Q-switched Nd:YAG laser protects human keratinocytes from oxidative stress and inflammation via AhR-Nrf2 pathway.

In recent years, some treatments for esthetic and pathologic skin conditions have increasingly been based on the use of non-ablative neodymium-doped yttrium aluminum garnet (Nd:YAG) laser due to its greater penetration ability than other types of lasers, few contraindications, minimal side effects, no damage for epidermidis and the rapid recovery of the treated patients. The skin is frequently exposed to many stressors such as radiation, toxic substances, metabolites, foods, mechanical insults, and allergen exposition that cause oxidative damage and have a decisive influence on the aging process. The imbalance between reactive oxygen species, reactive nitrogen species, and the malfunctioning of the antioxidant defense system promotes the establishment of an excessive inflammatory process, which can induce various diseases including cancer and neurodegenerative disorders. The present study investigated the cytoprotective function of Q-switched Nd:YAG laser against stress aging and cell injury in HaCaT cells. We evaluated the effect of the laser on antioxidant defenses, inflammation, metalloproteinases' expression, and the AhR-Nrf2 pathway. Q-switched Nd:YAG is able to upregulate the AhR pathway and the expression of IL-6 and TGF-ß, which are involved in wound repair process, and to downregulate the expression of MMP-2 and 9, so preventing the collagen degradation. Q-switched Nd:YAG can stimulate the cellular antioxidant defenses by activating the AhR-Nrf2 system.

Regulatory Ability of Lactiplantibacillus plantarum on Human Skin Health by Counteracting In Vitro Malassezia furfur Effects.

The skin serves as the first barrier against pathogen attacks, thanks to its multifunctional microbial community. Malassezia furfur is a commensal organism of normal cutaneous microflora but is also a cause of skin diseases. It acts on different cell pattern recognition receptors (TLRs, AhR, NLRP3 inflammasome) leading to cellular damage, barrier impairment, and inflammatory cytokines production. Lactobacillus spp. Is an endogenous inhabitant of healthy skin, and studies have proven its beneficial role in wound healing, skin inflammation, and protection against pathogen infections. The aim of our study is to demonstrate the ability of live Lactiplantibacillus plantarum to interfere with the harmful effects of the yeast on human keratinocytes (HaCat) in vitro. To enable this, the cells were treated with M. furfur, either alone or in the presence of L. plantarum. To study the inflammasome activation, cells require a stimulus triggering inflammation (LPS) before M. furfur infection, with or without L. plantarum. L. plantarum effectively counteracts all the harmful strategies of yeast, reducing the phospholipase activity, accelerating wound repair, restoring barrier integrity, reducing AhR and NLRP3 inflammasome activation, and, consequently, releasing inflammatory cytokines. Although lactobacilli have a long history of use in fermented foods, it can be speculated that they can also have health-promoting activities when topically applied.

An Unconventional Oral Candidiasis in an Immunocompetent Patient.

Oral candidiasis (OC) is an opportunistic fungal infection of the oral mucosae, sustained by Candida albicans or other non-albican Candida species (NAC), usually eradicated by conventional antifungals of the classes of azoles, polyenes, or derivative from echinocandins. OC usually occurs under predisposing local or systemic factors. C. lusitaniae is an opportunistic strain that is rarely responsible for human infection and occurs mainly in severe immunocompromised states. The present work reported an unconventional case of OC in an otherwise healthy immunocompetent woman sustained by C. lusitaniae and a multi-resistant strain of C. albicans.

Oral Candidiasis in Adult and Pediatric Patients with COVID-19.

Oral Candidiasis (OC) is an opportunistic fungal infection of the oral cavity, frequently reported under local and systemic predisposing circumstances. While the recurrence of OC HIV-infected subjects has been well described and reported, the association between oral candidiasis and the SARS-CoV-2 infection is a recent finding that still is worthy of further study. The present paper focuses on this novel association, reporting the incidence and prevalence of OC occurring during and after COVID-19 and the possible etiopathogenic mechanisms underlying the onset of OC in COVID-19 subjects. The work found that the immune inflammatory hypo reactions and immunosuppression found in children and adults with COVID-19 could favor the proliferation colonization of Candida species and the following infection. At the same time, poor oral hygiene and iatrogenic causes seem to be the main risk factors.

