Faculty Bibliography

BACKGROUND: There are an estimated 700,000 or more transgender people in the United States, however their dermatologic needs are not fully established in the medical literature. Unique needs relate to hormone therapy, prior surgeries, and other aspects of physical transitioning. OBJECTIVES: By examining attitudes and practices of transgender individuals, we aimed to identify areas for which dermatologists could contribute to their physical transformation. METHODS: This cross-sectional study used an anonymous online survey, distributed via lesbian, gay, bisexual, and transgender organizations; social media; and at targeted locations and events. RESULTS: A total of 327 people completed the survey (63% men, 29% women, 9% other). Most transgender women indicated that their face was most imperative to have changed, whereas men noted their chest, in turn influencing procedures. Of women's facial procedures, hair removal predominated, followed by surgery then injectables, mostly performed by plastic surgeons. Hormone-induced facial effects varied, usually taking over 2 years for maximal effect. When choosing procedures, money was the major barrier and good aesthetic outcome the primary concern. Participants did not think that facial procedures necessitate the currently accepted prerequisites for chest and genital surgery. LIMITATIONS: This study has limited size and convenience sampling. CONCLUSION: Dermatologists could contribute to the physical transformation of transgender patients through noninvasive procedures.

Loss of volume in the temples is an early sign of aging that is often overlooked by both the physician and the patient. Augmentation of the temple using soft tissue fillers improves the contours of the upper face with the secondary effect of lengthening and lifting the lateral brow. After replacement of volume, treatment of the overlying skin with skin-tightening devices or laser resurfacing help to complete a comprehensive rejuvenation of the temple and upper one-third of the face.

BACKGROUND: Inflammatory acne, particularly in post-adolescent women, is increasing in incidence. The most effective therapeutic modality for treatment of this type of acne has been the administration of oral tetracyclines. Long-term acne treatment with such drugs, however, is frequently accompanied by undesirable adverse reactions, including gastrointestinal disturbances, antianabolic effects, headaches, tinnitus, and photosensitivity. OBJECTIVE: To assess the usefulness of a novel dietary supplement in the overall management of patients with inflammatory acne vulgaris. METHODS: 235 patients with inflammatory acne vulgaris were enrolled by dermatologists in a multicenter, open-label, 8-week, prospective study evaluating the effects of adding NicAzel, 1 to 4 tablets daily, to their current acne treatment regimen. RESULTS: A statistically significant (P<.0001) number of patients demonstrated improvement over their previous acne treatment regimens after both 4 and 8 weeks of NicAzel (nicotinamide, azelaic acid, zinc, pyridoxine, copper, folic acid; Elorac Inc, Vernon Hills, IL) use. At week 8, 88% of the patients experienced a visible reduction in inflammatory lesions, and 81% of the patients rated their appearance as much or moderately better compared with baseline. Three-quarters (76%) of the patients thought NicAzel was at least as effective as previous treatment with oral antibiotics. CONCLUSION: Patients with inflammatory acne showed significant improvement in acne severity and overall appearance when NicAzel was added to their existing treatment regimen.

BACKGROUND: Patient satisfaction is the most important outcome in facial aesthetic surgery. However, the need for evidence-based evaluation of aesthetic procedures dictates the use of more objective and quantitative measures of treatment outcome. OBJECTIVE: The present study was undertaken to validate a new clinical outcome instrument, the Wrinkle Severity Rating Scale. METHODS: Five clinical investigators were presented with 30 photographic images of the lower face and asked to rate nasolabial fold severity on each side using the 5-grade Wrinkle Severity Rating Scale (WSRS). Standardized definitions of the five grades were provided to the investigators in visual (photographic) and descriptive formats. To take into account possible facial asymmetry, nasolabial folds on the left and right sides of the face were rated separately. Assessments were conducted independently and were repeated after >or=2 weeks. RESULTS: Intra-observer (test-retest) agreement was 68.7% (left side) and 72.7% (right side); weighted kappa coefficients for the left and right sides were 0.77 and 0.81, respectively. Mean inter-observer agreement (internal consistency) was 67.7% (left side) and 72.3% (right side); weighted kappa coefficients for the left and right sides were 0.75 (95% CI 0.70-0.79) and 0.78 (95% CI 0.72-0.83), respectively. CONCLUSION: The WSRS is a valid and reliable instrument for quantitative assessment of facial skin folds, with good inter- and intra-observer consistency. By allowing objective and reproducible grading of data, the WSRS should prove a useful clinical tool for assessing the effectiveness of soft-tissue augmentation and other facial contouring procedures