Improvement In Skin Appearance Research Articles

Cutaneous effects compared between higher fluence with fewer treatments and lower fluence with more treatments in a combined IR laser/radio frequency system

Background and aims: A combined infrared (IR) laser/radio frequency (RF) system has recently been reported to create rejuvenation‐related cutaneous effects, but was associated with high levels of pain and some complications. The present study was designed to evaluate the cutaneous effects of the same system with a lower fluence and more treatments. Methods: Twenty patients were randomly assigned into two groups of 10 individuals each: Group A was treated at 50 J/cm2 / 100 J/cm3 (laser/RF), respectively, two passes, three treatment sessions 30 days apart; Group B at 30 J/cm2 / 50 J/cm3, three passes, five treatment sessions 15 days apart. Objective comparisons were made at the same time points with a computer program based on the clinical photography. Results: Group A noted more improvement in wrinkles than Group B at the first assessment, but both groups showed slight and progressive deterioration at the 2‐ and 6‐month assessments. Improved skin appearance was maintained throughout in both groups. The authors recognize that the comparatively small number of subjects possibly limits the statistical power of the study. Conclusions: Lower fluences and more treatment sessions with the combined 900 nm laser/RF system were complication‐free, produced improvements in the overall skin condition and less pain during sessions, suggesting that this combination may produce better patient compliance. Further treatment sessions may improve the results with implications in skin rejuvenation.

Comparison of Patients' Assessments on Overall Facial Rejuvenation and Procedural Pain Seen with a Fluorescent Pulsed-Light Source and Those Seen with a Traditional Intense Pulsed-Light Source

Introduction: Intense pulsed-light (IPL) treatments are effective alternatives to ablative procedures for improving the appearance of photodamaged skin. Currently, there are multiple IPL sources to modulate photoaged skin, but there are no studies comparing the efficacy of or pain associated with 2 different PL sources. Therefore, we chose to compare patients' assessments of overall cutaneous rejuvenation and pain associated with a fluorescent PL source and a traditional IPL source. Materials and Methods: We performed a retrospective analysis of 24 patients who were treated with both a fluorescent PL source and a traditional IPL source. These patients completed questionnaire surveys that assessed (by a graded scale) pain during the procedure and overall satisfaction with each IPL source. The Wilcoxon signed-rank test for paired data as well as McNemar's test were used to compare overall facial rejuvenation and procedural pain between the 2 light sources. Results: For both light sources, most patients reported “fair” or better improvement in skin appearance. The patients did not report a significant difference in overall skin improvement between the treatments with each light source. In addition, most patients did not report having pain during recovery after procedures by either light source. However, patients did report significantly less pain during treatments with the fluorescent device compared with the traditional IPL source. Discussion: IPL sources provide safe and effective nonablative treatment for facial photorejuvenation. Patients are equally satisfied with the effects seen with both traditional and fluorescent PL source, but reported less pain with the fluorescent PL procedure during treatments.

ULTRASTRUCTURAL OBSERVATIONS OF HUMAN SKIN FOLLOWING IRRADIATION WITH VISIBLE RED LIGHT-EMITTING DIODES (LEDs): A PRELIMINARY IN VIVO REPORT

Ablative and nonablative skin rejuvenation procedures with lasers and intense pulsed light (IPL) systems have become very popular for photorejuvenating sun- and chronologically aged skin. Both procedures demand deposition of heat damage in the upper dermis. A new generation of light-emitting diodes (LEDs) with laser-like wavebands and phototherapeutically useful output powers are now reported to be successful for noninvasive athermal photorejuvenation of age-damaged skin. This study was designed to examine the ultrastructural changes induced by irradiation of human skin with visible red LED energy. Six adult male volunteers who satisfied all study criteria had the skin over their fibula irradiated once per week for 8 weeks with a visible red LED-based system at an irradiance of 105 mW/cm 2 , 15 min/session and a radiant flux of 94 J/cm 2 . Skin punch biopsies taken from each subject after the second and eighth treatment sessions were routinely prepared for transmission electron microscopy (TEM) and were examined under an electron microscope. After the 2nd session, the skin showed normal undamaged tissue with slight interstitial edema and vimentin filaments notable in fibroblasts. After the 8th session, the number of fibroblasts in the dermis had increased with numerous vimentin filaments in their cytoplasm, and a mild inflammatory infiltration could be seen. The ultrastructure of human skin after 8 LED phototherapy sessions showed no damage-related abnormalities. Mild athermallymediated inflammation was seen together with an increased fibroblast count and enhanced metabolism, which could be related to the enhanced synthesis of collagen and which in facial skin would probably result in an improved skin appearance.

Prescribing oral contraceptives on cosmetic purpose in adolescents

A new oral contraceptive (OC) containing dienogest (DNG) as progestagen with both antiandrogenic and antimineralocorticoid activity has been developed. Our objective was to compare the effects of 35 μg ethinil-estradiol (EE)/2 mg cyproterone acetate (CPA), 30 μg EE/150 μg desogestrel (DSG) and 30 μg EE/2 mg dienogest (DNG) on mild to moderate cases of acne. This prospective, comparative study was completed over 9 treatment cycles. A total of 114 young women with facial acne and seborrhea were recruited. Treatment was assigned in three groups: OC containing CPA or DSG for 6–9 cycles in 96 cases and DNG for 6 cycles in 18 cases. Acne lesions and sebum production were evaluated. After 3 cycles, all cases showed improvement of skin appearance. Depending on cases' evolution, we prolonged treatment for 6 cycles in 91 cases and for 9 cycles in other 23. At the end of the therapy, in first two groups, we obtained complete remission of acne in 92%, of seborrhea in 78%, of inflammatory lesions in 73%. In those 18 cases receiving OC containing DNG, we remarked superior results: improvement of lesions after 1-month treatment and complete healing after 6 cycles. This new preparation EE/DNG may provide useful hormone therapy for adolescents with androgen-related conditions such as greasy skin and acne.

