A new skin laxity scale for the buttocks: the Skin Laxity Visual Scale (SLVS).

BACKGROUND: The Skin Laxity Severity Scale for the buttocks was previously developed to separately assess buttock ptosis, a scalloped appearance of the skin, infragluteal fold, localized fat on the lower third of the buttocks, and linear depressed lesions. A more objective, faster and shorter version of this scale, to be evaluated visually, would be more feasible to apply in daily practice. OBJECTIVES: To present a new skin laxity scale for the buttocks: the Skin Laxity Visual Scale (SLVS). MATERIALS & METHODS: To establish the scale, investigators chose, by consensus, the most representative cases of each skin laxity grade. The images were graphically edited to better represent the degree of skin laxity identified in a previous study. Scale validity and reliability were assessed in two validation cycles, performed by eight dermatologists assessing 50 clinical cases. RESULTS: Overall, Kendall's, weighted-kappa, and intraclass correlation coefficients indicated very good reliability and consistent inter- and intra-rater agreement (p<0.001). The scale validity was confirmed by criteria validity tests (rs: 0.76, p<0.05). CONCLUSION: The SLVS for the buttocks is a reliable, reproducible, accurate and valid scale to identify skin laxity severity and its different features. It will very likely be an easy-to-use and convenient tool to appropriately assess improvement obtained with treatment and follow patients.

Buttocks' Skin Laxity Severity Scale.

BACKGROUND: Clinical scales are useful to assess skin laxity in different areas of the body. OBJECTIVE: To elaborate and validate a photonumeric scale to assess buttocks skin laxity. MATERIALS AND METHODS: The Buttocks' Skin Laxity Severity Scale (SLSS) was developed based on a sample of 120 patients. The SLSS validity and reliability were assessed in 2 validation cycles, performed by 8 dermatologists assessing 50 clinical cases. Both criteria and construct validity were tested. RESULTS: The Buttocks' SLSS is composed by 5 clinical aspects of skin laxity graded from absent (0) to severe (3): buttocks ptosis, skin scalloped appearance, infragluteal fold, localized fat on the lower third of the buttocks, and linear depressed lesions. Final skin laxity classification results from the sum of each item grade multiplied by its weight and varies from 0 to 24. Overall, Kendall, weighted kappa, and intraclass correlation coefficients indicated very good reliability and consistent interrater and intrarater agreement (p < .001). Cronbach alpha of 0.82 indicates high scale reliability. The scale validity was confirmed by criteria validity tests (rs: 0.72, p < .05). CONCLUSION: Buttocks' SLSS is a reliable and valid scale to identify skin laxity severity and its different features, and it is an accurate tool for clinical research.

Effects of different doses of abobotulinumtoxinA for the treatment of anterior gingival smile.

Botulinum toxin type A (BoNT-A) is an easy and fast treatment for gingival smile (GS). The objective of the study was to compare the reduction of gingival exposure using three different doses of abobotulinumtoxinA (ABO) in patients with different severities of anterior GS, and to assess treatment safety and patients' satisfaction. A prospective, single-center, randomized, double-blind study was conducted. Mild GS (2 to < 3 mm) was treated with 2.5 U of abobotulinumtoxinA (ABO) per side, moderate GS (3 to < 4 mm) with 5 U of ABO per side, and severe GS (4 mm or more) with either 2.5 U, or 5 U or 7.5 U of ABO per side. All the 41 enrolled patients completed the study. The mean gingival exposure reduced significantly 4 and 12 weeks after treatment. The average reduction of gingival exposure with 5 U was significantly larger than that obtained with 2.5 U, (3.46 ± 1.39 vs. 2.05 ± 1.29 mm; p = 0.004). All groups of GS severity presented statistically significant reduction in the gingival exposure 4 and 12 weeks after ABO injections. Twelve weeks after treatment, more than 80% of the patients were satisfied or very satisfied. There were no treatment-related adverse events reported by the patients or noticed by the investigators. Gingival smile can be safely and effectively managed with BoNT-A injections and specifically with ABO injections to target the LLSAN muscle. Further and larger studies may determine the exact influence of each factor on BoNT-A treatments of GS.

