RESUMO
Hyperpigmentation, uneven skin tone, textural changes, and dull skin are common cosmetic concerns in skin of color. Other signs of aging, including fine lines, deeper wrinkles, and skin laxity, also occur but may present in later decades. In-office procedures such as laser treatments, energy devices, toxins, fillers, and chemical peels are useful options for addressing the most common cosmetic concerns in skin of color patients. Skincare can play an important role in improving cosmetic outcomes when used in conjunction with in-office procedures. With the availability of these approaches, clinicians can now integrate in-office procedures with skincare strategies to offer patients with skin of color a comprehensive treatment plan that meets their needs. J Drugs Dermatol. 2024;23:8(Suppl 1):s5-10.
Assuntos
Técnicas Cosméticas , Envelhecimento da Pele , Higiene da Pele , Pigmentação da Pele , Humanos , Higiene da Pele/métodos , Hiperpigmentação/diagnóstico , Hiperpigmentação/terapia , Terapia a Laser/métodos , Abrasão Química/métodos , Preenchedores Dérmicos/administração & dosagem , RejuvenescimentoRESUMO
This study aimed to analyze the efficacy and safety of microneedling (MN), both alone and in combination with other treatments, to refine the approach for treating acne scars using MN. We systematically searched Pubmed, Cochrane Library, Embase, and Web of Science for randomized controlled trials examining MN or its combinations in patients with acne scars. All statistical analyses were performed using Stata 18 software. A total of 24 studies involving 1546 participants were included. The analysis revealed that MN combined with chemical peels (CP) exhibited the best results in terms of degree of improvement, patient satisfaction, and treatment efficacy compared to other treatments examined, including MN alone, MN with hyaluronic acid (HA), MN with botulinum toxinA (TA), MN with platelet-rich plasma (PRP), PRP alone, CP, and laser therapy. The results for MN combined with additional treatments were obviously better than for MN alone. Side effects such as erythema, pain, and post-inflammatory hyperpigmentation showed no significant differences across all treatments assessed.
Assuntos
Acne Vulgar , Cicatriz , Agulhas , Metanálise em Rede , Ensaios Clínicos Controlados Aleatórios como Assunto , Humanos , Acne Vulgar/complicações , Acne Vulgar/terapia , Resultado do Tratamento , Terapia Combinada/métodos , Cicatriz/etiologia , Cicatriz/terapia , Cicatriz/diagnóstico , Agulhas/efeitos adversos , Satisfação do Paciente , Abrasão Química/métodos , Abrasão Química/efeitos adversos , Agulhamento Seco/métodos , Agulhamento Seco/efeitos adversos , Ácido Hialurônico/administração & dosagem , Ácido Hialurônico/efeitos adversos , Plasma Rico em Plaquetas , Terapia a Laser/métodos , Terapia a Laser/efeitos adversos , Toxinas Botulínicas Tipo A/administração & dosagem , Toxinas Botulínicas Tipo A/efeitos adversos , Indução Percutânea de ColágenoRESUMO
BACKGROUND: There has been a proliferation of physicians of different levels of experience and training offering nonsurgical cosmetic procedures. Rising demand, compounded by increasing utilization of new and existing technologies by numerous physician specialties, compels discussion of adequate standardized training and patient safety. METHODS: A retrospective chart review of patients who presented to our single site dermatology clinic for managment of complications following chemical peel, laser or energy-based device treatments performed by core cosmetic physicians between the years of 2013 and 2024 was conducted. Core cosmetic physicians included plastic surgery, facial surgery/otolaryngology, oculoplastic surgery, and dermatology. Charts were reviewed for documentation of the type of complication, procedure causing the complication, and physician credentials, and referral source. RESULTS: Twenty-five patients were identified as having complications from chemical peeling, laser treatment or energy-based devices. Devices implicated included CO2 laser (fractional or fully ablative), chemical peels, 1064 nm long-pulsed Nd:YAG laser, 1320 nm Nd:YAG laser, intense pulsed light, 595 nm pulsed dye laser, Q-switched Nd:YAG laser, radiofrequency with and without microneedling, and 1550 nm erbium-doped fiber laser. Complications included hypertrophic scarring, atrophic scarring, post-inflammatory erythema, post-inflammatory hyperpigmentation, and post-inflammatory hypopigmentation. CONCLUSIONS: Even in experienced hands, complications can arise. It is imperative that all physicians offering cosmetic treatments are equipped to recognize clinical endpoints, identify and manage complications, or make a timely referral to decrease the risk of a permanent and potentially devastating esthetic outcome for patients.
