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Koza E, Ma MS, Ahmed A, Haq M, Shi VJ, Whiting D, Paghdal K, Weil A, Voravutinon N, Roongpisuthipong W, Poon E, Alam M. A comparison of 1550-nm fractional photothermolysis versus intense focused ultrasound for treatment of periorbital wrinkles: a randomized control trial. J Am Acad Dermatol 2024; 90:1035-1037. [PMID: 38211707 DOI: 10.1016/j.jaad.2023.12.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/15/2023] [Accepted: 12/23/2023] [Indexed: 01/13/2024]
Affiliation(s)
- Eric Koza
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Melissa S Ma
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Areeba Ahmed
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Misha Haq
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Victoria J Shi
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Dennis Whiting
- Department of Dermatology, The University of Chicago, Chicago, Illinois
| | - Kapila Paghdal
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Alexandra Weil
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Nataya Voravutinon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Wanjarus Roongpisuthipong
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Division of Dermatology, Department of Medicine, Vajira Hospital, Navamindrahiraj University, Bangkok, Thailand
| | - Emily Poon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Murad Alam
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
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Alam M, Hughart R, Champlain A, Geisler A, Paghdal K, Whiting D, Hammel JA, Maisel A, Rapcan MJ, West DP, Poon E. Effect of Platelet-Rich Plasma Injection for Rejuvenation of Photoaged Facial Skin: A Randomized Clinical Trial. JAMA Dermatol 2019; 154:1447-1452. [PMID: 30419125 DOI: 10.1001/jamadermatol.2018.3977] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance There remains little experimental evidence and no randomized clinical trial to date to confirm the benefit of platelet-rich plasma (PRP) for facial rejuvenation. Objective To investigate whether PRP injection improves the visual appearance, including texture and color, of photodamaged facial skin. Design, Setting, and Participants In this randomized clinical trial, participants and raters were masked to groupings. The setting was an academic-based, urban outpatient dermatology practice in Chicago, Illinois. Participants were adults aged 18 to 70 years with bilateral cheek rhytids of Glogau class II or greater. The duration of the study was August 21, 2012, to February 16, 2016. Interventions Each participant received 3 mL intradermal injections of PRP to one cheek and sterile normal saline to the contralateral cheek. Main Outcomes and Measures Primary outcomes were photoaging scores (with subscores for fine lines, mottled pigmentation, roughness, and sallowness) as rated by 2 masked dermatologists. Secondary outcomes included participant self-assessment scores of improvement on a 5-point scale (worsening, no change, mild improvement, moderate improvement, or significant improvement), participant overall satisfaction scores on a 4-point scale (not satisfied, slightly satisfied, moderately satisfied, or very satisfied), and participant-reported or investigator-observed adverse events. Results Of 27 enrolled participants, 19 (mean [SD] age, 46.37 [10.88] years; 17 female) were analyzed. Reported adverse events, which were not associated with the study agent, included redness (n = 18), swelling (n = 16), bruising (n = 14), pruritus (n = 1), skin scaling (n = 1), and dryness of skin (n = 1). No participants reported any adverse events at 12 months. Mean (SD) photoaging scores rated by 2 dermatologists showed no significant difference between PRP and normal saline for fine lines (baseline, 1.00 [0.75] vs 1.05 [0.78]; 2 weeks, 0.95 [0.71] vs 0.95 [0.71]; 3 months, 0.95 [0.71] vs 0.95 [0.71]; 6 months, 0.95 [0.71] vs 0.95 [0.71]), mottled pigmentation (baseline, 1.21 [0.53] vs 1.21 [0.54]; 2 weeks, 1.16 [0.60] vs 1.16 [0.60]; 3 months, 1.00 [0.47] vs 1.11 [0.46]; 6 months, 1.16 [0.69] vs 1.16 [0.69]), skin roughness (baseline, 0.47 [0.61] vs 0.47 [0.61]; 2 weeks, 0.47 [0.61] vs 0.47 [0.61]; 3 months, 0.47 [0.61] vs 0.47 [0.61]; 6 months, 0.37 [0.60] vs 0.37 [0.68]), and skin sallowness (baseline, 1.11 [0.88] vs 1.11 [0.88]; 2 weeks, 0.95 [0.85] vs 0.95 [0.85]; 3 months, 0.58 [0.61] vs 0.58 [0.61]; 6 months, 0.37 [0.68] vs 0.37 [0.68]). At 6 months after a single treatment, participants rated the PRP-treated side as significantly more improved compared with normal saline for texture (mean [SD] self-assessment score, 2.00 [1.20] vs 1.21 [0.54]; P = .02) and wrinkles (mean [SD] self-assessment score, 1.74 [0.99] vs 1.21 [0.54]; P = .03). Conclusions and Relevance Masked participants noted that both fine and coarse texture improved significantly more with a single treatment of PRP than with normal saline. Both participants and raters found PRP to be nominally but not significantly superior to normal saline. Trial Registration ClinicalTrials.gov Identifier: NCT01372566.
