Assessment of the Combined Efficacy of Needling and the Use of Silicone Gel in the Treatment of C-Section and Other Surgical Hypertrophic Scars and Keloids.

OBJECTIVE: To evaluate the individual effectiveness of needling therapy using the Dermapen (Dermapen, Salt Lake City, Utah) and topical therapy with silicone gel (Kelo-cote, Sinclair Pharma, London, England), and their combined effectiveness for the treatment of linear surgical scars, hypertrophic scars, and keloids. MATERIALS AND METHODS: Twenty patients were randomly selected and equally divided into 2 groups (A and B), with each group of 10 including 6 patients with keloids and 4 with hypertrophic scars. Treatment assignments were random. In group A, the entire scar was treated by skin needling, with silicone gel applied to half of the scar. Patients in group B were treated with silicone gel on the whole scar, with only half of the scar also treated with skin needling. During follow-up visits, clinical photographs, evaluation of the scars' thickness, skin ultrasound, and modified Vancouver Scar Scale were performed. RESULTS: Group A showed an average improvement of 68% (P < .01) on the half of the scar with the combination treatment (skin needling plus silicone gel) compared with a 52% improvement on the half of the scar that was treated with only skin needling. Group B showed an average improvement of 63% (P < .01) where the combination treatment was performed, compared with 47% improvement on the area treated with only the silicone gel. CONCLUSIONS: In conclusion, the combination of these 2 treatments is safe and effective for the treatment of hypertrophic scars and keloids. These modalities achieved favorable results with each patient adhering to the study paramenters.

Percutaneous collagen induction: an effective and safe treatment for post-acne scarring in different skin phototypes.

BACKGROUND: Atrophic scars can complicate moderate and severe acne. There are, at present, several modalities of treatment with different results. Percutaneous collagen induction (PCI) has recently been proposed as a simple and effective therapeutic option for the management of atrophic scars. OBJECTIVE: The aim of our study was to analyze the efficacy and safety of percutaneous collagen induction for the treatment of acne scarring in different skin phototypes. METHODS & MATERIALS: A total of 60 patients of skin types phototype I to VI were included in the study. They were divided into three groups before beginning treatment: Group A (phototypes I to II), Group B (phototypes III to V), and Group C (phototypes VI). Each patient had three treatments at monthly intervals. The aesthetic improvement was evaluated by using a Global Aesthetic Improvement Scale (GAIS), and analyzed statistically by computerized image analysis of the patients' photographs. The differences in the GAIS scores in the different time-points of each group were found using the Wilcoxon's test for nonparametric-dependent continuous variables. Computerized image analysis of silicone replicas was used to quantify the irregularity of the surface micro-relief with Fast Fourier Transformation (FFT); average values of gray were obtained along the x- and y-axes. The calculated indexes were the integrals of areas arising from the distribution of pixels along the axes. RESULTS: All patients completed the study. The Wilcoxon's test for nonparametric-dependent continuous variables showed a statistically significant (p < 0.05) reduction in severity grade of acne scars at T5 compared to baseline (T1). The analysis of the surface micro-relief performed on skin replicas showed a decrease in the degree of irregularity of skin texture in all three groups of patients, with an average reduction of 31% in both axes after three sessions. No short- or long-term dyschromia was observed. CONCLUSION: PCI offers a simple and safe modality to improve the appearance of acne scars without risk of dyspigmentation in patient of all skin types.

Clinical efficacy of a novel topical formulation for vitiligo: compared evaluation of different treatment modalities in 149 patients.

Current vitiligo treatments are not always satisfactory for both patients and dermatologists. Recently, combination therapies have been introduced in order to obtain better results and reduce risks in the management of the disease. Novel efficacious products are needed to improve the therapeutic possibilities of dermatologists in the respect of safety for the patients. The objective of the present study was to evaluate the effects of a novel topical in a gel formulation containing phenylalanine, cucumis melo extract, and acetyl cysteine in vitiligo. The present study used an open observational study to evaluate the efficacy and safety of the investigated product, given alone or in combination with 311-nm narrow band microphototherapy. Results were compared with those obtained treating a matched patient population with microphototherapy alone and with clobetasol propionate 0.05% ointment alone. One hundred forty-nine patients suffering from symmetrical vitiligo affecting less than 10% of the skin surface were evaluated. Patients affected by acral vitiligo only were excluded from the analysis. Treatment duration was scheduled for 12 weeks. Excellent repigmentation (>75%) was achieved by 38-73% of patients, depending on the treatment regimen. Mild to moderate side effects were observed only in patients treated with clobetasol 0.05% ointment. The tested gel formulation showed a good efficacy in improving vitiligo repigmentation. No side effects were observed.

