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1.
Clin Dermatol ; 41(2): 253-256, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37406979

RESUMO

Growing a cosmetic dermatology practice is an often complex and arduous task. Many factors must be considered to build and maintain a successful clinical practice. Devices and injectables are both integral components to operating a comprehensive cosmetic dermatology practice. Aesthetic physicians seeking to grow their cosmetic practice in these areas must be aware of the numerous considerations-both more obvious and more subtle-that play a role in the decision-making process, including the local market, patient demand, clinic space, and physician experience and training. This contribution is focused on the factors that should be carefully considered when one is looking to grow a cosmetic dermatology practice with devices and injectables.


Assuntos
Técnicas Cosméticas , Dermatologia , Humanos , Dermatologia/educação , Injeções
2.
Clin Dermatol ; 40(1): 11-18, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35190059

RESUMO

A port-wine stain (PWS) is a vascular birthmark present in 0.3% to 0.5% of newborns. If untreated, this erythematous patch will grow proportionally with the child to thicken and darken with age. PWSs have implications for the child's quality of life for many years, with cosmetic, medical, and psychosocial disability. Controversy exists in many aspects surrounding laser treatment of these birthmarks in the pediatric population. We have reviewed the clinical features as well as the historic and current laser treatment of PWS. We have also examined the current hot topics of debate surrounding the treatment of PWS in the pediatric population. These controversies include the patient age of treatment initiation, the long-term psychologic impact, the use of general anesthesia, the application of eye shields, and alternative treatments for recalcitrant PWS. We have concluded with a discussion on the future directions of management and treatment.


Assuntos
Hemangioma Capilar , Mancha Vinho do Porto , Criança , Estética , Humanos , Recém-Nascido , Mancha Vinho do Porto/psicologia , Mancha Vinho do Porto/terapia , Qualidade de Vida , Resultado do Tratamento
3.
J Cosmet Dermatol ; 20(11): 3492-3497, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34449965

RESUMO

BACKGROUND: Performing multiple cosmetic treatments in a single session to target different aspects of facial rejuvenation is an effective regimen. Picosecond lasers with a fractionated handpiece can target fine lines, which can supplement submental fat reduction procedures. However, limited data exist on the safety and efficacy of single-session treatment strategies. AIMS: To assess the safety and utility of paired facial treatment with 755 nm picosecond laser with diffractive lens array (DLA) and 1060 nm laser lipolysis of the submentum. PATIENTS/METHODS: A prospective clinical study investigated the utility of paired facial treatment with 755 nm picosecond laser with DLA and 1060 nm diode laser lipolysis of the submentum. Subjects received treatments during the same session. Subjects were enrolled to receive up to 3 picosecond laser and 2 lipolysis treatments at 2-8-week intervals. RESULTS: Eleven subjects completed the study. Mean age was 52.1 years, and 81.8% were female. Fitzpatrick skin types II-VI were represented. For investigator global aesthetics improvement scores (GAIS), 63.6%, 81.8%, and 85.7% had improvement from baseline at 30-, 90-, and 180-day follow-up, respectively. At 180-day follow-up, 100% maintained improvement from 90-day follow-up. At 90-day follow-up, calculations for neck laxity showed a significant improvement of 11.7% from baseline (p < 0.001) with a mean amount of lift of 42.7 mm2 , which was above the predetermined threshold (20 mm2 ). No serious or unexpected treatment effects were observed. CONCLUSION: Paired facial treatment with 755 nm picosecond laser with DLA and 1060 nm laser lipolysis of the submentum improved clinical aesthetic outcomes. This treatment regimen was demonstrated to be safe, well-tolerated, and well-liked by subjects.


Assuntos
Lasers de Estado Sólido , Terapia com Luz de Baixa Intensidade , Envelhecimento da Pele , Feminino , Humanos , Lasers de Estado Sólido/uso terapêutico , Lipólise , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
5.
J Drugs Dermatol ; 20(4): 475-476, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33852245

RESUMO

This case series demonstrates an exaggerated form of the clinical presentation of a known distressing late complication of retained hyaluronic acid filler – the “pale puffy pillow.” This presentation is often, unfortunately for the patient, misdiagnosed as festoons. However, the correction with liberal hyaluronidase is simple. Additionally, we have demonstrated that ablative fractional carbon dioxide laser resurfacing is an excellent tool that may be utilized after hyaluronidase to correct the residual skin laxity.J Drugs Dermatol. 20(4):475-476. doi:10.36849/JDD.5509.


