1
J Drugs Dermatol
. 2020 Apr 1;19(4):300-15.
CME/CE: ABOUT FACE: Navigating Neuromodulators and Injection Techniques for Optimal Results
Steve G Yoelin, Shino Bay Aguilera, Joel L Cohen, Michael H Gold, Joely Kaufman, Corey S Maas
PMID: 32401461
Abstract
Interest in the cosmetic use of neuromodulators for facial rejuvenation is increasing among physicians, other practitioners, and patients alike, and an expanding array of formulations and reported applications might be helping to drive this trend. Safety, efficacy, and a high level of patient satisfaction can be achieved with all the available botulinum neurotoxin type A (BTXA) products. With any of the formulations, optimal results require knowledge of the individual product’s unique properties and dosing, along with an understanding of the patient’s goals, relevant anatomy, and proper injection technique. This educational activity reviews these topics on the basis of the published literature and expert opinion. A series of case narratives is also included that provides readers with information and insights for achieving success in clinical practice.J Drugs Dermatol. 2020;19(4 Suppl 2):s5-15.

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2
J Drugs Dermatol
. 2020 May 1;19(5):493-497.
Antibiotic Practices in Mohs Micrographic Surgery
Matthew J Lin, Danielle P Dubin, Cerrene N Giordano, David A Kriegel, Hooman Khorasani
PMID: 32484626
Abstract
Background: Mohs micrographic surgery is a safe procedure with low rates of infection.

Objective: To establish current antibiotic prescribing practices amongst Mohs surgeons.

Methods and materials: 16-question survey sent to American College of Mohs Surgery members.

Results: 305 respondents with collectively 7,634+ years of experience. The majority performed outpatient surgery (95.0%) and avoided oral or topical antibiotics for routine cases (67.7% and 62.8%, respectively). Prophylactic antibiotics were routinely prescribed for artificial cardiac valves (69.4%), anogenital surgery (53.0%), wedge excision (42.2%), artificial joints (41.0%), extensive inflammatory skin disease (40.1%), immunosuppression (38.9%), skin grafts (36.4%), leg surgery (34.2%), and nasal flaps (30.1%). A minority consistently swabbed the nares to check for staphylococcus aureus carriage (26.7%) and decolonized carriers prior to surgery (28.0%).

Conclusion: Disparity exists in antibiotic prescribing practices amongst Mohs surgeons. There may be under-prescription of antibiotics for high risk factors like nasal flaps, wedge excisions, skin grafts, anogenital/lower extremity site, and extensive inflammatory disease. Conversely, there may be over-prescription for prosthetic joints or cardiac valves. Increased guideline awareness may reduce post-operative infections and costs/side effects from antibiotic over-prescription. J Drugs Dermatol. 2020;19(5): doi:10.36849/JDD.2020.4695.

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3
J Drugs Dermatol
. 2020 Apr 1;19(4):35-15.
CME: Re-examining the Optimal Use of Neuromodulators and the Changing Landscape: A Consensus Panel Update
Michael S Kaminer, Sue Ellen Cox, Steven Fagien, Joely Kaufman, Mary P Lupo, Ava Shamban
PMID: 32401457
Abstract
Since initial US Food and Drug Administration approval of botulinum toxin type A (BoNT-A) for aesthetic use in 2002, clinical evidence and experience with BoNT-A and understanding of facial anatomy have greatly increased, leading to rapid advances in treatment planning and implementation. BoNT-A use has expanded from the upper face to the midface, lower face, and neck, so that BoNT-A injection is the most common cosmetic procedure worldwide. Trends in facial aesthetics reflect growing patient diversity with respect to age, gender, and ethnicity. In October 2019, a multidisciplinary panel of 6 experts in minimally invasive injectable procedures in the specialties of dermatology and plastic surgery convened at the 2019 American Society for Dermatologic Surgery (ASDS) meeting in Chicago, IL. Their goal was to discuss recent advances in BoNT-A use in facial aesthetics, including implications of the introduction of new agents in light of an evolving patient population. J Drugs Dermatol. 2020;19(4 Suppl 1):s5-15To receive a CME certificate of participation, you should: •Read the entire publication, including the CME information. •Register or log in at www.paradigmmc.com/822 to complete and submit the online posttest and evaluation. Following online completion of the posttest and evaluation, a certificate of participation will be available for download/printing immediately.Erratum published for this article here.

