Sheetal Sapra - Academia.edu (original) (raw)

Papers by Sheetal Sapra

Scars, burns & healing, 2021

Introduction Keloid scars are therapeutically challenging and although many treatment options exi... more Introduction Keloid scars are therapeutically challenging and although many treatment options exist, there are no specific guidelines, and few reports have discussed keloids in the umbilical region. Methods Here, we present a successful treatment of a 31-year-old female with a history of a recurrent keloid in the umbilical region. The keloid was treated using intralesional cryotherapy followed by intralesional onabotulinumtoxinA and triamcinolone acetonide injections. Discussion The patient expressed high satisfaction, minimal side effects, and no recurrence. Conclusion Overall, due to the low rate of side effects, high patient satisfaction, and absence of recurrence, this treatment modality should be considered as an option for umbilical keloids. Lay Summary Background to subject: Keloids are a type of scar that are difficult to treat. There are many treatment options available, but there is no single best treatment for keloids that form around the belly button region. Question being asked: Is intralesional cryotherapy with intralesional onabotulinumtoxinA and triamcinolone acetonide injections effective at treating keloids in the belly button region? How the work was conducted: We treated a 31-year-old female with a keloid around the belly button region that returned after prior treatment. The keloid was treated using combination therapy of freezing the keloid from the inside out, which is called intralesional cryotherapy. This was followed by two types of injections, called onabotulinumtoxinA and triamcinolone acetonide, directly into the keloid. What we learned: Overall, due to the low rate of side effects, high patient satisfaction and the keloid not returning, this treatment plan should be considered as an option for keloids in the belly button region. What we did not learn: This treatment may or may not be effective and safe for all patients of all skin types and demographics as this treatment was performed for only one patient.

PubMed, Sep 1, 2022

Objective: To evaluate concomitant therapy of oral isotretinoin with multiplex pulsed dye laser a... more Objective: To evaluate concomitant therapy of oral isotretinoin with multiplex pulsed dye laser and Nd:YAG laser. Methods: A retrospective chart review of patients who received treatment of oral isotretinoin and non-ablative laser therapy to treat acne vulgaris at a single outpatient dermatology clinic site in Ontario, Canada between 2009 and 2017. Results: 187 patients were included, consisting of 45.5 percent males (n=85) and 54.5 percent females (n=102) with a mean age of 21.4 years. 31.6 percent (n=59) of patients reported experiencing side effects from concomitant isotretinoin and NAL therapy, the most common being eczema (n=14), erythema (n=11), significant dry skin/lips/eyes (n=8), flushing (n=6), and bruising (n=6). 99.2 percent of patients achieved clear or almost clear at treatment completion. Of those who expressed satisfaction, 65.2 percent (n=122) reported being satisfied with the treatment and the remaining patients did not report satisfaction nor dissatisfaction. Limitations: Limitations exist mainly due to the absence of standardized lesion counts and a comparator cohort. Thus, it is not possible to comment on whether the combination of isotretinoin and NAL is more efficacious that either treatment alone. Conclusion: Concomitant use of isotretinoin and non-ablative laser therapy is a safe and effective treatment option for acne vulgaris that provides patient satisfaction.

PubMed, Feb 1, 2017

Objective: To examine the effectiveness of intradermal botulinum toxin type A injection in improv... more Objective: To examine the effectiveness of intradermal botulinum toxin type A injection in improving skin texture and midface lift while reducing pore size and sebum production, as well as investigate the differences in effectiveness between onabotulinumtoxinA and abobotulinumtoxinA using intradermal and intramuscular injection methods. Design: A 16-week, single-blind, split-face, randomized study. Each patient served as their own control, receiving onabotulinumtoxinA and abobotulinumtoxinA randomized to either the left or right side of the face. Patients received intradermal botulinum toxin type A injections at Week 0 and intramuscular botulinum toxin type A injections at Week 2. Participants: Ten women aged 35 to 65 years who exhibited static rhytids in the glabellar and periorbital area. Measurements: The primary endpoint was efficacy of split-face treatment of intradermal and intramuscular onabotulinumtoxinA and abobotulinumtoxinA as assessed by a blinded evaluator using baseline and post-treatment photographs. The secondary endpoints included safety as assessed by adverse events and patient satisfaction measured by questionnaires completed at baseline and post-treatment. Results: Intradermal injection of botulinum toxin type A led to a statistically significant improvement in skin texture (p=0.004) while also resulting in mild midface lift (p=0.024), but did not provide a significant reduction of pore size and sebum production. There was no statistically significant difference between onabotulinumtoxinA and abobotulinumtoxinA when injected intradermally or intramuscularly. Conclusion: Intradermal injection of botulinum toxin type A appears to be a safe and effective therapy that provides an improvement in facial skin texture and midface lift. Registry: clinicaltrials.gov (ID#: NCT02907268).

