Dermatologic Surgery最新文献

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.

Background: While increasing evidence supports the safety and effectiveness of immunohistochemistry-assisted Mohs micrographic surgery (MMS) for superficially invasive melanoma, there is a paucity of the literature investigating its effect on final defect size.

Objective: To evaluate the tissue sparing effect of MMS for melanoma.

Materials and methods: Three hundred and twenty-eight patients with early-stage (T1a/T1b) cutaneous melanomas treated with MMS from January 2008 to December 2018 were evaluated. Measured defect sizes after Mohs tumor extirpation were compared with anticipated defect size that would result from standard-margin wide local excision (WLE). Average actual versus anticipated defect areas were compared using a paired t -test (95% confidence intervals).

Results: The following groups demonstrated a significantly smaller defect area for MMS-treated tumors when compared with anticipated standard-margin WLE defect: All tumors combined (13.8 cm 2 vs 10.4 cm 2 , p < .001), tumors requiring 1 stage (13.6 cm 2 vs 10.1 cm 2,p < .001), and tumors requiring 2 stages (13.2 cm 2 vs 10.5 cm 2 , p = .004). The majority of patients (83.5%, n = 274) achieved clear margins with 1 stage.

Conclusion: Immunohistochemistry-assisted MMS for early-stage invasive melanoma is associated with smaller final defect size and overall tissue sparing effect compared with standard WLE margins.

Background: Forehead flatness is common in Korean populations, and one of the most straightforward techniques for adding volume and achieving a concave forehead is injecting hyaluronic acid (HA) filler. However, definitive guidelines for this procedure are lacking, and careful attention to the arterial anatomy is required to avoid vascular complications.

Objective: The authors aimed to establish guidelines for performing forehead augmentation using Doppler ultrasound to identify vasculature before HA injection.

Methods and materials: Arterial mapping of the faces of 34 patients was performed using Doppler ultrasound. Each anatomic layer (skin, subcutaneous fat, and galea aponeurotica) of the forehead with blood vessels was identified. An average volume of 2.85 mL of HA filler was injected. Postoperative complications, such as infection, hematoma, bruising, nodules, skin necrosis, and blindness, were evaluated.

Results: Using Doppler ultrasound, the authors successfully traced all 3 blood vessels (supraorbital, supratrochlear, and frontal branch of the superficial temporal arteries) and avoided them during HA injection. None of the patients experienced arterial complications.

Conclusion: Doppler ultrasound proves to be an effective technique for arterial mapping, enabling the identification and avoidance of the major blood vessels of the forehead before HA filler injection.

Background: One-third of US adults are bothered by excessive sweating, approximately 5% are diagnosed with hyperhidrosis. A topical patch using targeted alkali thermolysis (TAT) was developed for treatment of this condition.

Objective: This study was intended to assess the efficacy and safety of the TAT-Patch for axillary sweat reduction.

Materials and methods: A randomized, multicenter, double-blind, sham-controlled, pivotal trial enrolled 120 subjects to a bilateral axillary treatment with a TAT patch (63 subjects) or sham patch (57 subjects).

Results: The primary end point was achieved; 64% of TAT-treated versus 44% of sham-treated subjects (p = .0332) improved from Hyperhidrosis Disease Severity Scale (HDSS) 3/4 to HDDS 1/2 at 4 weeks. Targeted alkali thermolysis treatment also showed a statistically significant improvement over sham treatment for all secondary end points, including gravimetric sweat production and subject-reported quality-of-life (QoL) assessments. The duration of effect is approximately 3 months, determined by the time to return to baseline HDSS. Mild-to-moderate treatment-site adverse events (AEs) were reported in 22% of TAT patch subjects. No serious or severe AEs were reported.

Conclusion: HDSS, GSP, and QoL findings confirm clinically meaningful sweat reduction and a significant improvement in quality of life following a single TAT patch treatment. This device has potential to offer a new, noninvasive treatment option that is well tolerated with minimal downtime.

Background: Retronychia, a condition marked by abnormal nail growth, is frequently underdiagnosed and misinterpreted, with a few reported cases in the literature.

Objective: To investigate the pathophysiology, identify contributing factors, and assess the outcomes of surgical and nonsurgical treatments for retronychia.

Methods and materials: A retrospective review of 107 retronychia cases diagnosed at the center between January 2021 and July 2022 was conducted.

Results: Predisposing factors were identified in 93.46% of cases, with 88.79% of patients reporting a habit of wearing socks during sleep before symptom onset. Noninvasive treatments targeting these factors led to full recovery in 79.55% of cases, while 13.64% experienced partial improvement, inducing reduced proximal nail fold inflammation. Nail avulsion, which involves removing the entire nail, achieved a relapse-free cure rate of 90.91%. When the innermost nail plate was preserved, the cure rate rose to 96.67%.

Conclusion: Chronic mechanical forces, frequently overlooked, play a pivotal role in retronychia onset and progression. Conservative management targeting these mechanical factors is recommended for patients with mild cases.