Evaluation, Prevention, and Management of Acne Scars: Issues, Strategies, and Enhanced Outcomes

Acne is a common disease affecting a high percentage of the younger population. Without appropriate and effective primary prevention of scarring, post-acne scars occur in about 80-95% of all patients. Acne scarring is the result of an alteration of the healing process and it can have deep psychosocial implications for patients. Scars can involve textural change in the superficial and deep dermis and it can also be associated with erythema or pigmentation. While the most effective strategy to reduce acne scarring is to prevent its formation, over the past decades, numerous aesthetic and surgical techniques have been proposed to improve the appearance of acne scarring. However, scar treatment still remains suboptimal; indeed, acne scarring management is a difficult therapeutic challenge for dermatologists. Several treatment options have been described to treat various acne scar types and clinical responses may differ from various factors, such as skin types. Treatment approaches for acne scarring should be individualized and primarily determined by the morphological features of each patient’s scars. Dermatologists need to better organize their assessment of acne scarring and develop a multistep treatment plans tailored to address patients’ individual needs. J Drugs Dermatol. 2018;17(12 Suppl):s44-48

Clinical Efficacy of a Novel Two-Part Skincare System on Pollution-Induced Skin Damage

Air pollution continues to be a global health concern and recent studies have shown that air pollutants can cause skin damage and skin aging through several pathways that induce oxidative stress, inflammation, apoptosis, and skin barrier dysfunction. Preventive measures need to be considered to retain optimal skin health, and topical skincare products may be able to alleviate the negative effects of air pollution on skin. A randomized, double-blind, placebo-controlled clinical usage study was conducted to assess the efficacy and tolerability of a novel two-part skincare system (LVS) that was developed to provide protection against environmental skin aggressors including air pollution. After 8 weeks of use in subjects exposed to extremely high levels of pollution, LVS provided significant improvements compared to placebo in all clinical efficacy parameters including crow's feet wrinkles, overall skin damage, skin tone evenness, tactile roughness, and visible redness. Subject self-assessment questionnaires showed that the treatment product was highly rated in self-perceived efficacy. Decreased SQOOH and MDA content in skin swab samples suggest that LVS helped to reduce oxidative stress in patients' skin. Histological analyses of biopsy samples using biomarkers related to skin structure, damage and function (collagen IV, MMP1, CPD, and CD1a) further support the clinical benefits of LVS. Altogether, the presented study is among the first to show that topical skincare products can help to reduce pollution-induced skin damage and improve skin quality, especially when specifically formulated with active ingredients that combat the harmful effects of air pollutants. J Drugs Dermatol. 2018;17(9):975-981.

[Keep an eye on the side effects]

A 52-year-old man presented with a progressive grey-black pigmentation of facial skin, sclera and teeth. The cause was long-term ingestion of minocycline, as confirmed by history and skin biopsy. Minocycline-induced hyperpigmentation can be divided into four main patterns based on clinical appearance, distribution, light- and electron microscopic characteristics. Some patterns can manifest within weeks of initiating therapy. One must be alert to the early signs and warn the patient about the often cosmetically disturbing and persistent minocycline-induced hyperpigmentation.

Odontogenous sinus tract to the chin--case report

This report describes the diagnosis, treatment and follow-up of a rare case of an odontogenic sinus tract to the chin. Despite the absence of caries, fillings, or crown damage, both lower central incisors were involved in a bony lesion. No history of any traumatic facial or dental injury was reported, and no orthodontic treatment with fixed appliances was performed. The findings on panoramic radiograph were incidental--the patient applied to the dental clinic due to a toothache in a lower first molar. The patient's history comprised seven-year-long unsuccessful dermatologic therapy. This included intraoral antibiotic and antihistamine intake, as well as topical antibiotic and steroid application. Endodontic treatment was proceeded, followed by recovery of the skin lesion. In the case of a single chronic suppurative or nodulocystic facial lesion, a dental clinical examination as well as a radiological assessment of the maxillary and mandibular dentition should be performed to exclude any odontogenic cause.

Successful treatment with topical tacrolimus in four cases of discoid lupus erythematosus

Discoid lupus erythematosus (DLE), a cutaneous form of lupus erythematosus, is characterized as atrophic and scaly erythema and the lesions are often refractory to a wide range of topical or systemic therapies. Herein, we present four cases of DLE that were successfully treated with topical tacrolimus. Tacrolimus ointment (0.1%) was applied to DLE lesions twice daily and the erythematous plaques readily diminished after 4-8 weeks. Adverse effects, such as burning sensation or irritations, were not observed. These results indicate that topical tacrolimus might be an effective and alternative treatment to control DLE.

