Reconstruction of Macrocheilia on the Lower Lip Through Bilateral Limited Excision and a Stepwise Single-Stage Approach (BLESS).

BACKGROUND: The surgical management of macrocheilia secondary to port-wine stains is complicated. OBJECTIVE: This study aimed to propose an innovative method for treating macrocheilia on the lower lip. METHODS: Patients who underwent the reconstruction of macrocheilia on the lower lip through the innovative approach were examined. Their preoperative and postoperative standard photographs were taken to evaluate the changes in lip length and thickness. The scores on Vancouver scar scale (VSS) and visual analog scale (VAS) were evaluated. RESULTS: Thirty-two patients who underwent the reconstruction of macrocheilia were examined. A follow-up of 12.2 months (6-36 months) was conducted. The lower lip contour and the mentolabial groove were reconstructed to normal appearance. The lip length was shortened from 5.38 ± 0.49 cm pretreatment to 4.59 ± 0.30 cm posttreatment (p = .016). The exposed vermilion was shortened from 2.05 ± 0.48 cm to 1.26 ± 0.12 cm posttreatment (p < .01). The mean VSS and VAS scores were 2.2 ± 1.5 and 8.4 ± 1.3, respectively. CONCLUSION: The bilateral limited excision and stepwise single-stage approach were safe and effective for reconstructing prominent macrocheilia on the lower lip. The technique was also easy to command for the beginners.

Comparison of the safety and efficacy of low fluence Q-switched 1064-nm and conventional Q-Switched 755-nm lasers in the treatment of café-au-lait macules: A prospective self-controlled trial.

BACKGROUND: Conventional high fluence Q-switched (HFQS) Alexandrite 755-nm are widely used in clinical café-au-lait macules (CALMs) treatment. There have been recent concerns regarding the efficacy and safety of low fluence Q-switched (LFQS) Nd: YAG 1064-nm lasers. OBJECTIVE: To evaluate the efficacy and safety of the conventional HFQS and LFQS laser in the treatment of CALMs. METHODS: Within 3 months, 20 patients underwent prospective self-controlled split-lesion treatments with HFQS once or twice depending on the recovery rate, and with LFQS six times biweekly. Then the more effective laser was selected for continued treatments. Efficacy outcomes were evaluated by a visual analog scale (VAS) biweekly during the comparative trail. Recovery process, side effects and recurrence were recorded during the trial and follow-up visit. Patient and physician preferences for laser selection were also recorded. RESULTS: The average VAS scores of areas treated with HFQS and LFQS were 2.92 ± 0.86 and 2.93 ± 1.13, respectively (p > 0.05). The most significant efficacy change of LFQS was after the fourth laser treatment (VAS score: 1.82-2.37, p < 0.001). 11 lesions treated with LFQS and 7 with HFQS achieved an optimal treatment response (3.67 ≤ VAS ≤ 4). Three patients relapsed on one side (one on LFQS, two on HFQS) and five on both sides. Adverse effects included temporary hypopigmentation, hyperpigmentation, uneven pigmentation, and mottled hypopigmentation. Doctors thought 80% of patients were suitable for LFQS. 70% of patients preferred LFQS posttreatment. CONCLUSIONS: The efficacy difference between the LFQS 1064-nm laser and HFQS 755-nm laser in treating CALMs in a 3-month comparative trial was statistically insignificant. LFQS is preferred by doctors and patients and is likely to help more patients achieve treatment efficacy than the HFQS within a short time, with fewer temporary adverse reactions, and a more even pigmentation. But it can cause mottled hypopigmentation. The LFQS had obvious lesion clearance after the fourth treatment.

Can 595-nm Pulsed Dye Laser in Conjunction With an Optical Clearing Agent Improve the Treatment of Port-Wine Stains?