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4
J Drugs Dermatol
. 2020 May 1;19(5):498-503.
Long-term Facial and Body Hair Removal With a Combined Radiofrequency and Optical Home-Use Device for All Skin Types
Jerome M Garden, Brian Zelickson, David Friedman, Tuvia D Kutscher, Doran M Rozen, Vince Afsahi
PMID: 32484632
Abstract
Objectives: To evaluate long term effectiveness and safety with the use of a combined radiofrequency and optical home hair removal device in all skin types and over both facial and body areas.

Methods: A combined intense pulsed light (IPL) and radiofrequency (RF) home device was used for hair removal. Two separate study designs were evaluated. In the first design, bilateral body areas were treated with 7 weekly procedures and then unilateral areas received up to 12 monthly maintenance treatments while the corresponding other side received no further therapy. For the second design, facial areas received 4 procedures in 2 to 5 days visits, followed by 2 weekly, and then 6 biweekly procedures. All patients in both study designs had hair count evaluations up to 12 months post their last procedure. The highest energy used was 4 J/cm².

Results: In the first design, 58 subjects participated of which 15% were skin types V-VI. A total of 188 anatomical sites were treated. Hair reduction at 6 and 12 months post the last procedure was 56% and 52% respectively for the maintenance side and 47% and 37% for the non-maintenance side. For the second design, 19 subjects had 59 facial sites treated. Fifteen percent were skin types V –VI. The overall hair reduction at the end of receiving their procedures was 45%. At 12 months post the last procedure, the hair reduction was 42%. Aside for transient mild erythema, there were no adverse effects noted.

Conclusions: Long term persistent hair reduction was achieved using an RF/IPL home-use hair reduction device. The combination of RF and optical energies allowed for the effective application of low energy usage. All skin types and both facial and body anatomical regions tolerated the procedures very well. J Drugs Dermatol. 2020;19(5):498-503. doi:10.36849/JDD.2020.4741.

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5
J Drugs Dermatol
. 2020 May 1;19(5):515-518.
A Combined Triple-Wavelength (755nm, 810nm, and 1064nm) Laser Device for Hair Removal: Efficacy and Safety Study
Akerman Lehavit, Galili Eran, Lapidoth Moshe, Levi Assi
PMID: 32484620
Abstract
Background: Photoepilation by a single-wavelength laser device is being commonly used for hair removal. Whether emitting multiple laser wavelengths to induce hair unit damage would be beneficial is yet to be established.

Objective: To evaluate the safety and efficacy of hair reduction using a novel simultaneous multi-wavelength laser device.

Patients and methods: A retrospective cohort study was carried out among adult males. Hairy sites were treated by a simultaneous triple-wavelength (755nm, 810nm and 1064nm) laser device (Soprano Titanium. Caesarea, Israel: Alma Lasers Ltd). Treatment parameters were: fluence of 7-9J/cm2, pulse frequency of 9-10Hz and spot sizes of 2cm2 or 4cm2. Participants underwent up to 6 treatments at 6-8 weeks intervals and were followed for 4-6 months. Clinical photography before and after treatment was documented. Treatment efficacy was assessed using Global Aesthetic Improvement Scale (GAIS; scale of 0 [no improvement] to 4 [excellent improvement; Over 75% hair reduction]) by two independent dermatologists. Participants’ satisfaction was rated on a scale of 1 (not satisfied) to 5 (very satisfied). Pain perception and adverse events were recorded as well.

Results: A total of 27 treatment sites among 11 participants, with Fitzpatrick skin type III-V, were included. Mean hair reduction was 3.4 out of 4 in the GAIS. Participants' satisfaction rate was high (mean, 4.8). No adverse events were recorded.

Conclusion: Simultaneous triple-wavelength laser device is a safe and effective hair removal modality. J Drugs Dermatol. 2020;19(5): doi:10.36849/JDD.2020.4735.

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6
J Drugs Dermatol
. 2020 May 1;19(5):504-514.
Halobetasol 0.01%/Tazarotene 0.045% Lotion for Moderate-to-Severe Psoriasis: Pooled Phase 3 Analysis of Males and Females
Linda Stein Gold, Boni Elewski, Zoe Draelos, Abby Jacobson, Tina Lin
PMID: 32484629
Abstract
Background: Previous results from two phase 3 studies demonstrated efficacy and safety of fixed combination halobetasol propionate 0.01%/tazarotene 0.045% (HP/TAZ) lotion in participants with moderate-to-severe plaque psoriasis. This post hoc analysis evaluated sex-specific efficacy and safety of HP/TAZ lotion.

