Method R: Efficacy of a cosmetic routine comprising six topical lipid-encapsulated products.

INTRODUCTION AND OBJECTIVE: Efficacy of cosmetic routines is reportedly available in several dermatological conditions, such as acne or rosacea. However, clinical evidence about objective advantages of skincare routine remains limited despite advertising often claims benefits. METHOD: We aimed to assess the subject satisfaction level and the benefit from daily use of an advanced skincare routine named Method R. We used four different approaches to try and demonstrate the efficacy of the method: Transdermal delivery test, ex-vivo efficacy test, Visioscan® VC 20, and patient survey. MetR consists of a six-step routine that shows an increased epidermal penetration and activity due to liposomation. RESULTS: Transdermal delivery test and ex-vivo efficacy test show increased efficacy for liposomated actives. The skincare routine is well tolerated, and is associated with a marked efficacy in global quality of skin, dyschromia/pigmentation, brightness, and hydration according to patient perception. The subject satisfaction level is high and the routine is safe. The continuous use of the routine for one month or more results in objective changes when measured with Visioscan® VC 20 plus.

Eccrine Nevus in the Forearm of a 16-Year-Old Presenting as Unilateral Hyperhidrosis: A Clinicopathological Correlation Paradigm.

A case of a purely eccrine nevus in an adolescent patient presenting with focal hyperhidrosis on an area comprising the left forearm and the dorsal aspect of the left hand is described. No clinically evident lesions were identifiable. Dermatopathologic findings were subtle, showing only a slight increase in the number of eccrine glands. Clinicopathological correlation was paramount to achieve the diagnosis.

Patient Satisfaction and Efficacy of Full-Facial Rejuvenation Using a Combination of Botulinum Toxin Type A and Hyaluronic Acid Filler.

BACKGROUND: Combination treatments using hyaluronic acid (HA) fillers and botulinum toxin Type A (BoNT-A) are common in aesthetic medicine; however, this has been evaluated in only a few clinical studies. OBJECTIVE: To evaluate subject satisfaction, efficacy, and safety of BoNT-A (Speywood Unit; s.U) and a range of HA fillers for full-facial aesthetic rejuvenation. MATERIALS AND METHODS: A 6-month, multicenter, open-label clinical study, using BoNT-A (s.U) and 5 HA fillers to treat up to 13 facial zones. Subject satisfaction questionnaires were administered 3 weeks and 6 months after the last injection. Global aesthetic improvement and improvement on each treated zone as well as safety were evaluated. RESULTS: A high level of satisfaction was achieved throughout the study, with 96.5% of subjects at least satisfied with the full-facial aesthetic outcome at 3 weeks, and 92.9% at 6 months. More than 91% considered the treatment outcome to meet or surpass their expectations, and more than 94% would recommend the treatment to others. At Week 3, subject and investigator assessment showed aesthetic improvement for all subjects. The treatment was well tolerated. CONCLUSION: The combination of BoNT-A (s.U) and HA fillers results in high patient satisfaction and in an overall improvement of aesthetic outcomes and quality of life.

Photorejuvenation using topical 5-methyl aminolevulinate and red light.

BACKGROUND: Photodynamic therapy has been proved to be effective in skin rejuvenation. OBJECTIVE: To evaluate clinical efficacy and side effects of photodynamic therapy using topical 5-methyl aminolevulinate and red light for photorejuvenation. METHODS: A randomized, prospective, split-face comparison study of 10 white, adult patients with moderate photodamage, Fitzpatrick skin types 2 or 3, and no occurrence of actinic keratosis was performed. Three treatments using topical methyl aminolevulinate cream, applied for 1 hour on one half of the face and 3 hours on the other half before illumination with red light. A blinded investigator prior to treatment and 2 months after the third treatment evaluated each side of the subject's faces. RESULTS: A moderate improvement in fine lines, tactile roughness, and skin tightness was observed in most of the patients, mostly on the 3-hour time side. There were no changes in mottled pigmentation or telangiectasias. Side effects were observed in all subjects (erythema, edema, scaling) mainly in the 3-hour incubation time side. LIMITATIONS: The small number of patients and the lack of placebo group. CONCLUSION: Methyl aminolevulinic-photodynamic therapy with red light can improve fine lines, tactile roughness and skin tightness in patients with moderate photoaging and no occurrence of actinic keratosis.

