Journal of Cutaneous and Aesthetic Surgery最新文献

Post-acne atrophic scars (PAS) are a common complication of acne, and their treatment can be limited in people of color due to dyspigmentation and scarring risks. This split-face study compared the efficacy of microneedling with topical insulin (TI) on one side of the face with microneedling with platelet-rich plasma (PRP) on the other side for the treatment of PAS. The study included 50 participants with Fitzpatrick skin types III to VI who had never been treated for PAS. Both sides of the face showed significant improvement, with the left side being treated with TI showing a 52% improvement and the right side being treated with PRP showing a 28% improvement. The treatment was well-tolerated, with no significant adverse effects, and no changes in blood glucose levels were observed. The researchers suggest that combining TI or PRP with microneedling can improve PAS treatment, with TI being a superior option due to its ease of use, low cost, and noninvasive nature.

Objectives: To study the efficacy and safety of microneedling radiofrequency (MNRF) in the treatment of acne scars.

Material and methods: This is a hospital-based and prospective interventional study. A total of 44 patients (18- 55 years old), skin types III-V, with acne scars, were enrolled. Four sessions of MNRF (Lumenis legend PRO Machine, with non-insulated needle tips GEN6, GEN6L; Israel) were done with an interval of 3 weeks between each session and followed up 1 month after the last session. The outcome was assessed by Goodman and Baron's qualitative and quantitative acne scar grading, physician global assessment (PGA), and patient satisfaction score (PSS).

Results: Out of 44 patients, four patients could not complete the study. Goodman and Baron's qualitative assessment showed patients with Grades 2, 3, and 4 were 6 (15%), 17 (42.5%), and 17 (42.5%), respectively. At the end of follow-up, patients with Grades 1, 2, 4, and 4 acne scars were 5 (12.5%), 24 (60%), 10 (25%), and 1 (2.5%), respectively, which were statistically significant (P < 0.05). Seven patients showed no improvement. Goodman and Baron's quantitative assessment showed an initial mean of 12.65 and an after-follow-up mean of 8.3, which was statistically significant (P < 0.05). PGA and PSS scores showed excellent to good responses of 70% and 82.5%, respectively. Adverse effects such as post-treatment erythema were seen in all patients, and edema was observed in 12 patients. Post-inflammatory hyperpigmentation was noted in two patients.

Conclusion: MNRF was found to be effective with a better safety profile for acne scars.

Objectives: Eyelid margin lesions cause discomfort by impeding both central and peripheral vision, depending on their position on the eyelids, thus hindering everyday routines. However, surgical excision, radiofrequency, electrocautery, and cryosurgery are employed for treatment, although they are complicated and have functional limitations. Carbon dioxide (CO₂) lasers were used to assess the efficacy, safety, and patient satisfaction with CO₂ laser ablation in managing eyelid margin lesions.

Material and methods: This is a pilot study of patients with eyelid margin lesions presented to a private clinic in urban Gujarat between June 2020 and June 2023. All patients were treated with a 10600 nm CO₂ laser with a power of 1-2 W in continuous mode. The eyelid lesions were classified into three categories based on their size: Small (1-3 mm), medium (4-6 mm), and large (7-10 mm). The clinical response was assessed by the treating physician at week 1 and week 4, and categorized as excellent (complete clearance of lesion), moderate (>50%), or poor (<50%). Patients were asked to rate their level of satisfaction on a three-point scale at the end of the follow-up period: Dissatisfied, somewhat satisfied, or very satisfied.

Results: Ten patients of all females with six of them having compound melanocytic nevi, two of them each had cystic hidradenoma, and one each had cyst of zeis and verruca vulgaris. Six of them had small lesions, two had medium, and two had large lesions. The clinical response grading of physicians at both 1 week and 4 weeks was excellent, and the patient satisfaction questionnaire yielded excellent outcomes.

Conclusion: The ablative CO₂ laser is an excellent device used for the treatment of eyelid margin lesions, particularly when performed by an expert and skilled dermatologist. The application of this treatment approach has proven to be very beneficial and shows excellent results in terms of both the esthetic appearance and structural function of the eyelids.

While various treatment options exist for vitiligo, surgical interventions have gained significant attention due to their potential for long-lasting repigmentation. Several surgical procedures have been developed, including miniature punch grafting, thin Theirsch's split-thickness skin grafting (STSG), suction blister technique, and ultrathin STSG. The decision-making process should also consider the potential risks and benefits associated with each technique. Factors such as graft survival, color match, post-operative complications, and long-term stability of repigmentation should be evaluated. In addition, patient factors such as comorbidities, skin type, and psychological impact should be carefully considered to ensure optimal surgical outcomes. We, hereby, aim to explore the potential execution of vitiligo surgery using the most conceivable technique, considering factors such as efficacy, safety, and patient-specific characteristics.

Objectives: Evaluate the controlled release of silicon from smart polydioxanone suture (Smart PDOs™) and the clinical effect of the Cartesian Technique™ in face lifting.

Material and methods: This study was preclinical and clinical trials randomized, uncontrolled, and phase I carried out. Preclinical trials included instrumental analysis of silicon-enriched sutures by light microscopy, electron microscopy, and Ultraviolet-visible (UV-vis) spectroscopy. The clinical trial included 35 patients with primary and secondary rhytides, grade I lipomatosis, and grade I deflation. Polydioxanone (PDO) sutures are inserted following the Cartesian Technique™, a vectorial lift from the intersection of the Cartesian planes of the face. Once the cannulas were inserted with the PDO thread, 0.1 mL of organic silicon was dosed. Turgidity was examined by the pinch test of skin turgor. To measure the position of flaccid or deflated tissues, the scale used was the deflation scale.

