Wayne D. Carey

Topical treatment of actinic keratoses with 3·0% diclofenac in 2·5% hyaluronan gel

Summary Background  Actinic keratoses (AKs) are premalignant skin lesions, which, if left untreated, can develop into squamous cell carcinoma. Current treatments for AKs are destructive and are often associated with significant adverse events. The development of an effective and well‐tolerated topical treatment for AK is desirable.

Quality of life in plaque psoriasis patients treated with voclosporin: a Canadian phase III, randomized, multicenter, double-blind, placebo-controlled study

BACKGROUND Quality of life assessments are important in the evaluation of new therapies for psoriasis. OBJECTIVE To determine the effect of voclosporin (VCS) treatment on quality of life in patients with psoriasis. PATIENTS AND METHODS 451 plaque psoriasis patients with ≥  10% body surface area involvement were randomly assigned in a double-blind fashion to 1 of 4 treatment groups (placebo, VCS 0.2 mg kg(-1) BID, VCS 0.3 mg kg(-1) BID, and VCS 0.4 mg kg(-1) BID) for up to 12 weeks of treatment. Quality of life was assessed using the Dermatology Life Quality Index (DLQI) and the Psoriasis Disability Index (PDI). RESULTS At 12 weeks, patients treated with VCS 0.4 mg kg(-1) BID had statistically significantly more favourable assessments than placebo-treated patients in all domains of the DLQI and the PDI. Patients treated with VCS 0.3 mg kg(-1) BID had statistically significant improvements in 5 of 10 domains of the DLQI and all domains of the PDI. Patients treated with VCS 0.2 mg kg(-1) BID had statistically significant improvements in 4 of 10 domains of the DLQI and 2 of 4 domains of the PDI. CONCLUSION Treatment with VCS 0.4 mg kg(-1) BID significantly improves the quality of life of patients with psoriasis.

Retraction of the Plunger on a Syringe of Hyaluronic Acid Before Injection: Are We Safe?

BACKGROUND Controversy exists concerning the need for aspiration before injection with hyaluronic acid (HA) fillers. OBJECTIVE The authors undertook a study of HA products to determine if blood could be aspirated back into a syringe of HA when the needle has been primed or filled with HA. METHODS AND MATERIALS Two studies were set up to determine if or when blood could be withdrawn from a heparinized fresh tube of blood into the HA syringe. Two different techniques were tested; one using a slow-pull retraction of the plunger and up to a 5-second waiting time before release versus a rapid pullback and quick release. RESULTS Review of these data demonstrates that the usual clinical method, which involves quick withdrawal and instant release of the syringe plunger does not allow for sufficient removal of the filler found intraluminal in the needle and may give rise to false negative results in vitro and likely in vivo with the exception being the Galderma/Medicis products. CONCLUSION In summary, withdrawal of the syringe plunger with no visible blood in the syringe does not eliminate the possibility of intravascular placement of the syringe needle.

Acne scar treatment with subcision using a 20-G cataract blade.

The treatment of acne scarring is complex and often involves multiple modalities. Some of the different options for managing scarring are chemical peels, laser resurfacing, photorejuvenation, mini punch grafts, and dermabrasion. Subcision, a nonoperative technique for managing depressed scars by percutaneously releasing scar bands within the dermis and subcutaneous tissue, was introduced in 1995. A needle is used to release the fibrous septa within the scar, resulting in the formation of new connective tissue underneath the scar.

Cytomorphometric parameters and the metastatic potential of cutaneous and uveal melanoma: a comparison with prognostic factors.

The Mean of the Ten Largest Nuclei (MTLN1) is one of the most important prognostic factors in uveal malignant melanoma. This study was performed to investigate the applicability of nuclear and nucleolar measurements as a prognostic factor for cutaneous melanoma. A routine light microscope (Carl Zeiss: Axiophot EL-Einnsatz; #451888) at 640 times magnification with a Micrometer Eye Piece (Carl Zeiss: #444034) was used to evaluate the correlation of MTLN1 and Mean of Ten Largest Nuclei (MTLN) with the occurrence of metastasis in 58 primary cutaneous melanoma. For uveal melanoma, cytologic classification was used for comparison. Prognostic value was determined by univariate and multivariate linear regression analysis. MTLN1 was the only significant factor for uveal melanoma (p = 0.05). For cutaneous melanoma, all factors were significantly associated with disease progression. MTLN1 was the only one to remain significant (p + 0.027) in multivariate linear regression analysis. Nuclear and nucleolar morphometry are significant prognostic factors for uveal and cutaneous melanoma.

Combined Advancement and Single-Lobed Nasolabial Transposition Flaps for a Nasal Sidewall Defect

A 70-year-old white man presented with a lesion on the right nasal sidewall. He had an unremarkable past medical history and took no medications. A 6-mm incisional biopsy was taken and confirmed a diagnosis of basal cell carcinoma. The lesion was removed using Mohs micrographic surgery, and there was a resultant 2.6by 1.9-cm full-thickness defect (Figure 1). The resection was carried down to the level of the nasal cartilage. The nasal mucosa was intact, and there was no cheek involvement. How would you reconstruct this defect?