Biomimetic hyaluronic acid-stabilized zinc oxide nanoparticles in acne treatment: A preclinical and clinical approach

Acne vulgaris is a common chronic inflammatory skin condition, often caused by C. acnes infection. While ZnO has shown promise as an antibacterial agent in acne treatment, concerns over toxicity and non-selective bacterial killing remain. In this study we developed a hyaluronic acid-stabilized nano‑zinc oxide (HA-ZnO) formulation aimed at enhancing the therapeutic efficacy and safety of ZnO for acne treatment. HA-ZnO was synthesized through biomimetic mineralization. HA-ZnO targeted acne-prone areas, especially sebaceous glands, without skin penetration. HA-ZnO demonstrated selective antibacterial activity against C. acnes, exhibiting a killing efficacy more than 16 times greater than that against S. epidermidis. The HA coating also improved ZnO's stability in acidic conditions, mitigating potential toxicity and side effects. Additionally, the sustained release of Zn2+ promoted cell proliferation and migration, reducing sebum secretion, and exerting anti-inflammatory effects, supporting scar-free acne repair and preventing recurrence. In preclinical models, HA-ZnO outperformed erythromycin ointment in treating acne, with no toxicity observed in zebrafish and HET-CAM. A clinical trial further confirmed its efficacy in reducing acne lesions and redness, with high safety. These results highlight HA-ZnO as a promising therapeutic strategy for acne, combining potent antibacterial and skin-repairing effects with enhanced safety.

Ultrasound assessment of botulinum toxin-A (BOTOX) injection into adult Arabian dromedary camels' lips: efficacy in detection and localization

BACKGROUND

Ultrasound imaging has become an invaluable tool in veterinary medicine, particularly in guiding injections and visualizing soft tissue structures. Recently, ultrasonography has been used in camel practice to detect cosmetic fillers, particularly in aesthetic evaluations. However, previous applications lacked a controlled experimental background. This study is the first to experimentally assess the effectiveness of ultrasound in detecting and localizing botulinum toxin (BOTOX) injections in camels, using two different doses, from the time of injection until the toxin's effect becomes undetectable.

OBJECTIVE

The objective of this study was to assess the efficacy of ultrasound in detecting and localizing botulinum toxin injection sites in camels' lips.

METHODS

This study involved 18 adult Arabian dromedary camels (9 Magateer and 9 Majaheem breeds) from the Camel Research Center, King Faisal University. The camels, aged 4.3 ± 1.3 years and weighing 405.5 ± 20.6 kg, were randomly assigned to three treatment groups (6 camels each). Treatments included 100 IU and 200 IU of botulinum toxin type A, and a control of 5 ml sterile saline, administered to the upper and lower lips. Morphological changes, inflammation, and lip thickness were assessed weekly for two months. Ultrasound examinations and hematological and biochemical analyses were conducted at specified intervals. Data were analyzed using two-way repeated-measures ANOVA and Tukey's test, with significance set at p < 0.05.

RESULTS

Morphological assessments revealed significant changes in the lips of camels treated with 200 IU BOTOX, showing the highest shape change scores (3 ± 0) compared to 100 IU BOTOX (1.75 ± 0.87) and control (0.4 ± 0). Inflammation and tissue reactions were more pronounced in the BOTOX-treated groups, with higher scores in the 200 IU group. Lip thickness increased significantly in the BOTOX groups, with the greatest thickening in the 200 IU group (2.4 ± 0.54 mm). Ultrasonographic findings showed structural changes and increased tissue thickness, peaking on Day 7 and gradually normalizing by Day 54. Hematological and biochemical profiles showed no significant differences between the treated and control groups.

CONCLUSIONS

The study demonstrates the effect of BOTOX on camel lip morphology and tissue characteristics, with higher doses (200 IU) causing more significant and prolonged changes. Both morphological scoring and ultrasonographic evaluation effectively monitored these effects, including the timeframe of BOTOX detection and when it became undetectable.

Advancements in Acne Scar Treatment: Exploring Novel Therapies

BACKGROUND

Acne-induced scarring remains a formidable challenge, compelling patients to explore surgical interventions. This study aims to delve into and showcase recent strides in acne scar treatment, with a specific focus on innovative therapies.

METHODS

Conducting a narrative review spanning studies from 2013 to 2023, this paper provides a general overview of interventions. The review included English-language studies with full-text availability. Rigorous data screening and extraction by two independent authors covered diverse facets, including study particulars, participant profiles, measurement tools, intervention durations, outcomes, and key findings. The initial search was performed within PubMed, Scopus, Google Scholar, and the gray literature.

RESULTS

Ultimately, 26 studies meeting inclusion criteria were included and reviewed for final analysis.

CONCLUSION

Recognizing the varied nature of acne scars, this narrative review underscores the need for personalized treatment strategies, considering scar type and severity. The study also emphasizes the potential necessity of combining treatments for optimal results. Despite substantial progress, ongoing research and more extensive studies are imperative to continually refine acne scar treatment outcomes, ultimately enhancing the well-being of those affected by this condition.

Photoaging: Current Concepts on Molecular Mechanisms, Prevention, and Treatment

Photoaging is the consequence of chronic exposure to solar irradiation, encompassing ultraviolet (UV), visible, and infrared wavelengths. Over time, this exposure causes cumulative damage, leading to both aesthetic changes and structural degradation of the skin. These effects manifest as rhytids, dyschromia, textural changes, elastosis, volume loss, telangiectasias, and hyperkeratosis, collectively contributing to a prematurely aged appearance that exceeds the skin's chronological age. The hallmarks of photoaging vary significantly by skin phototype. Skin of color tends to exhibit dyschromia and features associated with "intrinsic" aging, such as volume loss, while white skin is more prone to "extrinsic" aging characteristics, including rhytids and elastosis. Moreover, susceptibility to different wavelengths within the electromagnetic spectrum also differs by skin phototype, influencing the clinical presentation of photoaging, as well as prevention and treatment strategies. Fortunately, photoaging-and its associated adverse effects-is largely preventable and, to some extent, reversible. However, effective prevention and treatment strategies require careful tailoring to an individual's skin type. In this review, we summarize molecular mechanisms underlying photoaging, examine its clinical manifestations, outline risk factors and prevention strategies, and highlight recent advancements in its treatment.

Nonsurgical Rhinoplasty: A Modified Rino-4-Puntos Technique With Hyaluronic Acid Improves the Appearance of Nasal Septal Deviation

Background

Recently, we introduced the Rino-4-Puntos (R4P) nonsurgical rhinoplasty technique using hyaluronic acid (HA), which effectively addresses nose shape issues. However, no nonsurgical rhinoplasty procedure has been explicitly tested for improving the appearance of nasal septal deviation (NSD). This study aimed to evaluate the aesthetic outcome, longevity of results, safety, and patient satisfaction of the modified R4P (mR4P) technique, designed to address nose shape issues related to NSD.

Methods

This was a retrospective study of consecutive patients treated with mR4P. NSD is the leading cause of unpleasing aesthetics. The R4P technique involves targeted injections with an intermediate G prime (G') HA at the radix (point 1), supratip (point 2), and tip (point 3), and high G' HA at the columella (point 4). To specifically address nose shape issues caused by NSD, modifications were made to points 4.2 and 4.3 of the technique. At these points, the needle insertion point was repositioned to the side of deviation. Then, the needle was directed diagonally opposite the deviation toward the nasal tip.

Results

Eighty individuals (68.7% women) were included. The procedure is suitable for mild-to-moderate caudal NSD, including I- and C-shaped NSDs. Notably, 87.5% of the participants were very satisfied and 12.5% were satisfied with the aesthetic outcome. Most (81.2%) patients reported respiratory improvements after mR4P. The treatment effect lasted for a median of 11 months. No vascular complications occurred.

Conclusions

The mR4P technique improves the appearance of caudal NSD and provides good longevity of the aesthetic outcomes and safety.

Fractional CO2 laser alone versus combined with topical timolol or insulin for acne Scar treatment: a randomized controlled clinical trial

INTRODUCTION

Acne vulgaris is a common disease involving adolescents predominantly, which can lead to scar formation. This study aimed to compare the efficacy of fractional CO2 laser therapy, alone or combined with topical Timolol or insulin, for acne scar treatment, which has not been yet rigorously investigated.

METHOD

In this Randomized Controlled Trial (RCT) conducted in 2024, we enrolled 30 subjects and randomly assigned them to groups A and B. Both groups received bilateral fractional CO2 laser therapy; one group received unilateral topical 0.5% Timolol Maleate, while the other received unilateral topical regular insulin. Scar severity was assessed using the Scale for Acne Scar Severity (SCAR-S), Acne Scar Assessment Scale (ASAS), and Goodman and Baron Quantitative Global Scarring Grading System (GBAQGS) before and after the therapy. Additionally, patients' quality of life was evaluated using the Dermatologic Life Quality Index (DLQI) questionnaire at the designated time points. Statistical analyses were conducted using the IBM ™ SPSS Statistics application (version 26.0).

