Marta I. Rendon

Reliability assessment and validation of the Melasma Area and Severity Index (MASI) and a new modified MASI scoring method

BACKGROUND The Melasma Area and Severity Index (MASI), the most commonly used outcome measure for melasma, has not been validated. OBJECTIVE We sought to determine the reliability and validity of the MASI. METHODS After standardized training, 6 raters independently rated 21 patients with mild to severe melasma once daily over a period of 2 days to determine intrarater and interrater reliability. Validation was performed by comparing the MASI with the melasma severity scale. The darkness component of the MASI was validated by comparing it with the difference between mexameter scores for affected versus adjacent normal-appearing skin. The area component of the MASI was validated by comparing it with the area of each section of the face determined by computer-based measurement software. RESULTS The MASI score showed good reliability within and between raters and was found to be valid when compared with the melasma severity scale, mexameter scores, and area measurements. Homogeneity assessment by raters showed the least agreement and can be removed from the MASI score without any loss of reliability. LIMITATIONS Patients were limited to Hispanic, African, and Asian backgrounds. CONCLUSION The MASI is a reliable measure of melasma severity. Area of involvement and darkness are sufficient for accurate measurement of the severity of melasma and homogeneity can be eliminated.

Expert opinion: efficacy of superficial chemical peels in active acne management--what can we learn from the literature today? Evidence-based recommendations.

Background  Superficial chemical peels offer therapeutic results in a convenient, affordable treatment. Many clinicians use these peels in the treatment of acne and acne‐prone oily skin.

Treatment of the aged hand with injectable poly-l-lactic acid

Abstract We report the use of injectable poly-l-lactic acid (PLLA) for volume restoration in a 45-year-old white female who was concerned about the appearance of her hands. The patient expressed a desire for long-term restoration, and selected injectable PLLA because of its known 2-year duration of effect, although she was informed that injectable PLLA is not FDA-approved for use in the hands. After reconstitution with 8 ml of diluent plus lidocaine, 0.1–0.2-ml aliquots of injectable PLLA were injected into selected sites, up to 5 ml per hand. The patient underwent three identical treatments, followed by postinjection use of moisturizing cream and massage; improvement in appearance was noted by the patient between the second and third treatments. Correction was maintained for at least 18 months, with no adverse events. We have also briefly reviewed the literature on the use of injectable PLLA for volume restoration in the hand.

The effects of a high glycerin content hydrogel premolded mask dressing on post-laser resurfacing wounds.

Abstract Background: Laser resurfacing for the rejuvenation of facial skin remains a popular cosmetic procedure. Postoperative care for laser resurfacing is important to optimize healing, reduce pain and minimize complications. Objective: To compare the efficacy of the new dressing against placebo (Vaseline® cream) after Er:YAG laser resurfacing. Methods: Fifteen patients between 45 and 72 years of age with facial wrinkles were enrolled in the study. Patients underwent full-face Er:YAG procedures. The wounds were then dressed: one side of the face was treated with Vaseline and the other with a hydrogel dressing. Erythema, edema, pigmentation, average time of re-epithelization, pain score, itching, clinical evaluation of infection, crust formation and acidity were documented. Results: The hydrogel dressing decreased postoperative morbidity. The site treated by hydrogel showed a shorter epithelial healing time than the Vaseline site. The dressing relieved the immediate pain of facial resurfacing as well as preventing crust formation and itching. Conclusion: A hydrogel dressing is a better and suitable alternative to the open technique to manage post-laser wound healing.

Long-term aesthetic outcomes with injectable poly-L-lactic acid: observations and practical recommendations based on clinical experience over 5 years

Background  Facial rejuvenation techniques have evolved in recent decades driven by a paradigm shift to restoration of lost volume, and an increase in the number of available products. As clinical experience has increased, practitioners have further refined the use of these products.

Acne treatment patterns, expectations, and satisfaction among adult females of different races/ethnicities

Background Limited data are available on acne treatment patterns, expectations, and satisfaction in the adult female subpopulation, particularly among different racial and ethnic groups. Objective Describe acne treatment patterns and expectations in adult females of different racial/ethnic groups and analyze and explore their potential effects on medication compliance and treatment satisfaction. Methods A cross-sectional, Web-based survey was administered to US females (25–45 years) with facial acne (≥25 visible lesions). Data collected included sociodemographics, self-reported clinical characteristics, acne treatment use, and treatment expectations and satisfaction. Results Three hundred twelve subjects completed the survey (mean age, 35.3±5.9 years), comprising black (30.8%), Hispanic (17.6%), Asian/other (17.3%), and white (34.3%). More than half of the subjects in each racial group recently used an acne treatment or procedure (black, 63.5%; Hispanic, 54.5%; Asian/other, 66.7%; white, 66.4%). Treatment use was predominantly over-the-counter (OTC) (47.4%) versus prescription medications (16.6%). OTC use was highest in white subjects (black, 42.7%; Hispanic, 34.5%; Asian/other, 44.4%; white, 59.8%; P<0.05). The most frequently used OTC treatments in all racial/ethnic groups were salicylic acid (SA) (34.3%) and benzoyl peroxide (BP) (32.1%). Overall, compliance with acne medications was highest in white versus black (57.0±32.4 vs 42.7±33.5 days, P>0.05), Hispanic (57.0±32.4 vs 43.2±32.9 days, P>0.05), and Asian/other (57.0±32.4 vs 46.9±37.2 days, P>0.05) subjects. Most subjects expected OTC (73.7%) and prescription (74.7%) treatments to work quickly. Fewer than half of the subjects were satisfied with OTC treatment (BP, 47.0%; SA, 43.0%), often due to skin dryness (BP, 26.3%; SA, 44.3%) and flakiness (BP, 12.3%; SA, 31.1%). No statistically significant differences were observed among racial/ethnic groups in their level of satisfaction with OTC or prescription acne treatments. Conclusion Racial/ethnic differences were observed in acne treatment patterns in adult females, while treatment expectations were similar. Results indicate that treatment patterns and expectations may impact treatment satisfaction and medication compliance.