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Formerly Groot DermaSurgery

Systemic Psoriasis Treatments Associated With Decreased Mortality

January 25th, 2021 | General Info

Psoriasis is driven by elevated levels of cytokines in the skin and joints, stimulating inflammation. These cytokines also circulate in the blood, stimulating inflammation elsewhere in the body.

One study recently looked at the effect of systemic treatments for psoriasis on mortality in patients with moderate to severe psoriasis. The study was comprised of 12,099 adult patients with moderate to severe psoriasis who were followed followed for up to 10 years.

The study found that treatment with biologics and methotrexate was associated with lower risks of mortality. Systemic therapy appears to not only help with the skin and joints, but also may help reduce inflammation systemically.


Reduced risk of mortality associated with systemic psoriasis treatment in the Psoriasis Longitudinal Assessment and Registry (PSOLAR): A nested case-control analysis. Langley RG, Poulin Y, Srivastava B, Lafferty KP, Fakharzadeh S, Langholff W, Augustin M. J Am Acad Dermatol. 2021 Jan;84(1):60-69.

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Dupixent for bullous pemphigoid

January 20th, 2021 | General Info

Bullous pemphigoid is an autoimmune disorder characterized by the development of tense blisters on various areas of the body. Dupilumab (Dupixent) is a monoclonal antibody used initially in the management of atopic dermatitis, a type of eczema. Dupixent works on IL-4 and IL-31 receptors, effectively blocking them and this is how it helps control atopic dermatitis.

A recent multicenter trial demonstrated that 92.3% of patients treated with Dupixent achieved complete clearance or satisfactory response with no adverse effects. Typically, we have used either oral steroids or oral methotrexate, which are potent immunosuppressants, to control moderate to severe cases of bullous pemphigoid.

Dupixent may be a useful additional tool for the management of bullous pemphigoid.


Dupilumab as a novel therapy for bullous pemphigoid: A multicenter case series. Abdat R, Waldman RA, de Bedout V, Czernik A, Mcleod M, King B, Gordon S, Ahmed R, Nichols A, Rothe M, Rosmarin D. J Am Acad Dermatol. 2020 Jul;83(1):46-52.

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Chronic nodular prurigo treatment with dupilumab

January 8th, 2021 | General Info

Chronic nodular prurigo is a very difficult problem to treat. It is characterized by severely itchy papules and nodules scattered over the extremities and buttocks. It is a multi-factorial skin disease that is often refractory to treatment. Treatments include topical steroids, topical calcineurin inhibitors, phototherapy, antidepressants, and other medications.

A recent article in the Journal of the American Academy of Dermatology described a cohort of patients who were placed on dupilumab ( a monoclonal antibody that inhibits IL-4 and IL-13 and otherwise known as Dupixent) who responded extremely well after 16 weeks of therapy. IL-4 and IL-13 may help stimulate the itch-sensory neuronal pathways; consequently, inhibiting this pathway would be theoretically helpful. Further studies are required to substantiate this finding but this gives patients with this condition some hope that there is an effective treatment.


Dupilumab improves clinical manifestations, symptoms, and quality of life in adult patients with chronic nodular prurigo. Chiricozzi A, Maurelli M, Gori N, Argenziano G, De Simone C, Calabrese G, Girolomoni G, Peris K. J Am Acad Dermatol. 2020 Jul;83(1):39-45.

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Nanosecond pulsed electric field treatment of sebaceous hyperplasia

January 2nd, 2021 | General Info

At Nakatsui DermaSurgery, sebaceous hyperplasia are most commonly treated with the CO2 resurfacing laser. A recent study on a new treatment modality was published in Dermatologic Surgery on the use of nanosecond pulsed electric field therapy. Each sebaceous hyperplasia lesion was treated 1-2 times. Ninety percent of lesions cleared with electric field therapy. With respect to pain, 54% reported mild pain, whereas 15% reported moderate pain with treatment Patients did experience hyperpigmentation although this gradually faded with time. At day 60, 45% of lesions were hyperpigmented. Redness and swelling were noted initially but did nor persist. One of the persistent side effects was that of small depressions at 19% of treatment sites.

