Biomedical subjects

Joel L Cohen

Publications and source records attributed to Joel L Cohen.

9 recordsLinked to original sources

PubMed2006

Calcium hydroxylapatite for facial rejuvenation.

Porous calcium hydroxylapatite has been used in otolaryngology, dentistry and radiology for many years. Currently, calcium hydroxylapatite is gaining popularity for facial esthetics in the form of the product Radiesse (San Mateo, CA). Although Radiesse is not yet approved in the United States for cosmetic use, it is being used off-label by an increasing number of dermatologists and plastic surgeons for facial soft-tissue augmentation. Preliminary clinical and histologic studies have shown safety, efficacy and durability in various esthetic applications including the nasolabial folds and HIV lipoatrophy.

Biocompatible Materials↗

PubMed2006

Injection necrosis of the glabella: protocol for prevention and treatment after use of dermal fillers.

BACKGROUND: Injection of filler materials into the dermis is well tolerated, with few mild and transient side effects. Injection necrosis is a rare but clinically important potential complication caused by interruption of the vascular supply to the area by compression, injury, and/or obstruction of the vessel(s). The glabella is a particular danger zone for injection necrosis regardless of the type of filler used. OBJECTIVE: We recommend a protocol that may be used to help prevent and treat injection necrosis of the glabella after injection with dermal fillers. CONCLUSION: Injection necrosis in the glabellar region may be prevented by knowledge of the local anatomy and an understanding of its pathophysiology and treated by a suggested protocol.

Biocompatible Materials↗

PubMed2006

Lymphoepithelioma-like carcinoma of the skin: a report of two cases treated with complete microscopic margin control and review of the literature.

Lymphoepithelioma-like carcinoma of the skin (LELCS) is a rare cutaneous neoplasm with microscopic similarities to non-cutaneous lymphoepitheliomatous malignancies, particularly undifferentiated carcinoma of the nasopharynx. It can be clinically and histologically confused with other benign and malignant tumors. If not adequately treated, recurrence and distant metastasis are probable. We present two cases of LELCS treated surgically with complete microscopic margin control (one by the Mohs method and the other with en face permanent sections) and review the literature.

Aged, 80 and over↗

PubMed2006

Soft tissue augmentation.

Recent additions to the soft tissue augmentation armamentarium have greatly increased the dermatologic surgeon's choices in optimizing facial contouring and the treatment of acne scars. In this article, we review the science of fillers and look at the future of dermal fillers.

Acne Vulgaris↗

PubMed2003

Treatment of hyperhidrosis with botulinum toxin.

Focal hyperhidrosis is a common problem that affects up to 2.8% of the population with significant psychosocial implications. Traditional therapies have not proven effective for most of these patients, which further adds to patient anxiety. Botulinum toxin is emerging as a novel treatment for focal hyperhidrosis and is proving to be safe and effective. A therapeutic protocol for focal hyperhidrosis includes an individualized treatment plan for each site of involvement. For those who are affected in the palms and soles, the most common treatments include topical treatment with aluminum chloride, iontophoresis, botulinum toxin,systemic medications, and sympathectomy. For those who have axillary focal hyperhidrosis, iontophoresis is often difficult and botulinum toxin becomes the second line therapy. As of June 2003, BTX A has been approved for the treatment of hyperhidrosis in 13 countries: England, Canada, New Zealand, Australia, Taiwan, Netherlands, Switzerland, Brazil, Argentina, Columbia, El Salvador, Guatemala, and Mexico. With the currently available literature and ongoing studies, it should only be a short time before the U.S. Food and Drug Administration approves botulinum toxin therapy for focal hyperhidrosis in the United States.

Botulinum Toxins, Type A↗

PubMed2002

Penile paraffinoma: self-injection with mineral oil.

We present a 64-year-old patient with a 9-cm firm, irregular penile mass associated with phimosis, erectile dysfunction, and voiding difficulty. After he reluctantly admitted to multiple penile mineral oil self-injections for enlargement, surgical excision was performed. Pathologic examination was consistent with mineral oil granuloma (paraffinoma). Within several weeks after surgery, his erectile dysfunction and voiding complaints resolved. Paraffinomas have been encountered with the use of various oily substances injected for cosmetic purposes. Despite early warnings, these agents continued to be used to treat conditions ranging from hemorrhoids to wrinkles and even baldness. Fortunately, most of these fads have been abandoned by medical professionals, but the complicating lesions have been documented as having lag times as long as 30 years. Complete surgical excision remains the treatment of choice to prevent recurrence. Increased public awareness is needed for the prevention of this physically and psychologically debilitating problem.

