Pilot Study Examining the Safety and Efficacy of Calcium Hydroxylapatite Filler With Integral Lidocaine Over a 12-Month Period to Correct Temporal Fossa Volume Loss.

BACKGROUND: Age-related volume loss in the temporal fossae is due to thinning of the epidermis, loss of subcutaneous structural volume, and change in the bony architecture. Temporal concavities are important areas of 3-dimensional volume restoration. The temporal fossae is becoming an increasingly popular area for patients seeking soft tissue augmentation with injectable fillers such as calcium hydroxylapatite with integral lidocaine [CaHA (+)]. OBJECTIVE: This pilot study aims to define the safety, efficacy, technique, and patient-reported outcomes for injectable CaHA (+) to correct volume loss in the temporal fossae over a 12-month period. MATERIALS AND METHODS: This was a single-investigator, nonblinded study involving 20 participants. Participants received filler injection into their temporal fossae, with follow-up evaluations at Day 14, 6 weeks, and 3, 6, 9, and 12 months. RESULTS: CaHA (+) results in statistically significant improvement in temporal fossae appearance lasting up to 12 months. Subjects reported "moderate" global aesthetic improvement over the 12-month period. CONCLUSION: As the cosmetic field continues to advance, it is important for practitioners to have access to research regarding the efficacy and safety of injectables. These results show that CaHA (+) is an effective and safe option to correct temporal fossae volume loss associated with high patient satisfaction.

The Kinetics of Reversible Hyaluronic Acid Filler Injection Treated With Hyaluronidase.

BACKGROUND: Hyaluronidase is an enzyme capable of dissolution of hyaluronic acid (HA). There is a lack of evidence-based research defining time- and concentration-dependent reversal of HA filler using hyaluronidase. OBJECTIVE: To explore the efficacy of different concentrations of hyaluronidase in digesting commercially available HA-based reversible fillers-Belotero Balance (BEL), Juvederm Ultra XC (JUVXC), Juvederm Ultra Plus (JUVX+), Juvederm Voluma XC (JUVV), Restylane-L (RESL), Restylane Silk (RESS), and Perlane/Restylane Lyft (RESLYFT). MATERIALS AND METHODS: This was a blinded randomized study involving 15 participants. Participants received HA filler injection into their back, followed by no secondary injection, or injection with normal saline, 20 or 40 units of hyaluronidase. Using a 5-point palpation scale, the degradation of HA filler was monitored over 14 days. RESULTS: In the authors' study, there is a significant decrease in HA filler degradation using 20 and 40 units of hyaluronidase compared with no secondary injection or normal saline. There is no significant difference in HA filler dissolution when comparing 20 to 40 units of hyaluronidase. CONCLUSION: Lower concentrations of hyaluronidase may be just as effective as higher concentrations to degrade HA filler in situations where the reversal of cutaneous augmentation with HA filler arises.

The Two Faces of Fractionated Photodynamic Therapy: Increasing Efficacy With Light Fractionation or Adjuvant Use of Fractional Laser Technology.

"Fractionated photodynamic therapy (PDT)" is a new term being used by dermatologists to describe advances in PDT technology including fractionated light or the adjuvant use of fractional lasers. Although dermatologists have used PDT since the early 1990s for the treatment of photodamage and precancerous lesions, newer developments in technology have allowed for the treatment of non-melanoma skin cancers (NMSCs), in ammatory disorders, and even uses in the eld of anti-aging. Recent developments in fractionated light therapy have allowed for PDT with dark intervals and two-fold illumination schemes to increase cellular damage and apoptosis. Combining PDT with fractional laser technology has allowed for enhanced dermal penetration of topical photosensitizers including 5-aminolevulinic acid (ALA) and methyl aminolevulinate (MAL), as well as increased ef cacy of treatment. These advances in PDT technology will allow for increased convenience, decreased treatment time, only one application of topical photosensitizer, and decreased cost to the patient and dermatologist. J Drugs Dermatol. 2016;15(11):1324-1328..

Identifying and characterizing basal cell carcinomas in persons with albinism.

