Journal of Clinical and Aesthetic Dermatology最新文献

Objective: With advances in aesthetic procedures, best practices for postprocedure care to support immediate healing and augment efficacy are still without consensus. A postprocedure formula containing hydroxypropyl tetrahydropyrantriol (HPT) and niacinamide (NAM) has been developed. This study evaluated the functional benefits and clinical efficacy of pairing HPT/NAM formula with nonablative fractional laser treatment.

Methods: The functional benefits of HPT/NAM were explored using 2D cellular models, reconstructed skin equivalents, and ex vivo skin models. The clinical efficacy of a HPT/NAM formula vs. a clinical control (Aquaphor Healing Ointment) was investigated through a randomized, double-blind, split-face, multicenter, multiethnic study with a White and a Northeast Asian panel. The investigative products were randomly assigned to one side of the face following a single full-face fractional nonablative laser procedure, and the products were applied twice daily for 56 days.

Results: In vitro testing showed that the HPT/NAM combination decreased the secretion of prostaglandin E2 (PGE2), encouraged the production of glycosaminoglycan, α-smooth muscle actin, and various angiogenic growth factors. In both panels, the HPT/NAM formula demonstrated significant improvement vs. the clinical control for key anti-aging parameters such as fine lines, crow's feet wrinkles, skin roughness, and overall healthy appearance over the course of 56 days.

Limitations: This study only investigated the pairing of HPT/NAM formula with nonablative laser treatment.

Conclusion: This study demonstrated comparable healing benefits to the clinical control along with augmented skin resurfacing benefits with HPT/NAM use following a nonablative fractional laser treatment.

People with amputations using limb prosthetics commonly develop dermatologic complications, such as impaired skin integrity and folliculitis, at the residuum-prosthesis interface (RPI). Dermatologic complications are the primary cause of dissatisfaction with prosthetics, hindering rehabilitation and leading to prosthesis abandonment. This has a deleterious impact on health-related quality of life (HRQOL). Positive outcomes have been associated with laser hair reduction (LHR) for those with traumatic lower limb amputations; however, this has not been studied in those with upper limb amputations or amputations due to other conditions. We performed a prospective study to assess the effects of skin conditions at the RPI on HRQOL and determine the potential benefit from LHR. Four patients were identified: 75% (n=3) with lower-limb amputations and 25% (n=1) with upper limb amputations. Amputation indications included infection (25%, n=1), congenital malformations (25%, n=1) and trauma (50%, n=2). Participants received 6 sessions of LHR, either alexandrite 755nm alone or in combination with Nd:YAG 1064nm laser. The Skindex-16 survey was performed along with 7 amputee-specific questions. Improvements in HRQOL were seen in all patients and subscales, with an overall average improvement of 50%. Functioning subscale improvement was greatest, at 60%. All patients (100%) were satisfied with LHR treatment. To our knowledge, this is the first study to examine the impact of LHR on the HRQOL of people with upper and lower limb prostheses. LHR is a minimally invasive technique to treat and prevent common dermatologic complications of the RPI, promoting improved self-confidence and prosthesis fit. This study identified an important role for dermatologists to engage with this community to improve their functional capacity and quality of life.

Many inflammatory skin conditions share mechanistic pathways involving multiple receptors and cytokines. Perhaps there is no better endorsement of this idea than the foundational concept of "steroid-responsive dermatoses." Similarly, targeting the phosphodiesterase 4 (PDE4) enzyme, which exists at the crux of several pathways that contribute to inflammatory skin diseases, offers an avenue by which the pathogenesis of multiple conditions may be interrupted. This suggests that PDE4 inhibitors may assume a similar complementary framework for treating "PDE4 inhibitor-responsive dermatoses." Certain formulations of PDE4 inhibitors (including apremilast, crisaborole, and roflumilast) have undergone rigorous investigation in clinical trials and demonstrated robust efficacy and safety in many dermatologic conditions, achieving United States Food and Drug Administration approval for atopic dermatitis, psoriasis, and seborrheic dermatitis. Herein, we summarize the clinical evidence supporting the emerging concept of "PDE4 inhibitor-responsive dermatoses" and propose that PDE4 inhibition offers an additional pathway to achieving desired clinical outcomes.

