Treatment of facial photodamage and rhytides using a novel 1,565 nm non-ablative fractional erbium-doped fiber laser

  • Friedmann DP, Tzu JE, Kauvar AN, Goldman MP. Lasers Surg Med. 2015 Dec 29. doi: 10.1002/lsm.22461.

    BACKGROUND AND OBJECTIVE: Non-ablative fractional lasers (NAFL) generate microscopic non-contiguous columns of thermal injury in the dermis, resulting in collagen remodeling. This manuscript details our experience with a novel 1,565 nm scanned, erbium-doped fiber NAFL for the treatment of facial photodamage.

Combined Blue Nevi--Smooth Muscle Hamartomas: A Series of 12 Cases.

  • Tzu J, Goldman C, Perry A, Meehan S. J Cut Pathology. 2013 Oct;40(10):879-83.

    BACKGROUND: One of the most common types of combined melanocytic nevus is that of a blue nevus with ordinary melanocytic nevus. Blue nevi have also been described in association with non-melanocytic cell types, such as those of neural or mesenchymal derivation. Although there are rare descriptions in the literature of blue nevi with myomatous structures, the specific association of combined blue nevi with smooth muscle hyperplasia has not been reported.

Telangiectasia macularis eruptiva perstans

  • Altiner A, Tzu J, Patel R, Meehan S, Sanchez M. Dermatol Online J. 2011 Oct 15;17(10):7.

    ABSTRACT: We present a 31-year-old woman with a ten-year history of a progressive macular eruption; one of her macules demonstrated a wheal when rubbed. A biopsy was consistent with telangiectasia macularis eruptiva perstans. There were no signs and symptoms of systemic involvement despite the large body surface area of involvement.

Glomuvenous Malformations (Familial generalized multiple glomangiomas).

  • Brauer JA, Anolik R, Tzu J, Meehan S, Lieber CD, Geronemus RG..Dermatol Online J. 2011 Oct 15;17(10):9.

    ABSTRACT: A 15-year-old boy with a diagnosis of generalized multiple glomangiomas was referred for evaluation and treatment of enlarging and increasingly painful lesions on his right ankle. The patient underwent a series of two treatments with long-pulsed KTP 1064 nm laser that resulted in substantial improvement in appearance and decreased pain. Generalized glomuvenous malformations, or multiple glomangiomas, are the less common presentation of proliferation of glomus cells and may have extracutaneous involvement. Whereas surgical management is often employed and definitive for solitary lesions, interventions such as laser therapy, may be beneficial for improvement of functional impairment and cosmesis as was observed in our patient.

Morphea with discoid lupus erythematosus

  • Mir A, Tlougan B, O'Reilly K, Tzu J, Meehan S, Kamino H, Franks AG JrDermatol Online J. 2011 Oct 15;17(10):10.

    ABSTRACT: The presence of lupus erythematosus with morphea in the same patient has rarely been reported. In this case, we describe a woman with the overlap of discoid lupus erythematosus with superficial morphea, diagnoses that are supported by histopathologic features and laboratory studies.

Acanthosis nigricans in the setting of niacin therapy

  • Hartman R, Defelice T, Tzu J, Meehan S, Sanchez M.Dermatol Online J. 2011 Oct 15;17(10):11

    ABSTRACT: We report the case of a 63-year-old obese man with a rapid-onset of widespread acanthosis nigricans (AN) in the setting of having recently initiated treatment with niacin for dyslipidemia. Although obesity and insulin-resistance are risk factors for AN, AN associated with endocrine dysfunction tends to have a more gradual onset and limited involvement. Owing to our patient's age, the rapid onset, and extensive distribution of his eruption, we initially were concerned about paraneoplastic AN. However, an evaluation for a malignant condition was negative. The timing of the onset of our patient's eruption within several months of starting niacin therapy is consistent with niacin-induced AN. Niacin is known to cause rapidly progressive, widespread AN that is reversible upon discontinuation of the medication. We discuss the pathogenesis of AN, which is thought to be the final common manifestation of stimulation of different subtypes of tyrosine kinase receptors by various epidermal growth factors.

Papillary dermal elastosis

  • Newlove T, Tzu J, Meehan S.Dermatol Online J. 2011 Oct 15;17(10):12.

    ABSTRACT: There are numerous Acquired disorders of elastic tissue that are distinguished by a combination of clinical appearance, location, gender, an age of onset, and characteristic histopathologic findings. We present a case of a 36-year-old man with multiple confluent, hypopigmented papules that coalesced into plaques with prominent follicular ostium over the dorsal aspects of the forearms, shoulders, upper chest, and upper back. Histologically there was a selective loss of papillary dermal elastic fibers. The clinical and histopathologic findings, in this case, are consistent with an acquired disorder of elastic tissue which we believe represents the second reported case of papillary dermal elastosis.

