Showing papers in "Dermatologic Surgery in 2013"

A review of the metabolism of 1,4-butanediol diglycidyl ether-crosslinked hyaluronic acid dermal fillers.

Abstract: Background Cosmetic procedures are growing ever more common, and the use of soft tissue fillers is increasing. Practicing physicians need to be aware of the biological behavior of these products in tissue to enable them to respond to any safety concerns that their patients raise. Objectives To provide an overview of the metabolism of 1,4-butanediol diglycidyl ether (BDDE)-crosslinked hyaluronic acid (HA) dermal fillers and to examine the safety of the resulting byproducts. Methods A review of available evidence was conducted. Results After reaction with HA, the epoxide groups of BDDE are neutralized, and only trace amounts of unreacted BDDE remain in the product ( Conclusion Clinical and biocompatibility data from longer than 15 years support the favorable clinical safety profile of BDDE-crosslinked HA and its degradation products. Given the strength of the empirical evidence, physicians should be confident in offering these products to their patients.

Ultrasound in-depth characterization and staging of hidradenitis suppurativa.

Abstract: Background The clinical diagnosis of fistulous tracts and recurrent fluid collections in hidradenitis suppurativa (HS) may be complex. Information on subclinical involvement and grading of severity may improve management. Objective To study HS lesions and evaluate the relevance of adding ultrasound (US) to the clinical examination. Methods and Materials We reviewed the sonograms of consecutive patients with HS from January 1, 2010 to May 31, 2012. The abnormalities observed in the US examinations were organized, classified, and integrated into a clinical-sonographic scoring system (SOS-HS), to stage the disease. Results Thirty-four patients with HS with a total of 142 lesional areas were evaluated. US findings included subclinical fluid collections in 76.4% of the patients, fistulous tracts in 29.4%, dermal pseudocysts in 70.6%, and widening of the hair follicles in 100%. Concordance with the clinical HS scoring performed by dermatologists showed a significant fair agreement (k = 0.30; p < .001); concordance of SOS-HS with clinical scores was acceptable but significantly lower (k = 0.27; p = .02) because clinical scores consistently underestimated disease stage and severity. Conclusion US examination of HS lesions provides anatomic information that is clinically unavailable. HS is possible to stage sonographically.

Safety, Tolerance, and Patient Satisfaction With Noninvasive Cryolipolysis

Abstract: BackgroundComprehensive assessment of safety, tolerance, and patient satisfaction has not been established from noninvasive body contouring techniques, such as low-level laser therapy, ultrasound, radiofrequency, and infrared light, for reduction of subcutaneous fat.ObjectiveThis multicenter study i

Low-level light therapy for androgenetic alopecia: a 24-week, randomized, double-blind, sham device-controlled multicenter trial.

Abstract: BackgroundAndrogenetic alopecia (AGA) is a common disorder affecting men and women. Finasteride and minoxidil are well-known, effective treatment methods, but patients who exhibit a poor response to these methods have no additional adequate treatment modalities.ObjectiveTo evaluate the efficacy and

Laser Hair Removal: A Review

Abstract: BACKGROUNDUnwanted hair growth is a common aesthetic problem Laser hair removal has emerged as a leading treatment option for long-term depilationOBJECTIVESTo extensively review the literature on laser hair removal pertaining to its theoretical basis, current laser and light-based devices, and the

Intralesional Treatment for Keloids and Hypertrophic Scars: A Review

Abstract: BACKGROUNDAlthough differing in clinical presentation and prognosis, keloids and hypertrophic scars are generally characterized by abnormally proliferative scar tissue and are extremely debilitating. Several intralesional therapies have been studied in attempts to find a universally safe and effecti

Cutaneous squamous cell carcinoma and human papillomavirus: is there an association?

Abstract: Background The role of human papillomavirus (HPV) in the induction and maintenance of cervical, anogenital, and some oropharyngeal carcinomas is well recognized, but its role in cutaneous squamous cell carcinoma (SCC) remains to be elucidated. HPV is thought to act as a possible cocarcinogen in the development of SCC. Objective To review the literature assessing the correlation between and possible causation of HPV and cutaneous SCC in immunocompetent and immunocompromised populations. Methods We reviewed HPV sampling and detection methods, epidemiologic studies examining HPV carriage in immunocompetent and immunosuppressed individuals, and evidence asserting an association between HPV and cutaneous SCC. Results Although an abundant body of evidence points toward a link between HPV and cutaneous SCC, many studies indicate otherwise. Recent studies have focused on viral activity in addition to DNA presence. Conclusion The possibility exists that HPV may play a role in the induction but not maintenance of cutaneous SCC.

