Search Results for "Sclerotherapy and Vein Treatments"
Stephanie W. Lai MD, Mitchel P. Goldman MD
Background: Sclerotherapy has become the gold standard in the treatment of varicose veins. Foam sclerosing solution with
sodium tetradecyl sulfate (STS) is one of the most popular agents used. This study examined the possibility that relative
silicone content of different syringes may affect the overall foam stability.
Materials and Methods: A double-syringe system (DSS) technique to make sclerosing foam (STS 0.5% and air) was applied.
Four different brands of syringes were tested. The time required for half of the original volume of sclerosing solution
to settle was recorded.
Results: The time for the sclerosing solution to settle to half of its initial volume varied with each brand of syringes.
Conclusion: The type of syringe used in the DSS technique to produce foam for sclerotherapy is a determinant of foam
stability. Whether this will affect the result of sclerotherapy requires further investigation.
Robert A. Weiss MD, Margaret A. Weiss MD, Girish Munavalli MD MHS, Karen L. Beasley MD
Background and Objectives: Monopolar radiofrequency skin heating coupled with cryogen cooling of facial skin for skin
tightening has been utilized on over 10,000 patients since 2002. In order to establish the actual rate and degree of side effects
in our clinical experience, a retrospective chart review was performed.
Study Design: Charts and clinical images of over 600 consecutive patient treatments between May 2002 and June 2006 using
a monopolar radiofrequency device (Thermacool®, Thermage, Haywood, CA) for skin tightening at the Maryland Laser, Skin
and Vein Institute were retrospectively reviewed. The primary presentation for treatment was skin laxity of the lower face.
Treatment was delivered with a 1-cm2 standard tip at fluences of 81 to 124 J/cm2 (level of 12.5 to 15), a 1-cm2 “fast” tip at
fluences of 62 to 109 J/cm2 (level of 72.0 to 76.0), a 1.5-cm2 “big fast” tip at fluences of 75 to 130 J/cm2 (level of 61.5 to 65),
and a 3-cm2 “bigger” tip at equivalent fluences as each became available. As treatment algorithms evolved over 4 years,
the algorithm of multiple passes at lower fluence associated with better clinical outcomes and greater patient acceptance has
Results: The most common immediate and expected clinical effects were erythema and edema lasting less than 24 hours,
although 6 patients reported edema lasting for up to 1 week. There were no permanent side effects. In total, 2.7% of treatments resulted in temporary side effects, the most significant of which was slight depression on the cheedk (n=1), which papules (n = 4) and a linear superficial crust (n=1) with the original tip, all of which resolved within 1 week. One patient reported small erythematous subcutaneous nodules resolving in 17 days. Tenderness of the neck lasting form 2 weeks (n=2) to 3 weeks (n=1) was also reported.
Conclusions: Our data, obtained in an office setting without injectable anesthetic or IV sedation, indicate that monopolar RF for skin tightening is ver safe procedure. The treatment algorithm and tips have evolved over several years leading to increased safety and efficacy. Side effects are infrequent, self-limited, and minor, comparing favorably to other nonablative devices utilized for facial rejuvenation.
Robert A. Weiss, MD and Margaret A. Weiss, MD
Sclerotherapy for varicose and spider veins is a commonly performed procedure in dermatology and dermatologic surgery; before the advent of botulinum toxin injection for wrinkles, it was the most commonly requested cosmetic procedure. The dilemma of choosing a sclerosing agent is particularly acute in the U.S. because of diminished availability of sodium tetradecyl sulfate, and a distinct shortage of available alternatives. It is therefore even more important for dermatologists and other physicians to know how to utilize different classes of solutions to achieve similar results. Over the last two decades, significant progress has been made in understanding which solutions provide better results for any specific vessel size or location. We have had the opportunity to compare a number of solutions side by side in similar size vessels with similar sources of reflux. some differences have emerged between categories of solutions, concentrations of solutions, and the sites at which these agents are injected.
Nathan Cleaver DO,a James Ramirez MD,b and Stuart Gildenberg MDa
INTRODUCTION: Bevacizumab is a recombinant humanized antibody against vascular endothelial growth factor (VEGF). It is approved by the Food and Drug Administration (FDA) for metastatic colorectal cancer, advanced non-small cell lung cancer, metastatic renal cell cancer and glioblastoma. Bevacizumab has also been used off label in ophthalmology for age-related macular degeneration, diabetic retinopathy, retinal vein occlusions, retinopathy of prematurity, and other chorioretinal vascular disorders. Numerous case reports have described various cutaneous reactions in response to bevacizumab therapy including acneiform eruptions and exfoliative dermatitis.
CASE PRESENTATION: We report a case of a 63 year-old Caucasian female who presented with subacute cutaneous lupus erythematosus six weeks after initiating two intravitreal injections of bevacizumab for central serous choroidopathy.
CONCLUSION: We report the first documented case of a cutaneous lupus erythematosus eruption following bevacizumab administration as a monotherapy.
J Drugs Dermatol. 2013;12(9):1052-1055.
David L. Chen MDa and Joel L. Cohen MDa,b
Periorbital veins (POVs) are a common cosmetic concern. Anatomically, POVs are formed by superficial facial veins that start from the bridge of the nose, travel as supraorbital and infraorbital veins, and join venous branches from the lateral forehead and scalp. In patients with fair skin, or in patients whose facial skin is atrophied, POVs can become prominent. This can lead to a fatigued appearance, with perceived “dark circles” around the patients’ eyes. Previously described surgical therapies for prominent POVs are invasive and can leave unsightly scars, and sclerotherapy has been reported to lead to embolization that could lead to blindness. Here, we give examples of the use of 1,064 nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser to non-invasively treat or at least minimize prominent
POVs. We discuss various techniques, and review treatment schedules to achieve the optimal cosmetic outcome. Furthermore, potential pitfalls, such as local site reaction and laser-specific tissue damage, are explored. Overall, Nd:YAG laser does appear to be a safe and effective treatment for POVs that requires minimal post-treatment care.
J Drugs Dermatol. 2015;14(11):1360-1362.
Molly Wanner MD MBA, Mathew Avram MD JD
Cellulite, a skin surface change that is nearly ubiquitous in women, is a condition that remains elusive to treatment. In
fact, no treatment is completely successful as none are more than mildly and temporarily effective. Despite the lack of
evidence to support efficacy, treatment options continue to proliferate. This article will briefly review the currently available
data about cellulite treatments including noninvasive devices such as massage, radiofrequency, and laser and lightbased
treatments; invasive modalities including liposuction, mesotherapy, and subcision; and other treatments including
topical creams and carboxy therapy.
Kenneth R. Beer MD FAAD,a Stephanie Bayers BSBA,b and Jacob Beerc
The periorbital complex is a critical cosmetic unit. Treatments for this region range from topical prescriptions to enhance the brow hair to topical cosmeceuticals that improve the tone and texture of the skin. Lasers, radiofrequency, botulinum toxins, fillers, and a host of other treatments are used to treat the periorbital region. Judicious use of these treatments, alone or in combination, can greatly alter the appearance of the region. However, adverse events may also be associated with these treatments, and the clinician and patients need to consider both the risks and the benefits of treatment prior to embarking upon a regimen.
J Drugs Dermatol. 2014;13(suppl 1):s17-s20.
Shannon Famenini MD and Carolyn Goh MD
Currently, topical minoxidil and finasteride are the only treatments that have been FDA approved for the treatment of female pattern
hair loss and androgenetic alopecia. Given the incomplete efficacy and sife effect profile of these medications, some patients utilize
alternative treatments to help improve this condition. In this review, we illustrate the scientific evidence underlying the efficacy of these
alternative approaches, including biotin, caffeine, melatonin, a marine extract, and zinc.
J Drugs Dermatol. 2014;13(7):809-812.
Navid Bouzari MD, Keyvan Nouri MD, Hossein Tabatabai MD, Zahra Abbasi MD, Alireza Firooz MD, Yahya Dowlati MD PhD
Background: It is generally accepted that multiple laser treatments yield more effective clinical results; however, it is
not clearly known whether increasing the number of treatments would affect the incidence of adverse effect. The main
objective of the study was to assess the role of the number of treatments in the efficacy and safety of laser-assisted hair
removal in a relatively dark-skinned population.
Methods: A retrospective study of 313 consecutive laser-assisted hair removal treatments was conducted on a total of
23 patients (22 women, 1 man) with 58 anatomic areas by means of an alexandrite laser. Skin types of III and IV were
represented. The long-pulsed alexandrite system (Aphrodite, Quanta system, Italy) was used at a 755-nm wavelength
to deliver fluences ranging from 17 to 25 j/cm2 through a 10 mm spot size. The patients were divided into 4 groups
according to the number of treatments (group I ? 4, group II = 5, group III = 6, and group IV ? 7 treatments). Digital
photographs of the patients were used for hair counting. Adverse effects (hyperpigmentation, hypopigmentation, blister,
folliculitis) were questioned. The treatment was defined as successful if there was more than 50% hair reduction
and an absence of the adverse effects.
Results: There was a positive correlation between hair reduction and number of treatments (r = .402, p < .005). The
following side effects were observed: hyperpigmentation (two patients, both in group IV); hypopigmentation (one
patient in group IV) and blister (one patient in group IV); folliculitis (two patients in group III and IV). Treatment was
successful in 48.3% (28 out of 58) of the treatment sites. The success rate was 25% for ?4 treatments, and 76%, 58%,
and 15% for 5, 6, and ?7 treatments respectively (p = .002).
Conclusion: Patients who undergo more treatment sessions achieve a higher rate of hair reduction; although this may
be concomitant with an increase in the incidence of adverse effects. The benefit of more laser treatments should be balanced
with the risk of occurrence of side effects in each patient.
Joseph Bikowski MD FAAD
Clinicians must evaluate a voluminous amount of information from clinical trials when choosing among the growing number
of topical acne treatments. This article describes a simple way to evaluate and broadly compare the efficacy results of
well-controlled phase III clinical trials of topical acne treatments by taking into account the placebo effect (or active control
effect). Key efficacy results are drawn from the package inserts of 7 primary topical acne treatments. To account for
placebo effect, the mean percent reduction with placebo was subtracted from that of the active treatment for each type of
lesion and also calculated as an average of these differences for all lesions. Based upon the principles of research, this method
accounts for within study variances and offers a quick assessment of product efficacy. Clinicians should be cautioned that
this method only allows for broad comparisons and does not establish definitive differences between treatments.
David J. Goldberg MD, Snehal Amin MD, Bruce A. Russell MD, Robert Phelps MD, Norma Kellett MD, Laurence A. Reilly MD
Objectives: To evaluate the clinical efficacy and ultrastructural changes in photodamaged skin after combined 633-nm and
830-nm light-emitting diode (LED) treatments.
Methods: Thirty-six subjects received 9 LED treatments over the course of 5 weeks and were subsequently evaluated for final
clinical improvement 12 weeks after treatment. Five subjects were also biopsied to determine the ultrastuctural posttreatment
changes in collagen fibers.
Results: A statistically significant improvement in wrinkles was seen after profilometric analysis. The majority of subjects
reported improvements in softness, smoothness, and firmness at all time points. Electron microscopic analysis showed evidence
of post-LED treatment of thicker collagen fibers.
Conclusions: 633-nm and 830-nm LED treatments play a role in the treatment of photodamaged skin. LED treatments can be used as either a primary or adjunctive treatment modality.
Kristin L. Bater BAa and Evan A. Rieder MDb
INTRODUCTION: A limited number of treatments have been approved for androgenetic alopecia, however, myriad over-the-counter products for hair loss are available and readily purchased by consumers. This study aims to provide an overview of popular over-the-counter hair loss products and to review the available evidence regarding their use.
METHODS: Top-selling hair loss products were identified using sales data from the online retailer Amazon.com. The active ingredients, consumer ratings, quantity, and price were collected for each product. A search of the literature was conducted for ingredients that frequently appeared on the top-seller list.
RESULTS: Forty-two of the top 50 products met inclusion criteria, including orals (21.4%), topicals (35.7%), or shampoos/conditioners (42.9%). Common active ingredients included minoxidil, nutrients (ie, vitamins, minerals, proteins), and plant-based botanicals. 23.8% of products were FDA-approved treatments for androgenetic alopecia. Evidence for non-approved treatments is limited to small studies without generalizability.
DISCUSSION: While some over-the-counter treatments may be efficacious, more rigorous study is required. Dermatologists should be equipped to discuss the efficacy of these therapies as well as the risks and benefits associated with their use with patients.
J Drugs Dermatol. 2018;17(12):1317-1321.
Gabriella DiMarco MDa and Amy McMichael MDb
INTRODUCTION: Hair loss is a common complaint seen in dermatology clinics. From frustration and attempts at self-help, patients with hair loss may present to the dermatologist with false beliefs, or myths, about the causes of their condition and what treatments are effective.
METHODS: We identified 12 common myths about hair loss, categorized as myths about minoxidil treatment, vitamin and mineral supplements, natural topical treatments, and hair care practices. We performed a PubMed search to find evidence to support or refute each myth.
RESULTS: We found that there is little evidence to support many of these common hair loss myths. In some cases, randomized controlled trials have investigated the effects of particular therapies and point to the effectiveness of certain hair loss treatments.
DISCUSSION: In many cases, there have not been sufficient randomized controlled trials to evaluate the effect of different therapies and hair care practices on hair loss. It is best to guide patients toward treatments with a long track record of efficacy and away from those where little is known scientifically.
J Drugs Dermatol. 2017;16(7):690-694.
Non-invasive procedures for tissue tightening and elevation are new frontiers in dermasurgery. Current methods for achieving
a “nonsurgical face-lift” include radiofrequency and infrared light devices which disrupt non-covalent collagen bonds and
stimulate collagen production. This study evaluated a novel treatment protocol designed to achieve a nonsurgical face-lift
with electrical stimulation of muscle. Thirty-five women were treated with the Pan G Lift (Pan Germinal Systems,
Clearwater, Florida) to enhance skin and induce soft-tissue lifting via hypertrophy of the facial musculature. The protocol
consists of biweekly treatments for 10 weeks followed by monthly maintenance treatments. Results were evaluated by both
the investigating physician and patients for up to 12 months. Estimates of percentage improvement were based on a scale of
1 to 4 (1 = 0%-25% [mild]; 2 = 26%-50% [moderate]; 3 = 51%-75% [good]; and 4 = 76%-100% [marked]). After 10 weeks
(20 treatments), the median lifting improvement scores as assessed by patients and physician were the following: cheeks––2.0
and 2.0, jowls––2.0 and 2.0, and texture––2.0 and 2.0, respectively. Physician-evaluated eye lift and neck lift showed similar
improvement. At 12 months (32 treatments), lifting and skin texture changes (assessed by patients and physician) reached
3.0 to 4.0, respectively, while physician-evaluated eye lift and neck lift achieved at least a 3.0 at 20 and 26 treatments. At
one year (32 treatments), neck lift reached a 4.0. There was no downtime and no complications occurred. The non-invasive,
muscle-stimulating Pan G Lift is a novel procedure that yields significant 3-dimensional improvements of the face and neck
(nonsurgical face-lift), which demonstrates progressive improvement with continued monthly treatments over time.
Gabriele F. Muti MD,a Giorgio Astolfi MD,b Massimo Renzi MD,c and Pier P. Rovatti MDd
To assess the use and safety of calcium hydroxylapatite for volume restoration of the face and hands in clinical practice, subjects from four Italian aesthetic clinics who had received calcium hydroxylapatite augmentation treatment between January 2012 and December 2013 were recruited. Records were retrospectively reviewed for demographic characteristics, number of treatments, area treated, injection depth and volume, method of administration, and adverse events. A total of 1,783 treatments were administered to 800 subjects (female: 93.5%; mean age: 49.6 years). Overall, 620 (77.5%) subjects were treated over two sessions for a particular indication, and 243 (30.3%) treated over three sessions. The most frequently treated areas were the zygomatic area (men: 30.2%; women: 30.6% of all treatments), malar area (24.5% and 24.3%), and marionette lines (18.9% and 11.6%). A cannula was used for most treatments (86.7%). Injection volume ranged from 0.4 mL to 1.5 mL. Injection-site swelling and bruising occurred with 18.2% and 11.3% of treatments, respectively. Most cases resolved within one week and two weeks, respectively. No serious/unexpected adverse events occurred. In clinical practice, calcium hydroxylapatite is a versatile, well-tolerated treatment for filling folds and volume restoration of the face and hands.
J Drugs Dermatol. 2015;14(9):948-954.
Increased understanding of psoriasis has led to a shift in treatments from non-specific immunosuppressants to targeted biologics. Studies in psoriasis have demonstrated minimal risk and substantial benefit. As a result, dermatologists and patients are more frequently choosing biologics as first-line treatments for moderate-to-severe disease as our biologics options have recently increased.
Christopher I. Zoumalan MD FACS
Scar formation is the body’s natural healing response to reestablish dermal integrity following an injury. Excessive scarring, however, can cause significant cosmetic, functional, and psychological problems. A wide variety of topical creams, lotions, and oils are available for scar treatment or wound healing. Sieving through the options and selecting the best option for their patients can be challenging for clinicians, especially given that clinical evidence for many of the active agents in commonly used topical treatments is lacking. The goal of this review is to provide an overview of topical treatments utilized for scar management, including their mechanism of action and evidence of efficacy. As knowledge of the wound healing process is critical to understanding the effects of topical treatments, the pathophysiology of wound healing is also reviewed.
J Drugs Dermatol. 2018;17(4):421-425.
Ross M. Campbell MD, Christopher B. Harmon MD
Liposuction is the gold standard of body contouring procedures. Many patients, however, will not tolerate the invasiveness
and subsequent recovery time associated with this procedure, despite the likelihood of superior results. Consequently,
patients opt for minimally invasive forms of body contouring that require several treatments, have fewer associated side
effects, and afford more modest improvements. The MedSculpt™ device is one such modality that combines computerized
massage, vacuum suction, and ultrasound with a continuous sinusoidal pulse delivered at a frequency of 3 Hz. The efficacy
of this device was assessed in the reduction of thigh and abdominal circumferences. Five patients were included in this pilot
study. A total of 12 treatments were performed on a semiweekly basis to 2 abdomens and 3 pairs of thighs. Photographs
and circumferential measurements of each area were obtained prior to, and at the conclusion of, the treatment course. The
treatments were well tolerated and without side effects. The mean reduction in thigh circumference was 2.25 cm or 4%,
with a 5 cm reduction in 1 subject. Although limited improvement was seen in supraumbilical circumference, the mean
reduction in infraumbilical circumference was 6.5 cm or 7.3%, with a 10 cm reduction in 1 subject. Mild improvement in
skin tone, texture, and the appearance of cellulite was observed in all study participants. The results observed after 12 treatments were similar to or better tan those seen with other minimally invasive, body contouring devices.
Aditya K. Gupta MD PhD FAAD FRCP(C), Michael Uro DPM, Elizabeth A. Cooper BESc HBSc
Methods to treat onychomycosis are varied, using therapies that can be categorized as topical, oral or device-related. Since their
development, oral therapies have represented the gold standard for treatment over other methods. However, efficacy with oral therapies
remains limited, and safety may be an issue, leaving many patients requiring alternative treatments. With research advances,
topical therapies as alternatives for onychomycosis are being investigated with greater interest as new technologies are overcoming
previous limitations of topical treatments, such as lack of nail penetration. New device-related topical therapy methods are particularly
noteworthy, as they may allow for shorter, more convenient treatments for patients, reducing issues with topical compliance, and, in
cases of non-drug light-based therapies, they will avoid potential for drug reactions. Research in these fields is preliminary, and the
impact these methods may have on the future of onychomycosis remains to be seen.
Seth B. Forman MD, Robert Higginson PA-C, Algin B. Garrett MD
A case of psoriasis and psoriatic arthritis in a 38-year-old white male patient infected with human immunodeﬁ ciency virus (HIV) treat-
ed safely and effectively with mycophenolate mofetil (MMF) is reported. Treatments for psoriasis and psoriatic arthritis are manifold,
including topical, oral, intramuscular, intravenous, and subcutaneous therapies. These indicated treatments for psoriasis and psoriatic
arthritis result in suppression of the immune system.
Marco daCosta DiBonaventura PhD, Samuel Wagner PhD RP, Heidi C. Waters MS, MBA, Chureen Carter PharmD, MS
Psoriasis is a chronic autoimmune condition that affects over 7 million Americans, approximately 1–3 percent of the population.
Although there are a number of treatment options currently available, little is known about the treatment patterns of patients. Using
data from 1,006 psoriasis sufferers, the aim of the present study was to analyze patients’ treatment timeline, as well as their
perceptions about these treatments. Most respondents were white, female and had health insurance. The results suggested that
over-the-counter (OTC) and prescription topicals were the most common initial treatments, but systemic orals and biologics were
the most common treatments for patients who required a third-line or fourth-line treatment (and for patients with greater severity).
Treatment dissatisfaction was relatively high, with very few positive attributes associated with the current treatment options. Overall,
this study suggests that treatment options vary (at a statistically significant level) as a function of severity, and many patients, despite
the choices in the number and quality of treatment options, are generally dissatisfied.
Brian Somoano MD, Basil M. Hantash MD PhD, Edgar F. Fincher MD PhD, Peggy Wu MD, Hayes B. Gladstone MD
Background: Recent studies have suggested that a series of low-energy, single-pass ablative laser resurfacing micropeels can reduce
photoaging with decreased downtime. This randomized, prospective single-blinded trial sought to determine the ideal settings
of sequential erbium:yttrium-aluminum-garnet (Er:YAG) laser treatments that maximize efficacy and patient satisfaction.
Methods: Forty-six subjects with mild-to-moderate facial dyschromia and rhytides were evenly randomized to two Er:YAG treatment arms. Patients in the lower fluence (LF) (2.5 J/cm2) and higher fluence (HF) (3.8 J/cm2) groups each received three one-pass, full-face
treatments one month apart. Patient and investigator assessments of rhytides, dyschromia and global appearance were performed
at baseline and at four, eight and 20 weeks using a nominal scale from 1–4. Adverse events and patient satisfaction were also evaluated.
Results: Patient scores showed rhytid improvement only with HF treatments. Investigator scores at three months post-treatment
showed dyschromia was significantly improved in both study arms, with a 24 and 36 percent reduction for the LF and HF groups, respectively.
Global appearance scores improved by 25 and 32 percent, respectively. A trend towards greater post-procedure erythema
and time-to-erythema resolution was observed in the HF group. Mild peeling was the most common adverse event. Individuals who
underwent LF treatments were more likely to pursue future treatments.
Conclusion: Both settings resulted in moderate but significant improvement in dyschromia, although only HF treatment improved
rhytides. The decreased downtime of LF treatments made this the preferred choice of patients.
J Drugs Dermatol. 2011;10(2):179-176.
K. Wade Foster MD PhD, David J. Kouba MD PhD, Jennifer Hayes, Valerie Freeman PA, Ronald L. Moy MD
Liposuction is the gold standard of body contouring procedures. Many patients, however, will not tolerate the invasiveness
and subsequent recovery time associated with this procedure, despite the likelihood of superior results. Consequently,
patients opt for minimally invasive forms of body contouring that require several treatments, have fewer associated side
effects, and afford more modest improvements. The MedSculpt™ device is one such modality that combines computerized
massage, vacuum suction, and ultrasound with a continuous sinusoidal pulse delivered at a frequency of 3 Hz. The efficacy
of this device was assessed in the reduction of thigh and abdominal circumferences. Five patients were included in this pilot
study. A total of 12 treatments were performed on a semiweekly basis to 2 abdomens and 3 pairs of thighs. Photographs
and circumferential measurements of each area were obtained prior to, and at the conclusion of, the treatment course. The
treatments were well tolerated and without side effects. The mean reduction in thigh circumference was 2.25 cm or 4%,
with a 5 cm reduction in 1 subject. Although limited improvement was seen in supraumbilical circumference, the mean
reduction in infraumbilical circumference was 6.5 cm or 7.3%, with a 10 cm reduction in 1 subject. Mild improvement in
skin tone, texture, and the appearance of cellulite was observed in all study participants. The results observed after 12 treatments were similar to or better tan those seen with other minimally invasive, body contouring devices.
Michael H. Gold MD, Julie Biron BS
The use of photodynamic therapy (PDT) with 20% 5-aminolevulinic acid (ALA) for the treatment of acne vulgaris has
been explored. This study evaluates the safety and efficacy of a new Advanced Fluorescence Technology (AFT) pulsed
light source (420-950 nm) for photoactivation in ALA PDT for the treatment of moderate to severe inflammatory facial
acne vulgaris. Nineteen subjects received 4 ALA PDT treatments with the AFT pulsed light source. Treatments were
spaced 2 weeks apart. ALA was incubated for 15 to 30 minutes. At the end of the fourth treatment, the total reductions
in inflammatory and noninflammatory lesion counts were 54.5%and 37.5%, respectively.Median Global Severity Scores
suggest a trend toward reduction after several treatments. Investigator and subject assessments show moderate to marked
improvement in most patients. The new AFT pulsed light source with ALA PDT appears to be a safe and effective modality for the treatment of moderate to severe inflammatory acne vulgaris.
Mark A. Strom BS,a Girish C. Mohan MD,b and Peter A. Lio MDa
Dermatologists frequently employ combination therapy to treat various diseases, but the evidence to support the use of such combinations is often lacking. Synergy is an appealing although somewhat ambiguous concept in medicine. Utilizing synergy allows clinicians to provide the most efficacious combination of treatments to patients, while potentially minimizing adverse effects and reducing the development of drug resistance. Definitions of synergy vary, but ultimately converge on finding a therapeutic advantage in combining treatments. Here we discuss the concept of
Osvaldo Tomás Vázquez-Martínez MD, Jorge Ocampo-Candiani MD, Nora Méndez-Olvera MD, Fitzgeraldo A. Sánchez Negrón MD
We present a case of a 32-year-old male patient with a history HIV infection, who administered vitamin E and almond
oil into the malar region and chin. On histology the main pathological finding was a foreign body granulomatous reaction.
The patient was treated with 20-mg prednisone and intralesional triamcinalone. After three more treatments the
erythema and edema decreased with resolving post-inflammatory hyperpigmentation. We conclude that the use of oral
and intralesional steroids are effective treatments in foreign body reactions.
Laura Jordan DO MS and Hilary E. Baldwin MD b
Stratum corneum (SC) abnormalities are associated with disease-affected skin conditions such as inflammatory acne. Current topical acne treatment options including benzoyl peroxide and retinoids can worsen the barrier dysfunctions by increasing transepidermal water loss, depleting SC vitamin E levels, and relatively decreasing SC thickness. However, strategies exist to employ these treatments in a more effective manner and lessen barrier function disruption including use of less irritating vehicles or concomitant application of moisturizers. Patients also play a role in the outcome of their skin barrier function based on their compliance and administration technique. By increasing patient compliance and proper application of treatments, patient skin barrier function can improve. Additionally, future treatments are on the horizon that may customize acne therapy at a molecular level.
J Drugs Dermatol. 2016;15(10):1170-1173.
Amy Forman Taub MDa,b and Ann Cameron Schieber PA-Ca
The prolonged incubation time of Photodynamic Therapy (PDT) as well as the need for two treatments to achieve high efficacy have motivated physicians to experiment with treatment parameters and PDT enhancements in order to maximize results and practicality.
This review explores recent published strategies including occlusion, temperature elevation, pretreatment with topical 5-FU, and microneedle or laser-assisted reduction of the stratum corneum barrier. All of these innovations improve efficacy, reduce the need for multiple treatments or both, although there are concomitant increases in post-procedure side effects.
J Drugs Dermatol. 2015;14(11):1329-1334.
Jacqueline E. Greb BA, Caren Garber BA, and Alice B. Gottlieb MD PhD
BACKGROUND: Among patients with moderate-to-severe psoriasis, efficacy, and tolerability of available treatments based on psoriatic arthritis (PsA) history are not well-described.
OBJECTIVE: We evaluate disease characteristics and treatment response variation in the moderate-to-severe psoriasis population based on PsA history.
METHODS: Simple-measure for assessing psoriasis activity (S-MAPA) was used to retrospectively analyze treatment responses.
RESULTS: 191 moderate-to-severe psoriatic patients, 58 with and 133 without rheumatologist-diagnosed PsA were analyzed. Regardless of PsA history, S-MAPA improvement was similar with biologic monotherapy (46.2 versus 44.1; P=0.74), traditional systemic monotherapy (62.29 versus 38.12; P=0.22), and combination treatments (64.62 versus 52.71; P=0.40) after 12 weeks. PsA patients on biologic monotherapy experienced a higher infection rate than patients without PsA (0.57% versus 0.19%; P=0.01). PsA patients experienced more adverse events (AEs) associated with traditional systemic monotherapy than biologic monotherapy (3.25 versus 1.04; P=.001).
LIMITATIONS: The relatively small PsA cohort was the primary limitation.
CONCLUSIONS: Patients with moderate-to-severe psoriasis responded similarly to all treatments independent of PsA history. PsA patients received more overall treatments and more biologic monotherapy prescriptions. PsA patients had a greater infection risk on biologic monotherapy compared to those without PsA, and greater adverse events risk on traditional systemic monotherapy compared to biologic monotherapy.
J Drugs Dermatol. 2016;15(8):917-922.
Lin Gao MD PhD,* Ni Gao MD,* Wenting Song MD, Erle Dang MD PhD, Rong Yin MD PhD, Li Wang MD, and Gang Wang MD PhD
Both pulsed dye laser (PDL) and intense pulsed light (IPL) systems have been demonstrated to be effective for treatment of facial telangiectasia, however there have been very few comparative studies between both treatments involving purely Asian patient populations. In this study, we performed a retrospective analysis to compare the efficacy of PDL and IPL systems for the treatment of facial telangiectasia. A total of 416 patients with facial telangiectasia who were treated by PDL or IPLs in our department from August 2012 to March 2015 were included in this study. The subjects received one of the following five treatments: PDL 595 nm (9-12 J/cm2), MaxG (500-670 nm & 870-1200 nm, 30-46 J/cm2), IPL (560-1200 nm, 18-24 J/cm2), M22 560 (560-1200 nm, 15-18 J/cm2), and M22 590 (590-1200 nm, 15-20 J/cm2). Each treatment had two sessions with 6-week intervals. The improvement percentage score in facial telangiectasia after the final treatment was evaluated by two non-treating physicians. We found almost all patients (less than 95.00%) had marked improvements or nearly complete clearance of the lesions after PDL 595 nm or MaxG treatment, as compared to 41.38%-56.58% patients in the other three groups that showed similar degrees of improvements. Both PDL 595 nm (9-12 J/cm2) and MaxG (500-670 nm & 870-1200 nm, 30-46 J/cm2) treatments resulted in significantly superior vessel clearance than the IPL systems with other wavelength bands (560-1200 nm or 590-1200 nm) and relatively lower fluence (15-24 J/cm2). Our results also suggested fluence levels account for the significant differences in the effectiveness delivered by different IPL systems. We concluded that PDL 595 nm and MaxG showed comparable clinical efficacy and both treatments resulted in most beneficial outcomes.
J Drugs Dermatol. 2017;16(11):1112-1116.
Scott A. Davis MAa and Steven R. Feldman MD PhDa-c
BACKGROUND: Psoriasis is treated with several classes of treatments that may be used in combination, but the ways combination therapies are used are not well characterized.
PURPOSE: To determine the frequency of prescribing calcipotriene and other psoriasis drugs in combination.
METHODS: Visits with a sole diagnosis of psoriasis were selected from 1990-2010 data from the National Ambulatory Medical Care Survey. The number of combination therapies used, the leading therapies in each class of medications, and the leading types used in combination were analyzed.
RESULTS: About 10.2 million of 20.3 million psoriasis visits used multiple treatments. The mean number of prescribed medications increased over time (P=.0003). The top 10 treatments included 6 topical steroids, calcipotriene, 2 other topicals, and methotrexate. The most common combinations were topical steroid plus other topical (15.0%), multiple topical steroids (11.5%), topical steroid plus vitamin D analogue (9.7%), and topical steroid plus systemic treatment (6.9%). Vitamin D analogues and systemic treatments were prescribed with increasing frequency over time, while fewer topical steroids were used, and use of other topicals did not change significantly.
LIMITATIONS: Visits with multiple diagnoses had to be excluded to ensure that the medications listed were for psoriasis.
CONCLUSIONS: Combination therapy is the most common way to treat psoriasis in the United States. The wide range of combination therapies prescribed may reflect increased attention to individualization of treatment to match patients’ diverse preferences.
J Drugs Dermatol. 2013;12(5):546-550.
Lucija Kroepfl MBChBa and Jason J. Emer MDb
Acne is one of the most prevalent skin conditions seen by dermatologists. The cosmetic sequelae of severe acne, including scarring and pigmentation, have a profound psychological impact on those in icted. Topical (eg, retinoids, antibiotics, dapsone, hydroxyacids) and oral treatments (eg, antibiotics and/or spironolactone) are often bene cial to control acne or in the instance of oral isotretinoin use, rid the acne permanently; however, these treatments have very little affect on the ultimate cosmetic outcome of the acne scarring and skin texture that results. Given the variety of scar types that can form and the variability of responses seen in various skin types and textures, treatment options are vast without appropriate guidelines for pathways that dictate best timing, combinations, and options in given clinical scenarios. Current treatment options include solo or combina- tions of energy-based (eg, laser, radiofrequency), chemical-based (eg, peels, TCA cross), surgical-based options (eg, subcision, punch excision), microneedling, and llers and/or fat injections. Most recently, fractional radiofrequency-based treatments have been used to improve acne scarring with less reported downtime as compared to lasers or chemical peels and the ability to treat darker or sensitive skin types with less risk of scarring or hyperpigmentation. In severe cystic ares, scarring treatments are often postposed till the acne is under control and in many instances this can limit the dermatologists ability to affect future cosmetic treatments. Based on personal experience of various clinical scenarios in a busy laser practice that treats a signi cant number of patients with acne scarring, fractional radiofrequency is an excellent choice for treating all forms of acne scars with minimal risk to patients, even those on concurrent treatments such as isotretinoin. Additionally, fractional radiofrequency can be used in combination with all other treatment options to speed the time to clinical improvement appreciated by the patient. Here we present personal experiences of combination treatments for acne scarring, pigmentation and textural issues, and suggest that fractional radiofrequency be considered a “gold standard” treatment of acne scarring in those with dark or sensitive skin types or those on concurrent isotretinoin.
J Drugs Dermatol. 2016;15(11):1413-1419.
John Patrick Welsh MD, Carrie Ann Cusack MD, Christine Ko MD
Background: Carbon dioxide laser resurfacing remains the gold standard for the treatment of photoaged skin. Today, however,
fewer patients will tolerate the postoperative downtime associated with the use of this device. Fractional photothermolysis
was designed to overcome the disadvantages associated with ablative resurfacing. Prototype fractional lasers
(Fraxel®, Reliant Technologies Inc.) have required the use of blue tracking dye to give evenly spaced microtreatment zones,
and treatments are associated with moderate levels of discomfort because of microtreatment zone depths reaching
nearly 1000 ?m. Newer technologies have evolved that do not require tracking dye, and are less painful than older prototypes because microtreatments are associated with moderate levels of discomfort because of microtreatment zones are more superficial (100 to 300um) than that of the Fraxel laser. Newer devices offere advances in treating facial ryhtides and skin laxity through the use of 2 laser wavelengths (1320 nm/1440 nm)emitted sequentially through a specialized diffractive lens array that produces high-intensity microtreatment zones surrounded by low level heating.
Observations: One to 3 treatments with this combination fractional laser device were performed on 16 Caucasian females with static periocular rhytides or skin laxity affecting the nasolabial crease. There was a 3-week period between treatments. Improvement was noted in both areas after a small number of treatments.
Conclusion: The technology behind fractional lasers is rapidly evolving, and new devices offer significant advances over older prototypes. where id= 776;
Anne Han MD, Carolin Penrose MD, Arathi Goldsmith DO, Ellen S. Marmur MD
Dermatologic conditions associated with prolonged sun exposure represent a substantial portion of visits to the dermatologist’s office,
particularly among elderly populations. Actinic keratoses are premalignant lesions that increase in frequency with each decade
of life and have the potential to progress to squamous cell carcinoma. Non-melanoma skin cancers, such as squamous cell carcinoma
and basal cell carcinoma, also represent sun-related conditions that require early and aggressive treatment. Therapeutic options for
these conditions are abundant and range from topical field-directed therapies to destructive, lesion-directed procedures. Choice of
therapy depends on the types and extent of lesions with which a patient presents; often, a combination of treatments provides the
optimal means for successful outcomes. The following case-based review represents typical situations where multiple treatments
were combined to manage actinic keratosis, squamous cell carcinoma and basal cell carcinoma in patients over an extended treatment
No abstract details for the moment.
Anthony Chiaravalloti MDa and Michael Payette MD MBAb
IMPORTANCE: Hailey-Hailey disease, or familial benign chronic pemphigus, is a rare genodermatosis that can be challenging for both patients and dermatologists as the disease can significantly impact patients’ quality of life and is often difficult to control. In recalcitrant cases, multiple treatment modalities are often needed to obtain benefit. Unfortunately, most of the available evidence pertaining to treatment is scattered across case reports and retrospective analyses.
OBJECTIVE: To review successful treatments of Hailey-Hailey, synthesize the evidence, and provide recommendations for therapy.
Findings: The best evidence exists for treatment with topical steroids and topical antimicrobials. Refractory disease has shown the most benefit with addition of oral antibiotics, excisional procedures and botulinum toxin A. Other therapies are described but with much less supporting evidence.
CONCLUSIONS: Herein we review the literature to identify successful treatments for Hailey-Hailey disease. We have outlined the treatments with the most evidence. The difficult nature of treating this disease requires that clinicians approach each patient differently. The literature shows that no one regiment works for all patients.
J Drugs Dermatol. 2014;13(10):1254-1257.
S. Ray Peterson, MD and Leonard H. Goldberg, MD, FCRP
No abstract details for the moment.
Jill Waibel MD, Kenneth Beer MD
Burn scars are the result of wound healing following a partial-thickness or full-thickness thermal injury. Thermal injury can frequently
result in extensive scarring, which may have profound psychologic impact on the victim, serving as a visible and palpable reminder
of a traumatic event. Standard treatments for scars include the use of skin grafts, intralesional steroid injections, and pulsed-dye
laser treatments. The authors have previously described successful treatment of a burn scar with nonablative fractional resurfacing.1
Ablative fractional lasers may offer burn patients advantages over nonablative techniques, including improved function and cosmetic
outcomes. In addition, ablative fractional laser may require fewer treatments, and therefore, be a more cost-effective treatment
option for patients.
The authors report the use of fractional ablative laser for the treatment of a disfiguring scar that was more than 50 years old. To our
knowledge, this is the first report of this technology for the treatment of a scar resulting from a third-degree burn in the literature.
The demonstrated successful outcome in this case patient may indicate a progessive treatment option for many patients who have
been disfigured by these types of thermal injuries.
Jose Raúl Montes MD FACS FACCS and Elizabeth Santos DrPH
Men’s interest and participation in cosmetic procedures has increased in recent years; however, the factors that motivate or discourage men from undergoing these procedures is not well understood. To evaluate which factors impact men’s decisions towards cosmetic procedures, an observational, single-site, cross-sectional study utilizing a voluntary questionnaire was executed in a target population size of 209 men ≥21 years old who visited the study site from 2015 to 2017. A majority of the male respondents incorporate a basic skincare regimen into their daily routine (90%), have had experience with neurotoxin treatments (54%), and expressed interest in either neurotoxin or dermal filler treatments (77% and 83%, respectively). The main motivating reason to undergo a cosmetic procedure was pursuit of a youthful appearance and the main discouraging reasons were cost and time for appointments or recovery. This study suggests that a majority of our male patients have either embraced or are interested in cosmetic treatments, but the cost and time play a big role in their decision. As cosmetic providers, we should reflect a commitment to the male population through marketing efforts and offerings to increase participation in minimally invasive aesthetic procedures.
J Drugs Dermatol. 2018;17(9):941-946.
Severe childhood atopic dermatitis refers to the presence of recurrent, widespread, eczematous dermatitis that significantly interferes with the daily activities and/or the quality of life of the affected child and family. The vast majority of children with severe, long-standing atopic dermatitis can be managed with the appropriate use of topical treatments, including long-term maintenance therapy and adjunctive treatments. In the recalcitrant patient, second line therapies such as narrowband ultraviolet light therapy and systemic immunosuppressants such as cyclosporine, azathioprine, mycophenolate moefetil, and methotrexate have been shown to be safe and effective in children with severe atopic dermatitis and can lead to sustained clinical improvement. To date, biologic therapy has not been uniformly effective in childhood atopic dermatitis. Management of severe childhood atopic dermatitis, including topical and adjunctive treatments and second-line therapies including systemic immunosuppressants will be reviewed here.
J Drugs Dermatol. 2012;11(10):1158-1165.
Marie Rosalette Mortel BS and Jason Emer MD
Psoriasis and psoriatic arthritis are immune-mediated, chronic, inflammatory diseases that place a heavy burden on the lifestyle of
patients affected. Current understanding of the pathophysiology of these conditions has produced very encouraging new medical
developments, largely a consequence of research that has targeted precise elements of the immune cascade, expanding the repertoire
of therapeutic options available to dermatologists. Promising new treatments, such as antibodies to interleukin-12 and -23,
show superior efficacy and safety in treating psoriasis; the more sophisticated tumor necrosis factor antagonists significantly improve
symptoms of rheumatic and psoriatic arthritis and may also be effective in the treatment of plaque psoriasis. In this article, innovative,
new treatments for psoriasis and psoriatic arthritis are critically reviewed.
Eliot F. Battle Jr. MD
No abstract details for the moment.
J. Mark Jackson MDa and Michelle Pelle MDb
Many topical medications are available for the treatment of papulopustular rosacea. While treatments contain metronidazole, azelaic
acid, or sodium sulfacetamide-sulfur as the active ingredient, the composition of the vehicle formulations varies widely. These vehicles
come in gels, creams, lotions and foams; some ingredients are common to many vehicles, while some vehicles contain unique
ingredients designed to optimize skin penetration and delivery of the active drug to its target. Vehicles can also influence tolerability,
which is always a concern in patients with heightened skin sensitivity, and compliance, which is typically lower for topical treatments
than oral treatments. Ideally, the vehicle of any rosacea treatment should enhance drug delivery, be nonirritating and be easy to use.
Ingredients that help repair barrier function are also desirable. This review will focus on the key components of the vehicles from
the most commonly used topical therapies for papulopustular rosacea and how vehicle formulations influence the delivery of active
ingredient, skin barrier repair, tolerability and compliance.
J Drugs Dermatol. 2011;10(6):627-633.
Elmer David MD,a Hanan Tanuos MD,a Timothy Sullivan MD,b Albert Yan MD,c and Leon H. Kircik MDd-f
This study was a multicenter, double-blind, placebo-controlled, parallel-group pilot study of efficacy and tolerability of a nonsteroidal cream (Promiseb® Topical Cream; Promius Pharma, LLC, Bridgewater, NJ) for treatment of cradle cap when applied topically twice daily for up to 14 days in 42 pediatric subjects. Both treatments were similarly effective in reducing disease severity, as measured by success with Investigator's Global Assessment scores at day 7 or end of treatment, with 96% of subjects achieving success in the nonsteroidal cream group and 92% of subjects achieving success in the placebo cream group. Both treatments resulted in significant reductions from baseline in terms of erythema, crusting, scaling, and oiliness (P<.05), with no significant difference between treatments. There was a significant difference (P=.03) between treatment groups for percent reduction in scaling at the end of treatment, with a 90% reduction in the nonsteroidal cream group compared with a 58% reduction in the placebo cream group. All subjects in both groups had an overall safety score of excellent, and there were no adverse events related to treatment for either group.
J Drugs Dermatol. 2013;12(4):448-452.
Androgenetic alopecia is the progressive miniaturization of the scalp’s terminal follicles in aging men. Over 40% of Caucasian men develop
hair loss by the age of 40. Despite its prevalence, there are only two FDA approved medications to treat the condition. Recognizing
the unmet need, new medical, procedural, and surgical treatments are being adopted to combat progressive hair loss. This review examines emerging hair loss treatments including medical therapies that the target prostaglandins, low level light therapy, platelet rich plasma injections, and robotic hair transplantation.
J Drugs Dermatol. 2015;14(9):1036-1040.
Kosta Y. Mumcuoglu PhD
Of the pediculicides on the market, most are not 100% ovicidal and don’t have a residual activity of more than 2 days.
Therefore, at least 2 treatments are necessary to control the entire louse population. In order for a pediculicide to be effective
it should kill all active stages of the louse after a single treatment. Otherwise remaining lice will continue laying eggs
and the following treatments will not be fully effective, at least against the eggs. However, there is no general consensus as
to when the second treatment should be conducted. Taking into consideration that head louse eggs hatch between 5 to
11 days, it is suggested that a second treatment should be administered 10 days after the beginning of the treatment. This
might also explain why most of the clinical trials that were conducted by treating the patients twice with an interval of 6,
7, or 8 days showed a poor efficacy, and clinical trials where the pediculicide was applied with an interval of 10 days showed
an efficacy level of more than 90%.
K. Wade Foster MD PhD, David J. Kouba MD PhD, Edgar F. Fincher MD PhD, Zachary S. Glicksman, Jennifer Hayes, Valerie Freeman PA, Helen H. Fincher MD, Ronald L. Moy MD
Background: Carbon dioxide laser resurfacing remains the gold standard for the treatment of photoaged skin. Today, however,
fewer patients will tolerate the postoperative downtime associated with the use of this device. Fractional photothermolysis
was designed to overcome the disadvantages associated with ablative resurfacing. Prototype fractional lasers
(Fraxel®, Reliant Technologies Inc.) have required the use of blue tracking dye to give evenly spaced microtreatment zones,
and treatments are associated with moderate levels of discomfort because of microtreatment zone depths reaching
nearly 1000 ?m. Newer technologies have evolved that do not require tracking dye, and are less painful than older prototypes because microtreatments are associated with moderate levels of discomfort because of microtreatment zones are more superficial (100 to 300um) than that of the Fraxel laser. Newer devices offere advances in treating facial ryhtides and skin laxity through the use of 2 laser wavelengths (1320 nm/1440 nm)emitted sequentially through a specialized diffractive lens array that produces high-intensity microtreatment zones surrounded by low level heating.
Observations: One to 3 treatments with this combination fractional laser device were performed on 16 Caucasian females with static periocular rhytides or skin laxity affecting the nasolabial crease. There was a 3-week period between treatments. Improvement was noted in both areas after a small number of treatments.
Conclusion: The technology behind fractional lasers is rapidly evolving, and new devices offer significant advances over older prototypes.
Kenyatta Mireku BS,a Karen E. Huang MS,a Swetha Narahari MD,a Scott A. Davis MA,a and Steven R. Feldman MD PhDa,b,c
BACKGROUND: Many factors, including patients' methods of payment, may influence psoriasis treatment decisions.
OBJECTIVE: To characterize psoriasis treatments by patients' types of payment in the US outpatient office setting.
METHODS: Using the National Ambulatory Medical Care Survey (NAMCS), a large survey that samples outpatient office visits to US non-federally funded physicians, visits linked with sole diagnoses for psoriasis (ICD-9-CM: 696.1) were identified. There were 545 unweighted records. The types and number of treatments prescribed at these visits were categorized by expected major payment type to be used for the visit.
RESULTS: Mainstay psoriasis therapies such as vitamin D analogs and clobetasol were prescribed regardless of payment type. Retinoids were also within the most frequently prescribed psoriasis medications for all payment types, however they were less frequently prescribed than vitamin D analogs. Payment type did not have a significant effect on the number of medications prescribed at psoriasis visits.
LIMITATIONS: Data on treatment adherence and filling of prescriptions are not included in the NAMCS database.
CONCLUSION: Prescribing patterns for psoriasis medications are similar across payment type. Additional factors appear to modulate therapy choice for patients with psoriasis.
J Drugs Dermatol. 2013;12(10):1095-1097.
E. Victor Ross MD, Michael Swann MD, Seaver Soon MD,Arash Izadpanah MD, David Barnette MD,Scott Davenport BA
Background: Traditional full-face resurfacing has been limited to erbium-doped yttrium aluminium garnet (Er:YAG) and carbon dioxide
(CO2) lasers. These devices offer wavelength-specific advantages and disadvantages.
Methods: Nine patients were enrolled in a pilot study of a resurfacing system using a 2790-nm erbium:yttrium-scandium-galliumgarnet
(Er:YSGG) laser system. Two treatments were carried out 1 month apart over the entire face. Test spots were performed
prior to the full-face sessions to determine the optimal fluence for 1-pass laser resurfacing. Biopsies were performed at the time
of treatment and at the final follow-up visit one month after the second treatment. Clinical endpoints included changes in pigment
dyschromias, wrinkles, and skin tone. All outcomes were graded by blinded observers.
Results: Eight patients completed the 2 treatments. Biopsies showed thermal damage extending as deep as 80 μm below the stratum
corneum. Reepithelialization was complete within 4 days. No scarring, post inflammatory hyperpigmentation (PIH), or infections
Conclusion: A 2790-nm laser can be used for skin rejuvenation with a 4 day recovery window.
Emily P. Tierney MD and C. William Hanke MD MPH
Background: Previous laser treatments for Poikiloderma of Civatte (PC) (i.e., Pulsed dye, Intense Pulsed Light, KTP and Argon) are
limited by side effect profiles and/or efficacy. Given the high degree of safety and efficacy of ablative fractional photothermolysis
(AFP) for photoaging, we set out to assess the efficacy of PC with AFP.
Design: A prospective pilot study for PC in 10 subjects with a series of 1−3 treatment sessions. Treatment sessions were administered
at 6−8 week intervals with blinded physician photographic analysis of improvement at 2 months post-treatment. Evaluation was
performed of five clinical indicators, erythema/telangiecatasia, dyschromia, skin texture, skin laxity and cosmetic outcome.
Results: The number of treatments required for improvement of PC ranged from 1 to 3, with an average of 1.4. For erythema/telangiecatasia,
the mean score improved 65.0% (95% CI: 60.7%, 69.3%) dyschromia, 66.7% (95% CI: 61.8%, 71.6%), skin texture,
51.7% (95% CI: 48.3%, 55.1%) and skin laxity, 52.5% (95% CI: 49.6%, 55.4%). For cosmetic outcome, the mean score improved
66.7% (95% CI: 62.6%, 70.8%) at 2 months post treatment.
Conclusion: In this prospective study, AFP was both safe and effective for the treatment of the vascular, pigmentary and textural
components of PC. The degree of improvement observed in wrinkling, creping and laxity after AFP has not been reported with prior
laser treatments for PC.
Neil S. Sadick MD,1 Yoram Harth MD,2,3 Andrew S. Dorizas MD,6 Hanna Levy PhD,4 and Avner Shemer MD5
BACKGROUND: In the last decade, energy-based aesthetic treatments, using light, radiofrequency (RF), and ultrasound, have gained scientific acceptance as safe and efficacious for non-invasive treatment for aesthetic skin disorders. The phase-controlled multisource radiofrequency technology (3DEEP™), which is based on the simultaneous use of multiple RF generators, was proven to allow significant pigment-independent dermal heating without pain or the need of epidermal cooling. This study was performed in order to evaluate the efficacy and safety of a new handheld device delivering multisource radiofrequency to the skin for wrinkle reduction and skin tightening in the home setting.
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.
Alexander L. Berlin MD, Mussarrat Hussain MD, Robert Phelps MD, David J. Goldberg MD
Background and Objective: Studies documenting improvement following combined laser and light-based devices are
needed. The objective of this study was to evaluate clinical, histological, and ultrastructural changes in photodamaged
facial skin following sequential treatment with ablative superficial erbium:YAG (Er:YAG) laser peels and nonablative
intense pulsed light, or broadband light (BBL), treatments.
Study Design/Materials and Methods: Fifteen subjects with photodamaged facial skin and Fitzpatrick skin types I to III
underwent 3 monthly treatments with the Profile™ system (Sciton, Inc, Palo Alto, CA) utilizing very superficial
MicroLaserPeel™ settings of 2.5 to 5.0 J/cm2 and BBL™ settings of 515-, 560-, or 590-nm filters, 10-msec pulse duration,
and fluences of 12 J/cm2. Five subjects underwent pre- and post-treatment postauricular skin biopsies for evaluation of
treatment-induced light and electron microscopic changes.
Results: Twelve subjects completed the study. Both blinded evaluator and subject assessment of clinical changes documented
significant improvement in photodamaged skin, with the greatest improvement achieved in overall appearance
and epidermal dyspigmentation. These results were largely maintained at 3 months following the last treatment. Light
microscopy showed changes in the epidermis, collagen, and elastic fibers consistent with a wound repair mechanism to
the depth of 250 to 350 microns. Electron microscopy revealed a slight decrease in the average collagen fiber thickness,
pointing to an increase in type III collagen.
Conclusion: A protocol utilizing multiple combined superficial Er:YAG ablative treatments and nonablative BBL treatments
lead to a significant improvement in the clinical signs of photodamaged skin, with histological and ultrastructural
evidence of new collagen formation.
John J. Kohorst,a Clinton Hagen,b Christian L. Baum MD,c Mark D. P. Davis MDc
BACKGROUND: Treatment of hidradenitis suppurativa has been studied, but treatment strategies and outcomes have not been reported
for a large community-based group of patients.
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.
Stephanie J. Kang DO,a Scott A. Davis MA,a Steven R. Feldman MD PhD,a,b,c and Amy J. McMichael MDa
BACKGROUND: Dyschromias are becoming a more common concern among patients, particularly among persons of color. There are a variety of treatments, including more novel agents for dyschromias. Evaluating common agents prescribed among various races may prompt efforts to enhance care for dyschromias in patients of color.
OBJECTIVE: To determine whether racial or ethnic groups are treated differently for dyschromia. The secondary objective is to discover the main treatments used and determine trends over time in demographics.
METHODS: We searched the 1993-2010 National Ambulatory Medical Care Survey (NAMCS) for visits associated with a diagnosis of dyschromia (ICD-9 codes 709.00 or 709.09). The demographics and leading treatments were tabulated, and trends over time were assessed by linear regression.
RESULTS: There were about 24.7 million visits for dyschromia over the 18-year period. Among 5,531,000 patients with the sole diagnosis of dyschromia, there were 2,800 visits from females and 1,200 visits from males per 100,000 population. Females were more likely to receive prescription combination therapy for dyschromia than males by a ratio of 10 to 1. Leading treatments overall prescribed by dermatologists included hydroquinone, topical corticosteroids, and retinoids. Asians were 27% more likely to receive a combination therapy than non-Asians. African Americans and Hispanics were less likely to have a procedure performed for dyschromia.
LIMITATIONS: Data are based on a number of ambulatory care visits, which does not allow direct estimation of prevalence.
CONCLUSIONS: Dyschromia is a significant concern for many patients, and this is especially true among patients of color. Treatment for dyschromia is influenced by skin type, and thus ethnic or racial groups are treated differently. Studies have shown that combination therapy may offer better results than a single medication for hyperpigmentation disorders. Combination agents may be underutilized in African Americans and Hispanics for dyschromia.
J Drugs Dermatol. 2014;13(4):401-406.
Lana X. Tong MD MPH and Jeremy A. Brauer MD
Introduction: Acne vulgaris is common dermatologic condition with an estimated prevalence of 70 to 87%. Acne has been shown to have a significant impact on patient quality of life and mental health, especially as inflammatory lesions typically occur on cosmetically sensitive areas with the potential for permanent scarring. There have been numerous advances in the treatment of inflammatory acne with light-based and laser devices.
Objective: To review the current evidence for light-based and laser treatments in the management of inflammatory acne.
Methods: An analysis was conducted of PubMed indexed English language literature regarding management of inflammatory acne using light-based and laser treatments.
Results: Evidence for the utilization of laser and light-based therapy for acne was summarized in a comprehensive review. Laser and light-based treatment holds the advantages of improved patient compliance and safety profiles in comparison to pharmacologic therapy. Efficacy of device based treatment varied in comparison to standard topical treatment regimens, often more effective when used in combination therapy. Adverse effects reported were generally self-limited.
Discussion: These treatments do and will continue to play an important and enlarging role in the management of acne. Larger scale studies with standardization of treatment protocols are warranted.
J Drugs Dermatol. 2017;16(11):1095-1102.
Pedram Ghasri BS,a Brad A. Yentzer MD,a Tushar S. Dabade MD,a Steven R. Feldman MD, PhDa,b,c
Background: Combination therapy is a common and appropriate treatment strategy for moderate-to-severe psoriasis, as it provides for enhanced efficacy and decreased toxicity compared to the use of a single agent. Acitretin is an effective oral retinoid for psoriasis that seems to find its greatest value when complemented by other topical and systemic treatments.
Objective: The primary aim of this study is to assess the use of acitretin in combination with other treatments for psoriasis.
Methods: We assessed the use of acitretin for the treatment of psoriasis using nationally representative survey data from the
National Ambulatory Medical Care Survey (NAMCS).
Results: Among visits where acitretin was listed in the NAMCS, other psoriasis medications were co-prescribed in 62 percent of visits. The co-prescribed medications included topical corticosteroids (51%), calcipotriene (31%), biologics (6%), cyclosporine (5%), methotrexate (5%) and tazarotene (2%).
Conclusion: The use of acitretin in combination with other psoriasis treatments, particularly topical corticosteroids and calcipotriene, is a common practice. Acitretin is co-prescribed with the biologics, likely because of the relative lack of overlapping effects on immune
function. The immune-sparing method of action of acitretin makes combination treatment with the systemic agents an attractive
treatment option, especially in patients where further immunosuppression is unwarranted.
J Drugs Dermatol. 2011;10(8):876-880.
Inna Belenky PhD, Cruzy Tagger MD, and Andrea Bingham RE
The widely used intense pulse light (IPL) technology was first commercially launched to the medical market in 1994 and similar to lasers,
is based on the basic principle of selective photothermolysis. The main conflict during treatments with light-based technologies is between safety and efficacy of the treatment. The aim of this study was to evaluate new IPL technology, which integrates three different
pulse configurations, with specific attention on the safety and efficacy of the treatment. 101 volunteers (with Fitzpatrick skin types I-VI) were treated as follows: 9 patients underwent 8 bi-weekly acne clearance treatments, 51 patients underwent 6-12 hair removal treatments, 11 patients were treated for general skin rejuvenation, 15 patients were treated for pigmentation lesions, and 15 patients were treated for vascular lesions. No serious adverse events were recorded. All patients that were treated for hair removal achieved significant
hair clearance. The patients with facial rosacea responded the fastest to the treatment. Eight of nine patients that were treated for acne clearance achieved significant reduction in acne appearance. The results represented in this study support the approach that when taking into consideration both efficacy of the treatment and safety of the patients, the system should be “flexible” enough to allow exact treatment settings profile for each patient, according to their skin type and the symptom’s biophysical characteristics.
J Drugs Dermatol. 2015;14(11):1255-1260.
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
Men represent an important evolving segment of the cosmetic market. With the growing acceptability of cosmetic procedures along with societal and workplace pressure to maintain youthfulness, men increasingly seek the advice of aesthetic practitioners. Despite this so-called "Menaissance," there is a paucity of published literature regarding laser and light treatments of male skin. Herein the differences in male cutaneous physiology are addressed, followed by a review of light-based treatment of conditions largely unique to male skin, pseudofolliculitis barbae, and rhinophyma. Next, the publications related to laser treatment of male skin specifically are examined. We conclude with a discussion of personal observations derived from clinical experience with laser and light-based treatments in men.
J Drugs Dermatol. 2015;14(9):1061-1064.
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.
Nazanin Saedi MDa and Anand K. Ganesan MDb
BACKGROUND: The treatment of hyperpigmentation in darker-skinned patients (Fitzpatrick skin phototypes III-VI) has remained challenging for dermatologists. No studies have been conducted on hyperpigmentation under the eyes, axilla, and neck in darker-skinned patients. This survey was designed to assess current treatments of hyperpigmentation in these areas.
MATERIALS/METHODS: With approval from the institutional review board at the University of California, Irvine, an electronic survey was sent to practicing dermatologists that contained 18 questions regarding the approach to evaluating and treating hyperpigmentation under the eyes, in the axilla, and along the neck.
RESULTS: Fifty dermatologists completed the survey, and 46 (92%) reported treating patients with darker skin. The ethnic groups treated were Latino (97.8%), African American (97.8%), Middle Eastern (77.6%), and Asian (88.9%). Thirty-six reported treating patients with hyperpigmentation under the eyes, and 22 (61.1%) thought the hyperpigmentation was a result of idiopathic increase in melanin deposition. Forty-two responded to treating hyperpigmentation in the axilla, most of whom thought it was related to acanthosis nigricans (69.0%) or contact dermatitis (59.5%). Forty responded to treating hyperpigmentation on the neck, most of whom treated the condition with hydroquinone (66%). Treatments for these 3 areas were not found to be effective.
