Wound Healing Treatments After Ablative Laser Skin Resurfacing: A Review.

Laser resurfacing has progressed since the 1980s to treat a variety of medical and aesthetic indications with ever-evolving safety parameters. While laser technology has evolved to provide a more favorable safety profile and decrease wound healing time, advances in post-procedure healing agents have also helped to mitigate adverse effects, such as persistent erythema, dyspigmentation, acneiform eruptions, dermatitis, infections, and scarring. We reviewed the evidence of growth factors, stem cells, silicone and silicone polymers, botanical based treatments, fatty acids, probiotics, and closed dressings on post-ablative laser skin resurfacing. All reviewed agents demonstrated some evidence in improving post-procedure outcomes, albeit mixed in many cases. Additionally, these studies contain small numbers of participants, vary in type, strength, and clinical indication for which the resurfacing laser was used, and have differing postprocedural evaluation protocols and assessments. This highlights a need for standardization of clinical studies and the importance of choosing an optimal postprocedural skincare plan depending on every unique clinical scenario. J Drugs Dermatol. 2020;19(11):1050-1055. doi:10.36849/JDD.2020.5386.

Impending skin necrosis after dermal filler injection: A "golden time" for first-aid intervention.

Vascular compromise with impending skin necrosis is one of the most serious potential complications. Early recognition of vascular occlusion and swift and aggressive treatment are required to avoid any irreversible changes. However, initial symptoms of a vascular event are often dismissed as simple post-procedural discomfort. If more than 3 days pass after filler injection, crust formation is initiated over the erythematous base along with a rim of fibrous tissue. Due to the replacement of normal tissues by fibrous material, the healing process may result in scar formation in spite of debridement and aggressive dressing changes. Scars often cause contracture and subsequent cosmetic disfigurement, which results in a traumatic burden to the patient. By sharing our experience of the patients with filler induced skin necrosis, we suggest that treatment should be initiated no later than 3 days after the procedure.

Using a soft-silicone dressing to treat moist desquamation.

Skin reactions are a common side effect of radiotherapy. Radiotherapy damages basal cells and skin reactions occur when the basal layer is unable to produce enough new cells to compensate for the loss of damaged cells at the skin's surface. Skin reactions progress from erythema, through dry desquamation to moist desquamation. As yet, there are no nationally recognised guidelines for the management of radiotherapy-induced skin reactions. As a result, there is widespread variation in practice throughout the UK. Hydrocolloid and hydrogel dressings have been used to treat moist desquamation. However, this article describes the successful clinical experience with an alternative dressing, Mepilex Lite®. The clinical evidence presented also raises the question of whether Mepilex Lite can be used prophylactically as an alternative to aqueous cream on grade 1 (erythema) reactions. Further evidence on this indication for Mepilex Lite will be published in a BJN supplement in November 2014.

Treatment of injectable soft tissue filler complications.

BACKGROUND: Increasing use of dermal fillers, especially with the U.S. introduction of long-term and permanent fillers, is expected to increase the number of complications seen after treatment with these materials. OBJECTIVES: To provide physicians with an overview for treatment of dermal filler complications. RESULTS: Complications of dermal filler use can be treated successfully based on a firm understanding of the mechanisms and limitations of filler action and wound healing. Complications can be classified as immediate, early, or delayed onset; available treatment options are presented. CONCLUSION: Short- and long-term dermal fillers are increasingly becoming popular treatment options for signs of facial aging. Complications, although not common, can be treated effectively and excellent outcomes achieved.

The management of dermal filler complications.

Injectable fillers have gained widespread acceptance among the public and provide a nonsurgical means of rejuvenating the face. As the demand for fillers increases, facial plastic surgeons must become not only expert injectors but also experts in managing the complications of fillers. Little scientific data exists regarding the incidence of complications, and more adverse effects may be seen with longer-term follow-up of patients. The purpose of this article is to review the most commonly encountered complications and management thereof.

[Treatment of localized gingival erythema]. / Behandlung des lokalisierten gingivalen Erythems.

Forms of a localized erythema can be observed occasionally as an expression of inflamed gingiva. It is characterized by a localized sharply demarcated and painless swelling of the gingiva with considerable redness. The differential diagnosis is not unequivocal and appropriate diagnosis and therapy are a challenge. In the present case presentation we report on three cases, which showed good disease remission after simple antiseptic prophylactic measures. Based on the available literature possible etiologic factors are reviewed and a pragmatic treatment strategy is discussed.

Photobiomodulation as an Inflammatory Therapeutic Following Dental Prophylaxis in Canines.

