Types of Plastic Surgery

•  Head, face, and eyes
  
  
  
  
• Facelift
  Brow/forehead lift
  Eyelid lift
  Ear pinning
  Ear reshaping
  Hair replacement surgery
  Nasal surgery
  Nose reshaping
  Chin, cheek, or jaw reshaping / facial implants
  Lip augmentation
  Cleft lip and cleft palate
  Craniosynostosis (craniofacial anomaly)
  
  Mouth and teeth
  
  Oral and maxillofacial surgery
  
  Breasts
  
  Breast augmentation
  Breast reconstruction
  Breast reduction in men with gynecomastia
  Breast lift
  
  Abdomen
  
  Tummy tuck (abdominoplasty)
  Liposuction
  
  Hand and upper limb
  
  Chase Hand & Upper Limb Center
  
  Skin
  
  Chemical peel
  Dermabrasion / dermaplaning
  Collagen/fat injectable fillers
  Botox/filler injections (restylane, radiesse)
  Glycolic peels
  Laser peels
  Vein removal
  Scar revision
  Tattoo removal
  
  
  
  
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Dermatology Drug Pipeline

 The skin is the body’s largest organ, and dermatologists must be able to treat a variety of pathologies, including infectious, neoplastic, autoimmune, inflammatory, genetic, and traumatic. They must also know how to apply the many therapies developed to treat these different conditions, among them monoclonal antibodies, JAK inhibitors, DMARDs, steroids, antibiotics, and chemotherapeutic agents whose administration may be topical, oral, intravenous, intralesional, subcutaneous, or intramuscular. As a result, dermatology has always been one of the most robust markets for pharmaceuticals, one that is expected to reach $64 billion by 2027, which represents a compound annual growth rate of 12.9%. Such growth is driven not only by an increased incidence of common dermatoses such as acne, atopic dermatitis, and psoriasis, but also by patient demand for medications to treat common diseases for which there are no approved therapies and rare ones like epidermolysis bullosa.

Although there are more than 10 biologic agents available for use against psoriasis, more are in development given the common nature of the disease and the need for more effective therapies to address psoriasis and psoriatic arthritis. Adalimumab (Humira; AbbVie), the best-selling drug of 2020 with over $20 billion in sales, was approved by the FDA for multiple dermatologic conditions, including psoriasis, psoriatic arthritis, and hidradenitis suppurativa. Traditionally considered one of the best medications for inhibiting joint destruction, its efficacy in the skin is modest due to the fact that only 71% of patients achieve PASI 75 at week 16. By contrast, risankizumab (Skyrizi; Boehringer Ingelheim & AbbVie) is a new biologic for the condition whose use led to a PASI of 90 in 73% of patients. This highlights the continued need for newer, more effective therapies and particularly for those with lower rates of adverse events (AEs). This article will review some of the key dermatology drugs that may be approved in the coming year.

One of the most anticipated approvals is for ritlecitinib (Pfizer), a dual inhibitor of the TEC group of tyrosine kinases and Janus kinase 3 (JAK3) for the treatment of alopecia areata (AA). This autoimmune disease causes patchy hair loss on the scalp and can progress to hair loss in the entire body. It is important to treat AA because it is associated with poor health-related quality of life and can lead to psychological morbidities like anxiety and depression. Until the recent approval of baricitinib, a JAK 1 inhibitor, there were no FDA-approved therapies for the disorder and clinicians relied on minimally effective approaches with intralesional or topical corticosteroids.

Ritlecitinib was studied in the phase 2a ALLEGRO trial, a randomized, double-blind, multicenter study of patients with moderate to severe alopecia areata (≥50% scalp hair loss), including patients with totalis (complete hair loss on scalp) and universalis (complete hair loss over entire body). Ritlecitinib had an effect as early as 6 weeks, and after 24 months, at least 50% of patients who received it achieved a SALT-30 score and 25% a SALT-90 score. Sixty-seven percent of patients reported at least 1 AE. The most common AEs were headache (5/48 [10%]), nasopharyngitis (5/48 [10%]), and upper respiratory tract infection (4/48 [8%]).

