RESUMEN
BACKGROUND: Botulinum type-A toxin is a well established aesthetic and medical treatment. While the usage of type-B toxin is less common, there is a growing interest in using type-B toxin, especially in those who are treatment resistant. OBJECTIVE: To evaluate the primary FDA-approved clinical applications of rimabotulinumtoxinB, along with established and emerging off-label clinical indications. MATERIAL AND METHODS: Articles were reviewed from PubMed database and Food and Drug Adminstration guidelines. RESULTS: Facial rhytids tend to use a higher conversion ratio between type A and type B toxin, due to type B toxin's weaker affinity to muscles and higher affinity for sweat glands. Specially, a 1:100 to 1:50 ratio was utilized for glabellar rhytids, a 1:25 to 1:50 ratio for periocular rhytids, a 1:50 to 1:66.6 ratio for cervical dystonia, a 1:20 to 1:50 ratio for hyperhidrosis, and a 1:25 to 30 ratio for sialorrhea. CONCLUSION: Type B toxin has demonstrated its safety and efficacy in treating facial rhytids, cervical dystonia, sialorrhea and hyperhidrosis, with potential for novel applications under investigation. Regardless of injection location and clinical applications, dry mouth and dysphagia remained the most common side effects. Across all indications, type B toxin appeared to have a faster onset of action, a dose-dependent clinical duration, and a dose-dependent adverse effect profile.
Asunto(s)
Toxinas Botulínicas Tipo A , Hiperhidrosis , Humanos , Toxinas Botulínicas Tipo A/administración & dosificación , Toxinas Botulínicas Tipo A/efectos adversos , Hiperhidrosis/tratamiento farmacológico , Técnicas Cosméticas , Sialorrea/tratamiento farmacológico , Tortícolis/tratamiento farmacológico , Fármacos Neuromusculares/administración & dosificación , Fármacos Neuromusculares/efectos adversos , Uso Fuera de lo Indicado , Envejecimiento de la Piel/efectos de los fármacosRESUMEN
BACKGROUND: Peer-reviewed, clinical studies measuring the efficacy and usability of skin care products enhance their integrity and may guide experts in the field in providing recommendations. A single-blind, prospective clinical study was designed to assess the subject satisfaction, clinical benefit, and safety of three photodynamic topical formulations referred to as MMSRepose (MMSRep), MMSRevive (MMSRev), and MMSBalance (MMSB). Methods: Thirteen male and female patients (mean age 49 +/- 17.8 years) applied one of the three topical serums twice daily over a period of 12 weeks. Subjects returned for photography, and blinded investigator evaluation of rhytides (fine lines) and dyspigmentation were measured on a 6- and 4-point scale, respectively. Patient-perceived efficacy of multiple clinical outcomes was measured on a 5-point scale. Results: 100% of subjects reported at least a 1-grade improvement in global aesthetic at the conclusion of the study. Investigator assessment revealed an overall 53.3% decrease in rhytides, correlating to a mean point reduction from 1.65 +/- 0.77 to 0.77 +/- 0.53 (P<0.001) from baseline to week 12. Investigator assessment of dyspigmentation revealed a 62.7% decrease, correlating to a mean point reduction of 1.85 +/- 0.68 from week 1 to 0.69 +/- 0.48 at week 12 (P<0.001). CONCLUSION: Photodynamic serums demonstrate clinical efficacy in skin rejuvenation and high user satisfaction. There were no serious adverse events. This study is limited by the inability to randomize to placebo due to the small sample size, as subject retention was heavily impacted by the SARS-CoV-2 pandemic. Future studies may be indicated to undergo comparison with a larger cohort. J Drugs Dermatol. 2024;23(5):332-337. doi:10.36849/JDD.7167.
