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1.  Polypodium leucotomos as an Adjunct Treatment of Pigmentary Disorders 
Introduction: Extracts of the tropical fern Polypodium leucotomos appear to possess beneficial properties for the skin attributed to the presence of numerous compounds within the extract that have antioxidant and photoprotective properties. Orally administered Polypodium leucotomos may provide protection against the detrimental photoaging effects of sunlight and can also help reduce the frequency and severity of polymorphous light eruption. Polypodium leucotomos has also been shown to be beneficial for the prevention and potential treatment of several aesthetically relevant conditions. Objective: The purpose of this review is to investigate the beneficial role of Polypodium leucotomos as an adjunct treatment for vitiligo, melasma, and postinflammatory hyperpigmentation. Results: Based on a review of relevant literature including the results of a randomized, placebo-controlled study, the oral administration of Polypodium leucotomos significantly improved the severity of melasma in women after 12 weeks. Three randomized, double-blind, placebo-controlled studies have demonstrated significant improvements in vitiligo when oral Polypodium leucotomos therapy was combined with psoralens plus ultraviolet A and narrowband ultraviolet B. No controlled studies have assessed the efficacy of Polypodium leucotomos for the treatment of postinflammatory hyperpigmentation; however, its known antioxidant and anti-inflammatory properties and demonstrated effectiveness for melasma support its use for treating this condition. No adverse events have been associated with the use of Polypodium leucotomos. Conclusion: In addition to preventing many harmful effects associated with sunlight exposure, orally administered Polypodium leucotomos also appears to provide adjunctive benefits in treating vitiligo, melasma, and may have the potential to help with postinflammatory hyperpigmentation.
PMCID: PMC3970827
2.  Moisturizers and Ceramide-containing Moisturizers May Offer Concomitant Therapy with Benefits 
Introduction: Ceramide-containing moisturizers may offer benefits as an adjunct to acne treatment. Methods: An expert panel of 11 Canadian dermatologists, including an international clinical scientist, used the following modified Delphi process: 1) A systematic literature review for acne treatment, dry skin, irritation, depletion of ceramides in acne, and benefits of moisturizers and ceramide-containing moisturizers was conducted; 2) panel members gave their opinion on the resulting statements, taking into account their treatment practices; 3) a panel meeting was held during the 2011 Canadian Dermatology Update to determine final statements; 4) the panel reviewed the final document. Results: The panel reached the following consensus (11/11): 1) A very important reason for nonadherence to acne treatment is dry skin and irritation; 2) skin barrier dysfunction may contribute to acne; 3) dry skin and irritation commonly results from topical acne treatment; 4) dry skin and irritation commonly results from systemic retinoid therapy; 5) moisturizers can improve dryness and irritation resulting from acne treatment; 6) ceramide-containing moisturizers may enhance adherence and complement existing acne therapies; 7) adjunctive therapy with moisturizers should be considered in acne-treated patients. Conclusion: The panel proposes that adjunctive therapy with moisturizers, particularly ceramide-containing moisturizers, should be considered in acne-treated patients.
PMCID: PMC3970828
3.  Efficacy of a New Topical Nano-hyaluronic Acid in Humans 
Background: The aim of this study was to evaluate the efficacy of a new topical low molecular nano-hyaluronic acid preparation in treating wrinkles, skin hydration, and skin elasticity in humans. Methods: Thirty-three women with an average age of 45.2 were studied for a period of eight weeks to measure the anti-wrinkle efficacy of a new nano-hyaluronic acid. The measurements were performed in the periorbital regions by investigating the three-dimensional structure using a DermaTOP for wrinkles, Corneometer for skin hydration, Cutometer for skin elasticity, and a Chroma Meter for erythema. Thereafter, standardized images were taken and evaluated by six selected and trained raters at the end of the study for reduction of visible wrinkles as well as skin color uniformity and pigmentation. Results: The results of the study showed a statistically significant moisturizing effect of the product range (lotion, serum, and cream, after 2,4, and 8 weeks of treatment. Measurement of skin roughness showed a significantly finer skin structure after two weeks of treatment, and skin elasticity showed a significant improvement after 2 and 8 weeks of treatment. Conclusion: The new nano-hyaluronic acid clearly demonstrated a significant benefit in decreasing the depth of wrinkles (up to 40%), and skin hydration (up to 96%) and skin firmness and elasticity were significantly enhanced (up to 55%) at the end of eight weeks.
