Patient satisfaction with laser hair removal

Background Laser hair removal (LHR) is a widely used treatment for unwanted hair. Aim To determine patient satisfaction with LHR. Methods The clinic offered LHR by long pulse ruby, alexandrite and Nd:YAG. Patients attending the LHR clinic completed a patient satisfaction questionnaire. Satisfaction with LHR treatment was recorded on a linear analogue scale (LAS 0 = laser very much worse than alternative method; 10 = laser very much better than the alternative method). Results In terms of hair removal, 71% of patients were satisfied with their treatment. Laser treatment compared favourably with electrolysis and waxing. LHR scored 8.6 when compared with electrolysis and 7.7 when compared with waxing. During LHR treatments, 61% of patients used fewer ancillary methods than before. Most patients would recommend LHR to other persons with unwanted hair. Conclusions Most patients were satisfied with LHR.     

Skin hydration and transepidermal water loss in patients with a history of sulfur mustard contact: a case–control study

Background   Skin lesions are among the most common complications of contact with sulfur mustard.
Objective   This study was aimed to measure skin water content and transepidermal water loss (TEWL) in patients with a history of sulfur mustard contact.
Methods   Three hundred ten male participants were included in this study: 87 (28.1%) sulfur mustard–exposed patients with current skin lesions (group 1), 71 (22.9%) sulfur mustard–exposed patients without skin lesions (group 2), 78 (25.2%) patients with dermatitis (group 3) and 74 (23.8%) normal controls (group 4) The water content and TEWL of skin was measured at four different locations of the body: forehead, suprasternal, palm and dorsum of hand. Nonparametric statistical tests (Kruskal–Wallis) were used to compare the four groups, and P  < 0.05 was considered statistically significant.
Results   The mean age of participants were 44.0 ± 6.7, 41.9 ± 5.9, 43.8 ± 9.3 and 44.8 ± 8.9 years in groups 1 to 4, respectively ( P  = 0.146). Xerosis, post-lesional hyperpigmentation and lichenification were significantly more common in either sulfur mustard–exposed participants or non-exposed participants with dermatitis ( P  < 0.05). Skin hydration was higher in subjects with sulfur mustard contact than in non-injured participants ( P  < 0.05) in the dorsum and palm of hands and forehead. TEWL was significantly higher in participants only in suprasternal area and dorsum of hand.
Conclusion   Contact with sulfur mustard agent can alter biophysical properties of the skin-especially the function of stratum corneum as a barrier to water loss-several years after exposure.

Conflicts of interest

None declared.     

Malignant nodular hidradenoma of the skin: report of seven cases

Background Malignant nodular hidradenoma (MNH) is an infrequent, highly malignant, primary skin tumour derived from eccrine sweat glands. Most tumours occur in elderly individuals. MNH has very poor prognosis, high recurrence and a high rate of metastases. The best method of treatment is still unclear: radical surgical excision is widely used, and selective lymph node dissection is also suggested. The value of the adjuvant radiotherapy and chemotherapy has not been confirmed. Patients and treatment Seven MNH patients (4 men, 3 women, age 60–87 years) were treated between 1991 and 2007 in the Dermatology Unit of San Donato Hospital of Arezzo and in the Section of Dermatology of University of Siena, Italy. Tumours varied from 0.8 to 4.4 cm in size. All patients underwent local excision; five also had lymph node dissection. One patient underwent adjuvant radiotherapy, and three received chemotherapy. Results Six of seven patients died, with survival varying from 15 to 45 months. Distant metastases occurred in two patients. Survival time was inversely proportional to the size of the tumour. Conclusions MNH is an aggressive tumour and should be diagnosed and excised as early as possible. Histological parameters are paramount, but correct diagnosis also calls for attention to clinical presentation and any history of recurrence or recent enlargement of long‐standing lesions. In our experience, radiotherapy and chemotherapy do not seem to prolong survival.     

