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IMCAS World Congress 2024
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148

Clinical dermatology & dermatologic surgery - Contributed talks

Room: Room 341 - Level 3
Date: Friday 2 February 2024 at 08:30 to 10:00
Format: CONTRIBUTED TALKS > session made up of abstract submissions that were carefully reviewed and selected by the Scientific Board

Chairs

Prof Antonio A G MASSA

Dermatologist

Portugal

Dr Maria Cristina PUYAT

Dermatologist

Philippines

Lectures of the session

Hours	Speakers	Lecture title	Abstract	Number
08:30	Dr Cristina SOARE	Exploring the link between salivary pH, gastroesophageal reflux disease, and acne vulgaris: a controlled study	View	130829
08:39	Prof Tien Guan Steven THNG	Novel pathway for melasma: opening up new treatment options	View	130832
08:48	Dr George ZAHER	Botulinum toxin efficacy in facial and neck scar treatment	View	130833
08:57	Dr Victoria G BELO	A pilot study of combined use of fractional microneedling with RF and plant-derived exosomes for the treatment of melasma in Asian patients	View	130834
09:06	Dr Mahmoud RAGEH	The combined effect of CO2 laser, topical diclofenac 3%, and imiquimod 5% in treating high-risk basal cell carcinoma	View	133515
09:15	Dr Nenad STANKOVIC	Changing the paradigm in management of atrophic post-acne scarring with injectable skin boosters	View	133514
09:24	Dr Houriah NUKALY	Safety and efficacy of combination therapies with microneedling for treating different types of acne scars: a systematic review and network meta-analysis of randomized controlled trials	View	130830
09:33	Dr Ford LANNAN	Microwave ablation of eccrine glands for hyperhidrosis in residual limbs	View	135985
09:42		Q&A		130836

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Recommended sessions

Scars

Microneedling

Combined treatments

Melasma

Botulinum toxins

Dr Cristina SOARE

Dermatologist

Romania

Other author(s) : Delia Elena Thiess

Exploring the link between salivary pH, gastroesophageal reflux disease, and acne vulgaris: a controlled study

Objectives: The primary objective of this comprehensive study is to meticulously investigate the potential correlation between acne vulgaris and gastroesophageal reflux disease (GERD), two conditions hypothesised to be interconnected through systemic inflammation pathways. This is developed through analyzation of salivary pH levels as a non-invasive biomarker for GERD and its association with acne severity, thereby expanding the diagnostic toolkit for dermatological assessment and management.

Introduction: Emerging research underscores the crucial impact of gut health on skin condition. An imbalance in the gut microbiome has been associated with a range of skin disorders, including acne. Inflammation is now recognized as a key factor underlying both acid reflux and acne. Chronic internal inflammation can disrupt skin balance, leading to increased sebum production and clogged pores. While direct research linking acid reflux to acne is still in its early phases, emerging evidence suggests a potential connection.

Materials / method: In this forward-looking, controlled study, we included individuals with acne vulgaris alongside age- and gender-matched healthy participants. We assessed all subjects for the presence of GERD, diagnosing it based on salivary pH correlation. We measured the clinical severity of acne vulgaris using the Global Acne Grading System (GAGS).

Results: The study comprised 25 patients with acne vulgaris and 22 healthy controls matched by age and gender. All participants were female. The mean salivary pH for those with acne was 6.42±0.33, while for those without acne, it was 7.04±0.21. A Pearson correlation coefficient of approximately -0.745 indicates a strong negative correlation, suggesting that higher pH levels correlate with a reduced probability of having acne. The p-value of less than 0.001 confirms the statistical significance of this correlation.

Conclusion: The study reveals a significant link between lower salivary pH levels in acne vulgaris patients and the presence of GERD. These findings underscore the potential impact of acid reflux on acne severity and advocate for a holistic approach to dermatological treatment that considers the gut-skin axis. Further investigation is warranted to fully understand the implications for acne management and the potential for innovative treatments targeting the digestive system.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Prof Tien Guan Steven THNG

Dermatologist

Singapore

Other author(s) : Leah Vardy

Novel pathway for melasma: opening up new treatment options

Objectives: 1. Understand role of polyamine in skin pigmentation
2. The novel ;pathway of polyamines in the pathogenesis of melasma
3. Polyamine inhibitors in the management of melasma

Introduction: Melasma is a chronic disfiguring condition and can be difficult to treat. Current treatment options are directed at inhibiting the tyrosinase pathway. Uncovering new pathways in pathogenesis of melasma is essential for the development of new effective treatments. In this lecture, we report that a group of metabolites called polyamines are important in the control of melanogenesis in human skin. Polyamines are cationic molecules present in all cells and are essential for cellular function

Materials / method: 1. Polyamine enzyme ODC1 was found to be elevated in melanocytes in lesional skin of patients with melasma as compared to perilesional skin
2. Invitro experiments using melanocyte, keratinocyte/melanocyte cultures to demonstrate the effects of polyamine and pigmentation
3. Invitro experiments elucidating the mechanisms of pigment induction in polyamine pathways
4. Clinical trial of polyamine inhibitor as compared to 4% hydroquinone in the management of melasma.

