal Infections
New antifungal medicines on the market include topical drugs such as luliconazole, naftifine, efinaconazole, and tavaborole. This CME supplement translates a plethora of recent data on efficacy, ease of use, and safety data for each drug into dermatologists’ real world practices to help them optimize clinical outcomes in the treatment of onychomycosis, tinea corporis, tinea cruris, and tinea pedis.
However, proper drug selection is only one part of achieving a successful clinical outcome. This supplement also explains the patient education needed to avoid primary treatment failure, recurrence, or spread to other body parts or close contacts.
Sandeep S. Saluja MD, Anneli R. Bowen MD, and Christopher M. Hull MD| |
Omer Ibrahim, MD,a Joseph Doumit MD FRCPC,b Alexandra Zhang MDc| |
J Drugs Dermatol. 2015;14(7):750-752.
Noah Scheinfeld MD, Maurice J. Dahdah, Richard Scher MD| |
Fadwah Abdullah BPharm and Rashid M. Rashid MD PhD| |
Shannon Famenini MD and Carolyn Goh MD| |
J Drugs Dermatol. 2014;13(7):809-812.
Comparison Between Sequentional Treatment With Diode and Alexandrite Lasers Versus Alexandrite Laser Alone in the Treatment of Hirsutism
Laser systems that are commonly used for the treatment of hirsutism include the ruby laser (694 nm), the diode laser (800 nm), the alexandrite laser (755 nm) and the Nd:YAG laser (1084 nm). The diode laser and alexandrite laser are considered effective in treatment of hirsutism in dark-skinned patients. The response of hairs to these laser systems is variable and not complete. In this study, we compared the efficacy of these two laser systems for permanent hair removal. This was a randomized, controlled clinical trial that was performed with women of the age range 15−45 years old. After obtaining informed consent, the samples were randomized into two groups using random allocation software. The first group was treated with alexandrite laser alone (four sessions, two months apart). The second group was treated sequentially with diode laser for the first two sessions and alexandrite laser for the next two sessions. Overall, 111 patients (57 patients in the alexandrite laser group and 54 patients in the sequential diode-alexandrite laser group) were evaluated. There was no significant difference regarding mean of hair reduction between the two groups during the courses of treatment. Except for the first session, there was no significant difference regarding percent of patient satisfaction between the two groups (P value >0.05). Comparison between the two groups showed no significant difference one month, three months and six months after the last treatment (P value >0.05). Regarding the results of our study, there is no significant difference between sequential treatment with diode and alexandrite lasers versus alexandrite laser alone in the treatment of hirsutism. We suggest that in further studies, the efficacy of sequential treatment with other laser systems is evaluated against single treatment methods.
J Drugs Dermatol. 2011;10(11):1255-1259.
Introduction: Acitretin is a systemic retinoid drug used in the treatment of severe psoriasis. It has also been used for a spectrum of
other difficult-to-treat dermatoses, including hyperkeratotic and inflammatory dermatoses and non-melanoma skin cancers. Here we
review the available data regarding both FDA-approved and off-label uses of acitretin, clinically relevant adverse events, precautions
Methods: A PubMed literature search was conducted utilizing the search term "acitretin," which yielded 714 hits. Results were further limited to English language clinical trials in human subjects. Of 78 articles evaluated for relevance, 60 were included for review.
Results: Acitretin is effective as monotherapy and in multidrug therapeutic regimens for the treatment of psoriasis and other hyperkeratotic and inflammatory disorders, as well as for malignancy chemoprevention. Its use is limited by its teratogenic potential and other adverse effects, including mucocutaneous effects and hepatotoxicity. Potential adverse effects may be reduced or avoided by using lower doses of acitretin or in combination with other therapies.
Limitations: The reviewed studies include many small trials and case reports of the use of acitretin for psoriasis. Studies of acitretin therapy for the treatment of other cutaneous disorders are limited.
Conclusion: Acitretin is a beneficial treatment for psoriasis, and should be considered when not contraindicated. Particularly when used in combination with ultraviolet (UV) phototherapy, is a safe and cost effective therapeutic strategy.
J Drugs Dermatol.2011;10(7):772-782.
Background: Some dermatologic disorders are known to be much more common in patients of color, but the leading dermatologic
disorders in patients of color have not yet been described on the basis of nationally representative data.
Purpose: To determine the leading dermatologic disorders for each major racial and ethnic group in the United States.
Methods: We queried the National Ambulatory Medical Care Survey (NAMCS) for the leading diagnoses in patient visits to U.S. dermatologists from 1993 to 2009. The leading diagnoses were tabulated for each racial and ethnic group, and the top conditions were compared between groups. In a separate analysis, visits for skin conditions regardless of physician specialty were analyzed for leading diagnoses in each racial and ethnic group.
Results: The top five diagnoses for African-American patients in dermatology clinics were acne, unspecified dermatitis or eczema, seborrheic dermatitis, atopic dermatitis, and dyschromia. For Asian or Pacific Islander patients, the top five were acne, unspecified dermatitis or eczema, benign neoplasm of skin, psoriasis, and seborrheic keratosis. By contrast, in Caucasian patients, the top five were actinic keratosis, acne, benign neoplasm of skin, unspecified dermatitis or eczema, and nonmelanoma skin cancer. In Hispanic patients of any race, the leading diagnoses were acne, unspecified dermatitis or eczema, psoriasis, benign neoplasm of skin, and viral warts. When the leading dermatologic diagnoses across all physician specialties were assessed, the top diagnoses for African-Americans were unspecified dermatitis or eczema, acne, dermatophytosis of scalp and beard, sebaceous cyst, and cellulitis or abscess; for Asians or Pacific Islanders were unspecified dermatitis or eczema, acne, atopic dermatitis, urticaria, and psoriasis; and for Caucasians were acne, unspecified dermatitis or eczema, actinic keratosis, viral warts, and sebaceous cyst. For Hispanics of any race, they were unspecified dermatitis or eczema, acne, sebaceous cyst, viral warts, and cellulitis or abscess. For a sole diagnosis of a dermatologic condition, only 28.5% of African-Americans' visits and 23.9% of Hispanics' visits were to dermatologists, as compared to 36.7% for Asians and Pacific Islanders and 43.2% for Caucasians.
Limitations: The data are based on numbers of ambulatory care visits rather than numbers of patients. Data on race or ethnicity were not collected for some patients.
Conclusions: Several dermatologic disorders are much more commonly seen in patients of color. Acne and unspecified dermatitis or eczema are in the top five for all major U.S. racial and ethnic groups. There may be an opportunity to improve the care of patients of color by ensuring they have equal access to dermatologists.
J Drugs Dermatol. 2012;11(4):466-473.
Aditya K Gupta MD PhD FRCP(C), Karyn Nicol HBMSc| |
Hendrik Uyttendaele, Md, PhD; Joseph Obadiah, MD and Marc Grossman, MD| |
Comparison of the Efficacy of Long-Pulsed Nd:YAG Laser Intervention for Treatment of Onychomycosis of Toenails or Fingernails
Yan Li MD, Sisi Yu MS, Jing Xu MS, Ruina Zhang MS, and Junying Zhao BS| |
METHODS: One hundred and twelve affected fingernails or toenails in 37 patients with onychomycosis were randomized into Group 1 (22 patients with 50 affected fingernails) and Group 2 (15 patients with 62 affected toenails). These patients were further classified into three subgroups (Grade II, III, and IV) according to Scoring Clinical Index of Onychomycosis. All the affected nails were treated with long-pulse Nd:YAG 1064 nm laser intervention, once weekly, for continuous weeks, and were followed up for 24 weeks.
RESULTS: The response rates at weeks 8, 16, and 24 were 0, 0 and 52%, respectively, for Group 1, and 10, 32 and 71% for Group 2. The inter-group difference in efficacy was statistically significant (P<0.05). Even in the same subgroup, the response rate of Group 2 was higher than that of Group 1.
CONCLUSIONS: The efficacy of long-pulsed Nd:YAG 1064 nm laser intervention against affected toenails is superior to that against fingernails. It is also effective for treatment of onychomycosis with different severity.
J Drugs Dermatol. 2014;13(10):1258-1263.
Robert Buka, MD; Rachel Hille, MD and Patricia McCormack, MD| |
Grace Sun MD, Carina A. Wasko MD, Sylvia Hsu MD| |
Boni E. Elewski MD,a Aditya K. Gupta MD PhD FRCPC,b Ted Rosen MD,c Bryan D. Caldwell DPM,d David M. Pariser MD,e Leon H. Kircik MD,f Neal Bhatia MD,g and Antonella Tosti MDh| |
METHODS: We reviewed definitions of onychomycosis cure to develop a less stringent and more practical approach to assess improvement and treatment success.
RESULTS: Complete cure (totally clear nail and mycologic cure) remains an important regulatory standard. Mycologic cure (negative fungal culture and negative potassium hydroxide) is the only consistently reported outcome in clinical trials, however the potential for discrepancies between microscopy and culture can be problematic. We propose a more practical approach to assessing improvement in infected nails that relies on both physician and patient input in a similar fashion to other skin diseases.
CONCLUSIONS: Treatment success should be based on both physician and patient assessment of improvement in the affected toenails and negative fungal culture.
J Drugs Dermatol. 2016;15(5):626-632.
Aimee Leonard MD, Miriam Keltz Pomeranz MD, Andrew G Franks Jr MD| |
J Drugs Dermatol. 2013;12(10):1177-1179.
Evan Jones MD, Adam Korzenko BS, David Kriegel MD| |
Divya Sharma BS,a Mary-Margaret Kober MD,b and Whitney P. Bowe MDc| |
J Drugs Dermatol. 2016;15(1):9-12.
J Drugs Dermatol. 2012;11(2):160-167.
F. Emily Bell, MD and Melissa P. Daniles, MCS| |
Efinaconazole 10% and Tavaborole 5% Penetrate Across Poly-ureaurethane 16%: Results of In Vitro Release Testing and Clinical Implications of Onychodystrophy in Onychomycosis
Chris G. Adigun MD,a Tracey C. Vlahovic DPM,b Michael B. McClellan MS,c Kailas D. Thakker PhD,c Ryan R. Klein PhD,c Tuan A. Elstrom BS,d and Daniel B. Ward Jr. MD FAADd| |
OBJECTIVE: The purpose of this work was to determine through in vitro release testing (IVRT) whether poly-ureaurethane 16% allows for penetration of efinaconazole 10% or tavaborole 5%. Results could spur subsequent clinical studies which would have implications for the addition of an antifungal based on fungal confirmation, after addresssing the underlying nail dystrophy primarily.
METHODS: A vertical diffusion cell system was used to evaluate the ability of efinaconazole 10% and tavaborole 5% to penetrate across poly-ureaurethane 16%. The diffusion cells had a 1.0 cm2 surface area and approximately 8 mL receptor volume. Poly-ureaurethane 16% was applied to a 0.45 μm nylon membrane and allowed to dry before use. Efinaconazole 10% or tavaborole 5% was then applied to the poly-ureaurethane 16% coated membrane, and samples were pulled from the receptor chamber at various times. Reverse phase chromatography was then used to assess the penetration of each active ingredient across the membrane.
RESULTS: The flux and permeability of efinaconazole or tavaborole across poly-ureaurethane 16% were determined from efinaconazole 10% or tavaborole 5%, respectively. The flux and permeability of efinaconazole were determined to be 503.9 +/- 31.9 μg/cm2/hr and 14.0 +/- 0.9 nm/sec. The flux and permeability of tavaborole were determined to be 755.5 +/- 290.4 μg/cm2/hr and 42.0 +/- 16.1 nm/sec.
CONCLUSION: In addition to the treatment of onychoschizia, onychorrhexis, and other signs of severe dessication of the nail plate, a barrier that regulates TOWL should be considered in the management onychomycosis to address barrier dysfunction and to promote stabilization of the damaged nail. Previously published flux values across the nail are reported to be 1.4 μg/cm2/day for efinaconazole and 204 μg/cm2/day for tavaborole. These values are substantially lower than the herein determined flux for both molecules across poly-ureaurethane 16%. A comparison of the data suggests that poly-ureaurethane 16%, if used prior to efinaconazole or tavaborole, would not limit the ability of either active ingredient to access the nail, and therefore, would be unlikely to reduce their antifungal effect. Onychodystrophy is inherent in, and often precedes onychomycosis, and consideration should be given for initiation of treatment in the same sequence: stabilizing and protecting the nail plate barrier primarily, and subsequently adding oral or topical antifungals after laboratory confirmation. Future clinical studies will be needed to determine combination efficacy for in vivo use.
J Drugs Dermatol. 2016;15(9):1116-1120.
Kenneth R. Beer MD FAAD,a Stephanie Bayers BSBA,b and Jacob Beerc| |
J Drugs Dermatol. 2014;13(suppl 1):s17-s20.
Brian C. Schulte BSE, Wesley Wu MD, and Ted Rosen MD| |
J Drugs Dermatol. 2015;14(9):964-968.
Jennifer C. Sri BS, Charlotte L. Tsai MD, April Deng MD, Anthony A. Gaspari MD| |
Dina Coronado BS, Tejal Merchant MPharm, Sanjay Chanda PhD, and Lee T. Zane MD| |
J Drugs Dermatol. 2015;14(6):609-614.
Andrew F. Alexis MD MPH| |
Kelly K. Park MD, Rebecca C. Tung MD, Arlene Ruiz de Luzuriaga MD MPH| |
Jashin J. Wu MD FAADa and W.C. Valdecantos MDb| |
Psoriasis is a common, inflammatory disease that manifests itself as lesions on the skin, which greatly impacts the physical and psychological wellbeing of those affected. The current goal of treatment in psoriasis is to improve the signs and symptoms of disease, whilst minimizing the burden of disease on patient health-related quality of life. Psoriasis can also be associated with other comorbidities such as joint disease, cardiovascular disease, and depression, which can add to the complexity of treatment.
Adalimumab is a recombinant, fully human, monoclonal antibody against tumor necrosis factor alpha (TNF-α), which blocks the interaction of TNF with both of its cell-surface receptors, with high affinity and specificity. Adalimumab is well established for the treatment of moderate–severe chronic plaque psoriasis in adults, and has more recently been approved in the European Union for use in pediatric patients with severe chronic plaque psoriasis.
Here we provide a clinical guide for adalimumab and review existing data on the efficacy and safety of originator adalimumab in moderate–severe chronic plaque psoriasis in adult and pediatric patients. We discuss short- and long-term treatment with adalimumab, and efficacy in hard-to-treat psoriasis of the scalp, hands, feet, and nails, in addition to the impact on associated pain and pruritus. We also discuss treatment optimization with adalimumab in the context of relevant clinical scenarios, and treatment of complex patients with underlying comorbidities. Finally, we examine available real-world clinical data for adalimumab in psoriasis.
J Drugs Dermatol. 2017;16(8):779-790.
Adam J. Friedman MD FAAD,a Erika C. von Grote PhD,b Matthew H. Meckfessel PhDb| |
J Drugs Dermatol. 2016;15(5):633-639.
Fortunately, Promius Pharma, one of the leaders in this field, has now brought to market a generic formulation of clocortolone pivalate 0.1% that is exactly the same as their original branded product. This has been shown to be effective and well tolerated in the management of several corticosteroid-responsive dermatoses, and is a welcome addition to the treatment armamentarium.
Varun Kalhana and Neil Sadick MDb| |
Biologic drugs, a novel class of agents engineered to target specifc mediators of infammation, and small-molecule inhibitors that pen-etrate the cell membrane to interact with targets inside a cell represent the cutting-edge of pharmacological biomedical therapeutics. Clinical studies have already demonstrated the effectiveness of this new generation of drugs in treating a variety of medical illnesses and conditions that were refractory to traditional treatments. This review aims to describe the latest available or currently in-develop-ment drugs, biologic agents, and small molecule inhibitors for treatment of psoriasis, rosacea, alopecia areata, and atopic dermatitis.
J Drugs Dermatol. 2017;16(12):1224-1228
Phoebe Rich MD| |
METHODS: An analysis of 1655 patients, aged 18-70 years, randomized to receive efinaconazole topical solution, 10% or vehicle from two identical multicenter, double-blind, vehicle-controlled 48-week studies evaluating safety and efficacy. The primary end point was complete cure rate (0% clinical involvement of target toenail, and both negative potassium hydroxide examination and fungal culture) at Week 52. Three groups were compared: those with early disease (<1year), patients with a baseline disease of 1-5 years, and those with long-standing onychomycosis (>5years).
RESULTS: The majority of patients had long-standing disease; were older, male and white. While nail involvement of the target toenail did not differ noticeably amongst the three groups, the number of nails involved did increase progressively with disease duration. Differences were seen in terms of infecting pathogens in early disease that might have important treatment implications. Efinaconazole was more effective in treating early disease, however more than 40% of patients with long-standing disease were considered treatment successes.
LIMITATIONS: A period of 52 weeks may be too brief to evaluate a clinical cure in onychomycosis.
CONCLUSIONS: Treatment of onychomycosis early to avoid disease progression to other toenails is important. Once daily efinaconazole topical solution, 10% is particularly effective in these patients.
J Drugs Dermatol. 2015;14(1):58-62.
Zülal Erbagci MD, A. Almıla Tuncel MD, Ibrahim Erbagci MD| |
A Novel Microgel Complex Delivers Acne Medicine Deep into Follicles While Demonstrating High Patient Tolerance
Jeff Wu PhD, Jeannette Chantalat MBA, Jue-Chen Liu PhD| |
J Drugs Dermatol. 2015;14(2):176-182.
Lucia Seminario-Vidal MD PhD, Wendy Cantrell DNP, and Boni E. Elewski MD| |
J Drugs Dermatol. 2015;14(8):901-902.
John L. Meisenheimer MD| |
Vesna Petronic-Rosic MD MSc, Elizabeth Myers, Christopher R. Shea MD, Thomas Krausz MD| |
Whitney P. Bowe MD| |
J Drugs Dermatol. 2013;12(suppl 9):s133-s136.
Access of Efinaconazole Topical Solution, 10%, to the Infection Site by Spreading Through the Subungual Space
Boni E. Elewski MD,a Richard A. Pollak, DPM MS,b Radhakrishnan Pillai PhD,c Jason T. Olin PhDd| |
METHODS: 11 patients (mean age 48.5 years) were entered with clinically determined onychomycosis. Presence of fungal infection was confirmed by KOH testing in eight patients. Two separate applications of vehicle (with fluorescein incorporated for better visualization) were applied at the hyponychium, avoiding application to the exterior nail plate surface. Affected nails were later clipped to allow examination of the nail bed and further examination of the underside of the nail. Spread of formulation was assessed under visible and UV light conditions by photographing target toenails after vehicle application, and after nail clipping.
RESULTS: Assessments under both visible and UV light indicated that the vehicle had spread into the subungual space, with deposition of flourescein wherever vehicle had reached, including in the nail bed. Nail clippings also indicated deposition to the underside of the nail plate.
LIMITATIONS: The relative contributions of spreading into the subungual space, or permeation through the nail plate to the efficacy of efinaconazole topical solution, 10% in treating onychomycosis were not assessed.
CONCLUSIONS: This study suggests that the vehicle developed for efinaconazole topical solution, 10%, when applied at the hyponychium, spreads into the subungual space between the nail plate and nail bed, reaching the site of infection.
J Drugs Dermatol. 2014;13(11):1394-1398.
Mark Abdelmalek MD, Shruti Mahindrakar BS, Elizabeth Wiser MD| |
Iqbal Bukhari MD| |
The Use of the Flexible Scalpel for MinimallyInvasive and Minimally Scarring Surgery: A CaseSeries of Four Patients With Large Scalp Tumors
Bahar F. Firoz, MD MPH, Leonard H. Goldberg MD, Tracy Katz MD, Arash Kimyai-Asadi MD, Paul M. Friedman MD| |
Samreen Z. Choudhry MD,a Neal Bhatia MD,b Roger Ceilley MD,c Firas Hougeir MD,d
Robert Lieberman MD,e Iltefat Hamzavi MD,a and Henry W. Lim MDa
J Drugs Dermatol. 2014;13(2):148-153.
Pain Management With a Topical Lidocaine and Tetracaine 7%/7% Cream With Laser Dermatologic Procedures
Joel L. Cohen MD| |
J Drugs Dermatol. 2013;12(9):986-989.
Hannah Liu BS, Rachel Schleichert MD, and Anthony A. Gaspari MD| |
J Drugs Dermatol. 2013;12(3):360-361.
J Drugs Dermatol. 2012;11(8):979-987.
Navjeet K. Sidhu-Malik, MD and Andrew L. Kaplan, MD| |
Frank Martiniuk PhD, David S. Lee MD, Anthony Gaspari MD, Herman Yee MD PhD, Luis Chiriboga PhD, Maryann Huie PhD, Kam-Meng Tchou-Wong PhD, and William R. Levis MD| |
Monica B. Schadlow, MD; Grant J. Anhalt, MD and Animesh A. Sinha, Md, PhD| |
Jason J. Emer MD, Mary L. Stevenson MD, Orit Markowitz MD| |
Female-pattern androgenetic alopecia is a very common disorder that has been associated with extreme psychological morbidity. Few treatments have documented utility and many physicians are often overwhelmed with how little is pharmacologically available to treat this condition. Novel treatments that are effective, safe, less costly and simple are in high demand. We report a case of female-pattern androgenetic alopecia that failed to respond to a novel treatment with injected bimatoprost solution. Hypothetically, the treatment should have been effective and although we did not have success, this report suggests critical points to consider in the future of prostaglandin analogs, as well as other therapies being considered for the treatment of female-pattern hair loss.
J Drugs Dermatol. 2011;10(7):795-798.
Andrew F. Alexis MD MPHa and Paul Blackcloud BA| |
J Drugs Dermatol. 2013;12(suppl 9):s123-s127.
Terrence Colin Keaney MD| |
Gender plays a significant role in determining facial anatomy and behavior, both of which are key factors in the aging process. Understanding the pattern of male facial aging is critical when planning aesthetic treatments on men. Men develop more severe rhytides in a unique pattern, show increased periocular aging changes, and are more prone to hair loss. What also needs to be considered when planning a treatment is what makes men beautiful or “man-some”. Male beauty strikes a balance between masculine and feminine facial features. A hypermasculine face can have negative associations. Men also exhibit different cosmetic concerns. Men tend to focus on three areas of the face – hairline, periocular area, and jawline. A comprehensive understanding of the male patient including anatomy, facial aging, cosmetic concerns, and beauty are needed for successful cosmetic outcomes.
J Drugs Dermatol. 2017;16(6 Suppl):s91-93.
Tiffani K. Hamilton MD| |
Rapid Improvement in Digital Ischemia and AcralContracture in a Collodion Baby Treated With Topical Tazarotene
Rosemarie H. Liu MD, Beth Becker MD, Juliet Gunkel MD, Joyce Teng, MD, PhD| |
Lichenoid Dermatitis From Interferon alpha-2a in a Patient With Metastatic Renal Cell Carcinoma and Seronegative HCV
Amelia E. Bush MD,a Sharon R. Hymes MD,b and Sirunya Silapunt MDc| |
Cutaneous reactions to interferon, including a lichenoid drug reaction, are most commonly reported in patients undergoing treatment for hepatitis C virus (HCV) infection. There have been case reports of interferon-induced lichen planus in seronegative HCV patients with lymphoproliferative disorders and melanoma. We report the case of a 71-year-old man undergoing treatment with interferon for metastatic renal cell carcinoma (RCC) who developed an eruption 2 months after starting interferon. Clinical and histological findings from biopsies supported a diagnosis of interferon-induced lichen planus. To our knowledge, this is the first known case of a lichenoid drug eruption from interferon in a seronegative HCV patient with metastatic RCC.
J Drugs Dermatol. 2017;16(7):714-716.
Malgorzata Olszewska MD, Lidia Rudnicka MD| |
Multivesicular Emulsion: A Novel, Controlled-Release Delivery System for Topical Dermatological Agents
Joseph Bikowski MD, Radhakrishnan Pillai PhD, Braham Shroot PhD| |
Ritu Saini MD, Stephanie Lehrhoff MD, Deborah S. Sarnoff MD| |
James Q. del Rosso, Do, FAOCD| |
Clinical Relevance of Skin Barrier Changes Associated With the Use of Oral Isotretinoin: The Importance of Barrier Repair Therapy in Patient Management
James Q. Del Rosso DO FAOCD| |
J Drugs Dermatol. 2013;12(6):626-631.
J Drugs Dermatol. 2012;11(10):1166-1173.
The Presence of an Air Gap Between the Nail Plate and Nail Bed in Onychomycosis Patients: Treatment Implications for Topical Therapy
Aditya K. Gupta MD PhD FRCPC FAADa,b and Radhakrishnan Pillai PhDc| |
OBJECTIVE: To evaluate the ability of efinaconazole vehicle solution to reach the site of toenail onychomycosis through application to the hyponychium or hyponychium and dorsal nail surface, and assess the impact of the air gap between the nail plate and nail bed.
METHODS: Twenty-three participants with moderate to severe, mycologically-confirmed onychomycosis were enrolled (mean age, 48.5 years). Two separate applications of vehicle solution containing fluorescein for visualization were applied at the hyponychium or hyponychium and dorsal nail surface. Affected nails were later clipped to allow examination of the nail bed and further examination of the ventral surface of the nail. Spread of formulation was assessed under visible and UV light conditions by photographing target toenails after vehicle application and after nail clipping.