COVID-19 Related Information on Pediatric Dental Care including the Use of Teledentistry: A Narrative Review.

In addition to the direct impact of the SARS-CoV-2 infection, the COVID-19 pandemic reports multiple effects on people's health and psycho-physical well-being. In the dental field, oral hygiene sessions, regular dental check-ups, and aerosol-generating procedures were commonly postponed, thus resulting in repercussions on oral health also favored by the changing eating and oral hygiene habits during the multiple lockdowns. Furthermore, dental settings and practices were generally perceived as at high risk for SARS-CoV-2 transmission, thus unsafe, and by general and pediatric dentists themselves. Last, the consequences of stress related to deprivation of social life and playful activities should not be underestimated in children, exposing them to the deleterious effects of bad oral habits, with repercussions on the balanced growth and development of the stomatognathic system. The present work intends to analyze the medium-term and long-term impact of COVID-19 on pediatric oral and dental care provision, reviewing pediatric dentistry practice and oral and dental needs of pedodontics patients during the first peak and the various waves of the COVID-19 pandemic, and lessons learned.

Decreased expression of Malassezia furfur virulence factors after Q-switched Nd:YAG laser irradiation.

Malassezia spp. are lipophilic yeasts implicated in the pathogenesis of chronic skin diseases. Repeated therapies are often necessary due to the recurrence of this type of disease. Recently, laser and light-based devices used for the treatment of some skin diseases have shown good efficacy, few contraindications, and minimal side effects. The neodymium-doped yttrium aluminium garnet (Q-switched Nd:YAG) laser is one of the most commonly used lasers in dermatology. The aim of this study was to evaluate the effect of the Q-switched Nd:YAG laser (Medlite C6 laser, Conbio, USA) on the pathogenic mechanisms of M. furfur during skin infections. Following laser exposure, the ability of M. furfur to retain phospholipase activity, upregulate the aryl receptor and its associated pathway, and stimulate the immune response were tested. The Q-switched Nd:YAG laser was shown to attenuate the virulence of M. furfur. The Q-switched Nd:YAG laser should be considered as a valid therapeutic alternative for the treatment of Malassezia-associated infections.

Facial skin esthetic treatments with plasma radiofrequency ablation.

BACKGROUND: The field of esthetic dermatology continues to evolve rapidly, and esthetic procedures for facial skin play a key role in it. During recent years, patients have been demanding more non-invasive and safe technology characterized by satisfactory results and minimal downtime as compared to traditional surgical procedures. In the panorama of facial skin treatments, many options have different indications and limitations. AIMS: The aim of this study was to report the effectiveness of plasma radiofrequency (PRF) ablation in facial skin esthetic treatments, performed with D.A.S. Medical device (Technolux, Italia). METHODS: Once the dermatologist has diagnosed the unsightly facial skin disorder and ascertained that PRF ablation could be an appropriate approach, contraindications to treatment must be excluded. After the patient has signed the informed consent for treatment, it will be possible to proceed with the PRF ablation sessions. According to the esthetic disorder and the area of the face to be treated, PRF ablation is performed at energy and frequency values chosen depending on the case. RESULTS: Treatments are generally well tolerated by patients, and excellent esthetic results and no side effects are observed. CONCLUSIONS: Even today, plasma radiofrequency ablation is perhaps one of the most versatile minimal invasive techniques, regarding both for variety of indications as well as effectiveness and fast downtime. Its applications are many, ranging from the removal of unsightly skin lesions, to the correction of scars, treatment of blepharochalasis, periocular, and perioral wrinkles, active acne, that distort the homogeneity and the youthful appearance of the face. PRF ablation has shown to be an effective option demonstrating its value in this field.

Plasma Radiofrequency Ablation for Scar Treatment.

