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Background: Hyaluronic acid (HA)-based fillers are effective at mitigating acne scars due to their filling effect. Complexes of high and low molecular weight HA demonstrated a delayed biostimulatory effect., Objective: The authors sought to compare the results of acne scar treatment using a filler composed of complexes of high and low molecular weight HA versus a traditional cross-linking HA filler., Methods: Thirty patients with moderate-to-severe atrophic acne scarring were included in this prospective, split-face, double-blinded, randomized controlled study. Each underwent 3 monthly injections of a novel formula of combined high and low molecular weight HA (P) to the base of acne scars on 1 side of the face and traditional cross-linking HA (JV) filler on the other. Patients were evaluated 6 months after their last treatment for objective and subjective improvements., Results: For JV, statistically significant reductions were observed in the acne scar volume but nearly no change in elasticity and stretch during early treatments. For P, no significant differences were observed in early treatments; however, statistically significant improvements were observed in later visits., Conclusion: Although the traditional JV filler demonstrated an earlier impact than P, the latter produced delayed positive changes that were more pronounced than the traditional filler., Competing Interests: The authors have no conflict of interest to declare., (Copyright © 2023 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Netherton syndrome (NS) is a rare disorder of cornification associated with high morbidity. It is caused by bi-allelic mutations in SPINK5 encoding the serine protease inhibitor LEKTI. Previous studies have shown Th17 skewing with IL-23 upregulation in NS, raising the possibility that targeting these inflammatory pathways may alleviate disease manifestations. We ascertained the therapeutic efficacy of six doses of ustekinumab administered to three patients with NS over a period of 13 months using the Ichthyosis Area and Severity Index (IASI), the Dermatology Life Quality Index (DLQI), a visual analogue scale (VAS) for itch and the peak-pruritus numeric rating scale (PP-NRS). Histopathology analysis including CD3, CD4, CD8 and interleukin 17 (IL-17) immunostaining, was performed at baseline and 4 weeks following the last ustekinumab dose. Total IASI scores were reduced by 28% in two patients at week 16 with sustained response by week 56. No consistent improvement in DLQI, VAS for itch and PP-NRS scores was observed. The inflammatory infiltrate and the degree of acanthosis were slightly reduced at week 56 as compared to baseline. No significant change in immunostaining of the various inflammatory markers was observed at week 56. In conclusion, this case series did not demonstrate a significant therapeutic effect of ustekinumab in NS., (© 2022 Japanese Dermatological Association.)

Competing Interests: Conflicts of interest None disclosed.

Background: Current approaches for assessment of acne scars are subjective, including counting scar subtypes, subjective self-assessment, or scoring global acne scar severity., Aims: We aimed to validate accuracy and present initial data of a new, simple, non-contact, high-resolution 3D stereoscopic optical imaging system in the setting of acne scarring., Patients/methods: Ten patients treated for acne scars in the dermo-esthetic outpatient clinics in our institution from July to December 2019 were recruited from medical files and completed by telephone interview. Each patient was assessed by the 3D imaging system, the Qualitative Scarring Grading Score (QSGS), and the patient's questionnaire for Self-assessment of Clinical Acne-Related Scars (SCARS) before and 4 weeks after a single intervention., Results: Scar depth measured by the imaging system correlated significantly with the actual depth of printed surface depressions and the 3D optical imaging assessments. The changes in SCARS and 3D optical imaging assessments correlated significantly, but there were no correlations between changes in QSGS and 3D optical assessment measures, or between the QSGS and SCARS results., Conclusion: The new stereoscopic optical system is a reliable and practical objective method for assessing the cumulative depth of atrophic acne scars and monitoring treatment response. It is more sensitive, accurate, and informative than subjective scales., (© 2021 Wiley Periodicals LLC.)

