Dermatologic Surgery最新文献

Background: Platelet-rich plasma (PRP) shows potential in treating androgenetic alopecia but lacks evidence for endocrine-induced alopecia (EIA) or persistent chemotherapy-induced alopecia (pCIA).

Objective: To evaluate safety and efficacy of PRP in breast cancer survivors with EIA or pCIA.

Methods: In this single-center, randomized, controlled trial, EIA and pCIA patients received PRP injections on one side of their scalp monthly for 3 months. Evaluations occurred at baseline and at week 12, followed by an optional cross-arm at week 24. The primary outcome was difference in global assessment scale (GAS) at week 12, assessed by a blinded investigator. Secondary outcomes included adverse events, hair-related quality of life, trichoscopic data, and circulating tumor cell (CTC) assay.

Results: Fifteen EIA and 12 pCIA patients enrolled. GAS improved from baseline to week 12 (+1.2 each, p < .001) but not statistically significant between treated and untreated sides ( p > .05). Hair density increased for both sides (+21 and +16 hairs/cm 2 , respectively, p < .05), without difference between the sides ( p > .05). Quality of life showed no improvement (41.1-39.4, p > .05). Adverse events included grade 1 to grade 3 scalp pain. Two of 12 CTC assays detected malignant cells in PRP, but no tumor seeding events were observed.

Conclusion: PRP may increase hair density in EIA and pCIA patients and showed no adverse cancer outcomes or tumor seeding. Results may be confounded by possible PRP diffusion in split-scalp study design.

Clinicaltrialsgov id: NCT04459650.

Background: Cryolipolysis is an effective, well-tolerated noninvasive subcutaneous fat reduction treatment.

Objective: Assess participant satisfaction, effectiveness, and safety of a dual-applicator cryolipolysis system that can deliver simultaneous treatments.

Materials and methods: Adult participants received treatment to the abdomen/flanks (midsection). Participants could also receive treatment to upper arms, thighs, and submental area. Primary end point was participant satisfaction with midsection results at 12 weeks after final treatment. Secondary end points included independent photography review, participant satisfaction with additional body areas, and overall satisfaction. Exploratory end points included 3D imaging of midsection volumetric changes and assessments at 4 weeks after initial treatment. Safety was monitored throughout.

Results: Of 110 treated participants, 75% were female. Mean age and body mass index were 43 years and 25.1 kg/m 2 , respectively. Of 96 evaluable participants, 83.3% (80/96) were "satisfied/very satisfied" with midsection results. Reviewers correctly identified 88.0% (81/92) of baseline versus 12 weeks after final treatment midsection images. Mean (SD) subcutaneous fat volume loss was 194.8 (492.3) mL at 12 weeks after final treatment ( p < .001). Visible improvements were noted at 4 weeks after initial treatment by a majority of physician reviewers and participants. Five (4.5%, 5/110) participants reported 7 treatment-emergent adverse device effects.

Conclusion: The dual-applicator cryolipolysis system demonstrated high participant satisfaction, effectiveness, and safety.

Background: Eccrine porocarcinoma is a rare cutaneous adnexal malignancy. Factors associated with metastasis of porocarcinoma and evidence for the utility of sentinel lymph node biopsy are incomplete within the literature.

Objective: Determine prognostic factors that may guide the decision to pursue sentinel lymph node biopsy in patients with porocarcinoma.

Materials and methods: Retrospective analysis of the National Cancer Database and the Survival, Epidemiology, and End Results databases for cases of porocarcinoma. Multivariable logistic regression was performed examining tumor size and lymphovascular invasion for association with metastasis of porocarcinoma. The cumulative probability of sentinel node metastasis was calculated as a function of tumor size.

Results: A total of 1,351 patients were identified; 75 (5.6%) had a positive lymph node on pathology and 15 (1.1%) had distant metastatic disease. Patients with tumors greater than 17 mm in size had a 6.8% risk of occult lymph node metastasis identified by sentinel lymph node biopsy. In the subset of tumors analyzed for lymphovascular invasion, 40% (14 of 47) had metastasized at diagnosis.

Conclusion: Tumor size and lymphovascular invasion affect metastasis of porocarcinoma. Tumors greater than 17 mm in size or with lymphovascular invasion warrant consideration of sentinel lymph node biopsy.

Background: Validated clinical scales are needed to assess aesthetic improvement of the midface volume deficit after treatment with dermal fillers.

Objective: To develop a midface volume deficit rating scale and establish its reliability and sensitivity for grading subjects in clinical trials and routine practice.

Methods: A 5-grade photonumeric scale was developed by clinical experts based on real-subject photographs and validated through photographic and live subject evaluation.

Results: The mean intra-rater weighted Kappa score between the 2 sessions of photographic validation was 0.92. Inter-rater intraclass correlation coefficient (ICC) was 0.89 for the combined sessions. The average intra-rater weighted Kappa score and inter-rater ICC for the live validation reached 0.81 and 0.78, respectively. In addition, evaluators identified clinically significant differences between photographs of subjects presenting a 1-grade or 2-grade difference in 80% and 89% of cases, respectively.

Conclusion: The Teoxane Midface Volume Deficit Scale can measure the degree of volume deficit, detect a clinically meaningful difference of 1-grade, and is applicable to the ethnic diversity of the population. This scale is a repeatable, reproducible clinician-reported outcome and a useful tool for health care providers to classify midface volume depletion both in clinical trials and routine patient care.