Use of AbobotulinumtoxinA for Cosmetic Treatments in the Neck, and Middle and Lower Areas of the Face: A Systematic Review.

AbobotulinumtoxinA (aboBoNT-A) has been used for various cosmetic purposes, including minimization of moderate to severe lines, or other cosmetic indications, in the face and neck. We carried out a systematic review to identify all relevant evidence on the treatment approaches and outcomes of aboBoNT-A as a cosmetic treatment of the middle and lower areas of the face, and the neck. Embase, MEDLINE, Cochrane Library, congress proceedings and review bibliographies were searched for relevant studies. Identified articles were screened against pre-specified eligibility criteria. Of 560 unique articles identified, 10 were included for data extraction (three observational studies, 1 randomized controlled trial [with two articles] and five non-randomized trials). The articles provided data on gummy/asymmetric smile (2), marionette lines (5), masseter muscle volume (2), nasal wrinkles (2), perioral wrinkles (3) and the platysma muscle (4). All articles reporting on efficacy of aboBoNT-A demonstrated positive results, including reduction of wrinkles (5), reduction of masseter muscle (2) and degree of gummy smile (1) compared with before treatment. No serious adverse events were reported and patient satisfaction was high. In conclusion, positive findings support further research of aboBoNT-A for the middle and lower areas of the face, and in the neck, which are largely unapproved indications.

Treatment approaches and outcomes associated with the use of abobotulinumtoxinA for the treatment of hyperhidrosis: A systematic review.

BACKGROUND: Botulinum neurotoxin type A has been used for the treatment of hyperhidrosis. OBJECTIVE: To perform a systematic review of the literature to identify evidence on the treatment approaches and outcomes associated with abobotulinumtoxinA (aboBoNT-A) treatment of hyperhidrosis. METHODS: EMBASE, MEDLINE, and the Cochrane Library were searched for relevant observational studies, randomized controlled trials, and nonrandomized controlled trials. There were no date or country restrictions. Bibliographies of review articles and recent congress proceedings (2017-2019) were also searched. Articles were screened using predefined eligibility criteria and relevant data were extracted. RESULTS: Of 191 unique articles identified, 23 were considered relevant (3 observational studies, 10 nonrandomized controlled trials, and 10 randomized controlled trials). These articles provided data on axillary (13), palmar (7), and forehead (1) hyperhidrosis, compensatory hyperhidrosis of the back (1), Frey syndrome (1), and diabetic gustatory sweating (1). All studies reported that aboBoNT-A reduced sweating and no serious adverse events were observed. Patient satisfaction was high and improvements to quality of life were observed after aboBoNT-A treatment. LIMITATIONS: Variability in the injection technique when data were compared across studies. CONCLUSION: This study describes a range of treatment approaches and demonstrates positive outcomes of aboBoNT-A treatment for multiple types of hyperhidrosis.

Cutaneous Manifestations of COVID-19: A Report from the United Arab Emirates.

Coronavirus disease of 2019 (COVID-19) is a viral infection caused by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2). In addition to affecting mainly the respiratory tract, there have been many reported cutaneous manifestations of the disease. A retrospective case series based on history and clinical findings was performed across six hospitals in the UAE, including two field hospitals. A total of 324 patients with COVID-19 were identified and divided into three groups based on the severity of the disease. Forty-five (12.5%) patients had clearly identifiable cutaneous manifestation of COVID-19. Two patients each with alopecia areata and sclerosis of the extremities, respectively, were identified in the second group. Cutaneous manifestations of COVID-19 have been well reported across the literature. The experience in the UAE is similar to that of published reports. The occurrence of other cutaneous manifestations with an underlying autoimmune pathogenesis should raise the possibility of such conditions in those with COVID-19. (SKINmed. 2020;18:218-220).

A randomized, prospective, blinded, split-face, single-center study comparing polycaprolactone to hyaluronic acid for treatment of nasolabial folds.

