Polish Translation and Linguistic Validation of the SCAR-Q.

Introduction Patient-reported outcome measurements (PROMs) are gaining considerable popularity as tools to assess the effectiveness of the treatment in plastic surgery, being a complement to surgical outcomes. The SCAR-Q questionnaire has been recently developed for patients with surgical, traumatic, and burn scars. Aim The study aims to describe the process of translation and linguistic validation of the scar questionnaire (SCAR-Q) for use in Polish patients undergoing scar treatment. Material and methods An official Polish translation and language validation of the SCAR-Q were done in adherence to International Society for Pharmacoeconomics and Outcomes Research (ISPOR) guidelines. The process consisted of four steps: two independent forward translations, a back translation, a review of the back translation, and cognitive participant interviews. Results The field-tested version of the SCAR-Q consisted of 29 items across three scales measuring appearance concerns, symptoms, and the psychosocial impact of the scar. The forward translation was done by two independent translators and revealed specific difficulties in translation to the Polish language (4/29 items). The back translation showed no significant differences compared to the original English version. Cognitive debriefing interviews involved nine Polish patients with postraumatic scars, burn scars, and scars after skin tumor resection. Participants have not reported any major difficulties in understanding the content of the questionnaire. Conclusions The ISPOR provides a straightforward and thorough guideline for the PROMs translation process. The new SCAR-Q is an accessible and efficient PROM that can be implemented in Polish patients to assess the effectiveness of scar treatment.

Usefulness of three-dimensional digital image analysis for objective evaluation of the efficacy of non-facial port-wine stain treatment with large spot 532 nm laser.

INTRODUCTION: New devices such as the large spot KTP laser are being introduced for the treatment of port-wine stains (PWS). AIM: To assess the efficacy of the large spot 532 nm laser for non-facial PWS with 3D image analysis and compare it with subjective evaluation. MATERIAL AND METHODS: Twenty PWS were photographed with a 3D photo unit before and after 532 nm large spot KTP laser treatment. Fifteen lesions were previously treated by different devices and five were not. Objective analysis of percentage improvement based on a 3D digital assessment of combined color and area improvement was performed and rates of improvement were determined as well as subjective evaluation of before and after images by a physician on a 5-grade scale. RESULTS: Mean objective response was 57.0%. A poor response was observed in 5% with the objective method and with no patient with the subjective method. A moderate response was achieved by 25% and 30% with the objective and subjective assessment respectively. A significant response was obtained by 55% objectively and 10% subjectively. 75-100% was achieved by 15% and 60% in the objective and subjective analysis respectively. The two methods significantly correlated with each other but the average subjective improvement rates were higher than the objective rates. CONCLUSIONS: Both objective and subjective analysis indicated that the large spot 532 nm laser is highly effective in the treatment of the neck and trunk. 3D color and area objective analysis provides an accurate tool to measure the efficacy of PWS treatment.

Age-related changes in elastographically determined strain of the facial fat compartments: a new frontier of research on face aging processes.

INTRODUCTION: Our study goal was verification of shear-wave elastography (SWE) as an assessment tool enabling quantitative analysis of facial fat tissue elasticity, using the example of the deep medial cheek fat compartment (DMCFC), due to its major role in pseudoptosis etiology. AIM: Furthermore, we determined the age-specific reference values for DMCFC elasticity and analyzed its correlation with body mass index (BMI) and DMCFC thickness. MATERIAL AND METHODS: The study included 89 female patients (age: 18-63 years, mean: 45.9 ±14.2 years) with intact facial skin. Prior to the procedure, all participants were subjected to SWE of the DMCFC. Reference ranges for elastographic parameters were defined as ± 2 standard deviations (SD), or estimated by means of ROC analysis. RESULTS: The DMCFC elasticity correlated inversely with DMCFC thickness (R = -0.292, p < 0.001), age (R = -0.838, p < 0.001) and BMI of the study subjects (R = -0.258, p = 0.001). Age was found to be the only independent determinant of DMCFC elasticity on multiple linear regression analysis (ß = -0.837, p < 0.001). The cut-off values for DMCFC elasticity estimated during ROC analysis provided excellent accuracy in distinguishing between women from various age categories, and to a large degree overlapped with the reference intervals defined as ± 2 SD. CONCLUSIONS: Shear-wave elastography enables quantitative evaluation of facial fat pad elasticity, creating a new frontier in research on age-related processes. The results indicate that elasticity of the DMCFC decreases significantly with age. Tissue elasticity might be an indirect indicator of metabolic and structural properties of facial adipose tissue and its extracellular matrix.

