SAMCEP Society consensus on the treatment of upper facial lines with botulinum neurotoxin type A: A tailored approach.

BACKGROUND: The safety and efficacy of botulinum neurotoxin type A (BoNTA) treatments are well established, but injection techniques, target muscles, and toxin doses continue to evolve, with each refinement producing improvements in treatment outcomes. The recommendations in this consensus move away from standard templates and illustrate how to tailor treatments to individual patterns and strengths of muscle activity, and patient preferences. METHODS: Seventeen experts in the fields of plastic surgery, dermatology, ophthalmology, otorhinolaryngology, and neurology convened in 2022 to develop consensus-based recommendations for the use of botulinum toxin A for the treatment of horizontal forehead lines, glabellar frown lines, and crow's feet lines that reflect current clinical practice. The focus was on how to tailor injections to individual patients to optimize treatment outcomes. RESULTS: For each upper face indication, consensus members describe how to perform a dynamic assessment to optimize the dose and injection technique for each patient. A tailored treatment protocol is presented for commonly observed patterns of dynamic lines. Units of Inco are defined and the precise location of injection points, illustrated with the use of anatomical images. CONCLUSION: This consensus provides up-to-date recommendations on the tailored treatment of upper facial lines based on the latest research and collective clinical experience of the expert injectors. Optimal outcomes require thorough patient evaluation, both at rest and during animation, using both visual and tactile cues; detailed understanding of facial muscular anatomy and how opposing muscles interact; and use of a BoNTA with high precision to target identified zones of excess muscle activity.

[Eruptive granuloma after injection of Ellansé® successfully treated using methotrexate]. / Granulomes après injection d'Ellansé®, résolutifs sous méthotrexate.

BACKGROUND: Collagen stimulators such as Ellansé® are soft tissue fillers able to induce nucleogenesis. We describe a case of eruptive foreign body granulomas following injection of Ellansé® that were successfully treated using methotrexate. CASE REPORT: A 47-year-old woman received injections of Ellansé® for the wrinkled aspect of her cheeks. She had previously undergone injections of hyaluronic acid on the nasolabial folds. Nine months after the Ellansé® injections, the patient consulted for the recent appearance of multiple nodules on her face. Histological analysis of one of these nodules confirmed the presence of foreign-body granulomas developed in contact with spherical gaps of a size substantially identical to the Ellansé® vacuoles. Methotrexate 10mg per week for 3 months followed by 20mg per week for 9 months resulted in complete regression of the nodules. DISCUSSION: Ellansé® is composed of two biocompatible and bioabsorbable polymers: carboxymethylcellulose, responsible for immediate volume creation, and polycaprolactone, which promotes collagen synthesis. However, any injected product can cause varying degrees of granulomatous reaction. Hyaluronic acid was previously injected at several other sites on the patient's face. These lesions were not the result of poor injection technique. CONCLUSION: Although collagen stimulators are biocompatible and bioabsorbable substances, the development of foreign-body granulomas, while rare, is still possible. Methotrexate resulted in significant regression of nodules as of the third month of treatment.

[LED lights in dermatology]. / LED en dermatologie.

The use in dermatology of light-emitting diodes (LEDs) continues to be surrounded by controversy. This is due mainly to poor knowledge of the physicochemical phases of a wide range of devices that are difficult to compare to one another, and also to divergences between irrefutable published evidence either at the level of in vitro studies or at the cellular level, and discordant clinical results in a variety of different indications: rejuvenation, acne, wound healing, leg ulcers, and cutaneous inflammatory or autoimmune processes. Therapeutic LEDs can emit wavelengths ranging from the ultraviolet, through visible light, to the near infrared (247-1300 nm), but only certain bands have so far demonstrated any real value. We feel certain that if this article remains factual, then readers will have a different, or at least more nuanced, opinion concerning the use of such LED devices in dermatology.

Daylight photodynamic therapy with MAL cream for large-scale photodamaged skin based on the concept of 'actinic field damage': recommendations of an international expert group.

Conventional PDT (c-PDT) is a widely used and approved non-invasive treatment for actinic keratosis (AK). Recent clinical, histological and immunohistochemical observations have shown that c-PDT with methyl aminolevulinate (MAL) may also partially reverse the signs of photodamage. However, pain and the need for special light source equipment are limiting factors for its use, especially in the treatment of large areas. More recently, daylight PDT (DL-PDT) has been shown to be similar to c-PDT in the treatment of AK, nearly painless and more convenient to perform. To establish consensus on recommendations for the use of MAL DL-PDT in patients with large-scale photodamaged skin. The expert group was comprised of eight dermatologists. Consensus was developed based on the personal experience of the experts in c-PDT and DL-PDT, and results of an extensive literature review. MAL DL-PDT for large areas of photodamaged skin was evaluated and recommendations based on broad clinical experience were provided. As supported by evidence-based data from multicentre studies conducted in Australia and Europe, the authors defined the concept of 'actinic field damage' which refers to photodamage associated with actinic epidermal dysplasia, and provide comprehensive guidelines for the optimal use of DL-PDT in the treatment of actinic field damage. The authors concluded that MAL DL-PDT has a similar efficacy to c-PDT at 3-month (lesion complete response rate of 89% vs. 93% in the Australian study and 70% vs. 74% in the European study (95% C.I. = [-6.8;-0.3] and [-9.5;2.4] respectively) and 6-month follow-ups (97% maintenance of complete lesion response) in the treatment of AKs. The authors agree that DL-PDT is not only efficacious but also nearly pain-free and easy to perform, and therefore results in high patient acceptance especially for the treatment of areas of actinic field damage.

