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Journal of Cosmetic Dermatology Nov 2020Chemical peelings are used on a wide scale in cosmetic field including melasma treatment. They often provide clinicians with flexibility in tailoring treatments... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Chemical peelings are used on a wide scale in cosmetic field including melasma treatment. They often provide clinicians with flexibility in tailoring treatments according to patient needs and satisfaction.
OBJECTIVE
To evaluate safety and efficacy of chemical peeling as single agents in melasma management in patients with darker skin types.
METHODS
We included randomized controlled trials (RCTs) and prospective studies that assessed efficacy and safety of chemical peeling as single agents for facial melasma. An online bibliographic search was conducted, and data were extracted from the included studies.
RESULTS
Ten RCTs and three prospective comparative studies (No. of patients = 478) were included. The overall effect estimate favored Glycolic acid (GA) over trichloroacetic acid peel in terms of melasma activity and severity index (MASI) (mean difference [MD] -1.89, 95% CI [-3.26, -0.52], P = .007). On the other hand, the overall effect estimates did not favor GA over tretinoin (MD 0.53, 95% CI [-0.46, 1.52], P = .3), vitamin C iontophoresis (MD 1.50, 95% CI [-0.50, 3.50], P = .14), and amino fruit acid (MD 0.39, 95% CI [-0.64, 1.42], P = .46) in terms of MASI. The overall effect estimates favored trichloroacetic acid peel (MD -5.30, 95% CI [-6.41, -4.19], P < .001) and Jessner's solution (MD -3.20, 95% CI [-5.35, -1.05], P = .004) over topical hydroquinone in terms of MASI.
CONCLUSION
In conclusion, chemical peelings are effective as single agents for management of melasma in patients with darker skin types, with the use of topicals as maintenance treatment.
Topics: Chemexfoliation; Dermabrasion; Humans; Melanosis; Treatment Outcome; Tretinoin; Trichloroacetic Acid
PubMed: 32947652
DOI: 10.1111/jocd.13725 -
Dermatologic Therapy Jan 2020Hori's nevus is a pigmentation disorder reported mainly in middle-aged Asian women. There is no systematic review addressing its pharmacotherapy. The population for our...
Hori's nevus is a pigmentation disorder reported mainly in middle-aged Asian women. There is no systematic review addressing its pharmacotherapy. The population for our systematic review was patients with a clinical/histological diagnosis of Hori's nevus (both sex, any age group). We screened five literature databases using relevant keywords. All RCTs, observational studies and case series mentioning at least one intervention and outcome of that intervention were included. Nineteen studies were included in the final systematic review from total 680 identified nonduplicate records. Different forms of laser (alexandrite laser [QSAL and PSAL], Nd:YAG laser [QSNYL high fluence, low fluence, 532 followed by 1064 nm], Er: YAG and Nd:YAG combination, ruby laser [QSRL], CO laser followed by QSRL) and dermabrasion were found to be useful in treatment of Hori' nevus. Among alexandrite lasers, PSAL is more efficacious and safe than QSAL. In case of high fluence QSNYL, hyperpigmentation rate is quite high while low fluence QSNYL requires more number of treatment sessions. The combined 1064 nm + 532 nm protocol is better in terms of efficacy and safety. Er:YAG + Nd:YAG combination have similar efficacy and added advantage of synergistic action and no adverse event.
Topics: Asian People; Dermabrasion; Female; Humans; Laser Therapy; Male; Nevus of Ota; Randomized Controlled Trials as Topic
PubMed: 31714651
DOI: 10.1111/dth.13167 -
Journal of the American Academy of... Sep 2020No large studies have defined the best treatment of actinic cheilitis.
BACKGROUND
No large studies have defined the best treatment of actinic cheilitis.
METHODS
We conducted a systematic review to define the best therapies for actinic cheilitis in clinical response and recurrences.
RESULTS
We first identified 444 papers, and 49 were finally considered, including 789 patients and 843 treated areas. The following therapies were recorded in order of frequency: laser therapy, photodynamic therapy (PDT), 3% diclofenac in 2.5% hyaluronic acid, PDT + 5% imiquimod, aminolevulinic acid-laser or methyl-aminolevulinic acid-laser, 5% imiquimod, fluorouracil, partial surgery, 0.015% ingenol mebutate, 50% trichloroacetic acid, and laser + PDT. Concerning the primary outcome, complete clinical response was achieved in 76.5% of patients, and 10.2% had clinical recurrences. Partial surgery and laser therapy showed the highest complete response rates (14 of 14 [100%] and 244 of 260 [93.8%], respectively) with low recurrences. Only a limited number of patients were treated with other therapies, with the exception of PDT, with 68.9% complete responses and 12.6% of recurrences. Interestingly, when combined with 5% imiquimod, the efficacy of PDT was significantly enhanced.
