Targeted Nutritional Supplementation for Telogen Effluvium: Multicenter Study on Efficacy of a Hydrolyzed Collagen, Vitamin-, and Mineral-Based Induction and Maintenance Treatment.

Background: The condition of the hair is closely related to the nutritional state. Normal supply, uptake, and transport of nutrients are of fundamental importance in tissues with a high biosynthetic activity such as the hair follicle. Objective: The objective of the study was to evaluate the efficacy of a nutritional-based induction and maintenance treatment for telogen effluvium formulated with a combination of hydrolyzed collagen, amino acids, vitamins, and minerals. Patients and Methods: The clinical studies were conducted with each nutritional treatment individually, and both in sequential combination. Anagen/telogen ratio, hair density, and tolerability of treatment were assessed at baseline, 4 weeks of induction therapy, and another 12 weeks of maintenance treatment. Trichogram results showed a significant improvement of the anagen/telogen ratio between baseline and final visit at 16 weeks, with an increase of hair in anagen and a reduction of hair in telogen. Furthermore, a significant increase was observed in hair density. The effect size of the combination treatment was higher than that of each of the two products used separately as monotherapy. Conclusions: The study results provide a proof of concept for targeted nutritional supplementation for the treatment of telogen effluvium, with a special emphasis on the role of collagen, besides specific amino acids, vitamins, and minerals.

Chronic neuropathic facial pain after intense pulsed light hair removal. Clinical features and pharmacological management.

UNLABELLED: Intense Pulsed Light (IPL) photodepilation is usually performed as a hair removal method. The treatment is recommended to be indicated by a physician, depending on each patient and on its characteristics. However, the use of laser devices by medical laypersons is frequent and it can suppose a risk of damage for the patients. Most side effects associated to IPL photodepilation are transient, minimal and disappear without sequelae. However, permanent side effects can occur. Some of the complications are laser related but many of them are caused by an operator error or mismanagement. In this work, we report a clinical case of a patient that developed a chronic neuropathic facial pain following IPL hair removal for unwanted hair in the upper lip. The specific diagnosis was painful post-traumatic trigeminal neuropathy, reference 13.1.2.3 according to the International Headache Society (IHS). KEY WORDS: Neuropathic facial pain, photodepilation, intense pulse light.

Adherence to drug treatments and adjuvant barrier repair therapies are key factors for clinical improvement in mild to moderate acne: the ACTUO observational prospective multicenter cohort trial in 643 patients.

BACKGROUND: In acne, several studies report a poor adherence to treatments. We evaluate, in a real-life setting conditions, the impact of compliance to physician's instructions, recommendations and adherence to the treatments on clinical outcome in patients with mild to moderate acne in an observational, non-interventional prospective study carried out in 72 Dermatologic Services in Spain (ACTUO Trial). METHODS: Six-hundred-forty-three subjects were enrolled and 566 patients (88 %) completed the 3 study visits. Study aimed to evaluate the impact of adherence (assessed with ECOB scale) on clinical outcome, as well as how the use of specific adjuvant treatments (facial cleansing, emollient, moisturizing and lenitive specific topical products) influences treatment's adherence and acne severity (0-5 points score). Recommendation of specific adjuvant skin barrier repair products was made in 85.2 %. RESULTS: Overall, clinical improvement was observed throughout follow-up visits with an increased proportion of patients who reported reductions of ≥50 % on the total number of lesions (2 months: 25.2 %; 3 months: 57.6 %) and reductions of severity scores (2.5, 2.0 and 1.3 at 1, 2 and 3 months after treatment, respectively). Adherence to treatment was associated with a significant reduction on severity grading, a lower number of lesions and a higher proportion of patients with ≥50 % improvement. CONCLUSIONS: Good adherence to medication plus adherence to adjuvants was significantly associated with a higher clinical improvement unlike those that despite adherence with medication had a low adherence to adjuvants. A good adherence to adjuvant treatment was associated with improved adherence and better treatment outcomes in mild to moderate acne patients. (ISRCTN Registry: ISRCTN14257026).

