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Callan et al (Clin Cosmet Investig Dermatol. 2013;6:81-89) reported on the efficacy and safety profile of Juvéderm Voluma (Allergan, Inc) for midface volume deficiency in 103 participants over 24 months. Study participants received treatment with the hyaluronic acid filler to the malar area in 1 or 2 sessions over a 4-week period. An additional treatment was administered at week 78 of the study. At least a 1-point improvement on the midface volume deficit scale (MFVDS) and on the global aesthetic improvement scale (GAIS) was defined as clinically meaningful improvement. Of the 103 participants enrolled, 84% had moderate or significant volume deficiency at baseline. At week 8, 96% were reported to be responders on the MFVDS and 98% deemed themselves responders on the GAIS.

Seventy-two participants completed 24 months of treatment; 45 of these participants did not receive supplementary filler at week 78. Forty-three of the 45 (95.6%) participants were deemed responders on the MFVDS. At end of the study (n=72), 66 participants were either satisfied or very satisfied with the product, with 70 participants indicating that they would recommend the product to others. Adverse events included bruising, swelling, pain/tenderness, erythema, eyelid edema, and vasovagal syncope. Injection-site bruising and swelling were the most commonly reported adverse events. There was a single case of swelling in the left tear trough area, which occurred approximately 17 weeks after the week 4 treatment with the study product and 2 months after bilateral administration of Juvéderm Ultra (Allergan, Inc) to the tear troughs (done outside the study), which was speculated to have led to bilateral hardening of the Juvéderm Voluma implant. Oral prednisolone 5 mg daily was administered over 5 days and Hyalase (sanofi-aventis Australia)(100–150 U) was injected 3 times over a 3-week period. The swelling completely resolved approximately 1 month after the third Hyalase session.

What’s the issue?

Juvéderm Voluma currently is not available in the United States. It differs from other hyaluronic acid fillers in that it has a lower cohesivity but higher gel hardness that results in a more viscous solution. These properties are purported to be more suited for deeper injection in the skin at the deep dermal/subcutaneous level and submuscular/supraperiosteal level, which would allow for higher lift of tissue and volume restoration, while still being injected via a small-diameter needle. Although this filler has been used outside the United States, it will be interesting to see the adaptation and adoption in the US filler market. Is it the future of fillers or another one to add to the toolbox?

We want to know your views! Tell us what you think.

Callan et al (Clin Cosmet Investig Dermatol. 2013;6:81-89) reported on the efficacy and safety profile of Juvéderm Voluma (Allergan, Inc) for midface volume deficiency in 103 participants over 24 months. Study participants received treatment with the hyaluronic acid filler to the malar area in 1 or 2 sessions over a 4-week period. An additional treatment was administered at week 78 of the study. At least a 1-point improvement on the midface volume deficit scale (MFVDS) and on the global aesthetic improvement scale (GAIS) was defined as clinically meaningful improvement. Of the 103 participants enrolled, 84% had moderate or significant volume deficiency at baseline. At week 8, 96% were reported to be responders on the MFVDS and 98% deemed themselves responders on the GAIS.

Seventy-two participants completed 24 months of treatment; 45 of these participants did not receive supplementary filler at week 78. Forty-three of the 45 (95.6%) participants were deemed responders on the MFVDS. At end of the study (n=72), 66 participants were either satisfied or very satisfied with the product, with 70 participants indicating that they would recommend the product to others. Adverse events included bruising, swelling, pain/tenderness, erythema, eyelid edema, and vasovagal syncope. Injection-site bruising and swelling were the most commonly reported adverse events. There was a single case of swelling in the left tear trough area, which occurred approximately 17 weeks after the week 4 treatment with the study product and 2 months after bilateral administration of Juvéderm Ultra (Allergan, Inc) to the tear troughs (done outside the study), which was speculated to have led to bilateral hardening of the Juvéderm Voluma implant. Oral prednisolone 5 mg daily was administered over 5 days and Hyalase (sanofi-aventis Australia)(100–150 U) was injected 3 times over a 3-week period. The swelling completely resolved approximately 1 month after the third Hyalase session.

What’s the issue?

Juvéderm Voluma currently is not available in the United States. It differs from other hyaluronic acid fillers in that it has a lower cohesivity but higher gel hardness that results in a more viscous solution. These properties are purported to be more suited for deeper injection in the skin at the deep dermal/subcutaneous level and submuscular/supraperiosteal level, which would allow for higher lift of tissue and volume restoration, while still being injected via a small-diameter needle. Although this filler has been used outside the United States, it will be interesting to see the adaptation and adoption in the US filler market. Is it the future of fillers or another one to add to the toolbox?

We want to know your views! Tell us what you think.

Callan et al (Clin Cosmet Investig Dermatol. 2013;6:81-89) reported on the efficacy and safety profile of Juvéderm Voluma (Allergan, Inc) for midface volume deficiency in 103 participants over 24 months. Study participants received treatment with the hyaluronic acid filler to the malar area in 1 or 2 sessions over a 4-week period. An additional treatment was administered at week 78 of the study. At least a 1-point improvement on the midface volume deficit scale (MFVDS) and on the global aesthetic improvement scale (GAIS) was defined as clinically meaningful improvement. Of the 103 participants enrolled, 84% had moderate or significant volume deficiency at baseline. At week 8, 96% were reported to be responders on the MFVDS and 98% deemed themselves responders on the GAIS.

Seventy-two participants completed 24 months of treatment; 45 of these participants did not receive supplementary filler at week 78. Forty-three of the 45 (95.6%) participants were deemed responders on the MFVDS. At end of the study (n=72), 66 participants were either satisfied or very satisfied with the product, with 70 participants indicating that they would recommend the product to others. Adverse events included bruising, swelling, pain/tenderness, erythema, eyelid edema, and vasovagal syncope. Injection-site bruising and swelling were the most commonly reported adverse events. There was a single case of swelling in the left tear trough area, which occurred approximately 17 weeks after the week 4 treatment with the study product and 2 months after bilateral administration of Juvéderm Ultra (Allergan, Inc) to the tear troughs (done outside the study), which was speculated to have led to bilateral hardening of the Juvéderm Voluma implant. Oral prednisolone 5 mg daily was administered over 5 days and Hyalase (sanofi-aventis Australia)(100–150 U) was injected 3 times over a 3-week period. The swelling completely resolved approximately 1 month after the third Hyalase session.

What’s the issue?

Juvéderm Voluma currently is not available in the United States. It differs from other hyaluronic acid fillers in that it has a lower cohesivity but higher gel hardness that results in a more viscous solution. These properties are purported to be more suited for deeper injection in the skin at the deep dermal/subcutaneous level and submuscular/supraperiosteal level, which would allow for higher lift of tissue and volume restoration, while still being injected via a small-diameter needle. Although this filler has been used outside the United States, it will be interesting to see the adaptation and adoption in the US filler market. Is it the future of fillers or another one to add to the toolbox?

We want to know your views! Tell us what you think.

The British Journal of Dermatology recently described prognostic data regarding 1693 consecutive melanoma patients (American Joint Committee on Cancer stage I to II). Based on disease-free and overall survival and sentinel lymph node biopsy (SLNB) characteristics, the study found that the majority of regional lymph node metastases were in patients who did not undergo SLNB and that histologic regression was considered protective. The authors concluded that regression should not be an indication for SLNB in thin melanomas; in fact, it may be a favorable prognostic factor.

What’s the issue?

The art of medicine and its gray areas are respected and in full effect for melanoma, as clinicians always have to take into account the patient’s clinical history, comorbidities, and a fair amount of “gut instinct” in addition to the pathology specimen characteristics when deciding on surgical margins, imaging/laboratory tests, and particularly SLNB. How do you approach cases with regression? Although not an official upstaging factor anymore and now with evidence presented in the above study, how much do we worry and account for the mysterious route a particular melanoma took clinically and molecularly before the patient presented to us?

We want to know your views! Tell us what you think.