Scars are a common disfiguring sequela of various events such as acne, hidradenitis suppurativa, surgery, trauma, and burns, which can lead to serious psychosocial problems with a negative effect on the quality of life. Many conventional approaches have been proposed for the treatment of scars, including surgical techniques, dermabrasion, chemical peels, topical silicone gel, 5-fluorouracile and dermal fillers injection or autologous fat transfer for atrophic scars, and corticosteroids injection for hypertrophic and keloid scars; however, they have sporadic effects. Ablative lasers, such as carbon dioxide laser or Erbium Yag laser, are associated with many collateral effects limiting their application. Non-ablative laser treatments have been shown to be safer and to have fewer side effects, but they have a reduction of clinical efficacy compared to ablative lasers and a minimal improvement of scars. The demand for minimal invasive and safe technology for the treatment of a scars has stimulated the search for more effective novel therapy with fewer collateral effects. Plasma radiofrequency ablation is a new technique consisting of the generation of plasma energy through the production of ionized energy, which thermally heats tissue in a uniform and controlled manner, through a plasma radiofrequency device, inducing a sublimation of the tissue. The aim of this study is to evaluate the effectiveness of P-RF ablation in the treatment of scars performed with D.A.S. Medical device (Technolux, Italia), which is a tool working with the long-wave plasma radiofrequency principle.

Q-switched Nd-YAG laser alone and in combination with innovative hyaluronic acid gels improve keratinocytes wound healing in vitro.

During the last years, several attempts have been accomplished to improve the wound healing. Device application aimed at enhancing skin ability to reconstruct its damaged sites through a proper dermal regenerative process. In particular, Q-switched Nd-YAG laser (Medlite C6 laser, Conbio, USA) applied with a fluence of 8 J/cm2, a pulse width of 5 ns, and a spot size of 4 mm exerts a photo-mechanical action that improve skin repair. Besides, hyaluronan hybrid cooperative complexes (HCC) widely exploited in dermoesthetic applications proved specific actions on keratinocytes and fibroblasts monolayer repair. We evaluated this specific laser treatment in vitro on a wound healing model based on human keratinocytes (HaCaT) alone and in combination with HCC. In addition, we evaluated key biomarkers of dermal repair. Scratched HaCaT monolayers were treated with laser and successively with HA-based formulations (HHA and HCC). For each treatment and the control samples, at least 3 different wells were analyzed. Wound closure was quantified, measuring five view filed for each well at increasing incubation time, exploiting time lapse videomicroscopy and image analysis, permitting to compare the different healing rate of treatments respect to control. By real-time PCR and western blotting, we evaluated biomarkers of wound regeneration, such as integrins, aquaporin three (AQP3), and proinflammatory cytokines. The ANOVA test was used to assess statistical significance of the results obtained. Laser-treated cells achieved wound closure in about 37 h, faster than the control, while when coupled to HCC, the complete reparation was obtained in 24 h. Integrin αV was upregulated by treatments, with in particular about four-fold increase respect to the control when HCC + laser was used. In addition, integrin ß3 was upregulated by all treatments especially with the combination of laser and HCC proved more efficient than others (~ 14-folds). A slighter but significant increase of AQP3 gene expression of 61% was found for laser treatment while the latter combined with HCC determined an upregulation of 72%. By coupling laser treatment and HCC, further healing improvement and consistent biomarker modulation was observed. Our results may support clinical implementation of new dermatology protocols conjugating laser treatments with topical or injective HA formulations as a valid tool in treatments to repair scars or other skin defects.

Skin-Compatible Biobased Beauty Masks Prepared by Extrusion.

In the cosmetic sector, natural and sustainable products with a high compatibility with skin, thus conjugating wellness with a green-oriented consumerism, are required by the market. Poly(hydroxyalkanoate) (PHA)/starch blends represent a promising alternative to prepare flexible films as support for innovative beauty masks, wearable after wetting and releasing starch and other selected molecules. Nevertheless, preparing these films by extrusion is difficult due to the high viscosity of the polymer melt at the temperature suitable for processing starch. The preparation of blends including poly(butylene succinate-co-adipate) (PBSA) or poly(butylene adipate-co-terephthalate) (PBAT) was investigated as a strategy to better modulate melt viscosity in view of a possible industrial production of beauty mask films. The release properties of films in water, connected to their morphology, was also investigated by extraction trials, infrared spectroscopy and stereo and electron microscopy. Then, the biocompatibility with cells was assessed by considering both mesenchymal stromal cells and keratinocytes. All the results were discussed considering the morphology of the films. This study evidenced the possibility of modulating thanks to the selection of composition and the materials processing of the properties necessary for producing films with tailored properties and processability for beauty masks.