RESULTS

The subjects consisted of 20 females and 10 males of Persian ethnicity, with a mean age of 32.20 years. Despite significant improvements in acne scar severity, and quality of life observed following fractional CO2 laser therapy alone and in combination with topical Timolol or insulin application, no significant differences existed between these treatment approaches. No adverse effect was seen during the study.

CONCLUSION

Fractional CO2 laser alone or its combination with topical Timolol or insulin mitigated acne scar severity and enhanced patients' quality of life, despite the absence of significant differences.

Combined subcision with polydioxanone monofilament (PDO) threads versus polydioxanone monofilament (PDO) threads alone in treatment of atrophic post-acne scars

Acne scaring negatively impacts life quality. Treatment options vary in clinical effectiveness, side effects, and downtime. Polydioxanone threads (PDO) stimulate neo-collagenesis and create mechanical lift through artificial ligaments, while subcision is an office surgical method for managing atrophic scars. Both methods have their advantages and disadvantages. To assess the clinical efficiency and safety of PDO threads alone against combined subcision in the management of atrophic following-acne scars. Twenty patients with facial atrophic following acne scars were involved. The right side of the face was managed with PDO threads, while the left side was managed with subcision and PDO threads. Patients were assessed after three months using the Goodman and Baron qualitative and quantitative acne scarring grading systems. On the right side, improvement was excellent in two patients (10%), good in fourteen patients (70%), and poor in four patients (20%). On the left side, the improvement was excellent in six patients (30%), good in twelve patients (60%), and poor in two patients (10%). There was a statistically insignificant variance between both sides with a p-value of 0.308. There were no reported serious side effects, and the pain was tolerable. PDO thread insertion, either alone or combined with subcision, is safe and efficient in managing atrophic post-acne scars.

International Multicentric Study on Ultrasound Characteristics, Layer Location, and Corporal Distribution of Granulomas After Cosmetic Fillers Injections

OBJECTIVES

To provide insight into the characteristics, layer locations, and corporal distribution of the granulomatous reactions to cosmetic fillers.

METHODS

An international retrospective multicentric study was performed in centers that scan complications of cosmetic fillers. Inclusion criteria were patients with previous injections of known cosmetic fillers confirmed by ultrasound and ultrasonographic features of granulomatous reactions such as hypoechoic nodules, pseudonodules, or hypoechoic tissue surrounding the deposit regions. The ultrasound studies followed the published guidelines for performing dermatologic ultrasound examinations.

RESULTS

A total of 240 cases met the criteria. The leading fillers previously injected were 50.4% hyaluronic acid, 18.8% poly-L-lactic acid, 8.3% polymethylmethacrylate, 6.3% calcium hydroxyapatite, and 3.8% silicone oil. The main regions of granulomas were the lower lid, infraorbital, and medial cheek in 41.7%, the perioral region and lips in 19.2%, the lateral jaw and cheek in 14.6%, and the chin, pre-jowl, and medial jaw in 12.5%. The layers involved by the granulomatous reaction were hypodermis in 37.1%, the deep fat pad in 8.9%, the periosteum in 5.8%, the combination of hypodermis, deep fat pad, and muscle in 5.8%, and the combination of hypodermis, fascia, subfascial, deep fat pad, and muscle in 5.4%. The predominant corporal locations were the face, submandibular, and anterior neck, with 95.8% being 87.5% in the face.

CONCLUSION

Ultrasound can provide valuable and detailed anatomical information supporting diagnosis and management as well as valuable insights into the granulomatous reactions to fillers.

Insights into the morbidity profiles of epidemiologically excluded COVID-19 patients in primary care settings during the third wave of the pandemic in the Anuradhapura District, Sri Lanka

BACKGROUND

The COVID-19 pandemic has dramatically impacted healthcare systems worldwide, leading to changes in the delivery of healthcare services. A profound effect on the well-being of non-COVID-19 patients has been reported, but limited evidence is available from developing countries. This study aimed to describe the morbidity profiles of epidemiologically excluded COVID-19 patients during the pandemic in the primary care setting of the Anuradhapura District of Sri Lanka.

METHODS

This cross-sectional healthcare institution-based study collected morbidity profiles from six state-owned and five private primary care facilities (PCFs) in the Anuradhapura District during the third wave of the COVID-19 pandemic. Reasons for Encounters (RFEs) were recorded from physically available and epidemiologically excluded COVID-19 patients in a paper-based data format and coded using the International Classification of Primary Care.

RESULTS

Out of 1630 primary care encounters, 187 RFEs were identified. Most patients were females (n = 899, 55%) and in the adult age category (n = 1297, 79%). The median age of the patients was 39 years (interquartile range: 21-55). Older patients were likelier to seek primary care in the state sector (p < .001). Most children presented to the private sector compared to state PCFs (p < 0.001). The majority of females significantly utilised state sector PCFs (p = 0.043). Upper respiratory tract infections (n = 154, 9.00%) were the most common RFE. The highest burden of systemic RFEs was associated with dermatological (n = 294, 18%) and respiratory conditions (n = 274, 16%). More than one-third of adults (n = 487, 37.5%) suffered from a self-reported non-communicable disease (NCD). Hypertension (n = 235, 48%), diabetes mellitus (n = 184, 38%), and dyslipidemia (n = 134, 28%) were the most observed NCDs. Multimorbidity was reported in 195 (40%) adult patients with an NCD.

CONCLUSION

The pandemic has led to a shift in primary care morbidity profiles, with a higher incidence of dermatological and respiratory diseases and NCDs among healthcare seekers. Patients sought care from the state and private sector differently depending on age, sex, and nature of illness. Primary care services must prepare to adapt to changes in healthcare-seeking patterns and morbidity profiles during pandemics to ensure comprehensive care is available on demand.

Sneddon-Wilkinson Disease as a Manifestation of Severe Hypothyroidism

A Caucasian female in her 80s with a past history of hypothyroidism, chronic kidney disease, lichen sclerosus, and intertrigo presented originally with a pustular rash to an outpatient dermatology office. The patient was treated for intertrigo with nystatin and oral fluconazole before re-presenting four months later with new erythematous plaques and overlying small pustules in the groin, axilla, and inframammary folds. A shave biopsy was taken, and the patient was treated with triamcinolone for plaques on the abdomen and nystatin and hydrocortisone for intertriginous areas. After two weeks, the patient was admitted to the hospital with expressive aphasia and a presumed stroke, and an EEG consistent with metabolic encephalopathy. Her thyroid-stimulating hormone (TSH) level was found to be 29 mlU/L (reference: 0.27-4.20 mlU/L) and T4 level of 0.42 ng/dL (reference: 0.93-1.70 ng/dL), reflective of severe hypothyroidism. The patient was started on IV levothyroxine and methylprednisolone, with improvement in mental status and rash within six days of admission to the hospital. A review of initial biopsy histology showed subcorneal accumulation of neutrophils with spongiosis, consistent with Sneddon-Wilkinson disease (SWD). SWD commonly manifests as painless superficial pustular lesions arising within erythematous plaques. It is found to often be associated with multiple comorbidities, including thyroid disorders. Given this unique presentation of SWD prior to the onset of severe hypothyroidism and myxedema coma, clinicians should consider examining thyroid hormone levels in such patients to rule out hyperthyroidism and hypothyroidism.

Lip Sonoanatomy and Relevance to Aesthetic Filler Injections: A Pictorial Review

BACKGROUND

Lips are central to facial aesthetics, influencing overall balance and harmony. Ultrasound has become a key tool for assessing lip musculature and neurovascular structures, particularly in aesthetic filler injections. By enhancing precision and safety, ultrasound is valuable in procedures addressing age-related lip changes, yet standardized scanning protocols remain underexplored.

AIMS

This review examined lip anatomy, summarized ultrasound applications in aesthetic procedures, introduced a structured scanning protocol, and highlighted its role in guiding filler injections.

METHODS

A systematic search of PubMed, Scopus, Embase, and Web of Science was conducted up to August 1, 2024, using keywords related to ultrasound and lip anatomy. Studies involving human subjects or cadavers using ultrasound for lip assessment and injection guidance were included, whereas nonhuman studies, alternative imaging methods, and research unrelated to the lip region were excluded. Six studies met the criteria.

RESULTS

Ultrasound improves precision in lip injections by identifying key structures, including the superior and inferior labial arteries and the orbicularis oris muscle, reducing vascular risks. A structured scanning approach enhances procedural safety and efficacy.

CONCLUSIONS

Ultrasound is a valuable tool in aesthetic lip procedures, improving accuracy and minimizing complications. Further research is needed to refine protocols and establish ultrasound as a standard practice in lip augmentation.

