One-Year Safety Evaluation of New Hyaluronic Acid Fillers (YYS Series): A Prospective, Multicenter, Observational Study

BACKGROUND

With the continuous increasing availability of new filler products, each hyaluronic acid filler brand has distinctive pharmacokinetics, which may be associated with different complications. Therefore, the long-term safety of new generations of fillers should be evaluated.

OBJECTIVE

This prospective, multicenter, observational, postmarketing study (ClinicalTrials.gov identifier: NCT04738019) aimed to investigate the incidence of delayed-onset nodules and adverse reactions after the injection of new hyaluronic acid fillers (YYS series) into the facial skin.

METHODS

Subjects scheduled to receive an injection YYS series filler were followed up for 52 weeks. The authors aimed to determine the incidence of a self-reported delayed-onset nodule-a visible or palpable nodule or mass at the injection site that was detected beyond the 14th day following the injection-during the 1-year follow-up period.

RESULTS

Among the 1,022 subjects who received an injection of the YYS series, the incidences of delayed-onset nodules were 0% for YYS 360, YYS 540, and YYS 720. A 0.21% incidence (1 delayed hypersensitivity reaction) of a delayed-onset adverse reaction was noted for YYS 720, although none were reported for YYS 360 and YYS 540.

CONCLUSION

In this study, a notably low frequency of adverse reactions associated with the YYS series was observed.

Efficacy and Safety of PrabotulinumtoxinA in Subjects With Benign Masseteric Hypertrophy: A Double-Blind, Randomized, Placebo-Controlled, Multicenter, Phase 3 Trial and Open-Label Extension Study

BACKGROUND

Despite the widespread use of botulinum toxin (BTX) injection for the treatment of masseter muscle hypertrophy (MMH), there is no standard treatment option.

OBJECTIVE

We report the efficacy and safety for BTX in MMH over a period of 48 weeks.

METHODS

In double-blinded, placebo-controlled phase 3 trials, 180 patients (randomized 1:1) received treatment with placebo (normal saline) or prabotulinumtoxinA (48 units). Masseter muscle thickness (at maximal clenching and resting positions), 3D imaging analysis, and masseter muscle hypertrophy scale grades were analyzed at each time point. After the 24-week CORE study, all patients who met the same criteria of the CORE study at week 24 (n = 114) received only prabotulinumtoxinA, regardless of previous treatment, for an additional 24 weeks (48 weeks in total) for the open-label extension study.

RESULTS

The largest differences in mean and percent changes from baseline in masseter muscle thickness were observed at 12 weeks, and there were significant differences between the 2 groups at all time points (all p < .001). The effect was independent of the number of injections. No serious adverse event was observed.

CONCLUSION

PrabotulinumtoxinA could effectively ameliorate MMH without major complications.

Anti-melanogenic effect of exosomes derived from human dermal fibroblasts (BJ-5ta-Ex) in C57BL/6 mice and B16F10 melanoma cells

Exosomes are involved in intercellular communication by transferring cargo between cells and altering the specific functions of the target cells. Recent studies have demonstrated the therapeutic effects of exosomes in several skin diseases. However, understanding of the effects of exosomes on anti-pigmentation is limited. Therefore, we investigated whether BJ-5ta exosomes (BJ-5ta-Ex) derived from human foreskin fibroblasts regulate melanogenesis and delineated the underlying mechanism. Interestingly, treatment with BJ-5ta-Ex induced decreased melanin content, tyrosinase (TYR) activity, and expression of melanogenesis-related genes, including microphthalmia-related transcription factor (MITF), TYR, tyrosinase-related protein-1 (TRP1), and tyrosinase-related protein-2 (TRP2). In addition, BJ-5ta-Ex downregulated the cAMP/PKA and GSK-3β/β-catenin signaling pathways and upregulated the MAPK/ERK signaling pathway. Notably, treatment with BJ-5ta-Ex inhibited α-melanocyte-stimulating hormone-induced melanosome transport and decreased the expression of key proteins involved in melanosome transport, namely, rab27a and melanophilin (MLPH). To further confirm the depigmenting effects of BJ-5ta-Ex, we conducted experiments using a three-dimensional reconstituted human full skin model and ultraviolet B (UVB)-irradiated mouse model. Treatment with BJ-5ta-Ex improved tissue brightness and reduced the distribution of melanosomes. In UVB-irradiated mouse ears, BJ-5ta-Ex reduced the number of active melanocytes and melanin granules. These results demonstrate that BJ-5ta-Ex can be useful for the clinical treatment of hyperpigmentation disorders.

Exosomes derived from human dermal fibroblasts (HDFn-Ex) alleviate DNCB-induced atopic dermatitis (AD) via PPARα

Atopic dermatitis (AD) is a chronic inflammatory skin disease. Skin barrier dysfunction is the initial step in the development of AD. Recently, exosomes have been considered as potential cell-free medicine for skin defects such as aging, psoriasis and wounds. The aim of this study was to investigate the effects of human dermal fibroblast-neonatal-derived exosome (HDFn-Ex) on AD. HDFn-Ex increased the expression of peroxisome proliferator activated receptor α (PPARα) and alleviated the 1-chloro-2,4-dinitrobenzene (DNCB)-mediated downregulation of filaggrin, involucrin, loricrin, hyaluronic acid synthase 1 (HAS1) and HAS2 in human keratinocyte HaCaT cells. However, these effects were inhibited by the PPARα antagonist GW6471. In the artificial skin model, HDFn-Ex significantly inhibited DNCB-induced epidermal hyperplasia and the decrease in filaggrin and HAS1 levels via a PPARα. In the DNCB-induced AD-like mouse model, HDFn-Ex administration reduced epidermis thickening and mast cell infiltration into the dermis compared to DNCB treatment. Moreover, the decreases in PPARα, filaggrin and HAS1 expression, as well as the increases in IgE and IL4 levels induced by DNCB treatment were reversed by HDFn-Ex. These effects were blocked by pre-treatment with GW6471. Furthermore, HDFn-Ex exhibited an anti-inflammatory effect by inhibiting the DNCB-induced increases in IκBα phosphorylation and TNF-α expression. Collectively, HDFn-Ex exhibited a protective effect on AD. Notably, these effects were regulated by PPARα. Based on our results, we suggest that HDFn-Ex is a potential candidate for treating AD by recovering skin barrier dysfunction and exhibiting anti-inflammatory activity.

