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Context: High nevus density is a risk factor for cutaneous malignant melanoma. Melanocytic nevi originate in childhood and are largely caused by solar exposure.Objective: To determine whether use of broad-spectrum, high-sun protection factor (SPF) sunscreen attenuates development of nevi in white children.Design: Randomized trial conducted June 1993 to May 1996.Setting and Participants: A total of 458 Vancouver, British Columbia, schoolchildren in grades 1 and 4 were randomized in 1993. After exclusion of nonwhite children and those lost to follow-up or with missing data, 309 children remained for analysis. Each child's nevi were enumerated at the start and end of the study in 1996.Intervention: Parents of children randomly assigned to the treatment group (n=222) received a supply of SPF 30 broad-spectrum sunscreen with directions to apply it to exposed sites when the child was expected to be in the sun for 30 minutes or more. Children randomly assigned to the control group (n=236) received no sunscreen and were given no advice about sunscreen use.Main Outcome Measure: Number of new nevi acquired during the 3 years of the study, compared between treatment and control groups.Results: Children in the sunscreen group developed fewer nevi than did children in the control group (median counts, 24 vs 28; P=.048). A significant interaction was detected between freckling and study group, indicating that sunscreen use was much more important for children with freckles than for children without. Modeling of the data suggests that freckled children assigned to a broad-spectrum sunscreen intervention would develop 30% to 40% fewer new nevi than freckled children assigned to the control group.Conclusions: Our data indicate that broad-spectrum sunscreens may attenuate the number of nevi in white children, especially if they have freckles. JAMA. 2000. [ABSTRACT FROM AUTHOR]

Introduction: Fractional CO 2 laser therapy is used to treat fibrosing conditions similar to Peyronie's disease (PD). The aim of the study was to evaluate the safety and efficacy of using a fractional CO 2 laser in the management of chronic phase PD., Methods: This was a single-site, non-randomized, open-label study using a fractional CO 2 laser. Subjects underwent three treatment sessions every six weeks with a fractional CO 2 device. Topical triamcinolone was applied immediately after each treatment. Between treatments, patients performed penile modeling three times daily. Penile curvature assessments, self-reported questionnaires, and adverse event screenings were completed at baseline, 24 weeks, and 52 weeks., Results: Five patients were included in the study. The median baseline penile curvature was 37.0° (interquartile range [IQR] 33.0°, 53.0°), and at 52 weeks, this had reduced to a median curvature of 28.0° (IQR 17.50°, 44.0°, p=0.03), representing a median reduction in penile curvature by 24.3% (IQR 17.0%, 47.5%). The International Index of Erectile Function Overall scores were comparable at baseline and at 52 weeks (median 59.0, IQR 42.5, 66.5 vs. median 60.0, IQR 53.5, 70.0 respectively, p=0.81). Patients did report significant improvement in overall Peyronies' Disease Questionnaire scores from baseline to 52 weeks after laser treatment (median 26.0, IQR15.0, 29.5, vs. median 14.0, IQR 7.0, 22.50, respectively, p=0.03). Four patients reported self-limiting side effects immediately after laser therapy that resolved spontaneously within two weeks., Conclusions: With encouraging results at 52 weeks, fractional CO 2 laser therapy may serve as a well-tolerated and minimally invasive therapy for PD in the future.

Background: Panfacial treatment has the potential to positively impact psychosocial and emotional well-being., Objectives: The Canada HARMONY study evaluated the satisfaction and psychosocial impact of comprehensive, multimodal aesthetic treatment of the face and submental area from the patient perspective., Methods: Over 12 months, all patients ( N = 58) sequentially received treatment with hyaluronic acid (HA) fillers, onabotulinumtoxinA, and medical-grade skincare products, and eligible patients ( n = 13) also received ATX-101. The primary endpoint was the change from baseline on the FACE-Q Satisfaction with Facial Appearance Scale. Secondary endpoints included the following assessments: FACE-Q Expectations of Life Change, Psychological Function, Social Function, Satisfaction with Skin, and Aging Appraisal Scales; Global Aesthetic Improvement Scale (GAIS); and the Periorbital Aesthetic Appearance Questionnaire (PAAQ). Safety was monitored throughout the study., Results: Baseline FACE-Q Expectations of Life Change scores indicated realistic treatment expectations. Significant improvements from baseline were observed on the FACE-Q Satisfaction with Facial Appearance, Psychological Function, Social Function, Satisfaction with Skin, and Aging Appraisal Scales ( P < .0001 for all endpoints). Most patients rated "much improved" on the GAIS. The mean PAAQ total score significantly improved from baseline by 32.6 ( P < .0001). Most patients reported mild-to-moderate injection-site responses, which had a mean time to resolution of <14 days., Conclusions: Panfacial aesthetic treatment consisting of HA fillers, onabotulinumtoxinA, and ATX-101 improved patient-reported satisfaction, psychological function, social function, and aging appraisal across validated measures., (© The Author(s) 2025. Published by Oxford University Press on behalf of The Aesthetic Society.)

