December 2019 Editorial Message

VOL. 12, NO. 12 • December 2019

Dear Colleagues:

Welcome to the December 2019 issue of The Journal of Clinical and Aesthetic Dermatology. We begin this issue with a case report from Hoshy et al, in which the authors describe the case of a 77-year-old woman who presented with bilateral tender, swollen, erythematous, focally crusted cheeks with a discharge of pus and necrotic material. The condition developed one month after autologous fat transfer and a corrective injection procedure conducted to correct an overdone fat transfer. Histopathological examination of the discharged material revealed signs of a Prototheca infection. The patient was treated by surgical drainage accompanied by itraconazole 200mg daily for six months, leading to marked improvement.

Next, in an original research article from Kumar et al, titled, “Ratio Analysis Evaluation of Dermal Collagen and Elastic Fiber Contents: A Comparison Between the Horizontal and Vertical Directions of Skin Tissues,” the authors collected full-thickness skin samples in the horizontal and vertical directions from 15 areas of 32 human cadavers and measured the ratios between collagen and elastic fibers in the horizontal and vertical directions for the purpose of comparing the asymmetric distribution of dermal collagen and elastic fiber content in different areas, as well as in different directions in the same area. According to the authors, the evaluation of ratios of dermal collagen and elastic fibers in different directions, together with the data of asymmetric distribution, provides an important guideline for aesthetic surgeons looking to place elective incisions in the direction that will optimize aesthetic outcome.

After this, in a review article titled “Intravenous Hyaluronidase for Visual Loss Secondary to Filler Injection: A Novel Therapeutic Approach,” from McCann, the author discusses the therapeutic alternative of high-dose intravenous hyaluronidase as a relatively safe and previously unexamined approach to follow if visual loss has not been restored and for consideration as an alternative to retrobulbar injection in the event that an experienced ophthalmologist is not able to perform this procedure within 60 to 90 minutes, following which time, blindness is irreversible.

Following this, in a review article titled, “New and Emerging Topical Therapies for Psoriasis and Atopic Dermatitis,” Psomadakis and Han discuss topical therapies for psoriasis, including vitamin D analogs and corticosteroids, hydroxypropyl-chitosan nail lacquer, phosphodiesterase (PDE)-4 inhibitors, topical Janus kinase (JAK)/signal transducer and activator of transcription inhibitors, combination retinoid and corticosteroid lotion, PH-10, and tapinarof. In addition, the authors review topical therapies for atopic dermatitis, including selective PDE-4 inhibitors, JAK inhibitors, GATA-3 deoxyribozymes, and tapinarof.

After this, in a case report from Sharma et al, the authors discuss a 71-year-old man in North India who, based on clinicohistopathological findings, was diagnosed with lepromatous leprosy with Lucio phenomenon (LP). According to the authors, LP is a rare reactional state seen in cases of diffuse lepromatous leprosy and is observed almost exclusively in Mexico and Central America. Following diagnosis, the patient was started on a multibacillary multidrug therapy and began to show improvement after two weeks. 

Next, in a case study from Foshee et al titled, “Surgical and Functional Considerations of Dermatofibrosarcoma Protuberans Involving Facial Nerve Danger Zones,” the authors examined the functional neurologic outcomes in patients undergoing either Mohs micrographic surgery or wide local excision for facial dermatofibrosarcoma protuberans (DFSP).  Among the 44 cases of facial DFSP reported in the literature and the authors’ own two patients, Foshee et al found that only 10 cases reported neurologic functional status, with four of these 10 cases showing notable facial nerve deficits.

As part of our bi-annual “Emerging Authors in Dermatology” series, we present a case report from Dick et al, in which the authors discuss a case of a 32-year-old woman with common variable immunodeficiency who presented with Gardner-Diamond Syndrome, a psychological and dermatologic syndrome involving painful, ecchymotic, purpuric lesions that typically appear after a period of stress or minor trauma. 

Our online-only exclusive articles this month include an original research article from Chao et al, titled, “IncobotulinumtoxinA for the Treatment of Glabellar Frown Lines: A Prospective, Multicenter, Single-arm Study in Taiwan.” Here, the authors evaluated clinical effectiveness, longevity of treatment effects, and patient satisfaction with incobotulinumtoxinA for glabellar frown lines (GFL) in 45 patients with mild to very severe GFL. Investigators assessed improvements in dynamic GFLs at Days 14 and 120 using the validated five-point Merz scale (0=no lines; 4=very severe lines), and treatment satisfaction was reported by patients via a questionnaire. Merz scores at Day 14 were 0 or 1 point(s) for all patients, and improvements were maintained through Day 120.

Our second online-only exclusive is an original research article from Tanaka, titled, “Skin Tightening Following Multisource, Phase-controlled Radiofrequency Treatments with Novel Unique Concentric Electrodes in Asian Patients.” Here, the author reports results from his evaluation of a multisource, phase-controlled radiofrequency treatment with a unique concentric electrode configuration for skin tightening in 25 patients. Objective assessments with digital photographs and superimposed three-dimensional color images showed significant volumetric reduction in the treated areas. You can access our featured Online-only Exclusives articles via the journal’s website at: or via the digital edition at:

We hope you enjoy this issue of JCAD. As always, we welcome your feedback and submissions.

With regards,

James Q. Del Rosso, DO, FAOCDEditor-in-Chief, Clinical Dermatology

Wm. Philip Werschler, MD, FAAD, FAACSEditor-in-Chief, Aesthetic Dermatology

Seemal R. Desai, MD, FAAD— Associate Editor