Non-surgical blepharoplasty with the novel plasma radiofrequency ablation technology.

BACKGROUND: Surgical blepharoplasty is one of the most common plastic surgical procedures performed worldwide. It is carried out for treating both aesthetic and functional indications. As with any surgical procedures, the technique is not free from complications. The growing request for non-invasive, effective procedures, and safe technology for aesthetic treatments of eyelids has implied the research for novel treatment strategies marked by a good efficacy and less collateral effects when compared to surgical procedures. The choice fell on the relatively recent plasma skin regeneration technique. AIMS: The aim of this study is to evaluate the effectiveness of plasma radiofrequency ablation in non-surgical blepharoplasty performed with DAS Medical device (Technolux), a tool working with long-wave plasma radiofrequency principles. PATIENTS/METHODS: Ten patients affected by aesthetically unpleasant dermatochalasis, excess of tissue and fine wrinkles of the eyelids, were enrolled for non-surgical blepharoplasty with long-wave plasma radiofrequency ablation device. The treatment consisted of two sessions carried out at interval of 30 days. RESULTS: Treatments were well tolerated by all patients with no adverse effects and optimal aesthetic results. CONCLUSIONS: The technique consists of a modeling of the eyelids that must be sculpted reducing excess of skin, improving the appearance of eyelids, rejuvenating the eyes, and reducing eyelid heaviness. Long-wave plasma radiofrequency ablation could be an effective treatment for non-surgical blepharoplasty, and could offer an alternative choice to surgical procedures for aesthetic treatments of eyelids.

Plasma radiofrequency ablation for treatment of benign skin lesions: Clinical and reflectance confocal microscopy outcomes.

BACKGROUND: In the latest few years, plasma radiofrequency ablation has turned out a good option for treatment of several benign skin lesions. The technique can be easily performed to treat skin lesions with limited tissue invasion and no residual scars or hypo/hyperpigmentation areas. OBJECTIVE: The aim of this study was to assess the effects of plasma radiofrequency ablation in treatment of benign skin lesions, through clinical and reflectance confocal microscopy outcomes. METHODS: Six patients who presented benign skin lesions underwent long-wave plasma radiofrequency ablation treatment with DAS medical device (Technolux, Italia). Reflectance confocal microscopy analysis was performed at baseline and after 1 month. RESULTS: The treatment was well tolerated; only a slight erythema and a thin crust on the treated area were referred for 3-7 days after treatment. After one month from treatments, we observed the complete disappearance of the lesions and no significant signs of inflammation, redness, hypo/hyperpigmentation, or scars on the site of the treated areas; these clinical data were also confirmed by reflectance confocal microscopy analysis. CONCLUSIONS: Long-wave plasma radiofrequency ablation actually can be considered a well-tolerated, painless, safe, effective, and low-cost procedure for skin treatments.

Long-wave plasma radiofrequency ablation for treatment of xanthelasma palpebrarum.

Xanthelasma palpebrarum is the most common type of xanthoma affecting the eyelids. It is characterized by asymptomatic soft yellowish macules, papules, or plaques over the upper and lower eyelids. Many treatments are available for management of xanthelasma palpebrarum, the most commonly used include surgical excision, ablative CO2 or erbium lasers, nonablative Q-switched Nd:YAG laser, trichloroacetic acid peeling, and radiofrequency ablation. This study aims to evaluate the effectiveness of RF ablation in the treatment of xanthelasma palpebrarum, with D.A.S. Medical portable device (Technolux, Italia), a radiofrequency tool working with long-wave plasma energy and without anesthesia. Twenty patients, 15 female and 5 male, affected by xanthelasma palpebrarum, were enrolled for long-wave plasma radiofrequency ablation treatment. The treatment consisted of 3/4 sessions that were carried out at intervals of 30 days. Treatments were well tolerated by all patients with no adverse effects and optimal aesthetic results. The procedure is very fast and can be performed without anesthesia because of the low and tolerable pain stimulation. Long-wave plasma radiofrequency ablation is an effective option for treatment of xanthelasma palpebrarum and adds an additional tool to the increasing list of medical devices for aesthetic treatments.

Q-switched 1064 nm Nd-Yag nanosecond laser effects on skin barrier function and on molecular rejuvenation markers in keratinocyte-fibroblasts interaction.