Assuntos
Blefaroplastia/efeitos adversos , Edema/terapia , Ácido Hialurônico/efeitos adversos , Hialuronoglucosaminidase/administração & dosagem , Lasers de Gás/uso terapêutico , Adulto , Idoso , Blefaroplastia/métodos , Edema/etiologia , Pálpebras/efeitos dos fármacos , Pálpebras/efeitos da radiação , Feminino , Humanos , Ácido Hialurônico/administração & dosagem , Ácido Hialurônico/antagonistas & inibidores , Pessoa de Meia-Idade , Estudos Retrospectivos , Envelhecimento da Pele/efeitos dos fármacos , Resultado do Tratamento
6.
Lasers Surg Med ; 53(1): 50-54, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32529726

RESUMO

BACKGROUND AND OBJECTIVES: Fractional ablative 10,600-nm carbon dioxide (CO2 ) laser has well-demonstrated safety and efficacy in resurfacing treatment of scars in the adult population and in the treatment of pediatric burn scars. However, there is a paucity of literature regarding laser resurfacing of traumatic and surgical scars for cosmetic benefit in the pediatric population, and in majority of cases previously reported, this was done under general anesthesia. STUDY DESIGN/MATERIALS AND METHODS: This was a retrospective chart review of pediatric patients under the age of 18 who underwent fractional ablative CO2 laser resurfacing (FALR) of traumatic or surgical scars at a single center between 2018 and 2019, inclusive. Primary endpoints included safety and tolerance. RESULTS: A total of 31 FALR treatments were performed in 10 patients with traumatic and surgical scars located on the face (age 4-14 years, Fitzpatrick skin type [FST] I-IV, 60% female). Settings ranged from total energy per session 0.02-0.33 kJ, with a 7-mm tip and 30-50% coverage. Nine patients had two or more treatments (average 3, maximum 8) spaced at least 4 weeks apart. All resurfacing treatments were well-tolerated with local infiltration of 1% lidocaine with epinephrine (1:100,000). Six (67%) patients were treated with additional measures including pulsed dye laser, 1927-nm fractional non-ablative low-energy, low-density laser, or intralesional agents (5-fluorouracil, triamcinolone, botulinum toxin). At follow-up (of varied intervals), short-term erythema, as expected, was seen in six patients, and hyperpigmentation in one case (FST IV), both treated with aforementioned alternate devices. Although gradual, improvement in scar appearance and texture was seen with FALR treatments. No additional scarring, infection, or hypopigmentation was seen. CONCLUSIONS: Treatment with fractional ablative laser resurfacing is safe and well-tolerated in the pediatric population in an outpatient setting with local anesthesia. Traumatic scars may cause significant distress to children and parents alike. Multimodal therapy may lead to optimal cosmesis. Given the excellent tolerability, the authors recommend consideration of laser resurfacing in pediatric patients with traumatic or surgical scars when bothersome, either cosmetically or psychologically. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.


Assuntos
Terapia a Laser , Lasers de Gás , Adolescente , Adulto , Criança , Pré-Escolar , Cicatriz/etiologia , Cicatriz/patologia , Cicatriz/cirurgia , Face , Feminino , Humanos , Lasers de Gás/uso terapêutico , Masculino , Estudos Retrospectivos , Resultado do Tratamento
8.
Lasers Surg Med ; 53(6): 861-864, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33161588

RESUMO

BACKGROUND AND OBJECTIVES: Melasma may be related to aberrant blood vessels, but there has been no report on the utility of dynamic optical coherence tomography (D-OCT) in studying vessel characteristics in melasma. We studied the characteristics of cutaneous blood vessels in melasma and the effects of oral tranexamic acid (TXA) with D-OCT. STUDY DESIGN/MATERIALS AND METHODS: Six patients with moderate to severe melasma had a D-OCT scanning of the areas on the face affected by melasma and not affected by it. Three of them had scans within 3 months after starting oral TXA and at a follow-up visit. Blood flow at different depths of the skin and vessel diameter were compared between the melasma and normal skin. For those taking oral TXA, we compared the percent change of blood flow and diameter between the melasma and normal skin. RESULTS: Dermal blood flow and vessel diameter were greater in the melasma skin than in the normal skin. Oral TXA reduced dermal blood flow in both the melasma and normal skin, but the reduction was more dramatic in the lesional melasma skin. CONCLUSIONS: D-OCT findings that (i) dermal blood vessels in melasma are increased in size and flow and (ii) oral TXA reduced the vessel size and flow, providing evidence supporting the relationship between melasma and cutaneous blood vessels. D-OCT may be utilized in measuring response to treatments targeting melasma. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.