The Biomechanical Properties of the Skin

Abstract: BACKGROUNDThe skin possesses unique biochemical properties that allow it to protect and conform to the body that it covers. Elements constituting the dermis—collagen and elastin—primarily afford these properties.OBJECTIVESTo define these properties and explore their relevance with regard to aging sk

Volumizing hyaluronic acid filler for midface volume deficit: 2-year results from a pivotal single-blind randomized controlled study.

Abstract: BACKGROUNDHyaluronic acid (HA) gels are commonly used to correct age-related midface volume deficit (MVD), yet the Food and Drug Administration has not specifically approved them for this purpose.OBJECTIVETo study the safety and effectiveness of a new 20-mg/mL HA gel (VYC-20L) specifically formulate

Oral tranexamic acid enhances the efficacy of low-fluence 1064-nm quality-switched neodymium-doped yttrium aluminum garnet laser treatment for melasma in Koreans: a randomized, prospective trial.

Abstract: BackgroundTranexamic acid (TA) has recently gained in popularity in the treatment of pigmentary disorders.ObjectiveTo evaluate the clinical efficacy and safety of oral TA combined with low-fluence 1064-nm quality-switched neodymium-doped yttrium aluminum garnet (QSNY) laser for the treatment of mela

A Pilot Split‐Face Study Comparing Conventional Methyl Aminolevulinate‐Photodynamic Therapy (PDT) With Microneedling‐Assisted PDT on Actinically Damaged Skin

Abstract: BackgroundTopical photodynamic therapy (PDT) is an approved treatment for superficial nonmelanoma skin cancers. To enhance photosensitizer penetration into the epidermis, microneedling (MN) devices or ablative carbon dioxide lasers are combined with PDT.ObjectivesTo compare the efficacy and safety o

Safety and efficacy of intradermal injection of botulinum toxin for the treatment of oily skin.

Abstract: ObjectiveTo evaluate the safety and efficacy of intradermal injection of abobotulinumtoxinA for the treatment of oily skin.Methods and MaterialsTwenty-five patients with oily skin were treated in the forehead region with intradermal injections of botulinum toxin. Baseline and post-treatment sebum pr

Consensus recommendations on the aesthetic usage of botulinum toxin type A in Asians.

Abstract: BACKGROUNDThe use of botulinum toxin has rapidly expanded into various aesthetic applications. Any guideline representing a consensus for aesthetic treatments using botulinum toxin type A (BTA) in Asians has not been published.OBJECTIVESTo provide consensus recommendations on common aesthetic proble

Systematic Review of Clinical Trials of Small- and Large-Gel-Particle Hyaluronic Acid Injectable Fillers for Aesthetic Soft Tissue Augmentation

Abstract: BACKGROUNDHyaluronic acid (HA) is the most frequently injected filler for soft tissue augmentation in the United States.OBJECTIVETo systematically review published evidence for aesthetic use of small- and large-gel-particle HA.METHODS AND MATERIALSClinical data on anatomic area, level of evidence, p

Analysis of Skin Cancer Treatment and Costs in the United States Medicare Population, 1996–2008

Abstract: Background There is a skin cancer epidemic in the United States. Objective To examine skin cancer treatment modality, location, and cost and physician specialty in the Medicare population from 1996 to 2008. Methods Centers for Medicare and Medicaid Services databases were used to examine skin cancer treatment procedures performed for Medicare beneficiaries. Results From 1996 to 2008, the total number of skin cancer treatment procedures [malignant excision, destruction, and Mohs micrographic surgery (MMS)] increased from 1,480,645 to 2,152,615 (53% increase). The numbers of skin cancers treated by excision and destruction increased modestly (20% and 39%, respectively), but the number of MMS procedures increased more rapidly (248% increase). Dermatologists treated an increasing percentage (75–82%) of skin cancers during these years, followed by plastic and general surgery. In 2008, more than 90% of all skin cancers were treated in the office, with the remainder being treated in facility-based settings. Allowable charges paid to physicians by Medicare Part B for skin cancer treatments increased 137% from 1996 to 2008, from $266,960,673 to $633,448,103. Conclusions The number of skin cancer treatment procedures increased substantially from 1996 to 2008, as did overall costs to Medicare. Dermatologists treated the vast majority of skin cancers in the Medicare population, using a mix of treatment modalities, almost exclusively in the office setting.