BACKGROUND: Studies have demonstrated that glycerol can act as an optical clearing agent (OCA) to increase the light penetration through the skin and laser deposition to the target chromophore, thus potentially increasing the efficacy of laser treatment. OBJECTIVE: To evaluate whether a pulsed dye laser (PDL) in combination with an OCA can increase the efficacy in treating port-wine stains (PWSs). METHODS: Thirteen patients with untreated PWSs underwent 3 treatment sessions at 6-week intervals. Each PWS was divided into OCA + PDL sites (PDL treatment after topical use of 0.5 mL hydrous glycerol for 5 minutes), PDL sites, and untreated sites. The chromametric evaluation and visual evaluation (VAS) of the efficacy and the assessment of side effects were conducted 3 months after the final treatment. RESULTS: Visual evaluation was 2.69 versus 2.07 (p = .025) and 3.38 versus 3.07 (p = .04) for OCA + PDL and PDL-only sites after the first and second sessions. After the third session, the chromameter and VAS indicated no significant difference between the 2 sites. Permanent side effects were not observed. CONCLUSION: Greater efficacy was observed after the first 2 treatments on the OCA + PDL sites. Although after multiple sessions, the OCA + PDL treatment did not improve efficacy over just PDL alone.

Effectiveness and safety of nonablative fractional laser and infrared bipolar radiofrequency for treating periorbital wrinkles.

Non-ablative fractional laser (NAFL) and radiofrequency (RF) are popular for treating periorbital wrinkles owing to short downtime and low risk of side effects. To compare the effectiveness and safety of infrared bipolar radiofrequency (IR-RF) and NAFL, including 1540 nm Er: glass and 1927 nm thulium-doped laser, to determine the better option for clinical treatment of periorbital wrinkles. Twenty-seven patients assigned to 3 groups underwent split-face treatment. Two of the three treatments were randomly selected for patients in each group: IR-RF, 1540 nm Er: glass NAFL, and 1927 nm thulium-doped NAFL. Therapeutic outcomes were subjectively and objectively evaluated six months after the last treatment. Side effects and pain evaluations were conducted. Fitzpatrick wrinkle scores revealed no statistical difference for IR-RF, whereas the NAFL-treated sides exhibited significant improvements (p < .05). VISIA analysis of skin texture showed similar results. In IR-RF-treated sides, patients over 50 years old exhibited significant improvements compared with those below 50 (p < .05). The sample size was small. More objective evaluations like photometer measurements are required. NAFL is effective and safe for improving periorbital wrinkles, but IR-RF might be more suitable for elderly patients, particularly those with low pain tolerance.

Three-Year Results of Facial Photoaging in Asian Patients After Alexandrite 755 nm Picosecond Laser With Diffractive Lens Array: A Split-Face, Single-Blinded, Randomized Controlled Comparison.

BACKGROUND AND OBJECTIVE: The long-term efficacy of a picosecond alexandrite laser (PSAL) with a diffractive lens array (DLA) for the treatment of photoaging is absent. To observe the long-term efficacy of PSAL for the treatment of photoaging. STUDY DESIGN/MATERIALS AND METHODS: Each patient (n = 10) received 10 treatments at 2-week intervals. One side of the face was randomly selected for treatment. At 1, 3, 6, and 36 months after the final treatment, two blinded physicians evaluated photographs with four clinical indicators of photoaging (dyschromia, skin texture, skin laxity, and rhytids). A quartile scale was used. RESULTS: At baseline, there were no significant differences in dyschromia, skin texture, facial laxity, or rhytids between the treated and control sides (P > 0.05). Picosecond laser-treated side showed 0.85 and 1.05 (both P < 0.05) better for dyschromia at 3- and 6-month follow-up, and 0.6 (P < 0.05) better for skin texture at 6-month follow-up. At 36-month follow-up, the degree of photoaging is intensified on the control side while the rejuvenation efficacy maintained on the treated side, with 1.4, 0.75, and 0.8 (all P < 0.05) better for dyschromia, skin texture, and rhytids relative to the control side measures. CONCLUSION: Our results demonstrate the long-term efficacy and safety of PSAL with DLA for the treatment of facial photoaging. LIMITATION: Small sample size and the lack of objective evaluation. Lasers Surg. Med. © 2021 Wiley Periodicals LLC.

