Photographic Evaluation Research Articles

Intralesional injection of vitamin D3 versus zinc sulfate 2% in treatment of plantar warts: a comparative study

Background Plantar warts are common skin lesions caused by the human papilloma virus. It is characterized by the presence of a horny ring of hyperkeratosis surrounding the wart, making its elimination a therapeutic challenge. Several destructive agents are available for treatment with variable success. Intralesional vitamin D3 has been reported as a successful treatment of warts. Intralesional zinc sulfate has been found to be another successful therapeutic modality for wart elimination. Objective To compare the efficacy and safety of intralesional vit. D3 versus zinc sulfate in treatment of plantar warts. Patients and methods Forty patients were included in the study. Patients were randomly assigned to either vit. D3 group or zinc group. In vit. D3 group, patients received intralesional injection of 0.3 ml vitamin D3 (100,000 IU (2.5 mg/ml)), while zinc group patients received intralesional 2% zinc sulfate. Assessment of treatment efficacy and safety was carried out by clinical examination and comparative photographic evaluation before each session and up to 3 months after the last session. Results Eighty percent of vit. D3 treated patients and 70% of zinc sulfate patients showed complete response. Conclusions Intralesional vit. D3 and zinc sulfate appear to be effective treatment modalities for plantar warts.

Evaluation of therapeutic effectiveness of vitamin D3 injections in common warts in a tertiary care centre

<p class="abstract"><strong>Background:</strong> Warts or verrucae are the benign cutaneous manifestations caused by human papilloma virus. The treatment of wart possess a therapeutic challenge, as a result multiple modalities are existing for the treatment of cutaneous warts, which is cumbersome and may result in cosmetic disfigurement, chances of recurrences. The aim of the present study was to determine the resolution of common warts in response to vitamin D3 injections and to compare the resolution of common warts in the group receiving vitamin D3 with placebo group receiving normal saline.</p><p class="abstract"><strong>Methods:</strong> A total of 26 patients were enrolled and divided into Group A- received lesional injection of 0.2 ml vitamin D3 every 3 weeks for 3 months for the improvement in the size of warts. Group B- received 0.2 ml of normal saline injections as a control. The maximum of three sessions were carried in both groups. Clinical assessment was done by photographic evaluation at baseline, before each treatment session, and after completion of treatment.<strong></strong></p><p class="abstract"><strong>Results:</strong> In group A, 76.92% (10) of the patients showed complete clearance of wart with vitamin D3 injection, while in group B 8% (1) of patients with normal saline showed partial response. This therapy was well tolerated except for the minimal side effects like pain, redness and swelling at the site of injection.</p><p class="abstract"><strong>Conclusions:</strong> Intralesional Vit D3 injections may be a treatment option for warts, which has a good cosmetical acceptance and simple, well tolerated easily administrated in outpatient clinic rather than conventional treatment.</p>

Smartphone photography as a possible method of post-validation trachoma surveillance in resource-limited settings.

Validation of trachoma elimination requires monitoring after discontinuation of trachoma program activities, though such evaluations are not commonly done. Conjunctival examinations and smartphone photography were performed on a random sample of pre-school children from 15 villages in a region of Burkina Faso thought to have eliminated trachoma. No clinically active trachoma was detected by in-field or photographic evaluation. Smartphone images demonstrated high agreement with field grading (>99% concordance). Trachoma appears to have been eliminated from this area of Burkina Faso. Smartphone cameras may be a useful aid for monitoring in resource-limited settings.

