Photodynamic Therapy Using Intense Pulse Light to Treat an HIV Patient With Perianal Squamous Cell Carcinoma: A Case Report.

Anogenital warts are considered one of the most common sexually transmitted infections caused by the human papillomavirus (HPV). One of the primary considerations with HPV is the virus's high rate to develop into squamous cell carcinoma (SCC). SCC is one of the leading causes of skin cancer with a variety of treatment options. The gold standard of treatment for SCC is surgical excision. Complications may arise for those that are considered immunocompromised, or lack of efficacy may be taken into consideration for nonsurgical approaches. Herein, we suggest prompt diagnosis and treatment with photodynamic therapy (PDT) of HPV lesions to prevent disease progression and reoccurrence. The patient is a 54-year-old male nonsmoker with a past medical history of squamous cell carcinoma and HIV and presented with a perianal rash. Additionally, he confirmed associated symptoms of itchiness, irritation, and pain. At the time of his appointment, his CD4 count was 121 cells/µL, and he stated he was compliant with his antiretroviral therapy. Based on history and physical examination, the patient was empirically treated with oral fluconazole and topical nystatin-triamcinolone for two weeks. At follow-up, symptomatology worsened, and a biopsy was performed. Squamous cell carcinoma in situ was confirmed histologically. A secondary bacterial skin infection developed at the biopsy site. At this point, PDT was recommended due to compromised tissue and further risk of infection. At present, a gold standard of care for HPV infection does not exist. Prompt diagnosis and treatment of these lesions are important to recognize due to the high risk of the development of squamous cell carcinoma. Complications of secondary bacterial infections can arise with current treatment for squamous cell carcinoma, particularly in the immunocompromised. Non-surgical approaches for HPV have been less than desirable with higher recurrence rates of HPV lesions. Herein, we suggest the consideration of PDT treatment for HPV and SCC.

Nodules on the Anterior Neck Following Poly-L-lactic Acid Injection.

Poly-L-lactic acid (PLLA) is a synthetic biologic polymer that is suspended in solution and can be injected for soft-tissue augmentation. The most common adverse events generally are transient in nature, such as swelling, tenderness, pain, bruising, and bleeding. Persistent adverse events of PLLA primarily are papule and nodule formation. Injecting PLLA into the anterior neck is an off-label procedure and may cause a higher incidence of nodule formation.

The Adjunct Use of Platelet-Rich Plasma in Split-Thickness Skin Grafts: A Systematic Review.

OBJECTIVE: To summarize the available literature on platelet-rich plasma (PRP) as an adjunct to split-thickness skin graft (STSG) in an organized and easy-to-read format. These data may encourage surgeons to integrate PRP into their skin graft protocol. DATA SOURCES: The authors conducted a systematic search using the PubMed, Cochrane, and ClinicalTrials.gov databases for articles published from their respective inceptions to October 1, 2019, to identify relevant studies. STUDY SELECTION: A total of 629 articles were reviewed, and 5 were identified for inclusion in this study. The population of all studies was patients receiving an STSG to close a skin defect. DATA EXTRACTION: Articles were screened for the following outcome measures: graft take rates, edema or hematoma formation, instant adhesion of graft, healing time, length of hospital stay, scar hypertrophy, and frequency of dressing changes. DATA SYNTHESIS: The data were organized into two tables describing the studies and the selected outcome measures. CONCLUSIONS: The data suggest that PRP in STSG reduces healing time, length of hospital stay, and scarring and that it eliminates the need for sutures/staples. Further, these benefits may correlate with a decrease in overall expenditure. This systematic review suggests that further research on PRP and skin grafts is warranted.

Pyoderma Gangrenosum-associated Granulomatosis with Polyangitis: A Case Report and Literature Review.

Granulomatosis with polyangitis, formerly known as Wegener's granulomatosis, is a multi-system vasculitis that has a variable clinical presentation. Although uncommon, cutaneous symptoms can be the initial presenting symptom of granulomatosis with polyangitis. We present an unusual case of pyoderma gangrenosum followed by a diagnosis of granulomatosis with polyangitis. We also provide a review of current literature on therapeutic options.

Body contouring using 635-nm low level laser therapy.

Noninvasive body contouring has become one of the fastest-growing areas of esthetic medicine. Many patients appear to prefer nonsurgical less-invasive procedures owing to the benefits of fewer side effects and shorter recovery times. Increasingly, 635-nm low-level laser therapy (LLLT) has been used in the treatment of a variety of medical conditions and has been shown to improve wound healing, reduce edema, and relieve acute pain. Within the past decade, LLLT has also emerged as a new modality for noninvasive body contouring. Research has shown that LLLT is effective in reducing overall body circumference measurements of specifically treated regions, including the hips, waist, thighs, and upper arms, with recent studies demonstrating the long-term effectiveness of results. The treatment is painless, and there appears to be no adverse events associated with LLLT. The mechanism of action of LLLT in body contouring is believed to stem from photoactivation of cytochrome c oxidase within hypertrophic adipocytes, which, in turn, affects intracellular secondary cascades, resulting in the formation of transitory pores within the adipocytes' membrane. The secondary cascades involved may include, but are not limited to, activation of cytosolic lipase and nitric oxide. Newly formed pores release intracellular lipids, which are further metabolized. Future studies need to fully outline the cellular and systemic effects of LLLT as well as determine optimal treatment protocols.