LIMITATIONS
Heterogeneity across studies.
CONCLUSION
Laser therapy appears the best option among nonsurgical approaches for actinic cheilitis, and PDT showed higher efficacy when sequentially combined with 5% imiquimod. Larger studies are needed to confirm these data.
Topics: Aminolevulinic Acid; Carcinoma, Squamous Cell; Cheilitis; Combined Modality Therapy; Dermabrasion; Diclofenac; Disease Progression; Fluorouracil; Humans; Imiquimod; Laser Therapy; Lip Neoplasms; Photochemotherapy; Precancerous Conditions; Treatment Outcome
PubMed: 31400450
DOI: 10.1016/j.jaad.2019.07.106 -
Journal Der Deutschen Dermatologischen... Oct 2018This study aimed to compare the efficacy of vitiligo treatments with and without ablation therapy. (Meta-Analysis)
Meta-Analysis
BACKGROUND AND OBJECTIVES
This study aimed to compare the efficacy of vitiligo treatments with and without ablation therapy.
PATIENTS AND METHODS
We conducted a systematic review and meta-analysis of literature published before September 15, 2017. Comparative studies of vitiligo patients treated with and without ablation therapy were included. The primary outcome was ≥ 50 % repigmentation. Secondary outcomes were ≥ 75 % repigmentation and patient scores on a subjective visual analogue scale.
RESULTS
Fifteen studies with a total of 401 participants were included. The ablation-based combination therapy group had significantly superior results to the control group (odds ratio [OR] for ≥ 50 % repigmentation: 10.490, 95 % confidence interval [CI]: 4.632-23.757; OR for ≥ 75 % repigmentation: 5.812, 95 % CI: 2.194-15.393). Patients receiving ablation-based combination therapy were significantly more satisfied with the efficacy than the control group (standardized mean difference: 1.073, 95 % CI: 0.528-1.619). Subgroup analysis showed that the erbium laser group, CO laser group and fractional CO laser group achieved significantly better repigmentation than the control groups.
CONCLUSIONS
According to objective and subjective evaluations, treatments for vitiligo are more effective when combined with ablation therapy than when used alone.
Topics: Adrenal Cortex Hormones; Calcineurin Inhibitors; Combined Modality Therapy; Dermabrasion; Fluorouracil; Humans; Laser Therapy; Lasers, Gas; Lasers, Solid-State; Treatment Outcome; Vitiligo
PubMed: 30248232
DOI: 10.1111/ddg.13657 -
Dermatologic Surgery : Official... May 2018Many dermatologic procedures are painful and can be distressing to patients. (Review)
Review
BACKGROUND
Many dermatologic procedures are painful and can be distressing to patients.
OBJECTIVE
To determine whether nitrous oxide has been used in dermatology and whether literature supports its use in terms of providing analgesia and anxiety associated with dermatologic procedures.
METHODS
A search of PubMed and Cochrane databases was conducted through July 15, 2016, to identify studies involving nitrous oxide use in dermatology.
RESULTS
Eight studies were identified and reviewed. The use of nitrous oxide/oxygen mixture resulted in a significant reduction in pain when used for photodynamic therapy, botulinum toxin therapy for hyperhidrosis of both the palms and axilla, aesthetic procedures involving various laser procedures, and in the treatment of bed sores and leg ulcers. However, pain scores were higher when nitrous oxide/oxygen was used in the debridement of chronic ulcers when compared with the use of topical anesthesia. In addition, nitrous oxide has been reported effective at reducing pain in hair transplants, dermabrasion, excision and repairs, and pediatric procedures.
CONCLUSION
Current literature provides some evidence that nitrous oxide, used alone or as adjunct anesthesia, is effective at providing analgesia for many dermatologic procedures. Nitrous oxide has many potential applications in dermatology; however, further evidence from randomized controlled trials is needed.
Topics: Analgesia; Anesthetics, Inhalation; Dermatologic Surgical Procedures; Dermatology; Evidence-Based Medicine; Humans; Nitrous Oxide; Skin Diseases; Treatment Outcome
PubMed: 29701620
DOI: 10.1097/DSS.0000000000001464 -
Actas Dermo-sifiliograficas Apr 2018Photodynamic therapy (PDT) involves the combination of a light source and a photosensitizing agent to induce tissue damage via the generation of singlet oxygen. Although...