Journal of Cutaneous Medicine and Surgery, Jan 19, 2018

Actinic keratosis (AK) is a skin condition most frequently occurring in older, fair-skinned indiv... more Actinic keratosis (AK) is a skin condition most frequently occurring in older, fair-skinned individuals, especially those with Fitzpatrick skin types I and II. 1-3 AK commonly occurs on the arms, head, and neck due to long-term exposure to ultraviolet light. 1,3 While prevalence and incidence have not been clearly studied in Canada, the rates may resemble those found in Rotterdam, Netherlands (latitude 51.9N), where researchers found 29% of the adult women and almost half of the adult men examined had at minimum 1 AK. 4 Patients with AK often experience adverse physical and psychological symptoms, which include and are not limited to itching, burning, tenderness, dyspigmentation, and a decrease in selfconfidence. 5 In addition, AK has the potential to transform into invasive squamous cell carcinomas. 1,2 Due to the pervasiveness of AK in the general population and severe discomfort caused by its symptoms, effective treatment must be implemented to control the condition and prevent further progression in individual patients. Current treatments for AK include both lesion-directed and field-directed therapies. Lesion-directed therapies include cryosurgery, laser therapy, and curettage/excision/shave biopsy. 3,6,7 Field-directed therapies include ingenol mebutate (Picato), 5-fluorouracil (5-FU) (Carac, Efudex, Fluoroplex), chemical peeling, diclofenac (Solaraze), imiquimod (Aldara, Zyclara), and photodynamic therapy (PDT). 3,4,7 In Canada, cryosurgery is the most commonly used treatment. 3 However, research has found cryosurgery to be less effective than previously thought, and an editorial published in the Journal of the American Medical Association suggests that the tendency of dermatologists to rapidly jump to cryosurgery for treatment of AK can lead to patients feeling neglected. 8,9 Moreover, cryosurgery, as a lesion-directed method of treatment, can only be used to treat single AK lesions at a time and is thus limited in scope. While the second most popular course of AK

Acta dermato-venereologica, Jun 8, 2023

Actinic keratoses are skin lesions that form due to longterm, repeated exposure to the sun. Lesio... more Actinic keratoses are skin lesions that form due to longterm, repeated exposure to the sun. Lesions can progress to squamous cell carcinoma; hence a key treatment goal is to prevent malignant progression. There is limited guidance on personalizing care for individual patients and supporting shared decision-making between physicians and patients to prevent suboptimal treatment outcomes. To support personalized actinic keratoses care, a group of 12 expert dermatologists used e-surveys to generate recommendations and develop a clinical tool. These can be used to guide shared decision-making between patients and healthcare professionals to support optimal, personalized, long-term care.

Journal of Drugs in Dermatology, Oct 1, 2022

International Journal of Dermatology, Nov 1, 1989

ABSTRACT:The giant cell tumor of tendon sheath (localized nodular tenosynovitis) is the second mo... more ABSTRACT:The giant cell tumor of tendon sheath (localized nodular tenosynovitis) is the second most common tumor involving the hand but is only rarely reported in the dermatologic literature. A case of giant cell tumor and a review of the clinical and pathologic records of 111 patients are discussed.

JAMA Dermatology, Jun 1, 2013

Importance: Pearly penile papules (PPPs) are benign, dome-shaped lesions found around the corona ... more Importance: Pearly penile papules (PPPs) are benign, dome-shaped lesions found around the corona of the penis. Treatments have varied in the past; however, to our knowledge, the use of the pulsed dye laser (PDL) for this condition has never been reported in the literature. Such papules are histologically analogous to angiofibromas; thus, we report PDL is an appropriate, effective, and nonablative method of treatment. Observations: Four patients diagnosed with PPPs were treated with PDL. Each patient reported little to no discomfort during the procedure. Minimal bruising was found in all 4 patients, which diminished over time. One patient stated slight discomfort after the procedure; this however, resolved in a weeks' time. Complete clearance of the papules was noted after 2 to 3 treatments in 2 patients and a reduction of the papules in 2 patients. Conclusions and Relevance: These 4 case reports illustrate the advantages of using PDL when treating PPP. In each patient, the appearance of the papules was either completely diminished or significantly reduced after the procedure. This result was achieved with only minimal discomfort felt by the patients. The use of PDL offers dermatologists a new treatment modality for PPPs that is safe, easily performed, and produces excellent aesthetic results.

