Publications by authors named "Lauren Moy"

19 Publications

  • Page 1 of 1

A Comparison of Ferric Subsulfate Solution, Silver Nitrate, and Aluminum Chloride for Pain Assessment, Time to Hemostasis, and Cosmesis in Acrochordon Snip Excision.

J Clin Aesthet Dermatol 2020 Dec 1;13(12):32-37. Epub 2020 Dec 1.

Ms. Coakley, Mr. Wu, Mr. Kumar, and Ms. Dadrass are with Loyola University Chicago Stritch School of Medicine at Loyola University Medical Center in Maywood, Illinois.

Acrochordon (skin tag) removal by snip excision is a routine dermatologic procedure. Bleeding is a common sequelae of snip excision that requires hemostatic control. Chemical cautery is a common means of achieving hemostasis in this procedure. The aim of this study was to evaluate three different chemical cautery solutions for their time to hemostasis, pain upon application, and associated pigmentary changes. Twelve patients with six or more skin tags on the bilateral neck and/or axilla were enrolled. Two skin tags were cauterized with ferric subsulfate solution, two with silver nitrate, and two with aluminum chloride hexahydrate solution. Time to hemostasis and pain with application of each cautery solution to the skin tag was recorded. At a two-week follow-up appointment, patient satisfaction was assessed with a survey, and pigmentary changes were documented with digital photography. There was no significant variability in the time to hemostasis among the three chemical cautery solutions (=0.57). Pain response was significantly different among the three solutions (=0.003). Compared to silver nitrate (median=6.00, interquartile range [IQR]: 4.50-6.50), aluminum chloride hexahydrate (median=1.00, IQR: 0.50 to 6.00; Sidak =0.02) and ferric subsulfate (median=1.50, IQR: 0.00-3.50; Sidak =0.01) had a significantly lower pain response. Among participants, three (25%) experienced a pigmentary change with ferric subsulfate, two (17%) with aluminum chloride, and six (50%) with silver nitrate (overall = 0.14). These results indicate that the three standard chemical cautery solutions for skin tag snip excision have significant differences in pain upon application and pigmentary changes. This might be a relevant consideration when selecting a chemical cautery solution.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7819594PMC
December 2020

Surgical training tools for dermatology trainees: porcine vs. synthetic skin for excision and repair.

Arch Dermatol Res 2021 Jan 12. Epub 2021 Jan 12.

Departments of Dermatology, Otolaryngology and Surgery, Feinberg School of Medicine, Northwestern University, 676 N St Clair Suite 1600, Chicago, IL, 60611, USA.

Since dermatologists routinely perform surgery in an outpatient setting, ensuring that dermatology trainees are provided with opportunities to develop sufficient proficiency in excisional surgery and suture technique is paramount. The objectives of this study are to assess trainee preference for silicone-based synthetic skin compared with porcine skin as a surgical training medium and to assess the ability of trainees to successfully demonstrate basic surgical skills using the simulated skin model. Participants were a convenience sample of dermatology residents from the greater Chicago area, who were asked to perform an elliptical excision and bilayered repair on a silicone-based synthetic skin model. Residents were then surveyed regarding their satisfaction with the model. Four blinded dermatologist raters evaluated digital photographs obtained during the performance of the procedures and graded the execution of each maneuver using a surgical task checklist. Nineteen residents were enrolled. Residents were more likely to prefer pig skin to simulated skin for overall use (p = 0.040) and tissue repair (p = 0.018), but the nominal preference for tissue handling was nonsignificant (p = 0.086). There was no significant difference between satisfaction with pig skin versus synthetic skin with regard to excision experience (p = 0.82). The majority of residents (10/19) performed all surgical checklist tasks correctly. Of those residents who did not perform all steps correctly, many had difficulty obtaining adequate dermal eversion and wound approximation. Synthetic skin may be conveniently and safely utilized for hands-on surgical practice. Further refinement may be necessary to make synthetic skin comparable in feel and use to animal skin.
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http://dx.doi.org/10.1007/s00403-020-02181-zDOI Listing
January 2021

Pediatric dermatology emergencies.

