Publications by authors named "Laura Sandoval"

38 Publications

antimicrobial effect of chloroaluminum phthalocyanine nanoemulsion on periodontal bacteria.

J Indian Soc Periodontol 2021 May-Jun;25(3):267-269. Epub 2021 May 3.

Department of Basic Sciences, Stomatognathic System and Morphophysiology Research Group, Santo Tomás University, Bucaramanga, Colombia.

Context: Nowadays, complementary therapies are necessary for a major removal of microbial subgingival biofilm in the conventional treatment of periodontitis. Research has suggested the use of photodynamic therapy (PDT) as a promising therapy to manage oral cavity infections. This project proposes a new combination of photosensitizer chloroaluminum phthalocyanine and nanoemulsion as a strategy for improving bioactivity. The main purpose of this study was to evaluate the antimicrobial activity of nanoemulsion ClAlPc (ClAlPc-NE) on relevant periodontal bacteria before and after PDT.

Materials And Methods: The phototoxic and antibacterial effect of ClAlPc-NE was evaluated against epithelial cells derived from an African green monkey kidney using the colorimetric method with salt tetrazolium 3-(4.5-dimethylthiazolyl-2)-2.5-Diphenyltetrazolium bromide (Merck) and periodontopathogen bacteria ( (ATCC 33277), (ATCC 33384), and (ATCC 25611) using the plate microdilution method according to Tavares ., 2018, respectively. The light source used for the PDT was a LED laser (400-700 nm); the cells were irradiated for 2 min using 4.83 joules/cm.

Results: Antibacterial effect of NE-PcAlCl against with minimum inhibitory concentration (MIC) 0.63 μM after TFD was determined. In the case of and , no biological activity was found after PDT (MIC > 20 μM) under-evaluated experimental conditions. On the other hand, the ClAlPc-free and ClAlPc-NE cells were phototoxic on epithelial cells.

Conclusion: The results helped to identify the potential use of ClAlPc-NE to inhibit the periodontal bacterial and additional studies are being developed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/jisp.jisp_433_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8177176PMC
May 2021

What's Eating You? Black Butterfly (Hylesia nigricans).

Cutis 2021 Feb;107(2):68-70

Dr. González is from the Dermatology Service, Kennedy Hospital, Bogotá, Colombia. Dr. Sandoval is from the Dermatology Program, El Bosque University, Bogotá. Drs. Motta and Rolón are from Simón Bolívar Hospital, Bogotá. Dr. Motta is from the Dermatology Service, and Dr. Rolón is from the Dermatopathology Service.

Lepidopterism refers to the adverse medical effects of contact with insects of the order Lepidoptera, which includes both moths and butterflies. These effects typically result from contact with an insect during the caterpillar (larval) stage. Lepidopterism involves multiple pathologic mechanisms, including direct toxicity of venom and mechanical irritant effects. Clinical patterns associated with contact with lepidoptera include localized stinging reactions, papular urticaria and dermatitis, urticarial wheals, and hemorrhagic diathesis. Accurate diagnosis of symptoms associated with contact with caterpillars, butterflies, or moths is nearly impossible without a reliable history of exposure, as the histology of exposure is nonspecific. Treatment is largely empiric and should be based on symptoms. We report a case of lepidopterism in a patient with acute cutaneous lesions following exposure to an adult-stage black butterfly (Hylesia nigricans).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.12788/cutis.0170DOI Listing
February 2021

Effects of chlorpyrifos on cell death and cellular phenotypic specification of human neural stem cells.

Sci Total Environ 2019 Sep 20;683:445-454. Epub 2019 May 20.

Toxicología Ambiental, Centro Nacional de Sanidad Ambiental, Instituto de Salud Carlos III, Madrid, Spain.

Chlorpyrifos (CPF) is an organophosphate pesticide widely used in agriculture, whose traditional and well-known mechanism of action is the inhibition of the enzyme Acetylcholinesterase (AChE). Subacute exposures to CPF have been associated with alterations different from the inhibition of AChE. Because of the vulnerability of the developing nervous system, prenatal and early postnatal exposures are of special concern. Human neural stem cells (hNSC) provide the opportunity to study early stages of neural development and may be a valuable tool for developmental neurotoxicology (DNT). In the current work, the cell line hNS1 was used as a model system with the aim of validating this cell line as a reliable testing method. To evaluate the effects of CPF on early developmental stages, hNS1 cells were exposed to different concentrations of the pesticide and cell death, proliferation and cell fate specification were analyzed under differentiation conditions. Since hNS1 cells responded to CPF in a similar way to other human cell lines, we consider it may be a valid model for DNT chemical assessment. CPF induced apoptotic cell death only at the highest doses tested, suggesting that it is not toxic for the specific developmental stage here addressed under short term exposure. In addition, the higher doses of CPF promoted the generation of astroglial cells, without affecting neurogenesis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.scitotenv.2019.05.270DOI Listing
September 2019

Scabies herpeticum, an emerging clinical form of crusted scabies in AIDS patient: case report and literature review.

