A review of nonsurgical facial rejuvenation and the role of oxymetazoline hydrochloride ophthalmic solution, 0.1% in periorbital revitalization.

BACKGROUND: The demand for nonsurgical facial rejuvenation options is growing, yet the periorbital region remains an area of relative unmet need. This review explores nonsurgical options for facial rejuvenation and the role of oxymetazoline hydrochloride ophthalmic solution, 0.1%, in treating age-related blepharoptosis as part of periorbital rejuvenation. METHODS: Advisors experienced in facial rejuvenation met to discuss existing literature on the upper face and periorbital rejuvenation and the role of oxymetazoline hydrochloride ophthalmic solution, 0.1%, in treating facial aging. RESULTS: An array of nonsurgical options exist to address the signs of aging, including minimally invasive treatments, such as botulinum toxin injections and dermal fillers, and noninvasive therapy, such as lasers, chemical peels, and microdermabrasion. However, treating age-related ptosis in periorbital rejuvenation is mainly addressed surgically. The newly approved α-adrenergic receptor agonist oxymetazoline hydrochloride ophthalmic solution, 0.1%, provides a novel non-interventional approach to blepharoptosis. CONCLUSIONS: Facial rejuvenation is highly sought-after in this post-pandemic era. Each nonsurgical treatment option has its advantages and drawbacks. A patient-centered approach is necessary to select the appropriate procedure considering the patient's concerns and aesthetic sensibilities. The eyes are an area of primary concern for patients, yet surgery is the gold standard for treating ptosis. Oxymetazoline hydrochloride ophthalmic solution, 0.1%, is a safe and effective nonsurgical treatment for blepharoptosis.

Treatment of mild to severe acne with 1726 nm laser: A safe alternative to traditional acne therapies.

INTRODUCTION: Acne is the most common reason for dermatology consultation in adolescents and young adults. Consultation is often delayed despite unsuccessful self-treatment. Postponing effective treatment places acne sufferers at higher risk for permanent acne scars and post-inflammatory pigment changes. AIM: This review discusses clinical challenges with present therapeutic options for acne treatment and the role of a 1726 nm laser for acne. METHODS: Current acne treatment guidelines were reviewed. A literature review was conducted for trials of light-based acne therapy. The selectivity of previous light-based therapies was reviewed. RESULTS: Available acne therapy is effective, but treatment-related side effects are common. Acne treatment guidelines do not include recommendations for light-based treatments. Different types of light-based treatments have been tried but until now no wavelength specifically targeted sebaceous glands. CONCLUSION: The 1726 nm laser is safe and effective for treating mild to severe acne in all Fitzpatrick skin types. Acne resolution is apparent within the first month and improves for up to 2 years beyond treatment.

Patient safety in dermatologic surgery: Part I. Safety related to surgical procedures.

Surgical procedures involve unique elements related to patient safety. One must be aware of potential complications and safety issues within the practice of dermatologic surgery. Developing a high level of competence in skin surgery will address some safety issues, while implementing protocols and redundancies provides systems-based correction for other safety issues. We provide an in-depth review of patient safety in dermatologic surgery. In particular, we highlight the most common safety issues and methods for reducing error.

Patient safety in procedural dermatology: Part II. Safety related to cosmetic procedures.

Cosmetic procedures are growing in popularity and are associated with unique risks. Considering potential complications and prioritizing patient safety will help practitioners improve outcomes of elective procedures. In part II of this continuing medical education article, we provide a comprehensive review of patient safety in cosmetic procedures, including medical and legal issues surrounding the supervision and training of physician extenders.

Assessment of safety and efficacy of a bipolar fractionated radiofrequency device in the treatment of periorbital rhytides.

Bipolar radiofrequency (RF) has been used to treat photodamage. Periorbital rhytides are often difficult to treat. In this study bipolar RF was assessed in the 20 subjects, who are in treatment of periorbital rhytides and it was proved that it can successfully treat the periorbital rhytides.

