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1.
J Cosmet Dermatol ; 2024 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-38497328

RESUMO

BACKGROUND: Q-switched (QS) Nd: YAG laser is one of the treatment options for solar lentigines (SLs). However, the incidence of post-inflammatory hyperpigmentation (PIH) is a common complication, especially in dark-complexioned skin. Isobutylamido thiazolyl resorcinol (ITR) has been reported as a preventive modality for ultraviolet B (UVB)-induced hyperpigmentation. AIMS: This study aims to evaluate the efficacy and safety of ITR for the prevention of laser-induced PIH. PATIENTS/METHODS: A randomized, evaluator-blinded study including 24 subjects with SLs was conducted. Three SLs of each patient were randomized into three groups, which were to apply ITR twice daily, once daily, and no application for 2 weeks. Thereafter, 532-nm QS Nd: YAG laser was performed. Incidence of laser-induced PIH, relative melanin index (RMI), mean luminance score (L*), hyperpigmentation score, and adverse events were recorded for 2 months post-laser. RESULTS: The incidence of PIH at the 4th week after laser treatment was significantly lower in the ITR twice-daily group compared to the no-application group (20.83% vs. 50%, p = 0.028). There was no statistically significant difference in RMI, mean L*, and hyperpigmentation score between treatments at all visits. No serious adverse events were reported regarding ITR application and laser treatment. CONCLUSION: Two-week application of ITR prior to QS: Nd YAG laser treatment may potentially reduce the incidence of PIH. A longer duration of application, including after the laser procedure, may be more beneficial for the prevention of laser-induced PIH.

2.
Skin Res Technol ; 30(3): e13617, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38444188

RESUMO

INTRODUCTION: The prevalence of horizontal neck lines as a cosmetic concern is widely acknowledged, yet the available treatment options are limited, and no studies have investigated the use of polydioxanone-barbed threads. These threads, characterized by a finely braided structure, function as a scaffold to attract regenerative factors and facilitate the migration and proliferation of cells. This study aims to evaluate the outcomes of concurrent application of braided polydioxanone-barbed threads for addressing horizontal neck wrinkles. METHODOLOGY: A retrospective case series involving four female participants (aged 41, 43, 45, and 46) treated with polydioxanone-barbed threads for horizontal neck wrinkles between January 2023 and July 2023 was conducted. Adult patients were assessed at an 8-week follow-up, revealing a significant reduction in wrinkle intensity based on the Horizontal Neck Wrinkle Severity Scale. RESULTS: The analysis of horizontal neck lines demonstrated a notable decrease in wrinkle intensity according to the Horizontal Neck Wrinkle Severity Scale at the 8-week mark, and this improvement maintained statistical significance. Both patient Global Aesthetic Improvement Scale (GAIS) scores (90%-100%) and physician GAIS scores (100%) were rated as excellent. CONCLUSION: The subdermal application of polydioxanone-barbed threads for horizontal neck lines proves to be a secure and efficacious approach for treating horizontal neck wrinkles, with no observed Tyndall effect. This technique shows promise for rejuvenating the skin in the horizontal neckline region.


Assuntos
Polidioxanona , Pele , Adulto , Humanos , Feminino , Estudos Retrospectivos , Estética , Software
3.
Clin Cosmet Investig Dermatol ; 17: 259-277, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38321987

RESUMO

For dermatologists, diversities of human races result in an opportunity to encounter patients with various skin types. Cosmetic procedures have gained more popularity and become more accessible over the past decades. Thus, the selection of appropriate treatment protocol for each patient becomes inevitable. This review will focus on basic knowledge and key points in performing safe cosmetic-related procedures in patients with dark-complexioned skin. In terms of structure and function of the skin, people of color have equal epidermal thickness, corneocyte size and melanocyte number. However, they have more stratum corneum compaction, melanosome dispersion and melanocyte activity than fair skin individuals. Data regarding drug penetration and cutaneous irritation showed conflicting results. Superficial chemical peels and microdermabrasion can be done safely in dark-skinned patients. Medium-depth peel should be used with extreme caution. While deep-depth peel should be avoided at all times due to pigmentary and textural complications. Prolonged treatment interval, use of priming agents and sun protection are recommended. Injectable materials including botulinum toxin and soft tissue augmentation by hyaluronic acid filler can be done harmlessly in dark-skinned patients. Lasers and energy-based devices should be done with caution. Higher melanin dispersion and melanocyte activity acts as competitive chromophore. Pigmentary or textural changes can occur after aggressive treatment protocol. High energy setting, pulse stacking, short wavelength lasers and short treatment interval should be avoided in dark-skinned patients.

