Dermatology

Fort Myers, FL, United States

Dermatology

Fort Myers, FL, United States

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Goettmann S.,Dermatology | Zaraa I.,La Rabta Hospital | Moulonguet I.,Pathological Anatomy
Journal of the European Academy of Dermatology and Venereology | Year: 2012

Background Lichen planus limited to the nail is uncommon, and information about its long-term prognosis is lacking. Objectives We attempted to review the epidemiological, clinical and histological features, the response to treatment and the follow-up of a large series of patients with nail lichen planus (NLP). Methods We searched for the records of all patients with a clinical and histopathological diagnosis of isolated NLP apart from January 1997 to December 2008. The patients presented during this period and followed until December 2009 in the consultation for nail disorder were reviewed in detail. Results Data on 67 patients were collected, with an average age of 47 years (6-78 years). A male preponderance was observed (64%). The mean duration of the disease was about 38 months. Fingernails were the site of involvement in 94% of cases. Matrix involvement was observed in 91% of cases. A total of 120 specimen's biopsy were taken and was contributory in 90% of cases. Two specimens biopsy were practiced in 70.15% of patients. Systemic corticosteroids were used in 46 patients, and associated in 20 cases to intralesional corticosteroids. Conclusions Our findings indicate that if NLP is correctly diagnosed and appropriately treated. Nail biopsy is proven to be a relatively simple, safe and useful procedure with a minimal scarring risk. Long-term observation indicates that the prognosis of NLP is poor with high rate of relapses, with permanent damage to the nail unit. © 2011 The Authors. Journal of the European Academy of Dermatology and Venereology.


BACKGROUND:: Hyaluronic acid and calcium hydroxylapatite fillers are generally safe, efficacious, and well tolerated. However, complications are inevitable, as with any medical procedure. Nodules at the site of filler implantation may pose the greatest challenge, as treatment is often empiric and can be influenced by misconceptions. METHODS:: Hyaluronic acid and calcium hydroxylapatite filler nodules, with or without inflammation, may form at various times during and after injection. The probable causes of these complications are described. Clinicians can benefit from a problem-oriented approach to their diagnosis and management. The need to consider common causes-notably, infection-before rare ones, such as hypersensitivity to filler material, is discussed. RESULTS:: Better understanding of the possible causes of hyaluronic acid and calcium hydroxylapatite filler nodules effectively guides treatment and prevents underestimation of the role of contamination-including mycobacteria-in the pathogenesis of inflammatory nodules. It can also inform preventative strategies. The authors advocate ultrasonographic imaging for patients with persistent nodules, to help determine the precise nature and location of the implanted materials. CONCLUSIONS:: When used appropriately, hyaluronic acid and calcium hydroxylapatite fillers have low complication rates. Filler nodules are often treated without full evaluation of possible causes. A problem-oriented approach that does not overlook the most common causes could improve the outcome of these unfortunate events and help prevent their occurrence and/or recurrence. Complications from currently available hyaluronic acid and calcium hydroxylapatite fillers are typically related to aspects of the injection procedure, such as suboptimal technique and bacterial contamination, rather than to the products themselves. © 2013 by the American Society of Plastic Surgeons.


Sundaram H.,Dermatology | Cassuto D.,Dermatology
Plastic and Reconstructive Surgery | Year: 2013

BACKGROUND:: The purpose of this study was to present new rheologic data for hyaluronic acid filler products, correlate them with recent tissue integration studies, and provide a scientific rationale for selecting appropriate products for volume replacement within different tissue levels and anatomical zones. A brief overview of the methodology of filler rheology studies and data analysis is provided. METHODS:: Seven U.S. Food and Drug Administration-approved, cross-linked, nonanimal derived hyaluronic acid filler products were studied: one cohesive polydensified matrix hyaluronic acid (Belotero Balance, also known as Belotero Basic), three Hylacross hyaluronic acids (Juvéderm Ultra, Juvéderm Ultra Plus, and Juvéderm Voluma), and three nonanimal stabilized hyaluronic acids (Perlane, Restylane, and Restylane SubQ). The elastic modulus, complex viscosity, and viscous modulus of each filler gel were quantified. Tan delta for each filler gel and also for calcium hydroxylapatite filler (Radiesse) was calculated at 0.7 Hz. RESULTS:: Cohesive polydensified matrix hyaluronic acid (Belotero Balance) has the lowest elasticity and viscosity and the highest tan delta. This predicts its soft, flowing qualities and correlates with its homogeneous pattern of tissue integration after intradermal implantation. Nonanimal stabilized hyaluronic acid (Perlane and Restylane) has the highest elasticity and viscosity and low tan delta. This predicts its firm, less flowing qualities and correlates with a bolus-like pattern of tissue integration. Hylacross hyaluronic acid (Juvéderm) has intermediate elasticity, viscosity, and tan delta, correlating with its intermediate pattern of tissue integration. CONCLUSIONS:: Rheologic evaluation reliably predicts tissue integration patterns and appropriate clinical applications of the studied fillers. Paradigms of layered filler placement can be designed to optimally address individual patient need. © 2013 by the American Society of Plastic Surgeons.


