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Eosinophilic annular erythema (EAE) of childhood is a rare and recurrent skin condition, with only a few cases described in the literature. The etiology of EAE in children remains unclear. Clinical presentation shows a persistent, non-pruritic, urticarial annular lesions that enlarge in a centrifugal pattern. Biopsy is required for diagnosis which characteristically shows a perivascular eosinophilic infiltrate concentrated in the dermis. Although there is considerable overlap between EAE and Annular Erythema of Infancy (AEI), some proposed differences include age of onset, duration of lesions, presence of mucin deposition of histopathology, and time to resolution. This case report describes a rare case of EAE of childhood in a newborn with associated neonatal eosinophilic pustulosis and laboratory abnormalities.

Treatment of disseminated granuloma annulare (GA) can be challenging and there is no gold standard for treatment. We observed two cases of generalized GA that had been resistant to other treaments successfully treated with canary seed milk. Canary seed milk has antioxidant (contains vitamin E), anti-diabetic (DPP-4 inhibition), and anti-hypertensive (ACE inhibition) properties. Therefore, dermatologists can consider alpiste milk as a sole or supplemental treatment for patients with GA with or without comorbidities such as diabetes and hypertension, in GA patients who prefer alternative therapy or failed other treatments.

Background Eyebrow rejuvenation is a common cosmetic concern among patients presenting to dermatologists. Due to increased patient demand for non-invasive procedures, multiple non-surgical, and minimally invasive eyebrow rejuvenation techniques have been developed. Objective This review aims to highlight the various non-surgical eyebrow rejuvenation therapeutic techniques described in the medical literature. Methods a Materials: A review of published articles on non-surgical and minimally invasive eyebrow rejuvenation using neurotoxins, fillers, lasers, threads, bimatoprost solution, and tattooing was conducted using the PubMed database. Results Currently available non-surgical options for eyebrow rejuvenation include neuromodulators, fillers, laser resurfacing, radiofrequency, and minimally invasive procedures such as tattooing and brow lift using threading. Conclusion The eyebrow is a complex and dynamic region. A thorough understanding of the anatomy of the supraorbital region and familiarity with available, minimally invasive treatment options is essential to tailor an individualized approach consisting of one or more treatments to achieve optimal rejuvenation outcomes. J Drugs Dermatol. 2021;20(9):970-978. doi:10.36849/JDD.6188.

Laser hair reduction is a common practice that utilized light-based therapy to prevent future hair growth. Complications following laser hair reduction treatment include thermal burns, which may lead to hyper- or hypopigmentation, hair stimulation, scar, or transient erythema of treated areas.Review reports of persistent urticaria following laser hair reduction and discuss a rarely discussed laser complication.Pubmed literature review.There have been very rare reports of persistent urticaria following laser hair reduction. Similar case reports have also been described though no definitive reasoning for this reaction, nor consistent treatment has been documented.In this report, we present a patient who developed persistent urticaria with severe pruritus in the areas treated with laser hair reduction. Previous reports an association was found between allergies and post-treatment urticarial eruption, with 33/36 patients having allergies, mostly to dust mites which is similar to the patient presented. Other etiologies such as reaction to cryogen and physical urticaria are unlikely.Our report highlights a case of persistent urticaria with severe pruritus following laser hair reduction treatment, with both similarities and differences to other cases reported in the literature. While this is a rare side effect of laser hair removal, it should be monitored in patients who have a history of moderate to severe environmental allergies.

La construcción de la identidad en las redes sociales, sobre todo en Facebook, ha sido objeto de gran interés. ¿Cómo se construye la identidad en esta red social? En este artículo se presenta el caso de una joven -Sexologa Dalia Cortez (sic)- cuyo perfil se siguió durante año y medio. A través de sus publicaciones y en forma de pequeñas historias que en conjunto conforman relatos de vida, esta joven da cuenta de la construcción de su identidad a través del desarrollo de distintas máscaras y narrativas sobre sí. Entre los hallazgos encontrados destaca que la construcción identitaria se da en la imbricación entre la vida online y offline, y con la participación de los otros, quienes se convierten en vigilantes, comentaristas y referentes para el desarrollo y presentación del sí mismo.

