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Alcotzer I, Liassidou A, Hexsel D, Tsur Shenhav L, Artzi O. Optimal Changes Seen in Patients After Treatment With Poly- l -Lactic Acid: A Retrospective Descriptive Study. Dermatol Surg 2024; 50:69-74. [PMID: 37910604 DOI: 10.1097/dss.0000000000003993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
BACKGROUND Poly- l -lactic acid (PLLA) is a biostimulator that enhances collagen production and leads to volume restoration. It became popular because of its improvement of facial wrinkles and long-lasting effect, although the specific visible changes it causes in the facial area are not fully described. OBJECTIVE To identify and characterize the visible changes resulting from injecting PLLA into the facial area. METHODS A list of 678 patients who underwent 2 to 3 treatments with PLLA injections in this center between 2021 and 2022 were retrieved. After 2 rounds of evaluations, 31 independent international evaluators described the 3 main changes they observed in the before-and-after images (taken approximately 7 months after the last injection session) of the 12 patients with the most significant improvement. RESULTS A total of 1,015 descriptions were received. They were divided into categories based upon similarity. The main detected changes were better contouring and enhancement of the lateral face, a lifting effect and secondary impact on the nasolabial fold, and improvement of skin texture and skin firmness. CONCLUSION Poly- l -lactic acid injections were judged to be effective for contouring, lifting, and improving skin texture in the facial area. Further research is needed to validate these results and create an assessment scale for PLLA injections.
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Affiliation(s)
- Inbar Alcotzer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aspasia Liassidou
- Division of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Doris Hexsel
- Hexsel Dermatologic Clinic and Research Center, Porto Alegre, RS, Brazil
| | - Leah Tsur Shenhav
- Department of Military Medicine and "Tzameret", Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Medical Corps, Israel Defense Forces, Israel
| | - Ofir Artzi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Dhillon RK, Dayan SH, Hexsel D, Shridharani S, Chilukuri S, LaTowsky B, Fabi SG. Update: Cellulite Therapies and Optimizing Treatment Combinations. Aesthet Surg J 2023; 43:1508-1520. [PMID: 37184131 DOI: 10.1093/asj/sjad143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/24/2023] [Accepted: 05/01/2023] [Indexed: 05/16/2023] Open
Abstract
Cellulite in the proximal lower extremities is a reported concern among many adult females. The unsightly appearance of cellulite leads many affected individuals to seek treatment by trained specialists. The objective of this review is to provide the reader with an update on new and innovative therapies for cellulite including various treatment combinations to maximize therapeutic outcomes, and strategies for minimizing adverse events. The availability of new technologies and the results from recent clinical trials provide additional tools and data to consider when creating treatment plans for cellulite patients. This update to previous treatment recommendations is based on the most recent developments in cellulite management including the personal experiences of the authors with an emphasis on injectable enzymes, acoustic subcision, targeted verifiable subcision, and biostimulators. Formal clinical studies are warranted to compare various treatment modalities and further investigate combination regimens. LEVEL OF EVIDENCE: 5
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Hexsel D, Valente-Bezerra I, Mosena G, Oakim Mourao MA, Fabris VC. Subjective and Objective Measurements of the Facial Effects of Microdoses of Botulinum Toxin. Dermatol Pract Concept 2023; 13:e2023168. [PMID: 37557136 PMCID: PMC10412053 DOI: 10.5826/dpc.1303a168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Studies have suggested that botulinum toxin A may improve skin quality, and application protocols using hyper-diluted doses of botulinum toxin (microdosing) have been studied as a way to achieve therapeutic goals without fully paralyzing the targeted muscles. OBJECTIVES To evaluate the effects of a combined protocol utilizing both the standard dosing and the microdosing of AbobotulinumtoxinA for the improvement of skin quality, measured by objective and subjective measurements. METHODS Thirty patients were treated with botulinum toxin using both the standard technique and the microdosing technique. Objective (Sebumeter®, Mexameter® and digital dermoscopy pictures) and subjective (Global Aesthetic Improvement Scale and a clinical scale for evaluating the quality of facial skin) measurements of the effects in the treated areas were taken to assess the efficacy of the treatment. RESULTS Digital dermoscopy showed a marked reduction of erythema and telangiectasias. Erythema and telangiectasias improved both on objective and subjective measurements. Skin oleosity, static rhytids, papules and pustules and enlarged pores improved on subjective measurements. Patient satisfaction was high (93%) despite the high rate of adverse events (56%). CONCLUSIONS The combined application of standard doses and microdoses of AbobotulinumtoxinA is effective in improving the overall quality of facial skin. The effects on erythema and telangiectasias suggest that it is an effective treatment option for patients with erythematotelangiectatic rosacea. When applying microdoses of botulinum toxin in the lower and mid-face, the doses and pattern of injection should be customized for each patient to reduce the occurrence of adverse events.
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Affiliation(s)
- Doris Hexsel
- Brazilian Center for Studies in Dermatology, Porto Alegre, Rio Grande do Sul, Brazil
- Hexsel Dermatologic Clinic, Porto Alegre, Rio Grande do Sul, Brazil
| | - Indira Valente-Bezerra
- Brazilian Center for Studies in Dermatology, Porto Alegre, Rio Grande do Sul, Brazil
- Hexsel Dermatologic Clinic, Porto Alegre, Rio Grande do Sul, Brazil
| | - Gabriela Mosena
- Brazilian Center for Studies in Dermatology, Porto Alegre, Rio Grande do Sul, Brazil
- Hexsel Dermatologic Clinic, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Vitor Costa Fabris
- Brazilian Center for Studies in Dermatology, Porto Alegre, Rio Grande do Sul, Brazil
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Hexsel D, Valente-Bezerra I, Dos Santos Fogaça A, Kamamoto C, Camozzato F, Mosena G, Parizotto JT, Del Nero MP, Soirefmann M, de Matos RMC, Silva AF, Siega C. A new skin laxity scale for the buttocks: the Skin Laxity Visual Scale (SLVS). Eur J Dermatol 2023; 33:245-248. [PMID: 37594330 DOI: 10.1684/ejd.2023.4479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
BACKGROUND The Skin Laxity Severity Scale for the buttocks was previously developed to separately assess buttock ptosis, a scalloped appearance of the skin, infragluteal fold, localized fat on the lower third of the buttocks, and linear depressed lesions. A more objective, faster and shorter version of this scale, to be evaluated visually, would be more feasible to apply in daily practice. OBJECTIVES To present a new skin laxity scale for the buttocks: the Skin Laxity Visual Scale (SLVS). MATERIALS & METHODS To establish the scale, investigators chose, by consensus, the most representative cases of each skin laxity grade. The images were graphically edited to better represent the degree of skin laxity identified in a previous study. Scale validity and reliability were assessed in two validation cycles, performed by eight dermatologists assessing 50 clinical cases. RESULTS Overall, Kendall's, weighted-kappa, and intraclass correlation coefficients indicated very good reliability and consistent inter- and intra-rater agreement (p<0.001). The scale validity was confirmed by criteria validity tests (rs: 0.76, p<0.05). CONCLUSION The SLVS for the buttocks is a reliable, reproducible, accurate and valid scale to identify skin laxity severity and its different features. It will very likely be an easy-to-use and convenient tool to appropriately assess improvement obtained with treatment and follow patients.
