IMCAS

CASE REPORT ON THE USE OF COMBINATION (CYSTEAMINE-5% AND METFORMIN 30%) CREAM IN THE MANAGEMENT OF RECALCITRANT MELASMA

Objectives: To determine the efficacy of combination cysteamine 5% and Metformin cream 30% in the management of recalcitrant melasma

Introduction: Melasma is a common acquired pigmentary disorder characterized by symmetric hyperpigmented macules on the face. Recently, studies have shown that topical Cysteamine is a potent skin depigmenting agent. Topical metformin was recently studied for its melanopenic effects and potential use in melasma. [1]
We use the combination of Cysteamine and Metformin in our patient with recalcitrant melasma.

Materials / method: Our patient received combination Cysteamine cream plus metformin 30% was applied on the lesions once a day at bedtime , with sunscreen in the morning spf 50.

Results: A 45 year old women with Fitzpatrick skin type IV presented with facial dark brownish colour patches on centrofacial region. The patient apply combination of 5% cysteamine with metformin 30% cream over the affected area on face at night , sunscreen of Spf 50 in the morning for 5 weeks resulted in significant improvement with a reduction in the Masi score, without adverse effect.

Conclusion: The Cysteamine it’s a stable aminothiol and some thiol molecules are known to inhibit tyrosinase and peroxidase. The improvement of melasma using topical cysteamine cream 5% was seen in our patient. Topical cysteamine cream was found to be safer and better acceptable when compared to triple combination creams.
Metformin inhibits melanogenesis by reducing intracellular cyclic adenosine monophosphate accumulation, but is low lipophilicity obligates its use in high concentrations for topical efficacy[2].
Combination of Cysteamine at 5% and Topical metformin 30% cream at night for 5 weeks in our

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

The efficacy of Q-switched and Long-pulsed Nd: YAG (1064 nm) in the treatment of Lichen Planus Pigmentosis

Objectives: To effectively treat the LPP and provide an aesthetic improvement in terms of lightening of the hyperpigmented patches.

Introduction: A 28-year-old female was treated with Nd: YAG (1064 nm) and displayed encouraging results regarding the utilization of lasers in the management of LPP. She was treated using a 4-step protocol. The Q-switched Nd: YAG destroys melanin via selective photothermolysis, while the long-pulsed Nd: YAG targets the dermal vessels, hence dampening the inflammatory response and reducing the probability of developing post-inflammatory hyperpigmentation.

Materials / method: The first step involved a long-pulsed FRAC-3 mode (0.6 ms). 8 passes were carried out at and a 3 mm spot size over the full face. The second step involved 3 passes over the entire face with a low fluence beam of a Q-switched Nd: YAG at a pulse duration of 5 ns and an 8 mm spot size. The third step involved a fractional beam profile of the Q-switched Nd: YAG over the entire face. Finally, a single pass with a nonfractioned beam of Q- switched Nd: YAG with a higher fluence and a spot size varying from 4.7 to 5 mm only over the hyperpigmented patches. The pulse duration was 5 ns.

Results: There was minimal downtime, with erythema varying from 3 to 5 days which was treated using mild topical steroids and sunscreen. The patient displayed complete resolution in the LPP following 5 sessions.

Conclusion: The four-step Nd: YAG protocol can be an effective treatment modality for patients with LPP.

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

“Un-Happy New Year”: A case of Traumatic Tattooing on the face of a 22 year-old male managed with Q-switched Nd:YAG laser

Objectives: Title: “Un-Happy New Year”: A case of Traumatic Tattooing on the face of a 22 year-old male managed with Q-switched Nd:YAG laser
1. To present an uncommon case of traumatic tattooing on the face of a 22 year-old male.
2. To highlight the management options available and applied for this case to achieve the satisfactory long-term cosmetic results.

Introduction: Traumatic tattoos secondary to explosives are less common; known to cause abnormal skin pigmentation depending on the material and depth of injury from embedded foreign body particles. Key to management is immediate removal of the latter for the best possible cosmetic result. However, as this is not always possible in certain settings, the advent of laser technology in the form of ablative full beam or fractional lasers and non-ablative Q switched lasers have been successfully used either as a single or combined technique for safe and effective tattoo removal.

