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Rasetti-Escargueil C, Palea S. Embracing the Versatility of Botulinum Neurotoxins in Conventional and New Therapeutic Applications. Toxins (Basel) 2024; 16:261. [PMID: 38922155 PMCID: PMC11209287 DOI: 10.3390/toxins16060261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/26/2024] [Accepted: 05/27/2024] [Indexed: 06/27/2024] Open
Abstract
Botulinum neurotoxins (BoNTs) have been used for almost half a century in the treatment of excessive muscle contractility. BoNTs are routinely used to treat movement disorders such as cervical dystonia, spastic conditions, blepharospasm, and hyperhidrosis, as well as for cosmetic purposes. In addition to the conventional indications, the use of BoNTs to reduce pain has gained increased recognition, giving rise to an increasing number of indications in disorders associated with chronic pain. Furthermore, BoNT-derived formulations are benefiting a much wider range of patients suffering from overactive bladder, erectile dysfunction, arthropathy, neuropathic pain, and cancer. BoNTs are categorised into seven toxinotypes, two of which are in clinical use, and each toxinotype is divided into multiple subtypes. With the development of bioinformatic tools, new BoNT-like toxins have been identified in non-Clostridial organisms. In addition to the expanding indications of existing formulations, the rich variety of toxinotypes or subtypes in the wild-type BoNTs associated with new BoNT-like toxins expand the BoNT superfamily, forming the basis on which to develop new BoNT-based therapeutics as well as research tools. An overview of the diversity of the BoNT family along with their conventional therapeutic uses is presented in this review followed by the engineering and formulation opportunities opening avenues in therapy.
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Affiliation(s)
| | - Stefano Palea
- Humana Biosciences-Prologue Biotech, 516 Rue Pierre et Marie Curie, 31670 Labège, France;
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2
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Ghiu ITDP, Bittencourt RC, Seixas JF, Machado RM, Motta AT, Mattos CT. Malocclusion or laterorhinia: Which one impacts aesthetic facial perception the most? Orthod Craniofac Res 2024; 27:297-302. [PMID: 37936546 DOI: 10.1111/ocr.12727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION This study aimed to evaluate the perception of facial attractiveness when nose and teeth, together or isolated, present different degrees of disharmony. The secondary objective was to compare the perception of laypersons with that of dentists. MATERIALS AND METHODS This cross-sectional observational study included 112 individuals (58 laypersons and 54 dentists) that evaluated 6 manipulated images of the face of the same model, scoring their attractiveness using 10 cm Visual Analogue Scales (VAS), with least and most attractive at the left and right anchors, respectively. The images contained manipulations performed only on the nose (laterorhinia) and mouth (misaligned teeth), as follows: (1) standard photograph, with symmetrical nose + aligned teeth; (2) 2 mm nasal deviation + aligned teeth; (3) 4 mm nasal deviation + aligned teeth; (4) symmetrical nose + misaligned teeth; (5) 2 mm nasal deviation + misaligned teeth and (6) 4 mm nasal deviation + misaligned teeth. We used the repeated measures ANOVA test and Tukey's post-test for intra-group comparison of the images. The independent t-test was used for inter-group comparison of each image. RESULTS In the laypersons' group, the highest grades were given to images with aligned teeth and the lowest to misaligned teeth (smallest mean difference = 2.88 cm). For this group, there was no statistically significant difference (P-values ranged from .988 to 1.000) between scores of the three images in which teeth were aligned (range of 7.70-7.78 cm). In the group of dentists, highest grades were given to images with aligned teeth and the lowest to misaligned teeth. Difference between images 3 and 4 was not statistically significant (P = .204). All other differences between any image of straight teeth and any image with misaligned teeth were significant and the smallest mean difference between the two groups of images was 1.87 (P = .039). However, in the images with aligned teeth, there was also a statistically significant difference with higher scores to the images with symmetrical nose in contrast with those with significant laterorhinia (mean difference = 1.03 cm). CONCLUSION Teeth disharmonies had a more negative impact on the aesthetic perception of the face than did nose deviations, for both dentists and laypersons.
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Affiliation(s)
| | | | - Joana Figueiredo Seixas
- Department of Orthodontics, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil
| | - Ricardo Martins Machado
- Department of Orthodontics, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil
| | | | - Claudia Trindade Mattos
- Department of Orthodontics, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil
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Han X, Bai J, Kuang J. Efficacy and Safety of AbobotulinumtoxinA for Treatment of Moderate-to-Severe Glabellar Lines: A Meta-Analysis. Ophthalmic Plast Reconstr Surg 2024; 40:126-133. [PMID: 38319153 DOI: 10.1097/iop.0000000000002491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
PURPOSE This meta-analysis aimed to evaluate the safety and efficacy of abobotulinumtoxinA (ABO) and ABO solution for injection (ASI) for treating moderate-to-severe glabellar lines. METHODS The EMBASE, PubMed, and web of science databases were systematically searched. Methodological quality was checked using the Cochrane Risk of Bias tool. We also performed statistical analyses using Stata software to examine the efficacy and safety of ABO. RESULTS Nine randomized controlled trials were included in the meta-analysis. The results showed that at maximum frown, the proportion of responders as measured by the investigator's live assessment and subject's self-assessment of moderate-to-severe glabellar lines were significantly higher in the ABO and ASI treatment groups than in the placebo group. In addition, from baseline to maximum frown, the ≥1-grade improvement rate in moderate-to-severe glabellar lines severity was also significantly higher in the ABO and ASI treatment groups than in the placebo group. No significant differences in adverse events were found between ABO, ASI and placebo groups, indicating that ABO and ASI have good safety. CONCLUSIONS ABO and ASI are effective and safe options for the treatment of moderate-to-severe glabellar lines. More high-quality studies are needed to verify these conclusions.
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Affiliation(s)
- Xiaopan Han
- Department of ENT, Central Hospital Affiliated to Shandong First Medical University, Ji'nan, Shandong Province, China
| | - Jixian Bai
- Department of ENT, Pingyin People's Hospital, Ji'nan, Shandong Province, China
| | - Jing Kuang
- Department of Plastic Surgery, Central Hospital Affiliated to Shandong First Medical University, Ji'nan, Shandong Province, China
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Hall C. Optimizing Facial Aesthetics: Sequential Application of Botulinum Toxin A and Dermal Fillers for Enhanced Results. PLASTIC AND AESTHETIC NURSING 2024; 44:70-71. [PMID: 38166310 PMCID: PMC10786442 DOI: 10.1097/psn.0000000000000546] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
In recent years, the field of aesthetic medicine has witnessed significant advancements, offering patients a plethora of options to rejuvenate their appearance. Among the most popular techniques are the administration of botulinum toxin A (BoNT-A) and dermal fillers. This article delves into the rationale and benefits of preparing the face with BoNT-A to weaken depressor muscles before proceeding with dermal filler injections. This sequential approach not only enhances patient outcomes but also improves procedural safety and patient satisfaction while reducing the chances of needing filler. This article reviews the anatomy, scientific evidence, and clinical implications supporting this innovative approach while shedding light on the potential for revolutionizing facial aesthetic procedures. With advanced applications of BoNT-A, it is possible to slim round faces, reduce jowling, create hollowing in some patients by obliterating masseters, slim the parotid, extend the chin, and more.