The British Journal of Dermatology recently described prognostic data regarding 1693 consecutive melanoma patients (American Joint Committee on Cancer stage I to II). Based on disease-free and overall survival and sentinel lymph node biopsy (SLNB) characteristics, the study found that the majority of regional lymph node metastases were in patients who did not undergo SLNB and that histologic regression was considered protective. The authors concluded that regression should not be an indication for SLNB in thin melanomas; in fact, it may be a favorable prognostic factor.

What’s the issue?

The art of medicine and its gray areas are respected and in full effect for melanoma, as clinicians always have to take into account the patient’s clinical history, comorbidities, and a fair amount of “gut instinct” in addition to the pathology specimen characteristics when deciding on surgical margins, imaging/laboratory tests, and particularly SLNB. How do you approach cases with regression? Although not an official upstaging factor anymore and now with evidence presented in the above study, how much do we worry and account for the mysterious route a particular melanoma took clinically and molecularly before the patient presented to us?

We want to know your views! Tell us what you think.

The British Journal of Dermatology recently described prognostic data regarding 1693 consecutive melanoma patients (American Joint Committee on Cancer stage I to II). Based on disease-free and overall survival and sentinel lymph node biopsy (SLNB) characteristics, the study found that the majority of regional lymph node metastases were in patients who did not undergo SLNB and that histologic regression was considered protective. The authors concluded that regression should not be an indication for SLNB in thin melanomas; in fact, it may be a favorable prognostic factor.

What’s the issue?

The art of medicine and its gray areas are respected and in full effect for melanoma, as clinicians always have to take into account the patient’s clinical history, comorbidities, and a fair amount of “gut instinct” in addition to the pathology specimen characteristics when deciding on surgical margins, imaging/laboratory tests, and particularly SLNB. How do you approach cases with regression? Although not an official upstaging factor anymore and now with evidence presented in the above study, how much do we worry and account for the mysterious route a particular melanoma took clinically and molecularly before the patient presented to us?

We want to know your views! Tell us what you think.

The issue of increasing antibiotic resistance has become a serious global threat. The World Health Organization proclaimed that World Health Day 2011 would be dedicated to a comprehensive consolidated strategy to prevent regression to a preantibiotic era when infections were the single leading causes of death. At the 2013 G8 summit, the health ministers of the 8 wealthiest nations in the world proclaimed that antibiotic resistance is the single biggest threat to health security facing the 21st century. In addition to the problem of resistance, the use of antibiotics can lead to long-lasting alterations in the gut flora, making posttraumatic septicemia due to enteric organisms difficult to manage. Antibiotic use also has been associated with the development of inflammatory bowel disease in a number of well-done studies. Acute antibiotic side effects have included dyschromia, photosensitivity, potential hepatic and/or renal dysfunction, gastrointestinal tract distress, and various cutaneous events ranging from morbilliform eruptions to hives and even toxic epidermal necrolysis. All of the foregoing begs for more rational, appropriate, and circumspect use of antibiotic medications by all health care providers.

If the preceding commentary didn’t catch your attention, perhaps the findings from a recent article published online in the British Journal of Dermatology will. In this thoughtful and comprehensive review, a meta-analysis was performed on 20 large-scale observational studies involving individuals aged 0 to 25 years, which assessed the impact of antibiotic exposure in utero or within the first year of life on the subsequent risk for developing eczema. Both cross-sectional and longitudinal studies demonstrated a consistently increased risk (odds ratio, 1.4) of developing atopic eczema associated with postnatal antibiotic exposure. In fact, this association was so reliable that a dose-response association could be determined, suggesting a 7% increased risk for eczema for each additional oral or parenteral antibiotic course received during the first year of life. Why this effect happens remains uncertain, but the association is clear.

What’s the issue?

Think about your use of antibiotics! Do you use open-ended and prolonged courses for acne, rosacea, hidradenitis suppurativa, dissecting cellulitis of the scalp, and other conditions in adults? Are you contributing to the ever-expanding pool of antibiotic-resistant microbes carried by the adult population? When you do utilize antibiotics, do you always verify the presence of infection by culture? Do you always obtain sensitivities on bacterial isolates? Do you explicitly admonish antibiotic recipients or their parents/guardians to finish the antibiotic course and not save or share? This recent article now makes concerns about antibiotic use early in life highly relevant. Do you treat impetigo, for example, with one of the several approved topical agents or still routinely administer oral antibiotics? How would you manage neonatal acne or furunculosis in a young child? This paper from the British Journal of Dermatology supplies us with yet another good reason to evaluate and refine our own prescribing habits when it comes to antibiotics.

We want to know your views! Tell us what you think.

The issue of increasing antibiotic resistance has become a serious global threat. The World Health Organization proclaimed that World Health Day 2011 would be dedicated to a comprehensive consolidated strategy to prevent regression to a preantibiotic era when infections were the single leading causes of death. At the 2013 G8 summit, the health ministers of the 8 wealthiest nations in the world proclaimed that antibiotic resistance is the single biggest threat to health security facing the 21st century. In addition to the problem of resistance, the use of antibiotics can lead to long-lasting alterations in the gut flora, making posttraumatic septicemia due to enteric organisms difficult to manage. Antibiotic use also has been associated with the development of inflammatory bowel disease in a number of well-done studies. Acute antibiotic side effects have included dyschromia, photosensitivity, potential hepatic and/or renal dysfunction, gastrointestinal tract distress, and various cutaneous events ranging from morbilliform eruptions to hives and even toxic epidermal necrolysis. All of the foregoing begs for more rational, appropriate, and circumspect use of antibiotic medications by all health care providers.

If the preceding commentary didn’t catch your attention, perhaps the findings from a recent article published online in the British Journal of Dermatology will. In this thoughtful and comprehensive review, a meta-analysis was performed on 20 large-scale observational studies involving individuals aged 0 to 25 years, which assessed the impact of antibiotic exposure in utero or within the first year of life on the subsequent risk for developing eczema. Both cross-sectional and longitudinal studies demonstrated a consistently increased risk (odds ratio, 1.4) of developing atopic eczema associated with postnatal antibiotic exposure. In fact, this association was so reliable that a dose-response association could be determined, suggesting a 7% increased risk for eczema for each additional oral or parenteral antibiotic course received during the first year of life. Why this effect happens remains uncertain, but the association is clear.

What’s the issue?

Think about your use of antibiotics! Do you use open-ended and prolonged courses for acne, rosacea, hidradenitis suppurativa, dissecting cellulitis of the scalp, and other conditions in adults? Are you contributing to the ever-expanding pool of antibiotic-resistant microbes carried by the adult population? When you do utilize antibiotics, do you always verify the presence of infection by culture? Do you always obtain sensitivities on bacterial isolates? Do you explicitly admonish antibiotic recipients or their parents/guardians to finish the antibiotic course and not save or share? This recent article now makes concerns about antibiotic use early in life highly relevant. Do you treat impetigo, for example, with one of the several approved topical agents or still routinely administer oral antibiotics? How would you manage neonatal acne or furunculosis in a young child? This paper from the British Journal of Dermatology supplies us with yet another good reason to evaluate and refine our own prescribing habits when it comes to antibiotics.

We want to know your views! Tell us what you think.

The issue of increasing antibiotic resistance has become a serious global threat. The World Health Organization proclaimed that World Health Day 2011 would be dedicated to a comprehensive consolidated strategy to prevent regression to a preantibiotic era when infections were the single leading causes of death. At the 2013 G8 summit, the health ministers of the 8 wealthiest nations in the world proclaimed that antibiotic resistance is the single biggest threat to health security facing the 21st century. In addition to the problem of resistance, the use of antibiotics can lead to long-lasting alterations in the gut flora, making posttraumatic septicemia due to enteric organisms difficult to manage. Antibiotic use also has been associated with the development of inflammatory bowel disease in a number of well-done studies. Acute antibiotic side effects have included dyschromia, photosensitivity, potential hepatic and/or renal dysfunction, gastrointestinal tract distress, and various cutaneous events ranging from morbilliform eruptions to hives and even toxic epidermal necrolysis. All of the foregoing begs for more rational, appropriate, and circumspect use of antibiotic medications by all health care providers.

