Skin Quality Research Articles

PN-HPT® (Polynucleotides Highly Purified Technology) in facial middle third rejuvenation. Exploring the potential.

BackgroundWasting of soft tissues leads to flattening and deflation of the aging midface skin. Polynucleotides Highly Purified Technology (PN‐HPT®) demonstrated dermal hydration and elasticity as well as fibroblasts vitality and activity.AimsTo probe the value of PN‐HPT® in middle third rejuvenation in an open‐design, exploratory prospective cohort study in 40 real‐life ambulatorily treated women.MethodsThree treatment sessions—at baseline (2‐ml prefilled syringe containing 10 mg/ml PN‐HPT®, 10 mg/ml hyaluronic acid, 200 mM mannitol) as intradermic gel, and after 3 weeks (2‐ml prefilled syringe containing 20 mg/ml PN‐HPT® intradermic gel) and 6 weeks (same treatment as baseline). The protocol allowed supplemental treatment with specifically formulated PN‐HPT® (7.5 mg/ml) when needed in periocular and eyelid areas. Assessments: sequential photographs of the facial middle third at baseline, third treatment session and 6–8 weeks after the third treatment session; scoring of overall skin quality and texture, skin quality determinants (wrinkles and skin roughness, skin elasticity, skin brightness), scar appearance, and subjective satisfaction with impromptu 10‐cm Visual Analogue Scales.ResultsSignificant improvement of overall skin quality and texture (from 7.0 ± 1.06 at baseline session to 7.8 ± 0.99 at follow‐up), associated with highly significant improvements of wrinkles and skin roughness, elasticity, and brightness (–17.1%, +39.6%, and +51.1%, respectively). The severity scores of post‐acne scars decreased from 7.6 ± 1.32 to 4.2 ± 2.13. Individual satisfaction score at the end of treatment: 0.8 ± 0.28.ConclusionsPN‐HPT® candidate as a valuable option for facial middle third rejuvenation. Further trials will hopefully confirm these early results.

Skin measurement devices to assess skin quality: A systematic review on reliability and validity.

BackgroundMany treatments aim to slow down or reverse the visible signs of skin aging and thereby improve skin quality. Measurement devices are frequently employed to measure the effects of these treatments to improve skin quality, for example, skin elasticity, color, and texture. However, it remains unknown which of these devices is most reliable and valid.Materials and methodsMEDLINE, Embase, Cochrane Central, Web of Science, and Google Scholar databases were searched. Instruments were scored on reporting construct validity by means of convergent validity, interobserver, intraobserver, and interinstrument reliability.ResultsFor the evaluation of skin color, 11 studies were included describing 16 measurement devices, analyzing 3172 subjects. The most reliable device for skin color assessment is the Minolta Chromameter CR‐300 due to good interobserver, intraobserver, and interinstrument reliability. For skin elasticity, seven studies assessed nine types of devices analyzing 290 subjects in total. No intra and interobserver reliability was reported. Skin texture was assessed in two studies evaluating 72 subjects using three different types of measurement devices. The PRIMOS device reported excellent intra and interobserver reliability. None of the included reviewed devices could be determined to be valid based on construct validity.ConclusionThe most reliable devices to evaluate skin color and texture in ordinary skin were, respectively, the Minolta Chromameter and PRIMOS. No reliable device is available to measure skin elasticity in ordinary skin and none of the included devices could be determined to be designated as valid.

Impact of Dietary Zinc Chloride Hydroxide and Zinc Methionine on the Faecal Microbiota of Healthy Adult Horses and Ponies