Photolichenoid plaques with associated vitiliginous pigmentary changes

  • Tran K, Hartman R, Tzu J, Meehan S, Sanders SE, Pomeranz MK, Sanchez M.Dermatol Online J. 2011 Oct 15;17(10):13.

    ABSTRACT: A 49-year-old man with advanced HIV/AIDS on anti-retroviral therapy (HAART) and trimethoprim-sulfamethoxazole (TMP-SMX) presented with a several-month history of pruritic, erythematous, lichenified papules that coalesced into hyperkeratotic plaques on the trunk and extremities in a sun-exposed distribution. He shortly thereafter developed a progressive depigmentation over more than 80 percent of his body surface area. A biopsy specimen of an erythematous plaque on the trunk showed a superficial and mid-dermal infiltrate of lymphocytes with eosinophils, most consistent with either chronic lichenoid drug eruption or atypical lymphoproliferative disorder (ACLD) of HIV. The patient's lichenoid skin disease has persisted despite discontinuation of TMP-SMX, although it has improved partially with administration of topical glucocorticoids and acitretin. His depigmentation has continued to progress. We discuss the overlapping diagnostic entities which may be comprised by this patient's clinical disease, and highlight a unique presentation of the complex interaction between HIV infection and the skin.

Multiple human papillomavirus-16 associated digital squamous-cell carcinomas in an immunocompetent woman with prior human papillomavirus-related genital carcinoma

  • Hunt R, Hwa C, Tzu J, Patel R, Tyring SK, Stein J. Dermatol Online J. 2011 Oct 15;17(10):20.

    ABSTRACT: High-risk subtype human papillomavirus (HPV) infection, which is known to contribute to the oncogenesis of anogenital squamous-cell carcinoma (SCC), is detected in the majority of digital SCCs. Evidence suggests a genital-digital route of transmission of high-risk HPV, and most HPV-related digital SCCs occur near the nail unit in immunocompetent adults. As early HPV-related SCC commonly appears as a verrucous periungual papule, a biopsy should be considered if such a lesion persists or occurs in an individual who is likely to inoculate their digits with high-risk HPV from digital-genital contact with themselves or sexual partners. We present a 60-year-old woman, who has a personal history of vulvar and cervical SCC and an appreciable disease burden from SCCs that involved five digits of her hands.

Deep dermatophytosis caused by Trichophyton rubrum

  • Warycha MA, Leger M, Tzu J, Kamino H, Stein J.Dermatol Online J. 2011 Oct 15;17(10):21

    ABSTRACT: A 50-year-old man with hepatitis C virus infection and liver cirrhosis, who was awaiting transplantation, was admitted to the Transplant Surgery Service for treatment of a pleural effusion and an elevated ammonia level. Skin examination showed violaceous, firm nodules on the right thigh, which had been present for eight months. A fungal culture showed Trichophyton rubrum. The patient was started on itraconazole with improvement in the eruption.

Squamous-cell carcinoma in situ in a patient with oculocutaneous albinism

  • Berger E, Hunt R, Tzu J, Patel R, Sanchez M. Dermatol Online J. 2011 Oct 15;17(10):22.

    ABSTRACT: A 36-year-old African man from Guinea with a history of albinism presented with a many-year history of scaling and erythema of the face, neck, and arms. The patient had light eyes, hair, and skin. Physical examination showed extensive photodamage. A skin biopsy specimen from the posterior aspect of the lower leg showed a squamous-cell carcinoma in situ. The most common types of oculocutaneous albinism (OCA), OCA 1 and OCA 2, are autosomal recessive disorders of pigmentation that commonly affect the skin, hair, eyes, and ears. Photodamage and skin cancers plague patients with albinism. In Africa, where albinism is prevalent, albinos face a myriad of social and medical issues. Skin cancer surveillance is an important consideration for albinos, and sun protection is paramount.

Nevoid basal cell carcinoma syndrome

  • Leger M, Quintana A, Tzu J, Yee H, Kamino H, Sanchez M.Dermatol Online J. 2011 Oct 15;17(10):23-4.

    Abstract: Gorlin syndrome is an autosomal dominantly inherited disorder that results in numerous basal cell carcinomas as well as a number of other facial and skeletal findings. We present a patient with many classic features and review some of the treatment options available for these patients.

