Pyoderma gangrenosum is a rare neutrophilic dermatosis that results in painful cutaneous ulcers and is frequently associated with underlying hematologic disorders, inflammatory bowel disease, or other autoimmune disorder...Pyoderma gangrenosum is a rare neutrophilic dermatosis that results in painful cutaneous ulcers and is frequently associated with underlying hematologic disorders, inflammatory bowel disease, or other autoimmune disorders. Pathogenesis involves an imbalance between proinflammatory and anti-inflammatory mediators, leading to tissue damage from neutrophils. First-line treatment options with the greatest evidence include systemic corticosteroids, cyclosporine, and tumor necrosis factor alpha inhibitors. Other steroid-sparing therapies such as dapsone, mycophenolate mofetil, intravenous immunoglobulin, and targeted biologic or small molecule inhibitors also have evidence supporting their use. Wound care and management of underlying associated disorders are critical parts of the treatment regimen.
Postoperative pyoderma gangrenosum and peristomal pyoderma gangrenosum are 2 subtypes of pyoderma gangrenosum. The diagnosis is made as a clinicopathologic correlation when assessing a rapidly progressing ulcer with irre...Postoperative pyoderma gangrenosum and peristomal pyoderma gangrenosum are 2 subtypes of pyoderma gangrenosum. The diagnosis is made as a clinicopathologic correlation when assessing a rapidly progressing ulcer with irregular and undermined borders following a surgical procedure, trauma, or the creation of a stoma. Familiarity with the associated risk factors and distinguishing features of these disorders can facilitate prompt recognition, proper diagnosis, and the initiation of treatment. Management usually involves the use of corticosteroids and steroid-sparing agents as immunomodulators to shift the inflammatory neutrophilic dermatoses to chronic noninflammatory wounds and eventual healing.
Pyoderma gangrenosum (PG) is an inflammatory neutrophilic dermatosis with variable clinical features. The classic presentation is an ulceration with an erythematous to violaceous undermined border. Extracutaneous manifes...Pyoderma gangrenosum (PG) is an inflammatory neutrophilic dermatosis with variable clinical features. The classic presentation is an ulceration with an erythematous to violaceous undermined border. Extracutaneous manifestations may occur. Associated systemic diseases include inflammatory bowel disease, inflammatory arthritides, and hematologic disorders. The pathophysiologic mechanism of disease is not completely known but likely related to the cumulative impact of inflammation, immune-mediated neutrophilic dysfunction, and genetic predisposition. Incidence is between 3 and 10 people per million but may be greater due to under recognition. In this article, we will discuss the diagnostic criteria, disease subtypes, systemic associations, and workup.
Neutrophilic dermatoses are a group of inflammatory skin conditions characterized by a neutrophilic infiltrate on histopathology with no evidence of infection. These conditions present with a wide range of clinical manif...Neutrophilic dermatoses are a group of inflammatory skin conditions characterized by a neutrophilic infiltrate on histopathology with no evidence of infection. These conditions present with a wide range of clinical manifestations, including pustules, bullae, abscesses, papules, nodules, plaques, and ulcers. The classification of neutrophilic dermatoses is based on the localization of neutrophils in the skin. The pathogenic mechanisms of neutrophilic dermatoses involve autoinflammation, neutrophilic dysfunction, clonal somatic mutation and differentiation of the myeloid precursors as encountered in myeloid neoplasm.
Acute febrile neutrophilic dermatosis, or Sweet syndrome, has been described in 1964 and is now considered as a prototypical condition of the group of the neutrophilic dermatoses. Since this time, many clinical condition...Acute febrile neutrophilic dermatosis, or Sweet syndrome, has been described in 1964 and is now considered as a prototypical condition of the group of the neutrophilic dermatoses. Since this time, many clinical conditions have been included in this group and a clinical-pathological classification in 3 subgroups has been proposed. Neutrophilic infiltrates can localize in all internal organs. This defines the neutrophilic disease, which induces difficult diagnostic and therapeutic problems. Autoinflammation is the main pathophysiological mechanism of the neutrophilic dermatoses. There is a special link between myeloid malignancies (leukemia and myelodysplasia) and the neutrophilic dermatoses.