Journal of Drugs in Dermatology, Apr 1, 2023

Scars, burns & healing, 2022

Introduction Keloids are hypertrophic scars that commonly arise in the ear region. The authors’ o... more Introduction Keloids are hypertrophic scars that commonly arise in the ear region. The authors’ objectives were to (1) evaluate effectiveness of surgical shave excision followed by intralesional triamcinolone acetonide and onabotulinumtoxinA injections; and (2) evaluate safety and patient satisfaction. Methods and Materials This study was a retrospective chart review of patients who received treatment of extralesional surgical shave excision followed by intralesional triamcinolone acetonide and onabotulinumtoxinA injections to treat ear keloids at a single outpatient dermatology clinic. A prospective patient questionnaire was administered to the same patient population to collect recurrence and patient satisfaction. Results A total of 45 patients were included, consisting of 84.4% females (n = 38) and 15.6% males (n = 7) with a mean age of 25.5 years. Through retrospective chart review, early recurrence was seen in 6.7% of patients (n = 3), and via the prospective patient questionnaire, 11.1% of patients noted early keloid recurrence (n = 5). Of the patients who expressed their level of satisfaction in-clinic, 96.0% (n = 24) reported being satisfied or very satisfied and 4.0% (n = 1) were dissatisfied. Satisfaction was also assessed through the prospective patient questionnaire; of those who consented to the questionnaire, 100.0% (n = 24) were satisfied or very satisfied. Only 20.0% (n = 9) of all patients reported experiencing side effects, consisting of pruritus (11.1%; n = 5), tenderness (4.4%; n = 2), pain (2.2%; n = 1), and mild atrophy (2.2%; n = 1). Conclusion Extralesional surgical shave excision followed by intralesional triamcinolone acetonide and onabotulinumtoxinA injections may represent a promising treatment option for ear keloids. Evidence Level: 3 retrospective cohort study. Lay Summary Keloids are a type of raised scar, which can be painful and itchy for patients. Keloids can occur on various part of the body, including on the ear. They are challenging to treat and tend to come back. There are many treatment options, however, there is not one universal best treatment for keloids on the ear. We hoped to discover if shave excision followed by intralesional triamcinolone acetonide and onabotulinumtoxinA injections is effective at treating keloids on the ear. In order to answer this we completed a chart review of clinic patients, who have already completed the following combination treatment for keloids on the ear. The keloids were treated first by physically removing the bulk of the keloid with a scalpel, which is called shave excision. After the removal, triamcinolone acetonide and onabotulinumtoxinA were injected directly into the keloid. The rate of patient satisfaction and the rate of the keloid returning were collected during in-clinic visits and an optional post-clinic patient questionnaire. The treatment effectiveness and side effects experienced were reported during in-clinic visits. This indicated that with the low rate of side effects, high patient satisfaction, and low rate of keloid return, this treatment combination should be considered as an option for keloids on the ear. However, since this review was completed at one clinic with a small population of patients, it is not fully known if this treatment combination will work for all patients.

Journal of Cutaneous Medicine and Surgery, Apr 13, 2017

Archives of Dermatology, Dec 1, 1989

An indigent male patient presented with a widespread nodular eruption involving the torso and lim... more An indigent male patient presented with a widespread nodular eruption involving the torso and limbs. The differential diagnosis included nodular secondary syphilis, Kaposi's sarcoma, sarcoidosis, and lymphoma. Investigation confirmed secondary syphilis with positive cerebrospinal fluid serologic findings. Penicillin therapy produced a Jarisch-Herxheimer reaction despite pretreatment to diminish this. Discussion on the clinical features and treatment of syphilis is presented.

Dermatologic Surgery, May 1, 2015

BACKGROUND Hill and valley scarring is 1 of 3 atrophic scar types that occur as a result of acne,... more BACKGROUND Hill and valley scarring is 1 of 3 atrophic scar types that occur as a result of acne, becoming more apparent with facial skin aging. Treatment includes resurfacing techniques and the use of injectable fillers. Poly-L-lactic acid is an injectable collagen builder that has been used for the treatment of HIV-associated lipodystrophy and cosmetic enhancement. OBJECTIVE To determine the degree of correction attainable with poly-L-lactic acid and safety findings for the treatment of hill and valley acne scarring. MATERIALS AND METHODS Poly-L-lactic acid was injected over 3 to 4 serial treatments at 4-week intervals in 22 subjects in this single-arm, unblinded, open-label Phase II study. Efficacy was determined by physician, blinded evaluator, and subject assessment of scar improvement using Likert scales, comparing photographs taken by 3 camera systems at treatment visits 2 to 4 and follow-up to baseline. Subjects also assessed treatment satisfaction. RESULTS Percentage of patients with much to excellent improvement using the most sensitive camera system (VISIA-CR) ranged from 45.5% to 68.2%. Subject treatment satisfaction scores increased by 44%. One patient experienced a palpable nonvisible nodule. No subjects discontinued treatment. CONCLUSION Injectable poly-L-lactic acid facilitated improvement in hill and valley acne scarring and was well tolerated. Funding for this study provided by Sanofi-Aventis, Canada. Medical writing services provided by inScience Communications, Spinger Healthcare and funded by Sanofi-Aventis, Canada. J.A. Stewart is an employee of Sanofi-Aventis.

