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Medicina (Kaunas, Lithuania) May 2023Laser treatments have become popular in Dermatology. In parallel to technologic development enabling the availability of different laser wavelengths, non-invasive skin...
Laser treatments have become popular in Dermatology. In parallel to technologic development enabling the availability of different laser wavelengths, non-invasive skin imaging techniques, such as reflectance confocal microscopy (RCM), have been used to explore morphologic and qualitative skin characteristics. Specifically, RCM can be applied to cosmetically sensitive skin areas such as the face, without the need for skin biopsies. For these reasons, apart from its current use in skin cancer diagnosis, our systematic review reveals how RCM can be employed in the field of laser treatment monitoring, being particularly suitable for the evaluation of variations in epidermis and dermis, and pigmentary and vascular characteristics of the skin. This systematic review article aims to provide an overview on current applications of RCM laser treatment monitoring, while describing RCM features identified for different applications. Studies on human subjects treated with laser treatments, monitored with RCM, were included in the current systematic review. Five groups of treatments were identified and described: skin rejuvenation, scar tissue, pigmentary disorders, vascular disorders and other. Interestingly, RCM can assist treatments with lasers targeting all chromophores in the skin and exploiting laser induced optical breakdown. Treatment monitoring encompasses assessment at baseline and examination of changes after treatment, therefore revealing details in morphologic alterations underlying different skin conditions and mechanisms of actions of laser therapy, as well as objectify results after treatment.
Topics: Humans; Skin; Skin Neoplasms; Skin Diseases; Pigmentation Disorders; Microscopy, Confocal
PubMed: 37374244
DOI: 10.3390/medicina59061039 -
Journal of Maxillofacial and Oral... Jun 2023Temporomandibular joint ankylosis is a disabling condition which affects joint movements causing difficulty in speech, mastication and hygiene. Over time various... (Review)
Review
BACKGROUND
Temporomandibular joint ankylosis is a disabling condition which affects joint movements causing difficulty in speech, mastication and hygiene. Over time various interposition materials like meniscus, muscle, fascia, skin, cartilage, fat, dura and alloplastic materials have been used for the treatment of ankylosis and improve joint functions.
OBJECTIVE
The objective of this systematic review is to evaluate the effectiveness of dermis fat graft and temporalis myofascial flap as an interpositional material in treatment of temporomandibular joint ankylosis and to compare the effectiveness of the two materials.
MATERIALS AND METHODS
PubMed, Google scholar, and Cochrane library search in combination with hand search of relevant journals were conducted published in English from January 2000 to August 2021. Randomized controlled trials, prospective and retrospective cohort studies were included. Outcome measure included improvement in mouth opening. Risk of bias assessment was assessed using Cochrane risk of bias tool and Newcastle-Ottawa scale.
RESULTS
A total of 144 articles were found from the primary search which on thorough assessment, duplicate and exclusion removal resulted in 9 cohort studies and 1 randomized controlled trial that fulfilled the inclusion criteria. All the studies included reported significant improvement in mouth opening after interposition of the 2 materials. Four studies compared temporalis myofascial flap with dermis fat graft, 2 studies reported dermis fat graft gives better outcomes, whereas 1 study reported temporalis myofascial flap to be better and 1 study has been inconclusive.
CONCLUSION
Definitive conclusions cannot be drawn as there are number of limitations in the studies included. However a general consensus has been toward dermis fat graft owing to fewer complications.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s12663-023-01869-9.
