Good tolerance of hyaluronic acid filler injections during the COVID-19 pandemic.

BACKGROUND: The aim of our study was to identify and evaluate the complications related to hyaluronic acid during the COVID-19 pandemic. METHOD: Twelve dermatologists participated in this study. A cohort and a non-cohort follow-up were ensured. RESULTS: (1) Cohort follow-up: 1041 patients. 8% had a COVID-19 infection, 27% had received COVID-19 vaccination. 2% had immediate side effects (edema, erythema, bruising). 0.5% had delayed side effects (two inflammatory nodules, one nodule without inflammation, one edema). None of these side effects occurred in the context of infection or COVID-19 vaccinations. (2) Non-cohort follow-up: 7900 syringes used. Two early side effects (inflammatory edema) were reported, of which one occurred 15 days after vaccination. Two cases of delayed side effects such as inflammation on the injected area and inflammatory nodules occurred of which one was in the context of vaccination and one during COVID-19 infection. We estimate the frequency of complications possibly attributable to the disease or to the COVID vaccination to be 0.06% in our population. DISCUSSION: Complications of HA injections in the context of COVID-19 disease or vaccination appear to be very rare but the frequency could be underestimated because of the low rate of vaccination/infection in our population. Our study shows a very good tolerance of hyaluronic acid injections during the COVID-19 pandemic.

Skin tightening induced by fractional CO(2) laser treatment: quantified assessment of variations in mechanical properties of the skin.

BACKGROUND: Certain authors have reported the efficacy of fractional resurfacing laser treatment in patients with photodamaged skin resulting in skin tightening of treated area. OBJECTIVE: To assess skin tightening after CO(2) fractional resurfacing laser treatment by measuring variations in mechanical properties in treated areas. Dermal elasticity was measured using suction applied with an in vivo skin elasticity meter (Cutometer(®)). METHODS: A prospective observational study was undertaken from January 2007 to August 2009. Laser treatment was performed with the SmartXide Dot(®) (Deka(®), Firenze, Italy) CO(2) fractional resurfacing device. Patients were offered quantified analysis using the Cutometer(®) before and after treatment. RESULTS: Seventeen patients (61 areas treated) were included in the study. Median delay between before and after cutometric evaluations was 80 days. We found significant improvement in elastic (R2 +5.9%), viscoelastic (R8 -9.4%), fatigue (R3 and R9 -16.2% and -19.7%, respectively), and thickness (R0 -14.9%) parameters. These results are consistent with significant tightening and also elastic tissue improvement. CONCLUSIONS: It was possible to quantify skin tightening because of CO(2) fractional laser treatment using a noninvasive technique.

Propranolol for treatment of ulcerated infantile hemangiomas.

BACKGROUND: Ulcerated infantile hemangiomas (IH) are a therapeutic challenge. Propranolol, a nonselective beta-blocker, was recently introduced as a novel treatment for IH. OBJECTIVE: To evaluate our experience of propranolol in the management of ulcerated IH. METHODS: A national, multicenter, retrospective, observational study was conducted. Data were collected from the medical charts of patients treated from 2008 to 2009 and supplemented by information obtained from parents during targeted telephone interviews. RESULTS: Thirty-three infants with propranolol-treated ulcerated IH were included. The average time to complete ulceration healing was 4.3 weeks in 30 of 33 patients and was significantly faster for head-and-neck locations (P = .0354). The mean time to complete pain control was 14.5 days. Parents rated treatment as very effective for 27 of 31 patients and very well tolerated for 29 of 31 cases. LIMITATIONS: This was a retrospective uncontrolled study. CONCLUSION: Propranolol appears to be an effective and well-tolerated treatment for ulcerated IH.

High-resolution ultrasound imaging to demonstrate and predict efficacy of carbon dioxide fractional resurfacing laser treatment.

