Combination Foam and Liquid Sclerotherapy for Lower Extremity Reticular and Telangiectatic Veins: A Single-Center Retrospective Study.

BACKGROUND: Lower extremity reticular and telangiectatic veins are of common cosmetic concern. OBJECTIVE: To retrospectively evaluate results of lower extremity sclerotherapy using a combination of foam and liquid sclerosing agents. METHODS: A retrospective chart review of sclerotherapy patients at a dermatology practice (January 2014 to April 2023) was performed. RESULTS: Eight hundred and nine patients (775 women and 34 men) with a mean age of 49.6 ± 12.2 (18-84) years underwent a mean 1.4 ± 0.7 (1-7) sessions. Multiple different sclerosing agents were used, with 0.2% sodium tetradecyl sulfate foam/liquid predominating, although 72% glycerin liquid and 0.25% to 0.5% polidocanol foam/liquid were also used. Coagula occurred in 61.0% of patients at 2 weeks and 6.4% at 3 months, whereas postsclerotherapy hyperpigmentation was seen in 5.0% and 19.1% of patients at the same time points. Both were more common after first-round treatment, each with a trend toward decreased frequency with increasing session number. Telangiectatic matting was found in 2.3% of 3-month follow-up patients. Edema, superficial venous thrombophlebitis, migraines, and ulceration were rarely seen. Significant clinical improvement was noted in 72.0% of treatments. CONCLUSION: This retrospective chart review, the largest to date of its kind, confirms the safety and efficacy of cosmetic lower extremity sclerotherapy with a combination of foam and liquid sclerosing agents.

Uncovering Shortcomings in Advertising Strategies for Over-the-Counter Minoxidil Products on Amazon.

Introduction The over-the-counter (OTC) market for hair loss products, particularly those containing minoxidil, has significantly expanded due to the increased prevalence of hair loss. Minoxidil, a vasodilator medication, is known for its potential to stimulate hair growth. However, the rise in OTC formulations has led to misleading advertising and marketing, with some companies exaggerating the benefits of their products while minimizing potential adverse effects. Methods A Google Boolean Search was conducted to identify OTC minoxidil products. The topmost non-sponsored search engine result page was used for analysis. Products not containing any dosage of minoxidil were excluded, resulting in nine products. These were individually searched on Amazon and eight were analyzed for any addressed safety information and adverse effects profile. Results The analysis revealed that only two out of eight products (25%) reported safety information, and none of the products (0%) reported any adverse effects. Significant observations were found surrounding the transparency and accuracy of the advertising and marketing of these products. Many companies made bold claims about their products without providing supporting scientific evidence or studies. Furthermore, many of these OTC hair loss brands did not adequately mention and explain the adverse effects of the product. Conclusions The study highlights the need for greater transparency in the marketing of OTC minoxidil products. Companies should provide clear and accessible information about the safety and potential adverse effects of their products. This will empower consumers to make informed decisions and foster trust between the industry and the consumer. Furthermore, the authenticity and accuracy of marketing images should be ensured to avoid giving false hopes to consumers.

Sclerotherapy off the Lower Extremities: A Single-Center Retrospective Study of Veins Treated on the Dorsal Hands and Chest.

BACKGROUND: Few studies have evaluated the safety and efficacy of treatment of cosmetic dorsal hand and chest/breast veins. OBJECTIVE: To retrospectively evaluate results of dorsal hand and chest vein foam sclerotherapy. MATERIALS AND METHODS: A retrospective chart review of dorsal hand and chest vein sclerotherapy patients at a dermatology practice was performed between January 2014 and April 2023. RESULTS: Fifty-five patients (54 female and 1 male patients) with a mean age of 55.8 ± 10.5 (31-83) years underwent treatment. Mean number of sessions for dorsal hand ( n = 41) and chest ( n = 14) patients were 1.5 ± 0.9 (1-5) and 1.6 ± 1.2 (1-5), respectively. Both groups were predominantly treated with 0.2% sodium tetradecyl sulfate or 0.5% polidocanol foam. Rate of coagulum formation across all sessions in the dorsal hands and chest was 15.2% and 3.0%, respectively. Vein induration, edema, postsclerotherapy hyperpigmentation, and persistent erythema were rarely seen. No patients experienced superficial venous thrombophlebitis, erosion/ulceration, telangiectatic matting, or neurologic side effects. Seventy-five percent and 63.2% of chest and hand patients, respectively, demonstrated significant clinical improvement at 3-month follow-up, although not systematically evaluated. CONCLUSION: Foam sclerotherapy of dorsal hand and chest veins with detergent sclerosing agents is safe and effective with mild, self-limited adverse events.

