Andrea Willey

Reduction in the Incidence of Squamous Cell Carcinoma in Solid Organ Transplant Recipients Treated with Cyclic Photodynamic Therapy

BACKGROUND AND OBJECTIVES Squamous cell carcinomas (SCCs) produce significant morbidity in solid organ transplant recipients (SOTRs), particularly in patients who develop multiple tumors. Topical photodynamic therapy (PDT) has been shown to decrease the number of keratotic lesions in SOTRs, but the duration of the beneficial effect is limited. The aim of this study was to evaluate the potential benefit of cyclic PDT in the prevention of new SCCs in SOTRs. METHODS Twelve high‐risk SOTRs received cyclic PDT treatments at 4‐ to 8‐week intervals for 2 years. The development of new SCCs (invasive and in situ) performed 12 and 24 months after the start of cyclic PDT were compared with the number of SCCs developed during the year before initiation of cyclic PDT. RESULTS The median reduction in the 12‐ and 24‐month post‐treatment counts from the 1‐month pretreatment counts was 79.0% (73.3–81.8%) and 95.0% (87.5–100.0%), respectively. Treatments were well tolerated. CONCLUSION Cyclic PDT with 5‐aminolevulinic acid may reduce the incidence of SCC in SOTRs. Additional studies with larger numbers of patients and optimized protocols are necessary to further explore the potential benefits of cyclic PDT in the prevention of skin cancer in this high‐risk patient population.

Short course of oral cyclosporine in lichen planopilaris

Lichen planopilaris is a rare inflammatory disorder of unclear etiology that causes permanent scalp hair loss. Current treatments for lichen planopilaris are limited and do not alter the eventual outcome of the disease. Oral cyclosporine has been successful in treating severe and refractory lichen planus of the skin, and has produced sustained remission in some patients. We present 3 patients with lichen planopilaris who were treated with a short course of oral cyclosporine and report their clinical features and responses, using a standardized method of patient assessment and 3 specific outcome measures. In all 3 patients alleviation of symptoms, resolution of clinical activity, and halting progression of hair loss was achieved in 3 to 5 months with sustained effect at 12 months after a short course of cyclosporine therapy.

Elastometry and Clinical Results After Bipolar Radiofrequency Treatment of Skin

BACKGROUND The healing process of a novel radiofrequency bipolar system was recently shown to produce a profound increase in collagen and elastin content. OBJECTIVE To determine the relationship between subjective clinical improvement scores and changes in objective measures of mechanical skin properties. METHODS AND MATERIALS Elastometry measurements were made at baseline and 3 months after treatment. All patients received a treatment zone on the lower face. Patient assessments of results and physician ratings of wrinkle and skin laxity were collected at baseline and 3 and 6 months after treatment. Elastometry and clinical results were then compared. RESULTS Three months after treatment, elastometry measurements showed statistically significant improvement (5–12% decrease in Youngs Modulus and 10–16% decrease in retraction time). The average improvement correlated to a 2.6‐year improvement in skin property. Physician scores at 3 months showed a statistically significant improvement of 1.42 grades on the Fitzpatrick scale for wrinkles and 0.66 grades on the Alexiades scale for skin laxity, increasing to 1.57 and 0.70 improvement, respectively, at 6 months. Eighty‐nine percent and 91% of patients were satisfied or very satisfied with the procedure at 3‐ and 6‐month follow‐up, respectively. CONCLUSION Elastometry data showed an average decrease in Youngs Modulus and retraction time, both of which suggest that radiofrequency bipolar treatment resulted in more youthful skin. Better mechanical characteristics were consistent with improvements in wrinkles, laxity, and skin quality and appearance. Funding provided by Primaeva Medical, Inc. Drs. Willey, Kilmer, Newman, and Hantash serve on the advisory board of Primeava Medical. Drs. Berube and Renton and Mr. Krishna and Mr. McGill are employees of Primaeva Medical.

Temperature-modulated photodynamic therapy for the treatment of actinic keratosis on the extremities: a pilot study.

BACKGROUND The efficacy of photodynamic therapy (PDT) using topical 5-aminolevulinic acid (ALA) for the treatment of actinic keratosis (AKs) is lower on the distal extremities compared with the head and neck areas. The strong temperature dependence of porphyrin synthesis in biologic tissue suggests that heating skin during incubation may improve the efficacy of PDT, particularly in areas where biologic temperatures are naturally lower. The aim of this study was to evaluate the efficacy and tolerability of temperature-modulated PDT for the treatment of AKs on the extremities. METHODS In this IRB-approved, single-center study, the upper or lower extremities of 20 subjects were treated with 20% ALA under occlusion, followed by 10 J/cm2, 417-nm blue light. One of the 2 extremities treated was heated during the 1-hour incubation. Outcome measures included lesion counts, tolerability, and global improvement at baseline, 1 week, and 2 and 6 months after treatment. RESULTS The median temperatures of the heated and control sides were 38.8°C and 29.4°C, respectively. The median clearance for the heated side was significantly greater than the control side at 2 and 6 months (p < .0001). Typical PDT side effects were greater on the heated side compared with the control yet were well tolerated by all subjects. CONCLUSION Warming the skin during incubation of ALA seems to improve the efficacy of PDT in the treatment of AKs on the extremities and is well tolerated when heat application is controlled within the limits of safety.