Chronic actinic dermatitis treated with mycophenolate mofetil

Chronic actinic dermatitis (CAD) is a persistent photodermatosis that usually affects elderly men. We report two male patients, aged 55 years (patient A) and 49 years (patient B), who presented with an eczematous eruption on sun-exposed skin. Phototesting revealed a markedly reduced 24-h minimal erythema dose (MED). Both patients had refractory disease and developed significant side-effects to conventional therapies, including topical steroids, prednisolone, psoralen with ultraviolet A, azathioprine and ciclosporin. They had each received at least 6 years of treatment prior to commencing mycophenolate mofetil (MMF). Each noted a significant improvement in symptoms within 6 weeks and subsequent clearing of the eczematous lesions. Patient A still requires continuous treatment with MMF 500 mg twice daily to prevent relapses. Patient B maintains remission by using MMF 1 g twice daily only during the spring and summer months. Both patients have tolerated the treatment well with no abnormalities in blood cell counts or liver biochemistry. Since commencing MMF, their quality of life has significantly improved. These observations suggests that MMF should be considered as an alternative treatment to conventional therapies for refractory CAD.

[Systemic ALlambda amyloidosis associated with vascular fragility]

A 63-year-old patient had experienced bilateral spontaneous periorbital hemorrhage for one year. After hospitalization because of recurring hemoptysis, biopsies of skin and colon revealed systemic ALlambda amyloidosis. In addition, the heart and lungs appeared to be involved. Monoclonal gammopathy was excluded by a normal plasma cell count and a polyclonal expression pattern in a bone marrow sample and by radiographic examination. The patient was treated with a relatively non-aggressive regimen of melphalan and prednisolone monthly with careful hematologic monitoring. This approach led to a significant improvement in relevant parameters. Recent advances in diagnosis, monitoring and therapy have made it easier to manage patients with amyloidosis with their poor prognosis.

Effectiveness of small-volume, intralesional, delayed-release triamcinolone injections in orofacial granulomatosis: a pilot study

BACKGROUND

Orofacial granulomatosis (OFG) is an idiopathic disorder characterized by chronic orofacial swellings causing significant cosmetic and functional problems. Treatment with high-volume triamcinolone injections has been shown to be effective but requires nerve block anesthesia and causes a dramatic temporary increase of lip swelling.

OBJECTIVE

We have performed a noncomparative open-label pilot study in 7 patients with OFG in order to evaluate the effectiveness of small volumes of extended-release high-concentrate triamcinolone injections in reducing lip swelling and preventing recurrences.

METHODS

Seven patients with OFG were studied. Small-volume, intralesional, high-concentrate, extended-release triamcinolone was injected on the basis of a weekly schedule. A standard cycle consisted of 2 or 3 injection sessions over 14 or 21 days, depending on the clinical response.

RESULTS

After cycle completion, all patients remained without recurrences or with cosmetically acceptable slight lip enlargement for a mean time of 19 months (range, 8-30 months). No side effects were observed, except in one patient with hypopigmentation of the skin of the upper lip.

CONCLUSIONS

Slow-volume, intralesional, high-concentrate, extended-release triamcinolone injections appear to be effective in reducing lip enlargement in patients with OFG and do not require nerve block anesthesia or cause a temporary troublesome increase of swelling. A long disease-free period is generally obtained.

Full face laser resurfacing: Therapy and prophylaxis for actinic keratoses and non-melanoma skin cancer

BACKGROUND

Although there are many effective treatment modalities for individual actinic keratoses (AKs), widespread lesions on the photoaged face pose a challenge due to inefficient and ineffective therapy resulting in high rates of recurrence after local destruction. Full face laser resurfacing offers an effective and efficient treatment option that successfully reduces the number of AK's on diffusely damaged skin and may show a prophylactic benefit for preventing non-melanoma skin cancers.

OBJECTIVE

To assess the efficacy of full face laser resurfacing in reducing the number of facial AK's by comparing preoperative and postoperative numbers of lesions present and to observe the incidence of non-melanoma skin cancer after full face laser resurfacing.