Efficacy of dioic acid compared with hydroquinone in the treatment of melasma

Background  Melasma is a common disorder of pigmentation characterized by relatively symmetric, brown or gray–brown patches on sun-exposed facial areas. Hydroquinone, the most effective agent in melasma, is known to irritate the skin, and so new alternatives in the treatment of melasma are required. We sought to assess the clinical response of a new depigmenting agent in melasma.
Methods  Ninety-six Mexican female patients with melasma were enrolled in this open, comparative, 12-week study. The patients received 1% dioic acid cream (twice daily) or 2% hydroquinone cream (twice daily).
Results  There was a significant difference in the Melasma Area Severity Index (MASI) scores from baseline to the end of the study using treatment with dioic acid (baseline, 14.52 3.4; after 12 weeks of treatment, 6.05 ± 1.2; P  = 0.001) and hydroquinone (baseline, 15.22 ± 2.4; after 12 weeks of treatment, 6.34 ± 1.3; P  = 0.001); however, there were no significant differences between treatments (baseline, P  = 0.311; after 12 weeks of treatment, P  = 0.287). The side-effects were similar with both medications; however, pruritus was more common in patients using hydroquinone.
Conclusions  Dioic acid is an effective and highly tolerated skin product, although further controlled, blind, multicenter studies are required to support these results.     

Skin and systemic pharmacokinetics of tacrolimus following topical application of tacrolimus ointment in adults with moderate to severe atopic dermatitis

Background  Systemic exposure to tacrolimus following topical application of tacrolimus ointment is minimal. There are, however, no data on the distribution of tacrolimus in the skin.
Objectives  To assess the distribution of tacrolimus in the skin and the systemic pharmacokinetics of tacrolimus in adults with moderate to severe atopic dermatitis after first and repeated application of tacrolimus ointment.
Methods  We investigated skin distribution of topically applied tacrolimus and systemic pharmacokinetics of percutaneously absorbed tacrolimus in adults with atopic dermatitis after topical application of tacrolimus 0·1% ointment twice daily for 2 weeks. Tacrolimus concentrations were assessed in full-thickness skin biopsies and blood samples.
Results  Of 14 patients, 11 completed treatment and were analysed. Mean ± SD tacrolimus concentrations in the skin at 24 h after first and last ointment applications were 94 ± 20 and 595 ± 98 ng cm⁻³, respectively. At 168 h after stopping treatment, values were 97% lower than at 24 h after last application. Tacrolimus concentration decreased with increasing skin depth. Systemic tacrolimus exposure after ointment application was low and highly variable, with 31% of samples below the limit of quantification (0·025 ng mL⁻¹) and 94% below 1 ng mL⁻¹. Blood concentrations at 24 h after the first and last ointment applications were 750 and 1800 times lower, respectively, than those in skin. Physicians' assessments showed that tacrolimus ointment was effective and well tolerated.
Conclusions  Tacrolimus was primarily partitioned in the skin, with minimal systemic absorption after topical application, in patients with atopic dermatitis.     

Investigation of basal cell carcionoma by confocal laser scanning microscopy in vivo

Background/purpose In vivo confocal laser scanning microscopy (CLSM) allows to study human skin up to 200 µm deep non-invasively. Aim of this study was to investigate basal cell carcinoma (BCC) using in vivo CLSM, and to compare the micromorphologic features of BCC with uninvolved skin.
Methods Twelve patients with histological diagnosis of BCC referred to our department for tumor excision were investigated on the lesion(s) and on clinically uninvolved sites preoperatively by in vivo CLSM using the Vivascope 1000 (Lucid Inc., Rochester, USA). The images were compared to histological examinations of the excised tissue.
Results Typical changes in vasculature such as increase in number and diameter of the blood vessels, loss of the vascular architecture, parallelly and horizontally orientated vessels, and accumulation and rolling phenomena of bright reflecting cells of 11.88 ± 1.75 µm in diameter along the vessel wall were observed in all BCCs. The tumor stroma of the BCCs showed a strong reflectance mainly due to numerous bundles of collagen fibers encoating dark, cell-rich areas of tumor parenchym. In five patients, slim basaloid cells with relatively large, elongated dark nuclei were observed in the periphery of the tumor parenchym. In the fibrosing type of BCC, curled bundles of collagen with large cells represented the tumor stroma.
Conclusions BCC can be investigated by CLSM and provide typical features. Besides the tumor parenchym and stroma, typical changes in vasculature seem to be a sensitive criteria for BCC and may in future help in diagnosing BCC by CLSM as well as in assessing the margins of large tumors. We suggest that CLSM is a promising non-invasive tool for the diagnostics of BCC and the assessment of tumor margins prior to surgery.     

