Search Results for "Mohs Surgery"
Basil S. Cherpelis MD, L. Frank Glass MD, Sharron Ladd BS HTL, Neil Alan Fenske MD| |
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.
Ronen Alkalay MD, Joseph Alcalay MD, Joseph Shiri MD| |
Joseph Alcalay, MD| |
METHOD: Maps during MMS were taken using Samsung and LG tablets. The maps were saved to the cloud in the operating rooms. A short time after, the maps were downloaded to the laboratory’s computer by the Mohs technician and processed to a digital photographic map. When additional stage was needed, the map was uploaded by the technician to the cloud and viewed by the Mohs surgeon on the tablet in the operating room.
CONCLUSION: Mohs mapping on the cloud is a new method of mapping tissue in MMS. It is an easy, fast, and accurate method of mapping and serves the new era of modern web and photographic technologies.
J Drugs Dermatol. 2015;14(10):1127-1130.
Effectiveness of the Mohs and Close Technique in Increasing the Efficiency of a Mohs Micrographic Surgery
Sailesh Konda MD,a,b Joseph Francis MD,a,c Vishal A. Patel MDd| |
David R. Lambert MD, Sara B. Peters MD| |
Martin Zaiac MD,a Emily Tongdee BS,a Leeor Porges DO,b
Khasha Touloei DO,b Srdjan Prodanovich MD FAADc
OBJECTIVE: To investigate the utility of anesthetic blister induction at a suspected biopsy site to identify the location prior to Mohs surgery. The proposed technique is visualization of a blister that is induced by local anesthetic administration at the proposed biopsy site. The addition of this technique among others such as curettage, dermoscopy, and UV fluorescence can prevent wrong-site surgery.
METHODS: A biopsy site of a squamous cell carcinoma on a patient was compared via photography for visibility at the time of initial biopsy, weeks following biopsy, and post-anesthetic blister induction.
RESULTS: The biopsy site was easier to locate with the assistance of a blister that formed as a result of local anesthetic administration.
CONCLUSION: Blister induction by local anesthetic administration can assist in accurately identifying healed or obscured biopsy sites.
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.
Laura F. Sandoval DOa and Howard Steinman MDb| |
J Drugs Dermatol. 2017;16(2):180-181.
Keyvan Nouri, MD; Christopher O'Connell, BA; Juana Alonso, HTL; Maria Patricia Rivas, MD and Yadira Alonso| |
J. Alcalay MD, R. Alkalay MD, E. Grossman MD| |
Methods: We studied 121 patients (65 males) with a mean age of 60 ± 14 years (range 31-89) who were referred for Mohs micrographic surgery (MMS) during 2 consecutive months. Forty six patients had a history of hypertension. Blood pressure was measured in all subjects in the supine position with an automated device 5 times during surgery.
Results: Blood pressure decreased significantly during surgery from 152 ± 2/85 ± 1 mm Hg at baseline to 139 ± 2/79 ±1 at the end of the surgery (p < .05). Forty two patients (34%) had elevated BP levels at baseline whereas only 18 patients had these levels at the end of the first stage. There was no difference in surgery outcomes between those with elevated and those with normal BP levels at baseline.
Conclusions: Blood pressure levels decrease during MMS under local anesthesia and the outcome of patients with elevated BP is good. Thus, patients with elevated BP can safely undergo surgery under local anesthesia
Local Immune Modulator (Imiquimod 5% Cream) as Adjuvant Treatment after Incomplete Mohs Micrographic Surgery for Large, Mixed Type Basal Cell Carcinoma: A Report of 3 Cases
M.R.T.M. Thissen MD PhD, D.I.M. Kuijpers MD, G.A.M. Krekels MD PhD| |
Objective: We sought for possibilities to adjuvantly treat patients in which superficial basal cell carcinoma remained after incomplete Mohs sugery.
Mehtods: We report 3 cases of patients in which Mohs micrographic surgery for their large basal cell carcinomas was ceased for different unforseen reasons, with remainin superficial fields of BCC after the aggressive and deeply localized part had imiquimod 5% crea was given for 6 weeks, covering at least 1 centimeter around the surgically treated area.
Results: The treatment was well accepted with no serious side effects and a good cosmetic result. No recurrences were seen after a follow-up period of 20 to 34 months. Conclusion: A combination of surgical intervention for the central deeper part of the BCC and topical imiquimod 5% cream for the superficial part at the border might be a therapeutic option for those patients with multiple facial BCCs, severe sun damage, and extensive surgery in the past, in whom completion of the Mohs surgical procedure for the entire tumor is not possible for different reasons.
Anis Miladi MD, Jonathan Bingham MD| |
J Drugs Dermatol. 2011;10(3):257-259.
Christina A. Ogle BSE, Elisabeth K. Shim MD, James A. Godwin JD| |
Purpose: To investigate how commonly eye shields and lubricants are used during periorbital surgery and whether there are complications from their use.
Methods: The authors conducted a survey of oculoplastic and Mohs surgery fellowship directors. The questionnaire investigated the prevalence of use of eye shields and lubricants, complications encountered, and whether the standard of care requires or prohibits their use.
Results: A majority of those surveyed at least sometimes use eye shields in periorbital surgery, particularly to prevent patient injury. Most surgeons believe there are more pros than cons to their use. However, corneal abrasions may be encountered and may be related to the type of lubricant chosen. Surgeons using fat-based lubricants tended to encounter more complications with eye shield use.
Conclusion: Eye shield and lubricant use is common among oculoplastic and Mohs surgeons. However, most disagree as to whether the standard of care requires or forbids their use.
Rebecca Kleinerman MD, Alan Greenspan MD, Elizabeth K. Hale MD| |
Donald R. Stranahan MD, Basil S. Cherpelis MD, Neil Alan Fenske MD, L. Frank Glass MD| |
Effectiveness of the "Mohs and Close" Technique in Increasing the Efficiency of a Mohs Micrographic Surgery
Dhwani Mehta MD,a Rebecca Jacobson MD,a Tonja Godsey,b Brian Adams MD MPH,a and Hugh Gloster Jr. MD a| |
Kimberly K. Schulz MD and Hobart W. Walling MD PhD| |
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| |
Topical Hemostatic-Anesthetic Solution to Reduce Bleeding During Mohs Micrographic Surgery: A Case Control Study
Isaac Zilinsky MD,a Tamar Brutman Barazani PhD,b Boris Shenkman PhD,b Oren Weisman MD,c Nimrod Farber MD,c and Uriel Martinowitz MDb| |
OBJECTIVE: To investigate the efficacy of a hemostatic-anesthetic solution-impregnated gauze in decreasing bleeding between Mohs stages.
MATERIALS AND METHODS: Twenty patients were treated with a hemostatic-anesthetic solution composed of tranexamic acid, adrenaline, and lidocaine (TAL), and 20 others were treated with a saline solution for control. At the second Mohs stage, size measurements of the blood stain on a Telfa pad and the defect were recorded. The Rotation Thromboelastometry Method (ROTEM) was used to investigate a possible effect of lidocaine and adrenaline on the clot stability induced by tranexamic acid.
RESULTS: The ratio of blood stain size to Mohs defect size in the hemostatic anesthetic solution group was 1:1.47, whereas the ratio in the control saline group was 1:3.37 (P<.001). Results of the ROTEM test showed that lidocaine and adrenaline did not interfere with the effect of tranexamic acid on clot formation and stability.
CONCLUSION: The application of gauze impregnated with tranexamic acid, adrenaline, and lidocaine on a surgical wound may be effective in reducing bleeding between Mohs stages.
J Drugs Dermatol. 2016;15(7):851-855.
C. William Hanke, MD| |
Anne Goldsberry MD MBA, C. William Hanke MD MPH, and Nicholas B. Countryman MD MBA| |
J Drugs Dermatol. 2014;13(12):1463-1465.
Review of the Use of a Semisynthetic Bilaminar Skin Substitute in Dermatology and a Case Series Report of Its Utility in Mohs Surgery
Julie Akiko Gladsjo MD PhD, Silvia Soohyun Kim BA, and Shang I Brian Jiang MD| |
J Drugs Dermatol. 2014;13(5):537-541.
Basal Cell Carcinoma of the Nail Unit Treated with Mohs Micrographic Surgery: Superficial Multicentric BCC with Jagged Borders—A Histopathological Hallmark for Nail Unit BCC
Rana Anadolu Brasie MD, Asha R. Patel BS, Keyvan Nouri MD| |
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.
Ritu Saini MD, Deborah S. Sarnoff MD| |
Arash Kimyai-Asadi, MD; Elizabeth K. Hale, MD; Chrysalyne A. Schmultz, MD; David Goldberg, MD; C. William Hanke, MD and Ronald Moy, MD| |
Resident Rounds - Winning Poster: Rapid Wound Re-epithelialization and Basal Cell Carcinoma Clearance After Mohs Micrographic Surgery WithPostoperative Photodynamic Therapy
Matteo C. LoPiccolo MD,a Marsha L. Chaffins MD,a David J. Kouba MD PhDa,b| |
Cutaneous lymphadenoma (CL) is a benign neoplasm commonly presenting on the head and neck of young and middle-aged adults. Complete surgical excision of CL is the treatment of choice and appears to be curative. As compared to local excision without margin control, Mohs micrographic surgery (MMS) may allow for more definitive tumor extirpation for large cases of CL and allow for greater tissue preservation at functionally and aesthetically sensitive sites. We present a case of cutaneous lymphadenoma presenting on the right cheek of a middle-aged male who was successfully treated with MMS.
J Drugs Dermatol. 2011;10(11):1324-1326.
Allogeneic Growth Arrested Keratinocytes and Fibroblasts Delivered in a Fibrin Spray Accelerate Healing in Mohs Micrographic Surgery Wounds
Leon Kircik MD,a-c Jaime E. Dickerson Jr PhD,d,e Christina Kitten,f
Kathy A. Weedon BS,d and Herbert B. Slade MDd,g
METHODS: Open-label, randomized pilot study conducted at a single center. Subjects were randomized to either HP802-247 (5M cells/mL) applied weekly or bacitracin ointment applied daily. Treatment continued for up to 12 weeks or complete wound closure. Primary efficacy was effectiveness as measured by the Investigator’s Global Assessment of Healing (IGAH) scale. Secondary outcomes included median time to healing, investigator- and subject-scored signs and symptoms, and an assessment of scar by the investigator at 16 weeks postsurgery.
RESULTS: All subjects achieved favorable outcomes within the study period; however, these were reached more quickly for the HP802-247 group than for bacitracin. At 3 weeks postsurgery, healing was assessed as very effective for 75% of subjects in the HP802-247 group compared with 50% for bacitracin. Median time to closure was 24.5 days for HP802-247 and 29 days for bacitracin. Scores for signs and symptoms and scar were similar for both groups but, in general, were numerically better for HP802-247.
CONCLUSION: In this small pilot study, HP802-247 was found to provide a modest, incremental benefit in the healing of Mohs micrographic surgery wounds, suggesting that the healing of uncomplicated acute wounds may be slightly accelerated without enhancement of scarring.
J Drugs Dermatol. 2013;12(5):558-561.
Gary Goldenberg MDa and Omid Hamid MDb| |
J Drugs Dermatol. 2013;12(12):1371-1378.
2015 Arte Poster Competition First Place Winner: Assessing the Correlation Between Patient Anxiety and Satisfaction for Mohs Surgery
Maren C. Locke MD,a Eric C. Wilkerson MD,a Rachel L. Mistur MS,b Mahrukh Nisar MD,a W. Elliot Love DOa| |
J Drugs Dermatol. 2015;14(9):1070-1072.
Ronen Alkalay MD MBA, Joseph Alcalay MD, Alex Maly MD, Arieh Ingber MD, Clemens Fritsch MD, Thomas Ruzicka MD PhD, Claes D Enk MD PhD| |
Objective: To ascertain whether fluorescence imaging improves the clinical tumor border assessment by investigating the consistency between tumor size determination by MMS, clinical assessment, and fluorescence imaging.
Methods: Eighteen patients with histologically verified nodular BCCs on the face scheduled for MMS were included in the study. The night before the surgical procedure, 5-aminolevulinic methyl ester cream was applied to the lesion. The following morning, tumor borders were determined clinically (clinical size), after illumination with Wood’s light (fluorescence size), and by the tumor defect left on the skin surface following removal of the MMS specimen (Mohs size).
Results: The median tumor sizes were 93.05 mm2 (Mohs size), 61.05 mm2 (clinical size), and 72.75 mm2 (fluorescence size). The interclass correlation coefficients between Mohs size and fluorescence size was 0.984 and Mohs size and clinical size was 0.752.
Conclusion: Tumor border estimation by fluorescence imaging and clinical assessment underestimate the genuine tumor size determined by MMS; however, the fluorescence size showed a higher degree of consistency with the Mohs size than did the clinical size.
Adam J. Mamelak MD FRCPC, Steven Q. Wang MD, Leonard H. Goldberg MD FRCP| |
Background: Skin cancers on the nose are very common. Excision of these tumors results in surgical defects that can pose a chal- lenge to repair.
Objective: To present the authors’ experience of using linear closures (LC) to repair surgical defects on the nose in patients who underwent Mohs micrographic surgery (MMS).
Methods: A retrospective analysis was conducted of 4765 patients with skin malignancies on the nose that were treated with MMS between July 1997 and January 2006. The following variables were examined: type of repair, age, and sex of the patients, postopera- tive size of the defect, type of malignancy, location of the defect, and ﬁ nal length of the closure. Short-term and long-term complica- tions were evaluated and discussed. In a second study arm, a limited prospective cosmetic outcome assessment of patients with nasal defects repaired by LC compared to ﬂ aps and grafts was also conducted.
Results: There were 2053 patients (1020 men and 1033 women) who underwent LC of nasal defects after MMS. The average post- operative defect size was 1.7 X 0.9 cm, with an average closure length of 2.7 cm (range: 0.6 cm to 8.5 cm). The 2 major malignancies treated were basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) . Short-term complications were minimal. Nasal asym- metry and/or raising of the nasal alae were occasionally seen, which improved over time. The cosmetic outcomes of the LC group were rated higher than the ﬂ ap/graft group for lesions on the nose, although this was not statistically signiﬁ cant.
Conclusions: A vertical or slightly vertical linear closure for nasal defects after Mohs micrographic surgery is a robust and reliable method to deliver excellent cosmetic and functional results. Linear closure should be considered for small and mid-sized cutaneous nasal defects whenever possible.
Dermatofibrosarcoma Protuberans: Is Mohs Surgery Truly Superior? And the Success of Tyrosine Kinase Inhibitors
Joseph R. Kallini MDa and Amor Khachemoune MD FAADb| |
J Drugs Dermatol. 2014;13(12):1474-1477.
Bensal HP for Second Intention Healing Following Mohs Micrographic Surgery or Shave Skin Biopsy: An Open-label Pilot Study
Breanne Mordorski BA,a Adam J. Friedman MD,b and Leon H. Kircik MDc| |
J Drugs Dermatol. 2016;15(10):1197-1202.
Comparative Efficacy and Safety Results of Topical Hemostatic Powder and Sterile Compressed Foam Sponge in Second Intention Healing Following MohsMicrographic Surgery
Leon Kircik MD and James Q. Del Rosso DO| |
Nicholas B. Countryman MD MBA,a* Ross M. Levy MD,b, C.William Hanke MDa| |
J Drugs Dermatol. 2013;12(6):668-671.
Methods:In this prospective study, blood pressure (BP) was recorded in 100 consecutive patients who presented for MMS consultation and a subsequent MMS procedure, and compared on both days. Statistical analysis was performed using the paired Student t test and the significance of the findings was determined based on the corresponding P values. Progression from normotensive to hypertensive state while the doctor was in the room was stratified based on the patient's age, gender, and histories of smoking, hypertension (HTN), diabetes, and hyperlipidemia; as well as whether the doctor was wearing a white lab coat over blue surgical scrubs (50 patients) or blue surgical scrubs alone (50 patients).
Results: BP increased from baseline when the doctor entered the room and then decreased towards baseline after five minutes of the doctor being present. Elevation in BP was more evident in younger people, males, and those with HTN and hyperlipidemia. BP was slightly higher on the day of the consultation than on the day of the procedure. A higher number of patients became hypertensive when the doctor wore a white lab coat over blue surgical scrubs vs blue surgical scrubs alone. However, these changes in BP did not prove to be statistically significant.
Conclusion: Brief periods of WCHTN were seen on both days. However, these elevations in BP were not statistically significant and decreased towards baseline after five minutes. There were no cases in which elevation in BP associated with WCHTN was sufficient to result in the need to postpone or cancel MMS.
J Drugs Dermatol. 2012;11(9):e18-e22.
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.
Joseph Alcalay MD, Dani Ben-Amitai, Ronen Alkalay MD MBA| |
Rapid Wound Re-epithelialization and Basal Cell Carcinoma Clearance After MohsMicrographic Surgery With Postoperative Photodynamic Therapy
Kavitha K. Reddy MD, C. William Hanke MD MPH, Emily P. Tierney MD,| |
Objectives: To describe a novel case of a large multifocal BCC treated with postoperative PDT that showed results of tumor clearance and rapid re-epithelialization and to review the relevant literature.
Case Report: A patient presented for Mohs micrographic surgery (MMS) after recent biopsy revealed recurrent BCC. Mohs micrographic surgery was performed, where after six stages were taken, approximately 50% of the peripheral margins of the tumor remained positive for superficial BCC. Given the large size of the wound defect (12.5 cm x 9 cm) and superficial nature of the persistent tumor, the authors opted to treat the patient with adjuvant MAL-PDT in lieu of pursuing additional stages with MMS. The patient returned the following day for adjuvant therapy with MAL-PDT. Two consecutive treatments one week apart were given as an adjunctive treatment course for persistent BCC. At follow-up four weeks after the PDT treatment, the defect had fully reepithelialized. In the authors’ clinical practice, an untreated wound of this size typically heals in 10–12 weeks. The patient has been seen in six months of follow-up to date. Review of the literature relevant to use of MAL-PDT in treatment of basal cell carcinoma and literature describing effects of PDT on wound healing was performed.
Conclusion: MAL-PDT may be an effective adjuvant tool against large multifocal BCCs for which surgery has not resulted in clearance. Treatment with PDT resulted in rapid re-epithelialization of the surgical wound in this case. This observation is supported by prior in vitro studies and in vivo animal experiments demonstrating more rapid re-epithelialization of wounds and decreased scarring response after PDT.
Keyvan Nouri MD, Christopher J. Ballard BS, Navid Bouzari MD, Sogol Saghari MD| |
Malignancy Arising Within Cutaneous Tattoos: Case of Dermatofibrosarcoma Protuberans and Review of Literature
Kavitha K. Reddy MD,a C. William Hanke MD, MPH,b Emily P. Tierney MDa,b| |
Background. Dermatofibrosarcoma protuberans (DFSP) is an uncommon tumor of the skin with high rates of local recurrence. Several
reports describe a frequent history of local trauma. In one prior case, a DFSP arising in a tattoo site has been reported. Mohs micrographic surgery (MMS) has been used successfully for treatment.
Objective. To present a case of dermatofibrosarcoma protuberans arising in the site of a prior and current tattoo, and treated with Mohs micrographic surgery.
Methods. We present findings of a case of a DFSP arising in a tattoo and a review of Medline literature on the association between tattoos and cutaneous malignancy, and treatment of DFSP with MMS.
Results. Review of the literature confirms multiple reports of DFSP arising in sites of local trauma, as well as malignancies arising in sites of tattoos. The recurrence rate for MMS treatment of DFSP (0-6.6%) was found to be significantly lower than that for patients treated with wide local excision (13% to 95%).
Conclusions. DFSP should be considered in the differential diagnosis of neoplasms arising within areas of tattoos. Sites of local trauma and tattoos may show predilection for benign and malignant changes and should be evaluated during regular skin exams. Review of the literature confirms MMS is an ideal treatment modality for DFSP as the tumor often extends far beyond clinical margins.
J Drugs Dermatol. 2011;10(8):910-915.
J Drugs Dermatol. 2012;11(11):1358-1360.
J Drugs Dermatol. 2012;11(9):1108-1110.
Background: Surgical reconstruction of defects on the lower half of the nose mandates special considerations. Simple excision and suturing might cause a depressed scar and nostril flaring. Hence, the preoperative plan should be designed properly to avoid disfigurement and to achieve a successful reconstruction.
Objective: Three basic reconstructive concepts are essentially combined: 1.) The ratio between scar length and defect diameter should be extended beyond the standard 3:1 ratio; 2.) The defect should be positioned asymmetrically within the inferior half of the excision outline; and 3.) Para-median defects mandate an inferior, horizontal advancement (”sliding”) flap to avoid nostril flaring. A salvage technique is also discussed.
Methods: Data from patients treated by Mohs micrographic surgery for tumors of the inferior aspect of the nasal dorsum and reconstructed according to the proposed course of action was collected and reviewed.
Results: The proposed reconstructive path proved successful for all patients. Although one case required salvage skin grafting, all patients had aesthetically pleasing results. No postoperative complications were noted.
Conclusions: Simple excision and primary suturing is a viable method for treating lesions on the lower half of the nose, provided that the surgeon follows a set of basic reconstructive principles.
J Drugs Dermatol. 2012;11(2):226-228.
Euphemia W. Mu MDa and Steven S. Greenbaum MDb| |
The lower cutaneous lip is a highly visible and functionally sensitive unit, and numerous factors must be considered when deciding on the optimal repair for defects in this area. The transposition flap represents an excellent option in the reconstruction of larger lower cutaneous lip defects. We describe the use of random pattern transposition flaps for the repair of lower lateral cutaneous lip defects.
J Drugs Dermatol. 2017;16(4):385-387.
Thomas Lambert BA, Kimberly Mullinax MD, Jennifer Smith MD| |
Complex forehead defects may result from excision of tumors or trauma. The reconstructive challenge is determined by the extent of tissue loss, the quality of the remaining tissue, possibly comprised vascular supply to the affected region, and special considerations (eg, exposed bone or injury to underlying structures). This paper describes a novel reconstructive approach to correct a complex forehead defect with exposed bone and discusses the armamentarium of reconstructive options for such cases.
J Drugs Dermatol. 2012;11(6):759-761.
Ronen Alkalay MD MBA and Joseph Alcalay MD| |
J Drugs Dermatol. 2013;12(1):115-116.
Hani A. Al-Shobaili MD, Khalid M. AlGhamdi MD, Walid A. Al-Ghamdi MD FRCPC| |
Lindsey Goddard BBA,a Todd Mollet MD,b and Travis Blalock MDb| |
Objective: To evaluate discrepancy in size between the excised full-thickness skin and the excision (donor) site.
Methods: Data from 20 cases of full-thickness excisions was reviewed and analyzed.
Results: There was a considerable difference in length of both the short and long axes between the excised full-thickness skin and the excision site.
Conclusions: The initial size of a full-thickness skin graft should be smaller than the defect it is planned to cover.
J Drugs Dermatol. 2012;11(4):520-523.
Safety and Efficacy Evaluation of Pulsed Dye Laser Treatment, CO2 Ablative Fractional Resurfacing, and Combined Treatment for Surgical Scar Clearance
Joel L. Cohen MDa and Roy Geronemus MDb| |
Emily P. Tierney MD and C. William Hanke MD MPH| |
Objective: To evaluate and compare the results of recent studies comparing the cost effectiveness of MMS to other treatment modalities performed by dermatologists and other physicians performing treatment of NMSC (otolaryngologic (ENT) surgeons, plastic surgeons, general surgeons).
Results: MMS is equivalent in cost to excision with permanent sections, 12% less costly than office based excision with frozen sections and 27% less costly than excision with frozen sections in an ambulatory surgical center (ASC). The most significant difference between MMS and surgical excision was the facility fee of excision with frozen sections in an ASC, (differential of $443–$555). With surgical excision, 32–39% of cases require a second procedure for clear margins. Additionally, with subsequent procedures for surgical excision cases, there is likely a greater volume of tissue removed and ramifications on functional preservation and cosmesis, which are difficult to quantify.
Conclusion: Analysis of the existing literature on MMS relative to surgical excision confirms the value of MMS in both obtaining the highest initial cure rates and lowest recurrence rates. This analysis confirms that MMS is a cost effective treatment, which is lower in cost than surgical excision, which often includes an ASC facility fee and a subsequent re-excision procedure. Cost effectiveness analysis demonstrating the outcomes based efficiency of MMS are critical in the current health care climate with heightened sensitivity to financial pressures and declining reimbursement rates which may challenge our ability to provide patients with the optimal treatment for NMSC.
Perry Robins MD, Sherry Hsiung MD| |
Chemowraps as an Adjuvant to Surgery for Patients With Diffuse Squamous Cell Carcinoma of the Extremities
Margaret Mann MD, David R. Berk MD, Jeffrey Petersen MD| |
Methods: A series of 3 representative patients is presented. Before chemowraps were applied, biopsies and clinical lymph node examinations were performed to confirm the diagnosis of SCC. Patients were informed that chemowraps represent an off-label use of 5-FU to reduce actinic keratoses as an adjuvant to definitive surgery for SCCs.
Results: Three patients were referred for diffuse actinic damage and biopsy-proven SCCs on the legs. Patients tolerated chemowraps well (applied for 4-20 weeks) and showed reduction in clinical lesions at 6 weeks to 3 years follow-up.
Conclusions: Chemowraps may be useful in managing patients with diffuse SCCs in fields of severe actinic damage on the extremities. As an adjuvant to surgery, chemowraps may treat surrounding actinic keratoses, help define tumor borders, and minimize the extent of surgery required.
Reconstruction of Full-Thickness Defects With Bovine-Derived Collagen/Elastin Matrix: A Series of Challenging Cases and the First Reported Post-Burn Facial Reconstruction
J Drugs Dermatol. 2012;11(7):866-868.
Objective: The authors introduce a stepladder approach for alar reconstruction with a crus of helix composite graft according to the severity and complexity of the defect.
Methods: Data from 25 patients who underwent correction of full thickness alar defects with composite grafts was collected and reviewed.
Results: There were no complete graft failures in any of the cases. Ten patients (40%) had partial graft necrosis ranging from 5 to 50% (average 18%); two of them (20%) were heavy smokers.
Conclusions: Composite grafts should be considered for reconstruction of full thickness nasal ala defects, given the correct surgical technique is implemented.
J Drugs Dermatol. 2012;11(3):376-381.
J Drugs Dermatol. 2012;11(8):988-990.
Michael Payette MD MBA| |
Ritu Saini MD FAAD, Deborah S. Sarnoff MD FAAD FACP| |
Daniel S. Behroozan MD, Adrienne Glaich MD, Leonard H. Goldberg MD FRCP| |
Ali Alikhan MD and Alison J. Bruce MBBS| |
Resident Rounds Part I: Program Spotlight - The University of Louisville Dermatology Residency Training Program
William Adams MD and Sunita Crittenden MD| |
Omar A. Ibrahimi MD PhD Andrew A. Nelson MD Jennifer K. Tan, MD| |
Melanie Tuerk MD, Heidi Goodarzi MD, Summer Youker MD| |
Michael S. Digby MD and Nicole M. Owens MD FAAD| |
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 San Antonio Uniformed Services Health Education Consortium. 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.
