Use of vibrating anesthetic device reduces the pain of mesotherapy injections: A randomized split-scalp study

Is Vibration Anesthesia Effective and Safe for Pain Reduction in Botulinum Toxin Injection? A Randomized Split-Face Controlled Trial and Cadaver Experiment

BACKGROUND

Pain is an important issue in botulinum toxin injection. Vibration anesthesia is a noninvasive method for pain alleviation, but few studies have reported its use during botulinum toxin injection.

OBJECTIVES

The aim of this study was to investigate whether vibration anesthesia was effective and safe for pain reduction during botulinum toxin injection for masseter reduction.

METHODS

A randomized split-face controlled trial was performed in patients who required masseter reduction. Vibration anesthesia was randomly administered on either side. Study outcomes were pain scores on a visual analog scale, duration of effect, satisfaction, and complications. Intergroup comparison and linear regression analyses were performed.

RESULTS

In a total of 216 patients, the pain score on the vibration side (2.97 ± 1.44) was significantly lower than that on the nonvibration side (4.72 ± 2.13) (P < .0001), with a higher proportion of mild pain. Linear regression showed that a history of injection and more injection points and doses increased the pain, whereas a 2-mL syringe reduced the pain compared to a 1-mL syringe. Side effects were found in 19 patients and 21 sides (7%), but were not associated with vibration. High satisfaction was reported. A cadaver experiment confirmed that vibration did not alter the diffusion radius and depth of injection.

CONCLUSIONS

Vibration anesthesia significantly relieved pain during botulinum toxin injection for masseter reduction, and it did not cause adverse effects and or affect duration of effect. Therefore, we recommend vibration anesthesia, a larger syringe size, and fewer injection points to improve patient experience and satisfaction.

LEVEL OF EVIDENCE: 3 (THERAPEUTIC)

II Consensus of the Brazilian Society of Dermatology for the treatment of alopecia areata

BACKGROUND

Alopecia areata is a highly frequent disease with great variability in clinical presentation, severity, and prognosis. It has a significant negative impact on quality of life, especially in the moderate and severe forms.

OBJECTIVE

To disseminate guidelines, prepared by a group of Brazilian experts, for the treatment and follow-up of patients with alopecia areata.

METHODS

Eight specialists from different university centers with experience in alopecia areata were appointed by the Brazilian Society of Dermatology to reach a consensus on its treatment. Using the adapted DELPHI methodology, relevant elements were considered and then an analysis of the recent literature was carried out and the text produced. Consensus on the guidelines was defined with the approval of at least 70% of the panel of experts.

RESULTS/CONCLUSIONS

Treatments vary according to patient age and disease severity. Intralesional injectable corticosteroid therapy was considered the first option for localized disease in adults. In severe cases, Janus Kinase inhibitors are the treatment with the highest level of evidence. Systemic corticosteroid therapy and immunosuppressants (corticosteroid-sparing agents) are also options in these cases. Contact immunotherapy (diphencyprone) is an alternative for stable extensive cases. The assessment of side effects is as important as the hair regrowth rate.

Vibration assisted analgesia during intralesional corticosteroid therapy for alopecia

Intralesional corticosteroid therapy (ICT) is a recommended management strategy for various inflammatory hair loss disorders. Pain from ICT can limit the use of this treatment, particularly in younger people and those with needle phobia. We present data demonstrating that vibration assisted analgesia, is a safe, effective and easy to use technique, which minimises pain from ICT, allowing its use in a wider cohort of patients.

Female pattern hair loss: therapeutic update

Female androgenetic alopecia or female-pattern hair loss (FPHL) is highly prevalent and has a great impact on the quality of life. The treatment is a routine challenge in dermatological practice, as many therapeutic options have a limited level of evidence and often do not meet patients expectations. Lack of knowledge of the pathogenesis of the hair miniaturization process and the factors that regulate follicular morphogenesis restricts the prospect of innovative therapies. There is also a lack of randomized, controlled studies with longitudinal follow-up, using objective outcomes and exploring the performance of the available treatments and their combinations. Topical minoxidil, which has been used to treat female pattern hair loss since the 1990s, is the only medication that has a high level of evidence and remains the first choice. However, about 40% of patients do not show improvement with this treatment. In this article, the authors critically discuss the main clinical and surgical therapeutic alternatives for FPHL, as well as present camouflage methods that can be used in more extensive or unresponsive cases.