The COVID-19 pandemic has led to the global adoption of mask wearing to contain he rampant spread of the virus. Certain occupational groups, particularly health care providers, must wear masks for prolonged periods. Alongside this pandemic emerged the use of the all-encompassing term “Maskne”, used to describe mask-related dermatologic pathologies. Although there is an increase in acne and acneiform lesions associated with prolonged facial mask use, “Maskne” may be a misnomer, causing non-dermatologic providers to misdiagnose patients with acne when they, in fact, have perioral dermatitis.

The pathophysiology of melanoma involves malignant transformation of melanocytes. These can arise de novo or result from malignant transformation of a pre-existing nevus. This case report presents a patient with a new pigmented lesion, arising from a pre-existing neurofibroma, on her left scapula and no personal or family history of systemic neurofibromatosis. Biopsy confirmed the lesion to be malignant melanoma and, after excision, postoperative pathology showed a pre-existing neurofibroma. A review of the literature suggests there may be a link between the pathogenesis of neurofibroma and malignant melanoma, because NF1 mutations are observed in both neurofibromatosis and malignant melanoma. We hypothesize that the pre-existing neurofibroma created a proliferative environment that gave rise to the adjacent neoplasm. Further research is required to understand the shared pathway, because this may lead to novel forms of surveillance and treatment.

We highlight the use of intraprocedural hydrogen peroxide (H2O2) as a hemostatic agent during dermatologic surgery, with no clinical evidence of wound-healing impairment or worsening scar outcome. We describe the use of H2O2 to clean the surgical field and prevent mild persistent oozing of the wound edges intraoperatively.

Background Botulinum-derived neurotoxins have become a substantial tool in dermatologists' armamentarium for facial/neck rejuvenation. Current literature discusses anatomical "danger zones" to avoid during neurotoxin injection to prevent brow ptosis, blepharoptosis, and lower facial ptosis. Objective The aim of this study was to determine whether lidocaine 1% local anesthetic can be used to predict botulinum toxin treatment outcomes and prevent adverse effects of unwanted paralysis. Materials and methods One percent lidocaine was drawn up using BD ultra-fine 31 G (5/16″), 0.5-mL insulin syringes in the same quantity that would be drawn up for neurotoxin placement. The patient's face was cleansed and mapped; 0.1 mL of 1% lidocaine was injected × 5 sites in the glabella; and 3 sites were injected with 0.05 mL in the frontalis. The patient was assessed after 10 minutes. Results Improvement in frontalis and glabellar rhytides was appreciated, with noted "spocking" of the lateral brows. This technique allowed the authors to visualize the need for placement of toxin more laterally with eventual successful predictive placement for neurotoxin. Conclusion This technique of using local 1% lidocaine allows the practitioner to devise a neurotoxin distribution map tailored for each patient to limit unwanted paralysis from improper neurotoxin placement.

espanolLa investigacion describe analiticamente los procesos de formacion de seis estudiantes de licenciatura de la Facultad de Psicologia de la Universidad Nacional Autonoma de Mexico al participar en dos diferentes comunidades de practica profesional: un laboratorio de investigacion basica experimental y un centro comunitario de intervencion psicoterapeutica. A partir de observaciones participantes y de narraciones provenientes de entrevistas se analiza como los estudiantes se apropian del repertorio cultural de dichos escenarios al utilizarlo en situaciones especificas del quehacer del psicologo experimental y del psicologo clinico. Las comunidades de practica profesional posibilitan una aproximacion gradual al quehacer profesional al promover una participacion guiada en actividades de menor a mayor complejidad, acompanada por pares expertos y supervisada por docentes/profesionistas. Para caracterizar este proceso —conceptualizado por Jean Lave como participacion periferica legitima— proponemos la metafora de las escaleras de participacion formativa. EnglishThis research analytically describes the training processes for six undergraduate students in the School of Psychology at the National Autonomous University of Mexico, as they participate in two different communities of professional practice: a basic experimental research laboratory and a community center for psychotherapeutic intervention. Based on participants’ observations and narrations from interviews, analysis is focused on the ways in which students take on the cultural repertoire of these settings by using it in specific situations in the work of experimental and clinical psychologists. The communities of practice facilitate a gradual approximation of professional work, by promoting guided participation in activities from lesser to greater complexity, while accompanied by expert peers and supervised by teachers/ professionals. To characterize this process –conceptualized by Jean Lave as legitimate peripheral participation, we propose the metaphor of stairways of educational participation.

