To construct a facial-skincare adverse event atlas and detect category-level safety signals using the US FDA openFDA Cosmetic Adverse Events database.
Methods
We analyzed publicly available openFDA cosmetic adverse event reports (downloaded 2025-12-15; meta.last_updated 2025-12-10). Suspect products were classified into 12 facial-skincare subcategories using keyword rules, excluding hair, makeup, nail, fragrance, oral, deodorant, and bath/body cleansing products. MedDRA preferred terms were grouped into nine clinically interpretable reaction clusters. Reporting odds ratios (RORs) with 95% confidence intervals were computed versus the full database (primary) and within-cohort comparators (sensitivity), with false discovery rate (FDR) control. We performed “case-check” analyses for five prioritized signals to assess product concentration and temporal patterns.
Results
The broad facial cohort comprised 2927 reports and the strict facial sensitivity cohort 1573 reports. The strongest full-database signals were eye-area products with ocular symptoms (ROR 61.67; 95% CI 46.13–82.43), masks with burn-related events (ROR 27.95; 20.39–38.31), retinoid/anti-aging with swelling/angioedema (ROR 21.94; 17.20–28.00), serum/essence with ocular symptoms (ROR 17.82; 13.74–23.10), and exfoliant/peel/scrub with burn-related events (ROR 13.39; 9.68–18.53). Within-cohort comparators attenuated effect sizes but preserved core signals (e.g., eye-area × ocular symptoms within-broad ROR 9.14; 6.68–12.49). Case-check analyses showed low product-name concentration across signals, supporting category-level interpretation.
Conclusions
openFDA cosmetovigilance data can be leveraged to map facial-skincare adverse event patterns and prioritize plausible safety signals. Eye-area products showed especially strong ocular-related signals, and leave-on products (masks, retinoid/anti-aging, serum/essence) showed coherent burn- and swelling-related signals.
Hypertrophic scars and keloids, types of pathological scars, arise from dysregulated wound healing, marked by abnormal fibroblast activation and excessive extracellular matrix (ECM) deposition. Current treatments have high recurrence rates and side effects, necessitating targeted therapies. Exosomes, extracellular vesicles mediating intercellular communication, offer multi-target regulatory potential to address scar formation complexities.
Methods
This narrative review synthesizes in vitro and in vivo studies (2020–2025) from PubMed and Scopus on exosomes' role in regulating hypertrophic scars and keloids, proposing innovative therapeutic approaches.
Results
Therapeutic exosomes attenuate inflammation, promote wound healing, inhibit fibrosis, and modulate the scar microenvironment. They suppress fibroblast-to-myofibroblast transformation, regulate collagen synthesis, and inhibit fibrotic pathways, particularly via the Transforming Growth Factor-beta/Sma- and Mad-related protein (TGF-β/Smad) signaling pathway.
Conclusion
Exosomes are a promising cell-free therapy for pathological scars due to their multi-target regulatory capabilities. Future research should optimize large-scale production, standardize protocols, and develop targeted delivery systems to enable clinical translation, with validation through clinical trials.
{"title":"Exosomes in Hypertrophic Scars and Keloids: Mechanisms and Therapeutic Potentials—A Narrative Review","authors":"Mengke Wu, Jianfeng Zhang, Na Xiong, Yixiao Ma, Lingling Yong, Huaxu Liu, Qin Guo","doi":"10.1111/jocd.70705","DOIUrl":"10.1111/jocd.70705","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hypertrophic scars and keloids, types of pathological scars, arise from dysregulated wound healing, marked by abnormal fibroblast activation and excessive extracellular matrix (ECM) deposition. Current treatments have high recurrence rates and side effects, necessitating targeted therapies. Exosomes, extracellular vesicles mediating intercellular communication, offer multi-target regulatory potential to address scar formation complexities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This narrative review synthesizes in vitro and in vivo studies (2020–2025) from PubMed and Scopus on exosomes' role in regulating hypertrophic scars and keloids, proposing innovative therapeutic approaches.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Therapeutic exosomes attenuate inflammation, promote wound healing, inhibit fibrosis, and modulate the scar microenvironment. They suppress fibroblast-to-myofibroblast transformation, regulate collagen synthesis, and inhibit fibrotic pathways, particularly via the Transforming Growth Factor-beta/Sma- and Mad-related protein (TGF-β/Smad) signaling pathway.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Exosomes are a promising cell-free therapy for pathological scars due to their multi-target regulatory capabilities. Future research should optimize large-scale production, standardize protocols, and develop targeted delivery systems to enable clinical translation, with validation through clinical trials.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15546,"journal":{"name":"Journal of Cosmetic Dermatology","volume":"25 2","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12856728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146085892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jonathan Kadouch, Rolf Bartsch, Nabil Fakih-Gomez, Omar Haroon, Martina Kerscher, Luiz Perez, Rossana Vasconcelos, Yana Yutskovskaya, Carla de Sanctis Pecora
Background
The popularity of minimally invasive aesthetic procedures has increased globally, with a 40.9% increase in non-surgical procedures between 2019 and 2023. Dermal fillers have gained popularity for delivering visible results with short recovery times. Among these, hybrid dermal fillers combining calcium hydroxylapatite-carboxymethyl cellulose (CaHA-CMC) and cohesive polydensified matrix-hyaluronic acid (CPM-HA) offer tailored treatment with demonstrated efficacy and tolerability. However, standardized guidance for use remains limited.
Objective
To establish consensus among a panel of aesthetic healthcare professionals (HCPs) on the real-world use of CaHA-CMC:CPM-HA hybrid dermal fillers.
