Have you met our new addition, Totoro?


It’s not unusual for our Dermatologists to receive small gifts of gratitude from our patients. Most gifts from patients are a natural and innocent gesture of goodwill from an appreciative patient, motivated by gratitude or cultural customs.

Today we received a (very large) Totoro plush toy from a patient, which is actually pretty awesome considering we are big Studio Ghibli fans. In fact this Totoro is so big he won’t even fit into a normal-sized chair.

Our patient explained that they didn’t have enough room to keep Totoro and they couldn’t bear selling him to a stranger on Gumtree or eBay. How could we refuse the responsibility of providing this pre-loved icon with a happy home.

Totoro + Baby at Green Square DermatologyTotoro relaxing at Green Square Dermatology

If you look at the wall in the above pictures you’ll see part of a Studio Ghibli mural which decorates our Administration and Kitchen staff areas here at Green Square Dermatology.


Minimal Incision Extraction of Lipomas

ArticleGeneral, YouTube

Article: Minimal Incision Extraction of Lipomas
Authors: Michael T. Cosulich; Matthew A. Molenda; Eliot Mostow; Ashish C. Bhatia; Robert T. Brodell
JAMA Dermatology, December 2014


Lipomas are benign proliferations of mature fat that are occasionally tender. Common treatment approaches include elliptical excision, liposuction, and injection lipolysis. For most lipomas, we favor the minimal incision or “squeeze” technique, whereby lipomas are expressed through a small scalpel or punch incision. To our knowledge, the utilization rate of this simple, effective technique has not been previously studied.

Superficial subcutaneous lipoma


Minimal incision extraction has been adopted by many dermatologists because it is an office procedure with minimal complications, a specimen is produced to confirm the lesion’s benign nature, and lipomas are slow growing and unlikely to recur quickly, even if not completely removed. Minimal incision extraction is favored compared with elliptical excision because it is quick, easily and safely performed in the office setting, and allows removal during a standard visit rather than rescheduling patients for a more time-consuming elliptical excision. Lipoma extraction through MIE is particularly easy and practical in patients with multiple painful lipomas. Our survey revealed a significant difference between the rate of dermatologist use of MIE for 1-cm and 3-cm lipomas (67.8% vs 55.2%; P = .04), suggesting that practitioners find removing larger lipomas more difficult with this technique. Certainly, larger lipomas may require dissection, piecemeal removal, or more hemostasis, and are more time consuming, but MIE is still possible and more efficient than elliptical excisions in most cases.2 We have used MIE on lipomas of up to 14 cm. Limitations of this study include a geographically limited study population and the lack of data to discern whether respondents would choose different techniques based on body location.

The survey data demonstrate that approximately 33% of dermatologists do not use MIE, even for solitary 1-cm lipomas, and that the most commonly cited reason for not treating lipomas was being uncomfortable with this procedure. Perhaps after seeing a demonstration (Video) of this quick and simple technique, more dermatologists will be willing to attempt MIE. Other physicians may be waiting for more outcome data demonstrating the recurrence rate after MIE vs elliptical excisions. One case series using MIE had a recurrence rate of 1.4%, but this source did not disclose the follow-up period or provide comparative data.3 Our clinical experience with this procedure suggests that the recurrence risk after MIE is low, and when recurrences occur, they can be treated with the same MIE technique, avoiding the need for an elliptical excision.

WARNING: This video contains surgical procedures.
The Minimal Incision Extraction Demonstration video contains surgical procedures. To view this video click the link below:


View Full Article

DOI: 10.1001/jamadermatol.2014.3234


Effect of Ixekizumab on Patients with Psoriasis


Authors: April W. Armstrong; Charles W. Lynde; Sandy R. McBride; Mona Ståhle; Emily Edson-Heredia; Baojin Zhu; David Amato; Enkeleida Nikaï; Fan Emily Yang; Kenneth B. Gordon
JAMA Dermatology, June 2016


Therapies that reduce psoriasis symptoms may improve work productivity.


To assess the effect of ixekizumab therapy on work productivity, measured by the Work Productivity and Activity Impairment–Psoriasis (WPAI-PSO).

Design, Setting, and Participants

Three multicenter, randomized double-blind phase 3 trials conducted during the following periods: December 2011 through August 2014 (UNCOVER-1), May 2012 through April 2015 (UNCOVER-2), and August 2012 through July 2014 (UNCOVER-3). Adult outpatients with moderate-to-severe chronic plaque psoriasis were included.


In UNCOVER-1, patients were randomized 1:1:1 to subcutaneous placebo or 80 mg ixekizumab every 2 weeks (Q2W) or every 4 weeks (Q4W) for 12 weeks; UNCOVER-2 and UNCOVER-3 also had an etanercept arm (50 mg twice weekly). Maintenance of initial ixekizumab response was evaluated in UNCOVER-1 and UNCOVER-2 during a randomized withdrawal period following week 12 through week 60. The WPAI-PSO questionnaire was administered at baseline and week 12 for all patients and at weeks 24, 36, 52, and 60 for patients in UNCOVER-1 and UNCOVER-2.

Main Outcomes and Measures

Change in work productivity from baseline as measured by WPAI-PSO scores.


Across trials, 5101 patients consented; 3866 were randomized (mean [SD] age, UNCOVER-1, 45.7 [12.9] y, 68.1% male; UNCOVER-2: 45.0 [13.0] y, 67.1% male; UNCOVER-3: 45.8 [13.1] y, 68.2% male). At week 12 in UNCOVER-1, the ixekizumab Q4W and ixekizumab Q2W groups showed significantly greater improvements in WPAI-PSO scores (least squares mean change from baseline [SE]) relative to placebo: absenteeism (–3.5 [0.87], P < .001; –2.6 [0.84], P = .003, respectively, vs 0.2 [0.88]), presenteeism (–18.8 [1.28], P < .001; –18.3 [1.24], P < .001, vs 0.5 [1.30]), work productivity loss (–20.6 [1.38], P < .001; –19.8 [1.33], P < .001, vs –0.8 [1.40]), and activity impairment (–24.5 [1.18], P < .001; –25.2 [1.15], P < .001, vs 0.8 [1.18]). Similar results were obtained for UNCOVER-2 and UNCOVER-3, with the exception of absenteeism with ixekizumab Q4W in UNCOVER-2. Additionally, ixekizumab-treated patients showed significantly greater improvements in WPAI-PSO scores vs etanercept-treated patients: UNCOVER-2: presenteeism, work productivity loss, activity impairment (P < .001 both doses), UNCOVER-3: activity impairment (ie, regular activities outside of work) (ixekizumab Q2W; P = .009). Improvements in WPAI-PSO scores at week 12 were sustained to at least week 60.

Conclusions and Relevance

Ixekizumab-treated patients reported short- and long-term improvements in work productivity, which could lead to reduced productivity-related cost burden in patients with psoriasis.

Trial Registration

clinicaltrials.gov Identifiers: NCT01474512, NCT01597245, NCT01646177


View Full Article

DOI: 10.1001/jamadermatol.2016.0269


Five things worth knowing about nanoparticles and sunscreens

ArticleGeneral, YouTube

When summer arrives and people start thinking about sunburn and skin cancer. Check out five things worth knowing about nanoparticles in sunscreens.

Risk Bites Video is supported by:
University of Michigan Risk Science Center. http://riskscience.umich.edu
University of Michigan School of Public Health. http://www.sph.umich.edu/