Application of bimatoprost ophthalmic solution 0.03% for the treatment of eyebrow hypotrichosis: series of ten cases.

In December 2008, bimatoprost ophthalmic solution 0.03% was approved in the United States for the treatment of hypotrichosis of the eyelashes. Since then, there have been several reports in the literature on the off-label use of bimatoprost ophthalmic solution 0.03% for the treatment of thinning in other hair bearing areas, such as in the eyebrows and in the scalp. Herein, a prospective pilot study is presented in which bimatoprost ophthalmic solution 0.03% is evaluated for helping to re-grow hair in the eyebrow region of ten female patients.

Is white coat hypertension a concern in Mohs micrographic surgery?

OBJECTIVE: To examine white coat hypertension (WCHTN) in patients presenting for Mohs micrographic surgery (MMS) to determine whether it should be a concern. METHODS: In this prospective study, blood pressure (BP) was recorded in 100 consecutive patients who presented for MMS consultation and a subsequent MMS procedure, and compared on both days. Statistical analysis was performed using the paired Student t test and the significance of the findings was determined based on the corresponding P values. Progression from normotensive to hypertensive state while the doctor was in the room was stratified based on the patient's age, gender, and histories of smoking, hypertension (HTN), diabetes, and hyperlipidemia; as well as whether the doctor was wearing a white lab coat over blue surgical scrubs (50 patients) or blue surgical scrubs alone (50 patients). RESULTS: BP increased from baseline when the doctor entered the room and then decreased towards baseline after five minutes of the doctor being present. Elevation in BP was more evident in younger people, males, and those with HTN and hyperlipidemia. BP was slightly higher on the day of the consultation than on the day of the procedure. A higher number of patients became hypertensive when the doctor wore a white lab coat over blue surgical scrubs vs blue surgical scrubs alone. However, these changes in BP did not prove to be statistically significant. CONCLUSION: Brief periods of WCHTN were seen on both days. However, these elevations in BP were not statistically significant and decreased towards baseline after five minutes. There were no cases in which elevation in BP associated with WCHTN was sufficient to result in the need to postpone or cancel MMS.

Evaluation of the chemopreventative effects of ALA PDT in patients with multiple actinic keratoses and a history of skin cancer.

BACKGROUND: Actinic keratoses (AKs) are in situ epidermal tumors that may progress to invasive squamous cell carcinomas (SCCs). Aminolevulinic acid with photodynamic therapy (ALA PDT) is a field treatment for AK. OBJECTIVE: To evaluate the time to development of new non-melanoma skin cancers (NMSC) within one year of ALA-PDT treatment in immunocompetent patients with AK and a history of skin cancer. METHODS AND MATERIALS: One hundred forty anatomic sites in 114 patients were treated with topical ALA for a 1 to 3 hour incubation period followed by photodynamic therapy (PDT) with a blue light. All new NMSCs within the treatment areas were recorded over a 1-year observational period. RESULTS: Eighty-three anatomic sites (59%) did not develop new skin cancers within 1 year. Additionally, 92%, 78%, and 64% of anatomic sites were free of new skin cancers at 3, 6, and 9 months after treatment was initiated. Although approximately 41% of patients treated on both the scalp and face developed new skin cancers within 1 year of treatment, the average time to develop skin cancer was longer for the face (7.09 months) than for the scalp (5.34 months). CONCLUSION: In patients with a history of NMSC and multiple AKs, ALA PDT may be a valuable option for the prevention and delay of new NMSCs.

An unusual presentation of idiopathic basal cell carcinoma in an 8-year-old child.

We report the unusual case of a young child who developed an idiopathic basal cell carcinoma (BCC). The patient was otherwise healthy, with no history of excessive sun or radiation exposure or any predisposing factors for nonmelanoma skin cancer. This is a rare case that exemplifies the need for pediatricians and dermatologists to be aware that BCC may occur in children, even if they have no predisposing factors.

Treatment of Nevus of Ota in Fitzpatrick skin type VI with the 1064-nm QS Nd:YAG laser.

BACKGROUND: Nevus of Ota is a pigmented lesion that usually presents at birth. Due to a greater risk for complications, physicians have not always utilized laser therapy to treat these nevi in patients with darker skin types. OBJECTIVE: To evaluate the safety and efficacy of the 1,064-nm Q-switched neodymium-doped yttrium aluminium garnet (QS Nd:YAG) laser for the treatment of Nevus of Ota in two patients with Fitzpatrick skin type (FST) VI. RESULTS: After 4-13 treatment sessions with the 1,064-nm Q-switched Nd:YAG laser with a 4 mm spot size and fluence of 4-4.2 J/cm(2), two patients with FST VI noted substantial improvement in the appearance of the nevi. CONCLUSION: At conservative treatment settings, these two case reports have shown that the 1,064-nm QS Nd:YAG laser can be utilized to safely and effectively treat Nevus of Ota in individuals with FST IV-VI.