Methods
A modified Delphi process was conducted with 23 international HCPs. Statements were developed from scientific advisory board outcomes and a literature review, refined by a scientific steering committee and evaluated across three rounds. Consensus was defined as ≥ 80% agreement/disagreement.
Results
Consensus was reached on the safety, efficacy, and use of CaHA-CMC:CPM-HA hybrid dermal fillers for volumization, contouring, and skin quality improvement. Of 43 statements, 27 reached consensus in Round 1, 7 in Round 2, and 3 in Round 3. Recommendations included dilution ratios, the “foaming” technique, subdermal injection, and avoiding high muscle activity sites. Experts highlighted the synergistic effects and convenience of CaHA-CMC:CPM-HA fillers, while noting the need for further research on long-term safety and rheological properties.
Conclusion
These results provide a base for standardized hybrid dermal filler use. Agreement on topics including indications, efficacy, and safety underscore the experts' unified stance on hybrid dermal filler usage. These consensus statements can serve as guidelines to ensure effective and safe clinical practice.
{"title":"Real-World Usage of CaHA-CMC:CPM-HA Hybrid Dermal Fillers: Findings From a Delphi Panel","authors":"Jonathan Kadouch, Rolf Bartsch, Nabil Fakih-Gomez, Omar Haroon, Martina Kerscher, Luiz Perez, Rossana Vasconcelos, Yana Yutskovskaya, Carla de Sanctis Pecora","doi":"10.1111/jocd.70688","DOIUrl":"10.1111/jocd.70688","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The popularity of minimally invasive aesthetic procedures has increased globally, with a 40.9% increase in non-surgical procedures between 2019 and 2023. Dermal fillers have gained popularity for delivering visible results with short recovery times. Among these, hybrid dermal fillers combining calcium hydroxylapatite-carboxymethyl cellulose (CaHA-CMC) and cohesive polydensified matrix-hyaluronic acid (CPM-HA) offer tailored treatment with demonstrated efficacy and tolerability. However, standardized guidance for use remains limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To establish consensus among a panel of aesthetic healthcare professionals (HCPs) on the real-world use of CaHA-CMC:CPM-HA hybrid dermal fillers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A modified Delphi process was conducted with 23 international HCPs. Statements were developed from scientific advisory board outcomes and a literature review, refined by a scientific steering committee and evaluated across three rounds. Consensus was defined as ≥ 80% agreement/disagreement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Consensus was reached on the safety, efficacy, and use of CaHA-CMC:CPM-HA hybrid dermal fillers for volumization, contouring, and skin quality improvement. Of 43 statements, 27 reached consensus in Round 1, 7 in Round 2, and 3 in Round 3. Recommendations included dilution ratios, the “foaming” technique, subdermal injection, and avoiding high muscle activity sites. Experts highlighted the synergistic effects and convenience of CaHA-CMC:CPM-HA fillers, while noting the need for further research on long-term safety and rheological properties.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>These results provide a base for standardized hybrid dermal filler use. Agreement on topics including indications, efficacy, and safety underscore the experts' unified stance on hybrid dermal filler usage. These consensus statements can serve as guidelines to ensure effective and safe clinical practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15546,"journal":{"name":"Journal of Cosmetic Dermatology","volume":"25 2","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12856531/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146085913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>We read with great interest the recent article in the <i>Journal of Cosmetic Dermatology</i> entitled “Electron Microscopy–Based Study of Cannulas for Suspension-Based Dermal Filler and Biostimulator Application.” Radke et al. [<span>1</span>] compared 22-gauge blunt cannulas from two brands using electron microscopy, focusing on exit opening geometry and inner lumen surface features relevant to the risk of clogging during administration of suspension-based injectables. We offer the following comments in the spirit of complementing the authors' important findings with additional rheological and clinical context.</p><p>In the article, biostimulators are described as generally behaving as Newtonian fluids [<span>1</span>]. However, from a rheological standpoint, they should not be classified as Newtonian. Rather, they represent non-Newtonian particulate suspensions whose flow behavior is governed by microparticle–microparticle interactions, the properties of the suspending medium, and geometric confinement within needles or cannulas [<span>2</span>].</p><p>With respect to needle clogging, our clinical experience differs from the implication that clogging is common when using 22-gauge cannulas. Numerous biostimulators are currently approved for clinical use in China, and clogging is seldom encountered when using 27- or 25-gauge cannulas and is only very rarely observed with 23- or 22-gauge cannulas. Most instances of clogging occur with lyophilized, carboxymethylcellulose-based biostimulators, particularly Sculptra. When reconstitution is performed thoroughly and uniformly, the occurrence of clogging can be largely eliminated [<span>3, 4</span>].</p><p>Needle clogging is a multifactorial phenomenon. Prior research has shown that smaller needle inner diameter (ID), higher vehicle viscosity, and larger particle size significantly increase obstruction risk—findings consistent with our experience. Additional contributing factors are summarized in Table 1 [<span>5</span>]. Although Radke et al. cite a microparticle size range of 2–150 μm [<span>1</span>], most published reports indicate that the majority of commercially available biostimulators contain microparticles predominantly within the 20–80 μm range [<span>6</span>], which remains smaller than the ID of a 32-gauge needle (Table 2). In practice, clogging may occur through two principal mechanisms. First, microparticle aggregation may arise, particularly in products containing carboxymethylcellulose that require reconstitution before injection. When reconstitution is incomplete, some microparticles may form clumps; if the size of such a clump exceeds the needle ID, mechanical obstruction results. Second, microparticle jamming may occur in small-bore needles even when individual microparticles are smaller than the lumen. Near the needle orifice or within the lumen, interactions between multiple microparticles—mediated by wall-to-microparticle and microparticle-to-microparticle friction—may create