Fields of muscular and anhidrotic effects of 2 botulinum toxin-A commercial preparations: a prospective, double-blind, randomized, multicenter study.

BACKGROUND: Longevity of effects and dose equivalence of different botulinum toxin type A (BoNT-A) preparations need to be better clarified because BoNT-A units are manufacturer-specific. These points are of particular importance for new brands emerging in the market. OBJECTIVE: To assess the field of muscular and anhidrotic effects of 2 commercial preparations of BoNT-A (incobotulinumtoxinA: Xeomin [XEO]; abobotulinumtoxinA: Dysport [DYS]) administered to the upper third of the face. METHODS: Patients were randomized for the side of the forehead (left or right) in which the products were administered. All were treated receiving BoNT-A injections in 10 points (5 on each side) at a dose equivalence of 1.0:2.5 U (XEO:DYS). Clinical assessments and Minor test were performed at baseline and Days 28, 84, 112, and 140. Electromyography was performed at baseline and Days 28 and 140, and ultrasound was performed only at baseline. RESULTS: Eighty patients were enrolled in 2 research centers. Xeomin and DYS presented similar results regarding fields of muscular effects. However, a larger field of anhidrotic effects was found for DYS. There was a positive correlation between the muscle thickness and electromyography results. CONCLUSION: The results of this study suggest that a lower dose equivalence between DYS and XEO could be established.

Fields of anhidrotic effects of abobotulinumtoxinA in patients with compensatory hyperhidrosis.

BACKGROUND: Botulinum toxin type A can be used to treat compensatory hyperhidrosis (CHH), which presents areas of different intensity of sweating. More information about the anhidrotic effects is needed. OBJECTIVE: To evaluate the fields of anhidrotic effects (FAEs) resulting from different doses (5 and 10 U), dilution, and depths of injection of abobotulinumtoxinA in patients with CHH. METHODS: This was a prospective, single-center, pilot study. Ten patients suffering from CHH received 20 different injections of abobotulinumtoxinA on their backs. Midline received higher doses because of more intense sweating. The diameters of the FAEs were measured at 7, 30, and 180 days after the procedure. RESULTS: Diameters of the FAEs were significantly larger at Day 30 (p < .0001) and did not significantly differ when compared with different injection depths and volumes. Points injected with 10 U exhibited significantly larger vertical diameters at 7, 30, and 180 days (p values .05, <.0001, and .043, respectively) than those injected with 5 U, but no statistical significance was observed for the horizontal diameters. CONCLUSION: Areas of more intense sweating need higher doses to present similar diameters of the FAEs. Depth and volume of injections do not play a remarkable role on the FAEs diameters in patients suffering from CHH.

Objective assessment of erythema and pigmentation of melasma lesions and surrounding areas in long-term management regimens with triple combination.

BACKGROUND: Melasma has a negative impact on quality of life since it typically occurs on the face. OBJECTIVES: To evaluate the erythema and pigmentation of melasma lesions and the surrounding areas in patients receiving triple combination (TC: hydroquinone, tretinoin, and fluocinolone acetonide) regimens. METHODS: Patients first received an 8-week daily TC treatment and were then randomized to twice weekly or tapering regimen with TC. Melanin and erythema levels of lesions and surrounding areas were objectively measured using a narrowband reflectance spectrophotometer. RESULTS: Progressive reduction in the mean melanin levels was observed in the treatment phase. Following both maintenance regimens, there was no difference between melanin levels in the melasma lesions. Adverse effects were rare in both phases of the study and there was borderline reduction in erythema with regimen II. CONCLUSION: Both maintenance regimens were effective in maintaining results obtained during the initial treatment phase, and were safe and well-tolerated. Erythema was less intense with the tapering regimen.

