A prospective clinical study evaluating the efficacy and safety of a Laminin-5 fragment contained soothing cream in post-laser treatment care

BACKGROUND

Photothermolysis effect, resulting from laser procedures, can cause redness/erythema, skin irritation and burning sensation, these symptoms may persist more than several days after the procedure and leading to discomfort for patients. Proper management is necessary for the better outcome, especially in early period after the laser procedure. Laminin-5 fragment contained soothing cream (CEBELIA Extreme Care®), is believed to have the calming/soothing effect on overheated/irritated skin after undergoing the laser treatment. It is assumed that cream can help alleviate the redness, erythema and burning sensation commonly experienced after laser treatments. This study aimed to assess the effectiveness and safety of Laminin-5 fragment contained soothing cream (CEBELIA Extreme Care®) during the early post-laser care period.

MATERIALS AND METHODS

This prospective split-face study involved 28 patients who underwent CO2 laser procedures and met inclusion criteria. The laser treatment was performed on both sides of the midface, and subsequently, the Laminin-5 fragment contained soothing cream (CEBELIA Extreme Care®) was applied to one side of the midface. The efficacy of the cream was evaluated through objective measures, including photographic evaluation by two independent evaluators and assessment using an automatic skin analysis device. Subjective evaluations were also conducted.

RESULTS

The objective evaluation, based on the erythema score, revealed a statistical significant difference (p < 0.05) between the side treated with Laminin-5 fragment contained soothing cream (CEBELIA Extreme Care®) and the control side. The erythema score was 1.34 ± 2.469 after the laser treatment with subsequent application of the cream for 10 min and 0.7 ± 2.28 on the second day after the procedure. The subjective evaluation showed a statistically significant high of patient satisfaction. No complications were observed during the follow-up period.

CONCLUSION

The application of Laminin-5 fragment contained soothing cream (CEBELIA Extreme Care®) after the CO2 laser treatment was found to be effective, particularly when applied for 10 min after the laser treatment and on the second day after the procedure. Both objective and subjective evaluations yielded significantly different results. Patients reported a high satisfaction rate with the characteristics of the cream during the follow-up period.

Rosacea treatment with mussel adhesive protein delivered via microneedling: In vivo and clinical studies

BACKGROUND

Rosacea is a prevalent chronic dermatological condition marked by facial inflammation and erythema, significantly compromising the quality of life for affected individuals. Current treatment methods for rosacea are not considered ideal because of the complex etiology of the disease. Mussel adhesive protein (MAP) is a glycoprotein derived from the foot gland of mussels. The protein exhibits anti-inflammatory properties, relieves skin itching, and promotes wound healing.

AIMS

We aimed to explore the feasibility of using MAP administered via microneedle delivery for treating rosacea and the potential molecular mechanism involved.

MATERIALS AND METHODS

The therapeutic effect and mechanism of MAP microneedle delivery in an LL-37-induced rosacea-like mouse model were observed using morphological and histological methods. Twenty-seven patients with erythematotelangiectatic rosacea (ETR) underwent treatment once every 1 month, with three treatments constituting one treatment course. The therapeutic effect was evaluated by comparing the clinical images taken at baseline, after the first treatment course, and after the second treatment course. The red value, CEA, and GFSS score were also calculated.

RESULTS

In response to the microneedle delivery of MAP, innate immunity, inflammatory infiltration, and abnormal neurovascular regulation improved significantly in rosacea-like mice. In the clinical experiments, the microneedle delivery of MAP significantly improved the symptoms of erythema, flushing, and telangiectasia in patients with ETR, and no obvious adverse reactions were observed.

CONCLUSIONS

MAP delivered by microneedling is effective and safe for treating ETR.

Ethanol Embolotherapy for Cutaneous Erythema of High-Flow Vascular Malformations in the Head and Neck

BACKGROUND

Cutaneous erythema is one of the most common signs of arteriovenous malformations (AVMs) in the head and neck region, influencing aesthetic appearance. Surgical resection of AVMs may lead to cicatrization of the skin or aggravation of the lesion. Laser treatment, although effective in improving superficial vascular lesions, cannot prevent deep AVMs from further development.

OBJECTIVE

The authors propose an absolute ethanol embolization therapy that can effectively and safely eradicate the nidus with a favorable aesthetic outcome.

METHODS

The authors conducted a retrospective observational study of 14 AVM patients with distinct cutaneous erythema in the head and neck region undergoing embolotherapy in a single primary care center. Symptoms before and after treatment, complications, and degree of devascularization were recorded and assessed. Changes in cutaneous redness were evaluated using a previously reported quantitative measurement.

RESULTS

Complete symptomatic relief was observed in 5 patients, and major improvement was observed in 9 patients. The mean Δ a * value of the color change had a significant reduction of 6.50 ± 4.04, p < .001, indicating a remarkable remission of cutaneous erythema.

CONCLUSION

Ethanol embolization is an effective and safe treatment for head and neck AVMs with excellent aesthetic outcomes and might become a potential treatment method for other superficial vascular anomalies.

