Eficacy the Use of Combined Goji Berry Cream for Skin Rejuvination and Post-Inflammatory Hyperpigmentation: Two Case Reports

The most common side-effect of ablative fractional skin resurfacing in Asians is post inflammatory hyperpigmentation (PIH). Various attempts have been made to reduce the occurrence of PIH after laser treatment including sun avoidance, the use of preoperative and postoperative treatment regimens, and treatment using conservative energy settings and epidermal protection. To determine whether the use of broad-spectrum sunscreen with anti-inflammatory agents starting on the first day after fractional CO2 laser skin resurfacing reduces the incidence of post laser PIH. Thirty patients were treated with ablative fractional CO2 resurfacing on both sides of their faces at 10mJ and 10% density. Each subject was randomly treated on one side of the face with petrolatum ointment four times a day for the first week after laser treatment and on the other side of the face with petrolatum ointment four times a day plus broad-spectrum sunscreen with anti-inflammatory agents in the morning starting on the first day after laser treatment. Transepidermal water loss was recorded at baseline and every day for 1week. Melanin and erythema indexes were measured at baseline, 1-, 2-week, 1-, 2- and at 3-month post treatment. Of the 30 patients involved in the study, 26 received the treatment and attended 1-, 2-week, 1-, 2- and 3-month post-treatment visits. Four patients were withdrawn from the study because they could not attend every follow-up visit. There was no statistically significant difference in transepidermal water loss at baseline, immediately after laser treatment, or at the D1 to D7 follow-up visits. Erythema index had no significantly statistical difference at baseline, 1-, 2- and at 3-month after laser treatment. Furthermore, there was a statistically significant difference in melanin index at 1-week post laser treatment between both sides (P=0.001). Melanin index at the 1-week follow-up visit on the side treated with broad-spectrum sunscreen with anti-inflammatory agents starting on the first day after laser treatment was significantly less than the control side. The use of broad-spectrum sunscreen with anti-inflammatory agents starting on the first day after ablative fractional skin resurfacing can decrease the incidence of PIH after laser treatment at 1-week postoperatively.

Dupilumab, approved for the treatment of moderate‐to‐severe atopic dermatitis (AD), has been proven to improve skin barrier and postinflammatory hyperpigmentation on nonlesional areas. Previous studies, however, are only based on subjective visual assessments rather than objective biophysical measurements. We aimed to objectively measure transepidermal water loss (TEWL) and skin tone improvements after dupilumab treatment through bioengineering devices. Nineteen patients with severe AD were enrolled. Biophysical measurements were conducted in three nonlesional skin areas, the cheek, forearm, and lower abdomen, on a monthly basis for 5 months since the first dupilumab injection. TEWL was measured using a Tewameter®. Skin tones represented by L∗ (lightness), a∗ (redness), and b∗ (yellowness) parameters were measured by the spectrophotometer®; the erythema and melanin index measured by the narrow‐band reflectance spectrophotometer® were additionally assessed. Improvement from baseline was evaluated by the Wilcoxon’s rank‐sum test and Bonferroni correction. Correlation among biophysical parameters was evaluated by Pearson’s correlation. p < 0.05 was considered statistically significant. TEWL and skin tone parameters in all anatomical regions showed significant improvement. The L∗ and a∗ values of the arm and trunk significantly improved after 2 months of dupilumab therapy and the face 3 months after. Similarly, b∗ value of all anatomical regions significantly decreased after 1 month of treatment, and the TEWL did so after 2 months. When compared between anatomic regions, the trunk demonstrated higher improvement in L∗ value, the arm in erythema index, and the face in melanin index. TEWL positively correlated with erythema index (r = 0.51, p < 0.05), melanin index (r = 0.45, p < 0.05), and a∗ (r = 0.50, p < 0.05); negative correlation was observed with L∗ (r = −0.48, p < 0.05). On top of AD symptom relief, dupilumab objectively improves the skin barrier and skin tone of nonlesional areas.