Promotional effect of platelet-rich plasma on hair follicle reconstitution in vivo.

Abstract: BACKGROUNDPlatelet-rich plasma (PRP) containing various growth factors has attracted attention in various medical fields. PRP has recently been used during hair transplantation to increase hair density.OBJECTIVETo investigate the effects of PRP on hair follicle (HF) reconstitution.METHODS AND MATERI

Optical coherence tomography-based optimization of mohs micrographic surgery of Basal cell carcinoma: a pilot study.

Abstract: Background Optical coherence tomography (OCT) is a noninvasive imaging technique that uses a low-power infrared laser to image up to 2 mm beneath the skin's surface. Objective To test the feasibility and diagnostic value of using in vivo OCT to define excision margins before Mohs micrographic surgery (MMS) of basal cell carcinoma (BCC). Methods Patients with biopsy confirmed BCC undergoing MMS were recruited (n = 52). Excision margins defined by experienced dermatologists were compared with those of OCT-assessed borders and validated with histologic assessments. Results Forty-one (79%) lesions were clear after one MMS procedure; 11 (21%) lesions required a second MMS stage after excision of the clinician-predicted boundary. Generally, the OCT instrument indicated that the estimated clinical margin was 0.4-mm larger than the OCT margin. For lesions requiring a single MMS stage, OCT indicated that lesions were 1.4 ± 1.3 mm smaller than the Mohs excision. Before excision of lesions requiring more than one MMS stage, OCT always indicated that the lesion boundary would extend outside the planned MMS defect boundary. Conclusions The present study shows the prospective utility of using OCT to refine clinically estimated borders for MMS. OCT assessment has the potential to reduce the excised area without compromising the integrity of tumor-free borders.

Incidence, Risk Factors, and Preventative Management of Skin Cancers in Organ Transplant Recipients: A Review of Single- and Multicenter Retrospective Studies from 2006 to 2010

Abstract: Background Organ transplant recipients (OTRs) taking immunosuppressants are at high risk of skin cancer, which is the most common malignant condition in OTRs, so dermatologic surveillance is important for OTRs. Objectives To characterize the most common skin cancers arising from chronic immunosuppression in OTRs. Methods A PubMed search for retrospective single- and multicenter studies reporting skin cancer incidence from 2006 to 2010 was undertaken. Data regarding each study's immunosuppressive regimen, affected skin cancer cohort, and associated risk factors were extracted. Results Thirty-six articles that met our inclusion criteria reported incidences of nonmelanoma skin cancer (NMSC), Kaposi's sarcoma, melanoma, and Merkel cell carcinoma. NMSC was the most commonly reported cancer of all skin cancers after transplantation. Common risk factors were sex, age, sunlight exposure, and immunosuppressive agent-related (duration, type). Conclusion Sun education programs and frequent screenings in organ transplant clinics have provided the best preventative strategies after transplantation, although the characteristics of the immunosuppressive regimen also play an important role. Thus, the adjuvant strategy of modifying immunosuppression may be effective when confronting severe transplant-associated skin cancer. Although the decision-making process for curbing levels of immunosuppression is difficult, further long-term, randomized controlled studies should assess the effect of using less immunosuppressant medication while preserving graft function.

Evaluation of self-esteem and depression symptoms in depressed and nondepressed subjects treated with onabotulinumtoxinA for glabellar lines.

Abstract: BACKGROUNDBotulinum toxin type A (BoNT-A) injection has become the most popular cosmetic nonsurgical procedure, and it has been suggested that BoNT-A injections may improve emotional states when frown lines are treated.OBJECTIVESTo evaluate symptoms of depression and self-esteem before and after ona

Quantifying Soft Tissue Loss in Facial Aging: A Study in Women Using Magnetic Resonance Imaging

Abstract: BACKGROUNDFacial aging involves changes in the facial skeleton and soft tissues. There is limited quantitative data on soft tissue aging of the face.OBJECTIVEMagnetic resonance imaging (MRI) was used to quantify and compare facial soft tissue loss over time.METHODS AND MATERIALSTwo thousand thirty-s

Comparison of fractional erbium-doped yttrium aluminum garnet and carbon dioxide lasers in resurfacing of atrophic acne scars in Asians.