CONCLUSIONS: Hyperpigmentation under the eyes, under the arms, or on the neck is a significant problem in darker-skinned patients that is refractory to currently available treatments, highlighting the necessity of developing treatment approaches directed toward this population. Two cases of hyperpigmentation on the neck are presented, describing a new entity that primarily affects dark-skinned individuals.
J Drugs Dermatol. 2013;12(5):563-567.
Meredith K. Shaw,a Scott A. Davis MA,a Steven R. Feldman MD PhD,a,b,c and Alan B. Fleischer Jr. MDa
BACKGROUND: Moderate-to-severe psoriasis generally requires systemic therapy, and is often undertreated.
OBJECTIVE: To determine and analyze what courses of treatment and in what frequency are being utilized to combat psoriasis in the
METHODS: Analysis of data from the National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical
Care Survey (NHAMCS) of the National Center for Health Statistics. Data were analyzed to examine the prevalence of different therapy
techniques to combat psoriasis from 1993 through 2010. The trends for phototherapy, methotrexate (MTX), retinoids, cyclosporine A
(CSA), systemic steroids, and biologics were all analyzed over the entire 18-year period and independently before and after the introduction
of biologics in 2002.
RESULTS: From 1993 to 2010, the trend for total systemic treatments has not significantly increased (P=0.5). Frequency of phototherapy
treatments significantly decreased from 1993 to 2010 (P<0.001). Since the introduction of biologics in 2002, their frequency has significantly
increased, becoming the most frequently used treatment from 2008-2010 (P<0.0001).
LIMITATIONS: Severity of psoriasis was not recorded in the NAMCS and NHAMCS.
CONCLUSIONS: The frequency of systemic treatments to treat psoriasis has not significantly increased from 1993 to 2010. Despite the
introduction of biologics, it appears that little progress has been made in reducing under-treatment of moderate-to-severe psoriasis.
J Drugs Dermatol. 2014;13(8):917-920.
Tejaswi Mudigonda BS, Tushar S. Dabade MD, Steven R. Feldman MD PhD
Background: 308 nm excimer laser phototherapy is efficacious in the treatment of localized psoriasis. Different approaches regarding
dose fluency, number of treatments, and maintenance have been utilized, and there is yet to be a consensus on standard protocol.
Objective: To characterize treatment parameters for 308 nm excimer laser phototherapy.
Methods: We performed a PubMed search for studies describing excimer laser treatment protocol with particular attention to dosage
determination, dose adjustment, dose fluency, number of treatments, and maintenance.
Results: Seven prospective studies were found describing the excimer efficacy for psoriasis. All studies determined the initial treatment
dose using either the minimal erythema dose (MED) or induration. Fluency ranged from 0.5 MED (low) to 16 MED (high); one study demon-
strated that medium to high fluencies yielded better improvement in fewer number of treatments. Fluency adjustments during the course
of treatment were important to minimize phototherapy-associated side effects. The use of higher fluencies was reported to result in higher
occurrences of blistering. One study implemented a maintenance tapering of dose-frequency phase to better manage psoriasis flare-ups.
Conclusion: The 308 nm excimer laser is an effective therapy for psoriasis regardless of the method used to determine initial dosage,
dose fluency, or number of treatments. As its usage as a targeted monotherapy increases, future trials should consider evaluating and
modifying these parameters to determine the most optimal management of localized psoriasis. Based on our reviewed studies, there is
no consensus for a single excimer laser therapy protocol and as a result, patient preferences should continue to be an important consid-
eration for phototherapy regimen planning.
J Drugs Dermatol. 2012;11(1):92-97.
Jason J. Emer MD, Mary L. Stevenson MD, Orit Markowitz MD
Female-pattern androgenetic alopecia is a very common disorder that has been associated with extreme psychological morbidity.
Few treatments have documented utility and many physicians are often overwhelmed with how little is pharmacologically available
to treat this condition. Novel treatments that are effective, safe, less costly and simple are in high demand. We report a case of
female-pattern androgenetic alopecia that failed to respond to a novel treatment with injected bimatoprost solution. Hypothetically,
the treatment should have been effective and although we did not have success, this report suggests critical points to consider in the
future of prostaglandin analogs, as well as other therapies being considered for the treatment of female-pattern hair loss.
J Drugs Dermatol. 2011;10(7):795-798.
Martin Zaiac MD and Annabelle Clement MMS PA-C
Actinic cheilitis (AC), a common disorder of the lower lip, should be treated early to prevent progression to invasive squamous cell carcinoma. This study evaluated the safety and efficacy of photodynamic therapy (PDT) with 5-aminolevulinic acid (ALA) activated by blue light for the treatment of AC. Fifteen patients with clinically evident or biopsy-proven AC received two treatments with ALA PDT with blue light activation. Treatments were spaced three to five weeks apart. Most patients achieved 65% to 75% clearance three to five weeks after the first treatment and all achieved more than 75% clearance one month after the second treatment. Three patients achieved complete clearance. Pain and burning during irradiation were absent or mild. All patients said they would repeat the procedure. ALA PDT with 417 nm blue light is a promising option for the treatment of AC of the lower lip.
J Drugs Dermatol. 2011;10(11):1240-1245.
Introduction: This study evaluated the efficacy and tolerability of treating mild-to-moderate facial acne using a new, hand-held,
light-emitting diode blue light device in conjunction with a foam cleanser containing 5% glycolic acid and 2% salicylic acid plus a skin
rebuilding serum containing 1.25% salicylic acid, 0.5% niacinamide, 0.08% liposomal-based azelaic acid and superoxide dismutase.
Methods: Volunteers with mild-to-moderate facial inflammatory acne used the blue light device twice daily for eight weeks, plus the
cleanser before treatments and the serum after each evening treatment.
Results: Among 33 subjects aged 25–45 years old, 28 completed. In a 3 cm x 5 cm target area receiving a daily dose of ~29 J/cm2,
treatment was associated with significant reductions from baseline in the inflammatory lesion count from week 1 onward (P≤.01) and
in the non-inflammatory lesion count from week 4 onward (P≤.05). The number of flares was significantly reduced from baseline from
week 2 onward (P≤.05), and flare severity and flare redness were significantly reduced from baseline from week 4 onward (P≤.01 and
P≤.05, respectively). At week 8, more than 90 percent of subjects reported improvements in their skin’s overall appearance, clarity,
radiance, tone, texture and smoothness. In addition, 82 percent were satisfied, very satisfied, or extremely satisfied with the blue
light treatment system and 86 percent agreed the treatment system was much gentler than traditional acne treatments.
Conclusion: The blue light treatment system offers effective, rapid, convenient and well tolerated treatment of inflammatory and
non-inflammatory acne lesions. The majority of subjects consider it much gentler than traditional acne treatments and it facilitates effective
treatment without the need for antibiotic exposure. The blue light treatment system and blue light therapy alone are attractive
treatment options for acne vulgaris, both as alternatives to traditional acne treatments and as adjunctive treatments to complement
J Drugs Dermatol. 2011;10(6):596-602.
Anne Chapas MD FAAD and Kendra Gail Bergstrom MD FAAD
No abstract details for the moment.
Jennifer Rivard MD, Jennifer Janiga MD, Henry W. Lim MD
Psoriasis is a common skin condition affecting approximately 2.6% of the population in the US. The most effective current
therapies for psoriasis have suppressive activity against T lymphocytes directly or by modulating the biologic effects
of inflammatory cytokines. Tacrolimus has been used successfully to treat a number of T cell-mediated diseases. UVA1
has been shown to induce T lymphocyte apoptosis. Combination treatment is commonly used in the management of
psoriasis. Therefore, this pilot study was performed to evaluate if the combination of medium-dose UVA1
(50 J/cm2) and tacrolimus ointment is effective for the treatment of palmar plantar psoriasis. A total of 5 patients completed
the study of 30 UVA1 treatments, and another patient completed half of the treatments. No dramatic changes
in plaque thickness or scaling were seen with either tacrolimus alone or with the combination of tacrolimus and medium
dose UVA1 on palmar or plantar psoriasis.
By Danny Vleggaar MD, and Ute Bauer MD
The primary reason patients seek aesthetic treatments is to combat the signs of aging. However, the majority of facial treatments
and procedures fill specific wrinkles or pull-taught sagging skin, without returning the volume and contours of a youthful face.
Injectable poly-L-lactic acid (Sculptra™) is a synthetic, biodegradable polymer, popular in Europe for the correction of lipoatrophy.
The novel technique and mechanism of action of this product require physicians to adjust their practice of treating a specific line to
returning volume to a facial area. Sculptra™ has been used successfully for the correction of nasolabial folds, mid and lower facial volume
loss, jaw line laxity, and other signs of facial aging. Sculptra™ treatment provides a minimally invasive, effective, and prolonged
(18-24 months) facial enhancement correction with a low frequency of side effects and no need for allergy testing.
Andreas J. Bircher, MD and Christian Surber, MD
Unconventional (i.e. alternative, traditional, or complementary) treatments are used by many individuals for a variety of
symptoms and disorders. Reports on fraudulent products used for unconventional treatments are not uncommon.
These include herbal remedies offered as "natural" while containing non-labeled synthetic pharmacological ingredients
or even toxic agents, patients not being informed of active ingredients, products containing no active substances,
or unqualified individuals or "clinics" delivering dangerous advice or treatment. Reports on tainted topical products
remain rare due to the high analytical demands necessary to detect minimal traces of unknown ingredients, the fact
that patients often use medications from different sources, and patient over-reliance on the effectiveness of folk remedies
or advertised claims. The patients' assumption of receiving a safe and effective therapy by "natural" products has
shown to be unreliable. The authors urge that quality standards for "natural" and pharmaceutical products should be the
same and that only qualified professionals should deliver treatment and medical advice.
Background: Hyaluronic acids (HA) fillers abound in the European community, many with different names in different countries. One such HA is Belotero Basic, recently approved by the FDA in the United States.
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.
Theodore Rosen MD,a Sheila Fallon Friedlander MD,b Leon Kircik MD,c Matthew J. Zirwas MD,d
Linda Stein Gold MD,e Neal Bhatia MD,f Aditya K. Gupta MD PhD MBAg
Onychomycosis is an often overlooked and/or undertreated disease. This may be in part due to an under appreciation among both physicians and patients of its impact on quality of life and the potential for significant complications, from tinea corporis and cruris, to bacterial superinfection. Some health care providers are unaware of the effective low-risk treatments currently available. Changing demographic characteristics such as the relative aging of the population; the increasing prevalence of diabetes and peripheral vascular disease, and widespread iatrogenic immunosuppression; and changes in lifestyle practices such as earlier and greater participation in sports, are likely to lead to an increased prevalence of onychomycosis in both adults and children. Two topical onychomycosis treatments, efinaconazole 10% solution, and tavaborole 5% solution were recently approved by the FDA. This article reviews the state of knowledge and describes, briefly, these new treatment options.
J Drugs Dermatol. 2015;14(3):223-228.
Leslie S. Baumann MD, CPI,a Kristian Figueras MS,a Amanda Dahl BS CCRA,b Margarita Yatskayer MS,b and Christian Oresajo PhDb
This study evaluated the tolerance and efficacy of 2 facial skin products in subjects with acne using the following acne treatments: 1) treatment A, a combination of salicylic acid, capryloyl salicylic acid, HEPES, glycolic acid, citric acid, and dioic acid, and 2) treatment B (BenzaClin®, clindamycin 1% and benzoyl peroxide 5% gel). The treatment design included the split-face application of treatment A and treatment B and the full-face application of the cleanser, moisturizer, and sunscreen. Data were collected through physician visual assessments, subject irritation questionnaires and assessments, along with clinical photography. Results showed similar tolerance and efficacy for both treatments.
J Drugs Dermatol. 2013;12(3):266-269.
James J. Leyden MD and Lisa Parr PharmD
There has been a proliferation of treatments for facial rejuvenation but, curiously, the use of such treatments on other areas of the
body has not been widely investigated. The clinical effects of treating photodamaged skin of the neck and anterior chest area (décolletage)
with a proprietary copper zinc malonate lotion and a proprietary 4% hydroquinone cream (twice daily), plus tretinoin cream
(once daily), were evaluated in 42 females in a 24-week investigator-blind randomized study.
Treatment was associated with early and significant (P≤0.05) improvements in mean scores on an overall integrated assessment
of photodamage (from week 4 onward) and for multiple signs of photodamage—tactile roughness (from week 2 onward); mottled
hyperpigmentation, lentigines and fine wrinkling (from week 4 onward); laxity (from week 8 onward); and crepiness and coarse wrinkling
(from week 12 onward). Treatment was generally well tolerated and 94% of subjects were satisfied or very satisfied with the
overall improvement in their décolletage at week 24.
Background:Over the past 10 years, radiofrequency (RF) technology has been utilized for nonablative treatments for the treatment of
rhytides and skin laxity. This manuscript reviews the scientific background of collagen synthesis in vivo and in response to RF energy as
well as a clinical study of 17 patients receiving a series of facial treatments with a 4-MHz monopolar RF (Pellevé,Ellman International,
Inc, Oceanside, NY). Clinical methods, results, and a review of the literature for RF aesthetic treatments of the face are presented.
Methods:Seventeen patients were treated in one site with 6 total treatments scheduled as follows:1 session was performed every
15 days for 2 consecutive sessions, 1 session every month for 2 consecutive sessions, and 1 session every 2 months for 2 consecutive
sessions. Both the treating physician and the patients via live viewing and comparison with baseline photographs performed assessment
of results. Results are reported as averages across the 17 patients.
Results: Two weeks after the first treatment,patients noted an overall average of 25% to 30% improvement. Just before the last or
sixth treatment, there was an average of 50% improvement noted by the physician, with patients ranking an average self-improvement
of 48%. The treating physician rated average improvement of 46% compared with baseline,whereas the patients ranked average
improvement of 30% compared with baseline at 1 year after treatment was initiated (6 months after the final treatment).Patients find
this treatment to be very well tolerated, with minimal to no discomfort and no downtime or significant side effects.
Conclusions: The Pellevé 4-MHz monopolar RF device is effective, safe, and very well tolerated for treating laxity, texture, and wrinkles
of the skin without complication or discomfort. Evidence in the literature supports the scientific mechanism of action of acute collagen
modification and continued neocollagenesis observed with the system. In this cohort, patients maintain approximately 50% improvement
on average at 6 months and a 30% to 50% improvement 1 year after beginning the treatments, 6 months after completion.
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.
Macrene R Alexiades-Armenakas MD PhD, Roy G Geronemus MD
Actinic cheilitis (AC) is a common precancerous condition for which a safe, effective, rapid, and cosmetically favorable treatment is
needed. The objective of this study was to assess the safety and efficacy of the long-pulsed pulsed dye laser (LP PDL) (595 nm) with
photodynamic therapy (PDT) for the treatment of AC. This study was designed to be a prospective, proof-of concept pilot study to
assess safety and efficacy of LP PDL in conjunction with topical 20% 5-aminolevulinic acid solution PDT for the treatment of AC.
Control patients received LP PDL alone. The setting was an outpatient clinical research center. A volunteer sample of 21 patients
with biopsy-proven AC was enrolled (age range, 42-86 years; skin types I-III). All patients were refractory to prior therapies.
Patients with a history of herpes labialis were pre-treated with famcyclovir. Nineteen patients received one-to-three treatments of
topical 20% 5-aminolevulinic acid for 2-3 hours, followed by LP PDL (595 nm) at monthly intervals. Two control patients received
one treatment with LP PDL alone. Patients in the ALA-LP PDL group were followed at 1, 2, 3, 6, 9, and 12 months. Clearance of
AC was assessed by clinical evaluation. Control patients were followed to the one month interval.
We observed none-to-mild pain; slight-to-moderate erythema; no crusting, purpura, or scarring; treatment time of less than one
minute; and complete resolution of post-operative erythema by day three. Complete clearance was achieved in 13/19 (68%) of patients
following a mean of 1.8 treatments (7/13 (37%) after one, 2/13 (11%) after two, and 1/13 (21%) after three treatments). Patients were followed
for a mean of 4.1 (range 1-12) months. Among the remaining cases, partial clearing was achieved in two patients, recurrence during
the follow-up interval was observed in one patient, and failure to follow-up occurred in three patients. Post-operative impetiginization
occurred in three patients with erosive AC, which resolved with dicloxacillin therapy. Among the control patients, no clearing
Treatment of AC using LP PDL (595 nm) at nonpurpuric parameters following topical application of 5-aminolevulinic acid at short
incubation times is safe and effective. It may offer the advantages of rapid incubation, treatment, and recovery times, minimal discomfort,
excellent cosmetic outcome, and good efficacy rates. Patients with erosive AC should receive antibacterial prophylaxis.
Multiple treatments may be required for complete clearing.
Hilary Reich MD,a,b Irmina Wallander BA,a Lacie Schulte MS BA,a Molly Goodier BS,a and Brian Zelickson MDa
METHODS: In this split-face, evaluator-blinded study, 18 subjects were randomly assigned to receive either the SSR or NFL treatments on each side of the face. For the SSR facial sides subjects followed two morning-evening regimens. On the NFL sides subjects were treated 3 times with the 1927-nm laser at 4-week intervals. Three physician evaluators were asked to rate hyperpigmentation, global photoaging, and ne lines and wrinkles for each side of the face at baseline and at 3 months using a 5-point scale.
RESULTS: The SSR and NFL treatments provided comparable results for each skin attribute. Improvement from baseline was signi - cant in both treatment programs for each skin attribute. The greatest 3-month improvement for both programs was in hyperpigmen- tation. For global photoaging and ne lines and wrinkles, positive responses were slightly greater in the NFL than in the SSR facial sides. Subject preference for the SSR over the NFL was greatest for ne lines around the eyes, ne lines around the mouth, smooth texture, radiant complexion, and overall improvement while the NFL was preferred for skin rmness and evenness. When the study was completed5 of 18 split-face subjects decided to undergo NFR laser treatment on the non laser treated side along with using the SSR product and 13 of the 18 subjects continued to use the SSR products to their full face after the study.
CONCLUSION: The mass market skin care system of the present study provides improvement in hyperpigmentation, global photoaging, and ne lines and wrinkles comparable to that of a series of treatments with a non-ablative fractional laser.
J Drugs Dermatol. 2016;15(11):1366-1372.
Patricia K. Farris MD,a Nicole Rogers MD,a Amy McMichael MD,b Sophia Kogan MDc
Hair loss is a complicated problem that causes significant concern for those who are affected. Patients seeking medical treatment have limited options that include topical minoxidil and oral finasteride. While these treatments are backed by long term clinical use and research outcomes, many patients find topical minoxidil difficult to incorporate into their daily routine and some are concerned with the side effects associated with finasteride. In the office setting, patients may be treated with more invasive procedures such as platelet-rich plasma injections (PRP) and hair transplantation, treatments that often must be repeated and can lead to a costly investment.
Consumers are increasingly interested in natural treatments for hair loss. Many turn to basic supplements only to be disappointed when they fail to deliver due to lack of standardization and efficacy. In this paper we review the benefits of a nutraceutical containing a specific blend of highly purified, standardized, bio-optimized, and bioavailable botanical extracts to treat hair loss. These phytoactives were selected because of their diverse multi-modal biologic activity against inflammation, DHT, stress mediators, oxidative damage, and intermediary signaling cascades. This supplement represents a paradigm shift as it addresses not only the factors that trigger hair loss but the downstream mediators of inflammation as well. Multi-center clinical studies are currently underway to confirm the efficacy and benefits of this unique nutraceutical.
J Drugs Dermatol. 2017;16(11 Suppl):s141-148.
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Vineet Mishra MD,a Lee Miller MD,b Salman M. S. Alsaad MD,c and E. Victor Ross MDb
OBJECTIVE: To evaluate the efficacy of a fractional ablative micro-plasma radiofrequency (RF) device in the reduction of the appearance of abdominal striae.
METHODS: Five female patients (age range, 30-60) with abdomen striae alba (n=4) and striae rubra (n=1) were enrolled in the study. Skin type distribution among the 5 patients was two type II, one type III, and two type IVs. The device (Accent XL, Alma Lasers Inc.) is a radiofrequency fractional platform (40.68 MhZ) that deploys multiple conical pin electrodes on a moving handheld 6 cogs roller. Four treatments were performed every two weeks with settings based on test spots performed two weeks prior to a full treatment session. Assessment of striae was based on clinical severity of the lesions on a 1-4 scale, with “4” being the most severe. A questionnaire was administered to patients with possible subjective responses ranging from 0-4, with 0 being no improvement and quartiles from 1-4 (1= mild improvement, 2= fair improvement, 3= moderate improvement, and 4= marked improvement, respectively).
RESULTS: Three months after 4 treatments, a mean improvement of 20% was achieved (mean severity score changed from 2.9 to 2.5). Micro-wounds were approximately 200 μm wide on the surface, initially presenting as small gray “dots” and evolving into black dots lasting about 2 weeks. Mean pain was 2/10. Erythema and edema persisted for about one day. No pigmentation abnormalities were observed at the final evaluation. The results from the patient questionnaire revealed a mean score of 2.4/4, thus falling in the range of good to very good.
CONCLUSION: A fractional ablative micro-plasma RF roller device can improve improvement in the appearance of abdomen striae.
J Drugs Dermatol. 2015;14(11):1205-1208.
Suzanne Bruce MD,a Wendy Roberts MD,b Craig Teller MD,c and Lora Colvan BSd
BACKGROUND: Chemical peels are versatile treatments that involve chemical exfoliation of the skin for cosmetic improvement. Deeper peels produce more significant results, but can be associated with longer healing time and potential complications. Novel chemical resurfacing treatments (AGE and MELA) were developed in Europe to produce skin resurfacing via controlled inflammation to promote cell regeneration with minimum negative effects associated with conventional peelings. The AGE Resurfacing regimen is indicated for the treatment of photoaging, and consists of multi-ingredient peeling solution with trichloroacetic acid, pyruvic acid, salicylic acid, mandelic acid, and lactobionic acid. The MELA Resurfacing regimen addresses hyperpigmentation concerns and contains mandelic acid, potassium azeloyl diglycinate, retinol, salicylic acid, phytic acid, lactobionic acid, and lactic acid. Results of previously conducted US clinical experience trial of AGE and MELA resurfacing protocols rated 81% of subjects with some level of improvement according to physician assessment.
OBJECTIVES: To evaluate whether a daily skin care regimen used for 12 weeks could maintain the benefits achieved with AGE and MELA chemical resurfacing treatments.
METHODS: Subjects who completed participation in the AGE and MELA skin resurfacing clinical trial were recruited to participate in a continuation trial and used a daily regimen of MDRejuvena facial products for 12 weeks. No other facial products were permitted. Physicians assessed the severity of individual skin parameters at baseline and week 12 and provided global assessment. Subjects assessed improvement of individual skin parameters at week 12 and provided an overall assessment.
RESULTS: Thirteen subjects participated in the 12-week continuation trial. According to the physician’s global assessment, all subjects demonstrated some level of improvement at week 12 compared to baseline. Physician assessment showed a decrease in severity of all skin parameters assessed at week 12 compared to baseline. According to the subject overall assessment at week 12, 11 of 12 subjects noted some level of improvement, 1 subject saw no improvement, and 1 subject did not provide an overall assessment. Mild to moderate improvement was observed by subjects in all individual skin parameters assessed except for skin discoloration.
CONCLUSIONS: The results of the continuation study demonstrate that use of a daily skin care regimen, which include combination of 2 various strengths of MDRejuvena Rejuvaphyl® Rejuvenating Complex: low strength (LS) and high strength (HS), not only maintains but can enhance the beneficial effects of skin resurfacing treatments for at least 12 weeks.
J Drugs Dermatol. 2016;15(9):1145-1150.
Eliot F. Battle Jr. MD and Sally Battle CNMT
INTRODUCTION: It has been well established that patients with darker skin types (Fitzpatrick skin types IV-VI) have an increased incidence of thermal induced side effects from laser and radio frequency (RF) treatments. Complications include a higher risk of post-inflammatory hyperpigmentation, hypopigmentation, and scarring, leading to unsatisfactory clinical outcomes. Fractional technologies improve the safety when treating patients with skin of color by treating only fractions of the skin while leaving a healing reservoir of untreated skin that improves the healing process. Fractional RF tips with coated pins may offer a more advantageous safety profile, particularly in the skin-of-color population (Fitzpatrick skin types IV-VI) by increasing the protection of the epidermal layer by minimizing epidermal heating The current study was intended to evaluate the safety and efficacy of fractional RF technology for the treatment of patients with Fitzpatrick skin type VI.
METHODS: 35 subjects with skin type VI received 3 sessions of facial treatments, 4 weeks apart using a fractional RF device with 24 pin coated tip. The treatment's safety and efficacy were evaluated at 2 follow-up visits, 6 and 12 weeks after the last treatment.
RESULTS: Skin characteristics evaluations, including Fitzpatrick Wrinkles Classification, acne scars, and overall facial appearance demonstrated improvement in follow-up visits comparing to baseline. No significant unexpected adverse events were detected.
CONCLUSION: The current study proves the safety and efficacy of the fractional RF treatment modality with coated pins tips for skin rejuvenation treatments resulting in improved wrinkles, acne scars, and overall skin appearance, in patients with skin type VI.
J Drugs Dermatol. 2018;17(11):1169-1172.
Anastasia Saybel MD,a Ada Artemenko MD PhD,b Sergei Nikitin MD PhD,c and Alexei Kurenkov MD PhDd
This randomized, rater-blind, split-face study compared the safety and efficacy of incobotulinumtoxinA and abobotulinumtoxinA for the treatment of crow’s feet. Nine units of incobotulinumtoxinA were administered to the lateral periorbital region of one side of the face and 27 units of abobotulinumtoxinA to the other in healthy subjects (aged 35–55 years) with moderate-to-severe crow's feet at rest (2–3 points on the 5-point Merz Aesthetics Scale [MAS]). Investigators assessed efficacy using the MAS, while subjects assessed
using a 9-point global assessment scale. Secondary objectives included electromyography to assess muscle activity before injection and at 2 weeks, 4 months, and 6 months afterwards. Twenty women were enrolled and 18 completed the study. At rest and maximum smile, at each time point, the mean wrinkle scores were significantly lower (P≤ 0.05) than baseline for both treatments. No differences were noted between treatments. Responder (≥ 1-point improvement from baseline) rates for both products were 100% and 83% at 2 weeks and 4 months post-treatment, respectively. At 6 months post-treatment, responder rates were 67% and 61% for incobotulinumtoxinA and abobotulinumtoxinA, respectively. For both, the maximum changes in electromyography parameters were observed 2 weeks post-treatment. A response was maintained for 6 months (P≤ 0.05 vs baseline). Both treatments were well tolerated;
only mild adverse events were reported. In conclusion, for treatment of crow’s feet, incobotulinumtoxinA and abobotulinumtoxinA (1:3 dose) demonstrated comparable efficacy in terms of magnitude and longevity of effect. Both products demonstrated a high responder
rate, with the response being maintained for 6 months in the majority.
J Drugs Dermatol. 2015;14(11):1291-1296.
Patrick Bitter Jr. MD
BACKGROUND AND OBJECTIVE: A new 3-step protocol using broadband light allows patients with moderate to severe in ammatory acne to avoid potential side effects of systemic acne treatments and the risks and uncertainties associated with laser and light treatments to date. The protocol also addresses acne scarring and, with appropriate modi cations, all skin types.
METHODS: The protocol consists of 6 to 8 treatments performed with a single device that allows the user to select wavelength, spot size, uence, and pulse duration. Step 1 uses blue light with a large spot size and low uence to kill Propionibacterium acnes. Step 2 features red and yellow light with a smaller spot size and higher uence, which together exert anti-in ammatory effects and trigger neocollagenesis. Step 3 employs visible and infrared (IR) light with a high uence and 12-second pulse length, delivered with a constant motion technique, to enhance previous results while also targeting areas of frequent breakouts.
RESULTS: Challenging cases treated with the protocol include a young adult female with a nearly decade-long history of in ammatory and cystic acne. Her skin remained clear more than 6 months post-treatment. She reported her scarring reduction at 90%. Having treated more than 100 patients with the protocol, the author reports that approximately 80% of patients clear completely or achieve at least a 75% improvement in their in ammatory acne. Acne improvements start appearing 2 to 3 days after a treatment session. Red, purple, raised, or depressed acne scars less than 1 to 2 years old begin to fade 1 to 3 weeks post-treatment.
CONCLUSION: The 3-step protocol is safe and effective for patients with moderate to severe in ammatory acne and acne scarring.
J Drugs Dermatol. 2016;15(11):1382-1388.
Kim Papp MD PhD,a Alice B. Gottlieb MD PhD,b Luigi Naldi MD,c David Pariser MD,d Vincent Ho MD,
e Kavitha Goyal MD,f Steven Fakharzadeh MD PhD,f Marc Chevrier MD PhD,g Stephen Calabro MS,f
Wayne Langholff PhD,g and Gerald Krueger MDh
BACKGROUND: Safety surveillance is needed for biologic therapies for psoriasis.
OBJECTIVE: To assess the risk of adverse events of special interest (AEoSIs) with ustekinumab and other psoriasis treatments in a real-world setting using 2014 Psoriasis Longitudinal Assessment and Registry (PSOLAR) data. AEoSIs included malignancy (excluding nonmelanoma skin cancer), major adverse cardiovascular events (MACE), serious infection, and all-cause mortality.
METHODS: Cumulative rates of AEoSIs/100 patient-years (PY) are reported for ustekinumab, infliximab, other biologics (mostly adalimumab/etanercept), and non-biologics based on pre-specified analyses using attribution rules biased against ustekinumab. Risk factors for AEoSIs, including treatments, were determined using multivariate statistical analysis.
RESULTS: A total of 12,093 patients (40,388 PY) were enrolled in PSOLAR. Overall incidence rates were 0.68/100PY for malignancy, 0.33/100PY for MACE, 1.60/100PY for serious infection, and 0.46/100PY for mortality. Unadjusted rates of serious infection for infliximab (2.91/100PY) and other biologics (1.91/100PY) were numerically higher compared with ustekinumab (0.93/100PY). Exposure to the combined group of biologics other than ustekinumab was significantly associated with serious infection (hazard ratio=1.96, P<.001). None of the biologics was associated with increased risk of malignancy, MACE, or mortality.
LIMITATIONS: Observational data have inherent biases.
CONCLUSION: Analysis of 2014 PSOLAR data identified no increased risk of malignancy, MACE, serious infection, or mortality with ustekinumab.
J Drugs Dermatol. 2015;14(7):706-714.
BACKGROUND and OBJECTIVE: Scars from skin cancer surgery on the face can be quite prominent and not easily obscured by makeup. This report evaluates the use of an ablative fractional Er:YAG laser device for minimizing or blending scar lines in two patients who underwent repair of skin cancer defects on the face.
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.
Carolyn Jacob MD,a Brian Kinney MD,b Mariano Busso MD,c Suneel Chilukuri MD,d JD McCoy NMD,e Chris Bailey,f Radina Denkova MDg
OBJECTIVE: Surgical intervention has been the only method to improve the aesthetic appearance of buttocks apart from physical exercising. This study evaluates the efficacy of high intensity focused electro-magnetic (HIFEM) treatments as a non-invasive solution for improvement of buttocks through toning and lifting of gluteal muscles.
MATERIALS AND METHODS: A total of 75 patients (aged 22-59) were treated using a device with HIFEM technology which stimulates gluteal muscles (EMSCULPT, BTL Industries, Boston, MA). The protocol included four 30-minute treatments. Patients’ weight was monitored throughout the study. Standard photographs were taken at the baseline, after the 4th treatment, and at the 1-month follow-up. Two 7-point Likert scale questionnaires were used to evaluate patients’ buttock and treatment satisfaction. Total score of buttock satisfaction was calculated as a sum of all individual questions to reflect the overall perception of patients’ buttocks. The level of comfort during procedures was assessed on a visual analog scale (VAS).
RESULTS: The overall buttock satisfaction score (range, 4-28) of all subjects improved from 13.1±5.7 at baseline to 18.4±5.2 after the treatment and 18.9±5.1 at follow-up. For subjects with initial buttock dissatisfaction the scores improved from 8.7±1.6 to 16.3±3.1 after the treatment and to 17.3±3.1 at follow-up. The average score of all treatment satisfaction questions (range, 1-7) was 5.2±1.2 immediately after the treatments and 5.1±1.3 at follow-up. In total, patients initially dissatisfied with the appearance of their buttocks reported a significant 85% improvement after the fourth treatment. Immediately after the fourth treatment, all the subjects reported that their buttocks felt more lifted and toned. Results were maintained at one-month follow-up. Weight of the patients didn’t change significantly. Digital photographs showed aesthetic improvements of the buttocks for most of the patients. No adverse events were reported.
CONCLUSION: The results show that the investigated device safely and effectively improves the aesthetic appearance of buttocks non-invasively. The treatments not only resulted in a significant visual improvement but also increased patient confidence and satisfaction. The procedure is suitable for patients seeking improvement in tone, shape, lift, and tightness of the buttocks.
J Drugs Dermatol. 2018;17(11):1229-1232.
Alexiades-Armenakas MD PhD
Background: Acne patients who fail to respond to conventional treatments have been treated with isotretinoin, an effective
treatment coming under strict regulation due to the risk of significant side effects. Photodynamic therapy (PDT) may be a
viable alternative treatment for recalcitrant acne of various types and levels of severity.
Objective: To determine the safety and efficacy of combination PDT with topical 5-aminolevulinic acid (ALA) and activation
by long-pulsed, pulsed dye laser (LP PDL, 595 nm) energy with topical therapy in patients with mild to severe acne.
Methods: A prospective, controlled pilot, proof-of-principle study of 19 consecutive patients (aged 16-47 years, Fitzpatrick
skin types I-VI) with mild to severe cystic, inflammatory, or comedonal acne of the face was conducted. All patients had
failed conventional therapy, including oral antibiotics, topical treatments, hormonal therapy, laser procedures (without
ALA), and/or oral isotretinoin. Fifteen patients were treated with ALA PDT and 4 patients served as controls; all were
continued on topical medications. Patients undergoing PDT were initially randomized to receive either blue light or laser
energy. Because recrudescence occurred in 1 patient while undergoing multiple treatments with ALA and blue light, all
subsequent patients were treated with ALA and laser energy. The total number of patients treated with LP PDL-mediated
ALA PDT was 14. ALA was applied for a short 45-minute incubation followed by 1 minimally overlapping pass with the LP
PDL (595 nm, 7.0-7.5 J/cm2 fluence, 10-ms pulse duration, 10-mm spot size, and dynamic cooling spray of 30 ms with a 30-
ms delay). Patients treated with conventional therapy (oral antibiotics, oral contraceptives, and topical medications) or laser
energy without ALA PDT served as control groups. Patients were followed monthly for up to 13 months.
Results: Complete clearance was achieved in 100% (14 out of 14) patients in the LP PDL PDT-treated group. A mean of
2.9 treatments (range 1-6; 2.0-3.7, 95% CI; n=14) was required to achieve complete clearance for a mean follow-up time of
6.4 months (range 1-13; 3.8-8.9 95% CI; n=14). The patient mean percent lesional clearance rate per treatment was 77%
(64%-90%, 95% CI; n=14). Improvement in acne lesions became apparent within 1 to 2 weeks after the first treatment.
Clearance in the LP PDL PDT group was superior to control groups. In the LP PDL-only control group (n=2), the patient
mean percent lesional clearance rate per treatment was 32% without complete clearance after 3 to 4 treatments. In the oral
antibiotics, oral contraceptives, and topicals control group (n=2), the clearance rate per treatment was 20%, the mean clearance
rate per month was 4%, and complete clearance was not achieved after 6 to 10 months. In the LP PDL-mediated PDT
group, treatments were well-tolerated with minimal erythema lasting 1 to 2 days. No cases of crusting, blistering, purpura,
scarring, or dyspigmentation occurred. A reduction in the erythema in erythematous acne scars was observed.
Conclusion: For teenage to adult patients with recalcitrant comedonal, inflammatory, or cystic acne of various degrees
of severity, ALA PDT with activation by LP PDL appears to be a safe and effective treatment with minimal side effects.
LP PDL-mediated PDT may serve as an important alternative to isotretinoin. Cosmetically well-accepted, LP PDL PDT
combined with topical therapy is the first PDT modality to achieve complete clearance with long-term follow-up as
compared to controls.
Pilar Luis-Montoya MD, Patricia Pichardo-Velázquez MD, María Teresa Hojyo-Tomoka MD, Judith Domínguez-Cherit MD
Background: Treatment options for cutaneous striae are very limited.
Objective: To determine if subcision is an effective treatment for cutaneous striae and compare a combination with
0.1% tretinoin cream against a single treatment.
Methods: 14 patients were evaluated, each with 3 white striae. One stria received treatment with subcision, one with
tretinoin cream in a 0.1% concentration, and one with subcision plus tretinoin. The length of follow-up was 3 months.
Two blind investigators evaluated improvement by comparison of the initial and final digital photographs.
Results: Only 7 patients completed 3 months follow-up. A decrease of width and clinical improvement was observed
with the 3 treatments. However, some striae showed no change at all and there was no statistically significant difference
between treatments. Three patients presented necrosis in striae treated with subcision.
Conclusions: There are no studies in the medical literature about subcision for the treatment of cutaneous striae. This
is a preliminary study and considering the undesirable effects of necrosis in a high percentage of striae treated with subcision,
the subjective way of evaluation, and the small study group, we can not recommend subcision as a treatment for
cutaneous striae. Large studies are necessary to corroborate or to discard our findings.
Mira Stotland MD, Anne M. Chapas MD, Lori Brightman MD, Sean Sukal MD, Elizabeth Hale MD, Julie Karen MD, Leonard Bernstein MD, Roy G. Geronemus MD
Background: Improving the appearance of striae distensae, particularly striae alba, has remained a challenge due to the limited
availability of effective and low-risk treatment options. Fractional photothermolysis, a novel concept in skin rejuvenation, has been
reported to be effective in the treatment of facial rhytides, acne scars, and surgical scars, but its use in the treatment of striae has
not been well studied.
Objective: To determine the safety and efficacy of fractional photothermolysis treatment on striae alba and striae rubra.
Methods: Twenty female patients with striae rubra or striae alba on their abdomen, thighs, or buttocks were enrolled in the study.
Lesions were randomized to receive treatment, with site-matched normal control areas. Patients received a total of 6 treatments
using a 1550-nm, erbium-doped fiber laser with 2 to 3 weeks of elapsed time between treatments. Clinical response to treatment
was assessed at each visit, and at 1-month, 2-month, and 3-month follow-up intervals by the patient and investigator. A comparison
evaluation of 8 patients examining photographs of striae at baseline and at the 3-month follow-up evaluation which was assessed by
4 independent dermatologists using the quartile grading scale.
Results: The independent evaluators’ assessments of improvement from photographs of 8 randomly selected patients showed an
overall improvement of 26% to 50% in 63% (5/8) of patients. A less than 25% improvement in dyschromia was noted in 50% (4/8)
of patients. An improvement in texture of 26% to 50% was observed in 50% (4/8) of patients. The clinical responses were indepen-
dent of age, gender, and skin phototype. The treatments were tolerated well by all patients with a majority of patients experiencing
transient posttreatment erythema and edema.
Conclusion: Fractional photothermolysis can be effectively and safely used in the treatment of striae rubra and striae alba.
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
Alopecia and thinning hair are highly prevalent conditions affecting a large proportion of men and women. Diffused hair loss is often more difficult to diagnose in women, mostly due to over-reliance on the assumption of hormonal influences, and it is commonly treated with a multi-therapy approach. Clinical studies have demonstrated the effectiveness of a nutraceutical supplement to provide essential nutrients that aid in stimulating existing hair growth and reducing hair shedding. The supplement Viviscal® contains a proprietary blend of proteins, lipids, and glycosaminoglycans derived from sustainable marine sources. We present here a summary of studies that have examined the safety and efficacy of this nutraceutical; as well as discussions on hair loss and current therapies from a recently convened
expert panel in dermatology and plastic surgery.
J Drugs Dermatol. 2015;14(suppl 9):s15-s22.
BACKGROUND: The desire for and use of nonsurgical injectable esthetic facial treatments is on a rise in Asia. Recent advances, including more versatile facial fillers, refined injection techniques, and adoption of a global facial approach, have in turn contributed to improved patient outcomes and increased patient satisfaction. The sought after nonsurgical treatments include the use of botulinum toxin, con- touring of the face with soft tissue fillers, and thinning of the face with injection lipolysis.
AIM:To achieve a leaner, oval face shape with smooth contours.
METHODS: A combination technique was applied, whereby narrowing of face was achieved with use of botulinum toxin, contouring with soft tissue llers, and thinning the face with injection lipolysis. Treatments were applied on 15 women aged between 25 and 40 years and observed with follow up for 12 weeks. Hyaluronic acid (HA)-based dermal fillers (Perlane, Voluma, and Juvederm), botulinum toxin type A (Botox), and a lipolytic solution of phosphatidylcholine with deoxycholate (Dermastabilion, Aesthetic Dermal, Spain) were used to achieve a natural look in these patients with a fuller appearance of the face. The procedure was performed to reduce the facial width using botulinum toxin type A and the reduction of submental and cheek fat by injecting lipolysis injection.
RESULTS: All the women (n = 15) had edema for up to 2 weeks after undergoing lipolysis; however, two patients had edema for 3 weeks. After injecting the patient with botulinum toxin type A, no adverse event was observed; however, after using HA-based filler, one patient was observed to have bruising on the chin.
CONCLUSION: Use of HA-based fillers, neuromodulators (botulinum toxin), and injectable lipolytics are well-tolerated and are effective nonsurgical modalities to achieve facial recontouring for slimming of the face.
J Drugs Dermatol. 2016;15(12):1536-1542.
Erin Courtney RN BSN and David J. Goldberg MD JD
INTRODUCTION: Diode lasers are often considered as the gold standard preference for hair removal due to the deep penetration and ef- fective targeting of the hair follicle. A wide variety of diode lasers are available, which can differ in terms of their parameters (such as fluence, pulse duration, repetition rate, scanner, and cooling).
OBJECTIVE: The objective of the study was to evaluate the safety and ef cacy of hair removal with an 810 nm novel scanning diode laser, up to six months after last treatment.
METHODS: A scanning 810 nm diode laser was used for axillary hair removal of 14 female patients who received 3 treatments, 4-6 weeks apart. Follow-up on hair count was conducted 3 and 6 months after last treatment and compared to baseline hair count.
RESULTS: No unexpected or signi cant adverse events were recorded. An average hair count reduction of 72.8% after 3 months and 67.6% 6 months after the last treatment is demonstrated.
CONCLUSIONS: The examined 810 nm diode laser was proven to be safe and effective for hair removal. Results were sustained for 6 months after last treatment. Longer follow-up data are followed for further substantiation of the clinical effect. Scanning technology can provide for potentially faster and safer treatments.
J Drugs Dermatol. 2016;15(11):1330-1333.
Stacy Smith, MD; Dan Piacquadio, MD; Vera Morhenn, MD; Deborah Atkin, MD and Richard Fitzpatrick, ND
The efficacy of photodynamic therapy (PDT) using broad area treatment with 5-aminolevulinic acid (ALA) has not been compared
to topical 5-fluorouracil (5-FU) in the treatment of actinic keratoses (AK).
The purpose of this study was to compare the efficacy and tolerability of PDT using short incubation time, broad area treatment
with ALA plus activation with either blue light or laser light to topical 5-FU in the treatment of AK of the face and scalp.
Thirty-six subjects with AK of either the face or scalp were randomized to receive either application of ALA for 1 hour followed by
activation with blue light or pulsed dye laser or topical 5-FU. Efficacy was evaluated by grading AK lesions and photoaging signs.
Tolerability was assessed by scoring crusting /erosions, erythema and stinging /burning.
Treatment with PDT using ALA plus blue light was as effective as topical 5-FU in clearing AK. PDT using ALA plus laser light was
the least effective treatment. All treatments made improvements in the signs of photoaging. Both PDT treatments were better tolerated
In conclusion, broad area PDT treatment with ALA plus activation with blue light appears to be as effective as 5–FU in the treatment
of AK. ALA plus laser light is somewhat less effective than the above therapies. Efficacy could likely be improved with further
study of laser parameters and incubation tim
Linda Stein Gold MD,a Jerry Tan MD,b and Leon Kircik MDc
BACKGROUND: Outcomes for success in acne interventional trials include statistically significant differences from baseline between treatment arms in lesion counts (comedonal, inflammatory and/or total) and in thresholds of categorical improvement in investigator global assessments (IGA).
OBJECTIVES: We evaluated differences in outcome measures and definition of success in acne trials; and their impact on FDA approval and indications for acne medications.
METHODS: Review of acne clinical trial literature, prescribing information and regulatory guidelines for currently approved acne medications in the United States.
RESULTS: Numerous IGA scales exist with variations in specific categorical definitions. There are also differences in definitions of global success. Outcome success may not be accurately translated into corresponding terminology for indications.
CONCLUSIONS: Variability in IGA scales and definitions of success confound comparison of trial results for acne treatments. Harmonization and standardization of these factors will facilitate meta-analytics and treatment selection in patient care. Outcome measure success has not consistently been incorporated into acne medication indications.
J Drugs Dermatol. 2016;15(1):79-86.
Robert A. Weiss MD, Michael Gold MD, Natalie Bene MD, Julie A. Biron, Girish Munavalli MD, Margaret Weiss MD, Karen Beasley MD
Background and Objectives: The use of thermal heating in microscopic zones is generically termed “microrejuvenation.” The
objective of this study was to evaluate the benefits of using a novel 1440-nm Nd:YAG laser (Affirm™, Cynosure, Westford,
MA) with a novel approach for microscopic heating. This device utilizes a microarray of lenses delivering a 10-mm beam as
hundreds of high-fluence beamlets interspersed with a relatively uniform low-fluence background irradiation.
Study Design: Forty subjects (N = 40) at 2 study sites presenting with superficial rhytides and other symptoms of
photoaging or scars received 3 treatments at 4-week intervals using a T-250 lens array. Total fluence ranged from 3.0 to 7.0
J/cm2. Zimmer air cooling was used for all treatments. No topical anesthetic was required.
Results: The most common immediate and expected clinical effects were erythema and edema lasting less than 24 hours,
although 6 patients reported edema lasting for up to 1 week. There were no permanent side effects. In total, 2.7% of treatments
resulted in temporary side effects, the most significant of which was a slight depression on the cheek (n = 1), which
completely resolved within 3.5 months. Other side effects included localized areas of acneiform subcutaneous erythematous
papules (n = 4) and a linear superficial crust (n = 1) with the original tip, all of which resolved within 1 week. One patient
reported small erythematous subcutaneous nodules resolving in 17 days. Tenderness of the neck lasting from 2 weeks (n = 2)
to 3 weeks (n = 1) was also reported.
Results: In all, 92% of the patients completed 3 treatments. Of these, 85% completed the 1-month follow-up. At the
follow-up, 94% of subjects exhibited improvement in one or more categories, 82% exhibited mild to moderate improvement,
and 12% exhibited good improvement. Side effects were minimal and included mild posttreatment erythema and edema
resolving within 24 hours. Pain during treatment was judged minimal to moderate. Postauricular histology showed areas of
thermal injury up to 250 ?m deep and 150 ?m wide.
Conclusions: A 1440-nm beam split by a microlens array is a promising new approach for inducing nonablative
neocollagenesis in the remodeling of scars and rhytids. Histologic evidence confirms the microcolumnar nature of callagen heating using this microarray.
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.
Kyle B. Bartlett MD,a Scott A. Davis MA,a and Steven R. Feldman MD PhDa,b,c
BACKGROUND: Thirty to 40% of patients using topical treatments do not comply with their treatment regimen.
OBJECTIVE: To examine how tolerability is assessed, tolerability ratings, and clinical significance of tolerability ratings of topical antimicrobials for acne.
METHODS: A literature search was performed using the terms “tolerability AND acne AND (benzoyl peroxide OR antimicrobial OR clindamycin OR erythromycin OR dapsone OR sulfur OR sulfacetamide).” Inclusion criteria were: 1) evaluation of tolerability, 2) use of an identified topical antimicrobial for acne treatment without combination retinoid use, 3) an original study, in English.
RESULTS: Thirty-four of 132 articles met the inclusion criteria. Tolerability was measured through subject and investigator assessment of specific tolerability parameters and by reporting of adverse events. Nearly all of the acne treatments were well tolerated. Treatment related study discontinuation rates were low and had little to no relation to the degree of tolerability measures.
LIMITATIONS: Patients may be more adherent in clinical trials than in clinical practice. Differences in the measure used to assess tolerability make comparisons difficult.
CONCLUSIONS: Topical antimicrobial acne therapy is generally well tolerated. Discontinuation rates are low under study conditions. Tolerability of topical antimicrobial therapy for acne may not have great clinical significance.
J Drugs Dermatol. 2014;13(6):658-662.
Multiple types of anti-aging treatments are required to address the various etiologies of facial aging. Soft-tissue augmentation provides
a minimally invasive option for patients seeking to look younger. However, due to changes in facial skin, musculature, fat and
bone, anti-aging treatment requires a multifaceted approach. Injectable fillers may be combined with neurotoxins to resolve superficial
wrinkles and restore facial volume. These modalities may be used with laser resurfacing or chemical peels to address epidermal
and superficial dermal problems. Combining injectable soft-tissue augmentation treatments allows clinicians and patients to take
advantage of the benefits of each modality and to address the multiple effects of facial aging. This review is based on clinical experience
and a MEDLINE search for articles about volume replacement and soft-tissue augmentation. It provides a rationale that supports
the use of combination techniques/products for soft-tissue augmentation.
J Drugs Dermatol. 2011;10(2):125-132
Emil A.Tanghetti MDa and Danielle M.Tartar MD PhDb
INTRODUCTION: This study explored immediate heat signatures with different passing techniques and the delayed thermal data points with the picosecond Alexandrite laser with the 6mm at and fractional optic during and after treatment. We sought to clarify the im- mediate effects of heating and understand the thermal and short term clinical difference when using these optics.
RESULTS: There were no immediate differences or a signi cant temperature rise with different passing techniques using the at or the fractional optic. However, after treatments a signi cant temperature elevation over 24 hours with manageable erythema was noted with the fractional optic. Only faint redness was appreciated with the at optic.
CONCLUSION: The different passing methods with these optics did not result in a significant thermal change. However, the fractional optic produces a localized area of epidermal necrosis which results in a significant clinical and a delayed thermal effect. With multiple treatments over time, collagen, elastic tissue, and mucin is produced resulting in improvement of acne scars and photo-damaged skin. This process suggests that a well-placed epidermal injury can stimulate an inflammatory cascade with dermal remodeling.
J Drugs Dermatol. 2016;15(11):1347-1352.
Shiu-chung Au MD,a Abdulaziz Madani MD,a Marwan Alhaddad MD,a Maha Alkofide MD,a and Alice B. Gottlieb MD PhDa,b
BACKGROUND: The efficacy of biologic treatment for psoriasis has not been compared to that of conventional systemic therapies and phototherapy outside of clinical trial settings.
DESIGN: Retrospective, cross-sectional
METHODS: All patient visits with a code for psoriasis (ICD-9 696.1) in the clinical practice of two dermatologists with a high percentage (over 70% of chief complaints) of psoriasis patients from Jan 1, 2008 to Jan 4, 2012 inclusive were included in this retrospective data analysis. Patients were excluded if the baseline Physician's Global Assessment (PGA) at start of treatment was unknown, or less than 3 (moderate). The practice is a comprehensive psoriasis care center in the Northeastern United States serving a metropolitan population of over 4 million people. Patients were divided by treatment type (biologic, conventional systemic or both) and history of previous treatments. Patients were evaluated by Body Surface Area (BSA), PGA, Simple-Measure for Assessing Psoriasis Activity (S-MAPA, calculated by BSA multiplied by PGA). Patients were evaluated at baseline, 8, 12, 16, and 24 weeks after start of treatment. Patients must have completed at least 8 weeks on a single treatment in order to be included.
RESULTS: 46 courses of biologics, 12 courses of conventional systemic therapies, and 18 courses of both together were identified with PGA 3 or greater at baseline. Baseline S-MAPA for biologics was 74, for non-biologic systemics was 62.25. At week 24, S-MAPA improved 70.2% over baseline in patients treated with biologics, patients treated with non-biologic systemics improved by only 40.4% (P<0.05). The average number of prior treatments for patients on biologics was 1.87 versus 1.25 for patients on conventional systemic therapies (P=0.169).
CONCLUSION: Biologics show superior results to conventional systemic therapies (70% improvement versus 40% improvement) for the treatment of patients with moderate to severe psoriasis, as measured by decrease in S-MAPA (PGA multiplied by BSA) at week 24. These results were observed despite the fact that patients on biologics had a greater baseline severity and had a greater number of previous treatments.
J Drugs Dermatol. 2013;12(8):861-866.
Alice He BS,a Steven R. Feldman MD PhD,a,b,c and Alan B. Fleischer Jr. MDd
BACKGROUND: Atopic dermatitis (AD) is primarily treated with topical therapies, systemic immunosuppressants, or adjunctive therapies.
OBJECTIVE: As novel treatment approaches for AD emerge, we characterize AD treatment and examine trends in treatment over time.
METHODS: Visits for AD were identified in the 2003-2012 National Ambulatory Medical Care Survey (NAMCS). We identified topical
corticosteroids (TCS), antibiotics (Abx), antihistamines (AH), topical calcineurin inhibitors (TCI), and systemic immunosuppressants (SI)
prescribed at AD visits.
RESULTS: There were 990,000 annual visits for AD from 2003-2012 (3.2 visits/1000 people/year). TCS were the most frequently used medication (59% of visits). Topical calcineurin inhibitors (TCI) were the second most prescribed medication for AD among dermatologists
(23% of visits), while antihistamines were second among all other physicians (16-44% of visits). Unlike other medications, use of TCIs decreased over time.
LIMITATIONS: The NAMCS does not follow individual patients over time.
CONCLUSIONS: TCI use has been decreasing. New topical AD treatments may provide an alternative to TCS, better treatment outcomes for moderate-to-severe atopic dermatitis, and an alternative to systemic antihistamines whose efficacy in AD is unproven and whose general use in AD management is discouraged by the American Academy of Dermatology.
J Drugs Dermatol. 2018;17(2):135-140.
Doru Alexandrescu MD,a Sabrina Fabi MD,b Lindsey C.Yeh MD MS, c Richard E. Fitzpatrick MD,b and Mitchel P. Goldman MDb
BACKGROUND: The pathogenesis of keloids involves a hyperproliferative state due to molecular abnormalities, cellular driving pathways, such as TGF, VEGF, and the inactivation of proapoptotic genes. We reviewed the literature and compared various treatment combina- tions in the treatment of keloids in a one patient observation.
METHODS AND MATERIALS: Treatment modalities consisted of: intralesional 5- uorouracil (5-FU)/triamcinolone (TMC), 5-FU/verapamil, enal- april alone, verapamil alone, and fractional carbon dioxide laser. Size, height, and softness of the keloid, pain, itching, and pain were assessed.
RESULTS: 5-FU based treatments proved to be more ef cacious than the other modalities. 5-FU + TMC demonstrated the largest reduc- tion in keloid height and rmness. The greatest degree of scar softening and average size reduction was achieved with 5-FU/ TMC (80% and 70% reduction, respectively), followed by 5-FU/verapamil (50% and 33% reduction, respectively). The same combinations led to the greatest reduction in scar height (70% and 33%, respectively). All treatments led to resolution of pain and itching in the keloid. CONCLUSION: The favorable effects of the 5-FU + verapamil combination are new and deserve further exploration.
J Drugs Dermatol. 2016;15(11):1442-1447.
Tina S. Alster, MD and Elizabeth L. Tanzi, MD
Successful and long-standing eradication of sebaceous hyperplasia has remained difficult due to the propensity
of these lesions to be extensive. Current treatments include excision, electrodesiccation, laser vaporization,
and oral isotretinoin, each often associated with unacceptable side effects or lesional recurrence. The purpose
of this study was to evaluate the safety and effectiveness of laser-assisted photodynamic therapy using topical
5-aminolevulinic acid (5-ALA) and 595 nm pulsed dye laser (PDL) irradiation for the treatment of sebaceous
Ten patients with sebaceous hyperplasia received 1 or 2 treatments at 6 week intervals with topical 20% 5-ALA
followed 1 hour later by 595 nm PDL irradiation. Matched lesions served as controls and were either treated
with PDL alone or were left untreated. Patients were evaluated at regular intervals for 3 months.
Results demonstrated that combination topical 5-ALA and PDL treatment effected better clinical results than
PDL treatment alone. No changes were observed in untreated control lesions. Side effects were mild and limited
to transient erythema, edema, and focal crusting.
It is the conclusion of the authors that laser-assisted photodynamic therapy with topical 5-ALA and PDL irradiation
can achieve safe and effective improvement of sebaceous hyperplasia. Further study is warranted to
determine the longevity of the clinical results observed.
Lyn C. Guenther MD FRCPC,a Anneke Andriessen PhD,b Charles W. Lynde MD FRCPC,c John W. P.Toole BSc MD FRCPC,d Gary R. Sibbald MD FRCPC MACP FAAD M.Ed DSc (Hons),e James N. Bergman MD FRCPC,f Marc Bourcier MD FRCPC,g and Ian D.R. Landells MD FRCPCh
BACKGROUND: Atopic dermatitis (AD) is a common chronic skin condition, associated with significant patient morbidity. There are a myriad of excellent evidenced based guidelines to guide clinicians by an extensive review of all the available treatments. However, while well written and complete these papers may not always allow easy transition to clinical application.
OBJECTIVE: The purpose of this paper was to develop a practical case-based approach for the treatment and maintenance of AD, enabling translation of guidelines into clinical care.
METHODS: After literature searches, selected AD trials and recent existing guidelines were reviewed. Using a nominal group process for consensus, an expert panel of Canadian dermatologists determined the case features and corresponding treatments.
RESULTS: A patient focused clinical pathway with 7 cases was developed. For each case scenario, treatment for mild, moderate, and severe disease was recommended.
CONCLUSION: A practical case-based clinical pathway was developed for easy clinical application and optimal patient care.
J Drugs Dermatol. 2016;15(12):1485-1494.
Neil S Sadick MD, Robert Weiss MD, Suzanne Kilmer MD, Patrick Bitter MD
This multi-center study evaluating the role of Intense Pulsed Light (IPL) in the non-ablative rejuvenation of Type I and Type II photoaged
skin study was conducted in order to evaluate the clinical efficacy and safety of using IPL in treating clinical indications associated
with photoaged skin. Ninety-three patients of Fitzpatrick skin phenotypes I-III, Fitzpatrick Wrinkle Classes I-II, and Elastosis
Scores 1-6 were enrolled in the study. Up to five treatments were performed at 4-week intervals with follow-up visits at 4 and 6
months after the last treatment. Patients received full-face treatments using the recommended parameters of the Quantum SR /HR
(Lumenis Ltd.) with the 560 or 640 nm cutoff filter. Parameters of elastometry, physicians’ evaluation of the Elastosis Score (‘W/ES’),
and global improvement as well as patient satisfaction were analyzed. Results showed that the average Fitzpatrick W/ES improved
significantly (p<0.001) by 1.39 and 1.32 units at the 4 and 6 months follow-ups, respectively; an improved W/ES evaluation was recorded
for 82% and 75% of the patients at each of these time points. In conclusion, IPL treatment is an effective non-invasive, non-ablative
method for rejuvenating photoaged skin with minimal adverse events, no downtime, excellent long-term results, and a very high
measure of patient satisfaction.
Jeremy A. Brauer MD,a,d David H. McDaniel MD,b Bradley S. Bloom MD,d Kavitha K. Reddy MD,a
Leonard J. Bernstein MD,a,c and Roy G. Geronemus MDa,d
BACKGROUND: Long-term exposure to sunlight, including ultraviolet A and B, produces signs associated with photoaging and photodamage, including laxity and discoloration of the skin. Initial laser treatment for dyspigmentation included the use of ablative lasers, followed by Q-switched lasers and more recently fractional lasers.
OBJECTIVE: We investigated the safety and efficacy of a fractionated 1927nm non-ablative thulium laser for the treatment of photo-induced pigmentation.
METHODS: Prospective multi-center study of subjects with clinically identifiable photopigmentation. The study protocol was approved by BioMed Institutional Review Board (San Diego, CA). Subjects received two treatments with a non-ablative 1927nm fractionated thulium laser (Fraxel Dual 1550/1927 Laser System, Solta, Hayward CA), energy level of 10mJ, coverage of 40% and 4-6 passes. Subject pain, erythema and edema were recorded immediately after treatment. Two dimensional photography was obtained before each treatment and at one and three month follow up visits. Independent blinded physician assessment was performed evaluating overall improvement in appearance as well as pigment specific improvement.