Narrow-Band Intense Pulsed Light as Treatment for Erythematotelangiectatic Rosacea: A Retrospective Study

BACKGROUND

Erythematotelangiectatic rosacea can be successfully treated using various laser and light-based devices. However, the use of narrow-band intense pulsed light for the treatment of erythematotelangiectatic rosacea has not been investigated in detail. This retrospective study aimed to analyze the clinical efficacy of narrow-band intense pulsed light (500-600 nm) for the treatment of erythematotelangiectatic rosacea among Chinese individuals.  Methods: Patients with erythematotelangiectatic rosacea who had completed 3 sessions of treatment with narrow-band intense pulsed light and follow-up from July 2016 to December 2018 were retrospectively evaluated. Clinical improvement was assessed by 2 blinded dermatologists based on photographs obtained at each follow-up visit using the clinician erythema assessment scale and 5-grade scale.

RESULTS

Forty-five patients with erythematotelangiectatic rosacea treated with narrow-band intense pulsed light were included in this study. The effectiveness and excellent rates after 3 treatment sessions were 68.9% and 35.6%, respectively. An average of 2 treatment sessions was required among patients who achieved good or excellent clearance of erythema and telangiectasia. Except for transient erythema and edema, no severe adverse effects were observed.

CONCLUSIONS

Narrow-band intense pulsed light is a safe and effective treatment for erythematotelangiectatic rosacea. Even with a small number of treatment sessions, narrow-band intense pulsed light can deliver a significant therapeutic effect, which may be applicable in clinical practice. J Drugs Dermatol. 2023;22(11):1095-1098     doi:10.36849/JDD.4920.

Acne vulgaris

THE COMPARISONA. A 27-year-old Hispanic woman with comedonal and inflammatory acne. Erythema is prominent around the inflammatory lesions. Note the pustule on the cheek surrounded by pink color.B. A teenaged Black boy with acne papules and pustules on the face. There are comedones, hyperpigmented macules, and pustules on the cheek.C. A teenaged Black girl with pomade acne. The patient used various hair care products, which obstructed the pilosebaceous units on the forehead.

Wound Healing Treatments After Ablative Laser Skin Resurfacing: A Review

Laser resurfacing has progressed since the 1980s to treat a variety of medical and aesthetic indications with ever-evolving safety parameters. While laser technology has evolved to provide a more favorable safety profile and decrease wound healing time, advances in post-procedure healing agents have also helped to mitigate adverse effects, such as persistent erythema, dyspigmentation, acneiform eruptions, dermatitis, infections, and scarring. We reviewed the evidence of growth factors, stem cells, silicone and silicone polymers, botanical based treatments, fatty acids, probiotics, and closed dressings on post-ablative laser skin resurfacing. All reviewed agents demonstrated some evidence in improving post-procedure outcomes, albeit mixed in many cases. Additionally, these studies contain small numbers of participants, vary in type, strength, and clinical indication for which the resurfacing laser was used, and have differing postprocedural evaluation protocols and assessments. This highlights a need for standardization of clinical studies and the importance of choosing an optimal postprocedural skincare plan depending on every unique clinical scenario. J Drugs Dermatol. 2020;19(11):1050-1055. doi:10.36849/JDD.2020.5386.

Erythema of the skin after breast radiotherapy: It is not always recurrence

Recurrence of breast cancer is a predominant fear for patients who were treated for breast cancer. Acute and late dermatologic effects of radiotherapy are not uncommon and could have similar characteristics to breast cancer recurrence. Thus, it is important to highlight key differences between the clinical and histologic presentations of radiation effects and recurrence. Herein, we present two patients who presented with late dermatologic effects of radiotherapy months to years after treatment, neither of whom had workup consistent with cancer recurrence. We provide clinical and microscopic descriptions of each case and provide a review to differentiate various dermatologic conditions. This report aims to outline potential late dermatologic effects of radiation treatment and emphasise that changes in the breast do not always signal breast cancer recurrence.

Safety and Effectiveness of Microfocused Ultrasound for Treating Erythematotelangiectatic Rosacea

Background: Anecdotal reports indicate the use of microfocused ultrasound with visualization (MFU-V) improves facial redness. Objective: The purpose of this pilot study was to assess the safety and effectiveness of MFU-V for improving the signs and symptoms of erythematotelangiectatic rosacea. Methods & Materials: Healthy adults with a clinical diagnosis of erythematotelangiectatic rosacea were enrolled (N=91). Eligible subjects had baseline Clinician Erythema Assessment (CEA) scores ≥3 and Patient Self-Assessment (PSA) of erythema scores ≥2. Subjects were randomized to receive one or two low-density MFU-V treatments or one or two high-density MFU-V treatments. Subjects were evaluated at 90, 180, and 365 days after treatment. The primary effectiveness endpoint was treatment success, defined as a 1-point change in CEA scores at 90 days post-treatment. Results: Across groups, 75 to 91.3% of subjects achieved treatment success at 90 days post-treatment. Notable adverse events include bruising (44%), tenderness/soreness (43%), and redness (35%). Treatment results were sustained, lasting up to 1 year. Subject satisfaction was high based on self-assessment questionnaires. Conclusion: The results of this study demonstrated that a single, high-density MFU-V treatment may be effective for treating erythematotelangiectatic rosacea. Based on these results, a large, randomized controlled study of single, high-density MFU-V treatment for erythematotelangiectatic rosacea is warranted. J Drugs Dermatol. 2019;18(6):522-531.

