Fear Research Articles

Dermatosparaxis type of Ehlers-Danlos syndrome: case report

Background. The dermatosparaxial type of Ehlers-Danlos syndrome (EDSDERMS, VIIC, dEDS) is an extremely rare disorder. To date, 15 patients with this type of Ehlers-Danlos syndrome are known worldwide. The purpose was to improve knowledge and spread data about the orphan connective tissue di­sease — dEDS — on the example of a patient from a family in which the father and two sons have the same type of lesions. Materials and methods. We report a 6-year-old patient as well as his father and sibling with clinical symptoms of the dEDS, which we diagnosed based on the main diagnostic criteria: extreme skin fragi­lity, craniofacial features, superficial skin trauma, wrinkling of the palms, especially when they are exposed to water for a long time, and a tendency to ecchymosis with a risk of subcutaneous hematomas and bleeding. Secondary diagnostic criteria were represen­ted by atrophic scars, refractive errors (myopia), gingival margi­nal dysplasia, hypermobility of the finger and knee joints. The informed consent of the patient’s parents was obtained for the exa­mination and publication of information, and the parents agreed to the publication of clinical photographs. Results. After laboratory and instrumental studies and consultations with related specialists (hematologist, geneticist, cardiologist, pediatrician, orthopedist, dermatologist), we excluded such diseases as Marfan syndrome, MASS-phenotype, congenital coagulopathies and thrombocytopathies, hemophilia, isolated vascular pathologies, as well as other types of Ehlers-Danlos syndrome and identified dEDS in the patient only clinically. Genetic testing did not reveal any pathological mutations or exonic deletions/duplications. The negative result of genetic testing in dEDS is due to the fact that certain types of mutations (e.g., deep intronic mutations) cannot always be detec­ted by standard diagnostic genetic methods. Conclusions. It is possible to establish a diagnosis based on clinical symptoms, but an extended mutation search is mandatory for the entire family.

THU366 Type 1 Diabetes Complicated By Multiple Episodes Of Diabetic Ketoacidosis Secondary To Flares Of Hidradenitis Suppurativa

Abstract Disclosure: S.R. Vasavada: None. K.A. Chopra: None. L. Philipson: Grant Recipient; Self; Novo Nordisk. Background: Hidradenitis suppurativa (HS) is an inflammatory skin condition of the pilosebaceous unit characterized by subcutaneous nodules that if untreated can form purulent abscesses, fistulae, and sinus tracts. HS may result from dysregulated autoimmune response to skin flora with overexpression of inflammatory cytokines, such as IL-17A, TNF-a, IL-1B (Shah et al 2017). Although HS and type 1 diabetes both share underlying autoimmune etiologies, and autoimmune diseases have been reported in higher frequencies in HS than controls, co-incidence with type 1 diabetes is extremely rare (Straalen et al 2022). Herein, we describe a case of a patient with type 1 diabetes with recurrent admissions for diabetic ketoacidosis (DKA) secondary to HS flares. Clinical Case: 37-year-old female with medical history of type 1 diabetes, hypogammaglobulinemia, and HS presented with rectal pain and hematochezia. Previously, she had several hospitalizations due to HS flares complicated by episodes of DKA and 20+ corrective surgeries for infected HS lesions. Prior to admission, patient was treated with clindamycin lotion, spironolactone, and weekly adalimumab for HS. Patient’s initial labs showed DKA with glucose 494 mg/dL (RR 60-99 mg/dL), bicarbonate 21 mmol/L (RR 23-30 mmol/L), anion gap 16 mmol/L (RR 6-15 mmol/L), and beta hydroxybutyrate level 1.44 mmol/L (N <0.3 mmol/L). Hemoglobin A1c was 10.4% (RR <5.7%). Physical exam showed Hurley Stage 2 HS with multiple atrophic scars, boils, and double comedones on bilateral axillae. She was treated with insulin infusion and IV fluids. After anion gap closed and bicarbonate improved to 24 mmol/L (RR 23-30 mmol/L), she transitioned to regimen of insulin glargine 38 units and started mealtime insulin lispro using a ratio of 1 unit of lispro for 6 grams of carbs. Subsequent glucose values stabilized, ranging 120-200 mg/dL (RR 60-99 mg/dL) during hospitalization. She underwent colonoscopy due to concern for colonic involvement of HS, however pathology was normal. After multidisciplinary discussion with endocrinology and dermatology specialists, HS treatment with prednisone was avoided due to concern of worsening patient’s glycemic control. Patient started infliximab treatment and reported mild symptom improvement. Conclusion: This case showing a patient with multiple episodes of DKA triggered by flares of HS has demonstrated the importance of further study to improve our current understanding of the potential overlap of these two conditions to help guide future treatment decisions and improve patients’ overall quality of life. Reference: Shah A, Alhusayen R, Amini-Nik S. The critical role of macrophages in the pathogenesis of hidradenitis suppurativa. Inflamm Res. 2017;66(11):931-945. Straalen KR van, Prens EP, Gudjonsson JE (2022) Insights into hidradenitis suppurativa. J Allergy Clin Immun 149(4):1150–1161. Presentation: Thursday, June 15, 2023