Epidermal growth factor (EGF) is one of the important peptides in wound healing process. The effects of EGF have been increasingly studied in various types of ulcers. However, data on postablative laser resurfacing wound is still limited. To evaluate the effects of the topical EGF ointment on wound healing process and postinflammatory hyperpigmentation (PIH) prevention after fractional ablative laser resurfacing. This is a randomized split-face study. Nineteen healthy subjects were enrolled and completed follow up protocol. Patients received single treatment of fractional carbon dioxide laser on both cheeks. After randomization, each patient was assigned to apply one side of the face with topical EGF ointment and another side with petrolatum. Wound healing was evaluated by duration of scab shedding, duration of postlaser erythema, erythema index, and transepidermal water loss on the daily follow up period of seven days after treatment. PIH was evaluated at 2, 3weeks and 1, 2months follow up by photographs and melanin index. Most of patients were female with Fitzpatrick skin phototype III to V. Comparing with control (petrolatum), EGF treated side showed no significant difference in duration of scab shedding, duration of postlaser erythema, erythema index, and transepidermal water loss (P-value=.58, .22, .78, and .51, respectively). Incidence of PIH was 52.6% on EGF side and 57.9% on petrolatum side, however, it was not statistically different (P=.56). The melanin index was also not different as well (P=.96). Topical EGF might provide significant wound healing stimulation for chronic wound more than acute wound. Further studies, especially in post laser wound or other cosmetic purposes are needed.

Background and Objective: Little is known about the anti-pigmentation effects of whitening agents on solar lentigines. Epidermal growth factor (EGF) has been used as a booster for wound healing in the skin, and it has been suggested to have anti-pigmentation effects. This study aimed to evaluate the effect and safety of EGF-containing ointment for treating solar lentigines with a Q-switched (QS) 532 nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser (Bluecore company, Seoul, Republic of Korea). Materials and Methods: Subjects who underwent QS 532 nm Nd:YAG laser treatment of solar lentigines were randomly assigned to treatment with an EGF ointment or petrolatum. After the laser procedure, the subjects were administered the test ointment twice a day for 4 weeks. The physician’s assessment of the degree of pigment clearance and patient’s satisfaction were assessed after 4 and 8 weeks. Additionally, the melanin index (MI), erythema index (EI), transepidermal water loss (TEWL), and post-inflammatory hyperpigmentation (PIH) were evaluated. This trial was registered with ClinicalTrials.gov (NCT04704245). Results: The blinded physician’s assessment using 5-grade percentage improvement scale and patient’s satisfaction were significantly higher in the study group than in the control group at the 4th and 8th weeks. The MI was significantly higher in the control group than in the study group at the 4th and 8th weeks. The EI and TEWL did not differ significantly between the two groups at either time point. The incidence of PIH was higher in the control group (37.5%) than in the EGF group (7.14%) at the 8th week. Conclusions: The application of EGF-containing ointment on facial solar lentigines with a QS 532 nm Nd:YAG laser showed efficient and safe therapeutic effects, with less PIH. Thus, EGF-containing ointment could be suggested as the promising adjuvant treatment strategy with a QS laser for solar lentigines.

Background. Understanding the physiological, chemical, and biophysical characteristics of the skin helps us to arrange a proper approach to the management of skin diseases. Objective. The aim of this study was to measure 6 biophysical characteristics of normal skin (sebum content, hydration, transepidermal water loss (TEWL), erythema index, melanin index, and elasticity) in a normal population and assess the effect of sex, age, and body location on them. Methods. Fifty healthy volunteers in 5 age groups (5 males and females in each) were enrolled in this study. A multifunctional skin physiology monitor (Courage & Khazaka electronic GmbH, Germany) was used to measure skin sebum content, hydration, TEWL, erythema index, melanin index, and elasticity in 8 different locations of the body. Results. There were significant differences between the hydration, melanin index, and elasticity of different age groups. Regarding the locations, forehead had the highest melanin index, where as palm had the lowest value. The mean values of erythema index and melanin index and TEWL were significantly higher in males and anatomic location was a significant independent factor for all of 6 measured parameters. Conclusion. Several biophysical properties of the skin vary among different gender, age groups, and body locations.

