Phosphatidylcholine for the treatment of prominent lower eyelid fat pads: a pilot study.

PURPOSE: To find out whether the off-label use of Lipostabil is as effective as advertised for the nonsurgical treatment of bulging lower eyelid fat pads. METHODS: This is a pilot, randomized, placebo-controlled, double-blind, comparative, single-center study. Participants were 45 patients with full lower eyelids who were injected with 0.5 ml of Lipostabil in one eyelid and 0.5 ml of isotonic saline in the opposite lower eyelid as a control. Inclusion criteria were healthy adults older than 25 years. Exclusion criteria included patients with a known bleeding tendency or bleeding disorder and patients addicted to "antiwrinkle" products. The main outcome measures were reduction of lower eyelid fat pads and the occurrence of ocular or systemic side effects. RESULTS: The pre- and postinjection pictures of the 23 patients who completed the study were examined by 3 masked observers. They failed to differentiate the Lipostabil from the saline-injected eyelids or even the pretreatment from the posttreatment pictures in the majority of patients. CONCLUSIONS: Mesotherapy is hailed in the media as the most exceptional discovery since the introduction of botulinum toxin. Unfortunately, we failed to observe any improvement in appearance or reduction of fullness after multiple injections. Further studies are needed to determine whether Lipostabil is indeed ineffective for the management of eyelid fullness or the dose the authors used has to be increased.

Association of metabolic syndrome with female pattern hair loss in women: A case-control study.

BACKGROUND: Several studies have addressed the association of metabolic syndrome (MetS) with androgenetic alopecia (AGA) in men with few reports focusing on this association in females. The aim of this work was to investigate the association of MetS among Egyptian women with different stages of female pattern hair loss (FPHL) and to compare the results with age- and sex-matched controls. METHODS: This study included 90 female participants, 45 cases with different stages of FPHL classified according to the Ludwig scale and 45 healthy control participants that were age- and sex-matched with the cases. Assessment of MetS components was done according to the Adult Treatment Panel III criteria. RESULTS: Compared to the control group, a statistically significant association was found between FPHL and the presence of MetS with a tendency to increase with the severity of FPHL being greater in stage III > stage II > stage I. Among metabolic syndrome components, waist circumference (WC) (OR 5.6, 95% CI 2.2 -13.9, P = 0.0002) and hypertension (HTN) (OR 3.5, 95% CI 1.3-8.9, P = 0.008) were revealed as the most important factors associated with FPHL. WC also tended to increase with the severity of FPHL. CONCLUSIONS: We demonstrated a significant association between MetS and FPHL. Women with FPHL, particularly if associated with an increased WC or hypertension, should be screened for MetS criteria for early identification and management.

Necrolytic acral erythema: a patient from the United States successfully treated with oral zinc.

BACKGROUND: Recently, necrolytic acral erythema (NAE) has been described as a cutaneous marker for hepatitis C virus (HCV) infection. Only 2 cases have been reported in the United States. Successful remission has been induced only with interferon therapy with or without ribavirin. OBSERVATIONS: We describe a 46-year-old, HCV-positive African American woman with well-defined, dusky, erythematous plaques on the dorsa of the feet, Achilles tendons, legs, knees, and elbows. Histologic examination revealed confluent upper epidermal necrosis, acanthosis, papillomatosis, and superficial and deep perivascular inflammation. She was diagnosed as having NAE. We induced successful disease remission with oral zinc administration. This is the third NAE case reported in the United States and the first report of disease remission with oral zinc therapy alone. CONCLUSIONS: Since its initial description in Egypt, more cases of NAE are being reported in the United States. Increased awareness of this entity is crucial. Oral zinc might represent a less toxic alternative therapeutic option for patients with NAE.

Necrolytic acral erythema: a cutaneous sign of hepatitis C virus infection.

BACKGROUND: Hepatitis C virus (HCV) infection is globally epidemic. Several mucocutaneous diseases are well established in association with HCV infection. Few case reports describe the recently recognized HCV-related skin disorder termed necrolytic acral erythema (NAE). METHODS: Thirty patients with NAE were identified in a university-based dermatology clinic in Cairo, Egypt. These patients were observed over time to document the clinical and histologic findings of this disorder. RESULTS: All patients were infected with HCV. Erythematous papules arose most commonly on the dorsal aspect of the feet, particularly the dorsal surface of the great toe. Progression resulted in confluence into erythematous dusky plaques with adherent scale and central erosion. The eruption extended to involve the lower leg and other regions in some patients but never affected palms or soles, the nail bed, nail plate, or mucous membranes. Skin biopsy specimens from fully evolved lesions displayed psoriasiform changes in association with more characteristic findings of keratinocyte necrosis and papillomatosis. LIMITATIONS: We did not perform a prospective review of patients known to be infected with HCV. Patients were identified from a general clinic population and then assayed for HCV serology. CONCLUSIONS: NAE is a distinctive skin disorder associated with HCV infection in all cases reported to date. Recognition of this disease should alert practitioners to the need for viral testing and appropriate counseling of patients.