Efficacy of fractional CO2 laser therapy combined with hyaluronic acid dressing for treating facial atrophic acne scars: a systematic review and meta-analysis of randomized controlled trials.

The present work aimed to systematically identify the efficacy and safety of fractional carbon dioxide (CO2) laser plus hyaluronic acid (HA) dressing in dealing with facial atrophic acne scars. Randomized controlled trials (RCTs) concerning fractional CO2 laser in combination with HA dressing for treating atrophic acne scars were screened in 8 electronic databases (containing PubMed, Embase, the Cochrane Library, Web of Science, China National Knowledge Internet, Wanfang, Sinomed as well as VIP). Besides, for the purpose of evaluating the risk of bias of the enrolled RCTs, the Cochrane Collaboration tool was adopted. Statistical analysis was completed using Revman5.3 software and Stata 14.0 software. Meanwhile, the quality of evidence was assessed by the GRADE system. Finally, 6 studies involving 623 patients were enrolled. According to the findings in this study, compared with fractional CO2 laser alone, fractional CO2 laser therapy combined with HA dressing reduced the scores of ECCA (échelle d'évaluation clinique des cicatrices d'acné) grading scale (MD=-3.37,95% CI [-5.03, -1.70], P<0.0001), shortened the time of crust formation (MD=-0.42,95% CI [-0.80, -0.04], P=0.03) and the time of crust removal(MD=-1.31,95% CI [-1.67, -0.95], P<0.00001), enhanced patient satisfaction (RR=1.85, 95% CI [1.44, 2.38], P<0.00001). All the reported adverse events including hyperpigmentation, erythema, edema, mild itching, and slight burning pain were controllable. In addition, fractional CO2 laser combined with HA dressing therapy had a lower incidence of hyperpigmentation than fractional CO2 laser alone (RR=0.37, 95% CI [0.23, 0.61], P<0.0001). The level of evidence for outcomes was classified to be low to moderate. According to our findings, fractional CO2 laser combined with HA dressing is efficacious and safe option for facial atrophic acne scars. Nevertheless, more high-quality trials are required for further verification in the future.

Self-assembled adipose-derived mesenchymal stem cells as an extracellular matrix component- and growth factor-enriched filler.

The clinical application of mesenchymal stem cells (MSCs) is attracting attention due to their excellent safety, convenient acquisition, multipotency, and trophic activity. The clinical effectiveness of transplanted MSCs is well-known in regenerative and immunomodulatory medicine, but there is a demand for their improved viability and regenerative function after transplantation. In this study, we isolated MSCs from adipose tissue from three human donors and generated uniformly sized MSC spheroids (∼100µm in diameter) called microblocks (MiBs) for dermal reconstitution. The viability and MSC marker expression of MSCs in MiBs were similar to those of monolayer MSCs. Compared with monolayer MSCs, MiBs produced more extracellular matrix (ECM) components, including type I collagen, fibronectin, and hyaluronic acid, and growth factors such as vascular endothelial growth factor and hepatocyte growth factor. Subcutaneously injected MiBs showed skin volume retaining capacity in mice. These results indicate that MiBs could be applied as regenerative medicine for skin conditions such as atrophic scar by having high ECM and bioactive factor expression.