Background: With aging, repetitive contraction of the platysma leads to an increase in platysma prominence (PP), characterized by the accentuation of vertical neck bands and blunting of the jawline contour., Methods: This multicenter, double-blind, phase 2 study evaluated onabotulinumtoxinA treatment in adults with moderate to severe PP. Participants were randomized to receive 1 treatment of onabotulinumtoxinA low dose (LD), onabotulinumtoxinA high dose (HD), or placebo, and were followed up for 4 months. Efficacy end points were achievement of a 1 grade or greater improvement on both the left and right sides at day 14 at maximum contraction as assessed by the investigator (primary) or by participants (secondary) using validated scales. Safety was evaluated throughout., Results: Participants in the modified intent-to-treat population ( n = 164) had a mean age of 50 years; 95.1% were women and 93.9% were White. The primary end point was met for both onabotulinumtoxinA groups, with investigator-assessed 1 grade or greater improvement in 77.8% (LD) and 88.2% (HD) versus 12.0% (placebo) of participants on day 14 ( P < 0.0001 versus placebo). Based on participant self-assessment, 75.9% (LD) and 88.2% (HD) versus 18.0% (placebo) achieved 1 grade or greater improvement on day 14 ( P < 0.0001 versus placebo). Most treatment-related adverse events were procedure-related, transient, and mild in severity. The most frequent onabotulinumtoxinA-related adverse event was neck muscle weakness, reported in the HD group., Conclusion: OnabotulinumtoxinA was effective in improving the appearance of PP based on both investigators' and participants' ratings. Treatment was well tolerated., Clinical Question/level of Evidence: Therapeutic, I., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons.)

The Restylane&reg; portfolio of hyaluronic acid (HA) fillers comprises a broad range of products, each with a unique combination of gel strength/firmness and flexibility. Restylane&reg; Shaype&trade; (HASHA) is a new HA injectable produced with NASHA-HD&trade; technology and the most recent addition to the Restylane portfolio. NASHA-HD is an evolution of the NASHA&trade; platform that adds more HA and uses a more efficient cross-linking even though the degree of modification is kept low. HASHA has an HA-concentration of 25 mg/mL and a G prime (G') of 916 Pa (0.1 Hz). Experts recommend using HASHA for treatment in the chin area because its high G' allows a higher degree of correction/projection with lower injection volumes, especially in those patients with pronounced chin retrusion, together with a long duration of effect and good overall safety. Depending on the patient's needs and the aim of treatment, different approaches and injection techniques should be applied. This paper reflects the recommendations of an interdisciplinary expert panel for the use of HASHA for the correction of the chin area, including patient selection, product volume, product placement, injection technique, and post-treatment care. Recommendations were discussed and agreed as a consensus, according to cross-sectional expertise and clinical experience. &nbsp; J Drugs Dermatol. 2025;24(1):70-78. doi:10.36849/JDD.8593.

Background: RelabotulinumtoxinA (RelaBoNT-A) is a complex-free, ready-to-use, liquid botulinum toxin A., Objective: Efficacy/safety of RelaBoNT-A treatment for lateral canthal lines (LCL)., Methods: Randomized adults received RelaBoNT-A (30 U/side; n = 230) or placebo (n = 73) during a 6-month, double-blind, Ph3 study (Relabotulinumtoxin Aesthetic Development Study-2 [READY-2]). Primary end points (Month 1, maximum smile) comprised: composite ≥2-grade responder rate using concurrent LCL severity investigator live assessment (LCL-ILA) and subject live assessment (LCL-SLA); LCL-ILA 0 (none)/1 (mild) responder rate. Subject satisfaction and adverse events were also reported., Results: Month 1 composite ≥2-grade responder rates were 51.8% (RelaBoNT-A) and 1.4% (placebo; (p < .001). Month 1 none/mild LCL-ILA responder rates were 87.2% (RelaBoNT-A) and 11.9% (placebo; p < .001). Onset was reported Day 1 by 34%. At Month 6, LCL-ILA responder rates for RelaBoNT-A remained at 23.3% (none/mild) and 35.9% (≥1-grade improvement). Median return to baseline severity was 24.7 weeks; 64% (RelaBoNT-A group) had not returned to baseline at Month 6. RelaBoNT-A satisfaction was high through Month 6 (71%). Mild/moderate treatment-related adverse events occurred in 6.1% (RelaBoNT-A) and 5.5% (placebo)., Conclusion: RelaBoNT-A (60 U) treatment provided statistically significant improvement of moderate-to-severe LCL. One-third of subjects reported onset within 1 day and improvements were maintained through Month 6. Treatment satisfaction was high. RelaBoNT-A was well tolerated., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Society for Dermatologic Surgery, Inc.)

