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Journal of Drugs in Dermatology: JDD

James Quertermous, Seemal Desai, Julie Harper, Mark Lebwohl, Abel Torres, Leon H Kircik
Medication compounding gained national attention in the fall of 2012 after contaminated compounded medications produced in the New England Compounding Center infected 800 people with fungal meningitis and led to several fatalities. This prompted Congress to pass regulations on compounding through the Drug Quality and Security Act (DQSA) in 2013. The act increased oversight of patient-specific drug compounding taking place in compounding pharmacies, created 503(b) outsourcing facilities to obtain compounded drugs, and added regulations for obtaining compounded drugs from traditional 503(a) pharmacies...
July 1, 2018: Journal of Drugs in Dermatology: JDD
Leon H Kircik
Dermatology is often described as a "visual" specialty. While it is true that many of our diagnoses can be made based on a relatively quick recognition of morphology, such a characterization of our profession overlooks the reality that dermatologists are "doers" in the clinic. From aesthetic injections to biopsies and cryosurgery, much of our patient care time is spent performing minor and major procedures. We are well known for our in-office efficiency and cost saving practices.
July 1, 2018: Journal of Drugs in Dermatology: JDD
George A Zakhem, Vitaly Terushkin, Euphemia W Mu, David Polsky, Shane A Meehan
INTRODUCTION: Biopsies of atypical melanocytic nevi are among the most commonly performed procedures by dermatologists. Margin assessment is often used to guide re-excision, but can be a point of confusion as negative margins reported in the planes of sections examined do not always reflect complete removal of a lesion. This study investigates the rates of false negative margins after both punch and shave biopsies. METHODS: We performed a retrospective analysis of 50 consecutive punch and shave biopsy specimens (1) diagnosed as DN, and (2) reported as having clear margins in the planes of section examined...
July 1, 2018: Journal of Drugs in Dermatology: JDD
Margo H Lederhandler, Anthony Ho, Nooshin Brinster, Roger S Ho, Tracey N Liebman, Kristen Lo Sicco
Treatment of malignancy with anti-programmed cell death 1 (PD-1) immune checkpoint inhibitors can cause mucocutaneous side effects resulting from T cell activation. Due to their recent development, the full side effect profile remains to be fully elucidated, however dermatologic adverse events are most common. The main oral toxicities of these immune checkpoint inhibitors include: xerostomia, dysgeusia, and lichenoid reactions. Oral mucositis occurs more rarely in the setting of PD-1 inhibition, and few other reports of a Grade 3 or higher, severe, stomatitis have been reported in the literature...
July 1, 2018: Journal of Drugs in Dermatology: JDD
Gillian M Beer, Kenneth Beer
We present the case of a man that had a rapidly growing nodule on his face. Removal of the lesion was more difficult than anticipated because it was tightly adherent to adjacent tissue. Pathology from the lesion showed a malignant neoplasm thought to have arisen at a distant site. The evaluation of this patient may provide insights into the workup for patients that present with cutaneous metastatic malignancies of unknown etiology. In general, these patients need to be fully evaluated in an attempt to locate the primary lesion...
July 1, 2018: Journal of Drugs in Dermatology: JDD
Michelle W Cheng, Amy Kehl, Scott Worswick, Carolyn Goh
Alopecia areata is an autoimmune disease involving the hair follicle with a chronic, relapsing course. Tofacitinib is Janus kinase inhibitor approved for treatment of rheumatoid arthritis that has been shown to be effective in treatment of alopecia areata. We present a case series of 11 patients with severe alopecia areata on longstanding, regular to high dose oral tofacitinib with marked hair regrowth. Additionally, we present a case of moderate to severe alopecia areata successfully treated with topical tofacitinib cream...
July 1, 2018: Journal of Drugs in Dermatology: JDD
Brandon Worley, Joel L Cohen
BACKGROUND AND OBJECTIVE: Misperceptions have persisted regarding scanning full-field erbium laser that have caused it to be overshadowed by fractional ablative resurfacing. This can lead to sub-optimally treating the periocular and perioral skin. Our report describes the utility of a combined approach of fractional ablative CO2 with full-field erbium ablation for full face rejuvenation. Each laser has a role in creating the optimal outcomes for advanced photoaging in the fewest treatments...