Assuntos
Abrasão Química , Técnicas Cosméticas , Humanos , Estudos Retrospectivos , Abrasão Química/efeitos adversos , Técnicas Cosméticas/instrumentação , Técnicas Cosméticas/efeitos adversos , Feminino , Masculino , Terapia a Laser/efeitos adversos , Terapia a Laser/instrumentação , Pessoa de Meia-Idade , Adulto , Complicações Pós-Operatórias/etiologia , Lasers de Estado Sólido/uso terapêuticoRESUMO
Melasma is a chronic, acquired disorder of focal hypermelanosis that carries significant psychosocial impact and is challenging for both the patient and the treating practitioner to manage in the medium to long term. Multiple treatments have been explored, often in combination given the many aetiological factors involved in its pathogenesis. Therapeutic discoveries to treat melasma are a focal topic in the literature and include a range of modalities, with recent developments including updates on visible light photoprotection, non-hydroquinone depigmenting agents, oral tranexamic acid, chemical peels, and laser and energy-based device therapy for melasma. It is increasingly important yet challenging to remain up-to-date on the arsenal of treatments available for melasma to find an efficacious and well-tolerated option for our patients.
Assuntos
Abrasão Química , Melanose , Ácido Tranexâmico , Melanose/terapia , Melanose/diagnóstico , Humanos , Abrasão Química/métodos , Ácido Tranexâmico/uso terapêutico , Terapia a Laser/métodos , Resultado do Tratamento , Preparações Clareadoras de Pele/uso terapêutico , Preparações Clareadoras de Pele/administração & dosagem , Fármacos Dermatológicos/uso terapêutico , Terapia com Luz de Baixa Intensidade/métodos , Terapia com Luz de Baixa Intensidade/instrumentaçãoRESUMO
BACKGROUND: Chemical exfoliation of the skin is a frequently utilized treatment in dermatology to improve the appearance and health of photoaged skin. Photodamaged skin is especially prone to dryness and irritation. Over-exfoliation with at-home products are partially to blame for the "epidemic" of sensitive skin affecting over half the population. Combining AHA, BHA, and PHA together creates a complementary blend that has the potential to target numerous age-related changes in the skin including the appearance of pores and smoothing skin texture, while firming skin and increasing its collagen and moisture content. OBJECTIVES: The following study tested the clinical efficacy of a triple acid blend designed specifically for sensitive skin and measured improvements in signs of photodamage and hydration levels in the skin over time. METHODS: Thirty females aged 35-60 with mild to moderate facial lines, wrinkles, sun damage, uneven skin tone/texture, dark spots, or pores were enrolled. Subjects were instructed to use the test article, DWB-EN, on a clean face at night 3 times weekly with 48 h between applications for 4 weeks. RESULTS: Statistically significant improvements were noted in all parameters of photoaging clinical assessments (wrinkles, pores, overall appearance, luminosity, visible texture, skin tone evenness, hyperpigmentation) at the end of the 4-week study period. There were no instances of skin irritation throughout the duration of this study despite half of the women having sensitive skin. CONCLUSIONS: Overall, this study demonstrated the clinical efficacy and tolerability of DWB-EN for treating photoaging in subjects with all skin types.