Calcium Hydroxylapatite-Induced Inflammatory Facial Edema and Induration Due to Hashimoto's Thyroiditis.

We describe a patient who experienced a diffuse, treatment-refractory facial inflammatory reaction following the injection of calcium hydroxylapatite with lidocaine. The reaction was attributed to undiagnosed Hashimoto's thyroiditis. Exogenous thyroid hormone replacement therapy rapidly resolved the facial inflammation associated with this type of autoimmune hypothyroidism.

Prospective Study of 532-nm Picosecond Laser for the Treatment of Pigmented Lesions of the Face and Dorsal Hands.

BACKGROUND: Pigmented lesions from chronic UV photoaging are extremely common on the face and hands. OBJECTIVE: To evaluate the safety and efficacy of a 532-nm picosecond laser for these types of pigmented lesions. METHODS: This was a single-center, prospective, open-label clinical trial. Eligible subjects with pigmentation on the face and hands received 3 monthly treatments, with 1 month (1M) and 3 months (3M) follow-up. Change in investigator-graded overall facial and per lesion pigmentation and subject-graded satisfaction and pigmentation improvement was evaluated by a 5-point scale. Immediate skin response and adverse events (AEs) were evaluated post-treatment. The melanin index was measured using a mexameter. Randomized before and after photographs were graded by 3 blinded physicians for degree of pigmentation improvement. RESULTS: Twenty-five subjects (22F/3M) with Fitzpatrick skin types I-III were enrolled, with 23 subjects completing. Treatments used a 532 nm wavelength, 800 ps pulse duration, 4-6mm spot size, and 0.1 to 0.6J/cm2 fluence. Good-to-excellent clearance at 1M/3M was demonstrated in ≥95% of lesions (n = 116). Only mild treatment-related pain was reported, with transient post-treatment AEs (mean downtime of 2.1 ± 2.0 days) and no serious treatment-related AEs. Subject satisfaction (satisfied or very satisfied) was 95% at 1M and 91% at 3M. CONCLUSION: Treatment with a 532-nm picosecond laser is safe and highly effective for the treatment of the pigmented lesions of the face and dorsal hands.

Submental Area Treatment with ATX-101: Relationship of Mechanism of Action, Tissue Response, and Efficacy.

ATX-101 is an injectable, synthetically derived formulation of deoxycholic acid used for submental fat reduction. Methods: A narrative review of references relevant to the mechanism of action of ATX-101 and its relationship to efficacy and inflammatory adverse events was conducted. Results: When injected into subcutaneous fat, deoxycholic acid physically disrupts adipocyte cell membranes, leading to local adipocytolysis, cell death, and a mild, local inflammatory reaction consisting of macrophage infiltration and fibroblast recruitment. At Day 28 postinjection, inflammation largely resolves, and key histologic features include fibrotic septal thickening, neovascularization, and atrophy of fat lobules. Based on the mechanism of action of ATX-101 and the demonstrated inflammatory response, localized inflammation and swelling are expected following treatment. Indeed, postinjection swelling and other local injection-site events, including pain, erythema, and bruising, are common during and after treatment. Because of inflammatory sequelae following injection, reduction in submental fat is gradual and may require months before the full response is apparent. Patients may also require multiple treatment sessions to achieve their treatment goals. Repeated treatments may result in less pain and swelling over time owing to a combination of factors, including less target tissue allowing for lower doses/injection volumes, persistent numbness, and greater tissue integrity from thickened fibrous septa. Conclusions: Physicians can manage expectations by counseling patients that, based on the mechanism of action of ATX-101 and data from pivotal clinical trials, ATX-101 treatment results in localized inflammation/swelling and gradual submental fat reduction. Patient education about common local adverse events is critical.

