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E-Poster Abstracts 2020 ASDS Virtual Annual Meeting e-Poster Abstracts 2020 ASDS Virtual Annual Meeting 660 Nanometer Red Light and 2% Nitroglycerin Paste for the in angiogenesis (4). Nitroglycerin paste works by dilating small-caliber Management of Calcium Hydroxyapatite Vascular Occlusion arterioles and improving perfusion to dermal vasculature (5). These in a Hemophiliac with HIV-Associated Facial Lipoatrophy mechanisms of action likely lead to improved perfusion and scar reduction in the patient. Additionally, his impaired hemostasis likely also Author: Cheryl M. Burgess, MD, Center for Dermatology and contributed. Dermatologic Surgery Nitroglycerin paste and 660 nm red light may represent a promising Co-Author: Monica Williams, MD, MPH treatment for the management of CaHA filler induced vascular occlusion in patients with bleeding disorders or those in which anticoagulation Purpose: Vascular occlusion is a rare complication of dermal filler is contraindicated. Close follow-up is recommended. Further study injection that can lead to more severe complications including blindness of management practices in patients with impaired clotting or those and avascular necrosis of surrounding tissue. There is limited data on in whom anticoagulants are contraindicated is warranted, as well as a reversal agent for calcium hydroxyapatite (CaHA) based dermal filler studies exploring the use and mechanism of action of red light therapy in (1); and no available guidance for the management of CaHA induced avascular necrosis prevention. vascular occlusion in patients with clotting disorders or those in whom anticoagulation is contraindicated. References 1. Robinson DM. In vitro analysis of the degradation of calcium We present a case of vascular occlusion in a patient with a history of hydroxylapatite dermal filler: A proof-of-concept study. Dermatol Surg. hemophilia and HIV-associated facial lipoatrophy who presented one 2018 Nov;44 Suppl 1:S5-9. week after CaHA injections in the mid-face successfully managed with 2. van Loghem J, Funt D, Pavicic T, Goldie K, Yutskovskaya Y, Fabi S, 2% nitroglycerin paste and 660 nanometer red light. et al. Managing intravascular complications following treatment with calcium hydroxylapatite: An expert consensus. J Cosmet Dermatol. Design: A 59-year-old male with a history of hemophilia and HIV- 2020 Mar 17. associated facial lipoatrophy was managed with more than 10 treatments 3. Ablon G. Phototherapy with light emitting diodes: Treating a broad of CaHA and Poly-L-Lactic Acid (PLLA) dermal filler over his 20-year range of medical and aesthetic conditions in dermatology. J Clin history. These treatments were administered by his dermatologist and Aesthet Dermatol. 2018;11(2):21‐27. routinely preceded by infusion of clotting factor VIII. 4. Chung H, Dai T, Sharma SK, Huang YY, Carroll JD, Hamblin MR. The nuts and bolts of low-level laser (light) therapy. Ann Biomed Eng. 2012 One week following his most recent treatment of CaHA dermal filler, Feb;40(2):516-33. the patient presented with pain, crusting and purpura in the infraorbital 5. Kleydman K, Cohen JL, Marmur E. Nitroglycerin: A review of its use area of his right cheek. On examination, the patient had a crusted in the treatment of vascular occlusion after soft tissue augmentation. erythematous plaque associated with reticulated non-blanching Dermatol Surg. 2012 Dec;38(12):1889-97. Dermatol Surg. 2012 Dec;3 erythema in the right infraorbital region of the midface, along with an injected right sclera. The patient’s vital signs, Snellen visual acuity, confrontational visual fields and ocular motility were within normal limits. A Case of Penicillamine Induced Elastosis Perforans The patient initially noted bruising and persistent, dull, aching pain in his Serpiginosa right cheek within 24 hours of the procedure. However, he did not report these symptoms until one week later given his previous history of minor Author: Daniel Michalik, MD, Resident Physician, Cleveland Clinic post-procedure bruising. Foundation The patient’s presentation was consistent with vascular occlusion Co-Author: Jennifer Lucas, MD and compromise of infraorbital vessels for which anticoagulants or antiplatelet therapy are recommended. (2) However, he was not eligible Purpose: To describe a case of penicillamine induced elastosis for anticoagulation or antiplatelet therapy given his history of hemophilia. perforans serpiginosa presenting within a surgical site. The patient was treated with 2cc of normal saline (0.9 % NS) irrigation Design: Case report. to the injection site; and also began a regimen of 2% nitroglycerin paste Findings: A 52-year-old woman presented for evaluation of two firm once daily and 660 nanometer red light to prevent scarring and necrosis. papules that arose within a scar nine