Enhanced efficacy of photodynamic therapy after fractional resurfacing: fractional photodynamic rejuvenation.

BACKGROUND AND OBJECTIVES: Conventional ablative resurfacing is the gold standard for removing signs of cutaneous photodamage. Despite the excellent results one can achieve with this technique, it is accompanied with significant downtime and risks. Fractional resurfacing and photodynamic therapy (PDT) with aminolevulinic acid (ALA) have been used to improve the signs of photodamage with less downtime. However, independently they do not yield results as good as ablative resurfacing. This pilot study will examine the potential for synergistic effects of combining fractional resurfacing and ALA-PDT. MATERIALS AND METHODS: Four women with Fitzpatrick skin types II or III, mild to moderate rhytides and no actinic keratosis in the perioral area were treated. The perioral area was treated with 2 sessions of fractional resurfacing with the Fraxel SR (formerly Fraxel SR750, Reliant Technologies Inc, Palo Alto, CA) 3 weeks apart. Immediately after each fractional treatment we applied methyl 5-aminolevulinate (MAL or Metvix) on one half of the perioral area and 3 hours later we illuminated that area with a red light (Aktilite lamp, PhotoCure ASA, Oslo, Norway) in a dose of 37 J/cm2. Prior to treatment and at 4 and 12 weeks after the final treatment, a blinded investigator evaluated each side of the perioral area and rated the improvement from baseline as excellent, good, fair, or poor improvement of superficial wrinkles by comparing the results with pretreatment photographs. Patients also completed an evaluation form assessing their satisfaction with the treatment on each side of the perioral area while comparing the results with pretreatment photographs. RESULTS: The study showed increased improvement in superficial wrinkles in 3 out of 4 patients on the combined treatment side. In one patient, the investigator found no significant difference when comparing both sides. All the patients noted greater improvement in the combined fractional and PDT-treated side compared to the side only treated with fractional surfacing. CONCLUSION: This pilot study shows a potential for enhanced clinical results when using combined fractional resurfacing and ALA-PDT compared to fractional resurfacing alone.

Nonablative skin resurfacing: the role of PDT.

As demand for less invasive, highly effective cosmetic procedures grows, dermatologists must continue to explore and develop new treatment options. Nonablative skin resurfacing techniques offer an effective and noninvasive treatment for photorejuvenation. Several studies have shown improvement of photodamaged skin and increased collagen production after nonablative treatments using vascular lasers, mid-infrared lasers, intense pulsed light, radiofrequency devices, fractional resurfacing, and plasma skin rejuvenation. Among the novel methods for maximizing the efficacy of nonablative treatment is the concurrent use of a photosensitizing agent. The light sources currently most used for photodynamic rejuvenation are intense pulsed light and pulsed dye laser. We present some preliminary results on rejuvenation using Metvix and red light. We are still far from a thorough understanding of the molecular mechanism of rejuvenation with this technique, although a nonspecific immune response could be involved. Understanding the laser-tissue interactions associated with photodynamic therapy is crucial in selecting patients that will most likely benefit.

[Photodynamic therapy in dermatology]. / Terapia fotodinámica en dermatología.

Photodynamic therapy (PDT) is a therapeutic modality based on the photooxidation of biological materials induced by a photosensitizer, which selectively locates itself in certain tumorous cells or tissues, so that when illuminated by a light of the right length and at a sufficient dose, these cells are destroyed. In dermatology, PDT with topical 5-aminolevulinic acid or 5-methyl aminolevulinate is very effective in the treatment of actinic keratoses, basal cell carcinomas and Bowen's disease. In addition, very promising results have been obtained in inflammatory pathologies like morphea or sarcoidosis, infections like warts, and cosmetic processes such as photoaging, among others. This article reviews the most significant aspects of PDT in dermatology. First of all, we will review the basic fundamentals of photodynamic treatment. Next, we will outline its clinical applications in dermatology, both in oncological applications and all those dermatological processes in which PDT may play a role in their management. We will also discuss its promising cosmetic application in the treatment of photoaging. We will complete the review with photodiagnosis and the different non-invasive ways to monitor the effectiveness of PDT.

