Comparison of Safety and Efficacy of Two Brands of Botulinum Toxin A for the Treatment of Lateral Canthal Lines (Crow's Feet): A Split-Face Study.

Aim: To compare the safety and efficacy of Stunnox with the international brand of botulinum toxin A on lateral canthal lines. Materials and Methods: This was a nonrandomized, controlled, pilot, split-face study in 47 patients who were given two brands of Botulinum toxin A for the treatment of lateral canthal lines for 12 weeks. Evaluation of lines was assessed with grades of 0 (none), 1 (mild), 2 (moderate), and 3 (severe) at a maximum smile and rest by using ANTERA 3D camera. Results: There was a statistical significance in lateral canthal lines wrinkles reduction on the Stunnox sides compared to pretreatment and at weeks 4, 8, and 12, respectively (all P < 0.05). The wrinkle reduction was similar to the effects of the control internationally available brand of botulinum toxin A. The clinical improvement of lateral canthal line wrinkles was greatest at 4 weeks after injection and the improvement lasted until 12 weeks of treatment with no adverse events observed. Conclusion: In this split-face study, Stunnox botulinum toxin A showed a moderate but significant wrinkle-soothing effect without obvious side effects on the lateral canthal.

Role of Cyclosporine (CsA) in Immuno-dermatological Conditions.

Cyclosporine (CsA) is a calcineurin inhibitor that acts selectively on T cells. It has been used in dermatology since 1997 for its US Food and Drug Administration indication of psoriasis and off-label for various other inflammatory skin conditions, including atopic dermatitis, alopecia areata, urticaria, lichen planus and many others in pediatric, adults as well as in pregnant women. However, clinicians' preferences for management differ, which may have a bearing on the treatment selection. Hence, the purpose of this review is to outline the role of CsA in various skin conditions through consensus statement from six national experts in the field of dermatology.

The Role of Chemoimmobilization in Improving the Outcome of Scar Revision Surgery.

Background: The major goal of scar revision is to make the scar aesthetically more acceptable. The injection of botulinum toxin type A is known to help in improving the outcomes of scars by reducing the tension across the wound edges and by promoting better wound healing. Objective: The aim of this article is to evaluate the efficacy of botulinum toxin injection following scar revision surgeries. Materials and Methods: A prospective, comparative study involving 20 patients with post-traumatic scars over the face was conducted between July 2018 and July 2019. The patients were divided into two groups: group A underwent scar revision surgery followed by BTX injection on the day of suture removal and group B underwent scar revision surgery alone. The photographic assessment was done at the end of a 1-year follow-up, by three blind investigators based on a pre-designed scale to grade improvement. Results: The average grade of improvement of group A (3.02±1.1) was significantly higher when compared with that of group B (2.1±0.8) (P = 0.001). Conclusion: This study demonstrates that the combination treatment of scar revision with BTX injection is very effective in producing aesthetically better scars.

Surgical approach in the management of ear keloids: our experience with 30 patients.

BACKGROUND: Ear keloids are benign, fibrous proliferations due to excessive collagen synthesis and deposition. It is a popular practice to pierce earlobes for decorative earrings and adornment; this might trigger the keloid process. Although there are varied treatment modalities, it is unsatisfactory and has always been a challenge. The aim is to evaluate the efficacy of surgical treatment with intralesional therapy in auricular keloids. METHODS: We included 30 patients with 45 keloids over the ear. Patients were evaluated (including detailed history, complete physical and local examination), and photographs and written informed consent were taken. They were treated with: excision and closure, intralesional and/or surface cryotherapy, ablative laser, intralesional steroids, and 5-fluorouracil. Excision and closure, and intralesional cryotherapy were done under local anesthesia. Closure was done after intramarginal excision with or without raising auto flaps, followed by intraoperative intralesional steroids to margins. Recurrence was assessed at 3 weeks, 3 months, 6 months, and 1 year. RESULTS: The age group of patients ranged from 14 to 57 years. A total of 32 out of 45 (71.1%) keloids were excised and were combined with intraoperative and postoperative intralesional steroid injection, with sessions depending on the patient's response. Eight (17.7%) and five (11.1%) keloids were treated using intralesional cryotherapy and only intralesional steroids, respectively. A total of 16.6% of patients had recurrence with one patient having recurrence of bilateral earlobes keloid. CONCLUSION: Keloidectomy with intraoperative and postoperative intralesional steroid injections has been very effective in the treatment of ear keloids. Different treatment modalities act synergistically, but excision surgery gives good results as it aims at maintaining ear architecture.

Water lily in a subcutaneous plane - preventing complications of unplanned excision.

Human cysticercosis is caused by the larval form of Taenia solium (T. solium) and is a condition more commonly seen in tropical countries. The infestation can present with varied symptoms depending upon the site of infection, e.g. intramuscular, subcutaneous, intracerebral, or elsewhere. Diagnosing cysticercosis, although fairly easy, becomes challenging in unusual cases. Unplanned excisions can lead to catastrophic complications.

Follicular occlusion tetrad.

Follicular occlusion tetrad is a symptom complex consisting of four conditions having a similar pathophysiology. It includes Hidradenitis suppurativa, acne conglobata, dissecting cellulitis of the scalp and pilonidal sinus. The exact pathogenesis of this group of disease is unknown but evidence suggests that they share the same pathological process initiated by follicular occlusion in apocrine gland bearing areas. Though each of these conditions is commonly encountered singly, follicular occlusion tetrad as a symptom complex has been rarely reported in the literature.

Safety of performing invasive acne scar treatment and laser hair removal in patients on oral isotretinoin: a retrospective study of 110 patients.

BACKGROUND: It is reported that patients on oral isotretinoin have greater risk of developing scars and delayed wound healing with invasive procedures. It is recommended that these procedures be resumed 6-12 months after the last dose of oral isotretinoin. AIM: To assess and compare the safety and look for delayed wound healing, during invasive acne scar treatment and laser hair removal on (a) patients who were on oral isotretinoin, and (b) patients who were not on oral isotretinoin. METHODS: A comparative, retrospective study of 110 patients was done. Fifty-five patients with either acne scars or hirsutism who underwent procedures while on oral isotretinoin, and 55 patients who were not on oral isotretinoin were selected and grouped into A and B respectively. Group A patients were on 0.5 mg/kg/day isotretinoin orally through the entire procedure duration, while group B patients received topical medications alone. The subjects from both groups underwent invasive acne scar treatment and laser hair removal. Clinical and photographic assessment was done at baseline followed by four sessions with an interval of six weeks between each. RESULTS: Isotretinoin had not resulted in any untoward effects in patients who underwent the procedures. Atypical scarring, delayed wound healing, keloids, or hypertrophic scars were not observed in any patient. CONCLUSION: Isotretinoin does not appear to delay wound healing, and hence invasive procedures can be considered on patients on oral isotretinoin without any compromise on the outcome.