Sunscreen Use for Photoprotection in Skin of Color: A Literature Review.

BACKGROUND: To understand the prevalence and types of publications addressing darker skin types within the existing evidence base for sunscreen use.  Evidence Review: PubMed was searched from 1988, the time point at which the first skin of color (SOC) article was identified, through December 2022 using PubMed's Medical Subject Headings terms and keyword searches in title and abstract, with and without terms for SOC and ethnicity. Identified articles were reviewed for relevance, de-duplicated, and categorized; results are summarized. FINDINGS: Of the 5927 articles on sunscreen overall, only 314 (5.3%) articles addressed SOC, with the majority published since 2007 and representing only 4% to 7% of total publications annually except in 2022 when the proportion of SOC articles was 23.5%. Of the articles on SOC, many reported sunscreen knowledge and patient behaviors (29%), but very few reported clinical trials (5%). The 3 conditions most often discussed were melasma, post-inflammatory hyperpigmentation, and dyschromia. South Asian ethnicities (India, Pakistan, Bangladesh) had the highest representation within the literature, followed by Hispanics. CONCLUSIONS AND RELEVANCE: Although it was assumed there would be fewer papers discussing the use of sunscreen in darker skin types, the scale of the disparity revealed by this study is stark. The increase in a number of articles in 2022 suggests an increasing focus on SOC, but further discussion of the issues presented here will help the SOC community address gaps in the evidence base and better inform discussions on sunscreen and photoprotection between clinicians and patients.J Drugs Dermatol. 2024;23(7):575-577.  doi:10.36849/JDD.8250.

Remodeling of facial soft tissue induced by simultaneous application of HIFES and synchronized radiofrequency provides nonsurgical lift of facial soft tissues.

BACKGROUND: The application of radiofrequency (RF) and HIFES on the body provides improvement in skeletal muscle tissue, reduction in fatty tissue, reorganization of connective tissue, and skin texture improvement. However, overall facial appearance relies on both skin and underlying structures, specifically muscles and connective tissue which have to be treated as one unit to achieve proper care while preserving fatty layers that define youth facial appearance. AIMS: The aim of this study is to find whether the effect of novel RF + HIFES is safe and can induce the lifting of soft tissue and overall improvement in facial appearance. METHODS: In this study, 21 subjects were enrolled. The therapy was administered in four 20-min treatments on the forehead and cheeks. Photographs were evaluated by a Global Aesthetic Improvement Score (GAIS) and linear measurements of facial tissue lifting at 1- and 3-month follow-ups. Volumetric changes in the cheek area were investigated as well. The patients' satisfaction, safety, and comfort were documented throughout the study. RESULTS: The data indicated improvement in overall facial appearance, and 23% of average lifting was found in brows (p = 3.14 × 10-12 ) and cheeks (p = 6.00 × 10-15 ). The assessment of digital photographs showed an improvement in 100% of patients at 3-month follow-up. The treatments were safe, accompanied by high therapy comfort and subject satisfaction of 98%. CONCLUSIONS: The treatment by simultaneous RF and HIFES technology produces significant changes to the overall facial appearance, characterized by the lifting of facial tissues.

A multi-center, double-blind, randomized controlled study of the safety and effectiveness of Juvéderm injectable gel with and without lidocaine.

INTRODUCTION: Pain is a common patient complaint during dermal filler injections. The primary objective of this study was to compare a new formulation of Juvéderm((R)) injectable gel with lidocaine (denoted as JUV + L) to commercially-available Juvéderm((R)) injectable gel without lidocaine (denoted as JUV) with respect to procedural pain scores in subjects desiring nasolabial fold (NLF) correction. METHODS: Subjects received randomized treatment with the lidocaine filler in one NLF and the filler without lidocaine in the other NLF. Investigators determined the appropriate formulation (Ultra or Ultra Plus) and volume of material to inject but were blinded as to which syringe contained lidocaine. Subjects rated procedural pain (pain during injection) using an 11-point scale within 30 min after receiving treatment in both NLFs and compared procedural pain between right and left NLFs using a 5-point scale. NLF severity was rated by both subjects and investigators before and 2 weeks after treatment. RESULTS: The mean difference on the procedural pain scale was 3.4 (P < 0.0001), and 93% of subjects found JUV + L to be less or slightly less painful than JUV. Improvement in NLF severity was comparable for both products. Common treatment site reactions (CTRs) of pain and tenderness were considerably less frequent for JUV + L than JUV while all other CTRs showed no statistically significant differences. CONCLUSION: The dermal filler formulated with lidocaine is effective in reducing procedural pain during correction of facial wrinkles and folds while maintaining a similar safety and effectiveness profile to the filler without lidocaine.

Six-month safety results of calcium hydroxylapatite for treatment of nasolabial folds in Fitzpatrick skin types IV to VI.

