Comparing safety and efficacy of acoustic subcision at two different rapid acoustic pulse rates to improve the appearance of cellulite.

BACKGROUND: A recent study showed the safety and efficacy of a noninvasive acoustic subcision device to improve the appearance of cellulite via delivery of rapid acoustic pulses in a single treatment visit. OBJECTIVE: To evaluate and compare the safety and efficacy of a single rapid acoustic pulse treatment visit using an equivalent number of rapid acoustic pulses at a pulse rate of 100 or 50 Hz. METHODS: This single-center, prospective study enrolled 15 adult women with moderate to severe cellulite according to the Cellulite Dimple-At Rest Scale. Each participant would receive nominally 72,000 rapid acoustic pulses at a pulse rate of 50 Hz on the left buttock and thigh, and nominally 72,000 rapid acoustic pulses at a pulse rate of 100 Hz on the right buttock and thigh within one treatment visit. Efficacy was assessed by the ability of blinded, independent reviewers to correctly distinguish the pre- and post-treatment photos, participant satisfaction, and the change in Cellulite Dimple-At Rest scores for each treatment side. Safety was monitored throughout the conduct of the study. RESULTS: For both 100 and 50 Hz pulse rate treated areas, the majority (two out of three) of blinded reviewers correctly identified 100% of the pre/post-treatment photos. For both the 100 and 50 Hz treated areas, 80% of participants agreed/strongly agreed that their cellulite appeared improved at the 12-week follow-up visit. Significant improvements in Cellulite Dimple-At Rest scores were seen for both the 100 and 50 Hz treated areas. All participants thought both the 100 and 50 Hz pulse rate treatments were tolerable, and the pain (mean score ± SD; 2.2 ± 1.2) associated with each was identical. No unexpected or serious adverse events occurred. CONCLUSION: Acoustic subcision delivered via rapid acoustic pulses at 100 Hz, compared to 50 Hz, provides equivalent improvement in the appearance of cellulite while maintaining a similar safety and efficacy profile. For both pulse rates, treatment pain was minimal, and participant satisfaction was high.

Cellulite: Presentation and management.

BACKGROUND: Cellulite is a common dermatological condition with a female preponderance, affecting up to 90% post-pubertal females. It is characterized with dimpling and denting of the skin surface, giving it a Peau d'orange appearance. Once considered to be a benign physiological isolated skin condition of only an esthetic concern, cellulite is now considered a pathological entity with systemic associations and a negative psychological impact on patients. AIMS: The objective of this article was to discuss etiology, pathophysiology, and treatment of cellulite. MATERIALS AND METHODS: Literature was screened to retrieve articles from PubMed/Medline and Google Scholar and related websites. Cross-references from the relevant articles were also considered for review. Review articles, clinical studies, systematic reviews, meta-analysis, and relevant information from selected websites were included. RESULTS: Several treatment options from lifestyle modifications and topical cosmetic therapies to energy-based devices have been studied for its treatment. However, treatment remains a challenge despite many new modalities in the armamentarium. Laser and light therapies along with radiofrequency are useful treatment options with good safety profile. Acoustic wave therapy, subcision, and 1440-nm Nd:YAG minimally invasive laser are beneficial in cellulite reduction. DISCUSSION: Methodological differences in the trials conducted make it difficult to compare different treatment modalities. CONCLUSION: Overall, treatment needs to be individualized based on the patient characteristics and severity of the condition. A combination of treatments is often required in most patients for reducing cellulite.

Enfermedad invasiva por Streptococcus pyogenes con celulitis de manos bilateral: A propósito de un caso / Invasive Streptococcus pyogenes disease with bilateral cellulitis of the hands: A case report

El Streptococcus pyogenes o estreptococo B hemolítico Grupo A (EßHGA) suele ser una causa poco habitual de enfermedad invasiva en pediatría, la cual ha presentado un aumento en su incidencia en los últimos años. Se define como cualquier infección asociada al aislamiento de dicha bacteria de un sitio normalmente estéril y cuya presentación más frecuente es la bacteriemia. Los pacientes con EßHGA habitualmente se presentan con un sindrome febril asociado a manifestaciones clínicas relacionadas con el sitio primario de infección. Se presenta el caso de una paciente de 10 años, sin comorbilidades, que desarrolló enfermedad invasiva por EßHGA con bacteriemia e impacto secundario de piel y partes blandas resultando en una celulitis de manos bilateral