Tear trough and infraorbital region changes are one of the first signs recognizable aging. This is a common consultation for cosmetic dermatologists and there are many treatment options available.This article provides a review of the anatomy and changes that occur in the infraorbital region as we age. We also suggest the use of the osseous, color, underlying anatomy, laxity, adipose, rhytides (OCULAR) mnemonic to evaluate these changes and review the literature for treatments options.A literature search was performed through PubMed, using search terms "Tear trough," "Infra-orbital," "Dark-circles," "Lower-Eyelid," and "Midface."Fillers, lasers, radiofrequency devices, chemical peels, various topicals, and botulinum toxin are available non-surgical treatment options discussed in the literature found to significantly improve and rejuvenate the infraorbital region.A complete understanding of the anatomy and changes that occur with aging are of most importance when assessing the infraorbital region. Organizing these changes into the OCULAR mnemonic is one way to assess the infraorbital region and achieve optimal rejuvenation.

Hispanics/Latinos are one of the fastest growing segments in the skin of color population in the United States. Utilization of lasers especially in people with skin of color requires a thorough understanding of laser physics and laser tissue interactions. In this article, we will outline the different lasers used in our practice based on each chromophore. Pretreatment recommendations as well as management of complications will also be shortly discussed. Our goal is for the readers to grasp the importance of proper device selection, understand the concept of selective photothermolysis, and the various treatment parameters required for optimal safety and efficacy. J Drugs Dermatol. 2019;18(3 Suppl):s127-131.

In 2015, over 2.4 million patients had treatments with soft tissue fillers, with the largest population between 40 and 54 years of age and ranging in age from teenagers to nonagenarians (ASPS, Plastic Surgery Statistics Report 2015, 2015) (4). This data is also representative of the patient population seeking treatment with temporary fillers of the trunk and extremities where the average age is around 60 years, with females significantly outweighing males. All skin types are represented in this demographic, but skin types II–IV are far more common than V–VI.

Background The American Council of Graduate Medical Education, which oversees much of postgraduate medical education in the United States, has championed the concept of "milestones," standard levels of achievement keyed to particular time points, to assess trainee performance during residency. Objective To develop a milestones document for the American Society for Dermatologic Surgery (ASDS) Cosmetic Dermatologic Surgery (CDS) fellowship program. Methods An ad hoc milestone drafting committee was convened that included members of the ASDS Accreditation Work Group and program directors of ASDS-approved Cosmetic Dermatologic Surgery (CDC) fellowship training programs. Draft milestones were circulated through email in multiple rounds until consensus was achieved. Results Thirteen milestones were developed in the 6 Accreditation Council for Graduate Medical Education (ACGME) competency areas, with 8 of these being patient-care milestones. Additional instructions for milestone administration more specific to the CDS fellowship than general ACGME instructions were also approved. Implementation of semiannual milestones was scheduled for the fellowship class entering in July 2018. Conclusion Milestones are now available for CDS fellowship directors to implement in combination with other tools for fellow evaluation.

BACKGROUND Cutaneous biopsy sites are often difficult to discern or are frequently misidentified when patients present for the treatment of skin cancers. This frustrating situation can lead to delays in treatment and wrong site surgeries. Current methods aiming to prevent this situation are not perfect. OBJECTIVE This study seeks to determine the efficacy of ultraviolet-fluorescent tattoos in facilitating the correct identification of suspected nonmelanoma skin cancer biopsy sites. METHODS In this prospective cohort, 51 shave biopsy sites were tattooed with ultraviolet-fluorescent ink in a series of 31 patients suspected of having a cutaneous malignancy. At the time of follow-up, the ability of the patient and the physician to identify the correct site with and without ultraviolet illumination of the tattoo was recorded. Visibility of the tattoo was graded before and after treatment. RESULTS Patients could not positively identify their biopsy site in 35% of cases. In 7% of cases, physicians could not confidently identify the site without the aid of ultraviolet illumination. In conjunction with tattoo illumination, physicians confidently identified the site in 100% of the cases. No adverse events occurred. CONCLUSION Ultraviolet-fluorescent tattoos offer a safe and reliable means of accurately marking cutaneous biopsy sites.

