Predicting migraine responsiveness to botulinum toxin type A injections.

BACKGROUND: Botulinum toxin type A (BTX) is used prophylactically to reduce the frequency of migraine headaches, with inconsistent responses reported in the literature. The purpose of our study was to determine whether BTX injections at doses used for upper-face cosmetic purposes, which differ from doses typically used by headache specialists, could prevent imploding and ocular but not exploding migraines. OBSERVATIONS: Study participants were recruited among patients who had received or were planning to receive BTX injections for upper-face cosmetic purposes but also reported having migraines. Among the 18 patients who completed the study, most with imploding and ocular migraines experienced a significant reduction in their headache frequency, whereas those with exploding migraines generally did not. CONCLUSIONS: Our study supports the hypothesis that patients with imploding and ocular migraines are more responsive to BTX than those with exploding migraines. Injections of BTX at doses appropriate for cosmetic purposes may be sufficient to prevent migraine attacks.

Long-term efficacy of anchored barbed sutures in the face and neck.

BACKGROUND: The thread lift is a minimally invasive procedure that uses barbed sutures, inserted subcutaneously, to produce lifting of ptotic tissue of the face and neck. There are currently very limited data on longevity and patient satisfaction following barbed suture lifting procedures. OBJECTIVE: The purpose of this study was to assess long-term efficacy following the use of barbed sutures. MATERIALS AND METHODS: A satisfaction survey was mailed to 20 patients who were a minimum of 6 months (range, 6 to 16 months) postprocedure. Physician assessment of pre- and postprocedure photographs was also performed. RESULTS: At an average of 11.5 months postprocedure, patients felt that the barbed suture lift met their expectations, rating their satisfaction a 6.9 on a scale of 1 to 10. Independent physicians rated the overall improvement an average of 4.6 of 10. Higher scores were noted in Zone 1 (tear trough/malar fat pad and nasolabial folds) compared to Zone 2 (marionette lines, jowls, and jawline definition) and Zone 3 (platysmal bands and neck contour). CONCLUSION: The barbed suture lift procedure provides moderate long-term and sustained improvement for facial laxity, with most improvement seen in the tear trough/malar fat pads and nasolabial folds. In this study, clinical efficacy was seen up to 16 months postprocedure.

Eruptive vellus hair cysts.

A 20-year-old man presented with multiple, asymptomatic, follicular papules that were distributed over his abdomen. Microscopic examination showed classic features of a vellus hair cyst. The term eruptive vellus hair cysts refers to a benign condition, which may be inherited or acquired. Apart from occasional pruritus, cosmetic disability is the chief concern of most patients. An estimated 25 percent of lesions remit spontaneously; however, treatment of persistent lesions is often challenging with disappointing results.

Russell-Silver syndrome.

A 27-year-old woman presented with congenital growth retardation, facial dysmorphism, and limb asymmetry. Additional clinical findings lead to a diagnosis of Russell-Silver syndrome with sporadic occurrence. Treatment requires a multidisciplinary approach. Clinical features and treatment options are reviewed.

Tuberous sclerosis.

A 46-year-old woman presented with multiple, skin-colored, hyperpigmented, dome-shaped facial papules. Histopathologic examination was consistent with angiofibromas. Clinical history and examination were consistent with tuberous sclerosis. The clinical manifestations, pathogenesis, evaluation, and treatment of tuberous sclerosis are discussed.

Evidence of EGR1 as a differentially expressed gene among proliferative skin diseases.

Hyperproliferative epidermal disorders range from benign hyperplasias such as psoriasis to basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), the two most common cancers in the US. While they all arise from the epidermis, these diseases differ dramatically in biological behavior and their underlying gene expression patterns have not been compared. We thus examined mRNA transcript levels in these disorders to identify and further characterize differentially expressed genes. Transcript expression patterns distinguish these disorders and identify EGR1, among other genes, whose epidermal expression is decreased in BCC and SCC but is elevated in psoriasis. Egr-1 inhibits growth of benign and malignant epidermal cells in vitro and appears to suppress both Cdc25A expression and Cdk2 dephosphorylation. These data indicate that gene expression profiling can differentiate epidermal hyperproliferative diseases and suggest that Egr-1 may play a role in preventing uncontrolled epidermal growth.

Necrobiotic xanthogranuloma.

A 67-year-old man presented with a 13-year history of slowly enlarging yellow-red plaques on the face and lower extremity. A biopsy specimen was consistent with necrobiotic xanthogranuloma. Necrobiotic xanthogranuloma is a slowly progressive histiocytic disease that is associated with paraproteinemia in most cases; however, its pathogenesis remains unclear. Although there is no first-line therapy, anecdotal reports have shown variable benefit with chemotherapeutic agents.

Necrobiosis lipoidica.

A 68-year-old woman presented with a 3-year history of asymptomatic, yellow-brown plaques on the lower extremities with trauma-related superficial ulcers. A biopsy specimen was consistent with necrobiosis lipoidica. Necrobiosis lipoidica is a chronic granulomatous dermatitis that is associated with diabetes mellitus; however, its pathogenesis remains unclear. Topical glucocorticoids are first-line therapy; however, no treatment has proven efficacy in double-blind, placebo-controlled studies.

Multiple eruptive keratoacanthomas, de novo.

An 89-year-old man presented with the sudden eruption of multiple, erythematous papules and nodules on his lower extremities. A skin biopsy specimen showed keratoacanthoma. After 3 months of treatment with topical imiquimod cream, the keratoacanthomas failed to resolve. We review the different clinical subtypes, histologic features, and treatment options for multiple eruptive keratoacanthomas.