Pulsed Dye Laser for the Treatment of Hypergranulation Tissue with Chronic Ulcer in Postsurgical Defects
Steven Q. Wang MD, Leonard H. Goldberg MD FRCP| |
Ashley R. Mason MD and Melinda R. Mohr MDa| |
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 Eastern Virginia Medical School Dermatology Residency 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 email@example.com
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
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 firstname.lastname@example.org
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 email@example.com
Sheila M. Greenlaw MD,a Mariko Yasuda MD,a Karen Wiss MDa,b| |
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 Massachusetts Medical School 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 firstname.lastname@example.org
Nikoo Cheraghi MD,a Armand Cognetta Jr. MD,b and David Goldberg MDc| |
Background: Dermatologists were historically well versed in the use of radiation therapy for the management of non-melanoma skin cancers and various inflammatory dermatologic conditions. With the advent of Mohs micrographic surgery and therapeutic discoveries for treating inflammatory dermatoses, radiotherapy assumed loss of a role in the clinical repertoire of the dermatologist. In recent years, its importance has again been realized for the management of non-melanoma skin cancers not amenable to surgical treatment or as adjuvant or palliative therapy.
Objective: To review the evolving use of radiation therapy in the treatment of non-melanoma skin cancer.
Methods and Materials: All published literature regarding the applications of radiotherapy for the treatment of non-melanoma skin cancer were analyzed and collated.
Results: A comprehensive review of radiotherapy for the treatment of non-melanoma skin cancer was outlined.
Conclusion: Dermatologists should be well versed in radiation therapy in order to deliver the best possible care for patients, as radiotherapy is an important adjuvant tool for the treatment of non-melanoma skin cancer.
J Drugs Dermatol. 2017;16(5):464-469.
RESIDENT ROUNDS: PART I
History of Howard University Hospital Department of Dermatology and Residency Program
Program Spotlight: The Unified Division of Dermatology Residency Program of Albert Einstein College of Medicine
Adam Friedman MDa and Steven Cohen MD MPHa| |
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 Unified Division of Dermatology Residency Program of Albert Einstein College of Medicine. 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
Jorge Ocampo-Garza MD,a,b Nilton Gioia Di Chiacchio MD,b,c Eckart Haneke MD,d,e,f,g Francisco le Voci MD,b and Francisco Macedo Paschoal MD PhDb| |
Subungual melanoma is a rare variant of acral lentiginous melanoma that often has a poor prognosis compared with other types of melanoma. The aim of the present study is to report a case of a patient with recurrence of subungual melanoma treated with imiquimod 5%, which presented a total regression of the lesion and no recurrence for 4 years.
J Drugs Dermatol. 2017;16(3):268-270.
Single-Staged Tunneled Cheek Interpolation Flap With Cartilage Batten Graft for Repair of Nasal Ala Defect
Tatyana A. Petukhova MD MS, Jayne S. Joo MD, and Daniel B. Eisen MD| |
Surgical defects located within 5 mm of the nasal alar margin are at risk for alar elevation or collapse of the external nasal valve during wound healing. To reduce the chance of such complications, free cartilage grafts may be used as part of the reconstruction. However, if the defect is large enough so that the free cartilage graft does not fill most of the defect, wound contraction can still lead to alar displacement. In these situations, skin may need to be recruited from either the forehead or cheek in the form of an interpolation flap to cover both the free cartilage graft and the residual cutaneous defect. Typically, such reconstructions require multiple procedures at separate time periods and pose prolonged wound care and an inconvenience to the patient. We describe a case of a 94-year-old male who desired an aesthetic reconstruction of a large nasal alar defect that required only a single operative visit. To simplify the repair into a one-stage procedure, a tunneled cheek interpolation flap was performed over a free cartilage graft.
J Drugs Dermatol. 2017;16(3):288-290.
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.
RESIDENT ROUNDS: PART I
Program Spotlight: Department of Dermatology,Oregon Health & Science University
Melanie Warycha MD, Hideko Kamino MD, Narciss Mobini MD, Elizabeth K. Hale MD| |
Kenneth R.Beer 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 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.
Perry Robins MD| |
Resident Rounds. Part I: Program Spotlight: Virginia Commonwealth University Health System Department of Dermatology
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 Virginia Commonwealth University Health System Department of Dermatology. 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.
Use of Gelatin Sponges in Mohs MicrographicSurgery Defects and Staged Melanoma Excisions:A Novel Approach to Secondary Wound Healing
Peter P. Rullan MD, Carlos Vallbona PAC, Jennifer M. Rullan MD,Jonathan N. Mansbridge PhD, Vera B. Morhenn MD| |
Rapid Absorbing Gut Suture Versus 2-Octylethylcyanoacrylate Tissue Adhesive in the Epidermal Closure of Linear Repairs b.
Emily P. Tierney MD, Ronald L. Moy MD, David J. Kouba MD PhD| |
Objective: To compare the aesthetic outcomes and wound healing properties of 2 epidermal closure mechanisms: 2-octylethylcy- anoacrylate adhesive and rapid absorbing gut suture in skin closures.
Methods: A total of 8 patients were enrolled in this randomized right-left comparative trial. Patients were randomized for epidermal closure with one half of their wounds (chest [n=6] and upper extremities [n=2]) with tissue adhesive and the contralateral with rapid absorbing gut suture.
Results: Three months following wound closure, overall cosmetic outcome was slightly greater on the half closed with rapid absorb- ing gut suture (mean=3.56) relative to the tissue adhesive (mean=3.19, P=.05). For dyspigmentation, the half of the scar treated with the suture had a better outcome (mean=3.50) relative to tissue adhesive (mean=2.75) (P<.05). All other variables (ie, scar thickness, wound approximation, patient outcome, and preference) were highly equivalent.
Conclusion: Both rapid absorbing gut suture and tissue adhesive appear to be highly efﬁcacious techniques for epidermal closure. It appears that tissue adhesive may not be as effective in achieving optimal cosmesis for defects after Mohs micrographic surgery on the trunk and extremities in follow-up at 3 months.
Keyvan Nouri, MD and Halland Chen, MD| |
These potential side effects can be divided into intraoperative and postoperative complications. Intraoperative complications include bleeding, damage to vital organs, nerve injuries, allergic reactions to anesthetics, and electrocautery-associated complications. Postoperative complications include contact dermatitis, infection, chondritis, wound dehiscence, necrosis of the skin, suture spitting, suture tracking, excessive granulation tissue, non-healing wounds, pigment change, and scars/keloids. In this article, these surgical complications and their management will be covered.
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| |
Background: Upper lip wrinkling is a common complaint of patients seeking perioral rejuvenation. Lately, manual dermabrasion has
become more popular due to its safety, minimal cost, and favorable results. In several hospitals, the ability to efficiently ste rilize
sand paper has been questioned.
Methods: Between 2007 and 2010, 29 patients underwent manual dermabrasion of the skin of the upper lip using an electric cautery scratch pad during their surgeries.
Results: The average patient was aged 60.2 years. The average healing period was 5.8 days. Patient satisfaction from the procedure ranged from very good to excellent. No serious or long lasting complications have been encountered during our follow-up period.
J Drugs Dermatol.2012;11(5):649-652.
Guillermo Blugerman, MD; Diego Schavelzon, MD and Ruben Dreszman, MD| |
5-FU was first used as an antifibrotic in the 1960s in the field of ophthalmology to prevent scarring after glaucoma surgery, and to prevent recurrence after pterygia surgery1,2,3,4. In February of 1999 it was suggested as a potential way to prevent the formation of fibrotic adhesion after tendon surgery5. In March of 1999, Fitzpatrick published his paper on the use of 5-FU for the treatment of scar hypertrophy and keloids, presenting his results in some 1000 patients over 7 years6. Reading that paper inspired us immediately to use that drug ourselves in those difficult types of lesions7. Moved and excited by the results obtained, we decided to use the drug in other type of lesions in the subcutaneous tissue, due to the fact that in our practice we frequently see other pathologies linked to the excessive production of fibrous tissue.
It has been proved that in laboratory cultures the 5-FU barely reduces collagen reduction in normal fibroblasts, but produces a drastic reduction in the altered fibroblasts, as happens in Dupuytren's disease, acting on the gene controlling the amount of protein or the messenger8. It also seems to counteract the capacity of growth factor TGF-1 to stimulate collagen production8.
Rungsima Wanitphakdeedecha MD MA MSc,T. Minsue Chen MD, Tri N. Hguyen MD| |
Objective: To discuss the authors’ direct clinical experience with an acellular, fetal bovine dermal matrix for the treatment of Mohs micrographic surgery (MMS) wound management.
Methods: After the cutaneous malignancies were cleared by MMS, a sheet of the product was prepared according to the manufacturer’s instructions, trimmed to fit the defect, and then secured to the wound to enhance contact with the wound bed.
Results: Between June 2006 and July 2007, the product was used on a total of 10 wounds in 7 patients. Comorbidities included organ transplantation, Sezary syndrome with hepatitis C, and graft-versus-host disease. Seventy percent of the lesions were located on the lower extremities. The average defect area was 13.4 cm2 (range: 4.0-32.0 cm2). The dermal substitute was fully incorporated in 80% of defects and those that did not fully incorporate had exposed bone and tendon without the periosteum and peritendon, respectively.
Conclusion: Skin substitutes may provide temporary coverage of acute, full-thickness surgical wounds allowed to heal by second intent. They may facilitate wound management with acceptable aesthetic outcomes. Alternate reconstructive options, however, such as cutaneous flaps, should be considered when there is exposed bone and/or tendon without their periosteum and/or peritendon.
Joshua D. Fox MD,a Sander R. Dubovy MD,b Sara T. Wester MD,c and Keyvan Nouri MDa| |
J Drugs Dermatol. 2017;16(2):173-174.
Approximately 2.8 million basal cell carcinomas (BCCs) occur in the United States each year, accounting for 80% of all non-melanoma skin cancers. Historically, BCCs that are not surgically resectable or candidates for radiation therapy have had few treatment options. However, the development of vismodegib and its approval by the United States Food and Drug Administration (FDA) for use in patients with locally advanced or metastatic BCC carries with it a renewed sense of hope. Vismodegib is the first oral medication approved by the FDA for adults with metastatic or locally advanced BCCs who are not candidates for surgery or radiation or for BCCs that have recurred after surgery. The overwhelming majority of BCCs are the result of hedgehog pathway activation, and vismodegib inhibits a key regulatory protein in the hedgehog pathway, resulting in response rates of between 30% to 60% for locally advanced and metastatic BCCs.
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.
Objective: We present three original ideas: 1) a bilobed flap may be considered as a hatchet flap with a Z-plasty; 2) the trap door deformity (TDD) associated with a bilobed flap can be used as an advantage; and 3) an easy method for preoperative planning of a bilobed flap.
Methods: We collected data from patients who underwent excision of basal cell carcinoma (BCC) of the distal third of the nose and reconstruction with a hatchet or a bilobed flap within the last 20 years.
Results: Favorable cosmetic results were achieved when a hatchet flap was used to reconstruct defects of the inferior third of the nasal side wall, above or bordered with the alar crease, and when a bilobed flap was used to reconstruct nasal tip para-medial defects above the lower lateral cartilage convexity.
Conclusions: We suggest choosing between the hatchet and bilobed flaps for nasal reconstruction according to the defect location as outlined by our findings.
J Drugs Dermatol. 2012;11(1):99-102.
Adam Rees MD, Quyn Sherrod MD, Lorraine Young MD| |
J Drugs Dermatol. 2011;10(4):414-417.
Perry Robbins, MD| |
Vismodegib for Locally Advanced Basal Cell Carcinoma: Descriptive Analysis of a Case Series and Comparison to the Literature
Kathleen Sikora Viscusi MD and C. William Hanke MD MPH| |
METHODS: Data from patients who underwent vismodegib treatment for laBCC at a single institution from 3/6/2012 through 3/15/2015 was utilized in this study. For all included cases, treatment responses as recorded at the first follow-up after treatment cessation were assessed and are reported as complete clinical response (CCR), partial clinical response (PCR), stable disease, or progressive disease. In cases of CCR, clinical disease free survival (DFS) was calculated as the time from cessation of vismodegib until last available follow-up, death, or recurrence. Data pertaining to side effects and adverse events was also recorded, and results are presented using descriptive statistics.
RESULTS: A total of 24 patients and 31 tumors met inclusion criteria. CCR was observed in 17 of 31 tumors (55%), and 13 of 31 tumors (42%) demonstrated PCR. Stable disease was seen in one patient (one tumor) (3%). No cases demonstrated clinical tumor progression during treatment. The mean clinical DFS at time of data cut off for all cases of CCR was 9.3 months (range 2-21 months). In cases of PCR, the mean reduction in tumor size was 52% (range, 11%-80%). Only two patients (8%) discontinued treatment secondary to side effects.
CONCLUSION: Each patient and each tumor responds uniquely to vismodegib treatment, including variable tumor responses and a wide range of side effects and tolerability. This study highlights important unique observations, and our data as a whole adds to previously published studies, leading to thought provoking questions. Overall, the FDA approval of vismodegib for advanced basal cell carcinoma has markedly improved the prognosis and care of affected patients.
J Drugs Dermatol. 2015;14(9):956-962.
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.
Pyoderma Gangrenosum Following Breast Reconstructive Surgery: A Case Report of Treatment With Immunosuppression and Adjunctive Xenogeneic Matrix Scaffolds
Joseph Alcalay MD, President, ISDS C. William Hanke MD, Executive Director, ISDS Gerhard Sattler MD, Executive Director, ISDS| |
Background: Facial lipoatrophy is one of the most distressing manifestation for HIV patients. It can be stigmatizing, severely affecting
quality of life and self-esteem, and it may result in reduced antiretroviral adherence. Several filling techniques have been proposed
in facial wasting restoration, with different outcomes. The aim of this study is to present a triangular area that is useful to fill in facial
Methods: Twenty-eight HIV patients rehabilitated for facial wasting were enrolled in this study. Sixteen were rehabilitated with a non- resorbable filler and twelve with structural fat graft harvested from lipohypertrophied areas. A photographic pre-operative and post- operative evaluation was performed by the patients and by two plastic surgeons who were “blinded.” The filled area, in both patients rehabilitated with structural fat grafts or non-resorbable filler, was a triangular area of depression identified between the nasolabial fold, the malar arch, and the line that connects these two anatomical landmarks.
Results: The cosmetic result was evaluated after three months after the last filling procedure in the non-resorbable filler group and after three months post-surgery in the structural fat graft group. The mean patient satisfaction score was 8.7 as assessed with a visual analogue scale. The mean score for blinded evaluators was 7.6.
Conclusion: In this study the authors describe a triangular area of the face, between the nasolabial fold, the malar arch, and the line that connects these two anatomical landmarks, where a good aesthetic facial restoration in HIV patients with facial wasting may be achieved regardless of which filling technique is used.
J Drugs Dermatol 2012;11(2):202-208.
Treatment of Margin Positive Basal Cell Carcinoma With Vismodegib: Case Report and Consideration of Treatment Options and Their Implications
Stephanie Bayers BSBA,a Daniel L. Kapp MD FACS,b
Kenneth R. Beer MD FAAD,b and Benjamin Slavinc
J Drugs Dermatol. 2013;12(suppl 10):s147-s150.
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.
Dr. Osvaldo Vázquez-Martinez,a Dr. Kristian Eichelmann,b Dr. Martha García-Melendez,b Dr. Ivette Miranda,a Dr. Alberto Avila-Lozano,a Dr. David Vega,a and Dr. Jorge Ocampo-Candiania| |
OBJECTIVE: Determine the level of improvement of post-dermatological surgery scars.
METHODS: Thirty patients attending for excision lesion were recruited. They were randomized to 1 of 2 groups. Group 1 scar was randomly divided into 2 parts, one half received PDL 595 nm on 3 occasions; the first after suture removal, 15 and 45 days. Group 2 in one half laser application was simulated while the other was left untreated. The Vancouver scar scale (VSS) was used by an external evaluator to assess the scars. Two skin biopsies were also obtained one before and one after laser treatment.
RESULTS: The VSS at 45 days decreased in a significant way in the treatment group from 4 to 1 (P = .005). In the control group decreased from 2 to 1.3 (P = .056). No significant difference was found between the presence of inflammatory infiltrate of patients in the placebo group.
CONCLUSION: This study confirmed the usefulness of pulsed dye laser for improving the appearance of scars.
J Drugs Dermatol. 2015;14(11):1209-1212.
Irene J. Vergilis-Kalner MD, Yana Kriseman MD, Leonard H. Goldberg MD| |
Oge C. Onwudiwe MD,a Ellen S. Marmur MD,b and Joel L. Cohen MDc| |
J Drugs Dermatol. 2013;12(2):199-205.
Nonanatomic Free Cartilage Batten Grafting With Second Intention Healing for Defects on the Distal Nose
Objective: We report our experience using nonanatomic free cartilage batten grafts in combination with second intention healing for nasal ala defects.
Methods: A retrospective study of distal nose defects repaired using nonanatomic free cartilage batten grafting with second intention healing was performed. Detailed data on the quality of the scar, post-operative complications, free margin distortion, functional impairments, and patient satisfaction were recorded. Digital images were also shown to an experienced fellowship-trained Mohs surgeon to assess the overall aesthetic outcome using a 5-point score ranging from poor to excellent.
Results: Sixteen subjects were included in the study. Complications were common, but minor. Five (~31%) subjects had subtle contour depressions, three (~18%) subjects had excessive granulation tissue, two (~12%) subjects had post-operative ear pain at the donor site lasting up to 10 days, and one (~6%) subject had a hypertrophic scar at the recipient site. There were two occurrences (~12%) of mild alar notching but no occurrences of significant alar margin distortion or nasal valve dysfunction. In terms of aesthetic outcome, seven (~43%) were assessed by an independent fellowship-trained Mohs surgeon as having excellent aesthetic outcomes, six (~38%) were very good, and three (~19%) were good. All sixteen subjects reported satisfaction on follow-up evaluation.
Conclusions: Nonanatomic free cartilage grafting with second intention healing allows for facile, single-step repair of nasal ala defects with high patient satisfaction and aesthetically pleasing results. This provides an attractive alternative to other flap techniques, skin grafting, and healing via secondary intention.
J Drugs Dermatol. 2012;11(1):46-50.
Philip D. Shenefelt MD MS| |
Arash Kimyai-Asadi MD, Christy Shaffer MD, Vicki J Levine MD, Ming H Jih MD PhD| |
Antibiotic Prophylaxis for the Prevention of Endocarditis in Dermatologic Surgery: Sources of Controversy and Directions for Future Reserach
David J. Goldberg, MD and Chrys Delling Schmults, MD| |
Gerald A. Rosenblum MD| |
Mark Naylor MD| |
Martin Ray MDa and Michael Gold MDb| |
J Drugs Dermatol. 2015;14(11):1268-1271.
Joel L. Cohen MD| |
METHODS: Two patients underwent surgery to remove facial skin cancer tumors. The resulting scars after reconstruction of these skin cancer defects on the left cheek (Case 1) and right cheek (Case 2) each received 3 treatments with a fractional ablative laser device (ProFractional-XC, Sciton, Inc., Palo Alto, CA). Treatments were spaced about 1 month apart. Topical anesthetic cream applied 1 hour before treatment minimized patient discomfort during the procedure. Treatment depths ranged from 150 to 200 microns, 2 passes were performed, and coverage per pass was typically 22% and then 11% in the coagulation mode. Results were evaluated by digital photography before the initial treatment, approximately 4-5 weeks after each of the 3 treatments, and at approximately 7 months after the surgical procedures.
RESULTS: The fractional Er:YAG laser device significantly improved postsurgical scar lines in each patient without significant adverse effects. Prior to the laser sessions, these scars demonstrated hypopigmentation, hyperpigmentation, neovascularization, or diminished pore structures compared to the surrounding skin. These pigmentary, vascular or textural issues were all significantly improved by the fractional ablative Er:YAG laser.
CONCLUSION: The ablative fractional laser device of the present report safely minimizes and improves facial scars demonstrating not only textural alterations but also some pigmentary and vascular changes after reconstruction of skin cancer defects.
J Drugs Dermatol. 2013;12(10):1171-1173.
Evaluation of the Chemopreventative Effects of ALA PDT in Patients With Multiple Actinic Keratoses and a History of Skin Cancer
Objective: To evaluate the time to development of new non-melanoma skin cancers (NMSC) within one year of ALA-PDT treatment in immunocompetent patients with AK and a history of skin cancer.
Methods and Materials: One hundred forty anatomic sites in 114 patients were treated with topical ALA for a 1 to 3 hour incubation period followed by photodynamic therapy (PDT) with a blue light. All new NMSCs within the treatment areas were recorded over a 1-year observational period.
Results: Eighty-three anatomic sites (59%) did not develop new skin cancers within 1 year. Additionally, 92%, 78%, and 64% of anatomic sites were free of new skin cancers at 3, 6, and 9 months after treatment was initiated. Although approximately 41% of patients treated on both the scalp and face developed new skin cancers within 1 year of treatment, the average time to develop skin cancer was longer for the face (7.09 months) than for the scalp (5.34 months).
Conclusion: In patients with a history of NMSC and multiple AKs, ALA PDT may be a valuable option for the prevention and delay of new NMSCs.
J Drugs Dermatol. 2012;11(5):593-597.
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.
Omid Hamid MDa and Gary Goldenberg MDb| |
J Drugs Dermatol. 2013;12(11):1246-1252.
Divya Railan MD, Tina S. Alster MD| |
Methods: In a double-blind, placebo-controlled, crossover pilot study, we examined the efficacy of three botulinum toxin preparations (onabotulinumtoxinA, abobotulinumtoxinA, and rimabotulinumtoxinB) following oral supplementation with zinc citrate 50 mg and phytase 3,000 PU, zinc gluconate 10 mg, or lactulose placebo in individuals treated for cosmetic facial rhytids, benign essential blepharospasm, and hemifacial spasm.
Results: In seventy-seven patients, 92% of subjects supplemented with zinc 50 mg and phytase experienced an average increase in toxin effect duration of nearly 30%, and 84% of participants reported a subjective increase in toxin effect, whereas no significant increase in duration or effect was reported by patients following supplementation with lactulose placebo or 10 mg of zinc gluconate. The dramatic impact of the zinc/phytase supplementation on some patients' lives clinically unmasked the study and prompted an early termination.
Conclusions: This study suggests a potentially meaningful role for zinc and/or phytase supplementation in increasing the degree and duration of botulinum toxin effect in the treatment of cosmetic facial rhytids, benign essential blepharospasm, and hemifacial spasm.
J Drugs Dermatol. 2012;11(4):507-512.
Aim: Despite a mostly self-limiting course, infantile hemangiomas can cause severe functional and/or cosmetic problems. The aim of this
study was to determine the efficiency of propranolol treatment on infantile hemangiomas.
Methods: Sixty-seven infantile hemangioma patients were included in propranolol protocol in two institutions from 2009 to 2011. Participants included 36 boys and 31 girls. An associate protocol with radiology and pediatric cardiology was constructed for appropriate patient selection. Patients received a dose of 2 mg/kg/day, and all were admitted for the first 24 hours of therapy.
Results: Sixty-seven patients were included in the study. Mean age at the initiation of therapy was 7 months (1 to 24 months), and eleven patients were older than 12 months of age when propranolol was started. All patients showed improvement with varying responses. No side effects were detected during the treatment.
Conclusion: Previously defined treatments for hemangiomas were efficient, yet had a limited usage because of side effects. Propranolol, with a high efficacy (not as total involution but stabilization and regression) and feasibility deserves to be the first line therapy for infantile hemangiomas even after the proliferation phase.
J Drugs Dermatol. 2012;11(7):808-811.
João Carlos Pereira MD,a João Carlos Pereira Filho MD,b and João Pedro Cabrera Pereira MDc| |
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.
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.
NEWS, VIEWS, AND REVIEWS: A Tool for My Laser Practice I Simply Can’t Do Without: Shining a Light on My Favorite Light (Source)
Eric F. Bernstein MD MSE| |
J Drugs Dermatol. 2017;16(9):939-944.
David E. Orbuch BS,c Lauren Penn MD MS,b Bradley S. Bloom MD,a,b Jeremy A. Brauer MD,a,b Daniel B. Shin MS PhD,d Joshua Greenbaum,a Leonard J. Bernstein MD,a,e Elliot T.Weiss MD,a,e Robert T. Anolik MD,a,b and Roy G. Geronemus MD1,2| |
Porcia B. Love MDa and Roopal V. Kundu MDb| |
J Drugs Dermatol. 2013;12(4):403-409.
Alysa R. Herman, MD and John A. Carucci, MD, PhD| |
Melissa A. Bogle MD, Kenneth A. Arndt MD, Jeffrey S. Dover MD FRCPC| |
aPeter K. Lee MD PhD and bAndrew Kloser PhD| |
J Drugs Dermatol. 2013;12(8):925-930.
J Drugs Dermatol. 2012;11(9):1053-1058.
Robert A. Weiss, MD and Margaret A. Weiss, MD| |
Linear Hypopigmentation and CutaneousAtrophy Following Intra - Articular SteroidInjections for de Quervain's Tendonitis
Priya Venkatesan MD and William L. Fangman MD| |
Optimizing Facial Rejuvenation Outcomes by Combining Poly-L-Lactic Acid, Hyaluronic Acid, Calcium Hydroxylapatite, and Neurotoxins: Two Case Studies
Z. Paul Lorenc MD FACSa and Elizabeth Daro-Kaftan PhDb| |
J Drugs Dermatol. 2014;13(2):191-195.
A Novel Skin Cream Containing a Mixture of Human Growth Factors and Cytokines for the Treatment of Adverse Events Associated with Photodynamic Therapy
Michael H. Gold MD, Julie Biron| |
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.
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.
Antonio Rusciani MD, Angela Motta MD, Luigi Rusciani MD, Carmine Alfano MD| |
Neal Bhatia MD| |
Recent investigations have presented explanations on the possible mechanisms behind the anti-tumor activity of imiquimod, more specifically for its use in treating superficial BCC. There are studies currently underway as well as anecdotal data published for its possible use in treating squamous cell carcinoma (SCC), although this is not as widely accepted for off-label use as BCC among many dermatologists. However, many patients who may not be surgical candidates that present with tumors other than BCC have been successfully treated with imiquimod. This is a case of an elderly patient who could not undergo surgery that presented with a large keratoacanthoma and was clear of her tumor after five months using imiquimod 5% cream on a daily basis.
