Intradermal Injection of Botulinum Toxin: A Safer Treatment Modality for Forehead Wrinkles

Intramuscular injection of botulinum toxin A (BTXA) is commonly used for the treatment of forehead wrinkles. In practice, physicians often use an intradermal injection for this purpose, as they feel that there is a lower risk of adverse effects compared with intramuscular injection. However, there are no direct comparative studies between those two injection modalities. We conducted a 24-week long, double-blinded, split-face, pilot study of three participants to compare the efficacy and safety of intradermal or intramuscular injection of BTXA for the treatment of forehead wrinkles. Maximum improvement of wrinkles and the time to achieve maximum effect were similar for both methods. The brow level was lower on the intramuscular injection side throughout the follow-up period for all participants. Subjective satisfaction with wrinkles was similar on both sides, but patients felt more heaviness of the eyebrow on the intramuscular side. No serious side effects were noted. In conclusion, the anti-wrinkle effect of BTXA was not significantly different between intramuscular and intradermal injections. However, side effects such as eyebrow ptosis, and heaviness were more prominent after intramuscular injection.

Systemic antibody response to nano-size calcium phospate biocompatible adjuvant adsorbed HEV-71 killed vaccine

PURPOSE: Since 1980s, human enterovirus-71 virus (HEV-71) is one of the common infectious disease in Asian Pacific region since late 1970s without effective commercial antiviral or protective vaccine is unavailable yet. The work examines the role of vaccine adjuvant particle size and the route of administration on postvaccination antibody response towards HEV-71 vaccine adsorbed to calcium phosphate (CaP) adjuvant. MATERIALS AND METHODS: First, CaP nano-particles were compared to a commercial micro-size and vaccine alone. Secondly, intradermal reduced dosage was compared to the conventional intramuscular immunization. Killed HEV-71 vaccines adsorbed to CaP nano-size (73 nm) and commercial one of micro-size (1.7 microm) were administered through intradermal, intramuscular, rabbits received vaccine alone and unvaccinated animals. RESULTS: CaP nano-particles adsorbed HEV-71 vaccine displayed higher antibody than the micro-size or unadsorbed vaccine alone, through both parenteral immunization routes. Moreover, the intradermal route (0.5 microg/mL) of 0.1-mL volume per vaccine dose induced equal IgG antibody level to 1.0-mL intramuscular route (0.5 microg/mL). CONCLUSION: The intradermal vaccine adsorbed CaP nano-adjuvant showed safer and significant antibody response after one-tenth reduced dose quantity (0.5 microg/mL) of only 0.1-mL volume as the most suitable protective, cost effective and affordable formulation not only for HEV-71; but also for developing further effective vaccines toward other human pathogens.

Effects of Injection Depth and Volume of Stabilized Hyaluronic Acid in Human Dermis on Skin Texture, Hydration, and Thickness

BACKGROUND: Stabilized hyaluronic acid (S-HA) is used for soft tissue augmentation and can also be used for dermal hydration. According to previous reports, the injection volume of each shot is more than 0.02 cc for dermal hydration. Clinically, this is an excessive amount for this purpose, so I will introduce a modified method using particle type S-HA injection for dermal hydration. METHODS: One hundred fifty patients who had 1,000 injections of 1 cc S-HA by injector were analyzed. The patients were examined after 1, 2, 6, 12, and 24 months. Changes in skin texture were determined with regard to skin roughness and morphology, dermal hydration by electric resistance, dermal thickness by ultrasonic imaging, and biopsy. An intra-individual study was also performed to compare changes in skin texture between dermal and subdermal injections. RESULTS: Skin roughness significantly improved after this procedure. Electric resistance also decreased. The dermis of the face and hand were thickened about 4% after dermal injection. The injection depth was confirmed by biopsy. There were no significant changes in dermal thickness after subdermal injection with S-HA, which merely replaced fluid volume. Injections into the dermis changed both skin texture and thickness. CONCLUSIONS: Skin texture was improved after 1000 dermal injections (0.001 cc each) of particle type S-HA. Deeper injections only replaced the fluid volume and could not improve skin texture. For this purpose, the use of an injector or mesogun is recommended.

Multiple Subcutaneous Abscesses Complicating Staphylococcus aureus Bacteremia associated with BCG Vaccination

We report a case of 42-day-old girl with multiple abscesses in soft tissue sites and osteomyelitis caused by Staphylococcus aureus after an intradermal Bacillus Calmette-Guerin (BCG) vaccination. This may be an unusual complication of intradermal BCG vaccination.

Long-term immunogenicity of the influenza vaccine at reduced intradermal and full intramuscular doses among healthy young adults

PURPOSE: To prepare for vaccine shortages under an influenza pandemic, several antigen-sparing strategies have been investigated. This study was aimed to evaluate the immunogenicity of influenza vaccine at reduced intradermal and full intramuscular dose. MATERIALS AND METHODS: We compared the effect of one-fifth and one-half intradermal doses to the full intramuscular dose on immunogenicity in healthy young adults, using a commercial influenza vaccine. A hemagglutination inhibition assay was used to compare the immunogenicity of the vaccination methods. RESULTS: The one-fifth intradermal dose (3 microg hemagglutinin antigen, HA) was given to 30 participants, the one-half intradermal dose (7.5 microg HA) was given to 30, and the full intramuscular dose (15 microg HA) was given to 32. No significant differences among injection routes and dosages were seen for seroprotection rate, seroconversion rate, or geometric mean titer (GMT) fold-increase for A/H1N1, A/H3N2, and B at around 4 weeks from vaccination. Although GMT for influenza B was significantly lower at six months for the one-fifth intradermal vaccination compared to the full-dose intramuscular vaccination (32.8 vs. 63.2, p=0.048), all three groups met the Evaluation of Medicinal Products (EMA) immunogenicity criteria through 1 to 6 months. CONCLUSION: Intradermal administration of a one-fifth dose of influenza vaccine elicited antibody responses comparable to the intradermal one-half dose and a conventional intramuscular vaccination at 1 month post-vaccination. The immunogenicity of the one-fifth intradermal dose was sufficient to meet the requirement for the EMA criteria at six months after influenza vaccination.

Profound Hypotension after an Intradermal Injection of Indigo Carmine for Sentinel Node Mapping / 한국유방암학회지

Intradermal injections of indigo carmine for sentinel node mapping are considered safe and no report of an adverse reaction has been published. The authors described two cases of profound hypotension in women that underwent breast-conserving surgery after an intradermal injection of indigo carmine into the periareolar area for sentinel node mapping.