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Gonzalez C, Duque-Clavijo V, Kroumpouzos G, Concha AMG, Perez MO. ULTRASONOGRAPHIC FEATURES OF NON-VASCULAR COMPLICATIONS OF HYALURONIC ACID FILLERS: A RETROSPECTIVE STUDY AT A REFERENCE CENTER FOR DERMATOLOGIC ULTRASONOGRAPHY. Clin Dermatol 2024:S0738-081X(24)00080-4. [PMID: 38763380 DOI: 10.1016/j.clindermatol.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
Hyaluronic acid (H.A.) filler injections have been associated with early, temporary, and delayed-onset onset complications. High-resolution ultrasound (HRUS) with Doppler analysis has been increasingly used to detect and identify such complications. We describe comprehensively the most common ultrasonographic findings of non-vascular complications associated with H.A. filler injections. This retrospective, cross-sectional observational study was conducted at a reference center for dermatologic ultrasound in Bogotá, Colombia. Ultrasound reports documented the ultrasonographic findings of non-vascular complications of H.A. filler injections. Fifty-two complications were documented in a cohort of 50 patients (women, 88%). The infraorbital region was the most common site affected (23%), followed by the nasolabial (22%). The Tyndall effect was the most common complication (25% of all), followed by changes in rheology (21%) and pseudo-sarcoidal (foreign body granuloma) reaction (15%). The Tyndall effect stood out for its distinctive ultrasonographic characteristics. We discuss the ultrasonographic findings and pathogenesis of other complications, including filler migration, early hypersensitivity, aseptic abscess, overcorrection, and filler material interaction. The clinical presentation of H.A. filler complications can be confusing, delaying timely diagnosis and treatment. HRUS with Doppler analysis is a valuable tool for avoiding unnecessary treatments and ensuring timely diagnosis and treatment.
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Affiliation(s)
- Claudia Gonzalez
- Department of Radiology, Rosario University, Bogotá D.C., Colombia.
| | | | - George Kroumpouzos
- Department of Dermatology, Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Ana Maria Garcia Concha
- Department of Dermatology, Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá D.C., Colombia
| | - Miguel Olmos Perez
- Dermatology Department, San José Hospital, Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá D.C., Colombia
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Landau M, Silikovich F, Fida M, Cartier H, Kroumpouzos G. Oral Methotrexate Treatment of Delayed-Onset Inflammatory Reactions to Dermal Fillers. Aesthet Surg J Open Forum 2024; 6:ojae011. [PMID: 38690015 PMCID: PMC11060488 DOI: 10.1093/asjof/ojae011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
Background In aesthetic practice, delayed-onset (late) inflammatory reactions (DIRs) to dermal fillers are encountered. The treatment of DIRs can be challenging, with a response to established therapies, including oral antibiotics, intralesional and oral steroids, and hyaluronidase injection, occasionally reported as unsatisfactory. Objectives Evaluate the efficacy of low-dose oral methotrexate (MTX) therapy in treating recalcitrant DIRs. Methods We retrospectively reviewed cases of recalcitrant DIRs treated with oral MTX. Data collected included individuals' gender and age, medical history, filler type, facial area(s) injected, previous treatments attempted to dissolve the DIR, MTX treatment dosage and duration, and outcome. Adverse events were monitored throughout the treatment. Results Thirteen females with a mean age of 52.6 years (range, 31-67 years) who developed recalcitrant DIRs to dermal filler injection are included. Eight reactions were triggered by the injection of hyaluronic acid (HA) fillers, 4 by liquid injectable silicone (LIS), and 1 by polymethylmethacrylate (PMMA). The average starting dosage of MTX was 12.1 mg/week (range, 7.5-12.5 mg/week). Patients were treated for 2 to 3 months in most cases. The average follow-up post-MTX therapy was 11.8 months (range, 2-36 months). A complete response to MTX treatment was observed in 10 patients (6 HA and 4 LIS cases), partial response in 1 (HA case), and an unsatisfactory response in 2 (HA and PMMA cases). Treatment was well tolerated. Conclusions A short course of low-dose oral MTX is a possible treatment for DIRs that have not responded to established therapies. The promising results of this report require validation by powered studies. Level of Evidence 4
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Affiliation(s)
| | | | | | | | - George Kroumpouzos
- Corresponding Author: Dr George Kroumpouzos, 541 Main St, Suite 320, South Weymouth, MA 02190, USA. E-mail:
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Kroumpouzos G, Treacy P. Hyaluronidase for Dermal Filler Complications: Review of Applications and Dosage Recommendations. JMIR Dermatol 2024; 7:e50403. [PMID: 38231537 PMCID: PMC10836581 DOI: 10.2196/50403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/17/2023] [Accepted: 12/11/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Hyaluronidase (Hyal) can reverse complications of hyaluronic acid (HA) fillers, which has contributed substantially to the popularity of such procedures. Still, there are differing opinions regarding Hyal treatment, including dosage recommendations in filler complication management. OBJECTIVE We aimed to address unanswered questions regarding Hyal treatment for HA filler complications, including timing and dosage, skin pretesting, properties of various Hyals and interactions with HA gels, and pitfalls of the treatment. METHODS PubMed and Google Scholar databases were searched from inception for articles on Hyal therapy for filler complications. Articles were evaluated regarding their contribution to the field. The extensive literature review includes international leaders' suggestions and expert panels' recommendations. RESULTS There are limited controlled data but increasing clinical experience with Hyal treatment. The currently used Hyals provide good results and have an acceptable safety profile. Nonemergent complications such as the Tyndall effect, noninflamed nodules, and allergic or hypersensitivity reactions should be treated with low or moderate Hyal doses. Hyal should be considered with prior or simultaneous oral antibiotic treatment in managing inflammatory nodules. Hyal may be tried for granulomas that have not responded to intralesional steroids. Emergent complications such as vascular occlusion and blindness require immediate, high-dose Hyal treatment. Regarding blindness, the injection technique, retrobulbar versus supraorbital, remains controversial. Ultrasound guidance can increase the efficacy of the above interventions. CONCLUSIONS Hyal is essential in aesthetic practice because it can safely treat most HA filler complications. Immediate Hyal treatment is required for emergent complications. Aesthetic practitioners should be versed in using Hyal and effective dosage protocols.
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Affiliation(s)
- George Kroumpouzos
- GK Dermatology, PC, South Weymouth, MA, United States
- Department of Dermatology, Warren Alpert Medical School at Brown University, Providence, RI, United States
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Kroumpouzos G, Harris S, Bhargava S, Wortsman X. Complications of fillers in the lips and perioral area: Prevention, assessment, and management focusing on ultrasound guidance. J Plast Reconstr Aesthet Surg 2023; 84:656-669. [PMID: 37002059 DOI: 10.1016/j.bjps.2023.01.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/30/2022] [Accepted: 01/29/2023] [Indexed: 03/09/2023]
Abstract
An ever-increasing interest in perioral rejuvenation with dermal fillers reflects the esthetic importance of this region. However, filler injections in the lips and perioral area have been associated with various complications. Such complications are classified according to severity (mild, moderate, severe) or by the time of onset: immediate (within 24 h after injection), early (24 h to 4 weeks post-procedure), and late or delayed (>4 weeks after injection). While most complications are mild and manageable, vascular compromise, infections, and the development of delayed-onset nodules may significantly undermine the ultimate esthetic outcome and cause substantial morbidity. These more serious complications often require more invasive treatment modalities. This article details the prevention and management of such adverse events and discusses safe filler injection principles, including safety recommendations for the lips. Lastly, we highlight the use of ultrasound guidance in complication prevention (vascular mapping, filler identification, location, and extent), assessment (identification of intravascular embolus or external vascular compression by the filler implant), and management (real-time imaging of hyaluronidase or other drug injection in the affected area). Esthetic practitioners should be versed in injection anatomy, and the prevention, recognition, and management of filler complications in the perioral area.
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Affiliation(s)
- George Kroumpouzos
- Department of Dermatology, Warren Alpert Medical School at Brown University, Providence, RI, USA.
| | | | - Shashank Bhargava
- Department of Dermatology, R.D. Gardi Medical College and C.R. Gardi Hospital, Ujjain, India.
| | - Ximena Wortsman
- Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Santiago, Chile; Department of Dermatology, Faculty of Medicine, Universidad de Chile, Santiago, Chile; Department of Dermatology, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile.
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Türk CB, Mirza FN, Kroumpouzos G. A Screening Proposal for Zoom Dysmorphia in Virtual Settings. Life (Basel) 2023; 13:1678. [PMID: 37629535 PMCID: PMC10456071 DOI: 10.3390/life13081678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 08/27/2023] Open
Abstract
Zoom dysmorphia (ZD) is a facial dysmorphia that is triggered or aggravated by frequent virtual meetings. The frequent use of videoconferencing platforms has been linked to a distorted perception of facial images as individuals have an increased awareness of their appearance, given constant video feedback. As a result, dysmorphic concerns can develop. It is crucial to identify ZD as this condition interferes with an individual's life and can trigger or aggravate body dysmorphic disorder (BDD). A standardized approach for screening ZD in non-psychiatric settings has yet to be defined. We discuss the features of ZD and the challenges of screening for ZD in a virtual setting. To facilitate the recognition of ZD in telehealth consultations, we propose a comprehensive ZD screening questionnaire that includes questions related to typical ZD features and a BDD-focused question. The questionnaire is concise and allows the identification of individuals with a potential ZD. A BDD assessment in such individuals should follow.
