Split-scalp pilot study to evaluate effectiveness of Minoxidil 0,5% MMP® versus Topical Minoxidil 5% in the treatment of Female Pattern Hair Loss

Female Pattern Hair Loss (FPHL) is a common form of non-scaring hair loss that occurs in adult women. Although several treatments have already been proposed for FPHL, only Topical Minoxidil accumulated an adequate level of evidence. This study aimed to evaluate the therapeutic response of MMP® (intradermal infiltration) of Minoxidil formulation in the frontal-parietal-vertex regions compared with the gold-standard home administration of Minoxidil 5% Capillary Solution. This self-controlled comparative study evaluated 16 FPHL patients, without treatment for at least 6 months, confirmed by trichoscopy with TrichoLAB® software. They received 4 monthly sessions of MMP® with Minoxidil 0,5% on the right side of the scalp (frontal-parietal-vertex areas), followed by occlusion with plastic film for 12 h and prescription of Minoxidil 5% Solution for home use once a day, on both scalp sides, starting 72 h after the procedure. The reassessment trichoscopy was 6 weeks after the last session and they answered a "self-assessment" questionnaire. Treated scalp areas were compared and showed both treatments, in general, were effective, with no difference between them. If they were analyzed separately by treated areas, there were signs of better response in the parietal-vertex regions with treatment by MMP® with Minoxidil, while clinical treatment indicated a better response in the other regions. When patients were divided into more and less advanced cases, a better response in parietal-vertex regions treated by MMP® with Minoxidil in less advanced patients was confirmed. MMP® with Minoxidil showed a better response in the parietal-vertex regions in less advanced FPHL patients. It represents yet another resource to improve quality of life of these suffering patients.

Lessons learned in a decade: Medical-toxicological view of tattooing

Tattooing has been part of the human culture for thousands of years, yet only in the past decades has it entered the mainstream of the society. With the rise in popularity, tattoos also gained attention among researchers, with the aim to better understand the health risks posed by their application. 'A medical-toxicological view of tattooing'-a work published in The Lancet almost a decade ago, resulted from the international collaboration of various experts in the field. Since then, much understanding has been achieved regarding adverse effects, treatment of complications, as well as their regulation for improving public health. Yet major knowledge gaps remain. This review article results from the Second International Conference on Tattoo Safety hosted by the German Federal Institute for Risk Assessment (BfR) and provides a glimpse from the medical-toxicological perspective, regulatory strategies and advances in the analysis of tattoo inks.

4-Aminobenzoic acid, 2-phenoxyethanol and iodine used as tracers in a short-term in vivo-kinetics study for tattoo ink ingredients: Mass spectrometry method development and validation

Tattoos have been gaining popularity in recent years, leading to a growing interest in researching tattoo inks and the tattooing process itself. Since the exposure to soluble tattoo ink ingredients has not yet been investigated, we here present the method validation for a short-term biokinetics study on soluble tattoo ink ingredients. The three tracers 4-aminobenzoic acid (PABA), 2-phenoxyethanol (PEtOH) and iodine will be added to commercially available tattoo inks, which will subsequently be used on healthy study participants. Following the tattooing process, blood and urine will be sampled at specific time points and analysed for these tracers. For this purpose, a method using liquid chromatography separation coupled to a quadrupole time-of-flight mass spectrometer (LC-QTOF-MS) in positive and negative ESI mode for the quantification of PABA, PEtOH and selected metabolites and an inductively-coupled plasma (ICP)-MS method for the determination of iodine were developed and validated. For LC-QTOF-MS analysis, the most applicable additives for LC eluents (0.01 % formic acid for positive and 0.005 % acetic acid for negative mode) were identified. Protein precipitation with acetonitrile was chosen for sample preparation. The methods were validated for selectivity, specificity, carryover, linearity, limit of detection (LOD) and quantification (LOQ), matrix effects, accuracy and precision, stability under different conditions and dilution integrity according to national and international guidelines with an allowed maximum variation of ±15 %. The LC-QTOF-MS method met the imposed guideline criteria for most parameters, however, some metabolites showed strong matrix effects. Validation of the ICP-MS method revealed that the KED-H2 collision mode is superior to the standard analysis mode due to enhanced method accuracy. The methods were validated for the relevant matrices plasma, urine, tattoo ink and tattoo consumables and proved to be applicable for the main target substances in the short-term biokinetics study. A proof-of-concept study showed successful quantification of iodine and PABA metabolites. The PEtOH metabolite was also quantified, but showed strong matrix effects in urine. Therefore standard addition was selected as an alternative quantification method.