Management strategies for vascular complications in hyaluronic acid filler injections: A case series analysis

BACKGROUND

As hyaluronic acid (HA) filler injections have become increasingly popular in the esthetic field, so have their side effects. Vascular complications, which can lead to skin necrosis or permanent scarring, are a particularly dangerous complication and occur when the filler is injected directly into a blood vessel or when an adjacent blood vessel is compressed by the filler material.

OBJECTIVE

To assess the clinical prognosis based on post-procedural management and clinical findings of HA filler vascular complications.

METHODS

Herein, we present a case series of vascular complications due to HA filler and evaluate their clinical prognosis based on post-procedural management and clinical findings. Clinical assessments were performed using Doppler ultrasound, thermography, and laboratory tests.

RESULTS

Factors including white blood cell count, the time of treatment initiation, and time of hyaluronidase injection influenced the clinical outcomes. Early recognition and prompt hyaluronidase injection proved crucial in preventing further damage and improving prognosis.

CONCLUSION

This case series highlights the importance of early detection and appropriate management of HA filler complications. Physicians should be aware of the potential risks associated with fillers and promptly address any adverse effects to achieve optimal clinical outcomes. Further studies are warranted to confirm these findings and refine treatment strategies for the HA filler complications.

Exosomes derived from human dermal fibroblasts protect against UVB‑induced skin photoaging

Exosomes are used as innovative treatment options for repairing skin defects, such as aging, atopic dermatitis and wounds. However, the effects of exosomes obtained from human foreskin fibroblasts BJ‑5ta (BJ‑5ta Exo) on ultraviolet B (UVB)‑mediated photoaging have not been previously reported, at least to the best of our knowledge. Therefore, the present study aimed to investigate the anti‑photoaging effects of BJ‑5ta Exo on UVB radiation in human skin fibroblasts and SKH‑1 hairless mice. The results revealed that BJ‑5ta Exo decreased the production of reactive oxygen species and inhibited the decrease in the expression levels of superoxide dismutase 1 and 2, glutathione peroxidase and catalase following UVB exposure. In addition, BJ‑5ta Exo attenuated the decrease in nuclear factor erythroid 2‑related factor 2 levels induced by UVB rays, indicating its scavenging activity against oxidative stress. Moreover, BJ‑5ta Exo inhibited the UVB‑induced increase in the levels of γH2AX, p53/21 and cleaved PARP, whereas it promoted DNA double‑strand break repair through radiation sensitive 52 and effectively activated the TGF‑β1/Smad pathway. BJ‑5ta Exo also protected against UVB‑induced senescence, as indicated by the downregulation in the levels of senescence‑associated β‑galactosidase and p16. In a mouse model of photoaging, BJ‑5ta Exo prevented the UVB‑induced increase in transepidermal water loss, wrinkle formation and MMP‑1 expression, while also suppressing the UVB‑mediated decrease in collagen type I and elastin levels in the dorsal skin. Overall, the findings of the present study suggest that BJ‑5ta Exo represent an effective anti‑photoaging agent, which can be used as a component in cosmetic products.

Long-pulsed 1,064-nm gallium arsenide laser surgical device treatment for improving symptoms of onychomycosis: a comparative analysis

BACKGROUND

Onychomycosis is the most common infective nail disease, and treatment includes topical and systemic antifungal medications. Recently, laser therapy has emerged as a therapeutic option for patients who are unable to take oral antifungal agents. We investigated the effectiveness and safety of a novel long-pulsed 1,064-nm gallium arsenide (GaAs) laser surgical device for onychomycosis.

METHODS

This 24-week single-center, single-blind, active-controlled exploratory clinical study comparatively evaluated the long-pulsed 1,064-nm GaAs laser (Healer1064) with the short-pulsed Nd:YAG laser surgical device in 20 participants randomly assigned to receive either test or control treatment at 4-week intervals during the 12-week treatment period. The rate of clinical improvement was evaluated by two independent dermatologist evaluators using the Onychomycosis Severity Index-score (OSI-score) and Turbidity Scale with standard photographs. Overall improvement and patient satisfaction were evaluated. Safety evaluation included pain intensity and adverse events.

RESULTS

In 44 (test: 25; control: 19) cases in 19 participants who completed treatment, the clinical improvement rate in the test and control groups was 52.00% (13/52 cases) and 44.44% (9/19 cases), respectively, with significantly lower pain scores in the test than the control group for every treatment visit (P < 0.05) and without severe adverse events.

CONCLUSIONS

The novel long-pulsed 1,064-nm GaAs laser showed greater, albeit nonsignificant, clinical improvement and was associated with less pain during treatment. Thus, the Healer1064 can provide satisfactory treatment outcomes through painless and effective improvement in onychomycosis symptoms.

Full-thickness skin rejuvenation by a novel dual-length microneedle radiofrequency device: A proof-of-concept study using human skin

BACKGROUND

A novel dual-length microneedle radiofrequency (DLMR) device has been developed to achieve full-thickness skin rejuvenation by stimulating the papillary and reticular dermis simultaneously. This device's dual-level targeting concept need to be validated on human skin, although its clinical efficacy has been demonstrated in a previous study.

OBJECTIVES

This study evaluated the dual-depth targeting capability and the ability to induce rejuvenation in each layer of vertical skin anatomy, that is, the epidermis, papillary dermis, and reticular dermis, using full-thickness human facial skin samples.

METHODS

Human facial skin samples were obtained from 13 Asian patients who had facelift surgery. To validate the dual-depth targeting concept, DMLR-treated skin samples were analyzed using a digital microscope, thermal imaging, and hematoloxylin and eosin (H&E) staining immediately after DLMR application. On samples stained with H&E, Masson's tricrome, and Verhoeff-Van Gieson, histological observation and morphometric analysis were performed. Total collagen assay (TCA) and quantitative real-time polymerase chain reaction (qPCR) were used to assess changes in total collagen content and mRNA expression levels of collagen types I/III and vimentin, respectively.