{"title":"Needle Clogging in Biostimulator Injection: Rheological Context and Clinical Experience","authors":"Jui-Yu Lin, Chuan-Yuan Lin","doi":"10.1111/jocd.70713","DOIUrl":"10.1111/jocd.70713","url":null,"abstract":"<p>We read with great interest the recent article in the <i>Journal of Cosmetic Dermatology</i> entitled “Electron Microscopy–Based Study of Cannulas for Suspension-Based Dermal Filler and Biostimulator Application.” Radke et al. [<span>1</span>] compared 22-gauge blunt cannulas from two brands using electron microscopy, focusing on exit opening geometry and inner lumen surface features relevant to the risk of clogging during administration of suspension-based injectables. We offer the following comments in the spirit of complementing the authors' important findings with additional rheological and clinical context.</p><p>In the article, biostimulators are described as generally behaving as Newtonian fluids [<span>1</span>]. However, from a rheological standpoint, they should not be classified as Newtonian. Rather, they represent non-Newtonian particulate suspensions whose flow behavior is governed by microparticle–microparticle interactions, the properties of the suspending medium, and geometric confinement within needles or cannulas [<span>2</span>].</p><p>With respect to needle clogging, our clinical experience differs from the implication that clogging is common when using 22-gauge cannulas. Numerous biostimulators are currently approved for clinical use in China, and clogging is seldom encountered when using 27- or 25-gauge cannulas and is only very rarely observed with 23- or 22-gauge cannulas. Most instances of clogging occur with lyophilized, carboxymethylcellulose-based biostimulators, particularly Sculptra. When reconstitution is performed thoroughly and uniformly, the occurrence of clogging can be largely eliminated [<span>3, 4</span>].</p><p>Needle clogging is a multifactorial phenomenon. Prior research has shown that smaller needle inner diameter (ID), higher vehicle viscosity, and larger particle size significantly increase obstruction risk—findings consistent with our experience. Additional contributing factors are summarized in Table 1 [<span>5</span>]. Although Radke et al. cite a microparticle size range of 2–150 μm [<span>1</span>], most published reports indicate that the majority of commercially available biostimulators contain microparticles predominantly within the 20–80 μm range [<span>6</span>], which remains smaller than the ID of a 32-gauge needle (Table 2). In practice, clogging may occur through two principal mechanisms. First, microparticle aggregation may arise, particularly in products containing carboxymethylcellulose that require reconstitution before injection. When reconstitution is incomplete, some microparticles may form clumps; if the size of such a clump exceeds the needle ID, mechanical obstruction results. Second, microparticle jamming may occur in small-bore needles even when individual microparticles are smaller than the lumen. Near the needle orifice or within the lumen, interactions between multiple microparticles—mediated by wall-to-microparticle and microparticle-to-microparticle friction—may create ","PeriodicalId":15546,"journal":{"name":"Journal of Cosmetic Dermatology","volume":"25 2","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12859172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146093156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>Small, unsightly reticular veins are a frequent concern in dermatology clinics. While standard treatments like sclerotherapy are common, they can be complicated by extravasation, long-term hyperpigmentation, and the risk of arterial injection [<span>1</span>]. Furthermore, light-based therapies are often not effective for vessels larger than telangiectasias. We have developed a novel surgical method, which we term <i>angulated needle phlebectomy</i>, which uses a modified hypodermic needle to hook the desired vessels.</p><p>The technique is as follows: After marking the target veins, multiple punctures are made with an 18G needle. A 23G needle is then bent at its tip to an angle of 90 degrees or more with the use of a needle holder. This “angulated needle” is inserted through a puncture and advanced along the vessel. The needle is then rotated 5–7 times to grab the vein before pulling it out, extracting the vessel (Figure 1).</p><p>Figure 2 shows two photographs of a representative patient in which the targeted vein was removed, before and 1 week after the procedure. Notably, the procedure left only transient ecchymosis and tiny erythema from needle wounds. There was no observable scar or linear hyperpigmentation, a common side effect from thrombosed veins in sclerotherapy.</p><p>The technique differs from traditional hook phlebectomy [<span>2</span>] in its usage of the sharp tip of the 23G needle: It pierces the vascular wall multiple times in advancing and rotating parallel to the vessel, providing a stronger grasp than simple vertical hooking. Smaller vessels (0.1–0.5 cm in diameter), often too small and fragile to hook in our practice, become accessible with this technique. The method also eliminates the need for precise intravascular placement and the risk of extravasation and intra-arterial injection associated with sclerotherapy.</p><p>In clinical practice, this method also greatly facilitates the clearance of residual avulsed veins during hook phlebectomy because of its stronger grasping effect. Due to its small size and limited mechanical hooking strength, the angulated needle technique is not intended for the treatment of larger varicose veins; however, it may be particularly helpful for small reticular veins that are often difficult to engage with standard hook phlebectomy. Its use may also be limited for very small telangiectasias, but removal of the primary feeding reticular vein can still achieve satisfactory cosmetic results. In our clinics, we have used this technique either as a standalone procedure or as an adjunct to hook phlebectomy for small reticular veins, predominantly involving the lower extremities, including the thighs and calves, in several dozen patients. Follow-up ranged from 1 to 4 months. The side effects observed were limited to transient ecchymosis and mild erythema at the needle entry sites, which typically resolved more rapidly than after sclerotherapy, likely due to the absence of residual damaged or throm
