Objectives: To identify improvements in the structure of the epidermis and derma during the procedures performed with the use of the preparation, containg hyaluronic acis and sodium succinate..

Introduction: Many skin diseases, such as atopic dermatitis, seborrheic dermatitis, eczema, acne, rosacea and others, during the reconvalescence need the active participation of both a dermatologist and a cosmetologist with the goal of full physiological epithelization, moisturizing and preventing scarring and pigmentation. After the inflammatory dermatoses, we observe not only deeply dehydrated skin, which is associated with a decrease in the amount of hyaluronic acid, but also changes in the microcirculatory, which manifests itself in the form of impaired tone and vascular permeability. Often during the convalescence of dermatoses, after healing, there remains stable hyperpigmentation or depigmentation, as well as atrophic or hypertrophic scars, which is facilitated by a long process of regeneration at the sites of damage.

Materials / method: We observed 20 women aged 30 to 40 years in the stage of remission of atopic dermatitis (2 patients), seborrheic dermatitis (7), rosacea (2), acne (7), eczema (2). All women received 3 procedures, using a combined preparation containing sodium succinate (16 mg / ml) and hyaluronic acid (11 mg / ml or 18 mg / ml). The drug was administered intradermally in the technique of papular injections with a 30G needle, 2.0 ml per procedure, at intervals of 1 every 2 weeks.

Results: All patients showed a positive dynamic: a reduction in the intensity of hyperpigmentation, a more active skin regeneration (compared to similar areas in the same patient), improved skin turgor and elasticity, increased skin hydration. After the treatment there was a decrease in the severity of telangiectasia (mean score before treatment - 1.2, after treatment - 0.2), pigmentation (1.7 and 0.9 points), dry skin (1.1 and 0.1 points). A good moisturizing effect was noted in 18 (90%) patients, moderate - in 2 (10%). When studying the skin by the method of KLM, a reduction in the area of the areas of hyperpigmentation, as well as a reduction in its severity, regression of hyperkeratosis, a more even arrangement of the fibrous structures of the dermis, and improvement of microcirculation were observed. There was also an increase in skin thickness due to the above processes. Allergic reactions to drug administration have not been recorded. Absence of effect and negative dynamics during therapy were not revealed.

Conclusion: The protocol of using hyaluronic acid and sodium succinate has a good tolerance, promotes the acceleration of skin regeneration, restoration of normal skin hydration, normalization of pigmentation.

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Objectives: 1. To list the triggering factors of melasma relapse based on the studies of etiology and pathogenesis of this hypermelanosis
2. To name the cosmeceutical ingredients that trigger/prevent melasma relapse
3. To formulate evidence-based recommendations for successful management of melasma with lower risk of relapse

Introduction: Melasma is a chronic relapsing disease, which commonly affects women with darker skin phototypes. The etiological factors of melasma are: genetic predisposition, UV and blue light exposure, pregnancy, oral contraceptive pill (OCP) intake, diseases of liver and thyroid gland. In the pathogenesis, the progesterone and estrogen, vascular endothelial growth factor, dermal factors, genes TYR, MITF, SILV, TYRP1, play role.

Materials / method: In our study, 115 patients with facial hypermelanoses (melasma and postinflammatory hyperpigmentation) were examined. Methods: Wood’s lamp (Everplus skin analyzer B-601 16W) + dermoscopy (FotoFinder Handyscope 20x). Blood tests: CBC, liver function tests (bilirubin, AST, ALT, alkaline phosphatase, GGT, total blood protein, albumin, globulin), thyroid hormones (TSH, FT3, FT4), reproductive system hormones (FSH, LH, progesterone, prolactin, estradiol, testosterone free and total), ACTH, iron levels in blood serum, vitamins B12 and D levels (vitamin D 25-OH, total).

