Cyanoacrylate skin surface stripping and the 3S-Biokit advent in tropical dermatology: a look from Liège.

In the dermatopathology field, some simple available laboratory tests require minimum equipment for establishing a diagnosis. Among them, the cyanoacrylate skin surface stripping (CSSS), formerly named skin surface biopsy or follicular biopsy, represents a convenient low cost procedure. It is a minimally invasive method collecting a continuous sheet of stratum corneum and horny follicular casts. In the vast majority of cases, it is painless and is unassociated with adverse events. CSSS can be performed in subjects of any age. The method has a number of applications in diagnostic dermatopathology and cosmetology, as well as in experimental dermatology settings. A series of derived analytic procedures include xerosis grading, comedometry, corneofungimetry, corneodynamics of stratum corneum renewal, corneomelametry, corneosurfametry, and corneoxenometry.

Melasma: treatment strategy.

Melasma, a hypermelanosis of the face, is a common skin problem of middle-aged women of all racial groups, especially with dark complexion. Its precise etio-pathogenesis is evasive, genetic influences, exposure to sunlight, pregnancy, oral contraceptives, estrogen-progesterone therapies, thyroid dysfunction, cosmetics, and drugs have been proposed. Centro-facial, malar, and mandibular are well-recognized. Epidermal pigmentation appears brown/black, while dermal is blue in color, and can be distinguished by Wood's lamp illumination. The difference may be inapparent with mixed type of melasma in skin types V and VI. An increase in melanin in epidermis: basal and suprabasal layers and/or dermis is the prime defect. There is an increased expression of tyrosinase related protein-1 involved in eumelanin synthesis. The use of broad-spectrum sunscreen is important, lightening agents like retinoic acid (tretinoin), azelaic acid, and combination therapies containing hydroquinone, tretinoin, and corticosteroids, have been used in the treatment of melasma, and are thought to have increased efficacy as compared with monotherapy. Quasi-drugs, placental extracts, ellagic acid, chamomilla extract, butylresorcinol, tranexamic acid, methoxy potassium salicylate, adenosine monophosphate disodium salt, dipropyl-biphenyl-2,2'-diol, (4-hydroxyphenyl)-2-butanol, and tranexamic acid cetyl ester hydrochloride, in addition to kojic and ascorbic acid have been used. Chemical peeling is a good adjunct. Laser treatment is worthwhile.

Surgical and Noninvasive Modalities for Scar Revision.

Scar revision is of premier importance to the dermatologic surgeon. Some of the least invasive modalities include use of silicone gel sheets, resurfacing with electrosurgical instruments, dermabrasion, chemical peels, and subcision. Laser technology also has been implemented to selectively target and ablate fibrous scar tissue via selective thermolysis. Other lasers have been used to target dyschromia associated with scar formation. Lastly, invasive modalities of scar revision include excisional modalities and/or rearrangement of skin to enhance cosmesis of unsightly or morbid scars. Herein is a discussion of the multiple modalities of scar revision as well as advantages and disadvantages of each.

A review of minimally invasive cosmetic procedures.

In today's society the desire to maintain a youthful appearance has driven the development of minimally invasive dermatological procedures that are designed to rejuvenate the ageing face. The aim of this review is to present evidence for the use of techniques which can easily be incorporated into outpatient dermatology practice with low overhead expenditure. For this reason, laser and light-based treatments have been omitted. This review will instead focus on chemical peels, intradermal fillers and botulinum toxin. These techniques address the main aspects of facial ageing, namely photodamage, volume loss and dynamic lines, which correlate anatomically to skin, subcutaneous fat and muscle. A combination of such techniques will provide the practitioner with a reasonable portfolio of treatments for a balanced, holistic result.

Excellent clinical results with a new preparation for chemical peeling in acne: 30% salicylic acid in polyethylene glycol vehicle.

