Evaluation of the effectiveness and safety of combined oral and topical photoprotection with a standardized extract of Polypodium leucotomos (Fernblock®) in a Moroccan population with xeroderma pigmentosum.

BACKGROUND: Xeroderma pigmentosum (XP) is a rare autosomal-recessive genodermatosis resulting from a DNA-repair defect syndrome. The purpose was to evaluate the prevention on new malignant lesions in patients taking a supplement with Fernblock® (Polypodium leucotomos extract [PLE]) and secondarily correlation with the photoprotective behavior. METHODS: A prospective, single-center and open cohort study was conducted over a 12-month period. The study was performed in Morocco. Optimal photoprotection behavior was recommended. Patients were instructed to take one capsule containing 480 mg of Fernblock® and 5 mcg vitamin D and to apply sunscreen with a SPF50+ and Fernblock® every 2 h during sun exposure. The demographic, clinical, and dermatoscopic patient data were collected at baseline (T0) and following visits at 3 months (T3), 6 months (T6), and 12 months (T12) when it was assessed: Investigator Global Assessment (IGA), Patient/Guardian Global Assessment (PGA), Patient/Guardian Satisfaction Questionnaire, and Photographic and Adverse Events Registration. Pertinent statistical study was performed. RESULTS: Eighteen patients completed the study. Eleven patients (61%) finished the study without new lesions. Seven patients developed new lesions by the end of the study. Among them, only 30% showed an ideal photoprotective behavior. The lack of an optimal photoprotective behavior increased the probability of developing lesions by 2.5 times with 95% confidence interval. CONCLUSIONS: In our study, more than 60% of patients taking a supplement with Fernblock® did not develop new lesions, and furthermore, we detected that patients following almost ideal photoprotection were 2.5 times less likely to develop NMSC lesions.

Early and maintained application of the secretion of Cryptomphalus aspersa (SCA) 40% improves cutaneous healing after ablative fractional laser in skin aging.

BACKGROUND: Ablative fractional laser generates a regulated skin damage, which secondarily improves skin aging. AIMS: The main objective of the present study was to figure out if the adverse effects induced by laser and the skin recovery could improve with the application of a cosmetic product based on the secretion of Cryptomphalus aspersa (SCA). PATIENTS/METHODS: A prospective double-blind controlled study with vehicle in 10 patients with skin aging. The patients received one session of fractional ablative CO2  laser, and the formulation with SCA 40% was applied immediately and maintained throughout the 21-day duration of the study. The active treatment (SCA) was applied to one hemifacial area and vehicle to the other, and the patient acting was her own control. Clinical evaluations, dermoscopy, photography, and other parameters like cutaneous hydration, elasticity, and wrinkles were evaluated. In addition, the severity of the adverse effects was evaluated. RESULTS: Significant greater decrease in the density of microcolumns produced by laser was detected on the active-treated side, indicating greater and faster postprocedure recovery compared to the vehicle-treated side. In addition, side effects were reduced and some antiaging effects were more apparent on the side treated with SCA 40%. CONCLUSION: SCA 40% applied immediately after ablative laser, and during the next days, it can accelerate laser-induced damage regeneration. In addition, SCA improves the cosmetic outcome after laser application.

A cosmetic treatment based on the secretion of Cryptomphalus aspersa 40% improves the clinical results after the use of nonablative fractional laser in skin aging.

INTRODUCTION: The main purpose of this study was to evaluate whether the application of a cosmetic treatment based on the secretion of Cryptomphalus aspersa (SCA) enhances the clinical results, tolerance, and skin regeneration after nonablative laser treatment in patients with moderate photoaging. METHODS: Randomized, double-blind, split-face trial in 20 patients with moderate aging. Two sessions with fractional nonablative laser were performed, and the cosmetic treatments (SCA 40% on one hemiface and vehicle on the other) were applied immediately after laser session and daily during the study (28 days). Tewameter, Cutometer, Visioscan, VisioFace, photography, dermoscopy, and clinical evaluation were assessed. Side effects were also evaluated. RESULTS: A significant decrease in the density of microcolumns (25%, 71%, 32%, and 61% less density, respectively, at T3 P = 0.008, T7 P = 0.002, T22 P < 0.001, and T24 P < 0.001) was observed on the side treated with SCA compared to the vehicle-treated side. Cutaneous elasticity, area of wrinkles, and hydration on the SCA-treated side also showed a significant improvement compared to the vehicle-treated side. Both the researcher and patients observed a significant improvement on the side treated with SCA compared to the vehicle-treated side. Significantly fewer side effects (erythema, burning, and dryness) were also detected. CONCLUSION: A cosmetic product with SCA 40% applied immediately after laser and for a period thereafter enhances and accelerates repair of damage produced by the laser and significantly reduces related adverse effects. In addition, SCA treatment could improve clinical results. In conclusion, we suggest that SCA enhances the effectiveness of laser in the treatment of cutaneous aging.