PMCID: PMC3970829
4.  Diet and Dermatitis: Food Triggers 
Given increasing awareness of the link between diet and health, many patients are concerned that dietary factors may trigger dermatitis. Research has found that dietary factors can indeed exacerbate atopic dermatitis or cause dermatitis due to systemic contact dermatitis. In atopic dermatitis, dietary factors are more likely to cause an exacerbation among infants or children with moderate-to-severe atopic dermatitis relative to other populations. Foods may trigger rapid, immunoglobulin E-mediated hypersensitivity reactions or may lead to late eczematous reactions. While immediate reactions occur within minutes to hours of food exposure, late eczematous reactions may occur anywhere from hours to two days later. Screening methods, such as food allergen-specific serum immunoglobulin E tests or skin prick tests, can identify sensitization to specific foods, but a diagnosis of food allergy requires specific signs and symptoms that occur reproducibly upon food exposure. Many patients who are sensitized will not develop clinical findings upon food exposure; therefore, these tests may result in false-positive tests for food allergy. This is why the gold standard for diagnosis remains the double-blind, placebo-controlled food challenge. In another condition, systemic contact dermatitis, ingestion of a specific food can actually cause dermatitis. Systemic contact dermatitis is a distinct T-cell mediated immunological reaction in which dietary exposure to specific allergens results in dermatitis. Balsam of Peru and nickel are well-known causes of systemic contact dermatitis, and reports have implicated multiple other allergens. This review seeks to increase awareness of important food allergens, elucidate their relationship with atopic dermatitis and systemic contact dermatitis, and review available diagnostic and treatment strategies.
PMCID: PMC3970830
5.  Malassezia (Pityrosporum) Folliculitis 
Malassezia (Pityrosporum) folliculitis is a fungal acneiform condition commonly misdiagnosed as acne vulgaris. Although often associated with common acne, this condition may persist for years without complete resolution with typical acne medications. Malassezia folliculitis results from overgrowth of yeast present in the normal cutaneous flora. Eruptions may be associated with conditions altering this flora, such as immunosuppression and antibiotic use. The most common presentation is monomorphic papules and pustules, often on the chest, back, posterior arms, and face. Oral antifungals are the most effective treatment and result in rapid improvement. The association with acne vulgaris may require combinations of both antifungal and acne medications. This article reviews and updates readers on this not uncommon, but easily missed, condition.
PMCID: PMC3970831
6.  Refractory Postinflammatory Hyperpigmentation Treated Fractional CO2 Laser 
Objective: Postinflammatory hyperpigmentation is a reactive hypermelanosis of the skin that occurs as a consequence of an inflammatory process, such as acne, eczema, drug reactions, burns, chemical peelings, and laser applications. Although topical agents remain to be the first-line treatment of postinflammatory hyperpigmentation, treatment of recalcitrant cases is challenging. The Q-switched ruby laser, the low-dose Q-switched neodymium-doped yttrium aluminum garnet laser, and the fractional 1550nm erbium-doped fiber laser have been reported to improve postinflammatory hyperpigmentation. Design/setting/participants: The authors present a case of refractory postinflammatory hyperpigmentation successfully treated with two sessions of fractional CO2 laser in a 24-year-old woman with Fitzpatrick skin type III. Results: After two treatment sessions with a one-month interval, the lesion totally cleared without any complications. Conclusion: Although many laser systems, including fractional CO2 lasers, can cause postinflammatory hyperpigmentation, they also can be very efficacious tools by using conservative laser settings and by providing appropriate post-treatment care in recalcitrant postinflammatory hyperpigmentation treatment.
