Eyelid tightening by CO2 fractional laser, alternative to blepharoplasty.

BACKGROUND: Multiple approaches to achieve eyelid tightening have been introduced over the years. However, a solid foundation of knowledge as to the origins of the aging appearance is paramount to target the specific causes of this natural phenomenon. OBJECTIVE: This review aims to touch upon the diverse modalities used to achieve the best therapeutic approach for eyelid tightening. MATERIALS AND METHODS: A review of published articles on eyelid tightening using blepharoplasty and lasers was conducted. This information combined with an illustrative case example is presented. RESULTS: Although multiple treatment options exist, there are advantages and disadvantages for each. CONCLUSION: Understanding the cause of the aging periorbital area with appropriate application of the various treatment options available will lead to a natural and youthful appearing result. Fractional ablative CO2 laser remains an excellent alternative to traditional blepharoplasty.

Collagenase followed by compression for the treatment of earlobe keloids.

BACKGROUND: Many therapeutic options are available for treating keloids, but success rates vary widely, and the keloids often recur. The Food and Drug Administration has recently approved intralesional collagenase for the treatment of Dupuytren's contracture. This medication has not been explored for the treatment of earlobe keloids, a common problem. OBJECTIVE: To evaluate the safety and clinical efficacy of intralesional collagenase followed by compression for the treatment of earlobe keloids. MATERIALS AND METHODS: Six earlobe keloids in six patients were injected with a commercial collagenase preparation. Study participants were asked to use compression earrings daily thereafter. Patients were examined and photographed 1 day, 2 weeks, 4 weeks, 10 months, and 12 months after injection. Adverse events were assessed at each visit, and the keloids were measured and photographed. RESULTS: All patients had a decrease in the size of their earlobe keloid by an average of 50% (p = .02). Three of the six participants chose to have their earlobe keloids surgically excised for cosmetic reasons 6, 8, and 11 months after enrollment, so measurements for data analysis for these patients were taken after only 1, 1 and 10 months. All participants returned for follow-up at the last study visit 1 year after study commencement. The three patients who completed the study were pleased with the improvement of their earlobe keloid, although complete clearance was not achieved. Side effects included injection site swelling, tenderness, and one ulceration that spontaneously resolved within 2 weeks. CONCLUSION: Intralesional collagenase followed by compression appears to be a safe and modestly effective treatment for earlobe keloids. This approach warrants further investigation in larger studies with longer follow-up in motivated patients who decline surgical excision.

Targeted topical and combination laser surgery for the treatment of angiofibromas.

BACKGROUND AND OBJECTIVE: The angiofibromas of Tuberous sclerosis (TS) is well described manifestation. Due to the progressive nature of the skin lesion, a safe and effective technique for treating these disfiguring skin lesions is needed. STUDY DESIGN/PATIENTS AND METHODS: We report a targeted topical and combination laser technique for treating the angiofibromas of TS in one patient. This includes treatment with topical sirolimus, pinpoint electrosurgery, pulsed-dye laser treatment, and ablative fractional resurfacing (AFR). RESULTS: Improvement in the number and appearance of facial angiofibromas and erythema is noted, without scarring or adverse events. CONCLUSION: The technique of targeted therapy with sirolimus with electrosurgery, pulsed dye laser treatment, and AFR represents an innovative, safe therapeutic option for treating facial angiofibromas associated with TS.

Verrucous herpetic infection of the scrotum and the groin in an immuno-competent patient: Case report and review of the literature.

Atypical presentations of genital herpes are more commonly described among immuno-compromised patients. Furthermore, verrucous lesions may be attributed to acyclovir resistant strains of herpes simplex virus as well as co-infection with fungi and other viruses in this patient population. We describe the first case of verrucous genital herpes infection in an immuno-competent patient.

A case of acquired Zinc deficiency.

We report a case of adult-onset acquired zinc deficiency after bariatric surgery. Zinc deficiency may be inherited in the form of acrodermatitis enteropathica or acquired by low nutritional intake, malabsorption, excessive loss of zinc, or a combination of these factors.

Fatal Henoch-Schonlein purpura in an adult related to bowel perforation: report and review of the literature.

BACKGROUND: Henoch-Schonlein purpura is an idiopathic, IgA associated, systemic small-vessel vasculitis characterized by the clinical tetrad of palpable purpura, arthralgias, renal dysfunction, and abdominal pain. Whereas Henoch-Schonlein is an overwhelmingly pediatric disease, its rare diagnosis in adults carries a much higher morbidity and mortality. OBSERVATIONS: We describe a 52-year-old man with biopsy proven Henoch-Schonlein who expired from bowel perforation. CONCLUSIONS: Severe gastrointestinal complications and death from gastrointestinal involvement by Henoch-Schonlein purpura is rare. The authors surmise that multiple co-morbidities may have contributed to our patient's demise.

Easy as PIE (Postinflammatory Erythema).

BACKGROUND: No term exists to date describing the phenomenon of pink-to-red discoloration after an inflammatory acne lesion. OBJECTIVES: To introduce new terminology into the dermatology literature to describe erythema often seen after inflammatory acne vulgaris and to present a treatment option for this type of erythema. METHODS: New terminology describing erythema after inflammatory acne is addressed, and a treatment option for postinflammatory erythema is presented. RESULTS: Postinflammatory erythema is a new, accurate descriptor of erythema that occurs after inflammatory acne. Additionally, pulsed dye laser treatment improved postinflammatory erythema in the authors' patients. LIMITATIONS: This paper only presents anecdotal cases. CONCLUSION: The addition of postinflammatory erythema to the dermatology literature may facilitate accurate communication among providers and direct laser treatment for postinflammatory erythema.

Tyrosinase: a central regulatory protein for cutaneous pigmentation.

Cutaneous pigmentation or skin color is the body's natural protection against sun-induced damage. Skin color is determined primarily by melanin, a biopolymer that is synthesized within epidermal melanocytes, packaged in cellular organelles called melanosomes, and then dispersed to neighboring keratinocytes. The process of melanogenesis involves numerous molecules and intracellular pathways that are subject to regulation by endogenous and exogenous factors. Tyrosinase is the central and rate-limiting enzyme in melanin biosynthesis. Therefore, elucidation of the molecules and pathways that regulate tyrosinase levels and activity could identify target areas for the development of compounds to decrease excessive pigmentation on one hand or induce pigmentation on the other. The following commentary will summarize the key regulatory molecules and pathways involved in tyrosinase function.