Intralipotherapy, the State of the Art

Reconstruction intralipotherapy is a term commonly used in the field of aesthetic medicine, above all in Europe, which defines a specific injection technique developed for the treatment of localized fat with substances that provoke the lysis of adipocytes by means of an injection directly into the adipose tissue with a long needle. The aim of this study is to define the technique in detail and everything that is associated with it, on the basis of years of multicenter experience by doctors who perform it

Vertex Accentuation in Female Pattern Hair Loss in Asians

Background: The most common cause of hair loss seen in women is female pattern hair loss (FPHL), also known as female androgenetic alopecia. It affects the central part of the scalp, but spares the frontal hairline. Frontal accentuation was also described by Olsen. In Asian women, vertex thinning patterns are frequently developed, but there has been no report about vertex thinning pattern in female pattern hair loss. Objective: To find prevalence of vertex accentuation in female pattern hair loss (FPHL) in Asian women. Methods: Scalp hair counting (n/cm2 ) were measured at 3 different areas; vertex, mid scalp and frontal area respectively by digital dermoscope (Dino digital AM-413T). Visual counting and photography were performed. Outcomes were evaluated by gross appearance of vertex thinning and/or hair density <120 /cm2 in any of 3 areas. Results: 143 patients were evaluated. Mean age was 45.54 years. Of the hair loss type, 36.4% were mid-scalp, 33.6% were vertex accentuation and 30.1% were frontal accentuation, respectively. Age was not significantly different among the 3 types of hair loss (P- value 0.859). Conclusion: Although the most common female pattern hair loss type is diffuse type (Ludwig type), vertex accentuation pattern is the second most common pattern in this study. This study is the first to mention “Vertex accentuation” to be another pattern for FPHL

Ichthyosis Follicularis with Atrichia and Photophobia Syndrome: First Case Report in Thailand

We herein describe the first reported case of Ichthyosis Follicularis with Atrichia and Photophobia (IFAP) syndrome in Thailand. A 6-year-old boy presented with a history of photophobia since 1 month of age. Then he developed widespread follicular hyperkeratotic papules and subtotal non-scarring alopecia by the age of 10 months and 5 years, respectively. Sparse eyelashes and nail dystrophy were also noted. No neurological abnormalities, systemic involvement, and hearing impairment were observed. The clinical manifestations were consistent with IFAP syndrome, although genetic testing did not confirm the diagnosis of this rare disorder

Incidence of Ocular Toxicity from Iron Chelating Agents at Siriraj Hospital

Objective: To determine the incidences of ocular toxicity and ocular findings, including structural and functional abnormalities, caused by iron chelating agents and detected by an electrophysiologic test at Siriraj Hospital. Methods: A retrospective chart review was conducted of patients receiving multiple blood transfusions and iron chelation therapy who had an eye examination at Siriraj Hospital between January 1995 and December 2017. Results: Ninety-seven charts were reviewed. The 88 patients included comprised 41 males and 47 females. Their ages ranged from 1 year 11 months to 47 years, with children predominant (mean: 8.13 years). Beta thalassemia HbE was the main diagnosis (87.5%). After receiving iron chelating agents, 3 patients had abnormal eye findings with suspected ocular toxicity. Two had retinal pigmentary changes, but only one of those two displayed a mildly decreased response in a scotopic electroretinogram. Although the third patient also showed a decreased electroretinogram response, there were no obvious retinal changes. All three received the iron chelating agents desferrioxamine, deferiprone, and/or deferasirox at different doses and for various durations. Conclusion: Although some pigmentary retinopathy and decreased electroretinogram responses were found, leading to ocular toxicity being suspected, there was a very low incidence of ocular toxicity from the chelating agents. In addition, the dosages of the agents causing ocular toxicity, and the duration of that toxicity, were inconclusive. Moreover, a gold standard for identifying ocular toxicity caused by chelating agents was not able to be established. Consequently, the risks and benefits of employing eye screening coupled with an invasive procedure like an electrophysiologic test will need to be weighed, especially with pediatric patients

Intralesional Botulinum Toxin A Injection for Recalcitrant Alopecial Totalis and Alopecia Universalis: A Randomized, Double-Blind, Placebo-Controlled Trial

Background: Alopecia totalis (AT) and alopecia universalis (AU) have a high rate of recurrence and are very difficult to treat. To date, no consensus has been reach among clinicians regarding the best way to treat these conditions. It was recently proposed that botulinum toxin type A (BT) injection in alopecia areata may inhibit unmyelinated C fibers from releasing substance P and calcitonin-gene-related protein (CGRP), which showed a favorable clinical response in cephalalgic alopecia areata. Objective: To investigate the efficacy of botulinum toxin type A (BT) in the treatment of recalcitrant AT and AU. Methods: Twenty patients with either recalcitrant AT or AU were enrolled in this study. One half of the scalp was injected with BT 50 units 2.5 ml intradermally (dilution 20 units/ml) and the other half of the scalp was injected with normal saline 2.5 ml. Clinical assessments were performed using Severity of Alopecia Tool (SALT) score, scalp mapping, and photography. Patients were followed up monthly for 4 months after treatment to evaluate terminal hair regrowth. Results: Based on patient results at the 4-month follow-up, no clinical improvement in either recalcitrant alopecia totalis or alopecia universalis was observed. Conclusion: Although BT has been demonstrated to improve the clinical features of cephalalgia alopecia areata, BT was not shown to improve the clinical features of recalcitrant AT or AU in this study. In order to understand and explain the differences in these two clinical outcomes using BT in alopecia, further investigation is needed

Deposition of Triglyceride on Soft Contact Lenses from Lipid-Containing Artificial Tears

Objective: To determine the amount of triglyceride deposition from a lipid-containing artificial tear eye drop (Endura® ) on three different types of contact lenses after one day and one month of simulated use. Methods: Simulated use of artificial tears was performed in vitro on three different types of contact lenses, including: high water content (HW), low water content (LW), and silicone hydrogel (SI) contact lenses. To simulate one day of use, contact lenses were incubated in artificial tear solution for 16 hours. To simulate a one month of use, they underwent repeated cycles of 16-hour incubation in artificial tear solution, lens cleaning, and 8-hour storage in a multipurpose solution daily for 30 days. Triglyceride deposited was extracted and determined. Results: After one day of simulated use, amount of deposited triglyceride was significantly different among 3 types of contact lenses with the highest deposition in SI followed by LW and HW contact lenses; the corresponding values (mean ± SD) were 3.79 ± 0.35, 0.84 ± 0.27, and 0.26 ± 0.17 μg/lens, respectively. Only between SI and HW was it found to be statistically different. After one month of simulated use, deposition on SI lenses was slightly increased (6.56 ± 1.10 μg/lens) with that on LW and HW lenses remaining low (0.10 ± 0.12 and 0.55 ± 0.34 μg/lens, respectively). Conclusion: Triglyceride from lipid-containing artificial tears can absorb into contact lenses, particularly those made of silicone hydrogel, most notably after long periods of use. However, levels of triglyceride deposition are relatively low, when compared to lipid deposition from normal tear films during regular use