Radiofrequency in cosmetic dermatology: a review.

BACKGROUND: Fine lines and rhytides are clinically evident signs of photodamage. Traditionally, ablative and nonablative lasers have been used for nonsurgical facial rejuvenation, but their side effects and downtime have limited their use. OBJECTIVE: Radiofrequency (RF) is novel nonablative technology originally used to target photodamage. It differs from lasers in that it uses an electric current rather than a light source. It is frequently used in dermatology to treat skin laxity, rhytides, acne vulgaris and scarring, and cellulite. The goal of this review is to summarize the various types of RF devices and their uses and to determine the evidence-based efficacy of these devices. MATERIALS AND METHODS: This article reviews the current literature on RF, its uses and clinical effectiveness, and a practical guide for application of the assorted RF devices. RESULTS AND CONCLUSION: Results have been favorable for the different clinical uses of RF, but many studies are nonrandomized, noncomparative trials that use subjective means of evaluation. Overall, nonablative RF is a safe, tolerable, and effective tool for skin rejuvenation and cellulite treatment that produces modest results. RF should serve as an alternative but not as an equivalent substitute to surgery.

Necrolytic migratory erythema associated with a metastatic neuroendocrine tumor.

Necrolytic migratory erythema (NME) is a skin condition historically associated with pancreatic glucagonomas. Rarely it occurs in the absence of a pancreatic tumor, which has been described as pseudoglucagonoma syndrome. We describe a woman with a metastatic neuroendocrine tumor who developed NME 6 years after diagnosis of the tumor. Her laboratory data revealed essential fatty acid deficiency and a high level of glucagon. Although the pathogenesis of NME is not completely understood, zinc, essential amino acid, and fatty acid deficiencies have all been postulated as possible causative factors.

Effect of intravenous immunoglobulin with or without cytotoxic drugs on pemphigus intercellular antibodies.

BACKGROUND: Intravenous immunoglobulin (IVIg)--a relatively new approach to treat pemphigus--lowers serum levels of pemphigus antibodies; however, the optimal way to use this agent is unknown. OBJECTIVE: We sought to examine whether coadministration of a cytotoxic drug to patients with pemphigus improves the ability of IVIg to decrease serum levels of intercellular (IC) antibodies. METHODS: In this retrospective study, we analyzed changes in IC antibody levels in 20 patients with pemphigus who were treated with 24 courses of IVIg administered alone (n = 10) or with a cytotoxic drug (n = 14). Each course of IVIg consisted of 400 mg/kg daily of immunoglobulin given over 5 days every other week; this cycle was repeated 3 to 4 times. Serum levels of IC antibodies were measured at baseline, before treatment, and 1 week and 1 month after the last IVIg cycle. RESULTS: One week after the last IVIg cycle IC antibodies decreased by an average of 77% in the group treated with IVIg and cytotoxic drug compared with 48% in the group treated with IVIg alone (P = .54), and by 90% versus 43% 1 month later (P = .03). LIMITATIONS: A larger sample size is suggested for future studies. CONCLUSIONS: These observations confirm that IVIg can rapidly lower serum levels of autoantibodies in patients with pemphigus and its ability to do so is improved by the coadministration of a cytotoxic drug. These findings imply that the clinical effectiveness of IVIg in treating pemphigus, and possibly other autoantibody-mediated diseases, may be improved by the concurrent administration of a cytotoxic drug.

Acne and systemic disease.