This is an interesting new technique for treatment of sebaceous hyperplasia. Whether it will replace the use of CO2 resurfacing remains to be seen. Find out more about sebaceous hyperplasia.


Safety and Efficacy of Nanosecond Pulsed Electric Field Treatment of Sebaceous Gland Hyperplasia. Munavalli GS, Zelickson BD, Selim MM, Kilmer SL, Rohrer TE, Newman J, Jauregui L, Knape WA, Ebbers E, Uecker D, Nuccitelli R. Dermatol Surg. 2020 Jun;46(6):803-809.

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Hidradenitis Suppurativa Treatment with Clindamycin

January 2nd, 2021 | General Info

Hidradenitis suppurativa is a chronic, inflammatory, acne-like condition affecting the skin folds. It is a difficult condition to treat, and treatments range from oral and topical antibiotics to injectable biologic medications like Humira (adalimumab).

One of the common antibiotic regimens is a combination of clindamycin and rifampin. A recent study in the Journal of the American Academy of Dermatology suggests that clindamycin alone may be just as effective as clindamycin and rifampin.

In this study, 60 patients were treated with either clindamycin alone or with a combination of clindamycin and rifampin. At the end of 8 weeks of therapy, the benefits were found to be similar in both groups.

Although more studies need to be done, this study suggests we may be able to treat this condition with a single antibiotic rather than a combination.

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Botox injections for masseter reduction

December 31st, 2020 | General Info

botox for masseters treatment Edmonton

Botox is used very commonly to decrease the size of the masseters and to improve symptoms such as grinding, headaches, and TMJ disorders. Decreasing the size of the masseters leads to a slimming of the lower face. This type of non-surgical lower face contouring is very popular, particularly among Asians.

A recent review published in Dermatologic Surgery went through different injection methods for botulinum injections of the masseters in East Asians. Five different methods for injecting the masseters were described.

Different patients have different patterns of masseter hypertrophy and Dr. Nakatsui can decide which is the best way to inject you. Care must be taken when injecting as some of the side effects of injection include a sunken appearance to the cheek, focal bulging of the masseter, and weakening of the risorius muscle, which would affect your smile.

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Hair changes related to anticancer therapies

December 28th, 2020 | General Info

hair loss chemotherapy

There are many hair changes attributable to anticancer therapies. In approximately 65% of patients treated with chemotherapy and in up to 100% of areas treated with radiotherapy can lead to hair changes.

These can manifest as hair loss (alopecia), pigment changes, textural changes, and changes in hair cycle.

Hair Loss

Chemotherapy induced hair loss typically begins weeks after the first dose of chemotherapy and represents what is called an anagen effluvium, predominantly in areas of increased friction on the scalp. Eyebrows and eyelashes may also be affected. Usually asymptomatic, it can be associated with itch or pain. Two to six months after the chemotherapy has finished, the hair typically begins to regrow, although the hair loss can be persistent.

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Holiday Season Hours of Operation

December 28th, 2020 | General Info

holiday hours 2020 christmas new years

For this holiday season, our clinic will be closed from December 24, 2020 to December 31, 2021, although we will continue to answer phones to book appointments during regular office hours.

The office will be completely closed from January 1 to January 3, 2021, and we will not be answering phones on those days. Thank you and have a great holiday season! See you in 2021!

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Topical minocycline for rosacea

December 11th, 2020 | Treatments

We have used oral minocycline for rosacea for decades. However, there are risks associated with oral minocycline, even though they are rare. A topical formulation of minocycline is being investigated for the management of rosacea by a company called Vyne Therapeutics. Two studies with a total of 1521 patients compared 1.5% topical minocycline foam versus vehicle and the foam appears to be effective, safe, and well-tolerated. This may provide a good alternative for rosacea sufferers looking to avoid oral medications.

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Novel new oral medication being investigated for chronic hand eczema

December 10th, 2020 | General Info

A phase 2b study  by Asana Biosciences regarding a novel new medication for moderate to severe chronic hand eczema has shown some encouraging results. The medication is called gusacitinib and is a dual JAK/SYK inhibitor. The study showed statistically significant improvements in chronic hand eczema severity compared to placebo. It had an acceptable safety profile and was well tolerated. The most common side effects were headache, nausea, nasopharyngitis, and upper respiratory tract infection. A phase 3 trial is being finalized.