Peeling químico, una herramienta útil en la consulta / Chemical Peeling: A Useful Tool in the Office

Las exfoliaciones químicas (más conocidas como peelings químicos) son tratamientos utilizados frecuentemente en dermatología estética. En concreto el peeling con ácido tricloroacético se ha utilizado desde hace años y una de sus principales limitaciones clásicamente era sus efectos secundarios. Presentamos una revisión práctica de las características, mecanismos de acción, indicaciones y complicaciones de los peelings en general, tanto los superficiales como el peeling con ácido tricloroacético (AU)

Chemical peeling is a common treatment in cosmetic dermatology. A peel that has been used for many years is trichloroacetic acid. Its adverse effects have for a long time been a major limitation. We present a practical review of the characteristics, mechanisms of action, indications, and complications of superficial chemical peels and of peeling with trichloroacetic acid (AU)

Histological and Immunohistochemical Evaluation of the Efficacy of a New Cosmetic Formulation in the Treatment of Skin Photoaging.

Objective. Mechanism of action of cosmetic products is not often studied. The aim of this study is to determine the histological, immunohistochemical, and clinical changes of a new cosmetic formulation. Methods. Prospective, single-blind, patient-controlled, randomized study in 10 volunteers with mild to moderate skin photoaging on the back of their hands. The product was applied on one hand and a standard cream on the other hand, twice a day for three months. Standardized photographs were taken on basal (T0) and final visit (T1) and skin biopsies were performed. Changes on histological and immunohistochemical markers were studied. Subjective clinical changes were determined. Results. After treatment, a 26.3% improvement on epidermal thickness was detected and a significant increase on collagens I and III, elastin, and fibronectin fibers was achieved (p < 0.05). As the expression of MMPs remained stable, this improvement of dermal matrix was attributed to the stimulation of their synthesis. A significant clinical improvement on the treated hand was obtained, compared to control hand. Conclusion. This new cosmetic product with combination of three registered technologies (IFC-CAF, WGC, and RetinSphere), focused on regenerating dermal matrix and activating proliferation of skin cells, has shown to be efficient in the reversion of skin photoaging.

Chemical Peeling: A Useful Tool in the Office. / Peeling químico, una herramienta útil en la consulta.

Chemical peeling is a common treatment in cosmetic dermatology. A peel that has been used for many years is trichloroacetic acid. Its adverse effects have for a long time been a major limitation. We present a practical review of the characteristics, mechanisms of action, indications, and complications of superficial chemical peels and of peeling with trichloroacetic acid.

Assessment of the efficacy and safety of a combination of 2 topical retinoids (RetinSphere) in maintaining post-treatment response of acne to oral isotretinoin / Eficacia y seguridad del uso combinado de 2 retinoides tópicos (Retinsphere®) para el mantenimiento de la respuesta obtenida tras el tratamiento con isotretinoína oral

Introduction: The high rate of relapse of acne lesions following oral isotretinoin treatment is a common problem which remains unsolved. To avoid or minimize relapses, topical retinoids have been used for many years as maintenance treatment. However, adverse effects frequently occur. Aims: To determine the efficacy and safety of a new retinoid combination (Retinsphere technology) in maintaining post-treatment response to oral isotretinoin. Patients and methods: Prospective, randomized, double-blind and vehicle-controlled study of 30 patients with acne previously treated with isotretinoin. Treatment with the retinoid combination was applied to one side of the face and vehicle was applied to the other, once daily, for 3 months. Standardized photographs were taken using RBX technology at baseline, 1.5 months and 3 months. The primary efficacy endpoint was the appearance of relapse on the treated side compared to the vehicle-treated side. Other endpoints included lesion count, investigator-reported improvement, patient-reported improvement, impact on quality-of-life, and side effects. Results: Although the majority of patients did not reach the total target dose of oral isotretinoin, the relapse rate was significantly lower on the retinoid-treated side compared to the vehicle-treated side. Likewise, improved lesion count and excellent tolerance were observed. Conclusions: This new retinoid combination (Retinsphere technology) were effective and safe as maintenance therapy after post-treatment response to oral isotretinoin in patients with acne (AU)