A Brazilian cohort of individuals with Phelan-McDermid syndrome: genotype-phenotype correlation and identification of an atypical case

BackgroundPhelan-McDermid syndrome (PMS) is a rare genetic disorder characterized by global developmental delay, intellectual disability (ID), autism spectrum disorder (ASD), and mild dysmorphisms associated with several comorbidities caused by SHANK3 loss-of-function mutations. Although SHANK3 haploinsufficiency has been associated with the major neurological symptoms of PMS, it cannot explain the clinical variability seen among individuals. Our goals were to characterize a Brazilian cohort of PMS individuals, explore the genotype-phenotype correlation underlying this syndrome, and describe an atypical individual with mild phenotype.MethodologyA total of 34 PMS individuals were clinically and genetically evaluated. Data were obtained by a questionnaire answered by parents, and dysmorphic features were assessed via photographic evaluation. We analyzed 22q13.3 deletions and other potentially pathogenic copy number variants (CNVs) and also performed genotype-phenotype correlation analysis to determine whether comorbidities, speech status, and ASD correlate to deletion size. Finally, a Brazilian cohort of 829 ASD individuals and another independent cohort of 2297 ID individuals was used to determine the frequency of PMS in these disorders.ResultsOur data showed that 21% (6/29) of the PMS individuals presented an additional rare CNV, which may contribute to clinical variability in PMS. Increased pain tolerance (80%), hypotonia (85%), and sparse eyebrows (80%) were prominent clinical features. An atypical case diagnosed with PMS at 18 years old and IQ within the normal range is here described. Among Brazilian ASD or ID individuals referred to CNV analyses, the frequency of 22q13.3 deletion was 0.6% (5/829) and 0.61% (15/2297), respectively. Finally, renal abnormalities, lymphedema, and language impairment were found to be positively associated with deletion sizes, and the minimum deletion to cause these abnormalities is here suggested.ConclusionsThis is the first work describing a cohort of Brazilian individuals with PMS. Our results confirm the impact of 22q13 deletions on ASD and several comorbidities, such as hypotonia. The estimation of a minimal deletion size for developing lymphedema and renal problem can assist prediction of prognosis in PMS individuals, particularly those diagnosed in early infancy. We also identified one atypical individual carrying SHANK3 deletion, suggesting that resilience to such mutations occurs. This case expands the clinical spectrum of variability in PMS and opens perspectives to identify protective mechanisms that can minimize the severity of this condition.

A dose-ranging, parallel group, split-face, single-blind phase II study of light emitting diode-red light (LED-RL) for skin scarring prevention: study protocol for a randomized controlled trial

BackgroundSkin fibrosis is a significant global health problem that affects over 100 million people annually and has a profoundly negative impact on quality of life. Characterized by excessive fibroblast proliferation and collagen deposition, skin fibrosis underlies a wide spectrum of dermatologic conditions ranging from pathologic scars secondary to injury (e.g., burns, surgery, trauma) to immune-mediated diseases. Effective anti-scarring therapeutics remain an unmet need, underscoring the importance of developing novel approaches to treat and prevent skin fibrosis. Our in vitro data show that light emitting diode-red light (LED-RL) can modulate key cellular and molecular processes involved in skin fibrosis. In two phase I clinical trials (STARS 1 and STARS 2), we demonstrated the safety and tolerability of LED-RL at fluences of 160 J/cm2 up to 480 J/cm2 on normal human skin.Methods/designCURES (Cutaneous Understanding of Red-light Efficacy on Scarring) is a dose-ranging, randomized, parallel group, split-face, single-blind, mock-controlled phase II study to evaluate the efficacy of LED-RL to limit post-surgical skin fibrosis in subjects undergoing elective mini-facelift surgery. Thirty subjects will be randomly allocated to three treatment groups to receive LED-RL phototherapy or temperature-matched mock irradiation (control) to either periauricular incision site at fluences of 160 J/cm2, 320 J/cm2, or 480 J/cm2. Starting one week post-surgery (postoperative days 4–8), treatments will be administered three times weekly for three consecutive weeks, followed by efficacy assessments at 30 days, 3 months, and 6 months. The primary endpoint is the difference in scar pliability between LED-RL-treated and control sites as determined by skin elasticity and induration measurements. Secondary outcomes include clinical and photographic evaluations of scars, 3D skin imaging analysis, histological and molecular analyses, and adverse events.DiscussionLED-RL is a therapeutic modality of increasing importance in dermatology, and has the potential to limit skin fibrosis clinically by decreasing dermal fibroblast activity and collagen production. The administration of LED-RL phototherapy in the early postoperative period may optimize wound healing and prevent excessive scarring. The results from this study may change the current treatment paradigm for fibrotic skin diseases and help to pioneer LED-RL as a safe, non-invasive, cost-effective, portable, at-home therapy for scars.Trial registrationClinicalTrials.gov, NCT03795116. Registered on 20 December 2018.

