Category: Treatment

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Topographic Computer Analysis for Acne Scar Treatment on Face accompanying Biopsy Study after Dermal Injection of Hydrotoxin Mixture

Abstract

Background
Acne during youth can leave permanent facial scarring. The depressed acne scars can be treated by injection of stabilized hyaluronic acid (S‐HA) into the dermis. Due to the large number of acne scars, manual injection methods are technically difficult, and bear high risk of lump formation in the dermis. Therefore, the author designed a specific injection method to solve the two abovementioned problems.

Materials/Methods
102 Patients who suffered from acne scars were treated with a mixture of S‐HA (Restylane Vital®) and abobotulinumtoxinA (Dysport®). Using an automatic injector, microdroplets of the mixture (0.001cc of S‐HA and 0.125 U abobotulinumtoxinA) were delivered into 1000 intradermal sites on whole face except eyelids. This instrument radically reduced injection amounts per site (0.001cc), lessened manual operator efforts, and ensured consistent injection depth (from 0.8mm to 1.2mm depending on individual dermal thickness) into the facial dermis. The changes in each depression site of acne scars were evaluated by topographical computer analysis (point‐roughness), based on the 40 magnification microscopic photos generated. Depth measurements of each small acne scar point were taken one by one at the exact same point before and after the treatments. Global Aesthetic Improvement Scale (GAIS) was measured for improvement of acne scars at 1 and 6 months post‐treatment. Additionally, serial histologic examinations of the biopsy specimens evaluated neocollagenesis, neoelastinogenesis, and longevity state of the S‐HA.

Results
78 patients showed improvements of depressed acne scars in physical examinations, medical photos, and dermascopic photos.
Using topographic computer analysis, the average point‐roughness decreased 27.48 % (at 1‐month) from 29.042±6.85 (baseline) to 21.05±6.30 µm (P

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Challenges of COVID‐19 pandemic for dermatology

Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) is a new coronavirus responsible for the pandemic named coronavirus disease 2019 (COVID‐19). The disease causes SARS with a significant morbidity and mortality. We provide a review with a focus on COVID‐19 in dermatology. We discuss triage of suspected infectious patients, protection of medical doctors and nurses. We discuss the available data on cutaneous symptoms, although disease‐specific symptoms have yet not been observed. COVID‐19 is a challenge for the treatment of dermatologic patients, either with severe inflammatory disorders or with skin cancer. The consequences for systemic treatment are obvious but it will be most important to collect the clinical data for a better decision process. Last but not least, education in dermatology for students will not be temporarily possible in the classical settings. COVID‐19, although not a skin disease, by itself has an immense impact on dermatology.
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Overall safety of relamorelin in adults with diabetic gastroparesis: Analysis of phase 2a and 2b trial data

Summary

Background
Relamorelin, a pentapeptide ghrelin receptor agonist, accelerated gastric emptying significantly and improved symptoms in adults with diabetic gastroparesis in phase 2 trials.

Aim
To assess the safety and tolerability of relamorelin across phase 2 trials.

Methods
Safety assessments in patients aged 18‐75 years (weight, adverse events [AEs] and laboratory tests) from two randomised, double‐blind phase 2 trials (NCT01571297, NCT02357420; results published previously) were reviewed descriptively. Analysis of covariance assessed treatment effect on glycated haemoglobin (HbA1c) and blood glucose post hoc. Phase 2a and 2b trial durations were, respectively, 4 weeks (relamorelin 10 µg once or twice daily [b.d.] or placebo b.d.) and 12 weeks (relamorelin 10, 30 or 100 µg or placebo b.d.) with 1‐ and 2‐week, single‐blind placebo run‐ins.

