Late-Onset Reactions after Hyaluronic Acid Dermal Fillers: A Consensus Recommendation on Etiology, Prevention and Management.

Hyaluronic acid (HA) dermal fillers, generally considered low-risk, can lead to rare late-onset reactions (LORs) manifesting between 3 and 4 months postinjection, occasionally even as early as 24 h postinjection. The Complication Assessment and Risk Evaluation (CARE) board was established to review these reactions. In this publication, the authors aims to explore the etiological hypotheses underlying LORs, associated risk factors, prevention, and management approaches suggested by the CARE board. The CARE board identified three etiological hypotheses contributing to LORs. Firstly, the physicochemical structure of the filler, particularly low molecular weight HA, which may trigger an immune response. Secondly, infection, potentially introduced during injection or by dormant biofilm activation. Lastly, an imbalance in the host immune system, caused by factors like autoimmune diseases or viral infections, may lead to extended foreign body reactions, delayed type IV hypersensitivity, or adjuvant-based reactions. Based on these hypotheses, the board categorized various risk factors as patient-related (e.g., recent dental treatment, current medical status, active autoimmune disease), product-related (e.g., molecular weight), and procedure-related (e.g., aseptic technique and trauma). To reduce the risk of LORs, the CARE board recommends diligent patient selection, including comprehensive medical history assessment and informed consent. Practitioners should maintain an effective aseptic technique, and choose an appropriate product and injection depth for the anatomical location. Post-procedure, patients should receive education on proper filler care. Management of LORs depends on the suspected etiology, and the CARE board has proposed an algorithm to determine the most appropriate treatment. Hyaluronidase is recommended for noninflammatory reactions in the absence of active infection, while watchful waiting and/or steroid treatment may be preferred for inflammatory reactions. Hyaluronidase is not recommended as a first-line treatment for infections, which require drainage, bacterial culture, and antibiotic treatment. However, the board emphasizes the need for individualized evaluation and treatment in all cases.

Triamcinolone Injection in the Treatment of Malar Edema.

INTRODUCTION: Tear-through deformities can be a detectable sign of facial aging. Over recent years, minimally invasive procedures such as hyaluronic acid filler injections have been shown to be effective in improving this area. Malar edema is the accumulation of fluid over the malar eminence persisting for 1 month or more. Given its nature, the management remains problematic. The most commonly reported treatment modality is injection with hyaluronidase. OBJECTIVES: To determine the safety and efficacy of triamcinolone injection in the treatment of malar edema. METHODS: A total of 15 female patients with malar edema, with a mean age of 43.77 years, were treated with triamcinolone injections. The volume injected was chosen by the investigator. Prior to the triamcinolone injection, all patients had been treated with hyaluronidase, which turned out to be ineffective in all cases. Patients were asked to note all adverse effects. RESULTS: Satisfactory results were achieved after a single treatment session for 14 patients and after two treatments for one patient. Overall, injections with triamcinolone were well tolerated and no adverse reactions were reported. CONCLUSIONS: Injection with triamcinolone appears to be a safe and effective option for the management of malar edema following hyaluronic acid filler injection. Nevertheless, further research with larger patient groups is compulsory.

The Study of Antistaphylococcal Potential of Omiganan and Retro-Omiganan Under Flow Conditions.

