Journal of drugs in dermatology: JDD

Publisher: Strategic Communication in Dermatology


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  • Other titles
    Journal of drugs in dermatology (Online), JDD
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  • Material type
    Document, Periodical, Internet resource
  • Document type
    Internet Resource, Computer File, Journal / Magazine / Newspaper

Publications in this journal

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    ABSTRACT: This issue of JDD is dedicated to distinguished Professor Dr. Alan R. Shalita, longtime Chairman of the Department of Dermatology at SUNY Downstate, who was admired and beloved by the dermatology community and will be remembered as a mentor and friend to all who knew him.
    Journal of drugs in dermatology: JDD 04/2014; 13(4):381.
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    ABSTRACT: Patient interest and physician use of soft tissue augmentation have increased significantly in recent years, especially among younger patients. A recent consumer survey conducted on behalf of the American Society of Plastic Surgeons found that the majority of respondents would rather have a facial injectable treatment than a surgical treatment. In another recent survey, consumers gave the highest overall satisfaction ratings to injectable filler treatments (92%), including poly-L-lactic acid (PLLA), and injectable wrinkle relaxers (92%), with injectable fillers receiving the highest "extremely satisfied" rating (45%). Long-lasting benefit is a desirable attribute in soft tissue augmentation, making PLLA a favorable alternative for many patients. When considering the use of PLLA, clinicians should ensure that their patients understand its benefit profile, and that these benefits are consistent with the patients' cosmetic goals. The implementation of the latest recommendations on methodological approaches in the use of PLLA will minimize the occurrence of adverse events, further enhancing patient satisfaction. J Drugs Dermatol. 2014;13(suppl 4):s40-s43.
    Journal of drugs in dermatology: JDD 04/2014; 13(4):s40-3.
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    ABSTRACT: Poly-L-lactic acid (PLLA) was first approved for soft tissue augmentation in Europe in 1999 for the cosmetic correction of scars and wrinkles. Due, in part, to inadequate usage recommendations that included those related to product reconstitution and hydration, injection sites, techniques, and timing, and patient selection, PLLA use was initially associated with suboptimal cosmetic benefit and a high rate of specific adverse events, such as the formation of nodules. As clinical experience with PLLA has increased, the implementation of specific methodological changes has allowed greater, more consistent cosmetic effects to be achieved, with a low rate of adverse events. This enhanced PLLA methodology, coupled with an evolving understanding of the interplay between structures in the aging face, now allows predictably favorable results across a broad range of patient types. J Drugs Dermatol. 2014;13(suppl 4):s32-s34.
    Journal of drugs in dermatology: JDD 04/2014; 13(4):s32-4.
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    ABSTRACT: Melasma has a negative impact on quality of life since it typically occurs on the face. To evaluate the erythema and pigmentation of melasma lesions and the surrounding areas in patients receiving triple combination (TC: hydroquinone, tretinoin, and fluocinolone acetonide) regimens. Patients first received an 8-week daily TC treatment and were then randomized to twice weekly or tapering regimen with TC. Melanin and erythema levels of lesions and surrounding areas were objectively measured using a narrowband reflectance spectrophotometer. Progressive reduction in the mean melanin levels was observed in the treatment phase. Following both maintenance regimens, there was no difference between melanin levels in the melasma lesions. Adverse effects were rare in both phases of the study and there was borderline reduction in erythema with regimen II. Both maintenance regimens were effective in maintaining results obtained during the initial treatment phase, and were safe and well-tolerated. Erythema was less intense with the tapering regimen. J Drugs Dermatol. 2014;13(4):444-448.
    Journal of drugs in dermatology: JDD 04/2014; 13(4):444-8.