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What is cryomodulation and nanosecond pulsed electric field treatment?

October 14th, 2020 | General Info

Cryomodulation and nanosecond pulsed electric field treatment are two new technologies for the treatment of benign lesions like seborrheic keratoses. Cryomodulation is a technique using cooling technology to treat sunspots and seborrheic keratoses. The first to market device is Glacial RX by R2 Technologies.

Another new technology is nanosecond pulsed electric field treatment, which is a nonthermal, energy based technology used to treat seborrheic keratoses and other conditions. It will be interesting to see how effective these two new technologies will be.

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Needle Size May Affect Soft Tissue Filler Properties

October 14th, 2020 | General Info

A recent article in Dermatologic Surgery suggests that injectors (and patients) should be aware of the effects of needle size on the properties of fillers. Various types of fillers (monophasic and biphasic) were injected through 30G needles and the size and properties of the fillers were analyzed after they had been injected through the needles.  

Both monophasic (e.g. Juvederm products) and biphasic (e.g. Restylane) fillers were affected by the smaller needle size. They were affected in terms of the size of the extruded particles and in the properties (G’) of the extruded particles. Interestingly, biphasic fillers seemed to be affected more than monophasic fillers. In addition, larger particles seemed to be affected more than smaller particles as we would intuitively expect. 

Injectors should consider the size of the needle being used to inject fillers (especially biphasic fillers and fillers of larger particle size) as this might affect the performance and durability of the filler.


Soft Tissue Filler Properties Can Be Altered by a Small-Diameter Needle. Dermatol Surg 2020 Sep;46(9):1155-1162.

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Nuceiva–the Newest Botulinum Toxin on the Market

October 4th, 2020 | General Info

Nuceiva Edmonton

Nuceiva is the newest neuromodulator on the market for the treatment of glabellar frown lines. Whereas Botox is referred to as abobotulinumtoxin A, Nuceiva is referred to as prabotulinumtoxin A.

Similar to other brands such as Botox, Xeomin, and Dysport, Nuceiva™ works to smooth out creases in the face by decreasing muscle contraction.

It has been approved by Health Canada and the FDA.

Marketed as Jeuveau by a company called Evolus in the United States, it originated with a South Korean company called Daewoong. Nuceiva™ was authorized for sale by Health Canada in August of 2019 and was subsequently officially brought to the Canadian market by Clarion Medical Technologies in October 2019. It is also available in the European Union.

Nuceiva™ usually lasts about 3 to 4 months although this varies from person to person. A study published in Dermatologic Surgery in 2019 showed similar efficacy to Botox.

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The Latest on Bleach Baths for Eczema

July 14th, 2020 | General Info

eczema bleach baths

Bleach baths are a controversial therapy for patient with atopic eczema, also known as atopic dermatitis (AD). In recent years, there has been an increase in the use of bleach baths to decrease the severity of the eczema. However, a recent review showed that while bleach baths did seem to decrease the severity of atopic eczema, it was no more effective than water baths alone. There has been a lot of research into the effect of bleach baths on Staphylococcus bacteria and it seems like the concentration of bleach used in bleach baths may not be high enough to kill bacteria. There may be other anti-inflammatory properties that have yet to be discovered.

With all of the conflicting data out there, the best summation is probably what was stated in the latest Canadian consensus statement on pediatric atopic eczema: “bleach baths have not been consistently shown to improve outcomes in AD and may be used at the discretion of the treating health care provider.”

Lansang P et al, Approach to the Assessment and Management of Pediatric Patients With Atopic Dermatitis: A Consensus Document. Section IV: Consensus Statements on the Assessment and Management of Pediatric Atopic Dermatitis.

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Effect of Topical Anesthetic Prior to Laser Treatment for Blood Vessels

July 4th, 2020 | General Info

Pulsed dye laser (PDL) is a very effective treatment for redness of the face due to enlarged blood vessels. It has proven to be very safe and effective. However, there is some discomfort from the laser pulses and while most patients have no difficulty tolerating treatment without any anesthetic, some patients do find it difficult to tolerate. Topical anesthetic can be used to decrease the discomfort of laser treatments but there has always been the question of whether the vasoconstrictive properties (i.e. constriction of blood vessels) of the anesthetic might have an adverse effect on outcome if you are trying to get rid of blood vessels.

