Eric L. Maranda

Low-level laser therapy as a treatment for androgenetic alopecia.

Androgenetic alopecia (AGA) affects 50% of males by age 50 and 50% of females by age 80. Recently, the use of low‐level laser therapy (LLLT) has been proposed as a treatment for hair loss and to stimulate hair regrowth in AGA. This paper aims to review the existing research studies to determine whether LLLT is an effective therapy for AGA based on objective measurements and patient satisfaction.

Role of Mesenchymal Stem Cells in Dermal Repair in Burns and Diabetic Wounds

In this review we explore stem cell function in wounds that are resistant to healing, such as burn injuries and diabetic wounds. Diabetic ulcers are of interest due to their remarkable resistance to heal; severe thermal burns are addressed due to critical need for effective therapies for the prevention shock and improvement in scarring. Cell-based therapy utilizing mesenchymal stem cells (MSCs), also known as mesenchymal stromal cells, are currently being investigated as a therapeutic avenue for both chronic diabetic ulcers and severe thermal burns. The clinical utility of stem cells, in particular MSCs, in caring for these types of injuries is primarily based on repairing and replacing cellular substrates, attenuation of inflammation, increasing angiogenesis, and enhancing migration of reparative cells. MSCs are sought after due to their unique ability to initiate different wound-healing programs, depending on the environmental milieu. Thus, this review aims to highlight the properties of MSCs, including their characterization, immunogenicity, and function in the context of dermal repair and regeneration in severe burns and diabetic wounds. Additionally, relevant clinical and pre-clinical studies illustrating the impact of allogeneic and autologous sources of MSCs on therapeutic efficacy are reviewed. Insight into the properties of MSCs and the dramatic host-to-MSC interactions within these pathological states may lead to the development of effective strategies for improving outcomes in impaired wounds.

Low birth weight is associated with impaired murine kidney development and function

BackgroundLow birth weight (LBW) neonates have impaired kidney development that leaves them susceptible to kidney disease and hypertension during adulthood. The study here identifies events that blunt nephrogenesis and kidney development in the murine LBW neonate.MethodsWe examined survival, kidney development, GFR, gene expression, and cyto-/chemokines in the LBW offspring of malnourished (caloric and protein-restricted) pregnant mice.ResultsMalnourished pregnant mothers gave birth to LBW neonates that had 40% reduced body weight and 54% decreased survival. Renal blood perfusion was reduced by 37%, whereas kidney volume and GFR were diminished in the LBW neonate. During gestation, the LBW neonatal kidney had 2.2-fold increased apoptosis, 76% decreased SIX2+ progenitor cells, downregulation of mesenchymal-to-epithelial signaling factors Wnt9b and Fgf8, 64% less renal vesicle formation, and 32% fewer nephrons than controls. At birth, increased plasma levels of IL-1β, IL-6, IL-12(p70), and granulocyte-macrophage colony-stimulating factor in the LBW neonate reduced SIX2+ progenitor cells.ConclusionIncreased pro-inflammatory cytokines in the LBW neonate decrease SIX2+ stem cells in the developing kidney. Reduced renal stem cells (along with the decreased mesenchymal-to-epithelial signaling) blunt renal vesicle generation, nephron formation, and kidney development. Subsequently, the mouse LBW neonate has reduced glomeruli volume, renal perfusion, and GFR.

Treatment of Acne Keloidalis Nuchae: A Systematic Review of the Literature

Acne keloidalis nuchae (AKN) is a chronic inflammatory condition that leads to fibrotic plaques, papules and alopecia on the occiput and/or nape of the neck. Traditional medical management focuses on prevention, utilization of oral and topical antibiotics, and intralesional steroids in order to decrease inflammation and secondary infections. Unfortunately, therapy may require months of treatment to achieve incomplete results and recurrences are common. Surgical approach to treatment of lesions is invasive, may require general anesthesia and requires more time to recover. Light and laser therapies offer an alternative treatment for AKN. The present study systematically reviews the currently available literature on the treatment of AKN. While all modalities are discussed, light and laser therapy is emphasized due to its relatively unknown role in clinical management of AKN. The most studied modalities in the literature were the 1064-nm neodymium-doped yttrium aluminum garnet laser, 810-nm diode laser, and CO2 laser, which allow for 82–95% improvement in 1–5 sessions. Moreover, side effects were minimal with transient erythema and mild burning being the most common. Overall, further larger-scale randomized head to head control trials are needed to determine optimal treatments.

Laser and light therapies for the treatment of nail psoriasis.

