Objectives: The objective of this case is to discuss various treatment options for patients with recalcitrant difficult-to-treat trachyonychia from onychomycosis and verruca. And to discuss the challenges experienced during the treatment course.

Introduction: Initially, onychomycosis was treated with pulse dosing Itraconazole (400 mg daily for 7 days, repeated monthly for 3 months). Post-resolution, ND-YAG 1064 Long Pulse Laser (Fluence - 150J, Frequency - 15ms, spot size – 4mm) was done monthly for 3 sessions, alongside oral zinc gluconate (280 mg daily for 3 months). The patient received the Nonavalent HPV vaccine (6, 11, 16, 18, 31, 33, 45, 52, and 58) in three doses (week 0, month 2, and month 6), resulting in significant clearance.

For recurrence, topical imiquimod 5% cream was applied thrice weekly for 4 weeks, followed by betamethasone 0.0

Materials / method: Onychomycosis was treated with Itraconazole 400 mg daily for 7 days, monthly for 3 months. Post-resolution, ND-YAG 1064nm Long Pulse Laser (Fluence -150J, Frequency -15ms, spot size –4mm) was done monthly for 3 sessions, with oral zinc gluconate (280 mg daily for 3 months). Nonavalent HPV vaccine (6, 11, 16, 18, 31, 33, 45, 52, and 58) was then given in three doses (week 0, month 2, and month 6), resulting in significant clearance.
For recurrence, imiquimod 5% cream was applied thrice weekly for 4 weeks, followed by betamethasone 0.05% + calcipotriol 0.005% ointment twice weekly for 4 weeks.

Results: After the course of treatment, there is significant improvement to almost complete resolution of the dystrophic nails. Patient expressed significant satisfaction on her daily life after the treatment course.

Conclusion: Trachyonychia is a difficult condition to manage, often requiring a multimodal treatment approach and regular follow-up to address recurrences and ensure patient well-being.

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Objectives: Laser hair removal is a commonly used method in dermatology which is based on selective thermolysis and utilizes the appropriate wavelength, pulse width, and energy density to damage hair follicles. Given the prevalence of skin diseases such as psoriasis, dermatitis, and vitiligo, and the increasing popularity of laser hair removal, the aim of this study was to investigate the safety of laser hair removal in individuals
with skin diseases.

Introduction: Laser hair removal is performed in both medical hospitals and clinics by caregivers with varying levels of medical and technical education and this also can have an effect on the safety of this practice where approximately 30% of all complications
associated with laser therapy can be attributed to nonmedical personnel. While laser hair removal is generally a safe and effective method, its most common skin complications include folliculitis, post-treatment transient and reticulate erythema, perifollicular edema, ocular complications, pain, crusting, and purpura.

Materials / method: This retrospective study was conducted at the laser department of Razi Hospital on 99 patients who underwent laser hair removal from nearly 7000 cases. The inclusion criteria were patients referred for laser therapy with a history of skin diseases such as eczema, psoriasis, vitiligo, vascular collagen,
etc. The study also recorded information on patients who developed a specific skin disease after laser treatment, despite having no prior history of skin disease. To extract the data, all patient files were reviewed, and the patients were contacted to complete information.

Results: The exacerbation of disease after laser therapy was significantly associated with active skin disease (p = .021) and laser treatment at the site of the disease (p
< .001). The incidence of Koebner phenomenon was significantly associated with age (p = .017) and the number of sessions with the ND-YAG device (p = .034). The results indicated that the exacerbation of disease after laser therapy was not significantly associated with skin phototype, age, the number of sessions before complications, and the type of devices.

Conclusion: Based on the findings of this study and previous research, it is crucial to exercise caution when performing laser treatment on individuals with active skin disease and to avoid treating the affected area were possible. It is worth mentioning that skin darkening based on the Fitzpatrick criteria was not significantly associated with the occurrence of skin lesions after laser therapy. The occurrence of Koebner phenomenon after laser therapy was significantly associated with age and the number of ND-YAG device sessions. The use of the Alexandrite device for laser therapy carries a low risk.