BACKGROUND: Chemical peeling by salicylic acid in ethanol or another vehicle may be accompanied by stinging and burning followed by postinflammatory hyperpigmentation in the treated area, or salicylism. We have developed a new formulation: 30% salicylic acid in polyethylene glycol (SA-PEG). A topical application of SA-PEG remodels photodamaged skin in mice and humans, without systemic absorption. OBJECTIVE: The objective was to evaluate the safety and efficacy of SA-PEG for clinical use in the treatment of acne. MATERIALS AND METHODS: We evaluated the effects of the preparation histologically in mice and its safety and efficacy in 44 volunteers with normally aged skin and in 436 patients with acne. RESULTS: Histologic studies in animals showed no inflammatory changes in the skin following topical application of SA-PEG. Volunteers noted an improved skin texture. In the acne patients, the comedones and papules disappeared, resulting in an excellent outcome. There was a notable absence of stinging and burning, edema, bleeding, or crusting in the treated area. CONCLUSION: The SA-PEG preparation appeared to be safe and effective, with minimal associated inflammation or adverse effects, even in Asian patients who tend to develop hyperpigmentation or keloids. This preparation is thus ideal for chemical peeling.

A peel-off facial mask comprising myoinositol and trehalose-loaded liposomes improves adult female acne by reducing local hyperandrogenism and activating autophagy.

BACKGROUND: Hyperandrogenism and reduced skin autophagy have been implicated in the pathogenesis of adult female acne (AFA). Here, we tested whether a ready-to-use peel-off facial mask containing myoinositol (an androgen inhibitor) and trehalose-loaded liposomes (as activators of cutaneous autophagy) applied overnight every other day for 60 days can improve AFA. We also sought to investigate the molecular mechanisms underlying the clinical effects. OBJECTIVES: We conducted an uncontrolled, open-label clinical study in 40 cases of AFA to investigate the effect of the facial mask on lesion count, sebum production (measured with the Sebutape® technique), and Global Acne Grading System (GAGS) scale. We also investigated the changes from baseline to the end of treatment in androgen and beclin-1 levels (as a marker of authophagy) in skin biopsy supernatants. METHODS: Forty Caucasian patients with AFA were enrolled. Changes in clinical and molecular endpoints before and after treatment were investigated. RESULTS: The mean counts of comedones, papules, pustules, and nodular lesions decreased significantly (all P<.001). The mean Sebutape® score was reduced from 3.4±0.6 to 1.8±0.2 (P<.001), whereas the mean GAGS scale score decreased from 16.8±5.3 at baseline to 9.8±4.6 after treatment (P<.001). A significant decrease in testosterone and dehydroepiandrosterone sulfate in skin biopsy supernatants was observed, whereas beclin-1 levels increased significantly (P<.001). CONCLUSION: A ready-to-use peel-off facial mask containing myoinositol and trehalose-loaded liposomes improved the cosmetic appearance of AFA by reducing cutaneous androgen content and promoting skin autophagy.

The PAVE (peeling-assisted volume-enhancing) lift: A retrospective 6-year clinical analysis of a combined approach for facial rejuvenation.

The peeling-assisted volume-enhancing (PAVE) lift is a single-stage approach that combines superficial musculoaponeurotic system (SMAS) plication techniques with fat grafting and different peeling agents. To evaluate the safety of this approach, we analyzed the records of 159 patients who underwent surgery between 2008 and 2014. The percentage of complications observed was not higher than values reported in the literature for each treatment entity: surgical facelift: n=3 haematomas (1.89 %), n=2; temporary apraxia of the mandibular branch (1.26%); fat transfer: minor asymmetry in n = 5 cases (3.14%); peeling: temporary hyperpigmentation in trichloroacetic acid (n = 5; 3.8%) and phenol peels (n = 4; 3.1%), permanent hypopigmentation (n = 6; 5.6%), formation of skin miliae persisting longer than 2 to 3 months (n = 5; 4.6%) and prolonged erythema (n = 3; 0.28%) in phenol peels. The single-stage use of chemical peels, autologous fat transfer, and surgical rhytidectomy was safe.

Lasers and cosmetic dermatologic surgery for aging skin.

Many topical agents and physical modalities have been used throughout the years to give the face a more youthful appearance. The goal has always been to effectively and consistently rejuvenate the face while minimizing the time of recovery and risk for complications. Because each person is unique, there is no one modality that is best for everyone. This article reviews some of the options available for treating photoaged skin in 2001. Various lasers (e.g., vascular lesion, pigmented lesion, hair removal, and resurfacing), botulinum A toxin, chemical peels, and various dermal and subcutaneous filler substances all are discussed.