PubMed: 37122786
DOI: 10.1007/s12663-023-01869-9 -
Journal of Cranio-maxillo-facial... Mar 2023This systematic review aims to compare different fat-grafting techniques for cleft lip and palate repair. A search was conducted in PubMed, Embase, Cochrane Library,... (Review)
Review
This systematic review aims to compare different fat-grafting techniques for cleft lip and palate repair. A search was conducted in PubMed, Embase, Cochrane Library, gray literature and reference lists of selected articles. A total of 25 articles were included, 12 on closure of palatal fistula and 13 on cleft lip repair. The rate of complete resolution of palatal fistula ranged from 88.6% to 100% in studies with no control group, whereas in comparative studies patients receiving a fat graft showed better outcomes than those not receiving a graft. Evidence suggests that fat grafting can be indicated for the primary and secondary repair of cleft palate, with good results. The use of dermis-fat grafts in lip repair was associated with gains in surface area (11.5%), vertical height (18.5%-27.11%), and lip projection (20%). Fat infiltration was associated with increased lip volume (6.5%), vermilion show (31.68% ± 24.03%), and lip projection (46.71% ± 31.3%). The available literature suggests that fat grafting is a promising autogenous option for palate and fistula repair and for improvement of lip projection and scar aesthetics in patients with cleft. However, to develop a guideline, further studies are needed to confirm whether one technique is superior to the other.
Topics: Humans; Cleft Lip; Cleft Palate; Esthetics, Dental; Adipose Tissue; Retrospective Studies
PubMed: 37032224
DOI: 10.1016/j.jcms.2023.01.019 -
Surgery Jun 2023Dermatofibrosarcoma protuberans is a rare, slow-growing soft-tissue malignancy originating in the dermis that is characterized by an infiltrating growth pattern with a... (Review)
Review
BACKGROUND
Dermatofibrosarcoma protuberans is a rare, slow-growing soft-tissue malignancy originating in the dermis that is characterized by an infiltrating growth pattern with a marked tendency of local recurrence. Complete surgical resection with pathological margin clearance must be achieved to reduce the risk of tumor recurrence. Resulting defects often require extensive reconstructive procedures. Dermatofibrosarcoma protuberans of the scalp poses particular challenges owing to the proximity to the face and brain. This study aims to evaluate treatment options and proposes an algorithm for management of scalp dermatofibrosarcoma protuberans based on a multicentric case series and systematic review of the literature.
METHODS
A retrospective multicentric chart analysis of 11 patients with scalp dermatofibrosarcoma protuberans who presented within the last 20 years was performed regarding demographic data, pathological tumor characteristics, and surgical management (resection and reconstruction). Additionally, a further 42 patients (44 cases) were identified through a systematic Preferred Reporting Systems for Systematic Reviews and Meta-Analysis-based review of the literature searching the Medline and Embase databases.
RESULTS
In total, 30 cases were classified as primary and 20 cases as recurring scalp dermatofibrosarcoma protuberans (data from 5 cases were missing). The median tumor size was 24 cm (interquartile range 7.8-64), and the median defect size was 55.8 cm (interquartile range 48-112). Recurring scalp dermatofibrosarcoma protuberans was more often associated with invasion of deeper layers and required more extensive tumor resection to achieve negative margins. Within the subgroup that was managed with peripheral and deep en face margin assessment, no recurrence was observed. Most patients required local (41. 8%) or free flap (27.8%) reconstruction after dermatofibrosarcoma protuberans resection.
CONCLUSION
Whenever possible, peripheral and deep en face margin assessment-based techniques should be preferred for resection of scalp dermatofibrosarcoma protuberans because they provide superior oncological safety while preserving uninvolved tissue. Patients with locally advanced and recurring scalp dermatofibrosarcoma protuberans often require multidisciplinary treatment including neurosurgery, radiotherapy, and microvascular reconstructive surgery and should be referred to a specialized center.
Topics: Humans; Dermatofibrosarcoma; Neoplasm Recurrence, Local; Retrospective Studies; Scalp; Skin Neoplasms
PubMed: 37012145
DOI: 10.1016/j.surg.2023.02.026 -
Aesthetic Plastic Surgery Aug 2023There is a paucity of evidence comparing the safety of prepectoral and partial subpectoral implant-based breast reconstruction using acellular dermal matrices (ADM). We... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
There is a paucity of evidence comparing the safety of prepectoral and partial subpectoral implant-based breast reconstruction using acellular dermal matrices (ADM). We performed a meta-analysis to evaluate the postoperative complications of the two approaches.
