Journal of Clinical and Aesthetic Dermatology最新文献

Objective: Botulinum toxin injection is a well-established treatment for primary hyperhidrosis. The botulinum toxin-loaded detachable dissolvable microneedles (BoNT-MNs) were developed in a result of disadvantages of the intradermal procedure. This pilot study aims to evaluate the efficacy and safety of BoNT-MNs.

Methods: This within-subject study included ten adults (N=10; 100% female) with mild primary axillary hyperhidrosis. BoNT-MNs patches were prepared and each microneedle patch contained 15 units of onabotulinum toxin. BoNT-MNs and placebo patches were randomly applied to different sides of axilla. Iodine-starch test, dermatologists' and patients' satisfaction scores were assessed at baseline and Weeks 1, 2, 3, 4, 8, 12, 16, 20, and 24.

Results: All ten female subjects completed the trial. Notably, on the BoNT-MNs side, iodine starch scores exhibited an onset at Week 2, with a 57.14-percent reduction at Week 12, returning to baseline after Week 20. Dermatologists' and patients' satisfaction scores were consistently superior to the placebo side from Week 2 and Week 1, respectively, until Week 16, with statistical significance (p<0.05) observed at Week 12 and Week 2.

Limitations: This study involved a limited number of female participants and administered a single, small dosage of botulinum toxin in the BoNT-MNs.

Conclusions: Botulinum toxin-loaded detachable dissolvable microneedles patches offer a safe and effective method for reducing axillary sweating.

Clinical trial: This study was approved by the Institutional Review Board of Faculty of Medicine, Chulalongkorn University with IRB number 567/63, and registered in the Thai Clinical Trials Registry (Thaiclinicaltrials.org) under registration number TCTR20201230002.

Background: Online health-related information (HRI) has expanded access to medical knowledge. While there are benefits to the increasing availability of online HRI, there may be limitations to the accuracy, quality of information, and utilization across patient demographics.

Methods: A survey was administered to dermatology outpatients at the Keck School of Medicine of the University of Southern California to examine the utilization of internet and social media for acquiring dermatology-related information (DRI).

Results: A total of 200 patients completed the survey. A majority (90%) indicated utilizing the internet to research information about their dermatological condition. Approximately 74 percent researched their dermatological condition before visiting the dermatologist, and 80 percent researched their condition after seeing a dermatologist. Younger patients (ages 18-25) were more likely to utilize online HRI before and after their visit. When stratified by income level, those with an income of less than $20,000 a year were more likely to search online for symptom management. Overwhelmingly, patients (99%) preferred to receive DRI from a dermatologist over internet or social media.

Limitations: A limitation of our study is the exclusion of individuals with dermatologic issues who do not seek in-person dermatologic care, which may contribute to selection bias.

Conclusion: There are differences across demographics in the utilization of the internet and social media for obtaining DRI. Understanding patients' interactions with online HRI may allow providers and patients to work synergistically, leveraging online resources to support the dissemination of credible information and optimize patient outcomes.

Vitiligo is an autoimmune disorder that causes melanocyte damage and pigment loss. The clinical presentation of vitiligo consists of patchy areas of lighter skin and results from a loss of functioning melanocytes and may be more visible in darker skin toned patients. Vitiligo affects approximately 2 percent of children and adolescents in the United States, with half of the affected cases undiagnosed. Pediatric patients are at a high risk of experiencing psychosocial adverse events such as depression and anxiety if the vitiligo is not quickly or effectively treated due primarily to the visual presentation of the disease. These adverse events may be seen especially in patients with a darker skin tone. Treatments for pediatric vitiligo in the past has usually included phototherapy, topical corticosteroids, vitamin D and calcineurin inhibitors; topical ruxolitinib has been approved more recently for nonsegmental vitiligo in patients 12 years of age and older. In cases where disease is recalcitrant, the need for additional therapies is warranted. Roflumilast cream 0.3% is a highly selective, non-steroidal and potent topical phosphodiesterase 4 inhibitor approved in 2022 by the United States Food and Drug Administration for the treatment of psoriasis, in 2023 as a foam for the treatment of seborrheic dermatitis and in 2024, roflumilast cream 0.15% was approved for the treatment of atopic dermatitis, including in children down to six years of age. Topical roflumilast is well tolerated with a favorable safety profile among pediatric dermatology populations. We describe four cases of pediatric skin of color patients with facial vitiligo that were refractory to topical corticosteroids, ruxolitinib and phototherapy. All patients were started on roflumilast cream 0.3% once daily and demonstrated improvement in repigmentation.

