The Effects of a Non-crossed-linked Hyaluronic Acid Gel on the Aging Signs of the Face versus Normal Saline: A Randomized, Double-blind, Placebo-controlled, Split-faced Study.

Background: Skin bio-revitalization improves skin quality globally; it permits the rejuvenation of the skin by increasing hydration and by reconstructing an optimal physiological environment for the skin cells together with a micro-filling effect. Objective: To assess the comparative efficacy of a non-cross-linked hyaluronic acid (NCHA) preparation (M-HA®10, FILLMED Laboratories, France) on fine lines reduction and on skin hydration, radiance and mechanical properties, after three sessions of multiple intradermal injections, active versus placebo, on the face of subjects presenting aging signs. Methods: Thirty healthy subjects received filler injections on one side and a control solution (saline) on the contralateral side of the face. Fine lines depth, skin hydration, and mechanical properties were evaluated using instrumental methods. Skin radiance, cheek fold and crow's feet were scored clinically. In addition, Investigator and subject satisfaction rates were evaluated by the Global Aesthetic Improvement Scale and a subject self-assessment questionnaire. Results: Ten days after the last multi-injection session, the following significant results were observed compared to the control: a reduction of both crow's feet wrinkle depth (in the 110 to 1000µm range, -10% for NCHA and +7% for control) and clinical scoring of cheek wrinkles, and increases in skin radiance and hydration (+35%) and also skin firmness (+27%). The Investigator found that NCHA either improved or much improved the aesthetic aspect on 82% of subjects whereas no improvement was found on the saline side. Subjects found that NCHA significantly reduced wrinkles and increased both skin firmness and elasticity. Conclusion: Intradermal injection of NCHA can improve the quality of facial skin with aging signs by reducing fine wrinkles and improving hydration, firmness and radiance.

A precise analysis of the relative contribution of UVA1 and visible light colour domains in solar light-induced skin pigmentation.

BACKGROUND: Solar light induces or aggravates hyperpigmentation issues. The contribution of UVA1, as well as visible light (VL), especially high-energy blue-violet visible (HEV) light, is now clearly established. OBJECTIVES: This work aimed at determining the relative contribution of UVA1, HEV and VL wavelength bands and their sub-domains in pigmentation induction. METHODS: Two clinical studies using solar simulators equipped with specific bandpass physical filters were carried out. Volunteers (FSPT III-IV) were exposed on the back to UVA1 + HEV (350-450 nm), UVA1 (350-400 nm), HEV (400-450 nm) or part of UVA1 + HEV (370-450 nm) in Study 1 (n = 27) and to VL (400-700 nm), HEV (400-450 nm), Blue (400-500 nm), Green (500-600 nm) and Green+Red (500-700 nm) domains in Study 2 (n = 25). Pigmentation level was assessed by visual scoring and colorimetry at different time points postexposure, up to Day 43. RESULTS: Induced pigmentation was detected in all exposed conditions, peaking at 2 h and thereafter progressively decreasing but remaining persistent up to Day 43. In Study 1, UVA1 showed an additive effect with HEV, with a significant contribution coming from the Longest UVA1 rays (370-400 nm). Study 2 demonstrated that 24 h postexposure, the Blue domain accounted for 71% of VL-induced pigmentation, the HEV one for 47%, the Green one for 37% and the Green+Red one for 36%, confirming no significant effect for Red light. CONCLUSIONS: Altogether, these results underline the need for UVA1 photoprotection up to 400 nm and highlight the importance of protecting the skin from solar VL wavelengths and especially from HEV, Blue and Green light, to limit induced pigmentation.

The antiaging effects of a product containing collagen and ascorbic acid: In vitro, ex vivo, and pre-post intervention clinical trial.

Various substances, including collagen (Naticol®) and ascorbic acid, that inhibit and prevent skin aging have been studied. Collagen prevents skin aging, has anti-inflammatory effects, and assists in normal wound healing. Ascorbic acid is a representative antioxidant that plays a role in collagen synthesis. To achieve a synergistic effect of collagen and ascorbic acid on all skin types, we prepared a product named "TEENIALL." In addition, we used a container to separate ascorbic acid and collagen to prevent the oxidation of ascorbic acid. To confirm the effects of TEENIALL, we first confirmed its penetrability in fibroblasts, keratinocytes, melanocyte, and human skin tissues. Thereafter, we confirmed the collagen synthesis ability in normal human fibroblasts. Based on the results of in vitro tests, we conducted a clinical trial (KCT0006916) on female volunteers, aged 40 to 59 years, with skin wrinkles and hyperpigmentation, to evaluate the effects of the product in improving skin wrinkles, skin lifting, and pigmentation areas before using the product, and after 2 and 4 weeks of using the product. The values of nine wrinkle parameters that were evaluated decreased and those for skin sagging, pigmentation, dermal density, and mechanical imprint (pressure) relief were improved. Skin wrinkle and pigmentation were evaluated to ensure that the improvement effect was maintained even after 1 week of discontinuing the product use. The evaluation confirmed that the effects were sustained compared to those after 4 weeks of using the product. Additionally, skin wrinkles, skin lifting, radiance, and moisture content in the skin improved immediately after using the product once. Based on the results of in vitro and ex vivo experiments and the clinical trial, we show that the product containing ascorbic acid and collagen was effective in alleviating skin aging.