浅表婴儿血管瘤分布特点与疗效的关系探讨

 目的:探讨浅表婴儿皮肤血管瘤（IH）皮损特点与疗效的关系。方法：纳入77例未经任何治疗的浅表IH患儿,按照初诊时皮损分布特点分为散在分布组（A组）41例和融合分布组（B组）36例。两组均使用激光联合外敷马来酸噻吗洛尔滴眼液治疗,每次激光治疗后1周开始外敷药水,瘤体基本消退时停止治疗。取入选病例皮损周边正常皮肤作为对照组。分别于治疗前、治疗后4、8、12、16、20周,检测血红素 (EI) 值。治疗后每4周评价疗效、记录激光次数及不良反应。结果：①治疗4周后,A组有效率为21.95%,B组有效率为5.56%,差异有统计学意义（X²=4.21,P＜0.05）。治疗时间越长,两组有效率差异越明显。②A组平均激光治疗（1.54±0.81）次,B组平均激光治疗（2.89±1.21）次,两组比较差异有统计学意义（t=5.67,P＜0.01）。③治疗前B组 EI值（811.91±198.86）明显高于A组（676.14±158.14）及对照组（314.58±27.00）,三组比较差异有统计学意义（F=91.95,P＜0.01）。治疗16周后,A组 EI值已明显下降,与对照组比较差异无统计学意义（P＞0.05）;B组EI值仍明显高于A组及对照组,三组比较差异有统计学意义（F=50.42,P＜0.01）。结论：散在分布的浅表IH比融合分布的浅表IH激光治疗次数少,疗程短,有效率高。     

Clinical effect of low-energy double-pass 1450 nm laser treatment for acne in Asians

Background: While the 1450 nm diode laser is highly effective for the treatment of acne, its use is associated with considerable pain. Low-energy, double-pass irradiation was attempted as an alternative to prevent the occurrence of pain as an adverse effect.
Purpose: This study aimed to evaluate the clinical efficacy of low-energy, double-pass, 1450 nm diode laser treatment in the treatment of acne in Asian patients.
Methods: Thirty Japanese patients with inflammatory acne were treated with the low-energy, double-pass, 1450 nm diode laser at 2–4-week intervals. An open study was performed in patients that underwent at least five and up to 10 treatment sessions. The clinical effect was assessed using an acne grading scale.
Results: Of the 30 patients, 27 completed the study. The mean acne grades decreased from 3.9 to 1.4 ( P <0.01) in the 27 patients. The pain was tolerated by 25 patients, and two patients required local anesthesia. No remarkable side effects occurred in any of the patients; all but a few patients had transient faint erythema.
Conclusion: Low-energy, double-pass therapy is an alternative method that is beneficial for patients who complain of considerable pain. Furthermore, the method may have a lower risk of transient hyperpigmentation induced by cryogen spray, even in Asian patients who tend to develop inflammatory pigmentation.     