RESULTS

The DLMR device successfully induced thermal stimulation in the papillary and reticular dermis. The thickness, stacks, and dermal-epidermal junction convolution of the epidermis treated with DLMR were significantly increased. Collagen bundles in the dermis treated with DLMR exhibited a notable increase in thickness, density, and horizontal alignment. Dermal collagen levels were significantly higher in the morphometric and TCA data, as well as in the qPCR data for dermal matrix proteins.

CONCLUSIONS

Our DLMR device independently and precisely targeted the papillary and reticular dermis, and it appears to be an effective modality for implementing full-thickness rejuvenation.

The effect of low-intensity cold atmospheric plasma jet on photoaging-induced hyperpigmentation in mouse model

BACKGROUND

Cold atmospheric plasma (CAP) produces reactive oxygen/nitrogen species (RONS) in the target and can induce cytoprotective effects by activating hormesis-related pathways when its intensity is in the low range.

OBJECTIVES

The aim of this study is to evaluate the effect of low-intensified CAP (LICAP) on skin with photoaging-induced hyperpigmentation in an animal model.

METHODS

Changes in cell viability and RONS production following LICAP treatment were measured. For the in vivo study, 30 hairless mice underwent antecedent photoaging induction followed by the allocated therapy (i.e., LICAP, topical ascorbic acid (AA), or both). During the first 4 weeks of the treatment period (8 weeks), ultraviolet (UV)-B irradiation was concurrently administered. Visual inspection and measurement of the melanin index (MI) were performed to assess the change in skin pigmentation at Weeks 0, 2, 4, 6, and 8.

RESULTS

RONS production increased linearly until the saturation point. Cell viability was not significantly affected by LICAP treatment. At Week 8, MI was significantly decreased in every treatment group compared with the values at Week 0 and Week 4. The treatment effect of the concurrent therapy group was superior to that of the LICAP and AA groups.

CONCLUSION

LICAP appears to be a novel modality for photoprotection and pigment reduction in photodamaged skin. LICAP treatment and topical AA application seem to exert a synergistic effect.

Efficacy and safety of oral palmitoleic acid supplementation for skin barrier improvement: A 12-week, randomized, double-blinded, placebo-controlled study

Background

Palmitoleic acid (omega-7) has been reported to be effective primarily for metabolic disorders. Recently, it has been reported to help improve quality of life (QoL) by improving skin symptoms.

Objective

The aim of this randomized, double-blinded, placebo-controlled clinical study is to evaluate the efficacy and safety of oral palmitoleic acid in improving skin barrier, elasticity, and wrinkle formation in adult women.

Methods

In this randomized, double-blind, placebo-controlled clinical study, 90 healthy participants were enrolled and received 500 mg/day palmitoleic acid (intervention) or corn oil without palmitoleic acid (control) for 12 weeks. Skin hydration and transepidermal water loss and skin elasticity, surface roughness, eye wrinkle volume, and wrinkle severity were measured at 6-week intervals to assess the skin barrier function and efficacy in wrinkle improvement, respectively.

Results

After 12 weeks, skin hydration and transepidermal water loss significantly improved in the intervention group compared to the control group. Skin elasticity, surface roughness, eye wrinkle volume, wrinkle severity, and participant-assessed clinical improvement score did not significantly improve compared with the control group.

Conclusion

Oral palmitoleic acid effectively improves the skin barrier function improvement, which may enhance QoL in aging adults.

A comparison of dyeing efficacy between hair-oxidation-based and hair-coating-based shampoos for the treatment of gray hair

BACKGROUND

The process of hair dyeing causes hair damage, and periodic re-dyeing is required for newly grown hair. To avoid these hassles, hair color shampoos have been developed and are widely used. In this study, we compared the effects of two hair color shampoos with different dyeing principles to analyze the function of hair color shampoos. We analyzed hair tresses treated by hair-oxidation- and hair-coating-based shampoos.

MATERIALS AND METHODS

We measured the color, tensile properties, softness, elasticity, gloss, moisture content, and protein content of the hair tresses dyed with color shampoos. The hair structures were analyzed by scanning and transmission electron microscopies (SEM and TEM) and a hydroxy radical-based method.

RESULTS

The shampoo based on hair coating enhanced the hair dyeing effect and roughness, whereas that based on hair oxidation improved the color retention and moisture content in the hair tresses. Frictional resistance, gloss, and elasticity of the hair tresses were similar for the two products. However, according to the results of the protein loss test, TEM, and hydroxyl radical staining, the shampoo based on hair oxidation showed a longer dyeing retention compared to that based on hair coating but caused cuticle damage.

CONCLUSION

These results show that the two shampoos with different dyeing principles exhibit different hair dyeing abilities and hair health indices. Therefore, we recommend that hair color shampoos should be used according to the requirements of an individual.

Combination of Non-Ablative Fractional Laser with Q-Switched Laser for the Treatment of Becker's Nevus: Efficacy and Limitations

Becker's nevus (BN) is a benign hamartoma that may present as a distressing cosmetic problem. The treatment of BN poses a significant challenge as current therapeutic modalities are suboptimal and have an increased risk of adverse effects, such as scarring and dyspigmentation. We present the use of non-ablative fractional laser therapy combined with Q-switched Nd:YAG laser as a possible therapeutic option for BN treatment and review relevant literature to discuss its efficacy and limitations.

Cryolipolysis for abdominal subcutaneous fat reduction: a prospective, multicenter, single arm, clinical study

BACKGROUND

Various treatment methods are used for noninvasive body contouring.

OBJECTIVE

To evaluate the efficacy and safety of a newly designed cryolipolysis device using a three-dimensional cooling method for abdominal fat reduction.

METHODS

Twenty-five participants with clinically apparent abdominal fat tissue participated in the study. The thickness of fat tissue below the umbilicus level was measured using a caliper at baseline and 12 weeks after the first treatment. The height of abdominal subcutaneous fat tissue on ultrasonography and participant satisfaction were assessed at every visit for 16 weeks. All adverse events (AEs) during the study period were recorded. P values <0.05 were considered statistically significant.

