Split-face histological and biochemical evaluation of tightening efficacy using temperature- and impedance-controlled continuous non-invasive radiofrequency energy

Background: Bipolar radiofrequency (RF) is capable of heating dermal collagen fibers and inducing skin tightening by collagen remodeling. Objective: To substantiate safety and improvement of skin laxity following skin heating with a novel temperature- and impedance-controlled non-invasive radiofrequency (RF) device by histological and biochemical evaluations. Methods: A split-face study was performed on 4 subjects who underwent 8 weekly RF sessions on one side of their face, leaving the other side an untreated control and then underwent facelift procedure. Clinical evaluation by photographs was done prior to the surgical procedure. Ex vivo fragments were harvested from both sides and compared. Morphometric analysis of dermal collagen fibers, collagen synthesis, and elastin synthesis evaluations were compared in triplicates. Results: Facial skin tightening was apparent in split-face photographs. A significant increase of 7.9% in dermal collagen content, and a significant increase of 34.7% in collagen synthesis were demonstrated in the treated samples. No statistically significant effect on elastin synthesis was detected. Conclusions: Skin tightening following treatment with non-invasive RF has proven histologically and biochemically to derive from increase in dermal collagen synthesis and content.     

Treatment of pseudoxanthoma elasticum-like papillary dermal elastolysis with nonablative fractional resurfacing laser resulting in clinical and histologic improvement in elastin and collagen

Objective: Pseudoxanthoma elasticum-like papillary dermal elastolysis (PXE-PDE) is a rare skin condition seen predominantly in elderly females. These asymptomatic lesions are brought to the dermatologist’s attention due to patient’s displeasure in their appearance. We report a case of a 28-year-old female with PXE-PDE on the right neck treated with nonablative fractional resurfacing (NAFR). Case: The patient on examination had yellow-to-skin-colored papules that coalesced into a cobblestone-appearing plaque on her lateral neck. The area was treated with NAFR to improve texture and cosmesis. After three treatments, the patient noted at least a 50% improvement of appearance and texture in the affected skin. Adverse effects were mild without development of serious side effects, such as scarring and/or permanent dyspigmenation. Conclusion: Established therapies for elastin disorders like PXE-PDE have yielded unsatisfactory results by patient and clinician standards. Positive results with NAFR, illustrated in our PXE-PDE case, further provides a role for NAFR in elastin disorders.     

咪喹莫特对兔耳增生性瘢痕动物模型的影响

目的探讨咪喹莫特对全层皮肤缺损诱导的兔耳增生性瘢痕模型组织学变化的影响及可能的作用机制。方法 24只新西兰白兔双耳腹面手术切除2.0cm×5.0cm全层皮肤至筋膜,建立兔耳增生性瘢痕模型后,随机分成两组,每组12只,将每只兔左耳分别于伤后每日和隔日应用咪喹莫特,共8周,右耳为空白组(非用药组)。结果与非用药组相比较,经咪喹莫特应用8周后,每日用药组的瘢痕厚度(431.22±92.03)、胶原含量(46.56±19.02)和瘢痕指数(0.36±0.31),TIMP-1(16.64±2.14),α-SMA(3.85±1.26)和PCNA(5.68±1.07)均有显著下降(P<0.05),MMP-1(6.71±2.03)显著增加(P<0.05);而隔日用药组,除胶原含量(49.48±17.35)和PCNA(5.33±0.67)有显著下降(P<0.05),MMP-1(5.05±0.76)显著增加(P<0.05)外,瘢痕厚度(621.91±96.81)和瘢痕指数(0.79±0.34),α-SMA(7.13±1.16)和TIMP-1(24.77±4.17)均无明显改变(P>0.05);无论每日还是隔日应用咪喹莫特对TGF-β1的表达均无影响(P>0.05)。结论在创伤早期应用咪喹莫特可降低瘢痕厚度和胶原含量。     