If the preceding commentary didn’t catch your attention, perhaps the findings from a recent article published online in the British Journal of Dermatology will. In this thoughtful and comprehensive review, a meta-analysis was performed on 20 large-scale observational studies involving individuals aged 0 to 25 years, which assessed the impact of antibiotic exposure in utero or within the first year of life on the subsequent risk for developing eczema. Both cross-sectional and longitudinal studies demonstrated a consistently increased risk (odds ratio, 1.4) of developing atopic eczema associated with postnatal antibiotic exposure. In fact, this association was so reliable that a dose-response association could be determined, suggesting a 7% increased risk for eczema for each additional oral or parenteral antibiotic course received during the first year of life. Why this effect happens remains uncertain, but the association is clear.

What’s the issue?

Think about your use of antibiotics! Do you use open-ended and prolonged courses for acne, rosacea, hidradenitis suppurativa, dissecting cellulitis of the scalp, and other conditions in adults? Are you contributing to the ever-expanding pool of antibiotic-resistant microbes carried by the adult population? When you do utilize antibiotics, do you always verify the presence of infection by culture? Do you always obtain sensitivities on bacterial isolates? Do you explicitly admonish antibiotic recipients or their parents/guardians to finish the antibiotic course and not save or share? This recent article now makes concerns about antibiotic use early in life highly relevant. Do you treat impetigo, for example, with one of the several approved topical agents or still routinely administer oral antibiotics? How would you manage neonatal acne or furunculosis in a young child? This paper from the British Journal of Dermatology supplies us with yet another good reason to evaluate and refine our own prescribing habits when it comes to antibiotics.

We want to know your views! Tell us what you think.

In an article published online in Maclean’s magazine on May 14, 2013, postulated hypotheses regarding the potential cellular pathophysiology of longevity are summarized. Telomeres, telomerase, and telomerase activators each—individually or in concert—may have a critical role in this process.

Telomeres, the tiny bits of DNA that cap the ends of chromosomes, shorten each time a cell divides and also as people age. Telomeres function to prevent chromosomes from unraveling and fusing with each other, yet when they become too short, the cell dies. Shorter telomeres have been observed in patients with chronic stress, such as mothers of children with chronic illnesses and spouses who care for parents with Alzheimer disease; domestic abuse victims; and individuals with untreated depression. Several systemic conditions also are associated with shorter telomeres, including cancer, cardiovascular disease, dementia, diabetes mellitus, and osteoporosis. However, individuals who are older than 100 years have remarkably long telomeres. Hence, telomere length may be a more accurate indicator of a person’s physiologic age than one’s date of birth.

Telomerase, an antiaging enzyme, rebuilds telomeres and protects them from wearing down. Lifestyle changes, such as diet (with increased omega-3 fatty acids found in fish oils), exercise (approximately 30 minutes 4 or 5 times a week), and meditation, can potentially slow down the shortening of telomeres, increase telomerase activity, or both. Experiments performed on genetically engineered mice with a controllable telomerase gene show that when the enzyme is turned off, it becomes prematurely old, mentally impaired, and infertile. However, even after the mice reach this state of severe degeneration, the changes reverse when the gene is turned on again; the mice eventually resemble young active adults, with a healthy sheen restored to their hair coat, improved cognition, and restored fertility.

Telomerase activators, products that can stimulate telomerase, are the next logical progression in this quest to remain young. Indeed, at least one agent is commercially available (and sold as a nutritional supplement); however, the US Food and Drug Administration has not approved the oral agent.

What’s the issue?

The skin is the largest organ of the body. It is reasonable to speculate that the aging of one’s skin may be related to overall senescence. Therefore, the cellular longevity of a person’s keratinocytes also might be related to the length of their telomeres. Increasing the telomerase activity of these keratinocytes should favorably influence the length of the telomeres. To the best of my knowledge, a topical telomerase activator remains to be developed. However, it is very intriguing to consider the potential possibilities of a new topical cutaneous antiaging agent. Will the next antiaging agent for the skin be a topical telomerase activator?

We want to know your views! Tell us what you think.

In an article published online in Maclean’s magazine on May 14, 2013, postulated hypotheses regarding the potential cellular pathophysiology of longevity are summarized. Telomeres, telomerase, and telomerase activators each—individually or in concert—may have a critical role in this process.

Telomeres, the tiny bits of DNA that cap the ends of chromosomes, shorten each time a cell divides and also as people age. Telomeres function to prevent chromosomes from unraveling and fusing with each other, yet when they become too short, the cell dies. Shorter telomeres have been observed in patients with chronic stress, such as mothers of children with chronic illnesses and spouses who care for parents with Alzheimer disease; domestic abuse victims; and individuals with untreated depression. Several systemic conditions also are associated with shorter telomeres, including cancer, cardiovascular disease, dementia, diabetes mellitus, and osteoporosis. However, individuals who are older than 100 years have remarkably long telomeres. Hence, telomere length may be a more accurate indicator of a person’s physiologic age than one’s date of birth.

Telomerase, an antiaging enzyme, rebuilds telomeres and protects them from wearing down. Lifestyle changes, such as diet (with increased omega-3 fatty acids found in fish oils), exercise (approximately 30 minutes 4 or 5 times a week), and meditation, can potentially slow down the shortening of telomeres, increase telomerase activity, or both. Experiments performed on genetically engineered mice with a controllable telomerase gene show that when the enzyme is turned off, it becomes prematurely old, mentally impaired, and infertile. However, even after the mice reach this state of severe degeneration, the changes reverse when the gene is turned on again; the mice eventually resemble young active adults, with a healthy sheen restored to their hair coat, improved cognition, and restored fertility.

Telomerase activators, products that can stimulate telomerase, are the next logical progression in this quest to remain young. Indeed, at least one agent is commercially available (and sold as a nutritional supplement); however, the US Food and Drug Administration has not approved the oral agent.

What’s the issue?

The skin is the largest organ of the body. It is reasonable to speculate that the aging of one’s skin may be related to overall senescence. Therefore, the cellular longevity of a person’s keratinocytes also might be related to the length of their telomeres. Increasing the telomerase activity of these keratinocytes should favorably influence the length of the telomeres. To the best of my knowledge, a topical telomerase activator remains to be developed. However, it is very intriguing to consider the potential possibilities of a new topical cutaneous antiaging agent. Will the next antiaging agent for the skin be a topical telomerase activator?

We want to know your views! Tell us what you think.

In an article published online in Maclean’s magazine on May 14, 2013, postulated hypotheses regarding the potential cellular pathophysiology of longevity are summarized. Telomeres, telomerase, and telomerase activators each—individually or in concert—may have a critical role in this process.

Telomeres, the tiny bits of DNA that cap the ends of chromosomes, shorten each time a cell divides and also as people age. Telomeres function to prevent chromosomes from unraveling and fusing with each other, yet when they become too short, the cell dies. Shorter telomeres have been observed in patients with chronic stress, such as mothers of children with chronic illnesses and spouses who care for parents with Alzheimer disease; domestic abuse victims; and individuals with untreated depression. Several systemic conditions also are associated with shorter telomeres, including cancer, cardiovascular disease, dementia, diabetes mellitus, and osteoporosis. However, individuals who are older than 100 years have remarkably long telomeres. Hence, telomere length may be a more accurate indicator of a person’s physiologic age than one’s date of birth.

Telomerase, an antiaging enzyme, rebuilds telomeres and protects them from wearing down. Lifestyle changes, such as diet (with increased omega-3 fatty acids found in fish oils), exercise (approximately 30 minutes 4 or 5 times a week), and meditation, can potentially slow down the shortening of telomeres, increase telomerase activity, or both. Experiments performed on genetically engineered mice with a controllable telomerase gene show that when the enzyme is turned off, it becomes prematurely old, mentally impaired, and infertile. However, even after the mice reach this state of severe degeneration, the changes reverse when the gene is turned on again; the mice eventually resemble young active adults, with a healthy sheen restored to their hair coat, improved cognition, and restored fertility.