Intraocular involvement of Mantle cell lymphoma: A case report and literature review

Lymphomatous involvement of the ocular adnexal region (OAR) is generally rare; however, it constitutes the most common ocular malignancy. Most cases of ocular adnexal lymphomas are extra nodal marginal zone B cell lymphomas. Mantle cell lymphoma involvement (MCL) of the OAR is a less common presentation compared with other lymphomas and it has been reported anecdotally. Studies have suggested an association of OAR involvement with poor prognosis. Here, we report the case of a 61 year old man who started experiencing conjunctival erythema which was followed by development of bilateral proptosis. The diagnosis of Stage IV Mantle cell lymphoma with OAR involvement was confirmed 5 months after patient onset of symptomatology. He underwent treatment with systemic chemotherapy, which was followed by high-dose chemotherapy and autologous hematopoietic cell transplant. He is currently day +100 from his transplant and is in complete remission. A review of the literature regarding ocular involvement of MCL is also summarized.

Red man syndrome following the use of vancomycin-loaded bone cement in the primary total knee replacement: A case report

RATIONALE

Red man syndrome (RMS) is the most common allergic reaction to vancomycin. It generally occurs during rapid infusion of vancomycin; only few cases have been reported as results of local vancomycin administration. We hereby report a rare case where RMS developed after insertion of vancomycin-loaded bone cement in a primary total knee replacement (TKR).

PATIENT CONCERNS

A 74-year-old woman was admitted for a left TKR due to severe osteoarthritis. Erythematous changes over face, trunk, and extremities developed after the use of vancomycin-loaded bone cement.

DIAGNOSES

According to the clinical manifestations, the patient was diagnosed with vancomycin-induced RMS.

INTERVENTIONS

She was treated with fluid challenge and intravenous ephedrine, followed by intravenous diphenhydramine and hydrocortisone.

OUTCOMES

The patient's symptoms and signs relieved within 1 h after treatment.

LESSONS

Vancomycin-induced RMS may occur after the routine use of vancomycin-loaded bone cement in the primary TKR replacement.

MEDICAL RESPONSE TO A RADIOLOGICAL ACCIDENT INVOLVING AN IRIDIUM-192 SOURCE IN NANJING, CHINA

On 7 May 2014, a radiological accident involving a lost 192Ir source occurred in Nanjing, China, and overexposure of a worker occurred. After the accident, several national agencies specialized in medical response to radiation emergencies collaborated to carry out clinical case management and to offer psychological assistance to the affected workers and members of the public. In this article, the medical management of the victim is summarized and outcomes are shared in order to improve medical preparedness and response for a nuclear or radiological emergency. This case demonstrated that providing rapid, accurate, credible and consistent information to the public through the media, public health education and psychological assistance to the affected workers and members of the public, contribute to mitigation of psychological impact of such emergencies.

Annular Lesions: Diagnosis and Treatment

Annular lesions can present in a variety of diseases. Knowledge of the physical appearance and history of presentation of these skin findings can help in the diagnosis. A pruritic, annular, erythematous patch that grows centrifugally should prompt evaluation for tinea corporis. Tinea corporis may be diagnosed through potassium hydroxide examination of scrapings. Recognizing erythema migrans is important in making the diagnosis of Lyme disease so that antibiotics can be initiated promptly. Plaque psoriasis generally presents with sharply demarcated, erythematous silver plaques. Erythema multiforme, which is due to a hypersensitivity reaction, presents with annular, raised lesions with central clearing. Lichen planus characteristically appears as planar, purple, polygonal, pruritic papules and plaques. Nummular eczema presents as a rash composed of coin-shaped papulovesicular erythematous lesions. Treatment is aimed at reducing skin dryness. Pityriasis rosea presents with multiple erythematous lesions with raised, scaly borders, and is generally self-limited. Urticaria results from the release of histamines and appears as well-circumscribed, erythematous lesions with raised borders and blanched centers. Annular lesions occur less commonly in persons with fixed drug eruptions, leprosy, immunoglobulin A vasculitis, secondary syphilis, sarcoidosis, subacute cutaneous lupus erythematosus, and granuloma annulare.

Reticular Telangiectatic Erythema: A Chronic Hematoma Subsequent to Hip Replacement as an Underlying Cause

A 78-year-old woman with a history of bilateral hip replacements presented with an ill-defined erythematous plaque with foci of reticulated and indurated areas on the left thigh. Initially, a few weeks after her surgery, a small area of erythema appeared overlying the incision site. Over a 6-month period, the erythema slowly expanded before stabilizing in size (Figure 1). There was no pruritus, pain, or warmth. Orthopedic evaluation found no evidence of infection or malfunction of the hip prosthesis. A skin biopsy revealed telangiectasia of the superficial vessels. Based on the clinical and histopathologic findings, a diagnosis of reticular telangiectatic erythema (RTE) was established. An ultrasound scan revealed a greater trochanteric bursa distended by a chronic, organized hematoma measuring 12 cm at greatest dimension, secondary to a full-thickness tear of the left gluteus minimus (Figure 2), establishing the underlying cause of the RTE in this patient.