Skin cancers amongst four Nigerian albinos

Background  Albinism is an established risk factor for skin cancer in black Africans, and high levels of ultraviolet radiation increase the risk of the three major forms of skin cancer.
Methods  We present four albinos with histologic diagnoses of skin cancer who were seen at the University of Calabar Teaching Hospital, Calabar, Nigeria from January 2005 to December 2006. Skin cancer in these cases was compared with the total skin cancer affecting 29 patients during the study period.
Results  Twenty-nine patients presented with skin cancer during the study period. Four Nigerian albinos (two men and two women) with skin cancer accounted for 13.8% of the skin cancers observed during the 2-year period. They ranged in age from 22 to 40 years (mean, 27.8 years). The sites of the lesions included the head [squamous cell carcinoma (SCC) in two patients and basal cell carcinoma (BCC) in one patient] and the upper limb (melanoma). All tumors were excised; in addition, patients with SCC and melanoma received adjuvant chemotherapy. Two patients, one woman with SCC and the patient with melanoma, showed residual tumor because of inadequate excision. During the evaluation period between 14 and 18 months, the sites appeared to be healed with no evidence of recurrence in the male with SCC and female with BCC.
Conclusion  Albinism and solar radiation are risk factors for skin cancer. Early implementation of public education strategies on prevention should improve outcome.     

Local control of primary Merkel cell carcinoma: review of 45 cases treated with Mohs micrographic surgery with and without adjuvant radiation

BACKGROUND: Optimal treatment of primary Merkel cell carcinoma (MCC) is unknown. High local recurrence rates after excision alone compel some physicians to advocate postoperative radiation therapy to improve local control. OBJECTIVE: We wondered whether marginal recurrence and survival rates differed between patients with primary MCC treated with Mohs surgery alone and those treated with Mohs surgery and adjuvant postoperative radiation. METHODS: A collaborative retrospective study was performed; the study group consisted of 45 patients with stage I MCC who were histologically and clinically free of disease after Mohs excision. Twenty patients subsequently received elective postoperative radiation to the primary site, and 25 patients had no adjuvant radiation therapy. RESULTS: One marginal recurrence (4%) and 3 in-transit metastases were observed in the Mohs surgery alone group, whereas none were observed in the Mohs surgery and radiation group. The proportion of patients with these events was not significantly different between treatment groups. Overall survival, relapse-free survival, and disease-free survival were not significantly different between treatment groups. CONCLUSION: Adjuvant radiation appears unessential to secure local control of primary MCC lesions completely excised with Mohs micrographic surgery. Adjuvant radiation is recommended for patients unable to have complete excision or if complete histologic margin control is unavailable and should be considered for patients with large or recurrent tumors.     

Vascular endothelial growth factor in psoriasis: an indicator of disease severity and control

Background  Psoriasis is a chronic disease characterized by abnormal epidermal proliferation, inflammation and angiogenesis. It has been reported that vascular endothelial growth factor (VEGF) is overexpressed in lesional psoriatic skin and its serum levels are significantly elevated in patients with moderate to severe disease.
Objective  This study aims to evaluate the possible role of VEGF in the pathogenesis of psoriasis, and its significance as an indicator of disease severity and control.
Methods  Thirty patients with moderate to severe psoriasis and 10 healthy controls were subjected to baseline evaluation of VEGF. Patients were divided into three groups according to the received treatment: psoralen plus ultraviolet A (PUVA) thrice weekly (group 1), acitretin 50 mg daily (group 2), and combined PUVA twice weekly and acitretin 25 mg daily (group 3).Treatment continued for 16 weeks or up to clinical cure. Every patient was subjected to severity evaluation by Psoriasis Area and Severity Index (PASI) and measurement of serum VEGF before and after treatment.
Results  Mean serum levels of VEGF were significantly elevated in patients (327 ± 66.2 pg/mL) than control subjects (178 ± 83.4 pg/mL). A highly significant correlation was found between VEGF and PASI score, but not with other variables. The best clinical response, the least side-effects and the highest reduction of VEGF serum levels were achieved by the combined therapy.
Conclusion  The present study supported the proposed role of VEGF in the pathogenesis of psoriasis, and suggested that it could serve as a good indicator of disease severity and control.     

