A new skin laxity scale for the buttocks: the Skin Laxity Visual Scale (SLVS).

BACKGROUND: The Skin Laxity Severity Scale for the buttocks was previously developed to separately assess buttock ptosis, a scalloped appearance of the skin, infragluteal fold, localized fat on the lower third of the buttocks, and linear depressed lesions. A more objective, faster and shorter version of this scale, to be evaluated visually, would be more feasible to apply in daily practice. OBJECTIVES: To present a new skin laxity scale for the buttocks: the Skin Laxity Visual Scale (SLVS). MATERIALS & METHODS: To establish the scale, investigators chose, by consensus, the most representative cases of each skin laxity grade. The images were graphically edited to better represent the degree of skin laxity identified in a previous study. Scale validity and reliability were assessed in two validation cycles, performed by eight dermatologists assessing 50 clinical cases. RESULTS: Overall, Kendall's, weighted-kappa, and intraclass correlation coefficients indicated very good reliability and consistent inter- and intra-rater agreement (p<0.001). The scale validity was confirmed by criteria validity tests (rs: 0.76, p<0.05). CONCLUSION: The SLVS for the buttocks is a reliable, reproducible, accurate and valid scale to identify skin laxity severity and its different features. It will very likely be an easy-to-use and convenient tool to appropriately assess improvement obtained with treatment and follow patients.

Buttocks' Skin Laxity Severity Scale.

BACKGROUND: Clinical scales are useful to assess skin laxity in different areas of the body. OBJECTIVE: To elaborate and validate a photonumeric scale to assess buttocks skin laxity. MATERIALS AND METHODS: The Buttocks' Skin Laxity Severity Scale (SLSS) was developed based on a sample of 120 patients. The SLSS validity and reliability were assessed in 2 validation cycles, performed by 8 dermatologists assessing 50 clinical cases. Both criteria and construct validity were tested. RESULTS: The Buttocks' SLSS is composed by 5 clinical aspects of skin laxity graded from absent (0) to severe (3): buttocks ptosis, skin scalloped appearance, infragluteal fold, localized fat on the lower third of the buttocks, and linear depressed lesions. Final skin laxity classification results from the sum of each item grade multiplied by its weight and varies from 0 to 24. Overall, Kendall, weighted kappa, and intraclass correlation coefficients indicated very good reliability and consistent interrater and intrarater agreement (p < .001). Cronbach alpha of 0.82 indicates high scale reliability. The scale validity was confirmed by criteria validity tests (rs: 0.72, p < .05). CONCLUSION: Buttocks' SLSS is a reliable and valid scale to identify skin laxity severity and its different features, and it is an accurate tool for clinical research.

L-Lift Technique Using Poly-l-Lactic Acid: A Pilot Study.

BACKGROUND: Minimally invasive procedures that prevent and delay the aging process can be an alternative to more invasive surgical procedures. OBJECTIVE: To assess the efficacy and safety of L-Lift technique to improve skin firmness, facial global aesthetics, and the patient and investigator satisfaction. METHODS: Prospective, open, single-center study. Thirty participants underwent 3 treatment sessions 1 month apart and were assessed 8, 16, and 24 weeks after first injections. Assessments included the Facial Laxity Rating Scale (FLRS), Global Aesthetic Improvement Scale (GAIS), objective measurement of skin elasticity, and the Skin Distension Test. RESULTS: At Week 24, 60% of the patients had at least 1-class improvement in the FLRS for the middle face and 33% for the lower face. At Week 24, investigators considered that 90.0% of the patients improved according to the GAIS and 90.0% of the subjects considered they have improved. Skin elasticity (at Week 8 and at Week 16) and Skin Distension Test (at Week 24) assessments indicated improvement in skin firmness. Both patients and investigators were satisfied with the treatment at the study end. CONCLUSION: The technique is safe and efficacious. It may be particularly suitable for patients presenting initial signs of facial skin laxity.

Effects of different doses of abobotulinumtoxinA for the treatment of anterior gingival smile.

