Clinical and instrumental evaluation of skin improvement after treatment with a new 50% pyruvic acid peel

Understanding Melasma-How Can Pharmacology and Cosmetology Procedures and Prevention Help to Achieve Optimal Treatment Results? A Narrative Review

Melasma is a chronic skin condition that involves the overproduction of melanin in areas exposed to ultraviolet radiation. Melasma treatment is long-term and complicated with recurrence and resistance to treatment. The pathogenesis of melasma is highly complex with multiple pathologies occurring outside of the skin pigment cells. It includes photoaging, excessive melanogenesis, an increased number of mast cells, increased vascularization, and basement membrane damage. In addition, skin lesions related to melasma and their surrounding skin have nearly 300 genes differentially expressed from healthy skin. Traditionally, melasma was treated with topical agents, including hydroquinone, tretinoin, glucocorticosteroids and various formulations; however, the current approach includes the topical application of a variety of substances, chemical peels, laser and light treatments, mesotherapy, microneedling and/or the use of systemic therapy. The treatment plan for patients with melasma begins with the elimination of risk factors, strict protection against ultraviolet radiation, and the topical use of lightening agents. Hyperpigmentation treatment alone can be ineffective unless combined with regenerative methods and photoprotection. In this review, we show that in-depth knowledge associated with proper communication and the establishment of a relationship with the patient help to achieve good adherence and compliance in this long-term, time-consuming and difficult procedure.

Quantitative Evaluation of the Effectiveness of Chemical Peelings in Reducing Acne Lesions Based on Gray-Level Co-Occurrence Matrix (GLCM)

Purpose

Acne vulgaris is a chronic, inflammatory disease accompanied by lesions affecting the structure of the skin. Chemical peels are one of the methods of reducing acne vulgaris. There is still a lack of quantitative methods of assessing impact of cosmetic procedure on the skin. Skin condition depends on skin texture characterization; therefore, the analysis that provides data about the textures can be helpful in assessing the effectiveness of cosmetic treatments.

Patients and Methods

The study involved 24 volunteers with acne lesions. Each participant underwent 4 treatments using chemical peels at two-week intervals. Before, during and after procedure clinical photography were made. To assess effectiveness of chemical peeling in acne lesion reduction, we were used gray-level co-occurrence matrix (GLCM) analysis. Qualitative assessment of acne severity was made by 12 experts in dermatology.

Results

After a series of treatments, the GLCM contrast value decreased in each area of the face, and the GLCM homogeneity value increased, which means that the number of acne lesions was reduced. Expert assessment according to the IGA scale confirms the effectiveness of therapy with both salicylic and glycolic acid and pyruvic acid.

Conclusion

The results of this study prove that GLCM analysis is a useful tool for assessing the effectiveness of chemical peel treatments. It can also be used for quantitative assessment of skin texture.

A Comprehensive Review of Non-Energy-Based Treatments for Atrophic Acne Scarring

Scarring is a dire consequence of acne vulgaris. Particularly, atrophic acne scarring is highly prevalent among young adults, and its physical and psychological effects can persist throughout their lives if left untreated. This literature review will analyze various non-energy-based approaches to treating atrophic acne scarring, emphasizing recent advances within the last 5 to 10 years. To accomplish this, we performed a PubMed search for various acne scar treatments such as chemical peels, dermabrasion, microdermabrasion, subcision, microneedling, punch techniques, dermal fillers, and thread lifting. Our findings and analysis show that there is no panacean solution to treating atrophic acne scars, which explains the evolving trend towards developing unique combinatorial treatments. Although a fair comparison of each treatment approach is difficult to achieve due to the studies’ varying sample sizes, strength of evidence, treatment execution, etc, there still remains a level of consensus on what treatments are well suited for particular scar types.