Efficacy of a Moisturizer for Pruritus Accompanied With Asteatosis in Dialysis Patients: An Open-Label, Randomized, Exploratory Study

BackgroundIn dialysis patients, skin disorders (dryness and itching) are frequently observed and treated with a moisturizer, in the absence of clear evidence of efficacy.Study DesignAn open-label, randomized, before/after, parallel-group, comparative/exploratory study.Setting & Participants12 Japanese patients with chronic kidney failure undergoing maintenance hemodialysis who presented with dry skin and itching.InterventionPatients received a topical heparinoid moisturizer as the study drug for 2 weeks from the first day of the study treatment, followed by either a 2-week washout (group A: 6 participants) or further 2-week treatment (group B: 6 participants).OutcomesThe primary end point was change in water content in the stratum corneum in the hypochondrium. Secondary end points included change in visual analogue scale itching score and subjective evaluations of symptoms. To evaluate safety, adverse events were also investigated.MeasurementsWater content of the stratum corneum, dryness/itching improvement rating, itching visual analogue scale/duration of itching, photographic evaluation of skin symptoms, principal investigator’s overall assessment of study drug, and adverse events.ResultsMean water content of the stratum corneum in the combined groups significantly increased at week 2 (51.2 arbitrary units [AU] vs treatment start day, 31.6 AU; P<0.001), but significantly decreased at week 4 in group A, in which patients discontinued treatment with the study drug (39.4 AU; P = 0.005). Other efficacy end points, including the visual analogue scale itching score, were also improved by treatment with the study drug, but such improvement was not sustained after discontinuation of treatment. There were no adverse events related to the study treatment.LimitationsOnly Japanese patients were included in the study, with a small sample size.ConclusionsContinuous application of the topical heparinoid moisturizer increased water content in the stratum corneum and lessened itching in dialysis patients.FundingMaruho Co, Ltd.Trial RegistrationRegistered at the University Hospital Medical Information Network Clinical Trials Registry with study number UMIN000017016.

Treatment of atrophic acne scars using autologous platelet‐rich plasma vs combined subcision and autologous platelet‐rich plasma: A split‐face comparative study

Multiple therapeutic approaches are usually required when treating atrophic acne scars. Subcision was reported to be of value in improving rolling scars. Autologous platelet-rich plasma (PRP) has recently been proposed as an adjuvant treatment option for atrophic acne scars with few reports evaluating its efficacy. Our objective was to compare the effect of intradermal injection of PRP vs combined PRP and subcision in the treatment of atrophic acne scars. Thirty patients with bilateral atrophic acne scars were enrolled. Each patient received three monthly sessions. Each side of the face was randomly treated either with intradermal PRP alone or with combined treatment with subcision followed by PRP injection. Patients were assessed at 3 and 6months following the last treatment session. Evaluation of serial photographs was performed by two blinded investigators. Platelet-rich plasma alone showed a better response, fewer side effects, and shorter downtime compared to combined subcision and PRP. Autologous PRP injection can be a therapeutic option in the treatment of atrophic acne scars, with fewer complications and better tolerability than combined subcision and autologous PRP.

Low-fluence Q-switched Nd:YAG 1064-nm laser versus Q-switched Nd:YAG 532-nm laser in the treatment of hyperpigmented lips: a prospective, randomized, controlled, evaluator-blinded trial.