Background: The Chemical Reconstruction of Skin Scars (CROSS) technique was first described in 2002 and has since demonstrated safety and efficacy in multiple studies. We describe the treatment of six patients with a modified version of the CROSS method-the Painting CROSS trichloroacetic acid (TCA) technique. This technique has the advantage of offering even higher tissue selectivity and better control of the scar edges, enhancing both safety and efficacy., Methods: We retrospectively evaluated 31 scars of six patients who underwent a single treatment by the Painting CROSS TCA method. A 0.3 ml insulin syringe with a 30-gauge needle was filled with 0.05 ml of 85% TCA solution and then applied to the scar base with slight pressure until frosting was achieved. Patients were evaluated before and 3 months after treatment for scar volume deficit by a high-resolution three-dimensional imaging system., Results: The average volume of the 31 scars assessed in our study was 2.71 mm 3 before treatment and 1.96 mm 3 after treatment. There was a 26.3% average decrease in the volume of the scars after one treatment. Transient mild hyperpigmentation was noted in two patients after the treatment., Conclusion: Painting CROSS TCA technique has demonstrated efficacy in the treatment of acne scars after a single treatment., (© 2021 Wiley Periodicals LLC.)

Background: Melasma is a complex and poorly understood disorder, with high rates of treatment failure and recurrences., Objectives: We aimed to review the current knowledge of the pathogenesis of melasma and apply this knowledge to clinical implications on relevant therapeutic interventions., Methods: A systematic PubMed search was performed using the search term "((melasma[Text Word]) OR facial melanosis[Text Word]) AND (pathogenesis OR causality[MeSH Terms])" for articles published between 1990 and 2020. Included articles were then evaluated by two authors and assessed for relevant pathomechanistic pathways, after which they were divided into groups with minimal overlap. We then reviewed current treatment modalities for melasma and divided them according to the involved pathomechanistic pathway., Results: A total of 309 search results were retrieved among which 76 relevant articles were identified and reviewed. Five main pathomechanisms observed in melasma were identified: (1) melanocyte inappropriate activation; (2) aggregation of melanin and melanosomes in dermis and epidermis; (3a) increased mast cell count and (3b) solar elastosis; (4) altered basement membrane; and (5) increased vascularization. Treatment modalities were then divided based on these five pathways and detailed in 6 relevant tables., Conclusion: The pathophysiology of melasma is multifactorial, resulting in treatment resistance and high recurrence rates. This wide variety of pathomechanisms should ideally be addressed separately in the treatment regimen in order to maximize results., (© 2021 Wiley Periodicals LLC.)

Background: Acne vulgaris is common dermatologic condition with an estimated prevalence of 80%. Acne has been shown to have a significant impact on patient quality of life and mental health, especially as inflammatory lesions typically occur on cosmetically sensitive areas with the potential for permanent scarring. There have been numerous advances in the treatment of inflammatory acne with light-based and laser devices. This technology permits effective treatment of active acne and scarring, with a short recovery and a decreased side effect profile as compared to medicinal standard-of-care and photodynamic therapies., Objective: The case series study was aimed at evaluating the safety and efficacy of a 1064 nm Nd: YAG Quasi-longed pulse laser treatment for acne vulgaris., Methods: This was a prospective study of 19 subjects with moderate to severe. All subjects received 1064 nm Nd: YAG Quasi-longed pulse laser treatments, at 8 J/cm 2 fluence and accumulated 1000-4000 kJ according to treatment area at two weeks intervals. Primary end point was reaching a minimal AGSS score of between 1 and 2. Acne severity was assessed by two independent dermatologists according to AGSS scale before each treatment session and at the follow-up visit (8 weeks following last treatment). Subjects' self-assessment of Patient Global Impression of Change (PGIC) and overall satisfaction were also recorded. Safety was assessed by recording pain, adverse events, and downtime throughout the trial., Results: Investigator's US FDA AGSS scoring of acne appearance improvement shows an average of 6.6 treatments were required to reach the minimal AGSS score endpoint. Significant reduction in AGSS scores was recorded after 2 treatments (4.21 ± 0.65 vs 3.05 ± 0.83 p = 1.63E -05 ), and maintained a statistically significant reduction rate throughout the trial. Minimal AGSS scores were still detected after 8 weeks following final treatment. Subjects scored high satisfaction rates and PGIC scores (2.9 and 5.3, respectively). Some patients reported transient erythema as only adverse events recorded in the study., Conclusion: The 1064 nm Nd: YAG Quasi-longed pulse laser was found to be safe and highly effective for the treatment of facial acne. The treatments were well tolerated, and the subjects experienced no pain and no downtime. Light-based treatments do and will probably continue to play an important and enlarging role in acne management., (© 2021 Wiley Periodicals LLC.)