Telomerase activators, products that can stimulate telomerase, are the next logical progression in this quest to remain young. Indeed, at least one agent is commercially available (and sold as a nutritional supplement); however, the US Food and Drug Administration has not approved the oral agent.

What’s the issue?

The skin is the largest organ of the body. It is reasonable to speculate that the aging of one’s skin may be related to overall senescence. Therefore, the cellular longevity of a person’s keratinocytes also might be related to the length of their telomeres. Increasing the telomerase activity of these keratinocytes should favorably influence the length of the telomeres. To the best of my knowledge, a topical telomerase activator remains to be developed. However, it is very intriguing to consider the potential possibilities of a new topical cutaneous antiaging agent. Will the next antiaging agent for the skin be a topical telomerase activator?

We want to know your views! Tell us what you think.

Weiss and colleagues (J Am Acad Dermatol. 2013;68:98-102) conducted a 6-month safety, tolerance, and efficacy trial of nonablative 1927-nm fractional resurfacing of facial actinic keratosis (AK) with the Fraxel Dual (Solta Medical) laser. Twenty-four patients (5 male; 19 female) underwent up to 4 facial treatments with the 1927-nm laser with a 6-month follow-up period. The average patient age was 60 years, and Fitzpatrick skin types I and II were most common. Skin biopsy was performed in 7 patients prior to the initial procedure and at the 6-month follow-up.

Overall, there was an 86.6% reduction in absolute number of AK lesions at the 6-month follow-up visit. Cosmetic improvement was assessed on a 4-point scale. At the end of the 6-month study, the patients graded their improvement as 3.04 and investigators graded the improvement as 3.54. All 7 patient biopsies confirmed AK prior to treatment. At 6-month follow-up, 6 specimens (85.7%) showed histologic evidence of AK clearance.

What’s the issue?

The fractionated 1927-nm nonablative thulium laser is approved by the US Food and Drug Administration for the treatment of AK. Fraxel works by creating thermal zones, and the thermal damage targets AK lesions in the superficial skin. Actinic keratosis, the second most common condition treated by dermatologists, has many therapeutic options, including cryosurgery, photodynamic therapy, and multiple topical agents.

According to this study, 1927-nm fractional resurfacing appears to be a promising option for facial AK treatment. The added cosmetic benefit is a huge plus for many patients. More studies with long-term follow-up are needed.

How do you use Fraxel Dual to treat AK?

We want to know your views! Tell us what you think.

Weiss and colleagues (J Am Acad Dermatol. 2013;68:98-102) conducted a 6-month safety, tolerance, and efficacy trial of nonablative 1927-nm fractional resurfacing of facial actinic keratosis (AK) with the Fraxel Dual (Solta Medical) laser. Twenty-four patients (5 male; 19 female) underwent up to 4 facial treatments with the 1927-nm laser with a 6-month follow-up period. The average patient age was 60 years, and Fitzpatrick skin types I and II were most common. Skin biopsy was performed in 7 patients prior to the initial procedure and at the 6-month follow-up.

Overall, there was an 86.6% reduction in absolute number of AK lesions at the 6-month follow-up visit. Cosmetic improvement was assessed on a 4-point scale. At the end of the 6-month study, the patients graded their improvement as 3.04 and investigators graded the improvement as 3.54. All 7 patient biopsies confirmed AK prior to treatment. At 6-month follow-up, 6 specimens (85.7%) showed histologic evidence of AK clearance.

What’s the issue?

The fractionated 1927-nm nonablative thulium laser is approved by the US Food and Drug Administration for the treatment of AK. Fraxel works by creating thermal zones, and the thermal damage targets AK lesions in the superficial skin. Actinic keratosis, the second most common condition treated by dermatologists, has many therapeutic options, including cryosurgery, photodynamic therapy, and multiple topical agents.

According to this study, 1927-nm fractional resurfacing appears to be a promising option for facial AK treatment. The added cosmetic benefit is a huge plus for many patients. More studies with long-term follow-up are needed.

How do you use Fraxel Dual to treat AK?

We want to know your views! Tell us what you think.

Weiss and colleagues (J Am Acad Dermatol. 2013;68:98-102) conducted a 6-month safety, tolerance, and efficacy trial of nonablative 1927-nm fractional resurfacing of facial actinic keratosis (AK) with the Fraxel Dual (Solta Medical) laser. Twenty-four patients (5 male; 19 female) underwent up to 4 facial treatments with the 1927-nm laser with a 6-month follow-up period. The average patient age was 60 years, and Fitzpatrick skin types I and II were most common. Skin biopsy was performed in 7 patients prior to the initial procedure and at the 6-month follow-up.

Overall, there was an 86.6% reduction in absolute number of AK lesions at the 6-month follow-up visit. Cosmetic improvement was assessed on a 4-point scale. At the end of the 6-month study, the patients graded their improvement as 3.04 and investigators graded the improvement as 3.54. All 7 patient biopsies confirmed AK prior to treatment. At 6-month follow-up, 6 specimens (85.7%) showed histologic evidence of AK clearance.

What’s the issue?

The fractionated 1927-nm nonablative thulium laser is approved by the US Food and Drug Administration for the treatment of AK. Fraxel works by creating thermal zones, and the thermal damage targets AK lesions in the superficial skin. Actinic keratosis, the second most common condition treated by dermatologists, has many therapeutic options, including cryosurgery, photodynamic therapy, and multiple topical agents.

According to this study, 1927-nm fractional resurfacing appears to be a promising option for facial AK treatment. The added cosmetic benefit is a huge plus for many patients. More studies with long-term follow-up are needed.

How do you use Fraxel Dual to treat AK?

We want to know your views! Tell us what you think.

There has been a lot of recent news about empathy in the medical and lay press; likely because it translates into better patient satisfaction ratings (think Press-Ganey’s mission) and improved institutional finances (think patient compliance and reduced medical malpractice claims).   However, isn’t empathy just a bunch of touchy-feely vegans (no-offense) talking about stuff that really doesn’t matter in the long run?  Let’s see!

A working definition would be a good place to start.  Empathy is actually a “cognitive” event whereby the clinician (us) “understands” what patients are feeling, but does not actually “feel” what they are feeling.  Feeling a patient’s pain is considered sympathy, and too much of this leads one down the road to extra testing and/or procedures.  So, how can understanding a patient’s feelings improve your patient satisfaction ratings (and maybe your pay or bonus) and keep a subpoena out of your future? 

1.     Recent studies reveal that physicians (insert PAs or NPs) with higher empathy scores have better clinical outcomes in improving their patients’ compliance with chronic disease management such as diabetes mellitus as well as improved advice or instruction retention in mothers with sick children.  This means better A1Cs and less re-admits for sick kids.

2.     Studies further reveal that empathetic residents and physicians have far fewer conversations with risk managers and are rarely sued.  Lower lawsuit risks are less dependent upon severity of the medical/surgical outcome and more closely tied to empathetic behaviors; listening, eye-contact, a simple human touch, and returning phone calls.  You got it, showing genuine concern and warmth (even after a long surgery) promotes a strong and trusting relationship, allowing you to do your job without adverse outcomes.

3.     But does empathy actually affect you as a physician assistant or nurse practitioner?  Well, yes it does.  Simply being empathetic in your daily practice reduces your stress level.  You say, ‘come on!’  Studies of medical residents support statistically lower medical errors, improved personal life, less depression, and greater career satisfaction in those scoring higher on a highly validated and reliable empathy survey. 

4.     Well, we all know that listening to your patient eats into lunch time and gets you home even later than usual.  Not so.  Allowing patients to present their narrative results in a better history and permits the PA/NP to actively listen and digest the information.  Patients feel the difference and the time it takes, and you may find yourself ahead on the clock as well as feel better about your own performance.

Being the empathetic PA that I am (harrumph) let me and others know your feelings about empathy in your practice.  Feel free to nicely and anonymously lambast, (oops I mean describe) empathy stories in your clinical world.  The good and the bad are welcome!  Really.

