Effect of a Tranexamic Acid, Kojic Acid, and Niacinamide Containing Serum on Facial Dyschromia: A Clinical Evaluation

Background: Stubborn dyschromia such as melasma and post-inflammatory hyperpigmentation (PIH) are leading causes for cosmetic consultation. Topical treatment is challenging, using a range of modalities, to stop, hinder, and/or prevent steps in the pigment production process. Tranexamic acid (TXA), a potent plasmin inhibitor, is proposed to control pigmentation by inhibiting the release of inflammatory mediators involved in triggering melanogenesis. TXA has been recently introduced as a topical therapy aimed at reducing pigmentation in melasma. Methods: In a 12-week clinical study, a novel, topical facial serum containing 3% TXA, 1% kojic acid, and 5% niacinamide was evaluated for its effectiveness in treating melasma, PIH, and hyperpigmentation in Brazilian female subjects with Fitzpatrick skin types I-IV. Efficacy evaluations were performed at pre-treatment baseline, weeks 2, 4, 8, and 12, and included expert clinical grading, bio-instrumental measurements, and self-assessment questionnaires. Cutaneous tolerability was also evaluated by assessing subjective and objective irritation of the treatment area. Results: A significant improvement in the appearance of PIH, hyperpigmentation, melasma, skin texture, and skin tone homogeneity was observed beginning at week 2 and continued through week 12. Melanin index, as measured by Mexameter®, demonstrated a significant decrease by week 12 as compared to both pre-treatment baseline and control. Conclusions: The findings suggest that the test product is an effective and well-tolerated treatment option for addressing hyperpigmentary conditions, including melasma. Additional in vitro data suggests that TXA may act by mediating the inhibition of PGE2-stimulated human epidermal melanocytes. J Drugs Dermatol. 2019;18(5):454-459.

Baumann Skin Type in the Korean Male Population.

BACKGROUND: Research into the Baumann skin type (BST) has recently expanded, with growing interest in the development of an efficient and effective skin type classification system for better understanding of this skin condition. OBJECTIVE: We aimed to identify male-specific skin type characteristics with investigation into the distribution of BST by age and region in the Korean male population and to determine the intrinsic and extrinsic factors related to skin type. METHODS: A questionnaire was administered to collect information about age, region, working behavior, drinking behavior, smoking behavior, usual habit of sun protection, medical history, and the BST which consisted of four parameters; oily (O) or dry (D), sensitive (S) or resistant (R), pigmented (P) or non-pigmented (N), and wrinkled (W) or tight (T). RESULTS: We surveyed 1,000 Korean males aged between 20 and 60 years who were divided equally by age and region. Of the total respondents, OSNW type accounted for the largest percentage and ORPW type the lowest. In terms of Baumann parameters, O type was 53.5%, S type was 56.1%, N type was 84.4% and W type was 57.5%. Several behavioral factors were found to have various relationships with the skin type. CONCLUSION: The predominant skin type in the Korean male respondents was OSNW type, and the distribution of skin types with regards to age and region was reported to be distinct. Therefore, skin care should be customized based on detailed skin types considering the various environmental factors.

Liponeurofibroma: Clinicopathological features and histogenesis.

A neurofibroma is a common cutaneous benign tumor of neural origin. Various histological variants have been reported. Recently, sporadic reports of fatty variants have been reported but their clinicopathological features have not been well studied. The purpose of this study was to examine liponeurofibroma, and to report the distinctive clinicopathological features and histogenesis in comparison with the classic form. A retrospective study was performed on 130 cases. Immunohistochemical staining was performed for S100, factor VIIIa, perilipin and vascular endothelial growth factor. Masson's trichrome stain was also used. Intratumoral adipocytes were examined with transmission electron microscopy. Thirty-two (24.6%) cases were classified as liponeurofibroma on microscopic examination. This variant was more common in patients with neurofibromatosis type 1, older age and female sex. The most prevalent location was the head and neck. Intratumoral fat deposits showed differences in morphology and size compared with subcutaneous fat on light microscopy. Neurofibromatosis type 1 had the highest odds of fatty change in liponeurofibroma. In sporadic cases, fatty change can be caused by senescence, chronic injury, or tissue hypoxia secondary to internal or external stimuli. Further investigation is needed to identify the pathomechanism of fatty change in various cutaneous neoplasms, including neurofibroma.

Baumann Skin Type in the Korean Female Population.

BACKGROUND: To meet the need for a subspecialized skin type system, the Baumann skin type (BST) system was proposed. OBJECTIVE: To evaluate the distribution of BST types and influencing factors among Korean women. METHODS: BST questionnaires were administered to 1,000 Korean women. The possible responses were as follows: oily (O) or dry (D), sensitive (S) or resistant (R), pigmented (P) or non-pigmented (N), and wrinkled (W) or tight (T). The correlations of the BST with the subjects' age, location, ultraviolet (UV) ray exposure, drinking and smoking habits, and blood type were assessed. RESULTS: The OSNT, DSNT, DRNT, and OSNW skin types were the most common skin types (55.3%). The O, S, P, and W types accounted for 46.6%, 68.8%, 23.2%, and 31.9%, respectively. The proportion of the O and S type was the highest in Gyeongsangbuk-do (55.0%) and Seoul (77.2%). The proportion of the P and W type was the highest in Gyeongsangbuk-do (33.0%) and Chungcheong-do (39.0%). The O type decreased in the higher age group, whereas the P and W type showed a reversed tendency. In smokers, the proportion of W type was significantly higher than in the non-smokers (66.3% vs. 24.1%, p<0.05). CONCLUSION: The 4 most common BST types were OSNT, DSNT, DRNT, and OSNW. In the comparison across the 4 BST parameters according to the age, region, smoking and drinking habits, occupation, blood type, and UV exposure, significant differences were observed. Individualized and customized skin care is required according to the personal skin type.

