Background: Analysis of Internet search patterns is rapidly transforming the study of human behavior. Google’s data, accessed through Google Trends, have proven extremely insightful in several fields of medical research. Despite its adoption in other fields of medicine, Google Trends has not yet been explored in the field of plastic surgery. Methods: The number of cosmetic surgery procedures from 2005 through 2016 was obtained from the American Society of Plastic Surgeons annual reports. Using Google Trends, the most commonly used keywords describing each procedure were determined, and data regarding search interest over time, interest across geographic area, and Related Queries were obtained. The number of procedures performed annually was compared to relative search volume from the corresponding year and the year prior to determine correlation. Results: Of the 22 procedures evaluated, the annual number of eight procedures correlated with Internet search volume in the corresponding year, and six procedures correlated with the Internet searches performed in the year prior. Florida and New York were the states with the most searches for these procedures. Related Queries suggested that several factors, such as operative techniques, notable individuals undergoing procedures, and cost, variably drove correlations for different procedures. Conclusions: Google Trends is a powerful tool that can be used to better understand patient interest in, questions about, and decisions regarding cosmetic surgery procedures. These findings warrant action by aesthetic surgeons to increase interest, address misinformation, and help patients fill the gaps of information missed by Internet searches.
Introduction: The initial evaluation of cardiomyopathy (CM) is a common diagnostic challenge. Invasive coronary angiography is routinely performed to exclude ischemic cardiomyopathy (ICM). Clinical...
Acne is a known side effect of masculinizing hormonal therapy used in transgender men. In all people with acne, it can contribute to depression, body image issues and even suicidal ideation. Hormones, particularly testosterone, are often the first treatment for gender dysphoria ‐ the distress that can be caused by feeling and living a different gender to one's assigned gender ‐ in transgender men. These hormones can exacerbate acne, among other hair and skin issues. The aim of this article, from the USA, is to promote understanding for advising and treating transgender men who have acne as a result of masculinizing hormonal therapy. Studies suggest that the severity of acne peaks within the first 4 months of treatment. Although gradual improvement is noted within the first year, acne can be persistent, lasting years after testosterone therapy is started. Severity of acne is variable, with most patients experiencing milder lesions (spots). Acne tends to be most prominent on the back and chest, an area that may already be one of the greatest sources of dissatisfaction among transgender men. Standard acne treatments such as topical medications (creams) and antibiotics can be used, but hormonal therapy is likely to interact with the desired effects of testosterone in transgender men, which requires careful consideration and discussion. In cases that don't improve after these first‐line treatments, a powerful drug called isotretinoin is effective in patients on masculinizing therapy, though multiple courses of treatment may be needed. This drug can have unwanted side‐effects and doctors have to closely monitor patients on this drug. The study discusses other important considerations for doctors. Although the options for treating acne are similar to those used in cis‐gender patients (i.e. whose sense of personal identity and gender corresponds with their birth sex), several medical, social, and psychological considerations must be noted when treating transgender patients.
Masculinizing hormonal treatment in transgender men has the potential to increase the level of androgens at end organs, including the pilosebaceous unit. Androgen-induced sebocyte growth and differentiation, sebum production and infundibular keratinization may underlie the development of acne vulgaris among patients receiving this therapy.The aim of this article is to familiarize dermatologists with the sensitivities and challenges of treating acne in transgender male individuals.This review article discusses the pathogenesis and treatment of acne in transgender men on testosterone therapy and highlights the unique considerations in treating this underserved patient population.Despite the incidence of treatment-related acne and the unique considerations in treating transgender men, studies addressing this topic among this patient population are limited.Generally, the standard guidelines for the treatment of acne can be followed in treating these patients; however, several medical, social and psychological factors should be considered.
Objectives. Angiogenesis plays a critical role in SSc (scleroderma). The aim of this study was to examine the expression of growth-regulated protein-γ (Gro-γ/CXCL3), granulocyte chemotactic protein 2 (GCP-2/CXCL6) and their receptor CXCR2 in endothelial cells (ECs) isolated from SSc skin and determine whether these cells mount an angiogenic response towards pro-angiogenic chemokines. The downstream signalling pathways as well as the pro-angiogenic transcription factor inhibitor of DNA-binding protein 1 (Id-1) were also examined. Methods. Skin biopsies were obtained from patients with dcSSc. ECs were isolated via magnetic positive selection. Angiogenesis was measured by EC chemotaxis assay. Results. Gro-γ/CXCL3 and GCP-2/CXCL6 were minimally expressed in both skin types but elevated in SSc serum. Pro-angiogenic chemokine mRNA was greater in SSc ECs than in normal ECs. SSc ECs did not migrate to vascular endothelial growth factor (VEGF), Gro-γ/CXCL3, GCP-2/CXCL6 or CXCL16. The signalling pathways stimulated by these chemokines were also dysregulated. Id-1 mRNA in SSc ECs was lower compared with normal ECs, and overexpression of Id-1 in SSc ECs increased their ability to migrate towards VEGF and CXCL16. Conclusion. Our results show that SSc ECs are unable to respond to pro-angiogenic chemokines despite their increased expression in serum and ECs. This might be due to the differences in the signalling pathways activated by these chemokines in normal vs SSc ECs. In addition, the lower expression of Id-1 also decreases the angiogenic response. The inability of pro-angiogenic chemokines to promote EC migration provides an additional mechanism for the impaired angiogenesis that characterizes SSc.
