Novel Validated Five-point Photonumeric Scales for Assessment of Static and Dynamic Forehead Lines.

Background: The objective of this investigation was to create and validate five-point photonumeric scales which assess static and dynamic forehead lines. Methods: Two different novel five-point photonumeric scales for the assessment of static and dynamic forehead lines were developed. Moreover, a photoguide was created, including subjects from both sexes, all age groups, and different Fitzpatrick skin types. A total of 11 raters from all over the world were involved in the digital validation, whereas four raters performed a live validation. Results: The Croma Static Forehead Lines-Assessment Scale showed almost perfect inter and intra-rater agreement in both the digital and the live setting with inter-rater intraclass correlation coefficients of 0.86 [95% confidence interval (CI): 0.82-0.89] in the first digital rating and 0.82 [95% CI: 0.78-0.86] in the second digital rating. The Croma Dynamic Forehead Lines-Assessment Scale showed almost perfect inter and intra-rater agreement in the digital setting with inter-rater intraclass correlation coefficients of 0.83 [95% CI: 0.79-0.86] in the first digital rating and 0.80 [95% CI: 0.75-0.84] in the second rating and almost substantial agreement in the live setting. Conclusions: The Croma Static Forehead Lines-Assessment Scale and the Croma Dynamic Forehead Lines-Assessment Scale have excellent inter and intra-rater agreements to be justifiably used in the clinical and study setting, both digitally and live across ethnic groups.

Novel, Validated, 5-Point Photonumeric Scales for Assessment of the Perioral Region.

BACKGROUND: The use of validated scales is still considered the gold standard for evaluating the severity of an aesthetic facial condition. OBJECTIVES: The aim of this investigation was to create and validate 5-point photonumeric scales for the assessment of perioral lines and marionette lines. METHODS: A medical team created 2 different novel 5-point photonumeric scales for the assessment of perioral lines and marionette lines. Eleven international raters were involved in the digital validation, and 4 raters performed a live validation. RESULTS: For the Croma Static Perioral Lines-Assessment Scale, the digital interrater intraclass correlation coefficients (ICCs) were 0.88 (95% CI, 0.85-0.91) in the first rating and 0.87 (95% CI, 0.83-0.90) in the second rating. The digital intrarater ICCs were 0.90 (95% CI, 0.87-0.92). In the live rating, the interrater ICCs were 0.89 (95% CI, 0.85-0.93) in the first rating and 0.91 (95% CI, 0.87-0.93) in the second rating with an intrarater ICC of 0.91 (95% CI, 0.88-0.95). For the Croma Marionette Lines-Assessment Scale, the digital rating interrater ICCs were 0.85 (95% CI, 0.81-0.89) in the first rating and 0.87 (95% CI, 0.84-0.90) in the second rating with an intrarater ICC of 0.89 (95% CI, 0.88-0.91). In the live rating, the interrater ICCs were 0.73 (95% CI, 0.54-0.83) in the first rating and 0.79 (95% CI, 0.65-0.87) in the second rating with an intrarater ICC of 0.88 (95% CI, 0.83-0.94). CONCLUSIONS: The Croma Static Perioral Lines-Assessment Scale and the Croma Marionette Lines-Assessment Scale have exceptional inter- and intrarater agreements that justify their use in clinical and study settings for all ethnic groups.

Novel, Validated 5-Point Photonumeric Scales for Assessment of the Neck and Décolleté.

BACKGROUND: There is a scarcity of scales that assess platysmal bands, wrinkles in the décolleté, and horizontal neck lines in the digital and live setting. OBJECTIVES: The objective of this investigation was to create and validate 5-point photonumeric scales that assess horizontal neck lines, platysmal bands, and wrinkles in the décolleté. METHODS: A medical team created 3 different novel 5-point photonumeric scales for the assessment of horizontal neck lines, platysmal bands, and décolleté wrinkling. Eleven international raters were involved in the digital validation, and 4 raters performed a live validation. RESULTS: The Croma (Leobendorf, Austria) Horizontal Neck Lines Assessment Scale showed substantial interrater agreement and almost perfect intrarater agreement in the digital and live validations, respectively. The Croma Platysmal Bands Assessment Scale showed substantial intrarater agreement in both digital and live validations. For the décolleté, a static scale and a dynamic scale were created and validated. The Croma Static Décolleté Wrinkles Assessment Scale showed substantial and almost perfect interrater agreement in the digital and live validations, respectively, and the intrarater agreement in both was almost perfect. The Croma Dynamic Décolleté Wrinkles Assessment Scale showed almost perfect agreement in both validation settings for both interrater and intrarater measures. CONCLUSIONS: The Croma Horizontal Neck Lines Assessment Scale and the Croma Static and Dynamic Décolleté Wrinkles Assessment Scales have sufficient interrater and intrarater agreement for justifiable use in clinical and research settings.

Physician and patient satisfaction after use of calcium hydroxylapatite for cheek augmentation.