A Case of Fibroelastolytic Papulosis on the Neck of a Young Man

Fibroelastolytic papulosis of the neck (FEPN) encompasses a spectrum of two disorders that were previously reported as pseudoxanthoma elasticum-like papillary dermal elastolysis (PXE-PDE) and white fibrous papulosis of the neck (WFPN). The clinical presentation of FEPN is asymptomatic to mildly pruritic whitish-yellow papules that may coalesce into cobblestone patterned plaques that resemble pseudoxanthoma elasticum (PXE). The histology is characterized by a decrease or loss of elastic fibers in the papillary dermis and this is sometimes accompanied by a minimal or nodular increase of dermal collagen fibers. We report here on a 28-year-old Korean man with asymptomatic, multiple, skin-colored to slightly yellowish, match-head sized, cobblestone-patterned papules on the neck, and these were histologically consistent with FEPN and the papules showed slightly increased dermal collagen associated with decreased and fragmented elastic fibers, elastin and tropoelastin. The pathogenesis of FEPN in this case might have been related with mild dermal inflammation, followed by fragmentation, elastolysis and increased dermal collagen.     

Deficiency of tenascin-X causes abnormalities in dermal elastic fiber morphology

Deficiency of the extracellular matrix protein tenascin-X (TNX) was recently described as the molecular basis of a new, recessive type of Ehlers-Danlos syndrome. Here we report gross abnormalities of the elastic fibers and microfibrils in the dermis of these patients, and reduced dermal collagen content, as determined by quantitative image analysis. The ascending, fine elastic fibers in the papillary dermis were absent or inconspicuous and had few branches. The coarse elastic fibers of the reticular dermis were fragmented and clumped. At the ultrastructural level, irregular and immature elastin fibers and fibers devoid of microfibrils were observed. In TNX-deficient patients the dermal collagen density was reduced, but no structural abnormalities in the collagen fibrils were found. These findings suggest that both elastic fiber abnormalities and reduced collagen content contribute to the observed phenotype in TNX-deficient patients.     

Stimulation of collagen and elastin production in-vivo using 1,540 nm Er:Glass laser: assessment of safety and efficacy

ABSTRACT

Introduction: Induction of collagen and elastin remodeling in the human skin can be achieved by non-ablative fractional laser (NAFXL) and ablative fractional laser (AFXL). Our objective was to compare the safety, efficacy, tolerability, and ability to induce collagen and elastin remodeling of NAFXL versus AFXL in a series of treatments over time.

Materials and Methods: In this prospective, proof of principle, single-case study, the safety, tolerability and efficacy of the laser systems were assessed via histopathology and clinical evaluations including photographs. Optical biopsies by means of multiphoton tomography (MPT) were used to evaluate the induction of collagen and elastin remodeling.

Results: Treatments by both NAFXL and AFXL were well tolerated. The NAFXL system was found to be less painful and resulted in a shorter down- and healing times. MPT findings showed the superior capability of the AFXL procedure to induce collagen; on the other hand, elastin induction was more pronounced after NAFXL treatments.

Conclusions: While NAFXL is as effective and safe as the traditional AFXL, it is better tolerated and has a shorter downtime. Serial optical biopsies over time over time can be a useful tool to assess the induction of collagen and elastin remodeling in the human skin.     

Hydradermabrasion: an innovative modality for nonablative facial rejuvenation

Background Hydradermabrasion is a relatively new procedure that combines crystal‐free microdermabrasion with the pneumatic application of an antioxidant‐based serum. Objective This study aims to validate the safety and efficacy of hydradermabrasion for nonablative facial rejuvenation and to determine whether antioxidant levels could be increased in the skin with this technique. Methods Twenty female volunteers, aged 34–56 years, were randomized into two groups. Group A underwent a series of six facial hydradermabrasion treatments using a polyphenolic antioxidant serum spaced 7–10 days apart. In Group B, the same polyphenolic antioxidant serum was applied manually to the skin for a total of six treatments at 7‐ to 10‐day intervals. Digital photographs, skin biopsies, and skin polyphenolic antioxidant levels were obtained prior to and after the treatment regimen. Patient surveys were taken following the study. Results In Group A, treated skin demonstrated increased epidermal thickness, papillary dermal thickness, and polyphenolic antioxidant levels (P < 0.01). There was replacement of elastotic dermal tissue, collagen hyalinization, and increased fibroblast density. Fine lines, pore size, and hyperpigmentation were decreased following treatment. There were no reported complications. In Group B, there was no change in skin structure, antioxidant levels, or clinical skin attributes. Conclusion Hydradermabrasion effectively improved skin quality both clinically and histologically. There were no changes to suggest that pneumatic serum application adversely affected dermal components. After hydradermabrasion, skin polyphenolic antioxidant levels were increased. In contrast, the intermittent manual application of the polyphenolic antioxidant serum without the microdermabrasion element did not result in detectable skin changes.     