4.
J Cosmet Dermatol ; 2024 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-38327119

RESUMO

BACKGROUND: Exosomes have gained attention for their potential in skin rejuvenation. Currently, most exosome products are available for topical administration, and the use of subdermal injection as a route of administration has not been approved. AIMS: The purpose of this case report is to describe a case of skin necrosis that occurred following an intradermal injection of lyophilized exosomes. MATERIALS AND METHODS: We hereby report a case of a middle-aged man who experienced adverse effects after receiving an intradermal injection of lyophilized exosomes. Multiple injections of an exosome product were administered to treat enlarged facial pores. Shortly after the injection, the patient felt pain and noticed several dark red bumps. Three days after injection, the lesions transformed into palpable, painful, non-blanchable purplish papules and nodules, accompanied by central, tiny crusted erosions. The residual product was injected into the upper arm using an intradermal method. Similar lesions also appeared, and a skin biopsy showed necrotic keratinocytes, leukocytoclastic vasculitis, and eccrine necrosis. RESULTS: There are few reports available regarding complications, especially those related to intradermal exosomes. These complications include multiple foreign-body granulomatous reactions at the injection sites. In our case, oral prednisolone was administered for a duration of 7 days. After the treatment, the lesions exhibited notable improvement, eventually leaving post-inflammatory hyperpigmentation. CONCLUSION: Utilizing exosomes through unapproved methods should be avoided due to the possibility of adverse reactions that could cause aesthetic issues.

5.
Skin Res Technol ; 30(2): e13593, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38279602

RESUMO

OBJECTIVE: To assess the subjective experiences of patients following monopolar radiofrequency (RF) treatment for facial rejuvenation and anti-aging purposes. METHODS: A study involving 50 female patients (aged 30-70 years, Fitzpatrick skin type III and IV) who received a single session of RF treatment. Exclusion criteria comprised active infections, skin diseases, pregnancy, or history of recent anti-aging treatments. Thirty-four patients completed a 10-question questionnaire after 3 months of treatment. RESULTS: Among the respondents, 82% expressed satisfaction with the RF treatment, reporting significant improvements primarily in the mid and lower face, and eyelids. Mainly, patients noted improvements in skin laxity (52.9%), skin texture (17.6%), and skin tone (11.7%). Notably, 73.5% noticed changes within 1-2 months post-treatment, with the peak effect observed at 1-2 months. Mild complications (swelling and erythema) were reported, usually resolving within a week. The mean pain score was 1.94 (±0.66), indicating mild to moderate discomfort. DISCUSSION: Monopolar RF devices, apply high-frequency electric currents generating heat, stimulating collagen production for skin tightening. This study's unique focus on detailed subjective patient experiences provides insights valuable in clinical settings, aiding clinicians in managing patient expectations and achieving optimal results. The satisfaction rates align with previous findings, emphasizing RF treatment's efficacy in addressing facial laxity, especially in the mid and lower face. Positive feedback extended beyond skin tightening, encompassing skin texture and tone improvements. While the study's observation period was 3 months post-treatment, longer-term studies are warranted for comprehensive assessments. CONCLUSION: The study underscores the efficacy of monopolar RF device, as a non-invasive and effective anti-aging treatment. The findings contribute to diversifying the RF market, potentially aiding clinicians in optimizing patient care. Considering the growing complexity of patient demands and treatment responses, this study serves as a valuable reference for clinicians engaging in RF treatments.


