Skin boosters: Definitions and varied classifications.

BACKGROUND: The concept of "skin boosters" has evolved, marking a shift from traditional uses of hyaluronic acid (HA) fillers primarily for augmenting skin volume to a more diverse application aimed at improving dermal conditions. Restylane Vital and other HA fillers have been repurposed to combat skin aging and wrinkles by delivering HA directly to the dermis. OBJECTIVES: This review aims to define the term "skin booster" and to discuss the various components that constitute skin boosters. It seeks to provide a comprehensive overview of the different ingredients used in skin boosters, their roles, and their impact on enhancing dermal conditions. METHODS: A comprehensive review was conducted, focusing on representative skin booster ingredients. The approach involved analyzing the different elements used in skin boosters and their specific roles in enhancing dermal improvement. RESULTS: The findings indicate that skin boosters, encompassing a range of ingredients, are effective in improving the condition of the skin's dermis. The review identifies key ingredients in skin boosters and their specific benefits, including hydration, elasticity improvement, and wrinkle reduction. CONCLUSIONS: Skin boosters represent a significant development in dermatological treatments, offering diverse benefits beyond traditional HA fillers. This review provides valuable insights into the constituents of skin boosters and their effectiveness, aiding readers in making informed decisions about these treatments. The potential of skin boosters in dermatological practice is considerable, warranting further research and application.

Efficacy of Botulinum Toxin Type A for Prevention of Post-Mastectomy Scar in Transmen: A Prospective, Randomized Study.

BACKGROUND: Subcutaneous mastectomies in transmen have been gaining popularity. However, post-operative scars are an inevitable consequence. Recently, Botulinum neurotoxin A (BoNT-A) has shown positive effects in scar prevention. The objective of this study is to investigate the effectiveness of BoNT-A in scar prevention. METHODS: Fifteen patients who had undergone subcutaneous mastectomy were included. At 14 days post-surgery, either incoBoNT-A or a placebo was injected into the scar on each side. The primary outcome assessment measured the scar's severity using the Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scale (POSAS). The secondary outcome assessment evaluated the scar's color using a standard measurement device. Outcome assessments were conducted until 6 months post-surgery. RESULTS: There were significantly lower VSS scores in the BoNT-A group compared to the placebo at the end of the study (7.43 ± 0.26 vs. 8.82 ± 0.26, p < 0.001). The objective assessment revealed a statistically significant decrease in redness values in the BoNT-A group compared to the placebo at 3 and 6 months. CONCLUSION: BoNT-A has demonstrated effectiveness in scar prevention by reducing the severity of postoperative scar formation and improving overall scar appearance.

A double-blinded, randomized, split-side, vehicle-controlled study of the efficacy of cleanser containing Acanthus ebracteatus Vahl., Suregada multiflora, and Acacia concinna in patients with atopic dermatitis: A pilot study.

BACKGROUND: Barrier repair therapy is the key management approach for both eczematous and non-lesional skin of atopic dermatitis. The use of appropriate cleansers to enhance skin hydration is an adjunctive treatment that increases topical drug penetration. Anti-inflammatory properties of various medicinal plants in tropical Asia have been reported. OBJECTIVE: Investigate the efficacy of herbal cleanser containing a combination of herbal extracts from Acanthus ebracteatus Vahl., Suregada multiflora, and Acacia concinna on seemingly intact skin in patients with atopic dermatitis by measuring improvements in the skin barrier function. METHODS: This 2-week pilot study was a split-side, randomized, double-blinded, vehicle-controlled trial. All patients (n = 30) were asked to use both a cleanser with an active formulation containing the herbal extracts and a vehicle- controlled cleanser on each side of mid-volar forearm. Biophysical assessments including transepidermal water loss (TEWL), skin hydration, skin pH, and skin roughness were performed at baseline and upon study completion. RESULTS: Compared to baseline, the median percentage change in TEWL at the end of the study was significantly greater for the active side 10.4 (-19, 20.7) g/m2h than the control side -13.2 (-28.7, 9.1) g/m2h; p = 0.01. The median percentage change of skin hydration, skin pH, and skin roughness of the active side compared to the control side had no a statistical significance. CONCLUSIONS: This cleanser is beneficial when used as adjunctive therapy. Further studies should evaluate its anti- sinflammatory properties in the remedy or active phase of atopic dermatitis or other inflammatory skin diseases.