A recent study by Chunharas et al in April of 2020 (Lasers Surg Med. 2020 Apr;52(4):307-314) demonstrates that topical anesthesia with lidocaine and tetracaine do not interfere with the efficacy of pulsed dye lasers. This is great news for those who want to receive treatments with pulsed dye lasers.

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Reopening Announcement

June 11th, 2020 | General Info

Thank you for your patience! As Phase 2 is set to open on June 12, 2020, we are happy to announce that we are reopening as well! We have been following the Chief Medical Officer of Health instructions and have therefore not been able to see any of our patients since March 16, 2020, except for skin cancer patients and those with urgent needs.

We are happy to announce that we will be booking appointments for all those we had to cancel over the last few months, as well as accommodate those on our wait list. We look forward to see you back again! We thank you for your patience and understanding as we ourselves need to go through our phased approach to booking.


Dr. Nakatsui

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Prabotulinumtoxin A: a new type of Botox?

May 13th, 2020 | General Info

Prabotulinumtoxin A

In 2002, Botox (onabotulinumtoxin A) was the first botulinum toxin to gain FDA approval for the “temporary treatment of glabellar lines in adults.”  A recent study published in Dermatologic Surgery reviewed two Phase 2 randomized, multicenter, double-blind, placebo controlled trials with 2100 patients showed that a new version called prabotulinumtoxin A had a similar onset of action, duration of action, and adverse event profile as compared to Botox. On the market currently, we have Botox, Dysport, and Xeomin for the treatment of lines and wrinkles. We may see another agent available soon.



1.  2019 Dec;45(12):1610-1619

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Some Thoughts on COVID-19 and the Stats

April 12th, 2020 | General Info

covid-19 stats and graphsThoughts on COVID-19

I have uploaded a video about my thoughts on some of the data about COVID-19 put out by Alberta Health. I have also included a website (link below) that has an interesting graph that shows what happens when a country starts to gain control over COVID-19.  You may need click on the title of the blog to access the video and the link. Keep in mind these are my opinions only and may be incorrect. I hope you will find some of this interesting. Stay safe.

Dr. Nakatsui


Link to Aatish Bhatia’s graph on logarithmic Trajectory of COVID-19 Confirmed Cases

How to Properly Put on Surgical and Procedure Masks

April 11th, 2020 | General Info

putting on masks

Surgical and Procedure Masks

Putting on masks is something new to many people. In this era of COVID-19, social distancing, and trying to avoid spreading the virus to each other, masks may be one additional layer of protection. It is by no means 100% effective but if it does seem to reduce risk.

I have put together a video on how to apply these masks safely. If you know someone who might benefit from a simple overview, please send this on to them. In addition, I have an infographic on masks that I think is informative. Unfortunately, our blog only displays small thumbnails and I need to contact our web designers to change this before I post it. Stay tuned. Hopefully by next Tuesday I will post the infographic. You may need to click on the title of the blog to access the full blog. Stay safe.

Dr. Nakatsui


Temporary Closure due to the COVID-19 Public Health Emergency

March 18th, 2020 | General Info

covid-19 closureTemporary Closure

On Monday, March 16, 2020, the Nakatsui DermaSurgery Centre decided to take a leading initiative and temporarily close operations to help mitigate the spread of COVID-19. This was not an easy decision. In the end, we are confident that this was the best decision to protect our patients, our staff, and our community. We have stopped all non-essential services and are in the process of contacting patients who were scheduled to see us in the next two weeks to let them know what is happening. We will do our best to reschedule everyone as soon as possible once the situation improves. For our current patients who have more urgent medical needs, Dr. Nakatsui will make himself available to see you.

It is important to remember we should not panic as this infection will be well managed for the vast majority of those affected. However, we must assist our health care system by “flattening the curve” and preventing the exponential rise in COVID-19 and reducing the number of serious cases.

We will still be answering our phones and responding to emails for the time being. If you have any questions and concerns, please feel free to contact us at 780-482-1414 or via email at

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