The incidence of nonmelanoma skin cancers and actinic keratoses in South Florida.

BACKGROUND: Incidence of nonmelanoma skin cancer and actinic keratoses appears to be increasing worldwide due to increasing levels of ultraviolet radiation, lifestyle changes, and an aging population. Because of its demographics and geographic location, the population of South Florida is at risk for high rates of nonmelanoma skin cancer and actinic keratoses. OBJECTIVE: To determine the incidence of nonmelanoma skin cancer and actinic keratoses in two populations in South Florida by measuring treatments by dermatologists in health maintenance organization gatekeeper populations. METHODS: The incidence of nonmelanoma skin cancer and actinic keratoses in South Florida was determined by evaluating the number of nonmelanoma skin cancers and actinic keratoses treated by dermatologists (Current Procedural Terminology [CPT] Code Analysis) in two health maintenance organization populations; "commercial" (age 0-65, mean 27) and Medicare (age 65+, mean 68) in the calendar year 1996. RESULTS: The incidence of treatment of nonmelanoma skin cancer was 466.5 per 100,000 people per year in the "commercial" (age 0 to 65) population and 10,689.8 per 100,000 people per year in the Medicare age population. The incidence of treated actinic keratoses was 4,464.6 per 100,000 people per year and 110,450.3 in each population respectively. CONCLUSION: The studied populations in South Florida appear to have some of the highest incidence rates of nonmelanoma skin cancer in the world and extremely high rates of actinic keratoses. The findings suggest that there is an epidemic of nonmelanoma skin cancer in the South Florida community, which has significant implications for the future medical needs of both "commercial" and Medicare-age populations.

Effect of 635nm Low-level Laser Therapy on Upper Arm Circumference Reduction: A Double-blind, Randomized, Sham-controlled Trial.

OBJECTIVE: To assess the safety and efficacy of low-level laser therapy as a noninvasive method for reducing upper arm circumference. DESIGN: Randomized, double-blind study whereby healthy subjects (N=40) with a body mass index of 20 to 35kg/m(2) received three 20-minute low-level laser therapy (N=20) or sham treatments (N=20) each week for two weeks. MEASUREMENTS: Upper arm circumference was measured after three and six treatments and two weeks post-treatment. Primary success criterion was the proportion of subjects achieving a combined reduction in arm circumference of ≥1.25cm measured at three equally spaced points between the elbow and the shoulder. Secondary outcomes included total measurement change at each time point and subjective satisfaction ratings. RESULTS: After six treatments, the low-level laser therapy group showed a combined reduction in arm circumference of 3.7cm versus 0.2cm in the sham treatment group (p<0.0001). Significantly more subjects in the low-level laser therapy group (N=12; 60%) achieved ≥1.5cm total decrease in upper arm circumference versus sham-treated subjects (N=0; 0%) (p<0.0005). Low-level laser therapy treatment resulted in a combined reduction in arm circumference of 2.2cm after three treatments and 3.7cm after six treatments (for each, p<0.0001) indicating a progressive and cumulative treatment effect. Body mass index remained unchanged for all subjects. A significantly greater number of subjects in the low-level laser therapy treatment group were satisfied with their results (p<0.05), believed their upper arm appearance improved (p<0.0005), and indicated the results exceeded expectations (p<0.05). The treatments were painless and no adverse events were reported. CONCLUSION: Noninvasive low-level laser therapy is safe, painless, and effective in reducing upper arm circumference and is associated with a high degree of subject satisfaction.

Bacillary angiomatosis in an immunocompetent child: a case report and review of the literature.

Bacillary angiomatosis is an infectious disease caused by 2 gram-negative bacilli, Bartonella henselae and Bartonella quintana. This disease is characterized by vascular proliferations in the skin and/or visceral organs, and typically manifests in immunocompromised patients. However, we report a case of a 10-year-old immunocompetent female child with a questionable history of being scratched by a cat. Although initially diagnosed as a pyogenic granuloma, a diagnosis of bacillary angiomatosis was made based on histologic examination of the excised lesion demonstrating interstitial bacillary deposition on Warthin-Starry silver stain. The patient was successfully treated with 2 weeks of azithromycin after which all symptoms resolved.

Leukemia cutis in a patient with acute myelogenous leukemia: a case report and review of the literature.

Leukemia cutis is an infiltration of malignant neoplastic leukocytes or their precursors into the epidermis, dermis, or subcutis. These neoplastic cells are derived from abnormal leukocytes in the bone marrow where maturation aberrations occur. Acute myelogenous leukemia (AML) is the second most common cause of leukemia cutis and the most common leukemia among adults. In the elderly population, AML presents a challenge to the medical community because of the number of preexisting comorbid conditions and the safety profile of useful chemotherapeutic agents.