Impact of topical emollient, steroids alone or combined with calcipotriol, on the immune infiltrate and clinical outcome in psoriasis.

Psoriasis is a chronic inflammatory disease whereby long-term disease control remains a challenge for the patients. Latest evidence suggests that combined topical treatment with steroids and vitamin D analogue foam (Calcipotriol/Betamethasone) is efficient in long-term management of the disease and reducing the number of relapses. Its effects on cellular inflammation and cytokine production remain to be explored. We set out to examine the effect of topical therapies on cellular infiltrate and cytokine profile in the lesional skin of psoriasis patients. This was a monocentric, double-blind, randomized trial with 30 patients. Patients were treated with the combined Calcipotriol/Betamethasone foam, Betamethasone foam alone, Clobetasol Propionate ointment or placebo. 4 mm skin biopsies from lesional and non-lesional sites were taken before and 4 weeks after treatment. Cellular infiltrate, IFNγ and IL-17 were studied by immunofluorescence. Each patient was their own control. Evolution in skin inflammation was studied in parallel with changes in patient's epidermal thickness and their tPASI clinical score. Lesional skin was characterized by increased epidermal thickness, increased number of IL-17 and IFNγ producing CD8+ T cells, NK cells and neutrophils. All treatment reduced epidermal thickness and improved patients tPASI scores. Only the combined Calcipotriol/Betamethasone foam completely abolished epidermal and dermal influx of CD8+ T cells, reduced number of CD8 + IFNγ+ cells (but not CD8 + IL-17+ cells) and significantly reduced the number of MPO+ neutrophils which were predominantly IL-17+. None of the treatments had effect on NK cells. We have shown the combined topical treatment with Calcipotriol/Betamethasone foam to be effective in reducing cellular influx into lesional skin of psoriasis patients and this effect to be superior to emollient or Betamethasone alone. Its previously described efficacy in the clinic may be attributed to its unique and rapid ability to inhibit both adaptive CD8+ T cell and innate immune neutrophilia influx into the skin, which was not observed for the other treatments.

Prevention of Polymorphic Light Eruption Afforded by a Very High Broad-Spectrum Protection Sunscreen Containing Ectoin.

INTRODUCTION: Polymorphic light eruption (PLE) is the most common idiopathic, acquired photodermatosis. The pathophysiology of PLE is not yet fully understood but seems to involve immunological mechanisms, UVA-induced oxidative stress, and the subsequent elicitation of a cellular stress response affecting keratinocyte gene expression and skin immune function. In the present study, a high broad-spectrum sunscreen medical device (MD), containing a very high protection complex of UVB and UVA filters and ectoin, was investigated for its ability to protect against UVA-induced PLE. METHODS: The study was carried out as a monocentric, double-blinded, randomized, untreated controlled design. The test MD was applied (2 mg/cm2) on one side of the chest according to a randomization list of 15 patients with a typical history of PLE, and the contralateral area remained untreated. After product application, the test areas were exposed daily to increasing doses of UVA radiation (from 40 to 60 J/cm2) until a PLE reaction was detected or for a maximum of five consecutive days. Evaluations of induced PLE included clinical scoring and chromametry for erythema and pigmentation. RESULTS: Overall, no positive PLE reaction was observed on the side of the chest treated by the test MD, whereas positive PLE reactions were triggered on the untreated side of 13 subjects. Subjective sensations were very rare on the MD-treated side but were numerous and more severe on the untreated side. Chromametry and clinical visual inspection indicated that the skin color was unchanged on the MD-protected side, whereas high increased values of erythema and pigmentation were observed on the untreated chest side. CONCLUSION: This MD sunscreen based on a complex of UVA-UVB filters and 1% of ectoin may be effective in preventing UVA-induced PLE. New studies comparing this MD sunscreen versus the same product without ectoin should be conducted. CLINICALTRIALS: gov identifier: NCT05320315 (retrospectively registered 09/17/2021).

A method to assess the protective efficacy of sunscreens against visible light-induced pigmentation.