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Affiliation(s)
- Constance Hall
- Constance Hall, MSN, RN, FNP-C, is the current owner of The Secret Boutique, PLLC, Morehead City, NC. Constance is also the owner of her own CME course, The Foundations of Aesthetic Medicine offered through the University of Louisville School of Medicine, Louisville, KY, for which she receives a modest grant from AbbVie, North Chicago, IL
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Amici JM, Cogrel O, Jourdan M, Raimbault C, Canchy L, Kerob D, Madfes DC, Tian Y, Araviiskaia E. Expert recommendations on supportive skin care for non-surgical and surgical procedures. J Eur Acad Dermatol Venereol 2023; 37 Suppl 3:16-33. [PMID: 36635618 DOI: 10.1111/jdv.18855] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 01/04/2023] [Indexed: 01/14/2023]
Abstract
A thorough knowledge of non-surgical procedures (laser, peelings, injections, threads) and surgical procedures (combined surgeries and skin grafts), including contraindications and potential risks and side effects, (e.g. infection, hypopigmentation, hyperpigmentation, and scarring) is essential to be able to reduce their incidence and ensure the patient receives the most benefit from the procedure. Individuals with darker skin and of high Fitzpatrick phototype are at higher risk of dyschromias, notably melasma and post-inflammatory hyperpigmentation, which may be treated using aesthetic procedures but may also arise as a complication of some procedures. A group of experts in cosmetic surgery and dermatology reviewed the published literature and discussed recommendations for optimizing outcomes with practical advice on supportive skincare before, during and after non-surgical or surgical procedures. A broad-spectrum sunscreen with a high sun protection factor against UVB and high protection against UVA, especially long UVA, is essential for all treatment modalities for the prevention and potential improvement of pigmentation disorders. Supportive skin care management to prepare, cleanse and protect the skin and post-procedure skin care with healing and anti-inflammatory ingredients are recommended to speed up regeneration and wound healing whilst minimizing scarring and downtime. Additionally, adjunctive skin care to procedures with antioxidant, anti-ageing and lightening properties may enhance skin benefits.
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Affiliation(s)
- Jean-Michel Amici
- Dermatology Department, CHU Bordeaux, Hôpital Saint-André, Bordeaux, France
| | - Olivier Cogrel
- Mohs Surgery and Laser Unit, Dermatology Department, University Hospital of Bordeaux, Bordeaux, France
| | - Marie Jourdan
- Centre Laser International de la Peau-Paris (CLIPP), Paris, France
| | | | - Ludivine Canchy
- Laboratoire Dermatologique La Roche-Posay, Levallois-Perret, France
| | - Delphine Kerob
- Laboratoire Dermatologique La Roche-Posay, Levallois-Perret, France
| | | | - Yan Tian
- Dermatology Department, Air Force Medical Center, PLA, Beijing, China
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Wu W, Zhao Y, Chen Y, Zhong A. Comparing the Efficacy of Multiple Drugs Injection for the Treatment of Hypertrophic Scars and Keloid: A Network Meta-Analysis. Aesthetic Plast Surg 2023; 47:465-472. [PMID: 36536095 PMCID: PMC9945066 DOI: 10.1007/s00266-022-03163-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/25/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND There is no consensus regarding the choice of injected drugs for pathological scars. Although the clinical efficacy of different drug treatments was shown in many randomized controlled trials, the efficacies of many drugs are inconsistent. Therefore, this study aimed to determine how different effective drugs are for treating pathological scars. It is anticipated that the study findings may serve as guidelines for plastic surgeons. METHODS Relevant literature was extracted from the following databases Cochrane Library, Embase, PubMed, Web of Science, CNKI, Weipu, and Wanfang until June 2022, such as randomized clinical trials (RCTs) evaluating different injected drugs for the treatment of pathological scars, including BTA, TAC, 5-Fu, VER, and BLE. RESULTS This network meta-analysis of 1539 patients from 23 articles revealed that the most effective treatment for a pathological scar was TAC + BTA. The effective rate of TAC + BTA combination therapy was significantly different from that of the BTA, TAC, 5-Fu, VER, and BLM monotherapies. TAC+5-FU was more effective than TAC, 5-FU, VER, or BLM alone, and BTA was more effective than both TAC and 5-Fu. The effectiveness of VER and BLM was the same, but both were better than TAC and 5-Fu. No big differences were found between any of the other local injection therapies. CONCLUSIONS According to this network meta-analysis, a combination of keloid and hypertrophic scar injection treatment is recommended, especially BTA+TAC. However, this network meta-analysis has some limitations and must be further verified by larger samples and higher quality RCTs. LEVEL OF EVIDENCE III 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.
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Affiliation(s)
- Wenhao Wu
- Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 PR China
| | - Yang Zhao
- Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 PR China
| | - Yuxuan Chen
- Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 PR China
| | - Aimei Zhong
- Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 PR China
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Haney B. Acne: What primary care providers need to know. Nurse Pract 2022; 47:9-13. [PMID: 36165965 DOI: 10.1097/01.npr.0000873548.38624.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Beth Haney
- Beth Haney is an NP at University of California-Irvine Student Health Center, Irvine, and CEO/Owner/Nurse Practitioner at Luxe Aesthetic Center, Yorba Linda, Calif
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Talwar AA, Shulkin JM, Hitchner M, McAuliffe PB, Desai AA, Broach RB, Percec I. Use of Cosmetic Facial Injectables After Facial Aesthetic Surgery. Aesthet Surg J 2022; 42:1194-1204. [PMID: 35764098 DOI: 10.1093/asj/sjac171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Over the last two decades, both invasive and minimally-invasive aesthetic procedures have proliferated. Aesthetic surgeons often recommend injectable treatments after cosmetic facial surgery for multiple reasons. Yet, literature is lacking on how cosmetic surgery affects post-operative facial injectable use. OBJECTIVES The authors aim to identify predictors of facial injectable use after cosmetic facial surgery. METHODS All adult patients operated on by a single surgeon between 2013 and 2021 were retrospectively reviewed. Patients who had any of the following cosmetic facial surgeries were included: rhytidectomy, blepharoplasty, rhinoplasty, or genioplasty. Patient demographics, clinical history, intraoperative factors, and use of cosmetic facial injectables (neurotoxin, facial fillers, deoxycholic acid, poly-L-lactic acid) were recorded. RESULTS A total of 227 patients who underwent facial cosmetic surgery were reviewed, of which 158 were included. 89 patients had rhytidectomy (56.3%), 112 had blepharoplasty (70.9%), 28 had rhinoplasty (17.7%), and 7 had genioplasty (4.4%). 44.3% patients received injectables after their surgery (n=73), compared to only 17.7% before surgery (n=28) (p<0.001). The most common post-operative injectables were neurotoxins (48.5%) and facial fillers (46.0%), followed by deoxycholic acid (2.7%) and poly-L-lactic acid (2.7%). Multivariate regression revealed factors positively correlated with future injectable use were index blepharoplasty or rhinoplasty, and history of pre-operative neurotoxin injection (p<0.05). CONCLUSIONS Cosmetic facial injectables are an important consideration in achieving and maintaining optimal facial aesthetics. Their use, especially neurotoxins and facial fillers, increases among patients post-operatively. These results highlight the contribution of injectable procedures in the context of multidimensional care for augmenting facial aesthetics.
