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Objective To evaluate the safety and efficacy of the combined treatment with an optimized intense pulsed light (IPL) and a non-ablative fractional laser (NAFL) for facial rejuvenation.Methods A prospective,split-face,randomized,controlled study was conducted.A total of 22 testees with facial photoaging,who aged from 35 to 55 years,were enrolled into this study from the Department of Dermatology of Peking University First Hospital between March and June in 2017.By a random number table,the two sides of each testee's face were randomized to receive combined treatment with optimized IPL immediately followed by non-ablative 1 565 nm Erbium:Glass fractional laser (combined treatment group) or non-ablative 1 565 nm Erbium:Glass fractional laser alone (NAFL group) once every month for 3 sessions.Before the treatment,60 and 90 days after the treatment (1 month after the second and third treatment respectively),photos of the treatment regions were taken,skin physiology parameters (including skin melanin,erythema indices,water content of the stratum corneum,transepidermal water loss [TEWL],skin flexibility and glossiness) were measured,and subjective and objective clinical evaluation was carried out.After each treatment,adverse reactions were assessed by two dermatologists independently,including facial erythema,swelling and crusting,desquamation,pigmentation and pains.Results During the treatment course,1 testee dropped out due to pains,another 1 testee dropped out for personal reasons,and 20 testees completed the treatment and follow-up.The combined treatment group showed significantly decreased melanin indices on days 60 and 90 (152.9 ± 36.9 and 155.0 ± 38.1,respectively) compared with that before the treatment (168.4 ± 41.3,F =5.321,P ＜ 0.05).On day 60,the melanin index was significantly lower in the combined treatment group than in the NAFL group (159.4 ± 35.3,P ＜ 0.05).However,the melanin indices on days 60 and 90 in the NAFL group (159.4 ± 35.3,156.7 ± 36.3) did not significantly differ from that before the treatment (165.9 ± 35.4,P ＞ 0.05).No significant difference was observed between the pre-and post-treatment erythema indices in either of the two groups (both P ＞ 0.05).The water content of the stratum corneum on days 60 and 90 significantly increased compared with that before the treatment in both the combined treatment group (F =21.795,P ＜ 0.001) and NAFL group (F =21.798,P ＜ 0.001),while the TEWL on days 60 and 90 significantly decreased compared with that before the treatment in both the combined treatment group (F =8.848,P =0.001) and NAFL group (F =5.833,P ＜ 0.05).However,there were no significant differences in either of the water content of the stratum corneum or TEWL on days 60 and 90 between the two groups (P ＞ 0.05).On days 60 and 90,the combined treatment group and NAFL group both showed significantly increased skin flexibility (P＜ 0.05,0.001,respectively) and glossiness (both P ＜ 0.001) compared with those before the treatment.On day 90,the skin glossiness in the combined treatment group was higher than that in the NAFL group (P ＜ 0.05).The short-term adverse reactions included transient pain,erythema and swelling which lasted 2-3 days,and slight desquamation.The main adverse reaction was mild local pigmentation,which lasted 2-3 months and then subsided gradually.Conclusion The 3 sessions of treatment with an optimized IPL immediately followed by a 1 565 nm NAFL is clinically superior to those with the NAFL alone for improving the facial pigmentation and skin glossiness,and the adverse reactions are usually transient and mild.
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Objective To assess the efficacy and safety of nonablative 1 565-nm Er:Glass fractional laser in the treatment of striae gravidarum.Methods The left and right sides of the abdomens of 30 subjects with striae gravidarum were divided into 2 groups by simple randomization:treatment group treated with nonablative 1 565-nm Er:Glass fractional laser every 4 weeks for 3 sessions,and control group receiving no treatment.These subjects were followed up at the baseline,4th,8th and 12th week.At the same time,photos were taken,the skin flexibility was evaluated,and the width of striae was measured.Four weeks after the final treatment,clinical improvement was evaluated by 2 doctors,who were blind to the therapeutic protocol,according to clinical photos and three-dimensional (3D) images,and satisfaction scores were also evaluated.Skin biopsies were taken from the left and right sides of the abdomens of 3 subjects,and subjected to histopathological examination.Four months after the final treatment,all the subjects were telephoned for evaluation of adverse reactions and recurrence.Results A total of 27 subjects completed the whole trial.Four weeks after the final treatment,25 (92.6％) of the 27 subjects were considered to achieve an improvement by doctors.However,21 (77.8％) of the 27 subjects considered themselves to achieve an improvement.After 3 sessions of treatment,the treatment group showed a significant decrease in the largest width of striae from 4.852 mm to 3.296 mm (P ＜ 0.001) and a significant increase in skin flexibility from 0.803 to 0.878 (P ＜ 0.001).Histopathologically,the control group showed obviously atrophic epidermis and decreased collagen and elastin in the dermis,while the treatment group showed thickened epidermis and dermis,extended rete ridges,and increased collagen and elastic fibers which arranged more regularly.Immediate adverse reactions during the treatment included erythema and edema,and other adverse reactions included mild crust,itching and post-inflammatory hyperpigmentation (PIH).PIH was improved at 4 months after the final treatment compared with that at 4 weeks after the final treatment.Conclusion The nonablative 1 565-nm Er:Glass fractional laser can markedly improve the width and appearance of striae gravidarum,and increase skin flexibility in the treatment region.
