Martin Zaiac

Consensus on melanonychia nail plate dermoscopy

This statement, focused on melanonychia and nail plate dermoscopy, is intended to guide medical professionals working with melanonychia and to assist choosing appropriate management for melanonychia patients. The International Study Group on Melanonychia was founded in 2007 and currently has 30 members, including nail experts and dermatopathologists with special expertise in nails. The need for common definitions of nail plate dermoscopy was addressed during the Second Meeting of this Group held in February 2008. Prior to this meeting and to date (2010) there have been no evidence-based guidelines on the use of dermoscopy in the management of nail pigmentation.

Nail abnormalities associated with systemic pathologies

Nail abnormalities can arise in conjunction with or as a result of systematic pathologies. These pathologies include single-organ diseases, multisystemic diseases, and drug-induced insults. Clinical signs associated with these conditions include dyschromias, vascular alterations, periungual tissue changes, textural dystrophies, contour alterations, and growth-rate alterations. The associated systemic pathologies may affect any part of the nail apparatus, including the nail matrix, the nail plate, the nail bed, the underlying vasculature, and the periungual tissues. The anatomical location and extent of damage determine the clinically manifested anomaly.

An evolution in switching therapy for psoriasis patients who fail to meet treatment goals

Switching psoriasis treatment is a common, accepted practice that is used to improve disease management and improve patient outcomes (e.g., when patients are experiencing suboptimal efficacy and/or tolerability with a given therapy). Historically, switching treatment was often performed to limit patients’ cumulative exposure to conventional systemic agents (e.g., methotrexate, cyclosporine) with the goal of reducing end‐organ toxicity. However, the practice of switching treatments has evolved in recent years with the availability of highly effective and tolerable biologic agents. In current practice, near‐complete skin clearance with minimal side effects should be a realistic treatment goal for most patients with moderate‐to‐severe psoriasis, and consideration for switching therapies has shifted to become more focused on achieving maximum possible skin clearance, enhanced quality of life, and improved patient satisfaction. This review provides a discussion of recent guidance on switching psoriasis therapies, including initial considerations for when switching therapy may be advisable and challenges associated with switching therapy, along with an overview of published clinical studies evaluating outcomes associated with switching therapy. The goal of this review is to empower dermatologists to optimally manage their patients’ psoriasis by providing the tools needed to develop rational strategies for switching treatments based on the pharmacologic characteristics of available treatments and each patients clinical needs and treatment preferences.

Onychomatricoma with Concomitant Subungual Glomus Tumor

Onychomatricoma and glomus tumor are two rare subungual neoplasms with distinct clinical and histopathological features. We report a case of onychomatricoma associated with a glomus tumor in the subungual region of the same finger in a 45-year-old woman. Histopathological examination revealed characteristic findings of both onychomatricoma and glomus tumor. To the best of our knowledge, these two subungual tumors have never before been described occurring concomitantly.

Horizontal running mattress suture modified with intermittent simple loops

Using the combination of a horizontal running mattress suture with intermittent loops achieves both good eversion with the horizontal running mattress plus the ease of removal of the simple loops. This combination technique also avoids the characteristic railroad track marks that result from prolonged non-absorbable suture retention. The unique feature of our technique is the incorporation of one simple running suture after every two runs of the horizontal running mattress suture. To demonstrate its utility, we used the suturing technique on several patients and analyzed the cosmetic outcome with post-operative photographs in comparison to other suturing techniques. In summary, the combination of running horizontal mattress suture with simple intermittent loops demonstrates functional and cosmetic benefits that can be readily taught, comprehended, and employed, leading to desirable aesthetic results and wound edge eversion.

Resolution of Post-Surgical Hypergranulation Tissue with Topical Aluminum Chloride

Hypergranulation is the extension of granulation tissue beyond the required amount to close a tissue defect. We report our experience using aluminum chloride to treat a series of two patients with hypergranulation tissue. Both patients had lengthy treatment courses after Mohs surgery with growth of hypergranulation tissue that resolved once aluminum chloride was placed on the wound. Aluminum chloride is a useful hemostatic agent frequently employed in dermatology. It is a readily available and low-cost option for management of hypergranulation after dermatologic procedures. Chronic wounds are a common treatment challenge for clinicians. Due to its affordability and availability, clinicians may consider topical aluminum chloride when managing post-surgical hypergranulation tissue.

Aesthetic Procedures for Increased Lip Volume: Hyaluronic Acid Fillers in Nonsurgical Lip and Eye Rejuvenation Techniques

Patients often present for lip augmentation to correct the loss of volume and signs of aging commonly perceived with perioral aging, including but not limited to decreased vermillion showing, blunting of the Cupid’s bow, less visible white roll, vertical rhytids, marionette lines, formation of a mentalis crease, and deep nasolabial folds. Hyaluronic acid (HA) is popular filler for temporary lip augmentation (effects last 3–6 months) due to its hygroscopic properties and resulting natural appearance. Additionally, they have desirable safety profiles due to the reversibility by enzymatic degradation using hyalurodinase. Keeping in mind the important anatomy of the perioral region and its vascular supply and nerve innervation is essential to a successful procedure with good cosmetic results. This chapter includes detailed guidelines and a technique for injecting. Physicians should consult with patients as to their preferences for a desired look, but carefully manage expectations to avoid disappointments. HA fillers are well tolerated and rarely result in adverse reactions for patients. Commonly experienced reactions can include local inflammation, tenderness, and bruising. HA fillers are an effective first-line treatment option for patients who want to augment and revitalize their lips.

Complications Associated with Botulinum Toxin Administration

First approved in 1989 for the treatment of various neuromuscular disorders, it was not until 2002 that the US Food and Drug Administration (FDA) approved botulinum toxin for its first dermatologic application: enhanced cosmesis of glabellar lines. By 2004, the FDA extended its approval of onabotulinumtoxin A, or Botox®, to the treatment of primary axillary hyperhidrosis refractory to treatment with topical agents [1].

Local anesthesia injection technique for aesthetic removal of dermal nevi

Dermatologists should be aware of the surgical techniques that reduce the level of skin distortion following biopsy procedures. (1) a dilution of lidocaine with bacteriostatic 0.9% sodium chloride and (2) injection of the solution directly into the nevus. The nevus balloons in size and shape and becomes tenser resulting in a change in the skin level permitting for easy shave. Good injection technique of anesthesia may represent a simple, but important means to improve postoperative cosmetic outcomes.

Does Debulking Using Curettage Affect the Presence of Floaters

reasons. During MMS reconstruction procedures, the maxilla is often already exposed and thus serves as a convenient anchor for the suspension suture. Anchoring the suture superiorly at the orbital rim may require additional interventions to expose the area and could result in excessive flaring or upward distortion of the nostril, whereas anchoring laterally at the maxilla allows for good cosmesis. Although cartilage grafts are an excellent option for maintaining support of the ENV, they require a more-elaborate procedure than the suspension suture and may not be as effective at addressing INV collapse.