Eyebrow lifting using multidirectional absorbable thread

Background

Thread lifting is a common procedure in minimally invasive esthetic techniques and can also be used to raise the drooping soft tissue of the forehead by vertically inserting threads into the forehead.

Aims

This study aimed to examine the effect of forehead thread lifting on enhancing upper eyelid opening.

Methods

Fifteen patients were included in this study, all of whom underwent eyebrow thread lifting with MINT LIFT® UP. Photographs of the patients were taken before, immediately after, and 1 and 12 weeks after surgery. Changes in the position of the eyebrows and eyelids were measured. The paired t-test was used to determine the statistical significance of differences.

Results

At 1 week after surgery, the eyebrows were at a lower level compared with before surgery, and no significant changes in eye-opening were observed. However, at 12 weeks after surgery, the eyebrows and upper eyelids were both significantly elevated when compared to the preoperative state.

Conclusions

Eyebrow lifting can be performed using multidirectional thread lifting.     

Locking the line of convergence by botulinum toxin type A for the treatment of dynamic forehead wrinkles

Background

Treatment of horizontal forehead lines with botulium toxin type A is a common procedure that helps achieve a youthful and rejuvenated look. Adequate knowledge of the anatomy and an individualized treatment approach is the key to successful treatment outcome.

Aim

To evaluate the cosmetic outcome following treatment of dynamic forehead wrinkles by locking the line of convergence using botulinum toxin type A.

Patients and Methods

Fifty female patients with dynamic forehead wrinkles were included. The line of convergence was identified, and injection points were determined. Patients received injections of botulinum toxin type A in the upper part of the frontalis along the line of convergence. Patients were evaluated before injection and the response was evaluated after 2 weeks and after 3 months of injection.

Results

Post-treatment significant decrease in dynamic wrinkle scale was detected. The distance between the medial and lateral canthi and their corresponding lower brow margins on maximum brow elevation was also significantly decreased after treatment. Meanwhile, the validated brow positioning score revealed no significant change in the resting brow position when pre-and post-treatment scores were compared.

Conclusions

Treating forehead wrinkles by injecting botulinum toxin along the line of convergence is an effective technique that requires less overall amount of toxin, improves the appearance of the wrinkles and minimizes the risk of development of side effects.     

Is it possible to obtain long-lasting results with thread lift in the brow region? Introduction of a new suspension technique and evaluation of 50 patients

Background

Eyebrow region is a dynamic region, and it has a thinner skin prone to wrinkles and sagging. Descended brows could be repositioned immediately with fewer complications by the use of the threads. Despite all its advantages, the main drawback of absorbable thread lift is its short duration of lifting effect.

Aims

This report aims to describe our thread lift technique we have implemented to counteract the descent of the brows and evaluate our results in 50 patients.

Patients/Methods

A retrospective chart review was carried out over a period of 1 year from September 2019 to 2020 for the patients who underwent thread lifting for eyebrows in a private clinic in Ankara. Complications after the procedure, durability of the results, global esthetic improvement scale (GAIS) score, and patient satisfaction survey scores were recorded.

Results

The study group was composed of 50 female patients with a median age of 34 years. The median duration of the procedure is 15 months. Nine (18%) patients experienced complications related to the procedure including ecchymosis, edema, erythema, skin dimpling, and pain. Three weeks after the procedure, the position of the eyebrows of eight (16%) patients were improved, 18 (36%) patients were much improved, and 24 (48%) patients were very much improved according to GAIS.

Conclusions

So far, the most disappointing feature of the threads was the poor long-term sustainability of the outcomes. Our thread lift technique for brows offers a significant improvement in the position of the eyebrows in a short time with decreased downtime. More importantly, it can be possible to improve the longevity of the results with this approach.     

