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Competing Interests: Conflicts of interest Dr Bae reported serving on the advisory board for Abbvie outside the submitted work. Dr Mann reported serving as a consultant for Methapharma outside the submitted work. Author Ma; Drs Zafar, Goldman, Munavalli, Zimmet, Nguyen, Mishra, Cartee, Hsu, Silapunt, R.A. Weiss, and M.A. Weiss; Author Haq; Dr Ahmed; Authors Koza, Shi, and Dave; Drs Yi, Kang, Cahn, Kole, Friedmann, Chow, Minkis, Stücker, Schlick, Hoss, Hu, Kibbi, Saikaly, Greywal, Hooper, Vashi, Boucher, Ward, Neuhaus, Ghareeb, Luke, Karen, Suggs, Lucas, Decker, Brieva, Yoo, Suozzi, and Alam have no conflicts of interest to declare.

Dermatologists are at risk for blood-borne pathogen (BBP) exposures. We conducted a retrospective review of incidence reports to identify the incidence of BBP exposures in dermatologic procedures. Secondary aims included identification of the type of exposure, type of procedure associated with each exposure, anatomic locations of exposures, and instruments involved in each exposure. Data were obtained at 3 Mayo Clinic sites in Scottsdale, Arizona; Jacksonville Florida; and Rochester, Minnesota, from 2010 to 2021. Two hundred twenty-two exposures were identified over an 11-year period. Results indicated that quality improvement measures should focus on training all dermatologic staff to reduce BBP exposures.

Background: In total, 2.7 million injectable filler treatments were performed in 2019 in the United States. Although generally considered to be a safe treatment modality, adverse events may occur in rare situations., Objective: Analyze serious adverse events from injectable filler treatments, including infections, cutaneous necrosis, blindness, or delayed-onset nodule formation, spanning 11 years for 3 board-certified dermatologists and review their incidence, management, and outcomes., Materials and Methods: A retrospective analysis was performed of injectable filler treatments spanning 11 years at a multipractitioner outpatient clinic. Serious adverse events were identified, and treatment measures were documented. A literature search was performed to determine recent trends and outcomes for comparison., Results: Between January 2009 and August 2020, 18,013 mL of injectable filler was administered to 7,659 patients. Of the 18,013 mL administered, 74.1% comprised hyaluronic acid derivatives, 19.19% poly-l-lactic acid, and 6.71% calcium hydroxylapatite. Four serious adverse events were identified. Three events were delayed-onset skin nodule formation. One adverse event was related to vascular compromise and subsequent cutaneous necrosis. After appropriate treatment, all adverse events resolved without significant long-term sequelae., Conclusion: Serious adverse events associated with injectable fillers, when performed by board-certified dermatologists, are extremely rare and can be successfully managed with appropriate treatment., (Copyright © 2022 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Jawline augmentation with calcium hydroxylapatite has not yet been evaluated in a prospective study with a split-face design. This study aims to perform the first randomized controlled, split-face study on the efficacy and safety of calcium hydroxylapatite for jawline augmentation using the needle and cannula technique., Objective: To perform the first randomized controlled, split-face study on the efficacy and safety of calcium hydroxylapatite for jawline augmentation using the needle and cannula technique., Materials and Methods: This is a single-site, randomized, evaluator-blind trial enrolling a total of 10 healthy subjects with at least Grade 1 (mild) on a 4-point Jawline Scale. One side of the face was randomized to receive 1 to 2 syringes of calcium hydroxylapatite with lidocaine (total of 3 mL) for correction of wrinkles and folds along the jawline using both the cannula and needle method, and a balancing treatment will be performed 1 month later. Blinded investigator and subject evaluations will be performed immediately after treatment and at the 30-, 60-, and 90-day visits., Results: Ten subjects were enrolled and completed the trial. There was a improvement in the degree of wrinkling and skin sagging in the 4-point Jawline Scale, with an average of a 1.3-point improvement in the scale on the day of treatment and at the Day 30 visit, which remained improved greater than baseline after 3 months as graded by blinded investigators. The Clinician Global Aesthetic Improvement Score for the treated side versus control, as assessed by blinded investigators, demonstrated a improvement with a 2.3-point improvement on the 5-point scale, and by the final visit on Day 90, most patients had a much improved appearance from baseline., Conclusion: This study demonstrates that calcium hydroxylapatite is effective and safe for restoration and augmentation of the jawline using the unique needle and cannula technique., (Copyright © 2020 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Adverse effects from dermal fillers are uncommon. We report a case of filler-induced xanthelasma at the bilateral infraorbital region in a 43-year-old woman after multiple injections of hyaluronic acid to correct tear trough depression., Material and Methods: We report a case of a 43-year-old woman with a chief complaint of skin discoloration of the bilateral lower eyelids. Her history was significant for ten sessions of hyaluronic acid filler for tear trough deformity between December 2008 and May 2016. On clinical examination, she exhibited thin, soft, and yellow papules to her lower medial infraorbital hollows. A punch biopsy showed foamy histiocytes with a background of hypervascularization and focal extracellular lipid in the superficial dermis, consistent with xanthelasma., Results: Xanthelasma was treated with multiple passes of Er:YAG laser (Sciton Contour TRL) with a 4 mm spot size, fluence 7.5 J/cm2, and ablate/coagulate 50/50 at 6 Hz until clearance occurred. The perilesional skin was treated with 1-2 passes, fluence 7.5 J/cm2, ablate/coagulate 50/0 to blend in the cosmetic unit. Six-month follow-up showed notable improvement of all lesions., Discussion: There is a paucity of treatments described for filler-induced xanthelasma reaction. While broad conclusions cannot be drawn from one case, our experience indicates that complete resolution can be achieved with Er:YAG ablation. We hypothesize that this laser is an optimal treatment, as it can vaporize the lipid contents while minimizing adverse effects, such as scars and hyperpigmentation., (© 2021 Wiley Periodicals LLC.)

