Cosmetic Laser Procedures in Latin Skin

Hispanics/Latinos are one of the fastest growing segments in the skin of color population in the United States. Utilization of lasers especially in people with skin of color requires a thorough understanding of laser physics and laser tissue interactions. In this article, we will outline the different lasers used in our practice based on each chromophore. Pretreatment recommendations as well as management of complications will also be shortly discussed. Our goal is for the readers to grasp the importance of proper device selection, understand the concept of selective photothermolysis, and the various treatment parameters required for optimal safety and efficacy. J Drugs Dermatol. 2019;18(3 Suppl):s127-131.

Sunscreens causing cancer? The facts.

Recent reports about sunscreen safety have received widespread media attention with headlines on many news broadcasts and Web sites claiming, "Your sunscreen may be giving you cancer." Are claims that deem sunscreens unsafe true? Do the potential risks of sunscreen use outweigh the benefits? As dermatology residents, what do you tell your patients? This article addresses 2 major concerns by providing a critical analysis of the available evidence-based data as well as additional resources for further exploration.

Yoga for dermatologic conditions.

As both a dermatology resident and yoga instructor, I find the potential correlation between the 2 disciplines to be interesting and a growing topic of attention in the media today. With the rising trend of practicing yoga, which encompasses physical postures, breathing exercises, and meditation or mindfulness, it is inevitable that patients will inquire about the benefits of yoga in managing dermatologic problems. In this column, I will discuss the dermatologic manifestations of stress as well as the known health benefits of yoga as described in the literature so that residents may offer an objective opinion about yoga in response to patient inquiries.

Alopecia areata with white hair regrowth: case report and review of poliosis.

Alopecia areata is thought to be a T-cell mediated and cytokine mediated autoimmune disease that results in non-scarring hair loss. Poliosis has been described as a localized depigmentation of hair caused by a deficiency of melanin in hair follicles. A 57-year-old man with a history of alopecia areata developed white hair regrowth in areas of previous hair loss. We retrospectively reviewed the medical literature using PubMed, searching: (1) alopecia areata and (2) poliosis. Poliosis may be associated with autoimmune diseases including alopecia areata, as described in our case. However, it is also reported in patients who have cutaneous lesions, genetic syndromes, infections, medication use, and trauma. Hair regrowth following alopecia areata may be associated with poliosis. We hypothesize that the incidence of poliosis in areas of previous alopecia areata-related hair loss may be greater than reflected in the published literature.

Gefitinib-associated vitiligo: report in a man with parotid squamous cell carcinoma and review of drug-induced hypopigmentation.

Gefitinib is a tyrosine kinase inhibitor that targets and inhibits epidermal growth factor receptors. It was initially used to treat non-small cell lung cancer but has increasingly been used for other solid tumors such as those in the breast, colorectal sites, and head and neck, as in our patient. Vitiligo is an autoimmune disorder that results in the destruction of melanocytes and subsequent skin depigmentation and hypopigmentation. Previously described mucocutanous side effects of gefitinib at 250-500 mg/day include alopecia, asteatotic dermatitis, desquamation, hyperpigmentation, papulopustular acneiform eruption, pruritus, seborrheic dermatitis, and skin fragility. A 54-year-old man with metastatic squamous cell carcinoma to the parotid gland developed vitiligo within 1 month of starting gefitinib therapy. We retrospectively reviewed the medical literature using PubMed, searching: (1) gefitinib side effects, (2) drugs and (3) vitiligo. The patient with gefitinib-induced vitiligo continued to receive treatment with the drug during which time areas of skin hypopigmentation persisted and progressed. Etiology of drug-induced vitiligo includes alopecia areata therapies, anticonvulsants, antimalarials, antineoplastics, anti-Parkinson medications, and other miscellaneous drugs. No other individuals have been described with gefitinib-induced vitiligo. Albeit rare, gefitinib may be associated with the development of vitiligo.

Resident involvement in policy-making.

Politics greatly affect how physicians practice medicine. As dermatology residents, it is vital that we familiarize ourselves with the role of the American Academy of Dermatology Association in policy-making as well as opportunities for residents to help shape the future of our specialty.

Allergic contact dermatitis for residents.

Allergic contact dermatitis (ACD) is a very common skin disease faced by dermatologists. As residents, it is essential that we learn to appropriately diagnose and manage ACD and utilize helpful resources early on in our training.