Optimization of LCD-Based 3D Printing for the Development of Clotrimazole-Coated Microneedle Systems

Fungal infections pose a significant global health problem, affecting 20-25% of the population and contributing to over 3.75 million deaths annually. Clotrimazole (CLO) is a widely used topical antifungal drug, but its efficacy is limited by poor penetration through the stratum corneum. Microneedle (MN) systems, composed of micron-scale structures arranged on a patch, offer a promising strategy to overcome the outermost skin barrier and enhance drug penetration into deeper layers. However, optimizing MN design, particularly in terms of size, shape, and fabrication technology, is essential for efficient drug delivery. This study aimed to develop CLO-coated MN systems using an Liquid Crystal Display (LCD)-based 3D printing technique and a thin-film dip-coating method. A comprehensive optimization of printing parameters, including anti-aliasing, layer thickness, curing time, and printing angle, was conducted to ensure the desired mechanical properties. The optimized MNs were coated with either suspension or ethanol-based CLO-hydrogels, with ethanol hydrogel demonstrating superior characteristics. Additionally, the study investigated how microneedle geometry and coating formulation influenced drug release. Antifungal activity against reference and clinical origin Candida albicans strains varied significantly depending on the coating formulation. Finally, the acute toxicity test confirmed no significant toxic effects on Aliivibrio fischeri, indicating the potential biocompatibility and safety of the developed MN-based drug delivery system.

The role of ultrasound in facial hyaluronic acid dermal filler injections - A review article

Injectable dermal fillers have seen a remarkable rise in popularity in recent years for aesthetic enhancements, such as facial contouring and rejuvenation. Hyaluronic acid (HA)-based fillers are especially favored due to their tolerability, minimal invasiveness, and effectiveness. This review examines the applications of ultrasound in HA dermal filler procedures. A literature search was conducted from February 25 to 26, 2024, using Medline and Google Scholar to identify relevant studies on the use of ultrasound for facial HA dermal fillers. Inclusion criteria included peer-reviewed English language studies from the last decade and involving living human subjects. Eleven studies met these criteria. The findings indicate that ultrasound significantly enhances the accuracy and safety of HA filler procedures by enabling precise vascular mapping, filler detection, and complication detection and identification. By presenting evidence of reduced risks and improved outcomes, this review underscores the potential for ultrasound to become a standard tool in HA filler applications, representing an innovation and a new application for ultrasound in the field of aesthetic dermatology.

An Assessment of Current Clinician- and Patient-Reported Outcome Measures for Acne Scarring and Dyspigmentation: A Scoping Review

Acne-associated scarring and dyspigmentation (ie, erythema, hyperpigmentation) are common sequelae with significant psychosocial impact, but little is known about what measures are most often used to assess these outcomes. This scoping review evaluates the use of current patient-reported outcome measures (PROMs) and clinician-reported outcome measures (ClinROMs) for acne scars and dyspigmentation. For scars, 7 PROMs and 18 ClinROMs were used, with most being unvalidated. Similarly, for dyspigmentation, 4 PROMs and 8 ClinROMs were identified, but no validated PROMs were identified. These results highlight reliance on unvalidated measures in research and clinical trials and suggest the need for developing high-quality validated measures, particularly PROMs, to improve research quality and develop better treatments.

An out-of-season cold. Filler-induced vascular occlusion of the columellar artery causing necrosis of the cartilaginous anterior nasal septum: case report and a literature review

Hyaluronic acid fillers are widely employed for aesthetic procedures but can lead to vascular complications, including rare instances of arterial occlusion. We report a case of columellar artery occlusion following a nasal filler injection in a 30-year-old woman. The patient initially presented with subtle symptoms, including persistent rhinorrhoea and an unusual sensation of cold air. Rhinoscopy revealed full-thickness necrosis of the anterior nasal septum, likely due to compression or embolization of the septal branch of the superior labial artery; prompt treatment with hyaluronidase, aspirin, and topical antibiotics resulted in complete resolution. A literature review identified only one similar case, emphasizing this complication's rarity and potential underreporting. This case underscores the importance of early recognition and intervention in filler-induced vascular events.

Lip Volumization With Hyaluronic Acid: Comparative Ultrasonographic Evaluation of Cannula and Needle Techniques in a Multicenter Study

BACKGROUND

Lip volumization using hyaluronic acid (HA) is among the most popular aesthetic procedures due to the role of the lips in modern beauty standards. This study explored the ultrasound characteristics of HA deposits following injection using either cannula or needle techniques.

METHODS

A multicenter, descriptive study involving 27 patients from five aesthetic centers in Colombia, Spain, and Mexico was conducted. Ultrasound evaluations were performed pre- and post-procedure to assess anatomical changes, HA deposit morphology, and vascular mapping with Doppler. Patients were randomly assigned to either the cannula technique (11 patients, representing 41% of the cohort) or the needle technique (16 patients, representing 59% of the cohort). Satisfaction was measured using a subjective scale (1-5).

RESULTS

HA doses ranged from 0.4 to 1 cc. Among the 27 patients, 25 had a single type of deposit, while two patients presented with two different types simultaneously. Ultrasound examination revealed that 81% (22 patients) of labial arteries were located in the wet submucosa, 15% (four patients) in the dry submucosa, and 4% (one patient) intramuscularly. A total of nine patients presented with lip asymmetry, and two patients had lip hypotrophy; all 11 patients achieved correction, defined as the restoration of symmetrical lip volume and contour. Patient satisfaction was universally high, with 74% (20 patients) reporting complete satisfaction.

CONCLUSION

Ultrasound evaluation is an effective and safe method for assessing patients undergoing HA injections. Our observations indicate that injection techniques, whether using a needle or a cannula, influence the shape and location of HA deposits, with elongated deposits being more common with cannula use and round deposits predominantly associated with needle injections. Pre-procedure ultrasound allows for the identification of each patient's specific lip anatomy, aiding in injection planning, while post-procedure ultrasound helps verify the location of deposits and detect potential complications. These findings highlight the importance of careful technique selection and thorough anatomical assessment to optimize safety and aesthetic outcomes. Future research should focus on larger samples and long-term follow-up to validate these observations and further enhance procedural safety in aesthetic medicine.

Erosive Pustular Dermatosis of the Scalp Following Hair Transplantation: A Rare Complication

Erosive pustular dermatosis of the scalp (EPDS) is a rare inflammatory condition characterized by sterile pustules, crusts, and skin atrophy, leading to scarring alopecia. While typically affecting the elderly, this report discusses a rare instance in a 31-year-old male who developed EPDS following follicular unit extraction (FUE) for androgenetic alopecia. The diagnosis was confirmed through clinical, dermoscopic, and histopathological examination. Initial treatment with topical steroids showed temporary improvement, but the condition relapsed upon tapering. High-potency topical corticosteroids were ultimately effective. This case underscores the importance of early recognition of EPDS, highlighting the value of clinical, trichoscopic, and histopathologic examination in improving patient outcomes. It also expands the understanding of EPDS by suggesting that surgical trauma may trigger pathergy, potentially initiating the condition in younger individuals without typical risk factors. Given the increasing popularity of hair transplantation, clinicians must remain vigilant about rare complications like EPDS to ensure prompt diagnosis and prevent irreversible alopecia.

Energy-Based Skin Rejuvenation: A Review of Mechanisms and Thermal Effects

BACKGROUND

Energy-based photoelectric and ultrasonic devices are essential for skin rejuvenation and resurfacing in the field of plastic surgery and dermatology. Both functionality and appearance are impacted by factors that cause skin to age, and various energy types have variable skin penetration depths and modes of transmission.

AIM

The objective is to advise safe and efficient antiaging treatment while precisely and sensitively controlling and assessing the extent of thermal damage to tissues caused by different kinds of energy-based devices.

METHODS

A literature search was conducted on PubMed to review the mechanisms of action and thermal effects of photoelectric and ultrasonic devices in skin remodeling applications.

RESULTS

This paper reviews the thermal effects of energy-based devices in skin resurfacing applications, including the tissue level and molecular biochemical level. It seeks to summarize the distribution form, depth of action, and influencing factors of thermal effects in combination with the mechanisms of action of various types of devices.

CONCLUSION

Accurate control of thermal damage is crucial for safe and effective skin remodeling treatments. Thorough investigation of molecular biochemical indicators and signaling pathways is needed for real-time monitoring and prevention of severe thermal injury. Ongoing research and technological advancements will improve the accuracy and control of thermal damage during treatments.

Analysis of Hospitalization Cases for Filler Injection Complications: A Five-Year Retrospective Study Among Iranian People

INTRODUCTION

The skin is the largest organ system with many important clinical functions. Due to the increase in demand for cosmetic procedures and consequently the increase in complications from filler injections, this research aims to review the hospitalization cases involving filler complications.

METHODOLOGY

This study retrospectively and cross-sectionally reviews patient records hospitalized between the years 2016 to 2020, focusing on demographics (age, gender, residence), type of filler, type of complications, onset and duration of complications, duration of hospital stay, the person who administered the injection, and treatment outcomes. The goal is to understand the complications, prognosis, and potential risk factors.