PMCID: PMC3970832
7.  Mohs Surgery in Patients Immunobullous Diseases 
Background: Mohs surgery is one of the most effective treatment options for skin cancers as it offers one of the highest chances for cure. Mohs surgery is a precise technique that removes a layer at a time. Although this may be advantageous, this treatment method is difficult in patients with immunobullous diseases. Currently the guidelines for Mohs surgery do not discuss the premanagement of immunobullous patients about to undergo Mohs surgery. Objective: To advocate for increasing prednisone dose in patients with immunobullous disease prior to undergoing Mohs surgery. Case Report: The authors present a case of an excision of a squamous cell carcinoma from a 94-year-old woman with a history of pemphigus vulgaris using Mohs micrographic surgery. Conclusion: Current preoperative guidelines for Mohs surgery do not address the issue of altering steroid medications for patients with immunobullous disease prior to the procedure. The authors suggest that patients with a history of immunobullous disease undergoing Mohs micrographic surgery should have an increase in steroid dose prior to surgery.
PMCID: PMC3970833
8.  From the Test Tube to the Treatment Room 
The development of new drug classes and novel molecules that are brought to the marketplace has been a formidable challenge, especially for dermatologic drugs. The relative absence of new classes of antimicrobial agents is also readily apparent. Several barriers account for slow drug development, including regulatory changes, added study requirements, commercial pressures to bring drugs to market quickly by developing new generations of established compounds, and the greater potential for failure and higher financial risk when researching new drug classes. In addition, the return on investment is usually much lower with dermatologic drugs as compared to the potential revenue from “blockbuster” drugs for cardiovascular or gastrointestinal disease, hypercholesterolemia, and mood disorders. Nevertheless, some researchers are investigating new therapeutic platforms, one of which is boron-containing compounds. Boron-containing compounds offer a wide variety of potential applications in dermatology due to their unique physical and chemical properties, with several in formal phases of development. Tavaborole, a benzoxaborole compound, has been submitted to the United States Food and Drug Administration for approval for treatment of onychomycosis. This article provides a thorough overview of the history of boron-based compounds in medicine, their scientific rationale, physiochemical and pharmacologic properties, and modes of actions including therapeutic targets. A section dedicated to boron-based compounds in development for treatment of various skin disorders is also included.
PMCID: PMC3935647  PMID: 24578778
9.  Understanding the Burden of Adult Female Acne 
Objective: Typically regarded as an adolescent condition, acne among adult females is also prevalent. Limited data are available on the clinical characteristics and burden of adult female acne. The study objective was to describe clinical characteristics and psychosocial impact of acne in adult women. Design: Cross-sectional, web-based survey. Setting: Data were collected from a diverse sample of United States females. Participants: Women ages 25 to 45 years with facial acne (≥25 visible lesions). Measurements: Outcomes included sociodemographic and clinical characteristics, perceptions, coping behaviors, psychosocial impact of acne (health-related quality of life using acne-specific Quality of Life questionnaire and psychological status using Patient Health Questionnaire), and work/productivity. Results: A total of 208 women completed the survey (mean age 35±6 years), comprising White/Caucasian (51.4%), Black/African American (24.5%), Hispanic/Latino (11.1%), Asian (7.7%), and Other (5.3%). Facial acne presented most prominently on cheeks, chin, and forehead and was characterized by erythema, postinflammatory hyperpigmentation, and scarring. Average age of adult onset was 25±6 years, and one-third (33.7%) were diagnosed with acne as an adult. The majority (80.3%) had 25 to 49 visible facial lesions. Acne was perceived as troublesome and impacted self-confidence. Makeup was frequently used to conceal acne. Facial acne negatively affected health-related quality of life, was associated with mild/moderate symptoms of depression and/or anxiety, and impacted ability to concentrate on work or school. Conclusion: Results highlight the multifaceted impact of acne and provide evidence that adult female acne is under-recognized and burdensome.