Background: Fractional carbon dioxide (CO₂) laser resurfacing is an effective treatment of various dermatological conditions. Pain, erythema, and edema following fractional ablative resurfacing are key limitations to patient comfort and satisfaction.

Objective: This study aims to describe a novel technique using laser-assisted drug delivery to administer a combination of local anesthetics and epinephrine both during and after fractional CO₂ laser resurfacing, enhancing procedural anesthesia and postprocedure recovery.

Methods: We performed an observational review of patient-reported pain scores and clinical outcomes in patients treated with application of an anesthetic spray during and after fractional CO₂ laser resurfacing treatments.

Results: Patients demonstrated an average of 68% reduction in pain scores (p<0.001) scores postapplication, with additional clinical improvements in postlaser erythema and edema.

Conclusion: Laser-assisted drug delivery of local anesthetics and epinephrine after fractional ablative resurfacing appears to offer a simple, low-cost adjunct for improving patient experience and recovery. Further investigation is warranted.

Background: Oral lichen planus (OLP) is an inflammatory disease involving the oral mucosa. It affects roughly 0.5% to 2% of the global population and has an associated risk of oral squamous cell carcinoma. Treatment of moderate to severe OLP often requires immunosuppression. The durability of immunosuppressive medication is currently unknown and is important for understanding therapeutic testing needs.

Objective: We investigated traditional immunosuppressive drug survival in patients with OLP and evaluated potential discontinuation factors.

Methods: We retrospectively analyzed patients with OLP treated with methotrexate, mycophenolate, azathioprine, or cyclosporine. Time to medication discontinuation was evaluated using the Kaplan-Meier estimator, and Cox proportional hazards regression was used to compare the risk of discontinuing a medication between medications and across patient demographic and disease factors.

Results: We identified 125 treatment periods with mycophenolate (n=58), methotrexate (n=34), azathioprine (n=19), or cyclosporine (n=14). Most patients had erosive disease (92%), and median time (IQR) to discontinuation due to adverse events or inefficacy was 9.43 months (6.51-16.1). Overall, only cyclosporine was associated with higher risk of discontinuation compared to methotrexate (hazard ratio [HR]: 2.94; 95% confidence interval [CI]: 1.32-6.45). There was no evidence for risk differences across age or sex for the overall cohort. Within individual medication groups, age was associated with a small increased risk of discontinuing mycophenolate (HR: 1.05; 95% CI: 1.00-1.10) and a small decreased risk in cyclosporine (HR=0.94, 95% CI: 0.89-0.99). Otherwise, no demographic factors were associated with discontinuation. Treatment success was reported 8 times.

Discussion: Immunosuppressive medications were frequently discontinued after short time periods, and few were discontinued due to success. These data highlight the need for better systemic therapy in OLP.

Background: Efficacy evaluations of topical cosmetic products purported to produce younger-appearing skin require an objective assessment of perceived age. The aim of this study is to quantify the age-reversal efficacy of a facial skincare regimen containing sirtuin-targeting and other anti-aging ingredients in a multiethnic population in terms of change in perceived age, using a validated age prediction model.

Methods: In this single-center, monadic study, eligible participants (n=72) applied a 3-product regimen (serum, soft crème, and eye crème) twice daily for 12 weeks. High-resolution digital photographs of subjects were graded for 7 facial parameters using an 11-point photonumeric scale (0=no signs of aging; 10=severe signs of aging) at baseline and 2, 4, 6, 8, and 12 weeks. Predicted Age scores derived from the model algorithm at each assessment point were compared with baseline scores to calculate change in Predicted Age in years.

