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The light and laser-based devices used in cosmetic dermatology practice carry a risk of serious ocular injury if appropriate safety measures are not put in place. Currently there is a lack of enforced regulation around the use of these devices. This raises concerns for the handling of these devices by operators who may not have adequate training and qualifications. There is also no mandated reporting of adverse events, thus precluding determination of the true incidence of laser-induced ocular injuries. To decrease the risk of ocular and periocular laser-induced injuries, several practical measures can be implemented within the clinical setting. Scientific articles were identified by performing a literature review using terms relevant to laser eye safety and a narrative review was performed. This article explores several components of laser eye safety: patient screening and informed consent, clinical environment considerations, operator considerations, protective eyewear selection for operators and patients, when to use a corneal shield, how to place a corneal shield and what to do in the event of a suspected eye injury. It is our prerogative that a functional understanding of the scientific underpinnings of laser eye safety coupled with observance of published standards has the potential to reduce incidents. [ABSTRACT FROM AUTHOR]

BACKGROUND: Topical anesthesia has vasodynamic effects within the skin and therefore has the potential to change the presence of hemoglobin as a chromophore before intense pulsed light (IPL) and vascular laser treatments. It is unclear whether this is clinically relevant. Global consensus on the use of topical anesthetics in this context is lacking. OBJECTIVE: Review the effects of topical anesthetics on the skin microvasculature and the clinical implications of such effects on vascular treatments. METHODS: PubMed and Medline searches were performed to identify studies examining the vasodynamic effects of topical anesthesia on skin and evaluating differences in efficacy of IPL and vascular laser treatments with or without topical anesthetic use. RESULTS: Published studies reveal variable effects of different topical anesthetic agents on skin microvasculature. Only 3 controlled studies that directly examined the effect of topical anesthesia on clinical outcomes for pulsed dye laser (PDL) treatment of vascular conditions were identified. They did not support a difference in clinical outcomes with or without the use of topical anesthesia before PDL treatment. CONCLUSION: Although topical anesthetic agents have vasodynamic effects within the skin, there is currently insufficient evidence to advise against their use before light and laser-based vascular treatments. [ABSTRACT FROM AUTHOR]

BACKGROUND: Preference in eyebrow shape has been studied in young women, but less so in older adults, men, and a wide variety of ethnic groups. OBJECTIVE: To identify preference in eyebrow shape across age groups, genders, and ethnic groups for both the survey responder and the observed subject. METHODS: Digital images of subjects from 3 age groups (18–39, 40–59, and 60+ years), 2 genders (female and male), and 4 self-identified ethnic backgrounds were edited to correspond to 5 brow shapes (Anastasia, head-up, horizontal, rounded, and tail-up). Panels of images representing the same subject with different brow shapes were displayed and responders ranked them in order of attractiveness via an online survey. RESULTS: Six hundred fifty-two responders answered the survey. Survey responders generally preferred the Anastasia shape, but not in all subgroups. Strength of preference in eyebrow shape was more marked when observing images of women and less marked when observing men. CONCLUSION: An arched brow, such as the Anastasia shape, was the preferred eyebrow shape. This study is limited by its survey nature, underrepresentation of self-identified Black study responders, and categorization of data. Despite these findings, the authors advocate determining eyebrow shape preference individually with patients during cosmetic consultations. [ABSTRACT FROM AUTHOR]

