The use of retinoic acid in association with microneedling in the treatment of epidermal melasma: efficacy and oxidative stress parameters.

This study aimed to evaluate the effectiveness of isolated treatment with retinoic acid and its combination with the microneedling technique in facial melasma, seeking to associate these results with possible oxidative damage. This is a blinded randomized clinical trial with 42 women with facial melasma (skin phototype I-IV), randomized into Group A (microneedling and 5% retinoic acid) or Group B (5% retinoic acid alone). Four procedures were applied with 15 days intervals (4 blood collections). Clinical improvement was assessed using the Melasma Area Severity Index (MASI). Serum oxidative stress levels were evaluated by protein oxidation (carbonyl), lipid peroxidation (TBARS) and sulfhydryl groups, as well as enzyme activities of superoxide dismutase (SOD) and catalase (CAT). The statistical analyzes were performed by generalized estimation equation (GEE). There was a reduction in MASI scale and TBARS levels in both groups over time (p < 0.05), with no difference between groups (p = 0.416). There was also a substantial increase in the carbonyl levels at 30 days (p = 0.002). The SOD activity decreased after 30 days, regardless of group (p < 0.001), which was maintained after 60 days. In Group A, there was a reduction in sulfhydryl levels at 60 days (p < 0.001). It is important to highlight that both groups demonstrated efficacy in the clinical improvement of melasma within at least 60 days, reducing the MASI score by almost 50%. However, microneedling with retinoic acid seems to be the worst treatment because there is a reduction in the non-enzymatic antioxidant defense, which is important to protect against oxidative stress.

Clinical comparison of salicylic acid peel and LED-Laser phototherapy for the treatment of Acne vulgaris in teenagers.

Acne vulgaris treatments usually cause sensitivity, teratogenicity and bacterial resistance. Investigations of other therapeutic techniques, such as phototherapy, are highly relevant. Thus, we compared the effectiveness of two Acne vulgaris treatments in adolescents: peeling with salicylic acid (SA) and phototherapy. Teens were randomly divided into: group I, treatment with SA peels (10%) and group II, treatment with phototherapy (blue LED and red laser lights). Photographs were taken before and after ten sessions of each treatment, carried out weekly, and compared. To compare the differences between the treatments, the Student t-test was used. P values < 0.05 were considered significant. Both techniques are effective therapies for the treatment of acne in teenagers since the number of comedones, papules and pustules decreased significantly at the end of the session. However, when the two treatments were compared, phototherapy showed a significant difference in reducing the number of pustules. The combined use of red and blue lights due to their anti-inflammatory and wound-healing properties is a more efficient alternative for treating Acne vulgaris in relation to SA and proves more reliable and without side effects, improving the adolescents' skin health.

[Application of cantharidin, podophyllotoxin, and salicylic acid in recalcitrant plantar warts. A preliminary study]. / Aplicación de cantaridina-podofilotoxina-ácido salicílico en las verrugas plantares recalcitrantes. Un estudio preliminar.

INTRODUCTION: Plantar warts often are refractory to any treatment and can last for decades in adults. Recalcitrant warts are defined as those that have persisted for more than two years, or after at least two treatment modalities. METHODS: A total of 15 consecutive patients with recalcitrant plantar warts were included in this preliminary study. The treatment consisted of applying one to two sessions that comprised compounding 1% cantharidin, 5% of podophyllotoxin, and 30% salicylic acid (CPS), with an interval between applications of four weeks. RESULTS: With treatment and subsequent follow-up for six months, there was complete eradication of lesions in 15 patients, eight (53.3%) required a single application of the solution, and seven (46.7%) two applications, with no side effects. Patient satisfaction related to treatment was measured by a visual analog scale (VAS) of 10 cm in length, with an average score 9.73 ± 0.46, and all said they would proceed with the treatment again if necessary. CONCLUSIONS: Topical treatment by compounding is safe, effective, and a promising therapeutic modality when applied in recalcitrant plantar warts.

Superficial dermabrasion versus topical tretinoin on early striae distensae: a randomized, pilot study.