months after excision of an SCC. The patient had a total of eight, two-minute 660 nanometer red light She also noticed excess wrinkling of her neck over the past six years. sessions twice per week for one month; and once daily topical 2% Medication history was pertinent for a forty year history of penicillamine nitroglycerin paste for 8 weeks. for cystinuria. Examination of the anterior neck revealed two 3 mm Findings: Serial clinical evaluation of the patient demonstrated marked erythematous, crusted papules within a well-healed scar, in addition improvement. At 8-weeks post CaHA injection there was gradual to increased wrinkling and redundant skin folds. Histopathology restoration of the skin integrity and resolution of crusted plaques with demonstrated transepidermal elimination of abnormal thick elastic fibers minimal erythema, purpura, or skin sensitivity. At 24-weeks the vascular with perpendicular buds. Movat’s pentachrome stain showed coarse lesion was completely resolved with no signs of cutaneous scarring. tortuous elastic fibers throughout the papillary and reticular dermis. Summary: This case highlights the use of 660 nanometer red light and Summary: Long term administration of penicillamine has been 2% nitroglycerin paste in the management of late presenting dermal associated with dermatologic manifestations in 20-30% of patients. filler induced vascular occlusion in a patient with hemophilia where Penicillamine induced elastosis perforans serpigniosa (EPS) is a anticoagulation was contraindicated. well described manifestation occurring in 1% of patients taking this medication. Penicillamine induced EPS can be associated Prospective studies have demonstrated improvement in wound healing with other dermal abnormalities such as cutis laxa, non-hereditary and faster resolution of symptoms with the use of light emitting diode pseudoxanthoma elasticum or mucosal elastosis as a result of the same red light (3). In hair growth, 655 nm red light works by activating degenerative process leading some authors to suggest the broad term fibroblasts, growth factors and expression of type 1 procollagen and penicillamine induced degenerative dermatosis. Numerous treatment matrix metalloproteinase-9. Fibroblasts, growth factors and procollagen options have been described, including cryotherapy, intralesional are involved in wound healing, while metalloprotenase-9 is also involved kenalog, topical and oral retinoids, pulse dye laser, carbon dioxide laser and photodynamic therapy. e-Poster Abstracts 2020 ASDS Virtual Annual Meeting A Case of Strongyloides hyperinfection Syndrome Mimicking chloride (Mdn = 1.00) and ferric subsulfate (Mdn = 1.50) compared to the a Drug Rash pain response for silver nitrate (Mdn =6.00). Among the twelve patients, three (25%) experienced a pigmentary change when exposed to ferric Author: Divya Angra, MD, Resident Physician, Howard University subsulfate solution, two (17%) experienced a pigment change when Hospital exposed to aluminum chloride, and six (50%) experienced a pigment change when exposed to silver nitrate (overall p=0.17). No significant Co-Authors: Wen Chen, MD; Mary Maiberger, MD; Sachi Patel, MD; Ife difference was seen in the odds of experiencing a pigmentary change or Rodney, MD satisfaction response among the three solutions. Purpose: Recognize an uncommon dermatologic presentation of Summary: Application of three standard chemical cautery solutions Strongyloidiasis infection. Identify predisposing factors to Strongyloides exhibited significant differences in pain and pigmentary changes. Time hyperinfection syndrome. Differentiate drug-induced eruptions from to hemostasis was equivalent among the solutions, suggesting it may parasitic infection, in the setting of peripheral eosinophilia. not be a guiding factor in choice of a chemical cautery solution. These results are clinically relevant in the selection of one cautery solution over Design: Case report with review of literature. another based on individual patient needs. Findings: An 84-year-old African-American gentleman with history of metastatic prostate cancer was admitted for peripheral eosinophilia, A First Human Feasibility Study of Nano-pulse Stimulation altered mental status and a pruritic truncal rash of acute onset. Review (NPS) to evaluate the Potential Elimination of a Biopsy- of systems was positive for dyspnea, fatigue, generalized weakness confirmed Nodular or Superficial BCC in a Short-term Treat and diminished appetite. Physical examination revealed nontender, and Resect Study Design blanchable erythematous papules coalescing into plaques on the chest, abdomen and back. Bilateral anterior cervical lymph nodes Author: Christopher B. Harmon, MD, President, Surgical Dermatology were enlarged. A punch biopsy obtained from the left
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