Efficacy of transdermal microneedling redermalization with high-molecular-weight hyaluronic acid and sodium succinate in the correction of postacne scars

BACKGROUND: Acne is a chronic inflammatory skin disease of multifactorial nature that affects more than 80% of adolescents and is one of the top 10 most common diseases in the world. Currently, dermatologists have various techniques for the correction of postacne scars: from minimally invasive hydroxy acid peels to surgical excision of scar tissue. One of the most effective, affordable, and at the same time minimally invasive and safe treatment methods is microneedling ― micro-damage of the skin with thin needles in the lesion area, stimulating the production of collagen and elastin.&#x0D; AIM: to study the efficacy and safety of transdermal redermalization with microneedling using high-molecular-weight hyaluronic acid and sodium succinate in patients with atrophic postacne scars of varying severity.&#x0D; MATERIALS AND METHODS: A prospective study was carried out at the Clinic of Skin and Venereal Diseases of the Sechenov University. A. Rakhmanov, Sechenov University, with the participation of 80 patients with postacne scars of varying severity. The Hyalual Perfoskin Complex device was used for microneedling in combination with a sodium succinate preparation based on hyaluronic acid. The apparatus was used in a linear technique along the Langer tension lines and in mutually perpendicular direction, 1015 passes in each area (lower jaw, cheek-curve area, forehead area). Each subject underwent 4 treatments at 21-day intervals. Clinical assessment of the treatment dynamics before and after treatment was performed using the Miravex 3D multispectral imaging device. Before and after treatment, patients were evaluated for the severity of postacne scars according to the International Qualitative Scale for the classification of postacne scars, as well as a dermatological index of quality of life. Subjective evaluation of the effectiveness of therapy by the physician and the patient was performed using the International Global Aesthetic Improvement Scale one month after each treatment and 3 months after the last treatment.&#x0D; RESULTS: Among the 80 patients, 47 women and 33 men aged 18 to 46 years had atrophic postacne scars of varying severity: I in 9, II in 26, III in 40, and IV in 5 patients; the rashes were most often localized to the cheek-cusp (55; 69%) and forehead (15; 19%) and were represented by U-shaped (35; 44%), V-shaped (17; 21%), M-shaped (19; 24%) and macular (9; 11%) patterns. The duration of the disease averaged 5.33.2 years. Improvement of the clinical picture was observed in 92.5% of cases after treatment. For example, 8 patients with I degree of scarring managed to achieve complete clearing of the skin; out of 26 patients with II degree of scarring, 15 patients achieved I degree of severity and 10 patients experienced clinical remission at the end of treatment; in the group of patients with III degree of scarring (n=40), 18 patients had I degree of severity, 20 patients had II degree of severity; in the group of patients with IV degree of severity after 4 treatments, 2 patients had III degree of severity and 1 patient had II degree of severity. The dermatological quality of life index decreased by 77% on the average: from 18.632.28 to 4.253.16. The final result was considered "optimal aesthetic result" by doctors and patients in 86% and 82% of cases, respectively, "significant improvement" in 4% and 12% of cases, respectively, "improvement" in 2.5% and 4% of cases, respectively, and "no change" in 7.5% and 2%, respectively. All patients noted good tolerability of treatment. Thus, side effects in the form of skin redness and painful sensations were insignificant and passed on their own within 23 days after the procedure.&#x0D; CONCLUSION: Microneedling with high-molecular-weight hyaluronic acid and sodium succinate has demonstrated high efficacy and safety in the treatment of postacne scars of varying severity. The minimal invasiveness and affordability of the procedure result in high patient adherence to therapy.

Effectiveness of Mesenchymal Stem Cell Secretome on Wound Healing: A Systematic Review and Meta-analysis.