RESULTS: Forty men and women, ages 30 to 80 years, Fitzpatrick skin types I-IV, with photo-induced facial pigmentation were enrolled and treated, and 39 completed the three month follow up visit. Mean pain sensation for subjects during laser treatments was reported to be 4.3 on a 10-point scale. Mean scores for erythema, edema, and skin roughness throughout all treatments indicated moderate erythema, mild edema and mild skin roughness. Assessment of overall improvement was graded as moderate to very significant in 82% of subjects at one month and in 69% of subjects at three months after the second treatment. Assessment of lentigines and ephelides demonstrated moderate to very significant improvement in approximately 68% of subjects at the one month and in 51% of subjects at three months after the second treatment. Independent blinded physician assessment of randomized photography also demonstrated a durable response at three month follow up visit. Treatment was well tolerated and no serious adverse events related to treatment were observed or reported. Study limitations included a limited number of male subjects, lack of Fitzpatrick skin types V and VI, and decrease in improvement at 3 months post-treatment.
CONCLUSIONS: Two treatments with a 1927nm non-ablative fractionated thulium laser produced moderate to marked improvement in overall appearance and pigmentation with high patient satisfaction. The response to treatment was maintained at one and three months follow up.
J Drugs Dermatol. 2014;13(11):1317-1322.
Eric F. Bernstein MD MSE,a Kevin T. Schomacker PhD,b Amit S. Paranjape PhD,b Jayant D. Bhawalkar PhDb
BACKGROUND: A dual-wavelength, picosecond-domain, fractionated laser delivering 1,064nm and 532nm laser energy through a holographic optic was investigated for safety and effectiveness at improving the appearance of chronic photoaging.
MATERIALS AND METHODS: A total of 27 subjects were enrolled with 24 completing the study, and 14 subjects were treated with 1,064 nm and 10 with 532 nm. The 1,064 nm-treated subjects received 5 monthly treatments while the 532 nm-treated subjects received 4 monthly treatments. Improvement was measured by blinded evaluation of pre- and post-treatment images 12 weeks following the final treatment. Subjects also evaluated treatment effect and side-effects.
RESULTS: Blinded reviewers correctly identified the baseline image in 52 of 72 paired images, or 72% of the time, with a mean improvement score of 1.4 using an 11-point rating scale (P less than 0.0001). Post-treatment erythema, mild edema, and petechiae were the only side effects noted.
CONCLUSION: The fractionated, picosecond-domain, 532 nm and 1,064 nm laser is safe and effective for improvement of facial photodamage. The laser was well tolerated with mild erythema, edema, and petechiae as the most common side-effects.
J Drugs Dermatol. 2017;16(11):1077-1082.
Pravit Asawanonda MD DSc, Thanapong Sutthipong MD, Nattapa Prejawai MD
Idiopathic guttate hypomelanosis (IGH) is a very common skin disorder, although the precise prevalence of which is unknown. There
are no universally safe and efficacious treatments for this condition. The authors report the success of 1% pimecrolimus cream in
inducing repigmentation is this hypomelanotic disorder.
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
BACKGROUND: Botulinum toxin type A (BoNT-A) has been used for almost 20 years in cosmetic dermatology to reduce dynamic wrinkles
on single or multiple facial areas.
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
J Drugs Dermatol. 2013;12(12):1356-1362.
Noel M. Prevost MPAS PA-C, Joseph C. English III MD
Lichen planus of the nails is a destructive inflammatory onychodystrophy that is often difficult to treat. We report a case
of treatment with combined topical therapy of tazarotene gel and clobetasol gel. This modality may be effective for
patients with nail lichen planus without the potential adverse affects of systemic treatments.
Ramón H. Rosado MD, Ma. Emilia del Pino MD, Alejandro Azuela MD, Ma. Graciela Guzmán MD,
Background: Regardless of diet and exercise, genetics plays an important part in creating puckering skin or dimples, which
are difficult to hide at any age. The demand for a nonsurgical, noninvasive treatment of cellulite has inspired some
manufacturers to invest in a new age of sophisticated devices and treatment therapies to repair the skin and
improve contours. Although many of these new choices have demonstrated a smoothing effect (following a multitude of
treatments), the objective documentation has in most cases been limited to biopsies, circumference measurements, and
Hypothesis: We believe that the application of noninvasive high-energy radiofrequency (RF) to the skin of the thigh and
buttocks heats the subcutaneous adipose tissue, causing collagen fibers to contract. The resulting impact to the subcutaneous
tissue and collagen is expected to improve the skin’s external architecture. Given that the subcutaneous tissue and adipose
tissue are difficult to evaluate through histological methods, this investigation seeks to demonstrate the changes that occur
when applying 2 treatments of high-energy RF on the subcutaneous tissue of thighs and buttocks utilizing real-time
ultrasound image scanning.
Materials and Methods: Twenty-six healthy female patients (ages 18 to 50) with visible bilateral cellulite (grade 1 to 3) on
either the buttocks and/or thighs received 2 treatment sessions (15 days apart) of unipolar RF using the Accent RF System
(Alma Lasers Inc). The system utilizes a unipolar RF applicator that is electrically cooled to aid in patient comfort during
the treatment. Appropriate energy was set and the treatment was delivered in 3 passes of 30 seconds each. Evaluation of the
thickness of the subcutaneous tissue on buttocks and thighs took place before the first treatment, second treatment, and
15 days following the second treatment with a with real-time scanning image ultrasound (Philips Medical Systems). Clinical
improvement was objectively evaluated through comparative pre- and post-treatment measurements of the distance between
the stratum corneum to the Camper’s fascia and from the stratum corneum to the muscle. The study also evaluated the
structure and changes of the collagen (thickening and realignment of septae) resulting from 2 treatments of RF. Photography
was used to document contour and superficial changes.
Results: From the measurements of the distance between the stratum corneum to the Camper’s fascia and from the stratum
corneum to the muscle we were able to demonstrate that 68% of the patients presented a contraction of the volume of
Conclusions: Based on the demonstrated results with real-time ultrasound scanning, we have observed that 2 RF treatments on the subcutaneous tissue of the buttocks and thighs provide a volumetric contraction effect in the majority of patients. This validates the primary hypothesis of our protocol and establishes that the RF energy works on the connective tissue of the subcuaneous adipose tissue. This effect should be the same on any other body part.
Braden McKnight BS,a Rachel Tobin BS,b Yasmeen Kabir MD,c and Ronald Moy MDa
BACKGROUND: Non-ablative treatments for excess subcutaneous fat have been increasingly integrated into dermatologic practice.
Objective: The objective of this study was to determine the safety and efficacy of a tripolar radiofrequency device on tightening skin and reducing the circumference of the upper arms.
METHODS & MATERIALS: Twelve females received eight weekly non-ablative treatments using a tripolar radiofrequency device on the anterior and posterior upper arms. Evaluations included body weight, photographs, and circumference measurements at baseline and each subsequent week throughout the 8-week time period. The subjects and the investigator completed evaluations of clinical improvement
using a 5-point assessment scale.
RESULTS: A significant circumference reduction was achieved in each arm of all twelve patients. A mean reduction of 1.99 ± 0.94 cm (P=0.001) was observed between the initial and final measurements after the 8-week treatment period. At the 4-week follow up, the average circumferential reductions of the posterior and anterior upper arms were sustained. Patient evaluations indicated moderate to good improvement of size, tightness, and overall appearance. The procedure was well tolerated without pain.
CONCLUSION: Tripolar radiofrequency devices offer a safe and effective non-invasive technology with beneficial effects on the circumferential
reduction and overall appearance of the posterior and anterior upper arms.
J Drugs Dermatol. 2015;14(12):1463-1466.
Alan B. Fleischer Jr. MD, Alan Shalita MD, Lawrence F. Eichenfield MD, William Abramovits MD,Anne Lucky MD, Steven Garrett DDS, for the Dapsone Gel in Combination Treatment Study Group
Purpose: To evaluate the safety and efficacy of dapsone gel 5% in the treatment of acne when used in combination with adapalene
gel 0.1%, benzoyl peroxide gel 4% or moisturizer.
Methods: This was a twelve-week, randomized, double-blind study. Patients aged 12 years and older (n=301) applied dapsone gel
twice daily and were randomly assigned (1:1:1) to one of three additional treatments, applied once daily.
Results: By week 12, dapsone gel combined with any of the three additional treatments reduced the mean number of inflammatory
lesions. However, the authors did not detect a significant difference in the reduction of inflammatory lesions when dapsone
was used in combination with adapalene gel or with benzoyl peroxide gel compared to the dapsone plus moisturizer combination
group (P=0.052 for both versus moisturizer combination). Patients treated with dapsone gel combined with adapalene showed a
significantly better response in reduction in non-inflammatory and total acne lesion count than those who received the moisturizer
combination. Local adverse reactions in all three treatment groups were minimal and generally mild in severity.
Conclusion: Dapsone gel in combination with adapalene gel or benzoyl peroxide gel is safe and well tolerated for the treatment of
April A. Larson MD, Mitchel P. Goldman MD
There are few treatments that address both papulopustular and telangiectatic components of rosacea. We present a case
of rosacea that was unresponsive to treatment with antibiotics. We report the novel use of a new laser technology, the multiplexed
laser, for treatment of both papular and telangiectatic rosacea.
Nicole Hayre MD,a Melanie Palm MD,b and Peter Jenkin MDc
OBJECTIVE: The aim of this study was to compare clinical outcomes of a noninvasive selective radiofrequency (RF) eld device (BTL Vanquish METM, BTL Industries Inc., Boston MA) with its predecessor (VanquishTM, BTL Industries Inc., Boston MA). The BTL Vanquish METM system has been thoroughly redesigned for more efficient, predictable and homogenous energy delivery to the targeted tissue.
MATERIALS AND METHODS: In this multi-center study, 36 subjects with BMIs under 30 were randomly assigned to be treated in Group A (BTL Vanquish METM) or Group B (VanquishTM) in order to obtain a side by side comparison of the devices’ ef cacies. Each subject re- ceived 4 weekly 45-minute treatments with the device determined by their group assignments. Measurements of subject’s abdominal fat were taken prior to the first treatment and again four weeks after finishing the final treatment.
RESULTS: The primary outcome was abdominal fat thickness reduction as measured by ultrasound one month following each subject’s final treatment. Thirty four subjects completed the study. Two patients did not complete their treatments due to the reasons unrelated to the study (one from each group). Subjects in Group A treated with BTL Vanquish METM had an abdominal fat thickness reduction of 4.17 mm, or 29.46%, while subjects in Group B treated with VanquishTM had an abdominal fat thickness reduction of only 2.72 mm, or 15.21%. The 4 weekly treatments with BTL Vanquish METM in Group A produced a 53% higher reduction (4.17 mm vs 2.72 mm) of abdominal fat layer thickness than those in Group B. The standard deviation of ultrasound measurements in Groups A and B were 1.42mm and 2.21mm, respectively.
Assuming a homogenous response across the entire treatment area, the volume of fat reduced was calculated by multiplying the average measured reduction in fat layer by the surface area of the treatment applicator (2100 cm2; 325.5 square inches). It was calculated that Group A patients lost an average of 0.876 liter (0.23 liquid gallon) of fat, while Group B patients lost 0.571 liter (0.15 liquid gallon) of fat.
DISCUSSIONS AND CONCLUSIONS: The mean difference between the tested groups was statistically significant proving better outcomes in the Vanquish METM than its predecessor. Furthermore, the reduction in standard deviation of fat reduction measurements in Group A vs Group B is evidence that the Vanquish METM provides more consistent performance.
J Drugs Dermatol. 2016;15(12):1557-1561.
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.
Background: A distinct trend in aesthetic medicine is the patient's demand for efficient, noninvasive treatments with no downtime. Ongoing
with this, these so-called lunchtime procedures are expected to be as safe and painless as possible. A new technique based on a
combination of radiofrequency (RF) and pulsed electromagnetic fields (PEMF) was recently introduced and is supposed to be effective in
the treatment of facial wrinkles and virtually pain free. The objective of this study was to investigate the safety and efficacy of this technology
for the treatment of facial rhytides.
Methods: Thirty-one subjects with facial wrinkles and rhytides were entered into this study. Every subject received 10 treatments of the
face with a device that combines 1 MHz radiofrequency with PEMF with a flux of 15 gauss. Patients rated the pain level immediately after
the treatment by using a visual analog scale (VAS) for pain. Side effects were recorded at every visit. The study's efficacy end point was
evaluated by 2 blinded physicians who rated the standardized pictures from baseline and 3-month follow-up using the Fitzpatrick Wrinkle
and Elastosis Scale (FWES).
Results: No unexpected adverse side effects were detected or reported for the duration of the study. Both raters recognized improvements
of at least 1 grade on the FWES in 30 of 31 subjects (97%). The score decreased from 5.2 before the first treatment to 3.6 at 3
months after the last treatment. Furthermore, all patients rated the treatment to be free of pain on the VAS pain scale.
Conclusion: The results of this study show that the combination of multipolar RF with PEMF is a safe, effective, and painless approach to
treat facial rhytides and is suitable to answer the demands of patients for safe treatments without pain or downtime.
J Drugs Dermatol. 2012;11(11):1306-1309.
Background: Onychomycosis is a relatively common fungal infection. Current treatments have limited applicability and low cure rates.
Recently introduced laser therapy has shown to be a safe and effective treatment for onychomycosis. In this study, we evaluate a submillisecond Nd:YAG 1,064 nm laser for treating onychomycoses of the tonail.
Methods: Thirteen subjects (9 female, 4 male) with 37 affected toenails received 1 to 3 treatments 4 and/or 8 weeks apart with a
sub-millisecond 1,064 nm Nd:YAG laser. Diagnosis of onychomycosis was confirmed with microscopy. Average follow-up time was
16 weeks post-final treatment. Photos were taken and degree of turbidity was determined using a turbidity scale (ranging from "0 =
clear nail" to "10 = completely turbid nail") at each visit. Improvement in turbidity was determined by comparison of turbidity scores
at baseline and 16-week follow-up on average. Efficacy was assessed by an overall improvement scale (0 to 4), which combined improvement in turbidity scores and microscopic examination. Overall improvement was classified as "4 = complete clearance" if the
turbidity score indicated "0 = clear nail" accompanied by a negative microscopic result. No microscopic examination was performed
unless the turbidity score showed "0 = clear nail."
Results: Treatments were well tolerated by all subjects and there were no adverse events. Of the 37 toenails treated, 30 (81%) had
"moderate" to "complete" clearance average of 16 weeks post-final treatment. Nineteen toenails (51%) were completely clear and
all tested negative for fungal infection on direct microscopic analysis. Seven (19%) toenails had significant clearance and four (11%)
had moderate clearance.
Conclusions: The preliminary results of this study show this treatment modality is safe and effective for the treatment of onychomycosis
in the short term. Additional studies are needed to more fully assess the clinical and mycological benefits as well as optimize the treatment protocol and parameters.
J Drugs Dermatol. 2012;11(4):496-504.
Dornechia George MD, Ted Rosen MD
Various topical and systemic treatments have shown efﬁ cacy in plaque and palmoplantar psoriasis; however, studies regarding efﬁ -
cacy in inverse psoriasis are few. The authors present a case of a patient with severe inverse psoriasis who was successfully treated
with efalizumab, resulting in complete and sustained remission during prolonged maintenance therapy.
Scott A. Davis MA,a Brad A. Yentzer MD,a and Steven R. Feldman MD PhDa,b,c
BACKGROUND: Acitretin is indicated for severe psoriasis, but it is also a potent teratogen whose use should be avoided in women of childbearing potential. Topical medications, phototherapy, cyclosporine A, and new biologic agents provide safer alternatives for women of childbearing age with moderate to severe psoriasis.
PURPOSE: To determine the demographics of acitretin prescribing patterns as an assessment of acitretin use in women of child-bearing potential.
METHODS: We examined National Ambulatory Medical Care Survey (NAMCS) data from the years 1990-2009 to determine demographic data on patients who were prescribed etretinate or acitretin. We used age under 50 as a proxy for childbearing potential.
RESULTS: From 1996-2009, there were an estimated 29 million office visits for psoriasis. Females accounted for 14.3 million of these visits, and 6.5 million (45.6%) of them were under the age of 50. The NAMCS contained only one record of a female patient under the age of 50 being prescribed acitretin from 1996-2009, the years during which acitretin had been available in the United States. This corresponds to an estimated 2.3% of all psoriasis patients prescribed acitretin during this time (20,000 out of 890,000).
LIMITATIONS: The NAMCS estimates national trends based on a large nationwide database. While the use of acitretin in women under 50 is low, the precision of the estimate is limited by the small sample size provided by this database.
CONCLUSIONS: There are now many alternative treatments besides acitretin for women of childbearing potential with moderate to severe psoriasis. Acitretin is used at most infrequently in this population. In females of reproductive potential, acitretin should be reserved for non-pregnant patients who are unresponsive to other therapies or whose clinical condition contraindicates the use of other treatments.
J Drugs Dermatol. 2013;12(7):799-802.
Background: Impetigo is a highly contagious, superficial skin disease that is frequently seen in children. While data support the use
of topical antibiotics for treatment, the medications actually prescribed in practice are not well documented.
Objectives: To determine the prescribing pattern of dermatologists and nondermatologists when treating impetigo and the demographics
of the patients treated.
Methods: National Ambulatory Medical Care Survey data on office visits for impetigo were analyzed from 1997 to 2007. Patient
demographics and the treatments for impetigo were recorded.
Results: During this 10-year period, dermatologists managed an estimated 274,815 impetigo visits and nondermatologists an estimated
3,722,462 visits. Both dermatologists and nondermatologists most frequently prescribed oral antibiotics to treat impetigo.
Topical antibiotics were second most common, and a variety of combination treatments were used.
Conclusions: Oral antibiotics are the most common class of medications used to treat impetigo. There is an opportunity for physicians
to take advantage of the equally efficacious topical antibiotics for treating impetigo. A shift towards topical antibiotics would
likely decrease morbidity (resulting from adverse effects) associated with use of oral agents.
J Drugs Dermatol. 2012;11(4):489-494.
Brian Berman MD PhD, Mark S. Nestor MD PhD, Jessica Newburger DO,
Huynhee Park DO, and Nicole Swenson DO
OBJECTIVE: This randomized, 3-group study compared the efficacy and tolerability of 3 treatment modalities for facial actinic keratoses.
METHODS: Twenty-four healthy adult male and female subjects who had 4 to 8 clinically visible and discrete actinic keratoses on the face in a contiguous 25cm2 treatment area. Subjects were randomized into one of three treatment groups: 2 treatments with 5-aminolevulinic acid (ALA) and photodynamic therapy (PDT), 1 ALA-PDT treatment and 1 course of ingenol mebutate (ingenol mebutate) 0.015% gel daily for 3 consecutive days, or 1 course of ingenol mebutate gel alone. Actinic keratoses in the treatment field were counted at the baseline visit, and at the completion of the study (day 57 or day 71). At the site of application, local site reactions were graded at each visit.
RESULTS: Subjects in the two ALA-PDT treatment group had a 97.5% mean reduction (P<0.00001) from the number of baseline actinic keratosis; ALA-PDT plus ingenol mebutate gel group had an 86.7% mean reduction (P<0.00001); while subjects in the ingenol mebutate gel alone group had a 91.7% mean reduction from the number of baseline actinic keratoses. The peak composite LSR score was 4.625 for the ALA-PDT group, 10.375 for the ALA-PDT followed by ingenol mebutate gel group, and 12.625 for the ingenol mebutate gel alone group (P=0.0004 and 0.001, respectively).
CONCLUSION: ALA-PDT, ingenol mebutate gel, and a combination of the two treatment modalities are successful topical therapies for the reduction of actinic keratoses on the face. The group of subjects receiving 2 consecutive treatments with ALA-PDT, compared to treatment with ingenol mebutate gel alone or sequentially after one course of ALA-PDT had a significantly lower mean composite LSR score and a non-significant trend for greater efficacy.
J Drugs Dermatol. 2014;13(11):1353-1356.
E. Victor Ross MD,a Travis W. Blalock MD,a Douglas Winstanley DO,a Joel L. Cohen MD,b and James J. Childs PhDc
A melanin meter has been created to assess real time skin pigmentation to optimize settings for visible light aesthetic applications.
METHODS: A handheld meter was applied to non sun-damaged skin on the back of volunteers to measure skin pigmentation prior to treatment with IPL light sources over a range of pulse widths and ascending fluences. Curves for maximum epidermal tolerances as a function of pigmentation were determined. These curves were then tabulated for each pulse width in device software to provide guidance in the selection of fluences. Based on these findings, the device was applied in over 300 patients at a comprehensive laser and cosmetic dermatology center.
RESULTS: A pigment meter evaluation led to treatment parameter guidance in intense pulsed light applications. These suggested ranges for settings based on the melanin index score proved useful, accurate, and safe in applications over a broad range of skin colors and across various anatomic units of the skin.
CONCLUSION: A pigment meter can be used to identify appropriate settings with IPL treatments in order to enhance safety and efficacy when treating epidermal pigmented lesions, vessels, general photodamage and excessive hair (where the principles of selective photothermolysis
J Drugs Dermatol. 2016;15(4):421-432.
I report a patient with phenylketonuria who presented with pemphigus foliaceus or tinea amiantacea. The rash resolved
with treatment with tetracycline and niacinamide. This article outlines the uses and mechanisms of this therapy with
particular attention to its use in pemphigus, treatments, and scalp findings of pemphigus foliaceus and the dermatological
manifestations of PKU.
Jeanine Downie MD, a Katie Schneider BS, b Lisa Goberdhan BA, b Elizabeth T. Makino BS CCRA MBA, b and Rahul C. Mehta PhD b
Dyschromia is one of the primary complaints for patients with skin of color. Treatments need to achieve a balance between tolerability and efficacy to address existing hyperpigmentation without causing additional damage that could trigger post-inflammatory hyperpigmentation (PIH). An open-label, single-center study was conducted to assess the efficacy of a novel comprehensive pigmentation control serum (LYT2) combined with a series of three very superficial chemical peels (VP) in skin of color subjects. Seventeen female and male subjects aged 36 to 69 years with Fitzpatrick Skin Types III-VI and moderate to severe facial hyperpigmentation were enrolled in the 12-week clinical study. Subjects identified as Asian, Hispanic, African American, or Caucasian ethnicities. Subjects received a series of 3 VP treatments every 4 weeks. LYT2 was applied twice-daily in between VP treatments. Investigator assessments for overall hyperpigmentation, overall photodamage, and skin tone unevenness, as well as standardized digital photography and subject self-assessment questionnaires were conducted at all visits (baseline and weeks 4, 8, and 12). In vivo reflectance confocal microscopy (RCM) of a target lesion was conducted (in a subset of subjects) at baseline and week 12. Fourteen subjects completed the study. The treatment regimen provided statistically significant improvements in all efficacy parameters at weeks 8 and 12 (all P less than equal to 0.03, student’s t-test). Standardized digital photography and RCM images support the improvements in overall hyperpigmentation observed by the investigator. At the end of treatment, the regimen was highly rated by subjects with 100% of subjects (strongly agree/agree) that the combination “decreased the appearance of uneven skin tone and discolorations” and “reduced the appearance of sun damage.” In addition to this clinical study, independent case studies with this combination treatment regimen at a separate study site were also conducted with results that corroborate the formal clinical study findings. The comprehensive results from these studies suggest that the combination of a comprehensive pigmentation control serum with a series of 3 very superficial chemical peels may provide an effective treatment approach for hyperpigmentation in skin of color patients.
J Drugs Dermatol. 2017;16(4):301-306.
Martin Ray MDa and Michael Gold MDb
Traditional techniques used to treat dermatological conditions have typically involved surgery or full ablation of tissue. With the emergence
of fractional radiofrequency (RF) technology, treatment for various skin conditions no longer requires surgery or full ablation. Instead, these treatment techniques deliver thermal energy, derived from fractional RF energy, in a highly targeted manner through multiple micro-needles, referred to as pins. This technique hastens recovery time and leads to less reported side effects associated with traditional methods of tissue augmentation. While the efficacy of this treatment has been demonstrated, patient satisfaction has not been assessed and documented thoroughly. The current study examined patient-reported satisfaction following treatment with the Venus VivaTM as assessed across five separate domains of self-reported satisfaction; degree of comfort during treatment procedures, recovery time following treatment, convenience and efficiency of treatment appointments, treatment results, and whether the patient would recommend the treatment to a friend. Participants included 43 healthy adult volunteers who reported varying degrees of facial dermatological conditions, such as rhytides, hyperpigmentation, or the redness associated with acne vulgaris. Participants received between one and three treatments with the Venus VivaTM device. Patient satisfaction was assessed three months following the last treatment. Results indicated that patients are highly satisfied with treatments received from the Venus VivaTM device and are highly likely to recommend the procedure to a friend.
J Drugs Dermatol. 2015;14(11):1268-1271.
Neil S. Sadick MD FACP FAACS, Macrene Alexiades-Armenakas MD PhD, Patrick Bitter Jr. MD, George Hruza MD, R. Stephen Mulholland MD
Background: The authors previously reported their experience achieving non-ablative skin enhancement with serial,
full-face, intense pulsed light treatments in a large series of patients. A new method for skin renewal electro-optical synergy
(ELOS), which combines intense pulsed optical energy and conducted bipolar radiofrequency (RF) energy into a
single pulse, has been recently introduced. Intense pulsed optical energy and bipolar RF energy have been used in dermatologic
surgery for many years; however, this study represents the therapeutic impact of the combined energies.
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
Peter J. Aronson MD and Farah Malick MD
Alcoholism is a risk factor in the worsening of psoriasis. The authors present two cases of flared severe psoriasis in alcoholic patients
showing dramatic improvement of their skin disease using treatments directed towards correcting abnormalities commonly found as
sequelae of alcoholism such as endotoxin production, low serum magnesium levels and elevated plasma homocysteine levels.
Jill Waibel MD, Kenneth Beer MD, Vic Narurkar MDand Tina Alster MD
Fractional resurfacing has become an increasingly popular treatment for photodamage. Non-ablative and ablative fractional
resurfacing modalities both have a variety of different devices that may be utilized for treatments. Each modality has its own benefits
and drawbacks. In this article, the authors offer preliminary observations from hands-on experience with several different ablative
fractional lasers presently available.
Sila Seremet MD,a* Sunil Abhyankar MD,b* Tiffany J. Herd MD,b and Daniel Aires MDb
INTRODUCTION: Extracorporeal photopheresis (ECP) has been used for the treatment of advanced stage or treatment refractory cutaneous T-cell lymphoma (CTCL) since 1987, and more recently has also been shown to be of benefit for earlier stage resistant CTCL. Complete response rates in prior studies of ECP in early CTCL have ranged from 0% to 40%.
METHODS: We reviewed electronic medical records of all CTCL patients seen in the University of Kansas Cancer Center between June 2007 and May 2011. International review board approval was obtained. Inclusion criteria were (1) early stage CTCL and (2) ECP treatment. Data included demographics, type of intravenous access employed, CTCL subtype, cytogenetic features, adverse events, adjuvant treatments, and survival time in years. Treatment response was assessed via a modified severity weighted assessment tool (mSWAT). Primary outcome measures were response rates to ECP at 6 months and 12 months after beginning treatment.
RESULTS: Of 20 patients (13 female; 7 male), 7 were Stage 1A, 11 were 1B, and 2 were 2A. Seven patients with stable disease and 2 patients with progression at 6 months received adjuvant therapy (PUVA/systemic retinoids/metotrexate/interferon) in addition to ECP. Twelve-month response to ECP was 90%: 15 patients (75%) had complete responses, 3 (15%) had partial responses, 1 had stable disease, and 1 progressed.
CONCLUSION: Used alone or in combination with adjuvant treatments, ECP can be an effective treatment method in early stage CTCL.
J Drugs Dermatol. 2016;15(10):1212-1216.
Arisa Ortiz MD, Laila Elkeeb MD, Anne Truitt MD,Rasha Hindiyeh MD, Lisa Aquino MD, Minh Tran,Gerald Weinstein MD
Background: Current treatments for acne rosacea are often associated with unsatisfactory outcomes and adverse effects.
Objective: To determine the efficacy and tolerability of a new moisturizing lotion for improving the clinical signs and symptoms of
mild-to-moderate acne rosacea.
Methods: In a 12-week, open-label study, a moisturizing lotion containing furfuryl tetrahydropyranyladenine as PRK124 (0.125%,
Pyratine-XR™, Senetek PLC, Napa, CA) was applied twice daily to subjects with mild-to-moderate rosacea. Improvement in the appearances
of erythema and papules were assessed by the treating physician. Skin barrier function was measured by transepidmal
water loss after treatment. Tolerability and cosmetic outcome were evaluated by patients.
Results: Twenty-one participants completed the study. Overall clinical improvement was observed in 80% of subjects, with most
showing mild-to-moderate improvement. Erythema, papule counts, and telangiectasia were reduced. The reduction in TEWL was
significant at weeks 4 (p = 0.01), 8 (p < 005), and 12 (p<0.001). Rosacea symptoms (burning, stinging, dryness) were progressively
reduced, with reduction in dryness achieving statistical significance at weeks 4 (p = 0.035), 8 (p = 0.037) and 12 (p = 0.016). Treatments
were well tolerated and cosmetic outcomes were acceptable. Treatment-induced irritation was not observed.
Conclusion: The new moisturizing lotion containing furfuryl tetrahydropyranyladenine as PRK124 shows a continued trend toward
improvement of skin barrier function and the appearances of erythema and papules associated with mild-to-moderate rosacea during
12 weeks of treatment.
Stuart J. Anderson MBBS FRACGP FACCO FARGP,a Howard K. Steinman MD,b Jason D. Mazzurco DO MS,c and Anthony J. Dixon PhD MBBSd
OBJECTIVE: To determine whether field photodynamic therapy (PDT) of actinic keratoses (AKs) using a novel preparation of 5-aminolevulonic acid (ALA) would result in fewer subsequent invasive skin cancers developing on the face.
DESIGN: A prospective multi-center randomized controlled trial. The protocol was approved by the Bond University Human Research Ethics Committee in accord with the TGA’s Clinical Trial Notification Scheme. The trial was registered (12609000025235) on the Australian New Zealand Clinical Trials Registry.
SETTING: Six centers in four states in Australia.
PROTOCOL: Two treatments of ALA PDT, 2 weeks apart for each patient. Controls were observed. Patients were followed up with biopsies of any suspicious lesions every 6 months for 2 years.
MAIN OUTCOME MEASURE(S): Development of new skin cancers.
RESULTS: The trial was suspended after 3 months and closed after 6 months after ethics committee approval was withdrawn on the basis of a breakdown in trial governance. Over the following 2 years, some investigators noted and formally reported the continued occurrence of serious adverse events in excess of those described with other approved cutaneous PDT treatments. USA dermatologists with experience managing AKs with FDA approved ALA products subsequently confirmed prolonged and severe adverse events in 6 of the former trial intervention patients.
DISCUSSION AND CONCLUSIONS: Adverse effects experienced by patients using the investigational ALA PDT appeared more severe than those experienced when an FDA-approved ALA product is used. We believe the former should be further evaluated for safety. It is of concern that this ALA product and lamp could be promoted and used widely in Australia following these reports of significant adverse events and continued lack of TGA approval.
J Drugs Dermatol. 2014;13(1):62-66.
Jason J. Emer MD, Amylynne Frankel MD, Andrew Sohn BS, Mark Lebwohl MD
Corticosteroids are the mainstay of therapy for atopic dermatitis, but long-term use is associated with adverse effects. We sought
to evaluate the clinical efficacy of two steroid-sparing creams for atopic dermatitis. Twenty patients were enrolled in an investigatorblinded,
bilateral comparison study. Patients applied pimecrolimus cream twice daily to a target lesion on one side of the body and
also applied a topical medical device cream three times daily on a symmetrical target lesion on the opposite side of the body for
four weeks. Clinical assessments including Physician Global Assessment (PGA), Target Lesion Symptom Score (TLSS), subject selfassessment
and digital photography were performed at the baseline, 2 week, and 4 week visits. Seventy-five percent of patients
(pimecrolimus, 15 of 20; topical medical device, 15 of 20) were rated "clear" (0) or "almost clear" (1) by PGA for both medications
after four weeks. Percent improvement of the PGA from randomization for pimecrolimus cream and the topical medical device cream
were 72.50 and 71.67 respectively (P=0.9283). PGA scores decreased significantly from baseline for both treatments (P=0.004).
Overall, there was no statistically significant difference between treatment groups for PGA scores throughout the study (P=0.8236).
No cutaneous side effects were noted. Our study was limited by a small sample size and lack of double-blinding; however, both
treatments were found to be safe and effective in treating atopic dermatitis over four weeks. Significant improvements were noted
for all efficacy variables. In conclusion, a lipid-rich, non-steroidal, topical medical device cream was as effective in improving atopic
dermatitis as pimecrolimus cream.
J Drugs Dermatol. 2011;10(7):735-743.
Antibiotic resistance is described as “a global public health challenge” and a “major health security challenge of the 21st century”
by global health authorities,1 and there is a growing need for dermatologists to counteract it in their treatments of acne.3,4 Antibiotic
limiting regimens, such as a combination of topical retinoids and benzoyl peroxide, have shown effectiveness in the treatment of
acne; and topical probiotics could also play a needed role.
J Drugs Dermatol. 2014;13(suppl 6):s66-s70.
Robert Baran, MD and Aditya K. Gupta, MD, PhD, FRCP(C)
It is widely accepted that there is a finite failure rate when treating onychomycosis; a case report from the author serves as an example of multiple failures following treatments of varying duration and combinations, including oral-local, then oral-oral therapies. This article discusses the results obtained by authors who have varied the standard duration of therapy, increased the dosage of the oral antifungal agents, or have used two oral drugs in treating this condition.
James Q. Del Rosso DO, Hilary Baldwin MD, Guy Webster MD
Objectives:The objectives of these Guidelines are to provide an overview of the fundamental disease state of rosacea and quality of
life implications and outline available pharmacological treatments for rosacea with reference to supporting research and
literature. The pharmacological agents discussed are inclusive of those that are FDA-approved based on phase 3 pivotal
trials, commonly used agents based on extensive clinical experience, and less commonly used alternatives reported in peerreviewed
David B. Vasily MD, Mary E. Cerino RN, Ethel M. Ziselman MD, Zeina S. Tannous MD
Objective: Non-ablative, fractional lasers generate microscopic columns of coagulated tissue through the epidermis and dermis
to evoke a wound healing response. In this study, the authors examined the efficacy and safety of the non-ablative 1540 nm
erbium:glass fractional laser in the treatment of surgical and post-traumatic scars.
Methods: Clinical studies were conducted on a range of surgical and post-traumatic scars with a 1540 nm erbium:glass fractional
laser varying energy, pulse widths, treatment passes, and number of treatments. A histological study was conducted on a postsurgical
scar to follow the time course of healing post-treatment and the impact of the fractional treatment on normalization of scar
tissue, as compared to baseline histology of the scar.
Results: Histologic findings demonstrated rapid re-epithelialization of the epidermis within 72 hours of treatment. Remodeling of scar tissue
with renewal and reorganization of collagen fibers in the dermis was noted two weeks post-treatment. Clinical subjects, with Fitzpatrick
skin types II–V, received three to seven treatments with microbeam energies up to 60 mJ/μb and five passes. Relative to baseline, 73%
of treated scars improved 50% or more and 43% improved 75% or more. Side effects included mild swelling (95% of subjects), erythema
(94%) and purpura (5%), which all resolved within two to three days. Downtime was minimal-to-none for all subjects.
Conclusion: These data illustrate the safety and efficacy of the 1540 nm erbium:glass fractional laser in the treatment of surgical
and post-traumatic scars. Practitioners can vary energy and microbeam density in order to tailor the treatment to reflect the individual
David Rosmarin MA, Bruce E. Strober MD PhD
Interleukin 12 (IL-12) is an important cytokine produced by a variety of immune effector cells that leads to a type 1
helper T cell (Th1) response. IL-12 also directs T cells to the skin via induction of cutaneous lymphocyte antigen
(CLA) expression. In this article we report the current understanding of the immunobiology of IL-12, reviewing its
structure, receptor, and function. We also discuss the role of IL-12 in the pathogenesis of psoriasis. Some effective conventional
psoriasis treatments alter IL-12 levels. Importantly, specific antibodies directed against IL-12 may prove useful
against psoriasis but may also act by targeting IL-23 in addition to IL-12.
Emily Stamell Ruiz MD,a Joel L. Cohen MD,b,c
and Adam Friedman MDd
Although the therapeutic gold standard for basal cell carcinomas
(BCCs) is surgical excision, imiquimod, fluorouracil
cream, and photodynamic therapy are frequently used. All 3
modalities have been shown to be efficacious for the treatment
of superficial BCCs as well as other nonmelanoma
skin cancers; however, recent reports have emerged implicating
these agents in causing more aggressive recurrent
subtypes of BCCs. Here we review this literature as well as
offer an alternative explanation for these tumors.
Melanie D. Palm MD MBA,a Joel Schlessinger MD,b Valerie D. Callender MD,c Steven Fagien MD,d Kenneth Beer MD,e Suzanne Magante MS,f Sara Sangha PhDg
Perceptions of attractiveness can be negatively affected by submental fullness. Patients seeking to improve their submental contour have a variety of treatment options including surgical procedures, energy-based devices, and injectable treatment. The Condition of Submental Fullness and Treatment Outcomes Registry (CONTOUR) was designed to provide insights into the treatment of submental fat (SMF) in clinical practice. CONTOUR was a prospective observational study that enrolled 1029 adults at 91 sites in the United States and Canada. Patients were followed until treatment completion, discontinuation, or 1 year elapsed from enrollment without treatment. Final data from CONTOUR are reported here.
Of the 676 patients who underwent treatment, 570 were treated with ATX-101 (deoxycholic acid injection), 77 with energy-based devices, 23 with surgical liposuction, 5 with laser liposuction, and 9 with other treatments. The majority of treated patients were facial aesthetic treatment naive. A markedly greater percentage of patients with mild or moderate SMF at baseline received treatment with ATX-101 or energy-based devices, whereas the majority of patients undergoing liposuction had severe or extreme SMF. Physicians most frequently cited a preference for a noninvasive/minimally invasive procedure as the reason for choosing either ATX-101 or energy-based devices. The majority of patients were at least partially satisfied with results, regardless of the chosen treatment.
Data from CONTOUR indicate that cost is the most important factor in a patient’s decision to undergo treatment, that choice of treatment method is most influenced by SMF severity and preference for nonsurgical versus surgical intervention, and that the availability of noninvasive/minimally invasive options has made SMF treatment an attractive first procedure for patients who have not undergone previous facial aesthetic treatments.
ClinicalTrials.gov identifier: NCT02438813.
J Drugs Dermatol. 2019;18(1):40-48.
Shaundre Terrell BS, Daniel Aires MD, Eric S. Schweiger MD
Background: Studies indicate photodynamic therapy is an effective treatment of infl ammatory acne lesions on patients with Fitzpatrick
skin types 1–3. There is a lack of evidence in the literature regarding the use of photodynamic therapy to treat acne vulgaris in
African American patients. This article reports the fi rst case of blue light photodynamic therapy to treat moderate infl ammatory facial
acne on an African American patient with type 5 skin.
Observations: This article describes a 26-year-old African American woman with moderate infl ammatory facial acne vulgaris. On
examination, she had over 15 infl ammatory papules on her face and post-infl ammatory hyperpigmentation. The patient had a history
of treatment failure with the following therapies: topical benzoyl peroxide, topical antibiotics, topical retinoids and oral antibiotics. At
presentation, the patient was using a combination topical benzoyl peroxide/clindamycin product in the morning and tazoratene gel in
the evening without success. The patient was treated with 20% aminolevulinic acid/blue-light photodynamic therapy spaced monthly
for a total of four treatments, a once-daily application of hydroquinone 4% cream and her existing topical regimen. The patient reported
signifi cant improvement of infl ammatory acne lesions and post-infl ammatory hyperpigmentation following two treatments
with photodynamic therapy and was virtually clear of all acne lesions after the third treatment.
Conclusion: Photodynamic therapy is an emerging remedy for patients with acne vulgaris resistant to standard treatment, particularly
in patients with skin of color who are more sensitive to post-infl ammatory hyperpigmentation. In this African-American patient,
20% aminolevulinic acid/blue-light photodynamic therapy was effective in treating facial acne vulgaris.
Periorbital hyperpigmentation (POH) is a common worldwide problem. It is challenging to treat, complex in pathogenesis, and lacking straightforward and repeatable therapeutic options. It may occur in the young and old, however the development of dark circles under the eyes in any age is of great aesthetic concern because it may depict the individual as sad, tired, stressed, and old. While “dark circles” are seen in all skin types, POH is often more commonly seen in skin of color patients worldwide.1 With a shifting US demographic characterized by growing number of aging patients as well as skin of color patients, we will encounter POH with greater frequency. As forecasted by the US Census, by 2030 1 in 5 Americans will be 65 plus years old and greater than 50% of the population will possess ethnic skin of color.2 The disparity in the medical community’s understanding of POH versus popular demand for treatment is best illustrated when you have only 65 cited articles to date indexed on PubMed line3 compared to the 150,000,000 results on Google search engine.4 Most importantly POH may be a final common pathway of dermatitis, allergy, systemic disorders, sleep disturbances, or nutritional deficiences that lends itself to medical, surgical, and cosmeceutical treatments. A complete medical history with ROS and physical examination is encouraged prior to treating the aesthetic component. Sun protection is a cornerstone of therapy. Safety issues are of utmost concern when embarking upon treatments such as chemical peeling, filler injection, and laser therapy as not to worsen the pigmentation. Without intervention, POH usually progresses over time so early intervention and management is encouraged. The objective of this study was to review the current body of knowledge on POH, provide the clinician with a guide to the evaluation and treatment of POH, and to present diverse clinical cases of POH that have responded to different therapies including non-ablative fractional photothermolysis in two skin of color patients.
J Drugs Dermatol. 2014;13(4):472-482.
Steven B. Deliduka MD, Pearl C. Kwong MD PhD
Nevus comedonicus is a rare developmental defect of the pilosebaceous unit. It is also thought to be a variant of epidermal nevus.
Previously reported treatments include surgical excision, CO2 laser, dermabrasion, extraction, topical retinoic acid, and numerous topical
We present a case of a 7-year-old boy with bilateral nevus comedonicus who experienced cosmetic improvement with topical
tazarotene and calcipotriene cream. This combination represents a novel therapeutic approach to the treatment of this cutaneous
Kenneth Robert Beer MD
Radiesse was approved for cosmetic use by the US FDA in December of 2006. Prior to this approval it had been widely
used off-label for a variety of areas including lip augmentation. With increased use, complications including nodule formation
were reported. The formation of nodules at a site distant from the area of injection has not been reported to date.
This report documents such a case and discusses possible etiologies and treatments for these distant nodules.
Gabriel Serrano MD, Matilde Lorente MD, Madga Reyes MD, Fernando Millan MD, Adrian Lloret MD, Joaquin Melendez, Maria Navarro, Miguel Navarro MD
Topical aminolevulinic acid (ALA) photodynamic therapy (PDT) is currently being used for the treatment of actinic keratosis of the
face and scalp. This study reports the results obtained after three to four treatments with ALA-PDT in patients with acne (n=12),
photoaging (n=8) and vitiligo (n=6). ALA was applied on large areas (e.g., full face) and at very low strengths (1-2%). Side effects
were minimal and self-limited.
Eduardo H. Tschen MD,a Alicia D. Bucko DO,a Norihide Oizumi MS, Hideki Kawabata MS,Jason T. Olin PhD, and Radhakrishnan Pillai PhD
Background: Onychomycosis is a common nail infection that is difficult to treat successfully. The prevalence increases with age and is associated with diabetes. Oral treatments are limited by drug interactions and potential hepatotoxicity; topical treatments, by modest efficacy.
Objective: We investigated the efficacy and safety of a solution using a novel topical triazole antifungal, efinaconazole, in distal lateral subungual onychomycosis (DLSO).
Methods: Multicenter, randomized, double-blind, vehicle-controlled phase 2 study in mild to moderate toenail DLSO (n=135). Subjects randomized (2:2:2:1 ratio) to receive efinaconazole 10% solution (with or without semiocclusion), efinaconazole 5% solution, or vehicle, once daily for 36 weeks, with one 4-week posttreatment follow-up (week 40). Efficacy assessments included complete cure, mycologic cure, clinical efficacy, and other assessments of overall treatment effectiveness. No efficacy variables were designated as primary.
Results: At follow-up, complete cure was numerically higher in all active groups (16%-26%) compared with vehicle (9%). Mycologic cure rates with efinaconazole 10% semiocclusion, efinaconazole 10%, and efinaconazole 5% were 83%, 87%, and 87%, respectively. Efinaconazole 10% (with or without semiocclusion) demonstrated significantly greater clinical efficacy and treatment effectiveness when compared with vehicle (P=.0088 and .0064; .0056 and .0085, respectively, for both efinaconazole 10% groups). Adverse events were generally similar and mild. Local-site reactions were restricted to few subjects and did not differ meaningfully from those produced by vehicle.
Conclusions: This study provided evidence that once-daily efinaconazole 10% solution (with or without semiocclusion) applied topically for 36 weeks was more effective than vehicle in treating DLSO and was well tolerated. Based on these results, efinaconazole 10% solution was chosen for the phase 3 development program.
J Drugs Dermatol. 2013;12(2):186-192.
Julia S. Lehman MD, Gabriel F. Sciallis MD
Idiopathic proctodynia, an enigmatic pain syndrome affecting the perianal region, can be persistent, relatively refractory to treatment,
and associated with considerable psychological distress. The authors present the case of a patient with a long history of severe proc-
todynia that had been resistant to a range of topical and systemic treatments. With the use of topical amitriptyline hydrochloride 2.5%
and ketamine hydrochloride 0.5% cream, the patient’s pain resolved rapidly, leading to a substantially improved quality of life.
Background: Psoriasis is a common skin disease in Caucasians but less common in African-Americans.
Aims: Our aim is to evaluate caregiver opinions regarding the clinical presentations and treatment of psoriasis in African-Americans
compared to Caucasians.
Patients/Methods: A survey was sent to 29 dermatologists who are opinion leaders in the field of psoriasis. The survey included a
number of questions regarding the characteristics of the patients seen in their practice.
Results: A total of 29 surveys were completed and returned. All of the dermatologists use the extent of disease as a criterion to
determine the severity of the disease. Other criteria include scale, thickness, erythema, associated general symptoms, and dyspigmentation.
About 66% of the respondents reported the different manifestations of disease, such as more dyspigmentation, thicker
plaques, and less erythema in African-Americans. The most common first-line treatments for mild to moderate disease were highpotency
topical steroids (68%) followed by topical vitamin D analogues (41%). For moderate to severe disease, the most commonly
used first-line treatments were high-potency topical steroids (54%) and phototherapy (46%).
Conclusions: The clinical manifestations of psoriasis in African-Americans are not exactly the same as in Caucasians. Physicians
should be aware of the difference in clinical manifestations in African-Americans. Further research and large-scale studies are necessary
to elucidate the differences in the clinical presentation, natural course of the disease, and the criteria used for the evaluation
of severity among ethnic groups.
J Drugs Dermatol. 2012;11(4):478-482.
Divya Railan MD, Tina S. Alster MD
Topical anesthetic agents are frequently used by dermatologists to decrease the pain associated with a variety of cutaneous
procedures, including laser surgery, soft tissue augmentation, and other cosmetic surgical treatments. These lidocaine-containing
creams play an integral role in the cosmetic dermatology office by providing patient comfort with minimal side
effects. This review of topical lidocaine preparations should aid practitioners in the selection of an appropriate topical
anesthetic, taking into consideration its onset and duration of action and potential side effects.
Purpose: To determine whether oral zinc supplementation might affect the efficacy and duration of botulinum toxin treatments.
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.
Tracee Douse-Dean PA-C, Carolyn I. Jacob MD
The use of hyaluronic acid (HA) filler substances for facial skin wrinkling and volume loss has become popular. With increasing
use, physicians are likely to encounter side effects. One such side effect is a bluish discoloration known as the Tyndall
effect. Recently, we have encountered a few cases in which patients presented with a bluish tint in the areas where
hyaluronic acid was injected. A number of treatments can be performed to reverse these unwanted effects. We present a
simple method for correction of misplacement of HA gel.
Stephen K. Tyring MD PhD,a Theodore Rosen MD,b Brian Berman MD PhD,c Nathan Stasko PhD,d Todd Durham PhD,d Tomoko Maeda-Chubachi MD PhD MBAd
BACKGROUND: Nitric oxide (NO), a free radical gas, is endogenously produced in human cells. In high concentration, NO neutralizes many disease-causing microbes. The topical investigational drug SB206 releases NO and has the potential to treat skin diseases caused by viruses. Genital warts (condyloma acuminata) are primarily caused by human papillomavirus (HPV) types 6 and 11. Available treatments have low tolerability and efficacy rates and are inconvenient for the patient. Genital warts can recur if HPV is incompletely eradicated during treatment.
OBJECTIVE: Topical SB206 (berdazimer sodium plus carboxymethyl cellulose hydrogel) was assessed for tolerability, safety, and efficacy for up to12 weeks in patients with external genital and/or perianal warts (EGW/PAW) in a phase 2, double-blind, randomized, dose-escalation study.
METHODS: Patients (N=108) were randomly assigned to SB206 or vehicle in a 3:1 ratio: SB206 4% once (QD) or twice daily (BID), 8% QD, 12% QD, or corresponding vehicle. Treatment duration was up to 84 days. The primary efficacy endpoint was complete clearance of baseline EGW/PAW at or before week 12. Pearson’s Chi Square tests compared the efficacy of active vs vehicle treatments. Safety was assessed through adverse event and tolerability reports, physical examination findings, and clinical laboratory test results.
RESULTS: In the Intent-to-Treat population, the percentage of patients with complete clearance of baseline EGW/PAW at or before week 12 was higher for SB206 groups than for vehicle groups, with the greatest difference between SB206 12% QD (33.3%; P=0.010) and vehicle QD (4.3%).
CONCLUSION: Berdazimer sodium (SB206) plus hydrogel was efficacious and well tolerated in the treatment of EGW/PAW.
J Drugs Dermatol. 2018;17(10):1100-1105.
BACKGROUND AND OBJECTIVE: Laser induced post inflammatory hyperpigmentation
PIH, is a complication seen mostly in dark skinned
patients, it is not known whether giving the laser treatment at specific
menstrual period days, may predispose to PIH.
METHODS: Seven volunteers underwent fixed fractionated CO2 laser
treatments at four predetermined days spanning the menstrual cycle.
RESULTS: Two volunteers developed hypopigmentation while the rest
had hyperpigmentation. In those who developed PIH, the pigmentation
was most severe when done just before or after menstruation.
CONCLUSIONS: Laser induced PIH risk may be influenced by the
Alex M. Glazer MD,a Bryan D. Sofen MD,b Darrell S. Rigel MD,c and Jerome L. Shupack MDc
Generalized essential telangiectasia (GET) is a notoriously difficult to treat disorder with no current satisfactory treatments. This case and discussion report the use of 6-mercaptopurine (6-MP) as a successful treatment for GET. Moreover, we show that GET may represent a state of increased angiogenesis, a paradigm shift from the current understanding that these telangiectasias represent dilatations of only pre-existing vessels. This new view of GET may drive others to look at novel agents for treatment.
J Drugs Dermatol. 2017;16(3):280-282.
Nina Botto MD and Gary Rogers MD
This review discusses nontraditional modalities available for the treatment of basal cell carcinoma along with the existing evidence to support their respective uses in varying clinical situations. By definition, these modalities are nonsurgical, and in many cases, are not approved by the US Food and Drug Administration as treatments for basal cell carcinoma, including topical chemotherapies, photodynamic therapy, oral therapies, and complementary therapies. Nonetheless, as the population of patients with skin cancer increases at epidemic proportions, many of these modalities are, and will become, increasingly relevant in the dermatologist’s armamentarium.
J Drugs Dermatol. 2013;12(5):525-533.
Vic A. Narurkar MD,a Tina S. Alster MD,b Eric F Bernstein MD,c Tina J. Lin PharmD,d and Anya Loncaric MSe
BACKGROUND: Fractional photothermolysis (FP) is a popular treatment option for photodamaged skin and addresses shortcomings of ablative skin resurfacing and nonablative dermal remodeling. Previous studies have demonstrated that FP using the 1550nm wavelength has led to improvement of ultrastructural changes and clinical effects associated with photodamaged skin in the deeper dermal structures, while treatment with the 1927nm wavelength has shown clinical effects in the superficial dermis. Both wavelengths produce precise microscopic treatment zones (MTZs) in the skin. The two wavelengths used in combination may optimize the delivery of fractional nonablative resurfacing intended for dermal and epidermal coagulation of photodamage skin.
OBJECTIVES: To evaluate the safety and efficacy of a 1550/1927 Laser System (Fraxel Dual, Solta), using both 1550nm and 1927nm wavelengths in combination for treatment of facial and non-facial photodamage.
METHODS: Prospective, multi-center, post-market study in subjects with clinically identifiable photodamage (N=35) (Fitzpatrick skin types I-IV). Both 1550nm and 1927nm wavelengths were used at each treatment visit. Investigator assessment of the affected area(s) occurred at one week, one month and 3 months after a series of up to four treatments. Severity of adverse events (AEs) were assessed using a 4-point scale (where 0=none and 3=marked). Assessments included erythema, edema, hyperkeratosis, hyper- and hypo-pigmentation, scarring, itchiness, dryness, and flaking. Severity of photoaging, fine and coarse wrinkling, mottled hyperpigmentation, sallowness, and tactile roughness at baseline was assessed using the same scale. Investigators and subjects assessed overall appearance of photodamage and pigmentation based on a 5-point quartile improvement scale at all follow-up visits (where 0=no improvement and 4=very significant improvement [76%-100%]).
RESULTS: There was a positive treatment effect at all study visits, with moderate improvement (average reduction in severity of 21%-43%) observed 3-months after final treatment. Greatest reduction in severity of other benefit areas was at the 3-month follow-up visit, with a 21% and 30% decrease in severity in fine wrinkling and tactile roughness. No AEs or serious AEs were reported. Pain sensation during treatment was tolerable. Anticipated moderate erythema (mean score 1.6±0.5) and mild edema (mean score 0.8±0.7) were transient and resolved within 7-10 days. Anticipated and transient mild dryness (52% of subjects) and flaking (30%) were reported at the 1-week follow-up. There were no incidences of hyperkeratosis, scarring, or itchiness.
CONCLUSION: Treatments using both wavelengths associated with the combined 1550/1927 Laser System were well tolerated with limited, transient anticipated side effects and no serious AEs. Clinical efficacy in the appearance of photodamage and pigmentation was greatest following a series of up to 3 treatments.
J Drugs Dermatol. 2018;17(1):41-46.
The US Food and Drug Administration (FDA) held a hearing on the safety of dermal fillers in November of 2008 which generated a great deal of media attention and, more importantly, got our attention. The adverse reporting data came from the FDA’s Manufacturer and User Facility Device Experience (MAUDE) database and numbered 930 cases over the past 6 years, bringing the complication rate to an estimated 1 in 10 000. Some of the complications were severe, such as facial palsy or anaphylaxis; while others included scarring. Such rare but grave complications are generally considered acceptable risks for treatments of medical illnesses (eg, infections or carcinomas); but are these rare complications for elective cosmetic enhancement acceptable?
Rachel Seidel BAa and Ronald L. Moy MD FAADb,c
BACKGROUND: Atrophic acne scars are a common and psychologically devastating sequela of acne vulgaris that are refractory to the vast majority of topical treatments.
OBJECTIVE: We evaluated the efficacy of a topically applied synthetic epidermal growth factor (EGF) serum in reducing the appearance of atrophic acne scars.
METHODS: A single-center clinical trial was performed on nine self-selected male and female patients with Goodman & Baron grade II-IV atrophic acne scars. Subjects followed a standardized treatment regimen, including twice-daily application of EGF serum to scarred areas over 12 weeks. Subject progress was evaluated at baseline and 4-week intervals by clinical photography, Investigator Global Assessment (IGA), Goodman grade and patient self-assessment. Final patient perceptions were shared by written self-assessment at the end of the study. Before and after photographs were also evaluated by a blind investigator.
RESULTS: Eight subjects completed the trial. Compared to baseline, there was an improvement in mean IGA score from 2.875 (SEM= .327) to 2.38 (SEM = .375). Mean Goodman grade was reduced from 3.00 (SEM = .309) to 2.75 (SEM = .25). Of the eight pairs of before and after photographs given to a blind investigator, five were correctly chosen as the post-treatment image. Two were assessed as “excellent” (76-100%) improvement and three were assessed as "good" (50-75%) improvement. A one-tailed paired student t-test (α = .05) using blind investigator ratings of scar severity for each before and after photograph yielded a P-value of .0019, confirming the difference as statistically significant. On final self-assessment, all but one patient reported “good” to “excellent” improvement in their scars compared to baseline. 75% of patients who received alternative treatments in prior years reported EGF serum to be more efficacious.
CONCLUSION: These results suggest that topical EGF may improve the appearance of atrophic acne scars, though further study and more objective evaluation measures are required for definitive conclusions to be drawn.
J Drugs Dermatol. 2015;14(9):1005-1010.
Collin M. Costello MD,a Melody Maarouf MHS,b Vivian Y. Shi MDb
Dermatology is entering an exciting era with new, targeted immune-modulating medications for treating a variety of dermatologic conditions including psoriasis, atopic dermatitis (AD), and hidradenitis suppurativa. Previously, mainstay treatments consisted of topical corticosteroids or broad systemic immunosuppressants. Recently, our understanding of cytokine signaling cascades has grown, presenting new opportunities to target skewed immune responses. Two major classes are biologics and small molecules. Herein, we highlight the similarities and differences between these two categories of targeted medications.
J Drugs Dermatol. 2018;17(12):1330-1332.
Peter W. Hashim MD MHS,a Tinley Chen BA,a Mark G. Lebwohl MD,a Lauren B. Marangell MD,d Leon H. Kircik MDa,b,c
Brodalumab, a fully human antibody of the interleukin-17 receptor, is highly effective in the treatment of moderate-to-severe plaque psoriasis. However, based on safety signals identified in clinical trials, brodalumab carries a boxed warning regarding possible risks of suicidal ideation and behavior (SIB). The validity of this link remains controversial, especially in the context of the psoriasis population as well as clinical trial data from other recently approved treatments. Herein, we critically examine the association between brodalumab and SIB.
J Drugs Dermatol. 2018;17(8 Suppl):s29-34
Maria Mekas BSN,a,b Jennifer Chwalek MD,a,c Jennifer MacGregor MD,a,d and Anne Chapas MDa,c
BACKGROUND: Glycolic acid acts by chemical destruction of adhesions between skin cells to exfoliate superficial skin layers and excess pigmentation. It is well known to improve the appearance of photoaged skin, but is associated with varying degrees of skin irritation. Hydrolyzed salmon roe proteins destroy cell adhesions enzymatically with potentially less irritation than acid treatments. This double-blind prospective study assesses the efficacy and tolerability of hydrolyzed roe versus glycolic acid, and glycolic acid with citric acid.
METHODS: 75 female subjects with mild to moderate photodamage, all skin types, and ages 31-70 years, were enrolled. In this 12 week study of twice daily self-treatments, patients were assigned to one of 3 groups; Group 1 (n-19) was assigned hydrolyzed roe cream, Group 2 (n=17), 4% glycolic acid, or Group 3 (n-16), 8% glycolic acid plus 2% citric acid. All patients used the same mild face wash and SPF 30 sunscreen throughout the study. Patients were evaluated at weeks 0, 8 and 12 for objective and subjective tolerability, improvement in photodamage by VISIA Complexion Analysis, modified Packman and Gans method, Visual Analog Scale (VAS), and answered an opinion questionnaire.
RESULTS: Group 1 improved in skin clarity from a VAS 44.1 to 55.7 (P=0.0317) at week 12. VISIA mean scores correlated with office evaluation showing improvement in brown spots from 453 to 417 (P = 0.0115) at 12 weeks. Group 2 improved in superficial fine lines at week 8 (-5.9, P=0.0428) and week 12 (-9.1, P=0.0019). Group 3 improved at week 12 in skin clarity (11.5, P = 0.0469) and skin roughness (-13.3, P = 0.0426), and in hyperpigmentation at week 8 (-9.4, P=0.0462) and week 12 (-14.6, P= 0.0019).
CONCLUSION: Topical hydrolyzed roe protein used twice daily improves skin clarity. It has good tolerability with fewer instances of stinging
and burning than the other glycolic acid containing creams. Patient’s opinions of the 3 products were similar.
J Drugs Dermatol. 2015;14(11):1306-1319.
Onabotulinum Toxin A is the gold standard treatment for temporary dynamic rhytid reduction. Clinicians have observed a long-term and preventive benefit for patients beyond muscle relaxation particularly in patients who receive repeated treatments over time. These changes include progressive reduction of rhytides, prevention of dynamic rhytides, and improvements in skin quality. In this brief paper, we review basic science, clinical, and anecdotal evidence that explores a long-term and potential preventive effect of Onabotulinum Toxin A injections.
J Drugs Dermatol. 2017;16(6 Suppl):s87-90.