Post-inflammatory hyperpigmentation (PIH) is a common complication after laser surgeries. Recent studies applied epidermal growth factor (EGF) on the lasered area after laser surgery to decrease the incidence of PIH with controversial results. Therefore, a comprehensive literature review of randomized controlled trials (RCTs) was conducted to investigate the issue. Two reviewers independently searched the literatures, extracted, and analyzed the data. A total of seven RCTs involving 169 patients were included to evaluate the efficacy of EGF on recovery and PIH prevention after laser surgery. The results show that the incidence of PIH in the EGF group was relatively lower than that in the control group, although the difference was not statistically significant (OR 0.64, 95% CI 0.33 ~ 1.25, p = 0.19). However, the EGF groups had a significant decrease in melanin index (MI) scores at the 1st month after the laser surgery when compared to the control groups (SMD -1.57, 95% CI -2.83 ~ -0.31, p = 0.01). In addition, the patients on the EGF side rated significantly higher satisfactory scores (SMD 0.49, 95% CI 0.22 ~ 0.76, p = 0.0004). There was no significant difference as regard to changes in MI at the 2nd week and 2nd month, erythema index (EI), and trans-epidermal water loss (TEWL) at days 3 and 7 after laser therapy, respectively. The current meta-analysis found a limited temporary inhibitory effect of EGF-containing topical products on PIH with no significant effect on reducing post-laser erythema or promoting epidermal barrier repair. More studies are needed in the future due to the small sample size and marked intergroup heterogeneities.

Localized scleroderma (LS) is characterized by skin fibrosis, hyperpigmentation and soft tissue atrophy. Fat grafting has been widely used to correct LS deformity. To investigate the effect of fat grafting on the skin pigmentation of LS lesions. A prospective self-controlled study was conducted. Skin melanin and erythema indexes were measured by Mexameter® MX18 before and 3months after surgery. Differences between lesions and contralateral normal sites were compared to evaluate changes induced by fat grafting. Localized Scleroderma Cutaneous Assessment Tool and PUMC Localized Scleroderma Facial Aesthetic Index were used for clinical evaluation. Fourteen frontal linear LS patients participated in the study. Before surgery, the melanin index of the lesions was significantly higher than the contralateral sites (p = 0.023), while the erythema indexes were not significantly different (p = 0.426). Three months post-operation, the melanin index of the lesions significantly decreased (p = 0.008). There was no significant change in the erythema index of the lesions before and after fat grafting (p = 0.322). The LoSCAT and PUMC LSFAI scores demonstrated improved disease condition and facial esthetics after surgery. Fat grafting could alleviate skin hyperpigmentation and skin damage of LS lesions while having little effect on skin erythema and disease activity. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Regional and ethnic (racial) differences in skin properties are well known. However, regional and racial studies are limited and have studied skin properties using an insufficient number of subjects and limited ethnic groups, except in the case of some recent studies. The aim of this study was (1) to compare the skin biophysical parameter among the large scale of Southeast Asia females group and (2) to compare skin properties of the forehead and cheek. We measured and compared seven skin biophysical parameters, such as skin hydration, sebum, skin pH, melanin index, erythema index, skin elasticity and transepidermal water loss (TEWL), of the forehead and cheek of a large population of Indonesian (n = 200), Vietnamese (n = 100) and Singaporean females (n = 97). At the point of site difference, there were significant differences in five biophysical parameters (skin hydration, skin pH, melanin index, erythema index and skin elasticity) in Indonesian females. In Vietnamese and Singaporean women, they were significant differences in five biophysical parameters (skin hydration, skin pH, melanin index, erythema index and TEWL). At the point of ethnic difference, the Indonesian women had the highest skin pH and melanin index between the different ethnic groups. Vietnamese women had the highest skin hydration and TEWL in the forehead, whereas Singaporean women had the highest skin elasticity. The skin biophysical parameters are different between the forehead and cheek among Southeast Asian females. It also reveals that the biophysical parameters are different in same racial group.