Psoriatic involvement of the nail is notoriously refractory to conventional therapy. Nail psoriasis has a high incidence amongst patients with psoriasis. It remains a significant cosmetic problem and thus, has a significant impact on quality of life. More recently, light and laser therapies have emerged as modalities for treatment of nail psoriasis. In this study, the efficacies of light and laser therapies are systematically reviewed. Light therapies involve ultraviolet light (with or without photosensitizers) or intense pulsed light. Alternatively, laser therapy in nail psoriasis is primarily administered using a 595‐nm pulsed dye laser. These modalities have demonstrated significant improvement in psoriatic nail lesions, and even complete resolution in some cases. Both laser and light modalities have also been tested in combination with other systemic or topical therapeutics, with variable improvement in efficacy. Both laser and light therapies are generally well tolerated. Side‐effects of light therapies include hyperpigmentation, itching and erythema; whereas, side‐effects of laser therapy are more frequent and include pain, purpura/petechiae and hyperpigmentation. Patterns of response to therapy were also seen based on presenting characteristics of the nail lesions: subungual hyperkeratosis and onycholysis appeared to be the most responsive to therapy, while nail pitting was the most resistant. Light or laser therapies have the potential to be an efficient and cost‐effective in‐office based treatment for nail psoriasis. However, more large‐scale clinical trials are needed to assess their efficacy, particularly in combination with other therapeutic modalities.

Laser and light therapy for facial warts: a systematic review

Facial verruca plana, or flat warts, are benign skin papillomas caused by human papillomavirus infections. A large portion of cases are refractory to treatment and can cause psychosocial distress in patients. Laser and light modalities offer an alternative therapeutic approach that has not been extensively explored. We systematically reviewed PubMed for studies describing treatment of facial verruca plana using lasers, photodynamic therapy and infrared coagulation. Final inclusion and review of eighteen studies suggests laser and light therapies to have considerable potential in the treatment of this recalcitrant condition. In particular, yttrium aluminium garnet lasers, infrared coagulation and photodynamic therapies have been reported to demonstrate efficacy. Further studies with larger power are required to determine which method should be established as the alternative treatment of choice for recalcitrant facial verrucae.

Cryotherapy—As Ancient as the Pharaohs

In cryotherapy, also known as cryosurgery, cold temperatures are used to treat a wide variety of skin disease in modern dermatology. However, cryotherapy has its humble roots as far back as the Egyptians in 3000 BCE, when cold compresses were used to treat the inflammation of infected wounds. In the fifth century BCE, Hannibal’s Carthaginian mercenaries experienced the hemostatic and destructive tissue effects of the cold while crossing the Alps en route to Rome. In the Napoleonic times, cooling was used for anesthesia and amputation. It was not until the mid-1800s when modern use of cryotherapy was born. James Arnott, deemed the “father of modern cryosurgery,” was the first to use salted solutions with crushed ice to freeze cancers of the breast and cervix. The temperatures reached −18°C to −24°C, which was enough to freeze the tumors and lead to a reduction in size of the lesions and improved pain management. Eventually, Arnott used his cryosurgical device on acne and neuralgia. However, the device did not get cold enough for complete tissue destruction. It was not until after the industrial revolution when temperatures of −190°C could be reached to produce and harness liquid air, marking the beginning of the dermatologic cryosurgery era. New York physician Campbell White successfully used this to treat a myriad of skin diseases, from nevi, warts, varicose leg ulcers, and chancroids to herpes zoster and epitheliomas. While this approach was still unachievable at most institutions, solid carbon dioxide became the mainstay of treatment because the temperatures required were half that of liquid air. However, the method was limited to treating superficial skin conditions less than 1 to 2 mm deep. The post–World War II era further expanded the field by making liquid nitrogen readily available. To fix the problem of inadequate penetration of tissue freezing with available techniques, solid copper discs cooled by submersion in liquid nitrogen became widespread practice. In the mid-20th century, the dermatologists and innovators Douglas Torre and Setrag Zacarian created the first handheld cryosurgery device and brought the first commercial device to market. These pioneers, along with a handful of others, established the field of dermatologic cryosurgery as it is known today. From the early observations of the Egyptians and Greeks to the practice of cryotherapy using the handheld devices today, the field of cryosurgery has come a long way. The techniques are sound and have been effective in treating a wide array of benign, premalignant, and cancerous lesions. Thus, the ancient technique of cryotherapy will continue to play a role in the modern field of dermatology for years to come.