Michael H. Gold MD, Amanda D. Heath RN, Julie A. Biron BA, Lori Brightman MD, Mitchel P. Goldman MD,Amy Forman Taub MDc, Martin Braun MD, Suwimon Pootongkam MD and Pravit Asawanonda MD DSc
This supplement to the Journal of Drugs in Dermatology is supported by
Thomas G. Lewis MD, Ethan D. Nydorf MD
Intralesional bleomycin has been used for the treatment of warts since the 1970s. Currently, there is a limited amount of
evidence from randomized placebo-controlled trials comparing intralesional bleomycin with other local treatments for warts.
Numerous reports have been published on the use of intralesional bleomycin for the treatment of recalcitrant warts with cure
rates ranging from 14% to 99%. The majority of the data suggests that bleomycin is effective in over two-thirds of the reported
cases with minimal side effects. In this paper, we review the mechanism of action, pharmacokinetics, safety profile, supply
and storage, dosage scheme, techniques for administration, and efficacy of intralesional bleomycin for the treatment of warts.
Andrew F. Alexis MD MPH
The treatment of disorders of hyperpigmentation including
melasma, photoaging-related dyschromia, and postinflammatory
hyperpigmentation pose numerous challenges, especially in
patients with higher Fitzpatrick skin types (skin of color). Given
limitations in efficacy as well as safety and cost considerations
of available therapies, a “magic bullet” single treatment
modality for hyperpigmentation is currently lacking. Successful
treatment typically involves a combination of topical agents with
or without in-office procedures, exploiting the different mechanisms
of action of each agent or treatment modality. This article
will review recently published studies involving newer topical and
procedural approaches to this common dermatologic concern.
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
Safe and effective laser treatments are crucial, especially in darker-skinned individuals. Herein, we report our experience treating Fitzpatrick skin types IV to VI with a long-pulsed, 1,064-nm neodymium-doped yttrium aluminum garnet laser. With the right treatment settings, darkly pigmented individuals can undergo laser hair removal effectively.
J Drugs Dermatol. 2013;12(3):366-367.
Progressive pigmented purpura (PPP) is a group of dermatoses that are benign and usually self-limited. However, they may
persist for months or years with frequent recurrences. Numerous treatments have been tried, but no effective therapy has yet
proven to be successful. This report documents the treatment of a patient with one subtype of PPP using ascorbic acid and
a bioflavonoid rutoside given orally. A 42-year-old male with biopsy-proven Eczematoid-like Purpura of Doucas and
Kapetanakis was treated with ascorbic acid 500 mg twice a day and a bioflavonoid rutoside 50 mg twice a day. Treatment
was successful, with quick defervescence of the rash and no recurrence to date.
Jessica Price BS, Monali Bhosle MS, Steven R. Feldman MD PhD, Rajesh Balkrishnan PhD
An estimated 2.1% of Americans have psoriasis and approximately 30% of them have moderate to severe psoriasis. Although
the disease is not associated with mortality, it has a significant impact on health-related quality of life among patients. Several
therapies are available for psoriasis including topical agents, phototherapy, and systemic medications. Recently, effective
yet expensive biologic agents have been added as treatments for moderate to severe psoriasis. Biologics are recommended
in patients for whom all other available treatment options have failed. This extensive review provides important information
on the clinical and patient-related outcomes associated with the biologic agents used in psoriasis.
Sung Bin Cho MD, Sang Ju Lee MD PhD, Won Soon Chung MD, Jin Moon Kang MD, Young Koo Kim MD
In Asian patients, ablative laser therapies are seldom used to treat burn scars due to posttreatment dyschromia, especially when
nonfacial areas are treated. The non-ablative 1550-nm erbium-doped fractional photothermolysis system, although effective, requires
multiple treatment sessions. In the authors hands, a 34-year-old Korean woman achieved improved atrophy, contracture, texture and
color of a burn scar on her chest after two treatments spaced six weeks apart with an ablative 10,600 nm CO2 fractional laser system
(Ultrapulse® EncoreTM Laser, Lumenis Inc., Santa Clara, CA).
David M. Pariser MD FACP FAAD,a Janakan Krishnaraja MD,b Thomas M. Tremblay RN,d R. Michael Rubison PhD,c Ted W. Love MD,d and Benjamin F. McGraw III PharmDd
BACKGROUND: While muscarinic antagonists (anticholinergics) have shown efficacy in treating primary focal hyperhidrosis (PFH), side effects - most commonly dry mouth - are intolerable for most patients. THVD-102, a fixed-dose combination product has been developed combining oxybutynin, a muscarinic antagonist, and pilocarpine, a muscarinic agonist. The pilocarpine is at a dose level and release profile optimized to correct salivary flow impaired by oxybutynin yet not interfere with the therapeutic muscarinic antagonist effect of oxybutynin upon the sweat glands.
OBJECTIVES: This study evaluated safety, efficacy, dry mouth and quality of life with THVD-102 (oxybutynin 7.5 mg / pilocarpine 7.5 mg) in subjects with axillary and / or palmar PFH.
METHODS: After a 21-day open label treatment period with oxybutynin 5 mg twice daily to determine susceptibility of subjects to develop dry mouth, eligible subjects were randomized to 1 of 6 sequences of 3 study treatments (THVD-102, oxybutynin 7.5 mg, and placebo) in sequential 21day double-blind crossover treatment periods, each preceded by a washout period of at least 7 days.
RESULTS: A total of 24 subjects were randomized and 19 finished all crossover treatments. Changes from baseline to end of treatment in symptoms associated with PFH were statistically significant for both THVD-102 versus placebo and for oxybutynin versus placebo as assessed by multiple measures. Beneficial trends, not statistically significant, for gravimetric measurements were also observed. There were no statistically significant differences between THVD-102 and oxybutynin in PFH efficacy. Fewer subjects reported moderate to severe dry mouth while receiving THVD-102 compared to oxybutynin and more subjects categorized their dry mouth as none or mild while receiving THVD-102 compared to oxybutynin. Differences in reported dry mouth were statistically significant.
CONCLUSION: THVD-102 was generally well-tolerated. Both THVD-102 and oxybutynin 7.5 mg twice daily were effective in treating PFH. THVD-102 was associated with significantly reduced dry mouth compared to oxybutynin.
J Drugs Dermatol. 2017;16(2):127-132.
Jennifer Rivard MD, Henry W. Lim MD
Targeted phototherapy has been utilized in the past few years for the treatment of various dermatoses. In this article, we summarize
the experience of using 308-nm excimer laser at Henry Ford Hospital, Detroit, MI, for the treatment of psoriasis,
vitiligo, palmoplantar psoriasis, and hand dermatitis. A total of 34 patients were treated between January 2003 and February
2005. Of the 28 patients with psoriasis, over 80% had greater than 75% improvement after an average of 12 treatments.
While the number of patients was small, excimer laser showed promising results for palmoplantar psoriasis. Possibly due to
patient selection bias, we have not had the same success as other studies for the treatment of vitiligo with this modality.
Sandra Marchese Johnston, MD and Thomas D. Horn, MD, MBA
Warts are a common dermatologic problem. There are many treatments available. Intralesional injection of a skin test antigen has
been shown to be efficacious at eradicating all warts when only a part of one wart is injected. The aim of this study was to determine
whether injection of the combination of Candida albicans, mumps, and Trichophyton skin test antigens was more efficacious than and
as safe as single antigen injection. Seventy-one percent of subjects had resolution of their warts with the injection of the combination
of skin test antigens in this open label single arm study.
Salma Z. Pothiawala MD MPH, Brooke T. Baldwin MD, Basil S. Cherpelis MD, L. Frank Glass MD, Neil Alan Fenske MD
Phototherapy is well-recognized as effective therapy in early stage cutaneous T-cell lymphoma (patch and plaque), often resulting in complete clearance of clinical disease and subsequent remission. Although not curable, long-term remission can often be attained utilizing maintenance phototherapy, consisting of a course of less frequent treatments over time. Herein, the authors review the literature regarding the role of maintenance phototherapy in cutaneous T-cell lymphoma (CTCL) and its success in prolonging clinical remission and disease-free survival in CTCL.
Shino Bay Aguilera DO,a Miguel Aristizabal MD,b and Ann Reed DOc
Although infrequent, non-inflammatory nodules are potential complications associated with dermal filler injections. There is a lack of consensus in the literature regarding potential treatments to help resolve nodules associated with calcium hydroxylapatite (CaHA) filler injections. This case report describes the successful treatment of a non-inflammatory nodule related to CaHA injection using a combination of 5-fluorouracil, dexamethasone, and triamcinolone.
J Drugs Dermatol. 2016;15(9):1142-1143.
Photodynamic therapy with short-contact 5-aminolevulinic acid (Levulan® Kerastick®, Dusa Pharmaceuticals, Inc.)
and activation by intense pulsed light in an initial treatment and blue light in 3 subsequent treatments has resulted in
significant improvement in severity of acne, reduction in the number of lesions, improvement in skin texture, and
smoothing of scar edges in an Asian patient with severe (class 4) facial cystic acne and scarring.
Joseph B. Bikowski MD
This article will examine various clinical experiences with acne patients successfully treated with topical clindamycin 1% benzoyl
peroxide 5% gel (Duac®) alone and in combination with other acne treatments. Clindamycin 1% benzoyl peroxide 5%,
the only once-daily prescription topical aqueous gel combining a benzoyl peroxide and an antibiotic, has demonstrated excellent
tolerability and efficacy and is stable when used concomitantly with other therapies. A regimen of topical clindamycin 1%
benzoyl peroxide 5% gel, oral doxycycline hyclate (Doryx®), and adapalene gel (Differin®) seems especially advantageous from
a theoretical and practical perspective. Improvement is noted by means of photographic, physician, and/or patient assessments
at baseline and follow-up visits.
Jill S. Waibel MD,a Jason Pozner MD,b Christopher Robb MD,c Elizabeth Tanzi MDd
BACKGROUND: Laser skin resurfacing has continued to evolve over the past two decades. One of the most recent advances included a hybrid fractional laser resurfacing system that can sequentially utilize two wavelengths in its delivery, non-ablative coagulation with 1470 nm, and ablative vaporization with 2940 nm. The 1470 nm laser wavelength is absorbed by water, which is ideal for creating controlled zones of coagulation to chosen depths into the dermis up to 700 micrometers. The 2940 nm laser wavelength has a large water absorption coefficient, which results in precise ablation as desired in the epidermis up to 110 micrometers. This combination allows for fractionated non-ablative and ablative skin resurfacing simultaneously resulting in a cosmetic improvement in pigmentation, tone, texture of skin as well as other effects of photoaging.
METHODS: Open-label prospective, multi-center study in which 34 female subjects were enrolled with Fitzpatrick skin types I-IV, mean age of 52 ± 14 years. Each subject underwent two treatments, spaced 4-6 weeks apart. Follow up visits at 1 week, 2 weeks, and 1, 2, and 3 months after the first treatment. Photographs, numeric pain scores during treatment, and subject satisfaction survey questionnaires were evaluated. Photographs were analyzed by six blinded evaluators. The primary endpoint was to evaluate safety and efficacy of hybrid laser treatments for photodamage and dyschromia. The secondary endpoints included evaluating the tolerability of the treatment using the Wong Baker Face scale and patient satisfaction survey results.
RESULTS: Of the 29 subjects completing the study, 80% showed significant skin improvement on photographic analysis. Average numeric pain score was a 4 on a 0-10 scale. Survey results showed 100% satisfaction with treatment and achieved results. Two patients experienced post-inflammatory hyperpigmentation that resolved within 90 days. No other adverse events were reported.
CONCLUSION: The non-ablative and ablative hybrid fractional laser can be used to safely and efficaciously treat photodamaged skin with high patient satisfaction and minimal adverse events.
J Drugs Dermatol. 2018;17(11):1164-1168.
Macrene Alexiades MD PhDa,b
BACKGROUND: Fractional laser resurfacing enhances trans-epidermal delivery (TED), however laser penetration depths >250- μm fail to substantively increase drug delivery.
AIM: Evaluate the safety and efficacy of a novel acoustic pressure wave ultrasound device following fractional ablative Er:YAG 2940-nm laser (FELR) and topical agents for rhytids, melasma, and acne scars.
STUDY DESIGN: Randomized, blinded, parallel group split-face side-by-side, controlled study evaluating FELR and topical anti-aging and anti-pigment agents to entire face succeeded by ultrasound to randomized side. Fifteen subjects were enrolled to three treatment arms:rhytids, melasma, and acne scars. Two monthly treatments were administered with 1, 3, and 6 month follow-up. Efficacy was assessed by Comprehensive Grading Scale of Rhytids, Laxity, and Photoaging by Investigator and two blinded physician evaluators. Subject assessments, digital photographs, and reflectance spectroscopic analyses were obtained.
RESULTS: Rhytid severity was reduced from a mean of 3.25 to 2.60 on the 4-point grading scale. Spectrophotometric analysis demonstrated
increases in lightness (L*) and reductions in redness (a*) and pigment (b*), with greater improvements on the ultrasound side as compared to FELR and topicals alone. Moderate erythema post-treatment resolved in 7 days and no serious adverse events were observed.
CONCLUSION: In this randomized, paired split-face clinical study, FELR-facilitated TED of topical anti-aging actives with ultrasound treatment
is safe and effective with improvement in rhytids, melasma, and acne scars. Statistically significant greater improvement in pigment
levels was observed on the ultrasound side as compared to FELR-TED and topical agents alone.
J Drugs Dermatol. 2015;14(11):1191-1198.
Vic A. Narurkar MD FAAD
Bruising after dermal filler and neuromodulator injections is a common side effect and can have durations of 1 to 2 weeks. While it ultimately resolves, faster resolution can produce better outcomes for patients and also make patients more likely to return for future treatments. We report the successful reduction in bruising following injections of fillers with an intense pulsed light source. We also documented the onset of action of bruising resolution with serial photographs. Resolution started within the first hour of treatment and continued rapidly over 48 hours. This is the first-time reported study of resolution of bruising from injectables with intense pulsed light. Patient satisfaction is improved when such adverse events are minimized.
J Drugs Dermatol. 2018;17(11):1184-1185.
Lee Miller MD,1 Vineet Mishra MD,1 Salman Alsaad MD,1 Doug Winstanley MD,1 Travis Blalock MD,1
Chad Tingey MD,1 Jinze Qiu PhD,2 Sara Romine,1 E. Victor Ross MD1
BACKGROUND AND OBJECTIVES: Non-ablative fractional lasers cause little down-time, however, some patients want more noticeable results with fewer treatments. The 1940 nm wavelength matches one of the water absorption peaks in the mid infrared band of electromagnetic energy. The skin absorption is much stronger than other non-ablative wavelengths (1410-1550 nm) and weaker than ablative wavelengths (Er:YAG or CO2). The objective of this study was to characterize clinical efficacy using this technology to treat photodamaged skin in human subjects.
MATERIALS AND METHODS: Under an IRB approved study, eleven subjects with facial photodamage (1 male and 10 female) were enrolled and completed the study. The fractional 1940 nm laser was comprised of a thulium rod pumped by a pulsed alexandrite laser. The fractional patterns were generated by four separate handpieces (two dot (0.48mm and 0.76mm dot-to-dot distance or pitch) and two grid geometries) whereby a larger beam was broken up into smaller microbeams by a microlens system or reflective square grids. The low -pitch circular dot array handpiece, which is used most frequently, has a macro-spot size of 12 mm and a total applied energy of approximately 2-5 J (~ 4-10 mJ per beamlet). Contact skin cooling (5-20degC) was provided via a sapphire window at the distal end of handpiece. Pulses from the dot handpieces were applied with 20% overlap. The microspot size for the dot handpieces was ~ 0.2-0.3 mm. The two grid pattern handpieces included 0.4 mm wide lines with 45% and 0.7 mm wide lines with 65% coverage. Each subject received 3 full-face treatments 4-6 weeks apart. Anesthesia was achieved by 5% lidocaine cream and a cold air chiller. Typical treatments were carried out with two passes. Outcome assessments included changes in pigment, rhytides, laxity, elastosis, and texture, using a diffuse pigmentation scale and the Alexiades-Armenakas Comprehensive Grading Scale of Rhytides, Laxity, and Photodamage. Photographs of each patient from prior to treatment, and 3 months after treatment were analyzed by 3 blinded physician raters. A paired t-test was applied for each category comparing the pre treatment and 3-month post treatment results.
RESULTS: Three months after the final treatment, (a) mean pigment improvement was 21.1%, (b) rhytides were reduced by 14.3%, (c) laxity was reduced by 8.9%, elastosis was reduced by 22.3%, and (e) texture scores were unchanged. Reductions in pigmentation, rhytides, and elastosis were statistically significant (P ≤ 0.05). Clinical downtime was 3-5 days. Pain was variable (mean of 2.8/10) and side effects included two cases of mild focal vesiculation. No long-term side effects were noted. Histological analysis showed focal damage that extended about 200 μm deep to the surface.
CONCLUSION: The 1940nm thulium laser is safe, well tolerated, and results in reduced downtime compared to traditional resurfacing. The study demonstrated that the 1940 nm thulium laser could achieve injury patterns capable of skin rejuvenation.
J Drugs Dermatol. 2014;13(11):1324-1329.
BACKGROUND: The diffractive optic coupled with a picosecond pulsed alexandrite laser has been shown to effectively minimize pigmen- tation while improving the appearance of textural irregularities and rhytides. We evaluated the safety and ef cacy of the diffractive optic laser treatment for off of the face applications including the hands and décolletage in a pico-toning technique.
STUDY: 20 healthy female patients (40-70 years of age) were treated with a picosecond pulsed alexandrite laser with a diffractive lens. 10 of the patients were enrolled in a prospective hand assessment study (20 hands) while the remaining 10 subjects were enrolled in an IRB approved study treating photodamage of the décolletage. Protocol for both groups included 4 treatments to the designated area with a picopulsed alexandrite laser with a diffractive lens on a 6mm handpiece delivering 0.71 j/cm2 with 10 hz repetition at 3 week intervals (+- 7 days) with follow up at 1 month and 3 months post fourth treatment using standardized digital photography.
RESULTS: Statistically signi cant improvement in the overall appearance of pigmentation, texture and rhytides were recorded at each sub- sequent visit and at 1 and 3 months post the nal laser treatment. Clinical photographs were evaluated from baseline to the final photo at 3 months post last laser treatment by the treating physician, patient, and an independent evaluator. All hand subjects and chest subjects showed improvement in all 3 areas which were found to be statistically signi cant. No adverse events occurred in either study group.
CONCLUSION: These study results show signi cant improvement in not only pigmentation, but in texture and rhytides in all subjects receiving pico-toning laser treatments to off of the face areas. The laser was well tolerated by all patients with no adverse effects. The use of a diffractive lens optic on a 6 mm xed spot size handpiece with a picopulsed alexandrite laser, in a pico-toning technique, provides a safe, low uence, yet effective treatment for not only pigment dyschromia but also textural irregularities and rhytides when treating the hands and décolletage.
J Drugs Dermatol. 2016;15(11):1398-1401.
Hernan Pinto MDa and Luis G. Garrido MDb,c
Since ancient times, humans have fought a still-unwinnable battle against aging and time. The possibility of processing our own blood in order to obtain certain precious substances for a particular purpose has opened the gates for the development of new treatments, indications, and techniques. In this study, we obtained an autologous serum with very high concentrations of some growth factors and anti-inflammatory cytokines using a special syringelike device that exposed the blood to medical-grade glass spheres in a closed system. The application of this autologous conditioned antiaging serum achieved local beauty enhancement results by improving skin hydration, smoothness, and elasticity.
J Drugs Dermatol. 2013;12(3):322-326.
Lourdes Rodriguez Fdez.-Freire MD, Amalia Serrano Gotarredona MD, Joes Bernabeu Wittel MD, Agueda Pulpillo Ruiz MD PhD, Rocia Cabrera MD, Manuel Navarrete Ortega MD, Julia Conejo-Mir MD PhD
Cheilitis granulomatosa (CG) is a rare, idiopathic inflammatory disorder that usually affects young adults and clinically
is characterized by diffuse, non-tender, soft to firm swelling of one or both lips. A variant of granulomatous cheilitis
is Melkersson-Rosenthal syndrome when associated with facial paralysis and furrowed tongue. Several treatments
have been used with variable success. We report 3 cases of GC treated with oral clofazimine 100 to 200 mg daily for 3
to 6 months obtaining regression of lesions in all treated cases. Hyperpigmentation and elevation of liver enzymes were
observed as side effects.
Shilpa Gattu MD, Emily M. Becker MD, John Y. M. Koo MD
Cyclosporine has been shown to increase the risk of lymphoma when used in organ transplant patients; however, studies have failed
to demonstrate an increased risk of lymphoma when used at lower dermatologic doses for psoriasis. The authors present a case of
solid B-cell lymphoma occurring in a psoriasis patient with a history of intermittent exposure to high-dose methotrexate, followed by
low-dose cyclosporine for two years and subsequently transitioned to treatment with adalimumab. Methotrexate, cyclosporine and
adalimumab are each effective treatments for psoriasis. However, when faced with an interplay of several factors, closer surveillance
for malignancy is warranted than that which is currently considered for monotherapy.
Varun Kalhana and Neil Sadick MDb
Biologic drugs, a novel class of agents engineered to target specifc mediators of infammation, and small-molecule inhibitors that pen-etrate the cell membrane to interact with targets inside a cell represent the cutting-edge of pharmacological biomedical therapeutics. Clinical studies have already demonstrated the effectiveness of this new generation of drugs in treating a variety of medical illnesses and conditions that were refractory to traditional treatments. This review aims to describe the latest available or currently in-develop-ment drugs, biologic agents, and small molecule inhibitors for treatment of psoriasis, rosacea, alopecia areata, and atopic dermatitis.
J Drugs Dermatol. 2017;16(12):1224-1228
James M. Spencer MD MS
Efforts to improve the size and appearance of scars have included therapies as varied as laser treatments and onion extract gels. Silicone gel sheeting is well know to improve the appearance of hypertrophic scars, and may have a role in the management of routine surgical and traumatic scars. By varying the degree of cross linking, silicone elastomer can be a solid sheet or a liquid gel. In this pilot series, seven patients applied a liquid silicone gel twice a day to one half of a new surgical scar for three months. At the end of this time, the treated side was noticeably better in appearance in five of seven patients while two of seven had no difference. In no patient was the silicone treated side worse in appearance.
Michael Kockaert, MD and Martino Neumann, MD, PhD
The rejuvenation of aging skin is a common desire for our patients, and several options are available. Although there are some systemic methods, the most commonly used treatments for rejuvenation of the skin are applied topically. The most frequently used topical drugs include retinoids, alpha hydroxy acids (AHAs), vitamin C, beta hydroxy acids, anti-oxidants, and tocopherol. Combination therapy is frequently used; particularly common is the combination of retinoids and AHAs1. Systemic therapies available include oral retinoids and vitamin C. Other available therapies such as chemical peels, face-lifts, collagen, and botulinum toxin injections are not discussed in this article.
J. Daniel Jensen MD, Cooper Keane MD, Conway C. Huang MD, and Marian E. Northington MD
Ablative fractionated resurfacing has gained significant traction as an effective treatment for acne, burn, traumatic, and surgical scars over
recent years. We report a case of a severely depressed, atrophic scar on the cheek of a middle aged woman treated with a 10,600 nm factionated
CO2 laser. Serial treatments were performed, resulting in marked improvement in scar contour, texture, and overall cosmesis. Our
report highlights the utility of ablative fractionated resurfacing for the treatment of post-traumatic, atrophic scars on the face.
J Drugs Dermatol. 2014;13(7):861-862.
Catherine D. Buzney MA,a Caitlin Peterman BS,a Ami Saraiya MD,b Shiu-chung Au MD,b
Nicole Dumont,b Ryan Mansfield AS,b and Alice B. Gottlieb MD PhDa,b
BACKGROUND: Psoriasis treatments and therapeutic response as they relate to private versus public patient insurance in the United
States have not yet been reviewed. Improved understanding could clarify factors challenging optimal psoriasis management and offer
insight for dermatologists treating psoriasis within our healthcare system.
METHODS: 258 subjects were included from a database of psoriasis patients seen at Tufts Medical Center (Boston, MA) during
2008-2014. Insurance was classified as primarily private or public (Medicare or MassHealth/Medicaid). Patients required a minimum
of two consecutive visits per treatment and at least 8 weeks within one of four treatment categories: biologics, oral systemics/
phototherapy, combined biologics and oral systemics/phototherapy, or topicals only. Primary endpoint was the Simple-Measure for
Assessing Psoriasis Activity (S-MAPA) calculated by multiplying Physician Global Assessment by Body Surface Area. S-MAPA<3
constituted absolute clearance. Insurance type was evaluated as a predictor of prescribed treatment categories, maximum S-MAPA
improvement from baseline, and total drugs used per treatment course (“drug-switching”).
RESULTS: 80.2% (n=207) and 19.8% (n=51) had primarily private and public insurance, respectively. 69.6% with private insurance
were prescribed biologics versus 66.7% (public insurance) (P=0.689). 54% (private) versus 49% (public) achieved clearance
(P=0.514). However, S-MAPA decreased 78.35% from baseline in those with private insurance compared to 61.48% (public)
(P=0.036). On average, privately insured patients used at least twice as many same-category treatments, most commonly biologics,
than publicly insured individuals (P=0.003). Drug-switching was significantly associated with clearance (P=0.024). Multivariate
analysis demonstrated no significant differences in prescribed treatment categories, drug efficacy, clearance, S-MAPA, or drugswitching
with respect to patient age.
CONCLUSIONS: Treatment categories were comparably prescribed between insurance subgroups. However, privately insured patients
achieved significantly greater degrees of clearance and switched between more medications within biologic and systemic categories,
potentially explaining their overall improved therapeutic response. Further studies including cost-analysis could clarify any difference in the effectiveness of prescribed therapy for these two patient populations.
J Drugs Dermatol. 2015;14(2):119-125.
Porcia B. Love MDa and Roopal V. Kundu MDb
Keloids are the result of an overgrowth of dense fibrous tissue that usually develops after healing of a skin injury. Despite their common occurrence, keloids remain one of the most challenging dermatologic conditions to successfully treat. They are often symptomatic, do not usually regress spontaneously, and tend to recur after excision. Prevention of keloids is essential. A previous history of keloid development should be elicited. Wound closure with minimal tension and application of adjunctive therapies before abnormal healing is paramount. Education regarding wound care should be given in order to prevent infection and foreign body reactions. Elective surgery should be avoided in patients predisposed to developing keloids. In this article, we review recent advances in medical and surgical treatment of keloids.
J Drugs Dermatol. 2013;12(4):403-409.
Jennie B. Nally MD, Diane S. Berson MD
Therapeutic options for rosacea include topical agents, oral therapies, laser and light treatments, and surgical procedures.
Topical therapies play a critical role in the treatment of patients with papulopustular rosacea and erythematotelangiectatic
rosacea, and have the ability to effectively minimize certain manifestations of the disease, including papules, pustules, and
erythema. The 3 primary agents for the topical treatment of rosacea are metronidazole, azelaic acid, and sodium sulfacetamide-
sulfur. Each of these therapies is approved for the treatment of rosacea and has been validated by multiple studies.
Additional topical therapies including benzoyl peroxide, clindamycin, retinoids, topical steroids, calcineurin inhibitors, and
permethrin are not approved for the treatment of rosacea and play variable roles in the management of this condition.
Scott W. Dunbar MDa and David J. Goldberg MDa,b
Treatment options for cosmetic improvement of the skin and body continue to grow more numerous with each passing year. The decline
in utilization of invasive surgical treatments for aging and body contour correlates with the recent rise in laser and light devices. These light based technologies transmit either a single or broad wavelength of amplified light to the skin, resulting in volumetric tissue heating. Depending on the chromophore targeted and wavelength applied, varied applications exist to treat numerous cosmetic concerns.
Radiofrequency (RF) devices have become more popular recently as science has advanced and brought new, safer, and better therapies.
J Drugs Dermatol. 2015;14(11):1229-1238.
The stress hormone, cortisol, is known to affect the function and cyclic regulation of the hair follicle.
When cortisol is present at high levels it has been demonstrated to reduce the synthesis and accelerate the degradation of important skin elements, namely hyaluronan and proteoglycans by approximately 40%.
The following discussion outlines the relationship between stress, cortisol, and the effect on the normal function of the hair follicle. As a result of this connection, important correlations have been established in the literature to form a basis for novel, effective treatments of stress-related hair growth disorders.
Amongst various treatment methods and substances, oral supplementation with a specific bioavailable proteoglycan stands out as a promising new therapeutic treatment method.
J Drugs Dermatol. 2016;15(8):1001-1004.
Lauren Meshkov Bonati MDa and Sabrina Guillen Fabi MDb
BACKGROUND: There is growing demand for cosmetic treatments in the younger population, yet counseling and treating this age group can be difficult to justify.
OBJECTIVE: Chronologic changes that cause noticeable signs of aging are discussed within each age group. Age-appropriate cosmetic preventions and interventions are therefore recommended.
METHODS: A PubMed search was performed for high quality trials and evidence based reviews on the basic science of aging, as well as on cosmetic modalities and their histological, biochemical, and clinical effects.
RESULTS AND CONCLUSIONS: Specific age-related changes occur with each decade of life. A complete understanding of when these physiologic changes occur helps determine age-appropriate cosmetic counseling, preventions, and interventions.
J Drugs Dermatol. 2017;16(6 Suppl):s81-83.
Sarah A. Malerich BS,a,b Amer H. Nassar MD,b Andrew S. Dorizas MD,b,d Neil S. Sadick MDb,c
As the aging population in our society continues to grow, new technologies and procedures promising a more youthful appearance are continuously sought. The utilization of radiofrequency technology remains a novel method for the treatment of many aesthetic and medical dermatological indications. Innovative applications are constantly identified, expanding treatment options for various patient concerns including aging of the hands, cellulite, non-invasive lipolysis, and postpartum skin laxity. Non-invasive treatments are ideal for busy patients seeking minimal recovery time and so called lunch-time procedures. Furthermore, new developments in treatment devices enhance efficacy while decreasing patient discomfort.
J Drugs Dermatol. 2014;13(11):1331-1335.
The skin of color population in the United States is rapidly growing and the cosmetic industry is responding to the demand for skin of color targeted treatments. The aging face in skin of color patients has a unique pattern that can be successfully augmented by dermal fillers. Though many subjects with skin of color were not included in the pre-market dermal filler clinical trials, some post-market studies have examined the safety and risks of adverse events in this population. The safety data from a selection of these studies was examined. Though pigmentary changes occurred, there have been no reports of keloid development. Developing a patient-specific care plan and instituting close follow up is emphasized.
J Drugs Dermatol. 2011;10(5):494-498.
Psoriasis is a chronic inflammatory disease of the skin that can have a major effect on patient quality of life. Conventional psoriasis
treatments, often identified empirically, fail to meet the clinical needs for a safe and remittive therapy. These unmet needs, together
with the rapid advances in understanding the molecular basis of psoriasis, have led to the development of targeted biologic therapies.
Using recombinant DNA technology, a new generation of therapeutic agents is being designed to interfere at specific pathogenic steps
that involve T-cells or T-cell-mediated immune responses. These targeted therapies promise improved tolerability and safety in the
treatment of psoriasis. Furthermore, they will redefine clinical response in psoriasis by providing long-lasting remissions of disease
and extended treatment-free periods.
Background: Although reliable prevalence data are not available, adult acne is thought to be somewhat common, and it is not unusual for patients
to have acne as well as early signs of skin aging. A novel anti-acne/anti-aging formulation (Treatment A) has been developed for daily use by
patients to address both signs of skin aging and facial acne vulgaris. The novel, non-prescription formulation includes several ingredients shown
to target factors underlying the pathogenesis of acne vulgaris while also addressing multiple components in the pathophysiology of skin aging.
Methods: A blinded, randomized, split-face study was conducted to evaluate and compare the tolerability and efficacy of the novel anti-acne/
anti-aging product in subjects with photodamaged skin and acne vulgaris relative to tretinoin cream 0.025% (Treatment B). All subjects also
were given supportive skincare, consisting of a cleanser, moisturizer, and sunscreen. Each treatment was assessed for its effects on subjects'
appearance, lesion count reductions, and tolerability.
Results: Treatment A produced statistically significantly greater improvements in skin tone evenness, skin tone clarity, and blemishes
and blotchiness. There were also statistically greater reductions in total lesion count for acne patients on the side of the face treated with
Treatment A compared to Treatment B; Treatment A was also associated with early (day 2) improvement in skin tone evenness and clarity,
tactile skin smoothness, and blemishes and blotchiness. Both treatments demonstrated favorable tolerability.
Conclusion: The novel topical anti-aging/anti-acne therapy (Treatment A) within a comprehensive skin care regimen of cleanser, moisturizer, and
sunscreen may maximize efficacy and tolerability and contribute to our armamentarium for treating both photodamage and acne at the same time.
J Drugs Dermatol. 2012;11(6):737-740
Brooke Bair DO and David Fivenson MD
Background: Calcinosis cutis is a term used to describe a group of disorders which result in calcium deposits in the skin. These disorders can be separated based on etiology.
Objective and Methods: Sodium thiosulfate has been used to systemically treat calciphylaxis with little to no adverse effects. We report two cases of ulcerative calcinosis cutis which were refractory to multiple topical treatments and did not improve with correction of underlying electrolyte abnormalities.
Results: Both cases showed an excellent response to topical 25% sodium thiosulfate compounded in zinc oxide.
Limitations: We are limited by a small sample size (n=2) in this case series.
Conclusions:We recommend topical sodium thiosulfate 25% as an alternative treatment for dystrophic calcinosis cutis.
J Drugs Dermatol. 2011;10(9):1042-1044.
Acne is a very common skin disease; frequently seen in adolescents and often persisting or occurring into adulthood. Topical therapy is very effective in mild to moderate disease, and is used as maintenance therapy. Fixed combination products have been studied in moderately severe disease. Combinations of benzoyl peroxide and either clindamycin or adapalene appear very effective. When utilizing a topical retinoid alone or in combination, it is essential to incorporate an appropriate skin care regimen to minimize local irritation. In the absence of direct comparative clinical trials, this review provides timely guidance for clinicians on the use of these agents, and their benefits in special populations.
J Drugs Dermatol. 2015;14(6):567-572.
Cindy Berthelot MD, Allison Rivera MD, Madeleine Duvic MD
Mycosis fungoides (MF) is a rare neoplasm of epidermotropic CD4+ lymphocytes and represents a majority of all cutaneous
T cell lymphomas. Early stage MF is limited to cutaneous patches and plaques that can be treated with topical modalities
with high response rates. More aggressive systemic treatment of early disease does not alter survival or cure the disease
and could accelerate progression by causing immunosuppression. Topical corticosteroids, mechlorethamine, and carmustine
have been the mainstays of early treatment of MF for more than 30 years. More recently, topical formulations of
retinoids, novel rexinoids, methotrexate, immunomodulators, and photodynamic compounds have been investigated for
their potential roles in treating early MF. The future of topical treatments for MF is promising both as primary and adjunctive
Adam J. Luber BA, Shaheen H. Ensanyat BS, and Joshua A. Zeichner MD
The human circadian clock ensures that biochemical and physiological processes occur at the optimal time of day. In addition to a
central pacemaker in the body, recent evidence suggests that peripheral mammalian tissues also possess autonomous circadian oscillators,
which are regulated by genes linked to distinct tissue-specific functions. The skin is situated in a position naturally exposed
to diurnal environmental changes. The skin's chronobiological functioning influences skin aging, cell repair and development of skin
cancers, as well as optimal timing of drug delivery to the skin. An understanding of circadian skin-related functions and the impact
of their disruption allow clinicians to improve therapeutic decision-making and maximize the effectiveness of prescribed treatments.
J Drugs Dermatol. 2014;13(2):130-134.
Although liquid injectable silicone is safe for the majority of patients treated, there are a few individuals for whom this treatment
has been problematic. The problems that arise include migration and granuloma formation. In some instances the granulomas may
arise years after the injections. Treatment of these granulomas typically involves the use of steroids. However, the complications
associated with long-term steroid usage, as well as the limited efficacy in some patients, have prompted clinicians to seek alternative
treatments. This article presents the case of a woman who had delayed granuloma formation to liquid injectable silicone treated with
a combination of minocycline and celocoxib. The histology of this case, as well as potential mechanisms of action for the treatment,
are also presented.
Miriam S. Bettencourt MD
Actinic keratoses (AKs) are premalignant skin lesions caused by cumulative ultraviolet-light exposure that may progress to invasive squamous cell carcinoma (SCC). As the clinical presentation of AKs varies widely, only a histopathologic analysis of a biopsied sample can eliminate or confirm a diagnosis of invasive SCC. Reducing the burden of AK with a combination of lesion-directed and field-directed treatments may help to identify persistent, suspicious lesions that require further evaluation. We present 10 cases of SCC that were identified and histologically confirmed in 7 patients after complete or substantial clearance of AKs by sequential treatment of sun-damaged skin with cryosurgery and ingenol mebutate.
J Drugs Dermatol. 2015;14(8):813-818.
Joseph F. Fowler Jr. MD FAAD
Colloidal oatmeal suspensions are currently available in bath soaps, shampoos, shaving gels, and moisturizing creams, and several studies have been conducted that demonstrate the efficacy and safety of colloidal oatmeal for the treatment of inflammatory skin conditions. The diverse chemical polymorphism of oats translates into numerous clinical utilities for atopic dermatitis (AD) and eczema. Avenanthramides are the principle polyphenolic antioxidants in oats, and they have been shown to assuage inflammation in murine models of contact hypersensitivity and neurogenic inflammation and also reduce pruritogen-induced scratching in a murine itch model. Moreover, avenanthramides are a potent antioxidant. This paper will discuss various studies that have found colloidal oatmeal compounds to be beneficial in the treatment of AD and also as adjunctive treatments for AD.
J Drugs Dermatol. 2014;13(10):1180-1183.
Two primary factors are changing current approaches to the management of acne vulgaris (AV): the continuously evolving role of
Propionibacterium acnes in the pathophysiology of AV and recent evidence of an inflammatory basis for AV via innate immunity. The
developing concepts emphasize that acne is primarily an inflammatory disease. The emerging concept of subclinical inflammation
and its effect on development and progression of acne lesions correlating with the sequence of the underlying inflammation process
has been a major change in our understanding of acne pathogenesis. Thus, inflammation has become the major feature of the disease
process from onset to resolution, including postinflammatory erythema, postinflammatory hyperpigmentation, and scarring.
Our treatment targets may also need to be reconsidered, with more emphasis on anti-inflammatory treatments.
J Drugs Dermatol. 2014;13(suppl 6):s57-s60.
Ramsin Joseph Yadgar BS,a and Adam J. Friedman MDa,b
In recent decades, the stratum corneum (SC), has been recognized for its multifunctional role in maintaining the homeostasis of the human epidermal barrier. A better understanding of the SC’s ability to act as its own biosensor in detecting dysfunction and integrating restorative actions can help identify the origin of certain skin conditions. A more holistic understanding of the morphological changes of the SC during the natural aging process and how it deviates in disease states can help bring about new treatment strategies.
Some important recent clinical studies point to new treatments and add to the existing body of research on corneobiology. These studies offer some explanation of and validation for the various ingredients incorporated into moisturizers and barrier repair devices aimed at treating pruritus and xerosis associated with the aging skin.
J Drugs Dermatol. 2016;15(suppl 11):s91-94
Soloman Shockman MD, Kapila V. Paghdal MD PharmD, George Cohen MDb
Keloids and hypertrophic scars are abnormal responses to wound healing. In general, keloids may exhibit proliferative growth beyond
the margins of the scar and will remain persistent; whereas hypertrophic scars will stay contained to the original wound and may
regress over time. The authors will discuss the five different types of keloid: post-incisional, ear lobe, spontaneous, acne keloidalis
nuchae (AKN) and sessile. Many medical and surgical modalities have been studied in the treatment of these two entities, ranging
from silicone sheets, intralesional corticosteroid injections, cryosurgery, ligation, 5- fluorouracil, Allium cepa (onion) extract, lasers, imiquimod, interferon-α and intralesional verapamil and surgical excision. This review will discuss the pathogenesis, types and treatments
for keloids and hypertrophic scars.
Brian Berman MD PhDa,b and Eggert Stockfleth MD PhDc
There is a need for early, effective field treatments for actinic keratosis (AK) that target subclinical as well as clinically visible lesions to minimize the recurrence and emergence of new lesions. Ingenol mebutate gel is an effective and well-tolerated topical field therapy that has demonstrated sustained clearance and long-term reduction of AKs. This article reviews findings from the FIELD study program and highlights health-related quality of life (HRQoL) outcomes for patients receiving ingenol mebutate. Efficacy data from the FIELD study program are discussed and the tolerability profile of ingenol mebutate in the treatment of areas of up to 100 cm2 is considered. These findings are then placed in the context of HRQoL outcomes and their relevance for patients.
J Drugs Dermatol. 2016;15(5):535-542.
Amir Moradi MDa and Melanie Palm MDb
BACKGROUND AND OBJECTIVE: Currently there are many non-invasive radiofrequency (RF) devices on the market that are utilized in the field of aesthetic medicine. At this time, there is only one FDA cleared device on the market that emits RF energy using a non-contact delivery system for circumferential reduction by means of adipocyte disruption. Innovation of treatment protocols is an integral part of aesthetic device development. However, when protocol modifications are made it is important to look at the safety as well as the potential for improved efficacy before initiating change. The purpose of this study was to evaluate the safety and efficacy of a newly designed extended treatment protocol using an operator independent selective non-contact RF device for the improvement in the contour and circumferential reduction of the abdomen and flanks (love handles).
METHODS:Twenty-five subjects enrolled in the IRB approved multi-center study to receive four weekly 45-minute RF treatments to the abdomen and love handles. Standardized digital photographs and circumference measurements were taken at baseline and at the 1- and 3-month follow-up visits. Biometric measurements including weight, hydration and body fat were obtained at baseline and each study visit. A subset of 4 subjects were randomly selected to undergo baseline serum lipid and liver-related blood tests with follow-up labs taken: 1 day post-treatment 1, 1 day post-treatment 4, and at the 1- and 3-month follow-up visits.
RESULTS: Twenty-four subjects (22 female, 2 male), average age of 47.9 years (30-69 years), completed the study. The data of the twenty-four subjects revealed a statistically significant change in circumference P<.001 with an average decrease in circumference of 4.22cm at the 3-month follow-up visit. Lab values for the subset of 4 subjects remained relatively unchanged with only minor fluctuations
noted in the serum lipid values in two of the subjects. Three independent evaluators viewed pre-treatment and 3-month post treatment photographs to determine which photo was the after photo. The evaluators were able to correctly identify the post treatment photos with an 88% accuracy rate. Treatments were well tolerated by all subjects. No study related adverse events were reported.
CONCLUSION: This study found that an extended treatment protocol using a selective RF device is a safe and effective method for the reduction of circumference and improved contouring of the abdomen and love handles.
J Drugs Dermatol. 2015;14(9):982-985.
Steven R. Feldman MD PhD, Linda H. Stein Gold MD, Joshua A. Zeichner MD
This supplement covers practical, real world strategies for customizing acne regimens to the patients' specific needs. Dr. Linda Stein Gold presents information on topical retinoids and antibiotics and discusses the role of benzoyl peroxide. Dr. Joshua Zeichner describes the issues of acne treatment in specific populations, mainly pre-pubertal patients. Dr. Feldman describes the typical ways patients use their treatments and then concrete approaches dermatologists can undertake to enhance patients' adherence behavior.
This is a CME supplement; visit the JDD Medical Education Library
to participate in this activity and earn 2 AMA PRA Category 1 Credits.
Scott Fretzin MD, Jeffrey Crowley MD, Loretta Jones FNP-C, Melodie Young MSN RN ANP-C, Jeffrey Sobell MD
Hand and foot psoriasis can appear in a plaque-type or pustular-type form. Any form of psoriasis that occurs on the hands
and feet can have a debilitating effect on the patient’s daily functions. Here we present a case series of patients with plaqueor
pustular-type hand and foot psoriasis whose conditions were successfully managed with the biologic agent efalizumab.
In many of these patients, the disease was refractory to multiple systemic psoriasis treatments. Treatment with efalizumab was
effective and well-tolerated, with few adverse events. Many of the patients described here reported an improvement in both
their physical functioning and health-related quality of life. The efficacy of efalizumab in treating these cases of hand and
foot psoriasis suggests that it may provide therapeutic benefit.
Maira E. Herz Ruelas MD, Minerva Gómez MD, Oliverio Welsh MD DrSc, Horacio Decanini Arcaute MD, Jorge Ocampo-Candiani MD
Pityriasis rubra pilaris has no single effective therapy and there are some cases resistant to multiple treatments. Psoriasis has
clinical and therapeutic response overlaps with pityriasis rubra pilaris and there are several therapies common to both, such
as retinoids, methotrexate, cyclosporine A, phototherapy, and most recently infliximab. We report a case of a 10-year-old
boy with pityriasis rubra pilaris unresponsive to topical corticosteroids, salicylic acid, pimecrolimus, calcitriol, calcipotriol,
ultraviolet B targeted phototherapy, isotretinoin, systemic PUVA, acitretin, and etanercept. He was treated with efalizumab
1 mg/kg weekly and a successful outcome was obtained with a 50% improvement after the first dose. The patient remains
in remission after 9 months of treatment.
William P. Werschler MD FAAD, Susan Weinkle MD FAAD
With the growing number of injectable products for soft-tissue augmentation, non-surgical total facial restoration is within
reach. Nevertheless, the ideal injectable product has yet to be developed; at present different approaches are required for different
soft-tissue deficits. Products have previously been categorized as either temporary (requiring frequent touch-up treatments)
or permanent (associated with possible long-term complications and results that do not co-exist harmoniously with the
aging face). Although this dichotomy remains, longer-lasting or “semi-permanent” products are beginning to emerge. There
has long been a void in the availability of products that can effectively rejuvenate the face for between 2 and 5 years. This time
period would allow the patient to correct the continuing signs of aging with re-treatment at intervals that are tolerable from
both a financial and time-management perspective
Joesph F. Sobanko MD,a Jonathan Okman BA MBA,b and Christopher Miller MDa
Basal cell carcinomas (BCCs) are the most common cancer in the United States, and the overwhelming majority of BCCs are the result of hedgehog pathway activation. While locally advanced and metastatic BCC are rare, currently available treatments remain limited and are often unsuccessful. Vismodegib inhibits a key regulatory protein in the hedgehog pathway and was approved by the United States Food and Drug Administration in 2012. This orally-administered medication offers a novel approach for treating locally advanced and metastatic BCC. The following review will address vismodegib’s mechanism of action, published clinical trial data, and the questions that still remain unanswered about this new medication.
J Drugs Dermatol. 2013;12(suppl 10):s154-s155.
Infantile hemangiomas are benign vascular neoplasms of childhood that often have implications on development, cosmesis, and comfort.
Traditional therapy has involved either observation or corticosteroids, depending on location and size. Recent studies have reported
the successful use of beta-adrenergic antagonists in treating infantile hemangiomas. This succinct review discusses the properties and
current applications of beta-adrenergic antagonists as well as the established treatments for infantile hemangioma.
J Drugs Dermatol. 2012;11(7):826-829.
Facial wrinkles are the most visible morphological change of the aging process. Therefore, several rejuvenation methods have been developed to cure these unloved signs of the times, such as botulinum toxin, laser treatments as well as topical active ingredients. Recently, dermal fillers have become a popular means of addressing contour defects and soft-tissue augmentation. Although this aesthetic
treatment is considered to be relatively safe, the use of injectable dermal fillers is a minimally-invasive treatment, and as with any medical procedure, there is a risk for unwanted side effects.
J Drugs Dermatol. 2012;11(9):1053-1058.
Hui Deng MD PhD, Dingfen Yuan MD, Chunlin Yan MD, Xiaoxi Lin MD PhD, Xu’an Ding MD
Objective: To evaluate the efficacy and safety of a 2940 nm fractional photothermolysis laser in the treatment of acne scarring in
Methods: Twenty-six patients with moderate-to-severe atrophic scarring were treated with a 2940 nm-wavelength fractional photothermolysis
Results: All patients had encouraging results. Both skin elasticity and moisture content increased significantly after five treatments.
In post-treatment evaluations, both the patients treated, as well as an independent group of physicians each scored the atrophic scar
improvement as significant.
Conclusion: The 2940 nm fractional photothermolysis laser is safe and effective in the treatment of acne scarring.
Background: Scientific research in the field of energy-based and light-based procedures made it possible to develop a very new and innovative
generation of lasers that combine the benefit of a nonablative and a fractional laser device, promising skin rejuvenation without
harming the epidermis. With this pilot case series, we performed one of the first systematic reports evaluating efficacy and safety of the
fractional, nonablative Q-switched 1,064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser device in the treatment of rhytides
of the face, neck, and chest.
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.
Kelley Pagliai Redbord MD, C. William Hanke MD
Background: Topical photodynamic therapy (PDT) involves the use of a photosensitizing topical medication that is activated
by a light source in the presence of oxygen leading to cellular destruction and subsequent photorejuvenation. In
1999, the US FDA approved PDT for the treatment of nonhyperkeratotic actinic keratoses (AKs) on the face and scalp.
Observations: The study population comprised 85 patients treated with short-contact, topical aminolevulinic acid (ALA)-
PDT for a total of 247 treatments. Ninety percent of patients with a variety of dermatologic disorders had significant improvement
or total clearance. Ninety-eight percent of patients had no complications. Only 2 patients in our series had
a significant complication.
Conclusions: Short-contact, topical ALA-PDT is a safe and effective treatment for a variety of dermatologic disorders
including photoaging and AKs.
Antiphospholipid antibody syndrome (APS) results from autoantibodies to cell surface phospholipids or phospholipid-binding proteins resulting in clotting anomalies and can have devastating sequelae, including stroke, deep venous thrombosis, pulmonary embolism, and recurrent spontaneous abortions. However, cutaneous manifestations are the first sign of APS in up to 41% of patients. We present a case report of APS that developed several days after taking trimethoprim/sulfamethoxazole. The clinical and pathological features of this unique presentation, differential diagnoses, and treatments are discussed.
J Drugs Dermatol. 2012;11(9):1117-1118.
Fractional resurfacing or laser therapy (FLT) represents a technology that seeks to address the limitations of both ablative
resurfacing and nonablative treatments. Many companies now offer versions of fractionated erbium or carbon dioxide
lasers. The purpose of this paper is to examine FLT for difficult to treat applications such as melasma, acne scarring,
atrophic scarring, striae distensae, and deep rhytides. Fractional laser therapy is a truly novel approach to many conditions,
especially those with dermal pathology. Although published peer review data is limited, the ability to effectively
and safely treat these conditions in all skin types appears to have been significantly enhanced with this new modality.
We are early in our scientific explorations of what is possible with FLT.
Frank C. Victor, Alice B. Gottlieb
TNF-alpha is a key cytokine in innate immune responses and is increased in psoriatic lesions. TNF-alpha has
many effects, ranging from inflammation to apoptosis. These effects are reviewed to better understand the role
of TNF-alpha as it relates to the pathogenesis and treatment of psoriasis. TNF-alpha increases production of
pro-inflammatory molecules (e.g. IL-1, IL-6, IL-8, NF-kappaB, vasoactive intestinal peptide) and adhesion molecules
(e.g. intercellular adhesion molecule-1, P-selectin, E-selectin). TNF-alpha promotes apoptosis through
binding to the TNF-receptor 1; however, psoriatic lesions are hyperproliferative despite an increase in TNFalpha.
This paradox is partially explained as NF-kappaB activation seems to inhibit TNF-alpha-induced apoptosis.
The importance of TNF-alpha and apoptosis in psoriasis is shown through the review of clinical trials
using anti-TNF-alpha immunobiologics (e.g. etanercept, infliximab) and apoptosis-inducing treatments that
result in clinical improvement of the disease.
Steven H. Dayan MD,a Rachel N. Pritzker MD,b and John P. Arkins BSc
aClinical Assistant Professor, University of Illinios Department of Otolaryngology, Chicago, IL bDepartment of Medicine, Division of Dermatology, John H.Stroger Jr. Hospital of Cook Country, Chicago, IL cDeNova Research, Chicago, IL
Rosacea is a cutaneous condition with several clinical subtypes that are commonly seen in daily medical practice. There are many different
treatment modalities for each of the physical findings associated with this disease, and all have varying results. As the use of
onabotulinumtoxinA rises, its benefit in the treatment of a growing number of medical diseases increases. The authors report anecdotal
evidence of patients with rosacea experiencing improved symptoms of erythema and flushing after treatment with intradermal, microdroplets
of onabotulinumtoxinA. There were no adverse events reported for any of the treatments. The mechanism of action through a
likely neurogenic component to vascular dysfunction, inflammation, and hypersebaceous activity is reviewed.
J Drugs Dermatol. 2012;11(12):e76-e79.
Geraldine Cheyana Ranasinghe BS and Adam J. Friedman MD
The seborrheic keratosis is the most common benign skin tumor of middle-aged and elderly adults, affecting nearly 83 million individuals in the US alone. Although these are benign lesions, many patients still undergo some form of treatment. Clinicians are frequently presented with a challenge when determining whether to remove a seborrheic keratosis, and which treatment modality to use when doing so. The most commonly used method of removal is cryotherapy, however there are numerous other options that can be employed with varying degrees of efficacy. In this article, we highlight the use of topical keratolytics, vitamin D analogues, and lasers, to name a few. We also address potential side effects associated with these treatment options, as well as discuss patients’ preferences and concerns. We conclude with the most recent advances in topical treatments currently under clinical investigation, and offer treatment strategies aimed at maximizing patient satisfaction.
J Drugs Dermatol. 2017;16(11):1064-1068.
Acne vulgaris is the most common skin disease treated by physicians. Current topical and oral treatments may have shortand
long-term negative consequences. Since radiofrequency (RF) energy has been shown to reduce sebum production and
410-nm blue light has been shown to kill Propionibacterium acnes (P. acnes) cells, these modalities in combination should
be a highly effective treatment of acne vulgaris with little or no downtime or risk. This case report describes the efficacy
and safety of RF energy (Accent™, Alma Lasers Inc, Buffalo Grove, IL) and blue light (BLU-U®, Dusa Pharmaceuticals,
Inc, Wilmington, MA) used in combination to treat grade 4 cystic acne and acne scars in an Asian woman of skin type
IV. The results were considered excellent by both investigators and the patient, with improvement in the skin tone as an
added cosmetic benefit.
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.
The successful treatment of acne still remains problematic. Conventional therapies often prove inconsistent with unacceptable
side effects and recurrence rates, leading to patient noncompliance. A thermal phototherapy treatment using
a combination of blue light and red light has recently attracted much attention and seems to offer an effective alternative.
The objective of this study was to evaluate the efficacy of blue light (415 nm) in combination with red light (633 nm)
in the reduction of inflammatory lesions on the face of subjects (n=21) with mild to moderate acne vulgaris after a course
of 8 20-minute (blue) or 30-minute (red) alternated light treatments, self-administered by a handheld unit over a period
of 4 weeks. Lesion counts progressively reduced throughout the 4-week light therapy period and continued to reduce up
to 8 weeks posttherapy, with a final average reduction of 69% seen 8 weeks after the treatment course (P>.001). This pattern
is similar to previously reported studies.
Background: Alefacept is an effective intermittent treatment for psoriasis that can provide long-lasting remissions. Combination therapy with narrow-band ultraviolet B (nbUVB) phototherapy may enhance treatment outcomes and accelerate the onset of clinical response.
Objective: To assess the efficacy of alefacept in combination with nbUVB phototherapy compared to alefacept alone in subjects with moderate to severe psoriasis.
Methods: Ninety-eight adults with moderate to severe psoriasis were randomized to treatment with alefacept 15 mg intramuscularly (IM) once weekly for 12 weeks alone or in combination with three times weekly nbUVB treatments in this prospective, open-label, assessor-blinded, randomized, multicenter, parallel-group, 36-week study.
Results: A statistically significantly greater proportion of subjects in the alefacept plus nbUVB arm achieved the primary endpoint of PASI 75 at week 16 compared to subjects in the alefacept alone arm (44.9% vs 22.5%, P=0.032). Secondary outcomes were also in favor of the alefacept plus nbUVB group, including the proportion of subjects achieving a Physician Global Assessment (PGA) score of clear or almost clear at any time during the study (59.2% vs 34.7%, P=0.026) and reduction in percent body surface area (BSA) involved with psoriasis at week 16 (13.4% vs 8.0%, P<0.001). The onset of clinical response was significantly faster in the combination therapy group compared to monotherapy (mean time to PASI 75: 82 vs 107 days, P=0.007). Both treatments were generally well tolerated.
Limitations: Open-label, assessor-blinded study without a phototherapy-only treatment arm.
Conclusion: The addition of nbUVB to treatment with alefacept significantly enhanced and accelerated the clinical benefits of alefacept therapy and was generally safe and well-tolerated.
J Drugs Dermatol. 2012;11(8):929-937.
Yoram Harth MD FAADa,b and Ido Frank BSc MBAb
INTRODUCTION: Microneedle radiofrequency is a novel method that allows non-thermal penetration of the epidermis followed by RF
coagulation in selected depth of the dermis surrounded by zone of non-coagulative volumetric heating. The first generation of Microneedle
RF applicators used insulated needles. These treatments were limited by a few factors, including low volume of dermal heating,
lack of effect in the papillary dermis and pinpoint bleeding during the treatment. The system tested in this study (EndyMed PRO,
Intensif applicator, EndyMed Medical, Cesarea, Israel) utilizes special extra sharp tapered non-insulated microneedles and a special
pulse mode, allowing full coagulation during treatment and higher effective volume of dermal heat.
METHODS: After Ethics Committee approval, one female pig (Type Large white X Landrace, 34 Kg) was chosen for the study. The animal
was anesthetized using Ketamine, Xylazin and Isofluran. The EndyMed PRO, Intensif applicator (was used for treatment with different
needle depth penetration (1mm-3.5 mm) and in multiple energy settings. Six mm punch biopsies were harvested for histological analysis
at the following time points: immediately after the treatment, 4 days after the treatment and 14 days after the treatment. H&E and
Masson-Trichrome stains were processed.
RESULTS: Visual inspection of the treated skin, immediately after the treatment, revealed arrays of pinpoint erythematous papules
surrounded by undamaged epidermal tissue. Treatment field showed no sign of bleeding. Mild to moderate Erythema and Edema
developed a few minutes after the treatment, varying according to the total energy delivered. The histologies taken 4-day after therapy
showed in all energy settings, dry micro crusts over the treatment zones, with full healing of epidermis. In the 14-day specimens there
was a replacement of the crusts/debris by a normal looking stratum corneum with complete healing of epidermis and dermis.
DISCUSSION: The current in vivo study confirms that the EndyMed PRO Intensif applicator effective and predictable tool to create cylindrical
micro zones of coagulation in the papillary and reticular dermis with minimal damage to the epidermis. The histologies taken 4 days and
14 days after treatment show rapid epidermal renewal with predictable volume of coagulation in dermis related to the length of the needle
and the power used. Coagulation of capillaries during treatment allows a dry treatment field. The predictability of the effect and minimal
downtime may offer a significant advantage over treatments with ablative fractional lasers of insulated RF microneedles.
J Drugs Dermatol. 2013;12(12):1430-1433.
Tiffani K. Hamilton MD and Cheryl M. Burgess MD
With demand for minimally invasive cosmetic procedures rising in patients of color, it is becoming increasingly important for clinical
dermatologists to be aware of specific needs of these patients. This article therefore reviews considerations for using cosmetic
procedures on skin of color, and reports the authors’ clinical experience with the use of injectable poly-L-lactic acid (PLLA, Sculptra®,
Dermik Laboratories, a business of sanofi-aventis U.S. LLC) in this patient population. The authors’ experience indicates that patients
with skin of color may require an increased interval between treatments; however, with proper attention to patient selection and
administration technique, injectable PLLA can be used effectively in this patient group. Controlled clinical studies that include more
patients of color are needed to fully assess the benefits and risks of cosmetic products, such as injectable PLLA, in these populations.
Rosacea is a chronic disease that affects millions of men and women. Topical and oral antibiotics are effective,
yet often leave individuals with treatment plateau associated erythema and persistent flushing. We investigated
the use of intense pulsed light for treatment of the redness, flushing, and breakouts associated with rosacea.
Thirty-two consecutive patients of Fitzpatrick skin types I- III underwent 1 to 7 treatments with intense pulsed light.
Patients were assessed clinically and photographically. In addition, patients completed a detailed questionnaire
regarding their response to treatment.
Following treatment, eighty-three percent of patients had reduced redness, 75% noted reduced flushing and
improved skin texture, and 64% noted fewer acneiform breakouts. Complications were minimal and transitory.
It appears that intense pulsed light is an effective treatment for the signs and symptoms of rosacea and represents
a new category of therapeutic options for the rosacea patient.
