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Sun J, Lai YC, Lin YW, Fang CH, Sun JS. Enhancing cutaneous wound healing: A study on the beneficial effects of nano-gelatin scaffold in rat models. Int J Artif Organs 2024; 47:280-289. [PMID: 38624101 DOI: 10.1177/03913988241244661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
The challenges in achieving optimal outcomes for wound healing have persisted for decades, prompting ongoing exploration of interventions and management strategies. This study focuses on assessing the potential benefits of implementing a nano-gelatin scaffold for wound healing. Using a rat skin defect model, full-thickness incisional wounds were created on each side of the thoracic-lumbar regions after anesthesia. The wounds were left un-sutured, with one side covered by a gelatin nano-fibrous membrane and the other left uncovered. Wound size changes were measured on days 1, 4, 7, and 14, and on day 14, rats were sacrificed for tissue sample excision, examined with hematoxylin and eosin, and Masson's trichrome stain. Statistical comparisons were performed. The gelatin nanofibers exhibited a smooth surface with a fiber diameter of 260 ± 40 nm and porous structures with proper interconnectivity. Throughout the 14-day experimental period, significant differences in the percentage of wound closure were observed between the groups. Histological scores were higher in the experiment group, indicating less inflammation but dense and well-aligned collagen fiber formation. A preliminary clinical trial on diabetic ulcers also demonstrated promising results. This study highlights the potential of the nano-collagen fibrous membrane to reduce inflammatory infiltration and enhance fibroblast differentiation into myofibroblasts during the early stages of cutaneous wound healing. The nano-fibrous collagen membrane emerges as a promising candidate for promoting wound healing, with considerable potential for future therapeutic applications.
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Affiliation(s)
- Jason Sun
- Carmel Catholic High School, Mundelein, IL, USA
| | - Yi-Chung Lai
- Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Wen Lin
- Institute of Biomedical Engineering, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chih-Hsiang Fang
- Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Jui-Sheng Sun
- Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
- Department of Orthopedic Surgery, En Chu Kong Hospital, New Taipei City, Taiwan
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Sun Y, Yang L, Du L, Zhou Y, Xu K, Chen J, He Y, Qu Q, Miao Y, Xing M, Hu Z. Duo-role Platelet-rich Plasma: temperature-induced fibrin gel and growth factors' reservoir for microneedles to promote hair regrowth. J Adv Res 2024; 55:89-102. [PMID: 36849045 PMCID: PMC10770113 DOI: 10.1016/j.jare.2023.02.014] [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: 10/19/2022] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 02/27/2023] Open
Abstract
INTRODUCTION Alopecia concerns more than half our adult population. Platelet-rich plasma (PRP) has been applied in skin rejuvenation and hair loss treatment. However, the pain and bleeding during injection and the troublesome for fresh preparation of each action limit PRP's in-depth applying dedication to clinics. OBJECTIVES We report a temperature-sensitive PRP induced fibrin gel included in a detachable transdermal microneedle (MN) for hair growth. RESULTS PRP gel interpenetrated with the photocrosslinkable gelatin methacryloyl (GelMA) to realize sustained release of growth factors (GFs) and led to 14% growth in mechanical strength of a single microneedle whose strength reached 1.21 N which is sufficient to penetrate the stratum corneum. PRP-MNs' release of VEGF, PDGF, and TGF-β were characterized and quantitatively around the hair follicles (HFs) for 4-6 days consecutively. PRP-MNs promoted hair regrowth in mice models. From transcriptome sequencing, PRP-MNs induced hair regrowth through angiogenesis and proliferation. The mechanical and TGF-β sensitive gene Ankrd1 was significantly upregulated by PRP-MNs treatment. CONCLUSION PRP-MNs show convenient, minimally invasive, painless, inexpensive manufacture, storable and sustained effects in boosting hair regeneration.
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Affiliation(s)
- Yang Sun
- Department of Plastic and Aesthetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China; Department of Mechanical Engineering, University of Manitoba, 75A Chancellors Circle, Winnipeg, Manitoba R3T 2N2, Canada
| | - Lunan Yang
- Department of Plastic and Aesthetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Lijuan Du
- Department of Plastic and Aesthetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Yi Zhou
- Department of Plastic and Aesthetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Kaige Xu
- Department of Mechanical Engineering, University of Manitoba, 75A Chancellors Circle, Winnipeg, Manitoba R3T 2N2, Canada
| | - Jian Chen
- Department of Plastic and Aesthetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Ye He
- Department of Plastic and Aesthetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Qian Qu
- Department of Plastic and Aesthetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Yong Miao
- Department of Plastic and Aesthetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China.
| | - Malcolm Xing
- Department of Mechanical Engineering, University of Manitoba, 75A Chancellors Circle, Winnipeg, Manitoba R3T 2N2, Canada.
| | - Zhiqi Hu
- Department of Plastic and Aesthetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China.