BACKGROUND: Dermal fillers have continuingly been under development to increase safety, efficacy, and longevity. Biostimulatory dermal fillers, such as calcium hydroxylapatite fillers, have already been shown to be superior in efficacy compared to nonanimal stabilized hyaluronic acid (NASHA)-based fillers. AIMS: In this randomized split-face study, we compared a novel biostimulatory polycaprolactone (PCL)-based dermal filler with a NASHA-based dermal filler, for safety, efficacy, and duration of cosmetic correction for the treatment of nasolabial folds (NLFs). PATIENTS/METHODS: Forty subjects received a PCL-based dermal filler in one of their NLFs, and a NASHA-based dermal filler on the contralateral side. Efficacy was evaluated based on the Wrinkle Severity Rating Scale and Global Aesthetic Improvement Scale. RESULTS: After 6, 9, and 12 months post-treatment, NLFs treated with the PCL-based dermal filler showed statistically significant improvements on the Wrinkle Severity Rating Scale and greater improvements on the GAIS compared to NLFs treated with the NASHA-based dermal filler. Both products were found to be equally safe and well tolerated. CONCLUSION: Our results suggest that PCL-based dermal fillers offer longer-lasting performance over NASHA-based dermal fillers in NLFs treatment.

The role of Helicobacter pylori in urticaria and atopic dermatitis.

INTRODUCTION: Helicobacter pylori, a common cause of gastritis and peptic ulcer, has been associated with several extragastrointestinal diseases. Many studies have shown a positive relation between H. pylori infection and both chronic idiopathic urticaria and atopic dermatitis. METHODS: The study included 20 patients diagnosed with chronic idiopathic urticaria and 20 with atopic dermatitis. A randomized sample of 20 healthy individuals was selected as a control group. H. pylori infection was assessed using the C-urea breath test, and anti-H. pylori IgG antibody titers were determined by enzyme-linked immunosorbent assay. RESULTS: In the chronic idiopathic urticaria group, the urea breath test titer was positive in 75% of patients, and anti-IgG antibodies were also detected in 75% of patients. In the atopic dermatitis group, titer was positive in 70% and antibodies were detected in 65% of patients, while in the control group, the urea breath test titer was positive in 55% and antibodies were seen in 20% of patients. This difference was statistically highly significant (p < 0.001) in the case of anti-H. pylori antibodies in relation to chronic idiopathic urticaria and significant (p < 0.05) in the case of atopic dermatitis. CONCLUSIONS: These results provide some evidence of a relationship between H. pylori infection and both chronic idiopathic urticaria and atopic dermatitis. Treatment of infection demonstrated by reduction in C-urea breath test and anti-H. pylori antibody titers resulted in partial improvement of clinical symptoms in patients with atopic dermatitis.

Cell typing of the scabetic lesion and its clinical correlation.

Scabies is a pruritic dermatosis due to infestation by a mite that stimulates both humoral and cellular immune responses causing cutaneous lesions as well as pruritus. Changes in immune response pattern with treatment are associated with improvement in symptoms and clinical cure. In this study, we analysed the cellular infiltrate types and patterns in lesions of Scabies. Treated patients were divided into 2 groups as those with and without pruritus. In the pre-treatment cases, there was a high incidence of T3, T4, T6 and T8 infiltration in the lesions, with T4 greater than T8. Following treatment, it was noted that T8 density was significantly increased in patients who had resolution of symptoms. It can therefore be concluded that T4 cell dominance is the cause of persistant itching and T8 increase leads to improvement in the pruritus.

Herpes gestationis (Pemphigoid gestationis).

Herpes gestationis, coined by Milton in 1872, or gestational pemphigoid is the most clearly characterized dermatosis of pregnancy. It is a rare vesiculo-bullous eruption that develops during the last trimester or even postpartum and creates severe pruritus. Its etiology is unknown, but it is considered as an autoimmune-mediated dermatosis closely related to the pemphigoid group. Herpes gestationis is associated with a positive C3 deposition along the base of the epidermis in salt-split skin, with increased frequency of HLA-DR3 and also the combination DR3 and DR4. It has a high risk of prematurity and disappears in the postpartum period within weeks or months.

Psoriasis: a fresh look.

Psoriasis is a disease characterized by scaly skin lesions secondary to keratinocyte hyperplasia. The presence of active T cells in the lesions, experimental observations on disease transfer, and therapeutic efficacy of specific immunosuppressive drugs have led to the identification of the activated T lymphocyte as the primary factor for keratinocyte stimulation. Understanding the pathways of pathogenesis is fundamental in evolving therapies for intervention at different points in the pathogenic model and for curtailing the process. Advances in biotechnological methods have helped to create designer molecules and proteins that specifically recognize target receptors and chemicals that modify their actions. These drugs, termed "biologic response modifiers," are now being studied as specific immunosuppressive agents producing different T-cell and cytokine effects in psoriasis.