Henry Ford Hospital Dermatology Experience with Levulan Kerastick and Blue Light Photodynamic Therapy
Jennifer Rivard MD, David Ozog MD| |
Ted Rosen M.D.| |
Within a relatively short period of time after the first antimicrobial drugs were introduced, bacteria began exhibiting varying degrees of resistance. The excessive use (and abuse) of antibiotics in agriculture, and in both human and veterinary medicine, has played a critical causative role in the development of antibiotic resistance, which is now recognized as a global public health threat. Increasing concern over this issue should impact the practice of cutaneous medicine and surgery, as dermatologists can easily adopt new healthcare delivery patterns that might reduce the development of antibiotic resistance and still achieve acceptable treatment outcomes. Dermatologists should seriously consider any and all alternative therapies before committing to an extended course of antibiotic therapy for disease entities that are almost certainly not infectious. Conversely, dermatologists should carefully and closely adhere to dosage and duration recommendations when using antibiotics to treat a bona fide infectious disorder.
J Drugs Dermatol.2011;10(7):724-733.
Robert M. Hurwitz MD, Larry J. Buckel MD, Thomas J. Eads MD| |
J Drugs Dermatol. 2012;11(4):528-529.
Allison P. Weinkle BS,a Bryan Sofen MD,b and Jason Emer MDc| |
J Drugs Dermatol. 2015;14(11):1215-1228.
J Drugs Dermatol. 2012;11(9):1089-1093.
Nicole Van Buren MS and Tina S. Alster MD| |
Recent U.S. population statistics reveal dramatically shifting demographics that would anticipate a likely increase in this percentage. U.S. Census Bureau data projects that by 2050, people of color are expected to become the majority, comprising 54% of the U.S. population, with Latinos accounting for 30%, African Americans 15%, and Asians 9.2%. The rising popularity of cutaneous laser surgery as an accepted therapy for various skin pathologies, coupled with the diverse face of the patient population, has led to increased demand for laser treatment of darker skin tones.
Although difficult, effective laser therapy in patients with darker skin phototypes can be achieved. When determining a treatment protocol for an individual patient, the proper laser energy and wavelength are important in ensuring a substantial margin of safety while still achieving satisfactory results.
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).
Deborah S. Sarnoff MD FAAD FACPa and Robert H. Gotkin MD FACSb| |
J Drugs Dermatol. 2015;14(5):472-477.
Controversies in Skin Surgery: Electrodessication and Curettage Versus Excision for Low-risk, Small, Well-differentiated Squamous Cell Carcinomas
Matthew J. Reschly MD and Philip D. Shenefelt MD MS| |
Justin Yu BS*,a Bishr Aldabagh MD*,b Jennifer Wang BA,f Sue S. Yom MD,c,d Ivan El-Sayed MD,d
Daniel Knott MD,d Mary H. McGrath MD MPH,e and Sarah Arron MD PhDb
For the UCSF High Risk Skin Cancer Program
METHODS: We report four cases of advanced BCC that benefited from a multidisciplinary approach, as well as highlight treatment considerations and factors in the development of advanced BCC.
RESULTS: All four complex cases of advanced BCC presented to a multidisciplinary non-melanoma skin cancer tumor board with extensive tumor involvement. Treatment of disease was effective in preventing recurrence while optimizing aesthetic outcomes.
CONCLUSIONS: The multidisciplinary tumor board has a central and important role in the evaluation and management of advanced BCC.
J Drugs Dermatol. 2014;13(5):601-606.
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.
J Drugs Dermatol. 2012;11(11):1296-1299.
Sudeep J. Karve MS, Steven R. Feldman MD PhD, Brad A. Yentzer MD, Daniel J.Pearce MD, Rajesh Balkrishnan PhD| |
Eruptive Squamous Cell Carcinomas With Keratoacanthoma-like Features in a Patient Treated with Sorafenib
J Drugs Dermatol. 2011;10(3):308-310.
C. William Hanke MD,a Shivani K. Mhatre PhD,b David Oliveri BS,c Marko Zivkovic PhD,c Ivor Caro MD,b Daniel Bergström PhD,b* Keith Dawson MS,b and Camelia S. Sima MDb| |
Patrick Micheels MDa and Lisa Goodman MDb| |
J Drugs Dermatol. 2018;17(1):89-96.
Clinical Improvement and Safety of Ablative Fractional Laser Therapy for Post-Surgical Scars: A Systematic Review of Randomized Controlled Trials
Trenton Custis MDa,b and Daniel B. Eisen MDa| |
OBJECTIVE: To identify randomized trials that study the efficacy of ablative fractionated laser therapy for treatment of surgical scars.
METHODS AND MATERIALS: EMBASE, Web of Science, and Pubmed databases were searched for randomized trials with 10 or more surgical wounds. No restrictions were placed on the language of the publications.
RESULTS: Three randomized trials were identified that met the criteria for the review. One study found superior efficacy of ablative fractionated laser treatment of surgical scars compared to pulsed dye laser while the others found equivalent efficacy when compared to dermabrasion or pulsed dye laser. One study found a superior safety profile for ablative fractionated laser treatment over dermabrasion. No studies compared fractionated laser therapy to sham therapy or observation.
CONCLUSIONS: AFL compares well with the scar amelioration techniques of dermabrasion and pulsed dye laser. Additional studies are needed to further contrast AFL to these and other modalities as well as to observation alone.
J Drugs Dermatol. 2015;14(11):1200-1204.
John J. Kohorst,a Clinton Hagen,b Christian L. Baum MD,c Mark D. P. Davis MDc| |
OBJECTIVE: We sought to determine the treatments most commonly prescribed and the performance of all systemic and surgical treatments used in hidradenitis suppurativa patients in Olmsted County, Minnesota, treated over a 40-year period.
METHODS: A retrospective chart review was performed to evaluate hidradenitis suppurativa treatments in 376 episodes with 115 Olmsted County patients seen by a clinician at Mayo Clinic in Rochester, Minnesota, between 1968 and 2008. Treatment episode outcomes were recorded from clinical notes for the 73 treatment episodes that had a follow-up period of more than 30 days.
RESULTS: Systemic antibiotics alone were prescribed most frequently in 70.0% of episodes. Systemic antibiotics alone improved 39 of 49 treatment episodes (79.6%), including 13 episodes (26.5%) when the disease was fully cleared. All 5 of 5 episodes (100%) of surgical treatment alone improved, including 4 (80%) in which the disease was fully cleared. Surgery in combination with systemic antibiotic treatment yielded improvement in 5 episodes (71.4%), with 2 episodes (28.6%) showing complete clearance.
CONCLUSION: Systemic antibiotics were the most frequently prescribed treatment type in 115 patients over a 40-year period. Both systemic antibiotic therapy and surgical treatment are effective in disease management.
J Drugs Dermatol. 2014;13(7):827-831.
Facial Identity and Self-Perception: An Examination of Psychosocial Outcomes in Cosmetic Surgery Patients
Benjamin Slavin BA PAa and Jacob Beer BA PAb| |
The psychosocial health of patients undergoing cosmetic procedures has often been linked to a host of pre-existing conditions, including the type of procedure being performed. Age, gender, and the psychological state of the patients also contribute to the perceived outcome. Specifically, the presence or absence of Body Dysmorphic Disorder (BDD) has been identified as an independent marker for unhappiness following cosmetic procedures.1 However, no study has, to our knowledge, identified a more precise indicator that is associated with higher rates of patient dissatisfaction from cosmetic procedure. This review identifies facial identity and self-perception as potential identifiers of future patient dissatisfaction with cosmetic procedures. Specifically, we believe that patients with a realistic facial identity and self-perception are more likely to be satisfied than those whose self-perceptions are distorted. Patients undergoing restorative procedures, including blepharoplasty, rhytidectomy, and liposuction, are more likely to have an increased outcome favorability rating than those undergoing type change procedures, such as rhinoplasty and breast augmentation. Age, which typically is an independent variable for satisfaction, tends to be associated with increased favorability ratings following cosmetic procedures. Female gender is a second variable associated with higher satisfaction. The authors believe that negative facial identity and self-perception are risk factors for patient dissatisfaction with cosmetic procedural outcomes. Based on this assumption, clinicians may want to focus on the face as a particular area of psychosocial concern.
J Drugs Dermatol. 2017;16(6):617-620.
Zain Husain MD,a Joyce K. Ho,b and Basil M. Hantash MD PhD c| |
OBJECTIVE: Two cases of rapid SK eruptions, one the sign of Leser-Trélat (SLT) and one PLT, are presented, and the literature on SLT and PLT is reviewed.
METHODS: A literature review of SLT/PLT was performed by searching the PubMed database for all related English published cases.
RESULTS: We identified 109 cases of SLT and 12 cases of PLT, with a mean patient age of 61.8 years. SK eruptions were observed before (68.3%), after (22.1%), and at the time of (9.6%) malignancy diagnosis. The malignancy most frequently associated with SLT was gastric adenocarcinoma. The most common anatomical location of SK eruptions was the trunk (18.9%). Frequently reported associated signs and symptoms included pruritus (52%) and acanthosis nigricans (38.7%). The most common treatment included surgery (35.8%), chemotherapy (26.9%), and radiation therapy (26.9%). Treatment resulted in clinical improvement (45%), no change (30%), exacerbation (15%), or initial improvement followed by exacerbation of SKs. Patient outcomes included disease stability/ improvement (48.4%), recurrence (9.7%), exacerbation/metastasis/new malignancy (4.8%), and death (37.1%).
LIMITATIONS: This was a retrospective study and excluded non-English published cases.
CONCLUSION: This review updates the existing SLT literature and emphasizes the presence of PLT. Clinicians should be aware that SK eruptions may be early manifestations of an internal malignancy or other pathology. To our knowledge, this is the first review examining both SLT and PLT.
J Drugs Dermatol. 2013;12(5):e79-e87.
Yehuda Ullmann, MD; Oren Shoshani, MD; Lucian Fodor, MD; Yitzchak Ramon, MD; Nurit Carmi, PhD; Avi Suapk, MD; Richard Lincoln, MA and Amos Gilhar, MD| |
Human fat obtained by suction-assisted lipectomy was centrifuged and stored in a domestic refrigerator at -18°C for 7 months. After thawing, the fat was injected into the scalp of 10 nude mice, which served as the study group. In the control group (n = 10), fresh fat was injected.
Fifteen weeks later, the fat grafts were dissected out. Volumes, weights, and histological parameters were compared between the groups. The injected fat survived in both the study and the control groups but the histological parameters were significantly inferior in the frozen fat. The weight of the frozen fat was also significantly less compaired with the fresh fat. The volume of the frozen fat was inferior but not significantly. Based on this in vivo experiment, it is suggested to refrain from using fat that has been frozen for 7 months or longer. The longest period and the optimal conditions for fat preservation shoud be further investigated.
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.
Emily P. Tierney MD,a David J. Kouba MD PhD,b C. William Hanke MD MPHc| |
Objective: To review the literature on the safety of tumescent liposuction, liposuction under general anesthesia and laser-assisted liposuction.
Results: Aggregate safety data on liposuction under tumescent anesthesia reveals over 100,000 body areas treated with liposuction. There were no serious complications of death, emboli, hypovolemic shock, perforation of thorax or peritoneum, thrombophlebitis, seizures, or toxic reactions to drugs. In contrast, in the plastic surgery literature, liposuction under general anesthesia was associated with complications of deep venous thrombosis or pulmonary embolus, abdominal or other organ perforation, infection, and bleeding. Most recently, survey data in the European literature analyzed data showed 72 cases of severe complications from liposuction, including 23 deaths in a 5-year period from 1998 to 2002. The most frequent complications were bacterial infections such as necrotizing fasciitis, gas gangrene, and different forms of sepsis. Further causes of lethal outcome were hemorrhages, perforation of abdominal viscera, and pulmonary embolism.
Conclusion: Tumescent local anesthesia utilizing lidocaine with epinephrine allows the removal of large volumes of fat with minimal associated blood loss and postoperative morbidity.
J Drugs Dermatol. 2011;10(12):1363-1369.
J Drugs Dermatol. 2012;11(9):1041-1045.
The Effect of Lidocaine and Adrenaline on the Viability of Injected Adipose Tissue–– An Experimental Study in Nude Mice
Oren Shoshani MD, Joseph Berger MD, Lucian Fodor MD, Yitzchak Ramon MD, Avi Shupak MD, Izhak Kehat MD, Amos Gilhar MD, Yehuda Ullmann MD| |
Human adipose tissue, obtained by suction-assisted lipectomy, was injected subcutaneously into the scalp of nude mice. Local anesthesia of the fat donor site consisted of a solution with 600 mg of lidocaine (0.06%) and epinephrine 1:1000000. In a control group, normal saline with no local anesthesia or epinephrine was administered to the donor site. One cc of fat was injected after centrifugation into each animal scalp. There were 10 animals in each group.
The animals were sacrificed 15 weeks after the procedure. Graft weight and volume were measured, and histologic evaluation was performed. No significant differences were demonstrated between the groups in regard with the grafts’ weight and volume and the histologic parameters investigated.
In conclusion, local anesthesia solution, consisting of lidocaine and epinephrine, does not alter the take of fat grafts, and has no influence on the adipocytes viability.
Evaluation of the Safety and Efficacy of a Novel 1440nm Nd:YAG Laser for Neck Contouring and Skin Tightening Without Liposuction
Deborah S. Sarnoff MD FAAD FACP| |
OBJECTIVE: To test the safety and efficacy of a pulsed 1440nm Nd:YAG wavelength and side-firing fiber for the treatment of subcutaneous fat and skin laxity associated with the aging neck.
METHODS: Twenty-four subjects aged 40 to 65 years underwent laser lipolysis of the submental and anterior cervical areas. An average of 1205J per 5x5cm square was delivered, with a maximum internal temperature setting of 47 degrees C. Cervicomental Angle Score (CAS), Global Aesthetic Improvement Scale (GAIS), subject and investigator satisfaction, and safety were assessed.
RESULTS: At six months post-treatment, 79% of subjects had a significant improvement in the CAS (P<.001) and 79% demonstrated an improvement on the GAIS. Clinical improvement was marked and evident for all but one subject, with physician and patient satisfaction scores indicating overall satisfaction with the procedure and outcomes. Adverse events were mild and transient with no incidence of burns, seromas, hematomas, infection, or nerve damage.
CONCLUSION: The 1440nm Nd:YAG device with the side-firing fiber was safe and effective for the treatment of subcutaneous fat and skin laxity in the neck. This device offers an alternative to selected individuals aged 40 and over who do not wish to undergo rhytidectomy.
J Drugs Dermatol. 2013;12(12):1382-1388.
The Subcutaneous Loop: A Single Suture Technique for Skin Closure after Superficial and Subcutaneous Surgery
Sody Abby Naimer MD, Amnon Biton MD, Morris Topaz MD| |
Impact of Gene Expression Profiling on Decision-Making in Clinically Node Negative Melanoma Patients after Surgical Staging
Darryl Schuitevoerder MBBS,a Michael Heath MS,c Robert W. Cook PhD,e Kyle R. Covington PhD,e Jeanine Fortino HIMA,b Sancy Leachman MD PhD,d and John T. Vetto MD FACSa,b| |
Does Increasing the Dose of Abobotulinumtoxina Impact the Duration of Effectiveness for the Treatment of Moderate to Severe Glabellar Lines?
John H. Joseph MD,a Laura L. Eaton RN BSN,b James Robinson MS,c Allison Pontius MD,d and Edwin F.Williams III MDd| |
Methods: PubMed/MEDLINE and SCOPUS were searched using the following keywords: awareness, knowledge, behavior, sunscreen, hat, clothing, minorities, ethnic skin, Hispanic, Latino, and skin. Reference lists of selected studies were checked for additional studies. Studies that quantitatively evaluated primary skin cancer prevention efforts among US Hispanics were selected. Primary outcome measures included 1) use of sunscreen or sunblock, 2) use of sun-protective clothing and/or hats, and 3) shade seeking behavior. Selected studies were reviewed and quantitative data for each primary outcome measure were extracted. Additionally, we examined survey methodology and demographics of the studied populations.
Results: Studies evaluating primary prevention of skin cancer among US Hispanics are limited in number and study populations. Overall, 9.5-29.9% of the Hispanics evaluated reported wearing sunscreen either most of the time or always compared to 16.5-35.9% of NHW. Hispanics reported slightly higher rates of wearing hats compared to NHW, with 23.9-25.0% of Hispanics reporting wearing hats either most of the time or always compared to 20-20.7% of NHW. Trends in wearing sun protective clothing and shade seeking varied between different Hispanic populations evaluated, but overall prevalence of these practices remained low.
Conclusion: The limited studies suggest that improvements are needed in primary skin cancer prevention practiced by Hispanics. Future studies and interventions need to account for heterogeneity in socio-cultural backgrounds, degree of acculturation, and occupation among US Hispanics.
J Drugs Dermatol. 2012;11(5):580-586.
Virtually Painless Local Anesthesia: Diluted Lidocaine Proves to Be Superior to Buffered Lidocaine for Subcutaneous Infiltration
Background: Many physicians believe that buffering local anesthetics with sodium bicarbonate is the best technique for reducing the pain and discomfort associated with subcutaneous infiltration.
Objective: To compare the level of pain and discomfort associated with subcutaneous infiltration of lidocaine diluted with normal saline to that associated with traditionally buffered lidocaine.
Patients/Methods: In a prospective, double-blind trial, 31 patients were asked to use a visual analog scale to rank the level of pain and discomfort caused by two different solutions of lidocaine with epinephrine. Solution A: 3 mL of 1% lidocaine + epinephrine in 30 mL of bacteriostatic 0.9% sodium chloride in a 1:10 ratio, in which each mL contained 9 mg of sodium chloride and 9 mg of benzyl alcohol. Solution B: 5 mL of 8.4% sodium bicarbonate solution and 50 mL of 1% lidocaine + epinephrine in a 1:10 ratio.
Results: Twenty-eight out of 31 patients reported that the solution of lidocaine diluted with normal saline was the least painful upon injection.
Conclusion: Pain and discomfort during subcutaneous injection of lidocaine can be reduced by diluting the anesthetic with normal saline in a 1:10 ratio.
J Drugs Dermatol. 2012;11(10):e39-e42.
In-Vivo Histological Analysis of a Fractional CO2 Laser System Intended for Treatment of Soft Tissue
Elisabeth Hurliman MD,a Brian Zelickson MD,b Jeffrey Kenkel MDc| |
BACKGROUND: Fractional ablative lasers have been shown to be safe and effective for improving wrinkles, scars, skin texture, and dyspigmentation. However, the exact effects of this technology in vivo on epidermal and dermal skin constituents have not been delineated. This study evaluated the in vivo histological effects over time of treatment with a fractional ablative CO2 system, using different treatment parameters. MATERIALS AND METHODS: Healthy adult volunteers were enrolled in this multicenter clinical study. Study participants, previously scheduled for abdominoplasty, received fractional CO2 laser treatment on the abdomen at a predetermined time prior to surgery. Biopsies were taken at baseline and after CO2 treatment. Morphological and morphometric analyses were performed in the ablated and coagulated tissue areas. RESULTS: Nine healthy adult volunteers were treated. Histologic evaluation showed 800-900 micron diameter zones of ablation and coagulation confined to the upper most layer of the skin in the mode with the greatest fractional skin coverage using Light Mode 30 - 50% (spot diameter of 150 microns, 30-60 millijoules fluence), while ablation to levels of up to 900 microns in depth using the Deep Mode (spot diameter 150 microns, 50-80 millijoules). Healing times of treated tissue varied from 1-day post-treatment with the Light Mode, and up to 10 days post-treatment with the Deep Mode. No remnants of ablation or coagulation were seen after 30 days post CO2 treatment with either mode. There were no adverse events associated with treatments. CONCLUSION: Treatment of the skin using the fractional CO2 device leads to skin resurfacing via ablation and coagulation of the treated area at a depth proportional to the delivered energy. The higher the energy used, the greater the degree of ablation and coagulation in tissue, which can lead to a greater tissue response in terms of fibroblast activity, collagen remodeling, and new collagen formation.
J Drugs Dermatol. 2017;16(11):1085-1090.
The Efficacy and Tolerability of Dapsone 5% Gel in Female vs Male PatientsWith Facial Acne Vulgaris: Gender as a Clinically Relevant Outcome Variable
Objective: To evaluate the effect of gender on the efficacy and tolerability of dapsone 5% gel.
Methods: This was a pooled analysis of data from 2 identical phase 3 randomized, double-blind, and vehicle-controlled trials (DAP0203 and DAP0204) of dapsone 5% gel conducted in the United States and Canada between November 2002 and September 2003. A total of 2,898 patients with acne vulgaris were included in the pooled analysis. Of these, 1,453 patients (753 female, 700 male) received dapsone 5% gel twice daily, and 1,445 patients (767 female, 678 male) received vehicle twice daily. End points included the mean percentage reduction from baseline in acne lesion counts and the proportion of patients achieving clinical success (Global Acne Assessment Scale score of 0, clear skin, or 1, almost clear skin). Assessments were performed at baseline and at weeks 2, 4, 6, 8, and 12.
Results: The mean percentage reduction in acne lesion counts at 12 weeks was significantly greater in females than males in both treatment groups. The mean reduction in total lesion counts in dapsone-treated females and males was, respectively, 46.6% vs 35.8% (P<.0001). Reductions in papulopustular and comedonal lesion counts were likewise significantly higher in female than male patients (each P<.0001). Significantly more dapsone-treated females than males achieved clinical success (48.6% vs 34.4%; P=.0003).
Conclusion: The response to dapsone 5% gel appears to be influenced by gender, with female patients experiencing a significantly greater reduction in acne lesion counts and a significantly higher clinical success rate following 12 weeks of treatment. These data suggest that gender is a novel predictor of outcome that should be considered in acne clinical trial design and analysis.
J Drugs Dermatol. 2012;11(12):1417-1421.
C. Cantisani MD,a G. Paolino MD,a U. Bottoni MD,b and S. Calvieri MDa| |
AIM: we report our experience comparing conventional PDT (406 patients) with daylight-mediated PDT (D-PDT) 240 patients with multiple actinic keratoses (AK), afferent to our photodynamic outpatients clinic from September 2013 to June 2014.
MATERIALS AND METHODS: to establish predictors for the clinical response to conventional PDT and daylight PDT (DPDT), a retrospective study on 646 patients was performed. The following parameters have been evaluated: sex, age, anatomic site of the primary tumor and local skin reactions. We used the Spearmen’s coefficient between the clinical response and the predictors analyzed; while Odds Ratio (OR) was performed to evaluate general clinical response and local skin reaction between PDT and D-PDT patients. Subsequently, we performed a sub-analysis, focusing to the anatomical sites, and we subdivided anatomical sites in face and scalp, nose, trunk, and extremities.
RESULTS: a total of 406 patients treated with PDT and 240 patients treated with D-PDT, were enrolled in the current report. The median age was 71 years in PDT and 73 years in D-PDT. The mean clinical response in PDT was of 74.4% and 95% in D-PDT. Performing OR between PDT and D-PDT, according to the clinical response, we found a better behavior in patients treated with D-PDT (P < 0.03); the same significance was maintained according to the presence or absence of local skin reaction (P < 0.0002). Using no parametric Spearman’s Coefficient test among predictive factors and the therapeutical response we found that D-PDT showed a better clinical response in patients with AK size ≥0.6 mm (P < 0.03), while this evidence was not present in PDT. The nose remained in both PDT and DPDT the main anatomical site with a better clinical response to the treatment.
CONCLUSION: Since efficacy of D-PDT is comparable or superior to conventional type, but is simpler and better appreciated by patients, in our opinion it may be used routinely to treat sun exposed multiple AKs especially in sun damaged skin also for aesthetic purposes.
J Drugs Dermatol. 2015;14(11):1349-1353.
Enhanced Full-Face Skin Rejuvenation Using Synchronous Intense Pulsed Optical and Conducted Bipolar Radiofrequency Energy (ELOS): Introducing Selective Radiophotothermolysis
Neil S. Sadick MD FACP FAACS, Macrene Alexiades-Armenakas MD PhD, Patrick Bitter Jr. MD, George Hruza MD, R. Stephen Mulholland MD| |
Objective: The authors report their experience using an ELOS system (Aurora SR, Syneron, Yokneam, Israel) on 108 consecutive patients treated with a series of full-face procedures.
Methods: Patients received 5 full-face treatments every 3 weeks. Each treatment consisted of 1 to 8 full-face and segmental passes. The number of passes, specific wavelength of pulsed optical energy, and RF energy were determined by the patient’s skin type, dyschromia, wrinkle pathology, and presence of a tan. A total of 540 treatments were performed on 108 subjects. All patients had pre- and post-procedural photographs. Results were assessed by double-blinded physician photographic evaluation and patient satisfaction scales.
Results: Overall skin improvement was rated at 75.3%. Overall average wrinkle improvement was 41.2%, with an average Class 1 wrinkle improvement of 64.7%, Class 2 wrinkle improvement of 38.6%, and Class 3 wrinkle improvement of 20.4%. Improvement in skin laxity was rated at 62.9%. Skin texture was reported to improve 74.1%. Improvement in the appearance of pore size was rated at 65.1%. Average improvement in erythema and telangiectasia was 68.4%. Average improvement in hyperpigmentation and dyschromia was 79.3%. Overall patient satisfaction was 92%. The overall minor complication rate, including blistering, crusting, and stripping was 8.3%, and the major complication rate was less than 1%. One small, depressed nasal scar was observed in one patient.
Conclusions: This study demonstrates the safety and efficacy of a new technology using combined optical and conducted bipolar RF energies for noninvasive skin rejuvenation. The results show improvement in wrinkle reduction and amelioration of erythema, telangiectasia, and hyperpigmentation comparable to that reported for other intense pulsed light technologies.
Fractional, Nonablative Q-switched 1,064-nm Neodymium YAG Laser to Rejuvenate Photoaged Skin: A Pilot Case Series
Methods: Seven healthy female subjects (mean ±standard deviation age, 53.8 ± 10.0 years) with visible signs of facial and neck skin aging were treated with fractional, nonablative Q-switched 1,064-nm Nd:YAG laser device (Pixel QS Nd:YAG; Alma Lasers Ltd, Caesarea, Israel). Treated areas were the face, including the periorbital and perioral regions (particularly the upper lip), neck, and chest. Treatments consisted of 3 sessions at 2- to 4-week intervals. Follow-up was performed monthly following the final treatment. The Alexiades-Armenakas Comprehensive Grading Scale of Skin Aging was employed to assess efficacy. Pain ratings were recorded by 10-point visual assessment scoring.
Results: Employing the validated, quantitative grading scale for rhytides of the face and neck, a 0.29 grade improvement, or 11.3% improvement, over baseline grade was observed in the 7-subject cohort that completed follow-up following a mean of approximately 2 treatments at approximately 1-month follow-up. No pain and rapidly resolving minimal erythema were noted in all subjects during treatment.