Secretome provides promising potential in replacing cell-based therapies in wound repair therapy. This study aimed to systematically review and conduct a meta-analysis on the effectiveness of secretome in promoting wound healing. To ensure the rigor and transparency of our study, we followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, as registered in PROSPERO with ID: CRD42023412671. We conducted a comprehensive search on four electronic databases to identify studies evaluating the effect of secretome on various clinical parameters of wound repair. In addition, we evaluated the risk of bias for each study using the Jadad and Newcastle-Ottawa scale. To synthesize the data, we employed a fixed-effects model and calculated the mean difference or odds ratio (OR) with a 95% confidence interval (CI). Based on six included articles, secretome is known to affect several clinical parameters in wound healing included the size and depth of ulcers during healing; the E´chelle d'évaluation clinique des cicatrices d'acne (ECCA) score, epidermal thickness, collagen fibers, abnormal elastic tissues, volume of atrophic acne scars, skin pore volume, and erythema during acne scar healing; and microcrust areas, erythema index, transepidermal water loss, volume of atrophic acne scars, erythema, and relative gene expression of procollagen type I, procollagen type III, and elastin were evaluated in wound healing after laser treatment. Meta-analysis studies showed that secretome reduced ulcer size (mean difference: 0.87, 95% CI of 0.37-1.38, p = 0.0007), decreased ulcer depth (mean difference: 0.18, 95% CI of 0.11-0.25, p < 0.00001), and provided patient satisfaction (odds ratio: 9.71, 95% CI of 3.47-21.17, p < 0.0001). However, secretome failed to reach significance in clinical improvement (OR 0.38, 95% CI 0.10, 1.53, p = 0.06). The secretome provides good effectiveness in accelerating wound healing through a mechanism that correlates with several clinical parameters of wound repair.

Acne Scar Management: Minoxidil as a Promising Approach or a Mirage?

Atrophic and hypertrophic scars can result from various conditions, such as acne, trauma, and surgery. Minoxidil, a medication used for the treatment of severe hypertension and hair loss, has been explored as a potential treatment for scars. This review aims to evaluate the current evidence regarding the role of minoxidil in the treatment of scars. Previously published reviews have primarily focused on the use of minoxidil in hair loss and have only briefly mentioned its potential use for scars. However, minoxidil may have a beneficial effect as an antifibrotic agent. Several studies have reported reduced collagen accumulation and fibrosis after treatment with minoxidil. The proposed mechanism of action is inhibition of the production of lysyl hydroxylases (LHs), which modify and cross-link proteins by converting lysine to hydroxylysine, making collagen more resistant to degradation. Minoxidil, as an LH inhibitor, has been shown to potentially benefit wound healing and regeneration in vitro by inhibiting the proliferation and migration of fibroblasts. To date, direct studies of the efficacy of minoxidil in treating acne scars have not been conducted; however, its inhibitory effects on fibroblast function and antifibrotic outcomes in some in vivo studies suggest that such use may be considered.

Hidradenitis suppurativa from the typical patient to the new clinical phenotypes

Hidradenitis suppurativa (HS) is a clinically heterogeneous disease with a broad spectrum of clinical features. Attempts to classify HS into distinct clinical phenotypes could lead to a better understanding of the condition and the development of individualized treatment protocols. We summarize some of the existing phenotype classifications and present our experience with 250 patients and their many clinical presentations. We have emphasized the pathophysiologic and clinical overlap between HS and pyoderma gangrenosum. The more severe presentations can include erosive and ulcerative lesions, sometimes associated with vegetative changes leading to diagnostic quandaries. We propose a new phenotype of pyoderma gangrenosum–like HS in which painful ulcerative or vegetative lesions appear in sites affected by HS, their activity coincides with the flareups of classic inflammatory manifestations of HS, and they heal with cribriform or atrophic scars.

Fractional carbon dioxide laser combined with subcision for the treatment of three subtypes of atrophic acne scars: a retrospective analysis.

