Dermatologic Surgery最新文献

Background: The regenerative properties of exosomes make them especially appealing to treat skin and hair diseases. Preclinical studies suggest that exosomes may fuel hair growth by stimulating dermal papilla cells, activating hair follicle stem cells, and promoting angiogenesis. However, very limited data are available on the safety and efficacy of exosome use in human subjects.

Objective: To review the published literature on exosome use in human subjects with a focus on safety and the challenges facing clinical implementation in the treatment of androgenetic and nonscarring alopecias.

Materials and methods: A review was conducted of PubMed, EMBASE, and Cochrane databases and included 48 studies. Twenty-five studies were clinical trials, 14 case reports, 4 case series, 1 retrospective review, and 4 conference abstracts.

Results: Nine clinical studies were found relevant to alopecia. One hundred twenty-five patients received an exosome treatment for hair loss. Side effects were rare. However, in the broader field of dermatology, at least 10 serious adverse events have been reported.

Conclusion: Although exosomes have many promising therapeutic applications, there is demand for larger well-designed clinical trials with extended follow-up periods to prove efficacy and a need for consistent manufacturing standards and regulatory oversight to ensure product safety.

Background: Prior studies describe wide local excision and "slow Mohs" outcomes for periocular melanoma. Mohs micrographic surgery (MMS) with immunohistochemistry maximizes tissue preservation and offers same-day comprehensive margin evaluation, which facilitates expedited repair, and coordination of oculoplastic reconstruction when necessary.

Objective: To describe oncologic and reconstructive outcomes of invasive periocular cutaneous melanoma treated with immunohistochemistry-assisted MMS.

Materials and methods: Invasive melanoma cases affecting the eyelids or periorbital region treated with MMS between 2008 and 2018 were reviewed. Eyelid tumors and those in adjacent subunits were compared. Main outcome measures were recurrence, melanoma-specific death, and postreconstructive complications.

Results: Of 42 cases, 28 were classified as periorbital and 14 as eyelid involving. Most were T1 (37, 88.1%). There was 1 local recurrence in a patient with persistent positive conjunctival margin (2.4%). No local recurrences were observed in cases where negative Mohs margins were achieved, and no melanoma-related deaths occurred. Eyelid tumors were more likely to result in lid margin involving defects and require oculoplastic reconstruction. Eyelid complications developed in 10 cases (23.8%), and 5 (11.9%) required revision surgery.

Conclusion: Mohs micrographic surgery for periocular melanoma results in low rates of local recurrence and melanoma-specific death. Initial tumor location can aid in reconstructive planning.

Background: Thread lifting, a minimally invasive alternative to facial rhytidectomy, has shifted from using nonabsorbable to absorbable sutures. Although many thread lift options exist, the impact of these different properties on complication rates remains unclear.

Objective: To systematically compare thread lift complication rates across different suture materials, textures, fixation methods, and lift locations.

Materials/methods: A systematic review was conducted through February 2024, following PRISMA guidelines, using multiple databases. The study focused on absorbable sutures, excluding nonabsorbable materials. Statistical analysis used Chi-Square tests with Bonferroni correction.

Results: Nineteen studies, encompassing 1,406 patients, met inclusion criteria. A total of 876 complications were reported. Ecchymosis (19.49%), swelling (16.79%), and tenderness (9.96%) were the most frequent complications, while hematoma (0.64%), paresthesia (1.14%), and infection (2.49%) were least frequent. Complications varied significantly among the studied factors. Swelling and ecchymosis were more associated with polycaprolactone sutures, barbed threads, and midface lifts. Barbed threads were associated with more complications than smooth or coned threads, as were floating threads compared with fixed threads.

Conclusion: Variations in thread lift suture materials and fixation technique were associated with different complication rates. Thread lifts using absorbable sutures exhibited complication rates under 5%, suggesting a generally favorable safety profile.

Background: Among the treatment modalities for post-acne scars, microneedling is considered a safe and effective method.

Objective: To compare the efficacy and safety of combined microneedling with topical insulin versus microneedling with placebo (topical saline) in treating atrophic acne scars.

Methods and materials: Twenty-one patients with atrophic post-acne scars were randomized and treated in a split face manner with 4 sessions at 3-week intervals of microneedling using dermapen, followed by application of insulin on one side of the face and saline (placebo) on the other side. Evaluation of response was done before the sessions and after 1 month of the last session using the Global Scarring Grading System of Goodman & Baron and Lipper & Perez scores, Patient reported acne scar improvement using a 4-point scale, patient satisfaction, and the facial acne scar quality of life tools.

Results: Both therapeutic modalities yielded a statistically significant improvement of atrophic acne scars. By comparing both modalities, there was no statistical significance regarding clinical improvement and side effects.

Conclusion: Using topical insulin combined with microneedling may have a value in improving atrophic acne scars, suggesting further evaluation using different delivery systems, insulin formulations, and assessment modalities.