Botulinum toxin type A (BoNT-A) is an easy and fast treatment for gingival smile (GS). The objective of the study was to compare the reduction of gingival exposure using three different doses of abobotulinumtoxinA (ABO) in patients with different severities of anterior GS, and to assess treatment safety and patients' satisfaction. A prospective, single-center, randomized, double-blind study was conducted. Mild GS (2 to < 3 mm) was treated with 2.5 U of abobotulinumtoxinA (ABO) per side, moderate GS (3 to < 4 mm) with 5 U of ABO per side, and severe GS (4 mm or more) with either 2.5 U, or 5 U or 7.5 U of ABO per side. All the 41 enrolled patients completed the study. The mean gingival exposure reduced significantly 4 and 12 weeks after treatment. The average reduction of gingival exposure with 5 U was significantly larger than that obtained with 2.5 U, (3.46 ± 1.39 vs. 2.05 ± 1.29 mm; p = 0.004). All groups of GS severity presented statistically significant reduction in the gingival exposure 4 and 12 weeks after ABO injections. Twelve weeks after treatment, more than 80% of the patients were satisfied or very satisfied. There were no treatment-related adverse events reported by the patients or noticed by the investigators. Gingival smile can be safely and effectively managed with BoNT-A injections and specifically with ABO injections to target the LLSAN muscle. Further and larger studies may determine the exact influence of each factor on BoNT-A treatments of GS.

Effective and Safe Repeated Full-Face Treatments With AbobotulinumtoxinA, Hyaluronic Acid Filler, and Skin Boosting Hyaluronic Acid

Background: It is important to study full-face aesthetic combination treatments to establish well-founded individual treatment plans. Objective: To evaluate clinical outcome and perception of treatment with either abobotulinumtoxinA (ABO) or hyaluronic acid (HA) filler followed by repeated combined treatment with ABO, HA filler, and Restylane® Skinboosters (RSB). Methods & Materials: This study was conducted at four sites in Sweden, France, and Brazil and included subjects aged 35-50 years with mild/moderate nasolabial folds and moderate/severe upper facial lines. Monotherapy was ≤125 s.U ABO in at least two upper facial indications with optional touch-up or ≤1 mL HA filler in nasolabial folds/cheeks. At months 6 and 12, both cohorts received ≤125 s.U. ABO in upper facial lines with optional touch-up, ≤2 mL HA filler in nasolabial folds/cheeks (and other facial areas as applicable), and ≤1 mL RSB. Assessments included global facial aesthetic appearance and improvement, first impression, perceived age, wrinkle severity, satisfaction questionnaires, and adverse events. Results: Repeated full-face treatment with ABO, HA filler, and RSB was associated with better aesthetic outcome and higher levels of satisfaction than treatment with ABO or HA filler alone. However, even modest volumes of HA filler achieved good aesthetic outcomes and high satisfaction. Treatment of several indications was well tolerated. Conclusion: Aesthetic improvement and subject satisfaction was high and increased with each treatment. All treatments were well tolerated. These data may be used as support when establishing individual treatment plans. J Drugs Dermatol. 2019;18(7):682-689.

Efficacy, Safety, and Subject Satisfaction After AbobotulinumtoxinA Treatment of Upper Facial Lines.

BACKGROUND: Botulinum toxins are the treatment of choice for wrinkles in the upper third of the face. OBJECTIVE: The purpose of this study was to evaluate the efficacy, safety, and subject satisfaction of abobotulinumtoxinA (ABO) for treatment of upper facial lines. MATERIALS AND METHODS: Subjects aged 35 to 50 years with moderate-to-severe upper facial lines were included in this study. Subjects received a maximum of 125 s.U. ABO in at least 2 indications with optional touch-up after 2 weeks. Assessments included wrinkle severity, global aesthetic improvement, subject satisfaction, and adverse events (AEs) 1, 3, and 6 months after treatment. RESULTS: At Month 1, 100, 94, and 93% of subjects were responders in dynamic glabellar, lateral canthal, and forehead lines, respectively. All subjects were improved 1 month after treatment, and the majority of the subjects were still improved after 6 months. After treatment, most subjects were satisfied with the appearance of their face, felt better about themselves, and agreed that the treatment made them look the way they feel. Seven subjects (22%) had 8 ABO-related AEs (mild-moderate); headache was most commonly reported (9%). CONCLUSION: AbobotulinumtoxinA effectively treated upper facial lines, with high patient satisfaction. Treatment was generally well-tolerated.

