Efficacy of injecting hybrid cooperative complexes of hyaluronic acid for the treatment of vulvar lichen sclerosus: A preliminary study

Background

Lichen sclerosus is a chronic relapsing inflammatory skin disease, which involves most commonly the anogenital region. The gold standard in treatment is ultra-potent topical steroids (clobetasol propionate): it aims at controlling the symptoms, stopping further scarring and distortion, and reducing the risk of cancer.

Objectives

The aim of this preliminary study is to evaluate the efficacy of injecting Hybrid Cooperative Complexes of Hyaluronic Acid (HCC) for the treatment of vulvar lichen sclerosus (VLS).

Methods

Twenty female adult patients (range: 21–78 years), aged over 18, with histopathological diagnosis of lichen sclerosus and good general conditions were enrolled. Patients underwent HCC infiltration every month, for 3 times. Patients were evaluated at baseline (T0) and after one (T1) and six months (T2) after treatment. During every visit, each patient was studied clinically and with videothermography. Itching, burning sensation, pain, and dyspareunia were reported by patients at T0, T1, and T2. The effectiveness of the treatment on patients’ quality of life and sexual function was evaluated using the Dermatology Life Quality Index (DLQI) and the Female Sexual Function Index (FSFI) at T0 and at T2.

Results

The results of this preliminary study are very promising, in fact, all patients had a significant reduction in most symptoms after 1 and 6 months of HCC treatment. The reduction of patients with itching (p value ≤ 0.001), pain (p value = 0.031), and burning sensation (p = 0.004) at 6 months is significant. The analysis of DLQI scores revealed a significant improvement in patients’ quality of life. At baseline, the average score of DLQI (±SD) was 5.89 ± 3.68 while at follow-up it was 3.42 ± 2.36 (p = 0.002).

Conclusions

Our preliminary study has demonstrated the validity and tolerability of HCC infiltrations in patients with VLS, and the effectiveness of HCC in reducing symptoms and, thus, to improve sexuality and patient quality of life.     

Area four technique: An effective injection approach to the posterior facial frame aesthetic treatment with injectable hyaluronic acid fillers

Background

Defined as a contour line from the hairline, the zygomatic arch, to the ramus and gonial angle area of the mandible, posterior facial frame (PFF) is an important aesthetic units of the face. With the development of hyaluronic acid fillers and the improvement of injection techniques, minimally invasive injection has become one of the first options to improve PFF. However, effective and systematic injection methods to improve PFF are rarely reported in the literature.

Methods

We retrospectively analyzed 200 patients treated with area four technique for PFF. According to the clinical manifestations, PFF was divided into four types, and the injection strategies of the different types were described. GAIS (Global Aesthetic Improvement Scale) at 1 month and 3 months by patients after treatment was evaluated as primary end point. Nine-item aesthetic assessment scores reviewed by two independent observers with experience were performed.

Results

GAIS showed that patients' profile was remarkably improved for 90% of total number of subjects. Before and 3 months after treatment, the assessed scores of the lateral cheek lifting (3.17 ± 0.21 vs. 2.56 ± 0.31) and PFF (3.78 ± 0.56 vs. 2.19 ± 0.48) were statistically significant reduced (p < 0.01). The jawline contouring scale (2.32 ± 0.45 vs. 1.23 ± 0.31) and the lateral cheek fullness scale (3.01 ± 0.23 vs. 2.09 ± 0.17) showed a statistically moderate decrease (p < 0.05).

Conclusion

Area four technique provides a safe and convenient method for classifying and treating patients with insufficent PFF, which makes up for the multisite systematic injection of the face.     

