Clinical efficiency of polydioxanone threads in the treatment of postpartum abdominal tissue flaccidity: case report

Summary:Procedures with polydioxanone (PDO) threads are increasingly used for aesthetic indications. To date, eight cases of serious complications following the use of PDO threads have been published. In this case report, we present a case of a serious bacterial complication after a procedure with four PDO threads. A 52-year-old female patient presented to our center 1 month after undergoing the procedure at another center. Despite early symptoms, no treatment had previously been implemented. Perforating abscesses were found along the course of the threads. After 5 days of antibiotic therapy (amoxicillin 875 mg and clavulanic acid 125 mg p.o. every 12 hours), the threads were surgically removed due to skin rippling. During the procedure, the threads were found to be fragile, and several incisions were necessary to remove them. After 1 month, no signs of inflammation were reported. However, persistent deformities occurred due to delayed treatment implementation. Bacterial complications seem to be a typical complication following the procedure with PDO threads. PDO threads can be difficult to remove due their fragility. The possible need for surgical removal of the threads should be considered when selecting areas for application.

Background:Polydioxanone (PDO) threads have been used to improve face sag and laxity; however, they are seldom used for body laxity. Similarly, onabotulinum toxin type A has rarely been reported for intradermal use in skin tightening.Materials and Methods:We discuss use of PDO threads in combination with intradermal onabotulinum type A for the treatment of bilateral arm laxity after significant weight loss.Results:Bilateral skin laxity of arm was substantially corrected with two sessions of combination treatment with PDO threads and onabotulinum type A.Conclusion:A somewhat easy, significant, and effective technique leading to modest correction of arm laxity in this patient with PDO threads and onabotulinum toxin type A may suggest this method as an option for patients seeking non-surgical options with minimal downtime.

The age-dependent changes in the optical reflection characteristics have been studied about skin hydration, melanin index, or skin color. However, the age-dependent changes in the optical reflection have little attention on inner skin structures. To control the factors affecting the optical reflection except for dermal matrix, subjects were selected as our guideline and we evaluated the optical reflection of subsurface on skin layers of two age groups. Young and old healthy volunteers were recruited after signing a written informed consent form. Facial skin was measured by means of noninvasive measurements: skin hydration, color, epidermis and dermis thickness, dermal density, subsurface reflectance, and transmittance. Compared to young group, old group showed that dermal density and thickness was decreased significantly although epidermis thickness was not changed. In conclusion, dermal density is one of the major factors which affects the subsurface reflectance in skin.

Anti-aging cosmetics are widely used for improving signs of aged skin such as skin wrinkles, decreased elasticity, low dermal density and yellow skin tone. The present study evaluated the effects of cosmetic formulations, eye cream and facial cream, containing palmitoyl peptides, Silybum marianum (S. marianum) seed oil, vitamin E and other functional ingredients on the improvement of facial wrinkles, elasticity, dermal density and skin tone after 4 weeks period of application on aged human skin. Healthy volunteers (n=20) with aged skin were recruited to apply the test materials facially twice per day for 4 weeks. Skin wrinkles, elasticity, dermal density and skin tone were measured instrumentally for assessing the improvement of skin aging. All the measurements were conducted prior to the application of test materials and at 2 and 4 weeks of treatment. Crow's feet wrinkles were decreased 5.97% after 2 weeks of test material application and 14.07% after 4 weeks of application in comparison of pre-application. Skin elasticity was increased 6.81% after 2 weeks and 8.79% after 4 weeks. Dermal density was increased 16.74% after 2 weeks and 27.63% after 4 weeks. With the L* value indicating skin brightness and the a* value indicating erythema (redness), the results showed that brightness was increased 1.70% after 2 weeks and 2.14% after 4 weeks, and erythema was decreased 10.45% after 2 weeks and 22.39% after 4 weeks. Hence, the test materials appear to exert some degree of anti-aging effects on aged human skin. There were no abnormal skin responses from the participants during the trial period. We conclude that the facial and eye cream containing palmitoyl peptides and S. marianum seed oil, vitamin E and other ingredients have effects on the improvement of facial wrinkles, elasticity, dermal density and skin tone.