Results: In melasma, we found that polyamine regulator ODC1 is upregulated in melanocytes from lesional skin. Further investigation revealed that polyamine can promote pigmentation in human explants and primary melanocytes through induction of tyrosinase. Polyamine supplementation on normal epidermal melanocytes results in the activation of polyamine catabolism, which results in increased intracellular H2O2 while inhibition of polyamine catabolism prevents polyamine-induced promotion of tyrosinase levels. Finally a clinical trial showed the polyamine inhibitor is as effective as hydroquinone in melasma

Conclusion: Polyamines play an important role in skin homeostasis, especially in skin pigmentation. Interventions directed at this pathway will open up new avenues in the management of skin pigmentary disorders.

Disclosures

Did you receive any funding to support your research for this TOPIC?
Yes
Please specify entities (individual, company, society): From Singapore Research Grant

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
Yes
Please specify date...: Patent filed
and status : 2020

This work is presented thanks to the support of: ASTAR, Singapore

Dr George ZAHER

Plastic Surgeon

Egypt

Other author(s) :

Botulinum toxin efficacy in facial and neck scar treatment

Objectives: The aim of this lecture is to reveal the role of botulinum toxin injection along surgical wounds in diminishing the appearance of facial and neck scars, that can be a major devastating disfigurement for individuals leading to high levels of psycological distress causing self consciousness and lack of self confidence.

Introduction: Botulinum toxin injections are one of most common non- surgical cosmetics procedures worldwide. Despite its popular use to minimise the appearance of dynamic rhytides, it has also been mentioned in recent years as an option for treating scars and minimising thier appearance.

Materials / method: The efficacy and safety of injecting botulinum toxin in the treatment of postoperative facial and neck scars compared to control groups either injected with 0.9 % normal saline or recieving no injections after wound closure.

Results: Results were assessed using mainly subjective scar assessment scales as vancouver scar scales (VSS), Visual analogue scale ( VAS), Patient and observer scar assessment scale ( POSAS), Stony Brook Scar Evalution scale (SBSES). Most of scars showed significant improvement when injected with botulinum toxin, especially those injected during wound closure not only because it decreases the tensile force exacerbated on wound by the underlying muscle, but also by diminishing cellular activities responsible for formation of hypertrophic scars. Side effects and complications were almost not reported.

Conclusion: Injection of botulinum toxin along surgical wounds especially during wound closure, proved to be significantly effective and safe in minimising the appearance of facial and neck scars which will have a direct positive impact on patients degree of self confidence and style of live.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Dr Victoria G BELO

Dermatologist

Philippines

Other author(s) : GUADA CAPIZ MD-CO AUTHOR

A pilot study of combined use of fractional microneedling with RF and plant-derived exosomes for the treatment of melasma in Asian patients

Objectives: To establish if the combined use of fractional microneedling with radiofrequency and plant derived exosomes is an effective and safe treatment of melasma in Asian patients.

Introduction: Melasma is a benign but psychologically debilitating skin condition that can affect Asian skin at a higher rate than Caucasian skin due to the higher melanin production in Asian skin. The skin condition is also more prevalent in women than men. Melasma also affects around 40% of women and 20% of men in Southeast Asia. Chronic ultraviolet (UV) exposure, genetic factors, and sex hormones are generally believed to be involved in the occurrence of melasma. Pathophysiology reveals that the basal basement membrane of melasma patients has been found to have a vacuolar structure within keratinocytes a

Materials / method: Twenty patients with melasma underwent 3 sessions of fractional microneedling with RF all over the face followed by application of Exosomes 5cc 4-6 weeks interval. Responses to treatments were evaluated using the serial photography, Mexameter Melanin scores , MASI score, and the patient's overall assessment and satisfaction

Results: Combination therapy showed marked improvement in the appearance and size of pigments an average decrease of 7-10.2 in Melanin Mexameter reading values and MASI score average decrease of 5-8 points after three treatment sessions. It is also worthwhile to note the improvement in skin texture and tightening among all subjects.
Combination therapy showed a significant improvement of melasma with no remarkable side effects were reported.