AbobotulinumtoxinA Treatment of Glabellar Lines Using a New Reconstitution and Injection Volume: Randomized, Placebo-Controlled Data.

BACKGROUND: Increasing the reconstitution and injection volumes of abobotulinumtoxinA (aboBoNT-A) could provide more options for aesthetic healthcare professionals. OBJECTIVE: To evaluate efficacy and safety of aboBoNT-A treatment of moderate-to-severe glabellar lines (GL) versus placebo, using a new reconstitution and injection volume. Methods & Materials: In this 6-month, Phase III, randomized, double-blind study, subjects 18-64 years were administered aboBoNT-A 50 U (N=224) or placebo (N=77), as five 0.1-mL-injections (10 U) in the glabellar region following reconstitution of a 300-U-vial in 3 mL. Assessments included time to onset of effect, investigator- (ILA) and subject- (SSA) assessed GL severity, subject satisfaction, aesthetic improvement and safety. The primary endpoint was composite 2-grade response at month 1 (a GL severity of none-or-mild at maximum frown and ≥2-grade improvement from baseline concurrently on both ILA and SSA). RESULTS: Median time to onset was 2 days, 34% of subjects reporting effect on day 1. At month 1, the composite 2-grade responder rate was 65.8% for aboBoNT-A versus 0% for placebo, P<0.001, 91–92% had none-or-mild GL severity, and 95–100% had a ≥1-grade GL severity improvement. A ≥1-grade improvement was sustained in 46-56% of aboBoNT-A-treated subjects up to 6 months (P<0.001 vs placebo). Aesthetic improvement and subject satisfaction were high throughout 6 months and aboBoNT-A treatment was well tolerated. CONCLUSION: Safety and efficacy of GL treatment using 0.1 mL (10 U) aboBoNT-A per injection site were demonstrated, with rapid onset and up to 6 months’ duration of effect. Severity improvement was accompanied by sustained aesthetic improvement and subject satisfaction. J Drugs Dermatol. 2021;20(9):988-995. doi:10.36849/JDD.6130.

Ultrasound-guided foam sclerotherapy is safe and effective in the management of superficial venous insufficiency of the lower extremity.

BACKGROUND: Superficial venous disease of the lower extremity has a significant impact on quality of life. Both truncal and tributary vein reflux contribute to this disease process. Endovenous foam sclerotherapy is a widely used technique throughout the world for the management of superficial venous reflux and ultrasound guidance improves its safety and efficacy. METHODS: A PubMed search for ultrasound-guided foam sclerotherapy (UGFS) was conducted and all abstracts were reviewed to identify clinical trials and systematic reviews for a full-text analysis. Additional articles were also identified through searching the references of the selected studies. RESULTS: The production of foam for sclerotherapy in a 1:3 or 1:4 ratio of air to sclerosant is optimal in a low silicone, low-volume syringe system. Physiologic gas may decrease any side effects, with the trade-off of decreased foam stability. Proper technique with appropriate sterility and cleansing protocols are paramount for safe and effective treatment. The technical success of UGFS for great saphenous vein disease is inferior to endothermal and surgical modalities and retreatment is more common. However, the clinical improvement in patient-reported quality of life is similar between these three modalities. When used for tributary veins in combination with endothermal approaches of the truncal veins, UGFS has high rates of success with excellent patient satisfaction. UGFS has demonstrated an excellent safety profile comparable with or superior to other modalities. CONCLUSIONS: With proper technique, UGFS is safe and effective for the management of superficial venous disease.

