Delayed immunologic complications due to injectable fillers by unlicensed practitioners: our experiences and a review of the literature.

For a number of years, there have been unauthorized practitioners who have been illegally injecting substances. In this series of cases, delayed type hypersensitivity reactions occurred after having unknown material fillers injected by unlicensed practitioners. When injecting an unknown material, there can be a severe immune reaction due to the unknown number of antigens in the material, and therefore may act as a much stronger superantigen than conventional filler materials. It appears that the adverse effects in these cases are more severe and have tendency to break out after a longer period of time in comparison with those caused by approved fillers, likely due to operative technique and use of unverified materials. It is important to recognize the danger of such illegal procedures and to increase awareness of the public, as this has evolved into a significant public health issue.

Combined treatment with 595-nm pulsed dye laser and 1550-nm erbium-glass fractional laser for traumatic scars.

Facial scars can be caused by a traumatic event or indeed surgical procedures. Several treatment modalities have been suggested including surgical or resurfacing techniques, autologous fat transfer, and injection of fillers. However, these approaches have varying degrees of success and associated side effects. We report two Korean patients with traumatic scars. Both patients received combined consecutive treatment with 595-nm pulsed dye laser (PDL) and 1550-nm erbium-glass fractional laser. Both patients showed remarkable clinical improvements after a course of sessions. Therefore, simultaneous combined treatment with PDL and fractional laser may be considered a reasonable therapeutic option for traumatic facial scars.

Botulinum toxin for the treatment of refractory erythema and flushing of rosacea.

BACKGROUND: Persistent erythema and severe rosacea flushing can cause significant physical discomfort and emotional stress to patients. Currently, no satisfactory treatments are available. METHODS: We report two cases of refractory flushing and erythema of rosacea that were successfully treated with intradermal botulinum toxin injections. RESULTS: Good cosmetic results were achieved for both patients. The side effects during and after treatment were mild pain and localized bruising; these symptoms resolved within several days without further treatment. CONCLUSION: Intradermal botulinum toxin injection may be an effective treatment for refractory erythema and rosacea flushing that deserves further study in a larger patient population.

A multicenter, randomized, double-blind clinical study to evaluate the efficacy and safety of PP-501-B in correction of nasolabial folds.

BACKGROUND: Many new brands of hyaluronic acid (HA) fillers are being produced, but comparative research on the characteristics of similar products is limited. OBJECTIVE: To test the efficacy, tolerability, and safety of a new HA filler, PP-501-B (Cleviel Contour; Pacific Pharma, Seoul, Korea), which is used for correcting nasolabial folds (NLFs), and to compare the performance of PP-501-B with that of Restylane Perlane (Q-Med). MATERIALS AND METHODS: A total of 103 subjects with visible NLFs were enrolled in this randomized, multicenter, patient/evaluator-blind, active-controlled, matched-pair clinical study. Each subject was injected with PP-501-B in 1 NLF and Restylane Perlane in the other. All participants were reassessed for cosmetic changes at 8, 16, and 24 weeks. Wrinkle severity was rated using the 5-point Wrinkle Severity Rating Scale (WSRS). RESULTS: At Week 24, the mean improvement in the WSRS compared with baseline was 1.87 ± 0.73 for the PP-501-B side and 1.92 ± 0.71 for the Restylane Perlane side. Both fillers were well tolerated, and adverse reactions were mild. CONCLUSION: The new HA filler, PP-501-B, to the market, with suitable characteristics and ample safety profiles, will widen the selection of agents for physicians and patients because the purpose, area, and depth of filler injections vary.

Comparison of fractional, nonablative, 1550-nm laser and 595-nm pulsed dye laser for the treatment of facial erythema resulting from acne: a split-face, evaluator-blinded, randomized pilot study.

BACKGROUND: Postinflammatory erythema is commonly seen in patients with inflammatory acne. There are no reliable treatment guidelines for acne erythema. OBJECTIVE: We compared the effect and safety of a nonablative, 1550-nm fractional laser and a 595-nm pulsed dye laser (PDL) for the treatment of acne erythema. MATERIALS AND METHODS: Twelve Korean patients with acne erythema were enrolled. Sides of the face were randomized to receive treatment with a fractional laser or a PDL for a total of three treatments at 4-week intervals. The assessment of effectiveness was mean change in mexameter scores, investigator's and patients' clinical assessments. RESULTS: Statistically significant improvements in baseline acne erythema were observed through an improved erythema index on both treated sides. But, the improvements from each laser treatment were not significantly different. Mean scores of investigator assessments were 3.42 ± 0.67 in fractional laser-treated sites and 3.33 ± 0.65 in PDL-treated sites. Patients assessed their improvement as good or excellent in 91.7% of fractional laser-treated sites and 75% of PDL-treated sites. CONCLUSION: Both lasers are effective and safe modalities for the treatment of acne erythema; however, these data suggest better clinical efficacy with the use of a 1550-nm, erbium-glass fractional laser.