METHODS
PubMed, EMBASE, Web of Science and Cochrane Library were searched to retrieve relevant articles. The rates of the complications were, respectively, pooled, and relative risk (RR) was estimated with 95% confidence intervals (CIs) to compare the incidence between the two cohorts.
RESULTS
Ten articles reporting on 2667 breast reconstructions were eligible. The hematoma rate was lower in the prepectoral group (RR = 0.590, 95% CI 0.351-0.992). No significant difference was observed in terms of seroma (RR = 1.079, 95% CI 0.489-2.381), skin flap necrosis (RR = 0.936, 95% CI 0.587-1.493), infection (RR = 0.985, 95% CI 0.706-1.375), tissue expander/implant explantation (RR = 0.741, 95% CI 0.506-1.085), wound dehiscence (RR = 1.272, 95% CI 0.605-2.673), capsular contracture (RR = 0.939, 95% CI 0.678-1.300) and rippling (RR = 2.485, 95% CI 0.986-6.261). The RR of animation deformity for the prepectoral group compared with the subpectoral group was 0.040 (95% CI, 0.002-0.853).
CONCLUSIONS
This systematic review suggested that with appropriate patient selection, prepectoral breast reconstruction could avoid animation deformity without incurring higher risk of early wound complications, capsular contracture or rippling than partial subpectoral breast reconstruction. Plastic surgeons should complete a comprehensive assessment of the patients before choosing appropriate surgical approaches in clinical practice.
LEVEL OF EVIDENCE III
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Topics: Humans; Female; Breast Implants; Acellular Dermis; Mammaplasty; Postoperative Complications; Contracture; Breast Implantation; Breast Neoplasms; Retrospective Studies
PubMed: 36947180
DOI: 10.1007/s00266-023-03296-0 -
Dermatology Practical & Conceptual Nov 2022Several studies investigated the use of dermoscopy in the delineation of basal cell carcinoma (BCC) for Mohs micrographic surgery (MMS) with conflicting results. (Review)
Review
INTRODUCTION
Several studies investigated the use of dermoscopy in the delineation of basal cell carcinoma (BCC) for Mohs micrographic surgery (MMS) with conflicting results.
OBJECTIVES
The purpose of this systematic review with meta-analysis was to evaluate the effectiveness of the use of dermoscopy-guided MMS in the treatment of BCC.
METHODS
We included all comparative studies. Cases of BCC treated using dermoscopy-guided MMS (or slow MMS) were compared to those treated with curettage-guided MMS or "standard" MMS.
RESULTS
A total of 6 studies including 508 BCCs were reviewed. There was no statistically significant difference in the proportion of total margin clearance on the first MMS stage between BCCs removed using dermoscopy-guided MMS and those that had curettage or visual inspection. However, lateral margin involvement was significantly lower in BCCs that had dermoscopy-guided MMS.
CONCLUSIONS
Dermoscopy allows visualization of structures up to 1mm into the dermis. Therefore, it is rational to use it for lateral margin evaluation. Currently, there are two comparative studies showing the efficacy of dermoscopy for lateral margin evaluation during MMS. Future studies are required to develop an evidence-based recommendation regarding the utility of dermoscopy in MMS.