Clinical Features and Awareness of Hand Eczema in Korea.

BACKGROUND: Hand eczema is one of the most common skin disorders and negatively affects quality of life. However, a large-scale multicenter study investigating the clinical features of patients with hand eczema has not yet been conducted in Korea. OBJECTIVE: To identify the prevalence of various hand diseases, which is defined as all cutaneous disease occurring in hands, and to investigate the clinical features of patients with hand eczema and the awareness about hand eczema in the general population and to compare the prevalence of hand eczema between health care providers and non-health care providers. METHODS: To estimate the prevalence of hand diseases, we analyzed the medical records of patients from 24 medical centers. Patients were assessed by online and offline questionnaires. A 1,000 from general population and 913 hand eczema patients answered the questionnaire, for a total of 1,913 subjects. RESULTS: The most common hand disease was irritant contact dermatitis. In an online survey, the lifetime prevalence of hand eczema was 31.2%. Hand eczema was more likely to occur in females (66.0%) and younger (20~39 years, 53.9%). Health care providers and housewives were the occupations most frequently associated with hand eczema. Winter (33.6%) was the most common season which people experienced aggravation. The 63.0% and 67.0% answered that hand eczema hinders their personal relationship and negatively affects daily living activities, respectively. CONCLUSION: Hand eczema is a very common disease and hinders the quality of life. The appropriate identification of hand eczema is necessary to implement effective and efficient treatment.

Gene profiling analysis of the early effects of ablative fractional carbon dioxide laser treatment on human skin.

BACKGROUND: The use of carbon dioxide (CO2) laser-mediated ablative fractional resurfacing (AFR) is currently under extensive clinical investigation, but the molecular mechanisms underlying this process are unclear. OBJECTIVES: To determine the early expressed genes that are upregulated in human skin after treatment using a CO2 fractional laser. METHODS: Whole human skin was irradiated using an AFR CO2 laser, and changes in gene expression after 2 and 24 hours were analyzed using microarray analysis. The results were validated using reverse transcriptase polymerase chain reaction (RT-PCR). Laser scanning confocal microscopy (LSCM) was used to investigate the expression of the validated proteins after AFR CO2 laser treatment of skin that had been biopsied from seven Korean patients. RESULTS: Gene expression profiling showed that the most significantly upregulated genes in these skin samples were those encoding Wnt5a, cysteine-rich angiogenic inducer 61 (CYR61), and heat shock protein (HSP) 90. These results were confirmed using real-time RT-PCR and LSCM. CONCLUSIONS: Irradiation using an AFR laser may induce the expression of Wnt5a, CYR61, and HSP90 in human skin during the early remodeling phases, suggesting that the induction of proteins may be the preceding event that is associated with the clinical effects of laser treatment.

A herpes simplex virus infection secondary to acupuncture and cupping.

Acupuncture and cupping have a public reputation as being safe even though these practices can lead to complications such as trauma or infection. We report here on a case of herpes simplex virus (HSV) infection secondary to acupuncture and cupping in a 56-year-old woman. The patient, who had a history of acupuncture and cupping on her left forearm for treating her myalgia, developed painful papules. Histologically, the biopsy specimen showed characteristic ballooning degeneration and inclusion bodies in the epidermis and mid-dermis. These clinical and histological findings were consistent with the diagnosis of HSV infection.

Altered epidermal lipid layers induced by long-term exposure to suberythemal-dose ultraviolet.

BACKGROUND: Although several studies have reported on the biological effects of ultraviolet (UV) radiation, there have been only a few reports on the changes in epidermal lipids following long-term UV irradiation at suberythemal dose (SED), to which people are usually exposed during their lifetime. OBJECTIVES: To investigate the changes of epidermal lipid properties after long-term UV radiation with SED. MATERIALS AND METHODS: Hairless mice were irradiated three times weekly for 15 weeks at an SED of UV (UVB: 20 mJ/cm(2) ; UVA: 14 J/cm(2) ). Every three weeks, transepidermal water loss (TEWL) was measured by a Tewameter. The morphological alterations of stratum corneum (SC) lipid lamellae were examined by electron microscopy (EM). Activities of three key enzymes for mRNA of serine palmitoyl transferase, fatty acid synthase, and HMG CoA reductase were analyzed with real time reverse transcriptase-polymerase chain reaction. We also measured the amount of ceramide, cholesterol sulfate, and free fatty acid in the SC by high-performance thin-layer chromatography with exposed times. RESULTS: The SED UV-irradiated group showed increased TEWL after 12 weeks. Following the irradiation period, EM revealed incomplete and separated lamellae at SC intercellular space. mRNA of three key enzymes was increased until six weeks of UV irradiation and decreased thereafter. However, three major lipid amounts gradually decreased throughout the exposed period, with a notable decrease in ceramide. CONCLUSIONS: Long-term UV irradiation even with SED influences skin barrier function and structure with prominent ceramide decrease in SC intercellular lipid.