Thermography as a predictor of postherpetic neuralgia in acute herpes zoster patients: a preliminary study.

BACKGROUND/PURPOSE: Infrared thermal images in patients suffering from herpes zoster (HZ) may exhibit thermal asymmetry due to the unilateral distribution of HZ lesions. This study examined the usefulness of infrared thermography in acute HZ as a predictor for the development of postherpetic neuralgia (PHN). METHODS: The authors collected demographic and clinical data including age, sex, onset of skin lesion, pain intensity by a visual analogue scale (VAS) and the development of PHN from a total of 55 patients diagnosed with HZ. We evaluated the body surface thermographic parameters between the lesion and contralateral normal skin: maximal difference in the temperature (ΔT) and the size of the body surface area (BSA) showing thermal asymmetry. RESULTS: Temperatures of the lesions were found to be warmer than the control side in most patients with acute HZ. We compared the patient group who developed PHN with those who did not. In univariate analysis, patients with PHN were older (P=0.004), had a higher VAS score for pain (P<0.001), higher ΔT (P<0.001) and larger BSA (P=0.001). In logistic regression analysis to identify independent risk factors of PHN, older age (>60 years old) and ΔT more than 0.5 °C were found to be statistically significant.

Combined treatment with a nonablative infrared device and hyaluronic acid filler does not have enhanced efficacy in treating nasolabial fold wrinkles.

BACKGROUND: Although hyaluronic acid (HA) fillers are extensively used for the correction of facial wrinkles and folds, there is a limit to patient satisfaction, especially in patients with severe wrinkles. OBJECTIVE: To evaluate the potential for synergistic effects with combined treatment using a nonablative infrared (IR) device and HA filler in the treatment of nasolabial fold (NLF) wrinkles. MATERIALS AND METHODS: This was a split-face randomized study in which 12 Korean patients were treated with HA filler on both NLFs and with a nonablative IR device on the experimental side of the face. Clinical evaluations from subjects and investigators and photographs were obtained at baseline, just before and after the procedures, and 1 and 2 months after completion of the procedures. RESULTS: There were no significant differences between wrinkle severity and global aesthetic scores for HA gel implantation alone and HA gel with nonablative IR device treatment at any point. CONCLUSION: Combining the use of a nonablative IR device with HA filler does not appear to be superior to HA filler alone in the treatment of moderate to severe NLF wrinkles.

The effect of calcipotriol on the expression of human beta defensin-2 and LL-37 in cultured human keratinocytes.

BACKGROUND: Vitamin D has been reported to regulate innate immunity by controlling the expression of antimicrobial peptides (AMPs). OBJECTIVE: We investigated the effect of calcipotriol on the expression of AMPs in human cultured keratinocytes. METHODS: Keratinocytes were treated with lipopolysaccharide (LPS), TNF-alpha, Calcipotriol and irradiated with UVB, cultured, and harvested. To assess the expression of human beta defensin-2 and LL-37 in the control group, not exposed to any stimulants, the experimental group was treated with LPS, TNF-alpha, or UVB, and another group was treated again with calcipotriol; reverse transcriptase-polymerase chain reaction, Western blotting, and immunohistochemical staining were performed. RESULTS: In the experimental group treated with LPS, UVB irradiation, and TNF-alpha, the expression of beta-defensin and LL-37 was increased more than in the control group and then decreased in the experimental group treated with calcipotriol. CONCLUSIONS: Calcipotriol suppressed HBD-2 and LL-37, which were stimulated by UVB, LPS, and TNF-alpha.

The use of 1540 nm fractional photothermolysis for the treatment of acne scars in Asian skin: a pilot study.

