Tunis Med. 2008 Oct; 86(10): 895-8Khaled A, Ben Mbarek L, Zeglaoui F, Ezzine N, Fazaa B, Kamoun MRBACKGROUND: The aging of the population in the developed world is an accepted fact. Consequently, the number of aged patients with cutaneous cancer will increase in coming years. OBJECTIVE: The objective was to determine the nature of skin cancer occurring in elderly patients. METHODS: We retrospectively assessed all patients of 65 years of age and over, with histologically documented skin cancer, in the department of Dermatology of Charles Nicolle hospital of Tunis between 2000 and 2005. We studied sex, age and the type of tumours. RESULTS: 246 patients aged 65 years and over and presenting cutaneous cancers were collected. They represented 57.34% of all cutaneous cancers. The average age was 73 years with a majority (91.46%) between 70 and 85 years. Sex-ratio M/F was 1.82. Basal cell carcinoma (BCC) represented 68.2% of all cutaneous cancers in aged persons and 53.84% of all BCC independently of age. Squamous cell carcinoma (SCC) represented 23.5% of all cutaneous cancers in aged persons and 67.44% of all SCC independently of age. Eight cases (3.25%) of melanomas in aged persons were collected, representing 61.53% of the 13 cases of melanoma during these 5 previous years, independently of age. CONCLUSION: More than half of the collected cutaneous cancers during these 5 previous years have occurred in aged persons with a majority between the ages of 70 and 85 years. This is explained by a higher life expectancy in Tunisia. Through this study we conclude that the geriatric patient is at a high risk of developing cutaneous neoplasms especially carcinomas.

Psychol Health Med. 2009 May; 14(3): 273-9Sherr L, Harding R, Lampe F, Johnson M, Anderson J, Zetler S, Fisher M, Arthur G, Norwood S, Leake-Date H, Edwards SScant attention has been paid to the effects of ageing and HIV. This study examined age distribution and explored the impact of age on the experience of illness. One thousand and seven consecutive attenders at five UK HIV clinics were approached, 904 met inclusion criteria and 778 agreed to participate (86% response rate). They provided detailed information on demographics, experience of illness, physical and psychological symptoms, quality of life, treatment experience and doctor-patient communications. Twelve percent were aged over 50. There were significantly more males in the over 50s (86% vs. 75%), more gay males x(2) = 7, p = 0.04 and fewer females (14% vs. 25%) x(2) = 5; p = 0.03. No significant differences were found on measures of education, employment or migration status or physical symptom experience. The older group had significantly lower psychological and global burden scores and were more likely to take antiretrovirals (88% vs. 79%; p = 0.04). Triggers for treatment switching showed older participants significantly less burdened by food restrictions, pill burden, taste, nausea, diarrhoea, sleep disturbance, concentration problems, anxiety depression, skin rashes, liver complaints or a need for a simpler regimen. The older group were similar in employment, education and disclosure, but complained less and reported much higher tolerance.

Br J Dermatol. 2009 Mar 28; Valet F, Ezzedine K, Malvy D, Mary JY, Guinot CSummary Background Photographic severity scales depicting facial wrinkling are used extensively to assess the severity of skin ageing features, but they have been poorly investigated for their reproducibility. Objectives To investigate the reproducibility of ordinal scales depicting four skin ageing features illustrated by reference photographs. Methods A set of 253 images of caucasian women's faces was evaluated independently by four dermatologists using four different skin ageing severity scales: Larnier's overall photodamage, expression lines, glabellar frown lines, and wrinkles under the eyes. For each pair of dermatologists, degree of agreement was estimated using the weighted kappa statistic and degrees of distinguishability between adjacent categories along these scales were estimated using a recently developed log-linear method. Results The kappa statistic highlighted substantial degrees of agreement between dermatologists for the glabellar frown lines scale, and the log-linear method did not evidence any scale defect. For the three other scales, only fair to moderate degrees of agreement were observed between dermatologists. In addition, difficulties in distinguishing between some adjacent categories were evidenced. Conclusions The glabellar frown lines scale is a reproducible tool for assessment of the severity of facial wrinkling. The other scales should be redefined to improve their reproducibility, and therefore their quality, in future studies.