Cutis 2020 03;105(3):132-136

Division of Dermatology, Loyola University Medical Center, Maywood, Illinois, USA.

Many pediatric skin conditions can be safely monitored with minimal intervention, but certain skin conditions are emergent and require immediate attention and proper assessment of the neonate, infant, or child. We review the following pediatric dermatology emergencies so that clinicians can detect and accurately diagnose these conditions to avoid delayed treatment and considerable morbidity and mortality if missed: staphylococcal scalded skin syndrome (SSSS), impetigo, eczema herpeticum (EH), Langerhans cell histiocytosis (LCH), infantile hemangioma (IH), and IgA vasculitis.
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March 2020

A comparison of imaging software and conventional cell counting in determining melanocyte density in photodamaged control sample and melanoma in situ biopsies.

J Cutan Pathol 2020 Aug 30;47(8):675-680. Epub 2020 Mar 30.

Division of Dermatopathology, Department of Pathology, Loyola University Medical Center, Maywood, Illinois, USA, USA.

Background: Objective methods for distinguishing melanoma in situ (MIS) from photodamaged skin (PS) are needed to guide treatment in patients with melanocytic proliferations. Melanocyte density (MD) could serve as an objective histopathological criterion in difficult cases. Calculating MD via manual cell counts (MCC) with immunohistochemical (IHC)-stained slides has been previously published. However, the clinical application of this method is questionable, as quantification of MD via MCC on difficult cases is time consuming, especially in high volume practices.

Methods: ImageJ is an image processing software that uses scanned slide images to determine cell count. In this study, we compared MCC to ImageJ calculated MD in microphthalmia transcription factor-IHC stained MIS biopsies and control PS acquired from the same patients.

Results: We found a statistically significant difference in MD between PS and MIS as measured by both MCC and ImageJ software (P < 0.01). Additionally, no statistically significant difference was found when comparing MD measurements recorded by ImageJ vs those determined by the MCC method.

Conclusion: MD as determined by ImageJ strongly correlates with the MD calculated by MCC. We propose the use of ImageJ as a time-efficient, objective, and reproducible tool to assess MD.
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http://dx.doi.org/10.1111/cup.13681DOI Listing
August 2020

Vesiculobullous Eruption in a 3-Month-Old Infant.

Clin Pediatr (Phila) 2020 03 1;59(3):310-313. Epub 2019 Nov 1.

Loyola University Chicago, Maywood, IL, USA.

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http://dx.doi.org/10.1177/0009922819884584DOI Listing
March 2020

Circadian Rhythm and the Skin: A Review of the Literature.

J Clin Aesthet Dermatol 2019 Sep 1;12(9):42-45. Epub 2019 Sep 1.

Dr. Lyons is with the Department of Dermatology at Henry Ford Hospital in Detroit, Michigan.

Disruption of the circadian rhythm has been implicated in a wide variety of dermatologic conditions. Research has shown that previous ultraviolet light exposure can continue to damage the deoxyribonucleic acid (DNA) of the skin, even in the dark, and has demonstrated that repair of these skin cells peaks at night. In this article, the authors reviewed the current literature on circadian rhythm effects on the skin and describe and discuss its basic principles. Better understanding of the role circadian rhythm plays in overall skin health will assist physicians in providing optimal treatment to patients, including appropriate recommendations regarding the use of topical medications and skin care at their most effective times during a 24-hour cycle. Dermatologists should also be aware that adequate sleep is necessary for optimal DNA repair activity in the skin.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6777699PMC
September 2019

The Potential Uses of N-acetylcysteine in Dermatology: A Review.

J Clin Aesthet Dermatol 2019 May 1;12(5):20-26. Epub 2019 May 1.

Drs. May, Reservo, Tung, and Swan are with the Department of Dermatology at the Stritch School of Medicine at Loyola University Chicago in May wood, Illinois. Mses. Janeczek, Riopelle, and Vetter are with the Stritch School of Medicine at Loyola University Chicago in May wood, Illinois.