Materials / method: N/A

Results: A 22 year-old male presented with multiple dark blue scattered macules on the right maxilla extending to the right upper and lower eyelid, right ear, right side of the nose and chin. History started two years prior on New Year’s Eve after lighting fireworks which accidentally exploded on the right side of his face. Lesions healed without scarring however, unsightly dyspigmentation was left behind. He underwent 7 sessions of fractional CO2 laser done every 2 weeks in another clinic to no avail. Q switched Nd YAG laser was advised in our clinic with satisfactory promising results.

Conclusion: As conventional tattoos in this modern day are regarded as beauty marks intentionally placed as means of self-expression or to communicate socio-cultural significance, traumatic tattoos on the other hand are unintentional, indelible, and may cause depression secondary to permanent cosmetic disfigurement. Traumatic tattooing of the face require careful and efficient planning and management. In this era of advanced laser technology and and specialized technique of skin experts, more options are available to obtain a satisfactory long-term cosmetic result.

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 Region 1 Medical Center Department of Dermatology

Utilizing Variable Square Pulse Technology in an Er: Yag (2940 nm) laser to effectively treat atrophic acne scars

Objectives: To effectively manage the patient’s acne scars and provide an improvement in the Qualitative Global Acne scarring system score.

Introduction: A 27-year-old male is investigated in this study was treated with Er: YAG laser therapy for a total of 4 session conducted 4 weeks apart. The Variable Square Pulse Technology in the Er: Yag laser promotes greater depth of penetration when switched to a long pulse mode and a fractionated beam, especially to induce neocollagenesis at the base of deep atrophic scars. The variable pulsed Er:YAG laser may offer greater utility compared to earlier versions, demonstrating improvements in both safety and efficacy.

Materials / method: 1st step: 9 j/cm2 using a patterned beam intraorally with a 7 mm spot size to stimulate neocollgensis.
2nd step: Using an ablative beam on MSP at 8 j/cm2 and a 2 mm spot size over edges of scars.
3rd step: Using a fractional beam over the deep scars with an LP at 132 j/cm2 with Turbo 6 mode.
4th step: Using a fractional beam over the full face in 2 passes with an XLP at 26 j/cm2.
Qualitative Global Acne Scarring System score was evaluated before and after the four sessions of the Er:Yag laser treatments.

Results: There was minimal downtime, with erythema and crusting varying from 3-5 days. This was treated using mild topical steroids and sunscreen. The patient displayed a dramatic improvement in the Qualitative Global Acne Scarring System score from Grade 3 at baseline to Grade 1 after the last session. Studies have shown that on treatment of acne scars with variable pulsed Er:YAG subjects rate themselves as having at least fair improvement, with a significant change in the objective score also being evident.

Conclusion: Er:YAG laser treatment at 2094 nm presents a viable therapeutic option for young adults' acne scars, producing notable results with little recovery time.

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

Swift Resolution of Post-Inflammatory Hyperpigmentation: A Four-step Q-switched Nd:YAG and Long-pulsed Nd:YAG Protocol

Objectives: To effectively treat patient's post-inflammatory hyperpigmentation with a combination of Q-switched Nd:YAG and Long-pulsed Nd:YAG.

Introduction: Energy-based devices such as lasers often display rapid and superior responses compared to topical medication. However, medical literature still states that an average of 4.9 sessions are required to achieve the desired response[3]. We present the case of a 32-year-old female who presented with dark patches on her face since 3 months, secondary to acne vulgaris. A near-total clinical resolution was attained in three weeks after a single session of the protocol described below.

Materials / method: 1st step : 3 passes over the full face with a low fluence beam at 1.4 mJ/cm2 with a pulse duration of 5 ns and an 8 mm spot size.
2nd step : A single pass with a higher fluence (4.2 mj/cm2) and a spot size of 4.7 mm only over the hyperpigmented macules and patches. This promotes selective photothermolysis.
3rd step : FRAC-3 mode with a long-pulsed Nd:YAG at a pulse duration of 0.6 ms to target the dermal vessels. 8 passes were carried out at 14.9mj/cm2 and a 3 mm spot size over the entire face.
4th step: A fractional beam profile was used at 30 J/cm2 to cover entire face.