Exp Eye Res. 2009 Jun; 88(6): 1043-50van Deemter M, Ponsioen TL, Bank RA, Snabel JM, van der Worp RJ, Hooymans JM, Los LIThe human vitreous body undergoes structural changes with aging. This can be followed by a posterior vitreous detachment, which can result in ocular pathology. As in many collagenous tissues, age-related changes in the vitreous could be caused by the formation of advanced glycation end products (AGEs). The goal of this study was to find out whether the AGE pentosidine accumulates in the human vitreous with aging. With this data we were able to estimate the half-life of vitreous collagen. Furthermore, we analyzed whether there was a gender difference in pentosidine accumulation, as this was seen in other tissues as well. Using high performance liquid chromatography, pentosidine contents were determined in whole vitreous bodies and in separate parts of vitreous bodies, which were all obtained from human donor eyes. Our results show that pentosidine accumulates in the human vitreous. From the rate of accumulation we could roughly estimate that vitreous collagen has as a similar or shorter half-life compared to skin collagen. This supports the concept of collagen turnover in the vitreous. In general, the female vitreous experiences a faster pentosidine accumulation than the male vitreous, and most of the pentosidine accumulation in the former occurs after 50 years of age.

Int J Cosmet Sci. 2009 May 20; Borkow G, Gabbay J, Lyakhovitsky A, Huszar MSynopsis Copper plays a key role in several processes of skin formation and regeneration. Copper has been shown to be absorbed through intact skin. We hypothesized that sleeping on fabrics containing copper-impregnated fibres would have a positive cosmetic effect on the skin. The aim of this study was to confirm our hypothesis. A 4-week, double blind, parallel, randomized study was carried out in which 57 volunteers aged 40-60 years used either copper oxide containing pillowcases (0.4% weight/weight) or control pillowcases not containing copper. Photographs were taken by a professional photographer of each participant at the beginning of the study and at 2 and 4 weeks after the commencement of the study. Two expert graders (a dermatologist and a cosmetologist) evaluated the pictures for the effect on several cosmetic facial skin characteristics. The copper-containing pillowcases had a positive effect for the following facial characteristics: reduction of wrinkles (P < 0.001) and crow's feet/fine lines (P < 0.001) and improvement of general appearance (P < 0.001) at both 2 and 4 weeks. The differences were statistically significant (Wilcoxon scores and chi-squared tests). Consistent sleeping for 4 weeks on copper oxide containing pillowcases caused a significant reduction in the appearance of facial wrinkles and crow's feet/fine lines and significant improvement in the appearance of facial skin. In most trial participants, this effect was already noticeable within 2 weeks of using the copper oxide containing pillowcases.

PLoS ONE. 2009; 4(5): e5488Piwko-Czuchra A, Koegel H, Meyer H, Bauer M, Werner S, Brakebusch C, Fässler RBACKGROUND: There is a major discrepancy between the in vitro and in vivo results regarding the role of beta1 integrins in the maintenance of epidermal stem/progenitor cells. Studies of mice with skin-specific ablation of beta1 integrins suggested that epidermis can form and be maintained in their absence, while in vitro data have shown a fundamental role for these adhesion receptors in stem/progenitor cell expansion and differentiation. METHODOLOGY/PRINCIPAL FINDINGS: To elucidate this discrepancy we generated hypomorphic mice expressing reduced beta1 integrin levels on keratinocytes that developed similar, but less severe defects than mice with beta1-deficient keratinocytes. Surprisingly we found that upon aging these abnormalities attenuated due to a rapid expansion of cells, which escaped or compensated for the down-regulation of beta1 integrin expression. A similar phenomenon was observed in aged mice with a complete, skin-specific ablation of the beta1 integrin gene, where cells that escaped Cre-mediated recombination repopulated the mutant skin in a very short time period. The expansion of beta1 integrin expressing keratinocytes was even further accelerated in situations of increased keratinocyte proliferation such as wound healing. CONCLUSIONS/SIGNIFICANCE: These data demonstrate that expression of beta1 integrins is critically important for the expansion of epidermal progenitor cells to maintain epidermal homeostasis.