Results: Statistically significant decreases vs. baseline in calculated Predicted Age were observed as early as Week 2, with the difference increasing with continued product application (difference at Week 12 was -4.0 years). Each facial aging parameter improved at a different rate, with forehead lines and elongated cheek pores significantly improving as early as Week 2. Under eye lines and forehead lines showed the greatest calculated improvement over time.

Conclusion: Based on the Predicted Age model, the 3-product face/eye skincare regimen applied twice daily resulted in a significant decrease in calculated Predicted Age starting as early as 2 weeks, with continued improvement over time, and a decrease of 4.0 years by Week 12.

Objective: Because pearly penile papules (PPP) are common, asymptomatic, and benign lesions that are often cosmetically bothersome to patients, we sought to systematically review all available treatment options for PPP.

Methods: PubMed, Scopus, Embase, and Cochrane databases were queried with relevant terms, with all articles describing treatment modalities for PPP included in this review. Articles related to PPP but lacking treatment information or without novel clinical or patient data, unrelated to PPP, or not available in English were excluded.

Results: The database query yielded 254 unique articles. After screening and evaluation for duplicates and inclusion and exclusion criteria, 17 publications, all of which were retrospective case reports or case series, with 142 patients were included and analyzed. The most common modality used was ablative laser (10 articles), eight of which involved carbon dioxide laser, as well as erbium yttrium-aluminum-garnet (YAG) and holmium:YAG lasers. Liquid nitrogen (3 articles) and single reports of pulsed dye laser, nonablative 1550nm fractional laser resurfacing, and electrocoagulation with or without 30% trichloroacetic acid peel were also found. Most articles reported complete lesion removal and high patient satisfaction with no reports of infection or scarring.

Limitations: This review is primarily limited by publication bias, with variable or limited methods of reporting efficacy/response and adverse event data.

Conclusion: Multiple modalities can achieve safe and effective treatment of PPP with high patient and provider satisfaction.

Dermatologic infections, particularly fungal and viral, are globally prevalent and often lead patients to seek complementary and alternative medicines (CAMs). This review critically evaluates 17 studies investigating CAM efficacy in treating dermatologic infectious diseases, focusing on those evaluated in randomized controlled trials (RCTs). Tea tree oil shows modest benefit for fungal infections such as tinea pedis and onychomycosis, though studies are limited by poor blinding and dropout rates. For herpes simplex virus (HSV), propolis and Melissa officinalis demonstrate potential antiviral effects, but findings are limited by subjective outcomes and industry sponsorship. Green tea extract (polyphenon E) shows efficacy in treating genital warts, though adverse skin reactions and publication bias warrant caution. Other agents, including garlic-derived ajoene, honey mixtures, and podophyllin, show promise but lack robust RCT validation. While CAMs offer intriguing therapeutic avenues, rigorous trials with standardized outcomes are essential to guide evidence-based integration into dermatologic care and improve patient-centered treatment strategies.

Objective: The aim of this study was to develop a novel validated computational algorithm for calculating facial age based on the key universal parameters of the face and eyes that contribute to facial aging in women, independent of ethnicity and Fitzpatrick skin type.

Methods: Digital facial images of women (n=2825) of 4 different ethnicities, across all Fitzpatrick skin types (I-VI), were evaluated and scored on 15 facial aging markers using a 0 to 10 photonumeric scale (0=no sign of aging; 10=severe signs of aging). Least squares linear multiple regression analysis was performed to identify parameters that contribute independently to observable skin aging and to develop a mathematical algorithm to calculate facial age based on these parameters.

Results: The identified key universal parameters contributing to facial age, independent of ethnicity or skin type, were nasolabial folds, under eye lines, elongated cheek pores, forehead lines, under eye puffiness, uneven skin tone, and marionettes, which explained 71% of the variation in age. All parameters increased with age but at different rates, with forehead and marionette lines showing the largest changes with each progressive decade.

Conclusion: The algorithm developed for calculating facial age based on visual assessments of 7 identified key parameters may be an objective method to evaluate the efficacy of topical anti-aging products.