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Wawrzyk-Bochenek I, Rahnama M, Wilczyński S, Wawrzyk A. Quantitative Assessment of Hyperpigmentation Changes in Human Skin after Microneedle Mesotherapy Using the Gray-Level Co-Occurrence Matrix (GLCM) Method. J Clin Med 2023; 12:5249. [PMID: 37629289 PMCID: PMC10456105 DOI: 10.3390/jcm12165249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/03/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
AIM The aim of the study was to quantitatively assess the effectiveness of microneedle mesotherapy in reducing skin discoloration. The results were analyzed using the gray-level co-occurrence matrix (GLCM) method. MATERIAL AND METHODS The skin of the forearm (7 × 7 cm) of 12 women aged 29 to 68 was examined. Microneedle mesotherapy was performed using a dermapen with a preparation containing 12% ascorbic acid. Each of the volunteers underwent a series of four microneedle mesotherapy treatments. The effectiveness of the treatment was quantified using the methods of image analysis and processing. A series of clinical images were taken in cross-polarized light before and after a series of cosmetic procedures. Then, the treated areas were analyzed by determining the parameters of the gray-level co-occurrence matrix (GLCM) algorithm: contrast and homogeneity. RESULTS During image pre-processing, the volunteers' clinical images were separated into red (R), green (G) and blue (B) channels. The photos taken after the procedure show an increase in skin brightness compared to the photos taken before the procedure. The average increase in skin brightness after the treatment was 10.6%, the average decrease in GLCM contrast was 10.7%, and the average homogeneity increased by 14.5%. Based on the analysis, the greatest differences in the GLCM contrast were observed during tests performed in the B channel of the RGB scale. With a decrease in GLCM contrast, an increase in postoperative homogeneity of 0.1 was noted, which is 14.5%.
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Affiliation(s)
- Iga Wawrzyk-Bochenek
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Kasztanowa 3, 41-205 Sosnowiec, Poland; (I.W.-B.); (S.W.)
| | - Mansur Rahnama
- Chair and Department of Oral Surgery, Medical University of Lublin, Chodźki 6, 20-093 Lublin, Poland;
| | - Sławomir Wilczyński
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Kasztanowa 3, 41-205 Sosnowiec, Poland; (I.W.-B.); (S.W.)
| | - Anna Wawrzyk
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Kasztanowa 3, 41-205 Sosnowiec, Poland; (I.W.-B.); (S.W.)
- Silesian Park of Medical Technology Kardio-Med Silesia in Zabrze, M. Curie Skłodowskiej 10C, 41-800 Zabrze, Poland
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Gennai A, Baldessin M, Melfa F, Bovani B, Camporese A, Claysset B, Colli M, Diaspro A, Russo R, Strano P, Bollero D, Capparè G, Casadei A, Gallo G, Piccolo D, Salti G, Tesauro P. Guided Superficial Enhanced Fluid Fat Injection (SEFFI) Procedures for Facial Rejuvenation: An Italian Multicenter Retrospective Case Report. Clin Pract 2023; 13:924-943. [PMID: 37623266 PMCID: PMC10453478 DOI: 10.3390/clinpract13040085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/22/2023] [Accepted: 07/03/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND The aging process starts in the center of the face, in the periocular region and around the mouth, with a combination of volume loss, tissue descent, deepened wrinkles, and the loss of skin structure and quality. Recently, several studies have demonstrated the efficacy of therapies based on autologous adipose tissue grafting, which leverages the properties of stromal vascular fraction (SVF) and adipose-derived mesenchymal stem cells (ADSCs) to accelerate the regenerative processes of the skin. This study aims to verify the ability of guided superficial enhanced fluid fat injection (SEFFI) in the facial area to correct volume loss and skin aging, proving that this standardized procedure has a very low rate of complications. METHODS We retrospectively collected data from 2365 procedures performed in Italian centers between 2019 and 2021. Guided SEFFI was performed alone or combined with cosmetic treatments, including the use of hyaluronic acid filler, suspension threads, synthetic calcium hydroxylapatite, botulin toxin, and microneedling. RESULTS guided SEFFI was used alone in more than 60% of the patients and in all facial areas. In about one-tenth of the patients, guided SEFFI was combined with a botulin toxin treatment or hyaluronic acid filling. Other procedures were used more rarely. Ecchymosis in the donor or injection sites was the most frequent adverse event but was only observed in 14.2% and 38.6% of the patients, respectively. CONCLUSIONS The guided SEFFI technique is standardized and minimally invasive, leading to very few complications. It constitutes a promising antiaging medical treatment that combines effectiveness, safety, and simplicity.
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Affiliation(s)
| | | | | | - Bruno Bovani
- Centro di Chirurgia Ambulatoriale Esculapio, 06124 Perugia, Italy;
| | | | | | | | - Alberto Diaspro
- Rigeneralab Centre for Regenerative Medicine Torino, 10134 Torino, Italy;
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Jin Y, Li S, Yu Q, Chen T, Liu D. Application of stem cells in regeneration medicine. MedComm (Beijing) 2023; 4:e291. [PMID: 37337579 PMCID: PMC10276889 DOI: 10.1002/mco2.291] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 04/25/2023] [Accepted: 05/08/2023] [Indexed: 06/21/2023] Open
Abstract
Regeneration is a complex process affected by many elements independent or combined, including inflammation, proliferation, and tissue remodeling. Stem cells is a class of primitive cells with the potentiality of differentiation, regenerate with self-replication, multidirectional differentiation, and immunomodulatory functions. Stem cells and their cytokines not only inextricably linked to the regeneration of ectodermal and skin tissues, but also can be used for the treatment of a variety of chronic wounds. Stem cells can produce exosomes in a paracrine manner. Stem cell exosomes play an important role in tissue regeneration, repair, and accelerated wound healing, the biological properties of which are similar with stem cells, while stem cell exosomes are safer and more effective. Skin and bone tissues are critical organs in the body, which are essential for sustaining life activities. The weak repairing ability leads a pronounced impact on the quality of life of patients, which could be alleviated by stem cell exosomes treatment. However, there are obstacles that stem cells and stem cells exosomes trough skin for improved bioavailability. This paper summarizes the applications and mechanisms of stem cells and stem cells exosomes for skin and bone healing. We also propose new ways of utilizing stem cells and their exosomes through different nanoformulations, liposomes and nanoliposomes, polymer micelles, microspheres, hydrogels, and scaffold microneedles, to improve their use in tissue healing and regeneration.