BACKGROUND: Until now, photoprotection of human skin has involved the development of sunscreens effective in the ultraviolet (UV) domain. During the last ten years, several studies have shown that besides the well-known damaging effects of UV, visible (400-700 nm) and even infrared light (> 700 nm) can induce damage which contributes to photoaging. Furthermore, many photodermatoses are also known to be triggered by visible light (VL). OBJECTIVE/METHOD: An in vivo method is proposed to assess the protective efficacy of sunscreens in the VL domain. This method is based on the intensity of pigmentation induced by four repeated daily doses of VL, each equivalent to about one hour of midday sun. Exposures are performed using a solar simulator (xenon lamp) equipped with appropriate filters, and pigmentation is measured both clinically and by chromametry. Three commercially available sunscreens designed to protect in the visible range were evaluated. RESULTS: The results indicate that the VL-induced pigmentation was already significantly detectable visually and by chromametry 24 hours after the first exposure on the unprotected zone. Two products with moderate protective activity could be differentiated from the untreated zone from Day 3 to Day 5 and were also significantly less effective than a third tested product within the same study period. CONCLUSION: The method is simple, based on a clinical end point of VL-induced skin pigmentation, and can be performed within a 5-day period. It allows discrimination between products of different protective capacities. VL protection factor is also discussed.

Differences in visible light-induced pigmentation according to wavelengths: a clinical and histological study in comparison with UVB exposure.

The visible light spectrum is wide, and it can be hypothesized that all the wavelengths between 400-700 nm do not induce the same photobiological effects on pigmentation. We assessed the potential pro-pigmenting effects of two single wavelengths located at both extremities of the visible spectrum: the blue/violet line (λ = 415 nm) and the red line (λ = 630 nm). We made colorimetric, clinical, and histological assessments with increasing doses of those lights on healthy volunteers. Then, we compared these irradiations to non-exposed and UVB-exposed skin. Colorimetric and clinical assessments showed a clear dose effect with the 415-nm irradiation, in both skin type III and IV subjects, whereas the 630 nm did not induce hyperpigmentation. When compared to UVB irradiation, the blue-violet light induced a significantly more pronounced hyperpigmentation that lasted up to 3 months. Histological examination showed a significant increase of keratinocyte necrosis and p53 with UVB, as compared to 415- and 630-nm exposures.

A pilot study using reflectance confocal microscopy (RCM) in the assessment of a novel formulation for the treatment of melasma.

INTRODUCTION: Melasma is a common pigmentary disorder caused by abnormal melanin deposits within the skin. Hydroquinone (HQ) is presently the most popular depigmenting agent, however the treatment of melasma remains unsatisfactory, resulting in a need to evaluate new depigmenting agents. OBJECTIVE: The objective of this study was to assess, using standard methods and a novel technique, in vivo Reflectance Confocal Microscopy (RCM), the efficacy and safety of a new non-HQ bleaching agent Dermamelan® (Mesoestetic, Barcelona, Spain) in the treatment of melasma. METHODS: Ten women with melasma were enrolled in an open-label trial lasting four months. Patients were of Fitzpatrick skin types II-IV. A non-HQ depigmenting agent (Dermamelan) was applied once-daily for three months. Melasma Area and Severity Indices (MASI) were measured. Standard and UV-light photographs were taken and in vivo RCM, which detects pigmentary changes at a cellular level, was done. Evaluations were performed before treatment, on the first, second and third month of treatment and one month after treatment. Upon cessation of the trial, patients completed a questionnaire regarding efficacy and tolerance. RESULTS: At baseline, RCM detected hyperpigmented keratinocytes in all patients, dendritic cells in 2/10 patients, and melanophages in 2/10 patients. Based on the MASI score, Dermamelan treatment improved melasma by 50 percent. This was confirmed by standard and UV-light photography. Maximum therapeutic effect was usually reached by one month of treatment and was maintained at one month following its completion. Interestingly Dermamelan treatment also induced a statistically significant decrease of pigmented epidermal keratinocytes as detected by RCM. Patients with melanophages on RCM at baseline had a poorer outcome, but not those with dendritic cells. Mild irritation was the only adverse event observed during treatment. The majority of patients were satisfied with the result. CONCLUSION: This study suggests that Dermamelan produces significant rapid improvement of melasma at a clinical and cellular level and demonstrates the potential of RCM to monitor and possibly predict efficacy of a new depigmenting agent in the treatment of melasma.

Effectiveness of cross polarized light and fluorescence diagnosis for detection of sub-clinical and clinical actinic keratosis during imiquimod treatment.