{"title":"Angulated Needle Phlebectomy: A Novel Technique for Removing Small Reticular Veins","authors":"Wei-Ming Wu, Ling-Yi Wu","doi":"10.1111/jocd.70694","DOIUrl":"10.1111/jocd.70694","url":null,"abstract":"<p>Small, unsightly reticular veins are a frequent concern in dermatology clinics. While standard treatments like sclerotherapy are common, they can be complicated by extravasation, long-term hyperpigmentation, and the risk of arterial injection [<span>1</span>]. Furthermore, light-based therapies are often not effective for vessels larger than telangiectasias. We have developed a novel surgical method, which we term <i>angulated needle phlebectomy</i>, which uses a modified hypodermic needle to hook the desired vessels.</p><p>The technique is as follows: After marking the target veins, multiple punctures are made with an 18G needle. A 23G needle is then bent at its tip to an angle of 90 degrees or more with the use of a needle holder. This “angulated needle” is inserted through a puncture and advanced along the vessel. The needle is then rotated 5–7 times to grab the vein before pulling it out, extracting the vessel (Figure 1).</p><p>Figure 2 shows two photographs of a representative patient in which the targeted vein was removed, before and 1 week after the procedure. Notably, the procedure left only transient ecchymosis and tiny erythema from needle wounds. There was no observable scar or linear hyperpigmentation, a common side effect from thrombosed veins in sclerotherapy.</p><p>The technique differs from traditional hook phlebectomy [<span>2</span>] in its usage of the sharp tip of the 23G needle: It pierces the vascular wall multiple times in advancing and rotating parallel to the vessel, providing a stronger grasp than simple vertical hooking. Smaller vessels (0.1–0.5 cm in diameter), often too small and fragile to hook in our practice, become accessible with this technique. The method also eliminates the need for precise intravascular placement and the risk of extravasation and intra-arterial injection associated with sclerotherapy.</p><p>In clinical practice, this method also greatly facilitates the clearance of residual avulsed veins during hook phlebectomy because of its stronger grasping effect. Due to its small size and limited mechanical hooking strength, the angulated needle technique is not intended for the treatment of larger varicose veins; however, it may be particularly helpful for small reticular veins that are often difficult to engage with standard hook phlebectomy. Its use may also be limited for very small telangiectasias, but removal of the primary feeding reticular vein can still achieve satisfactory cosmetic results. In our clinics, we have used this technique either as a standalone procedure or as an adjunct to hook phlebectomy for small reticular veins, predominantly involving the lower extremities, including the thighs and calves, in several dozen patients. Follow-up ranged from 1 to 4 months. The side effects observed were limited to transient ecchymosis and mild erythema at the needle entry sites, which typically resolved more rapidly than after sclerotherapy, likely due to the absence of residual damaged or throm","PeriodicalId":15546,"journal":{"name":"Journal of Cosmetic Dermatology","volume":"25 2","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12853320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146085714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rahman Syed, Ameer Afzal Khan, Suleman Shah, Anfal Khan, Mohammad Idrees, Mohsin Ali, Mohammed Al Sinani, Mohammed Al Maqbali
Background
Platysma prominence (PP) is a common aesthetic concern associated with aging, leading to visible neck bands and loss of jawline definition. OnabotulinumtoxinA has emerged as a minimally invasive treatment; however, data from randomized controlled trials (RCTs) remain fragmented.
Aims
To systematically evaluate the efficacy and safety of onabotulinumtoxinA for treating moderate to severe PP through meta-analysis of RCTs.
Methods
PubMed, Cochrane CENTRAL, and ClinicalTrials.gov were searched from inception to March 2025 for RCTs comparing onabotulinumtoxinA with placebo in adults with PP. Two reviewers independently extracted data and assessed bias using the Cochrane RoB 2.0 tool. The primary outcomes were ≥ 1-grade and ≥ 2-grade improvement on the Clinician (C-APPS) and Participant (P-APPS) Allergan Platysma Prominence Scales. Secondary outcomes included patient satisfaction and treatment-emergent adverse events (TEAEs). Random-effects meta-analysis was used to estimate pooled risk ratios (RRs) with 95% confidence intervals (CIs).
Results
Three RCTs (n = 912) were included. OnabotulinumtoxinA significantly increased ≥ 1-grade (RR = 4.11; 95% CI, 3.60–4.69) and ≥ 2-grade (RR = 1.83; 95% CI, 1.54–2.17) improvements compared to placebo. Patient satisfaction was higher in the treatment group (RR = 5.55; 95% CI, 4.15–7.43). The incidence of TEAEs was similar between groups (RR = 0.95; 95% CI, 0.76–1.20), with most being mild and transient.
Conclusions
OnabotulinumtoxinA is an effective and well-tolerated minimally invasive option for improving platysma prominence, offering significant aesthetic and patient-reported benefits without increasing adverse effects.