Arch Dermatol Res. 2009 May 23; Lee YM, Kim YK, Eun HC, Chung JHS100A8, a calcium-binding protein, is associated with keratinocyte differentiation, inflammation and wound healing. S100A8 is induced by various skin stresses and diseases, which suggests that S100A8 plays a role in those processes. However, it has not been reported how the expression of S100A8 is affected during skin aging or whether S100A8 plays a role in the skin aging process. In this study, we investigated the changes in S100A8 mRNA and protein following acute UV irradiation to human buttock skin and by intrinsic aging and photoaging in human sun-protected (upper-inner arm) and sun-exposed (forearm) skin of elderly subjects. Real-time PCR, western blot and immunohistochemical staining analyses of UV-irradiated young buttock skin revealed that S100A8 protein expression was increased at 24 h (3.0-fold) and 48 h (4.4-fold) after UV irradiation. S100A8 mRNA and protein were more highly expressed by 2.3- and 4.0-fold, respectively, in the sun-protected skin of elderly people than in that of young people. In addition, the sun-exposed skin of elderly expressed more S100A8 mRNA and protein than the sun-protected skin of the same individuals. In immunohistochemical staining, facial (photoaged) skin >/=72 years showed higher epidermal expression of S100A8 than that of the other age groups. Based on the above results, our data suggest that the expression of S100A8 is affected by acute UV irradiation, intrinsic aging and photoaging processes.

Stem Cells. 2009 Feb 5; 27(5): 1164-1172Gago N, Pérez-López V, Sanz-Jaka JP, Cormenzana P, Eizaguirre I, Bernad A, Izeta AA major unanswered question in autologous cell therapy is the appropriate timing for cell isolation. Many of the putative target diseases arise with old age and previous evidence, mainly from animal models, suggests that the stem/progenitor cell pool decreases steadily with age. Studies with human cells have been generally hampered to date by poor sample availability. In recent years, several laboratories have reported on the existence, both in rodents and humans, of skin-derived precursor (SKP) cells with the capacity to generate neural and mesodermal progenies. This easily obtainable multipotent cell population has raised expectations for their potential use in cell therapy of neurodegeneration. However, we still lack a clear understanding of the spatiotemporal abundance and phenotype of human SKPs. Here we show an analysis of human SKP abundance and in vitro differentiation potential, by using SKPs isolated from four distinct anatomic sites (abdomen, breast, foreskin, and scalp) from 102 healthy subjects aged 8 months to 85 years. Human SKP abundance and differentiation potential decrease sharply with age, being extremely difficult to isolate, expand, and differentiate when obtained from the elderly. Our data suggest preserving human SKP cell banks early in life would be desirable for use in clinical protocols in the aging population. Stem Cells 2009;27:1164-1172.

Botulinum neurotoxin A (BoNT/A), the most poisonous substance to humans is a potential bioterrorist agent.

The light chain protein induces a flaccid paralysis through cleavage of SNAP-25 involved in acetylcholine release at the neuromuscular junction. BoNT/A is widely used as a therapeutic agent and to reduce wrinkles.

The toxin is used at very low doses which have to be accurately quantified. With this aim, internally quenched fluorescent substrates containing the fluorophore/repressor pair pyrenylalanine (Pya)/4-nitrophenylalanine (Nop) were developed.

The Nop and Pya were respectively introduced in positions 197 and 200 of the cleavable fragment (187-203) SNAP-25 (Nle(202)), acetylated at its N-terminus and amidated at its C-terminus.

Cleavage of this peptide occurred between positions 197 and 198, as in SNAP-25 and was easily quantified by the strong fluorescence emission of the metabolite. To increase the assay sensitivity, the previous substrate was lengthened to account for exosite binding to BoNT/A.

The peptide PL50 Ac-156-203 SNAP-25-NH2 (Nop(197), Pya(200), Nle(202)) and its analogue PL51, in which all the methionines were replaced by non oxidizable Nle, were synthesized.

