Marina Perper

Tranexamic Acid in the Treatment of Melasma: A Review of the Literature

Melasma is a common acquired pigmentary disorder marked by irregular hyperpigmented macules or patches and most commonly occurs in women of darker skin color. It is a chronic often-relapsing condition that causes negative psychosocial effects in those affected. Current treatments such as hydroquinone, kojic acid, and retinoids, among others, demonstrate variable efficacy and side-effect profiles. We conducted a comprehensive literature review examining the use of tranexamic acid (TA), a well-known anti-fibrinolytic agent, in the treatment of melasma. TA delivered orally, topically, and through physical methods works via the inhibition of ultraviolet (UV)-induced plasmin activity in keratinocytes. Predefined search terms were entered into PubMed. Articles were then independently screened by two authors to include only those written in the English language and relating to human subjects with at least mild melasma. The search identified 28 articles, 15 of which met the criteria for full review. The review revealed that TA treatment for melasma is equally effective or more effective than other standard therapies and may induce fewer side effects. Our comprehensive review suggests that TA may be a promising treatment option for melasma because of its demonstrated effectiveness alone and in combination with other modalities as well as its limited side-effect profile.

Effectiveness of Platelet-Rich Plasma for Androgenetic Alopecia: A Review of the Literature

Androgenetic alopecia (AGA) is a hair loss disorder affecting 80% of men and 50% of women throughout their lifetime. Therapies for AGA are limited and there is no cure. There is a high demand for hair restoration. Platelet-rich plasma (PRP), a treatment modality shown to promote wound healing, has also been explored as a treatment for AGA. This literature review was conducted to assess the effectiveness of PRP treatment for AGA. Twelve studies conducted from 2011 to 2017 were evaluated and summarized by study characteristics, mode of preparation, and treatment protocols. A total of 295 subjects were given PRP or control treatment in these studies, and evaluated for terminal hair density, hair quality, anagen/telogen hair ratio, keratinocyte proliferation, blood vessel density, etc. Some studies also provided subject self-assessment reports. Most of the studies reviewed showed effectiveness of PRP in increasing terminal hair density/diameter. Additional investigations are needed to determine the optimal treatment regimen for high efficacy of PRP in AGA.

Laser treatment of primary axillary hyperhidrosis: a review of the literature

Hyperhidrosis o`ccurs when the body produces sweat beyond what is essential to maintain thermal homeostasis. The condition tends to occur in areas marked by high-eccrine density such as the axillae, palms, and soles and less commonly in the craniofacial area. The current standard of care is topical aluminum chloride hexahydrate antiperspirant (10–20%), but other treatments such as anticholinergics, clonidine, propranolol, antiadrenergics, injections with attenuated botulinum toxin, microwave technology, and surgery have been therapeutically implicated as well. Yet, many of these treatments have limited efficacy, systemic side effects, and may be linked with significant surgical morbidity, creating need for the development of new and effective therapies for controlling excessive sweating. In this literature review, we examined the use of lasers, particularly the Neodynium:Yttrium-Aluminum-Garnet (Nd:YAG) and diode lasers, in treating hyperhidrosis. Due to its demonstrated effectiveness and limited side effect profile, our review suggests that Nd:YAG laser may be a promising treatment modality for hyperhidrosis. Nevertheless, additional large, randomized controlled trials are necessary to confirm the safety and efficacy of this treatment option.

Update on sunscreens distributed by major US retailers that meet American Academy of Dermatology recommendations