Background: The starch iodine test (SIT) is the gold-standard diagnostic tool for primary palmar hyperhidrosis (PPH)., Objective: This study aimed to evaluate the clinical effectiveness and safety profile of a novel approach for the detection of PPH by moisture response films (MRF) in comparison to the SIT., Methods: This prospective comparative study of the 2 tests was conducted on 17 patients with PPH. Disease severity was evaluated by the SIT and the MRF methods during 4 sessions (twice before and twice after botulinum toxin [BTX] injections) on different days and by different investigators. The physician's global assessment (PGA) scoring of the comparable visual results was evaluated by 2 blinded independent dermatologists. The Hyperhidrosis Disease Severity Scale (HDSS) scores of the patients at baseline and after the BTX injections were correlated with the SIT and MRF results., Results: The objective PGA scoring of the SIT results demonstrated poor correlation, whereas the objective PGA scoring of the MRF results correlated highly with the patients' HDSS scores both at baseline and after the BTX injections., Conclusion: Analysis of palmar hyperhidrosis by means of MRF was superior to SIT and was demonstrated to be more efficient, convenient, and accurate., (Copyright © 2021 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Background: Nail psoriasis is a common and potentially debilitating condition for which no effective and safe nonsystemic therapy is currently available. Recently, laser-assisted drug delivery (LADD) is being increasingly used to facilitate transcutaneous penetration of topical treatments., Objectives: We set to assess the efficacy and safety of combined pulse-dye laser and fractional CO2 laser-assisted betamethasonecalcipotriol gel delivery for the treatment of nail psoriasis., Material and Methods: We conducted a prospective, intrapatient comparative study in a series of 22 patients with bilateral fingernail psoriasis. Nails on the randomized hand were treated with 3 monthly sessions of pulse-dye laser to the proximal and lateral nail folds followed by fractional ablative CO2 laser to the nail plate. Between treatments and one month following the last treatment, the participants applied betamethasone propionate-calcipotriol gel once daily to the nail plate. Clinical outcome was ascertained using nails photography, the Nail Psoriasis Severity Index (NAPSI) and patient satisfaction., Results: Seventeen completed the study. Three participants withdrew from the study because of treatment-associated pain. Treatment was associated with a statistically significant improvement of the NAPSI scale (p < .002). Patient satisfaction was high., Conclusion: Combined PDL and fractional ablative CO2-LADD of betamethasone-calcipotriol gel should be considered for the treatment of nail psoriasis., (Copyright © 2020 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Background: Pulsed diode array laser systems are utilized extensively for various aesthetic indications such as removal of unwanted hair, treatment of vascular and pigmented lesions, and wrinkle reduction., Objective: The purpose of this study was to report and assess the experience of using a diode laser system delivering pulsed infrared laser light at the near-infrared (NIR) spectrum at wavelengths of 805 and 1060 nm., Methods: The study was a retrospective analysis of treatment outcomes in adult subjects treated at the clinic between January 2017 and April 2018 for wrinkles and pigmentation with a noninvasive aesthetic diode laser system. Subjects were treated at nominal wavelengths of 805 nm for pigmentation and 1060 nm for wrinkles reduction. Improvement in pigmentation and wrinkles, adverse events, and patient tolerability to treatment and satisfaction were evaluated., Results: Of 44 subjects with Fitzpatrick skin types II-IV, eight were treated for pigmentation and 36 for wrinkles. For both treatments, subjects reported tolerable pain levels. All immediate responses resolved within 48 hours post-treatment. Evaluation of treatment outcomes by two blinded evaluators demonstrated significant pigmentation clearance mean of 2.50 ± 0.15, (P < .05) in subjects treated for pigmentation, as well as significant improvement mean of 0.46 ± 0.12 (P = .005) in wrinkles in 13 subjects (41%) whose "before" and "after treatment" photographs were correctly identified by both blinded evaluators. Subjects were satisfied with the treatments., Conclusions: Use of the Diode laser effectively resulted in improvement in pigmentation and wrinkles, while maintaining a high safety profile with limited downtime., (© 2019 Wiley Periodicals, Inc.)