BACKGROUND: Striae distensae (SD) is a common skin condition, with a prevalence ranging from 40% to 90%, depending on the population studied. OBJECTIVES: To evaluate the efficacy of superficial dermabrasion and compare it with that of topical tretinoin cream in the treatment of narrow and early SD. MATERIALS AND METHODS: Prospective, single-center, randomized, open-label study. Thirty-two women presenting with early, untreated SD (striae rubra) were included in this study. One group received 16 weekly sessions of superficial and localized dermabrasion, and the other used 0.05% tretinoin cream daily. Striae width and length were measured and compared between groups and over time. Global Aesthetic Improvement Scale scores and subject satisfaction were also assessed. Biopsies were performed for subjects who agreed to undergo this procedure, followed by histologic analyses of the skin samples. RESULTS: Both treatments were efficacious, with significant improvement in early SD from baseline, but there was no significant difference between the two treatments. Histologic assessment showed improvement in epidermal and dermal layers for the dermabrasion treatment group. CONCLUSION: Both treatments had similar efficacy, but superficial dermabrasion had a lower frequency of side effects and better adherence of the patients.

Efficacy and safety of adapalene gel 0.1% and 0.3% and tretinoin gel 0.05% for acne vulgaris: results of a single-center, randomized, double-blinded, placebo-controlled clinical trial on Mexican patients (skin type III-IV).

BACKGROUND: The efficacy of topical retinoids is well known according to several clinical studies conducted predominantly among Caucasian patients. This study aimed to evaluate the efficacy and safety profile of adapalene and tretinoin among Mexican patients. AIMS: To compare adapalene 0.1 and 0.3% and tretinoin 0.05% in Mexican subjects with acne vulgaris. METHODS: We enrolled 171 patients in this single-center, randomized, double-blinded, placebo-controlled clinical trial. The patients applied on the face either adapalene 0.1%, adapalene 0.3%, tretinoin 0.05%, or placebo for 90 days and were evaluated for the reduction in total lesion counts and for the level of irritation. RESULTS: Tretinoin 0.05% and adapalene 0.3% were more effective than adapalene 0.1% and placebo in the reduction of both inflammatory and noninflammatory lesions. Most of adverse events to adapalene and many on tretinoin group were related to skin irritation, dry skin, scaling, pruritus, burning, and postinflammatory hyperpigmentation. CONCLUSION: Adapalene 0.3% and tretinoin 0.05% are comparable in efficacy, and adapalene 0.1% offers a better safety profile in Mexican patients.

[Isotretinoin embryopathy. Report of one case]. / Embriopatía por isotretinoína: Un daño evitable.

Retinoic acid is a widely used drug in the treatment of cystic acne. It has teratogenic effects that depend on the gestational period in which it is used. We report a seven months old female whose mother was exposed to retinoic acid in both pre-gestational and gestational periods. She had a retardation of psychomotor development and a brain MRI showed frontal atrophy and a malformation of the posterior fossa. We discuss the mechanisms of the teratogenic effects of retinoic acid.

Embriopatía por isotretinoína: Un daño evitable / Isotretinoin embryophaty: Report of one case

Retinoic acid is a widely used drug in the treatment of cystic acné. It has teratogenic effects that depend on the gestational period in which it is used. We report a seven months of female whose mother was exposed to retinoic acid in both pregestational and gestational periods. She had a retardation of psychomotor development and a brain MRI showed frontal atrophy and a malformation of the posterior fossa. We discuss the mechanisms ofthe teratogenic effeets of retinoic acid.

Alpha-hydroxy acids: unapproved uses or indications.

Alpha-hydroxy acids have been used for rejuvenation since ancient times, and now there are several on the market. Depending on the concentration, some have been shown to be effective as peeling agents and for rejuvenation. Glycolic acid and lactic acid are the alpha-hydroxy acids most frequently used in cosmetics, although there are many others used in combination. Some of the most striking advances in dermatology have followed the off-label use of drugs, which is widespread and unavoidable, but a well founded scientific approach to an individual patient's pathology must be emphasized as the number of products, regimens, and adjuncts increases exponentially in the cosmetic field. In this article the authors review some unapproved uses of alpha-hydroxy acids. More published data on the scientific value of these off-label indications that proves whether they are effective or not is needed.

Topical isotretinoin vs. topical retinoic acid in the treatment of acne vulgaris.

