Clinical and dermoscopic assessment of ablative carbon dioxide laser versus intradermal heparin sodium in xanthelasma.

BACKGROUND: Ablative carbon dioxide (CO2 ) laser is still a cornerstone in the management of xanthelasma. However, post-laser complications such as post-inflammatory hyperpigmentation or scarring have to be considered. Heparin sodium was recently suggested as an effective therapeutic modality for xanthelasma. OBJECTIVE: The aim of this work was to compare the therapeutic value of ablative CO2 laser versus intradermal heparin sodium in xanthelasma. METHODS: This study was piloted on 30 xanthelasma patients, whose lesions were randomly categorized into two groups. Group A was managed with CO2 laser ablation (2 sessions scheduled every 4 weeks), whereas Group B was managed with intradermal heparin sodium injections (10 sessions scheduled every week). Pre- and post-treatments evaluations were done both clinically and dermoscopically. RESULTS: Significant reduction of xanthelasma lesions was reported in response to both therapeutic interventions. However, the ablative CO2 laser was more significantly effective than intradermal heparin sodium. Interestingly, intradermal injection of heparin sodium was nearly as effective as ablative CO2 laser in early (<2 years duration) grade I and II xanthelasma, with a lower incidence of post-therapy side effects. CONCLUSIONS: Intradermal injection of heparin sodium could be suggested as a safe and cost-effective therapeutic technique for early mild grade I and II xanthelasma. Moreover, it could be recommended as a pre-operative management of grade III and IV xanthelasma to reduce the lesions to be easily ablated with CO2 laser.

Clinical assessment of a circadian-based antioxidant system combined with a comprehensive brightening serum in diverse subjects with moderate-to-severe facial hyperpigmentation.

BACKGROUND: Hyperpigmentation conditions can affect all skin types but occur more frequently in darker skin. Because many factors have been implicated in the etiologies of these disorders, multi-targeted approaches may be required to achieve a better overall outcome in a diverse patient population. AIMS: The purpose of this study was to investigate the safety and efficacy of a combination regimen of a comprehensive cosmetic brightening agent (LYT2) with a broad blend of antioxidants (LVS) to reduce hyperpigmentation and improve overall skin appearance. METHODS: The combination of LYT2 and LVS, in addition to a basic skincare routine, was evaluated in subjects of either Caucasian or Asian (a majority of whom were Indian) descent, presenting with moderate-to-severe hyperpigmentation. Efficacy evaluations consisted of investigator clinical grading of overall hyperpigmentation, skin tone evenness, and radiance, as well as subject self-assessment questionnaires. RESULTS: Immediate and progressive improvement was noted by the investigators for all assessed parameters. At the end of the 12-week study, investigators observed a 45% mean decrease from baseline for overall hyperpigmentation. In addition, a 50% improvement in skin tone evenness and a 58% increase in radiance was observed. These investigator assessments were matched by good patient scores for self-perceived efficacy parameters and high overall satisfaction. One patient (7%) showed a treatment-related adverse event. CONCLUSION: A combination skincare regimen that combines the pigmentation control of LYT2 with the broad antioxidant defense of LVS is a well-tolerated and effective treatment option to improve the appearance of facial hyperpigmentation and make skin more radiant.

Scar Assessment After Breast Reconstruction: Risk Factors for Hypertrophy and Hyperpigmentation in Asian Patients.

BACKGROUND: Breast scars after breast reconstruction can be hypertrophic and/or hyperpigmented, especially in Asian patients, whose skin is thicker and has increased melanin. Few studies have focused on breast scars after breast reconstruction, and the risk factors for an abnormal breast scar remain unknown. METHODS: We examined 257 Asian patients who underwent an immediate 2-stage unilateral implant-based breast reconstruction. Vascularity, hypertrophy, and hyperpigmentation of the patients' breast scars were assessed at 1 year postoperatively. Risk factors for an abnormal scar were analyzed statistically. Analyzed patient factors included age, body mass index, incision site (frontal or lateral), breast size (the weight of the resected specimen), skin necrosis at the initial operation (expander placement), and adjuvant therapy. RESULTS: At 1 year postoperatively, 161 patients (63%) showed normal vascularity, 77 patients (30%) showed mild vascularity, 18 patients (7%) showed moderate vascularity, and 1 patient (0.4%) showed severe vascularity. No patient factors were correlated with vascularity. Thirty-two patients (12%) showed hypertrophy, and the rate of hypertrophy was significantly higher in the patients with a lateral incision (n = 59) compared with those with a frontal incision (n = 198) (28.8% vs 7.6%, P < 0.01). Even in the frontal incision group, a lateral part of the frontal scar was likely to be hypertrophic. Forty-six patients (18%) showed hyperpigmentation, and the rate of hyperpigmentation was significantly higher in the patients with skin necrosis (n = 47) at the initial operation than those without skin necrosis (n = 210) (57.4% vs 9.0%, P < 0.01). Large breast was also a risk factor for hyperpigmentation due to its higher frequency of skin necrosis. CONCLUSIONS: In Asian patients who undergo breast reconstruction, the use of a lateral incision is a risk factor for hypertrophy, and skin necrosis at the initial operation is a risk factor for hyperpigmentation at the breast scar.