Sabrina Guillen Fabi MD, Carlotta Hill MD, Joslyn N. Witherspoon MD MPH, Susan L. Boone MD,Dennis P. West PhD FCCP CIP
Thalidomide is increasingly being used due to its effectiveness in the treatment of a variety of dermatologic conditions refractory to
other treatments. Although thalidomide’s side effects have been well-documented in the literature since its entry in the 1950s, some
of the risks associated with its use are still being discovered. Recently, increased incidence of venous thrombosis following thalidomide
use has been reported in the treatment of diseases with disease-related thrombotic risks, such as malignancy and lupus with
antiphospholipid antibody syndrome, as well as concomitant therapy with chemotherapy and/or systemic corticosteroids. We report
a case of deep venous thrombosis (DVT) and pulmonary embolus (PE) following thalidomide use in a patient with leprosy (erythema
nodosum leprosum, ENL) who was concurrently treated with prednisone, as well as a review of relevant literature. Our findings substantiate
an increase in risk for thrombosis following thalidomide use in the dermatology and non-cancer clinical setting.
Macrene Alexiades-Armenakas MD PhD
Several classes of nonablative laser and light technologies have been developed to target laxity, rhytides, and the
various aspects of photoaging. The combination of the 3 main classes of nonablative rejuvenation, infrared laser, intense
pulsed light, and radiofrequency energy, are assessed in the current study. Using a comprehensive grading scale developed
to evaluate the multiple categories of the aging skin, quantitative analysis of changes in each category as well as overall
improvement and patient satisfaction were calculated. The combination technology resulted in a patient mean (95% CI)
percent improvement per category of 10.9% (8.1% to 13.7%) per treatment and 26% (16.5% to 35.5%) overall following
a mean (±SD) of 2.4 (±1.2) treatments. In addition, the patient satisfaction was 71.4%, suggesting that combining
nonablative technologies may maximize clinical results and patient detection of improvement.
The maintenance of normal hydration is an important function of the skin. The stratum corneum provides an antimicrobial, antioxidant,
and UV barrier and plays an integral role in maintaining skin hydration. Environmental factors and disease states may compromise
the barrier function of the stratum corneum, leading to excessively dry skin. Evidence supports the use of moisturizers in
the treatment of various skin conditions, and a wide variety of these products are currently available. The presence of moisturizing
agents in a compound, however, may not guarantee optimal moisturization effects. Pharmacologic and physiologic (eg, concentration,
bioavailability, proper determination of moisturization effects), as well as patient-based considerations, can potentially influence
the effects of moisturizer ingredients. While moisturizers as adjunctive therapy have proven benefits in enhancing the management
of certain dermatologic conditions, the incorporation of moisturizing ingredients into topical treatments may not translate into clinical
benefit, particularly in enhancing skin barrier function.
Lilla Landeck MD, Sonja Sabath,a Swen Malte John MD, Guenther Gediga PhD, Nanna Y. Schurer MD
Chitosan is a deacetylated derivate (≥50%) of chitin, to which antimicrobial properties have been assigned. As bacterial resistances
to antibiotics are increasing, alternative treatments have been gaining in importance. In the present study, the authors investigated
the antimicrobial effect of a chitosan-containing spray in a randomized, double blind, placebo controlled clinical trial at the department
of dermatology of the University of Osnabrueck. Twenty-nine healthy volunteers applied a chitosan-containing (1% concentration,
low molecular chitosan, degree of deacetylation 87%) spray and a chitosan-free control (vehicle only) spray to the left and right foot
respectively for five days. Before and after treatment swabs were taken for microbiological analysis. Bacterial count of the chitosan
treated areas showed a significant decrease (P<0.001) compared to those areas treated with the chitosan-free spray. Thus, chitosan
might serve as an alternative local antimicrobial agent in the future.
Michael H. Gold MD, Julie Biron
Background and Objectives: Photodynamic therapy (PDT) with topical 5-aminolevulinic acid (ALA) is becoming a more
popular dermatologic procedure. Newer protocols have virtually eliminated any associated untoward effects. Phototoxicity,
although rare, can still occur and requires aggressive post-therapy care. Recently, a new biorestorative skin care cream, containing
human growth factors and cytokines, was used to treat 2 severe cases of PDT-associated phototoxicity.
Materials and Methods: This paper describes 2 case reports of severe phototoxicity following ALA-PDT treatments. The
novel skin care cream was utilized in both cases phototoxicity.
Results: Complete resolution of the phototoxic reaction was seen, leaving both patients with normal skin texture and tone.
Conclusions: This novel skin care cream may prove useful in wound healing following treatment with lasers and light
sources or dermatologic surgery.
Barbara D. Garcia MD, Mitchel P. Goldman MD, Michael H. Gold MD
Photodynamic therapy (PDT) and intense pulsed light therapy (IPL) are commonly used in the setting of photorejuvenation.
Patient expectations for minimal to no downtime associated with these procedures has become an increasingly
important issue. In an attempt to define a topical skin care regimen that would reduce procedure-related symptoms and
possibly enhance therapeutic efficacy, 4 separate topical products were examined. Avène Thermal Spring Water (Laboratoires
Dermatologiques Avène, Les Cauquillous, France), NIA 24™ (Niadyne, Inc, Research Triangle Park, NC),
MimyX™ cream (Stiefel Laboratories, Coral Gables, FL), and Biafine® (OrthoNeutrogena, Los Angeles, CA) were studied
individually in the setting of either PDT or IPL treatments. The results of these studies indicate that a pre- and/or
postprocedure topical skin care regimen can be beneficial in reducing postprocedure symptoms.
Robert Baran MD, Luc Thomas MD PhD
Yellow nail syndrome (YNS) is an uncommon disorder that is characterized by the slow nail growth, marked thickening, and yellow
to yellow-green discoloration of the fingernails or toenails. Although the etiology of YNS is unknown, a diagnosis is indicated by the
concurrent presentation of the nail changes, with lymphedema and respiratory manifestations. Although lymphedema and respiratory
manifestations are sometimes manageable with regimens of medical and surgical treatments, YNS treatment options are limited and
often unsuccessful. For the patient, YNS can also be cosmetically unacceptable and concealment with nail polish may not always be
possible. However, it is now widely accepted that the azole class of antifungals can stimulate linear nail growth. In addition, vitamin
E has also been reported in the treatment of YNS with positive results. Herein, the authors report on a promising combination treatment
of oral fluconazole pulse therapy and oral alpha-tocopherol (vitamin E) in 13 patients with YNS with clinical successes observed
in 2 individuals and clinical cures observed in 11 subjects.
Staci Brandt PA-C MSMR MBA
This article reviews the published literature about the efficacy of oral and topical zinc as treatments for acne vulgaris. The medical literature was systematically reviewed to identify relevant articles. Each published study was assessed for pathophysiologic results and the quality of the clinical evidence the study provided based on Strength of Recommendation Taxonomy (SORT) criteria. Finally, the body of evidence for using oral or topical zinc in the treatment of acne was assessed, again using SORT criteria. A SORT strength of recommendation of B (inconsistent or limited-quality patient-oriented evidence) appears to be appropriate for both oral and topical zinc. The preponderance of evidence suggests zinc has antibacterial and anti-inflammatory effects and that it may decrease sebum production.
J Drugs Dermatol. 2013;12(5):542-545.
Audrey S. Wang MD,a Larissa Larsen MD,a Shurong Chang MD PhD,a Tiffany Phan BA,a Jared Jagdeo MD MSa,b,c
Dermatofibromas are benign skin lesions that may be treated if symptomatic or for cosmetic concerns. We present a case of an African
American woman with an enlarging, pruritic dermatofibroma on the thigh that was treated with fractionated carbon dioxide (CO2) laser
three times approximately 5 weeks apart. Between laser treatments, topical corticosteroids were applied to the lesion for a total of 13
weeks. The dermatofibroma completely flattened and became asymptomatic within 1 month after the final laser treatment. We hypothesize
that the fractionated CO2 laser ablated a portion of the stromal component of the lesion and introduced microscopic channels
that facilitated deeper penetration of the topical corticosteroids into the lesion. This is the first reported case demonstrating the successful
treatment of a symptomatic dermatofibroma using combination therapy with fractionated CO2 laser and topical corticosteroids.
J Drugs Dermatol. 2013;12(12):1483-1484.
Irene J. Vergilis-Kalner MD, David J. Mann MD, Justin Wasserman MD, Vesna Petronic-Rosic MD MSc,Maria M. Tsoukas MD PhD
Pityriasis rubra pilaris (PRP) is a rare skin condition which typically presents in adults as red-orange plaques with islands of sparing,
perifollicular keratotic papules, waxy palmoplantar keratoderma, and erythema with fine, diffuse scale. Currently, there are no well-established
treatment guidelines for this condition. This is party due to a lack of universally effective treatments for PRP, with some cases
being resistant to multiple topical and systemic therapies. Systemic retinoids have been used with some success. Several phototherapy
regimens have lead to variable results. The authors present a case of PRP, unresponsive to 6 month treatment of isotretinoin, that was
subsequently treated with narrow-band ultraviolet B (NB-UVB) light therapy with complete resolution after four months of light treatment.
The observed clinical benefit may encourage future phototesting and consideration of NB-UVB light therapy in recalcitrant PRP cases.
Heather Woolery-Lloyd MD FAAD, Mohamed L. Elsaie MD MBA FAAD, Nidhi Avashia BS
Hyperhidrosis is a psychosocially embarrassing condition with a treatment history of varied success1, including topical application
of antiperspirants with aluminum salts (eg, Drysol®), oral anticholinergics, iontophoresis, and endoscopic
transthoracic sympathectomy. The use of botulinum toxin type A (Botox®) in humans for the treatment of hyperhidrosis
didn’t emerge until 1996.2,3 Botulinum toxin A is a safe and effective treatment for hyperhidrosis, and it has been shown
to improve the quality of life in affected patients.4 The toxin works by inhibiting the release of acetylcholine at the neuromuscular
junction, and affecting the postganglionic sympathetic innervation of sweat glands.5,6 The authors report a case
of inguinal hyperhidrosis treated with botulinum toxin A. Very few cases with similar treatments have been found in the
medical literature. More work should be done to find the optimal dose for treating this area, and affected patients should
be informed of the potential benefits of botulinum toxin therapy.
Kalindi Raval PharmD, Jennifer H. Lofland PharmD MPH PhD, Heidi C. Waters MS MBA, Catherine Tak Piech MBA
Plaque psoriasis is a chronic, inflammatory skin disease that can be difficult to treat. Traditional systemic agents, topical agents,
phototherapy and biologic therapies can be used for patients with psoriasis. The authors reviewed published results from a variety
of sources in order to better understand the effects of psoriasis treatments on patient satisfaction, patient adherence, healthcare
resource utilization and productivity. Patients with psoriasis consider many factors when evaluating therapies, including the time for
the therapy to be effective, cosmetic issues common with topical therapies and travel to and from phototherapy centers. Satisfaction
with and adherence to biologic therapies appears to be greater than for traditional therapies. Although biologic therapies are generally
more expensive than are traditional, these agents may contribute to decreased healthcare utilization and increased productivity.
J Drugs Dermatol. 2011;10(2):189-196.
D. K. Damle MD DNB, P. M. Mahajan MD, S. N. Pradhan MD, V. A. Belgaumkar MD, A. P. Gosavi MD, S. N. Tolat MD, N. R. Gokhale MD, C. B. Mhaske MD
Background: Mycetoma has a worldwide geographical distribution which is extremely uneven; however, it is a common disease in
India and responsible for causing signiﬁ cant morbidity. Treatment of this condition is often a challenge for the treating dermatologist.
The authors report a promising therapy for patients of actinomycotic mycetoma.
Methods: This assessment series included 18 patients with a conﬁ rmed diagnosis of actinomycetoma, and who had shown a poor
response to previous treatments. Patient received a combination therapy of the Welsh regimen (amikacin along with cotrimoxazole)
to which rifampicin was added as a third drug. Clinical evaluation included radiology and laboratory investigations.
Results: Sixteen patients out of 18 completed the combination therapy, which lead to remission. Two patients were lost to follow-up.
Of the 16 patients in remission, no recurrence was observed during a follow-up period of up to 18 months.
Abbas Rasi MD, Leila Tajziehchi MD
Background: Despite the availability of various medical treatments for pityriasis rosea, a large percentage of patients fail
to achieve satisfactory results. Erythromycin is reported to be effective in the treatment of pityriasis rosea.
Methods:We designed a placebo-controlled study on 184 patients with pityriasis rosea attending the outpatient dermatology
department at Hazrat-e-Rasul Hospital in Tehran, Iran. Adult patients were treated with 200 mg of erythromycin
4 times daily and children were treated with 20 to 40 mg/kg daily in 4 divided doses. Controls were given a placebo (an
emollient cream) that was not identical in appearance. Subjects were seen at follow-up visits 2, 4, 6, and 8 weeks after
Results: Both groups were comparable with regard to sex, age, and mean duration of disease at the time of attending the
clinic. We found no significant difference between the 2 treatment groups at weeks 4, 6, and 8 after beginning of treatment.
Conclusion: In this study, prescription of oral erythromycin did not promote complete clearing of lesions.
Nour J.Youssef MD,a Alain G.Rizk MD,a Omar A. Ibrahimi MD PhD,b,c and Zeina S.Tannous MDa,c
BACKGROUND The 800 nm long-pulsed diode laser machine is safe and effective for permanent hair reduction. Traditionally, most long-pulsed diode lasers used for hair removal had a relatively small spot size. Recently, a long-pulsed diode laser with a large spot size and vacuum assisted suction handpiece was introduced. The treatment parameters of each type of handpiece differ. Short and long-term clinical efficacy, treatment associated pain, and patient satisfaction are important factors to be considered.
OBJECTIVE: This study aims to conduct a direct head to head comparison of both handpieces of the 800nm long-pulsed diode laser by evaluating long term hair reduction, treatment associated pain and patient satisfaction.
METHODS: Thirteen subjects were enrolled in this prospective, self-controlled, single-center study of axillary laser hair removal. The study involved 4 treatments using a long pulsed diode laser with a large spot size HS handpiece (single pass), HS handpiece (double pass), and a small spot size ET handpiece according to a randomized choice. The treatment sessions were done at 4-8 week intervals with follow up visits taken at 6 and 12 months after the last treatment session. Hair clearance and thickness analysis were assessed using macro hair count photographs taken at baseline visit, at each treatment session visit and at follow up visits. Other factors including pain, treatment duration, and patients’ preference were secondary study endpoints.
RESULTS: At 6 months follow up visits after receiving four laser treatments, there was statistically significant hair clearance in the three treatment arms with 66.1 % mean percentage hair reduction with the ET handpiece, 43.6% with the HSS (single pass) and 64.1 % with the HSD (double). However, at one year follow up, the results significantly varied from the 6 months follow up. The mean percentage hair reduction was 57.8% with the ET handpiece treated axillas (n=9), 16.5% with the HSS (single pass) handpiece treated axillas (n=7), and 46.9% with the HSD (double pass) handpiece treated axillas (n=6). Thus, at one year follow up, there was a significant hair reduction that was similar in both the ET and HSD treated axillae (57.8% and 46.9 %), but only minimal hair reduction (16.5%)was observed in the HSS treated axillae.
CONCLUSIONS: This is the first study that compared the long-term efficacy of the ET and HS handpieces after four treatment sessions with up to 12 months follow up after the last treatment session. It is also the first study that provided head to head comparison between HS (double pass), HS (single pass), and ET handpiece taking into consideration the end hair reduction result, the time consumed, the pain score experienced, and the overall patient satisfaction. HSD had better hair clearance and patient satisfaction when compared to ET and HSS. The long term follow up results showed that ET was superior to HSS (P less than .05), but was not superior to HSD (P greater than 0.05). However, HSD treated patients had lower pain scores with HSD than with ET. We conclude that ET handpiece is almost as efficacious as HSD handpiece, and the desired end results could be achieved with HDD with better patient satisfaction, less treatment duration and less pain.
J Drugs Dermatol. 2017;16(9):893-898.
Veronica Russo MD MPH and Ali Alikhan MD
BACKGROUND: Hidradenitis suppurativa (HS) is a chronic, painful, inflammatory disorder of hair follicles and manifests with several cutaneous findings, including double comedones, papules, cysts, nodules, draining abscesses, and sinus tracts. It is associated with tremendous morbidity and decreased quality of life. Treatment of HS is challenging. Recently, there have been mixed reports regarding the efficacy of anakinra, an interleukin 1 receptor antagonist, in the management of HS.
CASE: A 55-year-old African American male with a several year history of severe HS, recalcitrant to multiple prior treatments, was treated with a 12 week course of anakinra 100 mg subcutaneously daily. After 3 months of therapy, minimal change was observed, and the patient strongly preferred to cease therapy due to lack of improvement and pain associated with daily injections.
CONCLUSION: Our case of severe HS proved refractory to anakinra. Tolerance of this therapy may be a limiting factor for some patients due to necessity for daily injections.
J Drugs Dermatol. 2016;15(6):772-774.
Steven Q. Wang MD, Leonard H. Goldberg MD FRCP
Background and Objective: Hypergranulation tissue may complicate postoperative wounds, causing them to become
chronic nonhealing ulcers. There is no reliably effective treatment. We report the use of the 595-nm pulsed-dye laser (PDL)
for the treatment of wounds healing by second intention and complicated by hypergranulation tissue after Mohs micrographic
Methods: In a retrospective case review, 9 patients with slow-healing or nonhealing postoperative wounds with hypergranulation
tissue were treated with the 595-nm PDL. The majority of the wounds were located on the scalp, forehead,
Results: All of the patients demonstrated dramatic improvement after one treatment. Most patients achieved complete
or near complete re-epithelialization of the ulcers after 1 to 2 treatments. The PDL treatment required no local anesthesia,
and there were no postlaser treatment complications reported.
Conclusions: The 595-nm PDL is an effective, safe, and reliable treatment to promote second intention healing in postsurgical
wounds complicated by the formation of hypergranulation tissue.
Background and Objectives: Laser- and light-based methods for hair removal, though effective, are expensive and may
be associated with adverse effects. Our objective was to evaluate the efficacy and safety of a thermal, handheld self-treatment
device (no!no!™ Thermicon™, Radiancy Inc, Orangeburg, NY) for removing unwanted hair.
Methods: Twelve of the 20 enrolled subjects underwent 6 supervised and 6 unsupervised self-treatments of their lower
legs and umbilicus-bikini areas at twice-weekly intervals for 6 weeks. Follow-up visits were scheduled at 2, 6, and 12 weeks
after the final treatment. Results were evaluated by pretreatment, post-treatment, and follow-up hair counts.
Results: For legs, the median clearance percentages were 48% post-treatment and 43.5% at 12 weeks. For the umbilicus-
bikini area, the median clearance percentage was 15% at 12 weeks.
Conclusions: The efficacy and safety of the no!no! Thermicon device for hair removal of the legs appear to be comparable
to those of laser devices.
Frank Rosengaus-Leizgold MD,a Elizabeth Jasso-Ramírez MD,bNathania Cárdenas Sicilia MDa
When viewing the most famous smiles in history (Figure 1), two constants become apparent: a smooth perioral surface and oral commissures that are turned upward (or horizontal as a minimum). Patients are often fixated on improving both the marionette lines and the downward oral commissures as these distractions are one of the most noticeable areas in the aging face to the average person. In addition, the downward turn of the oral commissures gives an impression of sadness. Unfortunately, the anatomy of this area makes non-surgical treatments less than satisfactory, and unpredictable in many cases. The senior author has developed a novel technique to treat the marionette lines and turn the corner of the mouth upward that has been named the Happy Face treatment. The key for a successful outcome is the assessment of the perioral anatomy and the understanding of the physio dynamics of the jowl to produce a Mona Lisa smile and a Happy Face.
J Drugs Dermatol. 2018;17(11):1226-1228.
Jessica L. Alexander MD, Amer N. Kalaaji MD, James M. Shehan MD, Benjamin K. Yokel MD, Mark R. Pittelkow MD
Background: Urticarial vasculitis is a form of cutaneous leukocytoclastic vasculitis clinically characterized by persistent and often painful urticarial lesions. Numerous systemic diseases have been associated with urticarial vasculitis, icluding cerain hematologic disorders. This distinctive form of cutaneous necrotizing vasculitis can be resistant to standard therapwutic modalities, necessitating more aggrssive intervention.
Mehods: We report a case of refractory urticarial vasulitis developing in association with B-cell chronic lymphocytic lukemia in a 46- year-old man. We also reviewed the literature to identify other cases of urticarial vasculitis managed with this therapeutic modality.
Results: The diesease progressively improved during 6 treatments with palsmapheresis (plasma exchange). In additional cases indentified in the literatrue, plasmaphersis was generally effective and well tolerated.
Conclusion: On the basis of these findings, we propose that plasmapheresis be considered a treatment option for refractory
Carey Kim MS,a Pantea Hashemi MD,b Michael Caglia MD,c and Kenneth Shulman MDd
BACKGROUND: Epidermodysplasia verruciformis (EV) is a rare genetic disorder characterized by widespread human papillomavirus (HPV) associated lesions and an increase susceptibility to cutaneous malignancies. A host of medications traditionally used to treat warty lesions have been used with variable results and limited success. To our knowledge, we describe the first reported case of a patient with Imiquimod resistant EV successfully treated with topical ingenol mebutate (Picato).
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.
Sara M. James BS,a Dane E. Hill MD,a and Steven R. Feldman MD PhDa,b,c
BACKGROUND: Costs for psoriasis have increased in recent years, in part due to the introduction of biologic agents.
OBJECTIVE: To identify the most common and most costly (from the payer perspective) drugs used in the treatment of psoriasis.
METHODS: We analyzed patient data from a large claims-based database in order to identify the most common and most costly medications
used in the treatment of psoriasis from 2010 to 2014.
RESULTS: The three most common psoriasis medications, accounting for 81.1% of all psoriasis medications, were topical corticosteroids.
The three most costly drugs, accounting for only 9.6% of all psoriasis medications, were biologics, accounting for 86% of the cost of psoriasis medications.
CONCLUSIONS: Biologic agents are used far less commonly in the treatment of psoriasis than topical treatments. Despite the relatively small number of patients using biologic agents, biologics are responsible for a large proportion of the cost of psoriasis pharmacotherapy.
J Drugs Dermatol. 2016;15(3):305-308.
Arielle W. Haves BA, Panta Rouhani Schaffer MD PhD MPH, and John A. Carucci MD PhD
The development of vismodegib and its recent approval by the United States Food and Drug Administration for use in patients with locally advanced or metastatic basal cell carcinoma (BCC) carries with it a renewed sense of optimism. Once BCC has progressed to an advanced, or so-called inoperable stage, there has been a paucity of effective therapies, making the new small molecule inhibitors targeting the hedgehog pathway particularly hopeful prospects. In order to better understand the utility of these new treatments, it is important to assess the existing economic, physical, and psychological burden of advanced BCC. This review aims to recognize the impact of inoperable and metastatic BCC, as well as to better characterize the various types of advanced BCC. The use of vismodegib as a prophylactic treatment in patients with basal cell nevus syndrome is also addressed, including possible adverse events, tumor resistance, and new onset malignancies.
J Drugs Dermatol. 2013;12(suppl 10):s151-s153.
Ricardo Ruiz-Rodriguez MD PhD, Laura López-Rodriguez MD
As demand for less invasive, highly effective cosmetic procedures grows, dermatologists must continue to explore and
develop new treatment options. Nonablative skin resurfacing techniques offer an effective and noninvasive treatment for
photorejuvenation. Several studies have shown improvement of photodamaged skin and increased collagen production after
nonablative treatments using vascular lasers, mid-infrared lasers, intense pulsed light, radiofrequency devices, fractional
resurfacing, and plasma skin rejuvenation. Among the novel methods for maximizing the efficacy of nonablative treatment
is the concurrent use of a photosensitizing agent. The light sources currently most used for photodynamic rejuvenation are
intense pulsed light and pulsed dye laser. We present some preliminary results on rejuvenation using Metvix and red light.
We are still far from a thorough understanding of the molecular mechanism of rejuvenation with this technique, although a
nonspecific immune response could be involved. Understanding the laser-tissue interactions associated with photodynamic
therapy is crucial in selecting patients that will most likely benefit.
Acne vulgaris is the most common skin condition affecting adolescents and young adults with a tremendous psychosocial impact. Its pathogenic hallmarks include follicular dyskeratosis, increased sebum production, and inflammation induced by Cutibacterium (formerly Propionibacterium) acnes within the follicle. Retinoids, derived from vitamin A, are the mainstays of acne treatment given they address the key pathogenic pathways of acne. Retinoids exert their effects through the binding of their nuclear receptors leading to downstream biological effects. The understanding of retinoid pharmacology has increased the diversity of retinoids with now both natural and synthetic retinoids available for use. For acne, retinoids can be administered both topically in a variety of formulations and combinations as well as systemically. With judicious use, this class of medication is well tolerated and very efficacious in managing acne. Furthermore, there is evidence showing its role in improving and preventing one of the most challenging post-acne changes, atrophic acne scarring. With a promising topical retinoid, trifarotene, on the horizon, the acne armamentarium will be further broadened to better manage acne and its related sequelae.
J Drugs Dermatol. 2018;17(12 Suppl):s51-55
Jennifer Rivard MD, David Ozog MD
Background and Objectives: Photodynamic therapy (PDT) with topical 5-aminolevulinic acid (ALA) is becoming a more
popular dermatologic procedure. Newer protocols have virtually eliminated any associated untoward effects. Phototoxicity,
although rare, can still occur and requires aggressive post-therapy care. Recently, a new biorestorative skin care cream, containing
human growth factors and cytokines, was used to treat 2 severe cases of PDT-associated phototoxicity.
Materials and Methods: This paper describes 2 case reports of severe phototoxicity following ALA-PDT treatments. The
novel skin care cream was utilized in both cases phototoxicity.
Results: Complete resolution of the phototoxic reaction was seen, leaving both patients with normal skin texture and tone.
Conclusions: This novel skin care cream may prove useful in wound healing following treatment with lasers and light
sources or dermatologic surgery.
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.
Leon H. Kircik MD, Neh Onumah MD, Joshua A. Zeichner MD, Elena Sotiriou MD PhD, Christina Goussi MD, Aimilios Lallas MD, Eleni Chovarda MD, Zoe Apalla MD, Elisabeth Lazaridou MD PhD, Demetris Ioannides MD PhD
This supplement to the Journal of Drugs in Dermatology help address various components of psoriasis and comorbidities, as well as hidradenitis suppurativa and biologic treatments. Dr. Kircik and Onumah's article covers psoriasis and its identified comorbidities or chronic proinflammatory disorders driven by similar immunopathologic expression of immune response mechanisms. Dr. Zeichner covers immunologic therapies for treatment of psoriasis-tumor necrosis factor (TNF) inhibitors and interleukin (IL)-12 and IL-23 inhibitors: etanercept, adalimumab, infliximab, golimumab, and ustekinumab. Dr. Zeichner also considers therapeutic management prior to initiating biologic therapy. Lastly, Drs. Elena Sotiriou MD PhD et al from Aristotle University in Thessaloniki, Greece provides perspectives on a prospective clinical trial of efficacy of adalimumab in the treatment of hidradenitis suppurativa. The study demonstrates the significant efficacy of the once weekly regimen, as well as its benefit regarding time to recurrence.
Mitalee P. Christman MD,a Daniel Belkin MD,b Roy G. Geronemus MD, a,band Jeremy A. Brauer MDa,b
Cellulite is the common rippling or dimpling of skin of the thighs and buttocks of women, formed from a confluence of skin laxity, tethering fibrous septa, and fat herniation. We describe an anatomical approach to evaluating the cellulite patient and selecting the best treatment from among available non-invasive, minimally invasive, and invasive therapies. It is crucial to consider the anatomy of the patient and the morphology of cellulite while choosing a treatment. Diffuse rippling represents increased adiposity and/or increased skin laxity which may stand to benefit from lipolytic and skin tightening modalities. Dimpling represents tethering by fibrous septa which may stand to improve from subcision by minimally invasive devices such as Cell na. Patients with both morphologies may be treated with a combination of treatments or Cellulaze. Careful evaluation of the patient can help identify the best therapeutic strategy.
J Drugs Dermatol. 2017;16(1):58-61.
Neil Sadick MD FACP FAACS
Recent advances in light therapy coupled with photosensitizers offer alternatives to topical creams and gels and systemic oral agents
for acne treatment. To examine the safety and efficacy of the photosensitizer 5-aminolevulinic acid (ALA) in patients with moderateto-
severe acne, a randomized, split-face study, using ALA on one side of the face, was followed by exposure of the entire face to
532 nm potassium titanyl phosphate (KTP) laser. Eight patients completed three treatments for up to 12 weeks. The average acne
grading at baseline was 3.20, and improved to 2.12 at 12 weeks (34% improvement). Use of ALA improved acne by 52% compared
with 32% on the side that did not receive the photosensitizer. Further studies are warranted to establish optimal parameters for
photosensitizer use combined with light therapy for treatment of moderate-to-severe acne; however, the combined use of ALA and
a 532 nm laser suggests promising results for acne treatment.
The seborrheic keratosis (SK), which is ubiquitous throughout all populations, is a benign tumor of the skin. SKs are among the top 20 dermatologic conditions treated by dermatologists. They have been reported to occur in individuals of all ages including children as young as age 15 years. Familial cases of SKs have been described with an autosomal dominant inheritance pattern. Mutations of the fibroblast growth factor receptor 3 gene (FGFR3) and the gene encoding for phosphoinositide 3-kinase (PIK3CA) have been demonstrated in SKs. In addition to a genetic predisposition, independent risk factors include advancing age and ultraviolet light exposure. It has been proposed that these two risk factors may also contribute to the development of SKs caused by the genetic mutation in FGFR3 gene, which is involved in regulating cell growth, differentiation, migration, and wound healing. The classic description of a SK is a papule or plaque with a soft, friable, hyperkeratotic surface, or a macule with a fine granular appearance. Variants include the stucco seborrheic keratosis and dermatosis papulosa nigra (DPN). Although diagnosed clinically, mimickers of SKs are well known with melanoma being the most concerning. Treatment of SKs is primarily procedural with new treatments in development.
J Drugs Dermatol. 2017;16(5):419-424.
Edwardo Tschen, MD and Terry Jones, MD
Topical acne therapies are widely used for the treatment of mild to moderately severe acne vulgaris. However, many available treatments have limitations associated with their use, including lengthy time to response, cosmetic acceptability, and photosensitivity. Combinations of topical antibiotics and comedolytics are especially useful, but some formulations have stability challenges. A new combination formulation that contains 1% clindamycin and 5% benzoyl peroxide(BenzaClin® Topical Gel) is currently available. In clinical trials, clinical improvement occurred at the first two follow-up visits and continued throughout treatment. In addition, combination therapy with clindamycin/benzoyl peroxide gel rapidly reduces Propionibacteria acnes counts and suppresses the emergence of clindamycin-resistant P. acnes. This formulation is stable at room temperature for up to 2 months after compounding. The aqueous gel vehicle is less drying, and there is no photosensitivity associated with its use. This study compares the combination treatment of 1% clindamycin and 5% benzoyl peroxide topical gel with other therapeutic options for mild to moderately severe acne vulgaris.
Lilia M. Correa-Selm MD,a Mahin Alamgir MD,b Babar K. Rao MDc
Over a decade ago, the FDA approved biologics for psoriasis, which changed how the disease is treated and, in most cases, has a significant
positive impact on the lives of patients. Side effects primarily identified during the investigational and research phase led to the development
of specific guidelines for treatment. The treatment guidelines have been amended to incorporate better understandings of side-effects over
the years that the disease has been treated. In this study, we focused on a chart review that included assessing the current guidelines and
their alignment with modern patient management and the recent side effects presented. This life-cycle evaluation included over 100 patients,
management of their treatment, laboratory abnormalities, criteria for choosing or changing to a different biologic, and the effects of the treatments
management throughout the years. The review identified some recommended changes in the application and treatment of psoriasis
with biologics. To further evidence our findings, we hope to expand this study to a larger scale with more patients.
J Drugs Dermatol. 2017;16(3):215-217.
Joseph B. Bikowski, MD; and Mitchel p. Goldman, MD
Advances continue to be made in the classification and treatment of rosacea, a chronic dermatologic syndrome. A new empiric classification
system identifies 4 rosacea subtypes (erythematotelangiectatic, papulopustular, phymatous, and ocular) that may aid in more
precise diagnosis. Several new therapies have recently been approved for treatment of rosacea. Azelaic acid 15% gel is a new firsttier
topical agent proven effective in reducing inflammatory lesions and erythema. New formulations of metronidazole and sulfacetamide
10%/sulfur 5% that offer cosmetic or tolerability advantages are now available. Intense pulsed light therapy has demonstrated
effectiveness in reducing flushing, erythema, and telangiectases, with greater tolerability than existing laser systems. Other treatments
under investigation include low-dose doxycycline hyclate (which may provide greater safety than existing oral antibiotics), benzoyl
peroxide/clindamycin gel, and tacrolimus ointment (for steroid-induced rosacea). With this expanded armamentarium of medical
and light-based therapies, clinicians can now implement a multifaceted approach to treatment, crafting new treatment combinations
to address the unique and evolving features of rosacea in each individual patient.
Background: Prior international clinical experience and domestic controlled clinical trials provide useful guidance for dosing of a
new botulinum toxin type A, abobotulinumtoxinA. Nonetheless, aftermarket experience is paramount in providing confirmatory “real
world” information on any recently introduced drug. This report describes the incorporation of abobotulinumtoxinA into an established
clinical practice that previously only utilized onabotulinumtoxinA for facial rejuvenation
Description: Retrospective review of 500 patients who received abobotulinumtoxinA injections.
Results: A total of 736 abobotulinumtoxinA treatments were administered to 500 patients. The most common areas treated were
corrugators, “crow’s feet,” frontalis, brow and platysma, respectively. A dose conversion ratio of 1:2.67 (onabotulinumtoxinA : abobotulinumtoxinA)
was determined. The majority of adverse events were considered to be mild and self-limiting. There were three
(0.6%) cases of ptosis.
Conclusion: Since its recent approval by the U.S. Food and Drug Administration (FDA), experience with abobotulinumtoxinA is evolving.
Utilizing a dose conversion ratio of 1:2.67 units (onabotulinumtoxinA: abobotulinumtoxinA) and the same injection techniques,
one can safely and effectively incorporate this new neurotoxin into his or her practice.
Magdalene Dohil MD, Leslie Baumann MD, Hema Sundaram MD, Jason Emer MD
The dermatologic application of natural ingredients in skin care has evolved
significantly in the past two decades. Research into the mechanisms and
biochemistry of natural ingredients has lead to the development of new
technologies and formulations that provide a therapeutic benefit in the
treatment of dermatologic conditions and the aging process.
Providing optimal patient outcomes continues to be a challenge in the
treatment and management of dermatologic conditions. Most physicians and
patients are interested in doing everything possible to optimize the
treatment of their skin disease. This is especially important in treating
patients with chronic disorders such as eczema, acne, psoriasis, rosacea,
photodamage and the negative effects of aging. Physicians and patients often
explore the therapeutic benefits of natural ingredients as alternative or
complementary treatments to conventional methods. It is important that
dermatologists remain up-to-date on the research and new advances in skin
care products with natural ingredients.
This is a CME supplement; visit the JDD Medical Education Library
to participate in this activity and earn 1 category 1 CME Credit.
Allison P. Weinkle BS,a Bryan Sofen MD,b and Jason Emer MDc
There is an increasing trend shifting the aesthetic focus downward from the face with a significant number of new treatments aimed at the aging neck and below. Clinical characteristics of neck youth include clear skin texture and tone without laxity or fat, in addition to a well-defined cervicomental angle and distinct mandibular border. Similarly to treating facial aging, the neck requires a comprehensive assessment of all factors involved in the aging process – loss of volume, increased skin laxity, worsening texture and clarity, and crepe skin/wrinkling – as each requires a combination approach for improvement. It is essential to address each above factors for more than minimal improvement. A multitude of options including neuromodulators, energy based devices, surgery, and injectable agents for fat reduction are available in our armamentarium and understanding these options solo, or ideally in combination, is essential for best practice and optimal results. Herein, we describe synergic approaches to the treatment of neck aging.
J Drugs Dermatol. 2015;14(11):1215-1228.
Nicole Van Buren MS and Tina S. Alster MD
Of the estimated 11.7 million cosmetic surgical and nonsurgical procedures performed in the United States (U.S.) in 2007, 22%
were performed on racial and ethnic minorities. Laser and light treatments rank in the top five most requested procedures in annual
surveys of cosmetic and dermatologic surgeons.
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.
Tina S. Alster MD, Elizabeth L. Tanzi MD, Esperanza C. Welsh, MD
Background: Photorejuvenation of facial skin has been reported after intense pulsed light (IPL) therapy alone and in conjunction
with topical 5-aminolevulinic acid (5-ALA), but no comparative studies between these regimens have been performed.
Objective: To evaluate the safety and effectiveness of combination topical 5-ALA and IPL compared to IPL treatment alone.
Methods: Ten patients with mild to moderate photodamage were randomly assigned treatment with 5-ALA + IPL on one facial
half and IPL alone on the contralateral side. Two treatments were delivered at 4-week intervals. Clinical improvement scores
were determined by masked evaluations of digital photographs obtained at baseline, prior to each treatment session, and at 1, 3,
and 6 months after the final treatment.
Results: Higher clinical improvement scores were noted on the combination 5-ALA + IPL treated areas. Mild edema, erythema,
and desquamation were observed on the facial halves where 5-ALA was applied. No scarring or unwanted pigmentary alteration
Conclusions: Photodynamic therapy with combination topical 5-ALA + IPL is safe and more effective for facial rejuvenation
than IPL treatment alone.
L. Rusciani MD, A. Paradisi MD, C. Alfano MD, S. Chiummariello MD, A. Rusciani MD
Background: Despite their benign nature, keloids may constitute a severe aesthetic and, in some cases, functional problem
with important repercussions on patients’ quality of life. There is no consensus on keloid treatment and no wholly
satisfactory therapy has yet emerged.
Objective: To assess the efficacy of cryotherapy in the treatment of keloids.
Methods: 135 patients with 166 keloids received cryosurgical treatment between 1990 and 2004. Freeze times and number
of sessions varied. Scar volume was measured before and after treatment. Median follow-up was 48.6 months (range 12.4-72.6
Results: Of the 166 lesions treated, 79.5% responded very well with a volume reduction of the initial mass of greater than
80% after a median of 3 treatments (range: 1-9). A good result was obtained in 14.5% of lesions, while results were unsatisfactory
in 6% of cases. The main adverse effects reported were atrophic depressed scars and residual hypopigmentation
(75% of cases). No recurrences arose during the follow-up period (12-72 months).
Conclusions: To date, cryotherapy appears to be the most effective, safe, economic, and easy-to-perform monotherapy to treat
keloid lesions and hypertrophic scars.
Donald V. Belsito, MD
Chronic idiopathic urticaria (CIU) is a serious disorder that can greatly compromise quality of life. While H1 antihistamines are the
accepted first-line treatment for CIU, older generations of these agents (e.g., hydroxyzine, diphenhydramine) are associated with
anticholinergic and CNS effects, such as drowsiness and sedation, that can pose risks to patients, especially when driving. Secondgeneration
agents available in the United States (U.S.) (e.g., cetirizine, desloratadine, fexofenadine, levocetirizine, loratadine) has
greatly reduced these CNS effects, making them the current treatments of choice in CIU, but their potency and tolerability profiles
vary. Differences in duration of in vivo receptor occupancy may affect the potency of H1 antihistamines. Levocetirizine appears to
have greater in vivo H1 receptor occupancy compared with later generation H1 antihistamines, which may confer an advantageous
efficacy/safety profile. This has been confirmed in a recent head-to-head study showing that levocetirizine was more effective than
desloratadine in improving pruritus in CIU patients. Fexofenadine has been shown to have a low occupancy of H1 antihistamine
receptors in the brain, which reduces the likelihood of sedation. More studies are required to further assess receptor occupancy and
other factors that may differentiate the second-generation H1 antihistamines.
Navid Ezra MD,a Mehran Taban MD,b Daniel Behroozan MDa,c,d
Background: Central serous chorioretinopathy (CSC), also known as central serous retinopathy (CSR), is a visual impairment, often temporary, usually in a single eye, which mostly affects males in the age group of 20 to 50 but may also affect women. CSC occurring after prolonged use of topical steroids in a patient with psoriasis is a novel complication in the English literature.
Observations: We describe a case of a 25-year-old male, with a 15-year history of corticoid ointment use for psoriasis, who presented with loss of vision secondary to CSR.
Conclusions: All topical steroid treatments were discontinued and the patient recovered his vision completely. Although topical corticosteroids are frequently utilized for psoriasis management with a low rate of complication, clinicians should be familiar with this rare yet distressing condition. Furthermore, patients with increased production of endogenous corticosteroids (e.g., those with Cushing's syndrome, hypertension, or obstructive sleep apnea) should be warned of the potential of chorioretinopathy following prolonged use of topical corticosteroids
J Drugs Dermatol. 2011;10(8):930-933.
Leon H. Kircik MD,a Varsha Bhatt PhD,b Gina Martin MOT,b and Radhakrishnan Pillai PhDb
The use of fixed combinations in acne vulgaris (acne) is very common, however comparative clinical trial data are limited. Cutaneous tolerability can influence patient compliance, and concerns about skin irritation with topical acne treatments have lead to a number of comparative split-face studies.
Recently, a new fixed combination product was introduced (clin 1.0%-BP 3.75% gel) that was shown to be effective in reducing both inflammatory and noninflammatory lesions in moderate to severe acne. Here, we assess the tolerability of clin 1.0%-BP 3.75% gel compared with adap 0.1%-BP 2.5% gel in healthy volunteers with no apparent facial redness or dryness over 21-days, using a split-face methodology.
Especially over the first two weeks of treatment, clin 1.0%-BP 3.75% gel was more tolerable than adap 0.1%-BP 2.5% gel, with statistically significant differences in cumulative change from baseline starting as early as day 8 (dryness) and day 9 (erythema), and composite index on days 8-12 and 16. Transepidermal water loss was less with clin 1.0%-BP 3.75% gel, although the difference was not statistically significant.
J Drugs Dermatol. 2016;15(2):178-182.
Adam S. Aldahan BS,a Stephanie Mlacker BS,a Vidhi V. Shah BA,a Lucy L. Chen MD,a Keyvan Nouri MD,a and James M. Grichnik MD PhDa,b
Cherry hemangiomas are common vascular proliferative lesions that can be concerning from a cosmetic perspective. Laser therapy is often used to eradicate cherry hemangiomas, but some lesions require multiple treatments or do not resolve at all. The suboptimal response to laser treatment may be due to limitations in penetration depth by vascular lasers such as the pulsed dye laser. Optical coherence tomography is a low-energy, light-based imaging device that can evaluate the depth and extent of vascular lesions such as cherry hemangiomas by allowing visualization of tissue structure and blood vessel architecture, which cannot be appreciated by clinical or dermatoscopic examination alone. We present optical coherence tomography images of a cherry hemangioma to demonstrate the precision and resolution of this imaging modality. Optical coherence tomography provides valuable information that has the potential to predict response to laser therapy without unnecessary attempts. Future prospective studies will determine its value for this purpose.
J Drugs Dermatol. 2016;15(6):713-714.
James Q. Del Rosso DO FAOCD, Suzanne Bruce MD, Michael Jarratt MD, Alan Menter MD, Gerald Staedtler
Rosacea is a leading reason why people seek the care of a dermatologist, accounting for nearly 7 million office visits annually. Pharmacologic
treatments include both topical and oral medications, which are increasingly being used in combination, especially at the
outset of therapy. This exploratory study assesses the safety, effectiveness and speed of onset of two common topical agents for
the treatment of rosacea—azelaic acid gel (AzA) 15% and metronidazole gel 1%—used in conjunction with anti-inflammatory dose
doxycycline (40 mg once daily).
Men and women (n=207) with mild-to-moderate papulopustular rosacea were enrolled and randomized to receive either AzA gel 15%
twice daily plus doxycycline 40 mg once daily (AzA group) or metronidazole gel 1% once daily plus doxycycline 40 mg once daily
(Metro group) for 12 weeks. Both regimens were safe, efficacious and well tolerated. Efficacy parameters revealed a possible trend
toward greater and earlier benefit with the AzA-based regimen than with the metronidazole-based regimen. These findings warrant
further investigation in a sufficiently powered study.
Richard Fried MD PhD and Marge Nighland BS
Patient satisfaction and quality of life are important considerations when assessing products used to treat acne vulgaris, as these
factors may affect treatment adherence and subsequent treatment outcomes. The objective of this analysis was to determine patient
satisfaction and improvement in quality of life after treatment with tretinoin gel microsphere (TGM) in a pump dispenser. Assessments
were made during a phase IV, prospective, 12-week, open-label, community-based trial in which 544 patients who were dissatisfied
with their current acne treatments received TGM 0.04% or 0.1% in addition to ≤ 2 concurrent non-retinoid acne therapies.
At week 12, significant improvement was reported in both patient acne therapy satisfaction and in the overall mean Acne Quality
of Life Index scale15 (P<0.0001 versus baseline for both measures). The majority of patients (82.3%) rated the pump dispenser as
an “excellent” or “very good” means of dispensing medication, and 86.0% rated their overall satisfaction with the pump treatment
application as “very satisfied” or “extremely satisfied.” The results of this study indicate that the use of TGM in a pump dispenser in
patients with acne vulgaris is associated with significant increases in both quality of life and patient satisfaction.
Stephanie Kao BA,a Alexi Kiss MD,b Tatiana Efimova PhD,b,c Adam J. Friedman MDc,d
Seborrheic keratosis (SK) is the most common skin tumor seen by dermatologists in everyday practice. Although the lesions are mostly benign, many patients still elect to have asymptomatic SK removed. The historical standards of treatment are cryosurgery and electrocautery, two surgical options that are effective at lesion removal but have high rates of postoperative adverse events such as treatment-site scarring and pigmentary alterations. The cosmetic outcomes of SK treatment modalities are of keen interest to dermatologists, as the American population becomes increasingly more diverse. In this article, the inclusion of darker Fitzpatrick skin types into clinical studies investigating post-treatment side effects of SK therapy is reviewed. The recent approval of a 40% hydrogen peroxide topical formulation is discussed in light of these issues, and several non-invasive topical treatments that optimize cosmetic outcomes of SK lesion removal are highlighted. Finally, treatment strategies aimed at reducing cost and minimizing the burden of adverse sequelae are provided.
J Drugs Dermatol. 2018;17(9):933-940.
Syringomas are common benign eccrine ductal adnexial tumors, commonly found in periorbital area. Periorbital syringomas are
aesthetically disturbing difficult to treat. Many treatment modalities are described in the literature, including topical and surgical
methods, with potential problems such as postinflammatory hyper- and hypopigmentation, low efficacy, or scar formation. We
present 5 patients with syringoma treated with the combination of radiofrequency ablation and carbon dioxide (CO2) lasers. Using
low-energy parameters on the CO2 laser, and low energy on the radiofrequency, we could complement both treatments maximizing
the destruction of the tumors and minimizing the adverse effects in only two sessions. This is a relatively easy, safe, and less
painful treatment, with good cosmetic results on periorbital syringomas.
J Drugs Dermatol. 2012;11(7):879-880.
Steven Bowman MD, Michael Gold MD, Adnan Nasir MD PhD, George Vamvakias
In the treatment of mild to moderate acne vulgaris, the combination of an antibiotic and benzoyl peroxide provides
enhanced efficacy over the individual agents, with the potential to decrease the emergence of resistant strains of
P. acnes. To evaluate treatment regimens combining the daily use of a clindamycin/benzoyl peroxide gel, a tretinoin
gel, and a clindamycin gel, the current randomized, evaluator-blind study was conducted. Results demonstrate that
once-daily administration of clindamycin/benzoyl peroxide gel (combination formulation) was as effective as clindamycin/
benzoyl peroxide gel + tretinoin gel + clindamycin gel. Both of these regimens provided greater efficacy than
tretinoin + clindamycin. Treatment with clindamycin/benzoyl peroxide demonstrated a significant benefit over other
treatments at Week 2, highlighting its rapid onset of action. All regimens were safe and generally well tolerated, with
less severe peeling seen in patients who received clindamycin/benzoyl peroxide. In conclusion, the regimens that
included clindamycin/benzoyl peroxide were more effective than tretinoin + clindamycin in the treatment of acne
vulgaris, with no clinical advantage of adding tretinoin + clindamycin to once-daily clindamycin/benzoyl
Logan W. Thomas BSc,a Erica B. Wang MD,b,c Jennifer Urban MD,c Jared Jagdeo MD MSb,c,d
Laser hair reduction is a well-established modality for a wide range of medical indications. Laser hair reduction can be beneficial for hemodialysis patients who undergo repeated adhesive tape application and removal at their hemodialysis site during hemodialysis sessions. There is a paucity of published literature on efficacious laser hair removal treatments for hemodialysis patients. Herein, we present a case of a 50-year-old male (Fitzpatrick III) with end-stage renal disease on hemodialysis, who achieved successful laser hair reduction at his hemodialysis vascular access site with five sessions of a neodymium:yttrium-aluminium-garnet (Nd:YAG) laser (1064 nm) to improve his quality of life by reducing the hair burden at the adhesive tape site application. We recommend providing this safe and effective hair reduction treatment option for hemodialysis patients given the decreased quality of life associated with end stage renal disease and hemodialysis.
J Drugs Dermatol. 2018;17(7):794-795.
Background and Objectives: The purpose of this study is to quantify the safety and effectiveness of a multiplexed 1,440 and 1,320 nm fractionated laser for the treatment of chronic photodamage.
Study Design: A total of twenty subjects with chronic photodamage were enrolled in this study. Subjects received a maximum of four full-face treatments at an average fluence of 9.5 J/cm2 at 1,320 nm and 2 J/cm2 at 1,450 nm, delivered sequentially using forced-air cooling, at monthly intervals. Digital photographs were taken two months following the final treatment and compared to pre-treatment photographs by two blinded physician observers.
Results: Improvement in photodamage, overall appearance, wrinkles, hyper-pigmentation, enlarged pores, and sagging skin was rated by blinded physician evaluation of digital photographs as being in the 25-50 percent range. Subjective ratings averaged improved for all criteria that were evaluated, including wrinkles, enlarged pores, redness, sagging skin and hyper-pigmentation.
Conclusions: The multiplexed 1,320 nm and 1,440 nm fractionated laser improves cuta/neous photodamage as assessed by objective and subjective criteria.
J Drugs Dermatol. 2011;10(11):1266-1270.
Yamini V. Saripalli MD, Anthony A. Gaspari MD
Tumor necrosis factor (TNF)-α is one of the oldest known cytokines in human physiology. It is involved in both normal and pathologic
states. Virtually every cell and organ in the body are affected by TNF-α.1 Though TNF-α is usually involved in inflammation
as a normal host defense response, when overproduced, it can become pathologic and affect almost every organ system. In
this article, we address the role of TNF-α in diseases such as rheumatoid arthritis, Crohn's disease, psoriasis, and ankylosing
spondylitis as well as the drugs used to modulate TNF-α. Specifically, we look at the structure, mechanism of action, and clinical
use for etanercept, infliximab, and adalimumab. Historically, we also review the drug lenercept, another TNF-α modulator. These
drugs offer alternative effective treatments to rheumatologic and dermatologic diseases without as many of the toxic side effects of
some of the traditional therapies. The traditional agents target TNF-α in addition to several other modes of action (disease modifying
anti-rheumatic drugs [DMARDS] such as cyclosporine and methotrexate) (Table 1).
Though TNF-α immunomodulation seems to be a very effective, promising treatment in several TNF-α mediated disease processes,
long-term studies need to be performed to assess the risk-benefit ratio of using these drugs over an extended period of time.
Eugene H. Gans PhD, Iqbal Sadiq MS, Tracy Stoudemayer, Marianne Stoudemayer BS, Albert M. Kligman MD PhD
Purpose: Prolonged topical corticosteroid use is often associated with atrophic skin changes. This trial compared signs
of skin atrophy related to 3 super-high-potency corticosteroids: fluocinonide 0.1% cream, clobetasol propionate 0.05%
cream, and 0.05% foam.
Patients and Methods: The test treatments were applied to the forearms 10 females twice daily for 21 days. Skin characteristics
were assessed pretreatment and posttreatment for atrophic changes. Further punch biopsies obtained from 5
subjects were assessed histologically.
Results: Clobetasol foam produced mild changes in noninvasive tests, but stained skin biopsies revealed structural changes
nearly comparable to clobetasol cream, which showed substantial atrophic changes. Fluocinonide cream was the least
atrophogenic, producing no or only mild effects that were slightly greater than vehicle.
Conclusions: Fluocinonide cream has a lower potential to produce atrophic changes of the skin than either clobetasol
cream or clobetasol propionate foam.
Actinic keratosis (AK) is common and lesions may progress to squamous cell carcinoma. The choice of therapy depends
mainly on 2 factors: the efficacy of therapeutic options and the number of lesions present. Cryotherapy alone is suitable
for treating a few lesions, whereas topical medications, photodynamic therapy (PDT) with 5-aminolevulinic acid (ALA),
or either in combination with cryotherapy are appropriate for treating multiple (>15) lesions. When combinations are
necessary, the total cost to treat multiple AKs to 100% clearance becomes important. This report provides a simple pharmacoeconomic
analysis of 4 FDA-cleared therapies (imiquimod, diclofenac, 5-fluorouacil [5-FU], and ALA PDT) for AK
given in combination with cryotherapy. This analysis assumes standard costs of procedures and office visits (based on April
2007 reimbursement data) and 2 treatment courses (medications: imiquimod, diclofenac, 5-FU) or sessions (ALA PDT)
of each modality followed by cryotherapy to 100% clearance. The total cost of each combination is $725.17 for ALA PDT,
$845.07 for diclofenac, $942.13 for 5-FU, and $1,473.39 for imiquimod. When phase III trial efficacies of the 4 modalities
are considered, the actual cost of using imiquimod or diclofenac increases because additional treatments may be required.
Among these 4 FDA-cleared therapies for multiple AK lesions, ALA PDT is the least expensive treatment and
imiquimod is the most expensive treatment under the stated assumptions.
Laura McDermott BA,a Raman Madan MD,a Reena Rupani MD,b and Daniel Siegel MDa
INTRODUCTION: Nail psoriasis is challenging to treat. The few currently available therapies are limited in efficacy, and often produce unfavorable
side effects. A plant extract widely used in Traditional Chinese Medicine, indigo naturalis (Qing Dai), is presented in this review as an alternative topical treatment for skin and nail psoriasis. The purpose of this article is to present information on a viable alternative treatment with a favorable side effect profile for a difficult disease to treat.
METHODS: A PubMed search for the term “indigo naturalis” was performed, and literature from 2006 to the present relevant to indigo naturalis and treatment of psoriasis and nail psoriasis was reviewed.
RESULTS: Indigo naturalis shares several therapeutic mechanisms with current psoriasis treatments, such as regulation of keratinocyte proliferation and differentiation, restoration of epidermal barrier function, and reduction of inflammatory processes. Clinically, it is well tolerated.
CONCLUSION: Recent research of indigo naturalis suggests that it is a safe, inexpensive, and effective alternative topical treatment for skin and nail psoriasis.
J Drugs Dermatol. 2016;15(3):319-323.
In the United States alone, 50% of women suffer from hair loss at some point in their lives and 50% of men experience hair loss before the age of 50. In addition to aesthetic concerns, alopecia and thinning hair have adverse psychological effects, such as low self-esteem and poor self-confidence.
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).
Emily P. Tierney MD and C. William Hanke MD MPH
Background: The carbon dioxide laser (CO2) has been proven to be an effective device for the treatment of photoaging.
However, it is associated with adverse side effects including prolonged erythema, edema, burning, milia, acne, crusting and
hypo-/hyperpigmentation. Delayed onset hypopigmentation after CO2 laser resurfacing can markedly detract from clinical outcomes.
To overcome the disadvantages of traditional ablative and non-ablative resurfacing, fractional photothermolysis (FP) has
been introduced. FP has been demonstrated in early case reports and case series to produce significant improvement in hypopigmentation
of acne and surgical scars.
Case Report: A 53-year-old Caucasian female with Fitzpatrick type I skin presented with a nine-month history of delayed onset hypopigmentation
following ablative CO2 laser resurfacing. After a series of three treatments at eight-week intervals with an ablative
fractionated CO2 laser device, the hypopigmentation and line of pigmentary demarcation between the face and neck improved by
Conclusion: Ablative fractional resurfacing is a safe and potentially effective modality for the treatment of CO2 laser induced hypopigmentation
on the face.
Whitney Bowe MD and Mary-Margaret Kober MD
Acne vulgaris is a multi-factorial disease affecting a significant
proportion of the population. A patient-centered approach is
most effective for the treatment of acne, focusing both on life
style interventions as well as pharmacologic therapy. Lifestyle
modifications include dietary counseling, as a link between
dietary choices and acne continues to grow. Pharmacologic
regimens must account for the severity of disease, emergence
of resistant bacterial strains and ease of patient compliance.
Combination topical therapy is often required for patients with
mixed inflammatory and comedonal acne, while oral medications
are frequently needed for severe cases or those involving
large surface areas such as the chest or back. With or without
a photosensitizer, light based treatments present an alternative
or adjuvant to traditional pharmacologic therapy. Novel formulations
of existing medications in addition to original compounds
continue in development, expanding therapeutic possibilities
for the future. With the emergence of antibiotic resistance,
we are forced to prescribe antibiotics more responsibly, while
exploring alternatives to this longstanding standard of care.
This article discusses current and emerging therapies for the
treatment of acne.
Joseph F. Fowler Jr. MD
Research into the pathophysiology of rosacea suggests a central role for inflammatory mediators such as nitric oxide
(NO), reactive oxygen species (ROS), and matrix metalloproteinases (MMPs). Effective treatments for rosacea,
including topical metronidazole and systemic antibiotics, have anti-inflammatory activity, which may be more important
than their antimicrobial activity in this setting. Phase III studies have substantiated the efficacy of anti-inflammatory
dose doxycycline (40-mg doxycycline monohydrate controlled-release capsules) administered once daily for the
treatment of inflammatory lesions of rosacea. Results of a 16-week, randomized, double-blind, placebo-controlled study
of anti-inflammatory dose doxycycline plus topical metronidazole gel 1% for mild to moderate rosacea are presented here.
At week 12, metronidazole was discontinued and patients continued on either placebo or doxycycline. Combination
therapy significantly reduced inflammatory lesion counts as early as week 4 and through week 12 compared to topical
metronidazole 1% gel monotherapy. The combined therapy appeared effective and well-tolerated.
The authors report a female patient with recalcitrant ulcerated necrobiosis lipoidica (NL) that was resistant to numerous systemic agents and who responded to treatment with intravenous immunoglobulin (IVIG), leading to resolution of the ulcerated areas for several
months. Subsequent treatment with two further courses of IVIG was less effective, but a course of intravenous methylprednisolone led to regression of the lesions. As well as briefly reviewing the literature on treatments used to treat ulcerated NL, we outline the pathological mechanisms thought to be involved in the condition and how the modes of action of IVIG might explain its apparent efficacy in this case. As far as we are aware, the response of ulcerated NL to IVIG or methylprednisolone has not been reported previously,
although other systemic preparations of corticosteroids have been used.
J Drugs Dermatol. 2012;11(2):256-259.
Danny Vleggaar MD,a Rebecca Fitzgerald MD,b and Z. Paul Lorenc MD FACSc
Patient interest and physician use of soft tissue augmentation have increased significantly in recent years, especially among
younger patients. A recent consumer survey conducted on behalf of the American Society of Plastic Surgeons found that the
majority of respondents would rather have a facial injectable treatment than a surgical treatment. In another recent survey, consumers
gave the highest overall satisfaction ratings to injectable filler treatments (92%), including poly-L-lactic acid (PLLA), and
injectable wrinkle relaxers (92%), with injectable fillers receiving the highest "extremely satisfied" rating (45%). Long-lasting benefit
is a desirable attribute in soft tissue augmentation, making PLLA a favorable alternative for many patients. When considering
the use of PLLA, clinicians should ensure that their patients understand its benefit profile, and that these benefits are consistent
with the patients’ cosmetic goals. The implementation of the latest recommendations on methodological approaches in the use
of PLLA will minimize the occurrence of adverse events, further enhancing patient satisfaction.
J Drugs Dermatol. 2014;13(suppl 4):s40-s43.
Macrene Alexiades-Armenakas MD PhD
Background: Previous studies have shown that although infrared light and radiofrequency delivered by stationary application is safe
and effective for the treatment of rhytides, a mobile delivery of radiofrequency energy can render the treatment as painless. In addition,
few studies have defined and assessed efficacy of these infrared treatments in treating laxity by quantitative grading.
Objective: This prospective study assesses the safety, efficacy, and pain profile of the application of infrared light with a mobile
delivery method for the treatment of facial and neck skin laxity as assessed by a tested, quantitative grading scale.