Results: There was minimal downtime, with erythema and crusting evident for 4 days post-procedure. This was treated using mild topical steroids and sunscreen. The patient displayed a dramatic improvement with only a single session leading to a near-complete resolution of her PIH.

Conclusion: A higher frequency of complete response, in a shorter duration of time can be achieved on using Q-switched Nd:YAG as compared to treatment only with topicals.

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

A point-of-care autofluorescence imagine device to visualise superficial infections over the skin

Objectives: Spectral results of the device are compared with the culture/KOH test results to determine if the pathogen type identified by the device coincides with the culture/ KOH report.

Introduction: Skin infections are caused by a variety of bacteria and fungus, which makes it harder to diagnose and propose an effective treatment immediately especially in rural areas due to lack of access to qualified dermatologists. Autofluorescence imaging hand-held devices leverage the inherent autofluorescence properties of the bacterium and fungal species to record the multi-spectral signatures and identify the same using identify the same using image processing and machine learning algorithms.

Materials / method: 1.Images of the region of interest are taken with the device
2.Swabs or biopsies are taken from the region of interest for culture/KOH tests
3.Spectral results of the device is compared with the culture/KOH test results

Results: Of the 64 patients imaged, the spectral signatures obtained from our device were able to detect pathogens: both bacteria and fungi
The device spectral results were compared against swab culture/KOH staining as appropriate and the device was able to detect 30 bacterial sites, 31 fungal sites and no infection in 3 sites.
The device was also able to pick up co-colonized wounds.

Conclusion: The hand-held screening device is a useful Point-of-Care tool for physicians to:
Improve the efficiency of wound debridement and cleaning
Increase swabbing accuracy
Continuously track wound healing
Improve the accuracy of first line treatment protocol
Enable better antibiotic stewardship

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

Autologous Fat Grafting: A minimally invasive therapeutic modality to treat facial lipoatrophy

Objectives: 1. To improve the facial contour over the areas of lipoatrophy
2. Restore facial symmetry with fat grafts.
3. To perform the procedure at a very low price due to the patient's financial constraints.

Introduction: A 33-year-old female was afflicted with facial lipoatrophy over the left cheek and temple secondary to lupus erythematosus panniculitis . The patient refused hyaluronic acid fillers due to her financial constraints. Hence, 2 sessions of fat grafting were done 6 weeks apart. This procedure yielded aesthetically pleasing results.

Materials / method: The patient was placed in a prone position and the gluteal fat pads were chosen for the donor sites. Tumescent anaesthesia was infiltrated using a blunt cannula, and eventually, the fat was extracted using a 2cc fat grafting cannula. It was processed using a combination of sedimentation, centrifugation, and filtering techniques to obtain the appropriate amount of microfat. The recipient site cheek and temple were cleaned, draped, and marked. Using an 18-gauge needle purified microfat was injected into the recipient sites and pressure dressing was applied over the donor site.

Results: Significant restoration of the facial contour was observed at the 6-week follow-up consultation. She complained of mild pain and itching during the first week after the procedure. The patient was informed that the average graft survival time can be between 6-8 months.

Conclusion: The discovery of adipose-derived stem cells from stromal vascular fractions and their role in extracellular matrix remodelling generated greater interest in using autologous fats in facial contouring. Fat grafting is an invaluable technique for the aesthetic correction of hemifacial atrophy at economical prices, especially in developing nations where a large proportion of the population cannot afford hyaluronic acid fillers.

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

Successful results in the treatment of Becker’s nevus with Q-switch NdYAG

Objectives: To provide a satisfactory cosmetic outcome to a young female with Becker’s nevus on the face

Introduction: An 18 year old female who presented with a hyperpigmented hypertrichotic patch over her right cheek, which was a source of major distress for her. She had previously recieved various modalities of treatment including topical therapy, lasers and chemical peels with little to no improvement noted by the patient. She received a total of 3 sessions of Q-switch NdYAG for hair and pigment reduction over a period of 2 months, following which the pigment was barely noticeable to her

