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Cosmetic and laser procedures are increasingly popular among patients and are skills in which dermatologists are regarded as well trained. Most dermatology residents intend to incorporate cosmetic procedures into their practice and prefer to learn such procedures during residency through direct patient care. However, there are notable challenges in optimizing how residents are trained in cosmetic and laser dermatology. To address these barriers and elevate the practice of cosmetic dermatology in academic medicine, the Association of Academic Cosmetic Dermatology (AACD) was founded in 2021 as the lead professional society for dermatologists who direct the education of resident trainees in cosmetic and laser dermatology. The AACD,a group of board-certified dermatologists who teach cosmetic and laser dermatology to residents, aims to improve cosmetic dermatology education through collaboration, research, and advocacy.

Cosmetic dermatology is a key subspecialty of academic dermatology. As such, academic centers are expected to demonstrate excellence in the teaching of cosmetic dermatology skills to trainees, the clinical delivery of cosmetic dermatology services to patients, and the performance of clinical research that advances knowledge and uncovers new therapies in cosmetic dermatology. The Association of Academic Cosmetic Dermatology (AACD), a newly formed medical professional society, includes as its principal aims the support of all of these areas. AACD is comprised of group of board-certified dermatologists who teach cosmetic and laser dermatology at US dermatology residency programs. An expert panel constituted by the AACD recently convened a workshop to review gaps pertaining to academic cosmetic dermatology. This panel considered needs and potential corrective initiatives in three domains: resident education, patient experience, and clinical research. The work of the panel was used to develop a roadmap, which was adopted by consensus, and which will serve to guide the AACD moving forward.

Background Sarcoidosis is a chronic granulomatous disease of unknown etiology. Cutaneous disease is common and includes two clinicopathologic categories: granulomatous infiltration or a reactive phenomenon. In the granulomatous infiltrative group, clinical manifestations can be variable. Ulcers in sarcoidosis are uncommonly recognized and have been categorized previously under the rubric of atrophic, necrobiosis-like, or ulcerative sarcoidosis. Patients and methods We evaluated retrospectively sarcoidosis patients presenting to the Johns Hopkins Department of Dermatology between June 1989 and May 2002. Multiple skin biopsies were performed for histopathologic evaluation. Investigation for extracutaneous manifestations, including routine serologic assays, chest radiography, pulmonary function tests, electrocardiogram, and angiotensin-converting enzyme level, and referral for ophthalmologic examination were performed in all patients. Results Of 147 consecutive patients presenting with cutaneous sarcoidosis, seven demonstrated ulcerative-atrophic sarcoidosis lesions. All patients were African-American (five females and two males). All patients had ulcers surrounded by atrophic necrobiosis lipoidica-like plaques on the pretibial areas. All patients had other mucocutaneous manifestations of sarcoidosis, with the majority having evidence of internal disease. Combined immunosuppressive and immunomodulatory therapy was effective in controlling the cutaneous manifestations of all patients with ulcerative sarcoidosis. Conclusions The ulcerative variant is a poorly defined subset of cutaneous sarcoidosis. Trauma, superimposed on atrophic plaques, appears to be the principal mechanism of this rare variant of cutaneous sarcoidosis.

Background. When closing surgical defects, optimal aesthetic results are obtained when cosmetic units are preserved and, whenever possible, when scars are placed in naturally occurring creases and folds. This is particularly challenging in the perialar region, where surgical defects can encompass more than one cosmetic subunit. Objective. To examine the reconstructive options and to demonstrate that the crescentic advancement flap for closures of defects in the perialar area is a superior alternative. Methods. This is a review of surgical approaches, a historical examination of perialar repairs, and an illustrative case. Results. A patient with a perialar defect was reconstructed using the crescentic advancement flap with excellent postoperative results. Conclusion. When compared with the other options, whenever feasible, the crescentic advancement flap, which has evolved over the years, remains a superior option for defects in the perialar location.

Background Pediatric pulse dye laser surgery is a low-risk, minimally painful procedure that provides unique challenges to the laser operator. In some centers, all of these procedures are performed under sedation or general anesthesia, which poses a greater risk than the procedure itself. Topical anesthesia has proven to ease the pain associated with these procedures, but anxiety resulting from protective eye wear still poses a major problem in young children. Objective To ease the anxiety of children undergoing brief laser procedures below the head and neck without sedation or general anesthesia by allowing interaction between parents and the patient during the procedure. Methods A standard hospital-issue 142 thread, 75% cotton/25% polyester sheet is doubled and clamped above the head of the treatment table. Forming a tent, it is draped over the patient's head and neck area while also covering the parent who is positioned beside the child. All patients also use topical anesthesia 1 to 2 hours before the procedure. Results The parent–child tent has been used in selected pediatric laser surgery patients at our institution over the past 7 years with great success and without any complications. Conclusions For brief laser procedures below the head and neck areas, the parent–child tent, which can be made from readily available materials, reduces the stress to both patient and parent and may obviate the need for further sedation or anesthesia.