RESULTS

A total of 58 patients were hospitalized due to complications arising from filler injections between 2016 and 2020. The average age of patients was approximately 37.79 years, ranging from 15 to 62 years old. A majority, 94.8%, were female and 62.1% were married. The most common filler used was hyaluronic acid, accounting for 81% of cases. Complications included cellulitis in 41.4% of cases, abscesses in 29.3%, granulomatous inflammation in 19%, and necrosis in 10.3%. The shortest hospital stay was 1 day and the longest was 9 days, with an average stay of approximately 2.33 days. In 65.5% of the cases, the injections were administered by medical professionals, and in 34.5%, by individuals without medical credentials. Married individuals generally sought hospital care later than others. Severe complications were more likely to occur when injections were administered by nonprofessionals. The time to seek medical attention was shorter for severe complications than for moderate ones. There were no deaths among the cases studied.

CONCLUSION

The study highlights the variation in complication severity associated with filler injections performed by nonmedical personnel, emphasizing the importance of prohibiting such practices. Educating patients about the early signs of complications can significantly reduce severe outcomes and decrease antibiotic resistance.

Molecular docking to investigate HLA-associated idiosyncratic drug reactions

Idiosyncratic drug reactions (IDRs) pose severe threats to patient health. Unlike conventionally dose-dependent side effects, they are unpredictable and more frequently manifest as life-threatening conditions, such as severe cutaneous adverse reactions (SCARs) and drug-induced liver injury (DILI). Some HLA alleles, such as HLA-B*57:01, HLA-B*15:02, and HLA-B*58:01, are known risk factors for adverse reactions induced by multiple drugs. However, the structural basis underlying most HLA-associated adverse events remains poorly understood. This review summarizes the application of molecular docking to reveal the mechanisms of IDR-related HLA associations, covering studies using this technique to examine drug-HLA binding pockets and identify key binding residues. We provide a comprehensive overview of risk HLA alleles associated with IDRs, followed by a discussion of the utility and limitations of commonly used molecular docking tools in simulating complex molecular interactions within the HLA binding pocket. Through examples, including the binding of abacavir and flucloxacillin to HLA-B*57:01, carbamazepine to HLA-B*15:02, and allopurinol to HLA-B*58:01, we demonstrate how docking analyses can provide insights into the drug and HLA allele-specificity of adverse events. Furthermore, the use of molecular docking to screen drugs with unknown IDR liability is examined, targeting either multiple HLA variants or a single specific variant. Despite multiple challenges, molecular docking presents a promising toolkit for investigating drug-HLA interactions and understanding IDR mechanisms, with significant implications for preemptive HLA typing and safer drug development.

From Nasolabial Folds to Pan-facial Rejuvenation-The Evolution of Fillers in my Career

This is a comprehensive review of facial fillers including landmark studies and expert commentary spanning the years from 2003 (when the first hyaluronic acid [HA] dermal filler underwent Food and Drug Administration approval in United States) to present.

Nonsurgical Rhinoplasty: Results from a Retrospective Study of Rino-4-Puntos Technique with Hyaluronic Acid

BACKGROUND

Nonsurgical rhinoplasty (NSR) utilizing hyaluronic acid (HA) filler injections is increasingly used to address nose shape issues. While refinements have been proposed, the technique lacks standardization.

OBJECTIVES

Our study aimed to evaluate the aesthetic outcome, longevity of results, safety, and patient satisfaction with the novel Rino-4-Puntos (R4P) NSR technique.

METHODS

This is a retrospective study of consecutive individuals treated with R4P between January 2021 and July 2023. All participants had one of the four indications: rectification of the dorsum (21%), triangulation of the tip (32%), projection (25%), and strengthening of the columella (22%). Each patient received two hyaluronic acid (HA) fillers: one with intermediate G prime (G') at Points 1-3 and another with high G' at Point 4, which is further divided into Points 4.1, 4.2, 4.3, and 4.4. The injection points were as follows: P1 (radix, 0.05-0.15 mL, supraperiosteal), P2 (supratip, 0.025 mL, suprachondrial), P3 (tip, 0.15 mL, deep fat), P4 (columella, 0.30 mL, supraperiosteal [4.1], or deep fat [4.2, 4.3, and 4.4]).

RESULTS

Four hundred individuals (n = 284 [71%] females) are included. The mean filler volume used was 0.65 ± 0.17 mL. Injecting small boluses (≤ 0.05 mL) in the midline at deep planes minimized the risk of adverse effects, as no vascular complications occurred. Ninety-three percent of participants considered the overall outcome at least satisfactory ("good," "very good," or "excellent"). The treatment effect was maintained for a median of 11 months.

CONCLUSIONS

The R4P technique refines NSR by combining enhanced aesthetic outcome, longevity, and safety.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Role of Fractional Radiofrequency in Long-term Acne Remission and Reduction of Acne Scar Load

BACKGROUND

Acne is an inflammatory skin disease afflicting the majority of the world's population at some point in their lifetime, and is seen to be chronic in about 50% of cases. Acne leads to significant social withdrawal, depression, and disfiguring scars in many cases. Available treatments are characterized by high rates of relapse, dangerous side effects, and social stigma, which often leads to poor patient compliance and treatment failure.

OBJECTIVES

The aim of this article was to discuss and share the authors' experiences utilizing fractional radiofrequency (RF) (Morpheus8; InMode Ltd., Lake Forest, CA) in the treatment of both active acne and acne scars.

METHODS

A retrospective review was conducted comparing 3 treatment modalities. In total, 356 patients received acne scar treatments. The cohort comprised a high-dose isotretinoin topical therapy series (n = 128, 36%), a 6-session ablative laser series (n = 89, 25%), and a 3-session fractional RF microneedling series (n = 139, 44).

RESULTS

Of the patients with extended 3-year follow-up, the relapse rates were: isotretinoin group, 36 of 54 (67%); laser group, 12 of 16 (75%), and fractional RF microneedling group, 7 of 29 (24%).

CONCLUSIONS

In treating older acne scars, fractional RF microneedling technology has served as an effective tool to tighten skin and fill in atrophic scars when used in conjunction with other techniques. This technology is very effective and very safe for treating all skin types with acne and acne scars.

The Predictive Factors of Acne Scarring and Post-Inflammatory Hyperpigmentation: A Retrospective Cohort Study

Introduction

Acne vulgaris, a prevalent dermatological condition, often results in long-term complications such as scarring and hyperpigmentation. While extensive research has focused on treatment modalities, there is a notable gap in understanding the factors contributing to the development of acne scarring and post-inflammatory hyperpigmentation (PIH).

Purpose

This study was conducted to identify the factors contributing to the development of acne scarring and post-inflammatory hyperpigmentation (PIH).

Patients and Methods

This retrospective cohort study, conducted at King Abdulaziz Medical City, Jeddah, Saudi Arabia, analyzed data from patients with acne vulgaris between 2016 and 2023 using the hospital's health information system, BESTCare. Statistical analysis was performed using RStudio (R version 4.3.1). We constructed a multivariable, multinomial logistic regression model to assess the independent predictors of four acne complication groups; no scarring/PIH, scarring alone, PIH alone, and acne scarring with PIH.

Results

Among 417 analyzed participants, 95 participants had acne scarring (22.8%), 93 participants had PIH alone (22.3%), and 151 participants had both acne scarring with PIH (36.2%), and only 78 participants did not develop scarring or PIH (18.7%). Isotretinoin use and papules acne were associated with increased risk of acne complications. While adapalene gel was protective against acne scarring only.

Conclusion

This retrospective study sheds light on factors influencing acne scarring and PIH among Acne Vulgaris patients. Our findings provide valuable insights for tailoring interventions and advancing our understanding of acne vulgaris complications in the future.

PDO screw threads versus fractional CO2 laser, after subcision, for atrophic acne scar remodelling: a randomized group-based comparative study

Atrophic acne scars present a significant therapeutic challenge. While subcision with various adjunctive treatments, including fractional CO₂ lasers and polydioxanone (PDO) threads, has been employed for scar remodeling, comparative evidence on their efficacy remains limited. This study aims to compare the clinical efficacy and patient satisfaction between subcision with fractional CO₂ laser and subcision with PDO screw threads in managing atrophic acne scars. A randomized, controlled study was conducted on 40 patients with atrophic acne scars. Patients were assigned to two groups: Group A underwent subcision with PDO screw threads insertion, and Group B underwent subcision followed by fractional CO₂ laser resurfacing. Outcomes were assessed using the Goodman and Baron grading system, Antera 3D imaging, and patient satisfaction. Significant scar improvement was observed in both groups, with Group B demonstrating greater reduction in scar severity and depth (p = 0.022). While Group A showed faster recovery and lower downtime, Group B yielded higher patient satisfaction scores. Subcision combined with fractional CO₂ laser resulted in superior long-term scar improvement, although PDO threads provided quicker recovery. The choice of treatment may depend on patient preferences and scar characteristics.