Asunto(s)
Satisfacción del Paciente , Fotoquimioterapia , Envejecimiento de la Piel , Humanos , Estudios Prospectivos , Femenino , Masculino , Persona de Mediana Edad , Fotoquimioterapia/métodos , Fotoquimioterapia/efectos adversos , Envejecimiento de la Piel/efectos de los fármacos , Método Simple Ciego , Adulto , Anciano , Resultado del Tratamiento , Fármacos Fotosensibilizantes/administración & dosificación , Fármacos Fotosensibilizantes/efectos adversos , Cuidados de la Piel/métodos , Administración Cutánea , RejuvenecimientoRESUMEN
BACKGROUND: Patients seek 3-dimensional volume restoration of the jawline to obtain a "defined" line. Injection of filler into the jawline is not approved by the Food and Drug Administration; however, dermatologists have injected this area with positive results, minimal adverse events, and high patient satisfaction. OBJECTIVE: This study explores the efficacy of premixed calcium hydroxylapatite filler with integral lidocaine [CaHA(+)] to correct volume defects of the jawline. It examines the longevity, safety, and patient satisfaction (up to 12 months) of CaHA(+) for jawline volume loss correction. MATERIALS AND METHODS: This is a single-investigator, nonblinded study. Twenty subjects received CaHA(+) filler injection in the jawline, with follow-up evaluations conducted at 14 days, 6 weeks, and 3, 6, 9, and 12 months. RESULTS: CaHA(+) injection in the jawline results in statistically significant restoration in volume and improvement in appearance lasting up to 12 months. Overall, subjects report "moderate" improvement on the Global Aesthetic Improvement Scale. CONCLUSION: It is important for cosmetic surgeons and dermatologists to have access to data on the efficacy and safety of injectables. The data obtained in this study show that CaHA(+) is an effective and safe option to correct jawline volume loss and is associated with high patient satisfaction.
Asunto(s)
Anestésicos Locales/administración & dosificación , Materiales Biocompatibles/administración & dosificación , Mentón , Técnicas Cosméticas , Rellenos Dérmicos/administración & dosificación , Durapatita/administración & dosificación , Lidocaína/administración & dosificación , Satisfacción del Paciente , Femenino , Humanos , Maxilares , Masculino , Persona de Mediana Edad , Proyectos Piloto , Estudios Prospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: The cosmeceutical industry is an ever-growing and in demand market, especially in Asia. Korea has been on the forefront of creating the newest generation and most innovative cosmeceuticals products including ingredients such as snail secretions, starfish powder, botanical extracts, green tea, and red ginseng. Given their increasing prevalence in the cosmeceutical industry, scientists have been conducting investigations into these extracts and their properties. OBJECTIVE: To summarize the current literature surrounding multiple natural ingredients found in Korean cosmeceutical products. METHODS: A review of the literature surrounding natural ingredients found in Korean cosmeceuticals was conducted using PubMed (U.S. National Library of Medicine). RESULTS: Multiple natural extracts have been found to have antiaging, antitumor, and antimelanogenic effects making them useful additives in current cosmeceutical products. CONCLUSION: With the public's increasing awareness of cosmeceutical products, it is important for physicians to understand the properties of these extracts in order to inform patients correctly and ensure patient safety.
Asunto(s)
Cosmecéuticos/química , Panax , Extractos Vegetales/farmacología , Envejecimiento de la Piel/efectos de los fármacos , Caracoles , Estrellas de Mar , Animales , Secreciones Corporales , Flores , Humanos , Polvos/farmacología , República de Corea , Sasa , Caracoles/metabolismo , TéRESUMEN
BACKGROUND: Age-related volume loss in the temporal fossae is due to thinning of the epidermis, loss of subcutaneous structural volume, and change in the bony architecture. Temporal concavities are important areas of 3-dimensional volume restoration. The temporal fossae is becoming an increasingly popular area for patients seeking soft tissue augmentation with injectable fillers such as calcium hydroxylapatite with integral lidocaine [CaHA (+)]. OBJECTIVE: This pilot study aims to define the safety, efficacy, technique, and patient-reported outcomes for injectable CaHA (+) to correct volume loss in the temporal fossae over a 12-month period. MATERIALS AND METHODS: This was a single-investigator, nonblinded study involving 20 participants. Participants received filler injection into their temporal fossae, with follow-up evaluations at Day 14, 6 weeks, and 3, 6, 9, and 12 months. RESULTS: CaHA (+) results in statistically significant improvement in temporal fossae appearance lasting up to 12 months. Subjects reported "moderate" global aesthetic improvement over the 12-month period. CONCLUSION: As the cosmetic field continues to advance, it is important for practitioners to have access to research regarding the efficacy and safety of injectables. These results show that CaHA (+) is an effective and safe option to correct temporal fossae volume loss associated with high patient satisfaction.
