Photodynamic therapy in dermatology: a review

Photodynamic therapy (PDT) is used for the prevention and treatment of non-melanoma skin cancer. Until recently, clinically approved indications have been restricted to actinic keratoses, nodular and superficial basal cell carcinoma, and, since 2006, Bowen disease. However, the range of indications has been expanding continuously. PDT is also used for the treatment of non-malignant conditions such as acne vulgaris and leishmaniasis, as well as for treating premature skin aging due to sun exposure. The production of reactive oxygen intermediates like singlet oxygen depends on the light dose applied as well as the concentration and localization of the photosensitizer in the diseased tissue. Either cytotoxic effects resulting in tumor destruction or immunomodulatory effects improving inflammatory skin conditions are induced. Treating superficial non-melanoma skin cancer, PDT has been shown to be highly efficient, despite the low level of invasiveness. The excellent cosmetic results after treatment are beneficial, too

Side‐to‐Side Closure

This chapter addresses the proper setting to use primary side‐to‐side closure, and the benefits of using this approach. Also contraindications to this technique will be discussed. Preoperative considerations, including anesthesia, closure techniques, and postoperative care instructions, will all be reviewed

Photodynamic Therapy

The following discussion entails describing the mechanism of action of photodynamic therapy, including the types of sensitizing agents used and the various light/laser sources that can be applied. Further, it will review the technique for applying the two‐step process of photodynamic therapy (PDT), and will include mention of possible adverse effects that can be associated with PDT

Biopsy Techniques

Abstract This chapter will review the various types of biopsies utilized in dermatologic surgery, and the indications for the different approaches. In addition, the appropriate instruments and instructions for proper technique will be discussed

Nonsteroidal anti-inflammatory drugs (NSAIDs) consideration by dermatologists during the COVID19 pandemic

Nonsteroidal anti-inflammatory drugs (NSAIDs) have been an important therapy in the treatment of a large number of cutaneous pathologies for more than three decades. Concerns have been raised that NSAIDs may be associated with an increased risk of adverse effects when used in patients with acute viral respiratory infections. Given the current SARS-CoV-2 (COVID-19) pandemic, the availability of reliable information for clinicians and patients is of extreme importance Although accumulating evidence support the existence of a harmful effect of NSAIDs in some infectious settings, no clinical studies demonstrating that such risk applies in case of COVID-19. Pending further research, a pragmatic and cautionary approach would be to avoid regular NSAID use or as first line option in suspicion of COVID19 symptoms

Inguinal hyperhidrosis misdiagnosed as urinary incontinence: treatment with botulinum toxin A

Hyperhidrosis is a psychosocially embarrassing condition with a treatment history of varied success, including topical application of antiperspirants with aluminum salts (e.g., Drysol), oral anticholinergics, iontophoresis, and endoscopic transthoracic sympathectomy. The use of botulinum toxin type A (Botox) in humans for the treatment of hyperhidrosis didn't emerge until 1996. Botulinum toxin A is a safe and effective treatment for hyperhidrosis, and it has been shown to improve the quality of life in affected patients. The toxin works by inhibiting the release of acetylcholine at the neuromuscular junction, and affecting the postganglionic sympathetic innervation of sweat glands. The authors report a case of inguinal hyperhidrosis treated with botulinum toxin A. Very few cases with similar treatments have been found in the medical literature. More work should be done to find the optimal dose for treating this area, and affected patients should be informed of the potential benefits of botulinum toxin therapy

Six‐Month, Double‐Blind, Randomized, Split‐Face Study to Compare the Efficacy and Safety of Calcium Hydroxylapatite (CaHA) Mixed with Lidocaine and CaHA Alone for Correction of Nasolabial Fold Wrinkles

BACKGROUND Safety, pain, duration of effect, and patient satisfaction are important concerns for physicians performing dermal filler injections. OBJECTIVE This randomized, double‐blind, split‐face study compared the 6‐month safety profile of dermal injections of calcium hydroxylapatite (CaHA) mixed with lidocaine (RDF‐L) with that of CaHA alone (RDF) in nasolabial folds (NLFs). The study also assessed differences in pain perception, efficacy, and patient satisfaction of RDF‐L and RDF for correction of nasolabial wrinkles. METHODS Sixteen adult subjects with moderate to deep NLFs according to the Lemperle Rating Scale were enrolled. Pain perception was recorded from patients using a validated visual analog pain scale. Efficacy judged by a blinded injector and an independent observer was evaluated up to 24 weeks. Patient satisfaction surveys were also collected. Adverse events were recorded throughout the study. RESULTS/CONCLUSIONS Neither RDF‐L nor RDF led to significant adverse events. Comparable and limited local adverse events typical of dermal fillers were noted in both groups. No difference in duration of effect in the NLFs was shown between RDF‐L and RDF. Much less pain was reported on the RDF‐L side. In general, patients were extremely satisfied with the treatment on both sides. BioForm Medical (San Mateo, CA) provided Radiesse soft tissue filler, lidocaine, and other necessary supplies. Dr. Grunebaum has received compensation for presentations to the medical community about products manufactured by BioForm Medical

Lasers for Hair Removal

Hair reduction can be achieved using lasers. The ideal patient for laser hair reduction has light skin with dark hair, so that the laser does not damage the epidermis while sufficiently targeting the hair follicle. The largest spot size and highest tolerable fluence should be used. During the treatment, it is important to overlap 10–20% with the laser spot to avoid generating skip areas. If any sign of epidermal damage becomes evident, the fluence should be reduced by 20–30%

Suturing Techniques

It is critical to review appropriate suturing techniques when learning the skills needed for dermatologic surgery. This chapter discusses the goals of good technique, will review the instruments and materials needed in different surgical settings, will address tension considerations and will describe the various suture approaches that may be used

Laser for Treatment of Vascular Lesions

Port wine stains, telangiectasias, spider angiomas, and hemangiomas can all be successfully treated using lasers. The pulse dye laser was specifically developed to target the 577‐nm absorption peak of oxyhemoglobin, and is the predominant laser used for vascular lesions