In Young Oh

Reduction in facial hyperpigmentation after treatment with a combination of topical niacinamide and tranexamic acid: a randomized, double-blind, vehicle-controlled trial

Facial hyperpigmentation occurs in multiple conditions. In addition, many Asian women desire a lighter skin color. Thus, there is a need for the development of skin lightening agents, and niacinamide and tranexamic acid (TXA) are promising candidates.

Comparison of efficacy and diffusion of three formulations of botulinum toxin type A in two patients with forehead hyperhidrosis

A number of studies have shown botulinum toxin type A (BoNTA) to be a very effective treatment for focal hyperhidrosis. However, the different formulations of BoNTA are not identical. They may differ in terms of both their electrophysiological and clinical behaviour, and results obtained with one formulation cannot therefore be extrapolated to another. As a result, different formulations may have different efficacy and tolerability profiles. The literature contains few reports of direct comparisons of different formulations of BoNTA. Some studies have suggested that the diffusion of BoNTA2 (Dysport; Ipsen Ltd., Slough, UK) is greater than that of BoNTA1 (BOTOX; Allergan, Inc., Irvine, CA, USA). In this study, we directly compared the efficacy and diffusion characteristics of three different formulations in two patients with forehead hyperhidrosis, including the new BoNTA3 (NABOTA, Daewoong, Co. Ltd., Seoul, Korea). We also investigated the diffusion area of the products to assess the area of effective action at the target site and to allow minimization of adverse effects. Two male patients, aged 32 and 34 years had been diagnosed as having forehead hyperhidrosis based on the US Food and Drugs Administration hyperhidrosis criteria. They had not received treatment with BoNTA in the preceding 12 months. We injected both patients with the three different formulations on the right (3.3 U BoNTA1), middle (8.3 U BoNTA2) and left (3.3 U BoNTA3) areas of the forehead. All injections were of identical volume (0.1 mL). Each product was reconstituted with 0.9% saline without preservative: 3 mL for BoNTA1 and BoNTA3, and 6 mL for BoNTA2. The injections were administered intramuscularly after marking each patient’s forehead with a template showing the three injection sites, which were 30 mm apart horizontally. We evaluated diffusion after 2 weeks by assessing the area of the anhidrotic halo using Minor iodine–starch test. To assess the efficacy, sweat production was quantified using transepidermal water loss (TEWL) and a corneometer. Two of the patients responded after 2 weeks to the BoNTA treatment, with an anhidrotic halo seen at each of the three injection sites. The largest area of anhidrosis was seen with BoNTA2, covering 6.7% of the total area, while BoNTA3 and BoNTA1 produced similarly sized areas of anhidrosis (2.5% and 2.6%, respectively) (Figs 1 and 2). The objective quantification of the forehead sweating before and after BoNTA injection is presented in Table 1. Two weeks after the treatment, there was an objective reduction in forehead sweating in all three patients. In our study, BoNTA injections proved to be an effective treatment for forehead hyperhidrosis. The amount of sweating was markedly reduced, as shown by TEWL and corneometer. The different areas of anhidrotic halo support the suggestions in previous reports that the area of diffusion appears to be greater with BoNTA2 than with BoNTA1. Minimizing the area of diffusion is important to minimize the potential for adverse effects (AEs), which is particularly important when the injection sites are close to other muscles, as is the case when treating,

Depressed Facial Scars Successfully Treated with Autologous Platelet-Rich Plasma and Light-Emitting Diode Phototherapy at 830 nm.

