Percutaneous collagen induction: An effective and safe treatment for post-acne scarring in different skin phototypes

Background: Atrophic scars can complicate moderate and severe acne. There are, at present, several modalities of treatment with different results. Percutaneous collagen induction (PCI) has recently been proposed as a simple and effective therapeutic option for the management of atrophic scars. Objective:The aim of our study was to analyze the efficacy and safety of percutaneous collagen induction for the treatment of acne scarring in different skin phototypes. Methods & materials: A total of 60 patients of skin types phototype I to VI were included in the study. They were divided into three groups before beginning treatment: Group A (phototypes I to II), Group B (phototypes III to V), and Group C (phototypes VI). Each patient had three treatments at monthly intervals. The aesthetic improvement was evaluated by using a Global Aesthetic Improvement Scale (GAIS), and analyzed statistically by computerized image analysis of the patients' photographs. The differences in the GAIS scores in the different time-points of each group were found using the Wilcoxon's test for nonparametric-dependent continuous variables. Computerized image analysis of silicone replicas was used to quantify the irregularity of the surface micro-relief with Fast Fourier Transformation (FFT); average values of gray were obtained along the x- and y-axes. The calculated indexes were the integrals of areas arising from the distribution of pixels along the axes. Results:All patients completed the study. The Wilcoxon's test for nonparametric-dependent continuous variables showed a statistically significant (p < 0.05) reduction in severity grade of acne scars at T5 compared to baseline (T1). The analysis of the surface micro-relief performed on skin replicas showed a decrease in the degree of irregularity of skin texture in all three groups of patients, with an average reduction of 31% in both axes after three sessions. No short- or long-term dyschromia was observed. Conclusion: PCI offers a simple and safe modality to improve the appearance of acne scars without risk of dyspigmentation in patient of all skin types. © 2014 Informa Healthcare USA on behalf of Informa UK Ltd

Collagen induction therapy for the treatment of upper lip wrinkles

Upper lip wrinkles are very common and impair the quality of life of many people due to their perceived unsightly appearance. Several options are available today for their treatment. A new therapeutic option, called collagen induction therapy (CIT), seems to be effective and safe for the treatment of upper lip wrinkles. The aim of this study is to demonstrate the efficacy and safety of CIT in the treatment of upper lip wrinkles. Ten female subjects, aged 50-65 years old, with upper lip wrinkles were enrolled. Each patient was treated with a specific tool in two sessions. Using a digital camera, photographs were taken of all the patients to evaluate the depth of the wrinkles and a silicon-print technique was used to obtain a microrelief impression of the wrinkles. Data of the cutaneous casts were analyzed by computerized image analysis. Analysis of the patients' photographs, supported by the sign test, and of the degree of irregularity of the surface microrelief, supported by Fast Fourier Transform and by wrinkle image processing, showed that, after only two sessions, the wrinkles' severity grade in most patients was greatly reduced. The present study confirms CIT as an effective and safe technique to improve upper lip wrinkles

Salicylic Acid Peel Incorporating Triethyl Citrate and Ethyl Linoleate in the Treatment of Moderate Acne: A New Therapeutic Approach.

BACKGROUND: Acne affects many adolescents. Conventional therapy often results in side effects and poor adherence, and the treatment does not consider the psychological effect of acne on patients, which is comparable with that of disabling diseases. OBJECTIVES: To evaluate the efficacy and tolerability of a peel (30% salicylic acid, triethyl citrate and ethyl linoleate) combined with a home therapy with three topical agents (triethyl citrate, ethyl linoleate and salicylic acid 0.5% cream, lotion) in moderate acne of the face. DESIGN: Prospective, observational, multicenter, open-label, postmarketing, phase IV study. METHODS: Patients were assessed by comparing Global Acne Grading System (GAGS) score and total lesion count from 15 days before the first peel (T-15 ), after four salicylic peels (every 10 ± 2 days (T0 , T10 , T20 , T30 ), and 20 days after of the end of the study (T50 ). This treatment was associated to a home therapy. RESULTS: Fifty-three patients completed the study. The average GAGS score fell 49% between T-15 and T50 (p < .001). No patient withdrew for adverse events. CONCLUSIONS: This therapy was effective and well-tolerated in all cases. Chemo-exfoliation sessions ensured the continuous monitoring of clinical results and improved patient quality of life

Acne radar: A new intuitive graphic visualization of quality of life in acne patients

Background: There are many instruments available in literature to evaluate the influence of acne on Qualify of Life (QoL), but many of these questionnaires rarely are performed in daily clinical practice. Many of these instruments require a long time for the compilation, and often they are not self completed. There are no simple and intuitive instrument that can be completed by patients alone, with a graphical representation of the results. Objective: To develop a new, rapid and intuitive graphic instrument to a questionnaire allowing both a quick assessment of the impact of acne on patients and, at the same time, increase patient's compliance and self-esteem. Methods: In our study 50 patients were recruited and questionnaire was administered following the main items evaluated in the validated index of QoL from previous studies for acne patients. We have applied an intuitive graph representation, the "Radar Graph", and other statistical methods like the Decisional Map and the Principal Component Analysis, to this questionnaire allowing a quick assessment of the impact of acne on patients. Results: The questionnaire evaluated have 10 items regarding 3 different area: the objective symptoms such as negative perception of their image (imperfection), sting and insomnia; the subjective symptoms such as depression, perception of illness, lack of serenity and shame; and the relational difficulties such as social relationships, working relationships, and intimate relations. The answers are given on a 10-point visual analogue scale. Conclusion: Our survey can be a new, rapid and intuitive graphic instrument to use in clinical practice