Consistent with a large increase in affinity for BoNT/A, PL50 and PL51 exhibit catalytic efficiencies of 2.6 10(6) M(-1)s(-1) and 8.85 10(6) M(-1)s(-1) respectively and behave as the best fluorigenic substrates of BoNT/A reported to date.

Under optimized assay conditions, they allow simple quantification of as low as 100 and 60 pg of BoNT/A respectively within 2 hours with a classical fluorimeter. Calibration of the method against the MLD50 assay unequivocally validates the enzymatic assay.


"Detection And Quantification Of Botulinum Neurotoxin Type A By A Novel Rapid In Vitro Fluorigenic Assay"
Appl Environ Microbiol. 2009 May 8; Poras H, Ouimet T, Orng SV, Fournié-Zaluski MC, Popoff MR, Roques BP (Hubmed.org)

Dermatol Surg. 2009 May 12; Bisaccia E, Kadry R, Rogachefsky A, Saap L, Scarborough DABACKGROUND Midface rejuvenation is a minimally invasive procedure designed to correct early ptosis of the cheeks and deepening nasolabial folds. Implementation of this technique requires a detailed understanding of the anatomy of this region in addition to recognizing the vectors of change that occur over time as one matures. Finally, aesthetic competence and requisite surgical skills are required to restore the midface in a minimally invasive fashion. OBJECTIVE To describe a new minimally invasive approach to facial rejuvenation using a novel absorbable suture with segmented stabilizers that allows for a superolateral reversal of the senescent changes of the midface. METHODS In a case series study, 30 patients with aging changes of the midface signed informed consent to have this procedure done. An incision was made in the preauricular area, followed by hydrodissection with tumescent anesthesia and blunt dissection with the aid of a 4-mm spatula cannula. Two angiocatheters (14GA 3.25 IN, 2.1 x 83 mm, 14 gauge) were tunneled through the malar fat pad and pierced the skin just lateral to the nasolabial fold. The angiocatheter was then removed and the suture tethered to facilitate the proper amount of lifting entirely in the subcutaneous supra-SMAS plane and anchored superolaterally to the temporalis fascia. The segmented stabilizers anchored themselves in multiple directions but ultimately lifted the tissues of the midface. RESULTS AND CONCLUSION This technique uses the multidirectional segmented stabilizers of the Monograms to counteract the downward displacement of the malar fat pad while simultaneously softening the nasolabial fold. This is a minimally invasive technique that addresses the multiple factors involved in the senescent changes of the midface. Proper patient selection, good aesthetic judgment, and surgical competence are required to restore the midface in a minimally invasive fashion. The objective of this study was to report a novel approach to midfacial rejuvenation using the Monograms. This cross-hatched suture achieves simultaneous malar fat pad elevation and nasolabial fold effacement. The midface lift adds another vital dimension to panfacial augmentation. The authors have indicated no significant interest with commercial supporters.