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Affiliation(s)
- Cemre Büşra Türk
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02114, USA;
- Department of Dermatology, Harvard Medical School, Boston, MA 02114, USA
| | - Fatima N. Mirza
- Department of Dermatology, Warren Alpert Medical School at Brown University, Providence, RI 02903, USA;
| | - George Kroumpouzos
- Department of Dermatology, Warren Alpert Medical School at Brown University, Providence, RI 02903, USA;
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Messas T, Lim RK, Burns L, Yumeen S, Kroumpouzos G. A critical review of COVID-19 course and vaccination in dermatology patients on immunomodulatory/biologic therapy: recommendations should not differ between non-pregnant and pregnant individuals. Front Med (Lausanne) 2023; 10:1121025. [PMID: 37332768 PMCID: PMC10272467 DOI: 10.3389/fmed.2023.1121025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 04/24/2023] [Indexed: 06/20/2023] Open
Abstract
COVID-19 can have detrimental effects on immunosuppressed patients. Here, we evaluate the evidence regarding continuing immunomodulatory/biologic (IMBI) therapy in pregnant dermatology patients during the COVID-19 pandemic. Also, we discuss the risks of COVID-19 vaccination in pregnant dermatology patients on IMBI therapy. As indicated in this review, regarding continuing IMBI therapy in pregnant dermatology patients during the pandemic, there is no compelling reason for treating them differently than non-pregnant. The body of evidence indicates that mRNA COVID-19 vaccines are safe during pregnancy. Studies on rheumatology patients, a group that overlaps significantly with the dermatology group, provided essential findings. IMBI in a non-pregnant rheumatology patient was not associated with COVID-19 mortality (except for rituximab), and vaccination of the rheumatology patient during pregnancy improved the obstetric outcomes compared to the unvaccinated patient. Based on this data, it can be stated that after weighing the benefit-risk profile of the available COVID-19 vaccines, the recommendation for the pregnant dermatology patient speaks in favor of the COVID-19 vaccination. COVID-19 vaccine recommendations in pregnant dermatology patients on IMBI should not differ from those for their non-pregnant counterparts.
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Affiliation(s)
- Tassahil Messas
- Department of Dermatology, University Hospital Centre, University of Constantine III, Constantine, Algeria
| | - Rachel K. Lim
- Alpert Medical School, Brown University, Providence, RI, United States
| | - Laura Burns
- Department of Dermatology, Alpert Medical School, Brown University, Providence, RI, United States
| | - Sara Yumeen
- Department of Dermatology, Alpert Medical School, Brown University, Providence, RI, United States
| | - George Kroumpouzos
- Department of Dermatology, Alpert Medical School, Brown University, Providence, RI, United States
- GK Dermatology, PC, South Weymouth, MA, United States
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Laughter MR, Anderson JB, Maymone MBC, Kroumpouzos G. Psychology of Aesthetics: Beauty, Social Media, and Body Dysmorphic Disorder. Clin Dermatol 2023:S0738-081X(23)00029-9. [PMID: 36882132 DOI: 10.1016/j.clindermatol.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
The perception of beauty is fluid within society and can morph based on cultural practices and societal interaction, such as social media exposure. The exposure to digital conference platforms has increased significantly, leading users to check their appearance constantly and find flaws in their perceived virtual appearance. Studies have shown that frequent social media use may lead to unrealistic body image ideals, a significant concern with appearance, and anxiety. Also, social media exposure can worsen body image dissatisfaction, social networking site addiction, and comorbidities of body dysmorphic disorder (BDD) such as depression and eating disorders. Additionally, excessive social media use can increase preoccupation with imagined image defects among BDD patients leading them to pursue minimally invasive cosmetic and plastic surgery procedures. This contribution aims to provide an overview of the evidence surrounding the perception of beauty, cultural aspects of aesthetics, and social media's consequences, especially on BDD's clinical specifics.
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Affiliation(s)
- Melissa R Laughter
- Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | | | - Mayra B C Maymone
- Department of Dermatology, Alpert Medical School, Brown University, Providence, Rhode Island, USA
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Türk CB, Maymone MB, Kroumpouzos G. Body Dysmorphic Disorder: a Critical Appraisal of Diagnostic, Screening, and Assessment Tools. Clin Dermatol 2023:S0738-081X(23)00028-7. [PMID: 36878447 DOI: 10.1016/j.clindermatol.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Body dysmorphic disorder (BDD) is a psychiatric condition characterized by profound concern about a minor or imagined defect in the appearance of individuals and increased preoccupation with the imagined/perceived defect. Individuals with BDD often undergo cosmetic intervention for the perceived imperfection but rarely experience improvement in their signs and symptoms following such treatment. It is recommended that aesthetic providers evaluate individuals face-to-face and screen for BDD with approved scales preoperatively to determine the candidate's suitability for the procedure. This contribution focuses on diagnostic and screening tools and measures of disease severity and insight that providers working in non-psychiatric settings can utilize. Several screening tools were explicitly developed for BDD, while others were designed to evaluate body image/dysmorphic concern. The BDD Questionnaire (BDDQ)-Dermatology Version (BDDQ-DV), BDDQ-Aesthetic Surgery (BDDQ-AS), Cosmetic Procedure Screening Questionnaire (COPS), and Body Dysmorphic Symptom Scale (BDSS) have been explicitly developed for BDD and validated in cosmetic settings. Limitations of screening tools are discussed. Given the increasing use of social media, future revisions of BDD instruments should consider incorporating questions relevant to patients' behaviors on social media. Current screening tools can adequately test for BDD despite their limitations and a need for updates.
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Affiliation(s)
- Cemre Büşra Türk
- Department of Dermatology, University of Health Sciences, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Mayra Bc Maymone
- Department of Dermatology, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - George Kroumpouzos
- Department of Dermatology, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA; GK Dermatology, PC, South Weymouth, Massachusetts, USA.
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Dimitrov D, Maymone MBC, Kroumpouzos G. Beauty Perception: A Historic and Contemporary Review. Clin Dermatol 2023:S0738-081X(23)00025-1. [PMID: 36878443 DOI: 10.1016/j.clindermatol.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
The power of beauty influences many aspects of modern society and daily life-perceptions surrounding beauty date to ancient philosophers and have evolved significantly throughout history. Still, there appear to be universally accepted physical characteristics of beauty that span different cultures. Human beings have an inherent ability to distinguish between attractive and non-attractive based on physical features that include facial averageness, symmetry, skin homogeneity, and sexual dimorphism (sex-typical characteristics). Although beauty standards have changed over time, youthful appearance has remained a permanent influential component of facial attractiveness. Each person's perception of beauty is influenced by environment and perceptual adaptation, an experience-based process. Perception of beauty varies by race and ethnicity. We discuss typical features of Caucasian, Asian, Black, and Latino beauty. We also review the effects of globalization on spreading foreign beauty culture and discuss how social media change traditional beauty stereotypes within the different races and ethnicities.
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Affiliation(s)
| | - Mayra B C Maymone
- Department of Dermatology, Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - George Kroumpouzos
- Department of Dermatology, Alpert Medical School, Brown University, Providence, Rhode Island, USA; GK Dermatology, PC, South Weymouth, Massachusetts, USA.
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Stamu-O'Brien C, Kroumpouzos G. The Role of Lipids in Vitiligo and Schizophrenia. Clin Dermatol 2023:S0738-081X(23)00034-2. [PMID: 36878451 DOI: 10.1016/j.clindermatol.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
The pathogenesis of vitiligo and schizophrenia has not been adequately clarified. We explore the role of lipids in these diseases. Both conditions have been associated with stress in several observations and studies. Research data indicate complex interactions between oxidative stress and metabolic syndrome-with lipid abnormalities being a significant component of the latter-in these diseases. The impaired membrane lipid homeostasis mechanism is related to the increased phospholipid remodeling caused by excessive oxidative stress in schizophrenia. We indicate that sphingomyelin is possibly involved in the pathogenesis of these diseases. Statins have anti-inflammatory and immunomodulating effects and an effect against oxidative stress. Preliminary clinical studies show that these agents may be beneficial in both vitiligo and schizophrenia, but their therapeutic value should be studied further.
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Affiliation(s)
| | - George Kroumpouzos
- Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, RI, USA.
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Yumeen S, Gowda A, Hsu MY, Kroumpouzos G. Annular Basal Cell Carcinoma Expanding Around Central Hypertrophic Scarring: A Case Report. Cureus 2023; 15:e35934. [PMID: 36911588 PMCID: PMC9997686 DOI: 10.7759/cureus.35934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2023] [Indexed: 03/11/2023] Open
Abstract
A case of annular basal cell carcinoma (BCC) with central atrophic scarring that developed secondary to spontaneous regression has been reported. We present a novel case of a large, expanding nodular and micronodular BCC with annular morphology with central hypertrophic scarring. A 61-year-old woman presented with a two-year history of a mildly itchy lesion on the right breast. Previously diagnosed as an infection, the lesion persisted after treatment with topical antifungal agents and oral antibiotics. Physical examination revealed a 5x6 cm plaque consisting of a pink-red arciform/annular edge with an overlying scale crust and a large, centrally positioned, firm, alabaster-colored portion. A punch biopsy of the pink-red rim revealed nodular and micronodular BCC features. A deep shave biopsy of the central bound-down plaque showed histopathology of scarring fibrosis with no findings of BCC regression. The malignancy was treated with two sessions of radiofrequency destruction, which led to the resolution of the tumor with no recurrence to date. Contrary to the previously reported case, BCC in our case was expanding, associated with hypertrophic scarring, and showed no signs of regression. We discuss several possible etiologies of the scarring centrally. With further awareness of this presentation, more such tumors can be detected at early stages to facilitate prompt treatment and prevent local morbidity.