Terapia fotodinámica / Photodynamic therapy

La terapia fotodinámica se basa en la interacción de un agente fotosensibilizante que cuando es estimulado por la longitud de onda apropiada inducela formación de radicales libres que causan necrosis celular. Es una de las técnicas más recientes empleada en el tratamiento de algunos tipos de cáncer,aunque actualmente ya se ha demostrado su eficacia en otras enfermedades inflamatorias. En dermatología su principal indicación es el carcinomabasocelular, pero también se ha empleado en carcinoma escamoso in situ —enfermedad de Bowen— y más recientemente en acné, rosácea, varices,fotorejuvenecimiento, liquen, liquen escleroso y atrófico y leshmaniasis, entre otras dermatosis1

Photodynamic therapy is based in the interaction of a photoactive agent that when is properly stimulated by a specific wavelength it induces free radi-cals that lead to cellular necrosis. This is one of the newest treatments for some types of cancer and other inflammatory diseases. In dermatology, pho-todynamic therapy is used for malignant neoplasias such as basal cell carcinoma, Bowen disease —in situ squamous cell carcinoma— and morerecently it has been applied to inflammatory skin diseases such as acne, rosacea, lichen plannus, lichen sclerosus et atrophicus, and other conditions —leishmaniasis, photodamaged skin, telagiectasias1

Long-lasting hypopigmentation induced by long-pulsed alexandrite laser photo-epilation.

BACKGROUND: Long-lasting hypopigmentation induced by laser hair removal systems has been reported. OBJECTIVE. : To evaluate clinical aspects of a female Caucasian that developed long-lasting hypopigmentation in the arms and forearms after photodepilation with a long-pulsed alexandrite laser. METHOD: A 29-year-old Caucasian female (phototype III) with localized hypertrichosis in the upper limbs was submitted to long-pulsed alexandrite laser-assisted hair removal. One treatment session was done with these laser parameters: a pulse width of 2 ms, a spot of 7 mm, and fluence energy of 18 J/cm2. RESULTS: The patient developed long-lasting hypopigmentation (more than 6 months) in the arms and forearms after a single treatment session of photodepilation. CONCLUSION: Long-pulsed alexandrite laser may induce reversible melanocyte suppression and long-lasting hypopigmentation.

Side-effects after IPL photodepilation.

BACKGROUND: Intense pulsed light (IPL) has been successfully used as an efficient hair removal system; however, possible side-effects have been not specifically addressed in the literature. OBJECTIVE: To assess all possible side-effects after IPL hair removal in a series of 49 females with facial hirsutism during a total of 390 treatment sessions of IPL photodepilation. METHODS: Immediate post-treatment clinical, photography evaluation, and a two-month post-treatment questionnaire were done in 49 females with facial hirsutism submitted to photodepilation with an IPL source (EpiLight trade mark, ESC, Israel). RESULTS: Side-effects observed were: transient erythema (n = 30), late evanescent erythema (n = 3), mild pain (n = 43), moderate pain (n = 6), crust formation (n = 9), superficial burning (n = 1), isolated vesicles (n = 3), transient hyperpigmentation (n = 8), transient hypopigmentation (n = 1), paradoxical effect (n = 5), persistent local heat sensation (n = 1), and minimal scar (n = 1). CONCLUSION: Even though common, most side-effects secondary to IPL photodepilation are mild and transient. Permanent side-effects such as scars are unlikely but they may occur. Growth of new, fine and dark hair may be seen in untreated areas in close proximity to the treatment area, especially in the neck, a side-effect that is reported for the first time in the literature.

Paradoxical effect after IPL photoepilation.

