Comprehensive Review of Thermomechanical Fractional Injury Device: Applications in Medical and Cosmetic Dermatology.

Objective: Our aim was to review the current and emerging dermatological applications of the novel thermomechanical fractional injury (TMFI) device, Tixel® (Novoxel, Netanya, Israel). Methods: A systematic review of PubMed using the search terms of "Tixel", "thermomechanical fractional", ["thermomechanical ablation" and "skin"], and ["thermomechanical ablation" and "dermatology"]. Results: Thirty-six articles matched our inquiry. Fifteen articles did not meet inclusion criteria. Of the remaining 21 articles, eight were related to device-assisted drug delivery, seven related to photoaging, and seven related to scientific/ preclinical exploration. Preclinical studies have shown ablative and non-ablative microchannel formation similar to that of CO2 laser but without charring, with clinical studies demonstrating efficacy for a wide range of applications including rhytides, hypertrophic scarring, infantile hemangiomas, and acne/rosacea. The treatment is well tolerated with minimal discomfort and downtime, showing promise for pain-averse and pediatric populations. Few adverse events have been reported, with a high degree of safety demonstrated in all Fitzpatrick types. Limitations: Heterogeneous result reporting among studies. Limited number of randomized controlled trials. Conclusion: Tixel® is an emerging TMFI device with a wide range of current and potential applications, including device-assisted drug delivery and treatment of rhytides, photoaging, and scars among other conditions. The device has both ablative and non-ablative settings and has been safely used in all Fitzpatrick skin types. Larger and randomized controlled trials are needed to compare this device to current standard of care treatments.

Mpox Case Presenting With Genital Lesions and Proctitis.

ABSTRACT: Monkeypox (Mpox) is a zoonotic Orthopoxvirus of the Poxviridae family, endemic to Africa. In August 2022, the US government declared it an emergency because of the worldwide spread. Traditionally, Mpox infection spreads through contact with infected animals. However, the 2022 outbreak Centers for Disease Control and Prevention (CDC) data note that 94% of cases had recent male-to-male sexual or close intimate contact, suggesting a novel sexual transmission. In this article, we report a 39-year-old HIV-positive man presenting with a diffuse cutaneous rash, perianal pain, and bloody stool of 2-week duration. A medical history includes intravenous drug use and multiple sexual partners. Physical examination revealed umbilicated, tan-colored, crusted cutaneous papules scattered across the face, trunk, and genital regions. Perianal lesion biopsy showed an acanthotic epidermis with spongiosis, ballooning degeneration of keratinocytes, and the formation of multinucleated syncytial keratinocytes. A dermal superficial/lichenoid mixed inflammatory cell infiltrate with multinucleated giant cells was noted. Perianal lesion polymerase chain reaction (PCR) was positive for Mpox. Colonoscopy revealed a 3-cm circumferential rectal ulcer with gray exudate and necrosis. A rectal ulcer biopsy showed an ulcerated mucosa with acute proctitis and necrosis. There were scattered macrophages with intranuclear inclusion and glassy vacuolization, and Mpox infection was confirmed by immunostaining with a Mpox-specific anti-Vaccinia virus antibody.

Melanoma Mimicker: Pigmented Mammary Paget Disease in a Man.

ABSTRACT: Male breast cancer comprises less than 1% of all breast cancer cases. Mammary Paget disease (MPD) represents a subset of breast cancer that presents with skin changes of the nipple and areola, and is frequently misdiagnosed clinically due to similarities with other disease states, leading to an average delay in diagnosis of 1 month to 2 years. Pigmented mammary Paget disease (PMPD) is an uncommon variant of MPD that clinically and histologically resembles malignant melanoma. Due to variable immunohistochemical staining patterns, analysis can be challenging and often requires interpretation of panels for accurate diagnosis. We present a rare case of PMPD in a male, originally diagnosed both clinically and histologically as malignant melanoma, to highlight the diagnostic challenges that this entity presents, and to review staining patterns which may be useful in its diagnosis.