Zinc supplements are often used in equine nutrition to support skin and hoof quality or the immune function. However, no data on the effects of dietary zinc on the intestinal microbiota of horses and ponies are available so far. In the present study, varying dietary zinc concentrations (maintenance (4 mg/kg BW0.75/day), 120 mg/kg dry matter (DM)/day and 240 mg/kg DM/day) were achieved by the supplementation of either zinc chloride hydroxide or zinc methionine (six treatment periods of 4 weeks each). Eight healthy adult ponies and two healthy adult horses were included, and faecal samples were collected at the end of each treatment period to analyse the microbiota (16S rDNA sequencing) and microbial metabolites. With increasing dietary zinc concentrations, the richness of the faecal microbiota decreased, independently of the zinc compound used. In addition, a decrease of the relative abundance of Bacteroidetes and Fibrobacteres as well as of acetate and total short-chain fatty acids in the faeces of the animals was observed at high zinc intakes. Effects on the bacterial order, family and genus level were also detected, which were partly more pronounced for zinc chloride hydroxide. It can be concluded that high dietary zinc levels decrease the richness and fermentative activity of the faecal microbiota of horses and ponies. Although all animals were healthy throughout the study, the effects could be critical for gut health, and deserve more research. The detected differences between the zinc compounds used indicate differences in the bioavailability of organic and inorganic zinc sources in equines.

Impact of sun exposure on adult patients affected by atopic dermatitis.

Background Atopic dermatitis management is challenging and usually requires intermittent or continuous, long-term treatment with topical and/or systemic antiinflammatory agents and appropriate skin care. Most patients affected by atopic dermatitis improve during sun exposure. It has been reported that the change from a subartic/temperate to a subtropical climate for 4 weeks improved significantly skin symptoms and quality of life in children, even for 3 months after return. However, until now the effect of sun exposure on adult patients with atopic dermatitis has never been investigated. Methods We conducted a retrospective study to assess the short-term effect of sun exposure during summer holidays on skin symptoms of adults affected by AD. Results One hundred and fourteen patients were enrolled in the study (62 males; aged 18-72 years, mean age 35.3 ± 12.6). Seventy-three out of 114 patients (64%) spent their holidays at the seaside, and 41/114 (36%) in the mountains; 38/41 (92.7%) subjects from the latter group reported that during their holidays they frequented outdoor swimming pools or solariums almost every day of their vacation. The sunlight effect was considered beneficial by 68/114 (59.6%) of patients. In particular, 38/114 patients (33.3%%) reported the improvement of AD and 30/114 (26.3%) the complete resolution of the disease during summer holiday. Conclusions Our data seem to suggest that sun exposure is beneficial in most patients, but not in all patients. In fact, sun exposure does not appear to improve skin symptoms or even aggravate them in about 4 out of 10 patients. This could be particularly important also in light of ongoing climate changes that may affect the clinical history of several skin diseases, among which AD.

Validation of a skin and coat scoring protocol in dogs

Skin and coat scores have been used to assess changes in skin and coat quality in dogs. The aim of this study was to evaluate a skin and coat protocol in dogs of different coat types. Skin and coat of long-haired, short-haired and wire-haired dogs were scored for alopecia, glossiness, greasiness, softness, scaliness and overall skin and coat quality by ten observers. Intraobserver and interobserver agreement was assessed using kappa values. Thirty-six client-owned dogs were included in the study. The overall intraobserver agreement was moderate when assessing greasiness and glossiness and substantial when assessing alopecia, softness, scaliness and overall skin and coat quality. The overall interobserver agreement was only slight to fair for all features assessed. In conclusion, the proposed skin and coat scoring protocol assesses different aspects of the skin and coat quality in dogs and is easy and non-invasive. Scoring skin and coat quality over time is only reliable if performed by the same person.

Cicatricial eyebrow restoration using the follicular unit extraction technique.

Cicatricial eyebrow loss that occurs after trauma or burns considerably reduces a person's self-confidence. Several methods, either surgical or nonsurgical, have been defined to reconstruct eyebrows. This study focused on eyebrow restoration using the atraumatic follicular unit extraction (FUE) technique in patients and emphasized certain details that should be considered during the treatment process. In this study, we discussed the management of 18 cases using this technique and their outcomes with respect to published literature. This study examined eyebrow restoration performed using a modified FUE technique in 18 patients who had cicatricial eyebrow loss due to trauma, excised congenital giant nevus, or burns. Moreover, special methods, including platelet-rich plasma, microneedling, steroid injections, and fat grafting, were used in each patient to increase the odds of graft survival. Aesthetically and functionally satisfactory outcomes were observed along with the appropriate orientation and symmetry of the eyebrows in all patients' follow-ups. Moreover, patients exhibited increased self-confidence, and the quality of skin, particularly in the transplantation area, was improved. There was no complication either in the recipient or in the donor site. Eyebrow restoration using the atraumatic FUE technique should be considered as the first treatment option in cases with cicatricial eyebrow loss as long as an appropriate evaluation and treatment method is followed for each patient.

