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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

Background Post-inflammatory hyperpigmentation is a frequent concern when treating solar lentigines. Objectives To assess the safety and efficacy of a triple combination cream with fluocinolone acetonide 0.01%, hydroquinone 4% and tretinoin 0.05% as adjuvant to cryotherapy in the treatment of solar lentigines in hands dorsum, and in the prevention of post-inflammatory hyperpigmentation after cryotherapy. Methods This prospective, randomized, controlled, investigator-blinded, single-centre study enrolled 50 patients. Twenty-five patients received a 2-week daily triple combination cream plus sunscreen pre-treatment and 25 received sunscreen alone. After that, cryotherapy was performed in all patients followed by a 3-week recovery period. After this period, patients received the same initial treatment and were followed up for 8 weeks. Melanin and erythema levels of a target and a control lentigo were objectively measured using a narrowband reflectance spectrophotometer. Lentigines count, colour homogeneity and global improvement were also assessed. Results The number of solar lentigines reduced in the first 2 weeks only in patients who used the triple combination 25 7 vs. 22 8( P < 0.0001), and reduced at the end of the study for both groups (P < 0.0001). The melanin levels also reduced in the first 2 weeks only in patients who used the triple combination 297 69 vs. 273 66 (P < 0.0001) and reduced at the end of the study for both groups (P < 0.0001). Erythema and residual blisters from cryotherapy were the reported adverse reactions. Conclusion Triple combination cream can be used to enhance the resolution of solar lentigines, and to significantly reduce melanin levels and lentigines count, improving treatment results. It was well-tolerated and did not increase the occurrence of neither erythema nor other side-effects after the cryotherapy.

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.

BACKGROUND The determination of the action halos of botulinum toxin type A aids in targeting specific muscles and/or sweat glands, thereby preventing the occurrence of side effects. OBJECTIVES The objective of this study was to compare the action halos of two commercial preparations of botulinum toxin type A, Dysport (Ipsen, Slough, UK) and BOTOX (Allergan, Irvine, CA). MATERIAL AND METHODS Eighteen volunteers received applications of both products into randomized sides of the frontalis muscle. Equivalent doses of 5U of Dysport and 2U of BOTOX were injected using the same technique, in the same volume (0.02mL), and at a controlled depth. Twenty-eight days later, clinical and photographic assessments were performed. RESULTS All the areas around the injected points were regular, round, or slightly oval and showed similar effects in the muscles and sweat glands. No statistically significant differences were observed between the mean sizes of the diameters of the halos produced by the two products. CONCLUSION Injections of Dysport and BOTOX at an equivalence ratio of 2.5:1U, respectively, applied at the same volume and depth, using the same technique resulted in similar action halos with regard to muscular and sweat gland activity. Both products seem to be safe and very predictable.

BACKGROUND There are numerous blades available for use in dermatologic procedures. There are different advantages that are inhere.nt to different blades due to their shape and size. One aspect of the blade that is instrumental to its performance, but is not objectively defined, is sharpness. This information could be useful when choosing a blade for a particular procedure. OBJECTIVE This study aims to objectively define the sharpness of blades used in dermatologic surgery. METHODS AND MATERIALS The Sharpness Tester (Cutlery and Allied Trades Research Association, Sheffield, UK) was used to test the force in Newtons a blade requires to cut through a silicone cylinder. New blades were used to determine a standard for the sharpness of new blades. Blades used for surgery were tested to determine the sharpness after use. RESULTS The sharpest blade is the double-edged razor blade (0.395 N) followed by the dermablade (0.46 N), plastic handled #15 (0.541 N), #15c (0.575 N), #10 (0.647 N), and the #15 blade (0.664 N). CONCLUSION The sharpness of a blade is an important factor in its ability to perform a task and should be taken into account when choosing a particular blade for a particular procedure.

Granuloma annulare (GA) is a benign idiopathic inflammatory condition without a consistently reliable treatment. We describe a case of GA with near-complete resolution after treatment with fractional photothermolysis using a 1,550-nm erbiumdoped yttrium aluminum garnet (Er:YAG) fractionated laser. GA is characterized by skin-colored to erythematous papules, classically with an annular configuration. There is a female predominance, with women twice as likely to be affected. Various clinical patterns are described, including localized, generalized, subcutaneous, macular, and perforating variants. Most cases of localized GA are self-limited; generalized cases tend to have more prolonged courses. Two histologic patterns are generally observed. The more common is an interstitial pattern of histiocytes scattered between collagen bundles. The second appearance is a palisading granuloma with histiocytes and lymphocytes surrounding a central area of collagen degeneration. With regard to management, there is no established treatment of choice, and observation alone is acceptable in many cases, given the benign and often self-limited course.

Medical grade liquid injectable silicone can be used for soft tissue augmentation to correct and replace lost volumes of the subcutaneous tissue. It is potentially a permanent tissue augmentation agent and is the most effective filler for certain indications. This article presents the history, mechanism of action, indications and contraindications, technique, and the possible complications of silicone and their treatment.

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