Solamargine Alleviated UVB-Induced Inflammation and Melanogenesis in Human Keratinocytes and Melanocytes via the p38 MAPK Signaling Pathway, a Promising Agent for Post-inflammatory Hyperpigmentation.

Post-inflammatory hyperpigmentation (PIH) is a common acquired pigmentary disorder occurring after skin inflammation or injury. Ultraviolet B irradiation could exaggerate PIH clinically due to its effect on promoting cutaneous inflammation and melanogenesis in keratinocytes and melanocytes, respectively. Solamargine (SM), a steroidal alkaloid glycoside extracted from Solanum undatum, significantly inhibits Ultraviolet B (UVB)-induced pro-inflammatory cytokines IL-1α, IL-1ß, IL-8, and IFN-γ, as well as paracrine melanogenic factors ET-1, α-MSH, and bFGF in human keratinocytes. Additionally, SM significantly attenuated UVB-induced melanin synthesis in human epidermal melanocytes through down-regulation of tyrosinase activity and expression of MITF, TRP-1, TRP-2, and tyrosinase. SM exerted an anti-inflammatory effect in UVB-irradiated keratinocytes through the p38 MAPK/Nrf2/HO-1 signaling pathway. With its anti-inflammatory and whitening effect, SM may improve PIH through paracrine regulations of keratinocytes and direct action on melanocytes, making it a promising agent for PIH.

Guideline for the diagnosis, treatment and long-term management of cutaneous lupus erythematosus.

Cutaneous lupus erythematosus (CLE) is an inflammatory, autoimmune disease encompassing a broad spectrum of subtypes including acute, subacute, chronic and intermittent CLE. Among these, chronic CLE can be further classified into several subclasses of lupus erythematosus (LE) such as discoid LE, verrucous LE, LE profundus, chilblain LE and Blaschko linear LE. To provide all dermatologists and rheumatologists with a practical guideline for the diagnosis, treatment and long-term management of CLE, this evidence- and consensus-based guideline was developed following the checklist established by the international Reporting Items for Practice Guidelines in Healthcare (RIGHT) Working Group and was registered at the International Practice Guideline Registry Platform. With the joint efforts of the Asian Dermatological Association (ADA), the Asian Academy of Dermatology and Venereology (AADV) and the Lupus Erythematosus Research Center of Chinese Society of Dermatology (CSD), a total of 25 dermatologists, 7 rheumatologists, one research scientist on lupus and 2 methodologists, from 16 countries/regions in Asia, America and Europe, participated in the development of this guideline. All recommendations were agreed on by at least 80% of the 32 voting physicians. As a consensus, diagnosis of CLE is mainly based on the evaluation of clinical and histopathological manifestations, with an exclusion of SLE by assessment of systemic involvement. For localized CLE lesions, topical corticosteroids and topical calcineurin inhibitors are first-line treatment. For widespread or severe CLE lesions and (or) cases resistant to topical treatment, systemic treatment including antimalarials and (or) short-term corticosteroids can be added. Notably, antimalarials are the first-line systemic treatment for all types of CLE, and can also be used in pregnant patients and pediatric patients. Second-line choices include thalidomide, retinoids, dapsone and MTX, whereas MMF is third-line treatment. Finally, pulsed-dye laser or surgery can be added as fourth-line treatment for localized, refractory lesions of CCLE in cosmetically unacceptable areas, whereas belimumab may be used as fourth-line treatment for widespread CLE lesions in patients with active SLE, or recurrence of ACLE during tapering of corticosteroids. As for management of the disease, patient education and a long-term follow-up are necessary. Disease activity, damage of skin and other organs, quality of life, comorbidities and possible adverse events are suggested to be assessed in every follow-up visit, when appropriate.

Effects of Solanum undatum extract (SR-T100) on photocarcinogenesis and photoaging of actinic keratosis.

SR-T100 gel, containing solamargine extracted from Solanum undatum (synonym: Solanum incanum), had good therapeutic effects on actinic keratosis (AK) in human and ultraviolet B-induced papilloma in mice. This study aimed to investigate the immunohistochemical changes in the human skin after SR-T100 treatment. An immunohistochemical study was performed and the changes in photocarcinogenesis and photoaging markers after 16-week SR-T100 gel treatment were documented. SR-T100 gel treatment for 16 weeks resulted in complete remission in nine AK lesions and partial remission in four AK lesions. SR-T100 gel abolished the expression of mutant p53 and SOX2 and restored the expression of NOTCH1. Additionally, SR-T100 gel improved wrinkling in human skin, while restoring the expression of lamin B1 and increasing synthesis of new elastic fibers. SR-T100 gel had therapeutic effects on photocarcinogenesis and photoaging of photodamaged skin with AK.