Staphylococcus aureus is considered one of the leading pathogens responsible for infections in humans and animals. The heterogeneous nature of diseases caused by these bacteria is due to the occurrence of multiple strains, differentiated by several mechanisms of antibiotic resistance and virulence factors. One of these is the ability to form biofilm. Biofilm-associated bacteria exhibit a different phenotype that protects them from external factors such as the activity of immune system or antimicrobial substances. Moreover, it has been shown that the majority of persistent and recurrent infections are associated with the presence of the biofilm. Omiganan, an analog of indolicidin - antimicrobial peptide (AMP) derived from bovine neutrophil granules, was found to exhibit high antistaphylococcal and antibiofilm potential. Furthermore, its analog with a reversed sequence (retro-omiganan) was found to display enhanced activity against a variety of pathogens. Based on experience of our group, we found out that counterion exchange can improve the antistaphylococcal activity of AMPs. The aim of this study was to investigate the activity of both compounds against S. aureus biofilm under flow conditions. The advantage of this approach was that it offered the opportunity to form and characterize the biofilm under more controlled conditions. To do this, unique flow cells made of polydimethylsiloxane (PDMS) were developed. The activity against pre-formed biofilm as well as AMPs-treated bacteria was measured. Also, the incorporation of omiganan and retro-omiganan into the channels was conducted to learn whether or not it would inhibit the development of biofilm. The results of the microbiological tests ultimately confirmed the high potential of the omiganan and its retro-analog as well as the importance of counterion exchange in terms of antimicrobial examination. We found out that retro-omiganan trifluoroacetate had the highest biofilm inhibitory properties, however, acetates of both compounds exhibited the highest activity against planktonic and biofilm cultures. Moreover, the developed methodology of investigation under flow conditions allows the implementation of the studies under flow conditions to other compounds.

Influence of UV nail lamps radiation on human keratinocytes viability.

Ultraviolet nail lamps are becoming increasingly popular, however, the safety of their use remains controversial. The following article directly responds to recently published literature data and aims to determine the viability of human keratinocytes irradiated by a UV nail-drying machine. Cells were exposed to 365-405 nm wavelength UV light emitted by a nail drying machine in two time variants: 4 and 20 min, with and without sunscreen cream SPF50 protection, and compared to the untreated control. Compared to the control, cell viability after irradiation for 4 min decreased insignificantly (p < 0.1), however for 20 min decreased by 35% (p < 0.0001). Furthermore, cells with sunscreen protection compared to those without showed significantly increased viability, regardless of time-variant (p < 0.0001). The study shows that 4-min irradiation does not significantly reduce the viability of human keratinocytes and the time of 20 min significantly alters the research results compared to 4 min, which corresponds to real conditions. The results suggest that typical manicure exposure time does not significantly affect keratinocyte viability, which could increase the risk of developing skin cancers. Despite the above results, it is recommended to use sunscreen protection on your hands during the procedure, which significantly increases the viability of keratinocytes during ultraviolet nail lamp radiation.

Interdisciplinary approach to synthesis, stability and antimicrobial activity of silver nanoparticles.

Introduction: Chronic wounds are an increasing problem for health care all over the world. New treatment options for this illness are desired, especially antimicrobial agents. Silver nanoparticles (AgNPs) can be a potential substance that may be used in treatment of chronic wounds due to the growing antibiotic resistance. Aim: To synthetize silver nanoparticles that are stable, pure and effective against bacteria. Material and methods: The synthesis was conducted with chemical methods using different coating factors. The antistaphylococcal properties were analysed with the microdilution method to determine minimal inhibition concentrations (MIC) value. AgNPs were purified by dialysis. Moreover, keratinocyte cytotoxic properties of AgNPs were also assessed. Results: A method of synthesizing stable and efficient AgNPs has been developed. The type of the coating substance has a significant effect on AgNPs antimicrobial properties. Most of the silver nanoparticles, synthesized based on literature data, turned out to be durable during a few hours. This study has proven that depending on the coating factor, AgNPs stability ranges from 4 weeks to even 12 months. Unfortunately, the type of the stabilizer used also affects the cytotoxicity of AgNPs. It has been shown that dialysis is a substance purification method that is cheap, simple and easy to apply when dealing with high volume solutions. Conclusions: AgNPs could be an alternative to widely used antibiotics and disinfectants. Nevertheless, the introduction of those substances to health care requires detailed long-term research not only in the field of safe use, yet also durability and purity of AgNPs solutions used.

An original study of ChatGPT-3.5 and ChatGPT-4 Dermatological Knowledge Level based on the Dermatology Specialty Certificate Examinations.

