Dermatologic Surgery最新文献

Background: Poor differentiation predicts adverse outcomes in cutaneous squamous cell carcinoma (CSCC), but there is no standardized, reliable grading system.

Objective: To explore which histologic features have the greatest impact on CSCC differentiation interrater agreement.

Materials and methods: In a prior study, 40 raters graded differentiation for 45 squamous cell carcinomas, and percent interrater agreements were calculated. Cases graded as well/moderately differentiated with 100% agreement (10), those graded as poorly differentiated with ≥80% agreement (5), and those that received a variety of grades with ≤60% agreement (7) were pulled for the current study. Three raters graded individual histologic features for each case, and percent interrater agreements were calculated using both the well/moderately/poorly differentiated grading system and a dichotomized system.

Results: The percent interrater agreements were 34.8% for mitoses, 53% for pleomorphism, 59.1% for keratinization, 66.7% for cellular cohesion/intercellular bridges, and 78.8% for tumor edges. Percent agreements improved with dichotomous grading; the largest improvement was seen within the group of cases that had been graded as well/moderately differentiated with 100% agreement in the prior study.

Conclusion: Future squamous cell carcinoma differentiation grading systems would benefit from eliminating mitotic rate, clearly defining how to grade other features, and dichotomous grading.

Background: Since the early 2000s, human fibroblast conditioned media (HFCM) has been used in topical growth factor skincare to support skin regeneration and skin rejuvenation. Human fibroblast conditioned media contains the fibroblast secretome including growth factors as well as exosomes. The potential benefits of topically applied exosomes are gaining interest in the medical aesthetic field.

Objective: This article aims to summarize the preclinical and clinical data available on regenerative HFCM-based topical skincare with a focus on studies investigating products applied to improve overall facial skin rejuvenation and/or after in-office cosmetic procedures. In addition, available data on fibroblast-derived exosomes will be covered.

Methods: A focused literature review was conducted to provide an overview of evidence on HFCM-based topical skincare.

Results: Human fibroblast conditioned media-based skincare significantly reduces signs of skin aging including photodamage, coarse lines and wrinkles, and sagging. After in-office cosmetic procedures, HFCM-based skincare can stimulate skin recovery and reduce downtime as well as provide skin quality benefits to enhance overall treatment outcomes. Application of purified exosomes from HFCM also demonstrated significant improvements in multiple skin aging parameters.

Conclusion: Human fibroblast conditioned media combines naturally secreted fibroblast-derived growth factors and exosomes that stimulate skin regeneration and rejuvenation as evidenced by a variety of assays and assessments including in vitro preclinical studies, clinical investigator grading, instrumentation measurements, biopsy analyses, and patient-reported outcomes.

Introduction: Ingrown toenail is a very common nail disorder, and partial matricectomy by phenolization is considered the most effective treatment technique. However, the contact time of the phenol with the nail matrix remains debatable.

Objective: To evaluate the recurrence rate of ingrown toenail after partial matricectomy by phenol for 45 seconds.

Methods: A total of 1,460 surgeries were performed, with a photographic record of 802 pictures for a period of 6 months. The presence of any nail spicule or sign of ingrowth during follow-up was considered a recurrence.

Results: A total of 802 surgeries were evaluated, with the most affected nails being the right (49.3%) and left (48%) big toes and most frequently the lateral fold (54.5%). The recurrence rate was 0.75% at 3 months and 1.87% at 6 months, and the medial nail fold had a higher recurrence rate than the lateral nail fold.

Conclusion: Forty-five seconds of contact time of 88% phenol with the nail matrix was enough and effective, resulting in low recurrence rates. Prospective studies are needed to better assess postoperative morbidity.

Background: A growing population of patients is seeking treatments that not only affect their overlying features but also restore a more biologically youthful structure and function to the underlying tissue. These strategies are part of what is known as regenerative aesthetics (RA). As an emergent field, clarity regarding the precise definitions and aims of RA and methods to measure the regenerative capacity of RA treatments are lacking.

Methods: A panel of 6 multidisciplinary experts discussed the foundational aspects of RA. Consensus statements covered aspects of RA including terminology, goals of treatment, treatment strategies, and biological benchmarks indicating regeneration. Consensus on a statement was defined as ≥75% agreement.

Results: Panelists emphasized the importance of natural, youthful tissue architecture and function including cellular and extracellular components. Replacement of a single biological component was not considered sufficient for an aesthetic treatment to be described as regenerative. Rather, the relative amounts, ratios, types, and organization are important to determine regenerative potential. Calcium hydroxylapatite is an example of an aesthetic injectable with evidence of regenerative capacity, as demonstrated by its ability to improve collagen type I/III ratios as well as induce the production of elastin and proteoglycans, which ultimately improve measures of skin quality.