BACKGROUND: During treatment of actinic keratosis (AK) lesions with imiquimod sub-clinical lesions often become visible. It is, however, unclear whether these sub-clinical lesions would be detectable beforehand. OBJECTIVE: The aim of this pilot study was to compare two techniques, cross polarized light photography (CPL) and fluorescence diagnosis (FD) using methyllevulinic acid and illumination with Wood's lamp for their ability to detect sub-clinical lesions. These findings were also compared with biopsy results taken before and after treatment with imiquimod 5% cream or vehicle. METHODOLOGY: Twelve patients with at least five clinically visible AK lesions in a single contiguous 20 cm(2) area on the head were recruited. Patient eligibility was determined at the screening visit, when they were randomized to treatment. The randomization was 3:1, active to vehicle (nine treated with imiquimod, three with vehicle cream) for a total duration of 24 weeks (six clinic visits). Patients were assessed for baseline AK lesion counts (clinical and sub-clinical) at the screening visit and final counts at week 20. RESULTS: The number of clinically observed AK lesions was significantly lower at week 12 and week 20 compared with baseline following imiquimod treatment versus vehicle. The number of counted lesions were significantly higher using the CPL method compared with clinical counting with imiquimod treatment at baseline (8.3 +/- 3.4 vs 5.8 +/- 1.3; P = 0.027) and week 20 (4.8 +/- 2.4 vs 3.0 +/- 1.7; P = 0.02) but not in the vehicle group. The FD lesion counting method did not show a significant increase in the number of detected lesions compared with clinical analysis in the imiquimod and placebo groups but when comparisons were performed using pooled data (treatments and visits combined) the results were significant. CONCLUSION: The number of sub-clinical and clinical AK lesions detected during treatment with imiquimod can be better demonstrated using the methods of CPL and FD, but statistical significance was reached only using the CPL method. This is only a preliminary study with a small number of patients and as a result it is difficult to conclude both statistical and clinical significance. However, results were encouraging and indicate that larger studies are needed to demonstrate the relevance of these two new methods for improved detection of clinical and especially sub-clinical AK lesions.

3% diclofenac in 2.5% hyaluronic acid (Solaraze) does not induce photosensitivity or phototoxicity alone or in combination with sunscreens.

Topical treatment with 3% diclofenac in 2.5% hyaluronic acid (Solaraze) has been extensively documented for the treatment of actinic keratoses (AK). Since sun protection is a vital part of AK management, two Phase IV studies were carried out to investigate the phototoxicity and photosensitisation potential of 3% diclofenac in 2.5% hyaluronic acid in combination with sunscreens. Patches of 3% diclofenac in 2.5% hyaluronic acid and control were applied under occlusion to the backs of healthy volunteers aged 18-65. In the phototoxicity study (n = 32), a single application followed by administration of the sunscreens and exposition with ultraviolet (UV) were done, whereas in the photosensitisation study, application was repeated twice weekly for three weeks, then once after a two-week rest phase. The erythema reaction was recorded, together with other local skin reactions. In both analyses, areas treated with 3% diclofenac in 2.5% hyaluronic acid in combination with sunscreens had the lowest incidence of erythema reactions, indicating that it was well tolerated when used in conjunction with sunscreen products, and with exposure to UV irradiation. The results showed that no phototoxic or photosensitisation reactions occurred with 3% diclofenac in 2.5% hyaluronic acid, either alone or in combination with sunscreens.

The new 940-nanometer diode laser: an effective treatment for leg venulectasia.

BACKGROUND: The 940-nm diode laser has been shown to be an effective treatment for leg veins. OBJECTIVE: We sought to evaluate the effectiveness of the 940-nm diode laser on leg veins, depending on the size and morphologic aspect of the treated vessels. METHODS: A total of 60 patients (mean age: 44.4 years, Fitzpatrick skin types I-IV) underwent up to 3 treatment sessions at 4-week intervals using the 940-nm diode laser. Treatment parameters were: vessels < 0.4 mm in diameter, 0.5-mm spot, pulse duration of 10 milliseconds, fluence 306 J/cm(2); 0.4 to 0.8 mm in diameter, 1-mm spot, pulse duration of 30 milliseconds, fluence 306 J/cm(2); and 0.8 to 1.4 mm in diameter, 1.5-mm spot, pulse duration of 70 milliseconds, fluence 317 J/cm(2). Repetition rate was 2.5 Hz. Success rate was evaluated through double-blind observation. RESULTS: Only 13.33% of patients with telangiectases less than 0.4 mm in diameter had a percentage of vessel clearance superior to 75%. However, 88.24% of patients with vessels between 0.8 and 1.44 mm in diameter obtained more than 75% vessel clearance. CONCLUSION: The treatment of leg veins by the 940-nm diode laser strongly depends on the size of the target vessel. Better results were obtained with 0.8- to 1.4-mm leg venulectases.