Laser eradication of pigmented lesions: a review.

BACKGROUND: Pigmented lesions include solar lentigines, seborrheic keratoses, dermatosis papulosa nigra, ephelides, café-au-lait macules, nevus spilus, Becker's nevus, postinflammatory hyperpigmentation, melasma, nevocellular nevi, congenital nevi, junctional and compound melanocytic nevi, nevus of Ota and Ito, Hori's nevus, and blue nevi. Advances in laser technology have resulted in the ability to treat pigmented lesions with greater safety and efficacy. OBJECTIVE: To review the literature on the use of cutaneous laser treatments for pigmented lesions using Medline. RESULTS: The literature cited the use of various lasers to treat pigmented lesions, including argon, carbon dioxide, erbium-doped yttrium aluminum garnet, Q-switched, long-pulsed ruby, alexandrite, diode, and fractional lasers. For each lesion, we describe the efficacy of laser treatments, treatment intervals, and settings used for a variety of diagnoses. CONCLUSION: The treatment of pigmented lesions continues to evolve as new laser technology emerges and improvements in existing devices are made. The ability to treat pigmented lesions with greater efficacy and safety has resulted from recent advances in laser technology.

Same-patient prospective comparison of Botox versus Dysport for the treatment of primary axillary hyperhidrosis and review of literature.

BACKGROUND: Botulinum toxin (BTX) is an effective, FDA-approved treatment for primary axillary hyperhidrosis. In this prospective study, two non-bioequivalent toxins: Botox (Allergan, Irvine, CA, USA) and Dysport (Ipsen Ltd., Slough, Berkshire, UK) were compared for the treatment of primary axillary hyperhidrosis. OBJECTIVE: The objective was to compare the injection site pain, efficacy, safety and tolerability of Botox versus Dysport in the treatment of primary axillary hyperhidrosis using a conversion factor of 1:3, respectively. METHODS: A patient with primary axillary hyperhidrosis was treated with 100 units of Botox into the right axilla and 300 units of Dysport into the left axilla. Patient was blinded as to which axilla received treatment and with which of the two toxins. Pain at the injection site of these two toxins was evaluated. The patient was subsequently followed for the next 10 months to evaluate the difference in these two toxins in regards to side effects, time to the onset of reduction of sweating and the duration of action of these two toxins. RESULTS: Significant difference was observed in the onset of action of these two toxins, with dramatic reduction in sweating being observed after one week of injection with Botox and after two weeks of injection with Dysport. At the two-week time point, similar success in eliminating sweating was reported in both axilla. The duration of benefits also differed between the two toxins, with elimination of sweating in the Dysport-treated axilla lasting six months and, in the Botox-treated axilla, nine months. No other differences were observed between these two toxins. CONCLUSIONS: Both Botox and Dysport led to a similar perceived reduction of sweating in the treatment of primary axillary hyperhidrosis when a conversion factor of 1:3 was used. However, Botox treatment resulted in a quicker onset of action and longer duration of benefits.

595 nm long pulsed dye laser with a hydrocolloid dressing for the treatment of hypergranulation tissue on the scalp in postsurgical defects.

The formation of hypergranulation tissue is an aberrant process that interferes with normal wound healing. Excessive granulation tissue results in the persistence of open wounds. It is resistant to currently available treatment modalities. We report a case series of patients with hypergranulation tissue on the scalp who were successfully treated with a 595 nm pulsed dye laser and hydrocolloid dressing.

Liquid nitrogen: temperature control in the treatment of actinic keratosis.

BACKGROUND: Actinic keratoses (AKs) are in situ epidermal tumors that may progress to invasive squamous cell carcinomas. Liquid nitrogen is used during cryotherapy to freeze the epidermis and upper dermis and is the standard treatment for individual AKs. OBJECTIVE: To evaluate the efficacy of a cryosurgery device incorporating an infrared sensor to measure the temperature at the skin surface while spraying liquid nitrogen on the surface of the skin during the treatment of AKs. METHODS & MATERIALS: Thirty-six patients with 180 thin AKs were treated with liquid nitrogen spray to a temperature of -5°C using the sensor to control the temperature at the skin surface. Patients were evaluated for cure rate, side effects, and healing time. RESULTS: At the 1-week follow-up, 66.7% of the lesions were cleared. By the 6-week follow-up, there was a 100% cure rate. Side effects were limited to redness, blistering, crusting, oozing, and ulceration at the 1-week follow-up and were resolved by the 6-week follow-up. No recurrence of AK, scarring, or hypopigmentation was noted. CONCLUSION: Cryotherapy with an integrated sensor for temperature control is an effective, safe, and precise treatment, allowing for a 100% short-term cure rate of AKs.

Vertical undermining for the closure of partial thickness surgical defects.