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Affiliation(s)
- Ankoor A Talwar
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Jared M Shulkin
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michaela Hitchner
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Phoebe B McAuliffe
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Abhishek A Desai
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Robyn B Broach
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Ivona Percec
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
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Kaur I, Kandhari R, Gupta J, Al-Niaimi F. Microdroplet botulinum toxin: A review. J Cutan Aesthet Surg 2022; 15:101-107. [PMID: 35965899 PMCID: PMC9364467 DOI: 10.4103/jcas.jcas_162_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Microbotox is the administration of multiple microdroplets of botulinum toxin in intradermal plane. It is increasingly becoming popular owing to its more favorable outcome and better safety profile than the conventional technique. The intention is to treat fine lines and wrinkles without imparting an undesired “frozen face like” appearance. Besides facial rejuvenation, it has found its way into the management of other indications such as rosacea, hyperhidrosis, keloid, and seborrhea. Being a relatively newer method, knowledge about the various dilution methods, desired volume, and correct depth of injection involved in this technique remain scarce. In this article, the authors have highlighted various indications, procedures, adverse effects, and contraindications of microbotox.
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10
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Mexiletine Can Be Used to Prevent and Reduce Facial Wrinkles. J Craniofac Surg 2021; 33:645-646. [PMID: 34608011 DOI: 10.1097/scs.0000000000008262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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11
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Yang S, Luo YJ, Luo C. Network Meta-Analysis of Different Clinical Commonly Used Drugs for the Treatment of Hypertrophic Scar and Keloid. Front Med (Lausanne) 2021; 8:691628. [PMID: 34568361 PMCID: PMC8458741 DOI: 10.3389/fmed.2021.691628] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/29/2021] [Indexed: 11/24/2022] Open
Abstract
Background: There is no uniform treatment for pathological scars, including keloids and hypertrophic scars, in clinic currently. Previously, multiple randomized controlled trials have examined the clinical efficacy of different treatments. Nonetheless, the results are inconsistent, and many treatments have not been directly compared. This makes it difficult to conclude which approach is more favorable, in terms of efficacy and safety, for the treatment of pathological scarring. This study aimed at evaluating the efficacy of different injection and topical treatment strategies for hypertrophic scar and keloid. Methods: Relevant literature from PubMed, Medline, Embase, Scopus, the Cochrane Central Register of Controlled Trials (CCRCT), and WHO International Clinical Trials Registry Platform (WHO-ICTRP) were searched, from database inception through November 2020. Randomized clinical trials evaluating different treatment strategies of pathological scars, including triamcinolone acetonide (TAC), verapamil (VER), 5-fluorouracil (5-FU), botulinum toxin A (BTA), bleomycin (BLM), and silicone gels were included in the study. Results: The network meta-analysis included a total of 2,009 patients from 29 studies. A network meta-analysis of injection and topical treatment strategies showed that the efficacy of TAC combined with BTA was best in the treatment of pathological scars. Combination therapies of TAC with 5-FU and TAC with BTA significantly improved the clinical efficiency. However, there was no statistically significant difference between other treatment strategies. The order of efficacy predicted by the surface under the cumulative ranking (SUCRA) curve was as follows: TAC+BTA (82.2%) > TAC+5-FU (69.8%) > BTA (67.3%) > 5-FU+silicone (59.4%) > TAC+silicone (58.3%) > 5-FU (49.8%) > BLM (42.0%) > TAC (26.7%) > VER (26.2%) > silicone (18.3%). There was no publication bias revealed based on the funnel diagram. Conclusion: This study recommends intralesional injection of TAC-BTA and TAC-5-FU combined therapies. But for patients who cannot tolerate the side effects, the use of silicone gels in combination with TAC is recommended. However, these conclusions need to be further confirmed by more randomized controlled trials.
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Affiliation(s)
- Sha Yang
- Department of Orthopaedics, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Engineering Research Center of Stem Cell Therapy, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yujia J Luo
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Engineering Research Center of Stem Cell Therapy, Children's Hospital of Chongqing Medical University, Chongqing, China.,Department of Neurosurgeons, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Cong Luo
- Department of Orthopaedics, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Engineering Research Center of Stem Cell Therapy, Children's Hospital of Chongqing Medical University, Chongqing, China
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Abstract
ABSTRACT Over the last 10 years there has been an explosion in the number of minimally invasive procedures that patients undertake with increasing uses of botulinum neurotoxin type A for off label indications. One area of expansion over the past several years is the "Lip Flip" which involves injection of botulinum neurotoxin type A along the vermillion border to improve lip contour, eversion and fullness. While techniques and results for "gummy smile" and perioral vertical rhytids have been previously reported, minimal literature exists on this new trend, including whether such increased interest truly exists. Therefore, the authors aim to explore whether there is a rising trend regarding "lip flip" and report on clinical results from patients treated in our practice.
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Zhang H, Tang K, Wang Y, Fang R, Sun Q. Use of Botulinum Toxin in Treating Rosacea: A Systematic Review. Clin Cosmet Investig Dermatol 2021; 14:407-417. [PMID: 33958886 PMCID: PMC8096341 DOI: 10.2147/ccid.s307013] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 03/30/2021] [Indexed: 01/22/2023]
Abstract
Background Rosacea is a chronic skin disorder characterized by erythema, flushing, telangiectasia, papules and pustules, phymatous changes, and ocular involvement. The aim of this study was to examine all published research articles in which botulinum toxin was used to treat rosacea and to evaluate the efficacy and safety of this treatment. Methods PubMed, Embase, Cochrane Library, and Web of Science database were used to identify articles eligible for systematic review on March 26, 2021. Prospective or retrospective studies which directly used botulinum toxin to treat rosacea were included and reviewed. Results Nine studies were included in this systematic review. Two were randomized controlled trials, graded as Level 2 for the quality of evidence. The total number of participants was 130, and the number of participants in each study ranged from 1 to 25. The improvement was observed in all studies in signs and symptoms compared with baseline. Adverse events were transitory and self-limited. Conclusion Botulinum toxin could have overall satisfying efficacy and safety in the treatment of rosacea, though limited by small sample size, imperfect study design, and short follow-up visits.