Techniques for Optimizing Surgical Scars, Part 3: Erythema, Hyperpigmentation, and Hypopigmentation

Surgical management of benign or malignant cutaneous tumors may result in noticeable scars that are of great concern to patients, regardless of sex, age, or ethnicity. Techniques to optimize surgical scars are discussed in this three-part review. Part 3 focuses on scar revision for erythema, hyperpigmentation, and hypopigmentation. Scar revision options for erythematous scars include moist exposed burn ointment (MEBO), onion extract, silicone, methyl aminolevulinate-photodynamic therapy (MAL-PDT), pulsed dye laser, intense pulsed light (IPL), and nonablative fractional lasers. Hyperpigmented scars may be treated with tyrosinase inhibitors, IPL, and nonablative fractional lasers. Hypopigmented scars may be treated with needle dermabrasion, medical tattoos, autologous cell transplantation, prostaglandin analogues, retinoids, calcineurin inhibitors, excimer laser, and nonablative fractional lasers.

You're the Flight Surgeon

Rojas J. You're the flight surgeon: F-16 pilot with papular rash. Aerosp Med Hum Perform. 2016; 87(7):661-663.

[A Case of a Multidisciplinary Team Approach to Serious Hand-Foot Syndrome Induced by High-Dose Cytarabine Therapy]

A 40's year-old female patient with acute myeloblastic leukemia received high-dose cytarabine(HD-Ara-C)as her third induction therapy. Because the pharmacist in charge noticed on a prior interview that she had experienced a mild skin eruption similar to hand-foot syndrome(HFS)in the previous round oftherapy(idarubicin and cytarabine), heparinoid lotion and hypoallergenic soap were used to prevent HFS. However, HFS occurred on day 3, and further developed on day 6 to grade 3 with painful erythema, swelling, and paresthesia affecting the entire surface of both hands. We cared for her with moisturization, lifestyle guidance, rotation of steroid ointment, and occlusive dressing techniques according to a multidisciplinary team approach composed ofa hematologist, dermatologist, pharmacist, and nurse. Her symptoms resolved on day 40.

Successful treatment of mild to moderate acne vulgaris with Dr Michaels® (also branded as Zitinex®) topical products family: a clinical trial

Acne vulgaris is an epidemic inflammatory skin disease of multi-factorial origin, frequently seen in adolescents and often persisting or occurring through to adulthood. Acne vulgaris is a nearly universal skin disease afflicting 79-95% of the adolescent population in westernized societies and is a significant cause of psychological morbidity in affected patients. Despite the various treatment options available for acne, there is still a need for a safe and effective option. The aim of the study was to investigate the efficacy and tolerability of Dr Michaels® (Zitinex®) product family in the treatment of papulo-pustular acne. 25 patients (17 female/8 male), aged 15-22, with a mild to moderate papulo-pustular acne, localized on the face and on the trunk, were included in this study. None of the patients had used any other kind of treatment in the 3 months prior to commencing this study. All of the patients were treated with Dr Michaels® (Zitinex®) facial exfoliating cleanser, activator formula, a cream, PSC 200 and PSC 900 oral supplements. Application time of Dr Michaels® (Zitinex®) products was 12 weeks. The treatment was been evaluated clinically at 0, 4, 8 and 12 weeks. All of the patients showed an improvement in all parameters of their acne (comedones, papules, pustules, hyperpigmentation and scars). The acne lesions and erythema had mostly resolved. The hyperpigmentation and pitted scarring had significantly reduced also, with the skin appearing smoother. The treatment was well tolerated and no side effects have been described. Our study demonstrates that the Dr Michaels® (Zitinex®) facial exfoliating cleanser, activator formula, cream and oral supplements PSC 200 and PSC 900 are an effective therapeutic option for the treatment of moderately severe acne vulgaris. Moreover, it highlights the safety profile of the Dr Michaels® (Zitinex®) product family in a case of acne compared to traditional first-line treatments.

Fractional Microneedling Radiofrequency Treatment for Acne-related Post-inflammatory Erythema

Post-inflammatory erythema is a common result of acne inflammation and is cosmetically unacceptable without effective treatment. Fractional microneedling radiofrequency (FMR) has potential for treatment of post-inflammatory erythema. The aim of this study was to evaluate the efficacy and safety of this treatment. A retrospective chart review was undertaken of 25 patients treated with 2 sessions of radiofrequency at 4-week intervals and 27 patients treated with oral antibiotics and/or topical agents. Efficacy was assessed through an investigator's global assessment of photographs, and the analysis of erythema with image analysis software and photometric devices. Histological changes resulting from the treatment were evaluated by skin biopsy. FMR treatment resulted in significant improvements in erythema with no severe adverse effects. Histological study revealed a reduction in vascular markers and inflammation. FMR is a safe and effective treatment for post-inflammatory erythema, with potential anti-inflammatory and anti-angiogenetic properties.