Improvements in Skin Quality Biological Markers in Skin Explants Using Hyaluronic Acid Filler VYC-12L

Hyaluronic acid (HA), both crosslinked and uncrosslinked, is used clinically to treat fine lines and provides additional improvements in skin quality attributes. The purpose of this study was to assess potential early differences in the expression of biological markers of skin quality in living human skin explants injected with uncrosslinked and crosslinked HA gels.

Methods

Living human skin explants injected with VYC-12L or noncrosslinked HA with mannitol (HYD) and noninjected controls were assessed via microscopy, histology, and immunohistochemistry on days 3 and/or 8 for biological markers of elasticity (collagen density, elastin, fibrillin-1) and hydration [aquaporin-3, acidic glycosaminoglycans (GAGs), HA]. Hydration was also assessed via a corneometer probe on days 0, 1, 2, and 8.

Results

On day 3 versus controls, VYC-12L moderately increased collagen density in the upper reticular dermis and clearly increased fibrillin-1 expression, with slight increases persisting on day 8. Increases with HYD were smaller and did not persist on day 8. Both VYC-12L and HYD increased aquaporin-3 expression and GAG content on days 3 and 8, but VYC-12L produced greater GAG increases in the reticular dermis. Day 8 instrument-assessed hydration increased by 49% and 22% for VYC-12L and HYD, respectively. Elastin expression in oxytalan and elaunin fibers was unchanged. Upper-dermal HA reductions suggested HA injection-induced hyaluronidase expression.

Conclusion

VYC-12L produced greater, more lasting improvements in biological markers of skin quality than HYD.

Expert Consensus on Injection Technique and Area-Specific Recommendations for the Hyaluronic Acid Dermal Filler VYC-12L to Treat Fine Cutaneous Lines

Background

VYC-12L is a hyaluronic acid (HA) injectable gel designed to treat fine cutaneous lines and improve skin quality attributes such as hydration and elasticity.

Objective

Expert consensus was sought on VYC-12L injection technique and primary treatment target areas.

Methods

A multinational group of aesthetic medicine clinicians (n = 128) attended product training and each identified ~10 patients for VYC-12L. After treating their first and last patients, the clinicians completed a survey on preferred injection methodology/technique, including injection angle, volume, and spacing. An expert panel (n = 12) discussed survey results and their clinical experiences to obtain consensus on VYC-12L technique and appropriate treatment areas.

Results

Recommendations included micro-depot injections of VYC-12L into the deep dermis with a 32G ½ inch needle inserted at <45º to the skin, spaced 0.5‒1.0 cm apart, with 0.01‒0.05 mL volume per injection (full-face total volume: ~2 mL). Recommended primary treatment areas were the malar, perioral, neck, and décolletage regions. Injection techniques for different treatment areas/demographic characteristics were similar, with some variability in treatment approach. Patient selection criteria, pre- and post-treatment guidelines, and managing patient expectations are important components of treatment.

Conclusion

These consensus recommendations may assist clinicians in optimizing the treatment of fine lines with VYC-12L.

A split-face comparative study to evaluate the efficacy of 50% pyruvic acid against a mixture of glycolic and salicylic acids in the treatment of acne vulgaris

BACKGROUND

One of the ways to treat acne is by using chemical peels. Salicylic, glycolic and pyruvic acids due to their keratolytic and antibacterial properties are often recommended for acne patients.

AIMS

The aim of the study was to compare the effect of a preparation containing glycolic and salicylic acids with pyruvic acid.

PATIENTS/METHODS

14 women diagnosed with acne took part in the study. The facial treatment area was divided into two parts: right (a preparation containing 50% pyruvic acid) and left side ( a preparation containing glycolic and salicylic acids). A series of four treatments was performed at 2-week intervals. Skin parameters, namely hydration, sebum secretion and skin colour were measured.

RESULTS

As a result of using 50% pyruvic acid, the hydration of the right side of the face increased statistically and there was a decrease in the amount of melanin in the epidermis. On the left side of the face, there was an increase in skin hydration after using a mixture of glycolic and salicylic acids. The increase in skin hydration on the left side of the chin and nose was not statistically significant. The use of the mixture of glycolic and salicylic acids affected the skin colour on the left side of the face, on the forehead, cheek and nose.