Assuntos
Técnicas Cosméticas , Terapia por Radiofrequência , Envelhecimento da Pele , Humanos , Feminino , Rejuvenescimento , Satisfação do Paciente , Face
6.
J Drugs Dermatol ; 23(1): 1337-1343, 2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-38206152

RESUMO

BACKGROUND: The objective was to provide international recommendations on anti-aging dermocosmetics for clinical practice starting with essential ingredients for protection and repair before working up to advanced products for specific concerns.  Methods: Seven international experts reviewed 8 hypothetical case scenarios covering different ages, skin issues (eg, sensitivity, acne, melasma), and exposure to exposome factors for both sexes and all Fitzpatrick skin types (FST). The RAND/UCLA appropriateness method was used to obtain consensus. Seventeen key ingredients were rated on a scale from 1 (totally inappropriate) to 9 (totally appropriate). Statistical analysis, 2 meetings, and email discussions refined the recommendations. RESULTS: High-factor broad-spectrum sunscreen (ie, protects against ultraviolet [UV] A and B rays), niacinamide, and other topical antioxidants were recommended for all scenarios. Further discussions were required for other ingredients. Tinted sunscreen/iron oxide were recommended for all FST, although compliance may be sub-optimal for darker skin phototypes (IV-VI), if not cosmetically acceptable. Combining a facial foundation with broad-spectrum sunscreen was recommended for darker phototypes to obtain visible light protection closely matching diverse color tones. Retinols were not recommended as a first-line treatment for sensitive skin, especially FST V and VI, due to the risk of irritation. After ablative laser treatment, alpha hydroxy acids should be avoided or used with caution in FST IV to VI due to the risk of post-inflammatory hyperpigmentation. CONCLUSION: We describe a simple, practical tool for use in daily dermatology consultations for providing recommendations on anti-aging dermocosmetics to cover diverse and inclusive populations of patients, addressing all skin types and international needs.  J Drugs Dermatol. 2024;23(1):1337-1343.     doi:10.36849/JDD.7798.


Assuntos
Higiene da Pele , Protetores Solares , Feminino , Masculino , Humanos , Consenso , Pele , Envelhecimento
7.
Toxins (Basel) ; 15(11)2023 10 31.
Artigo em Inglês | MEDLINE | ID: mdl-37999499

RESUMO

BACKGROUND: Subcutaneous mastectomies in transmen have been gaining popularity. However, post-operative scars are an inevitable consequence. Recently, Botulinum neurotoxin A (BoNT-A) has shown positive effects in scar prevention. The objective of this study is to investigate the effectiveness of BoNT-A in scar prevention. METHODS: Fifteen patients who had undergone subcutaneous mastectomy were included. At 14 days post-surgery, either incoBoNT-A or a placebo was injected into the scar on each side. The primary outcome assessment measured the scar's severity using the Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scale (POSAS). The secondary outcome assessment evaluated the scar's color using a standard measurement device. Outcome assessments were conducted until 6 months post-surgery. RESULTS: There were significantly lower VSS scores in the BoNT-A group compared to the placebo at the end of the study (7.43 ± 0.26 vs. 8.82 ± 0.26, p < 0.001). The objective assessment revealed a statistically significant decrease in redness values in the BoNT-A group compared to the placebo at 3 and 6 months. CONCLUSION: BoNT-A has demonstrated effectiveness in scar prevention by reducing the severity of postoperative scar formation and improving overall scar appearance.


Assuntos
Toxinas Botulínicas Tipo A , Neoplasias da Mama , Humanos , Feminino , Cicatriz/etiologia , Cicatriz/prevenção & controle , Toxinas Botulínicas Tipo A/uso terapêutico , Resultado do Tratamento , Estudos Prospectivos , Mastectomia/efeitos adversos
8.
J Cosmet Dermatol ; 22(6): 1805-1813, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-37102267

RESUMO

BACKGROUND: The unique anatomy of the Asian face, along with the influence of cultural forces and regional preferences, has led to the development of specialized approaches to rejuvenation and beautification that are applicable to the aesthetic practice within Asia as well as those who serve these patients internationally. AIMS: To discuss similarities and differences in anatomy and treatment preferences of Asian patients and explore how these differences may influence aesthetic practices. PATIENTS/METHODS: In support of clinicians who wish to serve a diverse patient population, a six-part international roundtable series focused on diversity in aesthetics was conducted from August 24, 2021 to May 16, 2022. RESULTS: The results of the sixth and final roundtable in the series, the Asian Patient, are described here. Anatomical differences and their influence on treatment preferences are discussed, and specific procedural information provided for management of facial shape and projection, including advanced injection techniques for the eyelid-forehead complex. CONCLUSIONS: The continued exchange of ideas and treatment techniques support not only optimal aesthetic outcomes for a diverse range of patients within a given practice, but also the evolution of aesthetic medicine. The expert approaches detailed here may be used to inform treatment plans tailored to the Asian population.