Intra-rater reproducibility of shear wave elastography in the evaluation of facial skin.

INTRODUCTION: Recently, esthetic medicine has been gaining its momentum worldwide, mostly due to the development of minimally invasive techniques. In our opinion, elastography can be a candidate for an objective quantitative method to evaluate facial skin condition. The aim of this study was to determine intra-rater reproducibility of shear wave elastography (SWE) in the evaluation of facial skin in patients qualified for minimally invasive nonsurgical facial rejuvenation treatment. AIM: To determine intra-rater reproducibility of shear wave elastography (SWE) in the evaluation of facial skin in patients qualified for minimally invasive nonsurgical facial rejuvenation treatment. MATERIAL AND METHODS: The study included 57 women between 40 and 67 years of age (mean: 51.5 ±7.3 years). Prior to the laser treatment, all participants were subjected to ultrasonographic examination and elastography of the skin. Upon visualization of the area of interest, the thickness of the dermis, subcutaneous tissue and superficial muscular aponeurotic system (SMAS) in millimeters was measured. Then, SWE was performed. RESULTS: No statistically significant differences were found in intraclass coefficient values (ICC) for elastographic parameters of the skin on the right and left side of the face (0.953 ±0.001 vs. 0.953 ±0.001, p = 0.992). Moreover, no significant differences were observed in the ICC values for the SWE parameters of various skin layers: dermis, subcutaneous tissue and SMAS (0.945 ±0.001 vs. 0.953 ±.001 vs. 0.961 ±0.001, p = 0.597). Women with normal body weight and overweight did not differ significantly in terms of their elastographic parameters of facial skin. CONCLUSIONS: Shear wave elastography is a reliable method for the evaluation of facial skin elasticity, providing highly reproducible results in all patients, regardless of their age and body weight.

A randomized phase 3b/4 study to evaluate concomitant use of topical ivermectin 1% cream and doxycycline 40-mg modified-release capsules, versus topical ivermectin 1% cream and placebo in the treatment of severe rosacea.

BACKGROUND: Randomized controlled studies of combination therapies in rosacea are limited. OBJECTIVE: Evaluate the efficacy and safety of combining ivermectin 1% cream (IVM) and doxycycline 40-mg modified-release capsules (ie, 30-mg immediate-release and 10-mg delayed-release beads) (DMR) versus IVM and placebo for treatment of severe rosacea. METHODS: This 12-week, multicenter, randomized, investigator-blinded, parallel-group comparative study randomized adult subjects with severe rosacea (Investigator's Global Assessment [IGA] score, 4) to receive either IVM and DMR (combination arm) or IVM and placebo (monotherapy). RESULTS: A total of 273 subjects participated. IVM and DMR displayed superior efficacy in reduction of inflammatory lesions (-80.3% vs -73.6% for monotherapy [P = .032]) and IGA score (P = .032). Combination therapy had a faster onset of action as of week 4; it significantly increased the number of subjects achieving an IGA score of 0 (11.9% vs 5.1% [P = .043]) and 100% lesion reduction (17.8% vs 7.2% [P = .006]) at week 12. Both treatments reduced the Clinician's Erythema Assessment score, stinging/burning, flushing episodes, Dermatology Life Quality Index score, and ocular signs/symptoms and were well tolerated. LIMITATIONS: The duration of the study prevented evaluation of potential recurrences or further improvements. CONCLUSION: Combining IVM and DMR can produce faster responses, improve response rates, and increase patient satisfaction in cases of severe rosacea.