Advances in management of dermatofibrosarcoma protuberans

Dermatofibrosarcoma protuberans (DFSP) is a rare soft-tissue tumor that most commonly presents on the trunk and extremities of adults. It is characterized by low metastatic potential and a favorable prognosis, but extensive subclinical growth can contribute to a high risk of local recurrence. Surgical excision is the first-line treatment, using Mohs micrographic surgery or wide local excision with careful evaluation of the peripheral and deep surgical margins. Adjuvant therapy may be beneficial in patients with unresectable, recurrent, or metastatic DFSP. Historically, adjuvant radiation therapy has been used to reduce the risk of local recurrence when residual disease is present after surgery. The advent of targeted molecular therapies, such as the selective tyrosine kinase inhibitor, imatinib mesylate, has provided new effective and safe options for adjuvant treatment of DFSP.     

Lipoma treatment with a subdermal Nd:YAG laser technique

Background  Lipoma is the most common benign mesenchymal tumor composed of mature fat cells. The standard treatment for lipoma is excision. Many treatments have been described in order to minimize the scars produced by surgical excision. The treatment of lipoma using a subdermal laser produces an effective disruption of fat cells and results in a small scar.
Objective  To evaluate the efficacy of subcutaneous intralesional application of a pulsed Nd:YAG laser as an option for the treatment of lipoma.
Methods  From January 2001 to November 2007, 20 patients (11 women and nine men) with lipomas were treated using a subdermal, pulsed, 1064-nm Nd:YAG laser. After laser treatment, the oily solution, the product of laser action, was removed with a 2-mm cannula using a negative pressure of 350 mmHg. Histology and cytology of the treated tissue were used to analyze the effects of the laser on the fat cells. Ultrasound was performed in some subjects before and after laser treatment.
Results  Subdermal lipoma treatment using a 1064-nm Nd:YAG laser resulted in complete or almost complete removal of the tumor in 100% of patients. Four partial relapses were observed that were treated successfully by the same procedure. Adverse effects were mild and temporary. The combination of a 1064-nm Nd:YAG laser and removal of the cell debris by a suction cannula presented an effective therapeutic option for patients with lipoma.
Conclusions  The treatment of lipoma using a 1064-nm Nd:YAG laser is a minor invasive procedure which does not result in large scars. Laser treatment is an effective and safe option for cellular disruption.     

Does pancreas transplant in diabetic patients affect the evolution of necrobiosis lipoidica?

Background  Necrobiosis lipoidica (NL) is a non-infectious granulomatous skin disorder, with average age of onset is between 30 to 41 years, and female : male ratio of 3 : 1. The strongest systemic disease associated is diabetes mellitus (DM). Many treatment options are used for NL with variable success. To verify if reversal of the diabetic state is related to improvement of NL, we compared the evolution of NL lesions in patients who received a pancreas transplant with those who received a kidney.
Methods  Retrospective chart review of diabetic patients with NL who underwent transplant.
Results  A total of fifteen patients were identified and divided into two groups: group I ( n  = 11) consisted of patients who underwent pancreas only or pancreas plus kidney transplant, group II ( n  = 4) underwent kidney only transplant. Of the eleven patients in Group I, five had NL lesions at the time of transplant and all achieved resolution of these lesions. One patient experienced recurrence of NL associated with transplant rejection. In group II, one patient who had NL lesions at the time of transplant had persistent lesions after the transplant. Resolution of NL was observed in 45% (five/eleven) of the cases in the pancreas +/− kidney transplant group, whereas the one patient who had active NL and kidney transplant failed to demonstrate improvement of the lesion after the procedure, despite the concomitant use of immunosuppressant therapy.
Conclusions  Patients experienced improvement of NL within 2–8 weeks following pancreas transplantation. Metabolic changes, improvement of the microcirculation and normalization of blood glucose levels may be playing a role in the resolution of NL.     