Abstract: Background The efficacy of fractional erbium-doped yttrium aluminum garnet (Er:YAG) and carbon dioxide (CO2) lasers are well substantiated. Objective To compare the efficacy and safety of these two laser systems for treatment of atrophic scars in dark-skinned patients. Materials and Methods Twenty-four subjects with acne scars were randomly treated with a fractional Er:YAG laser on one side and a fractional CO2 laser on the other side. All subjects received two treatments with a 2-month interval. Objective and subjective assessments were obtained at baseline and 1, 3, and 6 months after the final treatment. Results At the 6 month follow up, 55% and 65% of Er: YAG and CO2 laser sites, respectively, were graded as having more than 50% improvement of scars. Improvement progressed significantly from 1- to 6-month follow-up (p < .001). There was no significant difference in clinical improvement between the two systems at 1- (p = .90), 3- (p = .54), and 6-month (p = .87) follow-up. Reduction in scar volume corresponded to clinical evaluation. Conclusions Fractional Er:YAG and CO2 lasers provided comparable outcomes of scar treatment, but fractional CO2 laser was associated with greater treatment discomfort.

The convergence of medicine and neurotoxins: a focus on botulinum toxin type A and its application in aesthetic medicine--a global, evidence-based botulinum toxin consensus education initiative: part II: incorporating botulinum toxin into aesthetic clinical practice

Abstract: BackgroundThe new world of safe aesthetic injectables has become increasingly popular with patients. Not only is there less risk than with surgery, but there is also significantly less downtime to interfere with patients' normal work and social schedules. Botulinum toxin (BoNT) type A (BoNTA) is an

Music reduces patient anxiety during Mohs surgery: an open-label randomized controlled trial.

Abstract: BACKGROUNDMany patients undergoing Mohs micrographic surgery (MMS) experience anxiety and stress. Although music has been proven to reduce anxiety and promote relaxation in other fields of medicine, scant research investigates the effect of music on anxiety during MMS.OBJECTIVESTo determine whether

Clinical improvement of striae distensae in Korean patients using a combination of fractionated microneedle radiofrequency and fractional carbon dioxide laser.

Abstract: Background Striae distensae are dermal scars with flattening and atrophy of the epidermis. Objective To evaluate the efficacy and safety of combination therapy with fractionated microneedle radiofrequency (RF) and fractional carbon dioxide (CO2) laser in the treatment of striae distensae. Materials and Methods Thirty patients (30 female; mean age 33, range 21–51, Fitzpatrick skin type IV) with moderate to severe striae distensae were enrolled in this study. Patients were divided into three groups: fractional CO2 laser only (n = 10), microneedle RF only (n = 10), and combination (n = 10). Results Improvement was evaluated using a visual analogue scale (range 1–4). Mean clinical improvement score of the dermatologist was 2.2 in the fractional CO2 laser–treated group, 1.8 in the microneedle RF–treated group, and 3.4 in the combination group. Through skin biopsy, we observed thickened epidermis and a clear increase in the number of collagen fibers in the microneedle RF– and fractional CO2 combination–treated sites. Consistent with these results, greater expression of transforming growth factor-β1 and stratifin was observed in treated sites. Conclusion Combination therapy of fractionated microneedle RF and fractional CO2 laser is a safe treatment protocol with a positive therapeutic effect on striae distensae.

Topical and Intralesional Treatment of Nonmelanoma Skin Cancer: Efficacy and Cost Comparisons

Abstract: BackgroundTopical chemotherapy, topical immunomodulators, or intralesional chemotherapy may be used to treat nonmelanoma skin cancer (NMSC).ObjectivesTo review the cost and efficacy of topical and intralesional therapies for NMSC.MethodsLiterature search assessing the efficacy of NMSC treatment with

Ablative Fractional Resurfacing in Topical Drug Delivery: An Update and Outlook

Abstract: BACKGROUNDThe effective delivery of therapeutic molecules to varied targets in the skin and elsewhere has been an area of ongoing research and development.OBJECTIVETo review the structure of the skin with an emphasis on topical drug delivery and to present the rationale for the use of ablative and n

Oral antibiotics versus topical decolonization to prevent surgical site infection after Mohs micrographic surgery--a randomized, controlled trial.