Melasma: treatment with 10% tretinoin peeling mask.

BACKGROUND: Melasma is one of the most frequently acquired hyperpigmentation disorders clinically characterized by symmetrical brown patches on sun exposed areas. The first approach is an avoidance of sun exposure and inflammation combined with a use of photoprotection. Patient treatment is particularly difficult and challenging, and necessitates consideration of many therapies, including tretinoin to obtain an amelioration of this important skin condition. AIMS: To evaluate the efficacy of a 10% tretinoin peeling mask before and after treatment using standardized digital photos, mexameter measures, and melasma area and severity index (MASI) evaluation. PATIENTS/METHODS: The present study was carried out on 20 female patients. RESULTS: Physician global evaluation showed moderate or marked improvement of melasma in all patients using three parameters of assessment: digital photography, mexameter measurement, and the MASI. CONCLUSIONS: Tretinoin peeling mask can be considered an alternative treatment modality in treating melasma. We noted a particular high tolerability and efficacy without adverse events.

Pyruvic acid peels for the treatment of photoaging.

BACKGROUND: Pyruvic acid (CH3-CO-COOH), an alpha-keto-acid, has been recently used as a medium chemical peeling agent in subjects with inflammatory acne, moderate acne scars, greasy skin, actinic keratosis, and warts. OBJECTIVE: The aim of our study was to evaluate the efficacy and tolerability of 50% pyruvic acid on moderately photodamaged facial skin. METHODS: We treated 20 patients with four peeling sessions at 4-week intervals. We evaluated the patients clinically, and in order to obtain an objective assessment of the effect of pyruvic acid on pigmentary components of the skin, erythema and hyperpigmentation response were measured in all the patients before and after treatment using a Minolta Tri-Stimulus Colorimeter II. RESULTS: The clinical evaluation of the patients after the peeling sessions demonstrated a smoother texture, less evident fine wrinkles, and evident lightening of hyperpigmentations (freckles and lentigines). In fact, chemical peels cause a thinning of the epidermis and a thickening of the dermis. The patients treated reported very limited or no discomfort in the postpeel period. CONCLUSION: Thus, 50% pyruvic acid peeling can be proposed as a safe and efficient treatment for moderate facial skin aging.

The neuro-immuno-cutaneous-endocrine network: relationship between mind and skin.

Brain-body(skin) influences are bi-directional and skin should be considered as an active neuro-immuno-endocrine interface, where effector molecules act as common words used in a dynamic dialogue between brain, immune-system and skin. It has been widely demonstrated that stimuli received in the skin can influence the immune, endocrine and nervous systems at both a local and central level. However, the brain can also modulate inflammatory conditions locally induced in the skin. It has been experimentally demonstrated that intracerebral administration of the tridecapeptide alpha-MSH or even its COOH-terminal tripeptide can in fact inhibit cutaneous inflammation induced by the application of topical irritants and intradermal injection of cytokines. The skin can therefore alter the pharmacology of the CNS by releasing large amounts of NPs which obviously do work locally in the skin and beyond the skin. Alpha-MSH may represent a key molecule for understanding this aspect of cutaneous-immune-neuro-endocrine-mental biological communication, being it is also generated in the skin. This molecule may in the future be used as a potent anti-inflammatory agent in clinical dermatology, and preclinical trials are presently in progress.

Superpulsed CO2 laser treatment of basal cell carcinoma with intraoperatory histopathologic and cytologic examination.