RESULTS: There was a positive correlation between the size of the air gap and degree of affected nail involvement (R2=0.064). Assessments under both visible and UV light indicated that the vehicle had spread to the site of infection, with deposition of fluorescein wherever vehicle had reached, irrespective of application methodology or size of air gap. Nail clippings also indicated absorption into the ventral surface of the nail plate.
LIMITATIONS: The relative contributions of subungual versus transungual application of drug to the nail plate to the efficacy of efinaconazole topical solution, 10% in treating onychomycosis were not assessed.
CONCLUSIONS: This study suggests that the low surface tension vehicle developed for efinaconazole topical solution, 10% can reach the site of infection by application to the hyponychium, dorsal or ventral nail surface and nail folds. This multidirectional approach to drug delivery at the site of fungal infection may contribute to the magnitude of efficacy seen in clinical trials.
J Drugs Dermatol. 2015;14(8):859-863.
Veronica Russo MD MPH and Ali Alikhan MD| |
CASE: A 55-year-old African American male with a several year history of severe HS, recalcitrant to multiple prior treatments, was treated with a 12 week course of anakinra 100 mg subcutaneously daily. After 3 months of therapy, minimal change was observed, and the patient strongly preferred to cease therapy due to lack of improvement and pain associated with daily injections.
CONCLUSION: Our case of severe HS proved refractory to anakinra. Tolerance of this therapy may be a limiting factor for some patients due to necessity for daily injections.
J Drugs Dermatol. 2016;15(6):772-774.
Lauren C. Strazzulla BA, Lorena Avila MD, Kristen Lo Sicco MD, Jerry Shapiro MD| |
Lichen planopilaris (LPP) is a variant of lichen planus that affects the scalp causing scarring hair loss. Patients also frequently experience symptoms of scalp itch, pain, and burning. To date, there are no long-term remittive nor curative therapies available. Low-dose naltrexone has anti-inflammatory properties and has recently been described in the context of treating autoimmune conditions. This retrospective medical record review describes four LPP patients treated with low-dose (3 milligrams per day) naltrexone. This medication provided benefit in these four patients including reduction in symptoms of pruritus, clinical evidence of inflammation of the scalp, and disease progression. All patients tolerated naltrexone without adverse effects. This is the first case series demonstrating the beneficial effects of low-dose naltrexone for patients with LPP. This medication was well-tolerated by the patients and is cost-effective.
J Drugs Dermatol. 2017;16(11):1140-1142.
Evaluation of a Newly Available ELISA for Envoplakin Autoantibodies for the Diagnosis of Paraneoplastic Pemphigus
Jennifer Gall Powell MD,a,c Raminder K. Grover MD,a,b Richard W. Plunkett PhD,a,b
Kristina Seiffert-Sinha MD,a and Animesh A. Sinha MDa
OBSERVATIONS: We measured the specificity of IIF on RBE to be 86% which is on the lower end of the previously reported specificity of 83% to 98.9%. The ELISA for envoplakin autoantibodies has a technical sensitivity of 100%, diagnostic sensitivity of 83%, and specificity of 91%.
CONCLUSIONS AND RELEVANCE: This ELISA for envoplakin autoantibodies is now commercially available and technically easier to perform then the immunoblot. We recommend that this new ELISA serves as a confirmatory test in cases of a positive IIF on RBE given its higher specificity.
J Drugs Dermatol. 2015;14(10):1103-1106.
The Role of a Midpotency Topical Corticosteroid and the Clinical Relevance of Formulation Characteristics in the Management of Commonly Encountered Eczematous and Inflammatory Dermatoses in Adults and Children:Focus on the Pharmacologic Properties of Clocortolone Pivalate 0.1% Cream
James Q. Del Rosso DO FAOCDa and Leon H. Kircik MDb| |
J Drugs Dermatol. 2013;12(2)(suppl):s5-s10.
Excellent Aesthetic and Functional Outcome After Fractionated Carbon Dioxide Laser Skin Graft Revision Surgery: Case Report and Review of Laser Skin Graft Revision Techniques
Derek Ho BSa and Jared Jagdeo MD MSa,b,c| |
J Drugs Dermatol. 2015;14(11):1285-1288.
Joseph Alcalay MD, Dani Ben-Amitai, Ronen Alkalay MD MBA| |
Adam J. Mamelak MD, Adrianna Jackson MD, Rabia Nizamani BS, Ofer Arnon MD,Nanette J. Liegeois MD PhD, Richard J. Redett MD, Patrick J. Byrne MD| |
Objective: The authors describe the current role of leech therapy in cutaneous surgery and medicine.
Methods: Case series and review of the literature.
Results: Leech saliva contains anticoagulative, anti-aggregative and vasodilatory components. Combined with the annelid’s mechanical ability to extract blood, leeches can contribute to patients’ health with minimal risks.
Conclusion: Leeches should be considered as novel therapies for disorders of coagulation and venous congestion. Implementation of leech treatment should be tempered with the potential adverse effects, including Aeromonas infection and a drop in hematocrit that might require a blood transfusion.
Multiple Nonmelanoma Skin Cancers in a Patient With Epidermolytic Hyperkeratosis on Long-standingRetinoid Therapy
Deborah S. Sarnoff MD FAAD FACP, Ritu Saini MD FAAD| |
Leon H. Kircik MDa and Panagiotis Zografos MScb| |
J Drugs Dermatol. 2015;14(10):1113-1116.
Andreas J. Bircher, MD and Christian Surber, MD| |
Maj. Jeremy Scott Kennedy DO, Col. (Ret) Richard L. Devillez MD, Maj. Jeffrey Scott Henning DO| |
Plasmapheresis for Refractory Urticarial Vasculitis in a Patient with B-Cell Chronic Lymphocytic Leukemia
Jessica L. Alexander MD, Amer N. Kalaaji MD, James M. Shehan MD, Benjamin K. Yokel MD, Mark R. Pittelkow MD| |
Mehods: We report a case of refractory urticarial vasulitis developing in association with B-cell chronic lymphocytic lukemia in a 46- year-old man. We also reviewed the literature to identify other cases of urticarial vasculitis managed with this therapeutic modality.
Results: The diesease progressively improved during 6 treatments with palsmapheresis (plasma exchange). In additional cases indentified in the literatrue, plasmaphersis was generally effective and well tolerated.
Conclusion: On the basis of these findings, we propose that plasmapheresis be considered a treatment option for refractory urticarial vasculitis.
The Multifunctionality of 10% Sodium Sulfacetamide, 5% Sulfur Emollient Foamin the Treatment of Inflammatory Facial Dermatoses
Zoe Diana Draelos MD| |
Joseph F. Fowler Jr. MD, Heather Woolery-Lloyd MD, Heidi Waldorf MD, Ritu Saini MD| |
Claudia Hossain BS,a Dennis A. Porto MD,b Iltefat Hamzavi MD,b and Henry W. Lim MDb| |
J Drugs Dermatol. 2016;15(4):384-387.
Perry Robins MD, Eliot F. Battle Jr. MD, Andrew F. Alexis MD MPH, Fran Cook-Bolden MD, Yasser Alqubaisy MD, Michael P. McLeod MS, Keyvan Nouri MD, Nazanin Saedi MD, Henry H. Chan MBBS MD PhD, Jeffery S. Dover MD, Vasanop Vachiramon MD, Amy J. McMichael MD, Jason J. Emer MD, Candrice R. Heath MD, Susan C. Taylor MD, Joshua Zeichner MD| |
J Drugs Dermatol. 2012;11(6):708-713.
Leon H. Kircik MD, Neh Onumah MD, Joshua A. Zeichner MD, Elena Sotiriou MD PhD, Christina Goussi MD, Aimilios Lallas MD, Eleni Chovarda MD, Zoe Apalla MD, Elisabeth Lazaridou MD PhD, Demetris Ioannides MD PhD| |
George Chrysos MD PhD, Sotirios Mikros MD, Stelios Kokkoris MD, Androula Pastelli MD, George Kontochristopoulos MD PhD| |
Amrollah Ahmadi MD, Babak Barikbin MD, Mohsen Naseri MD PhD, Mohammadali Mohagheghi MD| |
Methods: In a randomized, double-blind clinical trial, 28 patients (11 male, 17 female) with chronic plaque-type psoriasis were randomly assigned to treatment and placebo groups. Patients in treatment group received HESA-A tablet 25 mg/kg twice a day orally and control group received placebo with the same method for 6 months and were followed clinically during the study.
Results: At the end of study, in the treatment group psoriatic plaques were absent (no evidence of psoriasis or complete remission) in 9 cases (64.2%) and was very mild (controlled, but not entirely cleared) in 5 cases (35.8%). Disease relief was observed in 10 (71.4%) patients after 4 months, in 2 cases (14.3%) after 5 months and in 2 (14.3%) other patients after 6 months while none of the controls showed disease improvement.
Conclusion: This study showed rapid and good efficacy and safety of HESA-A in the treatment of plaque-type psoriasis.
Magdalene Dohil MD, Leslie Baumann MD, Hema Sundaram MD, Jason Emer MD| |
Providing optimal patient outcomes continues to be a challenge in the treatment and management of dermatologic conditions. Most physicians and patients are interested in doing everything possible to optimize the treatment of their skin disease. This is especially important in treating patients with chronic disorders such as eczema, acne, psoriasis, rosacea, photodamage and the negative effects of aging. Physicians and patients often explore the therapeutic benefits of natural ingredients as alternative or complementary treatments to conventional methods. It is important that dermatologists remain up-to-date on the research and new advances in skin care products with natural ingredients.
This is a CME supplement; visit the JDD Medical Education Library to participate in this activity and earn 1 category 1 CME Credit.
E. Eugene Bain III MD,a Shane A. Meehan MD,a Elizabeth K. Hale MDa,b| |
J Drugs Dermatol. 2014;13(5):598-600.
Michael Lundin BS,a Simran Chawa BS,a Amit Sachdev MD,b Dhaval Bhanusali MD,c Kristina Seiffert-Sinha MD,d Animesh A. Sinha MD PhDd| |
J Drugs Dermatol. 2014;13(4):409-413.
Joseph Bikowski MD FAAD| |
Isaac Zilinsky MD,a Perry Robins MD,b Alon Liran MD,a Oren Weissman MD,a Eran Millet MD,a Nimrod Farber MD,a Josef Haik MD,a Eyal Winkler MDa| |
Although Mohs surgery is considered a skin-sparing technique, when dealing with aggressive skin tumor that penetrates the deep tissues, the Mohs surgeon usually sacrifices uninvolved skin. We present our technique of 3D Mohs as a new concept for skinsparing surgery. After raising a skin flap above the residual tumor, Mohs resection was performed on the deep tissues horizontally and simultaneously on the inner plan of the flap vertically. When "clear" borders were achieved, the skin flap was sutured back into place. The results show that the defect was significantly smaller, and the hair on the Mohs-treated vertical flap continue to grow, thus contributing to a more aesthetic outcome. We conclude that careful use of the 3D Mohs technique as we describe spares the healthy uninvolved skin and offers better aesthetic and functional result.
J Drugs Dermatol. 2011;10(11):1271-1274.
Alan B. Fleischer Jr MD| |
Rosacea and acne are chronic inflammatory skin conditions that share an inflammatory pathogenesis, but clinically remain quite distinct. Although many have long assumed that these conditions are primarily infectious, emerging evidence suggests that inflammation plays a critical role in the pathogenesis of these disorders. Part of the innate immune system, the antimicrobial and proinflammatory cathelicidins, may be downregulated by both azelaic acid and subantimicrobial doxycycline. In acne, the creation of papules, pustules and nodules is clearly mediated through immune mechanisms, and the antiinflammatory effects of retinoids play a key role in management. Recent observations help us understand in greater detail the role that inflammation plays in these two diseases, and the mechanisms by which commonly used medications exert their effect by modulating inflammatory processes. This review will present and synthesize recently acquired information as it relates to inflammatory acne and rosacea pathogenesis and clinical management.
J Drugs Dermatol. 2011;10(6):614-620.
Cutaneous Lupus Erythematosus in a Patient Undergoing Intravitreal Bevacizumab Injections: Case Report and Review of the Literature
Nathan Cleaver DO,a James Ramirez MD,b and Stuart Gildenberg MDa| |
CASE PRESENTATION: We report a case of a 63 year-old Caucasian female who presented with subacute cutaneous lupus erythematosus six weeks after initiating two intravitreal injections of bevacizumab for central serous choroidopathy.
CONCLUSION: We report the first documented case of a cutaneous lupus erythematosus eruption following bevacizumab administration as a monotherapy.
J Drugs Dermatol. 2013;12(9):1052-1055.
Yevgeniy Balagula MD,a Melissa P. Pulitzer MD,b Robert G. Maki MD,c Patricia L. Myskowski MDa| |
Imatinib mesylate (STI 571; Gleevec; Novartis Pharmaceuticals, Basel, Switzerland) is an orally available tyrosine kinase inhibitor that targets a constitutively activated BCR-ABL tyrosine kinase with additional inhibitory effects on platelet derived growth factor (PDGF) receptors alpha and beta, and KIT. It has revolutionized the treatment of adult and pediatric patients with Philadelphia chromosome positive chronic myelogenous leukemia (CML) and is also FDA-approved for KIT-positive advanced gastrointestinal tumor (GIST) and dermatofibrosarcoma protuberans. A wide spectrum of dermatologic toxicities has been associated with this agent, among which a maculopapular rash is the most common event. In addition, a variety of pigmentary abnormalities of the skin and mucosal surfaces have been reported. Hypopigmentation is a well-recognized adverse effect. In contrast, paradoxical hyperpigmentation has only rarely been documented. In this case report we describe imatinib-induced cutaneous hyperpigmentation and graying of hair occurring in the same patient with dermatofibrosarcoma protuberans treated with imatinib.
J Drugs Dermatol. 2011;10(9):1062-1066.
Lawrence Transfer Factor: Transference of Specifc Immune Memory by Dialyzable Leukocyte Extract from a CD8+ T Cell Line
Jason F. Wang BA,a Andrew J. Park BA,b Tina Rendini RN,c William R. Levis MD| |
Lawrence transfer factor (TF) is defned as dialyzable leukocyte extract (DLE) that can transfer antigen-specifc cell-mediated immunity from a person testing positive for the antigen in a delayed type hypersensitivity skin test manner to a person negative for the same antigen.
A recent article by Myles et al1 has identifed a DLE isolated from an established CD8+ T cell line capable of transferring antigen-specifc immunity. The DLE contains a portion of the beta chain of the T cell receptor and additional nucleotide and protein factors that are being subjected to further modern biochemical analysis.
After months of study that included interviews of TF physician-scientists, we conclude that an antigen-specifc TF exists for most, if not all, antigens. By working from a CD8+ T cell line with modern biochemical technology, it should be possible to identify and patent products capable of treating infectious diseases, antigen-responsive cancers, and autoimmune disorders.
J Drugs Dermatol. 2017;16(12):1198-1206.
Heather K. Hamilton MD,a Evelyn Lilly MD,a,b Kenneth A. Arndt MD,a and Jeffrey S. Dover MD FRCPCa| |
OBJECTIVE: To determine the prevalence of psychotropic medication use in cosmetic dermatology patients compared to the prevalence of such medication use in general dermatology patients.
METHODS & MATERIALS: The study was a retrospective chart review of female patients, 18 or older, new to a private practice. Exclusion criteria included dermatologic disorders with known psychosocial comorbidity. Psychotropic medication use was recorded.
RESULTS: The percentage of subjects in the medical group (n=156) who reported using psychotropic medications was 22.2% compared to 26.8% in the cosmetic group (n=154; P=0.09).
CONCLUSION: The prevalence of psychotropic medication use among all dermatology patients in our practice was relatively high, but there was no statistically significant difference in the rate of psychotropic medication use in cosmetic dermatology patients compared to general dermatology patients.
J Drugs Dermatol. 2016;15(7):858-861.
The Two Faces of Fractionated Photodynamic Therapy: Increasing Efficacy With Light Fractionation or Adjuvant Use of Fractional Laser Technology
Margit L.W. Juhasz MD,a,b Melissa K. Levin MD,a and Ellen S. Marmur MDa,c| |
Bone Mineral Density in Patients With Alopecia Areata Treated With Long-Term Intralesional Corticosteroids
Aman Samrao MD,a Jennifer M. Fu MD,a,b Steven T. Harris MD,b and Vera H. Price MDa| |
Methods: In this retrospective, cross-sectional case series, 18 patients with patchy alopecia areata treated at 4- to 8-week intervals with intralesional triamcinolone acetonide for at least 20 months were evaluated for BMD using dual-energy x-ray absorptiometry (DXA). Follow-up DXA measurements were obtained in those with abnormal findings.
Results: Nine out of 18 patients (50%) had abnormal DXA results. Patients with the following risk factors were more likely to have abnormal BMD: age older than 50 years, body mass index less than 18.5 kg/m2, lack of weight-bearing exercise, smoking history, postmenopausal status, past stress fracture, family history of osteopenia or osteoporosis, and a cumulative intralesional triamcinolone acetonide dose of greater than 500 mg.
Conclusion: Patients with patchy alopecia areata who receive chronic intralesional triamcinolone acetonide therapy should be counseled on preventive measures for osteoporosis and monitored for effects on BMD.
J Drugs Dermatol. 2013;12(2):e36-e40.
David S. Lee MD,a* Nicholas Gulati BA,b* Frank Martiniuk PhD,c William R. Levis MDd| |
J Drugs Dermatol. 2011;10(10):1192-1194.
Michael E. Farhangian BA,a Amy J. McMichael MD,a Karen E. Huang MS,a and Steven R. Feldman MD PhDa,b,c| |
OBJECTIVE: To better understand how AA was being treated in the United States, what type of patients are seen for AA, and what physicians treated them.
METHODS: We analyzed data from the National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2001 to 2010. We tabulated patient characteristics, the physicians who treated AA and what treatments were prescribed for AA.
RESULTS: There were an estimated 2.6 million outpatient visits for AA. Patients with AA were most commonly treated by a dermatologists (84.8%). Patients were most commonly treated with topical and injected corticosteroids (61.0%) followed by minoxidil (5.9%) and topical tacrolimus (5.7%). Males made fewer visits per 1,000 capita compared to females (P=0.01).
LIMITATIONS: The NAMCS and NHAMCS do not record severity of disease data.
CONCLUSIONS: Topical and injected corticosteroids are the mainstay of treatment for AA, however the use of steroid sparing agents such as minoxidil is low. Despite no studies demonstrating efficacy, topical tacrolimus was used almost as frequently as minoxidil.
J Drugs Dermatol. 2015;14(9):1012-1014.
Eruptive Squamous Cell Carcinomas With Keratoacanthoma-like Features in a Patient Treated with Sorafenib
J Drugs Dermatol. 2011;10(3):308-310.
Maritza Perez MD, Janiene Luke MD, Anthony Rossi MD| |
Melasma is an acquired skin condition characterized by irregular brown or hyperpigmented patches typically located on the forehead, cheeks, nose, chin and upper lip. The pathogenesis of melasma is not completely understood, but is thought to be influenced by genetics, UV exposure, thyroid dysfunction and hormonal influences from either pregnancy or hormonal therapeutic medications. Peoples of Latin descent comprise a vast array of skin colors and skin phototypes. Similarly, disorders of pigmentation, particularly melasma, occur more frequently in people of Latin descent when compared to the general population. Melasma can be particularly distressing to patients and has been shown to impact a patient's quality of life in several studies. These factors can raise significant quality of life issues and therefore treatment is not only significant for improving patient clinical outcomes, but is crucial in improving important psychological and emotional aspects of patients' overall well being. This article provides a stepwise approach to the treatment of melasma based on current literature recommendations.
J Drugs Dermatol. 2011;10(5):517-523.
Stanislav N. Tolkachjov MD,a Philip Y. Sun MS,b and Alina G. Bridges DOa| |
Pyoderma gangrenosum (PG) is a neutrophilic, ulcerative dermatosis that can develop at sites of cutaneous trauma, including surgical incisions, a phenomenon known as pathergy. The characteristic lesion is a painful, rapidly expanding ulceration with a violaceous undermined border.1 A biopsy taken from the expanding violaceous border shows predominantly neutrophilic dermal inflammation with neutrophilic abscess formation.
The etiology of PG appears to be variable among patients, as about a half of the reported cases are associated with systemic disease such as inflammatory bowel disease, rheumatoid arthritis, or myeloproliferative disorders, while the other half seem to be idiopathic.2 PG is difficult to diagnose as other etiologies, including infectious, vasculitic, and other inflammatory dermatoses, must be excluded.1 Histopathologic and biochemical markers of PG, such as dermal neutrophilic infiltrate or overexpression of interleukin-8,3 respectively, are not pathognomonic. Given that several drugs, such as hydralazine, mesalamine, and sunitinib, are reportedly associated with PG, failure to recognize this association and stop these medications may delay diagnosis and therapy. We report a case of idiopathic postoperative PG following video-assisted thoracic surgery (VATS).
J Drugs Dermatol. 2017;16(7):711-713.
Richard R. Winkelmann DO,a James Del Rosso DO FAOCD,b and Darrell S. Rigel MD MSc| |
J Drugs Dermatol. 2015;14(3):254-259.
Efficacy and Safety of the Topical Sensitizer Squaric Acid Dibutyl Ester in Alopecia Areata and Factors Influencing the Outcome
Ajith C. MD, Somesh Gupta MD DNB, Amrinder Jit Kanwar MD MNAMS| |
Objective: To study efficacy, safety, and factors influencing the outcome in the treatment of alopecia areata.
Method: During a 4-year period, 70 patients of alopecia areata, unresponsive to conventional therapies, were treated with SADBE for a period of 4 months and thereafter depending on the response with initial therapy. The percent scalp hair loss was calculated using “Severity of Alopecia Tool” (SALT) score before and after the therapy.
Results: Out of 70 patients, 6 were lost to follow-up and 4 could not develop sensitization; therefore, data of 60 patients was available for analysis. The overall success rate was 43%. In patients with <50% scalp involvement; the success rate was better (68%) than in those with >50% involvement (29%). The response was better in patients with late onset and shorter duration of disease. Family history of alopecia areata or other autoimmune diseases, personal or family history of atopy, presence of auto antibodies in serum, and presence of nail changes were associated with poorer prognosis. Out of 26 patients who responded, relapse occurred in 21 (81%) patients.
Conclusion: In conclusion, SADBE is an effective and well-tolerated mode of therapy in Indian patients of AA, although the long-term results of SADBE were not encouraging.
Aikaterini I. Liakou MD,a Michael J. Theodorakis MD,b Bodo C. Melnik MD PhD,c
Apostolos Pappas PhD,d and Christos C. Zouboulis MD PhDa
METHODS: Nutritional clinical studies in dermatology have been reviewed using the MedLine literature source and the terms "diet" or "nutrition" and "skin".
RESULTS & CONCLUSIONS: The data on the relationship between nutrition and skin are until now controversial and much more work is needed to be done to clarify possible etiological correlations.
J Drugs Dermatol. 2013;12(10):1104-1109.
Pimecrolimus 1% Cream in the Treatment of Cutaneous Lesions of Pemphigus Vulgaris: A Double-blind, Placebo-controlled Clinical Trial
Fariba Iraji MD, Ali Asilian MD, Amir Hossein Siadat MD| |
Carlos Galzote,a Mini Thomas PhD,b and Mukta Sachdev MDc| |
J Drugs Dermatol. 2016;15(10):1244-1248.
Transitioning From Brand to Generic With Topical Products and the Importance of Maintaining the Formulation and Therapeutic Profiles of the Original Product: Focus on Clocortolone Pivalate 0.1% Cream
James Q. Del Rosso DO FAOCDa and Leon H. Kircik MDb| |
J Drugs Dermatol. 2014;13(suppl 7):s77-s83.
Efstathios Rallis MD, Afrodite Economidi MD, Constantinos Verros MD, Pavlos Papadakis MD| |
Richard L. Gallo MD PhD,a Vivian W. Bucay MD,b Ava T. Shamban MD,c Janice Lima-Maribona DO,d Amy B.
Lewis MD,e Cherie M. Ditre MD,f Flor A. Mayoral MD,g Michael H. Gold MDh
J Drugs Dermatol. 2015;14(7):669-674.
Leon Kircik MD| |
The Sequence of Inflammation, Relevant Biomarkers, and the Pathogenesis of Acne Vulgaris: What Does Recent Research Show and What Does it Mean to the Clinician?
James Q. Del Rosso DO FAOCDa and Leon H. Kircik MDb| |
J Drugs Dermatol. 2013;12(suppl 8):s109-s115.
Neil S. Sadick MD, Michel Le Maître MD, Christine Coutanceau MS,Vincent Sibaud MD, Christelle Merial-Kieny PhD| |
Objective Melanin Measurements: Review of Novel Dosimetry Guidance Device for Intense Pulsed Light in Aesthetic Treatments
E. Victor Ross MD,a Travis W. Blalock MD,a Douglas Winstanley DO,a Joel L. Cohen MD,b and James J. Childs PhDc| |
METHODS: A handheld meter was applied to non sun-damaged skin on the back of volunteers to measure skin pigmentation prior to treatment with IPL light sources over a range of pulse widths and ascending fluences. Curves for maximum epidermal tolerances as a function of pigmentation were determined. These curves were then tabulated for each pulse width in device software to provide guidance in the selection of fluences. Based on these findings, the device was applied in over 300 patients at a comprehensive laser and cosmetic dermatology center.