The Endo-lift Laser (Intralesional 1470 nm Diode Laser) for Dermatological Aesthetic Conditions: A Systematic Review

BACKGROUND

The prominence of minimally invasive aesthetic approaches has become increasingly pivotal. The endo-lift laser method is an intralesional 1470 nm diode laser connected to a fiber that serves both therapeutic and aesthetic properties. We sought to evaluate the efficacy and safety of the endo-lift laser method for dermatological aesthetic applications.

METHODS

PubMed, Ovid-Embase, and Web of Science were systematically searched up to November 5th, 2023. A citation search was also performed. The National Institute of Health (NIH) Quality Assessment Tool was used to evaluate the quality of the studies.

RESULTS

Out of 339 articles, twenty-three relevant studies were included in the current review. Applying the endo-lift laser method for rejuvenation, including face and neck lifting, enhancing skin laxity, and disappearing wrinkles, folds, and lines, demonstrated favorable efficacy and safety profile. Moreover, most studies have shown that the endo-lift laser method is promising in eliminating the adipose tissue in the jowl, abdomen, thighs, and arms. The endo-lift laser technique was also efficacious in nose remodeling and blepharoplastic procedures, including treating eyelid and eyebrow ptosis, eye bag, eyebrow position, and eyelid laxity. Patients who suffer from several diseases, such as hidradenitis suppurativa, progressive lipodystrophy, acne vulgaris, scars, and keloids, benefit from procedural treatment with the endo-lift laser technique. Across all studies, the adverse events were mild and self-limiting. Investigating the endo-lift laser method in all aesthetic and therapeutic indications resulted in high patient satisfaction rates.

CONCLUSION

The endo-lift laser technique has therapeutic effects and is recommended for various dermatological aesthetic indications. Further clinical studies with control groups and larger sample sizes are needed to acquire more reliable evidence.

LEVELS OF EVIDENCE III AND IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Atrophic facial acne scars; bilateral comparison of two microneedle devices

Microneedling is a minimally invasive procedure using fine needles to puncture the skin.The aim of this study is to compare the clinical efficacy as well as the histological effects of dermaroller versus dermapen in the management of post-acne atrophic scars.The study was conducted on 10 patients with post-acne atrophic scars. A split-face study design was performed for 6 sessions 2 weeks apart. Dermaroller was used for the right side, while dermapen was used for microneedling of the left side of the face with 2.5 mm long needles for both sides. Biopsy was taken from both sides before and at 2 weeks after last session. Each biopsy was stained with Hematoxylin and Eosin, Orcein, and Masson trichrome stains. There was significant improvement (p < .05) on both sides of the face when comparing after treatment to baseline. In spite of better clinical improvement observed on the dermaroller-treated side, however a non-significant difference was observed between both sides of the face (p = .618). Meanwhile, there was a better improvement on boxcar and rolling scars than that on icepick scars. In conclusion, microneedling showed significant clinical and histological improvement in the management of atrophic post-acne scars with no significant difference between using dermaroller or dermapen. The dermaroller session is more rapid as it covers a larger skin surface area, but with more pain and bleeding during the session than dermapen, and post-session erythema and edema are slightly more apparent after dermaroller.

A Practice Approach to Acne Fulminans in Adolescents

Acne fulminans (AF) is a severe form of inflammatory acne commonly associated with adolescents. It is characterized by an abrupt onset of painful nodules and plaques and can progress to suppurative, ulcerative, and hemorrhagic lesions. AF can be associated with systemic symptoms such as fever, arthralgia, and bone pain. The etiology of AF is unknown but it has been linked to the use of certain medications and has been rarely found in autoinflammatory syndromes. In previous years, there have been reports of <200 cases in the literature; however, AF may be more common in clinical practice than reported. The most common presentation of AF is seen in adolescents starting isotretinoin therapy. Diagnosis of AF is determined based on its clinical findings. The main purpose of this article is to provide clinicians with a practical approach to treating AF. Current evidence for its treatment is limited to case reports and case series. The mainstay treatment of AF is a combination of prednisone and isotretinoin. It is important to taper or discontinue any exacerbating or precipitating medications such as isotretinoin, antibiotics, or androgens when AF is identified. Along with treatment of AF, it is important to treat associated scarring. Early identification and treatment of AF in adolescents is crucial to minimize both acute symptoms and long-term scarring, and further research is needed to determine optimal management.

Pustular and crusted lesions in systemic lupus erythematosus: A case report

Systemic lupus erythematosus (SLE) is the prototype of an autoimmune disease with various manifestations in the skin and several other organs. Subacute cutaneous lupus erythematosus may present with annular and psoriasiform lesions. There have been case reports of pustular lesions in SLE. Herein, we describe a known case of SLE, who developed pustular and crusted lesions which complicated the course of the disease. We considered Acute Generalised Exanthematous Pustulosis, Subcorneal Pustular Dermatosis, Pustular Psoriasis, Pustular Vasculitis, and Pustular Folliculitis as our initial differential diagnosis. A potassium hydroxide mount from crusted lesions showed scabies mites. With these findings, a diagnosis of SLE complicated with crusted scabies was made. She was managed with multiple systemic immunosuppressant and antiscabetic measures following which clinical improvement was seen with remission of her lesions.

Frequency of use and annual costs of biological therapy for psoriasis in Colombia in 2019

BACKGROUND

Evidence describing the types and annual costs of biological treatments for psoriasis in Latin America is scarce. This study aimed to estimate the frequency of use and costs of biologic therapy for psoriasis in Colombia in 2019.

METHODS

This secondary data analysis uses the International Classification of Diseases terms associated with psoriasis, excluding those related to psoriatic arthritis, based on data from the registry of the Colombian Ministry of Health. We estimated the prevalence of psoriasis per 100,000 inhabitants; then, we retrieved the frequency of use of biologic therapy in patients with psoriasis and estimated the cost per year of each and overall therapies in 2019 in US dollars (USD).

RESULTS

There were 100,823 patients with psoriasis in Colombia in 2019, which amounts to a prevalence of 0.2% in the general population. Of those patients, 4.9% received biologic therapy, most frequently males (60%). The most commonly used biological therapies for psoriasis in Colombia in 2019 were ustekinumab (35.2%), with an annual cost per patient of $12,880 USD; adalimumab (26%), with a yearly cost per patient of $7130 USD; and secukinumab (19.8%), with an annual cost per patient of $6825 USD.

CONCLUSION

This is the first study to describe the use and cost of biological therapy for psoriasis in Colombia. It provides valuable cost-awareness information for the Colombian health system.

Rare and novel complications of botulinum neurotoxin type A and dermal filler injections

Botulinum neurotoxin type A (BoNTA) and filler injection procedures usually provide predicted outcomes with a low incidence of complications. Most of the complications after these procedures have been extensively discussed. In this study, we report on these injectables' less well-known, recently reported, and novel complications and attempt to clarify the underlying mechanisms. Counterfeit or mishandled BoNTA has been associated with botulism. BoNTA has been linked to uncommon complications, including morphea-like lesions, nontuberculous mycobacterial infections, vascular occlusion, and pseudoaneurysm of the superficial temporal artery. Unusual complications from filler injection include nonscarring alopecia, intraoral necrosis, nontuberculous mycobacterial infections, xanthelasma-like reactions, intracranial perforation, and pneumosinus dilatans. Post-BoNTA injection nodules and filler infection from bone destruction due to cocaine use are new complications. These complications pose a challenge for diagnosis and treatment. This publication aims to assist in promptly identifying and managing these rare and novel complications when necessary.

Topical, light-based, and complementary interventions for acne: an overview of systematic reviews

BACKGROUND

Acne is a chronic inflammatory and immune-mediated disease of the pilosebaceous unit (the skin structure consisting of a hair follicle and its associated sebaceous gland). It is characterised by non-inflammatory lesions (open and closed comedones) and inflammatory lesions (papules, pustules, nodules, and cysts). Lesions may be present on the face, thorax, and back, with variable severity. Acne exhibits a global distribution and has a growing prevalence. Acne vulgaris is the most common form. Acne gives rise to complications such as scars and can seriously affect people's mental health, especially those with severe acne. Acne has a huge impact on the quality of life and self-esteem of those affected.

OBJECTIVES

To synthesise the existing evidence on the efficacy and safety of non-systemic pharmacological interventions and non-pharmacological interventions (physical therapy and complementary therapies) in the treatment of acne vulgaris and related skin complications.

METHODS

We searched the Cochrane Database of Systematic Reviews, Epistemonikos, MEDLINE, and Embase to 2 December 2021, and checked the reference lists of included reviews. At least two authors were responsible for screening, data extraction, and critical appraisal. We excluded reviews with high risk of bias as assessed with the ROBIS tool. We evaluated the overall certainty of the evidence according to GRADE (as carried out by the authors of the included reviews or ourselves). We provide comprehensive evidence from the review data, including summary of findings tables, summary of results tables, and evidence maps.