Results
Among 204 phase 2a and 393 phase 2b patients, respectively, 67% and 62% were female, and 88% and 89% had type 2 diabetes. Proportions of patients reporting serious AEs were similar across treatment groups, as were those with ≥1 treatment‐emergent AE (TEAE). TEAE‐related discontinuations were proportionally higher in relamorelin groups than placebo. Of 12 serious TEAEs in phase 2a, none occurred in >1 patient. In phase 2b, five serious TEAEs were reported in >1 patient, and one (100 µg) died (urosepsis), all unrelated to relamorelin. In phase 2b, increased HbA1c and fasting blood glucose levels were dose‐related (P 

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Long‐term results of the treatment of primary hyperhidrosis with oxybutynin: follow‐up of 1,658 cases

Abstract

Background
Hyperhidrosis (HH) is characterized by exaggerated sweating in a specific region due to hyperfunction of the sweat glands. In the late 2000s, we started treating patients with an anticholinergic, oxybutynin, that was not being used until then.

Objectives
To present, after 12 years of utilizing this medication in our service, the substantial experience obtained with the use of oxybutynin as an initial treatment of HH in a large series of 1,658 patients.

Methods
We analyzed 1,658 patients treated with oxybutynin for HH from May 2006 to June 2018. The patients were divided into four groups according to the main site of HH: the plantar group, the axillary group, the facial group, and the palmar group. To measure the degree of satisfaction, a quality of life (QoL) questionnaire was used.

Results
Pre‐treatment QoL was poor or very poor in more than 94% of the cases, and the palmar group had the worst quality of life. After treatment, we observed an improvement in the quality of life in 77% of patients. More than 70% of the patients in all groups present moderate or optimal subjective clinical improvement in sweating after treatment. The group with the best result was the facial group. Intense dry mouth was reported in 24.9% of all patients in all groups.

Conclusions
This study included a large number of patients followed for a long period and demonstrated the good effectiveness of treatment with oxybutynin for hyperhidrosis in the main sites of sweating.

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Psychotropic drugs in dermatology: A dermatologist’s approach and choice of medications

Abstract
Psychiatric symptoms in dermatology practice are increasingly being recognized. The use of psychiatric medications by dermatologist is dealt with caution and uncertainty in several psychodermatological conditions. Several skin conditions are associated with anxiety, depression, and obsessive‐compulsive symptoms. Some conditions such as delusion of parasitosis require antipsychotic medication treatment. Keeping in mind the importance of psychotropic medications and its use in dermatology, following brief review will familiarize dermatologists about the ease of understanding and prescribing psychotropic medications to help their patients with psychiatric symptoms and increase the compliance in treatment.
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Ventricular arrhythmia suppression with ivabradine in a patient with catecholaminergic polymorphic ventricular tachycardia refractory to nadolol, flecainide, and sympathectomy

Abstract
Conventional treatment strategies for catecholaminergic polymorphic ventricular tachycardia (CPVT) include avoidance of strenuous exercise and competitive sports, drugs such as ß‐blockers and flecainide and, cervical sympathectomy. An implantable cardioverter‐defibrillator (ICD) has been utilized if the response to these strategies is inadequate; however, ICD use in CPVT patients, in addition to usual complications, is associated with an increased risk of life‐threatening electrical storm. Ivabradine is a selective inhibitor of hyperpolarization‐activated cyclic nucleotide‐gated potassium channel 4 generated funny current (If), which has been shown to be efficacious in suppression of inappropriate sinus tachycardia, junctional tachycardia, atrial tachycardia, and ventricular ectopy in humans. We report an 18‐year‐old male with a severe CPVT phenotype refractory to flecainide, nadolol, and sympathectomy who exhibited suppression of ventricular arrhythmias after initiation of ivabradine. These findings are of importance as ivabradine could be an important add‐on therapy in CPVT patients who are drug refractory or are unable to continue conventional therapies at the recommended doses.
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Successful treatment of Pachyonychia congenita with Rosuvastatin

