Keyvan Nouri

Photodynamic Therapy for Actinic Cheilitis: A Systematic Review

BACKGROUND Actinic cheilitis (AC) is a premalignant lesion of the lips that can progress to squamous cell carcinoma and metastasize. Actinic cheilitis is difficult to treat because surgical treatments have significant adverse effects whereas less invasive procedures have uncertain efficacy. Photodynamic therapy (PDT) may offer a noninvasive yet effective treatment option for AC. OBJECTIVE To systematically review the safety and efficacy of PDT for AC. METHODS The terms “photodynamic,” “actinic,” “solar,” “cheilitis,” and “cheilosis” were used in combinations to search the PubMed database. Studies were considered for inclusion based on eligibility criteria, and specific data were extracted from all studies. RESULTS The authors identified 15 eligible case series encompassing a total of 242 treated subjects. Among studies that evaluated subjects for complete clinical response, 139 of 223 subjects (62%) showed complete response at final follow-ups ranging from 3 to 30 months. Among studies that evaluated subjects for histological outcome, 57 of 121 subjects (47%) demonstrated histological cure at final follow-ups ranging from 1.5 to 18 months. Cosmetic outcomes were good to excellent in the majority of subjects, and adverse events were well tolerated. CONCLUSION Photodynamic therapy is safe and has the potential to clinically and histologically treat AC, with a need for future randomized controlled trials.

Vascular Features of Nail Psoriasis Using Dynamic Optical Coherence Tomography

Background: Nail psoriasis is a painful and disfiguring nail disease that often leads to invasive biopsies. Dermoscopy of the hyponychium can be useful in the diagnosis showing twisted coiled vessels. Structural features of nail psoriasis have been described with optical coherence tomography (OCT). Objectives: To investigate vascular features of nail psoriasis using dynamic OCT. Methods: This was an observational, prospective, controlled study in which psoriasis patients with psoriatic nail changes and healthy control patients underwent OCT imaging of the distal nail plate and proximal nail fold. Vertical and horizontal OCT images were analyzed to describe structural and vascular features and to quantify blood flow at depth. Results: Sixteen psoriatic nails and 16 control nails were included. Psoriatic nails had significantly increased blood flow in the proximal nail fold at depths of 0.72 mm (p = 0.035) and 0.76 mm (p = 0.027). Nail thickness was significantly greater in psoriatic nails compared to control nails (p = 0.0016). Compared to control nails, psoriatic nails had dilated, disorganized blood vessels superficially in the proximal nail fold. Limitations: The main limitation of our study is the relatively small sample size. Conclusions: OCT can identify structural and vascular features specific to nail psoriasis.

Melanocyte-keratinocyte transplantation for postdiscoid lupus erythematosus depigmentation: Commentary

Discoid lupus erythematosus (DLE) is clinically characterized by well demarcated, erythematous, infiltrated plaques, with associated epidermal atrophy, telangiectasia, with a natural progression into hypo-/hyperpigmentation and scarring. The lesions are frequently distributed on scalp, face, and sun-exposed areas of upper part of the body. A depigmented lesion of discoid lupus is clinically differentiated from vitiligo by the presence of cutaneous atrophy and scarring. The mechanism of this depigmentation is still not known, but may be postinflammatory or cicatricial and may be definitive.

Psychological Impact of Cutaneous Congenital Vascular Lesions

Vascular lesions are abnormalities of vascular elements that appear at birth or in infancy. Cutaneous congenital vascular lesions are the most common pediatric birthmarks and can be divided into two different categories: hemangiomas and vascular malformations. Hemangiomas tend to involute, as the child grows older while other vascular malformations tend to persist. Congenital vascular lesions are found most commonly on the head and neck and can be isolated or part of a congenital syndrome such as Klippel-Trenaunay syndrome, Sturge-Weber syndrome and others. Vascular lesions, especially on exposed sites, can cause significant psychological distress for patients and family members.

L asers in the treatment of acne

Acne is a chronic disease of the pilosebaceous units, presenting as inflammatory or noninflammatory lesions, affecting primarily the face but also the back and chest. The mainstay of treatment remains topical retinoids, benzoyl peroxide, azelaic acid, antibiotics, and isotretinoin, many of which result in poor compliance, lack of durable remission, and incur adverse effects. The use of lasers to treat acne is continuously increasing because of their minimal complications, limited number of office-based treatments required, potential benefits of simultaneously treating acne scarring, and the rapid onset of results. The 1450 nm diode laser, 585- and 595-nm pulsed dye lasers (PDLs), near infrared diode lasers, 1320 nm Nd:YAG laser, 532 nm potassium titanyl phosphate laser, 1064 nm long-pulsed Nd:YAG laser, 1540 nm Erbium (Er):Glass Laser, and the 1550 nm Er:Glass fractional laser are among the most common lasers used to treat acne and acne scarring. These lasers target the underlying causes of acne including the colonization of Priopionibacterium acnes, high levels of sebum production, altered keratinization, inflammation, and bacterial colonization of hair follicles on the face, neck, and back. We review the efficacy and side effect profiles of various lasers used to treat acne.

Keratinocyte carcinoma data for Hispanic patients undergoing Mohs micrographic surgery in Miami, Florida from 2011 to 2014

results, 19% of abnormal Pap smears were found after and 24% were found concurrent with the skin biopsy. In our study, over half of condylomata tested negative for HPV by ISH. When positive, almost 90% showed low-risk HPV serotypes, which supports previous data. There was no correlation between the identification of HPV in condylomata and prior or future Pap smear abnormalities. Patients with skin specimens testing positive for high-risk HPV serotypes did not correlate with risk for cervical dysplasia or other anogenital HPVrelated complications. These findings suggest a lack of utility of tissue HPV testing on condylomata for predicting cervical or anogenital HPV-related complications. Limitations of our study include retrospective study design, relatively short follow-up durations, and few cases of condylomata testing positive for high-risk HPV, which thus limited study power. While validation from larger studies is required, these data may contribute to discussions regarding appropriate-use criteria for HPV ISH testing on genital squamous papillomas.

Modifications of body surface: piercings, tattoos, and scarification

Human bodies are products of both nature and culture, continually being modified and reshaped in response to varying situational contexts. Rebelling against the ideals of beauty and achieving individuality are just some of the motives people have for altering their bodies. With roots dating back thousands of years ago, body piercing, tattooing, and scarification have been both embraced and denounced throughout history. Today, 20% of British adults and up to 38% of Americans sport a type of long-term body adornment. Herein, we delve into the progression of these three practices throughout history to better understand their recent explosion in popularity and presence in almost every society today.