Methods: In two randomized, double-blind, phase 3 studies, participants were randomized (2:1) to receive HP/TAZ or vehicle lotion once daily for 8 weeks. Male and female participants were evaluated separately in this pooled analysis. Efficacy assessments included treatment success (at least 2‑grade improvement in Investigator's Global Assessment [IGA] score and score of clear/almost clear), impact on individual signs of psoriasis, and affected Body Surface Area (BSA).

Results: The analysis included 272 males (HP/TAZ, n=175; vehicle, n=97) and 146 females (HP/TAZ, n=101; vehicle, n=45). Significantly more participants achieved overall treatment success at week 8 with HP/TAZ versus vehicle in both male (38.4% vs 9.8%) and female (44.5% vs 9.9%) subgroups (P<0.001, both). Erythema, plaque elevation, and scaling were also reduced by week 8 in both males and females, with significantly more HP/TAZ-treated participants achieving at least 2‑grade improvement in each sign of psoriasis than vehicle-treated participants (P<0.001 each, both groups). Mean reductions in affected BSA were significantly greater with HP/TAZ versus vehicle lotion in both males and females (P≤0.001, both). The most frequent treatment-related adverse events were contact dermatitis, pruritis, and application site pain (each 4.0%) in females and contact dermatitis (7.6%) in males.

Conclusion: HP/TAZ lotion was highly effective and safe in both males and females with moderate-to-severe psoriasis over 8 weeks of once-daily use. J Drugs Dermatol. 2020;19(5): doi:10.36849/JDD.2020.5021.

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7
J Drugs Dermatol
. 2020 May 1;19(5):524-531.
Effects of Colloidal Oatmeal Topical Atopic Dermatitis Cream on Skin Microbiome and Skin Barrier Properties
Kimberly Capone, Frank Kirchner, Shifra Liba Klein, Neena K Tierney
PMID: 32484623
Abstract
Atopic dermatitis is characterized by dry, itchy, inflamed skin with a dysbiotic microbiome. In this clinical study (NCT03673059), we compared the effects of an eczema cream containing 1% colloidal oat and a standard moisturizer on the skin microbiome and skin barrier function of patients with mild to moderate eczema. Patients were randomly assigned to treatment with 1% colloidal oat eczema cream or a standard, non-fragranced daily moisturizer. Treatment lasted 14 days, followed by a 7-day regression period. Of 61 patients who completed the study, 30 received the 1% colloidal oat eczema cream and 31 received the standard moisturizer. At 14 days, the 1% colloidal oat eczema cream reduced mean Eczema Area Severity Index and Atopic Dermatitis Severity Index scores by 51% and 54%, respectively. Unlike treatment with the standard moisturizer, treatment with the 1% colloidal oat eczema cream was associated with trends towards lower prevalence of Staphylococcus species and higher microbiome diversity at lesion sites. The 1% colloidal oat eczema cream significantly improved skin pH, skin barrier function, and skin hydration from baseline to day 14, whereas the standard moisturizer improved hydration. Overall, the results demonstrate that topical products can have differing effects on the skin barrier properties and the microbiome. Importantly, we show that the use of a 1% colloidal oat eczema cream improves microbiome composition and significantly repairs skin barrier defects. J Drugs Dermatol. 2020;19(5):   doi:10.36849/JDD.2020.4924.

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8
J Drugs Dermatol
. 2020 May 1;19(5):532-538.
The Influence of Dermatologists' Use of Social Media on Attracting Patients
Emily C Murphy, Kamaria Nelson, Adam J Friedman
PMID: 32484619
Abstract
Background: Many dermatologists consider social media to be a useful tool for building their practices and personal brands. However, limited data exists on patients’ perceptions of the value of social media in dermatology.

Objective: To examine how social media influences patients when choosing a dermatologist and which aspects of dermatologists’ sites offer the most benefit to patients.

Methods: A cross-sectional study was completed by sampling a diverse online population using a 10-question survey.

Results: The survey was sent to 1,481 individuals; of the 57.5% who qualified, 98.5% completed the survey (N=715). Of the qualified respondents, 58% were female and 42% were male. Twenty five percent were 18-29 years, 24% were 30-44 years, 33% were 45-60 years, and 19% were over 60 years. Fifty-seven percent reported that social media is only slightly important or not at all important when selecting a dermatologist. According to respondents, patient reviews (68%), years of experience (61%), and medical information written by the dermatologist (59%) were the most important aspects of dermatologists’ social media sites. Cosmetic patients (P<0.0001), younger patients (P<0.0001), and participants with fewer years of education (P=0.0006) valued social media significantly more when selecting a dermatologist compared to their counterpart populations.