Comparative Effectiveness of 755-nm Picosecond Laser, 755- and 532-nm Nanosecond Lasers for Treatment of Café-au-Lait Macules (CALMs): A Randomized, Split-Lesion Clinical Trial.

BACKGROUND AND OBJECTIVES: Many types of lasers have been used to treat café-au-lait macules (CALMs) since the introduction of the selective photothermolysis theory. However, the efficacy and safety of picosecond lasers, compared with those of nanosecond lasers, have not been researched. To compare the efficacy and safety of 755 nm picosecond laser (PS-755 nm), Q-switched (QS) Alexandrite 755 nm nanosecond laser (QS-755 nm), and QS Nd:YAG 532 nm nanosecond laser (QS-532 nm) for treating CALMs. STUDY DESIGN/MATERIALS AND METHODS: Forty-one patients received several treatments at 3-month intervals. Lesions were divided into two or three approximately equal parts, which were randomly treated with PS-755 nm, QS-755 nm, and QS-532 nm. The safety and efficacy of three lasers were determined based on blinded visual assessments and self-reports of patients three months after the comparative trial. RESULTS: Visual assessment 3 months after the comparative trial revealed that there was no statistically significant difference among the sites treated by QS-755 nm (2.84 ± 1.11), QS-532 nm (2.63 ± 1.06), and PS-755 nm (2.74 ± 1.05) lasers. Five (26.32%) of 19 patients showed lesion recurrence. Adverse effects included acneiform miliaris, hypopigmentation, and hyperpigmentation, which were resolved within 12 months. Five (26.32%) of 19 patients who showed lesion recurrence 1-5 months after laser treatment had lightened or cleared at least 50% of the lesion. 46.67% of patients were satisfied or very satisfied with the outcome of the overall treatment. CONCLUSIONS: PS-755 nm, QS-755 nm, and QS-532 nm laser treatments were equally effective in treating and improving CALMs. PS-755 nm caused fewer adverse effects. Individuals can react differently to different types of lasers. Patch tests should be conducted before the treatment. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

Combination Therapy of Pulsed Dye Laser With Intense Pulsed Light in Port-Wine Stain Treatment: A Prospective Side-by-Side Comparison.

BACKGROUND: Pulsed dye laser (PDL) treatment currently represents the mainstream choice for port-wine stain (PWS) treatment in accordance with selective photothermolysis. However, most PWS lesions cannot be removed despite several treatments. Intense pulsed light (IPL) is reportedly an effective alternative to PDL for PWS treatment. No studies have thus far been reported on the combination therapy of PDL with IPL in PWS treatment. OBJECTIVE: This study evaluated the efficacy and safety of PDL with IPL for PWS treatment. METHODS: A total of 33 PWS lesions underwent 3 treatment sessions. Each PWS was divided into IPL + PDL, PDL, and untreated sites. Therapeutic outcomes were evaluated by visual assessment and chromametric assessment 3 months after the final treatment. RESULTS: The overall average blanching rates were 36.2% and 32.6% at the sites treated with IPL + PDL and PDL, respectively (p > .05). No permanent side effects were reported. CONCLUSION: In this laser setting, although IPL + PDL is a safe and effective PWS treatment, no significant improvement in the efficacy was observed using IPL + PDL in contrast to PDL alone.

Treatment of Congenital Melanocytic Nevi in the Eyelid and Periorbital Region With Ablative Lasers.