Effects of moisturizing skincare on skin barrier function and the prevention of skin problems in 3‐month‐old infants: A randomized controlled trial

An effective newborn skincare protocol has not been established. We aimed to evaluate the effects of moisturizing skincare, including using lotion and reducing routine bathing. Our hypothesis was that moisturizing skincare would improve skin barrier function. This randomized controlled trial included 227 healthy Asian newborns between 1 week and 3 months old. We compared moisturizing skincare (bathing every 2 days and using lotion daily; intervention, n = 113) to daily bathing without lotion (control, n = 114). We assessed the skin barrier function (transepidermal water loss [TEWL], stratum corneum hydration [SCH], skin pH and sebum secretion) as a primary outcome at 3 months old. We also assessed the incidence of skin problems according to parents’ diary reports. Compared with the control, the intervention group had a lower face TEWL (mean ± standard deviation, 14.69 ± 7.38 vs 17.08 ± 8.26 g/m² per h, P = 0.033), higher face SCH (60.38 ± 13.66 vs 53.52 ± 14.55, P = 0.001) and higher body SCH (58.89 ± 12.96 vs 53.02 ± 10.08, P < 0.001). Compared with the control, newborns in the intervention group had significantly lower rates of diaper dermatitis between birth and 1 month old (6.3% vs 15.9%, P = 0.022), and tended to have lower rates of body skin problems between 1 and 3 months (42.1% vs 55.2%, P = 0.064). Moisturizing skincare was effective for improving skin barrier function and preventing newborns’ diaper dermatitis. The results of our study may help parents make informed decisions about newborn skincare.     

Novel laser hair removal in all skin types

Background

Laser has been long accepted as a solution for excess or unwanted hair growth yet traditional lasers are not always ideal for safe and effective outcome for all skin types and hair characteristics. A diode laser module combining three wavelengths (755, 810, and 1064 nm) in a single pulse was developed to provide a fast and long-term solution for subjects with various profiles.

Aims

To evaluate the safety and efficacy of a Triple wavelength diode laser module for hair removal treatment in all skin types (Fitzpatrick I–VI).

Subjects and methods

This was a prospective, dual centered, single-arm study. Subjects were treated with a novel diode laser module. Thirty-six subjects were enrolled, sixteen with Fitzpatrick skin types I–IV (46%) and twenty with Fitzpatrick skin types V–VI (54%). Treatment areas were axilla and bikini lines. Subjects underwent 4 treatment sessions at 6 weeks ± 5 days intervals and attended a follow-up visit 3 months after the last treatment session. 2D digital photographs were taken at baseline and at the follow-up visit, and a hair count was conducted by three blinded evaluators.

Results

A significant reduction in hair count between baseline and the 3-month follow-up visit was observed in both axilla and bikini lines for all skin types. The mean hair reduction was 41.5 ± 19.4% and 48.1 ± 20.9% in the axilla and bikini line, respectively. A significant hair reduction was also observed within skin type groups; mean hair reduction 45.5 ± 16.9% and 40.3 ± 17.2% in skin types I–IV and V–VI, respectively, indicating similar efficacy for both light and dark skin types. No serious adverse events were reported.

Conclusions

This study demonstrates that the Soprano Titanium laser platform is safe and effective for hair removal treatment in all skin types.     

A combination treatment of drug-laser-photon for melasma: A retrospective study of clinical cases

Background

Combinational therapy such as taking tranexamic acid while using laser treatment has been proved potential efficacy by many experiments. However, there is few research which contains large samples and consistent observations.

Objective

We evaluated clinical efficacy and safety of a new systemic treatment of drug-laser-photon therapy.

Methods

Retrospective and randomized investigator-blinded study of 75 patients with mixed type melasma was analyzed. At each visit, standardized photographs were taken using VISIA. Modified melasma area and severity index (mMASI) scores were marked using photographs by two dermatologists.

Results

The mMASI score decreased significantly from 6.92 to 3.84 after the treatment. The VISIA analyze right cheek data shows: Spots (from 49.67 ± 3.43 to 56.09 ± 3.31), UV spots (from 41.39 ± 24.45 to 44.56 ± 25.86), and Brown spots (from 23.97 ± 17.89 to 28.16 ± 21.28) are statistically increased (p = 0.035, p = 0.018, p = 0.07). All patients feel varying degrees of improvement, about 10.17% felt very much improved, 30.51% felt much improved (51%–75%), 45.76% felt moderately improved (26%–50%), and 13.56% felt little improved (1%–25%).

Limitations

This study was no control group.

Conclusion

The efficacy and safety profile of the combination of drug-laser-photon therapy systemic treatment in melasma patients has been proved. It has potential possibility to become a new, reliable, widely suitable therapy strategy.     

