Cost of surgical intervention for reconstructive therapy of HIV-associated facial lipoatrophy.

This study aims to assess direct cost of reconstructive interventions with facial fillers for treatment of HIV (human immunodeficiency virus)-associated facial lipoatrophy (FLA). Evaluation was performed on data from patients enrolled in one arm of a comparative study of immediate versus delayed reconstructive treatment of facial lipoatrophy. Median costs were standardized for efficacy, estimated using data reported by physicians and patient reported outcomes. The variations of the results were evaluated with a sensitivity analysis. Evaluation was performed on 66 patients characterized by significant differences in terms of severity of FLA. Total cost resulted of €140,416.15, with a median cost per patient of €2126.04 (interquartile range [IQR]: 1599-2822). Taking into consideration severity of disease, median costs were €1641.67 (IQR: 1326.67-2126.04) and 2557.12 (IQR: 1939.34-2872.04) (P = 0.0) respectively for patients with low and high severity scores at baseline. Significant differences in term of cost-effectiveness ratios were also found between patients with different severity of FLA, and sensitivity analysis showed that these ratios increase with higher severity scores at baseline and vary widely depending on the costs of filler. Although these results cannot be considered representative because of important limitations, the present study suggests the severity of disease as an important determinant of costs.

Long-term preservation of permanent teeth in a patient with Papillon-Lefèvre syndrome treated with etretinate.

Papillon-Lefèvre syndrome (PLS) is a rare autosomal recessive genodermatosis characterized by the association of palmoplantar keratoderma with severe periodontopathy resulting in premature loss of both deciduous and permanent dentition. We treated a patient with PLS with etretinate and followed him for 10 years. Treatment was started at age 9 years, soon after the eruption of secondary dentition. Healing of cutaneous and periodontal lesions was obtained in a few months and maintained during the four years of treatment. Six years after etretinate withdrawal the teeth are still free of periodontal disease and firmly anchored to the alveolar bone. Our case confirms that retinoid therapy can positively influence the development of normal dentition in PLS when it is started during the eruption of the permanent teeth, and suggests that this result can be maintained for a long time even after stopping therapy.