Journal of Clinical and Aesthetic Dermatology最新文献

Objective: Dermatologists regularly encounter patients having expanded fields with numerous actinic keratosis (AK) lesions on the face and scalp. Field-directed red light photodynamic therapy (PDT) is a well-established treatment, yet published data on the safety of PDT on large areas is scarce. We aimed to evaluate the safety and tolerability of red light PDT in treating expanded AK fields on the face and scalp.

Methods: This was a non-randomized, open-label, multicenter study. After lesion preparation, 6g of 10% aminolevulinic acid (ALA) gel were applied to the treatment field (60 cm²) and incubated for three hours under a light-blocking, occlusive dressing before 10-minute illumination with a red light lamp (~635nm, 37 J/cm²). Safety and tolerability were assessed throughout the study.

Results: All participants (n=100) had adverse reactions. No previously unknown effects, serious adverse events, or deaths were reported. The most frequent application site reactions were pain/burning (96.0%), exfoliation (87.0%), and erythema (86.0%). Most treatment-emergent adverse events were of mild to moderate severity and lasted slightly longer compared to those experienced after treatment of smaller areas. The mean maximum pain during PDT was 7.4±2.1 on an 11-point numeric rating scale. A transient increase in blood pressure on the day that PDT was performed was not clinically significant.

Limitations: Although the allowed use of pain-reducing measures might have influenced evaluation of pain, it reflects how the procedure is managed in current practice.

Concklusion: PDT with 10% ALA gel and red light illumination on an expanded treatment field was generally well tolerated.

Objective: Clindamycin phosphate 1.2%/adapalene 0.15%/benzoyl peroxide 3.1% (CAB) gel-the only approved fixed-dose, triple-combination acne treatment-demonstrated superior efficacy to vehicle and component dyads, with favorable safety/tolerability in Phase 2 and Phase 3 studies. In order to examine efficacy and safety of CAB in patients with darker skin phototypes, a post hoc analysis of clinical trial data of participants who self-identified as "Black or African American" was conducted.

Methods: Data were pooled from two Phase 2 and two Phase 3, double-blind, 12-week studies (NCT03170388, NCT04892706, NCT04214639, NCT04214652). Eligible participants aged ≥9 years (≥12 years in NCT04892706) were randomized to once-daily CAB or vehicle. Endpoints included ≥2-grade reduction from baseline in Evaluator's Global Severity Score and clear/almost clear skin (treatment success) and inflammatory/noninflammatory lesion counts. Treatment-emergent adverse events (TEAEs) and cutaneous safety/tolerability were also assessed.

Results: Of 1,115 participants randomized to CAB or vehicle, 156 (14%) were Black. At Week 12, 32.0 percent of CAB-treated participants achieved treatment success versus 18.3 percent with vehicle (P=0.07). Inflammatory and noninflammatory lesion reductions were significantly greater with CAB versus vehicle (68.8% vs. 51.4% and 57.8% vs. 45.5%, respectively; P<0.05, both). TEAE severity was mild to moderate, and hyperpigmentation mean scores remained at/below baseline value (0.7; 1=mild).

Limitations: Studies were not powered to detect significant differences between CAB and vehicle for Black participants; therefore, P values are for informative purposes only.

Conclusion: CAB gel was efficacious and well tolerated in Black participants with acne.

This paper examines the multifaceted nature of beauty, encompassing evolutionary, biological, neurological, cultural, and individual factors. It explores the limitations of objective assessments, such as artificial intelligence (AI) algorithms like the Facial Aesthetic Index and Facial Youthfulness Index, which often fail to capture the diversity of individual preferences and cultural standards. While AI tools can provide valuable insights into facial features, their use in aesthetic medicine should be approached with caution, recognizing the importance of subjective perceptions. We emphasize the need for a collaborative approach that integrates AI insights with clinical expertise and patient involvement to achieve personalized and satisfying outcomes in aesthetic medicine. Ultimately, beauty is a complex and subjective experience that cannot be fully defined or assessed objectively, and successful aesthetic interventions require a holistic approach that values both objective data and individual perspectives.

Objective: The authors sought to determine the frequency and methods of race reporting in dermabrasion clinical trials.