Asunto(s)
Anestésicos Locales/administración & dosificación , Técnicas Cosméticas , Rellenos Dérmicos/administración & dosificación , Durapatita/administración & dosificación , Lidocaína/administración & dosificación , Técnicas Cosméticas/efectos adversos , Rellenos Dérmicos/efectos adversos , Durapatita/efectos adversos , Estética , Femenino , Humanos , Inyecciones Subcutáneas , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Proyectos Piloto , Envejecimiento de la Piel , Lóbulo TemporalRESUMEN
Recall erythema is a phenomenon occurring when an area of epidermis treated with laser is later exposed to a trigger, most often sunlight or hot water, causing erythema in the zone of laser treatment after post-treatment erythema has already resolved. Radiation recall dermatitis is a more specific subtype of recall erythema in which an area treated with radiation is subjected to another exposure causing erythema in the area of previous radiation. Cases of recall dermatitis after laser treatment are extremely rare and have only been reported with diode neodymium-doped yttrium aluminum garnet lasers. We report two cases of recall dermatitis following erbium-doped yttrium aluminum garnet resurfacing laser triggered by exposure to either hot water or direct sunlight, and in one case, radioablation of the thyroid gland. We will also provide a brief literature review of recall dermatitis in the setting of laser surgery.
Asunto(s)
Eritema/etiología , Láseres de Estado Sólido/efectos adversos , Radiodermatitis/etiología , Adulto , Femenino , Humanos , Terapia por Láser/efectos adversos , Masculino , Persona de Mediana Edad , Radioterapia/efectos adversos , Luz Solar/efectos adversosRESUMEN
BACKGROUND: Home optical devices are becoming an increasingly popular treatment modality sought out by patients for dermatologic pathologies such as acne, hair removal and anti-aging, as these devices are a low-cost and convenient therapy choice. METHODS: An Internet search using PubMed.gov was completed with search terms, "home device dermatology," "home device acne," "home device hair" or "hair removal," and "home device aging." RESULTS: Currently, there are multiple home optical devices available on the market. These devices have been approved for the treatment of acne, scars, hair removal, and wrinkles using intense pulsed light, light-emitting diode, heat, infrared, low-level light therapy, and laser. Although studies on home devices are limited, current dermatologic literature shows that these devices are promising with significant post-treatment results as well as a high level of safety. CONCLUSIONS: Home optical devices are mostly used without medical practitioner supervision. As home devices usually deliver less energy per session than with professional treatments, it is important that consumers are given realistic expectations of post-treatment outcomes. Patients may use home devices without disclosure to their physician and it is important as healthcare professionals to be aware of the existence of these devices, how to use the devices properly (including what diseases can be treated and which skin types are considered safe for use), as well as any adverse effects that may occur. New research endeavors are being completed to explore the used of home devices for the treatment of chronic inflammatory diseases such as psoriasis.