Int J Dermatol 2019 Oct 15;58(10):1205-1209. Epub 2018 Oct 15.

Medical Microbiology and Mycology Laboratory, El Bosque University, Bogota, Cundinamarca, Colombia.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ijd.14256DOI Listing
October 2019

Use of Nitrous Oxide in Dermatology: A Systematic Review.

Dermatol Surg 2018 May;44(5):661-669

Campbell University School of Osteopathic Medicine, Buies Creek, North Carolina.

Background: Many dermatologic procedures are painful and can be distressing to patients.

Objective: To determine whether nitrous oxide has been used in dermatology and whether literature supports its use in terms of providing analgesia and anxiety associated with dermatologic procedures.

Methods: A search of PubMed and Cochrane databases was conducted through July 15, 2016, to identify studies involving nitrous oxide use in dermatology.

Results: Eight studies were identified and reviewed. The use of nitrous oxide/oxygen mixture resulted in a significant reduction in pain when used for photodynamic therapy, botulinum toxin therapy for hyperhidrosis of both the palms and axilla, aesthetic procedures involving various laser procedures, and in the treatment of bed sores and leg ulcers. However, pain scores were higher when nitrous oxide/oxygen was used in the debridement of chronic ulcers when compared with the use of topical anesthesia. In addition, nitrous oxide has been reported effective at reducing pain in hair transplants, dermabrasion, excision and repairs, and pediatric procedures.

Conclusion: Current literature provides some evidence that nitrous oxide, used alone or as adjunct anesthesia, is effective at providing analgesia for many dermatologic procedures. Nitrous oxide has many potential applications in dermatology; however, further evidence from randomized controlled trials is needed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/DSS.0000000000001464DOI Listing
May 2018

Nasal Valve Reconstruction Using a Titanium Implant: An Outcomes Study.

Craniomaxillofac Trauma Reconstr 2017 Sep 22;10(3):175-182. Epub 2017 Mar 22.

Department of Dermatology, Wake Forest School of Medicine, Winston Salem, North Carolina.

Septoplasty alone is not always sufficient to correct nasal obstruction. Various techniques have been employed to repair nasal valve collapse and improve airflow. This article aimed to evaluate outcomes and quality of life following nasal valve reconstruction using a titanium implant in patients with nasal valve collapse. This is a single-center retrospective study that consisted of a telephone questionnaire of 37 quality-of-life measures and questions related to the surgical procedure and recovery process to evaluate postsurgical outcomes. Fifteen patients completed the survey. There was a significant improvement in nasal blockage/obstruction, breathing through the nose, sleeping, breathing through nose during exercise, the need to blow nose, sneezing, facial pain/pressure, fatigue, productivity, and restlessness/irritability after surgery. Overall, 100% of patients were satisfied with the results and would recommend this procedure. The most common postoperative complaints were pain (33%) and difficulty breathing (33%). Patients noticed no increase (20%) or a slight increase (73%) in the size of their nose. Sixty percent of patients cannot see the implant and 13% report the implant is barely noticeable. Nasal valve repair with a titanium implant was successful at improving symptoms of nasal obstruction and other quality-of-life issues. Satisfaction was high among all patients. The implants are palpable, thought to be visible by some patients, yet accepted by the majority of patients. This approach may be especially important in patients with prior nasal surgery but continue to experience refractory symptoms.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0037-1600900DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5526691PMC
September 2017

An Aggressive Microcystic Adnexal Carcinoma Infiltrating the Sternum.

J Drugs Dermatol 2017 Feb;16(2):180-181

Microcystic adnexal carcinoma is a rare cutaneous tumor that is often misdiagnosed and has the potential to be aggressive. Mohs surgery is the treatment of choice to prevent recurrences. We present a case of a large recurrent microcystic adnexal carcinoma on the sternum, initially diagnosed as a basal cell carcinoma. This tumor infiltrated the muscle and bone and was unresectable with Mohs surgery.