PMCID: PMC3935648  PMID: 24578779
10.  Comparison and Overview of Currently Available Neurotoxins 
Background: Botulinum toxin has been in use since the 1970s. Over the last few years, the indications for botulinum toxin use have extended for cosmetic and noncosmetic applications. Three preparations of botulinum toxin type A and one preparation of botulinum toxin type B are commercially available and approved for use in the United States by the United States Food and Drug Administration. Objective: To review the most recent literature on all commercially available botulinum toxins in the United States, their indications, Food and Drug Administration approvals, and handling (reconstitution, storage, and dilution). Methods: A literature review (not Cochrane type analysis) using several databases (PubMed, MEDLINE, textbooks, Food and Drug Administration homepage, and manufacturer information) was performed. Conclusion: Several different preparations of botulinum toxins exist worldwide, none of which are identical or interchangeable. Manufacturer recommendations on all available botulinum neurotoxins advise the use of unpreserved saline for reconstitution. Side effects are mostly mild and always self-limited. More serious complications are associated with higher doses, improper injection techniques, and occur in patients with underlying comorbidities.
PMCID: PMC3935649  PMID: 24587850
11.  Incorporation of a Barrier Protection Cream in the Management of Chronic Hand Dermatitis 
A commonly encountered skin disorder in outpatient dermatology practice is hand dermatitis. In a considerable subset of patients, hand dermatitis can be a major source of prolonged distress when a pattern of chronicity develops due to repeated exposure to a variety of potential etiological factors. Most of the etiological factors are exogenous in nature. Hand dermatitis is an equal opportunity disease that affects both genders and occurs in individuals from all ethnic and cultural backgrounds. It is important to note that the term hand dermatitis does not refer to one specific diagnostic entity. Rather, hand dermatitis refers to multiple patterns of clinical disease that can be induced by a variety of exogenous sources. Occupational exposures with inadequate hand protection may be an important cause of epidermal barrier disruption, and in some cases contact allergy may be the primary cause or contribute to chronic hand dermatitis. In certain individuals, endogenous sources, such as atopic skin, cutaneous allergy (eczematous pattern), or skin hypersensitivity (urticarial pattern), may innately create predisposition to the development of hand dermatitis. Hand dermatitis can become a chronic problem that is often difficult to manage effectively. As consistency with hand protection and avoidance of irritant and allergenic contactants are integral to the effective treatment of chronic hand dermatitis, there is a high dependence on consistent patient adherence. Regardless of the etiological factors causing chronic hand dermatitis, lack of consistent hand protection is often a major reason why therapeutic results are suboptimal in some cases as exposure to the causes of the hand dermatitis are not adequately prevented. Regular wearing of protective gloves is not always feasible depending on the occupation, and although topically applied skin barrier protectants may be helpful in some cases, scientific data are generally limited with many products. This article provides an overview of hand dermatitis, reviews data supporting the therapeutic benefit of a specific barrier protection hand cream, and discusses ingredient modifications to the original formulation. The newer formulation does not alter the skin barrier protection components; however, the new ingredients were selected to add barrier repair properties to the original product, which was designed only as a skin barrier protectant.
PMCID: PMC3935650  PMID: 24578780
12.  Congenital Self-Healing Reticulohistiocytosis 
Congenital self-healing reticulohistiocytosis, also known as congenital self-healing Langerhans cell histiocytosis or Hashimoto-Pritzker disease, is a Langerhans cell histiocytosis. It is characterized by skin lesions in the newborn period in an otherwise healthy infant that show a Langerhans cell infiltrate in the skin on histological analysis. These findings subsequently spontaneously involute. This report describes two newborns who presented at birth with differing presentations of congenital self-healing reticulohistiocytosis. A review of the disorder, including diagnosis and evaluation, is presented.
PMCID: PMC3935651  PMID: 24578781
13.  Corticosteroid and Fragrance Allergy Exacerbating Scalp Psoriasis 
Increasing evidence indicates that allergic contact dermatitis can worsen pre-existing psoriasis. The authors highlight a delayed-hypersensitivity reaction to a common psoriasis medication and discuss therapeutic interventions.
PMCID: PMC3935652  PMID: 24578782
15.  Kallikrein 5-Mediated Inflammation in Rosacea 
Rosacea is a chronic inflammatory condition of facial skin estimated to affect more than 16 million Americans. Although the pathogenesis of rosacea is not fully understood, recent evidence in vitro as well as in vivo has supported the role of increased levels of the trypsin-like serine protease, kallikrein 5, in initiating an augmented inflammatory response in rosacea. The increase in the quantity and magnitude of biological activity of kallikrein 5 leads to production of greater quantities of cathelicidin (LL-37), an antimicrobial peptide associated with increases in innate cutaneous inflammation, vasodilation, and vascular proliferation, all of which are characteristic features of rosacea. In this article, the authors review the literature supporting the role of kallikrein 5 in the pathophysiology of rosacea, including how therapeutic interventions modulate the effects of kallikrein 5, thus providing further support for this pathophysiological model that at least partially explains many of the clinical features of cutaneous rosacea.