In 2021, the FDA issued a warning about increased risk of health-related events like myocardial infarction, cerebral vascular accident, cancer, and death associated with JAK inhibitors like baricitinib. Preliminary data has shown that ritlecitinib may not have these side effects and, in particular, has now shown changes in lipid labs.  “It is clear that alopecia areata treatment remains a need for many dermatology patients,” said Christopher G. Bunick, MD/PhD, associate professor of dermatology at Yale School of Medicine. “Baricitinib was a major advance in care for AA patients; however, more therapeutic options are needed to help patients overcome this complex disease. Ritlecitinib differs from the current JAK inhibitor approved for AA because its mechanism of action is two-part: TEC kinase and JAK3 inhibition.”

Another candidate drug expected to be approved in 2023 is beremagene geperpavec (B-VEC) for the treatment of recessive dystrophic epidermolysis bullosa (RDEB). This chronic genodermatosis causes blistering, ulcerations, and scarring due to a mutation in COL7A1, which encodes collagen IIV (the anchoring fibril component of the basement membrane zone). B-VEC is a topical agent that can be repeatedly applied without serious AEs. Randomized, placebo-controlled, phase 1 and 2 clinical trials using B-VEC topically met important end points, including primary and secondary objectives of C7 expression, anchoring fibril assembly, wound surface area reduction, duration of wound closure, and time to wound closure following B-VEC therapy.9 No deaths or serious AEs were reported in the studies. Novel drug technology such as this has the potential to improve the treatment of rare dermatologic diseases.

It was expected that bimekizumab (Bimzel, UCB), a pipeline biologic medication for psoriasis, would be approved in 2022, but it was delayed by the FDA. It is an interleukin (IL)-17 blocker that selectively blocks IL-17A and IL-17F. It was studied versus secukinumab, and at week 16, 61.7% of patients in the bimekizumab group and 48.9% in the secukinumab group achieved PASI 100. Thus, bimekizumab was shown to be superior to secukinumab, which is already one of the most effective medications for psoriasis. Furthermore, in a phase 2b study, bimekizumab achieved significant improvements, with an acceptable safety profile, in the ACR50 score compared with placebo. Although additional long-term studies are needed, bimekizumab appears to be one of the most efficacious biologics for psoriasis and psoriatic arthritis. “Bimekizumab has shown excellent clinical results in psoriasis and psoriatic arthritis, the clinical space where it is likely to be approved and excel in patient outcomes, including PASI-100 responses, and it may also provide substantial benefit to patients with hidradenitis suppurativa”, Bunick said.

The coming year will prove to be an exciting one for dermatologic therapy and pharmacology. Given the more than 3000 diseases of the skin, hair, and nails that dermatologists have to treat, new and improved medications are always welcome and highly anticipated in this ever-evolving specialty.

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Top 3 Dermatology

 This week on HCPLive, several major research studies were explored in the dermatology field, with topics ranging from plaque psoriasis treatment options to gene therapy for dystrophic epidermolysis bullosa.

Some of the articles included in this list involve well-explored dermatologic conditions, whereas others covered rarer conditions with more rare genetic disorders.

The research included this week covered an array of topics, but these particular articles covered subjects of interest with a significant amount of depth and substantial data.

Highlights from This Week

1. Dystrophic Epidermolysis Bullosa: Positive Results from Topical Gene Therapy

The research explored in this article concerned a topical gene therapy known as beremagene geperpavec (B-VEC) for patients with the rare disorder known as dystrophic epidermolysis bullosa (DEB)—a condition known known to cause skin fragility and small everyday wounds.

The research demonstrated that the treatment group’s wounds saw a 70% complete wound closure rate following 6 months of B-VEC treatment, according to the study investigators.

“In a previous phase 1–2 study, electron microscopy of skin biopsy samples obtained from patients with recessive dystrophic epidermolysis bullosa showed that B-VEC restored C7 expression on immunofluorescence staining at the basement-membrane zone and induced formation of anchoring fibrils.”

The research was summarized by Aimee S. Payne, MD, PhD, of University of Pennsylvania’s Center for Cellular Immunotherapies.

2. Keratinocyte Grafts for Dystrophic Epidermolysis Bullosa Found to Be Safe, Efficacious

In this article, the research covered the long-term safety and efficacy seen in recessive DEB (RDEB) patients treated with autologous gene-corrected keratinocyte grafts (EB-101) for their wounds.

These keratinocyte grafts were developed by transducing keratinocytes with a retrovirus containing the COL7A1 gene and growing them into sheets which were used on RDEB patient wounds.

