Mary S. Brady, MD; Memorial Sloan-Kettering Cancer Center, New York, New York; Nikki S. Noce, New York University Medical Center, New York, New York

Disclosure: The authors report no relevant conflicts of interest. Read the rest of this article »

Ashley Collins, MD; Department of Biochemistry, North Carolina State University; Adnan Nasir, MD, Department of Dermatology, University of North Carolina, Chapel Hill, North Carolina

Abstract
Nanotechnology is a rapidly growing discipline that capitalizes on the unique properties of matter engineered on the nanoscale. Vehicles incorporating nanotechnology have led to great strides in drug delivery, allowing for increased active ingredient stability, bioavailability, and site-specific targeting. Botulinum toxin has historically been used for the correction of neurological and neuromuscular disorders, such as torticollis, blepharospasm, and strabismus. Recent dermatological indications have been for the management of axillary hyperhydrosis and facial rhytides. Traditional methods of botulinum toxin delivery have been needle-based. These have been associated with increased pain and cost. Newer methods of botulinum toxin formulation have yielded topical preparations that are bioactive in small pilot clinical studies. While there are some risks associated with topical delivery, the refinement and standardization of delivery systems and techniques for the topical administration of botulinum toxin using nanotechnology is anticipated in the near future.  (J Clin Aesthetic Dermatol. 2010;3(3):35–39.) Read the rest of this article »

Sarah Grim Hostetler, MD, Division of Dermatology, Ohio State University College of Medicine; Benjamin Kaffenberger, BS, The Ohio State University College of Medicine; Todd Hostetler, MD, Division of Allergy and Immunology, The Ohio State University Medical Center, Columbus, Ohio; Matthew J. Zirwas, MD, Division of Dermatology, Ohio State University College of Medicine

Abstract
Atopic dermatitis is a common, chronic skin condition. A subpopulation of patients may have cutaneous exposure to common airborne proteins exacerbating their disease through direct proteolytic activity, direct activation of proteinase-activated receptor-2 itch receptors, and immunoglobulin E binding. The most common airborne proteins significant in atopic dermatitis include house dust mites, cockroach, pet dander, and multiple pollens. The literature on atopy patch testing, skin-prick testing, and specific IgE is mixed, with greater support for the use of atopy patch test. Patients with airborne proteins contributing to their disease typically have lesions predominately on air-exposed skin surfaces including the face, neck, and arms; a history of exacerbations after exposure to airborne proteins; severe disease resistant to conventional therapies; and concurrent asthma. Treatment strategies include airborne protein avoidance, removal of airborne proteins from the skin, and barrier repair. Further research is needed to establish the benefit of allergen-specific immunotherapy.  (J Clin Aesthetic Dermatol. 2010;3(1):22–31.) Read the rest of this article »

Grace K. Kim, DO, Dermatology Research Fellow, Mohave Skin & Cancer Clinics, Las Vegas, Nevada; James Q. Del Rosso, DO, Dermatology Residency Director, Valley Hospital Medical Center, Las Vegas, Nevada, and Director of Dermatology Research, Mohave Skin & Cancer Clinics, Las Vegas, Nevada

Abstract
Psoriasis is a commonly encountered dermatosis with a variety of internal and external paradoxical factors contributing to the clinical course of the disease. There are several drugs described in the literature that have been associated with the initiation, exacerbation, and aggravation of psoriasis. Understanding the pathophysiology can provide clues to treatment and management of drug-induced and drug-aggravated psoriasis, which may be indistinguishable from idiopathic psoriasis. The clinical manifestations of drug-associated psoriasis can range from plaque-type psoriasis to severe erythroderma, thus warranting astute and sustained clinical observation.
(J Clin Aesthetic Dermatol. 2010;3(1):32–38.) Read the rest of this article »

Tobechi L. Ebede, MD, Department of Dermatology, Weill-Cornell Medical Center, New York, New York; Emily L. Arch, MD, Division of Dermatology, NorthShore University HealthSystem, Skokie, Illinois; Diane Berson, MD, Department of Dermatology, Weill-Cornell Medical Center, New York, New York

Disclosure: Drs. Ebede and Arch report no relevant conflicts of interest. Dr. Berson serves as a consultant and/or on the advisory board for Stiefel, Medicis, OrthoNeutrogena, Dusa, La Roche-Posay, and Galderma.

