An Assessment of Microneedling with Topical Growth Factors for Facial Skin Rejuvenation: A Randomized Controlled Trial.

BACKGROUND: The study of the use of growth factors in conjunction with microneedling is limited. It is hypothesized that the use of human growth factors will decrease recovery time by downregulating inflammation and will continue stimulating collagen synthesis initiated by microneedling. OBJECTIVE: We sought to evaluate the safety and efficacy of microneedling in combination with a novel human recombinant growth factor regenerative complex (PolyGF) for skin improvement. METHODS: This study was a randomized controlled trial evaluating changes in multiple skin parameters via provider, imaging, and patient self-assessments after four microneedling treatments, each spaced one month apart, with or without a novel growth factor. Twenty female patients aged 35 to 60 years were included. Evaluation parameters included fine lines and wrinkles, evenness of skin tone, skin clarity, age spots, skin smoothness, skin firmness, and hydration of skin via dermatologic Canfield VISIA (Fairfield, New Jersey) imaging, and patient self-assessment. RESULTS: Significant improvement in skin texture was reported to higher degrees for the PolyGF group by VISIA imaging assessments than in the control group. Subjective assessments in skin smoothness and hydration were significantly improved in the Poly GF groups. Hydration improvements were seen to a lesser degree in the control group. Improvements in firmness and texture were seen in both the PolyGF and control groups by subjective assessment. Significantly improved subjective assessments of skin tone and melanin index were reported only in the control groups. CONCLUSION: While microneedling improved skin in several parameters, the addition of the novel growth factor to microneedling helped improve skin texture and hydration to a higher degree. Further studies are needed to characterize the effects of growth factor serum in conjunction with microneedling.

Multiple Xanthogranulomas in a Teenager.

Juvenile xanthogranuloma (JXG) is a non-Langerhans cell histiocytosis that typically presents as a solitary lesion in infancy. Multiple lesions, especially in patients over one year of age, are rarely described in the literature. The authors report a case of a 17-year-old female who presented with multiple asymptomatic nodules and plaques. The diagnosis of xanthogranuloma was confirmed with histopathologic examination of foamy histiocytes and the characteristic Touton giant cells. The expected course of multiple JXG in older patients may differ from those presenting with a solitary lesion earlier in life.

Efficacy and Tolerability of an Acne Treatment Regimen with Antiaging Benefits in Adult Women: A Pilot Study.

Objective: The objective of this study was to assess clinical safety and efficacy of a novel acne treatment regimen in adult women. Methods: Participants in the study included an ethnically diverse group of adult women (n=24) with mild-to-moderate acne who were treated twice daily with a topical regimen (cleanser, acne cream, and rebalancing gel) for eight weeks. Following baseline assessments, subjects returned to clinic at Weeks 2, 4, and 8 for clinical assessments and self-assessment questionnaires. Results: Twenty-one of the 24 enrolled women completed the eight-week clinical trial. Statistically significant clinical improvements were seen in both acne and aging parameters over time. The product regimen was well tolerated without adverse reactions commonly seen with topical acne products. Conclusion: The regimen demonstrated efficacy and tolerability in adult women with acne and signs of skin aging.

A randomised phase 2 trial of dexamethasone versus prednisolone in castration-resistant prostate cancer.

BACKGROUND: Prednisolone is widely used as secondary hormonal treatment for castration-resistant prostate cancer (CRPC). We hypothesised that dexamethasone, another corticosteroid, is more active. OBJECTIVE: To compare the activity of prednisolone and dexamethasone in CRPC. DESIGN, SETTING, AND PARTICIPANTS: This single-centre, randomised, phase 2 trial was performed in 82 men with chemotherapy-naïve CRPC enrolled from 2006 to 2010. INTERVENTION: Prednisolone 5mg twice daily versus dexamethasone 0.5mg once daily versus intermittent dexamethasone 8mg twice daily on days 1-3 every 3 wk. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The main end point was prostate-specific antigen (PSA) response rate. Secondary end points included time to PSA progression, radiologic response rate using Response Evaluation Criteria In Solid Tumors (RECIST), and safety. RESULTS AND LIMITATIONS: The intermittent dexamethasone arm was dropped after no response was seen in seven patients. By intention to treat, confirmed PSA response was seen in 41% versus 22% for daily dexamethasone versus prednisolone, respectively (p=0.08). In evaluable patients, the PSA response rates were 47% versus 24% for dexamethasone and prednisolone, respectively (p=0.05). Median time to PSA progression was 9.7 mo on dexamethasone versus 5.1 mo on prednisolone (hazard ratio: 1.6; 95% confidence interval, 0.9-2.8). In 43 patients with measurable disease, the response rate by RECIST was 15% and 6% for dexamethasone and prednisolone, respectively (p=0.6). Of 23 patients who crossed over at PSA progression on prednisolone, 7 of the 19 evaluable (37%) had a confirmed PSA response to dexamethasone. Clinically significant toxicities were rare. CONCLUSIONS: Dexamethasone may be more active than prednisolone in CRPC. In the absence of more definitive trials, dexamethasone should be used in preference to prednisolone. PATIENT SUMMARY: We compared two different steroids used for treating men with advanced prostate cancer. Our results suggest that dexamethasone may be more effective than prednisolone and that both are well tolerated. CLINICAL TRIAL REGISTRY: EUDRAC 2005-006018-16.

Complications following injection of soft-tissue fillers.

BACKGROUND: Soft-tissue filler injection is a very common procedure in the United States. Although the safety profile is favorable, adverse events (AE) can occur, ranging from mild to severe in intensity. OBJECTIVES: The authors performed a literature search to identify the facial sites most prone to severe complications. They review the course of these complications and discuss preventive measures. METHODS: The National Library of Medicine, the Cochrane Library, and Ovid MEDLINE were searched, and relevant articles (published through August 2012) were retrieved based on prespecified inclusion criteria. The complications reviewed were limited to "severe" events, such as soft-tissue necrosis, filler embolization, visual impairment, and anaphylaxis. The filler materials included were those approved by the US Food and Drug Administration at the time of this study. RESULTS: Forty-one articles, representing 61 patients with severe complications, were identified. Data collected from these case reports included filler type, injection site, complication site, symptom interval, symptom of complication, time to therapy, modality of treatment, and outcome. The most common injection site for necrosis was the nose (33.3%), followed by the nasolabial fold (31.2%). Blindness was most often associated with injection of the glabella (50%). An estimated incidence of 0.0001% for developing a severe complication was calculated by reviewing society-based filler data and case reports within same time period. CONCLUSIONS: Although soft-tissue fillers are a popular choice for minimally invasive rejuvenation of the face, physicians should be aware of the serious potential adverse effects, recognize their presentations, and have appropriate treatments readily available.