- Email: [email protected]
A method to measure skin surface temperature real-time during use of warming cleansers
5378
5113
A four-year retrospective assessment of postoperative complications associated with Mohs micrographic surgery in immunosuppressed patients Pallavi Basu, BS, School of Medicine, University of California San Diego; Alina Goldenberg, MD, Department of Dermatology, University of California San Diego; Natasha Cowan, BS, School of Medicine, University of California San Diego; Robert Eilers, MD, Department of Dermatology, University of California San Diego; Jennifer Hau, MD, Department of Dermatology, University of California San Diego; Shang I. Brian Jiang, MD, Department of Dermatology, University of California San Diego
A metaanalysis exploring the relationship between PASI 75, PASI 100, and DLQI Kathryn T. Shahwan, MD, Massachusetts General Hospital, Harvard Medical School; Lisette M. Prens, BS, Massachusetts General Hospital; Alexa B. Kimball, MD, Beth Israel Deaconess Medical Center, Harvard Medical School
Purpose: Complication rates in dermatologic surgery are reported to be low. However, certain patient characteristics, including immunosuppressed (IS) status, may increase risk for post-operative (PO) complications including infection, bleeding, and necrosis. IS patients tend to develop more aggressive carcinomas, leading to greater PO defect size, procedure duration and risk of infection. This study aims to assess the PO complication rates associated with Mohs micrographic surgery (MMS) for IS patients compared to immunocompetent (IC) patients. Design: This is a retrospective cross-sectional chart review of all MMS cases from July 2011 to June 2015 with a biopsy-proven diagnosis of a NMSC. Complication was defined as any adverse event reported within 2 weeks of MMS, directly related to the procedure. IS state was assigned to patients who were solid organ transplant recipients (SOTR), on chronic immunosuppressive therapy use, or had a diagnosis of leukemia, lymphoma or HIV. Data were analyzed via independent t test, Fischer exact test, and logistic regression model. Summary We included 4151 MMS cases, 693 of which involved IS patients. Overall IS status was associated with 9.6 times the odds of having a PO complication (P ¼ .003). Among IS subtypes, SOTR had 8.824 times the odds of PO complication compared to all other IC cases (P ¼.006), while hematologic malignancy or HIV-positive status did not predict significantly higher odds. In particular, those with heart transplant had 7.89 times higher odds of PO complication compared to IC cases. Immunosuppressive therapy use was associated with 5.775 times the odds of PO complication (P ¼ .021), where sirolimus and tacrolimus displayed 18 and 9 times higher odds, respectively (P \ .001, .007). Logistic regression adjustment showed age, SCC diagnosis, zone 3 location, history of alcohol use, and IS state to be significant predictors for PO complication. Conclusion: IS patients are not only at higher risk for multiple, aggressive NMSCs, but may be at increased risk for overall PO complication following MMS. Specifically, SOTR and patients on immunosuppressive medications have a significantly higher chance of developing PO complication while patients with HIV or hematologic malignancies do not, compared to IC patients. In particular, heart transplant recipients or patients on sirolimus or tacrolimus may benefit from postprocedure infection prophylaxis as well as careful management and repair to avoid necrosis or hematoma.
Introduction: The introduction of highly effective biologic drugs to treat psoriasis has made complete skin clearance into an achievable goal. The incremental impact on quality of life, however, remains less known. A recent pooled data analysis revealed that subjects achieving PASI 100 were significantly more likely to achieve a DLQI score of 0 or 1, however this analysis only included phase III trials for brodalumab. We performed a metaanalysis to explore the relationship between PASI 75, PASI 100, and DLQI on a larger scale. Methods: A metaanalysis was performed in accordance with PRISMA guidelines. An electronic search was conducted in PubMed using the terms ‘‘psoriasis,’’ a list of systemic therapies used to treat psoriasis, and ‘‘quality of life.’’ Filters limiting the results to ‘‘Clinical Trials’’ and ‘‘Humans’’ were also placed. Articles were selected using the following criteria: randomized trials using systemic therapies to treat adults with moderate to severe plaque psoriasis. Relevant publications were also found by searching reference lists. PASI 75 and PASI 100 rates, as well as average percent reduction in DLQI, were abstracted from each article. A regression analysis was then performed with PASI 75 and PASI 100 as the independent variables, and percent decrease in DLQI as the dependent variable. Results: A total of 14 trials, reported in 12 articles, met inclusion criteria and were included in the analysis (n ¼ 7266 patients). The average DLQI score at baseline was 13.38 (95% CI, 12.43-14.33). The regression analysis revealed that 66% of the variation in DLQI change was attributable to PASI 75 and PASI 100 rates. Individually, PASI 75 significantly correlated with change in DLQI (P \.05), whereas PASI 100 did not (P ¼ .43). Discussion: The results of this metaanalysis reveal that PASI 75 is the most important significant predictor of DLQI improvement. An incremental value of a PASI 100 for the overall population could not be detected in this analysis and needs to be further explored. Commercial support: None identified.
