Showing papers in "Dermatologic Surgery in 2016"
TL;DR: This consensus document will be helpful for educating members on safe and effective PDT for a variety of indications and has evidence-based recommendations on different clinical applications for PDT.
Abstract: BACKGROUNDThe American Society of Dermatologic Surgery (ASDS) periodically develops consensus documents for its members concerning various aspects of dermatologic surgery. Advances in photodynamic therapy (PDT) have been many and PDT use has been established in a variety of skin conditions.OBJECTIVE
178 citations
TL;DR: Application of PRP showed a positive effect on AGA and could be regarded as an adjuvant therapy for AGA and a correlation between anagen hairs and patients >40 years and beginning of AGA was found.
Abstract: BACKGROUNDPlatelet-rich plasma (PRP) was identified as having a beneficial effect in alopecia and has been postulated as a new therapy for androgenetic alopecia (AGA).OBJECTIVETo assess the efficacy of PRP for the treatment of AGA.MATERIALS AND METHODSThis was a randomized, placebo-controlled, doubl
159 citations
TL;DR: This is the largest population-based study of DFSP derived from a cohort of almost 7,000 patients and shows the epidemiologic profile ofDFSP differs from most skin cancers, which is stable and highest among women and blacks.
Abstract: BACKGROUNDDermatofibrosarcoma protuberans (DFSP) is a rare cutaneous sarcoma for which data on risk factors, incidence, and survival are limited.OBJECTIVEThe authors sought to establish a comprehensive report on the incidence of and survival from primary DFSP.METHODSThe authors used data from the 18
123 citations
TL;DR: ATX-101 is a safe and efficacious, first-in-class, injectable drug for SMF reduction, and improvement in the psychological impact of SMF and satisfaction with treatment and p < .001 for all assessments vs placebo.
Abstract: BACKGROUNDATX-101, an injectable form of deoxycholic acid, is approved in the United States and Canada for submental fat (SMF) reduction.OBJECTIVETo report results of REFINE-1, a randomized, double-blind, placebo-controlled, Phase 3 trial investigating the efficacy and safety of ATX-101.METHODSSubje
103 citations
TL;DR: Platelet-rich plasma failed to demonstrate any statistically significant improvement in HMI or hair count in women with congenital female pattern hair loss, and the patient survey results suggest a therapeutic advantage of PRP as perceived by patients but not according to hair count or HMI.
Abstract: BACKGROUNDPlatelet-rich plasma (PRP) has been suggested as a therapeutic intervention for female androgenetic alopecia.OBJECTIVETo perform a pilot study on the effect of PRP scalp injections in women with female androgenetic alopecia.MATERIALS AND METHODSThis double-blind, multicenter, placebo-contr
92 citations
TL;DR: MMS with MART-1 immunostain achieved lower local recurrence rates and equivalent or higher Kaplan–Meier survival rates than conventional wide local excision and offers the advantage of more tissue-conserving margins than those recommended for conventional excision.
Abstract: BACKGROUNDMohs micrographic surgery (MMS) with melanoma antigen recognized by T-cell (MART-1) immunostaining is an effective treatment of cutaneous melanoma.OBJECTIVETo determine the efficacy of MMS with MART-1 immunostain in the management of invasive and in situ melanoma.METHODS AND MATERIALSA ret
84 citations
TL;DR: Expert consensus supports a combination approach using multiple modalities in specific sequence for the safe and effective treatment of the aging face.
Abstract: BACKGROUNDThe aging process is a complex interplay of intrinsic and extrinsic factors across multiple layers of the face. Accordingly, combining aesthetic interventions targeting different manifestations of aging often leads to better results than single modalities alone. However, no guidelines for
78 citations
TL;DR: In the authors' experience, broad-spectrum antibiotics in conjunction with repeated high-dose hyaluronidase injections into the inflammatory nodules were effective treatments and reported an exceptionally high rate of cutaneous reactions for this newly introduced filler.
Abstract: BACKGROUNDLate reactions to hyaluronic acid (HA)-based fillers have a recorded rate of 0.02%. The recent experience with a newly introduced filler in the tear trough area and the lips showed higher rate of reactions with a tendency to persistency and recurrences.OBJECTIVETo delineate the features of
73 citations
TL;DR: The authors' experience is that combining acne scar treatment techniques can be performed safely and synergistically with optimal patient outcomes.