Conclusion: The combination treatment of fractional microneedling RF therapy and application of plant derived Exosomes showed a significant therapeutic effect for melasma. Therefore, the combination treatment could be a new and safe adjunct therapy for the treatment of melasma

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Dr Mahmoud RAGEH

Dermatologist

Egypt

Other author(s) :

The combined effect of CO2 laser, topical diclofenac 3%, and imiquimod 5% in treating high-risk basal cell carcinoma

Objectives: We tried to evaluate the efficacy of combining ablative CO2 laser, imiquimod 5%, and
diclofenac 3% as a therapeutic regimen in high-risk
and inoperable BCC.

Introduction: Some basal cell carcinoma (BCC) patients are considered as a high risk regarding the site, size, histopathological variant, or recurrence. High-risk BCC is a challenging therapeutic problem due to the trial to balance between complete surgical excision from one side and tissue preservation from the other side.

Materials / method: The study was conducted on 14 patients that were assessed clinically and pathologically then categorized regarding the site, size, histopathology, and fitness for surgery as high-risk inoperable BCC. They received an ablative session of CO2 laser, followed by application of diclofenac sodium 3% gel once daily for 5 days and imiquimod 5% cream for another 2 days.

Results: All lesions were of large size >5 cm in diameter. Histopathology showed 4 patterns: nodular type in 8 patients, infiltrating type in 3 patients, metatypical type in 2 patients, and micronodular type in one patient. At the end of the treatment period, 9 patients showed significant (moderate to marked) improvement while 5 patients showed weak (poor to mild) response. Significant improvement was more observed in nodular type. Relapse was more observed during the 5th to 6th months with 2 patients showed no relapse.

Conclusion: This combined regimen is a good alternative therapeutic modality in high-risk inoperable BCC especially the nodular pathologic pattern.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Dr Nenad STANKOVIC

Stomatologist

Serbia

Other author(s) :

Changing the paradigm in management of atrophic post-acne scarring with injectable skin boosters

Objectives: Learning outcomes for the abstract on skin-boosters in APAS treatment:

Understand the definition and prevalence of APAS.
Identify the challenges of treating APAS with traditional methods.
Describe the mechanism of action of skin-boosters in APAS.
Summarize the clinical evidence supporting the use of skin-boosters in APAS.
Discuss the safety and efficacy of skin-boosters in APAS.
Identify the different types of APAS that can be treated with skin-boosters.
Explain the compatibility of skin-boosters with other treatments for APAS.

Introduction: Atrophic post-acne scarring (APAS) is the most common type of acne scarring, affecting an estimated 85% of individuals with acne. APAS is a significant source of distress for patients, and traditional treatments have been challenging and often unsatisfactory.

Materials / method: Skin-boosters with stabilized, non-cross-linked HA, combined with amino acids and vitamines.
Intradermal inections in patients with APAS.

Results: Clinical studies have shown that skin-boosters are effective in reducing the appearance of APAS. Our study found that a series of three treatments with skin-boosters resulted in a significant improvement in the appearance of APAS in 80% of patients and that skin-boosters were more comfortable in reducing the appearance of APAS than traditional treatments, such as dermabrasion and chemical peels.

Conclusion: The use of skin-boosters in the treatment of APAS represents a paradigm shift. Skin-boosters are a promising new treatment for atrophic post-acne scarring. They are minimally invasive, safe, and effective with minimal downtime and side effects. Skin-boosters can be used to treat all types of APAS and can be combined with other treatments for APAS to achieve optimal results.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Dr Houriah NUKALY

Saudi Arabia

Other author(s) : Waseem Alhawsawi, MBBS, Ibrahim Abdullah S Albalawi, Mohammed Hussain Almakrami, Mohammed Radwan, Jehad O Hariri, MD , FAAD, FAADP, ICDP, Hassan Alwafi

Safety and efficacy of combination therapies with microneedling for treating different types of acne scars: a systematic review and network meta-analysis of randomized controlled trials

Objectives: To determine whether the combination of microneedling with other agents is more effective than microneedling alone in terms of scar improvement, reduction in scar appearance, patient satisfaction, and adverse effects.