Fransway A.F.,Dermatology
Dermatitis | Year: 2013

Background: The North American Contact Dermatitis Group (NACDG) tests patients with suspected allergic contact dermatitis to a broad series of screening allergens and publishes periodic reports. Objective: The aims of this study were to report the NACDG patch-testing results from January 1, 2007, to December 31, 2008, and to compare results to pooled test data from the previous 2 and 10 years to analyze trends in allergen sensitivity. Methods and Materials: Standardized patch testing with 65 allergens was used at 13 centers in North America. χ2 analysis was used for comparisons. Results: A total of 5085 patients were tested; 11.8% (598) had an occupationally related skin condition, and 65.3% (3319) had at least 1 allergic patch test reaction, which is identical to the NACDG data from 2005 to 2006. The top 15 most frequently positive allergens were nickel sulfate (19.5%), Myroxylon pereirae (11.0%), neomycin (10.1%), fragrance mix I (9.4%), quaternium-15 (8.6%), cobalt chloride (8.4%), bacitracin (7.9%), formaldehyde (7.7%), methyldibromoglutaronitrile/ phenoxyethanol (5.5%), p-phenylenediamine (5.3%), propolis (4.9%), carba mix (4.5%), potassium dichromate (4.1%), fragrance mix II (3.6%), and methylchloroisothiazolinone/methylisothiazolinone (3.6%). There were significant increases in positivity rates to nickel, methylchloroisothiazolinone/ methylisothiazolinone, and benzophenone-3. During the same period of study, there were significant decreases in positivity rates to neomycin, fragrance mix I, formaldehyde, thiuram mix, cinnamic aldehyde, propylene glycol, epoxy resin, diazolidinyl urea, amidoamine, ethylenediamine, benzocaine, p-tert-butylphenol formaldehyde resin, dimethylol dimethyl hydantoin, cocamidopropyl betaine, glutaraldehyde, mercaptobenzothiazole, tosylamide formaldehyde resin, budesonide, disperse blue 106, mercapto mix, and chloroxylenol. Twenty-four percent (1221) had a relevant positive reaction to a non-NACDG supplementary allergen; and 180 of these reactions were occupationally relevant. Conclusions: Periodic analysis, surveillance, and publication of multicenter study data sets document trends in allergen reactivity incidence assessed in the patch test clinic setting and provide information on new allergens of relevance. © 2013 by the American Contact Dermatitis Society. All Rights Reserved.


Bhate C.,Dermatology | Schwartz R.A.,Dermatology | Schwartz R.A.,Preventive Medicine and Community Health
Journal of the American Academy of Dermatology | Year: 2011

Lyme disease (LD) is an increasingly recognized multisystem, insect-borne zoonosis. Prevalent worldwide, it has a variety of presentations at different stages of infection. The characteristic rash with central clearing known as erythema chronicum migrans, or simply erythema migrans, appears in its first stage. Typical features may be absent, and important variations are evident among cases seen in different parts of the world. LD may be difficult to diagnose clinically; knowledge about its epidemiology and transmission may be of assistance when the diagnosis is unclear. Based upon our experience with LD and a comprehensive literature review, we provide an update of LD epidemiology, pathophysiology, and management. We also cover the three clinical stages of LD that parallel those of syphilis, another spirochetal disease. © 2010 by the American Academy of Dermatology, Inc.


Lee R.,Dermatology | Schwartz R.A.,Dermatology | Schwartz R.A.,Preventive Medicine and Community Health
Journal of the American Academy of Dermatology | Year: 2011

Infective dermatitis (ID) is a chronic, relapsing dermatitis associated with human T-lymphotrophic virus (HTLV)-1 which was initially described in Jamaican children. Although most cases have been reported in Jamaica, ID may be seen in other HTLV-1 endemic areas, such as Brazil, Japan, sub-Saharan Africa, and Trinidad and Tobago. Since HTLV-1 infection has been implicated in the development of adult T-cell leukemia/lymphoma, an aggressive hematologic malignancy, and HTLV-1-associated myelopathy/tropical spastic paraparesis, a neurodegenerative disease, ID may serve as an early clinical marker for either condition. Although HTLV-1-associated infective dermatitis is considered by most to be rare, it has been increasingly diagnosed over the past 20 years; some suggest ID may be underdiagnosed. One should maintain suspicion of HTLV-1 infection among individuals in or from endemic areas, recognizing the clinical features and prognostic implications of infectious dermatitis. © 2009 by the American Academy of Dermatology, Inc.