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Affiliation(s)
- Doris Hexsel
- Brazilian Center for Studies in Dermatology, Porto Alegre, RS, Brazil, Hexsel Dermatologic Clinic, Porto Alegre, RS, Brazil
| | - Indira Valente-Bezerra
- Brazilian Center for Studies in Dermatology, Porto Alegre, RS, Brazil, Hexsel Dermatologic Clinic, Porto Alegre, RS, Brazil
| | | | | | | | | | | | | | | | | | - Aline Flor Silva
- Brazilian Center for Studies in Dermatology, Porto Alegre, RS, Brazil
| | - Carolina Siega
- Brazilian Center for Studies in Dermatology, Porto Alegre, RS, Brazil
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de Almeida AT, Pecora CDS, Boggio RF, Hexsel D, Miot HA. Regarding the multiple facets of academic misconduct in cosmetic medicine. Comments on "The anatomy behind eyebrow positioning: A clinical guide based on current anatomic concepts.". Plast Reconstr Surg 2023:00006534-990000000-01827. [PMID: 37163572 DOI: 10.1097/prs.0000000000010273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
| | | | | | - Doris Hexsel
- Medical Director of Hexsel Dermatologic Clínics; Principal investigator of the Brazilian Center for Studies in Dermatology, Porto Alegre-RS, Brazil
| | - Hélio Amante Miot
- Departamento de Dermatologia, Unesp medical School, Botucatu-SP, Brazil
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Hexsel D, Hexsel CL, Mosena G, Dos Santos ACK, Fabris VC. The Long-Term Resolution of Gummy Smile with Repeated Injections of Botulinum Toxins. J Eur Acad Dermatol Venereol 2023. [PMID: 37102361 DOI: 10.1111/jdv.19139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/17/2023] [Indexed: 04/28/2023]
Affiliation(s)
- D Hexsel
- Brazilian Center for Studies in Dermatology, Porto Alegre, RS, Brazil
- Hexsel Dermatologic Clinic, Porto Alegre, RS, Brazil
| | - C L Hexsel
- Hexsel Dermatologic Clinic, Porto Alegre, RS, Brazil
- Madison Medical Affiliates, Mohs Surgery, Glendale, WI, USA
- Assistant Clinical Professor, Department of Dermatology, Medical College of Wisconsin, USA
| | - G Mosena
- Brazilian Center for Studies in Dermatology, Porto Alegre, RS, Brazil
- Hexsel Dermatologic Clinic, Porto Alegre, RS, Brazil
| | - A C K Dos Santos
- Brazilian Center for Studies in Dermatology, Porto Alegre, RS, Brazil
| | - V C Fabris
- Hexsel Dermatologic Clinic, Porto Alegre, RS, Brazil
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Hexsel D, Dini TD, Belem L, Correa IT, Brandão A. Gluteal Subcutaneous Adipose Tissue in Women of Different Ages and Body Mass Index observed by Magnetic Resonance Imaging. J Cosmet Dermatol 2022; 21:2169-2175. [PMID: 35181990 DOI: 10.1111/jocd.14866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/27/2022] [Accepted: 02/16/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Magnetic resonance Imaging (MRI) is a recognized method to assess the morphological characteristics of subcutaneous adipose tissue (SAT). This study aimed to assess objectively different characteristics of SAT of women with different ages and body mass index (BMI) using MRI. MATERIALS AND METHODS Retrospective, observational study. Pelvic-MRI exams of 133 women aged between 15 and 80 years, with BMI 16 to 30 kg/m2 were assessed. RESULTS There was a moderate positive correlation between the total fat thickness and the BMI (r = 0.64; p<0.0001) considering the entire sample. Within the different age groups, strong positive correlation was observed for age groups 15 to 30 years (r=0.76; p<0.0001) and 46 to 60 years (r=0.75; p<0.0001), and moderate positive correlation in the others (r=0.61; p<0.0001 [31-45 years] and r=0.53; p<0.0001 [>61 years-old]). There was no correlation between age and fat layer thickness. Correlation between deep fat layer thickness and BMI showed similar pattern to that of the total fat layer. Within the different BMI groups, SAT thickness tends to decrease with aging in patients with low BMI. CONCLUSION Inside each age group, the average thickness of the total fat layer increases according to BMI. The results suggest that BMI influences the thickness of SAT throughout life and how SAT changes with age in patients with different BMI. In patients with moderate BMI, the thickness of SAT remains stable.
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Affiliation(s)
- Doris Hexsel
- Brazilian Center for Studies in Dermatology, Porto Alegre, RS, Brazil
| | - Taciana Dal'Forno Dini
- Dermatology Residency Program, Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Luciana Belem
- Fonte Imagem Clinic, Rio de Janeiro, Brazil.,National Cancer Institute, Casa de Saúde São José, Rio de Janeiro, RJ, Brazil
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Papaiordanou F, de-Oliveira GP, Hexsel D, Vattimo ACA. Colágeno e pele: da estrutura às evidências de sua suplementação oral. S&CD 2022. [DOI: 10.5935/scd1984-8773.20221400110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Hexsel D, Valente Bezerra I, Mosena G, Hexsel C. Considerations on zero-degree cellulite. J Cosmet Dermatol 2021; 21:134-136. [PMID: 34773726 DOI: 10.1111/jocd.14598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 10/25/2021] [Accepted: 11/01/2021] [Indexed: 11/27/2022]
Abstract
Cellulite affects almost all women, and it is characterized by surface relief alterations, mainly located on the thighs and buttocks, and other areas. Whereas depressed lesions occur due to the presence of thick subcutaneous fibrous septa that pull the skin surface down, raised areas result from the projection of underlying fat to the skin surface. We support that the absence of cellulite can be defined as the ideal balance between the mechanical forces that act between the subcutaneous structures, such as fat and fibrous septa and muscles, and the overlying skin.