Br J Dermatol. 2009 Apr 28; Watson RE, Ogden S, Cotterell LF, Bowden JJ, Bastrilles JY, Long SP, Griffiths CEBackground Very few over-the-counter cosmetic 'anti-ageing' products have been subjected to a rigorous double-blind, vehicle-controlled trial of efficacy. Previously we have shown that application of a cosmetic 'anti-ageing' product to photoaged skin under occlusion for 12 days can stimulate the deposition of fibrillin-1. This observation infers potential to repair and perhaps clinically improve photoaged skin. Objective We examined another similar over-the-counter cosmetic 'anti-ageing' product using both the patch test assay and a 6-month double-blind, randomized controlled trial (RCT), with a further 6-month open phase to assess clinical efficacy in photoaged skin. Methods For the patch test, a commercially available test product and its vehicle were applied occluded for 12 days to photoaged forearm skin (n = 10) prior to biopsy and immunohistochemical assessment of fibrillin-1; all-trans retinoic acid (RA) was used as a positive control. Sixty photoaged subjects were recruited to the RCT (test product, n = 30 vs. vehicle, n = 30; once daily for 6 months, face and hands) with clinical assessments performed at recruitment and following 1, 3 and 6 months of use. Twenty-eight volunteers had skin biopsies (dorsal wrist) at baseline and at 6 months treatment for immunohistochemical assessment of fibrillin-1 (test product, n = 15; vehicle, n = 13). All volunteers received the test product for a further 6 months. Final clinical assessments were performed at the end of this open period. Results In the 12-day patch test assay, we observed significant immunohistological deposition of fibrillin-1 in skin treated with the test product and RA compared with the untreated baseline (P = 0.005 and 0.015, respectively). In the clinical RCT, at 6 months, the test product produced statistically significant improvement in facial wrinkles as compared to baseline assessment (P = 0.013), whereas vehicle-treated skin was not significantly improved (P = 0.11). After 12 months, there was a significant benefit of the test product over that projected for the vehicle (70% vs. 33% of subjects improving; combined Wilcoxon rank tests, P = 0.026). There was significant deposition of fibrillin-1 in skin treated for 6 months with the test product [(mean +/- SE) vehicle 1.84 +/- 0.23; test product 2.57 +/- 0.19; ancovaP = 0.019). Conclusions In a double-blind RCT, an over-the-counter cosmetic 'anti-ageing' product resulted in significant clinical improvement in facial wrinkles, which was associated with fibrillin-1 deposition in treated skin. This study demonstrates that a cosmetic product can produce significant improvement in the appearance of wrinkles and further supports the use of fibrillin-1 as a robust biomarker for the repair of photoaged dermis.

Indian J Dermatol Venereol Leprol. 2007 Jul-Aug; 73(4): 277-9Savardekar P

Plast Surg Nurs. 2008 Jul-Sep; 28(3): 144-7Dugas B, Buchholz L

Indian J Dermatol Venereol Leprol. 2008 Jul-Aug; 74(4): 392-3Kaliyadan F, Manoj J, Venkitakrishnan S

J Dermatol Sci. 2008 Dec; 52(3): 205-9Hussein MR, Ab-Deif EE, Abdel-Motaleb AA, Zedan H, Abdel-Meguid AM

Nurs Clin North Am. 2007 Sep; 42(3): 485-500, viiBermann PEIntrinsic and extrinsic aging of the skin follow different pathways, but the end result is similar. Treatment options include cosmeceuticals, laser rejuvenation, chemical peels, and microdermabrasion. Preventing the effects of extrinsic aging involves using sunscreen-the right product, used in the right amount, at the right time, in the right places.

Dermatol Clin. 2008 Jul; 26(3): 341-58, vTaub AFMedical spas' menus of services vary widely and depend greatly on the medical director or owner's experience and predilection. Core services include: microdermabrasion, mild chemical peels, medical facials, laser hair removal, photorejuvenation, botulinum toxin, and injectable fillers. Common procedures include cellulite reduction, tissue tightening, and acne treatments. Less common procedures that are more likely to be performed in medical spas with direct on-site daily involvement of the medical director include: laser resurfacing, laser-assisted lipoplasty, sclerotherapy, photodynamic therapy, and cosmetic surgery. Multisite spas often use multi-platform devices to assist with uniformity in menu offerings and training.

Semin Cutan Med Surg. 2008 Sep; 27(3): 212-20Kempiak SJ, Uebelhoer NSuperficial 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.

J Craniofac Surg. 2008 May; 19(3): 812-6Emsen IMDermabrasion is a nonchemical, superficial skin resurfacing procedure. It owes its popularity to the simplicity and safety of the technique. Studies published in peer-reviewed journals have highlighted the benefits of multiple, once-a-week treatments in improving hyperchromic discolorations, facial scarring, and facial photodamage. The mechanism of action through which microdermabrasion ameliorates skin appearance is not fully understood. Several studies suggest that the clinical improvement is produced through a dermal remodeling/wound healing repair. Regardless of the mechanism, patients and operators alike recognize the efficacy of this procedure. We are introducing a new method to treatment of facial wrinkles. Dermabrasion with sandpaper is not a new procedure in mechanic dermabrasion. However, we used it for the first time in treating periorbital wrinkles.