Conclusion: The results of this pilot case series suggest that the treatment with the fractional, nonablative Q-switched 1,064-nm Nd:YAG laser device significantly improves superficial rhytides. With its outstanding safety, it seems to be particularly suitable for the treatment of sensitive areas, such as the periorbital region, lips, neck, and chest. The Q-switched Nd:YAG laser is a facile, safe, and fast treatment for aesthetic skin rejuvenation.
J Drugs Dermatol. 2012;11(11):1300-1304.
The Treatment of Inflammatory Facial Dermatoses With Topical Corticosteroids:Focus on Clocortolone Pivalate 0.1% Cream
Methods: Clocortolone pivalate 0.01% cream was applied to affected facial skin in subjects presenting with seborrheic dermatitis, contact dermatitis, atopic dermatitis, or psoriasis. Application was completed three times daily for 21 days. Assessments of erythema, edema, transudation, lichenification, scaling, pruritus and/or pain were completed at baseline and Days 4, 7, 14, and 21. Overall therapeutic response was assessed at all follow-up visits. Forty-nine subjects were entered, ranging in age from 1 month to 88 years of age. Thirty-eight subjects completed the studies, with 11 subjects lost to follow-up after the first visit. Individuals between the ages of 13 and 19 years were pre-emptively excluded to avoid potential application of a corticosteroid to acne-affected or acne-prone skin.
Results: Treatment with clocortolone pivalate 0.1% cream resulted in decreases in erythema, edema, transudation, lichenification, scaling, and pruritus/pain in 76% of treated study subjects. The overall therapeutic response in approximately two-thirds of the subjects (68%) was rated as good to excellent. There were 7 adverse events noted over the course of the study that were judged to be related to treatment, all of which were cutaneous and localized to the site of application (acneiform eruptions, burning, and folliculitis).
Conclusion: Clocortolone pivalate 0.1% cream was effective in relieving the signs and symptoms of corticosteroid-responsive inflammatory dermatoses involving facial skin, including seborrheic dermatitis, contact dermatitis, atopic dermatitis, and psoriasis. Overall, the safety profile was favorable and devoid of any treatment-related serious adverse events.
J Drugs Dermatol. 2012;11(10):1194-1198.
Deborah S. Sarnoff MD| |
James M. Spencer MD| |
Randa R. Khoury MDa and Brian B. Adams MD MPHa,b| |
Resident Rounds: Part I - Program Spotlight: Western University of Health Sciences – Silver Falls Dermatology, Salem, Oregon
Bryce L. Desmond DO and Ben M. Perry DO| |
C. William Hanke MD MPH FACP| |
Dr. Sherry Hsiung| |
Perry Robins MD and Loek Habbema MD| |
Elizabeth K. Hale MD| |
William S. Kaufman MD| |
Lauren Snitzer MD, Nora K. Shumway MD, and Habibollah Alamdari MD| |
Brent T. Goedjen MD, Matthew C. Gordon MD, Katherine J. Willard MD, Fridolin J. Hoesly MD, Jason C. Sluzevich MD, and James H. Keeling MD| |
Richard G. Asarch MDa,b and Adam Asarch MDc| |
Amanda Pickert MD| |
Perry Robins MD| |
Deborah S. Sarnoff MD FAAD FACP| |
Daneeque Woolfolk MD, Kehinde Ogunmakin MD, Jeffrey Brackeen MD, and Bryan Carroll MD| |
Resident Rounds. Part I. Program Spotlight: The Southern Illinois University Division of Dermatology Residency Training Program
Megan Lent MD and Melissa Sirichotiratana MD| |
Deborah S. Sarnoff MD| |
Ronald L. Moy MD| |
Maritza I.Perez MD| |
Postoperative Wound Care After Dermatologic Procedures: A Comparison of 2 Commonly Used Petrolatum-Based Ointments
Adisbeth Morales-Burgos MD,a,b Michael P. Loosemore MD, a,band Leonard H. Goldberg MDa-c| |
J Drugs Dermatol. 2013;12(2):163-164.
Resident Rounds: Part 1 - Program Spotlight: The University of Colorado Denver Dermatology Residency Program
David A. Norris MD, Ramin Fathi MD| |
Michael McLeod| |
Kristen Lo Sicco MD, Mona Sadeghpour MD, Laura Ferris MD PhD, Lisa Grandinetti MD| |
Benjamin H. Kaffenberger MD, Stephanie K. Fabbro MD, and Katya L. Harfmann MD| |
Wallace R. Nozile MD,a Eric W. Rudnick MD,a Stanton K.Wesson MD,a Sailesh Konda MD,a and Franklin P. Flowers MDb| |
Heather Kiraly Orkwis DO and Daniel M. Stewart DO| |
Tracy L. Donahue MD, Julia S. Minocha MD, Lisa Y. Shen MD, Jennifer L. Sorrell MD, and Roopal V. Kundu MD| |
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| |
Noori Kim MD, Crystal Agi MD, and Sewon Kang MD| |
Sandeep S. Saluja MD and Scott R. Florell MD| |
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| |
Program Spotlight: Nova Southeastern University, College of Osteopathic Medicine and Broward General Medical Center Dermatology Residency Training Program
Stanley Skopit, DO MSE| |
Resident Rounds. Program Spotlight: Wright State University Department of Dermatology Residency Training Program
Rishi K. Gandhi MD and Julian J. Trevino MD| |
Edith Bowers MD PhD| |
Joel L. Cohen MD| |
J Drugs Dermatol. 2013;12(11):1290-1292.
Neil Crowson MD,a and Travis W. Blalock MDb| |
Resident Rounds. Part I: Program Spotlight: The UCLA Division of Dermatology Residency Training Program
Melvin W. Chiu MD MPH a,band Robert L. Modlin MDa| |
Horatio F. Wildman MD and Richard D. Granstein MD| |
Tyler J. Maly MD and James E. Sligh MD PhD| |
Elizabeth A. Zeeck MD, Ryan T. Rogers MD, and Joseph C. Pierson MD| |
Ritu Saini MD| |
Phillip C. Hochwalt MD, Adam Asarch MD, John C. Selby MD PhD, and Marta VanBeek MD MPH| |
J Drugs Dermatol. 2013;12(6):692-693.
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| |
Resident Rounds: Part I - Program Spotlight: New York Medical College Dermatology Residency Program, New York, NY
Nikoo Cheraghi MD and Bijan Safai MD| |
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| |
Lindsey A. Brodell MD and Lynn A. Cornelius MD| |
Thuzar M. Shin MD PhD and Jeremy S. Bordeaux MD MPH| |
OBJECTIVE: To review suture techniques and how they influence scar cosmesis.
METHODS: PubMed was searched using the following key words: cosme* in combination with cutaneous suture, simple interrupted, simple running, running locked, vertical mattress, horizontal mattress, buried, subcuticular, running vertical mattress, running horizontal mattress, buried vertical mattress, butterfly suture, or pulley suture. Information on study type, number of patients, age, gender, defect type, anatomic location, suture technique, scar length, follow up, and outcomes measured were tabulated.
RESULTS: Twenty-four articles - 17 prospective randomized controlled trials including 1,473 subjects and 1,608 repairs and seven case series including 465 subjects and repairs - were reviewed. Fifteen articles - 12 randomized controlled trials and three case series - demonstrated that aesthetic outcome was influenced by suture technique, the majority of which showed subcuticular closure to be superior to simple interrupted or simple running sutures. No difference in aesthetic outcome was observed in nine studies, which included 370 repairs.
DISCUSSION: Review of the literature supports the use of subcuticular closure over simple interrupted or simple running sutures on the trunk and extremities for improved aesthetic outcome.
J Drugs Dermatol. 2014;13(8):967-969.
Elizabeth Gaines-Cardone MD and Elizabeth K. Hale MD SUNY Downstate Department of Dermatology, Brooklyn, NY| |
J Drugs Dermatol. 2012;11(5):655-656.
Susan Y. Chon MD,a Brittany L. Sambrano BS,b and Elizabeth R. Geddesa,b| |
OBSERVATIONS: We report a series of two patients with stage IV metastatic melanoma who presented to our Dermatology clinic for evaluation of a florid eruption of hyperkeratotic neoplasms (verrucae, actinic keratoses, and SCCs) within one month of initiating vemurafenib. After one month of acitretin, substantially fewer new neoplasms were observed in both patients.
CONCLUSIONS: Although not definitive, these cases suggest that acitretin may have a role in chemoprevention of a subset of patients with rapidly developing vemurafenib-associated neoplasms and slowing the progression of more aggressive SCCs and KAs. Future studies to evaluate acitretin may substantially improve the morbidity associated with vemurafenib.
J Drugs Dermatol. 2014;13(5):586-588.
Perry Robins, MD| |
Tiffany Y. Loh BS and Philip R. Cohen MD| |
PURPOSE: A red dot BCC in an older woman is described. Clinical and histological differences between red dot BCCs and telangiectasias are described.
METHOD: A 72-year-old woman initially presented with a painless red macule on her nose. Biopsy of the lesion established the diagnosis of a red dot BCC. Pubmed was searched for the following terms: angioma, basal cell carcinoma, dermoscope, diascopy, red dot, non-melanoma skin cancer, telangiectasia, and vascular. The papers were reviewed for cases of red dot basal cell carcinoma. Clinical and histological characteristics of red dot basal cell carcinoma and telangiectasias were compared.
CONCLUSION: Red dot BCC is an extremely rare variant of BCC that may be confused with benign vascular lesions. Although BCCs rarely metastasize and are associated with low mortality, they have the potential to become locally invasive and destructive if left untreated. Thus, a high index of suspicion for red dot BCC is necessary.
J Drugs Dermatol. 2016;15(5):645-647.
News, Views, and Reviews: Safety & Efficacy of Agents Used for Home Mole Removal and Skin Cancer Treatment in the Internet Age, and Analysis of Cases
Brandon L. Adler and Adam J. Friedman MD| |
Resident Rounds: Part III - Case Report: A Non-Syndromic Case of Multiple Unilateral Nodular and Pigmented Basal Cell Carcinomas
Jonathan Weiss MD, Freya Van Driessche MD, Erin X. Wei MD, and Arsalan Shabbir MD PhD| |
Sarah Sung MD,a Bareng A.S. Nonyane PhD,b
Hang Lee PhD,c Alexa B. Kimball MD MPHd
Urticaria After Methyl Aminolevulinate Photodynamic Therapy in a Patient With Nevoid Basal Cell Carcinoma Syndrome
J Drugs Dermatol. 2012;11(11):1364-1365.
Deborah S. Sarnoff MD FAAD FACP| |
Neil Sadick MD| |
Kristin Totoraitis BS,a Joel L. Cohen MD,b and Adam Friedman MDc| |
Surgical procedures are an important piece of a dermatologist’s daily practice. Therefore, the optimization of post-surgical wound healing is an area of utmost importance and interest. Although low risk, one notable barrier to proper wound healing is surgical site infection.
In an attempt to mitigate this risk and improve surgical outcomes, multiple topical products continue to be used both pre- and postprocedure. Traditionally, this includes both topical antibiotics and antiseptics. However, these products are not without consequence.
The overuse of topical antibiotics as prophylaxis for infection has contributed to increased bacterial resistance, and in fact is no longer recommended by the American Academy of Dermatology in clean post surgical wounds. Topical antiseptics, including chlorhexidine and povidone-iodine, can have a cytotoxic effect on keratinocytes and may actually impede wound healing as a result. In addition, chlorhexidine in particular can produce both otologic and ocular toxic effects when used on the face. Emerging products, such as hypochlorous acid, may be a potential alternative to the more commonly used agents, as it has effective antimicrobial actions and minimal adverse effects. Therefore, the purpose of this review is to highlight several topical products used to optimize post-surgical wound healing and discuss both their efficacy and safety.
J Drugs Dermatol. 2017;16(3):209-212.
Differentiation of Basal Cell Carcinoma Subtypes in Multi-Beam Swept Source Optical Coherence Tomography (MSS-OCT)
Adam Meekings BSc,a Sarah Utz BA,d Martina Ulrich MD,f Amanda Bienenfeld BA,d,e Naveen Nandanan MD,e Juliya Fisher MD,c Gordon McKenzie PhD,b Daniel M. Siegel MD FAAD,c Eleanor Feldman BA,c and Orit Markowitz MD FAADc| |
OBJECTIVES: To identify and describe key features of basal cell carcinoma (BCC) and its subtypes as they present in multi-beam Swept Source – OCT (MSS-OCT), and to correlate those against conventional histopathology.
METHODS: A total of 40 lesions were assessed by MSS-OCT prior to biopsy. 60-slice OCT images of the lesions were obtained and correlated with histology sections taken in the same plane. OCT scans were assessed retrospectively by a panel to determine the OCT criteria for BCC and its subtypes.
RESULTS: The following diagnostic criteria were identified: hyporeflective ovoid structures (40/40), dark halo boundaries (38/40), epidermal thinning (28/40), and collagen compression (14/40). Lesional tissue also showed a destruction of layers when compared to the surrounding normal tissue. In addition to the shared criteria, other subtypes showed distinct diagnostic criteria.
CONCLUSION: With its higher sensitivity, using MSS-OCT allowed for non-invasive, accurate identification of the key diagnostic features of BCC and its subtypes with high correlation to the histopathologic features found with biopsy.
J Drugs Dermatol. 2016;15(5):545-550.
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.
Eileen L. Axibal MD,a Julia D. Kreger MD,a Michael E. Contreras MD,b and Joel L. Cohen MD FAADa,b,c| |
Nina Botto MD and Gary Rogers MD| |
J Drugs Dermatol. 2013;12(5):525-533.
Effect of Midfacial Volume Augmentation With Non Animal Stabilized Hyaluronic Acid on the Nasolabial Fold and Global Aethestic Appearance
Brian S. Biesman MD FACSa and Whitney P. Bowe MDb| |
METHODS: Twenty subjects with moderate midfacial volume loss and prominence of nasolabial folds underwent injection of the midface with Perlane between May and July, 2009. The average volume administered was 3.68 +/- 0.55 ml. Assessments were performed by the injecting physician and subject self-assessment for 6 months following treatment.
RESULTS: 17 of 20 subjects completed all study visits. At the 6-month follow up visit 16 of 17 subjects were found to have clinically significant improvement of the midface and 14 of 17 subjects were found to have clinically significant improvement of the nasolabial folds. No serious adverse events occurred.
CONCLUSION: In this early stage, proof-of-concept trial, the majority of patients treated demonstrated clinically significant, aesthetically pleasing improvement 6 months after injection of Perlane in the midface.
J Drugs Dermatol. 2015;14(9):943-947.
Macrene Alexiades MD PhD| |
Targeted Therapy for Cutaneous Oncology: A Review of Novel Treatment Options for Non-Melanoma Skin Cancer: Part I
Brooke Walls DO,a Laura Jordan MS4,b Lisa Diaz DO PGY1,b and Richard Miller DO FAOCDc| |
J Drugs Dermatol. 2014;13(8):947-952.
Before OR After: Is There a Connection Between the Use of Adjunctive Nonmelanoma Skin Cancer Treatments and Subsequent Invasive Tumors?
Emily Stamell Ruiz MD,a Joel L. Cohen MD,b,c
and Adam Friedman MDd
Effect of Field Treatment of Actinic Keratosis With Ingenol Mebutate Gel on the Identification of Lesions for Biopsy
Miriam S. Bettencourt MD| |
J Drugs Dermatol. 2015;14(8):813-818.
Anthony M. Rossi MD,a,b Brian P. Hibler BS,a and Hillary Johnson-Jahangir MD PhDb| |
J Drugs Dermatol. 2015;14(7):747-749.
Kenneth R. Beer MD FAAD and Michael S. Beer| |
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.
Surgical Corner:A Poliglecaprone 25-Only Approach to Wound Closure:Cosmetic and Financial Advantages
Jesse M. Lewin MD,a Jeremy A. Brauer MD,b and Ariel Ostad MDa| |
J Drugs Dermatol. 2013;12(3):341-342.
Flor A. Mayoral MD| |
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.
Resident Rounds Part III: Case Report: Metastatic Cutaneous Squamous Cell Carcinoma in an African American Female
Jennifer N. Harb MD,a Alexandra L. Owens MD,a Kathryn Mooneyham Potter MD,a Michael Montuno MD,a Reordan O. De Jesus MD,b and Sailesh Konda MDa| |
Joesph F. Sobanko MD,a Jonathan Okman BA MBA,b and Christopher Miller MDa| |
J Drugs Dermatol. 2013;12(suppl 10):s154-s155.
Andrew F. Alexis MD MPH| |
Jessica Gandy BS, Brian Labadie BS, Dina Bierman Farshidi MD, and Christopher Zachary MBBS FRCP| |
BACKGROUND: Actinic keratoses (AKs) are dysplastic lesions of the epidermis that have the potential to progress to non-melanoma skin cancers (NMSC). Traditional photodynamic therapy (PDT) requires a pre-illumination incubation time, which adds to overall in-office time and has been linked to pain. Our group has found a novel protocol to effectively treat AKs with PDT that eliminates the pre-illumination incubation period and uses 2 back-to-back cycles of 16 minute 40 seconds.
METHODS: The patient was prepped with soapy water and isopropyl alcohol, and thick AKs were descaled with a curette. Next, 5-aminolevulinic acid (ALA) was applied to the treatment areas and the patient was immediately placed under the blue light for 33 minutes and 20 seconds (two cycles of 16m/40s).
RESULTS: During therapy, the patient reported no pain. At one week, treated areas revealed a good reaction. The procedure was repeated at one month to treat residual AKs. At a 4-month follow-up, the patient’s face and scalp showed near clearance of any AKs.
CONCLUSION: During PDT, the photosensitizer aminolevulinic acid (ALA), or in Europe methyl aminolevulinate (MAL), is utilized as a synthetic precursor that preferentially accumulates in dysplastic cells. The precursor then converts to PpIX via the heme pathway and causes apoptosis of the cells when excited, most commonly by either blue-violet (400-430 nm) or red (630-635 nm) light. Shorter incubation times are associated with reduced pain because less PpIX will have accumulated in the treated tissue by the start of the exposure to the light. The doubling of the light exposure time allows comparable levels of the photosensitizing molecule to accumulate and be activated so as to produce an equivalent reaction. The associated reduction in pain along with a more convenient treatment schedule makes this PDT protocol more tolerable and convenient to some patients.
J Drugs Dermatol. 2017;16(3):275-278.
A Systematic Review of Lower Lip Anatomy, Mechanics of Local Flaps, and Special Considerations for Lower Lip Reconstruction
Stefanos Boukovalas MD, Alexis L. Boson BS, Joshua P. Hays BS, C. Helen Malone MD, Eric L. Cole MD, and Richard F. Wagner Jr. MD| |
Reconstruction of defects of the lower lip can be very challenging. The aim of this review is to analyze the unique characteristics of lower lip anatomy and provide a systematic approach for lower lip reconstruction. A review of current literature was performed using the PubMed database. Articles analyzing the anatomic and histologic characteristics of the lower lip, mechanics of local faps, and different lower lip recon-struction techniques were included. Articles focused on lower lip reconstruction with free faps were excluded. The orbicularis oris has been described as the main supportive mechanism, however, a number of other structures have been shown to provide mechanical support to the lower lip, including septations of connective tissue extending from the epithelium to the orbicularis oris, a fbroelastic meshwork located in the mentolabial sulcus, and subdermal muscular fbers with dermal terminations in the area of the modiolus. Depending on the location, size, and depth of the wound, a number of reconstruction options are available. Preservation of the competency of orbicularis oris, relation-ship of the modiolus with associated muscles, and sensation, are critical components of functional reconstruction. Primary closure and local faps are assessed for these 3 components and analysis is provided. In conclusion, knowledge of the static and dynamic structural support of the lower lip, as well as the characteristics of different reconstructive options, is imperative for optimal functional and aesthetic outcomes.
J Drugs Dermatol. 2017;16(12):1254-1261.
Elizabeth Foley MD,a Sheila M. Greenlaw MD,a Jason Givan MD,b April Deng MD,c Mary Maloney MD,a David E. Geist, MDa| |
Targeted Therapy for Cutaneous Oncology: A Review of Novel Treatment Options for Non-Melanoma Skin Cancer: Part II
Brooke Walls DO,a Laura Jordan MS4,b Lisa Diaz DO PGY1,b and Richard Miller DO FAOCDc| |
J Drugs Dermatol. 2014;13(8):955-958.
William Levis MD| |
J Drugs Dermatol. 2012;11(1):106-108.
Resident Rounds: Part I - Program Spotlight: The University of Miami/Jackson Memorial Hospital Dermatology Residency Program
Jonathan Weiss MD, Elizabeth L. Nestor MD, Robert S. Kirsner MD PhD, and George W. Elgart MD| |
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.
Katlein França MD MSc,a Joel L. Cohen MD,b and Lisa Grunebaum MDc| |
OBJECTIVE: The objective of this article is to review studies about cosmeceuticals that can be used by people who previously had skin cancer and may work as agents that help in some way to prevent new skin cancer lesions.
CONCLUSION: Cosmeceuticals are antiaging skin products that overlap cosmetics and pharmaceuticals and are commonly available over the counter. This article reviewed several substances used in cosmeceuticals formulations that could be useful for individuals who have had previous skin cancers and need to prevent possible new lesions. Further studies are needed to better evaluate these products and their skin cancer preventive properties.
J Drugs Dermatol. 2013;12(5):516-518.
Laura Schilling MD,a Nazanin Saedi MD,a and Robert Weiss MDb| |
Sameep Kadakia MD, Boris Chernobilsky MD, and Codrin Iacob MD| |
J Drugs Dermatol. 2016;15(10):1270-1272.
Macrene Alexiades-Aremenakas MD PhD| |
Macrene Alexiades MD PhDa,b| |
Heidi A. Waldorf MD| |
The “Benjamin Button” effect inspired by the popular motion picture, is used to describe the goal of achieving a clearly younger and more attractive, yet still natural appearance utilizing noninvasive and minimally invasive therapies and procedures. Due to high patient demand for enhancement and rejuvenation of the face and body with minimal downtime, there is an ever-increasing number of companies developing products and devices, variety of indications, and field of practitioners offering them. Each option, including topicals, injectables, and devices, promises near magical results. Despite that, a brief review of online discussions and media resources reveals both patients complaining of inadequate results and celebrities with extreme appearances. For clinical practitioners, it is critical to understand the art, science, and economics of noninvasive rejuvenation in order to properly evaluate potential patients, set appropriate expectations, develop, and provide an effective noninvasive rejuvenation plan to achieve a true “Benjamin Button” effect for patients.
J Drugs Dermatol. 2017;16(6 Suppl):s74-76.
Fran E. Cook-Bolden MD| |
Danny Vleggaar MD,a Rebecca Fitzgerald MD,b and Z. Paul Lorenc MD FACSc| |
J Drugs Dermatol. 2014;13(suppl 4):s40-s43.
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.
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.
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.
Gary Goldenberg MDa and Omid Hamid MDb| |
C. William Hanke MD MPH FACP| |
Improving Consent Procedures and Evaluation of Treatment Success in Cosmetic Use of IncobotulinumtoxinA: An Assessment of the Treat-to-Goal Approach
Ravi Jandhyala MSc(Lond) MBBS(Lond) MRCS(Glasg) MFPM| |
Objective: To evaluate the TTG approach vs standard consent procedures in terms of patient understanding of the risks and benefits of treatment.
Methods: This study was undertaken in 2 phases among consecutive patients presenting for BoNT-A treatment. Phase 1 consisted of a crossover comparison of patient satisfaction with standard consent vs the TTG approach (n=20). Patient understanding of the likely outcomes and risks associated with treatment following consent and their overall preference were assessed using 10-point visual analog scales (VAS). Phase 2 assigned patients to receive no treatment (n=10) or treatment with BoNT-A (n=54) following consent with the TTG approach. Patients were followed up with 28 days later to assess whether the goals defined during consent had been met.
Results: The TTG approach significantly improved patient understanding of likely outcomes of BoNT-A treatment compared with standard consent (P=.004 when standard consent assessed first, and P=.002 when TTG assessed first). All patients assessed preferred the TTG approach (median VAS score in favor of TTG: 7.0, P<.0001). Target improvements were successfully met or exceeded in at least one treatment area (forehead, glabellar lines, crow's feet) in all patients treated with BoNT-A. In contrast, none of the untreated patients met their target improvements unless the target was defined as no change.
Conclusion: The TTG approach represents a significant improvement over standard consent in terms of the information it provides to patients. Further investigation of this concept is warranted.
J Drugs Dermatol. 2013;12(1):72-78.
Clara Yu DO , Maryam Shahsavari DO , Gloria Stevens MD,Ronald Liskanich DO , David Horowitz DO| |
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.
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.
Rebecca Kleinerman MD, Suzanne L. Kilmer MD, and Vera A. Chotzen MD| |
J Drugs Dermatol. 2013;12(6):701-703.
Response to the Possibility of the Application of Topical Photodynamic Therapy Leading to Development of More Histologically Aggressive Subtypes of Basal Cell Carcinomas
Irene J. Vergilis-Kalner MD and Joel Cohen MD| |
Scott KM Barr MD FRCPC,a Arie Benchetrit MD FRCPC,b Mariusz Sapijaszko MD FRCP,c
and Anneke Andriessen PhDd
OBJECTIVE: A 24-week study evaluated clinical efficacy with HA.
METHODS AND MATERIALS: Included were 15 healthy subjects recruited from 4 centers, between ages of 35 to 65 years, who had a Wrinkle Severity Rating Scale (WSRS) score ≥ 3, indicating moderate volume loss. Revanesse® Ultra (Prollenium), a HA dermal filler, was used. Primary study outcome was physicians scored facial volume correction, using the Global Aesthetic Improvement Scale (GAIS), comparing baseline (day 0) versus 24 weeks (end) and blindly assessed photographs. Subject satisfaction and comfort was evaluated using self-administered questionnaires at day 0 and at week 24.
RESULTS: N = 15, 13 female and 2 males with a mean age (years) of 48.52 ( SD ± 10.46) received treatment with HA and completed the 24-week study. At screening they had a moderate (mean 2.85, SD ± 0.45) WSRS score. At week 24 a market facial volume restoration was shown and no adverse events were reported. All patients reported to be satisfied with the obtained results.
CONCLUSION: Good – excellent volume enhancement was noted almost immediately after the HA injections, improving patient reported quality of life aspects. HA treatment was shown to be safe.
J Drugs Dermatol. 2015;14(1):19-23.
Eric S. Schweiger MDa,b and Lauren Sundick RPA-Ca| |
OBJECTIVE: To evaluate the safety and efficacy of a focal approach to fractional CO2 laser treatment for acne scars, coined “Focal Acne Scar Treatment” or “FAST”
PATIENTS and METHODS: This retrospective case series was conducted at Schweiger Dermatology, in New York, NY, with patients treated from November 2011 through May 2012. Overall, six patients (ages 18 to 48) were treated with the fractional CO2 laser resurfacing, using a so called “FAST” technique treating only the acne scars and leaving normal skin untreated. Evaluation was based on physician and patient assessment of improvement at one week and four weeks post-treatment.