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Affiliation(s)
- Sara Yumeen
- Dermatology, Warren Alpert Medical School at Brown University, Providence, USA
| | - Asha Gowda
- Dermatology, Warren Alpert Medical School at Brown University, Providence, USA
| | - Mei-Yu Hsu
- Dermatopathology, StrataDx, Lexington, USA
| | - George Kroumpouzos
- Dermatology, Warren Alpert Medical School at Brown University, Providence, USA
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Shrestha S, Regmi B, Pathak R, Kroumpouzos G. Idiopathic Acroosteolysis: A Novel Cutaneous Sign Can Help Identify the Condition Early. Case Rep Dermatol 2023; 15:51-55. [PMID: 36936732 PMCID: PMC10018418 DOI: 10.1159/000529727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 01/31/2023] [Indexed: 03/17/2023] Open
Abstract
Acroosteolysis (AO) is a rare condition characterized by resorption of the distal phalanges of the fingers and/or toes. It can be familial, idiopathic (IAO), occupational, or secondary. Other authors suggest a classification into primary (genetic disorders, lysosomal storage disorders) or secondary AO. Various skin and nail changes have been reported in this condition. However, the cutaneous change on the affected digit(s)/toe(s) during the natural course of AO has been poorly documented. A 5-year-old girl presented with a 3-month history of a distinct transverse boundary between normal skin proximally and affected crusted skin overlying osteolysis distally ("split" sign) on the plantar surface of the third toe. This boundary gradually elongated circumferentially to involve the dorsal surface. The mother gave a similar history of a delimitation line on the 2nd, 4th, and 5th toes of the right foot with durations of 3 months, 1 year, and 2 years, respectively, that disappeared before she noticed a shortening of those toes. X-rays revealed partial resorption of the terminal phalanx of the third toe and several lytic changes in the middle and terminal phalanx of the second, fourth, and fifth toes. The clinical features, radiology findings, and a workup that helped rule out conditions associated with AO (secondary AO) helped establish the diagnosis of IAO in our patient. This case study highlights that the natural course of IAO includes distinct skin findings, such as the "split" sign that we describe. This sign can help identify the condition early.
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Affiliation(s)
- Samir Shrestha
- Department of Dermatology, Rapti Province Hospital, Tulsipur, India
| | - Bashant Regmi
- Department of Radiology, Rapti Province Hospital, Tulsipur, India
| | - Raksha Pathak
- Department of Dermatology, Lumbini Province Hospital, Butwal, India
| | - George Kroumpouzos
- Department of Dermatology, Warren Alpert Medical School at Brown University, Providence, RI, USA
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Kroumpouzos G. Psychocutaneous medicine: A psychopathology-based, problem-focused approach. Clin Dermatol 2023; 41:1-4. [PMID: 36878446 DOI: 10.1016/j.clindermatol.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Affiliation(s)
- George Kroumpouzos
- Department of Dermatology, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA.
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Shrestha S, Pokharel R, Pathak R, Pandey P, Kroumpouzos G. Scalp Ulcer due to Intralesional Corticosteroid Injection. Skinmed 2023; 21:35-36. [PMID: 36987824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Affiliation(s)
- Samir Shrestha
- Department of Dermatology and Venereology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Ranju Pokharel
- Department of Dermatology and Venereology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Raksha Pathak
- Department of Dermatology and Venereology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Prajwal Pandey
- Department of Dermatology and Venereology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - George Kroumpouzos
- Department of Dermatology, Rhode Island Hospital, Alpert Medical School at Brown University, Providence, RI, USA;
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Maymone MBC, Kroumpouzos G. Incorporation of social media questions in body dysmorphic disorder scales: A proposed revision. Clin Dermatol 2022; 40:554-555. [PMID: 35182708 DOI: 10.1016/j.clindermatol.2022.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Mayra B C Maymone
- Department of Dermatology, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - George Kroumpouzos
- Department of Dermatology, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA; GK Dermatology, PC, South Weymouth, Massachusetts, USA.
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Dash G, Patil A, Kroumpouzos G, Galadari H, Gold M, Grabbe S, Goldust M. Hormonal Therapies in the Management of Acne Vulgaris. J Drugs Dermatol 2022; 21:618-623. [DOI: 10.36849/jdd.6494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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17
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Negbenebor NA, Shayegan LH, Cohen LM, Kroumpouzos G. Nonmelanoma Skin Cancer in the Setting of Erosive Pustular Dermatosis of the Scalp: A Case Series and Comment on Management Implications. Dermatol Ther 2022; 35:e15584. [DOI: 10.1111/dth.15584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 03/28/2022] [Accepted: 05/13/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Nicole A. Negbenebor
- Department of Dermatology Warren Alpert Medical School at Brown University Providence Rhode Island USA
| | - Leila H. Shayegan
- Department of Dermatology Warren Alpert Medical School at Brown University Providence Rhode Island USA
| | - Lisa M. Cohen
- Dermatopathology Section, StrataDx Lexington Massachusetts USA
| | - George Kroumpouzos
- Department of Dermatology Warren Alpert Medical School at Brown University Providence Rhode Island USA
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18
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Rathod D, Kroumpouzos G, Lallas A, Rao B, Murrell DF, Apalla Z, Grabbe S, Loquai C, Goldust M. Critical Review of the Sentinel Lymph Node Surgery in Malignant Melanoma. J Drugs Dermatol 2022; 21:510-516. [PMID: 35533034 DOI: 10.36849/jdd.6198] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Malignant melanoma is one of the most aggressive solid tumors but has low morbidity if treated at an early stage. Over the past decade, the advent of targeted therapy and immunotherapy have productively enriched the treatment options for advanced melanomas and further improved the prognosis. The treatment of melanoma is a rapidly evolving field. In patients with sentinel lymph node (SLN)-positive (SLN+) melanoma, the role of complete lymph node dissection (CLND) is still a matter of debate. Sentinel lymph node biopsy (SLNB) is a staging procedure for melanoma that is routinely offered to patients with tumor thickness ≥1 mm or ≥0.8 mm with additional risk factors and is widely accepted as an important diagnostic and prognostic tool, since SLN+ patients can receive adjuvant targeted treatment or immunotherapy. Currently, the role of CLND has largely been replaced by often recommended adjuvant therapies since their approval. This article provides an overview of sentinel lymph-node surgery in cutaneous melanoma. J Drugs Dermatol. 2022;21(5):510-516. doi:10.36849/JDD.6198.
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19
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Misitzis A, Bhargava S, Cunha PR, Kroumpouzos G. Aminolevulinic Acid-Photodynamic Therapy for Erosive Pustular Dermatosis of the Scalp: Comparison of Two Treatment Protocols and Participant Satisfaction. Skinmed 2022; 20:107-112. [PMID: 35532762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Treatment of erosive pustular dermatosis of the scalp (EPDS) is challenging. Topical and systemic medications have achieved limited success, and destructive modalities have been associated with EPDS recurrence because of the tendency of the condition to recur after any treatment that induces trauma to the skin. Our group has have recently reported two series of EPDS treated with aminolevulinic acid-photodynamic therapy (ALA-PDT). Here, we aimed at comparing the protocols utilized in those series regarding efficacy, cost, and patient satisfaction. The first protocol included one visit for curettage of the hyperkeratosis and a second one for ALA-PDT. The revised (second) protocol included all procedures (curettage and ALA-PDT) in one visit. A novel silicone gel was applied immediately after completion of PDT, and patients were instructed to apply it twice daily over the treated areas until their follow-up visit. Both protocols were efficacious and provided similar length of remission. The second protocol was less costly. Patients treated using the second protocol were more satisfied due to the ease of treatment completion in one visit and better postoperative healing. (SKINmed. 2022;20:107-112).
