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Journal of drugs in dermatology: JDD 11/2011; 10(11):1234. · 1.57 Impact Factor
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ABSTRACT: One of the most recent advancements in phototherapy is the development of localized delivery systems. One such device is the
excimer laser. The use of the excimer laser was first reported in dermatology by Bonis in 1997 for psoriasis treatment.1 Psoriasis has been reported to respond best to light at a wavelength of 313 nm.2 Since the excimer laser emits light at a wavelength of 308 nm, it was a logical choice for investigation. The excimer laser
has been found to be efficacious for not only patients suffering from psoriasis but also several disorders of hypopigmentation
including vitiligo. This chapter serves to discuss the use of the excimer laser for psoriasis and diseases of hypopigmentation.
08/2011: pages 193-198;
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ABSTRACT: The incidence of melanoma skin cancer is increasing rapidly, particularly among young women in the United States. Numerous studies have documented an association between the use of indoor tanning devices and an increased risk of skin cancer, especially in young women. Studies have shown that ultraviolet exposure, even in the absence of erythema or burn, results in DNA damage. Countries and regulatory bodies worldwide have recognized the health risks associated with indoor tanning. In the United States, 32 states have passed legislation to regulate the indoor tanning industry, but there is an urgent need to restrict the use of indoor tanning devices at the federal level. The Food and Drug Administration is currently reviewing the classification of these devices. For all of these reasons, the Food and Drug Administration should prohibit the use of tanning devices by minors and reclassify tanning devices to at least class II to protect the public from the preventable cancers and other adverse effects caused by ultraviolet radiation from indoor tanning.
Journal of the American Academy of Dermatology 05/2011; 64(5):893-902. · 3.99 Impact Factor
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ABSTRACT: The incidence of melanoma skin cancer is increasing rapidly, particularly among young women in the United States. Numerous studies have documented an association between the use of indoor tanning devices and an increased risk of skin cancer, especially in young women. Studies have shown that ultraviolet exposure, even in the absence of erythema or burn, results in DNA damage. Countries and regulatory bodies worldwide have recognized the health risks associated with indoor tanning. In the United States, 32 states have passed legislation to regulate the indoor tanning industry, but there is an urgent need to restrict the use of indoor tanning devices at the federal level. The Food and Drug Administration is currently reviewing the classification of these devices. For all of these reasons, the Food and Drug Administration should prohibit the use of tanning devices by minors and reclassify tanning devices to at least class II to protect the public from the preventable cancers and other adverse effects caused by ultraviolet radiation from indoor tanning.
Journal of the American Academy of Dermatology 02/2011; 64(4):e51-60. · 3.99 Impact Factor
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ABSTRACT: Artefill, a novel permanent filler approved by the U.S. Food and Drug Administration (FDA), has been used as an injectable implant for the correction of nasolabial folds. Fillers are considered a first line treatment for atrophic scars.
The authors evaluated the degree of correction and subject satisfaction of correction of atrophic acne scar(s) after injection of Artefill.
Fourteen qualified subjects participated in a single-center, open-label, pilot study. Atrophic acne scars were evaluated prior to injection. Subscision was performed, and then Artefill was injected into the scar. The degree of improvement was measured at weeks 2 and 4 and month 8. Subjects were asked to fill out a satisfaction survey at their eight-month visit.
Investigator ratings after eight months post procedure indicated that 96 percent of the atrophic acne scars showed some degree of improvement. There was no improvement in two out of a total of 57 scars evaluated. The majority of patients reported a moderate correction, correlating with a 51-75 percent improvement in their acne scars at eight months. No adverse events or side effects were noted.
Artefill demonstrated to be both an efficacious and safe therapy for the treatment of atrophic acne scars.
Journal of drugs in dermatology: JDD 09/2010; 9(9):1062-4. · 1.57 Impact Factor
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James M Spencer
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ABSTRACT: Efforts to improve the size and appearance of scars have included therapies as varied as laser treatments and onion extract gels. Silicone gel sheeting is well know to improve the appearance of hypertrophic scars, and may have a role in the management of routine surgical and traumatic scars. By varying the degree of cross linking, silicone elastomer can be a solid sheet or a liquid gel. In this pilot series, seven patients applied a liquid silicone gel twice a day to one half of a new surgical scar for three months. At the end of this time, the treated side was noticeably better in appearance in five of seven patients while two of seven had no difference. In no patient was the silicone treated side worse in appearance.
Journal of drugs in dermatology: JDD 07/2010; 9(7):856-8. · 1.57 Impact Factor
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Dermatologic Surgery 02/2010; 36(4):512-7. · 1.80 Impact Factor
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ABSTRACT: EPIDEMIOLOGY: Collectively uncommon with exception of AFX, seen principally in elderly, equal gender.