Assuntos
Envelhecimento da Pele , Humanos , Envelhecimento da Pele/efeitos dos fármacos , Envelhecimento da Pele/efeitos da radiação , Feminino , Adulto , Pessoa de Meia-Idade , Resultado do Tratamento , Abrasão Química/efeitos adversos , Abrasão Química/métodos , Pele/efeitos dos fármacos , Pele/efeitos da radiação , Combinação de Medicamentos , Face , Glicolatos/administração & dosagem , Glicolatos/efeitos adversos , Glicolatos/farmacologiaRESUMO
Although patients with refractory melasma have been treated using various methods, there is still no precise definition or summary of the therapies. To define refractory melasma and conduct a review of the treatments, we searched for relevant publications in PubMed, Web of Science, and the Cochrane Library, and a total of 35 references were obtained. Refractory melasma can be roughly defined as an ineffective treatment for melasma, including topical bleaching agents, chemical peels, laser therapy, microdermabrasion for more than six months, or chemical peels treated more than six times. Meanwhile, physicians should be careful when treating patients with darker skin and dermal or mixed types of melasma since these individuals do not respond well to treatment. Lasers combined with other methods, especially different types of lasers or topical agents, are considered more effective than monotherapy. Oral tranexamic acid (TXA) is a prospective cure for refractory melasma. Other methods include a combination of chemical peels, microneedling, or injections with additional therapies. In conclusion, we were able to provide a rough definition of refractory melasma and list the available therapies. According to the literature, the most prevalent treatment is laser combination therapy. However, laser treatment should be considered only after topical agents and chemical peeling have failed. Considering its side effects, efficacy, and safety, oral TXA may be a better option, but more research is needed to make a firm conclusion. Moreover, maintenance therapy is required after treatment.
Assuntos
Abrasão Química , Melanose , Melanose/terapia , Humanos , Abrasão Química/métodos , Ácido Tranexâmico/uso terapêutico , Ácido Tranexâmico/administração & dosagem , Terapia a Laser/métodos , Terapia com Luz de Baixa Intensidade/métodos , Terapia Combinada , Dermabrasão/métodosRESUMO
BACKGROUND: Improving the appearance of lentigines on the hands is a key component to hand rejuvenation. Soft tissue fillers revolumize hands, but do not address pigmentary changes. OBJECTIVE: This study investigated the effiacy of a 15% trichloroacetic acid (TCA) + 3% glycolic acid (GA) combination peel in improvement of appearance of hand lentigines. METHODS: A prospective evaluator-blinded, split-hand study was performed using a 15% TCA + 3% GA peel to treat patients with hand lentigines. Subjects received a total of 3 treatments at 4-week intervals on 1 hand, with the other hand serving as an untreated control. Final photographs were taken 12 weeks after the last treatment. Two blinded board-certified dermatologists graded improvement in hand lentigines using a 5-point scale. RESULTS: Eighteen of 20 patients completed the study (90%). The mean age was 64.4 years (SE 1.6, range 51-71). The mean pain scores were 3.8 (SE 0.4) on a 10-point scale (1 = no pain, 10 = extremely painful). Blinded evaluators correctly identified the after-treatment photographs in 16 patients (88%). Physician and patient-graded mean improvement of lentigines was significant for treated versus control hands ( p < .01). No adverse events were noted. CONCLUSION: A series of three 15% TCA + 3% GA peels are effective and safe in the treatment of hand lentigines.
Assuntos
Abrasão Química , Glicolatos , Ácido Tricloroacético , Humanos , Ácido Tricloroacético/administração & dosagem , Ácido Tricloroacético/efeitos adversos , Glicolatos/administração & dosagem , Pessoa de Meia-Idade , Abrasão Química/métodos , Estudos Prospectivos , Idoso , Feminino , Masculino , Lentigo/tratamento farmacológico , Método Simples-Cego , Mãos , Ceratolíticos/administração & dosagem , Resultado do TratamentoRESUMO
BACKGROUND: Melasma is a common chronic, relapsing pigmentary disorder that causes psychological impact. Chemical peels are a well-known therapeutic modality used for accelerating the treatment of melasma. OBJECTIVE: To review the published evidence on the efficacy and safety of chemical peels in the treatment of melasma. METHODS: A systematic review was done. A meta-analysis could not be done due to the heterogeneity of data. RESULT: The authors conducted a PubMed search and included prospective case series of more than 10 cases and randomized controlled trials (RCTs) that have studied the safety and/or efficacy of chemical peel in melasma. Out of 24 studies, 9 were clinical/comparative trials and 15 were RCTs. The total sample size was 1,075. The duration of the study varied from 8 to 36 weeks. Only 8 studies were split face. All studies used self-assessment, physician global assessment, and Melasma Area and Severity Index (MASI) for quantifying the results. Glycolic acid was found to be the most safe and effective in melasma. CONCLUSION: Chemical peels were found to be safe and effective in the management of melasma.