The Journal of clinical and aesthetic dermatology, Sep 1, 2022

Journal of Drugs in Dermatology, Oct 1, 2022

Scars, Burns & Healing, 2021

Introduction Keloid scars are therapeutically challenging and although many treatment options exi... more Introduction Keloid scars are therapeutically challenging and although many treatment options exist, there are no specific guidelines, and few reports have discussed keloids in the umbilical region. Methods Here, we present a successful treatment of a 31-year-old female with a history of a recurrent keloid in the umbilical region. The keloid was treated using intralesional cryotherapy followed by intralesional onabotulinumtoxinA and triamcinolone acetonide injections. Discussion The patient expressed high satisfaction, minimal side effects, and no recurrence. Conclusion Overall, due to the low rate of side effects, high patient satisfaction, and absence of recurrence, this treatment modality should be considered as an option for umbilical keloids. Lay Summary Background to subject: Keloids are a type of scar that are difficult to treat. There are many treatment options available, but there is no single best treatment for keloids that form around the belly button region. Question bei...

Journal of cutaneous medicine and surgery

Although etanercept is well tolerated and effective in moderate-to-severe plaque psoriasis, data ... more Although etanercept is well tolerated and effective in moderate-to-severe plaque psoriasis, data are limited in Canadian practice settings. To assess the effectiveness and safety of etanercept in Canadian patients with moderate-to-severe plaque psoriasis (Physician Global Assessment [PGA] ≥ 3) in routine practice. A 1-year, multicenter, open-label trial of 246 patients enrolled from March 2006 to July 2009 was conducted. Patients received etanercept 50 mg subcutaneously twice weekly for 3 months and then 50 mg once weekly for 9 months. The primary end point was the proportion of patients achieving a PGA score ≤ 2 at month 12. Secondary end points included the proportion of patients achieving PGA score ≤ 2 at months 3, 6, and 9 and change from baseline at month 12 for Patient Global Assessment (PtGA), body surface area, and Dermatology Life Quality Index (DLQI). Adverse events were reported. At month 12, 73.5% (95% CI 67.2-79.1) achieved a PGA score ≤ 2. The response was similar rega...

Scars, Burns & Healing

Introduction Keloids are hypertrophic scars that commonly arise in the ear region. The authors’ o... more Introduction Keloids are hypertrophic scars that commonly arise in the ear region. The authors’ objectives were to (1) evaluate effectiveness of surgical shave excision followed by intralesional triamcinolone acetonide and onabotulinumtoxinA injections; and (2) evaluate safety and patient satisfaction. Methods and Materials This study was a retrospective chart review of patients who received treatment of extralesional surgical shave excision followed by intralesional triamcinolone acetonide and onabotulinumtoxinA injections to treat ear keloids at a single outpatient dermatology clinic. A prospective patient questionnaire was administered to the same patient population to collect recurrence and patient satisfaction. Results A total of 45 patients were included, consisting of 84.4% females (n = 38) and 15.6% males (n = 7) with a mean age of 25.5 years. Through retrospective chart review, early recurrence was seen in 6.7% of patients (n = 3), and via the prospective patient questionna...

Journal of cutaneous medicine and surgery

Etanercept is well tolerated and effective in moderate to severe psoriasis; however, data on pati... more Etanercept is well tolerated and effective in moderate to severe psoriasis; however, data on patient-reported outcomes (PROs) in Canadian patients remain limited. To assess PROs in Canadian patients with moderate to severe psoriasis receiving etanercept in an open-label trial more representative of general clinical practice than traditional research studies. This 1-year, multicenter, single-arm study enrolled 246 patients. Patients received etanercept 50 mg subcutaneously twice weekly for 3 months and then 50 mg once weekly for 9 months. Primary and safety end points were reported previously. Change from baseline to month 12 for the Dermatology Life Quality Index (DLQI), EuroQoL-5D, and Treatment Satisfaction Questionnaire for Medication (TSQM) are secondary outcomes reported here. Post hoc analyses of PROs are also reported. Mean ± standard deviation (SD) DLQI total score improved from 13.7 ± 6.1 at baseline to 3.9 ± 5.6 at month 12. By month 12, 75% of patients achieved a clinical...

Background: Topical medications are the most commonly prescribed treatments for acne patients. Ho... more Background: Topical medications are the most commonly prescribed treatments for acne patients. However, adherence to these treatments and possible associations with clinical severity and quality of life (QoL) impact are unclear. Purpose: We evaluated the association between sociodemographic factors, clinical severity, and QoL impact and adherence to topical acne treatments. Methods: This was an observational study of acne patients referred for usual care to community-based dermatologists. Adherence was assessed with questionnaires after 2 months of acne therapy. The associations of adherence with factors of interest were evaluated by chi-square analysis and Spearman rank correlation. Results: In 152 acne patients treated with topical medications, low adherence was observed in 26%, medium in 49%, and high in 24%. Age, gender, duration of acne, education level, third-party drug plan coverage, smoking history, recreational drug use, ingestion of alcohol, and number of prescribed topica...