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Affiliation(s)
- Doris Hexsel
- Brazilian Center for Studies in Dermatology, Porto Alegre, Brazil
| | | | - Gabriela Mosena
- Brazilian Center for Studies in Dermatology, Porto Alegre, Brazil
| | - Camile Hexsel
- Brazilian Center for Studies in Dermatology, Porto Alegre, Brazil.,Madison Medical Affiliates, Mohs Surgery, Milwaukee, Wisconsin, USA.,Department of Dermatology, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA
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Suozzi KC, Kibbi N, Lee KC, Worley B, Furlan KC, Kang BY, Ibrahim SA, Poon E, Alam M, Harikumar V, Keimig EL, Alster TS, Bolotin D, Dover JS, Galadari H, Goodman GJ, Hexsel D, Kaminer MS, Kim JYS, Karen J, Lask G, Lewis AB, Maher IA, Paul BC, Negishi K, Touma DJ, Waldman A, Beer K, Bertucci V, Burgess CM, Casabona G, De Boulle KL, Fitzgerald R, Green JB, Goldman MP, Humphrey S, Ibrahim SF, Ibrahimi OA, Jagdeo J, Kim HS, Lawrence N, Marmur E, Matarasso SL, McDonald M, Obagi S, Ortiz AE, Philipp-Dormston WG, Rossi AM, Solish N, Taylor SC, Trindade de Almeida AR, Weinkle SH. Development of Objective Structured Assessment of Technical Skills in Facial Cosmetic Procedures: Botulinum Toxin Neuromodulator and Soft Tissue Filler Injection. J Am Acad Dermatol 2021; 86:463-467. [PMID: 34499988 DOI: 10.1016/j.jaad.2021.08.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Kathleen C Suozzi
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - Nour Kibbi
- Department of Dermatology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Kachiu C Lee
- Main Line Center for Laser Surgery, Philadelphia, PA, USA
| | - Brandon Worley
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Karina C Furlan
- Department of Pathology, Rush University Medical Center, Chicago, IL, USA
| | - Bianca Y Kang
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Sarah A Ibrahim
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Emily Poon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Murad Alam
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Department of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | | | - Vishnu Harikumar
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Emily L Keimig
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Tina S Alster
- Washington Institute of Dermatologic Laser Surgery, Washington, DC, USA
| | - Diana Bolotin
- Section of Dermatology, The University of Chicago, Chicago, IL, USA
| | - Jeffrey S Dover
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA; Department of Dermatology, Alpert Medical School, Brown University, Providence, RI, USA; SkinCare Physicians, Chestnut Hill, MA, USA
| | - Hassan Galadari
- College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
| | - Greg J Goodman
- Monash University, Melbourne, AUA; University College of London, London, UK
| | - Doris Hexsel
- Brazilian Center for Studies in Dermatology, Porto Alegre, GBR
| | - Michael S Kaminer
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA; SkinCare Physicians, Chestnut Hill, MA, USA
| | - John Y S Kim
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Gary Lask
- Department of Dermatology, University of California Los Angeles, Los Angeles, CA, USA; Department of Dermatology, University of Southern California, Los Angeles, CA, USA
| | | | - Ian A Maher
- Department of Dermatology, University of Minnesota Medical School, Minneapolis, MN, USA
| | | | - Kei Negishi
- Institute of Geriatrics, Tokyo Women's Medical University, Tokyo, JPN
| | | | - Abigail Waldman
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Vince Bertucci
- Division of Dermatology, University of Toronto, Toronto, ON, CAN
| | - Cheryl M Burgess
- Center for Dermatology and Dermatologic Surgery, Washington, DC, USA
| | | | | | | | - Jeremy B Green
- Skin Associates of South Florida, Skin Research Institute, Coral Gables, FL, USA
| | - Mitchel P Goldman
- Cosmetic Laser Dermatology, A West Dermatology Company, San Diego, CA, USA
| | - Shannon Humphrey
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, CAN
| | - Sherrif F Ibrahim
- Department of Dermatology, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Jared Jagdeo
- Department of Dermatology, State University of New York, Downstate Health Sciences University, Brooklyn, NY, USA; Dermatology Service, VA New York Harbor Healthcare System-Brooklyn Campus, Brooklyn, NY, USA
| | - Hei Sung Kim
- Department of Dermatology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, KOR
| | - Naomi Lawrence
- Division of Dermatology, Section of Procedural Dermatology, Cooper Hospital, Rowan University, Camden, NJ, USA
| | - Ellen Marmur
- Marmur Medical, Dermatology, New York, NY, USA; Department of Dermatology, The Mount Sinai Medical Center, New York, NY, USA
| | - Seth L Matarasso
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Michel McDonald
- Department of Dermatology, Vanderbilt University, Nashville, TN, USA
| | - Suzan Obagi
- Cosmetic Surgery & Skin Health Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Arisa E Ortiz
- Department of Dermatology, University of California, San Diego Health, La Jolla, CA, USA
| | - Wolfgang G Philipp-Dormston
- Faculty of Health, University Witten/Herdecke, Witten, DEU; Hautzentrum Koeln, Klinik Links vom Rhein, Cologne, DEU
| | - Anthony M Rossi
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA
| | - Nowell Solish
- Division of Dermatology, University of Toronto, Toronto, ON, CAN
| | - Susan C Taylor
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Susan H Weinkle
- Department of Dermatology and Cutaneous Surgery, University of South Florida, Tampa, FL, USA
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Hexsel D, Camozzato F, Valente-Bezerra I, Silva AF, Siega C. L-Lift Technique Using Poly-l-Lactic Acid: A Pilot Study. Dermatol Surg 2021; 47:1087-1092. [PMID: 33988551 DOI: 10.1097/dss.0000000000003064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Minimally invasive procedures that prevent and delay the aging process can be an alternative to more invasive surgical procedures. OBJECTIVE To assess the efficacy and safety of L-Lift technique to improve skin firmness, facial global aesthetics, and the patient and investigator satisfaction. METHODS Prospective, open, single-center study. Thirty participants underwent 3 treatment sessions 1 month apart and were assessed 8, 16, and 24 weeks after first injections. Assessments included the Facial Laxity Rating Scale (FLRS), Global Aesthetic Improvement Scale (GAIS), objective measurement of skin elasticity, and the Skin Distension Test. RESULTS At Week 24, 60% of the patients had at least 1-class improvement in the FLRS for the middle face and 33% for the lower face. At Week 24, investigators considered that 90.0% of the patients improved according to the GAIS and 90.0% of the subjects considered they have improved. Skin elasticity (at Week 8 and at Week 16) and Skin Distension Test (at Week 24) assessments indicated improvement in skin firmness. Both patients and investigators were satisfied with the treatment at the study end. CONCLUSION The technique is safe and efficacious. It may be particularly suitable for patients presenting initial signs of facial skin laxity.