Consensus recommendations from the American acne & rosacea society on the management of rosacea, part 4: a status report on physical modalities and devices

The fourth article in this 5-part series reviews physical modalities and devices used to treat cutaneous rosacea based on consensus recommendations from the American Acne & Rosacea Society (AARS) on the management of the common presentations of cutaneous rosacea. The major therapeutic uses of physical modalities and devices, especially laser and light-based systems, are for treatment of telangiectases and persistent facial erythema (background erythema). Phymas, especially rhinophyma, also are treated with physical modalities such as ablative lasers or surgical devices (eg, electrosurgical loop). Appropriately selected and properly used lasers and intense pulsed light (IPL) devices can successfully address specific clinical manifestations of rosacea that exhibit limited or no response to available medical therapies, such as telangiectases and background centrofacial erythema. Rosacea-associated symptoms also may improve. In most cases, treatment will need to be repeated intermittently to sustain improvement.

Noncontact monitoring of vascular lesion phototherapy efficiency by RGB multispectral imaging

A prototype low-cost RGB imaging system consisting of a commercial RGB CMOS sensor, RGB light-emitting diode ring light illuminator, and a set of polarizers was designed and tested for mapping the skin erythema index, in order to monitor skin recovery after phototherapy of vascular lesions, such as hemangiomas and telangiectasias. The contrast of erythema index (CEI) was proposed as a parameter for quantitative characterization of vascular lesions. Skin recovery was characterized as a decrease of the CEI value relative to the value before the treatment. This approach was clinically validated by examining 31 vascular lesions before and after phototherapy.

[Influence of immunovac-VP-4 therapy on innate immunity effectors in patients with darier erythema annulare centrifugum]

AIM

Detection of features of functioning ofinnate and adaptive immunity pathways in patients with Darier erythema annulare centrifugum (EAC).

MATERIALS AND METHODS

14 EAC patients aged 14 - 52 years were examined. The patients were ranked based on therapy variant. The first group consisted of 6 patients who had received Immunovac-VP-4 (Immunovac) against the background of basic therapy; the second group (4 patients) received cagocel against the background of basic therapy; the third group (4 patients) received only basic therapy; the group of healthy individuals consisted of 15 individuals. All the patients had the level ofcytokines in blood sera determined by solid-phase EIA by using Biosource (Austria) test-systems. Evaluation of TLR expression in peripheral blood mononuclear lymphocytes and keratinocytes was carried out by flow cytometry method by using monoclonal antibodies (Catlag Laboratories, USA) against the corresponding antigens; evaluation of content of lymphocyte subpopulations in blood was carried out by using monoclonal antibodies by flow cytometry method on FacsCalibur flow cytometer (Becton Dickinson, USA).

RESULTS

Immunotherapy by Immunovac and cagocel facilitated the increase of CD3+, CD4+, CD8+. Immunovac facilitated a significant increase ofinitially low values ofCD25+, CD95+ and normalization of CD72+; normalization of IgM level. Immunovac increased the level of serum IL-2, induced the increase of IFN-gamma synthesis in contrast to cagocel and basic therapy, the administration of those caused its decrease. TGF-beta increased during the course of Immunovac immunotherapy and decreased during basic therapy. In the course of basic therapy a significant increase of initially high level ofcytokine IL-I beta was observed.

CONCLUSION

Immunovac therapy resulted in correction of content of lymphocyte populations, sera cytokines, facilitating the normalization of immunocompetent cell proliferation processes, activation of NK-cells, macrophages and at the same time suppression of DTH reactions. Immunovac facilitated the enhancement ofTLR3, 9 expression in the skin that indicates the inclusion ofintracellular receptor mechanisms of innate immunity.

The use of the 300 microsecond 1064 nm Nd:YAG laser in the treatment of keloids

BACKGROUND

Keloids can be quite resistant to conventional methods of treatment. A wide range of treatment modalities exists, often with suboptimal results, recurrences, and adverse events occurring. Laser therapy with the carbon dioxide, erbium:YAG, Q switched frequency doubled neodymium-doped yttrium aluminium garnet (Nd:YAG), and 585/595 nm pulsed dye lasers have all be purported as potential treatment modalities however with limited efficacy and data especially in the skin of color population is limited. We report the successful use of the 300 microsecond 1064 nm Nd:YAG laser in treating keloids in patients with skin types ranging from Fitzpatrick I through VI with special attention in treating skin of color patients.

OBJECTIVE

We examined the use of the 300 microsecond 1064 nanometer (nm) Nd:YAG laser for the treatment keloids in patients with skin types ranging from Fitzpatrick I through VI.