Lip hyperpigmentation is an esthetic problem. Clinical data from controlled comparative studies is insufficient to support the efficacy of laser treatments for hyperpigmented lips. This study is aimed to compare the efficacy of low-fluence Q-switched Nd:YAG 1064-nm laser (LFQS 1064-nm) versus Q-switched Nd:YAG 532-nm laser (QS 532-nm) for the treatment of hyperpigmented lips. A randomized, controlled, evaluator-blinded study was conducted in thirty subjects. They were randomized into 2 groups. The first group was treated with five treatment sessions with a 2-week interval of LFQS 1064-nm laser while the second group was treated with a single session of QS 532-nm laser. The evaluation was conducted at baseline, 2weeks of each post treatment, and 4weeks after the last treatment session. The efficacy was assessed by melanin index, Methuen colored plate, photographic evaluation, pain score, patient's satisfaction, and patient's Dermatology Life Quality Index. The adverse effects were also recorded. All patients attained throughout the study protocol. The most frequent fluence applied was 2.4J/cm2 (2.2-2.5J/cm2) and 2.0J/cm2 (1.7-2.4J/cm2) in the LFQS 1064-nm group and QS 532-nm group, respectively. The results of the QS 532-nm group showed greater percentage of melanin index reduction and better average mean of photographic evaluation percentage changes from the baseline than the LFQS 1064-nm group (p < 0.001 and p < 0.001, respectively). The adverse effects were less likely to occur in the LFQS 1064-nm group. Few cases of scale, hypopigmentation, bleb formation, postinflammatory hyperpigmentation, and labial edema occurred only in the QS 532-nm group.

Determination of the age of bruises using a bilirubinometer

The dating of bruises can be of crucial interest in clinical forensic medicine, but the macroscopic or photographic evaluation of a bruise has not been regarded as reliable. Several methods have thus been regularly evaluated for this purpose, with reflectance spectrometry yielding promising results. The objective of this study is to evaluate the value of a bilirubinometer as a tool for dating bruises on living victims.A clinical follow-up was carried out on patients presenting a bruise with a known onset. Using a bilirubinometer, we obtained daily measurements of the bruise (bili-bruise) and of healthy skin (bili-skin). Potential confounding factors were collected: age, sex, body mass index, trauma mechanism and Fitzpatrick skin phototype.We followed 20 patients for a total of 88 measurements of bruises. Bili-skin values showed significant differences according to skin phototype. Differences between the bili-bruise and bili-skin values (Δ-bili) followed an increase phase, peaking between 3 and 5 days, and then there was a decrease phase. No significant Δ-bili value differences were observed based on the suspected confounding factors.Our results are in favour of a peak Δ-bili value generally at day 4 or 5 post-trauma. Notably, decreasing values were not observed before day 3. Decreasing Δ-bili values would then indicate a bruise resulting from an injury formed at least 3 days before the first measurement. Complementary work confirming such data would enable improvement of the performance of bruise dating in forensic medicine.

Use of Mastoid Periosteum Graft in Primary and Revision Rhinoplasty.

The authors initiated the use of a mastoid periosteum graft to augment or camouflage the dorsum and radix. This report describes the techniques and treatment outcomes of mastoid periosteum grafts in primary and revision rhinoplasty. Medical records of 62 patients who underwent rhinoplasty with mastoid periosteum were reviewed retrospectively. Of these, 21 patients who participated in follow-up for more than 6months were analyzed through a comparison of pre- and postoperative photographs. Aesthetic results were scored on a scale of 0 to 4 (0 = poor, 1 = fair, 2 = moderate, 3 = good, 4 = excellent) with photographic evaluation by two independent surgeons. A mastoid periosteum graft was used in 32 primary and 30 revision cases. The graft was used to augment the radix (28 cases), dorsum (15 cases), and both radix and dorsum (19 cases). Cartilage underlay was combined with mastoid periosteum grafts in 38 patients (61.3%, 17 in radix graft, 8 in dorsal graft, and 13 in both). The aesthetic outcome score assessed in 21 patients was 2.8 on average (3.2 in primary and 2.4 in revision cases). Cartilage combined cases showed better aesthetic outcome than free graft cases (3.1 vs. 2.5, respectively). Three cases of partial graft resorption were found, but there were no major complications. Mastoid periosteum grafting is a safe and effective method to augment the radix or dorsum in primary and revision rhinoplasty. Long-term partial resorption cannot be completely excluded, which necessitates further study. 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 .