BACKGROUND: Congenital melanocytic nevi (CMN) that occur on the eyelid and periorbital region cause cosmetic disfiguring. Laser treatment has aroused interest as an alternative treatment method, and resurfacing lasers have shown promising results. OBJECTIVE: This study aimed to evaluate the efficacy and safety of carbon dioxide laser and erbium:yttrium aluminum garnet laser to treat CMN of the eyelid and periorbital region. METHODS AND MATERIALS: Twenty patients with CMN were included in this study and were treated with either the CO2 or erbium:yttrium aluminum garnet laser. Clinical efficacy outcomes were evaluated by visual assessment and L*a*b* color space evaluation at least 6 months after treatment. RESULTS: The average (SD) visual evaluation improvement, assessed on a 5-point scale, was 2.8 (1.27). The mean (SD) values of the relative L* improvement rate and blanching rate of the CMN lesion were 32.0% (47.9%) and 34.1% (36.2%), respectively. Spearman rank correlation coefficient between the objective and subjective evaluations was significant (P < 0.001). Three cases developed partial hypopigmentation. No patient developed hypertrophic scars. CONCLUSION: The outcomes after laser treatment were variable, although half of the patients achieved greater than 50% clearance. It provides an alternative to surgical excision for the removal of CMN in the difficult regions. Surgery excision is inevitable for some patients.

A split-face, single-blinded, randomized controlled comparison of alexandrite 755-nm picosecond laser versus alexandrite 755-nm nanosecond laser in the treatment of acquired bilateral nevus of Ota-like macules.

BACKGROUND: Q-switched alexandrite lasers (QSALs) have been used for the treatment of acquired bilateral nevus of Ota-like macules (ABNOMs). Currently, picosecond alexandrite laser (PSAL) pulses have become available for pigmentary disorders. However, no studies have compared PSAL and QSAL in the treatment of ABNOM. OBJECTIVE: We sought to compare the efficacy and safety of PSAL and QSAL in the treatment of ABNOM. METHODS: Each patient (n = 30) received 3 treatments at 6-month intervals. Matching areas were delimitated on the face of each patient (left/right comparison); 1 side was treated with PSAL and the other side was treated with QSAL. The safety and efficacy of the 2 lasers were determined by visual assessment and self-report from patients 6 months after the final treatment. RESULTS: The PSAL-treated area achieved significantly better clearance (3.73 vs 2.4) with less severe pain (4.47 vs 5.16). The incidence rate of postinflammatory hyperpigmentation was 27.77% and 54.44% for the PSAL and QSAL treatments, respectively, and the duration of postinflammatory hyperpigmentation was 1.32 and 1.74 months, respectively (P < .001). LIMITATIONS: The limitations of our study include the small sample size and the lack of objective evaluation. CONCLUSION: Compared with QSAL, PSAL therapy afforded significantly better clinical outcomes and fewer side effects in the treatment of ABNOM.

Less is more: similar efficacy in three sessions and seven sessions of pulsed dye laser treatment in infantile port-wine stain patients.

Port-wine stains (PWS) affect 0.3 to 0.5% of newborns and pulsed dye laser (PDL) remains the treatment of choice. However, no reliable study regarding the benefits of more frequent has been conducted. We designed the present study to evaluate whether more frequent PDL treatments in infantile patients would achieve further lightening of erythema. We prospectively investigated 20 infants with PWS. Two adjacent sites were both treated for a 12-week duration and randomly allocated to be treated for seven sessions at 2-week intervals or three sessions at 6-week intervals. The efficacy outcome 2 months after the final treatment was determined by visual and chromameter evaluation. Sixteen patients completed the study with a total of 54 treatment sites. Similar results were observed in the two groups. The average blanching rates were 42.93% (SD = 27.92%) and 43.81% (SD = 32.80%) for PDL treatments with seven and three sessions, respectively (p = 0.374). Partial recovery from the laser treatment was more frequently observed and side effects were significantly higher at 2-week follow-ups (p < 0.001), resulting in a total of 3-13 weeks for skin recovery. More frequent PDL treatments do not necessarily increase efficacy in infantile PWS patients. Considering the potential risks and added costs, this practice may not be of benefit. (Clinical trial registration number: ChiCTR-ONC-17010857).

EMLA cream does not influence efficacy and pain reduction during pulsed-dye laser treatment of port-wine stain: a prospective side-by-side comparison.