METHODS & MATERIALS

A retrospective analysis of treatment efficacy was conducted on 44 patients with keloids. Three separate treatment groups were compared. The groups consisted of: a "control group" in which the whole keloid was only treated with intralesional corticosteroid (triamcinolone 10 mg/cc) (16 patients); a "laser only" group in which the patient's keloid was only treated with the 1064 nm Nd:YAG laser at a fluency of 13 to 18 Joules / centimeter2 (J/cm2), a fixed pulse duration of 300 microseconds, 5 mm spot size, and a total of 2000 pulses (14 patients); and a "combination group" that received both the aforementioned laser therapy and adjuvant intralesional triamcinolone (14 patients).

RESULTS

Patients in the "combination group" treated with the 300 microsecond 1064 nm Nd:YAG laser therapy plus intralesional corticosteroid and the "laser only" group both were observed to have durable clinical reduction in the thickness and erythema of the keloids. These results were shown to be superior to the "control group" whom were only treated with intralesional corticosteroids. Only mild and transient post treatment erythema was noted as an adverse effect.

STATISTICAL ANALYSIS

Data analysis was performed using IBM SPSS Statistics 19.0.0 (Armonk, NY). In order to assess the statistical significance of differences in keloid improvement among the three treatment groups, The Kruskal-Wallis test (non-parametric ANOVA test) was applied. The level of statistical significance was set at P< 0.05. A statistically significant difference in keloid improvement was appreciated between treatment groups (P<0.0001).

LIMITATIONS

A small sample size and the retrospective nature of the analysis are limitations to the study.<BR>

CONCLUSION

The 300 microsecond 1064 nm Nd:YAG laser proved effective in improving the clinical appearance of keloids. We recommended this laser protocol in conjunction with intralesional corticosteroids as a treatment option for patients with keloids, especially in the skin of color population. The 1064 nm Nd:YAG laser did not show post inflammatory hyperpigmentation nor hypopigmenatation, which are concerns for skin types IV to VI, and therefore is a suitable option for such patients.

Photopneumatic therapy for the treatment of keratosis pilaris

BACKGROUND

Current treatment options for keratosis pilaris (KP) are limited and are often found to be unsatisfactory to patients.

OBJECTIVE

Pilot study to determine if photopneumatic therapy (PPx) can improve the erythema and skin texture in KP.

METHODS

Ten patients with KP were treated with one session of PPx on the upper arm and then evaluated one month later for treatment efficacy.

RESULTS

Average investigator-assessed improvement was 27% in erythema and 56% in skin texture roughness. Average patient self-reported improvement was 52% in erythema and 53% in skin texture. The mean satisfaction score was 6.3 on a scale of 1 to 10 (median 7.5) and 8 out of 10 participants reported they would choose to receive PPx for their KP again in the future.

LIMITATIONS

Small number of patients, short follow-up period, and lack of blinding of the examiner and the patients making recall bias possible.

CONCLUSIONS

One treatment of PPx improved both the erythema and redness associated with KP over at least a one month period.

Skin conditions: common skin rashes in infants

Infants exhibit many skin rashes. Erythema toxicum neonatorum presents as erythematous macules, papules, and pustules on the face, trunk, and extremities; it typically resolves spontaneously within 1 week. Neonatal acne presents as comedones or erythematous papules on the face, scalp, chest, and back. Infantile acne is similar but starts after the neonatal period. Both conditions typically resolve spontaneously; failure to resolve within 1 year warrants evaluation for androgen excess. Neonatal cephalic pustulosis is an acne variant caused by hypersensitivity to Malassezia furfur. It is typically self-limited, but severe cases are managed with topical ketoconazole. Miliaria and milia are caused by sweat retention and present as tiny vesicles or papules; they resolve spontaneously. Contact diaper dermatitis is managed by keeping the diaper area clean and with open air exposure. Diaper dermatitis due to Candida albicans is managed with topical antifungals. Seborrheic dermatitis causes scaling on the scalp. Management involves shampooing and removing scales with a soft brush after applying mineral oil or petrolatum; severe cases are managed with tar or ketoconazole shampoo. Atopic dermatitis is related to food allergy in approximately one-third of children. Food allergy can be confirmed with oral food challenges or skin prick tests. Management includes elimination of irritants and triggers and use of low-potency topical steroids.

Acral erythema worsened by intravenous infusions of cyclosporin

Acral erythema is a frequent cutaneous reaction related to chemotherapy. A patient presented herein developed acral erythema related to cytosine arabinoside treatment and then graft versus host disease (GVHD). Subsequently, worsening of palmar erythema and pain occurred with intravenous cyclosporin infusions.

Paraneoplastic erythema annulare centrifugum eruption: PEACE

Erythema annulare centrifugum is a reactive erythema of various possible etiologies including, although less often, an associated cancer. Cancer-related erythema annulare centrifugum is most commonly associated with lymphoproliferative malignancies, specifically lymphoma and leukemia. Malignancy-associated erythema annulare centrifugum is more frequently seen in women than men and the presence of skin lesions usually precedes the clinical diagnosis of the underlying malignancy. Neoplasm-derived erythema annulare centrifugum lesions often resolve following treatment of the cancer. Recurrence of erythema annulare centrifugum may occur along with the relapse of the underlying malignancy. Paraneoplastic erythema annulare centrifugum eruption (PEACE) is speculated to be a result of a cytokine or other tumor-associated factors.