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Affiliation(s)
- Hanlin Zhang
- Department of Dermatology, Peking Union Medical College Hospital, Beijing, People's Republic of China
| | - Keyun Tang
- Department of Dermatology, Peking Union Medical College Hospital, Beijing, People's Republic of China
| | - Yuanzhuo Wang
- Department of Dermatology, Peking Union Medical College Hospital, Beijing, People's Republic of China
| | - Rouyu Fang
- Department of Dermatology, Peking Union Medical College Hospital, Beijing, People's Republic of China
| | - Qiuning Sun
- Department of Dermatology, Peking Union Medical College Hospital, Beijing, People's Republic of China
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Abstract
At the moment of soft tissue injury, an immediate wound healing ballet commences. This coordinated cascade of events works over minutes, hours, weeks, and months to restore tissue integrity and viability in an attempt to rebuild the site to its preinjured state. A thorough understanding of these processes, and options to navigate forks in the road, can help guide patient selection, surgical planning and execution, management of complications, and ultimately the restoration of tissue form and function for optimal outcomes. An exhaustive account of tissue healing mechanics is beyond the scope of this writing. However, a summation of much that is known of these processes and the directions research and therapeutic developments are currently aimed will help the facial plastic surgeon prevent or minimize debilitating functional and cosmetic consequences in the head and neck.
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Affiliation(s)
- Christian L Stallworth
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, UTHSC at San Antonio, San Antonio, Texas
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Luque A, Rojas AP, Ortiz-Florez A, Perez-Bernal J. Botulinum Toxin: An Effective Treatment for Flushing and Persistent Erythema in Rosacea. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2021; 14:42-45. [PMID: 33841616 PMCID: PMC8021409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Botulinum toxin has been used to treat persistent erythema and flushing in rosacea for several years. Here, we describe two women and one man, each with rosacea with flushing and permanent erythema refractory to conventional treatment, who achieved satisfactory and lasting results following intradermal application of botulinum toxin. Two different botulinum toxin types were used. Toxin concentrations of 3.75U per 0.1 mL (abobotulinum) and 1.25U per 0.1 mL (incobotulinum) were used for each patient were used for each patient. The outcomes were measured using polarized photography to evaluate the decrease in vascular involvement. In the three cases presented here, botulinum toxin was effective for controlling erythema and flushing associated with rosacea; we also observed a prolonged duration of these improvements without the rebound effect of topical therapies.
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Affiliation(s)
- Andres Luque
- All authors are with Hospital Universitario Centro Dermatológico Federico Lleras in Bogotá, Colombia
| | - Aida Paola Rojas
- All authors are with Hospital Universitario Centro Dermatológico Federico Lleras in Bogotá, Colombia
| | - Andrea Ortiz-Florez
- All authors are with Hospital Universitario Centro Dermatológico Federico Lleras in Bogotá, Colombia
| | - Juliana Perez-Bernal
- All authors are with Hospital Universitario Centro Dermatológico Federico Lleras in Bogotá, Colombia
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Ballan A, Nasr M, Jabbour S. An unusual tell sign of botulinum toxin injection in patients with facial flushing: incorporating a new questionnaire in the evaluation of botulinum toxin patients. J COSMET LASER THER 2021; 23:24-25. [PMID: 34459693 DOI: 10.1080/14764172.2021.1957114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Lately it has been established that intra-dermal botulinum toxin is also effective in treating many dermatological conditions including refractory erythematous-telangiectatic rosacea, post - menopausal facial flushing and other similar conditions.However, the desired effect of treating the reddening in patients suffering from facial flushing can become an undesirable and embarrassing side effect when these same patients present to the clinic for esthetic concerns such as upper face rhytids. In this case, intramuscular botulinum toxin injections used for wrinkles treatment will also secondarily treat the facial reddening in their localized skin diffusion zones and result in embarrassing white patches all over the face. The patchy appearance following botulinum toxin injections for esthetic purposes could be bothersome for some patients and could be a tell-tale sign of botulinum toxin injections.
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Affiliation(s)
- Anthony Ballan
- Department of Plastic Surgery, Saint Joseph University, Beirut, Lebanon.,Faculty of Medicine, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Marwan Nasr
- Department of Plastic Surgery, Saint Joseph University, Beirut, Lebanon.,Faculty of Medicine, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Samer Jabbour
- Department of Plastic Surgery, Saint Joseph University, Beirut, Lebanon.,Faculty of Medicine, Hotel Dieu de France Hospital, Beirut, Lebanon
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Foissac R, Benatar MJ. Influence of botulinum toxin type A esthetic injections on facial expressions. J Cosmet Dermatol 2021; 20:1405-1410. [PMID: 33539679 DOI: 10.1111/jocd.13980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 12/14/2020] [Accepted: 01/20/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Botulinum toxin type A (BoNT-A) injection remains the leading medical cosmetic procedure worldwide, with a high rate of patient satisfaction. However, it still suffers from patients' fear of being unable to transmit their emotions and of looking frozen from unnatural results. AIM This study aimed to determine whether BoNT-A can decrease the intensity of emotions in facial expressions. PATIENTS/METHODS In this single-center prospective study, 42 patient investigators assessed four patients' facial expressions for six emotions and neutral faces, before and after injection of 36 IU or 48 IU of onabotulinumtoxinA, using photographs. Photographs were presented on a tablet to the investigators. RESULTS There were no statistical differences between the before and after photographs for the intensity of emotions for all expressions (P > .05) except for the expression of surprise in the group of patients that received 48 IU of the injection (protocol with injection of the frontalis muscle). All patient investigators answered negatively to the question "Do you think that this patient has a 'frozen face'?". CONCLUSION This study shows that esthetic injection of BoNT-A in the upper face has no negative effects on facial expressions and does not lead to the feared "frozen face" when it is injected with respect for best practice guidelines. This study can be used as an example for patients who have some reticences against BoNT-A injection.
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Affiliation(s)
- Rémi Foissac
- Plastic and reconstructive Surgery, Clinique Saint George, Nice, France
| | - Marc J Benatar
- Plastic and reconstructive Surgery, Clinique Santa Maria, Nice, France
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CLINICAL CHARACTERISTICS OF POSTOPERATIVE SKIN SCARS IN PATIENTS WITH DIFFERENT CIRCADIAN RHYTHMS USING THE PLACENTA CRYOEXTRACT. WORLD OF MEDICINE AND BIOLOGY 2021. [DOI: 10.26724/2079-8334-2021-4-78-7-11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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19
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Harrison LM, Shapiro R, Johnson RM. Tissue Modification in Nonsurgical Facelift Options. Facial Plast Surg 2020; 36:688-695. [PMID: 33368123 DOI: 10.1055/s-0040-1721115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Nonsurgical facelifts are a term for a heterogeneous group of procedures used by physicians to improve facial rejuvenation without the use of operative techniques. Patients demand these services due to the reduced recovery time and generally lower risk. However, nonsurgical techniques, to be effective, must induce conformational change in the cells and tissues of the face. Therefore, these techniques are significant procedures that have associated risks. Understanding the tissue modifications and mechanisms of action of these techniques is vital to their safe and effective use. The purpose of this article is to provide a background of tissue modification in nonsurgical facelift options.