Materials / method: 3 sessions of Q-switch NdYAG 4 weeks apart with the following protocol was administered each time over the patch:
1. Fluence of 15 J/cm2 and spot size of 7 mm - 1 pass for hair reduction
2. Fluence of 1.4 mJ/cm2 with a pulse duration of 5 ns and an 8 mm spot size - 3 passes
3. Fluence of 4.2 mj/cm2 and spot size of 4.7 mm - 1 pass
4. FRAC-3 mode with fluence of 14.9 mJ/cm2 at a pulse duration of 0.6 ms and a 3 mm spot size - 8 passes

Results: The patient experienced erythema and tingling over the treated area for 2 days after the procedure, which was managed with topical steroids. There was no post inflammatory increase in the pigmentation. After 2 months of treatment, the patient was satisfied with the outcome, and with barely any noticeable pigmentation left, did not feel the need for further intervention

Conclusion: While there is much debate over the best modality of treatment of Becker’s nevus, Q-switch NdYAG presents a promising contender for a safe and effective therapy, delivering results in a short course

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

Obstructive sleep apnoea: A non-surgical treatment with Er: YAG (2940 nm) laser.

Objectives: 1. To provide symptomatic relief from snoring,
2. Improvement of the patient’s sleep quality
3. Observe an objective improvement in the airway opening via the Mallampati classification. (Figures 1,2 and 3).

Introduction: We conducted a study on 10 patients treated with Er: YAG (2940 nm) over three sessions performed at 0, 15 and 45 days. This laser exerts its effect via the photothermal contracture of collagen over the targeted sites in the oral mucosa, coupled with neocollagenesis by a heat shock protein-mediated mechanism. The advantage of utilizing Er: YAG is that it is a non-invasive and conservative procedure. Hence, it is ideal for patients who are apprehensive about undergoing surgery. Furthermore, there are minimal adverse effects and virtually no downtime after doing the procedure.

Materials / method: The patients were laid in a supine position and 10,000 shots of the laser were dispersed over the base of the tongue, buccal mucosa, pharyngeal arches, soft palate, uvula, tonsils, and posterior pharyngeal wall using a collimated beam, on the LP mode at 1.8 J/cm2 and a 7 mm spot size. The procedure lasted for approximately 20 minutes.

Results: 1. There were 3 patients with Mallampati class IV at baseline, which had improved to Mallampati class III at the end of 3 sessions.
2. 5 patients with Mallampati class III at baseline, which had improved to Mallampati class II at the end of 3 sessions.
3. 2 patients with Mallampati class II at baseline, which had improved to Mallampati class I at the end of 3 sessions.
4. The only adverse effect reported was a mild dryness over the back of the throat which was self-resolving after a few hours.

Conclusion: Er: YAG is an effective and non-invasive alternative to surgical treatments for relieving snoring.

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

Managing Melasma: A Four-step Nd: YAG (1064 nm) Protocol.

Objectives: To effectively treat melasma in all five patients and to quantify the improvement in their quality of life using melasma quality of life (MELASQOL) scores, which were measured at the first session and after a month post the 5th session.

Introduction: 5 women with melasma aged between 26 and 52 years, were treated with multiple modes and beam profiles of Q-switched and long-pulsed Nd: Yag laser (1064 nm), which yielded tremendous results. These patients were treated using a four-step protocol. The Q- Q-switched Nd: YAG destroys melanin via selective photothermolysis, while the long-pulsed Nd: YAG targets the dermal vessels.

Materials / method: 1st step involved 3 passes over the full face with a Q-switched Nd: YAG at a low fluence toning (1.4 mJ/cm2) with a pulse duration of 5 ns and an 8 mm spot size. The 2nd step involved a single pass with a higher fluence (5 mj/cm2) and a spot size varying from 4.7 to 5 mm only over the hyperpigmented patches. The third step involved a FRAC-3 mode on a long-pulsed Nd: YAG (0.6 ms pulse duration) to target the vascular component of melasma. 8 passes were carried out at 14.9 mj/ cm2 and a 3 mm spot size. Eventually, the Q-switched Nd: YAG fractional beam profile was used at 30 J/cm2 over the face.

Results: There was minimal downtime, with erythema varying from 3-5 days. This was treated using mild topical steroids and sunscreen. 5 sessions, done 3 weeks apart, were needed to provide optimal results (Figures 1, 2, 3, 4 and 5). There was a substantial improvement in the quality-of-life score, as quantified by a reduction in the mean MELASQOL score from 40.6 to 20.2.

