[Benefits of volumetric to facial rejuvenation. Part 2: Dermal fillers]. / Apport de la volumétrie au rajeunissement facial. Partie 2 : produits de comblement.

Injectable substances known as fillers are used to palliate age-related atrophy and ptosis, and for their so-called "pseudo-lifting" action. They do not replace face and neck lift, but allow it to be postponed or, when injected after surgical lifting, make the result durable. Hyaluronic acid has a predominant and unchallenged place among fillers, well ahead of poly-L-lactic acid or calcium hydroxyapatite. Approaches and injection methods are the same for all fillers, corresponding to those for autologous fat injection, the reference substance, with a few particularities. The substance used, the level of hyaluronic acid reticulation, and the depth of the injection depend on the injection site and intended effect. Effects range from smoothing superficial wrinkles to remodeling whole parts of the face. Complications related to such fillers are well known, especially in the case of hyaluronic acid, where overcorrection is the most frequent. To limit the risk of complications and also to offer each patient the most individually adapted corrections, before any procedure, the plastic surgeon needs to question the patient and perform precise medical examination.

[Adverse reactions to injectable fillers]. / Complications des produits de comblement injectables.

The number of "fillers" grows constantly and allows responding to an ever larger demand with mostly hyaluronic acid or collagen based products. However, products degrading more slowly, containing polylactic acid or bioactive ceramics. All these products bring in general satisfactory results. Their short term tolerance shows few side effects, benign and always reversible. Long term, foreign body granulomas are very rare if interrogation prior to patient's treatment is exhaustive. On the reverse, non degradable products are at the origin of unaesthetic and invalidating granulomas, often very delayed and resisting to various local treatments. For this reason, these products should not be used anymore or only very exceptionally, for soft tissue augmentation.

[Skin testing with cosmetics brought in by patients]. / Comment tester les produits cosmétiques apportés par les patients.

Detailed analysis of symptoms indicates which skin tests should be performed in a patient presenting an allergic reaction to cosmetics: the tests should be read after 15 to 60 min for immediate reactions and after 48 and either 72 or 96 h for eczematous reactions. If the results are inconclusive, additional tests should be performed (ROAT, re-test, usage test). Discrepancies between clinical symptoms and tests results should raise a suspicion of false-positive or false-negative tests.

[Adverse reactions to injectable fillers]. / Complications des produits de comblement injectables.

The number of "fillers" grows constantly and allows responding to an ever larger demand with mostly hyaluronic acid or collagen based products. However, products degrading more slowly, containing polylactic acid or bioactive ceramics. All these products bring in general satisfactory results. Their short term tolerance shows few side effects, benign and always reversible. Long term, foreign body granulomas are very rare if interrogation prior to patient's treatment is exhaustive. On the reverse, non degradable products are at the origin of unaesthetic and invalidating granulomas, often very delayed and resisting to various local treatments. For this reason, these products should not be used anymore or only very exceptionally, for soft tissue augmentation.

[Classification of the fillers available in France]. / Classification des produits de comblement disponibles en France.

In the last few years the number of dermal filler products has increased in a spectacular manner, thus offering multiple treatment possibilities acting on skin aging and natural or aging related morphological changes. Hyaluronic acid products, with various concentrations and crosslinking levels, provide very good results on the whole cutaneous and subcutaneous skin alterations. Volumator products, especially highly crosslinked hyaluronic acid and L.polylactic acid, allow a liposculpture often appreciated and complementary to wrinkles and skin depression treatments. Usage of non-degradable products, at the origin of invalidating granulomas, completely impossible to eliminate, should be avoided in the maximum of cases.

Dry skin in dermatology: a complex physiopathology.

Dry skin (xerosis) is a common dermatosis affecting people of varying skin types and ages and various areas of the body. It is associated with both skin thickening and skin thinning and is triggered by both exogenous (e.g. climate, environment, lifestyle) and endogenous (e.g. medication, hormone fluctuations, organ diseases) factors. Skin requires a water content of 10-15% to remain supple and intact. This water is either 'static' (i.e. bound) or 'dynamic'. The predominance of hydrophobic substances in intercellular constituents is a means of regulating the humidity of the skin. Emollients, highly effective treatment adjuncts in the management of all dry skin disorders, help to restore damaged intercorneocyte lipid structures and increase the water content of the skin, helping to reduce scaling and improving its barrier function.

[Contact allergy to antiseptics: 75 cases analyzed by the dermato-allergovigilance network (Revidal)]. / Allergie de contact aux antiseptiques: 75 cas analysés par le réseau Revidal de dermato-allergovigilance.