Utility of a dermatology interest group blog: the impact of medical student interest groups and Web 2.0 tools as educational resources.

The open access University of Texas Dermatology Interest Group blog was established in 2004 for the purposes of increasing communication and collaboration between medical students and dermatology faculty, residents, and alumni, as well as to promote educational opportunities and the missions for which the interest group was created. This blog is unique because of its longevity and continuous postings directed toward the educational and professional needs of medical students and residents. A blog user survey was performed to assess viewers' thoughts, purpose of viewing, demographic profile, subscriber status, usage of the blog and other Web 2.0 tools (forums, Facebook, blogs, Twitter, podcasts), and perceived usefulness. Sixty-one anonymous online surveys were completed during a 1-month period. Statistical analyses of the responses demonstrated that the utilization of web-based tools and the blog were valuable resources for students, especially for blog subscribers, those more involved in an interest group, and those reading the blog for a longer period of time. The usefulness and impact of this method of communication and dissemination of information in medical education may encourage other student groups, faculty advisors, and educators to implement similar educational tools at their institutions.

An outbreak of Candida albicans folliculitis masquerading as Malassezia folliculitis in a prison population.

Several inmates from a non-air-conditioned prison were sent to the University of Texas Medical Branch dermatology clinic for unexplained eruptions not responding to various treatments. They were initially diagnosed with Malassezia folliculitis based on clinical examination and histological findings. The patients' cultures from skin scrapings, however, revealed Candida albicans confirmed by growth on Mycosel agar and further by the germ tube production method. Five cases were brought to the clinic, but at least 30 other inmates were reported to have similar cutaneous eruptions. Given that these patients were generally immunocompetent, this is a rare finding. Factors favoring pseudohyphal growth for these patients included use of topical steroids and/or systemic antibiotics and hot and humid climate. All patients' folliculitis resolved with fluconazole and/or antifungal cream with no further complications.

Emergency ECT in an incapacitated, medically compromised patient with Huntington's disease.

Electroconvulsive therapy (ECT) is infrequently considered an "emergency" medical procedure; however, there are certain conditions in which there is considerable urgency to initiate ECT. For example, prompt administration of ECT to treat neuroleptic malignant syndrome and malignant catatonia is necessary to improve a patient's overall prognosis and potentially save the patient's life. In this case, a 57-year-old woman with Huntington's disease was admitted to our medical intensive care unit for failure to thrive due to severe psychotic symptoms. Prior to her admission, the patient had become increasingly psychotic and agitated, resulting in her refusal and/or inability to eat. Efforts to treat her severe psychiatric and behavioral symptoms with various psychopharmacological strategies were largely unsuccessful. As the patient's physical health continued to decline, with loss of approximately 35 pounds over 2 months, her family began making arrangements to transfer her to a hospice facility. The day before she was to be transferred, the psychiatry consultation-liaison service recommended ECT. Unfortunately, this recommendation was complicated because the patient was unable to provide consent. This case report describes the legal and administrative process used to ethically and legally administer ECT without consent from the patient or a court-appointed guardian in order to treat a life-threatening condition. To the best of our knowledge, this report documents the first time ECT has been granted "medical emergency" status in Texas.

Medical student Dermatology Interest Groups.

The Dermatology Interest Group (DIG) at the University of Texas Medical Branch (UTMB) blog (digutmb.blogspot.com) was created in 2004 with the aims of increasing communication and collaboration among students, faculty, residents, and alumni, promoting educational opportunities, and fostering the missions for which DIG was created. This blog is unique, because its frequent activity is directed toward the educational and professional needs of medical students and residents. We assessed the use of this blog by evaluating the number of blog views and audience members with relationship to the number of posts and post content over time via a tracking system. We found that there has been an increase in blog posts, views, and subscribers, as well as in areas of post content including dermatology resources/news/articles, residency applications, and resident-related information. Usefulness of such posts expands beyond UTMB students, which increases blog views and widens viewer audience. An international viewer population also was evaluated. Recorded blog viewing time was 1 minute, 57 seconds, which is more time than needed to read a post, suggesting use of additional blog information. This review of the DIG at the UTMB blog demonstrates how the use of web-based tools, in addition to the inherent benefits of medical student interests groups, are valuable resources for students, residents, and faculty.