Introduction: Acne scars are a common dermatological concern that can have a significant impact on an individual's self-esteem and quality of life. Despite the availability of various therapeutic interventions, achieving optimal outcomes in the treatment of acne scars remains a challenge due to the complex and diverse nature of scar tissue. Microneedling, a minimally invasive procedure that employs the use of fine needles to create controlled micro-injuries in the skin, has gained prominence as a treatment option for various dermatological conditions, including acne scars.

Materials / method: Random-effects model meta-analysis utilizing the DerSimonian and Laird technique was conducted, which is based on the inverse variance method. The findings will be illustrated using forest plots. The heterogeneity of the comparisons was assessed using the Chi-square test (Cochran's Q), with a statistical significance level of p = 0.005 (p < 0.005) rejects the null hypothesis of homogeneity). We employed the I^2 statistic to determine the proportion of total heterogeneity beyond chance: less than 25% heterogeneity is considered low, 25% to 50% is moderate, and more than 50% is high.

Results: From 18 randomized clinical trials, Microneedling alone demonstrated a significant average scar improvement of 45%, coupled with a high patient satisfaction rate of 70%. Among the combination therapies, Microneedling with Laser Therapy emerged as particularly noteworthy, exhibiting a statistically significant higher average scar improvement of 65% (95% CI: 60%–70%) compared to Microneedling Monotherapy (p = 0.02). The combination of Microneedling with Glycolic Acid Chemical Peels demonstrated a scar improvement of 55%. the combination with PRP average scar improvement of 60%.

Conclusion: Among the combination therapies was the superior performance of Microneedling with Laser Therapy. The combination of Microneedling with Glycolic Acid Chemical Peels and with Platelet-Rich Plasma (PRP) also demonstrated considerable scar improvement. Our findings demonstrate the efficacy and versatility of microneedling, both as a monotherapy and in combination with other modalities, offering clinicians a guide for tailoring effective and patient-centered approaches to acne scar management.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Dr Ford LANNAN

Dermatologist

United States

Other author(s) :

Microwave ablation of eccrine glands for hyperhidrosis in residual limbs

Objectives: There is currently no hyperhidrosis qualitative assessment tool that is validated for use in the residual limb. The Hyperhidroisis Disease Severity Score (HDSS) is a brief, single item scale that has recently been found to demonstrate a correlation with excessive sweating and impaired prosthetic function.5
Treatment of residual limb hyperhidrosis includes consideration of prosthetic components, topical, oral and injectable pharmacologic interventions. In our practice, microwave thermoablation is typically used as a last resort for refractory residual limb h

Introduction: Over 50% of people with amputations report discomfort related to excessive sweating inside their prosthesis.1 Hyperhidrosis of the residual limb can compromise both skin health and function within a prosthetic device. 2,3 Despite the prevalence of excessive sweating affecting residual limbs, there are very few studies devoted to assessment or treatment of this condition in persons with amputation.
Major methods used for objective assessment of sweat production include gravimetry and vapometry. Gravimetry is the measure of the mass of sweat per area per unit time. No standardized gravimetric cu

Materials / method: Sweating on a patient’s residual limb is measured before and after 15 minutes of exercise on a treadmill at 60% of their max heart rate in a temperature-controlled room. Both Gravimetry and vapometry are utilized.
Microwave thermoablation (miraDry) is performed on the residual limb in two consecutive treatments separating the limb by half (anterior/posterior) to avoid any theoretic possibility of compartment syndrome given the large amount of swelling associated with treatment. Treatment is conducted at level 5, a widely-accepted setting for treating hyperhidrosis.

Results: We found a positive correlation between subjective scores on the HDSS and TEWL values measured after exercise. For one patient that underwent microwave thermoablation on a lower extremity residual limb there was a 96.6% reduction in sweating when compared to an untreated area 4 years after treatment as measured by vapometry. For three patients that underwent microwave thermoablation on lower extremity residual limbs there was an average reduction of 2 points in HDSS scores, or 80% reduction in sweating. Improvement was sustained 4-6 years after treatment.

Conclusion: For patients with refractory residual limb hyperhidrosis, microwave thermoablation has demonstrated to be an overall good option with measurable effectiveness and long-lasting results. Our data support that patients have both objective and subjective decrease in sweating on the residual limb leading to overall satisfaction with the procedure. In our experience most of the side effects were mild, however, one of our patients had a major complication following the procedure that led to a prolonged period of time out of their prosthesis while the wounds healed.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

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IMCAS World Congress 2024 Program

148

Clinical dermatology & dermatologic surgery - Contributed talks

Chairs

Lectures of the session

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IMCAS World Congress 2024
Program