Fractional carbon dioxide (CO2) laser combined with subcision has been widely used for the clinical treatment, but the efficacy of the combined therapy on three types of atrophic acne scars remains unreported. This retrospective study analyzed the clinical data of 413 patients with atrophic acne scars, treated with fractional CO2 laser combined with subcision in the combined group and with fractional CO2 laser in the control group. The treatment efficacy was evaluated by the Investigator's Global Assessment (IGA) and the Échelle d'évaluation clinique des cicatrices d'acné (ECCA). We reported adverse reactions such as erythema, lump, skin sensitivity, acne recurrence, and hyperpigmentation that occurred in both treatment groups. The treatment efficiency of the combined group was significantly higher than that of the control group (P < 0.001). Among the three subtypes of atrophic acne scars, the ECCA scores in the combined group of boxcar-type and rolling-type scars after treatment were lower than those in the control group (P = 0.041, P < 0.001, respectively), and no statistical difference in scores between the two groups for icepick-type scars was seen (P = 0.062). There was no statistical difference in adverse reactions between the two groups (P = 0.361). Fractional CO2 laser combined with subcision is more effective than fractional CO2 laser in thetreatment of boxcar-type and rolling-type scars, but there is no significant difference in the treatment of icepick-type scars.

Efficacy of autologous adipose-derived stem cells and fractional carbon dioxide laser in the treatment of atrophic linear scars

Background Atrophic linear scars are scars that exhibit indentation or depression in the skin below the level of the surrounding tissues. Hyperpigmentation or hypopigmentation may be present. They are often caused by surgery, burns, and trauma. Objective To evaluate the efficacy of autologous adipose-derived stem cells (ADSCs) combined with fractional carbon dioxide (CO2) laser in the treatment of atrophic linear scars. Patients and methods This randomized, controlled preliminary study included 20 patients aged 20–45 years of both sexes with facial atrophic linear scars. The patients were randomized systematically into two groups: group A (combined ADSCs and fractional CO2 laser procedure) and group B (fractional CO2 laser only) of 10 patients each. The scar was evaluated using the Vancouver scar scale, along with a subjective satisfaction questionnaire, and ultrasound skin analysis at baseline and 1 month after the third treatment session. Results All participants completed the study. The mean Vancouver scar scale score improved significantly from 3.60±0.69 to 1.20±0.79 and from 2.20±1.03 to 1.60±0.52 with fractional CO2 laser plus ADSCs and CO2 laser procedure, respectively (P&lt;0.001). However, CO2 laser plus ADSCs was significantly superior. Ultrasound skin examination showed a statistically significant increase in dermal collagen density (thickness) in both groups. Conclusion Our study shows that treatment with CO2 laser exposure plus ADSCs is safe and more effective for atrophic linear scar management than CO2 laser exposure alone.

Epidermolysis bullosa: a tale of two sisters

Epidermolysis bullosa (EB) is a clinically and genetically heterogenous, inherited, mechanobullous disorder characterised by spontaneous or trauma induced blisters over skin and mucous membranes. Four major forms are: EB Simplex, EB Junctional, EB dystrophic and mixed. A 11-year-old and a 9 year old female child, both sisters, accompanied by their father, presented to dermatology OPD, with chief complaints of multiple raw areas over elbows and knees since infancy. There was history of fluid filled lesions which were induced by trauma or friction during handling or while playing. These lesions ruptured on their own or on trauma to form raw areas with crusting which further healed with scarring and small white raised lesions. Also, he gave history of loss of nails following blistering on toes in infancy. No associated systemic complaints were noted. On examination, both of them presented with multiple erosions and ulcers with oozing of blood, few bullae and crusted lesions over elbows, knees and feet. There were multiple atrophic scars and skin coloured to whitish papules [milia] over feet, ankles, elbows and knees. There were loss of nails of toes of both feet. On biopsy, histopathological examination revealed bullae at dermoepidermal junction. Diagnosis of EB junctional was made. EB is a rare inherited disorder. Its management includes prevention and healing of blisters and infection. Psychological support to patients and their families is of prime importance.

Comparative Study of Polydioxanone Monofilament (PDO) Threads Combined with Scar Subcision versus Fractional CO2 Laser Combined with Scar Subcision in Management of Atrophic Post Acne Scars