EMLA cream was developed to reduce pain during pulsed-dye laser (PDL) treatment; however, no standard assessment for the therapeutic outcomes of PDL with EMLA creams thus far available. This comparative, prospective clinical trial evaluates laser efficacy and pain reduction during PDL treatment with EMLA cream for local topical anesthesia. Nineteen patients with untreated port-wine stain (PWS) were treated using PDL and examined in this study. Treatment specifications included Vbeam® PDL (Candela Corp.), 595-nm wavelength, 9 J/cm2 radiant exposure, 0.45 ms pulse duration, 10 mm spot size, and cryogen spray cooling (40 ms cooling plus a 20 ms delay). A topical anesthetic (EMLA cream: 2.5% lidocaine and 2.5% prilocaine) and a placebo were applied to two respective testing areas on all patients prior to treatment. The visual analog scale (VAS) was used for pain assessment. Clinical therapeutic outcomes were evaluated by visual evaluation and with the use of a chromameter 2 months after 3PDL treatments. The average VAS scores were 3.15 ± 0.95 and 8 ± 0.57 for the EMLA cream site and the placebo site, respectively, at a significance level p < 0.001. The EMLA cream site and the placebo site had clearance or fading rates of 45.08 and 44.12%, respectively (p < 0.05). No serious side effects were reported. Patients reported a consistent decrease in pain during PDL treatment when the topical anesthetic EMLA cream was administered. Treatment of PWS by PDL with EMLA cream does not lead to a decrease in efficacy or an increase in side effects; instead, it significantly reduces pain during treatment. EMLA cream is a safe and effective local topical anesthetic for PWS treatment by PDL.

Facial tightening using a novel vacuum-assisted microneedle fractional radiofrequency system: A prospective, randomized, split-face study.

BACKGROUND: The microneedle fractional radiofrequency system (MFRS) is able to rejuvenate facial appearance by heating and coagulating certain depth of skin tissue. OBJECTIVE: To evaluate the safety and efficacy of a novel vacuum-assisted MFRS for facial contour tightening. METHODS: This prospective, randomized, split-face study included 21 patients who underwent three treatments with a vacuum-assisted MFRS at 1-month intervals. Half of the face was treated with the MFRS; the other half was untreated (control). Facial volume changes and wrinkles were objectively measured using a three-dimensional imaging system and VISIA-CR. RESULTS: Volume changes of the treated midface were -0.24 ± 0.75, -0.59 ± 0.92, and -0.55 ± 0.65 mL at 1, 3, 6 months follow-up; however, measurements of the control side were 0.08 ± 0.70, -0.08 ± 0.53, and - 0.10 ± 0.86 mL, indicating significant reductions (p < 0.05). The number of facial wrinkles on the treated side was significantly reduced to 12.44 ± 4.85 at 3 months and sustained at 6 months (11.11 ± 4.100) compared to the control side (14.89 ± 5.26 and 13.22 ± 4.44, respectively; p < 0.05). No long-term side effects occurred. CONCLUSION: The vacuum-assisted MFRS is safe and effective and is recommended for improving facial tightening and reducing wrinkles. This technology is sufficient to ensure the insertion depth, thus helping to improve the treatment accuracy and safety. The MFRS provides sustained effects for at least 6 months.

Evaluation of a Novel Microfocused Ultrasound with Three-Dimensional Digital Imaging for Facial Tightening: A Prospective, Randomized, Controlled Trial.

BACKGROUND: The excellent efficacy is mitigated by the limited safety profile of microfocused ultrasound procedures. OBJECTIVE: We sought to assess the safety and tightening efficacy of a novel microfocused ultrasound. METHODS: The randomized middle and lower face and submental region of the participants were treated with the novel device using the following transducers: M4.5, D4.5, M3.0, and D3.0. Improvement in paired comparison of pretreatment and posttreatment photographs, three-dimensional (3D) volumetric assessments, skin thickness measured by B-ultrasonography, and skin photoaging parameters were evaluated. Adverse events and patient satisfaction were also recorded. RESULTS: A total of 20 participants (20 female) were enrolled. Fourteen of 20 participants (70%) were judged to show clinically significant facial tightening during 3-month follow-up (P < 0.05). The mean volumetric change in the lower face, as quantitatively assessed after 3 months was -0.29 mL compared with +0.42 mL on the control side (P < 0.05). The VAS pain score was 3.00 ± 1.19 without any oral or intramuscular anesthesia. CONCLUSIONS: A small sample size, lack of clinical scales, and impersonalized treatment parameters. The novel microfocused ultrasound appears to be a safe and effective modality for lower-face tightening. CLINICAL TRIAL REGISTRATION NUMBER: ChiCTR 2200064666.