Microdermabrasion: A Clinical and Histopathologic Study

Microdermabrasion is a widely performed skin rejuvenation procedure. Few studies have examined its efficacy. To evaluate the clinical and histopathologic effects of microdermabrasion. Fourteen patients underwent microdermabrasion treatments over 12-14 weeks. Self-rated questionnaires were given before and after the treatment series and were evaluated by a paired t-test. Three of the 14 patients were treated for moderate to severe acne scarring. Acute histologic effects were assessed ex vivo on human abdominal skin. Chronic histopathologic effects were examined in three volunteers who underwent skin biopsies before and after a treatment series on the dorsal forearms. By patient assessment, there was statistically significant improvement in roughness, mottled pigmentation, and overall improvement of skin appearance, but not in rhytides. Acne scarring sometimes improved, but required deeper ablation. Acutely the stratum corneum was homogenized and focally compacted. Chronically there was epidermal hyperplasia, decreased melanization, and some increase in elastin. Microdermabrasion improves some aspects of photoaging and select cases of acne scarring.

A double-blind, comparative, placebo-controlled study of the efficacy and tolerability of 4% hydroquinone as a depigmenting agent in melasma

AIM: The objective of this study was to evaluate the efficacy and tolerability of hydroquinone 4% cream with sunscreens, controlled by placebo, in the treatment of melasma. METHODS: A total of 48 patients were randomly chosen, 24 in the hydroquinone 4% group and 24 in the placebo group. Patients were instructed to use and apply additional sunscreen. The treatment lasted 12 weeks, with an evaluation of efficacy, tolerability and photographs taken every 3 weeks. Efficacy was classified as 'total improvement', 'partial improvement' or 'failure'. Tolerability was classified as 'excellent', 'good', 'fair' or 'poor'. RESULTS: The difference between the efficacy of the hydroquinone 4% and placebo groups was statistically significant. In the hydroquinone group, 40% of the patients showed complete disappearance of spots at the end of the treatment and there was no therapeutic failure reported. In the placebo group, 10% of the patients showed 'total improvement' and therapeutic failures occurred in 20% of the patients. Both treatments were well tolerated, with no serious adverse events reported. CONCLUSIONS: The results indicate that hydroquinone 4% is a safe and effective drug for the treatment of melasma and that sunscreens are important as concomitant treatment by way of preventing repigmentation and improving skin appearance. ( J Dermatol Treat (2000) 11: 173-179)

Alpha hydroxyacids modulate stratum corneum barrier function

Alpha hydroxyacids (AHAs) are used to enhance stratum corneum desquamation and improve skin appearance. The purpose of this study was to evaluate whether some AHAs improve skin barrier function and prevent skin irritation. Eleven healthy subjects (aged 28 +/- 6 years, mean +/- SD) entered the study. Six test sites of 8 x 5 cm (four different AHAs, vehicle only (VE) and untreated control (UNT) were selected and randomly rotated on the volar arm and forearm. The four different AHAs at 8% concentration in base cream were glycolic acid (GA), lactic acid, tartaric acid (TA) and gluconolactone (GLU). The products were applied twice a day for 4 weeks (2 mg/cm2). At week 4, a 5% sodium lauryl sulphate (SLS) challenge patch test was performed under occlusion for 6 h (HillTop chamber, 18 mm wide) on each site. Barrier function and skin irritation were evaluated by means of evaporimetry (Servomed EP-1) and chromametry (a* value, Minolta CR200) weekly, and at 0, 24 and 48 h after SLS patch removal. No significant differences in transepidermal water loss (TEWL) and erythema were observed between the four AHAs at week 4. After SLS challenge, GLU- and TA-treated sites resulted in significantly lower TEWL compared with VE, UNT (P < 0.01) and GA (P < 0.05) both at 24 and 48 h. Similarly, a* values were significantly reduced after irritation in GLU- and TA-treated sites. This study shows that AHAs can modulate stratum corneum barrier function and prevent skin irritation; the effect is not equal for all AHAs, being more marked for the molecules characterized by antioxidant properties.

6E 1. Antiandrogens and antiestrogns—I 236. Antiandrogenic activities of 17β-hydroxy-16,16-di-methylestr-4-en-3-one (SC-14207) on sebum and hamster flank organs

A new oral contraceptive (OC) containing dienogest (DNG) as progestagen with both antiandrogenic and antimineralocorticoid activity has been developed. Our objective was to compare the effects of 35 μg ethinil-estradiol (EE)/2 mg cyproterone acetate (CPA), 30 μg EE/150 μg desogestrel (DSG) and 30 μg EE/2 mg dienogest (DNG) on mild to moderate cases of acne. This prospective, comparative study was completed over 9 treatment cycles. A total of 114 young women with facial acne and seborrhea were recruited. Treatment was assigned in three groups: OC containing CPA or DSG for 6–9 cycles in 96 cases and DNG for 6 cycles in 18 cases. Acne lesions and sebum production were evaluated. After 3 cycles, all cases showed improvement of skin appearance. Depending on cases' evolution, we prolonged treatment for 6 cycles in 91 cases and for 9 cycles in other 23. At the end of the therapy, in first two groups, we obtained complete remission of acne in 92%, of seborrhea in 78%, of inflammatory lesions in 73%. In those 18 cases receiving OC containing DNG, we remarked superior results: improvement of lesions after 1-month treatment and complete healing after 6 cycles. This new preparation EE/DNG may provide useful hormone therapy for adolescents with androgen-related conditions such as greasy skin and acne.