RESULTS

Twenty-four participants completed this study; the mean BMI of participants was 29.34±2.36 kg/m² . The mean thickness of abdominal subcutaneous fat was significantly lower at 12 weeks (40.4±6.8 mm, p<0.001) than at baseline (49.3±8.5 mm). Differences in the height of abdominal subcutaneous fat compared to that at baseline were 1.02±0.41 cm (12 weeks, p<0.001) and 1.13±0.44 cm (16 weeks, p<0.001). Rates of abdominal subcutaneous fat reduction at 12 and 16 weeks compared to that at baseline were 28.45% and 31.13%, respectively. The ratio of abdominal circumference to hip circumference at 12 and 16 weeks was significantly decreased compared to that at baseline. Most participants (95.8%) reported improvement in satisfaction scores at 16 weeks. There were no serious AEs during the entire study period.

CONCLUSION

The study demonstrated the efficacy of a noninvasive cryolipolysis device using a three-dimensional cooling method for reducing abdominal subcutaneous fat. This article is protected by copyright. All rights reserved.

A randomized, participant-and evaluator-blinded, matched-pair prospective study to compare the safety and efficacy between polycaprolactone-based fillers in the correction of nasolabial folds

BACKGROUND

Polycaprolactone (PCL)-based fillers are widely used for skin rejuvenation and wrinkle reduction.

OBJECTIVE

To compare the efficacy and safety of newly developed PCL-based fillers (SYB filler®; SF-01) and widely used existing PCL-based fillers (Ellansé-M®) for correction of moderate-to-severe nasolabial folds.

METHODS

In a randomized, participant-and evaluator-blinded, matched-pair, prospective study, participants were randomized for injections of SF-01 or Ellansé-M® in both nasolabial folds. Efficacy was evaluated using the Wrinkle Severity Rating Scale (WSRS), Global Esthetic Improvement Scale (GAIS), and a 3-dimensional (3D) scanner. All adverse events (AEs) were examined and reported.

RESULTS

At month 12, both SF-01-and Ellansé-M®-treated groups showed statistically significant improvements in the WSRS, GAIS, and 3D scanner scores compared to baseline. The difference in changes in WSRS scores at month 12 between the two groups was 0.08 ± 0.34 compared to baseline. The upper limit of the 95.0% confidence interval was 0.0031, which was lower than the predefined margin for non-inferiority (0.35). All AEs were injection site-related (swelling, pain, and erythema) and disappeared within 30 min after the procedure.

CONCLUSION

SF-01 was non-inferior to Ellansé-M® and demonstrated favorable efficacy and safety at 12 months after correcting moderate-to-severe nasolabial folds.

Estimation error of the body surface area in psoriasis: A comparative study of physician and computer-assisted image analysis (Image J)

BACKGROUND

Assessing the area involved, i.e., the body surface area (BSA), is essential in diagnosing the disease severity of psoriasis. However, the BSA estimated by physicians tends to be over-estimated and has shown high inter- and intra-rater variabilities. Furthermore, no reports suggesting the cause and clinical significance of overestimating the BSA results exist in psoriasis patients.

OBJECTIVES

We aimed to investigate the errors in estimating the BSA affected by psoriasis by comparing the physicians' results with those of computer-assisted image analysis (CAIA) and provide suggestions regarding the clinical implications of such errors.

METHODS

Using 43 images, 36 physicians visually estimated the BSA of psoriasis. Subsequently, the images were evaluated using CAIA (Image J). The BSA values determined by the physicians and CAIA were compared and matched. The BSA percentage was also graded from 0 to 6: no lesion (0), 1-9% (1), 10-29% (2), 30-49% (3), 50-69% (4), 70-89% (5), and 90-100% (6). Each grade range was divided, with the bottom and top 50% defined as the "first half" and "second half," respectively.

RESULTS

The average proportion of correct assessments by physicians was 49.4%. Physicians tended to overestimate the area involved by psoriatic lesions by 8.76%±8.82% compared to CAIA. The largest estimation error (proportion incorrect: 75.7%) was observed in Grade 3. Estimations located in the "second half" of the range demonstrated a higher proportion of inaccuracies compared to those in the "first half." An overestimating error occurred in certain morphological characteristics of the psoriatic lesions.

CONCLUSIONS

Inaccuracy of BSA estimation by physicians may be related that information from the human eye is perceived to be exaggerated compared to the actual size. Further research of using artificial intelligence (AI) technology is needed to reduce quantification error and develop an ideal BSA assessment system. Additionally, education and training are needed for physicians to accurately measure the BSA.

A Randomized, Double-Blind, Multi-Center, Placebo-controlled, Phase 2 Clinical Trial to Evaluate the Efficacy and Safety of DWJ211 in the Treatment of Moderate to Severe Submental Fat

Excessive accumulation of submental fat (SMF) causes a lower face cosmetic problem. A lipolytic injectable has recently been developed as a solution. To investigate the effects and safety of DWJ211 (a newly developed lipolytic injectable) in the reduction of SMF and to identify the optimum dose. In this multi-center, double-blind, placebo-controlled study, subjects with moderate to severe SMF were randomized to injections of DWJ211 0.5%, DWJ211 1%, DWJ211 2% or placebo in the submental area, every 4 weeks, up to week 12. Efficacy was determined by improvements in physician-assisted SMF rating scales (PA-SMFRS) and subject-assisted SMF rating scales (SA-SMFRS) 4 weeks after the last treatment (week 16). Safety was assessed by inquiries, subject diary entries of adverse events, laboratory tests, and vital sign checks. Of 140 enrolled subjects, 136 were included in the analysis. The proportions of subjects who achieved ≥1-grade improvement on the PA-SMFRS were 41.7%, 65.7%, 84.4%, and 72.7%, and the proportions of subjects who achieved ≥1-grade improvement on the SA-SMFRS were 50.0%, 71.4%, 93.8%, and 81.8% for the placebo, DWJ211 0.5%, DWJ211 1%, and DWJ211 2% group, respectively. Adverse drug reactions (ADRs) were more common in each of the treatment groups compared with placebo, with the most common ADR being injection site pain. No subjects experienced any serious adverse events. The 1% DWJ211 dose was beneficial for SMF reduction and had a tolerable safety profile. Thus, we selected 1% as the dose to be tested in a Phase 3 clinical trial. This article is protected by copyright. All rights reserved.