July 1, 2018: Journal of Drugs in Dermatology: JDD
Logan W Thomas, Erica B Wang, Jennifer Urban, Jared Jagdeo
Laser hair reduction is a well-established modality for a wide range of medical indications. Laser hair reduction can be beneficial for hemodialysis patients who undergo repeated adhesive tape application and removal at their hemodialysis site during hemodialysis sessions. There is a paucity of published literature on efficacious laser hair removal treatments for hemodialysis patients. Herein, we present a case of a 50-year-old male (Fitzpatrick III) with end-stage renal disease on hemodialysis, who achieved successful laser hair reduction at his hemodialysis vascular access site with five sessions of a neodymium:yttrium-aluminium-garnet (Nd:YAG) laser (1064 nm) to improve his quality of life by reducing the hair burden at the adhesive tape site application...
July 1, 2018: Journal of Drugs in Dermatology: JDD
Denise L Sweeney, Erica B Wang, Evan Austin, Jared Jagdeo
BACKGROUND: As body contouring procedures have become more popular, post-procedural skin laxity is a concern. Non-invasive body contouring technologies may effectively reduce body fat, but modestly affect skin tightening. OBJECTIVE: To assess the efficacy and safety of a topical skin tightening agent in combination with hyperthermic diode laser lipolysis. METHODS: Herein, we describe five patients in which a skin tightening concentrate of 5% yeast extract, 2% hydrolyzed rice protein content, and 2...
July 1, 2018: Journal of Drugs in Dermatology: JDD
Raymond L Garcia, Jerry L McCullough, Barry Reece, Frank J Massino
OBJECTIVE: To evaluate the efficacy and tolerance of topical 4HBAP (para-topolin [6-(4-hydroxybenzylamino) purine], a new aromatic cytokinin, in subjects with mild to moderate facial photodamage. METHODS: In this single-center, 12-week study subjects (n=39) applied topical 0.10% 4HBAP (the test article) and sunblock (SPF30) twice daily, in the early morning and in the evening. The efficacy and safety of the treatment were evaluated at study entry (baseline) and at 2, 4, 8 and 12 weeks...
July 1, 2018: Journal of Drugs in Dermatology: JDD
Omar Bari, Robert E Eilers, Ashley G Rubin, Shang I Brian Jiang
Dermatologic surgery performed on the lower extremities has an increased risk for surgical site infections (SSI). Our objective was to evaluate the clinical characteristics associated with SSI following Mohs micrographic surgery (MMS) and wide local excisions (WLE) performed below the knee. We performed a single-center retrospective chart review of patients (n=271) that underwent these procedures. Within 14 days of the lower extremity procedure, four of 175 MMS patients (2.3%) developed SSI compared to eight of 96 WLE patients (8...
July 1, 2018: Journal of Drugs in Dermatology: JDD
Hemali B Gunt, Stanley B Levy, Celeste A Lutrario
The objective of this 6-week clinical study was to demonstrate the effectiveness of a natural ingredient-based moisturizing cream versus a colloidal oatmeal moisturizing cream in improving the hydration, barrier function, appearance, and feel of dry leg skin. Thirty-two subjects completed the study. After a 5-day washout, subjects used the natural ingredient-based moisturizing cream and oatmeal-containing cream on randomly-assigned legs twice a day for a period of three weeks. For the following two weeks subjects did not use any moisturizer on their legs...
July 1, 2018: Journal of Drugs in Dermatology: JDD
Marita Zimmermann, David Rind, Rick Chapman, Varun Kumar, Sonya Kahn, Josh Carlson
BACKGROUND: Moderate-to-severe atopic dermatitis can be difficult and costly to treat. The long-term health and economic outcomes of a new therapy, dupilumab, have yet to be evaluated. We aimed to identify the cost-effectiveness of dupilumab compared to usual care in moderate-to-severe atopic dermatitis. METHODS: We compared dupilumab to usual care with emollients for adults with moderate-to-severe atopic dermatitis inadequately controlled with topical therapy, or for whom topical therapies were medically inadvisable...
July 1, 2018: Journal of Drugs in Dermatology: JDD
Suneel Chilukuri, Christopher W Robb, Steven F Weiner, Jody Grossman
Primary axillary hyperhidrosis (PAH), or excessive sweating limited to the axillary area, is a debilitating disease that severely and negatively impacts social and psychological well-being. Several treatment options are available for PAH; however, these options have been shown to provide varying effectiveness. Recent studies have suggested another treatment alternative offering an effective PAH treatment option with reported long-term results. High intensity focused fractional radiofrequency (HIFRF) microneedling is FDA cleared for the treatment of facial wrinkles...