Background: OnabotA is used to treat masseter muscle prominence (MMP)., Objective: To assess the safety and efficacy of OnabotA for MMP in a randomized study., Methods: This 12-month, multicenter, double-blind, placebo-controlled, phase 2 study randomized adults (18-50 years of age) with marked/very marked bilateral MMP (≥4 on the Masseter Muscle Prominence Scale [MMPS]) to OnabotA (24, 48, 72, or 96 U) or placebo; retreatment occurred at day 180 if MMPS ≥4. Lower facial volume at day 90 was measured using Vectra 3-dimensional photography. Safety assessments included computed tomography and dental exams. Evaluations occurred monthly through day 360., Results: Among 187 randomized subjects, significant lower facial volume reductions and percentage of responders (MMPS grade ≤3) were greater with OnabotA versus placebo at day 90 (P < .001 and ≤.008, respectively). Similar efficacy was observed with retreatment. No dose-related safety trends or clinically relevant changes in the mandible or teeth occurred. Localized impact on smile was reported with 96 U OnabotA (n = 4)., Limitations: Limited sample size per individual treatment group., Conclusion: OnabotA administered in 1 or 2 treatments over 1 year was associated with significant reductions in masseter muscle volume and MMP severity, with an acceptable safety profile., Competing Interests: Conflicts of interest Dr Carruthers is a consultant and researcher for Allergan Aesthetics, an AbbVie Company, Alphaeon, Bonti, Merz, and Revance. Dr Liew received honoraria and reimbursements as part of the speakers' bureau and advisory board of Allergan Aesthetics, an AbbVie Company, Galderma, and Teoxane. Dr Humphrey is a speaker, consultant, and/or investigator for Cutanea, Evolus, Galderma, L'Oreal, Merz, Bonti, Revance, and Allergan Aesthetics, an AbbVie Company. Dr Rivers is an advisory board member, speakers' bureau member, and investigator for AbbVie/Allergan; investigator and speakers' bureau member for Galderma; advisory board member, speakers' bureau member, paid consultant, and investigator for Leo Pharma; investigator for Pfizer; and founder and stockholder of Riversol Skin Care Solutions Inc. Drs Pan, Bowen, Lee, and Brin are employees of AbbVie and may hold AbbVie stock. Dr Chen has no conflicts of interest to declare., (Copyright © 2024 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Background: A hyaluronic acid (HA) filler intended for non-surgical improvement of chin appearance should ideally be of high strength/firmness (high G') to allow for deep injections on the bone. HASHA (Restylane Shaype) is a new hyaluronic acid (HA) injectable with high G' and high HA concentration (25 mg/mL), engineered by the new NASHA-HD (High Definition) technology. HASHA is suitable to be placed periosteally, aiming to mimic the natural shape of the bony chin. This pivotal clinical investigation evaluated effectiveness and safety of HASHA for augmentation and correction of chin retrusion.&nbsp; Methods: Subjects 18 years or older with mild or moderate chin retrusion by the Galderma Chin Retrusion Scale (GCRS), were randomized 3:1 to HASHA (n=103) or no treatment (n=37). Assessments included GCRS (blinded evaluator), aesthetic improvement (Global Aesthetic Improvement Scale [GAIS]), subject satisfaction, and safety.&nbsp; Results: GCRS responder rate (1-grade or greater improvement from baseline) was significantly higher for HASHA (83.3%) versus controls (10.8%) at month 3 (P&lt;0.001) and maintained through month 12 (P&lt;0.001). Aesthetic improvement was high throughout the study in the HASHA group, according to investigators (97% or greater) and subjects (89% or greater). Overall, subject satisfaction was high at month 3 and maintained at month 12. Product- or injection-related adverse events were mostly mild or moderate and transient. No product- or injection-related serious adverse events were reported., Conclusions: HASHA, a new NASHA-HD injectable with extra strength/firmness, was safe and effective for chin augmentation and correction of chin retrusion, with high aesthetic improvement and subject satisfaction throughout 12 months. J Drugs Dermatol. 2024;23(4):255-261.&nbsp; &nbsp; &nbsp;doi:10.36849/JDD.8145.

Background: Studies of predominantly White participants show that cryolipolysis reduces subcutaneous fat in the arms and inner thighs, but none have specifically tested for similar outcomes in participants of Chinese descent., Objectives: This study assessed the safety and effectiveness of cryolipolysis treatment for noninvasive subcutaneous fat reduction of arms and inner thighs in participants of Chinese descent to assess equivalence to results seen in a prior study of White participants., Methods: Replicating a similar study design, participants of first- or second-generation Chinese descent underwent cryolipolysis treatment of arms and/or inner thighs. Effectiveness was assessed using pretreatment and posttreatment photographic review by blinded, independent experts, investigator-assessed caliper measurements, and participant satisfaction 12 weeks posttreatment. Safety was assessed throughout., Results: Among 50 enrolled participants, 48 completed the study. The majority of participants (97.9%) were female, with a mean age of 36.0 years and mean BMI of 24.16 kg/m 2 (range 19.3-29.9 kg/m 2 ). Overall, 76.4% and 70.0% of pretreatment photographs of arms and pairs of inner thighs, respectively, were correctly identified by at least 2 of 3 reviewers. The mean reduction from baseline in caliper-measured fat thickness was 6.5 mm for arms and 6.6 mm for inner thighs, and the majority of participants (>60%) were satisfied with the treatment. No adverse events were reported., Conclusions: Cryolipolysis is a well-tolerated, effective means of noninvasive fat reduction of arms and inner thighs in participants of Chinese descent. The results from this study show similar effectiveness and safety in Chinese participants compared with White participants treated in a prior study., (© The Author(s) 2023. Published by Oxford University Press on behalf of The Aesthetic Society.)

