Author:
Ritu Saini, MD, Mohs'/Cosmetics Fellow, Park Avenue Dermatology & Plastic Surgery, LLP, New York, NY

Introduction

The annual Orlando Dermatology & Aesthetic Conference (ODAC) was held January 18-21, 2008, at the Buena Vista Palace Hotel & Spa in Orlando, Florida. In addition to several excellent presentations on therapeutic updates in cosmetic, surgical, and medical dermatology, there were also several fascinating discussions featuring expert panels, live demonstrations and small-group breakfast workshops. Many of the highlights of this meeting are reviewed below.,

Modern Dermatology Updates

Dr. Sherry H. Hsiung, New York, NY, Medical Editor of Journal of Drugs in Dermatology (JDD), presented an overview of the ongoing expansion of the JDD and highlighted interesting articles published in the journal during 2007.¹ One reported pilot study found no residual tumor when topical imiquimod was applied to nodular basal cell carcinoma following initial treatment with curettage.² Dr. Hsiung noted this may be a viable alternative to surgery in those patients with multiple co-morbidities and non-surgical candidates. Another article described a study demonstrating the utility in using pulsed dye laser for the treatment of hypergranulation tissue in chronic ulcers from post-surgical defects.³ Also, microdermabrasion prior to photodynamic therapy (PDT) was found to reduce the incubation time of aminolevulinic acid necessary for laser PDT.⁴ In a study reported by Dr. Richard Scher and colleagues, biotin which was found to be useful only for brittle nails and is not required for healthy nails.⁵ Another noteworthy study published in JDD was the clinical evaluation of a handheld self treatment device for hair removal was found to be efficaceous in removing light hair on darkly pigmented skin.⁶ However, only 60% of the patients enrolled in the study completed it, so it is not clear if there were any issues with tolerability or side effects resulting from using the device.

Dr. Boni Elewski, Professor and Vice Chair, Department of Dermatology, University of Alabama, Birmingham, AL, described new approaches for treating rosacea.⁷ After discussing the classification, diagnostic criteria, and pathogenesis, she presented her algorithm for treating rosacea topically, orally, and surgically. Dr. Elewski's first tier topical treatments include sulfacetamide/sulfur, metronidazole, and azelaic acid. She noted that topical clindamycin/erythromycin may be helpful for acne/rosacea overlap,^8,9 and that sulfur-based therapies may have anti-demodex properties. In addition to the widely used oral tetracyclines including doxycycline, she reported good results using ivermectin in the setting of demodex folliculitis that may mimic rosacea. She also reported that treatment with zithromax on the 1st and 15th day of each month was a good alternative to daily antibiotic therapy for rosacea. Finally, she pointed out that surgical modalities are often required for telangiectasias (pulsed dye laser, intense pulsed light) and rhinophyma (cold Steel excision, CO₂ laser, cauterizing scalpel) associated with rosacea.

Dr. Alan Shalita, Chairman SUNY (Brooklyn) Health Science Center, Brooklyn, NY, described controversial issues in acne pathogenesis and treatment.¹⁰ Of note, he touched on the controversy surrounding diet and acne, as less acne is seen in societies with low-glycemic diets. According to Dr. Shalita, the recommendation for testing for glucose-6-phosphate dehydrogenase (G6PD) deficiency in the prescribing information for topical dapsone has limited its use despite the fact that in clinical trials there has been no phototoxicity, allergic reaction or local irritation in patients treated with this drug. Other treatment options that he mentioned included the new adapalene gel 0.3% formulation which has been found to be effective for inflammatory and comedonal acne, Effaclar K by La-Roche Posay, PDT with blue light and the pulsed dye laser.

Dr. Boni Elewski gave a second presentation that focused upon superficial fungal infections.¹¹ One of her observations was that a condition is unlikely to be onychomycosis if the plantar surface of the foot is not involved. Similarly, when a patient presents with abnormal fingernails but normal toenails the condition is unlikely to be onychomycosis or psoriasis associated candidiasis infections. Dr. Elweski commonly prescribes fluconazole once a week for 4-8 weeks for Candida infections, and recommended treating severe onychomycosis for an extra month with either terbinafine 250 mg daily or itraconazole 400 mg QD X 1 week per month for up to 4 months.¹² When treating nail infections with topical preparations, such as ciclopirox 5% lacquer, curettage may allow for greater penetration of the topical, aiding in treatment. New drugs for treating tinea capitis include terbinafine and itraconazole.^13,14 In the pediatric population, these medications are dosed by weight. For instance, the dosage for terbinafine is 62.5 mg/day for <20 kg, 125 mg/day for 20-40 kg, and 250 mg/day for > 40 kg; this treatment regimen is found to be fairly well tolerated.¹³ Terbinafine was found to be more successful in treating infection with Trichophyton tonsurans than Microsporum canis.¹⁴ Interesting observations made by Dr. Elewski were that tinea capitis in post-menopausal women can resemble white piedra and seborrheic dermatitis is no longer associated with species of Pityrosporum, but with Malassezia globosa and M. restricta.