BACKGROUND: Initial applications of calcium hydroxylapatite (CaHA) focused on filling lines and wrinkles. Facial volumization with CaHA has not been fully explored. OBJECTIVE: The purpose of this large scale, prospective, randomized, controlled, multicenter study was to assess CaHA for cheek volumizing, including physician and patient satisfaction. METHODS: Subjects ( N = 116) were randomized to an immediate treatment group or to an untreated control group (crossed over at 3 months). Patients received CaHA injections in their cheeks, defined as the malar, submalar, zygoma, preauricular, and infraorbital areas. Assessments of quantitative changes in cheek volume using magnetic resonance imaging analysis, qualitative assessments by masked evaluators, and physician and patient satisfaction analyses were also performed, including overall satisfaction with aesthetic results and likelihood to return for future treatments. Safety was assessed across 12 months. RESULTS: Mean total treatment volume (107 patients) was 4.7 mL of CaHA. At all points, physicians reported satisfaction of 75% or more, with 92% satisfaction at 12 months. Most patients also reported being satisfied at all time points, with 80% satisfied at 12 months. No serious adverse events occurred. CONCLUSION: Midface volumizing with CaHA results in high physician and patient satisfaction up to 12 months from treatment.

Cell death induced by uridine 5'-triphosphate (UTP) in contrast to adenosine 5'-triphosphate (ATP) in human epidermoid carcinoma cells (A-431).

OBJECTIVE: Extracellular ATP has been reported as an important signaling molecule mediating quite divergent specific biological effects. Recent clinical trials suggest a potential role of ATP in cancer treatment. The aim of our study was to analyze the mechanisms of UTP in comparison to ATP-mediated cell death in an established cell line model (A-431). METHODS: Cell culture and proliferation assays, separation of nucleotides by thin-layer technique, measurement of cytosolic free Ca(2+), flow cytometry analysis (annexin V), ultra structure, semi-quantitative RT-PCR, standard statistics. RESULTS: ATP, when added as a single dose between 100 and 500 microM to A-431 cell cultures, showed increasing cytotoxicity, mainly as apoptosis, with a paradoxically decreasing effect at higher concentrations up to 1500 microM. Doses exceeding 1500 microM again led to increasing cytotoxicity. UTP at doses between 500 and 3000 microM resulted in increasing cell death following a normal sigmoid dose-response model. ATP and UTP were degraded by membrane-bound ectoenzymes. ATP degradation products, e.g. adenosine, also induced cell death. Dipyridamole, an adenosine uptake inhibitor, was able to abolish ATP toxicity, which was also counteracted by the addition of uridine. In addition, we found functional and transcriptional evidence for P2 receptors on A-431 cells. CONCLUSION: Extracellular ATP seems to act via degradation to adenosine and consecutive induction of apoptosis. In contrast, we were not able to demonstrate analogous mechanisms for cell death mediated by extracellular UTP, but were able to provide some evidence of classical ligand-receptor action of uncleaved UTP on A-431 cells.

Recommendations for the long-term treatment of psoriasis with infliximab: a dermatology expert group consensus.

BACKGROUND/AIMS: Infliximab has been approved for the treatment of chronic plaque psoriasis for only a few years. As physicians gain confidence in initiating and maintaining this therapy, guidance on the management of patients beyond several months or years is needed. To date, there is little or no information about the long-term management in clinical trials or guidelines. METHODS: Here we report on the key aspects related to the use of infliximab for the treatment of psoriasis. The data presented here were derived using a modified Delphi survey to obtain a consensus opinion of 11 dermatologists from Europe and Canada experienced in long-term therapy with infliximab. RESULTS/CONCLUSION: The Delphi participants reviewed several important topics related to biological therapy and infliximab. This paper is not intended to provide a recommendation on all practical aspects related to biological therapy; it has rather been written to provide useful and practical information on the 'best practice' use of infliximab.

Open-label study of infliximab treatment for psoriatic arthritis: clinical and magnetic resonance imaging measurements of reduction of inflammation.

OBJECTIVE: To evaluate infliximab efficacy and safety in disease-modifying antirheumatic drug-unresponsive psoriatic arthritis (PsA). METHODS: In a 54-week, open-label, compassionate-use study, 10 patients received intravenous infliximab (5 mg/kg; weeks 0, 2, 6; individualized dosing after week 10). Patients continued their current therapy (stable dose) until week 10. Assessments were performed at weeks 2, 6, 10, and 54. Magnetic resonance imaging (MRI) objectively measured joint inflammation at weeks 0 and 10. RESULTS: Patients achieved a 20% improvement according to the American College of Rheumatology (ACR) criteria (ACR20) in all patients by week 2; 8 patients improved 70% (ACR70) at week 10; 6 patients maintained ACR70 after week 54. Week 10 MRI revealed an 82.5% mean reduction in inflammation from baseline, and psoriasis area and severity index scores were reduced by 71.3% +/- 16.7%. There were no significant adverse events, severe infections, or infusion reactions. CONCLUSION: Infliximab was effective, safe, and well tolerated in PsA. Arthritis and psoriasis improved in all patients during the 54-week evaluation. Further investigation of the use of infliximab for PsA and psoriasis is warranted.