Psychodermatology pertains to the relationship between the skin and brain. This review aims to summarize the evidence of the mind body connection in four psychophysiological conditions: rosacea, atopic dermatitis (AD), acne vulgaris (AV), and psoriasis. A literature search was conducted using several English language databases. All four conditions share similar psychiatric co-morbidities, including but not limited to anxiety, depression, and suicidality. In rosacea, the upregulation of transient receptor potential vanilloid type 1, Toll like receptor 2, and Th17 cells releases downstream products that are simultaneously implicated in mood disorders. Stress exacerbates AV through the hypothalamic-pituitary-adrenal (HPA) system, which alters functioning of sebocytes and Cutibacterium acnes . In AD and psoriasis, the HPA axis influences Th1, Th2, Th22, and Th1, Th17 immune mediated responses, respectively. This leads to the secretion of pro-inflammatory cytokines which are also involved in the pathogenesis of anxiety and depression. Neurotransmitters implicated in mental illness, such as gamma-aminobutyric acid and serotonin, may also play a role in the development of AD and psoriasis. The management of cutaneous disease may mitigate psychological distress, and future research may show the corollary to also be true., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Clinical photography is essential in dermatology. However, a comprehensive literature review of photography in dermatology is lacking. This scoping review aims to summarize the literature regarding photography practices in dermatology, photography of skin of color, patient preferences, and medical-legal considerations. A search was conducted utilizing Embase, MEDLINE, PubMed, and Evidence Based Medicine databases in accordance with the PRISMA extension for Scoping Reviews. In total, 33 studies were summarized. Clinical photography is commonly used in biopsy site marking, assessment, diagnosis, disease monitoring, evaluation of treatment response, medical education, research, seeking advice from colleagues, and teledermatology. Although dermatologic photography remains devoid of skin of color representation, photographic considerations for darker skin are available. Most patients support medical photography, with a preference for clinical photographs to be taken by their own physicians, and for use of clinic/hospital-owned cameras over personal devices. Pertinent medical-legal issues include concerns around privacy, personal device use, and documentation of consent. Photography in dermatology is continuously evolving with broader applications. Improved practices and innovations will benefit individuals of various skin tones. Management of consent and privacy must be upheld to sustain the increasing ease of image capture and sharing., (© 2023 The Authors. Journal der Deutschen Dermatologischen Gesellschaft published by John Wiley & Sons Ltd on behalf of Deutsche Dermatologische Gesellschaft.)

Background: Clinical photography is essential in dermatology, in particular in the areas of surgical and cosmetic dermatology and has been evolving rapidly. However, many dermatologists desire more training in clinical photography and a comprehensive literature review of photography in dermatology is lacking., Objective: This scoping review aimed to summarize the literature regarding techniques for high-quality photography in dermatology., Materials and Methods: A literature search was conducted using Embase, MEDLINE, PubMed, and Evidence-Based Medicine databases in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews., Results: This review summarizes information from 74 studies. Camera type, resolution, lens choice, camera settings, environment and set-up, standardization, and types of clinical photography are all important factors in acquisition of high-quality photography., Conclusion: Photography in dermatology is continuously evolving with broader applications. Improved practices and innovations will benefit the quality of images., (Copyright © 2023 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Background: Data suggest that hyaluronic acid (HA) fillers using VYC technology have a higher incidence of delayed-onset nodule development at facial injection sites than earlier HA products., Objective: To assess the incidence of delayed-onset nodules with VYC products based on a single experienced injector., Methods and Materials: Patients with delayed-onset nodules after injections with VYC-20L, VYC-17.5L, and VYC-15L were identified by retrospective chart review., Results: Since 2010, 2139 patients received injections from the same physician with combinations of VYC-20L (57.6% of patients; 2.4 syringes/patient), VYC-17.5L (23.9%; 1.5), or VYC-15L (18.5%; 1.5). Seven female patients (mean age, 62 years) developed delayed-onset nodules for an overall incidence of 0.33%. A potential inflammatory trigger (reported by 6 patients) occurred 1-168 days prior to nodule development. Nodule biopsy in 1 patient confirmed a foreign-body granuloma. The most effective treatment incorporated prednisone with or without hyaluronidase, and in 2 patients, nodules resolved spontaneously. The incidence of delayed-onset nodules was not associated with injection technique or amount of product used., Conclusion: VYC-associated incidence of delayed-onset nodules (0.33%) was lower than earlier estimates from previous studies. In the current analysis, VYC-15L had a rate of delayed reactions comparable with non-VYC products., (© 2022 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