[Pemphigus erythematosus]

Pemphigus erythematosus, also known as Senear-Usher syndrome, was originally described as a variant of pemphigus with features of lupus erythematosus but regarded today as a localized form of pemphigus foliaceus and considered an autoimmune bullous disease. The autoantigen is desmoglein 1, a desmosomal adhesion protein in keratinocytes. A 69-year-old man presented with a 3-month history of erosions and blisters on the cheeks, which then also appeared on the trunk. Clinical and histopathologic criteria as well as immunofluorescence studies lead to the diagnosis of pemphigus erythematosus with transition to pemphigus foliaceus.

Light-emitting diode

Light-emitting diode (LED) photomodulation has become a recognized player in the world of lasers and light sources. It is used to treat a variety of clinical entities, including photorejuvenation, erythema-induced injury following laser and other cosmetic procedures, and acne vulgaris. Its use has increased and will increase further as our understanding of LED devices deepens.

Sunitinib in metastatic renal cell carcinoma: recommendations for management of noncardiovascular toxicities

The multitargeted tyrosine-kinase inhibitor sunitinib has emerged as one of the standards of care for good- and intermediate-risk metastatic renal cell carcinoma. Although generally associated with acceptable toxicity, sunitinib exhibits a novel and distinct toxicity profile that requires monitoring and management. Fatigue, diarrhea, anorexia, oral changes, hand-foot syndrome and other skin toxicity, thyroid dysfunction, myelotoxicity, and hypertension seem to be the most common and clinically relevant toxicities of sunitinib. Drug dosing and treatment duration are correlated with response to treatment and survival. Treatment recommendations for hypertension have been published but, currently, no standard guidelines exist for the management of noncardiovascular side effects. To discuss the optimal management of noncardiovascular side effects, an international, interdisciplinary panel of experts gathered in November 2009. Existing literature on incidence, severity, and underlying mechanisms of side effects as well as on potential treatment options were carefully reviewed and discussed. On the basis of these proceedings and the thorough review of the existing literature, recommendations were made for the monitoring, prevention, and treatment of the most common noncardiovascular side effects and are summarized in this review. The proactive assessment and consistent and timely management of sunitinib-related side effects are critical to ensure optimal treatment benefit by allowing appropriate drug dosing and prolonged treatment periods.

Granuloma faciale with disseminated extra facial lesions

Granuloma faciale (GF) is a rare cutaneous disorder categorized as a localized form of small vessel vasculitis. Clinically, it manifests as single or multiple, well-demarcated, red-brown plaques, papules and nodules, nearly always confined to the face. Herein, we report a 39-year-old man with multiple red-brown, infiltrated plaques on his face and extrafacial lesions on the back, shoulders, and both arms. Skin biopsy revealed typical histopathological findings of GF. The patient failed to respond to pulsed dye laser, but intralesional triamcinolone combined with cryotherapy led to an acceptable response.

JAAD grand rounds quiz*: Dusky intertriginous plaques and acral erythema after bone marrow transplant

LEARNING OBJECTIVES

At the conclusion of this learning activity, physician participants should be able to assess their own diagnostic and patient management skills and use the results of this exercise to help determine personal learning needs that can be addressed through subsequent CME involvement. Instructions for claiming CME credit appear in the front advertising section. See last page of Contents for page number.

INSTRUCTIONS

In answering each question, refer to the specific directions provided. Because it is often necessary to provide information occurring later in a series that give away answers to earlier questions, please answer the questions in each series in sequence.

Practical management of cutaneous reactions to the methylphenidate transdermal system: recommendations from a dermatology expert panel consensus meeting

BACKGROUND

Psychostimulants remain the most-used medications for attention-deficit/hyperactivity disorder (ADHD). The methylphenidate transdermal system (MTS) is the first stimulant patch dosage formulation to be approved by the US Food and Drug Administration for the treatment of the symptoms of ADHD in children aged 6 to 12 years. The MTS patch is approved to be applied once daily to the hip and worn for 9 hours. While cutaneous reactions may occur with any formulation of medication, they are more likely with transdermal administration.

OBJECTIVE

The purpose of this commentary was to describe the types of cutaneous reactions that have been reported with transdermal systems in general, review the cutaneous adverse events seen in clinical trials with the MTS specifically, and provide practical management suggestions for prevention and treatment of these potential cutaneous reactions.

METHODS

In September 2007, a group of child psychiatrists, pediatricians, developmental pediatricians, and pediatric neurologists who treat ADHD and have had experience in their practices with MTS convened to discuss cutaneous reactions in relation to its use. Information collected from this meeting and from the clinical trials database of the sponsor was reviewed by a panel of 3 dermatologic clinical experts in contact dermatitis and 1 pediatric dermatologist. The panel's recommendations form the basis for this report.

