Thread-Lifts: A Double-Edged Suture? A Comprehensive Review of the Literature.

BACKGROUND: Thread-lifting has experienced a recent surge in popularity as interest in minimally invasive techniques for facial rejuvenation continues to grow. By placing barbed sutures along specific trajectories to lift the superficial musculoaponeurotic system to address facial ptosis, thread-lifting carries several advantages over the traditional facelift. Over the past few decades, there have been ongoing advances in the implementation of thread-lifting using barbed sutures. OBJECTIVE: To review the current evidence regarding the safety and efficacy of thread-lifting for facial rejuvenation. MATERIALS AND METHODS: An analysis was conducted of PubMed indexed English language literature regarding thread-lifting using barbed sutures. RESULTS: Early studies using nonabsorbable barbed sutures described high revision and complication rates. Newer techniques implementing absorbable sutures have fewer adverse events, although the long-term efficacy of these procedures remains unclear. CONCLUSION: Thread-lifts play a substantial role in minimally invasive techniques for facial rejuvenation. Additional studies are needed to better evaluate the safety and long-term efficacy of this quick, in-office procedure.

Necrobiosis lipoidica.

We present a case of necrobiosis lipoidica (NL) of the right abdomen in a 75-year-old man. A skin biopsy performed showed a layered infiltrate of mono and multinucleated histiocytes palisaded around degenerated collagen bundles. Laboratory workup was unremarkable. The patient was treated with topical corticosteroids with cessation of progression of his disease, although the eruption did not resolve. There are a number of treatments for NL reported in the literature, all with varying efficacy. Although NL lesions are usually asymptomatic, patients with NL must be monitored closely for signs of ulceration or malignant transformation, in which case more aggressive treatment options may be warranted.

Lasers, Light, and the Treatment of Acne: A Comprehensive Review of the Literature.

INTRODUCTION: Acne vulgaris is common dermatologic condition with an estimated prevalence of 70 to 87%. Acne has been shown to have a significant impact on patient quality of life and mental health, especially as inflammatory lesions typically occur on cosmetically sensitive areas with the potential for permanent scarring. There have been numerous advances in the treatment of inflammatory acne with light-based and laser devices. OBJECTIVE: To review the current evidence for light-based and laser treatments in the management of inflammatory acne. METHODS: An analysis was conducted of PubMed indexed English language literature regarding management of inflammatory acne using light-based and laser treatments. RESULTS: Evidence for the utilization of laser and light-based therapy for acne was summarized in a comprehensive review. Laser and light-based treatment holds the advantages of improved patient compliance and safety profiles in comparison to pharmacologic therapy. Efficacy of device based treatment varied in comparison to standard topical treatment regimens, often more effective when used in combination therapy. Adverse effects reported were generally self-limited. DISCUSSION: These treatments do and will continue to play an important and enlarging role in the management of acne. Larger scale studies with standardization of treatment protocols are warranted.

J Drugs Dermatol. 2017;16(11):1095-1102.

Primary anetoderma with undifferentiated connective tissue disease.

Anetoderma is a rare benign elastolytic disorder that is characterized by focal loss of elastin fibers on histopathology and is often recalcitrant to treatment. We present a case of a patient with a 20-year history of pruritic and painful hyperpigmented atrophic papules clustered on the neck, axillae, inframammary folds, and right medial thigh. Although the histopathologyof her axillary lesions was consistent with anetoderma, her clinical presentation is unusual given the extent of involvement, reported pain and pruritus, and sharp demarcation of the distribution. The diagnosticuncertainty of this case led to added difficulty in management of a disease that is already notoriously difficult to treat and may significantly impact patient's quality of life.

Pediatric Lichen Sclerosus: A Review of the Epidemiology and Treatment Options.

Lichen sclerosus (LS) is a rare, chronic, inflammatory disease of the skin that primarily affects postmenopausal women but may occur in men and children as well. Approximately 7% to 15% of cases are believed to occur in children. The epidemiologic data for LS have been limited and treatment options are not well studied, particularly in children. We reviewed new developments available in the current literature on the epidemiology and management of LS for children.

Widely metastatic squamous cell carcinoma originating from malignant transformation of hypertrophic lichen planus in a 24-year-old woman: case report and review of the literature.

Hypertrophic lichen planus (HLP) is a T-cell-mediated process typically presenting with hypertrophic or verrucous plaques on the lower limbs. We report the case of a 24-year-old woman with a history of HLP since age 3 years presenting with rapid malignant transformation of one lesion into a large squamous cell carcinoma (SCC). Subsequent examination revealed progressive, widespread metastatic involvement, and the patient ultimately died from her disease. SCC associated with HLP is rare, with a review of the literature revealing fewer than 50 cases. This case highlights the need to be aware of suspicious changes in HLP and to educate patients as to when to be reevaluated.

Viral infections in acute graft-versus-host disease: a review of diagnostic and therapeutic approaches.

