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请注明日期: the patent for the invention in the process of reviewing
和审阅情况: 11.10.2017

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请注明名称（个人，公司，学会等等）: National institute of health

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请注明日期: Granted
和审阅情况: 4/4/2018

这项工作的完成感谢以下机构的支持： National institute of health

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Objectives: Melasma is one of the most common pigmentary disorders characterized by symmetrical pigmented macules on the face. It mostly affects women while exposing the sun or during pregnancy.

Introduction: The pathogenesis of melasma is complex and involves various risk factors such as genetic predisposition, UV exposure, darker phototype and hormonal influence. Because of it's chronic and relapsing course, as well as the fact that despite numerous treatment modalities available, the treatment still remains a challenge.

Materials / method: The study included 30 female volunteers of 25 to 45 years of age, diagnosed with melasma. The volunteers were either treatment naive or had not used any treatment modality for melasma for at least 6 months. The volunteers were given a cream based on resorcinol derivativate (4-n- butylresorcinol) during 30 days period. The efficacy of the treatment was measured by the device for face image analysis before and after 30 days of the treatment.

Results: 27 out of 30 subjects reported satisfaction with the results. 2 out of 30 patients reported moderate satisfaction, while 1 patient reported that she is not satisfied. Aside from the measured significant reduction in hyperpigmentation, they reported improved skin quality and texture.

Conclusion: The investigated resorcinol derivative-based cream has shown the fastest onset of action among all currently available topical preparations. Unlike other available topical preparations, this cream can be used throughout the year. In majority of cases, its effectiveness is better, and the results are seen faster than with fractional laser. Aside for its main purpose-the reduction in hyperpigmentation, it has shown a strong rejuvenation effect. This promising product may be a revolution both in the treatment of melasma and in skin measured

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Objectives: This objective intends to propose topical Estrogen as a novelty cosmeceutical for skin ageing by presenting recent evidence.

Introduction: Facial skin undergoes dramatic changes during menopause. It becomes thinner, paler and more dry. It is also associated with the appearance of perioral lines and more profound wrinkles. Evidence has shown that menopausal skin loses as much as 30% of its Collagen, both type I and II, in the first five menopausal years. This typically corresponds to a rapid drop in Estrogen levels.

Materials / method: Despite minor contradictory evidence, majority of studies have demonstrated a positive effect of topical Estrogen on collagen content and glycosaminoglycan’s activity. It has also been found to influence capillary blood flow, enhance wound healing and increase protection from photo-damage amongst other benefits. Intradermal Estrogen activity is a receptor-mediated process, and evidence suggests that the Estrogen Receptor-Beta (ER-beta) is the main receptor involved. ER-beta is highly expressed in keratinocytes, blood vessels and dermal fibroblasts.

Results: Topical Estrogen via receptor-Beta (ER-beta) facilitates the binding of Transcription factors NRF2 to promoter regions of antioxidant enzyme genes to enhance their transcription. This process leads to increased antioxidant activity and termination of damaging superoxide activity in the skin.

Conclusion: Topical estrogen can be used in all hypo-estrogenic conditions such as menopause, premature ageing and surgical menopause.
The research has also shown no significant increase in serum hormone levels or vaginal smears after application of topical Estrogen once daily on the facial skin, thereby reinforcing the safety of this type of application. In conclusion, the evidence provides a strong basis for the use of topical Estrogen in retarding skin ageing, with multiple benefits.

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Objectives: We present a new classification pathological scars based on their width, extension, placement to relaxed skin tension lines, affectation of critical zones, texture, flexibility, hardness, retraction, level with the surrounding tissue, color match with surrounding tissue and quality; that helps in the decision of the treatment methods to improve its appearance based on our experience in the Department of Maxillofacial and Plastic Surgery of the Salam Clinic (Tangier).

Introduction: Scars are a natural consequence of all dermal healing following surgical incisions, lacerations, or tissue loss.
When the scar has unfavorable characteristics, scar revision is often indicated to improve aesthetics, reduced recurrence, and/or correct functional limitations.
We have many treatment options (Cortico steroids, peeling, dermabrasion, silicone patches, subincision, PRP...) and the cosmetic surgeon must be knowledgeable of different techniques (minimally invasive vs surgical) to obtain the best results.
There are different evaluation methods (Vancouver, POSAS——) but are deficients.

Materials / method: The first step is to evaluate and treat critical factors like:
-Width.
-Extension.
-Placement to relaxed skin tension lines.
-Affectation of critical zones.
In the second step we have to evaluate and treat the hardness of the scar: we distinguish four factors (texture, flexibility, hardness and retraction):
1-Texture: we can find three types of scars
1.1-Smooth.
1.2-Fibrous band.
1.3 Surface fibrous folds.
2-Flexibility: we do 2 tests
2.1-Proof of Extension and Flexibility
2.2-Yielding to acupressure
3-Hardness (soft, hard, very hard)
4-Retraction

Results: Finally the third step is to evaluate and treat scar level, color and quality:
1-Level with the surrounding tissue: 3 options
1.1-Flat
1.2-Stepped: the edges can be soft or hard
1.3-Raised: can be
1.3.1-Hypertrophic
1.3.2-Keloid: if pediculated evaluate excision + humid cure +/- infiltrate CC
2-Color match with surrounding tissue
2.1-Yes
2.2-No:
2.2.1-White and visible?
2.2.2-Post-inflammatory hyperpigmentation?
2.2.3-Flat + hyper or hypo-pigmented.
2.2.4-Is it pink/red?
2.2.4.1-If keloid / hypertrophic: infitrate CC + peeling
2.2.4.2-If it is flat: is it red?

Conclusion: This new classification of pathological scar helps in the decision making of the scar treatment.

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