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.

Comparison of submillisecond pulse (FRAC3) and long-pulse 1064 nm Nd:YAG laser hair removal.

BACKGROUND: Laser hair reduction gained popularity in the last decade and is presently the most frequently used long-term hair removal method. It works on the principle of selective photothermolysis-the laser damages the hair follicle without damaging the skin. Shorter Nd:YAG pulses are also effective in hair reduction, while maintaining better comfort for the patient. AIMS: The aim of this study was to compare the short and long pulsed methods of Nd:YAG for facial hair removal on darker Fitzpatrick skin types (IV-V). PATIENTS/METHODS: This prospective split face, evaluator-blinded comparison of short-pulse Nd:YAG laser versus long-pulse Nd:YAG laser study included 10 untanned healthy women. There were two outcome measers, two blinded dermatologists compared baseline photographs with those taken 3 months after last session and FotoFinder was used to compare the terminal hair count reduction at the baseline and 3 months after 6th session. RESULTS: Both blinded assesors observed significant hair reduction with both lasers; excellent results were achieved in 20% with long pulse and in 55% with short pulse. Both treatment options showed reduction in number of terminal hair with statistical significance using FotoFinder. Comparison of the efficacy of the two pulse durations measured by percent reduction in the number of terminal hair 3 months after the last session showed no significant difference between the groups. CONCLUSION: Hair reduction using 1064 nm Nd:YAG is a safe and effective method of hair reduction especially in darker skin types. We have shown that short pulses are better or at least equally safe and effective as the "gold standard" long pulses.

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.

Safety of Performing Superficial Chemical Peels in Patients on Oral Isotretinoin for Acne and Acne-Induced Pigmentation.

BACKGROUND: Chemical peels are an integral part of dermatology practice for the treatment of acne, photoaging, and pigmentary dyschromias. Oral isotretinoin is considered the gold standard in the management of acne. Combining both is not currently recommended, due to the increased risk of complications like dryness, erythema, post-inflammatory hyperpigmentation, and scarring. OBJECTIVE: We sought to assess the safety and efficacy of superficial chemical peels in patients with acne taking isotretinoin and those not taking oral isotretinoin. METHODS: A comparative, retrospective analysis of three superficial chemical peels was performed; the analysis included 60 patients and 214 sessions that took place between August 2017 and January 2018. Of these, 47 patients were on oral isotretinoin (Group A) and 13 were not on isotretinoin (Group B). In Group A, a salicylic acid-mandelic acid peel (SMP) was performed on 22 patients, a glycolic acid peel was performed on 18 patients, and a modified Jessner's peel was performed on seven patients. In Group B, an SMP on eight, glycolic acid peel on four, and modified Jessner's peel on one patient(s), respectively, were performed. Complications, if any, were noted, and incidence rates were compared by photographic assessment. RESULTS: One patient in Group A and one patient in Group B had complications (persistent hyperpigmentation). The difference in the incidence of complications was insignificant between the two groups for all three superficial peels. Furthermore, it was noticed that patients in the isotretinoin group experienced faster and better improvement compared to those in the non-isotretinoin group. CONCLUSION: In our study, the use of isotretinoin did not result in any complications; hence, we encourage combination therapy to achieve enhanced and faster resolution of acne.

Overnight Alopecia: A Subtype of Acute Diffuse and Total Alopecia?

Acute diffuse and total alopecia (ADTA) is a variant of alopecia areata which lacks the typical patchy hair loss seen in classical alopecia areata and presents with an acute onset of diffuse hair loss commonly reported in young females with the duration from disease onset to diffuse hair loss ranging from 2 to 20 weeks. Although the clinical features of ADTA resemble telogen effluvium, dermoscopy can prove to be a useful tool for differentiating these two conditions and avoiding unnecessary investigations as specific dermoscopic findings of alopecia areata are invariably present along the disease course. Herein, we report a case of ADTA in a 42-year-old Indian female who presented with sudden onset of diffuse hair loss of only 1-day duration.

Complications of laser and light-based devices therapy in patients with skin of color.

Lasers and light-based devices are indispensable to an aesthetic dermatology practice. The growing popularity of lasers has been matched by a sharp increase in the incidence of complications. The Indian skin with its high melanin content is more prone to injury and careful setting of laser parameters, early detection of complications and immediate therapy are vital to avoiding permanent sequelae. We review the various complications that occur during laser procedures and their management.

Tofacitinib (Selective Janus Kinase Inhibitor 1 and 3): A Promising Therapy for the Treatment of Alopecia Areata: A Case Report of Six Patients.

BACKGROUND: Alopecia areata (AA) is a chronic autoimmune disorder characterized by patchy loss of hair from scalp, beard, eyebrows, or rarely even body hair. Rarely, the disease can be widespread and severe leading to loss of entire scalp and body hair causing apprehension and psychological stress in patients. Management of such cases is equally difficult with the available options of topical and systemic immunosuppressant. Tofacitinib, JAK3 inhibitor, is emerging as a promising drug for the management of severe and resistant cases of AA/totalis/universalis. OBJECTIVE: Our study aims to show the effectiveness of oral tofacitinib in the treatment of alopecia universalis (AU). METHODS: Six patients diagnosed with AU/alopecia totalis duration of disease 6 months-15 years refractory to other treatments were selected and were started on oral tofacitinib 5 mg twice daily up to 10 mg BID and were followed up every 4 weeks. The efficacy was measured by hair regrowth using photographic assessment, Severity of Alopecia Tool score, and physical examination. Patients will be followed up for 6 months after stopping treatment for assessing disease relapse. RESULTS: All our six patients showed dramatic response to oral tofacitinib. Patients were followed up every 4 weeks, and results were assessed. Significant hair regrowth was evident in all the patients by the end of 12 weeks. Currently, four of our patients are on oral tofacitinib 10 mg BID and are under follow-up. There was no relapse in one patient after stopping drug for 4 months. Another patient started developed AA patches in the eyebrows within 2 months of stopping tofacitinib. Acneiform eruptions were seen in two patients which were managed with topicals. CONCLUSION: In our patients, tofacitinib successfully alleviated AU in the absence of significant adverse side effects. We recommend that further controlled studies be required to establish safety and confirm efficacy.

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.