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Key Points PD-L1 structural variants are recurrent in mycosis fungoides with large cell transformation. PD-L1 structural variants in relapsed/refractory mycosis fungoides should prompt consideration of treatment with PD-1 inhibitors.

BACKGROUND: Therapeutic applications of light emitting diode-red light (LED-RL) are expanding, yet data on its clinical effects are lacking. OBJECTIVES: To evaluate the safety of high fluence LED-RL (≥160 J/cm(2)). METHODS: In two phase I, single-blind, dose escalation, randomized controlled trials, healthy subjects received LED-RL or mock irradiation to the forearm thrice weekly for three weeks at fluences of 160 to 640 J/cm(2) for all skin types (STARS 1, n=60) and at 480 to 640 J/cm(2) for non-Hispanic Caucasians (STARS 2, n=55). The primary outcome was the incidence of adverse events (AEs). The maximum tolerated dose was the highest fluence that did not elicit predefined AEs. RESULTS: Dose-limiting AEs, including blistering and prolonged erythema, occurred at 480 J/cm(2) in STARS 1 (n=1) and 640 J/cm(2) in STARS 2 (n=2). AEs of transient erythema and hyperpigmentation were mild. No serious AEs occurred. CONCLUSIONS: LED-RL is safe up to 320 J/cm(2) for skin of color and 480 J/cm(2) for non-Hispanic Caucasian individuals. LED-RL may exert differential cutaneous effects depending on race and ethnicity, with darker skin being more photosensitive. These findings may guide future studies to evaluate the efficacy of LED-RL for the treatment of various diseases. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02630303 and NCT03433222

Transcranial photobiomodulation is safe, based upon published literature. Photobiomodulation for neurological diseases primarily requires light to reach target neurons in the brain. Alternatively, light may change brain function by modulating photoreceptors, such as opsins in the skin or eye, that yield secondary effects or trigger a cascade. A critical concern is the ability of light penetration through the layers of the human cranium, including the scalp, skull, meningeal layers, and brain parenchyma. Light penetration depth depends on tissue optical properties, wavelength, skull anatomy, irradiance, and pulsing. Within the ultraviolet, visible, and near-infrared (NIR) regions, longer wavelengths and greater irradiance are associated with deeper penetration. NIR light appears to be superior in penetrating human calvaria and brain tissue compared to visible red light. Light penetration is dependent on the light source’s location. Understanding light propagation is critical in maximizing efficacy of transcranial photobiomodulation by providing sufficient light penetration into the human cranium to activate mechanisms for neuromodulation.

As body contouring procedures have become more popular, post-procedural skin laxity is a concern. Non-invasive body contouring technologies may effectively reduce body fat, but modestly affect skin tightening.To assess the efficacy and safety of a topical skin tightening agent in combination with hyperthermic diode laser lipolysis.Herein, we describe five patients in which a skin tightening concentrate of 5% yeast extract, 2% hydrolyzed rice protein content, and 2.5% tripeptide was used after 1500-2100 J/cm2 of hyperthermic 1060 nm diode laser.Overall, all patients had a subjective positive response and high satisfaction with the combined treatment results of improvement in skin laxity and fat reduction. In all five cases, patients demonstrated visible fat reduction and skin improvement on photographs taken between weeks 6-18 compared to baseline. Blinded investigators correctly predicted the order of the photographs based on treatment results. No adverse events were reported.This case series demonstrated that a combined topical skin tightening concentrate with a hyperthermic laser lipolysis device may achieve improved aesthetic outcomes without adverse events. J Drugs Dermatol. 2018;17(7):780-785.

Laser hair reduction is a well-established modality for a wide range of medical indications. Laser hair reduction can be beneficial for hemodialysis patients who undergo repeated adhesive tape application and removal at their hemodialysis site during hemodialysis sessions. There is a paucity of published literature on efficacious laser hair removal treatments for hemodialysis patients. Herein, we present a case of a 50-year-old male (Fitzpatrick III) with end-stage renal disease on hemodialysis, who achieved successful laser hair reduction at his hemodialysis vascular access site with five sessions of a neodymium:yttrium-aluminium-garnet (Nd:YAG) laser (1064 nm) to improve his quality of life by reducing the hair burden at the adhesive tape site application. We recommend providing this safe and effective hair reduction treatment option for hemodialysis patients given the decreased quality of life associated with end stage renal disease and hemodialysis. J Drugs Dermatol. 2018;17(7):794-795.

Transgender individuals may transition to their identified gender through social, hormonal, and procedural methods by using a multidisciplinary team of health care providers, including dermatologists. In this review, we discuss the medical and aesthetic dermatologic needs related to the transitioning of transgender patients and provide therapeutic and procedural recommendations. In addition to routine cutaneous conditions, dermatologists may need to treat hormonal therapy–related complications. Acumen for genital dermatology and familiarity with gender reassignment surgery is important for the dermatologist caring for a transgender patient. From a structural standpoint, transgender beauty poses a unique aesthetic task. We identify key differences in the facial structure and physique of males versus those of females. Dermatologists may have a tremendous impact on the lives of transgender individuals who seek to realize their gender identity.