Abstract: BACKGROUNDAcne scarring can be classified into atrophic icepick, boxcar, and rolling scars in addition to keloidal and hypertrophic scars. Additionally, these scars can be erythematous, hyperpigmented, and/or hypopigmented. Each scar type has a different structural cause warranting a customized appr
68 citations
TL;DR: Platelet-rich plasma therapy stimulates hair growth through the promotion of vascularization and angiogenesis, as well as encourages hair follicles to enter and extend the duration of the anagen phase of the growth cycle.
Abstract: Background Platelet-rich plasma (PRP) therapy is a novel procedure used to treat androgenetic alopecia (AGA). Objective Propose a mechanism of action of PRP therapy for AGA. Methods and materials A thorough literature search including PRP research for AGA therapy as well as PRP research in other areas of medicine was conducted. Results A mechanistic model for the action of PRP on the hair follicle was created. Conclusion Platelet-rich plasma therapy stimulates hair growth through the promotion of vascularization and angiogenesis, as well as encourages hair follicles to enter and extend the duration of the anagen phase of the growth cycle. The process is accomplished through growth factor-mediated increased activation of wingless (Wnt)/β-catenin, extracellular signaling regulated kinase (ERK), and protein kinase B (Akt) signaling pathways, which leads to the necessary cellular proliferation and differentiation.
65 citations
TL;DR: Well-planned surgical treatment aiming to remove or unroof the area of intractable hidradenitis suppurativa was highly effective in the management of this challenging disease.
Abstract: BACKGROUNDHidradenitis suppurativa is a progressive, recurrent inflammatory disease. Surgical management is potentially curative with limited efficacy data.OBJECTIVETo evaluate hidradenitis surgical patients.METHODSRetrospective review of outcomes of 590 consecutive surgically treated patients.RESUL
TL;DR: There are 3 major clinical causes of enlarged facial pores, namely high sebum excretion, decreased elasticity around pores, and increased hair follicle volume.
Abstract: BACKGROUNDEnlarged skin pores refer to conditions that present with visible topographic changes of skin surfaces. Although not a medical concern, enlarged pores are a cosmetic concern for a large number of individuals. Moreover, clear definition and possible causes of enlarged pores have not been el
TL;DR: Review of the literature revealed options for non- and minimally-invasive rejuvenation of the skin and volume restoration of the neck, but little literature was found on the safety and efficacy of combining such procedures.
Abstract: Background Aging of the neck is characterized by changes that include skin dyspigmentation, laxity, rhytides, loss of the mandibular contour, widening of the cervicomental angle, accumulation of submental fat, volume loss and prominence of the platysmal bands. Many cosmetic options exist to address these changes individually, but little literature exists about the safety and efficacy of combining such procedures and devices. Objective To review the existing literature and the authors' experience in safely and effectively combining aesthetic rejuvenation modalities for the neck. Methods A Medline search was performed on combination treatments for neck rejuvenation, and results are summarized. Practical applications for combining these procedures are discussed. Results Studies examining the efficacy and safety of intense pulsed light, ablative fractional lasers, nonablative fractional lasers, microfocused ultrasound with visualization, thermistor-controlled subsurface monopolar radiofrequency, cryolipolysis, ATX-101, liposuction, laser lipolysis, neuromodulators, and hyaluronic acid dermal fillers in the neck were found. The authors review their experience in combining these techniques. Conclusion Review of the literature revealed options for non- and minimally-invasive rejuvenation of the skin and volume restoration of the neck, but little literature was found on the safety and efficacy of combining such procedures. The authors' experience in clinical practice is that many neck rejuvenation techniques can be combined safely. A combination approach often produces the most optimal outcome for the patient seeking neck rejuvenation.
TL;DR: Both nonablative fractional laser 1,340 nm and microneedling are comparable and effective in the treatment of atrophic acne scars, and both are well tolerated, with fewer side effects and lower down time.
Abstract: BACKGROUNDThe efficacy and safety of nonablative fractional laser for acne scars treatment has been described in several studies. Recently, microneedling treatment has been showing promising results with lower costs, quick healing time, and low risk of postinflammatory hyperpigmentation (PIH).OBJECT
TL;DR: Variations in the arterial patterns between individuals with some having the ophthalmic and facial arteries quite separate and some people where there are connections between these systems translates into somewhat bizarre cases where injections in the lower face, even the labial arteries, have ended up with vision loss.
