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An unusual case of acquired partial lipodystrophy in undifferentiated connective tissue disease: Case report and review
4585
5575
An observational study of the safety and efficacy of tissue stabilized guided subcision—Final data Jeremy Green, MD, Skin Associates of South Florida; Roy Geronemus, MD, Laser & Skin Surgery of New York; Tina Alster, MD, Washington Institute of Dermatologic Laser Surgery; Suzanne Kilmer, MD, Laser and Skin Surgery Center of Northern California; Robert Weiss, MD, Maryland Laser Skin and Vein; Joel Cohen, MD, AboutSkin Dermatology; Michael Kaminer, MD, SkinCare Physicians
An unusual case of acquired partial lipodystrophy in undifferentiated connective tissue disease: Case report and review Emily Guo, BS, Baylor College of Medicine; Zetta Fayos, MD, Washington Hospital Center/Georgetown University; Christine Dewitt, MD, Washington Hospital Center/Georgetown University
Background/Objective: The purpose of this study is to collect observational data on real-life clinical use of a new tissue stabilized-guided subcision device cleared for long-term improvement of the appearance of cellulite. Methods: Fifty-three patients have been enrolled and received treatment. At baseline, D30, D90, and D180 patients completed a questionnaire to assess treatment value, impact on self-confidence and choice of clothing. Questions included rating how cellulite is affecting the clothing you wear and your selfconfidence, and if the improvement in cellulite was worth the cost of the treatment. Global aesthetic improvement scales (GAIS) were completed by the patient and clinician assessing overall aesthetic improvement at D180. Results: 53 adult female patients have been enrolled and treated. 31 patients received anesthetic solution of 0.1% lidocaine HCL and 1:1,000,000 epinephrine or equivalent w/ 10% sodium bicarbonate buffer; 7 patients received this same solution without the buffer. The remaining 15 patients received another solution based on physician’s discretion. Average time for anesthesia delivery and tissue release were 25 and 21 minutes, respectively. 81% (n ¼ 43) received treatment to both the buttocks and thighs, 13% (n ¼ 7) to buttocks only, and 6% (n ¼ 3) to thighs only with average areas treated of 24, 18 and 21 areas, respectively. Averages of perceived value (0 ¼ inexpensive, 5 ¼ price is just right, 10 ¼ expensive) were 5.4 at Baseline (n ¼ 53), and 6.1 at both D30 (n ¼ 50) and D90 (n ¼ 47) and 5.8 at D180 (n ¼ 46) suggesting that the price felt ‘just right’. Quality of Life responses (0 ¼ not at all affects to 10 ¼ very much affects) reflect average scores of 7.4 (baseline), 5.2 (D30), 4.6 (D90) and 5.2 (D180). This shows improvement in patient’s level of selfconfidence over time when compared to baseline. Average clothing choice scores of 4.5 (D30) 4.5 (D90), and 4.8 (D180) shows no impact of cellulite on clothing choices. The subject GAIS was collected at D180 (n ¼ 45) and showed that overall improvement was reported in 91% of subjects. The majority of subjects rated themselves as at least improved (69%. The clinician GAIS collected at D180 showed overall improvement in 96% of these subjects. No serious adverse events were reported. Expected treatment effects were similar to those reported in the pivotal trial supporting FDA clearance. Conclusion: Results indicate this FDA- cleared long-lasting cellulite treatment that takes an average of under one hour is safe and effective in real-life clinical practice. Patients report an increased level of self-confidence after treatment.
Case report: A 62-year-old woman with gout, hypertension, hyperlipidemia, and undifferentiated connective tissue disease (UCTD) came to dermatology clinic for follow up of scalp lesions. Her rheumatologic history was extensive with prior diagnoses of systemic lupus erythematosus (SLE), dermatomyositis (DM), mixed connective tissue disease, and CREST. Most recently, she has been followed by the National Institutes of Health for UCTD. On examination, there were pink atrophic plaques with overlying hair loss on the scalp, hypopigmented macules on the ears, poikiloderma across the upper chest and back, and subtle hyperpigmentation over her dorsal finger joints. Her examination was also particularly significant for marked atrophy of the buccal and malar fat pads, tight skin of her face, and increased prominence of the jaw line at the mandibular angle with prominent loss of adipose tissue and tight skin of the arms. In contrast, she had significant central fat deposition on the trunk. Laboratory findings were significant for chronically elevated CK and a history of positive ANA, however repeat ANA titers have been negative. Clinically she had no muscle weakness. MRI findings have shown tendinosis with no myositis or fasciitis. Discussion: Acquired partial lipodystrophy is characterized by a slow, symmetric progression of fat loss in the face and upper half of the body. It is more common in children and young adults and has a female predominance. On a review of the literature, acquired partial lipodystrophy in association with connective tissue diseases is rare but has been most well described in SLE, especially in association with C3 nephritic factor, hypocomplementemia, and mesangiocapillary glomerulonephritis type II. It has also been relatively well described in juvenile DM and less so in adult DM. There are rare reports in association with discoid lupus erythematosus, scleroderma, UCTD, and rheumatoid arthritis. Commercial support: None identified.