There has been a lot of recent news about empathy in the medical and lay press; likely because it translates into better patient satisfaction ratings (think Press-Ganey’s mission) and improved institutional finances (think patient compliance and reduced medical malpractice claims).   However, isn’t empathy just a bunch of touchy-feely vegans (no-offense) talking about stuff that really doesn’t matter in the long run?  Let’s see!

A working definition would be a good place to start.  Empathy is actually a “cognitive” event whereby the clinician (us) “understands” what patients are feeling, but does not actually “feel” what they are feeling.  Feeling a patient’s pain is considered sympathy, and too much of this leads one down the road to extra testing and/or procedures.  So, how can understanding a patient’s feelings improve your patient satisfaction ratings (and maybe your pay or bonus) and keep a subpoena out of your future? 

1.     Recent studies reveal that physicians (insert PAs or NPs) with higher empathy scores have better clinical outcomes in improving their patients’ compliance with chronic disease management such as diabetes mellitus as well as improved advice or instruction retention in mothers with sick children.  This means better A1Cs and less re-admits for sick kids.

2.     Studies further reveal that empathetic residents and physicians have far fewer conversations with risk managers and are rarely sued.  Lower lawsuit risks are less dependent upon severity of the medical/surgical outcome and more closely tied to empathetic behaviors; listening, eye-contact, a simple human touch, and returning phone calls.  You got it, showing genuine concern and warmth (even after a long surgery) promotes a strong and trusting relationship, allowing you to do your job without adverse outcomes.

3.     But does empathy actually affect you as a physician assistant or nurse practitioner?  Well, yes it does.  Simply being empathetic in your daily practice reduces your stress level.  You say, ‘come on!’  Studies of medical residents support statistically lower medical errors, improved personal life, less depression, and greater career satisfaction in those scoring higher on a highly validated and reliable empathy survey. 

4.     Well, we all know that listening to your patient eats into lunch time and gets you home even later than usual.  Not so.  Allowing patients to present their narrative results in a better history and permits the PA/NP to actively listen and digest the information.  Patients feel the difference and the time it takes, and you may find yourself ahead on the clock as well as feel better about your own performance.

Being the empathetic PA that I am (harrumph) let me and others know your feelings about empathy in your practice.  Feel free to nicely and anonymously lambast, (oops I mean describe) empathy stories in your clinical world.  The good and the bad are welcome!  Really.

There has been a lot of recent news about empathy in the medical and lay press; likely because it translates into better patient satisfaction ratings (think Press-Ganey’s mission) and improved institutional finances (think patient compliance and reduced medical malpractice claims).   However, isn’t empathy just a bunch of touchy-feely vegans (no-offense) talking about stuff that really doesn’t matter in the long run?  Let’s see!

A working definition would be a good place to start.  Empathy is actually a “cognitive” event whereby the clinician (us) “understands” what patients are feeling, but does not actually “feel” what they are feeling.  Feeling a patient’s pain is considered sympathy, and too much of this leads one down the road to extra testing and/or procedures.  So, how can understanding a patient’s feelings improve your patient satisfaction ratings (and maybe your pay or bonus) and keep a subpoena out of your future? 

1.     Recent studies reveal that physicians (insert PAs or NPs) with higher empathy scores have better clinical outcomes in improving their patients’ compliance with chronic disease management such as diabetes mellitus as well as improved advice or instruction retention in mothers with sick children.  This means better A1Cs and less re-admits for sick kids.

2.     Studies further reveal that empathetic residents and physicians have far fewer conversations with risk managers and are rarely sued.  Lower lawsuit risks are less dependent upon severity of the medical/surgical outcome and more closely tied to empathetic behaviors; listening, eye-contact, a simple human touch, and returning phone calls.  You got it, showing genuine concern and warmth (even after a long surgery) promotes a strong and trusting relationship, allowing you to do your job without adverse outcomes.

3.     But does empathy actually affect you as a physician assistant or nurse practitioner?  Well, yes it does.  Simply being empathetic in your daily practice reduces your stress level.  You say, ‘come on!’  Studies of medical residents support statistically lower medical errors, improved personal life, less depression, and greater career satisfaction in those scoring higher on a highly validated and reliable empathy survey. 

4.     Well, we all know that listening to your patient eats into lunch time and gets you home even later than usual.  Not so.  Allowing patients to present their narrative results in a better history and permits the PA/NP to actively listen and digest the information.  Patients feel the difference and the time it takes, and you may find yourself ahead on the clock as well as feel better about your own performance.

Being the empathetic PA that I am (harrumph) let me and others know your feelings about empathy in your practice.  Feel free to nicely and anonymously lambast, (oops I mean describe) empathy stories in your clinical world.  The good and the bad are welcome!  Really.

In the May 2013 issue of the British Journal of Dermatology (2013;168:1040-1046) Gao et al reported on a side-by-side comparison of the use of photodynamic therapy (PDT) versus the pulsed dye laser (PDL) for the treatment of 9 red and 6 purple port-wine stains (PWSs). Fifteen patients (age range, 11–36 years) with PWSs were chosen and 2 adjacent areas of the lesion were randomly assigned to receive either a single PDL treatment or a single PDT session. Eleven lesions were on the neck area, 3 on the upper arm, and 1 on the upper leg. The PDL had a wavelength of 585 nm, and PDT was performed with intravenous hematoporphyrin monomethyl ether and a low-power copper vapor laser (510.6 and 578.2 nm, respectively). The PDT-treated area was done 30 minutes after the PDL-treated area with the other areas being covered. The clinical outcome was measured colorimetrically (blanching rates) and visually.

For the red PWSs the blanching rates at 2 months with the PDL were 11% to 24% and 22% to 55% with PDT (P=.006). For the purple PWSs, blanching rates ranged from 8% to 33% with PDL and 30% to 45% with PDT (P=.0313). Two patients with purple PWSs showed no response to either PDT or PDL. All PDT sites developed localized edema, and all PDL sites developed edema, blistering, purpura, and crusts. Four patients with red PWSs developed hyperpigmentation at the PDL sites.

What’s the issue?
Although there have been studies showing that PDT is an effective treatment of PWSs, this study is a side-by-side quantitative comparison of PDL versus PDT. This study showed that PDT is as effective and as safe as PDL and possibly superior for the treatment of red and purple flat PWSs. This study represents promising steps forward in PDT treatment of dermatologic conditions.

Even though PDL therapy is considered the current standard for treatment of PWSs, this study does show good clearance with PDT. Pulsed dye laser therapy has been more readily available in North America and Europe, though in China, where this study took place, it is not common. The PDT in this study utilized an intravenous photosensitizer, which may not be suitable for all patients. Other limitations of this study include the small sample size and the possibility that treating the lesion halves in close proximity to each other may compound adverse effects. Because each half of the lesion (close proximity to one another) was treated, the effects of each treatment may have been compounded.

Could PDT become an adjuvant treatment in the armamentarium for resistant port-wine stains?

We want to know your views! Tell us what you think.

In the May 2013 issue of the British Journal of Dermatology (2013;168:1040-1046) Gao et al reported on a side-by-side comparison of the use of photodynamic therapy (PDT) versus the pulsed dye laser (PDL) for the treatment of 9 red and 6 purple port-wine stains (PWSs). Fifteen patients (age range, 11–36 years) with PWSs were chosen and 2 adjacent areas of the lesion were randomly assigned to receive either a single PDL treatment or a single PDT session. Eleven lesions were on the neck area, 3 on the upper arm, and 1 on the upper leg. The PDL had a wavelength of 585 nm, and PDT was performed with intravenous hematoporphyrin monomethyl ether and a low-power copper vapor laser (510.6 and 578.2 nm, respectively). The PDT-treated area was done 30 minutes after the PDL-treated area with the other areas being covered. The clinical outcome was measured colorimetrically (blanching rates) and visually.