Stephanie A. St Pierre, MD; Jennee Rommel, MD; Ana Ciurea, MD; Douglas Fife, MD; Simon S. Yoo, MD; Mary Martini, MD; Timothy M. Kuzel, MD; Jeffrey Wayne, MD; Alfred Rademaker, PhD; Dennis P. West, PhD; Murad Alam, MD; Department of Dermatology (Drs St Pierre, Yoo, Martini, and West) and Robert H. Lurie Comprehensive Cancer Center (Drs Yoo, Martini, Kuzel, Wayne, Rademaker, West, and Alam), Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Dermatology and Department of Medicine, Washington Hospital Center, Washington, DC (Dr Rommel); Department of Dermatology, MD Anderson Cancer Center, Houston, Texas (Dr Ciurea); Surgical Dermatology and Laser Center, Las Vegas, Nevada (Dr Fife); and Division of Hematology-Oncology (Dr Kuzel), Division of Surgical Oncology (Dr Wayne), and Department of Preventive Medicine (Dr Rademaker) and Dermatology (Dr Alam), Northwestern University, Chicago

To assess the strength of 2.0 barbed polypropylene suture, and, specifically, to determine the load required to break this suture, and to compare this with the strength of nonbarbed polypropylene suture.Rater-blinded, controlled trial. The individual responsible for setting up the experimental conditions was not blinded.Biomechanics laboratory in an academic medical center.This study did not include human subjects. Materials used included six 2.0 barbed polypropylene sutures and 3 each of 2.0, 3.0, 4.0, and 5.0 nonbarbed polypropylene sutures. Each suture was randomly selected from a different batch or box of similar sutures.Each suture was strung between 2 (top and bottom) cylinders and tied with a surgeon's knot. A tensile testing device was used to apply increasing force until the suture broke. Data were acquired through an analog-to-digital board on an IBM-compatible computer using commercially available software.Ultimate strength, stiffness, and elongation before suture rupture.Strength of the barbed sutures (mean [SD] ultimate strength, 39.5 [9.0] N) was intermediate between that of 2.0 (55.0 N) and 3.0 (36.4 N) nonbarbed sutures and was not significantly different from that of 3.0 nonbarbed sutures (P = .5). Barbed 2.0 polypropylene sutures differed significantly (P.001) from each of the other types of nonbarbed sutures on measures of stiffness and elongation. Elongation of barbed sutures was closest to that of 3.0 nonbarbed sutures (P = .002). Stiffness of the barbed sutures (mean [SD], 4.7 [0.7] N/mm) was markedly in excess of that of any of the other suture types (P.001).Barbed 2.0 polypropylene sutures seem to be at least as strong as 3.0 nonbarbed polypropylene sutures. As such, barbed sutures are significantly stronger than their rated strength, which has been stated as comparable to 4.0 nonbarbed sutures. This has implications for the long-term in vivo safety of barbed sutures.

Cryptococcal infections are seen mainly in immunocompromised hosts. The cutaneous manifestations of infection can include papules, plaques, nodules, vesicles, ulcers, ecchymosis, and, rarely, cellulitis. Cryptococcal meningitis is a life-threatening complication of this disease. Pemphigus vulgaris is a rare auto-immune blistering disease that can also be life-threatening. Treatment of pemphigus commonly entails both corticosteroids and steroid-sparing agents. We present a case of disseminated cryptococcal infection in a patient with pemphigus vulgaris treated with high dose corticosteroids as monotherapy. This case provides an opportunity to discuss the difficulty of managing two potentially mortal conditions in which the treatment of pemphigus vulgaris may exacerbate the disseminated cryptococcal infection.

Cutaneous T-cell lymphoma includes a heterogeneous group of lymphomas that share the unique feature of T lymphocytes which are tropic to the skin. Clinically, the presentation of this disease is protean and can range from a single lesion to generalized erythroderma. Unilesional mycosis fungoides, a rare variant, is presented here. Its morphology mimicked squamous cell carcinoma in situ, and was refractory to conventional therapies. A review of the treatment of this subset is also presented.