Commercial support: Study and poster sponsored by Ulthera, Inc.
4472 An observational study on patients suffering from atopic dermatitis undergoing a balneotherapy Sophie Seite, PhD, La Roche-Posay Dermatologic Laboratories; Arsene Jeliaskoff, MD, Thermal Care Center La Roche-Posay; Milena Dikova, MD, Thermal Care Center La Roche-Posay Introduction & Objectives: The objective of this survey was to evaluate the efficacy of a balneotherapy at the thermal care center of La Roche-Posay for patients suffering from atopic dermatitis (AD). Methods: Follow-up of 100 atopic patients (53% women, 47% men), 59% less than 16 years old (average age of children 7 years, average age of adults 40 years). At the beginning (before the first care) and at the end of a balneotherapy (D18) including high pressure filiform showers, baths, facial and body spray treatments as well as La Roche-Posay thermal water consumption, evaluations of the severity of AD (SCORAD), of the quality of life (DLQI, CDLQI) and self-assessment (PO-SCORAD) were performed. Results: Different reasons motivated the balneotherapy: erythema, tightness (dryness), itching, sleep problem and/or psychological reason. In average, patients have had 3 previous balneotherapies with an average 5.9 months of subsequent skin benefits and 6.2 months for quality of life improvement. At the end of the 3 weeks balneotherapy, there was an improvement of SCORAD, dropping from 46.8 to 27.8, for 88% of patients, with an intensity of the symptoms dropping from 10.2 to 5.8. There was also a significant improvement of the PO-SCORAD (-37%) with an intensity of symptoms dropping from 10.8 to 6.2. Self-assessment of the quality of life demonstrated a significant improvement of the impact of the disease on the daily activities, relations, leisure, and symptoms and feelings. Conclusions: This study showed that patients presenting atopic dermatitis and particularly disturbed by pruritus and xerosis are significantly improved at the end of a 3 week balneotherapy at La Roche-Posay thermal care center. Commercial support: Author: S. Seite, La Roche-Posay Dermatologic Laboratories, Asnieres, France. Author: R. Martin, L’Oreal Research and Innovation, Tours, France.
JUNE 2017
5187 An unusual case of multiple eruptive syringoma in an African American woman Julie Mireault, MD, Centre Hopsitalier de l’Universite de Montreal (CHUM); Michel Journet, MD, Centre Hopsitalier de l’Universite de Montreal (CHUM) A 55-year-old African American woman presented with a 15-year history of a pruritic papular eruption. She complained mainly of multiple hyperpigmented papules that appeared in successive crops on her face, neck, trunk and upper extremities. Her lesions were pruritic and were exacerbated with perspiration. Her medical history was unremarkable. There was no family history of similar lesions. Upon the first dermatologic consultation, a skin biopsy of a facial lesion was done and showed classic histopathological syringoma. She was treated with intralesional electrocoagulation over a well-defined 5 cm area on her left arm to evaluate her risk of posttreatment dyspigmentation. At one month follow-up, the syringomas had disappeared but there was postinflammatory hyperpigmentation over the area treated. Considering the cosmetic result of the treatment on her face, we decided to observe her residual syringomas. Syringomas are benign adnexal tumors derived from the intraepidermal portion of eccrine sweat ducts. They are seen more frequently in whites and are more common in women than in men. Multiple and eruptive syringomas are uncommon variants of syringoma with lesions occurring predominantly over the trunk and extremities with some distributed over the face and neck. The pathogenesis of eruptive syringoma still remains unclear. The usual clinical presentation consists of an asymptomatic eruption. Available treatments with variable success include electrocoagulation, CO2 laser, retinoid, surgical excision and trichloroacetic acid. This case is unusual in regards to the associated pruritus and the patient’s Fitzpatrick skin type. Commercial support: None identified.