Management of surgical soft tissue defects of the lower extremities.

Management of post-operative soft-tissue defects on the lower legs is challenging owing to arterial and venous insufficiency, poor skin quality including epidermal and dermal atrophy, insufficient tissue laxity, and increased risk of infection. This paper highlights the management of post-operative soft-tissue defects on the lower extremity that cannot be closed primarily or by reconstruction with a local flap. A systematic review of the literature was performed using the National Library of Medicine (NLM) PubMed online database. Articles were included if they reported the management of post-operative lower extremity soft-tissue defects with secondary intention healing, full-thickness skin graft, split-thickness skin grafts, or skin substitutes. Sixty-three articles were included for analysis. There are several options for managing surgical defects on the lower legs and the method chosen should depend on various factors, including the quality of the skin, vascularity and size of the defect, medical history of the patient, and the experience of the surgeon.

Myths and media in oral collagen supplementation for the skin, nails, and hair: A review.

As a key component of the hair, skin, and nails, there is strong consumer interest in the dermatologic efficacy of oral collagen supplementation. Oral supplementation with collagen peptides has increased in popularity in recent years. There are relatively few studies investigating the dermatologic effects of ingested collagen peptides, many of which are limited by sample size and variability of results. The question remains whether there is sufficient evidence to support companies' promises and consumers' goals. In this review, we investigate and compare the claims surrounding collagen supplementation on Instagram and YouTube, made by collagen companies, and established in the literature. Although some studies have demonstrated that collagen supplementation can enhance skin qualities such as elasticity and hydration, dermatologic claims in the media surpass any evidence currently supported by the literature. More research is needed to establish knowledge of the effects and physiologic mechanism of collagen supplementation. Dermatologists should be aware of the unsubstantiated proclamations of collagen made by companies and in social media, as well as what evidence is established thus far, to be equipped to discuss collagen supplementation with patients.

Combination treatment for buttock and abdominal remodeling and skin improvement using HIFEM procedure and simultaneous delivery of radiofrequency and targeted pressure energy.

BackgroundHigh‐intensity electromagnetic field procedure (HIFEM) is an effective tool for body shaping and muscle toning. Radiofrequency (RF) combined with targeted pressure energy (TPE) provides the solution for skin laxity and cellulite.AimsTo document the effect of consecutive use of HIFEM, RF, and TPE for treatment of abdomen and buttocks.MethodsFifteen subjects (44.3 ± 14.2 years, 22.3 ± 2.3 kg/m2) finished treatments and consequent follow‐ups. They were treated over the abdomen (Group 1, N = 7) or buttocks (Group 2, N = 8), receiving four treatment procedures consisting of HIFEM treatment administered first, immediately followed by the simultaneous RF & TPE treatment. Each session took approximately 50 min (30 min of HIFEM; up to 20 min of RF & TPE) depending on the treated area. Study outcomes were assessed by the circumference measurement, satisfaction and comfort questionnaires, and digital photographs.ResultsCombined treatments were safe and comfortable. At 1 month, the abdominal circumference significantly decreased by 4.4 cm, while buttocks showed a significant increase by 1.0 cm. The abdomen (−4.1 cm) and buttocks (+1.2 cm) circumference results were sustained for three months without a significant decline. Satisfaction was high in both groups (93.3%) since most subjects noted that the appearance of the treated area has been improved, referring to both body sculpting and skin appearance.ConclusionsThe consecutive application of HIFEM, RF, and TPE treatments noticeably improved the appearance of the abdomen and buttocks. Subjects showed enhancement of abdominal body contour, buttock lifting, and improved skin quality manifested by reduced skin laxity and cellulite.