Dual-plane hyaluronic acid treatment for atrophic acne scars.

Acne is a common condition that affects up to 80% of all adolescents. Scarring may affect some 95% as a function of severity and delay before treatment. The pathogenesis includes enzymatic degradation of collagen fibers and subcutaneous fat. This study aimed to treat atrophic acne scars using the Dual-Plane injection of Hyaluronic Acid. A total of 12 patients with moderate-to-severe atrophic acne scars were treated with a novel NAHYCO™ based Hyaluronic Acid filler, using a dual-plane technique for two treatment sessions at a 4-week interval. Results were objectively assessed by two blinded Dermatologists and subjectively evaluated by the patients themselves. A total of 8 out of the 12 patients reported moderate improvement, two indicated marked improvement and two rated minimal improvement. Dermatologists' mean global evaluation score was 2.5±0.43. The small sample size and regional nature of a single-center study. Nevertheless, both the expert dermatologists' and the patients' evaluations of standardized high-resolution medical photographs were consistent, suggesting that this inherent bias was negligible. The treatment led to impressive improvement in the depth of the scars, suggesting that this technique can result in safe and rapid amelioration of atrophic acne scars in only two sessions.

LED Light Sources and Their Complex Set-Up for Visually and Biologically Effective Illumination for Ornamental Indoor Plants

Ornamental plants are often used in indoor environments as part of biophilic design to improve the health and wellbeing of occupants, and to support sustainable, green architecture. Unfortunately, many plants do not thrive and need to be continuously replaced, which is economically unsustainable. The wavelengths and spectrum ratio of commonly used light sources such as light emitting diode (LED), and the lack of an appropriate light dark cycle (photoperiod), appear to be crucial influencing factors. Therefore, this study focuses on determining the optimal action spectrum of LEDs for visually and biologically effective illumination for plants, and humans as end users. This practice-based research study applies critical analysis of literature, photographic evaluation of the appearance of plants under various LED lighting in the form of a visual assessment questionnaire-based survey, and provides various measurements that record the properties of light including correlated color temperature (CCT), color rendering index (CRI), spectral power distribution (SPD), peak light wavelength (λP), photosynthetic photon flux density (PPFD) and daily light integrals (DLI). Research confirms the LED lighting used for horticultural food production cannot be applied to ornamental indoor plants due to fundamental differences in purpose. Such illumination provides fast growth for market consumption and usually makes plants appear unnatural, whereas ornamental plants in an indoor environment should grow at an appropriate speed which reduces maintenance costs and they should have a natural appearance. These new findings, supported by evidence and data, can help investors, clients, architects, landscape and lighting designers, as well as luminaire manufacturers, make improved, biophilic-sustainable lighting design choices.

Local retro-orbicularis oculus fat (ROOF) resection in upper blepharoplasty: A retrospective evaluation study of 65 bilateral upper blepharoplasties