Abstract: Background The optimal method of reducing the risk of surgical site infection (SSI) after dermatologic surgery is unclear. Empiric, preoperative antibiotic use is common practice but lacks supporting evidence for its efficacy in preventing SSI. Risk stratification for patients at high risk of postoperative SSI based on a nasal swab is a viable strategy when coupled with topical decolonization for positive carriers. We compared the rates of infection in patients undergoing Mohs micrographic surgery (MMS) with nasal carriage of Staphylococcus aureus who received oral antibiotics or topical decolonization. Methods A randomized, controlled trial with 693 patients was conducted over a 30-week period at a single surgical practice. Patients were stratified into nasal carriers or noncarriers of S. aureus based on a preoperative nasal swab. Nasal carriers of S. aureus were randomized to receive topical decolonization with intranasal mupirocin twice daily plus 4% chlorhexidine gluconate body wash daily for 5 consecutive days before surgery or statim pre- and postoperative doses of oral cephalexin. Results One hundred seventy-nine patients (25.8%) were identified as carriers of S. aureus. Ninety received topical decolonization, and 89 received oral antibiotics. These groups were compared with a swab-negative Mohs surgical cohort over the same time period. There were no significant differences between the groups in terms of demographic characteristics or comorbidities. Nine percent of patients receiving oral antibiotic prophylaxis and 0% receiving topical decolonization developed early SSI (p = .003). Conclusion In patients with demonstrable carriage of S. aureus, topical decolonization resulted in fewer SSI than in patients receiving perioperative oral antibiotics. Antibiotics should be reserved for clinically suspected and swab-proven infections rather than being prescribed empirically. Further efforts should be directed toward optimizing endogenous risk factor control for all patients presenting for MMS.

Quantitative volumetric analysis of progressive hemifacial atrophy corrected using stromal vascular fraction-supplemented autologous fat grafts.

Abstract: Background Progressive hemifacial atrophy (Parry-Romberg disease) is rare and involves all skin layers and subcutaneous soft and hard tissue. Autologous fat grafting has revolutionized the field of soft-tissue reconstruction and augmentation, but long-term maintenance is unpredictable. Stromal vascular fraction (SVF)-supplemented cell therapy offers new hope for improving fat graft survival, with good long-term results, but efficacy and long-term outcome in the clinic are rarely studied using objective data. Objective To compare the long-term viability of SVF-supplemented fat grafts and fat grafts alone for contour reconstruction of progressive hemifacial atrophy using quantitative volume analysis. Methods We treated 20 patients with stable hemifacial atrophy for at least 2 years with SVF-supplemented autologous fat grafting (n = 10) or fat grafting alone (n = 10). All patients were followed up every 3 months. Hemifacial volume was measured using computed tomography and the Philips Extended Brilliance Workspace. Results All patients had successful outcomes without complications, but fat survival and clinical improvement was greater with SVF-supplemented grafting than fat grafting alone after 6 months. Conclusion SVF-supplemented autologous fat transplantation is effective and safe for treating progressive hemifacial atrophy and can enhance the survival of grafts in the face without major complications.

Retrospective study of the treatment of infantile hemangiomas using a combination of propranolol and pulsed dye laser

Abstract: BACKGROUNDInfantile hemangioma (IH) clearance may be slow or incomplete in response to pulsed dye laser (PDL) or propranolol alone.OBJECTIVESTo evaluate whether IH treated with PDL and propranolol displayed more rapid and complete clearance than IH treated with propranolol alone.MATERIALS AND METHOD

Fractional Carbon Dioxide Laser Improves Nodular Basal Cell Carcinoma Treatment with Photodynamic Therapy with Methyl 5-Aminolevulinate

Abstract: BackgroundThe major limitation of photodynamic therapy with 5-aminolevulinic acid (ALA-PDT) is proper photosensitizer penetration. The nodular form of BCC (nBCC) is perceived as a contraindication to ALA-PDT because the tumor layer is thicker than 2 mm. We have improved on the results of previous st