BACKGROUND: Intense pulsed light (IPL) is an effective and safe hair removal method. However, it is not exempt from side effects. OBJECTIVE: To evaluate clinical and hormonal characteristics of females with facial hirsutism that developed hair growth in untreated areas close to the area submitted to IPL photoepilation ("paradoxical effect"). METHODS: A total of 49 females with facial hirsutism were included in a protocol of photoepilation with an IPL source. Hyperandrogenism of tumoral origin was excluded in all subjects. Serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), prolactin (PRL), testosterone (T), androstenedione (A), dehydroepiandrosterone sulfate (DHEAS), 17-OH-progesterone (OHP), and sex hormone binding globulin (SHBG) were determined prior to IPL treatment. Clinical and photographic evaluation was performed immediately before each treatment session and 2, 6, and 9 months after the last treatment session. Only cases with "paradoxical effect" were included in this study. RESULTS: A total of five patients with "paradoxical effect" were identified. The patients' ranged in age from 13 to 44 years and all of them had skin phototype III (Fitzpatrick scale). All these subjects were diagnosed with polycystic ovarian syndrome and presented ovarian hyperandrogenism. Patients underwent six to nine IPL sessions, and "paradoxical effect" appeared at different times during the protocol, between treatment session 3 and 6 months after the conclusion of treatment. CONCLUSION: IPL may induce activation of dormant hair follicles in untreated areas close to hirsute-treated areas.

Intense pulsed light for hairy grafts and flaps.

BACKGROUND: Intense pulsed light (IPL) is an effective and safe method of hair removal. OBJECTIVE: To evaluate the clinical response of hairy grafts and flaps of different anatomic areas to an IPL source. METHODS: Four patients (three men, one woman; 17-72 years old) with hairy skin grafts (n = 2) or flaps (n = 2) were included. Donor skin areas included the forehead (n = 1), supraclavicular (n = 1), abdomen (n = 1), and groin (n = 1). Excisional surgery was performed because of basal cell carcinoma (BCC) of the nasal wall (n = 1), squamous cell carcinoma (SCC) of the forehead (n = 1), congenital nevus of the malar region (n = 1), and breast carcinoma (n = 1). The treatment was IPL with the following parameters: wavelength 695-755 nm, pulse width 3.8-4.5 msec, delay 20-30 msec, spot size 10 mm x 45 mm, fluence 38-42 J/cm2, and an interval of 4 weeks. A total of one to six treatment sessions were administered. RESULTS: A progressive decrease in terminal hair and delayed hair growth rate (more than 8 months) were observed in all the patients. Improvement of skin coarseness, pigmentation, and erythema was also observed in the graft and its periphery in one patient. Persistent erythema (more than 48 hours) was the only side effect, observed in one patient. CONCLUSION: IPL is an effective method to depilate hairy grafts and flaps.

Aspectos clínicos particulares de la gota: Paniculitis por cristales de monourato sódico / Peculiar clinical aspects of gout: monosodium urate crystals Panniculitis

Antecedentes: La paniculitis es una manifestación rara de la gota.Objetivos: Revisar los aspectos clínicos e histopatológicos más importantes de la paniculitis por cristales de monourato sódico.Materiales y métodos: Observación clínica de paciente afecto de gota poliarticular asociada a tofos diseminados, nódulos subcutáneos fistulizados y úlceras en los miembros inferiores. El estudio histopatológico de un nódulo fistulizado mostró una reacción granulomatosa del tipo cuerpo extraño con estructuras filamentosas en forma de aguja intensamente birrefringentes, en su interior, en la dermis profunda y el tejido celular subcutáneo.Conclusiones: La paniculitis por cristales de monourato sódico es una manifestación rara de la gota, caracterizada clínicamente por la presencia de nódulos subcutáneos fistulizados o no y úlceras de los miembros inferiores. (AU)

Utilidad del láser de alejandrita (755 nm, 100 ns) en el tratamiento de las lesiones pigmentadas / Alexandrite laser (755 nm, 100 ns) for removal of pigmented lesions

El láser de alejandrita (755 nm, 100 ns) ha demostrado ser de utilidad en el tratamiento de lesiones melanocíticas superficiales, tales como léntigos simples y solares, lentiginosis y el componente superficial del nevo de Spilus, nevo de Becker y mancha café con leche. Las lesiones melanocíticas dérmicas como el nevo de Ota, nevo melanocítico adquirido y congénito, el componente profundo de las entidades ya señaladas y los pigmentos exógenos de color negro, azul y verde pueden igualmente ser tratados con esta técnica. El grado de aclaramiento depende de múltiples factores, entre los que cabe destacar la densidad de energía, el número de tratamientos aplicados y el tipo de lesión (AU)