Superficial dermabrasion versus topical tretinoin on early striae distensae: a randomized, pilot study.

BACKGROUND: Striae distensae (SD) is a common skin condition, with a prevalence ranging from 40% to 90%, depending on the population studied. OBJECTIVES: To evaluate the efficacy of superficial dermabrasion and compare it with that of topical tretinoin cream in the treatment of narrow and early SD. MATERIALS AND METHODS: Prospective, single-center, randomized, open-label study. Thirty-two women presenting with early, untreated SD (striae rubra) were included in this study. One group received 16 weekly sessions of superficial and localized dermabrasion, and the other used 0.05% tretinoin cream daily. Striae width and length were measured and compared between groups and over time. Global Aesthetic Improvement Scale scores and subject satisfaction were also assessed. Biopsies were performed for subjects who agreed to undergo this procedure, followed by histologic analyses of the skin samples. RESULTS: Both treatments were efficacious, with significant improvement in early SD from baseline, but there was no significant difference between the two treatments. Histologic assessment showed improvement in epidermal and dermal layers for the dermabrasion treatment group. CONCLUSION: Both treatments had similar efficacy, but superficial dermabrasion had a lower frequency of side effects and better adherence of the patients.

Full-face injections of variable total doses of abobotulinum toxin type A: A randomized, phase IV clinical trial of safety and efficacy.

BACKGROUND: Botulinum toxin type A (BoNT-A) has been used for almost 20 years in cosmetic dermatology to reduce dynamic wrinkles on single or multiple facial areas. OBJECTIVE: To evaluate the safety and efficacy of full-face treatments with various total doses of abobotulinum toxin A (ABO). METHODS: A total of 90 participants were enrolled. Subjects had at least two indications for BoNT-A treatments on each third of the face (upper, middle and lower). They were randomized into 3 groups, with pre-defined total dose range of ABO, varying from 120 to 250 U. RESULTS: Most of the subjects were women (96.5%). The statistically significant improvement from baseline lasted for more than 24 weeks for glabellar lines, and more than 16 weeks for forehead wrinkles and crow's feet, all P<0.001, with no differences between groups. The most frequent adverse event (excessive perioral weakness) was related to high dose in the perioral area. CONCLUSIONS: This is the first study to compare safety and efficacy of different doses of ABO administered to the entire face simultaneously. As long as the recommended doses are used, concomitant injections of ABO are safe and efficient, with no increase in adverse events.

Quality of life and satisfaction of patients after full-face injections of abobotulinum toxin type A: A randomized, phase IV clinical trial.

BACKGROUND: Although botulinum toxin type A (BoNT-A) has been used effectively and safely to reduce facial dynamic wrinkles, few studies assessed patients' quality of life and satisfaction after treatment. OBJECTIVE: To assess the quality of life and satisfaction of patients treated with full-face injections of variable doses of abobotulinum toxin A (ABO). METHODS: Ninety subjects were randomized into 3 different groups, receiving 120-165 U, 166-205 U and 206-250 U, respectively. WHOQOL- BREF and Satisfaction and Self-assessment Questionnaire (SSQ) were completed by subjects up to 6 months after treatment. RESULTS: Most of the subjects were women (96.5%). For the physical domain in WHOQOL, a difference was observed between baseline and visit 2 (p = 0.036). There was no difference between groups for mean grades regarding amount of wrinkles, beauty, harmony and symmetry. However, there was a significant difference in the mean grades between visits. Patients' opinions also showed an improvement in their self-image up to four months after treatment, according to the self-grading. CONCLUSION: The results presented in this study show improvements in patients' quality of life during the peak of action of BoNT-A treatment, regarding the physical aspect. In addition, patients reported good satisfaction after a full-face approach.

Impact of a cybertutor in dermatological teaching.