MAIN RESULTS

We retrieved and assessed a total of 733 records; however, only six reviews (five Cochrane reviews and one non-Cochrane review) with low risk of bias met the overview inclusion criteria. The six reviews involved 40,910 people with acne from 275 trials and 1316 people with acne scars from 37 trials. The age of the participants ranged from 10 to 59 years, with an average age range from 18 to 30 years. Four reviews included original trials involving only female participants and three reviews included original trials with only male participants. Main results for clinically important comparisons: Benzoyl peroxide versus placebo or no treatment: In two trials involving 1012 participants over 12 weeks, benzoyl peroxide may reduce the total (mean difference (MD) -16.14, 95% confidence interval (CI) -26.51 to -5.78), inflammatory (MD -6.12, 95% CI -11.02 to -1.22), and non-inflammatory lesion counts (MD -9.69, 95% CI -15.08 to -4.29) when compared to placebo (long-term treatment), but the evidence is very uncertain (very low-certainty evidence). Two trials including 1073 participants (time point: 10 and 12 weeks) suggested benzoyl peroxide may have little to no effect in improving participants' global self-assessment compared to placebo (long-term treatment), but the evidence is very uncertain (risk ratio (RR) 1.44, 95% CI 0.94 to 2.22; very low-certainty evidence). Very low-certainty evidence suggested that benzoyl peroxide may improve investigators' global assessment (RR 1.77, 95% CI 1.37 to 2.28; 6 trials, 4110 participants, long-term treatment (12 weeks)) compared to placebo. Thirteen trials including 4287 participants over 10 to 12 weeks suggested benzoyl peroxide may increase the risk of a less serious adverse event compared to placebo (long-term treatment), but the evidence is very uncertain (RR 1.46, 95% CI 1.01 to 2.11; very low-certainty evidence). Benzoyl peroxide versus topical retinoids: Benzoyl peroxide may increase the percentage change in total lesion count compared to adapalene (long-term treatment), but the evidence is very uncertain (MD 10.8, 95% CI 3.38 to 18.22; 1 trial, 205 participants, 12 weeks; very low-certainty evidence). When compared to adapalene, benzoyl peroxide may have little to no effect on the following outcomes (long-term treatment): percentage change in inflammatory lesion counts (MD -7.7, 95% CI -16.46 to 1.06; 1 trial, 142 participants, 11 weeks; very low-certainty evidence), percentage change in non-inflammatory lesion counts (MD -3.9, 95% CI -13.31 to 5.51; 1 trial, 142 participants, 11 weeks; very low-certainty evidence), participant's global self-assessment (RR 0.96, 95% CI 0.86 to 1.06; 4 trials, 1123 participants, 11 to 12 weeks; low-certainty evidence), investigators' global assessment (RR 1.16, 95% CI 0.98 to 1.37; 3 trials, 1965 participants, 12 weeks; low-certainty evidence), and incidence of a less serious adverse event (RR 0.77, 95% CI 0.48 to 1.25, 1573 participants, 5 trials, 11 to 12 weeks; very low-certainty evidence). Benzoyl peroxide versus topical antibiotics: When compared to clindamycin, benzoyl peroxide may have little to no effect on the following outcomes (long-term treatment): total lesion counts (MD -3.50, 95% CI -7.54 to 0.54; 1 trial, 641 participants, 12 weeks; very low-certainty evidence), inflammatory lesion counts (MD -1.20, 95% CI -2.99 to 0.59; 1 trial, 641 participants, 12 weeks; very low-certainty evidence), non-inflammatory lesion counts (MD -2.4, 95% CI -5.3 to 0.5; 1 trial, 641 participants, 12 weeks; very low-certainty evidence), participant's global self-assessment (RR 0.95, 95% CI 0.68 to 1.34; 1 trial, 240 participants, 10 weeks; low-certainty evidence), investigator's global assessment (RR 1.10, 95% CI 0.83 to 1.45; 2 trials, 2277 participants, 12 weeks; very low-certainty evidence), and incidence of a less serious adverse event (RR 1.27, 95% CI 0.98 to 1.64; 5 trials, 2842 participants, 10 to 12 weeks; low-certainty evidence). For these clinically important comparisons, no review collected data for the following outcomes: frequency of participants experiencing at least one serious adverse event or quality of life. No review collected data for the following comparisons: topical antibiotics versus placebo or no treatment, topical retinoids versus placebo or no treatment, or topical retinoids versus topical antibiotics.

AUTHORS' CONCLUSIONS

This overview summarises the evidence for topical therapy, phototherapy, and complementary therapy for acne and acne scars. We found no high-certainty evidence for the effects of any therapy included. Randomised controlled trials and systematic reviews related to acne and acne scars had limitations (low methodological quality). We could not summarise the evidence for topical retinoids and topical antibiotics due to insufficient high-quality systematic reviews. Future research should consider pooled analysis of data on new emerging drugs for acne treatment (e.g. clascoterone) and focus more on acne complications.

Effectiveness and safety of the modified multiple mode procedures versus traditional multiple mode procedures on treating facial atrophic acne scars: a propensity score matching retrospective cohort study

Multiple mode procedures (MMP) of fractional CO2 laser provide higher efficacy and shorter downtime in treating acne scars, compared to traditional fractional CO2 laser therapy. This study aims to evaluate the effectiveness and safety of modified MMP integrated with fractional microneedle radiofrequency (FMR), ultra-pulse CO2 laser and fractional CO2 laser in treating acne scars. A retrospective analysis of 162 acne scar patients treated with MMP or modified MMP was conducted. Acne scars were evaluated using the Echelle d'Evaluation Clinique des Cicatrices d'Acné (ECCA) grading scale, modified Manchester Scar Scale (mMSS), and Global Assessment Scale (GAS). Baseline variables were balanced with propensity score matching (PSM) to improve the comparability of treatment effectiveness and safety between groups. Among 162 patients with facial acne scars, 68 were treated with modified MMP and 94 with traditional MMP. After PSM, both groups had 55 patients with comparable baseline characteristics (P > 0.05). The ECCA score decreased more significantly in the modified MMP group (60%±11%) than in the MMP group (45%±16.6%, P < 0.001). The modified MMP group also had higher mMSS color score (2.6 ± 0.7 vs. 2.1 ± 0.9, P = 0.005), greater reduction in pore size and skin laxity (P < 0.001), shorter postoperative erythema duration (22.2 ± 4.0 vs. 31.3 ± 3.7 days, P < 0.001), but higher pain scores (Visual Analogue Scale, VAS: 6.7 ± 1.6 vs. 3.8 ± 0.8, P < 0.001). Modified MMP is more effective than traditional MMP in treating acne scars, especially for patients with large pores and skin laxity.

Pivoting Continuing Professional Development During the COVID-19 Pandemic: A Narrative Scoping Review of Adaptations and Innovations

INTRODUCTION

Most formal continuing professional development (CPD) opportunities were offered in person until March 2020 when the COVID-19 pandemic disrupted traditional structures of CPD offerings. The authors explored the adaptations and innovations in CPD that were strengthened or newly created during the first 16 months of the pandemic.

METHODS

The objectives of the narrative review were to answer the following questions: (1) what types of adaptations to CPD innovations are described? and (2) what may shape future innovations in CPD? The following databases were searched: Medline, Embase, CINAHL, and ERIC to identify the literature published between March 2020 to July 2021. The authors conducted a comprehensive search by including all study types that described adaptations and/or innovations in CPD during the stated pandemic period.

RESULTS

Of the 8295 citations retrieved from databases, 191 satisfied the inclusion criteria. The authors found three categories to describe adaptations to CPD innovations: (1) creation of new online resources, (2) increased use of the existing online platforms/software to deliver CPD, and (3) use of simulation for teaching and learning. Reported advantages and disadvantages associated with these adaptations included logistical, interactional, and capacity building elements. The review identified five potential future CPD innovations: (1) empirical research on the effectiveness of virtual learning; (2) novel roles and ways of thinking; (3) learning from other disciplines beyond medicine; (4) formation of a global perspective; and (5) emerging wellness initiatives.

DISCUSSION

This review provided an overview of the adaptations and innovations that may shape the future of CPD beyond the pandemic.

Simultaneous versus sequential fractional CO2 laser and subcision combination for management of post-acne atrophic scars: A split-face comparative study

BACKGROUND

A combination of fractional CO2 laser and subcision is usually employed for the treatment of post-acne atrophic scars. However, the efficacy and safety of both simultaneous and sequential combination therapies should be explored.

AIMS

To compare the efficacy and safety of simultaneous and sequential fractional CO2 laser and subcision combination therapies for post-acne atrophic scars.

