Dermatological Reviews最新文献

Introduction: The Juvéderm family of dermal fillers are injectable, long-lasting, homogenous, monophasic, monodensified hyaluronic acid fillers which are cross-linked with varying amounts of 1,4-butanediol-diglycidyl-ether (BBDE). Several formulations of Juvéderm exist, including the original Juvéderm Ultra® and Juvéderm Ultra Plus®, and the newer Juvéderm Voluma® XC. Differences in the Juvéderm product line stem from the hyaluronic acid (HA) concentration, gel hardness (G star (G*)), elastic properties (G prime (G′)), amount of molecular cross-linking (BBDE percentage), and technology utilized for cross-linking. Discussion: The Juvéderm filler lineup is such that each product is uniquely formulated for a specific indication. The lineup together has shown to be efficacious in treating superficial lines to deep-seated wrinkles. These fillers are unlikely to cause adverse immune reactions, and as with other HAFs, their effects can be reversed with the injection of hyaluronidase. Conclusion: This chapter discusses the variety of fillers currently in the market within the Juvéderm family, as well as several new products on the horizon. We detail product FDA approvals, indications, safety, and adverse events.

Restylane is a hyaluronic acid-based facial and hand dermal filler line used for cutaneous augmentation and fold-crease reduction approved by the United States Food and Drug Administration (FDA) in 2003. It is sourced from nonanimal products which confers low immunogenicity and mitigates risk of hypersensitivity reactions and forgoes the need for allergy testing. Restylane has been observed to have excellent longevity secondary to its unique cross-linking properties, lasting in the skin for up to 12 months. Despite its relatively low-risk profile, case reports indicate injection site reactions being common, with more serious adverse events being very rare. In these cases, dissolution of Restylane is performed with hyaluronidase, while intralesional steroids can be utilized to manage unwanted inflammatory reactions. Overall, its low reaction potential, established safety profile, facial filler product-line consistency as well as indication diversity, and prolonged mechanism of action have been leading factors in its continued popularity over the past two decades.

Acne vulgaris or “acne” is a prevalent and burdensome cutaneous condition that has been linked with unique mental health implications. Clinical (i.e., general and social anxiety, and major depression) and subclinical indicators (e.g., excessive worry, social self-consciousness, and low self-esteem) of internalizing disorders have been associated with acne across demographics (e.g., age groups and cultures). Considering the persistent burden of disease associated with these mental health outcomes, our primary aim was to concretely synthesize the relation between acne and internalizing symptoms. A secondary aim was to address the role that combined oral contraceptives and isotretinoin (e.g., Accutane), widely prescribed medical treatments for acne, may play in this relation as both have been linked to depression and anxiety. We discuss practical implications that may strengthen the effective biopsychosocial management of acne for suffering individuals. This review actively upholds and amplifies the call for longitudinal research that integrates the developmental psychology and dermatology literature to effectively treat acne in its entirety, including mental health.

To adequately guide future therapies, it is important to elucidate the pathogenesis of melasma. Chronic ultraviolet (UV) radiation exposure, hormonal stimulation, and genetic predisposition play a role in melasma. A widely accepted theory for the pathogenesis of melasma is the increase of melanin through UV, which leads to the upregulation of melanin stimulating receptors (MSR) such as melanocortin-1 receptors (MC1R), resulting in increased hormone binding and melanin production. Furthermore, there are similarities between the histopathologic presentation of melasma and solar elastosis, a hallmark of photo-aged skin. These overlaps include altered basement membrane, increased vascularization, and increased mast cell count. There is significant data showing greater degree of solar elastosis in the melasma skin compared to the perilesional skin. Additionally, an etiologic factor in the pathogenesis of melasma is hormonal exposure to estrogen. Melasma has increased prevalence among menstruating women, women on oral contraceptives, and pregnant women. In melasma lesions, studies have shown an increased number of estrogen receptors and progesterone receptors in the dermis and epidermis, respectively. Previously, increased melanogenesis was thought to be the sole contributing factor to the pathogenesis of melasma but more recently, aberrant vasodilation and angiogenesis have been found to play a role. Nitric oxide, a potent vasodilator, was found to be overexpressed at the dermal-epidermal junction and was hypothesized to contribute to melasma through stimulation of tyrosinase and increasing vascularity. In conclusion, the various mechanisms implicated in melasma include melanocyte dysfunction, solar elastosis, mast cell dysfunction, hormonal influence, vascular transformation, and basement membrane damage.