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Affiliation(s)
- Ye Jin
- School of PharmacyChangchun University of Chinese MedicineChangchunJilinChina
| | - Shuangyang Li
- School of PharmacyChangchun University of Chinese MedicineChangchunJilinChina
| | - Qixuan Yu
- School of PharmacyChangchun University of Chinese MedicineChangchunJilinChina
| | - Tianli Chen
- School of PharmacyChangchun University of Chinese MedicineChangchunJilinChina
| | - Da Liu
- School of PharmacyChangchun University of Chinese MedicineChangchunJilinChina
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Jarząbek‐Perz S, Dziedzic M, Kołodziejczak A, Rotsztejn H. Split-face evaluation: Gluconolactone plus oxybrasion versus gluconolactone plus microneedling. The effects on skin parameters. Skin Res Technol 2023; 29:e13353. [PMID: 37357656 PMCID: PMC10209840 DOI: 10.1111/srt.13353] [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: 04/27/2023] [Accepted: 05/05/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND The application of polyhydroxy acids and alpha-hydroxy acids to the skin is often used in cosmetology. To enhance the effect of gluconolactone chemical peeling, a combined method including water-oxygen oxybrasion or microneedle mesotherapy can be used. OBJECTIVES To evaluate skin parameters such as hydration, sebum, pH and TEWL after application of a 10% gluconolactone chemical peel in combination with oxybrasion and microneedling. MATERIALS AND METHODS Twenty-one Caucasian women participated in the study. A series of three split face treatments was carried out at 1-week intervals. Oxybrasion was performed on the right side of the face and micro-needle mesotherapy on the left side. A 10% gluconolactone solution was applied to the entire face. Before the first and third treatments and 2 weeks after the last treatment, skin parameters were evaluated. Photographic documentation was also made before and after the treatment series. RESULTS AND CONCLUSION Evaluation of skin parameters using Courage & Khazaka 580 Multi Probe Adapter probes (Courage + Khazaka electronic GmbH, Cologne, Germany) showed an increase in hydration and a decrease in sebum, pH and TEWL for both treatments. There were no statistically significant differences between the treatments. Combining chemical peeling of gluconolactone with oxybrasion and microneedle mesotherapy is a good method to seal the hydrolipid barrier and increase skin hydration.
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Affiliation(s)
- Sylwia Jarząbek‐Perz
- Department of Cosmetology and Aesthetic Dermatology, Faculty of PharmacyMedical University of LodzLodzPoland
| | - Marta Dziedzic
- Department of Cosmetology and Aesthetic Dermatology, Faculty of PharmacyMedical University of LodzLodzPoland
| | - Anna Kołodziejczak
- Department of Cosmetology and Aesthetic Dermatology, Faculty of PharmacyMedical University of LodzLodzPoland
| | - Helena Rotsztejn
- Department of Cosmetology and Aesthetic Dermatology, Faculty of PharmacyMedical University of LodzLodzPoland
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7
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Dong R, Jin Q, Zhi J, Luo Y, Yuan J, Pi L, Nan M, Jin Z, Jin C. Mussel adhesive protein treatment delivered by microneedling for sensitive skin: A clinical study. J Cosmet Dermatol 2023; 22:1835-1843. [PMID: 36718821 DOI: 10.1111/jocd.15645] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/28/2022] [Accepted: 01/10/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Mussel adhesive protein (MAP) is extracted from the mycelial glands of marine mussels. It has anti-inflammatory properties and may relieve skin itching and other symptoms. AIMS Based on the anti-inflammatory effect of MAP, this study was designed to treat sensitive skin (SS) using MAP delivered by skin microneedling. PATIENTS/METHODS Twenty-three Chinese female patients with SS were enrolled. Treatments were delivered three times at one-month intervals. Symptom improvement and recurrence rates, treatment safety, and patient satisfaction levels were evaluated. RESULTS After one course of treatment, 20 patients had a Symptom Score Reducing Index (SSRI) of >20%, with an effectiveness rate of 87%. At the end of treatment, all patients had an SSRI of >20%, and the effectiveness rate was 100%. Dryness, tightness, desquamation, flushing, burning, itching, and tingling improved. After treatment, the Clinical Erythema Assessment and Lesion Severity Index of Facial Telangiectasia scores were significantly decreased. Clinical photographs following treatment revealed improved erythema reaction and decreased capillary density. During treatment, the patients experienced mild pain and erythema and swelling reaction without exudation. Complications, such as pigmentation changes or scarring, were absent. Additionally, there were no cases of recurrence, and patient satisfaction levels were high. CONCLUSION MAP combined with microneedling can help treat SS, showing satisfactory safety outcomes and high patient satisfaction.