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Affiliation(s)
- Angelica Misitzis
- Department of Dermatology, Alpert Medical School of Brown University, Providence, RI
| | - Shashank Bhargava
- Department of Dermatology, R.D. Gardi Medical College, Ujjain, India
| | - Paulo R Cunha
- Department of Dermatology, Medical School of Jundiaí, Jundiaí, São Paulo, Brazil
| | - George Kroumpouzos
- Department of Dermatology, Alpert Medical School of Brown University, Providence, RI
- Department of Dermatology, Medical School of Jundiaí, Jundiaí, São Paulo, Brazil
- GK Dermatology, PC, South Weymouth, MA;
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20
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Sharma A, Kroumpouzos G, Kassir M, Galadari H, Goren A, Grabbe S, Goldust M. Rosacea Management: A Comprehensive Review. J Cosmet Dermatol 2022; 21:1895-1904. [PMID: 35104917 DOI: 10.1111/jocd.14816] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/11/2022] [Indexed: 11/28/2022]
Abstract
Rosacea is a chronic cutaneous disorder affecting primarily the face, characterized by erythema, transient or persistent, telangiectasia, and inflammatory lesions including papulo-pustules and swelling. The essential component of the disease is the persistent erythema of facial skin. Episodes of flushing (acute-subacute intermittent vasodilation) are common. Swelling and erythema of the nose along with dilatation of the pilosebaceous poral orifices, known as rhinophyma, can be noted in chronic cases. Rosacea affects up to 10% of the world population and is especially noted in fair skinned individuals aged 35 to 50. Women are affected more often than men. Several treatment modalities including topical medications, systemic drugs, lasers and light-based therapies have been used for the management of rosacea with variable results. Topical medications such as azelaic acid, metronidazole, and sulfacetamide/sulphur, oral antibiotics such as tetracyclines, and oral retinoids alone or, most commonly, in combination form the mainstay of treatment. Light therapies such as intense pulsed light and pulsed dye laser are best used for the eythemato-telangiectatic type. Topical brimonidine, oxymetazoline, ivermectin, tacrolimus, pimercrolimus, low-dose modified release tetracyclines and botulinum toxin are the new additions to the therapeutic armamentarium. This article provides a comprehensive review of the various therapies used for rosacea.
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Affiliation(s)
- Anuj Sharma
- Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Himachal Pradesh, Kangra (Tanda), India
| | - George Kroumpouzos
- Department of Dermatology, Alpert Medical School of Brown University Providence, Rhode Island, Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil.,GK Dermatology, PC, South Weymouth, Massachusetts, USA
| | - Martin Kassir
- Founding director, Worldwide laser institute, Dallas, USA
| | - Hassan Galadari
- College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Andy Goren
- Applied Biology, Inc, Irvine, CA, United States
| | - Stephan Grabbe
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Mohamad Goldust
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
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21
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Das K, Daveluy S, Kroumpouzos G, Agarwal K, Podder I, Farnbach K, Ortega-Loayza AG, Szepietowski JC, Grabbe S, Goldust M. Efficacy and Toxicity of Classical Immunosuppressants, Retinoids and Biologics in Hidradenitis Suppurativa. J Clin Med 2022; 11:jcm11030670. [PMID: 35160122 PMCID: PMC8836901 DOI: 10.3390/jcm11030670] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/09/2022] [Accepted: 01/18/2022] [Indexed: 12/05/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory disorder of the apocrine glands characterized by recurrent episodes. Although several therapies exist, none is completely curative. Several immunosuppressives have been studied with encouraging results and targeted approaches. In this review, we highlight the various immunosuppressives used in this condition along with their salient features to enable physicians to choose the correct therapy for their patients. The search of the peer-reviewed literature included clinical trials, scientific reviews, case series, case reports, and guidelines. The literature was identified from electronic databases (MEDLINE and PubMed) through November 2021; additional articles were included from the references of the identified articles.
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Affiliation(s)
- Kinnor Das
- Department of Dermatology Venereology and Leprosy, Silchar Medical College, Silchar 788014, India;
| | - Steven Daveluy
- Department of Dermatology, Wayne State University, Detroit, MI 48202, USA;
| | - George Kroumpouzos
- Department of Dermatology, Alpert Medical School of Brown University, Providence, RI 02903, USA;
- Department of Dermatology, Medical School of Jundiaí, São Paulo 13202-550, Brazil
- GK Dermatology, P.C, Weymouth, MA 02190, USA
| | - Komal Agarwal
- Department of Dermatology, CNMC, Kolkata 700014, India;
| | - Indrashis Podder
- Department of Dermatology, Venereology and Leprosy, College of Medicine and Sagore Dutta Hospital, Kolkata 700058, India;
| | - Katherine Farnbach
- Department of Dermatology, Oregon Health and Science University, Portland, OR 97239, USA; (K.F.); (A.G.O.-L.)
| | - Alex G. Ortega-Loayza
- Department of Dermatology, Oregon Health and Science University, Portland, OR 97239, USA; (K.F.); (A.G.O.-L.)
| | - Jacek C. Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-367 Wroclaw, Poland
- Correspondence: (J.C.S.); (M.G.)
| | - Stephan Grabbe
- Department of Dermatology, University Medical Center Mainz, 55131 Mainz, Germany;
| | - Mohamad Goldust
- Department of Dermatology, University Medical Center Mainz, 55131 Mainz, Germany;
- Correspondence: (J.C.S.); (M.G.)
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22
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Abstract
Optoacoustic imaging (OAI) is a hybrid imaging modality that integrates the benefits of optical contrast and ultrasound detection. Raster-scan optoacoustic mesoscopy (RSOM) is an emerging OAI method that provides information about several dermatological conditions' structural, functional, and molecular features. We searched PubMed and Google Scholar databases through September 2021 for articles relevant to OAI in the English language. This review contains 32 studies and other relevant literature. Several studies indicate that RSOM is helpful in inflammatory skin conditions such as psoriasis and eczema, especially as it allows more accurate quantification of inflammation-related alterations such as changes to the dermal vasculature. In psoriasis, RSOM can provide objective early diagnosis and monitoring of disease activity and treatment efficacy. Multispectral RSOM, a method in which skin is lightened at more than a single wavelength, is beneficial in diagnosing and monitoring hypoxia-associated conditions, such as systemic sclerosis and chronic wounds. OAI techniques can visualize the pathological vascularization of skin cancers and quantify their oxygenation status which helps differentiate them from normal skin. Also, they can measure the depth of malignant melanoma and detect the metastatic spread of melanoma cells to sentinel lymph nodes. As demonstrated in this article, there is a large spectrum of potential applications of OAI imaging, especially RSOM, in diagnosing, treating, and managing skin diseases.
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Affiliation(s)
- Tassahil Messas
- Department of Dermatology, University of Constantine III, University Hospital Centre, Constantine, Algeria
| | - Achraf Messas
- Faculty of Medicine, CHU Annaba, Badji Mokhtar University, Annaba, Algeria
| | - George Kroumpouzos
- Department of Dermatology, Alpert Medical School, Brown University, Providence, RI, USA; GK Dermatology, PC, S Weymouth, MA, USA.
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23
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Desai SA, Vakil Z, Kroumpouzos G. Transcutaneous Temperature-Controlled Radiofrequency Treatment: Improvement in Female Genital Appearance, Sexual Dysfunction, and Stress Urinary Incontinence. Aesthet Surg J 2021; 41:1400-1408. [PMID: 33843969 DOI: 10.1093/asj/sjab174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Transcutaneous temperature-controlled radiofrequency (TTCRF) treatment is an emerging modality for vulvovaginal rejuvenation. However, clinical experience with this modality is limited. OBJECTIVES The aim of this study was to examine the efficacy of TTCRF treatment in improving female genital appearance, sexual function, and stress urinary incontinence (SUI). METHODS Forty-eight patients complaining of sexual dysfunction (SD; n = 41) and/or SUI (n = 37) were included. Most patients had ≤3 TTCRF sessions. To evaluate the aesthetic results, photographs of the genital area taken before treatment were compared to those taken 6 weeks posttreatment in a blinded manner. Prior to treatment and 6 weeks after the final session, the Female Sexual Function Index (FSFI) questionnaire was administered to participants complaining of SD and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-UI-SF) to those with complaints/symptoms of SUI. Preprocedure scores were compared with postprocedure scores by paired t test. RESULTS Aesthetic improvement was noted in all patients. Preprocedure mean total FSFI score was 21.77 vs the respective postprocedure score of 25.79 (P < 0.00001). Most FSFI domains improved (pre- vs post-TTCRF mean score): sexual desire (from 2.99 to 3.54), arousal (from 3.14 to 3.83), orgasm (from 3.14 to 4.39), pain (from 4.41 to 5.04) (P < 0.00001 for all) and satisfaction (from 3.75 to 4.42; P = 0.001). Mean preprocedure ICIQ-UI-SF score was 10.10 and decreased to 4.81 (P < 0.00001) postprocedure. CONCLUSIONS A substantial improvement in genital appearance was observed. Assessment based on validated instruments demonstrated significant improvements in sexual function and SUI. TTCRF is a safe and effective treatment for these conditions. LEVEL OF EVIDENCE: 4
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Affiliation(s)
| | - Zahaan Vakil
- Department of Internal Medicine, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, India
| | - George Kroumpouzos
- Department of Dermatology, Alpert Medical School of Brown University, Providence, RI, USA
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24
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Gupta J, Kassir M, Kroumpouzos G, Katsambas A, Galadari H, Lotti T, Wollina U, Grabbe S, Goldust M. Deoxycholic Acid (ATX-101) for Fat Reduction. J Drugs Dermatol 2021; 20:1169-1173. [PMID: 34784130 DOI: 10.36849/jdd.3936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Excess, unwanted fat in submental and other body areas has been a focus of new modalities in aesthetics. Invasive and, more recently, non-invasive modalities for removal of unwanted fat have been on an increase. ATX-101 (deoxycholic acid injection) is the only injectable drug approved in the United States and Canada for reduction of moderate or severe submental fat in adults, with ongoing trials testing its efficacy in body contouring and lipomas. It has proven efficacy in submental fat reduction with a good safety profile. This article reviews the pharmacology, mechanism of action, clinical effects and adverse effects of ATX-101. It emphasizes on careful patient selection and advises on appropriate volume administration, number of treatments, and injection technique. The literature research includes peer-reviewed articles (clinical trials or scientific reviews). Studies were identified by searching electronic databases (MEDLINE and PubMed) till December 2019 and reference lists of respective articles. Only articles published in English language were included. J Drugs Dermatol. 2021;20(11):1169-1173. doi:10.36849/JDD.3936.
