Low-dose isotretinoin for the management of rosacea: A systematic review and meta-analysis.

BACKGROUND: Rosacea is a chronic, relapsing inflammatory dermatosis predominantly affecting the central face and can result in significant psychosocial impacts. Isotretinoin has been studied for rosacea due to its anti-inflammatory and sebum reduction properties, but its use remains limited likely due to its off-label use and potential adverse events. OBJECTIVE: This systematic review and meta-analysis investigated the efficacy and safety of low-dose isotretinoin (LDI; ≤0.5 mg/kg/day) for the four main types of rosacea: erythematotelangiectatic, papulopustular, phymatous and ocular rosacea. METHODS: Randomized and non-randomized studies evaluating LDI for rosacea were included. Incomplete studies, non-English studies and case reports were excluded. Study quality was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation scale. RESULTS: Of 435 studies, and 16 studies involving 1445 patients were included. LDI decreased lesion count (p = 0.03) and erythema (p = 0.01) with large effect [standardized mean difference (SMD) > 0.8]. Compared to topical retinoids and topical antimicrobials, isotretinoin had larger reductions in lesion count (p = 0.03) with moderate effect (SMD > 0.5). Mean lesion count and erythema remained reduced by 70% and 47%, respectively, at 16 weeks after LDI cessation. Relapse rate was 35% at 5.5 months post-isotretinoin, and three patients (0.4%) experienced worsening of rosacea. Three patients (0.4%) experienced serious adverse events. CONCLUSIONS: Study design heterogeneity limited more comprehensive comparisons. Overall, low-dose isotretinoin may serve as an effective treatment for rosacea with good tolerability and safety.

Clinical Impacts of Omalizumab on the Psychiatric Comorbidities of Chronic Spontaneous Urticaria: A Systematic Review and Meta-Analysis.

Individuals with chronic spontaneous urticaria (CSU) experience significant sleep disturbances and are at risk of anxiety and depression.

Microneedling as an adjuvant to topical therapies for melasma: A systematic review and meta-analysis.

BACKGROUND: Microneedling as an adjuvant to topical medications has shown promising but variable results in the treatment of melasma. OBJECTIVE: To conduct a systematic review and meta-analysis on the efficacy of microneedling as an adjuvant to topical therapies for the treatment of melasma. METHODS: This study followed PRISMA guidelines. All comparative, prospective studies on the use of topical interventions with microneedling for the treatment of melasma were included. Studies involving radiofrequency microneedling were excluded. RESULTS: Twelve eligible studies comprising 459 patients from 7 different countries were included. Topical therapies included topical tranexamic acid, vitamin C, platelet-rich plasma, non-hydroquinone-based depigmentation serums, and hydroquinone-based depigmenting agents. Topical therapy with microneedling improved melasma severity with a large effect (standardized mean difference >0.8) beyond 8 weeks, with best results seen at 12 weeks. Compared to topical therapy alone, topical therapy with microneedling resulted in an additional improvement in melasma severity with a moderate effect at 8 weeks and a large effect at 12-16 weeks. Microneedling was well tolerated across studies, with no serious adverse events reported. LIMITATIONS: Heterogeneity in study designs did not allow for a comparison of the efficacy of various topical therapies with microneedling. CONCLUSION: Microneedling is useful adjuvant to topical therapies for the treatment of melasma.

Radiofrequency Microneedling: A Comprehensive and Critical Review.

BACKGROUND: Many studies have evaluated radiofrequency microneedling (RFMN) in various dermatologic conditions. However, the efficacy and safety of RFMN, and how it compares with other energy-based devices in a clinician's armamentarium, remains unclear. OBJECTIVE: To review higher-quality evidence supporting RFMN and the dermatologic conditions which it can be used in. MATERIALS AND METHODS: A search was conducted in MEDLINE and EMBASE from inception to May 13, 2020, using the terms: "radiofrequency microneedling" OR "fractional radiofrequency" OR "radiofrequency needling" OR "radiofrequency percutaneous collagen induction." Only randomized, split body or blinded studies with original data on humans were included. Non-English or non-dermatology-related studies were excluded. RESULTS: Forty-two higher-quality studies were included after applying the inclusion and exclusion criteria. There were 14 studies for skin rejuvenation, 7 for acne scars, 6 for acne vulgaris, 5 each for striae and axillary hyperhidrosis, 2 for melasma, and 1 each for rosacea, cellulite, and androgenetic alopecia. CONCLUSION: Radiofrequency microneedling is an effective intervention that can be used repeatedly and safely in combination with other treatment modalities and in individuals with darker skin phototypes. Radiofrequency microneedling-induced dermal remodeling and neocollagenesis are slow and progressive but continue to improve even 6 months after treatment.

A cost-effectiveness analysis of DIEP vs free MS-TRAM flap for microsurgical breast reconstruction.