Lupus erythematosus tumidus with discoid lupus erythematosus induced alopecia of the scalp

  • Lehrhoff S, Tzu J, Patel R, Sanchez M, Franks AG Jr.Dermatol Online J. 2011 Oct 15;17(10):24-5.

    ABSTRACT: Lupus erythematosus tumidus (LET) is an uncommon variant of cutaneous lupus erythematosus. Lupus erythematodes tumidus is characterized by smooth, erythematous plaques on sun-exposed areas without surface changes, such as follicular plugs, atrophy, or scale. Histopathologic features include a lymphocytic, perivascular and periadnexal infiltrate with abundant interstitial, superficial, and deep dermal mucin without appreciable epidermal and vacuolar changes. Typically, LET is responsive to treatment with systemic antimalarials. We present a unique case of alopecia associated with LET, which was partially responsive to hydroxychloroquine. We also note that the plaque of LET is adjacent to the plaque of discoid lupus erythematosus.

The skin as an endocrine target

  • Camacho I, Tzu J, Kirsner R. J Invest Dermatol. 2010 Jan; 130(1): 6.

Regulation of vitamin D production is independent of skin color

  • Camacho I, Tzu J, Kirsner RS.J Invest Dermatol. 2010 Feb;130(2):330.

Who will develop pemphigus foliaceous?

  • Tzu J, Romagosa Y, Kirsner R.J Invest Dermatol. 2009 Jan;129(1):6

Dermoscopy research--an update

  • Braun RP, Rabinovitz H, Tzu J, Marghoob AA.Semin Cutan Med Surg. 2009

    ABSTRACT: Dermoscopy increases the clinician's diagnostic accuracy by as much as 30% over that of unaided visual clinical inspection alone and has been confirmed in 3 separate evidence-based publications using a meta-analysis of the literature. It can be viewed as an in vivo bridge between clinical morphology and histopathology. This "bridge" has provided clinician researchers with many new insights into morphology and tumor biology. In this article, we provide the reader with an overview of the different aspects of dermoscopy as a research tool. We cover different aspects, such as the new equipment, new structures, the importance of blood vessels, etc. PMID

Re-examining cutaneous immunity

  • Vega J, Tzu J, Kirsner R.J Invest Dermatol. 2009 Dec; 129 (12): 2740.

Bridging structure with function: structural, regulatory, and developmental role of laminins

  • Tzu J, Marinkovich MP.Int J Biochem Cell Biol. 2008; 40(2):199-214.

    ABSTRACT: The basement membrane is a highly intricate and organized portion of the extracellular matrix that interfaces with a variety of cell types including epithelial, endothelial, muscle, nerve, and fat cells. The laminin family of glycoproteins is a major constituent of the basement membrane. The 16 known laminin isoforms are formed from combinations of alpha, beta, and gamma chains, with each chain containing specific domains capable of interacting with cellular receptors such as integrins and other extracellular ligands.

From conventional to cutting edge: the new era of biologics in treatment of psoriasis.

  • Tzu J, Kerdel F. Dermatol Ther. 2008 Mar-Apr;21(2):131-41.

    Abstract Psoriasis is a chronic T-cell-mediated inflammatory disease of the skin and joints that affects 1-3% of the world population. Conventional treatments for moderate to severe psoriasis are associated with broadband immunosuppression and/or organ toxicities that can be problematic when used long term. Advances in the understanding of psoriasis pathogenesis have led to targeted therapy in the form of biologics. These agents have gained popularity as safe, effective, and convenient alternatives for the treatment of chronic, moderate to severe plaque psoriasis.

Use of biologics in the treatment of psoriasis.

  • Tzu J, Krulig E, Cárdenas V, Kerdel F. Rev Chilena Dermatol. 2008; 24(4):286-297

Biologic agents in the treatment of psoriasis.

  • Tzu J, Krulig E, Cardenas V, Kerdel F. G Ital Dermatol Venereol. 2008 Oct;143(5):315-27.

    Abstract Psoriasis is a chronic immune-mediated inflammatory disease, with an estimated prevalence of 1-3% worldwide. It is considered to be a multisystemic disorder, primarily affecting the skin and joints (psoriatic arthritis), and associated with other inflammatory conditions such as inflammatory bowel disease and coronary heart disease among others.

Why rituximab works.

  • Tzu J, Kim N, Kirsner R. J Invest Dermatol. 2008 Dec; 128 (12):2744.

Lichenoid paraneoplastic pemphigus in the absence of detectable antibodies.

  • Cummins DL, Mimouni D, Tzu J, Owens N, Anhalt GJ, Meyerle JH. J Am Acad Dermatol. 2007; 56(1):153-9.