[Optimization of the healing process after laser procedure, except photorejuvenation]. / Optimisation et gestion de la cicatrisation après acte laser, en dehors du photo-rajeunissement.

The use of Lasers in dermatology implies a crucial follow-up in order to optimize the final result and avoid any side effects. With the use of ablative laser devices, the initial phase is characterized by the development of crusts. These crusts necessitate the application of sterile ointments (regularly repeated throughout the day) as well as an antibiotic ointment two times a day. In a second step, comes a secondary inflammatory state, in the dermis, which is generally observed at the outset of all other laser treatments. The main purpose is to avoid it from being too sustained over time, but also to prevent the occurrence of post inflammatory hyperpigmentation. Obviously, a solar eviction will be strongly recommended. The risk being maximized with dark phototypes, the choice of the Laser, as well as its specific parameters will be specific and decisive.

[Polychromatic pulsed lamp]. / Lampes polychromatiques pulsées.

Intense pulsed lights have improved a lot these past few years and offer better efficiency as well as new treatment fields. They have become the first choice for numerous practitioners' offices. We are mainly describing in this article, new technical developments: electrical (square pulse, pulse repeatability...), optics (filters, spectrum, calibration, size and manoeuvrability of the hand-pieces...), cooling systems, new devices... We then document in our clinical practice the series of results and ever increasing studies, with more objective measures of the results (spectrophotometry...) and above all better level of proofs in many dermatological fields : hair removal and ostiofollicularis diseases, vascular, pigmented, rejuvenation, photodynamic photorejuvenation, carcinology, inflammatory and retentional acne, scars and striae...

[Light-emitting diodes (LED)]. / Diodes électroluminescentes (DEL).

LED home-use is now widely spread. In dermatology, numerous reports have stated their results for many indications: wound healing process, rejuvenation, acne and, of course, photodynamic therapy. Nevertheless, fluence, pulse duration and color of the LED are so variable as it is difficult to bring well codified results. But how should you not be interested in this field? It is already any more a near future but well and truly a therapeutic reality...

Evaluation of a new silver foam dressing in patients with critically colonised venous leg ulcers.

OBJECTIVE: To evaluate the performance (efficacy and safety) of an absorbent dressing impregnated with silver salts (UrgoCell Silver) in the management of leg ulcers with clinical signs of critical colonisation. METHOD: This was a prospective multicentre non-comparative phase III clinical trial. Patients were assessed weekly for up to four weeks. Assessment included clinical assessment of critical colonisation (severe spontaneous pain between dressing changes, erythema, oedema, malodour and heavy exudate), wound area tracing and photography. Acceptability was documented by the nursing staff when dressings were changed between two weekly evaluations. RESULTS: Forty-five leg ulcers were included. At baseline the mean number of clinical signs of critical colonisation per ulcer was 3.6 +/- 0.7, which decreased to 1.2 +/- 1.2 at the end of the fourth week of follow-up (an average reduction of 2.3 +/- 1.3, p < 0.001). Oedema, malodour, erythema and spontaneous pain disappeared at the fourth week in 80%, 70%, 69% and 65% of the treated ulcers respectively. Compared with baseline, the mean reduction in ulcer area was 35.0 +/- 58.0% (median 33%, p < 0.001) after the four weeks treatment. Granulation tissue covered a mean 77% of the ulcer surface area at four weeks, compared with 41% at baseline. Only three local events were documented: contact dermatitis, a burning sensation and erythema. CONCLUSION: The results suggest that the test dressing had a favourable influence on the wound prognosis, and was well tolerated and accepted in the treatment of venous leg ulcers with clinical signs of critical colonisation.

Evaluation of a lipidocolloid wound dressing in the local management of leg ulcers.