Assessment of efficacy and safety of a fractionated bipolar radiofrequency device for the treatment of lower face wrinkles and laxity.

Skin aging, as a natural course, is a gradual process. It can be classified as either intrinsic or photo-aging. In recent years, as the attention to lower face wrinkles and laxity has raised significantly, the demands to facial rejuvenation also increased, along with a variety of technologies coming into being. Fractional bipolar RF as a novel means of rejuvenation has been used in clinical practice, but questions remain in terms of its efficacy and safety. Considering a large population in our country and huge demands for skin tightening, we did this research to evaluate the efficacy and safety of fractional bipolar radiofrequency.

Postinflammatory hyperpigmentation: A comprehensive overview: Epidemiology, pathogenesis, clinical presentation, and noninvasive assessment technique.

Postinflammatory hyperpigmentation (PIH) commonly occurs after various endogenous and exogenous stimuli, especially in dark-skinned individuals. PIH is one of the most common complications of procedures performed using laser and other light sources. The severity of PIH is determined by the inherent skin color, degree and depth of inflammation, degree of dermoepidermal junction disruption, inflammatory conditions, and the stability of melanocytes, leading to epidermal and dermal melanin pigment deposition. The depth of melanin pigment is the key factor to predict prognosis and treatment outcome. Epidermal hyperpigmentation fades more rapidly than dermal hyperpigmentation. Various inflammatory disorders can eventually result in PIH. The evaluation of pigmentation using noninvasive tools helps define the level of pigmentation in the skin, pigmentation intensity, and guides therapeutic approaches. This first article in this 2-part series discusses the epidemiology, pathogenesis, etiology, clinical presentation, differential diagnoses, and investigation using noninvasive assessment techniques that objectively determine the details of pigmentation.

The assessment of the effect of a cosmetic product brightening the skin of people with discolorations of different etiology.

BACKGROUND: Hyperpigmentations are disorders displayed with a change in the color of the skin, its strange shape, the lack of symmetry, and irregular placement. They appear no matter on the age, gender, and often as a congenital defect. Disorder connected with overproduction of melanin by pigmentary cells. The change of color is due to endogenous and exogenous cause. OBJECTIVES: The aim of this thesis was to conduct a research in vivo. This will allow to judge the effectiveness of the cosmetic product which brightens the skin with hyperpigmentation problems. The characteristics of dermocosmetics were tested on people with various etiology of hyperpigmentation. The aim of the research was to assess the effect of the active substances used daily on skin hyperpigmentation. METHODS: The tests were carried out on groups of patients with hyperpigmentations. The application of the pharmaceutical and the use of specific apparatus measurements were taken on every medical checkup. A survey was conducted to assess the changes in the face, neck, and neckline skin. The research was based on the apparatus analysis of the skin condition (MPA® , VISIA® ). RESULTS: Regular application of the pharmaceutical caused brightening of hyperpigmentations (P < 0.05). General improvement in skin condition was also observed - the increase in skin elasticity, smoothness, and the enhancement of hydration levels. CONCLUSIONS: Dermocosmetics for people with hyperpigmentation are an essential part of their medical treatment. In case of epidermal hyperpigmentation, the recipe of individually chosen and tested combination of ingredients enables us to reach satisfactory results.