J Drugs Dermatol. 2017;16(2):180-181.

.
View Article and Find Full Text PDF

Download full-text PDF

Source
February 2017

Inhibition of Listeria monocytogenes in Fresh Cheese Using Chitosan-Grafted Lactic Acid Packaging.

Molecules 2016 Apr 8;21(4):469. Epub 2016 Apr 8.

Laboratory of Biopolymers and Pilot Plant of Bioprocessing of Agro-Industrial and Food By-Products, Biotechnology Department, Universidad Autónoma Metropolitana, Av. San Rafael Atlixco No. 186. Col. Vicentina, C.P., 09340 Mexico City, Mexico.

A chitosan from biologically obtained chitin was successfully grafted with d,l-lactic acid (LA) in aqueous media using p-toluenesulfonic acid as catalyst to obtain a non-toxic, biodegradable packaging material that was characterized using scanning electron microscopy, water vapor permeability, and relative humidity (RH) losses. Additionally, the grafting in chitosan with LA produced films with improved mechanical properties. This material successfully extended the shelf life of fresh cheese and inhibited the growth of Listeria monocytogenes during 14 days at 4 °C and 22% RH, whereby inoculated samples with chitosan-g-LA packaging presented full bacterial inhibition. The results were compared to control samples and commercial low-density polyethylene packaging.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/molecules21040469DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6273688PMC
April 2016

Clinical potential of brodalumab in the management of psoriasis: the evidence to date.

Psoriasis (Auckl) 2015 11;5:35-41. Epub 2015 Mar 11.

Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, NC, USA.

Brodalumab is an anti-IL-17 receptor monoclonal antibody currently in development for the treatment of moderate-to-severe plaque psoriasis. With many systemic psoriasis therapies to choose from, and several newer agents in development, physicians need up to date evidence for the use of these drugs. A PubMed search was conducted through August 1, 2014 to identify randomized controlled trials and systematic reviews of brodalumab for the treatment of psoriasis. Results of Phase I and II trials, as well as a few smaller studies, have provided promising data on efficacy, safety, health-related quality of life, pharmacokinetics, and changes in lesional skin. Early Phase III data continue to support the use of brodalumab as a potentially valuable option for the treatment of psoriasis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2147/PTT.S49996DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5683110PMC
March 2015

Comparison of photographic methods.

J Drugs Dermatol 2015 Feb;14(2):134-9

Background: Photo documentation has become increasing important in medicine, especially given the demand for cosmetic procedures. Standard photography is not always adequate; newer techniques exploring the use of polarized, cross and ultraviolet photography can give detailed information on subtle skin lesions including skin pigmentation and skin surface characteristics.

Objective: To use various methods of photography including standard photography, cross polarized light, parallel polarized light and ultraviolet passing photography to assess which method most effectively captures skin features such as texture, pigment, and/ or vascularity.

Methods: A prospective analysis comparing advanced photographic techniques including standard photography, polarized light photography, cross-polarized light photography and ultraviolet light passing photography. The photos were then evaluated and scored by two experts and a blinded observer to characterize the differences visualized in each type of photography compared to standard photography in terms of subsurface skin features, hypopigmentation, hyperpigmentation, and rhytids.

Results: 9 subjects completed the study. Overall, of the 3 photographic methods compared to standard photography, UV passing most enhanced the visualization of subsurface features and hypopigmentation, with increased hyperpigmentation as well. Enhancement of these features made UV passing best for capturing photodamage. Cross-polarized photography was best for visualizing hyperpigmentation, but also heightened visualization of hypopigmentation and subsurface features such as vascularity. Parallel-polarized photography enhanced visualization of skin texture.

Conclusions: These methods of photography show a quantifiable and reproducible selective ability to evaluate and document elements such as skin texture, vascularity, and pigmentation. Each of these techniques has unique properties that can add to the precision of the clinical evaluation and can be of particular value to providers of cosmetic procedures where photo documentation has become increasingly important in providing an objective means of evaluating outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
February 2015

Systemic treatment of papular dermatitis: A retrospective study.

J Dermatolog Treat 2015 Oct 12;26(5):431-4. Epub 2015 Feb 12.

a Department of Dermatology , Wake Forest School of Medicine , Winston-Salem , NC , USA.

Background: Papular dermatitis is an intensely pruritic eruption that is often refractory to conventional therapy.

