Hyaluronik Asit Dolgu Nodüllerinin Giderilmesinde Düşük Doz Hyaluronidazın Etkinliği

Effectiveness of Low Doses of Hyaluronidase to Remove Hyaluronic Acid Filler Nodules

JAMA Dermatol.  2018 Jul 1;154(7):765-772. doi: 10.1001/jamadermatol.2018.0515.

The aim of this randomized clinical trial was to determine the effectiveness and dose-related effect of hyaluronidase for the removal of injected hyaluronic acid filler with the hypothesis that low doses could correct minor injection-associated asymmetry. Buttons of hyaluronic acid filler placed in the arms of participants were treated with 0.1 mL of hyaluronidase 1.5 U/0.1 mL, 3.0 U/0.1 mL, or 9.0 U/0.1 mL, with 0.1 mL of saline used as the control. All of the areas injected with hyaluronidase were smaller on visual exam and less palpable at both 4 weeks and 4 months than the areas injected with saline. There was a dose-dependent response for both Restylane-L and Juvéderm Ultra XC but was more pronounced for Restylane-L.

The results suggest that hyaluronidase can be used in small doses for minor changes to hyaluronic acid filler due to its dose-related response.

 

Refrakter Vasküler ve Papülopüstüler Rosacea'nın Tedavisinde Botulinum Toksin ile Mezoterapi

Mesotherapy With Botulinum Toxin for the Treatment of Refractory Vascular and Papulopustular Rosacea

J Am Acad Dermatol. 2018 May 19. pii: S0190-9622(18)30808-9. doi: 10.1016/j.jaad.2018.05.014.

This clinical pearl describes the use of diluted botulinum toxin for the treatment of vascular symptoms in patients with rosacea. The authors describe the intradermal injection of botulinum toxin (10 U/mL) as 0.05-mL micro droplets into the hypervascular and telangiectatic central face. The injections were spaced 0.5 cm apart and were injected under topical anesthesia. The authors noted improvement in erythema, edema, telangiectasias, and flushing within 1 to 2 weeks, and the improvement lasted approximately for 3 to 4 months, after which repeat treatment was required. The clinical improvement is hypothesized to result from botulinum toxin blocking acetylcholine release at arrector pili muscles, thus reducing pore size, as well as from botulinum toxin locally blocking muscarinic receptors in sebaceous glands.

Diluted botulinum toxin mesotherapy may be a therapeutic option for treating refractory vascular symptoms in individuals with rosacea. However, larger prospective and randomized clinical trials are required to better define the therapeutic benefit and dosing requirements.

 

Tekrarlayan Kulak Memesi Keloidlerinin Önlenmesinde Postoperatif Intralezyonel Kortikosteroidlerin Etkileri

The Effects of Postoperative Intralesional Corticosteroids in the Prevention of Recurrent Earlobe Keloids

Dermatologic Surgery  2018 Jun;44(6):865-869.

A retrospective chart review was performed to evaluate whether intralesional corticosteroid injection was associated with lower recurrence of keloids. Keloids were more likely to occur if a lower number of injections (P<.001) were used, a planned serial injection protocol (P<.001) was not followed, or if treatment was done outside the department of dermatology (P < .001).

Combination therapy with surgical excision and postoperative intralesional corticosteroid injection of earlobe keloids was associated with fewer recurrences and, thus, may be an effective method to minimize the risk of keloid recurrence. The authors suggest that serial injections may lead to better outcomes.  

 

Geniş spektrumlu ultraviyole korumanın in vitro değerlendirmesi

In vitro assessment of the broad-spectrum ultraviolet protection of clothing

Journal of the American Academy of Dermatology August 2018 Volume 79, Issue 2, Pages 373–375

In this proof-of-concept study, the authors examined the UVA protection afforded by various dry clothing garments, including regular clothing fabrics (t-shirts, jeans), UV protective fabrics (athletic shirts, bathing suits), and commercially available sunscreens. All of the tested clothing garments exhibited broad-spectrum UV protection, which was highest for nylon bathing suits, denim jeans, and dark grey cotton shirts. All clothing garments tested also exhibited greater broad-spectrum UV protection than the sunscreens tested, apart from avobenzone.

These results show that clothing garments appear to provide better protection against UVA than most sunscreens, highlighting that dermatologists should be emphasizing the use of sun-protective clothing as first-line sun protection.

 

Çoklu Kutanöz Basaloid Skuamöz Hücreli Karsinomaların Tedavisinde İnsan Papillomavirüs Aşılarının Kombine Sistemik ve İntratümoral Uygulaması

Combined Systemic and Intratumoral Administration of Human Papillomavirus Vaccine to Treat Multiple Cutaneous Basaloid Squamous Cell Carcinomas

JAMA Dermatol. Published online July 3, 2018.

 The authors of this study reported a case of a 90-plus–year-old patient who presented with multiple large tumors on her lower leg, which were found to be basaloid squamous cell carcinomas (SCC). Due to her large tumor burden and age, surgery was not felt to be a viable treatment option, and the patient declined systemic chemotherapy. She was instead treated with two intramuscular doses of the 9-valent HPV vaccine 6 weeks apart, followed by four doses of diluted vaccine administered to the three largest tumors over a period of 8 months. Tumor regression was noted 2 weeks after the second intratumoral dose, and clinical resolution was demonstrated 11 months after the first intratumoral dose. At follow-up 24 months after the first vaccine administration, the patient had no evidence of recurrence.