Conclusion: The four-step Nd: YAG protocol can be a robust tool in the armament against melasma, yielding tremendous results after 5 sessions of therapy.

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

Monoazo Pigments in Red Tattoo Ink: The Cause of Lichenoid Reactions.

Objectives: To discern the causative elements in red tattoo ink that lead to lichenoid reactions.

Introduction: The increasing popularity of tattooing has spurred developments in the formulation of tattoo inks, which led to a shift from inorganic to organic tattoo inks. However, red tattoo inks are still notorious for causing allergic reactions. Thus, we conducted an analytic study on the contents of red tattoo ink after five patients with lichenoid reactions over their tattoo sites had presented to our clinic. These reactions appeared as erythematous plaques only limited to the areas of the red tattoo ink. The black and green tattoo sites were unremarkable.

Materials / method: Five male patients aged 22 to 44 years with erythematous, elevated lesions on recently tattooed areas were recruited into a study and skin biopsies were sent from the affected sites. Two diverse tattoo inks which were purchased from local stores, labelled “Red A” and “Red B”, were analysed using a UV-visible spectrometer, x-ray diffraction, Raman spectroscopy, Fourier transform infrared (FT-IR) spectroscopy, and elemental demand scanning (EDS) examination to identify the chemical constituents that may the cause of these reactions.

Results: The UV visible spectra of Red A and B in solution exhibited two absorption bands: one at 260-310 nm and the other at 360-590nm. X-ray diffraction, utilised to examine the composition and crystallinity of the red ink, revealed that both inks displayed diffraction patterns consistent with naphthol red . Raman spectroscopy revealed that the monoazo pigment Naphthol AS was present in both Red A and Red B. The presence of pigment PR170 in both inks was confirmed by FT-IR spectroscopy. EDS examination of both inks concluded that Red A contains a minute quantity of aluminium.

Conclusion: Compared to other inks, red ink contains azo pigment, which when exposed to UV rays in sunlight, may get reduced to aromatic amines resulting in various allergies. Thus, the presence of azo pigment in red tattoo inks may be the reason behind lichenoid dermatitis observed in five patients at the site with only red tattoos, sparing the regions with black ink.

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

Optimizing Outcomes in Russian Lip Technique: The key Indicators for Enhanced Satisfaction

Objectives: To identify the ideal anatomical indicators for the Russian Lip technique (vertical tenting) and assess the impact of these indicators on patient satisfaction. This study aims to establish a set of criteria that can predict the most favorable outcomes for individuals undergoing lip augmentation using this method.

Introduction: Lip augmentation using the Russian Lip technique involves injecting fillers to create a vertical tenting effect, enhancing the lip's natural shape while emphasizing vertical height and the definition of the Cupid's bow. [1,2,3] This study seeks to define the anatomical characteristics that constitute an ideal candidate for this procedure and to quantify the relationship between these characteristics and patient satisfaction levels .

Materials / method: This study analyzed the outcomes of the Russian Lip technique on 32 female cases, focusing on vertical tenting. Key anatomical parameters were measured, including lip width, the distance between the skin and muscle via ultrasound, the height of the red and white lip, the shape of the Cupid's bow, mouth corner patterns, philtrum alignment, and upper lip projection. Ideal case indications were determined based on these measurements, with patient satisfaction evaluated in relation to the adherence to these ideal indicators.

Results: The study revealed that lips with a width between 4.5 to 5 cm are the most suitable for the Russian Lip technique. Ideal candidates have a lip-to-muscle distance of 1.8 to 2.6 mm measured via ultrasound (figure 1) , a red lip height at the Cupid's bow peak of at least 8 mm (figure 2) , a V-shaped Cupid's bow, upward mouth corner patterns (figure 3) , parallel philtrum lines, and a maximum upper lip projection of 3 mm beyond the lower lip (figure 4). Non-presence of body dysmorphic disorder, a minimum philtrum length of 15 mm, and age under 40 were also among the ideal indications.