Limitations: Selection bias is possible given the survey was distributed only to SurveyMonkey® users.

Conclusion: Given the majority of patients reported that social media is not important or only slightly important, dermatologists should consider means other than social media to attract new patients to their practices. For dermatologists who use social media, they should highlight patient reviews, experience level, and original medical content. J Drugs Dermatol. 2020;19(5):   doi:10.36849/JDD.2020.4849.

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9
J Drugs Dermatol
. 2020 May 1;19(5):461-469.
Safety, Tolerability, and Efficacy of Repeat-Dose Injections of IncobotulinumtoxinA in the Treatment of Upper Facial Lines: Results From a Prospective, Open-Label, Phase III Study
Tanja Fischer, Gerhard Sattler, Welf Prager, Berthold Rzany, Tatjana Pavicic, Gerd Gauglitz, Petra Weissenberger, Shahbaz Riaz
PMID: 32484631
Abstract
In aesthetic practice, wrinkles in the upper face are commonly treated with repeat-dose injections. The objective of this study was to investigate the safety, tolerability, and efficacy of repeat-dose injections of incobotulinumtoxinA in the combined treatment of moder-ate to severe upper facial lines (UFL) [glabellar frown lines (GFL), horizontal forehead lines (HFL), and lateral periorbital lines (LPL)]. Healthy subjects (≥18 years) with moderate to severe GFL, HFL, and LPL on the Merz Aesthetics Scales (MAS) at maximum contrac-tion were administered 54 to 64 U of incobotulinumtoxinA (GFL, 20 U; HFL, 10 to 20 U; LPL, 24 U) in up to four, 120-day treatment cycles. Adverse events (AE) were recorded for each cycle until 120 ± 7 days after treatment. Investigator-assessed MAS scores were evaluated for each treated area at maximum contraction on day 30 [responder = score of “none” (0) or “mild” (1)]. Subject-assessed scores for overall appearance of the upper face of “much improved” or “very much improved” were noted at day 30 of each treatment cycle on the Global Impression of Change Scale (GICS). Overall, 140 subjects were treated, and 125 subjects completed the study. Mean injected units per injection cycle ranged from 56.3 U to 57.7 U. During the four-cycle study period 17.1% of total treated subjects experienced a treatment emergent adverse event (TEAE). TEAEs of special interest were documented for 9 subjects (6.4%), in 6 of these subjects (4.3%) the TEAEs were related to treatment. No clinically significant mean changes in laboratory and vital-sign values were observed from screening to final-treatment visit. Over the study interval, a response rate of > 80% on the investigator-assessed MAS was reported for all treated areas except HFL. Greater than 80% of subjects in cycles 1, 3, and 4 and 78.5% of subjects in cycle 2 reported ratings of “much improved” or “very much improved” on the GICS for the overall appearance of the upper face. Incobotu-linumtoxinA for the repeat-dose treatment of UFL is safe and well tolerated with a stable safety profile, without new formation of neutralizing antibodies and has excellent efficacy during prolonged administration. J Drugs Dermatol. 2020;19(5):461-469. doi:10.36849/JDD.2020.5013.

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10
J Drugs Dermatol
. 2020 May 1;19(5):547-552.
Treatment of Sebaceous Hyperplasia by Laser Modalities: A Review of the Literature and Presentation of Our Experience With Erbium-doped Yttrium Aluminium Garnet (Er:YAG)
Annie Liu, Mark B Taylor, Bahman Sotoodian
PMID: 32484621
Abstract
Introduction: Sebaceous hyperplasia (SH) is a common skin presentation in adults. Due to their unwanted yellow papular appearance, patients may desire their removal. Although several treatment modalities have been reported, the full range and efficacy of options are unclear.