INTRODUCTION
Photodynamic therapy (PDT) involves the combination of a light source and a photosensitizing agent to induce tissue damage via the generation of singlet oxygen. Although topical PDT has been approved for other indications, its use in facial photodamage is uncertain.
AIMS
To assess the efficacy and safety of PDT in facial skin photoaging.
METHODS
All randomized clinical trials (RCTs) evaluating the efficacy and safety of any form of topical PDT for the treatment of facial photodamage (dermatoheliosis) or photoaging in patients older than 18 years, were included. Photodynamic-therapy using any topical photosensitizing agent at any dose, and with any light-source, were considered. Comparators were chemical exfoliation, intense pulsed light (IPL), light emitting diodes (LED), dermabrasion or microdermabrasion, ablative or non-ablative lasers, injectables, surgery, placebo and/or no treatment. A systematic search in PubMed, Embase, Lilacs, Google Scholar and RCT's registry databases, was performed.
RESULTS
Search was conducted up to May 4th 2016. Four authors independently selected and assessed methodological quality of each RCT. According to inclusion criteria, twelve studies were included (6 aminolevulinate (ALA) trials and 6 methyl aminolevulinate (MAL) trials), but the majority of them had methodological constraints particularly in randomization description and patients/outcome assessors blindness.
DISCUSSION AND CONCLUSIONS
Overall results indicated that PDT either with ALA or with MAL was effective and safe for facial photodamage treatment, but high quality of evidence was found mainly for MAL studies.
Topics: Cosmetic Techniques; Humans; Photochemotherapy; Randomized Controlled Trials as Topic; Skin Aging
PubMed: 29295735
DOI: 10.1016/j.ad.2017.05.021 -
JAMA Dermatology Aug 2017The notion that systemic isotretinoin taken within 6 to 12 months of cutaneous surgery contributes to abnormal scarring or delayed wound healing is widely taught and... (Review)
Review
IMPORTANCE
The notion that systemic isotretinoin taken within 6 to 12 months of cutaneous surgery contributes to abnormal scarring or delayed wound healing is widely taught and practiced; however, it is based on 3 small case series from the mid-1980s.
OBJECTIVE
To evaluate the body of literature to provide evidence-based recommendations regarding the safety of procedural interventions performed either concurrently with, or immediately following the cessation of systemic isotretinoin therapy.
EVIDENCE REVIEW
A panel of national experts in pediatric dermatology, procedural/cosmetic dermatology, plastic surgery, scars, wound healing, acne, and isotretinoin was convened. A systematic PubMed review of English-language articles published from 1982 to 2017 was performed using the following search terms: isotretinoin, 13-cis-retinoic acid, Accutane, retinoids, acitretin, surgery, surgical, laser, ablative laser, nonablative laser, laser hair removal, chemical peel, dermabrasion, wound healing, safety, scarring, hypertrophic scar, and keloid. Evidence was graded, and expert consensus was obtained.
FINDINGS
Thirty-two relevant publications reported 1485 procedures. There was insufficient evidence to support delaying manual dermabrasion, superficial chemical peels, cutaneous surgery, laser hair removal, and fractional ablative and nonablative laser procedures for patients currently receiving or having recently completed isotretinoin therapy. Based on the available literature, mechanical dermabrasion and fully ablative laser are not recommended in the setting of systemic isotretinoin treatment.
CONCLUSIONS AND RELEVANCE
Physicians and patients may have an evidence-based discussion regarding the known risk of cutaneous surgical procedures in the setting of systemic isotretinoin therapy. For some patients and some conditions, an informed decision may lead to earlier and potentially more effective interventions.
Topics: Cicatrix; Dermatologic Agents; Dermatologic Surgical Procedures; Humans; Isotretinoin; Skin; Time Factors; Wound Healing
PubMed: 28658462
DOI: 10.1001/jamadermatol.2017.2077 -
Scars, Burns & Healing 2017Acne is a common condition that can result in permanent scarring. Acne scars can be broken down into three categories: atrophic; hypertrophic; and keloidal. Atrophic... (Review)
Review
INTRODUCTION
Acne is a common condition that can result in permanent scarring. Acne scars can be broken down into three categories: atrophic; hypertrophic; and keloidal. Atrophic scars can be further sub-classified into: ice pick; rolling; and boxcar.
OBJECTIVES AND METHODS
We have performed a comprehensive literature search of the last ten years in order to determine the efficacy and adverse reactions of commonly used treatments against post-acne scarring.