Abstract Background Acne is an inflammatory disorder of the pilosebaceous unit characterized by comedones, inflammatory papules, pustules, and nodules of the face, chest, and back. The inflammatory response in some acne patients results in permanent, disfiguring scars from either increased tissue formation or due to loss or damage of tissue. Many treatments have been attempted in order to improve acne scarring such as: chemical peels, surgical excision, subcision, punch grafting, dermabrasion, fillers and laser have been used to ameliorate atrophic acne scars with varying degrees of success Objectives The aim of this work was to study the efficacy of polydioxanone (PDO) monofilament threads combined with scar subcision versus fractional Co2 laser combined with scar subcision in management of atrophic acne scars. Patients and Methods This is a split-face pilot study included 10 patients with atrophic acne scars. The patients recruited from the Outpatient Dermatology Clinic at Ain Shams University Hospitals. Fractional CO2 laser sessions were done for the right side of the face (2 sessions - one month apart), and Polydioxanone (PDO) threads were inserted to the left side of the face (2 sessions - one month apart), each treatment modality was preceded by scar subcision. The patients were followed up for 3 months. The response of treatment was evaluated by Antera 3D camera. Results Our study revealed that treatment of the right side of the face with fractional CO2 Laser led to statistically significant improvement more than what was achieved by PDO threads on the left side. It was also found that both PDO monofilament threads and Fractional Co2 laser improved the skin texture. Conclusion .The current study confirmed the superiority of fractional CO2 laser for the management of atrophic post acne scars. Polydioxanone threads had an effect in improving the skin texture but their overall effect is not comparable to the effect of fractional CO2 laser. To the best of our knowledge, we were the first to compare between Fractional Co2 laser and poydioxanone threads regarding there efficacy in management of atrophic acne scars and to evaluate the response using Antera 3D camera.

Efficacy of ultraphonophoresis with an enzyme gel with high transcutaneous and proteolytic activity in patients with atrophic skin scars: a prospective interventional cohort comparative study

Introduction. The trend towards an increase in peacetime and wartime injuries and the frequent formation of severe cicatricial dysplasia dictate the need to develop an effective, universal, and widely available method for the prevention and correction of fibrotic skin deformities applied by doctors of various specialties: dermatocosmetologists, physiotherapists, and rehabilitologists. In addition to persistent irreversible structural damage and a visible skin defect, patients are concerned about itching and other subjective sensations in the scar area. Physical methods of correction using transdermal deliveries of enzyme fibromodulatory drugs are scientifically substantiated and are widely used in the rehabilitation period of patients with scars of various origins. Meanwhile, the therapeutic possibilities of influencing the subjective sensations of this group of patients remain only partially studied up to date. Materials and methods. A prospective interventional cohort comparative study of the efficacy and safety of using the ultraphonophoresis technique with an enzyme gel with a high transcutaneous and proteolytic ability in patients with atrophic skin scars was carried out. The study included 56 patients with a diagnosis of «atrophic scars» (ICD-10 Chapter XII: Diseases of the skin and subcutaneous tissue, L90). The entire sample was divided into groups with developing (n=27) and mature (n=29) scars. As a result of random distribution, the study subgroups (groups 1, 3 n=14 and n=15) and comparison subgroups (groups 2, 4 n=13 and n=14), in which the patients were prescribed topical therapy with traditionally used anti-scar drugs, were formed. During the study, clinical, instrumental, and medico-sociological research methods were used. Results. In the study groups, a high safety profile of gel ultraphonophoresis procedures and more significant changes in the macro-relief of the scar, instrumental indicators, and quality of life indicators have been established. Conclusion. The method of ultraphonophoresis with an enzyme gel with high transcutaneous and proteolytic activity in patients with atrophic skin scars has been scientifically substantiated and tested. The effectiveness of the treatment complex is 84–88 %.

