Effective and durable repigmentation for stable vitiligo: A randomized within-subject controlled trial assessing treatment with autologous skin cell suspension transplantation.

BACKGROUND: Vitiligo lesions are often challenging to repigment with conventional medical therapies. Surgical autologous melanocyte transfer methods can be utilized for stable vitiligo but demand specialized skills and equipment. A point-of-care autologous cell harvesting device was designed enabling simple preparation of autologous skin cell suspension (ASCS) containing melanocytes, keratinocytes, and fibroblasts providing a straightforward approach for cellular transplantation. OBJECTIVE: To evaluate the safety and effectiveness of ASCS for repigmentation of stable vitiligo lesions among adults. METHODS: A US multicenter, randomized, within-subject controlled trial compared ASCS to narrow band ultraviolet B only (Control) in similar vitiligo lesions. ASCS was applied after laser skin resurfacing and followed by narrow band ultraviolet B treatment. The primary effectiveness endpoint was the proportion of lesions achieving ≥80% repigmentation at week-24. Repigmentation durability was assessed at week-52. RESULTS: Among 25 subjects, 36% of ASCS-treated lesions achieved ≥80% repigmentation at week-24 compared to 0% for Control (P < .025), with durability through week-52. The safety profile of ASCS was acceptable, with favorable patient- and investigator-reported outcomes. LIMITATIONS: Study sample size limited robust subgroup analyses. CONCLUSION: Application of ASCS has potential as a treatment for repigmentation of stable vitiligo lesions with the potential to improve health-related quality of life and reduce burden of disease.

Melanoma Arising From a Pre-existing Neurofibroma in a Patient With No Prior Diagnosis of Systemic Neurofibromatosis 1 or 2: A Case Report.

ABSTRACT: The pathophysiology of melanoma involves malignant transformation of melanocytes. These can arise de novo or result from malignant transformation of a pre-existing nevus. This case report presents a patient with a new pigmented lesion, arising from a pre-existing neurofibroma, on her left scapula and no personal or family history of systemic neurofibromatosis. Biopsy confirmed the lesion to be malignant melanoma and, after excision, postoperative pathology showed a pre-existing neurofibroma. A review of the literature suggests there may be a link between the pathogenesis of neurofibroma and malignant melanoma, because NF1 mutations are observed in both neurofibromatosis and malignant melanoma. We hypothesize that the pre-existing neurofibroma created a proliferative environment that gave rise to the adjacent neoplasm. Further research is required to understand the shared pathway, because this may lead to novel forms of surveillance and treatment.

Non-Surgical Eyebrow Rejuvenation Techniques: A Review.

BACKGROUND: Eyebrow rejuvenation is a common cosmetic concern among patients presenting to dermatologists. Due to increased patient demand for non-invasive procedures, multiple non-surgical, and minimally invasive eyebrow rejuvenation techniques have been developed. OBJECTIVE: This review aims to highlight the various non-surgical eyebrow rejuvenation therapeutic techniques described in the medical literature. Methods & Materials: A review of published articles on non-surgical and minimally invasive eyebrow rejuvenation using neurotoxins, fillers, lasers, threads, bimatoprost solution, and tattooing was conducted using the PubMed database. RESULTS: Currently available non-surgical options for eyebrow rejuvenation include neuromodulators, fillers, laser resurfacing, radiofrequency, and minimally invasive procedures such as tattooing and brow lift using threading. CONCLUSION: The eyebrow is a complex and dynamic region. A thorough understanding of the anatomy of the supraorbital region and familiarity with available, minimally invasive treatment options is essential to tailor an individualized approach consisting of one or more treatments to achieve optimal rejuvenation outcomes. J Drugs Dermatol. 2021;20(9):970-978. doi:10.36849/JDD.6188.

Nonsurgical Treatments for Infraorbital Rejuvenation: A Review.

