Darius J. Karimipour

Mucinous carcinoma of the skin

Primary mucinous carcinoma of the skin is a rare adnexal neoplasm with sweat gland differentiation. We describe a case of primary mucinous carcinoma of the skin and characterize its clinical and histologic features. Mucinous carcinoma can occur in noncutaneous visceral sites and may metastasize to the skin. Thus it is important to exclude the possibility of a noncutaneous visceral primary tumor before diagnosing primary mucinous carcinoma of the skin.

Microdermabrasion: an evidence-based review.

Summary: Microdermabrasion is a popular technique used in the treatment of several skin problems, including acne, acne scarring, striae distensae, and photoaging. This article will review the relevant literature and use an evidence-based approach to evaluate the clinical efficacy of microdermabrasion in skin care. In summary, microdermabrasion appears to be a procedure that can produce changes in dermal matrix constituents and result in improvement in skin contour irregularities. It may also be beneficial in improving transepidermal delivery of certain medications. Its role in the treatment of dyschromias and acne vulgaris is limited.

Molecular Analysis of Aggressive Microdermabrasion in Photoaged Skin

OBJECTIVE To investigate dermal remodeling effects of crystal-free microdermabrasion on photodamaged skin. DESIGN Biochemical analyses of human skin biopsy specimens following microdermabrasion treatment in vivo. SETTING Academic referral center. PARTICIPANTS Volunteer sample of 40 adults, aged 50 to 83 years, with clinically photodamaged forearms. Intervention Focal microdermabrasion treatment with diamond-studded handpieces of varying abrasiveness on photodamaged forearms and serial biopsies at baseline and various times after treatment. MAIN OUTCOME MEASURES Quantitative polymerase chain reaction, immunohistochemistry, and enzyme-linked immunosorbent assay were used to quantify changes in inflammatory, proliferative, and remodeling effectors of normal wound healing. Type I and type III procollagen served as the main outcome marker of dermal remodeling. RESULTS Coarse-grit microdermabrasion induces a wound healing response characterized by rapid increase in induction of cytokeratin 16 and activation of the AP-1 transcription factor in the epidermis. Early inflammation was demonstrated by induction of inflammatory cytokines, antimicrobial peptides, and neutrophil infiltration in the dermis. AP-1 activation was followed by matrix metalloproteinase-mediated degradation of extracellular matrix. Consistent with this wound-healing response, we observed significant remodeling of the dermal component of the skin, highlighted by induction of type I and type III procollagen and by induction of collagen production enhancers heat shock protein 47 and prolyl 4-hydroxylase. Dermal remodeling was not achieved when microdermabrasion was performed using a medium-grit handpiece. CONCLUSIONS Microdermabrasion using a coarse diamond-studded handpiece induces a dermal remodeling cascade similar to that seen in incisional wound healing. Optimization of these molecular effects is likely the result of more aggressive treatment with a more abrasive handpiece.

Topical fluorouracil for actinic keratoses and photoaging: a clinical and molecular analysis.

OBJECTIVE To examine clinical and molecular changes after topical fluorouracil treatment of photodamaged human facial skin for actinic keratoses. DESIGN Nonrandomized, open-label 2-week treatment with fluorouracil cream, 5%, followed by clinical and molecular evaluation. SETTING Academic referral center. PATIENTS Twenty-one healthy volunteers, 56 to 85 years old, with actinic keratoses and photodamage. Interventions Twice-daily application of fluorouracil cream for 2 weeks and biopsies and clinical evaluation at baseline and periodically after treatment. MAIN OUTCOME MEASURES Gene and protein expression of molecular effectors of epidermal injury, inflammation, and extracellular matrix remodeling 24 hours after fluorouracil treatment; clinical improvement measured by evaluators, photography, and patient questionnaires. RESULTS One day after the final fluorouracil treatment, gene expression of the effectors of epidermal injury (keratin 16), inflammation (interleukin 1beta), and extracellular matrix degradation (matrix metalloproteinases 1 and 3) was significantly increased. Types I and III procollagen messenger RNA were induced at week 4 (7-fold and 3-fold, respectively). Type I procollagen protein levels were increased 2-fold at week 24. Actinic keratoses and photoaging were statistically significantly improved. Most patients rated photoaging as improved and were willing to undergo the therapy again. CONCLUSIONS Topical fluorouracil causes epidermal injury, which stimulates wound healing and dermal remodeling resulting in improved appearance. The mechanism of topical fluorouracil in photoaged skin follows a predictable wound healing pattern of events reminiscent of that seen with laser treatment of photoaging.

Lafora disease: Diagnosis by skin biopsy

Lafora disease is a fatal neurometabolic disorder characterized by progressive myoclonic epilepsy. Diagnosis relies upon the discovery of specific inclusion bodies in any of several organs. Dermatologists and dermatopathologists should be familiar with this condition because axillary skin biopsy is useful to diagnose this disorder. We present a case of Lafora disease diagnosed by axillary skin biopsy and review the conditions clinical, histologic, and ultrastructural features.

Nonlaser Superficial Resurfacing Techniques: Superficial Chemical Peels and Microdermabrasion

Superficial skin resurfacing is the application of various modalities to the skin with the goal of achieving a partial thickness skin injury that penetrates no deeper than the superficial papillary dermis. The approaches to superficial skin resurfacing may be classified into laser based and nonlaser techniques. Some of the most commonly used nonlaser, superficial resurfacing techniques include superficial chemical peels and microdermabrasion (MDA). Indications for superficial resurfacing include photoaging, fine rhytides, ichthyosis, acne vulgaris, melasma, solar lentigenes, and postinflammatory hyperpigmentation. Objective gains from superficial resurfacing are often modest, but these techniques continue to remain extremely popular with patients because of rapid healing (“minimal downtime”), low cost, and minimal risk. Typically, no anesthesia is required. Superficial resurfacing may also be combined with laser modalities. Superficial resurfacing techniques may be used on all Fitzpatrick skin types. These techniques yield the best results when used as a series of treatments combined with diligent use of a home topical regimen and daily photoprotection. As with any esthetic surgical procedure, careful patient selection, thorough patient education, and a mutual understanding of realistic outcomes will lead to the most satisfactory results.