PATHOGENESIS: AFX and AS–UV light, DFSP-translocation of PDGF and collagen genes t(17;22).
PATHOLOGY: AFX-storiform, anaplasia; DFSP-storiform, no anaplasia; LS-fascicles; AS-anastomosing sinusoids.
CLINICAL: AFX-face, ulcerated papule; DFSP-nodule trunk and exts.; LS-nodules; AS- face violaceous patch.
12/2009: pages 163-169;
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ABSTRACT: The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in the postoperative setting of dermatologic surgery is unknown. Such data could influence the empirical treatment of suspected infections.
To examine the period prevalence of MRSA infections in the postoperative setting of dermatologic surgery.
We performed chart reviews of 70 patients who had bacterial cultures taken from January 2007 to December 2007. In the 21 postsurgical cases, we analyzed age, risk factors, sites of predilection, method of repair, and pathogen of growth.
The mean age of the overall study population was 57, with the mean age of postsurgical MRSA-positive cases being 75.5. Of the 21 postsurgical cultures taken, 16 cultures grew pathogen, and two of the 16 (13%) pathogen-positive cultures grew MRSA.
This is a retrospective chart review of a relatively small sample size in one geographic location. Our patient population is known to contain a large number of retirees.
The increasing prevalence of MRSA skin and soft tissue infections and recommendation to modify empirical antibiotic therapy have been well documented in particular patient populations, but we caution against the empirical use of MRSA-sensitive antibiotics in the postoperative setting of dermatologic surgery. We advocate culturing all infectious lesions upon presentation and reserve empirical use of MRSA-sensitive antibiotics for high-risk patients or locations.
Dermatologic Surgery 02/2009; 35(3):420-4. · 1.80 Impact Factor
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ABSTRACT: The prevalence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) skin and soft tissue infection (SSTI) in private practice dermatology office is largely unknown and the prescribing of antibiotic treatment could be influenced by such data.
Investigators sought to examine the period prevalence of CA-MRSA infections involving skin and soft tissue in a suburban private practice dermatology setting.
Chart reviews of 170 patients who had bacterial cultures taken from January 2007 to November 2007 were performed, with an analysis of sex, age, immune status, species of growth, type of lesion, and culture site.
The mean age of the study population was 54.0 years (SD 21.8) and 51.1 % were male. Of the 170 cultures taken, 135 (79%) grew 1 or more bacteria and MRSA positive cultures were found in 28 (21%) of 135 cultures.
Only 1 geographic location was represented.
The rising rates of CA-MRSA skin and soft tissue infections should be evaluated with consideration of the unique populations that the majority of reports represent. There is little doubt that the prevalence of skin infections caused by CA-MRSA have increased dramatically and will likely continue to do so in the future. However, the authors caution the empiric prescribing of antibiotics presently known to be effective against CA-MRSA and advocate the culturing of all infectious lesions upon presentation and reserve these antibiotics (tetracyclines, trimethoprim-sulfamethoxazole [TMP-SMX], clindamycin, rifampin) for the treatment of high-risk patients and patients with culture proven CA-MRSA infections.
Journal of drugs in dermatology: JDD 09/2008; 7(8):751-5. · 1.57 Impact Factor
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Murad Alam,
Hayes Gladstone,
Edward M Kramer,
Jack P Murphy,
Keyvan Nouri,
Isaac M Neuhaus, James M Spencer,
Elizabeth Spenceri,
Susan Van Dyke,
Roger I Ceilley,
Ken K Lee,
Gregg Menaker,
Gary D Monheit,
David S Orentreich,
Benjamin Raab,
Kevin C Smith,
Nowell J Solish
Dermatologic Surgery 07/2008; 34 Suppl 1:S115-48. · 1.80 Impact Factor
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Journal of the American Academy of Dermatology 11/2007; 57(4):594-5. · 3.99 Impact Factor
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ABSTRACT: Microdermabrasion is a popular cosmetic procedure for skin rejuvenation, which is achieved by mechanical abrasion of the skin at a superficial level.
The objective was to study the efficacy of microdermabrasion in photoaging and to investigate the compatibility of a cleanser and a lotion with microdermabrasion.
Sixteen women underwent microdermabrasion to the face once a week for a total of six treatments. Subjects were also given a personal skin care regimen (cleanser and lotion). Colorimetry values as well as investigator and patients ratings for safety and efficacy were analyzed at various time points and compared to baseline.