Efficacy and safety of Politranexamide® liposomal emulsion on facial melasma: A comparative study

Introduction

Melasma is a human melanogenesis dysfunction that results in localized, chronic acquired hypermelanosis of the skin difficult to treat.

Methods

This prospective, randomized, single-blind, study aimed to compare the efficacy and tolerability of a liposomal emulsion based on Politranexamide® (SAMPLE A) with that of a competitor based on acetylglucosamine, ethyl linoleate and phenyl ethyl resorcinol (SAMPLE B) in patients affected by facial melasma on 26 patients. Disease severity was assessed by the Melasma Area Severity Index (MASI) at baseline and after 6 and 12 weeks of therapy. All patients were subjected to photo documentation using DermaView camera and Antera 3D camera.

Results

The mean MASI score at baseline was 10.93 ± 7 in the group A and 9.34 ± 6.29 in the group B, respectively. A significant decrease in MASI score from baseline was noted in both treatment groups as early as 6 weeks of follow-up (p = 0.00096 for SAMPLE A and p = 0.0049 for SAMPLE B) and was confirmed at the end of the treatment (p = 0.0006 for SAMPLE A and p = 0.00039 for SAMPLE B). Intergroup comparison revealed a greater improvement of melasma among patients in group A compared to those in group B that was quite statistically significant at weeks 6 (p = 0.055009) and significant after 12 weeks of follow-up (p = 0.032942). Both treatment groups experienced an improvement in Antera average level of melanin.

Conclusion

Our results suggested Politranexamide® to be a useful and safe therapeutic option in treating melasma, more effective than competitor used in this study.     

Oxybutynin gel versus nanoemulgel for treating primary palmar hyperhidrosis: A pilot double-blind randomized controlled trial

Introduction

Palmar hyperhidrosis or excessive palmar sweating can reduce one's quality of life as it is associated with significant physical and occupational disabilities. We compared the gel and nanoemulgel of oxybutynin in treating these patients.

Materials and Methods

This pilot study was performed as a double-blind controlled randomized clinical trial at Shahid Faghihi Hospital, Shiraz, Iran. In two randomly allocated groups of 15, patients diagnosed with primary palmar hyperhidrosis by an attending dermatologist applied half a fingertip (roughly 0.25 g) of 1% oxybutynin topical gel or 1% oxybutynin nanoemulgel to both palms every 12 h for one month. The Hyperhidrosis Disease Severity Scale (HDSS), Visual Analog Scale (VAS), and Dermatology Life Quality Index (DLQI) were used to assess the patients at the beginning and end of the study. Statistical analysis was performed using SPSS version 25.

Results

The groups were similar in terms of age (p = 0.800), sex (p = 0.096), and baseline HDSS, VAS, and DLQI scores. The mean HDSS scores decreased significantly (p = 0.001) over time in patients receiving the gel (3.00 ± 1.00 vs. 2.33 ± 0.61) or nanoemulgel (2.92 ± 0.82 vs. 2.14 ± 0.53), without a significant difference between the groups. The same was true for the VAS and DLQI scores. Three patients in each group experienced transient, self-limited anticholinergic side effects (p = 0.983).

Conclusion

Oxybutynin gel and nanoemulgel offer equal safety and similar efficacy in reducing the disease severity and increasing the quality of life of patients with palmar hyperhidrosis.     

Microneedle fractional radiofrequency in the treatment of periorbital dark circles

Background

Periorbital hyperpigmentation (POH) is a common disorder in the patients. Women are more upset with POH in compare to males. Several methods have been used to the POH, with different efficacy and adverse reactions.

Aim

The aim of the present study is to evaluate the efficacy of microneedle fractional radiofrequency (MRF) in treating POH.

Methods

So, nine patients with POH and the age range of 25–57 years, were treated by microneedle fractional radiofrequency (MRF). The outcome was evaluated via biometric assessment. The colorimeter was used to assess the skin lightness. Mexameter was used for evaluated the amount of Melanin in the periorbital skin. Cutometer was used for skin elasticity assessment. The skin ultrasound imaging system was utilized to estimate the epidermis and dermis diameter and density. Furthermore, Visioface was applied to assessed the skin color and wrinkles. Also patient's satisfaction and physician's assessment were evaluated.