    Abstract Paraneoplastic pemphigus (PNP) has been described as an antibody-mediated mucocutaneous disease occurring almost exclusively in patients with lymphocytic neoplasms. We describe 4 patients with the clinical features of the lichenoid variant of PNP in the absence of detectable autoantibodies

Advances in immunobiologic therapies for the treatment of psoriasis.

  • Tzu J, Mamelak A, Sauder DN. Clinical Applied Immunology Reviews. 2006; 6: 99-130.

    Abstract Psoriasis is a chronic, T-cell mediated autoimmune disorder that affects up to 2.5% of the population worldwide and is accompanied by substantial physical and psychosocial distress. Recent progress in understanding the mechanisms behind the efficacy of conventional treatments has transformed psoriasis from a disease of keratinocyte hyperproliferation to that of T cell pathogenesis.

Basement membrane and extracellular matrix molecules in the skin.

  • Tzu J, Li J, and Marinkovich MP. In: Extracellular Matrix in Development and Disease (Advances in Developmental Biology, Volume 15). Miner, JH, ed. Elsevier December 2005.

    Publisher Summary The dermal-epidermal basement membrane zone (BMZ) lies at the interface between the epithelium and underlying mesenchymal tissue. It is a highly organized structure with both similarities and differences compared to BMZs present in other tissues. In the skin, the BMZ serves many functions.

Downregulation of NDUFA1 and other oxidative phosphorylation related genes is a consistent feature of basal cell carcinoma

  • Mamelak AJ, Kowalski J, Murphy K, Yadava N, Zahurak M, Kouba DJ, Howell BG, Tzu J, Cummins DL, Liegeois NJ, Berg K, Sauder DN. Exp Dermatology. 2005 May; 14: 336-348.

    Abstract Basal cell carcinoma (BCC) is the most common cutaneous malignancy that, like other tumours, possesses a heterogeneous genetic composition. In order to select genes with consistent changes in expression among these tumours, we analysed BCC microarray expression data by using a novel approach, termed correlative analysis of microarrays (CAM). CAM is a nested, non-parametric method designed to qualitatively select candidates based on their individual, similar effects upon an array-wide closeness measure.

Laminin 10 is crucial for hair morphogenesis.

  • Li J, Tzu J, Chen Y, Zhang YP, Nguyen NT, Gao J, Bradley M, Keene DR, Oro AE, Miner JH, Marinkovich MP. EMBO J. 2003 May 15; 22 (10): 2400-10.

    Abstract The role of the extracellular matrix in cutaneous morphogenesis is poorly understood. Here, we describe the essential role of laminin-10 (alpha5beta1gamma1) in hair follicle development. Laminin-10 was present in the basement membrane of elongating hair germs, when other laminins were downregulated, suggesting a role for laminin-10 in hair development.

Rac function and regulation during Drosophila development.

  • Hakeda-Suzuki S, Ng J, Tzu J, Dietzl G, Sun Y, Harms M, Nardine T, Luo L, Dickson BJ. Nature. 2002 Mar 28; 416(6879):438-42.

    Abstract Rac GTPases regulate the actin cytoskeleton to control changes in cell shape. To date, the analysis of Rac function during development has relied heavily on the use of dominant mutant isoforms. Here, we use loss-of-function mutations to show that the three Drosophila Rac genes, Rac1, Rac2 and Mtl, have overlapping functions in the control of epithelial morphogenesis, myoblast fusion, and axon growth and guidance.

Rac function and regulation during Drosophila development.

  • Ng J, Nardine T, Harms M, Tzu J, Goldstein A, Sun Y, Dietzl G, Dickson BJ, Luo L. Nature. 2002 Mar 28;416(6879):442-7.

    Abstract Growth, guidance and branching of axons are all essential processes for the precise wiring of the nervous system. Rho family GTPases transduce extracellular signals to regulate the actin cytoskeleton. In particular, Rac has been implicated in axon growth and guidance. Here we analyse the loss-of-function phenotypes of three Rac GTPases in Drosophila mushroom body neurons. We show that progressive loss of combined Rac1, Rac2 and Mtl activity leads first to defects in axon branching, then guidance, and finally growth.

Dr. Julia Tzu

Dr. Julia Tzu is a double board certified dermatologist who specializes in Mohs and reconstructive skin surgery, laser surgery, and cosmetic dermatology. She is one very few dermatologists in the world who has devoted additional years of formalized fellowship training in both Mohs surgery as well as dermatopathology, making her amongst the most highly trained and elite dermatologists.


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