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Nilforoushzadeh MA, Ghane Y, Heidari N, Azizi H, Fathabadi F, Najar Nobari N, Heidari A. A systematic review of procedural modalities in the treatment of notalgia paresthetica. Skin Res Technol 2024; 30:e13723. [PMID: 38696233 PMCID: PMC11064992 DOI: 10.1111/srt.13723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 04/15/2024] [Indexed: 05/04/2024]
Abstract
BACKGROUND Notalgia paresthetica (NP) is a rare condition characterized by localized pain and pruritus of the upper back, associated with a distinct area of hyperpigmentation. Given the lack of standardized treatment and the uncertain efficacy of available options, applying procedural methods is of growing interest in treating NP. AIMS We sought to comprehensively evaluate the role of procedural treatments for NP. METHODS We systematically searched PubMed/Medline, Ovid Embase, and Web of Science until November 14th, 2023. We also performed a citation search to detect all relevant studies. Original clinical studies published in the English language were included. RESULTS Out of 243 articles, sixteen studies have reported various procedural modalities, with or without pharmacological components, in treating NP. Pharmacological procedures, including injections of botulinum toxin, lidocaine, and corticosteroids, led to a level of improvement in case reports and case series. However, botulinum toxin did not show acceptable results in a clinical trial. Moreover, non-pharmacological procedures were as follows: physical therapy, exercise therapy, kinesiotherapy, acupuncture and dry needling, electrical muscle stimulation, surgical decompression, and phototherapy. These treatments result in significant symptom control in refractory cases. Physical therapy can be considered a first-line choice or an alternative in refractory cases. CONCLUSION Procedural modalities are critical in the multidisciplinary approach to NP, especially for patients who are refractory to topical and oral treatments. Procedural modalities include a spectrum of options that can be applied based on the disease's symptoms and severity.
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Affiliation(s)
- Mohammad Ali Nilforoushzadeh
- Skin Repair Research CenterShahid Beheshti University of Medical SciencesTehranIran
- Skin and Stem Cell Research CenterTehran University of Medical SciencesTehranIran
| | - Yekta Ghane
- Skin Repair Research CenterShahid Beheshti University of Medical SciencesTehranIran
- Skin and Stem Cell Research CenterTehran University of Medical SciencesTehranIran
- School of MedicineTehran University of Medical SciencesTehranIran
| | - Nazila Heidari
- Skin Repair Research CenterShahid Beheshti University of Medical SciencesTehranIran
- Skin and Stem Cell Research CenterTehran University of Medical SciencesTehranIran
- School of MedicineIran University of Medical SciencesTehranIran
| | - Hanieh Azizi
- Skin Repair Research CenterShahid Beheshti University of Medical SciencesTehranIran
- Skin and Stem Cell Research CenterTehran University of Medical SciencesTehranIran
| | - Fatemeh Fathabadi
- Skin Repair Research CenterShahid Beheshti University of Medical SciencesTehranIran
- Skin and Stem Cell Research CenterTehran University of Medical SciencesTehranIran
- School of MedicineTehran University of Medical SciencesTehranIran
| | - Niloufar Najar Nobari
- Skin Repair Research CenterShahid Beheshti University of Medical SciencesTehranIran
- Skin and Stem Cell Research CenterTehran University of Medical SciencesTehranIran
| | - Amirhossein Heidari
- Skin Repair Research CenterShahid Beheshti University of Medical SciencesTehranIran
- Skin and Stem Cell Research CenterTehran University of Medical SciencesTehranIran
- Faculty of MedicineTehran Medical SciencesIslamic Azad UniversityTehranIran
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Notalgia Paresthetica Review: Update on Presentation, Pathophysiology, and Treatment. Clin Pract 2023; 13:315-325. [PMID: 36826171 PMCID: PMC9955802 DOI: 10.3390/clinpract13010029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 02/22/2023] Open
Abstract
PURPOSE OF REVIEW Notalgia paresthetica (NP) is a chronic cutaneous neuropathy primarily characterized by localized pruritus and associated dysesthesias, including sensations of pain, numbness, and tingling. The sensory neuropathy characteristic of NP is thought to result from spinal nerve entrapment caused by degenerative changes in the spine or musculoskeletal compression. This review summarizes the current medical literature with a focus on the past five years regarding NP, its pathophysiology, presentation, and current treatment options. RECENT FINDINGS Though treatments exist with varying efficacy, to date, there exists no definitive treatment for NP. Treatment options for NP are varied and range from topical and oral agents to interventional procedures and physical therapy. Of the treatments evaluated, topical capsaicin remains the most efficacious treatment for NP. CONCLUSIONS The lack of established treatment guidelines makes treating NP complicated as it dramatically affects patients' quality of life. Further research with larger sample sizes is needed to evaluate better the most effective treatment and dosing regimen for patients afflicted with NP.