Methods: In this study, 22 female subjects (aged 40-75 years; Caucasian and Asian ancestry) with a clinically observable excess of
laxity (minimum grade 2 out of 4) on the face received 1 to 3 treatments with incoherent infrared (1100-1800 nm) light at 2-week to
4-week intervals. Each light pulse was administered in a mobile continuous fashion within a localized area measuring approximately
1 handpiece tip-width laterally and vertically. A series of 4 to 5 pulses were administered across small grid areas, followed by 6 to 8
passes to each grid area, totaling approximately 300 to 450 pulses per treatment. Each mobile pulse was delivered at fluences of 45
to 46 J/cm2 to the face, 45 J/cm2 to the mandible, and 44 J/cm2 to the neck. Clinical results were evaluated employing a comprehensive
4-point grading scale from photographs at baseline, and the 1-month and 3-month follow-up visits after the final treatment. Pain
ratings were evaluated by visual analog scale (VAS) gradings and patient questionnaire immediately following treatment.
Results: All subjects completed and responded to treatment. The mean treatment number was 2.1 (+/- 0.9) and the mean follow-up
interval was 1.9 (+/- 1) months. The quantitative evaluations demonstrated: a mean baseline laxity grade of 2.9 +/- 0.5 and mean posttreatment
laxity grade of 2.5 +/- 0.6; and a mean difference in prelaxity grades versus postlaxity grades of 0.4 +/- 0.3 (95% CI; 0.2540-
0.5415). The data demonstrated a statistically significant difference between before and after measurements (P<.0001) and a mean
percent improvement in laxity grading scores of 14.1 +/- 11.3%. The treatment discomfort was rated as a mean of 0.7 (+/- 0.6) on a
VAS grading scale (0 to 10). By patient questionnaire, sensation during the treatment was rated as painless by 100% of patients and
rare (<5) transient moments of heat-related pain sensation were reported by 18% of patients. None of patients reported the procedure
as painful or as sensing frequent (>5) or persistent heat-related pain sensation during the treatment. Other side effects included
minimal erythema which resolved within 1 to 3 hours. No crusting, dyspigmentation, or scarring was observed.
Conclusion: This prospective clinical study with quantitative grading of laxity and VAS pain scores demonstrated that mobile delivery
of infrared light appears to be safe, clinically effective, and painless in reducing facial and neck laxity. The mobile infrared light delivery
allowed for delivery of approximately 30% higher fluence dosages and increased passes to each pulse area. The clinically observable
and quantified decreases in skin laxity following treatment were statistically significant.
Steven R. Feldman MD PhD,a Warren Winkelman MD PhD,b Eric Baum MD,c Norman Preston PhDb
One of the hurdles to effectively managing plaque psoriasis is lack of adherence to prescribed treatments. Up to 40% of subjects report
they do not adhere to their medication for a variety of reasons. Earlier response to treatment may be a motivator for subjects to better
adhere to treatment. Clobetasol propionate 0.05% spray (CPS) is a highly potent topical corticosteroid indicated for the treatment of
moderate to severe plaque psoriasis that has efficacy as early as 1 week after initiating therapy. Using data from the 2 CPS pivotal
trials, a post hoc analysis was performed to determine the relationship between week 1 improvements and week 4 treatment success
(defined as a score of 0 [clear] or 1 [almost clear] in overall disease severity [ODS]). Improvements in week 1 ODS and pruritus were
predictive of week 4 treatment success. Subjects who had ODS or pruritus scores of moderate or better at week 1 tended to be
treatment successes at week 4 whereas no relationship between week 1 scores and week 4 treatment success was observed for
those treated with vehicle spray. The results of this post hoc analysis indicate that early improvement correlates to treatment success.
J Drugs Dermatol. 2013;12(12):1456-1460.
May Elgash BS,a Ncoza Dlova MBChB FCDerm PhD,b Temitayo Ogunleye MD,c Susan C. Taylor MDc
Seborrheic dermatitis is a common, relapsing, inflammatory skin condition of unclear etiology. The Malassezia yeast genus are believed to play a role. Seborrheic dermatitis commonly affects areas of the skin with high sebum production, including the scalp, nasolabial folds, glabella, eyebrows, beard, ears, retroauricular skin, sternum, and other skin folds. Seborrheic dermatitis may present differently in individuals with skin of color. Darker-skinned individuals may present with scaly, hypopigmented macules and patches in typical areas of involvement. Arcuate or petal-like patches may be seen, specifically termed petaloid seborrheic dermatitis. Children of color often do not experience the classic “cradle cap” appearance of seborrheic dermatitis, and have erythema, flaking, and hypopigmentation of the affected areas and folds of skin. Seborrheic dermatitis tends to respond well to conventional treatments, although it tends to recur. Skin of color patients may require a modified treatment approach which takes into account differences in hair texture and hair washing frequency. This paper aims to highlight these differences to help reduce disparities in the management of seborrheic dermatitis in patients of color.
J Drugs Dermatol. 2019;18(1):24-27.
Tania Cestari MD PhD, Lucie Adjadj, Margaret Hux MSc, Maria Regina Shimizu, Vincent Pierre Rives PharmD
Background: A once-daily fixed combination of hydroquinone, tretinoin, and fluocinolone acetonide (Tri-luma) is a
newly available treatment for melasma.
Objective: To assess cost-effectiveness of triple combination therapy (TCT) applied once daily and hydroquinone alone
applied twice daily in the US, Argentina, Brazil, Chile, and Colombia from a payer’s perspective.
Methods: Clinical data and utilazation of key health resources (medication only) were assessed within an 8-week- clinical trial conducted in Brazil. Total cost per primary success (complete clearing) was used to compare each treatment with not treating and incremental cost effectiveness ratios were used to compare between treatments.
Results and Conclusion: TCT has a 30% better rate of complete clearing than hydroquinone with a lower cost in the hydroquinone. Results were robust to varying assumptions of success rates ans quantity used.
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
Over the last few years, there have been a number of important changes in how we appreciate and understand the aging face. Volume
loss is now recognized as a major component of facial aging. Treatment options that replace lost volume are increasingly used for
recontouring and rejuvenation of the aging face. In this review we present and discuss the European Expert Group recommendations
on the ideal use of the unique collagen stimulator, poly-L-lactic acid (PLLA, Sculptra®, Sinclair Pharmaceuticals) for facial rejuvenation
lasting up to 25 months. Optimal results are achieved based on a detailed knowledge of facial anatomy, correct treatment procedure,
specifically the right dilution, the correct injection technique, as well as appropriate patient aftercare. PLLA is an effective and safe collagen
stimulator that treats the whole face. PLLA is simple to use, provides the foundation for facial rejuvenation, is easy to combine
with other treatments, and gives long-lasting effects with a high level of patient satisfaction.
J Drugs Dermatol. 2014;13(9):1057-1066.
Rodrigo Moraes Ferraz MD,a Ulrika Sandkvist MSc,b and Björn Lundgren PhDb
Introduction: Soft tissue fillers manufactured with hyaluronic acid (HA) dominate the filler market around the world and the fact that HA can be dissolved using hyaluronidase contributes to its popularity. Degradation of cross-linked HA products can be performed in situ and access to hyaluronidase is therefore essential for health care professionals (HCP) to perform safe filler treatments. The aim of the present study was to develop an in vivo model where hyaluronidase degradation of HA fillers can be studied in a standardized manner and then secondly, to explore the degradation of marketed HA fillers with different product characteristics.
Methods: Intradermal injections of HA fillers were performed and the injection sites were treated with hyaluronidase. The degradation was evaluated by measuring the heights of the injection site bumps during 5-7 days and with histology at day 7 post injection.
Results: The results showed that there was a correlation between the hyaluronidase dose and HA filler degradation. The onset of the degradation was fast for all products and the products were easily degraded.
Discussion: This standardized animal model proved efficient in the study of in vivo degradation of HA fillers using injected hyaluronidase where products manufactured with different technologies were evaluated.
J Drugs Dermatol. 2018;17(5):548-553.
Sudeep J. Karve MS, Steven R. Feldman MD PhD, Brad A. Yentzer MD, Daniel J.Pearce MD, Rajesh Balkrishnan PhD
Basal cell carcinoma (BCC) is regarded as the most prevalent malignant skin tumor in whites. A variety of surgical and nonsurgical
interventions are available to treat BCC. In recent years, an immune response modifier drug, imiquimod, has been approved in treating
superficial BCC (sBCC). The objective of the authors was to review the published literature to evaluate outcomes such as efficacy,
safety, and quality of life associated with imiquimod treatment among patients with sBCC. A MEDLINE search of the literature was
performed to identify studies published between January 1, 1995 and March 31, 2008 that evaluated imiquimod efficacy, safety, and
quality of life in treating BCC. Overall, imiquimod 5% cream was associated with increased clinical and histologic clearance among
patients with sBCC as compared to placebo. The findings from short-term cost effectiveness studies suggest that use of imiquimod
5% cream can be more cost-effective than surgical interventions such as excision surgery among patients with superficial BCC.
Future studies evaluating long term cost effectiveness of imiquimod treatment are warranted.
Scott A. Elman AB,a Joseph F. Merola MD MMSc,a,b April W. Armstrong MD MPH,c Kristina Callis Duffin MD,d John Latella,e Amit Garg MD,f Alice B. Gottlieb MD PhDg
The International Dermatology Outcome Measures (IDEOM) group, comprising patients, physicians, health economists, industry partners, payers, and regulatory agencies, was established to develop unified and validated patient-centered outcome measures in dermatology in response to increasing demand to quantify effectiveness of treatments and performance outcomes among providers. IDEOM has chosen to start with psoriasis outcome measures, and then apply its methodology to other dermatologic diseases. In this paper, we review the background and progress to date of IDEOM, including an update of IDEOM activities as of our 2016 meeting in Washington DC, USA. Briefly, the progress-to-date of a Delphi process to create outcome measures for psoriasis was reviewed, including preliminary data from the first round of Delphi voting. Updates were also heard from industry partners including the National Psoriasis Foundation (NPF) and the US Food and Drug Administration (FDA). Furthermore, plans to establish outcome measures for hidradenitis suppurativa (HS) were discussed.
J Drugs Dermatol. 2017;16(2):119-124.
R Balkrishnan PhD, A P Kelly MD, A McMichael MD, H Torok MD
Melasma is a common hyperpigmentation of the face or neck that can have severe adverse psychological and emotional effects on
affected individuals. Although a variety of treatments have been used over the years, results have typically been less than satisfactory.
An open-label, community-based trial was undertaken at 393 centers in the United States, enrolling 1290 patients representing a
broad range of races/ethnicities and all Fitzpatrick skin types, to evaluate the efficacy and safety of a new melasma treatment that
combines fluocinolone acetonide 0.01%, hydroquinone 4.0%, and tretinoin 0.05% (FA+HQ+RA) in a hydrophilic cream formulation.
An additional objective of the study was to assess the impact of this therapy on the quality of life. Efficacy and safety were evaluated
at 4 and 8 weeks, and changes in a variety of quality of life parameters were analyzed at the conclusion of the study. All measures
of efficacy showed that FA+HQ+RA significantly (p<0.0001) improved melasma at 4 weeks with further improvement at 8 weeks across
all races/ethnicities and Fitzpatrick skin types. The treatment was safe and well tolerated. After 8 weeks of therapy, patients reported
that FA+HQ+RA had provided a variety of benefits that had enhanced their quality of life.
Suneel Chilukuri MD FAAD FACMS,a Christopher W. Robb MD PhD FAAD,b Steven F. Weiner MD,c Jody Grossman MT CCRAd
Primary axillary hyperhidrosis (PAH), or excessive sweating limited to the axillary area, is a debilitating disease that severely and negatively impacts social and psychological well-being. Several treatment options are available for PAH; however, these options have been shown to provide varying effectiveness. Recent studies have suggested another treatment alternative offering an effective PAH treatment option with reported long-term results. High intensity focused fractional radiofrequency (HIFRF) microneedling is FDA cleared for the treatment of facial wrinkles. The system is designed with a unique technology that is safe for use on patients presenting with all skin types. Based on its unique design and the clinical trial experience reported in the literature by Kim, et al1 and others,2,5 we offer it to our patients as a beneficial treatment option for primary axillary hyperhidrosis (PAH). We present here a clinical experience summary from three US centers providing hyperhidrosis treatments using the high-intensity radio-frequency device, including treatment parameters, clinical outcomes, and pre- and post-treatment images.
J Drugs Dermatol. 2018;17(7):745-748.
Fractional carbon dioxide (CO2) laser treatments have become a standard for treating a myriad of skin concerns. One of the biggest
challenges facing us in this regard is treating the vast number of patients with skin of color who we encounter regularly in our practices.
A novel superficial and deep CO2 ablative fractional device with both components coming from a single handpiece has been
developed and is now being evaluated for patients with skin of color. In the 5 patients studied, side effects were not apparent and
no postinflammatory hyperpigmentation was identified. This initial report suggests further evaluation is important to enhance our
ablative fractional therapies.
J Drugs Dermatol. 2012;11(11):1331-1335.
Andrew Blauvelt MD MBA,a April W. Armstrong MD MPH,b Gerald G. Krueger MDc
Psoriasis is a systemic inflammatory disease. Effective management requires treatment with agents targeting inflammation in skin, joints, and other tissues. Biologics for psoriasis are directed at more specific targets, have a better safety profile, are better tolerated, and are more effective than conventional systemic agents. Despite these advances, many patients with psoriasis remain undertreated, and overall patient satisfaction remains low. The dichotomy between ideal therapeutic outcomes and suboptimal outcomes (which are currently commonplace) is likely largely due to misperceptions about psoriasis and biologic treatments. This article discusses these misperceptions, including the notions that psoriasis is a benign disorder, and that conventional systemic therapies are safer than biologics
and adequate for most patients with moderate-to-severe disease. We present practical and evidence-based discussions to refute these misconceptions and provide useful resources for providers and patients that support access to advanced therapies. We believe that biologics represent optimal treatment for most patients with moderate-to-severe psoriasis, and until more effective approaches are generated, these efficacious and target-specific approaches should become the standard of care.
J Drugs Dermatol. 2015;14(8):805-812.
Melasma is a complex multifactorial disorder whose pathogenesis is not well understood. In addition to increased pigmentation, increased
vascularity associated with pigmentation is present. A variety of topical treatments targeting pigmentation are available with
temporary improvement of mainly the epidermal components of melasma. Intense pulsed light (IPL) is a broadband light source that
can target a wide range of cutaneous structures, including deeper pigmentation and vasculature. We describe 5 cases of persistent
facial melasma treated with the IPL and a hydroquinone-based skin care system (Obagi Nu-Derm; Obagi Medical Products, Long Beach,
CA), showing improvement of facial melasma pigmentation and vascularity.
J Drugs Dermatol. 2012;11(11):1316-1230.
Pemphigus vulgaris, foliaceous, and vegetans are potentially fatal, autoimmune, vesiculobullous mucocutaneous diseases. In order to prevent potentially fatal infection and other complications, most patients with pemphigus require treatment with systemic corticosteroids and immunosuppressive agents, although these medications often cause chronic and serious adverse effects. Many case reports and several trials have documented remissions and clinical improvement in cases of pemphigus recalcitrant to standard therapy, who were treated with either intravenous immunoglobulin (IVIG) or rituximab, alone or in combination with each other. Collectively, the body of evidence from these reports is large enough to spark consideration of these treatments early in the management of pemphigus. Among the potential benefits of a therapeutic strategy that includes these biologic agents are more rapid induction of remission, prevention of corticosteroid-related adverse effects, and decreased cost of therapy. Considering the outcomes from recent trials with these novel therapies, reevaluation of the best-practice treatment of pemphigus seems prudent and timely.
J Drugs Dermatol. 2012;11(10):1200-1206.
Jacob Dudelzak MD, Mussarrat Hussain MD,David J. Goldberg, MD JD
Background: Facial telangiectasias have been successfully treated with a variety of laser wavelengths. Shorter wavelengths (532
nm) are generally effective in the treatment of smaller vessels; longer wavelengths (1064 nm), although potentially more effective in
the treatment of larger vessels, may be associated with a higher complication rate. The 980-nm wavelength has the potential benefits
of a longer wavelength with the safety of shorter wavelengths.
Objective: The efficacy and safety of a new 980-nm diode laser in the treatment of facial telangiectasias was evaluated.
Materials and Methods: Twelve subjects, aged 44 to 67 years with Fitzpatrick skin types 1 to 3 and bilateral facial telangiectasias,
underwent 1 to 3 monthly treatments with a 980-nm diode laser using fluences ranging from 22.2 to 146.9 J/cm2, pulse durations of
50-160 ms, spot sizes of 0.7 to 1 mm, and pulse frequencies of 3 to 10 Hz. Clinical evaluation included digital photography, as well
as subject and investigator assessment of reduction in the size and appearance of telangiectasias on a 1 to 5 point scale. Adverse
effects were also assessed.
Results: Significant improvement in the appearance of telangiectasias was seen after treatment. No complications were observed.
Conclusion: A new 980-nm diode laser effectively treats facial telangiectasias without any observed complications.
Stacy R. Smith MD, Vera B. Morhenn MD, Daniel J. Piacquadio MD
Actinic keratoses (AKs) are a common precancerous condition and are said to account for 14% of visits to dermatologists in
the US each year. Along with cryotherapy, topical treatments are a mainstay of therapy for these lesions. One of the potential
benefits of topical therapy is less pain and irritation as compared to cryotherapy. Additionally, topical therapies have a
perceived benefit of treating subclinical lesions along with clinically evident keratoses. We conducted a bilateral comparison
study of the efficacy and tolerability of diclofenac 3% gel used for 90 days and 5% fluorouracil cream used for 28 days in thirty
patients with AK of the face and scalp. The diclofenac gel and 5-fluorouracil cream each demonstrated substantial efficacy
in the number of lesions cleared and the proportion of patients with significant lesion clearing. In most patients, diclofenac
induced only mild signs of inflammation compared to 5-fluoruracil, despite a longer treatment period. A greater number of
patients expressed significant satisfaction with diclofenac gel compared to the 5-fluorouracil cream.
Janelle M. Vega MDa, Vivian W. Bucay MDb, and Flor A. Mayoral MDa
Radiofrequency has been shown in a number of studies to be effective in tightening the skin of the face and neck. This multicenter study was undertaken to determine the efficacy of a monopolar radiofrequency system (Pelleve S5 Wrinkle Treatment Generator; Ellman International Inc, Oceanside, NY) in tightening the skin of the hands and is the first such study assessing the improvement of skin laxity of the hands. A total of 31 female patients with a median age of 56 years were enrolled in 2 centers. Each had a single hand treated, with randomization of the hand to be treated. A total of 3 treatments were performed at 2-week intervals. Follow-up photos were taken at 45 and 90 days after the final treatment. At 90 days, 89% of patients had visible improvement of the appearance of the treated hand based on the visual Global Aesthetic Improvement Scale. Of these, 50% had visible improvement from baseline, and 39% had marked improvement from baseline. Patients reported only mild to moderate discomfort during the treatment. No adverse events or side effects were reported. Monopolar radiofrequency was found to be safe and effective for treating hand wrinkles.
J Drugs Dermatol. 2013;12(1):24-26.
Patrick M. O’Shea BS and Aída Lugo-Somolinos MD
BACKGROUND: Recent studies have produced treatment algorithms for hand dermatitis, but there are limited current indications of systemic
treatments for chronic hand dermatitis.
OBJECTIVE: To compare the efficacy and safety of methotrexate and acitretin in the treatment of chronic hand dermatitis.
METHODS: A chart-retrospective review of all patients with hand dermatitis seen by the primary author at the University of North Carolina Dermatology and Skin Cancer Center from September 2007 to April 2013.
RESULTS: Eighty-three hand dermatitis charts were reviewed. Twenty-
nine patients received systemic therapy, of which 17 (26.5%) were treated systemically with acitretin and/or methotrexate. Of these 17 patients, four patients received courses of both acitretin and methotrexate independently after failing the alternative treatment
course. At 6 months, acitretin achieved clearance/almost clearance in 44% of patients, compared to 0% of those treated with methotrexate. At 12 months, 100% of patients treated with acitretin achieved clearance/almost clearance compared to 40% of patients treated with methotrexate. Adverse effects were minimal and as expected.
LIMITATIONS: This was a retrospective study, and the small sample size makes it difficult to generalize results.
CONCLUSION: Systemic retinoids are a good alternative for the treatment
of chronic hand dermatitis.
Ralph Fiore II DO, Sarah M. Coffman DO MSc, and Richard Miller DO
The emphasis on the preservation of youth is ever apparent as new antiaging products, cosmetic procedures, and advertising campaigns aim to address new ways to prevent the natural aging process. Many individuals prefer noninvasive surgical procedures involving minimal downtime and a speedy recovery. Although these cosmetic procedures are considered minor, complications do arise and infections can occur. While many species of bacteria can cause these infections, one such species that is usually over looked and can cause these infections are the atypical mycobacteria. Early diagnosis is important, as these infections can rapidly progress into more serious skin manifestations. We present a 31-year-old female with a 3-month history of a nonhealing ulcer on her cheek that started approximately 2 weeks following a cosmetic procedure with an injectable filler. This patient represents an uncommon complication that may occur in patients subjected to multiple facial injections, as their susceptibility to infection and secondary biofilm formation increases with their current and future injections. This case review highlights the growing number of cosmetic procedures in our society, the most common complications of these treatments, an emerging complication concerning the formation of biofilms, as well as a review of the literature on atypical mycobacteria infections.
J Drugs Dermatol. 2013;12(3):353-357.
Elizabeth G. Wilder MD,a Mahir Patel MD,a Katherine Hebeler BA,b and Alan Menter MDa
Ustekinumab is a human IgG1κ monoclonal antibody that binds with high affinity and specificity to the p40 protein subunit shared by both
the interleukin-12 and interleukin-23 cytokines. This study reviews clinical response and adverse events in 119 psoriasis patients who have
received ustekinumab for a minimum of 1 year. The medical records of 119 psoriasis patients treated with ustekinumab at our referral clinic
in Dallas between 2009 and 2013 were reviewed for response rates, side effects, and concomitant therapies. Of 119 patients, 117 (98%)
had plaque type psoriasis, with 40 (34%) patients having psoriasis affecting either their palms and/or soles. Forty-four (37%) patients had
psoriatic arthritis. The median follow-up period was 31 months. Fifty-six (47%) of the 119 patients obtained near complete clearance (response
of more than 90% of initial body surface area involvement) upon the final follow-up visit or at the time of ustekinumab treatment
discontinuation. Concomitant systemic treatments, primarily methotrexate, were given to 59 (50%) patients. Twenty-three (19%) patients
discontinued treatment, primarily for sub-optimal response or loss of response. Fifty (42%) patients required either an increase in the
dose of ustekinumab to 90 mg and/or administration more frequently than every 12 weeks to achieve and maintain psoriasis clearance.
J Drugs Dermatol. 2014;13(8):905-910.
Eric F. Bernstein MD MSE, Jay Bhawalkar PhD, Joan Clifford MPH, James Hsia PhD
Background: Multi-colored and even black tattoos often require more than one wavelength to remove the target pigment. The authors
report here a novel alexandrite laser with two Nd:YAG laser handpieces pumped by the alexandrite treatment beam enabling
the delivery of three wavelengths from a single device.
Objective: To describe and evaluate the effectiveness of a novel Q-switched laser-pumped laser for treating tattoos.
Materials and Methods: Twenty tattoos in 14 subjects were treated at four-week intervals using a combination of available wavelengths
(532, 755 and 1064 nm) as determined by the treating physician. Digital cross-polarized photographs were taken before treatment
and two months following the fourth and final treatment. Photographs were evaluated by three physician observers blinded
as to the treatment condition and rated for clearance by the following scale: 1=>95 percent, 2=76–95 percent, 3=51–75 percent,
4=26–50 percent and 5=0–25 percent clearance.
Results: The average clearance score was 3.1, in the 51–75 percent range, two months following four treatments. No scarring,
hyper- or hypopigmentation was noted on post-treatment photographs or by the treating physician.
Conclusion: The alexandrite and alexandrite-pumped 532 nm and 1064 nm Q-switched lasers are effective for removing decorative
tattoos, and represents the first commercial laser with laser-pumped, laser handpieces.
Janna M. Vassantachart MD,a Teo Soleymani MD,b and Jashin J. Wu MD FAADc
Psoriasis is a common, chronic immune-mediated inflammatory skin disorder that significantly impacts quality of life and has potential systemic complications. The majority of psoriatic patients have mild to moderate disease and are adequately controlled with topical medications. However, approximately 20% of patients have moderate-to-severe disease. Phototherapy has remained a mainstay option for patients with moderate-to-severe psoriasis resistant to topical treatments due to its efficacy, cost-effectiveness, and relative lack of side effects, in particular a lack of systemic immunosuppression seen with traditional and biologic systemic therapies. There are several well-established guidelines for phototherapy treatment of psoriasis proposed in the United States by the American Academy of Dermatology (AAD), in Europe by the European S3, and in the United Kingdom by the National Institute for Health and Care Excellence (NICE). The guidelines set by these groups are largely based on current evidence or expert panel consensus where evidence is lacking. This article reviews and compares the current recommendations of these guidelines for psoriasis phototherapy in regards to the initial clinical encounter, dosage, adverse reactions, and special considerations.
J Drugs Dermatol. 2016;15(8):995-1000.
Lauren K. Hoffman BSa and Leon Kircik MDb
BACKGROUND: Atopic dermatitis (AD) is a chronic, relapsing, inflammatory skin disorder. One of the most disturbing symptoms of AD is pruritus. The first line treatment for AD is topical corticosteroids, topical immunomodulators, topical barrier creams, oral antihistamines, and systemic treatments. Desoximetasone 0.25% spray is a superpotent topical corticosteroid delivered in a novel way and it may be a suitable option for the treatment of pruritus in adult atopic dermatitis patients.
STUDY DESIGN: A single-center, open labeled pilot study was conducted to investigate the efficacy and safety of desoximetasone 0.25% spray for pruritus in adult atopic dermatitis patients.
RESULTS: Twice daily application of desoximetasone 0.25% spray to affected areas resulted in a significant reduction in all outcomes (IGA, pruritus, VAS assessment of pruritus) within 1 week of initiation of treatment. The reductions exhibited were sustained throughout the study period of 4 weeks. Significant improvements in quality of life, as measured by the DLQI, were observed. No adverse events were reported.
CONCLUSION: Desoximetasone 0.25% spray is effective for treating pruritic symptoms of AD. Given its efficacy and convenience as a spray, desoximetasone 0.25% spray should continue to be evaluated as a treatment for AD in larger trials.
J Drugs Dermatol. 2017;16(9):919-922.
Background: Topical treatment of acne vulgaris on the back is challenging largely due to the extensive broad surface with difficult
to reach areas. A “leave-on” foam is suited for application to the trunk due to ease of application and spreadability. Prior to this trial,
no data on Propionibacterium acnes (P. acnes) reduction on the back has existed for any benzoyl peroxide (BP) formulations or other
Objectives: To evaluate the effectiveness of BP (5.3%) emollient foam and BP (8%) wash in reducing P. acnes levels on the back.
Methods: Five-week open-label single-center study of 20 healthy subjects (>18 years old), colonized with P. acnes on their backs
(>10,000 colonies per cm2). Subjects were treated once daily with BP (5.3%) foam for two weeks; no treatment in week 3, and BP
(8%) wash once daily for two further weeks. Quantitative bacteriologic cultures obtained at baseline and weeks 1, 2, 3, 5 and 6.
Results: Nineteen evaluable patients. Total P. acnes counts were reduced by 1.9 log (one week) and 2.1 log (two weeks) with BP
(5.3%) emollient foam. BP (8%) wash did not reduce P. acnes counts after two weeks.
Discussion: BP (5.3%) emollient foam was superior to BP (8%) wash in reducing P. acnes on the back. The lack of effect of BP (8%)
wash is surprising in view of the demonstrated results on the face and warrants further study.
Hilary C. Reich MD,a Irmina Wallander BA,b Lacie Schulte BA,b Hilary Frickman BA,b
and Suzanne Flickenger BA,b Brian Zelickson MDb
The home beauty device market is rapidly growing, having more than tripled in the last four years. This study evaluates several
specific attachment heads using a novel home skincare platform (HSP). By incorporating multiple treatment heads for cleansing,
skin smoothing, and skin infusion, this device has the potential to address many potential treatment goals. The first subset of this
study is a blinded, randomized split-face study evaluating the efficacy of the HSP device with a standard brush head for make-up
removal and compares the HSP device to a currently marketed home cleansing device. The results show that the HSP cleansing
head was comparable to the leading home skin cleansing device on the market. The HSP’s skin smoothing head showed statistically
significant improvement in erythema and dryness over baseline levels with significant histologic changes including normalization
of epidermal thickness in only 10 days of use. This is comparable to and exceeds many well-studied antiaging treatments
after weeks and months of therapy. Finally, the infusion head demonstrated improvement in skin hydration over baseline levels.
J Drugs Dermatol. 2015;14(4):391-399.
Lawrence F. Eichenfield MD,1 James Q. Del Rosso DO FAOCD,2 Anthony J. Mancini MD,3
Fran Cook-Bolden MD,4 Linda Stein Gold MD,5 Seemal Desai MD FAAD,6 Jonathan Weiss MD,7
David Pariser MD,8 Joshua Zeichner MD,9 Neal Bhatia MD,10 Leon Kircik MD11
As the pathophysiology of acne is complex and multifactorial, the continued influx of new basic science and clinical information requires careful analysis before drawing conclusions about what truly contributes to the development and progression of this chronic disease. Our objective is to review the latest evidence and highlight a number of important perspectives on the pathophysiology of acne. An improved understanding of acne pathogenesis should lead to more rational therapy and a better understanding of the role of P acnes opens new perspectives for the development of new treatments and management. Further research may be directed at targeting receptors, adhesion molecules, cytokines, chemokines or other pro-inflammatory targets implicated in the activation of immune detection and response (i.e., toll-like receptors [TLRs], protease-activated receptors [PARs]) that appear to contribute to the pathophysiology of acne. Therapeutic options that reduce the need for topical and/or oral antibiotic therapy for acne are welcome as bacterial resistance to antibiotics is a clinically relevant concern both in the United States and globally.
J Drugs Dermatol. 2015;14(3):263-268.
Shivani S. Patel BS,a Karen E. Huang MS,a Alan B. Fleischer Jr. MD,a and Steven R. Feldman MD PhDa,b,c
BACKGROUND: There is a reported global decrease in the number of clinical trials conducted in recent years. We aimed to determine if
this declining trend can be extrapolated to dermatologic clinical trials.
METHODS: We conducted a query of ClinicalTrials.gov for dermatologic clinical trials from 2009 to 2013 for 6 common skin conditions:
acne, psoriasis, rosacea, eczema and atopic dermatitis, actinic keratosis, and skin cancer. Results were sorted by condition and number
of study subjects. This study did not involve any participants apart from the researchers.
RESULTS: Although there is an increasing trend in the number of trials performed annually, the results were not significant (P=.08).
The average number of patients per study has not significantly changed (P=.12), but there was a significant increase in the number
of large studies (201+ subjects) conducted over time (P=.002). Although there was significant variation based on dermatologic condition
studied (global statistic P=.01), only skin cancer demonstrated a significant change in the number of studies registered annually
(β=10.6 studies/year, P=.04).
CONCLUSIONS AND RELEVANCE: The sky does not appear to be falling, at least not yet, with regard to continued development of treatments
for patients with skin disease.
J Drugs Dermatol. 2015;14(5):497-500.
Karine Zakarian MD, Alain Nguyen MD, Julie Letsinger MD, John Koo MD
Background: Fiber-optically targeted ultraviolet B (UVB) therapy has been shown to clear plaques of psoriasis in a significantly
fewer number of treatments and reduce overall cumulative UVB dose than traditional UVB phototherapy.
Objective: This article reviews existing theories in the literature attempting to explain the superior efficacy of targeted UVB.
Methods: Medline was used to perform a comprehensive review of the literature from 1965 to present. Only information
from the English language journals are reported in this study.
Results: The theories proposed to explain the higher efficacy of the excimer (XeCl) laser relative to traditional UVB
include the ability to use higher intensities of ultraviolet (UV) light and a more efficient induction of T cell apoptosis.
Conclusion: The possible explanations for the superior efficacy of the excimer laser over traditional UVB therapy for psoriasis
include: 1) a higher intensity UV light to plaques, which is more effective in clearing psoriasis; 2) penetration into
the dermis where it may induce T cell apoptosis, potentially to a greater extent than the wavelength or given energy level
predicts; and 3) the difference in the delivery of UVB light may result in cell death and skin immune system suppression
more effectively than traditional UVB.
Michael E. Farhangian BA,a Amy J. McMichael MD,a Karen E. Huang MS,a and Steven R. Feldman MD PhDa,b,c
BACKGROUND: Alopecia Areata (AA) is a non-scarring alopecia that affects millions of Americans, however the way it is treated and which patients seek treatment is not well characterized.
OBJECTIVE: To better understand how AA was being treated in the United States, what type of patients are seen for AA, and what physicians treated them.
METHODS: We analyzed data from the National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2001 to 2010. We tabulated patient characteristics, the physicians who treated AA and what treatments were prescribed for AA.
RESULTS: There were an estimated 2.6 million outpatient visits for AA. Patients with AA were most commonly treated by a dermatologists
(84.8%). Patients were most commonly treated with topical and injected corticosteroids (61.0%) followed by minoxidil (5.9%) and topical tacrolimus (5.7%). Males made fewer visits per 1,000 capita compared to females (P=0.01).
LIMITATIONS: The NAMCS and NHAMCS do not record severity of disease data.
CONCLUSIONS: Topical and injected corticosteroids are the mainstay of treatment for AA, however the use of steroid sparing agents such as minoxidil is low. Despite no studies demonstrating efficacy, topical tacrolimus was used almost as frequently as minoxidil.
J Drugs Dermatol. 2015;14(9):1012-1014.
Hasan Khosravi MD,a Michael P. Siegel PhD,b Abby S. Van Voorhees MD,c and Joseph F. Merola MD MMSca,d
Inverse or intertriginous psoriasis commonly involves skin fold areas including the axillae, perianal skin, intergluteal cleft, inframammary, genital/inguinal, abdominal, and retroauricular folds. After reviewing the literature for new treatments, a task force was convened to update a consensus on inverse psoriasis therapy. Short-term treatment continues to be low-potency topical steroids. In order to avoid steroid-induced adverse effects, long-term therapy includes topical immunomodulators, calcitriol, and calcipotriene. Second and third-line therapies include antimicrobials, emollients, and tar-based products. Inverse psoriasis resistant to topical therapy has been shown to respond to botulinum toxin injections, excimer laser therapy, and certain systemic agents (such as anti-TNF and anti-IL12/IL23 therapy). Based on promising results from case reports and prior clinical experience, these systemic agents should be strongly considered in inverse psoriasis resistant to topical therapy. However, they need further evidence-based evaluation. The use of randomized trials and objective severity indices may allow for more robust therapeutic data.
J Drugs Dermatol. 2017;16(8):760-766.
Caroline B. Costa-Orlandi PhD,a,b,* Breanne Mordorski BA,c,* Ludmila M. Baltazar PhD,b Maria José S. Mendes-Giannini PhD,a Joel M. Friedman MD PhD,d Joshua D. Nosanchuk MD,b Adam J. Friedman MDc,d,e
Topical antimicrobials are the ideal mode of onychomycosis treatment for efficient drug delivery and avoidance of sytemic effects associated with oral medications. However, high treatment costs, tissue penetration limitations, and low cure rates have continued to pose major challenges. To capitalize on the progress made by topical efinaconazole solution, efinaconazole was combined with inexpensive,
previously-characterized nitric oxide releasing nanoparticles (NO-np), which have been shown to offer sustained nitric oxide release over time and enhanced barrier penetration, while exerting broad spectrum antimicrobial and immunomodulating properties. NO-np were combined with efinaconazole in varying concentrations and applied against reference strains of Trichophyton rubrum using
a checkerboard method. Results demonstrated synergism of NO-np+efinaconazole against T. rubrum, which is noteworthy given the barriers present in the topical treatment of onychomycosis, and the multiple potential benefits offered by NO-np. Overall, this study illustrates the untapped potential of nanotechnology in the treatment of disorders of the skin, hair, and nails where drug delivery remains
J Drugs Dermatol. 2018;17(7):717-720.
Deede Y. Liu MD,a* Tarek Shaath BA,b* Anand N. Rajpara MD,a Cody Hanson BS,c
Garth Fraga MD,d Ryan Fischer MD,a and Daniel J. Aires MDa
Cutaneous T-cell lymphoma is a cancer of skin-homing T cells, of which mycosis fungoides (MF) is the most common variant.
MF treatments range from topical steroids to systemic chemotherapy. Resistant cutaneous MF nodules can present a special
challenge in that typical topical therapies may not penetrate thick lesions, and increasing systemic therapy brings added risk of
side effects. We report successful use of intralesional steroids (ILS) for treatment-resistant MF, including tumor-stage plaques
and nodules in 4 consecutive patients with focally resistant MF. ILS have been widely used to treat a broad range of cutaneous
conditions such as alopecia areata and keloids. Side effects of ILS include hypopigmentation, atrophy, telangiectasias, lilac discoloration,
acne, and striae. Rarely, and in circumstances involving unusually large doses, ILS may cause Cushing’s syndrome,
hypothalamus-pituitary-adrenal axis suppression, and reduced bone mineral density. The MF patients tolerated treatment well
without any of the above side effects other than local hypopigmention in a single patient. These results point toward further exploration
into ILS as a treatment for focally resistant MF.
J Drugs Dermatol. 2015;14(5):466-470.
Trenton Custis MDa,b and Daniel B. Eisen MDa
BACKGROUND: Ablative fractional laser (AFL) therapy for scars is an area of increasing interest. While the enthusiasm for these treatments
is high, a systematic review of their use on surgical scars has not been done.
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.
S.H. Babaeinejad MD and R.F. Fouladi MD
Topical treatments, such as adapalene and benzoyl peroxide (BPO), are popular in mild-to-moderate acne vulgaris. This study aimed to compare the efficacy, safety and tolerability of adapalene and BPO in mild acne vulgaris. In this single-center, randomized, double-blind, clinical trial, 60 patients with mild acne vulgaris received either topical adapalene 0.1% gel or topical BPO 2.5% gel on their face once daily for two months. The changes of acne lesion count (efficacy), any adverse effect (safety), and the patients’ overall satisfaction (tolerability) were compared after 3 months of follow-up. In both groups the mean number of noninflammatory, inflammatory and total lesions decreased significantly from baseline (10.77±5.54, 9.73±5.09, and 20.50±7.54, respectively in adapalene group; 11.50±5.92, 8.43±5.45, and 19.93±9.01, respectively in BPO group) to the third month (1.70±1.68, 0.33±0.66, and 0.50±0.78, respectively in adapalene group; 4.23±4.14, 0.33±0.71, and 4.13±4.44, respectively in BPO group; P<0.001 for all), posttreatment. Although the mean number of inflammatory lesions was significantly lower in BPO receivers only at first month (P =0.001), the mean number of noninflammatory and total lesions was significantly lower in adapalene group at second (P = 0.04 and 0.03, respectively) and third (P =0.02 and <0.001, respectively) months, posttreatment. The adverse events were minimal and self-limited (26.7% in adapalene group, 20% in BPO group, p=0.54). The patients’ overall satisfaction was good to excellent in 93.3% of adapalene receivers vs. 73.3% in BPO group (P=0.08). Both topical adapalene 0.1% and BPO 2.5% gels seem safe and effective in mild acne vulgaris, with a marginal tendency toward the former.
J Drugs Dermatol. 2013;12(7):790-794.
Intense pulsed light (IPL) has been a popular nonablative treatment of photodamage. A prospective, randomized, controlled,
single-blinded, split-face pilot study compared the efficacy and safety of 2 multitechnology broadband pulsed light
platform devices: an IPL device (Lumenis One, Lumenis Corporation, Santa Clara, CA) and a fluorescent pulsed light
with advanced fluorescent technology (AFT, Harmony System, Alma Lasers, Buffalo Grove, IL) device. Eight volunteer
subjects (skin types I-IV) with a 2.0 mean Global Score for Photoaging (scale 0-4) participated in the study. Subjects received
3 to 5 treatments 3 weeks apart in which one side of the face was treated with the IPL device and the other side
with the AFT device. During each treatment session, the face received 3 complete passes without anesthesia. Treatment
was aggressive and parameters were determined by test spot application. Treatment endpoints were mild erythema. Results
were evaluated by clinical observations of the investigator and comparison of pre- and post-treatment photographs
by subjects and 2 blinded dermatologists. Blinded evaluators agreed that improvements in dyspigmentation, telangiectasias,
erythema, and skin texture were similar on both sides of the face. Subject assessments of discomfort during treatment
were also comparable. Adverse effects were not observed.
Lindsey Warino MS, Rajesh Balkrishnan PhD, Steven R. Feldman MD PhD
Background: Clobetasol propionate is the most common topical therapy used for psoriasis in the US. Conventional dermatologic
wisdom is that ointment preparations provide the highest potency (due to their occlusive nature and moisturizing
ability) and are best suited for psoriasis. However, patients often find application of ointment to be messy, raising concerns
about both short-term and long-term adherence to treatment. This article reviews the current literature and assesses the relative
potency of clobetasol propionate ointment compared to other clobetasol propionate preparations in the treatment of
psoriasis. Relevant literature was identified by PubMed and Google searches. We included studies of psoriasis that reported
the percentage of subjects that achieved desired efficacy endpoints, as well as studies that reported the subjects’ mean change
in symptoms from baseline. We excluded studies conducted before 1980 and those that allowed concomitant treatments.
Observations: Efficacy rates ranged from 17% to 80% for the different vehicles: ointment, solution, foam, cream, lotion,
shampoo, and emollient.
Conclusions: Clobetasol propionate is a very effective treatment for psoriasis. Ointment preparations have similar efficacy to
other preparations in clinical trial situations. In clinical practice, a situation in which patient preferences are more likely to
affect compliance, it may be best to choose whichever vehicle patients find preferable.
Rungsima Wanitphakdeedecha MD MA MSc,Elizabeth L. Tanzi MD, Tina S. Alster MD
Background: A wide variety of laser and light-based therapies have been utilized for acne vulgaris; however, current techniques have
been limited by photosensitivity issues or inconsistent results.
Objective: To determine the clinical efficacy and side-effect profile of photopneumatic therapy for the treatment of facial acne
Methods: Twenty adults with mild to severe facial acne vulgaris received 4 successive treatments at 2-week intervals with a
combined photopneumatic device (intense pulsed light [IPL]: fluences=3.6-4.2 J/cm2; negative pressure=3 psi). Clinical improvement
was evaluated on a quartile grading scale using comparative digital photographs at baseline, and 1 month and 3 months after the final
treatment. Acne lesion counts were obtained at baseline, prior to each treatment session, and at the end of the study.
Results: Modest reduction in acne lesion counts and global clinical improvement was seen in the majority of patients. Patients with
severe acne experienced the most clinical improvement. Side effects were mild and limited to transient erythema and rare purpura.
Most patients experienced acne worsening early in the treatment course.
Conclusion: Photopneumatic therapy is a safe and effective treatment for acne vulgaris. Patients with more severe acne respond
best to treatment.
Catherine C. Motosko BS,a,b George A. Zakhem BS,a,b Roger S. Ho MD MPH,b Pierre B. Saadeh MD,a Alexes Hazen MDa
INTRODUCTION: Google Search is an important tool for patients researching skin care treatments and finding dermatologists. Data from individual patient’s searches are aggregated by Google and yield powerful data sets that can be used to trend population behaviors. This study investigates the correlations between the volume of Google searches and the number of procedures performed annually for both botulinum toxin type A and hyaluronic acid tissue fillers.
METHODS: The volume of queries performed between 2005–2016 including [botox] or [hyaluronic acid + Juvederm + Perlane + Restylane + Prevelle] were analyzed in relation to the annual number of procedures using botulinum toxin type A and hyaluronic acid based soft tissue fillers, respectively.
RESULTS: The number of procedures performed using botulinum toxin and hyaluronic acid correlated significantly with the relative search volume for related search terms in both the same year (P less than .001) and year prior (P less than .001).
CONCLUSIONS: Our findings highlight the importance of Google search data as a resource for understanding patient motivations and behavior. Dermatologists may use this resource as a tool to better address patient concerns and forecast local demand for specific procedures.
J Drugs Dermatol. 2018;17(11):1245-1246.
S.H. Babaeinejad MD and R.F. Fouladi MD
Topical treatments, such as adapalene and benzoyl peroxide (BPO), are popular in mild-to-moderate acne vulgaris. This study aimed to compare the efficacy, safety and tolerability of adapalene and BPO in mild acne vulgaris. In this single-center, randomized, double-blind, clinical trial, 60 patients with mild acne vulgaris received either topical adapalene 0.1% gel or topical BPO 2.5% gel on their face once daily for two months. The changes of acne lesion count (efficacy), any adverse effect (safety), and the patients’ overall satisfaction (tolerability) were compared after 3 months of follow-up. In both groups the mean number of noninflammatory, inflammatory and total lesions decreased significantly from baseline (10.77±5.54, 9.73±5.09, and 20.50±7.54, respectively in adapalene group; 11.50±5.92, 8.43±5.45, and 19.93±9.01, respectively in BPO group) to the third month (1.70±1.68, 0.33±0.66, and 0.50±0.78, respectively in adapalene group; 4.23±4.14, 0.33±0.71, and 4.13±4.44, respectively in BPO group; P<0.001 for all), posttreatment. Although the mean number of inflammatory lesions was significantly lower in BPO receivers only at first month (P=0.001), the mean number of noninflammatory and total lesions was significantly lower in adapalene group at second (P= 0.04 and 0.03, respectively) and third (P=0.02 and <0.001, respectively) months, posttreatment. The adverse events were minimal and self-limited (26.7% in adapalene group, 20% in BPO group, P=0.54). The patients’ overall satisfaction was good-excellent in 93.3% of adapalene receivers vs. 73.3% in BPO group (P=0.08). Both topical adapalene 0.1% and BPO 2.5% gels seem safe and effective in mild acne vulgaris, with a marginal tendency toward the former.
J Drugs Dermatol. 2013;12(9):1033-1038.
Brandon Worley MD MSc,a Andrew J. Nemechek MD FACS,b,c Samantha Stoler MD FAAD,d and Joel L. Cohen MD FAAD FACMSd,e,f
BACKGROUND: Alternative therapies are favored by some patients. In skin cancer, this may be to try to avoid surgery out of fear for the procedure and its functional or cosmetic consequences. Frequently, use of these therapies is not curative and can cause harm. Our objective is to detail a case where black salve was used as a natural remedy for an atypical fibroxanthoma and resulted in a severe burn. We highlight the challenges of communicating effective treatment options for those who have strong beliefs concerning natural remedies after a cancer diagnosis.
CASE REPORT: A 78-year-old man was referred for excision of a small atypical fibroxanthoma of the scalp. He had reservations about conventional treatments, he initially declined surgery. Later, he was found to have a severe burn over the site of the biopsy-proven AFX, extending to 20% of his scalp. He was found to have been applying black salve. Hospital admission and multiple stages of scalp reconstruction with Head and Neck Surgery were required.
CONCLUSION: For patients who desire to use alternative medicine, communication is all important. Integrative approaches to use traditional therapy while reconciling patient beliefs in natural medicine can improved oncologic, functional, and psychosocial outcomes.
J Drugs Dermatol. 2018;17(6):683-685.
Avnee Shah BS, Jenna ONeill MD, Steven R. Feldman MD PhD
Background: Alefacept has an established efficacy and safety profile for 12 weeks of treatment of severe chronic plaque type psoriasis. The effectiveness and safety of longer-term continuous use is not well characterized.
Methods: Fifteen subjects with moderate-to-severe chronic plaque type psoriasis were given weekly 15 mg alefacept injections for 16 consecutive weeks followed by monthly 15 mg injections for up to eight consecutive months, along with clobetasol propionate spray 0.05% twice daily for the first four weeks. Disease severity was measured using the Psoriasis Area and Severity Index (PASI) and the Investigator Global Assessment (IGA).
Results: Mean PASI scores improved 33 percent overall during the first month with combination treatment. There was an overall 21 percent worsening in PASI scores after the transition from weekly to monthly medication administration. Of the 15 initially enrolled patients, 27 percent achieved PASI 75 by end of study. No patients achieved an IGA of 0 or 1 by end of study. Two major adverse events were reported: low CD4 count and severe allergic dermatitis.
Conclusion: Topical clobetasol propionate 0.05% was only partially effective at augmenting the early treatment effect of alefacept. The authors did not observe marked benefit or major side effects by continuing additional monthly alefacept treatments beyond 16 weeks of weekly treatment.
Mary P. Lupo MD FAAD, Glenda Swetman MD, William Waller MD
Objectives: To determine if there is any effect on tolerance, adverse events or clinical outcome when lidocaine is added to large gel
particle hyaluronic acid (LGP-HA).
Materials and Methods: Single-centered, double-blinded, randomized, with-in patient trial, comparing patient comfort when receiving
LGP-HA injections versus injections of LGP-HA mixed with lidocaine hydrochloride 2% (LGP-HA + L). Results were determined
through patient questionnaires, standardized Canfield photography and blinded physician assessors. Participants were followed for
Results: Eighteen females were enrolled and completed the study. The average pain rating was significantly less when LGP-HA + L
was administered as reported by participants and blinded investigators. Average rating of bruising and redness were less with
LGP-HA + L, but not significant. After six months, 100 percent of participants and 100 percent of the primary and secondary
blinded investigators reported no difference in clinical outcome or longevity between the different treatments. There was no difference
in adverse events.
Conclusion: This is the first trial to report a six-month follow-up in a split-face study comparing LGP-HA + L to LGP-HA alone. All
participant and investigator reports found symmetry of the NLFs at six months, thus demonstrating that the addition of lidocaine to
LGP-HA does not affect longevity. Administration of LGP-HA + L is associated with less patient discomfort than administration of
Psoriasis is a chronic inflammatory skin disease that is characterized by thickened red plaques covered with silvery scales. Excimer laser therapy is a cutting-edge advancement in UVB phototherapy. In contrast to traditional phototherapy, the 308 nm excimer laser only targets psoriasis plaques, while it spares uninvolved skin. It allows for treatment with a supra-erythmogenic dose of UVB irradiation. Targeted UVB therapy is a possible treatment especially for many who have failed topical treatments, systemic therapy, and traditional phototherapy. For safe and effective psoriasis treatment, a combination of therapies may be used, including a combination of laser treatment with topical medications. We present two cases demonstrating effective treatment with excimer laser in conjunction with clobetasol spray and calcitriol ointment for 12 weeks. Long-term near-clearance of psoriasis was sustained after 6 months and one-year follow up periods without further therapy.
J Drugs Dermatol. 2012;11(8):994-996.
Michael H. Gold MD, Julie Biron BS
Introduction: A novel photopneumatic platform (Isolaz, Pleasanton, CA), combining vacuum pressure with a broadband
light source device has been designed to attack multiple targets for the effective treatment of acne.
Objective: The objective of this study was to evaluate the safety and efficacy of photopneumatic technology for the treatment
of mild to moderate acne vulgaris.
Methods: Eleven subjects (7 women) aged 15 to 54 years with skin types 1 to 4 presented with mild to moderate facial
acne (defined as 15 or more facial inflammatory or noninflammatory lesions) were recruited to the study. All subjects underwent
4 photopneumatic treatments at 3-week intervals with follow-up visits at 1 and 3 months.
Results: Inflammatory lesion counts continued to decrease for at least 3 months after the final treatment. At 3 months,
reductions in lesion counts were significant for both inflammatory (P=.0137) and noninflammatory (P=.0383) lesions.
Mean scores between visits consistently dropped sharply from their immediate posttreatment values for pain, erythema,
and edema. Nine subjects (82%) were moderately satisfied to very satisfied with treatment.
Conclusion: Results suggest that the photopneumatic device is a safe and effective modality for the treatment of mild to
moderate inflammatory and comedonal acne vulgaris.
Scalp psoriasis is a common life-altering skin condition causing a great deal of distress. It significantly affects quality of life and is difficult to manage. Treatment can provide variable results, often impacting patient compliance with therapy.
Salicylic acid is used as adjunctive therapy to other topical treatments because of its marked keratolytic effect. Its effectiveness as a monotherapy is not fully understood.
An emollient foam formulation of 6% salicylic acid (Salkera) in an ammonium lactate vehicle has recently become available. Efficacy, tolerability and patient acceptability of salicylic acid 6% emollient foam were assessed in an open-label pilot study of 10 subjects with scalp psoriasis.
All psoriasis severity parameters were reduced with a significant decrease in Psoriasis Scalp Severity Index (PSSI) score from 15.3 to 3.0 after four weeks of monotherapy (P<0.001). Sixty percent of subjects were either "completely cleared" or “almost cleared” of their psoriasis. No adverse events (AEs) were reported. All signs and symptom tolerability measures demonstrated statistically significant score decreases with the exception of oiliness severity and patient-reported burning tolerability.
Salicylic acid 6% emollient foam provides a useful option in the treatment of psoriasis that is highly effective, well tolerated and acceptable to patients.
J Drugs Dermatol. 2011;10(3):270-273.
Aditya K. Gupta MD PhD FRCPC,a Boni E. Elewski MD,b Ted Rosen MD,c Bryan Caldwell DPM,dd David M Pariser MD,e Leon H. Kircik MD,f Neal Bhatia MD,g and Antonella Tosti MDh
Recurrence (relapse or re-infection) in onychomycosis is common, occurring in 10% to 53% of patients. However, data on prevalence is limited as few clinical studies follow patients beyond 12 months. It has been suggested that recurrence after continuous terbinafine treatment may be less common than with intermittent or continuous itraconazole therapy, probably due to the fungicidal activity of terbinafine, although these differences tended not to be significant. Relapse rates also increase with time, peaking at month 36. Although
a number of factors have been suggested to play a role in recurrence, only the co-existence of diabetes has been shown to have a significant impact. Data with topical therapy is sparse; a small study showed amorolfine prophylaxis may delay recurrence. High concentrations of efinaconazole have been reported in the nail two weeks’ post-treatment suggesting twice monthly prophylaxis with topical treatments may be a realistic option, and may be an important consideration in diabetic patients with onychomycosis. Data suggest that prophylaxis may need to be continued for up to three years for optimal effect. Treating tinea pedis and any immediate family members is also critical. Other preventative strategies include avoiding communal areas where infection can spread (such as swimming pools), and decontaminating footwear.
J Drugs Dermatol. 2016;15(3):279-282.
Siegfried Segaert MD PhDa and Mads Røpke PhDb
Topical corticosteroids and vitamin D analogs are well established as safe and effective first-line treatments for mild to moderate plaque psoriasis. They act via distinct and complementary mechanisms of action: vitamin D analogs primarily counter epidermal dysregulation, inhibiting epidermal hyperproliferation and inducing keratinocyte differentiation, whereas corticosteroids act primarily as immunosuppressors, targeting pro-inflammatory cytokines and chemokines. Furthermore, both agents have additional activity that may complement their main effects: vitamin D analogs have some immunomodulatory properties and corticosteroids may impact on keratinocyte differentiation. Based on their dominant mechanisms of action, there is a strong scientific rationale for the combination of corticosteroids and vitamin D analogs in the treatment of plaque psoriasis. Indeed, the combination has been shown to have a greater effect on the immune-mediated mechanisms of psoriasis than either monotherapy used alone. There is also a strong biological rationale for decreased side effects with the combination. Vitamin D may restore epidermal barrier function, which is impaired with corticosteroid use, and counteract steroid-induced skin atrophy. Corticosteroids may reduce perilesional skin irritation induced by vitamin D analogs. Although clinical data strongly support improved efficacy and tolerability with a combination of calcipotriol and betamethasone dipropionate, additional studies are needed to further investigate their underlying mechanisms.
J Drugs Dermatol. 2013;12(8):e129-e137.
Hilary E. Baldwin MD FAAD,a Ariane K. Kawata PhD,b Selena R. Daniels PharmD MS,c
Teresa K. Wilcox PhD,b Caroline T. Burk PharmD MS,d Emil A. Tanghetti MDe
BACKGROUND: Limited data are available on acne treatment patterns in females through their adult years.
OBJECTIVE: The purpose of this analysis was to evaluate health care resource utilization (HRU) and treatment patterns in cohorts with
and without the use of acne medication and predictors of use.
METHODS: A cross-sectional, web-based survey was administered to US females (25–45 years) with facial acne (≥25 visible lesions).
Data collected included: sociodemographics and self-reported clinical characteristics, acne treatments, and health care professional
(HCP) visits. Subject characteristics associated with medication use were examined by logistic regression.
RESULTS: Approximately half of the total sample (N=208, mean age: 35±6) ever visited an HCP for acne and reported more over-the counter
(OTC) medication use (51.0%) than prescription (Rx) medication use (15.4%). Subjects did not use medications daily, averaging
from 12–18 days over the previous 4 weeks. Logistic regression showed that race and prior HCP visits for acne were significant predictors
of medication use (P<.05).
CONCLUSIONS: Adult females generally self-treated their acne using primarily OTC medications; however, poor compliance was observed
for Rx and OTC. Race and prior HCP visits for acne were significant predictors of current medication use.
J Drugs Dermatol. 2015;14(2):140-148.
Vasanop Vachiramon MD,a,b Trudy Brown LEI CLS CPE,a,c Amy J. McMichael MDa
Background: Laser hair removal (LHR) is increasingly popular for the treatment of unwanted hair. To date, there have been few studies to evaluate patient satisfaction and complications after LHR among people of color.
Objectives: To determine patient satisfaction and complications with long-pulsed Nd:YAG laser assisted hair removal in dark-complexioned skin individuals from the patient's point of view.
Patients/Methods: A survey questionnaire was administered to subjects with Fitzpatrick skin type VI between the ages of 21-70 years who had been treated with long-pulsed Nd:YAG for unwanted hair. Questions were comprised of those related to satisfaction and complications from treatment with LHR. Satisfaction was recorded on a linear analogue scale (LAS=not at all satisfied; 100=extremely satisfied).
Results: Fifty patients (female 41, male 9) completed the survey. All patients were satisfied with Nd:YAG LHR treatment with the mean satisfaction score of 84.2. All patients favor LHR treatment as compared to alternative methods. The majority of patients (79.3%) who had completed six or more LHR treatments were removing their hair less frequently than before LHR treatment. Hyperpigmentation after treatment was noted in three patients (6%), which lasted for 3-10 days. No hypopigmentation, blistering, or scarring was observed. All patients completing the study would recommend LHR for patients with unwanted hair with the mean recommendation score of 91.5.
Conclusions: Nd:YAG laser-assisted hair removal gives a high rate of patient satisfaction in terms of hair reduction with minimal complication among subjects of color.
J Drugs Dermatol. 2012;11(2):191-195.
Derek Ho BS,a,b Andrew Mamalis MD MS,a,b and Jared Jagdeo MD MSa,b,c
Onychodystrophy is a common, chronic malformation of the nail that is aesthetically displeasing and can signi cantly impact patient quality-of-life. Onychodystrophy can be associated with pterygium unguis that contributes to pain and appears as a V-shaped exten- sion of the proximal nail fold skin. Treatment options are limited, and topical or intralesional corticosteroids have minimal ef cacy and cause signi cant patient discomfort. Surgical revision of onychodystrophy is complex, and symptomatic or aesthetic improvements are difficult to achieve. There is limited published literature on laser treatment of noninfectious onychodystrophy or associated pterygium unguis. We present a case of a 68-year-old man with a 10-year history of painful traumatic onychodystrophy with associated pterygium unguis, who was successfully treated after three treatments of fractionated carbon dioxide (CO2) laser. Additionally, we review the medical literature on laser treatment of noninfectious onychodystrophy and pterygium unguis. To our knowledge, this is the first reported successful treatment of painful traumatic onychodystrophy and associated pterygium unguis using fractionated CO2 laser. We hope clinicians consider this treatment modality to relieve pain and improve aesthetics associated with traumatic onychodystrophy and associated pterygium unguis. We envision additional research investigating the mechanism of action of fractionated CO2 laser may con rm this treatment option for the management of traumatic onychodystrophy and associated pterygium unguis.
J Drugs Dermatol. 2016;15(11):1461-1464.
Lawrence Green MD,a Leon H. Kircik MD,b-d and Jennifer Gwazdauskas MBAe
Background: Acne vulgaris is a common dermatologic disease that most frequently affects adolescents and young adults. Over-the-counter (OTC) acne treatment regimens are increasingly being used by individuals with acne.
Objectives: To compare the efficacy, user satisfaction, and tolerability of the OTC regimens MaxClarity™, Proactiv®, and Murad® in the treatment of mild and moderate acne.
Methods: Two randomized, evaluator-blinded, split-face studies were conducted, each involving 20 subjects with acne, to evaluate MaxClarity against Proactiv (study 401) and MaxClarity against Murad (study 404) over 8 weeks.
Results: Clinically and statistically significant reductions in acne lesion counts were achieved at 8 weeks compared with baseline for each regimen using MaxClarity, Proactiv, and Murad. Similar reductions in lesion counts and improvements in Investigator's Static Global Assessment grades were observed between MaxClarity and either Proactiv or Murad, in the respective studies. MaxClarity was well tolerated, with no treatment-related adverse events observed in any treatment group and no discontinuations due to adverse events. Overall, most subjects were satisfied with all study treatments.
