Sergio Talarico

Low-dose oral isotretinoin versus topical retinoic acid for photoaging: a randomized, comparative study

Oral isotretinoin (ISO) is the only drug which promotes prolonged remission or cure of severe acne. It also has other properties, supporting its use for non‐acne indications. Retinoic acid (RA) is gold standard treatment for photoaging. ISO for photoaging treatment was reported in non‐controlled trials as alternative to RA, which causes skin irritation.

A randomized and controlled trial about the use of oral isotretinoin for photoaging

Topical retinoids are used to treat photoaging; oral isotretinoin is gold standard for acne; “off label” indications, including photoaging, have been reported with insufficient evidence of efficacy. This is a randomized controlled phase II trial with clinical and histological assessment to evaluate efficacy and safety of oral isotretinoin for photoaging. Study population was comprised of 32 menopausal or sterilized women, aged 40–55, divided in 2 groups: A (21) received 20mg isotretinoin, 3 times per week, nightly moisturizer, and daily sunscreen, for three months; B (11) just moisturizer/sunscreen. Main outcome measures were: overall clinical assessment; profilometry, corneometer and elasticity tests in periocular regions and left forearm; before/after biopsies from left forearm in patients of B and in 10 randomly selected of A. Microscopic blinded evaluation of epidermal thickness, dermal elastosis, new collagen, p53 epidermal expression was performed by quantitative digital image analysis. All data were submitted to statistical analysis. Clinical evaluation showed slight improvement; profilometry, corneometer and skin elasticity tests presented significant difference in pre/post values (P = 0.001 to 0.028), but no differences between A/B. Histological findings and p53 expression were comparable between groups before treatment (P > 0.1); microscopic analysis showed no differences between groups for most variables, after treatment. Slight but significant difference between A/B for p53 with major reduction post isotretinoin [0.66±0.31 vs. 0.94±0.34 respectively (P = 0.04) was observed. There were minor side effects and no significant laboratory test alterations. We concluded that no significant clinical, microscopic changes but p53 epidermal expression reduction were observed. The role of ultra‐violet induced p53 mutation in skin carcinogenesis reinforces retinoids chemoprevention. Oral isotretinoin seemed safe but not effective to treat photoaging. Caution should be considered for women prone to pregnancy. Further controlled studies are necessary.

Adverse effect of soft tissue augmentation with hyaluronic acid.

Cutaneous fillers have been employed in the treatment of wrinkles and scars. The high biocompatibility and rare adverse effects described in the literature represent advantages of hyaluronic acid (HA) compared to other fillers.

Validation of a New International Quality-of-Life Instrument Specific to Cosmetics and Physical Appearance BeautyQoL Questionnaire

OBJECTIVE To develop a new quality-of-life (QoL) instrument with international validity that specifically assesses cosmetic products and physical appearance. DESIGN In the first phase, semidirected interviews involved 309 subjects. In the second stage, an acceptability study was performed on 874 subjects. Thereafter, we recruited a total of 3231 subjects, each of whom completed the BeautyQoL questionnaire, a clinical checklist for the skin, the generic QoL 36-Item Short Form Health Survey, and a sociodemographic questionnaire. A retest was performed 8 days later on a subgroup of 652 subjects. SETTING Populations in France, the United Kingdom, Germany, Spain, Sweden, Italy, Russia, the United States, Brazil, Japan, India, China, and South Africa, representing 16 languages. PARTICIPANTS The general adult healthy population, including women and men. MAIN OUTCOME MEASURES Psychometric properties, construct validity, reproducibility, and internal and external consistency. RESULTS General acceptability was very good in the 16 languages, with a very low rate of no answers. The validation phase reduced the questionnaire to 42 questions structured in the following 5 dimensions that explained 76.7% of the total variance: social life, self-confidence, mood, energy, and attractiveness. Internal consistency was high (Cronbach α coefficients, 0.93-0.98). Reproducibility at 8 days was satisfactory in all dimensions. Results of external validity testing revealed that BeautyQoL scores correlated significantly with all 36-Item Short Form Health Survey scores except for physical function. CONCLUSION These results demonstrate the validity and reliability of the BeautyQoL questionnaire as the very first international instrument specific to cosmetic products and physical appearance.

Randomized study comparing the efficacy and tolerance of a lipohydroxy acid shampoo to a ciclopiroxolamine shampoo in the treatment of scalp seborrheic dermatitis.

Background  The success of a dandruff treatment depends not only on the ability of a shampoo to control dandruff, but also on patient compliance, which is closely linked to the cosmetic attributes of the product.