Assuntos
Toxinas Botulínicas Tipo A , Técnicas Cosméticas , Humanos , Face , Testa , Estética
9.
J Cosmet Dermatol ; 22(4): 1279-1285, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-36575874

RESUMO

BACKGROUND: The experience of pain during microfocused ultrasound with visualization (MFU-V) treatment is common and crucial for dictating patient satisfaction and retention. OBJECTIVE: To compare the pain perception during the MFU-V procedure between two pain reduction methods (topical anesthesia alone versus combined topical anesthesia with forced air cooling). MATERIALS AND METHODS: This was a prospective, single-blinded, randomized controlled trial. A square area on the inner side of both arms of healthy volunteers was marked as an experimental site and randomly assigned to receive each pain reduction method: topical anesthesia or combined topical anesthesia with forced air cooling. Thereafter, MFU-V was performed with a 4.5 MHz, 4.5 mm transducer (10 lines, 0.9 J) followed by a 7 MHz, 3.0 mm transducer (10 lines, 0.3 J). The visual analog scale (VAS) for pain was measured immediately after 4.5 mm transducer (T1a), immediately after 3.0 mm transducer (T1b), and after the entire procedure (T2). RESULTS: Twenty-one participants with a mean (SD) age of 34.67 (±6.18) years were enrolled. The mean (±SD) pain score of combined topical anesthesia with forced air cooling-treated area was 5.40 (±1.64), 4.80 (±1.63), and 5.40 (±1.56) at T1a, T1b, and T2, respectively. The mean pain score for topical anesthesia-treated areas was 5.89 (±1.45), 5.00 (±1.72), and 5.76 (±1.67) at T1a, T1b, and T2, respectively. There were no statistically significant differences in the pain perception between the two methods. CONCLUSION: The addition of forced air cooling is not beneficial for pain reduction during the MFU-V procedure because its temperature reduction effect cannot be delivered to the deep parts of the skin, which is the target site of MFU-V.


Assuntos
Anestesia Local , Satisfação do Paciente , Humanos , Adulto , Estudos Prospectivos , Dor/diagnóstico , Dor/etiologia , Dor/prevenção & controle , Percepção da Dor , Lidocaína , Anestésicos Locais
10.
Skin Res Technol ; 29(1): e13240, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36382669

RESUMO

BACKGROUND: The transient receptor potential vanilloid 1 (TRPV1) provides a heat and pain sensation (nociception). Capsaicin, a TRPV1 agonist, has been shown to induce a refractory period in the nerve terminal expressing TRPV1 and create long-term nerve terminal defunctionalization. OBJECTIVE: To evaluate the efficacy of capsaicin for pain reduction during microfocused ultrasound with visualization (MFU-V) treatment. METHODS AND MATERIALS: A randomized, split-side study including 24 subjects was conducted. A combined 0.025% capsaicin gel and topical anesthetic were randomly applied on one side of the neck, and a topical anesthetic monotherapy was applied on the contralateral side for 30 min before MFU-V treatment. Pain score (visual analog scale, 0-10) was evaluated at T1 (before MFU-V), T2a (after the 4.5-mm transducer treatment), T2b (after the 3.0-mm transducer treatment), and T3 (after the entire treatment). Side effects were recorded. RESULTS: Mean pain scores at T2a for combined and single regimens were 5.19 (±2.26) and 6.91 (±1.72), respectively (p < 0.001). The capsaicin-treated side had a lower pain score at T2b and T3 (p < 0.001). Redness was longer on the capsaicin-treated side (112.67 vs. 10.68 min, p < 0.001). No other adverse events including contact dermatitis were reported. CONCLUSION: A single application of a combined 0.025% capsaicin gel with topical anesthesia produces a significantly lesser pain score during the MFU-V treatment. Defunctionalization of TRPV1 may explain the alleviation of painful sensations caused by heat from MFU-V.