Cosmetic surgeons have conventionally used the line of ligaments to guide facial lifting or volumizing procedures. However, this line is only partially reliable in determining the limits of the mobile and fixed face, as...Cosmetic surgeons have conventionally used the line of ligaments to guide facial lifting or volumizing procedures. However, this line is only partially reliable in determining the limits of the mobile and fixed face, as the low point of this line was described in front of the movable jowl fat. This article proposes a new understanding of the ligament. To address this concept, the authors entitled this line the functional ligament line. This article links facial anatomy and its changes during movements to the injectable fillers according to their mechanism of action and rheologic properties.
Knowledge of the anatomy of the infraorbital region is key to understanding the full extent of clinically visible infraorbital defects and the underlying structures involved to achieve optimal aesthetic results. The auth...Knowledge of the anatomy of the infraorbital region is key to understanding the full extent of clinically visible infraorbital defects and the underlying structures involved to achieve optimal aesthetic results. The authors have developed a more anatomic approach to the infraorbital region, which has led to recognition of a specific anatomic area, defined previously as the aesthetic G-point. Shifting attention away from the tear trough itself and applying a surgical approach to aesthetic medicine can lead to more natural and complete results while at the same time minimizing the risk of undesired side effects and complications.
Lower eyelid skin is unique and different from that of other areas. In addition to being an area of high exposure to the sun and elements, there are anatomic considerations and specific histologic characteristics that ca...Lower eyelid skin is unique and different from that of other areas. In addition to being an area of high exposure to the sun and elements, there are anatomic considerations and specific histologic characteristics that can cause the skin in this area to be more sensitive. These attributes can readily cause under-eye wrinkling and pigmentation. This review aims to present an updated overview of the current knowledge regarding the clinical characteristics, diagnosis, and management of wrinkles and pigmentation in this area. These disorders are usually caused by different factors, such as genetics, aging, sun exposure, lack of sleep, and stress.
Skin specialists and practitioners are commonly requested to recommend on cosmetic products to improve skin appearance and address certain "non-medical" concerns. During residency and further education, dermatologists ra...Skin specialists and practitioners are commonly requested to recommend on cosmetic products to improve skin appearance and address certain "non-medical" concerns. During residency and further education, dermatologists rarely expand their knowledge regarding cosmetic ingredients, except if they are a cause of medical condition or disease, such as contact dermatitis. This review provides guidelines to the INCI list structure, together with basic principles of cosmetic products formulation.
In recent years, injectables have become increasingly popular in cosmetic procedures. The choice between using a needle or a cannula depends on several factors, including the site of injection, the filler type, the patie...In recent years, injectables have become increasingly popular in cosmetic procedures. The choice between using a needle or a cannula depends on several factors, including the site of injection, the filler type, the patient's preferences, and the practitioner's skills. Although needles are easy to use, cost-effective, and best for treating superficial rhytids, they may cause tissue injury. Cannulas are safer, particularly when injecting deep to the bone, and can provide more even distribution of filler material when filling large zones. An in-depth understanding of the facial anatomy and ongoing training are crucial for practitioners to develop and improve technical abilities.
Botulinum toxin A (BT) is the most required treatment in face rejuvenation. However, applications of BT on the lower third are off-label and specific tips for the treatment of this area should be taken into account to ac...Botulinum toxin A (BT) is the most required treatment in face rejuvenation. However, applications of BT on the lower third are off-label and specific tips for the treatment of this area should be taken into account to achieve best results. In the current study, literature concerning BT treatment of lower face has been revised and summarized according to anatomy and indications, tips, and complications. BT treatment of the lower face has been reported to be effective and safe when performed with adequate knowledge of anatomy and techniques.
Neuromodulator treatment of the upper face has been extensively studied and serves as an excellent tool to enhance facial appearance, non-verbal communication, and social functioning. Optimal outcomes are best achieved w...Neuromodulator treatment of the upper face has been extensively studied and serves as an excellent tool to enhance facial appearance, non-verbal communication, and social functioning. Optimal outcomes are best achieved when health care providers take an individualized approach, based on knowledge of structural and functional anatomy, thorough facial assessment, and customized injection techniques and patterns.