BACKGROUND AND OBJECTIVES: The deep inferior epigastric perforator (DIEP) flap may be associated with less long-term donor-site morbidity compared with free muscle-sparing transverse rectus abdominis myocutaneous flap (MS-TRAM) flap. However, DIEP flaps may have longer operative time and higher rates of acute postoperative complications. We performed a cost-effectiveness analysis (CEA) that compared the long-term costs and patient-reported outcomes between the two flaps. METHODS: A retrospective cohort of women who received free MS-TRAM or DIEP flap reconstruction between January 2008 and December 2012, with a minimum of 2-year follow-up, were recruited. Cost data of the primary reconstruction and any subsequent hospitalization due to complications from the reconstruction within 2 years were obtained. Each patient received a BREAST-Q questionnaire at 2 years post-reconstruction. RESULTS: In total, 227 patients (180 DIEP, 47 free MS-TRAM) were included. DIEP patients had significantly fewer abdominal hernia (P = 0.04). The adjusted-incremental cost-effectiveness ratios found that DIEP flap was more cost-effective to free MS-TRAM flap in the domains of "Physical Well-Being of the Abdomen" and "Satisfaction with Outcome." CONCLUSIONS: DIEP flap is the more cost-effective method of autologous breast reconstruction in the long-term compared with free MS-TRAM flap with respect to patient-reported abdominal well-being and overall satisfaction with the outcome.

Proceeding report of the Symposium on Hidradenitis Suppurativa Advances (SHSA).

Hidradenitis Suppurativa (HS) is a chronic debilitating skin condition that impairs the productivity and the quality of patients` lives. HS has recently drawn lots of attention among scholars to further expand their knowledge but it still loads with uncertainties and gaps to be explored. This publication addresses these uncertainties, and provides a road-map for researchers, scholars and clinicians from different disciplines for their future studies about HS. This is a proceeding report of the first Symposium on Hidradenitis Suppurativa Advances (SHSA), and it reviews the scientific sessions about the epidemiology, pathophysiology, presentations, and management of HS. This symposium was a great opportunity for experts in the HS field to exchange their knowledge, and improve their mutual understanding of this disease.

Parental use of sun protection for their children-does skin color matter?

BACKGROUND/OBJECTIVES: Excessive sun exposure during childhood is a risk factor for skin cancer. This study aimed to compare the frequency of ideal sun protection use between parents with lighter- and darker-skinned children and explore their attitudes and beliefs on sun safety and their choice of sun protection. METHODS: Parents of children aged 6 months to 6 years completed self-administered questionnaires about sun protection practices for their children. Parents assessed their child's Fitzpatrick phototype and were divided into lighter- (Fitzpatrick phototype I-III) and darker-skinned (Fitzpatrick phototype IV-VI) groups. Sun safety guidelines from the Canadian Dermatology Association were used to qualify ideal sun protection. RESULTS: A total of 183 parents were included. Overall, 31 parents (17%) used ideal sun protection for their children. As their children grew older, parents were less likely to use ideal sun protection (odds ratio = 0.69, 95% confidence interval = 0.53-0.90). Parents in the lighter-skinned group were more likely to use ideal sun protection for their children (odds ratio = 7.4, 95% confidence interval = 2.7-20.1), believe that sun exposure was harmful (odds ratio = 17.2, 95% confidence interval = 4.0-74.9), and perceive value in sun protection (odds ratio = 11.4, 95% confidence interval = 3.3-39.0); the darker-skinned group believed that darker skin tones provided more sun protection (odds ratio = 12.4, 95% confidence interval = 6.1-25.4). CONCLUSION: Ideal parental sun protection efforts are overall low, particularly in parents of darker-skinned children. The identified attitudes toward and beliefs about sun safety may aid in delivery of future sun protection interventions, especially in multiracial populations.

Acitretin.

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic, recurrent inflammatory disease of the pilosebaceous follicle that severely affects patients' quality of life and can be challenging for clinicians to manage. A few case series have reported on the efficacy of acitretin monotherapy in the treatment of intractable HS. OBJECTIVE: To assess the efficacy of acitretin for the treatment of intractable HS. METHODS: A retrospective review was conducted involving all patients with HS who received acitretin between January 2011 and January 2015 in a tertiary academic medical center. All patients with HS who received acitretin, either as a monotherapy or as an adjuvant to other systemic medications, were included, and clinical response was assessed using the physician global scale. RESULTS: Fourteen patients with HS (mean age 48 years [range 32-64 years]; 9 [64%] were men) received acitretin. Most patients (86%) had Hurley stage II or III disease. All patients had failed other standard systemic medications prior to initiating acitretin. Six patients (43%) received acitretin monotherapy, and 8 patients (57%) received acitretin as an adjuvant to other standard systemic medications. None of the patients who received acitretin monotherapy exhibited clinical improvements. Clinical improvements were observed in 7 of the 8 (87.5%) patients who received acitretin as an adjuvant to other systemic medications, with 3 patients (37.5%) exhibiting partial response and 4 patients (50%) exhibiting good response. CONCLUSIONS AND RELEVANCE: Acitretin monotherapy was ineffective for the treatment of intractable HS. Acitretin may be effective when used as an adjuvant to other systemic medications.