Results: The study has shown significant biochemical disturbances in patients with melasma, in males and in females, disturbances in sex hormone levels, deficiency and insufficiency of vitamin D in 71 (61,7%) of patients with hypermelanoses, which should be taken into consideration in management, treatment and rehabilitation of such patients. Treatment method with oral cholecalciferol and topical SPF cream and azelaic acid was proposed and has shown significant improvement in 62,2% of melasma cases compared to the group treated with traditional therapy (by MASI, DLQI, dermoscopy, vitamin D-status).

Conclusion: In order to successfully treat patients with melasma and to decrease the rate of relapse, it is important to inform patients that this is chronic relapsing disease, to collect family history of this facial hypermelanosis, to recommend consultation with endocrinologist (blood tests, discontinue OCP intake, compensate the deficiency of vitamin D and hormonal imbalance); to prescribe SPF cream with UVA, UVB and blue light protection, and cosmeceuticals that affect all stages of melanogenesis for more than 6 months; to stop the procedures that stimulate angiogenesis in cases of vascular melasma.

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Objectives: Though each defect and each patient is different, we devised an approach for face defects depending upon their locations. The proposed algorithm and getting mastered in suggested flap options can improve the outcome of the surgical reconstructed areas on the head and neck. It can serve as good guide for those doing skin cancers under local anesthesia.

Introduction: Skin cancers are common on exposed parts of the body with head and neck area comprising the major part of that. Early detection and early treatment can avoid complex procedures for those skin cancers. Tumor clearance with good margin should be the goal. There are several options available for reconstruction of surgical defects created after tumor excision ranging from simple wound closure to flaps and grafts.
The challenge is to achieve coverage without compromising on the tumor excision margins and also achieving aesthetically acceptable results without causing functional loss or anatomic

Materials / method: 1850 patients underwent surgery for the head and neck skin cancers under local anaesthesia from August 2016 to December 2018 at Waikato Hospital, Hamilton, New Zealand. All surgeries were performed as a day case and 650 of those cases required local flap reconstruction. We used nasolabial, glabellar, bilobed, forehead and hatchet flaps for nasal and medial canthus area defects. Rhomboid, V-Y advancement and cheek rotation flaps were used for cheek defects. Ears defects were reconstructed by flaps from pre and post auricular area. Forehead defects required advancement or transpositional flaps

Results: 650 required flaps of various types for head and neck area. 60 % of the patients were males and average age was 70 years. Patients had defects of various size and depths and we manage to cover them with flaps as mentioned above and made an algorithm of flap choice based on the location of the defects. 92 % flaps were successful with no problems, 6 % had wound healing problems/ minor infections and 2 % had minor flap necrosis and managed conservatively. 2 % required flap revisions.

Conclusion: The proposed algorithm and getting mastered in suggested flap options can improve the outcome of the surgical reconstructed areas on the head and neck. It can serve as good guide for those doing skin cancers under local anesthesia.

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Objectives: The flushing of rosacea can pose difficulty for a physician with it's poor response to treatment, frequent recurrences and patient dissatisfaction. in this presentation we would like to share our positive experience with adding intradermal injections of BoNTA to ipl treatments to enhance the results of solo IPL treatments.

Introduction: The flushing of rosacea can be very embarrassing and betray the emotions one prefers to keep to oneself. It can be triggered by alcohol, sun exposure, variety of food, sport activities and emotions. Although there are numerous treatments for telangiectasia, less so for superficial scatted red pigment the results sometimes are far from satisfactory and there are many recurrences.

Materials / method: In our study we enrolled 10 patients with erythematotelangiectatic rosacea who also had flushing. To evaluate the depth and the amount of chromophore before the treatments and to control the results we used the reproductive assessment with photos and cross –polarized regimen. The treatment plan included 5 ipl treatments with 2 weeks interval and 2 BoNTA injections sessions. During the first 2-3 procedures we used 560 filter for deeper telangiectasia. Later we switched on to 515 filter for the shallow superficial redness. On the sixth and seventh visit we injected BoNTA intradermaly.