Treatment of atrophic scars with fractional photothermolysis: short-term follow-up.

BACKGROUND: Various modalities have been used to treat scars, but limited efficacy and problematic side effects have restricted their application. OBJECTIVE: To determine the effectiveness and safety of fractional photothermolysis treatment of various atrophic scars in Korean patients. METHODS: Fifty-nine patients with atrophic scars (caused by acne, trauma, herpes zoster, and burns) were treated with fractional photothermolysis using either Fraxel™ SR 750 or Fraxel™ SR 1500 instruments. Each patient underwent one to three treatment sessions 3-4 weeks apart. The assessment of treatment response was conducted by three dermatologists, who independently evaluated a series of photographs using a quartile grading scale. Skin biopsies were taken before treatment and 4 weeks after the final treatment, and were examined for procollagen-1, matrix metalloproteinase-1 (MMP-1), and elastin by immunofluorescence staining. RESULTS: Four weeks after the final treatment, the mean overall improvement in objective grade was 2.0 when the Fraxel SR 750 was employed and 2.9 when the Fraxel SR 1500 was used. Confocal microscopy revealed an increase in procollagen-1 in dermis, with no difference or a slight increase in the levels of elastin and MMP-1. Side effects were minimal. CONCLUSIONS: After short-term follow-up, fractional photothermolysis appeared to be a safe and effective option for atrophic scar treatment of Asian skin.

Treatment of striae distensae with fractional photothermolysis.

BACKGROUND: Striae distensae are dermal scars characterized by flattening and atrophy of the epidermis. Although many treatment modalities have been tried with variable results, most have been disappointing. OBJECTIVE: To determine whether striae distensae might respond to fractional photothermolysis. METHODS: Twenty-two women with striae distensae were treated with two sessions each of fractional photothermolysis at a pulse energy of 30 mJ, a density level of 6, and eight passes at intervals of 4 weeks. Response to treatment was assessed by comparing pre- and post-treatment clinical photography and skin biopsy samples. RESULTS: Six of the 22 patients (27%) showed good to excellent clinical improvement from baseline, whereas the other 16 (63%) showed various degrees of improvement. Most of the lesions with excellent results were white in color and of long duration. Skin biopsy revealed that average epidermal thickness and dermal thickness were greater than at baseline. The immunoreactivity of procollagen type 1 increased after treatment. There were no significant side effects except erythema and mild pigmentation. CONCLUSION: Fractional photothermolysis may be effective in treating striae distensae, without significant side effects. Treatment outcomes were better in patients with white rather than red striae.

Increased expression of nerve growth factor receptor and neural endopeptidase in the lesional skin of melasma.

BACKGROUND: Characteristic clinical features of melasma are symmetry of hyperpigmentation and distribution related to trigeminal nerves, which suggest that the neural involvement could play a part in the pathogenic mechanisms of pigmentation. OBJECTIVE: To evaluate whether some neuropeptides and neurotrophins and their receptors were associated with the pathogenesis of melasma. METHODS: To investigate the involvement of neuronal system and neuropeptides in melasma, we examined the expression of nerve growth factor receptor (NGFR) and neural endopeptidase (NEP) in melasma lesional and nonlesional skin. Skin biopsies were obtained from lesional and nonlesional facial skin of six Korean women with melasma. Confocal laser scanning microscopic examination and western blot were performed. RESULTS: Melasma lesions showed markedly greater expression of NGFR and NEP than nonlesional skin. CONCLUSION: We suggest that neuroactive molecules, including NGF, is one of the critical factors for the pathogenesis of melasma, which may directly affect the microenvironment around melanocytes through a NGFR immunoreactivity (NGFR-IR) nerve fiber pathway, and higher levels of NEP in melasma has an important role in regulation of melanogenesis.

Autosomal recessive type 2 pseudoxanthoma elasticum presenting with generalized skin laxity.

Herein, we describe a sporadic case of recessive type 2 pseudoxanthoma elasticum. A 26-year-old woman without family history presented with cutis laxa-like marked wrinkling involving the whole-body and a serpiginous streak on the upper left arm. She denied any other systemic problems related to difficulty with visual acuity or vascular disease. A skin biopsy specimen from the loose skin showed the accumulation of calcified degenerated elastic fibers and foci of ossification in the dermis. Histopathological study from a serpiginous streak revealed mineralized debris that was eliminated through the epidermis, the finding consistent with elastosis perforans serpiginosa. Recessive type 2 pseudoxanthoma elasticum is very rare and the presenting case is interesting in that this patient presented with lesions of secondary ossification and elastosis perforans serpiginosa in association with pseudoxanthoma elasticum.