The severe acute respiratory syndrome coronavirus 2 pandemic has necessitated enhanced protection against viral transmission among healthcare professionals, particularly relating to handwashing and personal protective equipment. Some of these requirements may persist for years to come. They bring associated concerns around skin hygiene and general care, with damage to the face and hands now a well-documented consequence among healthcare professionals. This review assesses optimal skin care during the severe acute respiratory syndrome coronavirus 2 pandemic and in the "new normal" that will follow, identifies current knowledge gaps, and provides practical advice for the clinical setting. Regular, systematic hand cleaning with soap and water or an alcohol-based hand rub (containing 60%-90% ethanol or isopropyl alcohol) remains essential, although the optimal quantity and duration is unclear. Gloves are a useful additional barrier; further studies are needed on preferred materials. Moisturization is typically helpful and has proven benefits in mitigating damage from frequent handwashing. It may be best practiced using an alcohol-based hand rub with added moisturizer and could be particularly important among individuals with pre-existing hand dermatoses, such as psoriasis and eczema. Face moisturization immediately prior to donning a mask, and the use of dressings under the mask to reduce friction, can be helpful dermatologically, but more work is required to prove that these actions do not affect seal integrity. Nonetheless, such measures could play a role in institutional plans for mitigating the dermatologic impact of transmission control measures as we exit the pandemic., Competing Interests: Declaration of conflicting interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: J.K.R. has been a consultant, investigator, and speaker for AbbVie, Allergan, Galderma, Leo Pharma, and Pfizer; is a consultant for MetaOptima Technology Inc.; and is the founder and a shareholder of Riversol Skin Care Solutions Inc. J.P.A. reports no conflicts of interest to disclose. J.D. reports no conflicts of interest to disclose. L.C.G. has been a consultant, investigator, and speaker for AbbVie, Allergan, Janssen, and La Roche-Posay, and a speaker for Johnson & Johnson and Pierre Favre. C.M. reports no conflicts of interest to disclose. V.R. has been an investigator for AbbVie, Allergan, Galderma, Leo Pharma and Pfizer, and a speaker and consultant for AbbVie, Bausch Health, Celgene, Eli Lilly, Galderma, Janssen, Leo Pharma, L’Oréal (La Roche-Posay), Novartis, Pfizer, Proctor & Gamble, and Sanofi. N.R. reports no conflicts of interest to disclose. J.-F.T. reports no conflicts of interest to disclose. M.C.W. reports no conflicts of interest to disclose. C.Z. reports no conflicts of interest to disclose. D.Z. has been a consultant, investigator, and speaker for Genentech/Roche and Sanofi Genzyme., (© The Author(s) 2021.)

Background: Chlorhexidine gluconate is one of the most effective surgical preparations, but it has known potential ocular and ototoxicity., Objective: To review reported cases of ocular and ototoxicity caused by chlorhexidine and summarize the clinical situations in which chlorhexidine toxicity occurred., Methods: We performed a systematic review of PubMed and the Web of Science., Results: Fourteen cases reported sensorineural hearing loss from chlorhexidine instilled into the ear. Of the 38 cases of ocular toxicity, 8 cases were caused by direct instillation in the eye and 17 involved periocular surgical preparation. In the remaining cases, the area prepped was less defined. Seven cases involved preparation of the face, 1 for the scalp, 2 cases were drips from distant sites, and 3 cases did not specify the means of exposure., Conclusion: The vast majority of toxicity occurred in patients undergoing general anesthesia and was rarely seen in situations where surgery was performed by dermatologists. Ultimately, it should be up to the individual physician to decide whether chlorhexidine is the best choice for a particular outpatient procedure., (Copyright © 2020 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Minocycline-induced pigmentation (MIP) is an infrequent complication of minocycline therapy, with four subtypes each with distinct clinical features and histologic staining patterns. MIP may resolve following discontinuation of minocycline therapy or it may persist indefinitely. A 64-year-old Caucasian male presented with a 6 month history of progressive blue-gray facial pigmentation distributed symmetrically over his face. One session utilizing a 755 nm picosecond Alexandrite laser resulted in immediate and significant clearance of the pigment in all treated areas. Long-term follow-up at 2 years revealed no recurrence of the MIP.