Skin represents an interface between internal and external environment; it protects human body by regulating the water loss and the maintenance of body temperature, defending against irritant and pathogen agents, and against physical, chemical, and UV damage. It provides to essential physiological functions, such as the important antioxidant defense capacity; its protective/defensive function is performed by a high number of proteins, and shows important functions in maintenance of skin barrier homeostasis. Keratinocytes and fibroblasts play a pivotal role to determine or prevent skin aging in response to intrinsic or extrinsic stimuli, modulating cytokines and several biochemical factors. Non-ablative technologies are playing an increasing role in the management of skin aging, inducing a dermal remodeling without a visible epidermal damage. The objective of this study was to evaluate the effect of Q-switched 1064 Nd-YAG laser (Medlite Conbio C6 Nd-YAG laser, Cynosure USA) in skin barrier function, analyzing the constituents which are strongly altered in aging skin. Particularly, we evaluated the expression of filaggrin, TGase, HSP70, and aquaporins, on HaCaT cells. The expression of proinflammatory cytokines has been investigated too.As a second step of the study, we analyzed the modulation of the rejuvenation molecular markers on human skin fibroblasts (HDFs) stimulated with keratinocytes conditioned medium (KCM).Our results demonstrated that Q-switched 1064 nm Nd:YAG laser acts on the skin barrier function, increasing the expression of aquaporins, filaggrin, TGase, and HSP70, modulating the proinflammatory cytokines. In fibroblasts stimulated with keratinocytes conditioned medium (KCM) and irradiated with Q-switched 1064 nm Nd:YAG laser, we can observe a reduction of MMP-1 and an increase in procollagen, collagen type I, and elastin. Our results highlight that Q-switched 1064 nm Nd:YAG laser treatment could represent an effective weapon to fight skin aging.

Malassezia pachydermatis up-regulates AhR related CYP1A1 gene and epidermal barrier markers in human keratinocytes.

Cytochrome P450 CYP1A1 and CYP1B1 enzymes are regulated by the aryl hydrocarbon receptor (AhR), a transcription factor activated by a variety of ligands among which Malassezia metabolites. In this study, we analyzed the modulation of CYP1A1, CYP1B1, and AhR in human keratinocytes infected with different strains of Malassezia pachydermatis, as well as the upregulation of some genes involved in the epidermal homeostasis. We demonstrated that all the strains induced AhR activation and its nuclear translocation in HaCaT cells infected for 24 h, compared to untreated cells. The expression of CYP1A1 and CYP1B1, prototypical markers of the AhR signaling pathway, were upregulated with the level of CYP1A1 mRNA approximately 100-fold greater than that for CYP1B1. Filaggrin, involucrin, and TGaseI, proteins involved in epidermal differentiation, were all modulated by Malassezia pachydermatis strains, with the strongest induction observed for filaggrin. By contrast, quinone oxidoreductase 1 (NQO1), which is part of the antioxidant defense system involved in detoxification, was not modulated in our experimental model. In conclusions, our findings suggest that Malassezia pachydermatis infection of human keratinocytes induces activation of the AhR, and increases the expression of its responsive genes and markers of epidermal differentiation, paving the way for occurrence/exacerbation of pathological skin conditions.

Correction to: Effect of 1064-nm Q-switched Nd:YAG laser on invasiveness and innate immune response in keratinocytes infected with Candida albicans.

In the published online version of the article, the authors' given and family names were incorrectly captured. The corrected names are shown in the author group section above.

Effect of 1064-nm Q-switched Nd:YAG laser on invasiveness and innate immune response in keratinocytes infected with Candida albicans.