Assuntos
Melanose , Ácido Tranexâmico , Humanos , Lasers , Melanose/diagnóstico por imagem , Melanose/tratamento farmacológico , Tomografia de Coerência Óptica
11.
Dermatol Surg ; 47(4): 500-503, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33165055

RESUMO

BACKGROUND: Spread of botulinum toxin outside the treated muscle is a concern, when energy-based device treatment is performed on the same day as toxin injection. OBJECTIVE: We assessed the frequency of eyelid ptosis after the glabella/periorbital botulinum toxin injection and nonablative fractionated laser performed at the same session. METHODS AND MATERIALS: This single-center, retrospective study identified treatments consisting of glabella and/or periorbital botulinum toxin injection and nonablative fractionated laser treatment to full face from 2017 to 2019 and eyelid ptosis determined by documentation of the complication at a follow-up encounter, or prescription of apraclonidine. RESULTS: Six hundred sixteen treatments of glabella/periorbital botulinum toxin injection and full-face nonablative fractionated laser on the same day on 393 individuals were identified. Five hundred eighty treatments (94%) included botulinum toxin injected in the glabella, 541 (88%) in the periorbital areas, and 508 (82%) in the forehead. Nonablative fractionated lasers used to treat the cohort were a 1,927-nm thulium and a 1,550-nm er:glass laser. Eyelid ptosis complication was documented in one case (0.2%) following the combined laser and toxin treatment. CONCLUSION: The risk of spread of glabella/periorbital botulinum toxin to an unintended muscle was minimal in the setting of the concomitant full-face nonablative fractionated laser.


Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Terapia a Laser/métodos , Lasers de Estado Sólido/uso terapêutico , Ritidoplastia/métodos , Envelhecimento da Pele , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Fármacos Neuromusculares/administração & dosagem , Estudos Retrospectivos
14.
J Drugs Dermatol ; 18(2): 213-214, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30811151

RESUMO

Darier disease is an autosomal dominant genodermatosis of abnormal keratinization characterized by hyperkeratotic papules and plaques with a predilection for seborrheic areas. We report a case of a rare vesiculobullous variant of treatment-resistant Darier disease in a 55-year-old woman that failed topical tacrolimus and topical and oral glucocorticoids. Cetirizine was initiated at 10 mg daily and increased to 40 mg daily over four weeks, with resultant marked improvement of the patient's burning sensation. A punch biopsy revealed a perivascular infiltrate of eosinophils. This patient's symptomatic improvement with cetirizine, which has antagonizing properties against eosinophils, highlights the potential role of eosinophils in the pathogenesis of vesiculobullous Darier disease. We suggest that major basic protein secreted by eosinophils may propagate blister formation in vesiculobullous Darier disease by disrupting desmosomes. J Drugs Dermatol. 2019;18(2):213-214.


Assuntos
Antialérgicos/uso terapêutico , Cetirizina/uso terapêutico , Doença de Darier/tratamento farmacológico , Dermatopatias Vesiculobolhosas/tratamento farmacológico , Antialérgicos/farmacologia , Cetirizina/farmacologia , Doença de Darier/complicações , Doença de Darier/diagnóstico , Relação Dose-Resposta a Droga , Eosinófilos/efeitos dos fármacos , Feminino , Humanos , Pessoa de Meia-Idade , Dermatopatias Vesiculobolhosas/complicações , Dermatopatias Vesiculobolhosas/diagnóstico , Resultado do Tratamento
15.
J Drugs Dermatol ; 17(7): 807-809, 2018 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-30005106

RESUMO

Treatment of malignancy with anti-programmed cell death 1 (PD-1) immune checkpoint inhibitors can cause mucocutaneous side effects resulting from T cell activation. Due to their recent development, the full side effect profile remains to be fully elucidated, however dermatologic adverse events are most common. The main oral toxicities of these immune checkpoint inhibitors include: xerostomia, dysgeusia, and lichenoid reactions. Oral mucositis occurs more rarely in the setting of PD-1 inhibition, and few other reports of a Grade 3 or higher, severe, stomatitis have been reported in the literature. We present a case of a 78-year-old woman with Grade 3 ulcerative oral mucositis that occurred 13 months after initiation of PD-1 inhibitor, pembrolizumab, for the treatment for lung adenocarcinoma. She was successfully treated with prednisone, and pembrolizumab was temporarily held by her oncologist. Physicians should be aware of the possibility of severe mucositis in the setting of PD-1 inhibitors, as well as the management. J Drugs Dermatol. 2018;17(7):807-809.