E54 The Ehlers-Danlos syndrome, a disease of late diagnosis: report two cases

Abstract Introduction Ehlers-Danlos syndromes (EDS) are a heterogeneous group of rare inherited collagen disorders. Clinical signs are dominated by generalized joint hyper laxity, skin hyper elasticity and tissue fragility. The diagnosis is clinical in the absence of genetic testing. There is no curative treatment but it is possible today to improve the quality of life of these patients. We report two cases of EDS from a non-consanguineous marriage, without similar cases in their families. Observations CASE 1: Mrs N.B, 31 years old, 2nd of 4 siblings, with a history of heterozygous beta thalassemia, she presented with mechanical gonalgias secondary to patellar dislocations associated with ankle sprains since the age of 5 years. On clinical examination: generalized hyper mobility (Beighton score 9/9), hyper elasticity of the skin, skin fragility, atrophic scarring, papery skin of the knees, hyper transparency of the skin, epistaxis at the slightest scratching, the rest of the somatic examination was unremarkable. The standard biological workup, X-ray and ultrasound of the knees and ankles were without abnormalities. Classic EDS (I and II) was retained according to the 2017 international classification. The patient responded to tier I analgesics. Case 2 Mrs B.L, 24 years old, the third of five siblings, with a history of bronchial asthma, presented with bilateral and symmetrical polyarthralgia affecting the large and small joints with mixed type spinal pain associated with spontaneous myalgia in a context of profound asthenia evolving for 14 years. On osteoarticular examination, generalized joint hypermobility was noted (Beighton score 9/9); on the cutaneous level, transparency and hyperextensibility of the skin with multiple ecchymoses due to tissue fragility associated with delayed healing with cutaneous hyperesthesia, all associated with exertional dyspnea, chronic abdominal pain and gastroesophageal reflux since the onset of his illness. Biologically, no inflammatory syndrome. The autoimmune workup (RF, ACPA, FAN) was negative and other investigations were without abnormalities. X-rays of the chest, hands, wrists and knees were unremarkable. The patient was classified as having hypermobile EDS (type III) according to the international classification of the disease. The patient responded only partially to analgesics (levels I, II and III) and to tricyclic antidepressants. Conclusion The diagnosis of EDS must be made early in order to ensure optimal symptomatic management. The management must be multidisciplinary, including an evaluation, a psychological follow-up, a treatment of the pain and physiotherapy.

Dynamic panoramic presentation of skin function after fractional CO2 laser treatment

Fractional CO2 laser, as a typical ablative laser, has been used to assist in the treatment of many skin diseases, such as photoaging, atrophic scar, hypertrophic scar, superficial pigmentation, vitiligo, and so on. However, the dynamic changes in skin function after fractional CO2 laser treatment are still unclear. This study explored the changes in local skin function and possible regulatory mechanisms after fractional CO2 laser treatment for 1, 3, 5, and 7days through transcriptome high-throughput sequencing. The results showed that fractional CO2 laser tended to transform the "lesions" into "normal skin", regulate the skin barrier, coordinate the rearrangement of collagen, enhance the local microvascular circulation, activate the immune system to secrete a large number of cytokines, and act as an auxiliary tool to assist drug transport. In conclusion, according to the basic principle of destruction before reconstruction, fractional CO2 laser plays a key role of balancer in skin reconstruction.

Study on Acne Scarring and Its Relationship between Severity and Treatment of Active Acne: An Observational Study

Background: Incorrectly selected treatment or the presence of severe acne vulgaris can lead to the formation of atrophic scars. Objective: The purpose of the present study was to evaluate the acne scarring and its relationship between severity and treatment of active acne. Methodology: This was cross-sectional observation study was performed in the EW VM Health Bangladesh Ltd., Dhaka for a period of 6 months. Evaluation of the types, sites, and severity of acne scars was done, and details of the severity and treatment of acne were recorded. Patients of all age-groups presenting for treatment of acne scars were included in the study. Results: This study shows maximum (40%) were age group 31-40 years. Face was involved in all the patients with acne vulgaris, which included the cheeks (91%), forehead (43%), jaw (51%), chin (27.0%), and nose (16.0%). The most common type of lesion predominantly observed was comedones (54.0%) followed by papules (53.0%), pustules (43.0%), nodules (29.0%), and cysts (3.0%). It was observed that 21.0% were mild acne, 27.0% were moderate acne and 52.0% severe acne. In grading system of acne scaring, 19.0% were macular acne scar, 14.0% were mild acne scar, 28.0% were moderate acne scar and 39.0% were severe acne scar. Conclusion: This study found majority of patients with active acne delay treatment, which leads to increased acne scarring. Journal of Current and Advance Medical Research, July 2022;9(2):69-73

Microneedling with autologous platelet-rich plasma versus topical insulin for treating postacne scars: A split-face comparison

