Lawrence Green

Controlled, Randomized Study of Pain Levels in Subjects Treated with Calcium Hydroxylapatite Premixed with Lidocaine for Correction of Nasolabial Folds

BACKGROUND Calcium hydroxylapatite (CaHA) has been administered after nerve block injection of anesthetic agents. OBJECTIVES This prospective, randomized, split‐face, single‐blind study (50 subjects) assessed the pain reduction, safety, and effectiveness of premixing CaHA with 2% lidocaine for the treatment of nasolabial folds (NLFs). METHODS AND MATERIALS Subjects were randomized to receive treatment with CaHA alone in one NLF (control) and with CaHA premixed with lidocaine in the other NLF (treatment). Subjects completed pain assessments using a validated visual analog scale at specified time points immediately after injection, 1 hour after injection, and 1 month later. Subjects also indicated relative pain experience and preference assessments. Investigators completed aesthetic assessments at 2 weeks and 1 month. Subjects and investigators recorded adverse events. RESULTS Subjects reported statistically significantly less pain in the treatment fold than in the control fold and expressed unanimous preference for the treatment injection over the control. Aesthetic results were essentially equivalent for both treatments. CONCLUSION Investigators concluded that CaHA premixed with lidocaine results in significant pain reduction during dermal filler injection while maintaining the aesthetic improvement of CaHA without lidocaine and demonstrating comparable local transient adverse events for treatment and control. BioForm Medical (San Mateo, CA) provided the soft tissue filler, lidocaine, and other necessary supplies used in this study. All authors are members of the Bioform Medical Education Faculty.

Who do you prefer? A study of public preferences for health care provider type in performing cutaneous surgery and cosmetic procedures in the United States

BACKGROUND The public preference for provider type in performing cutaneous surgery and cosmetic procedures is unknown in the United States. METHODS An internet-based survey was administered to the lay public. Respondents were asked to select the health care provider (dermatologist, plastic surgeon, primary care physician, general surgeon, and nurse practitioner/physicians assistant) they mostly prefer to perform different cutaneous cosmetic and surgical procedures. RESULTS Three hundred fifty-four respondents undertook the survey. Dermatologists were identified as the most preferable health care provider to evaluate and biopsy worrisome lesions on the face (69.8%), perform skin cancer surgery on the back (73.4%), perform skin cancer surgery on the face (62.7%), and perform laser procedures (56.3%) by most of the respondents. For filler injections, the responders similarly identified plastic surgeons and dermatologists (47.3% vs 44.6%, respectively) as the most preferred health care provider. For botulinum toxin injections, there was a slight preference for plastic surgeons followed by dermatologists (50.6% vs 38.4%). Plastic surgeons were the preferred health care provider for procedures such as liposuction (74.4%) and face-lift surgery (96.1%) by most of the respondents. CONCLUSION Dermatologists are recognized as the preferred health care providers over plastic surgeons, primary care physicians, general surgeons, and nurse practitioners/physicians assistants to perform a variety of cutaneous cosmetic and surgical procedures including skin cancer surgery, on the face and body, and laser procedures. The general public expressed similar preferences for dermatologists and plastic surgeons regarding filler injections.

Perceptions of Expertise in Cutaneous Surgery and Cosmetic Procedures: What Primary Care Physicians Think

BACKGROUND Primary care physician (PCP) perceptions regarding expertise in cutaneous surgery and cosmetic procedures are unknown. METHODS An internet‐based survey was administered to physicians in primary care medicine residency programs in the United States. Respondents were asked to select the specialist most qualified to perform different cutaneous cosmetic and surgical procedures. RESULTS Five hundred sixty‐one PCPs undertook the survey. Dermatologists were identified as the most qualified specialist to evaluate and biopsy worrisome lesions on the face (95%), perform skin cancer surgery (56%), inject botulinum toxin (61%), inject fillers (55%), and perform laser procedures (75%). Seventy percent of respondents correctly defined Mohs micrographic surgery (MMS), and 60% of respondents selected a fellowship‐trained dermatologist as the best physician to perform MMS. U.S. medical school graduates were more likely than foreign medical school graduates to select a Mohs fellowship–trained dermatologist as the most qualified physician to perform MMS (adjusted odds ratio (AOR) = 1.52, 95% confidence interval (CI) = 1.05–2.21). PCPs without exposure to dermatology in medical school were about half as likely those with exposure to correctly define MMS (AOR = 0.51, 95% CI = 0.30–0.89). CONCLUSIONS Dermatologists are recognized as the most qualified specialist to perform a variety of cutaneous cosmetic and surgical procedures, including skin cancer surgery, botulinum toxin injections, filler injections, and laser procedures. Mohs fellowship–trained dermatologists were viewed as more qualified to perform MMS than other dermatologists, plastic surgeons, otolaryngologists, or ophthalmologists.

