Dermatologic Surgery最新文献

Background: Injectable biostimulators are widely used to improve facial aging signs. This study was performed to compare the genetic pathways affected by 2 different injectable biostimulators.

Methods: Randomized 13-week study (n = 21) comparing gene expression after poly l-lactic acid (PLLA-SCA) and calcium hydroxylapatite (CaHA-R) injections (baseline [BL] and Day 28) as treatment of nasolabial fold wrinkles. Punch biopsy was performed at BL and day 90; RNA was isolated, gene expression was analyzed, and bulk RNA sequencing performed. Data from both pathways were studied using the Search Tool for Retrieval of Interacting Genes/Proteins and Reactome databases.

Results: Analysis at Day 0 and Day 90 showed differing gene regulation for PLLA-SCA and CaHA-R (after accounting for minor differences at BL, p < .05 at Day 90 for 9-12 genes). PLLA-SCA uniquely correlates with genes involved in adipocyte regeneration, while CaHA-R did not affect these genes. Clinically, this could translate to healthy fat replacement with an enhanced effect beyond the improvement of the collagen structure and a longer-lasting effect with PLLA-SCA. Furthermore, the adipokines that appear to be upregulated are regenerative with a positive impact on skin health.

Conclusion: PLLA-SCA has a novel and unique signature, which supports a potential regenerative mechanism of action through its role in the modulation of adipocyte function.

Background: Dermal microcoring extracts cores of skin that are small enough to allow healing in a scarless fashion. Its use has been reported in the treatment of skin laxity, rhytides, and textural abnormalities.

Objective: To report the authors' clinical experience using dermal microcoring in a variety of cases.

Materials and methods: A retrospective chart review was performed looking at dermal microcoring cases for any indication between August 2022 and March 2024.

Results: Thirty-eight patients were treated. Overall, 32 (84.2%) patients were women, with median age of 67 years (R: 20-80 years). Fitzpatrick skin types I to V were represented. Among patients with adequate photographs for review, improvements of grade 3 and 4 (good and excellent) were seen in 85.7% (n = 18/21) treated for skin laxity and rhytides, 50.0% (n = 3/6) treated for acne scars, 66.7% (n = 2/3) treated for traumatic or surgical scars, and 100.0% (n = 3/3) treated for foreign material. Six (15.4%) patients experienced erythema or hyperpigmentation lasting more than 4 weeks, and 2 (5.1%) patients experienced temporary focal scarring, which improved with intralesional therapy and laser treatment. No patients experienced permanent dyspigmentation, prolonged edema, or infection.

Conclusion: Dermal microcoring has been demonstrated to safely and effectively treat skin laxity, rhytides, scars, and foreign material.

Background: Dermatologists are trained in diagnostic and therapeutic procedures for cutaneous lesions, yet comparative trends for basic dermatologic procedures across dermatology providers are lacking at the national level.

Objective: To trend common dermatologic procedures among general dermatologists, Mohs surgeons, primary care providers or primary care physicians (PCPs), and nonphysician clinicians (NPCs).

Methods: Longitudinal analysis of 2016 to 2021 Medicare Public Use Files.

Results: Aggregate dermatologic procedural volume decreased 3.0%. Procedural volume declined among general dermatologists (-11.7%), Mohs surgeons (-16.7%), and PCPs (-41.7%) but increased among NPCs (+57.5%). The proportion of procedures by general dermatologists decreased substantially for premalignant destructions (-6.2%), skin biopsies and shave removals (-4.7%), and malignant excisions (-4.1%) and more notably in counties that were nonmetro (-7.1%), low in income (-6.1%), and with <4.0 dermatologists per 100,000 population (-7.0%).

Conclusion: Aggregate procedural volume decreased across the study period with general dermatologists, Mohs surgeons, and PCPs performing a progressively smaller proportion. The increase in procedures by NPCs may help to address demand but underscores the value of formalized procedural training. The procedural decline by general dermatologists in rural and low-income counties and those with baseline dermatologist shortages may exacerbate existing unmet need. Primary limitation included lack of commercial data.

Background: High-risk cutaneous squamous cell carcinoma (cSCC) is associated with poor clinical outcomes. Traditionally, preoperative clinical tumor size ≥2 cm, based on Brigham and Women's Hospital (BWH) staging criteria, is high risk.

Objective: To compare outcomes of cSCC treated with Mohs micrographic surgery (MMS) with a preoperative size ≥2 cm (clinically ≥2 cm) versus cSCC with preoperative size <2 cm and postoperative defect size ≥2 cm (histologically ≥2 cm).

