Supenya Varothai

Efficacy and safety of a carbon-dioxide ablative fractional resurfacing device for treatment of atrophic acne scars in Asians

BACKGROUND Treatment of atrophic scars with a fractional laser resurfacing technique has demonstrated favorable outcomes, although data on the efficacy and adverse effects of this procedure in persons with dark-skinned phototypes are limited. OBJECTIVE This study was conducted to evaluate the efficacy and safety of carbon-dioxide ablative fractional resurfacing on atrophic acne scars in Asian individuals. METHODS Thirteen subjects (8 female and 5 male, aged 25-52 years) with skin phototype IV and atrophic acne scars were treated with 3 sessions of carbon-dioxide ablative fractional resurfacing laser on an average of 7-week interval. Objective (ultraviolet A-light video camera) and subjective (clinical evaluation by two blinded dermatologists) assessments were obtained at baseline and at 1, 3, and 6 months after the final treatment. RESULTS At the 6-month follow-up, 85% of the subjects were rated as having at least 25% to 50% improvement of scars. Improvement significantly progressed from the 1-month follow-up to the 6-month follow-up (P = .002). At 1 month after 3 treatments, surface smoothness (P = .03) and scar volume (P < .001) significantly improved, compared with baseline measurements. Of the subjects, 62% rated themselves as having at least 50% improvement in their scars. Mild postinflammatory hyperpigmentation was the most common adverse effect observed in 92% of the subjects or 51% of treatment sessions, and was completely resolved in an average of 5 weeks. LIMITATION The small sample size was a study limitation. CONCLUSIONS Carbon-dioxide ablative fractional resurfacing appears to be effective and well tolerated for the treatment of atrophic acne scars in Asians.

Direct immunofluorescence study in patients with lichen planus.

Background  Direct immunofluorescence (DIF) studies in patients with lichen planus (LP) show the deposition of multiple immunoglobulins (Igs) at the cytoid bodies (CBs) and fibrin at the dermoepidermal junction (DEJ). The deposition of Ig at the DEJ, as in patients with lupus erythematosus (LE), is occasionally found. For cases with no specific clinical and histologic characteristics, or with ambiguous features, DIF studies may be helpful in disease differentiation.

Treatment of striae distensae with a TriPollar radiofrequency device: A pilot study

Background: Striae distensae are a frequent skin condition for which treatment remains a challenge. Objectives: To determine the efficacy and safety of a TriPollar radiofrequency (RF) device for the treatment of striae in skin phototypes IV–V. Methods: Seventeen females with striae received six weekly treatments with a TriPollar RF device. The participants were evaluated using standardized photographs and a UVA-light video camera at baseline, and at 1 and 6 weeks after the final treatment. Side effects of treatment were recorded at every session. Results: At 1 week after the final treatment, 38.2% and 11.8% of the subjects were assessed to have 25–50% and 51–75% improvement of their striae, respectively. Compared with the 1-week follow-up, at the 6-week follow-up a higher percentage of the subjects were rated to have improvement of their striae. There were no significant differences in the striae surface smoothness at the 1- (p = 0.907) and 6-week (p = 0.057) follow-ups, compared with that of baseline. Twelve percent (2/17), 23% (4/17), and 65% (11/17) of the study subjects rated their satisfaction of the overall improvement as slightly satisfied, satisfied, and very satisfied, respectively. No adverse effect was reported. Conclusion: TriPollar RF appears to be a promising alternative for the treatment of striae distensae.

Therapeutic outcome of melasma treatment by dual-wavelength (511 and 578 nm) laser in patients with skin phototypes III–V

Recent evidence suggests that vascular abnormalities are involved in the pathogenesis of melasma. Copper bromide (CuBr) laser, which emits dual wavelengths (511 and 578 nm), enabling simultaneous and selective destruction of melanin‐containing cells and blood vessels, may be of benefit in the treatment of melasma.

Moisturizers for Patients with Atopic Dermatitis: An Overview

Atopic dermatitis is a chronic inflammatory skin condition result from epidermal barrier defect and immune dysfunction. Not only has lesional skin increase pH and transepidermal water loss but also non-lesional skin. Regular use of moisturizers helps maintain skin hydration and improve barrier dysfunction. Active ingredients in moisturizers can be classified into occlusives, humectants, and emollients according to their properties. Agents with anti-inflammatory effects are also added. This review mainly focus on active agents in moisturizers claimed of suitable for atopic skin, in order to provide more information and aid physicians in selecting and giving advice to patients with atopic dermatitis.

The pH of water from various sources: an overview for recommendation for patients with atopic dermatitis

Background Patients with atopic dermatitis (AD) have increased susceptibility to irritants. Some patients have questions about types of water for bathing or skin cleansing. Objective We studied the pH of water from various sources to give an overview for physicians to recommend patients with AD. Methods Water from various sources was collected for measurement of the pH using a pH meter and pH-indicator strips. Results Bottled drinking still water had pH between 6.9 and 7.5 while the sparkling type had pH between 4.9 and 5.5. Water derived from home water filters had an approximate pH of 7.5 as same as tap water. Swimming pool water had had pH between 7.2 and 7.5 while seawater had a pH of 8. Normal saline and distilled water had pH of 5.4 and 5.7, respectively. Facial mineral water had pH between 7.5 and 8, while facial makeup removing water had an acidic pH. Conclusion Normal saline, distilled water, bottled sparkling water and facial makeup removing water had similar pH to that of normal skin of normal people. However, other factors including benefits of mineral substances in the water in terms of bacteriostatic and anti-inflammation should be considered in the selection of cleansing water.