Abstract: We read with interest the article by Beleznay and coworkers in Dermatologic Surgery. The supposed mechanism for blindness seems to be intraarterial injection reaching the ophthalmic artery circulation and embolization into the end retinal artery. Unfortunately, there are variations in the arterial patterns between individuals with some having the ophthalmic and facial arteries quite separate and some people where there are connections between these systems. This translates into somewhat bizarre cases where injections in the lower face, even the labial arteries, have ended up with vision loss. Anywhere with access to the ophthalmic circulation is a potential source of embolization, so the temporal circulation is also a potential for blindness as is the nose through the dorsal nasal artery or the cheek through the zygomaticofacial artery, both branches of the ophthalmic.
TL;DR: It is verified that MIS on the head and neck can spread significantly beyond the clinical margin and the importance of confirming clearance histologically before closure procedures is demonstrated.
Abstract: BACKGROUNDComplete surgical excision of melanoma in situ (MIS) is curative. A 5-mm margin is often taken as the standard primary excision margin despite increasing evidence that this is frequently inadequate for tumor clearance.OBJECTIVETo calculate the proportion of patients requiring >5 mm margin
TL;DR: It is concluded that GA (35%) and SM acid peels are both equally efficacious and a safe treatment modality for melasma in Indian skin, and are more effective than phytic Acid peels.
Abstract: BACKGROUNDMelasma is acquired symmetric hypermelanosis characterized by light-to-deep brown pigmentation over cheeks, forehead, upper lip, and nose. Treatment of this condition is difficult and associated with high recurrence rates. Chemical peels have become a popular modality in the treatment of m
TL;DR: The focus of the review was to demonstrate the variety of topical treatments that have been used with the LADD method and the multitude of future studies needed to fully characterize the best application of this evolving technology.
Abstract: BACKGROUNDLaser-assisted drug delivery (LADD) is an evolving new therapy with many possible applications as a highly targeted customizable method for distribution of drugs within the skin. LADD offers the advantages of accessibility, noninvasiveness, compliance, safety, and effectiveness.OBJECTIVETo
TL;DR: The periorbital areas, in particular crow's feet and tear troughs, are of most concern and likely to be prioritized for treatment among aesthetically oriented men.
Abstract: BACKGROUNDThere is a paucity of data describing male attitudes toward age-related changes to their facial features and associated preferences for prioritizing treatment.METHODSInjectable-naive but aesthetically oriented men aged 30 to 65 participated in an online study (N = 600). Respondents indicat
TL;DR: As subcutaneous injection of deoxycholic acid has been shown to cause adipocytolysis, the reduction in submental fat achieved after ATX-101 treatment is expected to be long lasting, and this prediction is confirmed by data from long-term follow-up studies, which demonstrate that the treatment response is maintained over time in most subjects.
Abstract: In 2015, ATX-101 (deoxycholic acid injection; Kybella in the United States and Belkyra in Canada; Kythera Biopharmaceuticals, Inc, Westlake Village, CA [an affiliate of Allergan plc, Dublin, Ireland]) was approved as a first-in-class injectable drug for improvement in the appearance of moderate to severe convexity or fullness associated with submental fat ATX-101 has been evaluated in a clinical development program that included 18 Phase 1 to 3 studies supporting the current indication Since 2007, the toxicity and safety profiles of ATX-101 have been characterized in numerous preclinical studies, its pharmacokinetics, pharmacodynamics, and optimal treatment paradigm have been defined in multiple Phase 1 and 2 studies, and its efficacy and clinical safety have been confirmed in 4 large Phase 3 trials (2 conducted in Europe and 2 in the United States and Canada [REFINE-1 and REFINE-2]) As subcutaneous injection of deoxycholic acid has been shown to cause adipocytolysis, the reduction in submental fat achieved after ATX-101 treatment is expected to be long lasting This prediction is confirmed by data from long-term follow-up studies of up to 4 years after last treatment with ATX-101, which demonstrate that the treatment response is maintained over time in most subjects ATX-101 offers a durable, minimally invasive alternative to liposuction and surgery for addressing submental fullness
TL;DR: To the authors' knowledge, this is the largest group of patients with MCC treated with MMS from a single institution and indicates that MMS may be a useful treatment modality for this rare aggressive disease.