Aim: The aim of this study was to evaluate the efficacy of different non-steroidal systemic therapies for long-term control of disease in patients with papular dermatitis.

Methods: This was a single center, retrospective study involving a chart review of patients with a diagnosis of papular dermatitis who were prescribed systemic therapy between 1 January 2002 and 31 December 2012.

Results: Fourteen patients were identified that were treated with a systemic agent. Median duration of treatment was 25 months. Methotrexate was used first line in 12 patients, with control of disease achieved in eight patients with a dose between 2.5 and 10 mg weekly. Azathioprine and mycophenolate mofetil also provided control of disease when used as first-line therapy in the remaining two patients. While azathiopurine was effective in patients who failed methotrexate, gastrointestinal side effects limited its use long term.

Conclusions: Low dose weekly methotrexate, as well as, azathioprine and mycophenolate mofetil are long-term treatment options for patients with papular dermatitis refractory to other therapies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3109/09546634.2014.1002443DOI Listing
October 2015

Calcipotriene 0.005%--betamethasone dipropionate 0.064% ointment versus topical suspension in the treatment of plaque psoriasis: a randomized pilot study of patient preference.

Cutis 2014 Dec;94(6):304-9

Department of Dermatology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157-1071, USA.

Vehicle formulation plays a major role in patient adherence to topical psoriasis treatments. The objective of this study was to conduct a preliminary assessment of patient preference for ointment versus topical suspension formulations of calcipotriene 0.005%-betamethasone dipropionate 0.064% for treatment of plaque psoriasis. In our small cohort of 20 participants with mild to moderate plaque psoriasis, the topical suspension formulation was preferred over the ointment, though the difference was not statistically significant (P=.32). Overall, the topical suspension was rated as moderately appealing, while the ointment was rated as slightly appealing (P=.06). Subgroup analyses were limited due to the small sample size. The results of this study may provide clinicians with an alternative topical treatment of plaque psoriasis that provides the benefits of a combination product. In clinical practice, it may be best to offer patients both formulations and they can choose the product that is right for them.
View Article and Find Full Text PDF

Download full-text PDF

Source
December 2014

Trends in the Use of Neurotoxins and Dermal Fillers by US Physicians.

J Clin Aesthet Dermatol 2014 Sep;7(9):14-9

Center for Dermatology Research, Departments of Dermatology.

Background: Demand for minimally invasive cosmetic procedures have led to an increased market of available products for facial rejuvenation.

Objective: To characterize trends in the usage of aesthetic products, specifically the use of botulinum toxins and dermal fillers, by United States physicians.

Methods: Data from the National Ambulatory Medical Care Survey was analyzed from 1993 to 2010 to evaluate the use of dermal fillers and neurotoxins in the United States outpatient setting. The types of physician specialties administering these products and their preferences in products were characterized.

Results: There were an estimated 100,000 annual cosmetic visits at which a dermal filler was administered from 1993 to 2010. From 2002 to 2010, there were 140,000 annual cosmetic visits for a dermal filler and 440,000 visits for a neurotoxin. While collagen was the most common filler used over the entire study period, its use declined eight percent annually. Hyaluronic acid fillers were preferred from 2002 to 2010, followed by calcium hydroxylapatite filler, representing 50 percent and 16.1 percent of visits, respectively. The leading neurotoxin was onabotulinumtoxin A, used at 87.1 percent of visits. Dermatologists were the leading specialty for the cosmetic use of both dermal fillers and neurotoxins.

Conclusion: Providers' preference for cosmetic products appears to be influenced by their familiarity with them, with products that first came to market, such as the neurotoxin onabotulinumtoxin A and the hyaluronic acid fillers being used most frequently from 2002 to 2010.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4174914PMC
September 2014

Evaluation of headache relief with cosmetic onabotulinumtoxinA injections.

J Cosmet Dermatol 2014 Sep;13(3):224-31

The Goldman Center for Facial Plastic Surgery, PLLC, Boone, NC, USA.