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Affiliation(s)
- Doris Hexsel
- All authors are affiliated with the Brazilian Center for Studies in Dermatology, Porto Alegre, RS, Brazil
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Gotkin RH, Gout U, Sattler S, Piansay-Soriano ME, Wanitphakdeedecha R, Ghannam S, Rossi E, Ferrariz TS, Hexsel D, Frank K, Davidovic K, Sarnoff DS, Cotofana S. Global Recommendations on COVID-19 Vaccines and Soft Tissue Filler Reactions: A Survey-Based Investigation in Cooperation With the International Society for Dermatologic and Aesthetic Surgery (ISDS). J Drugs Dermatol 2021; 20:374-378. [PMID: 33852237 DOI: 10.36849/jdd.2021.6041] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Recent reports have surfaced from the United States Food and Drug Administration hearings in December 2020 regarding the COVID-19 vaccines and study participants who developed facial and/or lip swelling after receiving the newly developed drug. Despite an incidence rate of 0.02% in the vaccine arm of the Moderna mRNA-1273 trial, concerns have been expressed about the association of adverse reactions following soft tissue filler injections and the COVID-19 vaccines. The International Society for Dermatologic and Aesthetic Surgery (ISDS) understands these concerns and has designed the following study. METHODS A global survey was designed to capture the incidence of adverse events related to: (1) previous soft tissue filler injections, (2) soft tissue filler injections during positive testing for COVID-19, and (3) soft tissue filler injections during and after receiving any of the COVID-19 vaccines globally available. RESULTS The information of 106 survey participants from 18 different countries was analyzed. 80.2% (n=85) never experienced any adverse reaction following their soft tissue filler injection whereas 15.1% (n=16) experienced swelling and 4.7% (n=5) experienced pain that lasted longer than two days. Of those who received at least one dose of the COVID-19 vaccine (n=78), 94.9% reported not to have experienced any adverse reaction related to their previous soft tissue filler injection, whereas 5.1% (n=4) reported to have perceived pain that lasted longer than two days. CONCLUSION The data collected does not support the concern for an increased risk of developing adverse reactions following soft tissue filler injections associated with the COVID-19 vaccines compared to that risk associated with other previously described triggers or the default risk following soft tissue filler injections. J Drugs Dermatol. 20(4):374-378. doi:10.36849/JDD.2021.6041.
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Gotkin R, Gout U, Sattler S, Piansay-Soriano M, Wanitphakdeedecha R, Ghannam S, Rossi E, Ferrariz T, Hexsel D, Frank K, Davidovic K, Sarnoff D, Cotofana S. Global Recommendations on COVID-19 Vaccines and Soft Tissue Filler Reactions: A Survey-Based Investigation in Cooperation With the International Society for Dermatologic and Aesthetic Surgery (ISDS). J Drugs Dermatol 2021. [DOI: 10.36849/jdd.6041] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Hexsel D, Dal'Forno T, Camozzato F, Valente I, Soirefmann M, Silva AF, Siega C. Effects of different doses of abobotulinumtoxinA for the treatment of anterior gingival smile. Arch Dermatol Res 2020; 313:347-355. [PMID: 32725500 DOI: 10.1007/s00403-020-02096-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 05/13/2020] [Accepted: 06/17/2020] [Indexed: 10/23/2022]
Abstract
Botulinum toxin type A (BoNT-A) is an easy and fast treatment for gingival smile (GS). The objective of the study was to compare the reduction of gingival exposure using three different doses of abobotulinumtoxinA (ABO) in patients with different severities of anterior GS, and to assess treatment safety and patients' satisfaction. A prospective, single-center, randomized, double-blind study was conducted. Mild GS (2 to < 3 mm) was treated with 2.5 U of abobotulinumtoxinA (ABO) per side, moderate GS (3 to < 4 mm) with 5 U of ABO per side, and severe GS (4 mm or more) with either 2.5 U, or 5 U or 7.5 U of ABO per side. All the 41 enrolled patients completed the study. The mean gingival exposure reduced significantly 4 and 12 weeks after treatment. The average reduction of gingival exposure with 5 U was significantly larger than that obtained with 2.5 U, (3.46 ± 1.39 vs. 2.05 ± 1.29 mm; p = 0.004). All groups of GS severity presented statistically significant reduction in the gingival exposure 4 and 12 weeks after ABO injections. Twelve weeks after treatment, more than 80% of the patients were satisfied or very satisfied. There were no treatment-related adverse events reported by the patients or noticed by the investigators. Gingival smile can be safely and effectively managed with BoNT-A injections and specifically with ABO injections to target the LLSAN muscle. Further and larger studies may determine the exact influence of each factor on BoNT-A treatments of GS.
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Affiliation(s)
- Doris Hexsel
- Brazilian Center for Studies in Dermatology, Dom Pedro II 1592, Porto Alegre, RS, 90550-141, Brazil.
| | - Taciana Dal'Forno
- Brazilian Center for Studies in Dermatology, Dom Pedro II 1592, Porto Alegre, RS, 90550-141, Brazil.,Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Fernanda Camozzato
- Brazilian Center for Studies in Dermatology, Dom Pedro II 1592, Porto Alegre, RS, 90550-141, Brazil
| | - Indira Valente
- Brazilian Center for Studies in Dermatology, Dom Pedro II 1592, Porto Alegre, RS, 90550-141, Brazil
| | - Mariana Soirefmann
- Brazilian Center for Studies in Dermatology, Dom Pedro II 1592, Porto Alegre, RS, 90550-141, Brazil
| | - Aline Flor Silva
- Brazilian Center for Studies in Dermatology, Dom Pedro II 1592, Porto Alegre, RS, 90550-141, Brazil
| | - Carolina Siega
- Brazilian Center for Studies in Dermatology, Dom Pedro II 1592, Porto Alegre, RS, 90550-141, Brazil
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Arruda S, Hexsel D, Lim T, Waldorf H, Artzi O, Choi W, Ghana S, Gaomin H, Ho W, Puyat M, Rossi E, Shamban A, Sattler S, Sadick N. Recommendations for Dermatology Office Reopening in the Era of COVID-19. J Drugs Dermatol 2020; 19:e1-e9. [DOI: 10.36849/jdd.2020.5293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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16
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Cotofana S, Hexsel D, E.T. Avelar L, Munia C, Muniz M, Casabona G, Schenck T, Green J, Lachman N, Frank K. Calculating the Thickness of the Superficial Fatty Layer of the Body Using Age, Gender, and Body Mass Index. J Drugs Dermatol 2019; 19:36-44. [DOI: 10.36849/jdd.2020.4619] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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17
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Piquero-Casals J, Hexsel D, Mir-Bonafé JF, Rozas-Muñoz E. Topical Non-Pharmacological Treatment for Facial Seborrheic Dermatitis. Dermatol Ther (Heidelb) 2019; 9:469-477. [PMID: 31396944 PMCID: PMC6704200 DOI: 10.1007/s13555-019-00319-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Indexed: 11/26/2022] Open
Abstract
Facial seborrheic dermatitis (FSD) is a chronic and relapsing inflammatory skin disorder occurring in areas of the face rich in sebaceous glands. It clinically manifests as erythematous scaly macules or plaques, often associated with pruritus. Although the pathogenesis of seborrheic dermatitis is not yet fully understood, Malassezia yeast, hormones, sebum levels, and immune response are known to play important roles. Additional factors including drugs, cold temperatures, and stress may exacerbate the condition. Currently, the available treatments do not cure the disease but relieve symptoms. Various pharmacological treatments are available, including antifungal agents, keratolytics, topical low-potency steroids, and calcineurin inhibitors. All of them provide several benefits, but they also have potential side effects. Seborrheic dermatitis tends to have a chronic, recurrent course. To avoid the long-term use of drugs, topical non-pharmacological products such as cosmetics or medical devices may improve clinical outcomes. Products with antimicrobial and anti-inflammatory ingredients such as zinc, piroctone olamine, dihydroavenanthramide, biosaccharide gum-2, and stearyl glycyrrhetinate may speed FSD recovery and avoid flare-ups. Finally, the use of specific cleansers, moisturizers, and sunscreens formulated as light creams or gel/creams should be strongly recommended to all FSD patients. We provide a brief review of the most used non-pharmacological cleansers, topical gel/creams, and specific sunscreens in the management of FSD.