Background: Current treatments for acne are often accompanied by undesirable side effects and contribute to antibiotic resistance. Gold and silver nanoparticles are an emerging treatment method with potentially fewer adverse effects., Objective: To evaluate current literature discussing the various uses of gold and silver nanoparticles in the potential treatment of acne vulgaris., Materials and Methods: A search of PubMed, EMBASE, and SCOPUS databases was conducted through April 22, 2020 to identify studies using gold or silver nanoparticles in the treatment of acne vulgaris., Results: 16 original articles were identified in the systematic review including clinical studies, case reports, and in vitro publications. The available evidence found gold nanoparticles to be effective when combined with phototherapy to target overactive sebaceous glands and bacteria, or to mediate localized, targeted drug release. Silver nanoparticles have primarily been studied for their antibacterial properties., Conclusion: This review found gold and silver nanoparticles to be a promising treatment for acne vulgaris. Further randomized controlled studies are needed to determine clinical efficacy and the role of gold and silver nanoparticles in the treatment algorithm for acne. J Drugs Dermatol. 2021;20(6):666-670. doi:10.36849/JDD.5762.

Background: Aging of the face and upper neck is a complex process characterized by loss of collagen and elastic fibers, resulting in clinical skin laxity. Noninvasive interventions such as monopolar capacitively coupled radiofrequency (MRF) have gained popularity, offering a safer and more convenient alternative to traditional surgical face lift. The latest MRF device features larger tips, vibration, cooling, and impedance matching., Objective: We performed the first open-label clinical trial, measuring the efficacy, safety, and patient satisfaction of this device for noninvasive lifting and tightening of the face and upper neck., Materials and Methods: Forty subjects 30 to 60 years of age with mild/moderate skin laxity of the face and upper neck were enrolled. After pretreatment with ketorolac 60 mg intramuscular injection, subjects underwent treatment with MRF. Follow-up evaluations were performed on Days 30, 60, and 180., Results: Our study demonstrated that the newest generation MRF produced statistically significant improvement in skin laxity 6 months post-treatment, especially in the jowls and melolabial folds. According to the Investigator Global Aesthetic Improvement Score, 73% of subjects had improvement at 6 months post-treatment. Subject satisfaction and improvement questionnaires supported these findings., Conclusion: Our data coupled with the excellent adverse effect profile validates MRF as an attractive treatment modality for facial and upper neck skin laxity., (Copyright © 2021 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Background: Skin laxity of the upper knee and lower thigh is a common complaint among patients., Objective: This is a randomized, double-blinded, split-body, placebo-controlled study to evaluate the safety and efficacy of poly-L-lactic acid (PLLA) for treatment of upper knee skin laxity., Materials and Methods: Twenty female subjects between the ages of 30 and 65 years with upper knee laxity were enrolled. The patients were randomized to receive 3 treatments of PLLA in 1 knee, whereas the other knee received 3 treatments of bacteriostatic water., Results: Statistically significant improvement as rated on the physician global aesthetic improvement scale was seen at Day 56 after final treatment in the active knee when compared with the placebo knee. This improvement was sustained at Day 84 and Day 168 after final treatment visits. No statistically significant difference was seen between the active and placebo knees on the subject global aesthetic score or the subject satisfaction scale., Conclusion: Based on our study, PLLA may be a safe and effective modality in addressing upper knee skin laxity. Larger studies with longer follow-up times and a validated knee laxity scale are needed to further determine if and how much improvement can be achieved.