BACKGROUND: While immunosuppressive therapy for acute graft-versus-host disease (aGVHD) advances, viral reactivation has been found to be an increasingly common complication in these patients. Dermatologists may often be consulted on inpatient services for evaluation. OBJECTIVE: We investigated the literature for the role of viral infections in aGVHD and review the current evidence regarding management. METHODS: Articles in the public domain regarding aGVHD, cytomegalovirus, Epstein-Barr virus, varicella zoster virus, hepatitis viruses, parvovirus B19, and respiratory viruses were included. RESULTS: Dermatologic findings vary between different viral antigens, and some infections may be a marker for the development of aGVHD or worsen prognosis. LIMITATIONS: The heterogeneous cohorts of the studies reviewed often preclude direct comparison between results. CONCLUSION: The relationship between viral reactivation and aGVHD may be bidirectional and is worthy of further exploration. Additional studies are needed to determine appropriate prophylaxis and treatment.

Brimonidine tartrate for the treatment of facial flushing and erythema in rosacea.

Rosacea is a chronic inflammatory dermatologic condition that can often be disfiguring with significant negative impact on patients' quality of life. Sanrosa (brimonidine tartate) is a novel therapeutic agent targeting the facial flushing and erythema of rosacea through its α2 adrenergic receptor agonist activity. The goal of this article is to discuss current treatment options for rosacea and the properties of brimonidine tartate as well as the evidence surrounding its efficacy and safety profile.

Bilateral suborbital rash: a dermatologic manifestation of neuropsychiatric disease in a pediatric patient.

A 10-year-old girl presented with a new onset bilateral suborbital rash. Dermatologic examination revealed violaceous, non-tender, well-demarcated patches with an atypical distribution and pigmentation. After further investigation, a diagnosis of Munchausen syndrome was made and the patient was referred to her primary care provider for further management.

Management of human papillomavirus-related anal and colon cancer.

The incidence of human papillomavirus (HPV) and HPV-related anal cancer has been increasing at an alarming rate. Human immunodeficiency virus-positive patients are at a particularly high risk, with prevalence increasing rapidly in this population as life expectancies have increased. Screening has been very effective in reducing the morbidity and mortality of HPV-related cervical cancer, which suggests its role in reducing the burden of HPV-related anal cancer as well. With appropriate screening, patient education and treatment, the incidence of HPV-related anal cancer may be greatly reduced.

Nutrition: the future of melanoma prevention?

BACKGROUND: Melanoma is one of the deadliest forms of skin cancer, having a high metastatic potential and afflicting all age groups. The need for successful preventative measures is particularly urgent as metastatic melanoma is largely incurable. The beneficial role of nutrition and other natural compounds in the prevention and treatment of melanoma has been clearly demonstrated in the past, and is an exciting source for potential therapies in the future. OBJECTIVE: We sought to review updates in the current literature regarding new developments in the relationship between nutrition and melanoma risk and treatment. METHODS: Articles in the public domain regarding the impact of diet, grape seed proanthocyanidins, selenium, vitamin D, vitamin E, epigallocatechin-3-gallate, resveratrol, rosmarinic acid, lycopene, and fig latex on melanoma were included. RESULTS: Grape seed proanthocyanidins, epigallocatechin-3-gallate, resveratrol, rosmarinic acid, lycopene, and fig latex have demonstrated clear anticancer effects toward melanoma. The roles of selenium, vitamin D, and vitamin E, however, have been more controversial. LIMITATIONS: None. CONCLUSIONS: The role of natural compounds in the future of melanoma prevention and treatment is promising and one that is worthy of further exploration.

Impaired angiogenesis and mobilization of circulating angiogenic cells in HIF-1alpha heterozygous-null mice after burn wounding.

Hypoxia-inducible factor 1 (HIF-1) is a transcription factor that controls vascular responses to hypoxia and ischemia. In this study, mice that were heterozygous (HET) for a null allele at the locus encoding the HIF-1alpha subunit (HET mice) and their wild-type (WT) littermates were subjected to a thermal injury involving 10% of the body surface area. HIF-1alpha protein levels were increased in burn wounds of WT but not of HET mice on day 2. The serum levels of stromal-derived factor 1alpha, which binds to CXCR4, were increased on day 2 in WT but not in HET mice. Circulating angiogenic cells were also increased on day 2 in WT but not in HET mice and included CXCR4(+)Sca1(+) cells. Laser Doppler perfusion imaging demonstrated increased blood flow in burn wounds of WT but not HET mice on day 7. Immunohistochemistry on day 7 revealed a reduced number of CD31(+) vessels at the healing margin of burn wounds in HET as compared with WT mice. Vessel maturation was also impaired in wounds of HET mice as determined by the number of alpha-smooth muscle actin-positive vessels on day 21. The remaining wound area on day 14 was significantly increased in HET mice compared with WT littermates. The percentage of healed wounds on day 14 was significantly decreased in HET mice. These data delineate a signaling pathway by which HIF-1 promotes angiogenesis during burn wound healing.