BACKGROUND: The global use of artificial intelligence has the potential to revolutionize the healthcare industry. Despite the fact that artificial intelligence is becoming more popular, there is still a lack of evidence on its use in dermatology. OBJECTIVE: The study aimed to determine the capacity of ChatGPT-3.5 and ChatGPT-4 to support dermatological knowledge and clinical decision-making in medical practice. METHODS: Three dermatology specialty certificate tests, in English and Polish, consisting of 120 single-best-answer, multiple-choice format questions each, were used to assess ChatGPT-3.5 and ChatGPT-4 performance. RESULTS: ChatGPT-4 exceeded the 60% pass rate in every performed test, with a minimum of 80% and 70% correct answers for the English and Polish versions, respectively. ChatGPT-4 performed significantly better on each exam (p<0.01), regardless of the language, compared to ChatGPT-3.5. Furthermore, ChatGPT-4 answered clinical picture-type questions with an average accuracy of 92.98% and 84.21% for English and Polish questions respectively. The difference between the tests in Polish and English did not turn out to be significant but still, ChatGPT-3.5 and ChatGPT-4 in English performed better overall than in Polish by an average of 8 percentage points for each test. Incorrect ChatGPT answers were highly correlated with a lower difficulty index, which denotes questions with higher difficulty in most of the tests. (p<0.05). CONCLUSION: The dermatological knowledge level of ChatGPT was high, with a significantly better performance of ChatGPT-4 than ChatGPT-3.5. Although the use of ChatGPT will not replace the doctor's final decision, physicians should support artificial intelligence development in dermatology to raise the standards of medical care.

Are YouTube videos a reliable source of information about body dysmorphic disorder?

Purpose: Body dysmorphic disorder (BDD) is characterized by a preoccupation with a non-existing or minimal defect in appearance. It affects around 2% of the population, causes distress in daily functioning and reduces the quality of life. The aim of this study was to evaluate the usefulness and the quality of the most viewed videos regarding BDD on YouTube. Methods: YouTube was searched for the keywords "body dysmorphia" and "dysmorphophobia". The validated DISCERN instrument and the Global Quality Score (GQS) were used to assess video quality. The Video Power Index (VPI) score was used to evaluate the popularity of videos. Results: Only 3 videos were rated as good quality based on the DISCERN criteria. The mean DISCERN score between the raters was 32.89 ± 9.23, while the mean GCQ score was 2.84 ± 1.03. Even though only 23.7% of the videos were uploaded by a healthcare source, there was a significant difference between DISCERN scores depending on the source of the video: healthcare - 42 mean vs. non-healthcare - 30.07 mean (p = 0.0035). The mean score for the VPI was 2757 (range, 244.57-11,647.12). Conclusions: Our study showed that the quality of BDD-related videos on YouTube is poor. Physicians or healthcare organizations should publish more medical content on YouTube, increasing the amount of more reliable and better-quality content for patients.

Staphylococcus aureus from Atopic Dermatitis Patients: Its Genetic Structure and Susceptibility to Phototreatment.

We characterized the population of Staphylococcus aureus from patients with atopic dermatitis (AD) in terms of (i) genetic diversity, (ii) presence and functionality of genes encoding important virulence factors: staphylococcal enterotoxins (sea, seb, sec, sed), toxic shock syndrome 1 toxin (tsst-1), and Panton-Valentine leukocidin (lukS/lukF-PV) by spa typing, PCR, drug resistance profile determination, and Western blot. We then subjected the studied population of S. aureus to photoinactivation based on a light-activated compound called rose bengal (RB) to verify photoinactivation as an approach to effectively kill toxin-producing S. aureus. We have obtained 43 different spa types that can be grouped into 12 clusters, indicating for the first-time clonal complex (CC) 7 as the most widespread. A total of 65% of the tested isolates had at least one gene encoding the tested virulence factor, but their distribution differed between the group of children and adults, and between patients with AD and the control group without atopy. We detected a 3.5% frequency of methicillin-resistant strains (MRSA) and no other multidrug resistance. Despite genetic diversity and production of various toxins, all isolates tested were effectively photoinactivated (bacterial cell viability reduction ≥ 3 log10 units) under safe conditions for the human keratinocyte cell line, which indicates that photoinactivation can be a good option in skin decolonization. IMPORTANCE Staphylococcus aureus massively colonizes the skin of patients with atopic dermatitis (AD). It is worth noting that the frequency of detection of multidrug-resistant S. aureus (MRSA) in AD patients is higher than the healthy population, which makes treatment much more difficult. Information about the specific genetic background of S. aureus accompanying and/or causing exacerbations of AD is of great importance from the point of view of epidemiological investigations and the development of possible treatment options.

