A 32-year-old woman presented with asymptomatic hyperpigmentation of her forehead cosmetically concerning to the patient. It worsened during summer months and lessened during the winter. It has been present for five years. Her medical history was significant for ADD managed with stimulants. She has been on the same estrogen/progesterone combination oral contraceptive for ten years. Physical examination revealed a tan, macular rash on forehead without raised borders or scale. Urine HCG was negative.

Lichen Simplex Chronicus (LSC) is a chronic skin disease characterized by lichenified plaques, which occur as result of constant scratching or rubbing of skin. Pruritus is the predominant symptom that leads to the development of LSC. Frequent pruritus triggers include mechanical irritation, environmental factors, such as heat and sweating, and psychological factors, such as stress and anxiety.

From a psychodermatology point of view, the interruption of the never-ending itch-scratch cycle, which characterizes LSC, is of supreme importance for patient’s recovery. Furthermore, emotional tensions, as seen in patients with anxiety, depression, or obsessive-compulsive disorder, may play a key role in inducing a pruritic sensation, leading to scratching that can become self-perpetuating.

Referral to a psychiatrist or a psychotherapist might be required in many cases. However, this referral could be difficult in daily practice, given the patient’s unwillingness to seek mental health counseling. Therefore, the dermatologist should focus and be able to perform, at least at a very basic level, some easy psychological interventions that would help patients to end with the itch-scratch cycle, while helping the patients to accept the need to seek for mental help.

In this article, we describe easy cognitive behavioral techniques to address the factors that exacerbate and maintain itch-scratch cycle in LSQ patients. Moreover, we stress in the need that dermatologists should be trained in the usage of these techniques in order to help LSQ patients, especially when referral to a psychiatrist is hindered because of the patients’ reluctance of seeking mental help.

Study Background: Soft tissue temporary and semi-permanent fillers continue to increase in popularity worldwide for facial rejuvenation. The study aims to review the cosmetic use and complication rate in large retrospective case series of Polymethyl Methacrylate (PMMA) microspheres in facial rejuvenation.

Methods: The study is a retrospective case series of 779 patients that underwent PMMA filler by one senior provider (NM) for facial rejuvenation to 7 consistent and reproducible areas of the face determined from chart review in order of preference: Peri-oral (589), Infra-orbital (395), Nasolabial folds (379), Temporal (212), Cheek (161), Glabella (99), and Scar area (8) from February 2009 to September 2015 and the chart review was completed in May 2016.

Results: The average age at first injection was 51.4 years old with standard deviation of 12.2 years. Seven hundred and six patients were female and 73 were male. Forty-three (5.4%) patients injected with PMMA had nodular complications. The average time to first sign of complication was 1.2 years with a range of .02 to 4.61 years. Prior blepharoplasty, rhytidectomy, rhinoplasty, Fitzpatrick skin classification, or history of autoimmunity was not significant to nodular complication. Thirty-four patients resolved with multiple steroid injections averaging 3.7 injections to resolution. Five were lost to follow up. Four have had ongoing injections with one undergoing surgical resection for multiple infra-orbital and peri-oral nodules.

Conclusions: Injection of permanent PMMA filler using a subdermal technique in the context of facial rejuvenation is possible with clinically significant cosmetic benefit. Since this is an off-label use of PMMA filler, caution must be taken with full disclosure to the patient leading to informed consent.