Progress in the Use of Platelet-rich Plasma in Aesthetic and Medical Dermatology.

Platelet-rich plasma (PRP) has been receiving considerable attention in the field of dermatology since the elucidation of its mechanism and reports of its clinical efficacy. PRP alone or in combination with other therapies has demonstrated benefits for some cosmetic problems and skin diseases. Only a few transient or short-term side effects have been reported with the use of PRP. In this review, we highlight the potential efficacy and benefits of PRP with a focus on its applications in skin rejuvenation, androgenic alopecia, alopecia areata, chronic vitiligo, melasma, inflammatory nail disorders, and psoriasis. We suggest that detailed studies be conducted to standardize PRP preparation and optimize treatment methods in order to further improve its usefulness.

Customized Precision Facial Assessment: An AI-assisted Analysis of Facial Microexpressions for Advanced Aesthetic Treatment.

We introduced a novel protocol based on an artificial intelligence (AI)-assisted analytic system for facial expressions, Customized Precision Facial Assessment (CPFA), to evaluate and quantify the microexpressions of aesthetic concern. With the help of CPFA, physicians may be able to conduct static and dynamic assessments for the microexpressions of the ir patients and perform quantitative measurements before and after the treatments. Through the detection of microexpressions and its active action units of facial muscles, physicians are more likely to optimize the treatment with minimal intervention by precise localization of the foci of aesthetic concern. We presented 3 cases who received neuromodulators and injectable fillers, and we showed the differences in the area of treatment and outcomes of procedures between the CPFA-oriented treatments and human-facilitated ones. We found negative facial expressions decreased in all 3 cases in the group of CPFA while they decreased in only case 1 and case 2 in the group of human facilitated treatment. The CPFA group has more significant decrease in negative facial expression scores than the human group. This pilot study demonstrates that CPFA can objectively recognize and quantify the facial action units associated with negative emotions, and the physician may be able to customize the treatment for individuals accordingly with promising results.

The application of 595-nm pulsed dye laser for vascular anomalies in a Chinese population: a 10-year experience.

BACKGROUND: The 595-nm pulsed dye laser (PDL) has been used to treat vascular anomalies for about 30 years; however, there are insufficient data in Chinese patients concerning therapeutic efficacy, optimized parameters, and procedure techniques. OBJECTIVE: To study the efficacy and relevant factors in PDL therapy for vascular anomalies in Chinese patients. METHOD: We enrolled 431 patients with 8 different vascular anomalies and no previous treatment in this retrospective study. A detailed classification of vascular anomalies and various parameters and techniques of PDL were studied. The clinical outcomes were analysed using the Investigator Global Assessment. RESULTS: Improvements were significantly correlated with infantile haemangioma (IH) subtypes (p < 0.05). A significant correlation between efficacy and lesion colour, anatomical sites, and hypertrophic-type port-wine stain (PWS) was found (p < 0.05). There was no significant correlation between efficacy and age or sex (p > 0.05). CONCLUSION: PDL is an effective and safe therapeutic modality for managing vascular anomalies in Chinese patients. We determined that differentiating and identifying IH subtypes prior to treatment could be a useful parameter for predicting therapeutic results.  Lesion colour, sites, and hypertrophic changes in PWS are relevant therapeutic factors. PDL parameters and techniques differ according to the various vascular anomalies to achieve optimal results.

Spotted leucoderma after treatment of facial hyperpigmentation on hemodialysis patients employing 1064-nm Q-switched Nd:YAG laser.

The development of skin hyperpigmentation in patients with end-stage renal disease (ESRD) on hemodialysis (HD) have been well documented. However, the cosmetic concern was neither valued seriously nor treated effectively in the past. We report a female case who suffered from facial hyperpigmentation (FH). She was treated by large-spot sized, 1064-nm Q-switched Nd:YAG laser (QSNYL). A significant improvement was found after three treatment sessions at a fluence of 3.9 J/cm(2) with 8-day intervals, but spotted leucoderma developed at the fourth visit. Neither residual FH nor spotted leucoderma subsequently improved following two additional sessions of 1064-nm QSNYL at a lower fluence with topical hydroquinone and HeNe laser, and it persisted at the 1-year follow-up. This clinically specific round-shaped leucoderma suggested laser-induced damage to melanocytes due to unsuitable application. The 1064-nm QSNYL with a large spot size and an appropriate parameter may become an effective therapeutic modality if properly utilized.