Multidisciplinary Treatment in Toxic Epidermal Necrolysis.

Toxic epidermal necrolysis, Leyll's syndrome (TEN), is a rare mucocutaneous blistering disease burdened with high mortality rates. The diagnosis of TEN is based on clinical symptoms and histopathological findings. In approximately 90% of cases, it is a severe adverse reaction to drugs. In TEN, not only is the skin affected, but also mucosa and organs' epithelium. There are no unequivocal recommendations in regard to systemic and topical treatment of the patients. The aim of this paper is to review available literature and propose unified protocols to be discussed. Early management and multidisciplinary treatment are necessary to improve patients' outcome. Treatment of patients with TEN suspicions should be initiated with early drug withdrawal. TEN patients, like patients with burns, require intensive care and multidisciplinary management. Each patient with TEN should be provided with adequate fluid resuscitation, respiratory support, nutritional treatment, pain control, infection prophylaxis, anticoagulant therapy, and gastric ulcer prophylaxis. The key to local treatment of patients with TEN is the use of nonadherent dressings that do not damage the epidermis during the change. The aim of the systemic treatment is purification of the blood stream from the causative agent. The most efficient way to clarify serum of TEN patients' is the combination of plasmapheresis and IVIG. Immunomodulatory therapy can reduce the mortality five times in comparison with the patients with immunosuppression or lack of full protocol.

Comparison of the efficacy of novel non-invasive mechanical debridement methods - sterile sponge, monofilament fibre cloth and non-woven cloth impregnated with sodium hyaluronate and phospholipids in relation to traditional sterile gauze.

Introduction: According to the European guidelines, the first step for local wound preparation is debridement, which stands for removing of devitalized tissue such as slough or necrosis. There are numerous types of debridement, but not all of them can be performed by non-specialists. Most of the research investigating efficiency of novel debridement products are carried out or funded by pharmaceutical companies. Aim: To compare the efficacy of relative necrotic tissue removal after 30 days on patients subjected to debridement with sterile sponge, monofilament fibre cloth, non-woven cloth impregnated with sodium hyaluronate and phospholipids and traditional sterile gauze. Material and methods: By use of photographic documentation at 7 days' intervals and planimetry methods, the total wound surface area and sloughy tissue area was measured. Results: Results have shown that monofilament cloth was the most effective, removing on average 63.44 ±32.91% of necrotic tissue after the first procedure and 74.65 ±30.95% within 30 days of application, in comparison to the sterile gauze group that had on average only 23.53 ±19.16% of necrotic tissue removed at day 0 and 44.95 ±31.47% removed at day 30. Moreover, patients using all 3 products tested reported higher satisfaction with that treatment than those treated with gauze. Conclusions: Results imply that all those methods could be considered as they are well accepted by patients and cause less pain during the procedure, which is essential for good compliance and complete resolution of the lesions.

Microbiome in Hidradenitis Suppurativa-What We Know and Where We Are Heading.

Recently, interest in the microbiome of cutaneous diseases has increased tremendously. Of particular interest is the gut-brain-skin axis proposed by Stokes and Pillsbury in 1930. The microbiome has been suggested in the pathogenesis of hidradenitis suppurativa, however the link between the commensals and the host is yet to be established. Across all studies, the increased abundance of Porphyromonas, Peptoniphilus, and Prevotella spp., and a loss of skin commensal species, such as Cutibacterium in HS lesions, is a consistent finding. The role of gut and blood microbiome in hidradenitis suppurativa has not been fully elucidated. According to studies, the main link with the intestine is based on the increased risk of developing Crohn's disease and ulcerative colitis, however, further research is highly needed in this area. Lifestyle, dietary approaches, and probiotics all seem to influence the microbiome, hence being a promising modality as adjuvant therapy. The aim of this review was to present the latest reports in the field of research on skin, blood, and gut microbiome in terms of hidradenitis suppurativa.