Botulinum Toxin Type A for the Treatment of Skin Ulcers: A Review Article.

The normal biological wound healing process consists of three precisely and highly programmed phases that require optimal conditions including internal and external factors. Any negative factors that disrupt the sequence or time frame of the healing mechanism can result in a non-healing wound or chronic ulcers. Botulinum neurotoxin A (BoNT-A) which is generally known as anti-contraction of muscles has been reported as a successful treatment in various types of chronic ulcers. The aim of this study is to review the outcome of treatment with BoNT-A for chronic skin ulcers. The results demonstrated some positive effects of BoNT-A on chronic ulcers. Ischemic ulcers secondary to Raynaud's phenomenon seem to be the most promising type of ulcers that have benefited from BoNT-A. The rationale behind using BoNT-A to fasten the wound healing process is also discussed. Further clinical trial studies should be conducted to affirm the efficacy of wound healing using BoNT-A administration.

Assessment of the quality of life (QoL) of patients with dermatitis and the impact of patch testing on QoL: A study of 519 patients diagnosed with dermatitis.

BACKGROUND: Dermatitis can impair the quality of life (QoL) of patients. Knowledge of the QoL-associated factors and the impact of patch testing on QoL is limited. OBJECTIVES: To identify demographic and clinical factors affecting QoL, and to measure the impact of patch testing on QoL of dermatitis patients. METHODS: The data and Dermatology Life Quality Index (DLQI) questionnaires of 519 dermatitis patients were analyzed. Of these, 107 underwent patch testing and completed the questionnaires two times (once before testing and again 60 days afterward). RESULTS: The overall mean (±standard deviation) DLQI was 9.5 (±6.4). Patients aged 20 to 59 years and those who had more frequent disease exacerbations demonstrated significantly higher DLQIs. For each DLQI question, being female and aged 20 to 59 years were associated with impairments of various aspects of life, whereas the anatomical site of dermatitis impacted each question differently. The DLQI scores of the patients undergoing patch testing decreased significantly, irrespective of whether the test results were positive or negative. CONCLUSIONS: Being of a working age and having more frequent disease exacerbations had negative QoL impacts. In addition, patch testing improved almost every aspect of the DLQI.

Contact allergy to hair cosmetic allergens in Thailand.

BACKGROUND: Hair cosmetics such as hair dyes, bleaching, waving, and cleansing products are composed of numerous chemical ingredients. Allergic reactions to these contact allergens, other than p-phenylenediamine, are rarely reported. OBJECTIVES: To study the incidence of patch test reactions to hair cosmetic allergens and identify the factors associated with hair cosmetic allergy in Thailand. METHODS: We retrospectively reviewed the case records of patients who underwent patch testing from 2009 to 2018. Patients with at least one positive patch test reaction to a potential contact allergen associated with hair cosmetic ingredients were studied. RESULTS: Overall, 2842 patients were patch tested. Of the hair cosmetic allergen categories, preservatives had the highest rate of positive reactions, followed by surfactants and hair dyes. Perming agents were less problematic in comparison. The hands, head, and neck were the predominately affected sites of allergic reactions to hair cosmetic ingredients. CONCLUSIONS: Preservatives, surfactants, and hair dyes are important contact allergens, whereas perming agents are less likely to cause allergic reactions. Hair cosmetic ingredients are regulated by national agencies, which influences their extent of exposure and rates of contact allergies. Further continuous observation of hair cosmetic allergy is needed to provide the best patient care.