Cutaneous Manifestation as Initial Presentation of Metastatic Breast Cancer: A Systematic Review.

Metastatic breast cancer initially may present with cutaneous lesions. The goal of this systematic review was to evaluate available reports where the initial discovery of primary breast cancer occurred through the diagnosis of metastatic cutaneous lesions. We aimed to better understand these cases and the role of dermatologists in their diagnosis. A review of the literature for case reports and retrospective studies was conducted using the following databases: MEDLINE/PubMed, EMBASE, Cochrane library, CINAHL, and EBSCO. The PRISMA guidelines were utilized. Studies were included if they reported a cutaneous metastasis of a primary breast cancer in females. Studies were excluded if skin metastasis occurred in a patient with a history of breast cancer. Thirty-six publications were identified. Among these, 27 were case reports, and 9 were retrospective reviews. An enhanced understanding of how these cutaneous metastases present may be of clinical benefit to physicians, particularly dermatologists.

Efficacy and Safety of Intense Pulsed Light With a KTP/PDLlike Filter for the Treatment of Facial Telangiectasias.

BACKGROUND: An intense pulsed light (IPL) narrowband "KTP/PDL-like" filter (525–585 nm) may combine the tolerability of the IPL with the precision of KTP and PDL lasers. This study evaluated the impact of IPL with a KTP/PDL-like filter on telangiectasias. METHODS: This was a single-center, prospective study of 17 subjects with facial telangiectasias and skin types I–III. Three monthly treatments were performed using this specific filter, with follow-up visits at 1, 3, and 6 months. Telangiectasia improvement was assessed by the investigator and subjects using a 5-point scale. Facial photographs and safety assessments were obtained at each visit. Subject discomfort was evaluated using a visual analog scale (VAS) immediately posttreatment, and subject downtime was recorded at each subsequent visit. RESULTS: All facial telangiectasias significantly improved. At 1-month follow-up, >50% lesion clearance was noted in 97.1% of facial (n=36) and 85.7% of non-facial (n=7) lesions, with 73% of subjects satisfied or very satisfied. An increase in mean social downtime (0, 2.3, and 3 days) and VAS scores (3.5, 4.5, and 4.8) with treatments 1, 2, and 3, respectively, mirrored a stepwise increase in fluence with subsequent sessions. CONCLUSIONS: The use of a novel IPL narrowband KTP/PDL-like filter can significantly improve facial and non-facial telangiectasias with minimal downtime. J Drugs Dermatol. 2020;19(9):844-850. doi:10.36849/JDD.2020.4834.

An expert panel consensus on opioid-prescribing guidelines for dermatologic procedures.

BACKGROUND: Opioid overprescribing is a major contributor to the opioid crisis. The lack of procedure-specific guidelines contributes to the vast differences in prescribing practices. OBJECTIVE: To create opioid-prescribing consensus guidelines for common dermatologic procedures. METHODS: We used a 4-step modified Delphi method to conduct a systematic discussion among a panel of dermatologists in the fields of general dermatology, dermatologic surgery, and cosmetics/phlebology to develop opioid prescribing guidelines for some of the most common dermatologic procedural scenarios. Guidelines were developed for opioid-naive patients undergoing routine procedures. Opioid tablets were defined as oxycodone 5-mg oral equivalents. RESULTS: Postoperative pain after most uncomplicated procedures (76%) can be adequately managed with acetaminophen and/or ibuprofen. Group consensus identified no specific dermatologic scenario that routinely requires more than 15 oxycodone 5-mg oral equivalents to manage postoperative pain. Group consensus found that 23% of the procedural scenarios routinely require 1 to 10 opioid tablets, and only 1 routinely requires 1 to 15 opioid tablets. LIMITATIONS: These recommendations are based on expert consensus in lieu of quality evidence-based outcomes research. These recommendations must be individualized to accommodate patients' comorbidities. CONCLUSIONS: Procedure-specific opioid prescribing guidelines may serve as a foundation to produce effective and responsible postoperative pain management strategies after dermatologic interventions.

