Ivan D. Camacho

American Telemedicine Association's practice guidelines for teledermatology

The ATA assembled a group of experts to develop practice guidelines for teledermatology. This document represents the body of work that this distinguished group assembled. It was approved by the ATA Board of Directors and is presented here in its entirety.

Inflammatory Nodules Following Soft Tissue Filler Use: A Review of Causative Agents, Pathology and Treatment Options

Nodule development is a common complication following the use of fillers for soft tissue augmentation and is commonly categorized as inflammatory or non-inflammatory in nature. Inflammatory nodules may appear anywhere from days to years after treatment, whereas non-inflammatory nodules are typically seen immediately following implantation and are usually secondary to improper placement of the filler. Although inflammatory nodules are more common with permanent fillers such as silicone, inflammatory nodule development following administration of temporary fillers such as hyaluronic acid and collagen has also been reported. Treated many times with corticosteroids due to their anti-inflammatory properties, inflammatory nodules may be secondary to infection or biofilm formation, warranting the use of alternative agents. Appropriate and prompt diagnosis is important in avoiding delay of treatment or long-term complications for the patient. This paper addresses the etiology, development, and studied treatment options available for inflammatory nodules secondary to each of the major classes of fillers. With this knowledge, practitioners may expeditiously recognize and manage this common side effect and thus maximize functional and aesthetic benefit.

Regulation of Vitamin D Production Is Independent of Skin Color

6. What are the conclusions and clinical implications of the study? Vitamin D deficiency causes bone disease (i.e., rickets, osteomalacia, and osteoporosis), and low normal or “insufficient” levels have been associated with a variety of negative health outcomes, including certain types of cancers, neurologic disease, autoimmune disease, and cardiovascular disease (Stechschulte et al., 2009). Improving vitamin D levels has been advocated and supported by various reports, including a meta-analysis of 18 randomized trials on vitamin D, which found that individuals assigned to receive vitamin D had a 7% reduction in mortality from any cause (Autier and Gandini, 2007). Certain groups, including the elderly and those with darker skin, have lower levels of vitamin D in general, and they appear to be at greater risk for outcomes associated with insufficiency (Wolpowitz and Gilchrest, 2006). Some researchers have advocated increasing vitamin D levels through sun exposure. Clearly, a better understanding of the effect of ultraviolet (UV) irradiation on vitamin D levels is needed. Bogh et al. (2010, this issue) studied the effect of systematic broadband UVB exposure on individuals with varying vitamin D levels. After an initial screening of vitamin D levels in 182 individuals, 50 were exposed to UVB radiation. From this group, a subset of 28 non–sun worshippers (those who reported behaviors that result in limited sun exposure) were examined in detail to determine the factors that might affect vitamin D levels following UVB irradiation. Individuals with low baseline vitamin D levels increased their vitamin D levels after UVB irradiation significantly more than did those with higher baseline levels. This increase positively correlated with baseline total cholesterol levels, but it did not correlate with constitutive or facultative pigmentation. Through the following questions, we examine this paper in greater detail. For brief answers, please refer to the supplementary material online <http://www.nature.com/jid/journal/v130/n2/suppinfo/jid2009407s1.html>

Vaccines for Viral Diseases

Vaccination against viral agents has considerably alleviated the burden associated with viral diseases and has saved millions of lives worldwide. Global vaccination eradicated diseases like polio and other vaccines have led to a significant decline in infection rates and related complications of viral diseases. Important criteria for a disease to be susceptible of global elimination are that the disease is specific to humans and that there are no animal reservoirs for the infection.

The Skin as an Endocrine Target

Thyroid disease is common, and it often affects the skin. In fact, autoimmune thyroid diseases (AITDs) such as Graves disease and chronic lymphocytic thyroiditis affect 5% of the population; accordingly, they are the most common organ-specific autoimmune diseases (Stassi and De Maria, 2002; Weetman, 2003; Jacobson and Tomer, 2007). Although cutaneous manifestations of AITD are well described and thyroid hormone is known to regulate the development and function of skin (Leonhardt and Heymann, 2002; Burman and McKinley-Grant, 2006), a better understanding of these processes is needed. Therefore, Cianfarani et al. (2010, this issue) analyzed normal human skin, cultures of keratinocytes and dermal fibroblasts, and serum of patients with AITDs in hopes of elucidating the role of thyroid-specific molecules.