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OBJECTIVE: This 12-week, multicenter, open-label study investigated the efficacy and tolerability of the HydraFacial Clarifying Treatment for improving skin appearance in patients who present with acne vulgaris. METHODS: Twenty eligible adult patients with mild-to-moderate acne were enrolled at one of two treatment sites in the United States and were to undergo six HydraFacial Clarifying Treatments, one every two weeks for 12 weeks. Treatment occurs in three steps: cleansing and peeling; suction to extract dead skin cells, sebum, and debris; and application of blue LED light. Acne severity was graded by investigators and by patients using the Global Acne Severity Score (GASS). RESULTS: The proportion of patients with no acne or almost clear skin (GASS ≤1) at baseline versus final treatment increased from 20 to 65 percent per investigator assessment (p=0.0027), and from 5 to 55 percent per patient self-report (p=0.0016). At final treatment, more than 80 to 100 percent of both investigators and patients agreed or strongly agreed there was an improvement in skin appearance across multiple assessment parameters. Treatments were generally well tolerated. LIMITATIONS: Due to the nature of the treatment, blinding of neither investigators nor patients was feasible. CONCLUSION: The results presented here suggest that a series of six HydraFacial Clarifying Treatments improves overall skin appearance in patients with active acne.

Combination topical corticosteroids and vitamin D analog treatments for nail psoriasis are widely used in cream and ointment vehicles, but patients may prefer a foam vehicle due to ease of application and favorable cosmetic appearance. Calcipotriene 0.005%/betamethasone dipropionate 0.064% (Cal/BD) aerosol foam is an FDA approved therapy for plaque psoriasis, but may also be an effective treatment for nail psoriasis in a novel aerosol foam. We present a case series of 3 patients with mild to moderate nail psoriasis who responded positively to treatment with Cal/BD aerosol foam applied 1-2 times daily to affected nails for at least 6 weeks. Reduction of nail plate surface abnormalities and a decrease in inflammation of the nail folds were assessed with clinical evaluation and dermoscopy, and documented with serial photography. While further research on the efficacy and safety of Cal/BD aerosol foam as a treatment for nail psoriasis is needed, this report suggests its potential as a combination topical vitamin D analogue and high potency steroid in a foam vehicle.

BACKGROUND Dermatologists specialize in treating conditions of the skin, hair, and nails; however, it is our experience that the field of nail diseases is the least discussed facet of dermatology. Even less acknowledged is the complexity of nail procedures and how best to accurately code for these procedures. OBJECTIVE To convene a panel of experts in nail disease to reach consensus on the most accurate and appropriate Current Procedural Terminology (CPT) codes associated with the most commonly performed nail procedures. METHODS A questionnaire including 9 of the most commonly performed nail procedures and potential CPT codes was sent to experts in the treatment of nail disease, defined as those clinicians running a nail subspecialty clinic and performing nail procedures with regularity. A conference call was convened to discuss survey results. RESULTS Unanimous consensus was reached on the appropriate CPT codes associated with all discussed procedures. LIMITATIONS Although this article details the most commonly performed nail procedures, many were excluded and billing for these procedures continues to be largely subjective. This article is meant to serve as a guide for clinicians but should not be impervious to interpretation in specific clinical situations. CONCLUSION Billing of nail procedures remains a practice gap within our field. The authors hope that the expert consensus on the most appropriate CPT codes associated with commonly performed nail procedures will aid clinicians as they diagnose and treat disorders of the nail unit and encourage accurate and complete billing practices.