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Affiliation(s)
- Lucas M Harrison
- Department of Plastic Surgery, Wright State University, Dayton, Ohio
| | - Ryan Shapiro
- Department of Plastic Surgery, Wright State University, Dayton, Ohio
| | - R Michael Johnson
- Department of Plastic Surgery, Wright State University, Dayton, Ohio
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20
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Ekstein SF, Wyles SP, Moran SL, Meves A. Keloids: a review of therapeutic management. Int J Dermatol 2020; 60:661-671. [PMID: 32905614 DOI: 10.1111/ijd.15159] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/28/2020] [Accepted: 07/30/2020] [Indexed: 12/20/2022]
Abstract
Keloid scar formation arises from a disorganized fibroproliferative collagen response that extends beyond the original wound margins because of excessive production of extracellular matrix (ECM). Despite treatment options for keloid scars including medical and surgical therapies, such as intralesional steroid injection and surgical excision, the recurrence rate remains high. Herein we consolidate recently published narrative reviews, systematic reviews, and meta-analyses to provide an overview of updated treatment recommendations for keloidal scar formation. PubMed search engine was used to access the MEDLINE database to investigate updates regarding keloid incidence and treatment. More than 100 articles were reviewed. Keloid management remains a multimodal approach. There continues to be no gold standard of treatment that provides a consistently low recurrence rate; however, the increasing number of available treatments and synergistic combinations of these treatments (i.e., laser-based devices in combination with intralesional steroids, or 5-fluorouracil (5-FU) in combination with steroid therapy) is showing favorable results. Future studies could target the efficacy of novel treatment modalities (i.e., autologous fat grafting or stem cell-based therapies) for keloid management. This review article provides updated treatment guidelines for keloids and discusses insight into management to assist patient-focused, evidence-based clinical decision making.
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Affiliation(s)
- Samuel F Ekstein
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Steven L Moran
- Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA.,Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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21
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Wanitphakdeedecha R, Yan C, Apinuntham C, Rojanavanich V, Cembrano KAG, Eimpunth S, Manuskiatti W. Intradermal Micro-Dosing of AbobotulinumtoxinA for Face-Lifting: How Long Does It Last? Dermatol Ther (Heidelb) 2020; 10:779-789. [PMID: 32591944 PMCID: PMC7367985 DOI: 10.1007/s13555-020-00414-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Intradermal injection of botulinum toxin type A (BoNT/A) has been used off-label by many clinicians for face-lifting. Previous studies on abobotulinumtoxinA (ABO) (Dysport®; Ipsen Biopharm Ltd.) have demonstrated clinical efficacy in face-lifting when compared to normal saline solution (NSS). However, few clinical studies have evaluated ABO in terms of duration of sustained effects for face-lifting. METHODS Thirty subjects were enrolled, and their face was injected with ABO at a dilution of 1 vial:7 mL (500 U in 7 mL of NSS) using an intradermal injection technique. Standardized photographic documentation was obtained using a two-, and three-dimensional imaging system (Vectra H1, Canfield Scientific, Inc, Fairfield, NJ) at baseline, immediately after injection, 2 weeks after injection and at 1 , 2 , 3 , 4 , 5 and 6 months of follow-up after treatment. The face-lifting effects were graded by both the subjects and two blinded dermatologists who compared photographs taken at the different time points. Side effects were also recorded at the end of the study. RESULTS Of the 30 subjects, 28 completed treatment and attended every follow-up visit. All subjects were female with Fitzpatrick skin type II to IV. The average age of the subjects was 27.6 ± 3.4 (range 22-34) years. The total number of ABO units used varied for each subject (range 200-250 U), with the average (± standard deviation) dose being 237 ± 19 units. Most of the subjects reported significant face-lifting up to 3 months post-procedure. However, face-lifting assessed by blinded dermatologists was notably lower than that of each patient's evaluation. The difference in the facial contouring volume of the nasolabial fold and jawline, as measured by the Vectra H1 imaging system, was statistically significant from baseline up until 3 months after injection (p = 0.001 and p = 0.001, respectively). The only side effect found in this study was minimal bruising, which was seen in 13.8% of subjects. None of the subjects reported facial asymmetry, either at rest or during facial expression. CONCLUSION The results of this study demonstrate the face-lifting effect of ABO intradermal injection. The results show sustained effects up to 3 months after injection.
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Affiliation(s)
| | - Chadakan Yan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chalermkwan Apinuntham
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Kathryn Anne G Cembrano
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sasima Eimpunth
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Woraphong Manuskiatti
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Ramelli E, Brault N, Tierny C, Atlan M, Cristofari S. Intrascrotal injection of botulinum toxin A, a male genital aesthetic demand: Technique and limits. Prog Urol 2020; 30:312-317. [PMID: 32359923 DOI: 10.1016/j.purol.2020.04.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 04/09/2020] [Accepted: 04/15/2020] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Scrotal rejuvenation is a real male aesthetic demand. Scrotal injection of botulinum toxin makes the testicles smoother, less dangling and subjectively larger. METHODS Intrascrotal botulinum toxin injections were performed to a 44-year-old patient for aesthetic purposes. We used the intracremasteric injection protocol. Cremaster muscle injections and dartos muscle injections were performed. RESULTS The patient was satisfied. No adverse reaction to the intrascrotal botulinum toxin injection was observed. The patient wanted to repeat the procedure in the future. CONCLUSION At the moment, there is no recommendation about the aesthetic use of intrascrotal injections of botulinum toxin A and the risks are unknown. The purpose of this article is to show the feasibility, context and technical modalities of intrascrotal injection. The risk of infertility is real, but marginal for men who no longer have progeny's desire. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Eloi Ramelli
- Plastic surgery Department, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France; Plastic surgery Department, Hautepierre Hospital, University Hospital of Strasbourg, 1, avenue Molière, 67000 Strasbourg, France.