Streptococcus pyogenes or Group A Streptococcus (GAS) is an infrequent cause of invasive disease in pediatrics. Its incidence has increased in the last few years. It is defined as any infection associated with the isolation of GAS in a normally sterile site and its most frequent presentation is bacteremia. Patients with GAS bacteremia usually present with a febrile syndrome associated with clinical manifestations related to the primary site of infection. We present the case of a previously healthy, 10-year-old patient, who developed an invasive disease due to GAS with bacteremia and secondary impact of skin and soft tissues that developed in bilateral cellulitis of the hands

The Anatomical Basis of Cellulite Dimple Formation: An Ultrasound-Based Examination.

BACKGROUND: Cellulite is a common aesthetic condition that affects the majority of women. It is characterized by the inhomogeneous appearance of the skin overlying the gluteal and the posterior thigh region. Despite a wide array of treatment options, little has been done to evaluate the anatomical basis of cellulite formation. This study used ultrasound to visualize subcutaneous changes of cellulite to aid with treatment guidance and complication avoidance. METHODS: Cellulite dimples were examined on the bilateral thigh and buttock regions of 50 consecutive women and each dimple was scored with the Hexsel Cellulite Scoring System based on severity. Cellulite dimples were then analyzed by ultrasound to identify the presence, orientation, and origination of subcutaneous fibrous bands and the presence of associated vascular structures. RESULTS: Two hundred total sites were examined, with 173 dimples identified. Of these, 169 demonstrated the presence of fibrous bands (97.6 percent). The majority of bands demonstrated an oblique (versus perpendicular) orientation to the skin (84.4 percent), with the majority (90.2 percent) taking origin from the superficial fascia (versus the deep fascia). Overall, 11 percent of bands had an associated vascular structure. When stratified by body mass index, overweight and obese patients had a higher likelihood of having an associated blood vessel visualized (p = 0.01). Results were similar for dimples in the thigh compared to those located in the buttock region. CONCLUSIONS: Ultrasound appears to be a valid technique to image the subcutaneous architecture of cellulite. This technology can help guide surgeons in real time to improve outcomes and minimize complications while performing cellulite treatments.

Randomized, Double-Blind, Placebo-Controlled Study of Poly-L-Lactic acid for Treatment of Cellulite in the Lower Extremities.

BACKGROUND: Poly-l-lactic acid (PLLA) is an injectable volumizer with biostimulatory properties used for volumetric structural rejuvenation in patients with facial fat volume loss but has increasingly been utilized for off-face applications. OBJECTIVE: The objectives of this randomized, double-blind, placebo-controlled single center study was to assess the safety and effectiveness of PLLA for the treatment of lower extremity cellulite in adult women. METHODS: 31 healthy women were enrolled in the study. Eligible subjects received 3 treatments every 4 weeks with either PLLA (treatment group) or saline (control group) injections combined with subcision, into each of the glutes or thighs. Follow-up visits were at 1, 3, and 6 months after treatment. Assessments included live ratings, rating of standardized pictures by a blinded evaluator, patient questionnaires, safety, and tolerability ratings. RESULTS: At the 3 and 6-month follow-up, there was a statistically significant change in the global aesthetic improvement scale (GAIS) compared to baseline as assessed by blinded investigators. Significant improvements were shown in the cellulite severity scale (CSS) as well as in the subject satisfaction questionnaires. Treatments were found to be tolerable, and no severe treatment-related adverse events occurred. CONCLUSION: Repeated PLLA treatments combined with subcision are effective and safe in improving the appearance of cellulite. J Drugs Dermatol. 20(5): doi:10.36849/JDD.5380.