Assuntos
Abrasão Química , Melanose , Melanose/terapia , Humanos , Abrasão Química/métodos , Glicolatos/uso terapêutico , Glicolatos/administração & dosagem , Resultado do Tratamento , Ceratolíticos/uso terapêutico , Ceratolíticos/administração & dosagemRESUMO
BACKGROUND: Melasma is a common pigmentary condition that affects the patients' quality of life and all the prescribed treatment options till now are not satisfactory, especially in dark-skinned patients. OBJECTIVE: To evaluate the efficacy and safety of systemic metformin (1,000 mg and 500 mg) combined with trichloroacetic acid (TCA) peeling versus TCA alone in the treatment of melasma. PATIENTS AND METHODS: The study included 60 melasma patients divided into 3 groups: Group A received systemic metformin (1000 mg/d), Group B received systemic metformin (500 mg/d) and Group C received placebo. The 3 treatment groups were treated by TCA 25% over the whole face bimonthly for a total of 6 sessions. Melasma area and severity index (MASI), and Melasma impact Quality of life Scale (MELASQOL) were used to assess the outcome. RESULTS: There was a statistically significant decrease in the MASI, and the MELASQOL in the 3 studied groups after treatment with significantly better improvement in Group (A) than Group (C) ( p = .045). CONCLUSION: Systemic metformin is a safe and promising therapeutic option for treating melasma.
Assuntos
Abrasão Química , Melanose , Humanos , Abrasão Química/efeitos adversos , Melanose/terapia , Qualidade de Vida , Índice de Gravidade de Doença , Resultado do Tratamento , Ácido TricloroacéticoRESUMO
BACKGROUND: Facial acne scars are a prevalent concern, leading to the development of various treatment modalities. OBJECTIVES: This review aims to explore the latest advancements in the treatment of facial acne scars, focusing on both surgical and non-surgical methods. METHODS: The non-surgical treatments reviewed include topical medications (such as retinoids and alpha hydroxy acids) and non-invasive procedures (like microdermabrasion and chemical peels). Surgical options discussed are punch excision, subcision, and fractional laser treatments. RESULTS: Combination therapy, integrating both surgical and non-surgical approaches, is frequently utilized to achieve optimal results in scar improvement. CONCLUSION: Recent advancements in the treatment of facial acne scars provide promising options for individuals seeking improvement. However, these treatments have associated risks and potential adverse effects, highlighting the importance of consulting a dermatologist before beginning any treatment regimen.
Assuntos
Acne Vulgar , Abrasão Química , Humanos , Cicatriz/etiologia , Cicatriz/terapia , Cicatriz/patologia , Acne Vulgar/terapia , Acne Vulgar/cirurgia , Dermabrasão , Retinoides/uso terapêutico , Resultado do TratamentoRESUMO
BACKGROUND: Acanthosis nigricans is a non-inflammatory skin pigmentary disorder characterized by a dark, velvety appearance, primarily observed in the neck and axillary areas. It is commonly associated with obesity, diabetes, and insulin resistance. Although the primary treatment is correcting the underlying disorders, many aesthetic modalities have been established to improve appearance owing to cosmetic concerns. AIMS: We aimed to compare and investigate the effectiveness and side effects of tretinoin 0.05% and glycolic acid 70% in treating acanthosis nigricans lesions of the axillary and neck area. METHODS: This single-blinded, randomized trial recruited patients with neck or axillary involvement. Each patient was randomized to use cream tretinoin 0.05% every other night on one side, while the other side was treated with glycolic acid 70%, which was applied every 2 weeks at the clinic for four consecutive sessions. The study duration was 8 weeks, and patients were evaluated every 2 weeks based on their response to treatment, satisfaction, and side effects. RESULTS: Thirty patients, including 14 with neck lesions and 16 with axillary lesions, were included. Tretinoin was significantly more effective for axillary lesions in terms of treatment response and patient satisfaction (p = 0.02 and p = 0.008, respectively). It was also shown that as the severity of the lesions increased, the response to treatment and patient satisfaction decreased, specifically when treating axillary lesions with glycolic acid (p = 0.02 and p = 0.03, respectively). CONCLUSION: Neither method was significantly effective for neck lesions. However, tretinoin 0.05% was shown to be more efficacious in treating axillary lesions of acanthosis nigricans, despite causing minimal side effects.