Post-inflammatory hyperpigmentation (PIH) is an acquired hypermelanosis that can result from inflammatory dermatologic disease, trauma, or iatrogenesis from procedures. This condition disproportionately affects individuals with skin of color, and it can place a significant psychosocial burden on affected patients. The management of PIH is, therefore, of great interest to clinicians, especially dermatologists. The treatment of established PIH has long been a principal focus within the literature, with publications on the topic outnumbering publications on prophylaxis of PIH. Prophylaxis strategies to prevent PIH vary greatly in clinical practice, likely due to the absence of an evidence-based consensus. Published approaches to PIH prophylaxis include pretreatment (topical alpha hydroxy acids, retinoids, hydroquinone, and brimonidine) and post-treatment strategies (photoprotection, corticosteroids, and tranexamic acid). This review will examine the current literature on prophylaxis of PIH from energy-based device treatments. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. BACKGROUND: Laser test spots are commonly suggested for the assessment of clinical response and adverse effects, but use by laser operators is not well described. OBJECTIVE: To describe the use of laser test spots in the existing published literature regarding methodology (location, treatment parameters) and objective (clinical efficacy, safety, other). MATERIALS AND METHODS: This scoping review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines and included indexed studies performing test spots in human subjects for dermatologic conditions with clinical reassessment at a subsequent visit. RESULTS: Among 5,261 identified publications, 103 studies with 959 test spots were selected for inclusion. Test spots conducted were mostly on lesional skin (89.3%) assessing both clinical response and adverse effects (76.9%). Most test spots used multiple laser parameters with a single wavelength (48.3%). Fluence was most frequently adjusted either alone (30.1%) or in combination with pulse duration or spot size. Other described test spots examined single set of laser parameters, multiple wavelengths with various parameters, or were left unspecified. CONCLUSION: Laser test spot methodology was diverse and performed for dual objectives of efficacy and safety. The authors have compiled clinical considerations to assist laser operators in deciding whether performing a test spot may be beneficial to their patient. [ABSTRACT FROM AUTHOR]

Summary: Background: There is no accepted method to objectively assess the visual appearance of sunscreens on the skin. Methods: We present a method for sunscreen application, digital photography, and computer analysis to quantify the appearance of the skin after sunscreen application. Four sunscreen lotions were applied randomly at densities of 0.5, 1.0, 1.5, and 2.0 mg/cm2 to areas of the back of 29 subjects. Each application site had a matched contralateral control area. High‐resolution standardized photographs including a color card were taken after sunscreen application. After color balance correction, CIE L*a*b* color values were extracted from paired sites. Differences in skin appearance attributed to sunscreen were represented by ΔE, which in turn was calculated from the linear Euclidean distance within the L*a*b* color space between the paired sites. Results: Sunscreen visibility as measured by median ΔE varied across different products and application densities and ranged between 1.2 and 12.1. The visibility of sunscreens varied according to product SPF, composition (organic vs inorganic), presence of tint, and baseline b* of skin (P < .05 for all). Conclusion: Standardized sunscreen application followed by digital photography and indirect computer‐based colorimetry represents a potential method to objectively quantify visibility of sunscreen on the skin. [ABSTRACT FROM AUTHOR]

The evaluation of varieties of cultivated species is based on the implementation of multi-environmental trials that show high performances or strong limitations in some environments. To know the cause of these limitations, and to reason the adaptation of varieties to different environments, we propose a combined approach between the classical analysis of experimental results and a diagnostic approach using the DiagVar tool, which allows to assess the impact of limiting factors in each trial, the potential yield and the sensitivity of cultivars to those factors. This procedure is applied in a large and diversified field trial network including eight locations and three years to the comparison of two to four cultivars of the three agronomical pea types: spring peas, hr-winter peas (non-reactive to photoperiod) and Hr-winter peas (reactive to photoperiod). Estimates of potential yields from DiagVar for the three pea types were consistent with the experimental results, with higher values for hr-winter cultivars than for spring and Hr-winter ones. We shed light on specific limiting factors for each type, some of them being rarely quantified previously, which allows us to better target specific regions or environments for each pea type. Thus, spring types were more impacted by early limiting factors (loss of plants, low temperatures and radiation, lack of water, leading to reduced growth) and end-of-cycle stresses (high temperatures, water stress). Diseases had higher impacts on both winter types. Here we show for the first time that the lack of solar radiation affected particularly hr-winter type and the low crop nitrogen status affected more frequently spring peas. These results highlight the interest of carrying out an agronomic diagnosis in the analysis of varietal multi-environment trials, revealing the most important limiting factors to take into account while breeding new pea cultivars, particularly limiting factors that are difficult to directly observe. This method proves to be reliable and informative for breeders, technicians and agricultural advisors to discuss the adaptation of varieties to specific environment. • Association of an agronomic diagnosis via the DiagVar tool with an experimental approach. • Estimation of the yield potential of pea types and varieties. • Estimation of the contribution of limiting factors to yield decreases in each trial. • Confirmation of the role of well-known limiting factors of each pea type (water, heat, diseases). • Highlighting of the role of underestimated limiting factors (low radiation on winter types, nitrogen on spring type). [ABSTRACT FROM AUTHOR]

