Facial skin laxity is a bothersome sign of aging. In the past, the only option for treating laxity was surgery. While surgical lifting remains the gold standard, there has been a growing demand among patients for less invasive techniques. Patients are increasingly seeking procedures with little to no downtime, lower risk profiles, and a more natural appearance. The industry has responded to these demands with an emergence of noninvasive skin tightening devices. The rate of development and marketing of these devices has increased exponentially within the last decade. Whereas we previously had no options, now we are faced with many choices. How do we choose which technology is best for our patients? While there is a paucity of comparative trials to date, a critical exploration of these technologies is worthwhile. The underlying mechanism of action of all these treatments is essentially the same: heating of the dermis and subdermal areas while minimizing injury to the epidermis. In this article, we outline the different technologies and highlight the differences to help guide us in selecting the right treatment.
Leprosy in armadillos and sooty mangabeys has been manipulated by human experimentation. In the case of the armadillo, further study, including molecular techniques, is required to elucidate the role of the armadillo as a zoonosis in human leprosy. Experimentation with the sooty mangabey led to the discovery of an interaction between SIV and leprosy in rhesus monkeys, and prompted the continued investigation of the relationship between HIV and leprosy.
BackgroundIncreased levels of cryptic collagen epitope HU177 in the sera of melanoma patients have been shown to be associated with thicker primary melanomas and with the nodular histologic subtype. In this study, we investigate the association between HU177 shedding in the sera and clinical outcome in terms of disease-free survival (DFS) and overall survival (OS).MethodsSerum samples from 209 patients with primary melanoma prospectively enrolled in the Interdisciplinary Melanoma Cooperative Group at the New York University Langone Medical Center (mean age = 58, mean thickness = 2.09 mm, stage I = 136, stage II = 41, stage III = 32, median follow-up = 54.9 months) were analyzed for HU177 concentration using a validated ELISA assay. HU177 serum levels at the time of diagnosis were used to divide the study cohort into two groups: low and high HU177. DFS and OS were estimated by Kaplan-Meier survival analysis, and the log-rank test was used to compare DFS and OS between the two HU177 groups. Multivariate Cox proportional hazards regression models were employed to examine the independent effect of HU177 category on DFS and OS.ResultsHU177 sera concentrations ranged from 0-139.8 ng/ml (mean and median of 6.2 ng/ml and 3.7 ng/ml, respectively). Thirty-eight of the 209 (18%) patients developed recurrences, and 34 of the 209 (16%) patients died during follow-up. Higher HU177 serum level was associated with an increased rate of melanoma recurrence (p = 0.04) and with increasing mortality (p = 0.01). The association with overall survival remained statistically significant after controlling for thickness and histologic subtype in a multivariate model (p = 0.035).ConclusionsIncreased shedding of HU177 in the serum of primary melanoma patients is associated with poor prognosis. Further studies are warranted to determine the clinical utility of HU177 in risk stratification compared to the current standard of care.
A 29-year-old woman presented with a long-standing history of yellow-orange papules on her nose and cheeks, skin-colored papules at the proximal nail fold of several toes, and a skin-colored plaque on her back. These findings were diagnosed as facial angiofibromas, periungual fibromas, and a shagreen patch, respectively. They are characteristic of tuberous sclerosis, an autosomal dominant disorder in which mutations in tumor suppressor gene TSC1 or TSC2 result in the formation of benign hamartomas throughout the body. Previous computed tomography of the brain had shown such hamartomas in the patient. Almost all patients with this condition have at least one characteristic dermatologic feature. Central nervous system manifestations are a common source of morbidity, including infantile spasms, seizures, intellectual disability, and giant-cell astrocytomas. Many other organ systems may be involved. Proper identification of the dermatologic features of tuberous sclerosis may aid in the diagnosis of the condition and ultimately help to initiate appropriate screening examinations and genetic counseling.
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