Effectiveness and Safety of Sculptra Poly-L-Lactic Acid Injectable Implant in the Correction of Cheek Wrinkles.

BACKGROUND: The current study evaluated the effectiveness and safety of Sculptra injectable poly-L-lactic acid (PLLA-SCA) treatment in correcting cheek wrinkles compared with a no-treatment control. METHODS: Male/female immune-competent adults (aged >21 years) with moderate/severe cheek wrinkles, graded using the Galderma Cheek Wrinkle Scale (GCWS) at rest, were randomized 2:1 to receive PLLA-SCA injections (150 mg; 8 mL reconstitution in sterile water for injection) + 1 mL lidocaine hydrochloride (2%), administered immediately after reconstitution, or no treatment (control). Up to 3 additional treatments were allowed at monthly intervals, and follow-up was at months 7, 9, and 12. The primary endpoint was 1-grade or greater improvement in GCWS at rest for both cheeks at month 12. RESULTS: GCWS at rest responder rate was significantly higher with PLLA-SCA treatment versus the no-treatment control at months 7 (66.2% versus 38.6%; P=0.0043), 9 (70.6% versus 31.1%; P<0.0001), and 12 (71.6% versus 26.1%; P<0.0001). Treating investigators reported improvements in skin radiance (>95%), tighter appearance (>88%), and jawline contour (>85%). PLLA-SCA recipients reported high satisfaction levels regarding improvements in skin radiance (90% or greater), sagging (84% or greater), and firmness (91% or greater) as well as natural-looking results (85% or greater) and a desire for repeat treatment (84% or greater). Treatment-related adverse events were mostly mild in severity with no serious events related to PLLA-SCA injections. CONCLUSION: Injectable PLLA-SCA treatments were well tolerated and significantly reduced the severity of moderate/severe cheek lines and wrinkles, while improving skin quality. Effectiveness was durable over the 12-month study period with high subject-reported satisfaction, natural-looking appearance, and enthusiasm for repeat treatments. CLINICALTRIALS: gov registry number: NCT04124692J Drugs Dermatol. 2024;23(1):1297-1305.        doi:10.36849/JDD.7729.

A Randomized Trial to Assess Effectiveness and Safety of a Hyaluronic Acid Filler for Chin Augmentation and Correction of Chin Retrusion.

BACKGROUND: The chin is important for facial appearance, affecting overall balance and harmony of the face. The purpose of this study was to evaluate effectiveness of the hyaluronic acid filler Restylane Defyne for chin augmentation and correction of chin retrusion versus a no-treatment control. METHODS: Male and female subjects, aged 22 years or older, with mild to moderate chin retrusion, were randomized 3:1 to the hyaluronic acid filler Restylane Defyne ( n = 107) or no treatment ( n = 33). Assessments included live, blinded evaluations on a validated chin retrusion scale (Galderma Chin Retrusion Scale), aesthetic improvement (Global Aesthetic Improvement Scale), subject-reported FACE-Q Satisfaction with Chin, and safety follow-up. RESULTS: Galderma Chin Retrusion Scale responder rate (≥1 grade improvement) was higher for the hyaluronic acid filler Restylane Defyne (81 percent) than for control (6 percent) ( p < 0.001) at week 12, and remained higher at week 48 (74 percent versus 11 percent; p < 0.001). Aesthetic improvement rates were high throughout the study as reported by investigators (≥96 percent) and subjects (≥85 percent). Subject satisfaction was higher in the hyaluronic acid filler Restylane Defyne group than in the control group at week 12 ( p < 0.001). In the individual FACE-Q scale items, 87 to 98 percent of subjects were satisfied at week 12. Treatment-related adverse events were mild to moderate. CONCLUSIONS: The hyaluronic acid filler Restylane Defyne was safe and effective for augmentation of the chin region to improve the chin profile and associated with high aesthetic improvement and subject satisfaction. Effectiveness was sustained throughout 48 weeks. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Cryptococcal panniculitis in an immunocompromised patient: a case report and review of the literature.

Cryptococcus neoformans is a dimorphic fungus known to cause disease predominately in immuno-compromised patients. It is not uncommon for cryptococcal disease to manifest within the cutaneous tissues of these patients, and it can have drastically varied presentations, from ulcerated nodules to a more subtle cellulitis. We present a patient who underwent a cardiac transplant and developed a fever and mildly erythematous, indurated plaques on his legs and flank several years later. Skin biopsy revealed cryptococcal panniculitis and C neoformans subsequently grew from both the biopsy culture and the cerebrospinal fluid (CSF). This case report highlights the varied and subtle presentations of cutaneous cryptococcosis in immunocompromised patients and encourages a high index of suspicion for this potentially fatal disease in the setting of immunosuppression.

