1
|
Lim YH, Saberi SA, Kamal K, Jalian HR, Avram M. Retrospective Analysis of US Litigations Involving Dermatologists From 2011 to 2022. Dermatol Surg 2024:00042728-990000000-00698. [PMID: 38416806 DOI: 10.1097/dss.0000000000004142] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
BACKGROUND Physician malpractice lawsuits are climbing, and the reasons underlying litigation against dermatologists are unclear. OBJECTIVE To determine the reasons patients pursue litigation against dermatologists or dermatology practices. MATERIALS AND METHODS A retrospective analysis of all state and federal cases between 2011 and 2022 was performed after a query using "Dermatology" and "dermatologist" as search terms on 2 national legal data repositories. RESULTS The authors identified a total of 48 (37 state and 11 federal) lawsuits in which a practicing dermatologist or dermatology group practice was the defendant. The most common reason for litigation was unexpected harm (26 cases, 54.2%), followed by diagnostic error (e.g. incorrect or delayed diagnoses) (16 cases, 33.3%). Six cases resulted from the dermatologist failing to communicate important information, such as medication side effects or obtaining informed consent. Male dermatologists were sued at a rate 3.1 times higher than female dermatologists. CONCLUSION Although lawsuits from patients against dermatologists largely involve injury from elective procedures, clinicians should practice caution regarding missed diagnoses and ensure critical information is shared with patients to safeguard against easily avoidable litigation.
Collapse
Affiliation(s)
- Young H Lim
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | | | | | | | - Mathew Avram
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
- Dermatology Laser and Cosmetic Center, Massachusetts General Hospital, Boston, Massachusetts
| |
Collapse
|
2
|
Jalian HR, Fitzgerald R, Bowen B, Gamio S. Submental Fat Reduction Using Sequential Treatment Approach with Cryolipolysis and ATX‐101. J Cosmet Dermatol 2022; 21:2437-2444. [PMID: 35278262 PMCID: PMC9325515 DOI: 10.1111/jocd.14909] [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] [Received: 10/19/2021] [Revised: 02/11/2022] [Accepted: 03/04/2022] [Indexed: 11/29/2022]
Abstract
Background Submental fat (SMF) detracts from facial aesthetics and negatively impacts self‐image. Aims To evaluate safety, effectiveness, and satisfaction of cryolipolysis and ATX‐101 used sequentially to reduce SMF. Methods A prospective, open‐label, interventional, single‐site study enrolling 22‐ to 65‐year‐old participants rated as Grade 4 (extreme) on the Clinician‐Rated SMF Rating Scale (CR‐SMFRS). Co‐primary effectiveness endpoints were proportions of participants with ≥1‐grade and ≥2‐grade improvement on CR‐SMFRS at 12 weeks post final treatment. Additional assessments included ultrasound measurement of fat thickness and Subject Self‐Rating Scale (SSRS) scores at 12 weeks post final treatment. Safety was assessed throughout the study. Results Of 16 enrolled participants, 62.5% were female, mean age of 43, and mean body mass index of 31.8 kg/m2. 100% of participants achieved ≥1‐grade improvement, and 71.4% achieved ≥2‐grade CR‐SMFRS improvement. Mean (SD) reduction in SMF thickness was 0.2 mm (1.3), and SSRS scores ≥4 (slightly to extremely satisfied) were reported by 71.4% of participants. Adverse events (AEs) were mild and resolved by study end. No unanticipated adverse device effects or serious or unexpected AEs occurred. Conclusion Sequential treatment with cryolipolysis and ATX‐101 was found safe and effective for reducing extreme SMF, resulting in approximately a 2‐grade improvement.
Collapse
|
3
|
Abstract
Physical modalities provide an important adjunct to medical treatment of acne and rosacea. In patients who cannot tolerate or fail medical treatments, physical modalities offer an alternative approach. For cases of acne scarring, phymatous changes of rosacea, and rosacea-associated telangiectasia, physical modalities such as laser and light treatments represent the treatment of choice. We will review the use of laser and light treatments, photodynamic therapy, and other physical modalities such as targeted therapies for the treatment of acne and rosacea.