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Gazerani P. How Does Botulinum Toxin Inhibit Itch? Toxins (Basel) 2022; 14:toxins14100701. [PMID: 36287970 PMCID: PMC9610088 DOI: 10.3390/toxins14100701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/06/2022] [Accepted: 10/10/2022] [Indexed: 12/04/2022] Open
Abstract
Two decades after reports of the anti-pruritic effects of botulinum neurotoxins (BoNTs), there is still no approved product for the anti-itch indication of BoNTs, and most clinical case reports still focus on the off-label use of BoNTs for various itchy conditions. Few randomized clinical trials have been conducted with controversial results, and the beneficial effects of BoNTs against itch are mainly based on case studies and case series. These studies are valuable in presenting the potential application of BoNTs in chronic pruritic conditions, but due to the nature of these studies, they are categorized as providing lower levels of evidence or lower grades of recommendation. To obtain approval for the anti-pruritic indication of BoNTs, higher levels of evidence are required, which can be achieved through conducting large-scale and well-designed studies with proper control groups and established careful and reliable primary and secondary outcomes. In addition to clinical evidence, presenting the mechanism-based antipruritic action of BoNTs can potentially strengthen, accelerate, and facilitate the current efforts towards further investments in accelerating the field towards the potential approval of BoNTs for itchy conditions. This review, therefore, aimed to provide the state-of-the-art mechanisms underlying the anti-itch effect of BoNTs from basic studies that resemble various clinical conditions with itch as a hallmark. Evidence of the neuronal, glial, and immune modulatory actions of BoNTs in reducing the transmission of itch are presented, and future potential directions are outlined.
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Affiliation(s)
- Parisa Gazerani
- Department of Life Sciences and Health, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; or
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9220 Aalborg East, Denmark
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4
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Correa-Illanes G. Successful treatment of notalgia paresthetica with lidocaine 5% medicated plaster: a case report. Pain Manag 2022; 12:887-894. [PMID: 36189717 DOI: 10.2217/pmt-2022-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Notalgia paresthetica (NP) is a sensory neuropathy characterized by chronic, localized pruritus in a circumscribed area on the upper back. Pruritus, frequently resistant to treatment, may be accompanied by pain, paresthesia, allodynia and alloknesis. There is a paucity of data in the NP literature about the use of lidocaine 5% medicated plaster. This case involves a 75-year-old woman with NP and a history of many unsuccessful local or systemic treatments. The patient was treated with lidocaine 5% medicated plaster, while other therapies were progressively retired. After 11 weeks of therapy, a significant reduction in the intensity of itching was achieved and the itching area was reduced. The patient also reported an associated improvement in her quality of life throughout therapy. In conclusion, lidocaine 5% medicated plaster was successful in relieving itching and other symptoms in this case of NP.
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5
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Off-Label Use of Botulinum Toxin in Dermatology—Current State of the Art. Molecules 2022; 27:molecules27103143. [PMID: 35630620 PMCID: PMC9147387 DOI: 10.3390/molecules27103143] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 01/01/2023] Open
Abstract
Botulinum toxin (BoNT) is a neurotoxin produced by the Clostridium botulinum bacteria. Among seven different isoforms, only BoNT-A and BoNT-B are commercially used. Currently, botulinum toxin has been indicated by the U.S. Food and Drug Administration in several disorders, among others: chronic migraine, hyperhidrosis, urinary incontinence from detrusor overactivity, or cosmetics. However, there are numerous promising reports based on off-label BTX usage, indicating its potential effectiveness in other diseases, which remains unknown to many. Among them, dermatological conditions, such as rosacea, annal fissure, Raynaud phenomenon, hypertrophic scars and keloids, and also hidradenitis suppurativa, are currently being investigated. This article aims to provide a comprehensive update on the off-label use of botulinum toxin in dermatology, based on an analysis and summary of the published literature.