Puffy upper eyelids are normal in Asians, and full-incision blepharoplasty is commonly performed to remove some orbital fat to ameliorate the problem, but not all patients would exhibit obvious improvement. Local retro-orbicularis oculus fat (ROOF) is a layer of fibrofatty soft tissue that lies much deep into the orbicularis oculi in the upper eyelid, which is an important factor in the formation of puffy upper eyelids. This study was carried out to evaluate the clinical application (including the evaluation of photographs for the thickness of upper eyelid) of upper blepharoplasty combined with ROOF resection for correcting puffy upper eyelids. A total of 65 patients (5 males, 60 females) with puffy upper eyelids recruited from October 2015 to October 2016 were included in the study. Full-incision blepharoplasty combined with partial ROOF resection was performed on all patients. The thickness of soft tissue in the upper eyelid was measured by ultrasound biomicroscopy preoperatively and at 12 months postoperatively. All patients underwent surgery successfully, and 62 patients (124 eyes) were followed up for 12-15 months (mean 13.8 ± 2.7 months). Before the surgery, the thickness of the ROOF was 0.35±0.12 mm on the left and 0.42±0.08 mm on the right. Twelve months postsurgery, the thickness of the ROOF was 0.18±0.03 mm on the left and 0.20±0.02 mm on the right. During the follow-up period, all patients were satisfied with the esthetic effect, and no severe postoperative complications were observed. Puffy upper eyelids can be corrected effectively by local ROOF resection in esthetic blepharoplasty.

Outcome of photographic evaluation of facial appearance in orthognathic surgery: how does it correlate with planning of treatment and patient-reported outcome?

The outcome of treatment in orthognathic surgery is dependent on preoperative surgical planning. The main purpose of the present study was to evaluate from photographs the improvement in facial appearance after orthognathic surgery. In addition, the outcomes of two different planning techniques, 2-dimensional and 3-dimensional, were compared and the correlation between the outcome and health-related quality of life (HRQoL) assessed.The study was a randomised controlled trial with the intervention being either 2-dimensional or 3-dimensional treatment planning. An evaluation panel compared photographs taken before and after operation on patients with severe class III malocclusion. The change in facial appearance was rated, the two planning techniques compared, and the result correlated with previously published findings on cephalometric accuracy and HRQoL in the same group.Completed 12-month follow-up resulted in the inclusion of 57 subjects aged between 18 and 28 years at the time of operation (mean 21 years). We found significant differences between the two evaluations (p = 4.4E-9) but no significant difference in facial improvement between the planning techniques (p = 0.54). However, there was a correlation between cephalometric measurement of accuracy in the anterior maxilla and evaluation of improvement of facial appearance (p = 0.024, r = 0.30), but we found no correlation +between HRQoL and the evaluation of facial appearance (p = 0.31, r = -0.14). We conclude that there was an improvement in facial aesthetics after orthognathic surgery that was independent of the planning technique used.

Beware the Alar Base Optical Illusion in Assessment of Unilateral Cleft Lip Nasal Deformity

After repair of unilateral cleft lip, lateral drift of the alar base is expected and may require revision. Although the alar base appears wider than on the noncleft side, by measurement it could be symmetric or narrow. Is this an optical illusion? This is a retrospective photographic evaluation of children who underwent repair of unilateral complete cleft lip and palate. On submental standardized photographs, raters judged whether the alar base position was wider, equal to, or narrower than on the noncleft side. The true alar base position was measured by photogrammetry and the frequency of alar base misjudgment was assessed. On control photographs, the cleft side alar base was wider than the noncleft side. On test photographs, the cleft side alar base was narrower than the noncleft side. Possible association between misjudgment and nasal features was also evaluated. Data were analyzed using the Fisher's exact test. Three raters assessed 61 patients aged 6 to 9 years and treated between 1995 and 2015. In 77 percent of control photographs, raters correctly judged the cleft side alar base as wider. In 65 percent of test photographs, raters incorrectly judged the alar base position as wider on the cleft side. Asymmetry of nostril outline and a transverse nostril axis were associated with misjudged photographs (p < 0.05). Alar base assessment can be altered by an optical illusion. Simple anthropometry counters this misperception. Measurement should be repeated after correction of the deviated anterocaudal septum and elevation of the lower lateral cartilage. Thereafter, a decision is made on altering the alar base position. Diagnostic, II.