CONCLUSION

Chemical peels affect a wide range of pathological factors of acne. A mixture of acids yields fewer side effects than a single acid used in high concentration, but the therapeutic effects are comparable.

Improvements in satisfaction with skin after treatment of facial fine lines with VYC-12 injectable gel: Patient-reported outcomes from a prospective study

BACKGROUND

VYC-12, a hyaluronic acid injectable gel, is designed to treat fine lines and provides improvements in other skin quality attributes. A prospective study demonstrated the safety and effectiveness of VYC-12 for the improvement of fine lines as measured by changes in skin texture.

AIMS

To evaluate patient-reported outcomes in subjects treated intradermally with VYC-12 in the cheeks, forehead, and neck (optional) in the prospective study.

METHODS

Subjects received an initial treatment of VYC-12 (N = 131), with a touch-up treatment, if deemed necessary, offered 30 days later, and optional repeat treatment 9 months after initial or touch-up treatment. Subjects completed the FACE-Q Satisfaction With Skin scale and assessed willingness to recommend treatment to a friend at baseline, months 1, 4, 6, and 9, and month 1 after repeat treatment. Subjects also evaluated their return to normal daily social activities.

RESULTS

Satisfaction with skin improved from baseline in 90.8% of subjects at month 1, 88.4% at month 4, 83.6% at month 6, 76.4% at month 9, and 91.9% at month 1 after repeat treatment (P < .001, all time points). At least 94% of subjects returned to normal daily social activities one day after treatment (initial, touch-up, or repeat). More than 80% of subjects said they would recommend treatment to a friend at all time points through month 9 (97% at month 1 after repeat treatment).

CONCLUSION

Treatment with VYC-12 significantly improved satisfaction with skin in the majority of subjects, with most subjects returning to normal activities 1 day after treatment.

Chemical Peels in Melasma: A Review with Consensus Recommendations by Indian Pigmentary Expert Group

Melasma is a notorious dermatosis, often resistant to treatment. Chemical peeling constitutes an acceptable option of management of melasma (of any type and duration). In this article, as a group of experts from Pigmentary Disorders Society (PDS) in collaboration with South Asian Pigmentary Forum (SPF), we have tried to elaborate the various chemical peeling agents for the treatment of melasma. Besides, we have reviewed the indications, mechanism of action, rationality and the detailed procedure of peeling. The evidence in favor of various peeling agents have been summarized as well.

Development and Validation of a Photonumeric Scale for Evaluation of Facial Skin Texture

BACKGROUND

A validated scale is needed for objective and reproducible comparisons of facial skin roughness before and after aesthetic treatment in practice and in clinical studies.

OBJECTIVE

To describe the development and validation of the 5-point photonumeric Allergan Skin Roughness Scale.

METHODS

The scale was developed to include an assessment guide, verbal descriptors, morphed images, and real subject images for each grade. The clinical significance of a 1-point score difference was evaluated in a review of image pairs representing varying differences in severity. Interrater and intrarater reliability was evaluated in a live-subject validation study (N = 290) completed during 2 sessions occurring 3 weeks apart.

RESULTS

A score difference of ≥1 point was shown to reflect a clinically meaningful difference (mean [95% confidence interval] absolute score difference 1.09 [0.96–1.23] for clinically different image pairs and 0.53 [0.38–0.67] for not clinically different pairs). Intrarater agreement between the 2 validation sessions was almost perfect (weighted kappa = 0.83). Interrater agreement was almost perfect during the second rating session (0.81, primary end point).

CONCLUSION

The Allergan Skin Roughness Scale is a validated and reliable scale for physician rating of midface skin roughness.