Port-wine-stain-associated dermatitis: implications for cutaneous vascular laser therapy.

Port-wine stains are congenital vascular malformations affecting 0.3% to 0.5% of infants. Dermatitis occurring exclusively or most severely within port-wine stains has been described in the literature. Traditionally, topical corticosteroid therapy has been used for the treatment of dermatitis, while pulseddye laser treatment is considered a safe and effective means of lightening the appearance of congenital port-wine stains. To describe the development of port-wine stain-associated dermatitis as well as a rational treatment approach to these patients, we studied three children with facial, limb, or truncal port-wine stains who developed dermatitis within the congenital vascular malformation either prior to or during treatment with pulseddye laser. Laser therapy of dermatitis-affected areas was subsequently deferred pending resolution of the dermatitis with topical corticosteroid or topical calcineurin inhibitor treatment. While pulseddye laser therapy is an effective means of lightening port-wine stains and achieving lasting resolution of any associated dermatitis, this therapy to dermatitis-affected areas should be postponed until the inflammation resolves to minimize the risk of laser-associated adverse effects.

Gender differences in skin: a review of the literature.

BACKGROUND: There has been increasing interest in studying gender differences in skin to learn more about disease pathogenesis and to discover more effective treatments. Recent advances have been made in our understanding of these differences in skin histology, physiology, and immunology, and they have implications for diseases such as acne, eczema, alopecia, skin cancer, wound healing, and rheumatologic diseases with skin manifestations. OBJECTIVE: This article reviews advances in our understanding of gender differences in skin. METHODS: Using the PubMed database, broad searches for topics, with search terms such as gender differences in skin and sex differences in skin, as well as targeted searches for gender differences in specific dermatologic diseases, such as gender differences in melanoma, were performed. Additional articles were identified from cited references. Articles reporting gender differences in the following areas were reviewed: acne, skin cancer, wound healing, immunology, hair/alopecia, histology and skin physiology, disease-specific gender differences, and psychological responses to disease burden. RESULTS: A recurring theme encountered in many of the articles reviewed referred to a delicate balance between normal and pathogenic conditions. This theme is highlighted by the complex interplay between estrogens and androgens in men and women, and how changes and adaptations with aging affect the disease process. Sex steroids modulate epidermal and dermal thickness as well as immune system function, and changes in these hormonal levels with aging and/or disease processes alter skin surface pH, quality of wound healing, and propensity to develop autoimmune disease, thereby significantly influencing potential for infection and other disease states. Gender differences in alopecia, acne, and skin cancers also distinguish hormonal interactions as a major target for which more research is needed to translate current findings to clinically significant diagnostic and therapeutic applications. CONCLUSIONS: The published findings on gender differences in skin yielded many advances in our understanding of cancer, immunology, psychology, skin histology, and specific dermatologic diseases. These advances will enable us to learn more about disease pathogenesis, with the goal of offering better treatments. Although gender differences can help us to individually tailor clinical management of disease processes, it is important to remember that a patient's sex should not radically alter diagnostic or therapeutic efforts until clinically significant differences between males and females arise from these findings. Because many of the results reviewed did not originate from randomized controlled clinical trials, it is difficult to generalize the data to the general population. However, the pressing need for additional research in these areas becomes exceedingly clear, and there is already a strong foundation on which to base future investigations.

Neutrophilic dermatosis of the dorsal hand.

Neutrophilic dermatosis of the dorsal hands (NDDH) was originally described as pustular vasculitis (PV) of the hands. Recent debate focuses on categorizing this disorder in the family of neutrophilic dermatoses (ND), as opposed to a primary vasculitis. We present a case of NDDH with clinical and histologic features consistent with ND, and discuss the major concerns for this disease's reclassification.

Cutaneous Bipolaris infection in a neutropenic patient with acute lymphoblastic leukemia.

Bipolaris spicifera is a darkly pigmented (dematiaceous) fungus that uncommonly causes infections in humans. There are few cases of reported cutaneous Bipolaris infection in the literature. We report a case of a five-year-old boy with B-precursor-cell acute lymphoblastic leukemia who developed a cutaneous fungal infection on his left cheek Histopathological and microbiological findings identified the fungus as Bipolaris spicifera. Surgical excision and systemic antifungal therapy are the mainstay of treatment.