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Affiliation(s)
- Richeng Dong
- Department of Dermatology, Suzhou Mylike Cosmetic Hospital, Suzhou, China
| | - Qingmei Jin
- Department of Dermatology, Suzhou Mylike Cosmetic Hospital, Suzhou, China
| | - Jiahui Zhi
- Department of Dermatology, Suzhou Mylike Cosmetic Hospital, Suzhou, China
| | - Yinli Luo
- Department of Medical Cosmetology, Yanbian University Hospital, Yanji, China
| | - Jiachen Yuan
- Department of Medical Cosmetology, Yanbian University Hospital, Yanji, China
| | - Longquan Pi
- Department of Medical Cosmetology, Yanbian University Hospital, Yanji, China
| | - Meilan Nan
- Department of Medical Cosmetology, Yanbian University Hospital, Yanji, China
| | - Zhehu Jin
- Department of Medical Cosmetology, Yanbian University Hospital, Yanji, China
| | - Chenglong Jin
- Department of Dermatology, Suzhou Mylike Cosmetic Hospital, Suzhou, China
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8
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Salem RM, Salah SAE, Ibrahim SE. Microbotox injection versus its topical application following microneedling in the treatment of wide facial pores: A split face comparative study. J Cosmet Dermatol 2023; 22:1249-1255. [PMID: 36606384 DOI: 10.1111/jocd.15590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/01/2022] [Accepted: 12/11/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Enlarged facial pores and seborrhea are common cosmetic problems. Mesobotox has been proved to be effective safe therapeutic option. OBJECTIVE To compare the efficacy and longevity of intradermal mesobotox injection versus its topical application with microneedling for treatment of wide facial pores and seborrhea. MATERIALS AND METHODS This split face study was conducted on 20 patients with enlarged facial pores and seborrhea. One side of the face was treated with intradermal injection of botulinum toxin, the other was treated with its topical application following microneedling. Patient evaluation was performed after 1 month then after 4 months. CONCLUSION Microbotox can effectively and safely minimize enlarged facial pores with no downtime. Intradermal injection showed more patient satisfaction on the basis of greater efficacy, longevity of treatment than its topical application following microneedling.
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Affiliation(s)
| | | | - Samah Ezzat Ibrahim
- Dermatology and Andrology, Faculty of Medicine-Benha University, Benha, Egypt
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9
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Liu X, Barresi R, Kaminer M, Qian K, Thillou F, Bataillon M, Liao IC, Zheng Q, Bouez C. Utilization of ex vivo tissue model to study skin regeneration following microneedle stimuli. Sci Rep 2022; 12:18115. [PMID: 36302808 PMCID: PMC9613915 DOI: 10.1038/s41598-022-22481-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 10/14/2022] [Indexed: 12/30/2022] Open
Abstract
Microneedling is a popular skin resurfacing and rejuvenation procedure. In order to develop better adjunct products for consumers, there is a scientific need to establish greater understanding of the mechanism in which microneedling stimulates regeneration within skin. The purpose of this study is to develop a physiologically relevant ex vivo tissue model which closely mimics the actual microneedling procedure to elucidate its mechanism of action. In this study, human ex vivo skin was subjected to microneedling treatment and cultured for 6 days. Histological analysis demonstrated that the ex vivo skin was able to heal from microneedling injury throughout the culture period. Microneedling treatment stimulated proliferation and barrier renewal of the skin. The procedure also increased the levels of inflammatory cytokines and angiogenic growth factors in a dynamic and time dependent fashion. The tissue demonstrated hallmark signs of epidermal regeneration through morphological and molecular changes after the treatment. This is one of the first works to date that utilizes microneedled ex vivo skin to demonstrate its regenerative behavior. Our model recapitulates the main features of the microneedling treatment and enables the evaluation of future cosmetic active ingredients used in conjunction with microneedling.
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Affiliation(s)
- Xue Liu
- L’Oreal Research and Innovation, Clark, NJ USA
| | | | | | - Kun Qian
- L’Oreal Research and Innovation, Clark, NJ USA
| | | | | | | | - Qian Zheng
- L’Oreal Research and Innovation, Clark, NJ USA
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10
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Kirkby M, Sabri AB, Scurr D, Moss G. Microneedle-Mediated Permeation Enhancement of Chlorhexidine Digluconate: Mechanistic Insights Through Imaging Mass Spectrometry. Pharm Res 2022; 39:1945-1958. [PMID: 35689005 PMCID: PMC9314308 DOI: 10.1007/s11095-022-03309-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/27/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Chlorhexidine digluconate (CHG) is a first-line antiseptic agent typically applied to the skin as a topical solution prior to surgery due to its efficacy and safety profile. However, the physiochemical properties of CHG limits its cutaneous permeation, preventing it from reaching potentially pathogenic bacteria residing within deeper skin layers. Thus, the utility of a solid oscillating microneedle system, Dermapen®, and a CHG-hydroxyethylcellulose (HEC) gel were investigated to improve the intradermal delivery of CHG. METHODS Permeation of CHG from the commercial product, Hibiscrub®, and HEC-CHG gels (containing 1% or 4% CHG w/w) was assessed in intact skin, or skin that had been pre-treated with microneedles of different array numbers, using an Franz diffusion cells and Time-of-Flight Secondary Ion Mass Spectrometry (ToF-SIMS). RESULTS Gels containing 1% and 4% CHG resulted in significantly increased depth permeation of CHG compared to Hibiscrub® (4% w/v CHG) when applied to microneedle pre-treated skin, with the effect being more significant with the higher array number. ToF-SIMS analysis indicated that the depth of dermal penetration achieved was sufficient to reach the skin strata that typically harbours pathogenic bacteria, which is currently inaccessible by Hibiscrub®, and showed potential lateral diffusion within the viable epidermis. CONCLUSIONS This study indicates that HEC-CHG gels applied to microneedle pre-treated skin may be a viable strategy to improve the permeation CHG into the skin. Such enhanced intradermal delivery may be of significant clinical utility for improved skin antisepsis in those at risk of a skin or soft tissue infection following surgical intervention.
