Therapeutic Use of Hyaluronic Acid Fillers in the Treatment of Corticosteroid-Induced Skin and Subcutaneous Atrophy

Injectable "Skin Boosters" in Aging Skin Rejuvenation: A Current Overview

Aging-related changes in the skin, such as dullness, dehydration, and loss of elasticity, significantly affect its appearance and integrity. Injectable "skin boosters," comprising various biological materials, have become increasingly prominent in addressing these issues, offering rejuvenation and revitalization. This review offers a comprehensive examination of these injectables, detailing their types, mechanisms of action, and clinical uses. It also evaluates the evidence for their effectiveness and safety in treating age-related skin alterations and other conditions. The goal is to provide an insightful understanding of injectable skin boosters in contemporary dermatological practice, summarizing the current state of knowledge.

Glucocorticoid-Induced Skin Atrophy: The Old and the New

Glucocorticoids are major therapeutic agents highly used in the medical field. Topical glucocorticoids have biologic activities which make them useful in dermatology – anti-inflammatory, vasoconstrictive, immune suppressive and antiproliferative, in treating inflammatory skin disorders (allergic contact eczema, atopic hand eczema, nummular eczema, psoriasis vulgaris or toxic-irritative eczema). Unfortunately, the beneficial effects of topical glucocorticoids are shadowed by their potential for adverse effects – muscle or skin atrophy, striae distensae, rubeosis or acne. Skin atrophy is one of the most prevalent side-effects, with changes found in all skin compartments – marked hypoplasia, elasticity loss with tearing, increased fragility, telangiectasia, bruising, cutaneous transparency, or a dysfunctional skin barrier. The structure and function of the epidermis is altered even in the short-term topical glucocorticoid treatment; it affects stratum corneum components, subsequently affecting skin barrier integrity. The dermis is altered by directly inhibiting fibroblast proliferation, reducing mast cell numbers, and loss of support; there is depletion of mucopolysaccharides, elastin fibers, matrix metalloproteases and inhibition of collagen synthesis. Atrophogenic changes can be found also in hair follicles, sebaceous glands or dermal adipose tissue. Attention should be paid to topical glucocorticoid treatment prescription, to the beneficial/adverse effects ratio of the chosen agent, and studies should be oriented on the development of newer, innovative targeted (gene or receptor) therapies.

Biorevitalization of the skin with skin boosters: Concepts, variables, and limitations

Aging leads to diminished capacity in the functionality of all the skin layers, which in turn leads to a structurally weak and esthetically unappealing skin which is dull, dehydrated, and inelastic. Skin boosters can be defined as biological materials or bio-actives that help or encourage the skin to increase or improve its function. Boosters have been used in treating skin structural changes associated with aging as well as other factors such as corticosteroid-induced skin atrophy. Restoring the loss in skin nourishment and vital components is the concept involved in biorevitalization of the skin. The authors aim to present an update and a short review of skin boosters in this commentary.

Hyaluronic acid-based two-stage medical therapy to unfold the aged face: The centrifugal approach

BACKGROUND

Facial aging is a multifactorial process characterized by structural changes to the dermis and ligaments, lipoatrophy in the fat pads and hypodermis, remodeling of the bony skeleton, change in muscle tonicity and tissue descent.

AIMS

The purpose of this study is to evaluate the efficacy of a hyaluronic acid-based treatment for the aging face that addresses all its causes in a caudal to cranial and medial to lateral direction: the centrifugal technique.

METHODS

Between March 2015 and January 2018, 187 patients were treated with a high G' hyaluronic acid in two sessions, one/two weeks apart, to improve signs of facial aging, starting from the lower centrofacial area and progressing laterally and cranially. Results were assessed using a Global Aesthetic Improvement Scale (GAIS) judging pre- and post-treatment (32 weeks) pictures.

RESULTS

The technique effectively treated the aging face. The investigator and all patients evaluated the results improved or very much improved and agreed that the results were very natural looking.

CONCLUSION

Use of a systematic centrifugal technique to address the signs of facial aging resulted in significant and long-lasting improvement, as judged by the investigator and high patient acceptance and satisfaction.