Background: Foam sclerotherapy is a common treatment of lower extremity reticular veins. The effect of different liquid-gas ratios on foam stability and efficacy has been controversial., Objective: To evaluate the use of 2 different polidocanol (POL) to air ratios for the treatment of reticular veins of the lower extremities., Methods and Materials: Patients with lower extremity reticular veins were randomized to foam sclerotherapy with POL mixed with 4 mL of room air for one lower extremity or 2 mL for the other lower extremity. All telangiectasias were treated with glycerin immediately after treatment of the reticular veins. Adverse events (AEs) and efficacy were evaluated by both subject and blinded investigator., Results: Thirty subjects completed the study. No statistically significant difference was seen in AEs between the 2 different POL to air ratios by subject questionnaire and blinded investigator scores at all time points. Subjects and blinded investigator reported a mean improvement between 0% and 50% at Day 21 and 26% to 75% at Day 90, which was not significantly different between groups., Conclusion: Two different POL to air ratios, 1:2 versus 1:4, were similarly safe and efficacious for the treatment reticular veins of the lower extremities.

Background: Laser resurfacing is the gold standard procedure for photodamage, but is not without downtime and risk. Use of periprocedural products containing stem cell conditioned media may improve results and optimize healing., Study Design: This was a prospective, randomized controlled, double-blind study, evaluating the efficacy and tolerability of red deer umbilical cord-derived stem cell conditioned media (USCCM) cream and serum pre- and post- ablative facial resurfacing., Methods and Materials: Twenty patients with moderate to severe photodamage were randomized to receive vehicle or USCCM cream and serum pre- and post- ablative resurfacing of the face. Blinded investigators rated healing, tolerability, and efficacy, while subjects rated post-procedure symptoms, tolerability, and satisfaction., Results: Both the active and vehicle pre-procedure cream were soothing, calming and easy to use by all patients. There was a trend towards decreased facial erythema and crusting in the active versus vehicle group. A greater improvement in wrinkling occurred in the active group. The majority of subjects were very satisfied with the active products. There were no serious adverse events., Conclusion: Red deer umbilical cord-derived stem cell conditioned media (USCCM) is well tolerated, safe and efficacious for use pre- and post- facial laser resurfacing.J Drugs Dermatol. 2020;19(11): 1044-1048 doi:10.36849/JDD.2020.5246.

Laser resurfacing has progressed since the 1980s to treat a variety of medical and aesthetic indications with ever-evolving safety parameters. While laser technology has evolved to provide a more favorable safety profile and decrease wound healing time, advances in post-procedure healing agents have also helped to mitigate adverse effects, such as persistent erythema, dyspigmentation, acneiform eruptions, dermatitis, infections, and scarring. We reviewed the evidence of growth factors, stem cells, silicone and silicone polymers, botanical based treatments, fatty acids, probiotics, and closed dressings on post-ablative laser skin resurfacing. All reviewed agents demonstrated some evidence in improving post-procedure outcomes, albeit mixed in many cases. Additionally, these studies contain small numbers of participants, vary in type, strength, and clinical indication for which the resurfacing laser was used, and have differing postprocedural evaluation protocols and assessments. This highlights a need for standardization of clinical studies and the importance of choosing an optimal postprocedural skincare plan depending on every unique clinical scenario. J Drugs Dermatol. 2020;19(11):1050-1055. doi:10.36849/JDD.2020.5386.