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Affiliation(s)
- Jaime Piquero-Casals
- Department of Dermatology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain.
| | - Doris Hexsel
- Brazilian Center for Studies in Dermatology, Porto Alegre, RS, Brazil
| | | | - Eduardo Rozas-Muñoz
- Department of Dermatology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
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Hedén P, Hexsel D, Cartier H, Bergentz P, Delmar H, Camozzato F, Siega C, Skoglund C, Edwartz C, Norberg M, Kestemont P. Effective and Safe Repeated Full-Face Treatments With AbobotulinumtoxinA, Hyaluronic Acid Filler, and Skin Boosting Hyaluronic Acid. J Drugs Dermatol 2019; 18:682-689. [PMID: 31334927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background: It is important to study full-face aesthetic combination treatments to establish well-founded individual treatment plans. Objective: To evaluate clinical outcome and perception of treatment with either abobotulinumtoxinA (ABO) or hyaluronic acid (HA) filler followed by repeated combined treatment with ABO, HA filler, and Restylane® Skinboosters (RSB). Methods & Materials: This study was conducted at four sites in Sweden, France, and Brazil and included subjects aged 35-50 years with mild/moderate nasolabial folds and moderate/severe upper facial lines. Monotherapy was ≤125 s.U ABO in at least two upper facial indications with optional touch-up or ≤1 mL HA filler in nasolabial folds/cheeks. At months 6 and 12, both cohorts received ≤125 s.U. ABO in upper facial lines with optional touch-up, ≤2 mL HA filler in nasolabial folds/cheeks (and other facial areas as applicable), and ≤1 mL RSB. Assessments included global facial aesthetic appearance and improvement, first impression, perceived age, wrinkle severity, satisfaction questionnaires, and adverse events. Results: Repeated full-face treatment with ABO, HA filler, and RSB was associated with better aesthetic outcome and higher levels of satisfaction than treatment with ABO or HA filler alone. However, even modest volumes of HA filler achieved good aesthetic outcomes and high satisfaction. Treatment of several indications was well tolerated. Conclusion: Aesthetic improvement and subject satisfaction was high and increased with each treatment. All treatments were well tolerated. These data may be used as support when establishing individual treatment plans. J Drugs Dermatol. 2019;18(7):682-689.
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Wambier CG, Wambier SPDF, Hexsel D. Injectable poly-L-lactic acid: Instant hydration in lukewarm water bath and use of a thin needle to filter particles. J Am Acad Dermatol 2018; 79:e3-e4. [PMID: 29274794 DOI: 10.1016/j.jaad.2017.12.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 12/13/2017] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Doris Hexsel
- Brazilian Center for Studies in Dermatology, Rio de Janeiro and Porto Alegre, Brazil; Hexsel Dermatologic Clinics, Rio de Janeiro and Porto Alegre, Brazil
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Hexsel D, Zague V, Schunck M, Siega C, Camozzato FO, Oesser S. Oral supplementation with specific bioactive collagen peptides improves nail growth and reduces symptoms of brittle nails. J Cosmet Dermatol 2017; 16:520-526. [DOI: 10.1111/jocd.12393] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Doris Hexsel
- Brazilian Center for Studies in Dermatology; Porto Algre Brazil
| | - Vivian Zague
- Department of Cell and Developmental Biology; Institute of Biomedical Sciences; University of São Paulo; São Paulo Brazil
| | | | - Carolina Siega
- Brazilian Center for Studies in Dermatology; Porto Algre Brazil
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Hexsel D, Hexsel CL, Dal'Forno T, Schilling de Souza J, Silva AF, Siega C. Standardized methods for photography in procedural dermatology using simple equipment. Int J Dermatol 2017; 56:444-451. [PMID: 28197993 DOI: 10.1111/ijd.13500] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 08/02/2016] [Accepted: 09/20/2016] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Doris Hexsel
- Brazilian Center for Studies in Dermatology, Porto Alegre, Brazil
| | - Camile L Hexsel
- Brazilian Center for Studies in Dermatology, Porto Alegre, Brazil.,Madison Medical Affiliates, Glendale and Waukesha, WI, USA
| | - Taciana Dal'Forno
- Brazilian Center for Studies in Dermatology, Porto Alegre, Brazil.,Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Aline F Silva
- Brazilian Center for Studies in Dermatology, Porto Alegre, Brazil
| | - Carolina Siega
- Brazilian Center for Studies in Dermatology, Porto Alegre, Brazil
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Affiliation(s)
- Doris Hexsel
- Brazilian Center for Studies in Dermatology, Porto Alegre, RS, Brazil
| | | | - Aline Flor Silva
- Brazilian Center for Studies in Dermatology, Porto Alegre, RS, Brazil
| | - Carolina Siega
- Brazilian Center for Studies in Dermatology, Porto Alegre, RS, Brazil
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Hexsel D, Camozzato FO, Silva AF, Siega C. Evaluation of the effects of acoustic wave therapy on keloids. Surgical & Cosmetic Dermatology 2017. [DOI: 10.5935/scd1984-8773.201792969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Hexsel D, Dini TD, Souza JSD, Siega C. Rejuvenation of aging hands with a hyaluronic acid soft tissue filler range: efficacy, safety and patient satisfaction during six months. Surgical & Cosmetic Dermatology 2017. [DOI: 10.5935/scd1984-8773.2017941014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Hexsel D. Evidence-based review of botulinum toxin injections for aesthetic use. Toxicon 2016. [DOI: 10.1016/j.toxicon.2016.11.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hexsel D, Caspary P, Camozzato FO, Silva AF, Siega C. Reduction of body measures after a nine-session protocol with Low Level
Laser Therapy. Surgical & Cosmetic Dermatology 2016. [DOI: 10.5935/scd1984-8773.201683891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Alam M, Bolotin D, Carruthers J, Hexsel D, Lawrence N, Minkis K, Ross EV. Consensus statement regarding storage and reuse of previously reconstituted neuromodulators. Dermatol Surg 2015; 41:321-6. [PMID: 25705950 DOI: 10.1097/dss.0000000000000303] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Legacy recommendations suggest that vials of botulinum toxin be used within 24 hours of reconstitution and in a single patient. Current standard of care is consistent with storage after reconstitution and use of a single vial for several patients. OBJECTIVE To develop expert consensus regarding the effectiveness and safety of storage and reuse of botulinum toxin. MATERIALS AND METHODS The American Society for Dermatologic Surgery authorized a task force of content experts to review the literature and provide guidance. Data extraction was followed by clinical question review, a consensus Delphi process, and validation of the results by peer review. RESULTS After 2 rounds of Delphi process, the task force concluded by unanimous consensus and with the highest level of confidence that a vial of toxin reconstituted appropriately can, for facial muscle indications, be (1) refrigerated or refrozen for at least 4 weeks before injection without significant risk for contamination or decreased effectiveness and (2) used to treat multiple patients, assuming appropriate handling. CONCLUSION The standard of care, which allows for use of botulinum toxin more than 24 hours after reconstitution and in more than 1 patient per vial, is appropriate and consistent with the safe and effective practice of medicine.
