Vascular Endothelial Growth Factor Protects CD200-Rich and CD34-Positive Hair Follicle Stem Cells Against Androgen-Induced Apoptosis Through the Phosphoinositide 3-Kinase/Akt Pathway in Patients With Androgenic Alopecia BACKGROUND 5α-DHT can decrease the cell viability of the hair follicle stem cells (HFSCs) with CD34-positive and CD200-rich in bald scalp area of androgenic alopecia (AGA) patients and the apoptosis of HFSCs may be involved in the pathogenesis of AGA. The expression of Vascular endothelial growth factor (VEGF) turns to be weakened or disappeared in hair follicles of AGA patients. OBJECTIVE To investigate whether VEGF is involved in the apoptosis of HFSCs induced by 5α-DHT in the patients of AGA. METHODS By 5α-DHT, apoptosis of CD200-rich and CD34-positive HFSCs was induced and apoptotic rates up to 24 hours were assessed using flow cytometry. The expression grades of Bcl-2, Akt, caspase-3 and Bax were observed through Western blot analysis. RESULTS Vascular endothelial growth factor could cut 5α-DHT induced apoptosis down substantially in a concentration-dependent manner. The 5α-DHT induced decline in the rise of Bcl-2/Bax proportion and the increase in caspase-3 degrees were mostly reversed by using VEGF and the VEGF's anti-apoptotic actions were impeded through preventing the activation of phosphoinositide 3-kinase (PI3K)/Akt. CONCLUSION Vascular endothelial growth factor can protect CD200-rich and CD34-positive HFSCs from androgen induced apoptosis by means of the PI3K/Akt pathway. Address correspondence and reprint requests to: Qingquan Liu, Department of Dermatology, Beijing Shunyi Hospital of Traditional Chinese Medicine, Capital Medical University, Dongcheng District, Beijing, 101300, China, or e-mail: liuqingquan1962@126.com The authors have indicated no significant interest with commercial supporters. The authors have indicated no significant interest with commercial supporters. All procedures were conducted with the approval of the ethics committee of Beijing Hospital of Traditional Chinese Medicine Affiliated of Capital Medical University. © 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

Comparative Efficacy of 35% Glycolic Acid Peel Alone or in Combination With 10% and 20% Trichloroacetic Acid Spot Peel for Melasma: A Randomized Control Trial BACKGROUND To study and compare the therapeutic efficacy and side effects of 35% glycolic acid (GA) full face peel alone or in combination with 10% or 20% trichloroacetic acid (TCA) spot peel for facial melasma. METHODS Thirty patients with facial melasma were randomly divided into 3 equal Groups A, B, and C. Group A was treated with 35% GA full-face peel, Group B and C with 35% GA full-face peel followed by 10% and 20% TCA spot peel respectively once every 15 days. Four peels were performed once every 15 days. The response to the treatment was evaluated by the percentage reduction in melasma area severity index (MASI) scoring. RESULTS All 3 groups had significant reduction of MASI, but there was no significant difference between the groups. Group A had minimum side effects. CONCLUSION Chemical peels with GA alone or in combination with TCA do result in a significant improvement in melasma, but the combination of the peels in the same sitting does not seem to have any additive or synergistic effect while they may increase the side effects. Address correspondence and reprint requests to: Shimona Garg, MD, Department of Dermatology and Venereology, Government Medical College and Hospital, Sector 32 B, Chandigarh, 160031, India, or e-mail: gargshimona@gmail.com The authors have indicated no significant interest with commercial supporters. © 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

Reconstructive Conundrum: Repair of a Conchal Bowl Defect No abstract available

Strategies for Reducing Final Surgical Defect Sizes in the Treatment of Lentigo Maligna BACKGROUND Lentigo maligna (LM) is associated with disproportionately high surgical morbidity. OBJECTIVE The authors report on 2 strategies to reduce the surgical morbidity associated with LM. METHODS Forty LM lesions were removed with excisional biopsies without margins and closed with purse-string sutures. Invasive cases underwent staged excisions with 10-mm margins. Cases without invasion were treated with neoadjuvant topical imiquimod 5% cream (5 d/wk × 8 weeks) followed by conservative staged excisions with 2-mm margins using radial sections stained with hematoxylin and eosin and immunostaining with Mart-1, with or without SOX10. RESULTS Invasion was detected in 12/40 (30%) of the excisional biopsy specimens (average depth 0.45 mm). No invasion was detected in 28/40 (70%). All 24 patients who completed neoadjuvant topical imiquimod 5% cream before staged excisions had negative first-stage margins at 2 mm. Compared with average published margins for LM, this represents a 71.4% reduction in the required margin and an average reduction in the final surgical defect by 74%. CONCLUSION LM treatment by excisional biopsies with a purse-string closure enables accurate tumor staging and contracts the tumor footprint to its minimal size. Subsequent neoadjuvant imiquimod followed by a conservative staged excision with 2-mm margins allows for removal of LM with decreased surgical morbidity. Address correspondence and reprint requests to: Glen M. Bowen, MD, 4A 330 School of Medicine, 30 North 1900 East, Salt Lake City, UT 84132, or e-mail: glen.bowen@hci.utah.edu The authors have indicated no significant interest with commercial supporters. © 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