For the red PWSs the blanching rates at 2 months with the PDL were 11% to 24% and 22% to 55% with PDT (P=.006). For the purple PWSs, blanching rates ranged from 8% to 33% with PDL and 30% to 45% with PDT (P=.0313). Two patients with purple PWSs showed no response to either PDT or PDL. All PDT sites developed localized edema, and all PDL sites developed edema, blistering, purpura, and crusts. Four patients with red PWSs developed hyperpigmentation at the PDL sites.

What’s the issue?
Although there have been studies showing that PDT is an effective treatment of PWSs, this study is a side-by-side quantitative comparison of PDL versus PDT. This study showed that PDT is as effective and as safe as PDL and possibly superior for the treatment of red and purple flat PWSs. This study represents promising steps forward in PDT treatment of dermatologic conditions.

Even though PDL therapy is considered the current standard for treatment of PWSs, this study does show good clearance with PDT. Pulsed dye laser therapy has been more readily available in North America and Europe, though in China, where this study took place, it is not common. The PDT in this study utilized an intravenous photosensitizer, which may not be suitable for all patients. Other limitations of this study include the small sample size and the possibility that treating the lesion halves in close proximity to each other may compound adverse effects. Because each half of the lesion (close proximity to one another) was treated, the effects of each treatment may have been compounded.

Could PDT become an adjuvant treatment in the armamentarium for resistant port-wine stains?

We want to know your views! Tell us what you think.

In the May 2013 issue of the British Journal of Dermatology (2013;168:1040-1046) Gao et al reported on a side-by-side comparison of the use of photodynamic therapy (PDT) versus the pulsed dye laser (PDL) for the treatment of 9 red and 6 purple port-wine stains (PWSs). Fifteen patients (age range, 11–36 years) with PWSs were chosen and 2 adjacent areas of the lesion were randomly assigned to receive either a single PDL treatment or a single PDT session. Eleven lesions were on the neck area, 3 on the upper arm, and 1 on the upper leg. The PDL had a wavelength of 585 nm, and PDT was performed with intravenous hematoporphyrin monomethyl ether and a low-power copper vapor laser (510.6 and 578.2 nm, respectively). The PDT-treated area was done 30 minutes after the PDL-treated area with the other areas being covered. The clinical outcome was measured colorimetrically (blanching rates) and visually.

For the red PWSs the blanching rates at 2 months with the PDL were 11% to 24% and 22% to 55% with PDT (P=.006). For the purple PWSs, blanching rates ranged from 8% to 33% with PDL and 30% to 45% with PDT (P=.0313). Two patients with purple PWSs showed no response to either PDT or PDL. All PDT sites developed localized edema, and all PDL sites developed edema, blistering, purpura, and crusts. Four patients with red PWSs developed hyperpigmentation at the PDL sites.

What’s the issue?
Although there have been studies showing that PDT is an effective treatment of PWSs, this study is a side-by-side quantitative comparison of PDL versus PDT. This study showed that PDT is as effective and as safe as PDL and possibly superior for the treatment of red and purple flat PWSs. This study represents promising steps forward in PDT treatment of dermatologic conditions.

Even though PDL therapy is considered the current standard for treatment of PWSs, this study does show good clearance with PDT. Pulsed dye laser therapy has been more readily available in North America and Europe, though in China, where this study took place, it is not common. The PDT in this study utilized an intravenous photosensitizer, which may not be suitable for all patients. Other limitations of this study include the small sample size and the possibility that treating the lesion halves in close proximity to each other may compound adverse effects. Because each half of the lesion (close proximity to one another) was treated, the effects of each treatment may have been compounded.

Could PDT become an adjuvant treatment in the armamentarium for resistant port-wine stains?

We want to know your views! Tell us what you think.

JAMA Dermatology (formerly Archives of Dermatology) reported a study (Arch Dermatol. 2012;148:1083-1084) on the diagnosis of pigmented lesions by dermatologists compared with the MelaFind device (Mela Sciences), a handheld light unit that produces a 3-dimensional computer image of a pigmented lesion with subsequent recommendation of “high disorganization” versus “low disorganization.” Of 47 pigmented lesions (23 melanoma; 24 nonmelanoma), MelaFind recommended biopsy in 44 cases and no biopsy in 3 cases, with 1 lesion that was truly melanoma (96% sensitivity; 8% specificity), compared with a range of 48% to 100% (mean, 80%) sensitivity and 4% to 71% (mean, 43%) specificity among the study dermatologists. The authors quote in their conclusion paragraph that MelaFind is a “very sensitive tool to guide dermatologists.”

What’s the issue?

A recent patient forcefully suggested to me that our department should “keep up with the times” and invest in MelaFind. MelaFind’s Web site states that it is “not a screening device.” The physician fact sheet says that it is “the world’s first and only multi-spectral, non-invasive, painless, and 100% objective and automated computer vision technology that evaluates clinically atypical pigmented skin lesions and classifies them unambiguously and clearly based upon their level of 3-dimensional morphological disorganization.” Given these claims and its US Food and Drug Administration approval, how can we not own one? The word unambiguous has never been used to describe the clinical decision making and diagnosis of pigmented lesions, but we all hope for it. Quite well-known leaders in our field have spoken highly of this technology, though I await better-powered studies and more poignant data, or perhaps just a better grasp of how it works. Can someone aid us in understanding its true niche in clinical practice?

We want to know your views! Tell us what you think.

JAMA Dermatology (formerly Archives of Dermatology) reported a study (Arch Dermatol. 2012;148:1083-1084) on the diagnosis of pigmented lesions by dermatologists compared with the MelaFind device (Mela Sciences), a handheld light unit that produces a 3-dimensional computer image of a pigmented lesion with subsequent recommendation of “high disorganization” versus “low disorganization.” Of 47 pigmented lesions (23 melanoma; 24 nonmelanoma), MelaFind recommended biopsy in 44 cases and no biopsy in 3 cases, with 1 lesion that was truly melanoma (96% sensitivity; 8% specificity), compared with a range of 48% to 100% (mean, 80%) sensitivity and 4% to 71% (mean, 43%) specificity among the study dermatologists. The authors quote in their conclusion paragraph that MelaFind is a “very sensitive tool to guide dermatologists.”

What’s the issue?

A recent patient forcefully suggested to me that our department should “keep up with the times” and invest in MelaFind. MelaFind’s Web site states that it is “not a screening device.” The physician fact sheet says that it is “the world’s first and only multi-spectral, non-invasive, painless, and 100% objective and automated computer vision technology that evaluates clinically atypical pigmented skin lesions and classifies them unambiguously and clearly based upon their level of 3-dimensional morphological disorganization.” Given these claims and its US Food and Drug Administration approval, how can we not own one? The word unambiguous has never been used to describe the clinical decision making and diagnosis of pigmented lesions, but we all hope for it. Quite well-known leaders in our field have spoken highly of this technology, though I await better-powered studies and more poignant data, or perhaps just a better grasp of how it works. Can someone aid us in understanding its true niche in clinical practice?

We want to know your views! Tell us what you think.

JAMA Dermatology (formerly Archives of Dermatology) reported a study (Arch Dermatol. 2012;148:1083-1084) on the diagnosis of pigmented lesions by dermatologists compared with the MelaFind device (Mela Sciences), a handheld light unit that produces a 3-dimensional computer image of a pigmented lesion with subsequent recommendation of “high disorganization” versus “low disorganization.” Of 47 pigmented lesions (23 melanoma; 24 nonmelanoma), MelaFind recommended biopsy in 44 cases and no biopsy in 3 cases, with 1 lesion that was truly melanoma (96% sensitivity; 8% specificity), compared with a range of 48% to 100% (mean, 80%) sensitivity and 4% to 71% (mean, 43%) specificity among the study dermatologists. The authors quote in their conclusion paragraph that MelaFind is a “very sensitive tool to guide dermatologists.”

What’s the issue?