Differential in vitro responses of elastin expression to basic fibroblast growth factor and transforming growth factor β1 in upper,middle and lower dermal fibroblasts

Elastin mRNA levels were measured in cultured skin fibroblasts derived from upper, middle and lower dermal layers. The elastin mRNA levels were highest in the fibroblasts from the upper dermal layer and lowest in the lower dermal fibroblasts. Modulation of elastin expression by basic fibroblast growth factor and transforming growth factor β1 in the dermal fibroblasts was also studied. Basic fibroblasts growth factor downregulated elastin expression in the upper dermal fibroblasts but did not significantly change elastin expression in the middle and lower dermal fibroblasts. Upregulation of elastin expression by transforming growth factor β1 was greater in the upper dermal fibroblasts than in the middle and lower dermal fibroblasts. Platelet-derived growth factor induced no significant changes in the three types of dermal fibroblasts. The results suggest that the differential responses of elastin expression to potent modulators may be at least partially responsible for the abnormal elastin metabolism specifically observed in the upper dermal layer. Received: 21 November 1995     

A three‐dimensional skin equivalent reflecting some aspects of in vivo aged skin

Human skin undergoes morphological, biochemical and functional modifications during the ageing process. This study was designed to produce a 3‐dimensional (3D) skin equivalent in vitro reflecting some aspects of in vivo aged skin. Reconstructed skin was generated by co‐culturing skin fibroblasts and keratinocytes on a collagen–glycosaminoglycan–chitosan scaffold, and ageing was induced by the exposition of fibroblasts to Mitomycin‐C (MMC). Recently published data showed that MMC treatment resulted in a drug‐induced accelerated senescence (DIAS) in human dermal fibroblast cultures. Next to established ageing markers, histological changes were analysed in comparison with in vivo aged skin. In aged epidermis, the filaggrin expression is reduced in vivo and in vitro. Furthermore, in dermal tissue, the amount of elastin and collagen is lowered in aged skin in vivo as well as after the treatment of 3D skin equivalents with MMC in vitro. Our results show histological signs and some aspects of ageing in a 3D skin equivalent in vitro, which mimics aged skin in vivo.     

Poly-L-Lactic acid increases collagen gene expression and synthesis in cultured dermal fibroblast (Hs68) through the TGF-β/Smad pathway

Objective

Poly-L-Lactic Acid (PLLA) is a synthetic polymer which possesses biocompatible and biodegradable properties, and is widely used in the clinical filler material. This study focuses on the potential role of PLLA on the collagen production of dermal fibroblasts and its mechanism.

Methods

The dermal fibroblast Hs60 was treated with different concentration of PLLA. RT-qPCR was conducted for the determination of mRNA levels of collagen type I (COL1) alpha 1 (COL1A1), COL1 alpha 2 (COL1A2), elastin, matrix metalloproteinase 1 (MMP-1), tissue inhibitor of metalloproteinase 1 (TIMP-1), and TIMP-2. Procollagen Type I C-peptide (PIP) enzyme immunoassay (EIA) Kit assay was carried out to analyze procollagen production. Western Blot was employed to examine the effect of PLLA and transforming frown factor (TGF-β) receptor-specific inhibitor (SB431542) on protein levels of COL1A1 and TGF-β/Smad signaling pathway related proteins.