Assuntos
Capsaicina , Manejo da Dor , Humanos , Capsaicina/efeitos adversos , Anestésicos Locais/uso terapêutico , Dor/tratamento farmacológico , Ultrassonografia , Canais de Cátion TRPV/agonistas , Canais de Cátion TRPV/uso terapêutico
11.
J Cosmet Dermatol ; 22(3): 792-797, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36374232

RESUMO

OBJECTIVES: Microfocused ultrasound (MFU) and hyaluronic acid (HA) filler injection are increasingly popular aesthetic procedures. HA filler injection is generally recommended after MFU if combined treatment is required in a single visit. However, data regarding the safe and optimal time of MFU treatment after HA injection is still limited. The purpose of this study was to evaluate the degree of HA loss when performing MFU treatment after dermal filler injection. METHODS: Fourteen subjects were recruited in this pilot study. HA was injected intradermally on four 2 × 2 cm areas at the abdomen (0.25 ml/site). Site A was served as control whereas site B, C, D were treated with MFU using 1.5 mm transducer at 60 min, Day 14, and Day 28 after the injection, respectively. All experimental sites were biopsied using a 3-mm punch biopsy to evaluate the histopathological profile at baseline and Day 56. Grading of the quantity of retained HA was evaluated by a blinded experienced dermatopathologist. RESULTS: All 14 subjects completed the study. One subject has been excluded due to the poor quality of histopathologic slides. Seven subjects (53.9%) at site B and 6 subjects (46.2%) at site C had HA loss at Day 56 compared with baseline. The mean HA grading at baseline and Day 56 was 3.7 vs. 2.8 (p < 0.001) at site B and 3.7 vs. 3.0 (p = 0.001) at site C, respectively. There was no statistical difference between the mean HA grading at baseline and Day 56 at site D (3.7 vs. 3.3, p = 0.073). No inflammation or granuloma was observed on Day 56 of the study. CONCLUSIONS: MFU treatment after HA injection appears to be safe. However, some degree of HA loss was observed if MFU treatment was done within 2 weeks after HA injection.


Assuntos
Técnicas Cosméticas , Preenchedores Dérmicos , Envelhecimento da Pele , Humanos , Ácido Hialurônico , Projetos Piloto , Pele/patologia , Injeções , Resultado do Tratamento
12.
J Cosmet Dermatol ; 22(3): 798-803, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36374532

RESUMO

BACKGROUND: Hyaluronic acid (HA) filler injections have increased in popularity. They are usually performed in combination with other treatment modalities, including lasers and energy-based devices, to enhance cosmetic results. Theoretically, HA and other filler injections should be performed after laser- or energy-based device treatments. In some instances, however, practitioners are asked to administer laser- or energy-based device treatment after HA dermal filler injection. There is a concerning possibility of HA filler degradation as a result of bulk heating generated by lasers or energy-based devices, especially radiofrequency (RF). AIM: To evaluate the effect of RF treatment at different time points on HA degradation in vivo, using clinicohistological analysis. PATIENTS/METHODS: Fourteen volunteers were recruited and received intradermal HA filler injections in four sites on the abdomen. One site served as the control, and the other three sites were treated with monopolar RF on the same day after injection, at 14 and 28 days post-injection. Skin biopsies were performed at baseline and 56 days after HA injection. Histopathological sections were reviewed for residual filler in the tissue. RESULTS: The results showed that HA grading scores decreased in five (35.71%), one (7.14%), and one (7.14%) participants when RF was performed immediately, 14 and 28 days after injection, respectively. CONCLUSION: In conclusion, RF treatment after HA filler injection may affect the integrity of the HA filler in the tissue, especially if RF treatment was performed on the same day after HA injection.