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Affiliation(s)
- Murad Alam
- Departments of *Dermatology, †Otolaryngology, and ‡Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; §Section of Dermatology, University of Chicago Medicine, Chicago, Illinois; ‖Department of Ophthalmology, University of British Columbia, Vancouver, BC, Canada; ¶Department of Dermatology, Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil; #Brazilian Center for Studies in Dermatology, Porto Alegre, Brazil; **Division of Dermatology, Cooper University Hospital Medical Center, Marlton, New Jersey; ††Department of Dermatology, Weill Cornell Medical College, Cornell University, New York, New York; ‡‡Division of Dermatology, Scripps Clinic, San Diego, California
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Affiliation(s)
- Marina de Morais
- Brazilian Center for Studies in Dermatology, Porto Alegre, RS, Brazil
| | - Doris Hexsel
- Brazilian Center for Studies in Dermatology, Porto Alegre, RS, Brazil
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Hexsel D, Soirefmann M, Porto MD, Schilling-Souza J, Siega C, Dal'Forno T. Superficial Dermabrasion Versus Topical Tretinoin on Early Striae Distensae: A Randomized, Pilot Study. Dermatol Surg 2014; 40:537-44. [DOI: 10.1111/dsu.12460] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hexsel D, Soirefmann M, Fernandes JD, Siega C. Objective assessment of erythema and pigmentation of melasma lesions and surrounding areas in long-term management regimens with triple combination. J Drugs Dermatol 2014; 13:444-448. [PMID: 24719064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Melasma has a negative impact on quality of life since it typically occurs on the face. OBJECTIVES To evaluate the erythema and pigmentation of melasma lesions and the surrounding areas in patients receiving triple combination (TC: hydroquinone, tretinoin, and fluocinolone acetonide) regimens. METHODS Patients first received an 8-week daily TC treatment and were then randomized to twice weekly or tapering regimen with TC. Melanin and erythema levels of lesions and surrounding areas were objectively measured using a narrowband reflectance spectrophotometer. RESULTS Progressive reduction in the mean melanin levels was observed in the treatment phase. Following both maintenance regimens, there was no difference between melanin levels in the melasma lesions. Adverse effects were rare in both phases of the study and there was borderline reduction in erythema with regimen II. CONCLUSION Both maintenance regimens were effective in maintaining results obtained during the initial treatment phase, and were safe and well-tolerated. Erythema was less intense with the tapering regimen.
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Hexsel D, Hexsel C, Porto M, Siega C. Triple combination as adjuvant to cryotherapy in the treatment of solar lentigines: investigator-blinded, randomized clinical trial. J Eur Acad Dermatol Venereol 2014; 29:128-33. [DOI: 10.1111/jdv.12484] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 02/25/2014] [Indexed: 11/29/2022]
Affiliation(s)
- D. Hexsel
- Brazilian Center for Studies in Dermatology; Porto Alegre Brazil
| | - C. Hexsel
- Brazilian Center for Studies in Dermatology; Porto Alegre Brazil
| | - M.D. Porto
- Brazilian Center for Studies in Dermatology; Porto Alegre Brazil
| | - C. Siega
- Brazilian Center for Studies in Dermatology; Porto Alegre Brazil
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Hexsel D, Hexsel C, Siega C, Schilling-Souza J, Rotta FT, Rodrigues TC. Fields of effects of 2 commercial preparations of botulinum toxin type A at equal labeled unit doses: a double-blind randomized trial. JAMA Dermatol 2014; 149:1386-91. [PMID: 24108521 DOI: 10.1001/jamadermatol.2013.6440] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
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.
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Affiliation(s)
- Doris Hexsel
- Cosmetic Dermatology, Department of Dermatology, Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil 2Brazilian Center for Studies in Dermatology, Porto Alegre, Brazil
| | - Camile Hexsel
- Brazilian Center for Studies in Dermatology, Porto Alegre, Brazil
| | - Carolina Siega
- Brazilian Center for Studies in Dermatology, Porto Alegre, Brazil
| | | | | | - Ticiana C Rodrigues
- Brazilian Center for Studies in Dermatology, Porto Alegre, Brazil4Internal Medicine Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Hexsel D, Siega C, Schilling-Souza J, Porto MD, Rodrigues TC. A Comparative Study of the Anatomy of Adipose Tissue in Areas with and without Raised Lesions of Cellulite Using Magnetic Resonance Imaging. Dermatol Surg 2013; 39:1877-86. [DOI: 10.1111/dsu.12360] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hexsel D, Brum C, Porto MD, Soirefmann M, Siega C, Schilling-Souza J, Rodrigues TC. Full-face injections of variable total doses of abobotulinum toxin type A: A randomized, phase IV clinical trial of safety and efficacy. J Drugs Dermatol 2013; 12:1356-1362. [PMID: 24301236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Botulinum toxin type A (BoNT-A) has been used for almost 20 years in cosmetic dermatology to reduce dynamic wrinkles on single or multiple facial areas. OBJECTIVE To evaluate the safety and efficacy of full-face treatments with various total doses of abobotulinum toxin A (ABO). METHODS A total of 90 participants were enrolled. Subjects had at least two indications for BoNT-A treatments on each third of the face (upper, middle and lower). They were randomized into 3 groups, with pre-defined total dose range of ABO, varying from 120 to 250 U. RESULTS Most of the subjects were women (96.5%). The statistically significant improvement from baseline lasted for more than 24 weeks for glabellar lines, and more than 16 weeks for forehead wrinkles and crow's feet, all P<0.001, with no differences between groups. The most frequent adverse event (excessive perioral weakness) was related to high dose in the perioral area. CONCLUSIONS This is the first study to compare safety and efficacy of different doses of ABO administered to the entire face simultaneously. As long as the recommended doses are used, concomitant injections of ABO are safe and efficient, with no increase in adverse events.