Avaliação da eficácia do mmp® com 5-fluoracil versus mmp® sem medicação versus injeção subcutânea de 5-fluoracil para tratamento de leucodermias solares: ensaio clínico randomizado, monocego / Efficacy assessment of mmp® with 5-fluoracil versus drug-free mmp® versus subcutaneous injection of 5-fluoracil for the treatment of solar leukoderma: a randomized, single-blind clinical trial

INTRODUÇÃO: Leucodermias solares geram preocupações estéticas para os pacientes e nenhum tratamento é primeira escolha na literatura. MÉTODOS: Ensaio clínico randomizado, monocego. Foram selecionados nove pacientes, com presença de pelo menos 10 lesões de leucodermia em cada antebraço, totalizando 180 lesões. Avaliou-se a eficácia de 2 sessões do MMP® com 5-Fluoracil comparado com MMP® sem medicação e 5-Fluoracil intralesional para tratamento das leucodermias de antebraços. RESULTADOS: Das lesões avaliadas segundo a eficácia, todas apresentaram repigmentação, o que indica melhora clínica com qualquer dos 3 tratamentos. O 5-FU isolado foi o mais eficaz, com significância estatística, seguido do MMP®+5-FU. O MMP® sem medicação foi o menos eficaz. Dentre os efeitos adversos, hiperpigmentação, ardor, prurido e dor não tiveram significância estatística ao fim do estudo. O eritema do MMP®+5-FU foi significativamente superior na maioria das visitas. Todos os pacientes relataram melhora clínica após os procedimentos. Maior relato de dor com a técnica de MMP® com ou sem medicação. DISCUSSÃO: A melhor eficácia do 5-FU em relação ao MMP®+5-Fluoracil poderia ser explicada pela diferente técnica de aplicação da medicação. Supõe-se que o MMP® foi o menos eficaz devido a não utilização do 5-FU. Não existem na literatura trabalhos com o uso de 5-FU intralesional ou MMP®+5-FU ou MMP® isolado para tratar leucodermias solares. O eritema persistente do MMP®+5-FU seria resultado do trauma somado a reação inflamatória induzida pelo 5-FU. CONCLUSÃO: Após 2 sessões de tratamento, o 5-FU mostrou-se o mais eficaz e com maior tolerabilidade pelos pacientes. Descritores: Leucodermia solar; 5-Fluoracil; MMP®; Dermatologia

Effectiveness of erbium:YAG laser and cryosurgery in seborrheic keratoses: Randomized, prospective intraindividual comparison study.

BACKGROUND AND OBJECTIVE: Seborrheic keratoses (SK) are benign cutaneous lesions frequently seen in old age. The aim of the study is to compare the efficiency of Er:YAG lasers with cryotherapy in the treatment of SK. PATIENTS AND METHODS: The study was carried out on 42 patients with SK sized 0.5-3 cm, located on the back, chest, face and neck. Lesions with a similar size and location on the same patient were matched. In the same session, half of the lesions were treated with cryotherapy, while the other half were treated with Er:YAG lasers. All of the patients were clinically evaluated in two recalls with a one-month interval between appointments. The efficiency of the treatments was clinically evaluated. RESULTS: Following the first treatment, complete healing was detected in all of the lesions (100%) treated with Er:YAG lasers, while the healing rate was 68% in the cryotherapy group (p < 0.01). In the Er:YAG laser-treated group, hyperpigmentation was significantly lower and more erythema developed than in the cryotherapy group. CONCLUSION: Er:YAG lasers offer a one-step procedure which is a very simple and economic treatment and provides an alternative treatment method with better cosmetic results compared to cryotherapy.

A multimodal assessment of melanin and melanocyte activity in abnormally pigmented hypertrophic scar.