Assuntos
Técnicas Cosméticas , Preenchedores Dérmicos , Humanos , Ácido Hialurônico , Pele , Injeções , Injeções Intradérmicas
13.
J Clin Aesthet Dermatol ; 15(8): 16-21, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36061483

RESUMO

Background: Postinflammatory hyperpigmentation (PIH) is a common problem, especially in patients with darker skin tones. It can occur on any area of the body following external injuries or intense inflammatory conditions. However, there is limited evidence regarding the differences in dermatoscopic patterns between facial acne-related PIH and nonfacial acne-related PIH. Objective: We sought to determine the dermatoscopic features of acne-related PIH in facial and nonfacial areas in an Asian population. Methods: Patients with acne-related PIH in both facial and nonfacial areas were enrolled. Baseline demographic data, location, and duration of PIH were recorded. Dermatoscopic and clinical pictures of each patient were taken from the darkest PIH lesions of both areas. Differences in dermatoscopic patterns were analyzed. Results: Fifty patients were enrolled. The mean age was 26.74 (+ 6.75) years, and the Fitzpatrick Skin Types were III (66%) and IV (34%). In terms of morphological patterns of melanin, nonfacial PIH showed a significantly more regular pigment network than facial PIH (100% vs. 20%, p<0.05), while facial PIH exhibited a more pseudoreticular pigment network than nonfacial PIH (70% vs. 0%, p<0.05). In terms of vascularity, facial PIH demonstrated more telangiectasia and an increased vascular component compared to nonfacial PIH (56% vs. 16%, p<0.05). Moreover, hypopigmentation within the PIH lesion was demonstrated in both facial and nonfacial lesions (42% vs. 50%, p=0.541). Conclusion: Acne-related PIH in facial and nonfacial areas showed different morphological pigment patterns and degrees of vascularity. Dermatoscopic examination should be performed before treatment initiation.

14.
J Clin Aesthet Dermatol ; 15(6): 10-21, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35783570

RESUMO

Objective: We sought to examine the current skin quality trends and gaps in clinical practice in the Asia Pacific region and develop a practical guide to improve skin quality. Methods: Medical practitioners from 11 countries in the Asia Pacific region completed an online survey on current trends in skin quality treatment. A panel of 12 leading experts convened for a virtual meeting to develop a practical guide for skin quality improvement. Results: A total of 153 practitioners completed the survey. The four most common skin quality issues were uneven skin tone, skin surface unevenness, skin laxity, and sebaceous gland hyperactivity and enlarged pores. Most practitioners reported using a combination of treatment modalities for each skin quality issue. It was also observed that each treatment modality could be used to treat several skin quality issues. A multimodal approach targeting different interrelated issues across the tissue planes was recommended for balanced results. The panel developed a practical guide for the appropriate combinations and sequence of treatments, and created treatment protocols for specific skin quality outcome goals. The guide employed an "inside-out" approach, treating the deeper tissue planes prior to the superficial layers to achieve harmonious results. Limitations: Future studies are needed to support the recommended treatment protocols for skin quality improvement. Conclusion: These findings provide valuable insights on current skin quality trends and gaps in clinical practice. The practical guide provides a framework for practitioners to customize their treatment plan according to each patient's needs.

15.
Clin Cosmet Investig Dermatol ; 15: 1213-1223, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35800454

RESUMO

Complications such as delayed inflammatory reactions (DIRs) and unnatural outcomes can sometimes arise from hyaluronic acid (HA) dermal filler treatments and can be challenging to address. Given the popularity of HA dermal fillers for aesthetic procedures, there is a need for preventive strategies to minimize these complications. Two hundred practitioners from 10 regions in Asia Pacific who administer HA fillers completed a survey on prevention of DIRs and unnatural outcomes. Thirteen global experts convened to evaluate the current practices and propose practical approaches for safe and appropriate use of HA dermal fillers. From the survey, the top three measures used to reduce the risk of DIRs included choosing an appropriate HA filler, aseptic technique, and patient selection. Key strategies employed to achieve natural-looking outcomes were treatment customization, understanding the rheological properties and behavior of different HA fillers, and being conservative in treatment approach. The panel developed a concise reference guide aimed at minimizing the risk of DIRs while achieving natural aesthetic outcomes. Five practical considerations were recommended: patient assessment and individualization of treatment plan, choice of an appropriate HA filler, adequate knowledge of facial anatomy, strict adherence to aseptic methods, and proper injection technique. The panel highlighted the need for education efforts to increase awareness of differential immunogenicity between HA fillers and to improve understanding on the importance of preserving aesthetic individuality for optimal results. These practical insights from the global experts support practitioners in optimizing safety and quality of aesthetic treatment with HA fillers.