Minimally invasive procedures for the management of female pattern hair loss

BACKGROUND

Female Pattern Hair Loss (FPHL) is one of the most common types of hair loss in women. It is characterized by progressive follicular miniaturization leading to diffuse hair thinning over the midfrontal scalp with a negative impact on quality of life. Pharmacological treatments are commonly used, and hair follicle transplantation is an option for those cases with adequate donor area. Minimally invasive procedures, such as microneedling, mesotherapy, microinfusion of drugs into the scalp with tattoo machines (MMP®), and platelet-rich plasma (PRP) have been reported as adjuvant treatments.

AIMS

This study aims to summarize and discuss the efficacy of minimally invasive procedures described for the management of FPHL.

METHODS

Published articles indexed on the Pubmed database and Scopus that described minimally invasive procedures for the management of FPHL in humans were considered. Citations were reviewed and added for completeness. The search was for articles in English only. After excluding duplicate titles, 23 relevant articles were considered.

CONCLUSION

Minimally invasive procedures are promising options and may play a role in FPHL treatment. They can be used as adjunctive therapy for FPHL, in case of poor response to clinical therapy, or when patients prefer other care than the standard. We reinforce that these methods should be performed by an experienced medical professional following strict aseptic techniques. However, microneedling, mesotherapy, MMP, and PRP lack standardization and are supported by a low level of evidence yet. For the future, larger randomized clinical trials are essential to determine the efficacy and optimal protocols for these treatments.

Local anaesthetics in dermatological surgery: a review of adjuncts and pain reduction techniques

A variety of adjuncts for local anaesthesia (LA) exists for dermatological surgery, along with many options to reduce the pain of LA. This review aims to summarize the evidence relating to such adjuncts and methods to reduce the pain of LA. Adjuncts to LA can be an important consideration to optimize anaesthetic effect. Current evidence suggests that buffering and warming of LA fluid, along with cooling, pinching and administering vibrations to the skin are effective at reducing pain during administration. In this review, no significant difference in pain reduction was found between cooling and administering vibrations to the skin. Studies demonstrate that, overall, LA injection into distal sites is safe. However, the evidence specific to dermatological surgery is limited with regard to ways to reduce pain during LA injection and in determining the safety of LA for distal sites with confidence. Further high-quality research in the form of multicentre randomized controlled trials is required.

Effect of local vibrotherapy in sitting or lying position in two time protocols on the cellulite grade and change of body circumferences in women with cellulite

BACKGROUND

Vibrotherapy is becoming a new tool which can help to improve aesthetic appearance. One of its basic uses in cosmetology is eliminating cellulite changes.

AIM

The aim of the study was to analyze the effect of a 3-week series of local vibrotherapy in two positions and in two time protocols on selected body circumferences, WHR, WHtR and BAI, and the grade of cellulite.

PATIENTS AND METHODS

Volunteers underwent vibration treatments in a lying or sitting position for 30 or 60 minutes a day, for 3 weeks. Waist, hip, thigh and calf circumferences were measured before and after the first, and before and after the last treatment. The WHR, WHtR and BAI indicators were calculated. The grade of cellulite was assessed with use of the Nürnberger-Müller scale. A multivariate analysis of variance was performed to assess the impact of individual parameters.

RESULTS

After a series of treatments, a significant decrease in the grade of cellulite was noted, regardless of the treatment time or position. The circumferences of the thighs and hips didn't change. Both, the first and the last treatment allowed for change the calf circumference. The applied series of treatments allowed for lower the waist circumference also for change the WHR and WHtR indicators.

CONCLUSION

A series of vibration interventions reduced cellulite symptoms without affecting the hip and thigh circumferences. The treatment positions can be adjusted to the individual needs of the client and time of single treatment can be minimized to 30 min a day.