Background: 5-fluorouracil (5-FU) and imiquimod creams are accepted topical therapies for actinic keratosis (AK). Both are associated with a prolonged course of treatment with an inflammatory response that may preclude the treatment process. Objectives: To describe the treatment regimen and the extent of side effects in the use of the combined application of 5-FU and imiquimod creams in patients presenting with AKs and to demonstrate the convenience and ease of the methodology of this regimen. Methods: The patients applied 5-FU and imiquimod creams to their lesions daily for one week each month over the course of 3 months. The patients were seen after the completion of each one-week course to evaluate their progress and side effects. Results: There were 64 patients in the study, 48 of whom completed the study and demonstrated a clearing of their AKs by the end of the third course of treatment. All of the patients developed an inflammatory response at the sites of their AKs as well as at subclinical sites with no apparent AKs. Nearly all of these inflammatory reactions were confined to localized sites without involvement of the surrounding skin. Conclusions: Therapy with the combined application of 5-FU and imiquimod creams is a relatively rapid and convenient form of therapy as compared to the separate use of each medication.
Noah Scheinfeld MD, Maurice J. Dahdah, Richard Scher MD
Nail health and appearance are global concerns. We investigated the use of biotin vitamin E, alpha-tocopherol, vitamin
C (ascorbic acid), vitamin A, retinoids, retinol, retinal, silicon, zinc, iron, copper, selenium, and vitamin B12 (Cyanocobalamin)
in nail health and disease. The evidence that we adduce in this paper suggests that: 1) proper nail care seems to
help maintain nail health; 2) no evidence supports the use of vitamin supplementation with vitamin E, vitamin C (ascorbic
acid), vitamin A, retinoids, retinol, retinal, silicon, zinc, iron, copper, selenium, or vitamin B12 (Cyanocobalamin)
for improving the nail health of well-nourished patients or improving the appearance of nails affected by pathologic disease;
and 3) brittle nail syndrome appears to abate with supplementation with a 2.5-mg dose of biotin daily or a 10-mg
dose of silicon daily, a useful form of which is choline-stabilized orthosilicic acid.
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.
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.
Kelley Pagliai Redbord MD, C. William Hanke MD MPH FACP
We present a safer, more efficient, and more effective technique for full-face dermabrasion utilizing a combination of regional
nerve block anesthesia, refrigerant spray cryoanesthesia, and local infiltration anesthesia. This combination provides
a pain-free procedure with little to no discomfort for the patient while avoiding the risks of intravenous sedation
or general anesthesia.
Tom van Eijk MD, Martin Braun MD
Nonanimal Stabilized Hyaluronic Acid (NASHA) has proven itself as one of the safest, most versatile dermal fillers with
a high patient and physician satisfaction. The authors describe a novel technique to inject Restylane (NASHA) in the
dermis for optimal correction of dynamic facial lines. Mobile facial folds represent a greater challenge for correction using
standard injection techniques. The injection technique described is named the Fern Pattern Technique. The purpose of
the Fern Pattern Technique is to use Restylane in such a way that it becomes a skin stiffening agent, rather than a simple
filler in order to provide optimal correction for lines that deepen with expressive facial movements. The Fern Pattern
Technique also uses less material to provide a correction that is not visible at rest or during dynamic movement for
lines that deepen during a smile, as well as the dynamic lower nasolabial fold.
Yaxian Zhen MD PhD, Marianne Stoudemayer RN, George Vamvakias, Albert M. Kligman MD PhD
Topical therapies are effective in managing acne vulgaris but are associated with local adverse effects such as irritation
and dryness. This 4-week pilot study compared skin hydration in 36 healthy adult women randomized to treatment with
1 of 4 topical therapies: 2 different (jar and tube) clindamycin 1%/benzoyl peroxide 5% gels, sodium sulfacetamide 10%
lotion, or over-the-counter (OTC) moisturizing cream. Subjects treated with OTC moisturizer or sodium sulfacetamide
exhibited decreased water loss, increased water retention, similar or improved levels of skin hydration, and decreased desorption
rates. In contrast, subjects treated with jar or tube clindamycin/benzoyl peroxide had increased water loss, decreased
water retention, decreased hydration, and increased desorption rates. Skin dryness decreased slightly in the moisturizer
group. No serious adverse events occurred. Overall, the OTC moisturizer had the best skin hydration profile. Sodium sulfacetamide
demonstrated some moisturizing characteristics, and no clinically relevant differences were noted between jar
and tube clindamycin/benzoyl peroxide gels.
Ricardo Ruiz-Rodriguez MD PhD, Laura López MD, Daniel Candelas MD, Brian Zelickson MD
Background and Objectives: Conventional ablative resurfacing is the gold standard for removing signs of cutaneous
photodamage. Despite the excellent results one can achieve with this technique, it is accompanied with significant downtime
and risks. Fractional resurfacing and photodynamic therapy (PDT) with aminolevulinic acid (ALA) have been used
to improve the signs of photodamage with less downtime. However, independently they do not yield results as good as
ablative resurfacing. This pilot study will examine the potential for synergistic effects of combining fractional resurfacing
Materials and Methods: Four women with Fitzpatrick skin types II or III, mild to moderate rhytides and no actinic keratosis
in the perioral area were treated. The perioral area was treated with 2 sessions of fractional resurfacing with the Fraxel
SR (formerly Fraxel SR750, Reliant Technologies Inc, Palo Alto, CA) 3 weeks apart. Immediately after each fractional
treatment we applied methyl 5-aminolevulinate (MAL or Metvix) on one half of the perioral area and 3 hours later we
illuminated that area with a red light (Aktilite lamp, PhotoCure ASA, Oslo, Norway) in a dose of 37 J/cm2. Prior to treatment
and at 4 and 12 weeks after the final treatment, a blinded investigator evaluated each side of the perioral area and
rated the improvement from baseline as excellent, good, fair, or poor improvement of superficial wrinkles by comparing
the results with pretreatment photographs. Patients also completed an evaluation form assessing their satisfaction with the
treatment on each side of the perioral area while comparing the results with pretreatment photographs.
Results: The study showed increased improvement in superficial wrinkles in 3 out of 4 patients on the combined treatment
side. In one patient, the investigator found no significant difference when comparing both sides. All the patients noted greater
improvement in the combined fractional and PDT-treated side compared to the side only treated with fractional surfacing.
Conclusion: This pilot study shows a potential for enhanced clinical results when using combined fractional resurfacing and ALA-PDT compared to fractional resurfacing alone.