Thiamidol® in moderate-to-severe melasma: 24-week, randomized, double-blind, vehicle-controlled clinical study with subsequent regression phase.

Thiamidol® was the most potent inhibitor of human tyrosinase out of 50000 screened substances. In vivo, it was well tolerated and improved melasma significantly. This was the first 24-week, randomized, double-blind, vehicle-controlled, cosmetic clinical study to assess the efficacy and tolerability of thiamidol in moderate-to-severe melasma of phototype III-V subjects with subsequent regression phase. Females allocated to verum (n=23), applied daily Dual Serum followed either by Day Care SPF30 in the morning or by Night Care in the evening, all containing Thiamidol. The vehicle group (25 females) followed the same skin care routine using the corresponding vehicle formulations. Subjects came back for a follow-up visit 13-20weeks after treatment (regression phase). Assessments included clinical photography, Melasma Area and Severity Index (MASI), skin lightness, quality of life, and tolerability. Baseline demographics and hyperpigmentation were well balanced across the treatment groups. Clinical photography and MASI improved with Thiamidol significantly versus baseline (p<0.001) and vehicle (p<0.001-0.043) at all time points up to treatment end. At follow-up, the MASI was still significantly lower than at baseline but similar for verum and vehicle. Skin lightness and quality of life improved significantly versus baseline without significant differences between verum and vehicle. This study demonstrated that Thiamidol is well tolerated and superior in improving melasma compared to baseline and vehicle over a treatment period of 24weeks.

O17 What lies beneath: A case of lymphohistiocytic myofasciitis in a 4-year-old girl

Case report - IntroductionA 4-year-old girl presented with a 1-year history of difficulty dressing, walking, and getting up from the ground. Examination revealed thickening of the skin, and the presumptive diagnosis was that of scleroderma. However, the dramatic loss of movement seemed out of proportion to her skin changes and therefore further investigations were completed. Her final diagnosis was that of a myofasciitis, a rare diagnosis in a child. This case highlights the importance of a thorough investigative process in order to make the correct diagnosis and explains our management plan for this young girl. Case report - Case descriptionA 4-year-old girl, previously well presented with a 1-year history of difficulty dressing, walking, and getting up from the ground. Her joints were never swollen. There were no other systemic symptoms. There was no past medical history. Developmentally all her milestones were achieved on time prior to symptom onset, though she always found it difficult to climb the stairs. Examination revealed thickening of the skin that felt like advanced scleroderma. The skin on her forearms and ankles was quite turgid. There was an area of morphea around her right shoulder. There were no areas of erythema. There was striking limitation of range of movement of her wrists and shoulders. There was marked stiffness around both ankle joints, although this appeared to be due to the overlying tissue structure, rather than the joint. Diagnosis was likely scleroderma. However, the skin changes seemed out of proportion with the dramatic loss of range of movement. An MRI of her shoulder girdle revealed dramatic fasciitis involved in the deep fascial planes, just superficial to the muscles. This was marked around the shoulder girdle. Her eosinophil counts gradually climbed. A plausible diagnosis was Eosinophilic Fasciitis/overlap with scleroderma features. This too is unusual in a young child. A muscle biopsy was performed. A full thickness biopsy of her right lateral bicep was taken. This revealed lymphohistiocytic granulomatous inflammation involving the skin, fascia and biceps muscle. The patient was started on high-dose methylprednisolone, for 3 consecutive days, followed by weaning oral prednisolone and subcutaneous methotrexate. Two months later her condition was completely transformed. She had gained full range of movement in all her joints. Her skin quality had greatly improved. She remained on methotrexate weekly. A repeat MRI was organised 8 months after commencing treatment. This revealed a dramatic improvement. She remains on methotrexate alone. Case report - DiscussionMyofasciitis is an unusual inflammatory myopathy almost exclusively described within the adult population. Myofasciitis is a distinctive entity, which is different from the usual idiopathic inflammatory myopathies, sarcoid myopathy and fasciitis-panniculitis syndrome. Clinical presentation can be non-specific particularly with the paediatric population. Hypotonia, developmental delay, fatigue, myalgia and muscle weakness have all been reported. Clinical presentation can be apparent in infancy, or slightly later in childhood. In macrophage myofasciitis the muscle biopsy typically reveals a monomorphous infiltration of the connective tissue by sheets of densely packed periodic acid-Schiff positive macrophages. There may be intermingled lymphocytes and muscle fibre damage.A few different associations have been postulated. Intramuscular injections containing aluminium adjunct may be associated with macrophagic myosfasciitis but the underlying process for this remains unclear. The association with autoimmune disease and macrophagic myofasciitis suggests that those from a particular genetic background may be more likely to develop this condition. Genetic predisposition, however, most likely accounts for the variability in the prevalence of macrophagic myofasciitis in different populations. Given the paucity of literature on macrophage myofasciitis in the paediatric population there is no clear consensus for a treatment strategy. On reviewing the literature many children were first treated with high dose IV pulsed methylprednisolone, followed by oral prednisolone, some received IV Immunoglobulin. Case report - Key learning pointsAs with many inflammatory muscle disorders patients are often seen by numerous clinicians prior to arriving at paediatric rheumatology. This may mean a prolonged time period before the patient receives appropriate treatment. Through delivering good education to our colleagues mainly in general paediatrics and general practice hopefully this will continue to improve.This case report highlights the importance of a muscle biopsy for diagnosis. Without tissue the correct diagnosis would not be possible and subsequently the treatment given may not be the most suitable for the patient.The histology for this myofasciitis is rare - in adult practice, but definitely within paediatric practice.Methotrexate is well recognised as a suitable and evidence-based treatment for many inflammatory myopathies. Although this condition is slightly different, it has worked incredibly well for the patient. This highlights that when faced with uncertainty as clinicians it is important to consider what we think theoretically will work for our patients.