UNLABELLED: This is a clinical, prospective, and longitudinal study comparing the efficacy and incidence of averse effects of topical isotretinoin against those of topical retinoic acid in the treatment of acne vulgaris. The 30 participants were recruited from the patients attending the outpatient clinic of the Department of Dermatology of "Dr Manuel Gea González" General Hospital in Mexico City. They belonged to either sex and any race, their ages ranged between 13 and 30 years, and they presented with 15 to 100 facial inflammatory lesions (papulo-pustules) and/or 15 to 100 noninflammatory lesions (comedones) and no more than three nodulo-cystic lesions. The criteria of exclusion were as follows: pregnancy or lactation, systemic treatment with steroids, antibiotics, antiandrogens, or oral retinoids in the preceding 24 months, treatment with ultraviolet radiation, hypersensitivity to retinoids, or a severe systemic illness. From 44 interviewed patients, 14 were excluded. A detailed clinical history was obtained from the remaining individuals, the degree of seborrhea was recorded, and acne lesions were counted. Each patient received either isotretinoin gel 0.05% or retinoic acid cream 0.05%. The patients were instructed to wash their faces in the mornings and evenings with a neutral soap, and to apply the product after the evening cleansing. The patients were examined again after 2, 4, 8, and 12 weeks of treatment and, at each appointment, the number of lesions was recorded and the severity of acne was graded according to the classification of Plewig and Kligman. The seriousness of the adverse effects, such as stinging, pruritus, erythema, xerosis, and desquamation, was evaluated blindly by an investigator who did not know what group the patient belonged to, and graded as 1 = mild, 2 = moderate, and 3 = severe. The efficacy of each drug was determined by the reduction in the number of lesions between weeks 0 and 12 of treatment. An excellent response corresponded to a 76%-100% reduction of the lesions, a good response to a 51%-75% reduction, a fair response to a 26%-50% reduction, and a poor response to a 0%-25% reduction. The results were analyzed statistically using the chi-square test, the exact test of Fisher and the test of Wilcoxon-Mann-Whitney. The changes in the numbers of lesions between weeks 0 and 12 were analyzed separately for each group of treatment, and the level of statistical significance was fixed at 0.05. The analysis was performed with the aid of a Stat program, version 4.0. RESULTS: The patients were assigned randomly to either Group I (isotretinoin) or Group II (retinoic acid). Each group was composed of 15 individuals and, as a coincidence, in each group there were nine women and six men. The clinical differences between the groups at the first visit were not statistically significant. In both groups, there was, in general, a good response to treatment (Fig. 1). Both drugs had a similar degree of efficacy on inflammatory lesions. At the first visit, grades III and IV predominated, whereas, after 12 weeks of treatment, most patients were classified in grades I or II (Fig. 2). Similar results were observed regarding noninflammatory lesions (Fig. 3). Ten of the patients of Group II complained of stinging associated with the treatment, especially at weeks 8 and 12, as well as erythema and desquamation at the 12th week. Erythema and stinging lasted for minutes or hours, whereas desquamation persisted for several days. Seven individuals receiving isotretinoin mentioned irritation, which was of a mild degree.

Peelings químicos, manejo del paciente: prevención y tratamiento de los efectos secundarios / Chemical peelings, managements of patients: prevention and treatment of side effects

El objetivo de éste trabajo es dar a conocer a los dermatólogos no introducidos en el tema, en qué consiste un peeling, indicaciones, contraindicaciones y tipos de peeling con ácido tricloroacético al 35 por ciento, ya que consideramos que es importante conocer bien la técnica y los cuidados pre y posoperatorios para minimizar los efectos secundarios. Se hace una revisión de los probables efectos secundarios que pueden aparecer y se comenta su manejo en la experiencia personal de los autores. Los peelings químicos representan un avance en el tratamiento del envejecimiento cutáneo, pero debemos conocer bien el manejo del paciente, ya que la finalidad de un peeling es simepre mejorar la calidad de la piel

Peelings químicos, manejo del paciente: prevención y tratamiento de los efectos secundarios / Chemical peelings, managements of patients: prevention and treatment of side effects

El objetivo de éste trabajo es dar a conocer a los dermatólogos no introducidos en el tema, en qué consiste un peeling, indicaciones, contraindicaciones y tipos de peeling con ácido tricloroacético al 35 por ciento, ya que consideramos que es importante conocer bien la técnica y los cuidados pre y posoperatorios para minimizar los efectos secundarios. Se hace una revisión de los probables efectos secundarios que pueden aparecer y se comenta su manejo en la experiencia personal de los autores. Los peelings químicos representan un avance en el tratamiento del envejecimiento cutáneo, pero debemos conocer bien el manejo del paciente, ya que la finalidad de un peeling es simepre mejorar la calidad de la piel (AU)