Hypohidrotic Ectodermal Dysplasia Milia Treatment With Fractional Carbon Dioxide Laser and Laser-Assisted Drug Delivery of Triamcinolone.

Hypohidrotic ectodermal dysplasia (HED) is a genetic disorder characterized by hypohidrosis, hypodontia, and hypotrichosis. Skin manifestations, including dyspigmentation and milia-like papules that coalesce into plaques, are difficult to treat. There is no cure for HED, therefore treatment is focused on managing symptoms and improving quality of life. There is limited evidence in the literature for safe and effective treatments improving HED-related facial skin aesthetics. The facial skin rashes caused by HED demonstrate an unmet clinical need in dermatology. Current therapies are limited to prevention methods such as keeping the skin cool by avoiding heat and applying topical moisturizers to help treat dry, pruritic skin. Herein we present a method for successful treatment of a 34-year-old African American male using fractional carbon dioxide CO2 ablative laser with laser-assisted drug delivery of triamcinolone 0.1% ointment that resulted in decreased milia-like papules, improved dyspigmentation, smoother skin tone, and high patient satisfaction. J Drugs Dermatol. 2023;22(11):1130-1132    doi:10.36849/JDD.7650.

Musculoskeletal steroid injections during the COVID-19 pandemic.

INTRODUCTION: This study aims to determine whether musculoskeletal corticosteroid injections increase the risk for COVID-19. METHOD: 734 patients who received a corticosteroid injection during the COVID-19 pandemic were followed and their COVID status within 30 days after the injection checked. The results were then compared with an age and sex matched control group. RESULTS: No statistically significant difference in the frequency of COVID-19 cases between the two groups was found. CONCLUSION: It appears that the use of musculoskeletal corticosteroid injections during the COVID-19 pandemic does not confer increased risk of contracting the virus.

Update on Current Treatment Recommendations for Primary Cutaneous Melanoma.

Primary cutaneous melanoma describes any primary melanoma lesion of the skin that does not have evidence of metastatic disease. This article reviews the current workup, treatment, and follow-up recommendations for primary cutaneous melanoma (stages 0, I, and II). Specific attention is focused on recent updates with regard to staging, sentinel lymph node biopsy, and surgical modalities.

Pharmacotherapeutic strategies for standard treatment-resistant psoriasis.

INTRODUCTION: Psoriasis management includes a variety of treatments including localized therapies and systemic treatments; however, many patients report inadequate clinical response and resistance to therapy. Currently there is no treatment algorithm that incorporates effective strategies to tackle the various barriers leading to resistance. AREAS COVERED: The authors evaluate the scope of resistance, the reasons it occurs, and provide the reader with strategies for overcoming resistance in both localized and systemic therapies for psoriasis. EXPERT OPINION: Refractory psoriasis involves modifiable and non-modifiable factors that warrant different approaches to maximize clinical response. Treatment-resistance to topical therapies may be due to poor adherence. Improving adherence involves incorporating patients' treatment preferences, improving the physician-patient relationship, and simplifying treatment regimens. Treatment-resistance to systemic therapies can be due to non-adherence but can also be due to ineffective dosing, development of anti-drug antibodies, and severe disease that necessitates multiple drugs. After addressing non-adherence, strategies to maximize systemic therapies include increasing the dosage, combining treatments, drug switching and incorporating pharmacogenetics.

A Rare Axonal Variant of Guillain-Barré Syndrome following Elective Spinal Surgery.

Acute motor and sensory axonal neuropathy (AMSAN) is a rare axonal variant of Guillain-Barré syndrome. AMSAN is considered the most severe form of GBS, known for its rapid onset of severe symptoms, and often leading to quadriparesis within 7 days of initial symptom onset. We present a case of a middle-aged Caucasian female who developed AMSAN 2 weeks following an elective spinal surgery. Although rare, GBS has been reported as a complication of surgery. GBS classically presents as ascending motor weakness starting in the lower extremities following a gastrointestinal or upper respiratory tract infection. This patient's GBS manifested slightly differently, with both sensory and motor symptoms of her thoracic region and lower extremities, with no preceding history indicative of infection. To the authors' knowledge, this is the first reported case of AMSAN following spinal surgery. Because of its risk of significant morbidity and mortality, as well as similar presentation to more common spinal postoperative complications, GBS should always be included in the differential diagnosis whenever motor or sensory weakness is observed after spinal surgery.

Myopic shift in a pseudophakic eye with an accommodating IOL following vitrectomy with gas tamponade.

PURPOSE: To report the case of a patient with Crystalens, an accommodating posterior-chamber intraocular lens (IOL), who experienced a myopic shift following subsequent vitrectomy with gas tamponade. We propose a hypothesis as to why this myopic shift occurred and analyze its validity based on current literature. OBSERVATIONS: A patient had cataract surgery with implantation of a Crystalens AT-50AO +21D. Preoperative A-scan measured anterior chamber depth (ACD) to be 3.69 mm. The refraction was emmetropic following cataract surgery. Nine months later, the patient required pars plana vitrectomy with gas tamponade for a rhegmatogenous retinal detachment, followed by vitrectomy, membrane peel, and air/fluid exchange for epiretinal membrane. The retinal repair was anatomically successful, however, the patient experienced a -1.0 D myopic shift. ACD measurement following vitrectomy was 5.08 mm. CONCLUSIONS AND IMPORTANCE: Myopic shift following vitrectomy with gas tamponade in pseudophakic eyes is widely reported. This patient's myopic shift was assumed due to anterior movement of the Crystalens caused by a gas bubble placed during retinal detachment repair as this is the prevailing theory in the literature [1]. However, a comparison of the patient's ACD measurements does not support the above hypothesis. Further study is needed to determine the mechanism of myopic shift seen in pseudophakic patients following vitrectomy, specifically those with gas.

Replication and extension of the dual pathway model of disordered eating: The role of fear of negative evaluation, suggestibility, rumination, and self-compassion.

OBJECTIVE: The dual pathway model, a theoretical model of eating disorder development, suggests that thin ideal internalization leads to body dissatisfaction which leads to disordered eating via the dual pathways of negative affect and dietary restraint. While the dual pathway model has been a valuable guide for eating disorder prevention, greater knowledge of characteristics that predict thin ideal internalization is needed. METHOD: The present study replicated and extended the dual pathway model by considering the addition of fear of negative evaluation, suggestibility, rumination, and self-compassion in a sample of community women and female university students. RESULTS: Results showed that fear of negative evaluation and suggestibility predicted thin ideal internalization whereas rumination and self-compassion (inversely) predicted body dissatisfaction. Negative affect was predicted by fear of negative evaluation, rumination, and self-compassion (inversely). DISCUSSION: The extended model fit the data well in both samples. Analogue and longitudinal study of these constructs is warranted in future research.