Dear Editor: Depressed facial scars not only lead to cosmetic problems, but also have psychological effects such as emotional debilitation, embarrassment, poor self-esteem, and social isolation. Many techniques are available for the correction of depressed facial scars, including subcision, dermabrasion, chemical peeling, laser technology, fat grafting, and use of fillers; however, these techniques have resulted in varying degrees of success and associated adverse effects1,2. It has been postulated that autologous platelet-rich plasma (PRP) could be used for the treatment of depressed facial scars, because it can enhance wound healing, which has been shown to accelerate tissue repair3. In addition, we evaluated the additional effects of treatment with light-emitting diode (LED) phototherapy at 830 nm after injections of autologous PRP. A 20-year-old woman presented with a single erythematous, atrophic, depressed, and round defect on the right cheek (Fig. 1A). She had been treated with 1,064-nm long-pulse Nd:YAG laser for a small acne scar 2 weeks before her visit to our clinic and thereafter the scar had become larger and painful. She was worried about the cosmetic appearance of the defect. We decided to use autologous PRP along with LED phototherapy at 830 nm and she received 8 sessions of treatment to the scar lesion at 2-week intervals. PRP was produced by using a commercially available 2-part system (Prosys PRP; T-Cell Bio Inc., Seoul, Korea) consisting of a disposable separation kit and a concentration kit. Approximately 3 ml of PRP was produced for each session. After autologous PRP injection, the lesion was illuminated with an LED at 830 nm (Smartlux™; Medmix, Seoul, Korea; light dose 72 J/cm2) for 20 minutes. The treatment caused a substantial improvement of the lesion and symptoms, with good cosmetic results (Fig. 1B). No adverse effects were evident except for some spot bleeding at the injection sites and slight erythema that resolved within 48 hours. She agreed to use her clinical photographs in this study. Fig. 1 (A) Post-laser depressed scar on the face. (B) Marked improvement after 8 sessions. The possible mechanism of PRP in the reconstruction of a depressed scar is by promoting the recovery of laser-damaged skin through the numerous growth factors present in PRP, especially platelet-derived growth factor. This growth factor may help stimulate the production of other growth factors important in tissue remodeling, which promote connective tissue healing by upregulating collagen and protein synthesis3. Infrared wavelength phototherapy with an LED at 830 nm has anti-inflammatory effects, and is useful for the regeneration of damaged skin. The wavelength of 830 nm is well known to dramatically increase the action potentials of wound-healing cells, particularly those in the inflammatory and remodeling stages4, and would therefore cause a considerably faster resolution of post-laser adverse effects such as erythema and pain5. Although comparative studies between the use of only PRP, only LED, combined therapy of PRP and LED, and control treatments are needed to evaluate the precise results of these modalities, the present study may provide evidence supporting the clinical efficacy of autologous PRP and LED phototherapy at 830 nm in treating scars caused by laser application. These techniques might be used for various kinds of dermatologic scars and surgical scars to obtain excellent clearance in an easy and safe manner. In conclusion, autologous PRP injection and additional LED phototherapy at 830 nm are effective, safe treatment options for depressed facial scars.

Treatment of infraorbital dark circles in atopic dermatitis with a 2790-nm erbium: yttrium scandium gallium garnet laser: A pilot study

Abstract Background: Although many Asian atopic patients have orbital darkening symptom and the demand to treat this condition is increasing, little has been reported in the literature on the treatment of infraorbital dark circles in atopic dermatitis. Objective: To evaluate the clinical efficacy and safety of 2790-nm erbium:yttrium scandium gallium garnet (Er:YSGG) laser therapy for reducing infraorbital dark circles in atopic dermatitis patients. Materials and methods: Ten Korean patients over 21 year with mild atopic dermatitis and infraorbital dark circles were enrolled in this study. Patients who need active atopic dermatitis treatments are excluded because of the possibility of aggravation after laser treatment. They were treated for dark circles using a 2790-nm Er:YSGG laser. The treatment parameters were 1.8–2.2 J/cm² fluence, 6-mm spot size, and 0.3-ms pulse width with 10% overlap over the infraorbital areas once with a 4-week interval between treatments. Efficacy was assessed with a quartile grading score ranging from 0 to 5 by a blinded investigator, and the patients also documented their degree of satisfaction with the same grading score. All possible side effects were evaluated. Results: The clinical assessment showed 74.5% (2.7) and 72.5% (2.5) improvements, and the patient satisfaction scale scores improved an average of 74% (2.4) and 71.5% (2.3) at 2 months and 4 months after treatment, respectively. There were no severe side effects or aggravation of atopic dermatitis. Conclusion: Our study suggests that 2790-nm Er:YSGG laser therapy can be effectively and safely used in the treatment of infraorbital dark circles in atopic dermatitis patients.