Commercial support: None identified.
5736 A method to measure skin surface temperature real-time during use of warming cleansers Gregory Peterson, PhD, L’Oreal; Rachel Cvetkovich, L’Oreal; Matthew Winterscheid, L’Oreal; Michael Kearney, L’Oreal; Alexandra Skinner, L’Oreal; Katherine Ortblad, MPA, L’Oreal
EhlerseDanlos syndrome is a group of heritable disorders of the connective tissue. Six subtypes have been identified. Hypermobility type, previously classified as type III, is the most common. Genes involved in the development and of the extracellular matrix of many tissues are affected. Individuals with EhlerseDanlos syndrome, hypermobility type have hyperextensible joint, with various skin findings including atrophic scars. We report a case of hypertrophic scar formation in a patient with EhlerseDanlos syndrome, hypermobility type. Treatment for EhlerseDanlos syndrome, hypermobility type is supportive with pain management, as there is no cure. Treatment of hypertrophic scars include, compression bandages, a wide variety of topical medications, intralesional medications, as well as lasers.
Background: Cleansing the skin is an important step to remove dirt/debris, accumulated sebum/oil, and makeup from its surface. A segment of the cleanser market includes cleansers that provide a warming sensation during use. The sensation can either be created through sensory-only effects (eg, capsaicin, salicylates, etc.) or through an exothermic reaction when an anhydrous cleanser with warming agent (eg, zeolites or magnesium sulfate) is exposed to water upon use. In order to better understand the latter, a methodology was developed to assess the extent of temperature change of a warming cleanser. Objective: To assess the extent of warming using a warming cleanser cleansed with sonic cleansing (SC) and manual cleansing (MC) compared to a non-treatment control site (NTC). Methods: Thirty women between the ages of 18-65 were enrolled in a single visit study using the volar surface of the forearm; three test sites were identified. Test sites 1 & 2 were randomized to a cleansing method (SC, MC); test site 3 was always the NTC. A thermocouple temperature sensor was secured to each test site (using a transparent wound healing film); temperature was measured (with data logger) at a rate of 4 readings per second. Each test site was cleansed for 15 seconds using the randomized cleansing method and equal amounts of water and warming cleanser. An additional study compared the SC and MC with a nonwarming cleanser. Results: With application of cleanser and water, the temperature at both test sites quickly cooled to approximately 1.28C (2.28F) below that of the NTC site (prior to the exothermic reaction taking place), warmed to a peak temperature [2.98C (5.38F) and 1.78C (38F) above the NTC site for the SC and MC, respectively], and then cooled following a bell-shaped curve. The average change in temperature (difference between peak and lowest temperatures at the treatment sites) were 4.28C (7.58F) for the warming cleanser with SC compared to 2.58C (4.58F) for the warming cleanser with MC (P \.01). The warming effect (temperature above the NTC, P # .05) lasted longer at the SC site (19.5 seconds) compared to the MC site (14 seconds). Using a nonwarming cleanser, neither the MC nor SC increased skin surface temperature alone.
Commercial support: None identified.
Commercial support: 100% is Sponsored by L’Oreal Beauty Devices.