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Objectives: Periorbital dermatitis is common skin condition usually caused by allergic contact dermatitis, which can be triggered by fragrances and preservatives found in many cosmetic products. First-line therapy for periorbital dermatitis involves calcineurin inhibitors, which block the protein that activates the cells causing the inflammation. The objective of this case study was to review the efficacy of polynucleotides as an alternative treatment for patients who do not want to use or do not respond to calcineurin inhibitors.

Introduction: Our patient had severe dryness and flakiness around her eyes with lichenification, and accentuation of lines.

Pimecrolimus cream (Elidel 1%) and hydrating skincare had been used for 3 months with no effect. We discussed changing to Tacrolimus 0.1%, however this was declined by the patient.

Polynucleotides were discussed as a treatment option as they promote a trophic and stimulating action on existing fibroblasts that increases collagen synthesis. They also increase hydration and reduce inflammation. We discussed that polynucleotides could potentially improve dermatitis and skin quality.

Materials / method: The treatment area was numbed for 30 minutes with EMLA cream. A 30-gauge needle with 2ml syringe was used to inject small intradermal blebs around the upper lid, lower lid and crow’s feet area. We used polynucleotides with 20mg per ml over 4 sessions as she demonstrated good tolerability.

Ice was used to help control the bleeding and increase treatment comfort.

The patient was informed of potential side effects, including temporary swelling, redness and tenderness around the injection site. She was also informed of a small chance of allergic reaction and bruising.

Results: The patient had a significant reduction in inflammation, redness and flakiness. Normal hydration levels were restored, and there was improved elasticity. She said her skin felt much softer and less tight, while also reporting the skin around her eye was less sore and itchy. The patient had a small amount of bruising, but she did not complain of any side effects, and was very happy with the overall result. The patient will return for maintenance in six months.

Conclusion: We have found polynucleotides to be an excellent addition to clinical practice as they can be used as a standalone treatment or in combination with others. Clinical research suggests they work well to prime the skin, with evidence indicating that polynucleotides can make skin more receptive to laser, radiofrequency, fillers, chemical peels, microneedling and surgery. We have valued being able to offer patients an effective option for treating concerns around the eyes – an area which is generally regarded as challenging to treat. Further research is welcome.

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Objectives: To outline the efficacy and safety in the use of artificial intelligence (AI) controlled pulsed system in skin rejuvenation
To present objective evidence for reduction in skin dyschromias
To illustrate improvement in skin texture

Introduction: Intense pulsed light systems are regularly used for the treatment of skin dyschromias and textural imperfections To date, all IPL devices are controlled manually by the operator and are commonly associated with untoward effects, especially in darker phototypes.
We present an Intelligent-control (AI) pulsed light system technology which incorporates a Skin Positioning System, with real-time, 3D spatial data on the handpiece’s position and orientation. Hence, it is possible to perform treatments safely, avoiding any pulse stacking and preventing skip areas and striping on the skin.

Materials / method: A retrospective series of fifteen patients, Fitzpatrick skin types I-V, who had been treated for various skin dyschromias including rosacea, pigmentation, generalised discolouration and uneven skin texture, were analysed. The patients had undergone a course of five monthly treatments and were assessed by 3D photography and subsurface illumination to evaluate their progress.

Results: All patients obtained positive results with visible improvement in skin texture as well as a reduction in erythema and pigmentation. No treatment associated adverse events were seen

Conclusion: The Artificial Intelligence controlled pulsed light system was shown be safe and effective in the treatment of skin imperfections, in all Fitzpatrick skin types I-V.

The use Artificial Intelligence heralds a new era in Aesthetic Medicine.

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Objectives: To evaluate the efficacy and efficiency of high molecular weight non-crosslinked hyaluronic acid plus succinic acid mesotherapy in rosacea patients who are not responding to the classic topical treatment.
To establish the improvement in general parameters such as erythema, telangiectasia, hydration and relapsing of the condition in a 1 year follow-up.
To compare its costs with laser therapy, as a highly used co-adjuvant therapy.