Methylsulfonylmethane: Applications and Safety of a Novel Dietary Supplement

Methylsulfonylmethane (MSM) has become a popular dietary supplement used for a variety of purposes, including its most common use as an anti-inflammatory agent. It has been well-investigated in animal models, as well as in human clinical trials and experiments. A variety of health-specific outcome measures are improved with MSM supplementation, including inflammation, joint/muscle pain, oxidative stress, and antioxidant capacity. Initial evidence is available regarding the dose of MSM needed to provide benefit, although additional work is underway to determine the precise dose and time course of treatment needed to provide optimal benefits. As a Generally Recognized As Safe (GRAS) approved substance, MSM is well-tolerated by most individuals at dosages of up to four grams daily, with few known and mild side effects. This review provides an overview of MSM, with details regarding its common uses and applications as a dietary supplement, as well as its safety for consumption.

Development and Validation of a Photonumeric Scale for Evaluation of Facial Fine Lines

BACKGROUND

A validated scale is needed for objective and reproducible comparisons of facial fine lines before and after treatment in practice and clinical studies.

OBJECTIVE

To describe the development and validation of the 5-point photonumeric Allergan Fine Lines Scale.

METHODS

The Allergan Fine Lines Scale was developed to include an assessment guide, verbal descriptors, morphed images, and real subject images for each scale grade. The clinical significance of a 1-point score difference was evaluated in a review of multiple image pairs representing varying differences in severity. Interrater and intrarater reliability was evaluated in a live subject validation study (N = 289) completed during 2 sessions occurring 3 weeks apart.

RESULTS

A score difference of ≥1 point was shown to reflect a clinically significant difference (mean [95% CI] absolute score difference, 1.06 [0.92-1.21] for clinically different image pairs and 0.50 [0.38-0.61] for not clinically different pairs). Intrarater agreement between the 2 live subject validation sessions was almost perfect (weighted kappa = 0.85). Interrater agreement was substantial during the second rating session (0.76, primary end point).

CONCLUSION

The Allergan Fine Lines Scale is a validated and reliable scale for physician rating of severity of superficial fine lines.

Comparison the effectiveness of pyruvic acid 50% and salicylic acid 30% in the treatment of acne

BACKGROUND

Acne vulgaris is a chronic inflammatory disease of the pilosebaceous follicles and one of the most common skin diseases. The peeling method has been recently found to be effective for acne treatment. This study aimed to compare the efficacy of pyruvic acid 50% and salicylic acid 30% peeling in the treatment of mild to moderate acne.

MATERIALS AND METHODS

In a prospective single-blinded clinical trial, 86 patients with acne were randomly assigned into two groups. In both groups, the routine treatment of acne (topical solution of erythromycin 4%, triclorocarban soap, and sunscreen) were used twice a day for 8 weeks. In addition, salicylic acid 30% for the control group and pyruvic acid 50% for the case group were used. In both groups, acne severity index (ASI) was calculated before and at week 2, 4, 6, and 8 of the treatment. Patient satisfaction was assessed at the end of the treatment. Side effects were recorded using a checklist.

RESULTS

In both groups, the reduction in the number of comedones, papules, and ASI were statistically significant (P < 0.001) in the course of treatment. However, it was not significant regarding the number of pustules (P = 0.09). None of the number of comedone, papules, pustules, and ASI was statistically different between study groups. Both treatment groups had similar side effects except for scaling in the fifth session, which was significantly lower in salicylic acid - treated patients (P = 0.015).

CONCLUSION

Both pyruvic acid 50% and salicylic acid 30% are effective in the improvement of mild to moderate acne with no significant difference in efficacy and side effects.

Evidence-based treatment for melasma: expert opinion and a review

Introduction

Melasma is one of the most common pigmentary disorders seen by dermatologists and often occurs among women with darker complexion (Fitzpatrick skin type IV–VI). Even though melasma is a widely recognized cause of significant cosmetic disfigurement worldwide and in India, there is a lack of systematic and clinically usable treatment algorithms and guidelines for melasma management. The present article outlines the epidemiology of melasma, reviews the various treatment options along with their mode of action, underscores the diagnostic dilemmas and quantification of illness, and weighs the evidence of currently available therapies.