The tubulin polymerization and Src kinase signaling inhibitor tirbanibulin is being investigated as a topical treatment for actinic keratosis, a precursor of squamous-cell carcinoma.In two identically designed double-blind trials, we randomly assigned, in a 1:1 ratio, adults with actinic keratoses on the face or scalp to receive either topical tirbanibulin or vehicle (placebo) ointment. The ointment was applied by the patients to a 25-cmA total of 702 patients were enrolled in the two trials (351 patients per trial). Complete clearance in trial 1 occurred in 44% of the patients (77 of 175) in the tirbanibulin group and in 5% of those (8 of 176) in the vehicle group (difference, 40 percentage points; 95% confidence interval [CI], 32 to 47; P0.001); in trial 2, the percentages were 54% (97 of 178 patients) and 13% (22 of 173), respectively (difference, 42 percentage points; 95% CI, 33 to 51; P0.001). The percentages of patients with partial clearance were significantly higher in the tirbanibulin groups than in the vehicle groups. At 1 year, the estimated percentage of patients with recurrent lesions was 47% among patients who had had a complete response to tirbanibulin. The most common local reactions to tirbanibulin were erythema in 91% of the patients and flaking or scaling in 82%. Adverse events with tirbanibulin were application-site pain in 10% of the patients and pruritus in 9%, all of which resolved.In two identically designed trials, tirbanibulin 1% ointment applied once daily for 5 days was superior to vehicle for the treatment of actinic keratosis at 2 months but was associated with transient local reactions and recurrence of lesions at 1 year. Trials comparing tirbanibulin with conventional treatments and that have longer follow-up are needed to determine the effects of tirbanibulin therapy on actinic keratosis. (Funded by Athenex; ClinicalTrials.gov numbers, NCT03285477 and NCT03285490.).

Lichen planus is a benign inflammatory disorder of unknown etiology that may affect the skin, mucosae, scalp, and nails. When the nails are affected, it may lead to permanent destruction with severe functional and psychosocial consequences. Therefore, prompt diagnosis and early treatment are essential, even in mild cases. There are currently no guidelines for the management of nail lichen planus and the published literature on treatment is limited. The aim of this review is to provide practical management recommendations for the classical form of nail lichen planus, especially when restricted to the nails. Topical treatment has poor short-term efficacy and may cause long-term side effects. Instead, intralesional and intramuscular triamcinolone acetonide should be considered first-line therapies. Oral retinoids are second-line choices, and immunosuppressive agents may also be considered., SCOPUS: re.j, info:eu-repo/semantics/published

FMX101 4% topical minocycline foam has been shown to be an effective and safe treatment for acne vulgaris (AV).To further evaluate the efficacy and safety of FMX101 4% in treating moderate to severe acne vulgaris.A 12-week, multicenter, randomized (1:1), double-blind, vehicle-controlled study was conducted. Coprimary end points were the absolute change in inflammatory lesion count from baseline and the rate of treatment success (Investigator's Global Assessment score of 0 or 1 with a ≥2-grade improvement).There were 1488 participants in the intent-to-treat population. The FMX101 4% group had significantly greater reductions in the number of inflammatory lesions from baseline (P .0001) and a greater rate of treatment success based on Investigator's Global Assessment (P .0001) versus the foam vehicle group at week 12. FMX101 4% was generally safe and well tolerated.The efficacy and safety of FMX101 4% were not characterized in participants with mild AV.FMX101 4% topical minocycline foam was effective and safe for the treatment of moderate to severe AV.

Nevus lipomatosus cutaneous superficialis (NLCS) is a rare cutaneous hamartoma characterized by mature adipocytes in the dermis. Here, we present a unique case of NLCS in a 57-year-old female that strikingly resembled an acrochordon, demonstrating features of the classical and solitary form of NLCS. This presentation of NLCS has not been widely reported and emphasizes that the diagnosis of NLCS should be considered when evaluating suspected acrochordons.

Introduction: Complex regional pain syndrome (CRPS) is characterized by chronic pain out of proportion to injury following trauma. CRPS most commonly results after crush-type injury to the hand and may be associated with various cutaneous symptoms believed to be driven by vasomotor instability. Existing reports in the literature have employed a range of methodologies to describe and evaluate cutaneous and vascular changes in CRPS, though there exists no current gold standard for diagnosis. Case Presentation: Here, we report a 71-year-old male with a 10-year history of CRPS who presented with abnormal capillaries on onychoscopy, demonstrating a “lightning-storm” pattern. Conclusion: Previous studies have shown increased blood flow to the cutis in the early stage of CRPS, yet diminished cutaneous flow during the later stages. However, one study showed increased nail capillary diameter in patients with later stage CRPS. Due to a variety of reported clinical characteristics and a nonspecific clinic presentation, both the recognition and diagnosis of CRPS is difficult. Nail fold capillaroscopy may be a useful and accessible tool for evaluating patients with CRPS.