Introduction: Rosacea is a highly prevalent dermatosis affecting 5% worldwide. Its impact is not only physical but also mental, as over 60% of patients present depression, and anxiety among other psychological manifestations.
Currently, the gold standard topical treatments present no more than a 3% success rate, and rosacea complications such as disfigurations, burning sensation, and pain can largely affect a patient's health. High molecular weight non-crosslinked hyaluronic acid plus succinic acid intradermotherapy has shown anti-inflammatory, regenerative, and vascular modulatory capacities.

Materials / method: In this study, we evaluated the use of 3 sessions of this mesotherapy (once per month) with 1.1% of high molecular weight non-crosslinked hyaluronic acid plus 1.6% succinic acid (2 mL in total full face in papules technique) as a coadjuvant treatment for rosacea in a group of 20 male and female patients, 40-45 years old, Fitzpatrick 1-3 without comorbidities, under topical treatment with ivermectin 2%, metronidazole 0.75% and photoprotection, but without results or clear improvement. The erythema, hydration, and facial telangiectasia were evaluated every session for proper quantification.

Results: Our results showed a reduction of 80% in the base erythema, also an improvement of 30% in hydration, a reduction of 20% in facial telangiectasia, and a significant reduction of relapsing or rosacea episodes in a 1-year time frame, after the 3 sessions, when compared with patients who only used the topical treatment. In addition, the costs were significantly lower than laser therapy in a private health system setting.

Conclusion: In conclusion, we demonstrate that using this combination as mesotherapy is efficient, safe, and cost-effective, co-adjuvant therapy.

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Objectives: A metanalysis of 340 studies concludes that interacting genes and proteins are vastly complex and intricate with many unknowns which currently prevent us from solving the anti-ageing equation in terms of gene expression. Molecular studies involving genome modification should take into consideration the importance of apparently opposing genes and proteins which when seen as a whole, can orchestrate an optimal systemic balance. Gene expression is often a double-edged sword with positive effects turning negative when a particular gene is overexpressed.

Introduction: Rejuvenation as a result of gene expression is still an open area of research with studies that have either been limited to in vitro research or clinical studies claiming success based on a limited perspective that selectively emphasises the benefits of certain genes while leaving the negative outcomes in the shadows of their silence. For example, some investigators relate the presence of ZMPSTE24, IGF1R, NGF4, EEF2, EIF4FBP1 CCL18, and other genes with “rejuvenation,” selectively focusing on potential benefits while ignoring the involvement of certain genes in malignancies and inflammation.

Materials / method: Well-controlled gene expression molecular experimental studies with mechanotherapy and effortless exercise have limited themselves to the observation of increased slow skeletal genes associated with muscle growth. Exercise and nutrition are still the safest and most ethical methods of gene expression, at least until genome editing can be extended to delaying ageing, in the near or distant future. As observed in the research analysing gene expression as the result of different types of exercise, inflammatory events are counterbalanced by antagonizing anti-inflammatory ones.

Results: Health relies on optimal biological homeostasis and the harmonious interaction of opposite processes levelling and stabilizing each other. Exercise modalities and lifestyle still represent the cornerstone of delaying ageing and the most riskless method of increasing longevity by triggering processes that balance each other. As observed in the research analysing gene expression as the result of exercise, inflammatory events are counterbalanced by antagonizing anti-inflammatory ones.

Conclusion: Health results from opposite processes levelling and stabilizing each other. Optimum is not the absence of inflammation but the absence of inflammatory processes progressing beyond the point of their necessity. Rejuvenation as a result of gene expression is still an open area of research with studies that have either been limited to in vitro research or clinical studies claiming success based on a limited perspective that selectively emphasises the benefits of certain genes while leaving the negative outcomes in the shadows of their silence.

