Whitney Valins

Pharmacotherapy of actinic keratosis

Actinic keratosis (AK) represents the initial intraepidermal manifestation of abnormal keratinocyte proliferation with the potential of progression to squamous cell carcinoma (SCC). When in limited numbers, clinically visible AKs are treated individually with ablative and/or surgical procedures (lesion-directed treatment), while multiple and sublinical AKs are treated with field-directed therapies that use ablative, nonablating and other topically applied treatment modalities. Owing to difficulties in predicting which AK will progress to SCC, the general rule is to treat all AKs. The goals of treatment are to eliminate the AKs, minimizing their risk of progression to invasive SCC, while pursuing good cosmetic outcomes. Prevention is the most important treatment modality for AKs. Avoidance of sun and artificial sources of ultraviolet light, applying sunscreen and self-examination are among the most effective preventive measures. Chemopreventive modalities such as retinoids, 2-(Difluoromethyl)-dl-ornithine (DFMO), perillyl alcohol, T4 endonuclease V, and dl-α-tocopherol are described. Lesion-directed treatment modalities include cryotherapy, surgery and electrodessication with or without curettage. Field-directed treatment modalities include nonablative and ablative laser resurfacing, dermabrasion, chemical peels, topical immunomodulators (imiquimod, 5-fluorouracil and diclofenac) and photodynamic therapy. And, finally, newer and investigational treatment modalities such as ingenol mebutate, resiquimod and betulinic acid are also being discussed.

Exacerbation of facial acne vulgaris after consuming pure chocolate

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Laser therapy in black skin.

This article provides a systematic overview of laser, light, and other energy devices for patients of African descent. It also reviews complications in skin of color and some treatment options for these adverse events.

Alteration in Hair Texture Following Regrowth in Alopecia Areata: A Case Report

BACKGROUND Alopecia areata is a common cause of hair loss seen in 3.8% of patients in dermatology clinics and in 0.2% to 2.0% of the general US population. The pathology of the disease remains poorly understood. Hair loss in alopecia areata can range from a single patch to 100% loss of body hair. When hair regrowth occurs in alopecia areata, the new hair may demonstrate pigment alterations, but a change in hair texture (ie, curly or straight) has rarely been reported as a consequence of alopecia areata. OBSERVATIONS We report a case of a 13-year-old African American boy who experienced an alteration of hair shape following regrowth after alopecia areata. The new hair recapitulated his hair shape from early childhood. CONCLUSIONS The precipitating factor for a change in hair texture in alopecia areata may be a result of treatment, pathophysiologic changes, or a combination of both. Whether the change is triggered at the level of stem cell differentiation, by cytokine or hormonal influences, gene expression during hair follicle development, a combination of all of these, or an unknown cause is a question that remains to be answered.

Letter: A Comparison Study of the Tensile Strength of Sutures Used in Dermatologic Surgery Following Exposure to Petrolatum

A variety of sutures are currently used in dermatologic surgery, each with unique characteristics that include suture material, number of filaments, diameter, fluid absorption ability, elasticity, memory and plasticity, ability of the suture to cut through tissue, and tensile strength (TS). These characteristics, along with nature of the wound, such as its location, shape, and size, and the preference and previous experience of the surgeon, help to determine the type of suture to be used in each individual case.

Pharmacotherapy of Basal Cell Carcinoma, Anogenital Warts, and Actinic Keratoses: Focus on Topical Imiquimod

Imiquimod, an imidazoquinoline compound, has been widely-recognized for its ability to induce both innate and adaptive immune responses. Topical imiquimod has been approved for the treatment of actinic keratoses (AK), external genital warts (EGW), and superficial basal cell carcinoma (BCC). There are reports of many successful off-label uses as well. The pharmacology and mechanisms of action, safety, efficacy, and adverse effects with regards to differing concentrations and dosing regimens are discussed in depth in this chapter. Field-directed therapies for AK along with non-surgical treatments for BCC are rapidly-evolving, with increasing numbers of studies providing evidence-based rationale for their use in management.

Asymptomatic Tumors in a 64-Year-Old Man—Quiz Case

Cary Chisholm, MD; Brook Brouha, MD, PhD; Phillip Lee, MD; Doyle Hansen, MD; Clay Cockerell, MD; Scott & White Memorial Hospital, Temple, Texas (Dr Chisholm); Texas A&M University Health Sciences Center, College Station (Dr Chisholm); University of California, San Diego (Drs Brouha, Lee, and Hansen); University of Texas Southwestern Medical Center, Dallas (Drs Brouha and Cockerell); and Dermpath Diagnostics, Dallas (Drs Brouha and Cockerell)