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    ABSTRACT: Dyschromias are becoming a more common concern among patients, particularly among persons of color. There are a variety of treatments, including more novel agents for dyschromias. Evaluating common agents prescribed among various races may prompt efforts to enhance care for dyschromias in patients of color. To determine whether racial or ethnic groups are treated differently for dyschromia. The secondary objective is to discover the main treatments used and determine trends over time in demographics. We searched the 1993-2010 National Ambulatory Medical Care Survey (NAMCS) for visits associated with a diagnosis of dyschromia (ICD-9 codes 709.00 or 709.09). The demographics and leading treatments were tabulated, and trends over time were assessed by linear regression. There were about 24.7 million visits for dyschromia over the 18-year period. Among 5,531,000 patients with the sole diagnosis of dyschromia, there were 2,800 visits from females and 1,200 visits from males per 100,000 population. Females were more likely to receive prescription combination therapy for dyschromia than males by a ratio of 10 to 1. Leading treatments overall prescribed by dermatologists included hydroquinone, topical corticosteroids, and retinoids. Asians were 27% more likely to receive a combination therapy than non-Asians. African Americans and Hispanics were less likely to have a procedure performed for dyschromia. Data are based on a number of ambulatory care visits, which does not allow direct estimation of prevalence. Dyschromia is a significant concern for many patients, and this is especially true among patients of color. Treatment for dyschromia is influenced by skin type, and thus ethnic or racial groups are treated differently. Studies have shown that combination therapy may offer better results than a single medication for hyperpigmentation disorders. Combination agents may be underutilized in African Americans and Hispanics for dyschromia. J Drugs Dermatol. 2014;13(4):401-406.
    Journal of drugs in dermatology: JDD 04/2014; 13(4):401-6.
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    ABSTRACT: Acne vulgaris is a common skin disease in which abnormal desquamation, excess sebum production, proliferation of Propionibacterium acnes, and production of proinflammatory mediators all contribute to the pathogenesis of the disease. A review of the literature shows that our current understanding of acne pathogenesis continues to evolve. Recent data suggests that inflammatory mediators may play a more important role than previously realized; however, how these mediators work independently as well as together in acne lesion progression is not well understood. Several cell types and mediators involved in the pathology of acne are responsible for producing or exacerbating an inflammatory response. Here, we present an updated theoretical model of acne lesion progression that highlights the role inflammatory mediators may play throughout acne lesion development. J Drugs Dermatol. 2014;13(4):459-463.
    Journal of drugs in dermatology: JDD 04/2014; 13(4):459-63.
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    ABSTRACT: Porphyria cutanea tarda (PCT) is a blistering skin disorder that occurs most commonly in middle-aged individuals. It is caused by decreased uroporphyrinogen decarboxylase (UROD) activity, which results in elevated levels of uroporphyrinogen. Occurrence remains very rare in children with some sources quoting as few as 50 reports of childhood cases.1 The literature reports occasional cases of PCT onset with various drugs, including barbiturates, estrogens, griseofulvin, rifampicin, sulfonamides, imatinib, methotrexate, tamoxifen, and cyclophosphamide, however its incidence in childhood is uncommon.2-6 We present a case of new-onset PCT in an eight year-old following treatment of pre-B cell acute lymphoblastic leukemia with multi-agent chemotherapy. J Drugs Dermatol. 2014;13(4):489-491.
    Journal of drugs in dermatology: JDD 04/2014; 13(4):489-91.
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    ABSTRACT: Alopecia areata (AA) is a common, non-scarring, autoimmune hair-loss disorder with a complex genetic and environmental etiology. A higher incidence rate of AA in the female population is well described. It is unclear why females are more likely to be diagnosed with AA and what, if any, differences in disease phenotype exist between males and females. The identification of gender specific characteristics of disease may help clinical management and patient education in cases of AA. Accordingly, we recruited 481 North-American Caucasian AA patients (336 female, 145 male) to assess age of onset, autoimmune and atopic co-morbidity, nail involvement, family history of AA and autoimmune disease, and disease subtype. There was a female predominance (female to male ratio 2.3:1) in this AA study population. We found that male AA patients are more likely to be diagnosed in childhood (age <10 years, P= 0.067) and have a family history of AA (P= 0.004). On the other hand, female AA patients are more likely to be diagnosed in adolescence (age 10-20 years, P= 0.083), have co-morbid nail involvement (P= 0.0257), and have concomitant autoimmune disease (P= 0.014), particularly thyroid disease (P= 0.058). The clinical implications of disease heterogeneity between males and females remains to be determined. J Drugs Dermatol. 2014;13(4):409-413.