Objective: To determine the efficacy of laser modalities in the treatment of SH. The authors will also specifically assess the efficacy, recurrence rate and side effect profile of SH treatment with Er:YAG wavelength using a variable long pulsed (VLP) Er:YAG laser (SP Dynamis Fotona laser, Ljubljana, Slovenia) Methods & Materials: A comprehensive literature search was performed through PubMed, EMBASE, and Web of Science, using the search terms [(sebaceous hyperplasia)] and [(laser[s], Er:Yag, Er:Glass, Fraxel, CO2, PDL, Pulse dye laser, Diode, Xe-Cl, Excimer, Argon, KTP, Ruby, Alexandrite or Nd:YAG)]. The search yielded a total of 119 results and 8 were identified as relevant to this reviewResults: Pulse dye laser (PDL) provides a wide range of treatment results from complete reduction to flattening of the SH without significant adverse events; recurrence rates were unreported. Short PDL showed faster treatment response than long PDL. CO2 laser can produce considerable positive cosmetic outcomes with marked clinical improvement without any recurrence, but significant adverse effects have been reported. The 1450-nm diode laser has been described to produce good (75%) clinical improvement and lesion shrinkage ranging from 50% to greater than 75% without lasting adverse effects. In our clinic, Er:YAG has provided very significant cosmetic outcomes with a low recurrence rate and minimal adverse effects.

Conclusions: Laser modalities can provide satisfactory results for removing SH. It is crucial that the laser is being used by an expert who is familiar with the device as well as understand the laser tissue interaction to minimize patient adverse effects while providing the best cosmetic outcome. In our experience, Er:YAG laser can provide a safe and highly effective solution for SH. J Drugs Dermatol. 2020;19(5)   doi:10.36849/JDD.2020.3971.

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11
J Drugs Dermatol
. 2020 May 1;19(5):519-523.
Risk of Non-Melanoma Skin Cancer in Connective Tissue Disease and The Impact of Immunosuppressive Therapy
Nilanthi D Gunawardane, Makdine Dontsi, Liisa L Lyon
PMID: 32484614
Abstract
The risk of skin cancer in connective tissue disease and the impact of immunosuppressive therapy on this risk has not been well studied. The objective of this study is to investigate the risk of non-melanoma skin cancer in patients with connective tissue disease and to assess the impact of immunosuppressive therapy on this risk. This is a retrospective case control cohort study of 8281 patients with connective tissue disease (systemic lupus erythematosus, Sjogren’s disease and scleroderma) and 8281 age, race, and gender matched controls followed for a 5-year period between 2002-2012, who obtained their care from a large integrated multispecialty group practice in Northern California. The odds ratio for developing squamous cell skin cancer among patients with connective tissue disease was 1.47 (95% CI, 1.14-1.90) (P=0.003) while the odds ratio for developing all non-melanoma skin cancer was 1.26 (95% CI, 1.08-1.49) (P=0.005). Patients on immunosuppressive medication for at least one year had an OR of 1.69 (95% CI, 1.16-2.45) of developing non-melanoma skin cancer (P=0.006) when controlled for age, race, gender, type of connective tissue disease, smoking status, and health care utilization. Our study shows an increased risk of non-melanoma skin cancer among patients with connective tissue disease. We also note that patients on immunosuppressive therapy for at least one year had an increased incidence of non-melanoma skin cancer. Further studies are needed to confirm these findings. J Drugs Dermatol. 2020;19(5):  doi:10.36849/JDD.2020.4781.

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12
J Drugs Dermatol
. 2020 May 1;19(5):556-558.
MRI Assessment of Arm and Calf Muscle Toning With High-Intensity Focused Electromagnetic Technology: Case Study
Bruce Katz
PMID: 32484622
Abstract
Arms and calves have long been a subject of interest in aesthetic medicine. Current surgical and non-invasive procedures focus on sagging skin and fat deposits without targeting the muscles. The aim of this study is to investigate the feasibility of high-intensity focused electromagnetic (HIFEM) technology for arm and calf toning through simultaneous fat reduction and muscle strengthening. In this case study, two subjects received four 20-minute HIFEM treatments of biceps, triceps, and calves, with the outcomes assessed by MRI. The analysis of MRI images showed an average increase in all three muscle groups, biceps muscle mass 17.1%, triceps muscle mass 10.2%, and gastrocnemius muscle mass increased by 14.6%. In addition, the arm fat thickness was decreased by 12.8% on average and the calf fat thickness decreased by 9.9%. The results suggest that HIFEM technology is a feasible modality for both arm and calf toning. However, it will be necessary to continue to validate this outcome in a larger sample size study. J Drugs Dermatol. 2020;19(5): doi:10.36849/JDD.2020.4546.