Morgan A.J.,Dermatology and Pathology | Schwartz R.A.,Dermatology
International Journal of Dermatology | Year: 2010

Cutaneous polyarteritis nodosa is a rare form of vasculitis relating to small-to-medium-sized arteries. Its etiology is unknown. Clinical manifestations include tender subcutaneous nodules, livedo reticularis, cutaneous ulcers and necrosis. Although it is distinct from systemic polyarteritris nodosa in that it lacks significant internal organ involvement, extra-cutaneous manifestations may be evident. Commonly encountered symptoms include fever, malaise, myalgias, arthralgias, and paresthesias. Exclusion of systemic polyarteritis nodosa is essential in diagnosis. The clinical course is chronic with remissions, relapses, and a favorable prognosis. Mild cases may resolve with nonsteroidal anti-inflammatory drugs. If more severe, treatment with systemic corticosteroids generally achieves adequate response; however, adjunctive therapy is often necessary to allow reduction in steroid dosage. © 2010 The International Society of Dermatology.


Tajirian A.L.,Dermatology | Goldberg D.J.,Dermatology | Goldberg D.J.,Mount Sinai School of Medicine
Journal of Cosmetic and Laser Therapy | Year: 2010

More than ever, dermatologic surgeons are faced with a multitude of suture and other closure materials when evaluating a surgical wound. Given there is no single material that is ideal for all situations, the physician must decide which material is best suited for that particular closure. This review seeks to summarize the major properties of common suture materials as well as other closure materials including adhesive tapes, glues and staples. © 2010 Informa UK, Ltd.


Bhate C.,Dermatology | Schwartz R.A.,Dermatology | Schwartz R.A.,Preventive Medicine and Community Health
Journal of the American Academy of Dermatology | Year: 2011

Lyme disease (LD) is most often diagnosed clinically, and the differential diagnosis of erythema migrans may be challenging. Recent advances have raised questions about the efficacy of traditional diagnostic modalities, but may soon facilitate consistent identification of patients with Lyme borreliosis. Therapeutic recommendations vary with the stage of disease, and treatment usually leads to complete resolution. The management of patients with "chronic Lyme disease" is controversial. A number of preventative measures have been evaluated; those involving the avoidance of tick bites with protective clothing and insect repellents remain the simplest and most effective. © 2010 by the American Academy of Dermatology, Inc.


Sundaram H.,Dermatology
Plastic and Reconstructive Surgery | Year: 2015

Background: Fine lines and crepey skin are dermal manifestations of multilevel, age-related volume loss. It is, therefore, logical to combine intradermal volumetry for fine lines with subcutaneous volumetry for contours. This publication provides evidence-and experience-based rationales for application of cohesive polydensified matrix hyaluronic acid filler (Belotero Balance). Methods: Evidence level II data demonstrate efficacy of this product and longevity for up to a year or more with intradermal, superficial blanch injection. Its softness, flow tendencies, and homogeneous tissue integration are informed by low elasticity (G-Œ) and viscosity, high cohesivity, and high tan delta. Ultrastructural analysis confirms variable-density cross-linking, intended to confer resilience, and absence of detectable particles, minimizing Tyndall effect. Results: Scientific properties of Belotero Balance predict its 3-dimensional tissue expansion with prominent horizontal vectoring. We define this as superficial flow volumetry. High cohesivity and resilience can maintain structural integrity in typically mobile facial areas with strong muscular forces, uneven pressure, and significant hyaluronidase activity. This facilitates a natural appearance, both in repose and animation. Conclusions: Based on available evidence and experience, cohesive polydensified matrix hyaluronic acid is a notably efficacious fine line filler. The ideal fine line filler would restore dermis structurally and dynamicaly.moving as one with it, efficaciously expanding it, withstanding mechanical stress, swelling minimally, and potentially stimulating collagenesis. The relative contributions of space-filling, water binding, and collagenesis have implications for efficacy. A focus of current research is to determine the impact of filler cohesivity and tissue integration on these ideal qualities. Copyright © 2015 by the American Society of Plastic Surgeons.

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