Stacy M. Chimento BA, Meggan Newland MD, Carlos Ricotti MD, Steven Nistico MD, Paolo Romanelli MD
Background and Objective: According to a European pilot study, the 308-nanometer (nm) Excilite μ™ (DEKA, Florence,
Italy) system may be a promising tool for patients with vitiligo by offering targeted phototherapy, a rapid onset of repigmentation,
and few adverse effects. The objective of this study was to evaluate the clinical efficacy and safety of the 308-nm
Excilite μ in the treatment of vitiligo.
Methods and Limitations: Ten patients with stable vitiligo were exposed to 10 weeks of targeted phototherapy with the
Excilite μ device, followed by 5 weeks of observation. Skin types 1 and 2 were not included in the cohort, and Wood’s
light examination was not documented.
Results: At 2 weeks, repigmentation was observed in 60% of the subjects, according to patient assessment, and 50% of
the subjects, according to the treating physician and independent observer assessments. All patients maintained the repigmentation
during the 5-week, follow-up period.
Conclusion: The 308-nm Excilite μ is a safe and fast-acting therapeutic option in patients with stable vitiligo and skin
types 3 through 6.
Leon Kircik MD, Jerry Bagel MD, Neil Korman MD PhD, Alan Menter MD, Craig A. Elmets MD,John Koo MD, Yu-Ching Yang PhD, Chiun-Fang Chiou PhD, Frank Dann MD, Seth R. Stevens MD
Background: Moderate to severe psoriasis is a significant inflammatory disease that frequently requires systemic therapies
to effectively treat the underlying disorder. Etanercept and narrow-band ultraviolet light B (NB-UVB) are widely
used to treat this disease.
Objective: To evaluate the effectiveness, tolerability, and patient-reported outcomes of combination etanercept plus
NB-UVB phototherapy in moderate to severe plaque psoriasis.
Methods: This 12-week, single-arm, open-label study evaluated the combination of etanercept 50 mg twice weekly and
NB-UVB thrice weekly in 86 patients. The primary outcome measure was ≥75% improvement from baseline in the
Psoriasis Area and Severity Index (PASI 75). Other measures included PASI 90, PASI 100, and the Dermatology Life
Quality Index (DLQI).
Results: At week 12, 26.0% achieved PASI 100, 58.1% achieved PASI 90, and 84.9% of patients achieved PASI 75. Mean
improvement from baseline in DLQI was 84.4%. No unexpected, untoward adverse events were noted.
Conclusions: A 12-week course of etanercept plus NB-UVB phototherapy was well tolerated and produced clinically meaningful
improvements in signs and symptoms of moderate to severe plaque psoriasis and in patient-reported outcomes.
Further investigation of the safety and efficacy of the use of such combination for this indication in controlled clinical
trials would be of interest.
Proportionally projecting feminine lips are considered attractive sexually. With aging, predictable changes occur in the
lips, which often prompt women to seek lip rejuvenation for enhancement. Although there is an ever-expanding list of
products for lip augmentation, very little technical information and guidelines for correct enhancement are available in
the dermatological literature. This review provides clinical guidelines for a systematic approach to lip augmentation and
rejuvenation, and documents clinical experience with Evolence® Breeze™, a novel, porcine collagen-derived dermal filler.
Before undertaking such procedures, thorough lip assessments and clearly defined treatment objectives are needed. Fifteen
women, ages 42 to 61 years, underwent procedures using Evolence Breeze; 6 required augmentation and 9 required
rejuvenation. Only minimal swelling was noted immediately after lip injection. At 3 months, results were rated as “very
good” by 8 patients (53%), “good” by 5 (33%), and “satisfactory” by 2 (13%). At 6 months, all had ongoing results.
Robert Matheson MD, Steven Kempers MD, Debra Breneman MD, Zoe Draelos MD, Candice E. Johnson MD PhD,Robert Loss MD, Daniel J. Hogan MD, Robert Schoenfeld MD, Scott Checketts MD, Leon Kircik MD,David Fivenson MD, Adelaide A. Hebert MD, Judith Williams MD, Regina Hamlin MD, Daniel Groisser MD,Dan Piacquadio MD
Background: Hydrocortisone butyrate (HCB) is currently marketed as a cream, ointment, and solution. A new lotion
formulation of hydrocortisone butyrate 0.1% (Locoid® lotion) has been developed and evaluated.