Collapse
Affiliation(s)
| | - Yakir Levin
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Molly Wanner
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| |
Collapse
|
4
|
Ray Jalian H, Tam J, Vuong LN, Fisher J, Garibyan L, Mihm MC, Zurakowski D, Evans CL, Rox Anderson R. Selective Cryolysis of Sebaceous Glands. J Invest Dermatol 2015; 135:2173-2180. [DOI: 10.1038/jid.2015.148] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 03/09/2015] [Accepted: 03/19/2015] [Indexed: 11/09/2022]
|
5
|
D'Souza LS, Jalian HR, Jalian C, Alam M, Eisen DB, Avram MM, Ibrahimi OA. Medical professional liability claims for Mohs micrographic surgery from 1989 to 2011. JAMA Dermatol 2015; 151:529-32. [PMID: 25650805 DOI: 10.1001/jamadermatol.2014.4495] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Few studies specifically address lawsuits involving Mohs surgery. OBJECTIVE To better characterize the types of medical professional liability claims involving Mohs surgery. DESIGN, SETTING, AND PARTICIPANTS Retrospective legal document review of an online national database. Any legal proceeding involving the search words Mohs and cancer was included. MAIN OUTCOMES AND MEASURES Number of medical professional liability claims involving Mohs surgery for factors including year of litigation, location, physician specialty, injury sustained, cause of legal action, and verdict. RESULTS Forty-two cases were identified, which occurred from 1989 to 2011. Of the cases identified, 26 involved non-Mohs surgeons as the primary defendant, mostly due to a delay of or failure in diagnosis (n = 16), cosmetic outcome issues (n = 8), lack of informed consent (n = 7), and a delay of or failure in referral to a Mohs surgeon (n = 6). Common causes for litigation against Mohs surgeons as the primary defendant (n = 16) were lack of proper informed consent (n = 5) and cosmetic outcome issues (n = 4). Only 1 case against a Mohs surgeon was judged for the plaintiff. CONCLUSIONS AND RELEVANCE The most common lawsuits pertaining to Mohs surgery list non-Mohs surgeons as the primary defendants. Closer coordination between non-Mohs surgeons and Mohs surgeons may help minimize risk to both parties and lead to better patient care. Small sample size is the primary limitation, in part owing to exclusion of out-of-court settlements from the database.
Collapse
Affiliation(s)
- Logan S D'Souza
- Department of Dermatology, University of Connecticut Health Center, Farmington
| | - H Ray Jalian
- Wellman Center for Photomedicine, Harvard Medical School, Boston, Massachusetts3Department of Dermatology, Massachusetts General Hospital, Boston4Division of Dermatology, David Geffen School of Medicine at UCLA (University of California, Los Angeles)
| | | | - Murad Alam
- Department of Dermatology, Northwestern University, Chicago, Illinois
| | - Daniel B Eisen
- Department of Dermatology, University of California Davis, Sacramento
| | - Mathew M Avram
- Wellman Center for Photomedicine, Harvard Medical School, Boston, Massachusetts3Department of Dermatology, Massachusetts General Hospital, Boston
| | - Omar A Ibrahimi
- Wellman Center for Photomedicine, Harvard Medical School, Boston, Massachusetts3Department of Dermatology, Massachusetts General Hospital, Boston8Connecticut Skin Institute, Stamford
| |
Collapse
|
6
|
Affiliation(s)
- H Ray Jalian
- Division of Dermatology, University of California, Los Angeles
| | - Mathew M Avram
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston3Department of Dermatology, Massachusetts General Hospital, Boston
| |
Collapse
|
7
|
Abstract
IMPORTANCE Cryolipolysis is the noninvasive reduction of fat with localized cutaneous cooling. Since initial introduction, over 650,000 cryolipolysis treatment cycles have been performed worldwide. We present a previously unreported, rare adverse effect following cryolipolysis: paradoxical adipose hyperplasia. OBSERVATIONS A man in his 40s underwent a single cycle of cryolipolysis to his abdomen. Three months following his treatment, a gradual enlargement of the treatment area was noted. This enlargement was a large, well-demarcated subcutaneous mass, slightly tender to palpation. Imaging studies revealed accumulation of adipose tissue with normal signal intensity within the treatment area. CONCLUSIONS AND RELEVANCE Paradoxical adipose hyperplasia is a rare, previously unreported adverse effect of cryolipolysis with an incidence of 0.0051%. No single unifying risk factor has been identified. The phenomenon seems to be more common in male patients undergoing cryolipolysis. At this time, there is no evidence of spontaneous resolution. Further studies are needed to characterize the pathogenesis and histologic findings of this rare adverse event.