J AM ACAD DERMATOL
AB41
5575
An observational study of the safety and efficacy of tissue stabilized guided subcision—Final data Jeremy Green, MD, Skin Associates of South Florida; Roy Geronemus, MD, Laser & Skin Surgery of New York; Tina Alster, MD, Washington Institute of Dermatologic Laser Surgery; Suzanne Kilmer, MD, Laser and Skin Surgery Center of Northern California; Robert Weiss, MD, Maryland Laser Skin and Vein; Joel Cohen, MD, AboutSkin Dermatology; Michael Kaminer, MD, SkinCare Physicians
An unusual case of acquired partial lipodystrophy in undifferentiated connective tissue disease: Case report and review Emily Guo, BS, Baylor College of Medicine; Zetta Fayos, MD, Washington Hospital Center/Georgetown University; Christine Dewitt, MD, Washington Hospital Center/Georgetown University
Background/Objective: The purpose of this study is to collect observational data on real-life clinical use of a new tissue stabilized-guided subcision device cleared for long-term improvement of the appearance of cellulite. Methods: Fifty-three patients have been enrolled and received treatment. At baseline, D30, D90, and D180 patients completed a questionnaire to assess treatment value, impact on self-confidence and choice of clothing. Questions included rating how cellulite is affecting the clothing you wear and your selfconfidence, and if the improvement in cellulite was worth the cost of the treatment. Global aesthetic improvement scales (GAIS) were completed by the patient and clinician assessing overall aesthetic improvement at D180. Results: 53 adult female patients have been enrolled and treated. 31 patients received anesthetic solution of 0.1% lidocaine HCL and 1:1,000,000 epinephrine or equivalent w/ 10% sodium bicarbonate buffer; 7 patients received this same solution without the buffer. The remaining 15 patients received another solution based on physician’s discretion. Average time for anesthesia delivery and tissue release were 25 and 21 minutes, respectively. 81% (n ¼ 43) received treatment to both the buttocks and thighs, 13% (n ¼ 7) to buttocks only, and 6% (n ¼ 3) to thighs only with average areas treated of 24, 18 and 21 areas, respectively. Averages of perceived value (0 ¼ inexpensive, 5 ¼ price is just right, 10 ¼ expensive) were 5.4 at Baseline (n ¼ 53), and 6.1 at both D30 (n ¼ 50) and D90 (n ¼ 47) and 5.8 at D180 (n ¼ 46) suggesting that the price felt ‘just right’. Quality of Life responses (0 ¼ not at all affects to 10 ¼ very much affects) reflect average scores of 7.4 (baseline), 5.2 (D30), 4.6 (D90) and 5.2 (D180). This shows improvement in patient’s level of selfconfidence over time when compared to baseline. Average clothing choice scores of 4.5 (D30) 4.5 (D90), and 4.8 (D180) shows no impact of cellulite on clothing choices. The subject GAIS was collected at D180 (n ¼ 45) and showed that overall improvement was reported in 91% of subjects. The majority of subjects rated themselves as at least improved (69%. The clinician GAIS collected at D180 showed overall improvement in 96% of these subjects. No serious adverse events were reported. Expected treatment effects were similar to those reported in the pivotal trial supporting FDA clearance. Conclusion: Results indicate this FDA- cleared long-lasting cellulite treatment that takes an average of under one hour is safe and effective in real-life clinical practice. Patients report an increased level of self-confidence after treatment.
Case report: A 62-year-old woman with gout, hypertension, hyperlipidemia, and undifferentiated connective tissue disease (UCTD) came to dermatology clinic for follow up of scalp lesions. Her rheumatologic history was extensive with prior diagnoses of systemic lupus erythematosus (SLE), dermatomyositis (DM), mixed connective tissue disease, and CREST. Most recently, she has been followed by the National Institutes of Health for UCTD. On examination, there were pink atrophic plaques with overlying hair loss on the scalp, hypopigmented macules on the ears, poikiloderma across the upper chest and back, and subtle hyperpigmentation over her dorsal finger joints. Her examination was also particularly significant for marked atrophy of the buccal and malar fat pads, tight skin of her face, and increased prominence of the jaw line at the mandibular angle with prominent loss of adipose tissue and tight skin of the arms. In contrast, she had significant central fat deposition on the trunk. Laboratory findings were significant for chronically elevated CK and a history of positive ANA, however repeat ANA titers have been negative. Clinically she had no muscle weakness. MRI findings have shown tendinosis with no myositis or fasciitis. Discussion: Acquired partial lipodystrophy is characterized by a slow, symmetric progression of fat loss in the face and upper half of the body. It is more common in children and young adults and has a female predominance. On a review of the literature, acquired partial lipodystrophy in association with connective tissue diseases is rare but has been most well described in SLE, especially in association with C3 nephritic factor, hypocomplementemia, and mesangiocapillary glomerulonephritis type II. It has also been relatively well described in juvenile DM and less so in adult DM. There are rare reports in association with discoid lupus erythematosus, scleroderma, UCTD, and rheumatoid arthritis. Commercial support: None identified.