PubMed: 36534540
DOI: 10.5826/dpc.1204a176 -
Chemosphere Feb 2023The various ingredients and impurities that can be detected within tattoo inks have been associated with a myriad of dermatologic complications. Legislation regarding... (Meta-Analysis)
Meta-Analysis Review
The various ingredients and impurities that can be detected within tattoo inks have been associated with a myriad of dermatologic complications. Legislation regarding these antigenic substances varies widely around the world, with Europe serving as both the research and regulatory center on these intradermal formulations. Although industry is said to be moving away from metallic and metalloid pigments in exchange for organic or organometallic dyes, surveys of commercially available inks continue to detect these elements at concentrations considered unsafe for application into the dermis. In order to better assess the formulation and safety of tattoo ink, we present a systematic review and meta-analysis of studies quantifying restricted metals and metalloids in commercially available tattoo ink products. Among the papers selected, inconsistencies were noted in the degree of specificity by which ink products were identified and the elements sampled for. In addition, the analytical targets' valency and/or solubility were not always considered in accordance with regulation criteria. Of note, chromium, by total content and that of its regulated +6 valency, exceeded its maximum allowed concentration in nearly every sample tested. Total copper content exceeded the limit for soluble copper in half of inks sampled. In descending order, concentrations of cadmium, barium, mercury, soluble copper, arsenic, zinc, antimony, and lead violated regulations in one-sixth or fewer of samples tested. Cobalt and tin levels never violated regulation. Overall, our findings indicate that unsafe levels of restricted elements continue to be detected across studies, warranting further investigation under a regulatory lens.
Topics: Tattooing; Ink; Copper; Metalloids; Metals; Coloring Agents
PubMed: 36436582
DOI: 10.1016/j.chemosphere.2022.137291 -
The Annals of Pharmacotherapy Aug 2023This article reviews clinical trials to assess the efficacy, safety, and clinical application of once-daily roflumilast 0.3% cream for the treatment of plaque psoriasis. (Review)
Review
OBJECTIVE
This article reviews clinical trials to assess the efficacy, safety, and clinical application of once-daily roflumilast 0.3% cream for the treatment of plaque psoriasis.
DATA SOURCES
A systematic review of the literature was performed using the terms OR OR in MEDLINE (PubMed) and EMBASE databases between January 2012 and October 2022. Bibliographies and the ClinicalTrials.gov website were also searched to identify further studies.
STUDY SELECTION AND DATA EXTRACTION
Studies written in English and relevant to pharmacology, clinical trials, and safety were considered for inclusion.
DATA SYNTHESIS
In two 8-week phase III clinical trials, disease severity as assessed by a score of "clear" or "almost clear" and a 2-point improvement on Investigator Global Assessment (IGA) was 42.4% and 37.5% at week 8 in DERMIS-1 and DERMIS-2, respectively, compared to 6.1% and 6.9% in the control groups. In the 52-week phase III trial, treatment success rates for plaque psoriasis and intertriginous psoriasis were similar to the 8-week data with 45% of patients in the treatment group were evaluated as an IGA of "clear" or "almost clear" at week 52.
RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE IN COMPARISON TO EXISTING DRUGS
Roflumilast is a new US Food and Drug Administration (FDA)-approved topical phosphodiesterase inhibitor that shows promise for the treatment of mild-severe plaque psoriasis. It is an effective and safe topical nonsteroidal alternative to currently available topical corticosteroids, but there are currently no comparative studies with other psoriasis treatments.
CONCLUSION
Roflumilast is effective and safe for the treatment of plaque psoriasis and intertriginous psoriasis. Future trials should compare its efficacy and tolerability with that of the older, clinically established topical corticosteroids. Prohibitive factors may include limited patient adherence to topical treatments and cost.