RESULTS
A total of 36 relevant articles were identified on the following interventions: subcision (n = 10), dermabrasion (n = 1), microneedling (n = 8), dermal fillers (n = 5), and chemical peeling (n = 12).
DISCUSSION
Improvement in the appearance of post-acne scarring following subcision is in the range of 10-100%. Microdermabrasion achieved the least significant results. A total of 27.3% patients did not achieve any benefit despite eight treatment sessions, and only 9.1% achieved good results. All patients treated with microneedling achieved some improvement in scar appearance in the range of 31-62%. Dermal fillers also led to favourable outcomes. In particular, treatment with PPMA led to improvement in 84% of patients. Utilising chemical peels, trichloroacetic acid (TCA) CROSS achieved >70% improvement in 73.3% of patients, whereas 20% glycolic acid did not lead to any improvement in 25%.
CONCLUSION
Post-acne scarring is a common and challenging condition with no easy and definitive solution. The above interventions have been used with varying degrees of efficacy, each having both pros and cons. All have been deemed to be safe with few and transient adverse reactions. However, further trials with a larger number of patients are necessary in order to reach more concrete conclusions regarding their efficacy.
PubMed: 29799567
DOI: 10.1177/2059513117695312 -
Journal of Drugs in Dermatology : JDD Nov 2015Ablative fractional laser (AFL) therapy for scars is an area of increasing interest. While the enthusiasm for these treatments is high, a systematic review of their use... (Comparative Study)
Comparative Study Review
BACKGROUND
Ablative fractional laser (AFL) therapy for scars is an area of increasing interest. While the enthusiasm for these treatments is high, a systematic review of their use on surgical scars has not been done.
OBJECTIVE
To identify randomized trials that study the efficacy of ablative fractionated laser therapy for treatment of surgical scars.
METHODS AND MATERIALS
EMBASE, Web of Science, and Pubmed databases were searched for randomized trials with 10 or more surgical wounds. No restrictions were placed on the language of the publications.
RESULTS
Three randomized trials were identified that met the criteria for the review. One study found superior efficacy of ablative fractionated laser treatment of surgical scars compared to pulsed dye laser while the others found equivalent efficacy when compared to dermabrasion or pulsed dye laser. One study found a superior safety profile for ablative fractionated laser treatment over dermabrasion. No studies compared fractionated laser therapy to sham therapy or observation.
CONCLUSIONS
AFL compares well with the scar amelioration techniques of dermabrasion and pulsed dye laser. Additional studies are needed to further contrast AFL to these and other modalities as well as to observation alone.
Topics: Cicatrix; Dermabrasion; Humans; Laser Therapy; Lasers, Dye; Postoperative Complications; Randomized Controlled Trials as Topic
PubMed: 26580867
DOI: No ID Found -
Journal of the European Academy of... Jun 2015Benign familial chronic pemphigus, or Hailey-Hailey disease (HHD), is a recurrent bullous dermatitis that tends to have a chronic course with frequent relapses.... (Review)
Review
Benign familial chronic pemphigus, or Hailey-Hailey disease (HHD), is a recurrent bullous dermatitis that tends to have a chronic course with frequent relapses. Long-term treatment options include surgery with skin grafting or dermabrasion. Both are highly invasive and carry significant risks and complications. More recently, 'laser-abrasion' has been described as a less invasive option with a better side-effect profile. In this article, we systematically review the safety and efficacy of carbon dioxide laser therapy as a long-term treatment option for HHD, as well as provide a review of other lasers that have been reported with this goal. A total of 23 patients who had been treated with a carbon dioxide laser were identified. After treatment, 10 patients (43%) had had no recurrence, 10 (43%) had greater than 50% improvement, 2 (8%) had less than 50% improvement and 1 (4%) patient had no improvement at all (follow-up period ranged from 4 to 144 months). Laser parameter variability was wide and adverse effects were minimal, including dyspigmentation and scarring. Reviewed evidence indicates this therapy offers a safe, effective treatment alternative for HHD with minimal risk of side-effects. Larger, well-designed studies are necessary to determine the optimal treatment parameters.
Topics: Carbon Dioxide; Cicatrix; Humans; Lasers, Dye; Lasers, Gas; Lasers, Semiconductor; Lasers, Solid-State; Pemphigus, Benign Familial; Pigmentation Disorders; Recurrence; Treatment Outcome
PubMed: 25418614
DOI: 10.1111/jdv.12875