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Affiliation(s)
- Murad Alam
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Rosemara Hughart
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Amanda Champlain
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Amelia Geisler
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Kapila Paghdal
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Dennis Whiting
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Josh A Hammel
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Amanda Maisel
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Matthew J Rapcan
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Dennis P West
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Emily Poon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Alam M, Hughart R, Geisler A, Paghdal K, Maisel A, Weil A, West DP, Veledar E, Poon E. Effectiveness of Low Doses of Hyaluronidase to Remove Hyaluronic Acid Filler Nodules: A Randomized Clinical Trial. JAMA Dermatol 2019; 154:765-772. [PMID: 29710212 DOI: 10.1001/jamadermatol.2018.0515] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance Although hyaluronidase is known to remove hyaluronic acid fillers, use of low doses has not been well studied. Objective To assess the effectiveness and dose-related effect of small quantities of hyaluronidase to treat hyaluronic acid filler nodules. Design, Setting, and Participants Split-arm, parallel-group, randomized clinical trial at an urban academic center. Participants were 9 healthy women. Recruitment and follow-up occurred from February 2013 to March 2014; data analysis occurred from February to July 2016. Interventions Each participant received aliquots (buttons) of either of 2 types of hyaluronic acid fillers into bilateral upper inner arms, respectively. At 1, 2, and 3 weeks each button was treated with a constant volume (0.1 mL) of variable-dose hyaluronidase (1.5, 3.0, or 9.0 U per 0.1 mL) or saline control. Main Outcomes and Measures Both a blinded dermatologist and the participant independently assessed detectability. Results Seventy-two treatment sites on 9 women (mean [SD] age, 45.8 [15.7] years) received all interventions and were analyzed. There was a significant difference in physician rater assessment between saline and hyaluronidase at 4 weeks (visual detection: mean difference = 1.15; 95% CI, 0.46-1.80; P < .001; palpability: mean difference = 1.22; 95% CI, 0.61-1.83; P < .001) and 4 months (visual detection: mean difference = 0.77; 95% CI, 0.33-1.26; P = .001; palpability: mean difference = 0.82; 95% CI, 0.38-1.25; P < .001) that was mirrored by participant self-assessment at 4 weeks (visual detection: mean difference = 0.87; 95% CI, 0.26-1.48; P = .006; palpability: mean difference = 1.59; 95% CI, 1.41-1.77; P < .001) and 4 months (visual detection: mean difference = 1.31; 95% CI, 1.09-1.53; P < .001; palpability: mean difference = 1.52; 95% CI, 1.03-2.01; P < .001), and hyaluronidase was associated with greater resolution of buttons compared with normal saline. The 9.0-unit hyaluronidase injection sites were significantly less palpable than the 1.5-unit sites at both 4 weeks (mean difference = 0.50; 95% CI, 0.01-.99; P = .045) and 4 months (mean difference = 0.47; 95% CI, 0.14-0.81; P = .007). Dose dependence was more notable for Restylane-L. Conclusions and Relevance Although very small doses of hyaluronidase can remove hyaluronic acid fillers from patient skin, slightly higher doses often result in more rapid resolution. Trial Registration clinicaltrials.gov Identifier: NCT01722916.
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Affiliation(s)
- Murad Alam
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Department of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Rosemara Hughart
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Amelia Geisler
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Kapila Paghdal
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Amanda Maisel
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Alexandra Weil
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Dennis P West
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Emir Veledar
- Center for Research and Grants, Baptist Health South Florida, Coral Gables.,Rollins School of Public Health, Department of Epidemiology, Emory University, Atlanta, Georgia.,School of Medicine, Department of Medicine, Emory University, Atlanta, Georgia.,Robert Stempel College of Public Health and Social Work, Department of Biostatistics, Florida International University, Miami
| | - Emily Poon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Alam M, Geisler A, Warycha M, Paghdal K, Roongpisuthipong W, Schlessinger DI, Chen BR, Reynolds KA, West DP, Poon E. Effect of postinjection facial exercise on time of onset of botulinum toxin for glabella and forehead wrinkles: A randomized, controlled, crossover clinical trial. J Am Acad Dermatol 2019; 80:1144-1147. [PMID: 30617028 DOI: 10.1016/j.jaad.2018.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 08/28/2018] [Accepted: 10/01/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Murad Alam
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
| | - Amelia Geisler
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Kapila Paghdal
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Wanjarus Roongpisuthipong
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Division of Dermatology, Department of Medicine, Vajira Hospital, Navamindrahiraj University, Bangkok, Thailand
| | - Daniel I Schlessinger
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Brian R Chen
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Dennis P West
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Emily Poon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Abstract
Reticular erythematous mucinosis (REM) is a rare cutaneous condition often referred to as plaque-like mucinosis and midline mucinosis. Although the exact etiology remains undefined, efforts to elucidate pathogenesis, disease associations, and prospective treatment modalities have been encouraging. Induction of the disease has been associated with viral processes, solar irradiation, specific cell lines, and cytokines such as Interleukin (IL)-1β. Clinically, patients typically develop erythematous macules and papules that coalesce into reticulated patterns on the midline of the chest or back. The lesions have a tendency to respond to systemic antimalarial therapy, but novel therapeutic approaches with ultraviolet A1 light (UVA1) and pulse dye laser (PDL) have been promising. Histologically, REM is associated with a mild, predominantly lymphocytic infiltrate with variable deep perivascular extension. Mucin may be seen in the upper and mid dermis and is prominent around the infiltrate and appendages. IgM deposits may be visualized under direct immunoflourescence along the basal layer. Because of the similarities between REM and tumid lupus, the two disease processes have often been grouped together. The remarkable overlap between the two diseases suggests that the two conditions may actually be the same disease.
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Affiliation(s)
- Sumeet Thareja
- Department of Dermatology and Cutaneous Surgery, University of South Florida, Tampa, USA.
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