IMPORTANCE: Despite the growing popularity of cosmetic procedures, the sociocultural and quality-of-life factors that motivate patients to undergo such procedures are not well understood. OBJECTIVE: To estimate the relative importance of factors that motivate patients to seek minimally invasive cosmetic procedures. DESIGN, SETTING, AND PARTICIPANTS: This prospective, multicenter observational study was performed at 2 academic and 11 private dermatology practice sites that represented all US geographic regions. Adult patients presenting for cosmetic consultation or treatment from December 4, 2016, through August 9, 2017, were eligible for participation. EXPOSURES: Participants completed a survey instrument based on a recently developed subjective framework of motivations and a demographic questionnaire. MAIN OUTCOMES AND MEASURES: Primary outcomes were the self-reported most common motivations in each quality-of-life category. Secondary outcomes were other frequently reported motivations and those associated with specific procedures. RESULTS: Of 529 eligible patients, 511 agreed to participate, were enrolled, and completed the survey. Typical respondents were female (440 [86.1%]), 45 years or older (286 [56.0%]), white (386 [75.5%]), and college educated (469 [91.8%]) and had previously received at least 2 cosmetic procedures (270 [52.8%]). Apart from motivations pertaining to aesthetic appearance, including the desire for beautiful skin and a youthful, attractive appearance, motives related to physical health, such as preventing worsening of condition or symptoms (253 of 475 [53.3%]), and psychosocial well-being, such as the desire to feel happier and more confident or improve total quality of life (314 of 467 [67.2%]), treat oneself or celebrate (284 of 463 [61.3%]), and look good professionally (261 of 476 [54.8%]) were commonly reported. Motivations related to cost and convenience were rated as less important (68 of 483 [14.1%]). Most motivations were internally generated, designed to please the patients and not others, with patients making the decision to undergo cosmetic procedures themselves and spouses seldom being influential. Patients younger than 45 years were more likely to undertake procedures to prevent aging (54 of 212 [25.5%] vs 42 of 286 [14.7%] among patients ≥45 years; P

This article is based on ethnographic work with two “crews” of young graffiti artists in southern Mexico City. The crews share certain characteristics with gangs or urban tribes, but more with “communities of practice”: they live in the “figured world” of graffiti, a community of practice at the local and global level. Through participation, including observation and the study of fanzines, group members learn the language, technical and social skills, and values of this figured world. Their reasons to paint and the topics they express are varied, but authentic expression is fundamental. Graffiti allows these young people to establish an interesting interplay of identities in the world of graffiti versus their ordinary lives.

This article is based on the finding that for many students, high school is a place for young people's life and living together, a place for subjectivisation. The process of subjectivisation is approached through a discussion that questions conceptions of students as strategists of their school trajectory, as well as conceptions of youth life as the excitement of vibrating together. The claim is made that young people's life at school is a process of finding meaningful Others: other styles, other friends, and the other gender. Faced with options and risks, students also develop reflexivity. These topics are examined in three different scenarios: a general high school that is part of the university system in Mexico City, a technical high school in the metropolitan area, and community intercultural high schools in an indigenous rural zone.