PMCID: PMC3930536  PMID: 24563692
16.  What’s New in the Medicine Cabinet? 
This article is the first in a periodic series of therapeutic topics with short reviews gleaned from major dermatology meetings, especially Scientific Poster Sessions, and is designed to provide information that may assist the readers in adapting information from the literature to their clinical practice. The topics covered in this issue are discussions of the clinical relevance of newer information about acne pathophysiology, acne in adult women, and topical corticosteroid spray formulations for chronic plaque psoriasis.
PMCID: PMC3930537  PMID: 24563693
17.  Safety and Efficacy of Facial Rejuvenation with Small Gel Particle Hyaluronic Acid with Lidocaine and AbobotulinumtoxinA in Post-Chemotherapy Patients 
Background: Due to advances in detection and treatment, approximately 70 percent of cancer patients are living more than five years after diagnosis. Research indicates that appearance worries are of great concern to cancer survivors impacting their quality of life. This is the first Phase IV investigator-initiated study to investigate the safety and efficacy of facial rejuvenation with small gel particle hyaluronic acid with lidocaine and abobotulinumtoxinA in post-chemotherapy patients. Methods: The safety and efficacy of facial rejuvenation with small gel particle hyaluronic acid with lidocaine and abobotulinumtoxinA was assessed in nine post-chemotherapy patients. Efficacy of small gel particle hyaluronic acid with lidocaine and abobotulinumtoxinA was measured at baseline, Week 2, and Week 8, using a wrinkle severity assessment score. Safety and tolerability of both products were assessed throughout the study by monitoring the occurrence of adverse events. Results: Patients received a mean total of 2.4mL of small gel particle hyaluronic acid with lidocaine in the nasolabial folds and 57.8 Units of abobotulinumtoxinA to glabellar lines at baseline. Additionally, at Week 2, a mean total l.OmL of small gel particle hyaluronic acid with lidocaine was administered to four patients. The mean investigator’s wrinkle severity assessment score at baseline was 2.22, indicating mild-to-moderate severity. At each of Weeks 2 and 8, there were significant improvements from baseline in wrinkle severity (p=0.004). Overall, small gel particle hyaluronic acid with lidocaine was well tolerated. Adverse events (i.e., bruising, redness, swelling, pain, tenderness, itching or other adverse events) were localized, self-limiting, and resolved within 1 to 2 days. The only adverse event attributed to abobotulinumtoxinA was soreness and slight tenderness at an injection site reported in one patient. Conclusion: Both study products were well tolerated in post-chemotherapy patients with no significant adverse events. There was a clinically meaningful and statistically significant improvement in wrinkle severity at Week 2 post-administration as compared to baseline. This improvement was maintained in all patients at Week 8.
PMCID: PMC3930538  PMID: 24563694
18.  The Effect of Incobotulinumtoxin A and Dermal Filler Treatment on Perception of Age, Health, and Attractiveness of Female Faces 
Objectives: Facial age, health, and attractiveness assessments play a major role in human social interaction and affect the way we perceive and think about others. Modern cosmetic dermatology provides a bewildering array of facial treatment procedures with botulinum toxin type A and dermal filler application being the most requested. The authors sought to determine the effect of facial rejuvenation procedures, such as application of incobotulinumtoxin A and dermal filler injections, on people's perception of age, health, and attractiveness. Methods: Ten women underwent three consecutive facial rejuvenation procedures with incobotulinumtoxin A, calcium hydroxylapatite, and a hyaluronic acid. Digital facial images were taken before treatment and after each subsequent treatment and presented to a total of 150 third-party assessors who judged the images for age, health, and attractiveness. Results: Each procedure was associated with a significant reduction in perceived age and an increase in perceived health and attractiveness compared with pre-treatment images. The effects were cumulative such that faces perceived as the youngest, healthiest, and most attractive had received all three treatments, followed in descending order by incobotulinumtoxin A and calcium hydroxylapatite treatment, and incobotulinumtoxin A alone. Conclusion: The authors demonstrate that naive judges are readily able to perceive the effect of nonsurgical facial rejuvenation procedures with incobotulinumtoxin A, calcium hydroxylapatite, and hyaluronic acid in terms of age, health, and attractiveness judgments. These effects were greatest when incobotulinumtoxin A and dermal filler treatments were combined.