Conclusion: The Russian Lip technique demonstrates significantly higher satisfaction rates when applied to individuals matching specific anatomical criteria. This study establishes a clear set of indicators that can guide practitioners in selecting ideal candidates for this procedure, thereby maximizing the likelihood of achieving favorable aesthetic outcomes and high patient satisfaction. These findings underscore the importance of a tailored approach to lip augmentation, considering individual anatomical characteristics to optimize the effectiveness of the Russian Lip technique.

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

The effects of cleansers on skin pH, recovery time for skin pH normalization, and the impact of using a cleanser with a pH close to the physiological

Objectives: This study aims to assess the impact of using a cleanser with a pH value of 4.8, close to the physiological pH of skin, on skin health over an 8-week period. Specifically, it examines changes in skin pH, the time required for skin pH to return to its baseline (recovery time), and observable skin conditions such as redness, Transepidermal Water Loss (TEWL), and pore visibility in a cohort of 86 women and 24 men with Rosacea and average skin pH values of 5.45 and 5.32, respectively.

Introduction: The skin's pH is a critical factor in maintaining its barrier function and overall health. Disruptions to skin pH can lead to various dermatological issues. This study investigates how cleansers with a pH aligned to that of the skin affect its pH balance, recovery time, and other skin health indicators, providing insight into the potential benefits of selecting pH-appropriate skincare products.

Materials / method: Participants included 86 women and 24 men, subjected to an 8-week regimen using a cleanser with a pH of 4.8. Skin pH, TEWL, redness, and pore size were measured at baseline, weekly, and at study completion. Significant changes were anticipated from the second week, with recovery times and participant satisfaction also evaluated.

Results: By the second week, significant improvements were observed: skin pH adjusted to 5.15 in women and 5.2 in men, with further reduction to 4.95 and 5.05, respectively, by the fourth week. Skin redness and TEWL decreased significantly (p-value < 0.001), and pores became less visible. Recovery time dropped dramatically from 105 minutes for women and 98 for men to 35 and 31 minutes, respectively, by the eighth week. Satisfaction increased by 65% among women and 70% among men.

Conclusion: The study conclusively shows that using a cleanser with a pH close to the skin's natural pH significantly improves skin health, as evidenced by reduced recovery times, improved skin conditions, and high levels of participant satisfaction. These findings underscore the importance of choosing skincare products that maintain the skin's natural pH balance, potentially leading to healthier skin and improved dermatological outcomes. Further research is encouraged to explore long-term benefits and effects on various skin types.

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

Differential Injection Points of Botulinum Toxin in Eastern Asians, Middle Eastern, and Caucasian Ethnicities: An Ultrasound-Guided Analysis

Objectives: To compare the differences in optimal botulinum toxin injection points among East Asian, Middle Eastern, and Caucasian individuals by utilizing ultrasound measurements of the labiomandibular fold divided into six squares, focusing on distance from the depressor labii inferioris (DLI), soft tissue thickness, and depressor anguli oris (DAO) muscle thickness.

Introduction: Facial rejuvenation often addresses downturned mouth corners, a sign of sadness or aging. This study explores the anatomical bases of such conditions, linked to the hyperactivity of the depressor angularis oris muscle and gravitational effects, leading to the creation of melomental folds or "marionette lines"[1][2][3].

Materials / method: A total of 114 cases were evaluated, including 32 cases in South Korea (20 females and 12 males), 26 Caucasian cases (16 females and 10 males), and 56 Middle Eastern cases (36 females and 20 males), with an age range of 25 to 51 years and a mean BMI of 27.3. Ultrasound was used to measure the DLI distance, soft tissue thickness, and DAO muscle thickness at the center of each square within the labiomandibular fold .

Results: In all groups, the greatest DLI distance was in the upper lateral squares by the labiomandibular fold. DAO muscle's depth and thickness varied, with East Asians and Middle Easterners having thinner DAO muscles, ranging 1.4-6 mm, compared to Caucasians at 2.2-4.1 mm. The middle squares' DAO fibers were 5.1 mm deep and 3.2 mm thick for East Asians, 4.2 mm and 2.8 mm for Middle Easterners, and 4.4 mm and 3.1 mm for Caucasians.