Scars, burns & healing, 2021

Introduction Keloid scars are therapeutically challenging and although many treatment options exi... more Introduction Keloid scars are therapeutically challenging and although many treatment options exist, there are no specific guidelines, and few reports have discussed keloids in the umbilical region. Methods Here, we present a successful treatment of a 31-year-old female with a history of a recurrent keloid in the umbilical region. The keloid was treated using intralesional cryotherapy followed by intralesional onabotulinumtoxinA and triamcinolone acetonide injections. Discussion The patient expressed high satisfaction, minimal side effects, and no recurrence. Conclusion Overall, due to the low rate of side effects, high patient satisfaction, and absence of recurrence, this treatment modality should be considered as an option for umbilical keloids. Lay Summary Background to subject: Keloids are a type of scar that are difficult to treat. There are many treatment options available, but there is no single best treatment for keloids that form around the belly button region. Question being asked: Is intralesional cryotherapy with intralesional onabotulinumtoxinA and triamcinolone acetonide injections effective at treating keloids in the belly button region? How the work was conducted: We treated a 31-year-old female with a keloid around the belly button region that returned after prior treatment. The keloid was treated using combination therapy of freezing the keloid from the inside out, which is called intralesional cryotherapy. This was followed by two types of injections, called onabotulinumtoxinA and triamcinolone acetonide, directly into the keloid. What we learned: Overall, due to the low rate of side effects, high patient satisfaction and the keloid not returning, this treatment plan should be considered as an option for keloids in the belly button region. What we did not learn: This treatment may or may not be effective and safe for all patients of all skin types and demographics as this treatment was performed for only one patient.

PubMed, Sep 1, 2022

Objective: To evaluate concomitant therapy of oral isotretinoin with multiplex pulsed dye laser a... more Objective: To evaluate concomitant therapy of oral isotretinoin with multiplex pulsed dye laser and Nd:YAG laser. Methods: A retrospective chart review of patients who received treatment of oral isotretinoin and non-ablative laser therapy to treat acne vulgaris at a single outpatient dermatology clinic site in Ontario, Canada between 2009 and 2017. Results: 187 patients were included, consisting of 45.5 percent males (n=85) and 54.5 percent females (n=102) with a mean age of 21.4 years. 31.6 percent (n=59) of patients reported experiencing side effects from concomitant isotretinoin and NAL therapy, the most common being eczema (n=14), erythema (n=11), significant dry skin/lips/eyes (n=8), flushing (n=6), and bruising (n=6). 99.2 percent of patients achieved clear or almost clear at treatment completion. Of those who expressed satisfaction, 65.2 percent (n=122) reported being satisfied with the treatment and the remaining patients did not report satisfaction nor dissatisfaction. Limitations: Limitations exist mainly due to the absence of standardized lesion counts and a comparator cohort. Thus, it is not possible to comment on whether the combination of isotretinoin and NAL is more efficacious that either treatment alone. Conclusion: Concomitant use of isotretinoin and non-ablative laser therapy is a safe and effective treatment option for acne vulgaris that provides patient satisfaction.

PubMed, Feb 1, 2017

Objective: To examine the effectiveness of intradermal botulinum toxin type A injection in improv... more Objective: To examine the effectiveness of intradermal botulinum toxin type A injection in improving skin texture and midface lift while reducing pore size and sebum production, as well as investigate the differences in effectiveness between onabotulinumtoxinA and abobotulinumtoxinA using intradermal and intramuscular injection methods. Design: A 16-week, single-blind, split-face, randomized study. Each patient served as their own control, receiving onabotulinumtoxinA and abobotulinumtoxinA randomized to either the left or right side of the face. Patients received intradermal botulinum toxin type A injections at Week 0 and intramuscular botulinum toxin type A injections at Week 2. Participants: Ten women aged 35 to 65 years who exhibited static rhytids in the glabellar and periorbital area. Measurements: The primary endpoint was efficacy of split-face treatment of intradermal and intramuscular onabotulinumtoxinA and abobotulinumtoxinA as assessed by a blinded evaluator using baseline and post-treatment photographs. The secondary endpoints included safety as assessed by adverse events and patient satisfaction measured by questionnaires completed at baseline and post-treatment. Results: Intradermal injection of botulinum toxin type A led to a statistically significant improvement in skin texture (p=0.004) while also resulting in mild midface lift (p=0.024), but did not provide a significant reduction of pore size and sebum production. There was no statistically significant difference between onabotulinumtoxinA and abobotulinumtoxinA when injected intradermally or intramuscularly. Conclusion: Intradermal injection of botulinum toxin type A appears to be a safe and effective therapy that provides an improvement in facial skin texture and midface lift. Registry: clinicaltrials.gov (ID#: NCT02907268).