Objective: The objective of this study was to evaluate the efficacy and safety of HCB 0.1% lotion compared to the vehicle
in subjects aged 3 months to less than 18 years with mild to moderate atopic dermatitis (AD).
Methods: In this multicenter double-blind study, 284 subjects with mild to moderate AD were randomized 1:1 to receive
HCB 0.1% lotion or the vehicle for a duration of 4 weeks. “Treatment success” was defined as those subjects with a final
Physician Global Assessment (PGA) score of 0 or 1 that had at least a 2-point reduction in the PGA score from baseline
to day 29. Safety was assessed by monitoring adverse events.
Results: Analyses of the final PGA score showed a significant treatment effect (P<.001) in favor of the HCB 0.1% lotion
group. The safety profile of the HCB 0.1% lotion was also favorable.
Limitations: The study did not assess the durability of the treatment effects (ie, safety and efficacy) after completion of the
4-week treatment period nor the potential need for longer term therapy given the chronic nature of AD.
Conclusion: Results demonstrate the safety and efficacy of HCB 0.1% lotion in the treatment of mild to moderate AD
in children 3 months to 18 years of age.
Julio Cesar Tavares Ferreira MD, Alessandra Haddad MD PhD, Simone Arruda Navarro Tavares
Introduction: Results from clinical observations have demonstrated that percutaneous infiltration of carbon dioxide improves
the appearance of the skin in adjacent areas. No studies have been found in the literature that showed evidence
of histological changes caused by carbon dioxide injections.
Objectives and Methods: A blind cross-sectional pilot study was performed in the Departments of Pharmacology and
Morphology of the Federal University of Ceará, with the aim of histologically investigating whether intradermal and/or
subcutaneous injection of medicinal carbon dioxide would increase collagen turnover in rats. Ten male Wistar rats were
used, aged 3 months (2 animals) and 14 months (8 animals). The 2 younger rats were used as controls. Four of the older
rats received injections of saline solution (0.9%), and were also considered to be controls. In the remaining 4, carbon
dioxide was injected into the subcutaneous cellular tissue and intradermally. Biopsy samples were collected before and
after treatment with carbon dioxide.
Results: Collagen turnover increased in the treated animals in comparison with the controls. Compression of collagen
bundles in the tissue samples where intradermal injection was used was more intense than in the subcutaneous treatment.
The histological characteristics of the samples with carbon dioxide injected intradermally were similar to the characteristics
of the younger rats (controls).
Conclusions: The results obtained corroborate clinical observations of aesthetic improvements in the facial skin with carbon
dioxide injections. Future research should address the comparison between intradermal and subcutaneous injections,
the volume of gas used, and the frequency of treatment sessions.
Katherine H. Flanagan MD, Rosemary King PA-C, Dee Anna Glaser MD
Severe hyperhidrosis affects 2.8% of the population and can be emotionally devastating. First-line therapy employs topical
agents such as aluminum chloride (AC), but efficacy and tolerability vary widely. Botulinum toxin type A (BTX-A)
is FDA-approved for the treatment of primary focal axillary hyperhidrosis unresponsive to topical therapy. A single-center,
randomized, parallel, open-label, 12-week study was performed to compare the efficacy and safety of BTX-A with 20%
AC for the treatment of primary focal axillary hyperhidrosis. Twenty-five subjects were randomized to either BTX-A or
AC treatment, and were evaluated for treatment response by an improvement of ≥2 grades on the Hyperhidrosis Disease
Severity Scale (HDSS). At week 4, 92% of the subjects in the BTX-A group achieved treatment response compared with
33% of the subjects in the AC group. Overall, treatment with BTX-A was more effective and provided greater patient
satisfaction than with AC. Treatment with AC was effective and tolerated in 29% of the subjects.