16.
Toxins (Basel) ; 14(6)2022 06 14.
Artigo em Inglês | MEDLINE | ID: mdl-35737067

RESUMO

The normal biological wound healing process consists of three precisely and highly programmed phases that require optimal conditions including internal and external factors. Any negative factors that disrupt the sequence or time frame of the healing mechanism can result in a non-healing wound or chronic ulcers. Botulinum neurotoxin A (BoNT-A) which is generally known as anti-contraction of muscles has been reported as a successful treatment in various types of chronic ulcers. The aim of this study is to review the outcome of treatment with BoNT-A for chronic skin ulcers. The results demonstrated some positive effects of BoNT-A on chronic ulcers. Ischemic ulcers secondary to Raynaud's phenomenon seem to be the most promising type of ulcers that have benefited from BoNT-A. The rationale behind using BoNT-A to fasten the wound healing process is also discussed. Further clinical trial studies should be conducted to affirm the efficacy of wound healing using BoNT-A administration.


Assuntos
Toxinas Botulínicas Tipo A , Doença de Raynaud , Úlcera Cutânea , Toxinas Botulínicas Tipo A/farmacologia , Toxinas Botulínicas Tipo A/uso terapêutico , Humanos , Doença de Raynaud/tratamento farmacológico , Úlcera Cutânea/tratamento farmacológico , Úlcera/tratamento farmacológico , Cicatrização
17.
Toxins (Basel) ; 14(6)2022 06 17.
Artigo em Inglês | MEDLINE | ID: mdl-35737078

RESUMO

Incobotulinum toxin A (IncoBoNT-A) is effective in preventing ultraviolet B (UVB)-induced hyperpigmentation. This prospective, randomized, controlled study aimed to evaluate the effect of IncoBoNT-A on the treatment of UVB-induced hyperpigmentation in 15 volunteers. Five hyperpigmentation squares (2 × 2 cm) were induced by local UVB on the abdomen at baseline. At Day 7, each site was randomized to receive no treatment (control), normal saline, or intradermal IncoBoNT-A injection with 1:2.5, 1:5, and 1:7.5 dilutions (12, 6, and 4 units, respectively). The mean lightness index (L*), hyperpigmentation improvement score evaluated by blinded dermatologists, and participant satisfaction scores were obtained at Days 21, 28, and 35. At Day 21, improvements in mean L* of 1:2.5, 1:5, and 1:7.5 IncoBoNT-A-treated, saline-treated, and control sites were 14.30%, 12.28%, 6.62%, 0.32%, and 4.98%, respectively (p = 0.86). At Day 28, the improvement in mean L* in IncoBoNT-A-treated groups was superior to that in the other groups. In terms of the hyperpigmentation improvement score, 12 participants (80%) experienced better outcomes with the IncoBoNT-A-injected site compared with the other sites. IncoBoNT-A, especially at higher concentrations, showed some positive effects on the treatment of UVB-induced hyperpigmentation. This may serve as an adjuvant treatment for hyperpigmentary conditions that are aggravated by UVB.


Assuntos
Hiperpigmentação , Raios Ultravioleta , Humanos , Hiperpigmentação/tratamento farmacológico , Hiperpigmentação/prevenção & controle , Estudos Prospectivos , Resultado do Tratamento , Raios Ultravioleta/efeitos adversos
18.
Plast Reconstr Surg Glob Open ; 10(6): e4407, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35747253

RESUMO

Botulinum neurotoxin A (BoNT-A) injection is the most widely performed aesthetic procedure and a first-line therapeutic option for various medical conditions. The potential for BoNT-A immunoresistance and secondary nonresponse related to neutralizing antibody (NAb) formation warrants attention as the range of BoNT-A aesthetic applications continues to expand. Methods: An international multidisciplinary panel reviewed published evidence on BoNT-A immunoresistance in aesthetic and therapeutic applications and discussed best practices integrating clinical, ethical, and aesthetic considerations. Consensus statements relating to awareness, assessment, and management of the risk of NAb-related secondary nonresponse in aesthetic practice were developed. Results: There was a consensus that, as doses used in aesthetic practice become like those in therapeutics, rates of NAb formation may be expected to increase. However, the true extent of NAb formation in aesthetics is likely underestimated due to limitations of published evidence and variability in treatment patterns of aesthetic patients. Since BoNT-A therapy is often lifelong, practitioners need to recognize immunogenicity as a potential complication that might affect future therapeutic use and strive to minimize modifiable risk factors. The selection and use of a BoNT-A product with the least immunogenic potential from the beginning may thus be advantageous, especially when treatment with high doses is planned. Conclusions: In view of current trends in BoNT-A aesthetic use, it is essential for practitioners to conduct thorough clinical assessments, inform patients of treatment risks, and develop BoNT-A treatment plans to minimize immunogenicity. This can help preserve the option of continued or future BoNT-A treatment with satisfactory outcomes.

