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

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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.

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“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.

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Эта работа не была поддержана никаким прямым или не прямым финансированием. Находится под собственной ответственностью автора. 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.

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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.

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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

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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.

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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

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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.

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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.

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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.

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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.

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IMCAS Asia 2024
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NON-SPONSORED SCIENTIFIC E-POSTER

Рекомендуемые сессии

IMCAS Asia 2024 Программа

NON-SPONSORED SCIENTIFIC E-POSTER

Рекомендуемые сессии

IMCAS Asia 2024
Программа