Nat Biotechnol. 2008 Nov; 26(11): 1261-8Prausnitz MR, Langer RTransdermal drug delivery has made an important contribution to medical practice, but has yet to fully achieve its potential as an alternative to oral delivery and hypodermic injections. First-generation transdermal delivery systems have continued their steady increase in clinical use for delivery of small, lipophilic, low-dose drugs. Second-generation delivery systems using chemical enhancers, noncavitational ultrasound and iontophoresis have also resulted in clinical products; the ability of iontophoresis to control delivery rates in real time provides added functionality. Third-generation delivery systems target their effects to skin's barrier layer of stratum corneum using microneedles, thermal ablation, microdermabrasion, electroporation and cavitational ultrasound. Microneedles and thermal ablation are currently progressing through clinical trials for delivery of macromolecules and vaccines, such as insulin, parathyroid hormone and influenza vaccine. Using these novel second- and third-generation enhancement strategies, transdermal delivery is poised to significantly increase its impact on medicine.

J Women Aging. 2007; 19(3-4): 69-87Hurd Clarke L, Repta R, Griffin MThis paper analyzes findings from in-depth interviews with 44 women aged 50-70 regarding their perceptions of and experiences with non-surgical cosmetic procedures such as Botox injections, laser hair removal, chemical peels, microdermabrasion, and injectable fillers. While 21 of the women had used a range of non-surgical cosmetic procedures, 23 women had not. The data are discussed in light of feminist theorizing on cosmetic surgery which has tended to ignore the experiences of older women and has been divided in terms of the portrayal of cosmetic surgery as either oppressive or liberating. We found that some of the women used the procedures to increase their physical attractiveness and self-esteem, others viewed the procedures as excessively risky, and still others argued that the procedures stemmed from the social devaluation of later life. Treatments that involved the alteration of the surface of the body tended to be viewed as less risky than the injection of foreign substances into the body.

Cutis. 2007 Jan; 79(1 Suppl Combining): 13-6Briden E, Jacobsen E, Johnson CMicrodermabrasion and superficial glycolic acid peels are common aesthetic procedures. Microdermabrasion alone provides the benefits of exfoliation but may provide faster results and increased patient satisfaction when combined with superficial glycolic acid (alpha-hydroxy acid) peels because of the significant antiaging effects of glycolic acid peels. A roundtable discussion was held with dermatologists to review methods of combining these procedures. The first method included alternating glycolic acid peels and microdermabrasion treatments every 2 weeks, enabling the patient to receive both a peel and microdermabrasion in the same month. With the second method, microdermabrasion may be used prior to the superficial glycolic acid peel to increase the exfoliation and antiaging effects of both treatments within the same visit. This second method is considered to be a more aggressive approach and usually is reserved for patients with a history of procedures. Lastly, combining treatments can be used to maintain a patient's skin after the initial treatment stage, usually performed every other month or seasonally, depending on the patient. As with all combination treatments, safety precautions and monitoring the patient's skin throughout treatment are crucial to success.

J Cosmet Laser Ther. 2008 Dec; 10(4): 237-41Sadick NS, Anderson D, Werschler WPBACKGROUND: Current options for treating the aging hand include microdermabrasion, fractional thermolysis, chemical peeling, intense light sources and laser therapy (such as pigment lasers and ablative resurfacing), as well as injectable fillers and volumizers to correct soft tissue atrophy. OBJECTIVE: This article reviews the latest technologies in hand rejuvenation and provides data from three clinical practices using injectable poly-l-lactic acid (PLLA) for soft tissue augmentation. METHODS: Patient data from three clinical practices were retrospectively collected and tabulated. This included baseline patient data, the number of injections and vials of product used, and adverse events. RESULTS: PLLA was used to improve volume loss in the hand to the satisfaction of a majority of patients. The most commonly reported adverse events, such as bruising, swelling and pain, were injection-related and resolved within a few days of treatment. No papules or nodules were reported in any patients and there were no serious adverse events. CONCLUSION: The overall results from the three clinics presented here show that patients were very satisfied with the results of PLLA treatment for the hands, and experienced only minor and short-term injection-related adverse events.