Results

The results displayed that the periorbital skin lightness 32.38% ± 5.67 and elasticity of the R2: 40.29% ± 8.18, R5: 39.03 ± 5.38 and R7: 42.03% ± 14.16 were significantly improved after treatment (p < 0.05). Also the melanin content of the skin was decreased (49.41% ± 9.12). The skin layers were denser in the dermis and also in the epidermis (skin density: 30.21% ± 10.16 and skin thickness: 41.12% ± 13.21) (p < 0.05). The results revealed the decrease in the percent change of the skin color (30.34% ± 9.30) and wrinkle (area: 25.84% ± 6.43 and volume: 30.66% ± 8.12) (p < 0.05). Similarly, the physician and patient's assessment were confirmed the obtained outcomes.

Conclusion

In conclusion, the microneedle RF technique is practicable, effective and safe method for periorbital dark circles treatment.     

Balance of Treg versus T‐effector cells during systemic treatment with adalimumab and topical treatment with calcipotriol–betamethasone dipropionate ointment

Diminished suppressive capacity of regulatory T cells (Treg) has been demonstrated in blood and in lesional skin of psoriatic patients. Treatment with anti‐TNFα restored the number and function of circulating Treg in psoriasis. We aimed to study Treg in the skin of psoriatic patients undergoing topical treatment with calcipotriol–betamethasone dipropionate (CBD) ointment (n = 12) or systemic treatment with anti‐TNFα agent adalimumab (n = 10). Skin biopsies were collected from patients with chronic plaque psoriasis who responded to the above‐mentioned treatments with a SUM‐score improvement of at least 50% (at the end of treatment). Biopsies were processed for immunohistochemistry. As Treg function is associated with a numerical balance between Treg and effector T cells, Foxp3/CD4 ratios were calculated. It appeared that both treatments cause a significant decrease in the presence of Foxp3+ cells. However, in patients that were treated with CBD ointment, we observed lower Foxp3/CD4 ratios after 8 weeks of treatment compared to baseline (t = 0: 0.41 ± 0.08; t = 8: 0.22 ± 0.04, P = 0.033), whereas in patients who were treated with adalimumab we observed an increase of the Foxp3/CD4 ratios after 1.5 and 16 weeks of treatment compared to baseline (t = 0: 0.25 ± 0.04; t = 1.5: 0.32 ± 0.06; t = 16: 0.49 ± 0.10, P = 0.15). Based on Foxp3/CD4 ratios, we can conclude that adalimumab treated skin differs from CBD treated skin with regard to the anti‐inflammatory/inflammatory balance. We suggest that, in contrast to CBD ointment, adalimumab favours local Treg function in the skin.     

Effect of pdo facelift threads on facial skin tissues: An ultrasonographic analysis

Background

Recent studies demonstrate that PDO threads, after being introduced into the facial skin, provide benefits due to collagen formation around the thread and improved vascularization.

Aims

This work aims to report the ultrasound and photographic follow-up after the execution of the facelift thread technique, thus evaluating the anti-aging treatment that PDO threads will provide for human facial skin.

Methods

The facelift will be performed using PDO thread 18G cannulated Sculpt i- Thread FML 100 × 185 mm, and 29G PDO thread Needled Flat i-Thread 38 × 50 mm. A total of 10 patients were selected for the study; all of them had medium-grade facial ptosis and aged 40–50 years old. In order to control tissue changes after thread, insertion ultrasound measurements will be made with Philips ultrasound 12 MHz linear probe at maximum resolution, initial evaluations and control of 30, 60, 90, and 120 days, measuring the skin layers: epidermis\dermis and hypodermis. Photographic control was performed before and after 120 days of intrusion of the PDO threads.

Results

The formation of collagen around the PDO thread was evidenced through ultrasound images in all patients in this study, as well as improvement in the appearance of the skin and sagging, evaluated by photographic control.