BACKGROUND: CO2 laser is currently one of the most versatile and useful laser devices in dermatologic practice in the fields of both cosmetology and oncology. The CO2 laser in a superpulsed mode enables the operator to effect precise and adequate vaporization of the affected area, with the possibility to appreciate visually the depth achieved, and, when necessary, to perform histologic and cytologic examination of the surrounding skin. OBJECTIVE: To show superpulsed CO2 laser treatment of basal cell carcinoma. METHODS: One hundred forty patients presenting single, multiple, superficial, or nodular basal cell carcinoma (BCC) have been treated with the superpulsed CO2 laser. Before the laser treatment the lesion was subjected to cytologic examination by scraping; this examination was then repeated when the papillary dermis was clinically detectable, and again when the operator considered the BCC completely vaporized. In selected subjects, histopathologic examination was done three times (biopsies were obtained at the same time as the samples for the cytologic examination). RESULTS: Recovery time was fast, with good healing outcomes. After 3 years follow-up no recurrences were seen. The cytologic and histopathologic examinations showed BCC in the specimens obtained prior to and during laser therapy, but not in those obtained after laser therapy. CONCLUSION: This technique causes minimal thermal cellular damage and no severe morphologic cellular alterations. Thus it permits an intraoperatory cytologic and histopathologic examination. Finally, this technique enables the operator to recognize the different skin levels removed by vaporization and to stop the vaporization as soon as unaffected dermis has been reached, as shown by intraoperatory cytologic and histopathologic examination.

Can the brain inhibit inflammation generated in the skin? The lesson of gamma-melanocyte-stimulating hormone.

The neuro-immuno-cutaneous-endocrine network is not a simple construct featuring organ systems intimately involved in the bridge between body and mind. Mind-body influences are bi-directional and the skin should be considered an active neuroimmunoendocrine interface, where effector molecules of neuropeptides act as common words used in a dynamic dialogue between brain, immune system and skin. Gamma-melanocyte stimulating hormone (gamma-MSH), one of the principal neuroimmunomodulating peptides, seems to exercise some control on the cutaneous inflammatory process, through a central action mediated by descending anti-inflammatory neural pathways and via local direct influence on inflammatory cells infiltrating the dermis, such as monocytes, macrophages and neutrophils. Gamma-MSH down-regulates the production of proinflammatory cytokines, while the production of the anti-inflammatory cytokine IL-10 is stimulated by gamma-MSH. Finally, gamma-MSH seems to regulate the expression of surface molecules in immunocompetent cells. Thus, further studies may lead to the use of gamma-MSH as an important anti-inflammatory agent in clinical dermatology.

New and established topical corticosteroids in dermatology: clinical pharmacology and therapeutic use.

Currently, topical glucocorticosteroids are the most frequently used drugs in dermatologic practice. Over the years, research has focused on strategies to optimize potency and, in particular, the anti-inflammatory and immunosuppressive capacity of these drugs, while minimizing adverse effects. However, 'ideal' topical corticosteroids have not yet been synthesized. They should be able to permeate the stratum corneum and reach adequate concentrations in the skin without reaching high serum concentrations. Such characteristics can be obtained by increasing the natural lipophilicity of corticosteroids, e.g. by esterification. In the past, many structural modifications have been made to improve the efficacy of topical corticosteroids to produce drugs with greater potency, although this has often been associated with a higher likelihood of adverse effects. Betamethasone dipropionate and clobetasol propionate, known as fifth-generation corticosteroids, are a typical example of potent molecules that can control specific dermatoses very rapidly, but which are associated with a high risk of topical and systemic adverse effects. Recently, steroid components have been synthesized that aim to have adequate anti-inflammatory effects and minimal adverse effects. The newest topical corticosteroids used for the treatment of different dermatoses and allergic reactions of the respiratory tract (in particular asthma) are budesonide, mometasone furoate, prednicarbate, the di-esters 17,21-hydrocortisone aceponate and hydrocortisone-17-butyrate-21-propionate, methylprednisolone aceponate, alclometasone dipropionate, and carbothioates such as fluticasone propionate. These new topical corticosteroids are evaluated in the current review, which compares the risk/benefit ratio of each molecule with established agents. The new molecules, compared with the well known and established corticosteroids, generally have a higher anti-inflammatory effect, good compliance among patients (only a once-daily application is needed), rarely induce cross-sensitivity reactions and have weak atrophogenicity.