PATIENTS AND METHODS

This single-blind, split-face clinical trial included 34 patients with post-acne atrophic scars at our institution. Each patient underwent three sessions of subcision combined with fractional CO2 laser, with a 1-month interval between each session. The left side of the face was treated with simultaneous combination therapy, whereas the right side was treated with sequential combination therapy. Treatment efficacy was assessed at 4, 8, and 12 weeks; and 3 and 6 months after the last session.

RESULTS

Simultaneous and sequential treatments demonstrated comparable efficacy. Regarding the adverse events, the side of the face undergoing simultaneous treatment experienced longer swelling duration, higher pain levels during laser treatment, and shorter downtime.

CONCLUSIONS

Despite the longer swelling time and higher pain levels during laser treatment in the simultaneous treatment side, the effectiveness and satisfaction level of the CO2 fractional laser and subcision for treatment of the acne scars were comparable between the two combinations, with a shorter downtime for the simultaneous than for the sequential combination therapy.

The Redefinition and Volumization of the Lip Area with Hyaluronic Acid: A Case Series

Background: The increasing popularity of non-surgical cosmetic enhancements for the lower face and perioral area, particularly through hyaluronic acid (HA) fillers, reflects the growing desire for improved lip volume and definition. This study showcases the effects of a specific HA filler on lip fullness, shape, and overall perioral rejuvenation. Methods: We conducted a retrospective single-site observational analysis of adult female patients treated with Genefill Soft Fill HA injections in the lips and perioral areas. Both patient and physician satisfaction were evaluated using the Likert scale and Global Aesthetic Improvement Scale (GAIS), respectively. The outcomes for natural appearance, volume, and durability were assessed using a five-point scale. The patients were followed up with for up to six months to monitor any adverse events. Results: The cohort included thirteen female patients with an average age of 55.3 ± 8.3 years. Approximately 1.2 ± 0.4 mL of filler was used per patient. The results indicate high satisfaction, with scores above 4 for naturalness, volume, and durability. Over 92% of patients reported a significant improvement in appearance. No moderate or severe adverse events were reported. Conclusions: Genefill Soft Fill HA filler is both effective and safe for enhancing lip esthetics, with high satisfaction rates among recipients and no significant adverse events observed.

Ultrasonographic features of nonvascular complications of hyaluronic acid fillers: a retrospective study at a reference center for dermatologic ultrasonography

Hyaluronic acid filler injections have been associated with early, temporary, and delayed-onset complications. High-resolution ultrasound with Doppler analysis has been increasingly used to detect and identify such complications. We comprehensively describe the most common ultrasonographic findings of nonvascular complications associated with hyaluronic acid filler injections. This retrospective, cross-sectional, observational study was conducted at a reference center for dermatologic ultrasound in Bogotá, Colombia. Ultrasound reports documented the ultrasonographic findings of nonvascular complications of hyaluronic acid filler injections. Fifty-two complications were documented in a cohort of 50 patients (women, 88%). The infraorbital region was the most common site affected (23%), followed by the nasolabial region (22%). The Tyndall effect was the most common complication (25% of all), followed by changes in rheology (21%) and pseudosarcoidal (foreign body granuloma) reaction (15%). The Tyndall effect stood out for its distinctive ultrasonographic characteristics. We discuss the ultrasonographic findings and pathogenesis of other complications, including filler migration, early hypersensitivity, aseptic abscess, overcorrection, and filler material interaction. The clinical presentation of hyaluronic acid filler complications can be confusing, delaying timely diagnosis and treatment. High-resolution ultrasound with Doppler analysis is a valuable tool for avoiding unnecessary treatments and ensuring timely diagnosis and treatment.

Dapsone Use in Dermatology

Dapsone, initially synthesized for textile dyeing, gained recognition in the 1930s for its antibacterial properties, leading to its utilization in dermatology for leprosy and dermatitis herpetiformis. Despite US Food and Drug Administration (FDA) approval for these conditions, dapsone's off-label uses have expanded, making it a valuable option in various dermatologic conditions. This review seeks to highlight the common uses of dapsone in its FDA indications and off-label indications. Diseases in which dapsone is considered first-line therapy or adjunctive therapy are reviewed, with highlights from the resources included. An overview of dapsone's pharmacokinetics, pharmacodynamics, indications, dosages, and safety profile are also reviewed. Dapsone's versatility and safety profile make it a cost-effective treatment option in dermatology, particularly for patients with limited access to specialized medications. Ongoing clinical trials are also described exploring dapsone's efficacy in novel dermatologic uses. Dapsone has been a valuable adjunctive therapy across various dermatologic conditions for years and evidence for its use continues to expand.

Aesthetic management of lips and perioral region with Hylacross® and Vycross® hyaluronic-acid based fillers: A document of recommendations

BACKGROUND

Lip volumization and perioral rejuvenation with hyaluronic-acid (HA) based dermal fillers are generating increasing interest and demand. However, this topic is still having many unmet needs nowadays. This document aimed to provide tips and recommendations that may help clinicians to achieve optimal and more predictable aesthetic outcomes.

METHODS

A multidisciplinary group of aesthetic medicine doctors from Spain and Portugal reviewed the tools used for assessing the patient and aesthetic outcomes, as well as the different techniques and products used in lips/perioral rejuvenation.

RESULTS

The consensus panel provided specific recommendations focusing on the basic information to collect before performing the aesthetic procedure; comprehensive approach to lips/perioral region rejuvenation; clinical and aesthetic assessment tools; product and technique selection; patient profile and needs; and safety issues (complications/adverse-events).

CONCLUSIONS

The rapid evolution of techniques and tools for assessing the patient and aesthetic outcomes, as well as the development of new HA-based fillers makes it necessary to update the clinical recommendations that guide the daily practice of clinicians, particularly those who have less experience with these procedures. This document addressed relevant subjects related to lip/perioral-region rejuvenation to perform the correct procedure, with the appropriate HA-based, on the right patient; to help specialists to obtain optimal and predictable aesthetic outcomes.

Prevalence of skin manifestations in patients with COVID-19: a systematic review and meta-analysis

Background

COVID-19 presents extrapulmonary manifestations that can aid in the diagnosis. Skin manifestations have been reported but their characteristics are not yet clear. Health professionals need information about its prevalence and main characteristics.

Methods

This systematic review followed the PRISMA criteria. The protocol was registered in the PROSPERO (number CRD42020193173). Seven electronic databases and the gray literature were searched independently by two researchers. Observational analytical studies that presented data on the prevalence of skin manifestations in patients aged 19 or older with COVID-19 were included. Prevalence estimates were synthesized through a meta-analysis using random-effects models. Association meta-analysis and comparisons were performed for individual characteristics.

Results

We included 31 studies with 10,934 patients, of which 10,121 tested positive for COVID-19. The general prevalence of skin manifestations was 29% (95% CI: 17.0-43.0; I2: 99%), the most in Africa, with a mean duration between 7 and 9 days and the most frequently affecting feet+hands (75%) and the trunk (71%). Patients with mild/moderate COVID-19 had more of chilblain-like+pernio-like lesions (97%) and inflammatory lesions (86%) than patients with severe or critical COVID-19. Manifestations of vascular origin were only in elderly patients and were significant with the severity of COVID-19 (p = 0).

Conclusion

The global prevalence of skin manifestations is similar to other signs and symptoms of COVID-19. Skin assessment should be considered when investigating and diagnosing COVID-19 in adult and elderly patients.Systematic review registration: PROSPERO, identifier CRD42020193173, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020193173.

The Concept of Health Debt Incurred during the COVID-19 Pandemic on the Example of Basal Cell Skin Cancer Diagnosis in Lower Silesia

Introduction: This study explores the impact of the COVID-19 pandemic on the diagnosis of basal cell carcinoma (BCC) in Lower Silesia, Poland, comparing pre-pandemic, pandemic, and post-pandemic periods. It investigates how different medical facilities adapted to the pandemic's challenges and the subsequent implications for cancer diagnosis. Methods: Data from histopathology and cytology laboratories were analyzed, focusing on BCC diagnoses from 2018 to 2022. This study included various medical centers categorized by size and source of implementation. Statistical analyses were conducted to compare diagnoses before, during, and after the pandemic. Results: During the initial wave of the pandemic, there was a significant reduction in newly diagnosed BCC cases, followed by a surge post-pandemic. Larger medical centers adapted more effectively, while district hospitals faced challenges. Private practices maintained stable diagnosis rates. The increase in diagnoses post-pandemic suggests a backlog of undiagnosed cases during the pandemic. Discussion: Challenges in accessing healthcare during the pandemic led to delayed cancer diagnoses. Larger medical centers were better equipped to handle the crisis, while district hospitals struggled. Private practices maintained stability, possibly due to pre-scheduled appointments. Recommendations include public education on symptom recognition and standardizing histopathological evaluation protocols. Conclusions: Despite data limitations, this study provides valuable insights into the pandemic's impact on cancer diagnosis, highlighting the need for proactive measures in future health crises to ensure timely detection and treatment of cancer cases.