Rejuvenation of periocular region in Koreans: A multimodal approach combining botulinum toxin,fillers, and micro‐focused ultrasound with visualization for optimal results

Periorbital aging involves all layers of the skin, fat, and the bony orbit. Therefore, a multimodal approach is necessary. Twenty Korean subjects who required periorbital rejuvenation were enrolled in this study. First, micro‐focused ultrasound with visualization (MFU‐V) was performed across the supra‐brow area, lateral canthus, and the infraorbital area. Next, the filler was injected into the sunken upper eyelid, lateral eyebrow, and the infraorbital area. Lastly, botulinum toxin was administered into the forehead, glabella, crow's feet, and the lateral orbital rim below the brow on the same day. Photographs were taken at baseline; immediately after treatment; and at 1, 4, and 12 weeks of follow‐up. The average eyebrow height was increased by 3.5 mm, and the maximum height was elevated by 3.9 mm at week 12. Physician visual analogue scale (VAS) scores regarding the whole periorbital area and eyebrow ptosis were continuously improved throughout the observation period. Physician VAS scores for infraorbital hollow and superior sulcus deformity improved immediately after the procedure and were maintained at week 12. Adverse events were mild and transient. We believe that a multimodal approach combining MFU‐V, fillers, and botulinum toxin results in significant periocular rejuvenation.     

Retrospective real-world study of Definisse threads for jaw line reshaping in Indian patients (REDEFINE JAW study)

Background

Thread lifting is a minimally invasive aesthetic procedure that lifts and realigns sagging tissue. Definisse double-needle threads are the latest fourth generation absorbable, monofilament, suspension barbed threads of synthetic origin with convergent bidirectional barbs. Definisse thread produces dual action; mechanical action gives a lifting effect and over a period, it promotes histological revitalizing action.

Objectives

To evaluate the real-world efficacy and safety of Definisse double-needle threads for lower facial lifting for jaw line reshaping in Indian patients.

Methods

This is an observational, retrospective study involving patients who underwent treatment for lower-face reshaping using Definisse double-needle 12 cm threads.

Results

Fifty patients with a mean age of 47.44 years were included in the study with an average follow-up of 5.14 months. All the patients have undergone Jawline Reshaping (JR) procedure, while 70% of patients also underwent Malar Reshaping (MR) technique simultaneously. Mean of Physician and Subject Global Aesthetic Improvement Scale (PGAIS and SGAIS) showed improvement immediately after the procedure (mean scores 2.82 and 2.7, respectively) and showed further improvement at the follow-up (3.72 and 3.58, respectively). Moreover, most of the patients immediately after the procedure rated the improvement in PGAIS and SGAIS as “much improved” compared to pre-procedure appearance (78% and 66%, respectively), while, at follow-up, 76% and 66% of the patients, respectively, rated “improved very much” compared to pre-procedure appearance.

Conclusion

Current study has demonstrated the effectiveness of the latest Definisse threads in Indian patients in performing tissue repositioning to provide a noticeable lifting effect. Procedure was also well tolerated and none of the patients developed serious complications.     

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).     

中老年上睑松弛手术治疗方法探讨

目的探讨中老年上睑皮肤松弛的美容外科治疗方法。方法对123例上睑松弛症患者行重睑去皮术,并根据其伴随的不同病症选择施行眉切除术,部分睑板切除术,提眉术及额部除皱术。结果上睑松弛症状明显改善,效果满意。结论对上睑松弛症,应全面评估,根据不同症状,施行相应手术,在改善眼部功能的同时,达到较佳的美容效果。     

Two years’ outcome of thread lifting with absorbable barbed PDO threads: Innovative score for objective and subjective assessment

Background: Thread-lifting rejuvenation procedures have evolved again, with the development of absorbable threads. Although they have gained popularity among plastic surgeons and dermatologists, very few articles have been written in literature about absorbable threads. This study aims to evaluate two years’ outcome of thread lifting using absorbable barbed threads for facial rejuvenation. Methods: Prospective comparative stud both objectively and subjectively and follow-up assessment for 24 months. Results: Thread lifting for face rejuvenation has significant long-lasting effects that include skin lifting from 3–10 mm and high degree of patients’ satisfaction with less incidence rate of complications, about 4.8%. Augmented results are obtained when thread lifting is combined with other lifting and rejuvenation modalities. Conclusion: Significant facial rejuvenation is achieved by thread lifting and highly augmented results are observed when they are combined with Botox, fillers, and/or platelet rich plasma (PRP) rejuvenations.     