BACKGROUND: The potential value of multimedia programs as an accessory instrument for medical education has already been demonstrated in several areas. However, most of them lack adequate validation. The authors proposed this study in order to develop and evaluate a computer multimedia program, aiming at providing a more attractive and state of the art learning tool in dermatology. METHODS: The cybertutor was developed containing clinical cases, self-education classes, and short video presentations. In order to evaluate its impact, 50 undergraduate students attending the third year of Medical School at UFRGS were randomized into two groups: group 1 was submitted to a multimedia program on a specific dermatological subject - parasite infestations, and group 2 to standard classes on the same subject. Both classes were taught by an experienced teacher, on the same subject and at the same time. In the end, the level of knowledge acquisition for the two groups was evaluated by a multiple choice test. RESULTS: The average of correct answers was 11.16 (SD = 1.625) in group 1 and 11.96 (SD = 1.645) in group 2. There were no statistically significant differences between the two groups (P = 0.09). The majority (80%) of the students who attended the cybertutor group showed interest in taking part in similar activities. CONCLUSIONS: According to this study, multimedia programs may be used for undergraduate education in Dermatology as a complementary educational tool. Contact with an instructor is still considered to be important and should be offered simultaneously.

Double-blind, randomized, controlled clinical trial to compare safety and efficacy of a metallic cannula with that of a standard needle for soft tissue augmentation of the nasolabial folds.

BACKGROUND: Injection-related side effects and complications are likely to occur during or after filler injections; they are mainly caused by the injection technique. OBJECTIVE: To assess safety and efficacy of a metallic cannula to inject hyaluronic acid (HA) filler in the nasolabial folds and to compare the safety of this cannula with that of a standard needle. METHODS: This was a prospective, randomized, phase II, double-blinded study that included 25 participants with Grade 2 to 3 for bilateral nasolabial folds according to the Modified Fitzpatrick Wrinkle Scale (MFWS). The side of the injection was randomized (cannula or needle), and 0.5 mL of HA was injected into each nasolabial fold. RESULTS: At day 3, mean MFWS score fell from 2.40 ± 0.40 to 1.46 ± 0.52 (p < .001) on the cannula-injected side and from 2.40 ± 0.40 to 1.48 ± 0.60 (p < .001) on the regular needle-injected side. Participants reported fewer side effects on the side injected with the new tool on the day of the injections: pain (p = .03), edema (p < .001), redness (p = .01) and hematoma (p < .001) than on the needle side. CONCLUSION: The new cannula is a safe and useful tool to inject HA fillers in the nasolabial folds, producing less pain, edema, hematoma, and redness than regular needles.

Field effect of two commercial preparations of botulinum toxin type A: a prospective, double-blind, randomized clinical trial.

BACKGROUND: The dose equivalence of commonly used commercial preparations of botulinum toxin type A, Dysport (abotulinumtoxinA [ABO] 500 U, Ipsen Biopharm Limited, Wrexham, United Kingdom) and Botox (onabotulinumtoxinA [ONA] 100 U, Allergan, Irvine, CA), remains unclear. OBJECTIVE: We sought to evaluate the field effect for ABO and ONA at dose equivalences of 2.5:1.0 U and 2.0:1.0 U, in both muscular and sweat gland activity. METHODS: In all, 59 female patients with forehead wrinkles were enrolled. Patients were randomized for dose equivalence between ABO and ONA, group A (2.0:1.0 U, ABO:ONA) or group B (2.5:1.0 U, ABO:ONA) administered in the frontalis muscles. Clinical assessment, Minor test, and electromyography evaluations were performed at baseline, 28 days, and 112 days. RESULTS: In group B, the field of anhidrotic effect of ABO showed a greater area and larger horizontal diameter than ONA at 28 and 112 days. At maximum frontalis muscle activity (day 112) patients receiving ABO demonstrated greater improvement based on the Wrinkle Severity Scale. No differences were found in frontalis muscle activity at rest between groups A and B based on results of Wrinkle Severity Scale, electromyography, and interindividual variability data at 28 and 112 days. LIMITATIONS: Currently, there are no objective measurements other than electromyography to evaluate the field effect of botulinum toxin type A in muscles. CONCLUSION: At a dose equivalence of 2.0:1.0 U (ABO:ONA), similar field effects were found for both muscle and sweat gland activity. At a higher dose equivalence of 2.5:1.0 U (ABO:ONA), injections of ABO showed greater area and larger horizontal diameter in field of anhidrotic effect at 28 and 112 days than ONA.