Granuloma↗

PubMedDate not supplied

Metastatic zosteriform squamous cell carcinoma in an immunocompetent patient.

BACKGROUND: Although described in several reports of internal malignancies metastasizing to the skin, zosteriform metastases have been reported in only two cases of cutaneous squamous cell carcinoma (SCC). In both of these reports, the patients were immunosuppressed related to renal transplantation. OBJECTIVE: We present a case of an immunocompetent patient with zosteriform metastases originating from a recurrent cutaneous SCC. The lesions were present along the maxillary division of the trigeminal nerve. METHODS: Biopsies from eight lesions were studied using hematoxylin and eosin (H&E) and with immunohistochemistry. RESULTS: Neural involvement was detected in H&E preparations before and during excision of the metastatic nodules by Mohs micrographic surgery. The tumor cells reacted with antikeratin antibodies. The patient has had no evidence of recurrence or metastases 30 months following surgery. CONCLUSION: To our knowledge, this is the first case of cutaneous SCC with zosteriform metastases in a patient with an intact immune system. SCC should be included in the differential diagnosis of lesions presenting in a dermatomal distribution.

Aged, 80 and over↗

PubMedDate not supplied

The effect of atopic dermatitis on total burden of illness and quality of life on adults and children in a large managed care organization.

OBJECTIVE: To assess the impact of atopic dermatitis (AD) on total burden of illness and quality of life in a managed care population. METHODS: This study included retrospective evaluation of electronic claims, patient surveys of financial burden and quality of life (QOL), and medical chart review. A total of 962 AD patients had 12 months of claims data available. Of these, the Dermatology Life Quality Index (DLQI), SF-36, and Children's Dermatology Life Quality Index (CDLQI) were mailed to 400 participants (42%) who consented to take part in the prospective evaluation, 298 of whom returned evaluable questionnaires (75% response rate to survey and 31% of eligible patients). Survey responders comprised the cohort used for determination of economic and humanistic burden of illness. Additionally, socioeconomic demographics, out-of-pocket expenses, and clinical history (including disease severity) were collected via survey. Provider assessments of disease severity were collected via chart review. RESULTS: The patient mean age was 17.22+/-0.94 years, which was not unexpected considering AD is the eighth most common disease in people younger than 25 years. Mean 167 dollars per person, or only 27.4% of the total burden. A vast majority of the direct medical expenditures occurred in the outpatient setting and were composed primarily of clinic visits and medications. Approximately 50% of the total burden of illness associated with AD resulted from days lost from work. The remainder of the burden was out-of-pocket costs to the patients and their families. More than 75% of the out-of-pocket costs resulted from household items and medications. The mean DLQI score for the 107 adults was 6.6+/-5.4, and the mean CDLQI score among the 132 children aged 4 to 16 years was 5.8+/-5.9, compared with adults without skin disease (0.5+/-1.1) and children without skin disease (0.38+/-0.71) in the validation populations. Patient-assessed severity demonstrated a stronger correlation with CDLQI and DLQI than did provider-assessed severity. CONCLUSION: Atopic dermatitis, while not a life-threatening illness, imposes a financial burden on the health care system, but even more so on the individual. Indirect costs, such as the purchase of special household items and days lost from work, comprise a great proportion of this burden and should not be overlooked when evaluating this disease.

Journal Article↗

PubMedDate not supplied

Botulinum toxin type a in the treatment of dermatochalasis: an open-label, randomized, dose-comparison study.

OBJECTIVE: To compare the efficacy and safety of 2 doses of botulinum toxin type A in the treatment of dermatochalasis. METHODS: Forty patients with mild to moderate dermatochalasis were randomly assigned to receive 1 of 2 doses of botulinum toxin type A in the lateral infrabrow--4 U/brow or 6 U/brow--and followed up for 20 weeks. RESULTS: Investigator assessment showed the proportion of responders (> or = 1 grade improvement in severity of dermatochalasis on a scale of none, mild, moderate, or severe) at week 2 was 32% with 4 U and 47% with 6 U. Compared with the lower dose group, the higher dose group also reported a greater degree of improvement, significantly higher ratings for feelings of attractiveness and feelings of satisfaction with appearance, and a higher incidence of satisfaction. CONCLUSION: Single-site injection of botulinum toxin type A in the lateral infrabrow can offer effective treatment for mild to moderate upper eyelid dermatochalasis.

Botulinum Toxins, Type A↗