Conclusion: The LADDER technique , suggesting an initial injection point 1 cm lateral and 1 cm inferior to the mouth corner at a depth of less than 2 mm with 1 IU of Bont-A, followed by a second point 1 cm lateral and inferior to the first, with a depth of 4-6 mm and 2 IU, was effective in treating all cases with only one asymmetry in a Middle Eastern subject and two non-responses. For asymmetry, an additional injection in the middle lateral square with 1 IU corrected the issue completely. This study underscores the importance of understanding ethnic anatomical differences for optimizing Bont-A injection

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

Efficacy of a Non-Laser Based Protocol for the Treatment of Mixed Epidermal/Dermal Melasma: A Comparative Study

Objectives: To compare the therapeutic outcomes of two non-laser based treatment protocols for mixed melasma, utilizing modified triple combination therapy (TCT) with adjunctive treatments, and assess their effectiveness through the Melasma Area and Severity Index (MASI).

Introduction: Melasma presents a significant challenge in dermatology, with its pathogenesis rooted in genetic predisposition, hormonal influences, and UV radiation exposure. Classified into epidermal, dermal, and mixed types based on the depth of pigment deposition, melasma requires a tailored therapeutic approach. Traditional treatments have ranged from topical agents to procedural interventions, including lasers, which have been effective in targeted pigment reduction.

Materials / method: In a study of 27 women aged 27-42 with untreated mixed melasma, two groups underwent a 12-week treatment plus 24-week recurrence monitoring. Group 1 received modified TCT (2% hydroquinone, 1% hydrocortisone, 0.05% tretinoin) and, from week 4, four L-PRP plus microneedling sessions at three-week intervals. Group 2 had a similar regimen but used tranexamic acid with microneedling instead of L-PRP. Both paused TCT around microneedling sessions and took Polypodium leucotomos extract daily. MASI scores at baseline, week 12, and week 36 assessed efficacy and recurrence.

Results: MASI Improvement: Group 1 showed an average MASI reduction from 22.4 (baseline) to 8.6 (week 12), and Group 2 from 23.1 (baseline) to 5.4 (week 12).
Patient Satisfaction: In Group 1, 8 reported excellent satisfaction, 4 good to excellent, 2 medium to good, and 3 experienced recurrence. In Group 2, 10 reported excellent satisfaction, and 3 good to excellent, with no recurrence noted up to week 36.
Safety: No significant adverse effects were observed in either group, including no cases of hydroquinone halo or dyspigmentation.

Conclusion: Both non-laser based treatment protocols demonstrated significant improvement in MASI scores, with Group 2 showing a slightly better outcome and no recurrence during the follow-up period. This study suggests that modified TCT combined with microneedling and either L-PRP or tranexamic acid presents a viable alternative to laser treatments for mixed melasma, with high patient satisfaction and minimal adverse effects.

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

Anti-Senescence Effect of Skin Cells by Porcine Placenta Extract

Objectives: To verify porcine placental extracts (Pla-Ext.)'s effects on human skin aging, we investigated its reactions to Human Dermal Fibroblast (HDF) and its ability to resist damage when stress is applied. At this time, we compared the following items: the effects of human mesenchymal stem cell-derived Exosome (hMSC-Exo.) alone; the combined effect of Pla-Ext. and hMSC-Exo.; the effects of Pla-Ext added-hMSC-derived Exosomes (Pla/MSC-Exo.) recovered from the culture medium. This study aims to explore Pla-Ext.'s action area, mechanism, and its anti-aging effects on human skin.

Introduction: In Japan, the human placenta pharmaceutical is a pharmaceutical, and it has been improved as an injection medicine from the burying therapy of the tissue, and liver function improvement, etc. are certified as an indication. Porcine and equine placental preparations also exist as cosmetics and supplements. However, from a pure scientific perspective, materials with such multi-biological activities are extremely rare. There are many Pla-Ext.’s cosmetics that are applied to the skin, which have been largely well received, but the extent of efficacy and mechanism of action have not been clarified.

Materials / method: hMSC-derived Exosomes were collected from a medium where hMSCs were cultured with P-Ext. The following were considered: 1. Effect on normal HDF; 2. Verification of HDF resistance to photoaging stimulation (UV); 3. Verification of HDFs under glycative stress (AGE); 4. Verification of HDF resistance to oxidative stress (H2O2) damage; 5. Verification of inhibitory effect on intracellular reactive oxygen species (ROS) accumulation in HDFs under the H2O2. Collagen, Elastin, and Hyaluronic acid synthase-mRNA levels were measured when these stresses were added to HDF.

