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ellulite is characterized by alterations to the skinsurface of the affected areas, giving an orangepeel, cottage cheese, or mattress-like appearance.Depressed lesions are the most frequent and occurbecauseofthepresenceoffibrousseptapullingtheskindown, whereasraised areas resultfrom the projectionof underlying fat to the skin surface. These lesionsaffect mainly women after puberty, and on theposterior upper thighs and buttocks.With the aging process, the skin becomeshyperdistended and loose, resulting in a drapedappearance, and consequently worsening all cellulitelesions. Skin laxity is a significant aggravating factorof cellulite, commonly seen in patients after thefourth decade of life, sometimes earlier. Hexsel andcolleagues

Botulinum neurotoxin type A injection to correct and/or reverse the physical effects of aging process has become one of the most frequently requested cosmetic procedures at an outpatient setting. Careful clinical evaluation together with proper use of the techniques, including pre- and post-procedures recommendations, reconstitution of the products, techniques, and doses, are described in this article. This article also covers the main indications of botulinum neurotoxin type A for aging face and other aesthetic uses, as well as some possible adverse reactions and their management.

Hidradenitis suppurativa (HS) is a chronic inflammatory disease involving the intertriginous areas.We sought to conduct clinical and histopathologic evaluation of the efficacy of long-pulsed neodymium:yttrium-aluminium-garnet laser treatment for HS.We conducted a prospective, randomized, right-left within-patient controlled trial for HS (n = 22). Four monthly laser sessions were performed. Disease activity was measured at baseline, and treatment response was assessed before each laser session and monthly for 2 months after the completion of laser treatment, using a modified scoring system based on Sartorius score. Histologic examination was performed at baseline, immediately after laser treatment, and at 1 and 4 weeks after treatment. A patient questionnaire was circulated on the last visit to assess patients' level of satisfaction.There was progressive improvement in disease activity, most significantly during the 4 months of treatment, which was maintained during the 2-month posttreatment follow-up period. Averaged over all anatomic sites, the percent improvement was 72.7% on the laser treated side, and 22.9% on the control side (P.05). Histologic examination showed an initial acute neutrophilic infiltrate. Granulomatous inflammation was present on follow-up biopsy specimens 4 weeks later. An inflammatory infiltrate surrounded the hair shaft remnants, denoting destruction of hair follicles.Small sample size was a limitation.Long-pulsed neodymium:yttrium-aluminium-garnet laser, together with topical benzoyl peroxide and clindamycin, is significantly more effective than topical benzoyl peroxide and clindamycin alone for the treatment of HS. Preliminary review of histopathology suggests the mechanism of action is destruction of the hair follicle. The overall success of the treatment in both clearing pre-existing lesions and preventing new eruptions, coupled with high patient satisfaction, makes the neodymium:yttrium-aluminium-garnet laser a promising treatment advance for this highly disabling condition.

Hidradenitis suppurativa (HS) is a chronic suppurative condition for which there is limited efficacy of medical and surgical treatments.To assess whether the 1,064-nm neodymium-doped yttrium aluminium garnet (Nd:YAG) laser is an effective treatment for HS.Prospective, randomized, controlled study for patients with stage II to III HS disease (n=22). A series of 3 monthly laser sessions were performed. Treatment response was measured before each laser session and 1 month after the completion of laser treatment (HS Lesion, Area, and Severity Index (HS-LASI) scale). A modification was made to include symptoms (erythema, edema, pain, and purulent discharge; modified HS-LASI, 0-3 scale).The percentage change in HS severity after 3 months of treatment was -65.3% over all anatomic sites, -73.4% inguinal, -62.0% axillary, and -53.1% inframammary. For all anatomic sites combined and each individual anatomic site, the change in HS severity from baseline to month 3 was statistically significant at the treated sites (p.02 for modified HS-LASI and HS-LASI) but not at the control sites (p.05 for modified HS-LASI and HS-LASI).The long-pulse Nd:YAG laser is effective for treatment of HS. The effectiveness of Nd:YAG laser, a hair epilation device, supports the primary follicular pathogenesis of the condition.

