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DaxibotulinumtoxinA for Injection (DAXI) is a novel botulinum toxin type A product containing daxibotulinumtoxinA with a stabilizing excipient peptide (RTP004). DAXI immunogenicity was assessed in three phase 3 glabellar line studies (two placebo-controlled, single-dose studies and an open-label repeat-dose safety study). Binding antibodies to daxibotulinumtoxinA and RTP004 were detected by validated ELISAs. Samples positive for daxibotulinumtoxinA-binding antibodies were evaluated further for titer and neutralizing antibodies by mouse protection assay. Overall, 2786 subjects received DAXI and 2823 subjects were exposed to RTP004 as DAXI (n = 2786) or placebo (n = 37). Treatment-related anti-daxibotulinumtoxinA binding antibodies were detected in 21 of 2737 evaluable subjects (0.8%). No subject developed neutralizing antibodies. Treatment-related anti-RTP004 binding antibodies were detected in 35 (1.3%) of 2772 evaluable subjects. Binding antibodies were generally transient, of low titer (<1:200), and no subject had binding antibodies to both daxibotulinumtoxinA and RTP004. All subjects with treatment-induced binding antibodies to daxibotulinumtoxinA or RTP004 achieved none or mild glabellar line severity at Week 4 following each DAXI cycle, indicating no impact on DAXI efficacy. No subjects with binding antibodies to daxibotulinumtoxinA or RTP004 reported immune-related adverse events. This evaluation of anti-drug antibody formation with DAXI shows low rates of antibody formation to both daxibotulinumtoxinA and RTP004.

There is a wide diversity of opinions regarding the management of delayed inflammatory reactions (DIRs) secondary to hyaluronic acid (HA)-based fillers. The plethora of approaches has led the authors to conduct a review regarding management and treatment of DIRs as well as establish therapeutic guidelines for this purpose. A review of the literature was performed through databases such as PubMed using keywords including HA-fillers and complications, delayed HA filler sequelae and therapy, soft tissue and dermal filler reactions and management. Additionally, a survey comprised of questions regarding the management and treatment of DIRs was sent to 18 physicians highly experienced with soft-tissue filler injections in 10 countries. Their answers and recommendations were analyzed and debated amongst these panelists. Sixteen panelists favored antibiotic therapy as first-line treatment for DIRs, specifically dual antibiotic therapy consisting of a fluoroquinolone along with a tetracycline or macrolide for a period of 3-6 weeks. The majority refrained from the use of intralesional (IL) or systemic steroids except in the case of disfiguring or recalcitrant reactions. IL hyaluronidase was recommended by 13 panelists; however, some preferred a watchful waiting approach for a period of 48 hours to 2 weeks prior to IL hyaluronidase, and in cases where antibiotics did not lead to improvement. A consensus was reached and summarized to propose a clear, easy-to-follow, stepwise algorithm for the treatment of DIRs.

Graduate medical education (GME) in the USA is an increasingly organized and formalized process overseen by regulatory bodies, notably the American Council of Graduate Medical Education (ACGME), and associated specialty-specific Residency Review Committees (RRCs) to ensure that trainees, including residents and fellows, receive comprehensive, high-quality didactic education, clinical training, and research experience. Among the required elements of GME, performance of independent research is emphasized less than clinical and didactic education. In general, there are no ACGME requirements that trainees successfully publish papers in the peer reviewed. Indeed, unlike as is the case with procedure case logs, there are no minimum thresholds for specific numbers of abstracts presented, posters accepted, or manuscripts published. As such, while residencies and fellowships in certain disciplines or institutions may require considerable, documented research activity, others may not. Since future attending physicians are expected to be experts in their fields, able to digest relevant medical knowledge, critically evaluate emerging findings in the literature, and lead multi-professional healthcare teams, they must have a level of facility with the medical literature than can only be acquired by having performed research and having published papers themselves. Publishing one paper during training is easily attainable for all trainees. Having this be an ACGME requirement will necessitate protected time, research methods education, and mentorship for trainees. This can be accomplished without disrupting the other elements of resident and fellow training. From an ACGME perspective, required scholarly activity will support the competencies of practice-based learning and improvement as well as professionalism. In lay terms, benefits will be a higher level of education and attainment for trainees, and a potentially higher standard of health care for our patients.

Back for a new edition, Zoe Draelos' outstanding resource to cosmetic dermatology again provides a highly-illustrated, clinical guide to the full range of cosmetic skin treatments.Bringing together experts from research, industry, surgery and practice, it is structured in four distinct parts for easy navigation by the busy clinician:Basic Concepts - giving an overview of the physiology pertinent to cosmetic dermatology and the delivery systems by which treatments can take effect;Hygiene Products - evaluating cleansing and moisturising products;Adornment - looking at aesthetic techniques such as cosmetics, nail protheses and hair treatment;Antiaging - ie, injectables, resurfacing and skin contouring techniques, and the rapidly growing area of Cosmeceuticals.With over 300 high-quality images and key summary boxes throughout, this new edition incorporates the newest procedural innovations in this rapidly developing field. Perfect for all dermatologists, especially those specialising in cosmetic dermatology and whether hospital-based or in private practice, it provides the complete cosmetic regimen for your patients and will be an indispensable tool to consult over and over again.

Graft-versus-host disease (GVHD) is a well-known complication of allogeneic bone marrow transplantation and is increasingly being recognized after solid-organ transplantation and transfusion 1 – 3 . Like GVHD occurring after bone marrow transplantation, transfusion-associated GVHD is characterized by fever, skin rash, diarrhea, and hepatitis. However, transfusion-associated GVHD typically occurs much sooner (median, 10 to 12 days after transfusion), is frequently associated with bone marrow aplasia, usually does not respond to immunosuppressive therapy, and is fatal in most cases 4 – 10 . Since gamma irradiation of cellular blood components before transfusion can prevent the development of transfusion-associated GVHD, it is critical to identify susceptible . . .

THE past decade has witnessed important advances in the field of dermatology, several of which we have selected for review in this paper. Acne Vulgaris Acne vulgaris, the most common skin disease seen in dermatologic practice, affects approximately 17 million people in the United States. 1 Its precise cause is unknown, although abnormal keratin production with obstruction of the follicular opening, increased production of sebum (lipids secreted by the androgen-sensitive sebaceous glands), and proliferation of Propionibacterium acnes (anaerobic follicular diphtheroids) leading to inflammation play a part. 1 Topical treatments for mild and moderate cases of acne include comedolytic agents, such as tretinoin . . .

Figure 1. Basal-Cell Carcinoma. Basal-cell carcinoma appears most frequently as a classic pearly papule (Panel A). It can also take other forms. Panel B shows multiple superficial multicentric lesions on a patient's back that may be associated with the ingestion of inorganic arsenic, Panel C shows a single pigmented lesion that can be mistaken for a melanoma, and Panel D shows a cicatricial lesion, present for five years on the forehead of a 29-year-old woman.

According to Nazanin Saedi, MD, associate professor of dermatology and director of laser surgery and cosmetic dermatology at Thomas Jefferson University, it's not surprising that patients, themselves, don't realize how good they look. Botox and fillers have now joined skincare, makeup, hair, and nails as the standard in maintaining beauty. Dermatologist Jeffrey S. Dover, MD, practices with 14 dermatologists and nearly 100 staff at SkinCare Physicians in Chestnut Hill, Mass.

In the past decade, studies have demonstrated Propionibacterium acnes resistance related to antibiotic treatment of acne in the U.S. and U.K. To determine the prevalence . . .