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Affiliation(s)
- Melissa Kirkby
- School of Pharmacy and Bioengineering, Keele University, Keele, ST5 5BG, UK
| | - Akmal Bin Sabri
- School of Pharmacy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
- School of Pharmacy, Medical Biology Centre, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK
| | - David Scurr
- School of Pharmacy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Gary Moss
- School of Pharmacy and Bioengineering, Keele University, Keele, ST5 5BG, UK.
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11
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Pająk J, Szepietowski JC, Nowicka D. Prevention of Ageing-The Role of Micro-Needling in Neck and Cleavage Rejuvenation: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159055. [PMID: 35897441 PMCID: PMC9332435 DOI: 10.3390/ijerph19159055] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/12/2022] [Accepted: 07/15/2022] [Indexed: 11/18/2022]
Abstract
Although interest in aesthetic medicine is growing, the focus is often placed outside of the facial area, namely on the skin of the neck and cleavage. Exposure to the sun and muscle movements cause the prompt development of wrinkles that may appear there, even before they show up on the face. We conducted a literature review devoted to micro-needling to identify its role in anti-ageing treatments and to determine the gaps in current knowledge. A search in Medline identified 52 publications for neck and face micro-needling. Micro-needling is an anti-ageing procedure that involves making micro-punctures in the skin to induce skin remodelling by stimulating the fibroblasts responsible for collagen and elastin production. It can be applied to the skin of the face, neck, and cleavage. Two to four weeks should be allowed between repeated procedures to achieve an optimal effect. The increase in collagen and elastin in the skin can reach 400% after 6 months, with an increase in the thickness of the stratum granulosum occurring for up to 1 year. In conclusion, micro-needling can be considered an effective and safe aesthetic medicine procedure which is conducted at low costs due to its low invasiveness, low number of adverse reactions, and short recovery time. Little evidence identified in the literature suggests that this procedure requires further research.
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Affiliation(s)
- Justyna Pająk
- Department of Dermatology, Venereology and Allergology, Wrocław Medical University, 50-368 Wroclaw, Poland; (J.P.); (J.C.S.)
| | - Jacek C. Szepietowski
- Department of Dermatology, Venereology and Allergology, Wrocław Medical University, 50-368 Wroclaw, Poland; (J.P.); (J.C.S.)
| | - Danuta Nowicka
- Department of Dermatology, Venereology and Allergology, Wrocław Medical University, 50-368 Wroclaw, Poland; (J.P.); (J.C.S.)
- Faculty of Physiotherapy, Wroclaw University of Health and Sport Sciences, 51-612 Wroclaw, Poland
- Correspondence:
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12
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Tang Z, Hu Y, Wang J, Fan Z, Qu Q, Miao Y. Current application of mesotherapy in pattern hair loss: A systematic review. J Cosmet Dermatol 2022; 21:4184-4193. [PMID: 35253335 DOI: 10.1111/jocd.14900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 01/11/2022] [Accepted: 03/01/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Ziyuan Tang
- Department of Plastic and Aesthetic Surgery Nan Fang Hospital of Southern Medical University Guangzhou Guangdong Province 510515 China
| | - Yiming Hu
- Beijing Institute of Technology Zhuhai Guangdong Province 519000 China
- Pace University New York NY10024 USA
| | - Jin Wang
- Department of Plastic and Aesthetic Surgery Nan Fang Hospital of Southern Medical University Guangzhou Guangdong Province 510515 China
| | - Zhexiang Fan
- Department of Plastic and Aesthetic Surgery Nan Fang Hospital of Southern Medical University Guangzhou Guangdong Province 510515 China
| | - Qian Qu
- Department of Plastic and Aesthetic Surgery Nan Fang Hospital of Southern Medical University Guangzhou Guangdong Province 510515 China
| | - Yong Miao
- Department of Plastic and Aesthetic Surgery Nan Fang Hospital of Southern Medical University Guangzhou Guangdong Province 510515 China
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13
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Transdermal Drug Delivery in the Pig Skin. Pharmaceutics 2021; 13:pharmaceutics13122016. [PMID: 34959299 PMCID: PMC8707795 DOI: 10.3390/pharmaceutics13122016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 12/04/2022] Open
Abstract
Transdermal delivery can be accomplished through various mechanisms including formulation optimization, epidermal stratum corneum barrier disruption, or directly by removing the stratum corneum layer. Microneedling, electroporation, a combination of both and also the intradermal injection known as mesotherapy have proved efficacy in epidermal-barrier disruption. Here we analyzed the effects of these methods of epidermal-barrier disruption in the structure of the skin and the absorption of four compounds with different characteristics and properties (ketoprofen, biotin, caffein, and procaine). Swine skin (Pietrain x Durox) was used as a human analogue, both having similar structure and pharmacological release. They were biopsied at different intervals, up to 2 weeks after application. High-pressure liquid chromatography and brightfield microscopy were performed, conducting a biometric analysis and measuring histological structure and vascular status. The performed experiments led to different results in the function of the studied molecules: ketoprofen and biotin had the best concentrations with intradermal injections, while delivery methods for obtaining procaine and caffein maximum concentrations changed on the basis of the lapsed time. The studied techniques did not produce significant histological alterations after their application, except for an observed increase in Langerhans cells and melanocytes after applying electroporation, and an epidermal thinning after using microneedles, with variable results regarding dermal thickness. Although all the studied barrier disruptors can accomplish transdermal delivery, the best disruptor is dependent on the particular molecule.
