Welcome to the July 2018 issue of The Journal of Clinical and Aesthetic Dermatology. We begin this issue with a study titled “What Health-related Quality of Life (HRQoL) Factors Influence the Decision of Patients with Acne to Visit a Dermatologist?” by Chernyshov et al. Researchers included 150 patients in their study: 75 patients with acne who sought treatment from a dermatologist (“active” group) and 75 individuals with a confirmed diagnosis of acne who had not sought treatment from a dermatologist (“passive” group). The participants in each group were matched according to acne severity grade (mild, moderate, or severe) and sex and then were assessed for HRQoL factors related to their acne using the Dermatology Quality of Life Index (DLQI) and Cardiff Acne Disability Index (CADI) questionnaires. The investigators reported that total DLQI and CADI scores were significantly higher in the “active” group compared to “passive” group, regardless of acne severity, concluding that the perceived effect of acne on HRQoL is a greater predictive factor for an individual to seek professional treatment of his or her acne than the acne severity level. The authors acknowledge that the significant imbalance between the number of female versus male patients in the study (11 men and 64 women in each group) could lead to an underrepresentation of the male point of view, limiting the significance of their findings.
Next, in the cross-sectional, consecutive study titled “Patterns of Over-the-counter (OTC) Lightening Agent Use among Patients with Hyperpigmentation Disorders: A United States-based Cohort Study,” by Saade et al, researchers assessed 406 patients with hyperpigmentation disorders, the majority of which were women and had Fitzpatrick Skin Types IV to VI, for frequency of and factors associated with the use of OTC lightening products. Data revealed that 51.0 percent of study responders reported using OTC agents, with hydroquinone being the most commonly used cream (59.1%); and 28.9 percent felt that the greater expense of the product correlated with greater efficacy. The authors reported patients with a diagnosis of melasma or PIH were most likely to use an OTC product compared to individuals with other hyperpigmentation disorders. Additionally, data revealed that the majority of patients with hyperpigmentation disorders believed that OTC creams were safe to use without physician supervision. The authors acknowledge several limitations, including the predominance of female subjects, all of which came from a single center; the cross-sectional study design, with the drawbacks of recall bias, misinterpretation of questions, and reporter bias; and the focused nature of the survey questions, all of which limit the significance of their findings.
Following this, in a study titled “Androgenetic Alopecia (AGA) Treatment in Asian Men,” Tanaka et al retrospectively evaluated the effectiveness of their AGA combination therapy that comprised oral finasteride once daily, oral and topical minoxidil twice daily, and an injectable of lidocaine and treatment solution (with multiple ingredients). The authors reviewed the charts of 18,918 male patients who were treated in their center using the combination therapy. Effectiveness of the therapy was measured by investigator-assessed digital photographs (taken before and after treatment) and patient assessments that were recorded six and 12 months after treatment. The authors reported that significant improvement was observed by investigators, via digital photographs, in all patients, and that 96 percent and 80 percent of the patients reported satisfaction at six and 12 months post-treatment follow-up appointments, respectively. The authors describe mechanisms of action and treatment complications. The authors acknowledge that lack of a control group and lack of a comparison of dosage strengths and frequencies limit the significance of their findings.
Next, Forbes et al report the results of their pilot study, “Process of Post-operative Telephone Follow-up Implementation for Mohs Micrographic Surgery (MMS): A Pilot Study.” Here investigators evaluated the process of a routine telephone follow-up (TFU) system for capturing postoperative complications or concerns among Mohs micrographic surgery (MMS) patients (N=349). During a two-month period at their facility, investigators called MMS patients 24 to 48 hours post-surgery to assess bleeding, swelling, and pain control and at one-week post-surgery to assess wound care, signs of infection, or other concerns. They collected and analyzed completed TFU rate, time to complete calls, and patient-reported complication rate data, and reported that 75.4 percent and 66.5 percent of the patients were successfully contacted during the 24- to 48-hour follow-up window and at the one-week interval, respectively. The authors offer that TFU could be a practical and efficient method of assessing and mitigating MMS postoperative complications.
Following this, Fried et al report the results of their study titled “Patient-perceived Emotional and Functional Benefits of Poly-L-Lactic Acid (PLLA) for the Treatment of Facial Volume Loss.” Researchers recruited 50 subjects (49 women and 1 man) from two community dermatology centers in the United States to undergo monthly injections of PLLA for improvement of facial volume loss. Patient self-assessment questionnaires (The Facial Volume Restoration Outcome Questionnaire and the Rosenberg Self Esteem Scale) were completed at baseline and 6 months after first injection. Additionally, facial volume loss was assessed on a 0 to 4 scale (Investigator Global Assessment [IGA]) before and after treatment by either the principle investigator or a sub-investigator. The authors reported that 30 percent of the subjects who completed pre- and post-injection assessment measures indicated increased confidence, sense of control, and comfort with others, among other self-esteem items. Additionally, the authors reported that 43 percent of the subjects felt more optimistic and 33 percent felt less anxious, and that the IGA of facial volume loss improved from 2.2 at baseline to 1.2 at six-month follow-up assessment. The authors acknowledge that the self-report assessment model and lack of quantification of Likert scale gradations used in the study, as well as the lack of a comparison group(s) limit the significance of their findings.
Next, in a case report titled “Progressive Facial Papules in an African-American Patient: An Atypical Presentation of Seborrheic Dermatitis,” Friedmann et al describe the presentation of a variant of seborrheic dermatitis (SD) in a 30-year-old African-American woman with progressive facial papules. The authors describe differentials and treatment methods.
Finally, all JCAD readers are encouraged to read the Letter to the Editor from Ann M. Smith, President and CEO of Ferndale Healthcare, Inc. It is important that dermatologists and their staff not be confused by the “Statement from the FDA Commissioner Scott Gottlieb, M.D. on New FDA Actions to Keep Consumers Safe from the Harmful Effects of Sun Exposure, and Ensure the Long-term Safety and Benefits of Sunscreens,” as only certain products have been implicated in improper advertising. From our perspective, only certain companies have been purporting unsubstantiated claims regarding their products, and Ferndale Healthcare, Inc. is not one of them.
We hope you enjoy this issue of JCAD. As always, we welcome your feedback and submissions.
James Q. Del Rosso, DO, FAOCD
Editor-in-Chief, Clinical Dermatology
Wm. Philip Werschler, MD, FAAD, FAACS
Editor-in-Chief, Aesthetic Dermatology
Seemal R. Desai, MD, FAAD