Hyaluronic acid plus mannitol treatment for improved skin hydration and elasticity.

BACKGROUND: Mesotherapy treatment of aging skin aims to replace depleting levels of minerals, vitamins, amino acids, and hyaluronic acid (HA). AIM: To investigate the efficacy of 13.5 mg/g uncross-linked HA+0.9% mannitol (HA+mannitol) on skin hydration and elasticity. PATIENTS/METHODS: Four centers enrolled 34 women: Subgroup 1 comprised 27 subjects injected using a "depot" technique; Subgroup 2 comprised seven subjects injected using a "picotage" technique. RESULTS: A notable difference was seen between the two subgroups in outcome and subject satisfaction. In Subgroup 1, a significant improvement was seen in hydration, anisotropy, and skin roughness, but Subgroup 2 showed no significant improvements. Most physicians assessed HA+mannitol as "easy/very easy" to inject. Physician esthetic assessment in Subgroup 1 was "improved/very improved" for >90% of subjects at Day 60, and >80% according to subject assessment. 95% of subjects were delighted with treatment, and 85% would undergo repeat treatment and would recommend treatment to a friend. However, results for Subgroup 2 indicated 86% of subjects were unhappy with treatment and 83% would refuse to undergo repeat treatment. CONCLUSIONS: HA+mannitol is effective for skin hydration, anisotropy, and roughness when treated using a depot technique.

[Atypical bipolar disorders]. / Troubles bipolaires atypiques.

Some epidemiologic data reveal how difficult detecting atypic bipolar disorders is: 9 years of progression before the diagnosis is properly established and a specific treatment is initiated, and intervention of 4 to 5 different specialists. Incomplete symptomatology, impulsive actions, periodic alcohol abuse, compulsive buying behaviors, acute delusional episodes, medicolegal actions and comorbidities can hide or modify bipolar symptomatology. Bipolarity should be systematically screened for in case of substance abuse (40 to 60 percent of bipolar disorders), anxiety disorders (panic disorder, generalized anxiety, obsessive-compulsive disorders etc.) and feeding disorders. In these various situations, history taking and clinical examination will help to detect signs of bipolarity: reaction to antidepressants, inefficiency, paradoxical worsening, development of behavior disorders and mood changes. Besides screening for thymic disorders, the examination will be completed by history taking of thymic disorders, suicide, toxic abuse, anxiety disorders, personal history of attention deficit hyperactivity disorder in childhood, depression or postpartum psychosis in women, as well as premenstrual depressive manifestations.

[Management of bipolar disorders]. / Prise en charge des troubles bipolaires.

Management of the bipolar disorders is well codified and rests on the prescription of mood stabilisers and psychotherapeutic measures. Mood stabilisers have considerably improved the prognosis of bipolar disorder, in limiting the number of recurrences. Lithium is still the leader of mood stabilisers. It has a preventative and curative action that has effect on the two poles of the illness. Carbamazepine, valpromide and its derivatives, and olanzapine are indicated in the case of resistance or contra-indication to lithium therapy and are more easily handled in the curative treatment of the manic state. Other therapeutic measures have been proposed in order to optimise the medical treatment and to act in anticipation of the precipitating elements. Psycho educational measures, the roles of which have been undervalued for a long time, are today the best-evaluated psychological treatments. An elevated level of proof exists for these treatments. Their value is stressed in most of the reference texts. The benefits of this complementary approach exists on different levels: early recognition of symptoms that announce a recurrence, improvement in compliance, acceptance of the illness, better management of the social life, both professional and emotional, control of precipitating factors... Recently published studies report a reduction in the number of recurrences and relapses, a reduction in the duration of hospitalisation, a better balance in the family life and an improvement in compliance.

[Which signs in a depressed patient could indicate a manic transformation?]. / Quels signes chez un déprimé peuvent faire craindre un virage maniaque?

Which signs in a depressed patient could indicate a manic transformation? All depressive states can give way to a state of manic excitation. The transformation can be spontaneous or favoured by antidepressants. The principal indices of risk of mood transformation are a personal or family history of mood disorders, thymic lability, marked psychomotor inhibition, the existence of overeating and hypersomnia, early age of onset, acute onset and resolution of episodes. It is important in the presence of these elements to re-evaluate the indication for an antidepressant and to consider the prescription of a mood stabiliser as monotherapy or in association with an antidepressant.