BackgroundA combination of minimally invasive modalities can induce collagen regeneration more quickly and promote the penetration of topical agents, thus promoting skin rejuvenation. In this study, we aimed to investigate the synergistic efficacy of extracellular matrix compound (ECM-C) via microneedle (MN) and radiofrequency (RF) on periorbital wrinkles.MethodA total of 25 participants with periorbital wrinkles were selected for this study. The left and right side of the periorbital area was randomly given ECM-C via MN or ECM-C via MN combined with RF. MN combined with ECM-C treatment was given 5 times at 2 weeks intervals, whereas RF treatment was given 3 times at 4-week intervals. The following items were assessed: wrinkles by VISIA® system; biophysical parameters such as skin hydration, transepidermal water loss (TEWL), erythema index, and melanin index by CK multiple probe adapter; and skin elasticity and skin thickness by DermaLab Combo® photographs were taken at the baseline and 2 weeks after the last treatment. Subjective assessments, such as Crow's Feet Grading Scale (CFGS) and Global Aesthetic International Scale (GAIS), were also recorded.ResultA total of 25 participants with an average age of 43 years participated in this trial. Periorbital wrinkles on both sides decreased after the treatment, and the side treated with ECM via MN and RF showed better improvement than the other side with ECM-C via MN alone. Skin hydration increased after the treatment on both sides. TEWL, skin erythema, and skin melanin indexes were not changed. Skin elasticity and skin thickness increased more on the side of ECM-C via MN and RF than on the other side of ECM-C via MN alone. The evaluation scores for CFGS improved on either side; however, no difference was found for CFGS and GAIS between intergroup comparisons after the treatment.ConclusionThe objective assessment of wrinkles, elasticity, and thickness of periorbital skin improved more on the side with ECM-C treatment via MN combined with RF than on the other side of ECM-C treatment via MN only. However, no statistically significant difference was found between the subjective CFGS and GAIS evaluation of the two sides.

Various tests have been carried out to determine the irritant potential of soaps/cleansers. This study was carried out to compare the effects of four different soap formulations on biophysical parameters of the skin, including trans-epidermal water loss (TEWL) and erythema index. Four different soap formulations (creamy, glycerin containing, syndet, and traditional alkaline soaps) were studied. Twenty healthy volunteers were enrolled and 8% solutions (W/V) of the soaps made with distilled water, 20% sodium dodecyl sulfate (positive control) and water (negative control) were applied to their volar forearms as a single dose patch test. The patches remained on the sites for 4hours. The skin TEWL and erythema index were measured before applying the patches and 24 and 72hours after removal of them using TEWAmeter and Mexameter probes, respectively. Alkaline and creamy soaps caused a significant increase in TEWL 24hours after patch removal. However, 72hours after patch removal, this increase was significant only in case of alkaline soap (P-value=0.002). A decreasing trend in skin erythema was observed 24 and 72hours after application of syndent, glycerin, and creamy soaps. In case of creamy soap, this decrease was significant 72hours after patch removal (P-value=0.006). Traditional alkaline soap increased TEWL and skin erythema, which are signs of prolonged damage to the skin barrier. However, the effects of other formulations were transient, and TEWL returned to baseline at 72hours. Creamy soap even showed a relative protective effect (decrease in erythema index compared to baseline), probably due to the lanolin content of the formulation.