Abstract
Acne vulgaris is a common and chronic disorder of the pilosebaceous unit. Standard treatment protocols include topical retinoids, topical and oral antimicrobials, and isotretinoin. Hormonal therapies can be added to the regimen in some patients. This article will review the hormonal pathogenesis of acne, discuss the basics of an endocrine evaluation, and provide an overview of the current hormonal treatment options in women. (J Clin Aesthetic Dermatol. 2009;2(12):16–22.) Read the rest of this article »

Matthew J. Zirwas, MD; Jessica L. Holder, BS, Department of Internal Medicine, Division of Dermatology, The Ohio State University College of Medicine, Columbus, Ohio

Abstract
Patient education is an important aspect of patient care in dermatology. Successful education increases patient satisfaction and results in improved outcomes and adherence. This article discusses the role of patient education in dermatology. Specifically, Part I of the review examines evidence demonstrating the benefits of patient education and recognizes the challenges that limit effective patient education. These challenges can be summarized as barriers to understanding, poor patient recall, conflicting information, and barriers to physician delivery. Further descriptions and an assessment of these limitations along with methods to combat them are included in the review.
(J Clin Aesthetic Dermatol. 2009;2(12):24–27.) Read the rest of this article »

Matthew J. Zirwas, MD; Jessica L. Holder, BS, Department of Internal Medicine, Division of Dermatology, The Ohio State University College of Medicine, Columbus, Ohio

Abstract
Patient education is an important aspect of patient care in dermatology. Successful education increases patient satisfaction and results in improved outcomes and adherence. This article individually evaluates several patient-education strategies: verbal education, written information, group-based learning, audiotapes, videotapes, computer-assisted education, and the internet. The review presents the strengths and limitations of each strategy based on recognized barriers to effective patient education that were discussed in Part 1. Additionally, a summary of recommendations for effective patient education is provided.  (J Clin Aesthetic Dermatol. 2009;2(12):28–34.) Read the rest of this article »

Mark Bechtel, MD; Catherine Sanders, MS; Ann Bechtel, RN, BSN
The Ohio State University College of Medicine, Columbus, Ohio

Disclosure: Dr. Bechtel is a speaker for Amgen, Centocor, Genentech, and Abbott. Ms. Sanders and Ms. Bechtel report no relevant conflicts of interest.

Abstract
Biologic agents have been a significant advancement in the management of psoriasis. Along with significant clinical improvement, there have been concerns for emerging side effects with the use of biologics. Reports have emerged showing the association between efalizumab and the development of progressive multifocal leukoencephalopathy and other demyelinating disorders. Tumor necrosis factor-alpha inhibitors have been associated with various demyelinating disorders. As such, it is imperative for dermatologists to be well informed regarding how to notify patients about the risks of biologic treatment. Dermatologists must be able to identify the signs and symptoms of neurological complications and recognize when to refer patients to neurologists for diagnostic workup, disease confirmation, and any necessary treatment. This review is a compilation of evidence showing the association between biologic therapy and neurological complications, as well as an overview of the clinical presentation and diagnosis of such diseases.
(J Clin Aesthetic Dermatol. 2009;2(11):27–32.) Read the rest of this article »

Amylynne Frankel, MD; Carolin Penrose, MD; Jason Emer, MD
Mount Sinai School of Medicine, Department of Dermatology, New York, New York

Abstract
Cutaneous tuberculosis occurs rarely, despite a high and increasing prevalence of tuberculosis worldwide. Mycobacterium tuberculosis, Mycobacterrium bovis, and the Bacille Calmette-Guérin vaccine can cause tuberculosis involving the skin. Cutaneous tuberculosis can be acquired exogenously or endogenously and present as a multitude of differing clinical morphologies. Diagnosis of these lesions can be difficult, as they resemble many other dermatological conditions that are often primarily considered. Further, microbiological confirmation is poor, despite scientific advances, such as the more frequent use of polymerase chain reaction. The authors report a case that illustrates the challenges faced by dermatologists when considering a diagnosis of cutaneous tuberculosis. (J Clin Aesthetic Dermatol. 2009;2(10):19–27.) Read the rest of this article »

Jorge Garcia-Zuazaga, MD, MS, Director, Mohs Micrographic Surgery, Department of Dermatology, University Hospitals Westlake Medical Center; Malcolm S. Ke, MD, Division of Dermatology, University of California Los Angeles; Marlene Willen, MD, Chair, Department of Dermatology, MetroHealth Medical, Cleveland, Ohio

Abstract
Cysts are entities encountered frequently in dermatological clinics. Various types of cysts have been described and include trichilemmal cysts, epidermoid cysts, steatocystomas, and the myriad of developmental cysts (branchial cleft cyst, thyroglossal duct cysts, bronchogenic cysts). Moreover, not all lesions that appear clinically as cystic structures are, in fact, cysts. Increased awareness of these mimickers and a systematic approach to the evaluation of these cases is essential. The authors report seven cases, over the course of six years, presenting to their dermatology department, all of which were originally clinically diagnosed as “cysts” and referred to the authors for management. In this article, the authors review seven cyst mimickers and describe important aspects of these diagnoses to increase awareness of the importance of a preoperative biopsy and evaluation. It is important to have a thorough understanding of the wide differential diagnosis of cutaneous nodules and to consider other causes of lesions that appear to be cysts, particularly in the anatomical locations described.  (J Clin Aesthetic Dermatol. 2009;2(10):28–33.) Read the rest of this article »