{"title":"Efficacy and Safety of OnabotulinumtoxinA for the Treatment of Platysma Prominence: A Systematic Review and Meta-Analysis of Randomized Controlled Trials","authors":"Rahman Syed, Ameer Afzal Khan, Suleman Shah, Anfal Khan, Mohammad Idrees, Mohsin Ali, Mohammed Al Sinani, Mohammed Al Maqbali","doi":"10.1111/jocd.70701","DOIUrl":"10.1111/jocd.70701","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Platysma prominence (PP) is a common aesthetic concern associated with aging, leading to visible neck bands and loss of jawline definition. OnabotulinumtoxinA has emerged as a minimally invasive treatment; however, data from randomized controlled trials (RCTs) remain fragmented.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To systematically evaluate the efficacy and safety of onabotulinumtoxinA for treating moderate to severe PP through meta-analysis of RCTs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>PubMed, Cochrane CENTRAL, and ClinicalTrials.gov were searched from inception to March 2025 for RCTs comparing onabotulinumtoxinA with placebo in adults with PP. Two reviewers independently extracted data and assessed bias using the Cochrane RoB 2.0 tool. The primary outcomes were ≥ 1-grade and ≥ 2-grade improvement on the Clinician (C-APPS) and Participant (P-APPS) Allergan Platysma Prominence Scales. Secondary outcomes included patient satisfaction and treatment-emergent adverse events (TEAEs). Random-effects meta-analysis was used to estimate pooled risk ratios (RRs) with 95% confidence intervals (CIs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Three RCTs (<i>n</i> = 912) were included. OnabotulinumtoxinA significantly increased ≥ 1-grade (RR = 4.11; 95% CI, 3.60–4.69) and ≥ 2-grade (RR = 1.83; 95% CI, 1.54–2.17) improvements compared to placebo. Patient satisfaction was higher in the treatment group (RR = 5.55; 95% CI, 4.15–7.43). The incidence of TEAEs was similar between groups (RR = 0.95; 95% CI, 0.76–1.20), with most being mild and transient.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>OnabotulinumtoxinA is an effective and well-tolerated minimally invasive option for improving platysma prominence, offering significant aesthetic and patient-reported benefits without increasing adverse effects.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15546,"journal":{"name":"Journal of Cosmetic Dermatology","volume":"25 2","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12855634/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146085902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>In countries with intense solar irradiation such as Brazil, the skin operates simultaneously as a biological organ, a phenotypic marker of aging, and a visible marker of social belonging [<span>1</span>]. Marks produced by chronic photoexposure acquire meanings that extend beyond cutaneous physiology. They become embedded in social, economic, and symbolic dynamics that influence behavior, aesthetic expectations, and subjective experiences of aging. Amid ongoing ethical debates on whether aging should be viewed as pathological or socially constructed, it is relevant to examine how photoaged skin in Brazil may function as a visible stigma linked to social class and structural inequality [<span>2, 3</span>]. This phenomenon is deeply rooted in the structural hierarchy of labor and racialized class stratification, where cutaneous health outcomes are inextricably linked to systemic inequalities that determine environmental exposure and access to protective resources [<span>4</span>].</p><p>A significant clinical paradox emerges: while these patients pursue idealized digital textures, they frequently present with Fear of Overfilling (FOF) [<span>9</span>], a clinically meaningful anticipatory anxiety frequently observed in aesthetic practice centered on iatrogenic identity loss that acts as a psychological barrier to treatment. The coexistence of these phenotypes reveals an ethical dilemma for cosmetic dermatology: while one population seeks to reduce stigmata linked to structural inequality, the other navigates a tension between unrealistic digital ideals and the fear of clinical distortion [<span>9</span>].</p><p>Sun exposure in Brazil is marked by ambivalence. While culturally associated with leisure, it often reflects occupation and unequal access to care [<span>1, 2</span>]. Conversely, smooth skin signals aesthetic capital. Treating photoaging may partially reduce perceived inequalities, while lack of access tends to reinforce them [<span>2, 8, 10</span>]. At the same time, the hypervisibility of distorted results in digital environments has reshaped public perception. The widespread use of filters modifies subjective perceptions of normality [<span>3</span>], while “Zoom dysmorphia” has intensified self-scrutiny [<span>4, 5</span>]. Among clinicians, repeated exposure to filtered demands may induce “perception drift,” where normal variations are reinterpreted as defects [<span>8</span>].</p><p>Furthermore, the normalization of Overfilled Face Syndrome (OFS) in social media reinforces FOF, challenging the therapeutic alliance as patients overestimate the risk of unnatural outcomes [<span>9, 11</span>]. Beyond the aesthetic and psychological dimensions, it is imperative to acknowledge that photoaging, regardless of social class, is the primary clinical precursor to skin cancer. Both phenotypes are subject to the cumulative and deleterious effects of ultraviolet radiation, which remains a critical public health concern in Brazil due to the high