STUDY DESIGN

A retrospective chart review of 24 patients with widespread facial AK's (greater than 30) treated with full face UPCO(2) and/or Er:Yag laser resurfacing was performed. All patients were a minimum of 1 year post-operative following facial laser resurfacing. The recurrence of AK's and the occurrence of facial non-melanoma skin cancers in these patients was assessed through chart analysis.

RESULTS

Widespread AK's were effectively eliminated in all patients. Twenty-one patients (87%) remained lesion free for at least 1 year. Fourteen of the 24 patients (58.3%) showed no new lesions during a 2-year follow-up. There was an overall 94% reduction in total number of AK's. Adverse effects included transient perioral scarring in one patient, S. aureus infection in two patients, and dyschromia in two patients.

CONCLUSIONS

Full face laser resurfacing provides long-term effective prophylaxis against AKs and may reduce the incidence of AK related squamous cell carcinoma.

Pseudofolliculitis barbae: review and update on new treatment modalities

Pseudofolliculits barbae, PFB, is a common cutaneous disease encountered frequently in medical practice. PFB represents a chronic inflammatory condition of the hair follicle caused by ingrown hairs producing an inflammatory foreign body reaction. The pathogenesis of PFB is multifactorial. Factors such as hair type and direction of hair growth play a role in the initial inflammatory reaction. In the armed forces, PFB represents a real challenge for both the physician and the patient. The combat environment, with the recent threat of biological and chemical weapons, requires the servicemen to be clean-shaven for appropriate gas mask fitting around the face. This article will review the etiology, pathogenesis, classification, and newer treatment modalities in the management of PFB.

Facial cellulitis in childhood: a changing spectrum

BACKGROUND

Before conjugated Haemophilus influenzae type b (Hib) vaccination, a syndrome known as buccal cellulitis, usually caused by Hib and often accompanied by bacteremia, was seen. We investigated the incidence and cause of facial cellulitis at our hospital during the 10 years before and the 10 years after introduction of the vaccine.

METHODS

Records of patients discharged with a diagnosis of facial cellulitis or infections of the oral cavity were reviewed. Fisher's exact test was used to compare rates of cellulitis during the two decades.

RESULTS

Trauma was the most common antecedent to facial cellulitis in both eras. Buccal cellulitis accounted for 7/25 (28%) of cases before Hib vaccination and 0/19 cases since. Pneumococcal buccal cellulitis was not seen in either decade.

CONCLUSIONS

Buccal cellulitis due to Hib is a disappearing disease. Eighty-nine percent of recent inpatient cases of childhood facial cellulitis were related to trauma, tooth problems, or severe sinusitis. Facial cellulitis due to S pneumoniae is rare.

Effects of electric field reduction in visual display units on skin symptoms

OBJECTIVES

This study investigated the facial skin complaints of office workers before and after the static electric fields of a visual display unit were reduced.

METHODS

On the basis of a screening survey of 4556 office workers in 11 companies, 120 of 227 subjects reporting facial skin complaints were randomly selected to this double blind intervention study. Antistatic measures were used to reduce the static electric fields of the visual display unit in the intervention group but not in the control group, which worked with a visual display unit resembling that of the intervention group. Electric fields, dust concentration, health complaints, and psychological behavior tests were recorded before and after the intervention.

RESULTS

The intervention group reported statistically significantly fewer facial skin complaints than the control group. In the intervention group, among those with an office dust concentration of >58 microg/m3, a median reduction of 1.5 skin index points (scale 0-8) was achieved, whereas there was no change in the control group. In the regression model "group category" was still a significant variable after control for background factors. In addition, further linear regression analyses indicated that several static electric field parameters were predictors of the skin complaint reduction.

CONCLUSIONS

This field trial indicates that removing static electric fields from visual display units can probably help reduce the facial skin complaints of workers in offices with high dust concentrations.

Disappointing results following resurfacing of facial skin with CO2 lasers for prophylaxis of keratoses and cancers

BACKGROUND

With the development of the short-pulse CO2 laser it was hoped that this resurfacing would prevent recurrent actinic keratoses and basal cell cancers similar to resurfacing with dermabrasion, laser abrasion, and deep chemical peel. However, we have begun to see patients that are developing keratoses and cancers within months following laser resurfacing.

OBJECTIVE

To document the problems of recurrent keratoses and basal cell cancers in patients following CO2 laser resurfacing.

