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Psychosocial issues and body dysmorphic disorder in aesthetics: Review and debate

Sun, Mary D; Rieder, Evan A
Body dysmorphic disorder (BDD) is a serious and debilitating psychiatric condition that disproportionately presents in dermatologic and cosmetic surgery patients. BDD is currently underrecognized in cosmetic medical settings and is thought to be underdiagnosed by behavioral health professionals. The significant comorbidities associated with this disorder, as well as potential harm done to both patient and physician, raise ethical and medicolegal concerns regarding its treatment. Although cosmetic interventions have historically been discouraged in BDD, recent studies have provided controversial evidence of benefit in certain cohorts. The rise of "snapchat dysmorphia" and the proposed explanatory phenomenon of perception drift have generated further debate around the de novo development or unmasking of BDD. We critically review and summarize existing debates around the treatment of BDD in cosmetic medicine. We provide guidance for screening, clinical interviewing, and the provision of psychoeducation in cases of suspected BDD.
PMID: 35190063
ISSN: 1879-1131
CID: 5167912

Revisiting Solitary Pedunculated Lipofibromas

Adotama, Prince; Hutson, Seneca D; Rieder, Evan A; Stein, Jennifer A; Kim, Randie H
OBJECTIVES/OBJECTIVE:Pedunculated lipofibromas are soft, compressible, skin-colored nodules that typically present as an acquired solitary lesion, predominantly located on the buttocks and thighs. We aimed to differentiate between pedunculated lipofibromas and nevus lipomatosus superficialis. Although benign, this may be important as treatment options vary. METHODS:We describe 3 cases of solitary pedunculated lipofibromas occurring in older, obese adults that required clinicopathologic correlation for the correct diagnosis. RESULTS:The histopathologic features of pedunculated lipofibromas include a broad-based lesion with aggregates of mature adipocytes extending upwards into the dermis without an associated inflammatory infiltrate. The primary histopathologic differential diagnoses include fibroepithelial polyps with adipocytes and nevus lipomatosus superficialis, which is more frequently found in children or young adults and is typically characterized clinically by multiple lesions with a cerebriform to verrucoid surface. CONCLUSIONS:While the precise relationship between pedunculated lipofibromas and nevus lipomatosus is still unknown, we propose using pedunculated lipofibroma as a more specific clinical term to refer to solitary pedunculated or broad-based fatty lesions with a smooth surface that occur in older patients and in a wide anatomic distribution.
PMID: 34124747
ISSN: 1943-7722
CID: 4950212

Photo-Editing Software and the Mere Exposure Effect in Dermatology and Aesthetics

Rieder, Evan A; Mariwalla, Kavita
PMID: 34699447
ISSN: 1524-4725
CID: 5042362

Psychiatric Disorders and Suicidal Behavior in Patients with Acne Prescribed Oral Antibiotics versus Isotretinoin: Analysis of a Large Commercial Insurance Claims Database

Ugonabo, Nkemjika; Love, Elyse; Wong, Priscilla W; Rieder, Evan A; Orlow, Seth J; Kim, Randie H; Nagler, Arielle R
BACKGROUND:The association between isotretinoin and psychiatric disturbance, including depression and suicidal behavior, is controversial. OBJECTIVE:To investigate whether acne patients prescribed isotretinoin or antibiotics were more likely to have psychiatric disorders and/or engage in suicidal behavior. METHODS:Retrospective cohort study identified acne patients prescribed isotretinoin or oral antibiotics in the IBM® MarketScan® Databases of commercial US insurance claims data from 2011-2017 who were also diagnosed with psychiatric disorders or suicidal behavior. RESULTS:A total of 72,555 patients were included. Compared to acne patients prescribed isotretinoin, patients in the general population were 1.47 times more likely to be diagnosed with suicidal ideation or attempt (adjusted OR 1.47; 1.27, 1.70, p <.0001). However, the general population (adjusted OR 0.87; 0.84, 0.89, p<0.0001) and acne patients prescribed antibiotics (adjusted OR 0.88; 0.85, 0.91, p<0.0001) were less likely to have a psychiatric diagnosis compared to acne patients prescribed isotretinoin. The prevalence of suicidal behavior during isotretinoin treatment was lower (0.10%) (p=0.082), than during the year prior to (0.22%) and during the year after isotretinoin treatment (0.34%), (p = 0.004). LIMITATIONS/CONCLUSIONS:Study excludes individuals with public or no insurance and relies on physician coding accuracy. CONCLUSIONS:Compared to the general population, acne patients prescribed isotretinoin were less likely to engage in suicidal behavior. Further exploration is warranted into the slight increase in suicidal behavior seen in isotretinoin patients one year after therapy.
PMID: 33727021
ISSN: 1097-6787
CID: 4817712