BACKGROUND: Fractional resurfacing is a new laser treatment used mainly for treating photoaging and acne scars. OBJECTIVE: To demonstrate the efficacy of carbon dioxide (CO(2) ) fractional resurfacing laser treatment using high-resolution ultrasound imaging and to evaluate factors predictive of response to the treatment. MATERIALS AND METHODS: A prospective observational study was undertaken from January 2007 to August 2009. Laser treatment was performed using a CO(2) fractional resurfacing device. Patients were offered high-resolution ultrasound imaging to follow up their treatment. Dermal and subepidermal nonechogenic band (SENEB) thicknesses were measured. RESULTS: Twenty-four consecutive patients were included, allowing follow-up of 107 areas. Statistical analysis showed a significant increase in dermal thickness (mean variation +25.1%, (95% confidence interval=19.0-31.2). SENEB thickness was not changed. Older age and greater initial thickness were associated with a smaller increase in dermal thickness according to multivariate analysis. The region treated was also found to be a significant predictive factor. Smoking, topical anesthesia, severity of local side effects induced by the laser treatment, and phototype were not associated with significant modification of dermal thickness after laser treatment. CONCLUSION: This is the first report on the use of high-resolution ultrasound imaging to assess the efficacy of fractional laser operating with standard parameters. Increase in dermal thickness was evidenced, possibly explained by collagen neosynthesis or conformational changes in the extracellular matrix component, increasing dermal hydration, although there was no modification of SENEB thickness, suggesting that the skin retains the sequelae of ageing. The treatment appeared to be more effective in younger patients, probably because their fibroblasts are more prone to synthesizing collagen. Thinner skins were more effectively treated than thicker skins because they could be stimulated throughout their thickness with the treatment parameters used.

[Arteriovenous malformations]. / Malformations artérioveineuses.

Arteriovenous malformations are serious high-flow vascular malformations. Four progressive stages have been described: dormancy, expansion, destruction and heart failure. Progression from one stage to another is not systematic but depends on events - physiological or traumatic, sometimes iatrogenic. Pulsed Doppler imaging of venous waveforms and magnetic resonance imaging (MRI) are the most informative examinations for both diagnosis and follow-up of arteriovenous malformations.Arteriography and angio-MRI help guide treatment decisions. Treatment of the malformation must not be envisioned until it reaches a symptomatic stage. It most often combines an endovascular procedures and wide surgical excision. A syndromic form must be considered in cases of systemic angioma.

Preoperative measurement of thickness of cutaneous melanoma using high-resolution 20 MHz ultrasound imaging: A monocenter prospective study and systematic review of the literature.

Histologic measurement of the thickness of melanoma is a major prognostic factor and governs the size of the surgical excision (1cm for melanomas less than 1 mm thick, 2 cm for melanomas thicker than 2 mm and 3 cm beyond 4 mm). To determine whether high-resolution ultrasound can be used to predict surgical margins and, thus, to operate on patients in a single procedure avoiding further re-excision, we performed a systematic review of studies published from January 1987 to June 2007 and a prospective study. The systematic review selected 14 studies comparing histologic and ultrasound measurements and showing correlation coefficients generally greater than 0.9. Data available from 7 of the 14 studies (total 869 patients) showed predictive values of adequate margins in at least 72% of lesions using preoperative measurement of ultrasound thickness. The prospective study included 31 patients referred with a primary melanoma from March 2005 to March 2007. Ultrasound measurement of thickness was possible except for thin melanomas (<0.4 mm) in areas with marked photoaging, in the plantar zone, and in the case of very thick melanomas exceeding the explored depth (7.6 mm). The average thickness was 1.96 mm measured by ultrasound (SD: 2.15) and 1.95 mm by histology (SD: 2.62) and the Bland and Altman graph showed moderate agreement between ultrasound and histology. Limits of agreement were estimated at -1.4 and +1.8, corresponding to relative limits of agreement of -40 to +80%. Ultrasound predicted appropriate margins (1, 2 or 3 cm wide according to sonometric thickness) in 26 of the 31 subjects (84%, 95% CI 66-95). Preoperative high-resolution ultrasound is a noninvasive examination that can help in choosing appropriate surgical margins and should reduce the need of partial or excisional biopsy before surgery, and the need for further re-excision.