Using a validated swine model of human scar formation, hyperpigmented and hypopigmented scar samples were examined for their histological and optical properties to help elucidate the mechanisms and characteristics of dyspigmentation. Full-thickness wounds were created on the flanks of red Duroc pigs and allowed to heal. Biopsies from areas of hyperpigmentation, hypopigmentation, and uninjured tissue were fixed and embedded for histological examination using Azure B and primary antibodies to S100B, HMB45, and α-melanocyte-stimulating hormone (α-MSH). Spatial frequency domain imaging (SFDI) was then used to examine the optical properties of scars. Hyperpigmentation was first noticeable in healing wounds around weeks 2 to 3, gradually becoming darker. There was no significant difference in S100B staining for the presence of melanocytes between hyperpigmented and hypopigmented scar samples. Azure B staining of melanin was significantly greater in histological sections from hyperpigmented areas than in sections from both uninjured skin and hypopigmented scar (P < .0001). There was significantly greater staining for α-MSH in hyperpigmented samples compared with hypopigmented samples (P = .0121), and HMB45 staining was positive for melanocytes in hyperpigmented scar. SFDI at a wavelength of 632 nm resulted in an absorption coefficient map correlating with visibly hyperpigmented areas of scars. In a red Duroc model of hypertrophic scar formation, melanocyte number is similar in hyperpigmented and hypopigmented tissues. Hyperpigmented tissues, however, show a greater amount of melanin and α-MSH, along with immunohistochemical evidence of stimulated melanocytes. These observations encourage further investigation of melanocyte stimulation and the inflammatory environment within a wound that may influence melanocyte activity. Additionally, SFDI can be used to identify areas of melanin content in mature, pigmented scars, which may lead to its usefulness in wounds at earlier time points before markedly apparent pigmentation abnormalities.

Retrospective analysis of melasma treatment using a dual mode of low-fluence Q-switched and long-pulse Nd:YAG laser vs. low-fluence Q-switched Nd:YAG laser monotherapy.

BACKGROUND: Despite the effectiveness of low-fluence Q-switched Nd:YAG laser (QSNY) treatment in melasma, adverse events, including mottled hypopigmentation (MH) and rebound hyperpigmentation (RH) have been reported. OBJECTIVE: To compare the effectiveness and safety of combination therapy using low-fluence QSNY and long-pulse Nd:YAG laser (LPNY) (Dual toning), with low-fluence QSNY monotherapy (QS toning), in Asian melasma patients. MATERIALS AND METHODS: Patients were treated for 10 sessions at 1-week intervals with QSNY (6 mm spot); 2.5-3.0 J/cm(2) for QS toning (n = 177) or 2.1-2.5 J/cm(2) for dual toning (n = 183). The dual toning group was immediately treated with LPNY (7 mm spot, 15-17 J/cm(2)). The results were evaluated using the modified Melasma Area and Severity Index (mMASI) score and the physician's global assessment. RESULTS: MH or RH were significantly lower (1.1% vs. 14.1%) and the treatment efficacy was improved (median decrease of mMASI, 3.6 vs. 3.0) in the dual toning group compared with the QS toning group. Periorbital melasma showed distinctively high rates of adverse events in the QS toning group (23.9% vs. 5.7%), which were significantly reduced in the dual toning group (2.9%). CONCLUSION: Dual toning could represent a safe and effective treatment for Asian melasma patients, as it is associated with minimal adverse events and improved treatment efficacy compared with QS toning monotherapy.

Microneedling for acne scars in Asian skin type: an effective low cost treatment modality.

BACKGROUND: Postacne scarring is disfiguring, both physically as well as psychologically. Over the past two decades, multiple modalities for treatment of acne scars have emerged and microneedling with dermaroller is one of them. OBJECTIVE: To evaluate the efficacy and safety of microneedling treatment for atrophic facial acne scars. MATERIAL AND METHODS: Thirty-six patients (female--26, male--10) of postacne atrophic facial scars underwent five sittings of dermaroller under topical anesthesia at monthly intervals. Objective evaluation of improvement was performed by recording the acne scar assessment score at baseline and thereafter at every visit. Pre- and posttreatment photographs were compared, and improvement was graded on quartile score. Final assessment was performed 1 month after the last sitting. Patients were asked to grade the improvement in acne scars on visual analog scale (VAS, 0-10 point scale) at the end of study. RESULTS: Of 36 patients, 30 completed the study. The age group ranged from 18 to 40 years, and all patients had skin phototype IV or V. There was a statistically significant decrease in mean acne scar assessment score from 11.73 ± 3.12 at baseline to 6.5 ± 2.71 after five sittings of dermaroller. Investigators' assessment based on photographic evaluation showed 50-75% improvement in majority of patients. The results on visual analog scale (VAS) analysis showed "good response" in 22 patients and "excellent response" in four patients, at the end of study. The procedure was well tolerated by most of the patients, and chief complications noted were postinflammatory hyperpigmentation in five patients and tram-trek scarring in two patients. CONCLUSION: Microneedling with dermaroller is a simple and cheap, means of treatment modality for acne scars remodulation with little downtime, satisfactory results and peculiar side effects in Asian skin type.