{"title":"Photoaging as a Social Marker and the D.I.F.A. Assessment: Addressing Social Stratification, the Filtered Ideal, and Identity Preservation in Brazil","authors":"Rafael Rodrigo Crisanto de Oliveira","doi":"10.1111/jocd.70700","DOIUrl":"10.1111/jocd.70700","url":null,"abstract":"<p>In countries with intense solar irradiation such as Brazil, the skin operates simultaneously as a biological organ, a phenotypic marker of aging, and a visible marker of social belonging [<span>1</span>]. Marks produced by chronic photoexposure acquire meanings that extend beyond cutaneous physiology. They become embedded in social, economic, and symbolic dynamics that influence behavior, aesthetic expectations, and subjective experiences of aging. Amid ongoing ethical debates on whether aging should be viewed as pathological or socially constructed, it is relevant to examine how photoaged skin in Brazil may function as a visible stigma linked to social class and structural inequality [<span>2, 3</span>]. This phenomenon is deeply rooted in the structural hierarchy of labor and racialized class stratification, where cutaneous health outcomes are inextricably linked to systemic inequalities that determine environmental exposure and access to protective resources [<span>4</span>].</p><p>A significant clinical paradox emerges: while these patients pursue idealized digital textures, they frequently present with Fear of Overfilling (FOF) [<span>9</span>], a clinically meaningful anticipatory anxiety frequently observed in aesthetic practice centered on iatrogenic identity loss that acts as a psychological barrier to treatment. The coexistence of these phenotypes reveals an ethical dilemma for cosmetic dermatology: while one population seeks to reduce stigmata linked to structural inequality, the other navigates a tension between unrealistic digital ideals and the fear of clinical distortion [<span>9</span>].</p><p>Sun exposure in Brazil is marked by ambivalence. While culturally associated with leisure, it often reflects occupation and unequal access to care [<span>1, 2</span>]. Conversely, smooth skin signals aesthetic capital. Treating photoaging may partially reduce perceived inequalities, while lack of access tends to reinforce them [<span>2, 8, 10</span>]. At the same time, the hypervisibility of distorted results in digital environments has reshaped public perception. The widespread use of filters modifies subjective perceptions of normality [<span>3</span>], while “Zoom dysmorphia” has intensified self-scrutiny [<span>4, 5</span>]. Among clinicians, repeated exposure to filtered demands may induce “perception drift,” where normal variations are reinterpreted as defects [<span>8</span>].</p><p>Furthermore, the normalization of Overfilled Face Syndrome (OFS) in social media reinforces FOF, challenging the therapeutic alliance as patients overestimate the risk of unnatural outcomes [<span>9, 11</span>]. Beyond the aesthetic and psychological dimensions, it is imperative to acknowledge that photoaging, regardless of social class, is the primary clinical precursor to skin cancer. Both phenotypes are subject to the cumulative and deleterious effects of ultraviolet radiation, which remains a critical public health concern in Brazil due to the high ","PeriodicalId":15546,"journal":{"name":"Journal of Cosmetic Dermatology","volume":"25 2","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12853232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146093184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Andrei Metelitsa, R. Sonia Batra, Anne Chapas, Jeffrey Fromowitz, Emmy Graber
<p>The contact-cooled 1726 nm laser (Aviclear, Cutera Inc., Brisbane, CA) treats acne vulgaris by selective thermolysis of sebaceous glands [<span>1</span>]. The device has demonstrated efficacy and safety across a broad range of patients with mild to severe inflammatory acne in clinical trials [<span>2, 3</span>]. In the pivotal trial leading to FDA clearance, 104 subjects (103/104 were graded as moderate or severe at baseline) received three treatments at 2–5 week intervals [<span>3</span>]. A per-protocol analysis of the trial (Table 1) showed significant improvements in both inflammatory lesion count (ILC) and investigator global assessment (IGA) [<span>3, 4</span>]. While study findings are promising, guidance on effective translation of findings to real-world clinical practice and how to best approach patients who may already be on medications is needed.</p><p>Here, an expert consensus group of five dermatologists presents best-practice recommendations for patient selection, treatment optimization, adjunctive therapies, and management strategies. Panelists were selected based on having performed the highest number of contact-cooled 1726 nm treatments, to date, as well as recognized expertise in managing acne. A nominal group technique was used: individual participant best practices were first collected individually via 1-h phone interview and clarified via follow-up e-mail communications. Next, a series of two 1-h virtual discussions were held, where panelist approaches were shared and discussed and a consensus was developed on the guidance for clinical practice presented here. The recommendations presented herein have been approved by all panelists/authors. Agreement was discussion based and there was no formal voting or Delphi process. Recommendations are based on clinical experience in treating over 1600 patients, collectively.</p><p>Contact-cooled 1726 nm laser therapy represents an innovative and effective addition to the acne treatment armamentarium. Its targeted selectivity for sebaceous glands and sustained clinical results set it apart from earlier laser-based modalities. Achieving optimal outcomes requires careful patient selection, clear expectation-setting, thorough counseling regarding the potential for transient acne flares, and the judicious use of adjunctive medications and supportive therapies. As clinical experience and evidence continue to accumulate, treatment protocols will likely become increasingly individualized, further refining and enhancing the role of contact-cooled 1726 nm laser therapy in comprehensive acne management.</p><p>All of the Authors Listed Participated in the Development of Recommendations and Each Aided in the Development and Review of This Commentary.</p><p>The authors have nothing to report.</p><p>The patient featured provided written consent for use of their image.</p><p>All authors serve as consultants for Cutera Inc.</p><p>Data sharing not applicable to this article as no datasets were generate