AIM: To determine the clinical features of contact dermatitis caused by antiseptics and to ascertain whether the substance responsible is the antiseptic itself or the excipients. PATIENTS AND METHODS: A multicenter, retrospective study based on analysis of all cases reported over a 2-year period to the Dermato-Allergology Vigilance network known as Revidal. Each dossier contained details of the clinical characteristics of lesions, the incriminated antiseptic, the mode of exposure and the results of patch tests done with the antiseptic in question. RESULTS: 75 patients (mean age: 44 years) were sensitized to chlorhexidine (14 cases), hexamidine (20 cases), povidone iodine (14 cases), mercuric antiseptics (3 cases), triclocarban (Septivon, 17 cases), hexamidine-chlorhexidine-chlorocresol (Cytéal, 4 cases), or chlorhexidine surfactant (Hibiscrub), cetrimide or chlorhexidine digluconate (Diaseptyl) (1 case each). Exposure was therapy-related (68 cases), work-related (6 cases; 5 in health workers and 1 in a cattle farmer due to povidone-iodine) or related to cosmetics (1 case, hexamidine). The clinical features consisted mainly of localized contact dermatitis, although generalized eczema occurred in 9 cases due to hexamidine contact. Sensitization was due to the antiseptic itself (53 cases) or to the excipients alone (22 cases), particularly in the 17 cases caused by Septivon. In 27/75 cases (35%), patients exhibited polysensitization to antiseptics belonging to different chemical classes or to other topical drugs. CONCLUSION: Sensitization to antiseptics is probably not rare, with various sources of exposure being present in everyday life. Patch tests are essential for diagnosis in order to distinguish between antiseptic-related and excipient-related sensitization and to screen for polysensitization to topical drugs.

[Slowly absorbable and non absorbable injectable products]. / Les produits injectables lentement et non résorbables.

Products which are non absorbable or slowly absorbable make the correction of facial wasting of any origin possible. These highly efficient products are unfortunately sometimes responsible for complications or even undesirable after effects. In order to avoid this the following are necessary: clinical and histological analysis of facias granulomas, a proposal for guidelines for their use which would predict in situ tolerance.

Sensitive skin: a complex and multifactorial syndrome.

Many people complain of discomfort after application of commonly used skin care products, particularly to the face. This hyperreactivity of the skin is a non-immunologically mediated skin inflammation. It seems to be the result of an intolerance of the skin to various stimuli that are normally well tolerated. It is difficult to assess the prevalence of 'sensitive skin' and sensitive skin-related cosmetic intolerance because of the many possible exogenous and endogenous factors that trigger or aggravate this multifactorial syndrome. A thorough history is essential. Sometimes patch testing is needed both to standard allergens and also to all the patients' cosmetics and skin care products. All cosmetics should be stopped and then reintroduced one by one, at intervals of one to two weeks. The number, type and frequency of the application of skin care products used in the final programme should remain limited. Some patients benefit from psychological or even psychiatric help. Management is usually difficult and all therapeutic measures should be undertaken with patience and tenacity.

Tolerance profile of a sterile moisturizer and moisturizing cleanser in irritated and sensitive skin.

BACKGROUND: This study evaluates the tolerance of preservative free sterile cleanser and sterile moisturizer in irritated and sensitive face skin. MATERIALS AND METHODS: An exploratory, open-label study using the cleanser and the moisturizer in combination was performed with 98 patients with a documented history of allergic contact dermatitis. The 2 products could each be used once or twice daily for 28 days. The assessment parameters at baseline and end of treatment (day 28) included the intensity of erythema, dryness/scaling by the investigator and subjective signs (burning, pruritus and stinging), according to a defined 4-point scale (absent to severe). In addition, a global assessment of the change from baseline and the overall tolerance of the products were performed by the investigator at the end of treatment. RESULTS: Ninety-four patients were included for the efficacy analysis and 96 patients for the safety analysis. At baseline, a majority of patients expressed some degree of erythema (63%), and dryness/scaling (56%). Fewer patients experienced subjective signs at baseline (44%). At the end of treatment, the results showed a statistically significant improvement of all the objective signs of irritated skin (P = .0001, Mac Nemar test), as well as the subjective signs of sensitive skin (P < 0.02). This was confirmed by the overall investigator assessment, showing an excellent or good response in 90% of the patients. In the safety analysis, 1 patient developed contact allergy to 1 ingredient of the test products (carbomer), and 3 patients exacerbated their dermatitis. CONCLUSION: Taken together, these results suggest that adequately formulated cosmetics might reduce both irritated and sensitive skin, with clinical improvement of dryness, erythema and stinging.