In recent studies, N-acetylcysteine has been shown to be efficacious in several dermatologic conditions. The aim was to review clinical trials that assess the efficacy of N-acetylcysteine in cutaneous disorders. The PubMed database was searched and a manual search of clinical trials in the references was performed. Studies included randomized, controlled studies, uncontrolled studies, meta-analyses, and systemic reviews published between years 1966 and 2017. Efficacy of N-acetylcysteine was shown in excoriation disorder, onychophagia disorder, trichotillomania, acne vulgaris, Type I lamellar ichthyosis, bullous morphea, systemic sclerosis, toxic epidermal necrolysis, atopic dermatitis, xeroderma pigmentosum, and pseudoporphyria. Studies also show benefits in wound healing and photoprotection. The review of available literature suggests that N-acetylcysteine could potentially serve as a safe, tolerable, and effective therapeutic option for a variety of dermatologic conditions.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6561714PMC
May 2019

DNA Repair Enzyme Containing Lip Balm for the Treatment of Actinic Cheilitis: A Pilot Study

J Drugs Dermatol 2019 06;18(6):576

Background: DNA repair enzymes have been shown to reduce actinic keratoses and non-melanoma skin cancers, but their use for the treatment of actinic cheilitis has not been studied. Objective: The purpose of this pilot study was to examine the efficacy of a DNA repair enzyme lip balm containing T4 endonuclease in reducing the severity of actinic cheilitis in patients who applied the lip balm twice daily for 3 months. Methods: We performed a prospective study in which 29 patients with a diagnosis of actinic cheilitis underwent a 3-month trial using a topical DNA repair enzyme lip balm containing T4 endonuclease applied to the lips twice daily. The primary, objective outcome was percent of actinic lip involvement, measured using computer software by dividing the calculated affected surface area by the calculated total surface area. Additional outcomes included pre- and post-intervention determination of an actinic cheilitis score on the Actinic Cheilitis Scale, which visually and tactilely quantifies the percentage of lip involvement, amount of roughness, erythema, and tenderness as well as a physician assessment using the Global Aesthetic Improvement Scale. Results: Twenty-five of the 29 enrolled patients completed the trial. The lip balm significantly decreased the percentage of affected lip surface area (P<0.0001). According to the Actinic Cheilitis Scale, data demonstrate that the lip balm significantly decreased the percentage of lip involvement (P=0.002), amount of roughness (P=0.0012)), erythema (P=0.0020), and tenderness (P=0.0175). The total Actinic Cheilitis Scale score also significantly improved after the 3-month treatment period (P<0.0001). According to the Global Aesthetic Improvement Scale, the average score for all 26 patients was 1.04. Conclusion: This study suggests that topical DNA repair enzyme lip balm containing T4 Endonuclease could potentially be a safe and efficacious way to improve and treat actinic cheilitis. J Drugs Dermatol. 2019;18(6):576-579
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June 2019

Non-Invasive Buccal Swab Gene Testing for Skin Cancer Risk

J Drugs Dermatol 2019 May;18(5):448-453

Background: Studies have identified numerous genetic polymorphisms associated with increased risk of melanoma and non-melanoma skin cancer (NMSC). In this pilot study, we aimed to examine whether previously identified melanoma and non-melanoma associated single nucleotide polymorphisms (SNPs) which were found to be associated with cutaneous malignancy were also present in a relatively heterogeneous population with a history of skin cancer versus an age and environmental matched controls. The undertaking of this project serves to further the current understanding of the genetic profile for those at higher risk for developing skin cancer. Methods: Nineteen NMSC patients and their age-matched and environmental controls underwent genotyping of 7 previously discovered SNPs associated with melanoma and NMSC. Results: In a random, heterogeneous population in Southern California, SNP’s Chr1, PAD16, PIGU, TDG had a similar association with NMSC previously reported in prior studies. Due to small trial size, no conclusions or observable associations could be drawn from the SNPs MC1R, TP53, and XRCC1. Conclusion: This data supports that 4 of the 7 SNP’s studied had similar associations and could potentially be predictive tool of NMSC risk in this patient population. The remaining three SNP’s did not have a definitive association with malignancy. Larger studies are needed to further elucidate the specific roles of these SNPs collectively and ultimately to develop a genetic profile for those patients at increased risk of developing skin cancer. J Drugs Dermatol. 2019;18(5):448-453.
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May 2019

Is melanocyte density our last hope? Comparison of histologic features of photodamaged skin and melanoma in situ after staged surgical excision with concurrent scouting biopsies.

