Nonablative monopolar radiofrequency for the reduction of facial pores and sebum excretion in Thai patients: A novel approach.

BACKGROUND: Enlarged facial pores are visible topographic features of the skin that have been associated with cutaneous photoaging and increased sebum production. It has remained a common dermatologic concern, gaining a significant number of in-clinic consults. Available treatment modalities often operate on a single mode of action, consequently offering limited and short-term outcomes. OBJECTIVE: This study aimed to evaluate the long-term efficacy and safety of a nonablative monopolar radiofrequency (NMRF) for pore tightening and sebum output reduction in Thai patients. METHODS: Nineteen patients with enlarged pores underwent two sessions of NMRF treatments at 4-week intervals. The measurements of pore volume, skin texture, average pore size, sebum production, and skin elasticity were quantified using Antera® 3D imaging system, dermoscopic image analysis with ImageJ software, Sebumeter® and Cutometer®. Clinical evaluation by two dermatologists was done using blinded clinical photographs. All objective and subjective assessments were done at the baseline, a month after the first treatment, and during follow-up visits 1, 3, and 6 months after the last treatment. Adverse effects were also recorded during each visit. RESULTS: Seventeen out of the 19 subjects completed the study protocol. The mean pore volume significantly reduced by 24% from the baseline at 1 month after the first treatment (p < 0.016). The pore volume continued to decrease by 34% and 38% a month (p < 0.001) and 6 months (p < 0.001) following the final treatment, respectively. Sebum excretion likewise significantly decreased from baseline by 39% (p = 0.002) and 36% (p < 0.001), 3 and 6 months after the second treatment, respectively. Skin texture and elasticity also significantly improved following two NMRF sessions. The objective assessments of the pore appearance corresponded to subjective clinical evaluations. The treatment was well-tolerated without significant side effects, such as dyspigmentation, textural alteration, and scarring. CONCLUSION: NMRF appears to be effective and safe for the reduction of pore size and sebum production, with therapeutic outcomes persisting up to 6 months after two treatment sessions.

Natural history and clinical course of patients with dermographism in a tropical country: a questionnaire-based survey.

Background: Dermographism is the most common form of chronic inducible urticaria. However, the natural history and clinical course of patients with dermographism in tropical countries has not fully been described. Objective: To examine clinical features, natural history and clinical course of dermographism in Thai patients according to their experiences. Methods: A cross-sectional, internet-based survey was conducted in 2021. All study respondents completed a 45-item questionnaire that was circulated on social media regarding dermographism. Results: Among the 2,456 respondents who reported dermographism, 1,900 had symptomatic dermographism (SD), while 556 had simple dermographism (SimD). Of the respondents who reported SD and SimD, the female to male ratio was 2.2:1 and 2.4:1, respectively. The median age of the first episode of SD and SimD was 16 and 15 years, respectively. Older age, greater body weight, cardiovascular diseases, allergic conjunctivitis, atopic dermatitis, changes in temperature, and family history of dermographism were all factors linked to an increased probability of SD. Half of the respondents with SD reported moderate itch severity. Moreover, about half of SD and almost all of SimD respondents let the wheal resolve on its own. Second generation H1-antihistamines were most commonly prescribed while over-the-counter medicines were taken by both SD and SimD respondents. Conclusion: This survey highlights several aspects of dermographism in Thai patients which can be useful for healthcare providers. SD is troublesome and affects the quality of life of many patients, leading some to seek medication themselves.

Efficacy and Safety of Clinacanthus nutans Lindau Cream vs. Podophyllin for the Treatment of Adults with Condyloma Acuminata.

Human papillomavirus (HPV) infection causes condyloma acuminata (CA). Podophyllin is the standard treatment. Clinacanthus nutans Lindau (C. nutans), a medicinal plant, has potent anti-inflammatory and antiviral effects. C. nutans cream is widely used in Thailand to treat the herpes simplex virus. We proposed that C. nutans might also induce CA clearance. There are no studies of C. nutans treatment of CA. This randomized controlled trial at Siriraj Hospital, Thailand, was conducted between January 2018 and December 2019. CA samples were obtained from 10 men with at least two CAs 1 centimeter apart. Each wart was randomized to a 4-week treatment with either C. nutans or podophyllin. The participants were 24 to 72 years old. Most HPV types were low-risk HPVs (HPV 11, HPV 6). Median CA clearance with podophyllin was a 97% CA clearance with podophyllin and 82% with C. nutans. C. nutans may be an alternative treatment for CA.