Nevus sebaceous is a congenital epidermal hamartoma characterized by hyperplastic changes to the epidermis and adnexa. Nevus sebaceous is associated with an elevated risk of cutaneous neoplasms, most often benign; however, malignant neoplasms, most notably basal cell carcinoma, can also present in these patients. Although a rare occurrence, more often affecting adult patients, squamous cell carcinomas have also been reported to arise at the site of pre-existing nevus sebaceous. Herein we report a unique case of a patient with basal cell carcinoma and squamous cell carcinoma arising concurrently in the same nevus sebaceous.

A 51-year-old female with a history of rheumatoid arthritis was admitted for progressive fevers, chills and malaise. Five weeks prior, she started minocycline for an RA exacerbation. Two weeks after starting minocycline she developed an abscess on her right ankle that was treated at an urgent care facility with ceftriaxone and trimethoprim-sulfamethoxazole. She had minimal improvement so was switched to clindamycin. She developed additional abscesses on her right ankle and right axilla and spiking fevers so she was treated with incision and drainage under general anesthesia. Routine blood work obtained prior to surgery revealed severe neutropenia (0.74 103/ul) and the patient was urgently referred to the emergency department. Skin biopsy was obtained on admission and revealed ulceration, necrosis, acute and chronic inflammation, vasculitis with vascular thrombosis and rod-shaped bacteria in blood vessel walls and lumina consistent with ecthyma gangrenosum. The following day tissue and blood cultures confirmed the growth of Pseudomonas aureginosa. Bone-marrow biopsy showed decreased granulopoiesis and hematopoiesis, and a diagnosis of minocycline-induced agranulocytosis presenting as ecthyma gangrenosum was made. The patient had dramatic improvement with appropriate antibiotic therapy, discontinuation of minocycline and initiation of filgrastrim. She has remained healthy without recurrence for 17 months.

A 37-year-old South-Asian male presented to our clinic with a crusty, verrucous-like, scaly plaque of the left ala of the nose. After ruling out infectious and other epidermal bullous diseases, we finalized a diagnosis of localized pemphigus foliaceus, an exceptionally rare disorder with only 15 cases reported in the literature to date. The hyperkeratotic lesions responded favorably to a 3-week regimen of triamcinolone ointment and a onetime intralesional triamcinolone 2.5 mg/mL injection.

Nail involvement in psoriasis is common, and the severity of it does not always parallel the intensity of cutaneous disease. We created a consensus group, of which the aim was to provide practical recommendations for the treatment of nail psoriasis in patients without skin psoriasis or with mild skin lesions with no indication for a systemic treatment. This collaborative process was conducted by an international panel of dermatologists with special expertise in nail disorders, using formal consensus methods. During this process, the panel strived to establish an agreement regarding the definition of nail psoriasis, the severity of nail psoriasis, and treatment response. Treatment recommendations are provided regarding nail psoriasis severity and matrix or bed involvement. Few-nail disease was considered as nail psoriasis affecting ≤3 nails. In the case of matrix involvement only, intralesional steroid injections were considered the treatment of choice. Topical steroids alone or in combination with topical vitamin D analogues were suggested for nail psoriasis limited to the nail bed. For the systemic treatment of nail psoriasis acitretin, methotrexate, cyclosporine, small molecules, and biologics may be employed., SCOPUS: re.j, info:eu-repo/semantics/published

First described in 1992, onychomatricoma is a rare, benign, fibroepithelial tumor of the nail matrix with few reported cases in the literature. The tumor predominately affects the fingers of Caucasian women during the 5th decade of life and is typically slow growing and painless. The authors present a unique clinical presentation of a giant onychomatricoma in a darker-skinned 60-year-old South Asian individual who presented with a large dome-shaped nail that was smooth, shiny, and green.