Henna—A Temporary Body of Art

Amidst joyous chatter, choreographed dances, and the aromas of South Asian food, a bride is joined by close friends in her childhood home as she delights in a once-in-a-lifetime celebration. As part of the festivities, a red-brown paste is expertly applied to her arms, hands, legs, and feet in intricate designs of leaves, flowers, and geometric shapes. This paste, otherwise known as henna, is an integral part of this timeless Mehndi ceremony. Derived from the plant Lawsonia inermis, temporary henna tattoo paste (or mehndi) is a mixture of the plant’s extracts with water or oil. Decorative patterns are skillfully drawn onto the skin with a brush or thin stick and allowed to dry. A dressing can be applied to improve penetration of the paste into the stratum corneum. Over the course of a few weeks, as corneocytes gradually shed, the tattoos will fade. The practice of henna has a celebrated history dating back over 5000 years to South Asia, the Middle East, and Africa. Largely associated with the feminine form, use of henna by brides dates back to 2100 BC in Syria, and ancient spiritual rituals dedicated to goddesses often included henna tattoos. Owing to its unique pigment, henna can also provide relief from the heat when applied to the hands, feet, and scalp. In the past, henna even played a role in the treatments of leprosy and smallpox. Contemporary decorative henna maintains a strong association with traditional celebrations, and its designs often vary with geographic region or culture. In India, fine lines of lacy, floral, paisley patterns are used, while African henna displays bold lines and geometric designs. Recent popularization of henna in Western culture has been sparked by tourists and even popular musicians like the Spice Girls. The red paste traditionally used, known as “red henna,” rarely produces adverse effects. However, recent reports of allergic reactions have been attributed to the use of new additives such as coffee, black tea, and even animal urine, which help achieve a darker pigment known as “black henna.” The primary culprit in the recent rise of skin reactions is the ingredient paraphenylenediamine (PPD), a coal-tar hair dye. In addition to achieving a darker and longer-lasting color, PPD helps shorten the duration of the tattooing process. While traditional henna sessions can last up to 12 hours, black henna reduces the time to less than 2 hours. Use of black henna may be tempting, but its potential for allergic contact dermatitis, severe delayed-type reactions, and more permanent effects, such as persistent leukoderma or hyperpigmentation, is cause for concern. Perhaps it is best to respect the traditional practice of red henna, lest a temporary tattoo result in a permanent scar.

Clinical Features and Treatment of Penile Schwannoma: A Systematic Review

Schwannomas, although common in the head and limbs, are an exceedingly rare tumor of the penis. We conducted a systematic review to include 33 patients with schwannoma of the penile shaft or glans penis. Most patients presented with a single painless nodule on the dorsal aspect of the penile shaft. These nodules were slow growing, with an average of 62 months from the onset to presentation. Several cases were accompanied by sexual dysfunction. Most histologic studies were consistent, with a benign schwannoma that showed a palisading Antoni A and Antoni B pattern without malignant changes in cell morphology. Of the 14 studies in which a history of genetic disease was investigated, only 2 reported a connection to neurofibromatosis. These tumors were treated with surgical excision, and 4 malignant cases received additional chemotherapy or radiotherapy. All the patients had achieved full remission by the final follow-up examination. Given the rarity of this tumor, the present review of available case studies serves to comprehensively describe the clinical presentation and treatment approaches to penile schwannoma.

A case of eosinophilic fasciitis associated with pyoderma gangrenosum

a macular lesion located on the right breast. She has been operated for atrial septal defect at the age of 16 by amplatzer septal occluder. Her parents had noticed during the postnatal period an erythematous patchy lesion located at the lateral part of the right breast. An echo Doppler investigation of the red plaque during the first year of life revealed fast-flow arterial vascularization compatible with IH. The parents reported that the lesion had grown for a few months and then spontaneously involuted within a few years. On examination, she had a 4 x 2.5 cm hypopigmented wellcircumscribed patch with a few telangiectasias (Fig. 1). She had right breast hypoplasia compared to contralateral breast (Fig. 2). Physical examination revealed no other abnormalities. We report a case of breast hypoplasia following a small IH on the ipsilateral breast. Only one case of a mixed IH of the breast that resulted in pronounced hypoplasia breast has been reported. As IH is sometimes associated with malformations, we here debate this link. We raise the question of an analogy between some IH and some developmental defects such as Becker’s naevus syndrome. Although Becker’s naevus generally occurs as an isolated finding, several ipsilateral developmental abnormalities have been described, particularly breast hypoplasia. The term Becker’s naevus syndrome has been proposed to describe the association of a Becker’s naevus with ipsilateral non-cutaneous abnormalities. Poland syndrome is a unilateral defect of pectoral muscle and ipsilateral syndactyly, with absence or hypoplasia of the breast and nipple, axillary hair loss and dermatoglyphic abnormalities. The association of congenital haemangioma with Poland syndrome has also been reported. Our case is the second case of breast hypoplasia and IH reported; this could be a syndromic IH with breast malformation. Conversely, Theiler et al. believe that deep IH might interfere with normal breast gland development, even postnatally. Here, considering the small size of IH, we do not think that this could be a complication due to a deep IH of the breast bud. Correction of atrial septal defects can be associated with the potential to affect unilateral breast development after a right anterolateral thoracotomy, which was not the case here. Theiler et al. recommend to consider this potential complication in female infants with mixed or deep IH involving the breast and advocate consideration of systemic therapy to prevent this outcome. As for Becker’s naevus syndrome, we raise the question of a link between IH and secondary breast hypoplasia. We thus invite dermatologists and paediatricians to report such cases, in order to ascertain a potential relationship. If breast hypoplasia results from involvement of the underlying breast bud, treatment with oral propranolol could possibly prevent mammary hypoplasia. No funding source supported the work.