Síndrome larva migrans cutánea en pediatría / Cutaneous Larva Migrans Syndrome in Pediatrics

La dermatosis denominada larva migrans cutánea: (LMC) es una infección cutánea secundaria a infestación parasitaria por la migración de larvas de anquilostomas animales a la epidermis humana, frecuentemente por contacto directo con suelos contaminados, especialmente en zonas tropicales. Se caracteriza por la aparición de lesiones induradas, eritematosas con patrón irregular o serpiginoso acompañado de prurito. Describimos un caso de LMC en una niña, adquirido durante unas vacaciones en Colombia y tratado inicialmente como celulitis con antibióticos (AU)

Cutaneous larva migrans (CLM) is an infection secondary to parasitic infestation due to the migration of animal hookworm larvae into the human skin, frequently by direct contact with contaminated grounds, especially in the tropics. Clinically, it is characterized by the appearance of indurated, erythematous lesions with irregular or "creeping eruption" pattern and pruritus. This article describes a case of CLM infection in a pediatric patient, it was acquired during the holidays in Colombia, diagnosed as cellulitis and treated accordingly with antibiotics without success (AU)

Réplica a «Actualización en el abordaje y manejo de celulitis» / Comments on «An Update on the Treatment and Management of Cellulitis»

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Development and Validation Clinician and Patient Reported Photonumeric Scales to Assess Buttocks Cellulite Severity.

BACKGROUND: The Clinician Reported Photonumeric Cellulite Severity Scale (CR-PCSS) and Patient Reported PCSS (PR-PCSS) are newly developed tools for assessing cellulite severity. OBJECTIVE: To report on the reliability, validity, and ability to detect a change in cellulite severity on the buttocks of adult women with the CR-PCSS and PR-PCSS. MATERIALS AND METHODS: Content validity of both scales was established through concept elicitation and cognitive interviews. Test-retest reliability was evaluated, and intra-rater (both scales) and inter-rater (CR-PCSS only) reliability were estimated using intraclass correlation coefficients (ICCs) for agreement and consistency. Ability to detect a change was determined using the Subject-Global Aesthetic Improvement Scale (GAIS) or Investigator-GAIS as anchors. RESULTS: For the CR-PCSS (n = 6) at baseline and Day 2, the mean interrater ICCs were ≥0.70 and mean intrarater ICCs (95% confidence interval [CI]) were ≥0.81 (0.72-0.90) for both buttocks. For the PR-PCSS (n = 99) at baseline and Day 14, the mean test-retest reliability ICCs (95% CI) were ≥0.86 (0.79-0.91) for both buttocks. A clinically meaningful change was 1.0 point on the PR-PCSS and 1.0 on the CR-PCSS. CONCLUSION: The CR-PCSS and PR-PCSS reliably assess cellulite severity of the buttocks and can detect a clinically meaningful change after treatment for cellulite.

Subcision™ plus poly-l-lactic acid for the treatment of cellulite associated to flaccidity in the buttocks and thighs.

BACKGROUND: There is a growing demand for procedures to treat cellulite. Subcision™ is widely used for cellulite correction, and injectable poly-L-lactic acid (PLLA) has been shown to be an effective option for various body conditions. AIMS: Present the results of combining Subcision™ plus PLLA, in the same session, in patients with cellulite and flaccidity. PATIENTS/METHODS: Twenty-four women underwent Subcision™ followed by PLLA injections. An expert panel of dermatologists evaluated before and after photographs according to Global Aesthetic Improvement Scale (GAIS). Patients also answered a satisfaction questionnaire. RESULTS: The author describes the results, as well as number of sessions and dose used. The most frequent GAIS score was "great improvement." No nodules or granulomas appeared in the treated areas. CONCLUSION: The combination of Subcision™ plus PLLA, in the same treatment session, promotes safe and desirable results for cellulite associated with flaccidity.