Results

With the increase of PLLA concentration, the production of procollagen gradually increased, and both protein and mRNA levels of COL1A1 and COL1A2 gradually increased (p < 0.001). Elevated PLLA concentrations increased elastin, TIMP-1, and TIMP-2 levels and attenuated MMP-1 expression. PLLA increased TGF-β levels in a dose-dependently manner. p-Smad2 and p-Smad3 protein levels were also increased by PLLA, but the influences were reversed by SB431542 (p < 0.001). Similarly, increased levels of COL1A1, COL1A2, TIMP-1, and TIMP-2 caused by PLLA were significantly inhibited by SB431542, whereas MMP-1 was typically elevated (p < 0.001).

Conclusion

Poly-L-Lactic Acid promotes the collagen production of dermal fibroblasts by activating the TGF-β/Smad signaling pathway. The findings may lay a foundation for clinical material applications of PLLA.     

Electrical stimulation increases blood flow and haemoglobin levels in acute cutaneous wounds without affecting wound closure time: evidenced by non‐invasive assessment of temporal biopsy wounds in human volunteers

Recent studies highlighted the beneficial effects of a novel electrical stimulation waveform, the degenerate wave (DW), on skin fibroblasts and symptomatic skin scarring. However, no study to date has investigated the role of DW on acute cutaneous wounds. Therefore, we evaluated this in a trial using a temporal punch biopsy model. Twenty healthy volunteers had a biopsy performed on day 0 (left arm) and day 14 (right arm). On day 14, DW was applied. Participants were randomised into two groups. Objective non‐invasive assessments were performed on days 0, 7, 14, 60 and 90 using spectrophotometric intracutaneous analysis and full‐field laser perfusion imaging. There were statistically significant increases in mean flux on day 14 (P = 0.027) in the post‐DW arm. Haemoglobin levels increased on day 7 for the post‐DW arm compared to without DW (P = 0.088). Differences in melanin levels were higher post‐DW on the left arm between randomised groups on day 90 (P = 0.033). Haemoglobin levels in the vascular ring increased significantly from day 7 to 90 (P < 0.001 for post‐DW and without DW arms). This study, for the first time, shows that DW increases blood flow and haemoglobin levels in acute healing wounds without affecting wound closure time and may have potential application in enhancing acute cutaneous healing.     

Immunohistochemical studies of amyloid P component distribution in normal human skin

The distribution of amyloid P component (AP) in normal human skin was investigated by a light and electron microscopic immunoperoxidase technique, using antibodies to serum amyloid P component (SAP). AP, or an immunologically cross-reactive protein, was found to be specifically localized to the microfibrils of papillary oxytalan fibers and to the peripheral microfibrillar mantle surrounding the elastin core of mature elastic fibers in the reticular dermis; collagen fibers were not stained with anti-SAP. AP was not detected in the dermal-epidermal basement membrane or in the basement membranes surrounding dermal papillary blood vessels and eccrine structures. These findings, which establish the detailed distribution of normal tissue AP in the skin, provide a basis for further studies of the function and behavior of this protein in health and disease.     

Safety and efficacy of topical cantharidin for the treatment of pediatric molluscum contagiosum: a prospective,randomized, double‐blind,placebo‐controlled pilot trial

Topical cantharidin is a commonly used treatment for molluscum contagiosum (MC). However, studies validating its safety and efficacy are limited. We conducted a 6‐week, randomized, double‐blind, placebo‐controlled trial with subsequent open‐label extension to assess the safety and effectiveness of cantharidin in treating pediatric MC. Ninety‐four participants with MC were randomized to receive cantharidin or placebo, with or without occlusion. The primary outcome was complete lesion clearance. Secondary outcomes included post‐treatment lesion count, adverse events, and side effects. No significant differences between the study arms, including baseline lesion count, were observed. The overall mean (SD) baseline lesion count was 22.2 (12.9). The number of participants achieving total clearance is as follows: 7/23 (30.4%) in the cantharidin only arm, 10/24 (41.7%) in the cantharidin with occlusion arm, 2/25 (8.0%) in the placebo with occlusion arm, and 3/22 (13.6%) in the placebo only arm. Post hoc analysis demonstrated that 17/47 (36.2%) participants in the combined cantharidin arms achieved clearance compared to 5/47 (10.6%) in the placebo arms (P = 0.0065). The mean (SD) lesion count change from baseline was ?5.1 (12.2) in the placebo only arm; the mean change (SD) was ?17.4 (12.8) in the cantharidin only arm (P = 0.0033) and ?15.9 (11.6) in the cantharidin with occlusion arm (P = 0.0101). No serious adverse events or side effects were observed. Topical cantharidin was well‐tolerated and associated with the resolution of MC.     