Chronic headaches are common and can have a significant effect on quality of life. Approved treatment options are vast and include the use botulinum toxin injections. The objective of this study is to evaluate the effects of purely cosmetic onabotulinumtoxinA (BOTOX) injections on the frequency and severity of chronic headaches. Patients seeking treatment of hyperfunctional facial lines were enrolled to complete pre- and posttreatment questionnaires assessing headache symptoms. Quantitative data was compared using paired two-tailed student t-tests between groups of patients who received onabotulinumtoxinA injections, both onabotulinumtoxinA and hyaluronic acid (Restylane) injections, and hyaluronic acid injections. One hundred and ten patients were enrolled; 73 completed the study. Of the 45 patients with pretreatment headaches, 76% (22/29) that received cosmetic onabotulinumtoxinA injections alone and 69% (27/39) that received onabotulinumtoxinA with or without hyaluronic acid injections reported overall improvement in headaches. Patients who received only onabotulinumtoxinA reported a significant decrease in the frequency (P = 0.0016) and severity (P = 0.0002) of headaches, and the number of days over-the-counter medications were taken (P = 0.0238). It took an average 9.5 days for headache improvement vs. 4.4 days for an appearance change. In patients who received only hyaluronic acid injections (n = 6), no significant improvement in headaches was reported. Overall satisfaction was high and unaffected by whether patients experienced headache relief. The majority of patients (93%) reported that they would "definitely" or "likely" receive onabotulinumtoxinA injections again in the future. Purely cosmetic onabotulinumtoxinA injections of doses between 15-50 units can significantly decrease the severity and frequency of headaches.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jocd.12098DOI Listing
September 2014

Rosacea: new and emerging treatments.

Drugs 2014 Sep;74(13):1457-65

Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1071, USA.

Rosacea is a chronic inflammatory skin condition that negatively impacts patients' quality of life. We sought to review important aspects of the pathogenesis of rosacea and the role of new treatment options in its management. New, emerging treatments show promise; however, quality randomized controlled trials for many of these drugs are lacking. Brimonidine tartrate is an effective newly approved treatment for erythematotelangiectatic rosacea. Topical oxymetazoline has potential for the treatment of erythematotelangiectatic rosacea, with efficacy described in case reports and randomized controlled trials currently underway. Both oral and topical ivermectin have been studied for the treatment of papulopustular rosacea, both showing benefit; however, only topical ivermectin 1 % cream has been studied in randomized controlled trials. As our understanding of the etiology of rosacea continues to evolve, so will our options for therapeutic interventions. Further studies need to be performed to assess the long-term safety and efficacy of these treatments.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s40265-014-0281-xDOI Listing
September 2014

Spinal injections: trends in the US outpatient population.

South Med J 2014 Aug;107(8):528-9

From the Departments of Dermatology, Pathology, and Public Health Sciences, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, North Carolina.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.14423/SMJ.0000000000000144DOI Listing
August 2014

What's new in the topical treatment of allergic skin diseases.

Curr Opin Allergy Clin Immunol 2014 Oct;14(5):436-50

aCenter for Dermatology Research, Departments of Dermatology bPathology cPublic Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.

Purpose Of Review: To review recent literature on the topical treatment of allergic skin diseases to help clinicians make informed evidence-based decisions.

Recent Findings: Twenty-four publications were identified from a PubMed search of randomized controlled trials and systematic reviews of topical treatment of atopic dermatitis and allergic contact dermatitis published from 1 January 2013 to 31 January 2014. Studies on the topical treatment of atopic dermatitis largely supported the recommended use of topical corticosteroids and topical calcineurin inhibitors. Barrier therapy continues to play an important role without evidence supporting use of one emollient over another. Lipoxin A4, an eicosanoid with anti-inflammatory properties, and a 5% cis-urocanic acid emulsion cream were effective in the treatment of atopic dermatitis, although studies were small. Adjunct therapy with bleach baths, natural oils, and textiles all showed some benefit; however, studies are limited. Literature on topical treatment of allergic contact dermatitis was limited to one publication, providing evidence for a natural multicomponent cream as maintenance therapy after control of disease with a topical corticosteroid.

Summary: There is strong evidence for the use of topical anti-inflammatory therapies in the treatment of atopic dermatitis. There is little evidence to suggest that one emollient is better than others.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/ACI.0000000000000093DOI Listing
October 2014

Treatment of a deep infantile hemangioma using a penetrating insulated electrosurgical electrode (sublation).

Dermatol Surg 2014 Jun;40(6):702-4

Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, North Carolina Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/dsu.0000000000000014DOI Listing
June 2014

Electrosurgery: part II. Technology, applications, and safety of electrosurgical devices.

J Am Acad Dermatol 2014 Apr;70(4):607.e1-607.e12

Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina.