Collapse
Affiliation(s)
- H Ray Jalian
- Division of Dermatology, University of California, Los Angeles, Los Angeles2Wellman Center for Photomedicine, Massachusetts General Hospital, Boston
| | - Mathew M Avram
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston3Department of Dermatology, Massachusetts General Hospital, Boston
| | - Lilit Garibyan
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston3Department of Dermatology, Massachusetts General Hospital, Boston
| | - Martin C Mihm
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - R Rox Anderson
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston3Department of Dermatology, Massachusetts General Hospital, Boston
| |
Collapse
|
8
|
Affiliation(s)
- H. Ray Jalian
- Division of Dermatology, University of California, Los Angeles2Wellman Center for Photomedicine, Massachusetts General Hospital, Boston
| | | | - Mathew M. Avram
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston4Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
9
|
Jalian HR. Introduction to basic science section. Lasers Surg Med 2014; 46:125-6. [PMID: 24535761 DOI: 10.1002/lsm.22239] [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: 11/06/2022]
Affiliation(s)
- H Ray Jalian
- Division of Dermatology, University of California, Los Angeles, California; Wellman Center for Photomedicine, Massachusetts General Hospital, Massachusetts
| |
Collapse
|
10
|
Garibyan L, Sipprell WH, Jalian HR, Sakamoto FH, Avram M, Anderson RR. Three-dimensional volumetric quantification of fat loss following cryolipolysis. Lasers Surg Med 2013; 46:75-80. [PMID: 24535759 DOI: 10.1002/lsm.22207] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [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: 11/05/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Cryolipolysis is a noninvasive and well-tolerated treatment for reduction of localized subcutaneous fat. Although several studies demonstrate the safety and efficacy of this procedure, volumetric fat reduction from this treatment has not been quantified. This prospective study investigated the change in volume of fat after cryolipolysis treatment using three-dimensional (3D) photography. MATERIALS AND METHODS A prospective study of subjects treated with cryolipolysis on the flank (love handle) was performed at Massachusetts General Hospital. Volume measurements were performed with a Canfield Scientific Vectra three-dimensional camera and software to evaluate the amount of post procedure volume change. Clinical outcomes were assessed with caliper measurements, subject surveys, and blinded physician assessment of photographs. RESULTS Eleven subjects were enrolled in this study. Each subject underwent a single cycle of cryolipolysis to one flank. The untreated flank served as an internal control. The follow-up time after treatment was 2 months. The mean amount of calculated absolute fat volume loss using 3D photography from baseline to 2 months follow-up visit was 56.2 ± 25.6 from the treatment site and 16.6 ± 17.6 cc from the control (P < 0.0001). A mean absolute difference of 39.6 cc between the treated and untreated sides was calculated at 2 months post-treatment. Comparison of caliper measurements from baseline to 2 months post-treatment demonstrated significant reduction of the treated flank from 45.6 ± 5.8 mm at baseline to 38.6 ± 4.6 mm at 2 months post-treatment (P < 0.001). The untreated flank did not show significant reduction with caliper measurements demonstrating 45.3 ± 5.0 mm at baseline and 44.6 ± 5.1 mm at 2 months post-treatment (P = 0.360). No unexpected side effects or adverse events were reported. Post-treatment satisfaction surveys demonstrated 82% of subjects were satisfied with the results. CONCLUSIONS Cryolipolysis is a safe, well-tolerated, and effective noninvasive fat removal methodology that on average leads to 39.6 cc of fat loss of the treated flank at 2 months after a single treatment cycle.
Collapse
Affiliation(s)
- Lilit Garibyan
- Wellman Center for Photomedicine and Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Maryland, 02114
| | | | | | | | | | | |
Collapse
|
11
|
Jalian HR, Avram MM, Stankiewicz KJ, Shofner JD, Tannous Z. Combined 585 nm pulsed-dye and 1,064 nm Nd:YAG lasers for the treatment of basal cell carcinoma. Lasers Surg Med 2013; 46:1-7. [DOI: 10.1002/lsm.22201] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2013] [Indexed: 11/09/2022]
Affiliation(s)
- H. Ray Jalian
- Division of Dermatology, David Geffen School of Medicine; UCLA; Los Angeles Califoria 90025
- Department of Dermatology; Massachusetts General Hospital; Boston Massachusetts
- Wellman Center for Photomedicine; Massachusetts General Hospital; Boston Massachusetts
| | - Mathew M. Avram
- Department of Dermatology; Massachusetts General Hospital; Boston Massachusetts
- Wellman Center for Photomedicine; Massachusetts General Hospital; Boston Massachusetts
| | - Kelly J. Stankiewicz
- Department of Dermatology; Massachusetts General Hospital; Boston Massachusetts
- Wellman Center for Photomedicine; Massachusetts General Hospital; Boston Massachusetts
| | - Joshua D. Shofner
- Department of Dermatology; Massachusetts General Hospital; Boston Massachusetts
- Wellman Center for Photomedicine; Massachusetts General Hospital; Boston Massachusetts
| | - Zeina Tannous
- Department of Dermatology; Massachusetts General Hospital; Boston Massachusetts
- Wellman Center for Photomedicine; Massachusetts General Hospital; Boston Massachusetts
- Department of Dermatology; Lebanese American University; Beirut Lebanon
| |
Collapse
|
12
|
Affiliation(s)
- John B Korman
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | |
Collapse
|
13
|
Abstract
Historically, the approach to body contouring has largely involved invasive procedures, such as liposuction. Recently, several new devices for noninvasive fat removal have received clearance by the Food and Drug Administration for the treatment of focal adiposity. Modalities are aimed primarily at targeting the physical properties of fat that differentiate it from the overlying epidermis and dermis, thus selectively resulting in removal. This review will focus on 3 novel approaches to noninvasive selective destruction of fat.