METHODS

Thirty-five patients with extreme sun damage were seen at 3, 6, and 12 months following CO2 laser resurfacing for repeat color and ultraviolet photography and clinical examination to look for erythematous dyskeratotic lesions or papules with pearly borders.

RESULTS

Five of our patients (14.3%) who had undergone recent CO2 resurfacing developed actinic keratoses and basal cell cancers.

CONCLUSION

CO2 laser resurfacing is not as effective as dermabrasion, chemabrasion, and deep chemical peel for the prophylaxis of actinic keratoses and basal cell cancers, especially in Fitzpatrick type I and II patients.

Famciclovir prophylaxis of herpes simplex virus reactivation after laser skin resurfacing

BACKGROUND

Cutaneous laser resurfacing with carbon dioxide and erbium:YAG lasers has achieved remarkable clinical results with a relatively low risk of morbidity and complications. The incidence of herpes simplex virus (HSV) reactivation after resurfacing can be decreased by prophylaxis with antiviral agents. Famciclovir is effective in the suppression and treatment of HSV infections; however, no studies have examined the optimum dosing regimen for HSV prophylaxis in laser resurfacing.

OBJECTIVE

The objective of this study was to determine the efficacy of 2 doses of famciclovir as prophylactic anti-HSV therapy during cutaneous laser resurfacing.

METHODS

Ninety-nine consecutive patients undergoing full-face laser or perioral resurfacing received either 500-mg or 250-mg famciclovir twice daily, beginning 24 hours prior to laser resurfacing and continuing for 10 days.

RESULTS

No HSV recurrences were seen in 90% of patients receiving famciclovir at either dose. Approximately one-third of patients in each group with a positive history of oral herpes labialis experienced HSV recurrence compared to 5% of those without a known HSV history.

CONCLUSIONS

Famciclovir 250-mg or 500-mg twice daily is effective in the prevention of HSV recurrence in patients undergoing cutaneous laser resurfacing. Based on our clinical experience, a 500-mg dose is suggested for patients with a strong history of HSV, while 250-mg should be sufficient for those without prior HSV.

Effect of pretreatment on the incidence of hyperpigmentation following cutaneous CO2 laser resurfacing

BACKGROUND

Transient hyperpigmentation is the most common complication seen following cutaneous carbon dioxide (CO2) laser resurfacing.

OBJECTIVE

The purpose of this study was to determine whether the use of a topical skin lightening regimen prior to cutaneous laser resurfacing reduces the incidence of post-laser resurfacing hyperpigmentation.

METHODS

One hundred consecutive CO2 laser resurfacing patients (skin types I-III) were randomized to receive preoperative treatment with 10% glycolic acid cream twice daily (n=25), hydroquinone 4% cream qHS and tretinoin 0.025% cream twice daily (n=25) or no pretreatment (n=50, control) for at least 2 weeks. Clinical and photographic assessments were performed prior to laser resurfacing and at 4 and 12 weeks following treatment.

RESULTS

There was no significant difference in the incidence of post-CO2 laser resurfacing hyperpigmentation between subjects who received pretreatment with either topical glycolic acid cream or combination tretinoin/hydroquinone creams and those who received no pretreatment regimen.

CONCLUSION

It is postulated that reepithelialization after cutaneous laser resurfacing includes follicular melanocytes that have not been affected by topical pretreatment. When instituted as a component of the skin care regimen postoperatively, topical hydroquinone, tretinoin and/or glycolic acid preparations may be helpful in reducing post-laser resurfacing hyperpigmentation.

Skin symptoms after the reduction of electric fields from visual display units

OBJECTIVES

The objective of this work was to determine whether facial skin symptoms are reduced by decreasing static and low-frequency electric fields produced by visual display units.

METHODS

The electric fields were reduced by electric-conducting screen filters. Twenty subjects took part in the study while working at their ordinary jobs, first two weeks without any filter, then two weeks with an inactive filter and two weeks with an active filter (or in reversed order). The inasctive filters were identical to the active ones except that the ground cable was cut. Measurements showed that the inactive filters reduced the static electric fields nonsignificantly less than the active filters. For extremely low-frequency fields the difference was greater, and the active filters reduced the very low-frequency fields significantly more than the inactive ones.