RESULTS: All six patients treated with the Focal Acne Scar Treatment technique of fractional CO2 laser resurfacing had significant improvement post treatment ranging from 40% to 70% as estimated by the treating dermatologist and patient at four weeks post treatment. Patient satisfaction was high following FAST method. Temporary post-inflammatory hyperpigmentation was seen in two patients but resolved after a single 1550 nm Erbium Glass fractional laser treatment.
CONCLUSION: The Focal Acne Scar Treatment technique is an effective method of improving the appearance of atrophic acne scars. Higher energy and density levels can be used when utilizing this technique, resulting in improved outcomes when compared with whole face fractional CO2 laser resurfacing. Healing is improved and faster with this technique and no increased incidence of permanent adverse events were found. More studies are needed to further evaluate this new technique.
J Drugs Dermatol. 2013;12(10):1163-1167.
Kevin C. Randolph,a Robert T. Brodell MD,b,c,d Nancye McCowanb| |
J Drugs Dermatol. 2012;11(9):1069-1079.
Efficacy and Safety of Incobotulinumtoxin A for the Correction of Glabellar Lines Among Patients With Skin Types IV to VI
Brooke A. Jackson MDa and Mark R. Vogel MAb| |
OBJECTIVE: To investigate the efficacy and safety of incobotulinumtoxin A [Xeomin® (XEO)] for the correction of glabellar lines among non-Caucasian patients with Fitzpatrick skin types IV to VI.
METHODS: This open-label, single-center, post-marketing study treated 29 patients with Fitzpatrick skin types IV to VI with moderate to severe glabellar frown lines. Evaluation at day 0 included standardized photographs and patient and investigator assessments. Post evaluation, XEO was administered at 5 intramuscular injection sites with equal aliquots of 4 units per 0.1 mL. Photographs and assessments were repeated at days 30 and 90.
RESULTS: Response to treatment was defined as a 1 or more point improvement in patient and investigator assessments. At day 30, 100% (n = 29; 95 C.I. 0.87, 1.00; P< .001) responded to treatment. At day 90, 69% (n=20; 95% C.I. 0.52, 0.83; P= .42) responded to treatment. The safety profile was similar to previously reported trials with BoNTA.
CONCLUSION: The efficacy and safety of XEO among patients with skin types IV to VI is similar to that among persons with fairer skin.
J Drugs Dermatol. 2015;14(4):350-353.
Derek Ho BSa,b and Jared Jagdeo MD MSa,b,c| |
J Drugs Dermatol. 2015;14(2):199-200.
Kathleen M. Casamiquela BAa and Philip R. Cohen MDa-c| |
J Drugs Dermatol. 2013;12(2):223-226.
Summer D. Moon BS a and James M. Spencer MD MS b| |
J Drugs Dermatol. 2013;12(1):107-108.
Tina Rendini RN and William Levis MD| |
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.
Evan A. Rieder MD,a Euphemia W. Mu MD,a and Jeremy A. Brauer MDa,b,c| |
J Drugs Dermatol. 2015;14(9):1023-1026.
Elephantiasis nostras verrucosa is a rare disorder characterized by dermal fibrosis, hyperkeratotic, verrucous, and papillomatous le- sions that result from both chronic filarial and nonfilarial lymphedema. Various treatment options have been reported for this disease. We present a 64-year-old man with erythrodermic psoriasis and elephantiasis nostras verrucosa in whom the lesions were resolved almost completely after acitretin treatment.
J Drugs Dermatol. 2012;11(3):402-405.
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
Kian Karimi MD FACS and Alexandra Reivitis BA| |
J Drugs Dermatol. 2017;16(9):932-934.
Successful Treatment of Keloid With Fractionated Carbon Dioxide (CO2) Laser and Laser-Assisted Drug Delivery of Triamcinolone Acetonide Ointment in an African-American Man
Ekaterina Kraeva MD,a,b Derek Ho MD,a,b and Jared Jagdeo MD MSa,b,c| |
J Drugs Dermatol. 2017;16(9):925-927.
Suneel Chilukuri MD FAAD FASDS and Gregory Mueller MD FACS| |
Assessing Improvement of Facial Appearance and Quality of Life after Minimally-Invasive Cosmetic Dermatology Procedures Using the FACE-Q Scales
Brian P. Hibler BS, Jonathan Schwitzer MD, and Anthony M. Rossi MD| |
OBJECTIVE: We sought to determine the impact of laser resurfacing and injectable treatment (neurotoxin or fillers) on patient perceived improvement in facial appearance.
METHODS and MATERIALS: Patients were asked to complete FACE-Q scales (Satisfaction with Facial Appearance, Satisfaction with Facial Skin, and Appraisal of Facial Lines) at their pre-procedure consultation and/or at post-procedural follow-up. Item means (range 1-4) and Rasch transformed scores (range 0-100) were compared pre to post-procedure using two sample t-tests. Higher FACE-Q scores indicated greater satisfaction.
RESULTS: Overall, patients experienced a statistically significant improvement in all three scales pre- to post-procedure (P <0.05). Sub-group analysis showed statistically significant improvement in Satisfaction with Facial Appearance and Satisfaction with Facial Skin for both the laser resurfacing group and injectables group with moderate effect sizes. Improvement on Appraisal of Facial Lines trended toward improvement but did not reach statistical significance.
CONCLUSION: Our results support the ability to directly measure and quantify meaningful improvement in appearance among facial cosmetic dermatology patients using FACE-Q scales. Reporting this data is important, as this is the first step towards evidence-based cosmetic procedures in dermatology.
J Drugs Dermatol. 2016;15(1):62-67.
Derek Ho BSa,b and Jared Jagdeo MD MSa,b,c| |
Noah Goldfarb MD,1,2 Kimberly Bohjanen MD,1,3 and Neal A. Foman MD1,3| |
Laurel M. Morton MD,a Kevin C. Smith MD FRCPC,b Jeffrey S. Dover MD FRCPC,a,c,d,e Kenneth A. Arndt MDa,d,e,f| |
J Drugs Dermatol. 2013;12(11):1219-1222.
A Retrospective Comparison Between Preoperative and Postoperative Breslow Depth in Primary Cutaneous Melanoma: How Preoperative Shave Biopsies Affect Surgical Management
Michael Saco MDa,b and Jack Thigpen MD FACSb| |
OBJECTIVE: The current retrospective chart review was performed to determine whether preoperative shave biopsies are acceptable for evaluating lesions suspicious for melanoma and whether shave biopsies lead to underestimation of Breslow depth great enough to require additional surgeries.
METHODS: A consecutive sample of 242 primary cutaneous melanoma cases surgically excised between January 1, 2004 and December 31, 2010 in a private practice setting was analyzed for this study.
RESULTS: Breslow depth underestimation occurred in 8 of 226 shave biopsy cases (3.5%). Differences in preoperative and postoperative Breslow depths in shave biopsy cases were not statistically significant (P=0.48). Underestimation of Breslow depth, melanoma transection, positive deep biopsy margins, and tumor upstaging did not lead to statistically significant changes in surgical management.
CONCLUSIONS: Based on the results from the current study and available literature, the authors posit that preoperative deep excisional shave biopsies performed by dermatologists are accurate for determining Breslow depth and for planning surgical management of melanomas.
J Drugs Dermatol. 2014;13(5):531-536.
Nora K. Shumway MD, Lauren Snitzer MD, Habibollah Alamdari MD, and Kari Martin MD| |
Efficacy of Early Initiation of a Gel Containing Extractum Cepae, Heparin, and Allantoin for Scar Treatment: An Observational, Noninterventional Study of Daily Practice
Gunter H. Willital MDa and Jeannette Simon MDb| |
Aim: To investigate the efficacy of early initiation of Contractubex in the prevention of excessive scarring and promotion of physiological scar formation.
Methods: In total, 1,268 patients were included in this observational, noninterventional study. Patients were assessed at visit 1 (within 3 weeks of the injury), when treatment was initiated, with subsequent assessments after 2 to 3 months of treatment, and at the end of the study (after 4 to 5 months of treatment). Parameters measured included scar size, color, and pliability (consistency/hardness), as well as patients' and physicians' subjective assessments of treatment efficacy and tolerability.
Results: After 2 to 3 months of treatment, there were statistically significant improvements in color and pliability of the scar, sensation of pain, tension, and pruritus compared with visit 1 (P<.0001). By the end of the study, further statistically significant improvements compared with visit 1 were observed for all parameters. Only about 1% of scars were rated as markedly red or markedly hardened at the final visit. In addition, there was a reduction of 31.5% in mean scar width and of 47.8% in mean scar height at the end of the observation period. A high percentage of patients (85.8%) and physicians (86.6%) rated the treatment as good or very good with respect to prevention of excessive scarring and promotion of physiological scar development. Tolerability was described as good or very good by 92.0% of physicians and 91.5% of patients.
Conclusions: The results of this study suggest that the scar gel is effective in preventing excessive scarring and promoting physiological scar formation when treatment is initiated early. In addition, the treatment was well tolerated.
J Drugs Dermatol. 2013;12(1):38-42.
Reversing Facial Fillers: Interactions Between Hyaluronidase and Commercially Available Hyaluronic-Acid Based Fillers
Veena Rao MD,a Sulene Chi MD PhD,a and Julie Woodward MDa,b| |
METHODS: Four commonly used HA fillers were exposed to varying concentrations of Vitrase (ovine testicular hyaluronidase) and Hylenex (human recombinant hyaluronidase) in vitro. The gross properties of these fillers were then observed to evaluate time- and dose-response; photographs were obtained to allow visual comparison at 1 minute and 5 minutes post-exposure.
RESULTS: At a concentration of 0.1 mL Vitrase to 0.2 mL filler, Restylane dissipated most followed by Juvéderm; Belotero most retained its form. Hylenex at the same concentration showed similar results, again affecting Restylane most and Belotero least. Response to treatment with both hyaluronidases increased substantially over time, increasing progressively from exposure to 5 minutes post-exposure. When exposed to Hylenex at 15 U and 30 U to 0.2 mL filler, Belotero retained its form most, followed by Juvéderm, Juvéderm Voluma, and then Restylane. The effects on filler structure increased with 30 U concentration vs 15 U concentration of Hylenex.
DISCUSSION: Available hyaluronidases and HA fillers appear to have differing physical properties that influence their interaction in a time and dose-dependent manner. Knowledge of the ways in which specific fillers interact with different hyaluronidases may help achieve desired cosmesis when aiming to adjust delicate facial fillers.
J Drugs Dermatol. 2014;13(9):1053-1056.
A Randomized, Prospective Trial Evaluating Surgeon Preference in Selection of Absorbable Suture Material
J Drugs Dermatol. 2012;11(2):196-201.
W.Walsh Thomas MDa and Jason D. Bloom MDb| |
J Drugs Dermatol. 2011;10(11):1277-1280.
Lawrence S. Bass MD FACSa and Sean T. Doherty MD FACSb| |
J Drugs Dermatol. 2018;17(1):106-112.
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Surgical Corner: A Prospective Randomized Evaluation of Cyanoacrylate Glue Devices in the Closure of Surgical Wounds
Joseph Maloney BA,a Gary S. Rogers MD,b,c and Mitesh Kapadia MD PhDd| |
OBJECTIVE: To compare the use of two currently marketed medical adhesives; LiquiBand® Flow Control and High Viscosity Dermabond ™ for the topical closure of surgical incisions.
METHODS: In a prospective blinded manner, subjects were randomly assigned LiquiBand® or DermabondTM for topical closure of a surgical incision. Variables compared included ease of use, time taken to close wound, subject and surgeon satisfaction with device and wound closure, cosmetic outcome at 90 days, and complication rates.
RESULTS: Use of both devices resulted in effective wound closure with similar high levels of cosmesis subject and surgeon satisfaction, with only minor complications reported. There was no statistically significant difference between the devices for all the parameters studied, with the exception that the Liquiband device was found to significantly reduce the amount of time required for closure.
CONCLUSION: As the two devices appear substantially equivalent in terms of key surgeon and patient variables, product cost should be the primary determinant in selection of the tissue glue device.
J Drugs Dermatol. 2013;12(7):810-814.
Quantitative & Qualitative Evaluation of the Efficacy of a 1440 nm Nd:YAG Laser With Novel Bi-Directional Optical Fiber in the Treatment of Cellulite as Measured by 3-Dimensional Surface Imaging
Bruce Katz MD| |
OBJECTIVE: To evaluate the safety and efficacy of a single cellulite treatment using an Nd:YAG 1440-nm laser delivered with a special fiber delivery system and temperature control.
METHODS: Women with cellulite on their thighs and buttocks were enrolled in a prospective Institutional Review Board–approved study. Subjects were 15 healthy females of all Fitzpatrick Skin types with cellulite (grades II-III). A single treatment was performed with an average of seven 5 x 5 cm squares treated per leg. Evaluations with 2D and 3D imaging, patient and blinded evaluator scales as well as skin histology were performed at baseline, 3 and 6 months post treatment.
RESULTS: In the 2D photographs, blinded evaluators were able to identify treated photographs versus baseline in 90% of cases and the number of sites with improvement in contour irregularities was 94%. With 3D imaging, the average decrease in skin depressions (dimples) was 49% at 6 months and 66% of patients showed improvement in overall skin contour at 6 months follow-up. Patient and physician satisfaction scores were high and no adverse events were reported.
CONCLUSION: The Nd:YAG 1440 nm laser with a special fiber delivery system produced significant improvement in cellulite with one treatment after 6 months of follow up. There were no adverse events.
J Drugs Dermatol. 2013;12(11):1224-1230.
Background: The non-inflammatory linear verrucous subtype of epidermal nevi (LVEN) although generally benign, can be aestheti-
cally displeasing and functionally disfiguring to patients.
Objective: To provide a permanent improvement in the clinical appearance of LVEN with minimal scarring.
Method: Electroplaning with Surgitron®FFPF EMC was the chosen method of treatment.
Results: Electroplaning is a simple, safe, and effective method for improving the appearance of non-inflammatory linear epidermal nevi.
J Drugs Dermatol. 2012;11(4):474-477.
Safety and Effectiveness of Small and Large Gel-Particle Hyaluronic Acid in the Correction of Perioral Wrinkles
Background: FDA-approved for the correction of moderate-to-severe facial wrinkles and folds, small gel-particle hyaluronic acid (SGP-HA, Restylane,® Medicis Aesthetics, Inc., Scottsdale, AZ) and large gel-particle hyaluronic acid (LGP-HA, Perlane,® Medicis Aesthetics, Inc., Scottsdale, AZ) were studied to evaluate their safety for the correction of oral commissures, marionette lines, upper perioral rhytides and nasolabial folds (NLFs).
Objectives: The primary objective of this study was to investigate the safety of SGP-HA and LGP-HA in treating facial wrinkles and folds around the mouth; the secondary objective was to evaluate the effectiveness of these products.
Methods: This open-label, 4-week study at two US centers evaluated SGP-HA and LGP-HA in patients who intended to undergo intradermal injection for correction of of perioral wrinkles and folds. At screening, a 5-grade Wrinkle Severity Rating Scale (WSRS) was used to evaluate the baseline appearance of bilateral NLFs, and a 6-grade Wrinkle Severity (WS) scale was used to evaluate the appearance of bilateral oral commissures, marionette lines and upper perioral rhytides. To qualify, each patient must have had moderate-to-severe wrinkles at one pair of marionette lines and upper perioral rhytides. Each wrinkle was treated to optimal correction with either SGP-HA or LGP-HA at the discretion of the treating investigator. All reported local and systemic adverse events (AEs) were recorded. At two weeks after treatment or touch-up, the treating investigator and the patient assessed appearance using the Global Aesthetic Improvement Scale (GAIS).
Results: Twenty patients with a mean age of 59.6 years (range 49 to 65 years) were treated with an average of 5.58±1.15 mL of HA for the entire perioral area. Treatment areas included NLFs, marionette lines, oral commissures and perioral rhytides. Eighteen of 20 patients received both SGP-HA and LGP-HA. Product was injected into the mid or deep dermis using primarily linear threading and multiple punctate pools. Patients experienced a total of 66 treatment-emergent AEs (TEAEs); each patient experienced at least one TEAE. The reported events in decreasing order of occurrence were bruising, tenderness, swelling, redness, headache and discomfort. Bruising was more common in the NLFs and marionette lines than in the oral commissures and perioral rhytides. Tenderness occurred more often in the perioral rhytides than in the other areas. The maximum intensity of all TEAEs was considered mild. Most TEAEs resolved within seven days, with an average duration of four days. No serious TEAEs occurred during the study. One hundred percent of GAIS evaluations by both investigators and patients indicated improvement, regardless of filler used or area treated.
Conclusion: Both SGP-HA and LGP-HA were found to be safe and effective for the correction of perioral wrinkles and folds, with few differences among treatment areas Both investigator and patient GAIS evaluations indicated aesthetic improvement after SGP-HA and LGP-HA treatment in the perioral area.
J Drugs Dermatol. 2011;10(9):982-987.
An Evaluation of the Benefits of a Topical Treatment in the Improvement of Photodamaged Hands With Age Spots, Freckles, and/or Discolorations
Michael H. Gold MDa,b and Conor Gallagher PhDc| |
OBJECTIVE: To evaluate the efficacy of a topically applied cream formulated with an alpha-hydroxy acid, depigmenting agents, and antioxidants to improve the appearance of characteristics associated with photodamaged hands.
METHODS: This was a single-site, open-label study of a proprietary topical treatment (Vivité Vibrance Décolleté, Allergan, Inc.) in adult female subjects with moderate-to-severe photoaging of the hands. The treatment was administered to the hands twice daily over an 8-week period. Treatment efficacy was assessed at baseline and weeks 4 and 8 using the Investigator Global Assessment (IGA) score based on the percentage coverage and color depth of photodamaged areas. The severity of age spots, freckles, and hand skin discoloration were also assessed; digital and ultraviolet photography of the hands was performed. Subject-reported assessments of treatment efficacy were evaluated using a questionnaire administered at week 8. Statistical significance was defined with an α set at P≤.05.
RESULTS: Thirty-five subjects were enrolled with a mean age of 55.6 years; 33 subjects completed the study. The IGA of the appearance of hand photodamage improved from a mean (standard deviation) score of 5.0 (0.8) at baseline to 3.1 (1.5) and 2.6 (1.3) at weeks 4 and 8, respectively (1=mild; 9=severe). Based on expert-grader evaluation, subjects demonstrated statistically significant improvements from baseline in IGA at weeks 4 and 8 in age spots and freckling at weeks 4 and 8, (P<.0003) and in skin discolorations at week 8 (P<.05). The majority of subjects reported that they perceived improvements in each of the 9 parameters associated with skin appearance. No adverse events were reported.
CONCLUSIONS: The appearance of age-related hand pigmentation characteristics were significantly improved at 4 and 8 weeks of treatment. Subjects reported post-treatment improvements in other characteristics associated with healthy skin.
J Drugs Dermatol. 2013;12(12):1468-1472.
Deborah S. Sarnoff MD| |
Jonathan M. Sykes MD,a Amir Allak MD MBA,a and Brian Klink MDb| |
Macrene Alexiades-Armenakas MD PhD| |
J Drugs Dermatol. 2011;10(5):494-498.
Recent Trend in the Choice of Fillers and Injection Techniques in Asia: A Questionnaire Study Based on Expert Opinion
Soo-Keun Lee MDa and Hei Sung Kim MDb| |
OBJECTIVE: To evaluate the recent trend in the choice of fillers and injection techniques among leading dermatologists in Asia and offer guidance to those who practice facial fillers.
METHODS: A panel of dermatologists, who are recognized as filler experts and key speakers in Korea were asked to fill out an in-depth questionnaire on fillers in 2012. The results of the 2012 questionnaire are presented and compared with the questionnaire results of the exact same group of doctors in 2011.
RESULTS: Those who participated in the questionnaire study practiced fillers for an average of 10.6 years with an average of 32.8 filler cases per week. Common indications for filler injection were midface augmentation and nose augmentation. Indications that most drastically increased between 2011 and 2012 were midface and forehead augmentation. For the nasolabial folds, the most preferred choice of filler product, needle, injection technique and injection depth was Radiesse®, 27G short needle, Layering technique and the Upper subcutaneous fat layer. For filler rhinoplasty, the preferred choices were Radiesse®, 27G short needle, Linear threading technique and the Mid-deep fatty layer. For dark circles, the favored choices were Esthelis Basic®, 30G short needle, Vertical technique and the SOOF (suborbicularis oculi fat) layer. For forehead augmentation, the most favored choices were Juvederm Voluma®, 23G cannula, Linear threading technique and Fanning and the Supraperiosteal layer. The physicians’ satisfaction score for the nasolabial folds, filler rhinoplasty, dark circles and forehead augmentation was 71.5, 90, 84.5 and 87 respectively.
CONCLUSION: On general, filler experts preferred fillers with relatively high visco-elasticity for the nasolabial folds, nose augmentation and forehead augmentation but chose fillers with low visco-elasticity for dark circles. Linear treading technique (with or without fanning) was universally popular but Vertical injection was considered more useful for dark circles and the nasal tip.
J Drugs Dermatol. 2014;13(1):24-31.
Kenneth R. Beer MD FAAD,a Stephanie Bayers BSBA,b and Jacob Beerc| |
J Drugs Dermatol. 2014;13(suppl 1):s17-s20.
NEWS, VIEWS, & REVIEWS: Memory Age: What It Is, Why It’s Important, and Practical Applications for Medical Aesthetics Practitioners
Lovely Laban MSN GNP-C| |
A recent study by a leading medical aesthetics practice has revealed that women have a “Memory Age” that is about 10 years younger than their actual age. Skin by Lovely (Portland, OR; Santa Monica, CA) asked 350 women ages 30-70 to reveal their Memory Age. Participants were asked to close their eyes, conjure up a mental picture of themselves, and state what age they looked in their minds.
Efficacy and Safety of IncobotulinumtoxinA for the Treatment of Platysmal Bands of the Aging Neck: An Open-Label, Prospective Pilot Study
Elena I. Gubanova MD,a Olga S. Panova MD,b Elena A. Sanchez MD,b
Maria Y. Rodina MD,a and Polina A. Starovatovaa
OBJECTIVE: To determine the efficacy and safety of incobotulinumtoxinA for the treatment of platysmal bands.
METHODS: Women, 35–65 years of age, with platysmal bands scoring 2 or 3 on the validated 5-point Merz dynamic platysmal bands scale received a total of 60 U incobotulinumtoxinA divided between four platysmal bands (20 U in both medial bands and 10 U in both lateral bands). Investigator assessments according to the 5-point scale were made at baseline and from standardized clinical photographs taken at follow-up visits 14±2, 56±7 and 84±7 days after treatment. The global aesthetic improvement scale (GAIS) and a novel questionnaire were used to assess subject treatment satisfaction. Adverse events were recorded.
RESULTS: Twenty-five women (mean age 51.8 years) were included in the study. With a responder defined as a subject with at least a 1-point improvement from baseline on the dynamic platysmal bands scale, the response rate at maximum contraction was 100% at Day 14 as assessed by the investigator. By the same definition, a high response rate (96%) was maintained at maximum contraction at Day 84. Subjects reported that, at Day 84, 86.3% of the maximal effect (defined as the effect on Day 14) persisted. Subject-reported satisfaction was high, as indicated by the self-assessment on the GAIS and results from the subject satisfaction questionnaire. Treatment- related adverse events were mild and reversible.
CONCLUSION: IncobotulinumtoxinA is an effective, well-tolerated treatment for platysmal bands, with a high percentage of the treatment effect maintained at 3 months after treatment. Investigator and subject assessments both indicated high levels of treatment satisfaction.
J Drugs Dermatol. 2013;12(12):1461-1466.
Joshua A. Farhadian,a Bradley S. Bloom,b and Jeremy A. Brauera,b,c| |
J Drugs Dermatol. 2015;14(9):1029-1034.
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.
Expert Consensus on Absorbable Advanced Suspension Technology for Facial Tissue Repositioning and Volume Enhancement
Mark S. Nestor MD PhD,a Glynis Ablon MD,b Anneke Andriessen PhD,c Julius Few MD,d Michael H. Gold MD,e David J. Goldberg MD PhD,f Z. Paul Lorenc MD,g Stephen Mandy MD PhD,h and Susan H. Weinkle MDi| |
BACKGROUND: Signs of facial aging include wrinkles, loss of subcutaneous volume, decreased tone, texture, and sagging of the skin. The objective of this review is to determine whether facial suspension absorbable sutures are a safe and effective modality for facial rejuvenation.
METHOD: A group of US plastic surgeons and dermatologists who practice medical aesthetics convened to review evidence obtained from literature searches and to reach a consensus on clinical practice guidelines for the use of facial absorbable suspension sutures.
RESULTS: Currently, there are different types of lifting sutures available. Absorbable, facial suspension sutures allow for superior repositioning of tissue along a vector line together with the added benefit of volumization of the area. These benefits are for patients who have moderate facial aging and require treatment beyond the use of injectable products only.
CONCLUSIONS: Treatment with absorbable facial suspension sutures, when performed properly, is associated with minor and infrequent complications and offers a beneficial clinical alternative to traditional facial rejuvenation techniques.
J Drugs Dermatol. 2017;16(7):661-666.
A Proposed Method for Upper Eyelid and Infrabrow Tightening Using a Transcutaneous Temperature Controlled Radiofrequency Device With Opaque Plastic Eye Shields
Douglas J. Key MD and Lauren Boudreaux DO| |
David L. Chen MDa and Joel L. Cohen MDb| |
A Randomized Study to Assess the Efficacy of Skin Rejuvenation Therapy in Combination With Neurotoxin and Full Facial Filler Treatments
Steven H. Dayan MD FACS,a,b,c Thuy-Van T. Ho MD,c Jonathan T. Bacos BA,a,d Nimit D. Gandhi MD,a Arjun Kalbag PhD,a Selika Gutierrez-Borst MS RNa,b| |
BACKGROUND: Although non-surgical treatment options for facial rejuvenation are well-established, the literature remains limited regarding the combined effect of topical skin treatment with filler and neurotoxin on patient appearance and satisfaction. The objectives of this study were to assess the impact of a skin rejuvenation therapy in combination with neurotoxin or hyaluronic acid filler injection on skin quality and general aesthetic improvement as well as on short-term self-esteem.
METHODS: From 2015 to 2017, 20 female patients were enrolled in our study and were randomized into two groups. Patients in Group A used a basic skin care regimen following hyaluronic acid filler and neurotoxin treatment, while those in Group B utilized the Nu-Derm® skin care system (Obagi Medical Products, Inc) afterwards. Each subject and the principal investigator filled out various assessments pre- and post-treatment to evaluate for change in skin quality (Fitzpatrick Wrinkle Assessment Scale [FWAS] and Skin Quality Assessments [SQA]), aesthetic appearance (Global Aesthetic Improvement Scale [GAIS]), patient satisfaction (Subject Satisfaction Assessment [SSA]), and self-esteem (State Self-Esteem Scale [SSES]).