J Cutan Pathol 2019 Aug 25;46(8):555-562. Epub 2019 Apr 25.

Division of Dermatology, Department of Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois.

Differentiating melanocytic hyperplasia (MH) on photodamaged skin from junctional lentiginous melanocytic proliferations (JLMP), early evolving melanoma in situ (MIS), or the periphery of a lesion of MIS on staged excision can be challenging. Although previous cross-sectional studies have elucidated important criteria for distinguishing MH on photodamaged skin from more concerning lesions, this study highlights a technique to treat JLMP and MIS with staged mapped excision and baseline scouting biopsies of adjacent nonlesional photodamaged skin to assist in determination of surgical margin clearance. Additionally, we compare the lesional and photodamaged control biopsies from the same patient to evaluate relevant histologic criteria that may be used to distinguish MH in photodamaged skin from JLMP/MIS, while minimizing confounding factors. There was a statistically significant difference (P ≤ 0.05) found for melanocyte density, irregular melanocyte distribution, melanocyte clustering, follicular infundibulum involvement, and nesting. However, criteria such as nesting, epithelioid cells and melanocyte clustering were seen in both photodamaged skin and MIS. These findings underscore the fact that histologic features of photodamaged skin can overlap with the histopathological features of MIS. Of all of the criteria evaluated, melanocytic density was the most objective histologic criterion and did not show overlap between the sun-damaged and JLMP/MIS groups.
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http://dx.doi.org/10.1111/cup.13462DOI Listing
August 2019

Review of the Efficacy and Safety of Topical for the Treatment of Psoriasis and Atopic Dermatitis.

J Clin Aesthet Dermatol 2018 Dec 1;11(12):42-47. Epub 2018 Dec 1.

Ms. Janeczek is with the Stritch School of Medicine, Loyola University Chicago in Maywood, Illinos.

Due to the emerging trend of alternative medicine, patients inquire about natural remedies to alleviate their symptoms. Dermatologists should be aware of the efficacy and safety of topical botanical treatments available on the market. native to the United States, has been recently shown to have anti-inflammatory properties useful in cutaneous disorders. Our aim was to review clinical trials that assess the efficacy and safety in cutaneous disorders. We searched PubMed, MEDLINE, and the Web of Science databases and performed a manual search of clinical trials in the references. We excluded and animal trials. Risk of bias was assessed using the Cochrane Risk of Bias Tool. Of the 502 articles identified, eight met the inclusion criteria. Specifically, seven trials studied the effects in psoriasis and one studied that in atopic dermatitis. Clinical trials have not been identified in any other cutaneous disorder using this plant extract. Risk of bias of included trials were either unclear or low risk. Five of seven studies showed a statistically significant improvement with in psoriasis, while one study showed efficacy in the treatment of atopic dermatitis. Several studies have shown that leads to a statistically significant improvement of symptoms in psoriasis and atopic dermatitis with minimal side effects.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6334833PMC
December 2018

Contemporary Mohs Micrographic Surgery Histologic Preparation Methods, Laboratory-Assistive Personnel Training, and Practice Setting-A Survey Study.

Dermatol Surg 2019 06;45(6):768-771

Division of Dermatology, Loyola University Medical Center, Maywood, Illinois.

Background: The Mohs histotechnologist (MH) performs tissue preparation, sectioning, and staining, which are critical tasks in ensuring a successful Mohs micrographic surgery (MMS).

Objective: To assess current norms in MH training, practice setting, and utilization of specific histologic techniques.

Materials And Methods: A 16-question survey was created and distributed using Survey Monkey to all members of the American Society for Mohs Histotechnology.