Introduction: Calcium hydroxyapatite (CaHa; also spelled “hydroxylapatite”) is the main mineral component of bone, calcified cartilage, and teeth. It has been used since the 1970s in many specialties, including orthopedics, urology, otolaryngology, maxillofacial surgery, and radiology, as a bioactive implant that promotes chemical attachment of the soft tissue to its surface. In 2001, Radiance FN (now Radiesse) was introduced as a CaHa-based product and approved by the US Food and Drug Administration (FDA) as a radiographic tissue marker, for soft tissue vocal fold augmentation, and for implants in maxillofacial defects. Currently, it is also used outside the United States and off-label in the United States for facial soft tissue augmentation. Microspheres of CaHa are suspended in a mixture of water, glycerin, and carboxymethylcellulose gel that provides a scaffold for tissue infiltration. Once injected, the gel is degraded and the CaHa infiltrates the surrounding cells. CaHa is nonirritating, and the carrier gel components are classified as safe by the FDA. Although a great variety of fillers are currently on the market, CaHa (Radiesse) has demonstrated the longest duration in tissue without any reports of antigenicity, migration, or granuloma formation. In this study, we report our experience with CaHa (Radiesse) for aesthetic soft tissue augmentation. Materials and Methods: A total of 139 patients were treated over an 18-month period at 2 private offices in Argentina and the United States. Exclusion criteria included previous use of permanent tissue fillers in the treatment area. Patients with previous use of hyaluronic acid fillers in the treatment area (up to 1 year prior to the study) were allowed to participate in the study. Radiesse was injected from 1-mL prefilled syringes with 27½-gauge needles in different areas such as nasolabial folds, lips, marionettes lines, cheeks, and cellulite dimples. Patient satisfaction and adverse effects were assessed by both physicians and patients during the procedure and during follow-up visits up to 1 year later. Results: Minimal pain, erythema, edema, and bruising were noted during and immediately after the procedure. All of the patients treated were satisfied with their results after one visit. There were no long-term adverse effects during the study period or on follow-up visits. Evaluation of 75% of the patients 1 year after treatment revealed persistence of filling effects. Discussion: CaHa used for aesthetic soft tissue augmentation yields immediate clinical results with high patient satisfaction.

BACKGROUND: Anxiety toward pain has been shown in several studies to increase postoperative pain after surgical procedures. This anxiety can be measured by several validated questionnaires, the Pain Catastrophizing Scale (PCS) and the Pain Anxiety Symptoms Scale (PASS). Higher scores on these scales correlate with increased pain after surgery, but this has not yet been demonstrated in dermatologic surgery. OBJECTIVE: To assess whether pain anxiety will predict postoperative pain after Mohs micrographic surgery (MMS). MATERIALS AND METHODS: Patients at 2 private Mohs practices were recruited to fill out 2 pain questionnaires, the PCS and the PASS. Their postoperative pain was assessed after MMS. RESULTS: Three hundred fifty-six patients completed the study. Overall, most patients experienced little postoperative pain after Mohs surgery. However, for people with high anxiety toward pain, they also experienced statistically significant greater postoperative pain. Other factors that contributed to greater postoperative pain included female gender and lower extremity location. Second intention healing had lower pain than other repair types. CONCLUSION: This study shows that postoperative pain is affected by pain anxiety, even in dermatologic surgery. However, most patients still had very little discomfort after surgery, further supporting MMS as an effective and safe procedure with relatively few postoperative problems.

A simplified approach to treat venous lakes of the vermillion lip is presented. Our method involves the use of a 30 gauge hypodermic needle to deliver a low-powered, high-frequency electrical current from a hyfrecator power source into the venous lake lesion.

Intense pulsed light (IPL) is a high-intensity, polychromatic, noncoherent light source used to treat a variety of skin conditions. It is frequently used to treat vascular lesions using the principles of selective photothermolysis, and it is often the technique of choice due to its range of effective wavelengths. When used properly, it can be more effective than vascular lasers with fewer side effects such as purpura and scarring, and may reach deeper targets within the skin with its longer wavelengths. The various cutoff filters and energy settings make IPL a versatile and indispensible tool in dermatology.

The nail unit can be a challenging anatomic location for surgical removal of neoplasms. Although uncommon, malignancies do affect this specialized epithelial structure. In particular, Bowen's disease and more invasive squamous cell carcinoma (SCC) are the most common neoplasm's to affect the nail unit and surrounding structures. Other neoplasm's such as basal cell carcinoma and malignant melanoma can also affect the nail unit, but less frequently, and will not be discussed in the scope of this review. Mohs micrographic surgery continues to be the treatment of choice because of the procedure's tissue-sparing qualities. A clear understanding of the anatomy and the histology of the nail unit, a review of the technique of Moh's surgery of the nail anatomy, as well as a review of the literature are presented.