Conclusions

We can define that the PDO threads used for the facelift are effective in the formation of collagen around the thread (observed through the increase in the dermal layer), and improvement of the condition of the anti-aging factor through sagging skin, vascularization and thinning of the superficial fat layer (observed through the reduction of the subcutaneous or hypodermis layer).     

Evaluation of hematological parameters in patients using systemic isotretinoin with diagnosis of acne vulgaris

Objectives

Oral isotretinoin is the most effective treatment option in patients with acne. However, it can cause various hematologic and biochemical abnormalities. This study aimed to evaluate hematologic abnormalities during oral isotretinoin treatment in patients with acne.

Material and Methods

In this cross-sectional study, the hematologic and inflammatory parameters of 138 patients with acne using 0.3-1 mg/kg/day oral isotretinoin for at least 6 months were retrospectively analyzed.

Results

In the study, the female-to-male ratio was 2.83, and the mean age of the patients was 23.1 ± 5.8 years. At the third and sixth months of isotretinoin treatment, there was a statistically significant decrease in the neutrophil count compared to the pre-treatment values (p = 0.003 and p = 0.032, respectively). The platelet count showed the most statistically significant increase (p < 0.001) at the first month of treatment. The most statistically significant decrease in the neutrophil-to-lymphocyte ratio (NLR) was observed at the third month of treatment (p < 0.001). No significant changes were observed in hemoglobin, hematocrit, white blood cell count, mean corpuscular volume, and mean platelet volume.

Conclusions

There was a decrease in neutrophils and NLR and an increase in platelets during isotretinoin treatment, and these changes were usually mild. However, it would be appropriate to monitor blood counts during treatment in patients with neutropenia or thrombocytosis.     

Topical Lactiplantibacillus plantarum LB244R® ointment alleviates skin aging: An exploratory trial

Background

The skin is of vital importance for health and well-being. As people age, the skin undergoes visual and morphological changes such as wrinkling, loss of elasticity, increased pigmentation, and decreased cell turnover. This is not only visually unappealing to many but can also pose health issues.

Aim

In this study, a probiotic ointment (PO) containing live lactic acid bacteria (LAB) (Lactiplantibacillus plantarum LB244R®) was investigated for its ability to alleviate symptoms of skin aging in an exploratory clinical trial.

Methods

The PO was applied twice daily for 56 days by 21 subjects. Anti-aging efficacy was evaluated by skin ultrasonography, skin biomechanical properties, skin hydration, and clinical evaluations at day 0, 28, and 56.

Results

Sub-epidermal low echogenic band thickness decreased (0.261 ± 0.069 mm to 0.247 ± 0.055 mm) after 56 days. Dermal density increased (324.689 ± 57.506 pixel/mm² to 367.831 ± 75.790 pixel/mm²). Skin hydration increased (34.1 ± 6.9 to 51.3 ± 10.0 AU). Additionally, skin firmness increased, as shown by decreasing values (0.264 ± 0.038 to 0.228 ± 0.037 mm). Skin elasticity increased (0.578 ± 0.045 to 0.618 ± 0.044). Trans-epidermal water loss decreased (9.1 ± 2.0 g/h/m² to 8.5 ± 1.3). All clinical evaluations, Crow's feet, spot score, smoothness score, and complexion radiance, were improved.

Conclusion

The PO improved all measured parameters with statistical significance after 56 days of application, clearly demonstrating the potential of the PO as an anti-aging agent and reaffirming the potential of topical probiotic LAB. Future studies need to elucidate the mode of action of anti-aging effects by probiotics, but at present time, this study paves the way for the use of probiotic LAB topically to alleviate aging of the skin.     

Ethnic variations in the epidemiology of bullous pemphigoid in Israel

Background

No ethnic or geographic predisposition to bullous pemphigoid (BP) was reported so far.

Objective

To evaluate trends in the incidence of BP in northern Israel, shedding light on differences between two distinct ethnic populations who inhabit the same region, namely Jews and Arabs.

Methods

Bullous pemphigoid incidence was retrospectively estimated from January 2000–December 2015 in two Israeli regions with a total population of 1.56 million inhabitants.