    Journal of drugs in dermatology: JDD 04/2014; 13(4):409-13.
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    ABSTRACT: Poly-L-lactic acid (PLLA) was approved for use in Europe in 1999. In the United States, it was approved by the Food and Drug Administration in 2004 for the treatment of facial lipoatrophy associated with human immunodeficiency virus, and in 2009 for cosmetic indications in immune-competent patients. The need for consistent, effective PLLA usage recommendations is heightened by an increased consumer demand for soft tissue augmentation and a shift toward a younger demographic. Over the past 14 years, considerable experience has been gained with this agent, and we have come to better understand the clinical, technical, and mechanistic aspects of PLLA use that need to be considered to optimize patient outcomes. These consensus recommendations regarding patient selection, proper preparation and storage, optimal injection techniques, and other practical considerations reflect the body of evidence in the medical literature, as well as the collective experience of this author group. J Drugs Dermatol. 2014;13(suppl 4):s44-s51.
    Journal of drugs in dermatology: JDD 04/2014; 13(4):s44-51.
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    ABSTRACT: Primary Focal Axillary Hyperhidrosis (PHH) is a chronic disorder of excessive underarm sweat that causes significant impairment of an individual's daily activities. Multiple studies have established the psychosocial burden of PHH and its negative impact on quality of life. Current first-line therapies include the use of topical aluminum chloride with limited efficacy. Second line therapy includes the use of Botulinum toxin, which is effective, but duration is limited to 6-7 months. Objective: The purpose was to evaluate the long term efficacy and safety of the Nd:YAG 1440nm wavelength with a unique delivery fiber (SideLaze) and the Smartlipo TriPlex device (Cynosure Inc). Fifteen subjects were recruited to an approved Institutional Review Board study. Outcome measures were comprised of clinical and quantitative evaluation of functional impairment. This included HDSS scale, physician and subject evaluation, and digital photography of before and after starch iodine tests utilizing image processing and analysis software. Subjects received a single treatment and were evaluated at 1 week and at 3, 6, and 12 months post treatment. Responders were defined as those that scored an HDSS score of 1 or 2 post-treatment. Those that were non-responsive at 6 months received a second treatment. All patients responded to treatment with 72% reporting a two-point HDSS score improvement and 28% reporting a 1-point improvement at 1-year follow-up. The average HDSS score improvement was 1.9/3.0. Three of the 15 patients at 6 months received a second treatment. The HDSS average score for all patients remained statistically stable at 1-year follow-up. Treatment of axillary hyperhidrosis with the 1440nm Nd:YAG-pulsed laser combined with a targeted fiber and temperature-sensing device provides a safe and minimally invasive approach to the treatment of axillary hyperhidrosis with minimal side effects and long-term efficacy. J Drugs Dermatol. 2014;13(4):449-456.
    Journal of drugs in dermatology: JDD 04/2014; 13(4):449-56.
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    ABSTRACT: Vemurafenib is a recently approved targeted therapy for advanced melanoma harboring the B-Raf valine-to-glutamate mutation at residue 600 (V600E). In many patients, the use of vemurafenib leads to a rapid onset of cutaneous neoplasms, including squamous cell carcinomas, keratoacanthomas, and benign keratoses. Paradoxical activation of the mitogen-activated protein kinase (MAPK) pathway by vemurafenib in the setting of RAS hyperactivation has been demonstrated in the laboratory and may account for the pathogenesis of some of these neoplasms. Activating RAS mutations have been discovered in vemurafenib-associated squamous cell carcinomas, but have not been reported in benign keratoses, which are a more common side effect that affects patient quality of life. Here, we report on the mutational analysis of RAS genes at known activating hotspots in verrucous keratoses from a stage IV melanoma patient undergoing vemurafenib therapy. The results lend genetic evidence to the current hypothesis for how some of these lesions develop and suggest potential strategies in the research on preventive and therapeutic measures. J Drugs Dermatol. 2014;13(4):495-497.