Factors associated with multiple contact allergies in Thai dermatitis patients: A 10-year retrospective study.

BACKGROUND: Multiple contact allergies (MCAs) are defined as three or more positive patch test reactions to unrelated antigens. Factors associated with MCAs include female sex, older age, and certain eczema sites. OBJECTIVES: To investigate the prevalence of MCAs, risk factors for their development, and patterns of allergen combinations. METHODS: This retrospective, case-control study was conducted on patients suspected of having allergic contact dermatitis who had been patch tested with a baseline series in the period January 2007 to December 2016. RESULTS: Of the 2178 included patients, 531 (24.4%) had MCAs. A multivariate analysis showed that a generalized distribution of dermatitis represented the highest risk factor (odds ratio [OR] 3.97), followed by a history of metal allergy (OR 3.18). The other significantly associated factors were, in order of decreasing frequency, the dermatitis sites (hands/feet, extremities, and face), age ≥25 years, and occupationally related dermatitis; their ORs were <3. CONCLUSIONS: The factors that were significantly associated with MCAs were identified. The ranking of the common contact allergens among MCA patients was comparable with that of non-MCA patients. Metal and fragrance allergens were frequently found to cause concurrent positive reactions in MCA patients.

Randomized investigator-blinded comparative study of moisturizer containing 4-t-butylcyclohexanol and licochalcone A versus 0.02% triamcinolone acetonide cream in facial dermatitis.

BACKGROUND: Facial dermatitis can result from various conditions, some of which are of a chronic and relapsing nature. The use of topical corticosteroid therapy may lead to additional adverse effects. OBJECTIVE: To compare the efficacy of moisturizer containing 4-t-butylcyclohexanol, which acts as a sensitivity regulator, and licochalcone A, an anti-inflammatory agent from the licorice plant Glycyrrhiza inflata, with that of 0.02% triamcinolone acetonide (TA) for the treatment of facial dermatitis. METHODS: This was a randomized, prospective, investigator-blinded study. Eighty participants with mild to moderate facial dermatitis were randomly treated with either the test facial moisturizer or 0.02% TA twice daily for the first 2 weeks. For the subsequent 2 weeks, all patients used only the test moisturizer. Clinical assessment by investigators, bioengineering measurements, patients' subjective evaluation, and clinical photography were performed at baseline, week 2, and week 4. RESULTS: Both treatments showed a statistically significant improvement with regard to physician clinical assessment, skin hydration, transepidermal water loss, and patient-assessed visual analog scale after 2 and 4 weeks of treatment compared with baseline. The test facial moisturizer produced better skin hydration than TCS. The improvement in TEWL after 4 weeks of using the test moisturizer was comparable with 2-week treatment with 0.02% TA cream. However, subjective evaluation by patients indicated that TA more rapidly improved sensation sensitivity. CONCLUSION: The test facial moisturizer was slower than 0.02% TA in improving facial dermatitis, but showed greater benefit in erythema control and skin hydration.

Oral Candida Colonization in Thai Patients with Psoriasis.

OBJECTIVE: To investigate the prevalence and risk factors of oral Candida colonization in psoriatic patients at Siriraj Hospital. MATERIAL AND METHOD: Sixty patients with psoriasis, aged older than 18 years, were recruited for the study group. Sixty healthy individuals similar to the patients in the study group in terms of age and gender were recruited for the control group. Candida spp. was isolated from oral swabs and oral rinses taken from all subjects. RESULTS: During the study period, 27 (45.0%) psoriatic patients used only topical treatment and the remaining patients were on systemic treatment. Oral Candida colonization was significantly higher in patients with psoriasis (30%), as compared with healthy controls (13.3%). Candida albicans was the predominant Candida species isolated. Presence of oral candidiasis was significantly associated with systemic treatment. CONCLUSION: Oral Candida colonization is associated with psoriasis, especially in patients who receive systemic treatment.

Prevalence of Cutaneous Bacterial Colonization in Thai Patients with Psoriasis.