Role of digital photography in evaluation of gallbladder specimens following laparoscopic cholecystectomy for gallstone disease: a prospective observational study

Background: Digital photography helps in accurate documentation of macroscopic features of specimens and preventing inaccuracies in description of macroscopic features. Some studies recommend a digital color print be sent with each specimen to histopathology laboratory. The aim of the study was to assess the necessity of histopathological examination of resected specimen of gallbladder with no features suspicious of carcinoma gall bladder on clinicoradiological study.Methods: It is a prospective observational study conducted in the Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, between 2014 and 2016. Patients between 18 to 60 years of age with gall stone disease with no features suspicious of carcinoma gall bladder on clinicoradiological study were recruited in the study. Post-cholecystectomy gallbladder specimens were considered as subjects of study. Specimen were photographed and sent for histopathological examination. Macroscopic features on digital photography were compared with histopathological findings.Results: About, 39/100 (39%) gallbladder specimens showed abnormal findings on digital photography; 30/39 (77%) had ulcerations, 5/39 (13%) had polypoidal lesions and 4/39 (10%) had diffuse wall thickening. 1/39 (2.6%) specimens with abnormal finding on digital photography was found to be malignant on histopathological examination. The sensitivity, specificity, negative predictive value and positive predictive value of digital photography was 100%, 67.7%, 100% and 3.03% respectively.Conclusions: Digital photography can prove to be a good tool in documenting macroscopic features of gallbladder specimens. Digital photography is associated with high sensitivity and negative predictive value; however, larger sample size is required to establish its significant correlation.

Are Preferred Scalp Locations for Alopecia Areata Patches a Clue to Neuronal Etiology?

Background: Alopecia areata (AA) is an autoimmune disease causing hair loss in 2% of the population. Anecdotally, hair specialists report that patches localize to the scalp periphery. Changes in sensory innervation and/or scalp vasculature may play a role in the development and localization of alopecic patches. Objective: To evaluate the most common locations of initial alopecic scalp patches. Materials and Methods: A retrospective chart review, with comprehensive evaluation of clinical photographs, was conducted from July 2016 to June 2018 to include AA patients (n = 112). Clinical data was collected on gender, age, race, time until presentation at the clinic, and areas of hair loss on initial presentation. Results: The most common areas of initial AA patches in both females and males were the occiput (49 vs. 48.5%), parietal (46.9 vs. 21.2%), vertex (26.5 vs. 18.2%), and frontal (24.5 vs. 18.2%) regions; 26.8% of patients present with either alopecia totalis or universalis. Limitations: This is a single-center study with underrepresentation of minority races. Conclusion: AA patches most commonly present on the occiput of the scalp in both female and male patients. Cervical spine nerves C3 and C2 supply sensory innervation and the occipital artery supplies blood to this area.

A series of in vitro and human studies of a novel lip cream formulation for protecting against environmental triggers of recurrent herpes labialis.

PurposeThese studies describe the testing of a novel, daily-use lip cream designed for individuals with lips prone to recurrent herpes labialis (RHL) that protects against environmental triggers.Subjects and methodsIn vitro occlusive and in vitro and in vivo photoprotection analyses, a characterization of normal vs dry lips, and a randomized, evaluator-blinded, clinical trial that assessed the lip cream in healthy subjects with dry lips were conducted. In the clinical trial, subjects applied the lip cream or were untreated and evaluated using transepidermal water loss (TEWL), corneometry, visual assessments of lip dryness, expert photographic evaluations, and subject-rated outcomes.ResultsThe lip cream’s in vitro water vapor transmission rate (84.1 g/(m2 h)) indicated moderate occlusivity. The lip cream, but not placebo or control (water), reduced ultraviolet A (UVA)- and UVB-induced DNA damage, and tumor necrosis factor-α (EpiDermFT) and pros-taglandin E2 release (EpiDermFT and EpiGingival™). The lip cream’s in vivo sun protection factor (SPF) was 12.2 (lower confidence limit, 11.3) and SPF/UVA protection factor ratio was 0.9. The characterization of dry vs normal lips identified differences in moisturization. In the clinical trial, the lip cream significantly decreased TEWL (difference: −7.19 [95% CI: −11.41, −2.98]; P<0.01), increased corneometry (difference: 4.62 [95% CI: 1.05, 8.19]; P<0.05), and reduced visual dryness (difference: −1.48 [95% CI: 2.24, −0.71]; P<0.001) compared to untreated subjects. Significant benefits were also observed on expert photographic assessments of scaling (difference: −0.89 [95% CI: −1.75, −0.03]; P< 0.05), cupping (difference: −1.50 [95% CI: −2.30, −0.70]; P<0.001), and healthy appearance (difference: −1.44 [95% CI: −2.29, −0.58]; P<0.01); differences in overall healthy appearance were not significant (P=0.51). Subject-rated assessments indicated improvements in cracking, dryness, and flaking in the lip cream group but worsening in untreated subjects.ConclusionThese studies indicate that this novel, daily-use lip cream protects against UV radiation, drying, and chapping, which are established environmental RHL triggers.