Clinical evaluation of non-ablative radiofrequency facial rejuvenation

OBJECTIVE: To evaluate the clinical efficacy of non-ablative cutaneous radiofrequency (RF) facial rejuvenation. DESIGN: Prospective study with longitudinal follow-up of a validation cohort set in an urban, private practice of an ambulatory facial plastic surgery center in southern California. METHODS: A consecutive sample was enrolled of 35 healthy adults with moderate facial aging, manifested by skin laxity, rhytids, and ptosis (brow, midface, jowls). Following intravenous sedation anesthesia, the study area was treated with 115-144 J/cm² using the non-ablative RF device (ThermaCool TC^TM). The main outcome measures were the objective measurement of brow height, investigator evaluation of skin parameters, a patient satisfaction questionnaire, and standardized photography, at fixed time intervals. RESULTS: At 12 weeks, a statistically significant increase in mean vertical brow height of 1.6-2.4 mm was observed in patients treated exclusively with the RF device (p<0.0001). All skin parameters (laxity, wrinkles, clarity, pore size) were improved. Complications and side effects were minimal. Patients were uniformly satisfied. CONCLUSIONS: The ThermaCool TC RF system represents a promising non-invasive method of obtaining moderate facial rejuvenation in the appropriately selected patient. Long-term results are pending.     

The severity of wrinkling at the forehead is related to the degree of ptosis of the upper eyelid

Background: Most studies on wrinkle formation have focused on changes in the dermal condition that promote the fixation of transiently formed wrinkles. Little is known about the age‐dependent changes in transient wrinkle formation in response to altered facial expression or the mechanism leading to fixed wrinkle formation. Objective: To clarify the mechanism of wrinkle formation at the forehead, we investigated the factors that influence the severity of transient wrinkling and the relationship of transient with fixed wrinkles, using a newly established method to evaluate transient wrinkle formation. Methods: Transient wrinkles were generated by requesting subjects to gaze in an upward direction. Foreheads of the subjects with or without an upward gaze at a fixed angle were photographed and the severity of wrinkles at the forehead was graded from 0 to 5 in 50 healthy Japanese female volunteers in their 20s, 40s, or 60s. Skin elasticity was measured using a Cutometer^®. Frontalis muscle activity and ptosis of the upper eyelid were estimated by measuring movement of the eyebrow during upward gazing and the position of the upper eyelid of the open eye, respectively. Results: Wrinkles formed transiently at the forehead by upward gazing were highly reproducible in each subject. Their severity increased with aging and was highly correlated to that of fixed wrinkles (R=0.81, P<0.001). Therefore, this method appears to be suitable for studying the mechanism of transient wrinkle formation and the relationship between transient and fixed wrinkles at the forehead. The severity of transient wrinkles was correlated with elevation of the eyebrow during upward gazing (R=0.69, P<0.001), but not with dermal elasticity. This suggests that transient wrinkles are induced by increased frontalis muscle activity during upward gazing. Frontalis muscle activation was negatively correlated with upper eyelid position (R=−0.37, P<0.05), which descended with aging, meaning ptosis of the upper eyelid, and negatively correlated with the severity of transient wrinkles induced by upward gazing (R=−0.43, P<0.05). Furthermore, the upper eyelid position was also negatively correlated with the severity of fixed wrinkles (R=−0.44, P<0.05). Conclusion: These results suggest that ptosis of the upper eyelid is associated with increased activation of the frontalis muscle during upward gazing and increased severity of transient and fixed wrinkling at the forehead.     