The Pigmented Lesion Assay (PLA) is a gene expression test that helps rule out melanoma and has the potential to reduce the need for surgical biopsies of atypical pigmented skin lesions. Utilizing a new technological platform for the non-invasive profiling of skin, the assay analyzes samples collected from adhesive patches for expression of two key genes (PRAME and LINC00518) known to be overexpressed in melanoma. The test result is binary (positive/negative) based on the detection of one or both genes. PLA positive cases are generally biopsied to establish the histopathologic diagosis, while PLA negative cases are considered for ongoing monitoring. The combination of visual inspection with histopathology, the current gold standard for melanoma diagnosis, has a relatively low negative predictive value (NPV) of approximately 83%, meaning that 17% of melanomas will be interpreted as benign lesions. In contrast, the PLA has a very high NPV (>99%). Further, with its high specificity (69-91%), use of the PLA can reduce the number of false positive samples subjected to histopathology review. By adding the PLA to the current care pathway, the number of surgical biopsies needed to find a melanoma (number needed to biopsy) is markedly reduced from 20-25 biopsies for dermatologists and 39 biopsies for physician assistants, to an average of 2.7. To date, unnecessary surgical procedures of benign lesions have been reduced by 88% based on a sample of more than 20,000 analyzed cases. This has resulted in fewer missed melanomas and significant cost savings to health care systems., Competing Interests: Jason Rivers has been an advisory board member, investigator, speaker, consultant, or received honoraria from Allergan, DermTech,Galderma, Janssen, Leo, MetaOptima, Regeneron, Sanofi, Valeant. Michael Copely has no conflicts to disclose. Ryan Svoboda participated in a fellowshipprogram partly funded by Castle Biosciences and received and participated in an focus group for Castle Biosciences, for which he received an honorarium.Darrell Rigel is a consultant for DermTech.

Objectives: Cryolipolysis of the arms has been demonstrated to be an effective treatment for non-invasive reduction of subcutaneous fat. This study evaluated the safety and efficacy of the concurrent use of a new commercially-available small applicator in conjunction with an existing medium sized applicator for the customized treatment of arm fat., Methods: Bilateral arms of 15 eligible subjects were simultaneously treated using one or two vacuum applicators with flat contours. Either a medium or small cryolipolysis applicator with an oblong cup-shaped cooling surface was selected to treat upper arm fat. The shape of the fat bulge in each subject's arm was assessed and up to two treatment cycles (-11°C for 35 minutes each) were delivered to each arm in one session, based upon investigator discretion. Throughout the procedure and at the completion of each treatment cycle, investigators assessed the subject's level of comfort, as well as sensory and motor nerve effects. Post-treatment manual massage was performed, and clinical assessments of each treatment site were recorded. Adverse events were recorded to monitor procedural safety. Baseline and 12 weeks post-treatment photographs and ultrasound measurements were taken to assess efficacy. Subject questionnaires were administered to evaluate satisfaction., Results: Fifteen female subjects (mean age of 51.1, mean BMI of 26.8) completed the study. Ultrasound imaging revealed statistically significant fat layer reduction of 2.5 mm (SD ± 2.4 mm, 95%CI 1.6-3.3). Subject surveys administered 12 weeks post-treatment demonstrated 87% satisfaction with the arm cryolipolysis procedure. A panel of blinded, independent physicians correctly identified 83% of the before and after photos. Clinical assessments found adverse events were mild and included erythema and mild swelling that resolved without intervention. Mild treatment area numbness was reported by 73% of subjects at the 4-week interim visit and fully resolved at the 12-week visit., Conclusion: This study documents the first reported customized approach for assessment and treatment of arm fat using a small or medium cup applicator with varied applicator placement. By incorporating one or two treatment cycles per arm in a single session, the issue of variable fat distribution in people's arms can be addressed. This approach was shown to be a safe and effective way to reduce unwanted arm fat with high patient satisfaction. Lasers Surg. Med. © 2018 Wiley Periodicals, Inc., (© 2018 Wiley Periodicals, Inc.)

Introduction: Plants and algae have played a central role in the treatment of skin conditions in both traditional First Nations healing and in modern dermatology. The objective of this study was to examine the evidence supporting the dermatological use of seaweed, witch hazel, bearberry, and mayapple., Methods: Four plants and algae used in traditional First Nations treatments of skin disease were selected based on expert recommendations. Several databases were searched to identify relevant citations without language restrictions., Results: Seaweed has potential clinical use in the treatment of acne and wrinkles and may be incorporated into biofunctional textiles. Witch hazel is an effective and well-tolerated treatment of inflammation and diaper dermatitis. Bearberry leaves contain arbutin, a skin-lightening agent that is an alternative for the treatment of hyperpigmentation. Mayapple contains podophyllotoxin, a treatment for condyloma accuminata, molluscum contagiosum, and recalcitrant palmoplantar warts., Discussion: Common plants and algae are replete with bioactive agents that may have beneficial effects on the skin. Further research will open the door to new and innovative products in the future. Limitations of this study include that the scope of our study is limited to 4 plants and algae, a small sample of the breadth of plants used by First Nations for dermatological treatments.

Background: Cryolipolysis of the arms has been shown to be an effective but somewhat time-consuming process., Objective: The study evaluated safety and efficacy of a contoured cup cryolipolysis applicator for reduction of arm fat. The prototype was designed to maximize tissue contact with the cooling surface to improve comfort, while reducing treatment time by 25 minutes., Materials and Methods: Both arms were treated using a prototype device that delivered treatment in 35 minutes at -11°C. Photographic and ultrasound documentation was captured at baseline and 12 weeks post-treatment. Efficacy was assessed by photo review and measurement of fat reduction in ultrasound images. Immediately after 1, 4, and 12 weeks post-treatment, clinical assessments were performed to evaluate treatment areas and sensory alterations., Results: Thirty women were enrolled and completed treatments to both arms. Ultrasound measurements found mean fat layer reduction of 3.2 mm with an SD of 2.7 mm. Blinded independent photo review found 85.2% correct identification of baseline photographs by at least 2/3 of reviewers. There were no unanticipated adverse device effects. Four study subjects experienced numbness in the treatment area beyond the 12-week visit that subsequently resolved without intervention., Conclusion: These data suggest that the CoolCup prototype applicator provides rapid, safe, and effective arm treatment.