Single-center, assessor-blind study to evaluate the efficacy and safety of DA-5520 topical gel in patients with acne scars: A pilot study

BACKGROUND

Unlike various topical treatment options for acne vulgaris, options for acne scars mostly involve invasive interventions. So far, only a few clinical trials have investigated the effects of topical treatment for acne scars.

OBJECTIVES

We evaluated the safety and efficacy of DA-5520, a recently developed topical gel for the treatment of different types of acne scars.

METHODS

A 12-week prospective, randomized, active-controlled, evaluator-blind, single-center study involving 36 participants with acne scars was performed. Participants were randomized into four different groups at a 1:1:1:1 ratio: laser resurfacing with DA-5520 application (test 1); laser resurfacing without DA-5520 application (control 1); comedone extraction with DA-5520 application (test 2); and comedone extraction without DA-5520 application (control 2). For 12 weeks, participants in the two test groups applied DA-5520 twice daily, while participants in the control groups applied moisturizers alone. Participants in the test 1 and control 1 groups received a single session of laser resurfacing at visit 1 (week 0). All participants were followed up at 1, 4, 8, and 12 weeks, and objective scar evaluation using the échelle d'évaluation clinique des cicatrices d'acné (ECCA) score was performed at each visit.

RESULTS

Clinical improvement of acne scars, confirmed by the ECCA grading scale (1 for atrophic scar and 2 for hypertrophic scar), was observed after using DA-5520 when combined with laser resurfacing or individually, and no associated adverse reactions were noted.

CONCLUSIONS

Preliminary results of this study revealed that DA-5520 may be a promising new formulation for treating all type of acne scars.

Possibility of exosome‑based coronavirus disease 2019 vaccine (Review)

Coronavirus disease 2019 (COVID‑19) is a global pandemic that can have a long‑lasting impact on public health if not properly managed. Ongoing vaccine development trials involve classical molecular strategies based on inactivated or attenuated viruses, single peptides or viral vectors. However, there are multiple issues, such as the risk of reversion to virulence, inability to provide long‑lasting protection and limited protective immunity. To overcome the aforementioned drawbacks of currently available COVID‑19 vaccines, an alternative strategy is required to produce safe and efficacious vaccines that impart long‑term immunity. Exosomes (key intercellular communicators characterized by low immunogenicity, high biocompatibility and innate cargo‑loading capacity) offer a novel approach for effective COVID‑19 vaccine development. An engineered exosome‑based vaccine displaying the four primary structural proteins of SARS‑CoV‑2 (spike, membrane, nucleocapside and envelope proteins) induces humoral and cell mediated immunity and triggers long‑lasting immunity. The present review investigated the prospective use of exosomes in the development of COVID‑19 vaccines; moreover, exosome‑based vaccines may be key to control the COVID‑19 pandemic by providing enhanced protection compared with existing vaccines.

Evaluation of nail surface topography using a three-dimensional in vivo optical skin imaging system

BACKGROUND

The analysis of nail surface topography is a subject of ever-increasing interest in dermatology, especially in cosmetic studies. However, there is no accurate and scientifically sound instrumental method that can identify and provide quantitative data on nail surface topography.

MATERIALS AND METHODS

The right index fingers of 78 healthy individuals were examined. The severity of nail roughness was rated by two independent dermatologists on a scale of 1 to 3. Using the phaseshift rapid in vivo measurement of the skin (PRIMOS) system, three-dimensional microtopography was performed, and the roughness parameter values were calculated and evaluated. The relationship between clinical nail roughness grade and nail roughness parameter values obtained utilizing PRIMOS was evaluated.

RESULTS

A moderate correlation was found between the roughness parameter values and the clinical roughness grade. Our study showed that an overall relationship exists between the nail roughness parameter values obtained using PRIMOS and clinically observed nail surface changes.

CONCLUSION

With further studies, PRIMOS could be a valuable tool for clinicians and researchers for conducting an accurate and objective patient assessment in daily practice and demonstrating effectiveness of different therapies for nail dystrophy or evaluating cosmetic effects of various topical treatments in future clinical trials.

A study of the microbiological profile of filler-induced skin necrosis

Skin necrosis is one of the most severe complications following filler injections, and can result in permanent aesthetic defects. Although an increasing number of studies have addressed the management of dermal filler complications, no study has described the spectrum of microbial pathogens. The aim of this study was to delineate the bacterial profile and prognostic factors of filler-related skin necrosis by reviewing the clinical and microbiological features of these patients. A retrospective medical record review of patients undergoing treatment for skin necrosis induced by fillers was conducted. In total, 10 cases were identified, with injection sites being the nasolabial fold (70%; n = 7), nasal dorsum (20%; n = 2) and nasal tip (10%; n = 1). Reviewing the culture results, the true culture-positive rate was found to be 50% after cases of contamination were excluded. To avoid permanent sequelae, all physicians should be aware of possible secondary infections when treating filler-induced skin necrosis.

Changes in skin characteristics after using respiratory protective equipment (medical masks and respirators) in the COVID-19 pandemic among healthcare workers

BACKGROUND

The coronavirus disease-2019 (COVID-19) outbreak has presented unique dermatologic challenges due to respiratory protective equipment (RPE)-related skin conditions.

OBJECTIVE

To objectively evaluate the effects of RPE including medical masks and respirators on the skin barrier by measuring various physiological properties of the skin.

METHODS

A cross-sectional study was designed. Twenty healthy healthcare workers were included in this study. Skin parameters including skin hydration, transepidermal water loss (TEWL), erythema, sebum secretion, pH, and skin temperature were measured in the RPE-covered and RPE-uncovered areas of the face 4 and 8 hours after wearing RPE and 14 hours after not wearing RPE.