Driven by public demand, new safe and effective approaches for achieving dermal rejuvenation are continuously being developed. Recently, there has been growing interest and advances in carbon dioxide therapy, or carboxytherapy. Based on the Bohr effect, carboxytherapy enhances the release of O₂ from the blood into the surrounding tissues in response to increased blood CO₂. Injections of CO₂ promote wound healing, reduced scar tissue, and increase collagen turnover, making it a useful tool for achieving a broad range of aesthetic benefits. A significant advancement in CO₂ technology is the development of a topical gel for the transcutaneous release of carbon dioxide (CO₂ Lift. Lumisque, Inc., Weston FL). Similar to the changes observed following CO₂ injections, the application CO₂ gel increases microcirculation and capillary growth. For example, applying a CO₂ gel mask after skin rejuvenation procedures, such as nanofractional radiofrequency therapy, is a safe and effective means to improve clinical outcomes and reduce treatment-related adverse events. The following manuscript is a review and discussion based on a roundtable discussion conducted at the Generational Dermatology Symposium in Rancho Mirage, California, on February 16-19, 2023. The use of carboxytherapy using a CO₂ gel represents a new multi-purpose new for medical, aesthetic, pediatric, and female health practitioners for improving patient skin health and appearance.

Objective: The primary objective of these studies was to evaluate the potential of a serum containing Macrocystis pyrifera ferment (MPF-Serum) to both strengthen the barrier of intact skin and enhance barrier recovery after a non-ablative laser procedure or glycolic acid chemical peel.

Methods: Two whole-face clinical trials and three split-face, randomized, controlled clinical trials were conducted in women aged 31 to 65 years. The effect of MPF-Serum on barrier integrity and strength was assessed by transepidermal water loss measurement before and after controlled tape-stripping experiments and in-clinic 70% glycolic acid peel and non-ablative laser procedures.

Results: Application of MPF-Serum twice daily for eight weeks on intact skin significantly increased mean moisturization by 16 percent and improved barrier integrity by 11 percent (p≤0.05 for both). Likewise, barrier strength across 8x tape-stripped skin showed a 30-percent improvement after eight weeks of treatment. In studies involving non-ablative laser procedures, MPF-Serum pre-treatment or post-treatment improved post-procedure barrier recovery to a greater extent than standard moisturizer. Likewise, in a study involving 70% glycolic peel, MPF-Serum pre-treatment improved post-procedure barrier recovery to a greater extent than no pre-treatment.

Limitations: These clinical studies were conducted at a limited number of sites, with limited sample sizes and populations.

Conclusion: This topical MPF-Serum effectively improves barrier integrity and strength and helps to reduce recovery time from dermatologic procedures such as glycolic acid peel and laser treatments.

Background: Acne vulgaris (acne) is a common disorder with a complex, multi-faceted pathophysiology. To date, there has not been a single topical treatment that targets all aspects of acne pathophysiology (ie, increased sebum production, presence of Cutibacterium acnes, inflammation, and follicular hyperkeratinization). As such, topical treatments need to be utilized in combination to target all four of the major recognized pathophysiologic components in acne lesion formation.

Objective: This single-center prospective evaluation assessed the safety, tolerability, and efficacy of clindamycin phosphate 1.2%/adapalene 0.15%/benzoyl peroxide (BPO) 3.1% gel used concurrently with clascoterone 1% cream for treatment of acne in an eight-week, open-label pilot evaluation.

Methods: Six subjects (N=6), aged 21 to 27, were enrolled and evaluated at Week 0, Week 2, Week 4, and Week 8 with respect to erythema, dryness, and inflammatory lesion count (ILC).

