Faculty Bibliography

BACKGROUND: Acne is a common skin condition often requiring complex therapeutic regimens. Patient nonadherence to prescribed medication regimens is a factor in treatment failure. OBJECTIVE: The goal of this study was to determine if daily automated text messages would result in increased adherence to recommended use of topical acne medication and consequently greater improvement in acne. METHODS: Forty patients with mild to moderate acne were prescribed clindamycin/benzoyl peroxide 1%/5% gel in the mornings and adapalene 0.3% gel in the evenings for 12 weeks. Each medication tube was fitted with an electronic Medication Event Monitoring System cap (MEMS, Aardex Group, Sion, Switzerland) (to record the date and time of every opening/closing of the tube). Twenty patients were randomly assigned to receive customized twice-daily text messages instructing them to apply their morning and evening medication. The remainder of patients (N = 20), who did not receive text messages, served as control subjects. RESULTS: Mean adherence rates for the correct application of both medications on a daily basis over 12 weeks was 33.9% for patients in the reminder group and 36.5% for patients in the control group (P = .75). Patients in both groups had similar clinical improvement of their acne. LIMITATIONS: The small sample size may limit the ability to detect differences between the study groups. CONCLUSIONS: Electronic reminders in the form of daily, customized text messages were not associated with significant differences in adherence to topical medications in patients with mild to moderate acne and had no significant effect on therapeutic response.

BACKGROUND: Lung transplant recipients (LTR) have an increased risk of cutaneous squamous cell carcinoma (SCC) due to immunosuppressive therapy. Voriconazole, which is associated with phototoxic side effects in some patients, may be an additional risk factor for SCC in this population. METHODS: To test whether voriconazole is a risk factor for developing SCC in LTR, we evaluated cumulative exposure to voriconazole in 327 adults who underwent lung transplantation at one center between 1991 and 2010. Voriconazole exposure was assessed as a time-varying covariate. We used survival analysis methods to assess the risk of developing SCC over time. RESULTS: Exposure to voriconazole was associated with a 2.6-fold increased risk for SCC. This phenomenon was dose-dependent: the risk for SCC increased by 5.6% with each 60-day exposure at a standard dose of 200 mg twice daily. At 5 years after transplant, voriconazole conferred an absolute risk increase for SCC of 28%. CONCLUSIONS: These results suggest that caution should be taken when using voriconazole in LTR because this drug increases the already high risk for SCC in this population.

BACKGROUND: Melasma, a common disorder of hyperpigmentation, is often resistant to therapy. Although salicylic acid peels have been reported to be useful for patients with recalcitrant melasma, controlled trials are lacking. OBJECTIVE: We sought to determine the efficacy of salicylic acid peels when added to hydroquinone in the treatment of melasma. METHODS: Twenty Latin American women with moderate to severe bilateral melasma were treated with a series of 20% to 30% salicylic acid peels every 2 weeks for a total of 4 peels on one side of the face along with 4% hydroquinone cream to both sides of the face twice daily. The primary efficacy variable was reduction in pigmentation of the peeled side compared with the unpeeled side using narrowband reflectance spectrophotometry. RESULTS: Eighteen patients completed the study. Although both sides had significant reduction in pigment intensity, there was no difference between the peeled and unpeeled side with all outcome measures. LIMITATIONS: Patients were limited to Latin American women and only 4 peels were performed. CONCLUSION: A series of four 20% to 30% salicylic acid peels are not effective in the treatment of melasma when added to twice-daily 4% hydroquinone cream.

Intense pulsed light technology has revolutionized the noninvasive treatment of a whole variety of cutaneous cosmetic problems. Today's machines are safer, more diverse, less painful, and readily available. Intense pulsed lights can be used to treat vascular and pigmented lesions and are used for facial rejuvenation and the removal of unwanted hair. Newer, less powerful home-device intense pulsed light sources will not replace those used in a physician's office but will augment the use of today's more powerful medical office systems.

Psoriasis is a chronic inflammatory skin disorder that can cause substantial disability. The recognition of psoriasis as an immunologically mediated disease led to the development of agents that specifically target key steps in the pathological process. This review focuses on these biological agents, and presents results from phase II and III clinical trials together with the safety profile and approved indications for alefacept, efalizumab, etanercept, infliximab and adalimumab. Preliminary safety and efficacy data for the newer therapeutic agents, such as CNTO-1275 and ABT-874, are also described.

Rejuvenation of the aging neck with botulinum toxin injections is a minimally invasive, safe, and effective treatment modality with a very high patient satisfaction rate. Treatments are usually started early in the aging process of the neck to prevent further degenerative changes and are performed thereafter at 4- to 6-month intervals. It is the ideal alternative to rhytidectomy when the patient is too young for face-lift surgery or for patients unwilling to take recuperation time. Furthermore, botulinum toxin therapy can be used to correct jowl and platysmal band asymmetry occurring after suboptimal rhytidectomy. Botulinum exotoxin should not be used in pregnant or lactating women or in patients with a known sensitivity to human albumin or with a history of neuromuscular disorders.

The use of botulinum toxin for cosmetically restoring an aging neck is a simple procedure that has great patient satisfaction. It is also a safe and effective therapeutic modality for any patient desiring rejuvenation of his or her neck, but who at the same time does not desire any recuperation time or is unwilling to undertake the potential risks associated with plastic surgery. Currently, both botulinum toxin type A (BTX-A) and B are being used to treat the aging neck with great success. However, our clinical experience has been more vast with BTX-A, and the accomplishment of several clinical trials with it has yielded more precise results. BTX-A can be used to correct early signs of aging as well as more advanced forms. It helps correct jowl formation and platysmal banding as well as horizontal rhytides in the neck.