Some skin diseases may modify epidermal barrier function. Psoriasis is a chronic multi-systemic inflammatory disease that affects the epidermal barrier. Phototherapy is an option for treating psoriasis, but little is known about how epidermal barrier function is modified by phototherapy in psoriatic patients. (a) To compare skin homeostasis between involved and uninvolved skin in psoriatic patients with healthy controls (b) To evaluate changes in the epidermal barrier function in psoriatic patients treated with phototherapy. Sixty patients with plaque-type psoriasis and sixty gender and age-matched healthy controls were enrolled. Temperature, transepidermal water loss (TEWL), stratum corneum hydration (SCH), pH, elasticity, erythema and melanin index were measured using non-invasive tools in the healthy control and involved and uninvolved psoriatic skin before and after phototherapy. Healthy controls had lower TEWL and erythema index and higher SCH than psoriatic patients, both at uninvolved psoriatic skin and psoriasis plaques. TEWL was higher at psoriasis plaques than at uninvolved skin (19.20 vs 11.57g/h/m2 ; P<.001). Following phototherapy, a decreasing trend was observed for TEWL, of 1.03 (SD 0.75) and 0.97 (SD 0.81)g/h/m2 for uninvolved and involved skin respectively. SCH was significantly lower at psoriatic plaques than at uninvolved skin (7.32 vs 36.62Arbitrary Units [AU]; P<.001). SCH increased by 1.15AU (SD 0.26) on psoriatic plaques after the phototherapy session (P<.001). Psoriatic plaques showed epidermal barrier dysfunction compared to uninvolved skin and healthy controls. Phototherapy may improve epidermal barrier function in psoriatic patients. SCH increased after a phototherapy session on the psoriatic plaques.

Background/Purpose Photobiomodulation (PBM) using light-emitting diodes (LEDs) benefits tissue regeneration and wound healing. However, evidence regarding the efficacy of LED for post-inflammatory erythema (PIE) and post-inflammatory hyperpigmentation (PIH) is limited. The aim of this study was to explore the effect of medical LED (830 nm and 590 nm) in the prevention and treatment of PIE and PIH. Methods The invivo PIE/PIH model was simplified to erythema and pigmentation reaction after acute UVB exposure. 308 nm LED light (225 or 270 mJ/cm2) was induced invivo in the PIE/PIH model on the thigh of ten healthy subjects. Every subject received therapeutic and preventive irradiation (n = 10 in each group). 830 nm (60 J/cm2) and 590 nm LEDs (20 J/cm2) were irradiated, respectively. For therapeutic irradiation, the PIE/PIH model was induced on D1, and LEDs were irradiated on D0, 1, 3, 6 and 8. For preventive irradiation, LEDs were irradiated on D0, 1, 3, 6, and 8 and the PIE/PIH model was induced on D9. Erythema index (EI), melanin index (MI), transdermal water loss (TEWL), and C-Cube photography were measured during 10-day follow-up visits. Results For therapeutic irradiation, ΔEI and ΔMI in the 830 nm treatment group were significantly lower than in the control group (ΔEI: 9.30 vs. 11.52, p = 0.027; ΔMI: 7.79 vs. 9.25, p = 0.026). No significant difference was found between the 590 nm treatment group and the control group in ΔEI or ∆MI (p > 0.05). For preventive irradiation, ΔEI in the 830 nm prevention group and the 590 nm prevention group were both significantly lower than the control group (830 nm: 9.85 vs. 19.90, p = 0.001; 590 nm: 12.50 vs. 19.90, p = 0.008). No significant difference was found between the two prevention LED groups (p > 0.05). Conclusions Both 830 nm and 590 nm LEDs showed preventive effects for PIE, and 830 nm LEDs could effectively improve PIE and PIH.

