BACKGROUND/OBJECTIVE: Fractional ablative CO2 laser is an effective treatment for hypertrophic scars (HTS) and can enhance topical drug penetration through laser-assisted drug delivery. Although intralesional triamcinolo...BACKGROUND/OBJECTIVE: Fractional ablative CO2 laser is an effective treatment for hypertrophic scars (HTS) and can enhance topical drug penetration through laser-assisted drug delivery. Although intralesional triamcinolone is a standard treatment for HTS, it is associated with more adverse effects than topical steroids and has limited applicability for large scars. PATIENTS AND METHODS: This single-institution, prospectively collected, retrospective chart review included 55 patients who underwent laser-assisted drug delivery treatment of either triamcinolone alone or a combination of triamcinolone and 5-fluorouracil. Scars were assessed using 4 subjective scales and objective firmness measurements. RESULTS: Both groups demonstrated significant reductions in scar assessment scores after 3 treatments, but there were no significant differences between the 2 treatment modalities. However, comparisons of baseline with posttreatment scores showed greater improvement in the combination group, suggesting a potential but not statistically significant advantage of combination therapy. CONCLUSION: Although both groups exhibited improvements in scar outcomes, neither showed significant improvement between groups, suggesting clinical effectiveness without clear superiority. In addition, there were equivocal differences in variables representing adverse effects. Given the comparable efficacy and adverse effects, this study suggests that adding 5-fluorouracil to triamcinolone may not be warranted in laser-assisted drug delivery treatment of hypertrophic scar.
BACKGROUND: Historically, geographic disparities have reduced access to Mohs surgery across various regions of the United States. OBJECTIVE: To assess nationwide distribution of Mohs surgeons over time, compared to state...BACKGROUND: Historically, geographic disparities have reduced access to Mohs surgery across various regions of the United States. OBJECTIVE: To assess nationwide distribution of Mohs surgeons over time, compared to state census data and average number of Mohs stages. MATERIALS AND METHODS: A cross-sectional analysis was performed using the Medicare Public Use Files for 2013 and 2023. RESULTS: From 2013 to 2023, there was an overall national increase (+13.76%) in number of Mohs surgeons per capita. Only District of Columbia (-4.79%), MN (-11.20%), ND (-7.72%), RI (-4.06%), SC (-8.26%), SD (-21.23%), TN (-12.81%), VT (-3.05%), and WV (-9.73%) exhibited decreases in Mohs surgeons per capita. All these experienced either no change or a decrease in Mohs surgeon number while census increased, except for SC, in which population growth outpaced Mohs surgeon number growth. Most states also experienced a decrease in numbers of Mohs stages performed over time. Only HI, ME, and NE exhibited increases in number of stages on all anatomic sites. AL (+1.14%), ID (+6.59%), KS (+0.33%), MS (+7.05%), MT (+2.24%), and UT (+6.71%) exhibited increases in Mohs stages on the trunk/extremities only. CONCLUSION: National per capita access to Mohs surgeons has increased while number of Mohs surgery stages have decreased over the last decade of Medicare data.
BACKGROUND: Blepharoptosis, or drooping of the upper eyelid, is commonly encountered by dermatologic surgeons due to aging, medical conditions, periocular procedures, and/or inadvertent neurotoxin administration. Proper...BACKGROUND: Blepharoptosis, or drooping of the upper eyelid, is commonly encountered by dermatologic surgeons due to aging, medical conditions, periocular procedures, and/or inadvertent neurotoxin administration. Proper recognition and management are critical for both functional and cosmetic outcomes. OBJECTIVE: To review clinically relevant anatomy, diagnostic evaluation, and nonsurgical treatments for acquired ptosis, emphasizing considerations specific to dermatologic practice. MATERIALS AND METHODS: A literature review of PubMed and Embase identified English-language studies and clinical trials addressing the diagnosis and management of blepharoptosis, with emphasis on nonsurgical and dermatologic applications. RESULTS: Key diagnostic tools include the marginal reflex distance 1, levator function testing, and standardized preprocedure and postprocedure photography. Oxymetazoline 0.1% demonstrates modest but statistically significant improvement in marginal reflex distance 1 and superior visual field improvement in randomized trials. Off-label adrenergic agents and targeted pretarsal botulinum toxin injections may offer adjunctive benefits, although supporting evidence is limited. CONCLUSION: Dermatologic surgeons are positioned to identify and manage mild acquired ptosis using validated metrics and nonsurgical options. Selective botulinum toxin placement can be considered in selected cases; supporting evidence remains limited. Appropriately identifying cases that need referral for surgical repair will also benefit patient care by improving vision, daily function, and cosmesis.
BACKGROUND: Being chronic, combination therapies in vitiligo are beneficial, especially in refractory cases. Fractional CO2 laser (FCL) delivery of 5-fluorouracil (5-FU) has been successful in stable vitiligo. Topical me...BACKGROUND: Being chronic, combination therapies in vitiligo are beneficial, especially in refractory cases. Fractional CO2 laser (FCL) delivery of 5-fluorouracil (5-FU) has been successful in stable vitiligo. Topical methotrexate (MTX) is a potential, safer alternative to systemic route in vitiligo. OBJECTIVE: To investigate efficacy/safety of FCL with MTX versus 5-FU in stable vitiligo, and to assess serum and lesional interleukin (IL)-23 as possible therapeutic markers. MATERIALS AND METHODS: A total of 42 patients with vitiligo were enrolled. FCL was applied at 50 and 100 mJ energies, followed by topical MTX in group I and 5-FU in group II for 3-monthly sessions. Modified Vitiligo Area Scoring Index (VASI) and photography evaluated response, along with evaluation of serum and lesional interleukin-23 (IL-23). RESULTS: Both MTX and 5-FU with FCL produced significant reductions, without difference, in VASI. All groups exhibited considerable repigmentation by photography, with earlier response in higher energy FCL+5-FU after treatment and continuous improvement in FCL + MTX at follow-up. Post-treatment reductions in serum and lesional IL-23 occurred in all groups, with greater decrease in serum IL-23 with MTX and lesional IL-23 with higher-energy FCL. CONCLUSION: MTX provides comparable efficacy and safety with 5-FU after FCL for stable, nonsegmental vitiligo. IL-23 is a new treatment biomarker in vitiligo.
BACKGROUND: Second intention healing is a frequent choice after dermatologic surgery, but prolonged wound care and daily dressings can pose practical challenges for patients. Tissue adhesives offer a low-maintenance alte...BACKGROUND: Second intention healing is a frequent choice after dermatologic surgery, but prolonged wound care and daily dressings can pose practical challenges for patients. Tissue adhesives offer a low-maintenance alternative; however, their role in second intention healing remains underexplored. OBJECTIVE: To evaluate the efficacy of n-butyl cyanoacrylate tissue adhesive on second intention healing compared with the standard of care using petroleum-based dressings. METHODS: In this randomized controlled trial, 47 patients with postoperative wounds of the hands, feet, or genital region after Mohs micrographic surgery or excision received standard of care (n = 22) or tissue adhesive (n = 25). At 2 weeks postoperation, the tissue adhesive group was rerandomized to receive standard of care (n = 13) or tissue adhesive (n = 12). All patients received standard of care for the remainder of the study. Re-epithelialization, postoperative complications, and patient satisfaction were recorded at the 2-, 4-, and 12-week postoperative follow-up visits. RESULTS: Re-epithelialization, postoperative complication rates, and patient satisfaction scores were comparable among groups (p > .05). CONCLUSION: Tissue adhesive is a viable alternative to the standard of care for second intention healing, simplifying postoperative management without compromising healing outcomes or patient satisfaction.