Specific gel-cream as adjuvant to oral isotretinoin improved hydration and prevented TEWL increase – a double-blind, randomized, placebo-controlled study

Background  Hydrating and emollient products are often recommended to patients under isotretinoin therapy to control the most frequent mucocutaneous side effects and to improve adherence to treatment.
Aims  To assess, using noninvasive biophysical tests, the clinical and instrumental effectiveness of a hydrating gel-cream compared with placebo as an adjuvant to isotretinoin for treatment of facial skin in patients with inflammatory acne.
Methods  Prospective, double-blind, randomized study, using MULTI SKIN MC750, on the adjuvant effect of a hydrating gel-cream for acne (active product) vs. a gel-cream without active substances (placebo). Follow-up lasted 3 months.
Results  Sixty-six patients were included. Thirty-four were administered the active product, and 32 placebo. Though the number of lesions fell significantly in both groups, the mean number of papules on day 30 was significantly lower in the active product group. The active product group showed a significant increase in hydration, while the placebo group showed a significant increase in transepidermal water loss (TEWL). Seborrhoea decreased significantly in both groups; there were no differences between them.
Conclusions  Compared with placebo, the specific gel-cream with active products as an adjuvant to oral isotretinoin improved hydration, prevented TEWL increase, and reduced inflammatory acne lesions after 30 days.     

Nerve blocks provide effective pain relief during topical photodynamic therapy for extensive facial actinic keratoses

Background.  Photodynamic therapy (PDT) is a first-line therapeutic option for skin areas with multiple actinic keratoses (AKs). Its main drawback is the pain perceived during the irradiative phase, especially when treating field cancerization in the facial area. Effective pain-relieving strategies are needed.
Aim.  To determine the effectiveness of peripheral nerve blocks in achieving pain relief during PDT for extensive facial AKs.
Methods.  In total, 16 patients with symmetrically distributed facial AKs, mainly on the forehead, were enrolled in the study. Nerve blocks were applied unilaterally, and the nonanaesthetized side of the treatment area served as control. Maximum pain during PDT was evaluated using a visual analogue scale (VAS). Pain experienced after PDT was evaluated by telephone interview within 2 weeks of treatment. Cure rates were assessed at follow-up at least 4 weeks after treatment.
Results.  Pain was significantly reduced on the anaesthetized side ( P  < 10⁻⁸). The mean ± SEM VAS score on the blocked side of the face was 1.3 ± 0.3 compared with 7.5 ± 0.5 on the nonanaesthetized side. Pain relief persisted 1–2 h after PDT. The nerve block was generally not experienced as painful (14/16 patients). Almost all patients (15/16 patients) would like to receive nerve blocks bilaterally if future PDT were needed. Excellent clinical results were observed in all patients after 4–20 weeks.
Conclusion.  Nerve blocks provide efficient pain relief during PDT when treating patients with field cancerization of the forehead. Nerve blocks were not found to affect the clinical outcome of PDT, and were generally well tolerated by the patients.     

Simplified surgical treatment of chondrodermatitis nodularis by cartilage trimming and sutureless skin closure

Background  Chondrodermatitis nodularis (CN) is a common painful ear condition, most commonly seen at the apex of the helix. Many different treatment methods for it have been advocated but excision of cartilage alone has been shown to be therapeutically and cosmetically effective.
Objectives  To describe and present our experience of a simplified and minimally invasive method of cartilage trimming for CN with sutureless skin closure.
Methods  A retrospective review of all cases of CN seen in our department treated by this technique.
Results  Of 34 patients treated over 12 years, 19 were men (mean age 61 years; range 47–83) and 15 were women (mean age 65 years; range 48–92). Right ( n  =   18) and left ( n  =   17) ears were almost equally represented. One patient required treatment for both ears. The antihelix was involved in seven cases; the remainder involved the helix. All patients were reviewed at 4 months. An excellent response with no discomfort or clinical recurrence of CN was observed in 32 (94%).
Conclusions  Our simplified technique of cartilage trimming and sutureless skin closure is a rapidly performed, minimally invasive and highly effective method of treating CN.     