Abstract
Pachyonychia congenita (PC) is a rare genetic disorder affecting nails, skin, oral mucosae, larynx, hair and teeth. Patients with PC present with nail thickening and painful plantar keratoderma. Additional features include hyperhidrosis, oral leukokeratosis, follicular keratosis, palmar keratoderma, cutaneous cysts, hoarseness or laryngeal involvement, coarse or twisted hair and abnormalities of the teeth 1. Current treatment focuses on symptom relief 2. Several experimental therapies (including siRNA, mTOR‐inhibition) have been developed but did not reach clinical use 3, 4. We herein report on the effective therapy of a 9‐year‐old female with PC due to a heterozygous KRT6A mutation. After failed efficacy of common available therapies, our patient was successfully treated with Rosuvastatin.
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Ischemic ulcers of the toes secondary to Raynaud’s phenomenon in a child successfully treated with botulinum toxin

Abstract
Raynaud’s phenomenon (RP) is an episodic vasospastic response to cold or emotional stress causing color changes and pain. These attacks can lead to digital ischemia, ulcers, and gangrene. Severe and refractory RP in children is a therapeutic challenge for clinicians because there are no standardized treatment protocols for these patients. We present a case of RP involving the toes of a child successfully treated with botulinum toxin A.
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A Phase 2a Trial Investigating the Safety and Tolerability of the Novel Cortical Enhancer IRL752 in Parkinson’s Disease Dementia

Abstract

Background
IRL752 is a novel small‐molecule compound that acts to regioselectively enhance norepinephrine, dopamine, and acetylcholine neurotransmission in the cerebral cortex.

Objective
The primary objective of the trial was to investigate the safety and tolerability of IRL752 in patients with Parkinson’s disease and dementia.

Methods
Patients with Parkinson’s disease and dementia were randomized to IRL752 or placebo treatment (3:1 ratio) for 28 days. The study drug was given as an adjunct treatment to the patients’ regular stable antiparkinsonian medication. Dosing was individually titrated for 14 days after which the dose was kept stable for an additional 14 days.

Results
A total of 32 patients were randomized to treatment, and 29 patients completed the 4‐week treatment. Adverse events were generally mild and transient and were mostly reported during the dose titration phase. There were 2 serious adverse events, and none of them were related to the experimental treatment. The average dose achieved in the stable dose phase was 600 mg daily, yielding a 2‐hour postdose plasma concentration of about 4 μM on day 28. Exploratory assessment of secondary outcomes indicated efficacy for symptoms and signs known to be poorly responsive to levodopa.

Conclusions
IRL752 appears to be safe and well tolerated for a 4‐week treatment in patients with Parkinson’s disease and dementia. © 2020 International Parkinson and Movement Disorder Society

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Successful treatment of Pityriasis Versicolor by photodynamic therapy mediated by methylene blue

Abstract

Background
Although systemic therapies are recommended for severe or recalcitrant cases of pityriasis versicolor (PV), they are not free of important side effects and drug interactions. Photodynamic therapy (PDT) utilizes the action of singlet oxygen and free radicals produced by a light‐activated photosensitizer to kill viruses, bacteria, or fungi. In this study, the effect of a PDT mediated by methylene blue (MB) in PV was evaluated.

Methods
Five women with PV disseminated on the back and diagnosed by fresh microscopic analysis were treated with a solution of MB (2%) applied to the PV lesions for 3 minutes. Next, a red LED lamp (λ = 630±5 nm, 37 J/cm2), placed 100 mm from the skin for 10 minutes, was applied on the dyed PV lesions. Six sessions of MB/PDT were implemented with a 2‐week interval in between. Wood’s lamp examination was used to monitor fungal infection at each time point.

Results
Complete cure was observed in the five women at the 4 weeks post‐treatment follow‐up. Fluoresce images from PV lesions by Wood’s lamp allowed to evaluate whether the lesions were healed or not at each time point. No patient showed relapse at the 6‐month follow‐up. The patients did not have any adverse effect, and good cosmetic outcome was observed.

Conclusions
Six sessions of MB/PDT spaced at 14‐day intervals are sufficient for the treatment for PV in healthy patients.