Dermatology. 2009; 218(3): 193-202Gerritsen MJ, Smits T, Kleinpenning MM, van de Kerkhof PC, van Erp PEThe response rates of photodynamic therapy (PDT) vary widely. Limited uptake of topically applied 5-aminolaevulinic acid (ALA), or its methyl ester (MAL), and suboptimal production of protoporphyrin IX (PpIX) may account for these differences. Recently, we demonstrated that hyperkeratosis is an important negative factor in ALA uptake. This review has its focus on pretreatment of the skin in order to improve the clinical outcome of ALA/MAL PDT. Pretreatment of hyperkeratosis can be achieved with keratolytics, curettage/debulking, tape stripping, microdermabrasion or laser ablation. Penetration enhancers may alter the composition or organization of the intercellular lipids of the stratum corneum. Several studies have been performed on the use of dimethyl sulfoxide, azone, glycolic acid, oleic acid and iontophoresis to increase the penetration of ALA. As PpIX production is also dominated by temperature-dependent processes, elevating skin temperature during ALA application may also improve treatment results. Another approach is the use of additives that interact with the heme biosynthetic pathway, e.g. by removing ferrous iron with iron-chelating substances such as: ethylenediaminetetraacetic acid; 3-hydroxypyridin-4-ones; 1,2-diethyl-3-hydroxypyridin-4-one-hydrochloride; and desferrioxamine. In conclusion, simple pretreatments or additions to the regular practice of PDT, aimed to optimize intralesional PpIX content, improve the clinical outcome.

Dermatol Surg. 2007 Sep; 33(9): 1005-26Taub AFBACKGROUND: Simple procedural treatments such as comedone extraction and intralesional steroids have been utilized for many years as adjunctive therapy for acne. In the past 5 years, new technologies and procedures have become available that present new options for the treatment of acne. OBJECTIVES: The objective was to review, summarize, and evaluate the key studies of procedural therapies for the treatment of acne as well as place them in perspective with current clinical practice. METHODS: Studies selected for evaluation had at least 10 patients and clear statements of purpose, acne severity, patient selection, follow-up evaluations, previous and concurrent medications, treatment parameters, methods for evaluating results, and adverse effects. All studies were complete and published (in English) in peer-reviewed journals. RESULTS AND CONCLUSIONS: Earlier procedural therapies were adjunctive to medical therapy, such as intralesional steroids, chemical peels, and microdermabrasion. Newer methods include radiofrequency, light or laser, and photodynamic therapy that represent treatment alternatives for systemic medications. Still early in their development, these new procedures provide an important, novel set of options for the treatment of acne. The most developed and studied therapies are blue or blue/red light combinations, 1,450-nm diode laser, and photodynamic therapy with 5-aminolevulinic acid or indocyanine green. Review of the literature of more up-to-date physical procedures provides a starting point for physicians seeking to treat their acne patients safely and effectively with these new methods.

Dermatol Surg. 2008 Aug; 34(8): 1026-31Man J, Rao J, Goldman MBACKGROUND AND OBJECTIVE: Cosmetic surgery to counteract the aging process is an evolving field. Most procedures have concentrated on the face; however, the hands are an often-neglected area. Current methods of hand rejuvenation include autologous fat injection, sclerotherapy, intense pulsed light, chemical peel, and microdermabrasion. Only autologous fat injection restores dermal thinning. We compare the use of hyaluronic acid (Restylane, Medicis Aesthetics Inc.) versus collagen (Cosmoplast, INAMED Aesthetics) for soft tissue augmentation of the dorsal hands. MATERIALS AND METHODS: Ten female patients who demonstrated dermal thinning of the dorsal hands were randomized to receive 1.4 mL of hyaluronic acid or 2.0 cm(3) collagen to alternate interphalangeal spaces of dorsal hands. Patients returned at 1 week, 1 month, 3 months, and 6 months for digital photography and completion of a patient/physician questionnaire. RESULTS: Hands were scored by two separate blinded physicians on scales of 1 to 5 for clearance of veins. Patients scored both tolerability and satisfaction on a scale of 1 to 5. Analysis showed a mean difference of 0.95 (0.004), median difference of 0.9 (0.008) for clearance, and a mean difference of 0.90 (0.010) with a median difference of 1.0 (0.031). The satisfaction difference was not significant with a mean difference of 0.80 (0.070) and median difference of 1.0 (0.117). CONCLUSION: Aging of the hands is a common problem that is often overlooked. The use of soft tissue fillers is a viable tool in hand rejuvenation. In this study hyaluronic acid proved to be superior in efficacy to collagen.