{"title":"Consensus Panel Recommendations for Optimizing Use of a Contact-Cooled 1726 nm Laser for the Treatment of Acne","authors":"Andrei Metelitsa, R. Sonia Batra, Anne Chapas, Jeffrey Fromowitz, Emmy Graber","doi":"10.1111/jocd.70699","DOIUrl":"10.1111/jocd.70699","url":null,"abstract":"<p>The contact-cooled 1726 nm laser (Aviclear, Cutera Inc., Brisbane, CA) treats acne vulgaris by selective thermolysis of sebaceous glands [<span>1</span>]. The device has demonstrated efficacy and safety across a broad range of patients with mild to severe inflammatory acne in clinical trials [<span>2, 3</span>]. In the pivotal trial leading to FDA clearance, 104 subjects (103/104 were graded as moderate or severe at baseline) received three treatments at 2–5 week intervals [<span>3</span>]. A per-protocol analysis of the trial (Table 1) showed significant improvements in both inflammatory lesion count (ILC) and investigator global assessment (IGA) [<span>3, 4</span>]. While study findings are promising, guidance on effective translation of findings to real-world clinical practice and how to best approach patients who may already be on medications is needed.</p><p>Here, an expert consensus group of five dermatologists presents best-practice recommendations for patient selection, treatment optimization, adjunctive therapies, and management strategies. Panelists were selected based on having performed the highest number of contact-cooled 1726 nm treatments, to date, as well as recognized expertise in managing acne. A nominal group technique was used: individual participant best practices were first collected individually via 1-h phone interview and clarified via follow-up e-mail communications. Next, a series of two 1-h virtual discussions were held, where panelist approaches were shared and discussed and a consensus was developed on the guidance for clinical practice presented here. The recommendations presented herein have been approved by all panelists/authors. Agreement was discussion based and there was no formal voting or Delphi process. Recommendations are based on clinical experience in treating over 1600 patients, collectively.</p><p>Contact-cooled 1726 nm laser therapy represents an innovative and effective addition to the acne treatment armamentarium. Its targeted selectivity for sebaceous glands and sustained clinical results set it apart from earlier laser-based modalities. Achieving optimal outcomes requires careful patient selection, clear expectation-setting, thorough counseling regarding the potential for transient acne flares, and the judicious use of adjunctive medications and supportive therapies. As clinical experience and evidence continue to accumulate, treatment protocols will likely become increasingly individualized, further refining and enhancing the role of contact-cooled 1726 nm laser therapy in comprehensive acne management.</p><p>All of the Authors Listed Participated in the Development of Recommendations and Each Aided in the Development and Review of This Commentary.</p><p>The authors have nothing to report.</p><p>The patient featured provided written consent for use of their image.</p><p>All authors serve as consultants for Cutera Inc.</p><p>Data sharing not applicable to this article as no datasets were generate","PeriodicalId":15546,"journal":{"name":"Journal of Cosmetic Dermatology","volume":"25 2","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12856072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146085728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Taikong Blue Lavender Essential Oil (TLEO) is derived from a proprietary space-bred cultivar of Lavandula angustifolia and cultivated under pristine conditions in Xinjiang, China. TLEO has long been used by regional people to treat various skin disorders such as hyperpigmentation, trans-epidermal water loss, collagen degradation, and poor wound healing. Despite the ethnopharmacological applications of TLEO, the molecular basis of its dermatological efficacy remains poorly defined.
Method
This study integrated network pharmacology, molecular docking, and in vitro assays to systematically investigate how TLEO works against inflammatory skin conditions, focusing on its key compounds and biological targets.
Results
A total of 66 skin disorder-related genes were identified through network pharmacology, with gene enrichment analyses highlighting the TNF signaling pathway as a critical mediator. Protein–protein interaction analysis revealed MMP9, EGFR, and PTGS2 as core targets. Molecular docking confirmed that linalool and linalyl acetate, the primary constituents of TLEO, exhibited moderate binding affinities with these targets. In vitro experiments using TNF-α-stimulated HaCaT cells demonstrated that treatment with 0.01% TLEO significantly (p < 0.05) reduced oxidative stress markers (NO, ROS, MDA), restored antioxidant enzymes (SOD, CAT), and downregulated inflammatory cytokines (IL-6, IL-1β, IL-8). TLEO also inhibited the phosphorylation of p38 MAPK and NF-κB p65, suppressed PTGS2 and MMP9 expression, and restored EGFR levels, indicating anti-inflammatory and barrier-restorative functions.
Conclusions
The study establishes a scientific foundation for the use of TLEO as a multifunctional ingredient in dermatological applications and highlights its value as a sustainable crop for regional economic development in Xinjiang.
背景：泰康蓝薰衣草精油（Taikong Blue Lavender精油，TLEO）是在中国新疆的原始条件下，由一种太空栽培的薰衣草（Lavandula angustifolia）衍生而成。TLEO长期以来被地区人民用于治疗各种皮肤疾病，如色素沉着、经表皮失水、胶原蛋白降解、伤口愈合不良等。尽管TLEO的民族药理学应用，其皮肤功效的分子基础仍然不明确。方法：本研究结合网络药理学、分子对接、体外实验等方法，系统研究TLEO抗炎性皮肤的作用机制，重点研究其关键化合物和生物学靶点。结果：通过网络药理学共鉴定了66个皮肤疾病相关基因，基因富集分析突出了TNF信号通路是一个关键的中介。蛋白-蛋白相互作用分析显示MMP9、EGFR和PTGS2是核心靶点。分子对接证实，TLEO的主要成分芳樟醇和乙酸芳樟醇与这些靶标具有中等的结合亲和力。结论：本研究为TLEO作为一种多功能成分在皮肤科的应用奠定了科学基础，突出了其作为新疆区域经济发展的可持续作物的价值。
{"title":"Unveiling the Therapeutic Potential of “Taikong Blue” Lavender Essential Oil and Its Key Compounds in Skin Problems via Network Pharmacology and In Vitro Validation","authors":"Fei Liu, Yingyu Zhang, Minhazul Abedin, Jingyi Song, Suzhen Yang, Hongxiang Lou, Xixi Dou, Junsong Xiao, Hua Wu","doi":"10.1111/jocd.70640","DOIUrl":"10.1111/jocd.70640","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Taikong Blue Lavender Essential Oil (TLEO) is derived from a proprietary space-bred cultivar of <i>Lavandula angustifolia</i> and cultivated under pristine conditions in Xinjiang, China. TLEO has long been used by regional people to treat various skin disorders such as hyperpigmentation, trans-epidermal water loss, collagen degradation, and poor wound healing. Despite the ethnopharmacological applications of TLEO, the molecular basis of its dermatological efficacy remains poorly defined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>This study integrated network pharmacology, molecular docking, and in vitro assays to systematically investigate how TLEO works against inflammatory skin conditions, focusing on its key compounds and biological targets.