Chemotherapeutical treatment of basal cell carcinoma with bleomycin via microinfusion of the drug into the skin (MMP®)

BACKGROUND

Bleomycin is a chemotherapeutical drug used to treat several neoplasias, including non-melanoma skin cancer; it is effective in the treatment of basal cell carcinoma (BCC) via intralesional infiltration. Transdermal drug delivery, which includes technologies such as CO2 Laser, Dermapen, Dermaroller and MMP®, delivers the desired medication to treat skin neoplasias and also acts in skin rejuvenation.

OBJECTIVE

To treat BCC lesions using bleomycin via MMP®.

METHODS

Ninety-eight BCC lesions in different anatomical areas were treated using MMP® technology to administer and uniformly distribute bleomycin throughout the lesion and in the established safety margin.

RESULTS

The cure rate after six months was 96.94%; and recurrences were not associated with lesion size and/or depth. Adverse effects were the expected ones.

STUDY LIMITATIONS

The follow-up time was only six months.

CONCLUSION

This therapeutic route showed to be promising and effective.

Efficacy and Safety of 5-Fluorouracil Tattooing to Repigment Idiopathic Guttate Hypomelanosis: A Split-Body Randomized Trial

BACKGROUD

Idiopathic guttate hypomelanosis (IGH) is a common skin disorder with no standard treatment.

OBJECTIVE

Assess the efficacy and safety of 5-fluorouracil (5FU) compared with saline, delivered using a tattoo machine, to repigment IGH lesions.

METHODS

This split-body randomized single-blinded trial recruited adults with symmetrical IGH lesions. A tattoo machine was used to deliver 5FU in IGH lesions of 1 limb and saline in the contralateral limb. Outcomes were the number of achromic lesions 30 days after treatment compared with baseline, patient satisfaction, and local or systemic adverse events.

RESULTS

Twenty-nine patients (28 women) were included. The median number of achromic lesions decreased significantly in 5FU-treated limbs (baseline: 32, interquartile range (IQR) 23-37 × post-treatment: 12, IQR 6-18, p = .000003) and saline-treated limbs (baseline: 31, IQR 24-43 × post-treatment: 21, IQR 16-31, p = .000006), but reduction was significantly more pronounced in 5FU-treated limbs ( p = .00003). All participants were satisfied or very satisfied with results on 5FU-treated limbs. There were no adverse events.

CONCLUSION

5-fluorouracil delivery using a tattoo machine was more effective than saline to repigment IGH lesions, with high patient satisfaction and no adverse events.Clinicaltrials.gov : NCT02904564.

Female pattern hair loss: therapeutic update

Female androgenetic alopecia or female-pattern hair loss (FPHL) is highly prevalent and has a great impact on the quality of life. The treatment is a routine challenge in dermatological practice, as many therapeutic options have a limited level of evidence and often do not meet patients expectations. Lack of knowledge of the pathogenesis of the hair miniaturization process and the factors that regulate follicular morphogenesis restricts the prospect of innovative therapies. There is also a lack of randomized, controlled studies with longitudinal follow-up, using objective outcomes and exploring the performance of the available treatments and their combinations. Topical minoxidil, which has been used to treat female pattern hair loss since the 1990s, is the only medication that has a high level of evidence and remains the first choice. However, about 40% of patients do not show improvement with this treatment. In this article, the authors critically discuss the main clinical and surgical therapeutic alternatives for FPHL, as well as present camouflage methods that can be used in more extensive or unresponsive cases.