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25
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Kroumpouzos G. Extensive ecchymosis and edema associated with injection of human hyaluronidase in the periorbital area: A report of three cases. Dermatol Ther 2021; 34:e15155. [PMID: 34623722 DOI: 10.1111/dth.15155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 10/04/2021] [Indexed: 11/29/2022]
Affiliation(s)
- George Kroumpouzos
- Department of Dermatology, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
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26
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Yepuri V, Patil AD, Fritz K, Salavastru C, Kroumpouzos G, Nisticò SP, Piccolo D, Sadek A, Badawi A, Kassir M, Gold MH, Große-Büning S, Grabbe S, Goldust M. Light-Based Devices for the Treatment of Facial Erythema and Telangiectasia. Dermatol Ther (Heidelb) 2021; 11:1879-1887. [PMID: 34562267 PMCID: PMC8611125 DOI: 10.1007/s13555-021-00607-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Indexed: 10/26/2022] Open
Abstract
Facial erythema is one of the most common outpatient complaints in dermatology. There are various causes of facial erythema and several devices are available for its treatment. Pulsed dye laser (PDL) and intense pulsed light (IPL) are the two common light devices used for these conditions. In this review, we evaluated the literature to assess efficacy of IPL versus PDL in facial erythema and telangiectasia. We searched published articles including clinical trials or reviews articles, case series, and case reports. Electronic databases (MEDLINE and PubMed) were searched to retrieve the articles. Reference lists of selected articles were also considered for the review. Articles published in English language until June 2021 were considered for this review.
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Affiliation(s)
- Vani Yepuri
- Venkat Charmalaya, Centre for Advanced Dermatology and Post Graduate Training, Bangalore, Karnataka, India
| | - Anant D Patil
- Department of Pharmacology, Dr. DY Patil Medical College, Navi Mumbai, India
| | - Klaus Fritz
- Dermatology and Laser Center, Reduitstr. 13, 76829, Landau, Germany.,"Carol Davila" University of Medicine and Pharmacy, 37 Dionisie Lupu Str, 020021, Bucharest, Romania
| | - Carmen Salavastru
- "Carol Davila" University of Medicine and Pharmacy, 37 Dionisie Lupu Str, 020021, Bucharest, Romania.,"Colentina" Clinical Hospital, Pediatric Dermatology Discipline, Dermato-Oncology Research Facility, 19-21 Stefan cel Mare Str, Bucharest, Romania
| | - George Kroumpouzos
- Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode, Island.,Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil.,GK Dermatology, PC, South Weymouth, Massachusetts, USA
| | - Steven Paul Nisticò
- Dermatology Unit, Department of Health Sciences, Magna Graecia University of Catanzaro, 88100, Catanzaro, Italy
| | | | - Ahmed Sadek
- Cairo Hospital for Dermatology and Venereology (Al-Haud Al-Marsoud) Manager, Cairo, Egypt
| | - Ashraf Badawi
- Medical Laser Applications, National Institute of Laser Enhanced Sciences, Cairo University, Giza, Egypt.,Dermatology and Allergology Department, Faculty of Medicine, Szeged University, Szeged, Hungary.,, Oakville, Canada
| | | | - Michael H Gold
- Gold Skin Care Center, Tennessee Clinical Research Center, Nashville, TN, USA
| | | | - Stephan Grabbe
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Mohamad Goldust
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany.
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27
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Bhargava S, McKeever C, Sadoughifar R, Kroumpouzos G. Availability of personal protective equipment among dermatologists in the COVID-19 pandemic: Assessment and risk factors in a web-based, global study. Clin Dermatol 2021; 39:451-456. [PMID: 34518003 PMCID: PMC7849520 DOI: 10.1016/j.clindermatol.2021.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: The availability of personal protective equipment (PPE) among dermatologists during the Coronavirus Disease 2019 (COVID-19) pandemic has not been studied. Methods: We have assessed PPE availability among dermatologists and relevant aspects of hospital service by surveying 733 dermatologists. Results: Considerable percentages of respondents had to purchase their own PPE (40.2%) and were not provided with it at the hospital (37.7%). Only 27% of respondents provided hospital service, and 18.4% were assigned to nondermatologic duty. A substantial percentage (64.4%) indicated the availability of hospital-issued management guidelines (HIMG) for COVID-19 patients. Nearly half of the survey participants (49.1%) responded that the health care system was not equipped for the pandemic. Purchasing one's own PPE was strongly associated with the private practice setting and continent, with the highest rates in Central and South America and in Europe (P < .001). PPE availability at a hospital was associated with 2 continents, with the highest rates in Europe and in North America (P < .001). In logistic regression, the most important factor reducing the odds ratio (OR) for purchasing their own PPE was HIMG for COVID-19 patients (OR, 0.55; 95% confidence interval [CI], 0.32-0.97). Respondents’ assessment that the health care system was equipped for COVID-19 was the most powerful increaser of OR for PPE availability (OR, 9.43; 95% CI, 5.37-16.56) followed by >1,000 COVID-19 cases in a participant's country. Conclusions: Substantial percentages of respondents had to purchase their own PPE and were not provided with it at the hospital. Strategies to increase PPE availability should be implemented by hospitals, industry, and government authorities.
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Affiliation(s)
| | - Charles McKeever
- Department of Dermatology, University of Panama Medical School and Social Security Hospital, Panama City, Panama
| | | | - George Kroumpouzos
- Department of Dermatology, Alpert Medical School, Brown University, Providence, Rhode Island, USA.
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28
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Abstract
This contribution focuses on the effects of coronavirus disease 2019 (COVID-19) on dermatology practice. We discuss the impact on practice volume and procedures and on the considerable increase in teledermatology use. We also describe the important roles that dermatologists have played in enhancing infection prevention and on the frontline. During the crisis, dermatologists have faced the challenge of a shortage of resources, such as personal protective equipment, in the health care system. In addition, they have been involved in managing cutaneous manifestations related to COVID-19 and occupational disease caused by personal protective equipment. Dermatologists have made a diligent effort to identify melanoma and to ensure the treatment of high-risk skin cancers. Safety guidelines have been suggested to minimize the potential risks associated with the systemic use of immunosuppressant agents and immunomodulators in patients with severe inflammatory skin disease during the pandemic. Finally, social distancing necessitated that dermatology conferences take place virtually and teaching via e-learning increased.
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Affiliation(s)
| | - Nicole Negbenebor
- Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | | | - Serene Ahmad
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - George Kroumpouzos
- Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island, USA; Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil.
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29
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Affiliation(s)
- George Kroumpouzos
- Department of Dermatology, Alpert Medical School, Brown University, Providence, RI, USA
- Department of Dermatology, GK Dermatology, PC, S Weymouth, MA, USA
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30
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Lim RK, Kalagara S, Chen KK, Mylonakis E, Kroumpouzos G. DERMATOLOGY IN A MULTIDISCIPLINARY APPROACH WITH INFECTIOUS DISEASE AND OBSTETRIC MEDICINE AGAINST COVID-19. Int J Womens Dermatol 2021; 7:640-646. [PMID: 34462725 PMCID: PMC8388141 DOI: 10.1016/j.ijwd.2021.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/21/2021] [Accepted: 08/22/2021] [Indexed: 12/27/2022] Open
Abstract
The care for patients infected with COVID-19 requires a team approach, and dermatologists may collaborate with other specialties, especially infectious disease (ID) medicine and obstetrics and gynecology (ObGyn), at every stage of the infection process. A broad spectrum of cutaneous manifestations may occur early in COVID-19 infection, making appropriate dermatologic identification critical for an early diagnosis. There is prognostic value in appropriately identifying different types of COVID-19–associated skin manifestations, which have been linked to disease severity. Such observations emanated from dermatology research, especially large series and international registries of cutaneous manifestations relating to COVID-19, and impact COVID-19 care provided by most health care providers. Also, research based on international registries of skin reactions from the COVID-19 vaccines has an impact across disciplines. An increased risk for severe illness from COVID-19 is encountered during pregnancy, and dermatologists’ role is to urge ObGyn and other clinicians to monitor and educate pregnant patients about the potential for eruptions as a manifestation of COVID-19. ID and ObGyn experts indicate that teledermatology enhanced the interaction among health care providers and improved COVID-19 care. More than 40% of all dermatology consultations at a tertiary care hospital were done via teledermatology. Future collaborative research involving dermatology and specialties, such as ID and ObGyn, could help delineate guidelines for dermatology consultations in patients infected with COVID-19 and determine cases appropriate for teledermatology.
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Affiliation(s)
- Rachel K. Lim
- Alpert Medical School at Brown University, Providence, Rhode Island
| | - Saisanjana Kalagara
- Division of Infectious Diseases, Alpert Medical School at Brown University, Providence, Rhode Island
| | - Kenneth K. Chen
- Division of Obstetric and Consultative Medicine, Alpert Medical School at Brown University, Providence, Rhode Island
| | - Eleftherios Mylonakis
- Division of Infectious Diseases, Alpert Medical School at Brown University, Providence, Rhode Island
| | - George Kroumpouzos
- Department of Dermatology, Alpert Medical School at Brown University, Providence, Rhode Island
- Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil
- GK Dermatology, PC, S Weymouth, Massachusetts
- Corresponding Author.