A recent patient forcefully suggested to me that our department should “keep up with the times” and invest in MelaFind. MelaFind’s Web site states that it is “not a screening device.” The physician fact sheet says that it is “the world’s first and only multi-spectral, non-invasive, painless, and 100% objective and automated computer vision technology that evaluates clinically atypical pigmented skin lesions and classifies them unambiguously and clearly based upon their level of 3-dimensional morphological disorganization.” Given these claims and its US Food and Drug Administration approval, how can we not own one? The word unambiguous has never been used to describe the clinical decision making and diagnosis of pigmented lesions, but we all hope for it. Quite well-known leaders in our field have spoken highly of this technology, though I await better-powered studies and more poignant data, or perhaps just a better grasp of how it works. Can someone aid us in understanding its true niche in clinical practice?

We want to know your views! Tell us what you think.

Professor Cyril Karabus is a 78-year-old pediatric oncologist who has dedicated his life to treating children with malignancy and is widely respected for his expertise and compassion. He was arrested in the United Arab Emirates (UAE) on August 18, 2012, while returning to his home in South Africa with his wife and daughter following his son’s wedding in Canada. The flight had stopped at Abu Dhabi International Airport overnight and he was detained by passport control. He was unaware that more than 10 years earlier he had been tried and convicted in absentia for manslaughter and falsifying documents (medical records) after the death of a 3-year-old girl with acute myeloblastic leukemia in 2002 while he was temporarily working in the UAE (Br Med J. 2012;345:e6815)(The Cancer Letter. 2012;38[46]:11).

The injustice of Professor Karabus’ arrest and detention by the UAE’s judicial system is deplorable. A South African activist organization called the Treatment Action Campaign stated that by no modern principle of jurisprudence is it acceptable to try a foreign citizen in absentia without informing him/her. The South African Medical Association has cautioned members about working in the UAE and the British Medical Association has protested the conditions in which he had been held (Br Med J. 2012;345:e6815). More recently, the World Medical Association (WMA) stated that an advisory notice will be published in the World Medical Journal and on the WMA Web site about the working conditions and legal risks for physicians working in the UAE (http://www.wma.net/en/30publications/10policies/30council/cr_16/).

Professor Karabus recently was released after being held for 9 months (since August 2012) even though the prosecution could not find the disputed medical records. On March 21, 2013, a judge acquitted Professor Karabus of all charges. However, the prosecution elected to appeal the judge’s decision, keeping Professor Karabus in the UAE. He was finally released and was back home in South Africa on May 18, 2013. The WMA continues to emphasize the risks for physicians working in the UAE (http://www.wma.net/en/40news/20archives/2013/2013_15/index.html).

What’s the issue?

First, is it still safe for doctors to accept locum tenens abroad? Perhaps yes, but it may be prudent to carefully assess the judicial system of the country in which one is considering to work before accepting the employment opportunity.

Second, should academic centers and particularly medical institutions be receiving large sums of money from foreign dictatorships, such as the UAE? Currently, there are several major medical institutions—Johns Hopkins University in Baltimore, Maryland; the Children’s National Medical Center in Washington, DC; and The University of Texas MD Anderson Cancer Center in Houston—that accept substantial financial contributions from the Zayed family who govern the UAE (Clin Dermatol. 2013;31:325-326).

We want to know your views! Tell us what you think.

Professor Cyril Karabus is a 78-year-old pediatric oncologist who has dedicated his life to treating children with malignancy and is widely respected for his expertise and compassion. He was arrested in the United Arab Emirates (UAE) on August 18, 2012, while returning to his home in South Africa with his wife and daughter following his son’s wedding in Canada. The flight had stopped at Abu Dhabi International Airport overnight and he was detained by passport control. He was unaware that more than 10 years earlier he had been tried and convicted in absentia for manslaughter and falsifying documents (medical records) after the death of a 3-year-old girl with acute myeloblastic leukemia in 2002 while he was temporarily working in the UAE (Br Med J. 2012;345:e6815)(The Cancer Letter. 2012;38[46]:11).

The injustice of Professor Karabus’ arrest and detention by the UAE’s judicial system is deplorable. A South African activist organization called the Treatment Action Campaign stated that by no modern principle of jurisprudence is it acceptable to try a foreign citizen in absentia without informing him/her. The South African Medical Association has cautioned members about working in the UAE and the British Medical Association has protested the conditions in which he had been held (Br Med J. 2012;345:e6815). More recently, the World Medical Association (WMA) stated that an advisory notice will be published in the World Medical Journal and on the WMA Web site about the working conditions and legal risks for physicians working in the UAE (http://www.wma.net/en/30publications/10policies/30council/cr_16/).

Professor Karabus recently was released after being held for 9 months (since August 2012) even though the prosecution could not find the disputed medical records. On March 21, 2013, a judge acquitted Professor Karabus of all charges. However, the prosecution elected to appeal the judge’s decision, keeping Professor Karabus in the UAE. He was finally released and was back home in South Africa on May 18, 2013. The WMA continues to emphasize the risks for physicians working in the UAE (http://www.wma.net/en/40news/20archives/2013/2013_15/index.html).

What’s the issue?

First, is it still safe for doctors to accept locum tenens abroad? Perhaps yes, but it may be prudent to carefully assess the judicial system of the country in which one is considering to work before accepting the employment opportunity.

Second, should academic centers and particularly medical institutions be receiving large sums of money from foreign dictatorships, such as the UAE? Currently, there are several major medical institutions—Johns Hopkins University in Baltimore, Maryland; the Children’s National Medical Center in Washington, DC; and The University of Texas MD Anderson Cancer Center in Houston—that accept substantial financial contributions from the Zayed family who govern the UAE (Clin Dermatol. 2013;31:325-326).

We want to know your views! Tell us what you think.

Professor Cyril Karabus is a 78-year-old pediatric oncologist who has dedicated his life to treating children with malignancy and is widely respected for his expertise and compassion. He was arrested in the United Arab Emirates (UAE) on August 18, 2012, while returning to his home in South Africa with his wife and daughter following his son’s wedding in Canada. The flight had stopped at Abu Dhabi International Airport overnight and he was detained by passport control. He was unaware that more than 10 years earlier he had been tried and convicted in absentia for manslaughter and falsifying documents (medical records) after the death of a 3-year-old girl with acute myeloblastic leukemia in 2002 while he was temporarily working in the UAE (Br Med J. 2012;345:e6815)(The Cancer Letter. 2012;38[46]:11).

The injustice of Professor Karabus’ arrest and detention by the UAE’s judicial system is deplorable. A South African activist organization called the Treatment Action Campaign stated that by no modern principle of jurisprudence is it acceptable to try a foreign citizen in absentia without informing him/her. The South African Medical Association has cautioned members about working in the UAE and the British Medical Association has protested the conditions in which he had been held (Br Med J. 2012;345:e6815). More recently, the World Medical Association (WMA) stated that an advisory notice will be published in the World Medical Journal and on the WMA Web site about the working conditions and legal risks for physicians working in the UAE (http://www.wma.net/en/30publications/10policies/30council/cr_16/).

Professor Karabus recently was released after being held for 9 months (since August 2012) even though the prosecution could not find the disputed medical records. On March 21, 2013, a judge acquitted Professor Karabus of all charges. However, the prosecution elected to appeal the judge’s decision, keeping Professor Karabus in the UAE. He was finally released and was back home in South Africa on May 18, 2013. The WMA continues to emphasize the risks for physicians working in the UAE (http://www.wma.net/en/40news/20archives/2013/2013_15/index.html).

What’s the issue?

First, is it still safe for doctors to accept locum tenens abroad? Perhaps yes, but it may be prudent to carefully assess the judicial system of the country in which one is considering to work before accepting the employment opportunity.

Second, should academic centers and particularly medical institutions be receiving large sums of money from foreign dictatorships, such as the UAE? Currently, there are several major medical institutions—Johns Hopkins University in Baltimore, Maryland; the Children’s National Medical Center in Washington, DC; and The University of Texas MD Anderson Cancer Center in Houston—that accept substantial financial contributions from the Zayed family who govern the UAE (Clin Dermatol. 2013;31:325-326).

We want to know your views! Tell us what you think.