J Cosmet Laser Ther. 2008 Dec; 10(4): 187-92Dudelzak J, Hussain M, Phelps RG, Gottlieb GJ, Goldberg DJBACKGROUND: Mechanical exfoliation using microdermabrasion has been used as a minimally invasive treatment of photodamage, as well as to improve absorption of topical agents. Phonophoresis, a method of electrically assisted percutaneous delivery of macromolecules, relies on ultrasonic waves producing alterations within the stratum corneum that result in increased absorption. OBJECTIVE: To determine the effects on photodamaged facial skin that resulted from the ultrasound-enhanced delivery of a combined hyaluronic acid, retinol, and peptide-containing complex following microdermabrasion. METHODS: Seven individuals, aged 40-65, with Fitzpatrick skin types I-III and class I-III rhytids, underwent eight weekly aluminum oxide crystal microdermabrasion procedures (Parisian Peel; Aesthetic Technologies, Golden, CO, USA), followed by administration of a topical combined hyaluronic acid, retinol, and peptide-containing complex, propelled through ultrasound phonophoresis. The participants continued manual twice-daily application of the topical complex between treatments. Clinical evaluation included digital photography, and patient and investigator assessment of changes in skin dryness, texture, brightness, tone, and rhytids. The 3-month post-treatment histologic evaluation consisted of pre- and post-treatment biopsies evaluated for microscopic and ultrastructural changes. RESULTS: An overall mild clinical improvement in the skin was noted. A slight increase in vascularity within the papillary dermis, increased reticulin stain (type III collagen), and ultrastuctural evidence of increased type I collagen indicate dermal injury with resulting new collagen formation. CONCLUSION: Microdermabrasion followed by ultrasonic phonophoretic application of topical products represents a novel dermal delivery approach to photorejuvenation.

J Cosmet Dermatol. 2008 Dec; 7(4): 275-80Freedman BMBACKGROUND: Hydradermabrasion is a relatively new procedure that combines crystal-free microdermabrasion with the pneumatic application of an antioxidant-based serum. OBJECTIVE: This study aims to validate the safety and efficacy of hydradermabrasion for nonablative facial rejuvenation and to determine whether antioxidant levels could be increased in the skin with this technique. METHODS: Twenty female volunteers, aged 34-56 years, were randomized into two groups. Group A underwent a series of six facial hydradermabrasion treatments using a polyphenolic antioxidant serum spaced 7-10 days apart. In Group B, the same polyphenolic antioxidant serum was applied manually to the skin for a total of six treatments at 7- to 10-day intervals. Digital photographs, skin biopsies, and skin polyphenolic antioxidant levels were obtained prior to and after the treatment regimen. Patient surveys were taken following the study. RESULTS: In Group A, treated skin demonstrated increased epidermal thickness, papillary dermal thickness, and polyphenolic antioxidant levels (P < 0.01). There was replacement of elastotic dermal tissue, collagen hyalinization, and increased fibroblast density. Fine lines, pore size, and hyperpigmentation were decreased following treatment. There were no reported complications. In Group B, there was no change in skin structure, antioxidant levels, or clinical skin attributes. CONCLUSION: Hydradermabrasion effectively improved skin quality both clinically and histologically. There were no changes to suggest that pneumatic serum application adversely affected dermal components. After hydradermabrasion, skin polyphenolic antioxidant levels were increased. In contrast, the intermittent manual application of the polyphenolic antioxidant serum without the microdermabrasion element did not result in detectable skin changes.