Background: In the past 5 years, several absorbable sutures for use in minimally invasive suture lifts have appeared on the market. These newer sutures were preceded by several iterations of nonabsorbable counterparts, all of which were eventually removed from the market because of complications., Objective: This review will provide a history of suture lift experience, review the published evidence on the safety and efficacy of currently available absorbable suture lift materials, and detail the clinical experience of the authors using these products., Materials and Methods: A review of relevant clinical terms was performed on PUBMED and MEDLINE databases. All articles were reviewed, and further studies examined from citations of selected articles. Articles that focused on suture lifting using extensive dissection were excluded., Results: Twelve studies detailed the results of absorbable suture lifting largely through patient satisfaction surveys or retrospective chart review of cases. No randomized controlled studies were available., Conclusion: Data on suture lifting are limited, with largely descriptive and retrospective case reports available in the literature entailed Oxford Centre evidence-based medicine Levels 2a to 5. Based on the available data, suture lifting appears to be safe and well tolerated, with patient satisfaction similar to or above that reported for other noninvasive lifting and tightening procedures. However, due to the lack of randomized controlled trials, the authors give the suture lifting Strength of Recommendation Level C. Further controlled studies are necessary to determine efficacy, longevity, and safety of this technology.

Noninvasive vaginal rejuvenation (NVR) is a growing area of interest in dermatology. With age, childbirth, and hormonal changes, many women develop changes in their vaginal tissue that can be functionally and psychologically distressing. Until recently, treatment options were limited to topical application, hormonal treatments, kegel exercises, and surgical options such as labiaplasty, vaginoplasty, and perineoplasty. 1 In the last decade, there has been a rise in minimally invasive devices for vulvovaginal laxity (VVL), atrophic vaginitis (AV), orgasmic dysfunction (OD), and stress urinary incontinence (SUI). These include ablative carbon dioxide (CO 2 ) lasers, nonablative lasers, and radiofrequency (RF) devices. No devices are currently cleared by Food and Drug Administration (FDA) for noninvasive vaginal rejuvenation (NVR), although international agencies have given varying levels of approval. 1-3 This review will focus on the radiofrequency modalities used off-label for NVR.

Background: Though a rare tumor, sebaceous carcinoma is relatively well-described in immunocompetent patients, in whom it often occurs in a periorbital distribution where it has an overall poor prognosis with a high metastasis rate. The effect of transplant-related immunosuppression on the development of sebaceous carcinoma and its outcomes has not been characterized., Methods: We collected 9 cases from a single institution of patients developing sebaceous carcinoma after solid organ transplantation. We analyzed clinicopathologic features., Results: We estimate the prevalence of sebaceous carcinoma post-solid organ transplantation to be 0.09%. The mean age at diagnosis was 66.1 years (std 7.0 years). The mean time between transplantation and sebaceous carcinoma diagnosis was 7.1 years (std 5.1 years). All tumors occurred in extra-ocular distribution. Two patients likely had Muir-Torre syndrome, of whom 1 died from metastatic sebaceous carcinoma. No other patients developed metastatic disease or had disease-related death. Mohs micrographic surgery and wide local excision were equally effective and there were no recurrences with either procedure., Conclusions: Our study found that sebaceous carcinoma in solid organ transplant recipients occurs in in an extraorbital distribution with only 1 patient developing metastatic disease. Both Mohs micrographic surgery and wide local excision are acceptable treatment modalities for sebaceous carcinoma in transplant recipients., (© 2017 The International Society of Dermatology.)

Severe adverse events associated with varicella-zoster virus (VZV) vaccination are rare. The authors describe a 53-year-old woman with no known immunodeficiency who presented with diffuse pruritic rash 17 days after receiving the varicella virus vaccine live. She had a low level of white blood cells and received a diagnosis of thrombocytopenia with elevated aminotransferase levels. Punch biopsy demonstrated positive VZV immunostaining and viral culture positive for VZV. After treatment with acyclovir, her rash improved and her white blood cell and platelet counts returned to normal. Mild reactions to vaccines including localized rash are well recognized. Disseminated infections have been reported in patients with congenital and acquired immunodeficiency, but systemic postvaccination infections are rare in immunocompetent adults. This case highlights the importance of recognizing adverse events associated with vaccination.