345 A Novel Fixation Method for Unstable Ankle Fractures in The Elderly with Poor Quality Skin, Via Dual Percutaneous Tibiotalar Cannulated Screws

Abstract Introduction The incidence of ankle fractures is highest in the elderly population due to poor bone quality. Osteoporosis and poor overlying skin increase risk of infection, wound breakdown, and fixation failure. This ultimately results in worse functional outcomes. This retrospective case-series describes a novel dual percutaneous tibiotalar cannulated screw fixation method, for managing unstable ankle fractures, in high-risk elderly patient with low functional demand. Method Six elderly patients were identified between January 2019-2020 who underwent dual tibiotalar cannulated screw fixation for unstable ankle fractures. Pre-operative and post-operative pain and mobility scores were obtained via telephone consultation and case-note review. Radiographs were analysed pre-operatively for fracture type and post-operatively for complications such as, talar shift. Wound Infection post-operatively was monitored. Results The mean age was 86.8 with an average ASA grade of three. Functional outcomes were excellent with 83.3% of patients remaining ambulatory with no post-operative pain at an average follow-up of 10.25 months. Three patients (50%) had excellent post-operative radiographs with evidence of union and no talar shift. Two patients (33.3%) had either non-union or minor talar shift, and one patient (16.7%) had multiple radiological complications likely due to delayed fixation. All three patients remained ambulatory and had minimal post-operative pain. There were no reports of soft tissue injury or infection due to the surgery. Conclusions Dual percutaneous tibiotalar cannulated screws can be used to manage unstable ankle fractures in the low demand elderly patient, with poor skin quality. Function outcomes were good with satisfactory post-operative mobility and minimal pain in the majority of cases.

Facial Aesthetic Priorities and Concerns: A Physician and Patient Perception Global Survey.

