We report the use of injectable poly-l-lactic acid (PLLA) for volume restoration in a 45-year-old white female who was concerned about the appearance of her hands. The patient expressed a desire for long-term restoration, and selected injectable PLLA because of its known 2-year duration of effect, although she was informed that injectable PLLA is not FDA-approved for use in the hands. After reconstitution with 8 ml of diluent plus lidocaine, 0.1–0.2-ml aliquots of injectable PLLA were injected into selected sites, up to 5 ml per hand. The patient underwent three identical treatments, followed by postinjection use of moisturizing cream and massage; improvement in appearance was noted by the patient between the second and third treatments. Correction was maintained for at least 18 months, with no adverse events. We have also briefly reviewed the literature on the use of injectable PLLA for volume restoration in the hand.
Poly-L-lactic acid (PLLA) is approved by the US Food and Drug Administration (FDA) for the treatment of human immunodeficiency virus (HIV)-associated lipoatrophy. Over the past several years, PLLA has been increasingly used as a treatment for lipoatrophy secondary to the natural process of aging. There have been no reports on the use of PLLA for trauma-induced facial lipoatrophy and asymmetry. In this article, we review the safety, effectiveness, treatment guidelines, mechanism of action, and quality-of-life (QOL) impact of PLLA. We present a patient with facial lipoatrophy and asymmetry secondary to injury from a motor vehicle accident that was effectively treated using PLLA. The future role of PLLA in the treatment of trauma-induced facial lipoatrophy and asymmetry, as well as other disorders, also is discussed.
The Hispanic population is the third largest growing group in the United States and is projected to increase to 119 million by 2060. Skin of color populations including Hispanics are more susceptible to a variety of pigmentary disorders including melasma and post-inflammatory hyperpigmentation (PIH). Most previous treatment options for these disorders remain unsatisfactory. Current treatment options include topical therapies using skin lightening/bleaching agents, chemical peels, and physical therapies such as microdermabrasion, microneedling, radiofrequency, and lasers. Combination therapies using skin lighting agents, peels, and physical means are also commonly used. New trends include protection and prevention using sunscreens, physical blockers, and the use of new and effective anti-oxidants and anti-inflammatory agents. The choice of therapeutic agents involves assessment of the risk-benefit profile of each individual. As the pathophysiology of melasma and PIH are being intensely investigated and studied, the treatment options are also expanding. In this review, the current therapeutic options are summarized and new and emerging treatment options for PIH and melasma are discussed. J Drugs Dermatol. 2019;18(3 Suppl):s112-114.
The addition of Sculptra to the esthetic dermatology landscape in September 2004 brought a new opportunity for facial rejuvenation. Sculptra, which is polymerized lactic acid (PLA), received approval from the Food and Drug Administration for the treatment of HIV-associated lipoatrophy. Since its approval, it has gained acceptance among cosmetic dermatologists and plastic surgeons, and its inclusion in any update of esthetic dermatology is certainly warranted. Its uses for esthetic indications are now being substantiated by clinical trials and, as experience with this product increases, it is likely that it will be more widely used for these reasons.
The Women's Dermatologic Society (WDS) is a nonprofit physician organization that promotes mentorship and service in the Dermatology community.In the fall of 2013, the WDS had noted declining membership and engagement of dermatology residents and recent graduates.Mentorship during residency is associated with increased satisfaction, and participation in subspecialty societies leads to development of skills necessary to advocate for one's specialty (Flint et al., 2009;Freeman et al., 2008;Skelley et al., 2015).In order to identify possible gaps in communication and engagement with members, especially the younger physician demographics, the authors electronically surveyed the WDS membership from November 2013 through February 2014.The Institutional Review Board of Massachusetts General Hospital approved this study as an exempted study (Protocol Number: 2014P000379).There was a 51% response rate composed of dermatologists (64%), trainees (31%), and dermatology researchers and corporate members (5%).The age distribution of respondents showed peaks in ranges of 31 to 35 years (29%) and 25 to 30 years (18%), reflecting capture of target demographics.Of respondents, 30% had not attended a WDS event that year.Furthermore, only 21% of respondents had participated in mentorship programs and 12% in service programs.The top reason cited for lack of participation was "unaware of activities/ opportunities" (47%).Notably, 5% of respondents were unaware they were listed as WDS members, reflecting a phenotype of individuals who are participatory enough in nature to respond to email surveys and yet with whom the organization had not successfully communicated their membership status.Mobile application (app) and social media use were queried, revealing that 93% of respondents owned iPhone-compatible devices and 90% used smartphones for professional activities.Over 70% of members and 84% of resident members stated they would use a WDS mobile app if one were available.For social media apps, 75% of respondents endorsed use, with Facebook being the most widely used platform.Nearly 70% of respondents used social media at least weekly, and 43% cited daily or multiple times per day usage.
Acne treatment guidelines suggest a combination approach with topical therapy including a topical retinoid, benzoyl peroxide and an oral antibiotic, or oral isotretinoin (OI), as first-line treatment options for severe acne vulgaris (AV). This study evaluated the efficacy and safety of a daily regimen of 0.3% adapalene and 2.5% benzoyl peroxide (0.3% A/BPO) gel and oral doxycycline 100 mg twice daily in severe (nonnodulocystic, non-conglobate) inflammatory AV.This was a phase 4, 12-week, single-arm, openlabel, multi-center investigational study. Subjects (males and females, 12 or older, with severe inflammatory AV, Investigator Global Assessment [IGA] 4, and less than equal to 4 nodulocystic lesions, n=186) were considered OI candidates at baseline by the investigator. OI candidacy was re-evaluated at each study visit. Efficacy endpoints included inflammatory lesion (IL) reduction (week 12), IGA success (defined as IGA 0 [Clear] or 1 [Almost Clear], weeks 4, 8, and 12), percent reduction in lesions (weeks 4, 8, and 12), and subject questionnaires (week 12). Safety assessments included adverse events (AEs) and tolerability.Mean IL counts were significantly reduced from baseline to the end of the study (mean [SD]; baseline, 44.8 (21.73); week 12, 14.8 (16.11); mean percent reduction, 66.2% [30.47]; P less than .0001). By week 12, 37.1% of subjects achieved IGA Success (n=69, P less than .0001). Most subjects self-reported at least moderate improvement in AV (90.2%), and were "Satisfied" or "Very Satisfied" with the study treatment overall (83.2%). 41.9% of the subjects were no longer considered by their investigator to be OI candidates at week 4. At 12 weeks, only 19.9% were still considered OI candidates.0.3% A/BPO + DOX is an effective and safe treatment option for severe inflammatory AV, before starting OI treatment, or as an alternative when OI cannot be used. ClinicalTrials.gov identifier: NCT02899000 J Drugs Dermatol. 2018;17(3):264-273. .