Results: Response rate was 30%. Most MHs received on-the-job training from other MHs or the Mohs surgeon. Mohs histotechnologists largely performed tasks related to tissue processing while Mohs surgeons generally illustrated the Mohs layer map. Automated routine staining was used in most laboratory tests, and laboratory tests used similar staining techniques. Most respondents worked in private offices verses academic centers. Total staining time was significantly longer at academic medical centers versus private offices (7 vs 5 minutes, p = .01).

Conclusion: These findings provide an updated profile of current laboratory training and tissue preparation techniques at MMS practices across the country. Understanding the roles of the MH in laboratory functioning may help laboratories adopt best practices.
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http://dx.doi.org/10.1097/DSS.0000000000001747DOI Listing
June 2019

Treatment of burn scars in Fitzpatrick phototype III patients with a combination of pulsed dye laser and non-ablative fractional resurfacing 1550 nm erbium:glass/1927 nm thulium laser devices.

Scars Burn Heal 2018 Jan-Dec;4:2059513118758510. Epub 2018 Feb 23.

Division of Dermatology, Department of Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA.

Introduction: Burn scars cause cosmetic disfigurement and psychosocial distress. We present two Fitzpatrick phototype (FP) III patients with burn scars successfully treated with combination pulsed dye laser (PDL) and non-ablative fractional lasers (NAFL).

Case 1: A 30-year-old, FP III woman with a history of a second-degree burn injury to the bilateral arms and legs affecting 30% body surface area (BSA) presented for cosmetic treatment. The patient received three treatments with 595 nm PDL (7 mm, 8 J, 6 ms), six with the 1550 nm erbium:glass laser (30 mJ, 14% density, 4-8 passes) and five with the 1927 nm thulium laser (10 mJ, 30% density, 4-8 passes). Treated burn scars improved significantly in thickness, texture and colour.

Case 2: A 33-year-old, FP III man with a history of a second-degree burn injury of the left neck and arm affecting 7% BSA presented for cosmetic treatment. The patient received two treatments with 595 nm PDL (5 mm, 7.5 J, 6 ms), four with the 1550 nm erbium:glass laser (30 mJ, 14% density, 4-8 passes) and two with the 1927 nm thulium laser (10 mJ, 30% density, 4-8 passes). The burn scars became thinner, smoother and more normal in pigmentation and appearance.

Discussion: Our patients' burn scars were treated with a combination of PDL and NAFL (two wavelengths). The PDL targets scar hypervascularity, the 1550 nm erbium:glass stimulates collagen remodelling and the 1927 nm thulium targets epidermal processes, particularly hyperpigmentation. This combination addresses scar thickness, texture and colour with a low side effect profile and is particularly advantageous in patients at higher risk of post-procedure hyperpigmentation.

Conclusion: Our cases suggest the combination of 595nm PDL plus NAFL 1550 nm erbium:glass/1927 nm thulium device is effective and well-tolerated for burn scar treatment in skin of colour.
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http://dx.doi.org/10.1177/2059513118758510DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5965338PMC
February 2018

Cosmetic Dermatology Training During Residency: Outcomes of a Resident-Reported Survey.

Dermatol Surg 2018 Sep;44(9):1216-1219

Division of Dermatology, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois.

Background: As the demand for cosmetic treatments increases, it is important for dermatology residents to be educated about and achieve proficiency in dermatologic cosmetic procedures.

Objective: To assess dermatology residents' educational exposure to cosmetic dermatology.

Materials And Methods: An anonymous 18-question survey was sent electronically to 1,266 dermatology residents requesting information about cosmetic dermatology training during residency.

Results: Two hundred sixty-eight residents responded to the survey (21% response rate). Most residents receive didactic instruction (94%) and hands-on training (91%) on cosmetic dermatology topics during residency. Survey participants in residency programs perceived as supportive of cosmetic dermatology training are more frequently provided lectures (70% vs 31%, p < .001) and procedural training (100% vs 69%, p < .001) in cosmetic dermatology as compared to residents in unsupportive programs. Eighty-nine percent of respondents reported hands-on training as the most effective method for developing proficiency in cosmetic procedures.

Conclusion: Providing safe and competent patient care should serve as the impetus for expanding cosmetic dermatology education and training for residents.
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http://dx.doi.org/10.1097/DSS.0000000000001557DOI Listing
September 2018

Male Surgical Neck Rejuvenation.