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6
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Martina E, Diotallevi F, Radi G, Campanati A, Offidani A. Therapeutic Use of Botulinum Neurotoxins in Dermatology: Systematic Review. Toxins (Basel) 2021; 13:toxins13020120. [PMID: 33562846 PMCID: PMC7915854 DOI: 10.3390/toxins13020120] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/19/2021] [Accepted: 01/22/2021] [Indexed: 12/21/2022] Open
Abstract
Botulinum toxin is a superfamily of neurotoxins produced by the bacterium Clostridium Botulinum with well-established efficacy and safety profile in focal idiopathic hyperhidrosis. Recently, botulinum toxins have also been used in many other skin diseases, in off label regimen. The objective of this manuscript is to review and analyze the main therapeutic applications of botulinum toxins in skin diseases. A systematic review of the published data was conducted, following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Botulinum toxins present several label and off-label indications of interest for dermatologists. The best-reported evidence concerns focal idiopathic hyperhidrosis, Raynaud phenomenon, suppurative hidradenitis, Hailey–Hailey disease, epidermolysis bullosa simplex Weber–Cockayne type, Darier’s disease, pachyonychia congenita, aquagenic keratoderma, alopecia, psoriasis, notalgia paresthetica, facial erythema and flushing, and oily skin. Further clinical trials are still needed to better understand the real efficacy and safety of these applications and to standardize injection and doses protocols for off label applications.
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Özcan D, Seçkin D, Kibaroğlu S, Bernhard JD. Intralesional triamcinolone acetonide in notalgia paresthetica: Treatment outcomes in five patients. Dermatol Ther 2020; 33:e13462. [DOI: 10.1111/dth.13462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/17/2020] [Accepted: 04/17/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Deren Özcan
- Department of Dermatology Başkent University Faculty of Medicine Ankara Turkey
| | - Deniz Seçkin
- Department of Dermatology Başkent University Faculty of Medicine Ankara Turkey
| | - Seda Kibaroğlu
- Department of Neurology Başkent University Faculty of Medicine Ankara Turkey
| | - Jeffrey D. Bernhard
- Department of Dermatology University of Massachusetts Medical School Worcester Massachusetts USA
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8
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Morcillo Pérez C, Guerras Normand I, García Chinchetru MC. [Notalgia paresthetica: Treatment with botulinum toxin type A]. Rehabilitacion (Madr) 2020; 54:142-145. [PMID: 32370829 DOI: 10.1016/j.rh.2019.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 07/17/2019] [Indexed: 11/16/2022]
Abstract
Notalgia paresthetica is a sensory mononeuropathy caused by compression localized in the dorsal region. The condition is clinically characterised by the presence of pruritus, paresthesias and hyperalgesia associated with a hyperpigmented patch in the correspondingt dermatoma, substantially impairing quality of life. We report the cases of two patients aged between 35 and 65years with chronic symptoms and treated in our service with botulinum toxin type A in the affected areas. We observed a decrease in the EVA pain scale and the intensity of the pruritus after infiltrations, as well as a reduction in the hyperpigmented patch at the first, third and sixth months after the intradermal injections that has been maintained after a year. We conclude that botulinum toxin typeA treatment could be a safe and useful alternative in these patients, as it has been shown to be effective over a longer term than available treatments to date, although further studies are required to confirm our findings.