Successful treatment of Hailey-Hailey disease with intradermal botulinum toxin injections has been previously reported. The main disadvantages of this treatment are the excruciating pain and the risk of infections due to the numerous injections. We sought to evaluate the clinical effectiveness and safety profile of a novel approach using an energy-based device (Tixel, Novoxel, and Israel), followed by the topical application of botulinum toxin Type A for the treatment of Hailey-Hailey disease. A retrospective study of all cases of histologically diagnosed cases of Hailey-Hailey disease treated with Tixel device followed by topical application of botulinum toxin between 2018 and 2019 was performed. Epidemiologic, clinical, and treatment data, including effectiveness score and safety, were reviewed. The study included eight patients, of whom seven patients (87.5%) showed good or partial response. No systemic or local adverse effects were reported. There was no difference in effectivity between different body areas. Response to treatment ranged between patients with an average duration of 7.125 months after the second treatment. Tixel treatment followed by topical application of botulinum toxin can be considered in the treatment of Hailey-Hailey disease. This approach is less invasive, less painful, and yet effective as well as safe., (© 2019 Wiley Periodicals, Inc.)

Light-based modalities appear to be effective for ameliorating surgical scar appearance; however, protocols for achieving such outcomes have yet to be established. We studied the safety and efficacy of a combination of pulsed dye laser (PDL) and fractional ablative CO 2 laser (FACL) for the attenuation of post-lumpectomy scarring. We conducted a prospective, evaluator-blinded, comparative split-scar study in post-lumpectomy patients. One-half of the scar was treated with three sessions of 595-nm PDL and FACL at 1-month intervals, starting within 6 weeks after suture removal. The entire scar was also treated with standard moisturizers and silicone gels. Six months after the last treatment, the two halves of the scar were assessed by three uninvolved physicians who used the Observer Scar Assessment Scale as well as by the patients who used the Patient and Observer Scar Assessment Scale. Eighteen female patients (mean age, 51.3 years) with a mean scar length of 7.8 cm completed the treatment and follow-up. Six months after the last treatment, both the physician evaluators and the patients noted significant improvements for all assessed scar parameters in the laser-treated scar area compared with the untreated scar area. The treatment was well tolerated, and no remarkable adverse events were reported. All 18 participants were satisfied with the treated scar areas. A combination PDL and FACL protocol starting up to 6 weeks after suture removal is a safe and effective method for the attenuation of post-lumpectomy scar formation.

Background: The term "obesity paradox", refers to lower mortality rates in obese patients, and is evident in various chronic cardiovascular disorders. There is however, only scarce data regarding the clinical implication of obesity and pulmonary hypertension (PH). Therefore, in the current study, we evaluated the possible prognostic implications of obesity in PH patients., Methods: We assessed 105 consecutive PH patients for clinical and hemodynamic parameters, focusing on the possible association between Body Mass Index (BMI) and mortality. Follow-up period was 19 ± 13 months., Results: Sixty-one patients (58%) had pre-capillary PH and 39 patients (37%) out-of-proportion post-capillary PH. During follow-up period, 30 patients (29%) died. Death was associated with reduced functional-class, inverse-relation with BMI, higher pulmonary artery and right atrial pressures, pulmonary vascular resistance and signs of right ventricular failure. In multivariate analysis, obesity (BMI ≥ 30 kg/m²), was the variable most significantly correlated with improved survival [H.R 0.2, 95% C.I 0.1-0.6; p = 0.004], even after adjustment for baseline characteristics. Obese and very-obese (BMI ≥ 35 kg/m²) patients had significantly less mortality rates during follow-up (12% and 8%, respectively) than non-obese patients (41%), p = 0.01. The tendency of survival benefit for the obese vs. non-obese patients was maintained both in the pre-capillary (10% vs. 46% mortality, p = 0.008) and disproportional post-capillary PH patients (11% vs. 40% mortality, p = 0.04)., Conclusions: Obesity was significantly associated with lower mortality in both pre-capillary and disproportional post-capillary PH patients. It seems that in PH, similarly to other chronic clinical cardiovascular disease states, there may be a protective effect of obesity, compatible with the "obesity paradox"., (Copyright © 2012 Elsevier Ltd. All rights reserved.)