Dermatol Surg 2017 Nov;43 Suppl 2:S203-S207

*Private Practice, Dermatology, Beverly Hills, California; †Loyola University Medical Center, Department of Dermatology, La Grange Park, Illinois.

Background: Patients who are aging, with weight gain, and increased skin laxity, request dermatologists to improve their neck area. Surgical and nonsurgical options are reviewed as well as benefits and side effects. This article will focus on how surgical techniques can be applied for male patients in particular.

Objective: To review surgical neck rejuvenation therapies available currently to find the best option for male patients.

Conclusion: Surgical treatment of the male neck to improve mandibular contour and loose neck skin requires tightening of the platysmal muscle and usually skin removal in the postauricular sulcus and into the hairline. Most patients choose to have this performed underline tumescent anesthesia when given the choice of sedation versus local anesthesia. The other surgical variations of improving the neck contour on a male include using a direct excision by a midline incision starting in the submental crease and extending down the anterior neck. This approach allows for maximum tightening of the platysmal bands. The incision line can be minimized using intraoperative laser resurfacing immediately after suturing. Chin implants are necessary in some patients to give good neck improvement. The isolated neck lift is one the most common procedures requested by men asking for neck improvement.
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http://dx.doi.org/10.1097/DSS.0000000000001347DOI Listing
November 2017

Improvement of Actinic Keratoses Using Topical DNA Repair Enzymes: A Randomized Placebo-Controlled Trial.

J Drugs Dermatol 2017 Oct;16(10):1030-1034

Background: Actinic keratoses (AKs) are proliferations of abnormal keratinocytes, which may progress into non-melanoma skin cancers. Although multiple treatment modalities exist for AKs, their incidence continues to rise, making new methods of both prevention and treatment necessary. DNA repair enzymes have been shown to reverse sun-damage, resulting in reduced rates of AKs and non-melanoma skin cancer (NMSC) in specific patient populations.

Objective: We investigated the efficacy of a topical DNA repair enzyme lotion as a field therapy for AKs.

Methods: In a single center, randomized double-blind study, we randomly assigned 15 patients with AKs on their face or scalp to receive topical DNA repair enzyme lotion or placebo (Eucerin Professional lotion). Lotion was self-applied to a treatment field twice daily for 8 consecutive weeks. Complete clearance (primary outcome) was assessed at week 8, and local reactions were quantitatively measured. Follow-up at week 12 assessed for continued clearance of AKs.

Results: Thirteen subjects completed the trial. Compared to baseline, patients who used the repair enzyme had significantly fewer AKs than those using the control lotion after 8-weeks treatment. Specifically, there was a 46.6% percent decrease in AKs the DNA repair enzyme lotion group compared to a 32.7% decrease in the placebo group. Significance between the two groups was noted at the12 week follow-up, where there was an additional 29.2% decrease in AK percentage in the DNA repair enzyme group, while the placebo group had a 31.4% increase in AKs (P=0.0026). On final self-assessment, 85% of subjects reported being at least "satisfied" with the ability of the medication to decrease their AK burden. No side effects were reported.

Conclusion: These results suggest that topical DNA repair enzymes may help reduce the number of AKs in individuals with moderate-to-severe photodamaged skin. Additionally, there may be a lasting effect of the DNA repair if application is discontinued. Further, cutaneous malignancies were not detected in any of the subjects during the study period. Despite the brevity of the study, these preliminary results suggest the role of DNA repair enzymes for not only treatment, but also skin cancer prevention. Further study and more objective evaluation measures are required for definitive conclusions to be drawn.

J Drugs Dermatol. 2017;16(10):1030-1034.

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October 2017

Improvement of Atrophic Acne Scars in Skin of Color Using Topical Synthetic Epidermal Growth Factor (EGF) Serum: A Pilot Study.