Asunto(s)
Acné Vulgar/terapia , Remoción del Cabello/instrumentación , Tratamiento de Luz Pulsada Intensa/instrumentación , Terapia por Láser/instrumentación , Fototerapia/instrumentación , Autocuidado/instrumentación , Envejecimiento de la Piel/efectos de la radiación , HumanosRESUMEN
BACKGROUND: Hyaluronidase is an enzyme capable of dissolution of hyaluronic acid (HA). There is a lack of evidence-based research defining time- and concentration-dependent reversal of HA filler using hyaluronidase. OBJECTIVE: To explore the efficacy of different concentrations of hyaluronidase in digesting commercially available HA-based reversible fillers-Belotero Balance (BEL), Juvederm Ultra XC (JUVXC), Juvederm Ultra Plus (JUVX+), Juvederm Voluma XC (JUVV), Restylane-L (RESL), Restylane Silk (RESS), and Perlane/Restylane Lyft (RESLYFT). MATERIALS AND METHODS: This was a blinded randomized study involving 15 participants. Participants received HA filler injection into their back, followed by no secondary injection, or injection with normal saline, 20 or 40 units of hyaluronidase. Using a 5-point palpation scale, the degradation of HA filler was monitored over 14 days. RESULTS: In the authors' study, there is a significant decrease in HA filler degradation using 20 and 40 units of hyaluronidase compared with no secondary injection or normal saline. There is no significant difference in HA filler dissolution when comparing 20 to 40 units of hyaluronidase. CONCLUSION: Lower concentrations of hyaluronidase may be just as effective as higher concentrations to degrade HA filler in situations where the reversal of cutaneous augmentation with HA filler arises.
Asunto(s)
Rellenos Dérmicos/farmacocinética , Ácido Hialurónico/farmacocinética , Hialuronoglucosaminidasa/farmacología , Adulto , Rellenos Dérmicos/administración & dosificación , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Femenino , Humanos , Ácido Hialurónico/administración & dosificación , Inyecciones Subcutáneas , Masculino , Factores de TiempoRESUMEN
"Fractionated photodynamic therapy (PDT)" is a new term being used by dermatologists to describe advances in PDT technology including fractionated light or the adjuvant use of fractional lasers. Although dermatologists have used PDT since the early 1990s for the treatment of photodamage and precancerous lesions, newer developments in technology have allowed for the treatment of non-melanoma skin cancers (NMSCs), in ammatory disorders, and even uses in the eld of anti-aging. Recent developments in fractionated light therapy have allowed for PDT with dark intervals and two-fold illumination schemes to increase cellular damage and apoptosis. Combining PDT with fractional laser technology has allowed for enhanced dermal penetration of topical photosensitizers including 5-aminolevulinic acid (ALA) and methyl aminolevulinate (MAL), as well as increased ef cacy of treatment. These advances in PDT technology will allow for increased convenience, decreased treatment time, only one application of topical photosensitizer, and decreased cost to the patient and dermatologist. J Drugs Dermatol. 2016;15(11):1324-1328..
Asunto(s)
Terapia por Luz de Baja Intensidad/métodos , Fotoquimioterapia/métodos , Fármacos Fotosensibilizantes/administración & dosificación , Enfermedades de la Piel/tratamiento farmacológico , Enfermedades de la Piel/radioterapia , Administración Cutánea , Ácido Aminolevulínico/administración & dosificación , Ácido Aminolevulínico/análogos & derivados , Ensayos Clínicos como Asunto/métodos , Terapia Combinada/métodos , Humanos , Enfermedades de la Piel/diagnóstico , Resultado del TratamientoRESUMEN
Facial changes with aging include thinning of the epidermis, loss of skin elasticity, atrophy of muscle, and subcutaneous fat and bony changes, all which result in a loss of volume. As temporal bones become more concave, and the temporalis atrophies and the temporal fat pad decreases, volume loss leads to an undesirable, gaunt appearance. By altering the temporal fossa and upper face with hyaluronic acid filler, those whose specialty is injecting filler can achieve a balanced and more youthful facial structure. Many techniques have been described to inject filler into the fossa including a "fanned" pattern of injections, highly diluted filler injection, and the method we describe using a three-injection approach. Complications of filler in the temporal fossa include bruising, tenderness, swelling, Tyndall effect, overcorrection, and chewing discomfort. Although rare, more serious complications include infection, foreign body granuloma, intravascular necrosis, and blindness due to embolization into the ophthalmic artery. Using reversible hyaluronic acid fillers, hyaluronidase can be used to relieve any discomfort felt by the patient. Injectors must be aware of the complications that may occur and provide treatment readily to avoid morbidities associated with filler injection into this sensitive area.
