A validated photonumeric cellulite severity scale for the area above the knees: the knee cellulite severity score.

BACKGROUND: Treatment for cellulite above the knees is increasingly requested. However, a classification of cellulite of this area has not yet been developed. OBJECTIVE: To validate the proposed knee cellulite severity score (KCSS) for the assessment of cellulite and skin laxity above the knee. MATERIALS AND METHODS: Based on standardized photographs of cellulite and skin laxity above the knees of 57 females (114 knees), three key morphological aspects of cellulite were identified. A photonumeric KCSS was developed and validated by three independent assessors. RESULTS: The three key cellulite morphological features (number of depressions, depth of depressions and presence of laxity) are each graded from 0 to 3, producing a classification of no lesions (0), mild (1-3), moderate (4-6) and severe (7-9). Evaluators at different time points repeated similar classifications (intraclass correlation coefficient >0.9), which were also similar among the assessors (inter-observer reliability >0.9). All three key morphological aspects were deemed necessary, and positively contributed, to the overall scale (item-total correlation analysis values >0.89, P < 0.05). CONCLUSIONS: The KCSS is a consistent, comprehensive, reliable, and reproducible tool for standardized and objective assessment of the severity of cellulite and skin laxity above the knees.

In Vitro Evaluation of the Biological Availability of Hyaluronic Acid Polyethylene Glycols-Cross-Linked Hydrogels to Bovine Testes Hyaluronidase.

During last years, hyaluronic acid- (HA-) based dermal fillers have grown rapidly and continuously, as reported by the American Society of Aesthetic Plastic Surgery (ASAPS). In fact, HA fillers are considered the gold standard technique for soft tissue augmentation, deep skin hydration, and facial recontouring, playing a key role as an alternative to plastic surgery. HA fillers are less invasive, more biocompatible, and safer and with a more natural and immediate result if compared to plastic surgery. Hence, the safety of HA-based dermal fillers plays a crucial role, mostly in terms of biocompatibility and adjustability in case of unpleasant results and side effects such as, tyndall effect, edema, or granulomas. Hyaluronidase is a naturally occurring enzyme, present in the human body, and can degrade HA fillers avoiding more severe complications. In this article, we analyzed the bioavailability of hyaluronidase degradation of five fillers of Neauvia® hydrogels line (MatexLab SA, Lugano, CH), composed of pure hyaluronic acid and based on PEGDE cross-linking (polyethylene glycol) technology that guarantees a higher biocompatibility and an optimal biointegration and rheological characteristics. The performed in vitro testing is based on the colorimetric determination of the N-acetyl-D-glucosamine (NAG) present in solution after incubation with hyaluronidase, determined at different time points in order to assess the kinetic of each product degradation (1h, 3h, 6h, 24h, 48h, 72h, 120h, and 168h). The aim of this study was to assess, in vitro, how the difference in HA content and PEGDE concentration of the analyzed fillers can influence the product biocompatibility, intended as product enzymatic clearance and duration in time. The results demonstrated that the method was reproducible and easy to perform and that all the analyzed fillers are naturally immediately available for hyaluronidase-mediated degradation.

Chemical peeling in ethnic skin: an update.

With the growth of cosmetic dermatology worldwide, treatments that are effective against skin diseases and augment beauty without prolonged recovery periods, or exposing patients to the risks of surgery, are increasing in popularity. Chemical peels are a commonly used, fast, safe and effective clinic room treatment that may be used for cosmetic purposes, such as for fine lines and photoageing, but also as primary or adjunct therapies for acne, pigmentary disorders and scarring. Clinicians are faced with specific challenges when using peels on ethnic skin (skin of colour). The higher risk of postinflammatory dyschromias and abnormal scarring makes peels potentially disfiguring. Clinicians should therefore have a sound knowledge of the various peels available and their safety in ethnic skin. This article aims to review the background, classification, various preparations, indications, patient assessment and complications of using chemical peels in ethnic skin.

Diphenylcyclopropenone (diphencyprone, DPCP) in the treatment of chronic severe alopecia areata (AA).

BACKGROUND: Diphenylcyclopropenone (DPCP) has been reported to be an effective topical immunotherapy of extensive alopecia areata (AA) with highly variable reported results. OBJECTIVE: The purposes of this study were to assess the efficacy, side effects, and adverse prognostic factors in the treatment of alopecia areata with DPCP. METHODS: 21 patients were included in the study with chronic and extensive AA. Patients were sensitized in the beginning with 2% DPCP, and the concentrations were increased gradually beginning with 0.000001% every one to two weeks for a period of 6 months. RESULTS: 15 patients (71.4%) had a complete or partial recovery at the end of the treatment period. Most frequent side effects were erythema at the site of application, pigmentation, and lymph node enlargement. The most important adverse prognostic factors were duration of AA, history of atopy, and presence of nail changes. CONCLUSION: Treatment of AA with topical DPCP is effective. Though the treatment may have some side effects, in most cases they are tolerable and respond well to treatment.