RESULTS: A pigment meter evaluation led to treatment parameter guidance in intense pulsed light applications. These suggested ranges for settings based on the melanin index score proved useful, accurate, and safe in applications over a broad range of skin colors and across various anatomic units of the skin.
CONCLUSION: A pigment meter can be used to identify appropriate settings with IPL treatments in order to enhance safety and efficacy when treating epidermal pigmented lesions, vessels, general photodamage and excessive hair (where the principles of selective photothermolysis are applied).
J Drugs Dermatol. 2016;15(4):421-432.
Sean D. Doherty MD, Sylvia Hsu MD| |
Methods: The medical records of 48 patients treated with thalidomide at Baylor College of Medicine (Houston, TX) were retrospectively reviewed to determine the conditions treated with thalidomide, dosing, effi cacy, treatment duration, side effects, adverse events, and reason for discontinuing therapy.
Results: Forty-eight patients (men=18, women=30) with a mean age of 49.6 years (range: 20-79) were included in this study. Patients were treated for prurigo nodularis, discoid lupus erythematosus, tumid lupus erythematosus, subacute cutaneous lupus erythematosus, systemic lupus erythematosus, lichen planus, lichen planopilaris, cutaneous sarcoidosis, and prurigo nodularis. All conditions were refractory to standard therapy. Patients were treated for a mean of 7.5 months (range: 3 days to 70 months). In most of the disorders, a majority of patients experienced clinical improvement. The most common reason for discontinuation of therapy was side effects, the most frequent being peripheral neuropathy.
Limitations: This study was limited by being retrospective in nature.
Conclusion: Thalidomide effectively treats some dermatologic conditions that are refractory to standard medications. There are inconveniences associated with obtaining the medication and it is expensive. Physicians must be vigilant for possible side effects, especially peripheral neuropathy.
The Current State of Dermatologists’ Familiarity and Perspectives of Biosimilars for the Treatment of Psoriasis: A Global Cross-Sectional Survey
Iviensan F. Manalo MD,a Kathleen E. Gilbert MD,b and Jashin J. Wu MDc| |
BACKGROUND: Biologic patent expiration, accelerated approval pathways, and business interests of third party payers and the biopharmaceutical industry are driving the development of biosimilars to treat immune-mediated disorders like psoriasis. No studies have investigated dermatologists’ familiarity and perspectives of biosimilars.
OBJECTIVES: To assess: (1) dermatologists’ familiarity with biosimilars and interchangeability and (2) their perspectives toward biosimilar properties, including interchangeability, indication extrapolation, and immunogenicity risk.
METHODS: For this prospective survey study, we distributed electronic and paper questionnaires to dermatologists from selected societies and attendees at the 73rd annual American Academy of Dermatology meeting between March 20, 2015 and May 30, 2015. Primary outcome was dermatologists’ familiarity with biosimilars. Secondary aims included dermatologists’ confidence in biosimilar efficacy and safety, familiarity concerning the concept of interchangeability and perspectives regarding indication extrapolation, interchangeability, and immunogenicity risk.
RESULTS: Of the 116 total dermatologists who completed the questionnaire, 73 (62.9%) were slightly to very unfamiliar with biosimilars. On a 5-point Likert scale, dermatologists were somewhat to very concerned with the practice of interchangeability (3.4±1.1) and slightly uncomfortable to fairly comfortable in prescribing biosimilars for an extrapolated indication (3.3±1.0).
CONCLSUIONS: Our survey identified that the majority of dermatologists were unfamiliar with biosimilars. Dermatologists were consistently concerned regarding safety issues surrounding the practice of interchangeability without provider knowledge.
J Drugs Dermatol. 2017;16(4):336-343.
Amir A. Bajoghli MD, Jane Y. Yoo MPP, Duyen T. Faria DO| |
Methods: The authors present a unique dual approach to treatment of MPTT in both the excision and wound revision phases. First, Mohs micrographic surgery is utilized for more discrete removal of malignant tissue, as opposed to wide excision. Then, a novel device called DermaClose® RC is used in wound revision, a device that has proven to be more effective in promoting wound closure than traditional suturing.
Results: Mohs micrographic surgery was used to excise the tumor in three stages. The resulting irregular wound measured 6.3 x 5.6 cm, and was repaired with the device. Following the application of the device, the wound reduced in size to 1.5–1.0 cm. Postoperatively, the patient had no evidence of recurrent disease at seven months.
Conclusion: Use of the DermaClose RC tissue expander following a Mohs surgical procedure provides an effective functional and cosmetic alternative to a skin graft which creates a donor site wound and creates a more complicated, time consuming procedure. The dual approach discussed here–of Mohs micrographic surgery performed in tandem with wound revision via the tissue expanding device is one that may yield promising benefits but warrants further evaluation.
Ann G. Martin. MD| |
James R. Schwartz PhD| |
J Drugs Dermatol. 2016;15(2):140-144.
Vitamin A and Its Derivatives in Experimental Photocarcinogenesis: Preventive Effects and Relevance to Humans
Stanley S. Shapiro PhD,a Miri Seiberg PhD,b and Curtis A. Cole PhDc| |
J Drugs Dermatol. 2013;12(4):458-463.
A Substitute for Skin Grafts, Flaps, or Internal Tissue Expanders in Scalp Defects Following Tumor Ablative Surgery
Moris Topaz MD,a,b Narin-Nard Carmel BSc,c Guy Topaz BSc,c Isaac Zilinsky MDd| |
OBJECTIVES: To evaluate the efficacy of the TopClosure® system in primary closure of moderate and large scalp defects, as a substitute for skin grafts, flaps, and tissue expanders.
METHODS: We report a retrospective series of 8 patients requiring resection of 9 scalp tumors resulting with moderate to large size defects that otherwise would have required reconstruction with skin grafts, flaps, or tissue expanders. TopClosure® was applied for intraoperative cycles of stress-relaxation, followed, when indicated, by additional steps of mechanical creep and scar secure.
RESULTS: Skin defects, averaging 3.5 cm, were managed by TopClosure®, enabling, primary closure in all wounds. Immediate wound edge approximation was reached through stress-relaxation in 2 wounds by heavy tension sutures within one hour. Further skin stretching by mechanical creep was required in 7 wounds, achieving staged primary closure in an outpatient setting. TopClosure® was further applied to secure the skin for up to 3 weeks following surgery.
CONCLUSIONS: The TopClosure system, effectively, aided closure of moderate and large scalp defects by stress-relaxation and mechanical creep and serving as a topical tension-relief platform for tension sutures, allowing mobilization of skin and subcutaneous tissue without undermining or need of drainage, for early, direct wound closure. Local complications were minimal and donor site morbidity was eliminated. Surgical time, hospital stay and costs were reduced, and post-operative wound aesthetics were improved.
J Drugs Dermatol. 2014;13(1):48-55.
Pearl E. Grimes MD| |
OBJECTIVE: To assess the efficacy and safety of bimatoprost 0.03% alone and in combination with a topical steroid (mometasone) compared with mometasone alone in patients with nonsegmental vitiligo on nonfacial areas in a proof-of-concept study.
METHODS: This randomized, double-blind, controlled study was conducted over a 20-week treatment period. Patients were randomized to 1 of 3 treatment groups: bimatoprost monotherapy (n=11), bimatoprost plus mometasone (n=10), and mometasone plus placebo (n=11). The primary outcome was global response at week 20, based on an investigator’s assessment of improvement score of at least 5 (at least 50%–75% improvement from baseline) on an 8-point scale (0=worse; 7=cleared). Other outcomes included global response at other visits, response by anatomic site, change from baseline lesion severity (overall and by site), and safety.
RESULTS: Because of a lack of response observed for the primary end point, a post hoc analysis with a less stringent definition of response (score of ≥4 [25%–50% improvement]) was conducted. In this analysis, 46% of the bimatoprost plus mometasone group responded overall compared with 18% in the bimatoprost monotherapy group, and no patients in the mometasone plus placebo group. Greater response rates were observed in both bimatoprost groups compared with the mometasone plus placebo group starting at week 12. There were no differences among groups in signs and symptoms of irritation.
CONCLUSIONS: Bimatoprost alone or with mometasone provided greater repigmentation than treatment with mometasone alone. Larger studies that also assess facial lesions are warranted.
J Drugs Dermatol. 2016;15(6):703-710.
Stephanie J. Kang DO,a Scott A. Davis MA,a Steven R. Feldman MD PhD,a,b,c and Amy J. McMichael MDa| |
OBJECTIVE: To determine whether racial or ethnic groups are treated differently for dyschromia. The secondary objective is to discover the main treatments used and determine trends over time in demographics.
METHODS: We searched the 1993-2010 National Ambulatory Medical Care Survey (NAMCS) for visits associated with a diagnosis of dyschromia (ICD-9 codes 709.00 or 709.09). The demographics and leading treatments were tabulated, and trends over time were assessed by linear regression.
RESULTS: There were about 24.7 million visits for dyschromia over the 18-year period. Among 5,531,000 patients with the sole diagnosis of dyschromia, there were 2,800 visits from females and 1,200 visits from males per 100,000 population. Females were more likely to receive prescription combination therapy for dyschromia than males by a ratio of 10 to 1. Leading treatments overall prescribed by dermatologists included hydroquinone, topical corticosteroids, and retinoids. Asians were 27% more likely to receive a combination therapy than non-Asians. African Americans and Hispanics were less likely to have a procedure performed for dyschromia.
LIMITATIONS: Data are based on a number of ambulatory care visits, which does not allow direct estimation of prevalence.
CONCLUSIONS: Dyschromia is a significant concern for many patients, and this is especially true among patients of color. Treatment for dyschromia is influenced by skin type, and thus ethnic or racial groups are treated differently. Studies have shown that combination therapy may offer better results than a single medication for hyperpigmentation disorders. Combination agents may be underutilized in African Americans and Hispanics for dyschromia.
J Drugs Dermatol. 2014;13(4):401-406.
Wendy E. Roberts MD| |
J Drugs Dermatol. 2014;13(4):472-482.
Objective: The objective of this study was to determine the role of immunity and inflammation in androgenetic alopecia in women and modulate therapy according to inflammatory and immunoreactant profiles.
Materials and Methods: 52 women with androgenetic alopecia (AA) underwent scalp biopsies for routine light microscopic assessment and direct immunofluroescent studies. In 18 patients, serologic assessment for antibodies to androgen receptor, estrogen receptor and cytokeratin 15 was conducted.
Results: A lymphocytic folliculitis targeting the bulge epithelium was observed in many cases. Thirty-three of 52 female patients had significant deposits of IgM within the epidermal basement membrane zone typically accompanied by components of complement activation. The severity of changes light microscopically were more apparent in the positive immunoreactant group. Biopsies from men with androgenetic alopecia showed a similar pattern of inflammation and immunoreactant deposition. Serologic assessment for antibodies to androgen receptor, estrogen receptor or cytokeratin 15 were negative. Combined modality therapy with minocycline and topical steroids along with red light produced consistent good results in the positive immunoreactant group compared to the negative immunoreactant group.
Conclusion: A lymphocytic microfolliculitis targeting the bulge epithelium along with deposits of epithelial basement membrane zone immunoreactants are frequent findings in androgenetic alopecia and could point toward an immunologically driven trigger. Cases showing a positive immunoreactant profile respond well to combined modality therapy compared to those with a negative result.
J Drugs Dermatol. 2011;10(12):1404-1411.
Maha Fadel PhD, Manal Salah MD, Nevien Samy PhD, Mona Soliman MD| |
Objectives: To evaluate the efficacy and tolerability of liposomes loaded methylene blue (LMB) based photodynamic therapy in patients with mild-to-moderate acne vulgaris in a randomized, controlled and investigator blinded study.
Materials and methods: Liposomes loaded methylene blue (LMB) was prepared and studied for different pharmaceutical properties and formulated in hydrogel (MB 0.1%). Permeability and selective sebaceous gland targeting in mice skin was studied. Gel containing LMB was used for treating 13 patients complaining of mild-moderate acne vulgaris once a week for two weeks. Efficacy evaluation included changes in lesions counts, clinical assessments of clinical improvement by patients and evaluating dermatologists. Pain and local adverse effects were also evaluated.
Results: The mechanism of the drug released from liposomes (both in pH=5.5 and in pH=7.2) was following zero order kinetics with significant increase in the drug released in pH=5.5. Drug released from free methylene blue (FMB) gel was significantly higher (P≤0.05) with Higuichi’s diffusion model than LMB gel, which followed zero order kinetics. Free MB gel showed superficial destruction in the mice hair shaft while LMB showed complete destruction of pilosebaceous unit. After only two sessions, there was a 83.3% reduction in the number of inflammatory acne lesions and a 63.6% reduction in the number of non-inflammatory acne lesions. At 12 weeks, 90% of patients had a moderate-to-marked improvement of their acne in the treated areas. Most patients had no pain; also no serious adverse side effects were recorded. All the patients had no edema. Slight transient hyperpigmentation was seen only in three patients.
Conclusion: Liposomal MB hydrogel selectively delivered MB to sebaceous gland and was effective in photodynamic treatment of mild-to-moderate acne vulgaris.
Objective: The aim of this prospective study was to identify possible characteristic trichoscopy patterns of diseases leading to primary cicatricial alopecia.
Methods: Trichoscopy was performed in a total of 1,884 consecutive patients presenting with hair loss. In this group, 84 patients were diagnosed with cicatricial alopecia and 1,800 patients with non-cicatricial alopecia. Sixty healthy persons served as healthy controls. Trichoscopy was performed with the use of Fotofinder II videodermoscopy system. Following unique or characteristic features were identified: scattered dark-brown discoloration of the skin, large yellow dots and thick arborizing vessels in cutaneous (discoid) lupus erythematosus (n=20), tubular perifollicular scaling and elongated blood vessels in lichen planopilaris (n=28), minor perifollicular scaling in frontal fibrosing alopecia (n=19), tufted hairs with starburst pattern perifollicular hyperplasia in folliculitis decalvans (n=9) and large, "3D" yellow dots imposed over dystrophic hairs in dissecting cellulitis (n=8).
Results: All patients with cicatricial alopecia trichoscopy showed white and milky-red areas lacking follicular openings. These features were not found in patients with non-cicatricial alopecia or healthy controls.
Conclusion: These results indicate that trichoscopy may be applied as a quick and non-invasive auxiliary method in differential diagnosis of diverse diseases leading to cicatricial alopecia, such as cutaneous lupus erythematosus, classic lichen planopilaris, frontal fibrosing alopecia, folliculitis decalvans, and dissecting cellulitis.
J Drugs Dermatol. 2012;11(6):753-758
Methods: Five patients were enrolled in the study. All patients presented with epidermal pigmented lesions on the arms, hands, chest, or legs. Patients were all female with a mean age of 59 years. At the initial evaluation, baseline pigment readings were determined with a pigment meter. Test spots were performed with escalating doses of alexandrite laser (ClearScan ALX, Sciton, Palo Alto, CA) deployed by a 7-mm spot equipped with a 30 mm x 30 mm scanner and a 10-ms pulse duration. Contact cooling was used, and temperature was maintained at 18°C to 20°C. Patients returned 4 to 7 days after test spots for evaluation for the purpose of optimizing settings. The highest settings that allowed for epidermal preservation and crusting of the hyperpigmented lesions were applied for the remainder of the treatment zones. Determinations of improvement were made by evaluation of photographs with standard settings using polarized and nonpolarized images. At each appointment, baseline pigment measurements were made to ensure there were no significant changes between treatment sessions. Two treatment sessions were performed approximately 4 weeks apart, and the final evaluation was 3 months after the final treatment.
Results: Evaluation by a panel of blind observers determined a mean improvement of approximately 30%. Darker lesions responded better than lighter lesions. So-called low-contrast lesions performed the poorest. Pain was approximately 2/10 with the use of 5% lidocaine numbing cream applied approximately 45 minutes before each procedure. Pain was most severe where there was underlying hair.
Conclusion: A long-pulse alexandrite laser equipped with contact cooling can achieve significant pigmentation improvement.
J Drugs Dermatol. 2012;11(11):1327-1330.
Blockade of Melanin Synthesis, Activation and Distribution Pathway by a Nonprescription Natural Regimen Is Equally Effective to a Multiple Prescription-Based Therapeutic Regimen
Carl Thornfeldt MD,a,b Ronald L. Rizer PhD,c Nathan S. Trookman MDd| |
OBJECTIVE: To measure the effectiveness of a novel blend of primarily natural ingredients that inhibits all but one of the steps in melanin synthesis, activation and distribution. Three common types of HP were treated and compared with one of the most commonly prescribed available regimens. This comprises two prescription products and two nonprescription products containing known depigmenting lightening ingredients.
MATERIALS and METHODS: The initial trial consisted of 56 females of 3 different races were treated in a 3-armed parallel, investigatorblinded prospective controlled clinical trial of 18 weeks duration. The treatment phase was 12 weeks long, followed by a 6 week, nontreatment regression phase. This trial was conducted in the winter at over 6,000 feet above sea level. The natural ingredient (NI) blend consists of two cosmeceutical products together containing 22 ingredients. A second 1-year open trial of 31 panelists of 3 races was instituted to document continual improvement using both NI products without irritation and sensitization.
RESULTS: The novel herbal blend regimens had comparable efficacy in treating HP and preventing rebound of mottled HP, dyschromia and melasma as the commercial regimen containing two prescription products. The 12-month open study demonstrated continued visible improvement of the HP with NI regimens without irritation and sensitization.
CONCLUSION: The novel primarily natural ingredient product regimens are equally effective in treating three types of cutaneous HP as is a regimen containing prescription hydroquinone 4%, tretinoin 0.05% and two nonprescription leave on products.
J Drugs Dermatol. 2013;12(12):1449-1454.
Clinical Efficacy and Safety of a Multimodality Skin Brightener Composition Compared With 4% Hydroquinone
Elizabeth T. Makino BS CCRA MBA,a James H. Herndon Jr. MD,b Monya L. Sigler PhD,b Vincent Gotz MS MBA,c John Garruto BS,a and Rahul C. Mehta PhDa| |
J Drugs Dermatol. 2013;12(3 suppl 1):s21-s26.
Methods: This study was conducted to assess the effect of systemic isotretinoin on the serum level of folic acid. Sixty-one patients, including 38 women and 23 men (mean age 23.6 ± 6 years) with severe or moderate acne that was resistant to conventional treatments, were supplemented with 0.5 mg/kg/d of oral isotretinoin for 30 days. They were instructed not to use any other drugs having an effect on the folic acid level nor change their diet. The serum levels of folic acid were measured at the baseline and at the end of the treatment period. Statistical analyses were carried out using the paired t test.
Results: Mean levels of folic acid were 26.75 ± 9.42 nmol/L at baseline, and and 23.6 ± 8.42 nmol/L after 30 days of isotretinoin supplementation. This showed a significant decrease in the serum level of folic acid (P=.008).
Conclusion: Given the significant decrease in the serum level of folic acid following a 30-day use of oral isotretinoin in acne patients, and considering the important role of folic acid in metabolic functions, we recommend further studies to assess the effect of longer periods of isotretinoin treatment, in addition to studies including other relevant factors in folic acid metabolism (e.g., serum homocysteine levels). Moreover, folic acid supplementation in acne patients using isotretinoin is recommended.
J Drugs Dermatol. 2012;11(9):e23-e24.
Clinical Efficacy and Safety of a Multimodality Skin Brightener CompositionCompared With 4% Hydroquinone
Elizabeth T. Makino BS MBA,a James H. Herndon Jr. MD,b Monya L. Sigler PhD,b Vincent Gotz MS MBA,c John Garruto BS,a and Rahul C. Mehta PhDa
aSkinMedica, Inc, Carlsbad, CA bThomas J. Stephens & Associates, Inc, Carrollton, TX cProPharmaCon, LLC, Carlsbad, CA
J Drugs Dermatol. 2012;11(12):1478-1482.
Efficacy and Tolerability of Two Commercial Hyperpigmentation Kits in the Treatment of Facial Hyperpigmentation and Photo-Aging
Objective: This investigator-blinded, randomized trial was undertaken to compare two commercial hyperpigmentation systems (kits) used for the treatment of facial hyperpigmentation and photo-aging.
Methods: Female subjects with at least mild facial hyperpigmentation and photo-aging were randomized to treatment with either the four product SkinMedica (SKM) regimen or the 7-product Obagi (OMP) regimen. Evaluations were conducted at baseline, 4, 8, and 12 weeks. Subjects were evaluated by the blinded investigator for clinical efficacy and tolerability using grading scales. Standardized digital photographs were taken at baseline and week 12. Self-assessment questionnaires were completed at week 12. Thirty-five females (SKM=17, OMP=18) completed the 12-week study.
Results: Both treatment regimens showed a significant improvement at week 12 (compared to baseline) for Overall Hyperpigmentation, Global Photo-aging and Sallowness. At week 12, there was no significant difference between treatment groups in Global Response to Treatment. Tolerability was good for both regimens based on investigator assessments. Subject self-assessments showed no consistent differences in efficacy between the two regimens. Similarly, there was no significant difference in subject satisfaction or intent to continue use between the two regimens.
Conclusion: This clinical study demonstrated that both systems were equally effective at reducing hyperpigmentation and global photo-aging in females with mottled pigmentation and photodamaged facial skin.
J Drugs Dermatol. 2012;11(8):964-968.
Suzanne Bruce MD| |
OBJECTIVE: The skin brightening complex was studied for efficacy and tolerability in subjects with moderate to severe facial hyperpigmentation.
METHODS: Subjects were instructed to apply skin brightening complex to the entire face twice daily and to follow a standard skin care regimen (facial cleanser, moisturizer, and sunscreen) during the course of the study. The study was conducted over a 12-week period and consisted of evaluation visits at baseline and at weeks 4, 8, and 12. At each visit, subjects were evaluated by an investigator for clinical efficacy and tolerability using grading scales. Standardized digital photographs and spectrophotometric assessments were also taken. Self-assessment questionnaires were completed at weeks 4, 8, and 12. To assess longer-term safety and efficacy, 10 subjects elected to continue treatment for an additional 12 weeks (24 weeks total), with evaluations at weeks 18 and 24.
RESULTS: Twenty-six subjects completed the 12-week study, and 8 subjects completed treatment for an additional 12 weeks (24 weeks in total). In the 12-week study, the skin brightening complex was shown to be effective and significantly improved Overall Hyperpigmentation at weeks 4, 8, and 12 compared with baseline. The skin brightening complex also significantly improved the Mottled Pigmentation Area and Severity Index ([MoPASI], a modified Melasma Area and Severity Index [MASI] scale) at weeks 8 and 12 compared with baseline. These efficacy benefits continued at 24 weeks. The product was well tolerated at all evaluation visits. Subject questionnaires showed 80% or more of the subjects reporting pigmentation improvement and satisfaction with the skin brightening complex at all evaluation visits.
CONCLUSION: This HQ-free skin brightening complex was effective and well tolerated in subjects with facial hyperpigmentation who were treated for as long as 24 weeks.
J Drugs Dermatol. 2013;12(3 suppl 1):s27-s31.
Macrene Alexiades-Armenakas MD PhD| |
Macrene Alexiades-Armenakas MD PhD holds three Harvard degrees, an extensive 20+ year background in research, and runs clinical and laboratory studies focusing on anti-aging skin care, acne, skin cancer, and lasers. Her clinical practice on Park Avenue is focused on dermatology and laser surgery. Dr. Alexiades holds a BA from Harvard University, where she was elected to Phi Beta Kappa and awarded the Fay Prize, the highest undergraduate honor, an MD from Harvard Medical School, and a PhD in Genetics from Harvard University. She is dual certified in medicine, surgery, and dermatology in the EU as well as the US.
Jeremy B. Green MD a board-certified dermatologist, graduated cum laude with a bachelor's degree from Princeton University. He completed his medical education at the Northwestern University Feinberg School of Medicine and the University of Miami Miller School of Medicine where he graduated with Alpha Omega Alpha (AOA) honors. He trained at the University of Miami Department of Dermatology where he served as its chief resident. Dr. Green currently practices with Dr. Brandt Dermatology Associates in Coral Gables, Florida, where they have chosen to make the Excel V laser an integral part of their practice.
Neil Sadick MD FAAD FAACS FACP FACPh a native New York City resident, completed his medical school training at SUNY Upstate. His residency, in internal medicine, was completed at Cornell/North Shore University/Memorial Sloan Kettering Medical Center. Dr. Sadick then went on to train in dermatology at New York Hospital, during which time he served as chief resident until the completion of his training in 1983. Dr. Sadick holds five board certifications in internal medicine, dermatology, cosmetic surgery, hair restoration surgery, and phlebology. Dr. Sadick is the medical director and owner of Sadick Aesthetic Surgery and Dermatology with locations on Park Avenue in New York City and Great Neck, Long Island.