Topical antioxidant application augments the effects of intense pulsed light therapy

Background There has been great interest in improving the efficacy of nonablative technologies by combining them during facial skin rejuvenation. The purpose of this study was to determine whether the addition of topical polyphenolic antioxidants to an intense pulsed light (IPL) treatment regimen augmented the effects of facial IPL treatments. Methods Thirty female volunteers, ages 34–52, with skin phototypes 1–3 were randomly assigned into three groups: group A (n = 10) received three full‐face IPL treatments spaced 3 weeks apart; group B (n = 10) underwent 6‐weekly full‐face treatments of a pneumatically applied topical polyphenolic antioxidant solution; group C (n = 10) received the combination of the three full‐face IPL treatments and the six full‐face topical antioxidant applications. Skin biopsies, skin polyphenolic antioxidant levels, and skin moisture content levels were obtained and clinical efficacy variables were noted prior to and following the treatment period. Results Compared to group A, group C demonstrated significantly greater epidermal and papillary dermal thickness, decreased lipid peroxide concentration, increased skin moisture content, and increased polyphenolic antioxidants levels (P < 0.05). There was qualitative improvement in hydration, texture, and pore size. Compared to group B, group C demonstrated significantly greater papillary dermal thickness (P < 0.05), and qualitative improvement in reduction of fine lines, reduction of hyperpigmentation, and skin dullness. group B and group C had equivalent polyphenolic antioxidant levels, lipid peroxide concentration, and epidermal thickness. Conclusion The addition of polyphenolic antioxidants to an IPL regimen improved the clinical, biochemical, and histological changes seen following IPL treatment alone. These data support the use of multimodal therapy to create synergy and to optimize clinical outcomes in nonablative facial skin rejuvenation.     

Alternative treatment of psoriasis with balneotherapy using Leopoldine spa water

BACKGROUND: Leopoldine spa water is a hypotonic water rich in sulphate that has been used occasionally for balneological treatments in psoriatics. We evaluated the anti-inflammatory effects of this salso-sulphate water on the skin of subjects with psoriasis. PATIENTS AND METHODS: We selected 10 volunteer subjects (23-58 years old), who presented symmetrical, bilateral psoriasis involving at least 40% of the body surface. All the subjects were subjected to the following treatment schedule: (i) immersion of both arms in water twice a day [the right arm was immersed in Leopoldine spa water at its natural source temperature (27.2 degrees C) for 30 min, and the left arm was immersed in double-distilled water for 30 min at a constant temperature of 27 degrees C]; (ii) both arms were exposed to the sun for 60 min after each immersion; and (iii) vaseline containing moisturizing creams were applied liberally. The treatment was continued for 4 weeks and was well tolerated by all subjects. Response to treatment was assessed by means of the modified Psoriasis Area and Severity Index (PASI). Six of the 10 subjects volunteered to undergo a cutaneous biopsy of lesional skin both before and 4 weeks after treatment to allow for assessment of modifications of the cutaneous infiltrate in the areas treated. RESULTS: At the end of 4 weeks the average pretreatment PASI score of the left arms was 5.72 (range 4-9.6) while the right arms had a mean PASI of 5.56 (range of 3.2-9). At the end of the study the average PASI score was 0.78 for the arms treated with Leopoldine spa water and 2.83 for the arms treated with double-distilled water. The mean PASI improvement score for the Leopoldine spa water treated arms was 85.9% while the double-distilled water treated arms showed a PASI improvement score of 50.5%. An immunohistological study showed significant differences between the cutaneous samples taken 4 weeks after treatment and those taken before treatment with Leopoldine spa water. There were significant decreases in the numbers of epidermal CD4+ and CD8+ T lymphocytes and CD1a+ Langerhans cells (microscopic field at x 22 objective), as well as a decrease in the epidermal keratinocyte expression of intercellular adhesion molecule-1 and interleukin-8 and the dermal expression of CD4+ and CD8+ T lymphocytes. CONCLUSIONS: These data show the potential anti-inflammatory effects of Leopoldine mineral waters on human skin affected by psoriasis.     