Introducción: Existe un alto porcentaje de pacientes que presentan reidivas de acné tras el uso de isotretinoína oral. Para evitar o minimizar dichas recidivas el uso de retinoides tópicos se ha utilizado en ocasiones, aunque con mala tolerancia dada la sensibilidad de la piel tras los tratamientos con isotretinoína oral. Objetivos: Determinar la eficacia y seguridad de una nueva combinación de retinoides (tecnología Retinsphere®) en el mantenimiento de la respuesta postratamiento con isotretinoína oral. Pacientes y Métodos: Estudio prospectivo, aleatorizado, doble ciego controlado con vehículo en 30 pacientes con acné tratado previamente con isotretinoína oral. El tratamiento con la combinación de retinoides se aplicó en una hemicara, mientras que en la otra hemicara se aplicó vehículo, durante 3 meses. Se tomaron fotografías estandarizadas con tecnología RBX en el momento basal, al mes y medio y a los 3 meses. La variable principal para determinar la eficacia fue la aparición de recidivas en el área tratada con retinoides vs lado tratado con vehículo. Otras variables estudiadas fueron recuento de lesiones, mejoría percibida por el investigador y el paciente, impacto en la calidad de vida y efectos adversos. Resultados: La mayoría de los pacientes no habían alcanzado la dosis diana de isotretinoína oral, y sin embargo el porcentaje de recidivas fue significativamente menor en el lado tratado con retinoides frente al lado tratado con vehículo. Además se objetivó una disminución en el recuento de lesiones y una excelente tolerancia. Conclusiones: Esta nueva combinación de retinoides (tecnología Retinsphere®) demostró eficacia y seguridad en el mantenimiento de respuesta postratamiento con isotreinoína oral en pacientes con acn (AU)

Assessment of the efficacy and safety of a combination of 2 topical retinoids (RetinSphere) in maintaining post-treatment response of acne to oral isotretinoin.

INTRODUCTION: The high rate of relapse of acne lesions following oral isotretinoin treatment is a common problem which remains unsolved. To avoid or minimize relapses, topical retinoids have been used for many years as maintenance treatment. However, adverse effects frequently occur. AIMS: To determine the efficacy and safety of a new retinoid combination (Retinsphere technology) in maintaining post-treatment response to oral isotretinoin. PATIENTS AND METHODS: Prospective, randomized, double-blind and vehicle-controlled study of 30 patients with acne previously treated with isotretinoin. Treatment with the retinoid combination was applied to one side of the face and vehicle was applied to the other, once daily, for 3 months. Standardized photographs were taken using RBX technology at baseline, 1.5 months and 3 months. The primary efficacy endpoint was the appearance of relapse on the treated side compared to the vehicle-treated side. Other endpoints included lesion count, investigator-reported improvement, patient-reported improvement, impact on quality-of-life, and side effects. RESULTS: Although the majority of patients did not reach the total target dose of oral isotretinoin, the relapse rate was significantly lower on the retinoid-treated side compared to the vehicle-treated side. Likewise, improved lesion count and excellent tolerance were observed. CONCLUSIONS: This new retinoid combination (Retinsphere technology) were effective and safe as maintenance therapy after post-treatment response to oral isotretinoin in patients with acne.

Fluorescence diagnosis and photodynamic therapy for Bowen's disease treatment.

INTRODUCTION: It has already been demonstrated the high efficacy of photodynamic therapy (PDT) for Bowen's disease (BD) treatment. Fluorescence diagnosis consists on registration of the fluorescence emitted by tissue after application of a photosensitizer, indicating presence of tumoral cells. It has been described as a useful tool for actinic keratosis. Different results have been published about fluorescence diagnosis for basal cell carcinomas. Very few reports about the role of fluorescence diagnosis for this entity exist and this is the first one which correlates the fluorescence image after PDT with the histopathological response. OBJECTIVES: To assess the role of fluorescence diagnosis during BD follow-up. METHODS: We carried out an observational, retrospective and descriptive study. A total of 29 BD biopsy proven lesions were included. All the lesions had been treated with the standard protocol (Topical methyl- aminolaevulinic acid under occlusion for 3 hours and followed by illumination with red-light (630 nm, 38 J/cm(2), 7.5 minutes. Two sessions one week apart). Clinical and fluorescence photographs were taken before treatment and one month after the 2(nd) one. At that moment a post-treatment biopsy was performed. Clinical response was classified as partial, complete or no response. Fluorescence response was classified as negative, intermediate or intense. The follow-up period and the adverse events observed including pain were also collected. RESULTS: We found statistical association between fluorescence and the clinical and histopathological evaluations performed after treatment. Fluorescence diagnosis obtained a 100% sensitivity (higher than clinical evaluation alone) and a specificity of 85.7% (CI: 70.8-100). CONCLUSIONS: Fluorescence diagnosis seems a valid diagnostic tool, useful during the follow up of Bowen disease lesions with the advantage of avoiding unnecessary post-treatment biopsies.

Dynamic skin changes of acute radiation dermatitis revealed by in vivo reflectance confocal microscopy.