Skin hyperpigmentation in end-stage renal disease (ESRD) patients has been attributed to the accumulation of middle-molecular-weight (MMW) substances. Although an MMW mechanism suggests that hyperpigmentation may be improved by high-flux haemodialysis (HF-HD) and haemodiafiltration (HDF), this possibility has not been explored. In the present study, we investigated the impact of different dialysis modalities on skin colour in HD patients. Eighty-two ESRD patients on HD were divided into low-flux HD (LF-HD), HF-HD and HDF groups. The melanin index (MI) and erythema index (EI) of the abdomen and the flexor side of the forearm (non-sun-exposed areas) and the forehead (sun-exposed area) were determined by using a narrow-band reflectance spectrophotometer at baseline and after 12 months. Even though absolute values of baseline and follow-up MI and EI of the three sites were comparable among the three groups, forehead MI and EI were significantly decreased after 12 months in the HDF group (P < 0.05). In addition, the change in forehead MI was significantly greater in the HDF than in the LF-HD group (-1.0 +/- 2.4% versus 0.3 +/- 1.6%, P < 0.05). Moreover, beta(2)-microglobulin reduction rates were negatively correlated with both changes in forehead MI (P < 0.01) and EI (P < 0.05). Skin colour of sun-exposed areas was signi- ficantly decreased in ESRD patients receiving HDF therapy, suggesting that enhanced removal of MMW substances by convection may prevent or reduce hyperpigmentation in HD patients.

Traditional attempts at alleviating photoaging-associated facial pigmentation conditions such as melasma, mottled hyperpigmentation, and post-inflammatory hyperpigmentation have yielded disfiguring cosmetic results. Laser toning using a low-fluence Q-switched 1064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser has been more commonly applied to date. However, the treatment efficacy and safety of this approach have not been widely reported. This study therefore evaluated the efficacy and safety of picosecond 1064-nm Nd:YAG laser application for photoaging-associated facial pigmentation treatment in Korean subjects. Forty-seven Korean subjects with photoaging-associated facial pigmentation underwent picosecond 1064-nm laser application. The clinical improvement of 17 patients was assessed by objective measurements such as melanin and erythema indices. All subjects received six biweekly treatments with the laser in a three-pass fashion delivering approximately 2000 to 2500 shots using a zoom handpiece with a spot size of 7mm, fluence ranging from 0.4 to 0.7J/cm2, and a repetition rate of 10Hz. Clinicians evaluated the improvement of pigmentation using the pigmentation area and severity index (PSI), and subjects reported their satisfaction level on a four-point scale. Statistical analyses were performed using the SPSS version 19.0 for Windows software program (IBM Corp., Armonk, NY, USA). Forty-seven subjects (45 females and two males) completed this study with a 12-week follow-up period. The average decrease in PSI value at 12weeks after treatment was 6.85 ± 6.35 points (p < 0.001). The average decreases in the values of the erythema and melanin indices were 19.41 ± 64.64 points (p = 0.234) and 28.88 ± 32.89 points (p = 0.002). An analysis of 32 subjects' reports (68.1%) suggested good or excellent improvement. No serious adverse effects were observed during treatment or the follow-up period. Picosecond 1064-nm Nd:YAG laser application appears to be safe and effective in improving various photoaging-associated facial pigmentation conditions in Korean skin.

ABSTRACTBackground: Fractional carbon dioxide laser resurfacing (FxCR) is a routine treatment of Dermatology while many patients suffered the damage of skin barrier function after FxCR.Objective: To evaluate the benefits of antimicrobial peptides (AMPs) and hyaluronic acid (HA) compound mask on wound healing after FxCR on human and mouse skin.Methods: Twenty-four subjects were treated with FxCR on the bilateral cheeks. AMPs and HA compound mask was applied on the FxCR-treated area of left cheek. The erythema index (EI), melanin index (MI), transepidermal water loss (TEWL) of FxCR-treated areas on both cheeks were measured. By HE staining, immunohistostaing and western blotting, we analyzed epidermal thickness, FLG, IVL expression and protein levels of cramp in FxCR treated dorsal mice skin.Results: The EI, MI, and TEWL in the AMPs and HA compound mask-treated area of left cheek were significantly lower than those in the untreated area of right cheek. Topically application of AMPs and HA compound mask reduced thickening of mouse skin and also result in an increase in the production of FLG, IVL and cramp.Conclusion: Application of AMPs and HA compound mask is an effective method for enhancing wound healing after FxCR, by reducing transient adverse effects such as erythema, hyperpigmentation, and increased TEWL.