| | - Nicolas Brault
- Plastic surgery Department, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France
| | - Chloe Tierny
- Plastic Surgery and Burns Unit, University Hospital of Bordeaux, FX Michelet Center, place Amelie Raba-Leon, 33076 Bordeaux, France
| | - Michael Atlan
- Plastic surgery Department, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France; Paris VI, Sorbonne University, Pierre et Marie Curie Campus, 4, place Jussieu, 75005 Paris, France
| | - Sarra Cristofari
- Plastic surgery Department, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France; Paris VI, Sorbonne University, Pierre et Marie Curie Campus, 4, place Jussieu, 75005 Paris, France
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23
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Ismail A, El‐Kholy S, Farid C. Botulinum toxin type A in chronic non‐dyshidrotic palmar eczema: A side‐by‐side comparative study. J Dermatol 2020; 47:601-608. [DOI: 10.1111/1346-8138.15344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 03/09/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Aisha Ismail
- Department of Dermatology, Venereology and Andrology Faculty of Medicine Alexandria University Alexandria Egypt
| | - Samar El‐Kholy
- Department of Dermatology, Venereology and Andrology Faculty of Medicine Alexandria University Alexandria Egypt
| | - Carmen Farid
- Department of Dermatology, Venereology and Andrology Faculty of Medicine Alexandria University Alexandria Egypt
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24
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Guo X, Song G, Zhang D, Jin X. Efficacy of Botulinum Toxin Type A in Improving Scar Quality and Wound Healing: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Aesthet Surg J 2020; 40:NP273-NP285. [PMID: 31155638 DOI: 10.1093/asj/sjz165] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Botulinum toxin type A-induced "chemoimmobilization" has long been utilized for improved scar quality and wound healing; however, current evidence is limited to small studies, and evidence-based information is inadequate to make well-informed decisions. OBJECTIVES The purpose of this study was to evaluate the efficacy of botulinum toxin type A (BTA) to improve scars and wound healing. METHODS The authors searched databases, including Pubmed, Embase, and Cochrane Library, to identify randomized clinical trials (RCTs) that compared outcomes of surgical scars and wounds treated with BTA vs those treated with blank or placebo controls. The Visual Analog Scale, Vancouver Scar Score, scar width, and reported patient satisfaction were utilized in evaluating outcomes. Adverse events were also recorded. RESULTS Eleven RCTs involved a total of 486 cases (374 patients). Quantitative synthesis suggested that compared with the control group, patients in the BTA treatment group had significantly higher Visual Analog Scale scores (mean difference [MD] = 1.30, 95% confidence interval [CI]: 1.05 to 1.55), lower Vancouver Scar Scores (MD = -1.62, 95% CI: -2.49 to -0.75, P = 0.0003), and thinner scars (MD = -0.15, 95% CI: -0.20 to -0.11, P < 0.00001). Patient satisfaction was higher in the BTA group than in the control group (risk ratio: 1.25, 95% CI: 1.06 to 1.49, P = 0.01). Trivial adverse events were reported. CONCLUSIONS This meta-analysis of RCTs provides reliable evidence that BTA injection is superior to placebo or blank control group in improving scar quality and wound healing in the face and neck for Asians, and negative outcomes for BTA treatment in these patients include only trivial adverse events. However, inadequate evidence supports utilization of BTA in Caucasians for primary surgical scars or for scars in locations other than the face and neck. Further studies on the standardized injection regimen and technique of BTA are warranted for clinical practice. LEVEL OF EVIDENCE: 1
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Affiliation(s)
- Xiaoshuang Guo
- 16th Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Guodong Song
- 16th Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Dong Zhang
- 16th Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Xiaolei Jin
- 16th Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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25
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Efficacy, Safety, and Subject Satisfaction After AbobotulinumtoxinA Treatment for Moderate to Severe Glabellar Lines. Dermatol Surg 2020; 46:61-69. [PMID: 31356432 DOI: 10.1097/dss.0000000000002013] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The aesthetic use of botulinum toxins is widely accepted in routine treatment of glabellar lines. OBJECTIVE To strengthen existing efficacy and safety data, and examine subject satisfaction concerning abobotulinumtoxinA (ABO) treatment for moderate to severe glabellar lines. MATERIALS AND METHODS A 150-day prospective, single-dose, multicenter, randomized, parallel-group, placebo-controlled, double-blind study of 300 subjects treated with ABO (50 Units [U]). Response was defined as having no or mild glabellar lines after treatment (primary objective was Day 30 response). Glabellar line severity, onset and duration of effect, satisfaction, treatment emergent adverse events (TEAEs), and treatment-related adverse events (TRAEs) were assessed. RESULTS Median time to onset of effect was 2 days. Day 30, ABO treatment response was 89% and 85% for investigator and subject assessments, respectively (p < .001 vs placebo). At Day 120, 60% of subjects demonstrated ≥1 grade improvement and 45% at Day 150. Subject satisfaction concerning glabellar line appearance was high (93%) at Day 14 and maintained by 35% through Day 150 with ABO treatment. No serious AEs were related to study treatment. CONCLUSION Most ABO-treated subjects sustained ≥1 grade glabellar line improvements over 120 days, and satisfaction was maintained by >30% of subjects throughout 150 days. ABO was well tolerated.
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Elnaggar RK, Samhan AF, Elshafey MA. Differential Effects of Extracorporeal Shockwave Therapy and Botulinum Toxin-A Injection on Postburn Contractures and Gait Kinematics in Burn Children. J Burn Care Res 2019; 41:612-618. [DOI: 10.1093/jbcr/irz212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Abstract
Postburn contracture is a complex and multifactorial problem that requires intensive inputs from the burn care staff. This study endeavored to evaluate the effectiveness of extracorporeal shockwave therapy and botulinum toxin-A for treating the postburn plantar flexion contracture and optimizing ankle kinematics in burn children. Thirty-eight children with burns and plantar flexion contracture were randomized to receive the standard physical rehabilitation program (control group; n = 13), unfocused extracorporeal shockwave therapy (0.2 mJ/mm2) once a week over four consecutive weeks in addition to the standard physical rehabilitation (n = 12), or botulinum toxin-A injection (0.5–2 U/kg/muscle group with maximum dose of 12 U/kg/body weight) once at entry besides the standard physical rehabilitation (n = 13). Dorsiflexion active range of motion and ankle kinematics were measured before and immediately after treatment. The posttreatment dorsiflexion active range of motion increased significantly in the extracorporeal shockwave therapy group (P = .025) and botulinum toxin-A group (P = .04) when compared to the control group. Likewise, the initial stance–dorsiflexion, stance-maximum dorsiflexion, and swing-peak dorsiflexion angle improved significantly in the extracorporeal shockwave therapy group (P ˂ .001, P = .005, and P = .002, respectively) and botulinum toxin-A group (P = .004, P = .012, and P ˂ .001, respectively) compared to the control group. No significant differences were observed between the extracorporeal shockwave therapy and botulinum toxin-A groups with respect to any of the measured variables. To conclude, extracorporeal shockwave therapy and botulinum toxin-A injection could be effectively used to treat postburn plantar flexion contracture and to optimize the ankle kinematics during walking in children, without preference for either of them.
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Affiliation(s)
- Ragab K Elnaggar
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Ahmed F Samhan
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
- Department of Physical Therapy, New Kasr El-Aini Teaching Hospital, Faculty of Medicine, Cairo University, Egypt
| | - Mohammed A Elshafey
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Pourang A, Rockwell H, Karimi K. New Frontiers in Skin Rejuvenation, Including Stem Cells and Autologous Therapies. Facial Plast Surg Clin North Am 2019; 28:101-117. [PMID: 31779934 DOI: 10.1016/j.fsc.2019.09.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
One of the greatest challenges in the progression of aesthetic medicine lies in providing treatments with long-term results that are also minimally invasive and safe. Keeping up with this demand are developments in autologous therapies such as adipose-derived stem cells, stromal vascular fraction, microfat, nanofat, and platelet therapies, which are being shown to deliver satisfactory results. Innovations in more traditional cosmetic therapies, such as botulinum toxin, fillers, and thread lifts, are even more at the forefront of the advancement in aesthetics. Combining autologous therapies with traditional noninvasive methods can ultimately provide patients with more effective rejuvenation options.