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Hypergranulation is the extension of granulation tissue beyond the required amount to close a tissue defect. We report our experience using aluminum chloride to treat a series of two patients with hypergranulation tissue. Both patients had lengthy treatment courses after Mohs surgery with growth of hypergranulation tissue that resolved once aluminum chloride was placed on the wound. Aluminum chloride is a useful hemostatic agent frequently employed in dermatology. It is a readily available and low-cost option for management of hypergranulation after dermatologic procedures. Chronic wounds are a common treatment challenge for clinicians. Due to its affordability and availability, clinicians may consider topical aluminum chloride when managing post-surgical hypergranulation tissue.

The nail matrix biopsy is an important technique in confirming or excluding a diagnosis of melanoma in a patient with longitudinal melanonychia. Dermatologists are the first-line diagnosticians for these pigmented lesions of the nail unit, however, for different reasons, some are reluctant to perform a nail biopsy. This case demonstrates how a poor biopsy technique resulted in a misdiagnosis in a patient with melanoma in situ. J Drugs Dermatol. 2018;17(5):587-588.

Switching psoriasis treatment is a common, accepted practice that is used to improve disease management and improve patient outcomes (e.g., when patients are experiencing suboptimal efficacy and/or tolerability with a given therapy). Historically, switching treatment was often performed to limit patients’ cumulative exposure to conventional systemic agents (e.g., methotrexate, cyclosporine) with the goal of reducing end‐organ toxicity. However, the practice of switching treatments has evolved in recent years with the availability of highly effective and tolerable biologic agents. In current practice, near‐complete skin clearance with minimal side effects should be a realistic treatment goal for most patients with moderate‐to‐severe psoriasis, and consideration for switching therapies has shifted to become more focused on achieving maximum possible skin clearance, enhanced quality of life, and improved patient satisfaction. This review provides a discussion of recent guidance on switching psoriasis therapies, including initial considerations for when switching therapy may be advisable and challenges associated with switching therapy, along with an overview of published clinical studies evaluating outcomes associated with switching therapy. The goal of this review is to empower dermatologists to optimally manage their patients’ psoriasis by providing the tools needed to develop rational strategies for switching treatments based on the pharmacologic characteristics of available treatments and each patient's clinical needs and treatment preferences.

Onychomatricoma and glomus tumor are two rare subungual neoplasms with distinct clinical and histopathological features. We report a case of onychomatricoma associated with a glomus tumor in the subungual region of the same finger in a 45-year-old woman. Histopathological examination revealed characteristic findings of both onychomatricoma and glomus tumor. To the best of our knowledge, these two subungual tumors have never before been described occurring concomitantly.

Onycholysis - the separation of the nail plate from the nail bed occurs in fingers and toenails. It is diagnosed by the whitish appearance of the separated nail plate from the nail bed. In fingers, the majority is caused by trauma, manicuring, occupational or self-induced behavior. The most common disease producing fingernail onycholysis is psoriasis and pustular psoriasis. Phototoxic dermatitis, due to drugs can also produce finger onycholysis. Once the separation occurs, the environmental flora sets up temporary colonization in the available space. Finger onycholysis is most common in women. Candida albicans is often recovered from the onycholytic space. Many reports, want to associate the yeast as cause and effect, but the data are lacking and the treatment of the candida does not improve finger onycholysis. A reasonable explanation for the frequent isolation of Candida and Pseudomonas in fingernail onycholysis in women, is the close proximity the fingers have to the vaginal and gastrointestinal tract. Fifty per cent of humans harbour C. albicans in the GI tract and it is frequently carried to the vagina during hygienic practices. Finger onycholysis is best treated by drying the nail 'lytic' area with a hair blower, since all colonizing biota are moisture loving and perish in a dry environment. Toenail onycholysis has a very different etiology. It is mechanical, the result of pressure on the toes from the closed shoes, while walking, because of the ubiquitous uneven flat feet producing an asymmetric gait with more pressure on the foot with the flatter sole.

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Summary Dermatologists should be aware of the surgical techniques that reduce the level of skin distortion following biopsy procedures. (1) a dilution of lidocaine with bacteriostatic 0.9% sodium chloride and (2) injection of the solution directly into the nevus. The nevus balloons in size and shape and becomes tenser resulting in a change in the skin level permitting for easy shave. Good injection technique of anesthesia may represent a simple, but important means to improve postoperative cosmetic outcomes.