A 50-year-old previously healthy white woman developed a tender erythematous draining subcutaneous nodule on her left cheek, 9 months after receiving multiple injections of bovine embryonic cells in different areas of the face, neck, and chest as a skin rejuvenation treatment. Over the subsequent 4 months, multiple similar nodules developed on the injected areas. The lesions, which were initially painful, became asymptomatic as they developed purulent drainage and ruptured onto the skin surface. There were no associated fevers, chills, or sweats. The nodules failed to respond to a 2-month course of oral prednisone and intralesional triamcinolone acetonide. Physical examination showed red, firm, subcutaneous nodules some of which were draining a serosanguinous exudate ( Fig. 1). While a presumptive diagnosis of foreign body granuloma was made, the possibility of an atypical mycobacterial infection remained, and therefore tissue was submitted for culture. While awaiting culture results, the patient was started on minocycline, 50 mg twice daily. Figure 1. Neck with disseminated subcutaneous erythematous nodules due to M. chelonae that developed following injections of “bovine embryonic cells” Download figure to PowerPoint The biopsy showed a collection of chronic and granulomatous inflammatory cells, intermixed with a few areas of polymorphonuclear abscesses within the dermis ( Fig. 2). Doubly refractile foreign material was not detected. Although acid-fast bacilli were not observed with Ziehl–Neelsen stain, tissue culture grew mycobacterial colonies after 1 week of incubation. The isolate was subsequently identified as Mycobacterium chelonae, and clarithromycin, 500 mg twice daily, was added to the antimicrobial regimen on the basis of the susceptibility profile. There was significant improvement and the lesions resolved clinically over the following 6 weeks. Figure 2. Skin biopsy specimen from facial nodule shows granulomatous inflammation within the papillary dermis (hematoxylin and eosin, ×40) Download figure to PowerPoint

Wound repair is characterized by the presence of a fibrin-rich matrix, but the effect of fibrin on re-epithelialization remains unclear. In this study, we determined the effects of different fibrin matrices on cultured human neonatal keratinocytes. Using purified fibrinogen and fibrin gels generated by the enzymatic action of thrombin, batroxobin (it leads to retention of fibrinopeptide B), or Agkistrodon contortrix thrombin-like enzyme (ACTE; it leads to retention of fibrinopeptide A), we determined the effect of each of these matrices on keratinocyte morphology, attachment, spreading, and replication as compared to tissue culture plastic. Morphologically, keratinocytes seeded on fibrin surfaces were more rounded and formed three-dimensional structures. Specific cell attachment, as measured at either 37°C or 4°C, was not altered on the different fibrin substrates (P > .05) but was increased on fibrinogen and factor XIII cross-linked fibrin (P < .01). However, keratinocytes seeded on fibrin, regardless of the presence or absence of fibrinopeptides A or B, showed a marked decrease (up to 71%) in cell numbers by days 5 (P = .0357) and 10 (P = .0114). Keratinocyte spreading was decreased by 78.8% (P = .0006), 80.3% (P = .0001), and 89.2% (P = .0001) on thrombin-, batroxobin-, and ACTE-generated fibrin, respectively, but not on fibrinogen-coated dishes. However, either the addition of fibronectin or cross-linking of fibrin with factor XIII allowed full keratinocyte spreading to occur (P = .0002 and P = .0013, respectively). We conclude that fibrin inhibits keratinocyte spreading in the absence of other matrix or plasma proteins or cross-linking by factor XIII. J. Cell. Physiol. 174:58–65, 1998. © 1998 Wiley-Liss, Inc.

Schamberg's disease is a pigmented purpuric dermatosis that is generally asymptomatic, however, patients with Schamberg's disease often seek treatment for aesthetic improvement. Many topical and systemic therapies have been tried without consistent results. This case series describes the treatment of five patients with Schamberg's disease of the lower extremities using Advanced Fluorescence Technology (AFT) pulsed light with favorable results.