Oral supplementation with specific bioactive collagen peptides improves nail growth and reduces symptoms of brittle nails.

BACKGROUND: Brittle nail syndrome is a common problem among women and refers to nails that exhibit surface roughness, raggedness, and peeling. AIM: The goal of this study was to investigate whether daily oral supplementation with collagen peptides alleviates the symptoms of brittle nails and improves nail growth rate. METHODS: In this open-label, single-center trial, 25 participants took 2.5 g of specific bioactive collagen peptides (BCP, VERISOL® ) once daily for 24 weeks followed by a 4-week off-therapy period. Nail growth rate and the frequency of cracked and/or chipped nails as well as an evaluation of symptoms and global clinical improvement score of brittle nails were assessed by a physician during treatment and 4 weeks after discontinuation. RESULTS: Bioactive collagen peptides treatment promoted an increase of 12% nail growth rate and a decrease of 42% in the frequency of broken nails. Additionally, 64% of participants achieved a global clinical improvement in brittle nails, and 88% of participants experienced an improvement 4 weeks post-treatment. The majority of participants (80%) agreed that the use of BCP improved their nails' appearance, and were completely satisfied with the performance of the treatment. CONCLUSIONS: This study demonstrated that the daily ingestion of BCP increased nail growth and improved brittle nails in conjunction with a notable decrease in the frequency of broken nails.

Avaliação dos efeitos da terapia por ondas acústicas em queloides / Evaluation of the effects of acoustic wave therapy on keloids

Introdução: A terapia por ondas acústicas estimula os processos de regeneração e recuperação dos tecidos. Nesse sentido, espera-se que esse equipamento possa atuar em cicatrizes. Objetivo: Avaliar a eficácia e segurança da terapia por ondas acústicas na melhora de queloides. Métodos: Estudo aberto, prospectivo, unicêntrico que incluiu 20 participantes com diagnóstico clínico de queloide. Foram realizadas oito sessões de terapia por ondas acústicas, uma por semana, durante oito semanas. Os participantes foram avaliados no momento basal e uma e 12 semanas após o término do tratamento. Medidas de elasticidade e avaliação clínica pela Escala de Cicatrizes de Vancouver foram realizadas. Ao final do tratamento foi observada a satisfação dos participantes com o tratamento. Resultados: Após o tratamento, a percentagem de participantes com espessura do queloide entre dois e 5mm caiu de 71% para 47%, aumentando a percentagem de participantes com espessura menor do queloide na amostra total (<2mm, de 24% para 41%). Os aspectos da vascularização e flexibilidade também apresentaram melhora em alguns participantes. Não foram relatados eventos adversos relacionados ao tratamento. Conclusões: O tratamento por ondas acústicas é seguro e pode ser eficaz na melhora funcional de lesões de queloide e de alguns aspectos clínicos da lesão.

Introduction: Acoustic wave therapy stimulates tissue regeneration and healing processes. Therefore, it is expected that this treatment modality might have effects on scars. Objective: To evaluate the efficacy and safety of acoustic wave therapy in the improvement of keloids. Methods: An open, prospective, monocentric study was carried out with 20 participants with clinical diagnosis of keloid. Weekly sessions of acoustic wave therapy were performed, for eight weeks. Participants were assessed at baseline and at 1 and 12 weeks after the end of the treatment. The investigators took measurements of elasticity and performed clinical evaluations based on the Vancouver Scars Scale. At the end of the treatment the participants' satisfaction with the treatment was evaluated. Results: After the treatment, the percentage of participants with keloid thickness between 2mm and 5mm decreased to 47% (from 71%), increasing the percentage of participants with reduced keloid thickness in the total sample (<2mm, to 41% from 24%). Some participants also had improvement in the keloids' vascularization and pliability. No treatment-related adverse events have been reported. Conclusions: Acoustic wave treatment is safe and can be effective in the improvement of the keloid's functionality and some clinical aspects.

Acoustic wave therapy for cellulite, body shaping and fat reduction.