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 66 skin disorder-related genes were identified through network pharmacology, with gene enrichment analyses highlighting the TNF signaling pathway as a critical mediator. Protein–protein interaction analysis revealed MMP9, EGFR, and PTGS2 as core targets. Molecular docking confirmed that linalool and linalyl acetate, the primary constituents of TLEO, exhibited moderate binding affinities with these targets. In vitro experiments using TNF-<i>α</i>-stimulated HaCaT cells demonstrated that treatment with 0.01% TLEO significantly (<i>p <</i> 0.05) reduced oxidative stress markers (NO, ROS, MDA), restored antioxidant enzymes (SOD, CAT), and downregulated inflammatory cytokines (IL-6, IL-1<i>β</i>, IL-8). TLEO also inhibited the phosphorylation of p38 MAPK and NF-<i>κ</i>B p65, suppressed PTGS2 and MMP9 expression, and restored EGFR levels, indicating anti-inflammatory and barrier-restorative functions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The study establishes a scientific foundation for the use of TLEO as a multifunctional ingredient in dermatological applications and highlights its value as a sustainable crop for regional economic development in Xinjiang.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15546,"journal":{"name":"Journal of Cosmetic Dermatology","volume":"25 2","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12848645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146063746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ahmed AlJabr, Aseel Muhana I. AlAnazi, Rakan Abdulkarim A. AlEtebi
Background
Hyperpigmentation disorders, including melasma and post-inflammatory hyperpigmentation (PIH), are common dermatologic conditions associated with significant cosmetic and psychological burden. Tranexamic acid (TXA), an antifibrinolytic agent, has gained increasing attention due to its anti-inflammatory and antimelanogenic properties.
Objective
To review the current evidence on the efficacy and safety of tranexamic acid in the management of hyperpigmentation disorders, particularly melasma and PIH.
Methods
A narrative literature review was conducted using PubMed, Scopus, and Google Scholar to identify clinical and observational studies evaluating the efficacy, safety, and comparative outcomes of oral, topical, and intradermal tranexamic acid in hyperpigmentation disorders. Data were descriptively analyzed with comparison to standard treatments such as hydroquinone and laser therapies.
Results
Evidence from randomized and comparative studies demonstrates that oral, topical, and intradermal TXA significantly reduce pigmentation indices and improve quality-of-life scores in patients with melasma and PIH. Oral TXA at doses of 250–500 mg twice daily showed sustained clinical improvement with minimal adverse effects, most commonly mild gastrointestinal symptoms and menstrual irregularities. Topical and intradermal formulations demonstrated comparable or superior efficacy to hydroquinone with fewer irritant reactions. Combination therapies (e.g., TXA with hydroquinone or laser) yielded enhanced and longer-lasting outcomes.
Conclusion
Tranexamic acid represents a promising and well-tolerated therapeutic option for hyperpigmentation disorders. Its efficacy across multiple administration routes, favorable safety profile, and synergistic potential with existing therapies support its expanding role as both a primary and adjunctive treatment in dermatologic pigment management.
{"title":"Tranexamic Acid for Hyperpigmentation Disorders: A Literature Review on Efficacy and Safety in Melasma and PIH","authors":"Ahmed AlJabr, Aseel Muhana I. AlAnazi, Rakan Abdulkarim A. AlEtebi","doi":"10.1111/jocd.70692","DOIUrl":"10.1111/jocd.70692","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hyperpigmentation disorders, including melasma and post-inflammatory hyperpigmentation (PIH), are common dermatologic conditions associated with significant cosmetic and psychological burden. Tranexamic acid (TXA), an antifibrinolytic agent, has gained increasing attention due to its anti-inflammatory and antimelanogenic properties.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To review the current evidence on the efficacy and safety of tranexamic acid in the management of hyperpigmentation disorders, particularly melasma and PIH.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A narrative literature review was conducted using PubMed, Scopus, and Google Scholar to identify clinical and observational studies evaluating the efficacy, safety, and comparative outcomes of oral, topical, and intradermal tranexamic acid in hyperpigmentation disorders. Data were descriptively analyzed with comparison to standard treatments such as hydroquinone and laser therapies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Evidence from randomized and comparative studies demonstrates that oral, topical, and intradermal TXA significantly reduce pigmentation indices and improve quality-of-life scores in patients with melasma and PIH. Oral TXA at doses of 250–500 mg twice daily showed sustained clinical improvement with minimal adverse effects, most commonly mild gastrointestinal symptoms and menstrual irregularities. Topical and intradermal formulations demonstrated comparable or superior efficacy to hydroquinone with fewer irritant reactions. Combination therapies (e.g., TXA with hydroquinone or laser) yielded enhanced and longer-lasting outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Tranexamic acid represents a promising and well-tolerated therapeutic option for hyperpigmentation disorders. Its efficacy across multiple administration routes, favorable safety profile, and synergistic potential with existing therapies support its expanding role as both a primary and adjunctive treatment in dermatologic pigment management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15546,"journal":{"name":"Journal of Cosmetic Dermatology","volume":"25 2","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12848551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146063819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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