David B. Vasily MD FAAD received a Bachelor of Science in Biology degree, with honors from Moravian College, magna cum laude. He obtained his medical degree from SUNY at Buffalo School of Medicine. Following his internship at Allentown Hospital, he completed a dermatology residency at Geisinger Medical Center in Danville, Pennsylvania. Dr. Vasily is board-certified by the American Board of Dermatology and a Fellow of the American Academy of Dermatology. He is a well-known dermatologist, who has also served as founder and president of Lehigh Valley Dermatology Associates, Ltd. since its inception over 30 years ago.
Home-Based Wrinkle Reduction Using a Novel Handheld Multisource Phase-Controlled Radiofrequency Device
Neil S. Sadick MD,1 Yoram Harth MD,2,3 Andrew S. Dorizas MD,6 Hanna Levy PhD,4 and Avner Shemer MD5| |
PATIENTS AND METHODS: A total of 69 participants (age 54.3 years ± 8.09; age range 37-72 years) were enrolled in the study after meeting all inclusion/exclusion criteria (100%) and providing informed consent. Participants were provided with the tested device together with a user manual and treatment diary, to perform independent treatments at home for 4 weeks. The tested device, (Newa™, EndyMed Medical, Cesarea, Israel) emits 12 W of 1Mhz, RF energy through six electrodes arranged in a linear fashion. Independent control of RF polarity through each one of the 6 electrodes allows significant reduction of energy flow through the epidermis with increased dermal penetration. Participants were instructed to perform at least 5 treatments a week, for one month. Four follow-up visits were scheduled (once a week) during the period of independent treatments at home, following 4 weeks of home treatments, 1 month follow-up visit (1 month after treatment end) and at 3 months follow-up (3 months following treatment end).
Analysis of pre-and post treatment images was conducted by three uninvolved physicians experienced with the Fitzpatrick Wrinkle and Elastosis Scale. Fitzpatrick Wrinkle and Elastosis score of each time point (4 weeks following home use treatments; 1 month follow-up, 3 months follow-up) was compared to baseline.
Participants were asked a series of questions designed to explore usability concerns and level of satisfaction regarding the device use and subjective efficacy.
RESULTS: Altogether, 62 subjects completed the study course and follow-up visits. No unexpected adverse effects were detected or reported throughout the independent treatment. All study participants did not experience any difficulties while operating the tested device for independent wrinkle reduction treatments. Photographic analysis of pre- and post-one month of independent home use treatments, and one and three months follow-up after end of treatment course, was conducted by three uninvolved board certified dermatologists. Analysis of results revealed improvement (downgrade of at least 1 score according to the Fitzpatrick scale) in 91.93%, 96.77%, and 98.39% of study subjects (according to the first, second, and third reviewer, respectively). Results were found to be statistically significant. The majority of study participants were very satisfied from the results of the independent treatment using the tested device for wrinkle reduction.
J Drugs Dermatol. 2014;13(11):1342-1347.
Leon H. Kircik MD| |
Kristen Lo Sicco MD, Mona Sadeghpour MD, Laura K. Ferris MD PhD| |
Twenty-Nail Transverse Melanonychia Induced by Hydroxyurea: Case Report and Review of the Literature
Osamuede Osemwota MD,a John Uhlemann MD,a and Adam Rubin MDb| |
Twenty-nail transverse melanonychia from hydroxyurea is a rare phenomenon, only reported four times previously. Here we describe a 51-year-old female who presented with 20-nail transverse melanonychia 3 months after initiating hydroxyurea therapy. Transverse melanonychia is a benign process but can cause patients significant distress, and thus is an entity with which dermatologists should recognize. We then review the cutaneous manifestations, differential diagnosis, and clinical considerations when evaluating patients with transverse melanonychia from hydroxyurea or other causes.
J Drugs Dermatol. 2017;16(8):814-815.
Program Spotlight: The USF Department of Dermatology and Cutaneous Surgery Residency Training Program
Resident Rounds is a section of the JDD dedicated to highlighting various dermatology departments with residency training programs. Resident Rounds includes three sections: (1) a program spotlight, highlighting pertinent information about the department and residency training program; (2) a section presenting study materials used by residents at the program; and (3) a section designed to highlight recent interesting cases seen at the institution. This issue of Resident Rounds features the USF Department of Dermatology and Cutaneous Surgery Residency Training Program. The editor of Resident Rounds is Omar A. Ibrahimi MD PhD. He is currently the Director of Cutaneous Laser and Cosmetic Surgery and a Mohs surgeon at the University of Connecticut. Dr. Ibrahimi is also a Visiting Scientist at the Wellman Center for Photomedicine at Massachusetts General Hospital/Harvard Medical School. If you are interested in highlighting your training program in a future issue, please contact Dr. Ibrahimi at OIbrahimi@jddonline.com.
Kenneth R. Beer MD FAAD| |
Generational Dermatology: Model for Prevention and Multi Decade Approach Toward the Evolving, Aging Patient
Wendy E. Roberts MD FAAD| |
J Drugs Dermatol. 2013;12(12):1396-1399.
Kathleen M. Casamiquela BAa and Philip R. Cohen MDa-c| |
J Drugs Dermatol. 2013;12(2):223-226.
Pterygium Inversum Unguis: Report of an Extensive Case With Good Therapeutic Response to Hydroxypropyl Chitosan and Review of the Literature
Roberta Marinho Falcão Gondim MD PhD,a,b Pedro Bezerra da Trindade Neto MD PhD,a and Robert Baran MDc| |
J Drugs Dermatol. 2013;12(3):344-346.
Shari R. Lipner MD PhD| |
Charlene Lam MD MPH, Jeffery J. Miller MD MBA, and Joslyn S. Kirby MD| |
Palmoplantar Pustulosis With Fulminant Dystrophic 20-Nail Psoriasis in a Patient Receiving Adalimumab Therapy
Vineet Mishra MDa, Ralph C. Daniel MDb, Craig A. Elmets MDa, Anna Levin MDc, and Boni E. Elewski MDa| |
A Randomized, Double-Blinded Trial Evaluating the Efficacy and Tolerability of Vectical Ointment (Calcitriol 3 mcg/g Ointment) When Compared to Betamethasone Diproprionate Ointment (64 mg/g) in Patients With Nail Psoriasis
Lauren Kole MD, Wendy Cantrell DNP, and Boni Elewski MD| |
DESIGN: Single-center, double-blind study.
SETTING: One academic center.
PARTICIPANTS: 10 adult male and female subjects with psoriasis of the fingernails and/or toenails.
MEASUREMENTS: The primary efficacy evaluation was the absolute reduction of nail thickness (mm) of the target nail. A secondary endpoint was the improvement in the Physician Global Assessment score of disease severity.
RESULTS: Patients treated with either betamethasone diproprionate ointment or calcitriol ointment demonstrated a similar reduction of nail thickness of the selected target nail. The difference between the two groups was not statistically significant (P=0.42).
CONCLUSION: This small study illustrates that calcitriol ointment may be as effective as betamethasone diproprionate in the treatment of nail psoriasis, and its promise should be further investigated in a subsequent larger trial.
J Drugs Dermatol. 2014;13(8):912-915.
Kendra Gail Bergstrom MD FAAD| |
A Retrospective Review of Treatment Results for Patients With Central Centrifugal Cicatrical Alopecia
Ariana Eginli BA, Emily Dothard MD, Courtney W. Bagayoko MD, Karen Huang MS, Alyssa Daniel MD, and Amy J. McMichael MD| |
INTRODUCTION: Central centrifugal cicatricial alopecia (CCCA) is a form of scarring alopecia primarily affecting women of African descent on the crown of the scalp. Limited data exists regarding evidence-based treatment for CCCA.
OBJECTIVE: To examine photos of subjects with CCCA before and after treatment in order to evaluate results of treatment and compare results of different treatment regimens.
METHODS: Photographs of 15 subjects with CCCA before and after treatment were evaluated by two blinded investigators who assigned disease severity scores to photographs based on a published scale: Central Scalp Alopecia Photographic Scale in African American Women.
RESULTS: Median change in severity score (post-treatment severity score – pre-treatment severity score) was 0.5 (P = 0.58) for all 15 subjects receiving a series of 7 to 8 intralesional steroid injections along with topical steroids (Class I/II) +/- minoxidil and +/- anti-dandruff shampoo, indicating worsening of disease after treatment. Subjects receiving minoxidil versus those who did not (0.25 vs 0.5; P = 0.38) and subjects receiving anti-dandruff shampoo versus those who did not (0.0 vs 0.5; P = 0.42) demonstrated no statistically significant difference in pre- and post-treatment severity scores. Of 15 subjects, 5/15 (33.3%) had decreased severity scores, 8/15 (53.3%) had increased severity scores, and 2/15 (13.3%) had no change in severity scores.
CONCLUSIONS: Although no statistically significant difference was found in pre- versus post-treatment disease severity, this may indicate intralesional steroid injections and topical steroids +/- minoxidil and +/- anti-dandruff shampoo halt disease progression.
J Drugs Dermatol. 2017;16(4):317-320.
Justin Finch MD| |
Prognostic Factors for Complete Cure Following Treatment of Mild and Moderate Toenail Onychomycosis With Efinaconazole Topical Solution 10%
Nathaniel J. Jellinek MD FAAD FACMSa and Andrew Korotzer PhDb| |
METHODS: A subgroup analysis of patients, aged 18 to 70 years, randomized to receive efinaconazole topical solution 10% or vehicle from 2 identical multicenter, double-blind, vehicle-controlled 48-week studies evaluating safety and efficacy. The primary end point, complete cure rate (0% clinical involvement of target toenail, and both negative potassium hydroxide examination and fungal culture) at week 52 was evaluated based on mycologic cure at week 24, and the degree of clinical improvement in nail involvement at week 12.
RESULTS: Over a quarter (25.1%) of patients treated with efinaconazole topical solution 10% who could demonstrate at least 10% improvement in affected nail involvement by week 12 progressed to complete cures at week 52. Similarly, 21.7% of patients who demonstrated mycologic cure at week 24 achieved complete cures at week 52.
CONCLUSIONS: Early clinical improvement and mycologic clearance may help to predict treatment success with efinaconazole topical solution 10%.
J Drugs Dermatol. 2015;14(8):871-875.
Uchenna R. Okereke MD,a Sara Colozza,b David E. Cohen MD MPHc| |
OBSERVATIONS: A 60 year-old female with stage IV lung cancer was treated with erlotinib (100 mg/d). The patient elected to discontinue erlotinib after four years secondary to adverse systemic reactions. However, five months later small, monomorphic, rough, folliculocentric papules with surrounding mild erythema characteristic of keratosis pilaris were noted on upper back and arms.
CONCLUSIONS AND RELEVANCE: This serves as the first documented case of new onset keratosis pilaris in a patient after discontinuation of erlotinib. We report the present case to show the possible association of keratosis pilaris with not only RAF inhibitors, but also the EGFR inhibitor erlotinib. Further investigation will determine whether this is a class effect with other systemic EGFR inhibitors.
J Drugs Dermatol. 2014;13(11):1410-1411.
Ali Alikhan MD and Alison J. Bruce MBBS| |
Perry Robins, MD| |
J Drugs Dermatol. 2011;10(7):799-801.
The projections of increases in the number of skin of color patients over the next several decades, necessitates expertise in cultural competence for health care providers. Acquiring competency begins with practitioners reflecting on their self identity and personal beliefs. Additionally, understanding African-American cultural habits and practices and their impact on disease is critically important. We review, in this article, the fundamentals of becoming cultural competent. Patients are best served when their physician embraces their culture, their view of the health care system as well as habits and practices.
J Drugs Dermatol. 2012;11(4):460-465.
Resident Rounds Part I: Program Spotlight: Department of Dermatology, Columbia University Medical Center
Bobby Y. Reddy MD and Cheryl Hutt MD| |
Deborah S. Sarnoff MD FAAD FACP| |
The Founding of an Organization: The First 33 Years of the International Society for Dermatologic Surgery
Henry W. Randle MD PhDa, Perry Robins MDb, and C. William Hanke MD MPH FACPc| |
J Drugs Dermatol. 2012;11(8):939-942.
Resident Rounds. Part III B: Tumor Necrosis Factor-α Antagonists and Alopecia Areata: A Class-Wide Adverse Effect
James L. Griffith MS,a Johnathan J. Ledet MD,b Boni E. Elewski MDb| |
Amanda Pickert MDa and Harper Price MDb| |
Julia Schwartz, MD, Thomas Lee, MD| |
The content of these case studies, ideal to review during peer study groups, was developed by Julia Schwartz, MD and Thomas Lee, MD under the guidance of dermatologist Adam Friedman, MD, FAAD, Associate Professor of Dermatology, Residency Program Director, Director of Translational Research, Department of Dermatology GW University.
Pipeline Previews brings to you information on the newest drugs and medical products as they become available to the dermatologic community. This department may include additional information from the manufacturers, plus reports from physicians who wish to share their clinical experience with these new products. In addition, we will inform our readers about the latest drugs receiving Food and Drug Administration (FDA) approval.
Resident Rounds Part I. The State University of New York Downstate Medical Center Dermatology Residency Training Program
Jaimie B. Glick MD and Ravneet Ruby Kaur MD| |
Jeffrey F. Scott MD, Danyelle Dawes MD, and Kevin D. Cooper MD| |
Luliconazole Retention in Stratum Corneum and Prevention of Fungal Infection in a Guinea Pig Tinea Pedis Model
Hiroyasu Koga PhD,a Yasuko Nanjoh,a Tetsuo Toga PhD,a Radhakrishnan Pillai PhD,b William Jo PhD,b and Ryoji Tsuboi PhDc| |
METHODS: Luliconazole 1% cream or terbinafine 1% cream were topically applied once daily to hind limbs of guinea pigs for 14 days. Drug concentration in stratum corneum of plantar skin was measured by HPLC-UV on days 1, 3, 7, 10, and 14. Separately, creams were applied daily for 5 days to the hind limbs of guinea pigs and skin drug release determined. In addition, drug retention in the stratum corneum was assessed by infecting guinea pigs with Trichophyton mentagrophytes, 14 and 21 days after a single application of luliconazole or terbinafine creams.
RESULTS: Luliconazole stratum corneum concentrations were higher than those of terbinafine throughout the study. Concentrations of luliconazole and terbinafine were 71.6μg/g and 36.6μg/g, respectively, after a single application (P<.05), reaching steady state after 10 days. Cumulative release of luliconazole from the stratum corneum was 4.5 times greater than with terbinafine. Unlike terbinafine, no fungal invasion of the stratum corneum was seen 14 days post-treatment with luliconazole.
CONCLUSIONS: Drug concentrations of luliconazole in the stratum corneum and subsequent release are greater than those achieved with terbinafine and may contribute to clinical efficacy. Luliconazole may also provide greater protection against disease recurrence.
J Drugs Dermatol. 2016;15(1):104-108.
Jeremy Hugh, MD| |
Resident Rounds: Part 1 - Program Spotlight: The University of Colorado Denver Dermatology Residency Program
David A. Norris MD, Ramin Fathi MD| |
Andrew F. Alexis| |
Rapid Treatment of Subungual Onychomycosis Using Controlled Micro Nail Penetration and Terbinafine Solution
Ivan Bristow PhD,a Robert Baran MD,b and Michelle Score BSc (Hons)c| |
J Drugs Dermatol. 2016;15(8):974-978.
Charlene Lam MD MPH, Jeffrey J. Miller MD MBA, and Joslyn S. Kirby MD| |
Susan Weinkle MDa,b and Michael Saco MDa| |
Aging gracefully has taken on a whole new meaning over the past few decades as new aesthetic treatments have been developed and are becoming more sophisticated by the day. The aging process, which is exacerbated by chronic UV exposure, results in dyspigmentation, loss of skin laxity, precancerous and cancerous skin lesions, fat loss and redistribution, and bone resorption. Laser and light devices can be used to treat dyspigmentation, while neuromodulators and soft tissue fillers can be used for rhytides and revolumization. Newer procedures include using resorbable polyglycolide/L-lactide suspension sutures with bidirectional cones for mid face revolumization, deoxycholic acid injections for submental fat reduction, and radiofrequency energy. Certain over-the-counter products can increase the risk of postprocedure bruising, while arnica and bromelain may help decrease this risk. Dermatologists continue to be at the forefront of aesthetic treatments, ready and willing to help the aging population look and feel their best.
J Drugs Dermatol. 2017;16(6 Suppl):s84-86.
Laura McDermott BA,a Raman Madan MD,a Reena Rupani MD,b and Daniel Siegel MDa| |
METHODS: A PubMed search for the term “indigo naturalis” was performed, and literature from 2006 to the present relevant to indigo naturalis and treatment of psoriasis and nail psoriasis was reviewed.
RESULTS: Indigo naturalis shares several therapeutic mechanisms with current psoriasis treatments, such as regulation of keratinocyte proliferation and differentiation, restoration of epidermal barrier function, and reduction of inflammatory processes. Clinically, it is well tolerated.
CONCLUSION: Recent research of indigo naturalis suggests that it is a safe, inexpensive, and effective alternative topical treatment for skin and nail psoriasis.
J Drugs Dermatol. 2016;15(3):319-323.
Prospective Internally Controlled Blind Reviewed Clinical Evaluation of Cryolipolysis Combined With Multipolar Radiofrequency andVaripulseTechnology for Enhanced Subject Results in Circumferential Fat Reduction and Skin Laxity of the Flanks
Julius Few MD,a Michael Gold MD FAAD,b and Neil Sadick MD FACP FAACS FACPh FAADc| |
Effect of Infliximab on Health-Related Quality of Life and Disease Activity by Body Region in Patients With Moderate-to-Severe Psoriasis and Inadequate Response to Etanercept: Results from the PSUNRISE Trial
Robert E. Kalb MD,a Andrew Blauvelt MD,b Howard L. Sofen MD,c Marc Chevrier MD,d David Amato DO,d
Stephen Calabro MS,d Jim Wang PhD,e Brad Schenkel MS,f and Alice B. Gottlieb MD PhDg
METHODS: PSUNRISE is a multicenter, open-label, prospective study evaluating the efficacy and safety of switching from etanercept to infliximab in psoriasis patients with an inadequate response to etanercept. Patients received intravenous infusions of infliximab 5 mg/ kg at weeks 0, 2, 6, 14, and 22. HRQoL was assessed using the Dermatology Life Quality Index (DLQI), the 36-item Short-Form Health Survey (SF-36), and the EuroQoL (EQ-5D) index and EQ-5D visual analog scale (VAS; 0-100 cm) among patients receiving at least one infliximab infusion. Subgroup analyses (t- test) were performed to compare mean DLQI improvement between patients who achieved and did not achieve clinical response (Physician’s Global Assessment [PGA] 0/1 and at least a 75% improvement in the Psoriasis Area and Severity Index [PASI 75]) at weeks 10 and 26.
RESULTS: A total of 215 patients received at least one infliximab infusion. A DLQI score of 0 or 1 (no negative effect on HRQoL) was achieved by 3.7%, 44.2%, and 41.4% of patients at weeks 0, 10 and 26, respectively. Mean changes in SF-36 Physical Component Summary scores were 1.8 (week 10) and 2.4 (week 26); corresponding changes in Mental Component Summary scores were 4.5 and 5.0. The mean change in EQ-5D index score was 0.08 at week 10 and 0.09 at week 26; respective mean changes in EQ-5D VAS score were 7.73 and 9.49. Mean improvements in DLQI were significantly higher for patients achieving versus those not achieving PGA 0/1 (P=0.0193 [week 10] and P=0.0010 [week 26]) and PASI 75 response (P<0.0001 [week 10]; P=0.0012 [week 26]).
CONCLUSION: Psoriasis patients with prior inadequate response to etanercept demonstrated sustained improvements in HRQoL after switching to infliximab, and HRQoL improvements were associated with clinical responses.
J Drugs Dermatol. 2013;12(8):874-880.
Optimizing Topical Antifungal Therapy for Superficial Cutaneous Fungal Infections: Focus on Topical Naftifine for Cutaneous Dermatophytosis
James Q. Del Rosso DO FAOCDa and Leon H. Kircik MDb| |
A variety of topical antifungal agents are available for the treatment of SCFIs, and they encompass a few major chemical classes: the polyenes (ie, nystatin), imidazoles (ie, ketoconazole, econazole, oxiconazole, etc), allylamines (ie, naftifine, terbinafine), benzylamines (ie, butenafine), and hydroxypyridones (ie, ciclopirox). The 2 major classes that represent the majority of available topical antifungal agents are the azoles and the allylamines. Overall, the allylamines are superior to the azoles in activity against dermatophytes, although both are clinically effective. The reverse is true against yeasts such as Candida spp and Malassezia spp, although topical allylamines have proven to be efficacious in some cases of tinea versicolor and cutaneous candidiasis.
Naftifine, a topical allylamine, is fungicidal in vitro against a wide spectrum of dermatophyte fungi and has been shown to be highly effective against a variety of cutaneous dermatophyte infections. Rapid onset of clinical activity and favorable data on sustained clearance of infection have been documented with naftifine. The more recent addition of naftifine 2% cream has expanded the armamentarium, with data supporting a clinically relevant therapeutic reservoir effect after completion of therapy.
J Drugs Dermatol. 2013;12(suppl 11):s165-s171.
Boni E. Elewski MD,a Phoebe Rich MD,b Antonella Tosti MD,c David M. Pariser MD,d Richard Scher MD,e Ralph C. Daniel MD,f and Aditya K. Gupta MDg| |
J Drugs Dermatol. 2013;12(7 suppl 2):s96-s103
Kendra Gail Bergstrom MD FAAD| |
Alison M. Tisack MD, Richard H. Huggins MD, and Henry W. Lim MD| |
J Drugs Dermatol. 2013;12(7):819-820.
Resident Rounds: Part I: Program Spotlight: The University of California, Irvine Department of Dermatology Residency Training Program
Nazanin Saedi MD, Amy Reinstadler MD, Sam Truong MD, Kristen Kelly MD| |
Resident Rounds is a new section of the JDD dedicated to highlighting various dermatology departments with residency training programs. Resident Rounds will feature three sections: (1) a program spotlight, highlighting pertinent information about the department and residency training program; (2) a section presenting study materials used by residents at the program; and (3) a section designed to highlight recent interesting cases seen at the institution. This issue of Resident Rounds features the University of California, Irvine Department of Dermatology Residency Training Program. The editor of Resident Rounds is Omar A. Ibrahimi, MD, PhD. Dr. Ibrahimi is a recent graduate of the Harvard Combined Program in Dermatology and currently a fellow in Mohs, Laser and Cosmetic Surgery at the University of California Davis. If you are interested in highlighting your training program in a future issue, please contact Dr. Ibrahimi at firstname.lastname@example.org
Tina Rendini RN and William Levis MD| |
Amy E. Rose MD| |
Stuart Maddin MD,a John Quiring PhD,b and Lynne Bulgerc| |
METHODS: This phase 3, randomized, placebo-controlled trial investigated the noninferiority of 1 itraconazole 200-mg tablet to 2 itraconazole 100-mg capsules dosed QD for 12 weeks, with a 40-week follow-up period. Clinical Cure (Investigator’s Global Assessment plus mycological examination) was the primary outcome measure and Clinical Improvement was a secondary endpoint. Safety and efficacy of itraconazole 200-mg tablets were also compared with placebo.
RESULTS: Significantly more patients in the intent-to-treat per-protocol populations on itraconazole (200-mg tablet or 2 100-mg capsules) achieved Complete Cure and Clinical Improvement compared with placebo. For both endpoints, itraconazole 200-mg tablet QD was noninferior to itraconazole 100-mg capsules and superior to placebo. All treatment groups demonstrated a similar safety profile with no new safety signals identified.
LIMITATIONS: Absolute patient blinding was not possible; the number of tablets versus capsules differed, and the appearance of the active drugs could not be masked. However, efficacy was based on objective assessments from blinded investigators.
CONCLUSIONS: Once-daily itraconazole 200-mg was well-tolerated, and may be an effective alternative to 2 itraconazole 100-mg capsules for the treatment of toenail onychomycosis. The convenience of a simpler dosing regimen may improve patient compliance (ClinicalTrials.gov number, NCT00356915).
J Drugs Dermatol. 2013;12(7):758-763.
RESIDENT ROUNDS: PART I
Program Spotlight: Department of Dermatology,Oregon Health & Science University
Efficacy of Tofacitinib, an Oral Janus Kinase Inhibitor, on Clinical Signs of Moderate-to-Severe Plaque Psoriasis in Different Body Regions
Alan Menter MD,a Kim A. Papp MD PhD FRCPC,b Huaming Tan PhD,c Steve Tyring MD PhD,dRobert Wolk MD PhD DSc,c and Marjorie Buonanno MSN RNc| |
METHODS: This exploratory analysis of a Phase IIb, 12-week, dose-ranging study (clinicaltrials.gov identifier: NCT00678210) evaluated tofacitinib efficacy in four body regions of patients with moderate-to-severe chronic plaque psoriasis. Patients (n=197) were randomized to tofacitinib 2, 5, or 15 mg, or placebo, twice daily (BID). Psoriasis Area and Severity Index (PASI) score, body surface area values and change from baseline to week 12 were measured according to body region (head/neck, upper limbs, trunk and lower limbs). Change in Target Plaque Severity Score (TPSS) from baseline to week 12 was measured according to typically responsive as well as non-responsive treatment areas.
