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Stretch marks (SM) occur in areas of dermal damage, produced by stretching of the skin. In early stages, they are red to pink (striae rubra); over time, they become increasingly atrophic and white (striae alba). Different treatments may be indicated for early (striae rubra) or old (striae alba) SM, but no definite gold standard treatment has been determined. Microdermabrasion has been studied as a treatment for both early and old SM. It induces epidermal and dermal changes through superficial wounding. Another similar treatment, the superficial localized dermabrasion, is a very low-cost procedure that can improve striae rubra after multiple sessions, especially the narrow ones.

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.

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.

Photography is an important tool in dermatology. Reproducing the settings of before photos after interventions allows more accurate evaluation of treatment outcomes. In this article, we describe standardized methods and tips to obtain photographs, both for clinical practice and research procedural dermatology, using common equipment. Standards for the studio, cameras, photographer, patients, and framing are presented in this article.

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.

The purpose of this study was to determine the effect of visible light on the immediate pigmentation and delayed tanning of melanocompetent skin; the results were compared with those induced by long-wavelength UVA (UVA1). Two electromagnetic radiation sources were used to irradiate the lower back of 20 volunteers with skin types IV-VI: UVA1 (340-400 nm) and visible light (400-700 nm). Pigmentation was assessed by visual examination, digital photography with a cross-polarized filter, and diffused reflectance spectroscopy at 7 time points over a 2-week period. Confocal microscopy and skin biopsies for histopathological examination using different stains were carried out. Irradiation was also carried out on skin type II. Results showed that although both UVA1 and visible light can induce pigmentation in skin types IV-VI, pigmentation induced by visible light was darker and more sustained. No pigmentation was observed in skin type II. The quality and quantity of pigment induced by visible light and UVA1 were different. These findings have potential implications on the management of photoaggravated pigmentary disorders, the proper use of sunscreens, and the treatment of depigmented lesions.

Subcision® is a simple surgical technique used for the treatment of cutaneous depressions. It was originally described by Orentreich and Orentreich for the treatment of cutaneous scars and wrinkles in 1995.1 (level of evidence *C) Subsequently, Subcision® was reported for the treatment of cellulite and liposuction sequella by Hexsel and Mazzuco in two series of cases with 462 (*C) and 2323 (*C) patients.3 Subcision® has also been reported for the treatment of atrophic depressed scars4 (*C), acne scars5 (*C), stretch marks6 (*B), and auricular deformities in rabbits7 (*C).

Background/Purpose: Hydroa vacciniforme (HV) is a rare photodermatosis that primarily affects children. It is characterized by photodistributed vesicles that heal with scarring. The purposes of this study are to perform the initial investigation into the effect of HV on quality of life (QoL) and gain insight into disease diagnosis and management. Methods: Using the listserv from a web-based, international HV support group, either the Dermatology Life Quality Index (DLQI) or the Children's DLQI (CDLQI), and an HV-specific questionnaire were administered. Results: Fifteen HV patients participated, nine (60%) males and six (40%) females. Median age at onset was 7 years, and 11/15 (73%) were younger than 18 years. The majority of patients were Caucasian (73%). Children cited life quality as being negatively impacted by an inability to play outdoors while adults noted QoL influences due to limitations on clothing choices. The mean CLDLQI and DLQI scores, 12.1 and 8.5, respectively, suggest a higher negative QoL impact than previously reported indices for generalized eczema, atopic dermatitis, and psoriasis. Conclusion: When compared with other dermatoses, HV appears to have an equal or greater impact on patients' QoL. Dermatologists should be aware of the psychosociologic impact of this disease, especially on young HV patients.

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.

The modern history of phototherapy began in 1801 when the German scientist JW Ritter isolated ultraviolet (UV) radiation. This knowledge was first utilized for dermatological therapeutic purposes in 1893 when Danish dermatologist Finsen used filtered sunlight to treat lupus vulgaris. The first employment of an artificial UV radiation source for the treatment of skin diseases came in 1894 when Lahman in Germany utilized the combination of a carbon arc lamp and a parabolic mirror to successfully treat lupus vulgaris. The transition from heliotherapy to phototherapy was solidified in 1901 when Finsen, who had replaced filtered sunlight with the carbon arc lamp for the treatment of lupus, published his results. Finsen won the Nobel Prize for medicine in 1903 for his work. He is recognized as the founder of modern phototherapy.2 Montgomery was the first to treat vitiligo with phototherapy in 1904 in the form of a Finsen light.3Although phototherapy had been established by this time as a legitimate therapeutic modality for some disorders, the low output of carbon arc lamps limited their usefulness. The journey toward a radiation source capable of higher output began with the development of the quartz lamp by the German Kuch in 1906. The concept of using the quartz lamp for therapeutic purposes was spearheaded by Hagelschmidt in 1911. A quartz lamp with a high UV output was developed by Kromayer in 1912. The greatly increased UV output of this device significantly expanded the range of skin diseases that could be treated with phototherapy.

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