BACKGROUND: Historically, persons with albinism (PWA) were thought to develop squamous cell carcinoma (SCC) more frequently than basal cell carcinoma (BCC). Recent evidence suggests BCCs in PWA are more common than initially hypothesized. OBJECTIVE: To characterize the presentation of BCC in PWA. METHODS: Fifty-four PWA with lesions suspicious for non-melanoma skin cancer sought care at Tanzanian dermatologic clinics from 2017 to 2019. Demographic and clinical presentation data were recorded. Histologic analysis of each sample was completed. RESULTS: The majority of PWA were female (53.7%), with a mean age of 34.6 ± 14.9 years and a mean duration of disease of 0.70 ± 0.73 years. Physician description of histologically proven BCC included ulceration (41.7%), erythema (16.7%), and scale (16.7%). Lesions were most commonly located on the trunk (47.1%) and face (41.2%). Histologic analysis demonstrated 30.2% of lesions were BCC, 26.4% SCC, and 17% Bowen's disease. LIMITATIONS: Patient population was limited to those visiting clinics, and data were limited by accuracy of the medical record. CONCLUSIONS: Basal cell carcinoma occurs at a higher rate than SCC in our population, suggesting BCC in PWA is underdiagnosed. It is important to recognize BCC early in PWA to avoid large disease burden and high rates of morbidity and mortality.

The role of systemic treatments for skin lightening.

BACKGROUND: Pigmentation of the skin occurs as a result of increased melanin production or deposition due to various reasons including age, hormonal imbalances, endocrine disease, inflammation, and/or exposure to damaging radiation, resulting in dermatologic conditions such as lentigines, melasma, or postinflammatory hyperpigmentation. Although numerous topical therapies exist for skin lightening, they are limited by efficacy and pigmentation recurrence after treatment cessation. New research into systemic therapies for hyperpigmentation has been promising. OBJECTIVE: To summarize the current literature for systemic skin lightening therapies. METHODS: A review of the literature surrounding systemic skin lightening therapies was completed using PubMed (US National Library of Medicine). RESULTS: Multiple systemic therapies for skin lightening exist including oral carotenoids, glutathione, melatonin, Polypodium leucotomos hydrophilic extract, procyanidin, and tranexamic acid. Preliminary data for the treatment of hyperpigmentation are promising, and currently, these oral treatments appear safe. It is not suggested to use intravenous glutathione for skin lightening due to the increased risk of adverse events. CONCLUSION: With the patient population seeking effective systemic treatments for skin pigmentation, it is important for dermatologists to understand the properties, the efficacy, and the adverse events profile of each compound, thus ensuring proper use by patients, and that patients are appropriately counseled regarding treatment expectation and safety.

The use of natural ingredients in innovative Korean cosmeceuticals.

BACKGROUND: The cosmeceutical industry is an ever-growing and in demand market, especially in Asia. Korea has been on the forefront of creating the newest generation and most innovative cosmeceuticals products including ingredients such as snail secretions, starfish powder, botanical extracts, green tea, and red ginseng. Given their increasing prevalence in the cosmeceutical industry, scientists have been conducting investigations into these extracts and their properties. OBJECTIVE: To summarize the current literature surrounding multiple natural ingredients found in Korean cosmeceutical products. METHODS: A review of the literature surrounding natural ingredients found in Korean cosmeceuticals was conducted using PubMed (U.S. National Library of Medicine). RESULTS: Multiple natural extracts have been found to have antiaging, antitumor, and antimelanogenic effects making them useful additives in current cosmeceutical products. CONCLUSION: With the public's increasing awareness of cosmeceutical products, it is important for physicians to understand the properties of these extracts in order to inform patients correctly and ensure patient safety.

A review of available laser and intense light source home devices: A dermatologist's perspective.

BACKGROUND: Home optical devices are becoming an increasingly popular treatment modality sought out by patients for dermatologic pathologies such as acne, hair removal and anti-aging, as these devices are a low-cost and convenient therapy choice. METHODS: An Internet search using PubMed.gov was completed with search terms, "home device dermatology," "home device acne," "home device hair" or "hair removal," and "home device aging." RESULTS: Currently, there are multiple home optical devices available on the market. These devices have been approved for the treatment of acne, scars, hair removal, and wrinkles using intense pulsed light, light-emitting diode, heat, infrared, low-level light therapy, and laser. Although studies on home devices are limited, current dermatologic literature shows that these devices are promising with significant post-treatment results as well as a high level of safety. CONCLUSIONS: Home optical devices are mostly used without medical practitioner supervision. As home devices usually deliver less energy per session than with professional treatments, it is important that consumers are given realistic expectations of post-treatment outcomes. Patients may use home devices without disclosure to their physician and it is important as healthcare professionals to be aware of the existence of these devices, how to use the devices properly (including what diseases can be treated and which skin types are considered safe for use), as well as any adverse effects that may occur. New research endeavors are being completed to explore the used of home devices for the treatment of chronic inflammatory diseases such as psoriasis.