RESULTS

Skin hydration, TEWL, erythema, pH, and skin temperature increased in the RPE-covered areas after wearing RPE for 4 and 8 hours. By contrast, in the RPE-uncovered areas, skin hydration decreased and TEWL, erythema, and pH showed minimal changes over time. Based on the repeated-measure analysis, the changes in skin physiological properties over time were significantly different between RPE-covered and RPE-uncovered areas.

CONCLUSION

We observed that skin physiological characteristics change with the prolonged use of RPE such as medical masks and respirators. These changes may lead to various adverse skin reactions after long-term use.

Randomized, double-blind, active-controlled, multicentre, phase III clinical trial with two stages to assess the safety and efficacy of letibotulinum toxin a vs. onabotulinum toxin a for subjects with moderate to severe crow's feet

BACKGROUND

Letibotulinum toxin A (LeBA) was approved by the Ministry of Food and Drug Safety (known as the Korea Food & Drug Administration) for cosmetic indications in 2012. However, the efficacy and safety of this newly introduced LeBA have not been investigated in crow's feet lines (CFL) treatment and standardization before its universal use.

OBJECTIVE

The aim of this multicentre, double-blind, randomized, parallel, active-controlled Phase III clinical trial with two stages (ClinicalTrials.gov identifier: NCT03408236) was to investigate the non-inferiority of LeBA vs. the existing onabotulinum toxin A (OnBA) for the treatment of CFL.

METHODS

A total of 240 subjects were randomized to either the test (LeBA) or control (OnBA) group. At the baseline and at weeks 4 while maximum smiling (primary efficacy assessment), 8, 12 and 16, investigator's on-site evaluation, independent evaluator, evaluation by the subjects, subjects' satisfaction assessment and safety assessment were performed.

RESULTS

At week 4, the response rate of primary efficacy assessment was 69.75% and 68.33% in the test (LeBA) and control (OnBA) groups, respectively, without a significant difference. Other minor secondary evaluation results showed significant differences suggesting that LeBA offered better improvement than OnBA, but the overall results did not show significant differences between the two groups.

CONCLUSION

This study showed that LeBA was as effective and safe as OnBA for the treatment of CFL at the same doses.

Mechanism and clinical applications of needle-free injectors in dermatology: Literature review

BACKGROUND

Needle-free jet injectors are devices that deliver drugs using a high-speed jet without a needle. Recent studies have significantly increased our understanding of the mechanisms of needle-free jet injectors, and technical advancements have broadened the scope of application of the device.

AIMS

We aimed to provide an up-to-date review of previous literature regarding the mechanism of action and clinical applications of needle-free jet injectors in dermatology field.

METHODS

We conducted a PUBMED search for studies on needle-free jet injectors using the following parameters: "Pneumatic injector" OR "needleless injector" OR "needle-free injector" OR "jet injector." Among 191 results, 72 articles focusing on their mechanisms of action, cutaneous delivery patterns, and clinical applications in dermatology were selected for review.

RESULTS

Significant clinical evidence has been published confirming the potential of needle-free jet injectors in treating various dermatologic conditions. In particular, these devices have the potential to be used in various skin remodeling treatment, especially in skin rejuvenation procedures by injecting various esthetic materials.

CONCLUSION

As proven by accumulated experience, the applications of NFJIs are not restricted to vaccine or insulin delivery in dermatology field. However, this literature review shows that until now, there are no clinical guidelines that standardize the optimal parameters when using NFJIs on various clinical settings. Therefore, further studies should be performed in order to investigate the full potential of these devices in dermatology, to ensure safe and effective outcomes in clinical practice.

Reduced pain with injection of hyaluronic acid with pre-incorporated lidocaine for nasolabial fold correction: A multicenter, double-blind, randomized, active-controlled, split-face designed, clinical study

BACKGROUND

Injection of hyaluronic acid (HA) filler for nasolabial fold (NLF) correction is a popular aesthetic procedure. In relation to HA filler injections, effective pain control for patient comfort is an important concern.

OBJECTIVES

We compared the pain relief achieved by HA filler with 0.3% lidocaine (HAF-Lidocaine) with that achieved by HA filler without lidocaine (HAF) for NLF correction.

PATIENTS/METHODS

A total of 62 subjects with visible NLFs were enrolled in this double-blind study at two university hospitals and injected with HAF-Lidocaine and HAF, randomly assigned to the each NLFs. Subjects assessed pain using the visual analog scale (VAS). Blinded independent dermatologists assessed the Wrinkle Severity Rating Scale (WSRS) and subjects assessed the Global Aesthetic Improvement Scale (GAIS) for the evaluation of effectiveness. All adverse events during the follow-up period were recorded.

RESULTS

Immediately after treatment, 95.2% of subjects who were treated with HAF-Lidocaine reported reduced pain when compared with those who were treated with HAF and the mean VAS score difference was 38.6 mm. At 15, 30, 45, and 60 minutes after treatment, respectively, 67.7%, 41.9%, 32.3%, and 21.0% of subjects experienced reduced pain. Based on the mean WSRS and GAIS scores and the incidence of local injection site reactions, the clinical effectiveness and safety profile of HAF-Lidocaine were comparable to those of HAF.

CONCLUSION

We conclude that HA filler containing pre-incorporated lidocaine could reduce pain in Korean patients for NLF correction, and the addition of lidocaine does not affect the effectiveness and safety of HA filler.

Systemic contact dermatitis induced by Rhus allergens in Korea: exercising caution in the consumption of this nutritious food

Systemic contact dermatitis (SCD) develops when a person who was previously sensitized to an allergen is exposed to the same allergen via the systemic route. In East Asia, the use of lacquer for polishing furniture is common and a part of the traditional culture. Contact exposure to tableware polished with Rhus lacquer may lead to sensitization. In Korea, SCD is commonly observed after systemic exposure to Rhus, a nutritious food item consumed because of the common belief of it improving the immune system. In this study, we reviewed the medical records of 21 Korean patients with SCD caused by Rhus ingestion. We found that the most significant epidemiological factor for SCD was the season of the year. Furthermore, 66.67% of the patients presented with leucocytosis and 23.81% showed increased liver enzyme levels. It is important to educate people on the risks associated with the systemic ingestion of Rhus.