Immunomodulatory Drugs in the Treatment of Hidradenitis Suppurativa-Possibilities and Limitations.

Hidradenitis suppurativa, also known as acne inversa, is a chronic, progressive, debilitating, recurrent inflammatory skin disease characterized by the occurrence of very severe, persistent, painful nodules, abscesses, and fistulas, most commonly found in the skin folds of the axilla, groin, gluteal, and perianal areas. Treatment is rather difficult and typically requires the use of multiple modalities. Regardless of the presence of several therapeutic options, treatment often turns out to be ineffective or poorly selected concerning the clinical picture of the disease. Thus, the search for new biologics and other target treatments of hidradenitis suppurativa is ongoing. The safety and efficacy of adalimumab, still the only U.S. Food and Drug Administration approved biologic in the hidradenitis suppurativa treatment, paved the way for new drugs to be compared with it. Several more drugs with new immunological targets are currently under investigation for the treatment of acne inversa. The aim of the article was to present the current and future targets of acne inversa treatment, simultaneously providing insights into the molecular pathomechanisms of the disease.

Wound debridement products and techniques: clinical examples and literature review.

The term "debridement" stands for the removal of necrotic material, scabs, devitalized tissues, dried serous fluid, infected tissues, biofilm, stratified epidermis, pus, hematomas, foreign bodies, bone fragments and other impurities whose presence delays wound healing. It is an inseparable element of wound healing therapy. Properly performed debridement leads to improvement of microcirculation in the wound, reduction in inflammation and lowering of the level of metalloproteinases, stimulation of wound edges and epidermis, reduction in unpleasant odour and reduction in the risk of infection and improvement of the patient's quality of life. There are many debridement techniques approved by the European Wound Management Association. The selection of the most appropriate method depends on many factors such as tissue type, presence of biofilm, depth and location of the wound, underlying cause (venous, arterial), skills of the person performing the debridement and the preferences of the patient him/herself. In our work we present not only a systematic review of most of the debridement techniques used nowadays, but also our clinical cases showing results of those different techniques.

Off-Label Use of Botulinum Toxin in Dermatology-Current State of the Art.

Botulinum toxin (BoNT) is a neurotoxin produced by the Clostridium botulinum bacteria. Among seven different isoforms, only BoNT-A and BoNT-B are commercially used. Currently, botulinum toxin has been indicated by the U.S. Food and Drug Administration in several disorders, among others: chronic migraine, hyperhidrosis, urinary incontinence from detrusor overactivity, or cosmetics. However, there are numerous promising reports based on off-label BTX usage, indicating its potential effectiveness in other diseases, which remains unknown to many. Among them, dermatological conditions, such as rosacea, annal fissure, Raynaud phenomenon, hypertrophic scars and keloids, and also hidradenitis suppurativa, are currently being investigated. This article aims to provide a comprehensive update on the off-label use of botulinum toxin in dermatology, based on an analysis and summary of the published literature.

Hidradenitis suppurativa: a review of current treatment options.

Hidradenitis suppurativa (HS) is a chronic, progressive, debilitating, recurrent inflammatory skin disease characterized by the occurrence of very severe, persistent, painful nodules, abscesses, and fistulas, most commonly found in the skin folds of the axilla, groin, gluteal, and perianal areas. The pathogenesis of HS is still not completely understood; currently, it is considered to be an immune-mediated inflammatory illness (IMID). Due to the significant decrease in the patients' quality of life and a delayed beginning of a treatment, the selection of the appropriate therapy is extremely important in these patients. Regardless of the fact that there are multiple treatment options for HS, no uniformly effective therapy has been found. All the guidelines underline the need for a multidisciplinary approach to the disease, which enables providers to create the right management of HS. This article aims to provide updates on the current treatment options of acne inversa to raise awareness and improve the management of the disease.