Objective: The aim of this study was to determine if a single photobiomodulation treatment can reduce oral erythema and edema following routine dental prophylaxis in canines. Background: Photobiomodulation therapy has been documented to accelerate healing time through mitigation of erythema and edema in human and veterinary patients. Methods: Canine patients were randomly assigned into three groups: CG (Control, n = 9, mock gingiva treatment without irradiation), LTG (left side treated, n = 8, irradiation of left upper and lower dental arcade), and RTG (right side treated, n = 7, irradiation of right upper and lower dental arcade). Immediately following anesthetized dental prophylaxis, the canines in the RTG and LTG received four points of irradiation (GaAlInP-650 nm, continuous wave, 0.1 W, 0.2 W/cm2, 100 sec, 10 J, 20 J/cm2). Erythema and edema along the gingival surface of each dental arcade were scored 24 h after treatment by a blinded veterinary evaluator. Analysis of variance and Bonferroni correction were used for data analysis. Results: Using a composite evaluation, there was significantly lower inflammation scores for the RTG (p = 0.017) and LTG (p = 0.025) relative to the CG at the location of the lower right dental arcade. Evaluating erythema individually, a significant reduction was found in the LTG (p = 0.049) when compared with the CG for the lower left dental arcade. Conclusions: Despite the limitations in this study, the canines who received a single photobiomodulation treatment demonstrated some degree of reduction in oral inflammation and erythema following dental prophylaxis.

Randomized, single-blinded, crossover study of a novel wound dressing vs current clinical practice after percutaneous collagen induction therapy.

INTRODUCTION: Skin rejuvenation procedures have become common with sophisticated technologies with reduced downtime and related risks. Recently, microneedling has been paired with radiofrequency to create Fractional Radiofrequency Microneedling (FRFM) to induce neocollagenesis. Frequently, topical products are applied immediately after the needling. This procedure is known as percutaneous collagen induction therapy (PCIT). Postoperative topical wound care is critical for prompt rapid and safe healing, with moist wound healing deemed of primary importance for fast and correct scarring process. An ideal dressing enables a moist environment while reducing postprocedural inflammatory responses in the first stages of wound healing. OBJECTIVE: To evaluate whether an innovative silicone-based wound dressing is superior than standard of care therapy in decreasing severity and duration of treatment-site acute inflammatory reactions post PCIT. MATERIALS AND METHODS: Endymed PRO Intensif Handpiece (Endymed, Israel) was used for the full-face FRFM procedure. Subjects (n = 20) applied treatment (Stratacel® -Stratpharma SG, Switzerland) and control (Aquaphor® -Beiersdorf Inc, USA) immediately after the procedure and daily; they were evaluated immediately postprocedure (baseline assessment), at 2, 3 and 7 days postprocedure. Digital and 3D pictures (Antera 3D Camera for Skin Analysis-Miravex, Ireland) were taken at each assessment. RESULTS: All patients healed properly without reporting adverse reactions to any of the studied products. Erythema at each study visit was significantly reduced with the use of the novel wound dressing (P < 0.001). A statistically significant difference in favor of the innovative wound dressing also emerged with respect to the patient-rated product properties (P = 0.008), such as feel on skin, drying time and stickiness. CONCLUSIONS: The novel wound dressing reduced signs of acute inflammation following PCIT when compared to standard of care, without reporting adverse events and resulting in a more favorable outcome from a patient perspective.

Pegylated liposomal doxorubicin-associated hand-foot syndrome: recommendations of an international panel of experts.

BACKGROUND: Hand-foot syndrome (HFS) is dose-limiting and the most common cumulative toxicity associated with pegylated liposomal doxorubicin (PLD). It can cause considerable discomfort and lead to therapy interruption. Numerous approaches to HFS management have been reported, but there is no consensus. METHODS: Published literature (identified via Medline and internet search) and expert experience regarding HFS and its pathogenesis, incidence, risk factors, prevention and treatment in patients undergoing treatment with PLD were collected and reviewed by a panel of experts. A consensus technique was used to develop recommendations. FINDINGS: The pathogenesis of PLD-associated HFS has been recently elucidated. Systems used to grade, prevent and treat HFS in individuals treated with PLD vary widely. A randomised clinical study demonstrated that PLD dose intensity reduction can prevent HFS. While there is limited literature support, patient education and supportive measures were endorsed by the expert panel as effective strategies for HFS prevention and treatment. An easy to use HFS grading and management algorithm was developed, early signs and symptoms of HFS outlined and specific recommendations for supportive care developed. INTERPRETATION: The paucity of data on the management of PLD-associated HFS led the expert panel to develop consensus-based recommendations. Patient education and supportive measures are important elements in the management of HFS and dose intensity reduction has documented efficacy in prevention. At a PLD dose intensity not exceeding 10mg/m(2) weekly, HFS can be easily managed. Phase III research to support the efficacy other interventions is lacking.

Red man syndrome following the use of vancomycin-loaded bone cement in the primary total knee replacement: A case report.