BACKGROUND: Recently, the cosmetic market has seen an increase in the options for treatment for people with dark skin. OBJECTIVES: This study evaluates the use of calcium hydroxylapatite (CaHA), a dermal filler indicated for the correction of moderate to severe facial wrinkles and folds, including the nasolabial folds (NLFs) in individuals with dark skin. METHODS: This open-label, nonrandomized, prospective, five-center trial enrolled 100 patients aged 18 and older with Fitzpatrick skin types IV to VI. CaHA was injected subdermally with a 25- to 27-gauge needle. Participants received a range of 0.6 to 2.8 mL of CaHA and returned at 3 and 6 months to be assessed for keloid formation, hypertrophic scarring, and hyper- or hypopigmentation. If necessary, each subject was offered a touch-up at the conclusion of the 6-month visit. RESULTS: No reports of keloid formation, hypertrophic scarring, hypo- or hyperpigmentation, or other clinically significant adverse events were recorded. CONCLUSIONS: People with dark skin injected subdermally with CaHA do not show signs of keloid formation, hypertrophic scarring, or hyper- or hypopigmentation. Because of this safety feature, as well as other characteristics of the product already shown in clinical literature, CaHA is an attractive dermal filler in this population.

Restoration of the orbital aesthetic subunit in complex midface defects.

OBJECTIVES/HYPOTHESIS: Although various options exist for restoration of the orbital defect in complex craniofacial resections, the aesthetic appearance and functional result of the orbit are optimized when the bony orbital architecture, orbital volume, and facial contour are specifically addressed. The study describes an approach using free tissue transfer for restoration of the native orbital aesthetic subunit. STUDY DESIGN: Retrospective case series. METHODS: Nineteen patients (male-to-female ratio, 14:5; mean age, 52 y [age range, 8-79 y]) in the study period between 1997 and 2001 had orbital defects that could be classified into one of the following categories: 1) orbital exenteration cavities only, 2) orbital exenteration cavities with resection of less than 30% of the bony orbital rim, or 3) radical orbital exenteration cavities with resection of overlying skin and bony malar eminence. Group 1 had reconstructions with fasciocutaneous forearm flaps; group 2, with osseocutaneous forearm flaps; and group 3, with osseocutaneous scapula flaps. RESULTS: Eighteen of 19 patients achieved a closed orbital reconstruction with restoration of the orbital aesthetic subunit. Among 16 patients with more than 4 months of follow-up, 10 patients had minimal or no resulting facial contour deformity and 8 patients engaged in social activities outside the home on a frequent basis. Five of the nine patients who were working before their surgery were able to return to work. CONCLUSION: Patients with complex midface defects involving the orbit can undergo free tissue transfer and have successful restoration of the native orbital aesthetic subunit without an orbital prosthesis.

Low intensity pain reported during elicitation of the H-reflex: no effects of trait anxiety and high intensity cycling exercise.

The aims of the experiment were to describe the intensity of pain perceptions experienced in response to elicitation of the H-reflex and examine the roles of trait anxiety and high intensity cycling exercise on those pain responses. Males (n=24) with high (n=12) or low (n=12) trait anxiety provided ratings of pain intensity in response to elicitation of the H-reflex before and after: resting for 20 min, cycling for 20 min at a high intensity (75% of peak oxygen consumption), or cycling for 20 min at a low intensity (40% of peak oxygen consumption). The results indicated that (i). low intensity pain was experienced during the elicitation of the H-reflex; (ii). high trait anxious males did not report more pain during the elicitation of the H-reflex, and (iii). there was no effect of high intensity cycling exercise on reducing post-exercise pain intensity associated with H-reflex elicitation. It is concluded that elicitation of the H-reflex reliably results in a low intensity pain.

Conventional diamond fraise vs manual spot dermabrasion with drywall sanding screen for scars from skin cancer surgery.

OBJECTIVE: To directly compare cosmetic improvement and postoperative sequelae resulting from dermabrasion of surgical scars with conventional motor-powered diamond fraise vs manual dermabrasion with medium-grade drywall sanding screen. DESIGN: Patients were randomly assigned to receive treatment with conventional diamond fraise dermabrasion to one half of the scar and manual dermabrasion with a drywall sanding screen to the other half in a prospective, comparative clinical study. Blinded observers assessed clinical variables during a 6-month follow-up period. SETTING: University hospital/cancer center-based cutaneous surgery unit. PATIENTS: Twenty-one healthy volunteers, Fitzpatrick skin type I to III, with contour irregularities resulting from granulation (7 patients) or reconstruction (14 patients) after skin cancer excision. INTERVENTIONS: One half of the patient's scar was treated with motor-powered diamond fraise dermabrasion and the other half was treated with manual dermabrasion with medium-grade drywall sanding screen. MAIN OUTCOME MEASURES: Correction of contour, scarline visibility, time to reepithelialization, presence or absence of milia, degree of postoperative erythema, hypertrophic scarring, patients' subjective reports of postoperative pain, and presence of pigmentary changes were observed for both methods. Standardized scoring systems were used to quantify outcome measures. RESULTS: According to the standardized scoring systems, no differences were found between the 2 methods at any point. In addition, no significant differences were found between the methods for any measure at any of the time points. CONCLUSION: Both dermabrasion techniques are equally effective in improving the cosmetic appearance of surgical scars.