Dermatologic Surgery最新文献

Background: For full-thickness Mohs eyelid defects, closure involves reconstruction of the posterior lamella (conjunctiva and tarsus) and anterior lamella (skin and orbicularis muscle).

Objective: This study examines the necessity of dedicated posterior lamellar reconstruction in the repair of large, full-thickness eyelid defects based on functional and histologic analysis of the posterior margin without dedicated reconstruction of the posterior mucosa.

Methods: A case series of consecutive large Mohs eyelid defects (>50% loss of palpebral conjunctiva) repaired with myocutaneous flaps without dedicated posterior mucosal reconstruction were reviewed. Postoperative complaints were recorded. Biopsies of the posterior eyelid were reviewed from 4 patients during scheduled 4- to 6-week secondary separation of interpolated flaps or debulking.

Results: Twenty-six cases were identified, of which 16 (62%) lost >90% of the involved eyelid. A variety of flaps were employed (paramedian/glabellar, Fricke, nasolabial rotation, Mustarde) with good outcomes. Complications were uncommon and infrequent. All 4 biopsy specimens showed "squamous epithelium," "conjunctival epithelium," or "mucosa" without evidence of keratinization.

Conclusion: This series suggests that posterior mucosa reconstruction may not be necessary in cases of full-thickness eyelid defect repair as large myocutaneous flaps may act as a matrix for de novo regeneration, or extension, of conjunctival-like squamous epithelium on the posterior eyelid.

Background: Poly-l-lactic acid (PLLA) is widely used in dermatology, traditionally through subcutaneous injections. Alternative delivery methods such as ablative fractional lasers (AFLs) and needle-based devices have gained interest, but limited data exist on their efficacy.

Objective: To assess the effectiveness of AFLs and needle-based devices for PLLA delivery and the impact of channel morphology on PLLA uptake.

Methods: Full-thickness human abdominal skin samples were treated with fractional CO2 laser, fractional difference frequency generation (DFG) laser, fractional microneedle radiofrequency (MNRF), and microneedle (MN). After applying PLLA topically, real-time particle movement into the channels was detected through optical coherence tomography (OCT). Histology assessed the vertical distribution of PLLA.

Results: Optical coherence tomography captured PLLA particles descending into channels from AFLs, but not MNRF or MN. Histology confirmed PLLA uptake in up to 80.3% of CO2 channels and 61.9% of DFG channels, compared with minimal uptake with MNRF (1.4%) and MN (0.7%). The CO2 laser enabled deeper penetration (120-240 μm), whereas the DFG laser delivered more superficially (0-120 μm).

Conclusion: Ablative fractional lasers effectively delivered PLLA through the skin, while needle-based devices showed minimal uptake. Among AFLs, channel geometry influenced vertical particle distribution. In vivo and clinical studies are needed to assess PLLA retention and its impact on remodeling.

Background: The light-emitting diode cap being investigated is FDA cleared for the treatment of androgenetic alopecia (AGA).

Objective: Evaluating 3 versions of a red and blue light LED cap: (1) 625- and 660-nm red light, (2) 425-nm blue light, and (3) both 425-nm blue light and 625- and 660-nm red light against sham.

Patients and methods: Twenty-six-week, multicenter, randomized, controlled, double-blinded study. Adults aged 18 to 65 years with AGA were randomized to an active device or sham and underwent 10-minute treatments daily.

Results: One hundred sixty subjects were randomized. Ninety-one subjects were excluded for the per-protocol analysis. The per-protocol population included participants who completed 16 weeks of treatment, had no major protocol violations, and were at least 80% treatment compliant. Although the primary endpoint (mean change in non-vellus hair count from baseline to week 16) did not reach statistical significance in the individual study arms, in the pooled analysis (combining the 3 active study arms), there was a statistically significant ( p = .033) difference versus sham. The pooled study cap group achieved 28.5 more hairs per cm 2 when compared with sham.

Conclusion: The LED caps were well tolerated and increased hair density in patients with AGA.

Background: Pruritus and pain symptoms secondary to hypertrophic scars (HTSs) are associated with multiple factors, with age, body mass index (BMI), and scar thickness being the main risk factors (RFs).

Objective: This study mainly discusses the clinical symptoms associated with postburn HTSs and analyzes RFs for itching and pain requiring pharmacological intervention.

Materials and methods: All clinical data of 93 patients with postburn HTSs who visited the Burn Department of Shanghai Seventh People's Hospital between January 1, 2021 and January 1, 2023 were collected and analyzed retrospectively. Referring to the University of North Carolina "4P" Scar Scale, patients were rated as either "with" or "without" according to whether they had "scar itching symptoms requiring pharmacological intervention."

Results: Smoking, third-degree burns, unused silicone drugs, and total burn surface area 30% to 50% were independent RFs for requiring pharmacological intervention for postburn scar pruritus (odds ratio [OR] = 2.998, 3.924, 3.588, and 5.965, p < .05). Age, increased BMI, greater scar thickness, and duration of hyperplasia not more than 1 year significantly increased the risk of scar pain requiring medical intervention (OR = 1.626, 2.441, 20.830, 11.646, and 11.136, p < .05).

Conclusion: The clinical value of these factors is that they can help physicians better identify those patients who may require pharmacological intervention to control itching and pain.