Acne is the most common disease of the skin. It affects 85% of teenagers, 42.5% of men, and 50.9% of women between the ages of 20 and 30 years.96,97 The role of hormones, particularly as a trigger of sebum production and sebaceous growth and differentiation, is well known. Excess production of hormones, specifically androgens, GH, IGF-1, insulin, CRH, and glucocorticoids, is associated with increased rates of acne development. Acne may be a feature in many endocrine disorders, including polycystic ovary disease, Cushing syndrome, CAH, androgen-secreting tumors, and acromegaly. Other nonendocrine diseases associated with acne include Apert syndrome, SAPHO syndrome, Behçet syndrome and PAPA syndrome. Acne medicamentosa is the development of acne vulgaris or an acneiform eruption with the use of certain medications. These medications include testosterone, progesterone,steroids, lithium, phenytoin, isoniazid, vitamins B2, B6, and B12, halogens, and epidermal growth factor inhibitors. Management of acne medicamentosa includes standard acne therapy. Discontinuation of the offending drug may be necessary in recalcitrant cases. Basic therapeutic interventions for acne include topical therapy, systemic antibiotics,hormonal agents, isotretinoin, and physical treatments. Generally, the severity of acne lesions determines the type of acne regimen necessary. The emergence of drug-resistant P acnes and adverse side effects are current limitations to effective acne management.

Drug-resistant herpes simplex virus in HIV infected patients.

Herpes simplex virus type 2 (HSV2) infection is a major source of morbidity in human immunodeficiency virus (HIV)-infected patients, since reactivations - whether symptomatic or asymptomatic - are associated with increased HIV viral load and viral shedding. Acyclovir, valacyclovir and famcyclovir are indicated for the treatment of HSV2 in HIV patients. This class of drugs has been shown to enhance survival in HIV-infected individuals. However, with the emergence of drug-resistant strains of HSV2, the rates of resistance among HIV patients are almost ten-fold those in immunocompetent individuals, comparing 0.6% to 6%. These HSV2 infections tend to be more severe and to recur. More ominously, disease progression of HIV is promoted by concurrent infection with HSV2. Intravenous foscarnet and cidofovir may be used for acyclovir-resistant HSV; however, resistance to these drugs has been documented. Newer therapies such as the toll-like receptor agonist imiquimod and immunomodulating dipeptides offer promise for the treatment of HSV2 in HIV-infected individuals.

Treatment of disseminated superficial actinic porokeratosis (DSAP) with the Q-switched ruby laser.

BACKGROUND: Disseminated superficial actinic porokeratosis (DSAP) is one clinical subtype of porokeratosis, a cutaneous disorder of keratinization. A variety of approaches may be used to treat DSAP. The ruby laser appears to be a promising option for DSAP treatment. Traditionally, the ruby laser is used to treat hair removal and lesions involving hyperpigmentation. Its use may be further applied to treat the hyperpigmented lesions of DSAP. OBJECTIVE: This study examines the efficacy of the ruby laser in treating a case of DSAP. METHODS: A 48-year-old female, with a history of pseudoxanthoma elasticum and DSAP, received three Q-switched ruby laser treatments (694 nm) to over 50 sites on the lower and upper extremities. Clinical outcome and patient satisfaction was followed-up. RESULTS: Minimal to moderate erythema and appropriate whitening was noted after each treatment. The patient tolerated treatments well and hyperpigmentation and erythema of the majority of the lesions decreased. The patient was very pleased with the results and reports satisfactory cosmetic outcome 3 months later. CONCLUSION: The results obtained from the current case suggests that the ruby laser is moderately successful in treating DSAP and may still provide a good alternative to other available treatments. Further studies are needed to investigate the potential of combined ruby laser treatment for DSAP and to determine the appropriate laser pulse duration and fluence for effective treatment.

Paradoxical effects of hair removal systems: a review.

Although a variety of lasers have proven to be clinically effective for long-term hair removal, the use of these lasers has also been associated with undesirable side effects, such as hyper- and hypopigmentation, crusting, erythema, and edema. One notable side effect that seems to be underreported in the literature is the growth of fine dark hair in untreated areas close to the treated ones. This contradictory hypertrichosis is known as the paradoxical effect. In this paper, we review the published reports of the paradoxical effect and offer some possible explanations for this effect. The paradoxical effect has been documented most commonly after the use of induced pulse light and alexandrite lasers. One possible explanation is the activation of dormant hair follicles by suboptimal fluences. Another mechanism may be the synchronization of hair growth cycles by direct light stimulation.