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Hexsel D, Brum C, Porto MD, Soirefmann M, Siega C, Schilling-Souza J, Rodrigues TC. Quality of life and satisfaction of patients after full-face injections of abobotulinum toxin type A: A randomized, phase IV clinical trial. J Drugs Dermatol 2013; 12:1363-1367. [PMID: 24301237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Although botulinum toxin type A (BoNT-A) has been used effectively and safely to reduce facial dynamic wrinkles, few studies assessed patients' quality of life and satisfaction after treatment. OBJECTIVE To assess the quality of life and satisfaction of patients treated with full-face injections of variable doses of abobotulinum toxin A (ABO). METHODS Ninety subjects were randomized into 3 different groups, receiving 120-165 U, 166-205 U and 206-250 U, respectively. WHOQOL- BREF and Satisfaction and Self-assessment Questionnaire (SSQ) were completed by subjects up to 6 months after treatment. RESULTS Most of the subjects were women (96.5%). For the physical domain in WHOQOL, a difference was observed between baseline and visit 2 (p = 0.036). There was no difference between groups for mean grades regarding amount of wrinkles, beauty, harmony and symmetry. However, there was a significant difference in the mean grades between visits. Patients' opinions also showed an improvement in their self-image up to four months after treatment, according to the self-grading. CONCLUSION The results presented in this study show improvements in patients' quality of life during the peak of action of BoNT-A treatment, regarding the physical aspect. In addition, patients reported good satisfaction after a full-face approach.
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Hexsel D, Lacerda DA, Cavalcante AS, Filho CASM, Kalil CLPV, Ayres EL, Azulay-Abulafia L, Weber MB, Serra MS, Lopes NFP, Cestari TF. Epidemiology of melasma in Brazilian patients: a multicenter study. Int J Dermatol 2013; 53:440-4. [DOI: 10.1111/j.1365-4632.2012.05748.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Doris Hexsel
- Cosmetic Dermatology at the Department of Dermatology; Pontificia Universidade Catolica do Rio Grande do Sul; Porto Alegre RS
- Brazilian Center for Studies in Dermatology; Porto Alegre RS
| | - Davi A. Lacerda
- Hospital Local de Sapopemba e Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo; São Paulo SP
| | | | | | | | | | - Luna Azulay-Abulafia
- Dermatology Service; Santa Casa de Misericórdia do Rio de Janeiro; Rio de Janeiro RJ
| | - Magda B. Weber
- Department of Dermatology; Universidade Federal de Ciências da Saúde de Porto Alegre; RS
| | - Marcio S. Serra
- Department of Dermatology of the Gaffrèe & Guinle University Hospital; Universidade Federal do Estado do Rio de Janeiro; Rio de Janeiro RJ
| | | | - Tania F. Cestari
- Service of Dermatology; Hospital de Clinicas de Porto Alegre; UFRGS; Porto Alegre RS Brazil
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Hexsel D, Brum C, Siega C, Schilling-Souza J, Forno TD, Heckmann M, Rodrigues TC. Evaluation of Self-Esteem and Depression Symptoms in Depressed and Nondepressed Subjects Treated with OnabotulinumtoxinA for Glabellar Lines. Dermatol Surg 2013; 39:1088-96. [DOI: 10.1111/dsu.12175] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hexsel D, Siega C, Schilling-Souza J, Oliveira DHD. Noninvasive treatment of cellulite utilizing an expedited treatment protocol with a dual wavelength laser-suction and massage device. J COSMET LASER THER 2013; 15:65-9. [DOI: 10.3109/14764172.2012.759237] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hexsel D, Soirefmann M, Donida Porto M, Siega C, Schilling-Souza J, Brum C. Double-Blind, Randomized, Controlled Clinical Trial to Compare Safety and Efficacy of a Metallic Cannula with that of a Standard Needle for Soft Tissue Augmentation of the Nasolabial Folds. Dermatol Surg 2012; 38:207-14. [DOI: 10.1111/j.1524-4725.2011.02195.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hexsel D, Brum C, do Prado DZ, Soirefmann M, Rotta FT, Dal'Forno T, Rodrigues TC. Field effect of two commercial preparations of botulinum toxin type A: a prospective, double-blind, randomized clinical trial. J Am Acad Dermatol 2011; 67:226-32. [PMID: 22041253 DOI: 10.1016/j.jaad.2011.08.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 08/17/2011] [Accepted: 08/19/2011] [Indexed: 11/16/2022]
Abstract
BACKGROUND The dose equivalence of commonly used commercial preparations of botulinum toxin type A, Dysport (abotulinumtoxinA [ABO] 500 U, Ipsen Biopharm Limited, Wrexham, United Kingdom) and Botox (onabotulinumtoxinA [ONA] 100 U, Allergan, Irvine, CA), remains unclear. OBJECTIVE We sought to evaluate the field effect for ABO and ONA at dose equivalences of 2.5:1.0 U and 2.0:1.0 U, in both muscular and sweat gland activity. METHODS In all, 59 female patients with forehead wrinkles were enrolled. Patients were randomized for dose equivalence between ABO and ONA, group A (2.0:1.0 U, ABO:ONA) or group B (2.5:1.0 U, ABO:ONA) administered in the frontalis muscles. Clinical assessment, Minor test, and electromyography evaluations were performed at baseline, 28 days, and 112 days. RESULTS In group B, the field of anhidrotic effect of ABO showed a greater area and larger horizontal diameter than ONA at 28 and 112 days. At maximum frontalis muscle activity (day 112) patients receiving ABO demonstrated greater improvement based on the Wrinkle Severity Scale. No differences were found in frontalis muscle activity at rest between groups A and B based on results of Wrinkle Severity Scale, electromyography, and interindividual variability data at 28 and 112 days. LIMITATIONS Currently, there are no objective measurements other than electromyography to evaluate the field effect of botulinum toxin type A in muscles. CONCLUSION At a dose equivalence of 2.0:1.0 U (ABO:ONA), similar field effects were found for both muscle and sweat gland activity. At a higher dose equivalence of 2.5:1.0 U (ABO:ONA), injections of ABO showed greater area and larger horizontal diameter in field of anhidrotic effect at 28 and 112 days than ONA.