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13
J Drugs Dermatol
. 2020 May 1;19(5):477-482.
The Influence of Supportive Oncodermatology Interventions on Patient Quality of Life: A Cross-Sectional Survey
Leora Aizman, Kamaria Nelson, Andrew D Sparks, Adam J Friedman
PMID: 32484625
Abstract
Background: Dermatologic adverse events (dAEs) secondary to anticancer treatments reduce patients’ quality of life (QOL) and result in interruptions in anticancer therapy.

Objective: Determine if a comprehensive supportive oncodermatology program improves patients’ QOL scoring.

Methods: This was a cross-sectional survey of adult cancer patients enrolled in the George Washington University Supportive Oncodermatology Clinic. All patients were above age 18 years and received dermatologic care between May 1, 2017 and November 1, 2019. Fifty-five patents meeting inclusion criteria were invited to complete an online survey with questions adapted from the Dermatology Life Quality Index (DLQI) and Patient Satisfaction Questionnaire (PSQ-18).

Results: Survey initiation rate was 61.8% (34/55) and completion rate 88.2% (30/34). Average QOL score prior to treatment was 6.5 (moderate effect on QOL) and 3.8 (small effect) afterwards (P=0.0005; 95% CI -3.9 to -1.). Average satisfaction score was 4.15 ± 0.7 (satisfied). Impact on treatment adherence earned the lowest score (3.67, neutral to satisfied).

Limitations: Recall bias Conclusion: Enrollment was significantly associated with improved QOL. Dermatologic care also resulted in overall satisfied patient outcomes, although many patients were unsure if these dermatologic interventions aided in anticancer treatment adherence, highlighting the need for evidence-based management strategies for dAEs. J Drugs Dermatol. 2020;19(5):  doi:10.36849/JDD.2020.5040.

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14
J Drugs Dermatol
. 2020 May 1;19(5):471-474.
Multiple Primary Melanomas Occurring Around the Same Time: A Review of Terminology and Implications
Shawn Shih, Christina Dai, Terri Shih, Amor Khachemoune
PMID: 32484627
Abstract
Multiple primary melanomas (MPMs) have been reported to occur in 2-10% of melanoma patients. This study conducted a review of the literature to elucidate the definitions of terminology used to describe MPMs that were diagnosed in close temporal proximity as well as explore common risk factors. Terminology found in the literature included “concurrent”, “simultaneous” and “synchronous” with varying definitions that ranged from 0-6 months between diagnoses of the first and subsequent melanomas. Eight cases are described in chronological order, and the incidence of MPMs diagnosed around the same time were reported as 22-39%. Nevus spilus was identified as a potential risk factor for MPMs. This study highlights that MPMs are not uncommon, and clinicians should remain aware that MPMs can be diagnosed at or around the same time, warranting thorough skin exams. J Drugs Dermatol. 2020;19(5): doi:10.36849/JDD.2020.4953.

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15
J Drugs Dermatol
. 2020 May 1;19(5):487-492.
Importance of Complete Skin Clearance in Psoriasis as a Treatment Goal: Implications for Patient-Reported Outcomes
Andrew Blauvelt, Jashin J Wu, April Armstrong, Alan Menter, Clive Liu, Abby Jacobson
PMID: 32484628
Abstract
Psoriasis is associated with physical, psychological, social, and economic burdens that lead to substantial impairment over a patient’s lifetime. It is important to understand how different skin clearance levels may relate to patient perceptions of psoriasis symptoms and health-related quality of life. Here, we highlight notable advantages to complete skin clearance relative to high levels of efficacy without complete skin clearance, including meaningful improvements in patient-reported signs and symptoms of psoriasis, a higher mean proportion of symptom-free days, and significant improvements in quality of life. We also review biologic therapies associated with high percentages of complete skin clearance and significant improvements in signs and symptoms of psoriasis, notably brodalumab. These therapies are likely to play important roles in the future treatment of moderate-to-severe psoriasis, given that improvement in quality of life is of significant value relative to biologics or other systemic therapies associated with lower rates of complete skin clearance. J Drugs Dermatol. 2020;19(5): doi:10.36849/JDD.2020.4957.