Dietary Recommendations for Adults With Psoriasis or Psoriatic Arthritis From the Medical Board of the National Psoriasis Foundation: A Systematic Review

Importance Psoriasis is a chronic, inflammatory skin disease and has significant associated morbidity and effect on quality of life. It is important to determine whether dietary interventions help reduce disease severity in patients with psoriatic diseases. Objective To make evidence-based dietary recommendations for adults with psoriasis and/or psoriatic arthritis from the Medical Board of the National Psoriasis Foundation. Evidence Review We used literature from prior systematic reviews as well as additional primary literature from the MEDLINE database from January 1, 2014, to August 31, 2017, that evaluated the impact of diet on psoriasis. We included observational and interventional studies of patients with psoriasis or psoriatic arthritis. The quality of included studies was assessed using the Newcastle-Ottawa scale for observational studies and the Cochrane Risk of Bias Tool for interventional studies. We made evidence-based dietary recommendations, which were voted on by the National Psoriasis Foundation Medical Board. Findings We identified 55 studies meeting the inclusion criteria for this review. These studies represent 77 557 unique participants of which 4534 have psoriasis. Based on the literature, we strongly recommend dietary weight reduction with a hypocaloric diet in overweight and obese patients with psoriasis. We weakly recommend a gluten-free diet only in patients who test positive for serologic markers of gluten sensitivity. Based on low-quality data, select foods, nutrients, and dietary patterns may affect psoriasis. For patients with psoriatic arthritis, we weakly recommend vitamin D supplementation and dietary weight reduction with a hypocaloric diet in overweight and obese patients. Dietary interventions should always be used in conjunction with standard medical therapies for psoriasis and psoriatic arthritis. Conclusions and Relevance Adults with psoriasis and/or psoriatic arthritis can supplement their standard medical therapies with dietary interventions to reduce disease severity. These dietary recommendations from the National Psoriasis Foundation Medical Board will help guide clinicians regarding the utility of dietary interventions in adults with psoriatic diseases.

Secukinumab Improves Scalp Pain, Itching, Scaling, and Quality of Life in Patients With Moderate-to-Severe Scalp Psoriasis.

Abstract Introduction: Scalp psoriasis adversely affects patients’ lives and is often resistant to treatment; however, it has not been a major focus of a clinical study. This analysis assessed the effect of secukinumab on patient-reported outcomes (PRO) of scalp psoriasis. Methods: A randomized, double-blind, placebo-controlled, multicenter study was conducted in 102 adult patients with moderate-to-severe scalp psoriasis. Patients were randomized 1:1 to secukinumab 300 mg or placebo. Patients rated their scalp-related pain, itching and scaling using a 0–10 numeric rating scale (higher scores indicate greater severity). Scalp dermatitis-related quality of life (QOL) was assessed at baseline and then every 4 weeks using the Scalpdex. Analysis of covariance models examined PRO effect up to 12 weeks. Results: Baseline scalp pain, itching and scaling mean (SD) values were 3.1 (3.00), 6.7 (2.60) and 7.3 (2.02) and similar for both treatment groups. At week 12, patients treated with secukinumab reported greater reduction in scalp pain (−1.98 vs. 0.61), itching (−4.07 vs. −0.04) and scaling (−5.76 vs. −0.95) as well as greater improvements in Scalpdex total scores (−39.62 vs. −7.91) compared with placebo (all p < .001). Discussion/Conclusions: Secukinumab in moderate-to-severe scalp psoriasis reduces scalp pain, itching, and scaling and improves patients’ QOL.

Topical glycopyrronium tosylate for the treatment of primary axillary hyperhidrosis: Results from the ATMOS-1 and ATMOS-2 phase 3 randomized controlled trials

Background: Glycopyrronium tosylate (GT) is a topical anticholinergic developed for once‐daily treatment of primary axillary hyperhidrosis. Objective: Assess the efficacy and safety of GT for primary axillary hyperhidrosis. Methods: ATMOS‐1 and ATMOS‐2 were replicate randomized, double‐blind, vehicle‐controlled, 4‐week phase 3 trials. Patients were randomized 2:1 to GT 3.75% or vehicle applied once daily to each axilla for 4 weeks. Coprimary endpoints were responder rate (≥4‐point improvement from baseline) on item 2 (severity of sweating) of the Axillary Sweating Daily Diary (ASDD), which is a newly developed patient‐reported outcome measure, and absolute change from baseline in axillary gravimetric sweat production at week 4. Safety evaluation included treatment‐emergent adverse events. Results: Pooled data, which are consistent with the individual trial results, show that significantly more GT‐treated patients achieved an ASDD‐Item 2 response than did those treated with vehicle (59.5% vs 27.6%), and they had reduced sweat production from baseline (–107.6 mg/5 min vs –92.1 mg/5 min) at week 4 (P < .001 for both coprimary end points). Most treatment‐emergent adverse events were mild or moderate and infrequently led to discontinuation. Limitations: Short trial duration and inherent challenges in gravimetrically assessing sweat production. Conclusions: GT applied topically on a daily basis over 4 weeks reduced the severity of sweating as measured by ASDD‐Item 2, reduced sweat production as measured gravimetrically, and was generally well tolerated in patients with primary axillary hyperhidrosis.

Commentary on Applications of the Excimer Laser: A Review.

A coherent monochromatic ultraviolet B light, the excimer 308 nm laser, is now an established technology that has evolved over the last decade to show efficacy to treat muchmore than its original indication of psoriasis. It is also one of those rare lasers that treats skin conditions that are not necessarily cosmetic, and as such has its own set of Medicare established procedure codes (96920–96922) for insurance billing. In this issue of dermatologic surgery, Beggs and colleagues have provided a much needed updated review of the 308 nm excimer laser and the myriad of skin diseases it has been reported to help. In addition, a review of treatment protocols for the most well established and studied uses for the excimer laser (psoriasis and vitiligo) is provided.