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Affiliation(s)
- C Morcillo Pérez
- Servicio de Rehabilitación, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España.
| | - I Guerras Normand
- Servicio de Rehabilitación, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - M C García Chinchetru
- Servicio de Rehabilitación, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
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9
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Berger AA, Urits I, Hasoon J, Simopoulos T. Alleviation of notalgia paresthetica with duloxetine after several lines offailed treatment: A case report. Case Rep Womens Health 2020; 26:e00197. [PMID: 32274333 PMCID: PMC7132164 DOI: 10.1016/j.crwh.2020.e00197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 10/25/2022] Open
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10
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<p>Eastern Pain Association Annual Meeting 2019 Abstract Session Award Winners</p>. J Pain Res 2020. [PMCID: PMC7184860 DOI: 10.2147/jpr.s246073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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11
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Meng J, Chen W, Wang J. Interventions in the B-type natriuretic peptide signalling pathway as a means of controlling chronic itch. Br J Pharmacol 2020; 177:1025-1040. [PMID: 31877230 DOI: 10.1111/bph.14952] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 11/08/2019] [Accepted: 11/19/2019] [Indexed: 12/22/2022] Open
Abstract
Chronic itch poses major health care and economic burdens worldwide. In 2013, B-type natriuretic peptide (BNP) was identified as an itch-selective neuropeptide and shown to be both necessary and sufficient to produce itch behaviour in mice. Since then, mechanistic studies of itch have increased, not only at central levels of the spinal relay of itch signalling but also in the periphery and skin. In this review, we have critically analysed recent findings from complementary pharmacological and physiological approaches, combined with genetic strategies to examine the role of BNP in itch transduction and modulation of other pruritic proteins. Additionally, potential targets and possible strategies against BNP signalling are discussed for developing novel therapeutics in itch. Overall, we aim to provide insights into drug development by altering BNP signalling to modulate disease symptoms in chronic itch, including conditions for which no approved treatment exists.
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Affiliation(s)
- Jianghui Meng
- School of Life Sciences, Henan University, Henan, China.,National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland.,School of Biotechnology, Faculty of Science and Health, Dublin City University, Dublin, Ireland
| | - Weiwei Chen
- School of Life Sciences, Henan University, Henan, China
| | - Jiafu Wang
- School of Life Sciences, Henan University, Henan, China.,School of Biotechnology, Faculty of Science and Health, Dublin City University, Dublin, Ireland
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12
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Physical Medicine and Rehabilitation Role on Notalgia Paresthetica: Case Report and Treatment Review. Am J Phys Med Rehabil 2019; 97:929-932. [PMID: 30439740 DOI: 10.1097/phm.0000000000000946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Notalgia paresthetica is a rarely reported T2-T6 sensory neuropathy whose etiology and treatment are not fully established. Although it is believed to be common in dermatological practice, it remains underrecognized, underdiagnosed, and therefore underreported. This case-report provides a physical medicine and rehabilitation perspective on notalgia paresthetica diagnosis and treatment. This article presents a case report of a 39-yr-old woman with pain, pruritus, and a hyperpigmented area in the right dorsal infra scapular region. The diagnosis of notalgia paresthetica was established. She was successfully treated with topical anesthetics, postural corrective exercises, scapular muscle strengthening, and pectoral muscle stretching. In this context, different treatment options were reviewed. A small set of pharmacological and nonpharmacological techniques were identified. Several of these modalities belong to the physical medicine and rehabilitation field of action.
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13
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Nahidi Y, Delghandi SR, Kiafar B, Saki A. The therapeutic effects of 1540-nm nonablative fractional erbium laser on macular amyloidosis: a randomized clinical trial. J DERMATOL TREAT 2019; 32:340-344. [PMID: 31411528 DOI: 10.1080/09546634.2019.1655136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This aim of this study was to determine the effect of 1540-nm nonablative fractional erbium on macular amyloidosis. METHODS This phase-II clinical trial study has been performed with parallel group with blinding of the evaluator. The skin lesions of the patients (15 patients and 30 lesions) with cutaneous macular amyloidosis were randomly assigned into laser and no-treatment groups. In the laser group, treatment was performed by 1540-nm nonablative fractional erbium laser. Thereafter, the patients' lesions were compared in terms of pigmentation, rippling, thickness, and subjective response. RESULTS The lesions of the intervention group significantly improved in the three-month follow-up compared to the control group (in the control and intervention group, improved pigmentation was observed in 20 and 53.3% with p = .02, improved rippling in 6.7 and 60% with p = .007, diminished lichenification in 0 and 53.1% with p = .007, and overall lesion improvement in 20 and 60% with p = .03, respectively). In investigating the subjective response through patient global assessment, the patients in the intervention group had a greater satisfaction (p = .01). There was a considerable improvement of pruritus in the intervention group (p = .001). CONCLUSIONS Use of 1540-nm nonablative fractional erbium laser offered a suitable efficacy to treat macular amyloidosis without significant complications.