Effect of pulse width of a variable square pulse (VSP) erbium:YAG laser on the treatment outcome of periorbital wrinkles in Asians.

Background  Uses of appropriate laser parameters are essential for an optimum outcome with minimal risks of complications.

In vitro-in vivo correlation study for the dermatopharmacokinetics of terbinafine hydrochloride topical cream.

Background: To investigate the relationship between dermatopharmacokinetic (DPK) tape stripping from in vitro and in vivo using 1% terbinafine hydrochloride topical cream as the model formulation. Methodology: In vitro and in vivo tape strippings were conducted on separated pig ear skin used as a biological membrane for franz diffusion cell testing and the non-hairy skin area at the ventral forearms of healthy volunteers, respectively. Terbinafine (1%) topical cream was applied to the skin for 0.5, 2, and 4 h. The drug profiles of terbinafine across the stratum corneum were determined immediately (time 0 h), and at 0.5, 1, 2, and 4 h after removing the formulation. The amounts of terbinafine were analyzed by a validated high-performance liquid chromatography-ultraviolet method. The area under the curve (AUC) and the maximum amounts of terbinafine absorption (Qmax) were obtained from pharmacokinetic software. Partition coefficient (KSC/veh) and diffusion parameter (D/L2) were derived from the Fick’s second law equation. During the schedule time of 8 h, the deviations of in vitro and in vivo data were 6.61 and 30.46% for AUC and Qmax, respectively. There was insignificant difference of the KSC/veh and the D/L2 between excised pig ear and human skin. In addition, KSC/veh and D/L2 at Tmax of 2 h were used to predict the AUC presented the value of 4.7481 %h whereas the true value calculated from pharmacokinetic software provided the value of 5.9311 %h differing from each other in approximate of 20%. Conclusions: In vitro tape stripping using the separated pig ear skin as a viable membrane of the franz diffusion cell testing demonstrates the potential to represent in vivo tape stripping in human for topical bioavailability/bioequivalence study of terbinafine hydrochloride 1% topical cream.

A double-blinded, randomized, vehicle-controlled study to access skin tolerability and efficacy of an anti-inflammatory moisturizer in treatment of acne with 0.1% adapalene gel

Abstract Introduction: Topical retinoids are considered to be the first-line agents and maintenance therapy of acne; however, irritation side effects are major concern issues. Noncomedogenic moisturizers are sometimes added to relieve cutaneous irritations. This study aimed to compare tolerability and efficacy of moisturizers containing licochalcone A, l-carnitine and 1,2-decanediol (active formulation) with a placebo in mild to moderate severe acne in Asian subjects. Methods: This was an 8-week double-blind, prospective, randomized controlled study. All patients (n = 120) were randomized equally into three groups: (A) adapalene gel, (B) adapalene gel with the active formulation and (C) adapalene gel with the placebo. The severity of acne, skin bioengineering measurements and skin tolerability were recorded during the study. Results: Compared to baseline, the active formulation group showed significant reductions in inflammatory lesions and total lesions at the end of the study without flare-up. Moreover, skin irritations were less detected than in the other two groups by corneometer and transepidermal water loss measurements. Conclusions: The concomitant usage of adapalene gel and the moisturizer containing licochalcone A, l-carnitine and 1,2-decanediol could reduce undesirable side effects without interfering the efficacy of adapalene. This moisturizer may be superior to placebo to prevent cutaneous irritations and enhance patients’ adherence to acne medications.

The pH of antiseptic cleansers.

BACKGROUND Daily bathing with antiseptic cleansers are proposed by some physicians as an adjunctive management of atopic dermatitis (AD). As atopic skin is sensitive, selection of cleansing products becomes a topic of concern. OBJECTIVE Our purpose is to evaluate the pH of various antiseptic body cleansers to give an overview for recommendation to patients with AD. METHODS Commonly bar and liquid cleansers consisted of antiseptic agents were measured for pH using pH meter and pH-indicator strips. For comparison, mild cleansers and general body cleansers were also measured. RESULTS All cleansing bars had pH 9.8-11.3 except syndet bar that had neutral pH. For liquid cleansers, three cleansing agents had pH close to pH of normal skin, one of antiseptic cleansers, one of mild cleansers and another one of general cleansers. The rest of antiseptic cleansers had pH 8.9-9.6 while mild cleansers had pH 6.9-7.5. Syndet liquid had pH 7 and general liquid cleansers had pH 9.6. CONCLUSION The pH of cleanser depends on composition of that cleanser. Adding antiseptic agents are not the only factor determining variation of pH. Moreover, benefit of antiseptic properties should be considered especially in cases of infected skin lesions in the selection of proper cleansers for patients with AD.