Results: ILC decreased from 23.50 +/- 8.17 at baseline to 9.50 +/- 7.53 at Week 8 from baseline to Week 12. Average subject-reported adherence rate was 93.81%, and the most commonly reported side effects were burning/stinging and erythema; all were rated as mild.

Conclusion: This pilot evaluation, albeit small and open-label, demonstrates promising results for the first studied combination of topical agents to target all four aspects of acne pathophysiology. Further large-scale studies are needed to further elucidate the additive efficacy and side effect profile when these two topical medications are used concomitantly.

Seborrheic dermatitis (SD) is an inflammatory skin disease with multifactorial etiology, involving genetic and environmental factors. Many conventional therapies for SD (ie, topical antifungals, topical corticosteroids) are associated with incomplete efficacy, frequent and sometimes rapid disease recurrence, and restrictions on duration of therapy and anatomic sites of application. This may be because they cannot target multiple disease processes and/or are limited by safety considerations. Topical roflumilast foam was approved for the treatment of SD in 2023, but additional options are needed. The pathophysiology of atopic dermatitis (AD) and psoriasis have similarities with SD, supporting the hypothesis that tapinarof cream 1% once daily (QD) may be beneficial and well tolerated for patients with SD. Tapinarof is a non-steroidal, topical aryl hydrocarbon receptor agonist approved for the treatment of plaque psoriasis in adults. Tapinarof downregulates pro-inflammatory cytokines implicated in AD and plaque psoriasis, restores the skin barrier through upregulation of skin barrier components, and reduces oxidative stress. Here, we report that tapinarof cream 1% QD used for the treatment of four adults with mild-to-severe SD affecting the face, neck, back, and chest, demonstrated a rapid onset of efficacy and noticeable improvements in disease activity. Efficacy was maintained after treatment discontinuation, indicating a possible remittive effect as previously described in plaque psoriasis. The efficacy and potential remittive effect may be attributed to the unique mechanism of action and clinical profile of tapinarof cream. Tapinarof is a novel topical therapy that may be beneficial for patients with SD.

Background: Post acne erythema (PAE) is a common sequela of inflammatory acne vulgaris resulting from the dilatation of microcapillaries within the papillary dermis, thinning of the epidermis, and release of inflammatory cytokines. OBJECTIVE: The authors sought to compare the safety and efficacy of topical Brimonidine tartrate 0.33% gel versus A 577-nm pro-yellow laser for treatment of post acne erythema.

Methods: This was a comparative study, randomized clinical trials conducted on 60 adult patients with PAE. Patients were assigned into two groups: Group I included 30 patients who received brimonidine tartrate 0.33% gel once daily for three months, and Group II included 30 patients who received Pro-yellow laser with 577-nm therapy, for four sessions at three weeks intervals. Evaluation of erythema was done by Clinician's Erythema Assessment (CEA) and Patient's Self-Assessment (PSA) scales at baseline and at the end of the therapy. The dermoscopic images were analyzed for percent area of erythema and the optical density (OD) using ImageJ® freeware.

Results: Twenty-two patients (73.3%) were females and eight patients (26.7%) were males in Group I. In Group II, 20 patients (66.7%) were females and 10 patients (33.3%) were males. The mean±SD age of the studied groups was 22.07 years ±2.64 ranging from 20 to 24 years in Group I versus 20.93 years ±2.88 ranging from 19 to 23 years in Group II. Clinical improvement is distributed as follows among Group I; 56.7 percent are excellent, 56.7 percent good, 26.7 percent poor, and 10 percent fair for Group II; 33.3 percent good, 6.7 percent poor, and 60 percent excellent. There was no statistically significant difference between studied groups as regard Clinician's Erythema Assessment (CEA), Patient's Self-Assessment (PSA) mean area percentage and the optical density (OD) before treatment, while a statistically significant difference between studied groups after treatment was observed (p<0.001).

Conclusion: Topical brimonidine tartrate 0.33% gel and 577-nm pro yellow laser were effective and well tolerated therapeutic options for treatment of Post acne erythema (PAE), however the 577-nm Pro yellow laser was superior to brimonidine tartrate 0.33% gel.