Robert J. Sage

UV-based therapy and vitamin D

The ultraviolet (UV) light spectrum has long been known to induce biologic effect on the skin. For a large number of cutaneous disorders, phototherapy and photochemotherapy are effective therapeutic options with excellent safety profiles and well‐documented side effects. Despite their ease of administration and benefits, phototherapeutic treatment modalities require appropriate space for the equipment, trained staff, and patient education prior to initiating treatment. However, when the initial barriers to treatment can be overcome, UV therapy can offer patients significant relief from their cutaneous disease. Furthermore, UVB‐based phototherapy can produce significant alteration to vitamin D levels. With the recent research implicating association of low vitamin D levels with a variety of health conditions, whether patients receiving phototherapy or, more specifically, those getting vitamin D supplement may be protected from these diseases remains to be established.

Kwashiorkor from a severe dietary restriction in an 8‐month infant in suburban Detroit, Michigan: case report and review of the literature

Kwashiorkor is a type of protein‐calorie malnutrition often seen in children of impoverished countries and famine. The condition occurs in the setting of insufficient protein intake in the presence of sufficient caloric intake. We report a case of a 8‐month‐old male infant in the suburban Detroit, MI, USA who presented with diffuse edema, erythroderma and desquamation, a “bull‐dog” face, diarrhea, and irritability, consistent with kwashiorkor as a result of severe dietary restriction. The mother had placed the child on a severely restrictive diet, consisting only of RICE DREAM® milk, sweet potatoes and bananas, with the assumption that it would help his rash. Nineteen prior cases of kwashiorkor induced in infants by dietary restriction of “well intending” parents have been reported in the US literature. Malnutrition is often under diagnosed or misdiagnosed in developed countries such as the United States. The results, if unrecognized or untreated, may be devastating. This makes it imperative that physicians consider this diagnosis, recognize potential risk factors and be prepared to accurately assess overall nutritional status of patients.

Subcuticular Incision Versus Naturally Sourced Porcine Collagen Filler for Acne Scars: A Randomized Split-Face Comparison

BACKGROUND Subcuticular incision is performed to release fibrotic bands beneath acne scars and to stimulate neocollagenesis. Naturally sourced porcine collagen has been approved for filling moderate to deep facial wrinkles and nasolabial folds. To our knowledge, naturally sourced porcine collagen filler has not yet been tried as a treatment for correcting atrophic acne scars. OBJECTIVE To objectively assess and directly compare the efficacy and safety of subcuticular incision versus naturally sourced porcine collagen dermal filler in correcting atrophic and rolling acne scars. MATERIALS AND METHODS We performed a prospective, randomized, split‐face, single‐blind study to evaluate intermediate long‐term efficacy of subcision and collagen dermal filler on 20 unilateral faces. Patients and blinded physicians evaluated results. RESULTS Patients rated subcision as superior to collagen dermal filler at 3 months (p=.03). At 6 months, subcision had a slightly higher rating than collagen dermal filler (p=.12). Blinded evaluators leaned toward subcision at 3 months (p=.12) and at 6 months showed no preference (p=.69). CONCLUSION Subcuticular incision and naturally sourced porcine collagen dermal filler appear to be efficacious for improving atrophic and rolling acne scars. Patients may prefer subcuticular incision over collagen dermal filler. Blinded evaluators found no significant difference between the treatments. The authors indicate no significant interest with commercial supporters.

Granulomatous Foreign Body Reaction to Hyaluronic Acid: Report of a Case After Melolabial Fold Augmentation and Review of Management

&NA; The authors have indicated no significant interest with commercial supporters.

Therapeutic Hotline: Recommendations on photoprotection and vitamin D

Interest in the health benefits of vitamin D continues to increase and is at the forefront of much research and debate. Insufficient vitamin D levels have been linked in epidemiologic studies to decreased physical performance, cardiac health, autoimmune disease, neurologic disorders, colorectal and breast cancers, and total mortality. Consequently, health authorities are reviewing the most recent available data and updated recommendations on optimal vitamin D levels are pending. Daily intake of 1000 international units (IU) of vitamin D for adults and 400 IU of vitamin D for children may be appropriate for patients protecting their skin from UV radiation and can be safely obtained from diet and/or dietary supplementation. Patients should be counseled on sun protection regimens to prevent unprotected sun exposure and discouraged from using artificial tanning devices. As available information on vitamin D and its associated health benefits evolves, and as new evidence emerges, updated recommendations are sure to follow.

Mohs Micrographic Surgery for the Treatment of Cellular Neurothekeoma and Review of Its Use in Surgical Management of Benign Tumors

&NA; The authors have indicated no significant interest with commercial supporters.

Comparing Ablative Fractionated Resurfacing, Photodynamic Therapy, and Topical Imiquimod in the Treatment of Trichoblastomas of Brooke-Spiegler Syndrome: A Case Study

&NA; Graceway Pharmaceuticals, Bristol, Tennessee, provided the imiquimod cream used in this study.

Evaluation of Orbicularis Oculi Muscle Stripping on the Cosmetic Outcome of Upper Lid Blepharoplasty: A Randomized, Controlled Study

Background Many variations in the surgical treatment of upper eyelid blepharoplasty have been described, including orbicularis oculi muscle stripping. There is no evidence in the literature to support the efficacy of this technique in improving the aesthetic results of the procedure. Objectives To conduct a single‐blind, randomized, controlled, split‐face pilot study to evaluate the effects of orbicularis oculi muscle stripping on upper lid blepharoplasty. Methods Ten subjects were randomized to receive upper lid blepharoplasty with orbicularis oculi muscle stripping on one side and skin‐only blepharoplasty on the other. Patients and two blinded physicians evaluated the aesthetics of the eyelids at 1‐, 3‐, and 17‐month follow‐up visits. Results Blinded physician evaluation failed to show a difference in the overall cosmetic appearance of the eyelids between the control and treatment sides at any time point. Analysis of the composite of all patient scores showed a trend favoring the control side at 3 months (p = .28) and the treatment side at 17 months (p = .50), but neither difference was significant. Conclusion Based on the data from this pilot study, orbicularis oculi muscle stripping appears to have no affect on the aesthetic outcome of upper lid blepharoplasty.

Intermediate-thickness skin grafting for repair of cutaneous defects after Mohs micrographic surgery.

&NA; The authors have indicated no significant interest with commercial supporters.

The filleted ellipse technique is useful for taking initial Mohs layers on linear excisions with positive margins.

&NA; The authors have indicated no significant interest with commercial supporters.