19.
J Cosmet Dermatol ; 21(8): 3343-3350, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35377518

RESUMO

BACKGROUND: Botulinum toxin type A (BTX-A) has been used experimentally under various dermatological conditions. Recent studies have revealed a preventive effect of BTX-A against ultraviolet B (UVB)-induced skin hyperpigmentation. OBJECTIVE: We examined the effect of BTX-A for the treatment of UVB-induced hyperpigmentation in humans. MATERIAL AND METHODS: A prospective, double-blind, randomized controlled trial was conducted. UVB irradiation induced five separate hyperpigmented squares on the abdomen. Seven days after irradiation, all squares were randomly assigned to five intervention groups: control, 0.9% normal saline injection, 12 units (1:2.5), 6 units (1:5), and 4 units (1:7.5) of onabotulinum toxin injections. The lightness index (L*), hyperpigmentation improvement score rated by a blinded physician, and participant satisfaction scores were obtained at 14, 21, and 28 days after injection. RESULTS: Fifteen participants (mean age 36.9 years, Fitzpatrick skin types III-IV) completed the study. The BTX-A (1:2.5)-treated site had a lower degree of hyperpigmentation at all time points, as measured by mean L* and hyperpigmentation improvement scores. However, there were no statistically significant differences between the groups. Participants were most satisfied with the control site. CONCLUSION: Intradermal BTX-A injection had no therapeutic effect on UVB-induced hyperpigmentation. However, the role of BTX-A injections in the treatment of other hyperpigmentary conditions requires further elucidation.


Assuntos
Toxinas Botulínicas Tipo A , Hiperpigmentação , Adulto , Método Duplo-Cego , Humanos , Hiperpigmentação/tratamento farmacológico , Hiperpigmentação/etiologia , Estudos Prospectivos , Resultado do Tratamento , Raios Ultravioleta/efeitos adversos
20.
J Clin Aesthet Dermatol ; 15(3): 16-20, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35342501

RESUMO

Background: Dermatoscopy is a noninvasive diagnostic tool for pigmented lesions. However, data regarding dermatoscopic features in melasma and Hori's nevus, which are commonly found in Asian populations, are still lacking. In addition, melasma coexisting with Hori's nevus presents a particular diagnostic challenge and they generally require different treatments. Objective: We sought to describe the dermatoscopic features of melasma and Hori's nevus and to establish diagnostic clues for each condition. Methods: Fifty patients with melasma and 46 patients with Hori's nevus were enrolled in the study. Dermatoscopic pictures were taken with Dermlite DL200 HR (3Gen, San Juan Capistrano, Califorinia) and evaluated by two blinded board-certified dermatologists. Results: The dermatoscopic features more prominently seen in melasma compared to Hori's nevus include light brown pigmentation (98% vs. 10.9%, P<0.001), regular pigment network (38% vs. 2.2%, P<0.001), irregular pigment network (98% vs. 63%, P<0.001), arcuate structure (68% vs. 13%, P<0.001), circles (48% vs. 10.9%, P<0.001), sparing of follicles and sweat gland openings (98% vs. 4.3%, P<0.001), and telangiectasias (52% vs. 19.6%, P=0.001). In contrast, the common features of Hori's nevus include blue-brown or grey pigmentation (63% vs. 0%, P=0.001) and speckled homogenous pattern (52.2% vs. 0%, P<0.001). Conclusion: Dermatoscopy is a useful diagnostic tool for distinguishing between melasma and Hori's nevus. In patients with coexistence of both conditions, dermatoscopy can be used to confirm the diagnosis and aid the proper treatment.

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