Results

A total of 287 new‐onset BP patients (mean age: 77.6 ± 12.1) were identified. The incidence rate was 11.4 per million inhabitants per year (95% CI, 10.2–12.9). The crude incidence rate in Jews was 4.8‐fold higher than that in Arabs (16.4 vs. 3.4 cases per million per year, respectively [P < 0.0001]). After adjusting for age, the discrepancy between the two populations diminished (11.7 vs. 8.9 cases per million per year, respectively) but remained statistically significant (P = 0.032). The incidence increased consistently from 7.6 cases per million per year in the calendar period 2000–2005 to 12.6 and 14.3 cases in 2006–2010 and 2011–2015, respectively (P < 0.0001). Bullous pemphigoid patients of Arab ancestry presented with the disease significantly earlier than Jews (69.5 ± 15.3 vs. 78.7 ± 11.1 years, respectively, P = 0.002).

Conclusions

The incidence of BP in northern Israel has increased in the last 16 years and is significantly higher among Jews compared to Arabs. The age of presentation is remarkably different between patients belonging to the two populations.     

Validation of the Cardiff acne disability index and the impact of educational materials in a Romanian cultural adaptation context

Background

Acne has a high impact on patients being a chronic, common, and visible skin condition. Knowledge regarding treatment improves outcomes. The Cardiff Acne Disability Index (CADI) is commonly used in clinical practice for quality-of-life assessment. It has been validated in many languages, however, not in Romanian.

Aims

To validate the Romanian adaptation of the CADI and educational materials for acne patients.

Patients and Method

A 12-week prospective cross-sectional Web-based study, including 3rd- to 5th-year medical students attending our university was conducted. We obtained permission from the CADI copyright owner and performed the steps of the standardized translation process. The Romanian CADI adaptation was delivered online in a test–retest setup, during which participants were offered acne educational materials and completed a knowledge evaluation questionnaire.

Results

A total of 95 complete answers were analyzed. The Romanian CADI adaptation showed good internal consistency, with Cronbach's α = 0.807 in the first application and Cronbach's α = 0.839 in the second. High test–retest reliability was observed, with interclass correlation coefficient ICC = 0.987 and Spearman's rank correlation coefficient r_s = 0.970 for the overall CADI scores between the two administrations. The mean baseline score in the knowledge evaluation questionnaire was 15.52 points (±1.556), with a statistically significant improvement after exposure to the educational material (Z = −7.207, p < 0.001). This material was considered useful or very useful by 78(82.8%) participants.

Conclusion

Romanian acne patients can benefit from CADI, a reliable and disease-specific tool for quality-of-life evaluation, together with validated, guideline-aligned educational material in their language.     

Tranexamic acid microinjections versus tranexamic acid mesoneedling in the treatment of facial melasma: A randomized assessor-blind split-face controlled trial

Background

Melasma is a hyperpigmentary disorder causing cosmetic disfigurement. We aimed to compare the efficacy and safety of tranexamic acid (TXA) microinjections with TXA mesoneedling for facial melasma.

Methods

This randomized assessor-blind split-face controlled trial included patients with symmetric facial melasma. One side of the face received TXA (100 mg/ml) mesoneedling and the other side intradermal TXA microinjections. The interventions were repeated three times with 4-week intervals (weeks 0, 4, and 8). The primary outcome was improvement in modified Melasma Area and Severity Index (mMASI) 4 weeks after the final treatment session. Secondary outcomes were complications and patient satisfaction with the treatments evaluated by a visual analog scale (VAS).

Results

All 27 patients included in the study were female (mean age: 44.22 ± 8.39 years). Both groups were comparable in terms of mMASI scores before and after treatment (standardized mean difference [SMD] = 0.32, 95% confidence interval [CI] −0.22; 0.85, p = 0.248 and SMD = −0.13, 95% CI −0.66; 0.40, p = 0.633, respectively). The mMASI score change from baseline was not different (SMD = −0.39, 95% CI −0.93; 0.15, p = 0.157). However, patient satisfaction was significantly higher with TXA mesoneedling (SMD = 0.77, 95% CI 0.21; 1.32, p = 0.007). Post-inflammatory hyperpigmentation occurred in one patient in the TXA mesoneedling group. Erythema, scaling, and edema were significantly higher with TXA mesoneedling (p < 0.001).