RESULTS: At week 12, mean improvements in PASI and body surface area values were significantly greater with tofacitinib doses vs placebo across all four body regions measured (P<0.0001). TPSS in responsive areas decreased (improved) with tofacitinib 2, 5, and 15 mg BID vs placebo: -4.35, -4.79 and -6.32, vs -2.06, respectively (P<0.0001). In non-responsive areas, TPSS decreased with tofacitinib 2, 5, and 15 mg BID vs placebo: -3.74, -4.60 and -6.15, vs -2.23, respectively (P<0.01).
CONCLUSION: Short-term (12-week) treatment with oral tofacitinib produced clinical improvement across all body regions assessed in patients with moderate-to-severe plaque psoriasis, including areas typically non-responsive to treatment.
J Drugs Dermatol. 2014;13(3):252-256.
Prospective Efficacy and Safety Evaluation of Laser Treatments With Real-Time Temperature Feedback for Fungal Onychomycosis
Jill Waibel MD, Adam Jared Wulkan MD, and Ashley Rudnick| |
METHODS: Twenty-one patients with PAS or culture proven fungal onychomycosis were prospectively treated with laser until target temperature of 46 - 48 degrees Celsius was achieved using real-time infrared temperature feedback. The laser and light therapies used were 1319nm, 1064nm and BroadBand Light. Exclusion criteria included mixed infection and no other prior therapeutic interventions. Subjects received four treatment sessions one week apart. Assessments included PAS & cultures at one, three and six months post treatment. Patients also were asked a pain score from 1-10 during treatment.
RESULTS: Patients tolerated the procedures well with high satisfaction. Average treatment time was 10 minutes. No adverse events were noted. Patients reported mild-moderate transient discomfort during treatment. Six-month culture results revealed 20/21 negative for fungal organisms.
CONCLUSION: Laser therapy offers a safe and effective new option for onychomycosis. This may be the optimal therapy for a large market that needs alternative or adjunct to current therapies. Laser is quick, painless therapy that does not require any oral medications or blood test for monitoring. Additional larger scientific studies are needed to confirm our pilot study results.
J Drugs Dermatol. 2013;12(11):1237-1242.
Paclitaxel-Associated Subungual Pyogenic Granuloma: Report in a Patient With Breast Cancer Receiving Paclitaxel and Review of Drug-Induced Pyogenic Granulomas Adjacent to and Beneath the Nail
Subungual and periungual pyogenic granuloma occur in association with certain systemic medications. Paclitaxel is an antitumor drug of the taxane family used in the management of breast cancer. Taxanes have many associated nail changes that may occur in patients receiving either docetaxel or paclitaxel for systemic chemotherapy. The nail changes in a 68-year-old woman with metastatic breast cancer who presented for nail changes after receiving 12 cycles of weekly paclitaxel are described herein: nail plate red-brown discoloration, onycholysis with leukonychia, proximal subungual hemorrhage, and subungual pyogenic granuloma. The literature on systemic medications associated with the development of subungual and periungual pyogenic granulomas is reviewed; drugs associated with the development of pyogenic granuloma at the locations include antineoplastics, antiretrovirals, epidermal growth factor receptor inhibitors, immunosuppressants and retinoids. In conclusion, subungual pyogenic granuloma can occur not only in patients receiving docetaxel, but also in patients treated with paclitaxel. And, paclitaxel should be included in the list of drugs associated with the occurrence of subungual pyogenic granuloma
J Drugs Dermatol. 2012;11(2):262-268.
Aditya K. Gupta MD PhD FRCPC a,b and Andrew Korotzer PhDc| |
J Drugs Dermatol. 2016;15(10):1260-1266.
Resident Rounds is a section of the JDD dedicated to highlighting various dermatology departments with residency training programs. Resident Rounds includes three sections: (1) a program spotlight, highlighting pertinent information about the department and residency training program; (2) a section presenting study materials used by residents at the program; and (3) a section designed to highlight recent interesting cases seen at the institution. This issue of Resident Rounds features the Henry Ford Hospital Department of Dermatology Residency Training Program. The editor of Resident Rounds is Omar A. Ibrahimi MD PhD. He is currently the Director of Cutaneous Laser and Cosmetic Surgery and a Mohs surgeon at the University of Connecticut. Dr. Ibrahimi is also a Visiting Scientist at the Wellman Center for Photomedicine at Massachusetts General Hospital/Harvard Medical School. If you are interested in highlighting your training program in a future issue, please contact Dr. Ibrahimi at OIbrahimi@jddonline.com.
Enhancing Transungual Delivery and Spreading of Efinaconazole Under the Nail Plate Through a Unique Formulation Approach
Leon H. Kircik MD| |
J Drugs Dermatol. 2014;13(12):1457-1461.
Improvement of Nail and Scalp Psoriasis Using Apremilast in Patients With Chronic Psoriasis: Phase 2b and 3, 52-Week Randomized, Placebo-Controlled Trial Results
Catherine M. Nguyen BS,a Argentina Leon MD,b Melissa Danesh BS,c Kourosh Beroukhim BS,d Jashin J. Wu MD,e and John Koo MDb| |
METHODS: We reviewed the results of the phase IIb and phase III clinical trials for apremilast in treating nail and scalp psoriasis.
RESULTS: In ESTEEM 1, patients on apremilast showed a 22.5%, 43.6%, and 60.2% improvement in NAPSI at weeks 16, 32, and 52. 33.3%, 45.2%, and 63% of patients achieved NAPSI-50, respectively. In ESTEEM 2, patients on apremilast showed a 29%, 60%, and 59.7% improvement in NAPSI at weeks 16, 32, and 52, with 44.6%, 55.4%, and 68.6% of patients achieving NAPSI-50. In PSOR-005 at week 16, patients on a dose of 30 mg twice weekly had a 42.9% improvement in NAPSI with 45.5% reaching NAPSI-50. For scalp psoriasis, 46.5%, 37.4%, and 73% of patients achieved an Sc-PGA of 0 or 1 at weeks 16, 32, and 52 in ESTEEM 1. In ESTEEM 2, 40.9%, 32.4%, and 62.5% of patients achieved an Sc-PGA of 0 or 1 at weeks 16, 32, and 52.
CONCLUSION: With its limited safety profile of only diarrhea and headache and no additional lab requirements, apremilast may be a safer and more convenient alternative for patients with severe nail and scalp psoriasis.
J Drugs Dermatol. 2016;15(3):272-276.
A Randomized, Prospective, Sham-Controlled Study of Localized Narrow-Band UVB Phototherapy in the Treatment of Plaque Psoriasis
Adriane A. Levin BA,a,b Saud Aleissa MD,a Nicole Dumont,a Francisca Martinez,a Courtney Donovan RN,a
Shiu-chung Au MD,a Afnan Hasanain MD,a and Alice B. Gottlieb MD PhDa,c
OBJECTIVE: We aimed to evaluate the efficacy of the Levia® localized NB-UVB phototherapy machine in the treatment of patients with symmetrical psoriatic lesions.
DESIGN: We performed a prospective, double-blinded, sham-treatment controlled study of this device beginning March 2012 through April 2014.
SETTING: a comprehensive dermatology clinic in the northeastern United States.
PARTICIPANTS: 21 subjects with chronic plaque psoriasis.
INTERVENTIONS: Each patient had one lesion randomized to receive the Levia treatment and one lesion (the control) treated with visible light. Treatment was administered three times a week for twelve weeks. Target lesion score (TLS), a rating of 0-4 each of erythema, scaling, and thickness, was measured biweekly by a blinded assessor, and visual analogue scale of pruritus was recorded by subjects.
MAIN OUTCOMES AND MEASURES: The primary outcome, formulated prior to study initiation, was the percentage of lesions achieving clear or almost clear TLS after 12 weeks of treatment. Secondary endpoints included changes in target lesion pruritus VAS, percentage improvement in TLS, and the percentage of subjects achieving 50% improvement in TLS (TLS-50).
RESULTS: The primary endpoint, TLS of three or less, was not achieved (P=0.118), but the secondary endpoints of percentage improvement in TLS (P=0.043) and TLS-50 (P=0.0195) were significantly superior in treated compared to sham-treated lesions. Percentage improvement in pruritus VAS was not significant (P=0.0565).
CONCLUSIONS AND RELEVANCE: This device was found to be efficacious, though not necessarily to the point of clearance, in the treatment of psoriasis over a 12-week period.
TRIAL REGISTRATION: www.clinicaltrials.gov, identifier: NCT02107482, http://clinicaltrials.gov/show/NCT02107482
J Drugs Dermatol. 2014;13(8):922-926.
Alyssa Daniel MD,a Cheryl J. Gustafson MD PA-C,a Pamela J. Zupkosky BS,b Anne Candido BSME,b Helen R. Kemp PhD,b Greg Russell MS,c and Amy McMichael MDa| |
METHODS: Ninety African American men were randomized to 1 of 3 treatment groups shaving 2 to 3 times per week with standard products (control group), shaving daily with standard products (daily standard group) or shaving daily with advanced products (daily advanced). The number of pustules, papules, ingrown hairs, and investigator's assessment of severity and subjective symptoms of itching and burning/stinging were assessed at baseline, week 6, and week 12. The response to treatment was also assessed by the investigator and the subject at weeks 6 and 12. Secondary measures including questionnaires regarding baseline shave practices were also correlated with outcomes variables.
RESULTS: There were no significant differences noted between the 3 groups for papule (P=.32) or pustule (P=.46) count for the 12-week study. However, there was a significant mean papule reduction from baseline detected for both the control and daily advanced groups. In addition, compared to baseline, there was a significant reduction in ingrown hairs for the control group, and a directional reduction in ingrown hairs for the daily advanced group. There were significant group differences between the control group and both daily shaving groups, with the control group seeing significantly fewer ingrown hairs (P=.005 for control vs daily standard group and P=.04 for control vs daily advanced group). There were no significant group differences among the 3 groups for investigator-graded severity (P=.43) and response to treatment (P=.51). There was a significant perceived improvement in the response to treatment (P=.007) and itching (P=.002) for the daily advanced group vs the control group.
J Drugs Dermatol. 2013;12(4):410-418.
Ixekizumab Is Effective in Subjects With Moderate to Severe Plaque Psoriasis With Significant Nail Involvement: Results From UNCOVER 3
Ellen B. Dennehy PhD,a Lu Zhang MS,a David Amato DO,a Orin Goldblum MD,a and Phoebe Rich MDb| |
MATERIALS AND METHODS: The design of UNCOVER-3, a Phase 3, multicenter, double-blind, placebo- and active-controlled trial that evaluated the efficacy and safety of ixekizumab for moderate to severe psoriasis, has been published previously. Patients were randomized to receive blinded placebo, etanercept (50 mg twice weekly) or 80 mg ixekizumab every 2 weeks (IXEQ2W) or every 4 weeks (IXEQ4W) for 12 weeks. At week 12, all patients were assigned to open-label ixekizumab 80 mg every 4 weeks through week 60. In this 60-week post hoc subset analysis, we evaluated only those patients with significant baseline nail involvement, defined as fingernail NAPSI ≥16 and at least 4 fingernails involved.
RESULTS: Ixekizumab Q2W or Q4W resulted in greater improvement in nail psoriasis than placebo or etanercept by week 12 of administration, as measured by percent NAPSI reduction (IXEQ2W 39% improvement, IXEQ4W 40%, etanercept 28%, placebo -4.7%). At week 24, significantly more patients receiving ixekizumab exhibited no signs of nail involvement (IXEQ2W/Q4W 34%, IXEQ4W/Q4W 30%). Similar gains were observed at 60 weeks in all treatment groups.
CONCLUSION: Ixekizumab led to improvement in fingernail psoriasis by week 12 compared with placebo. Continued improvement in fingernail psoriasis with ixekizumab was observed, with >50% of patients achieving complete fingernail psoriasis resolution (NAPSI=0) at week 60.
J Drugs Dermatol. 2016;15(8):958-961.
News, Views, and Reviews. Cutaneous Hyperandrogenism: Role of AntiandrogenTherapy in Acne, Hirsutism, and Androgenetic Alopecia
Aimee Krausz BA and Adam J. Friedman MD| |
Raza Aly PhD,a Aditya K. Gupta MD PhD,b,c Tate Winter PhD,d Lee T. Zane MD,e Tracey Vlahovic DPMf| |
J Drugs Dermatol. 2017;16(10):1016-1021.
Wendy Cantrell DNP, Theresa Canavan MD, and Boni Elewski MD| |
J Drugs Dermatol. 2015;14(5):524-526.
Lawrence F. Eichenfield MD| |
Jashin J. Wu MDa and Young M. Choi BS| |
Aditya K. Gupta MD PhD FRCPC,a Boni E. Elewski MD,b Ted Rosen MD,c Bryan Caldwell DPM,dd David M Pariser MD,e Leon H. Kircik MD,f Neal Bhatia MD,g and Antonella Tosti MDh| |
J Drugs Dermatol. 2016;15(3):279-282.
Alka Gupta MPharma and Hemanta Kumar Kar MDb| |
METHODS: Miconazole loaded vesicles were prepared by coacervation phase separation technique using nonionic surfactants and stabilizers. The antimycological activity of vesicles was performed using agar disc diffusion technique.
RESULTS: The miconazole nitrate lipid vesicles F5A and F5B showed maximum activity with higher zones of inhibition ie, 13.95+1.54 mm and 13.64+0.65 mm, respectively, after 3 days (For all comparisons, P<.05 was considered significant).
CONCLUSION: The findings of this study suggest antifungal potential of a novel preparation of miconazole nitrate vesicles vs Candida albicans in the treatment of mycoses in dermatological practice.
J Drugs Dermatol. 2016;15(6):734-737.
Noah Goldfarb MD,1,2 Kimberly Bohjanen MD,1,3 and Neal A. Foman MD1,3| |
Salicylic Acid 6% in an Ammonium Lactate Emollient Foam Vehicle in the Treatment of Mild-to-Moderate Scalp Psoriasis
Leon Kircik MD| |
J Drugs Dermatol. 2011;10(3):270-273.
Jason Chouake and Adam Friedman| |
Efficacy of Isotretinoin and Acitretin in Treatment of Frontal Fibrosing Alopecia: Retrospective Analysis of 54 Cases
Adriana Rakowska MD PhD,a Agnieszka Gradzińska MD,a Małgorzata Olszewska MD PhD,a and Lidia Rudnicka MD PhDb| |
J Drugs Dermatol. 2017;16(10):988-992.
Shari R. Lipner MD PhD and Richard K. Scher MD FACP| |
J Drugs Dermatol. 2015;14(5):492-494.
Theodore Rosen MD,a Sheila Fallon Friedlander MD,b Leon Kircik MD,c Matthew J. Zirwas MD,d
Linda Stein Gold MD,e Neal Bhatia MD,f Aditya K. Gupta MD PhD MBAg
J Drugs Dermatol. 2015;14(3):223-228.
Kavita Darji BA and Nicole M. Burkemper MD| |
Pityriasis folliculorum has been described as a dry type of rosacea with extensive proliferation of Demodex folliculorum in pilosebaceous follicles of the skin. This skin condition is frequently difficult to manage, with various treatment options showing mixed efficacy. Oral ivermectin, a macrocyclic lactone parasiticide with anti-inflammatory and anti-parasitic effects, is one of the leading treatment modalities for demodicosis. Topical ivermectin has recently been FDA approved as therapy for rosacea. We present the case of a woman with pityriasis folliculorum who showed significant improvement from using topical ivermectin with no adverse events related to treatment.
J Drugs Dermatol. 2017;16(12):1290-1292.
Anthony Chiaravalloti MD,a Ali Banki DOb,c,d| |
Amelanotic melanoma (AM) is one of the great masqueraders in dermatology. It is a very difficult clinical diagnosis to make because these tumors are devoid of pigment and other clues of melanoma. They are commonly misdiagnosed clinically as other benign and malignant conditions. We present a new case of AM in an 84-year-old woman with a history of non-melanoma skin cancer. She had a thin pink plaque that was initially misdiagnosed as a basal cell carcinoma. We also discuss dermoscopy and its valuable role to improve diagnostic accuracy. A review of dermoscopic features that favor and oppose the clinical diagnosis of AM is discussed. Even with dermoscopy, it is still important to have a high index of suspicion and a low threshold to biopsy when the clinical diagnosis is unclear.
J Drugs Dermatol. 2017;16(11):1164-1165.
Khalifa E. Sharquie MD PhD,a Adil A. Noaimi MD DDV FICMS,b and Hana A. Al-Mudaris MDc| |
OBJECTIVES: To perform melanocytes transplantion in patients with vitiligo using a new needling micrografting technique.
PATIENTS and METHODS: This interventional case study took place at the Department of Dermatology and Venereology at Baghdad Teaching Hospital from December 2010 to September 2011. Twelve patients with vitiligo were included. A split-thickness skin graft was taken from the normal area and cut into micropieces ranging from 0.1 mm to 0.3 mm in diameter. The recipient area was anesthetized, and the micrografts were then implanted into the dermis using the needling technique. The number of implanted micrografts depended on the size of the recipient area. Follow-up was conducted every 2 weeks for the first month and then every 4 weeks for a further 16 weeks.
RESULTS: The intake rate of grafting at week 2 ranged from 90% to 100%. The micrografts started producing noticeable pigmentation at week 2, and pigmentation was obvious at week 4. At week 8, the rate of pigmentation ranged from 10% to 90% (25.24%), and at week 16 it ranged from 10% to 100% (61.36%).
CONCLUSION: This new approach to the treatment of vitiligo delivers rapid and satisfactory pigmentation.
J Drugs Dermatol. 2013;12(5):e74-e78.
Detection and Relevance of Naftifine Hydrochloride in the Stratum Corneum Up to Four Weeks Following the Last Application of Naftifine Cream and Gel, 2%
Stefan Plaum MD, Amit Verma DrPH MPH, Alan B. Fleischer Jr. MD,
Babajide Olayinka MSc, and Bhushan Hardas MD
OBJECTIVE: The objective is to use tape stripping methodology to assess the amount of drug available in the SC over a 28 day period following the last dose.
METHODS: This was an open-label, single-exposure study on subjects comparing the amount of drug that was absorbed into the SC following topical application for 2-weeks. Twelve subjects were dosed daily (6 with naftifine cream, 2% and 6 with naftifine gel, 2%). Subjects had twelve 8 cm2 test application sites demarcated on the upper back. Twenty-five individual sequential strips were obtained from each test site. Of these, 11 sites were dosed once daily with the drug (5.0μL/cm2) for days 1 to 14 and the final site served as the control. On days 15, 29, and 43, a site was stripped to collect the SC in order to process the amount of drug present.
RESULTS: Naftifine was present on all tape strip samples collected over the 28 day period following two weeks of application. Furthermore, the most relevant, deeper tape strip sets reflecting the SC, showed potentially clinically relevant presence of naftifine in the skin for 28-days post-treatment.
CONCLUSIONS: Naftifine was present in the tape strips on all sample collection days up to and including four weeks following the last drug application. These findings help explain the progressive improvement in clinical and mycological response rates during the treatment period and for up to four weeks post-treatment in the clinical trials using naftifine.
J Drugs Dermatol. 2013;12(9):1004-1008.
Macrene Alexiades MD PhD| |
Lindsey A. Brodell MD and Lynn A. Cornelius MD| |
Helen M Torok MDa and Radhakrishan Pillai PhDb| |
Tretinoin is widely used in the treatment of acne. Despite significant advances in formulation development, irritation and dryness can
be particularly bothersome, especially during the first 3-4 weeks, impacting adherence. Dose titration and adjunct use of moisturizers
have been commonly employed. Co-prescribing with benzoyl peroxide (BPO) or a BPO/antibiotic combination is also common
practice. The tretinoin molecule is unstable and can be degraded by BPO, further complicating treatment regimens.
Lately, formulation technology has focused on providing more efficient penetration of the tretinoin into the skin layers so that lower concentrations of tretinoin might afford better tolerability, but maintain good efficacy; incorporating moisturizing excipients to minimize irritation; and providing greater stability to the tretinoin molecule. This approach would be particularly relevant in a pediatric acne population where efficacy/tolerability balance is important and treatment regimens must take into account lifestyles, but little data exist on the use of tretinoin in this patient population.
A micronized formulation of tretinoin (0.05%) gel has been developed that provides a more efficient delivery of tretinoin, because of its optimal particle size, no degradation by BPO and better cutaneous tolerability than tretinoin microsphere (0.1%) gel without compromising efficacy in a pediatric population.
J Drugs Dermatol. 2011;10(6):647-652.
Christine Rønneberg Mehren MD,a Anders Clemmensen MD,a Anne Boe-Hansen Dall MD,a
Peter Philipsen PhD,a and Robert Gniadecki MDa,b
AIM: To assess the relative contribution of the different symptom domains on HRQoL in psoriasis.
METHODS: 165 psoriasis patients (41.2 % with psoriasis arthritis (PsA)) were enrolled in a single-center cohort-study. For the assessment of HRQoL, patients completed EuroQoL (EQ-5D), the Short Form 36-item Health Survey (SF-36), the Health Assessment Questionaire (HAQ), and Dermatological Life Quality Index (DLQI) questionnaires. Multiple regression analysis was applied to determine the contribution of the measured parameters to the EuroQoL score (used as a reference measure for overall HRQoL).
RESULTS: Psoriasis arthritis (PsA) patients showed a higher impairment in all HRQoL measures than the patients without PsA. PASI, number of affected joints (PsA-score), DLQI and HAQ were significant predictors of HRQoL (R2=0.57). HAQ was the dominant contributor to HRQoL, both in patients with PsA and without PsA (partial eta 0.23 and 0.28, respectively.) Final model with improved R2 (0.61) was obtained by backward regression analysis, and included 6 parameters: PASI, PsA-score, and three questions from HAQ and one question from DLQI questionnaire.
CONCLUSION: Musculoskeletal symptoms are an essential component of HRQoL in psoriasis, even in patients without active PsA. A model consisting of PASI, PsA-score, and 4 questions derived from DLQI and HAQ seems to reflect total HRQoL impairment in psoriasis. This finding may further optimize drug therapy in psoriasis.
J Drugs Dermatol. 2014;13(3):246-250.
Thomas Beachkofsky MD and W. Chad Cragun MD FAAD| |
Candace Thornton Spann MD| |
J Drugs Dermatol. 2011;10(6):654-657.
Whitney P. Bowe MD| |
Isaac Zilinsky MD,a-c* Nimrod Farber MD,a-c* Oren Weissman MD,a Hadar Israeli MD,a Eyal Winkler MD,a and Josef Haik MDa| |
J Drugs Dermatol. 2013;12(2):206-207.
Peter W. Hashim MD MHS,a Mark G. Lebwohl MD,a Leon H. Kircik MDa,b,c| |
Deborah S. Sarnoff MD FAAD FACP| |
Giuseppe Ricci MD, Monica Martinelli BS, Stefania Luppi PhD, Leila Lo Bello MD, Michela De Santis MD,Kristina Skerk MD, and Gabriella Zito MD| |
J Drugs Dermatol. 2012;11(12):1511-1513.
Anne Goldsberry MD MBA, C. William Hanke MD MPH, Katherine E. Hanke
Laser and Skin Surgery Center of Indiana, Carmel, IN
OBJECTIVE: We also sought to evaluate whether the VISIA Complexion Analysis System (Canfield Imaging Systems, Fairfield, NJ) could be a tool to help patients better understand their skin complaints.
METHODS: Twenty-one consecutive women were recruited for VISIA analysis. Each subject underwent VISIA analysis and completed a follow up survey.
RESULTS: 86% of respondents reported that the VISIA analysis helped them understand their initial concern. 86% noted that the VISIA brought other skin problems to their attention. 100% of the subjects responded that they would recommend VISIA analysis to others. 62% of subjects responded that they would prefer to go to a practice with a VISIA system in comparison to a practice without VISIA.
CONCLUSION: The VISIA Complexion Analysis System is a beneficial tool for dermatology and aesthetic practices with the potential to aid in patient education.
Johanna Sheu MS,a Susan V. Kattapuram MD,b James M. Stankiewicz MD,c and Joseph F. Merola MD MMScd| |
OBSERVATIONS: We present a case of a 36-year-old male treated with oral dimethyl fumarate for 16 weeks who developed a bilateral eosinophilic fasciitis-like disorder of the thighs. Magnetic resonance imaging revealed a fluid collection in the fascial plane and histopathologic examination revealed an inflammatory infiltrate with dermal and subcutaneous edema and sclerosis consistent with eosinophilic fasciitis. We discuss studies reporting peripheral eosinophilia with fumaric acid medications as well as the literature exploring possible mechanisms.
CONCLUSIONS: With the anticipated widespread use of dimethyl fumarate for multiple sclerosis patients, it is important for practitioners to recognize the symptoms of eosinophilic fasciitis and be aware of a possible association of oral dimethyl fumarate treatment with the development of an eosinophilic fasciitis-like disorder.
J Drugs Dermatol. 2014;13(9):1144-1147.
Andrew F. Alexis MD MPH| |
J Drugs Dermatol. 2014;13(suppl 6):s61-s65.
Tracy L. Donahue MD, Julia S. Minocha MD, Lisa Y. Shen MD, Jennifer L. Sorrell MD, and Roopal V. Kundu MD| |
Theodore Rosen MD| |
J Drugs Dermatol. 2015;14(suppl 10):s48-s54.