Nonspecific urethritis and reactive arthritis.

Nongonococcal urethritis (NGU) is a common sexually transmitted infection most often caused by Chlamydiae and Mycoplasmae. A few other organisms, as well as some nonsexual factors, also contribute to its etiology. NGU can result in considerable physical and psychological morbidity. In a few cases, it can lead to complications like reactive arthritis, and pelvic inflammatory disease, with their attendant morbidities. Correct diagnosis and treatment is therefore imperative in proper management of these cases. While earlier diagnostic support for these infections was limited and expensive, the advent of new methods like the nucleic acid amplification assays (NAA tests) has contributed significantly to better diagnosis. Treatment as per suggested guidelines and follow up of cases and contacts are all crucial in management. Counseling, including advice on behavior change, goes a long way in preventive strategies.

Case study: erythrokeratodermia variabilis.

A 4-year-old girl presented to the dermatology clinic with complaints of erythematous skin lesions on her face, extremities,forearms, and joints. The patient was a product of a full-term, normal pregnancy and delivery and was born to healthy parents. The parents are cousins. The condition started a few months after birth with small, hyperkeratotic patches on her cheeks. These lesions did not respond to the treatment that was given. The condition progressed and a few months later similar skin lesions started to appear on her forearms and knees. Different types of treatment, such as topical antibiotics,emollients, topical steroids, and systemic antihistamines, have been tried without any benefit. Some lesions showed variable exacerbations and remissions. There was no family history of a similar problem, although her older brother showed marginal hair loss without any skin lesions. On physical examination (Figures 1-3), hyperkeratotic erythrodermic plaques of variable thickness with sharply demarcated borders were seen on cheeks, extensor surfaces of forearms, and on the knees. The palms,soles, nails, and teeth were normal. The hair showed normal appearance, but there was no hair growth on the margins of the scalp. The laboratory investigations showed normal complete blood count and normal serum zinc and ferritin levels. Urine microscopy and examination was normal. Skin biopsy was taken and histopathology showed nonspecific features of hyperkeratosis with moderate papillomatosis and acanthosis (Figure 4). A diagnosis of erythrokeratodermia variabilis was made and the patient was started on emollients as treatment. There was not much improvement with the treatment.

Botulinum toxin in the treatment of axillary hyperhidrosis.

INTRODUCTION: Axillary hyperhidrosis can be a source of social isolation and embarrassment. The available treatments are either ineffective or have intolerable side effects. The search for a simple, long-lasting, and safe treatment has led to the use of botulinum-A toxin injections in those with excessive axillary hyperhidrosis. MATERIALS AND METHODS: Fifteen patients participated in this study. All had a history of axillary hyperhidrosis of 1-6 years duration and were using different types of therapies without any benefit. Each patient was injected intradermally with 125 units of botulinum-A toxin (Dysport, Spenywood Pharmaceutical) in 5-6 points over an elliptical area on each side. Patient follow-up was performed using the iodine-starch test. RESULTS: A total of 14 out of the 15 patients had complete anhidrosis 1 week after the injection. This result lasted for periods ranging from 1-6 months. No side effects were encountered. CONCLUSION: Intradermal injection of botulinum-A toxin seems to be a safe, rapid, and effective method of treatment in axillary hyperhidrosis.

Comparative evaluation of different hair removal lasers in skin types IV, V, and VI.

BACKGROUND: Lasers permit treatment of unwanted excess hair with less discomfort than other methods of epilation. Many lasers with different parameters are now available from which the dermatologist can choose. Improved clinical results are made possible by the high specificity and selectivity of the laser systems to pigmented hair because of the use of an appropriate wavelength with the proper pulse and duration. OBJECTIVES: We aimed to compare the results of treatment of skin types IV, V, and VI using three different laser systems. METHODS: One hundred female patients were compared using different laser systems: 35 patients underwent epilation using a Nd-Yag laser, 33 patients using an Alexandrite laser, and 32 patients using a Diode laser. RESULTS: Follow up 12 months after the multiple treatments (three to six sessions) showed an insignificant difference between these three groups (35-40%). CONCLUSION: Our findings indicate that all three laser systems tested can be used for dark skin; however, one should select a system that minimizes side-effects, primarily hypo- and hyper-pigmentation, especially when used for skin types IV, V, and VI.