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31
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Buch J, Patil A, Kroumpouzos G, Kassir M, Galadari H, Gold MH, Goldman MP, Grabbe S, Goldust M. Idiopathic guttate hypomelanosis: Presentation and Management. J COSMET LASER THER 2021; 23:8-15. [PMID: 34304679 DOI: 10.1080/14764172.2021.1957116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Idiopathic guttate hypomelanosis (IGH) is a benign, typically asymptomatic, acquired leukoderma characteristically affecting mature individuals. Although the etiopathogenesis is unclear, chronic sun exposure and senile degeneration are important triggers. Researchers have been engaged in a continuous effort to unveil the gray areas encompassing different aspects of IGH pathogenesis. IGH is a clinical diagnosis; however, histopathology and dermoscopy may aid in quetionable cases. Patients often seek cosmetic treatment. There has been no standard therapy for this condition. Newer treatment modalities range from topical agents to procedure-based therapies and have enhanced the therapeutic armamentarium. Here we discuss the pathogenesis, presentation, and management of IGH.
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Affiliation(s)
- Jeta Buch
- Private Practitioner, Ahmedabad, India.,Department of Pharmacology, Dr. DY Patil Medical College, Navi Mumbai, India.,Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island, USA; Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil; GK Dermatology, PC, South Weymouth, Massachusetts, USA.,Worldwide Laser Institute, Dallas, USA.,College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.,Gold Skin Care Center, Tennessee Clinical Research Center, Nashville, TN, USA.,Cosmetic Laser Dermatology: A West Dermatology Company, San Diego, CA, USA, Department of Dermatology, University of California, San Diego, CA, USA.,Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.,Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Anant Patil
- Private Practitioner, Ahmedabad, India.,Department of Pharmacology, Dr. DY Patil Medical College, Navi Mumbai, India.,Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island, USA; Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil; GK Dermatology, PC, South Weymouth, Massachusetts, USA.,Worldwide Laser Institute, Dallas, USA.,College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.,Gold Skin Care Center, Tennessee Clinical Research Center, Nashville, TN, USA.,Cosmetic Laser Dermatology: A West Dermatology Company, San Diego, CA, USA, Department of Dermatology, University of California, San Diego, CA, USA.,Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.,Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - George Kroumpouzos
- Private Practitioner, Ahmedabad, India.,Department of Pharmacology, Dr. DY Patil Medical College, Navi Mumbai, India.,Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island, USA; Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil; GK Dermatology, PC, South Weymouth, Massachusetts, USA.,Worldwide Laser Institute, Dallas, USA.,College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.,Gold Skin Care Center, Tennessee Clinical Research Center, Nashville, TN, USA.,Cosmetic Laser Dermatology: A West Dermatology Company, San Diego, CA, USA, Department of Dermatology, University of California, San Diego, CA, USA.,Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.,Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Martin Kassir
- Private Practitioner, Ahmedabad, India.,Department of Pharmacology, Dr. DY Patil Medical College, Navi Mumbai, India.,Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island, USA; Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil; GK Dermatology, PC, South Weymouth, Massachusetts, USA.,Worldwide Laser Institute, Dallas, USA.,College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.,Gold Skin Care Center, Tennessee Clinical Research Center, Nashville, TN, USA.,Cosmetic Laser Dermatology: A West Dermatology Company, San Diego, CA, USA, Department of Dermatology, University of California, San Diego, CA, USA.,Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.,Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Hassan Galadari
- Private Practitioner, Ahmedabad, India.,Department of Pharmacology, Dr. DY Patil Medical College, Navi Mumbai, India.,Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island, USA; Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil; GK Dermatology, PC, South Weymouth, Massachusetts, USA.,Worldwide Laser Institute, Dallas, USA.,College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.,Gold Skin Care Center, Tennessee Clinical Research Center, Nashville, TN, USA.,Cosmetic Laser Dermatology: A West Dermatology Company, San Diego, CA, USA, Department of Dermatology, University of California, San Diego, CA, USA.,Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.,Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Michael H Gold
- Private Practitioner, Ahmedabad, India.,Department of Pharmacology, Dr. DY Patil Medical College, Navi Mumbai, India.,Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island, USA; Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil; GK Dermatology, PC, South Weymouth, Massachusetts, USA.,Worldwide Laser Institute, Dallas, USA.,College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.,Gold Skin Care Center, Tennessee Clinical Research Center, Nashville, TN, USA.,Cosmetic Laser Dermatology: A West Dermatology Company, San Diego, CA, USA, Department of Dermatology, University of California, San Diego, CA, USA.,Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.,Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Mitchel P Goldman
- Private Practitioner, Ahmedabad, India.,Department of Pharmacology, Dr. DY Patil Medical College, Navi Mumbai, India.,Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island, USA; Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil; GK Dermatology, PC, South Weymouth, Massachusetts, USA.,Worldwide Laser Institute, Dallas, USA.,College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.,Gold Skin Care Center, Tennessee Clinical Research Center, Nashville, TN, USA.,Cosmetic Laser Dermatology: A West Dermatology Company, San Diego, CA, USA, Department of Dermatology, University of California, San Diego, CA, USA.,Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.,Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Stephan Grabbe
- Private Practitioner, Ahmedabad, India.,Department of Pharmacology, Dr. DY Patil Medical College, Navi Mumbai, India.,Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island, USA; Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil; GK Dermatology, PC, South Weymouth, Massachusetts, USA.,Worldwide Laser Institute, Dallas, USA.,College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.,Gold Skin Care Center, Tennessee Clinical Research Center, Nashville, TN, USA.,Cosmetic Laser Dermatology: A West Dermatology Company, San Diego, CA, USA, Department of Dermatology, University of California, San Diego, CA, USA.,Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.,Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Mohamad Goldust
- Private Practitioner, Ahmedabad, India.,Department of Pharmacology, Dr. DY Patil Medical College, Navi Mumbai, India.,Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island, USA; Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil; GK Dermatology, PC, South Weymouth, Massachusetts, USA.,Worldwide Laser Institute, Dallas, USA.,College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.,Gold Skin Care Center, Tennessee Clinical Research Center, Nashville, TN, USA.,Cosmetic Laser Dermatology: A West Dermatology Company, San Diego, CA, USA, Department of Dermatology, University of California, San Diego, CA, USA.,Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.,Department of Dermatology, University Medical Center Mainz, Mainz, Germany
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Arora P, Mrig S, Goldust Y, Kroumpouzos G, Karadağ AS, Rudnicka L, Galadari H, Szepietowski JC, Di Lernia V, Goren A, Kassir M, Goldust M. New Coronavirus (SARS-CoV-2) Crossing Borders Beyond Cities, Nations, and Continents: Impact of International Travel. Balkan Med J 2021; 38:205-211. [PMID: 34274909 PMCID: PMC8880972 DOI: 10.5152/balkanmedj.2021.21074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The third outbreak of coronavirus in the form of the COVID-19 infection started in Wuhan, China, in December 2019. The early and rapid spread of this infection across borders can be largely attributed to international air travel that has become a part of modern globalization. In this article, we analyze the spread of the novel coronavirus (SARS-CoV-2) along the routes of international travel, both by air and by sea. Pitfalls of various screening methods used at the airports and the importance of optimal aircraft ventilation are discussed. Also, we suggest measures that can be taken to reduce the risk of transmission associated with air travel.
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Affiliation(s)
- Pooja Arora
- Department of Dermatology, Post Graduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Sumit Mrig
- Department of Ear Nose and Throat, Max Smart Super-Speciality Hospital, New Delhi, India
| | - Yaser Goldust
- Department of Architecture, University of Mazandaran, Faculty of Art and Architecture, Babolsar, Iran
| | - George Kroumpouzos
- Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island, USA;Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil
| | - Ayşe Serap Karadağ
- Department of Dermatology and Venereology, İstanbul Medeniyet University School of Medicine, Göztepe Training and Research Hospital, İstanbul, Turkey
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Hassan Galadari
- College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Vito Di Lernia
- Dermatology Unit, Arcispedale Santa Maria Nuova, Azienda USL-IRCCS di Reggio Emilia, Italy
| | - Andy Goren
- Applied Biology, Irvine, California, USA
| | | | - Mohamad Goldust
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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33
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Kroumpouzos G, Kassir M, Gupta M, Patil A, Goldust M. Complications of Botulinum toxin A: An update review. J Cosmet Dermatol 2021; 20:1585-1590. [PMID: 33864431 DOI: 10.1111/jocd.14160] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/02/2021] [Accepted: 04/09/2021] [Indexed: 12/01/2022]
Abstract
Cosmetic surgery procedures have increased manifolds all over the world owing to the ever-increasing demand of people to look beautiful and young. Injectable treatments like botulinum toxin are becoming more popular owing to their rapid, well-defined, and lasting results for the reduction of facial fine lines, wrinkles, and facial rejuvenation. These emerging treatments are quite safe but can have certain adverse effects. In this article, we have highlighted the complications and side effects of botulinum toxin based on the anatomical location. The possible causes and precautions to prevent these complications are also discussed. The search of literature included peer-reviewed articles including clinical trials and scientific reviews. Literature was identified from electronic databases (MEDLINE/PubMed) through January 2021 and references of respective articles and only the articles published in English language were included.