Application of subcutaneous radiofrequency after liposuction on midface: A minimally invasive technique for midface rejuvenation

Background

Popular demand for minimally invasive soft tissue tightening is continuously on the rise. In recent years, subcutaneous radiofrequency or radiofrequency-assisted liposuction (RFAL) has been reported to produce the desired surgical outcome on lower-face and body tightening. However, few studies are found using subcutaneous radiofrequency for midface rejuvenation.

Aims

This study was performed to review our surgical method for the midface rejuvenation using subcutaneous radiofrequency combined with liposuction and to evaluate the clinical outcomes.

Patients/Methods

This retrospective observational study involved 31 patients with mild-to-moderate mid-face laxity. All patients received liposuction combined with subcutaneous radiofrequency on midface from June 2020 to June 2022. Clinical results were assessed objectively using photographs and subjectively by a patient satisfaction survey.

Results

All patients recovered well without major complications. High patient satisfaction was attained. The mean score of midface laxity (GGS) as evaluated by jury decreased from 3.3 preoperatively to 1.6 postoperatively.

Conclusions

Our midface tightening technique is safe and effective for patients with a mild-to-moderate midface aging appearance.

Level of Evidence

Therapeutic IV.     

Clinical validation of the upper face first principle—A clinical,prospective, interventional split-face study

Background

Previous clinical and anatomic investigations have identified the clinical relevance of facial biomechanics. Based on this new understanding, principles for facial aesthetic procedures were established: Lateral Face First, Deep Layers First, and Upper Face First.

Objective

To test the upper face first principle by showing that an injection sequence, starting in the upper face is superior to an injection sequence starting in the lower face.

Methods

This study was designed as an interventional split-face study administering the same amount and type of soft tissue filler for the upper, middle, and lower face but in a different sequence: upper, middle, lower face versus lower, middle, and upper face. A total of 15 patients (5 males and 10 females) with a mean age of 39.4 years (9.6) and a mean BMI of 23.4 kg/m² (1.7) were studied. Follow-up at D0, D30, and D90 was conducted utilizing semiquantitative scores and objective 3D imaging.

Results

Despite not reaching statistical significance, midfacial volume and jawline contouring were rated better at every follow-up visit (D0, D30, D90) when treated with the upper versus the lower face first injection algorithm. The global aesthetic improvement scale showed statistically significantly better values for the upper face first algorithm when compared to the lower face first algorithm at all evaluated time points with all p < 0.001.

Conclusion

Applying the upper face first injection algorithm seems to result in better aesthetic outcomes when directly compared to the lower face first algorithm. Semiquantitative and objective outcome measurements confirm its clinical effectiveness.     

Successful Hair Transplant of Eyebrow Alopecia Areata

Background:

Alopecia areata of the eyebrows can be difficult to treat. Intralesional triamcinolone or potent topical steroids are considered the mainstay of medical therapy. This case illustrates the results of an experimental hair transplant to the eyebrows following years of modest response to intralesional triamcinolone.

Objective:

The aim of this study was to ascertain the benefits of a hair transplant for chronic eyebrow alopecia areata not responding to appropriate medical therapy.

Methods:

A hair transplant was performed with tumescent anesthesia and a total of 85 mini and micrografts placed in the right eyebrow. Followup after the hair transplant occurs every 8 weeks.

Results:

The patient was free of eyebrow alopecia areata for 8 months following the initial hair transplant. Although the disease relapsed, hair growth is now manageable with intralesional cortisone injection performed six times per year.

Conclusions:

For the first time in years, this patient was given 8 months of reprieve from his eyebrow alopecia areata and is currently well-maintained on monthly intralesional cortisone which originally was of only modest benefit. The patient is pleased with the outcome.

Antécédents:

Alopecia areata des sourcils peut être difficile à traiter. L’administration intralésionnelle de triamcinolone ou de stéroïdes topiques puissants est considérée le principal traitement. Ce cas illustre les résultats d’une greffe de cheveux expérimentale sur les sourcils à la suite d’une année de faible réaction au traitement intralésionnel au triamcinolone.