Subcision with platelet-rich plasma and microneedling versus subcision with saline and micro-needling in posttraumatic scars

BACKGROUND

In treating post-traumatic scars, this study compared the safety and effectiveness of combined subcision with saline and microneedling versus combined subcision with platelet-rich plasma and microneedling. Combined subcision with saline and microneedling or combined subcision with platelet-rich plasma and microneedling were used to treat 36 consecutive individuals with post-traumatic scarring. The Modified Manchester score was used to assess texture change, pigmentation, and surface distortion changes. Each change was given a score between 1 and 4. A lower score (range: 3-12) indicates a better result. The mean of the three individual scores was determined. For best outcomes, each patient needed four treatment sessions for each scar, with a one-month follow-up period following the final treatment. The three variables in group B had mean scores of 1.4 ± 0.5, 2 ± 0.8, and 2.2 ± 0.9, respectively, for texture change, pigmentation, and surface distortion. With a mean score of 1.4 ± 0.5, texture change had the best response out of the three variables we evaluated. The investigator determined that the mean improvement score for patients in group B's overall appearance was 5.61 ± 1.19. The study has shown that the combination of subcision with platelet-rich plasma, and microneedling appears to be a promising treatment for posttraumatic scars due to its low risk and high efficacy. Our findings suggest that this is a safe method for treating posttraumatic scars, with few side effects and a low chance of recurrence.

IRB LOCAL APPROVAL NUMBER

04-2023-300279.

CLINICAL TRIAL REGISTRY

NCT06135480.

Advances in the Management of Localized Scleroderma: A Systematic Review of Laser Therapy and Injectable Filler Approaches

Localized scleroderma (LS), commonly known as morphea, presents a significant clinical challenge due to its chronic, inflammatory nature affecting the skin and potentially underlying tissues. This systematic review explores the innovative approach of combining laser therapy and injectable fillers, specifically hyaluronic acid, for the treatment of LS. We conducted a comprehensive literature review following PRISMA guidelines, examining articles from MEDLINE/PubMed to assess the combined efficacy of these treatments in improving both esthetic and functional outcomes for LS patients. The search yielded 64 articles, with six selected for in-depth analysis for a total of nine patients, covering a range of patient demographics and treatment types. Our review highlights cases where fractional CO2 laser therapy promoted long-term tissue remodeling and instances where hyaluronic acid fillers effectively addressed skin atrophy and volume loss, enhancing both immediate and long-lasting esthetic improvements. The synergy between these treatments suggests a promising dual approach, aiming to maximize esthetic outcomes and to improve the quality of life for LS patients. This review underscores the necessity of further research to establish a comprehensive, evidence-based clinical pathway integrating both treatments for managing LS, thereby enhancing patient satisfaction and addressing the multifaceted nature of this challenging dermatological condition.

The impact of social media information exposure on appearance anxiety in young acne patients: a moderated chain mediation model

Introduction

The boom of social media has provided a wider space for ordinary people to display themselves, but visual presentation has also intensified the focus on appearance, which in turn triggers anxiety about appearance. The study aims to investigate the impact of social media information exposure on appearance anxiety in young acne patients and the pathways and mechanisms that cause this effect.

Methods

A moderated chain mediation model was constructed, and a questionnaire was used to collect information on social media information exposure, internalization of beauty ideals, fear of negative evaluation, self-esteem, and appearance anxiety in young acne patients (N = 382), and the relationships between the variables were explored through regression analysis.

Results

The results show that there was a significant path of effect (t > 2.5, p < 0.05) between social media information exposure, internalization of beauty ideals, fear of negative evaluation, and appearance anxiety. Self-esteem significantly moderated the relationship between social media information exposure and internalization of beauty ideals (t < -2, p < 0.05).

Discussion

In conclusion, in young acne patients, internalization of beauty ideals and fear of negative evaluation chain mediated the association between social media information exposure and appearance anxiety, and young acne patients' internalization of beauty ideals was inversely correlated with their level of self-esteem.

Teledermatology Versus In-Person Visits for the Follow-Up of Atopic Dermatitis Patients

BACKGROUND

In recent years, teledermatology has rapidly emerged as a healthcare delivery method with potential implications for managing chronic inflammatory dermatoses like atopic dermatitis (AD).

OBJECTIVES

This study assesses the utility of telemedicine in the management of AD by comparing virtual care with traditional in-office visits with the aim of identifying differences in clinical outcomes between these 2 healthcare delivery modalities.

METHODS

Patients of all ages with AD were recruited from 2 dermatology practices. Consecutive patients presenting to the clinics who met the inclusion criteria were invited to enrol in the study. Those who consented to participate were randomly assigned to the virtual or in-person arm of the study, with the opportunity to decline care in either study arm. The inclusion criteria required participants to have a confirmed diagnosis of AD. Exclusion criteria included significant comorbidity that might affect the course of treatment, inaccessibility to teleconsults such as not having a camera for video conferences, and self-declared limitations in operating Zoom. Patients were assessed at baseline (week 0), 4 to 6 weeks, and 8 to 12 weeks using 6 efficacy parameters.

RESULTS

In the virtual group, all 6 dermatological measures suggested improved outcomes. Average Body Surface Area scores decreased (β = -.07, 95% CI = -0.1, -0.3) over the course of follow-up. Virtual care patients had 80% lower odds of moderate-to-severe uncontrolled disease (OR = 0.2; 95% CI = 0.06, 0.5) and pruritus (OR = 0.2, 95% CI = 0.05, 0.7) over time.

CONCLUSIONS

This study supports teledermatology as a feasible and effective option for providing follow-up care for atopic dermatitis patients of various demographic standings.

Combination biologics or targeted synthetic disease-modifying anti-rheumatic drugs in the treatment of spondyloarthritis: a systematic literature review

INTRODUCTION

The advent of biologic and targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) have transformed the management of immune-mediated rheumatic diseases, including spondylarthritis (SpA). However, the data about combining b/ts DMARDs in the treatment of SpA are scarce. The study objectives were to assess the efficacy and safety of combination b/tsDMARD in SpA.

METHODS

We conducted systematic literature review (PubMed and Medline) with two independent reviewers, one adjudicator, exploring the efficacy and safety of combination b/tsDMARDs in the treatment of SpA. Inclusion criteria were studies published in last 20 years, English language, interventions included use of two b/tsDMARDs, and minimal three-month follow-up.

RESULTS

Out of 1936 initial hits, 28 manuscripts fulfilled the inclusion criteria. Two were randomized controlled trials, and the remaining were retrospective cohort studies or case series. Combination of apremilast with bDMARD, or TNF inhibitor plus IL12/23 inhibitor were the commonest and reported good efficacy with no increased safety signal.

CONCLUSIONS

There is not enough data to fully evaluate efficacy and safety of combination b/tsDMARDs in SpA treatment. Limited information shows apremilast plus bDMARD, or TNF inhibitor plus IL12/23 inhibitor combination to be efficacious and safe. Randomized controlled trials and larger cohort with a longer follow-up are required.

Late-Onset Reactions after Hyaluronic Acid Dermal Fillers: A Consensus Recommendation on Etiology, Prevention and Management

Hyaluronic acid (HA) dermal fillers, generally considered low-risk, can lead to rare late-onset reactions (LORs) manifesting between 3 and 4 months postinjection, occasionally even as early as 24 h postinjection. The Complication Assessment and Risk Evaluation (CARE) board was established to review these reactions. In this publication, the authors aims to explore the etiological hypotheses underlying LORs, associated risk factors, prevention, and management approaches suggested by the CARE board. The CARE board identified three etiological hypotheses contributing to LORs. Firstly, the physicochemical structure of the filler, particularly low molecular weight HA, which may trigger an immune response. Secondly, infection, potentially introduced during injection or by dormant biofilm activation. Lastly, an imbalance in the host immune system, caused by factors like autoimmune diseases or viral infections, may lead to extended foreign body reactions, delayed type IV hypersensitivity, or adjuvant-based reactions. Based on these hypotheses, the board categorized various risk factors as patient-related (e.g., recent dental treatment, current medical status, active autoimmune disease), product-related (e.g., molecular weight), and procedure-related (e.g., aseptic technique and trauma). To reduce the risk of LORs, the CARE board recommends diligent patient selection, including comprehensive medical history assessment and informed consent. Practitioners should maintain an effective aseptic technique, and choose an appropriate product and injection depth for the anatomical location. Post-procedure, patients should receive education on proper filler care. Management of LORs depends on the suspected etiology, and the CARE board has proposed an algorithm to determine the most appropriate treatment. Hyaluronidase is recommended for noninflammatory reactions in the absence of active infection, while watchful waiting and/or steroid treatment may be preferred for inflammatory reactions. Hyaluronidase is not recommended as a first-line treatment for infections, which require drainage, bacterial culture, and antibiotic treatment. However, the board emphasizes the need for individualized evaluation and treatment in all cases.