Comparison of different energy response for lipolysis using a 1,060-nm laser: An animal study of three pigs

BACKGROUND

Non-invasive body-sculpting procedures are becoming increasingly popular. The application of 1,060 nm of laser energy transcutaneously to hyperthermically induce the disruption of fat cells in the abdomen is a type of non-invasive procedure.

AIMS

The purpose of this study was to compare the treatment results from two parameters of the same system, each with different energy output levels, in an in vivo porcine model to determine the most effective application.

METHODS

Female pigs (n = 3) were used in this study. We examined the effects of the treatment using photography, ultrasonography, gross and microscopic pathology, and histological examination in order to determine the mechanism of action, efficacy, and safety of the procedure. Blood chemistry analysis was performed before each session to check lipid levels and to monitor for any adverse changes in markers that may indicate liver damage. Biopsies were taken and routinely processed with hematoxylin and eosin and Oil Red O stains to examine for tissue damage at baseline and after each treatment. Terminal deoxynucleotidyl transferase deoxyuridine triphosphate nick end labeling (TUNEL) assays were performed to check for apoptotic-related DNA damage.

RESULTS

Ultrasonic imaging of the same area before and after the application of 1,060 nm of laser energy at outputs of 0.9 and 1.4 W/cm² showed that the density of the fat layer changed immediately after irradiation due to the transient heat transfer in the fat layer. Preclinical evaluation was performed to obtain comparison data on the safety and efficacy of subcutaneous fat reduction after applying the different energy outputs of 0.9 and 1.4 W/cm² .

CONCLUSION

Based on our findings, we suggest that long-term histologic changes through the use of these devices suggest a comparative effectiveness of the treatment energy.

Preclinical evaluation for removal of bulging lower eyelid fat using ultrasound-assisted lipolysis on a Yorkshire pig

PURPOSE

The purpose of this study is to evaluate the efficacy and safety of treating lower eyelid fat bulging with ultrasound-assisted lipolysis (UAL) by performing a preclinical evaluation of the procedure on a Yorkshire pig.

METHODS

Two white Yorkshire pigs had lower eyelid fat bulging treated with UAL using a probe with a diameter of 1.0 mm or less. Fourteen days after treatment, we evaluated the changes in fat thickness from ultrasound, changes in skin contour (volume and height) from the Antera 3D™, and the disruption of fat cells and changes in collagen synthesis from histological evaluation.

RESULTS

Fourteen days after treatment, the fat layer was significantly reduced with no damage to the skin surface. The mean change in the subcutaneous fat layer thickness was decreased 1.51-0.75 mm in ultrasound analysis. The skin contour of the treated area also decreased with time from 202.5 to 163.5 mm in mean volume and 0.8111 to 0.646 mm in mean height. Masson's trichrome staining showed that the UAL treatment induced the regeneration and remodeling of collagen.

CONCLUSION

The results of this study demonstrate that UAL successfully reduced the bulging lower eyelid fat of a Yorkshire pig and also increased collagen contraction to tighten skin. UAL may be a beneficial and well-tolerated treatment option for lower eyelid fat bulging.

Synergistic effects of using novel home-use 660- and 850-nm light-emitting diode mask in combination with hyaluronic acid ampoule on photoaged Asian skin: A prospective, controlled study

BACKGROUND

Recently, light-emitting diode (LED) devices are among those mostly preferred for esthetic application because they improve the appearance of photoaged skin characterized by wrinkles, sagginess, pigmented lesions, and others. In addition, the use of hyaluronic acid (HA) for skin rejuvenation is already well proven.

AIMS

This study aims to evaluate the synergistic effects of using home-use LED mask device with HA ampoule.

METHODS

The total number of recruited subjects was 48:24 in Group A treated with both home-use LED mask device and HA ampoule and 24 in Group B treated with HA ampoule only, for 4 weeks. To assess the efficacy of the treatment, the following were used: Antera 3D CS, EOS 800D with Image-Pro Plus, DUB-USB, VisioFace Quick, and Visioscan VC98.

RESULTS

After treatment, the volume measurement (mm³ ) for prejowl sulci and nasolabial fold flattening as well as the area measurement (pixel) for lower chin firmness improvement was significantly reduced, and the number of pores (ea) for enlarged pores as well as the desquamation index (%) for the amount of corneocytes significantly decreased in both Group A and Group B. Moreover, the percentage of skin density significantly improved. Furthermore, Group A showed a significantly faster and higher rate of improvement than Group B.

CONCLUSION

The use of 660- and 850-nm home-use LED mask device can generate synergistic effects on home-use topical applications like HA on photoaged face, and such device can be safely and efficiently used daily in personal environments.

The Effects of Fabric Containing Chamaecyparis obtusa Essential Oil on Atopic Dermatitis-Like Lesions: A Functional Clothing Possibility

BACKGROUND

Essential oil derived from Chamaecyparis obtusa (EOCO) has been used as an alternative treatment for allergy-related diseases due to its immune-modulating characteristics. Clothing has the longest and most intense contact with human skin, and functional fabrics with intrinsic properties have been increasingly implemented in medical applications. Specially designed fabrics may support atopic dermatitis (AD) treatment. In this study, the effects of fabric containing EOCO on AD were investigated using an NC/Nga mouse model.

METHODS

The fabric was applied for 6 h per day for 14 days. The therapeutic effects were evaluated according to measurements of skin lesion severity (modified SCORAD score), transepidermal water loss (TEWL), serum IgE and inflammatory cytokine levels, lesion thickness measured after hematoxylin and eosin staining, and immunohistochemical and Western blot analysis for skin epidermal differentiation protein.

RESULTS

The EOCO group exhibited significantly reduced modified SCORAD score, TEWL, and serum IgE levels. Among the inflammatory cytokines analyzed, only the mean values of regulated on activation, normal T cell expressed and secreted were observed to be decreased compared with other control groups. The histological analysis of the skin also revealed that the EOCO group expressed reduced epidermal hyperplasia and recovered filaggrin, involucrin, and loricrin expression.

CONCLUSIONS

It was confirmed that fabric containing EOCO has anti-atopic and anti-inflammatory properties. The study data show that fabric containing EOCO can be implemented as an alternative functional clothing for people suffering from AD.