Asunto(s)
Técnicas Cosméticas/efectos adversos , Rellenos Dérmicos/administración & dosificación , Ácido Hialurónico/administración & dosificación , Envejecimiento de la Piel/efectos de los fármacos , Arterias/patología , Infecciones Bacterianas/etiología , Ceguera/etiología , Contusiones/etiología , Cara , Granuloma de Cuerpo Extraño/etiología , Humanos , Inyecciones Subcutáneas/efectos adversos , Necrosis/etiología , Dolor/etiología , Piel/irrigación sanguínea , Piel/patología , Lóbulo Temporal/anatomía & histologíaRESUMEN
Lentigo maligna (LM) and lentigo-maligna melanoma (LMM) are pigmented skin lesions that may exist on a continuous clinical and pathological spectrum of melanocytic skin cancer. LM is often described as a "benign" lesion and is accepted as a melanoma in situ; LM can undergo malignant transformation to particularly aggressive melanoma. LMM is an invasive melanoma that shares properties of LM, as well as exhibiting the metastatic potential of malignant melanoma. Unfortunately, LM/LMM diagnosis based on dermoscopy is rather ambiguous, and these lesions are often mistaken for junctional dysplastic nevi over sun-damaged skin, pigmented actinic keratosis, solar lentigo, or seborrheic keratosis. Diagnosis must be made on biopsy using distinct dermatopathologic features. These include a pagetoid appearance of melanocytes, melanocyte atypia, non-uniform pigmentation/distribution of melanocytes, and increased melanocyte density in a background of extensive photodamage. Advancements in immunohistochemical staining techniques, including soluble adenylyl cyclase (antibody R21), makes diagnosis easier and allows the definition of borders down to a single cell. After a pathologic diagnosis, there are a variety of treatment options, both surgical and non-surgical. Although surgical removal with a wide excision border is the preferred treatment due to decreased recurrence rates, experimental combination therapies are gaining popularity. However, no matter the treatment, LM/LMM carries a high recurrence rate, and patients must be monitored rigorously for recurrence as well as the appearance of additional skin lesions/cancers.
RESUMEN
The addition of chemical additives to consumer cosmetic products is a common practice to increase cosmetic effectiveness, maintain cosmetic efficacy, and produce a longer-lasting, more viable product. Recently, manufacturers have come under attack for the addition of chemicals including dioxane, formaldehyde, lead/lead acetate, parabens, and phthalate, as these additives may prove harmful to consumer health. Although reports show that these products may indeed adversely affect human health, these studies are conducted using levels of the aforementioned chemicals at much higher levels of exposure than those found in cosmetic products. When cosmeceuticals are used as per manufacturer's instructions, it is estimated that the levels of harmful additives found in these products are considerably lower than reported toxic concentrations.