Improving patient appearance. A look at adjunct maxillofacial soft tissue surgery.

Adjunctive esthetic procedures, performed with the more traditional oral and maxillofacial surgery, can improve patients' total facial appearance. Three examples illustrate dramatic improvements.

Cosmetic oral and maxillofacial surgery.

The dental specialty of oral and maxillofacial surgery over the last fifteen years has been intimately involved in not only altering the bony facial skeleton, but also the esthetic defects of the facial soft tissue drape. These procedures are currently being taught, in many of our residency programs, along side the art and science of dentoalveolar surgery. When one combines the modification of both the skeletal and soft tissues, the resultant effect can be greater than the sum of its parts. Should one take this a step further and add to the list, proper arch form as prepared by the orthodontist along with cosmetic shape and appearance of the dentition by the restorative dentist using the latest in cosmetic dental techniques, what transforms is a result that has never been seen heretofore in the annals of dentofacial care. To follow are a number of case reports illustrating some salient points.

Comparative study of the effect of 50% pyruvic and 30% salicylic peels on the skin lipid film in patients with acne vulgaris.

UNLABELLED: Pyruvic (alfa-keto acid) and salicylic (beta-hydroxy acid) acids are superficial peels frequently used in patients with acne vulgaris. AIM: The aim of the study was to compare the effect of 50% pyruvic and 30% salicylic peels on facial sebum secretion in patients with acne vulgaris, aged 13-30. MATERIAL AND METHODS: The level of secreted sebum was determined in 20 men and women. Ten patients were treated with 50% pyruvic acid and the remaining 10 with 30% salicylic acid. Each peel was applied five times at 2-week intervals. The sebum measurements were taken in the T- and U-zones using a Sebumeter SM 815 (Courage & Khazaka, Germany). The last, sixth measurement was taken 2 weeks after the treatment. RESULTS: A statistically significant decrease in the level of secreted sebum in both U- and T- zones was observed in the patients studied after the third application of 50% pyruvic peel and the second application of 30% salicylic peel. Two weeks following the completion of therapy, sebumetric measurements demonstrated a greater reduction in the facial skin lipid film among the patients treated with salicylic peel. CONCLUSIONS: Peels with 50% pyruvic acid and 30% salicylic acid are the procedures that significantly contributed to a decrease in the level of secreted sebum on the facial skin surface in the group of patients studied. A greater therapeutic effect was observed following 30% salicylic peel, which might be associated with its high lipophilic properties and easier penetration through the lipid barriers of the epidermis.

A single-blinded comparative study between the use of glycolic acid 70% peel and the use of topical nanosome vitamin C iontophoresis in the treatment of melasma.

BACKGROUND: Melasma is a common pigmentary disorder. Despite the availability of a wide range of skin-lightening treatments, melasma of skin remains a therapeutic challenge. OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of nanosome vitamin C iontophoresis and to compare the therapeutic effects of nanosome vitamin C iontophoresis vs. glycolic acid peel 70% in the treatment of melasma in Egyptian women. METHODS: This study included 14 patients of melasma with skin type IV-V taken for a right-left comparison study of six sessions. Glycolic acid 70% peel was applied on the right side, whereas nanosome vitamin C was applied by iontophoresis on the other side. The results are evaluated using the melasma area and severity index score and with photographs at baseline and after six sessions. Also the photographs were evaluated by two single-blinded physicians before and after sessions. RESULTS: Both sides were improved, but the side treated with nanosome vitamin C showed better results. Side effects were few and transient. CONCLUSION: We concluded that nanosome vitamin C is a new, safe and effective, easy and painless method in the treatment of melasma.

Management of acne scarring, part II: a comparative review of non-laser-based, minimally invasive approaches.