The Food and Drug Administration (FDA) regulates sunscreens as over-the-counter drugs. This article describes sunscreen actives available in the United States, new developments available elsewhere, and the amendment to the FDA 1999 sunscreen monograph, released on August 27, 2007, which proposes a new grading system for ultraviolet B protection, a cap of the sunburn protection factor to 50+, and a 4-star grading of ultraviolet A protection. In addition, current data on combination sunscreen and insect repellent products are discussed. Application of a combination product too frequently poses the risk of insect repellent toxicity, whereas application too infrequently invites photodamage. It may be prudent to follow the same approach of our Canadian colleagues of discontinuing combination products until more investigations are available.

Electromagnetic radiation has vast and diverse effects on human skin. Although photobiologic studies of sunlight date back to Sir Isaac Newton in 1671, most available studies focus on the UV radiation part of the spectrum. The effects of visible light and infrared radiation have not been, until recently, clearly elucidated. The goal of this review is to highlight the effects of visible light on the skin. As a result of advances in the understanding of skin optics, and comprehensive studies regarding the absorption spectrum of endogenous and exogenous skin chromophores, various biologic effects have been shown to be exerted by visible light radiation including erythema, pigmentation, thermal damage and free radical production. It has also been shown that visible light can induce indirect DNA damage through the generation of reactive oxygen species. Furthermore, a number of photodermatoses have an action spectrum in the visible light range, even though most of the currently available sunscreens offer, if any, weak protection against visible light. Conversely, because of its cutaneous biologic effects, visible light is used for the treatment of a variety of skin diseases and esthetic conditions in the form of lasers, intense pulsed light and photodynamic therapy.

With recent advances in the treatment of cellulite and localized fat, a comprehensive objective method of measuring cellulite can be potentially useful, especially since important morphological aspects of cellulite are not part of the current classification. Objective To develop and to validate a new photonumeric cellulite severity.Based on standardized photographs of 55 patients with cellulite, five key morphological aspects of cellulite were identified. A new photonumeric severity scale was developed and validated.The five key morphological features of cellulite were identified and included the number of depressions, depth of depressions, clinical appearance of evident raised lesions, and presence of flaccidity and the grade of cellulite. Each item was graded from 0 to 3, allowing final classification of cellulite as mild, moderate, and severe. Results for validation of the scale are statistically significant (P0.05) and are as follows: intraclass correlation coefficient0.7; correlation item-total0.7, with the exception of the right buttock; intraclass correlation coefficients 0.881-0.922; Cronbach's alpha 0.851-0.989 and factor analysis 68-76%.The proposed photonumeric scale is a consistent, comprehensive, reliable, and reproducible tool for the standardized and objective assessment of the severity of cellulite. Conflicts of interest The authors hereby affirm that neither the manuscript nor any part of it has been published or is being considered for publication elsewhere.

Importance This article provides new data on a controversial issue, the influence of doses on the diffusion characteristics of 2 botulinum toxins type A. Objective To assess the fields of effect of abobotulinumtoxinA and onabotulinumtoxinA at the same labeled unit dose (1:1 U) comparing sweat gland and muscle activity. Design, Setting, and Participants A prospective, single-center, randomized, double-blind study was conducted at the Brazilian Center for Studies in Dermatology in Porto Alegre, Brazil. The participants included 19 women. Interventions Each patient received 2 U of abobotulinumtoxinA on one side of the forehead and 2 U of onabotulinumtoxinA on the other side. Main Outcomes and Measures Horizontal and vertical diameter and area of the fields of anhidrotic effect, the amplitude of evoked compound muscle action potentials, and the 4-point validated Wrinkle Severity Scale were assessed at 28 days. Results The horizontal and vertical diameters of the fields of effect and the areas were significantly larger for onabotulinumtoxinA than those obtained for abobotulinumtoxinA. There were no significant differences between the products in the Wrinkle Severity Scale scores and Evoked Compound Muscle Action Potentials. OnabotulinumtoxinA had significantly more diffusion than abobotulinumtoxinA when isovolumetric injections of the same labeled unit dose of the products were injected. Conclusions and Relevance Although many studies state that diffusion is product dependent and abobotulinumtoxinA diffuses more than onabotulinumtoxinA, findings from the present study confirm that diffusion is dose dependent and the more potent dose tested diffuses more. Trial Registration clinicaltrials.gov Identifier:NCT01732809