Abstract: Background Merkel cell carcinoma (MCC) is a rare, aggressive malignant neoplasm. Traditionally, wide local excision has been used for local control. However, the tissue-sparing capability of Mohs micrographic surgery (MMS) and the greater certainty of complete tumor removal offer a potential advantage over wide local excision if MMS offers acceptable cure rates. Objective This study aims to help elucidate management of MCC and includes one of the largest groups of patients from a single institution. Materials and methods This study is a retrospective chart review of 22 patients with cutaneous MCC treated with MMS at our practice over 20 years. Clinical characteristics and outcomes were examined. The study protocol conformed to the ethical guidelines of the 1975 Declaration of Helsinki as reflected in the approval by our institution's human research review committee. Results The overall local recurrence rate was 5% (1/22). The overall rate of biopsy-proven metastasis to regional lymph nodes was 14% (3/22). No cases of distant metastases were documented. Conclusion To our knowledge, this is the largest group of patients with MCC treated with MMS from a single institution and indicates that MMS may be a useful treatment modality for this rare aggressive disease.
TL;DR: Recommendations have been provided for the optimal combination and ideal sequence of botulinum toxin, hyaluronic acid, calcium hydroxylapatite, and microfocused ultrasound with visualization in nonfacial areas across all skin phototypes.
Abstract: BACKGROUNDThe popularity of aesthetic procedures in the face has led to greater disparity between treated areas and those that still show evidence of true age. Although many areas of the body often require multiple treatment procedures for optimal rejuvenation, combination therapy for specific areas
TL;DR: Based upon published studies, there is insufficient data to support use of arnica and bromelain post procedure, and the authors recommend additional research to determine the efficacy and safety ofArnicaand bromELain to prevent and/or treat ecchymosis and edema in patients.
Abstract: BACKGROUNDThe management of postprocedure skin care is of significant interest to dermatologists and other physicians. Ecchymosis and edema are common temporary postprocedure unwanted effects. Two botanically-derived products, arnica and bromelain, are used internationally by physicians to limit ecc
TL;DR: The use of autologous fat transfer for breast augmentation is still controversial due to ongoing concerns regarding its efficacy and safety, most notably, concerns about breast cancer risk and detection.
Abstract: BACKGROUNDThe use of autologous fat transfer for breast augmentation is still controversial due to ongoing concerns regarding its efficacy and safety, most notably, concerns about breast cancer risk and detection.OBJECTIVETo summarize the current knowledge on the safety and efficacy of autologous fa
TL;DR: The results confirm the safety and effectiveness of low-fluence QS Nd:YAG laser for treating melasma; however, the high recurrence suggests poor long-term results when the laser is used as a monotherapy.
Abstract: BACKGROUNDMelasma is a frequent and difficult to treat skin disorder. Results of laser therapy are inconsistent.OBJECTIVETo determine the safety and efficacy of low-fluence Q-switched neodymium-doped yttrium aluminum garnet (QS Nd:YAG) laser for melasma treatment and assess recurrence rates and hist
TL;DR: The-532 nm KTP laser is comparable in efficacy and safety to the 595-nm PDL laser in the treatment of erythematous surgical scars.
Abstract: BACKGROUND The pulsed dye laser (PDL) has long been used for treatment of erythematous and hypertrophic scars. Its effectiveness has been attributed in large part to its vascular-specificity. The vascular-specific potassium titanyl phosphate (KTP) laser has also been reported to be clinically effective for scars, but has not been compared to the PDL. OBJECTIVE To compare the safety and clinical efficacy of a 532-nm KTP laser versus a 595-nm PDL in improving the appearance of erythematous surgical scars. METHODS Twenty patients with matched bilateral erythematous surgical scars or a single linear erythematous scar measuring longer than 5 cm were enrolled in the study. Single scars were divided into equal halves with each half randomized to receive 3 successive treatments at 6-week intervals with either a 532-nm KTP laser (Excel V; Brisbane, CA) or a 595-nm PDL (Cynergy; Cynosure Inc., Chelmsford, MA) at equivalent laser parameters. Bilateral matched scars were similarly randomized to receive three 532-nm KTP or 595-nm PDL treatments. Clinical efficacy was evaluated 12 weeks after the third (final) laser treatment by independent, blinded photographic scar assessments. Secondary evaluations included final investigator and subject treatment/satisfaction assessments, Vancouver scar scale (VSS) scores, subject scar symptoms, intraoperative pain scores, and incidence of side effects. RESULTS Clinical improvement of erythematous surgical scars was observed with both 532-nm KTP and 595-nm PDL systems. No statistically significant differences between the 2 treatment arms were noted in the independent, blinded photographic scar assessments, investigator and subject treatment/satisfaction assessments, subject scar symptoms, and intraoperative pain scores. The KTP arm produced statistically significant improvement for the vascularity component of the VSS only. Side effects were limited to mild treatment discomfort and minimal transient post-treatment erythema and purpura. No vesiculation, infection, scarring or other adverse events were experienced. Subject satisfaction surveys mirrored the observed clinical effects. CONCLUSION The-532 nm KTP laser is comparable in efficacy and safety to the 595-nm PDL laser in the treatment of erythematous surgical scars.