Pain and Bruising Levels After Lip Augmentation: A Comparison of Anterograde and Retrograde Techniques Using an Automated Motorized Injection Device. A Blinded, Prospective, Randomized, Parallel Within-Subject Trial BACKGROUND Dermal fillers for lip augmentation can be injected using various techniques. Although all seem to provide acceptable results, it is not clear which technique is safer, less painful, and provides greater patient comfort. OBJECTIVE To compare patients' self-reported pain intensity during the injection of hyaluronic acid dermal filler for lip augmentation, with 2 different techniques, anterograde versus retrograde. METHODS AND MATERIALS Prospective, single-center, within-subject, single-blinded, randomized controlled trial. All subjects received injections in the lip with hyaluronic acid–based filler, each side using the anterograde or retrograde injection technique. An automated motorized injection device was used to ensure a homogeneous deposition flow of the product injected and reduce operator bias. Pain intensity was self-assessed using a 100-mm visual analog scale. Presence and severity of bruising were recorded. RESULTS Forty-four women (mean age 30.3 years) were randomized. Mean self-reported pain score was 53.1% lower with the anterograde technique than with the retrograde (p < .0001). The anterograde technique had lower rates of site reactions, showed a faster recovery time, and 68.2% of patients favored this technique. CONCLUSION This study demonstrated that the anterograde technique was less painful, and led to fewer bruising and site reactions than the retrograde technique when using an automated device. LEVEL OF EVIDENCE I. Address correspondence and reprint requests to: Hassan Galadari, MD, College of Medicine and Health Sciences, United Arab Emirates University, Dubai, P.O. Box 17666, Al Ain, United Arab Emirates, or e-mail: hgaladari@uaeu.ac.ae Materials were provided by Teoxane Laboratories. No other financial support was provided. H. Galadari serves as a consultant for Teoxane SA. P. Delobel is an employee of Teoxane SA that provided scientific support and medical writing assistance at the request of the authors and did not receive any honorarium, or another form of additional financial aid related to the development of this article. E. Sanchez-Vizcaino Mengual is an employee of i2e3 Biomedical Research Institute and provided medical writing assistance. The remaining author has indicated no significant interest with commercial supporters. © 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

Type II Cutaneous Meningioma: A Case Report and Discussion No abstract available

Combination Therapy With Microneedling and Platelet-Rich Plasma for Acne Scarring: A Systematic Review and Meta-analysis No abstract available

Pharmacologic and Nonpharmacologic Interventions for Perioperative Anxiety in Patients Undergoing Mohs Micrographic Surgery: A Systematic Review BACKGROUND Perioperative anxiety is associated with negative patient outcomes in Mohs micrographic surgery (MMS). Both pharmacologic and nonpharmacologic therapies have been used to alleviate perioperative anxiety in MMS. OBJECTIVE To systematically evaluate the efficacy of therapies aimed at reducing perioperative anxiety in MMS. METHODS AND MATERIALS Eligible articles were identified using PubMed MEDLINE, Cochrane Central Register of Controlled Trials, metaRegister of Controlled Trials, ClinicalTrials.gov, and World Health Organization International Clinical Trials Registry Platform. All available studies investigating interventions to reduce perioperative anxiety during MMS were considered. RESULTS Of the 183 abstracts identified and screened, 5 studies met inclusion criteria. Three studies reported a postintervention reduction in patient anxiety (midazolam, educational video, and personalized music). Two studies reporting on similar interventions did not find an effect. CONCLUSION There is currently limited evidence to support either pharmacologic or nonpharmacologic therapy for alleviation of perioperative patient anxiety in MMS. Midazolam may provide patients a short-term benefit, though any estimate of the effect is very uncertain. Personalized music may be a promising nonpharmacologic intervention for future research. Address correspondence and reprint requests to: Angie Y. Wan, BA, Department of Dermatology, University Hospitals, 11100 Euclid Ave, Cleveland, Ohio, or e-mail: ayw16@case.edu Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.dermatologicsurgery.org). The authors have indicated no significant interest with commercial supporters. © 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

Catamenial Exacerbations of Cutaneous Neoplasms No abstract available

Treatment of Benign Adnexal Tumors in Birt–Hogg–Dubé Syndrome With Surgical Debulking in Combination With Fractional and Fully Ablative Carbon Dioxide Laser Resurfacing No abstract available