OBJECTIVE: To evaluate the efficacy, tolerance and acceptability of Urgotul and DuoDERM E dressings in the local management of venous or mixed-aetiology leg ulcers. METHOD: This was a prospective multicentre randomised phase IV clinical trial conducted open-label in parallel groups. It involved 20 investigating centres, including hospital dermatology and vascular medicine departments, and private practices. Dermatologists and angiologists/phlebologists took part. Subjects were adult, non-immunosuppressed patients presenting with a non-infected, non-malignant leg ulcer of predominantly venous origin (ABPI > 0.8). Ulcers were between 4cm2 and 40cm2 in size, with granulation tissue covering more than 50% of their surface area. Ulcer duration ranged from three to 18 months. Patients were followed-up by the investigating physician for eight weeks on a weekly basis; this included clinical examination, wound area tracings and photographs. Nurses (hospital or visiting) assessed exudate volume and clinical appearance at dressing changes. RESULTS: Ninety-one patients were included: 47 in the Urgotul group and 44 in the DuoDERM E group. Baseline patient demographic data and wound characteristics were comparable in the two groups. After eight weeks of treatment wound surface area had reduced by a mean of 61.3% in the Urgotul group and 52.1% in the DuoDERM E group (NS); dressings were changed more frequently in the DuoDERM E group (2.54 +/- 0.57 times per week versus 2.31 +/- 0.45 in the Urgotul group, p = 0.047). Thirty-three local adverse events were recorded in 27 patients: 10 in the Urgotul group and 23 in the DuoDERM E group (p = 0.039). Nurses reported better acceptability for the Urgotul dressing, based on pain on removal, maceration and odour (p < 0.0001). CONCLUSION: Both dressings showed similar efficacy for the local treatment of venous leg ulcers. Nevertheless, medical and nursing staff reported better tolerance and acceptability for the Urgotul dressing.

Use of intense pulsed light in the treatment of scars.

BACKGROUND: Reducing erythema and infiltration of inflamed, hypertrophic, and colloidal scars have been a challenge for healthcare providers. Peer-reviewed scientific data for intense pulsed light systems are lacking. OBJECTIVE: A chronicle of three patients who have participated in the treatment of inflamed, hypertrophic, and colloidal scars, using intense pulsed light. METHODS: Intense pulsed light with a selection of wavelengths, pulse durations, and energy densities was used on patients with inflamed, hypertrophic, and colloidal scars. RESULTS: A definite improvement in scar tissue was observed and achieved in all the cases. CONCLUSION: Intense pulsed light source with the correct outputs is an effective tool for the treatment and improvement of inflamed, hypertrophic, and colloidal scars.

[Pachydermodactyly in adolescents: a sign of discomfort?]. / Pachydermodactylie de l'adolescent: expression d'un mal-être?

BACKGROUND: Pachydermodactyly is an acquired dermatosis related to psychological disturbances. CASE REPORT: A 16 year-old boy presented with fibrous skin hypertrophy of proximal interphalangeal joint areas of both hands suggestive of pachydermodactyly. Skin biopsy confirmed the fibromatous nature of hypertrophy. The personal history of the child confirmed that pachydermocactyly was due to compulsive rubbing stretching movements in a patient with psychological troubles. CONCLUSIONS: Pachydermodactyly, mainly observed among male teenagers, must be considered as an induced dermatosis and distinguished from primary fibromatosis.

[Hyperimmunoglobulinemia D or periodic fever syndrome. Cutaneous manifestations in 3 cases]. / Syndrome hyper-IgD ou pseudo-maladie périodique. Manifestations cutanées dans 3 observations.

INTRODUCTION: We describe 3 cases of hyperimmunoglobulinemia D syndrome (hyper-IgD syndrome). CASES REPORT: As the 2 first cases are conventional with an onset in childhood, the third one appeared later suggesting possibility of acquired syndrome. The 3 cases presented with one or several skin eruptions during febrile attacks. COMMENTS: Up to now, 64 cases of this syndrome have been described. Skin lesions are observed in 80 p. 100 of patients. In this particular clinical context, they must lead to the diagnosis. This 3 cases and the review of literature show that skin manifestations are polymorphic, transient, not very symptomatic and not correlated to IgD rates. Histological examination may reveal urticarial reaction with leucocytoclasic vasculitis, where IgD could directly or not interact.

[Pyoderma gangrenosum, subcorneal IgA pustulosis and recurrent neutrophilic pleural and pulmonary diseases in a patient with IgA gammopathy]. / Pyoderma gangrenosum, pustulose sous-cornée à IgA et pleuropneumopathies neutrophiliques récidivantes chez une malade porteuse d'une gammapathie à IgA.

INTRODUCTION: The term "neutrophilic dermatosis" is normally used to cover a number of dermatoses characterized by their response to corticotherapy or to drugs effective on the neutrophilic polynuclear. Neutrophilic dermatosis was frequently associated with hematologic disease. We study the case of a neutrophilic dermatosis accompanied by a pulmonary involvement and then review the literature on the reported cases of neutrophilic dermatosis with extra-cutaneous localisations. CASE STUDY: A woman aged 54 displayed a pyoderma gangrenosum successively followed by a pustular dermatosis (related to subcorneal pustular dermatosis of Sneddon-Wilkinson) and by a pulmonary involvement not caused by any underlying infection. The laboratory results revealed a benign IgA gammaglobulin. The use of corticotherapy and a relay by dapsone led to the gradual disappearance of the cutaneous and pulmonary lesions. DISCUSSION: Pulmonary involvement have been observed in the Sweet syndrome and in the pyoderma gangrenosum. The neutrophilic lung is diagnosed once a tumorous or infectious cause has been eliminated and on the basis of the response to the cortisone treatment. CONCLUSION: The link between pulmonary involvement and neutrophilic dermatosis is sometimes mentioned but is in fact often difficult to confirm. The positive reaction to corticosteroids could be a diagnostic test.