Assuntos
Acantose Nigricans , Axila , Abrasão Química , Glicolatos , Ceratolíticos , Pescoço , Satisfação do Paciente , Tretinoína , Humanos , Glicolatos/administração & dosagem , Glicolatos/efeitos adversos , Feminino , Método Simples-Cego , Adulto , Tretinoína/administração & dosagem , Tretinoína/efeitos adversos , Acantose Nigricans/tratamento farmacológico , Masculino , Ceratolíticos/administração & dosagem , Ceratolíticos/efeitos adversos , Resultado do Tratamento , Adulto Jovem , Abrasão Química/efeitos adversos , Abrasão Química/métodos , Pessoa de Meia-Idade , Adolescente , Creme para a Pele/administração & dosagem , Creme para a Pele/efeitos adversos , Administração CutâneaAssuntos
Abrasão Química , Emulsificantes , Abrasão Química/métodos , Humanos , Fenol/uso terapêuticoRESUMO
BACKGROUND: This study was conducted to improve standards of care in the cosmetic treatment of sun damage, fine lines, and wrinkles. Chemical Peels and Neurotoxins have been traditionally used cosmetically as monotherapies. This study aimed to confirm that the same-day combination created no additional side effects while also improving outcomes. METHODS: The multi-generational study enrolled 30 patients with Fitzpatrick I-VI representation. The Roberts Skin Type Classification System was used to establish baseline patient information. Patients were treated with a VI Peel®, followed by Botox®. Objectively, photographic matching, Wrinkle Severity Scale, Uniformity of Pigment Scale, and Skin Tone Scales were used to evaluate skin improvement. Patient questionnaires were issued to assess satisfaction. RESULTS: Safety of the same-day combination was established with no adverse events reported. Improvements on the Wrinkle Severity Scale showed an average rating dropping from 1.46 to 0.59 representing a 60% improvement. Improvements on the Uniformity of Pigment Scale showed an average rating dropping from 2.27 to 0.92 representing a 59% improvement. Improvements on the Skin Tone Scale showed an average rating dropping from 2.35 to 0.71 representing a 70% improvement. Questionnaires correlated with objective findings with high satisfaction. Conclusion: This study confirmed the safety of the same-day combination. The efficacy of VI Peel & Botox same-day treatment was clinically proven by the improvements to Wrinkle Severity, Uniformity of Pigment, and Skin Tone via photographic matching. While perception studies indicated strong patient satisfaction with the combination. J Drugs Dermatol. 2024;23(1):1349-1354. doi:10.36849/JDD.7194R1.
Assuntos
Toxinas Botulínicas Tipo A , Abrasão Química , Humanos , Neurotoxinas/efeitos adversos , Toxinas Botulínicas Tipo A/efeitos adversos , Dermabrasão , Pele , Ácido Dioctil Sulfossuccínico , FenolftaleínaRESUMO
OBJECTIVE: To observe the efficacy and safety of supramolecular salicylic acid monotherapy and supramolecular nicotinamide in the treatment of chloasma. METHODS: A total of 28 female patients with chloasma diagnosed in the dermatology outpatient department of our hospital were randomly divided into an experimental group and a control group, with 14 cases in each group. All patients were treated with 30% supramolecular salicylic acid every 2 weeks, for a total of 8 treatments. The experimental group was treated with 10% supramolecular nicotinamide once in the morning and once in the evening, and the control group was a blank control. Before each exfoliation treatment, subjects were photographed with a VISIA skin detector, and skin image analysis and modified melasma area and severity index (MASI) score were performed. RESULTS: According to the MMASI decrease rate (%) before and after treatment, the effective rate of the experimental group was 64.29%, and the effective rate of the control group was 14.29%. The results of the GriffithS10 and VISIA were improved. During the whole treatment, there was one mild adverse reaction in both groups. CONCLUSION: Salicylic acid stripping combined with nicotinamide in the treatment of chloasma is safe and effective, can improve skin conditions, and can be widely applied in clinical practice.