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16
J Drugs Dermatol
. 2020 May 1;19(5):485-486.
Topical Fluorouracil Therapy for Residual Superficial Basal Cell Carcinoma Following Mohs Micrographic Surgery
Hannah Pederson, Cecil Jordan Staples, Chad Housewright
PMID: 32484617
Abstract
When treating invasive basal cell carcinoma (BCC) with Mohs micrographic surgery (MMS), including infiltrative and nodular subtypes, the goal is complete surgical removal of the tumor. In some cases, after several stages of MMS, residual foci of superficial BCC are noted with no dermal invasive components apparent. Some patients and surgeons have opted for halting surgery and treating residual superficial BCC with adjuvant topical fluorouracil. In this retrospective study, this treatment method is shown to be effective with a recurrence rate of BCC of 3.7% over a mean follow up of 28 months. This treatment method reduces the number of stages of MMS as the surgery is stopped was invasive BCC is removed. This can be beneficial when considering the morbidity of prolonged surgical procedures in frail, elderly patients experiencing surgical fatigue, the cost of additional stages, and the cost of advanced repairs due to enlarging defect size. J Drugs Dermatol. 2020;19(5): doi:10.36849/JDD.2020.4811.

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17
J Drugs Dermatol
. 2020 May 1;19(5):539-542.
Utilization of an Online Cash-Pay Pharmacy for Topical 5-Fluorouracil Prescriptions in Older Patients
Jessica E Payne, Rima I Ghamrawi, I-Chun J Lin, Steven R Feldman
PMID: 32484613
Abstract
Background: High cost of prescription medications presents a challenging issue for older patients with multimorbidities. Topical 5-fluorouracil (5-FU) is an effective treatment for actinic keratoses (AK), a highly prevalent condition among elderly populations, but it is often associated with unpredictable retail prices and high out-of-pocket costs. One online pharmacy offers branded prescription medications at fixed, low prices, but it may be less accessible to older patients for numerous reasons.

Objective: To determine if the number of patients receiving topical 5-FU from an online pharmacy is proportionate to the national data on expected payment types for patients prescribed topical 5-FU for AK.

Methods: We conducted a cross-sectional study using weighted pooled data from the National Ambulatory Medical Care Survey (NAMCS) on topical 5-FU prescriptions for AK from 2007-2016. Data regarding online pharmacy use were provided by Dermatology.com for the year 2019.

Results: Among patients with AK prescribed topical 5-FU, the most prevalent payment source was Medicare (54%) followed by private insurance (40%). On the online pharmacy, the majority of patients had commercial insurance (71%) followed by Medicaid (12%).

Limitations: Data from Dermatology.com are limited.

Conclusions: Lower-cost medications from the online pharmacy site may improve adherence and outcomes in older adults and decrease total cost associated with AK treatment. However, the online pharmacy is underutilized by this population. J Drugs Dermatol. 2020;19(4): doi:10.36849/JDD.2020.4690.

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18
J Drugs Dermatol
. 2020 May 1;19(5):452-458.
A Randomized Trial of Broad Area ALA-PDT for Field Cancerization Mitigation in High-Risk Patients
Daniel Piacquadio, Anna Houlihan, Mary Beth Ferdon, James E Berg, Stuart L Marcus
PMID: 32484630
Abstract
Background: The relationship between actinic keratoses (AKs) and nonmelanoma skin cancers (NMSCs) is well established. Patients with field cancerization are at high risk of developing new lesions. A treatment to interrupt new lesion formation or progression is required.

Objective: To evaluate occurrence of AKs in high-risk patients after field aminolevulinic acid–photodynamic therapy (ALA–PDT).

Methods: In this randomized, parallel-group, evaluator-blinded, 52-week study, patients with 4–15 facial AKs (N = 166) were random-ized (ALA 2x vs ALA 3x vs vehicle [VEH]-pooled [VEH 2x+VEH 3x], 1:1:1) to receive 2 or 3 PDT treatments (1-hour incubation) following cryotherapy at screening.

Results: More ALA-treated patients than VEH-treated patients had no AKs at week 52 (ALA 2x, 36.0%, P=0.0102; ALA 3x, 37.5%, P=0.0089; VEH, 18.9%). Week 52 lesion recurrence rates were 7.7% (P=0.0004) and 6.1% (P<0.0001) for ALA 2x and ALA 3x, respec-tively, versus 15.5% for VEH. Therapy was well tolerated; no patient requested early termination of light treatment. ALA 3x reduced NMSC development versus VEH (5 vs 12 lesions, P=0.0014).

Conclusion: 2 or 3 ALA–PDT treatments with 1-hour incubation can significantly reduce occurrence of AKs after 1 year in patients at high risk of NMSC versus VEH–PDT (NCT02239679). J Drugs Dermatol. 2020;19(5):452-458. doi:10.36849/JDD.2020.4930.