Cosmeceuticals for cellulite.

Cellulite is characterized by alterations to the skin surface, presenting as dimpled or puckered skin of the buttocks and posterior and lateral thighs. It mainly affects women. Cellulite occurrence is believed to be due to structural, inflammatory, morphological and biochemical alterations of the subcutaneous tissue. However, its pathogenesis is not completely understood. Topical treatments for cellulite include many agents, such those that increase the microcirculation flow, agents that reduce lipogenesis and promote lipolysis, agents that restore the normal structure of dermis and subcutaneous tissue, and agents that scavenge free radicals or prevent their formation. There are many cosmetic and medical treatments for cellulite. However, there is little clinical evidence of an improvement in cellulite, and none have been shown to lead to its resolution. The successful treatment of cellulite will ultimately depend upon our understanding of the physiopathology of cellulite adipose tissue.

Cybertutor: a teaching tool in Dermatology.

It was developed a teaching tool in Dermatology for undergraduate medical students, using an interactive website, the Cybertutor. Clinical cases, lectures and updated bibliography were selected. Photographies of dermatological lesions were taken from ambulatory patients. The topics of the lectures were based on the current curriculum of the Federal University of Rio Grande do Sul. The Cybertutor is a dynamic and modern teaching tool, allowing constant innovation.

Cybertutor: um objeto de ensino na Dermatologia / Cybertutor: a teaching tool in Dermatology

Foi desenvolvido um objeto de ensino em Dermatologia voltado para a graduação, que utiliza um web site interativo, o Cybertutor. Selecionaram-se casos clínicos didáticos, aulas teóricas e referências bibliográficas atualizadas. As fotografias das lesões foram obtidas pela seleção de pacientes atendidos no ambulatório de Dermatologia. Os temas das aulas se basearam no currículo vigente da Universidade Federal do Rio Grande do Sul (UFRGS). O Cybertutor é um objeto de ensino dinâmico, moderno e atual, que possibilita constante inovação.

It was developed a teaching tool in Dermatology for undergraduate medical students, using an interactive website, the Cybertutor. Clinical cases, lectures and updated bibliography were selected. Photographies of dermatological lesions were taken from ambulatory patients. The topics of the lectures were based on the current curriculum of the Federal University of Rio Grande do Sul. The Cybertutor is a dynamic and modern teaching tool, allowing constant innovation.

Side-by-side comparison of areas with and without cellulite depressions using magnetic resonance imaging.

BACKGROUND: Cellulite is characterized by alterations in the relief of the skin surface. Magnetic resonance imaging (MRI) is recognized as a reliable technique for measuring adipose volume according to body site and for the visualization of the subcutaneous structures. OBJECTIVE: To compare subcutaneous tissue in areas with and without cellulite on the buttocks of same subjects using a noninvasive technique. METHODS AND MATERIALS: Thirty female patients with cellulite on the buttocks underwent MRI. An area with cellulite and another without cellulite on the contralateral buttock were selected. Two soft gelatin capsules of different sizes were used as skin markers to differentiate the areas with and without cellulite. RESULTS: Fibrous septa were visualized in 96.7% of the area with cellulite depressions; most of them were ramified (73.3%) and presented a high-intensity signal on T2 images (70%). All fibrous septa found in the examined areas were perpendicular to the skin surface. The average fibrous septa thickness was 2.18 +/- 0.89 in the area with cellulite and 0.27 +/- 0.64 in the area without cellulite. CONCLUSION: Results of the MRI analysis showed that cellulite depressions on the buttocks were significantly associated with the presence of underlying fibrous septa.