Efficacy and Safety of Using Noninsulated Microneedle Radiofrequency Alone Versus in Combination with Polynucleotides for the Treatment of Melasma: A Pilot Study.

INTRODUCTION: This split-face, double-blind, randomized controlled study investigated the efficacy and safety of using a microneedling radiofrequency (RF) device with polynucleotides (PN) versus RF alone for the treatment of melasma. METHODS: Thirty adult participants with melasma (Fitzpatrick skin types III-V) received three treatments with an invasive, bipolar, pulsed-type microneedling RF device on both sides of the face. The treatment sessions occurred once every 2 weeks. The hemifaces of each participant were designated for treatment and control with PN and normal saline solution (NSS), applied after treatment with RF. Measurements were made of melanin index (MI), erythema index (EI), skin roughness (by the Antera 3D system), modified melasma area severity index (mMASI) for each hemiface, and patients' self-assessed improvement. These occurred at baseline and again following the final treatment (2 weeks and 1, 2, 3, and 6 months after). Mean values were obtained for MI, EI, skin roughness, and mMASI. A generalized estimating equation (GEE) was used to compare the obtained values for the outcome measures across all assessment points. RESULTS: All patients were women (mean age, 43.2 ± 7.0 years). Mixed melasma predominated (61.5%; n = 16), and the mean duration of melasma was 8.9 ± 6.5 years. Twenty-six participants were followed up to the 6-month assessment point. Significant improvements were observed from baseline in MI, skin roughness, and mMASI scores for both the PN and control sides at 6 months, with no statistically significant differences between sides. Patients' self-assessed improvement scores also showed a positive trend. Melasma recurrence was observed in three patients at 2, 3, and 4 months after the last treatment session (10% recurrence rate). CONCLUSIONS: The combination of an invasive, bipolar, pulsed-type microneedling RF with PN is not superior compared with microneedling RF alone in the treatment of melasma. Microneedling RF may be considered as safe and efficacious for the improvement of skin roughness, and as an adjunctive treatment option for melasma. CLINICAL TRIAL REGISTRATION: This study was registered on ClinicalTrials.gov and assigned NCT number TCTR20210804002.

Clinical manifestations and progression, seasonal variation, and environmental factors associated with Paederus dermatitis among patients attending the outpatient dermatology clinic of Thailand's largest national tertiary referral center: a prospective cohort study.

INTRODUCTION: Paederus dermatitis (PD) is a skin reaction to a chemical substance called paederin, which emanates from a beetle of Paederus spp. This study's objective was to investigate the clinical manifestations and progression, seasonal variation, and environmental factors associated with PD among patients attending the outpatient dermatology clinic of Siriraj Hospital. METHODS: This prospective cohort study included patients who were diagnosed with PD at the Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand during the October 2017 to July 2018 study period. Sociodemographic and environmental data were collected by questionnaire. RESULTS: Twenty-five PD patients (16 females, 9 males) were included with a mean age of 40.9 years (range 17-69 years). The most common sites were the upper and lower extremities. Erythema, linear, and kissing lesions (where two skin surfaces contact) were found in 100%, 32%, and 28% of patients, respectively. Seventy-six percent of patients demonstrated more than one lesion. Eighty percent of patients lived in Bangkok, and 44% of patients had a home near a farm or forest. Fluorescent lighting was used in the homes of 24 patients. All 25 patients were treated with topical steroid, and some received other supportive regimens. Two patients had post-inflammatory hyperpigmentation as a complication; only 7 of 25 patients attended the scheduled follow-up visit. CONCLUSION: In Thailand, PD presents throughout the year, but the most active month is December. Skin lesions vary from mild irritant dermatitis to severe dermatitis, and the average time to complete cure is 12 days. History and clinical manifestation are essential for accurate diagnosis.