RESULTS

Most symptoms were less pronounced with active filters than with inactive filters. The differences were small, and for one symptom only, tingling, pricking or itching, the result was statistically significant. The recorded physical and psychosocial factors did not explain the reduction with the use of active filters. Days with a long period spent near a visual display unit resulted in significantly more pronounced symptoms than days with short time. The findings registered by a dermatologist did not reveal any consistent difference between the two periods with filters.

CONCLUSION

The results weakly support the hypothesis that skin symptoms can be reduced by a reduction of electric fields.

Low doses of low molecular weight heparin in vivo inhibits the elicitation of contact hypersensitivity

Low-dose low molecular heparin inhibits T lymphocyte-mediated autoimmune disease and allograft reactions in mice in vivo and in vitro. High doses of heparin are not effective. The purpose of this preliminary study was to analyze the effect of low-dose, low molecular weight heparin (Enoxaparin, Clexane) on the expression of patch testing in patients with contact dermatitis. Eleven patients with allergic contact dermatitis, and positive patch tests reactions, were given a single subcutaneous injection of Clexane 3 mg (0.03 ml) and were reevaluated for positive reactions after the injection. Eight out of 21 positive reactions (38%) became negative after the injection and 4 out of 21 reactions (19%) changed from ++ before the injection to + after. An impressive improvement was observed in 3 patients with chronic allergic contact dermatitis. Low-dose low molecular weight heparin inhibits the elicitation of allergic contact dermatitis.

Clean rooms and itchy faces

Seventy-one male employees whose working environment was a temperature and dust controlled low-humidity 'Clean Room' and 144 male employees working in a natural factory environment were compared by means of period percentage prevalences of occurrence, severity and frequency of subjective symptoms of facial dermatitis. Using a cross-sectional interviewer-administered questionnaire it was possible to assess the percentage prevalence of each of 3 facial dermatitis symptoms among both low humidity exposed and non-exposed workers. The two prevalences were compared by calculating a ratio (the percentage prevalence ratio or PPR) of the prevalence of symptoms in the exposed, to that in the non-exposed workforce. A confidence interval (CI) for the PPR was also calculated. For the symptom of itching, the PPR was 1.65 (CI 1.32-2.07) in favour of the study group, whilst for the symptoms of redness and urticaria the PPRs were 1.96 (CI 1.54-2.48) and 2.53 (CI 1.40-4.59) respectively. The occurrence of a greater prevalence of all symptoms in the low-humidity exposed workforce confirms the clinical and laboratory reports of previous workers. A comparison was also made between the two groups of workers of both the severity, and the frequency of occurrence of symptoms. Whilst there was no statistically significant difference between the exposed and non-exposed groups for prevalence of one symptom, among those who had experienced two symptoms there was a PPR of 2.43 (CI 1.37-4.30) between the two groups. Furthermore, among those workers who had experienced all 3 symptoms of facial dermatitis there was a PPR of 3.38 (CI 1.18-8.93) in favour of the low-humidity exposed workforce.(ABSTRACT TRUNCATED AT 250 WORDS)

A clinical study for the control of facial mucocutaneous herpes virus infections. I. Characterization of natural history in a professional school population

One thousand thirty-one dental and dental hygiene students, faculty and staff at The University of Michigan School of Dentistry were interviewed in order to identify those with a past history of perioral mucocutaneous herpetic infection. Subsequently, the population was followed for 9 (+/- 3) months in order to determine various parameters of disease expression. Analysis of the results indicate the following: 1. In this professional population, 20.5 per cent described prior experience with perioral herpes. No sex difference was noted. 2. Prevalence increased with age. In the faculty-staff group (mean age 32.9 years +/ 11.8) prevalence was 30.7 per cent, whereas in the student -roup (mean age, io.6 years+/- 3.8) prevalence was 17.7 per cent. Occupational and/or socioeconomic factors did not appear to account for the age-related difference in prevalence. 3. Only 40 per cent of those who related prior disease experience developed lesions within the observation period of 9 (+/-3) months. 4. The recurrence rate, based upon an observation period of 9 (+/-3) months, in those persons who related prior disease experience was found to be 1.3 episodes per year (0.1 per month). 5. Duration of lesions ranged between 3 and 17 days, with a mean of 9 days. 6. The lower lip was the most common site of a lesion. 7. Triggering factors associated with development of a lesion in order of decreasing frequency were found to be; emotional stress, exposure to sun, and illness.