The advances of self-crossing hyaluronic acid (SC-HA) fillers combination use with polydioxanone thread in minipigs were examined for compatibility, effectiveness, and immune response. A 12-week experiment was conducted using 6 minipigs (3 male and 3 female each) to evaluate the effects of SC-HA filler. The molecular weight of SC-HA filler was fixed at 200 kDa and alternative storage modulus of G80, G250, and G500 were examined. The procedure involved injecting SC-HA filler and polydioxanone threads into the skin tissue of anesthetized minipigs, and tissue sampling after 1 month (three minipigs), and 3 months (three minipigs) for histological staining and analysis. The immune reaction was observed during the experiment. The practitioner reported it was easy to inject the SC-HA filler in combination with polydioxanone threads. All four storage modulus of SC-HA fillers were injectable within the polydioxanone thread containing cannula. Also, during the procedure, there were no immune responses at the treated sites. The results of the histological tissue examination confirmed that there was no chemical interaction between SC-HA filler and the existing polydioxanone thread, and it was observed that SC-HA filler was more uniformly distributed within the tissue with lower storage modulus, resulting in a higher production of collagen in the surrounding filler. When combined with scaffold polydioxanone thread, the scaffold polydioxanone thread helped spread the filler evenly, resulting in a more evenly distributed collagen around the filler. Today, the combination therapy of filler and polydioxanone thread in one procedure is challenging due to the high viscosity of conventional fillers. However, this study confirmed that combination therapy of filler and polydioxanone thread is possible with SC-HA fillers. Additionally, it was found that polydioxanone thread does not seem to interfere with the crosslinking reaction of SC-HA filler, and if used with a higher pH of polydioxanone, it may enhance the cross-linking reaction and achieve a higher viscosity value. Finally, the study resulted in the idea of concrete as SC-HA filler and reinforcing rod for polydioxanone thread.

Ruby laser-assisted hair removal is thought to work via selective photothermolysis, which relies on light reaching the deeper layers of skin, and the absorption of light by the target chromophore, melanin. It is therefore possible that efficacy of treatment is affected by anatomic factors that determine the amount of light reaching the hair bulbs (i.e., skin color, depth of intracutaneous hair, epidermal thickness and dermal density) and the melanin content of hair. To examine this hypothesis, a prospective study was performed. Forty-eight volunteers were treated with the Chromos 694 Depilation Ruby Laser at a single standard fluence of 11 J/cm2. Treatment efficacy was determined by measuring hair density at 3 and 7 months after treatment. Epidermal depth and dermal density were measured from 2-mm biopsies taken before treatment, and the intracutaneous hair length was determined from plucked hair. Skin color was assessed using a spectrophotometer, and melanin content of dissolved hair was assessed using spectrophotometry. Efficacy of treatment for each patient was compared with the patient's age, intracutaneous hair length, epidermal depth, dermal density, skin color, and total melanin content and relative eumelanin content of hair. No correlation was found between the efficacy of treatment and age and the various anatomic factors. Patients with higher eumelanin content in their hair had better long-term results (Spearman rank test, p = 0.00219). The results suggested that the efficacy of treatment did not depend solely on the amount of laser light penetrating the skin but correlated well with the eumelanin content of hair. The clinical implication of this finding is discussed.

The present manuscript is a clinical case report in which antimicrobial photodynamic therapy (aPDT) - using a low-power laser (660 nm) associated with methylene blue photosensitizer (0.01%) - was considered for treating a case of complication after implantation of spiculated polydioxanone (PDO) threads, an aesthetic procedure worldwide performed in facial cosmetic non-surgical procedures. A 72-year-old female patient presented an infection in the face region where the PDO thread was implanted (mandible angle). After divulsion and local drainage, it was decided to associate aPDTusing a low-level laser associated with a 0.01% methylene blue photosensitizer. Two sessions of aPDT were performed - on sequential days - and within 48 hours the region was dry and without signs of secretion.The use of aPDTseems to be a promising and effective option in cases of infections after implantation of PDO threads, consisting ofa safe technique, of low execution complexity and without adverse effects.

A recent survey of practicing plastic surgeons showed that regenerative medicine is the current top interest of esthetic consumers worldwide. Patients are frequently requesting correction of small regions, instead of opting for an all-encompassing procedure associated with prolonged recovery time. Thus, the field of “microlifting” has emerged. This is a new approach in which minimally invasive procedures can be utilized to accomplish outcomes formerly reserved for traditional surgery. The combination of polydioxanone (PDO) threads and topical exosomes is a method of treating both underlying soft tissue laxity and the surface of aging skin. The application of exosomes can deliver topical growth factors and targeted peptides to assist in rapid skin surface healing. More than a simple delivery vesicle, exosomes communicate with cells at the recipient site and can induce cellular change. PDO threads can be used subcutaneously as both a suspension device and regenerative biostimulatory device. Usually resorbed at 6 months post-insertion, these threads leave behind a linear network of collagen and elastin fibers that remains long after the polydioxanone is gone. Combination therapies can target several concerns when performed simultaneously. This regenerative method is well accepted by patients due to minimal cost and recovery time.