Conclusions

TXA mesoneedling was comparable with TXA microinjection in the treatment of facial melasma, while patient satisfaction was significantly higher with TXA mesoneedling; however, the high frequency of complications occurring with this treatment should be taken into account.     

Effectiveness of combined use of targeted pressure energy,radiofrequency, and high-intensity focused electromagnetic fields to improve skin quality and appearance of fat and muscle tissue in different body parts

Background

Inevitable signs of aging are especially noticeable in middle to elder age when stretch marks, loose skin, cellulite, and body-contour changes naturally appear.

Aims

To verify efficacy of high-intensity focused electromagnetic field (HIFEM), radiofrequency (RF), and Targeted Pressure Energy (TPE) combination treatment to address unfavorable changes in skin, fat, and muscle tissue.

Methods

The device simultaneously emitting monopolar RF and TPE energies was consecutively combined with simultaneous HIFEM+RF procedure in 32 subjects (21–64 years, 17.4–33.5 kg/m²) for treatment of thighs (N = 15; back, inner, or front), buttocks/saddlebags (N = 7), abdomen (N = 8), and upper arms (N = 2). All patients underwent four weekly, combined treatments of 30-min HIFEM+RF procedure followed by 15–30 min RF+TPE, depending on treatment area. Circumferential measurements, digital photographs, subject satisfaction, and comfort questionnaires were assessed up to 3-months post-treatment.

Results

Majority of participants found treatments comfortable, no adverse events occurred. Subjects showed substantial improvement in all treated areas from 1-month follow-up. Combination of HIFEM+RF, monopolar RF, and TPE resulted in significant circumference decrease. Generally, more pronounced results were seen at 3 months when subjects showed −5.2 cm on abdomen, −3.0 cm on thighs, and −5.5 cm on saddlebags, respectively. Ninety-four percent of subjects were satisfied with treatment results, most noticed improvement in cellulite, skin laxity, and muscle definition.

Conclusions

Results showed high patient satisfaction and efficacy in improving body contour and skin quality. Combining simultaneous HIFEM+RF procedure with simultaneous monopolar RF+TPE treatments considerably enhanced body contour and skin tissue. The procedure proved versatile and may effectively treat multiple body parts.     

Abnormal nuclear expression of aquaporin-3 in lesional and perilesional skin of vitiligo patients: A novel immunohistochemical finding

Background

Vitiligo is a skin disease characterized by a complex etiopathogenesis. Keratinocyte apoptosis may play a role in vitiligo pathogenesis. Aquaporin-3 (AQP-3) is an aqua-glyceroporin that controls keratinocyte proliferation and differentiation.

Aim

To assess the immunohistochemical expression of AQP-3 in lesional and perilesional skin of vitiligo patients compared to healthy control skin.

Methods

A total of 20 patients with generalized non-segmental vitiligo and 20 age- and sex-matched healthy controls were included. Lesional and perilesional skin of vitiligo patients, as well as normal skin of control subjects, were biopsied. The immunohistochemical expression of AQP3 in the epidermis was examined.

Results

Compared to control skin, both lesional and perilesional skin showed a significant reduction in the intensity of membranous staining of AQP-3 (p < 0.001, p = 0.002, respectively). Moreover, the membrano-cytoplasmic pattern of AQP-3 staining was significantly detected in 80% of lesions and 85% of perilesional biopsies, while it was absent in control skin (p < 0.001). Additionally, nuclear AQP-3 expression was significantly detected in 35% of lesions and 55% of perilesional biopsies, while it was not detected in control skin (p = 0.012, p < 0.001, respectively). No statistically significant difference was detected between lesional and perilesional skin.

Conclusions

To our knowledge, this is the first immunohistochemical research to show a significant abnormal nuclear expression of AQP-3 in lesional and perilesional skin of vitiligo patients. This abnormality may reflect impaired functions of AQP-3, leading to keratinocyte apoptosis with subsequent melanocyte death and development of vitiligo.     

Mask-related adverse skin reactions in orientals during COVID-19: Prevalence,social-psychological impacts and risk factors for acne exacerbation

Background

COVID-19 pandemic has caused mask-related skin problems on health-care professions, yet very few studies have investigated the prevalence in oriental general population.