Topics: Humans; Adrenal Cortex Hormones; Aminopyridines; Dermatologic Agents; Immunoglobulin A; Psoriasis; Severity of Illness Index; Treatment Outcome; Clinical Trials as Topic
PubMed: 36420929
DOI: 10.1177/10600280221137750 -
International Journal of Environmental... Oct 2022The present review aimed to systematically review skin toxicity changes following breast cancer radiotherapy (RT) using ultrasound (US). PubMed and Scopus databases were... (Review)
Review
The present review aimed to systematically review skin toxicity changes following breast cancer radiotherapy (RT) using ultrasound (US). PubMed and Scopus databases were searched according to PRISMA guidelines. The characteristics of the selected studies, measured parameters, US skin findings, and their association with clinical assessments were extracted. Seventeen studies were included with a median sample size of 29 (range 11-166). There were significant US skin changes in the irradiated skin compared to the nonirradiated skin or baseline measurements. The most observed change is skin thickening secondary to radiation-induced oedema, except one study found skin thinning after pure postmastectomy RT. However, eight studies reported skin thickening predated RT attributed to axillary surgery. Four studies used US radiofrequency (RF) signals and found a decrease in the hypodermis's Pearson correlation coefficient (PCC). Three studies reported decreased dermal echogenicity and poor visibility of the dermis-subcutaneous fat boundary (statistically analysed by one report). The present review revealed significant ultrasonographic skin toxicity changes in the irradiated skin most commonly skin thickening. However, further studies with large cohorts, appropriate US protocol, and baseline evaluation are needed. Measuring other US skin parameters and statistically evaluating the degree of the association with clinical assessments are also encouraged.
Topics: Humans; Female; Breast Neoplasms; Mastectomy; Breast; Skin Diseases; Skin
PubMed: 36294025
DOI: 10.3390/ijerph192013439 -
Annals of Palliative Medicine Jul 2022The efficacy and safety between connective tissue graft (CTG) and acellular dermal matrix (ADM) remain inconsistent. Meta-analysis is a valuable approach to resolve... (Meta-Analysis)
Meta-Analysis
Efficacy and safety of acellular dermal matrix versus connective tissue graft for root coverage of Miller's Class I and II gingival recession: a systematic review and meta-analysis.
BACKGROUND
The efficacy and safety between connective tissue graft (CTG) and acellular dermal matrix (ADM) remain inconsistent. Meta-analysis is a valuable approach to resolve inconsistencies across studies and provide a high level of evidence to comprehensively evaluate the effect and safety of ADM versus CTG for root coverage of Miller's Class I and II gingival recession. Our study was conducted to comprehensively analyze the efficacy and safety of ADM versus CTG for root coverage in patients with gingival recession.
METHODS
Articles on randomized controlled trials (RCTs) that compared the ADM with CTG for adult patients with the gingival recession in terms of percent root coverage (PRC), clinical attachment level (CAL), keratinized tissue (KT), probing depth (PD), recession width (RW), and recession depth (RD) were identified in PubMed, Embase, Cochrane Library, and Web of Science databases until 15 May 2020. Weighted mean difference (WMD) was used as the statistic for measurement data and the effect sizes were expressed as 95% confidence intervals (CIs).
RESULTS
A total of 24 RCTs were eligible for the final analysis. A total of 587 patients with 1,315 gingival recession sites were involved in the study. There were 724 loci in the ADM group and 591 loci in the CTG group. The patients who underwent ADM had a higher gain in CAL (WMD: 0.25, 95% CI: 0.03 to 0.47, P=0.026) but a smaller gain in KT width (WMD: -0.44, 95% CI: -0.63 to -0.25, P<0.001) than those who underwent CTG. No significant differences were found between the patients who underwent ADM and those who received CTG in PRC (WMD: -1.61, 95% CI: -3.49 to 0.28, P=0.094), PD (WMD: 0.07, 95% CI: -0.01 to 0.14, P=0.067), RW (WMD: 0.07, 95% CI: -0.10 to 0.23, P=0.437), and RD (WMD: 0.11, 95% CI: -0.10 to 0.31, P=0.294).
DISCUSSION
The ADM treatment for patients with gingival recession may be superior to CTG in gaining CAL, but CTG has a significant advantage over ADM for gaining KT width. ADM can be considered in the future as a treatment for root coverage in patients with gingival recession.
Topics: Acellular Dermis; Adult; Connective Tissue; Gingiva; Gingival Recession; Humans; Surgical Flaps; Treatment Outcome
PubMed: 35927781
DOI: 10.21037/apm-22-656