Abstract Post-acne atrophic scars (PAS) are a common complication of acne, and their treatment can be limited in people of color due to dyspigmentation and scarring risks. This split-face study compared the efficacy of microneedling with topical insulin (TI) on one side of the face with microneedling with platelet-rich plasma (PRP) on the other side for the treatment of PAS. The study included 50 participants with Fitzpatrick skin types III to VI who had never been treated for PAS. Both sides of the face showed significant improvement, with the left side (TI) showing a 52% improvement and the right side (PRP) showing a 28% improvement. The treatment was well-tolerated, with no significant adverse effects, and no changes in blood glucose levels were observed. The researchers suggest that combining TI or PRP with microneedling can improve PAS treatment, with TI being a superior option due to its ease of use, low cost, and noninvasive nature.

Application of Picosecond Laser in Dermatology

ABSTRACT Background: Lasers are one of the most important treatment modalities in dermatology. Lasers interact with chromophores through several mechanisms that depend on fluence and pulse durations. Early lasers worked by photothermal interaction with pulse durations of 1 microsecond to 1 second. A picosecond laser is developed to confine photothermal effects and produce photomechanical effects and plasma induction. Purpose: To understand the mechanism of action and application of picosecond lasers for dermatological disorders. Review: Non-fractional picosecond lasers work by photomechanical interaction. Photomechanical interaction happens when pulse duration is less than inertial confinement time, causing fractures of chromophores with lower energy, or “cold ablation”. Fractional picosecond lasers work by laser-induced optical breakdown (LIOB). In LIOB, accelerated seed electrons cause an electron avalanche that produce a collection of free electrons called plasma, which ablates tissues. LIOB in the skin is always followed by photodisruption. In LIOB, vacuoles and debris were eliminated transdermally and dermal collagen and elastin increased. Picosecond laser may be applied in disorders requiring destruction of chromophores and for collagen and elastin disorders. It is currently the first-line treatment for tattoo removal (Nevus of Ota and Acquired Bilateral Nevus of Ota-like macules, or ABNOM). It has good efficacy and safety for solar lentigines, freckles, and cafe-au-lait macules (CALM). It is an additional treatment for moderate to severe melasma and hypertrophic scars, in combination with other treatments. The fractional picosecond laser showed moderate improvement and low risk of postinflammatory hyperpigmentation (PIH) for atrophic acne scars and produced improvement in striae alba.

Analysis of Opportunities and Prospects of Lipofilling Method in Patients with Atrophic Skin Scarring: A Literature Review

Analysis of Opportunities and Prospects of Lipofilling Method in Patients with Atrophic Skin Scarring: A Literature Review

Efficacy of Fractional Carbon Dioxide Laser versus Fractional Carbon Dioxide Laser with Platelet-Rich Plasma in Treatment of Striae Distensae in a Tertiary Care Center: A Comparative Study.

Striae distensae are atrophic scars that are often cosmetically distressing. The efficacy of fractional carbon dioxide (CO2) laser and platelet-rich plasma (PRP) in treating striae individually has been evaluated previously. However, not many studies described the combined efficacy of both. The aim of this study was to compare the efficacy and safety of fractional CO2 laser alone and in combination with PRP. Twenty-four patients with striae presenting bilaterally in the abdomen, upper limbs, and lower limbs were included. PRP was prepared by double-spin method and cell count was done to ensure at least fourfold concentration of platelets. The patients were treated CO2 laser on both sides and PRP on the left side along with laser, every month for three sessions. Digital photography and dermoscopy were done at baseline, every treatment session, and 6 months after treatment. Clinical improvement was assessed by comparing photographs and patient satisfaction before and after treatment. All patients showed improvement on both sides. In CO2-laser-treated patients, responses in 6 patients (25%) were moderate, 14 (56%) were good, and 4 (16.6%) were excellent. In CO2-laser and PRP-treated patients, responses in 5 patients (20.8%) were moderate, 11 (45.8%) were good, and 8 (33.3%) were excellent. Hyperpigmentation was the most common side-effect seen (19 patients) on both sides, which resolved spontaneously by 6 months. These results support the use of ablative CO2 fractional laser as effective and safe treatment modalities for striae. However, slightly better efficacy was noted with the addition of PRP.