Cameron K. Rokhsar

Efficacy of topical sensitizers in the treatment of alopecia areata

It has been more than 2 decades since the first report of the use of dinitrochlorobenzene to induce hair growth in 2 patients with alopecia areata. Other topical sensitizers, namely squaric acid dibutylester and diphenylcyclopropenone, have been used with variable success. This article reviews the efficacy and safety of the use of topical sensitizers in the treatment of alopecia areata.

Fractional Photothermolysis for the Treatment of Postinflammatory Hyperpigmentation after Carbon Dioxide Laser Resurfacing

A common complication of carbon dioxide (CO2) laser resurfacing is postinflammatory hyperpigmentation, which can occur in up to 20% to 30% of all patients. Although most cases respond to topical therapy with retinoids, steroids, hydroquinone, topical vitamin C, or some combination, 5% to 10% of all patients treated with CO2 laser resurfacing can develop chronic, lifelong, treatment-resistant dyschromia. In this report, we describe a case of CO2 laser–induced pigmentation refractory to topical bleaching agents treated with fractional photothermolysis. This is a gentle approach to laser resurfacing, whereby the skin is resurfaced fractionally (15–30%) each treatment session. This is accomplished using a 1,550-nm wavelength laser to place microscopic zones of thermal damage in the epidermis and dermis surrounded by islands of normal tissue. The normal skin left untreated serves as a reservoir for healing, allowing the skin to heal rapidly. This procedure is typically repeated for four to six sessions every 2 to 4 weeks. In this way, one can resurface a large portion of the skin over time. To our knowledge, this is the first report of CO2 laser–induced dyschromia treated with this modality.

Nonsurgical Rhinoplasty: An Evaluation of Injectable Calcium Hydroxylapatite Filler for Nasal Contouring

For decades, surgical rhinoplasty has been the therapeutic gold standard for individuals seeking to improve the cosmetic appearance of their nose. The technique, however, is not without its drawbacks. In many cases, postoperative edema and ecchymoses have resulted in prolonged downtimes as well as significant delays in achieving desired cosmetic outcomes. Furthermore, the need to raise an alar flap can result in scarring in the alar crease, particularly among patients with a hereditary predisposition toward hypertrophic scars/keloids. Finally, as with any surgical procedure, rhinoplasty has been associated with intrinsic perioperative complications, including reactions to anesthesia, infection, bleeding, and in rare instances, death.

Fractional Resurfacing for the Treatment of Pearly Penile Papules

Pearly penile papules (PPPs), also known as Tyson’s glands or hirsutoid papillomas, are pearly white, dome-shaped, 1to 2-mm closely aggregated papules located on the glans penis. These lesions are most commonly encountered in a single or double row, circumferentially distributed on the corona and sulcus. They are found in up to 30% of postpubertal males, most often in the second or third decade. They also are reported to be more common in black men and in those who are uncircumcised. The lesions are typically asymptomatic and do not appear to have any functional significance. While PPPs were initially postulated to be a source of smegma or an organ of the nervous system, they have definitively been demonstrated to be a type of angiofibroma. PPPs are benign and require no treatment other than reassurance. That being said, many patients seek treatment citing cosmetic or psychological concerns, and numerous therapies have been tried including cryotherapy, electrodesiccation, shave excision, and CO2 laser ablation.

Safety and Efficacy of Microfocused Ultrasound in Tightening of Lax Elbow Skin.

BACKGROUND With the increased popularity of minimally invasive cosmetic treatments, this study evaluates the efficacy and safety of microfocused ultrasound with visualization (MFU-V) for tightening lax skin above the elbow. METHODS Subjects were treated bilaterally above the elbows with MFU-V using transducers with different focal depths. Photographs were taken before treatment and at 90- and 180-day follow-ups. Masked observer ratings and physician and subject global aesthetic improvement scales (PGAIS and SGAIS) were completed at follow-ups. Safety, based on adverse event (AE) incidence, was assessed. RESULTS Masked blinded assessment was completed at 90 days; 56% showed aesthetic improvement. Overall improvement in SGAIS was 83% and 81% at 90 and 180 days, respectively. The overall improvement in PGAIS was 94% at both 90 and 180 days. Patient satisfaction questionnaires showed that 83% noticed improvements in elbow characteristics at 90 days, with 81% still indicating improvement at 180 days. No serious AEs or treatment-related AEs were reported. CONCLUSION This pilot study suggests that MFU-V is a safe and promising nonsurgical option for the treatment of skin laxity above the elbow. Based on the positive results of this study, a larger trial is warranted together with testing different treatment densities to optimize this noninvasive approach.

Traumatic neuromas of the penis: a clinical, histopathological and immunohistochemical study of 17 cases.

We present 17 penile traumatic neuromas. The mean patient age at presentation was 38 years (range 23–59 years). The most common site involved was the penile shaft. The lesions ranged from 1 to 7 mm in greatest dimension. The clinical diagnosis in all cases included condyloma acuminatum. In all cases, a history of trauma because of prior biopsy and/or circumcision was found. Histologically, all lesions showed similar features consisting of an increased number of dermal nerve bundles embedded within a fibrous stroma. Often, single or multiple Meissner corpuscle‐like structures were noted in the papillary dermis. Our study suggests that circumcision or other forms of trauma to the skin of the penis likely plays an important role in the pathogenesis and clinical presentation of this peculiar neural neoplasm. We call attention to this entity because it is often clinically misdiagnosed as condyloma acuminatum.

The short pulse carbon dioxide laser versus the colorado needle tip with electrocautery for upper and lower eyelid blepharoplasty.

Various techniques for blepharoplasty have been described, including those performed with the assistance of the short pulse carbon dioxide laser and those performed with the assistance of the Colorado microdissection needle attached to an electrocautery unit. Although the superiority of the carbon dioxide laser to cold steel has been demonstrated for the performance of eyelid blepharoplasty, no studies have ever compared the carbon dioxide laser to the Colorado needle.

Nonsurgical Rhinoplasty: Cosmetic Nasal Contouring Through the Use of Fillers

As the demand for noninvasive alternatives to cosmetic procedures continues to increase, the nonsurgical rhinoplasty represents an exciting frontier for both physicians and patients alike. Being one of the most recent additions to the injectable repertoire, the “nonsurgical nose job” offers a quick, minimally invasive, financially feasible option for those seeking aesthetic change. While temporary, this revolutionary method can be used for patients who are not emotionally, medically, or economically prepared for surgery or those who would like a “trial run” prior to an operation. It is also a good option to address some concerns regarding postsurgical rhinoplasty complications. Using a calcium hydroxylapatite gel (Radiesse, Bioform Inc., San Mateo, CA), the provider injects into the subcutaneous tissues or superperiosteal plane after the application of a topical numbing agent. The substance can then be used to mold the nose: heightening or creating a bridge, raising the tip, correcting asymmetries, and disguising bumps, dents, deviations, or other irregularities.