Acne scarring is a commonly encountered yet extremely challenging problem to treat for the dermatologist. As acne scarring can lead to significant psychological distress and low self-esteem, it is of utmost importance to have effective and satisfying treatments in the physician's armamentarium. However, many treatments are unsatisfying, leading to patient disappointment and frustration. Although early treatment of acne lesions and inflammation with isotretinoin is beneficial in preventing acne scarring, many patients still present with troubling noticeable scars. Despite the advances in pharmacology and technology, scar treatment still remains suboptimal and is tainted with several adverse effects. However, some treatments can provide benefits. This review article exhaustively discusses and analyzes the various minimally invasive approaches to the treatment of acne scarring with an emphasis on pharmacologic agents, such as isotretinoin for atrophic acne scars and corticosteroids and chemotherapeutic drugs for hypertrophic scars. Intralesional injections of corticosteroids are efficacious in reducing keloid scar formation in addition to preventing recurrence following surgical excision. In-office and minimally invasive procedural management, including chemical peels, dermabrasion, tissue augmentation, and punch excision is also discussed. Superficial chemical peels are efficacious in treating atrophic scars with relatively few adverse effects and complications. Although dermabrasion is used less often with the advent of laser resurfacing, this technique remains as a viable option for those with atrophic scars. Post-inflammatory hyperpigmentation can be managed successfully with topical agents such as azelaic acid and hydroquinone. The efficacy of various treatment modalities is highlighted with a focus on choosing the correct modalities for specific scar types.

Evaluation of CROSS technique with 100% TCA in the management of ice pick acne scars in darker skin types.

BACKGROUND: Acne scars are difficult to treat. Chemical reconstruction of skin scars (CROSS) is a technique using high strength trichloroacetic acid (TCA) focally on the atrophic acne scars to induce collagenization and cosmetic improvement. OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of CROSS technique using 100% TCA in ice pick scars in dark skin types IV and V. METHODS: Thirty patients with ice pick acne scars were initially primed for 2 weeks before the procedure. The priming agents used were hydroquinone 4% applied in the morning and tretinoin 0.025% in the night. Sunscreens were advised to prevent postinflammatory hyperpigmentation. Subsequently, they underwent focal application of 100% TCA with a wooden toothpick in each individual scar, at 2 weekly intervals, for four sessions. Improvement was assessed by the physician, photographic assessment by an independent investigator, and patient feedback by visual analogue scale after the fourth treatment. RESULTS: Excellent improvement (more than 70%) was observed in the majority of patients (73.3%), while 20% patients showed good improvement (50-70%) and 6.7% patients had fair results (30-49%) at the end of four sessions. Transient hypopigmentation was observed in one patient and hyperpigmentation in two patients. However, no significant adverse effects such as prolonged pigmentary changes or scarring were noted. CONCLUSION: Treatment of ice pick acne scars with the CROSS technique using high strength 100% TCA is a safe, minimally invasive, efficacious, and cost-effective technique in darker skin. Adequate priming and continued use of hydroquinone and tretinoin reduces complications and promotes healing.

Aging well--the role of minimally invasive aesthetic dermatological procedures in women over 65.

BACKGROUND: The western world is getting older. Aging well has become the new target of preventative medicine. Aesthetic dermatology can contribute to this quest. Females over 65 represent an important and growing group of consumers of cosmetic procedures. In this group, there is a paucity of scientific evaluation of aesthetic procedures. OBJECTIVE: To review the use of minimally invasive procedures for facial rejuvenation in women over 65. METHODS: Drawing from both the literature and personal experience, the opportunities, modifications, and limitations of minimally invasive techniques for facial rejuvenation in older women are considered. RESULTS: In this older age group, dermal fillers, chemical and laser peels, and nonablative photorejuvenation remain useful and can each be used as stand-alone treatments. In this age group, botulinum toxin (BTX) injections are more often used in combination with other procedures. CONCLUSIONS: With respect to aesthetic procedures, women over 65 are different from younger women. More scientific investigation is necessary to better meet needs of this growing part of the population. Available data suggest that aesthetic dermatology can make a major contribution to the complex matter of aging well.

Recontouring, resurfacing, and scar revision in skin cancer reconstruction.

Residual disfigurement is a common problem for patients who have undergone skin cancer reconstruction. Restoring form and function in these patients is an artistic and technical endeavor. The efficacy of surgical scar revision, dermabrasion, chemical peels, and laser resurfacing is predicated upon the skin's innate ability to regenerate over time in response to mechanical, chemical, and thermal or ablative stresses. The patient and surgeon should be accepting of a process that is often gradual and may proceed in stages. Achieving proficiency with the secondary procedures for improving scars and local flaps may allow the motivated surgeon to mold an initially passable surgical result into an excellent one.