BACKGROUND OnabotulinumtoxinA (OnabotA) injections are effective to treat palmar hyperhidrosis (HH) but are quite painful. OBJECTIVE To evaluate efficacy and pain of OnabotA injection using a needle-free jet apparatus compared with the traditional needle injection to treat palmar HH. METHODS Twenty patients were recruited for a prospective open-label study. Their right hand was injected with 1% lidocaine with a jet injector, after which OnabotA was injected with a needle. The left hand was injected with OnabotA directly using the jet injector. Pain scores were recorded for both techniques. At 0, 1, 3, and 6 months, severity of palmar HH was evaluated with the Hyperhidrosis Disease Severity Scale (HDSS). RESULTS One point reduction in the HDSS score at 1 month showed no statistical difference between both hands (p = .451). However, the HDSS score at 1 month from baseline dropped by 1.6 for the hand treated with traditional needle injection of OnabotA compared with 1.25 for the hand treated with jet injections (p = .031). There was no statistical difference in the pain on injection with both techniques (p = .1925). CONCLUSION This study demonstrates effective and relatively painless use of a low-pressure jet injector for OnabotA in palmar HH. [ABSTRACT FROM AUTHOR]

Background: Smoking has been associated with psoriasis prevalence and severity. Objective: To evaluate prevalence of smoking in patients with psoriasis and to examine the relationship between smoking and psoriasis severity. Methods: MEDLINE, EMBASE, and Cochrane databases (1960-2012) and conference proceedings (2010-2012) were systematically searched using keywords relevant to psoriasis and smoking. Controlled studies addressing psoriasis and smoking status were included. A meta-analysis for the relative risk of smoking in psoriasis patients was performed. Results: Meta-analysis identified a significant association between smoking and psoriasis with a relative risk of 1.88 (95% CI, 1.66-2.13) for smoking in patients with psoriasis versus patients without psoriasis. Eight articles of 11 with data on smoking and psoriasis severity suggested that severity increases with smoking status. Conclusions: This literature review is in favor of a positive association between the prevalence of smoking and psoriasis as well as an association between smoking and severity of psoriasis. [ABSTRACT FROM AUTHOR]

Recently, HAs have been specifically manufactured to improve skin quality attributes, such as firmness, hydration, and texture.[1] These fillers have low cohesivity, low HA concentration, and are delivered through multiple microdroplet injections. (A) Evenly spaced papules at sites of microdroplet injections of HA fillers (patient's photograph). Microdroplet injection involves evenly spaced superficial injections of specifically designed HA which may explain the presence of erythema as part of the filler reaction. [Extracted from the article]

Background: Treating nail psoriasis is challenging. Corticosteroid matrix injection with needle is a conventional treatment but pain is often a limitation. Objective: Evaluate efficacy and safety of triamcinolone acetonide needle-free injection with the Med-Jet MBX in psoriatic fingernail. Methods: Seventeen patients were enrolled between January 2012 and January 2013. Four treatments sessions were scheduled every 4 ± 1 weeks. Clinical efficacy was evaluated according to Nail Psoriasis Severity Index (NAPSI) score of target nail differences before and after the treatment. Results: Mean baseline NAPSI score was 6.5 on an 8-point scale (95% confidence interval [CI] 5.652-7.348) and mean final NAPSI score was 2.8 on an 8-point scale (95% CI 1.859-3.741), demonstrating statistically significant treatment efficacy (p=.0007). NAPSI score for target nail from baseline to end of treatment was decreased by 46.25%. Conclusion: Treatment with triamcinolone acetonide delivered by Med-Jet MBX is a safe, minimally painful and effective treatment for nail psoriasis. [ABSTRACT FROM AUTHOR]