CONCLUSIONS

Mild to moderate erythema is a common cutaneous effect with MTS use, and is generally not a cause for discontinuation if seen in isolation. Irritant contact dermatitis is relatively common and can be reduced and treated by alternating patch application sites, moisturizing, gentle skin care, and application of topical corticosteroids at the previous patch sites if needed. Allergic contact dermatitis (ACD) and allergic contact urticaria are rare when MTS is worn as directed in the prescribing information. MTS should be discontinued if ACD is suspected.

Standard management options for rosacea, part 2: options according to subtype

The standard management options were developed by a consensus committee and review panel of 26 experts to assist in providing optimal patient care based on the standard classification and grading systems for rosacea that were developed to perform research; analyze results and compare data from different sources; and provide a common terminology and reference for the diagnosis, treatment, and assessment of results in clinical practice. We discuss the standard management options for rosacea in 2 parts: (1) overview and broad spectrum of care, and (2) management options according to subtype. The menu of options is considered provisional and may be expanded and updated as appropriate. Managing the various potential signs and symptoms of rosacea calls for consideration of a broad spectrum of care, and a more precise selection of therapeutic options may become increasingly possible as the mechanisms of action of therapies are more definitively established.

Long‐term clinical results of IPL photorejuvenation

BACKGROUND

Non-ablative photorejuvenation is characterized by the reduction of intrinsic and extrinsic changes in photodamaged skin. Only short-term improvement has been documented previously.

OBJECTIVE

To evaluate quantitatively the short-term and long-term clinical effectiveness of multiple full-face IPL treatments for non-ablative facial photorejuvenation.

METHODS

A total of 47 patients with varying degrees of photodamaged skin and rosaceal dermatitis underwent a series of four to five IPL treatments with a Vasculight (Lumenis Corp). Treatments were conducted every 3-4 weeks. Photographs were taken at baseline and after the treatment series was completed at both 6 weeks and 6 months. Adverse effects and clinical improvement were documented. A patient satisfaction questionnaire was completed and reviewed at the 6-month evaluation period.

RESULTS

Standardized evaluation of rhytids showed a statistically significant improvement in wrinkles at both evaluation endpoints. Some degradation occurred over time. Facial vascularity, dyschromia, and large pore size progressively improved from the 6-week measurement to the 6-month measurement.

CONCLUSION

This clinical study demonstrates that non-ablative facial rejuvenation is associated with long-term clinical improvement of facial rhytids, abnormal vascularity and pigmentary disorders with minimal risks and side effects to the patient.

The utilization of nonthermal blue (405–425 nm) and near infrared (850–890 nm) light in aesthetic dermatology and surgery—a multicenter study

BACKGROUND

A major cause of skin aging is a chronic micro-inflammation triggered by UV radiation and external pollutants. It has been demonstrated that blue light diminishes inflammatory conditions and near infrared light enhances circulation.

OBJECTIVES

To assess the effectiveness of a non thermal dual wavelength -- blue (405 - 420 nm) and near infrared (850 - 900 nm) -- light source in skin rejuvenation, in the reduction of the duration of post skin resurfacing erythema and in the acceleration of healing of post surgical conditions (face lift and breast augmentation).

METHODS

We have utilized a non contact, hand free dual wavelength light source (iClearXL and Clear100XL, Curelight Ltd) to treat over 60 patients and perform three controlled studies in four centers. Follow up duration was three months. Control group for photo-rejuvenation consisted of patients treated with Glycolic peeling and daily appliance of vitamin C Control group for post skin resurfacing erythema duration consisted of patients untreated by the light source and control group for post surgical healing consisted of patients untreated by the light source or treated by the light source on one side only.

RESULTS

Post skin resurfacing erythema duration is reduced by 90%. The healing of post surgical conditions is substantially accelerated and discomfort is reduced. The anti aging effect of the light source includes: reduction of pore size in 90% of patients with stable results at three months follow up, enhanced skin radiance in 90% of patients with stable results at three months follow up and smoothing of fine wrinkles in 45% of patients with stable results at three months follow up. The control group showed poor results which were stable for a duration of less than one month.

CONCLUSIONS

A non thermal, non contact / hand free light source emitting at 405-420 nm and 850-900 nm considerably enhances aesthetic and surgical aesthetic procedures without consuming user time.

[Cryotherapy in treatment of skin demodecosis]

Demodecosis is wide spread chronic skin disorder caused by the mite - Demodex folliculorum. It frequently involves the mid facial region: nasolabial folder, the nose, the chin and eyes. The treatment depends on the severity of the inflammatory skin disorder and includes complex of oral and topical drug treatment. The aim of the study was to determine the efficiency of criotherapy in complex treatment of demodecosis. We have observed 38 patients of both sexes aged 19-54. The patients were divided into two groups - "A" and "B". Patients with erythematosquamose form of the disease were treated with Trichopol peros and oral antibiotics in case of inflammatory lesions. For topical treatment in group "A" Rosamet cream was used. In group "B" Rosamet cream and criotherapy were used. The results of our study have demonstrated effectiveness of criotherapy in combination with Rosamet cream. A significantly faster decrease of inflammatory lesions and reduce the erythema was observed in group "B". Therefore the usage of criotherapy with Rosamet cream is recommended to get quick therapeutic effect.