Combined treatment with 595-nm pulsed dye laser and 1550-nm erbium-glass fractional laser for traumatic scars.

Facial scars can be caused by a traumatic event or indeed surgical procedures. Several treatment modalities have been suggested including surgical or resurfacing techniques, autologous fat transfer, and injection of fillers. However, these approaches have varying degrees of success and associated side effects. We report two Korean patients with traumatic scars. Both patients received combined consecutive treatment with 595-nm pulsed dye laser (PDL) and 1550-nm erbium-glass fractional laser. Both patients showed remarkable clinical improvements after a course of sessions. Therefore, simultaneous combined treatment with PDL and fractional laser may be considered a reasonable therapeutic option for traumatic facial scars.

1,213 Cases of Treatment of Facial Acne Using Indocyanine Green and Intense Pulsed Light in Asian Skin.

BACKGROUND: Photodynamic therapy (PDT) has been used for acne, with various combinations of photosensitizers and light sources. OBJECTIVE: We evaluated the effectiveness and safety of indocyanine green (ICG) and intense pulsed light (IPL) in the treatment of acne. MATERIALS AND METHODS: A total of 1,213 patients with facial acne were retrospectively reviewed. Patients received three or five treatments of ICG and IPL at two-week intervals. Clinical response to treatment was assessed by comparing pre- and posttreatment clinical photographs and patient satisfaction scores. RESULTS: Marked to excellent improvement was noted in 483 of 1,213 (39.8%) patients, while minimal to moderate improvement was achieved in the remaining 730 (60.2%) patients. Patient satisfaction scores revealed that 197 (16.3%) of 1,213 patients were highly satisfied, 887 (73.1%) were somewhat satisfied, and 129 (10.6%) were unsatisfied. There were no significant side effects. CONCLUSION: These results suggest that PDT with ICG and IPL can be effectively and safely used in the treatment of acne.

Photoletter to the editor: An eczema-like, pruritic, nonbullous form of bullous pemphigoid.

We report a case with an unusual manifestation of bullous pemphigoid (BP) in a 57-year-old woman. She presented with a one-month history of pruritus and multiple annular patches with central regression on her trunk and extremities and there were no signs of corresponding internal malignancy. Eosinophilic spongiosis was observed in histopathologic examination and direct immunofluorescence studies revealed a strong linear staining pattern of the basement membrane zone with C3 and IgG. This unusual case indicates that a lack of blisters does not necessarily exclude a diagnosis of BP, and supports previous reports suggesting gyrate erythema can be an initial manifestation of bullous disease.

Botulinum toxin for the treatment of refractory erythema and flushing of rosacea.

BACKGROUND: Persistent erythema and severe rosacea flushing can cause significant physical discomfort and emotional stress to patients. Currently, no satisfactory treatments are available. METHODS: We report two cases of refractory flushing and erythema of rosacea that were successfully treated with intradermal botulinum toxin injections. RESULTS: Good cosmetic results were achieved for both patients. The side effects during and after treatment were mild pain and localized bruising; these symptoms resolved within several days without further treatment. CONCLUSION: Intradermal botulinum toxin injection may be an effective treatment for refractory erythema and rosacea flushing that deserves further study in a larger patient population.

Novel treatment of neck wrinkles with an intradermal radiofrequency device.

Neck wrinkles commonly develop owing to the aging process. However, recently, the number of patients with neck wrinkles has been increasing. Also, an increasing number of young patients have presented with this condition, possibly because of the effect of the head-down posture that they adopt when using their computer or smartphone. We report two cases of young adults with a prominent neck wrinkle. In case 1, a 29-year-old woman with a neck wrinkle was treated with six intradermal radiofrequency (RF) procedures. Her neck wrinkle was significantly improved with the RF treatment. In case 2, a 32-year-old woman with a wrinkle and generalized light brownish tiny papules on the neck was treated with three intradermal RF procedures simultaneously with 30% glycolic acid peeling. Her wrinkle and skin tone were improved dramatically. We conclude that intradermal RF has a considerable efficacy for reducing neck wrinkles.

Berberine regulates melanin synthesis by activating PI3K/AKT, ERK and GSK3ß in B16F10 melanoma cells.

Berberine, an isoquinoline alkaloid, has a wide range of beneficial properties, including anti-bacterial, anti-inflammatory, anti-cancer, and cholesterol-lowering effects. Recently findings suggest that berberine improves glucose and lipid metabolism disorders. In the present study, we examined the mechanism underlying the inhibitory effect of berberine on α-melanocyte-stimulating hormone (α-MSH)-stimulated B16F10 melanoma cells. The results showed that berberine attenuated α-MSH induction of the microphthalmia-associated transcription factor (MITF) and tyrosinase in a dose-dependent manner. To elucidate the mechanism underlying the inhibitory effect of berberine, we examined the effect of α-MSH-stimulated phosphorylation of PI3K/AKT, ERK, and GSK3ß. The results showed that treatment with berberine resulted in a reduction in the phosphorylation of PI3K/AKT, ERK, and GSK3ß. Taken together, the results suggested that berberine inhibits melanin synthesis and tyrosinase activity by downregulating the expression of MITF and tyrosinase. Thus, these findings may contribute to the potential application of berberine in the prevention and treatment of skin pigmentation disorders.