OBJECTIVE: To determine bacterial colonization of skin, scalp, nares, nails, and psoriasis lesion in Thai psoriasis patients and compare findings with those of healthy controls. MATERIAL AND METHOD: Sixty patients with chronic plaque-type psoriasis and 60 healthy controls of similar age and gender were enrolled. Swabs of nares, scalp, nails, and non-lesional skin were taken from all subjects. Swabs of lesional skin were taken from psoriasis patients. Aerobic bacteria were isolated from swab specimens. RESULTS: Patients with psoriasis had significantly higher rate of bacteria colonization in nares, scalp, and nails than those of healthy controls. Firmicutes spp. was the most common phyla, followed by Proteobacteria spp. in both groups. Coagulase-negative staphylococci (CoNS) were the most common pathogens isolated from lesional skin, non-lesional skin, scalp, and nares of psoriasis patients. Streptococcus spp. was found only in psoriasis patients. CONCLUSION: Similar to findings from Caucasian psoriasis patients, Firmicutes spp. was found to be the most common phyla colonizing the skin of Asian psoriasis patients. Streptococcus spp. was found to colonize only the skin. Further studies are needed to determine the clinical significance of streptococcal skin colonization in psoriasis patients.

Contact sensitizers in commercial hair dye products sold in Thailand.

BACKGROUND: Hair dyes are known to contain potent contact allergens for which sensitization rates have increased over the last decade. OBJECTIVE: To examine the type and frequency of potent contact sensitizers labelled on hair dyes sold in metropolitan Bangkok, Thailand. METHODS: During the 2013-2014 study period, labelled ingredient information from home use and professional hair dye products was collected. RESULTS: Two hundred and fifty-two hair dye products were evaluated. One hundred and forty-nine products from 48 brands were domestically produced in Thailand, and 103 products were from 23 multinational brands produced in countries other than Thailand. Two hundred and fourteen of 252 (84.9%) hair dye products were found to contain strong skin sensitizers, with 118 (46.8%) being found in domestically produced products, and 96 (38.1%) being found in multinational brand products. Thirty-eight hair dye products (15.1%) were free of potent skin sensitizers. The number of domestically produced products (31, 20.8%) that were free of potent skin sensitizers was significantly higher (p = 0.002) than the number of multinational brand products (7, 6.8%). CONCLUSIONS: p-Phenylenediamine was the most prevalent potent sensitizer found among domestically produced hair dyes available on the market. Our findings indicate regional differences in hair dye allergen exposure.

A double-blinded, randomized, vehicle-controlled study to access skin tolerability and efficacy of an anti-inflammatory moisturizer in treatment of acne with 0.1% adapalene gel.

INTRODUCTION: Topical retinoids are considered to be the first-line agents and maintenance therapy of acne; however, irritation side effects are major concern issues. Noncomedogenic moisturizers are sometimes added to relieve cutaneous irritations. This study aimed to compare tolerability and efficacy of moisturizers containing licochalcone A, l-carnitine and 1,2-decanediol (active formulation) with a placebo in mild to moderate severe acne in Asian subjects. METHODS: This was an 8-week double-blind, prospective, randomized controlled study. All patients (n = 120) were randomized equally into three groups: (A) adapalene gel, (B) adapalene gel with the active formulation and (C) adapalene gel with the placebo. The severity of acne, skin bioengineering measurements and skin tolerability were recorded during the study. RESULTS: Compared to baseline, the active formulation group showed significant reductions in inflammatory lesions and total lesions at the end of the study without flare-up. Moreover, skin irritations were less detected than in the other two groups by corneometer and transepidermal water loss measurements. CONCLUSIONS: The concomitant usage of adapalene gel and the moisturizer containing licochalcone A, l-carnitine and 1,2-decanediol could reduce undesirable side effects without interfering the efficacy of adapalene. This moisturizer may be superior to placebo to prevent cutaneous irritations and enhance patients' adherence to acne medications.