Connecticut Skin Institute

Ibrahimi, Omar A. MD, PhD; Stankiewicz, Kelly J. MD; Jalian, H. Ray MD; Saluja, Sandeep S. MDAuthor Information

Phototherapy is effective in treating psoriasis and other skin conditions. However, clinic-based phototherapy can be time-consuming, expensive, and inconvenient. Conventional home phototherapy addresses many hurdles, but has other limitations. Assess the treatment efficacy, adherence, and satisfaction of a novel ultraviolet B home phototherapy system. Eight patients with stable plaque psoriasis completed a multicenter, prospective, open label, interventional study using a home phototherapy device designed to improve treatment control and adherence. Matched control and study lesions were assessed on each subject. A dosing protocol based on American Academy of Dermatology guidelines for narrowband UVB phototherapy was managed by the phototherapy system. Responsiveness to the treatment was measured using the Psoriasis Severity Index (PSI) at 10 weeks versus control. Patient satisfaction was graded on a five-star Likert scale. At 10 weeks, all patients experienced improvement in the treated lesions, with a mean improvement of 57% in PSI (P<0.0001 compared to baseline and P<0.0002 compared to the control lesions). Patient treatment adherence was 96% and treatment satisfaction was 100% five-star rated. Control lesions did not significantly change in PSI over the 10-week period (P=0.1411). The home phototherapy system provided a safe and effective means to manage plaque psoriasis.

High-expression alleles of macrophage migration inhibitory factor (MIF) are linked genetically to the severity of systemic lupus erythematosus (SLE). The U1 small nuclear RNP (snRNP) immune complex containing U1 snRNP and anti-U1 snRNP antibodies, which are found in patients with SLE, activates the NLRP3 inflammasome, comprising NLRP3, ASC, and procaspase 1, in human monocytes, leading to the production of interleukin-1β (IL-1β). This study was undertaken to investigate the role of the snRNP immune complex in up-regulating the expression of MIF and its interface with the NLRP3 inflammasome. MIF, IL-1β, NLRP3, caspase 1, ASC, and MIF receptors were analyzed by enzyme-linked immunosorbent assay, Western blotting, quantitative polymerase chain reaction, and cytometry by time-of-flight mass spectrometry (CytoF) in human monocytes incubated with or without the snRNP immune complex. MIF pathway responses were probed with the novel small molecule antagonist MIF098. The snRNP immune complex induced the production of MIF and IL-1β from human monocytes. High-dimensional, single-cell CytoF analysis established that MIF regulates activation of the NLRP3 inflammasome, including findings of a quantitative relationship between MIF and its receptors and IL-1β levels in the monocytes. MIF098, which blocks MIF binding to its cognate receptor, suppressed the production of IL-1β, the up-regulation of NLRP3, which is a rate-limiting step in NLRP3 inflammasome activation, and the activation of caspase 1 in snRNP immune complex-stimulated human monocytes. The U1 snRNP immune complex is a specific stimulus of MIF production in human monocytes, with MIF having an upstream role in defining the inflammatory characteristics of activated monocytes by regulating NLRP3 inflammasome activation and downstream IL-1β production. These findings provide mechanistic insight and a therapeutic rationale for targeting MIF in subgroups of lupus patients, such as those classified as high genotypic MIF expressers or those with anti-snRNP antibodies.

The purpose of this study was to determine the efficacy and safety of a 1060 nm diode laser system with multiple handpieces for permanent hair reduction. An open-label, prospective, multi-center study of adult subjects (≥18 years old) of any skin type, having dark brown or black hairs at the areas to be treated and seeking to permanently remove hair underwent six treatment sessions, at 4 to 6 weeks intervals with either a 1060 nm chilled sapphire tip or seven treatment sessions, at 6 weeks interval with a large spot vacuum based handpiece. Subjects received treatments on various body areas using chilled sapphire tip or large spot size vacuum-assisted handpiece. Hair counts as well as assessments of hair coarseness and color were performed using photographs taken at baseline, prior to pre-selected treatments and at the follow up visits. At every visit, immediate skin responses and adverse events were evaluated by the investigator and treatment associated pain level experienced was quantified by the subjects. Subjects were asked to assess their improvement and satisfaction at pre-selected treatment sessions and at all the follow up visits. A sub group of subjects that were treated with the large spot size vacuum-assisted handpiece contributed two punch biopsy specimens for histological analysis. A total of 16 subjects age 33 ± 10.9 years were treated with the chilled sapphire tip, and 26 subjects age 36.3 ± 7.67 years were treated with the large spot size vacuum-assisted handpiece. Treatment with chilled sapphire tip yielded a mean of 68%, 82%, and 76% skin type-independent hair reduction in axillae, shin, and arm, respectively, at 6 month follow up visit as compared to baseline. The majority of subjects (≥80%) rated their hair reduction to be either good or very good and were satisfied to highly satisfied with the outcome. Treatment with the large spot size vacuum-assisted handpiece, was most effective in axillae and calves, with a 77.9% and 78.5% hair count reduction, respectively, at the 6 month follow up visit. Subjects reported high satisfaction and improvement throughout the treatments and follow-up periods. Treatments with both handpieces were not associated with intolerable pain levels and common post procedural responses included mild to moderate erythema and/or edema. The 1060 nm diode laser system is safe and effective for hair removal and long-term hair reduction in all skin types including darkly pigmented individuals. Lasers Surg. Med. 50:893-901, 2018. © 2018 Wiley Periodicals, Inc.

Primary care physician (PCP) perceptions regarding expertise in cutaneous surgery and cosmetic procedures are unknown. An internet-based survey was administered to physicians in primary care medicine residency programs in the United States. Respondents were asked to select the specialist most qualified to perform different cutaneous cosmetic and surgical procedures. Five hundred sixty-one PCPs undertook the survey. Dermatologists were identified as the most qualified specialist to evaluate and biopsy worrisome lesions on the face (95%), perform skin cancer surgery (56%), inject botulinum toxin (61%), inject fillers (55%), and perform laser procedures (75%). Seventy percent of respondents correctly defined Mohs micrographic surgery (MMS), and 60% of respondents selected a fellowship-trained dermatologist as the best physician to perform MMS. U.S. medical school graduates were more likely than foreign medical school graduates to select a Mohs fellowship-trained dermatologist as the most qualified physician to perform MMS (adjusted odds ratio (AOR)=1.52, 95% confidence interval (CI)=1.05-2.21). PCPs without exposure to dermatology in medical school were about half as likely those with exposure to correctly define MMS (AOR=0.51, 95% CI=0.30-0.89). Dermatologists are recognized as the most qualified specialist to perform a variety of cutaneous cosmetic and surgical procedures, including skin cancer surgery, botulinum toxin injections, filler injections, and laser procedures. Mohs fellowship-trained dermatologists were viewed as more qualified to perform MMS than other dermatologists, plastic surgeons, otolaryngologists, or ophthalmologists.