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19
J Drugs Dermatol
. 2020 May 1;19(5):544-546.
Successful Treatment of Painful Cutaneous Vasculopathy With Rivaroxaban in a Patient With Systemic Lupus Erythematosus
Nathan H Leisenring, Jennifer L Rogers, Stacy Telloni, Parisa Mansoori, Rami N Al-Rohil, Anne L Marano
PMID: 32484618
Abstract
Novel oral anticoagulant (NOAC) medications have revolutionized hematology and cardiology. Recently, NOACs have demonstrated additional promise in dermatology. Specifically, rivaroxaban, a direct factor Xa inhibitor NOAC, has been shown to be successful in the treatment of livedoid vasculopathy. Herein, we describe a patient with systemic lupus erythematosus who presented with painful cutaneous vasculopathy, demonstrated on biopsy with occlusive microvascular fibrin thrombi without evidence of concurrent vasculitis. Interestingly, imaging and laboratory studies did not show evidence of hypercoagulability, arterial disease, or embolic disease. The patient’s vasculopathy and pain progressed despite antiplatelet therapy, often considered first-line in cases of microvascular occlusive disease. However, with rivaroxaban therapy, the patient experienced complete regression of her painful lesions, thereby supporting a further role for NOACs in cutaneous vasculopathy treatment. J Drugs Dermatol. 2020;19(5) doi:10.36849/JDD.2020.4684.

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20
J Drugs Dermatol
. 2020 Apr 1;19(4):428.
Exacerbation of Pediatric Periorificial Dermatitis: A Novel Adverse Reaction
Jordan Parker, Brett Neill, Jacob Whitsitt, Anand Rajpara, Daniel Aires
PMID: 32401455
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21
J Drugs Dermatol
. 2020 Apr 1;19(4):431-432.
A Survey Study of Human Papillomavirus Vaccination Practices by Dermatologists
Alexander M Cartron, Sorana Raiciulescu, John C Trinidad
PMID: 32401459
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22
J Drugs Dermatol
. 2020 Apr 1;19(4):429-430.
The Cash Pharmacy Model May Effectively Lower Prescription Drug Prices
Matthew C Johnson, Ramiz N Hamid, Steven R Feldman
PMID: 32401458
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23
J Drugs Dermatol
. 2020 Apr 1;19(4):433.
Is It Time to Redefine Lidocaine Administration Guidelines in Mohs Surgery?
Kelly Flanagan, Riley McLean, Dori Goldberg
PMID: 32401456
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24
J Drugs Dermatol
. 2020 Apr 1;19(4):436.
Is the Coronavirus (COVID-19) Pandemic an Indication to Temporarily Modify Dermatological Management Plans?
Mohammed Shanshal
PMID: 32401460
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25
J Drugs Dermatol
. 2020 May 1;19(5):560-561.
Pityriasis Lichenoides Chronica in a Patient With Ankylosing Spondylitis Treated With Etanercept
Mohamad Goldust, Jeffrey M Weinberg, Leon H Kircik, Sidharth Sonthalia, Vito Di Lernia, Dipali Rathod
PMID: 32484616
Abstract
Background: Pityriasis lichenoides chronica, a papulosquamous disorder often considered a subtype of pityriasis lichenoides. It is considered a clonal T-cell disorder, which may be associated with cutaneous T-cell lymphoma that may develops in response to foreign antigens.

Case presentation: We present a 38-year-old male patient with ankylosing spondylitis who was on treatment with etanercept. After 8 weeks of treatment, the patient presented with scaly erythematous papules, on the back and arms. He was diagnosed clinically with pityriasis lichenoides chronica.

Conclusion: Pityriasis lichenoides chronica should be included among the broad clinical spectrum of chronic inflammatory skin diseases which may occur during treatment with TNF-alpha antagonists. J Drugs Dermatol. 2020;19(5): doi:10.36849/JDD.2020.2191.

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26
J Drugs Dermatol
. 2020 May 1;19(5):554-555.
COVID-19 Pandemic: Are There Unique Cutaneous Manifestations in Patients Infected With SARS-CoV-2?
Chapman Wei, Adam J Friedman
PMID: 32484624
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27
J Drugs Dermatol
. 2020 May 1;19(5):562-565.
Analysis of Wait Times for Online Dermatology Appointments in Most and Least Dermatologist-Dense Cities
Laura Xiang, Shari R Lipner
PMID: 32484615
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