Low doses of 3-phenyl-lawsone or meglumine antimoniate delivery by tattooing route are successful in reducing parasite load in cutaneous lesions of Leishmania (Viannia) braziliensis-infected hamsters

Current therapeutic ways adopted for the treatment of leishmaniasis are toxic and expensive including parasite resistance is a growing problem. Given this scenario, it is urgent to explore treatment alternatives for leishmaniasis. The aim of this study was to evaluate the effect of 3-phenyl-lawsone (3-PL) naphthoquinone on Leishmania (Viannia) braziliensis infection, both in vitro and in vivo, using two local routes of administration: subcutaneous (higher dose) and tattoo (lower dose). In vitro 3-PL showed low toxicity for macrophages (CC₅₀ >3200 µM/48h) and activity against intracellular amastigotes (IC₅₀ = 193 ± 19 µM/48h) and promastigotes (IC₅₀ = 116 ± 26 µM/72h), in which induced increased ROS generation. Additionally, 3-PL up-regulated the production of cytokines such as tumor necrosis factor alpha (TNF-α), monocyte chemotactic protein 1 (MCP-1), interleukin-6 (IL-6) and IL-10 in infected macrophages. However, the anti-amastigote action was independent of nitric oxide production. Treatment of hamsters infected with L. (V.) braziliensis from one week after infection with 3-PL by subcutaneous (25 µg/Kg) or tattooing (2.5 µg/Kg) route, during 3 weeks (3 times/week) or 2 weeks (2 times/week) significantly decreased the parasite load (p<0.001) in the lesion. The reduction of parasite load by 3-PL treatment was comparable to reference drug meglumine antimoniate administered by the same routes (subcutaneous 1mg/Kg and tattoo 0.1mg/Kg). In addition, treatment started from five weeks after infection with 3-PL per tattoo also decreased the parasite load. These results show the anti-leishmanial effect of 3-PL against L. (V.) braziliensis and its efficacy by subcutaneous (higher dose) and tattoo (lower dose) routes. In addition, this study shows that drug delivery by tattooing the lesion allows the use of lower doses than the conventional subcutaneous route, which may support the development of a new therapeutic strategy that can be adopted for leishmaniasis.

Minimally invasive procedures for the management of female pattern hair loss

BACKGROUND

Female Pattern Hair Loss (FPHL) is one of the most common types of hair loss in women. It is characterized by progressive follicular miniaturization leading to diffuse hair thinning over the midfrontal scalp with a negative impact on quality of life. Pharmacological treatments are commonly used, and hair follicle transplantation is an option for those cases with adequate donor area. Minimally invasive procedures, such as microneedling, mesotherapy, microinfusion of drugs into the scalp with tattoo machines (MMP®), and platelet-rich plasma (PRP) have been reported as adjuvant treatments.

AIMS

This study aims to summarize and discuss the efficacy of minimally invasive procedures described for the management of FPHL.

METHODS

Published articles indexed on the Pubmed database and Scopus that described minimally invasive procedures for the management of FPHL in humans were considered. Citations were reviewed and added for completeness. The search was for articles in English only. After excluding duplicate titles, 23 relevant articles were considered.

CONCLUSION

Minimally invasive procedures are promising options and may play a role in FPHL treatment. They can be used as adjunctive therapy for FPHL, in case of poor response to clinical therapy, or when patients prefer other care than the standard. We reinforce that these methods should be performed by an experienced medical professional following strict aseptic techniques. However, microneedling, mesotherapy, MMP, and PRP lack standardization and are supported by a low level of evidence yet. For the future, larger randomized clinical trials are essential to determine the efficacy and optimal protocols for these treatments.

Is it possible to repigment iatrogenic and traumatic hypochromic lesions? A case series using the MMP® drug delivery technique with 5-fluorouracil and bleomycin

OBJECTIVES

We present the results of 11 patients with hypochromic lesions treated with antifibrotic agents delivered through the MMP^® technique.