Objectif:

Établir les avantages d’une greffe de cheveux en cas d’une alopécie chronique des sourcils qui ne répond pas aux traitements médicaux.

Méthodes:

Une greffe de cheveux a été effectuée sous anesthésie locale par tumescent. Quatre-vingt cinq mini et micro greffons ont été greffés au sourcil droit. Le suivi pour la greffe de cheveux est effectué chaque huit semaines.

Résultats:

L’alopecia areata n’a pas affecté le sourcil du patient pendant une durée de huit mois après la greffe initiale. Bien que la maladie ait repris son cours, 1’alopécie est sous contrôle au moyen d’injections intralésionnelles de cortisone six fois par année.

Conclusion:

Pour la première fois depuis des années, ce patient a eu huit mois de répit et profite à présent d’un traitement à la cortisone intralésionnelle, un traitement qui avait peu d’effets auparavant. Le patient est satisfait des résultats.     

Rheumatoid arthritis, gold therapy, contact allergy and blood cytokines

Background

During the last decade, medium-dose UVA1 phototherapy (50 J/cm²) has achieved great value within the treatment of severe atopic dermatitis (AD). The purpose of our study was to investigate to what extent UVA1 irradiation is able to modulate the status of protease activity by the use of a monoclonal antibody labeling cathepsin G.

Methods

In order to further elucidate the mechanisms by which medium-dose UVA1 irradiation leads to an improvement of skin status in patients with AD, biopsy specimens from 15 patients before and after treatment were analyzed immunohistochemically for proteolytic activation.

Results

Compared to lesional skin of patients with AD before UVA1 irradiation, the number of cells positive for cathepsin G within the dermal infiltrate decreased significantly after treatment. The decrease of cathepsin G⁺ cells was closely linked to a substantial clinical improvement in skin condition.

Conclusions

In summary, our findings demonstrated that medium-dose UVA1 irradiation leads to a modulation of the expression of cathepsin G in the dermal inflammatory infiltrate in patients with severe AD. Cathepsin G may attack laminin, proteoglycans, collagen I and insoluble fibronectin, to provoke proinflammatory events, to degrade the basement membrane, to destroy the tissue inhibitor of metalloproteinases and to increase the endothelial permeability. Therefore, its down-regulation by UVA1 phototherapy may induce the reduction of skin inflammation as well as improvement of the skin condition.     

Efficacy and safety of clindamycin phosphate 1.2%/tretinoin 0.025% formulation for the treatment of acne vulgaris: pooled analysis of data from three randomised,double-blind,parallel-group,phase III studies

Background

The efficacy and safety of clindamycin phosphate 1.2%/tretinoin 0.025% (Clin-RA) were evaluated in three 12-week randomised studies.

Objectives

To perform a pooled analysis of data from these studies to evaluate Clin-RA’s efficacy and safety in a larger overall population, in subgroups of adolescents and according to acne severity.

Materials & Methods

4550 patients were randomised to Clin-RA, clindamycin, tretinoin and vehicle. Evaluations included percentage change in lesions, treatment success rate, proportions of patients with ≥50% or ≥80% continuous reduction in lesions, adverse events and cutaneous tolerability.

Results

In the overall population, the percentage reduction in inflammatory, non-inflammatory and total lesions and the treatment success rate were significantly greater with Clin-RA compared with clindamycin, tretinoin and vehicle alone (all p<0.01). The percentage reduction in all types of lesions was also significantly greater with Clin-RA in the adolescent subgroup (2915 patients, p<0.002) and in patients with mild/moderate acne (3662 patients, p<0.02) versus comparators. In patients with severe acne (n = 880), the percentage reduction in all lesion types was significantly greater with Clin-RA versus vehicle (p<0.0001). A greater proportion of Clin-RA treated patients had a ≥50% or ≥80% continuous reduction in all types of lesions at week 12 compared with clindamycin, tretinoin and vehicle. Adverse event frequencies in the active and vehicle groups were similar. Baseline-adjusted mean tolerability scores over time were <1 (mild) and similar in all groups.