Conclusions: MaxClarity is an effective alternative to either Proactiv or Murad for use in the treatment of mild and moderate acne.
J Drugs Dermatol. 2013;12(2):180-185.
Wm. Philip Werschler MD FAAD FAACS,a Julius W. Few Jr. MD,b Carolyn I. Jacob MD FAAD,c
John H. Joseph MD,d James M. Spencer MD MS,e and Amy Forman Taub MDf
Most patients with acne have some degree of facial scarring even after their acne resolves, extending the period of psychosocial distress. Unfortunately, management of acne scars remains challenging. Many treatments for post-acne scarring including chemical peels, skin needling, laser resurfacing, surgical repair, subcision lifting, and punch elevation lifting, are limited by moderate and unpredictable results, significant morbidity, and substantial patient investments in time and money. The most recent addition to the armamentarium is tissue augmentation with soft tissue fillers, including a recently approved polymethylmethacrylate-collagen filler. Matching individual patient needs to the appropriate treatment is crucial. While many patients with acne scars have unrealistic expectations about treatment outcomes, open, honest, and realistic dialogue regarding their treatment options and concerns can facilitate realistic expectations. This article is based on a consensus discussion by the authors, who all have experience managing post-acne scarring, as well as the content of a series of live CME-accredited symposia in connection with major dermatology meetings.
J Drugs Dermatol. 2016;15(5):518-525.
Steven P. Davison MD DDS, Joseph F. Sobanko MD, Mark W. Clemens MD
Background: Keloids occurring on the chest can be deforming with significant painful sequelae for patients. These lesions can pose
a therapeutic dilemma for the dermatologic surgeon as certain excision defects may be too large to close primarily and recurrences
tend to be high (40–100%). A collagen-glycosaminoglycan copolymer (Integra) has been found to be useful in the surgical treatment
of scar excisions as the bovine collagen and glycosaminoglycans provide a template for neocollagenesis. Additionally, this dermal
regeneration template concomitantly reduces tensile forces on the wound.
Methods: The authors’ group has followed five patients with chronic chest keloids refractory to myriad of interventions and treated
these patients with surgical excision followed by Integra placement into the wound bed on the chest. Split-thickness grafts were
applied shortly thereafter. Patients were followed at regular intervals and all patients received adjuvant therapy with single-dose radiation
and intralesional chemotherapy (triamcinolone and/or 5 fluorouracil).
Results: This treatment protocol has provided a cure rate of 100% over an average of 43 months follow-up. The symptoms often
accompanied by these chest keloids also appear to improve.
Conclusion: The authors believe that this study provides the groundwork for further investigation of Integra for surgical management
of keloids. A placebo-controlled study should be performed to adequately determine if this data holds true.
Jerry Tan MD,a/sup> Sewon Kang MD,b/sup> and James Leyden MDc
Although there have been few formal studies, scarring is a known bothersome companion of acne vulgaris. We performed a prospective study of subjects consulting a dermatologist for active acne to assess the frequency of acne scarring. Investigators performed a short questionnaire on all acne patients seen at their office for one consecutive 5-day work week to assess scar frequency. Additionally, the first four subjects with acne scars identified were enrolled for a second phase (scar cohort) of the study during which the investigator collected further medical history and performed a clinical evaluation and the patient completed a self-administered questionnaire about scar perceptions and impact on quality of life. A total of 1,972 subjects were evaluated by 120 investigators. Among these, 43 percent (n=843) had acne scarring. Subjects with acne scars were significantly more likely to have severe or very severe acne (P less than .01); however, 69% of the subjects with acne scars had mild or moderate acne at the time of the study visit. Risk factors correlated with increased likelihood of scarring were acne severity, time between acne onset and first effective treatment, relapsing acne, and male gender. Treatments that can completely resolve acne scars are not yet available – prevention and early treatment remain a primary strategy against scars. It is vital for clinicians who manage individuals with acne to institute effective therapy as early as possible, since treatment delay is a key modifiable risk factor for scarring.
J Drugs Dermatol. 2017;16(2):97-102.
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.
Elena I. Gubanova MD,a,b Polina A. Starovatova MD,a,b Maria Y. Rodina MDc
In this evaluator-blind, placebo-controlled study, microinjections of stabilized hyaluronic acid (HA) gel for rejuvenation of aging hands were evaluated. Patients received three injections of 1.0 ml HA gel (20 mg/ml HA) in the dorsum of one hand and 1.0 ml saline in the other, over 3 months (M). Treatments were compared up to M03; comparisons with Day 1 (D01) were made up to M05 and M12 (extension study). Efficacy was evaluated by patients and investigators using the Global Aesthetic Improvement Scale (GAIS). Self-assessment questionnaires, biomechanical measurements, and adverse events (AEs) were analyzed.
Thirty women (mean age: 53 years) provided data up to M05. At M03, HA gel treatment improved hand skin condition in all patients versus D01, according to the GAIS; improvements were sustained to M12. Mean patient scores at M01–M03 were significantly higher for HA gel than for saline (P<0.05). Self-assessment questionnaire grades up to M03 were generally significantly better for HA gel versus saline (P<0.05); grades were maintained to M12. Statistically significant improvements with HA gel in hydration and elasticity was demonstrated at M03, compared with D01 and saline (P<0.05), and in terms of skin roughness versus D01. Maximum roughness (P<0.05) and waviness (P<0.01) were significantly improved versus saline.
All AEs were mild and anticipated, with no serious AEs.
Overall, HA gel injections were generally well tolerated and efficacious for rejuvenation of aging hands compared with saline. Sustained improvements at 12 months compared with baseline indicate that efficacy could be maintained long term.
J Drugs Dermatol. 2015;14(3):288-295.
A 45-year-old woman with marital and working troubles, a personal history positive for malignant melanoma, and a family history of vitiligo presented with adrenergic urticaria (AU), which at first responded to propranolol, but later became unresponsive to both β-blockers and antihistamines. Meanwhile, rheumatoid arthritis became apparent. Treatment with corticosteroids and methotrexate led to remission of neither the rheumatologic nor the dermatologic condition. Attempts to taper the immunosuppressive treatment were invariably followed by recurrence of adrenergic urticaria, which still proved unresponsive to propranolol, as did the rheumatoid arthritis. The courses of the diseases strictly paralleled each other. Rheumatoid arthritis could have triggered adrenergic urticaria by simply adding a supplemental stress, but also by systemically activating mast cells, which are known to be involved in the pathogenesis of chronic inflammatory diseases. A brief discussion of either the dermatological manifestations of, or treatments for rheumatoid arthritis is provided, in order to illustrate the kind of clinical difficulties that such atypical patients pose to physicians.
Adrenergic urticaria is an uncommon yet probably under-diagnosed form of urticaria,¹ which is considered a form of neurogenic acute reaction mainly triggered by acute stress.²,³ The author presents a case of AU, however, that is only partially explained by a stress setting, though it is strongly associated with the course of an autoimmune disease.
J Drugs Dermatol. 2012;11(3):409-412.
Alexis Lyons MD MS,a Jillian Roy RN,a Jennifer Herrmann MD FAAD,a,b,c Lisa Chipps MD FAAD,a,c
OBJECTIVES: The objective of this study was to examine the efficacy and safety of a novel fractional microneedling radiofrequency device to improve the appearance of rhytides and skin laxity of the décolletage.
METHODS: Twelve subjects received a total of three fractional microneedling radiofrequency treatments with Endymed Intensif (EndyMed Ltd., Cesarea, Israel) at least three weeks apart. Primary outcome measure was clinical efficacy quantified by a patient survey to assess treatment satisfaction as well as a physician Global Aesthetic Improvement Scale (GAIS). Photos were taken before every treatment and at a follow-up appointment.
RESULTS: Assessments by two board-certified dermatologists revealed an overall improvement in 67% of patients. Seventy percent of subjects rated their post-treatment skin laxity and rhytides as improved, while 60% of patients rated their skin texture as improved. Eighty percent of subjects were at least slightly satisfied with their treatment. Forty percent of subjects would recommend this treatment to others.
CONCLUSIONS: Subjects in this study demonstrated an overall improvement in décolletage appearance in regard to skin tightening, wrinkles, and skin texture suggested by overall patient satisfaction (80%) and physician-rated GAIS improvement (67%). This study suggests that fractional microneedling radiofrequency devices are a safe and efficacious way to improve overall décolletage appearance with little down time.
J Drugs Dermatol. 2018;17(1):74-76.
Background/Objectives: This study compares the efficacy, safety, and side-effect profile of three different firing modes in a single laser emitting both dual-wavelength multiplexed laser pulses and single-wavelength pulses for removing unwanted axillary hair in subjects with Fitzpatrick skin types II-V.
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.
Eric F. Bernstein MD MSE,a Jay Bhawalkar PhD,b Joan Clifford MS,b James White,b James Hsia PhDb
Background: Due to the hemoglobin-selective wavelength of the 595 nm pulsed-dye laser, it is a device of choice for treating cutaneous
vascular lesions. However, it is less effective and removing dyschromia, which along with hypervascularity is a cardinal sign of cutaneous
photodamage. A novel 607 nm dye laser was developed as a first step in creating a dual-wavelength pulsed-dye laser.
Study Design/Materials and Methods: Twenty-five subjects with dyschromia on the chest due to chronic photodamage were
enrolled into an open-label study to explore the safety and efficacy of a 607 nm pulsed-dye laser, with 22 completing the study. Two
treatments were administered to the chest, one month apart, with fluences ranging from 3-6 J/cm,2 using a 10 mm diameter spot
and pulse duration of 1.5 msec. Cross-polarized digital photographs were taken before and two months following the final treatment
and rated for improvement by physicians in a blinded fashion.
Results: Improvement was rated on a five-point scale with no subjects rated as poor (<25%) clearance, three subjects (13.6%)
demonstrating fair (26-50%) improvement, seven subjects (31.8%) rated as good (51-75%) improvement, 12 (54.5%) were rated as
excellent (76-95%) improvement, while none were rated as outstanding improvement (>95%).
Conclusion: This is the first study of the 607 nm pulsed-dye laser which showed it to be safe and effective for treating dyschromia of
the chest due to chronic photodamage, and may in the future expand the ability of the pulsed-dye laser to treat photodamaged skin.
J Drugs Dermatol. 2011;10(4):388-394.
Gary Grove PhD,a Charles Zerweck PhD,a and Jennifer Gwazdauskas MBAb
Benzoyl peroxide (BPO) is a cornerstone of acne therapy, often used in combination with a topical antibiotic and/or a retinoid. Three
independent 2-week studies were conducted in healthy subjects to compare the tolerability and irritation potential of topical treatment
with Duac® Gel (BPO 5%–clindamycin phosphate 1.2%) vs Acanya® Gel (BPO 2.5%–clindamycin phosphate 1.2%), Aczone® Gel (dapsone
5%), or Epiduo® Gel (BPO 2.5%–adapalene 0.1%). For each study, subjects were randomized to apply one of the comparative
products on one side of the face; the contralateral side remained untreated. Primary (erythema and dryness) and secondary tolerability
assessments were performed throughout the study. Independent blinded expert grader assessments of erythema found no significant
overall difference between any of the comparative groups. Treatment with Epiduo Gel resulted in a significant increase in dryness
and evaporative water loss values compared with Duac Gel. Overall, subject self-assessments were equally favorable across all study
groups, although the Epiduo Gel group reported a higher frequency of adverse perceptions (ie mild burning/stinging). In conclusion,
the four topical acne medications tested were well tolerated throughout the study period. Treatment with Epiduo Gel resulted in a
significant increase in dryness, evaporative water loss, and sensations of burning and stinging. No other significant differences in self-assessment
perceptions were observed between treatments.
J Drugs Dermatol. 2013;12(6):644-649.
Emily P. Tierney MD and C. William Hanke MD MPH
Background: Ablative laser resurfacing of the neck has been tested with the ultrapulsed CO2, ablative Er:YAG and short pulse duration
CO2 laser with mixed results in terms of efficacy and side effect profiles. Given the preliminary reports of safety and efficacy of
ablative fractional photothermolysis (AFP) for the face, we set out to assess the efficacy of AFP for the neck.
Design: A prospective pilot study for neck resurfacing in 10 subjects with a series of one-to-three treatment sessions. Treatment sessions
were administered at six-to-eight week intervals with blinded physician photographic analysis of improvement at two months
post-treatment. Blinded physician photographic evaluation was performed of four clinical indicators, skin texture, skin laxity, rhytides
and overall cosmetic outcome.
Results: The number of treatments required for improvement of neck texture and laxity ranged from 1–3, with an average of 1.4.
For skin texture, the mean score improved 62.9% (95% CI: 57.4%, 68.4%), skin laxity, 57.0% (53.2%, 60.8%), and rhytides, 51.4%
(48.3%, 54.5%). For overall cosmetic outcome, the mean score improved 59.3% (55.1%, 63.5%) at two months post treatment.
Conclusion: In this prospective study, AFP was both safe and effective for the treatment of neck laxity, rhytids and skin texture. The
degree of improvement observed in wrinkling, texture and laxity after AFP coupled with the benign side effect profile has not been
reported with previous trials of ablative laser resurfacing of the neck.
Bruce Berman MD PhD, Jitendrakumar K. Patel MD,Oliver A. Perez MD, Martha H. Viera MD, Sadegh Amini MD,Samantha Block, Deborah Zell MD, Sujatha Tadicherla MD,Adriana Villa MD, Claudia Ramirez MD, Tami De Araujo MD
Background: Tumor necrosis factor-alpha (TNF-α) is a proinfl ammatory and profi brotic cytokine that inhibits degradation of collagen
and glycosaminoglycans. Etanercept, a recombinant TNF-α receptor fusion protein, may decrease excessive fi brous tissue in keloids.
Objective: To evaluate the tolerability and effi cacy of etanercept as compared to triamcinolone acetonide (TAC) for the treatment
Methods: Twenty subjects were randomly assigned to receive monthly intralesional injections of either 25 mg of etanercept or 20
mg of TAC for 2 months. Keloids were evaluated at baseline, week 4, and week 8 by subjects and investigators in a blinded fashion
using physical, clinical, and cosmetic parameters. Photographs were taken and adverse events were noted during each evaluation.
Results: Etanercept improved 5/12 parameters including signifi cant pruritus reduction, while TAC improved 11/12 parameters at
week 8, although no statistical difference was observed as compared to baseline. There was no signifi cant difference between the
2 treatment groups. Both treatments were safe and well tolerated.
Conclusion: Etanercept was safe, well tolerated, improved several keloid parameters, and reduced pruritus to a greater degree than
TAC therapy. However, further studies are required before it can be recommended for the treatment of keloids.
Emil A. Tanghetti MD,a Jeffrey S. Dover MD FRCPC,b David J. Goldberg MD,c Sunil S. Dhawan MD,d Lei Luo MPH,e David R. Berk MD,e Gurpreet Ahluwalia PhD,e and Nancy Alvandi PhDe
BACKGROUND: Persistent facial erythema is a clinically challenging feature of rosacea.
OBJECTIVE: To evaluate persistent erythema reduction on the first day of treatment from pooled data from two pivotal trials of topical oxymetazoline cream 1.0% (oxymetazoline) in persistent facial erythema of rosacea.
METHODS: In two identically designed, phase 3, multicenter trials, adults with moderate to severe persistent facial erythema of rosacea (Clinician Erythema Assessment [CEA] grade ≥3 and Subject Self-Assessment [SSA] grade ≥3) were randomized 1:1 to once-daily topical oxymetazoline or vehicle; the primary efficacy endpoint was ≥2-grade composite CEA and SSA improvement from baseline on day 29. This post hoc analysis evaluated the proportion of patients achieving ≥1-grade composite and individual CEA and SSA improvement at 1, 3, 6, 9, and 12 hours postdose on day 1 (N=885).
RESULTS: Significantly more patients achieved ≥1-grade composite and individual CEA and SSA improvement with the first application of oxymetazoline than with vehicle (P less than 0.001) at all postdose time points, beginning with hour 1. Day 1 safety assessments were similar between treatments.
LIMITATIONS: Short-term, post hoc analysis.
CONCLUSIONS: A ≥1-grade improvement in persistent erythema achieved after the first dose of once-daily topical oxymetazoline demonstrated clinically meaningful improvement from the beginning of therapy.
J Drugs Dermatol. 2018;17(6):621-626.
Ricardo Ruiz-Rodriguez MD PhD, Laura Lopez MD, Daniel Candelas MD, Javier Pedraz MD
Background: Photodynamic therapy has been proved to be effective in skin rejuvenation.
Objective: To evaluate clinical efficacy and side effects of photodynamic therapy using topical 5-methyl aminolevulinate
and red light for photorejuvenation.
Methods: A randomized, prospective, split-face comparison study of 10 white, adult patients with moderate photodamage,
Fitzpatrick skin types 2 or 3, and no occurrence of actinic keratosis was performed. Three treatments using topical
methyl aminolevulinate cream, applied for 1 hour on one half of the face and 3 hours on the other half before illumination
with red light. A blinded investigator prior to treatment and 2 months after the third treatment evaluated each side
of the subject’s faces.
Results: A moderate improvement in fine lines, tactile roughness, and skin tightness was observed in most of the patients,
mostly on the 3-hour time side. There were no changes in mottled pigmentation or telangiectasias. Side effects were observed
in all subjects (erythema, edema, scaling) mainly in the 3-hour incubation time side.
Limitations: The small number of patients and the lack of placebo group.
Conclusion: Methyl aminolevulinic-photodynamic therapy with red light can improve fine lines, tactile roughness and
skin tightness in patients with moderate photoaging and no occurrence of actinic keratosis.
Habib Ansarin MD, Sayied Savabynasab MD,Ashkan Heshmatzade Behzadi MD, Nader Sadigh MD,Jaleh Hasanloo MD
Background: Levamisole is an agent without much potential use alone, but through immunomodulation, may synergistically improve
the efficacy of other drugs like doxycycline in the treatment of acne vulgaris.
Objective: The goal of this study was to determine the efficacy of levamisole in addition to doxycycline in the treatment of patients
suffering from severe nodulocystic acne.
Methods: A double-blind, randomized, placebo-controlled trial was conducted in the dermatology clinic of Rasoul-e-Akram Hospital in
Tehran, Iran in 2006. Sixty patients were randomly assigned to 1 of 2 study groups. The case group was administered oral levamisole
2.5 mg/kg/wk (up to 150 mg/wk) plus doxycycline 100 mg daily and the control group was given 100 mg of oral doxycycline daily and
a placebo. Patients were evaluated at baseline, and at 2-month, 4-month, and 6-month checkpoints.
Results: The responses to treatment were significantly higher in the case group according to the reduction in total lesions count,
acne severity index; and papule/pustule and nodule/cyst count at the 2nd, 3rd, and 4th visits.
Conclusion: Results indicated that adding oral levamisole to doxycycline is an effective treatment for severe nonresponsiveness
to conventional treatments of acne vulgaris. In the patient group, levamisole was well tolerated with an acceptable safety profile.
At the time of publication, this study is the first clinical trial that suggests levamisole as an effective new treatment for severe acne
Rivka C. Stone MD PhD and Marjana Tomic-Canic PhD
Acne vulgaris, a common disorder of pilosebaceous follicles, adversely affects quality of life in patients. Formation of papules and pustules in inflammatory acne is orchestrated by a sustained host immune response whose features are incompletely understood, impeding the development of novel targeted therapies. To this end, we utilized transcriptome data previously obtained from lesional
and non-lesional skin of 18 patients with inflammatory acne. We identified an acne “signature” of 217 genes that were coordinately up-or down-regulated in lesional skin of patients from two cohorts. Pathway analysis was enriched for biological processes of innate and adaptive immunity. We employed bioinformatics techniques to identify drugs predicted to target acne-relevant immune processes
through their known effects on the expression of subsets of inflammatory acne “signature” genes. Using this approach, we linked minocycline to modulation of neutrophil and lymphocyte migration via its downregulation of IL1B, IL6, CXCL8, and CCR2 expression that is increased in lesional acne skin in vivo. Similar networks were constructed for tretinoin and salicylic acid therapies. Finally, we predicted a novel role for small molecule inhibitors of MEK/ERK signaling in the treatment of inflammatory acne. Taken together, our findings suggest that bioinformatics approaches can be successfully employed in the discovery an development of acne therapeutics.
J Drugs Dermatol. 2017;16(11):1166-1169.
Colloidal oatmeal has been used for decades to soothe and ameliorate atopic dermatitis and other pruritic and/or xerotic dermatoses.
In-vitro and/or in-vivo studies have confirmed the anti-inflammatory, barrier repair, and moisturizing properties of this compound. A
broad set of studies has been conducted in recent years to assess the effects of colloidal oatmeal as adjunct treatment in the management
of atopic dermatitis (AD). This paper will review these studies. In these investigations, patients in all age groups (3 months to 60
years) with mild to moderate atopic dermatitis were included and allowed to continue their prescribed topical medications. These studies
found that the daily use of moisturizers and/or cleansers containing colloidal oatmeal significantly improved many clinical outcomes
of atopic dermatitis from baseline: investigator's assessment (IGA), eczema area and severity index (EASI), itch, dryness, and quality of
life indices. Safety results showed that the formulations were well tolerated in babies, children, and adults with AD.
J Drugs Dermatol. 2012;11(7):804-807.
Qiuhong Yang MS,a* Daniel J. Aires MD JD,b* Shuang Cai PhD,a Garth R. Fraga MD,b
Da Zhang MD,b Cicy Z. Li MS,b and M. Laird Forrest PhDa
BACKGROUND: Melanoma is a deadly skin cancer with rapidly rising incidence. While localized melanoma can be treated with excision, there are at present no similarly effective treatments for regional and distant disease, so survival rates are low. One problem is that melanoma is chemo-resistant, and most chemotherapy doses are limited by systemic toxicity. A method for delivering high-dose chemotherapy directly to tumors and draining lymph nodes could have the advantage of allowing much higher effective doses with reduced systemic exposure.
METHODS: Human melanoma cell line A-2058 tumor cells were injected into athymic mice. After tumors grew to 50~100 mm3 mice were divided into five groups: (1) nontreated (2) intravenous (i.v.) cisplatin, (3) i.v. nano hyaluronan-conjugated cisplatin (HA-Pt), (4) subcutaneous (s.c.) peri-tumoral cisplatin, and (5) s.c. peri-tumoral HA-Pt. All treatment groups received 3 weekly doses of 10 mg/kg.
RESULTS: Tumors grew progressively in all control, i.v. cisplatin, and s.c. cisplatin groups. Tumors showed a trend toward slower growth in the i.v. HA-Pt group, but all animals died or were euthanized per protocol within 3 weeks of treatment. Tumors showed shrinkage only in the subcutaneous peri-tumoral HA-cisplatin group; one of these mice appeared to be cured.
CONCLUSIONS: Peri-tumoral HA-cisplatin may be shown potential as a therapeutic option in treatment of certain types of melanoma.
J Drugs Dermatol. 2014;13(3):283-287.
Lisa K. Chipps MD MS,a,b,c Jason Bentow MD,c Heidi B. Prather MD,d Jeffrey J. So MS PA-C,a
Jonathan M. Schouest BS,a and David M. Ozog MD,a,e Ronald L. Moy MDa,b
OBJECTIVE: To use 3D photography to evaluate the clinical efficacy of a novel radiofrequency delivery device used to improve the appearance
of rhytids and laxity of the face and neck.
STUDY DESIGN: Forty-nine subjects received a total of two radio-frequency treatments to the face and neck one-month apart. The novel
radio-frequency delivery device was used to heat the dermis between 41-43°C for five heat cycles. Primary outcome measures were
clinical efficacy quantified by the Global Assessment Improvement Scale (GAIS) and a patient survey that assessed treatment satisfaction.
RESULTS: Assessments of 3D photographs revealed an overall improvement in 74% of study subjects. 85% of patients noted an overall
improvement in the appearance of their skin. 81% of patients rated their post-treatment skin laxity as improved, 85% rated their skin
smoothness as improved and 62% rated their skin brightness as improved.
CONCLUSION: Subjects in this study demonstrated an overall improvement in face and neck appearance with regard to skin tightening,
wrinkles, and skin texture suggested by overall patient satisfaction (85%) and physician-rated GAIS improvement (74%). This study
suggests that radiofrequency applied with a continuous thermal treatment device is a safe and efficacious way to improve the overall
appearance of aging facial skin.
J Drugs Dermatol. 2013;12(11):1215-1218.
Megan A. Kinney MHAM BS,a Brad A. Yentzer MD,a Alan B. Fleischer Jr. MD,a Steven R. Feldman MD PhDa,b,c
Background: Acne vulgaris has been treated with long-term courses of antibiotics since the 1960s. Antibiotic-resistance of Propionibacterium
acnes (P. acnes) was first documented in the late 1970s, and, over 20 years later, the problem of antibiotic resistance
Purpose: The aim of this study was to assess trends in prescribing antibiotics for acne from 1997−2006.
Methods: The authors examined the National Ambulatory Medical Care Survey (NAMCS) database and recorded medications at all
visits to the physician in which acne vulgaris (ICD-9-CM code 706.1) was the only diagnosis from 1997−2006.
Results: Declines in the use of erythromycin and isotretinoin (both P<0.001) for acne were noted for all physicians. Tetracyclines saw
significant increases in use by both dermatologists and non-dermatologists (P<0.01 and P=0.05, respectively). Prescribing of benzoyl
peroxide monotherapy was unchanged for non-dermatologists (P=0.22) and is on the decline for dermatologists (P<0.001). The use
of BPO + clindamycin combination topical treatments rose sharply for all physicians (P<0.001), resulting in greater use of both total
BPO and total clindamycin for acne over time (P<0.001). Topical retinoid use increased among dermatologists (P<0.05) but appeared
to be on the decline among non-dermatologists (P=0.067).
Conclusion: The development of antibiotic resistance is of concern. Greater awareness of retinoid use for maintenance therapy,
using topical benzoyl peroxide to prevent resistance, and limiting use of oral antibiotics to as short a time period as possible are measures
to contribute to better eco-responsible acne treatment.
Koichiro Kameyama MD PhD
Background and Objective: Deep heating or denaturation of collagen has been reported to be necessary for nonablative
skin rejuvenation. The purpose of this study was to examine whether thermally damaged collagen is an indispensable factor
to increase the amount of collagen in vivo. Epidermal and dermal responses to infrared light therapy using a Titan source
were examined with the aim of correlating histological and clinical responses in human and amelanotic mouse skin.
Study Design/Materials and Methods: Ten, 20, or 30 J/cm2 infrared light were irradiated on the human subject’s skin
(thigh), while 5, 10, 20, or 30 J/cm2 were used on amelanotic mouse skin. Biopsies were taken and analyzed using hematoxylin
and eosin (H&E) and Elastica von Gieson stain.
Results: Ten or 20 J/cm2 infrared light increased the amount of both collagen and elastin in all layers of the dermis without
denaturing the collagen in human skin. A higher dose of 30 J/cm2 also increased the amount of collagen and elastin,
but denatured the collagen in human skin. (In addition to the thigh, 2 treatments of 10 J/cm2 infrared light improved
skin toning and texture on the subject’s face.) In mouse skin, 5 or 10 J/cm2 remarkably increased the amount of both collagen
and elastin, and of epidermal cells. Twenty or 30 J/cm2 increased the amount of collagen and elastin and the number
of keratinocytes, but caused some vacuolated degeneration of keratinocytes. The presence of denatured collagen was
not evident due to the high density of collagen.
Conclusions: This study shows that the denaturation of collagen is not required to increase the amounts of collagen or
elastin in vivo in human skin. The activation of the mitochondria as well as the denaturation of collagen may play important
roles in infrared phototherapy.
Ulrike Blume-Peytavi MD,a Jerry Shapiro MD,b Andrew G. Messenger MD,c Maria K. Hordinsky MD,d Paul Zhang PhD,e Carlos Quiza MD,e Uday Doshi PhD,e and Elise A. Olsen MDf
BACKGROUND: A once-daily minoxidil topical foam (MTF) has been developed to treat female pattern hair loss.
OBJECTIVE: Determine noninferiority of once-daily 5% MTF versus twice-daily 2% minoxidil topical solution (MTS) based on the change from baseline in target area hair count (TAHC) at 24 weeks.
METHODS: In a randomized, phase III trial, women with female pattern hair loss received once-daily 5% MTF (n=161) or twice-daily 2% MTS (n=161) for 52 weeks. Primary endpoint was change from baseline in TAHC at 24 weeks. Secondary endpoint was change from baseline in TAHC at 12 weeks. Exploratory endpoints included change in total unit area density and change in overall scalp coverage.
RESULTS: Once-daily 5% MTF increased TAHC from baseline (adjusted mean ± standard error) by 23.9 ± 2.1 hairs/cm2 at week 24. Twice-daily 2% MTS increased TAHC 24.2 ± 2.1 hairs/cm2 at week 24. The treatment difference was –0.3 hairs/cm2 (95% CI = –6.0, 5.4). Since the lower bound of the 95% CI was less than –5.0, the prespecified noninferiority goal was not met. Both treatments were well tolerated.
CONCLUSIONS: Once-daily 5% MTF and twice-daily 2% MTS induced hair regrowth in female pattern hair loss, but prespecified noninferiority criteria were not met.
ClinicalTrials.gov identifier: NCT01145625
J Drugs Dermatol. 2016;15(7):883-889.
Cutaneous T-cell lymphomas (CTCLs) are a relatively uncommon group of lymphoproliferative disorders in
which a malignant population of T cells is localized to the skin at presentation. Of the 4 classic CTCL phases
(patches, infiltrated plaques, tumors, Sézary syndrome), the majority of patients present with early stage patch
or plaque disease, which can usually be effectively managed using skin-directed therapies. Traditional skindirected
therapies include topical corticosteroids, topical chemotherapeutic agents (mechlorethamine, carmustine),
electron beam therapy (local and total skin), and phototherapy (UV-A, UV-B). Each of these has
demonstrated efficacy in early stage disease; however, with the exception of topical corticosteroids, all have
some disadvantages and are associated with significant adverse events, particularly secondary skin malignancies
and skin damage. Bexarotene is a synthetic retinoid analog that selectively activates retinoid X receptors. In
clinical trials, bexarotene gel demonstrated efficacy for the topical treatment of cutaneous lesions in patients
with stage IA or IB CTCL who have refractory or persistent disease following other therapies or who cannot
tolerate other therapies. Initial evidence indicates that bexarotene gel may be active as first-line therapy in
early stage disease. Its role in combination with other treatments remains to be determined. Topical bexarotene
gel is generally well tolerated and offers patients greater convenience compared with traditional skin-directed
therapies, with a flexible administration regimen. The availability of bexarotene gel provides patients and
physicians with a new skin-directed treatment option for early stage CTCL.
Jason D. Bloom MD,a Jeremy B. Green MD FAAD,b Whitney Bowe MD,c Erika von Grote PhD,d and Alessandra Nogueira MDd
The proportion of men seeking facial rejuvenation with botulinum neurotoxin type A (BoNTA) products is increasing. The number of male patients treated in the 5-year period between 2009 and 2014 grew by 25%. There is little clinical data supporting gender-specific efficacy with regard to dosing and injection placement in men. To nurture the confidence associated with treatment of male patients, clinicians are in need of more informational materials to develop their evaluation and treatment strategies. Three BoNTA products are currently available in the United States (US) for treatment of the upper face. The varying potency of the different BoNTA formulations is reflected by disparate dose-response characteristics, meaning they are not interchangeable for injection purposes. Clinicians who are familiar with the characteristics of all the BoNTA options will be equipped with the necessary tools to provide their male patients with a desired outcome.
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.
Alejandro Molina-Leyva MD, Husein Husein-Elahmed MD, Ramon Naranjo-Sintes PhD,
and Jose Carlos Ruiz-Carrascosa MD
BACKGROUND: There are few studies analyzing the behavior of ustekinumab in the complex management of psoriasis within diary clinical
OBJECTIVE: To assess the utility of ustekinumab in a psoriasis unit.
METHODS: Analysis of the prospective data gathered during the follow-up of 30 consecutive psoriasis patients treated with ustekinumab at
a single referral centre. Three effectiveness endpoints were defined 12 weeks, 28 and “long-term treatment”. The main outcome measure
was improvement from baseline PASI at week 28 and at a point of adjustment of prolonged treatment signed as “long-term treatment”.
RESULTS: Overall 82.1% and 42.8% patients achieved respectively PASI75 and PASI90 response rates at week 28. Long-term treatment
maintained efficacy outcomes 81.5% and 40.7% PASI75 and PASI90, respectively were observed. At week 28, patients naïve to TNFα-
blockers agents and patients with a baseline PASI >10 had better PASI75 and PASI90 response rates than previously treated patients.
CONCLUSIONS: In clinical practice, the efficacy and patient adherence to ustekinumab are excellent and even better to the data obtained
in clinical trials. Clinical indicators of psoriasis severity: previous treatments with tumor necrosis factor α blockers agents and active
treatment beside small increases in PASI determine a delayed maximal response.
J Drugs Dermatol. 2014;13(8):971-974.
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.
Zorica Jovanovic PhD,a Nariman Angabini MD,b Sonja Ehlen MD,c Zrinka Bukvic Mokos MD,d Milica Subotic MD,e and Gitta Neufang PhDa
BACKGROUND: Sensitive skin and rosacea are skin conditions, which may affect the quality of life of the patients considerably. In vitro and in vivo data indicated that the combination of trans-t-butylcyclohexanol and licochalcone A is an effective combination for alleviating the increased sensitivity of rosacea subtype I.
OBJECTIVE: Objective of this open dermocosmetic study was to investigate the efficacy and tolerability of a skin care product containing the anti-inflammatory licochalcone A and the TRPV1 antagonist trans-t-butylcyclohexanol in subjects with sensitive skin prone to redness and rosacea.
METHODS: 1221 subjects with sensitive skin and rosacea stage 0-II applied the test product twice daily for 4 weeks. Clinical assessment of sensitive skin and rosacea symptoms were performed at baseline and after 4 weeks. Additionally, at treatment end the test subjects filled a self-assessment questionnaire.
RESULTS: After 4 weeks of application, both, clinical and subjective assessment have shown improvement of all symptoms of sensitive skin and rosacea in a significant number of subjects (P less than 0.001). The test product was efficacious and very well tolerated also when used in conjunction with pharmacological treatments of the skin condition under scrutiny.
Conclusions: The study confirmed the good tolerability and efficacy of the skin care product in the management of sensitive skin prone to redness and rosacea when used alone or in combination with other therapies.
J Drugs Dermatol. 2017;16(6):605-611.
Brian Berman MD PhD,a Glynis R. Ablon MD,b Neal D. Bhatia MD,c Roger I. Ceilley MD,d David J. Goldberg MD JD,e Mark S. Nestor MD PhD,a and Susan H. Weinkle MDf
Dermatologists treat actinic keratosis (AK) primarily because these lesions have the potential to progress to invasive squamous cell carcinoma. Patients, on the other hand, generally seek treatment to remove the lesions and achieve an improved appearance of their skin following treatment. In selecting a treatment option for AK, dermatologists should consider post-treatment cosmesis, because cosmetic outcomes differ across AK treatments. To obtain expert opinion on the cosmetic sequelae related to chronically photodamaged skin and the treatment of AK, an expert panel meeting among dermatologists was conducted in February 2016. These experts reviewed current treatment options for photodamage, including AK, and discussed the relative merits of the various cosmetic assessments commonly used by investigators and patients in both clinical trial and dermatology practice settings. A main goal of the expert panel meeting was to propose assessment tools that could be specifically designed to characterize cosmesis results after treatment of AK. The panel agreed that existing tools for measurement of cosmetic outcomes following treatment of photodamage could also be used to evaluate cosmesis after treatment of AK. Digital photography is probably the best method used for this, with validation by other technologies. Better measurement tools specifically for assessing cosmesis after AK treatment are needed. Once they are developed and validated, regulatory agencies should be educated about the importance of including cosmetic outcomes as a component of product labeling.
J Drugs Dermatol. 2017;16(3):260-265.
Kavita Beri MDa and Sandy S. Milgraum MDb
INTRODUCTION: As we enter a new age of increasing demand in novel cosmetic therapies, we are challenged to provide excellent results with minimal downtime and safety in all skin types. In this open case series we are studying the improvement in rhytides by combining
a novel, FDA-approved, non-ablative fractionated Q-switched ND: YAG 1,064-nm laser that acts in the deep dermis, with a topical containing plant stem cell extract and N-acetyl glucosamine (NAG) that acts in the superficial dermis.
METHOD: Six healthy females (Skin types III - V) were selected for the study with mean average age of 56 years +/- 11 years. The rhytides on the face and neck were assessed using a comprehensive grading scale. Patients were then divided into two groups, one received only laser treatment with the fractionated QSW 1,064 nm laser and the other group received combined treatment with the laser and topical. Patients were assessed again at 4 and 8 weeks.
RESULTS: We observed an enhanced anti-aging effect of the laser in the patients with combined treatment.
DISCUSSION: Understanding the effect of this novel laser therapy on human stem cells and investigating the basis of its synergistic effect with plant stem cell extract and NAG will lead us to better understand stem cell activity. Non-ablative tissue regeneration is the next step in providing optimal anti-aging treatments.
J Drugs Dermatol. 2015;14(11):1342-1346.
Guy F. Webster MD PhD
Topical fixed-combination products and topical retinoid monotherapy are established first-line treatments for mild-to-moderate acne vulgaris, yet adequate comparative data are lacking. The following evidence-based review addresses the question: "In patients with mild-to-moderate acne, are topical fixed-combination products or topical retinoids a more efficacious choice in reducing noninflammatory, inflammatory and total lesions after 12 weeks of treatment?" To identify relevant studies, a PubMed search was performed using "acne" and search terms for adapalene, tretinoin, tazarotene, benzoyl peroxide, clindamycin, or erythromycin. Forty-two studies from January 1991 to November 2009 were included. The studies were evaluated using the Strength of Recommendation Taxonomy, and all but seven received the highest level of evidence grade. To evaluate efficacy, a side-by-side comparison was made using reduction in acne lesion counts at week 12 for study groups treated with fixed-combination therapy or retinoid monotherapy. Twenty-nine studies containing relevant efficacy data for fixed-combination therapy and retinoid monotherapy are summarized here. Nine studies compared fixed-combination therapy with retinoid monotherapy; in eight of these studies, fixed-combination therapy was significantly more efficacious in reducing acne lesion counts. This evidence-based review analyzes clinical evidence to date for these therapies to provide guidance in determining appropriate treatment for patients with mild-to-moderate acne.
J Drugs Dermatol. 2011;10(6):636-644.
William C. Ports DVM,a Steven R. Feldman MD PhD,b Pankaj Gupta PhD,a Huaming Tan PhD,a Theodore R. Johnson PhD,c and Robert Bissonnette MDd
Intra-subject, left-right, randomized, controlled study designs are often used for proof-of-concept studies in dermatology. This design was used to evaluate the safety and efficacy of a topical solution of tofacitinib (NCT00678561), a small-molecule Janus kinase inhibitor under investigation for the topical and oral treatment of patients with chronic plaque psoriasis. Eighty-one patients, each with matched left and right target plaques, were randomized to 2%, 0.2%, or 0.02% tofacitinib or vehicle solution once or twice daily. Patients treated one plaque as per their randomization group (2%, 0.2%, 0.02% tofacitinib, or vehicle solution), and used vehicle to treat the contralateral plaque for 4 weeks. Except during clinic visits, study drug applications were performed unsupervised outside the clinical trial site. Intra-subject, vehicle-adjusted mean percent change from baseline in Target Plaque Severity Score at week 4 (primary efficacy endpoint) was not significantly different from baseline for any treatment group (P values of 0.28–0.68). However, skin biopsy analyses detected tofacitinib in both tofacitinib- and vehicle-treated plaques of some patients, suggesting cross-contamination or solution misapplication.
Lack of efficacy with tofacitinib relative to vehicle may be due to the intra-subject study design with unsupervised applications.
These findings have potential implications for future intra-subject studies of topical treatments.
J Drugs Dermatol. 2015;14(8):777-784.
Anne Marie Tremaine MD, Arisa Ortiz MD, Laila Elkeeb MD, Minh Tran, Gerald Weinstein MD
Background: Many patients with rosacea cannot tolerate extended treatment periods with topical agents because their skin sensitivity
is often increased.
Objective: To determine the long-term efficacy and tolerability of a new moisturizing lotion for improving the signs and symptoms
of mild-to-moderate rosacea.
Methods: In a 48-week, open-label study, a moisturizing lotion containing furfuryl tetrahydropyranyladenine as PRK-124 (0.125%,
Pyratine-XR™, Senetek PLC, Napa, CA) was applied twice daily by 18 subjects with mild-to-moderate rosacea. Clinical improvements
were assessed by the treating physician. Skin barrier function was measured by transepidermal water loss after treatment. Tolerability
and cosmetic outcome were evaluated by subjects.
Results: Subjects experienced a mean 44 percent reduction in erythema severity and a mean 89 percent reduction in inflammatory
lesion count at week 48. Reductions were significant (P≤0.05) in both erythema and lesions at weeks 24, 36 and 48. Statistically significant
(P≤0.05) improvements in telangiectasias, transepidermal water loss and dryness were noted. Overall clinical improvement
was observed in 81 percent of subjects and the investigator’s global assessment steadily improved throughout the study. Treatments
were well-tolerated and cosmetically acceptable. Treatment-induced skin irritation was not observed.
Conclusion: The new moisturizing lotion containing furfuryl tetrahydropyranyladenine as PRK 124 is efficacious, does not irritate skin,
and is well tolerated for at least 48 weeks.
Rosacea is a common disorder that is both under recognized and undertreated. Prevalence figures indicate that it may be present in
1 of every 10 adults in a primary care waiting room. Untreated, patients with rosacea can suffer significant emotional, workplace, and
social impairments. While rosacea has been recognized since ancient times, only recently have investigators begun to identify the
pathophysiologic elements responsible for the characteristic erythema, flushing, dysesthesias, and papulopustular manifestations of
the disease. Although the etiology of rosacea is unclear, inflammation appears to be a central element. Experimental evidence suggests
that abnormalities of the skin's innate and adaptive immune responses may play pivotal roles. Once recognized, effective topical
and systemic therapies can be prescribed to lessen the impact of the disease on the patient's life. Although initially administered in an
empiric fashion, it now seems clear that the role of antibiotics in patients with rosacea depends upon their anti-inflammatory rather
than their antimicrobial properties. Consequently, practitioners have the opportunity to practice good antibiotic stewardship when treating
the disease, particularly with systemic therapies. Therapy with subantimicrobial dosing and with topical treatments can modulate
the inflammation of rosacea without exerting antibiotic pressure responsible for the emergence of antibiotic resistance.
J Drugs Dermatol.2012;11(6):725-730.
Carl R. Thornfeldt MDa and Ronald L. Rizer PhDb
INTRODUCTION: Research has shown that a disrupted stratum corneum permeability barrier coupled with chronic inflammation induce signs of extrinsic aging (photoaging). An novel herbal-based three product cosmeceutical regimen used to reverse these two anomalies that does not contain retinol, soy, niacinamide, tea, L-ascorbic acid or esters, hydroxy acids, tocopherol, or growth factors was tested in six human clinical trials to determine effectiveness and safety in reversing photoaging.
MATERIALS AND METHODS: Six randomized split face, double blind, prospective, controlled clinical trials involving a total of 110 subjects compared a cosmeceutical blend of novel herbs in regimens consisting of one to three products to several common antiaging topical treatments. These comparative products include prescription tretinoin, physician strength idebenone, kinetin, polyhydroxy, lactic and glycolic acids in reversing signs of photoaging.
RESULTS:The novel cosmeceutical blend regimen showed superior efficacy and safety in all six trials.
DISCUSSION: These trials substantiate that herbs not used in common antiaging products effectively and safely mitigate and reverse photoaging signs and symptoms. The novel concept of treating photoaging and preventing its progression by repairing and optimizing the stratum corneum barrier, while reversing and inhibiting chronic cutaneous inflammation, has now been proven.
J Drugs Dermatol. 2016;15(2):218-223.
Hypertrophic Surgical Scars: A Pilot Study Supriya G. Bellew MD, Margaret A. Weiss MD, Robert A. Weiss MD
Background: The short-pulsed pulsed dye laser (PDL) has been previously reported to improve the appearance of
hypertrophic scars. Prolonged purpura following treatment led to the development of the newer long-pulsed pulsed
dye laser (LPDL). Intense pulsed light (IPL) has been extensively used to improve the various components of photodamage
and to reduce the incidence of purpura, but its effect on scars has not been analyzed. The objective of
this pilot study was to prospectively determine and compare the safety and efficacy of LPDL and IPL on surgically
Methods: Breast reduction scars (N = 10 scars) and abdominoplasty scars (N = 5 scars) were treated using both
LPDL and IPL. For breast reduction scars, one side was treated with each technique. For abdominoplasty scars, one
half of the scar was treated with each device. Two treatments were performed 2 months apart. Physician global
assessment scores of improvement were determined by side-by-side comparison of preoperative and randomly presented postoperative photographs. Patient pain scores during treatment were also obtained and the presence of post-treatment purpura was assessed.
Result: Mean improvement on a 0 to 3 oint scale was 2.2(55%) after the first LPDL treatment and 3.2 (80%) after the second. Mean improvement was 1.8(45%) after the first IPL treatment and 2.6(65%) after the second. Differnces in improvement between the LPDL and IPL sides were not statisdtically significant. Patients rated IPL. as more painful thatn LPDL. The incidence of post-treatment pupura was lower with IPL.
Conclusions: This pilot study suggests that LPDL and IPL are equally effective in improving the appearance of hypertrophic surgicak scars. IPL offers a movel method of treating scars that minimizes the risk of purpura.
Erin Gilbert MD PhDa and Lucia Calvisi MDb
BACKGROUND: There are numerous dermal fillers available to injectors in the US and Europe for the correction of age-related volume loss in the midface and perioral regions. Product availability differs between these two aesthetic markets due to US Food and Drug Administration (FDA) regulatory requirements. The purpose of this study is to discuss differences in filler selection by two practitioners in the US and Europe based upon both stylistic approach and filler availability in each market.
OBJECTIVE: To analyse and discuss the approach to midface as well as lip and perioral volume restoration by two independent dermatologists working in the US and Italy.
METHODS: Seven patients were selected for discussion and divided into two groups: 1) those requiring midface volumization and 2) those undergoing perioral or lip volume replacement. Patients in the midface group were injected with Juvéderm Voluma® XC, Juvéderm® Volift® with lidocaine, Restylane- L®, Perlane-L® or Radiesse®. Patients in the perioral and/or lip group were injected with Juvéderm® Volbella™, with lidocaine, or Belotero Balance™. Patients were photographed before and immediately after injection to evaluate aesthetic outcomes. In each case, filler selection was based upon patient characteristics, anatomical considerations and inherent filler properties.
Results: All patients were extremely satisfied with their treatments. There were no significant immediate or delayed complications following treatment with any of the dermal fillers used.
CONCLUSIONS: Volume restoration in the midface and perioral or lip region can be effectively achieved using a variety of dermal fillers. The dermal filler portfolio available in Europe is exponentially larger than that in the US. Product selection in either market is ultimately the result of the physician’s experience injecting each dermal filler, as well as his or her personal preferences.
J Drugs Dermatol. 2014;13(1):67-74.
Bernard Poulain PhD,a Patrick Trevidic MD,b Micheline Clavé MD,c Claude Aharoni MD,d Martine
Baspeyras MD,e Patrick Bui MD,f Hugues Cartier MD,g Marie-Hélène Charavel MD,h Pierre Coulon MD,i
Serge Dahan MD,j Jean-Marie Dallara MD,k Denis Delonca MD,l Laurent Dumas MD,m
Eric Essayagh MD,n Olivier Galatoire MD,o Nicolas Georgieu MD,p Yann Grangier MD,q
Philippe Humbert PhD,r Anne Le Pillouer-Prost MD,s and Alain Mojallal MDt
Botulinum neurotoxins are the most popular non-surgical treatments for aesthetic indications, but there is uncertainty about whether
certain formulations are comparable in efficacy and safety and can be substituted for one another by a simple one to one dose
conversion ratio. An expert panel of French practitioners was convened to establish a consensus on the clinical equivalence in efficacy
and safety of OnabotulinumtoxinA (900 KDa) and IncobotulinumtoxinA (neurotoxin free from complexing proteins - 150 KDa).
The consensus was divided into three sections incorporating a biological, bibliographic and clinical analysis of the two toxins. This
included a review of the published data that have directly compared the two toxins for aesthetic indications and a survey of the
panel's extensive clinical experience with the two toxins in terms of efficacy and safety. All panel members reviewed and endorsed
the content of each section. Among this expert panel of French aesthetic physicians and biologists there was consensus that OnabotulinumtoxinA
and IncobotulinumtoxinA are clinically equivalent in terms of efficacy and safety, and that a switch from one drug
to the other can be made using a simple 1:1 conversion ratio.
J Drugs Dermatol. 2013;12(12):1434-1446.
Martina Kerscher MD PhD,a Rungsima Wanitphakdeedecha MD MA MSc,b Ada Trindade de Almeida MD,c Corey Maas MD FACS,d and Jürgen Frevert PhDe
Aesthetic dermatologic applications of botulinum neurotoxin (BoNT), including treatment of glabellar lines, horizontal forehead lines, and crow’s feet, were the most common non-surgical cosmetic procedures in the US in 2017, with high levels of subject satisfaction. Since the first BoNT type A (BoNT-A) formulation was approved in 1989, the number of formulations available on the world’s commercial markets has increased and new approvals are expected. BoNT is produced by Clostridium botulinum in nature as part of a large protein complex. However, the unnecessary clostridial proteins, which dissociate from BoNT under physiological conditions with a half-life of less than 1 minute, have no role in clinical applications. Data demonstrate that BoNT administration can elicit an immunological response, leading to production of neutralizing antibodies that can be associated with reduced efficacy or treatment non-response. As repeat treatments are required to maintain efficacy, clinicians should be aware of the possibility of antibody development and choose a BoNT with the lowest risk of immunogenicity. IncobotulinumtoxinA is manufactured using advanced technology to precisely isolate the pure BoNT without unnecessary clostridial proteins, and with low immunogenicity and high specific activity. In incobotulinumtoxinA clinical studies, no previously BoNT-naïve subjects developed neutralizing antibodies, and there was no secondary non-response to incobotulinumtoxinA treatment. Here we review the role of unnecessary clostridial proteins in BoNT-A and discuss the unique incobotulinumtoxinA manufacturing and purification process with a focus on the implications for use in aesthetic medicine.
J Drugs Dermatol. 2019;18(1):52-57.
Kateřina Fajkošová MUDr,a Alena Machovcová MD PhD MBA,b,c Meltem Onder MD,d and Klaus Fritz MDd,e
In this study, the efficacy of non-contact, selective radiofrequency (RF) were evaluated for body contouring as non-invasive fat and circumferential reduction of the abdomen. 40 healthy (36 female, 4 male) subjects showing significant volume of subcutaneous fat tissue on the abdomen and waistline were included. Once a week for 30 minutes, 4 sessions were performed. The applicator was placed on a supplied spacer covering the treatment area. Maximum power was 200W, which induced heat in the fat and connective tissue layer. The homogeneity of heat distribution and temperature of the skin surface were controlled. The circumferential reduction was measured at the baseline and after the last treatment. The photographs and adverse effects were recorded. Participants completed the self-evaluation questionnaires and rated their level of satisfaction. All subjects tolerated the treatments well. The only side effect was mild to moderate erythema. 35 subjects finished the protocol as planned and 5 subjects dropped off due to events not related to the study. 32 subjects had a 1-13 cm decrease in abdominal circumference and 3 subjects did not show significant response (0-1 cm). Most likely, a very thin fat layer was the reason for lack of response (the non-responding group was the thinnest patient group). No significant differences were found between men and women. The average decrease of 4.93cm was calculated as a result of circumferential reduction statistical evidence. This study demonstrates that the selective RF system designed for contactless deep tissue heating is a painless, safe, and effective treatment for non-surgical body contouring and circumferential fat reduction.
J Drugs Dermatol. 2014;13(3):291-296.
Amy McMichael MD,a Hanh Pham MA,b Erika von Grote PhD,c and Matthew H. Meckfessel PhDc
Female pattern hair loss (FPHL), also known as female androgenic alopecia, affects over 21 million women in the United States with devastating effects on self-esteem and psychosocial functioning. Topical minoxidil 2% and 5% formulations are the only US Food and Drug Administration-approved treatments for FPHL. The length of time it typically takes to observe the benefits is a challenge for many patients, and may affect adherence to treatment. Herbal extracts, which are also believed to promote healthier-looking hair, have a long history of use in hair care formulations. The safety and efficacy of a twice-daily regimen of 2% minoxidil solution used in combination with the botanical hair solution for 12 weeks in 54 subjects was evaluated in a multicenter, single-arm, open-label study. Assessments included investigator and subject ratings of improvement and subject satisfaction. Investigator ratings indicated significant improvement
in hair growth and overall treatment benefits in as early as 6 weeks (P<.001). Subject self-ratings indicated significant satisfaction with hair volume and quality improvement at week 6 (P<.001). Subjects also indicated an increase in self-confidence and attractiveness
at week 12 (P<.001). The investigator and subject-assessed efficacy and subject satisfaction with this regimen provides clinicians with an effective treatment option for FPHL that also provides a high level of patient acceptance, which ultimately may help promote minoxidil treatment adherence.
J Drugs Dermatol. 2016;15(4):398-404.
Gilberto E. Flores PhD,a Sophie Seité PhD,b Jessica B. Henley MS,c Richard Martin MS Ing,d
Hana Zelenkova MD,e Luc Aguilar PhD,f Noah Fierer PhDa,c
Atopic dermatitis (AD) is a chronic inflammatory skin disorder that results in areas of dry, itchy skin. Several cultivation-dependent and –independent studies have identified changes in the composition of microbial communities in these affected areas over time and when compared to healthy control individuals. However, how these communities vary on affected and unaffected skin of the same individual, and how these communities respond to emollient treatment, remains poorly understood. Here we characterized the microbial communities associated with affected and unaffected skin of 49 patients with AD before and after emollient treatment using high-throughput sequencing of the 16S rRNA gene. We found that microbial diversity and community composition was different between affected and unaffected skin of AD patients prior to treatment. Differences were driven primarily by the overabundance of Staphylococcus species on affected skin and a corresponding decrease in bacterial diversity. After 84-days of emollient treatment, the clinical symptoms of AD improved in 72% of the study population. Microbial communities associated with affected skin of these treatment responders more closely resembled unaffected skin after treatment as indicated by increased overall diversity and a decrease in the abundance of Staphylococcus species. Interestingly, Stenotrophomonas species were significantly more abundant in the communities of ‘responders’, suggesting a possible role in restoration of the skin microbiome in patients with AD. We demonstrated that the comparison of affected and unaffected skin from the same individual provides deeper insight into the bacterial communities involved in the skin dysbiosis associated with AD. These data support the importance of emollients in the management of AD although future studies should explore how emollients and other treatments help to restore skin dysbioses.
J Drugs Dermatol. 2014;13(11):1365-1372.
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
Background: Basal cell carcinoma (BCC) is a common malignancy accounting for 80% of all nonmelanoma skin cancers. Mohs micrographic
surgery (MMS) is considered superior to alternative treatments, but the procedure is time consuming and costly. Alternative
simpler techniques to facilitate accurate tumor demarcation are therefore in demand. Fluorescence imaging following application of
5-aminolevulinic acid is a noninvasive diagnostic technique that gives rapid information about the superficial extent of the skin tumor.
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.
Joe Gorelick MSN FNP-BC,a Wendy Cantrell DNP CRNP,b Kristine Kucera PA-C MPAS DHS,c Karen A. Veverka PhD,d Kara Gooding MMS PA-Ce
Psoriasis is a chronic, immune-mediated inflammatory disease characterized by localized scaling and plaques associated with itching and pain. In some cases, topical therapies are effective to treat mild to moderate psoriasis. Topical agents can be used concomitantly with other treatments for moderate and severe or treatment-resistant psoriasis. Patient adherence to medication regimens remains a major challenge in therapy, especially with topical agents, for which adherence can be affected by the amount of time needed for application, the treatment formulation, cost, and cosmetic characteristics. This study was conducted to obtain feedback from patients clinically diagnosed with psoriasis regarding their satisfaction following once-daily topical application of the fixed combination calcipotriene (Cal) 0.005% and betamethasone dipropionate (BD) 0.064% foam for 15 days. Patients completed a 13-question online survey. In this community-based setting of patients with mild to severe psoriasis, patients were satisfied with Cal/BD foam after 15 days of use; 94% were satisfied or highly satisfied with symptom relief. Most of the patients (88%) were satisfied with how Cal/BD foam felt on their skin. After 15 days of use, 94% of patients would recommend Cal/BD foam to other patients with psoriasis, with 73% being very likely to do so. These findings may have important implications for optimizing medical decision-making, treatment adherence, and health outcomes in clinical practice. The cosmetic acceptability of the fixed combination Cal/BD foam formulation and patient satisfaction may make Cal/BD aerosol foam a more acceptable topical treatment than other currently available vehicles for patients with plaque psoriasis.
J Drugs Dermatol. 2018;17(8):880-884.
Objective: To characterize the prevalence of psychiatric disorders in patients with moderate-to-severe psoriasis and compare health care costs between patients with and without psychiatric comorbidities.
Methods: In a retrospective, matched case-control study, data for services from nearly 75 health care plans in the United States (U.S.) were collected from PharMetrics Patient Centric Database using International Classification of Diseases, Ninth Revision Clinical Modification codes, identifying a total of 39,855 adults with moderate-to-severe psoriasis (n=7,971) and without (controls; n=31,884). Patients with psoriasis had at least one psoriasis health care claim and received at least one medical/prescription treatment claim within two consecutive years. Psychiatric comorbidities and treatments among patients and controls were determined by claims. Annual inpatient, outpatient, emergency room, and prescription costs for those with and without psoriasis and those with and without psychiatric disorders were compared.
Results: Patients had significantly higher prevalence of anxiety (6.9% versus 4.4%), depression (9.2% versus 5.3%), bipolar disorder (1.1% versus 0.5%), or delirium (0.3% versus 0.1%; P<0.05) than controls (others P<0.0001). Significantly higher proportions of patients with psoriasis received antidepressants (6.1% versus 0.9%), anxiolytics (5.0% versus 0.8%), or antipsychotics (5.9% versus 0.9%) compared with controls (each P<0.0001). Total health care costs for patients with psoriasis (US $11, 369.47) were significantly higher than for controls ($3,427.60; P<0.001). Psoriasis patients with psychiatric disorders had significantly higher health care costs ($17,637.66) than those without psychiatric disorders ($10,362.80; P<0.001).
Conclusion: The prevalence of psychiatric disorders is higher in patients with moderate-to-severe psoriasis than in controls. Annual health care costs are higher in psoriasis patients with psychiatric disorders than in those without psychiatric disorders.
J Drugs Dermatol. 2011;10(8):843-850.
Steven R. Feldman MD PhD,a Cary P. Werner MS,b and Alessandra B. Alió Saenz MDb
BACKGROUND: Tazarotene 0.1% gel and cream are effective topical treatments for acne. Tazarotene foam, 0.1% was developed to provide an alternative, safe, and effective formulation.
OBJECTIVE: To evaluate efficacy and tolerability of tazarotene foam, 0.1% in adults and adolescents with acne vulgaris.
METHODS: Two randomized, double-blind, vehicle-controlled, parallel-group studies were conducted at 39 centers in the United States and Canada. The first study involved 744 participants and the second 742, aged 12 to 45 years, who were randomized to receive treatment with either tazarotene foam, 0.1% or vehicle foam once daily for 12 weeks. Lesion counts, Investigator's Static Global Assessments (ISGA), and Subject's Global Assessments (SGA) were evaluated at baseline and weeks 2, 4, 8, and 12. Tolerability was monitored throughout the study.
RESULTS: At week 12 in both studies, treatment with tazarotene foam led to greater decreases from baseline in mean absolute and percentage change in lesion counts (noninflammatory, inflammatory, and total), greater proportion of participants with ≥2-grade improvement in ISGA score, and greater proportion of participants with ISGA score of 0 or 1 than vehicle treatment (P<.001 for all). Only application-site skin irritation and dryness were reported by >5% of participants in active treatment groups in both studies.
LIMITATIONS: The efficacy and tolerability of tazarotene foam were not compared directly with those of other formulations.
CONCLUSION: Tazarotene foam, 0.1% significantly reduced the number and severity of acne lesions after 12 weeks and had a safe and acceptable tolerability profile.
J Drugs Dermatol. 2013;12(4):438-446.
