Dermal fillers are often utilized to enhance facial features as well as correct signs of aging on the face. Common side effects seen with dermal fillers are injection site erythema, edema, and secondary infection. Uncommon yet severe effects of filler injection result from vascular occlusion, causing skin necrosis, blindness, or even stroke. Vision loss typically occurs immediately after injection. Partial vision loss is associated with better prognosis. In case of visual compromise, an ocular massage and reduction of ocular pressure should be initiated immediately. The instruments used as well as the pressure and volume of the injection can contribute to unwanted complications. Anti‐thrombolytics, including hyaluronidase for hyaluronic acid injection, may offer some benefit in the case of vascular occlusion. Aesthetic providers must have thorough knowledge of facial anatomy and proper injection technique to mitigate the risk of these dreaded adverse events.
Restylane is a hyaluronic acid‐based facial and hand dermal filler line used for cutaneous augmentation and fold‐crease reduction approved by the United States Food and Drug Administration (FDA) in 2003. It is sourced from nonanimal products which confers low immunogenicity and mitigates risk of hypersensitivity reactions and forgoes the need for allergy testing. Restylane has been observed to have excellent longevity secondary to its unique cross‐linking properties, lasting in the skin for up to 12 months. Despite its relatively low‐risk profile, case reports indicate injection site reactions being common, with more serious adverse events being very rare. In these cases, dissolution of Restylane is performed with hyaluronidase, while intralesional steroids can be utilized to manage unwanted inflammatory reactions. Overall, its low reaction potential, established safety profile, facial filler product‐line consistency as well as indication diversity, and prolonged mechanism of action have been leading factors in its continued popularity over the past two decades.
Toxoplasma gondii is a parasite that affects about 20–80% of the global population. Chronic infection with toxoplasma, also called latent infection, has largely been considered to be asymptomatic with minimal to no clinical effects or sequelae. Though there is now clear evidence in animal models and mounting evidence in humans that latent toxoplasmosis can have various effects on behavior, personality, cognition, and even psychiatric conditions. In this chapter, we will explore the role latent toxoplasmosis plays in the behavior of animals and humans, and discuss the possible mechanisms for the observed effects.
ImportanceDisseminated superficial actinic porokeratosis (DSAP) is an inherited or sporadic disorder of keratinization associated with germline variations. There is no effective standard of care therapy for DSAP, but treatment with topical lovastatin combined with cholesterol cream has shown promise.ObjectivesTo evaluate and compare the safety and efficacy of topical lovastatin 2% plus cholesterol 2% cream (lovastatin-cholesterol) and topical lovastatin 2% cream (lovastatin) alone in adults diagnosed with DSAP.Design, Setting, and ParticipantsThis patient- and assessor-blinded, randomized clinical trial was conducted at the Medical University of South Carolina between August 3, 2020, and April 28, 2021. Nonpregnant adults with a previous clinical or histological diagnosis of DSAP were eligible. Data were blindly analyzed after study completion.InterventionsParticipants were randomized to once- or twice-daily application of either lovastatin-cholesterol cream (n = 17) or lovastatin cream (n = 14) to symptomatic regions for 12 weeks.Main Outcomes and MeasuresThe primary efficacy measure was the effect of the treatment on DSAP at the end of treatment (12 weeks) as measured by the DSAP General Assessment Severity Index (DSAP-GASI; scored from 0-4, with 0 indicating clear and 4 indicating severe). Treatment efficacy was based on investigator-standardized photographs provided by the participants because of the need for evaluation via telehealth during the COVID-19 pandemic. Secondary efficacy measures included patient-reported outcomes, application frequency, and adverse events (AEs).ResultsOf the 87 participants screened, 32 were enrolled. One participant randomized to receive lovastatin-cholesterol did not receive the intervention, leaving 17 participants (mean [range] age, 59.2 [40-83] years; 13 females [76.5%]; all White) allocated to receive lovastatin-cholesterol treatment and 14 participants (13 female [92.9%]; mean (range) age, 53.7 [33-71] years; all White) to receive lovastatin treatment. Twelve participants in each treatment group qualified for the analysis. Disease severity decreased from week 1 to week 12 by 50.0% (from 3.08 [95% CI, 2.57-3.60] to 1.54 (95% CI, 1.04-2.05] points on the DSAP-GASI; P < .001) in the lovastatin-cholesterol group and 51.4% (from 2.92 [95% CI, 2.40-3.43] to 1.50 [95% CI, 0.99-2.01] points; P < .001) in the lovastatin group. There was no significant difference between the treatment groups according to application frequency at the end of 12 weeks. Adverse events reported included myalgia (n = 2), elevation in the creatine kinase level (n = 1), application discomfort (n = 4), and rash (n = 1). No serious AEs occurred, and all participants with an AE were able to complete the study.Conclusions and RelevanceThis randomized clinical trial found improvements in DSAP severity in both treatment groups, without serious AEs, indicating a limited benefit with the addition of cholesterol. These results suggest that lovastatin cream may be a new primary treatment option for patients diagnosed with DSAP.Trial RegistrationClinicalTrials.gov Identifier: NCT04359823
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