The Cost-Effectiveness of Pulsed-Dye Laser Therapy Among Thai Patients with Facial Port-Wine Stain: A Retrospective Study and Economic Evaluation.

INTRODUCTION: Port-wine stain (PWS) is a progressive capillary malformation that does not resolve spontaneously without treatment. Pulsed dye laser (PDL) is currently the gold standard treatment for PWS, although it is difficult to attain complete clearance and recurrences are common. This study determined the cost-effectiveness of PDL treatment among Thai patients with facial PWS. METHODS: This was a retrospective chart review of 109 Thai patients with facial PWS and treated with PDL at Siriraj Hospital, Thailand from January 2008 to December 2017. The primary outcome of the study was the cost-effectiveness of PDL treatment in the clinical improvement of facial PWS. RESULTS: Ten PDL treatment sessions will have an expected clinical improvement of 60%. At the 10th treatment, the marginal incremental improvement with respect to visit is approximately equal to one. The succeeding treatment sessions will only give an additional improvement of 5-10%. CONCLUSION: A total of 10 PDL treatment sessions was considered cost-effective as it can achieve 60% clinical improvement among Thai patients with facial PWS.

Symptomatic Dermographism: A Systematic Review of Treatment Options.

BACKGROUND: Symptomatic dermographism (SD), the most common form of chronic inducible urticaria, presents with transient wheals accompanied by itching in response to scratching. Little is known about available treatment options and their efficacy in SD. OBJECTIVE: To systematically review the efficacy of treatment options for patients with SD. METHODS: Using predefined search terms, we searched for relevant literature published until September 2019. The systematic review process was consistent with Preferred Reporting Items for Systematic Reviews and Meta-Analysis recommendations. RESULTS: The 23 studies identified included 15 randomized controlled trials; 22 and 17 assessed treatment responses in patients with SD by provocation/threshold testing and patient/physician clinical assessment, respectively. Thirteen different treatments were investigated in a total of 430 adult patients. The most frequently studied therapy, first-generation H1-antihistamines, showed variable efficacy and significant side effects. In contrast, second-generation H1-antihistamines (2ndAH1), in all studies, were effective and well tolerated. Monotherapy with an H2-antihistamine (AH2) was not effective, whereas adding an AH2 increased the efficacy of treatment with an H1-antihistamine (AH1). SD improved with omalizumab. All other treatments were only investigated in small, unrepeated, and/or uncontrolled studies. There are no studies on updosing of 2ndAH1. CONCLUSIONS: The available SD studies are heterogeneous, mostly monocentric, old, small, and unrepeated, pointing to a high need for more and better studies. We suggest that 2ndAH1 should be the first-line treatment. In uncontrolled cases, the combination of AH1 and AH2 may be tried. Even though there is no evidence of its efficacy over standard dosage, updosing of 2ndAH1 may be considered based on the extrapolation of evidence from chronic spontaneous urticaria; omalizumab should be added in recalcitrant patients.

Multiple myeloma concealed by adrenal Cushing syndrome: a case report and review of the literature.

BACKGROUND: Cushing syndrome coexisting with multiple myeloma has been previously described in a few reports. Overlapping clinical manifestations can lead to misdiagnoses. CASE PRESENTATION: We presented an extremely rare case of a 33-year-old Thai woman with concomitant kappa light chain myeloma with adrenal Cushing syndrome, both of which were related to skeletal manifestations. A precedence report indicated that treatment of the Cushing syndrome could exacerbate the myeloma symptoms. Therefore, we were faced with the dilemma of which disease should be addressed first. We decided to treat our patient with a combination chemotherapy followed by an autologous stem cell transplant. Subsequently, a left laparoscopic adrenalectomy was successfully undertaken. CONCLUSION: We have reported the first association between adrenocorticotropic hormone-independent Cushing syndrome resulting from a left autonomous cortisol-secreting adrenal adenoma, and multiple myeloma.