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Affiliation(s)
- Yalda Nahidi
- Cutaneous Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyedeh Rozita Delghandi
- Resident of Dermatology, Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bita Kiafar
- Cutaneous Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Azadeh Saki
- Health Faculty, Mashhad University of Medical Sciences, Mashhad, Iran
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Ansari A, Weinstein D, Sami N. Notalgia paresthetica: treatment review and algorithmic approach. J DERMATOL TREAT 2019; 31:424-432. [DOI: 10.1080/09546634.2019.1603360] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Ahmed Ansari
- College of Medicine, University of Central Florida, Orlando, FL, USA
| | - David Weinstein
- College of Medicine, University of Central Florida, Orlando, FL, USA
| | - Naveed Sami
- College of Medicine, University of Central Florida, Orlando, FL, USA
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Howard M, Sahhar L, Andrews F, Bergman R, Gin D. Notalgia paresthetica: a review for dermatologists. Int J Dermatol 2017; 57:388-392. [DOI: 10.1111/ijd.13853] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 09/23/2017] [Accepted: 11/09/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Matthew Howard
- Department of Medicine; St Vincent's Hospital; Melbourne Victoria Australia
| | - Lukas Sahhar
- Royal Victorian Eye and Ear Hospital; Melbourne Victoria Australia
| | - Frank Andrews
- Physiotherapist. Berwick Physio; Berwick Victoria Australia
| | - Ralph Bergman
- Physiotherapist. Think Physio; Mulgrave Victoria Australia
| | - Douglas Gin
- Department of Dermatology; Alfred Hospital; Melbourne Victoria Australia
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16
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LaRosa C, Chiaravalloti A, Jinna S, Berger W, Finch J. Laser treatment of medical skin disease in women. Int J Womens Dermatol 2017; 3:131-139. [PMID: 28831422 PMCID: PMC5555278 DOI: 10.1016/j.ijwd.2017.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 05/09/2017] [Accepted: 05/09/2017] [Indexed: 01/01/2023] Open
Abstract
Laser treatment is a relatively new and increasingly popular modality for the treatment of many dermatologic conditions. A number of conditions that predominantly occur in women and that have a paucity of effective treatments include rosacea, connective tissue disease, melasma, nevus of Ota, lichen sclerosus (LS), notalgia paresthetica and macular amyloidosis, and syringomas. Laser therapy is an important option for the treatment of patients with these conditions. This article will review the body of literature that exists for the laser treatment of women with these medical conditions.
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Affiliation(s)
- C. LaRosa
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT
| | - A. Chiaravalloti
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT
| | - S. Jinna
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT
| | - W. Berger
- Frank H. Netter MD School of Medicine, Quinnipiac University, North, Haven, CT
| | - J. Finch
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT
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17
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Forbat E, Ali F, Al-Niaimi F. Non-cosmetic dermatological uses of botulinum neurotoxin. J Eur Acad Dermatol Venereol 2016; 30:2023-2029. [DOI: 10.1111/jdv.13772] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 04/19/2016] [Indexed: 12/29/2022]
Affiliation(s)
| | - F.R. Ali
- Dermatological Surgery & Laser Unit; St John's Institute of Dermatology; St Thomas' Hospital; London UK
| | - F. Al-Niaimi
- Dermatological Surgery & Laser Unit; St John's Institute of Dermatology; St Thomas' Hospital; London UK
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18
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Shumway NK, Cole E, Fernandez KH. Neurocutaneous disease. J Am Acad Dermatol 2016; 74:215-28; quiz 229-30. [DOI: 10.1016/j.jaad.2015.04.059] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 04/06/2015] [Accepted: 04/22/2015] [Indexed: 02/01/2023]
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