RESULTS: Subjects in both treatment groups demonstrated significant improvement in skin quality, as illustrated in the change in FWAS and SQA scores, at 12 weeks after initiating full facial rejuvenation treatment. However, there were no significant differences in FWAS and SQA ratings between the treatment groups. Regarding aesthetic appearance, a statistically significant difference in GAIS scores between Groups A and B was observed at 6 weeks after treatment only. In evaluating for patient satisfaction and self-esteem, there were no significant differences in SSA and SSES ratings over time within each treatment group or between the treatment groups.
CONCLUSIONS: Our study confirms that facial rejuvenation therapy involving hyaluronic acid filler and neurotoxin injections combined with a topical skin treatment regimen leads to improvement in skin quality and aesthetic appearance as well as to patient satisfaction. Additional larger studies are needed to better delineate the most ideal combination facial rejuvenation therapy for optimizing patient appearance and satisfaction.
J Drugs Dermatol. 2018;17(1):48-54.
Hema Sundaram MD FAAD| |
Gary D. Monheit, MD| |
Steven H. Dayan MD FACS,a,b,c Katherine Cho MPH,a,c Mary Siracusa BS,a,c and Selika Gutierrez-Borst MS RNa,c| |
MATERIALS AND METHODS: Twenty-seven women were recruited in order to examine the effects of cosmetic make-up on first impressions. The photographs of individual subjects wearing the control cosmetics, their own make-up, and no make-up were randomly assigned to three binders (A, B, and C). Three hundred evaluators participated (100 evaluators per book) and completed a 10-point First Impression Scale for each of the 27 photos in their binder.
RESULTS: Statistical analysis of the collected data was conducted in SPSS using two-tailed t-tests to determine the statistical significance of the differences between first impressions of Own Make-up vs No Make-up, No Make-up vs Control Make-up, and Own Makeup vs Control Make-up. There was a significant difference in improvement in all pairings across all 8 categories in the First Impressions questionnaire particularly in perceived age between own make-up, no make-up, control make-up (41, 42, 38; P<0.001).
DISCUSSION: Our study evaluated the first impressions, age perception, self-esteem, and the quality of life impact that cosmetic makeup has on women’s appearance and confidence. Subjects wearing cosmetic make-up appeared 4 years younger than those wearing no make-up. And the control cosmetic make-up subjects on average projected a 37% better first impression than subjects wearing no make-up. We objectively quantified and qualified the benefits of applying cosmetic make-up. Make-up can reduce the perceived age, improve the first impression projected and increase the self-esteem of those who apply it.
J Drugs Dermatol. 2015;14(4):366-374.
Hema Sundaram, MD, FAAD| |
Ralph Fiore II DO, Sarah M. Coffman DO MSc, and Richard Miller DO| |
J Drugs Dermatol. 2013;12(3):353-357.
Emily Stamell Ruiz MD,a Amber Ingram BS,b Angelo Landriscina BA,b Jiaying Tian MD MPH,b Robert S. Kirsner MD PhD,c and Adam Friedman MDb,d| |
OBJECTIVES: To identify United States (US) dermatology residents’ impressions regarding their preparedness to care for wounds, and to assess the amount and type of training devoted to wound care during residency.
DESIGN, SETTING, AND PARTICIPANTS: An online survey among current US dermatology residents enrolled in a residency training program.
MAIN OUTCOMES AND MEASURES: The primary goal was to determine whether dermatology residents believe more wound care education is needed, evaluate preparedness to care for wounds, and identify future plans to manage wounds.
RESULTS: Responses were received from 175 of 517 (33.8%) US Dermatology residents contacted. The majority of residents did not feel prepared to manage acute (78.3%) and chronic (84.6%) wounds. Over three quarters (77.1%) felt that more education is needed. Fewer than half (49.1% and 35.4%) of residents planned to care for acute and chronic wounds, respectively, when in practice.
CONCLUSIONS AND RELEVANCE: There is a gap in wound care education in US dermatology residency training. This translates to a low percentage of dermatology residents planning to care for wounds in future practice. Dermatology residents need to receive focused wound care training in order to translate the underpinnings of wound healing biology and ultimately better serve patients.
J Drugs Dermatol. 2015;14(7):716-720.
Changes in Self-Perceptions of Photoaging Severity and Skin Cancer Risk After Objective Facial Skin Quality Analysis
Yoon-Soo Cindy Bae MD,a,b Edward Jong Bae BA,b Joyce H. Wang MD,b and Barbara A. Gilchrest MDb| |
Background: Despite public education efforts, many people at risk for skin cancer do not practice safe sun behaviors.
Objective: To determine whether machine-based evaluation of UV-induced alterations (VISIA scan) changes self-assessment of facial photoaging, skin cancer risk, and willingness to improve sun protective habits. In addition, to determine whether VISIA scan analysis reveals differences between those with versus without a history of skin cancer, men versus women, those older than 50 versus less than 50 years of age, and Fitzpatrick skin types I-III versus IV-VI.
Methods: Volunteers attending a health expo were recruited and queried about their perceived risk of skin cancer and degree of skin photoaging. All participants underwent facial skin quality analysis of both sides of the face, and then completed a follow-up survey.
Results: Participants’ scored self-perceptions of overall skin aging were all statistically significantly worse after VISIA scan analysis. There was no change in perceived skin cancer risk, but most participants expressed intent to improve their sun protection habits.
Limitations: Limitations to this study include selection bias, recall-misclassification bias, and social desirability bias.
Conclusion: Intervention with facial skin analysis can positively affect subjects’ stated intent to use sun protection, indicating the importance of appearance in these health decisions.
J Drugs Dermatol. 2017;16(5):453-459.
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.
Comparative Study of the Efficacy and Tolerability of a Unique Topical Scar Product vs White Petrolatum Following Shave Biopsies
Leon H. Kircik MD| |
The principles underlying scar formation are now better understood. Products are being developed to address those critical components of the wound-healing process, namely inflammation, hydration, and collagen maturation. A multicomponent scar product was previously shown effective in preventing exaggerated scarring in patients undergoing various surgical procedures. The present outpatient study was conducted in patients undergoing shave biopsies. Following reepithelialization, this investigator-blinded, randomized, 8-week trial compared twice-daily application of either the scar product or the standard of care, white petrolatum. Evaluation visits were conducted at baseline and at weeks, 1, 2, 4 and 8. Subjects were evaluated by the blinded investigator for clinical efficacy and tolerability using grading scales. Standardized digital photographs were taken at each visit, and subjects completed a self-assessment questionnaire regarding treatment effectiveness and satisfaction. Twenty-eight subjects completed the 8-week study. The scar product provided earlier improvements than the white petrolatum. At week 1, 70% of subjects receiving the scar product demonstrated at least 50% global improvement in scar appearance vs only 42% of the subjects receiving white petrolatum. The more rapid improvement was accompanied by greater reductions in stinging/burning and itching with the scar product at all visits. Importantly, there was also greater subject satisfaction with the scar product at all visits. This scar product may be useful in hastening the healing of cutaneous shave biopsies and reducing the stinging/burning and itching associated with the normal healing process.
J Drugs Dermatol. 2013;12(1):86-90.
Leopoldo Duailibe Nogueira Santos MD and Jerry Shapiro MD FRCPC| |
News, Views, and Reviews. Valeant Pharmaceuticals Latest Investment: The Fight Against Domestic Violence
Ryan Weldon, Valeant Pharmaceuticals Executive Vice President & Company Group Chairman| |
Jean Carruthers MD FRCSC FRC (OPHTH)a and Alastair Carruthers MD MRCP FRCPCb| |
J Drugs Dermatol. 2014;13(suppl 1):s7-s11.
The Prophylactic Use of a Topical Scar Gel Containing Extract of Allium Cepae, Allantoin, and Heparin Improves Symptoms and Appearance of Cesarean-Section Scars Compared With Untreated Scars
Jorge Ocampo-Candiani MD,a Osvaldo T. Vázquez-Martínez MD,a José Luis Iglesias Benavides MD,b Kristin Buske MD,c Annette Lehn,d and Clemens Acker MDd| |
OBJECTIVE: To investigate the efficacy of the topical scar gel, Contractubex, in the early treatment of C-section scars.
MATERIALS & METHODS: A total of 61 females, aged ≥18 years, who had given birth by elective C-section for the first time within the last 5–10 days, were included in this prospective, randomized, single-center study. Patients were advised to apply the topical scar gel twice daily (treatment group), or received no treatment (control group). Efficacy was evaluated at 6 and 12 weeks after a baseline visit using the Patient and Observer Scar Assessment Scale (POSAS), a validated scar assessment tool comprised of a Patient Scale and an Observer Scale.
RESULTS: Analysis revealed a significant change in the POSAS Patient Scale total score, with a 14.2% improvement in the treatment group compared with a decline of similar magnitude (−14.8%) in the control group at week 6. Significant improvements were also seen for POSAS Patient Scale sub-items in the treatment group compared with the control group for scar color (13.6% vs −18.5%, respectively, P=0.0284), stiffness (12.5% vs −34.6%, respectively, P=0.0029), and irregularity (29.4% vs −46.2%, respectively, P=0.0140) after 6 weeks of treatment. No significant changes were observed for the POSAS Observer Scale total score or its subitems after treatment with the topical scar gel, although there was a strong overall trend in favor of the treatment group. No significant adverse events were observed during the study.
CONCLUSION: Contractubex represents an efficacious and well-tolerated preventative treatment that rapidly and significantly improves the color, stiffness and irregularity of C-section scars.
J Drugs Dermatol. 2014;13(1):176-182.
Ana Rita Rodrigues-Barata MD and Francisco M. Camacho-Martínez MD| |
OBJECTIVE: To evaluate the type and management of undesirable effects of nonanimal reticulated or stabilized HA observed in our cosmetic unit in the past 3 years.
MATERIALS and METHODS: The consecutive patients using HA attending to our clinic in the past 3 years were divided into 3 categories, according to the time of presentation of the adverse reactions: immediate, early, and late-onset complications. All patients were treated.
RESULTS: Twenty-three patients presented to our clinic complaining of complications after soft tissue augmentation with HA. Ten patients presented immediate-onset complications, 8 showed early-onset complications, and 5 cases complaint of late-onset complications. Treatment of the first group consisted of hyaluronidase injection, massage, and topical antibiotics. Early- and late-onset complications were treated with intralesional triamcinolone acetonide. All patients improved, with the exception of a woman with recurrent granulomas.
CONCLUSION: Generally, undesirable effects of HA (immediate, early, or late onset) are not frequent, and when present, they improve if treated properly. Physicians need to be aware of these possible adverse events in order to establish proper treatment and prevent scarring or other sequelae.
J Drugs Dermatol. 2013;12(4):e59-e62.
Stefanie Luebberding PhDa and Macrene Alexiades-Armenakas MD PhDa,b| |
In October 2013 the FDA approved for the first time ever an injectable dermal filler for the augmentation of age-related volume loss. This low-molecular-weight (LMW) 20mg/ml hyaluronic acid (HA) filler competes on the market with poly-L-lactic acid (PLLA) and calcium hydroxylapatite (CaHA), that have been used off-label for many years to restore age-related volume loss. The safety profile and efficacy of all three injectables has been intensively evaluated in innumerous clinical studies. However, each volume filler has its benefits and disadvantages, including usage, method of action and duration of effect that are reviewed in this article.
J Drugs Dermatol. 2013;12(12):1339-1344.
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.
Terrence Keaney MD| |
J Drugs Dermatol. 2015;14(9):1036-1040.
Treatment of Hidradenitis Suppurativa by Photodynamic Therapy With Aminolevulinic Acid: Preliminary Results
Eric S. Schweiger MD,a Christy C. Riddle MD,b Daniel J. Aires MDb| |
Background: The current standard of care for hidradenitis suppurativa (HS) includes antibiotics (oral/topical), retinoids (oral/topical)
and intralesional steroids and is unsatisfactory. Photodynamic therapy (PDT) with 20% 5-aminolevulinic acid (ALA) has been used
"off label" to treat acne vulgaris and may hold promise as a therapy for HS. This open-label, non-blinded study investigated the efficacy
and safety of ALA PDT for the treatment of HS using two blue light sources and intense pulsed light (IPL) for photoactivation.
Methods: Twelve subjects with active HS enrolled to undergo ALA PDT once weekly for four weeks with follow-up visits 4, 8, and 12 or more weeks later. Nine subjects completed the study through the week 8 follow-up visit. Lesions were counted at each treatment visit at week 4, week 8 and at the final week.
Results: Mean lesion counts were 11.25 at baseline, 6.5 at 4 weeks (50.8% reduction), and 7.5 at 8 weeks (29.9% reduction). Mean Global Severity Scores were 2.2 at baseline, 1.5 at 4 weeks, and 1.8 at 8 weeks. Mean DLQI scores were 17.3 at baseline, 13.1 at 4 weeks (27.2% improvement), 14.00 at 8 weeks (19.3% improvement) and 14.0 (19.3% improvement) at the final week (16-62 weeks). Three subjects (25%) had complete clearance and no active lesions 4 weeks after the final treatment. Treatments were more tolerable for subjects treated with blue light than with IPL.
Conclusion: ALA PDT may be a safe and effective treatment of hidradenitis suppurativa.
J Drugs Dermatol. 2011;10(4):381-386.
Safety and Efficacy of a Cohesive Polydensified Matrix Hyaluronic Acid for the Correction of Infraorbital Hollow: An Observational Study With Results at 40 Weeks
Oscar Hevia MD,a,b Bernard H. Cohen MD,b,c and David J. Howell PhDd| |
OBJECTIVE: The objective of this study was to determine the safety and efficacy of the latest hyaluronic acid filler, created with a cohesive polydensified matrix, with a low elasticity and viscosity, for infraorbital hollows correction.
METHODS AND MATERIALS: Subjects (49) with at least a grade 2 Merz infraorbital hollow scale in the Validated Assessment Scales for the mid face (0-4) of the right and/or left side were photographed and treated at baseline, and with a touch up treatment after 2 weeks if necessary. Subjects were also photographed at 2, 6, and 10 months after baseline, with optional retreatment at 6 months. The photographs were graded by a blinded sub-investigator.
RESULTS: Mean hollowness scores for both eyes, either individually or combined, at 2, 6, and 10 months were considerably improved compared to baseline (P <.001). No serious adverse events were reported. Of the 46 subjects completing the study, 31 (66%) did not request retreatment after 6 months. At 10 months, 27/31 (87%) still exhibited a hollowness improvement of at least 1-point from baseline.
CONCLUSION: Belotero Balance was safe and effective for the correction of infraorbital hollows.
J Drugs Dermatol. 2014;13(9):1030-1036.
The Need for Consensus Recommendations on the Use of Injectable Poly-L-LacticAcid for Facial and Nonfacial Volumization
Danny Vleggaar MD, Rebecca Fitzgerald MD, and Z. Paul Lorenc MD FACS| |
Clinical Assessment of Immediate and Long-Term Effects of a Two-Step Topical Hyaluronic Acid Lip Treatment
Elizabeth T. Makino BS CCRA MBA,a Priscilla Tan BA,a Kun Qian MD,b Michael Babcock MD FAAD,b and Rahul C. Mehta PhDa| |
Key features of lip aging include loss of volume, color, and definition as well as increases in lines/wrinkles and uneven skin texture. A single-center, open-label clinical study was conducted to assess the efficacy and tolerability of a novel, topical two-step lip treatment (HA5 LS) in female subjects presenting with mild to moderate lip dryness and mild to severe lip condition. Subjects were instructed to apply HA5 LS at least three times a day to ensure coverage 8 hours a day for four weeks. Clinical assessments for efficacy and tolerability were conducted at baseline, baseline post-application, week 2, and week 4. Standardized digital photography, subject self-assessment questionnaires, and instrumentation measurements for skin hydration (corneometer) and lip plumpness (digital caliper) were also conducted. Thirty-six female subjects aged 22-40 years enrolled in the study. HA5 LS provided instant and long term effects, achieving significant improvements in all clinical grading parameters including lip texture, color, definition/contour, scaling, cupping, lines/wrinkles, lip plumpness, and overall lip condition from baseline post-application to week 4 (all P less than equal to .001; Wilcoxon signed-rank test). Instrumentation measurements for hydration and digital caliper at weeks 2 and 4 were also significant (all P less than equal to .032; paired t-test). HA5 LS was also well-tolerated and highly-rated by subjects throughout the study duration. Results from this study suggest that HA5 LS addresses the key features of lip aging, providing both instant and long-term benefits.
J Drugs Dermatol. 2017;16(4):366-371.
Babu Singh MD,a Terrence Keaney MD,b and Anthony M. Rossi MDc,d| |
J Drugs Dermatol. 2015;14(9):1052-1059.
Dramatic Clearance of HIV-Associated Bowenoid Papulosis Using Combined Oral Acitretin and Topical 5% Imiquimod
Joel Hua-Liang Lim MRCP,a Kar-Seng Lim MRCP,b and Wei-Sheng Chong FRCPc| |
Megasessions: Efficacy of Fewer, Longer Treatment Sessions for Fat Reduction in Noninvasive Body Contouring Using a Radiofrequency Based Device
Diane Duncan MD FACS| |
While the field of noninvasive body contouring is booming, many patients still note a lesser result than they might achieve with a single session of liposuction or dermolipectomy. The duration of a noninvasive fat reduction treatment series can be daunting. Patients have questioned the worth of these procedures when the expected benefit is modest and the time they devote to the project is significant. An eight-patient mini-study was performed to see if two or three “megasessions” could be substituted for eight weekly sessions of bipolar radiofrequency based fat reduction treatments. Patients were randomized into a two session or three session group by drawing straws. The device used was the BodyFX bipolar RF device by InMode. This device employs a suction coupled vacuum that heats a section of skin and soft tissue in the treatment region and delivers a high voltage pulse. Each patient was treated for 2 hours per session, using the Body FX, more superficial Mini FX, and the Deep FX device in an effort to treat on a multilevel basis. Preoperative 2D and 3D Vectra photos were taken, and were repeated at 1 month and 3 months post-treatment. Volumetric analysis and patient assessment showed similar results with a two or three treatment “megasession” protocol when compared with the traditional protocol of eight weekly sessions. While the cohort number was not statistically significant, the photographs and measurements are compelling enough to warrant further investigation into this treatment protocol.
J Drugs Dermatol. 2017;16(5):478-480.
Stabilized Hyaluronic Acid-based Gel of Non-animal Origin for Skin Rejuvenation: Face, Hand, and Decolletage
Meike Streker MD, Tilmann Reuther MD, Nils Krueger MD PhD, and Martina Kerscher MD| |
OBJECTIVE: To assess the efficacy and safety of a stabilized HA-based gel of non-animal origin manufactured using the patented NASHA® technology (Restylane® Vital Light, Q-Med AB, Uppsala, Sweden) administered using a pre-filled micropuncture injector device for rejuvenation of the skin.
METHODS: Three treatment sessions 4 weeks apart were performed on one side of the face, the dorsum of one of the hands and one side of the decolletage, leaving the other side untreated. Skin quality was assessed via blinded live evaluation and subject satisfaction by questionnaire. Aesthetic change was evaluated independently by the subject and a blinded evaluator. Subjects were followed up to week 36.
RESULTS: Thirty subjects aged 40–65 years were enrolled. Overall skin quality across all three treatment areas was judged to be improved on the treated side in over 80% of subjects throughout the study. Significant aesthetic improvements on the treated sides were observed at all visits, with the exception of the decolletage at week 36.
CONCLUSIONS: This was the first study that used a micropuncture injector device for injection of NASHA gel, and reveals that this is a promising treatment option for rejuvenation of the skin.
J Drugs Dermatol. 2013;12(9):990-994.
A Randomized, Split-Face, Histomorphologic Study Comparing a Volumetric Calcium Hydroxylapatite and a Hyaluronic Acid-Based Dermal Filler
Yana Yutskovskaya MD,a Evgenjia Kogan MD,b and Eugene Leshunov MDa| |
OBJECTIVE: To compare neocollagenesis and elastin production stimulated by Radiesse® (calcium hydroxylapatite; CaHA, Merz Pharmaceuticals GmbH) and a hyaluronic acid-based filler (HA; Juvéderm® VOLUMA®).
METHODS: Twenty-four women, aged 35–45, participated in this split-face, comparative study. Punch biopsies were taken 4 and 9 months after supraperiostal injection of each filler into the ipsilateral or contralateral postauricular area. Samples were analyzed for collagens type I and III, elastin, Ki-67, and inflammatory and angiogenic markers.
RESULTS: At month 4, collagen type III was greater with CaHA vs HA (P=0.0052). By month 9, type I staining was higher with CaHA vs HA (P=0.0135), whereas type III was lower with CaHA than HA (P=0.0019). Staining for elastin, Ki-67 and angiogenesis was greatest with CaHA at both timepoints. Inflammatory markers increased most with HA treatment.
CONCLUSIONS: CaHA resulted in more active, physiologic remodeling of the extracellular matrix than HA by stimulating a two-step process whereby collagen type I gradually replaced type III. Increased elastin stimulated by CaHA also indicates active remodeling. The results of this study suggest that, in the first 9 months after treatment, by reconstituting tissue homeostasis without inducing inflammation suggests CaHA has more desirable characteristics for a dermal filler than HA.
J Drugs Dermatol. 2014;13(9):1047-1052.
Efficacy and Safety of IncobotulinumtoxinA in Asian Subjects: A Pooled Analysis of Clinical Trials in the Treatment of Glabellar Frown Lines
Kyle Seo MD PhD,a,b Tsen-Fang Tsai MD,c Yates Yen-Yu Chao MD,d Greg J. Goodman FACDe,f| |
METHODS: Efficacy data were pooled from several Phase II/III trials that used 20 U incobotulinumtoxinA to treat glabellar frown lines in Asian subjects. The variable of interest was investigator-assessed improvement in scores on the 4-point Facial Wrinkle Scale from baseline to days 30, 60, 90, and 120. Subjects with a 1-point improvement were considered ‘responders’. Data were also assessed for treatment-emergent adverse events, treatment-emergent serious adverse events, and adverse events of special interest among a pool of incobotulinumtoxinA safety studies.
RESULTS: Four trials were pooled, comprising 19 Asian and 563 non-Asian subjects. At maximum frown on day 30, 100% of Asians and 87% of non-Asians were responders; by day 120, values were 37% and 40%, respectively. At rest on day 30, 63% of Asians and 56% of non-Asians were responders. Corresponding values for day 120 were 11% and 25%. The mean change in score on the Facial Wrinkle Scale from baseline over time was similar in both groups. Very few adverse events occurred. Overall, treatment-emergent adverse events were lower amongst Asians than non-Asians.
CONCLUSIONS: Compared with non-Asians, a trend towards slightly higher responses was observed in Asians at maximum frown. There were no clinically relevant differences in the safety of incobotulinumtoxinA when administered to Asian and non-Asian subjects.
J Drugs Dermatol. 2016;15(9):1084-1087.
Adalimumab Treatment in Women With Moderate-to-Severe Hidradenitis Suppurativa from the Placebo-Controlled Portion of a Phase 2, Randomized, Double-Blind Study
Alice Gottlieb MD PhD,a Alan Menter MD,b April Armstrong MD,c Christopher Ocampo MD,d Yihua Gu MS,d and Henrique D. Teixeira PhDd| |
J Drugs Dermatol. 2016;15(10):1192-1196.
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| |
Communication Concepts for Prevention and Early Intervention in Aesthetic Medicine: Consensus and Literature Review
Uliana Gout MD,a Chytra V. Anand MD,b Andre Braz MD,c Yates Yen Yu Chao MD,d Sabrina Guillen Fabi MD FAAD FAACS,e Martina Kerscher MD PhD,f Marina Landau MD,g Tatjana Pavicic MD,h Peter Hsien Li Peng MD,i Berthold Rzany MD ScM,j Gerhard Sattler MD,k Tunk Tiryaki MD,l Heidi A. Waldorf MD,m and Thierry Besins MDn| |
J Drugs Dermatol. 2017;16(9):859-864.
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.
Derek Ho BSa and Jared Jagdeo MD MSa,b,c| |
OBJECTIVE: We sought to systematically review clinical studies and expert opinions of this 20 mg/ml HA dermal filler and to provide evidence-based recommendations and expert opinions.
METHODS AND MATERIALS: A search of the computerized bibliographic databases Medline, Embase, Embal, Biosis, SciSearch, Pascal, HCAPlus, IPA, and Dissertation Abstracts was performed on August 18th 2014.
RESULTS: Thirteen articles met inclusion and were included in our review: clinical trials with this 20 mg/ml HA dermal filler (10) and expert opinions and questionnaire survey studies of experts (3). This 20 mg/ml HA dermal filler has shown consistent, favorable results for treatment of age-related facial volume loss, aesthetic enhancement, and HIV facial lipoatrophy.
CONCLUSION: HA fillers are safe and effective with minimal recovery time and complications. Future studies with longer follow-up period and use of this 20 mg/ml HA dermal filler on areas other than midface may provide additional efficacy and safety outcomes.
J Drugs Dermatol. 2015;14(9):934-940.
"Deep Heating” Noninvasive Skin Tightening Devices: Review of Effectiveness and Patient Satisfaction
Suneel Chilukuri MD FAAD FASDSa and Jason Lupton MDb| |
Non-surgical aesthetic devices intended for treatment of lax and loose skin have gained popularity due to their ability to non-invasively improve patient’s aesthetic condition and its low side effect profle. This study is intended to review available peer reviewed literature about Ultherapy, ThermaCool, and Exilis Ultra 360 non-invasive skin tightening devices to compare their treatment effcacy and patient subjective satisfaction.
J Drugs Dermatol. 2017;16(12):1262-1266.
Christine S. Ahn BA,a Rosa Mateus MD,b Irfan Khan BA,c Babar K. Rao MDb,d| |
J Drugs Dermatol. 2013;12(12):1477-1480.
Steven H. Dayan MD FACS,a,b John P. Arkins BS,c Clyde C. Mathison MDd| |
Background: As the number of soft tissue filler injections increases, the number of adverse events associated with injection may rise. Impending necrosis represents a serious complication that, if not treated correctly and timely, may have grave consequences.
Objective: We describe a protocol utilizing hyaluronidase, nitroglycerin paste, aspirin, antacid and a topical oxygen therapy that may be used to treat impending necrosis subsequent to injection with soft tissue fillers.
Conclusion: We have successfully treated nine post-filler injection adverse events involving impending necrosis or necrosis following both hyaluronic acid and calcium hydroxylapatite injections using our protocol.
J Drugs Dermatol. 2011;10(9):1007-1012.
Anh N. Tran MSa,b and John Y. Koo MDa| |
J Drugs Dermatol. 2014;13(9):1118-1122.