Electrosurgical currents can be delivered to tissue in monopolar or bipolar and monoterminal or biterminal modes, with the primary difference between these modes being their safety profiles. A monopolar electrosurgical circuit includes an active electrode and a dispersive (return) electrode, while there are 2 active electrodes in bipolar mode. In monoterminal mode, there is an active electrode, but there is no dispersive electrode connected to the patient's body and instead the earth acts as the return electrode. Biterminal mode uses a dispersive electrode connected to the patient's body, has a higher maximum power, and can be safer than monoterminal mode in certain situations. Electrosurgical units have different technologies for controlling the output power and for providing safety. A thorough understanding of these technologies helps with a better selection of the appropriate surgical generator and modes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jaad.2013.09.055DOI Listing
April 2014

Electrosurgery: part I. Basics and principles.

J Am Acad Dermatol 2014 Apr;70(4):591.e1-591.e14

Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina.

The term electrosurgery (also called radiofrequency surgery) refers to the passage of high-frequency alternating electrical current through the tissue in order to achieve a specific surgical effect. Although the mechanism behind electrosurgery is not completely understood, heat production and thermal tissue damage is responsible for at least the majority--if not all--of the tissue effects in electrosurgery. Adjacent to the active electrode, tissue resistance to the passage of current converts electrical energy to heat. The only variable that determines the final tissue effects of a current is the depth and the rate at which heat is produced. Electrocoagulation occurs when tissue is heated below the boiling point and undergoes thermal denaturation. An additional slow increase in temperature leads to vaporization of the water content in the coagulated tissue and tissue drying, a process called desiccation. A sudden increase in tissue temperature above the boiling point causes rapid explosive vaporization of the water content in the tissue adjacent to the electrode, which leads to tissue fragmentation and cutting.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jaad.2013.09.056DOI Listing
April 2014

Pilot randomized-control trial to assess the effect product sampling has on adherence using adapalene/benzoyl peroxide gel in acne patients.

J Drugs Dermatol 2014 Feb;13(2):135-40

Background: The treatment of acne can be difficult, with suboptimal adherence resulting in poor treatment outcomes.

Purpose: To determine whether demonstrating to patients how to properly apply a topical acne medication through the use of a sample product will improve adherence.

Methods: Subjects with mild to moderate acne were instructed to use adapalene/benzoyl peroxide gel once daily for six weeks. Subjects were randomized into sample or no sample group. Sample group received a demonstration on how to apply the medication using a product sample. The primary outcome was median adherence, recorded using electronic monitoring, and secondary outcomes were efficacy measures including the Acne Global Assessment (AGA) and lesion counts and the Perceived Medical Condition Self-Management Scale (PMCSMS).

Results: Data from 17 patients was collected and analyzed. Median adherence rates were 50% in the sample group and 35% in the no sample group (p=0.67). The median percent improvement in non-inflammatory lesions were 46% for the sample group and 33% for the no-sample group (p=0.10).

Limitations: The small size of this pilot study limited the extent of subgroup analyses.

Conclusions: Objective electronic monitoring expanded our previous observations of poor adherence in the treatment of acne. There is a considerable potential effect size on adherence for the use of samples, supporting the need for future, well powered studies to assess the value of using samples in the treatment of acne and other dermatologic skin diseases.
View Article and Find Full Text PDF

Download full-text PDF

Source
February 2014

Systemic therapies for psoriasis: an evidence-based update.

Am J Clin Dermatol 2014 Jul;15(3):165-80

Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1071, USA,

Background: The treatment of psoriasis has evolved over the years, with the focus now largely on the use of biologic agents. With treatment options expanding, evidence-based studies to guide physicians' treatment decisions become increasingly important.

Objective: Our objective was to review current literature to provide an evidence-based update on systemic therapies for psoriasis.

Methods: A systematic review of the literature was conducted from 1 January 2012 through 1 July 2013 to identify all randomized clinical trials and systematic reviews of systemic psoriasis treatments.

Results: A total of 46 publications were identified and reviewed. Randomized clinical trials for the treatment of psoriasis focused heavily on biologic agents, both currently approved agents and anti-interleukin (IL)-17 agents in development. The anti-IL-17 agents appear effective according to phase II clinical trials. Several new oral agents are being studied, and, although they do not appear as effective as the biologic agents, they may be an option as an alternative to traditional oral agents, with more favorable safety profiles. Several systematic reviews focused on efficacy among the biologics, with infliximab consistently superior to the others, and etanercept the least effective of the tumor necrosis factor-alpha inhibitors. Longer-term safety data on biologics is now available and encouraging.