BackgroundMinimally invasive and noninvasive facial aesthetic treatments are increasingly popular, and a greater understanding of patient perspectives on facial aesthetic priorities is needed.ObjectivesThe authors surveyed facial aesthetic concerns, desires, and treatment goals of aesthetically conscious men and women, and physicians, in 18 countries.MethodsThis was a global, internet-based survey on desired appearance and experiences with, or interest in, facial aesthetic treatments. Eligible respondents were aesthetically conscious adults (21-75 years). Eligible aesthetic physicians were required to see ≥30 patients per month for aesthetic reasons, have 2 to 30 years of experience in clinical practice, and spend ≥70% of their time in direct patient care.ResultsA total of 14,584 aesthetically conscious adults (mean age, 41 years; 70% women) and 1315 aesthetic physicians (mean age, 45 years; 68% men) completed the survey. Most respondents (68%) reported that aesthetic procedures should be sought in their 30s to 40s; physicians recommended patients seek treatment earlier. Respondents expressed greatest concern over crow’s feet lines, forehead lines, facial skin issues, hair-related concerns, and under-eye bags or dark circles; in contrast, physicians tended to underestimate concerns about under-eye bags or dark circles, mid-face volume deficits, and skin quality. Although both physicians and respondents cited cost as a major barrier to seeking aesthetic treatments, respondents also emphasized safety, fear of injections or procedure-related pain, and concern about unnatural-looking outcomes.ConclusionsThis global survey provides valuable insight into facial aesthetic concerns and perspectives that may be implemented in patient education and consultations to improve patient satisfaction following aesthetic treatments.

Virtual skin: Assessing Player Experience of Attractiveness with the User Experience Questionnaire (UEQ)

There are numerous subfields within visual communication, one of which is new media, alongside conventional practices such as advertising, photography, the web, animation, and signage. Blogs, social media, video games, email and the pervasiveness of smartphones have all resulted in the emergence of new media that are inextricably linked to the internet and the online environment. since the first mobile game, "Tetris", in 1994 and “Snakes" in 1997, the visual element in mobile games has evolved significantly, culminating in the modern-day mobile gaming world. These changes have involved progress from the black and white images of the early games to the variety of colours used in game visuals today and the creation of virtual goods in-app games. A skin is one of these virtual goods or items and is synonymous with a virtual appearance, outfit or cosmetic item that can be used to modify and enhance the appearance of a player's avatar. This is a cosmetic item and purely aesthetic in nature, serving no functional purpose. Among players, the desire for a skin is undeniable. Apart from the "beauty factor," another hidden value is inherent in players' perceptions of their interactions with purely aesthetic items. To determine the attractiveness of the skin in mobile games, preliminary research on skin evaluation was conducted to ascertain players' perceptions of recent virtual skins they had used in-game. The purpose of the study was to identify players’ perceptions of the attractiveness of the skin they used. To conduct the research, the Standard User Experience Questionnaire (UEQ) was used to determine the attractiveness of the skin as a virtual product. The UEQ is composed of six scales and twenty-six items that assess attractiveness on a hedonic and pragmatic level. Thirty respondents were chosen, and data analysis was performed using UEQ Data Analysis Tools. The product's benchmark was divided into five UX quality categories: excellent, good, above average, below average, and bad. The results indicate that stimulation is an excellent proxy for the UX quality of skin and efficiency is above average; meanwhile, attractiveness, perspicuity, dependability, and novelty were below average.

Clinical experience with a new injectable hyaluronic acid designed to improve skin quality in a private clinic in Brazil: A retrospective cohort study.

BackgroundJuvéderm Volite is a skin‐conditioning hyaluronic acid (HA) gel for intradermal injection that provides longer‐lasting effects with a lower concentration of hyaluronic acid. Few studies evaluating its use for aesthetic purposes are available.AimTo examine the use and safety of Juvéderm Volite in daily clinical practice.MethodsA retrospective cohort study of subjects treated with Juvéderm Volite for aesthetic purposes from May 2018 to October 2019 in Rio de Janeiro. Data were extracted from the attending physician's records obtained at each medical appointment. Subjects were assessed according to their age group and treatment characteristics, which include the use of cannulas vs needles and the effectiveness and safety of associated treatments in a single session. Need for subsequent treatment was stratified by touch‐up treatment (<3‐month period) and repeat treatment (≥3‐month period). Safety assessment was based on the report of nodule formation and late hypersensitivity in patients. Appropriate statistical tests were used for data analysis.ResultsOne hundred and eight subjects were included in the study analysis. The total number of treatment sessions consisted of 159, with a mean follow‐up time of 300.3 days. Of the total 108 subjects, 8.4% required touch‐up treatment for optimum correction and repeat treatment occurred in 9.0%. No cases of adverse events were reported during the follow‐up period.ConclusionsThis study has shown, based on clinical observation, that Juvéderm Volite is a useful tool to improve skin quality, requiring fewer and less frequent maintenance treatments. No serious adverse events were reported during the follow‐up period.