Vertical undermining for repair of partial thickness defects is a new effective technique that allows the wound edges of partial thickness defects to be freed and mobilized so that they can be repaired primarily. This technique does not call for the removal of the residual dermis at the base of the wound, allowing for conservation of the healthy tissues. By leaving the partial thickness dermis in place, this technique significantly decreases wound- healing times, as well as leads to improved cosmetic outcomes and increased patient satisfaction.

Keratoacanthomas: overview and comparison between Houston and minneapolis experiences.

Keratoacanthomas represent approximately 1% of skin malignancies treated in a Mohs practice in Houston, TX. The authors compared the age of onset, sex, location and month of prevalence of keratoacanthomas between Houston, TX and Minneapolis, MN. An earlier age of presentation was observed in men in Houston (65.9 years) versus in women (71.3 years) or in men and women in Minneapolis (71 years). There was a predominance of facial tumors in Texas males compared to females and tumors seen in Minneapolis. The tumors occurred more frequently during the winter months in Houston, TX versus June, November and December in Minneapolis, MN.

Folliculocentric lichen sclerosus et atrophicus.

A 71-year-old black woman presented to the dermatology clinic with a several-year history of increasing numbers of itchy white spots spreading over the chest, back, elbows, and legs. In 2004, the patient developed clusters of mildly pruritic hypopigmented and depigmented macules on her back and left shoulder along with depigmented flat papules on the lower extremities. The patient's condition was unresponsive to topical triamcinolone and tacrolimus, after which she was lost to follow-up for 3 years until her entire chest became involved. Her medical history was significant for hypertension and diabetes mellitus and her medications included amlodipine, aspirin, atorvastatin, hydrochlorothiazide, irbesartan, and metformin. Family history, social history, and review of systems were unremarkable. Physical examination revealed multiple shiny white perifollicular macules, some with slight scale, on the trunk (Figure 1) and extremities (Figure 2). On the left shoulder and back were 2 shiny plaques with hypopigmented macules and follicular scale within. Punch biopsies from the abdomen and back showed atrophy of the epidermis, edema and sclerosis of the papillary dermis, and a patchy lichenoid lymphocytic infiltrate (Figure 3). Despite inspecting multiple step sections, we were unable to histopathologically confirm the clinically apparent folliculocentric distribution. Based on the clinical and histological findings, extragenital lichen sclerosus et atrophicus (LSA) was diagnosed and the patient was treated with clobetasol proprionate 0.05% ointment. While being prepared for narrowband UV-B therapy, a serologic screen revealed antinuclear antibodies at 1:640 with a homogeneous pattern. A subsequent rheumatologic evaluation was negative for autoimmune disorders; pertinent negative serologies included anti-double-stranded DNA, smooth muscle, mitochondrial, thyroid, and parietal cell antibodies.

Bilobed flap for reconstruction of defects of the helical rim and posterior ear.

When contemplating the repair of defects involving the ear, second intention healing and full or split thickness skin grafts are often considered for reconstructive choices. Closing the combined full thickness helical rim and posterior ear defects, however, represents a reconstructive challenge because of the lack of available freely mobile skin anteriorly, superiorly, and inferiorly to the defect. The choice of the bilobed flap circumvents this challenge by rotating the skin and recruiting the tissue from the post-auricular sulcus, the lower pole of the posterior ear, and, if necessary, from the superior area of the neck adjacent to the posterior ear. This bilobed flap also enables an inconspicuous closure of the donor site and provides sufficient blood supply to ensure flap viability in a simple one-stage repair. Herein, we describe two cases in which we used the bilobed flap to rotate skin from the post-auricular surface to reconstruct full thickness skin defects involving the helical rim and posterior ear, with excellent cosmetic results.

Pityriasis rubra pilaris sensitive to narrow band-ultraviolet B light therapy.

Pityriasis rubra pilaris (PRP) is a rare skin condition which typically presents in adults as red-orange plaques with islands of sparing, perifollicular keratotic papules, waxy palmoplantar keratoderma, and erythema with fine, diffuse scale. Currently, there are no well-established treatment guidelines for this condition. This is party due to a lack of universally effective treatments for PRP, with some cases being resistant to multiple topical and systemic therapies. Systemic retinoids have been used with some success. Several phototherapy regimens have lead to variable results. The authors present a case of PRP, unresponsive to 6 month treatment of isotretinoin, that was subsequently treated with narrow-band ultraviolet B (NB-UVB) light therapy with complete resolution after four months of light treatment. The observed clinical benefit may encourage future phototesting and consideration of NB-UVB light therapy in recalcitrant PRP cases.

Lichen planus arising in radiation therapy treatment sites.

A 59-year-old woman with a history of metastatic breast cancer presented for evaluation of hyperpigmented, reticulated, pruritic plaques on her left arm and left thigh after undergoing localized radiation therapy to the left breast and left thigh. These painful plaques with surrounding erythema appeared to follow Blaschko lines and punch biopsy results were histologically consistent with lichen planus. Herein we report a case of radiation-induced lichen planus.