“In conclusion, autologous gene-corrected keratinocyte grafts may be a safe, durable treatment for chronic RDEB wounds, and the results of this Phase 1/2a trial demonstrate early evidence of sustained, long-term clinical benefit for patients with RDEB.”

The research team was led by Jodi Y. So, MD, of the Stanford University School of Medicine’s Department of Dermatology.

3. Study Indicates Deucravacitinib Superior to Apremilast, Placebo for Plaque Psoriasis Patients

The research included in this article was the result of the phase 3 trial known as POETYK PSO-2, which indicated that adult plaque psoriasis patients saw better efficacy from deucravacitinib treatment than from apremilast and placebo.

The investigators’ research concluded that their patients' response rates for outcomes increased by 24 weeks, and were found at weeks 16 and 24 to be consistently higher with deucravacitinib compared to apremilast.

“The overall safety profile of deucravacitinib, including a slight increase in the risk of nonserious viral infections, appears to be consistent with the mechanism of selective TYK2 inhibition.”

The investigators were led by Bruce Strober, MD, PhD, of the Depart of Dermatology at Yale University School of Medicine.

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Sun allergy

 Overview

Sun allergy is a broad term. It describes several conditions that cause an itchy rash to form on the skin after being in sunlight or other sources of ultraviolet (UV) radiation. Polymorphous light eruption is the most common form of sun allergy.

Some people have a hereditary type of sun allergy. Others develop symptoms only when triggered by another factor — such as taking medication or touching certain plants. Other types of sun-related reactions occur for reasons that are unclear.

Mild sun allergy may clear up without treatment. Severe rashes may be treated with steroid creams or pills. If you have severe sun allergy, you may need to take preventive steps. For example, wear clothing that shields you from the sun.

Symptoms

How skin with sun allergy looks varies widely depending on the color of your skin and what's causing the symptoms. Signs and symptoms may include:

Itchiness (pruritus)
Stinging
Tiny bumps that may merge into raised patches
A flushing of the exposed area
Blisters or hives

Symptoms usually occur only on skin that has been exposed to the sun or other source of UV light. Symptoms show up within minutes to hours after sun exposure.

When to see a doctor

See a health care provider if you have unusual, bothersome skin reactions after being in the sun. For severe or persistent symptoms, you may need to see someone who specializes in diagnosing and treating skin disorders (dermatologist).

Causes

Causes of sun allergy include immune system reactions to sunlight, certain medications and chemicals that make the skin more sensitive to the sun. It isn't clear why some people have a sun allergy and others don't. Inherited traits may play a role.


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Dermatology Melanoma

 Melanoma

Melanoma, the most serious type of skin cancer, develops in the cells (melanocytes) that produce melanin — the pigment that gives your skin its color. Melanoma can also form in your eyes and, rarely, inside your body, such as in your nose or throat.

The exact cause of all melanomas isn't clear, but exposure to ultraviolet (UV) radiation from sunlight or tanning lamps and beds increases your risk of developing melanoma. Limiting your exposure to UV radiation can help reduce your risk of melanoma.

The risk of melanoma seems to be increasing in people under 40, especially women. Knowing the warning signs of skin cancer can help ensure that cancerous changes are detected and treated before the cancer has spread. Melanoma can be treated successfully if it is detected early.

Symptoms

Melanomas can develop anywhere on your body. They most often develop in areas that have had exposure to the sun, such as your back, legs, arms and face.

Melanomas can also occur in areas that don't receive much sun exposure, such as the soles of your feet, palms of your hands and fingernail beds. These hidden melanomas are more common in people with darker skin.

The first melanoma signs and symptoms often are:

A change in an existing mole
The development of a new pigmented or unusual-looking growth on your skin

Melanoma doesn't always begin as a mole. It can also occur on otherwise normal-appearing skin.

Normal moles

Normal moles are generally a uniform color — such as tan, brown or black — with a distinct border separating the mole from your surrounding skin. They're oval or round and usually smaller than 1/4 inch (about 6 millimeters) in diameter — the size of a pencil eraser.

Most moles begin appearing in childhood and new moles may form until about age 40. By the time they are adults, most people have between 10 and 40 moles. Moles may change in appearance over time and some may even disappear with age.

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