Journal of Cutaneous Medicine and Surgery, Jan 19, 2018

Actinic keratosis (AK) is a skin condition most frequently occurring in older, fair-skinned indiv... more Actinic keratosis (AK) is a skin condition most frequently occurring in older, fair-skinned individuals, especially those with Fitzpatrick skin types I and II. 1-3 AK commonly occurs on the arms, head, and neck due to long-term exposure to ultraviolet light. 1,3 While prevalence and incidence have not been clearly studied in Canada, the rates may resemble those found in Rotterdam, Netherlands (latitude 51.9N), where researchers found 29% of the adult women and almost half of the adult men examined had at minimum 1 AK. 4 Patients with AK often experience adverse physical and psychological symptoms, which include and are not limited to itching, burning, tenderness, dyspigmentation, and a decrease in selfconfidence. 5 In addition, AK has the potential to transform into invasive squamous cell carcinomas. 1,2 Due to the pervasiveness of AK in the general population and severe discomfort caused by its symptoms, effective treatment must be implemented to control the condition and prevent further progression in individual patients. Current treatments for AK include both lesion-directed and field-directed therapies. Lesion-directed therapies include cryosurgery, laser therapy, and curettage/excision/shave biopsy. 3,6,7 Field-directed therapies include ingenol mebutate (Picato), 5-fluorouracil (5-FU) (Carac, Efudex, Fluoroplex), chemical peeling, diclofenac (Solaraze), imiquimod (Aldara, Zyclara), and photodynamic therapy (PDT). 3,4,7 In Canada, cryosurgery is the most commonly used treatment. 3 However, research has found cryosurgery to be less effective than previously thought, and an editorial published in the Journal of the American Medical Association suggests that the tendency of dermatologists to rapidly jump to cryosurgery for treatment of AK can lead to patients feeling neglected. 8,9 Moreover, cryosurgery, as a lesion-directed method of treatment, can only be used to treat single AK lesions at a time and is thus limited in scope. While the second most popular course of AK

Acta dermato-venereologica, Jun 8, 2023

Actinic keratoses are skin lesions that form due to longterm, repeated exposure to the sun. Lesio... more Actinic keratoses are skin lesions that form due to longterm, repeated exposure to the sun. Lesions can progress to squamous cell carcinoma; hence a key treatment goal is to prevent malignant progression. There is limited guidance on personalizing care for individual patients and supporting shared decision-making between physicians and patients to prevent suboptimal treatment outcomes. To support personalized actinic keratoses care, a group of 12 expert dermatologists used e-surveys to generate recommendations and develop a clinical tool. These can be used to guide shared decision-making between patients and healthcare professionals to support optimal, personalized, long-term care.

Journal of Drugs in Dermatology, Oct 1, 2022

International Journal of Dermatology, Nov 1, 1989

ABSTRACT:The giant cell tumor of tendon sheath (localized nodular tenosynovitis) is the second mo... more ABSTRACT:The giant cell tumor of tendon sheath (localized nodular tenosynovitis) is the second most common tumor involving the hand but is only rarely reported in the dermatologic literature. A case of giant cell tumor and a review of the clinical and pathologic records of 111 patients are discussed.

JAMA Dermatology, Jun 1, 2013

Importance: Pearly penile papules (PPPs) are benign, dome-shaped lesions found around the corona ... more Importance: Pearly penile papules (PPPs) are benign, dome-shaped lesions found around the corona of the penis. Treatments have varied in the past; however, to our knowledge, the use of the pulsed dye laser (PDL) for this condition has never been reported in the literature. Such papules are histologically analogous to angiofibromas; thus, we report PDL is an appropriate, effective, and nonablative method of treatment. Observations: Four patients diagnosed with PPPs were treated with PDL. Each patient reported little to no discomfort during the procedure. Minimal bruising was found in all 4 patients, which diminished over time. One patient stated slight discomfort after the procedure; this however, resolved in a weeks' time. Complete clearance of the papules was noted after 2 to 3 treatments in 2 patients and a reduction of the papules in 2 patients. Conclusions and Relevance: These 4 case reports illustrate the advantages of using PDL when treating PPP. In each patient, the appearance of the papules was either completely diminished or significantly reduced after the procedure. This result was achieved with only minimal discomfort felt by the patients. The use of PDL offers dermatologists a new treatment modality for PPPs that is safe, easily performed, and produces excellent aesthetic results.