Limitations: Current studies of traditional oral therapies are lacking.

Conclusions: Current studies continue to support the use of biologic agents in the treatment of moderate to severe psoriasis, with better efficacy and safety profiles than traditional systemic agents. Newer anti-IL-17 agents and several new oral agents are in development and have shown promise in clinical trials.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s40257-014-0064-xDOI Listing
July 2014

Commentary on "gynecomastia: etiologies, clinical presentations, diagnosis, and management".

South Med J 2014 Jan;107(1):50-1

From the Department of Dermatology, Center for Dermatology Research, and the Department of Endocrinology and Metabolism, Wake Forest School of Medicine, Winston-Salem, North Carolina.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/SMJ.0000000000000034DOI Listing
January 2014

Measure of atopic dermatitis disease severity using actigraphy.

J Cutan Med Surg 2014 Jan-Feb;18(1):49-55

Background: Analyzing adherence to treatment and outcomes in atopic dermatitis is limited by methods to assess continual disease severity. Atopic dermatitis significantly impacts sleep quality, and monitoring sleep through actigraphy may capture disease burden.

Purpose: To assess if actigraphy monitors provide continuous measures of atopic dermatitis disease severity and to preliminarily evaluate the impact of a short-course, high-potency topical corticosteroid regimen on sleep quality.

Methods: Ten patients with mild to moderate atopic dermatitis applied topical fluocinonide 0.1% cream twice daily for 5 days. Sleep data were captured over 14 days using wrist actigraphy monitors. Investigator Global Assessment (IGA) and secondary measures of disease severity were recorded. Changes in quantity of in-bed time sleep were estimated with random effects models.

Results: The mean daily in-bed time, total sleep time, and wake after sleep onset (WASO) were 543.7 minutes (SEM 9.4), 466.0 minutes (SEM 7.7), and 75.0 minutes (SEM 3.4), respectively. WASO, a marker of disrupted sleep, correlated with baseline (ρ  =  .75) and end of treatment IGA (ρ  =  .70). Most patients did not have marked changes in sleep. IGA scores declined by a median change of 1 point at days 7 (p  =  .02) and 14 (p  =  .008).

Conclusions: Using actigraphy, atopic dermatitis disease severity positively correlated with sleep disturbances. Actigraphy monitors were well tolerated by this cohort of atopic dermatitis subjects.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2310/7750.2013.13093DOI Listing
April 2014

Home ultraviolet light therapy for psoriasis: why patients choose other options.

Dermatol Online J 2014 Dec 13;21(2). Epub 2014 Dec 13.

Wake Forest School of Medicine.

Background: Psoriasis is a common inflammatory skin condition for which office-based and home phototherapy are safe and effective treatments. However, patients who are prescribed home phototherapy devices often choose other treatment options.

Objective: To determine the reasons why patients do not purchase a home phototherapy device after it has been recommended and prescribed by their physician.

Methods: Patients who were written a prescription for a home phototherapy device but did not fill the prescription were identified and contacted by the National Biological Corporation to participate in a telephone survey consisting of 4 questions regarding why they did not pursue a prescribed home ultraviolet device and how they were currently treating their psoriasis.

Results: The most common reason for not obtaining the prescribed home phototherapy device was using a biologic agent (31%). The second and third most frequently reported reasons were "cost share too high" and "insurance will not cover" (18% and 17%, respectively), together accounting for 35%.

Limitations: The reason why patients were prescribed biologics while having an unfilled home phototherapy device prescription was not obtained.

Conclusions: Out of pocket cost is a significant barrier to home phototherapy, even to patients who are well insured.
View Article and Find Full Text PDF

Download full-text PDF

Source
December 2014

Are wash outs needed in clinical trials of topical agents?

J Dermatolog Treat 2014 Feb;25(1)

Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3109/09546634.2013.851907DOI Listing
February 2014

Current and future evidence-based acne treatment: a review.

Expert Opin Pharmacother 2014 Feb 27;15(2):173-92. Epub 2013 Nov 27.

Wake Forest School of Medicine, Center for Dermatology Research, Departments of Dermatology , Winston-Salem, North Carolina , USA +1 760 217 1457 ; +1 336 716 7732 ;

Introduction: Current acne treatment guidelines, as well as, treatment efficacy, safety, tolerability and patient preferences must all be considered in determining appropriate treatment regimes. Literature can assist physicians' evidence-based recommendations according to these factors.