TL;DR: To know the different appearances of the facial artery can be helpful for filler injection in aesthetic medicine but also for planning flaps in reconstructive surgery.
Abstract: Background The facial artery is said to be the main vessel for the blood supply of the anterior face. However, its course is quite often not as described in the textbooks. Objective The purpose of this study was to find out the different courses of the facial artery, its anastomoses, and its position in relation to the fat compartments of the face. Materials and methods With 60 hemifaces three-dimensional reconstructions with computed tomography, cross dissections and horizontal sections were performed. Results Of note, 4 types of facial arteries were identified. Not even half of the specimens showed a textbook course of the facial artery and only a quarter of the specimens had a textbook course of the artery on both sides. Conclusion To know the different appearances of the facial artery can be helpful for filler injection in aesthetic medicine but also for planning flaps in reconstructive surgery.
TL;DR: There is insufficient number of studies evaluating the best combination of therapies for hand rejuvenation, but it is likely that their strategic combination and sequence of application by a trained clinician will ensure a favorable outcome in addressing patient concerns.
Abstract: BACKGROUNDHand rejuvenation has been recognized to play a key role in complementing and restoring an overall youthful look.OBJECTIVEAging hands present specific characteristics that require a carefully designed combinational treatment for a successful clinical outcome from a practitioner's and patie
TL;DR: Positive margins after WLE are uncommon and when a patient has multiple risk factors for positive margins at WLE, histologically clear margins should be obtained through mapped serial excision or Mohs micrographic surgery.
Abstract: BACKGROUND A small percentage of patients will have positive histological margins after primary wide local excision (WLE) of cutaneous melanoma (CM). Risk factors that predict marginal involvement at WLE remain unclear. OBJECTIVE To identify risk factors associated with positive margins after WLE of CM. MATERIALS AND METHODS A retrospective review of patients treated at a single institution for CM with sentinel lymph node biopsy from 1997 to 2011 was conducted. RESULTS Positive margins occurred in 6% of patients. Patients with positive margins were older (72.4 vs 60.7, p < .001), had thicker tumors (3.6 vs 1.9 mm, p < .001), and often involved the head and neck region (p < .001). Patients with positive margins at WLE had positive margins on initial biopsy (p = .012) and a higher rate of a melanoma in situ component on initial biopsy (24% vs 11%, p = .02). The 5-year local recurrence rate was significantly different between those with positive and negative margins at WLE (16.0% vs 6.9%; p = .047). CONCLUSION Positive margins after WLE are uncommon. When a patient has multiple risk factors for positive margins at WLE, histologically clear margins should be obtained through mapped serial excision or Mohs micrographic surgery.
TL;DR: Fractional microneedling radiofrequency treatment showed modest clinical and histologic improvement of rosacea, and it might be used as an alternative or in combination with other treatment methods.
Abstract: Background Fractional microneedling radiofrequency (FMR) is an emerging treatment modality, but its effect on rosacea has not been studied yet. Objective To investigate the potential impact of FMR treatment on clinical improvement and histologic changes in rosacea patients. Materials and methods A 12-week, prospective, randomized, split-face clinical trial was conducted. Two sessions of FMR were performed on one side of the cheeks with 4-week interval and the other side remained untreated. Erythema index from DermaSpectrometer and a* value from Spectrophotometer CM-2002 were measured at each visit for the objective measurement of erythema. Histologic analysis of skin samples was also carried out. Results Clinical evaluation and photometric measurement revealed the reduction of redness in the treated side compared with untreated side and baseline. Erythema index decreased 13.6% and a* value decreased 6.8% at Week 12 compared with baseline. Reduced expression of markers related to inflammation, innate immunity, and angiogenesis was observed in immunohistochemical staining of tissue obtained after FMR treatment. Conclusion Fractional microneedling radiofrequency treatment showed modest clinical and histologic improvement of rosacea, and it might be used as an alternative or in combination with other treatment methods.