Objective: Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis are on a spectrum of rare reactions primarily attributable to drugs. Timely diagnosis, cessation of the offending drug and bum center care are associated with favorable outcomes. Acute blistering disease has a wide differential diagnosis, including autoimmune bullous disease and other drug reactions. The aim of our study was to identify the final diagnosis in patients transferred for widespread blistering disease and to identify clinical features at admission predicting final diagnosis. Methods: We performed a 5-year retrospective chart review (2006-2011) of the clinical features at admission of patients transferred to a burn ward with widespread blistering disease. Clinical features at admission were compared between patients. Results: 12 patients had a final diagnosis of Stevens-Johnson Syndrome or Toxic Epidermal Necrolysis and 7 patients had an alternative final diagnosis. Skin detachment surface area at admission was superior in the Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis group. Presence of tense bullae and pustules was associated with an alternative final diagnosis. Conclusion: Extensive skin detachment surface and morphological features (tense bullae, pustules) were statistically significant clinical clues to final diagnosis. Patients transferred for widespread blistering disease should be thoroughly evaluated in order to exclude other causes of acute blistering disease. [ABSTRACT FROM AUTHOR]

The article presents a case study of 65-year-old woman with unwanted pigmented lesions on the face for 10 years, with a history of kidney transplantation 15 years before for treatment of idiopathic renal failure and was on low-dose prednisone, mycophenolate mofetil, cyclosporine and diltiazem. The patient undergone laser surgery using Q-switched alexandrite laser resulting to the darkening of skin colored camouflage tattoo, which was corrected using carbon dioxide laser surgery.

Background: Granuloma annulare (GA) is challenging to treat, especially when generalized. A systematic review to support the use of light‐ and laser‐based treatments for GA is lacking. Methods: We performed a systematic review by searching Cochrane, MEDLINE, and Embase. Title, abstract, full‐text screening, and data extraction were done in duplicate. Quality appraisal was performed using the Joanna Briggs Institute critical appraisal tool for case series. Results: Thirty‐one case series met the inclusion criteria, representing a total of 336 patients. Overall, psoralen ultraviolet light A (PUVA) showed the greatest frequency of cases with complete response (59%, n = 77/131), followed by photodynamic therapy (PDT) (52%, n = 13/25), ultraviolet light B (UVB)/narrowband UVB (nbUVB)/excimer laser (40%, n = 19/47), UVA1 (31%, n = 27/86), and lasers (29%, n = 8/28). Overall across treatment modalities, higher response rates were seen in localized GA compared to generalized GA. Conclusions: The body of evidence for light‐ and laser‐based treatment of GA is sparse. Our results suggest that PUVA has a high clearance rate for GA but its use may be limited by concerns of carcinogenesis. Although PDT has the second highest clearance rate, adverse effects, small sample sizes, impractical treatment delivery (especially with generalized disease), and long‐term concerns of carcinogenesis may limit its use. Although UVB/nbUVB/excimer laser appeared slightly less effective than other light therapies, we recommend UVB/nbUVB/excimer laser therapy as a first‐line treatment for patients with generalized GA given wider availability and a favorable long‐term safety profile. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. BACKGROUND: The eye is susceptible to damage during dermatologic laser treatments. OBJECTIVE: Discuss the anatomy of the eye related to these procedures, the principles of laser–eye interactions, and ocular injuries reported with dermatologic laser treatments. METHODS: PubMed and Embase searches were conducted to identify cases of eye injuries associated with dermatologic laser treatments. RESULTS: One hundred nineteen cases of eye injury associated with dermatologic laser treatments were identified. Fifty-nine cases targeted the eyelid during resurfacing and caused ectropion, while 60 cases resulted from direct injury of ocular structures. In most of the cases of the latter, improper eye protection was used (44 of 60, 73%). In nearly all these cases, it was the patient who sustained a potentially avoidable ocular injury (52 of 60, 87%). Thirty-one patients had persistent ocular symptoms at follow-up (52%). The most common procedure in this context was laser hair removal of the face (35 of 60, 58%). Most of the cases developed injuries specific for the particular laser based on its wavelength and affinity to target certain ocular chromophores (59 of 60, 98%). CONCLUSION: Most of the dermatologic laser–associated eye injury cases have occurred in the context of laser resurfacing or laser hair removal and are potentially preventable. [ABSTRACT FROM AUTHOR]