4512 A hypertrophic scar in a patient with hypermobility type, EhlerseDanlos syndrome Ganary Dabiri, MD, Roger Williams Medical Center; Todd Vinovrski, MD, New England Tissue Issue; Jessica Kirk, MD, Roger Williams Medical Center
JUNE 2017
J AM ACAD DERMATOL
AB15
5113
A four-year retrospective assessment of postoperative complications associated with Mohs micrographic surgery in immunosuppressed patients Pallavi Basu, BS, School of Medicine, University of California San Diego; Alina Goldenberg, MD, Department of Dermatology, University of California San Diego; Natasha Cowan, BS, School of Medicine, University of California San Diego; Robert Eilers, MD, Department of Dermatology, University of California San Diego; Jennifer Hau, MD, Department of Dermatology, University of California San Diego; Shang I. Brian Jiang, MD, Department of Dermatology, University of California San Diego
A metaanalysis exploring the relationship between PASI 75, PASI 100, and DLQI Kathryn T. Shahwan, MD, Massachusetts General Hospital, Harvard Medical School; Lisette M. Prens, BS, Massachusetts General Hospital; Alexa B. Kimball, MD, Beth Israel Deaconess Medical Center, Harvard Medical School
Purpose: Complication rates in dermatologic surgery are reported to be low. However, certain patient characteristics, including immunosuppressed (IS) status, may increase risk for post-operative (PO) complications including infection, bleeding, and necrosis. IS patients tend to develop more aggressive carcinomas, leading to greater PO defect size, procedure duration and risk of infection. This study aims to assess the PO complication rates associated with Mohs micrographic surgery (MMS) for IS patients compared to immunocompetent (IC) patients. Design: This is a retrospective cross-sectional chart review of all MMS cases from July 2011 to June 2015 with a biopsy-proven diagnosis of a NMSC. Complication was defined as any adverse event reported within 2 weeks of MMS, directly related to the procedure. IS state was assigned to patients who were solid organ transplant recipients (SOTR), on chronic immunosuppressive therapy use, or had a diagnosis of leukemia, lymphoma or HIV. Data were analyzed via independent t test, Fischer exact test, and logistic regression model. Summary We included 4151 MMS cases, 693 of which involved IS patients. Overall IS status was associated with 9.6 times the odds of having a PO complication (P ¼ .003). Among IS subtypes, SOTR had 8.824 times the odds of PO complication compared to all other IC cases (P ¼.006), while hematologic malignancy or HIV-positive status did not predict significantly higher odds. In particular, those with heart transplant had 7.89 times higher odds of PO complication compared to IC cases. Immunosuppressive therapy use was associated with 5.775 times the odds of PO complication (P ¼ .021), where sirolimus and tacrolimus displayed 18 and 9 times higher odds, respectively (P \ .001, .007). Logistic regression adjustment showed age, SCC diagnosis, zone 3 location, history of alcohol use, and IS state to be significant predictors for PO complication. Conclusion: IS patients are not only at higher risk for multiple, aggressive NMSCs, but may be at increased risk for overall PO complication following MMS. Specifically, SOTR and patients on immunosuppressive medications have a significantly higher chance of developing PO complication while patients with HIV or hematologic malignancies do not, compared to IC patients. In particular, heart transplant recipients or patients on sirolimus or tacrolimus may benefit from postprocedure infection prophylaxis as well as careful management and repair to avoid necrosis or hematoma.
Introduction: The introduction of highly effective biologic drugs to treat psoriasis has made complete skin clearance into an achievable goal. The incremental impact on quality of life, however, remains less known. A recent pooled data analysis revealed that subjects achieving PASI 100 were significantly more likely to achieve a DLQI score of 0 or 1, however this analysis only included phase III trials for brodalumab. We performed a metaanalysis to explore the relationship between PASI 75, PASI 100, and DLQI on a larger scale. Methods: A metaanalysis was performed in accordance with PRISMA guidelines. An electronic search was conducted in PubMed using the terms ‘‘psoriasis,’’ a list of systemic therapies used to treat psoriasis, and ‘‘quality of life.’’ Filters limiting the results to ‘‘Clinical Trials’’ and ‘‘Humans’’ were also placed. Articles were selected using the following criteria: randomized trials using systemic therapies to treat adults with moderate to severe plaque psoriasis. Relevant publications were also found by searching reference lists. PASI 75 and PASI 100 rates, as well as average percent reduction in DLQI, were abstracted from each article. A regression analysis was then performed with PASI 75 and PASI 100 as the independent variables, and percent decrease in DLQI as the dependent variable. Results: A total of 14 trials, reported in 12 articles, met inclusion criteria and were included in the analysis (n ¼ 7266 patients). The average DLQI score at baseline was 13.38 (95% CI, 12.43-14.33). The regression analysis revealed that 66% of the variation in DLQI change was attributable to PASI 75 and PASI 100 rates. Individually, PASI 75 significantly correlated with change in DLQI (P \.05), whereas PASI 100 did not (P ¼ .43). Discussion: The results of this metaanalysis reveal that PASI 75 is the most important significant predictor of DLQI improvement. An incremental value of a PASI 100 for the overall population could not be detected in this analysis and needs to be further explored. Commercial support: None identified.