Objective

To investigate the prevalence of mask-related adverse skin reactions in Orientals, to explore psychological influence, to identify risk factors for mask-related acne exacerbation.

Methods

We performed a survey through social media. Participant demographics, skin condition before and after COVID-19, and the influence of adverse skin on social-psychological conditions were collected. We compared characteristics between individuals with or without acne exacerbation, and we performed a logistic regression to identify risk factors.

Results

Six hundred and six participants (62.3%) responded the survey and 23.3% complained their facial acnes become exacerbated since COVID-19. The social-psychological impact of acnes is more prevalent in women. Risk factors for mask-related acne exacerbation were occupation as health-care workers (OR = 1.861, p = 0.027), prolonged wearing of N95 masks (OR = 3.167, p = 0.001), and touching of acnes (OR = 2.65, p = 0.002). Sex, pre-existed acnes, and prolonged wearing time per day are also associated with acne exacerbation.

Conclusions

Mask-related adverse skin reactions are common in Orientals, and could lead to negative social-psychological effects.     

Cost‐of‐illness of psoriasis – results of a German cross‐sectional study

Background

Though psoriasis poses a substantial chronic socio‐economic burden, few studies have addressed the economic impact in Germany.

Objectives

The objective was to evaluate the annual costs of psoriasis in Germany from the societal perspective.

Methods

A cross‐sectional study was performed in randomly selected German dermatology practices and clinics in 2013/2014 using standardized questionnaires of illness‐related costs. Costs were grouped by perspective and category as well as analysed by sex and age. Group differences were tested by non‐parametric tests.

Results

Complete data were obtained from 1158 patients in 132 centres. Annual average costs for patients with psoriasis: total costs € 5543 ± € 8044, systemic treatment costs (paid by the statutory health insurances [SHI]) € 3733 ± € 7322, out‐of‐pocket costs € 224 ± € 406, total SHI costs € 4940 ± € 7533, direct costs € 5164 ± € 7581 and indirect costs € 379 ± € 2087. Significant higher costs in male and significant lower costs in 65+‐year‐old patients were found.

Conclusions

Psoriasis induces a considerable economic burden. Between 2003 and 2014, costs have markedly shifted from hospital, out‐of‐pocket and indirect costs towards systemic drug costs.     

Evaluation of pro-atherogenic lipid profile and high atherohenic indexes in patients with Behçet's disease: A case–control study

Background

Behçet's disease is a systemic auto-immune and auto-inflammatory chronic disease in which genetic and environmental factors play a role. Patients with Behçet's are at significant risk for developing many comorbidities, including cardiovascular diseases.

Aims

It was aimed to investigate the relationship between serum lipid parameters and atherogenic indexes to evaluate the cardiovascular risk status in patients with Behçet's disease.

Patients/Methods

This study was designed as a single-center, retrospective case–control study. The study was conducted with 212 patients over 18 years of age, 106 in the case group and 106 in the control group.

Results

There was a significant difference in lipid values between the patients with Behçet's disease and the control group. While the serum triglyceride, total cholesterol, low-density lipoprotein cholesterol (LDL-C), and non-high-density lipoprotein cholesterol (NHC) levels were significantly higher, the high-density lipoprotein cholesterol (HDL-C) level was low in patients with Behçet's disease. From atherogenic indexes, Atherogenic Index of Plasma (AIP) (0.03 ± 0.27 vs. −0.07 ± 0.23, p = 0.003), Castelli Risk Index I (CRI-I) (4.24 ± 1.07 vs. 3.02 ± 0.96, p < 0.001), Castelli Risk Index II (CRI-II) (2.65 ± 0.81 vs. 1.84 ± 0.59, p < 0.001) and Atherogenic Coefficient (AC) (3.24 ± 1.07 vs. 2.02 ± 0.96, p < 0.001) levels were significantly higher in patients with Behçet's disease.

Conclusion

Our study shows that patients with Behçet's have a higher pro-atherogenic lipid profile and atherogenic indexes at high risk. Patients with Behçet's have an increased risk of cardiovascular diseases associated with atherosclerosis.