Andrew S. Dorizas MD,a Amer H. Nassar MD,a and David J. Goldberg MDb,c| |
EVIDENCE REVIEW: Evidence gathered from a pivotal study involving 1,383 patients with 1,831-pigmented lesions. The isolated use of the pediatric population within this study was used to determine the specificity and sensitivity of such a device with comparison to a dermatologists evaluation.
FINDINGS: For all lesions from the assessed pediatric population the biopsy ratio was equivalent for the Multispectral Digital Skin Lesion Analysis device as for the dermatologists when performing as independent reviewers. Furthermore analyzed data suggests that dermatologists who incorporate the Multispectral Digital Skin Lesion Analysis device perform better than they would independently or if they were to follow the device blindly without incorporating their own judgment.
CONCLUSION AND RELEVANCE: An approach that integrates automated imaging technology like the Multispectral Digital Skin Lesion Analysis device, along with another diagnostic aid, with the end result being cost-effective, easy to use by even non-experts and comforting for the pediatric patient is likely to compete to be the new gold standard in successful early diagnosis and management of melanoma.
J Drugs Dermatol. 2014;13(10):1269-1273.
Tracey C. Vlahovic DPMa and Warren S. Joseph DPM FIDSAb| |
METHODS: A post-hoc analysis of 112 patients, aged 29-70 years, randomized to receive efinaconazole topical solution, 10% or vehicle from two identical multicenter, double-blind, vehicle-controlled 48-week studies evaluating safety and efficacy. The primary end point was complete cure rate (0% clinical involvement of target toenail, and both negative potassium hydroxide examination and fungal culture) at week 52.
RESULTS: Mycologic cure rates (OC) were significantly greater with efinaconazole (56.5% and 56.3% in diabetic and non-diabetic patients respectively) compared to vehicle (P=0.016 and P<0.001, respectively). The primary end point, complete cure, was also greater for efinaconazole (13.0% and 18.8%, respectively vs 3.7% and 4.7%). Treatment success (percent affected target toenail ≤10%) for efinaconazole was 40.8% and 47.7%, respectively vs 18.5% and 18.2% with vehicle. There was no statistically significant difference between the diabetic and non-diabetic populations for any efficacy endpoint. Adverse events associated with efinaconazole were local site reactions and clinically similar to vehicle.
CONCLUSIONS: Once daily efinaconazole topical solution, 10% may provide a useful topical option in the treatment of diabetic patients with onychomycosis.
J Drugs Dermatol. 2014;13(10):1186-1190.
Laura Diluvio MDa, Elena Campione PhDa, Cristina Mordenti MDa, Valentina Bagnolo MDb, Caterina Cerminara MDb, Sergio Chimenti MDa, and Luca Bianchi MDa| |
Miriam Bettencourt MD| |
J Drugs Dermatol. 2016;15(8):1026-1028.
Leon H. Kircik MD| |
J Drugs Dermatol. 2016;15(Suppl 2):s44-48.
Analysis of Body Regions and Components of PASI Scores During Adalimumab or Methotrexate Treatment for Patients With Moderate-to-Severe Psoriasis
Alexander A. Navarini MD,a Yves Poulin MD,b Alan Menter MD,c Yihua Gu MS,d and Henrique D. Teixeira PhDd| |
OBJECTIVE: Highlight treatment response patterns potentially hidden by PASI score's compounded weighted-average calculation.
METHODS: Patients with moderate-to-severe psoriasis enrolled in the phase-3, 16-week, randomized CHAMPION study, and received adalimumab, methotrexate, or placebo. PASI scores were assessed post hoc for improvement, by body region and component.
RESULTS: At Week 16, a significantly greater percentage of adalimumab-treated patients vs methotrexate- and placebo-treated patients, achieved PASI 75, PASI 90 and PASI 100 response in each body region and component. 55.7% of adalimumab-treated patients reached PASI 100 response in the head and neck region vs 16.7% overall. Two key components of PASI, induration and desquamation, were affected by treatment more than erythema, the third component. Adalimumab was particularly effective in complete resolution of induration (44.9% of patients) vs methotrexate (10.9%). For all PASI body regions and components, mean percent improvement in score at Weeks 2, 4, 8, 12, and 16 was significantly greater (P<0.05) for adalimumab treatment vs methotrexate or placebo.
CONCLUSION: Adalimumab therapy resulted in complete resolution of individual body regions in at least 30.6% up to 55.7% of patients in CHAMPION. This was more than twice that of methotrexate and placebo. PASI improvement by body region is a novel and an important patient-relevant outcome worthy of reporting in future studies.
J Drugs Dermatol. 2014;13(5):554-562.
Jeremy B. Green MD,a,b Andrei I. Metelitsa MD FRCPC,c,d Joely Kaufman MD,a,b and Terrence Keaney MDe,f,g,h| |
J Drugs Dermatol. 2015;14(9):1061-1064.
Methods: Searches were performed in Medline and EMBASE. Extensive bibliographical research was performed in order to identify additional relevant data sets using Web of Science. Results were screened for inclusion of more than one anatomical site, the use of validated methods, and the use of human subjects.
Results: We identified eight relevant studies, from which we present data.
Conclusion: Determining regional variations in PA is a complex yet critically important task. Current data sets are scarce and inadequate for drawing complete conclusions, but the data seem to suggest increased PA in the forehead and genital skin compared with other anatomical regions. It is our hope that, with the advent of new technologies, an anatomical PA map will begin to emerge from the data. Such descriptive understanding will guide investigation into the mechanisms involved in determining anatomical site differences in PA.
J Drugs Dermatol. 2012;11(10):e48-e51.
Resident Rounds. Part I: Program Spotlight: Tulane University's Dermatology Residency Training Program
James L. Griffith Jr. MS, Darya Shlapak MBA, Robert Bacigalupi MD, and Erin E. Boh MD PhD| |
Saad Al Mohizea MD| |
METHODS: Seven volunteers underwent fixed fractionated CO2 laser treatments at four predetermined days spanning the menstrual cycle.
RESULTS: Two volunteers developed hypopigmentation while the rest had hyperpigmentation. In those who developed PIH, the pigmentation was most severe when done just before or after menstruation.
CONCLUSIONS: Laser induced PIH risk may be influenced by the menstrual cycle.
Resident Rounds: Part I - Program Spotlight: Department of Dermatology, University Hospitals Case Medical Center
Jeffrey F. Scott MD, Ashley Feneran DO, and Kevin D. Cooper MD| |
Pearl E. Grimes MD| |
Six female subjects with Fitzpatrick skin types IV-V in good general health between the ages of 46 and 63 years with moderate epidermal facial melasma are presented herein. Subjects applied the skin brightener twice daily, morning and evening, and returned to the clinic at weeks 4, 8, and 12. By week 12, Investigator Overall Hyperpigmentation scores and MASI scores improved by an average of 22% and 38% from baseline, respectively. Additionally, 100% of subjects showed at least a 25% increase in Global Improvement at week 12. The skin brightener was well tolerated with no reports of erythema, edema, scaling, burning/stinging, or itching.
Results from these case studies suggest that this multimodality skin brightener may provide an alternative treatment to hydroquinone for moderate melasma in skin of color. However additional clinical studies would be needed.
J Drugs Dermatol. 2014;13(3):364-366.
Macrene R. Alexiades-Armenakas MD PhD| |
Ted Rosen MD| |
J Drugs Dermatol. 2016;15(Suppl 2):s49-55.
Resident Rounds. Part I. Program Spotlight: The University of Alabama at Birmingham Department of Dermatology Residency Training Program
James L. Griffith MS,a Johnathan J. Ledet MD,b J. Daniel Jensen MD,b
Jeremy D. Jackson MD,b and Boni E. Elewski MDb
Nicholas Ross, Michele Farber MD, and Joya Sahu MD| |
Of the many tattoo reactions the most common are allergic, granulomatous, lichenoid, photosensitive, pseudolymphomatous, and infectious. Eruptive milia are a rare complication with only three prior reports in the English literature. A 19-year-old African American female presented with tiny, white papules confined within the margins of a tattoo. She denied trauma or associated symptoms at the site. Biopsy demonstrated deposits of black granular material within the dermis and a small infundibular cyst; a diagnosis of eruptive milia within tattoo was made. The milia responded to treatment with urea 40% cream and tretinoin 0.1% cream. Given its rarity, it is important to recognize the presentation of this disorder as other tattoo reactions require more aggressive management. While further research is necessary to determine the exact pathogenesis of this condition, the authors propose a mechanism along with a review of the literature to discuss management.
J Drugs Dermatol. 2017;16(6):621-624.
Successful Treatment of Traumatic Onychodystrophy and Associated Pterygium Unguis With Fractionated Carbon Dioxide Laser: Case Report and Review of the Literature
Derek Ho BS,a,b Andrew Mamalis MD MS,a,b and Jared Jagdeo MD MSa,b,c| |
Systematic Review of Vismodegib Toxicity Profile in the Treatment of Advanced Basal Cell Carcinomas Compared to Other Systemic Therapies in Dermatology
Margit L.W. Juhász MSca and Ellen S. Marmur MDa,b| |
J Drugs Dermatol. 2014;13(6):729-733.
Theresa N. Canavan MD and Boni E. Elewski MD| |
J Drugs Dermatol. 2015;14(suppl 10):s42-s47.
News, Views, & Reviews
The Role of RNA Interference in Dermatology: Current Perspectives and Future Directions
Deborah S. Sarnoff MD FAAD FACPa and Robert H. Gotkin MD FACSb| |
J Drugs Dermatol. 2015;14(5):472-477.
Successful Treatment of Patients Previously Labeled as Having Delusions of Parasitosis With Antidepressant Therapy
Ashley Delacerda MD, Jason S. Reichenberg MD, and Michelle Magid MD
Department of Dermatology, University of Texas Southwestern, Austin, TX
J Drugs Dermatol. 2012;11(12):1506-1507.
Adam R. Mattox DO MS, Jeaneen A. Chappell MD, and M. Yadira Hurley MD| |
J Drugs Dermatol. 2013;12(2):217-219.
This article focuses on such findings in selected multiple cutaneous lesions that may be classified according to the primary cutaneous feature as vascular, pigmentary, nevoid hamartomas, and tumors/neoplastic conditions. The clinical presentation of each entity and its significance, appropriate diagnostic evaluation, therapeutic and prognostic considerations and pertinent differential diagnoses will be reviewed.
J Drugs Dermatol. 2012;11(7):812-817.
Ethan T. Routt MD,a Shelbi C. Jim On MD,a Joshua A. Zeichner MD,a and Leon H. Kircik MDb,c,d| |
J Drugs Dermatol. 2014;13(4):391-395.
Evaluation of Moisturizing Effect of Methanolic Extract of Five Medicinal Plants Incorporated Into Cream Bases Using Impedance and Extensiometry Methods
Background: Skin moisturizing is an important issue due to its impact on skin function. Adverse reactions to herbal extracts have been rarely reported and can be used in moisturizers. This study was conduct to evaluate moisturizing effect of a methanolic extract of five medicinal plants incorporated into cream bases.
Methods: Methanolic extract of five medicinal plants including olive, burdock, licorice, mallow and marsh horsetail was prepared. The extracts were dissolved in distilled water completely and freeze-dried to a dry powder. These extracts were added separately to the cream based formulation that has been suggested to be appropriate for adding herbal extracts. Moisturizing effects of these creams with herbal extracts were assessed using the impedance method on 12 rats equally divided into six groups (one control and five cases), as well as the extensiometry method on 25 mice divided into five groups (in each group one cream with herbal extract and control cream were tested concurrently). Obtained results were compared with the control cream based.
Results: The maximum moisturizing effect was observed with the marsh horsetail. Other creams with herbal extracts, except the one with the licorice, also exerted significantly higher moisturizing effect compared to the controls (P<0.05). Regarding the force for skin tearing, the differences were statistically significant in all groups when compared to the control group (P<0.05) and the highest difference was seen in the marsh horsetail group (2.0832 ± 0.6811 kgN).
Conclusions: The highest moisturizing activity was observed using marsh horsetail extract that can be explained by flavonoids content of marsh horsetail.
J Drugs Dermatol. 2011;10(10):1116-1121.
Brandon L. Adler BA and Adam J. Friedman MD| |
Non-Tuberculous Mycobacterial Infections Following Cosmetic Laser Procedures: A Case Report and Review of the Literature
Jacqueline Goulart Berliner MD,a Bishr Aldabagh MD,a Thaddeus Mully MD,b
Siegrid S. Yu MD,a Brian S. Schwartz MD,c Timothy G. Berger MDa
J Drugs Dermatol. 2015;14(1):80-83.
J Drugs Dermatol. 2012;11(8):1000-1002.
David Schairer BA, Laura Schairer BA, Adam Friedman MD| |
Clobetasol Propionate 0.05% Spray for the Management of Moderate-to-Severe Plaque Psoriasis of the Scalp: Results From a Randomized Controlled Trial
Background: Clobetasol propionate 0.05% spray is available for treating moderate-to-severe plaque psoriasis; however, there is limited information with plaque psoriasis of the scalp.
Objective: Evaluate the efficacy, safety, and quality-of-life impact of clobetasol propionate 0.05% spray in patients with moderate to severe plaque psoriasis of the scalp.
Methods: Multicenter, randomized, double-blind, vehicle-controlled study involving 81 men and women with moderate-to-severe (Global Severity Score [GSS] = 3 or 4) plaque psoriasis of the scalp. Eligible patients were treated with clobetasol propionate 0.05% spray or vehicle spray, which was applied twice daily for up to four weeks. The primary efficacy end point was the GSS of psoriasis of the scalp after four weeks. Safety assessments included local tolerability, presence of Cushing's syndrome, and adverse events.
Results: At the end of treatment, 85 percent (35/41) of patients in the clobetasol propionate 0.05% spray group achieved success (GSS clear or almost clear), compared with 13 percent (5/40) in the vehicle spray group (P < .001). The proportion of patients treated with clobetasol propionate 0.05% spray who achieved a rating of clear (GSS = 0) after two weeks and at the end of treatment was 12 percent and 51 percent, respectively. Clobetasol propionate 0.05% spray was well tolerated, and there were no serious adverse events or reported cases of folliculitis or Cushing's syndrome.
Conclusion: Treatment with clobetasol propionate 0.05% spray for up to four weeks is effective and well tolerated for moderate-to-severe plaque psoriasis of the scalp.
J Drugs Dermatol. 2011;10(8):888-895.
Shannon Famenini BS,a Nima M. Gharavi MD PhD,b and David P. Beynet MDb| |
J Drugs Dermatol. 2014;13(4):484-486.
Alan R. Shalita MD and Whitney P. Bowe MD| |
Kendra Gail Bergstrom MD FAAD| |
Resident Rounds. Program Spotlight: Wright State University Department of Dermatology Residency Training Program
Rishi K. Gandhi MD and Julian J. Trevino MD| |
Background: Scalp hyperkeratosis and/or alopecia are common pediatric dermatologic findings. In Caucasian children, scalp hyperkeratosis
of childhood is most often associated with atopic and seborrheic dermatides. Recent data is lacking on the clinical meaning of scalp hyperkeratosis and alopecia in children of color.
Objective: To determine diagnosis associated with scalp hyperkeratosis and/or alopecia in a predominately Black and Hispanic pediatric patient population.
Methods: A retrospective chart review was conducted for all children (0-17 years of age) seen at our institution who had a scalp fungal culture for the evaluation of scalp hyperkeratosis and/or alopecia from January 2007 to September 2009. Fungal culture was performed using cotton swab technique, plating onto Sabouraud's and Mycosel media. Demographic features, fungal culture results, clinical symptoms, physical findings and final diagnosis were reviewed.
Results: 164 children were identified who were eligible for inclusion in the study, 75 of whom were Black and 56 Hispanic/Latino. Scalp hyperkeratosis was noted in 106 patients and alopecia was noted in 71 subjects. Tinea capitis was the final diagnosis in 50 out of 80 children who had hyperkeratosis without alopecia (60%), 16 of 43 children with alopecia alone (37.2%) and 23 of 28 children with both hyperkeratosis and alopecia (82.1%, P=0.0007). The odds ratio of tinea capitis in the presence of hyperkeratosis with alopecia was 7.49 with a 95 percent confidence limit of 2.19-25.70.
Conclusion: Scalp hyperkeratosis, especially when accompanied by alopecia, is usually associated with tinea capitis in Black and Hispanic children. Fungal culture and empirical anti-fungal therapy are warranted in children of color with scalp hyperkeratosis.
J Drugs Dermatol. 2011;10(5):511-516.
Ross Brothers MD, Rawn E. Bosley MD, and Steven Daveluy MD| |
J Drugs Dermatol. 2014;13(8):960-966.
Clinical Trial Review is a JDD department designed to provide physicians with information on drugs and devices undergoing clinical testing. It is our goal to inform the reader of the status of select drug and device studies relevant to the practice of dermatology before this information is available through standard channels. To participate in or learn more about these and additional trials, visit www.clinicaltrials.gov.
Jean Carruthers MD FRCSC FRC (OPHTH)a and Alastair Carruthers MD MRCP FRCPCb| |
J Drugs Dermatol. 2014;13(suppl 1):s7-s11.
Leon H. Kircik MD| |
Christopher S. Hale MDa and William R. Levis MDb| |
Edith Bowers MD PhD| |
Jared Jagdeo MD MS| |
Kristen Lo Sicco MD, Mona Sadeghpour MD, Laura Ferris MD PhD, Lisa Grandinetti MD| |
Jenny A. Mandell MD, Jaimie B. Glick MD, and Ravneet Ruby Kaur MD| |
Amanda Abramson Lloyd MD| |
Here we present the first case of a patient from Ottawa Canada, presenting with leprosy-like illness associated with Mycobacterium lepromatosis. The patient had no history of travel to leprosy-endemic areas or any obvious risk factors. Clinically, the patient presented with an anesthetic maculopapular rash on the trunk, back, and extremities. A skin biopsy of a lesion revealed a dermal lymphohistiocytic infiltration involving the vessels with an inflammatory process extending to the nerves. A neurological exam also identified a severe sensorimotor polyneuropathy. Concurrently, the patient was diagnosed with non-resectable, non small cell carcinoma of the lung, further complicating his clinical presentation. A Kinyoun stain of nasal blows and a Fite stain of the skin biopsy revealed few to moderate acid fast bacilli respectively. Cultures of the skin biopsy and multiple nasal blows were negative. Molecular studies of a skin biopsy sample including sequence analysis of a 765 bp region of the 16s rRNA gene eventually identified the organism with 100% homology to M. lepromatosis. The patient was treated for leprosy and appeared to improve slightly on therapy but died as a result of his malignancy approximately five months after the initiation of therapy. This represents the first case of a patient with M. lepromatosis like illness outside of Mexico and Singapore.
J Drugs Dermatol. 2012;11(2):229-233.
Andrew C. Krakowski MD,a Lawrence F. Eichenfield, MDb| |
Dhaval Bhanusali MD, Marcelyn Coley MD, Jonathan I. Silverberg MD MPH PhD, Andrew Alexis MD MPH and Nanette B. Silverberg MD| |
Objective: To determine prevalent fungal species and response to standard antifungal therapy in inner-city children of color.
Methods: An IRB-approved chart review of demographic, clinical, diagnostic, and therapeutic data was conducted for children and young adults (0 to 18 years of age) who had scalp fungal culture performed for scalp hyperkeratosis and/or alopecia over a 2.5 year time-period. Supplemental parental phone interview was performed for missing data points.
Results: A total of 84 patients with final diagnosis of tinea capitis were identified—52% male, 60.6% African-American, 28.2% Hispanic, and 9.9% Caucasian. Complete resolution at 4 weeks was uncommon in all demographic groups (Hispanic: 11.7%, African-American: 41.3%). The Hispanic group and the youngest patients (aged less than 4 years) were less likely to respond to initial therapy, but the results were not significant. Of the 80 tinea capitis patients initially treated with griseofulvin, 41 out of 54 children (76%) had complete response to micronized suspension +/- crushed tablet (33% required shift to tablets from suspension) and 20 out of 26 (76.9%) cleared on crushed tablets alone. Of the 19 griseofulvin failures, 5 cleared on fluconazole suspension, 7 on terbinafine sprinkles, 3 on itraconazole therapy, and 4 were lost to follow-up. Of the 47 patients who could be evaluated long-term after a single course of oral griseofulvin at 6 weeks or greater, 38 had documented long-term mycological cure (80.8%) and 42 had long-term clinical cure (89%). Trichophyton tonsurans (n=40) was the most prevalent causative species identified on culture, followed by Alternaria species (n=10) and Microsporum canis (n=1).
Limitations: Retrospective chart review: patient population has a high rate of usage of over-the-counter antifungal creams and shampoos, affecting culture results.
Conclusions: Tinea capitis is still the most common cause of Trichophyton tonsurans in New York City. Response rates to griseofulvin are similar to rates seen in the 1970s, but require higher dosing and conversion to crushed tablets in partial responders. Usage of crushed ultramicronized griseofulvin, terbinafine sprinkles, itraconazole, and fluconazole are alternative regimens for those children whose tinea capitis does not clear on griseofulvin suspension.
J Drugs Dermatol. 2012;11(7):852-856.
Nils Krueger PhD,a Stefanie Luebberding MSc,a Gerhard Sattler MD,b C. William Hanke MD,c
Macrene Alexiades-Armenakas MD,d and Neil Sadick MDe
J Drugs Dermatol. 2013;12(7):737-742.
Elizabeth Lazaridou MD PhD, Christina Fotiadou MD, Christina Giannopoulou MD, Demetrios Ioannides MD PhD| |
The painful, erythematous and eroded vulva often proves to be a diagnostic problem both clinically and histologically. Its differential diagnosis includes both non-neoplastic and neoplastic diseases like Bowen's disease and squamous cell carcinoma (SCC). We report the case of a 62-year-old woman diagnosed, after considerable delay, with Bowen's disease of the vulva that eventually progressed to invasive SCC, despite the treatment with imiquimod 5% cream. Our case indicates, on one hand, that dermoscopy could contribute to the accuracy of the pre-operative clinical diagnosis. On the other hand it confirms the fact that treatment of Bowen's disease of the vulva could be rather intriguing. Although imiquimod 5% cream is an effective, non-invasive treatment option for large lesions or poor healing sites, it should be administered with great consideration in carefully selected cases.
J Drugs Dermatol. 2012;11(1):110-112.
Resident Rounds: Part I. Program Spotlight: Pennsylvania State University Dermatology Residency Program
Charlene Lam MD MPH, Jeffrey J. Miller MD MBA, and Joslyn S. Kirby MD| |
Aanand N. Geria MD, Christina N. Lawson MD, Rebat M. Halder MD| |
J Drugs Dermatol. 2011;10(5):483-489.
The Efficacy and Safety of Tavaborole, a Novel, Boron-Based Pharmaceutical Agent: Phase 2 Studies Conducted for the Topical Treatment of Toenail Onychomycosis
Mirna E. Toledo-Bahena MD,a Alicia Bucko DO JD,b Jorge Ocampo-Candiani MD,c Maira E. Herz-Ruelas MD,c
Terry M. Jones MD,d Michael T. Jarratt MD,e Richard A. Pollak DPM MS,f Lee T. Zane MDg
METHODS: One double-blind, randomized, vehicle-controlled study (study 1) and two open-label studies (studies 2 and 3) examined the efficacy, safety, and optimal dosing concentration of tavaborole topical solution applied once daily or three times weekly for 180 days at concentrations of 1.0%, 2.5%, 5.0%, or 7.5%. Patient cohort 3 of study 2 received open-label tavaborole 5.0% once daily for 360 days. All three studies assessed day 180 treatment success, defined as complete or partial clinical evidence of clear nail growth plus negative fungal culture.
RESULTS: A total of 336 patients were included in the intent-to-treat (ITT) or modified ITT populations and efficacy analyses across the 3 studies. In study 1, treatment success rates at day 180 were higher with tavaborole 2.5%, 5.0%, and 7.5% vs vehicle (27%, 26%, and 32% vs 14%, respectively; slope P=0.030). In cohort 3 of study 2, 7% of patients achieved treatment success with tavaborole 5.0% at day 360. Negative culture rates at day 180 in study 1 were numerically higher for tavaborole 2.5%, 5.0%, and 7.5% vs vehicle (slope P=0.046). Application-site reactions of general irritation, erythema, scaling, and stinging/burning were most common with tavaborole 7.5%, were generally mild to moderate, and resolved with treatment discontinuation and/or a reduction in dosing frequency. No systemic safety concerns were observed.
CONCLUSION: Tavaborole solution demonstrated favorable efficacy and safety in phase 2 clinical studies. Based on these findings, tavaborole topical solution, 5% was further investigated in larger, more definitive phase 3 studies. Results from these completed phase 3 studies will provide additional evidence regarding the safety and efficacy of tavaborole in the treatment of toenail onychomycosis.
J Drugs Dermatol. 2014;13(9):1124-1132.
Mona S. Foad MD and Erin Winters BA| |
J Drugs Dermatol. 2013;12(3 suppl 1):s42-s44.
Timothy P. Wu BA and Jennifer A. Stein MD PhD| |
J Drugs Dermatol. 2013;12(5):568-572.