Journal of Drugs in Dermatology, Apr 1, 2023

Scars, burns & healing, 2022

Introduction Keloids are hypertrophic scars that commonly arise in the ear region. The authors’ o... more Introduction Keloids are hypertrophic scars that commonly arise in the ear region. The authors’ objectives were to (1) evaluate effectiveness of surgical shave excision followed by intralesional triamcinolone acetonide and onabotulinumtoxinA injections; and (2) evaluate safety and patient satisfaction. Methods and Materials This study was a retrospective chart review of patients who received treatment of extralesional surgical shave excision followed by intralesional triamcinolone acetonide and onabotulinumtoxinA injections to treat ear keloids at a single outpatient dermatology clinic. A prospective patient questionnaire was administered to the same patient population to collect recurrence and patient satisfaction. Results A total of 45 patients were included, consisting of 84.4% females (n = 38) and 15.6% males (n = 7) with a mean age of 25.5 years. Through retrospective chart review, early recurrence was seen in 6.7% of patients (n = 3), and via the prospective patient questionnaire, 11.1% of patients noted early keloid recurrence (n = 5). Of the patients who expressed their level of satisfaction in-clinic, 96.0% (n = 24) reported being satisfied or very satisfied and 4.0% (n = 1) were dissatisfied. Satisfaction was also assessed through the prospective patient questionnaire; of those who consented to the questionnaire, 100.0% (n = 24) were satisfied or very satisfied. Only 20.0% (n = 9) of all patients reported experiencing side effects, consisting of pruritus (11.1%; n = 5), tenderness (4.4%; n = 2), pain (2.2%; n = 1), and mild atrophy (2.2%; n = 1). Conclusion Extralesional surgical shave excision followed by intralesional triamcinolone acetonide and onabotulinumtoxinA injections may represent a promising treatment option for ear keloids. Evidence Level: 3 retrospective cohort study. Lay Summary Keloids are a type of raised scar, which can be painful and itchy for patients. Keloids can occur on various part of the body, including on the ear. They are challenging to treat and tend to come back. There are many treatment options, however, there is not one universal best treatment for keloids on the ear. We hoped to discover if shave excision followed by intralesional triamcinolone acetonide and onabotulinumtoxinA injections is effective at treating keloids on the ear. In order to answer this we completed a chart review of clinic patients, who have already completed the following combination treatment for keloids on the ear. The keloids were treated first by physically removing the bulk of the keloid with a scalpel, which is called shave excision. After the removal, triamcinolone acetonide and onabotulinumtoxinA were injected directly into the keloid. The rate of patient satisfaction and the rate of the keloid returning were collected during in-clinic visits and an optional post-clinic patient questionnaire. The treatment effectiveness and side effects experienced were reported during in-clinic visits. This indicated that with the low rate of side effects, high patient satisfaction, and low rate of keloid return, this treatment combination should be considered as an option for keloids on the ear. However, since this review was completed at one clinic with a small population of patients, it is not fully known if this treatment combination will work for all patients.

Journal of Cutaneous Medicine and Surgery, Apr 13, 2017

Archives of Dermatology, Dec 1, 1989

An indigent male patient presented with a widespread nodular eruption involving the torso and lim... more An indigent male patient presented with a widespread nodular eruption involving the torso and limbs. The differential diagnosis included nodular secondary syphilis, Kaposi's sarcoma, sarcoidosis, and lymphoma. Investigation confirmed secondary syphilis with positive cerebrospinal fluid serologic findings. Penicillin therapy produced a Jarisch-Herxheimer reaction despite pretreatment to diminish this. Discussion on the clinical features and treatment of syphilis is presented.

Dermatologic Surgery, May 1, 2015

BACKGROUND Hill and valley scarring is 1 of 3 atrophic scar types that occur as a result of acne,... more BACKGROUND Hill and valley scarring is 1 of 3 atrophic scar types that occur as a result of acne, becoming more apparent with facial skin aging. Treatment includes resurfacing techniques and the use of injectable fillers. Poly-L-lactic acid is an injectable collagen builder that has been used for the treatment of HIV-associated lipodystrophy and cosmetic enhancement. OBJECTIVE To determine the degree of correction attainable with poly-L-lactic acid and safety findings for the treatment of hill and valley acne scarring. MATERIALS AND METHODS Poly-L-lactic acid was injected over 3 to 4 serial treatments at 4-week intervals in 22 subjects in this single-arm, unblinded, open-label Phase II study. Efficacy was determined by physician, blinded evaluator, and subject assessment of scar improvement using Likert scales, comparing photographs taken by 3 camera systems at treatment visits 2 to 4 and follow-up to baseline. Subjects also assessed treatment satisfaction. RESULTS Percentage of patients with much to excellent improvement using the most sensitive camera system (VISIA-CR) ranged from 45.5% to 68.2%. Subject treatment satisfaction scores increased by 44%. One patient experienced a palpable nonvisible nodule. No subjects discontinued treatment. CONCLUSION Injectable poly-L-lactic acid facilitated improvement in hill and valley acne scarring and was well tolerated. Funding for this study provided by Sanofi-Aventis, Canada. Medical writing services provided by inScience Communications, Spinger Healthcare and funded by Sanofi-Aventis, Canada. J.A. Stewart is an employee of Sanofi-Aventis.

