Novel management of granuloma formation secondary to dermal filler: A multi-modality approach.

BACKGROUND: Dermal fillers for soft tissue augmentation have become increasingly popular among patients of all ages and ethnicities. With more widespread use, there has been an increased incidence of adverse reactions, one of which is the granulomatous foreign body reaction (GFBR). MATERIALS & METHODS: We present a three patient case series in which GFBR secondary to dermal filler was successfully treated with a multi-leveled approach. The first modality involves intralesional injection of a mixture containing 1 cc of 5-fluorouracil (5-FU), 0.5 cc of dexamethasone sodium phosphate, and 0.1 cc of triamcinolone 10. The lesion is injected intradermally in small aliquots, similar to scar treatment. The patient then takes colchicine 1.2 mg loading dose on day 1, then 0.6 mg twice per day for 4 days concurrently with naproxen 500 mg orally once daily for 5-7 days. This process may be repeated in 6 weeks if the lesions have not resolved and PDL laser may be employed for residual post-inflammatory erythema. RESULTS: All three patients presented in this case series had significant aesthetic improvement in their dermal filler-derived foreign body granulomatous reactions. CONCLUSION: GFBR provides both a medical and aesthetic issue for these patients including mental distress, pain, and dysfunction, therefore having an effective treatment for GFBR will affect medical management of these patients, improving patient outcomes and satisfaction. Our proposed regimen for GFBR has been shown to be highly efficacious and safe for these patients, providing a significant improvement in both function and cosmesis of the area.

Dupilumab Improves Clinical Scores in Children and Adolescents With Moderate to Severe Atopic Dermatitis: A Real-World, Single-Center Study.

BACKGROUND: Dupilumab has proven safe and effective in children and adolescents with atopic dermatitis (AD) in clinical trials. However, comprehensive real-world studies in the pediatric AD population are still needed. OBJECTIVE: To characterize the long-term treatment responses and adverse events of dupilumab-treated children and adolescents with AD during dermatology follow-up assessments. METHODS: We reviewed electronic medical records from March 2017 to September 2021 of moderate to severe AD patients starting dupilumab at less than age 18 years. Demographics, AD scores (body surface area [BSA], Eczema Area and Severity Index [EASI], and Investigator's Global Assessment [IGA]) as well as safety data were collected. RESULTS: A total of 89 patients, 50 females (56.2%) and 39 males (43.8%), were included. Mean ± SD treatment duration was 1.3 ± 0.9 years. Of these, 73 had score assessments at baseline and weeks 12 to 24. Mean ± SD improvements in BSA, EASI, and IGA were 63.1% ± 29.2%, 39.6% ± 29.9%, and 59.6% ± 30.7%, respectively. All patients (n = 23) who received dupilumab for 1 year or more achieved 75% improvement in EASI and IGA 0/1, and 60.8% achieved 90% improvement in EASI. Positive history of atopy was associated with greater percent improvement in BSA at weeks 12 to 24 (P < .05). Twelve patients had adverse events (13.5%), of which conjunctivitis (5.6%) and joint pain (2.2%) were most common. There were no serious adverse events. CONCLUSIONS: Dupilumab was well-tolerated and effective in treating pediatric and adolescent AD regardless of age, sex, race, or ethnicity.

Face-off: Social Media Responsibility in Medicine and Nonsurgical Treatment of the Face.

The practice of reaching an audience through social media to promote nonsurgical treatments of the face is in its infancy. Young adults, arguably the most health-literate generation to date, comprise both the majority of users targeted by social media and the fastest growing demographic seeking cosmetic consultation. We know that this age group is also at an increased risk of depression and body dysmorphia in an era where nonsurgical cosmetic options are typically thought to be gateways to surgical treatments. In light of these facts, it seems the ethics of medicine might be lagging behind the amorphous, rapidly evolving nature of social media and, specifically, its use as a platform for business promotion and health information. As cosmetic treatments become a normalized facet of society's health care routine, in large part due to its ubiquity on social media platforms, its promotion by providers requires reexamination so that its pro-social potential can be realized. This is ensured by fostering a social media presence and in-office attitude that treatments should be an agreement between patient and provider on realistic expectations and how best to meet them.

Pulsed Dye Laser Treatment of Port-Wine Stains in Infancy Without the Need for General Anesthesia.

Importance: Recent concerns regarding repetitive use of general anesthesia in children younger than 3 years have placed greater importance on the controversy surrounding the timing of the initiation of port-wine stain (PWS) laser treatment. Objective: To evaluate the use of PWS treatments at the age of 1 year or younger in the office setting without general anesthesia. Design, Setting, and Participants: Retrospective cohort study based on medical record reviews at a single, high-volume laser center for children who started pulsed dye laser treatment at the age of 1 year or younger for their PWS between 2000 and 2017. The data cutoff was at 1 year after the initial treatment to have comparable data points. Main Outcomes and Measures: The primary outcome was improvement of PWSs using before and after photographs, which were reviewed by 4 physicians independently and graded using the following 5-point visual analog scale (VAS): poor (grade 1: 0%-25% improvement), fair (grade 2: 26%-50% improvement), good (grade 3: 51%-75% improvement), excellent (grade 4: 76%-99% improvement), and complete (grade 5: 100% improvement) clearance. Results: Of the 197 patients (73 [37.1%] boys; 124 [62.9%] girls), most (149 [75.6%]) had facial lesions. The mean age at the time of first treatment was 3.38 months (range, 5-355 days) and the mean number of treatments was 9.8 (range, 2-23; median, 10). Per the mean physician VAS grading of 197 patients, 51 patients (25.9%) showed 100% clearance (mean [range] VAS score of 4.78 [4.5 - 5]); 81 patients (41.1%) showed 76 to 99% improvement (mean [range] VAS score of 3.91 [3.5 to <4.5]); 44 patients (22.3%) showed 51% to 75% improvement (mean [range] VAS score of 2.86 [2.5 to <3.5]); 13 patients (6.6%) showed 26% to 50% improvement (mean [range] VAS score of 2.12 [1.5 to <2.5]); and 8 patients (4.1%) showed 0 to 25% improvement (mean [range] VAS score of 0.78 [0 to <1.5]). The presence of a V1 (first branch of the trigeminal nerve [ophthalmic nerve]) lesion was associated with a statistically significantly higher clearance rate by a VAS grade of 0.55 (95% CI, 0.25-0.84; P < .001). The mean (SD) VAS grade for all patients was 3.65 (1.26), corresponding to excellent clearance. None of the patients experienced scarring or permanent pigmentary change. Conclusions and Relevance: In this study, treatment of PWSs in infancy was both safe and effective. Early intervention allows for treatment without general anesthesia, maximizing the chance to achieve clearance before school age and thereby minimizing the negative outcome of PWSs for both the patient and the family.