Results: The controlled release of organic silicon from the PDO sutures was verified. Its clinical application revealed that after 8 days the improvement in turgidity, wrinkle reversal, and flaccidity tightening was maintained in 100% of the sample. At 15 days, reversal of rhytides was observed, softening of deep furrows in 80%, and the initial turgor and skin tightening maintained without deflation in 90% of cases. Histopathological findings reveal that silicon synergistically potentiates the tissue effect of the PDO suture, generating greater biostimulation of fibroblasts with better quality collagen fibers, greater restructuring and redensification of the skin, and avoiding the late inflammatory response.

Conclusion: The Cartesian Technique™ with Smart PDOs™ is an effective protocol for skin replenishment that enhances cell biostimulation through the release of bioactive drugs.

Patients seeking reconstructive facial surgery desire aesthetically pleasing outcomes with minimal visible scarring. For scalp incisions, beveled angle of 45° is typically preferred to preserve hair follicles. However, no consensus exists regarding the ideal incision angle for the brow area. This observational study analyzed the surgical outcomes of 12 patients with eyebrow defects treated using a simple elliptical excision with a beveled incision, addressing various indications such as posttraumatic scars, post-burn scars, and tumors. Outcomes were evaluated using the Physician Global Esthetic Improvement Scale at 7 days and 3 months post-surgery. At 7 days, 50% of patients showed very good improvement, and the other 50%showed moderate improvement. By 3 months, 33% of patients exhibited exceptional improvement, 50% showed very good improvement, and 17% demonstrated moderate improvement. This study concludes that direct excision and approximation with an angled incision along the hair follicle direction provide favorable aesthetic results for eyebrow reconstruction.

Objectives: Acne scarring occurs from skin damage following acne healing. Treatments such as chemical peels, dermabrasion, and laser therapy can effectively enhance scars' appearance but could be expensive. This study aimed to reflect participants' awareness of treatment options and their willingness to pay (WTP), evaluating their association with sociodemographics, severity, and quality of life (QoL).

Material and methods: A cross-sectional study was conducted in Riyadh, Saudi Arabia, from June to July of 2023. Study participants were chosen using a non-probability sampling technique. Participants were aged 18 or older, had acne scarring, and resided in Riyadh. Data analysis was performed using RStudio, with P < 0.05 indicating statistical significance.

Results: A total of 401 adult participants were included in the study. The prevalence of acne scarring among the participants was 63.4%. About 45.8% of the participants expressed a WTP of <1000 Saudi Riyals (SAR), while 42.2% were willing to pay 1000-6000 SAR. The most well-recognized acne scar management modalities were laser resurfacing (66.3%) and chemical peels (64.1%), while the least recognized were collagen/fat filler injections (23.9%) and radiofrequency microneedling (27.7%).

Conclusion: The most recognized acne scar treatment modalities were laser resurfacing and chemical peels. Participants were willing to pay for reasons such as psychological impact, income levels, and awareness of treatment modalities. The findings could influence dermatologists to start awareness campaigns to debunk misconceptions about acne scar treatment modalities and their efficacy in improving QoL.

Vitiligo is an acquired depigmenting disorder due to the destructive loss of melanocytes, clinically presenting as hypopigmented or depigmented macules and/or patches. Many theories have been proposed to explain its etiopathogenesis among which cell-mediated immunity is one of the crucial links. Estimation of vitiligo activity and extent in a patient is important in tailoring an optimal treatment regimen. Interleukin-6 (IL-6) and high-sensitivity C-reactive protein (HsCRP) are sensitive indicators for systemic inflammation and are found to be relevant in determining vitiligo disease activity. This study was conducted to estimate serum levels of IL-6 and HsCRP in vitiligo patients and to correlate them with the disease activity and extent in order to assess if these serum markers serve as objective indicators of vitiligo disease activity. This was a hospital-based cross-sectional study of 58 vitiligo patients diagnosed clinically irrespective of age, gender, and any ongoing or past treatment. Disease activity and extent were calculated using the vitiligo disease activity (VIDA) score and vitiligo area severity index (VASI), respectively. Serum levels of IL-6 and HsCRP were obtained and their correlation with VIDA and VASI values were statistically analyzed. A weak negative statistically insignificant correlation was found between IL-6 and VIDA (P = 0.092). No correlation was found between VIDA and HsCRP (P = 0.998). A weak positive, statistically insignificant correlation was found between VASI and IL-6 as well as between VASI and HsCRP (P = 0.175 and P = 0.238, respectively). Although statistically insignificant, the patients who were not on immunosuppressive therapy showed higher mean values of IL-6 and HsCRP compared to those who were on immunosuppressive therapy. In contrast to the findings of previous studies, our study found a weak negative correlation between VIDA and IL-6 levels possibly attributable to the difference between the mean levels of IL-6 among the subgroups of patients who were, and were not on immunosuppressive therapy. The VIDA score and HsCRP levels did not show any statistical correlation. However, patients who were not on immunosuppressive therapy showed a higher albeit statistically insignificant mean value of HsCRP. Our observations suggest that any ongoing and/or treatment in the recent past, especially immunosuppressive therapy, and any co-morbidities should be essentially considered while investigating for sensitive serum markers of inflammation as determinants of vitiligo disease activity.

Ingrown toenails is a painful foot problem seen in primary care among young men. To provide immediate pain relief, some types of splints are placed in the gutter to separate it from the ingrown lateral nail. There are time-consuming and effort-intensive procedures that use available nail separators and elevators to separate the nail plate. Here, the hub of the syringe is cut obliquely to create a beveled or slant edge to create a custom nail separator which is a useful device for the easy and less painful separation of the ingrown nail plate from its gutter, which is an important stage of nail splinting.