Methods: A PubMed search for terms: "dermabrasion," "derm-abrasion," and "derm abrasion" was conducted, yielding 1,786 papers. The "Clinical Trial" and "Randomized Control Trial" filters were applied. Non-English manuscripts were excluded. Remaining manuscripts were manually screened. Forty-one papers met final inclusion criteria.

Results: Forty-six percent (n=19) of studies included mention of race, skin color, or Fitzpatrick skin type (FST). Four studies reported FST of 78 dermabrasion participants. Of these, 19 percent had FST I, 27 percent had FST II, 32 percent had FST III, 17 percent had FST IV, and 1 percent had FST V. Three patients (4%) were lost to follow-up and did not have FSTs reported. Twenty-two percent (n=9) of the studies including 513 patients reported race or skin color. The races of 107 (21%) could be definitively extracted. Of these 107 patients, 94 percent were White, five percent were Black, and one percent were Asian.

Limitations: Our search was limited to PubMed-indexed articles which were categorized as 1) clinical trials or 2) randomized control trials. Articles that were incorrectly indexed in accordance with the search tool may have been inadvertently excluded.

Conclusion: Our analysis suggests that the collection and reporting of racial demographic information has been rare in dermabrasion clinical trials. The absence of this demographic information limits the generalizability of the results. Given the health disparities that arise due to racism, investigators should collect and report participant races to improve risk stratification and transparency.

Objective: We evaluated the cosmetic outcome and clearance of actinic keratoses (AKs) using photodynamic therapy (PDT) with microneedling-assisted delivery of 10% aminolevulinic acid (ALA) gel (Ameluz®, Biofrontera, Woburn, MA) with 30-minute incubation followed by 10-minute illumination with a red light (BF-RhodoLED®, 635nm, 37 J/cm²).

Methods: Five subjects were treated with red light PDT using microneedling-assisted delivery of 10% ALA gel. ALA gel was applied on the face and incubated for 30 minutes without occlusion, followed by illumination with a red light for 10 minutes (635nm, 37 J/cm²). Follow-up (FU) visits were made at Weeks 1, 2, 4, and 8. The primary endpoints were changes in subject- and investigator-graded Global Aesthetic Improvement Scale (GAIS) scores and assessment of quality in wrinkle, color evenness, texture, spot, and pore analyses with Canfield Visia-CR imaging system. Secondary endpoints were: 1) AK clearance as quantified by the count of AKs at eight-week FU versus baseline and 2) safety as measured by subject-reported pain (10-point VAS scale) during red-light illumination and adverse events.

Results: Investigator- and subject-graded GAIS scores showed a sharp increase to "much improved" at two weeks and increased to "very much improved" at eight weeks. There was an average 24.93-percent improvement in texture and an average 10.30-percent improvement in skin tone (color) evenness. AK lesion clearance ranged from 70 to 100 percent, with the mean at 89.2±14.9 percent. Three subjects achieved 100-percent clearance. The mean pain score during red-light illumination was 3.2±1.6. All subjects completed the study.

Limitations: The study included a small number of subjects (N=5).

Conclusion: Our results indicate that red light PDT using microneedling-assisted delivery of 10% ALA gel and a short 30-minute incubation is a safe and tolerable procedure producing good cosmetic outcomes in several skin quality parameters, such as texture and skin tone evenness, as well as an AK lesion clearance rate of 89.2 percent at Week 8, relatively low pain scores, and a reduced PDT treatment time.

This clinical review examines what is known about exosomes and their applicability to aesthetic dermatology. Exosomes are extracellular vesicles with crucial roles in intercellular communication. Their biogenesis is complex and not completely understood, but they are generally formed intracellularly in the endosomal compartment of a cell or through direct plasma membrane release. Several mechanisms of exosome uptake have been described and are dependent on the molecular characteristics of the recipient cell and exosome membrane. Furthermore, there are a multitude of exosome isolation and characterization techniques, each with their own potential advantages and disadvantages. Exosomes have demonstrated promise in preclinical models across various domains of aesthetic dermatology, including as anti-aging and anti-inflammatory therapies and as therapeutics for wound healing, scar reduction, and hair regeneration. However, clinical studies are lacking, and there are substantial safety concerns, such as the potential risk of infections, unwanted inflammatory response, and promotion of malignancy. Further research is needed to develop more precise analytical techniques to better understand the composition of exosomes, their safety profiles, and their potential applications to patient care.