PMCID: PMC3930539  PMID: 24563695
19.  Pyoderma Gangrenosum Leading to Bilateral Involvement of Ears 
Pyoderma gangrenosum is a destructive inflammatory disease that commonly occurs in an idiopathic way. Its occurrence in the auricular area is very rare, although this fact does not seem to determine a different behavior of the disease with regard to ulcer aspects and response to treatment. The authors report the case of a patient with pyoderma gangrenosum affecting both earlobes. The patient responded well to treatment with oral prednisone and has not shown relapses after a six-month follow-up.
PMCID: PMC3930540  PMID: 24563696
21.  Topical Corticosteroid Application and the Structural and Functional Integrity of the Epidermal Barrier 
Topical corticosteroids are a very important part of the treatment of many skin disorders, especially eczematous dermatoses. When utilized properly and judiciously these agents often achieve excellent results in clearing or markedly improving many dermatological disorders. As some studies have shown, topical corticosteroids, despite their ability to decrease inflammation through several mechanisms, induce abnormalities in lipid synthesis and intercellular bilayer structure in the stratum corneum, which appear to prolong epidermal barrier recovery. These adverse effects may contribute to eariier eczematous flaring if measures to provide barrier repair are not undertaken. In addition, although topical corticosteroids are applied only to sites affected by the skin eruption, the incorporation of “barrier friendly” excipients into the vehicle that improve stratum corneum permeability barrier function and integrity is very rational.
PMCID: PMC3848648  PMID: 24307921
22.  Infrared Camera Evaluation of the Cooling Effect of Triamcinolone Acetonide Aerosol 
Objective: Triamcinolone acetonide spray is a topical corticosteroid indicated for the relief of inflammatory/pruritic manifestations of corticosteroid-responsive dermatoses. There are clinical reports of an antipruritic, cooling sensation appreciated upon application. This study was designed to quantify the cryotherapeutic cooling effect of triamcinolone acetonide spray. Design: Using an infrared video camera, skin surface temperature was evaluated for change upon application of the triamcinolone acetonide and two comparator ingredient components of triamcinolone acetonide: ethanol alcohol in a non-aerosolized spray and triamcinolone acetonide cream. Setting: This was an open-label, single center, comparator study. Participants: This study enrolled 20 subjects with a diagnosis of either an acute or chronic steroid-responsive dermatosis. Ten additional controls were also enrolled. Measurements: Using an infrared video camera, skin surface temperature was evaluated for change upon application of the triamcinolone acetonide and two comparator ingredient components of triamcinolone acetonide:ethanol alcohol in a non-aerosolized spray and triamcinolone acetonide cream. Results: Across every study cohort, the average change in skin surface temperature with triamcinolone acetonide (between 16-18°C; P<0.001 for all comparisons, Figures 1 and 2) was significantly greater than the change demonstrated by both the non-aerosolized spray (between 5-7°C) and the triamcinolone acetonide cream (between 5.0-6.5°C). Conclusion: The transient temperature change of nearly 20°C with triamcinolone acetonide is most likely attributable to the refrigerant properties of the isobutane propellant of this product. Similar to other common cryotherapy methods, triamcinolone acetonide can achieve very low skin surface temperatures, which may result in localized relief of pruritus.