Complete resolution of a large basaloid SCC tumor burden was achieved by treatment with systemic and intratumoral 9-valent HPV vaccine in a patient who was not a surgical candidate. Even tumors that were not directly injected resolved with no evidence of recurrence 24 months after initiation of treatment.

This is the first report, to our knowledge, of complete regression of a cutaneous malignant tumor after combined systemic and direct intratumoral injection of the 9-valent HPV vaccine. This report suggests that the HPV vaccine may have therapeutic utility for SCCs in patients who are poor surgical candidates, have multiple lesions, or defer surgery.

 

Güneş Koruyucu İçeriğindeki Oxybenzone / Benzophenone-3’ ın Dermatolojik ve Çevresel Toksikolojik Etkisi

Dermatological and environmental toxicological impact of the sunscreen ingredient oxybenzone/benzophenone‐3

Journal of cosmetic dermatology 2018;17:15–19

The environment effects of commonly used organic UV filters have become a pressing topic. Organic UV filters have been identified in water sources worldwide, with oxybenzone noted as the most frequently detected in the largest concentrations. Organic filters are prevalent in waste from sunscreen and cosmetic manufacturing facilities. These filters are not easily removed by common waste treatment plant techniques. Oxybenzone has also been shown to contribute to coral reef bleaching. Furthermore, 4-methylbenzylidene camphor, oxybenzone, octocrylene, and octinoxate

 have been identified in various species of fish worldwide, which may have consequences for the food chain.

These authors suggest potential solutions to reduce environmental toxic effects of organic UV filters, which include seeking shade; wearing photoprotective clothing, wide-brimmed hats and sunglasses; and using sunscreens with inorganic filters (titanium dioxide and zinc oxide).

 

Alüminyum-İçeren Boğmaca Aşısı Çocuklarda Kontakt Alerjiye Neden Olabilir

Comparison of reactivity to a metallic disc and 2% aluminium salt in 366 children, and reproducibility over time for 241 young adults with childhood vaccine‐related aluminium contact allergy

Contact Dermatitis 24 March 2018

Individuals with contact allergy to aluminum can develop intensely pruritic subcutaneous nodules at the site of injection with aluminum-adsorbed vaccines. The authors of this study patch tested children who developed these itchy nodules from an aluminum-adsorbed pertussis vaccine both after vaccination then again 5 to 7 years later. Of the 455 individuals tested, 366 individuals had a positive patch test result to aluminum. A total of 241 of these individuals underwent repeat patch testing 5 to 7 years later, 77% of whom had a negative result after retesting, implying loss of the contact allergy over time. The authors also found that the aluminum chloride salt was a more sensitive test for aluminum contact allergy than metallic aluminum as significantly more individuals reacted to the salt than the metal. Interestingly, the stronger the reaction to the aluminum salt, the more likely the individual was to react to the metallic aluminum as well.

Itchy subcutaneous nodules after administration of aluminum-adsorbed vaccines seem to be due to contact allergy to aluminum. This study shows that, unlike other type IV hypersensitivity allergies which are thought to be life-long, this allergy may resolve with time in the majority of individuals

 

Yüz Kırışıklıkları ve Cilt Kalitesini Artırmak İçin Krem Formülasyonunun Etkinlik ve Güvenliğinin Değerlendirilmesi

Single-Center, Double-Blind, Randomized, Placebo-Controlled, Study of the Efficacy and Safety of a Cream Formulation for Improving Facial Wrinkles and Skin Quality

Journal of Drugs in Dermatology 2018;17(6):664-669.

This study evaluated the effects of a new antiaging cream, Nimni Cream by HydroPeptide. This cream is composed of antioxidants and essential amino acids intended to increase collagen deposition in the dermis and improve overall skin quality. A total of 20 participants with skin types I to IV were included in the study: 15 in the treatment group and 5 in the placebo group. Participants initially applied the cream twice weekly at bedtime to the face and neck, increasing to daily as tolerated. Participants were evaluated at baseline, week 4, and week 8 of treatment. After 8 weeks of treatment, there was improvement in the Fitzpatrick Wrinkle Scale scores in the treatment group, but this did not reach statistical significance, presumably due to the short duration of treatment. Facial skin quality, including fine lines, mottled pigmentation, pore size, clarity/radiance, smoothness, and overall global photodamage were significantly improved in the treatment group. No significant adverse effects or tolerability issues were reported.

In this small, short-term trial, significant improvement in skin quality of the face, but not the neck, was reported with Nimni Cream by HydroPeptide versus placebo. A larger-scale study with longer follow-up is currently underway.

 

Kapsamlı Yama Testinin Tıbbi Gerekliliği

The Medical Necessity of Comprehensive Patch Testing

Dermatitis. 29(3):107–111, May 2018

Allergen identification is crucial in the management of allergic contact dermatitis (ACD). The commercially available T.R.U.E Test screening panel (36 allergens) is reported to have a detection rate of, at most, 66.0% of the clinically relevant reactions identified by the North American Contact Dermatitis Group (NACDG). Notably, up to 50% of allergens causing occupational dermatitis are missed. Studies show that 21% to 34% of ACD diagnoses would be missed by the NACDG screening series without the use of supplemental allergens. Comprehensive testing with supplemental allergens beyond a screening series may increase the diagnostic yield and the likelihood of achieving a cure for ACD.

The authors emphasize the need to integrate the patient's medical history, examination findings, and environmental exposure history to implement comprehensive and customized allergen testing in the management of ACD.