Terapia fotodinámica en dermatología / Photodynamic therapy in dermatology

La terapia fotodinámica (TF) es una modalidad terapéutica basada en la fotooxidación de materiales biológicos inducida por un fotosensibilizante, el cual se localiza selectivamente en determinadas células o tejidos tumorales, de forma que al ser iluminadas con una luz de adecuada longitud y en dosis suficiente, dichas células resultan destruidas. En dermatología, la TF con ácido 5-aminolevulínico o 5-metilo aminolevulinato tópicos es muy efectiva en el tratamiento de queratosis actínicas, carcinomas basocelulares y enfermedad de Bowen. Además, se han obtenido resultados muy prometedores en patología inflamatoria como la morfea o la sarcoidosis, infecciones como las verrugas y procesos cosméticos, como el fotoenvejecimiento, entre otras. El presente artículo revisa los aspectos más relevantes de la TF en dermatología. En primer lugar se hará una revisión de los fundamentos básicos del tratamiento fotodinámico; posteriormente se expondrán sus aplicaciones clínicas en dermatología, tanto las oncológicas como todos aquellos procesos dermatológicos en los que la TF puede desempeñar un papel en su manejo, sin olvidar su prometedora aplicación cosmética en el tratamiento del fotoenvejecimiento. Finalizaremos la revisión con el fotodiagnóstico y las diferentes formas de monitorización no invasiva de la efectividad de la TF

Photodynamic therapy (PDT) is a therapeutic modality based on the photooxidation of biological materials induced by a photosensitizer, which selectively locates itself in certain tumorous cells or tissues, so that when illuminated by a light of the right length and at a sufficient dose, these cells are destroyed. In dermatology, PDT with topical 5-aminolevulinic acid or 5-methyl aminolevulinate is very effective in the treatment of actinic keratoses, basal cell carcinomas and Bowen's disease. In addition, very promising results have been obtained in inflammatory pathologies like morphea or sarcoidosis, infections like warts, and cosmetic processes such as photoaging, among others. This article reviews the most significant aspects of PDT in dermatology. First of all, we will review the basic fundamentals of photodynamic treatment. Next, we will outline its clinical applications in dermatology, both in oncological applications and all those dermatological processes in which PDT may play a role in their management. We will also discuss its promising cosmetic application in the treatment of photoaging. We will complete the review with photodiagnosis and the different non-invasive ways to monitor the effectiveness of PDT

Photodynamic therapy with 5-aminolevulinic acid for recalcitrant familial benign pemphigus (Hailey-Hailey disease).

Familial benign pemphigus is a chronic, recurrent, autosomal dominant blistering disease that may significantly affect quality of life. Surgical methods are often needed to control flares in difficult cases. We describe the use of photodynamic therapy (PDT) with topical 5-aminolevulinic acid (ALA) followed by irradiation with incoherent light (ALA-PDT) in 2 patients with chronic, recalcitrant familial benign pemphigus.

Piodermia gangrenosa asociada a leucemia linfocítica crónica / Pyoderma gangrenosum associated with chronic lymphocytic leukemia

La piodermia gangrenosa es un proceso ulcerativo asociado frecuentemente a enfermedades linfoproliferativas. La asociación a leucemia linfocítica crónica es un hecho excepcional. Describimos el caso de un varón de 72 años que presentó úlceras cutáneas en piernas de 4 meses de evolución y que posteriormente fue diagnosticado de leucemia linfocítica crónica. El paciente presentó curación total de las lesiones cutáneas tras tratamiento con ciclosporina (AU)