The Efficacy and Safety of Hyaluronic Acid Microinjection for Skin Rejuvenation in Vietnam.

BACKGROUND:Aging is an increasing concern of modern society, particularly facial ageing. In recent years, the microinjection technique has increasingly been emphasised as a skin rejuvenation strategy. Hyaluronic acid (HA) plays an important role in the hydration of the extracellular space and can thus improve skin hydration, firmness and viscoelastic properties.AIM:To evaluate the efficacy and safety of HA microinjection in skin rejuvenation.METHODS:We enrolled thirty participants underwent three sessions of HA microinjection involving multiple injections in the face or back of the hands at 2-week intervals. The aesthetic outcomes were assessed at baseline and after 2, 4 and 8 weeks. Clinical evaluation was based on the Global Aesthetic Improvement Scale (GAIS) and the Wrinkle Severity Rating Scale (WSRS).RESULTS:Evaluation of photographs from 2, 4 and 8 weeks revealed significant clinical improvement in the brightness, texture and wrinkling of the skin. Analysis of the GAIS and WSRS scores revealed statistically significant results after 2 months.CONCLUSION:Most of the participants felt satisfied with the treatment (93.3%).

Anticataract activity of forskolin by inhibiting polyol pathway for the prevention of diabetic complication

Pharmacognosy Research,2019,11,4,352-355.DOI:10.4103/pr.pr_68_19Published:November,2019Type:Original ArticleAuthors:Damera Sujatha, Ajmera Rama Rao, and Ciddi Veeresham Author(s) affiliations:Damera Sujatha, Ajmera Rama Rao, Ciddi Veeresham Department of Pharmacognosy, University College of Pharmaceutical Sciences, Kakatiya University, Warangal, Telangana, India. Abstract:Background: Cataract is the opacification or optical dysfunction of the crystalline lens. Diabetes has been considered to be one of the major risk factors of cataract. Objective: The present study was designed to evaluate the anticataract activity of antioxidants such as Coleus forskohlii (CF) Briq and its phytoconstituent forskolin (FS) which were subjected to prevent cataract formation in vitro on glucose‑induced cataract model. Materials and Methods: Goat lenses were incubated in Krebs‑Ringer bicarbonate buffer pH 7.5 (supplemented with Taxim and streptomycin) containing 55 mM glucose (cataractogenesis) with fidarestat; CF methanolic extract; and FS at a concentration of 1 µg/mL, 100 µg/mL, and 10 µg/mL for 24 hr at 37°C with 5% CO2 and 95% air. Glucose‑induced opacification of goat lens began 8–10 hr after incubation and was complete in 24 hr. Polyol (galactitol) levels in incubated lenses were estimated spectrophotometrically. Results: Cataractous lenses showed higher content of galactitol. However, lens treated with fidarestat, CF methanolic extract, and its phytoconstituent FS showed lower content of galactitol. Conclusion: CF and FS prevented the formation and progress of cataract by glucose, as evidenced by lens transparencies with photographic evaluation and lens galactitol levels. Keywords:Aldose reductase, Cataract, Coleus forskohlii, Forskolin, Polyol pathway.View:PDF (941.95 KB)