Danny Vleggaar MD, Rebecca Fitzgerald MD
It is becoming widely accepted that volume changes in the skin and soft tissue contribute greatly to age-related facial
reshaping. A significant contribution to these volume changes is the loss of craniofacial skeletal support to the overlying
soft tissue. Gravity, once considered the major culprit in facial aging, is now recognized to determine the
direction, rather than the extent, of tissue deflation. Although the sequence of events observed in aging is somewhat
predictable, its pace among individuals is variable and may be influenced by both intrinsic (eg, gender, genetics)
and extrinsic (eg, photoaging, smoking, stress) factors. Changes in different tissue layers within a single individual
do not occur independently, but interdependently; changes in one tissue within an individual may influence subsequent
changes in other tissues. Midfacial soft tissue descent has been observed in response to decreased craniofacial
support in both congenital craniofacial hypoplasia and following trauma, leading to a hypothesis that the loss
of underlying bony support for any reason, including aging, leads to soft tissue descent in the face. As craniofacial
support (the “table”) decreases, it leaves less surface area for the outer soft tissue envelope (the “tablecloth”) causing
it to fold or sag. Replacing this deep support with craniofacial implants has been shown to reposition the overlying
soft tissue. Following a brief review of the current literature on aging changes in the skin, soft tissue, and bone;
the authors describe their experience with the use of poly-L-lactic acid (PLLA), both as a soft tissue volumizer and
as an injectable craniofacial implant in a supraperiosteal location to address both soft tissue volume loss and loss of
craniofacial support. In the cases presented, the most striking result noted was the ability to restore a youthful proportion
to the perioral area, which had not been achieved previously with soft tissue treatment alone.
Koichiro Kameyama MD PhD
Background and Objective: Deep heating or denaturation of collagen has been reported to be necessary for nonablative
skin rejuvenation. The purpose of this study was to examine whether thermally damaged collagen is an indispensable factor
to increase the amount of collagen in vivo. Epidermal and dermal responses to infrared light therapy using a Titan source
were examined with the aim of correlating histological and clinical responses in human and amelanotic mouse skin.
Study Design/Materials and Methods: Ten, 20, or 30 J/cm2 infrared light were irradiated on the human subject’s skin
(thigh), while 5, 10, 20, or 30 J/cm2 were used on amelanotic mouse skin. Biopsies were taken and analyzed using hematoxylin
and eosin (H&E) and Elastica von Gieson stain.
Results: Ten or 20 J/cm2 infrared light increased the amount of both collagen and elastin in all layers of the dermis without
denaturing the collagen in human skin. A higher dose of 30 J/cm2 also increased the amount of collagen and elastin,
but denatured the collagen in human skin. (In addition to the thigh, 2 treatments of 10 J/cm2 infrared light improved
skin toning and texture on the subject’s face.) In mouse skin, 5 or 10 J/cm2 remarkably increased the amount of both collagen
and elastin, and of epidermal cells. Twenty or 30 J/cm2 increased the amount of collagen and elastin and the number
of keratinocytes, but caused some vacuolated degeneration of keratinocytes. The presence of denatured collagen was
not evident due to the high density of collagen.
Conclusions: This study shows that the denaturation of collagen is not required to increase the amounts of collagen or
elastin in vivo in human skin. The activation of the mitochondria as well as the denaturation of collagen may play important
roles in infrared phototherapy.
Yujie Feng, Junying Zhao, Michael H. Gold MD
Background: Skin aging consists of photoaging and intrinsic aging. It is characterized clinically not only by rhytides, but
also by pigmentary alterations and facial telangiectasias. There continues to be a growing interest in the efficacy of intense
pulsed light (IPL) devices in the treatment of skin aging, as well as further defining its mechanism of action.
Objectives: The objective of this clinical trial was to evaluate the effects and the mechanism of action of an IPL by comparing
clinical photographs and biopsy results before and after treatment.
Methods: A total of 58 patients were treated using a new IPL device. Clinical photographs were taken before treatment
and compared to those taken 3 weeks after the treatment. Also, 4 cases had pathological analyses of tissues that were stained
by haematoxylin-eosin and Uana orcein. Immunohistology of human collagen of types 1 and 3 and quantitative analyses
of elastin and collagen were performed by a poly-functional digital image light microscope; a transmission electron
microscope was used for 2 of the cases to look for additional changes.
Results: After 3 treatments, 62.1% of the patients showed improvement in wrinkles and skin texture. Pigmentation improved
in 84.6% of the patients, and a reduction in telangiectasis was seen in 81.25% of the patients. Pathological examination
showed that both type 1 and type 3 collagens increased following treatment, but elastin content decreased;
however, the elastin fibers were arranged more neatly. In the transmission electron microscope study, the amount of
fibroblast activity increased, the fibroblasts were more active, and there were more collagen fibers neatly rearranged within
Conclusion: Clinical and pathological studies demonstrated that the IPL was effective in improving wrinkles and skin
texture. The mechanism of action may be through the increasing activity of the fibroblasts, hyperplasia of the fibroblasts,
and rearrangement of both collagen and elastin within the stroma.