The effect of ultraviolet radiation exposure on the prevalence of mast cells in human skin

BACKGROUND: Dermal mast cells have been implicated as important effector cells in innate immunity, hypersensitivity responses and ultraviolet (UV)B-induced suppression of cell-mediated immune responses to contact allergens. Humans, like mouse strains, display variations in dermal mast cell prevalence. The factors determining these differences are yet to be fully elucidated. In mice, expression of the receptor for stem cell factor, c-kit, on dermal mast cells correlates with prevalence. OBJECTIVES: To evaluate dermal mast cell prevalence and mast cell c-kit expression in non-sun-exposed and sun-exposed skin in the same donor. METHODS: In 14 subjects, biopsies of skin (4 mm) were sampled from the skin sites of buttock, inner arm, shoulder and back of hand skin and dermal mast cell prevalence quantified. Non-sun-exposed buttock and chronically sun-exposed hand skin were evaluated for mast cell expression of c-kit and elastin content, a feature of photoageing and surrogate marker of UV exposure. RESULTS: The prevalence of dermal mast cells was significantly higher in hand skin than in the three other anatomically different skin sites. Significant correlations were observed in hand but not buttock skin between increasing dermal mast cell densities, extent of elastin content in the papillary dermis and age of the subject. Cellular expression of c-kit correlated with mast cell prevalence in hand skin. However, no relationship was observed in hand skin between c-kit expression, elastin content and age. CONCLUSIONS: The prevalence of mast cells in human skin is altered by factors that are intrinsic (mechanisms regulating c-kit expression) and extrinsic (chronic sun exposure), and the fact that the associations of mast cell prevalence with age is explained by the latter being a correlate of cumulative sun exposure.     

A short-term screening protocol, using fibrillin-1 as a reporter molecule, for photoaging repair agents

Photoaged skin is characterized by coarse and fine wrinkles. The mechanisms of wrinkle formation are undetermined, but appear to be due to changes within the matrix of the dermis and at the dermal-epidermal junction. Previous studies have identified marked reductions in procollagens I and III, collagen VII, and the fibrillin-rich microfibrillar apparatus in this area. Topically applied all-trans retinoic acid can repair photoaged dermal matrix, but this takes at least 6 mo of treatment. In this study, we have examined the abundance and distribution of fibrillin-1 prior to, and following, 192 wk of all-trans retinoic acid treatment. We have further developed a short-term protocol to determine the utility of potential repair agents, using fibrillin-1 as the marker for outcome. Individuals with clinically assessed severe photoaging were recruited to the study (n = 8). 0.025% all-trans retinoic acid, 5% sodium lauryl sulfate (irritant control), or vehicle were applied under occlusion to photoaged extensor forearm. A fourth control area was also occluded. After 96 h, punch biopsies were taken under local anesthesia and processed for either transmission electron microscopy or snap frozen. Frozen sections were prepared for immunohistochemistry and in situ hybridization immunohistochemistry. Electron microscopy revealed aberrant elastic fibers in the papillary dermis of photoaged forearm skin, with sparse microfibrillar apparatus and interstitial collagen. After application of 0.025% all-trans retinoic acid, there was increased deposition of both these dermal matrix components, with the aberrant elastic fibers no longer apparent. Significant increases (p < 0.05) were observed at the protein and mRNA levels for fibrillin-1 following all-trans retinoic acid and sodium lauryl sulfate treatments, with all-trans retinoic acid having a significantly greater effect than irritant control (p < 0.001); however, neither application had significant effect on the abundance of collagen VII or its mRNA. Investigation of collagen I synthesis revealed no difference following treatments. To ascertain the clinical relevance of using fibrillin-1 as a marker for photoaging, facial skin was biopsied at baseline and after long-term (192 wk) topical all-trans retinoic acid treatment (n = 5). Biopsies were wax-embedded and sections prepared for immunohistochemistry for fibrillin-1. Significant increases in the abundance of the microfibrillar apparatus was observed proximal to the dermal- epidermal junction (p < 0.001) following long-term all-trans retinoic acid application. This study indicates that all-trans retinoic acid can significantly affect fibrillin-1 content in photoaged skin. Furthermore, fibrillin-1 can be used as a "reporter" molecule in short-term protocols for testing the utility of topical agents in the repair of photoaged skin.     

