Welcome to the August 2018 issue of The Journal of Clinical and Aesthetic Dermatology. We start this issue with a study by Azevedo et al titled “Vitamin D Deficiency, Skin Phototype, Sun Index, and Metabolic Risk Among Patients with High Rates of Sun Exposure Living in the Tropics.” Here, investigators sought to determine the association between metabolic risk and serum 25-hydroxycholecalciferol (vitamin D [25-OHD]) levels, skin phototype, and sun index in a sample of 729 patients (mean age 65.13±9.18 years) who presented to primary care and endocrinology clinics, located in the tropics, during a six-month period. The authors reported that although they were not able to find significant differences between the vitamin D deficient and sufficient groups regarding age, BMI, waist circumference, or presence of diabetes, they did find a high prevalence of vitamin D deficiency among their study participants, despite living in a high sun exposure area. They also reported that this deficiency was associated with increased serum triglycerides and decreased HDL-C levels.
Next, in a review article titled “A Practical Approach to Chemical Peels: A Review of Fundamentals and Step-by-step Algorithmic Protocol for Treatment,” Soleymani et al provide an up-to-date analysis of all currently available chemical peels for dermatologic use, as well as a step-by-step instructional protocol for an algorithmic approach to treatment.
Following this, in a study by Ablon titled “Safety and Effectiveness of an Automated Microneedling Device in Improving the Signs of Aging Skin,” researchers evaluated the efficacy and safety of an automated microneedling device when used for the rejuvenation of facial skin among 48 subjects aged 35 to 75 years with signs of facial skin aging. Following four microneedling sessions 30 days apart, subjects were assessed at baseline and at 30, 60, 90, and 150 days after the first treatment for changes in appearance of wrinkles (using Lamperle Grading Scale) and skin laxity and texture (using modified Alexiades-Armenakas Grading Scale). Digital fringe projection technology (PRIMOS) was also used as a method of assessment. The author reports that statistically significant mean improvements were observed at Days 90 and 150 post-treatment, with minimal pain, discomfort, or downtime, and only minor, easily managed side effects; however, the author acknowledges that clinical evaluation of the technique using a more ethnically diverse study group is needed to support the findings of this study.
Following this, in a case study by Corduff titled “The 12-point Revitalization Guide to Pan-facial Application of Injectable Fillers in Older Women,” the author presents a 12-point revitalization guide, based on personal experience, as an approach for the pan-facial application of calcium hydroxylapatite and hyaluronic acid fillers specific to the aging female face. Three cases are presented to illustrate the application technique. The author acknowledges that the small number of patients described in this case study and the assessment of treatment outcomes using the appraisal of a single investigator and patient self-reporting limit the significance of the presented results.
Next, in a study by Elawar and Dahan titled “Non-insulated Fractional Microneedle Radiofrequency Treatment (MFRF) with Smooth Motor Insertion for Reduction of Depressed Acne Scars, Pore Size, and Skin Texture Improvement: A Preliminary Study,” researchers evaluated an MFRF device as a means to treat atrophic acne scars, improve skin texture, and reduce pore size. Nineteen patients were enrolled in the study, and each patient received 2 to 6 MFRF treatments with one-month intervals between treatments. Treated areas were visually assessed one month and three months following last treatment for skin response, including edema, erythema, and burns, and pain was assessed using a standard pain scale of 0 to 10. The authors report no adverse events were observed; pain, as subjectively reported by subjects, was minimal; and subjective and objective overall treatment satisfaction was high. The authors conclude that MFRF shows promise as an effective minimally invasive treatment for acne scars, skin texture improvement, and pore size reduction, but acknowledge that the small sample size and short follow-up period limit the significance of their results. A more robust study with a larger patient sample and longer period of follow-up (?6 months) following last treatment are needed to support their findings.
Following this, in a study titled “Management of Truncal Acne Vulgaris with Topical Dapsone 7.5% Gel,” by Del Rosso et al, investigators evaluated the efficacy and safety of dapsone 7.5% gel used once daily as monotherapy for the treatment of truncal acne vulgaris (AV) involving the chest and back. In this three-center, open-label, 16-week study, the authors report that by Week 16, 55 percent of the subjects achieved a two-grade improvement in IGA rating and 45 percent were graded as clear or almost clear, with a marked progressive reduction in inflammatory lesions, non-inflammatory (comedonal) lesions, and total lesions compared to baseline. The authors conclude that dapsone 7.5% gel is an effective treatment for truncal AV, though they acknowledge that a large-scale RCT evaluating the efficacy of this agent for truncal AV is needed to support their findings.
Finally, in a study titled “A Randomized, Active Comparator-controlled Clinical Trial of a Topical Botanical Cream for Skin Hydration, Elasticity, Firmness, and Cellulite” by Yimam et al, researchers assessed the effectiveness of a topical botanical cream (UP1307) on cellulite, skin hydration, firmness, and elasticity after two, four, and eight weeks of use compared to an active comparator. A total of 44 women 18 to 59 years of age were enrolled in this single-blind, randomized, controlled study. Test products were gently applied in a circular motion to the area identified by subjects as the target cellulite area twice per day for eight weeks. Patients were assessed using Corneometer® (for skin hydration) and Cutometer® (for skin elasticity and firmness), expert clinical grader evaluations for cutaneous changes and cellulite, and self-report patient questionnaires at each visit (2, 4, and 8 weeks). The authors report that significant improvement in skin hydration, firmness, and elasticity over time were observed in both groups of patients, with findings corroborated with objective instrumental measurements, though there was overall superiority of UP1307 between groups. Additionally, the authors report that almost half of the subjects using UP1307 reported reductions in cellulite appearance.
We hope you enjoy this issue of JCAD. As always, we welcome your feedback and submissions.
James Q. Del Rosso, DO, FAOCD—Editor-in-Chief, Clinical Dermatology
Wm. Philip Werschler, MD, FAAD, FAACS—Editor-in-Chief, Aesthetic Dermatology
Seemal R. Desai, MD, FAAD—Associate Editor