Methods

A panel of eminent dermatologists was created and their expert opinion was sought to address lacunae in information to arrive at a working algorithm for optimizing outcome in Indian patients. A thorough literature search from recognized medical databases preceded the panel discussions. The discussions and consensus from the panel discussions were drafted and refined as evidence-based treatment for melasma. The deployment of this algorithm is expected to act as a basis for guiding and refining therapy in the future.

Results

It is recommended that photoprotection and modified Kligman’s formula can be used as a first-line therapy for up to 12 weeks. In most patients, maintenance therapy will be necessary with non-hydroquinone (HQ) products or fixed triple combination intermittently, twice a week or less often. Concomitant camouflage should be offered to the patient at any stage during therapy. Monthly follow-ups are recommended to assess the compliance, tolerance, and efficacy of therapy.

Conclusion

The key therapy recommended is fluorinated steroid containing 2–4% HQ-based triple combination for first line, with additional selective peels if required in second line. Lasers are a last resort.

Electronic supplementary material

The online version of this article (doi:10.1007/s13555-014-0064-z) contains supplementary material, which is available to authorized users.

Influence of azelaic and mandelic acid peels on sebum secretion in ageing women

INTRODUCTION

Azelaic acid and mandelic acid are superficial peels commonly applied in people of various age groups. As they are mild and do not cause any side effects, they are also often used in elderly people.

AIM

To compare the influence of azelaic and mandelic acid peels on facial sebum secretion in mature women aged 49-71 years.

MATERIAL AND METHODS

The level of secreted sebum was measured in 28 women. Eleven women were treated with azelaic acid peel and 17 with mandelic acid peel. Each of the peels was applied five times with 2-week intervals. The measurements were made on the cheeks and chin with the use of Sebumeter SM 15 (Courage & Khazaka, Germany). The last measurement, i.e. the sixth one, was made 2 weeks after the treatment.

RESULTS

We observed a significant increase in sebum secretion in the U-zone after the application of 20% azelaic peel and 40% mandelic peel. Neither peel significantly affected sebum secretion in the T-zone.

CONCLUSIONS

Peels with 20% azelaic acid and 40% mandelic acid might be considered treatments which contribute to an increase in sebum secretion in ageing women.

Chemical peels for melasma in dark-skinned patients

Melasma is a common disorder of hyperpigmentation, which has a severe impact on the quality of life. Inspite of tremendous research, the treatment remains frustrating both to the patient and the treating physician. Dark skin types (Fitzpatrick types IV to VI) are especially difficult to treat owing to the increased risk of post-inflammatory hyperpigmentation (PIH). The treatment ranges from a variety of easily applied topical therapies to agents like lasers and chemical peels. Peels are a well-known modality of treatment for melasma, having shown promising results in many clinical trials. However, in darker races, the choice of the peeling agent becomes relatively limited; so, there is the need for priming agents and additional maintenance peels. Although a number of new agents have come up, there is little published evidence supporting their use in day-to -day practice. The traditional glycolic peels prove to be the best both in terms of safety as well as efficacy. Lactic acid peels being relatively inexpensive and having shown equally good results in a few studies, definitely need further experimentation. We also recommend the use of a new peeling agent, the easy phytic solution, which does not require neutralisation unlike the traditional alpha-hydroxy peels. The choice of peeling agent, the peel concentration as well as the frequency and duration of peels are all important to achieve optimum results.

Acne scars: pathogenesis, classification and treatment

Acne has a prevalence of over 90% among adolescents and persists into adulthood in approximately 12%-14% of cases with psychological and social implications. Possible outcomes of the inflammatory acne lesions are acne scars which, although they can be treated in a number of ways, may have a negative psychological impact on social life and relationships. The main types of acne scars are atrophic and hypertrophic scars. The pathogenesis of acne scarring is still not fully understood, but several hypotheses have been proposed. There are numerous treatments: chemical peels, dermabrasion/microdermabrasion, laser treatment, punch techniques, dermal grafting, needling and combined therapies for atrophic scars: silicone gels, intralesional steroid therapy, cryotherapy, and surgery for hypertrophic and keloidal lesions. This paper summarizes acne scar pathogenesis, classification and treatment options.