METHODS

Eleven patients with hypochromic lesions because of external injuries were treated at a single clinic with 5-fluorouracil (5-FU) and/or bleomycin using the MMP^® drug delivery technique. Treatment sessions were repeated at 30-day intervals until patient satisfaction. The primary outcome was repigmentation of the lesions, assessed independently by two dermatologists and by the patient.

RESULTS

The MMP^® technique injected 0.048 mg/cm² of 5-FU or 0.0028 U/cm² of bleomycin. The accumulated 5-FU and bleomycin density per patient ranged from 0.02 to 0.77 mg and 0.0022 to 0.2800 U/ml, respectively. Patients were treated with 1 to 6 MMP^® sessions with 5-FU (3 patients), bleomycin (6 patients), or both drugs (2 patients). After the last session, all patients had a significant improvement (>75%) of the lesions compared to baseline. There were no procedure-related short- or long-term adverse effects in any of the participants up to their last follow-up visit.

CONCLUSIONS

The injection of antifibrotic agents using the MMP^® technique was effective and safe in the treatment of hypochromic lesions. This can be a new therapeutic option for these lesions.

Successful Treatment of Alopecia Areata Patches with Triamcinolone Acetonide Using MMP®: Report of 2 Cases

Intralesional (IL) injection of corticosteroids is an effective treatment of alopecia areata (AA). A novel drug delivery technique that uses a tattoo machine (MMP®) has been successfully used to treat other skin disorders. We tested this technique to treat AA. We used the Cheyenne dermopigmentation machine (Anvisa 80281110016; Germany) with a 27 Magnum needle cartridge (Anvisa 80281110015) at a frequency of 70 Hz and needle depth of 1.0 mm. A triamcinolone acetonide (TAC) solution was placed in a sterile receptacle and loaded onto the cartridge by capillarity. We produced micropunctures of the skin with the medication-soaked needles until the affected area was covered by a bloody dew. Case 1: J.C.V., a male, with a diagnosis of AA in patches was treated with 1-monthly session with 2.5 mg/mL TAC delivered by MMP® (4 sessions in total). Case 2: L.M.V., a 78-year-old female with a diagnosis of AA was treated with 1-monthly session with 10 mg/mL TAC delivered by MMP® (4 sessions in total). MMP® is a novel technique that combines microneedling with drug delivery, and it could be used to deliver IL TAC to AA patients. This technique promotes a more uniform absorption of corticosteroids than traditional treatment methods of AA.

Safety of tattoos and permanent make-up: a regulatory view

The continuous increase in the popularity of tattoos and permanent make-up (PMU) has led to substantial changes in their societal perception. Besides a better understanding of pathological conditions associated with the injection of highly diverse substances into subepidermal layers of the skin, their regulation has occupied regulatory bodies around the globe. In that sense, current regulatory progress in the European Union is an exemplary initiative for improving the safety of tattooing. On one hand, the compilation of market surveillance data has provided knowledge on hazardous substances present in tattoo inks. On the other hand, clinical data gathered from patients enabled correlation of adverse reactions with certain substances. Nevertheless, the assessment of risks remains a challenge due to knowledge gaps on the biokinetics of highly complex inks and their degradation products. This review article examines the strategies for regulating substances in tattoo inks and PMU in light of their potential future restriction in the frame of the REACH regulation. Substance categories are discussed in terms of their risk assessment and proposed concentration limits.

Original Method to Repigment Achromic Laser Tattoo Removal Scars

Laser tattoo removal is expensive, painful, and time-consuming. Even with the use of the right laser equipment, it is often impossible to eliminate all pigments. Incomplete tattoo removal, one of the undesired effects of laser treatment, is widely disseminated in the media and accepted by most patients. However, few patients know that laser tattoo removal can cause permanent scars. Some patients who develop achromic scars can feel disappointed with the results of laser tattoo removal and take legal action against the physician responsible for the treatment. This paper describes our experience with a drug delivery treatment called MMP® (“Microinfusão de Medicamentos na Pele,” Portuguese acronym for “Microinfusion of Drugs in the Skin”) that repigments and improves the final esthetic results of achromic laser tattoo removal scars.