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14
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Ziaeifar E, Ziaeifar F, Mozafarpoor S, Goodarzi A. Applications of microneedling for various dermatologic indications with a special focus on pigmentary disorders: A comprehensive review study. Dermatol Ther 2021; 34:e15159. [PMID: 34657363 DOI: 10.1111/dth.15159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 10/09/2021] [Accepted: 10/13/2021] [Indexed: 11/30/2022]
Abstract
Microneedling can accelerate skin repair through numerous complex processes triggered by micro-injuries it produces on the skin surface with very thin needles. The current growth in the application of microneedling in the treatment of cutaneous diseases can be explained by its numerous effects on the skin as reported in the literature. Despite the numerous studies conducted on the application of microneedling in the treatment of skin lesions, its effects on pigmented skin lesions have remained relatively unexplored. The present review comprises an examination of the evidence for the application of microneedling in skin diseases in general and a comprehensive review of the applications of microneedling in pigmentation disorders. The review involved a search of all clinical studies, including trials, case reports, and case series, in the databases MEDLINE/PubMed and Google Scholar using the following keywords: "microneedling," "dermal needling," "percutaneous collagen induction," "skin needling," "dermaroller," and "dermatology disorder." Pertinent data were extracted from all relevant articles published from 1990 to April 2021, and focused on the application of microneedling in the treatment of pigmented skin lesions. Despite the limited number of available studies, evidence suggests the effectiveness and safety of microneedling in treating vitiligo, melasma, and periorbital hypermelanosis. It is noteworthy that the combination of any type of non-aggressive needing technique with other effective therapies (especially topical agents and mesotherapy) yields more promising therapeutic results than single therapy for melasma, dark cycles, and vitiligo as the prototype of pigmentary disorders. However, single needling therapy is significantly effective, too.
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Affiliation(s)
- Elham Ziaeifar
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine، Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Fatemeh Ziaeifar
- Department of General Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Samaneh Mozafarpoor
- Department of Dermatology, Skin Disease and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azadeh Goodarzi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine، Iran University of Medical Sciences (IUMS), Tehran, Iran
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15
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Cao Z, Jin S, Wang P, He Q, Yang Y, Gao Z, Wang X. Microneedle based adipose derived stem cells-derived extracellular vesicles therapy ameliorates UV-induced photoaging in SKH-1 mice. J Biomed Mater Res A 2021; 109:1849-1857. [PMID: 34060700 DOI: 10.1002/jbm.a.37177] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 03/17/2021] [Accepted: 03/22/2021] [Indexed: 12/18/2022]
Abstract
Extracellular vesicles from adipose derived stem cells (ADSCs-EVs) have shown immunomodulation and anti-photoaging effects; however, the skin barrier prevents their absorption via skin. Meanwhile, microneedle (MN) is a widely used and minimally invasive tool for dermal delivery of drugs, it also has neocollagenesis effect by creating tiny injuries and initiating wound healing process. To investigate the effect of MN combined with ADSCs-EVs on skin aging, photoaging in SKH-1 mice was induced by chronic exposure to ultraviolet radiation. Then the mice were treated following a split-dorsal scheme, in which one side had MN alone or MN + EVs treatment and the other side was left untreated. For the side treated with MN alone or MN + EVs, the epidermal thickness was decreased and the skin barrier function was enhanced compared with the untreated side. However, MN + EVs group showed the least wrinkles, the highest collagen density and the most organized collagen fibers among the three groups. The level of CD11b + cell infiltration was lower in MN + EVs group than that in the MN group at 3 day after the treatment. These results indicated that MN treatment alone could improve epidermal structure and function of photoaging skin, and a combination with ADSCs-EVs would accelerate the restoration of inflammation caused by MN and improve the content of collagen. In all, this study indicated that a combination of MN and topical applied ADSCs-EVs was a feasible and safe strategy to ameliorate photoaging, providing a new avenue for safe administration of EVs.
