Dermatologic Surgery最新文献

Background: Microneedling is a common minimally invasive procedure for skin rejuvenation. Granulomatous reactions after microneedling have been rarely reported.

Objective: To systematically review the literature for granulomatous reactions from microneedling.

Materials and methods: A systematic review of the Medline, Scopus, Google Scholar, and Cochrane databases was performed for articles describing granulomatous reactions to microneedling.

Results: Thirteen studies were selected for inclusion after full-text review, which described 15 patients (26-74 years old) with non-necrotizing granulomatous inflammation postmicroneedling. Motorized microneedling pen use and topical Vitamin C application were implicated in a majority of cases. Although delayed-type hypersensitivity was commonly proposed as the underlying etiology, patch testing or further workup was rarely performed. Improvement or clearance occurred inconsistently with myriad treatment options, including topical steroids, oral antibiotics, and systemic anti-inflammatory medications.

Conclusion: Granulomatous reactions to microneedling and microneedling-mediated transepidermal drug delivery can rarely occur and may be treatment-resistant.

Background: RelabotulinumtoxinA (RelaBoNT-A) is a complex-free, ready-to-use, liquid botulinum toxin A.

Objective: Efficacy/safety of RelaBoNT-A treatment for lateral canthal lines (LCL).

Methods: Randomized adults received RelaBoNT-A (30 U/side; n = 230) or placebo ( n = 73) during a 6-month, double-blind, Ph3 study (Relabotulinumtoxin Aesthetic Development Study-2 [READY-2]). Primary end points (Month 1, maximum smile) comprised: composite ≥2-grade responder rate using concurrent LCL severity investigator live assessment (LCL-ILA) and subject live assessment (LCL-SLA); LCL-ILA 0 (none)/1 (mild) responder rate. Subject satisfaction and adverse events were also reported.

Results: Month 1 composite ≥2-grade responder rates were 51.8% (RelaBoNT-A) and 1.4% (placebo; ( p < .001). Month 1 none/mild LCL-ILA responder rates were 87.2% (RelaBoNT-A) and 11.9% (placebo; p < .001). Onset was reported Day 1 by 34%. At Month 6, LCL-ILA responder rates for RelaBoNT-A remained at 23.3% (none/mild) and 35.9% (≥1-grade improvement). Median return to baseline severity was 24.7 weeks; 64% (RelaBoNT-A group) had not returned to baseline at Month 6. RelaBoNT-A satisfaction was high through Month 6 (71%). Mild/moderate treatment-related adverse events occurred in 6.1% (RelaBoNT-A) and 5.5% (placebo).

Conclusion: RelaBoNT-A (60 U) treatment provided statistically significant improvement of moderate-to-severe LCL. One-third of subjects reported onset within 1 day and improvements were maintained through Month 6. Treatment satisfaction was high. RelaBoNT-A was well tolerated.

Background: As new roles in health care appear and existing roles grow, there is concern that nonphysicians may appropriate physician titles. Protecting titles is essential to ensuring that patients understand the qualifications and training of their health care providers.

Objective: The purpose of this review was to evaluate the existing state laws as they apply to the protected and prohibited use of physician specialist titles and "doctor" in a clinical setting.

Materials and methods: Existing state laws, the Westlaw legal database, and BillTrack50 were examined for existing laws, court cases, and proposed legislation regarding the use of "physician," "surgeon," "dermatologist," and "doctor."

Results: General physician titles and suffixes, such as "M.D.," "D.O.," "physician," and "surgeon," are broadly protected throughout a majority of the United States. Unlike general physician titles, specialist titles, including "dermatologist," are only protected in 3 states and Washington, DC. Most states allow for the broad use of "doctor" by nonphysicians in clinical settings but require explicit clarification of the practitioner's doctoral field.

Conclusion: While general physician titles are protected in almost all states, specialist titles, such as "dermatologist," are protected in exceptionally few. There are ongoing efforts by state legislatures to update laws and enact protection for specialist titles.

Background: Reduced bruising and swelling after aesthetic procedures accelerates recovery. Arnica montana is widely used by physicians and promoted on social media, although its efficacy in aesthetic medicine remains uncertain.

Objective: To evaluate the validity of social media claims regarding Arnica's therapeutic benefits, focusing on aesthetic injectable procedures.

Materials and methods: Social media platforms, TikTok and Reddit, were searched on April 24, 2024, covering a 2-year period, using terms: "arnica montana," "arnica," "arnica filler," "arnica botox," and "arnica gel." A literature review was conducted using OVID Medline and Embase databases with keywords "arnica" and "arnica montana."

Results: A total of 48 TikTok posts and 305 Reddit entries were identified; with 91.7% and 58% of posts, respectively, endorsing Arnica use, primarily without scientific evidence. The literature review revealed limited and mixed evidence for Arnica's efficacy, with only 1 study addressing dermatologic injectable procedures. Systematic reviews indicated a small effect size for Arnica in surgical settings, with no specific focus on dermatologic applications.

Conclusion: Despite its popularity on social media and frequent use by health care providers, scientific evidence supporting Arnica's efficacy in reducing bruising and swelling after aesthetic procedures remains inconclusive. Social media discussions predominantly supported Arnica use, with limited opposition noted.