Assuntos
Adenocarcinoma/tratamento farmacológico , Anticorpos Monoclonais Humanizados/efeitos adversos , Antineoplásicos Imunológicos/efeitos adversos , Neoplasias Pulmonares/tratamento farmacológico , Estomatite/induzido quimicamente , Adenocarcinoma/secundário , Idoso , Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Feminino , Humanos , Neoplasias Pulmonares/patologia , Melanoma , Receptor de Morte Celular Programada 1/antagonistas & inibidores , Índice de Gravidade de Doença , Estomatite/diagnóstico , Estomatite/tratamento farmacológico
16.
Dermatol Online J ; 24(11)2018 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-30695981

RESUMO

We report a case of Escherichia coli infection of a cephalohematoma in an infant delivered by vacuum extraction. After excluding potential complications, the patient was treated with intravenous ceftriaxone while hospitalized followed by oral cephalexin after discharge. Infection is a rare but serious complication of cephalohematomas in the newborn period. Escherichia coli is the most common pathogen responsible for infected cephalohematomas. Clinicians should be aware that infected cephalohematomas may be complicated by sepsis, meningitis, or osteomyelitis.


Assuntos
Traumatismos do Nascimento/etiologia , Traumatismos Craniocerebrais/etiologia , Infecções por Escherichia coli/etiologia , Hematoma/etiologia , Vácuo-Extração/efeitos adversos , Antibacterianos/uso terapêutico , Ceftriaxona/uso terapêutico , Infecções por Escherichia coli/diagnóstico , Infecções por Escherichia coli/tratamento farmacológico , Humanos , Lactente , Masculino
17.
Dermatol Online J ; 24(12)2018 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-30677801

RESUMO

The term, acquired perforating dermatoses (APD), represents a group of skin conditions that develop in adulthood and are characterized by transepidermal elimination of dermal connective tissue. This appears clinically as a papulonodule with a keratotic core. Although APD is typically associated with diabetes mellitus, chronic renal failure, and several other conditions causing generalized pruritus, there have been reports in the literature describing an association of APD with select drugs including sorafenib. We present a case of acquired perforating dermatosis in a patient with HIV and hepatocellular carcinoma undergoing treatment with sorafenib.


Assuntos
Antineoplásicos/efeitos adversos , Doenças do Colágeno/induzido quimicamente , Dermatopatias/induzido quimicamente , Sorafenibe/efeitos adversos , Idoso , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/tratamento farmacológico , Doenças do Colágeno/diagnóstico , Doenças do Colágeno/patologia , Infecções por HIV/complicações , Humanos , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/tratamento farmacológico , Masculino , Dermatopatias/diagnóstico , Dermatopatias/patologia
19.
Ann Emerg Med ; 66(1): 13-8, 18.e1, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25748480

RESUMO

STUDY OBJECTIVE: Disposition decision for patients with possible acute coronary syndrome in the emergency department (ED) is driven primarily by perception of short-term risks. We sought to evaluate communication between patient and physician about these risks by ascertaining the content of discussions surrounding disposition decision. METHODS: We conducted matched-pair surveys of patients admitted for possible acute coronary syndrome and their physicians in 2 academic, inner-city EDs. After disposition conversation, trained research assistants administered surveys querying perceived and communicated risk estimates and purpose of admission. Primary exclusion criteria were ECG or troponin value diagnostic of acute coronary syndrome. The primary outcome measure was agreement in assessment of the risk of myocardial infarction, defined as the proportion of patient-physician pairs whose risk estimates were within 10% of each other. RESULTS: A total of 425 patient-physician survey pairs were collected. Fifty-three percent of patients were men. Patients reported discussing the likelihood of their symptoms' being due to myocardial infarction in 65% of cases, whereas physicians reported this in 46%. After their discussion, physicians' (n=415) median estimate of short-term risk was 5% (95% confidence interval [CI] 3% to 7%), whereas patients' (n=401) was 8% (95% CI 5% to 11%). Most patients (63%; 95% CI 57% to 67%) reported that this estimate remained the same or increased after their conversation. Risk agreement within 10% occurred in 36% of cases (n=404; 95% CI 32% to 41%). Patients' median estimates of the mortality of myocardial infarction at home versus in the hospital were 80% (n=398; 95% CI 76% to 84%) and 10% (n=390; 95% CI 7% to 13%), respectively, whereas physician estimates were 15% (n=403; 95% CI 12% to 18%) and 10% (n=398; 95% CI 7% to 13%). CONCLUSION: Our survey demonstrates poor communication, with overestimation of both the risks of myocardial infarction and potential benefit of hospital admission. These findings suggest that communication surrounding disposition decisions in chest pain patients may at times be ineffective or misleading.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Comunicação , Serviço Hospitalar de Emergência , Relações Médico-Paciente , Síndrome Coronariana Aguda/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/psicologia , Admissão do Paciente/estatística & dados numéricos , Medição de Risco/métodos , Adulto Jovem
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