Elastography reference values of facial skin elasticity.

INTRODUCTION: With an introduction of new ultrasonographic transducers, skin elastography may find an application in dermatology and aesthetic medicine enabling direct evaluation of various pathological or natural processes. AIM: To verify which elastographic technique, strain elastography (SE) or shear wave elastography (SWE), is a better candidate for the reference method of facial skin elasticity examination and to determine normal ranges for elastographic parameters in various facial regions. MATERIAL AND METHODS: The study included 71 female volunteers (age: 40-67 years, mean: 52 ±7.5 years). All participants were subjected to SE and SWE of the skin in five anatomical regions: the forehead, suborbital regions, cheeks, nasolabial folds and chin. Reference ranges for elastographic parameters were defined as 95% confidence intervals and ±2 standard deviations and estimated by means of ROC analysis. RESULTS: Shear wave elastography parameters, but not SE indices, showed strong inverse correlations with the patient age. No significant correlations were found between SE and SWE parameters of the facial skin. In contrast to SWE, no significant correlations were observed between bilateral SE parameters. Based on these findings, SWE was chosen as the reference method to determine age-specific normative values for the elasticity of the facial skin. Reference and cut-off values of SWE parameters were defined for three age groups. CONCLUSIONS: Shear wave elastography is suitable for the determination of elastographic parameters of normal facial skin, and can be used to determine reference ranges thereof. Elasticity of the facial skin decreases considerably with age, and this factor should be considered during determination of reference values for the elastographic parameters.

Predictive value of dermoscopy for the treatment of port-wine stains with large spot 532 nm laser.

OBJECTIVE: We wanted to evaluate dermoscopy as a tool to predict the efficacy of port-wine stain (PWS) laser treatment. STUDY DESIGN AND METHODS: Large spot 532 nm laser was used for the treatment of 67 PWS. Efficacy was assessed with an objective 3D digital imaging analysis. Dermoscopy images were taken before the treatment and analyzed semi quantitatively for features and patterns. RESULTS: The following dermoscopic features: "superficial vessels," "deep vessels," "deep lakes," "superficial lakes," and "thick vessels total" were identified as positive determinants of maximal global clearance effect (GCEmax), whereas "thin long vessels," "bright background total," "whitish veil," "white circles," and "perifollicular erythema" were found to be negative determinants. Rapid response correlated positively with "superficial vessels," "superficial lakes," and "thick vessels total" scores and showed inverse correlations with "bright-red background," "bright background total," "white circles," "peacock eyes," and "perifollicular erythema" scores. "Superficial vessels," "thick vessels total," and "pale-pink patchy background" were predictors of the lack of response. Dominance of "deep vessels" was a predictor of 75% of responses and dominance of "brown areas" feature was the predictor of clearance. Patients responded to treatment differently, depending on the dermoscopic pattern of PWS. CONCLUSION: Dermoscopy may be useful to predict the response of PWS to laser treatment: its rapidity, the risk of no response, and 75% response and clearance. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

Shear Wave Elastography in the Evaluation of Facial Skin Stiffness After Focused Ultrasound Treatment.

BACKGROUND: No objective method for the evaluation of facial aesthetic procedures has been proposed thus far. The authors hypothesized that shear wave elastography may be an appropriate method to evaluate the outcomes of some aesthetic treatments. OBJECTIVE: The aim of the study was to compare elastographic parameters of facial skin, subcutaneous fat, and superficial musculoaponeurotic system before high-intensity focused ultrasound treatment and 60 days after this procedure. METHODS AND MATERIALS: The study included 57 female patients aged 51.5 ± 7.3 years. Shear wave elastography of facial skin was performed before the aesthetic procedure and 2 months thereafter. RESULTS: Baseline stiffness of all examined layers correlated inversely with patients' age. Sixty days after the aesthetic treatment, the stiffness of all tissues improved significantly. The extent of the improvement correlated inversely with patients' body mass index. CONCLUSION: Shear wave elastography can accurately assess the outcomes of facial treatment with high-intensity focused ultrasound. Using this method, the authors documented improved stiffness of facial skin as early as 60 days after the procedure. The beneficial effect of the aesthetic treatment was observed regardless of patients' age but was less evident in women with excess body weight.