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Affiliation(s)
- Doris Hexsel
- Brazilian Center for Studies in Dermatology, Porto Alegre, Brazil.
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Arellano I, Cestari T, Ocampo-Candiani J, Azulay-Abulafia L, Bezerra Trindade Neto P, Hexsel D, Machado-Pinto J, Muñoz H, Rivitti-Machado M, Sittart J, Trindade de Almeida A, Rego V, Paliargues F, Marques-Hassun K. Preventing melasma recurrence: prescribing a maintenance regimen with an effective triple combination cream based on long-standing clinical severity. J Eur Acad Dermatol Venereol 2011; 26:611-8. [DOI: 10.1111/j.1468-3083.2011.04135.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ascher B, Talarico S, Cassuto D, Escobar S, Hexsel D, Jaén P, Monheit GD, Rzany B, Viel M. International consensus recommendations on the aesthetic usage of botulinum toxin type A (Speywood Unit) - part II: wrinkles on the middle and lower face, neck and chest. J Eur Acad Dermatol Venereol 2010; 24:1285-95. [DOI: 10.1111/j.1468-3083.2010.03728.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ascher B, Talarico S, Cassuto D, Escobar S, Hexsel D, Jaén P, Monheit GD, Rzany B, Viel M. International consensus recommendations on the aesthetic usage of botulinum toxin type A (Speywood Unit) - part I: upper facial wrinkles. J Eur Acad Dermatol Venereol 2010; 24:1278-84. [DOI: 10.1111/j.1468-3083.2010.03631.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hexsel D, Spencer JM, Woolery-Lloyd H, Gilbert E. Practical applications of a new botulinum toxin. J Drugs Dermatol 2010; 9:s31-s37. [PMID: 20361474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The injection of Clostridium botulinum type A neurotoxins is among the most commonly performed cosmetic procedures, both in the U.S. and worldwide. The U.S. Food and Drug Administration (FDA) approval of a new botulinum neurotoxin type A in April 2009 (BoNT-A, Dysport, Medicis, Scottsdale, AZ-hereafter referred to as "Dysport") has broadened the neurotoxin market and provides new therapeutic alternatives to practitioners. The introduction of this product raises questions about how to best use it. In this supplement, the authors address critical similarities and differences between onabotulinumtoxinA (Botox, Allergan, Irvine, CA--hereafter referred to as "Botox") and abobotulinumtoxinA (Dysport). The authors also provide practical guidelines for the use of Dysport based on clinical experience and peer-reviewed, published clinical trials. In the authors' opinion, Botox and Dysport can be used for similar "on-" and "off-label" applications. Judicious use of either product requires an understanding of how the two products differ in order to avoid side effects and achieve optimal results. Common Questions: Are these two toxins the same or different and how? How are inter-product "unit" conversions addressed? Does injection technique differ? Does one product result in greater adverse events? Does one product last longer or "diffuse" better than the other? What other toxins can be expected on the market in the future?
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Affiliation(s)
- Doris Hexsel
- Department of Dermatology at the Pontificia Universidade Catolica do Rio Grande do Sul, Brazil.
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Kane M, Donofrio L, Ascher B, Hexsel D, Monheit G, Rzany B, Weiss R. Expanding the use of neurotoxins in facial aesthetics: a consensus panel's assessment and recommendations. J Drugs Dermatol 2010; 9:s7-s25. [PMID: 20919448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Injection of botulinum toxin type A (BoNTA) is the most common nonsurgical aesthetic procedure undertaken in the United States (U.S.). A new formulation of BoNTA (abobotulinumtoxinA, Dysport™) has recently been approved in the U.S. for the treatment of glabellar lines. This product has been used for facial aesthetics in other parts of the world for more than 15 years, whereas in the U.S. a different formulation (onabotulinumtoxinA, Botox® Cosmetic) has been used for many years. The various formulations of neurotoxins are unique and are not interchangeable nor are doses convertible from one product to another, so it is important that recommendations be developed to assist U.S. clinicians in understanding the differences between the two available formulations of BoNTA, which should ensure successful outcomes with these products. A group of worldwide experts on the aesthetic use of BoNTA convened in February 2009 in New York, NY, to review the use of BoNTA and to develop consensus recommendations for the use of the new formulation, since such guidelines previously had only been published in German. This publication summarizes key discussions from the meeting as well as recommendations and suggestions regarding the use of abobotulinumtoxinA in the areas of the face most commonly treated with BoNTA.
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Abstract
OBJECTIVE/AIM To examine approaches to therapy for melasma in Latin Americans and to propose treatment algorithms for patients with mild, moderate and severe melasma. BACKGROUND Melasma is prevalent in up to 10% of the Latin American population. It is found in all racial groups and is more common in subjects with darker skin phototypes. A number of topical treatments and procedures have been used for melasma. Topical treatments containing hydroquinone are the most popular. Care must be taken when treating melasma to avoid inducing post-inflammatory hyperpigmentation and ochronosis. Determination of the severity of melasma (using the Melasma Area Severity Index and/or Physician's Global Assessment) and choice of the most effective and suitable treatment and/or procedure for individual patients is therefore essential. Sun protection is mandatory for all melasma patients. METHODS Thirty-one clinical studies of topical treatments, chemical peels and laser and other therapies used for treating melasma were assessed for the level and quality of clinical evidence, by the Latin American Pigmentary Disorders Academy. The results of this analysis were combined with differential diagnosis guidelines and methods for assessing treatment success to establish algorithms for treating mild and moderate-to-severe melasma. RESULTS The most appropriate first-line treatment for mild melasma is hydroquinone 4%, triple combination cream containing hydroquinone 4%, tretinoin 0.05% and fluocinolone acetate 0.01%, double combination (e.g. 4% hydroquinone and 0.1% tretinoin) or non-phenolic therapy where there is an allergy to compounds. In moderate-to-severe melasma, triple combination cream is the recommended first-line treatment. Second-line treatment is double combination or hydroquinone 4% where triple therapy is not available or if allergic to compounds. Sun avoidance measures and broad spectrum sunscreens with high SPF are fundamental for the successful management of the disease.
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Affiliation(s)
- T Cestari
- University of Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Brazil.
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Ortonne JP, Arellano I, Berneburg M, Cestari T, Chan H, Grimes P, Hexsel D, Im S, Lim J, Lui H, Pandya A, Picardo M, Rendon M, Taylor S, Van Der Veen JPW, Westerhof W. A global survey of the role of ultraviolet radiation and hormonal influences in the development of melasma. J Eur Acad Dermatol Venereol 2009; 23:1254-62. [DOI: 10.1111/j.1468-3083.2009.03295.x] [Citation(s) in RCA: 127] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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