BACKGROUND: Tear trough and infraorbital region changes are one of the first signs recognizable aging. This is a common consultation for cosmetic dermatologists and there are many treatment options available. OBJECTIVE: This article provides a review of the anatomy and changes that occur in the infraorbital region as we age. We also suggest the use of the osseous, color, underlying anatomy, laxity, adipose, rhytides (OCULAR) mnemonic to evaluate these changes and review the literature for treatments options. MATERIALS AND METHODS: A literature search was performed through PubMed, using search terms "Tear trough," "Infra-orbital," "Dark-circles," "Lower-Eyelid," and "Midface." RESULTS: Fillers, lasers, radiofrequency devices, chemical peels, various topicals, and botulinum toxin are available non-surgical treatment options discussed in the literature found to significantly improve and rejuvenate the infraorbital region. CONCLUSION: A complete understanding of the anatomy and changes that occur with aging are of most importance when assessing the infraorbital region. Organizing these changes into the OCULAR mnemonic is one way to assess the infraorbital region and achieve optimal rejuvenation.

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.

Predictive Techniques for Neurotoxin Outcomes.

BACKGROUND: Botulinum-derived neurotoxins have become a substantial tool in dermatologists' armamentarium for facial/neck rejuvenation. Current literature discusses anatomical "danger zones" to avoid during neurotoxin injection to prevent brow ptosis, blepharoptosis, and lower facial ptosis. OBJECTIVE: The aim of this study was to determine whether lidocaine 1% local anesthetic can be used to predict botulinum toxin treatment outcomes and prevent adverse effects of unwanted paralysis. MATERIALS AND METHODS: One percent lidocaine was drawn up using BD ultra-fine 31 G (5/16″), 0.5-mL insulin syringes in the same quantity that would be drawn up for neurotoxin placement. The patient's face was cleansed and mapped; 0.1 mL of 1% lidocaine was injected × 5 sites in the glabella; and 3 sites were injected with 0.05 mL in the frontalis. The patient was assessed after 10 minutes. RESULTS: Improvement in frontalis and glabellar rhytides was appreciated, with noted "spocking" of the lateral brows. This technique allowed the authors to visualize the need for placement of toxin more laterally with eventual successful predictive placement for neurotoxin. CONCLUSION: This technique of using local 1% lidocaine allows the practitioner to devise a neurotoxin distribution map tailored for each patient to limit unwanted paralysis from improper neurotoxin placement.

ASDS Cosmetic Dermatologic Surgery Fellowship Milestones.

BACKGROUND: The American Council of Graduate Medical Education, which oversees much of postgraduate medical education in the United States, has championed the concept of "milestones," standard levels of achievement keyed to particular time points, to assess trainee performance during residency. OBJECTIVE: To develop a milestones document for the American Society for Dermatologic Surgery (ASDS) Cosmetic Dermatologic Surgery (CDS) fellowship program. METHODS: An ad hoc milestone drafting committee was convened that included members of the ASDS Accreditation Work Group and program directors of ASDS-approved Cosmetic Dermatologic Surgery (CDC) fellowship training programs. Draft milestones were circulated through email in multiple rounds until consensus was achieved. RESULTS: Thirteen milestones were developed in the 6 Accreditation Council for Graduate Medical Education (ACGME) competency areas, with 8 of these being patient-care milestones. Additional instructions for milestone administration more specific to the CDS fellowship than general ACGME instructions were also approved. Implementation of semiannual milestones was scheduled for the fellowship class entering in July 2018. CONCLUSION: Milestones are now available for CDS fellowship directors to implement in combination with other tools for fellow evaluation.

Prediction of postoperative pain after Mohs micrographic surgery with 2 validated pain anxiety scales.