BACKGROUND: Cellulite is a common aesthetic condition that affects almost every woman. OBJECTIVE: To evaluate the efficacy of acoustic wave therapy (AWT) for cellulite and body shaping. METHODS: In this open-label, single-centre trial, 30 women presenting moderate or severe cellulite underwent 12 sessions of AWT on the gluteus and back of the thighs, over six weeks. The following assessments were performed at baseline, and up to 12 weeks after treatment: Cellulite Severity Scale (CSS), body circumference measurements, subcutaneous fat thickness by magnetic resonance imaging (MRI), quality of life related by Celluqol® and a satisfaction questionnaire. RESULTS: The treatment reduced cellulite severity from baseline up to 12 weeks after the last treatment session (subjects presenting severe cellulite: 60% to 38%). The mean CSS shifted from 11.1 to 9.5 (p < 0.001). Hips circumferences reduced from 99.7 and 103.2 cm to 96.2 and 100.3 cm (respectively, p < 0.001). The average thickness of the subcutaneous fat tissue also decreased (28.3 ± 6.5 mm to 26.7 ± 6.1mm; p < 0.001). The treatment also improved quality of life. More than 90% of the subjects would undergo the treatment again and 89% were satisfied with the results. No serious adverse events were reported. CONCLUSIONS: AWT is a safe treatment to improve cellulite appearance and reduce body circumferences.

Bromoderma in an infant

Abstract Bromoderma is a cutaneous eruption caused by the absorption of bromide. Clinical manifestations include acneiform and vegetative lesions. We report the case of an infant with bromoderma caused by the use of syrup for abdominal colic containing calcium bromide. The lesions regressed after discontinuation of the drug.

Redução de medidas corporais após nove sessões de tratamento com laser de baixa intensidade / Reduction of body measures after a ninesession protocol with Low Level Laser Therapy

Introdução: A terapia com laser de baixa intensidade tem sido considerada alternativa não invasiva para remodelamento corporal e redução do tecido subcutâneo. Objetivo: Avaliar a eficácia do laser de baixa intensidade na redução de medidas corporais e do tecido adiposo subcutâneo da região do abdômen e do quadril. Métodos: Estudo aberto, prospectivo, unicêntrico incluiu 25 mulheres com acúmulo de gordura localizada na região do quadril e abdômen. Nove sessões de low level laser therapy foram realizadas ao longo de três semanas. As participantes foram avaliadas no basal e em 1, 4 e 12 semanas após o tratamento. Aferição de peso e medidas de circunferência corporal, exames de perfil lipídico e de ressonância magnética foram realizados. Resultados: As medidas de circunferência abdominal apresentaram redução significativa até 12 semanas após o tratamento. Na região do quadril, as participantes apresentaram redução mais marcante uma semana após a última sessão. Também uma semana após a finalização do tratamento, 80% das participantes consideraram que o tratamento melhorou o contorno do seu corpo. Nenhum evento adverso relacionado ao tratamento foi relatado. Conclusões: O tratamento com a low level laser therapy é seguro e eficaz na redução das medidas de circunferência, principalmente na região abdominal.

Introduction: Low level laser therapy has been considered a non-invasive treatment alternative to body remodeling and fat tissue reduction. Objective: To evaluate the efficacy of low level laser therapy in reducing body circumference measures and subcutaneous adipose tissue of the abdomen and hips areas. Methods: An open, prospective, monocentric study was performed including 25 women with localized fat on the hips and abdomen. Nine sessions of low level laser therapy were performed over 3 weeks. The participants were assessed at baseline and at 1, 4 and 12 weeks after treatment. Assessment of weight and body circumferences, lipid profile tests and MRI were performed. Results: The abdominal circumference measurements showed a significant reduction up to 12 weeks after the treatment. Participants showed a more marked reduction in the hips region one week after the last session. Also one week after the completion of the treatment, 80% of the participants considered that the treatment improved their body contour. There was absence of reports of adverse events related to the treatment. Conclusion: Low level laser therapy is safe and effective in reducing the circumference measurements, particularly in the abdominal region.

Bromoderma in an infant.

Bromoderma is a cutaneous eruption caused by the absorption of bromide. Clinical manifestations include acneiform and vegetative lesions. We report the case of an infant with bromoderma caused by the use of syrup for abdominal colic containing calcium bromide. The lesions regressed after discontinuation of the drug.