Commercial support: Study and poster sponsored by Ulthera, Inc.
4472 An observational study on patients suffering from atopic dermatitis undergoing a balneotherapy Sophie Seite, PhD, La Roche-Posay Dermatologic Laboratories; Arsene Jeliaskoff, MD, Thermal Care Center La Roche-Posay; Milena Dikova, MD, Thermal Care Center La Roche-Posay Introduction & Objectives: The objective of this survey was to evaluate the efficacy of a balneotherapy at the thermal care center of La Roche-Posay for patients suffering from atopic dermatitis (AD). Methods: Follow-up of 100 atopic patients (53% women, 47% men), 59% less than 16 years old (average age of children 7 years, average age of adults 40 years). At the beginning (before the first care) and at the end of a balneotherapy (D18) including high pressure filiform showers, baths, facial and body spray treatments as well as La Roche-Posay thermal water consumption, evaluations of the severity of AD (SCORAD), of the quality of life (DLQI, CDLQI) and self-assessment (PO-SCORAD) were performed. Results: Different reasons motivated the balneotherapy: erythema, tightness (dryness), itching, sleep problem and/or psychological reason. In average, patients have had 3 previous balneotherapies with an average 5.9 months of subsequent skin benefits and 6.2 months for quality of life improvement. At the end of the 3 weeks balneotherapy, there was an improvement of SCORAD, dropping from 46.8 to 27.8, for 88% of patients, with an intensity of the symptoms dropping from 10.2 to 5.8. There was also a significant improvement of the PO-SCORAD (-37%) with an intensity of symptoms dropping from 10.8 to 6.2. Self-assessment of the quality of life demonstrated a significant improvement of the impact of the disease on the daily activities, relations, leisure, and symptoms and feelings. Conclusions: This study showed that patients presenting atopic dermatitis and particularly disturbed by pruritus and xerosis are significantly improved at the end of a 3 week balneotherapy at La Roche-Posay thermal care center. Commercial support: Author: S. Seite, La Roche-Posay Dermatologic Laboratories, Asnieres, France. Author: R. Martin, L’Oreal Research and Innovation, Tours, France.
JUNE 2017
5187 An unusual case of multiple eruptive syringoma in an African American woman Julie Mireault, MD, Centre Hopsitalier de l’Universite de Montreal (CHUM); Michel Journet, MD, Centre Hopsitalier de l’Universite de Montreal (CHUM) A 55-year-old African American woman presented with a 15-year history of a pruritic papular eruption. She complained mainly of multiple hyperpigmented papules that appeared in successive crops on her face, neck, trunk and upper extremities. Her lesions were pruritic and were exacerbated with perspiration. Her medical history was unremarkable. There was no family history of similar lesions. Upon the first dermatologic consultation, a skin biopsy of a facial lesion was done and showed classic histopathological syringoma. She was treated with intralesional electrocoagulation over a well-defined 5 cm area on her left arm to evaluate her risk of posttreatment dyspigmentation. At one month follow-up, the syringomas had disappeared but there was postinflammatory hyperpigmentation over the area treated. Considering the cosmetic result of the treatment on her face, we decided to observe her residual syringomas. Syringomas are benign adnexal tumors derived from the intraepidermal portion of eccrine sweat ducts. They are seen more frequently in whites and are more common in women than in men. Multiple and eruptive syringomas are uncommon variants of syringoma with lesions occurring predominantly over the trunk and extremities with some distributed over the face and neck. The pathogenesis of eruptive syringoma still remains unclear. The usual clinical presentation consists of an asymptomatic eruption. Available treatments with variable success include electrocoagulation, CO2 laser, retinoid, surgical excision and trichloroacetic acid. This case is unusual in regards to the associated pruritus and the patient’s Fitzpatrick skin type. Commercial support: None identified.
J AM ACAD DERMATOL
AB41