Conclusion

Clin-RA is safe, has superior efficacy to its component monotherapies and should be considered as one of the first-line therapies for mild-to-moderate facial acne.

     

Severity of Psoriasis Among Adult Males is Associated with Smoking,Not with Alcohol Use

Context:

Lifestyle factors such as tobacco smoking and alcohol use can affect the presentation and course of psoriasis. There is a paucity of data on this subject from India.

Aims:

To find out whether increased severity of psoriasis in adult Indian males is associated with tobacco smoking and alcohol use.

Settings and Design:

Cross-sectional study in the Department of Dermatology of a Tertiary Care Teaching Hospital.

Subjects and Methods:

Male patients above 18 years of age attending a psoriasis clinic between March 2007 and May 2009 were studied. Severity of psoriasis (measured using Psoriasis Area and Severity Index – PASI) among smokers and non-smokers was compared. We also studied the correlation between severity of psoriasis and nicotine dependence (measured using Fagerström Test for Nicotine Dependence) and alcohol use disorders (measured using Alcohol Use Disorders Identification Test–AUDIT).

Statistical Analysis:

Z-test, Odd''s ratio, Chi-square test, Spearman''s correlation coefficient.

Results:

Of a total of 338 patients, 148 were smokers and 173 used to consume alcohol. Mean PASI score of smokers was more than that of non-smokers (Z-test, z = −2.617, P = 0.009). Those with severe psoriasis were more likely to be smokers (χ² = 5.47, P = 0.02, OR = 1.8, Confidence Interval 1.09-2.962). There was a significant correlation between PASI scores and Fagerström score (Spearman''s correlation coefficient = 0.164, P < 0.01). Mean PASI scores of persons who used to consume alcohol and those who did not were comparable.(Z-test, z = −0.458, P = 0.647). There was no association between severity of psoriasis and alcohol consumption.(χ² = 0.255, P = 0.613, Odds Ratio = 1.14, CI 0.696-1.866). There was no correlation between PASI scores and AUDIT scores (Spearman''s correlation coefficient = 0.024, P > 0.05).

Conclusions:

Increased severity of psoriasis among adult males is associated with tobacco smoking, but not with alcohol use.     

Erythema‐directed digital photography for the enhanced evaluation of topical treatments for acne vulgaris

Background

Erythema‐directed digital photography is a novel method for evaluating the efficacy and tolerability of topical acne treatments. Here, we describe three case reports in which erythema‐directed digital photography was used to evaluate acne before and after up to 12 weeks of treatment with clindamycin 1%/tretinoin 0.025% (Clin‐RA).

Materials and methods

Erythema‐directed digital photography was used to evaluate acne in three patients with mild‐to‐moderate facial acne, two of whom had refused to continue previous topical acne treatment (benzoyl peroxide 5% and clindamycin 1%/benzoyl peroxide 5%) due to persistent irritation. Acne lesions and erythema were evaluated using standard clinical photography and erythema‐directed digital photography (VISIA‐CR^™ system) before and after 8‐12 weeks of treatment with Clin‐RA.

Results

Erythema‐directed digital photography revealed background erythema from previous topical acne treatments that was not evident from standard clinical photographs and allowed a better visualization of both inflammatory and non‐inflammatory lesions. In all patients, there was a clear improvement in background erythema and a reduction in acne lesions following treatment with Clin‐RA.

Conclusion

This study has demonstrated for the first time that erythema‐directed digital photography can enhance the evaluation of the efficacy and tolerability of topical acne treatments. These cases show that Clin‐RA was associated with improved efficacy and tolerability vs previous treatments with topical monotherapy (benzoyl peroxide 5%) or a topical fixed‐dose combination (clindamycin 1%/benzoyl peroxide 5%).