There were no significant changes in safety and tolerance variables throughout the study. Clinical efficacy variables (fine wrinkles, dullness, pigmentation, and large pores) significantly improved by the third treatment, with further improvement by the end of the study (six treatments). Subjects perceived improvement in facial photoaging variables. Colorimetry showed increased brightness and decreased yellowness of target skin sites on the face throughout the study.
Multiple microdermabrasions were effective in significantly improving various facial photoaging variables. The personal skin care regimen used was well tolerated by the subjects.
Dermatologic Surgery 12/2006; 32(11):1353-7. · 1.80 Impact Factor
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Mark S Nestor,
Michael H Gold,
Arielle N B Kauvar,
Amy F Taub,
Roy G Geronemus,
Eva C Ritvo,
Mitchel P Goldman,
Dore J Gilbert,
Donald F Richey,
Tina S Alster, [......],
Alastair Carruthers,
Jean Carruthers,
David J Goldberg,
C William Hanke,
Nicholas J Lowe,
David M Pariser,
Darrell S Rigel,
Perry Robins, James M Spencer,
Brian D Zelickson
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ABSTRACT: Photodynamic therapy (PDT) has significant promise in improving outcomes of patients with a variety of cutaneous conditions. A group of experts met to review the principles, indications, and clinical benefits of PDT with 5-aminolevulinic acid (ALA). They also reviewed PDT with methyl aminolevulinate. The experts established consensus statements for pretreatment, posttreatment, ALA contact time, light sources, and numbers of sessions associated with ALA PDT for actinic keratosis and superficial basal cell carcinoma, photorejuvenation and cosmetic enhancement, acne, sebaceous skin, rosacea, and rhinophyma. They based consensus recommendations on their clinical experience and the medical literature. They also suggested future applications of ALA PDT. Experts concluded that ALA PDT is a safe and effective modality for the treatment of conditions commonly encountered in dermatology. Since downtime is minimal, the technique is suitable for patients of all ages and lifestyles. Appropriate light sources are available in many dermatology offices. The expanding clinical and financial benefits of PDT justify the purchase of an appropriate light source.
Journal of drugs in dermatology: JDD 03/2006; 5(2):140-54. · 1.57 Impact Factor
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ABSTRACT: Basal cell and squamous cell carcinomas both arise in the epidermis of fair-skinned people in response to ultraviolet light, with the overall frequency of basal cell carcinoma being 4 times that of squamous cell carcinoma. Despite the similarities in the population at risk, and the presumed etiology of these tumors, it is unclear if any one individual has a proclivity to develop only one type of tumor.
The study explores whether or not there is a pattern of expression of basal versus squamous cell carcinoma among people with these cancers.
This case-control study involved patients with a total of more than 3 and fewer than 10 basal or squamous cell carcinomas. Patient age and gender, as well as number and location of diagnosed basal and squamous cell carcinomas were gathered and patterns within these values were sought.
Patients found to have at least one basal cell carcinoma tended to produce more basal cell carcinomas and patients found to have at least one squamous cell carcinoma tended to produce more squamous cell carcinomas.
The study supports the possibility that people who develop basal cell carcinoma are more likely to develop more basal cell carcinomas. Similarly, people who develop squamous cell carcinoma are more likely to develop more squamous cell carcinomas.
Journal of drugs in dermatology: JDD 02/2006; 5(1):40-4. · 1.57 Impact Factor
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James M Spencer
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ABSTRACT: Curettage and electrodesiccation (C&D) is a widely used method to treat nodular basal cell carcinoma (BCC). However, residual tumor is present immediately after the procedure in approximately 20 to 40% of cases. Imiquimod, a topical immune response modifier that targets Toll-like receptor 7, is currently approved for superficial BCC.
In a double-blind, vehicle-controlled study, the administration of imiquimod after C&D was investigated to determine if the combination regimen would reduce the frequency of residual tumor compared with C&D alone in patients with nodular BCC.
Twenty patients received three cycles of C&D followed by imiquimod 5% or vehicle cream once daily for 1 month as adjunctive therapy. The primary end point was the frequency of residual tumor. The secondary end points included the time to heal and cosmetic appearance.
Twenty patients were randomized to the imiquimod (n = 10) or vehicle (n = 10) treatment group. At 8 weeks, the proportion of patients with residual tumor was substantially decreased with imiquimod therapy (10%) compared with vehicle (40%). Wounds in the vehicle group healed more quickly than those in the imiquimod group, although by 8 weeks, all excision sites were healed. The majority of scars in the control group were atrophic and hypopigmented, whereas most scars in the imiquimod group were flat and slightly pink.
Imiquimod 5% cream once daily for 1 month as adjunctive therapy after C&D substantially reduced the frequency of residual tumor and improved the cosmetic appearance compared with C&D alone. These preliminary results suggest that further studies to investigate imiquimod adjunctive therapy are warranted.