Synthesis of (S)-(+)-decursin and its analogues as potent inhibitors of melanin formation in B16 murine melanoma cells

We report the synthesis of a novel series of highly potent melanin inhibitors which were obtained through structural modification of an anticancer compound S-(+)-decursinol. The in vitro inhibitory potencies of the newly synthesized compounds were evaluated against α-MSH induced melanin production in B16 murine melanoma cells. Among the compounds evaluated, compounds 2, 3, 6b, 7a, 7b, 8a and 8b emerged as highly potent inhibitors of melanin production. Besides, these compounds demonstrated significantly low cytotoxicity.

Inhibitory effect of novel tetrahydropyrimidine-2(1H)-thiones on melanogenesis

The series of imidazoldine-2-thiones 2 and tetrahydropyrimidine-2-thiones 3 were discovered as inhibitor of alpha-MSH-induced melanin production in melanoma B16 cells. The primary bioassay showed that 1-(4-ethylbenzyl)-tetrahydropyrimidine-2(1H)-thione 3e (>100% inhibition at 10 microM, IC(50)=1.2 microM) and 1-(4-tert-butylbenzyl)-tetrahydropyrimidine-2(1H)-thione 3f (>100% inhibition at 10 microM, IC(50)=0.76 microM) exhibited potent inhibitory effect against alpha-MSH-induced melanin production. Compounds 3 inhibit the biosynthesis of tyrosinase without affecting its catalytic activity in melanogenesis.

Superficial chemical peels and microdermabrasion for acne vulgaris

Superficial chemical peels and microdermabrasion are used for many dermatologic conditions. A common condition treated with these modalities is acne vulgaris. In this review, we discuss the theory behind the technique of these procedures and describe the application and complications of each of these procedures in the office setting. The evaluation of patients before proceeding with the procedure and discuss pre- and postpeel regimens used for patients is discussed. We also analyze studies on both of these in-office procedures and comparative studies between the 2 most commonly used superficial chemical peeling agents, glycolic and salicylic acid.

Progress in metabolic engineering of Saccharomyces cerevisiae

The traditional use of the yeast Saccharomyces cerevisiae in alcoholic fermentation has, over time, resulted in substantial accumulated knowledge concerning genetics, physiology, and biochemistry as well as genetic engineering and fermentation technologies. S. cerevisiae has become a platform organism for developing metabolic engineering strategies, methods, and tools. The current review discusses the relevance of several engineering strategies, such as rational and inverse metabolic engineering, evolutionary engineering, and global transcription machinery engineering, in yeast strain improvement. It also summarizes existing tools for fine-tuning and regulating enzyme activities and thus metabolic pathways. Recent examples of yeast metabolic engineering for food, beverage, and industrial biotechnology (bioethanol and bulk and fine chemicals) follow. S. cerevisiae currently enjoys increasing popularity as a production organism in industrial ("white") biotechnology due to its inherent tolerance of low pH values and high ethanol and inhibitor concentrations and its ability to grow anaerobically. Attention is paid to utilizing lignocellulosic biomass as a potential substrate.

New and experimental treatments of cloasma and other hypermelanoses

In clinical practice, acquired hyperpigmentations represent the most common disorders of pigmentation the dermatologist has to treat. Despite the large number of depigmenting agents available, the treatment of hyperpigmentations is often unsuccessful and disappointing and is still a challenge for dermatologists. This article focuses on the chemical compounds reported to be in depigmenting or skin lightening agents, their proposed mechanism of action, and their clinical efficacy in the treatment of melasma and hypermelanoses, mainly based on randomized clinical trials. It also reviews chemical peels and their indications, together with the possible uses of laser and intense pulsed light.