Q-S laser micro-drilling and multipass full-beam Q-S laser for tattoo removal \u2014 a case series

The purpose of this study was to evaluate the safety and efficacy of a new combined method of Q-S laser-assisted tattoo removal. Ten patients with 13 professional, mostly mono-chromatic black tattoos were recruited. All tattoos received the same Q-S laser treatment sequence. An objective evaluation of tattoo clearing was assessed by careful analysis of a standardized collection of digital images taken from each tattoo, 2 months after each laser session, with the help of a custom-made pigment-fading percentage photographic ruler. The percentages of pigment clearance and side effects were evaluated by 4 independent dermatologists. Patient satisfaction and perceived discomfort during and post-procedure were evaluated according to specific scales. Clinical evaluators confirmed an average photographic pigment clearance of 97% after a median 4.85 treatment sessions. The Frac-Tat® method required 40% fewer sessions compared to those calculated by Kirby-Desai estimates. Photographic assessment of laser-exposed skin quality performed 2 months after tattoo clearing was considered almost comparable with untreated peripheral skin, confirming a very low side effect score. The Frac-Tat QS laser-assisted tattoo removal sequence used in our study showed a high degree of safety and efficiency, clearing exogenous pigments in a relatively few number of sessions. Preliminary ablative photo-acoustic fractional 1064-nm Q-S laser micro-drilling was considered an essential step in optimizing tattoo removal, increasing wavelength-independent micro-columnar clearing of deeper dermal exogenous pigments. Our preliminary observations also confirmed a significant improvement of tattoo procedure-induced micro-textural changes thanks to a tissue remodeling effect induced by the 1064-nm Q-S fractional laser photo-acoustic ablation.

Increased Skin Clearance and Quality of Life Improvement with Brodalumab Compared with Ustekinumab in Psoriasis Patients with Aggravating Lifestyle Factors.

IntroductionObesity, smoking, and alcohol consumption are prevalent in psoriasis patients and have been associated with increased disease severity and reduced treatment adherence and response. This post hoc analysis of pooled data from the phase 3 AMAGINE-2 and -3 trials compared the efficacy of brodalumab versus ustekinumab in psoriasis patients with aggravating and potentially treatment-confounding lifestyle risk factors.MethodsThis post hoc analysis evaluated complete skin clearance, as measured by a 100% reduction of Psoriasis Area and Severity Index (PASI100) and quality of life (QoL), as measured by a Dermatology Life Quality Index (DLQI) score of 0/1, by the presence of risk factors (obesity, tobacco or alcohol use). A competing risk model assessed cumulative incidence over 52 weeks with outcomes of PASI100 or inadequate response.ResultsThis analysis included 929 patients (brodalumab 210 mg, n = 339; ustekinumab, n = 590) with moderate-to-severe psoriasis. At week 52, odds ratios (95% confidence intervals [CIs]) for complete clearance with brodalumab versus ustekinumab were 2.50 (1.14–5.46, P = 0.0186), 4.64 (2.80–7.69, P < 0.0001), 2.06 (1.25–3.40, P = 0.0045), and 2.55 (0.55–11.91, P = 0.2117) in patients with no, one, two, or three risk factors, respectively. Corresponding odds ratios (ORs) (95% CIs) for DLQI 0/1 with brodalumab versus ustekinumab were 1.72 (0.78–3.79, P = 0.1883), 2.49 (1.54–4.02, P < 0.0002), 1.57 (0.97–2.54, P = 0.0666), and 2.07 (0.45–9.57, P = 0.3438). The 52-week cumulative incidence of patients achieving PASI100 was consistently higher for brodalumab versus ustekinumab, regardless of number of risk factors (P < 0.0001 for one or two risk factors and P = 0.0029 for three risk factors).ConclusionsHigher levels of complete skin clearance and QoL were achieved and maintained with brodalumab versus ustekinumab in patients with moderate-to-severe psoriasis, regardless of the presence of lifestyle risk factors.Clinical Trial RegistrationAMAGINE-2 (NCT01708603); AMAGINE-3 (NCT01708629).Supplementary InformationThe online version contains supplementary material available at 10.1007/s13555-021-00618-5.