The widespread use of masks during the COVID-19 pandemic presents a new avenue for protecting the lower half of the face from the harms of sun exposure. The increased social acceptability of masks, which may persist post-pandemic, has the potential to impact prevention of photosensitive disorders, photoaging, and skin cancer. The authors sought to review clinically relevant information on the ultraviolet (UV) shielding properties of masks. This synthesis of current research will help physicians counsel patients on optimal mask choices, from both dermatological and public health viewpoints. The variables impacting the UV protection of masks were reviewed, including fabric type, construction, porosity, and color. Other factors related to wear and use such as moisture, stretch, laundering, and sanitization are discussed in the context of the pandemic. Black, tightly woven, triple-layered polyester cloth masks were determined to be optimal for UV protection. The most protective choice against both SARS-CoV-2 and UV radiation is a medical mask worn underneath the aforementioned cloth mask. In order to preserve the filtration capacity of the fabric, masks should be changed once they have become moist. Washing cotton masks before first use in laundry detergents containing brightening agents increases their UV protection. Overall, cloth masks for the public that are safest against SARS-CoV-2 are generally also the most protective against UV damage. People should be encouraged to procure a high-quality mask to simultaneously help reduce the spread of SARS-CoV-2 and shield against sun exposure. Further investigation is needed on the UV-protective properties of medical masks. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 19-year-old Caucasian woman who was admitted to the emergency room because of abdominal pain, nausea and vomiting. She had a giant congenital cellular blue nevus (GCCBN) of the scalp since birth. Magnetic resonance imaging and surgical exploration showed a deeply infiltrative lesion surrounding the lymph nodes, left parotid gland and cervical muscles. Other clinical examination revealed signet-ring cell colon adenocarcinoma.

Transcutaneoususeofalong-pulsed1,064-nmNd:YAG laser represents a novel use of this device as an adjunctive treatment for refractory delayed-onset nodules caused by PMMA fillers. Goldman and Wollina 4 s described 2 patients with PMMA lip nodules who responded positively with the use of subdermal 1,064 nm Nd:YAG laser andbluntsuction cannula. [Extracted from the article]

Background: Sex and gender have increasingly been recognized as significant risk factors for many diseases, including dermatological conditions. Historically, sex and gender have often been grouped together as a single risk factor in the scientific literature. However, both may have a distinct impact on disease incidence, prevalence, clinical presentation, severity, therapeutic response, and associated psychological distress. Objectives and project description: The mechanisms that underlie differences in skin diseases between males, females, men, and women remain largely unknown. The specific objectives of this review paper are: To highlight the biological differences between males and females (sex), as well as the sociocultural differences between men and women (gender) and how they impact the integumentary system. To perform a literature review to identify important sex- and gender-related epidemiological and clinical differences for various skin conditions belonging to a range of disease categories and to discuss possible biological and sociocultural factors that could explain the observed differences. To discuss dermatological skin conditions and gender-affirming treatments within the transgender community, a population of individuals who have a gender identity which is different than the gender identity they were assigned at birth. Future impact: With the rising number of individuals that identify as non-binary or transgender within our increasingly diverse communities, it is imperative to recognize gender identity, gender, and sex as distinct entities. By doing so, clinicians will be able to better risk-stratify their patients and select treatments that are most aligned with their values. To our knowledge, very few studies have separated sex and gender as two distinct risk factors within the dermatology literature. Our article also has the potential to help guide future prevention strategies that are patient-tailored rather than using a universal approach. [ABSTRACT FROM AUTHOR]