Ultrasonographic elastography in the evaluation of normal and pathological skin - a review.

The aim of this review article is to discuss the role of ultrasonographic elastography, a technique used to quantify tissue stiffness, in the evaluation of normal and pathological skin. A growing body of evidence suggests that elastography may be used for the diagnosis and monitoring of skin pathologies, in particular tumors, and fibrotic and sclerotic processes. Our knowledge about the elastographic parameters of normal skin is sparse, which together with the lack of reference values for cutaneous stiffness constitutes a serious limitation to the use of elastography in some medical disciplines, including aesthetic medicine.

Treatment of Previously Treated Facial Capillary Malformations: Results of Single-Center Retrospective Objective 3-Dimensional Analysis of the Efficacy of Large Spot 532 nm Lasers.

BACKGROUND: Current treatment of facial capillary malformations (CM) has limited efficacy. OBJECTIVE: To assess the efficacy of large spot 532 nm lasers for the treatment of previously treated facial CM with the use of 3-dimensional (3D) image analysis. PATIENTS AND METHODS: Forty-three white patients aged 6 to 59 were included in this study. Patients had 3D photography performed before and after treatment with a 532 nm Nd:YAG laser with large spot and contact cooling. Objective analysis of percentage improvement based on 3D digital assessment of combined color and area improvement (global clearance effect [GCE]) were performed. RESULTS: The median maximal improvement achieved during the treatment (GCE) was 59.1%. The mean number of laser procedures required to achieve this improvement was 6.2 (range 1-16). Improvement of minimum 25% (GCE25) was achieved by 88.4% of patients, a minimum of 50% (GCE50) by 61.1%, a minimum of 75% (GCE75) by 25.6%, and a minimum of 90% (GCE90) by 4.6%. Patients previously treated with pulsed dye lasers had a significantly less response than those treated with other modalities (GCE 37.3% vs 61.8%, respectively). CONCLUSION: A large spot 532 nm laser is effective in previously treated patients with facial CM.

Retrospective single center study of the efficacy of large spot 532 nm laser for the treatment of facial capillary malformations in 44 patients with the use of three-dimensional image analysis.

OBJECTIVE: We wanted to asses the efficacy of large spot 532 nm laser for the treatment of facial capillary malformations with the use of three-dimensional (3D) image analysis. STUDY DESIGN AND METHODS: Retrospective single center study on previously non-treated patients with facial capillary malformations (CM) was performed. A total of 44 consecutive Caucasian patients aged 5-66 were included. Patients had 3D photography performed before and after and had at least one single session of treatment with 532 nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser with contact cooling, fluencies ranging from 8 to 11.5 J/cm2 , pulse duration ranging from 5 to 9 milliseconds and spot size ranging from 5 to 10 mm. Objective analysis of percentage improvement based on 3D digital assessment of combined color and area improvement (global clearance effect [GCE]) were performed. RESULTS: Median maximal improvement achieved during the treatment (GCEmax ) was 70.4%. Mean number of laser procedures required to achieve this improvement was 7.1 (ranging from 2 to 14)). Improvement of minimum 25% (GCE 25) was achieved by all patients, of minimum 50% (GCE 50) by 77.3%, of minimum 75% (GCE 75) by 38.6%, and of minimum 90% (GCE 90) by 13.64. CONCLUSION: Large spot 532 nm laser is highly effective in the treatment of facial CM. 3D color and area image analysis provides an objective method to compare different methods of facial CM treatment in future studies. Lasers Surg. Med. 49:743-749, 2017. © 2017 Wiley Periodicals, Inc.