Results: 1. Five additive substances did not stimulate HDF, and cell proliferation was highest in Pla-Ext.
2. UV increased Elastin and Hyaluronic acid synthase other than collagen. Pla-Ext. increased Collagen, while the others reduced it. hMSC-Exo. also showed damage resistance to Elastin and Hyaluronic acid synthase. Pla/MSC-Exo. showed resistance to all parameters.
3. AGE reduced all parameters, while both Pla-Ext. and Pla/MSC-Exo. increased them.
4. H2O2 reduced all parameters. Pla-Ext. and Pla-Ext.+hMSC-Exo. mitigated Collagen damage.
5. ROS accumulated due to H2O2 stress. Pla-Ext. reduced it.

Conclusion: Pla-Ext. was found to have a cell proliferation-promoting effect on normal skin fibroblasts. Pla-Ext. showed resistance to three types of stress (photoaging, glycation stimulation, and hydrogen peroxide stimulation). It was suggested that it acts on processes related to cellular aging. It was also suggested that stimulating hMSCs with Pla-Ext. may cause some changes in the exosomes secreted from them.

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

Speakers	Lecture title	Abstract	Number
Dr Elaine ALCALDE	CASE REPORT ON THE USE OF COMBINATION (CYSTEAMINE-5% AND METFORMIN 30%) CREAM IN THE MANAGEMENT OF RECALCITRANT MELASMA	View	136347
Dr Divya ASNANI	The efficacy of Q-switched and Long-pulsed Nd: YAG (1064 nm) in the treatment of Lichen Planus Pigmentosis	View	138494
Dr Stefanie Mae BELMES MORALES	“Un-Happy New Year”: A case of Traumatic Tattooing on the face of a 22 year-old male managed with Q-switched Nd:YAG laser	View	138504
Dr Yash BUCCHA	Utilizing Variable Square Pulse Technology in an Er: Yag (2940 nm) laser to effectively treat atrophic acne scars	View	138495
Dr Shubham DEOKAR	Swift Resolution of Post-Inflammatory Hyperpigmentation: A Four-step Q-switched Nd:YAG and Long-pulsed Nd:YAG Protocol	View	138497
Dr Aayush GUPTA	A point-of-care autofluorescence imagine device to visualise superficial infections over the skin	View	138493
Dr Aayush GUPTA	Autologous Fat Grafting: A minimally invasive therapeutic modality to treat facial lipoatrophy	View	138513
Dr Akanksha JAKHAR	Successful results in the treatment of Becker’s nevus with Q-switch NdYAG	View	138516
Dr Rohit KOTHARI	Obstructive sleep apnoea: A non-surgical treatment with Er: YAG (2940 nm) laser.	View	138496
Dr Rohan MANOJ	Managing Melasma: A Four-step Nd: YAG (1064 nm) Protocol.	View	138498
Dr Rohan MANOJ	Monoazo Pigments in Red Tattoo Ink: The Cause of Lichenoid Reactions.	View	138515
Dr Nima NAELI	Optimizing Outcomes in Russian Lip Technique: The key Indicators for Enhanced Satisfaction	View	137361
Dr Ahmad NAZARI	The effects of cleansers on skin pH, recovery time for skin pH normalization, and the impact of using a cleanser with a pH close to the physiological	View	137322
Dr Ahmad NAZARI	Differential Injection Points of Botulinum Toxin in Eastern Asians, Middle Eastern, and Caucasian Ethnicities: An Ultrasound-Guided Analysis	View	137738
Dr Ahmad NAZARI	Efficacy of a Non-Laser Based Protocol for the Treatment of Mixed Epidermal/Dermal Melasma: A Comparative Study	View	137739
Dr Keita TAKANASHI	Anti-Senescence Effect of Skin Cells by Porcine Placenta Extract	View	138468

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IMCAS Asia 2024 Program

FOCUS ON NON-SPONSORED SCIENTIFIC E-POSTER

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IMCAS Asia 2024
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