Commercial support: None identified.
5736 A method to measure skin surface temperature real-time during use of warming cleansers Gregory Peterson, PhD, L’Oreal; Rachel Cvetkovich, L’Oreal; Matthew Winterscheid, L’Oreal; Michael Kearney, L’Oreal; Alexandra Skinner, L’Oreal; Katherine Ortblad, MPA, L’Oreal
EhlerseDanlos syndrome is a group of heritable disorders of the connective tissue. Six subtypes have been identified. Hypermobility type, previously classified as type III, is the most common. Genes involved in the development and of the extracellular matrix of many tissues are affected. Individuals with EhlerseDanlos syndrome, hypermobility type have hyperextensible joint, with various skin findings including atrophic scars. We report a case of hypertrophic scar formation in a patient with EhlerseDanlos syndrome, hypermobility type. Treatment for EhlerseDanlos syndrome, hypermobility type is supportive with pain management, as there is no cure. Treatment of hypertrophic scars include, compression bandages, a wide variety of topical medications, intralesional medications, as well as lasers.
Background: Cleansing the skin is an important step to remove dirt/debris, accumulated sebum/oil, and makeup from its surface. A segment of the cleanser market includes cleansers that provide a warming sensation during use. The sensation can either be created through sensory-only effects (eg, capsaicin, salicylates, etc.) or through an exothermic reaction when an anhydrous cleanser with warming agent (eg, zeolites or magnesium sulfate) is exposed to water upon use. In order to better understand the latter, a methodology was developed to assess the extent of temperature change of a warming cleanser. Objective: To assess the extent of warming using a warming cleanser cleansed with sonic cleansing (SC) and manual cleansing (MC) compared to a non-treatment control site (NTC). Methods: Thirty women between the ages of 18-65 were enrolled in a single visit study using the volar surface of the forearm; three test sites were identified. Test sites 1 & 2 were randomized to a cleansing method (SC, MC); test site 3 was always the NTC. A thermocouple temperature sensor was secured to each test site (using a transparent wound healing film); temperature was measured (with data logger) at a rate of 4 readings per second. Each test site was cleansed for 15 seconds using the randomized cleansing method and equal amounts of water and warming cleanser. An additional study compared the SC and MC with a nonwarming cleanser. Results: With application of cleanser and water, the temperature at both test sites quickly cooled to approximately 1.28C (2.28F) below that of the NTC site (prior to the exothermic reaction taking place), warmed to a peak temperature [2.98C (5.38F) and 1.78C (38F) above the NTC site for the SC and MC, respectively], and then cooled following a bell-shaped curve. The average change in temperature (difference between peak and lowest temperatures at the treatment sites) were 4.28C (7.58F) for the warming cleanser with SC compared to 2.58C (4.58F) for the warming cleanser with MC (P \.01). The warming effect (temperature above the NTC, P # .05) lasted longer at the SC site (19.5 seconds) compared to the MC site (14 seconds). Using a nonwarming cleanser, neither the MC nor SC increased skin surface temperature alone.
Commercial support: None identified.
Commercial support: 100% is Sponsored by L’Oreal Beauty Devices.
4512 A hypertrophic scar in a patient with hypermobility type, EhlerseDanlos syndrome Ganary Dabiri, MD, Roger Williams Medical Center; Todd Vinovrski, MD, New England Tissue Issue; Jessica Kirk, MD, Roger Williams Medical Center
JUNE 2017
J AM ACAD DERMATOL
AB15