Collapse
Affiliation(s)
- H Ray Jalian
- Laser and Cosmetic Center and Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | | |
Collapse
|
14
|
Abstract
The development of fractional photothermolysis is a milestone in the history of laser technology and cutaneous resurfacing. Based on the concept that skin is treated in a fractional manner, where narrow cylinders of tissue are thermally heated and normal adjacent skin is left unaffected, the fractional devices have shown effectiveness in treating a variety of conditions. Since its development, we are becoming more adept at using optimal parameters to induce near carbon dioxide laser benefits with a much more comfortable postoperative period and fewer complications. The future remains bright for fractionated laser devices and with new devices and wavelengths, the applications of this technology continue to grow.
Collapse
|
15
|
Ibrahimi OA, Jalian HR, Shofner JD, Anderson RR. Yellow Light Gone Wild: A Tale of Permanent Laser Hair Removal With a 595-nm Pulsed-Dye Laser. JAMA Dermatol 2013; 149:376. [DOI: 10.1001/jamadermatol.2013.1300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
16
|
Jalian HR, Avram MM. Cryolipolysis: a historical perspective and current clinical practice. Semin Cutan Med Surg 2013; 32:31-34. [PMID: 24049927] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Dermatologists have long used cold-based therapeutic approaches for a variety of applications. Based on the differences in chemical composition, it is possible to selectively target certain tissues rich with lipid, while sparing the surrounding tissue predominantly containing water. With historical observations of cold-induced panniculitis suggesting the feasibility of this strategy, cryolipolysis has emerged as a new methodology using controlled cooling to selectively target fat. Both preclinical and clinical studies have established the safety and efficacy of cryolipolysis for noninvasive body contouring. This review will focus on the evolution of cryolipolysis from initial case reports of cold-induced panniculitis, to preclinical and clinical studies, and the current clinical practice.
Collapse
Affiliation(s)
- H Ray Jalian
- Dermatology Laser and Cosmetic Center, Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, 40 Blossom Street, Thier 2, Room 204, Boston, MA 02114, USA.
| | | |
Collapse
|
17
|
|
18
|
Miller LS, Sørensen OE, Liu PT, Jalian HR, Eshtiaghpour D, Behmanesh BE, Chung W, Starner TD, Kim J, Sieling PA, Ganz T, Modlin RL. TGF-α Regulates TLR Expression and Function on Epidermal Keratinocytes. J Immunol 2005; 174:6137-43. [PMID: 15879109 DOI: 10.4049/jimmunol.174.10.6137] [Citation(s) in RCA: 124] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The expression of TLRs on epithelial cells provides a first line of defense against invading pathogens. We investigated the regulated expression and function of TLR5 and TLR9 on human keratinocytes, because we found by immunohistochemistry that these TLRs are expressed in distinct layers of the epidermis. We found that TGF-alpha, a growth and differentiation factor that is present during wound healing and in psoriasis, increased the expression of both TLR5 and TLR9 on keratinocytes. In addition, TGF-alpha regulated the function of TLR5 and TLR9, because activation with their respective ligands enhanced the production of IL-8 and human beta-defensins. These findings provide evidence that TGF-alpha up-regulates TLR expression and function, augmenting host defense mechanisms at epithelial surfaces.
Collapse
Affiliation(s)
- Lloyd S Miller
- Division of Dermatology, Department of Microbiology, Immunology, and Molecular Genetics, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|