J Drugs Dermatol 2017 Apr;16(4):322-326

BACKGROUND: Atrophic scarring in skin of color is a common, permanent, and distressing result of uncontrolled acne vulgaris. Ablative lasers and chemical peels are frequently used to improve the appearance of atrophic scars, primarily through the stimulation of collagen and elastin; however, these treatment modalities are associated with risks, such as dyspigmentation and hypertrophic scarring, especially in patients with darker skin.

OBJECTIVE: We evaluated the efficacy of topically applied synthetic epidermal growth factor (EGF) serum in reducing the appearance of atrophic acne scars in skin of color.

METHODS: A single-center clinical trial was performed on twelve healthy men and women (average age 32.5) with Fitzpatrick Type IV-V skin and evidence of facial grade II-IV atrophic acne scars. Subjects applied topical EGF serum to the full-face twice daily for 12 weeks. Scar improvement was investigated at each visit using an Investigator Global Assessment (IGA), a Goodman grade, clinical photography, and patient self-assessment.

RESULTS: Eleven subjects completed the trial. Compared to baseline, there was an improvement in mean IGA score from 3.36 (SEM = 0.15) to 2.18 (SEM = 0.33). Mean Goodman grade was reduced from 2.73 (SEM = 0.19) to 2.55 (SEM = 0.21). Of the eleven pairs of before and after photographs, nine were correctly chosen as the post-treatment image by a blind investigator. On self-assessment, 81% reported a "good" to "excellent" improvement in their scars compared to baseline (P = 0.004).

CONCLUSION: Topical EGF may improve the appearance of atrophic acne scars in skin of color. Additional, larger studies should be conducted to better characterize improvement.

J Drugs Dermatol. 2017;16(4):322-326.

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April 2017

Immunomodulation by imiquimod in patients with high-risk primary melanoma.

J Invest Dermatol 2012 Jan 18;132(1):163-9. Epub 2011 Aug 18.

Division of Dermatology, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California 90502, USA.

Imiquimod is a synthetic Toll-like receptor 7 (TLR7) agonist approved for the topical treatment of actinic keratoses, superficial basal cell carcinoma, and genital warts. Imiquimod leads to an 80-100% cure rate of lentigo maligna; however, studies of invasive melanoma are lacking. We conducted a pilot study to characterize the local, regional, and systemic immune responses induced by imiquimod in patients with high-risk melanoma. After treatment of the primary melanoma biopsy site with placebo or imiquimod cream, we measured immune responses in the treated skin, sentinel lymph nodes (SLNs), and peripheral blood. Treatment of primary melanomas with 5% imiquimod cream was associated with an increase in both CD4+ and CD8+ T cells in the skin, and CD4+ T cells in the SLN. Most of the CD8+ T cells in the skin were CD25 negative. We could not detect any increases in CD8+ T cells specifically recognizing HLA-A(*)0201-restricted melanoma epitopes in the peripheral blood. The findings from this small pilot study demonstrate that topical imiquimod treatment results in enhanced local and regional T-cell numbers in both the skin and SLN. Further research into TLR7 immunomodulating pathways as a basis for effective immunotherapy against melanoma in conjunction with surgery is warranted.
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http://dx.doi.org/10.1038/jid.2011.247DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3229834PMC
January 2012

Reduced number of actinic keratoses with topical application of DNA repair enzyme creams.

J Drugs Dermatol 2010 Dec;9(12):1519-21

Department of Dermatology, David Geffen School of Medicine at UC LA, Los Angeles, CA, USA.

Background: Actinic keratosis is regarded as a carcinoma in situ by some dermatologists and its incidence continues to rise. Exposure to ultraviolet (UV) radiation is considered to be an important risk factor for developing these pre-malignant lesions. DNA repair enzymes have been shown to reverse sun-damage, resulting in reduced rates of actinic keratoses and non-melanoma skin cancers in specific patient populations.

Methods: Seventeen patients were evaluated for differences in actinic keratoses following topical application of T4N5 liposome lotion over 48 weeks.

Results: Compared to baseline, a statistically significant reduction in the number of actinic keratoses was seen following the treatment period.

Discussion: This study suggests that DNA repair enzyme creams effectively reduce the number of actinic keratoses in normal individuals with moderate-to-severe photodamaged skin.
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December 2010