Reliability assessment and validation of the postacne hyperpigmentation index (PAHPI), a new instrument to measure postinflammatory hyperpigmentation from acne vulgaris.

BACKGROUND: There are no validated outcome measures for postinflammatory hyperpigmentation (PIH). OBJECTIVE: We sought to determine the reliability and validity of an outcome measure for PIH after acne in patients with skin of color. METHODS: A postacne hyperpigmentation index (PAHPI) was developed. Six raters scored 21 patients with PIH twice. Reliability was determined within and between raters, whereas validity was evaluated by comparing scores with severity ranking by an independent dermatologist. The pigment intensity scores were compared with the melanin index of each patient using a narrowband reflectance spectrophotometer. A quality-of-life score (Skindex-29) was also compared with PAHPI scores. RESULTS: Total PAHPI scores showed good reliability within and between raters and were valid when compared with clinical severity and melanin indices. Good correlation was achieved between the total PAHPI score and the emotion subscale of the Skindex-29. LIMITATIONS: Generalizability of results is limited to African American females. CONCLUSION: The PAHPI shows good reliability and validity when scored on patients with PIH from acne vulgaris. The PAHPI also correlates well with the emotional impact of PIH as measured by the Skindex-29. Future studies should assess the ability of the PAHPI to change with improvement of PIH from acne after treatment.

Tratamento da hipercromia cutânea idiopática da região orbital com Erbium Laser: uma avaliação retrospectiva / Treatment of idiopathic cutaneous hyperchromia of the orbital region (ICHOR) with Erbium Laser: a retrospective assessment

Introdução: a hipercromia cutânea idiopática da região orbital dá um aspecto cansado à face. Sua etiologia ainda não é bem entendida. Causas primárias incluem hiperpigmentação da derme, por depósitos de melanina, ou pela vascularização superficial visível através da pele palpebral inferior. Causas secundárias são associadas com doenças sistêmicas e autoimunes. As opções de tratamento são muito vastas, com o laser sendo relativamente recente. Objetivos: o objetivodesteestudo é avaliar os resultados, a longo prazo, com o uso do Er:YAG(erbium) laser, nadiminuiçãodahiperpigmentação periorbital. Métodos: dez pacientes, incluindo oito mulheres e dois homens, foram submetidos ao tratamento da região periorbital usando Erbum:YAG laser, entre 2003 e 2006. Os pacientes foram avaliados comA e B períodos após o procedimento. Os critérios de avaliação incluíram a redução da pigmentação periorbital e a satisfação do paciente. Resultados: o tratamento com Er:YAG laser mostrou redução da hipercromia periorbital efetiva, com significativa melhora precoce e tardia, além da manutenção dos resultados, durante o período de avaliação, com satisfação dos pacientes. Discussão: a ablação com o Er:YAG laser mostrou-se efetiva na redução da hipercromia idiopática periorbital, com resultados duradouros. Complicações menores e raras incluíram hiperpigmentação transitória, pigmentação residual e leve hipocromia, em alguns casos.

Introduction: idiopathic Cutaneous Hypercromia of the Orbital Region (HCIRO),give a sad, tired aspect to face. Its etiopathology is to date still not well understood. Primary causes include hyperpigmentation from dermal deposits of melanin, or from superficial vascularization that is visible through the lower palpebral skin. Secondary causes are associated with systemic and autoimmune disorders. Treatment for HCIRO varies greatly, with laser treatment being relatively recent. Objectives: theobjective of this study was to clinically evaluate the long-term results of treatment using the Er:YAG (erbium)laser to diminish idiopathic periorbital hyperpigmentation. Methods: ten patients, eight females and two males underwent treatment of the periorbital region using ablative Erbium: YAG laser treatment between 2003 and 2006. The patients were evaluated at 2 and 6 month and 2-5 years post-procedure. The evaluation criteria included clinical reduction of periorbital pigmentation and patient satisfaction. Results: the treatment with Er:YAG laser, reduction of idiopathic periorbital hyperchromia was effective at early and long-term evaluation points, with the results being maintained during the period of evaluation with good patient satisfaction. Discussion: ablative treatment with Er:YAG laser was found to be effective in reduction of idiopathic periorbital hyperchromia, with a long-lasting result. Complications were minorandrare, and included mild hyperpigmentation, residual pigment, and hipopigmentation.