PMCID: PMC3848649  PMID: 24307922
23.  Open-Label Treatment of Moderate or Marked Melasma with a 4% Hydroquinone Skin Care System Plus 0.05% Tretinoin Cream 
Objective: To evaluate treating epidermal melasma using a 4% hydroquinone skin care system plus tretinoin 0.05% cream. Design: Multicenter open-label study with all patients receiving above-mentioned treatment for up to 24 weeks. Setting: Private dermatology and plastic surgery clinics and clinical research facilities. Participants: Thirty-seven adult females with moderate or marked epidermal melasma, melasma pigmentation of mild-to-marked intensity and Fitzpatrick skin type III to VI. Measurements: Melasma severity melasma pigmentation intensity melasma improvement, patient satisfaction, quality-of-life measures, erythema, dryness, peeling, burning/stinging. Results: No patient discontinued due to lack of efficacy or treatment-related adverse events. Treatment was associated with a significant reduction from baseline in melasma severity and melasma pigmentation intensity from Week 4 onward (P≤0.001), and 100 percent of patients showed improvement from Week 8 onward. At Week 24, 100 percent of patients were “satisfied” or “very satisfied” with the overall effectiveness of their treatment. Patients’ quality of life also improved (e.g., the proportion of patients feeling embarrassed or self-conscious about their skin “a lot” or “very much” declined from 78 percent at baseline to four percent at Week 24). Mean and median scores for erythema, dryness, peeling, and burning/stinging did not exceed trace levels. Conclusion: Treating moderate-to-severe melasma using the 4% hydroquinone skin care system plus 0.05% tretinoin can significantly reduce the severity of melasma and the intensity of melasma pigmentation within four weeks. Treatment was generally well tolerated and associated with an improved quality of life and high levels of patient satisfaction.
PMCID: PMC3848650  PMID: 24307923
24.  Halometasone 0.05% Cream in Eczematous Dermatoses 
Objective: The authors aimed to document the real-life performance of halometasone 0.05% w/w cream in day-today practice through this multicenter, open-label, Phase 4 study in India. Methods: The authors enrolled 302 eligible patients either with acute or chronic eczema and treated them with halometasone 0.05% cream daily. Efficacy variables (i.e., investigator’s global assessment and pruritis severity score) were assessed at baseline and end of study. Physician’s global evaluation of efficacy was assessed at the end of treatment. Treatment response was assessed as either a success or failure based on improvement in investigator’s global assessment. Results: Study population included 61.26 percent male and 38.74 percent female participants, with the average age being 30.79±14.52 (mean±SD) years. Contact dermatitis was seen in 22.52 percent of the study population. The mean (±SD) duration of primary diagnosis was 461.45 days (±854.67). The most common type observed was “chronic” (60.49%), followed by “acute” (24.83%) conditions. Levocetirizine was the most commonly prescribed concomitant medication (31.39%), followed by emollients (15.33%). The mean and median duration of therapy was 18.50 and 25 days, respectively. Post therapy, there was a significant (p<0.0001) reduction in the severity of eczema and pruritus. Therapeutic success defined as cure (85.43%) and improvement (11.26%) was seen in 96.69 percent of patients. Physician’s global evaluation of efficacy showed that in 96.67 percent of patients, treatment produced either an “excellent” (31.67%) or “good” (65.00%) response. Adverse events were reported in only 0.99 percent (3/302), with erythema being most common (0.66%). Conclusion: Halometasone is efficacious with a good safety and tolerability profile in patients with noninfected corticosteroid-responsive eczematous dermatoses.
PMCID: PMC3848651  PMID: 24307924
25.  A Review of Trimethylaminuria: (Fish Odor Syndrome) 
Trimethylaminuria, better known as fish odor syndrome, is a psychologically disabling condition in which a patient emits a foul odor, which resembles that of rotting fish. The disorder is most commonly caused by an inherited deficiency in flavin monooxygenase 3, the vital enzyme for the metabolism of trimethylamine, which is the compound responsible for the unpleasant odor. The condition is uncommon, but there has been recent research to suggest that the diagnosis may often be overlooked. Moreover, it is important to be cognizant of this condition because there are reliable diagnostic tests and the disorder can be devastating from a psychosocial perspective. While there is no cure, many simple treatment options exist that may drastically improve the quality of life of these patients. This article will review the literature with an emphasis on the psychosocial impact and treatment options.
PMCID: PMC3848652  PMID: 24307925

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