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Affiliation(s)
- Aunna Pourang
- Department of Dermatology, University of California, Davis, 3301 C Street, Suite 1400, Sacramento, CA 95816, USA
| | - Helena Rockwell
- University of California, San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Kian Karimi
- Rejuva Medical Aesthetics, 11645 Wilshire Boulevard #605, Los Angeles, CA 90025, USA.
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Scala J, Vojvodic A, Vojvodic P, Vlaskovic-Jovicevic T, Peric-Hajzler Z, Matovic D, Dimitrijevic S, Vojvodic J, Sijan G, Stepic N, Wollina U, Tirant M, Thuong NV, Fioranelli M, Lotti T. Botulin Toxin Use in Rosacea and Facial Flushing Treatment. Open Access Maced J Med Sci 2019; 7:2985-2987. [PMID: 31850105 PMCID: PMC6910814 DOI: 10.3889/oamjms.2019.784] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/06/2019] [Accepted: 07/07/2019] [Indexed: 12/24/2022] Open
Abstract
Botulinum toxin (BTX) is a neurotoxin derived from the Clostridium botulinum bacterium that inhibits the release of acetylcholine at the neuromuscular junction level whose effects has been used for many years to treat a variety of muscular/neuromuscular conditions and more recently also for cosmetic use. BTX has experimented in some dermatological conditions, which include Rosacea and facial flushing treatment with good results. The complex mechanism underlying those results is not completely understood but was proposed a release inhibition of acetylcholine from peripheral autonomic nerves of the cutaneous vasodilatory system combined with the blockade substance P and calcitonin gene-related peptide (CGRP) thus modulating blood vessel dilatation. We analysed the published data on BTX off label applications rosacea and flushing retrieved from PubMed.
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Affiliation(s)
| | - Aleksandra Vojvodic
- Department of Dermatology and Venereology, Military Medical Academy, Belgrade, Serbia
| | - Petar Vojvodic
- Clinic for Psychiatric Disorders "Dr. Laza Lazarevic", Belgrade, Serbia
| | | | | | | | | | - Jovana Vojvodic
- Clinic for Psychiatric Disorders "Dr. Laza Lazarevic", Belgrade, Serbia
| | - Goran Sijan
- Clinic for Plastic Surgery and Burns, Military Medical Academy, Belgrade, Serbia
| | - Nenad Stepic
- Chief of Clinic for Plastic Surgery and Burns, Military Medical Academy, Belgrade, Serbia
| | - Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Dresden, Germany
| | | | - Nguyen Van Thuong
- Vietnam National Hospital of Dermatology and Venereology, Hanoi, Vietnam
| | - Massimo Fioranelli
- Department of Nuclear Physics, Sub-nuclear and Radiation, G. Marconi University, Rome, Italy
| | - Torello Lotti
- Department of Dermatology, University of G. Marconi, Rome, Italy
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Scala J, Vojvodic A, Vojvodic P, Vlaskovic-Jovicevic T, Peric-Hajzler Z, Matovic D, Dimitrijevic S, Vojvodic J, Sijan G, Stepic N, Wollina U, Tirant M, Thuong NV, Fioranelli M, Lotti T. Botulin Toxin Use in Scars/Keloids Treatment. Open Access Maced J Med Sci 2019; 7:2979-2981. [PMID: 31850103 PMCID: PMC6910812 DOI: 10.3889/oamjms.2019.783] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/06/2019] [Accepted: 07/07/2019] [Indexed: 12/27/2022] Open
Abstract
Botulinum toxin (BTX) is a neurotoxin protein derived from the Clostridium botulinum bacterium that inhibits the release of acetylcholine at the neuromuscular junction level whose effects has been used for many years to treat a variety of muscular/neuromuscular conditions and more recently also for cosmetic use. BTX has experimented in some dermatological conditions which include scar prevention and treatment with good results The complex mechanism underlying those results is not completely understood but several mechanisms were proposed release inhibition of different substances like (TGF)-β, substance P, calcitonin gene-related peptide (CGRP) and glutamate thus modulating cutaneous inflammation and wound healing. We analysed the published data on BTX off label applications on scars and keloids retrieved from PubMed.
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Affiliation(s)
| | - Aleksandra Vojvodic
- Department of Dermatology and Venereology, Military Medical Academy, Belgrade, Serbia
| | - Petar Vojvodic
- Clinic for Psychiatric Disorders "Dr. Laza Lazarevic", Belgrade, Serbia
| | | | | | | | | | - Jovana Vojvodic
- Clinic for Psychiatric Disorders "Dr. Laza Lazarevic", Belgrade, Serbia
| | - Goran Sijan
- Clinic for Plastic Surgery and Burns, Military Medical Academy, Belgrade, Serbia
| | - Nenad Stepic
- Chief of Clinic for Plastic Surgery and Burns, Military Medical Academy, Belgrade, Serbia
| | - Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Dresden, Germany
| | | | - Nguyen Van Thuong
- Vietnam National Hospital of Dermatology and Venereology, Hanoi, Vietnam
| | - Massimo Fioranelli
- Department of Nuclear Physics, Sub-nuclear and Radiation, G. Marconi University, Rome, Italy
| | - Torello Lotti
- Department of Dermatology, University of G. Marconi, Rome, Italy
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Euler T, Valesky EM, Meissner M, Hrgovic I, Kaufmann R, Kippenberger S, Zöller NN. Normal and keloid fibroblasts are differentially influenced by IFN-γ and triamcinolone as well as by their combination. Wound Repair Regen 2019; 27:450-461. [PMID: 30994217 DOI: 10.1111/wrr.12722] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 04/12/2019] [Accepted: 04/15/2019] [Indexed: 12/14/2022]
Abstract
Impaired wound healing as well as imbalanced cell proliferation and extracellular matrix synthesis and degeneration can cause aberrant scarring. The most severe impacts of such scarring on patients' lives are stigmatization and physical restriction. Although, a broad variety of combinatorial approaches with, e.g., glucocorticoids, chemotherapeutics, and immunomodulators are used, there is still a high recurrence rate of keloids. The aim of this study was to investigate which influence interferon γ (IFN-γ, 1.000-10.000 IU/mL) and/or triamcinolone acetonide (TA, 1 μg/mL) have on proliferation, cell viability, collagen type I synthesis, and cytokine secretion in healthy and keloid fibroblasts. It was shown that mono-treatment with IFN-γ or TA for 2 days induced a severe reduction of the proliferative potential in both cell species. The combinatory treatment (IFN-γ plus TA) of keloid fibroblasts enhanced the anti-proliferative effect of the mono-treatments, whereas no additional anti-proliferative effect was observed in normal fibroblasts. Furthermore, we observed that the combinatory treatment regimen reduced the expression of α-smooth muscle actin (α-SMA), an actin isotype contributing to cell-generated mechanical tension, in keloid fibroblasts. In normal fibroblasts, α-SMA was reduced by the mono-treatment with IFN-γ as well as by the combinatory treatment. The analysis of collagen-type I synthesis revealed that TA did not reduce collagen type I synthesis in normal fibroblasts but in keloid fibroblasts. IFN-γ reduced in both cell species the collagen type I synthesis. The combination of TA and IFN-γ intensified the previously observed collagen type I synthesis reduction in keloid fibroblasts. The herein presented data suggest the combinatory application of IFN-γ and TA as a promising therapy concept for keloids.