Intralesional triamcinolone injections for the treatment of nail dystrophy: A case series

Nail dystrophy can be temporary or permanent and affects quality of life for many patients. It can be secondary to an inflammatory condition; however, many cases are idiopathic. Despite many efforts, there is no promising treatment. Local steroid injection is one of the standard therapies offered for nail dystrophy, but there have been few formal open trials or case reports of its efficacy. This study investigated the impact of intralesional triamcinolone injections on the management and safety of nail dystrophy. Overall, 12 patients with 55 nails affected by nail dystrophy were enrolled. All lesions were injected with triamcinolone acetonide (2.5 mg/mL, 0.1 cc) through the proximal nail fold with a 30 g needle. Injections were administered every 4 weeks. Efficacy was retrospectively evaluated using physician's global assessment of clinical photographs graded on a 5-point scale as 0, no improvement; 1, slight improvement; 2, moderate improvement; 3, marked improvement; and 4, almost resolved. All adverse events that occurred during treatment were recorded. All patients presented with slight improvement of nail dystrophy after 1 to 3 months. The treatment durations varied from 6 to 12 months (mean, 8.58 months). The average time to observed therapeutic effect was 1.91 months after first treatment. The mean outcome assessment score was 2.8 points, with two patients each showing slight and moderate improvement and five showing marked improvement; in three, the dystrophy was almost resolved. Side effects of this regimen were minimal. Intralesional triamcinolone injections are an effective and safe method for the treatment of nail dystrophy.

Improvement of a slimming cream's efficacy using a novel fabric as a transdermal drug delivery system: An in vivo and in vitro study

Penetration of any compound into the body from the outside is prevented primarily by the corneal layer of the epidermis. The only way to circumvent the properties of the corneal layer is to disrupt it. Currently, transdermal systems can currently only deliver drugs that are of low molecular weight. The purpose of the present study was to assess the improvement of the slimming cream's efficacy using a novel fabric, with the aim of developing an improved method for transdermal drug delivery. The current study was conducted on four groups of guinea pigs. The control group was untreated, whereas the test groups were treated with either slimming cream and no fabric, slimming cream with 100% cotton fabric or slimming cream with the novel fabric. Ultrasound and microscopic histological analysis were used to assess animals. The results demonstrated that compared with the other groups, the novel fabric group demonstrated the greatest reductions in fat layer thickness, adipocyte size and number and proliferator-activated receptor-γ levels in adipose tissue. Furthermore, the novel fabric also enhanced the transdermal delivery of rhodamine B base and caffeine penetration compared with the control fabric (3.18-fold). In conclusion, the results of the present study demonstrated that the novel fabric can potentially be used to enhance transdermal drug delivery.

Sequential delivery of long-pulsed 755-nm alexandrite laser and long-pulsed 1,064-nm neodymium:yttrium-aluminum-garnet laser treatment for pigmented disorders

BACKGROUND

Long-pulsed (LP) lasers at pulse durations of 1-300 ms have been used to destroy nests of nevi cells by selectively targeting pigment chromophores.

OBJECTIVE

To evaluate dual-wavelength LP laser-induced tissue reactions.

METHODS

The patterns of LP 755-nm alexandrite (Alex) and/or 1064-nm neodymium (Nd):yttrium-aluminum-garnet (YAG) laser-induced tissue reactions were macroscopically evaluated using a tattoo-embedded phantom. Additionally, a pilot in vivo human study was performed for common acquired melanocytic nevus, of which dermoscopic images and high-speed cinematographs were obtained.

RESULTS

Combinations of Nd:YAG and Alex laser treatments at interpulse intervals of 10 or 20 ms generated round to oval zones of photothermal and photoacoustic injury in two distinctive areas containing disintegrated tattoo particles. Treatment at interpulse intervals of 10 or 20 ms between Alex and Nd:YAG pulses elicited lesser degrees of thermal damage to surrounding tissues, compared to treatment at 100 or 200 ms. Immediately after combined LP laser treatment of human nevus lesions in vivo, Nd:YAG-Alex treatment at a 20-ms interpulse interval exhibited more remarkable crusting and erosive appearances than Alex-Nd:YAG treatment.

CONCLUSION

For treating pigmented disorders, sequential delivery of LP Nd:YAG and Alex pulses at short interpulse intervals of 10-20 ms can effectively destroy nests of pigment chromophores.

Registered Nurses (RNs)' knowledge sharing and decision-making: the mediating role of organizational trust

AIM

This study study aimed to investigate the effects of explicit and tacit knowledge sharing on clinical decision-making abilities and the mediating role of trust among registered nurses at Korean hospitals.

BACKGROUND

Decision-making abilities comprise a key area of nursing practice and link nurses' perceptions with behaviours.

INTRODUCTION

Tacit knowledge is embedded within an individual and cannot be expressed or transmitted to other people in a specific form. Over time, new nurses gradually gain experience and tacit knowledge and become experts. Trust, an organizational characteristic, may serve as a potential mediator in the association between knowledge sharing and decision-making abilities among nurses. However, few studies have investigated the mediatory role of trust in this association.

METHOD

The data were collected from 210 nurses selected via random sampling. The research instrument in the model included Knowledge-Sharing Behavior, Trust, and Clinical Decision-Making in Nursing Scale. Structural equation modelling was used to analyse the collected data.

FINDINGS

The study findings showed that explicit knowledge sharing directly affects decision-making abilities, whereas tacit knowledge sharing is only associated with decision-making abilities when trust plays a mediating role.

DISCUSSION

A higher level of organizational trust can improve clinical decision-making abilities via tacit knowledge sharing.

CONCLUSION

This study demonstrated that unlike explicit knowledge, which is shared more easily, tacit knowledge sharing does not directly lead to clinical decision-making abilities. A higher level of organizational trust leads to a stronger beneficial effect of tacit knowledge sharing on clinical decision-making abilities.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

These findings concerning the mediatory role of trust on the association between knowledge sharing and clinical decision-making abilities provide new knowledge that will allow nurses, managers, and researchers to support the clinical decision-making abilities of nurses.