Activation of the WNT/β-catenin pathway has emerged as a potential therapeutic target in androgenetic alopecia (AGA). Methyl vanillate (MV) - a safe plant-derived ingredient - has been recently shown to activate the WNT/β-catenin signaling. Objectives Two distinct substudies were conducted. First, we designed a 6-month, uncontrolled, open-label clinical study to investigate whether topically applied MV may increase hair count and hair mass index (HMI) in female AGA. Second, we conducted a molecular study on the effect of MV on WNT10B mRNA expression in scalp biopsies of women with AGA. A total of 20 Caucasian women (age range: 25-57 years) with AGA (Sinclair grade 1-2) were included. The research product was an alcohol-free formulation supplied in the form of a spray containing 0.2% MV as the active ingredient. In the clinical study, hair count and HMI were found to increase at 6 months by 6% (P < 0.01) and 12% (P < 0.001), respectively, compared with baseline. No participant discontinued treatment due to adverse effects, and the overall patient satisfaction was good. At the molecular level, the topical application of the research product resulted in a 32% increase in WNT10B mRNA expression levels in the temporal scalp area (P < 0.001). Our pilot data suggest that topical MV can increase hair count and HMI by inducing WNT10B expression in the scalp, potentially serving as a novel treatment strategy for female AGA. Research grants from Biodue SpA. This study was partly funded by Biodue SpA (Italy). 1.764 JCR (2016) Q2, 30/63 Dermatology 0.715 SJR (2016) Q2, 37/151 Dermatology No data IDR 2016 UEM

Patients often present for lip augmentation to correct the loss of volume and signs of aging commonly perceived with perioral aging, including but not limited to decreased vermillion showing, blunting of the Cupid’s bow, less visible white roll, vertical rhytids, marionette lines, formation of a mentalis crease, and deep nasolabial folds. Hyaluronic acid (HA) is popular filler for temporary lip augmentation (effects last 3–6 months) due to its hygroscopic properties and resulting natural appearance. Additionally, they have desirable safety profiles due to the reversibility by enzymatic degradation using hyalurodinase. Keeping in mind the important anatomy of the perioral region and its vascular supply and nerve innervation is essential to a successful procedure with good cosmetic results. This chapter includes detailed guidelines and a technique for injecting. Physicians should consult with patients as to their preferences for a desired look, but carefully manage expectations to avoid disappointments. HA fillers are well tolerated and rarely result in adverse reactions for patients. Commonly experienced reactions can include local inflammation, tenderness, and bruising. HA fillers are an effective first-line treatment option for patients who want to augment and revitalize their lips.

First approved in 1989 for the treatment of various neuromuscular disorders, it was not until 2002 that the US Food and Drug Administration (FDA) approved botulinum toxin for its first dermatologic application: enhanced cosmesis of glabellar lines. By 2004, the FDA extended its approval of onabotulinumtoxin A, or Botox®, to the treatment of primary axillary hyperhidrosis refractory to treatment with topical agents [1].

Warts are the most common nail tumor generally caused by human papilloma virus (HPV) 1, 2, 4, 27, and 57. HPV 16 and 18 are associated with malignant transformation to squamous cell carcinoma, while HPV 2 and 7 are associated with "butcher's warts." Current treatments range from topical and intralesional therapies to systemic agents and surgical procedures. Despite the numerous available possibilities for treatment, intralesional bleomycin appears to be the most effective treatment for periungual warts.

Nail psoriasis affects up to 90% of patients with psoriasis in their lifetime and is seen in 80% of patients with psoriatic arthritis. These changes of nail psoriasis often cause significant pain, psychological effects, and result in restrictions of daily activities. In patients with nail psoriasis, the choice of effective therapy is limited and depends on various factors, including the severity of the disease, the ability of patients to tolerate treatment, and their ability to pay (insurance) for what are, in some cases, expensive treatments. In recent years, biological therapies have proved effective in improving nail psoriasis, have generally proved to be well tolerated and require minimal patient monitoring. In the right situation, therefore, the use of biological agents is justified in patients with psoriatic nail disease.