Methods: Prospective data were collected from January 1, 2014, to December 31, 2020, on MMS cases for cSCC with a preoperative and/or postoperative size ≥2 cm. Clinical outcomes were followed until March 15, 2023. Data were analyzed using multivariate regression.

Results: Three hundred thirty cases of MMS for cSCC were included. Cutaneous squamous cell carcinoma clinically ≥2 cm occurred more frequently in elderly patients; cSCC histologically ≥2 cm were more commonly located in the H region, required wider surgical margins, and more MMS stages to achieve clearance. There were no significant differences in rates of recurrence and metastasis between the groups.

Conclusion: These data suggest that postoperative (histologic) MMS defect size may allow for better risk stratification of high-risk cSCC and improved staging of cSCC.

Background: Cellular senescence, an irreversible cell cycle arrest with secretory phenotype, is a hallmark of skin aging. Regenerative exosome-based approaches, such as topical human platelet extract (HPE), are emerging to target age-related skin dysfunction.

Objective: To evaluate the cellular and molecular effects of topical HPE for skin rejuvenation after 12 weeks of twice daily use.

Methods: Skin biopsies were obtained for histological evaluation of senescence markers, p16INK4a and p21CIP1/WAF1. Telomere-associated foci, coassociation of telomeres, and DNA damage marker, γH2AX, were assessed. RNA sequencing evaluated senescence associated secretory phenotype (SASP) and extracellular matrix pathways.

Results: p16INK4a and p21CIP1/WAF1 staining in senescent skin cells revealed low and high expression subgroups that did not correspond to chronological age. Topical HPE significantly reduced high p16INK4a cells in the dermis (p = .02). There was also a decrease in telomere damage after topical HPE (p = .03). In patients with high senescent cells at baseline, there was a 40% reduction in proinflammatory SASP. Extracellular matrix remodeling pathways, including collagen and elastic fibers, were up-regulated.

Conclusion: Topical HPE, applied on intact skin, reduced senescence signaling and senescence-associated telomere damage after 12 weeks of twice daily use, targeting a path for skin longevity or healthy skin aging.

Background: Nevus of Ota (NOTA) is a dermal melanocytosis acquired in early childhood or pregnancy. Given their color variability, NOTA often require a combination of wavelengths for successful treatment. Quality-switched lasers have consistently shown efficacy in targeting dermal pigment, while picosecond lasers (PSLs) are an emerging technology for pigmentary disorders.

Objective: To further elucidate its efficacy, the authors conducted a retrospective review of 17 patients with NOTA treated with a 785-nm PSL for brown NOTA lesions between 2021 and 2023.

Materials and methods: The primary end point analyzed clinical improvement based on before and after photography reviewed by 3 board-certified dermatologists using a five-point visual analog scale.

Results: Seventeen patients of Fitzpatrick skin types (FSTs) II to V, ranging from ages 14 to 38 years, were included in this study. Patients were treated for an average of 3.2 sessions in 2 to 3-month intervals. Visual analog scale scores demonstrated a mean clearance of 51% to 75%. No pigmentary alterations were noted.

Conclusion: Because NOTA is common in higher FSTs, the authors believe that the 785-nm PSL is an excellent treatment option for brown NOTA in these skin types. This study highlights the need for further investigation to determine optimal treatment parameters for the color-based laser treatment approach for NOTA.

Background and objectives: The effect of environmental and genetic factors on the aging process is widely acknowledged. Yet, the extent to which each factor decisively contributes to the perception of looking younger or older remains a subject of debate. This study seeks to identify the factors linked to the perceived age among Turkish women.

Patients and methods: Ten assessors scored the perceived ages of 250 female patients based on facial photographs. The study aimed to assess the impact of environmental factors and anthropometric measurements on the perception of aging. A comprehensive analysis involved conducting 9 perioral and 6 periorbital anthropometric measurements on all study participants.

Results: Exercise ( p = .001), mild photodamage (stage 1-2) ( p = .001), consistent sunscreen use ( p = .001), the length of the palpebral fissure ( p = .043), and the height of the upper vermilion ( p = .019) demonstrated significant associations with a more youthful appearance.

Conclusion: Environmental factors, including exercise, photoprotection, sunscreen use, and anthropometric measurements such as palpebral fissure length and upper vermilion height, play a significant role in contributing to a more youthful appearance.