(n 1⁄4 237), and chloroquine in 62.2% (n 1⁄4 61). Patients on these medications are not mutually exclusive; most patients were taking either hydroxychloroquine or chloroquine in combination with quinacrine. Quinacrine was discontinued more often than other antimalarials because of the cost and barriers to its access (quinacrine 23.4%, n 1⁄4 33; hydroxychloroquine 4.6%, n 1⁄4 11; chloroquine 16.4%, n 1⁄4 10) rather than because of the side effects (quinacrine 30.5%, n 1⁄4 43; hydroxychloroquine 42.6%, n 1⁄4 101; chloroquine 49.2%, n 1⁄4 30) (Table II). Following side effects, quinacrine was restarted in 27.7% (n 1⁄4 13), hydroxychloroquine in 25.7% (n 1⁄4 26), and chloroquine in 16.7% (n 1⁄4 5). There were 2 instances of mild transaminitis and 3 of slight hematologic disturbances not clearly attributable to quinacrine. In prior reports of World War II soldiers, 1/500,000 patients experienced aplastic anemia at dosages exceeding 100 mg/day. Quinacrine safety is thus supported by evidence from this large cohort. Our study is limited by its retrospective methodology. It is crucial to continue to examine the repercussions of the loss of quinacrine availability considering the lack of suitable alternatives.

Airborne contact dermatitis caused by fragrance diffusers in Uber cars

A 45-year-old Uber driver with severe contact dermatitis of the face and prominent eyelid involvement reported that dermatitis flared during his work days. Patch tests were positive for Myroxylon pereirae (balsam of Peru) and fragrance mix I. After discussing possible sources of his fragrance exposure, he mentioned the use of a fragrance diffuser to improve the smell of his car. His dermatitis dramatically improved after removal of the diffuser. Following this, 4 more cases of ABCD caused by fragrances were identified in Uber clients (3 females and 1 male), who experienced periodical flares of their skin lesions in association with time spent in Uber cars containing fragrance diffusers. Patch tests were positive for fragrance mix I in 1 case, and for fragrance mix I and M. pereirae in the remaining 3 cases.

Optical coherence tomography image processing for in vivo 3-dimensional visualization of basal cell carcinoma

The use of optical coherence tomography (OCT) imaging of basal cell carcinoma (BCC) has been widely studied leading to the description of multiple defining features with the conclusion that this imaging modality may assist in diagnosing, subtyping, and managing BCCs. Features described include lobular structures, epidermal projections, stretching effect of dermis, increased vasculature, and 1 study specifically describes a hyporeflective central region that correlates histologically with central tumor necrosis suggesting a rapid growth.1,2 Considering the many studies describing these features, there remains a disconnect with clinical applicability.3 One study concluded that using OCT significantly improved diagnostic specificity for BCC when compared to clinical and dermoscopic assessment.4 Furthermore, the development of computer diagnostic classification of BCCs has been attempted using machine learning of multiple user measured parameters of several OCT images.5 Although a step toward improved clinical application of OCT for BCC diagnosis, there is still a gap between using OCT for research and clinical decisionmaking purposes. This study investigates a new approach for analysis of OCT images of BCC.

In vitro determination of Mexican Mestizo hair shaft diameter using optical coherence tomography

Mexican mestizo population has a pluriethnic mixture of Amerindian, European and African ancestry, predominant in most Latin American countries. Until now, there are no reports about hair characteristics in this population, necessary to define normal values, for hair diseases evaluation and comparison among other ethnic groups.

Multifocal congenital pyogenic granuloma successfully treated with oral propranolol

Disseminated congenital pyogenic granuloma (DCPG) is an uncommon condition. Individual lesions of DCPG share clinical and histologic similarities with infantile hemangioma (IH); endothelial glucose transporter 1 (GLUT‐1), which is highly expressed in IH but generally not in pyogenic granulomas (PG), is an important diagnostic tool. Treatment for DCPG remains difficult. We describe a case of DCPG effectively treated with propranolol.

Non-invasive Rejuvenation/Skin Tightening: Light-Based Devices

The popularity of non-invasive cosmetic improvement of the skin has continued to grow amongst patients and practitioners alike.

Pterygium inversum unguis secondary to gel polish

Pterygium inversum unguis (PIU) is characterized by the abnormal adherence of the hyponychium to the ventral surface of the nail plate. It can be both unsightly and painful, resulting in morbidity for patients. Gel polish is a popular nail cosmetic that has been reported to cause several complications. PIU may be another adverse outcome.