Dermatologic Surgery 01/2006; 32(1):63-9. · 1.80 Impact Factor
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James M Spencer
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ABSTRACT: Microdermabrasion is a simple, safe, office cosmetic procedure in which aluminum oxide crystals or other abrasive substances are blown onto the face, then vacuumed off, using a single handpiece. This procedure has rapidly become widely utilized for a variety of cosmetic objectives, including the improvement of photoaging, hyperpigmentation, acne, scars and stretch marks. Despite its widespread use, little is known about its actual mechanism of action. The few published studies suggest that patients and physicians alike report a mild benefit when microdermabrasion is utilized for photoaging. Histologic evaluation reveals little actual abrasion of the skin with the procedure, yet changes are seen in the dermis. Given the safety, simplicity and patient satisfaction associated with microdermabrasion, it is likely to remain a popular treatment.
American Journal of Clinical Dermatology 02/2005; 6(2):89-92. · 1.71 Impact Factor
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Henry W Lim,
W Howard Cyr,
Edward DeFabo,
June Robinson,
Martin A Weinstock,
Janusz Z Beer,
Sharon A Miller,
Allan C Halpern,
Vincent A DeLeo,
Darrell Rigel, James M Spencer
Journal of the American Academy of Dermatology 12/2004; 51(5):781-4. · 3.99 Impact Factor
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ABSTRACT: Recent reports show that 308-nm excimer laser may be an effective and safe method for the treatment of vitiligo, which is usually resistant to other available treatment methods.
The objective was to study the effectiveness of the new 308-nm excimer laser for the treatment of vitiligo.
A retrospective chart review of thirty-two patients with 55 spots of vitiligo were enrolled; a population-based sample was studied that included men and women, adults and children, with different ethnic backgrounds. The treatment was started with the lowest dose, which is 100 mJ/cm(2) (comparable to one minimal erythema dose value and one multiplier). Depending on Fitzpatrick skin type, the dose was raised gradually in a stepwise fashion. In skin types I to II, the same does was repeated twice before going up to avoid burns. Patients were treated for 30 sessions, or 75% repigmentation, whichever comes first.
Overall 55 spots were treated: 29 (52.8%) had 75% pigmentation or greater, and 35 (63.7%) had 50% pigmentation or greater. The best results were on the face: of the 21 spots treated 15 (71.5%) had 75% pigmentation, and 16 (76.2%) had 50% pigmentation or greater. Other areas (neck, extremities, trunk, and genitals) had moderate response in comparison to the face. The least response was on the hands and feet; of the 5 spots treated only 20% showed 50% pigmentation or more.
Slightly more than 50% of the patients tested showed 75% or more pigmentation of their lesions, after 30 treatments or less; most of the responders had Fitzpatrick skin type III and above. All the untreated patches (controls) remained unchanged. This demonstrates that the 308-nm excimer laser is an effective method of treatment for vitiligo.
Dermatologic Surgery 08/2004; 30(7):983-6. · 1.80 Impact Factor
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ABSTRACT: Vitiligo is an acquired skin disorder that is characterized by well-defined, often symmetric white patches. Although current therapeutic modalities are directed toward increasing melanocyte melanin production, few treatment modalities address the immunologic nature of the disease.
To determine whether excimer laser, a known therapeutic modality, in combination with tacrolimus, a topical immunomodulator, accelerate response time and/or improve the degree of response in patients with this disorder.
Eight subjects diagnosed with vitiligo were recruited to participate in this institutional review board-approved double-blind, placebo-controlled study. Twenty-four symmetric vitiliginous patches (elbows, knees) from eight subjects received excimer laser treatment three times per week for 24 treatments or 10 weeks. Additionally, topical tacrolimus 0.1% ointment (Protopic) and placebo (Aquaphor) were applied to randomized patches (left or right) twice daily throughout the length of the trial. Vitiliginous patches were monitored with photographs at baseline, every 2 weeks, and 6 months after treatment. Biopsies were performed on subjects with significant results.
Twenty vitiliginous patches from six subjects qualified for evaluation. Fifty percent of patches treated with combination excimer laser and tacrolimus achieved a successful response (75% repigmentation) compared with 20% for the placebo group. Subjects who responded successfully repigmented faster (19%) with combination therapy compared with excimer laser alone. Additionally, three subjects experienced transient hyperpigmentation in lesions treated with combination therapy.
Combining topical immunomodulators with known phototherapeutic modalities may represent a key advancement in the treatment of disease.
Dermatologic Surgery 03/2004; 30(2 Pt 1):130-5. · 1.80 Impact Factor