     

Unilateral transient forehead paralysis following injury to the temporal branch of the facial nerve

BACKGROUND: Cutaneous surgery in the temporal region of the forehead can lead to injury to the superficial temporal branch of the facial nerve. A flattened forehead and with ipsilateral forehead paralysis can occur with damage to this nerve. METHODS: A case is presented of transient forehead paralysis resulting from Mohs' micrographic surgery with reconstruction of the defect. The paralysis resolved over a period of fifteen months. RESULTS: The anatomy of the nerve makes it susceptible to injury during cutaneous surgery. The area of danger is the area superior to the zygomatic arch and lateral to the lateral eyebrow where the nerve is closest to the skin. CONCLUSIONS: Restoration of motor function usually occurs without intervention, but may take several months. Should motor function not recur, nerve grafting of a repair of the ptotic brow may be needed. The anatomy of the nerve is reviewed and brow lifting options are discussed.     

Acne-specific quality of life questionnaire (Acne-QoL): translation, cultural adaptation and validation into Brazilian-Portuguese language

BACKGROUND

many studies about the psychosocial impact of acne have been reported in international medical literature describing quality of life as a relevant clinical outcome. It is well known that the patient''s perception about the disease may be different from the physician''s evaluation. Therefore, it is important to use validated instruments that turn the patient''s subjective opinion into objective information.

OBJECTIVES

to translate into Brazilian-Portuguese language and to culturally adapt a quality of life questionnaire, the Acne-Specific Quality of Life Questionnaire (Acne-QoL), as well as to evaluate its reliability and validity.

METHODS

measurement properties were assessed: 1) validity: comparison between severity and Acne-QoL domain scores, correlations between acne duration and Acne-QoL domain scores, and correlation between Acne-QoL domain scores and SF-36 components; 2) internal consistency: Cronbach''s α coefficient; 3) test-retest reproducibility: intraclass correlation coefficient and Wilcoxon test.

RESULTS

Eighty subjects with a mean age of 20.5 ± 4.8 years presenting mild (33.8%), moderate (36.2%) and severe (30%) facial acne were enrolled. Acne-QoL domain scores were similar among the different acne severity groups except for role-social domain. Subjects with shorter acne duration presented significant higher scores. Acne-QoL domains showed significant correlations, both between themselves and with SF-36 role-social and mental health components. Internal consistency (0.925-0.952) and test-retest reproducibility were considered acceptable (0.768-0.836).

CONCLUSIONS

the Brazilian-Portuguese version of the Acne-QoL is a reliable and valid satisfactory outcome measure to be used in facial acne studies.     

Effects of alefacept on health-related quality of life in patients with psoriasis: results from a randomized,placebo-controlled phase II trial

Introduction

Chronic plaque psoriasis has a profound impact on patient quality of life (QOL), including adverse psychosocial effects, impaired daily activities, anxiety, and depression.

Objective

To assess health-related QOL in a randomized phase II trial of alefacept (human LFA-3/IgG₁ fusion protein), a selective immunomodulator for psoriasis.

Study design

Multicenter, randomized, placebo-controlled, double-blind trial.

Methods

229 patients with moderate to severe psoriasis were randomized to alefacept (0.025, 0.075, or 0.150 mg/kg) or placebo by 30-second intravenous bolus once weekly for 12 weeks and followed for 12 additional weeks. Patients completed a general (SF-36®¹ Health Survey) and dermatology-specific (Dermatology Life Quality Index [DLQI] and Dermatology Quality Of Life Scales [DQOLS]) QOL surveys at each study visit.

Results

Patients treated with alefacept had significantly greater improvements on dermatology-specific QOL scales compared with patients receiving placebo (p < 0.05). Patients who achieved a ≥50% or a ≥75% reduction in Psoriasis Area and Severity Index (PASI) reported similar improvement in QOL, which was significantly greater than that of other patients.

Conclusions

The clinical effect of alefacept on psoriasis is associated with an improvement in patients’ QOL. Among patients with moderate to severe psoriasis, an improvement in PASI of 50% or more is associated with better QOL scores.