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Affiliation(s)
- Teresa Euler
- Frankfurt/Main, Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Goethe University, Germany
| | - Eva M Valesky
- Frankfurt/Main, Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Goethe University, Germany
| | - Markus Meissner
- Frankfurt/Main, Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Goethe University, Germany
| | - Igor Hrgovic
- Frankfurt/Main, Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Goethe University, Germany
| | - Roland Kaufmann
- Frankfurt/Main, Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Goethe University, Germany
| | - Stefan Kippenberger
- Frankfurt/Main, Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Goethe University, Germany
| | - Nadja N Zöller
- Frankfurt/Main, Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Goethe University, Germany
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Abstract
This year, many publications have focused on understanding, avoiding and treating vascular complications when injecting fillers. New protocols for the use of hyaluronidase have shown their effectiveness in preventing skin necrosis or blindness after vascular embolism when injecting hyaluronic acid. Other areas of interventional dermatology have been well documented: myomodulation is an interesting concept that describes the impact of the injection depth of a filler on muscle forces in order to correct the balances between the lowering and elevators during congenital or acquired defcits with aging. Treatment of melasma remains diffcult but the prescription of oral tranexamic acid could be useful. Botulinum toxin is expanding its feld of activity for both aesthetic and medical treatments. Pulsed dye laser remains the reference treatment for port wine stains, but the rate of recurrence by post laser neo-angiogenesis justifes the need of reliable and effective adjuvant treatments.
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Affiliation(s)
- C Raimbault
- Dermatologue libérale, 30, rue des Clercs, 57000 Metz, France, présidente du Groupe de dermatologie esthétique et correctrice (gDEC) de la Société française de dermatologie, past présidente de l'Association de dermatologie esthétique et laser de l'Est (ADELE).
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Kasyanju Carrero LM, Ma W, Liu H, Yin X, Zhou B. Botulinum toxin type A for the treatment and prevention of hypertrophic scars and keloids: Updated review. J Cosmet Dermatol 2018; 18:10-15. [PMID: 30548742 DOI: 10.1111/jocd.12828] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 10/31/2018] [Accepted: 10/31/2018] [Indexed: 12/30/2022]
Affiliation(s)
| | - Wei‐wei Ma
- Department of Dermatology the First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Hou‐fang Liu
- Department of Dermatology the First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Xu‐feng Yin
- Department of Dermatology the First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Bing‐rong Zhou
- Department of Dermatology the First Affiliated Hospital of Nanjing Medical University Nanjing China
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Friedman O, Koren A, Niv R, Mehrabi JN, Artzi O. The toxic edge-A novel treatment for refractory erythema and flushing of rosacea. Lasers Surg Med 2018; 51:325-331. [PMID: 30311683 DOI: 10.1002/lsm.23023] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2018] [Indexed: 01/17/2023]
Abstract
PURPOSE Rosacea is a common, chronic facial skin disease that affects the quality of life. Treatment of facial erythema with intradermal botulinum toxin injection has previously been reported. The primary objective of the study was the safety and efficacy of thermal decomposition of the stratum corneum using a novel non-laser thermomechanical system (Tixel, Novoxel, Israel) to increase skin permeability for Botulinum toxin in the treatment of facial flushing of rosacea. METHODS A retrospective review of16 patients aged 23-45 years with Fitzpatrick Skin Types II to IV and facial erythematotelangiectatic rosacea treated by Tixel followed by topical application of 100 U of abobotulinumtoxin. A standardized high-definition digital camera photographed the patients at baseline and 1, 3, and 6 months after the last treatment. Objective and subjective assessments of the patients were done via Mexameter, the Clinicians Erythema Assessment (CEA), and Patients self-assessment (PSA) scores and the dermatology life quality index (DLQI) validated instrument. RESULTS The average Maxameter, CEA, and PSA scores at 1, 3, and 6 months were significantly improved compared with baseline (all had a P-value <0.001). DLQI scores significantly improved with an average score of 18.6 at baseline at 6 months after treatment (P < 0.001). Self-rated patient satisfaction was high. There were no motor function side-effects or drooping. CONCLUSION Thermal breakage of the stratum corneum using the device to increase skin permeability for botulinum toxin type A in the treatment of facial flushing of rosacea seems both effective and safe. Lasers Surg. Med. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Or Friedman
- The Plastic Reconstructive Surgery Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Koren
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Dr. Artzi Treatment and Research Center, Tel Aviv, Israel
| | - Roni Niv
- Dr. Artzi Treatment and Research Center, Tel Aviv, Israel
| | - Joseph N Mehrabi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofir Artzi
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Dr. Artzi Treatment and Research Center, Tel Aviv, Israel
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Alter KE, Karp BI. Ultrasound Guidance for Botulinum Neurotoxin Chemodenervation Procedures. Toxins (Basel) 2017; 10:toxins10010018. [PMID: 29283397 PMCID: PMC5793105 DOI: 10.3390/toxins10010018] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 12/12/2017] [Accepted: 12/21/2017] [Indexed: 12/28/2022] Open
Abstract
Injections of botulinum neurotoxins (BoNTs) are prescribed by clinicians for a variety of disorders that cause over-activity of muscles; glands; pain and other structures. Accurately targeting the structure for injection is one of the principle goals when performing BoNTs procedures. Traditionally; injections have been guided by anatomic landmarks; palpation; range of motion; electromyography or electrical stimulation. Ultrasound (US) based imaging based guidance overcomes some of the limitations of traditional techniques. US and/or US combined with traditional guidance techniques is utilized and or recommended by many expert clinicians; authors and in practice guidelines by professional academies. This article reviews the advantages and disadvantages of available guidance techniques including US as well as technical aspects of US guidance and a focused literature review related to US guidance for chemodenervation procedures including BoNTs injection.
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Affiliation(s)
- Katharine E Alter
- Functional and Applied Biomechanics Section, Rehabilitation Medicine, Clinical Center, National Institutes of Health, Bethesda, MD 20892-1604, USA.
| | - Barbara I Karp
- Combined Neurosciences IRB, National Institutes of Health, Bethesda, MD 20892-1604, USA.
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Commentary on ATX-101 (Deoxycholic Acid Injection) for Paradoxical Adipose Hyperplasia Secondary to Cryolipolysis. Dermatol Surg 2017; 44:755-757. [PMID: 29059144 DOI: 10.1097/dss.0000000000001321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- Jeffrey S Dover
- Associate Clinical Professor of Dermatology, Yale University School of Medicine, New Haven, CT, USA
- Adjunct Associate Professor of Dermatology, Brown Medical School, Providence, RI, USA
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