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Objectives: -Understand exosomes' role in intercellular communication and their promise for skin regeneration and wound healing
-Evaluate exosomes as innovative treatments for inflammatory and autoimmune skin conditions
-Identify challenges such as standardization issues, preclinical model limitations, and the need for comprehensive safety evaluations
-Focus on improving exosome purification, understanding their diversity, and establishing robust regulatory frameworks
-Stress the importance of rigorous clinical validation and enhanced regulatory oversight to fully realize exosome potential in dermatology

Introduction: Exosomes, nanoscale vesicles (30–150 nm) with a lipid bilayer,have emerged as crucial elements in dermatology due to their role in intercellular signaling &their potential as cell-free therapeutics.Rich in proteins, lipids& nucleic acids, these vesicles retain the biological properties of their source cells and offer promising advancements in skin regeneration,wound healing &management of inflammatory & autoimmune skin disorders.Recent research underscores their ability to bridge medical &cosmetic dermatology,highlighting the need for further exploration to unlock their full clinical potential

Materials / method: Literature Review: Reviewed peer-reviewed articles in dermatology from PubMed, Google Scholar, and Scopus.
Content Analysis: Analyzed dermatology content from PubMed, ResearchGate, Google Scholar, and professional dermatology forums, categorizing it and assessing engagement with analytics tools.

Results: Exosomes in dermatology show promise for skin regeneration, wound healing, and managing inflammatory and autoimmune conditions. They enhance scar treatment, promote hair growth, and aid in wound recovery. Derived from sources like stem cells and dermal papillae, they improve skin conditions and reduce scarring. However, challenges in isolation standardization and long-term safety need addressing. Despite these hurdles, ongoing research suggests that exosomes could revolutionize dermatological treatments with their unique therapeutic capabilities.

Conclusion: Exosomes are revolutionizing dermatology, bridging the gap between potential and application. They play a significant role in skin regeneration, wound healing, and treating inflammatory and autoimmune skin diseases. Stem cell-derived exosomes offer innovative solutions with reduced risk compared to direct stem cell therapies. However, challenges in purification, standardization, and regulation remain. Future research must address these issues to fully realize exosomes' therapeutic potential and ensure their safe clinical use.

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Objectives: We watnt to show the effectiveness of electroporation added to microabrasion, increasing the transdermal delivery of active ingredients such as Lumicen gel and TKN HA xs 2% solution, TKN HA mw 2%, in the treatment of the patient.

Introduction: Hyperkeratosis is first of all an adaptive physiological phenomenon that aims, through the accelerated production of strongly keratinized cells, to strengthen the resistance of the epidermis.
Hyperkeratosis is the thickening of the stratum corneum (the outermost layer of the epidermis), often associated with the presence of an abnormal amount of keratin and also usually accompanied by an increase in the granular layer.
It can be caused by vitamin A deficiency or chronic exposure to arsenic.
From the analysis of the studies, two types of approaches for the treatment of hyperkeratosis.

Materials / method: Technology: MesojectGun
Machine parameters:
Electroporation 5
Contact degree 5
Product dosage 3
Frequency 5
Assets:
Lumicen solution 1ml + Lumicen gel 1 ml - 2ml of the mixture
We make this mixture because the substances having different molecular weight ensure penetration into different layers of the skin.
+TKN HA MW2% - 1ml + TKN HA XS2% - 1ml - 2ml
We make this mixture because substances with different molecular weights act in different ways. The low molecular weight one acts faster and for less time; the one with medium molecular weight, on the other hand, ensures later and longer hydrati

Results: The patient adhered well to the clinical treatment, as it proved to be effective and painless.
The clinical improvement of the patient shows that the choice of ELECTROPORATION + MICROABRASATION, to facilitate the transdermal delivery of the chosen assets was satisfactory.
And the choice of active ingredients was effective for hydration and skin reorganization of the patient’s plantar regions D and E.

Conclusion: PDRN has the capacity for skin hydration, high cell regeneration power and is a powerful anti-inflammatory.
TKN HA XS 2% and TKN HA MW 2% have high moisturizing power and increased skin elasticity.
With the blends carried out we achieve distinct depths (lumicen gel and solution) and prolonged action (TKN HH XS 2% and TKN HA MW 2%).
The patient is in monthly follow-up for reassessment of the conduct and repetition of the indicated procedure whenever necessary.
This treatment can be effective at any time of the year and is indicated for all patients.

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