Ronda S. Farah

Venous Leg Ulcerations: A Treatment Update

Opinion statementSelecting the appropriate treatment for venous leg ulcerations is essential for optimal wound healing and patient quality of life. Compression therapy remains the mainstay of treatment for these wounds. Compression methods should be carefully selected and tailored for compatibility with patients’ daily life. Pain management should not be neglected. When response to compression therapy is limited, adjuvant therapy such as medication, débridement, or surgical procedures should be considered on an individual basis.

Squamous neoplasms arising within tattoos: clinical presentation, histopathology and management

Tattooing, which involves the placement of ink into the skin, is an ancient decorative technique that has remained popular in modern society. Tattoos have long been known to cause cutaneous reactions, which include the emergence of neoplasms such as keratoacanthoma (KA) and squamous cell carcinoma (SCC) in tattooed areas of the skin. We review the clinical presentations, histology and treatment options for squamous neoplasms, primarily KA and SCC, arising in tattoos.

Photobiomodulation therapy for androgenetic alopecia: A clinician’s guide to home-use devices cleared by the Federal Drug Administration

ABSTRACT The market for home-use photobiomodulation devices to treat androgenetic alopecia has rapidly expanded, and the Food and Drug Administration (FDA) has recently cleared many devices for this purpose. Patients increasingly seek the advice of dermatologists regarding the safety and efficacy of these hair loss treatments. The purpose of this guide was threefold: (1) to identify all home-use photobiomodulation therapy devices with FDA-clearance for treatment of androgenetic alopecia; (2) to review device design, features and existing clinical evidence; and (3) to discuss practical considerations of photobiomodulation therapy, including patient suitability, treatment goals, safety, and device selection. A search of the FDA 510(k) Premarket Notification database was conducted using product code “OAP” to identify all home-use devices that are FDA-cleared to treat androgenetic alopecia. Thirteen commercially available devices were identified and compared. Devices varied in shape, wavelength, light sources, technical features, price, and level of clinical evidence. To date, there are no head-to-head studies comparing the efficacy of these devices. Photobiomodulation therapy devices have an excellent safety profile and mounting evidence supporting their efficacy. However, long-term, high quality studies comparing these devices in diverse populations are lacking. As these devices become increasingly popular, dermatologists should be familiar with this treatment modality to add to their therapeutic armamentarium. Abbreviations: AGA, androgenetic alopecia; FDA, Food and Drug Administration; IEC, International Electrotechnical Commission; LED, light-emitting diode; PBMT, photobiomodulation therapy.

Dramatic Saxophone Penis as a Result of Topical Imiquimod Use

penis would not be surprising. The low incidence of genital involvement may be owing in part to reluctance of patients such as ours to report genital disease. Health care professionals should be aware of potential varying presentations of this condition because the earlier the underlying neoplasm is diagnosed, the more likely it will be resectable. Appropriate referral for evaluation of the aerodigestive tract should be expedited, and if necessary, exploration for more unusual underlying tumors should be initiated.

Phaeoacremonium parasiticum phaeohyphomycosis in a patient with systemic lupus erythematosus treated successfully with surgical debridement and voriconazole: A case report and review of the literature.

Highlights • Purulent drainage, woody induration and sinus tract formation suggest mycetoma.• Phaeohyphomycosis management may require debridement and prolonged antifungal therapy.• Microbiological identification is needed for optimal medical management.

Photobiomodulation and Hair Growth

Since the initial Food and Drug Administration clearance of the first photobiomodulation device for androgenetic alopecia in 2007, the market for these devices has rapidly expanded. Sixteen unique devices are currently available to consumers with varying designs, treatment durations and frequency. While the precise mechanism for hair growth stimulation remains to be elucidated, current evidence suggests the laser light alters hair cycle duration to promote the anagen growth phase. Photobiomodulation devices have an excellent safety profile with pruritus and skin dryness reported to be the most common side effects. Overall, research has demonstrated clinical efficacy of these devices, including randomized controlled studies. As photobiomodulation continues to emerge as a treatment modality for androgenetic alopecia, additional information on the most effective light sources, precise light wavelength, treatment schedule, and effectiveness on various hair diseases is still needed.

To test or not to test: A study examining the return rates of rosacea patients treated with a pulsed dye laser

ABSTRACT Pulsed dye laser (PDL) is an effective treatment option for erythematotelangiectatic rosacea. The use of a test spot allows patients to experience the procedure on a small area prior to further treatment. The purpose of this study was to elucidate whether the use of a no charge test spot influenced return rates for further PDL treatment. Data were obtained retrospectively using International Classification of Diseases (ICD)-10 codes for rosacea. Sixty charts were identified: 26 patients initially received a PDL test area free of charge, whereas 34 patients initially underwent full PDL treatment. Patients who experienced the test spot laser treatment had a lower return rate compared to those that directly underwent full PDL treatment. However, this difference was not statistically significant (Fisher’s exact test p = 0.2883). Future studies evaluating and identifying factors that influence PDL return rates are needed. Abbreviations: ETR: Erythematotelangiectatic rosacea; PDL: pulsed dye laser; ICD: International classification of diseases

The rise of transcutaneous drug delivery for the management of alopecia: A review of existing literature and an eye towards the future

ABSTRACT Introduction: Fractional lasers and microneedling devices are increasingly used with topical drugs to treat various conditions, including alopecia, as they grant access to dermal structures such as hair follicles and cutaneous vasculature. Objective: To perform a comprehensive review on transcutaneous drug delivery for the management of alopecia. Methods: PubMed, Embase, and Ovid Medline databases were searched using terms including: alopecia, microneedling, lasers, androgenetic alopecia (AGA), alopecia areata (AA), drug delivery. Articles were examined for inclusion criteria: diagnosis of alopecia regardless of type, use of fractional laser or microneedling devices, and subsequent administration of topical medication. Results: 8 studies, 6 prospective clinical trials and 2 case series, examining either AA or AGA were identified. For AA, five studies examined microneedling together with topical triamcinolone in three of these, while two studies used photodynamic therapy. Regarding AGA, two studies used topical minoxidil plus microneedling, and one examined topical finasteride with fractional erbium glass laser. Improvement was seen in 6 of the 8 studies. Discussion: Transcutaneous drug delivery via fractional laser and microneedling is a promising modality with preliminary evidence for increased hair regrowth over topical therapy alone. Further studies are needed to elucidate treatment parameters and appropriate device selection for drug delivery.

Acquired partial lipodystrophy treated with poly-L-lactic acid and hyaluronic acid fillers: a case report

ABSTRACT Acquired partial lipodystrophy (APL), also known as Barraquer-Simons syndrome, is a rare disorder characterized by progressive fat loss in the upper body. Use of poly-L-lactic acid and hyaluronic acid (HA) fillers for the treatment of APL is neither approved by the Food and Drug Administration nor described in the literature. Herein, we describe a case of APL that achieved significant improvement in facial volume following treatment with combination poly-L-lactic acid and HA fillers.

Health-related quality of life in patients with cutaneous T-cell lymphoma?

Little is currently known about health‐related quality of life (HRQoL) of patients with cutaneous T‐cell lymphoma (CTCL), a condition characterized by chronic, pruritic, visible lesions, features which may be uniquely influential.