Introduction: First Nations people have a long history of working with medicinal plants used to treat skin diseases. The purpose was to assess the dermatologic therapeutic potential of western red cedar, white spruce, birch, balsam poplar, and black spruce., Methods: Based on expert recommendations, 5 trees were selected that were used in First Nations medicine for cutaneous healing and have potential and/or current application to dermatology today. We searched several databases up to June 12, 2014., Results: Western red cedar's known active principal compound, β-thujaplicin, has been studied in atopic dermatitis. White spruce's known active principal compound, 7-hydroxymatairesinol, has anti-inflammatory activity, while phase II clinical trials have been completed on a birch bark emulsion for the treatment of actinic keratoses, epidermolysis bullosa, and the healing of split thickness graft donor sites. Balsam poplar has been used clinically as an anti-aging remedy. Black spruce bark contains higher amounts of the anti-oxidant trans-resveratrol than red wine., Discussion: North American traditional medicine has identified important botanical agents that are potentially relevant to both cosmetic and medical dermatology. This study is limited by the lack of good quality evidence contributing to the review. The article is limited to 5 trees, a fraction of those used by First Nations with dermatological properties.

Background: Onychomycosis is a cosmetic and, at times, medical concern; therefore, effective and safe alternatives to treatment are needed., Objective: To determine the efficacy of a 1064-nm Nd:YAG laser for the treatment of onychomycosis in a real-world setting., Methods: A single-centre retrospective chart review was conducted between 2012 and 2013. One hundred consecutive patients with a culture- and/or potassium hydroxide-confirmed diagnosis of onychomycosis were treated at least twice. Baseline and follow-up photographs were taken, and the change in degree of clinical nail involvement of the subject's great toenail was determined by a blinded reviewer using validated planimetry measurement., Results: A total of 199 hallux nails from 100 subjects were assessed. The mean infected area decreased from 53.2% at baseline to 50.8% at the end of the study (paired t test, P = .054; Wilcoxon signed rank test, P = .006). Degree of nail involvement was statistically significantly associated with amount of improvement; subjects who had the greatest degree of nail involvement improved the most, while those with less severe disease showed a worsening of nail appearance (Kruskal-Wallis test, P < .001). Three-quarters (72.6%) of nails that had more than 67% nail involvement showed statistically significant improvement (χ 2 test, P = .001). Adverse events were limited to mild to moderate pain at the time of therapy. A total of 76 subjects were assessed for treatment satisfaction: 60% were very satisfied with treatment despite limited clinical improvement in some cases., Conclusions: Laser therapy has a very limited positive clinical effect on the appearance of onychomycosis after 2 treatment sessions.

Rosacea is a chronic facial inflammatory dermatosis characterized by background facial erythema and flushing and may be accompanied by inflammatory papules and pustules, cutaneous fibrosis and hyperplasia known as phyma, and ocular involvement. These features can have adverse impact on quality of life, and ocular involvement can lead to visual dysfunction. The past decade has witnessed increased research into pathogenic pathways involved in rosacea and the introduction of novel treatment innovations. The objective of these guidelines is to offer evidence-based recommendations to assist Canadian health care providers in the diagnosis and management of rosacea. These guidelines were developed by an expert panel of Canadian dermatologists taking into consideration the balance of desirable and undesirable outcomes, the quality of supporting evidence, the values and preferences of patients, and the costs of treatment. The 2015 Cochrane review "Interventions in Rosacea" was used as a source of clinical trial evidence on which to base the recommendations., (© The Author(s) 2016.)

Actinic keratosis (AK), a common cutaneous lesion with the potential to transform into squamous cell carcinoma, has traditionally been treated with ablative and/or surgical procedures. Recently, a topical formulation combining 0.5% 5-fluorouracil with 10% salicylic acid (5-FU-SA) was introduced in Europe under the trade name Actikerall™ for the treatment of grade I/II AKs. In a single randomized phase III trial, 5-FU-SA was shown to be superior to diclofenac 3% gel in hyaluronic acid, as measured by the histological clearance of one defined lesion (72% vs. 59.1%) and by complete clinical clearance (55.4% vs. 32.0%). 5-FU-SA should be applied once daily to a total area of up to 25 cm(2), which may include the lesion(s) and a small area of surrounding skin (rim of healthy skin should not exceed 0.5 cm), for up to 12 weeks. The most common side effects are local inflammation and pruritus at the application site, and no serious adverse effects have been reported to date. Now commercially available in Canada, 5-FU-SA represents a patientapplied therapeutic option for the treatment of both overt and subclinical AKs.