Quality of life in alopecia areata: A disease-specific questionnaire

Background Alopecia areata (AA) is an autoimmune disease affecting about 2% of the population, which has a considerable impact on quality of life (QoL). There are no disease-specific questionnaires to assess QoL in patients suffering from AA. Objective To validate a new disease-specific questionnaire for AA, named AA-QLI, and to compare the consequent Quality of Life Index (QLI) with the commonly known Dermatology Life Quality Index (DLQI) to verify if it can provide a more comprehensive tool for patients. Methods A total of 50 patients affected by AA were administered both the AA-QLI, created by us, and the well-known DLQI. With the aim to detect suitable QLI, we propose to use two multivariate analyses: a principal component analysis approach on the data collected with both questionnaires to compare their capability to measure the QoL; a structural equation modelling on our AA-QLI to identify which category of symptoms mostly affects the QoL. Results The scores of both the questionnaires are quite close, except for a few cases. Statistical analysis shows a higher specificity of the AA-QLI for evaluating QoL. Among the three areas in which AA-QLI is divided, 'Relationship' has a major impact on the QLI, followed by 'Subjective symptoms'; 'Objective signs' has a lower weight on the QLI. Conclusion AA-QLI is a good instrument to evaluate the real impact of AA on QoL. It can be helpful both for the physician and for the patient. © 2012 European Academy of Dermatology and Venereology

A new classification and clinical predictivity for some naevus variants

Background. The incidence of cutaneous melanoma is rapidly increasing in Europe. Active research is directed toward the identification of naevi as a risk factor. Objective. The aim of our case-control study was to observe different numbers of moles and different mole typology associations in order to evaluate clinical predictivity and to establish a new classification for some naevus variants. Methods. A case-control study was carried out, enrolling 64 cases affected by melanoma and 183 controls, between October 2009 and February 2011. Each patient was interviewed and subjected to clinical examination. The resulting data were analysed using the statistical elaboration program SPSS 16.0. Results. The association of target naevus with other variants increases the degree of risk (target + small brown Odds Ratio 5.25; confidence interval 1.8-15.4); (target + small brown + small black + large brown odds ratio 5.0; confidence interval 1.1-22.4). Therefore, other variants and/or other variant combinations do not significantly increase risk. Conclusion. People presenting two naevus variants in association with other naevus variants seem to run a major risk. The general nonuniformity of the whole naevus panorama should be carefully considered

Bilateral Chilblain-like Lesions of the Toes Characterized by Microvascular Remodeling in Adolescents During the COVID-19 Pandemic.

Importance: Chilblain-like lesions have been one of the most frequently described cutaneous manifestations during the COVID-19 pandemic. Their etiopathogenesis, including the role of SARS-CoV-2, remains elusive. Objective: To examine the association of chilblain-like lesions with SARS-CoV-2 infection. Design, setting, and participants: This prospective case series enrolled 17 adolescents who presented with chilblain-like lesions from April 1 to June 30, 2020, at a tertiary referral academic hospital in Italy. Main outcomes and measures: Macroscopic (clinical and dermoscopic) and microscopic (histopathologic) analysis contributed to a thorough understanding of the lesions. Nasopharyngeal swab, serologic testing, and in situ hybridization of the skin biopsy specimens were performed to test for SARS-CoV-2 infection. Laboratory tests explored signs of systemic inflammation or thrombophilia. Structural changes in peripheral microcirculation were investigated by capillaroscopy. Results: Of the 17 adolescents (9 [52.9%] male; median [interquartile range] age, 13.2 [12.5-14.3] years) enrolled during the first wave of the COVID-19 pandemic, 16 (94.1%) had bilaterally localized distal erythematous or cyanotic lesions. A triad of red dots (16 [100%]), white rosettes (11 [68.8%]), and white streaks (10 [62.5%]) characterized the dermoscopic picture. Histologic analysis revealed a remodeling of the dermal blood vessels with a lobular arrangement, wall thickening, and a mild perivascular lymphocytic infiltrate. SARS-CoV-2 infection was excluded by molecular and serologic testing. In situ hybridization did not highlight the viral genome in the lesions. Conclusions and relevance: This study delineated the clinical, histologic, and laboratory features of chilblain-like lesions that emerged during the COVID-19 pandemic, and its findings do not support their association with SARS-CoV-2 infection. The lesions occurred in otherwise healthy adolescents, had a long but benign course to self-resolution, and were characterized by a microvascular remodeling with perivascular lymphocytic infiltrate but no other signs of vasculitis. These results suggest that chilblain-like lesions do not imply a concomitant SARS-CoV-2 infection. Ongoing studies will help clarify the etiopathogenic mechanisms