Larva de Attagenus na cavidade nasal em um paciente com complicações após o uso de preenchimento de ácido hialurônico / Attagenus larva in the sinus cavity in a patient with complications after the use of hyaluronic acid filler

Uma ampla variedade de preenchimentos dérmicos está agora disponível para uso na indústria da beleza. Apresentamos o caso de uma mulher de 33 anos com complicações após injeção de ácido hialurônico por um não médico. Duas semanas após a injeção, dor nos seios da face bilateral, febre e sensação de queimação ocorreram na área da bochecha. Ela foi submetida a um diagnóstico detalhado revelando larva de Attagenus nos seios paranasais. Apesar do tratamento, os sintomas continuaram presentes, sendo administrada hialuronidase na região infraorbital com remissão completa

A wide range of dermal fillers is now available for use in the beauty industry. We present a case of a 33-year-old woman with complications after hyaluronic acid injection by a non-medical practitioner. Two weeks after the injection, bilateral sinus pain, fever, and burning sensation occurred in the cheek area. She underwent a detailed diagnosis revealing Attagenus larva in the paranasal sinus. Despite treatment, the symptoms remained. Thus, hyaluronidase was administered in the infraorbital area, obtaining a full remission.

Could a handbook serve as a useful educational intervention in improving disease knowledge? A cross-sectional study among patients with hidradenitis suppurativa in Poland.

Introduction: Hidradenitis suppurativa (HS) is a chronic, recurrent inflammatory skin disease characterized by the occurrence of severe, painful nodules, abscesses, and fistulas, most commonly found in the skin folds of the axilla, groin, gluteal, and perianal areas. The disease is of interest to many researchers, however, verified information for patients is still limited. Aim: To evaluate the baseline knowledge about acne inversa among patients suffering from the disease as well as to assess whether an educational intervention as a handbook can improve patients' knowledge of their illness. Material and methods: This research study was a cross-sectional survey conducted on HS Facebook support group. The respondents completed an anonymized questionnaire assessing their state of knowledge about acne inversa. After 1 month they were presented with a handbook. Thereafter the patients completed nearly the same anonymized questionnaire assessing the state of knowledge after reading the handbook. Results: We enrolled 102 participants before (group A) and 30 participants after (group B) the educational intervention. The vast majority of the participants (83.3%) appraised the idea of preparing a handbook as 10 points. In both groups, respondents who were aware of their disease severity had significantly superior results than the participants who were not. After reading the handbook extensively, more patients assessed the state of their general HS knowledge as 'good' than before. Conclusions: Our study demonstrated that knowledge about HS among patients is still insufficient. Tools such as handbooks may prove useful in disseminating expertise and helping patients to understand their disease.

Antibiotic-Related Adverse Drug Reactions in Patients Treated on the Dermatology Ward of Medical University of Gdansk.

Adverse drug reactions (ADRs) are unexpected reactions to a medication administered in a correct way at a standard dose. Drug-induced skin reactions account for 60-70% of all ADRs. The aim of the study is to determine the prevalence of antibiotic-related dermatological ADR in patients treated in the department of Dermatology, Venerology and Allergology of the University Clinical Center in Gdansk, Poland, in the years 2004-2021. A retrospective analysis of patients' medical files was conducted in order to identify cases of ADR connected with the use of antibiotics, yielding 84 cases. The most common group of antibiotics were ß-lactam, causing ADR in 47 patients. ß-lactam antibiotics in our study included amoxicillin, alone and combined with clavulanic acid, and cephalosporins, affecting 22, 18 and 7 patients, respectively. In conclusion, ß-lactam antibiotics showed the highest prevalence among antibiotic-induced skin reactions. They accounted for 15% of cases of all dermatological drug reactions and 55% of those caused by antibiotics. Especially amoxicillin, prescribed as a single drug or in combination with clavulanic acid, was commonly the culprit. Due to its wide use in the hospital and outpatient clinic, these adverse reactions have to be kept in mind by both hospital staff and general practitioners.