Background: It is unknown whether the histologic subtypes of basal cell carcinoma (BCC) arise from a common progenitor cell or whether other factors play a role in their development., Objective: To investigate the relationship between the different BCC histopathologic subtypes and anatomical distribution of BCCs in a Canadian dermatology practice., Methods: The charts of all patients diagnosed with BCC between 1993 and 2005 from a single private dermatology practice in Vancouver, Canada, were reviewed. Descriptive data analysis was undertaken to look at the distribution of histologic subtypes based on age, gender, and anatomical location., Results: Nodular BCCs accounted for 58% of all tumors. Sixty-six percent of these were situated on the head/neck (odds ratio [OR] = 3.0, 95% confidence interval [CI] = 2.1-4.3, P < .0001). Infiltrative (OR = 2.4, 95% CI = 1.5-4.1, P = .0003) and superficial BCCs were more common in women (OR = 3.7, 95% CI = 2.5-5.7, P < .0001), affected the trunk (OR = 3.2, 95% CI = 2.1-4.9, P < .0001), and appeared in younger individuals (OR = 1.8, 95% CI = 1.2-2.7, P = .004)., Conclusion: Our results show a preference of distinct BCC subtypes for certain anatomical locations., (© The Author(s) 2015.)

Background: Various onabotulinumtoxinA doses are effective in treating forehead lines (FHL), with a trend toward lower doses., Objective: To evaluate efficacy and safety of onabotulinumtoxinA dose-ranging treatment of FHL when the frontalis area and glabellar complex are treated together., Materials and Methods: Adults with moderate-to-severe FHL received onabotulinumtoxinA 40 U (FHL, 20 U; glabellar lines [GL], 20 U), 30 U (FHL, 10 U; GL, 20 U), or placebo. Response was assessed at weeks 1, 2, day 30, and monthly to day 180. Coprimary efficacy end points were investigator- and subject-assessed Facial Wrinkle Scale scores of none or mild (day 30). Patient-reported outcomes, onset/duration of effect, and adverse events (AEs) were evaluated., Results: Responder rates (investigator/subject, respectively) were 40-U group, 91.2%/89.5%; 30-U group, 86.4%/81.4%; placebo, 1.7%/5.1%. OnabotulinumtoxinA resulted in significantly greater responder rates than placebo (p < .001). Adverse events were mild to moderate and similar between groups (most common AEs: nasopharyngitis [4.6%] and headache [4.0%])., Conclusion: Treatment of FHL with onabotulinumtoxinA 40 and 30 U (in frontalis and glabellar complex muscles) was tolerable, effective, and sustained. Both doses significantly reduced FHL severity; however, the 40-U dose demonstrated a trend toward greater sustained benefit and longer duration of effect versus the 30-U dose, with similar AE rates.

Background: Glomuvenous malformations (GVMs) (previously known as glomus tumours) are uncommon, benign, vascular neoplasms. Current treatments include surgical excision and sclerotherapy, often with high recurrence rates and poor cosmetic results., Objective: We sought to use a nonsurgical approach for treatment of a GVM., Methods: We present a patient with an acquired, biopsy-proven GVM of the heel unamenable to surgical excision, treated with a long pulsed 1064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser., Results: Excellent cosmesis and long-term remission were achieved after several treatment sessions., Conclusion: Our experience provides further evidence to support the safety and effectiveness of the 1064-nm Nd:YAG laser in the management of large and surgically challenging GVMs., (© The Author(s) 2015.)

Background: Patient satisfaction with treatment is an important outcome in facial aesthetic medicine., Objective: To evaluate subject satisfaction with onabotulinumtoxinA treatment of glabellar lines (GL) and crow's feet lines (CFL) using the validated Facial Line Satisfaction Questionnaire (FLSQ)., Methods: In this randomized double-blind study, subjects with moderate/severe GL and CFL received onabotulinumtoxinA (20 U, GL; 24 U, CFL) or placebo. Over 120 days, the following were assessed: satisfaction, achievement of treatment expectations, satisfaction with duration of treatment (FLSQ), severity of GL and CFL (Facial Wrinkle Scale [FWS]), and aesthetic improvement (Global Aesthetic Improvement Scale)., Results: Satisfaction in the per-protocol population was significantly greater at Day 60 in the onabotulinumtoxinA group (n = 60) compared with placebo (n = 57) for GL (81.7% vs 0%; p < .001). Most subjects treated with onabotulinumtoxinA remained satisfied up to 120 days. Achievement of treatment expectations (86.7%; Day 60), satisfaction (81.7%; Day 60), and satisfaction with the duration of treatment (61.6%; Day 90) were significantly better with onabotulinumtoxinA than placebo (p < .001) for GL and CFL combined. Efficacy (FWS) and aesthetic improvement were observed in most subjects at Days 30 and 60, respectively., Conclusion: High satisfaction rates are achieved and sustained in subjects treated with onabotulinumtoxinA for GL and CFL combined.