Optical Coherence Tomography Imaging of Erythematotelangiectatic Rosacea During Treatment With Brimonidine Topical Gel 0.33%: A Potential Method for Treatment Outcome Assessment
Jennifer Urban BS,a Arunee H. Siripunvarapon MD,b Adam Meekings BS,c
Amy Kalowitz BS,b and Orit Markowitz MD FAADb
OBJECTIVE: To examine and describe how OCT skin morphology changes when exposed to brimonidine topical gel 0.33% in the treatment of erythematotelangiectatic rosacea.
METHODS: Normal in vivo telangiectasias and erythematous patches and papules were examined prior to treatment clinically, dermatoscopically, and through OCT scans. Brimonidine topical gel 0.33% was applied to the face and OCT images were acquired at defined time intervals: baseline; immediately (<5 minutes) after application; 4 hours after application; and after 2 weeks’ once daily application. OCT morphology was then described.
RESULTS: OCT imaging showed an increase in the mean gray value (MGV), a measure of dermal reflectivity, corresponding to a decrease in dermal edema. MGV measurements for the nasal telangiectasia were: baseline, MGV 10,471 (standard deviation [SD] 6,847); immediate, MGV 15,634 (SD 8,983); after 4 hours, MGV 16,357 (SD 7,647); and after 2 weeks, MGV 15,505 (SD 6,870). MGV measurements for the chin erythema were: baseline, MGV 8,850 (SD 4,969); immediate, MGV 10,799 (SD 5,266); after 4 hours, MGV 12,419 (SD 6,714); and after 2 weeks, MGV 13,395 (SD 6,170). No significant change in vessel lumen diameter was appreciated. Vessel lumen diameter for the facial papule ranged from 0.13 mm at baseline, 0.09 mm immediately after treatment, 0.09 mm after 4 hours, and 0.11 mm after 2 weeks.
CONCLUSIONS: OCT scanning showed a decrease in the dermal hyporeflectivity of the dermis consistent with a decrease in dermal edema. The OCT scans obtained did not show any significant change in vessel lumen diameter. These results may reflect an increase in vascular tone, which can be attributable to the clinical improvement and decreased erythema noted in the patient. This technology could potentially be used for the non-invasive in vivo monitoring of other topical treatments.
J Drugs Dermatol. 2014;13(7):821-826.
The Mechanisms and Potential Impact of Stem Cell Activation in Skin Rejuvenation: An Evidence-Based Analysis
Hema Sundaram MD| |
Stem cells can propagate indefinitely in an undifferentiated state; or, with appropriate signals, differentiate into various types of mature cells. Strong interest in stem cell therapies for degenerative diseases has extended to skin aging, itself a degenerative process. This article reviews mechanisms of skin aging, and enables an evidence-based approach to topical skin rejuvenation - specifically, to formulations labeled as stem cell products.
J Drugs Dermatol. 2017;16(4):378-384.
Horatio F. Wildman MD and Richard D. Granstein MD| |
Nazanin Saedi MDa and Anand K. Ganesan MDb| |
MATERIALS/METHODS: With approval from the institutional review board at the University of California, Irvine, an electronic survey was sent to practicing dermatologists that contained 18 questions regarding the approach to evaluating and treating hyperpigmentation under the eyes, in the axilla, and along the neck.
RESULTS: Fifty dermatologists completed the survey, and 46 (92%) reported treating patients with darker skin. The ethnic groups treated were Latino (97.8%), African American (97.8%), Middle Eastern (77.6%), and Asian (88.9%). Thirty-six reported treating patients with hyperpigmentation under the eyes, and 22 (61.1%) thought the hyperpigmentation was a result of idiopathic increase in melanin deposition. Forty-two responded to treating hyperpigmentation in the axilla, most of whom thought it was related to acanthosis nigricans (69.0%) or contact dermatitis (59.5%). Forty responded to treating hyperpigmentation on the neck, most of whom treated the condition with hydroquinone (66%). Treatments for these 3 areas were not found to be effective.
CONCLUSIONS: Hyperpigmentation under the eyes, under the arms, or on the neck is a significant problem in darker-skinned patients that is refractory to currently available treatments, highlighting the necessity of developing treatment approaches directed toward this population. Two cases of hyperpigmentation on the neck are presented, describing a new entity that primarily affects dark-skinned individuals.
J Drugs Dermatol. 2013;12(5):563-567.
Kathleen Sikora Viscusi, MD| |
Savita Chaudhary MD Fellow ISDa and Surabhi Dayal MDb| |
OBJECTIVE: To assess the efficacy of combination of topical regimen (2% hydroquinone, 1% hydrocortisone and 0.05% tretinoin) with serial glycolic acid peeling in the treatment of melasma in Indian patients.
METHODS: Forty Indian patients of moderate to severe epidermal variety melasma were divided into two groups of 20 each. One Group i.e. peel group received topical regimen (2% hydroquinone, 1% hydrocortisone and 0.05% tretinoin) with serial glycolic acid peeling and other group i.e. control group received topical regimen (2% hydroquinone, 1% hydrocortisone, 0.05% tretinoin).
RESULTS: There was an overall decrease in MASI from baseline in 24 weeks of therapy in both the groups (P value < 0.05). The group receiving the glycolic acid peel with topical regimen showed early and greater improvement than the group which was receiving topical regimen only.
CONCLUSION: This study concluded that combining topical regimen (2% hydroquinone, 1% hydrocortisone and 0.05% tretinoin) with serial glycolic acid peeling significantly enhances the therapeutic efficacy of glycolic acid peeling. The combination of glycolic acid peeling with the topical regimen is a highly effective, safe and promising therapeutic option in treatment of melasma.
J Drugs Dermatol. 2013;12(10):1149-1153.
Jesper F. Nygart MD,a Victoria A. Nygart MSoc,a Marie Borggren PhD,b Michael Tvede MDc| |
METHOD: This retrospective study of outcomes following polyacrylamide hydrogel injections includes 657 subjects from one centre, which had facial injections from 2001 and 2011. Until 2007 prophylactic antibiotics were not given prior to treatment, but in September 2007 a single oral dose of azithromycin (Zitromax) and moxifloxacin (Avelox) was introduced as prophylactic antibiotics. A total of 496 subjects were injected before 2007 without antibiotic prophylactic treatment, and 161 subjects received these two antibiotics prior to treatment from September 2007.
RESULTS: The prophylactic antibiotics (azithromycin and moxifloxacin) significantly reduced the incidence of clinical signs of inflammation/infections from 7 to 2% (P=0.03).
CONCLUSION: Even though the incidence of inflammation/infections following injection of polyacrylamide hydrogel is relatively low, it may be reduced further by using prophylactic antibiotic treatment. Based on our experience, we recommend prophylactic antibiotics to patients who have facial augmentation with polyacrylamide hydrogel in order to avoid infection and risk of biofilm formation due to contamination during injection with naturally occurring micro flora from skin and lips.
J Drugs Dermatol. 2014;13(5):571-573.
Jordan Fabrikant DO,a Khasha Touloei DO,b and Stuart M. Brown MDc| |
J Drugs Dermatol. 2013;12(7):775-779.
J Drugs Dermatol. 2012;11(9):1117-1118.
Fran E. Cook-Bolden MD| |
Program Spotlight - The University of Texas Southwestern Medical Center Dermatology Residency Program
Ponciano D. Cruz Jr. MD| |
Resident Rounds is a section of the JDD dedicated to highlighting various dermatology departments with residency training programs. Resident Rounds includes three sections: (1) a program spotlight, highlighting pertinent information about the department and residency training program; (2) a section presenting study materials used by residents at the program; and (3) a section designed to highlight recent interesting cases seen at the institution. This issue of Resident Rounds features the University of Texas Southwestern Medical Center Dermatology Residency Program. The editor of Resident Rounds is Omar A. Ibrahimi, MD, PhD. He is currently the Director of Cutaneous Laser and Cosmetic Surgery and a Mohs surgeon at the University of Connecticut. Dr. Ibrahimi is also a Visiting Scientist at the Wellman Center for Photomedicine at Massachusetts General Hospital/Harvard Medical School. If you are interested in highlighting your training program in a future issue, please contact Dr. Ibrahimi at OIbrahimi@jddonline.com
Development and Clinical Assessment of a Comprehensive Product for Pigmentation Control in Multiple Ethnic Populations
Elizabeth T. Makino BS CCRA MBA,a Kuniko Kadoya PhD,a Monya L. Sigler PhD,b Peter D. Hino MD FAAD,b and Rahul C. Mehta PhDa| |
A Multicenter, Randomized, Double-Blind Study of the Efficacy and Safety of Calcipotriene Foam, 0.005%, vs Vehicle Foam in the Treatment of Plaque-type Psoriasis of the Scalp
Steven R. Feldman MD PhD,a William J. Eastman MD,b Thomas Brundage MS,b and Mary Mills BSb| |
OBJECTIVES: To evaluate the efficacy and safety of calcipotriene foam, 0.005%, for plaque-type psoriasis of the scalp.
METHODS: Subjects (n=363) were randomized into an 8-week, multicenter, double-blind, vehicle-controlled, parallel-group, phase 3b study of calcipotriene foam, 0.005% (NCT01139580). Primary end point was the proportion of subjects with an Investigator's Static Global Assessment (ISGA) score of 0 (clear) or 1 (almost clear) at week 8 for scalp involvement. Body involvement, target lesion score, and improvement for erythema, scaling, and plaque thickness were also assessed.
RESULTS: At week 8, more subjects in the calcipotriene foam, 0.005% group (40.9%) met the primary end point vs the vehicle foam group (24.2%; intent-to-treat [ITT] population; P<.001); a significant difference between groups was also observed at weeks 2 (P=.041) and 4 (P<.001). No significant difference was observed between treatment groups for ISGA of body psoriasis (ITT population; P=.544). In the per-protocol population, but not the ITT population, more subjects in the calcipotriene foam, 0.005%, group than the vehicle foam group met the secondary end points for scaling (P=.019) and plaque thickness (P=.027). Incidence of adverse events in both treatment groups was low; calcipotriene foam, 0.005%, was associated with erythema. Limitations: An 8-week study provides limited safety and efficacy data.
CONCLUSION: Calcipotriene foam, 0.005%, was more effective than vehicle foam for improving scalp psoriasis over an 8-week period, with improvements evident from week 2, and had a similar safety profile to vehicle foam.
J Drugs Dermatol. 2013;12(3):300-306.
Wallace Nozile MS, Cheri N. Adgerson MD, and George F. Cohen MD| |
J Drugs Dermatol. 2015;14(4):343-349.
Rebecca Kleinerman MD, Thomas H. King MD, and Daniel B. Eisen MD| |
J Drugs Dermatol. 2013;12(1):60-65.
Flor A. Mayoral MD and Janelle M. Vega| |
J Drugs Dermatol. 2011;10(11):1320-1321.
Calcipotriene Plus Betamethasone Dipropionate Topical Suspension for the Treatment of Mild to Moderate Psoriasis Vulgaris on the Body: A Randomized, Double-Blind, Vehicle-Controlled Trial
Alan Menter MD,a Linda Stein Gold MD,b Michael Bukhalo MD,c Steven Grekin DO,d Steven Kempers MD,e Brent M. Boyce MD,f Cecilia Ganslandt MD, gJohn Villumsen MSc,h and Mark Lebwohl MDi| |
Methods: This was a randomized, double-blind, vehicle-controlled, 4-arm trial in 1,152 subjects. The co-primary efficacy end points were the proportion of subjects achieving controlled disease based on the Investigators' Global Assessment of disease severity at weeks 4 and 8. Adverse events, vital signs, and clinical laboratory measurements were also assessed.
Results: At week 4, a greater proportion of subjects in the calcipotriene plus betamethasone group achieved controlled disease compared with subjects in the calcipotriene-only and vehicle-only treatment groups. At week 8, a statistically significantly (P<.01) greater proportion of subjects in the calcipotriene plus betamethasone group achieved controlled disease compared with subjects in the 3 other treatment groups. Adverse events and other safety assessments were similar between the groups.
Conclusion: The topical suspension containing calcipotriene plus betamethasone dipropionate traditionally used for scalp psoriasis is also a safe and effective once-daily treatment for psoriasis vulgaris on the body.
J Drugs Dermatol. 2013;12(1):92-98.
J Drugs Dermatol. 2012;11(4):528-529.
The authors report a female patient with recalcitrant ulcerated necrobiosis lipoidica (NL) that was resistant to numerous systemic agents and who responded to treatment with intravenous immunoglobulin (IVIG), leading to resolution of the ulcerated areas for several months. Subsequent treatment with two further courses of IVIG was less effective, but a course of intravenous methylprednisolone led to regression of the lesions. As well as briefly reviewing the literature on treatments used to treat ulcerated NL, we outline the pathological mechanisms thought to be involved in the condition and how the modes of action of IVIG might explain its apparent efficacy in this case. As far as we are aware, the response of ulcerated NL to IVIG or methylprednisolone has not been reported previously, although other systemic preparations of corticosteroids have been used.
J Drugs Dermatol. 2012;11(2):256-259.
A Case of Erythema Elevatum Diutinum With Pancytopenia: Focus on Dapsone-Induced Hematologic Side Effects and Colchicine as a Safe Treatment Option
Emek Kocatürk MD, Bachar Memet MD,
Ilteris Oguz Topal MD, Tülin Yüksel MD,
Pelin Kuteyla Ülkümen MD, Utkan Kızıltaç MD
Hilary E. Baldwin MD,a Marge Nighland BS,b Clare Kendall MA,c David A. Mays PharmD MBA,c Rachel Grossman MD,b,c and Joan Newburger PhDc| |
J Drugs Dermatol. 2013;12(6):638-642, e94-e105.
Patrick Bitter Jr. MD| |
Safe and Efficacious Use of Intralesional Steroids for the Treatment of Focally Resistant Mycosis Fungoides
Deede Y. Liu MD,a* Tarek Shaath BA,b* Anand N. Rajpara MD,a Cody Hanson BS,c
Garth Fraga MD,d Ryan Fischer MD,a and Daniel J. Aires MDa
J Drugs Dermatol. 2015;14(5):466-470.
The Effects of a Daily Skincare Regimen on Maintaining the Benefits Obtained from Previous Chemical Resurfacing Treatments
Suzanne Bruce MD,a Wendy Roberts MD,b Craig Teller MD,c and Lora Colvan BSd| |
OBJECTIVES: To evaluate whether a daily skin care regimen used for 12 weeks could maintain the benefits achieved with AGE and MELA chemical resurfacing treatments.
METHODS: Subjects who completed participation in the AGE and MELA skin resurfacing clinical trial were recruited to participate in a continuation trial and used a daily regimen of MDRejuvena facial products for 12 weeks. No other facial products were permitted. Physicians assessed the severity of individual skin parameters at baseline and week 12 and provided global assessment. Subjects assessed improvement of individual skin parameters at week 12 and provided an overall assessment.
RESULTS: Thirteen subjects participated in the 12-week continuation trial. According to the physician’s global assessment, all subjects demonstrated some level of improvement at week 12 compared to baseline. Physician assessment showed a decrease in severity of all skin parameters assessed at week 12 compared to baseline. According to the subject overall assessment at week 12, 11 of 12 subjects noted some level of improvement, 1 subject saw no improvement, and 1 subject did not provide an overall assessment. Mild to moderate improvement was observed by subjects in all individual skin parameters assessed except for skin discoloration.
CONCLUSIONS: The results of the continuation study demonstrate that use of a daily skin care regimen, which include combination of 2 various strengths of MDRejuvena Rejuvaphyl® Rejuvenating Complex: low strength (LS) and high strength (HS), not only maintains but can enhance the beneficial effects of skin resurfacing treatments for at least 12 weeks.
J Drugs Dermatol. 2016;15(9):1145-1150.
Successful Use of 1064 Nm Nd:YAG in Conjunction With 2790 Nm YSGG Ablative Laser for Traumatic Scarring
Rajiv I. Nijhawan MDa and Maritza I. Perez MDb| |
J Drugs Dermatol. 2014;13(1):80-81.
Efficacy of a Novel Rosacea Treatment System: An Investigator-Blind, Randomized, Parallel-Group Study
James J. Leyden MD| |
Introduction: A rosacea treatment system (cleanser, metronidazole 0.75% gel, hydrating complexion corrector, and sunscreen SPF30) has been developed to treat rosacea.
Methods: Thirty women with mild or moderate erythema of rosacea on their facial cheeks were randomly assigned to use one of the following for 28 days: the rosacea treatment system (RTS); RTS minus metronidazole (RTS-M); or metronidazole 0.75% gel plus standard skin care (standard cleanser and standard moisturizer/sunscreen) (M+SSC).
Results: At day 28, global improvement was evident in 90 percent of patients using RTS, 60 percent using RTS-M, and 67 percent using M+SSC. Erythema was significantly lower with RTS from day 14 onward, and unchanged with M+SSC. The proportion of patients reporting their skin was easily irritated at least sometimes was 40 percent with RTS, 70 percent with RTS-M, and 89 percent with M+SSC.
Conclusion: The rosacea treatment system may offer superior efficacy and tolerability to metronidazole plus the standard skin care used in this study.
J Drugs Dermatol. 2011;10(10):1179-1185.
Zoe Diana Draelos MD,a Jwala Karnik MD,b and Gail Naughton PhDc| |
Psoriasis and Cardiometabolic Disease: A Brief, Focused, Educational Intervention on Cardiometabolic Risks
Courtney J. Burnett BS, Dennis P. West PhD, Alfred W. Rademaker PhD, and Roopal V. Kundu MD| |
J Drugs Dermatol. 2016;15(10):1176-1180.
Cheryl Gray MD,a Sheila M. Greenlaw MD,a Christine Alavian MD,a Karen Wiss MDb| |
Joanna Harp MD,a Joshua M. Schulman MD,a and Jack S. Resneck, Jr MDb| |
Resident Rounds is a section of the JDD dedicated to highlighting various dermatology departments with residency training programs. Resident Rounds includes three sections: (1) a program spotlight, highlighting pertinent information about the department and residency training program; (2) a section presenting study materials used by residents at the program; and (3) a section designed to highlight recent interesting cases seen at the institution. This issue of Resident Rounds features the University of California, San Francisco, School of Medicine, Dermatology Residency Program. The editor of Resident Rounds is Omar A. Ibrahimi, MD, PhD. He is currently the Director of Cutaneous Laser and Cosmetic Surgery and a Mohs surgeon at the University of Connecticut. Dr. Ibrahimi is also a Visiting Scientist at the Wellman Center for Photomedicine at Massachusetts General Hospital/Harvard Medical School. If you are interested in highlighting your training program in a future issue, please contact Dr. Ibrahimi at email@example.com
Joshua A. Farhadian,a Bradley S. Bloom,b and Jeremy A. Brauera,b,c| |
J Drugs Dermatol. 2015;14(9):1029-1034.
Lissy Hu BA,a Christina Alexander BA,b Nicole F. Velez MD,c F. Clarissa Yang MD,c
Alvaro Laga Canales MD MMSc,c,d Stephanie Liu MD,c and Ruth Ann Vleugels MD MPHc,
J Drugs Dermatol. 2015;14(6):628-630.
Adam B. Blechman MD,a Christine E. Cabell MD,b Christine H. Weinberger MD,c Anna Duckworth MD,d Justin J. Leitenberger MD,e Fiona O. Zwald MD,f and Mark A. Russell MDg| |
The Food and Drug Administration approved Ruxolitinib in 2011 for the treatment of primary myelofibrosis. Five-year safety data showed a higher incidence of skin cancer in patients treated with Ruxolitinib compared to best available therapy for myelofibrosis. This report presents a series of five patients with history of myelofibrosis treated with Ruxolitinib who subsequently developed numerous skin cancers with aggressive biological behavior. Each patient in this report was treated by a Mohs surgeon affiliated with an academic institution. All patients had a history of myelofibrosis and were exposed to Ruxolitinib. Some patients were exposed to other immunomodulatory medications such as Hydroxyurea and Rituximab. The total number of skin cancers and skin cancers with particularly aggressive behavior were noted. All five patients in this series developed numerous skin cancers with aggressive biological behavior during or after therapy with Ruxolitinib. Also, one patient developed lentigo maligna melanoma and another developed metastatic undifferentiated pleomorphic sarcoma. The repeat observation of skin cancers with aggressive features during JAK inhibitor treatment suggests that these medications may promote cutaneous malignant transformation in at risk patients. Further surveillance and testing of JAK kinases regarding the risk of skin cancers is indicated.
J Drugs Dermatol. 2017;16(5):508-511.
Lauren Meshkov Bonati MD,a Gorana Kuka Epstein MD,b and Tamara Lazic Strugar MDa| |
INTRODUCTION: Microneedling procedures are growing in popularity for a wide variety of skin conditions. This paper comprehensively reviews the medical literature regarding skin needling efficacy and safety in all skin types and in multiple dermatologic conditions.
METHODS: A PubMed literature search was conducted in all languages without restriction and bibliographies of relevant articles reviewed. Search terms included: “microneedling,” “percutaneous collagen induction,” “needling,” “skin needling,” and “dermaroller.”
RESULTS: Microneedling is most commonly used for acne scars and cosmetic rejuvenation, however, treatment benefit has also been seen in varicella scars, burn scars, keloids, acne, alopecia, and periorbital melanosis, and has improved flap and graft survival, and enhanced transdermal delivery of topical products. Side effects were mild and self-limited, with few reports of post-inflammatory hyperpigmentation, and isolated reports of tram tracking, facial allergic granuloma, and systemic hypersensitivity.
DISCUSS: Microneedling represents a safe, cost-effective, and efficacious treatment option for a variety of dermatologic conditions in all skin types. More double-blinded, randomized, controlled trials are required to make more definitive conclusions.
J Drugs Dermatol. 2017;16(4):308-314.
The Effect of Benzoyl Peroxide 9.8% Emollient Foam on Reduction of Propionibacterium acnes on the Back Using a Short Contact Therapy Approach
Benzoyl peroxide (BP) exerts its therapeutic effect for acne vulgaris through reduction of Propionibacterium acnes. A 1.0 to 2.0 log reduction in P acnes has been demonstrated primarily on the face with use of “leave-on” BP formulations, but also with some BP cleansers. In addition to use for facial acne vulgaris, cleanser formulations of BP are commonly used for truncal acne vulgaris due to ease of use on a large body-surface area and to avoid bleaching of fabric. To date, evaluation of P acnes reduction on the trunk has not been well studied with BP formulations, especially with the use of recognized and standardized methods to accurately determine P acnes colony counts. A previous study demonstrated that a BP 8% cleanser did not reduce counts of P acnes on the back when subjects were instructed to apply the cleanser in the shower, allow it to dry for 20 seconds on the skin, and then rinse off the cleanser. Evaluation of specified time intervals between application on the back and rinsing with BP formulations would help to better define the necessary skin contact time associated with high reductions of P acnes (>90%), recognizing also the potential roles of BP concentration and vehicle. This 2 week study using quantitative bacteriologic cultures evaluates the effectiveness of BP 9.8% emollient foam in reducing P acnes levels on the back with 2 minutes of skin contact time and compares results with a BP 5.3% “leave-on” emollient foam formulation. Short contact therapy utilizing a 2 minute skin contact time with BP 9.8% emollient foam used once daily over a 2 week duration was highly effective in reducing the quantity of P acnes organisms on the back and provided comparable colony count reduction to “leave on” therapy using BP 5.3% emollient foam.
J Drugs Dermatol. 2012;11(7):830-833.
Dalia G. Aly MD,a Ihab Y. Abdallah MD,b Noha S. Hanafy MD,a Mohamed L. Elsaie MD,a,c and Neveen A. A. Hafizd| |
Aim: To evaluate the possible relationship between serum leptin in nonobese patients with psoriasis and other randomly selected skin diseases.
Subjects and methods: Eighty subjects (40 patients with psoriasis, 20 patients with other randomly selected skin diseases, and 20 healthy controls) were included in the study. Fasting serum leptin levels of the study groups were examined by sandwich enzyme-linked immunosorbent assay.
Results: Elevated serum leptin levels were detected in both nonobese patients with psoriasis (P=.004) and those with other randomly selected skin diseases (P=.05). Leptin levels failed to correlate to the Psoriasis Area and Severity Index score of psoriatic patients. Both sexes demonstrated comparable levels of serum leptin in psoriatic patients, while female patients suffering from other skin diseases showed higher levels of serum leptin than did males of the same group.
Conclusion: Leptin may play a role in the immunopathogenesis of psoriasis and other skin diseases, even in the absence of obesity as a cofactor.
J Drugs Dermatol. 2013;12(2):e25-e29.
Resident Rounds. Part III: Erosive and Desquamative Syphilis Associated With Mucositis in the Setting of Acquired Immune Deficiency Syndrome
James Quertermous MS, J. Michael Bernardi MD, Janine Malone MD, Jeffrey P. Callen MD| |
A Case of Multiple Atypical Nevi With Co-Localized Basal Cell Carcinomas on the Scalp: Insight into the Pathogenesis
Lixia Z. Ellis MD PhD,a Joel L. Cohen MD,a,b Whitney High MD JD MEng,a,c and Theresa A. Scholz MDd| |
J Drugs Dermatol. 2015;14(5):502-505.
Selective Radiofrequency Therapy as a Non-Invasive Approach for Contactless Body Contouring and Circumferential Reduction
Kateřina Fajkošová MUDr,a Alena Machovcová MD PhD MBA,b,c Meltem Onder MD,d and Klaus Fritz MDd,e| |
J Drugs Dermatol. 2014;13(3):291-296.