The Journal of clinical and aesthetic dermatology, Sep 1, 2022

Journal of Drugs in Dermatology, Oct 1, 2022

Scars, Burns & Healing, 2021

Introduction Keloid scars are therapeutically challenging and although many treatment options exi... more Introduction Keloid scars are therapeutically challenging and although many treatment options exist, there are no specific guidelines, and few reports have discussed keloids in the umbilical region. Methods Here, we present a successful treatment of a 31-year-old female with a history of a recurrent keloid in the umbilical region. The keloid was treated using intralesional cryotherapy followed by intralesional onabotulinumtoxinA and triamcinolone acetonide injections. Discussion The patient expressed high satisfaction, minimal side effects, and no recurrence. Conclusion Overall, due to the low rate of side effects, high patient satisfaction, and absence of recurrence, this treatment modality should be considered as an option for umbilical keloids. Lay Summary Background to subject: Keloids are a type of scar that are difficult to treat. There are many treatment options available, but there is no single best treatment for keloids that form around the belly button region. Question bei...

Journal of cutaneous medicine and surgery

Although etanercept is well tolerated and effective in moderate-to-severe plaque psoriasis, data ... more Although etanercept is well tolerated and effective in moderate-to-severe plaque psoriasis, data are limited in Canadian practice settings. To assess the effectiveness and safety of etanercept in Canadian patients with moderate-to-severe plaque psoriasis (Physician Global Assessment [PGA] ≥ 3) in routine practice. A 1-year, multicenter, open-label trial of 246 patients enrolled from March 2006 to July 2009 was conducted. Patients received etanercept 50 mg subcutaneously twice weekly for 3 months and then 50 mg once weekly for 9 months. The primary end point was the proportion of patients achieving a PGA score ≤ 2 at month 12. Secondary end points included the proportion of patients achieving PGA score ≤ 2 at months 3, 6, and 9 and change from baseline at month 12 for Patient Global Assessment (PtGA), body surface area, and Dermatology Life Quality Index (DLQI). Adverse events were reported. At month 12, 73.5% (95% CI 67.2-79.1) achieved a PGA score ≤ 2. The response was similar rega...

Scars, Burns & Healing

Introduction Keloids are hypertrophic scars that commonly arise in the ear region. The authors’ o... more Introduction Keloids are hypertrophic scars that commonly arise in the ear region. The authors’ objectives were to (1) evaluate effectiveness of surgical shave excision followed by intralesional triamcinolone acetonide and onabotulinumtoxinA injections; and (2) evaluate safety and patient satisfaction. Methods and Materials This study was a retrospective chart review of patients who received treatment of extralesional surgical shave excision followed by intralesional triamcinolone acetonide and onabotulinumtoxinA injections to treat ear keloids at a single outpatient dermatology clinic. A prospective patient questionnaire was administered to the same patient population to collect recurrence and patient satisfaction. Results A total of 45 patients were included, consisting of 84.4% females (n = 38) and 15.6% males (n = 7) with a mean age of 25.5 years. Through retrospective chart review, early recurrence was seen in 6.7% of patients (n = 3), and via the prospective patient questionna...

Journal of cutaneous medicine and surgery

Etanercept is well tolerated and effective in moderate to severe psoriasis; however, data on pati... more Etanercept is well tolerated and effective in moderate to severe psoriasis; however, data on patient-reported outcomes (PROs) in Canadian patients remain limited. To assess PROs in Canadian patients with moderate to severe psoriasis receiving etanercept in an open-label trial more representative of general clinical practice than traditional research studies. This 1-year, multicenter, single-arm study enrolled 246 patients. Patients received etanercept 50 mg subcutaneously twice weekly for 3 months and then 50 mg once weekly for 9 months. Primary and safety end points were reported previously. Change from baseline to month 12 for the Dermatology Life Quality Index (DLQI), EuroQoL-5D, and Treatment Satisfaction Questionnaire for Medication (TSQM) are secondary outcomes reported here. Post hoc analyses of PROs are also reported. Mean ± standard deviation (SD) DLQI total score improved from 13.7 ± 6.1 at baseline to 3.9 ± 5.6 at month 12. By month 12, 75% of patients achieved a clinical...

Background: Topical medications are the most commonly prescribed treatments for acne patients. Ho... more Background: Topical medications are the most commonly prescribed treatments for acne patients. However, adherence to these treatments and possible associations with clinical severity and quality of life (QoL) impact are unclear. Purpose: We evaluated the association between sociodemographic factors, clinical severity, and QoL impact and adherence to topical acne treatments. Methods: This was an observational study of acne patients referred for usual care to community-based dermatologists. Adherence was assessed with questionnaires after 2 months of acne therapy. The associations of adherence with factors of interest were evaluated by chi-square analysis and Spearman rank correlation. Results: In 152 acne patients treated with topical medications, low adherence was observed in 26%, medium in 49%, and high in 24%. Age, gender, duration of acne, education level, third-party drug plan coverage, smoking history, recreational drug use, ingestion of alcohol, and number of prescribed topica...