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Affiliation(s)
- George Kroumpouzos
- Department of Dermatology, Alpert Medical School of Brown University, Providence, RI, USA.,Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil.,GK Dermatology, PC, South Weymouth, MA, USA
| | - Martin Kassir
- Founding Director, Worldwide Laser Institute, Dallas, TX, USA
| | - Mrinal Gupta
- DNB Dermatology Consultant Dermatologist, Treatwell Skin Centre, Jammu, India
| | - Anant Patil
- Department of Pharmacology, Dr. DY Patil Medical College, Navi Mumbai, India
| | - Mohamad Goldust
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
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34
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Buch J, Karagaiah P, Raviprakash P, Patil A, Kroumpouzos G, Kassir M, Goldust M. Noninvasive diagnostic techniques of port wine stain. J Cosmet Dermatol 2021; 20:2006-2014. [PMID: 33788368 DOI: 10.1111/jocd.14087] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/09/2021] [Accepted: 03/16/2021] [Indexed: 12/29/2022]
Abstract
Port-wine stain (PWS) is a benign capillary malformation that most commonly occurs in the head and neck. It is present at birth and progresses over time. It is formed by progressive dilatation of post-capillary venules and is associated with hypertrophy and nodularity with increasing age, leading to cosmetic disfigurement and psychological aggravation. It is caused by genetic mosaicism in GNAQ and GNA11 genes. Histopathology is the gold standard for assessment of PWS but it is invasive and may cause scarring. Inadequate characterization of the lesions may predispose to inadequate treatment protocols as well as higher treatment dosages. Clinical evaluation of treatment efficacy is subjective and may not be a representative of actual results. Therefore, an objective visualization modality is required. With evolving technology, numerous optical instruments have been developed for objective evaluation and visualization of subsurface structures. These include VISIA-CR™ system, videodermoscopy, high-frequency ultrasound (HFUS), laser speckle contrast imaging (LSCI), reflectance spectrophotometers and tristimulus colorimeter, laser Doppler flowmetry (LDF), cross-polarized diffuse reflectance imaging system (CDR), reflectance confocal microscopy (RCM), optical coherence tomography (OCT), and spatial frequency domain imaging (SFDI). These semi-quantitative modes of diagnosis are complementary to each other. Some can be used in the clinical setting while others, due to high instrument cost, are limited to the research settings. In this review, we bring to you a brief overview of noninvasive diagnostic modalities in PWS.
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Affiliation(s)
- Jeta Buch
- Private Practitioner, Ahmedabad, India
| | - Priyanka Karagaiah
- Department of Dermatology, Bangalore Medical College and Research Institute, Bangalore, India
| | | | - Anant Patil
- Department of Pharmacology, Dr. DY Patil Medical College, Navi Mumbai, India
| | - George Kroumpouzos
- Department of Dermatology, Alpert Medical School of Brown University, Providence, RI, USA.,Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil.,GK Dermatology, PC, South Weymouth, MA, USA
| | | | - Mohamad Goldust
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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35
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Bhargava S, McKeever C, Kroumpouzos G. Impact of COVID-19 pandemic on dermatology practices: Results of a web-based, global survey. Int J Womens Dermatol 2021; 7:217-223. [PMID: 33072835 PMCID: PMC7550183 DOI: 10.1016/j.ijwd.2020.09.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/26/2020] [Accepted: 09/29/2020] [Indexed: 12/14/2022] Open
Abstract
The spectrum and magnitude of changes in dermatology practice induced by the COVID-19 pandemic have not been adequately studied. OBJECTIVE This study aimed to assess the immediate and long-term effects of the pandemic on dermatology practice on a large scale, including the clinical activity of participants, frequency and types of procedures used, and teledermatology (TD) use. METHODS This web-based, global survey included 733 dermatologists. The primary outcomes are percentages of respondents providing in-person consultations, hospital service, and TD and performing procedures. Factors in logistic regression models that may influence the odds ratio (OR) for TD use during pandemic and for future use also were analyzed. RESULTS The percentages of respondents providing in-person consultations (46.6% vs. 100% before the pandemic) and hospital service (27% vs. 52.8% before the pandemic) as well as performing procedures (25.6% vs. 100% before the pandemic) decreased, whereas practicing TD increased three-fold (75.2% vs. 26.1% before the pandemic) during the pandemic (p < .001 for each). Practice location was associated with TD use during the pandemic and with its expected use in the future (p < .001 for both), with North American respondents indicating the highest use. TD use during the pandemic showed a positive correlation with TD use before the pandemic, performing procedures and, more specifically, with biopsies of suspicious pigmented lesions during the pandemic (p < .001 for each). TD use before the pandemic was the most powerful predictor of TD use during the pandemic (OR: 16.47; 95% confidence interval, 7.12-38.06). More than two third of participants (68.6%) expect to use TD in the future. The factor with the largest increase in OR on the expectation of future TD use was >1000 COVID-19 cases in the country (OR: 3.80; 95% confidence interval, 2.33-6.21). CONCLUSION This survey indicates a profound immediate effect of the pandemic on dermatology practice. The pandemic appears to have substantially contributed to an increased use of TD in the long run.
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Affiliation(s)
- Shashank Bhargava
- Department of Dermatology, R.D. Gardi Medical College, Ujjain, India
| | - Charles McKeever
- Department of Dermatology, University of Panama Medical School and Social Security Hospital, Panama City, Panama
| | - George Kroumpouzos
- Department of Dermatology, Alpert Medical School, Brown University, Providence, RI, United States
- Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil
- GK Dermatology, PC, S Weymouth, MA, United States
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Kroumpouzos G. Cutaneous manifestations of COVID-19: An unusual presentation with edematous plaques and pruritic, erythematous papules, and comment on the role of bradykinin storm and its therapeutic implications. Dermatol Ther 2021; 34:e14753. [PMID: 33406308 PMCID: PMC7883275 DOI: 10.1111/dth.14753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 10/25/2020] [Accepted: 01/03/2021] [Indexed: 02/04/2023]
Affiliation(s)
- George Kroumpouzos
- Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil.,GK Dermatology, Providence, Massachusetts, USA
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Murrell DF, Kroumpouzos G, Gupta A, Lernia V, Sadoughifar R, Goldust M. Role of music therapy in reducing the burden of dermatological diseases during
COVID
‐19. Dermatol Ther 2020; 33:e14086. [DOI: 10.1111/dth.14086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/22/2020] [Accepted: 07/24/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Dedee F. Murrell
- Department of Dermatology, St George Hospital, Faculty of Medicine University of New South Wales Sydney New South Wales Australia
| | - George Kroumpouzos
- Department of Dermatology Alpert Medical School of Brown University Providence Rhode Island USA
- Department of Dermatology Medical School of Jundiaí São Paulo Brazil
| | | | - Vito Lernia
- Dermatology Unit Arcispedale Santa Maria Nuova‐IRCCS di Reggio Emilia Reggio Emilia Italy
| | | | - Mohamad Goldust
- University of Rome G. Marconi Rome Italy
- Department of Dermatology University Hospital Basel Basel Switzerland
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Sharma A, Kroumpouzos G, Lotti T, Goldust M. COVID-19 and alcohol use. Drug Alcohol Rev 2020; 40:683-684. [PMID: 32881129 DOI: 10.1111/dar.13163] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 06/20/2020] [Accepted: 08/17/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Aseem Sharma
- Department of Dermatology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion Hospital, Mumbai, India
| | - George Kroumpouzos
- Department of Dermatology, Alpert Medical School of Brown University, Providence, USA.,Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil
| | - Torello Lotti
- Department of Dermatology, University of Studies Guglielmo Marconi, Rome, Italy
| | - Mohamad Goldust
- Department of Dermatology, University of Studies Guglielmo Marconi, Rome, Italy.,Department of Dermatology, University Hospital Basel, Basel, Switzerland
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40
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Bhargava S, Sarkar R, Kroumpouzos G. Mental distress in dermatologists during COVID-19 pandemic: Assessment and risk factors in a global, cross-sectional study. Dermatol Ther 2020; 33:e14161. [PMID: 32770716 PMCID: PMC7435490 DOI: 10.1111/dth.14161] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/01/2020] [Accepted: 08/05/2020] [Indexed: 01/16/2023]
Abstract
There is a sparsity of data regarding the mental health status of dermatologists during COVID-19 pandemic. Evaluate the effects of pandemic on mental health of dermatologists on a large scale and identify risk factors for mental distress. 733 dermatologists were included in this cross-sectional, web-based survey. Mental distress was reported by 77.2% of responders. Considerable percentages of participants experienced stress (73.9%), irritation (33.7%), insomnia (30%), or depression (27.6%), and 78.6% were overwhelmed with the amount of pandemic information they were receiving. Mental distress was significantly associated with practice years, volume of patients seen per week before pandemic, personal protective equipment availability at hospital (P = .001 for each), practice location (continent; P < .001), and participant's assessment that the healthcare system was not equipped for the pandemic (P = .003). Stress was associated with hospital service (P = .003), and depression with being overwhelmed with the amount of pandemic information received (P = .004). In a logistic model, teledermatology use was the most powerful predictor of mental distress (OR, 1.57 [95% CI, 1.07-2.32]). Mental distress was common among dermatologists during this pandemic. Teledermatology use was the most powerful predictor of mental distress. Preventative strategies and psychosocial interventions should be implemented.