Prospective Multicenter Clinical Trial of a Minimally Invasive Temperature-Controlled Bipolar Fractional Radiofrequency System for Rhytid and Laxity Treatment

BACKGROUND A minimally invasive fractional bipolar radiofrequency (FRF) was developed. OBJECTIVE To evaluate safety and efficacy of FRF in reducing face and neck rhytides and laxity. MATERIALS AND METHODS This prospective, open‐label, multicenter clinical trial enrolled 100 subjects with mild to severe facial and neck rhytides and laxity at seven centers in a per‐protocol analysis. One single‐pass FRF treatment was administered through five 32 g‐needle electrode pairs at a preselected real‐time fixed temperature of 62 to 78°C, energy duration for 3 to 5 seconds, and impedance restrictions of 200 to 3,000 Ohms, ensuring intradermal delivery. Five blinded dermatologists and plastic surgeons graded randomized standardized baseline and follow‐up photographs of 53 and 42 subjects at 3‐ and 6‐month follow‐up intervals, respectively, using the Fitzpatrick wrinkle and Alexiades‐Armenakas laxity scales. Subject assessments and adverse events were recorded in 100 subjects. RESULTS Blinded evaluations revealed correct pre‐ and post‐treatment identification in 100% of scored cases, mean improvement of 25.6% on the Fitzpatrick Wrinkle Scale and 24.1% on the Alexiades‐Armenakas laxity scale at 6 months, and 100% response rate for rhytides and 95% for laxity. Subgroup analysis revealed maximal rhytid reduction in the mean target temperature of 66.7, energy duration of 4.2 seconds, and volume of denatured collagen of mm3 denatured collagen group. Adverse events included transient erythema, edema, and ecchymoses, resolving within 1 to 5 days, and two incidents of temporary pinpoint depressions. More than 90% of subjects were satisfied or very satisfied. CONCLUSION Real‐time temperature‐controlled FRF is a highly reproducible, safe, effective nonsurgical treatment of face and neck rhytides and laxity and provides important insights into neocollagenesis, neoelastogenesis, and clinical outcomes.

Tinea capitis mimicking cicatricial alopecia: What host and dermatophyte factors lead to this unusual clinical presentation?

Tinea capitis is the most common dermatophyte infection in children. The clinical presentation varies from subtle asymptomatic scaling to inflammatory suppurative nodules and draining tracks. Both chronic and acute inflammatory infections may damage the hair follicle leading to secondary cicatricial alopecia. In rare instances, the initial presentation can mimic a primary cicatricial alopecia. We present three cases of tinea capitis in children masquerading as cicatricial alopecia and discuss the possible host immune and fungal antigenic factors that may influence the course of disease and its clinical presentation. An understanding of the clinical morphology of tinea capitis in the context of both host and fungal factors may improve treatment strategies and direct future paradigms of therapy.

Black-spot poison ivy.

In black-spot poison ivy dermatitis, a black lacquerlike substance forms on the skin when poison ivy resin is exposed to air. Although the Toxicodendron group of plants is estimated to be the most common cause of allergic contact dermatitis in the United States, black-spot poison ivy dermatitis is relatively rare.

Through and Through Defect on the Helix and Antihelix.

A70-year-old man underwentMohs micrographic surgery for a basal cell carcinoma on the left ear helix. Complete tumor extirpation resulted in a full thickness defect with a loss of one third of the lower ear helix andantihelix, extending fromthemid-helix, to the lobule andmedially to the conchal bowl (Figure 1). The presence of a second basal cell carcinoma on the postauricular skin overlying the mastoid precluded the use of this skin reservoir for flap reconstruction. How would you repair this defect?

Botulinum Toxin Type A for Relief of Intractable Pain After Face and Brow-Lift Surgery.

Refractory pain after rhytidectomy is a rare, but distressing, problemwith few effective interventions. In recent years botulinum toxins have been effectively used for a variety of painful conditions, including persistent painofuncertain etiologyafter headandneck surgery. The authors describe a patientwho developed refractory pain in the scars within the temporal hairline 1.5 years after rhytidectomy with superficial muscular aponeurotic system (SMAS) tightening, platysmaplasty, and anterior hairline brow-lift procedures. Intralesional injection of onabotulinum A directly into the scars provided relief within a few days and has been maintainedwith quarterly injections for 3 years.Recent identification of synaptosomal-associated protein 25 (SNAP25) on sensory neuronsmay explain the efficacy of onabotulinumA in treatingpersistent pain of various etiologies, including facial surgery.

Narben, Keloide und Dehnungsstreifen

Um eine umfassende Bewertung der derzeit verfugbaren Lasergerate und Behandlungsschemata vorzunehmen, sind grose, kontrollierte Studien erforderlich. Die Bestimmung des Narbentyps ist ausschlaggebend fur die Auswahl des geeigneten Lasers sowie der Behandlungsparameter. Sowohl ablative als auch nichtablative Laser, deren Zielstruktur die Gefase im Narbengewebe oder das kollagenumgebende Gewebewasser sind, konnen zur Verbesserung des Aussehens von Narben beitragen. Fraktioniertes Resurfacing ermoglicht eine tiefe Penetration der Lichtenergie bei gleichzeitiger Schonung des gesunden Gewebes und stellt einen vielversprechenden Ansatz fur die Behandlung verschiedener Narbenarten dar. Obwohl der ideale Zeitpunkt fur die Behandlung noch nicht geklart wurde, ist ein fruhzeitiger Beginn der Laserbehandlung bei den meisten Narben vorteilhaft. Die Forschung wird sich zukunftig neben der Narbenbehandlung auch dem Einsatz von Lasern zur Stimulierung der Geweberegeneration und zur Narbenpravention widmen.