Michael J. Bernhardt MDa and Matthew F. Myntti PhDb
The traditional disease model of acne has been one of follicular plugging due to ‘sticky epithelial cells’ associated with increased sebum production with deep follicular anaerobic conditions favoring P. acnes- generated inflammation. P. acnes biofilms have been found more frequently in patients with acne than controls. Biofilms are genetically coded to create adhesion to the pilosebaceous unit followed by production of a mucopolysaccharide coating capable of binding to lipid surfaces. Traditional therapies for acne have involved mixtures of oral and topical antibiotics admixed with topical keratolytics and retinoids, which are aimed at traditional bacterial reduction as well as downregulating the inflammatory cascade. These approaches are limited by side effect and compliance/tolerability issues. As the P. acnes biofilm may, in fact, be the instigator of this process, we studied the use of a topical agent designed to reduce the P. acnes biofilm to see if reducing the biofilm would be therapeutically efficacious. We present data of a proprietary topical non-prescription agent with a novel pharmaco mechanism designed to attack the biofilm produced by P. acnes. Our data shows a decrease of inflammatory lesions by 44% and non-inflammatory lesions by 32% after 12 weeks and also provided for a meaningful improvement in the quality of life of the patients in the study. These improvements were achieved with a product that was not associated with burning, chafing, irritation, or erythema, which can be seen with topical treatments. It is apparent from this study that by addressing the biofilm which protects the P. acnes bacteria through the use of the Acne Gel, the incidence of acne symptoms can be greatly reduced, while having no negative impacts on the patients’ skin (ClinicalTrials.gov registry number NCT02404285).
J Drugs Dermatol. 2016;15(6):677-683.
Rachel Seidel BAa and Ronald L. Moy MD FAADa,b
BACKGROUND: Under-eye bags are a common manifestation of age and a frequent complaint among patients who no longer feel youthful.
Non-invasive topical agents are largely ineffective at reducing their appearance.
OBJECTIVE: We studied the ability of a topical serum containing epidermal growth factor (EGF) to minimize the appearance of
METHODS: A single-center clinical trial was performed on eighteen volunteer male and female patients with under-eye bags. Subjects
applied EGF serum to the infraorbital area twice daily for 12 weeks. At each visit, subjects were evaluated using clinical photography
and written self-assessment. A grade on the Merz Infraorbital Hollowness Scale was also given and two independent, blind investigators
assigned an Investigator’s Global Assessment (IGA) score. At the trial’s end, patients shared their final evaluation and perception
of results with a questionnaire.
RESULTS: Sixteen subjects completed the trial. The final average Merz grade was 1.63 (SEM = .273), statistically significantly lower
than the mean baseline average of 2.06 (SEM = .232) (P = .0019). A reduction in average IGA score was also significant (P < .0001).
Average initial IGA was 2.75 (SEM = .270) and average final IGA was 2.00 (SEM = .310). All but two subjects reported improvement
at the final visit. Improvement was quantified as 76-100% by two subjects, 50-75% by three subjects, and 25-49% by nine subjects.
Eleven subjects classified their under-eye bags as milder at the end of the trial compared to the first visit. Seven subjects reported
greater satisfaction with their overall facial appearance. Of the subjects who had used other topical treatments in the past, two
reported the serum to be “significantly better” and four said it was “better” in treating their under-eye bags.
CONCLUSION: Our results offer evidence that topical EGF can reduce the appearance of under-eye bags.
J Drugs Dermatol. 2015;14(4):405-410.
Eric Lee MD, Mina Zarei MD, Charlotte LaSenna BS, Gabriel Villada MD, and Paolo Romanelli MD
INTRODUCTION: Psoriasis is a chronic, inflammatory autoimmune disease that affects about 3% of the general population in the United States with 17% suffering from moderate to severe psoriasis. The disease process is believed to be mediated by tumor necrosis factor (TNF)-α and cytokines secreted by specialized T-cell populations including Interleukin (IL)-17, IL-22, and Interferon (IFN) γ. IL-17 plays an important role in psoriasis. In this study we evaluated the expression of IL-17A in variants of psoriasis including plaque, palmoplantar, scalp, pustular, and guttate subtypes via immunohistochemistry (IHC).
METHODS AND MATERIALS: A search of the University of Miami Dermatopathology database was performed to identify all available patient
specimens within the various subtypes of psoriasis. IL-17A IHC staining was performed using 4 μm paraffin skin sections. 1:25 dilution of IL-17A antibody was used. Stained slides were analyzed using a semi-quantitative scoring method ranging from negative to three plus.
RESULTS: Palmoplantar and pustular psoriasis cases showed consistently strong IL-17A staining. Plaque psoriasis cases showed intermittent
to strong IL-17A staining. The results in the scalp and guttate psoriasis cases showed variable results.
CONCLUSION: The results of our study suggests the significant role of the cytokine IL-17A in the development of palmoplantar and pustular
psoriasis. However, scalp and guttate subtypes showed variable expression from negative to strongly positive, which demonstrates a case by case basis expression of IL-17A. Therefore, exploring the IHC characterization of subtypes of psoriasis will help dermatologists better understand the pathogenesis of each subtype and help clinicians optimize treatments.
J Drugs Dermatol. 2015;14(10):1133-1136.
BACKGROUND: Over-the-counter acne treatments have assumed more importance for the dermatologist as access and affordability of prescription acne medications has decreased.
AIM: This research evaluated the efficacy of a three step acne treatment regimen containing stabilized botanical anti-inflammatory ingredients as compared to a currently marketed acne regimen.
METHOD: 80 female/male subjects 12+ years with mild to moderate acne (at least 10 inflammatory and 10 non-inflammatory lesions) were enrolled for 12 weeks and randomized to use the study botanical anti-inflammatory acne regimen or the traditional benzoyl peroxide
comparator. Evaluations included investigator global assessment, investigator tolerability assessment, acne lesion characteristics (erythema, lesion height, diameter of inflammation, and amount of pus), subject product assessment, and digital photos at baseline, 2, 4, and 12 weeks.
RESULTS: The botanical regimen outperformed the comparator in terms of target lesion erythema, height, inflammation, and pus at weeks 2 and 4, perhaps due to anti-inflammatory ingredients, however parity was reached between the two products by week 12. No difference in lesion counts between the two groups was noted at week 2, however by week 4, there was a lower lesion count with the study regimen in terms of closed comedones (P<0.001) and inflammatory (P=0.016) lesions than the comparator. This statistically significant difference continued into week 12 with a reduction in closed comedones (P=0.006) for the study regimen.
CONCLUSION: Modern OTC cosmetic formulation ingredients including emollients, anti-inflammatory/antioxidants, and sensitive skin modulators provided an improved skin appearance, less lesional erythema, and a better overall appearance in subjects with acne treated for 12 weeks.
J Drugs Dermatol. 2015;14(12):1418-1421.
Linda Stein Gold MD,a William P. Werschler MD,b Jennifer Mohawk PhDc
BACKGROUND: Acne vulgaris affects a diverse group of people, and there is an increasingly wide variety of acne treatments. Because of the many options, clinicians have a better ability to individualize treatment; however, achieving optimal results relies on understanding how various agents perform in specific population segments. Fixed-combination adapalene plus benzoyl peroxide (A/BPO) is a first-line recommended acne therapy and is available in two adapalene concentrations (0.1% and 0.3%) combined with BPO 2.5%. This analysis investigated whether gender and age have an impact on either the efficacy or safety of topical A/BPO 0.3%.
METHODS: A post-hoc subanalysis was performed on data from a multicenter, randomized, double-blind, parallelgroup, 12-week study of A/BPO gel 0.3%/2.5% or vehicle gel in subjects ≥ 12 years old with moderate to severe acne vulgaris (Investigator global assessment [IGA] of 3 or 4). Efficacy measurements included achievement of an IGA of clear (0) or almost clear (1), and change in lesion counts from baseline to week 12. Safety measures included adverse events and cutaneous tolerability. The intent to treat (ITT) and safety populations were analyzed.
RESULTS: The A/BPO gel 0.3%/2.5% treatment group included 217 subjects. Among the subjects, 111 were 12-17 years old and 106 were ≥ 18 years old; 104 were male and 113 were female. A/BPO 0.3%/2.5% was safe, tolerable, and significantly superior to vehicle in success rates (IGA 0 or 1) and reduction of inflammatory/noninflammatory lesions (P≤0.05) across both age groups and genders.
CONCLUSIONS: A/BPO 0.3%/2.5% treatment achieved success and was equally effective and safe in younger vs older subjects and in males vs females. These results support the use of A/BPO 0.3%/2.5% in all subjects 12 and older.
Clinicaltrials.gov registry: (NCT01880320)
J Drugs Dermatol. 2017;16(6):582-589.
Steven R. Feldman MD PhDa and Diana M. Chen MDb
Background: Products that may cause irritation are widely used to treat acne. Irritation has the potential to reduce treatment adherence.
How patients manage irritation and dryness is not well characterized.
Objectives: To study self-reported irritation, its impact and coping mechanisms in patients who had been treated for acne with a
clindamycin-5% benzoyl peroxide (BPO) product.
Methods: An Internet-based survey of 200 subjects, aged 15-40 years who had used a clindamycin-5% BPO fixed combination
product in the last six months on at least 50 percent of their face, at least five days per week.
Results: The majority of subjects (57%) had moderate acne, 28 percent had severe acne. Bothersome side effects of the clindamycin-
5% BPO combination included dry skin (55%), flaky/peeling skin (45%), irritated skin (44%), itchy skin (39%) and redness (37%).
As a result, subjects used the product only as a spot treatment (33%), only when breakouts seemed worse (28%), or less often than
recommended (32%); stopped using from time to time (32%); switched to a different prescription medication and/or an over-thecounter
acne product (28%); or stopped using altogether (10%). 41 percent of subjects reported using moisturizers to counteract
dryness and redness.
Limitations: We queried patients concerning use of combination clindamycin/BPO products and not other products.
Discussion: Irritation to clindamycin-5% BPO is a common problem that reduces patients' use of the medication. Strategies to
improve treatment include communication with patients on possible side effects, providing written instruction on how to manage
irritation and dryness and consideration of alternative topical treatments and treatment regimens.
J Drugs Dermatol. 2011;10(6):605-608.
Ashish C. Bhatia MDa,b and Felipe Jimenez PhDc
The biggest hurdle in the treatment of acne vulgaris is patient non-compliance that is due in large part to poor tolerability to common acne medications. As such, new acne treatments must be developed that balance good anti-acne efficacy with excellent tolerability in order to ensure patient adherence and by extension ensure good clinical outcomes. The goal of the present study was to determine the tolerability and efficacy of a novel skin care system, composed of a cleanser, containing 1% salicylic acid and botanical ingredients, and a treatment gel, containing 1% salicylic acid, 10% buffered glycolic acid and botanical ingredients for the treatment of mild acne. In this single-center, open-label clinical study, 25 male and female volunteers used the test cleanser and test gel twice daily over six weeks. Tolerability assessments showed that the skin care regimen was very well tolerated by all study volunteers. Acne severity was significantly reduced by two acne grades at six weeks. Inflammatory lesion counts were significantly reduced, on average, by 59.06% (P≤ 0.0001), 91.62% (P≤ 0.0001), 90.85% (P≤ 0.0001) and by 98.55% (P≤ 0.0001) at weeks 1, 2, 4, and 6, respectively. Non-inflammatory lesion counts were reduced, on average, by 13.54% (ns), 38.95% (P≤ 0.0001), 44.48% (P≤ 0.0001), and by 56.10% (P≤ 0.0001) at weeks 1, 2, 4, and 6, respectively. Standardized photography also demonstrated a progressive reduction in acne lesions over time. In conclusion, results of the present study suggest that the tested skin care regimen offers rapid acne clearance and excellent tolerability that together may help to improve patient adherence as well as treatment outcome.
J Drugs Dermatol. 2014;13(6):678-683.
Mingliang Zhang PhD,a Chureen Carter PharmD MS,a William H. Olson PhD,b Michael P. Johnson MS,c Susan K. Brenneman PT PhD,c Seina Lee PharmD MS,d Kamyar Farahi PhDe
Background: There is limited research exploring patient preferences regarding dosing frequency of biologic treatment of psoriasis.
Methods: Patients with moderate-to-severe plaque psoriasis identified in a healthcare claims database completed a survey regarding experience
with psoriasis treatments and preferred dosing frequency. Survey questions regarding preferences were posed in two ways: (1) by
likelihood of choosing once per week or 2 weeks, or 12 weeks; and (2) by choosing one option among once every 1-2 or 3-4 weeks or 1-2
or 2-3 months. Data were analyzed by prior biologic history (biologic-experienced vs biologic-naïve, and with one or two specific biologics).
Results: Overall, 426 patients completed the survey: 163 biologic-naïve patients and 263 biologic-experienced patients (159 had some experience
with etanercept, 105 with adalimumab, and 49 with ustekinumab). Among patients who indicated experience with one or two biologics,
data were available for 219 (30 with three biologics and 14 did not specify which biologic experience).
The majority of biologic-naïve (68.8%) and overall biologic-experienced (69.4%) patients indicated that they were very likely to choose the least
frequent dosing option of once every 12 weeks (Table 1). In contrast, fewer biologic-naïve (9.1% and 16.7%) and biologic-experienced (22.5% and
25.3%) patients indicated that they were very likely to choose the 1-week and 2-week dosing interval options, respectively. In each cohort grouped by
experience with specific biologics, among those with no experience with ustekinumab, the most chosen option was 1-2 weeks. The most frequently
chosen option was every 2-3 months, among patients with any experience with ustekinumab, regardless of their experience with other biologics.
Conclusions: The least frequent dosing interval was preferred among biologic naïve patients and patients who had any experience with
ustekinumab. Dosing interval may influence the shared decision-making process for psoriasis treatment with biologics.
J Drugs Dermatol. 2017;16(3):220-226.
Emil A. Tanghetti MD, Carolyn Hamann MBA, and Margo Tanghetti BS
INTRODUCTION: Topical Fluorouracil 5% cream (5-FU) and 20% aminolevulinic acid (ALA)/ photodynamic therapy (PDT) are both FDA approved
for the treatment of Actinic Keratosis (AK). We have studied the use of these 2 agents alone and in a sequential manner. We have also used a 5-FU re-challenge 3 months after treatment to highlight the efficacy of these treatments.
METHODS: This was an investigator-blinded randomized study in which 30 patients were randomized 1:1:1 into the following groups: Group 1 patients pretreated for 6-7 days with 5-FU, ALA applied with incubation of 2 hours, ALA removed with wet gauze, illuminated treated areas with 10 J/cm2 with Blu-U device; Group 2 patients treated with 5-FU BID for 6-7 days and no ALA/PDT; Group 3 patients received no pretreatment, ALA applied with incubation of 2 hours, ALA removed with wet gauze, illuminated treated areas with 10 J.cm2 with Blu-U device. Patients were seen at screening/baseline, treatment for ALA/PDT, 24 hours post treatment, 1 week post treatment
and 3 months post treatment. All subjects were then given a re-challenge course of 5-FU for 6 days and reassessed.
RESULTS: AK counts in all groups were dramatically decreased and similar at 1 and 3 months post treatment. The re-challenge brought a significant difference with many subclinical lesions in the area of activity in the ALA and 5-FU alone groups.
CONCLUSIONS: All three arms appeared equal in treating visible AKs. These data strongly suggests a synergistic role of 5-FU with ALA/PDT over ALA/PDT or 5-FU alone in treating the subclinical lesions demonstrated on a 5-FU re-challenge. Treatment of these subclinical lesions should result in a longer remission. The data also suggests that a 5-FU re-challenge could be a clinical tool to judge the efficacy of treatment for AK if these subclinical lesions are proven to be an AK precursor.
J Drugs Dermatol. 2015;14(11):1241-1244.
Jennifer Krejci-Manwaring MD, Martha Ann McCarty MS PA-C, Fabian Camacho MS MA, Janeen Manuel PhD,Jennifer Hartle MPH, Alan Fleischer Jr MD, Steven R. Feldman MD PhD
Background: Hand dermatitis is a chronic inflammatory skin disorder for which systemic immunosuppressive therapy is
often needed. Topical treatments could complement the use of systemic corticosteroids.
Objective: To evaluate symptoms of hand dermatitis in subjects treated with a prednisone taper combined with topical
tacrolimus 0.1% ointment versus vehicle.
Methods: Thirty-two subjects with moderate to severe hand dermatitis were enrolled in a randomized double-blind controlled
trial. Subjects received a 3-week taper of prednisone and was randomized 2:1 to apply topical tacrolimus or its vehicle
twice daily for 12 weeks. Disease severity was evaluated at baseline and at 5 follow-up visits (weeks 1-14). Any
occurrence of relapse was recorded by patients.
Results: Twenty-two of the 32 subjects (69%) had relapse of their disease. The mean time to recurrence for tacrolimus
versus vehicle was 48 versus 39 days, respectively (P=.78). A greater improvement of induration (P=.003) and scaling
(P=.003) for patients with tacrolimus compared to vehicle was detected, as well as subjective improvement (%) from week
1 to week 12 (P=.04) compared to vehicle. Improvement in erythema (P<.0001), fissuring (P=.0003), pruritus (P=.06),
and investigator’s global assessment (P<.0001) with tacrolimus was not found to exceed improvement with vehicle.
Limitations: Small sample size provides limited power to detect differences in response.
Conclusions: Topical tacrolimus improves induration and scaling, and there is a trend suggesting it prolongs the time to
Objective: This clinical study assessed the safety and efficacy of an investigational topical product for the treatment of onychomycosis (nail fungus).
Method: A prospective, multi-center, single-arm, self-controlled clinical investigation was done with adult subjects that met the inclusion criteria, primarily culture-confirmed dermatophyte infection of at least one great toe. Subjects self-treated in a weekly regimen of topical application for six months, with clinical assessment at one, three, and six months. Primary efficacy endpoint was clearance of fungal nail infection after six months of weekly treatment. Primary safety endpoint was freedom from product-related adverse events for the duration of the treatment term.
Results: Fifty males and 13 females, ages 24 to 65, infected with Trichophyton (n=62) or Epidermophyton (n=1) were enrolled; 53 completed six months of assessment. Sixty percent showed improvement in clinical parameters (nail color, nail plate involvement, onycholysis, thickness, and hyperkeratosis) at six months. Cumulative rates of dermatophyte-negative culture results (test of cure) were 28, 36, and 62 percent of subjects after one, three, and six months of treatment, respectively. Three minor adverse events were device-related, with no unanticipated or serious adverse events.
Limitations: This study was single-arm and self-controlled; 53 of 63 enrolled subjects completed the study.
Conclusion: This study describes a new topical medical device with safety and efficacy profiles that compare favorably to results reported for topically applied onychomycosis drug treatments.
J Drugs Dermatol. 2011;10(10):1186-1191.
Palak Patel MS,a Hsien-Chang Lin PhD,b,c Steven R. Feldman MD PhD,d Alan B Fleischer Jr MD,d Milap C. Nahata MS PharmD,e Rajesh Balkrishnan PhDb,c
Background: Acne is a common condition for which multiple treatment options are available. The patterns of pharmacotherapy for
acne and similar conditions, and the effect of those patterns on cost, are not well characterized.
Objective: This study examined the impacts of patient demographics and medication choices on patients' health status and associated
Methods: A retrospective cross-sectional study was conducted using the 2007 Medical Expenditure Panel Survey (MEPS) database.
Information on patient demographics, health status, medication utilization and medication costs was obtained from the database
representing 3,784,816 patients with acne and similar conditions.
Results: Weighted multiple linear regression analyses indicated that the use of topical retinoids was preferred in combination with
other treatments rather than as monotherapy. Oral antibiotics were widely prescribed and their use was associated with a significant
decrease in total annual prescription spending. Use of oral retinoids and oral contraceptives increased the annual prescription costs
significantly. Increase in annual drug refills was not associated with the improvement in health status.
Conclusion: We observed an association with medication choice for acne and acne-related conditions on medication spending. Pharmacologic
treatment of acne significantly adds to acne-related annual healthcare costs compared to non-pharmacologic treatment.
J Drugs Dermatol.2011;10(7):766-771.
Steven R. Feldman MD PhD,a Shonda A. Foster PharmD MS,b Baojin Zhu PhD,b Russel Burge PhD,b,c Sarah Al Sawah PhD,b and Orin M. Goldblum MDb
BACKGROUND: Newer psoriasis treatments can achieve greater levels of effcacy than older systemic therapies; however, current pso-riasis costs are substantial. We sought to estimate costs per additional responder associated with ixekizumab and etanercept, versus placebo, using effcacy data from phase 3 clinical trials (UNCOVER-2 and UNCOVER-3).
METHODS: In UNCOVER-2/UNCOVER-3, patients received subcutaneous placebo, etanercept 50 mg twice weekly (BIW), or ixekizumab one 80 mg injection every 2 weeks (Q2W) after a 160-mg starting dose. Twelve-week induction-phase Psoriasis Area and Severity Index (PASI) 75, PASI 90, and PASI 100 response rates for ixekizumab, etanercept, and placebo were obtained from pooled data from the overall and United States (US) subgroup intention-to-treat (ITT) populations, and used to calculate numbers needed to treat (NNTs) to achieve one additional PASI 75, PASI 90, or PASI 100 response for ixekizumab Q2W and etanercept BIW versus placebo. Twelve-week drug costs per patient were calculated based on the UNCOVER-2/UNCOVER-3 dosing schedule and wholesale acquisition costs. Mean costs per additional responder for PASI 75, PASI 90, and PASI 100 for each treatment versus placebo were calculated for pooled UN-COVER-2/UNCOVER-3 overall and US subgroup ITT populations.
RESULTS: Pooled overall ITT population: costs per additional PASI 75, PASI 90, or PASI 100 responder were US $37,540, US $46,299, or US $80,710 for ixekizumab Q2W and US $57,533, US $120,720, or US $404,695 for etanercept BIW, respectively. US subgroup ITT population: costs per additional PASI 75, PASI 90, or PASI 100 responder were US $38,165, US $49,740, or US $93,536 for ixekizumab Q2W and US $69,580, US $140,881, or US $631,875 for etanercept BIW, respectively.
CONCLUSIONS: Twelve-week costs per additional responder were lower for ixekizumab Q2W than for etanercept BIW across all levels of clearance (PASI 75, PASI 90, and PASI 100) in the pooled UNCOVER-2/UNCOVER-3 overall and US subgroup ITT populations.
J Drugs Dermatol. 2017;16(12):1246-1252.
Nevien A. Sami PhD, Abeer T. Attia PhD, Ashraf M. Badawi
Background: Achieving an effective management of acne vulgaris with minimal complications remains a difficult challenge
for physicians. Moreover, the rise in antibiotic-resistant strains reduce the future usefulness of current mainstay therapies,
and accordingly, the need for alternative therapies is mandatory. Phototherapy has been shown to be an effective
treatment for acne, and there has been a renewed interest in photodynamic therapy as a treatment modality for this condition.
Objectives: To evaluate the effectiveness of pulsed dye laser (PDL), intense pulsed light (IPL) and light-emitting diode
(LED) phototherapy for the treatment of moderate to severe acne vulgaris.
Methods: Forty-five patients with moderate to severe acne were randomly divided into 3 equal groups. Group 1 was treated
with a PDL, group 2 was treated with IPL, and group 3 was treated with a blue-red combination LED. Treatment was continued
until a ≥90% clearance of patient lesions was achieved. Clinical assessments were conducted before starting treatment,
at 1 month as a midpoint evaluation, and after the final treatment session.
Results: Patients treated with the PDL reached a ≥90% clearance of their inflammatory lesions after a mean of 4.1±1.39
sessions, while patients treated with IPL required a mean of 6±2.05 sessions. Patients treated with the LED required a
mean of 10±3.34 sessions. At the mid-point evaluation, the percent reduction in acne lesions treated with the PDL was
90% or more, in cases of IPL and the LED, the percent reductions were 41.7% and 35.3%, respectively. Laser and light
phototherapy sessions were well tolerated with minimal adverse events experienced as being mild and usually self-limiting.
Conclusions: The encouraging results of the present study contributes evidence of phototherapy as useful therapeutic option
for treatment of moderate to severe acne, and validates further studies to evaluate treatments with a larger number
of patients and for a longer period of follow-up.
Anish Nadkarni BS, Mohammed D. Saleem MD, and Steven R. Feldman MD PhD
BACKGROUND: Topical corticosteroids are the most common dermatologic medications and are available in numerous different vehicles. Adherence is limited by traditional vehicles because they are messy and time consuming to apply. The preferred spray formulations have the advantage of being applied with ease, resulting in improved adherence and subsequently improved psoriasis. One limitation of topical treatments, especially spray vehicles, is the potential for irritation and sensitization.
OBJECTIVE: To evaluate the irritation and sensitization potential of topical desoximetasone spray formulation.
METHODS: A multicenter, double-blinded, randomized, controlled study assessed the irritancy and sensitization of 0.25% and 0.05% topical desoximetasone spray. Controls included vehicle, a positive control (0.1% sodium lauryl sulfate), negative control (0.9% saline), and an active comparator control (clobetasol spray). The primary outcome of the study was to evaluate the difference in mean cumulative irritation and potential sensitization response of desoximetasone 0.25% and 0.05% topical sprays.
RESULTS: Of the 297 enrolled, 269 completed the study per protocol for the irritation phase and 250 completed the protocol for the sensitization phase. At 22 days, desoximetasone 0.25 and 0.5% spray were less irritating than clobetasol 0.05% spray; mean irritation score difference of -0.46 and -0.57, respectively. Median total irritation score over the 22 days was 0 for all products. No subjects demonstrated any sensitization reaction to any of the six products. No serious adverse reactions were reported.
LIMITATIONS: Selection bias, use of a healthy population, limits the external validity. In addition, the duration of the study was short lived, unlike numerous inflammatory skin diseases.
Conclusions: Desoximetasone spray has little potential for irritation or sensitization. The availability of another spray option for patients desiring less messy treatment may facilitate better adherence and treatment outcomes.
J Drugs Dermatol. 2017;16(8):755-758.
Steven R. Feldman MD PhD,a William J. Eastman MD,b Thomas Brundage MS,b and Mary Mills BSb
BACKGROUND: Calcipotriene ointment and cream are effective treatments for psoriasis, but many patients with scalp psoriasis prefer lighter, less messy vehicles.
OBJECTIVES: To evaluate the efficacy and safety of calcipotriene foam, 0.005%, for plaque-type psoriasis of the scalp.
METHODS: Subjects (n=363) were randomized into an 8-week, multicenter, double-blind, vehicle-controlled, parallel-group, phase 3b study of calcipotriene foam, 0.005% (NCT01139580). Primary end point was the proportion of subjects with an Investigator's Static Global Assessment (ISGA) score of 0 (clear) or 1 (almost clear) at week 8 for scalp involvement. Body involvement, target lesion score, and improvement for erythema, scaling, and plaque thickness were also assessed.
RESULTS: At week 8, more subjects in the calcipotriene foam, 0.005% group (40.9%) met the primary end point vs the vehicle foam group (24.2%; intent-to-treat [ITT] population; P<.001); a significant difference between groups was also observed at weeks 2 (P=.041) and 4 (P<.001). No significant difference was observed between treatment groups for ISGA of body psoriasis (ITT population; P=.544). In the per-protocol population, but not the ITT population, more subjects in the calcipotriene foam, 0.005%, group than the vehicle foam group met the secondary end points for scaling (P=.019) and plaque thickness (P=.027). Incidence of adverse events in both treatment groups was low; calcipotriene foam, 0.005%, was associated with erythema.
Limitations: An 8-week study provides limited safety and efficacy data.
CONCLUSION: Calcipotriene foam, 0.005%, was more effective than vehicle foam for improving scalp psoriasis over an 8-week period, with improvements evident from week 2, and had a similar safety profile to vehicle foam.
J Drugs Dermatol. 2013;12(3):300-306.
Cindy Wassef BA,a Adriana Lombardi MD,b Sairah Khokher MD,c and Babar K. Rao MDc
INTRODUCTION: Vitiligo is a condition caused by the destruction of melanocytes, resulting in areas of skin without pigmentation. While many
topical therapies exist for its treatment, not all patients respond to such treatments. Various surgical, laser and other alternative therapies
are available for use as well.
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.
Linda Stein Gold MD,a Leon Kircik MD,b Joseph Fowler MD,c Jerry Tan MD,d Zoe Draelos MD,e Alan
Fleischer MD,f Melanie Appell MD,g Martin Steinhoff MD,h Charles Lynde MD,i
Hong Liu MSc,j and Jean Jacovella MDk
on behalf of the Ivermectin Phase III Study Group
BACKGROUND: Treatments for papulopustular rosacea (PPR) are limited.
OBJECTIVE: To demonstrate the efficacy and safety of once-daily ivermectin 1% cream in subjects with moderate to severe PPR.
METHODS: Two identically designed, randomized, double-blind, controlled studies of ivermectin 1% cream (IVM 1%) or vehicle once daily for 12 weeks were conducted in subjects with moderate to severe PPR. Efficacy assessments were Investigator's Global Assessment (IGA) of disease severity and inflammatory lesion counts. Safety assessments included incidence of adverse events (AEs) and local tolerance parameters. Subjects evaluated their rosacea and completed satisfaction and quality of life (QoL) questionnaires.
RESULTS: In both studies, a greater proportion of subjects in the IVM 1% group achieved treatment success (IGA “clear” or “almost clear”): 38.4% and 40.1% vs 11.6% and 18.8% for vehicle (both P<.001), respectively. Ivermectin was superior to vehicle in terms of reduction from baseline in inflammatory lesion counts (76.0% and 75.0% vs 50.0% for both vehicle groups, respectively). For all endpoints, starting at week 4 and continuing through week 12, IVM 1% was statistically significantly superior (P<.001). Fewer subjects treated by IVM 1% reported dermatologic AEs, and a higher proportion of subjects were observed to have no skin dryness or itching compared to vehicle. Significantly more subjects receiving IVM 1% reported having an “excellent” or “good” improvement, along with an improved QoL.
CONCLUSION: Ivermectin 1% cream was effective and safe in treating inflammatory lesions of papulopustular rosacea.
J Drugs Dermatol. 2014;13(3):316-323.
Yujie Feng, Junying Zhao, Michael H. Gold MD
Background: Skin aging consists of photoaging and intrinsic aging. It is characterized clinically not only by rhytides, but
also by pigmentary alterations and facial telangiectasias. There continues to be a growing interest in the efficacy of intense
pulsed light (IPL) devices in the treatment of skin aging, as well as further defining its mechanism of action.
Objectives: The objective of this clinical trial was to evaluate the effects and the mechanism of action of an IPL by comparing
clinical photographs and biopsy results before and after treatment.
Methods: A total of 58 patients were treated using a new IPL device. Clinical photographs were taken before treatment
and compared to those taken 3 weeks after the treatment. Also, 4 cases had pathological analyses of tissues that were stained
by haematoxylin-eosin and Uana orcein. Immunohistology of human collagen of types 1 and 3 and quantitative analyses
of elastin and collagen were performed by a poly-functional digital image light microscope; a transmission electron
microscope was used for 2 of the cases to look for additional changes.
Results: After 3 treatments, 62.1% of the patients showed improvement in wrinkles and skin texture. Pigmentation improved
in 84.6% of the patients, and a reduction in telangiectasis was seen in 81.25% of the patients. Pathological examination
showed that both type 1 and type 3 collagens increased following treatment, but elastin content decreased;
however, the elastin fibers were arranged more neatly. In the transmission electron microscope study, the amount of
fibroblast activity increased, the fibroblasts were more active, and there were more collagen fibers neatly rearranged within
Conclusion: Clinical and pathological studies demonstrated that the IPL was effective in improving wrinkles and skin
texture. The mechanism of action may be through the increasing activity of the fibroblasts, hyperplasia of the fibroblasts,
and rearrangement of both collagen and elastin within the stroma.
Mark S. Nestor MD PhDa and Glynis R. Ablon MDb
Background: Studies on the pharmacodynamics of abobotulinumtoxinA (ABO) and onabotulinumtoxinA (ONA) have produced inconsistent results. This may be due to the lack of objective measurement methods.
Objective: To assess and compare pharmacodynamic attributes, including onset of action, spread and efficacy of ABO and ONA using a novel Frontalis Activity Measurement Standard (FMS) and 4-point Frontalis Rating Scale (FRS).
Methods: Twenty subjects with severe frontalis lines at maximum elevation received equal volumes of ABO or ONA using a dose ratio of 2.5:1 in five injection points on contralateral sides of the frontalis (statistical n=40). Subjects were evaluated using the FMS and FRS for 30 days using pre-defined endpoints for onset and effectiveness. Other assessments included areas of effectiveness and injection pain.
Results: For ABO vs. ONA, the FMS revealed a median Initial Onset of 12 vs. 48 hours (P<0.001), Full Onset of 24 vs. 72 hours (P<0.001) and Complete Onset of three vs. five days (P=0.01). The FRS indicated an Initial Onset for ABO and ONA of 18 hours vs. two days (P=0.002), Full Onset of two vs. three days (P=0.001) and Complete Onset of four days vs. eight days (P=0.01). The FMS showed 90 percent of ABO treatment achieved Complete Efficacy vs. 75 percent for ONO, while 90 percent of ABO treatments reached Complete Efficacy using the FRS vs. 65 percent for ONO. No differences in area of effectiveness or spread were observed. Most subjects (80%) reported ABO injections were less painful than ONA injections (P<0.05).
Conclusion: The FMS appears to be a sensitive, objective tool for measuring ABO and ONA pharmacodynamics. Using a dose ratio of 2.5:1, ABO displayed significantly earlier onset of effect and less injection pain than ONA but similar areas of effectiveness.
J Drugs Dermatol. 2011;10(10):1148-1157.
Joel L. Cohen MDa and Roy Geronemus MDb
BACKGROUND & OBJECTIVE: Surgical scars are an unwanted sequela following surgical procedures. Several different treatment modalities and approaches are currently being employed to improve the cosmesis of surgical scars with each having varying degrees of success. The objective of this study was to assess the ef cacy and safety pulsed dye laser treatment, CO2 ablative fractional resurfacing, and a combined treatment with these two modalities for the cosmetic improvement of surgical scarring that occurred following the surgical removal of skin cancer from different anatomic areas.
MATERIALS AND METHODS: Twenty-five patients with surgical scarring most frequently on the face following recent surgical excision of skin cancer with Mohs surgery were included in this multicenter, prospective clinical study. Patients were randomized into 4 treatment arms, namely, pulsed dye laser alone, CO2 laser alone, a combined treatment with these two modalities, and CO2 ablative fractional resurfacing on the same day of surgery to half of the scar, followed by a combined treatment with the two modalities to that half of the scar. Patients in each study arm received a total of 3-4 treatments, while those patients in Arm 4 underwent an additional treatment with CO2 laser immediately after surgery. Patients were followed up at 1 and 3 months after the final treatment session.
RESULTS: No adverse events were seen. Significant improvements in the appearance of scars were achieved in all study arms, as as- sessed by the Vancouver Scar Scale and Global Evaluation Response scales, with the best clinical outcomes seen in those scars that underwent a combination treatment. All patients reported very high satisfaction from treatment.
CONCLUSION: Both pulsed dye laser treatment and CO2 ablative fractional resurfacing, when used as a monotherapy, are safe and effective in the treatment and improvement of recent surgical scarring. When both of these modalities are used in combination, however, they appear to potentially have a synergistic effect and an accelerated outcome on the cosmesis of recent surgical scars.
J Drugs Dermatol. 2016;15(11):1315-1319.
Infliximab is a chimeric monoclonal antibody, which acts by binding to both the soluble and membrane-bound tumor necrosis factor-a. In clinical practice, it is used as either monotherapy or in combination with other systemic therapies, particularly methotrexate. This study reviews clinical response and adverse events in 120 psoriasis patients with moderate-to-severe psoriasis who have received infliximab for a minimum of one year. The medical records of 120 infliximab-treated psoriasis patients at our referral psoriasis clinic in Dallas between 2002-2008 were reviewed for response rates, side effects and concomitant therapies. Of 120 charts reviewed, 112 (93%) patients had plaque type psoriasis, six (5%) had recalcitrant palmoplantar disease and two (1.6%) had severe acropustulosis of Hallopeau. Eighty-four (70%) patients had symptomatic psoriatic arthritis. The mean follow-up time was 2.2±1.1 years. One hundred and nine (91%) of the 120 patients had clearance of their psoriasis (response of more than 90% of initial BSA) at a median time of 12 weeks. Concomitant systemic treatments, primarily methotrexate, were given to 62 (52%) patients. Nineteen patients (16%) discontinued infliximab in the post-one-year treatment period for a variety of reasons, primarily failure to maintain adequate response. One hundred and four (87%) of patients required more than the standard dose of 5 mg/kg every eight weeks to maintain clearance. Infliximab either as monotherapy or in combination with traditional antipsoriatic agents is an effective and well-tolerated treatment option
for patients with moderate to severe psoriasis and psoriatic arthritis on therapy for over one year and continuing for the long term.
J Drugs Dermatol. 2011;10(5):539-544.
Guy Webster MD PhD, Phoebe Rich MD, Michael H. Gold MD, Serena Mraz MD, Barry Calvarese MS, Diana Chen MD
Background: Oral antibiotics are commonly prescribed for moderate or severe acne, but there may be limitations due to concerns
about side effects associated with systemic treatments.
Objective: To evaluate the efficacy and safety of a fixed combination clindamycin phosphate 1.2% and benzoyl peroxide 2.5%
(clindamycin-BP 2.5%) aqueous gel in the treatment of moderate or severe acne subpopulations.
Methods: Two multicenter, double-blind studies randomized 2,813 subjects with moderate or severe acne to clindamycin-BP 2.5%
gel, each active ingredient, or vehicle gel, once daily for 12 weeks. Efficacy evaluations included inflammatory and non-inflammatory
lesion counts and evaluator’s global severity score at baseline and weeks 4, 8 and 12. Adverse events and subjects’ evaluations of
product tolerability were also monitored. Subpopulation efficacy and safety analyses by baseline acne severity were performed for
the combined data from the two phase 3 studies.
Results: Clindamycin-BP 2.5% gel significantly reduced inflammatory, non-inflammatory and total lesions compared with each active
ingredient and vehicle in subjects with moderate acne and compared with vehicle in severe acne subjects at week 12. Significant
improvements in evaluator’s global severity score were evident for subjects with moderate acne in the clindamycin-BP 2.5% group
compared with each active ingredient and vehicle and compared with vehicle in subjects with severe acne at week 12. Rates of
adverse events were low and similar between treatment groups and baseline acne severity.
Conclusion: Clindamycin-BP 2.5% aqueous gel is an effective and safe once-daily treatment for moderate or severe acne.
Ava T. Shamban MD, Mikiko Enokibori MD, Vic Narurkar MD, Donna Wilson RN
Objective: Treatment of acne vulgaris with light sources necessitates multiple targets including Propionibacterium acnes
and sebaceous glands. Traditional light sources such as blue light capitalize on P acnes bacteria as targets while infrared
lasers and radiofrequency devices target the sebaceous gland. A novel device combining vacuum and a unique broadband
light source was designed to combine multiple targets for the effective treatment of acne. The objective of this study was
to demonstrate the safety and efficacy of a novel device that uses a combination of broadband light and pneumatic energy
for the treatment of acne vulgaris.
Methods: In a retrospective multicenter study, clinical data were collected from 56 patients with mild to severe acne. Patients had been treated 2 to 4 times with a portable photopneumatic device (Aesthera PPx, Aesthera Corporation, Pleasanton, CA) that delivers broadband light (400 to 1200 nm) to the treatment site via a hand piece. For 11 of the 56 photographs taken before and after PPx treatment.
Results: For the 56 patients, the median physician-rated clearance increased from 50% after a single treatment to 90% after the fourth treatment, whereas the median patient-rated clearance improved form 50% after a single treatment to 78% after the fourth treatment. On a 4-point scale, both physician-rated and patient-rated median overall satisfaction levels increased from a 3 after a single treatment, to 4 after the second, third, and fourth treatments. Clinically significant adverse events were not observed. For the 11 patients evaluated by photography, the median papule and pustule lesion counts decreased from 2 to 0, respectively. Median acne severity (Burton scale) decreased from 2 before treatment to 1 after the final treatment (scale 1-4). Adverse events were limited to mild erythema.
Conclusion: Photopneumatic technology provides a safe and effective treatment of mild to sever acne vulgaris.
Peter W. Hashim MD MHS,a Tinley Chen BA,a Julie C. Harper MD,b and Leon H. Kircik MDa,c,d
Background: Azelaic acid demonstrates anti-inflammatory, anti-oxidative, anti-comedogenic, and anti-microbial effects. Azelaic acid 20% cream is currently approved for the treatment of acne vulgaris, and azelaic acid 15% foam has recently been approved for rosacea. Given the favorable tolerability profile of foam preparations, it is reasonable to assume that azelaic acid 15% foam could serve as a viable treatment option for facial acne.
Objective: To examine the efficacy and safety of azelaic acid 15% foam in the treatment of moderate-to-severe facial acne
Methods: Twenty subjects with moderate-to-severe facial acne vulgaris were enrolled in this two-center, open-label pilot study. All study subjects were treated with azelaic acid 15% foam for 16 weeks. Efficacy analyses were based on the change in facial investigator global assessment (FIGA) and changes in total, inflammatory, non-inflammatory lesion counts between baseline and week 16.
Results: There was a significant reduction in FIGA scores from baseline to week 16 (p = .0004), with 84% of subjects experiencing at least a 1 grade improvement, and 63% of subjects achieving a final grade of Clear or Almost Clear. All subjects experienced reductions in inflammatory and total lesion counts by week 16, and 89% of subjects experienced reductions in non-inflammatory lesions. Azelaic acid 15% foam was well tolerated, with almost all instances of erythema, dryness, peeling, oiliness, pruritus, and burning being of mild or trace degree, and most adverse effects resolving by the end of the study.
Conclusion: Azelaic acid 15% foam is effective and safe in the treatment of facial acne vulgaris. Given the convenience of foam vehicles, azelaic acid 15% foam should be considered as a viable treatment option for this condition.
J Drugs Dermatol. 2018;17(6):641-645.
Nicole M. Golbari BA,a Martina L. Porter MD,b Alexa B. Kimball MD MPHc
Introduction: Despite a growing arsenal of therapies for psoriasis and, consequently, an increasing number of advertisements for these treatments, many psoriasis patients still remain untreated. While the primary treatment seeking motivations for these patients have been identified, it is unknown if the commercials for the medications designed to encourage patient engagement in treatment are relevant to these concerns.
Methods: Online databases for national television advertisements were searched for psoriasis treatment commercials broadcast between 2000 and 2018. Each advertisement video was viewed 3 times and separately assessed for the content displayed or information conveyed in images, text, and voice-over speech. Additionally, references to known patient motivations for seeking treatment, including concerns about skin symptoms or appearance (embarrassment, scaling/flaking, pain, discomfort, itch, etc.) were recorded.
Results: A total of 20 commercials were assessed. Of those, 100% emphasized “clear skin” as the result of the treatment that was being marketed. Bothersome skin symptoms, however, were less frequently displayed; scaling/flaking, pain/discomfort, and itch were present in 15%, 5%, and 0% of commercials, respectively. Similarly, text or images displaying sadness, shame or covering of skin were in 40%, 45% and 30% the advertisements, respectively. None (0%) of the commercials evaluated displayed images of people scratching or verbally addressed skin itching as a bothersome symptom of psoriasis.
Conclusions and Relevance: While the advertisements assessed in this study did exhibit patient concerns regarding skin appearance, skin symptoms including skin itching, flaking, pain and discomfort were not equally addressed. As these are known factors that motivate psoriasis patients to actively engage in treatment, targeted ads that better demonstrate these concerns may help prompt under-treated patients to seek care.
J Drugs Dermatol. 2018;17(8):886-887.
Michael T. Jarratt MD,a Terry M. Jones MD,b Joan-En Chang-Lin PhD,c Warren Tong PharmD MS,c David R. Berk MD,c Vince Lin PhD,c and Alexandre Kaoukhov MDc
BACKGROUND: Reducing the dosing frequency of topical acne treatments to once daily may improve adherence.
OBJECTIVE: Evaluate pharmacokinetics (PK), safety, and tolerability of 3 formulations of once-daily dapsone gel, 7.5% and of twice-daily dapsone gel, 5% over 28 days in patients with moderate acne vulgaris.
METHODS: This phase 1, multicenter, parallel-group study randomized males and females aged 16 to 35 years to 1 of 3 dapsone gel, 7.5% formulations (DAP-11078, DAP-11079, or DAP-11080 double-blind; applied once daily) or to dapsone gel, 5% (investigator-blinded only, applied twice-daily). Blood samples were collected for PK assessments of dapsone and its metabolites, N-acetyl dapsone (NAD) and dapsone hydroxylamine (DHA), before the morning dose on days 1, 7, 14, 18, 21, 26, 27, and 28, and at several follow-up time points (days 29–32). Safety profile assessments included adverse events (AEs), physical examinations, laboratory tests, and local tolerability assessments.
RESULTS: Steady-state dapsone, NAD, and DHA concentrations were reached within 7 days of the first dose in all treatment groups. Daily systemic exposures of the 3 dapsone gel, 7.5% formulations were approximately 25% to 40% lower than that for dapsone gel, 5%, and these differences were statistically significant. Among the 3 dapsone gel, 7.5% formulations, the highest daily exposure of dapsone (per the AUC) was observed with DAP-11080, with respective Cmax and AUC0-24 being approximately 28.6% and 28.7% lower relative to dapsone gel, 5%.
Most AEs were mild to moderate in intensity. The safety profiles for all 3 formulations of once-daily dapsone, 7.5% gel and twice-daily dapsone gel, 5% were similar following 28 days of topical administration. All 4 dapsone formulations were well tolerated.
CONCLUSIONS: This study demonstrated lower systemic exposure with all 3 once-daily dapsone gel, 7.5% formulations than with twice-daily dapsone gel, 5%. All 4 formulations were well tolerated and demonstrated similar safety profiles.
J Drugs Dermatol. 2016;15(10):1250-1259.
Douglas J. Key MD and Lauren Boudreaux DO
BACKGROUND: Laxity of the eyelid and periorbital area, a common manifestation of aging, is usually addressed via blepharoplasty and/ or fat transfer. Given the trend toward safer, less invasive treatments preferred by those patients reticent to undergo more invasive procedures, viable alternatives have been sought. Transcutaneous temperature controlled radiofrequency (TTCRF) integrates non- invasive super cial RF treatment with automatic temperature feedback control of energy deposition, as a stimulator of overall collagen remodeling; however, the globe of the eye is particularly sensitive to RF energy. The purpose of the study was to propose a method by which TTCRF and other non-ablative modalities could be used to treat eyelid and infrabrow laxity, with autoclavable opaque black haptic scleral contact lenses protecting the globe of the eye.
METHODS: Subjects (n=40, 36 women and 4 men, age range, 33-72) with mild to moderate laxity of the eyelid and infrabrow were treated with TTCRF using black plastic eye shields (Oculoplastik, Montreal, Quebec, Canada) to protect the globe of the eye from heat and RF energy. With the shields in place subjects were treated with the 10 mm small monopolar emitter of the ThermiSmooth device (Thermi, Irving, Tex.), using small circular looping motions to safely elevate the temperature of target tissue to the therapeutically rel- evant range for approximately 6 minutes; tissue temperature was measured in real time using the device’s forward-looking infrared imaging.
RESULTS: No major adverse events were recorded. Treatment was safe and tolerable for all subjects.
CONCLUSION: The use of autoclavable opaque black plastic eye shields provides a safe method of treating the upper eye lid and infrabrow using TTCRF.
J Drugs Dermatol. 2016;15(11):1302-1305.
Brandon Worley MD MSc,a Joel L. Cohen MD FAAD FACMSa,c,d
Background and Objective: Misperceptions have persisted regarding scanning full-field erbium laser that have caused it to be overshadowed by fractional ablative resurfacing. This can lead to sub-optimally treating the periocular and perioral skin. Our report describes the utility of a combined approach of fractional ablative CO2 with full-field erbium ablation for full face rejuvenation. Each laser has a role in creating the optimal outcomes for advanced photoaging in the fewest treatments.
Methods: A patient with severe photodamage and etched-in lines underwent full face fractional ablative CO2 (CO2RE, Syneron Candela) and full-field ablative perioral and periocular erbium laser (Contour TRL, Sciton Inc.). The pre-procedure consultations included evaluation of the severity of the photodamage and etched-in lines, as well as discussion of patient goals and appropriate treatment options. Photos of similar patients and post-treatment recovery were reviewed. Fully ablative lasers are generally avoided in Fitzpatrick skin type IV-VI. Prior to treatment, full face nerve blocks and topical anesthesia was provided. Full facial fractional ablative CO2 laser was then applied in one orthoganol pass to the whole face. This was followed by treating the infraorbital and perioral skin with four passes of full field erbium laser. Visualized residual lines were focally treated. Marked improvement was seen in a single treatment session.
Results: Standardized digital imaging revealed dramatic improvement in skin texture and etched lines.
Conclusion: For appropriately selected patients, combination fractional ablative CO2 and full-field ablative erbium resurfacing for facial rejuvenation is safe, efficacious and merits consideration.
J Drugs Dermatol. 2018;17(7):796-799.
Yael Politi MD,a Assi Levi MD,b,c Igor Snast MD,b,c Dean Ad-EL MD,c,d,e Moshe Lapidoth MD MPH b,c
INTRODUCTION: Acne vulgaris is a common skin disorder with a significant impact on patients' quality of life. There is currently no treatment designated to treat acne lesions and scars concurrently. However, mid-infrared lasers may promote neocollagenesis within atrophic scars, while exerting a beneficial effect on acne lesions.
OBJECTIVES: To determine the safety and efficacy of an integrated cooling-vacuum-assisted non-fractional 1540-nm Erbium:Glass laser for the treatment of acne lesions and scars.
PATIENTS AND METHODS: Twenty-two patients (8 male, 14 female) with mild-to-moderate acne and moderate-to-severe acne scars were included. Patients were treated using a non-fractional 1540-nm Er:Glass laser (Harmony XL™, Alma Lasers Ltd.). Acne lesions and scars were exposed to 3-4 stacked pulses emitted at a rate of 3Hz for up to two passes per treatment session (spot size, 4 mm; fluence, 400-600 mJ/pulse), receiving overall 3-7 treatments with 2-3-week intervals. Patients were followed-up one and three months following their last treatment. Clinical evaluation including (i) overall aesthetic appearance, (ii) acne lesions, and (iii) acne scars, assessed independently by two dermatologists and graded on a scale of 0 (exacerbation) to 4 (76-100 percent improvement); and (iv) pain perception, adverse effects and patients’ satisfaction.
RESULTS: All but one patient completed treatment and follow-up and had moderate-to-significant improvement in all outcomes (overall aesthetic appearance, mean 3.9 [1 month] and 3.75 [3 month] improvement; acne lesions, 3.5 [1 month] and 2.3 [3 month] improvement; scarring 4 [1 month] and 4.2 [3 month] improvement). Pain and adverse effects were mild and transient. Patients' mean satisfaction was 4.2.
CONCLUSION: Cooling-vacuum-assisted 1540 nm laser is a safe and effective modality for the simultaneous treatment of acne lesions and scars.
J Drugs Dermatol. 2018;17(11):1173-1176.
Background: Tumor necrosis factor inhibitors are valuable tools for dermatologists. As their use increases, rare adverse events are more likely to be encountered.
Objective: We describe one patient who developed sarcoidosis while being treated for psoriasis with etanercept. We sought to review to previously reported cases and further characterize the nature of this reaction.
Methods: A literature search was performed with the key words "sarcoidosis, sarcoid, etanercept, infliximab, adalimumab, granulomatous, and drug reaction." All relevant cases in the English language were included and evaluated for demographic data, duration of therapy prior to developing sarcoid, duration of sarcoid signs/symptoms, treatments used and time to resolution after discontinuation of the drug.
Results: Including the present case, there are 34 cases of sarcoidosis developing during anti-tumor necrosis factor therapy. All previously reported cases were patients with a primarily rheumatologic diagnosis. In all but one case, discontinuation of the drug resulted in complete resolution of symptoms. The lung and surrounding lymph nodes were the areas most commonly affected. The average amount of time between initiation of therapy and onset of symptoms was 22 months. The average time to resolution of symptoms after discontinuation of the drug was 5.2 months.
Limitations: This is a retrospective case review.
Conclusions: These data indicated that sarcoid is a possible adverse effect of tumor necrosis factor inhibitor therapy that should be noted by dermatologists using these drugs. While it has been reported in the rheumatology literature, it may be under-recognized by dermatologists.
J Drugs Dermatol. 2012;11(5):609-612.
Han-deng Tu MD,a,b,c Yuan-hong Li MD PhD,b Hong-fu Xie MD,a Jia-mei Xiong MD,c Bing Wang MD,b Xue-gang Xu MD,b La-ga Tong MD,b LiLi MD,b Michael H. Gold MD,d and Hong-Duo Chen MDb
BACKGROUND: Although pulsed dye laser (PDL) has long been regarded as the gold standard in treating port-wine stain (PWS), advanced PWS with deeper coloration may display resistance because of limited penetration depth of 585 or 595-nm light. Recently, a dual-wavelength laser system has been reported to achieve pronounced fading in many patients.
OBJECTIVE: The objective was to evaluate the efficacy and safety of a dual-wavelength laser device in treatment of neck and facial PWS in a direct side-by-side comparison.
METHODS: Sixteen Chinese patients with neck and/or facial PWSs were enrolled in the study. All lesions were randomly divided into two area, treated area and adjacent untreated area. Five successive treatments using a dual-wavelength laser system (595-nm PDL combined with 1,064-nm Nd:YAG laser) were delivered on treated areas at 4- to 6-week intervals. The adjacent area was not treated as self control. Two blinded dermatologists evaluated the clinical changes by comparing the before and after photos. Erythema index (EI) values were measured with a non-invasive instrument.
RESULTS: After five sessions of treatment, over 62.5% (10/16) patients achieved more than 50% (moderate or significant) improvement. The efficacy maintained at the 3-month follow-up visit. The values of EI on treated area showed a significant decrease. Adverse effects of treated area were limited.
CONCLUSION: Using this split-face module, the dual-wavelength laser system is proved to be effective and well tolerated in treating neck and facial PWSs in Chinese patients. Adverse effects were minimal and acceptable.
J Drugs Dermatol. 2015;14(11):1336-1340.
Thomas Bieber MD,a Olivier Chosidow MD PhD,b Neil Bodsworth MD,c Stephen Tyring MD,d
Jana Hercogova MD,e Mark Bloch MD,f Matthew Davis MD,g Michael Lewis MD,h
David Boutolleau MD,i Pierre Attali MD MSc,j and the LIP Study Group
BACKGROUND: Single-day, high-dose systemic antiviral drugs are effective in the treatment of labial herpes (herpes labialis [HL]). Aciclovir
Lauriad® mucoadhesive buccal tablet (ABT) is an innovative drug delivery system providing high and prolonged exposure to aciclovir in
the oral cavity, supporting its evaluation as a single low dose in HL.
METHODS: In this multicenter double-blind placebo-controlled patient-initiated trial, 775 patients with recurrent HL were randomly
assigned to either a single application of ABT 50 mg or a matching placebo as soon as prodromal symptoms occurred. The primary
endpoint was the time to healing (TTH) of primary vesicular lesion (modified intention-to-treat population). Other endpoints included
incidence of blocked episodes, duration of herpes episodes, and incidence and time to next recurrence evaluated during a 9-month
follow-up period (intention-to-treat population).
RESULTS: With ABT 50 mg, median TTH of primary vesicular lesion was reduced (7 days vs 7.3 days, P=.015), the incidence of blocked
herpes episodes was increased by 24.2% (34.9% vs 28.1%; P=.042), and the median duration of herpes episodes was reduced (5.6
days vs 6.4 days, P=.003). During the 9-month follow-up period, recurrence of herpes lesions was less frequent (64.2% vs 73.6%;
P=.027) and delayed (205 days vs 165 days, P=.041) in the ABT 50 mg. Both treatments were safe.
CONCLUSION: A single application of ABT improves all endpoints of HL and might modify its clinical course in decreasing the incidence
and delaying the onset of the next recurrence.
J Drugs Dermatol. 2014;13(7):791-798.
Mark B. Taylor MDa, Jamal S. Yanaki MS EdDb, David O. Draper PhDc, Joe C. Shurtz BSc, and Mark Coglianese PhDc
Background: Treatment of melasma and postinflammatory hyperpigmentation is often challenging. No ideal short-term and long-term treatment is available. Vitamin C alone and in combination with iontophoresis has been studied and found to be useful; however, no long-term studies have been published.
Methods: In this study, 35 patients (34 female, 1 male) were treated with a novel full-face iontophoresis mask (FFIM) and a proprietary vitamin C (ascorbyl glucoside) preparation. Patients received one in-office treatment and 12 to 24 at-home treatments over 1 to 2 months in conjunction with a strict maintenance regimen consisting of a mandelic/malic acid skin care regimen, broad-spectrum ultraviolet A/ultraviolet B sunblock, a wide-brimmed hat, and sun-avoidance behavior. Follow-up after the initial in-office treatment ranged from 1 to 54 months (mean, 26 months). Four independent observers graded improvement of melasma and PIH using a 4-point scale. Before the study, high-performance liquid chromatography was used to verify iontophoretic penetration of vitamin C into the skin to a level of 0.2 cm in healthy volunteers (2 male, 2 female).
Results: A mean 73% improvement in abnormal pigmentation was observed at the end of FFIM/vitamin C treatment. Greater than 25% improvement was observed in 32 of 35 patients, and greater than 50% improvement in 22 of 35 patients. Melasma Area and Severity Index scores demonstrated substantial improvement from baseline for all patients, with a mean improvement of 15.7.
Conclusions: Full-face iontophoresis of vitamin C appears to be an effective short-term treatment for melasma and postinflammatory hyperpigmentation. A protocol of strict sun avoidance in combination with a mandelic/malic acid skin care regimen appears to be useful in maintaining the improvement.
J Drugs Dermatol. 2013;12(1):45-50.
Welf Prager MD,a Karla Agsten MD,b Maria Kravtsov MSc,c and Prof. Martina Kerscher MDd
BACKGROUND: Injection of hyaluronic acid (HA) volumizing fillers in the malar area is intended for rejuvenation of the mid-face. The choice of products, depth, and technique of injection depends on the desired level of volume enhancement and practitioners’ preferences.
OBJECTIVE: To describe a volumizing injection technique in the scope of a controlled, randomized, double-blind, single-center, split-face clinical study.
Materials & Methods: A total of 45 subjects with bilateral symmetrical moderate to severe volume loss in the malar area received a single 2 mL injection of CPM®-26 (Cohesive Polydensified Matrix®) on one side and VYC®-20 (VYCROSS®) on the contralateral side of the face. The same injection technique was applied for both sides of the face. Use of anesthetics, overcorrection, and touch-ups were not permitted. The investigator completed a product satisfaction questionnaire. Adverse events (AE) and injection-site reactions (ISRs) were reported during the study.
RESULTS: The products were placed at the epiperiosteal depth in 88.9% (n=40), at the subdermal depth in 8.9% (n=4) and at both levels in 2.2% (n=1) of subjects. Fanning technique using cannulae was applied in most cases (97.8%, n=44). Results of the investigator satisfaction questionnaire allowed to characterize CPM-26 in comparison to other volumizing gels. Both study products were generally well tolerated. Local reactions were transient and of mild to moderate intensity, with the most frequent ones being redness, pain, and swelling.
CONCLUSION: Adequate injection technique in volumizing treatments is essential to create a natural aesthetic rejuvenation while respecting the safety aspect of the procedures. A 22G blunt cannula used with CPM-26 was preferred due to an easier and a more homogeneous distribution of the product. The investigator also appreciated CPM-26 for its ease of injection, positioning, lifting, and volumizing capacity.
J Drugs Dermatol. 2017;16(4):351-357.
Christy C. Riddle MD, Shaundre N. Terrell BS, Molly B. Menser DO, Daniel J. Aires MD,Eric S. Schweiger MD
Background: Photodynamic therapy (PDT) is increasing in dermatology. Antibiotic resistance and the challenges of isotretinoin
therapy have led to investigation of PDT in the treatment of acne vulgaris.
Objective: To review the results of clinical trials and case series with respect to light source, topical photosensitizing agent, adverse
events, efficacy and skin type.
Methods: A non-critical review is presented of a PubMed search for studies examining PDT in the treatment of acne vulgaris.
Results: The authors found 21 clinical trials and case series of various designs. Eight studies employed a split-face design comparing
photosensitizer to placebo, no treatment or another photosensitizer. Two trials used three test spots and one control spot per patient.
Three studies utilized control subjects receiving no photosensitizer with or without light therapy. All 21 studies reported a reduction in
inflammatory lesions and/or a significant improvement in acne. The light sources utilized included blue light, pulsed-dye laser (PDL),
intense pulsed light (IPL) and red light. Studies comparing the use of PDT to light therapy alone demonstrated greater improvement
in treatment groups pretreated with a photosensitizer.
Conclusion: All studies reported reduction in inflammatory lesions or significant improvement in acne. Several studies confirm a
light source combined with photosensitizer is sup