    Journal of drugs in dermatology: JDD 04/2014; 13(4):495-7.
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    ABSTRACT: Periorbital hyperpigmentation (POH) is a common worldwide problem. It is challenging to treat, complex in pathogenesis, and lacking straightforward and repeatable therapeutic options. It may occur in the young and old, however the development of dark circles under the eyes in any age is of great aesthetic concern because it may depict the individual as sad, tired, stressed, and old. While "dark circles" are seen in all skin types, POH is often more commonly seen in skin of color patients worldwide.1 With a shifting US demographic characterized by growing number of aging patients as well as skin of color patients, we will encounter POH with greater frequency. As forecasted by the US Census, by 2030 1 in 5 Americans will be 65 plus years old and greater than 50% of the population will possess ethnic skin of color.2 The disparity in the medical community's understanding of POH versus popular demand for treatment is best illustrated when you have only 65 cited articles to date indexed on PubMed line3 compared to the 150,000,000 results on Google search engine.4 Most importantly POH may be a final common pathway of dermatitis, allergy, systemic disorders, sleep disturbances, or nutritional deficiences that lends itself to medical, surgical, and cosmeceutical treatments. A complete medical history with ROS and physical examination is encouraged prior to treating the aesthetic component. Sun protection is a cornerstone of therapy. Safety issues are of utmost concern when embarking upon treatments such as chemical peeling, filler injection, and laser therapy as not to worsen the pigmentation. Without intervention, POH usually progresses over time so early intervention and management is encouraged. The objective of this study was to review the current body of knowledge on POH, provide the clinician with a guide to the evaluation and treatment of POH, and to present diverse clinical cases of POH that have responded to different therapies including non-ablative fractional photothermolysis in two skin of color patients. J Drugs Dermatol. 2014;13(4):472-482.
    Journal of drugs in dermatology: JDD 04/2014; 13(4):472-82.
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    ABSTRACT: Topical tretinoin has been a standard treatment for acne vulgaris for more than 4 decades. While tretinoin has demonstrated proven efficacy in the treatment of acne lesions, it also is associated with the potential for skin irritation. Newer formulations have been designed to optimize both the drug concentration and the delivery vehicle with the aim to enable clinicians to provide increasingly effective acne treatment that minimizes irritation. These therapies include formulations with varying concentrations of tretinoin and vehicles that utilize a microsponge delivery system, hydrogels and micronized tretinoin, or propolymers. The purpose of this review is to evaluate different formulations and combinations of tretinoin in the treatment of acne vulgaris. While these advanced formulations were designed for controlled release of active ingredient, and have the potential to reduce cutaneous irritation relative to standard tretinoin cream and gel formulations, there is a need for comparative studies to evaluate the relative benefits of each of these advanced tretinoin formulations in optimizing acne treatment. J Drugs Dermatol. 2014;13(4):466-470.
    Journal of drugs in dermatology: JDD 04/2014; 13(4):466-70.
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    ABSTRACT: Topical treatment is a pillar of dermatologic practice. The delivery of drug by a topical vehicle is dependent on complex physical chemistry and on how well patients apply the product. The potency of topical agents is not solely dependent on the concentration of active drug in the vehicle. A corticosteroid molecule may have vastly different potency depending on what vehicle is used to deliver it. Similarly, a new gel vehicle is able to deliver considerably more active antifungal than an older vehicle technology and may represent a promising vehicle for other novel formulations. The use of new vehicles can provide more effective means for treating patients with skin disease. J Drugs Dermatol. 2014;13(4):423-427.
    Journal of drugs in dermatology: JDD 04/2014; 13(4):423-7.
  • Journal of drugs in dermatology: JDD 04/2014; 13(4):386-388.