Shanna Spring MD and Ilona J. Frieden MD| |
Terrence C. Keaney MD FAAD,a,* Robert Anolik MD,b André Braz MD,c Michael Eidelman MD,d Joseph A. Eviatar MD FACS,e Jeremy B. Green MD FAAD,f Derek H. Jones MD,g Vic A. Narurkar MD,h Anthony M. Rossi MD FAAD,i and Conor J. Gallagher PhDj| |
BACKGROUND: The number of nonsurgical aesthetic procedures performed in men is growing rapidly. However, there are limited data on treatment principles and goals for the male aesthetic patient.
OBJECTIVE: To review the objective data available on male aging and aesthetics and to synthesize with expert opinion on treatment considerations specific to male patients.
METHODS: Expert advisors met to discuss anatomical differences in male versus female facial anatomy related to aging, facial treatment preferences in aesthetically oriented men, and current dosing data for facial injectable treatments in male versus female patients.
RESULTS: Symmetry, averageness, sexual dimorphism, and youthfulness are generally accepted as factors that contribute to the perception of attractiveness. There are differences between men and women in facial anatomy, concepts of attractiveness in the context of masculinity and femininity, and treatment objectives. A communication gap exists for men, as evidenced by the lack of information available online or by word of mouth about injectable treatments.
CONCLUSIONS: Approaches to aesthetic consultation and treatment should differ between men and women based on the fundamental dissimilarities between the sexes. Educating men about available aesthetic treatments and about the safety and side effects associated with each treatment, as well as addressing concerns about their treatment results looking natural, are key considerations.
J Drugs Dermatol. 2018;17(1):19-28.
Treatment of Actinic Cheilitis by Photodynamic Therapy With 5-Aminolevulinic Acid and Blue Light Activation
Martin Zaiac MD and Annabelle Clement MMS PA-C| |
J Drugs Dermatol. 2011;10(11):1240-1245.
J Drugs Dermatol. 2012;11(7):879-880.
Oregano Extract Ointment for Wound Healing: A Randomized, Double-Blind, Petrolatum-Controlled Study Evaluating Efficacy
Jennifer Ragi MD,a Amy Pappert MD,a Babar Rao MD,a Daphna Havkin-Frenkel PhD,b Sandy Milgraum MDa| |
Background: Wound healing is a dynamic and complex process affected by tissue hydration, the presence of bacteria, inflammation, and other variables. Oregano has potent antibacterial, antifungal, antioxidant, and anti-inflammatory properties. Studies of oregano ointment
on wound healing are lacking.
Objective: To determine the efficacy of 3% oregano extract ointment on wound healing.
Methods: An investigator initiated, randomized, double-blind, petrolatum-controlled study was performed to determine the effects of oregano ointment on wound healing. Forty patients who underwent surgical excision were enrolled and randomized. Cultures were obtained on day 12 and scars were evaluated using the Patient and Observer Scar Assessment tool on day 12, 45, and 90.
Results: The oregano ointment group had 19 percent of cultures test positive for Staphlococcus aureus compared to 41 percent in the petrolatum group. One patient in the oregano ointment group developed a cellulitis compared to three patients in the petrolatum group. The oregano group had a statistically significant improvement over petrolatum in scar color, pigmentation, and pliability.
Conclusion: Oregano extract ointment decreased bacterial contamination and subsequent infection on post-surgical wounds and had equivalent overall scar appearance compared to petrolatum.
J Drugs Dermatol. 2011;10(10):1168-1172.
Consensus Recommendations on the Use of Injectable Poly-L-Lactic Acid for Facial and Nonfacial Volumization
Danny Vleggaar MD,a Rebecca Fitzgerald MD,b Z. Paul Lorenc MD FACS,c J. Todd Andrews MD,d Kimberly Butterwick MD,e Jody Comstock MD,f C. William Hanke MD,g T. Gerald O’Daniel MD FACS,h Melanie D. Palm MD MBA,i Wendy E. Roberts MD,j Neil Sadick MD,k and Craig F. Teller MDl| |
J Drugs Dermatol. 2014;13(suppl 4):s44-s51.
Evaluation of a New Adipocytolytic Solution: Adverse Effects and Their Relationship With the Number of Vials Injected
Hernán Pinto MD,a Carlota Hernández MD,b Cinara Turra MD,c Marisa Manzano MD,d
Laura Salvador MD,d Paloma Tejero MDe
J Drugs Dermatol. 2014;13(12):1451-1455.
Douglas J. Key MD| |
METHODS: Subjects (n=14) presenting with abdominal laxity were treated up to four times using the transcutaneous monopolar RF device at one or two zones in the abdominal region (at operator’s discretion). Non-expert blinded graders rated correction on an arbitrary scale (0=no laxity, 4=maximum laxity) after choosing the order of the before-and-after photo sets. A patient satisfaction survey was also administered.
RESULTS AND DISCUSSION: The two graders correctly ordered 10 of 14 photo sets in agreement. Average rated improvement was 0.75 and 0.80 for graders 1 and 2, respectively. Patient survey results revealed average perceived tightening of 2.14 points on a 0 to 4 scale (0=lowest tightening result, 4=highest tightening), and 8 of 14 subjects would recommend treatment to others.
CONCLUSION: Transdermal monopolar RF is a safe and effective modality for non-invasive body slimming.
J Drugs Dermatol. 2015;14(11):1272-1278.
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.
An Open-label, Pilot Study to Assess the Effectiveness and Safety of Hyaluronic Acid Gel in the Restoration of Soft Tissue Fullness of the Lips
Nowell Solish MD FRCPa and Arthur Swift MD FRCSb| |
Objectives: Evaluate the effectiveness of small gel particle hyaluronic acid filler (Restylane® Injectable Gel [SGP-HA]; Medicis Aesthetics Inc., Scottsdale, AZ) in lip augmentation using the Medicis Lip Fullness Scale (MLFS). Assess subjective improvement in lip appearance using the Global Aesthetic Improvement Scale (GAIS).
Patients, Materials and Methods: Investigators treated 21 adults. The primary efficacy endpoint was an increase in lip fullness at least one grade on MLFS at eight weeks post-treatment. Adverse events were reported using patient diaries.
Results: Sixteen of 18 evaluable subjects (89%) had an improvement at least one grade on MLFS in both lips. MLFS and GAIS scores were consistent, suggesting clinically significant aesthetic improvement. Adverse effects were transient and mostly mild to moderate in severity.
Conclusion: Lip augmentation with SGP-HA was well tolerated and resulted in clinically meaningful increases in lip fullness.
J Drugs Dermatol. 2011;10(2):145-149.
Clinical Evaluation and Quantitative Analysis of Axillary Hyperhidrosis Treated With a Unique Targeted Laser Energy Delivery Method With 1-Year Follow Up
David Caplin MD FACSa and Jordan Austin BSb| |
METHODS: Fifteen subjects were recruited to an approved Institutional Review Board study. Outcome measures were comprised of clinical and quantitative evaluation of functional impairment. This included HDSS scale, physician and subject evaluation, and digital photography of before and after starch iodine tests utilizing image processing and analysis software. Subjects received a single treatment and were evaluated at 1 week and at 3, 6, and 12 months post treatment. Responders were defined as those that scored an HDSS score of 1 or 2 post-treatment. Those that were non-responsive at 6 months received a second treatment.
RESULTS: All patients responded to treatment with 72% reporting a two-point HDSS score improvement and 28% reporting a 1-point improvement at 1-year follow-up. The average HDSS score improvement was 1.9/3.0. Three of the 15 patients at 6 months received a second treatment. The HDSS average score for all patients remained statistically stable at 1-year follow-up.
CONCLUSIONS: Treatment of axillary hyperhidrosis with the 1440nm Nd:YAG-pulsed laser combined with a targeted fiber and temperature-sensing device provides a safe and minimally invasive approach to the treatment of axillary hyperhidrosis with minimal side effects and long-term efficacy.
J Drugs Dermatol. 2014;13(4):449-456.
Del Rosso, J.Q.| |
Cindy Wassef BA,a Adriana Lombardi MD,b Sairah Khokher MD,c and Babar K. Rao MDc| |
OBJECTIVE: The objective of this review was to describe the various surgical, laser, and alternative therapies available for vitiligo. A literature review was conducted through Pubmed and Ovid using the search terms "Vitiligo treatment”, “Vitiligo surgery”, “Vitiligo laser”. Since no articles were available about needling on both Pubmed and Ovid using the search criteria, individual articles were sought out through Google.
RESULTS: The literature review yielded many possible surgical interventions including autologous mini-punch grafting, suction epidermal blister grafting, split-thickness grafting, and cultured and noncultured melanocyte keratinocyte transfer. Laser options included the helium-neon and xenon-chloride lasers, with tattooing and needling serving as other options. While all the above techniques can provide improvement to pigmentation in vitiliginous patches, physician comfort and experience are important factors with regards to outcome. Our case series of four patients treated with the needling method yielded favorable results, with repigmentation rates ranging from 25-50%, with one patient having 90% repigmentation.
CONCLUSION: There are many surgical, laser, and alternative treatment options available for vitiligo when conventional medical therapy fails or for use in conjunction with medical therapies. Autologous mini punch grafting and needling both have minimal equipment requirements and are easy to learn. Physician experience and comfort play a large role in outcome and availability of services.
J Drugs Dermatol. 2013;12(6):685-691.
Shlomit Halachmi, MD PhD,a Dan Ben Amitai MD,b,d and Moshe Lapidoth MD MPHc,d| |
MATERIALS and METHODS: Twelve consecutive patients with moderate to severe acne scarring, who had completed a series of fractional laser resurfacing, underwent microinjections of 20 mg/mL hyaluronic acid (HA) gel into discrete depressed acne scars on the face.
RESULTS: Immediate visual improvement was observed in all lesions. The procedure was well tolerated. Adverse events were limited to transient pinpoint bleeding at the injection site.
CONCLUSION: Microinjection of low viscosity HA offers a valuable technique for the treatment of discrete depressed acne scars.
J Drugs Dermatol. 2013;12(7):e121-e123.
Fractional CO2 Laser Treatment vs Autologous Fat Transfer in the Treatment of Acne Scars: A Comparative Study
Omar A. Azzam MD a, Ahmed T. Atta MDb, Rehab M. Sobhi MD, and Pakinam I.N. Mostafa MSca| |
Objective: To compare fractional CO2 laser treatment and fat grafting in the treatment of acne scars.
Materials and methods: Twenty patients were included in this study, 10 received 3 sessions of fractional CO2 laser therapy, and 10 received fat grafting. All patients were then followed up for 3 months, and results were assessed with digital photographs taken by a committee of 3 physicians, by a single-blinded physician, and by reports of patient satisfaction.
Results: In the fractional CO2 laser treatment group, under 20% of patients were graded as having excellent scar improvement, 0 as having marked scar improvement, under 10% as having mild scar improvement, and almost 70% as having moderate scar improvement. In the fat-grafting group, the scar and overall improvement were graded as 30% excellent, 30% marked, 20% moderate, and 20% mild.
Conclusion: Fat grafting proved to be more effective in the treatment of acne scars than ablative fractional CO2 laser treatment. There were many points in its favor, the most significant being the clinical improvement in scars and texture. This supports the stem cell theory of adipose tissue in regenerative medicine.
J Drugs Dermatol. 2013;12(1):e7-e13.
Kristin K. Marcum MD,a Neal D. Goldman MD,c and Laura F. Sandoval DOb| |
OBJECTIVE: To use various methods of photography including standard photography, cross polarized light, parallel polarized light and ultraviolet passing photography to assess which method most effectively captures skin features such as texture, pigment, and/ or vascularity.
METHODS: A prospective analysis comparing advanced photographic techniques including standard photography, polarized light photography, cross-polarized light photography and ultraviolet light passing photography. The photos were then evaluated and scored by two experts and a blinded observer to characterize the differences visualized in each type of photography compared to standard photography in terms of subsurface skin features, hypopigmentation, hyperpigmentation, and rhytids.
RESULTS: 9 subjects completed the study. Overall, of the 3 photographic methods compared to standard photography, UV passing most enhanced the visualization of subsurface features and hypopigmentation, with increased hyperpigmentation as well. Enhancement of these features made UV passing best for capturing photodamage. Cross-polarized photography was best for visualizing hyperpigmentation, but also heightened visualization of hypopigmentation and subsurface features such as vascularity. Parallel-polarized photography enhanced visualization of skin texture.
CONCLUSIONS: These methods of photography show a quantifiable and reproducible selective ability to evaluate and document elements such as skin texture, vascularity, and pigmentation. Each of these techniques has unique properties that can add to the precision of the clinical evaluation and can be of particular value to providers of cosmetic procedures where photo documentation has become increasingly important in providing an objective means of evaluating outcomes.
J Drugs Dermatol. 2015;14(2):134-139.
Jessica El-Kehdy MD,a Eckart Haneke MD,b and Paula G. Karam MDc| |
J Drugs Dermatol. 2013;12(2):228-230.
Lindsay K. McGuire MD,a Elizabeth K. Hale MD,a and Loyd S. Godwin MDb| |
J Drugs Dermatol. 2013;12(10):1181-1183.
Tapan Patel MBBS MRCP,a Oren Tevet MScb| |
This study evaluated the clinical efficacy and safety of pneumatic injections of Hyaluronic Acid in the treatment of acne scars.
Two patients (Fitzpatrick skin type IV-V) with acne scars received two sessions of pneumatic, needleless injections of crosslinked hyaluronic acid (HA) at 4-week intervals. The treatment response was assessed by comparing pre‐ and 3‐month posttreatment clinical photography.
The patients’ acne scar grade improved from 2 to 1 in the first case, and 3 to 2 in the second case, based on independent physician assessment. Patient degree of satisfaction was similar to the physicians' assessment. No significant adverse events were noted. We conclude that pneumatic injection technology to deliver HA to the tissue is an effective and safe method for improving acne scars, even in patients with dark complexion.
J Drugs Dermatol. 2015;14(1):74-76.
Loeb Habbema MD,a Jennifer C. Tang MD,b Gerhard Sattler MD,c C. William Hanke MDb| |
The neck is one of the most common areas treated by liposuction. Neck liposuction decreases fat volume, causes skin contraction, and restores a more youthful appearance. We present a large case series (n=987) performed by three dermatologic surgeons. Five patients developed temporary post-operative marginal mandibular dysfunction, one patient had submandibular gland ptosis and one patient had arterial bleeding. Seroma, skin necrosis, scarring, and hyperpigmentation did not occur following neck liposuction. Neck liposuction performed with tumescent local anesthesia is a safe procedure associated with a low incidence of nerve injury and other complications.
J Drugs Dermatol. 2018;17(1):30-34.
A Phase I Safety and Pharmacokinetic Study of ATX-101: Injectable, Synthetic Deoxycholic Acid for Submental Contouring
Patricia Walker MD PhD,a,b Jere Fellmann PhD,b and Paul F. Lizzul MD PhD MBA MPHb| |
J Drugs Dermatol. 2015;14(3):279-284.
J Drugs Dermatol. 2012;11(9):1122-1123.
The Frontalis Activity Measurement Standard: A Novel Contralateral Method for Assessing Botulinum Neurotoxin Type-A Activity
Background: There are conflicting data regarding the specific attributes of botulinum neurotoxin type-A (BoNTA) products including onset of action, duration and spread because accurate, objective methods for assessing their clinical activity are lacking.
Objective: To refine definitions for BoNTA activity utilizing the frontalis muscle and describe the Frontalis Activity Measurement Standard (FMS), an objective method for measuring changes in frontalis muscle activity as a metric for assessing BoNTA pharmacodynamics.
Methods: As part of a study to assess BoNTA activity, 20 subjects with severe frontalis lines at maximum elevation were injected with two BoNTA products at five points on contralateral sides of the frontalis. Changes in maximum baseline frontalis elevation were measured by a blinded investigator using the previously-validated Frontalis Rating Scale (FRS) and the FMS. Frontalis activity endpoints were redefined to include Initial, Full and Complete Onsets of action and Partial, Full and Complete efficacy.
Results: Differences in the onset of effect of the BoNTA products were detected with both the FRS and FMS; however, the FMS detected changes in frontalis activity earlier than the FRS. A significant correlation between the FRS and FMS was documented.
Conclusion:The frontalis muscle activity allows for enhanced assessment of BoNTA activity and attributes. The FMS appears to be a sensitive and objective tool for measuring pharmacodynamic parameters of BoNTA. Refining definitions of BoNTA activity provides a more accurate means for describing the clinical effects of BoNTA.
J Drugs Dermatol. 2011;10(9):968-972.
Two-Treatment Protocol for Skin Laxity Using 90-Watt Dynamic Monopolar Radiofrequency Device With Real-Time Impedance Intelligence Monitoring
David McDaniel MD,a Robert Weiss MD,b Margaret Weiss MD,b Chris Mazur BS,a and Charmaine Griffin CCRPa| |
OBJECTIVE: The objective was to validate effectiveness of a modified treatment protocol for a unique monopolar radiofrequency device, which has been engineered with greater power and self-monitoring circuitry.
METHODS: Twenty-four female subjects received bilateral monopolar radiofrequency treatments to the mid and lower face from the sub malar region to the submentum. Subjects completed 1 and 3 month follow ups with digital imaging. Skin biopsies (on 4 subjects) and ultrasound measurements (on 12 subjects) were completed.
RESULTS: Assessments demonstrated a reduction in skin laxity of 35%, a reduction in fine lines/wrinkles of 42%, and a reduction in the appearance of global photodamage of 33%. Expert photograding demonstrated 92% of subjects showing at least a mild improvement in skin laxity at three months post treatment. 50MHz ultrasound measurements in 12 subjects showed an increase of 19% in skin density. Histology showed a marked increase in dermal collagen and elastin fibers in two subjects who demonstrated a clinically noticeable reduction in skin laxity and minimal changes in two subjects who demonstrated minimal clinical improvements. There were no significant adverse events reported.
CONCLUSION: This modified radiofrequency device and treatment protocol was well tolerated and produced improvements in the appearance of skin laxity and overall anti-aging effects in the majority of subjects. Objective measurements including ultrasound and histology help explain the clinical outcome.
J Drugs Dermatol. 2014;13(9):1112-1117.
Injectable Non-Animal Stabilized Hyaluronic Acid as a Skin Quality Booster: An Expert Panel Consensus
Magda Belmontesi MD,a Francesca De Angelis MD PhD,b Carlo Di Gregorio MD PhD,c Ivano Iozzo MD,d Marina Romagnoli MD,e Giovanni Salti MD,f and Matteo Tretti Clementoni MDg| |
J Drugs Dermatol. 2018;17(1):83-88.
Mohamed Réda Khmamouche MD,a,b Adil Debbagh MD,a Tarik Mahfoud MD,b Rachid Aassab MD,a
Siham Lkhoyaali MD,a Mohamed Ichou MD,b and Hassan Errihani MDa
J Drugs Dermatol. 2014;13(8):983-984.
Shino Bay Aguilera DO FAAD,a Sean Branch DO FAAD,b and Luis Soro DO FAADa| |
A 12-Month, Prospective, Evaluator-Blinded Study of Small Gel Particle Hyaluronic Acid Filler in the Correction of Temporal Fossa Volume Loss
Amir Moradi MD,a Azadeh Shirazi MD,b and Jeanette Moradi CRCa| |
STUDY DESIGN: This is a US Food and Drug Administration-approved, blinded, prospective, single-center, open-label trial enrolling 20 subjects undergoing subcutaneous injection of SGP-HA for rejuvenation of the temples. Primary outcomes were measured using a standardized grading system—the Hollowness Severity Rating Scale (HSRS)—at each visit by the treating investigator, a blinded physician assessment of randomized photos using the HSRS, and patient questionnaires over a 12-month period. AEs were monitored by the investigator and via patient diaries.
RESULTS: At weeks 4, 12, and 24, and month 12, all graders (ie, investigator, blinded physician assessor, and patients) reported improvement overall in hollowness. At baseline, temporal fossa hollowness was measured as moderate to severe. At week 4 to month 12, temporal fossa was graded at none or only mild hollowness. No touch-ups were necessary at week 4 on all subjects. All AEs were mild or moderate and resolved within 2 weeks.
CONCLUSION: Our study demonstrates clinically significant efficacy and safety in the use of Restylane for temple augmentation and, thus, facial rejuventation.
J Drugs Dermatol. 2013;12(4):470-475.
Andrew F. Alexis MD MPHa,b and Jasmine O. Obioha MDc| |
Aging is a complex process influenced by both extrinsic and intrinsic factors. Premature signs of aging due to cumulative UV exposure represent a major concern of the cosmetic patient. Skin of color is less susceptible to photodamage and thus signs of aging are less pronounced and occur later than in Caucasians. Understanding structural and functional differences among different racial/ethnic groups is important to achieve favorable treatment outcomes when addressing aging concerns.
Metastatic Squamous Cell Carcinoma Presenting as an Erythematous Nodule in a Man With Lung Adenocarcinoma
Dorota Z. Korta PhD,a Jesse M. Lewin MD,b Shane A. Meehan MD,b and Sarika M. Ramachandran MDb| |
J Drugs Dermatol. 2014;13(10):1277-1279.
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.
Raffaele Rauso MD,a,b,c Antonio Rusciani MD,d and Giuseppe Curinga MDe| |
J Drugs Dermatol. 2014;13(10):1282-1284.
Autumn Bagwell PharmD BCPS, Abbey Loy PharmD BCPS, M. Shawn McFarland PharmD FCCP BCACP BCPS, and Amber Tessmer-Neubauer DPM| |
CASE SUMMARY: A 49 year-old Caucasian female with non-significant past medical history presented to the podiatry clinic for treatment of verrucae. Debridement was performed and monochloroacetic acid was applied to affected areas seven times over seven months. The patient was diagnosed and treated for herpes zoster with acyclovir for ten days. Following acyclovir completion, only one verruca remained with complete resolution at the next follow-up podiatry visit.
DISCUSSION AND CONCLUSION: Few previous trials have supported the use of acyclovir cream in treatment-resistant plantar warts. However, no case reports to date describe the efficacy of oral acyclovir in the treatment of verruca. While a causal relationship has not been solidified between verrucous lesion resolution and treatment with acyclovir, it can be inferred and warrants additional attention.
J Drugs Dermatol. 2016;15(2):237-238.
Daniel J. Aires MD JD,*a Jo Wick PhD,*b Tarek S. Shaath MD,*c Anand N. Rajpara MD,a Vikas Patel MD,a Ahmed H. Badawi PhD,c Cicy Li MS,c Garth R. Fraga MD,d Gary Doolittle MD,e and Deede Y. Liu MDa| |
J Drugs Dermatol. 2016;15(5):527-532.
A Prospective Split-Face Study of the Picosecond Alexandrite Laser With Specialized Lens Array for Facial Photoaging in Chinese
Yiping Ge MD, Lifang Guo MD, Qiuju Wu MD, Mengli Zhang MD, Rong Zeng MD, and Tong Lin MD PhD| |
Ramsin Joseph Yadgar BS,a and Adam J. Friedman MDa,b| |
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| |
Efficacy and Tolerability of a New Monophasic, Double-Crosslinked Hyaluronic Acid Filler for Correction of Deep Lines and Wrinkles
Tatjana Pavicic PhD
Clinic and Polyclinic for Dermatology and Allergology, Ludwig-Maximilians-University, Munich, Germany
Objective: To investigate the efficacy and tolerability of Belotero.
Methods and Materials: A total of 149 patients received injections. Efficacy was assessed on the Wrinkle Severity Rating Scale (WSRS) and the Global Aesthetic Improvement Scale (GAIS). Adverse events were recorded at each evaluation session.
Results: Mean WSRS improved significantly (P<0.001) by 1.9 score points without any decline throughout the 12-week period. Improvement was found in 89.9 percent of patients on the (GAIS), 59.7 percent of whom were designated as very much/much improved. Investigator and patient satisfaction was stated in more than 90 percent of cases as excellent/good. Adverse events, exclusively localized to the injection area, occurred in 85.9 percent of patients immediately after injection and declined to 12.8 percent in week 2. None were serious.
Conclusion: The findings indicate the benefit of the highly cross-linked, monophasic hyaluronic acid dermal filler, especially in the treatment of patients with deep and extremely deep folds. Overall, the filler appears to be well tolerated. This evaluation raised no major safety concerns.
J Drugs Dermatol. 2011;10(2):134-139.
Ahmad Jabbar MD,a Suleima Arruda MD,b and Neil Sadick MD FAAD FAACS FACP FACPhc| |
Injectable soft-tissue augmentation agents have become popular alternatives to surgical procedures for the aging face and body. In contrast to temporary, space-occupying replacement fillers such as collagen-based and hyaluronic acid products, poly-l-lactic acid (PLLA) has been demonstrated to gradually promotes deposition of collagen via a biostimulatory response, with therapeutic effects lasting approximately two years. In 2004, the FDA approved its use for rejuvenation of facial contours secondary to lipoatrophy associated with antiretroviral therapy for HIV infection. By 2009 PLLA was FDA-approved for the correction of nasolabial fold contour deficiencies and other lines and wrinkles. There have since been limited but promising results with off-label use of PLLA for nonfacial volumization as well, including the hands, neck/décolleté, abdomen, and gluteal area. The objective of this article is to review clinical evidence, current trends, and technical considerations for the use of PLLA for nonfacial, body rejuvenation.
J Drugs Dermatol. 2017;16(5):489-494.
Deborah S. Sarnoff MD FAAD FACPa,b and Robert H. Gotkin MD FACSb,c| |
OBJECTIVE: To demonstrate that a combination technique called ACELIFT – an acronym for the Augmentation of Collagen and Elastin using Lasers, Injectable neurotoxins, Fillers, and Topicals – in selected patients, is a viable, safe, and effective alternative to a facelift.
METHODS: Ten healthy women, ages 50 to 62 (mean age = 58), with cervical and facial stigmata of aging were enrolled in a prospective study conducted in the authors’ private practice. Patients underwent a two-step procedure; the first step was laser lipolysis of the submental and anterior cervical areas with a pulsed 1440nm Nd:YAG laser with a side-firing fiber (PrecisionTx, Cynosure, Westford, MA). Three months later, the patients were treated in a single session that combined injectable neurotoxin, fillers, and fractional (Fx) CO2 laser resurfacing delivered in a novel “hammock” distribution. After two weeks, following complete re-epithelialization, the patients were started on a topical regimen that included daily use of sunscreen and antioxidants and nightly use of retinoids and peptides. This regimen was continued for a period of six months when all patients returned for final evaluation.
RESULTS: Nine months following the initiation of treatment, all patients were evaluated by the following: Global Aesthetic Improvement Scale, cervicomental angle scale, physician, and subject evaluation. Clinical improvement was evident, and often marked, for all subjects. Both physician and subject satisfaction scores were high, indicating overall satisfaction with the procedure and the outcomes. Side-effects were mild and transient; there were no incidents of adverse scarring, thermal injuries, permanent nerve injury, or dyschromia, hematomas, seromas, or infection. Subjects were likely to recommend the procedure to a friend.
CONCLUSIONS: In properly selected patients, the ACELIFT proved to be a safe and effective, minimally invasive alternative to a facelift. There was little downtime and high patient satisfaction.