Heterochromia of the hair involves the presence of two distinctive colors of scalp hair in one individual. We report the case of a 4-year-old girl with reddish streaks of scalp hair, heterochromia of the eyelashes, and cutaneous hypopigmentation following the lines of Blaschko., (© 2016 Wiley Periodicals, Inc.)

Prurigo pigmentosa (PP) is a rare inflammatory dermatosis of unknown cause characterized by a predominantly truncal eruption of pruritic erythematous papules in a reticular pattern, resolving with hyperpigmentation. PP is twice as common in girls and women, and the mean age at onset is 25 years. Diagnosis of PP is challenging and is aided by characteristic histopathologic findings. We report a case of PP in a 17-year-old white boy. The eruption arose during strict adherence to a ketogenic diet., (© 2013 Wiley Periodicals, Inc.)

The PSORS4 genetic risk factor for psoriasis is a deletion of two late cornified envelope (LCE) genes (LCE3C_LCE3Bdel) in a cluster of five LCE3 genes with a proposed role in skin repair. We previously showed that 1,25-dihydroxyvitamin D3 (1,25D) modestly upregulates transcripts from all five LCE3 genes as monitored by real time PCR in primary human keratinocytes. Herein we report that cyanidin, a plant-derived compound with anti-inflammatory/anti-oxidant properties, upregulates expression of all five LCE3 genes in cultures of differentiating primary human keratinocytes to a greater extent that does 1,25D. This action of cyanidin is dependent on the differentiation state of the keratinocytes, with a stronger effect after the cells have been incubated with 1.2mM calcium for 24h. Competition displacement assays using radiolabeled 1,25D revealed that cyanidin directly competes as a ligand for vitamin D receptor (VDR) binding with an estimated IC50 of 500μM. However, 20μM cyanidin is sufficient to upregulate LCE3 genes. The 25-fold discrepancy between the cyanidin concentration required for upregulating LCE3 genes in intact keratinocytes vs. that required for direct binding to VDR in vitro suggests that cyanidin may be: (a) metabolized to a more active VDR ligand in keratinocytes and/or (b) functioning via a non-VDR mediated mechanism. The fact that cyanidin is the most potent upregulator of global LCE3 gene expression reported to date suggests that this or related compounds may have potential in psoriasis therapy., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Psoriasis is a chronic inflammatory skin disease featuring abnormal keratinocyte proliferation and differentiation. A genetic risk factor for psoriasis (PSORS4) is a deletion of LCE3B and LCE3C genes encoding structural proteins in terminally differentiated keratinocytes. Because analogs of 1,25-dihydroxyvitamin D3 (1,25D) are used in psoriasis treatment, we hypothesized that 1,25D acts via the vitamin D receptor (VDR) to upregulate expression of LCE 3A/3D/3E genes, potentially mitigating the absence of LCE3B/LCE3C gene products. Results in a human keratinocyte line, HaCaT, suggested that 1,25D, low affinity VDR ligands docosahexaenoic acid and curcumin, along with a novel candidate ligand, delphinidin, induce LCE transcripts as monitored by qPCR. Further experiments in primary human keratinocytes preincubated with 1.2 mM calcium indicated that 1,25D and 10 μM delphinidin upregulate all five LCE3 genes (LCE3A-E). Competition binding assays employing radiolabeled 1,25D revealed that delphinidin binds VDR weakly (IC50 ≈ 1 mM). However, 20 μM delphinidin was capable of upregulating a luciferase reporter gene in a VDRE-dependent manner in a transfected keratinocyte cell line (KERTr). These results are consistent with a scenario in which delphinidin is metabolized to an active compound that then stimulates LCE3 transcription in a VDR/VDRE-dependent manner. We propose that upregulation of LCE genes may be part of the therapeutic effect of 1,25D to ameliorate psoriasis by providing sufficient LCE proteins, especially in individuals missing the LCE3B and 3C genes. Results with delphinidin further suggest that this compound or its metabolite(s) might offer an alternative to 1,25D in psoriasis therapy.