A Prospective Trial of the Microneedle Fractional Radiofrequency System Application in the Treatment of Infraorbital Dark Circles.

Background: Infraorbital dark circles (IDC) are commonly consulted in aesthetic practice. There is not yet a multifactorial approach to facilitating their treatment. Objective: To investigate the safety and efficacy of the microneedle fractional radiofrequency (MRF) system for the treatment of IDC. Methods: A prospective, split-face, evaluator-blind clinical trial was conducted to study the change in the overall appearance, color, and wrinkles in 21 female patients with mixed type IDC before and after MFR treatment. Results: Both patients and independent evaluators found significant improvement on the global aesthetic scales after the MFR treatment, especially on periorbital wrinkles (p=0.031). Trends in decreased melanin density in the IDC area were found, but no statistical differences were established. No side effects were observed. Conclusion: MFR is a safe and effective modality for improving mixed type IDC by correcting the structural factors.

Prospective trial of microneedle fractional radiofrequency in the hand rejuvenation treatment.

AIM: This study aimed to evaluate the safety and efficacy of a novel therapeutic strategy, a microneedle fractional radiofrequency system, for hand rejuvenation. MATERIAL AND METHOD: Sixteen subjects were enrolled in a self-controlled evaluator-blind prospective trial. All subjects received three microneedle fractional radiofrequency treatments at 4 weeks intervals. Hand volume was evaluated through subjective (Hand Volume Rating Scale) and quantitative measurements. Patients were also assessed on the Global Aesthetic Improvement Scale using digital photographs. Patients were followed up at 1, 3, and 6 months after the last radiofrequency treatment. RESULTS: Statistically significant improvements on the Global Aesthetic Improvement Scale and Hand Rating Volume Scale were noted (p < 0.05). Compared with the control side, the treated hand showed a 44% improvement in dorsal skin surface roughness (p < 0.05). Quantitative measurements of hand volume showed a trend toward increased volume for the treated hand, but the difference was not statistically significant. CONCLUSION: We conclude that microneedle fractional radiofrequency is a safe therapeutic option for hand rejuvenation.

Histological Characteristics of Port-Wine Stains with Complete Regression After Photodynamic Therapy Treatment: A 7-Year Follow-Up.

Background: Vascular-targeted photodynamic therapy (PDT) is an effective alternative treatment choice for port-wine stains (PWSs). The histological characteristics of PWSs after PDT treatment have not yet been reported. Objective: To investigate the morphological features of PWSs treated by PDT and define the histopathological characteristics of PWS that achieve clinical cure. Methods: Thirteen patients with facial PWSs, who presented with complete regressive PWS lesions after a mean of 4.38 (standard deviation = 4.907) sessions of PDT. Post-treatment biopsy samples were obtained from each patient. The number of blood vessels, vascular diameter, and depth were measured and compared in all samples of PDT-regressive sites, PDT-resistant sites, and normal skin. Results: Within the 7-year follow-up after PDT, there was no recurrence in the regression area of PDT. In the PDT-regressive sites, within 800 µm of the dermal-epidermal junction, the dilated vessels were occluded and remained fissure-like after PDT. Conclusions: When the vascular lesions within 800 µm of the dermal-epidermal junction were closed after PDT, a stable clinical cure (no recurrence) was achieved.

Blood Perfusion May Determine the Therapeutic Effect of Pulsed Dye Laser on Port-Wine Stains Located on Extremities.