In the nonablative laser field, a new technology that emits a 675-nm wavelength red light is emerging. A literature review was performed to examine its efficacy and safety in the treatment of skin diseases. Various datab...In the nonablative laser field, a new technology that emits a 675-nm wavelength red light is emerging. A literature review was performed to examine its efficacy and safety in the treatment of skin diseases. Various databases were searched (PubMed, Google Scholar, and ClinicalTrials.gov) up to March 2023. Skin aging disorders, melasma, and acne scars were the main diseases discussed in the literature. Although the therapeutic outcomes were variable, all of the studies reported good clinical outcomes. The new 675-nm laser system, targeting collagen, is promising in the treatment of aging-related skin conditions, melasma, and acne scars.
The introduction of selective photothermolysis by Drs. John Parrish and Rox Anderson in 1983 revolutionized how lasers are used in dermatology. The theory allowed for lasers to be used in a variety of applications both s...The introduction of selective photothermolysis by Drs. John Parrish and Rox Anderson in 1983 revolutionized how lasers are used in dermatology. The theory allowed for lasers to be used in a variety of applications both safe and effectively, and the number of applications has only expanded with time. From the first application on vascular birthmarks to more recent applications for acne, this review covers the evolution of lasers from the beginning to where we are headed.
Superficial chemical peels are one of the most popular skin resurfacing procedures in a dermatologists' clinic today due to quick application process, fast recovery, good patient acceptance, and excellent cosmetic result...Superficial chemical peels are one of the most popular skin resurfacing procedures in a dermatologists' clinic today due to quick application process, fast recovery, good patient acceptance, and excellent cosmetic results. The role of various peeling agents like glycolic acid, salicylic acid, trichloroacetic acid, Jessner's solution, retinoic acid, and lactic acid in the management of melasma has been established as that of an additional or maintenance therapy. This article details the current evidence and recommendations for the use of chemical peels in the treatment of melasma, a chronic and recurrent hyperpigmentary disorder.
Chemical peeling is a procedure used for cosmetic improvement of the skin or treatment of some medical skin disorders, by the application of chemical exfoliant. In spite of a long history of clinical use of chemical peel...Chemical peeling is a procedure used for cosmetic improvement of the skin or treatment of some medical skin disorders, by the application of chemical exfoliant. In spite of a long history of clinical use of chemical peels, understanding of the science behind the procedure is still evolving. In this article, we review new concepts, understandings, and publications in the field of chemical peels.
Cellulite is a common cosmetic concern among postpubertal women. Despite its high prevalence, there have been only a few high-quality studies assessing its exact prevalence, risk factors, and pathophysiologic mechanisms....Cellulite is a common cosmetic concern among postpubertal women. Despite its high prevalence, there have been only a few high-quality studies assessing its exact prevalence, risk factors, and pathophysiologic mechanisms. It has been difficult to achieve long-lasting results with the available treatments, including topical agents, energy-based devices, subcision, and injectables. In this review, the authors summarize the proposed etiologic factors, grading scales, and treatment options. Further well-designed studies are essential to improve our knowledge of the condition and lead to improved treatment strategies.
Facial overfilled syndrome is an underdiagnosed aesthetic complication due to multiple incorrect placements of fillers. Facial distortion due to the overfilled syndrome can be exaggerated by facial expressions and moveme...Facial overfilled syndrome is an underdiagnosed aesthetic complication due to multiple incorrect placements of fillers. Facial distortion due to the overfilled syndrome can be exaggerated by facial expressions and movements and worsens with tissue ptosis due to aging. Commonly "produced" by practitioners depending solely on fillers as a single modality for treatment, the overfilled syndrome can be seen among those who had volume overload in the midface, forehead, chin, and nose. Incorrectly placed dermal fillers, poor selection of filler products, overzealous attempts by the injectors, and overly enthusiastic clients who "chase the lines" are the common causes of this phenomenon.
Despite different ethnic origins among Asians, midface enhancement is the most frequent noninvasive procedure for hyaluronic acid injection either as a stand-alone treatment or as part of the pan-facial beautification st...Despite different ethnic origins among Asians, midface enhancement is the most frequent noninvasive procedure for hyaluronic acid injection either as a stand-alone treatment or as part of the pan-facial beautification strategy. Because Asians often have an aesthetically undesirable wide, flat, and short face, improving the projection of midface and midline facial structures is an indispensable aesthetic procedure in creating a smaller facial appearance with better three-dimensionality. Achieving an oval facial shape together with increased facial height is also required in most circumstances for a natural and balanced result.