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Affiliation(s)
- Shashank Bhargava
- Department of Dermatology, R.D. Gardi Medical College, Ujjain, India
| | - Rashmi Sarkar
- Department of Dermatology, Lady Hardinge Medical College, New Delhi, India
| | - George Kroumpouzos
- Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil.,GK Dermatology PC, Weymouth, Massachusetts, USA
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Pradhan S, Kroumpouzos G, Goldust M. Hand eczema due to frequent hand washing in combat with COVID-19. J Cosmet Dermatol 2020; 19:2474-2475. [PMID: 32716605 DOI: 10.1111/jocd.13639] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/18/2020] [Accepted: 07/20/2020] [Indexed: 01/09/2023]
Affiliation(s)
- Swetalina Pradhan
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, Patna, India
| | - George Kroumpouzos
- Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island.,Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil
| | - Mohamad Goldust
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
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Galadari H, Gupta A, Kroumpouzos G, Kassir M, Rudnicka L, Lotti T, Berg RV, Goldust M. COVID 19 and its impact on cosmetic dermatology. Dermatol Ther 2020; 33:e13822. [PMID: 32531133 PMCID: PMC7307115 DOI: 10.1111/dth.13822] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 06/10/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Hassan Galadari
- College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | | | - George Kroumpouzos
- Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil
| | | | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Torello Lotti
- Department of Dermatology, University of Studies Guglielmo Marconi, Rome, Italy
| | | | - Mohamad Goldust
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
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Ravelli FN, Goldust M, Kroumpouzos G. Assessment of prurigo of pregnancy in patients without atopic background. Int J Womens Dermatol 2020; 6:384-389. [PMID: 33898704 PMCID: PMC8060660 DOI: 10.1016/j.ijwd.2020.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 06/12/2020] [Accepted: 06/24/2020] [Indexed: 11/19/2022] Open
Abstract
Background Prurigo of pregnancy (PP), a specific pregnancy dermatosis, has been associated with atopic background in the patient and/or the patient's family. However, this association was not validated in some studies, and cases without atopic background have been reported. Objective This study aimed to evaluate the clinical features of PP not related to atopic background and search for comorbid conditions in medical and obstetric records. Methods In this case series, patients with typical PP presentation (i.e., pruritic, discrete papulonodules on the extensor surfaces of the extremities) diagnosed at the dermatology clinics of tertiary referral hospitals were evaluated. The exclusion criteria included missing historical data, inadequate follow-up, laboratory test results suggestive of other pruritic conditions, history of atopic disease, and family history of atopy. Clinical and laboratory data including course, response to treatment, serum total immunoglobulin E level, and comorbidities in the medical and obstetric history were collected. Results Twenty patients developed PP predominantly during the late second or early third trimester. Nine patients reported that itching developed first, versus 10 patients who reported that lesions started first (one patient was uncertain about onset). There was no recurrence postpartum (mean postpartum follow-up, 17 months). Serum total immunoglobulin E level was elevated in 3 of 14 patients tested (21.4%). Obstetric history (n = 12) included polymorphic eruption of pregnancy (16.6%), PP (16.6%), and gestational pruritus (8.3%). Two of 20 patients (10%) had a history of pruritic skin condition (prurigo nodularis and pruritus of unclear etiology) while not pregnant. Medical history (n = 20) included psychiatric disease (20%) (obsessive compulsive disorder and anxiety), hypothyroidism (10%), and obesity (10%). Conclusion PP can develop in patients without an atopic background. This finding should be considered when classifying specific pregnancy dermatoses. A thorough medical and family history with a focus on atopy should be obtained from every patient with a gestational eruption, and patients should be counseled accordingly.
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Affiliation(s)
| | - Mohamad Goldust
- Department of Dermatology, University of Rome Guglielmo Marconi, Rome, Italy
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - George Kroumpouzos
- Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island, United States
- Department of Dermatology, Medical School of Jundiaí, Jundiaí, São Paulo, Brazil
- Corresponding author.
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Goldust M, Kroumpouzos G, Murrell DF, Rudnicka L, Das A, Lotti T, Navarini AA. Update on COVID-19 effects in dermatology specialty. Dermatol Ther 2020; 33:e13523. [PMID: 32378293 PMCID: PMC7267429 DOI: 10.1111/dth.13523] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 04/30/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Mohamad Goldust
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - George Kroumpouzos
- Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode, Island.,Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil
| | - Dedee F Murrell
- Department of Dermatology, St George Hospital, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Anupam Das
- Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal, India
| | - Torello Lotti
- Department of Dermatology, University of Studies Guglielmo Marconi, Rome, Italy
| | - Alexander A Navarini
- Department of Dermatology & Allergy, University Hospital of Basel, Basel, Switzerland
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Goldust M, Shivakumar S, Kroumpouzos G, Murrell DF, Mueller SM, Navarini AA. Where do we stand as dermatologists in combat with COVID-19. Dermatol Ther 2020; 33:e13638. [PMID: 32441435 PMCID: PMC7280715 DOI: 10.1111/dth.13638] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/07/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Mohamad Goldust
- University of Rome G. Marconi, Rome, Italy.,Department of Dermatology & Allergy, University Hospital of Basel, Basel, Switzerland
| | | | - George Kroumpouzos
- Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil
| | - Dedee F Murrell
- Department of Dermatology, St George Hospital, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Simon M Mueller
- Department of Dermatology & Allergy, University Hospital of Basel, Basel, Switzerland
| | - Alexander A Navarini
- Department of Dermatology & Allergy, University Hospital of Basel, Basel, Switzerland
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Goldust M, Kroumpouzos G, Murrell DF, Jafferany M, Lotti T, Wollina U, Shivakumar S. Use of face masks in dermatology department during the COVID-19 outbreak. Dermatol Ther 2020; 33:e13521. [PMID: 32378315 PMCID: PMC7267171 DOI: 10.1111/dth.13521] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/03/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Mohamad Goldust
- Department of Dermatology and Allergy, University Hospital Basel, Basel, Switzerland
| | - George Kroumpouzos
- Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil
| | - Dedee F Murrell
- Department of Dermatology, St George Hospital, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Mohammad Jafferany
- College of Medicine, Central Michigan University, Saginaw, Michigan, USA
| | - Torello Lotti
- Department of Dermatology, University of Studies Guglielmo Marconi, Rome, Italy
| | - Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital of the Technical University of Dresden, Dresden, Germany
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Goldust M, Shivakumar S, Kroumpouzos G, Murrell DF, Rudnicka L, Jafferany M, Navarini AA. Virtual conferences of dermatology during the COVID-19 pandemic. Dermatol Ther 2020; 33:e13774. [PMID: 32506609 DOI: 10.1111/dth.13774] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 06/02/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Mohamad Goldust
- Department of Dermatology and Allergy, University Hospital Basel, Basel, Switzerland
| | - Swathi Shivakumar
- Consultant Dermatologist, Cosmetiq Clinic, Thiruvananthapuram, Kerala, India
| | - George Kroumpouzos
- Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil
| | - Dedee F Murrell
- Department of Dermatology, St George Hospital, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | | | - Alexander A Navarini
- Department of Dermatology and Allergy, University Hospital Basel, Basel, Switzerland
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Goren A, Rathod D, Kroumpouzos G, Jafferany M, Goldust M. Safety measures in dermatology help minimize spread of COVID-19. Dermatol Ther 2020; 33:e13773. [PMID: 32506600 PMCID: PMC7300612 DOI: 10.1111/dth.13773] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 06/02/2020] [Indexed: 12/03/2022]
Affiliation(s)
- Andy Goren
- Applied Biology, Irvine, California, USA
| | - Dipali Rathod
- Consultant Dermatologist, Mumbai, Maharashtra, India
| | - George Kroumpouzos
- Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil
| | - Mohammad Jafferany
- College of Medicine, Central Michigan University, Saginaw, Michigan, USA
| | - Mohamad Goldust
- Department of Dermatology, University of Rome, G. Marconi, Rome, Italy.,Department of Dermatology and Allergy, University Hospital Basel, Basel, Switzerland
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Bhargava S, Gupta M, Kroumpouzos G. Protection comes at a cost: Doctor's life inside personal protection equipment. Dermatol Ther 2020; 33:e13758. [PMID: 32495994 PMCID: PMC7300588 DOI: 10.1111/dth.13758] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 05/24/2020] [Accepted: 05/29/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Shashank Bhargava
- Department of Dermatology, R. D. Gardi Medical College, Ujjain, India
| | | | - George Kroumpouzos
- Department of Dermatology, Alpert Medical School, Brown University, Providence, Rhode Island, USA.,Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil
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Goldust M, Agarwal K, Kroumpouzos G, Jafferany M, Lotti T, Podder I. Mental health status of dermatologists during the COVID-19 pandemic: A technology-based therapy. Dermatol Ther 2020; 33:e13723. [PMID: 32474959 PMCID: PMC7300558 DOI: 10.1111/dth.13723] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/14/2020] [Accepted: 05/27/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Mohamad Goldust
- University of Rome G. Marconi, Rome, Italy.,Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | | | - George Kroumpouzos
- Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil
| | - Mohammad Jafferany
- College of Medicine, Central Michigan University, Saginaw, Michigan, USA
| | - Torello Lotti
- University of Studies Guglielmo Marconi, Rome, Italy
| | - Indrashis Podder
- Department of Dermatology, College of Medicine and Sagore Dutta Hospital, Kolkata, India
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