Background: Port-wine stains (PWS) on proximal limbs respond better to pulsed dye laser (PDL) than PWS on distal limbs. Objective: To investigate whether the superiority of PDL efficacy on the proximal limbs is related to variations in blood perfusion. Methods: Patients with untreated PWS on the extremities underwent three sessions of PDL. Blood perfusion of the selected sites on both the proximal and distal limbs, as well as control sites, was detected by laser speckle imaging before treatment. After treatment was completed, the therapeutic effect was evaluated both objectively and subjectively. Results: A total of 19 patients were included. Seventeen of them presented with PWS on the upper extremities and 2 patients on the lower extremities. The mean speckle flow imaging value of the PWS on the upper arms and thighs was significantly lower [80.51 ± 16.96 perfusion unit (PU), control: 66.36 ± 13.18 PU] than that on the hands and feet (155.68 ± 71.86 PU, control: 72.82 ± 18.97 PU). Meanwhile, the average blanching rate on the proximal and distal limbs was 48.33% and 22.12%, respectively. Significant correlations were identified between blood perfusion and PDL efficacy (r = -0.351, p = 0.031). Conclusions: PWS in the proximal limbs responded better to PDL than PWS on distal limbs. This variation in efficacy may be attributed to differences in blood perfusion. Clinical trial registration no. ChiCTR-OCB-15007326.

Imaging and Pathological Characteristics of Port-Wine Stain Patients with Tissue Hypertrophy Before Laser Therapy: Retrospective Data.

Background: Port-wine stain (PWS) patients may simultaneously have accompanied soft tissue hypertrophy. The outcome of laser therapy can be poor. Objective: To study the imaging and histopathological characteristics of PWS patients with facial overgrowth. Materials and methods: We retrospectively assessed the effect of therapy on a subset of PWS patients with facial overgrowth. The degree of hypertrophy and the density of enhanced signals on T1-weighted magnetic resonance imaging (MRI) were independently graded by two radiologists using a quartile scale. Biopsies/resection of tissue deep to the facial muscle was reviewed and compared with flat PWS. Results: Thirty-two PWS patients with facial hypertrophy and 15 patients with flat PWS were included. MRI revealed a statistically significant correlation between the degree of hypertrophy and the density of enhanced signals (3.02 ± 0.92 vs. 2.47 ± 0.69; p < 0.01). Histological features of a subset of patients showed that vascular malformations existed in the dermis and also in the subcutaneous fat and muscle with much larger vessel diameters (fat, 0.048 vs. 0.020; muscle, 0.035 vs. 0.017) and thicker vessel walls (fat, 0.014 vs. 0.006; muscle, 0.010 vs. 0.006) (both p < 0.05). Conclusions: The imaging and pathological findings indicate that capillary malformation in subcutaneous tissue might be a major cause of poor therapeutic effect of laser therapy for PWS. Clinical trial registration no.: ChiCTR1800014278.

Targeting delivery and minimizing epidermal diffusion of tranexamic acid by hyaluronic acid-coated liposome nanogels for topical hyperpigmentation treatment.

Hyperpigmentation is a common complaint and distressing problem in dermatology, and tranexamic acid (TA) is an effective treatment agent but limited by the delivery to melanocytes in the epidermis. Herein, a novel TA naogels (named HA/TA-LP), combining the advantages of liposomes and hyaluronic acid (HA), are prepared and assessed for topical hyperpigmentation treatment with targeting delivery and minimizing epidermal diffusion. Morphological characteristics indicate numerous TA-loaded liposomes packed in HA gels. In vitro cell studies using human A375 melanoma cells show that HA/TA-LP can promote the uptake of TA by targeting delivery with resulting inhibition of tyrosinase activity and melanin production. Guinea pigs are used to construct hyperpigmentation models and investigate the topical delivery and treatment efficacy of HA/TA-LP. In vivo topical delivery studies indicate HA/TA-LP realize the effective delivery into melanocytes with an ideal balance of effective permeability and minimizing epidermal diffusion. Subsequently, hyperpigmentation treatment assessments reveal that HA/TA-LP inhibit tyrosinase activity and melanin production under the radiation of UVB. Our study identifies favorable properties of HA/TA-LP for treating hyperpigmentation, and provides an experimental basis for further clinical application.