Celulitis glútea de repetición en un varón joven / Recurrent Buttock Cellulitis in a Young Man

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Lesiones cutáneas y eosinofilia como forma de presentación de síndrome de Wells / Wells' syndrome presented as skin lesions and eosinophilia

El síndrome de Wells o celulitis eosinofílica es una rara entidad cutánea, caracterizada por el polimorfismo de sus lesiones y por la presencia aumentada de eosinófilos tanto en las lesiones como en sangre periférica. Su etiología permanece desconocida, y la falta de especificidad de sus lesiones hace que en ocasiones su diagnóstico resulte difícil, representando la biopsia cutánea una prueba clave (figuras en llama). Su tratamiento inicial son los corticoides, aunque puede autolimitarse sin nuevos brotes. Presentamos el caso de una paciente con lesiones cutáneas asociado a eosinofilia en el contexto de un síndrome de Wells

Wells' syndrome or eosinophilic cellulitis is a rare skin disease characterized by the polymorphism of the lesions and by the increased presence of eosinophils both in the lesions and in peripheral blood. Its etiology remains unknown, and the lack of specificity of its lesions often makes diagnosis difficult. Skin biopsy is a key test (flame figures). The initial treatment is corticosteroids, though the disease can be self-limited, with no further outbreaks. We present the case of a woman with skin lesions associated with eosinophilia in the context of a Wells' syndrome

Pseudocelulitis recurrente inducida por gemcitabina: descripción de un caso / Recurrent gemcitabine-induced pseudocellulitis: a case report

INTRODUCCIÓN: Gemcitabina es un agente antineoplásico usado en el tratamiento de un gran número de neoplasias malignas. Está asociado frecuentemente a reacciones adversas cutáneas como prurito, rush o alopecia. Menos frecuentemente, se ha visto asociado a un cuadro llamado "pseudocelulitis". En este estudio presentamos un caso de un paciente con pseudocelulitis recurrente tras tratamiento con gemcitabina. Descripción del caso: Paciente oncológico, con historia pasada de linfedema en miembros inferiores acude a consulta por cuadros recurrentes de celulitis en miembro inferior homolateral al brazo de infusión del fármaco gemcitabina. El paciente no presenta fiebre. Presenta eritema bien delimitado, edema con fóvea, caliente y con dolor a la palpación. En la analítica se obtienen valores normales, y no se observa evidencia de trombosis venosa profunda. Basado en los hallazgos clínicos, naturaleza aguda y recurrente de la patología, se llegó, por descarte, a un diagnóstico de pseudocelulitis inducida por gemcitabina. El cuadro fue tratado con antihistamínicos y antiinflamatorios no esteroideos. Al final del seguimiento, el paciente presentaba una notoria mejoría de los síntomas. CONCLUSIÓN: En pacientes tratados con gemcitabina, que presenten episodios de celulitis, es importante establecer clínica y analíticamente, si se trata o no de una celulitis infecciosa. Ya que, de tratarse de un cuadro de pseudocelulitis, el tratamiento no se compone de antibióticos y el periodo de hospitalización será menor

INTRODUCTION: Gemcitabine is an antineoplastic agent used in the treatment of a large number of malignant neoplasms. It is frequently associated with adverse skin reactions such as pruritus, rush or alopecia. Less frequently, it has been associated with a condition called "pseudocellulitis". In this study, we present a case of a patient with recurrent pseudocellulitis after treatment with gemcitabine. Case description: Oncological patient, he had history of lymphedema in the lower extremity, is referred to consultation with complaint of recurrent cellulitis in the homolateral lower extremity from the infusion arm of gemcitabine. The patient does not have fever. It presents well-defined erythema, pitting edema, warmth and tenderness to palpation. Analytical values were normal, and evidence of deep vein thrombosis is not observed. Based on the clinical findings, acute and recurrent nature of the pathology, a diagnosis of pseudocellulitis induced by gemcitabine was reached. The patient was treated with antihistamines and nonesteroideal anti-inflammatory. At the end of the follow-up, the patient showed a marked improvement in symptoms. CONCLUSION: In patients treated with gemcitabine, who present episodes of cellulitis, it is important to establish clinically and analytically, whether or not it is an infectious cellulitis. Since it is a case of pseudocellulitis, the treatment is not composed of antibiotics and the period of hospitalization will be shorter

Utilidad de una escala de riesgo basada en la procalcitonina sérica para la discriminación temprana entre fascitis necrosante y celulitis de las extremidades / Usefulness of a risk scale based on procalcitonin for early discrimination between necrotising fasciitis and cellulitis of the extremities