In the April 2013 issue of the Journal of Drugs in Dermatology (2013;12:428-431), Clark et al retrospectively reviewed 115 laser sessions with the 1550-nm erbium-doped fractional nonablative laser (Fraxel Re:Store SR 1550, Solta Medical) in 45 patients with Fitzpatrick skin types IV to VI to assess the rate of postinflammatory hyperpigmentation and the associated laser parameters. The fluence, treatment level, and number of passes were all reviewed, as well as any posttreatment complications (ie, erythema, blistering, edema, bruising, pain) and long-term (1 month) complications (ie, hypopigmentation, hyperpigmentation). All patients were pretreated with hydroquinone cream 4% 2 weeks before, stopping 7 days before treatment and then continuing 4 weeks thereafter. Also, continuous forced-air cooling was used during treatment as well as posttreatment ice packs. Fifty-eight percent (26/45) of treatments were performed in patients with Fitzpatrick skin type IV, 24% (11/45) with type V, and 18% (8/45) with type VI. Laser parameters ranged from 4 to 70 mJ, treatment level 2 to 9, and 4 to 8 passes. Of 115 sessions, 5 (4%) were associated with postinflammatory hyperpigmentation; 2 of these instances occurred in 1 patient. The occurrence of postinflammatory hyperpigmentation was found to be statistically significant (P=.05), correlating with higher mean energy levels compared to those without hyperpigmentation (60.8 vs 44.7 mJ). Only 1 episode of postinflammatory hyperpigmentation lasted longer than 1 month, and 2 of 5 cases had only transient (<7 days) hyperpigmentation. All 5 cases resolved.

What’s the issue?

The 1550-nm erbium-doped fractional nonablative laser is being used for many skin conditions and has a low incidence of adverse effects when appropriate laser parameters are chosen. When treating darker skin phototypes with this technology, the concern for postinflammatory pigmentary alteration is more concerning. Higher treatment densities used in darker phototypes have been associated with a greater risk for postinflammatory hyperpigmentation. In their review, the authors showed that higher energy levels were associated with their cases of postinflammatory hyperpigmentation, with the caveat that they were careful not to use higher density or treatment levels than they would have used in lighter phototypes. Importantly, all 5 cases of hyperpigmentation did resolve and only 1 lasted longer than 1 month (2 months in total). This analysis reinforces that the 1550-nm erbium-doped fractional nonablative laser is quite safe in Fitzpatrick skin types IV to VI when appropriate parameters are utilized, as well as methodical pretreatment and posttreatment with hydroquinone, concomitant cooling, and strict posttreatment sun protection. With the right parameters, the treatment is quite safe; however, what are the optimal treatment parameters to provide efficacious and lasting results?

We want to know your views! Tell us what you think.

In the April 2013 issue of the Journal of Drugs in Dermatology (2013;12:428-431), Clark et al retrospectively reviewed 115 laser sessions with the 1550-nm erbium-doped fractional nonablative laser (Fraxel Re:Store SR 1550, Solta Medical) in 45 patients with Fitzpatrick skin types IV to VI to assess the rate of postinflammatory hyperpigmentation and the associated laser parameters. The fluence, treatment level, and number of passes were all reviewed, as well as any posttreatment complications (ie, erythema, blistering, edema, bruising, pain) and long-term (1 month) complications (ie, hypopigmentation, hyperpigmentation). All patients were pretreated with hydroquinone cream 4% 2 weeks before, stopping 7 days before treatment and then continuing 4 weeks thereafter. Also, continuous forced-air cooling was used during treatment as well as posttreatment ice packs. Fifty-eight percent (26/45) of treatments were performed in patients with Fitzpatrick skin type IV, 24% (11/45) with type V, and 18% (8/45) with type VI. Laser parameters ranged from 4 to 70 mJ, treatment level 2 to 9, and 4 to 8 passes. Of 115 sessions, 5 (4%) were associated with postinflammatory hyperpigmentation; 2 of these instances occurred in 1 patient. The occurrence of postinflammatory hyperpigmentation was found to be statistically significant (P=.05), correlating with higher mean energy levels compared to those without hyperpigmentation (60.8 vs 44.7 mJ). Only 1 episode of postinflammatory hyperpigmentation lasted longer than 1 month, and 2 of 5 cases had only transient (<7 days) hyperpigmentation. All 5 cases resolved.

What’s the issue?

The 1550-nm erbium-doped fractional nonablative laser is being used for many skin conditions and has a low incidence of adverse effects when appropriate laser parameters are chosen. When treating darker skin phototypes with this technology, the concern for postinflammatory pigmentary alteration is more concerning. Higher treatment densities used in darker phototypes have been associated with a greater risk for postinflammatory hyperpigmentation. In their review, the authors showed that higher energy levels were associated with their cases of postinflammatory hyperpigmentation, with the caveat that they were careful not to use higher density or treatment levels than they would have used in lighter phototypes. Importantly, all 5 cases of hyperpigmentation did resolve and only 1 lasted longer than 1 month (2 months in total). This analysis reinforces that the 1550-nm erbium-doped fractional nonablative laser is quite safe in Fitzpatrick skin types IV to VI when appropriate parameters are utilized, as well as methodical pretreatment and posttreatment with hydroquinone, concomitant cooling, and strict posttreatment sun protection. With the right parameters, the treatment is quite safe; however, what are the optimal treatment parameters to provide efficacious and lasting results?

We want to know your views! Tell us what you think.

In the April 2013 issue of the Journal of Drugs in Dermatology (2013;12:428-431), Clark et al retrospectively reviewed 115 laser sessions with the 1550-nm erbium-doped fractional nonablative laser (Fraxel Re:Store SR 1550, Solta Medical) in 45 patients with Fitzpatrick skin types IV to VI to assess the rate of postinflammatory hyperpigmentation and the associated laser parameters. The fluence, treatment level, and number of passes were all reviewed, as well as any posttreatment complications (ie, erythema, blistering, edema, bruising, pain) and long-term (1 month) complications (ie, hypopigmentation, hyperpigmentation). All patients were pretreated with hydroquinone cream 4% 2 weeks before, stopping 7 days before treatment and then continuing 4 weeks thereafter. Also, continuous forced-air cooling was used during treatment as well as posttreatment ice packs. Fifty-eight percent (26/45) of treatments were performed in patients with Fitzpatrick skin type IV, 24% (11/45) with type V, and 18% (8/45) with type VI. Laser parameters ranged from 4 to 70 mJ, treatment level 2 to 9, and 4 to 8 passes. Of 115 sessions, 5 (4%) were associated with postinflammatory hyperpigmentation; 2 of these instances occurred in 1 patient. The occurrence of postinflammatory hyperpigmentation was found to be statistically significant (P=.05), correlating with higher mean energy levels compared to those without hyperpigmentation (60.8 vs 44.7 mJ). Only 1 episode of postinflammatory hyperpigmentation lasted longer than 1 month, and 2 of 5 cases had only transient (<7 days) hyperpigmentation. All 5 cases resolved.

What’s the issue?

The 1550-nm erbium-doped fractional nonablative laser is being used for many skin conditions and has a low incidence of adverse effects when appropriate laser parameters are chosen. When treating darker skin phototypes with this technology, the concern for postinflammatory pigmentary alteration is more concerning. Higher treatment densities used in darker phototypes have been associated with a greater risk for postinflammatory hyperpigmentation. In their review, the authors showed that higher energy levels were associated with their cases of postinflammatory hyperpigmentation, with the caveat that they were careful not to use higher density or treatment levels than they would have used in lighter phototypes. Importantly, all 5 cases of hyperpigmentation did resolve and only 1 lasted longer than 1 month (2 months in total). This analysis reinforces that the 1550-nm erbium-doped fractional nonablative laser is quite safe in Fitzpatrick skin types IV to VI when appropriate parameters are utilized, as well as methodical pretreatment and posttreatment with hydroquinone, concomitant cooling, and strict posttreatment sun protection. With the right parameters, the treatment is quite safe; however, what are the optimal treatment parameters to provide efficacious and lasting results?

We want to know your views! Tell us what you think.