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    ABSTRACT: In December of 2013 the Food and Drug Administration announced it would look further into the safety and efficacy of the biocide triclosan and requested further safety data as part of a new review with the Environmental Protection Agency. The use of triclosan has increased exponentially since its introduction in in 1972, to the point that 75% of commercial soap brands contain triclosan and 76% of a nationwide sample of adults and children excrete triclosan in the urine. This announcement raised an important dialog about the appropriate use of all over the counter biocides. Particular concerns include whether these biocides are more effective than regular soaps, whether they may create new drug resistant bacteria, and whether they may also act as hormone disruptors in humans or the environment.
    Journal of drugs in dermatology: JDD 04/2014; 13(4):501-3.
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    ABSTRACT: The prevalence of adult acne in the US appears to be increasing over the last few decades. But what's behind the rise: is it nature or nurture? We are well aware that genetics can strongly influence a patient's risk of developing acne. However, significant changes in germline genetic variants are unlikely to have occurred over the last 20 years. Consequently, we are forced to examine environmental variables, including diet. This review article presents the most updated evidence supporting a link between refined carbohydrates and acne. Based on the data summarized here, dermatologists should encourage their acne patients to minimize their intake of high glycemic index foods. J Drugs Dermatol. 2014;13(4):428-435.
    Journal of drugs in dermatology: JDD 04/2014; 13(4):428-35.
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    ABSTRACT: The treatment of disorders of hyperpigmentation including melasma, photoaging-related dyschromia, and postinflammatory hyperpigmentation pose numerous challenges, especially in patients with higher Fitzpatrick skin types (skin of color). Given limitations in efficacy as well as safety and cost considerations of available therapies, a "magic bullet" single treatment modality for hyperpigmentation is currently lacking. Successful treatment typically involves a combination of topical agents with or without in-office procedures, exploiting the different mechanisms of action of each agent or treatment modality. This article will review recently published studies involving newer topical and procedural approaches to this common dermatologic concern.
    Journal of drugs in dermatology: JDD 04/2014; 13(4):382-5.
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    ABSTRACT: Injection-related adverse events (AEs) may occur with the use of any injectable substance, including all commercially available fillers. The most common of these AEs include discomfort, bruising, edema, and erythema, which are generally transient and resolve spontaneously. The majority of AEs widely felt to be associated with poly-L-lactic acid (PLLA) are papules, nodules, and granulomas. Papules and nodules, which are histologically distinct from granulomas, tend to arise several weeks after injection, are generally palpable, asymptomatic, and nonvisible, and will typically resolve on their own, but can be camouflaged with the use of hyaluronic acid. They generally result from suboptimal product reconstitution or placement and, as such, their incidence can be minimized by improved injection methodology. In contrast, true inflammatory granulomas are very rare (incidence 0.01%-0.1%), seem to be systemic in nature, and represent an overabundance of host reaction to PLLA. Granulomas may become apparent months or years post-injection and may persist and grow over time. Their treatment is geared toward halting the increased secretion of interstitial substances and invasion of cells, and may include the administration of steroids and antimetabolites such as 5-fluorouracil. J Drugs Dermatol. 2014;13(suppl 4):s35-s39.
    Journal of drugs in dermatology: JDD 04/2014; 13(4):s35-9.
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    ABSTRACT: The use of cosmeceuticals by patients is now commonplace. Without consultation and direction from an informed clinician, marketing pressures can lead consumers to make poor product choices that can result in wasted money and unsatisfactory outcomes. Skin professionals need a scientifically based, succinct tool to guide their patients toward best topical skincare practices. The Skin Health and Beauty PyramidTM is an educational framework and product guide created from extensive scientific literature and study review on ingredients, formulations and technologies affecting skin biology. This clinical tool can simplify product choices for physicians and clinicians in the process of professionally guiding patients toward the optimal use of topical products to achieve best outcomes for skin health and beauty. J Drugs Dermatol. 2014;13(4):414-421.
    Journal of drugs in dermatology: JDD 04/2014; 13(4):414-21.

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