Efficacy and safety of intense pulsed light with a KTP filter for the treatment of solar lentigines.

BACKGROUND: Optical energy-based devices, including intense pulsed light (IPL) and potassium titanyl phosphate (KTP) lasers achieve reduction of pigmented and vascular lesions in a relatively similar number of treatments. This study aimed to evaluate the efficacy and safety of an IPL with a "KTP-like" filter emitting a wavelength of 525-585 nm for the treatment of solar lentigines on the hands and face. METHODS: This was a single center, prospective, open-label clinical trial including 16 healthy Caucasian subjects (15 females, mean age, 55 years; skin types II and III) with hand and facial solar lentigines. Subjects were treated with three IPL treatment sessions with a KTP-like filter conducted at monthly intervals. Follow-up evaluations were performed 1, 3, and 6 months after the last treatment session. Overall pigmentation improvement, pigmentation clearance per lesion, adverse events, and subject tolerability to treatment were evaluated. RESULTS: Significant improvements in facial and hand pigmentation were noted at all follow-up visits (P < 0.0001). One month after the last treatment session, good to excellent outcomes were noted in 74.6% of treated facial areas and 90% of treated hand regions. Although the effect of treatment gradually declined in both treatment regions over the 6-month follow-up period, over 60% of subjects demonstrated good to excellent results at the study end. Clinical effectiveness was further confirmed by the reduction in Melanin Index (MI) following each treatment as compared to baseline. Downtime and complications were minimal. CONCLUSIONS: IPL treatment with a KTP-like filter is a well-tolerated and effective method for reducing facial and hand pigmentation. Lasers Surg. Med. 51:500-508, 2019. © 2019 Wiley Periodicals, Inc.

Cryolipolysis for Noninvasive Contouring of the Periumbilical Abdomen With a Nonvacuum Conformable-Surface Applicator.

BACKGROUND: Although most cryolipolysis treatments are performed with vacuum applicators, some patients may have areas of fibrous, nonpinchable fat or find vacuum suction to be uncomfortable. OBJECTIVE: This study evaluates a nonvacuum conformable-surface applicator for cryolipolysis of the periumbilical abdomen. METHODS/MATERIALS: Twenty subjects with periumbilical subcutaneous fat were treated with a nonvacuum cryolipolysis applicator in this prospective, single-center, open-label clinical trial. Each subject underwent a single treatment cycle with an optional second treatment 10 weeks later. Efficacy was evaluated by blinded review of digital photographs. Subject satisfaction was assessed at 10-week follow-up. RESULTS: Twenty subjects completed one treatment, of which 6 underwent the optional retreatment. Independent review demonstrated 77% correct identification of baseline photographs after one treatment, which improved to 100% after a second treatment. Patient questionnaires after one treatment revealed 50% satisfaction, with 60% willing to recommend the procedure and 60% reporting visible fat reduction. After second treatment, however, 100% were satisfied, 83% were willing to recommend, and 100% reported visible fat reduction. CONCLUSION: Cryolipolysis with a nonvacuum conformable-surface applicator is safe, effective, and well tolerated for noninvasive reduction of fibrous periumbilical abdominal fat. Efficacy and subject satisfaction is significantly greater with 2 treatments than with a single session.

Progressive Facial Papules in an African-American Patient: An Atypical Presentation of Seborrheic Dermatitis.

This case report highlights a unique variant of seborrheic dermatitis (SD) in a 30-year-old African-American woman with progressive facial papules. Four weeks of uninterrupted mild potency topical corticosteroid therapy produced marked improvement of signs and symptoms of biopsy-confirmed SD. SD mimicking cutaneous sarcoidosis is a unique treatment-responsive variant of SD that may be more likely to be encountered in African-American patients.