Resveratrol exerts growth inhibitory effects on human SZ95 sebocytes through the inactivation of the PI3-K/Akt pathway.

Resveratrol is known to be a naturally produced polyphenol that is able to reduce cell proliferation in several types of cancer cells and adipocytes. However, the antiproliferative effects of resveratrol on the growth of human sebocytes are not yet clear. In the present study, we investigated possible cellular pathways associated with these growth inhibitory effects on human SZ95 sebocytes. Our results revealed that resveratrol inhibited the proliferation of sebocytes, and that this resulted in disruption of the cell cycle. The inactivation of extracellular signal-regulated protein kinase (ERK), Akt and peroxisome proliferator-activated receptor (PPAR)-γ was also shown to be involved in the inhibition of sebocyte growth by resveratrol. To examine the antiproliferative effects of resveratrol, we determined the levels of cell cycle control proteins. Resveratrol inhibited cyclin D1 synthesis, whereas it stimulated p21WAF1/CIP1 (p21) and p27KIP1 (p27) synthesis. In addition, we demonstrated that the resveratrol-mediated cell cycle arrest resulted in an increase in the proportion of cells in the sub-G0/G1 phase. Moreover, we found that the growth inhibitory effects of resveratrol were enhanced by treatment with LY294002 [a phosphatidylinositol 3-kinase (PI3-K) inhibitor] more so than by treatment with PD98059 (a MEK inhibitor), which indicates that resveratrol exerts its inhibitory effects on sebocyte proliferation through the inhibition of Akt. Linoleic acid (LA) is a well-established lipid inducer in sebocytes and is known to stimulate sebocyte differentiation through the upregulation of PPAR-γ. In this study, resveratrol was found to decrease the lipid content and PPAR-γ expression during LA-stimulated lipogenesis. Our results indicate that resveratrol plays a critical role in the inhibition of sebocyte growth through the inactivation of the Akt pathway. The present data suggest that resveratrol may be used as a therapeutic agent for the treatment of acne vulgaris.

Mycophenolate antagonizes IFN-γ-induced catagen-like changes via ß-catenin activation in human dermal papilla cells and hair follicles.

Recently, various immunosuppressant drugs have been shown to induce hair growth in normal hair as well as in alopecia areata and androgenic alopecia; however, the responsible mechanism has not yet been fully elucidated. In this study, we investigate the influence of mycophenolate (MPA), an immunosuppressant, on the proliferation of human dermal papilla cells (hDPCs) and on the growth of human hair follicles following catagen induction with interferon (IFN)-γ. IFN-γ was found to reduce ß-catenin, an activator of hair follicle growth, and activate glycogen synthase kinase (GSK)-3ß, and enhance expression of the Wnt inhibitor DKK-1 and catagen inducer transforming growth factor (TGF)-ß2. IFN-γ inhibited expression of ALP and other dermal papillar cells (DPCs) markers such as Axin2, IGF-1, and FGF 7 and 10. MPA increased ß-catenin in IFN-γ-treated hDPCs leading to its nuclear accumulation via inhibition of GSK3ß and reduction of DKK-1. Furthermore, MPA significantly increased expression of ALP and other DPC marker genes but inhibited expression of TGF-ß2. Therefore, we demonstrate for the first time that IFN-γ induces catagen-like changes in hDPCs and in hair follicles via inhibition of Wnt/ß-catenin signaling, and that MPA stabilizes ß-catenin by inhibiting GSK3ß leading to increased ß-catenin target gene and DP signature gene expression, which may, in part, counteract IFN-γ-induced catagen in hDPCs.

Phosphatidylcholine and bipolar radiofrequency for treatment of localized fat deposits.

Bipolar radiofrequency (RF) is capable of delivering higher energy fluencies direct to the dermis through a needle electrode. This produces heat when the tissue electrical resistance converts the electric current to thermal energy in the tissue. A 38-year-old man visited our clinic for reduction of submental fat deposit, but otherwise in overall good health. After deciding to perform phosphatidylcholine (PPC) injections subcutaneously, we concerned about edema and swelling of injection site lasted several weeks. We wanted to shorten the period of edema and swelling, and we decided to add bipolar RF treatment. After 1 week of PPC injection combined with RF treatment, overall volume of jowl was decreased and edema and swelling on the PPC injected site markedly subsided. This reduction of fat deposit lasts longer than 1 year. Follow-up for 1 year demonstrated that the cosmetic results were well maintained.

Safety evaluation of topical valproate application.

The potential role of topical valproate (VPA) in hair regrowth has been recently suggested. However, safety reports of VPA as a topical formulation are lacking. Therefore, in the present study, we investigated whether VPA causes skin irritation in humans. We first performed a cell viability test and showed that VPA did not exhibit toxicity toward HaCaT keratinocytes, fibroblasts, and RBL-3H mast cells. We then performed clinical patch test and skin irritation test through transdermal drug delivery with the help of microneedle rollers. No significant findings were obtained in the clinical patch test. In the skin irritation test, only 1 patient showed erythema at 1 hr, but the irritation reaction faded away within a few hours. Erythema and edema were not observed at 24 hr. We concluded that VPA has minimal potential to elicit skin irritation. Therefore, we consider that VPA can safely be applied to human skin.