Dermatologic Surgery最新文献

Background: Botulinum neurotoxins in aesthetic medicine require reconstitution, which may cause administration errors.

Objective: To evaluate liquid nivobotulinumtoxinA treatment of lateral canthal lines (LCL) and glabellar lines (GL).

Materials and methods: Participants with moderate-to-severe LCL with/without moderate-to-severe GL were enrolled in 2 double-blind randomized clinical trials. Study 002 participants received nivobotulinumtoxinA 24 U or placebo for LCL treatment. Study 006 participants received nivobotulinumtoxinA 24 U (LCL), nivobotulinumtoxinA 44 U (LCL+GL), or placebo. Each study allowed up to 2 additional doses. The composite primary end point was the proportion of participants achieving ≥2-grade improvement on the Facial Wrinkle Scale (FWS) by investigator and participant assessment at maximum smile; the coprimary end point was investigator- and participant-assessed FWS "none or mild" rating.

Results: At Day 30, significant responder rates versus placebo were observed for LCL in Study 002 (30.3% vs 2.6%, p < .001) and for LCL and LCL+GL in Study 006 (20.6% and 22.8% vs 0%, p < .001) for the composite end point. "None or mild" investigator/participant assessment of LCL (Study 002: 62.7%/56.5%; Study 006: 56.4%/43.6%) and LCL+GL (60.8%/47.3%) were significantly higher versus placebo ( p < .001). Headache was the most common adverse event.

Conclusion: Liquid nivobotulinumtoxinA was effective and well-tolerated for treating moderate-to-severe LCL with/without GL.

Background: Evaluating postoperative outcomes after Mohs micrographic surgery (MMS) necessitates the use of patient-reported outcome measures (PROMs) and clinician (± patient) scar assessment tools.

Objective: To review patient- and clinician-reported outcome tools that have been developed to evaluate postoperative outcomes that are relevant to MMS.

Methods: A literature search was conducted to identify patients and clinician-reported outcome tools developed for surgery on the head and neck and for skin cancer surgery (including MMS).

Results: Sixteen articles were included. Five PROMs (dermatology life quality index, Skindex 16/29, skin cancer index [SCI], Skin Cancer Quality of Life Impact Tool/SF, Facial Apperance Related Questionnaire [FACE-Q]) and 5 clinician (± patient) scar assessment tools (Vancouver Scar Scale, Patient and Observer Scar Assessment Scale [POSAS], Manchester Scar Scale [MSS], Stony Brook Scar Evaluation Scale, Global Cosmetic Rating/Visual Analog Scale) are evaluated in detail. Among PROMs, the SCI and FACE-Q Skin Cancer module have demonstrated the strongest validation for facial skin cancers. Emerging tools, for example, Mohs micrographic surgery reconstruction questionnaire-12, reflect efforts to refine patient-centered outcome assessment specific to MMS. Clinician scar assessment tools remain valuable with POSAS widely regarded for combining objective scar characteristics with patient-reported symptoms. Vancouver Scar Scale and MSS offer structured observer-based evaluations, whereas other tools provide simple early postoperative assessments.

Conclusion: Integrating PROMs with clinician-reported scar assessment tools enables a comprehensive, multidimensional understanding of surgical outcomes-capturing both the subjective patient experience and objective clinical metrics.

Background: Approximately 10% of patients report penicillin allergy. Based on historical guidelines, patients with a penicillin allergy should receive an alternative to cephalexin for prophylaxis in dermatologic surgery.

Objective: To determine, based on evidence, if cephalexin should be used as a first-line prophylactic antibiotic in dermatologic surgery for patients with penicillin allergy.

Methods: Systematic review of the literature was performed with defined search terms.

Results: Less than 5% of those with penicillin allergy labels have a true penicillin allergy. For patients with true, persistent penicillin allergy, there is an overall low cross-reactivity with cephalosporins, especially with cephalosporins that do not share identical R1 side chain. The first-generation cephalosporins, including cephalexin, have a slightly higher risk of cross-reactivity in patients with reported allergy to amino-penicillins (amoxicillin, ampicillin) but not other penicillins. The risk of severe cross-reactivity of cephalosporins in patients with low-risk penicillin allergies is extremely low. Cephalexin has a superior side effect profile and efficacy compared to alternatives.

Conclusion: Cephalexin should be used as the first-line prophylactic antibiotic in dermatologic surgery for patients with documented penicillin allergy, including anaphylaxis. There may be a higher risk of cross-reactivity with cephalexin in patients with a confirmed amino-penicillin allergy.

Background: Androgenic alopecia (AGA) is a cosmetically disfiguring condition, which accounts for most cases of diffuse hair loss among females, negatively impacting their quality of life. Combining Fractional CO 2 (FCO 2 ) or Fractional Microneedling Radiofrequency (FMRF) with topical minoxidil 5% could achieve a better clinical outcome.

Objective: To compare efficacy and safety of FCO 2 and FMRF, combined with minoxidil, for the treatment of female AGA.

Methods: Thirty patients with female AGA were randomly assigned to 2 groups (simple computerized randomization). Group A patients received FCO 2 to 1 randomly selected side of the scalp, and Group B patients received FMRF to 1 randomly selected side of the scalp (picking masked labeled cards). Patients received minoxidil 5%.

Results: Significant increase in trichoscopic hair counts and density was found after treatment with each modality whether minoxidil 5% alone, minoxidil combined with FCO 2 , or minoxidil combined with FMRF. A significantly greater increase in trichoscopic hair counts and density followed the treatment with minoxidil + FMRF, compared to either minoxidil + FCO 2 or minoxidil alone.

Conclusion: It can be proposed that combining FMRF with minoxidil for the treatment of female AGA could be associated with higher efficacy and tolerability, compared to the other treatment modalities.