Candida albicans is an opportunistic pathogen commensal in the oral cavity, vagina, and healthy skin. Common therapeutic options for fungal infections are topical or systemic antifungal drugs. Recently, in cutaneous pathologies, lasers and light-based treatments have emerged showing few contraindications and minimal side effects. The Q-switched (Nd-YAG) laser at a wavelength of 1064 nm has been shown to be useful in dermatology, dentistry, and some other medical specialties. It is used to treat onychomycoses, warts, and wounds and in some other treatments. We analyzed the effect of Q-switched (Nd-YAG) laser 1064 nm on human keratinocytes infected with C. albicans. In particular, we evaluated the effect of laser on invasiveness of C. albicans and on inflammatory and protective response of HaCaT cells infected. The results obtained did not show inhibitory, fungicidal, or fungistatic effects of laser on yeast; in addition, laser did not affect HaCaT vitality. HaCaT cells infected with C. albicans and irradiated with laser showed a reduction of invasiveness of TNF-α and IL8 gene expression and an increase of immunomodulatory cytokines such as TGFß. Furthermore, laser induces a significant over-expression of HSP70B (heat shock protein) and of HBD-2 (Human ß defensin-2) in HaCaT infected with C. albicans, compared to the untreated control. The use of Q-switched Nd:YAG laser in skin mycosis caused by C. albicans reduces yeast invasiveness in keratinocytes, downregulates inflammatory activities, and facilitates cytoprotection and antimicrobial defense. Our results offer a promising therapeutic strategy in the management of skin candidiasis, also in combination with conventional therapies.

Anti-Inflammatory, Immunomodulatory, and Tissue Repair Activity on Human Keratinocytes by Green Innovative Nanocomposites.

The use of raw materials obtained by waste and processed through innovative industrial methodologies has generated an industry of about a trillion dollars in a short time, and in the near future will provide resources and services for the conservation and sustainable use of natural resources in order to ensure a better and fairer welfare for the human race. The production of nano-fiber chitin non-woven tissue is in accordance with the Organization for Economic Co-operation and Development (OECD) and European Union (EU) bio-economic programs: 100% biodegradable, ecological, and therefore useful in decreasing dependence on fossil fuel resources. The aim of our study is the evaluation of different formulations of a non-woven tissue obtained from electrospinning of a mixture of nanochitin fibrils, lignin, and poly (ethylene) oxide (PEO) on the restoration of damaged tissues. Wound repair is a complex process that involves epithelial and immune cells and includes the induction of metalloproteinases, inflammatory mediators, and angiogenic factors. Our in vitro results have shown that all of the realized chitin nanofibrils-bio-lignin non-woven tissues tested as nontoxic for human keratinocytes (HaCat) cells. Furthermore, the bio-composites that included bio-lignin at 0.1% have been able to modulate the expression of pro-inflammatory cytokines (Tumor Necrosis Factor-α, IL-1α, and IL8), lipopolysaccharide (LPS)-induced, and matrix metalloproteinases (MMPs) and human beta-defensin 2 (HBD-2) expression in HaCat cells, suggesting an anti-inflammatory and immunomodulatory role. Taken together, our results suggest that our chitin nanofibrils-bio-lignin non-woven tissue represents a skin-friendly tool that is able to favor a correct and fast wound repair.

Correlation between genetic variability and virulence factors in clinical strains of Malassezia pachydermatis of animal origin.

Malassezia pachydermatis is a yeast belonging to the microbiota of the skin and mucous membranes of dog and cat, but it can also act as pathogen, causing dermatitis. The aim of this work was to evaluate the genetic variability of M. pachydermatis strains isolated from symptomatic dogs and cats and determine a correlation between genotype and phenotype. For this purpose eleven strains of M. pachydermatis were molecularly classified by nested-polymerase chain reaction (nested-PCR) based on ITS-1 and ITS-2 regions, specific for fungal rRNA genes. Furthermore, random amplification of polymorphic DNA (RAPD) was applied for genetic typing of M. pachydermatis isolates identifying four different genotypes. Strains belonging to genotype 1 produced the highest amount of biofilm and phospholipase activity. The inflammatory response induced by M. pachydermatis strains in immortalized human keratinocytes (HaCat cells) was significantly different when we compared the results obtained from each strain. In particular, HaCat cells infected with the strains belonging to genotypes 1 and 2 triggered the highest levels of increase in TLR-2, IL-1ß, IL-6, IL-8, COX-2 and MMP-9 expression. By contrast, cells infected with the strains of genotype 3 and those of genotype 4 did not significantly induce TLR-2 and cytokines. The results obtained might suggest a possible association between genotype and virulence factors expressed by M. pachydermatis strains. This highlights the need for a more accurate identification of the yeast to improve the therapeutic approach and to monitor the onset of human infections caused by this emergent zoonotic pathogen.