BACKGROUND: A better knowledge of the dynamic biological changes that the skin undergoes in response to ionizing radiation is advisable to improve the management of radiation dermatitis, allowing selection of patients needing treatment or close monitoring. OBJECTIVE: To describe the evolution of the skin in response to ionizing radiation through the reflectance confocal microscopy (RCM) features of acute radiation dermatitis. METHODS: In this prospective descriptive study, six women (median age, 55 years; range, 45-80 years) diagnosed with breast cancer in stages IA-IB undergoing adjuvant radiotherapy were included in the study through consecutive sampling. Clinical, dermoscopic and RCM evaluation of the skin were performed prior to treatment and on days 1, 15, 30 and 45 after radiotherapy. RESULTS: While clinical features of radiation dermatitis emerged after 30 days on average, histopathological changes were detectable by RCM after a mean time of 15 days. The main RCM features included initial appearance of spongiosis, exocytosis and inflammatory cells followed by the presence of dendritic-shaped cells, 'streaming-like figures', 'broken geographic papillae', epidermal architectural disarray, effacement of rete ridges, melanophages and, finally, hyperpigmentation of the basal layer. CONCLUSIONS: RCM may safely detect the dynamic biological changes that the skin undergoes in response to ionizing radiation, even before than clinical onset of acute radiation dermatitis. Therefore, RCM may be useful to make an early and non-invasive diagnosis of radiation dermatitis during radiotherapy, allowing an early selection of patients needing treatment or close monitoring and avoiding skin biopsies.

Effectiveness of photodynamic therapy in Bowen's disease: an observational and descriptive study in 51 lesions.

INTRODUCTION: Bowen disease (BD) or squamous cell carcinoma (SCC) in situ affects both skin and mucous membranes and has the potential to progress to invasive SCC. Photodynamic therapy (PDT) has been approved recently for the treatment of BD. Some studies have demonstrated its efficacy and good cosmetic outcome. OBJECTIVE: To assess the efficacy of PDT in the treatment of BD. PATIENTS AND METHODS: We carried out an observational, retrospective and descriptive study. A total of 47 patients with 51 lesions of BD were included. All the lesions were confirmed with previous cutaneous biopsy. All patients were treated with the standard protocol. Topical methyl-aminolaevulinic acid was occluded during 3 h and followed by illumination with red-light (630 nm, 38 J/cm2, 7.5 min). Clinical and fluorescence photographs images were taken before each session. All patients received two sessions one week apart. Clinical response was classified in partial or complete response. Fluorescence response was classified in negative, intermediate or intense. The follow-up period and the adverse events observed including pain were also collected. RESULTS: A total of 20 men and 27 women with a mean age of 75.57 years old were treated with PDT. Lesions were most frequently located in the lower limbs. Globally, 76.09% of the lesions achieved complete response after 2 sessions with a medium follow-up of 16.61 months. Fluorescence of the lesions disappeared when clinical response was achieved, but not always. The most common adverse effect was an immediate burning sensation. All lesions showed an excellent cosmetic result. CONCLUSION: Photodynamic therapy is an effective treatment for BD in terms of both clinical remission and cosmetic results, with good tolerance and minimal adverse effects.

Pulsed dye laser as an excellent choice of treatment for lupus tumidus: a prospective study.

BACKGROUND: Clinical manifestations of cutaneous lupus erythematosus (CLE) vary widely, and different subtypes of this autoimmune disease exist. Tumidus subtype (LT) has been recently separated from the chronic subtypes and is now considered an independent entity due to its particular clinical and histological features. Different treatments are usually prescribed for CLE. Our group has experience of CLE effectively treated with pulsed dye laser (PDL). It was our impression that better responses were achieved in the LT subtype, but no controlled prospective studies with PDL have been specifically performed. MATERIALS AND METHODS: A prospective study was performed on 10 patients with histologically confirmed LT treated with PDL. All patients were treated with 595 nm PDL using the 10 mm spot size at 0.5 ms pulse width and a fluence of 8 J/cm(2). Biopsies were taken before and 4 weeks after treatment and were stained with haematoxylin-eosin. RESULTS: Evaluation after PDL treatment showed clinical improvement in all of them without side-effects and reduction of the dermal lymphocytic infiltrate in 9/10 of the patients. Epidermal changes were absent in all patients. Mucin deposition persisted only in one patient. However, 50% of the patients developed new lesions nearby or distant to the treated zones. CONCLUSIONS: PDL therapy is an effective and fast treatment option for acute flares of LT; however, it does not prevent recurrences. A histological improvement has been confirmed in this study. Purpura seems to be necessary to achieve a good response.

Unilateral taxane-induced onychopathy in a patient with a brain metastasis.

Chemotherapy using taxanes have been useful in the treatment of several types of solid tumors. Nail abnormalities have been reported primarily with the use of docetaxel, but also with low dose, weekly paclitaxel. We report a patient with 20-nail onycolysis associated with the use of paclitaxel that resolved after stopping the medication and then recurred after the use of docetaxel, but spared all the nails of a paretic hand.