Objective: Skin aging is accelerated by glycative stress, which promotes the accumulation of advanced glycation end products (AGEs) and impairs the extracellular matrix. A randomized, double-blinded, placebo-controlled trial evaluated a dietary supplement containing rosemary extract (BioR), demonstrating tissular and visible improvements in skin quality. The data reported herein evaluated markers associated with glycative stress and AGEs from skin biopsies and tape strips obtained following dietary supplement use.

Methods: Female participants (N=104), aged 40 to 65 years, with moderate-to-severe skin dullness and roughness/texture, and mild-to-moderate erythema, pore size, and uneven pigmentation were randomized to BioR (n=52) or placebo ([PLB] n=52). Capsules were taken with food over 12 weeks. Subjects (n=16, BioR; n=16, PLB) underwent 3mm punch biopsies (volar upper arm) and tape stripping (16 tape strips, each; volar forearm) at baseline and 12 weeks for analysis of 4-hydroxynonenal protein adducts (4HNE [oxidative stress marker]) and AGEs.

Results: Immunohistochemistry and ELISA revealed that levels of 4HNE protein adducts were significantly decreased from baseline in the BioR versus PLB group (p<0.005; biopsies) and significantly decreased from baseline in the BioR group alone (p<0.05; tape strips) at 12 weeks. Significant reductions in AGEs occurred in the BioR versus PLB group (p<0.005; biopsies) at 12 weeks. No significant changes from baseline occurred in 4HNE protein adduct levels or AGEs in the PLB group.

Conclusion: After 12 weeks, a dietary supplement containing rosemary extract led to significant reductions in a marker associated with oxidative stress, a component of glycation, and AGEs versus placebo in skin in addition to visible improvements in skin quality.

Background: Treatment of post-liposuction skin irregularities (PLSI), a complication of liposuction, can be challenging.

Objective: Considering the increasing request of treatment of PLSI, the aim of this study is to evaluate the efficacy and safety of CaHA diluted/hyperdiluted to PLSI.

Methods: A retrospective study on a total of eight PLSI areas in six women treated with CaHA diluted/hyperdiluted was performed. Efficacy was estimated on pictures of affected areas collected before and four months after treatment, according to the recently validated PLSI scale and Student's t-test for paired samples was performed to analyze data. Eventual adverse events were used to evaluate safety.

Results: Our results showed a statistically significant improvement of number and depth of depressions and a trend toward reduction of skin laxity.

Conclusion: This study reported the efficacy and safety of CaHA diluted/hyperdiluted for PLSI treatment. Larger studies are encouraged to support the results of this pilot study.

Genital involvement is a frequent complication of plaque psoriasis (PsO) and is associated with substantial emotional and physical burden. We report a case of a male patient with genital PsO who did not respond to multiple systemic and topical therapies but achieved complete clearance with roflumilast cream 0.3% (a potent phosphodiesterase 4 inhibitor). After 28 weeks of initial treatment with guselkumab, body surface area (BSA) affected had fallen from 42 to 8 percent; however, new genital lesions were noted. After eight months of additional topical treatment, BSA affected had fallen to 2 percent, but the patient had developed gluteal cleft lesions as well. Over the next three years, several topical and systemic treatments were tried, but his genital and gluteal cleft disease persisted and intense pruritus developed. Based on concerns about continued topical corticosteroid use, the lack of efficacy observed thus far, and the potential for rebound flare, once-daily roflumilast cream 0.3% was initiated. At Week 8, BSA affected had fallen to 1 percent, and was limited to residual scalp disease (which had not been treated with roflumilast); the genitals and gluteal cleft were clear, with slight erythema present only on the scrotum. At 16 weeks, genital and gluteal cleft disease remained well-controlled with no evidence of active disease. Overall, roflumilast cream 0.3% was well tolerated with no pruritus, folliculitis, irritation, or contact dermatitis observed.