News

An expert says dermatologists must be careful not to overlook or misdiagnose four aggressive skin cancers whose incidence rates are rising - lentigo maligna, atypical fibroxanthoma, Merkel cell carcinoma and high-risk squamous cell carcinoma.

When choosing among temporary, semipermanent and permanent dermal fillers, increased longevity may also mean increased risks, an expert says.

The abundant array of cosmetic creams on the market can be a source of confusion for consumers. Categorizing products by function provides a method for understanding their ingredients and benefits.

Many new techniques are being used to reshape the body. Fractional lasers require much less downtime than other lasers, and electromagnetic radiation has presented a new direction for treating varicose veins, making stripping and ligation a less popular treatment option.

Options for off-face resurfacing include ablative treatments, nonablative treatments, photo- dynamic therapy and fractional ablative treatments, an expert says.

Laser-assisted hair removal, photorejuvenation and laser treatment of acne and atrophic scars can now be offered to patients with skin of color. However, it is still important to proceed with caution because all risks are not eliminated with newer technologies.

Choosing appropriate treatments for nonablative facial rejuvenation requires that dermatologists understand the pathophysiology of photoaging, according to an expert.

Despite several manufacturers' claims that they have developed hair conditioners that replace 18-MEA after chemical processing, once that protective layer is damaged, it is permanently destroyed, an expert says.

Emerging therapies that treat onychomycosis are expected to help patients who do not respond to currently available therapies. Both systemic and topical, these new therapies also will have shorter treatment periods, which can possibly improve patient compliance.

Successfully adding head and neck rejuvenation treatments to one's practice requires starting with fillers, toxins, chemical peels and whatever devices one already owns, an expert says.

Hair restoration has been revolutionized by new techniques, such as follicular unit transplantation. Modern hair transplants are undetectable, an expert says.

Traditional teaching for nail surgery proposes complete nail removal, but there are a variety of options - not just for total nail avulsion techniques, including the lateral nail plate curl and the trap-door avulsion - but also for partial nail avulsion, according to Nathaniel Jellinek, M.D.

The current theory about brittle nails is that the condition is due to a decrease in water content and water retention of the nail plate, an expert says. Treatment includes educating patients and using inexpensive, over-the-counter products.

Several risk factors can impair the wound-healing process in the elderly, such as poor nutrition, depression and the inappropriate use of medications. A focal point in wound healing is the investigation of drugs with the potential to limit scarring. Researchers are identifying targets, such as Transforming Growth Factor-beta3, to develop therapies aimed at minimizing scarring.

The new Bikowski Acne Severity Index (BASI) effectively combines common medical jargon for describing acne lesions, which helps physicians grade these lesions more accurately.

Clinicians need to determine the underlying etiology when managing wounds that are the result of tropical infections. They can do this by culturing bacteria or taking a biopsy.

Untreated skin tears can become complex wounds and demand the care of a dermatologist. Up to 1.5 million skin tears occur annually in adults in healthcare facilities in the United States. Natural changes in the aging process, including diminished elasticity and decreased tensile strength, make the skin more susceptible to a tear.

Important pediatric diagnoses for consulting dermatologists include Kawasaki disease, an expert says. It recently has been linked with a specific genetic polymorphism, which suggests that uncontrolled inflammation plays a role in its etiology.

Nickel, dubbed the "allergen of the year," has led to increased cases of contact dermatitis. Common sources of nickel include jewelry, zippers, snaps, clasps and other clothing fasteners, as well as cellular phones and many cosmetic creams.

Difficult melasma cases require maintenance treatments and ongoing sun avoidance, because to date, no treatments can guarantee long-term success, an expert says.

Recent developments in pediatric atopic dermatitis include the discovery of filaggrin gene mutations and their possible role, a new appreciation of the epidermis' role in the immune system and renewed emphasis on patient education, an expert says.

Patients with eyelid dermatitis frequently require patch testing with allergens not included in the standard TRUE Test, an expert says.

Schools, sports programs, and day care centers provide ideal "breeding grounds" for methicillin-resistant Staphylococcus aureus infections. Any suspicious lesion should be cultured early. Comprehensive education is needed to minimize risk of transmission and to quell hysteria.

A patient with low-grade fibrosarcoma has not needed an amputation of the limb but rather local excision of tumors, according to her dermatologist.

Sclerotherapy can produce excellent but highly variable results and requires good training, experience and a thorough discussion of risks, benefits and patient expectations, an expert says.

Ethyl chloride spray can be used to lessen the discomfort associated with Botox injections. The spray is available in pharmacies or through medical suppliers. Because the spray is highly flammable, it should not be used near electrodesiccation. It can be stored at room temperature.

Acknowledging the relative flood of vitamin D research that's been published in recent years, the National Academies' Institute of Medicine (IOM) has entered discussions with U.S. and Canadian government agencies regarding a re-evaluation of national vitamin D guidelines.

A recent report linking low vitamin D levels with increased mortality risk has dermatologists - and even a report co-author - concerned that many Americans could misinterpret its findings as justification to significantly increase sun exposure.

Protocols for future face transplants are in place, but securing donors remains difficult, says the surgeon who operated on France's first male face transplant patient.

Although they've garnered little publicity, composite tissue allotransplantation (CTA) programs based at two Eastern U.S. hospitals are steadily progressing, with plans for face and other composite-tissue transplants, their leaders say.