Ceramide 1 and ceramide 3 act synergistically on skin hydration and the transepidermal water loss of sodium lauryl sulfate-irritated skin

Background  Stratum corneum intercellular lipids, such as ceramides, play an important role in the regulation of skin water barrier homeostasis and water-holding capacity.
Aim  To evaluate the potential water retention capacity of control emulsion and three oil-in-water (o/w) emulsions containing ceramide 1, ceramide 3, or both.
Methods  Fifteen healthy Asian women (age, 20–30 years) with healthy skin, pretreated with sodium lauryl sulfate (SLS), applied the tested emulsions twice daily over a period of 28 days. Skin hydration and transepidermal water loss (TEWL) values were measured on the indicated days with a Corneometer®825 and a TEWAMETER TM210, respectively.
Results  The maximum increase in skin humidity was reached after 4 weeks, with values of 21.9 ± 1.8% and 8.9 ± 0.9% for emulsion C and control emulsion, respectively. The maximum decrease in TEWL was also reached after 4 weeks, with values of 36.7 ± 4.7% and 5.1 ± 0.8% for the same emulsions.
Conclusions  It can be concluded that all the tested ceramide-containing emulsions improved skin barrier function when compared with untreated skin. There was some indication that ceramides 1 and 3 contained in emulsion C might exert a beneficial synergistic effect on skin biochemical properties, such as skin hydration and TEWL, and play a key role in the protection mechanism against SLS irritation.     

Photodynamic therapy for acne vulgaris: a randomized, controlled, split-face clinical trial of topical aminolevulinic acid and pulsed dye laser therapy

Background  There remains the need for more effective therapeutic options to treat acne vulgaris. Interest in light-based acne treatments has increased, but few randomized, controlled clinical trials assessing the value of photodynamic therapy (PDT) for acne have been reported.
Aims  We sought to examine the efficacy of PDT using 5-aminolevulinic acid (ALA) and pulsed dye laser therapy in the treatment of acne.
Patients/methods  We conducted a randomized, controlled, split-face, single-blind clinical trial of 44 patients with facial acne. Patients were randomized to receive three pulsed dye laser treatments to one side of the face after a 60–90 min ALA application time, while the contralateral side remained untreated and served as a control. Serial blinded lesion counts and global acne severity ratings were performed.
Results  Global acne severity ratings improved bilaterally with the improvement noted to be statistically significantly greater in treated skin than in untreated skin. Erythematous macules (remnants of previously active inflammatory lesions) decreased in number in treated skin when compared with control skin and there was a transient but significant decrease in inflammatory papules in treated skin when compared with untreated skin. There were no other statistically significant differences between treated and untreated sides of the face in terms of counts of any subtype of acne lesion. Thirty percent of patients were deemed responders to this treatment with respect to improvement in their inflammatory lesion counts, while only 7% of patients responded in terms of noninflammatory lesion counts.
Conclusions  PDT with the treatment regimen employed here may be beneficial for a subgroup of patients with inflammatory acne.     

Platelet-rich fibrin matrix for improvement of deep nasolabial folds

Background  Dermal augmentation continues to grow as an aesthetic facial procedure. Many exogenous filler materials rely on an autologous fibrotic response for volume augmentation.
Aims  To evaluate the efficacy of a single injection of autologous platelet-rich fibrin matrix (PRFM) for the correction of deep nasolabial folds (NLFs).
Patients/methods  Whole blood was obtained from 15 adults, and an activated autologous PRFM produced using a proprietary system (Selphyl^®; Aesthetic Factors, Inc., Wayne, NJ, USA) was then injected into the dermis and immediate subdermis below the NLFs. Subjects were photographed before and after treatment; NLFs were rated by the treating physician before and after treatment using the Wrinkle Assessment Scale (WAS) and patients rated their appearance at each post-treatment visit using the Global Aesthetic Improvement Scale. Patients were evaluated at 1, 2, 6, and 12 weeks after treatment.
Results  All patients were treated to maximal (no over-) correction, with a mean reduction in WAS score of 2.12 ± 0.56. At 1 week after treatment, this difference was 0.65 ± 0.68, but rose to 0.97 ± 0.75, 1.08 ± 0.59, and 1.13 ± 0.72 at 2, 6, and 12 weeks after treatment, respectively ( P  < 0.001). No patient noted any fibrosis, irregularity, hardness, restricted movement, or lumpiness.
Conclusions  PRFM can provide significant long-term diminution of deep NLFs without the use of foreign materials. PRFM holds significant potential for stimulated dermal augmentation.