Kenneth Beer MD PA,a Michael S. Beer,a and Danielle Applebaum MS IVb| |
J Drugs Dermatol. 2013;12(6):694-697.
A Pilot Study Using Reflectance Confocal Microscopy (RCM) in the Assessment of a Novel Formulation for the Treatment of Melasma
Katerina Tsilika,a Jean Luc Levy MD,c Hee Young Kang MD PhD,a Luc Duteil PhD,a Abdallah Khemis MD,a Rosalind Hughes MD,a Thierry Passeron MD PhD,a,b Jean Paul Ortonne MD,a Philippe Bahadoran MD PhDa,b| |
Introduction:Melasma is a common pigmentary disorder caused by abnormal melanin deposits within the skin. Hydroquinone (HQ)
is presently the most popular depigmenting agent, however the treatment of melasma remains unsatisfactory, resulting in a need
to evaluate new depigmenting agents.
Objective: The objective of this study was to assess, using standard methods and a novel technique, in vivo Reflectance Confocal Microscopy (RCM), the efficacy and safety of a new non-HQ bleaching agent Dermamelan® (Mesoestetic, Barcelona, Spain) in the treatment of melasma.
Methods: Ten women with melasma were enrolled in an open-label trial lasting four months. Patients were of Fitzpatrick skin types II–IV. A non-HQ depigmenting agent (Dermamelan) was applied once-daily for three months. Melasma Area and Severity Indices (MASI) were measured. Standard and UV-light photographs were taken and in vivo RCM, which detects pigmentary changes at a cellular level, was done. Evaluations were performed before treatment, on the first, second and third month of treatment and one month after treatment. Upon cessation of the trial, patients completed a questionnaire regarding efficacy and tolerance.
Results: At baseline, RCM detected hyperpigmented keratinocytes in all patients, dendritic cells in 2/10 patients, and melanophages in 2/10 patients. Based on the MASI score, Dermamelan treatment improved melasma by 50 percent. This was confirmed by standard and UV-light photography. Maximum therapeutic effect was usually reached by one month of treatment and was maintained at one month following its completion. Interestingly Dermamelan treatment also induced a statistically significant decrease of pigmented epidermal keratinocytes as detected by RCM. Patients with melanophages on RCM at baseline had a poorer outcome, but not those with dendritic cells. Mild irritation was the only adverse event observed during treatment. The majority of patients were satisfied with the result.
Conclusion: This study suggests that Dermamelan produces significant rapid improvement of melasma at a clinical and cellular level and demonstrates the potential of RCM to monitor and possibly predict efficacy of a new depigmenting agent in the treatment of melasma.
J Drugs Dermatol. 2011;10(11):1260-1264.
Progressive Multifocal Leukoencephalopathy and Reversible Progressive Leukoencephalopathy Syndrome in Dermatologic Therapy
Barry Ladizinski MD,a Misha M. Heller BA,b Tina Bhutani MD,c Kristine B. Zitelli MD,c and John Y. M. Koo MDc| |
J Drugs Dermatol. 2013;12(2):e20-e24.
Jeffrey F. Scott MD, Barbara Reichert MD, Miesha Merati DO, Kord Honda MD, and Kevin D. Cooper MD| |
Fatal Cutaneous Strongyloidiasis as a Side Effect of Pemphigus Foliaceus Treatment With Mycophenolate Mofetil
Magalys Vitiello MD,b Michael Shelling MD,a Ivan Camacho MD,a Clara Milikowski MD,a Francisco A. Kerdel BSc MBBSb| |
J Drugs Dermatol. 2011;10(4):418-421.
Neocollagenesis in Deep and Superficial Dermis by Combining Fractionated Q-Switched ND:YAG 1,064-nm With Topical Plant Stem Cell Extract and N-Acetyl Glucosamine: Open Case Series
Kavita Beri MDa and Sandy S. Milgraum MDb| |
METHOD: Six healthy females (Skin types III - V) were selected for the study with mean average age of 56 years +/- 11 years. The rhytides on the face and neck were assessed using a comprehensive grading scale. Patients were then divided into two groups, one received only laser treatment with the fractionated QSW 1,064 nm laser and the other group received combined treatment with the laser and topical. Patients were assessed again at 4 and 8 weeks.
RESULTS: We observed an enhanced anti-aging effect of the laser in the patients with combined treatment.
DISCUSSION: Understanding the effect of this novel laser therapy on human stem cells and investigating the basis of its synergistic effect with plant stem cell extract and NAG will lead us to better understand stem cell activity. Non-ablative tissue regeneration is the next step in providing optimal anti-aging treatments.
J Drugs Dermatol. 2015;14(11):1342-1346.
Anna Cristina Garza-Mayers BA PhDa,b and Daniela Kroshinsky MD MPHa,b| |
BACKGROUND: Treatment of vitiligo is aimed at repigmentation and often consists of multiple modalities, none of which are universally or rapidly successful. Extensive cases are most often treated with ultraviolet light therapy, which can be both costly and time-consuming. Though vitiligo is an autoimmune disease, there is no current data to support systemic immunosuppressive monotherapy.
CASE SUMMARY: Here we present a case series of 3 patients with vitiligo treated for 11-16 months with low-dose methotrexate (12.5-25 mg per week) with folic acid supplementation with clinically significant skin repigmentation, with response within 6 months in one case. There were no severe adverse effects reported.
CONCLUSION: These cases demonstrate an unexplored effective and steroid-sparing therapeutic alternative in patients with vitiligo for whom topical therapy has failed and phototherapy is cost-prohibitive or ineffective.
J Drugs Dermatol. 2017;16(7):705-706.
Central Serous Chorioretinopathy Associated With Topical Corticosteroids in a Patient With Psoriasis
Navid Ezra MD,a Mehran Taban MD,b Daniel Behroozan MDa,c,d| |
Background: Central serous chorioretinopathy (CSC), also known as central serous retinopathy (CSR), is a visual impairment, often temporary, usually in a single eye, which mostly affects males in the age group of 20 to 50 but may also affect women. CSC occurring after prolonged use of topical steroids in a patient with psoriasis is a novel complication in the English literature.
Observations: We describe a case of a 25-year-old male, with a 15-year history of corticoid ointment use for psoriasis, who presented with loss of vision secondary to CSR.
Conclusions: All topical steroid treatments were discontinued and the patient recovered his vision completely. Although topical corticosteroids are frequently utilized for psoriasis management with a low rate of complication, clinicians should be familiar with this rare yet distressing condition. Furthermore, patients with increased production of endogenous corticosteroids (e.g., those with Cushing's syndrome, hypertension, or obstructive sleep apnea) should be warned of the potential of chorioretinopathy following prolonged use of topical corticosteroids
J Drugs Dermatol. 2011;10(8):930-933.
Topical Amitriptyline Combined With Ketamine for the Treatment of Erythromelalgia: A Retrospective Study of 36 Patients at Mayo Clinic
Timothy J. Poterucha BS,a Sinead L. Murphy BS,b Mark D. P. Davis MD,c Paola Sandroni MD PhD,d Richard H. Rho MD,e Roger A. Warndahl RPh,f and William T. Weiss RPhf| |
METHODS: We retrospectively evaluated 36 patients with erythromelalgia who were treated with compounded topical amitriptyline-ketamine from January 1, 2004, through January 31, 2011.
RESULTS: Thirty-two patients (89%) were female. Mean (standard deviation) age was 44.7 (15.8) years (range, 5-74 years). Patients applied the medication 1 to 6 times per day (median, 5 times). One patient (3%) had complete relief from symptoms, 14 (39%) had substantial relief, 12 (33%) had some relief, 7 (19%) had no relief, and 2 (6%) had local worsening of symptoms. No patients had systemic adverse effects.
CONCLUSIONS: A majority of patients with erythromelalgia (75%) reported improvement in pain with topical application of a compounded amitriptyline-ketamine formulation. The medication was well tolerated.
J Drugs Dermatol. 2013;12(3):308-310.
Short-Term Combination Therapy and Long-Term Relapse Prevention in the Treatment of Severe Acne Vulgaris
J Drugs Dermatol. 2012;11(2):174-180.
Julia Schwartz MDa and Adam J. Friedman MDa,b| |
The Impact of Inoperable Advanced Basal Cell Carcinoma: the Economic, Physical, and Psychological Burden of the Disease
Arielle W. Haves BA, Panta Rouhani Schaffer MD PhD MPH, and John A. Carucci MD PhD| |
J Drugs Dermatol. 2013;12(suppl 10):s151-s153.
Treating Onychomycoses of the Toenail: Clinical Efficacy of the Sub-Millisecond 1,064 nm Nd: YAG Laser Using a 5 mm Spot Diameter
Background: Onychomycosis is a relatively common fungal infection. Current treatments have limited applicability and low cure rates.
Recently introduced laser therapy has shown to be a safe and effective treatment for onychomycosis. In this study, we evaluate a submillisecond Nd:YAG 1,064 nm laser for treating onychomycoses of the tonail.
Methods: Thirteen subjects (9 female, 4 male) with 37 affected toenails received 1 to 3 treatments 4 and/or 8 weeks apart with a sub-millisecond 1,064 nm Nd:YAG laser. Diagnosis of onychomycosis was confirmed with microscopy. Average follow-up time was 16 weeks post-final treatment. Photos were taken and degree of turbidity was determined using a turbidity scale (ranging from "0 = clear nail" to "10 = completely turbid nail") at each visit. Improvement in turbidity was determined by comparison of turbidity scores at baseline and 16-week follow-up on average. Efficacy was assessed by an overall improvement scale (0 to 4), which combined improvement in turbidity scores and microscopic examination. Overall improvement was classified as "4 = complete clearance" if the turbidity score indicated "0 = clear nail" accompanied by a negative microscopic result. No microscopic examination was performed unless the turbidity score showed "0 = clear nail."
Results: Treatments were well tolerated by all subjects and there were no adverse events. Of the 37 toenails treated, 30 (81%) had "moderate" to "complete" clearance average of 16 weeks post-final treatment. Nineteen toenails (51%) were completely clear and all tested negative for fungal infection on direct microscopic analysis. Seven (19%) toenails had significant clearance and four (11%) had moderate clearance.
Conclusions: The preliminary results of this study show this treatment modality is safe and effective for the treatment of onychomycosis in the short term. Additional studies are needed to more fully assess the clinical and mycological benefits as well as optimize the treatment protocol and parameters.
J Drugs Dermatol. 2012;11(4):496-504.
Comparison of the Effects of Contractubex® Gel in an Experimental Model of Scar Formation in Rats: An Immunohistochemical and Ultrastructural Study
Mustafa T. Sahin MD,a Sevinc Inan MD,b Serap Ozturkcan MD,a Elif Guzel MDc Cemal Bilac MD,a Gülsen Giray MD,b Sevda Muftuoglu MDd| |
Background: Contractubex® gel, a commercial treatment for scars, consists of a mixture of onion extract (cepea extract), heparin sodium,
and allantoin. It exerts a softening and smoothing effect on indurated, hypertrophic, painful, and cosmetically-disfiguring scar tissue.
Aim: To compare and discuss the immunohistochemical and ultrastructural effects of treatment of an experimental scar in a rat model with Contractubex gel.
Methods: Thirty-two Sprague-Dawley rats were divided into four groups. Skin biopsies were taken to develop full thickness wounds. After 10 days, Contractubex gel, heparin, and allantoin were topically applied daily to groups 2, 3, and 4, respectively. Group 1 was the control group. On the 30th day, scar tissues were excised to investigate the immunohistochemical and ultrastructural effects of these agents. For this purpose we used TGF-beta, laminin, and fibronectin primary antibodies.
Results: Increased immunoreactivities of laminin, fibronectin, and TGF-beta in control group, moderate immunoreactivities in heparin and allantoin groups, and mild immunoreactivities in the Contractubex gel group were observed. In semi-thin sections, Group 2 showed the thinnest epidermis of the four groups. In electron micrographs of Group 2, completely keratinized and normally appearing cells could be seen.
Conclusions: Immunohistochemical and ultrastructural observations demonstrated that the Contractubex gel significantly improved the quality of wound healing and reduction of scar formation. Also, it was a more appropriate treatment choice than heparin monotherapy and allantoin monotherapy in keloidal and hypertrophic scars.
J Drugs Dermatol. 2012;11(1):74-81.
Joseph Alcalay MD,a Gil Tauber MD,b Eyal Fenig MD,c and Emmilia Hodak MDb| |
PATIENTS: Two patients with 3 large and aggressive basal cell carcinomas were treated with Vismodegib for 6 months. The treatment was followed by Mohs micrographic surgery.
RESULTS: Two tumors disappeared clinically and one was reduced dramatically in its size following treatment with vismodegib. Mohs surgery in all three tumors revealed residual islands of BCC although margins were cleared at the end of surgery.
CONCLUSIONS: Neoadjuvant therapy with vismodegib for 6 months prior to Mohs surgery was effective in reducing the size of primary and recurrent aggressive basal cell carcinoma. However, residual tumor nests were found during surgery. Further larger studies are needed to evaluate the efficacy of Vismodegib as a neoadjuvant treatment prior to Mohs surgery.
J Drugs Dermatol. 2015;14(3):219-221.
Macrene Alexiades MD PhD| |
Nicholas B. Countryman MD MBA,a* Ross M. Levy MD,b, C.William Hanke MDa| |
J Drugs Dermatol. 2013;12(6):668-671.
Efficacy of Benzoyl Peroxide (5.3%) Emollient Foam and Benzoyl Peroxide (8%) Wash in Reducing Propionibacterium acnes on the Back
James J. Leyden MD| |
Objectives: To evaluate the effectiveness of BP (5.3%) emollient foam and BP (8%) wash in reducing P. acnes levels on the back.
Methods: Five-week open-label single-center study of 20 healthy subjects (>18 years old), colonized with P. acnes on their backs (>10,000 colonies per cm2). Subjects were treated once daily with BP (5.3%) foam for two weeks; no treatment in week 3, and BP (8%) wash once daily for two further weeks. Quantitative bacteriologic cultures obtained at baseline and weeks 1, 2, 3, 5 and 6. Results: Nineteen evaluable patients. Total P. acnes counts were reduced by 1.9 log (one week) and 2.1 log (two weeks) with BP (5.3%) emollient foam. BP (8%) wash did not reduce P. acnes counts after two weeks.
Discussion: BP (5.3%) emollient foam was superior to BP (8%) wash in reducing P. acnes on the back. The lack of effect of BP (8%) wash is surprising in view of the demonstrated results on the face and warrants further study.
J Drugs Dermatol. 2012;11(9):1122-1123.
Biological Effects of Ingenol Mebutate Gel in Moderate to Severe Actinic Fields Assessed by Reflectance Confocal Microscopy: A Phase I Study
Martina Ulrich MD,a,b Susanne Lange-Asschenfeldt MD,a Kresten Skak PhD,c Torsten Skov MD,c Marie Louise Østerdal MsC,c Hans-Joachim Röwert-Huber MD,a John Robert Zibert PhD,c and Eggert Stockfleth MDa,d| |
J Drugs Dermatol. 2016;15(10):1181-1189.
Efficacy and Safety of Naftifine HCl Cream 2% in the Treatment of Pediatric Subjects With Tinea Corporis
Michael Gold MD,a Sunil Dhawan MD,b Amit Verma DrPH MPH,c Michael Kuligowski MD PhD MBA,c and David Dobrowskic| |
OBJECTIVE: To evaluate the efficacy and safety of two-weeks once daily application of naftifine cream 2% in the treatment of tinea corporis among pediatric subjects.
METHODS: At baseline, 231 subjects were randomly assigned 1:1 to naftifine cream 2% (n=116) and vehicle (n=115). Treatment effect consisting of mycologic determination (KOH and dermatophyte cultures) and scoring of clinical symptom severity was evaluated at baseline, week 2 (end of treatment) and week 3. Efficacy was analyzed in 181 subjects (n=88, naftifine; n=93, vehicle) with a positive baseline dermatophyte culture and KOH for whom week 3 assessments were available. Safety was evaluated by adverse events (AE) and laboratory values in 231 subjects (n=116, naftifine; n=115, vehicle).
RESULTS: Children with tinea corporis treated with naftifine cream 2% demonstrated significantly greater improvements from baseline over vehicle for mycological cure (P<0.0001) and treatment effectiveness (P=0.003) as early as 2 weeks (end of treatment). Response rates continued to increase post-treatment and were the highest 1-week after completion of the therapy (P=0.003 for complete cure; and P<0.001 for mycological cure and treatment effectiveness). Treatment related adverse events were minimal.
CONCLUSIONS: Treatment with naftifine cream 2% applied once daily for two weeks was well-tolerated and was effective in treating tinea corporis in children. Further improvement was observed 1-week after treatment completion for all key outcome measures (complete cure, mycological cure, treatment effectiveness, clinical cure, and clinical success) and clinical signs and symptoms (erythema, induration, and pruritus).
J Drugs Dermatol. 2016;15(6):743-748.
A Randomized, Multicenter, Double-Blind, Vehicle-Controlled Study Evaluating the Efficacy and Safety of Luliconazole Cream 1% Once Daily for 7 Days in Patients Aged ≥ 12 Years With Tinea Cruris
Terry M. Jones MD,a Michael T. Jarratt MD,b Ines Mendez-Moguel MD,c Nelly Paz MD,d Steven K. Grekin DO,e
Christina Cognata Smith PharmD MBA,f and Mandeep Kaur MD MSf
OBJECTIVE: This phase 3 study evaluated the safety and efficacy of topical luliconazole cream 1% in patients with tinea cruris.
METHODS: 483 patients were enrolled and 256 male and female patients aged ≥12 years with clinically evident tinea cruris and eligible for modified intent-to-treat analysis were randomized 2:1 to receive luliconazole cream 1% (n=165) or vehicle (n=91) once daily for 7 days. Efficacy was evaluated at baseline and at days 7, 14, 21, and 28 based on mycology (potassium hydroxide, fungal culture) and clinical signs (erythema, scaling, pruritus). The primary outcome was complete clearance at day 28 (21 days posttreatment). Safety evaluations included adverse events and laboratory assessments.
RESULTS: Complete clearance was obtained in 21.2% (35/165) of patients treated with luliconazole cream 1% compared with 4.4% (4/91) treated with vehicle (P<0.001). The safety profile of luliconazole cream 1% was similar to vehicle.
LIMITATIONS: The study was conducted under controlled conditions in a relatively small population.
CONCLUSION: Luliconazole cream 1% applied once daily for 7 days is more effective than vehicle and well tolerated in patients with tinea cruris.
J Drugs Dermatol. 2014;13(1):32-38.
Long-term Safety of Ketoconazole Foam, 2% in the Treatment of Seborrheic Dermatitis: Results of a Phase IV, Open-Label Study
Zoe D. Draelos MD a, Steven R. Feldman MD PhD b, Victoria Butners BSc c, and Alessandra B. Alió Saenz MD c| |
Objective: To assess the long-term safety of ketoconazole foam, 2%, twice daily, as required.
Methods: A 12-month, open-label, multicenter study. Subjects were evaluated at baseline and at weeks 4, 8, 16, 26, 39, and 52 (or early termination [ET]) for adverse events (AEs), serious AEs (SAEs), target lesion erythema, scaling, and pruritus, as well as Investigator's Static Global Assessment (ISGA) scores. Physical examinations were performed at baseline and at week 52/ET, and laboratory evaluations at baseline and at weeks 8, 26, and 52. A poststudy product-preference questionnaire was completed.
Results: Of 500 subjects enrolled, 498 were included in the safety population, and 363 completed the study. Overall, 57% of subjects reported ≥1 AE. Treatment-related AEs occurred in 14% of subjects, including application-site irritation (8%), application-site pain (4%), application-site pruritus (1%), and increased alanine aminotransferase (1%). Seven subjects were withdrawn because of treatment-related AEs. No SAEs (21 in 17 subjects) were considered to be related to study drug. Mean target lesion erythema, scaling, and pruritus scores improved by 2 units from baseline at all study visits; mean ISGA score improved by 1 unit at week 4 and by 2 units at subsequent visits. The foam vehicle was preferred by 67% of subjects.
Limitations: Evaluation of severity was limited to target lesion; no objective measure of adherence.
Conclusion: The long-term safety profile of ketoconazole foam, 2%, in subjects with seborrheic dermatitis was favorable and efficacy was maintained. This trial was registered at clinicaltrials.gov (NCT00703846).
J Drugs Dermatol. 2013;12(1):e1-e6.
Randomized, Double-Blind, Split-Face Study Evaluating Fractional Ablative Erbium:YAG Laser-Mediated Trans-Epidermal Delivery of Cosmetic Actives and a Novel Acoustic Pressure Wave Ultrasound Technology for the Treatment of Skin Aging, Melasma, and Acne Scars
Macrene Alexiades MD PhDa,b| |
AIM: Evaluate the safety and efficacy of a novel acoustic pressure wave ultrasound device following fractional ablative Er:YAG 2940-nm laser (FELR) and topical agents for rhytids, melasma, and acne scars.
STUDY DESIGN: Randomized, blinded, parallel group split-face side-by-side, controlled study evaluating FELR and topical anti-aging and anti-pigment agents to entire face succeeded by ultrasound to randomized side. Fifteen subjects were enrolled to three treatment arms:rhytids, melasma, and acne scars. Two monthly treatments were administered with 1, 3, and 6 month follow-up. Efficacy was assessed by Comprehensive Grading Scale of Rhytids, Laxity, and Photoaging by Investigator and two blinded physician evaluators. Subject assessments, digital photographs, and reflectance spectroscopic analyses were obtained.
RESULTS: Rhytid severity was reduced from a mean of 3.25 to 2.60 on the 4-point grading scale. Spectrophotometric analysis demonstrated increases in lightness (L*) and reductions in redness (a*) and pigment (b*), with greater improvements on the ultrasound side as compared to FELR and topicals alone. Moderate erythema post-treatment resolved in 7 days and no serious adverse events were observed.
CONCLUSION: In this randomized, paired split-face clinical study, FELR-facilitated TED of topical anti-aging actives with ultrasound treatment is safe and effective with improvement in rhytids, melasma, and acne scars. Statistically significant greater improvement in pigment levels was observed on the ultrasound side as compared to FELR-TED and topical agents alone.
J Drugs Dermatol. 2015;14(11):1191-1198.
Consuelo V. David BA,a Hong Nguyen BS,b Gary Goldenberg MDc| |
The immunomodulatory characteristics and topical application of imiquimod (IQ), a toll-like receptor 7 agonist, have lead to extensive off-label therapeutic trials. Off-label use is not uncommon in dermatology. However, clinicians must make informed decisions to ensure safe and effective implementation when standardized protocols are lacking. We present the highest level of clinical evidence for each off-label application of IQ, summarize management steps, treatment regimens, and results. We hope consolidation of this information will facilitate implementation of informed and evidence-based clinical decisions. Forty-six off-label applications were reported. Treatments were generally applied in the same manner, tailored to induce an inflammatory response and reduced with the development of adverse reactions. The efficacy of imiquimod ranged from promising to suboptimal compared to standard treatments and protocols. Clinicians who choose to use IQ off-label should have a firm understanding of the extent an application has been studied and how to manage adverse events.
J Drugs Dermatol. 2011;10(11):1300-1306.
Daniel Y. Sugai MD,a Cheryl J. Gustafson MD,a Jacqueline F. De Luca MD,a Scott A. Davis MA,aJoseph L. Jorizzo MD,a Kenneth S. O'Rourke MD,b and Steven R. Feldman MD PhDa,c,d| |
OBJECTIVE: The objectives for this study were to evaluate trends in the medications prescribed for the management of lupus erythematosus (LE) and to assess how treatment varies among different specialists.
METHODS: Outpatient visits for treatment of lupus and its comorbidities were identified in the National Ambulatory Medical Care Survey (NAMCS), a representative survey of visits to physician offices in the United States. Data was evaluated to determine patient demographics, treatments prescribed by each specialty, and comorbidities encountered during the study period of 1993-2010.
RESULTS: From 1993-2004, prednisone was the most frequently prescribed medication; however, prednisone became the second most frequently prescribed medication in 2005-2010, as hydroxychloroquine became the leading medication prescribed for LE. In primary care physicians and other non-dermatology specialists, the most frequently prescribed medications for lupus were prednisone and hydroxychloroquine; whereas, hydroxychloroquine and triamcinolone were the top two medications preferred by dermatologists.
LIMITATIONS: The NAMCS collects cross-sectional data, such that individual patients cannot be followed over time. Hence, it does not provide data regarding the incidence of disease, patient age at the time of diagnosis, change in individual patient’s medication regimens over time, or prognosis related to patient demographics. In addition, it is possible that the physician did not always record nonprescription medication use, such as NSAIDS, since these are typically used first line.
CONCLUSION: First-line treatment of LE changed minimally from 1993 to 2010, with prednisone and hydroxychloroquine serving as the primary medications utilized by most physicians for the management of LE.
J Drugs Dermatol. 2014;13(5):545-552.
George F. Cohen MD and Christopher M. Wolfe DO| |
Recalcitrant cutaneous sarcoidosis with perianal involvement is rare. To our knowledge we present the first documented case of cutaneous sarcoidosis with perianal involvement successfully treated with adalimumab.
J Drugs Dermatol. 2017;16(12):1305-1306.