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Objective To evaluate the inhibitory effect of butyl flufenamate (BT) on ultraviolet (UV)-induced acute skin phototoxic reaction,and to investigate its possible mechanisms.Methods Eight SKH-1 hairless mice were included in this study.The back of each SKH-1 hairless mouse was divided into six regions,which were then randomly classified into six groups:blank group receiving no treatment,UV group receiving UV radiation only,BT + UV group and vehicle + UV group topically treated with BT ointment and vehicle respectively followed by UV radiation,UV + BT group and UV + vehicle group topically treated with BT ointment and vehicle respectively after UV radiation.Skin samples were obtained from these mice at 24 hours after treatment.Subsequently,hematoxylin-eosin (HE) staining was performed,real-time PCR was carried out to detect mRNA expressions of caspase-3,p53,COX-2,PGER1,interleukin (IL)-1β,IL-6,and an immunofluorescence assay was conducted to observe the expression of caspase-3.Statistical analysis was carried out by repeated-measures analysis of variance (ANOVA).Results Compared with the UV group,both BT + UV group and UV + BT group showed a decrease in the degree of skin edema and number of apoptotic cells at 24 hours after UV radiation.Real-time PCR showed that the mRNA expressions of caspase-3,p53,COX-2,PGER1,IL-l β and IL-6 were significantly higher in the UV group than in the blank group (all P ＜ 0.05),but significantly lower in the BT + UV group than in the UV group (all P ＜ 0.05),and only the expressions of caspase-3 and p53 mRNAs were significantly decreased in the UV + BT group compared with the UV group (both P ＜ 0.05).The immunofluorescence assay revealed that the expression of caspase-3 increased in the UV group compared with the blank group,but decreased in both BT + UV group and UV + BT group compared with the UV group.Conclusion BT could partially inhibit UV-induced acute skin phototoxicity in SKH-1 hairless mice.
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Objective To investigate the effect of fusidic acid cream on inflammatory reaction caused by skin barrier damage.Methods Eight male SKH-1 hairless mice were included in this study.The back of each of these mice were equally divided into six regions measuring 1 cm × 2 cm in size,which were then assigned into six groups:blank control group remaining untreated,barrier-impaired group,barrier-impaired and fusidic acid-treated group,barrier-impaired and vehicle-treated group,barrier-unimpaired and fusidic acid-treated group,barrierunimpaired and vehicle-treated group.Stratum corneum was removed by adhesive tape stripping to establish an animal model of acute skin barrier damage in the corresponding skin regions of these mice,and fusidic acid cream or vehicle was topically applied to the corresponding regions once.Twelve hours later,skin surface swab samples were collected from the back of these mice followed by bacterial culture and colony counting.Mice were then sacrificed,and skin tissue specimens were resected from these mice,and subjected to real-time fluorescence-based quantitative PCR for the measurement of the mRNA expressions of myeloid differentiation factor 88 (MyD88),interleukin-1α (IL-1α),IL-6,epidermal antibacterial peptides S100a8 and S100a9.Statistical analysis was carried out by repeated-measures analysis of variance (ANOVA) and least significant difference (LSD) test.Results The mRNA expressions of MyD88,IL-1α,IL-6,S100a8 and S100a9 were all significantly higher in the barrier-impaired group than in the blank control group (all P ＜ 0.05).Specifically,the mRNA expression level of MyD88 in the barrier-impaired group was 8 times that in the blank control group (8.3 ± 3.0 vs.0.8 ± 0.4).Compared with the barrier-impaired group,the barrier-impaired and fusidic acid-treated group showed a significant decrease in the mRNA expressions of IL-1α (2.8 ± 0.3 vs.20.1 ± 10.0,F =47.11,P ＜ 0.01),IL-6 (1.6 ± 2.3 vs.9.4 ± 4.0,F =16.18,P＜ 0.01),S100a8 (1.5 ± 1.4 vs.5.0 ± 1.6,F=59.71,P＜ 0.05) and S100a9 (1.2 ± 0.7 vs.3.4 ± 1.6,F=21.94,P ＜ 0.05).Conlusions Fusidic acid cream could attenuate the inflammatory reaction caused by acute skin barrier damage,which might partly explain its action mechanism in the treatment of inflammatory skin diseases.