Considering Aesthetic Procedures During an International Viral Pandemic

Akintilo, Lisa; Rieder, Evan A
PMID: 34840643
ISSN: 1941-2789
CID: 5065372

How We Do It: Body Dysmorphic Disorder for the Cosmetic Dermatologist

Sun, Mary D; Rieder, Evan A
PMID: 33795577
ISSN: 1524-4725
CID: 4862362

Observer-Reported Outcomes and Cosmetic Procedures: A Systematic Review

Shah, Payal; Rieder, Evan A
BACKGROUND:Cosmetic procedures have demonstrated beneficial effects on physical appearance based on anatomic markers as well as patient-perceived self-image and quality of life. Recent studies of observer-reported outcomes (OROs) suggest an additional benefit from aesthetic interventions. OBJECTIVE:The authors aimed to review the evidence of OROs from cosmetic procedures performed on the head and neck. PATIENTS, METHODS AND MATERIALS:PubMed, Embase, and Cochrane Library databases were searched for relevant studies, yielding 24 included original investigations. RESULTS:These studies captured 686 total patients, 8,257 observer evaluations, and a variety of interventions including face-lifts, blepharoplasty, rhinoplasty, and minimally invasive treatments including botulinum toxins and hyaluronic acid fillers. Forty-one distinct reported OROs were grouped into 12 descriptive domains. Domains were further grouped into 3 higher-order categories: aesthetics and wellness, social capacities, and skills and competencies. Improved perception after cosmetic intervention is most reproducibly demonstrated for the following ORO domains: age, attractiveness, sociability, relationship success, and occupational and financial competency. CONCLUSION:The synthesized findings imply a tertiary layer of benefit for cosmetic intervention beyond anatomical and patient-centered outcomes through enhanced perceptions of others. These findings may inform the pre-procedure risk-benefit discussion with patients of cosmetic medicine and drive future research into longitudinal outcomes.
PMID: 32769529
ISSN: 1524-4725
CID: 4871352

The "bumpy" adolescent nose: Acne associated angiofibroma-like nasal papules

Roman, Jorge; Krueger, Loren D; Young, Trevor K; Rieder, Evan A; Rothman, Lisa R; Lakdawala, Nikita; Nagler, Arielle R; Meehan, Shane A; Orlow, Seth J; Oza, Vikash S
BACKGROUND/OBJECTIVE/OBJECTIVE:Papular scars are a recently described clinical phenotype of acne scarring characterized by papules occurring on the nose and chin. We have observed a similar presentation of nasal papules among patients seen in our clinic for acne and sought to further characterize the clinical and histopathological characteristics of this entity. METHODS:In this single-site case series, a retrospective review of electronic medical records of patients with nasal papules in association with acne vulgaris between April 2018 and April 2019 was performed. Clinical and histopathologic findings were recorded. RESULTS:We identified 20 patients who presented with a similar clinical phenotype of predominantly skin-colored, dome-shaped papules concentrated on the nose and chin in association with a history of more classic facial acne vulgaris. Papular lesions were seen predominately in adolescent Hispanic males. Concomitant acne on other areas of the face was identified in 18 patients at presentation while two patients had a history of adolescent acne. Biopsies were performed for five patients. Histopathologic examination demonstrated features of fibrosis and dilated thin-walled blood vessels, typical of angiofibromas. CONCLUSION/CONCLUSIONS:We present a series of adolescent patients with large, flesh-colored to erythematous papules seen predominantly on the nose. These lesions are histologically indistinguishable from angiofibromas and may represent an under-recognized yet disfiguring sequela of acne that may disproportionately affect adolescents with skin of color.
PMID: 32767593
ISSN: 1525-1470
CID: 4555732

Cosmetic Procedure Use as a Type of Substance-Related Disorder

Shah, Payal; Rangel, Lauren K; Geronemus, Roy G; Rieder, Evan A
PURPOSE/OBJECTIVE:We aim to demonstrate an initial proof of concept for the presence of addictive behaviors in cosmetic procedure utilization . METHOD/METHODS:ology Adult subjects visiting a cosmetic dermatology practice with history of at least one cosmetic procedure and consideration of at least one cosmetic procedure in the past 12 months were included. Two previously validated instruments in the detection of alcohol use disorder (AUD), the CAGE (Cut down, Annoyed, Guilty, Eye-opener) questionnaire and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria were modified to evaluate subjects for a substance-related disorder (SRD) in cosmetic procedure. RESULTS:Of 153 adults, 34 (22.2%) met modified CAGE criteria and 40 (26.1%) met modified DSM-V criteria. Results from both instruments were significantly associated (P < 0.0002). Significant differences in consideration and utilization of cosmetic treatments were found in SRD positive versus negative groups (P<0.0001; P=0.009). CONCLUSIONS:and Relevance A type of SRD involving cosmetic procedures may exist and qualifying individuals may have increased cosmetic treatment utilization. Future efforts to rigorously validate an instrument for SRD detection in cosmetic procedure use are warranted for future research and clinical application.
PMID: 32920038
ISSN: 1097-6787
CID: 4592342

An approach to cosmeceuticals

Chapter by: Milam, Emily C; Rieder, Evan A
in: Essential psychiatry for the aesthetic practitioner by Rieder, Evan A [Ed]; Fried, Richard G [Ed]
Hoboken, NJ, US: Wiley Blackwell, 2021
pp. 42-48
ISBN: 978-1-119-68012-3
CID: 5095462