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Affiliation(s)
- Zhi Cao
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.,Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Shanghai, Tongji Univeirsity School of Medicine, Shanghai, China, China
| | - Shengkai Jin
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.,Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Shanghai, Tongji Univeirsity School of Medicine, Shanghai, China, China
| | - Peiru Wang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Qiumin He
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Yuling Yang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Zhengliang Gao
- Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Shanghai, Tongji Univeirsity School of Medicine, Shanghai, China, China.,Institute of Geriatrics (Shanghai University), Affiliated Nantong Hospital of Shanghai University (The Sixth People's Hospital of Nantong), School of Medicine, Shanghai University, Nantong, China.,Shanghai Engineering Research Center of Organ Repair, School of Medicine, Shanghai University, Shanghai, China
| | - Xiuli Wang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
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16
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Salloum A, Bazzi N, Maalouf D, Habre M. Microneedling in vitiligo: A systematic review. Dermatol Ther 2020; 33:e14297. [DOI: 10.1111/dth.14297] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/19/2020] [Accepted: 09/05/2020] [Indexed: 01/21/2023]
Affiliation(s)
- Antoine Salloum
- Department of Dermatology Saint George Hospital University Medical center Beirut Lebanon
| | - Nagham Bazzi
- Internal medicine department, Faculty of Medicine Lebanese University Beirut Lebanon
| | - Diane Maalouf
- Department of Dermatology Saint George Hospital University Medical center Beirut Lebanon
- Department of Dermatology, Faculty of Medicine Balamand University Beirut Beirut Lebanon 1003 Lebanon
| | - Maya Habre
- Department of Dermatology Saint George Hospital University Medical center Beirut Lebanon
- Department of Dermatology, Faculty of Medicine Balamand University Beirut Beirut Lebanon 1003 Lebanon
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17
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Kamila MZP, Helena R. The effectiveness of ferulic acid and microneedling in reducing signs of photoaging: A split-face comparative study. Dermatol Ther 2020; 33:e14000. [PMID: 32654286 DOI: 10.1111/dth.14000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/05/2020] [Accepted: 07/08/2020] [Indexed: 11/30/2022]
Abstract
Photoaging is closely related to ultraviolet-induced oxidative stress. Ferulic acid is a plant-based antioxidant with antiaging activity. Combining ferulic acid peel with microneedling enhances its transdermal penetration. This study was designed to evaluate the efficacy of 14% ferulic acid peel combined with microneedling for facial photoaging. Sixteen women aged 45 to 60 years with Fitzpatrick skin types II and III were enrolled in this trial. All patients received eight treatment sessions with a full face application of chemical peeling based on 14% ferulic acid in 1-week intervals. During each session, on the right half of patient's face, peeling application was followed by microneedling. Efficacy was measured using Multi Probe Adapter (Courage + Khazaka electronic). The measurement of hydration, elasticity, melanin index, and erythema index were taken before treatments, after eighth session and 1 month after the last application. The objective evaluation showed statistically significant improvement in all measured skin parameters (P < .05), after ferulic acid peel application, as well as ferulic acid peel followed by microneedling. Combined therapy showed significantly greater improvement especially in skin elasticity, comparing to peeling administered alone. Ferulic acid has a significant bleaching, antiredness, smoothing, and moisturizing activity. When combined with microneedling, the efficiency is increased, in particular regarding skin elasticity.
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Affiliation(s)
- Master Zduńska-Pęciak Kamila
- Chair of Cosmetology, Department of Cosmetology and Aesthetic Dermatology, Faculty of Pharmacy, Medical University of Łódź, Łódź, Poland
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18
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Sabri A, Ogilvie J, McKenna J, Segal J, Scurr D, Marlow M. Intradermal Delivery of an Immunomodulator for Basal Cell Carcinoma; Expanding the Mechanistic Insight into Solid Microneedle-Enhanced Delivery of Hydrophobic Molecules. Mol Pharm 2020; 17:2925-2937. [PMID: 32510228 DOI: 10.1021/acs.molpharmaceut.0c00347] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Basal cell carcinoma (BCC) is the most common cutaneous malignancy in humans. One of the most efficacious drugs used in the management of BCC is the immunomodulator, imiquimod. However, imiquimod has physiochemical properties that limit its permeation to reach deeper, nodular tumor lesions. The use of microneedles may overcome such limitations and promote intradermal drug delivery. The current work evaluates the effectiveness of using an oscillating microneedle device Dermapen either as a pre- or post-treatment with 5% w/w imiquimod cream application to deliver the drug into the dermis. The effectiveness of microneedles to enhance the permeation of imiquimod was evaluated ex vivo using a Franz cell setup. After a 24-h permeation experiment, sequential tape strips and vertical cross-sections of the porcine skin were collected and analyzed using time-of-flight secondary ion mass spectrometry (ToF-SIMS). In addition, respective Franz cell components were analyzed using high-performance liquid chromatography (HPLC). Analysis of porcine skin cross-sections demonstrated limited dermal permeation of 5% w/w imiquimod cream. Similarly, limited dermal permeation was also seen when 5% w/w imiquimod cream was applied to the skin that was pretreated with the Dermapen, this is known as poke-and-patch. In contrast, when the formulation was applied first to the skin prior to Dermapen application, this is known as patch-and-poke, we observed a significant increase in intradermal permeation of imiquimod. Such enhancement occurs immediately upon microneedle application, generating an intradermal depot that persists for up to 24 h. Intradermal colocalization of isostearic acid, an excipient in the cream, with imiquimod within microneedle channels was also demonstrated. However, such enhancement in intradermal delivery of imiquimod was not observed when the patch-and-poke strategy was used with a non-oscillating microneedle applicator, the Dermastamp. The current work highlights that using the patch-and-poke approach with an oscillating microneedle pen may be a viable approach to improve the current treatment in BCC patients who would prefer a less invasive intervention relative to surgery.