Long‐wave infrared radiation reflected by compression stockings in the treatment of cellulite: a clinical double‐blind, randomized and controlled study

Cellulite refers to changes in skin relief on the thighs and buttocks of women, with a prevalence of 80–90%, causing dissatisfaction and search for treatment. Etiopathogenesis is multifactorial, as follows: herniation of the hypodermis towards the dermis, facilitated by perpendicular fibrous septa, changes in the dermal extracellular matrix, decreased adiponectin, genetic polymorphism, microcirculation alterations and inflammatory process. There are numerous therapeutic approaches, with little evidence of effectiveness. The long‐wave infrared (LWIR) radiation interacts with water, improves microcirculation and stimulates metabolic processes. To date, the use of tissues with potential reflection of LWIR radiation has not been systematically investigated as adjuvant treatment for cellulite.

“Blepharopeeling” in the Upper Eyelids: A Nonincisional Procedure in Periorbital Rejuvenation—A Pilot Study

Currently, the best results in cosmetic surgery have been obtained through combined surgical and/or nonsurgical procedures. Thus, in the past decade, the search for less invasive or combined procedures aimed at skin rejuvenation enlarged the spectrum of cosmetic surgery. Due to advances in laser therapy, the use of chemical peels by dermatologists for treating facial aging, mainly in the periorbital area, has decreased despite its low cost and effectiveness.

High Patient Satisfaction of a Hyaluronic Acid Filler Producing Enduring Full-Facial Volume Restoration: An 18-Month Open Multicenter Study.

BACKGROUND Volume restoration is an essential part of facial rejuvenation. OBJECTIVE To assess long-term full-facial volume restoration using HAEL Volume Lidocaine hyaluronic acid filler. METHODS An 18-month open study in 60 subjects with at least Grade 2 on the 4-point volume loss scale (VLS) for full face and at least 2 indications affected among chin, temporal areas, jawline, cheeks, cheekbones, and nasolabial folds (NLF). Performance was assessed by VLS, Lemperle rating scale (LRS), investigator Global Aesthetic Improvement Scale (GAIS), and 3-dimensional (3D) imaging. RESULTS Most subjects (71.6%) had 3 or 4 indications injected, most commonly cheekbones (96.7%) and NLF (93.3%). At 18 months, at least a 1-grade improvement in VLS was observed for full face (68.3% of subjects), chin (77.8%), temporal areas (73.7%), cheeks (66.6%), cheekbones (58.6%), jawline (43.1%), and NLF (71.4%; LRS). For all indications, more than 60% of the volume gained at 3 weeks was sustained at 18 months based on 3D digital imaging. At 18 months, 95.0% of subjects had improved full-face GAIS and all subjects were satisfied with their aesthetic outcome. One subject (1.6%) had treatment-related adverse events. CONCLUSION Full-facial volume restoration was well sustained over 18 months with high patient satisfaction and good tolerability.

5-Fluorouracil superficial peel for multiple actinic keratoses

Background  Chronically photodamaged skin usually presents with multiple, widespread, actinic keratoses (AKs), and treatment of the entire affected area is recommended.

Quality of life assessment in cosmetics: specificity and interest of the international BeautyQol instrument

The wide use of cosmetics and their perceived benefits upon well‐being imply objective descriptions of their effects upon the different dimensions contributing to the quality of life (QoL). Such a goal pleas for using relevant and validated scientific instruments with robust measurement methods. This paper discusses the interest of the new validated questionnaire BeautyQoL specifically designed to assess the effect of cosmetic products on physical appearance and QoL. After conducting a review of skin appearance and QoL, three phases of the international codevelopment have been carried out in the following sequence: semi‐directed interviews (Phase 1), acceptability study (Phase 2), and validation study (Phase 3). Data collection and validation process have been carried out in 16 languages. This review confirms that QoL instruments developed in dermatology are not suitable to assess cosmetic products, mainly because of their lack of sensitivity. General acceptability of BeautyQol was very good. Forty‐two questions have been structured in five dimensions that explained 76.7% of the total variance: Social Life, Self‐confidence, Mood, Vitality, and Attractiveness. Cronbachs alpha coefficients are between 0.932 and 0.978, confirming the good internal consistency of the results. The BeautyQol questionnaire is the first international instrument specific to cosmetic products and physical appearance that has been validated in 16 languages and could be used in a number of clinical trials and descriptive studies to demonstrate the added value of these products on the QoL.