BACKGROUND: Various modalities have been used to treat acne scars, but limited efficacy and considerable side effects have restricted their proper use. Recently, a new-generation fractional photothermolysis modality has been introduced that has deeper penetrating ability; however, a 1540 nm fractional photothermolysis study has not yet been performed. OBJECTIVES: To evaluate the efficacy and safety of 1540 nm fractional photothermolysis for the treatment of acne scars in Asian skin. METHODS: Sixteen volunteers (Fitzpatrick skin types III-IV) with mild to moderate acne scars were enrolled. Acne scar lesions were treated with 1540-nm fractional photothermolysis (Starlux 1540). Three treatment sessions were performed for each patient 4 weeks apart. Outcome assessments included the following four methods: (1) clinical evaluation of the photographs that were taken before and after the treatment; (2) comparison of the quality of life (QOL) of the patients before and after the treatment; (3) patients' satisfaction with the treatment; and (4) comparison of the quantity of collagen and elastic fibers in the skin biopsies before and 12 weeks after the last treatment. RESULTS: A mild to moderate clinical improvement was observed in most of the patients. Moreover, the QOL of all the patients improved, and all of them were satisfied with the results of the treatment. Significant collagen and elastic-fiber increases were also observed after the treatment, and side effects were limited to transient erythema and edema, which occurred in 50% of the patients. No severe side effect was observed. CONCLUSIONS: 1540 nm fractional photothermolysis is an effective and safe method for improving acne scar, even in Asian skin.

Long-pulsed Nd:YAG laser treatment of warts: report on a series of 369 cases.

Various treatment methods have been adopted in the management of warts; however, there is still no consensus on first-line treatment. This study was designed to evaluate the efficacy of long-pulsed Nd:YAG laser in the treatment of warts. Over the course of 1 yr, 369 patients with recalcitrant or untreated warts were exposed to a long-pulsed Nd:YAG laser. The following parameters were used: spot size, 5 mm; pulse duration, 20 msec; and fluence, 200 J/cm(2). No concomitant topical treatment was used. In all, 21 patients were lost during follow up; hence, the data for 348 patients were evaluated. The clearance rate was 96% (336 of the 348 treated warts were eradicated). The clearance rate of verruca vulgaris after the first treatment was very high (72.6%), whereas the clearance rate of deep palmopantar warts after the first treatment was low (44.1%). During a median follow-up period of 2.24 months (range, 2-10 months), 11 relapses were seen (recurrence rate, 3.27%). In conclusion, long-pulsed Nd:YAG laser is safe and effective for the removal or reduction of warts and is less dependent on patient compliance than are other treatment options.

Lipedematous Alopecia in an Asian Woman: Is It an Advanced Stage of Lipedematous Scalp?

Lipedematous alopecia (LA) is a rare disease entity that manifests as increased thickness of subcutaneous fatty tissue in the scalp with a variable degree of acquired, non-scarring alopecia. Although the pathogenesis of alopecia in LA is not clear, it is assumed that the increased thickness of subcutaneous fat retards hair growth by disturbing the peripheral microenvironment of the hair bulb. LA is clinically distinguishable from lipedematous scalp (LS) in that LS is not associated with any hair abnormalities, while LA is characterized by variable degree of hair loss. However, both LA and LS share increased scalp thickness. Here, we describe a rare case of LA on the frontal scalp of an Asian woman, further characterize the clinical and histologic features, and suggest applying an integrated diagnosis as lipedematous diseases of the scalp.

Randomized Clinical Trial to Evaluate the Efficacy and Safety of Combination Therapy with Short-Pulsed 1,064-nm Neodymium-Doped Yttrium Aluminium Garnet Laser and Amorolfine Nail Lacquer for Onychomycosis.

BACKGROUND: Onychomycosis is one of the most prevalent fungal diseases in the general population. However, treatment is of limited effectiveness and must be administered for long periods of time. Systemic antifungal agents are associated with adverse effects. OBJECTIVE: We evaluated the clinical efficacy and safety of a 1,064-nm neodymium-doped yttrium aluminium garnet (Nd:YAG) laser with amorolfine nail lacquer to treat onychomycosis. METHODS: The 128 patients were randomly divided to 2 groups: 64 in the experimental group were treated with 1,064-nm Nd:YAG laser therapy and amorolfine nail lacquer; the other 64 were in a control group treated with topical amorolfine lacquer monotherapy. The laser treatment was 4 sessions at 4-week intervals and amorolfine lacquer was applied once a week for 16 weeks. Efficacy was assessed as response rate from standardized photographs with ImagePro®Plus (Media Cybernetics, Inc., USA) analysis, microscopic examination, and subjective evaluation. RESULTS: At 16 weeks, the experimental group showed a significantly higher cumulative cure rate than the control group (71.88% vs. 20.31%, p<0.0001). Clinical therapeutic effects were linked to patient satisfaction. The percent of "very satisfied" or "satisfied" responses was higher in the test group than the control group (81.25% vs. 23.44%). The treatment regimen was well tolerated, with transient discomfort observed in the test group. CONCLUSION: The 1,064-nm Nd:YAG laser with amorolfine nail lacquer was effective and safe for treating onychomycosis. This therapy should be considered an alternative treatment, especially for patients with contraindications to systemic antifungal agents.