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Affiliation(s)
- Akmal Sabri
- School of Pharmacy, University of Nottingham, Nottingham NG72RD, United Kingdom
| | - Jane Ogilvie
- Walgreens Boots Alliance, Thane Road, Nottingham NG90 1BS, United Kingdom
| | - John McKenna
- Leicester Royal Infirmary University Hospitals Leicester Dermatology Department, Infirmary Square, Leicester LE1 5WW, United Kingdom
| | - Joel Segal
- Department of Mechanical, Materials and Manufacturing Engineering, Faculty of Engineering, University of Nottingham, Nottingham NG8 1BB, United Kingdom
| | - David Scurr
- School of Pharmacy, University of Nottingham, Nottingham NG72RD, United Kingdom
| | - Maria Marlow
- School of Pharmacy, University of Nottingham, Nottingham NG72RD, United Kingdom
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19
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Mazzuco R. Subcision™ plus poly-l-lactic acid for the treatment of cellulite associated to flaccidity in the buttocks and thighs. J Cosmet Dermatol 2020; 19:1165-1171. [PMID: 32176410 DOI: 10.1111/jocd.13364] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 02/07/2020] [Accepted: 02/24/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is a growing demand for procedures to treat cellulite. Subcision™ is widely used for cellulite correction, and injectable poly-L-lactic acid (PLLA) has been shown to be an effective option for various body conditions. AIMS Present the results of combining Subcision™ plus PLLA, in the same session, in patients with cellulite and flaccidity. PATIENTS/METHODS Twenty-four women underwent Subcision™ followed by PLLA injections. An expert panel of dermatologists evaluated before and after photographs according to Global Aesthetic Improvement Scale (GAIS). Patients also answered a satisfaction questionnaire. RESULTS The author describes the results, as well as number of sessions and dose used. The most frequent GAIS score was "great improvement." No nodules or granulomas appeared in the treated areas. CONCLUSION The combination of Subcision™ plus PLLA, in the same treatment session, promotes safe and desirable results for cellulite associated with flaccidity.
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20
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Minh PPT, Bich DD, Hai VNT, Van TN, Cam VT, Khang TH, Gandolfi M, Satolli F, Feliciani C, Tirant M, Vojvodic A, Lotti T. Microneedling Therapy for Atrophic Acne Scar: Effectiveness and Safety in Vietnamese Patients. Open Access Maced J Med Sci 2019; 7:293-297. [PMID: 30745984 PMCID: PMC6364723 DOI: 10.3889/oamjms.2019.098] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 01/16/2019] [Accepted: 01/17/2019] [Indexed: 01/21/2023] Open
Abstract
AIM To evaluate the effectiveness and safety of micro-needling therapy in atrophic acne scar treatment. METHOD A prospective, single centred study was implemented in a total of 31 patients suffering from atrophic acne scar grade 2 to 4 of Goodman and Baron scaring grading system was recruited. They were treated by microneedle derma roller every week in 3 months. The scars were evaluated by a magic system camera and by dermatologists clinically using Goodman and Baron scaring grading system, and Lipper and Perez score at baseline, at final treatment, 1 month and 2 months after the final treatment. RESULTS The results showed improvement in all patients. The mean of Goodman and Barron's grade was decreased from 3.29 ± 0.59 at baseline, 2.23 ± 0.56 at final treatment, 1.93 ± 0.58 one month after the completion of therapy and to 1.77 ± 0.57 two months after the completion of therapy (with the p-value < 0.05). Similarly, Lipper and Perez score also dropped significantly from 36.48 ± 12.07 at baseline to 23.16 ± 15.01 at final treatment, to 17.83 ± 7.00 one month after the final treatment and to 16.37 ± 7.29 at two months after the final treatment (p-value < 0.05). Skin roughness and hyperpigmented spots got improved significantly. History of having nodular-cystic or vulgaris acne did not affect the effectiveness of the therapy. Side effects of the therapy were burning sensation, erythema but they were very mild and recovered in 1-2 days. No severe complication and post-inflammatory hyperpigmentation were noted. 83.3% of the patients satisfied after the completion of the therapy. CONCLUSION Skin needling is an effective and safe method for the treatment of atrophic acne scars.
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Affiliation(s)
| | - Diep Dang Bich
- National Hospital of Dermatology and Venereology, Hanoi, Vietnam
| | | | - Thuong Nguyen Van
- National Hospital of Dermatology and Venereology, Hanoi, Vietnam
- Dermatology and Venereology Faculty, Hanoi Medical University, Vietnam
| | - Van Tran Cam
- National Hospital of Dermatology and Venereology, Hanoi, Vietnam
| | - Tran Hau Khang
- National Hospital of Dermatology and Venereology, Hanoi, Vietnam
- Dermatology and Venereology Faculty, Hanoi Medical University, Vietnam
| | | | | | | | - Michael Tirant
- University of Rome G. Marconi, Rome, Italy
- Psoriasis Eczema Clinic, Melbourne, Australia
| | - Aleksandra Vojvodic
- Department of Dermatology and Venereology, Military Medical Academy of Belgrade, Belgrade, Serbia
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