Vol. 13, No. 3 • March 2020
Welcome to the March 2020 issue of The Journal of Clinical and Aesthetic Dermatology. We begin the issue with an original research article from Janeczek et al, in which the authors used a standard Wood’s lamp to visualize porphyrins associated with Corynebacterium minutissimum (C. minutissimum) in 30 patients with inverse psoriatic plaques. C. minutissimum is the bacterium responsible for causing erythrasma, a superficial infection. Just over half (56.6%) of patients in the study showed evidence of this bacterium. Specifically, 45.5 percent of inverse psoriatic lesions were found to be positive for C. minutissimum, with the highest prevalence of erythrasma located in the gluteal cleft. The authors recommend clinicians to maintain a high suspicion for C. minutissimum in patients with inverse psoriasis due to the organism’s potential to trigger or exacerbate psoriatic lesions.
Next, in a brief report by Brooks titled, “Treatment of Melanoma Excision Wound With 50% Zinc Chloride Solution Astringent—Mohs Melanoma Surgery Without the Paste,” the author reviews efficacy and safety data of 50% zinc chloride solution, when applied to open, fresh-tissue melanoma excision wounds, without the traditional black paste vehicle. The black paste cannot be formulated to USP standards due to the presence of stibnite, an antimony component not recognized by the FDA as a generally safe substance. According to the author, data indicate the paste-free solution is effective and safe for astringent treatment of melanoma excision wounds.
We also present two separate case reports by Calvão et al and Gillihan et al. First, Calvão et al describe the case of a 62-year-old male patient with longstanding Hailey-Hailey disease who presented with worsening of pre-existing lesions and recent appearance of large, tense bullae and intense pruritus in the inguinal region, trunk, and arms. The case was further complicated by the occurrence of eczema herpeticum. Next, Gillihan et al describe the case of a 34-year-old male patient who presented with neutrophilic urticarial dermatosis without underlying systemic findings. Diagnosis, differentials, and treatment are discussed in both case reports.
Following this, in an original research article from al Mokadem et al, the authors assessed the clinical efficacy and safety of topical timolol maleate 0.5% for the treatment of acne and rosacea. A total of 116 patients (58 patients with rosacea and 58 patients with acne) were treated with topical timolol maleate 0.5% every night before bedtime for eight weeks. The investigators observed improvements in disease severity in both patient groups, compared to baseline; however, the observed improvement in the rosacea group was not statistically significant. The investigators concluded that topical timolol maleate 0.5% was an effective treatment for acne, especially noninflammatory lesions, and rosacea, especially erythematotelangiectatic rosacea, with minimal side effects.
Next, in a case study from Johnson et al, the authors present three patients with refractory melasma previously treated with hydroquinone. Nightly applications of cysteamine cream (washed off after 15 minutes) combined with four monthly laser treatments using a 650-microsecond neodymium-doped yttrium aluminium garnet 1,064-nm laser were prescribed. After four months, all three patients reported satisfaction with the results of this combination therapy. None of the patients experienced irritation with the product or discomfort or downtime with the laser sessions. The authors acknowledge the need for randomized, controlled studies with a larger patient base and objective assessment measures to confirm their findings.
Following this, Lim et al present findings from their three-month, single-center, double-blind, randomized, vehicle-controlled trial that evaluated a daily skincare routine for treatment of facial photoaging in women 45 to 65 years of age. The skin care formulations used in the study contained two extracts derived from the gastropod Cryptomphalus aspersa. Fifty women were randomized to receive either the active ingredients (n=30) or placebo vehicle (n=20). Clinical evaluations included objective measurements of barrier function and skin hydration, elasticity, and color/brightness. Subjects in the active treatment group experienced reductions in transepidermal water loss, as well as significant improvements in skin roughness, firmness, and elasticity. Both groups showed significant improvements in fine lines and wrinkles.
Following this, we present an original research article from Rahman et al, in which the authors assessed the serum levels of biotin in 60 patients with telogen effluvium and 20 control subjects. The scalp of each patient was clinically and dermoscopically examined. Serum biotin levels were measured using enzyme-linked immunosorbent assay kits. The investigators found that serum levels of biotin were optimal in both groups, with no significant differences between the groups. Insignificantly lower biotin levels in elderly patients, smokers, athletes, those with a history of recurrent infections, and women who were pregnant and/or lactating were observed. The authors concluded that biotin supplementation in patients who are not biotin-deficient may serve no benefit and may skew lab test results.
We conclude the issue with a retrospective analysis from Gao et al, who evaluated the efficacy and safety of a multisource 3DEEP radiofrequency technology combined with fractional skin resurfacing (FSR) for the treatment of periocular skin aging. A total of 15 patients underwent monthly treatment sessions of 3DEEP and FSR for three months. Improvements in skin moisture levels, elasticity, wrinkles, pore size, and texture, relative to baseline (p<0.01), were observed. There was no significant difference in transepidermal water loss following treatment, compared to baseline (p>0.05).
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— Associate Editor