Asunto(s)
Cosméticos/efectos adversos , Emulsionantes/efectos adversos , Conservadores Farmacéuticos/efectos adversos , Animales , Seguridad de Productos para el Consumidor , Cosméticos/química , Cosméticos/normas , Dioxanos/efectos adversos , Emulsionantes/química , Emulsionantes/normas , Formaldehído/efectos adversos , Humanos , Compuestos Organometálicos/efectos adversos , Parabenos/efectos adversos , Ácidos Ftálicos/efectos adversos , Conservadores Farmacéuticos/química , Conservadores Farmacéuticos/normas , Medición de Riesgo , Factores de RiesgoRESUMEN
Vismodegib is a first-in-class, hedgehog-signal inhibitor that is FDA-approved for use with advanced basal cell carcinomas (BCCs) that cannot be removed by either surgical resection or treated with radiation. Release of the drug was fast-tracked because of need for this type of drug, and its overall efficacy in clinical trial by producing either regression or even resolution of advanced BCCs. Compared to placebo, patients using vismodegib have arrested BCC progression, reduced size of BCC, and decreased recurrence of BCC. Unfortunately, vismodegib has notable adverse effects (especially those of alopecia, gastrointestinal, muscle spasms, and dysguesia) that make dermatologists reluctant to prescribe the drug and patients unwilling to undergo therapy. In this article, we tackle this dilemma by comparing the toxicity profile of vismodegib to the adverse effect profiles of other dermatologic chemotherapeutics, immunomodulators, retinoids, and biologics. Considering that many of these drugs carry their own risks and those drugs used to treat advanced melanoma have similar toxicity profiles to that of vismodegib, we hope dermatologists and patients alike will be more willing to try vismodegib as a treatment option for advanced BCCs in the future.
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Anilidas/efectos adversos , Antineoplásicos/efectos adversos , Carcinoma Basocelular/tratamiento farmacológico , Piridinas/efectos adversos , Anilidas/farmacología , Anilidas/uso terapéutico , Antineoplásicos/farmacología , Antineoplásicos/uso terapéutico , Carcinoma Basocelular/patología , Progresión de la Enfermedad , Humanos , Recurrencia Local de Neoplasia , Piridinas/farmacología , Piridinas/uso terapéutico , Neoplasias Cutáneas/tratamiento farmacológico , Neoplasias Cutáneas/patologíaRESUMEN
Herpes simplex virus (HSV) prophylaxis may be underutilized in cosmetic surgery at a time when cosmetic procedures are increasing. Our goal is to review the data regarding HSV prophylaxis in order to remind cosmetic surgeons when to consider adding this regimen to their patient perioperative care.
Asunto(s)
Antivirales/uso terapéutico , Herpes Simple/prevención & control , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/virología , Simplexvirus/efectos de los fármacos , Cirugía Plástica/métodos , Aciclovir/uso terapéutico , Dermabrasión , Utilización de Medicamentos , Herpes Labial/prevención & control , Herpes Simple/epidemiología , Herpes Simple/virología , Humanos , Complicaciones Posoperatorias/epidemiología , Simplexvirus/fisiologíaAsunto(s)
Carcinoma Basocelular/terapia , Carcinoma de Células Escamosas/terapia , Cirugía de Mohs/métodos , Fotoquimioterapia/métodos , Neoplasias Cutáneas/terapia , Ácido Aminolevulínico/uso terapéutico , Carcinoma Basocelular/complicaciones , Carcinoma Basocelular/patología , Carcinoma de Células Escamosas/complicaciones , Carcinoma de Células Escamosas/patología , Color , Terapia Combinada/métodos , Humanos , Periodo Intraoperatorio , Queratosis Actínica/complicaciones , Queratosis Actínica/terapia , Fármacos Fotosensibilizantes/uso terapéutico , Neoplasias Cutáneas/complicaciones , Neoplasias Cutáneas/patologíaRESUMEN
Ultrasonic imaging has been used in the field of dermatology for nearly 30 years. In this review, we seek to explain the basic principles of ultrasound as they relate to the skin. Based on differences in keratin, collagen, and water content, ultrasonic waves are reflected back to a transducer and translated into a gray-scale image for interpretation. The technicalities of the process and its variations (power, continuous wave Doppler ultrasound, ultrasound elastography) are briefly reviewed, and we further highlight many of the applications for ultrasound in the treatment and diagnosis of dermatologic conditions, including melanoma and nonmelanoma skin cancer, benign tumors, inflammatory diseases, and lipoablation. Each of these entities is uniquely characterized using ultrasonic techniques. Based on published sources, we contend that although ultrasound is still being fine-tuned for application in dermatology and largely remains in experimental phases, it has potential for use in many arenas of our specialty.