J Drugs Dermatol. 2014;13(9):1038-1046.
Nevil Khurana MS and Christine Urman MD| |
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| |
News, Views, and Reviews. Less May Be More for MRSA: The Latest on Antibiotics, the Utility of Packing an Abscess, and Decolonization Strategies
Kendra Gail Bergstrom MD FAAD| |
J Drugs Dermatol. 2014;13(1):89-92.
Full-Face Injections of Variable Total Doses of Abobotulinum Toxin Type A: A Randomized, Phase IV Clinical Trial of Safety and Efficacy
Doris Hexsel MD,a,b Cristiano Brum MD Ms,a,c Manoela D. Porto MD,a Mariana Soirefmann MD Ms,a,b Carolina Siega BSc,a Juliana Schilling-Souza BPharm,a and Ticiana C. Rodrigues MD PhDa,d| |
OBJECTIVE: To evaluate the safety and efficacy of full-face treatments with various total doses of abobotulinum toxin A (ABO).
METHODS: A total of 90 participants were enrolled. Subjects had at least two indications for BoNT-A treatments on each third of the face (upper, middle and lower). They were randomized into 3 groups, with pre-defined total dose range of ABO, varying from 120 to 250 U.
RESULTS: Most of the subjects were women (96.5%). The statistically significant improvement from baseline lasted for more than 24 weeks for glabellar lines, and more than 16 weeks for forehead wrinkles and crow's feet, all P<0.001, with no differences between groups. The most frequent adverse event (excessive perioral weakness) was related to high dose in the perioral area.
CONCLUSIONS: This is the first study to compare safety and efficacy of different doses of ABO administered to the entire face simultaneously. As long as the recommended doses are used, concomitant injections of ABO are safe and efficient, with no increase in adverse events.
J Drugs Dermatol. 2013;12(12):1356-1362.
The Optimal Filler: Immediate and Long-Term Results With Emulsified Silicone(1,000 centistokes) With Cross-Linked Hyaluronic Acid
Methods and Materials: A simple, permanent method of tissue augmentation is described. U.S. Food and Drug Administration- approved liquid silicone (Silikon®) is emulsified with cross-linked hyaluronic acid through a Luer-Lok to Luer-Lok connector between two 3-cc syringes. This stable emulsion is injected through a 27G needle or through a 25G or 27G microcannula into the middermis, subcutaneous tissue, or periosteum.
Results: The results of 95 cases are described. The emulsion is most beneficial for distensible acne valleys, nasolabial folds, glabellar frown lines, augmentation of the vermilion border of the lips, and projection of the nose, cheekbones, and chin. Exterior nasal deviations and soft tissue defects are also improved. Complications are minimal and include temporary bruising, erythema, and mild edema. Any temporary small nodules are easily leveled with massage. Occasionally, it takes a repeat session at 1 month to completely elevate depressions. The resulting elevations remain stable during the 2-year follow-up period. No silicone granulomas have developed.
Conclusions: This methodology has replaced many indications for temporary, semipermanent, or permanent fillers.
J Drugs Dermatol. 2012;11(11):1336-1341.
Corrugator Supercilii Muscle Terminal Nerve Ablation Using a Novel Thread Technique for the Treatment of Hyperdynamic Vertical Glabellar Furrows
Background: A novel percutaneous corrugator supercilii muscle terminal nerve CSMTN ablation technique is proposed for the treatment
of hyperdynamic vertical glabellar furrows (HVGF).
Technique: Two surgical marks are placed on each eyebrow. One is placed at the level of the lateral canthus and the second at the outer border of the limbus. At each of the four marks, the following steps are carried out: (1) a guiding needle is used to punch the frontal skin at 3 mm above the eyebrow (orifice A) and will then travel deeply at the level of the supraperiostium and emerge outside the skin 3 mm below the eyebrow (orifice B) at the palpebral skin; (2) the needle is then reentered exactly at orifice B and will travel underneath the skin at a more superficial level in the subcutaneous layer and then emerge outside exactly at orifice A. Both ends of the thread are gently pulled in a sawing motion with counter tension until no more resistance is felt from the anatomical structures involved, and then the loops of thread are withdrawn from orifice A.
Results: Forty-seven subjects underwent bilateral CSMTN ablation. In the first 10 cases, the authors performed only one neurotomy per eye and observed a 50 percent HVGF recurrence rate. Then, the authors chose to perform two neurotomies per side and had a three percent recurrence rate (1/37) with a high degree of patient satisfaction. Major complications such as deforming hematomas, eyelid ptosis, abscess, scar formation or adhesions were not observed during follow up.
Conclusion: This novel technique may represent a simple and permanent solution for HVGF.
J Drugs Dermatol.2011;10(7):762-765.
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.
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.
Annie Chiu MD,a Sabrina Fabi MD,b Steven Dayan MD,c and Alessandra Nogueira MDd| |
J Drugs Dermatol. 2016;15(9):1076-1082.
News, Views & Reviews. A Biopsy Diagnosis? Clinical Clues and Patterns to Help Distinguish Cutaneous Metastases: Part I of II
Karin Blecher BA and Adam Friedman MD| |
A Novel, Multistep, Combination Facial Rejuvenation Procedure for Treatment of the Whole Face With IncobotulinumtoxinA, and Two Dermal Fillers- Calcium Hydroxylapatite and a Monophasic, Polydensified Hyaluronic Acid
Tatjana Pavicic MD,a Julius W. Few MD,b and Jürgen Huber-Vorländer MDc| |
J Drugs Dermatol. 2013;12(9):978-984.
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.
The Evolution of Injectable Poly-L-Lactic Acid From the Correction of HIV-Related Facial Lipoatrophy to Aging-Related Facial Contour Deficiencies
Cheryl Burgess MD| |
Isabela T. Wieczorek MD,a Brian P. Hibler BS,b and Anthony M. Rossi MDc| |
J Drugs Dermatol. 2015;14(9):1043-1051.
Why Are Dermatologists Still Talking About Acne? Because So Many People Have It... and We Are Always Seeking Better Ways to Manage It
James Q. Del Rosso, DO| |
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.
Benjamin Bashline DO,a Megan Morrison DO,a James Ramirez MD,b and Ann LaFond MDc,d| |
J Drugs Dermatol. 2014;13(8):976-978.
Mariah Johnson MD, Ramin Fathi MD, and Theodore Alkousakis MD| |
A Multi-Center, Open-Label, Prospective Study of Cannula Injection of Small-Particle Hyaluronic Acid Plus Lidocaine (SPHAL) for Lip Augmentation
Raj Chopra MD FACS,a Miles Graivier MD FACS,b Sabrina Fabi MD FAAD FAACS,c Mark Nestor MD PhD,d Patricia Meuse PhD,e Jay Mashburn PhDf| |
BACKGROUND: The use of blunt-tipped microcannulas for injection of hyaluronic acid (HA) filler in the lip and perioral area has gained popularity as they provide important safety-related advantages compared to traditional hypodermic needles. This study was conducted to assess the safety and effectiveness associated with the use of a blunt-tipped microcannula for lip augmentation and correction of perioral rhytids using a small-particle, hyaluronic acid gel plus lidocaine (SPHAL).
METHODS: A multi-center, open-label, prospective, study enrolled 60 subjects. Subjects reported injection-related events (IREs) for 2 weeks posttreatment via diary. Adverse events (AEs) were collected throughout the study. Secondary assessments at 4 and 12 weeks posttreatment included treating investigator- and subject-reported improvement in lip fullness using the Global Aesthetic Improvement Scale (GAIS) and investigator-assessed improvement in lip fullness using the Medicis Lip Fullness Scale (MLFS).
RESULTS: Sixty subjects were enrolled and treated with a mean total volume (ie, both lips and optional perioral rhytids) of 2.2 mL. Treatment-emergent adverse events (TEAEs) reported and assessed as related to the product and/or injection procedure included injection site swelling (13.3%), injection site bruising (6.7%), and injection site pain (1.7%). These were typically mild and transient in nature. No serious AEs (SAEs) were reported. Following treatment, clinically significant improvement using the GAIS and MLFS was demonstrated throughout the study (GAIS improvement at week 12 for both lips: investigator-reported, 98.0%; subject-reported, 84.3%; MLFS improvement at week 12: investigator-reported, 96.1%).
CONCLUSION: SPHAL was well tolerated and effective following injection with a blunt-tipped microcannula. No unanticipated safety concerns were identified in the study population.
J Drugs Dermatol. 2018;17(1):10-16.
Sabine Zenker MD| |
INTRODUCTION: Looking at alternatives to standard injectables and devices for rejuvenation, typical indications for facial rejuvenation are poor skin quality, pigmentary changes, and the loss of shape. Looking for effective treatments for those indications in the aesthetic field, one can notice a kind of “retro”-trend: easy-to-perform, non- or minimally-invasive, low-investment-requiring procedures are regaining a lot of popularity. And, over time, those treatments are becoming well defined and far more specific.
OBJECTIVE: To discuss an indication-specific full-face concept for facial rejuvenation using alternatives to standard injectables and devices for rejuvenation. Materials and Methods: The strategy of this indication-specific full-face concept is based on a three-pillar-principle: regeneration, regulation, and reshaping. In parallel to this concept, major indications such as poor skin quality, pigmentary changes, and loss of shape and definition are discussed. To address those indications, therapeutic principles such as topicals (cosmeceuticals, magistral formulations), mesotherapy, needling, chemical peelings, injection lipolysis, and thread lifting will be demonstrated.
CONCLUSION: As an alternative to standard injectables and devices, an indication-specific approach for a concept of full-face rejuvenation is based on the three-pillar-principle of regeneration, regulation, and reshaping by easy-to-perform, non- or minimally-invasive procedures for rejuvenation.
J Drugs Dermatol. 2017;16(6 Suppl):s98-103.
Comprehensive Thermoregulation for the Purpose of Skin Tightening Using a Novel Radiofrequency Treatment Device: A Preliminary Report
Douglas J. Key MD| |
METHODS: A retrospective chart review of 18 subjects undergoing thermistor-controlled subdermal skin tightening via percutaneous radiofrequency was conducted. During the treatment, epidermal temperature was concurrently monitored by a handheld infrared laser thermometer and a forward looking infrared camera system and peak temperatures readings were reported and evaluated.
RESULTS: Mean temperatures of 43.6 and 38.2oC were reported for the infrared camera and infrared thermometer. The Bland-Altman plot analysis reported a bias of 5.38oC and 95% limits of agreement between 0.60 and 10.15oC. Additionally, the mean difference or bias of 5.38oC was statistically significant (P less than 0.0001).
CONCLUSION: Our preliminary data supports a superior form of thermoregulation for the purposes of skin tightening that integrates continuous subsurface and epidermal temperature monitoring.
J Drugs Dermatol. 2014;13(2):185-189.
Letter to the Editor: The New Face of Fillers: Integrating Evidence, Experience and a Little Imagination at the Next Frontier
Hema Sundaram MD| |
Tatjana Pavicic MD| |
J Drugs Dermatol. 2013;12(9):996-1002.
Carey Kim MS,a Pantea Hashemi MD,b Michael Caglia MD,c and Kenneth Shulman MDd| |
CASE: A patient with a 5 year history of EV failed to respond to a 6 week course of 5% imiquimod on the forehead and was subsequently treated with a 3 day course of 0.015% Picato gel which resulted in significant clinical improvement. A one month follow-up examination showed no reoccurrence of the lesions with the patient reporting continued satisfaction of the outcome.
CONCLUSION: Our case provides insight into the potential use of ingenol mebutate for EV patients unresponsive to traditional medical treatments.
J Drugs Dermatol. 2016;15(3):350-352.
Evaluation of a Low Energy, Low Density, Non-Ablative Fractional 1927nm Wavelength Laser for Facial Skin Resurfacing
Jeremy A. Brauer MD,a,b Hamad Alabdulrazzaq MBChB,a Yoon-Soo Cindy Bae MD,a,b
and Roy G. Geronemus MDa,b
DESIGN: Prospective non-randomized trial.
SETTING: Single center, private practice with a dedicated research department.
PARTICIPANTS: Subjects with clinically diagnosed facial photodamage, melasma, or post inflammatory hyperpigmentation
INTERVENTIONS: Subjects received four to six treatments at 14-day intervals (+/- 3days) with a low energy low density non-ablative fractional 1,927-nm laser (Solta Hayward, CA) with an energy level of 5 mJ, and density coverage of either 5%, 7.5%, or 10%, with a total of up to 8 passes.
MAIN OUTCOME AND MEASURES: Blinded assessment of clinical photos for overall improvement at one and three months post final treatment. Investigator improvement scores, and subject pain and satisfaction scores for overall improvement were recorded as well.
RESULTS: We enrolled 23 subjects, average age 45.0 years (range, 25-64 years), 22 with Fitzpatrick Skin Types I-IV and 1 with Type VI, with facial photodamage, melasma, or post inflammatory hyperpigmentation. Approximately 55% of subjects reported marked to very significant improvement at one and three months post final treatment. Blinded assessment of photography of 20 subjects revealed an average of moderate improvement at one-month follow up and mild to moderate improvement at three months. Average subject pain score was 3.4/10 during treatment.
CONCLUSIONS AND RELEVANCE: Favorable outcomes were demonstrated using the low energy low density, non-ablative fractional 1,927-nm laser in facial resurfacing for photodamage, melasma, and post inflammatory hyperpigmentation. Results were maintained at the 3-month follow up, as demonstrated by investigator and subject assessments, as well as blinded evaluations by three independent dermatologists utilizing photographs obtained from a standardized facial imaging device.
J Drugs Dermatol. 2015;14(11):1262-1267.
Purpura and Fillers: A Review of Pre-Procedural, Intra-Procedural, and Post-Procedural Considerations
Todd E. Schlesinger MD,a Joel L. Cohen MD,b and Sarah Ellison| |
J Drugs Dermatol. 2013;12(10):1138-1142.
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.
Georgia Schuller-Levis MD,a William Levis MD,b and Israel Dvoretzkyc| |
J Drugs Dermatol. 2014;13(10):1194-1196.
J Drugs Dermatol. 2012;11(9):1081-1088.
Brighter Eyes: Combined Upper Cheek and Tear Trough Augmentation: A Systematic Approach Utilizing Two Complementary Hyaluronic Acid Fillers
J Drugs Dermatol. 2012;11(9):1094-1097.
A Preliminary Study on the Safety and Efficacy of a Novel Fractional CO2 Laser With Synchronous Radiofrequency Delivery
Robert H. Gotkin MD FACSa,c and Deborah S. Sarnoff MD FAAD FACPb,c| |
J Drugs Dermatol. 2014;13(3):299-304.
Cosmetic Complications: Rare and Serious Events Following Botulinum Toxin and Soft Tissue Filler Administration
Eric P. Sorensen BSa,b and Christine Urman MDb| |
OBJECTIVE: This article aims to review the rare but serious complications associated with the injectables used in cosmetic dermatology, and the pathogenesis, diagnosis, and management of each.
METHODS AND MATERIALS: A literature review for case reports pertaining to rare adverse events following botulinum toxin or soft tissue fillers was performed using the MEDLINE database.
RESULTS: Complications of BTX included dry eye syndrome, strabismus and diplopia, superficial temporal artery pseudoaneurysm, neck weakness, hoarseness, and dysphagia. Complications associated with soft tissue fillers included tissue necrosis, inflammatory nodules, hypersensitivity reaction, and blindness and cerebral ischemia.
CONCLUSION: The injector should be comfortable in diagnosing and managing the above complications, and the patient should be counseled about these potentially harmful adverse events prior to injection.
J Drugs Dermatol. 2015;14(5):486-491.
Redaelli Alessio MD,a Berthold Rzany MD ScM,b Linda Eve MD,c Yann Grangier MD,d
Pedro Herranz MD,e Frédérique Olivier-Masveyraud MD,f and Danny Vleggaar MDg
J Drugs Dermatol. 2014;13(9):1057-1066.
Omar A. Ibrahimi MD PhD,a Robert A. Weiss MD,b Margaret A. Weiss MD,b Christian R. Halvorson MD,b Flor Mayoral MD,c E. Victor Ross MD,d and Joel L. Cohen MDe| |
J Drugs Dermatol. 2015;14(9):1065-1068.
Milad Moqadam,a Konstantin Frank,b Christina Handayan,a Mustafa Hakami,a Fahd Benslimane MD,c Robert H. Gotkin MD,d Neil S. Sadick MD,e and Sebastian Cotofana MD PhDf| |
Background: Individualized neuromodulator injections of the forehead are increasingly important to maximize patient safety and satisfaction and to yield the best aesthetic outcome. To assess the location of maximal muscle contraction, it would beneficial to relate the shape and location of the forehead lines to the morphology of the underlying frontalis muscle.
Materials and Methods: We investigated the shape of forehead lines and their relationship to the morphology of the underlying frontalis muscle using anatomic dissection in a sample of 31 human body donors, with a mean age at death of 77.2 ± 13.2 years (range, 47–93) of which n=29 (93.5%) were of Caucasian and n=2 (6.5%) of African-American ethnicity and of which n=16 (51.6%) were females (n=15 males; 48.4%).
Results: Horizontal forehead lines were classified into straight n=13 (41.9%) and wavy n=18 (58.1%) lines. The presence of wavy forehead lines (as compared to straight lines) was significantly related to the presence of a midline aponeurosis (r = 0.69; P less than 0.001) and to a greater muscle fascicle angle (12.67 ± 2.60° vs 10.18 ± 2.12°) (r = 0.47; P less than 0.001), but was not statistical significantly influenced by age, gender, or ethnicity (all P greater than 0.05).
Conclusion: According to the shape of the forehead lines, physicians can appreciate the morphology of the underlying frontalis muscle. This understanding will facilitate more accurate neuromodulator injections and a better aesthetic outcome. It may also result in decreased dosages and increased injection intervals for maximal patient safety. Level of evidence: IV
J Drugs Dermatol. 2017;16(5):471-477.
Five-Year Retrospective Review of Safety, Injected Volumes, and Longevity of the Hyaluronic Acid Belotero Basic for Facial Treatments in 317 Patients
Objective: The objective of this article is to report on use of this HA in a German clinic, over a period of 5+ years, in 317 patients (668 treatments).
Methods and Materials: Authors retrospectively examined patient charts of 317 patients (312 females), aged 24 to 87 years. Chart review showed areas treated, range of volumes per area, and mean volumes. Patient satisfaction data was collected anecdotally over the five years.
Results: Volumes of the HA injected ranged from 0.2 mL to 3.0 mL, depending on the area being treated. No serious adverse events were noted in the chart review, nor was any Tyndall effect observed in the treated areas. Anecdotal information suggests high patient satisfaction with results, based on the return of these patients to the clinic for other treatments over the more than five years.
Conclusion: Belotero Basic provides aesthetically pleasing results for treatment of facial defects, without carrying a risk of serious adverse events. North American physicians now have a new HA to consider as part of their treatment protocols.
J Drugs Dermatol. 2012;11(9):1032-1035.
Effect of Systemic Isotretinoin Therapy on Mucociliary Clearance and Nasal Surface Mucosa in Acne Patients
Zennure Takci MD,a Gulcin Guler Simsek MD,b Hayriye Karabulut MD,c
Yunus Buran MD,c and Ayse Serap Karadag MDd
METHODS: A total of 30 patients with severe or moderate acne were enrolled in this study. The median prescribed dose of isotretinoin was 0.75 mg per kg per day. Clinical and biochemical examinations were carried out periodically. The ST and nasal cytology were performed before treatment and during the third month of therapy.
RESULTS: Of the 30 patients who initially agreed to participate in the research, 21 completed the study (18 female and 3 male, mean ± standard deviation (SD) aged 20.9 ± 4.7 years, range 15-32 years). There was a significant difference between the mucociliary clearance time for subjects in the pre- and post-treatment periods (173.8 ± 89.2 seconds vs 245.2 ± 191.6 seconds, respectively; P=.009). Cytological examination revealed that the squamous cell ratio was significantly lower and the reactive changes of the respiratory epithelium were significantly higher 3 months after isotretinoin therapy than before therapy (P=.010, P=.002, respectively). There were mild signs of inflammation according to the number of neutrophilic leukocytes (8.3% vs 26.6%, P=.06) after 3 months of isotretinoin therapy.
CONCLUSION: Systemic isotretinoin alters the mucociliary transport, decreases the squamous cell ratio, increases the reactive changes in the respiratory epithelium significantly, and increases neutrophils in the nasal surface mucosa in the third month of treatment.
J Drugs Dermatol. 2013;12(8):e124-e128.
Rebecca Kleinerman MD, Thomas H. King MD, and Daniel B. Eisen MD| |
J Drugs Dermatol. 2013;12(1):60-65.
Kathleen J. Smith MD| |
The Evaluation of Hyaluronic Acid, With and Without Lidocaine, in the Filling of Nasolabial Folds as Measured by Ultrastructural Changes and Pain Management
Josefina Royo de la Torre MD, Paloma Cornejo MD, Gema Pérez MD, Irene Cruz MD, Estefania Muñoz BSc, Maria J. Isarría MD, and J. Moreno-Moraga MD| |
OBJECTIVE: To compare the 1-year clinical results of filling the nasolabial fold with 2 types of filler: large-gel particle HA and large-gel particle HA plus 0.3% lidocaine (HA+L). We compared the level of pain during treatment and 10 minutes after treatment and assessed the safety and efficacy profile, satisfaction, and histological findings (using reflectance confocal microscopy [RCM]).
MATERIALS and METHODS: We performed a comparative, parallel-group, double-blind trial with an external observer (blinded to the type of treatment administered). The filler was applied to the nasolabial fold in 119 patients (HA in 62 patients and HA+L in 57). Patients were followed at months 3, 9, and 12. Pain was evaluated using a visual analog scale. Efficacy and satisfaction were evaluated using the Wrinkle Severity Rating Scale and the Global Aesthetic Improvement Scale. RCM images (n=32) were taken at baseline and at months 3 and 12.
RESULTS: Pain: The severity of pain was decreased in patients treated with HA+L on application (P<.001) and 10 minutes later (P=.008). Efficacy and satisfaction: No significant differences existed between the 2 groups at months 3, 9, and 12. RCM: Skin rejuvenation occurred with a 32% increase in the height of the dermoepidermal junction at month 12 (P<.001), which was similar in both groups. Adverse events: At month 3, the most common adverse events (AEs) were erythema (68%) and hematoma (11%). No AEs were recorded at months 9 or 12.
CONCLUSION: The use of HA+L provides pain relief without affecting efficacy, satisfaction, safety, or the duration of results. RCM showed that the changes in the dermoepidermal junction represented a histological improvement in the skin with similar results in both groups.
J Drugs Dermatol. 2013;12(3):e46-e52
J Drugs Dermatol. 2011;10(12):1370-1375.
Efficacy of Extended-Release 45 mg Oral Minocycline and Extended-Release 45 mg Oral Minocycline Plus 15% Azelaic Acid in the Treatment of Acne Rosacea
J. Mark Jackson MD,a Douglas J. Lorenz PhD,b and Leon H. Kircik MDc-e| |
J Drugs Dermatol. 2013;12(3):292-298.
Martha H. Viera MD, Caroline V. Caperton MD MSPH, Brian Berman MD PhD| |
Occurring with higher proportions in skin of color, keloid formation is seen in individuals of all races, with the lowest incidence in albinos. Interestingly, prevalence of keloids is correlated to skin pigmentation, with dark-skinned individuals suffering disproportionately. Many factors are taken into consideration when deciding which modalities to use in the treatment of keloids, including size, anatomical site, cause, symptoms, duration of treatment and not least importantly, pigmentation of the patient. In patients with skin of darker color it is necessary to communicate the effects these treatments may have on epidermal pigmentation to the patient. Of course, the best treatment for keloids remains prevention. Physicians should be alert to delays in wound healing, persistent erythema, or pruritus as impending symptoms of possible keloid formation and make all reasonable attempts to reduce inflammation and tension on the skin with appropriate methods.
J Drugs Dermatol. 2011;10(5):468-480.
A Review of Clinical Trials Conducted With Oral, Multicomponent Dietary Supplements for Improving Photoaged Skin
Jay Birnbaum PhD,a Anne Le Moigne,b Lisa Dispensa MS RD,c and Larry Buchner BAd| |
J Drugs Dermatol. 2015;14(12):1453-1461.
Natalie A. Wright MDa and Philip R. Cohen MDb-d| |
Fixed drug eruption, a medication-associated mucocutaneous reaction, rarely presents as a delayed adverse reaction to intravenous non-ionic contrast media. We describe a 57-year-old woman with a history of metastatic renal cell carcinoma who repeatedly developed a sharply demarcated, erythematous patch on her left breast after receiving the iodinated non-ionic contrast media iohexol for staging computed tomography scans. Recurrent fixed drug eruption may be avoided by using another contrast medium. Prophylactic treatment with systemic corticosteroids may prevent repeated fixed drug eruption if an alternative contrast agent cannot be used.
J Drugs Dermatol. 2011;10(7):802-804.
Cosmetic Use of AbobotulinumtoxinA in Men: Considerations Regarding Anatomical Differences and Product Characteristics
Jason D. Bloom MD,a Jeremy B. Green MD FAAD,b Whitney Bowe MD,c Erika von Grote PhD,d and Alessandra Nogueira MDd| |
Among the product options available in the US, Dysport® (abobotulinumtoxinA) (Galderma Laboratories, L.P., Fort Worth, Texas) is unique in that its recommendations for reconstitution provide the clinician with 2 different final product concentrations. The flexibility provided by a variable dose may be a valuable tool for tailoring treatments to male patient-specific needs, which may include a more conservative outcome, maintaining a certain degree of muscle activity and expressivity. Achieving a conservative outcome may be the key to a positive experience for the male patient.
J Drugs Dermatol. 2016;15(9):1056-1062.
Evaluation of the Safety and Efficacy of a Non-contact Radiofrequency Device for the Improvement in Contour and Circumferential Reduction of the Inner and Outer Thigh
David McDaniel MDa and Petra Samková MDb| |
MATERIALS AND METHODS: A total of 30 female subjects age 32 to 59 (average 42.4) were enrolled in the study. After meeting the inclusion/ exclusion criteria each subject received 4 weekly 30-minute bilateral thigh treatments (1 hour total treatment time). As the primary outcomes, circumferential reduction was measured and clinical before and after photographs were taken for assessment. Safety of the device was assessed by means of reported adverse events.
RESULTS: All 30 subjects completed the entire treatment series and 1 month follow-up visit. The average reduction measured on both thighs was 3.86 cm with statistical significance P< 0.05. There was no significant change in weight for any of the subjects. During the course of the study two adverse events occurred, but were deemed unrelated to the treatment.
CONCLUSIONS: Based on the measurements obtained the device under investigation was considered safe and effective in terms of improved contour and circumferential reduction of inner and outer thighs.
J Drugs Dermatol. 2015;14(12):1422-1424.