Results: All patents noticed the significant improvement in redness of the face and dramatic decrease of flushing episodes both in everyday life and after the exposure to triggers. According to cross-polarizes assessment we saw disappearance of deep telangiectasia, and considerable decrease in superficial redness.

Conclusion: We think that adding intradermal injections of BoNTA to ipl treatments can significantly enhance the results, prolong the clear period and significantly change the quality of life of many patients with no downtime and rather low cost.

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Objectives: The objective of this study is to establish the enhanced immunomodulatory effect of Tacrolimus when combined with the probiotic Bacillus clausii in the treatment of Segmental Vitiligo

Introduction: The cornerstone of Vitiligo treatment is aimed to arrest depigmentation and stimulate repigmentation. Probiotics have been shown to modulate host immune response suppressing self-reactive CD-8, T-cell activity, thus helping arrest melanocyte destruction. This case report explores the combined use of Bacillus clausii oral suspension with a more established immunomodulator, Tacrolimus in the treatment of Vitiligo.

Materials / method: The subject was instructed to cleanse and dry the skin, and apply a thin layer of topical tacrolimus ointment 0.1% using cotton swab on depigmented skin, to be done twice a day for 8 weeks. She was asked to orally take 5ml vial of Bacillus clausii 2 billion oral suspension, twice a day prior to meals for 8 weeks.

Results: Clinically appreciable repigmentation was observed over 6 weeks of treatment, beginning from the perifollicular areas extending peripherally.

Conclusion: The autoimmune theory of Vitiligo implicates the levels of T Regulatory Cells (Tregs) that suppress the self-reactive CD8+ T Cell- mediated destruction of melanocytes. The immunomodulatory effect of Bacillus clausii is demonstrated by skewing of treg-Th17 cell balance in vivo (enhanced Treg and decreased pro-inflammatory Th17 levels). Further studies are recommended to establish the combined immunomodulatory effects of Tacrolimus and Bacillus clausii.

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Objectives: Evaluate the efficacy and safety of a combined pulse dye laser and fractional ablative CO2 laser-assisted drug delivery of Betamethasone-Calcipotriol gel in the treatment of fingernail psoriasis.

Introduction: Psoriasis is a cutaneous inflammatory condition affecting 1-3% of the population. Nail psoriasis affects 60-80% of psoriasis patients. Most therapies are only partial effective. Pulse-dye and long-pulse Nd-YAG lasers have been reported to improve the condition. We aim to assess the efficacy and safety of a combination treatment of pulse-dye laser and fractional CO2 laser-assisted betamethasone – calcipotriol gel delivery for the treatment of nail psoriasis.

Materials / method: We conducted a prospective, intra-patient comparative study, treating one hand while the other hand served as the control. 22 participants (15 males and 7 females) with bilateral fingernail psoriasis enrolled in this trial. Nails on a randomized hand were treated with 3 monthly sessions of pulse-dye laser to the proximal and lateral nail folds followed immediately by fractional ablative CO2 laser assisted BCG delivery to the nail plate. In between treatment and one month following last treatment, the participants applied BCG once daily to the nail plate. At baseline and follow-up visits (6, 9

Results: Seventeen of the 22 patients enrolled in the study completed the study. The treatment was mostly well tolerated except for 3 participants who withdrew the study due to pain experienced during treatment. The participants demonstrated statistically significant improvement of the NAPSI scale on the treated side at 12 months(14.12 vs 19.43; P value= 0.002) including the nail bed (5.87 vs 8.31; P value= 0.031) and nail matrix (8.25 vs 11.06; P value= 0.007). Every NAPSI parameter responded differently to treatment. Patient satisfaction was high, averaged 2.06 (scale 0-3).

Conclusion: We successfully demonstrated a significant improvement of nail psoriasis following a combined vascular laser (PDL) and a laser assisted drug delivery for Betamethasone-Calcipotriol gel.

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