BackgroundPrevious reports have revealed inadequate resident education and textbook representation of dermatological conditions in patients with skin of color (SoC). This suggests that the literature and continuing medical education are important alternative dermatology educational resources to aid in diagnosing and treating patients of color.ObjectiveThis study develops criteria to assess and examine the prevalence of SoC-related publications among top dermatology journals.MethodsWe developed the first-ever prespecified criteria that allow for the assessment of diversity in the dermatologic literature. The archives of 52 dermatology journals from January 2018 to October 2020, selected based on Scopus ranking, were analyzed for journal characteristics and content regarding skin and hair of color, diversity and inclusion, and socioeconomic/health care disparities that affect underrepresented populations with SoC.ResultsOur study reveals that the average percentage of overall publications relevant to SoC is quite low. The percent of SoC articles ranged from 2.04% to 16.8% with a mean of 16.3%. The top-performing dermatology journals in SoC were, not surprisingly, from countries with populations with SoC; however, the Journal of Cosmetic and Laser Therapy, Australasian Journal of Dermatology, and Journal of the American Academy of Dermatol Case Reports were among the top 10. Research and higher-impact journals were among the lowest in SoC rankings, including the Journal of Investigative Dermatology, Experimental Dermatology, and Journal of the American Academy of Dermatology, and had <5% of articles on SoC.ConclusionWe believe that the criteria we established could be used by journal editors to include at least 16.8% of SoC-relevant articles in each issue. Increasing SoC content in the dermatological literature, and particularly in high-impact journals, will serve as an invaluable educational resource and aid in promoting excellence in the care of patients with SoC.

Retinol is widely used for topical application for antiaging. However, the efficacy and effect rate of different concentrations of retinol have been rarely analyzed. Therefore, in this study, the efficacy and rate of effect of retinol concentrations from 1500 to 6600IU, on various skin parameters, have been compared. Seventy-two Korean women aged 40-59years participated in this study. Retinol was used by them for 24weeks; the effects were measured at 0, 2, 4, 8, 12, and 24weeks. The measurement parameters for aging were crow's feet, forehead wrinkles, nasolabial fold, dermal density, and elasticity and that for skin color were skin brightness, yellowness, redness, and standard deviation of skin brightness. The texture of the skin was measured by measuring the skin roughness and pores, and the skin barrier function was evaluated through hydration, sebum, and desquamation. Low concentration retinol (1500-2500IU) had a significantly higher effect in skin color, brightness, and elasticity and faster improvement rate in skin brightness and elasticity compared to that for high concentration (3300-6600IU). High concentration of retinol had a significantly higher effect in wrinkles, dermal density and pores and faster improvement rate for wrinkles, skin texture, pores, and desquamation compared to that for low concentration. This study evaluated the changes caused by different concentration of retinol over a long period of time. The results of this study have great implications as the optimal concentration of retinol can be prescribed for an accurate period for the desired results without side effects.

Skin cancers are often misdiagnosed or diagnosed late in skin of color (Fitzpatrick types 4-6) resulting in increased morbidity and mortality. Rare skin cancers such as Eccrine Porocarcinoma (EPC), which accounts for 0.005% to 0.01% of all epidermal skin neoplasms, are even less likely to be accurately diagnosed in skin of color. Eccrine Porocarcinoma is often misdiagnosed as Squamous cell carcinoma (SCC), Basal Cell Carcinoma (BCC), melanoma, and seborrheic keratosis. The paucity of case reports of EPC in skin of color adds to the challenge of achieving accurate, timely diagnosis and treatment in this patient population. The purpose of this research is to review case reports of EPC documented in skin of color, highlighting salient clinical and histopathological characteristics of EPC, and to describe an additional case of EPC in skin of color that was initially misdiagnosed as seborrheic keratosis. Our search combined “eccrine porocarcinoma” and one of the following terms: “ethnic skin”, “skin of color”, “black”, “dark skin”, “African American”, “Indian”, “Native American”, “Asian”, “Hispanic”, “Indigenous Peoples”, “Middle Eastern” —as these tend to correspond with Fitzpatrick IV – VI types. Google scholar, PubMed, and Ovid MedLine Databases were used to search for articles. Case reports ranging from 1994 to present day were included in analysis.