Assuntos
Abrasão Química , Melanose , Humanos , Feminino , Ácido Salicílico/efeitos adversos , Niacinamida/efeitos adversos , Pele , Abrasão Química/métodos , Melanose/tratamento farmacológico , Resultado do TratamentoRESUMO
Atrophic acne scars are the most common type of acne scars and are classified into three main types: icepick, boxcar, and rolling scars. Various procedures and techniques for atrophic acne scarring are discussed in detail, with stronger evidence-based support for lasers (non-fractional, fractional, ablative, and non-ablative), platelet-rich plasma as adjunctive treatment, chemical peels (glycolic acid, trichloroacetic acid, and Jessner's solution), dermal fillers such as hyaluronic acid, and microneedling, and lesser quality evidence for microdermabrasion, subcision, and lipoaspirate grafting. Further research is needed to optimize treatment protocols, assess the efficacy of monotherapies, and establish standardized guidelines for clinicians. This paper will provide a comprehensive review of the evidence-based management of atrophic acne scars, including currently commonly utilized therapies as well as more innovative treatment options.
Assuntos
Acne Vulgar , Abrasão Química , Dermatologia , Humanos , Cicatriz/etiologia , Cicatriz/terapia , Cicatriz/patologia , Acne Vulgar/complicações , Acne Vulgar/terapia , Abrasão Química/métodos , Terapia Combinada , Atrofia/terapia , Resultado do TratamentoRESUMO
Acne vulgaris stands out as the most prevalent skin disorder among teenagers and young adults, causing physical discomfort and considerable economic and psychological burdens on individuals and society. A wide range of topical and systemic therapies are available in acne treatment. Chemical peeling is a skin resurfacing technique designed to rebuild healthy skin using exfoliating substances, a simple and affordable process with various dermatological uses. Chemical peels, classified as superficial, medium, and deep, have been utilized for acne vulgaris and multiple other skin issues. In these chemical peels, a diverse range of chemical substances is employed, each with its unique mode of action. Among these, α-hydroxy and ß-hydroxy acids have gathered attention for their efficacy in reducing acne lesions and enhancing overall skin appearance. Acids, such as salicylic acid, glycolic acid, or lactic acid, are commonly used in chemical peels due to their exfoliating and sebum-regulating properties. Despite the widespread use of these acids, there exists a lack of consensus regarding the most effective acid type and concentration for treating acne-prone skin. This review aims to bridge this knowledge gap by evaluating the effectiveness and safety of various organic acids used in chemical peels specifically for acne-prone skin. The findings of this comprehensive bibliographic review indicate that organic acid-based chemical peels represent effective and safe treatment options for individuals with acne-prone skin. Their adaptability sets these treatments apart; the choice of organic acid can be tailored to meet individual patient needs and tolerability levels. This personalized approach ensures that patients receive optimal care while minimizing the risks associated with the treatment. As research in this field progresses, it is anticipated that a more nuanced understanding of the ideal acid type and concentration will emerge, further enhancing the efficacy and safety of chemical peels for acne-prone skin.
Assuntos
Acne Vulgar , Abrasão Química , Adolescente , Adulto Jovem , Humanos , Ceratolíticos/uso terapêutico , Ceratolíticos/farmacologia , Acne Vulgar/tratamento farmacológico , Ácido Salicílico/farmacologia , Abrasão Química/métodos , PeleRESUMO
Facial resurfacing is a fundamental part of rejuvenation but it is often ignored because of the perceived difficulty. Lasers are an option, but they have proved inadequate for difficult rhytids (ie, perioral) both in quality and longevity. Croton oil peels can give excellent results with remarkable permanence. The misconception of danger and difficulty will be dispelled and the reality that these peels can be done in a controlled fashion and are within the grasp of any practitioner will be discussed.