Rationale and Preclinical Evaluation of a Multimodal Topical Body Skincare Product for Toning and Tightening.

A novel tightening and toning cream (TTC) was designed to improve body skin quality at multiple levels by engaging several key pathways that contribute to skin function, strength, and integrity. Evaluation of gene expression in both human in vitro 3D skin and ex vivo skin treated with TTC demonstrated changes reflecting improved extracellular matrix and dermal integrity, lymphatic drainage, mitigation of inflammation, cellular clearance and recycling, and adipocyte metabolism. This study provides the rationale and preclinical support for the use of TTC as a standalone agent to improve body skin quality or in combination with body contouring procedures. J Drugs Dermatol. 2021;20(10):1041-1044. doi:10.36849/JDD.6401.

The use of non-chrome mineral tanning materials as a preferable environmentally friendly tanning material

Mineral chrome tanning agent is the most widely used tanning agent for various types of leather articles, given its various advantages. Besides its many advantages, there is a negative side to chrome tanneries, namely the presence of waste disposal that is harmful to the environment. Therefore, this study aims to determine the quality of mineral tanning materials other than chrome (aluminium and titanium) as a substitute for leather tanning (free of chrome). The research raw materials were 12 pieces of pickled goatskin. The chemicals used are aluminium tanning agent (Novaltan Al), titanium tanning agent, salt (NaCl), Peramit MLN, Derminol OCS, MgO, NaHCO3, BCG indicator, Rellugan GT 50, Tanigan PAK, Lipoderm Liquor SAF, Dermagen GPA, Derminol SPE, Derminol NLM, Acid dyestuff, formic acid, Sincal DR and anti-fungal. The method used is to carry out the tanning process using aluminium tanning agents with levels of 2%, 4%, and 6% Al2O3, continued the combination between aluminium and titanium tanning agent. The results obtained were analyzed for the cross-sectional and content of the leather using the EDX method, a shrinkage temperature (Ts) test, and physical quality of crust skin. The results showed that the higher the Al2O3 content, the more Al content in the leather, but the lower the wrinkle temperature of the leather. Meanwhile, the longer the processing time, the aluminium content in the skin increases. The use of aluminium and titanium tanning agent can improve the physical quality of the skin, both in terms of tensile strength and skin softness. The conclusion that can be drawn is the use of 2% free of chrome (aluminium) tanning material can produce Ts of 71°C. The physical quality of the crust skin from aluminium and titanium mineral tanning agents is better than the single-use of aluminium.

Role of botulinum toxin A in improving facial erythema and skin quality

Botulinum toxin A (BTX-A) injections have become the most popular noninvasive cosmetic procedures performed worldwide. With growing interest, investigators continue to uncover an expanding array of aesthetic indications for BTX-A. Botulinum toxin A has been used off-label in the management of masseter hypertrophy for facial slimming, platysmal bands, nasal 'bunny' lines, perioral rhytides, gummy smile and scars, to name a few. Interestingly, the injection of multiple microdroplets of dilute BTX-A into the dermis, sometimes referred to as 'microbotox', has been investigated as a tool for facial rejuvenation. A handful of prospective studies and case series have demonstrated the benefit of BTX-A in the treatment of facial erythema and improving skin texture. The aim of this review is to summarize and appraise currently available data on the role of BTX-A in treating facial erythema and skin quality, with a special focus on potential pathophysiologic mechanisms.