Titanium cutaneous metallosis after reverse total shoulder arthroplasty

BackgroundDermoscopy is undoubtedly a useful tool to improve diagnostic accuracy and minimize the number of unnecessary biopsies. However, much of the literature on dermoscopy focuses on findings in lighter-skin phototypes, leaving potential gaps of knowledge regarding its use in skin of color (SoC). As the clinical applications of dermoscopy continue to increase, understanding dermoscopic patterns in SoC is imperative.ObjectiveThis review discusses the literature on dermoscopic findings of neoplasms in SoC, highlighting unique and characteristic dermoscopic features.MethodsA literature review was performed using the PubMed database. Case reports, case series, case-control studies, and systematic reviews were included.ResultsA total of 8326 studies were identified based on the selected search terms, and 41 were included in this review based on relevance.ConclusionThere are specific dermoscopic characteristics in SoC for benign nevi, acral lentiginous melanoma, ethnic melanonychia, and dermatofibroma; however, there is a lack of published data about specific features of cutaneous melanoma, subungual melanoma, pigmented basal cell carcinoma, and pigmented squamous cell carcinoma in SoC. Because pigmented basal cell carcinoma, pigmented squamous cell carcinoma, ethnic melanonychia, and acral lentiginous melanoma are diagnosed at later stages in this population, it is important to understand their dermoscopic features. Further descriptive studies are needed to better characterize unique dermoscopic features in neoplasms in SoC.

One of the most prevalent congenital wall abnormalities in children, umbilical hernias are often linked to premature or small-for-gestational-age babies. In cases of intestinal malrotation or if the cecum is very movable, generalized peritonitis may facilitate the imprisonment of these hernias. We described a case of a 4-month-old baby who had a prior reducible umbilical hernia with a history of fever, vomiting, poor appetite, and constipation for around 48 h. The patient experienced significant intestinal bloating, vomiting, irreducibility of the umbilical hernia, skin pigmentation, and erythema at the umbilical site within 2 days after hospitalization. When there was no free abdominal air, a direct abdominal x-ray revealed evidence of hydro-gas stasis and various hydro-aerial levels that were pertinent to the ileum. In order to reduce the hernia, the patient had an emergency surgical treatment where the hernia sac was isolated and released from the ileal loop, which was securely attached to a fibrin plate. When the herniary sac was opened, a gangrenous and perforated appendix was found inside. On the seventh postoperative day, the patient was released from the hospital after an uncomplicated postoperative stay. Our patient's clinical presentation is similar to that of only one other case report involving a 25-day-old male patient. Our case presented with a variant of the clinical symptoms of the previously described umbilical hernia, which became unfixable and strangulated as a result of appendix inflammation. The appendix was discovered inside the hernia sac during surgery.

This study focuses on both the individual understanding of how polydioxanone threads and hyaluronic acid fillers work, plus the combined used of both techniques to improve the anti-aging treatment and deliver the best possible results to our patients. The combination of treatments is, in most cases, the best approach to reduce signs of aging, improve skin quality and fix asymmetries and face proportions. However, the combination of treatments should be well studied and planned so that the single procedures result in a balanced and efficient harmonization. The aim is to get together information which reinforces the hypothesis that PDO threads are more easily degraded when applied together with hyaluronic acid fillers. Methods: This study is a literature review. It is important to use planning skills, money resources and scientific knowledge to take maximal advantage of the options we have available in aesthetic medicine and get the best outcome. With that purpose, a detailed literature search about the topic was done in Pubmed. Several articles were used to elaborate this study, including case reports and laboratory in vitro experiments. Results: Polydioxanone is a homopolymer of paradioxanone, biodegradable by hydrolysis, since in contact with watery substances, its ester chains are broken and low molecular weight chain segments diffuse, which leads to its heterogenous biodegradation by layers, from the periphery to the center. Hyaluronic acid is a biocompatible and widely available polysaccharide from the glycosaminoglycan family. It is a hydrophilic polymer and so, it improves water retention. In vitro experiments have shown that hyaluronic acid, induces rapid biodegradation of PDO threads by hydrolysis, starting already 24h after the contact with polydioxanone, leading to an increase in the fibers’ interlaminar and intrafibrillar space, with those empty spaces corresponding to zones of hydrolysis. At 48h, these spaces increase as the dissolution of the peripheral and central layers occurs. After 72h, empty spaces in the central layer and a frayed pattern on the periphery of the thread are seen, with disorganization of fibrils, breakage of molecules and loss of mass. The degradation happens from the periphery to the center, causing small cracks and allowing water to diffuse into the center. A case report of a woman with complications post PDO thread implantation, in which hyaluronic acid was injected in 3 occasions (0,5mL each time) as a way to try to speed up the process of polydioxanone degradation and accelerate the treatment of these complications, showed that after 21 days, the patient showed improvements, with reduction of oedema and at 45 days there were visibly less skin folds and irregularities caused by the thread. Conclusions: The stipulated hypothesis that hyaluronic acid increases the speed of degradation of PDO threads is correct. As such, both products shouldn’t be used simultaneously, not because complications will develop, but because it is not an efficient, result friendly choice, since PDO threads’ durability will significatively decrease. Contrarily, in cases in which PDO thread implantation lead to complications, injecting of hyaluronic acid could be an option to accelerate the treatment of those complications, as an alternative to surgical intervention.