Fundamento y objetivo: Valorar la utilidad de una la escala de riesgo basada en la procalcitonina sérica (PCT) comparada con la escala Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) en la discriminación precoz entre la fascitis necrosante (FN) y la celulitis en las extremidades. Material y método: Estudio retrospectivo de pacientes consecutivos con diagnóstico confirmado de FN en una extremidad (n=11). Ese grupo de estudio fue comparado con 23 pacientes consecutivos con diagnóstico de celulitis severa en miembros en el mismo periodo. Se analizaron los datos clínicos y los parámetros rutinarios de laboratorio, siendo la variable principal el nivel sérico de PCT al ingreso. La capacidad de discriminación para el diagnóstico de FN de los dos métodos -nivel de PCT y puntuación de la escala LRINEC- fue evaluada mediante la curva COR y determinada por el cálculo del área bajo la curva (ABC). Resultados: El ABC fue significativamente mayor con la medición de la PCT, tanto como variable continua como cuando el riesgo era categorizado. El punto de corte para el nivel de PCT con mayor ABC bajo la curva fue a partir de 0,87ng/ml (sensibilidad 90,9%; especificidad 82,6%), mientras que alcanzaba una puntuación de 5 en la escala LRINEC (sensibilidad 72,7%; especificidad 82,6%). Conclusión: La medición de la PCT fue un método más efectivo que la escala LRINEC para discriminar precozmente entre FN y celulitis de las extremidades. Un nivel bajo de PCT, asociado al cuadro clínico y a la exploración física, es de especial utilidad para descartar el diagnóstico precoz de FN

Background and objective: To assess the usefulness of a risk scale based on serum procalcitonin (PCT) compared to the Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) scale in the early discrimination between necrotising fasciitis (NF) and cellulitis of the extremities. Materials and methods: Retrospective study of consecutive patients with confirmed diagnosis of NF in one limb (n=11). This study group was compared with 23 consecutive patients with a diagnosis of severe limbs cellulitis during the same period. The clinical data and laboratory parameters were analysed, the main variable was the serum level of PCT upon admission. The capacity for NF diagnosis of the two methods, PCT level and LRINEC scale score, were evaluated by ROC curve and determined by the calculation of the area under the curve (AUC). Results: The AUC was significantly higher with PCT measurement, both as a continuous variable and when the risk was categorised. The cut-off point for the PCT level with the highest AUC under the curve was from 0.87ng/ml (sensitivity 90.9%, specificity 82.6%), whereas it was a score of 5 on the LRINEC scale (sensitivity 72.7%, specificity 82.6%). Conclusion: PCT measurement was a more effective method than the LRINEC score for early discrimination between NF and cellulitis of the extremities. A low level of PCT, associated with the patient's clinical status and physical examination is especially useful to rule out an early diagnosis of NF

Validated Assessment Scales for Cellulite Dimples on the Buttocks and Thighs in Female Patients.

BACKGROUND: New treatment methods for cellulite require globally accepted scales for aesthetic research and patient evaluation. OBJECTIVE: To develop a set of grading scales for objective assessment of cellulite dimples on female buttocks and thighs and assess their reliability and validity. MATERIALS AND METHODS: Two photonumeric grading scales were created and validated for dimples in the buttocks in female patients: Cellulite Dimples-At Rest, and Cellulite Dimples-Dynamic. Sixteen aesthetic experts rated photographs of 50 women in 2 validation sessions. Responses were analyzed to assess inter-rater and intra-rater reliability. RESULTS: Overall inter-rater reliability and intra-rater reliability were both "almost perfect" (≥0.81, intraclass correlation efficient and weighted kappa) for the At Rest scale. For the Dynamic scale, inter-rater reliability and intra-rater reliability were "substantial" (0.61-0.80). There was a high correlation between the cellulite scales and body mass index, age, weight, and skin laxity assessments. CONCLUSION: Consistent outcomes between raters and by individual raters at 2 time points confirm the reliability of the cellulite dimple grading scales for buttocks and thighs in female patients and suggest they will be a valuable tool for use in research and clinical practice.