July 1, 2018: Journal of Drugs in Dermatology: JDD
Francisco Kerdel, Frank Don
Psoriasis is a chronic, immune-mediated, inflammatory disease that if left untreated can result in prolonged subclinical inflammation that affects a variety of organs, including the heart, liver, kidney, and intestines, as well as joints and muscles. Relatedly, psoriasis significantly increases patients' risks for developing certain comorbidities. Disease progression in psoriasis is unpredictable, and some patients have mild disease that is stable for many years, while in others, mild disease quickly progresses to moderate-to-severe psoriasis...
July 1, 2018: Journal of Drugs in Dermatology: JDD
Melanie D Palm, Lisa M Misell
OBJECTIVE: The efficacy of various pre-medication strategies for comfort management during microfocused ultrasound with visualization (MFU-V) treatment has not been studied. The present objective was to compare 2 topical analgesics (lidocaine 4% and benzocaine 20%) formulated with a novel transdermal delivery system with compounded lidocaine 23%/tetracaine 7% (23/7) to mitigate discomfort during MFU-V treatment. METHODS: This was a randomized, double-blinded, split-face study...
July 1, 2018: Journal of Drugs in Dermatology: JDD
David M Pariser, Lawrence J Green, Linda Stein Gold, Jeffrey L Sugarman, Tina Lin, Radhakrishnan Pillai
BACKGROUND: Psoriasis is a chronic, immune-mediated disease that varies widely in its clinical expression. Topical corticosteroids (TCS) are the mainstay of treatment. Long-term safety remains a concern, limiting use, and posttreatment flare is common. Tazarotene has also been shown to be effective in psoriasis, with efficacy maintained several weeks posttreatment. Fixed combination therapy with TCS and tazarotene may improve psoriasis signs and minimize posttreatment flare or rebound...
July 1, 2018: Journal of Drugs in Dermatology: JDD
Caroline B Costa-Orlandi, Breanne Mordorski, Ludmila M Baltazar, Maria José S Mendes-Giannini, Joel M Friedman, Joshua D Nosanchuk, Adam J Friedman
Topical antimicrobials are the ideal mode of onychomycosis treatment for efficient drug delivery and avoidance of sytemic effects associated with oral medications. However, high treatment costs, tissue penetration limitations, and low cure rates have continued to pose major challenges. To capitalize on the progress made by topical efinaconazole solution, efinaconazole was combined with inexpensive, previously-characterized nitric oxide releasing nanoparticles (NO-np), which have been shown to offer sustained nitric oxide release over time and enhanced barrier penetration, while exerting broad spectrum antimicrobial and immunomodulating properties...
July 1, 2018: Journal of Drugs in Dermatology: JDD
Brandon M Kirsch, Laurie Burke, Jeremy Hobart, David Angulo, Patricia S Walker
INTRODUCTION: Patients with primary axillary hyperhidrosis (AHH) suffer from a variety of symptoms. Improved patient-reported outcome (PRO) measures are needed to better assess and categorize the severity of AHH symptoms experienced by patients because the widely used Hyperhidrosis Disease Severity Scale (HDSS) is a single-item measure that cannot capture the broad scope of disease impact. METHODS: The Hyperhidrosis Disease Severity Measure-Axillary (HDSM-Ax) was developed for determining the severity of excessive sweating in patients with primary focal AHH based on face-to-face concept elicitation interviews with 58 AHH patients, a literature review, and expert clinical input...
July 1, 2018: Journal of Drugs in Dermatology: JDD
Z Paul Lorenc, David Goldberg, Mark Nestor
BACKGROUND: Absorbable suspension sutures for tissue repositioning represent a minimally invasive approach to facial rejuvenation. With 2015 FDA 510(k) approval of Silhouette InstaLift™ (Sinclair Pharma, Irvine, CA), a completely absorbable device comprised of 82% PLLA/18% PLGA sutures and bi-directional cones, came the challenge of developing optimal technique for achieving effective, precise, and durable tissue repositioning. Here, the authors discuss the importance of straight-line vector planning (SLVP) and positioning of the suture perpendicular to the plane to be elevated in obtaining optimal results for tissue repositioning...
July 1, 2018: Journal of Drugs in Dermatology: JDD
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