BACKGROUND: Anxiety toward pain has been shown in several studies to increase postoperative pain after surgical procedures. This anxiety can be measured by several validated questionnaires, the Pain Catastrophizing Scale (PCS) and the Pain Anxiety Symptoms Scale (PASS). Higher scores on these scales correlate with increased pain after surgery, but this has not yet been demonstrated in dermatologic surgery. OBJECTIVE: To assess whether pain anxiety will predict postoperative pain after Mohs micrographic surgery (MMS). MATERIALS AND METHODS: Patients at 2 private Mohs practices were recruited to fill out 2 pain questionnaires, the PCS and the PASS. Their postoperative pain was assessed after MMS. RESULTS: Three hundred fifty-six patients completed the study. Overall, most patients experienced little postoperative pain after Mohs surgery. However, for people with high anxiety toward pain, they also experienced statistically significant greater postoperative pain. Other factors that contributed to greater postoperative pain included female gender and lower extremity location. Second intention healing had lower pain than other repair types. CONCLUSION: This study shows that postoperative pain is affected by pain anxiety, even in dermatologic surgery. However, most patients still had very little discomfort after surgery, further supporting MMS as an effective and safe procedure with relatively few postoperative problems.

Ultraviolet-Fluorescent Tattoo Facilitates Accurate Identification of Biopsy Sites.

BACKGROUND: Cutaneous biopsy sites are often difficult to discern or are frequently misidentified when patients present for the treatment of skin cancers. This frustrating situation can lead to delays in treatment and wrong site surgeries. Current methods aiming to prevent this situation are not perfect. OBJECTIVE: This study seeks to determine the efficacy of ultraviolet-fluorescent tattoos in facilitating the correct identification of suspected nonmelanoma skin cancer biopsy sites. METHODS: In this prospective cohort, 51 shave biopsy sites were tattooed with ultraviolet-fluorescent ink in a series of 31 patients suspected of having a cutaneous malignancy. At the time of follow-up, the ability of the patient and the physician to identify the correct site with and without ultraviolet illumination of the tattoo was recorded. Visibility of the tattoo was graded before and after treatment. RESULTS: Patients could not positively identify their biopsy site in 35% of cases. In 7% of cases, physicians could not confidently identify the site without the aid of ultraviolet illumination. In conjunction with tattoo illumination, physicians confidently identified the site in 100% of the cases. No adverse events occurred. CONCLUSION: Ultraviolet-fluorescent tattoos offer a safe and reliable means of accurately marking cutaneous biopsy sites.

A simplified minimally invasive technique for the treatment of venous lakes.

A simplified approach to treat venous lakes of the vermillion lip is presented. Our method involves the use of a 30 gauge hypodermic needle to deliver a low-powered, high-frequency electrical current from a hyfrecator power source into the venous lake lesion.

Novel laser hair removal in all skin types.

BACKGROUND: Laser has been long accepted as a solution for excess or unwanted hair growth yet traditional lasers are not always ideal for safe and effective outcome for all skin types and hair characteristics. A diode laser module combining three wavelengths (755, 810, and 1064 nm) in a single pulse was developed to provide a fast and long-term solution for subjects with various profiles. AIMS: To evaluate the safety and efficacy of a Triple wavelength diode laser module for hair removal treatment in all skin types (Fitzpatrick I-VI). SUBJECTS AND METHODS: This was a prospective, dual centered, single-arm study. Subjects were treated with a novel diode laser module. Thirty-six subjects were enrolled, sixteen with Fitzpatrick skin types I-IV (46%) and twenty with Fitzpatrick skin types V-VI (54%). Treatment areas were axilla and bikini lines. Subjects underwent 4 treatment sessions at 6 weeks ± 5 days intervals and attended a follow-up visit 3 months after the last treatment session. 2D digital photographs were taken at baseline and at the follow-up visit, and a hair count was conducted by three blinded evaluators. RESULTS: A significant reduction in hair count between baseline and the 3-month follow-up visit was observed in both axilla and bikini lines for all skin types. The mean hair reduction was 41.5 ± 19.4% and 48.1 ± 20.9% in the axilla and bikini line, respectively. A significant hair reduction was also observed within skin type groups; mean hair reduction 45.5 ± 16.9% and 40.3 ± 17.2% in skin types I-IV and V-VI, respectively, indicating similar efficacy for both light and dark skin types. No serious adverse events were reported. CONCLUSIONS: This study demonstrates that the Soprano Titanium laser platform is safe and effective for hair removal treatment in all skin types.