Areas Covered: To determine the current and future direction of pharmacotherapy for treatment of acne, a PubMed search was conducted to identify all clinical trials involving the treatment of acne from 2009 to 2012. A total of 65 publications met inclusion criteria and were reviewed. Literature was heavily focused on the efficacy and tolerability of topical combination therapies and supported their use compared with monotherapy. A few studies on topical antiandrogens and antioxidants showed an alternative approach to targeting acne. Studies on oral monotherapy provided some evidence for the use of pulsed azithromycin for acne in adolescents. Literature also supports the use of low-dose isotretinoin for moderate acne, which was comparable in efficacy to high-dose regimes and better tolerated.

Expert Opinion: Combination acne therapy, whether it be combination topical therapy or combination oral and topical therapy, is well supported by recent studies. Given the multifactorial pathogenesis of acne and the hurdles of adherence to treatment, we anticipate greater development of and reliance on combination acne products in the future.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1517/14656566.2014.860965DOI Listing
February 2014

Are patients willing to participate in surveys?

J Dermatolog Treat 2014 Oct;25(5):365-6

Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Medical Center Boulevard , Winston-Salem, NC 27157-1071 , USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3109/09546634.2013.853953DOI Listing
October 2014

Adherence to a five day treatment course of topical fluocinonide 0.1% cream in atopic dermatitis.

Dermatol Online J 2013 Oct 16;19(10):20029. Epub 2013 Oct 16.

Wake Forest School of Medicine.

Background: Adherence in the treatment of chronic inflammatory skin diseases such as atopic dermatitis is poor. Methods to improve adherence have proven difficult.

Purpose: To determine whether a short course of treatment with a high-potency corticosteroid will improve adherence compared to longer treatment studies and if improvement in disease and itch continues after treatment.

Methods: 10 patients with mild to moderate atopic dermatitis were instructed to apply fluocinonide 0.1% cream twice daily for 5 days. Adherence was self-reported and electronically monitored. Treatment outcomes were assessed in terms of Visual Analog Scale of Itch (VAS), Eczema Area and Severity Index (EASI), and Investigator Global Assessment (IGA) scores.

Results: The median adherence rate was 40% (range of 0-100). The median percent change in VAS from baseline measures on days 7 and 14 were 90% (range -13, 100, p=0.02) and 52% (range 0, 100, p=0.004). On days 7 and 14, 20% and 70% patients achieved an EASI-75 and 40% and 60% an IGA of 0 or 1.

Limitations: Small sample size limited subgroup analyses.

Conclusions: Adherence rates with short-term treatment were similar to previously reported rates in longer term treatment studies. However, even non-adherent patients had significant improvement in itch and disease severity.
View Article and Find Full Text PDF

Download full-text PDF

Source
October 2013

Adherence to ustekinumab in psoriasis patients.

J Drugs Dermatol 2013 Oct;12(10):1090-2

Background: Adherence to the treatment of psoriasis is poor and effects treatment outcomes. Literature on adherence to biologic therapy for the treatment of psoriasis is limited and difficult to measure. However, ustekinumab, which until recently was only approved to be administered in office, offers an opportunity to assess adherence through chart review.

Purpose: The purpose of this study is to determine adherence rates and reasons for nonadherence to ustekinumab in the treatment of psoriasis.

Methods: This was a single center, retrospective study involving a chart review of patients with a diagnosis of psoriasis and administration of ustekinumab seen at one clinic between October 1, 2009 and June 1, 2013. We assessed the number of injections administered, the time between injections, and reasons for nonadherence.

Results: 45 patients received ustekinumab for the treatment of psoriasis. The median time between doses of ustekinumab (n=164) was 13 weeks (91 days, interquartile range 89, 98). For patients that received at least 3 doses of ustekinumab, overall median adherence was 100% (IQR 66.7, 100). The median adherence to the 45 mg dose (n=26) was 100% (IQR 75, 100) and to the 90 mg dose (n=18) was 80% (IQR 60, 100; P=0.11).

Limitations: Only limited information was found on reasons for nonadherence.

Conclusions: Adherence to ustekinumab in psoriasis patients appears to be higher than reported adherence rates to topical therapies and treatment with self-administered biologics. Many factors may contribute to the greater adherence.
View Article and Find Full Text PDF

Download full-text PDF

Source
October 2013