Non-invasive cryolipolysis to reduce subcutaneous fat in the arms

Background: Cryolipolysis received U.S. Food and Drug Administration clearance for reducing fat from the flanks, abdomen, and thighs. The upper arms are an off-label indication for cryolipolysis, and outcome data on reducing fat from the arms using a cryolipolytic device has rarely been published. Objective: This pilot study evaluated cryolipolysis to reduce upper arm fat. Materials and methods: A flat vacuum applicator was used to treat seven subjects in a single-side study. The patients underwent one cycle of upper-arm cryolipolysis treatment, and the contralateral arm served as a control. Follow-up was conducted at 8 weeks. Equalization treatments were delivered subsequently to the opposite arm. Efficacy was evaluated by ultrasound imaging, physician's assessment, and patient satisfaction. Side effects and adverse events were monitored. Results: Ultrasound measurements showed a decrease in the fat layer at 83.3% of the 12 measured sites. The mean reduction in fat layer thickness was 15.3%, corresponding to 2.03 mm. A significant difference was detected between baseline and 8-week assessments (p = 0.001). Conclusion: One treatment using a flat vacuum cryolipolysis applicator was safe and effective to reduce arm fat.     

Morphological skin ageing criteria by multiphoton laser scanning tomography: non-invasive in vivo scoring of the dermal fibre network

Background: Morphological changes in the dermal collagen and elastin fibre network are characteristic for skin ageing and for pathological skin conditions of the dermis. Objectives: To characterize pathological and physiological conditions by multiphoton laser scanning tomography (MLT) in vivo, it is necessary to investigate and identify morphological alterations related to ageing. Methods: In vivo MLT was used to image two‐photon excited autofluorescence (AF) and second harmonics generation (SHG) in human dermis of 18 volunteers of different ages. Criteria for the evaluation of age‐dependent morphological changes in MLT images were fibre tension and morphology, network pattern, clot formation and image homogeneity. These criteria were weighted and a score was calculated. Results: The resulting MLT‐based Dermis Morphology Score is correlated with age (R² = ?0.90) and with the previously published SHG to AF Ageing Index of Dermis (R² = 0.66). The two groups of young (age 21–38) and old (age 66–84) volunteers showed a significant difference in MLT score values (P < 0.001). Conclusions: We could demonstrate an in vivo relationship between morphological characteristics of human dermis assessed by MLT and age. The present score allows the semi‐quantitative evaluation of specific morphological changes of the dermal fibre network in ageing skin by in vivo AF and SHG imaging. This method will be useful for diagnostics of pathological conditions and their differentiation from ageing effects.     

Ultrastructural aspects of the skin in lipoid proteinosis (Urbach-Wiethe disease)

Lipoid proteinosis is a rare autosomal recessive disease, characterized by hyaline deposits of PAS-positive material in tissues due to mutations in the ECM1 gene. This study evaluated the ultrastructure of the skin of a 6-year-old child affected by this condition. The light microscopy identified PAS-positive hyaline deposits, which were more intense in the papillary dermis. Scanning electron microscopy of the dermis showed a compact papillary dermis and fibrillar deposits in the middle dermis. Transmission electron microscopy clearly showed the deposition of fibrillar material in the dermis, forming clusters adherent to elastic fibers, between the collagen bundles and the collagen fibers, and also filling up the cytoplasm of dermal fibroblasts.