RATIONALE: Red man syndrome (RMS) is the most common allergic reaction to vancomycin. It generally occurs during rapid infusion of vancomycin; only few cases have been reported as results of local vancomycin administration. We hereby report a rare case where RMS developed after insertion of vancomycin-loaded bone cement in a primary total knee replacement (TKR). PATIENT CONCERNS: A 74-year-old woman was admitted for a left TKR due to severe osteoarthritis. Erythematous changes over face, trunk, and extremities developed after the use of vancomycin-loaded bone cement. DIAGNOSES: According to the clinical manifestations, the patient was diagnosed with vancomycin-induced RMS. INTERVENTIONS: She was treated with fluid challenge and intravenous ephedrine, followed by intravenous diphenhydramine and hydrocortisone. OUTCOMES: The patient's symptoms and signs relieved within 1 h after treatment. LESSONS: Vancomycin-induced RMS may occur after the routine use of vancomycin-loaded bone cement in the primary TKR replacement.

Blood vessel changes during pregnancy: a review.

The profound endocrine upheaval of pregnancy is frequently associated with changes in the function and structure of the blood and lymph microvasculature of the skin and mucosae. Palmar erythema is frequent but rarely severe and is associated with burning sensations. Spider telangiectasias develop in the majority of pregnant White women but are less often identified in women with darker skin. Hemangiomas and glomus tumors occur in one-third of women. A firm edema may develop on the face and extremities in the final months of pregnancy. Venous hypertension and varicosities of the lower limbs are common. Gingivitis, gum hypertrophy, and pyogenic granuloma are common in the oral cavity. The vaginal mucosa is also affected, showing a violaceous aspect, at times accompanied by varicosities of the vulva. Many gestational vascular changes regress spontaneously in the postpartum phase. Some vascular tumors may need to be treated with a vascular laser or intense pulsed light.

Clopidogrel (Plavix) desensitization: a case series.

Clopidogrel (Plavix) is a thiopyridine that inhibits the ADP-dependent pathway for platelet activation and has been shown in numerous trials to be effective for a wide variety of patients with cardiovascular disease, particularly those who have undergone coronary stent implantation and who present with acute coronary syndromes. Allergic rashes are one of the common side effects of clopidogrel, which leads to its discontinuation. Type I (Gell and Combs classification) allergic reactions to drugs may be amenable to drug desensitization, allowing safe and prolonged use of the drug. This case series describes a protocol for clopidogrel desensitization over an 8-hr period using 15 doubling doses of clopidogrel given by mouth to achieve a maintenance dose of 75 mg a day. This case series suggests that patients who have had type I drug allergy to clopidogrel may be rapidly desensitized using this protocol. Further studies enrolling a larger number of patients are indicated to confirm the safety and efficacy of this regimen.

Gyrate erythema in a patient with dental radicular cyst.

Nonspecific gyrate erythemas (NGE) are commonly associated with hypersensitivity reactions to exogenous or endogenous antigens. A case of NGE with clinical resemblance to tinea corporis in a patient with a dental radicular cyst is reported. Cutaneous lesions disappeared after surgical excision of the dental cyst. The clinical and pathological details are described and the relationship between radicular cyst and cutaneous lesions discussed. Earlier reports are reviewed and the possibility of a focal origin is emphasized.

Comparison of two cleansing pastes for the removal of biofilm from dentures and palatal lesions in patients with atrophic chronic candidiasis.

The efficacy of 2 oral hygiene products, an experimental toothpaste specific for complete denture cleansing and a regular standard toothpaste, was compared in terms of denture biofilm removal and cure of palatal lesions in patients with atrophic chronic candidiasis. The degree of correlation between presence of biofilm and mucosa erythema was also evaluated. Twenty-four complete denture wearers (45-80 years old) were divided into 2 groups: experimental paste and standard toothpaste (Sorriso-Kolynos, Brazil). Both groups received soft toothbrushes. The internal surfaces of upper dentures were stained using 1% sodium fluorescein and photographed at a 45 masculine angle at 0, 15, 30 and 60 days. The slides were scanned and the areas of interest (denture total area and biofilm area) were measured (Image Tool software). The degree of erythema was evaluated on slides according to the Prosthesis Tissue Index. There was a significant reduction (1%) in the degree of biofilm (ANOVA/Tukey) between the two initial visits (0 and 15 days) and the two final visits (30 and 60 days), and in the average erythema scores (Kruskal-Wallis) between 0 and 60 days, in both groups. The Mann-Whitney test showed a significant difference (1%) between pastes in terms of biofilm degree, but no difference was found for the erythema score. Correlation values between biofilm and erythema degree were 0.3801 (experimental paste) and (0.3678 (standard toothpaste). We may therefore conclude that the experimental product was efficient for the removal of denture plaque biofilm.