Improvement in skin wrinkles using a preparation containing human growth factors and hyaluronic acid serum

Abstract Background: Skin aging is accompanied by wrinkle formation. At some sites, such as the periorbital skin, this is a relatively early phenomenon. Objective: We evaluated the anti-wrinkle effect of a preparation containing human growth factor and hyaluronic acid serum on periorbital wrinkles (crows feet). Materials and methods: In total, 23 Korean women (age range: 39–59 years), who were not pregnant, nursing, or undergoing any concurrent therapy, were enrolled in this study. All the patients completed an 8-week trial of twice-daily application of human growth factor and hyaluronic acid serum on the entire face. Efficacy was based on a global photodamage score, photographs, and image analysis using replicas and visiometer analysis every 4 weeks. The standard wrinkle and roughness parameters used in assessing skin by visiometer were calculated and statistically analyzed. Results: Periorbital wrinkles were significantly improved after treatment, with improvements noted both by physicians assessment and visiometer analysis. Conclusion: Topical application of human growth factor and hyaluronic acid was beneficial in reducing periorbital wrinkles.

Facial scar treated with an intradermal radiofrequency device.

Facial scars can result from several pathologic conditions, such as acne, scleroderma, cutaneous lupus erythematosus, postviral complications from viruses such as varicella-zoster, or trauma, as in the case described herein. These scars lead not only to cosmetic problems, but also to psychological effects such as emotional debilitation, embarrassment, poor self-esteem, and social isolation. Although there are a variety of techniques for the correction of facial scars, radiofrequency (RF) treatment is recently used modality for scar correction (1). RF device delivers uniform heat to the dermis to induce collagen remodeling (2). A minimally invasive intradermal needle RF device (INNOfi ll, Pacifi c Pharma, Korea) was applied to treat facial scars (Figure 1). The devices incorporated 21-, 27-, or 30-gauge RF needle electrodes in combination with a patch-type electrode. The entire RF needle was insulated with a biocompatible parylene layer, leaving the distal 1 mm exposed to act as the electrode in the tissue. A separately conducted RF needle designed to apply radiofrequency was inserted into the skin to stimulate initial collagen contraction and a wound healing response. A 32-year-old man presented with a single erythematous, depressed, curved burn scar on the chin (Figure 2a). The patient was worried about

Methods for Locating the Pores of Epidermal Cysts

Dear Editor: Epidermal cysts manifest as dermal or subcutaneous mobile nodules, and may have a clinically visible central punctum representing the plugging of the pilosebaceous unit from which cheesy debris may be expressed. If treatment is desired, complete excision is the definitive treatment. The region of fusiform excision may be smaller than the area deformed by the cyst; however, the excision should include any poral opening attaching the cyst to the surface. If the entire cyst wall is not removed, the cyst can recur. Because the pore of an epidermal cyst is typically located at the center of the lesion, it is important for surgeons to be aware of the exact location of the central punctum of an epidermal cyst. Tumescent local anesthesia was first described by Klein in 19871. He detailed the infiltration of large volumes of a diluted solution of lidocaine with epinephrine into fat before liposuction. Since then, the use of the tumescent technique has expanded to include other dermatological surgical procedures such as hair transplantation, laser surgery, and abdominoplasty2,3. We describe the use of a simple pinch method and dermal tumescent anesthesia to locate the pores of epidermal cysts during excision. The pinch method is a very easy technique to perform. The pore of an epidermal cyst can be made deeper and wider by pinching the skin with the thumb and the index finger. If the pore is already visible, the punctum can be made more prominent by using the pinching maneuver. If it is difficult to identify the pores on the basis of the gross appearance, the pores can be made visible by pinching several suspected lesions (Fig. 1). Fig. 1 Pinch method. (A) On pinching the skin with the thumb and index finger, the pore of the cyst becomes deeper and wider. (B) An easy case: An already visible pore of a cyst (top panel) is made more prominent by using the pinching maneuver

Autoerythrocyte sensitization syndrome presenting with general neurodermatitis

Autoerythrocyte sensitization syndrome (AES) was first described by Gardner and Diamond in 1955, when four women with painful bruising were depicted. Patients with AES typically present with the development of recurrent, spontaneous, painful ecchymosis, frequently preceded by a prodrome of pain or itching of the skin. The patients are sensitive to their own red blood cells injected intradermally, and underlying coagulopathies are thought to be absent. We introduce a 70-year-old woman presenting with recurrent episodes of painful bruising on the trunk and extremities.