IMCAS

Comparison of The efficacy and safety of fractional erbium: YAG laser in combination with Tranexamic acid delivery by different methods: SA and MA

Objectives: To evaluate the efficacy of fractional erbium:YAG laser-assisted delivery of tranexamic acid (TXA) compared to TXA monotherapy in the treatment of melasma, and to assess the outcomes of different TXA delivery methods.

Introduction: Melasma is a chronic, recurrent hyperpigmentation disorder that primarily affects individuals with darker skin tones (Fitzpatrick III–IV). Due to its multifactorial pathogenesis and high relapse rate, combination therapies are often preferred over monotherapies. TXA has shown promise in melasma treatment through anti-angiogenic and anti-melanogenic mechanisms; however, its topical delivery is limited by poor skin penetration. Fractional erbium:YAG laser may enhance TXA delivery and improve outcomes while maintaining safety in darker skin types.

Materials / method: A systematic review and meta-analysis were conducted per PRISMA guidelines. PubMed, Google Scholar, and Web of Science were searched for studies comparing fractional erbium:YAG laser-assisted TXA delivery to TXA monotherapy. Included studies reported outcomes such as mMASI, MASI, pigment reduction, adverse events, or relapse. Risk of bias was assessed using the Newcastle-Ottawa Scale. Meta-analysis used a random-effects model to calculate standardized mean differences (SMDs) and heterogeneity (I²).

Results: Thirteen studies with a total of 585 participants were included.

mMASI: Overall effect was not statistically significant (SMD = -0.0802, p = 0.8685), but short-term improvement was noted at 3 months (SMD = 1.9802).
MASI: No significant effect observed (SMD = 0.0039, p = 0.9877); a small negative trend was seen at 6 months.
Heterogeneity: High for mMASI (I² = 92.5%) and moderate for MASI (I² = 50.3%).
Most studies reported minimal adverse events, with erbium:YAG being safer than fractional CO₂ in darker skin.

Conclusion: Fractional erbium:YAG laser-assisted delivery of TXA may offer superior short-term benefits in melasma treatment compared to TXA alone. However, the long-term efficacy is inconsistent and diminishes over time. High variability among studies highlights the need for well-designed, standardized RCTs with longer follow-up periods to confirm clinical effectiveness and safety.

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Incidence of conjunctivitis adverse event with biological therapies in moderate to severe atopic dermatitis: a systematic review and meta-analysis

Objectives: We aimed at providing pooled incidence estimates using meta-analysis for the incidence of conjunctivitis with Dupilumab and other new agents namely, Lebrikizumab and Tralokinumab.

Introduction: Atopic dermatitis (AD) is a chronic inflammatory skin disorder.
Conjunctivitis is an inflammation or infection of the transparent membrane (conjunctiva) that lines the eyelid.2
Biologics that have been approved for AD includes Dupilumab (anti IL4/13) and recently a new anti-IL13 namely Tralokinumab.1

Materials / method: As viewed in Figure 1, we systematically review the randomized controlled trials pertaining to the incidence of any conjunctivitis subtype with Dupilumab, Lebrikizumab and Tralokinumab.
A thorough search in Medline (PubMed), Directory of Open Access Journals, and ClinicalTrials.gov using the terms “Atopic dermatitis” and “biologics” or “Dupilumab” or “IL4/13” or “Tralokinumab” or “IL13” or “Lebrikizumab”.
The Mantel-Haenszel (MH) method (fixed-effect) was used to evaluate the risk of developing conjunctivitis among AD patients undergoing biological therapies.
We found a total of 17 studies

Results: A total of 213/4197 patients receiving biological treatments complained of conjunctivitis.
Comparatively, conjunctivitis affected just 32 out of the 1633 participants in the control group.
Pooled MH Odds ratio was 3.11 (95% CI: 2.13-4.50) with no significant outlier effects.
There was no publication bias (Egger’s regression p= 0.59).
No subgroup differences were found between different agents (Q= 0.23, p= 0.89).

no statistical difference between the incidence of conjunctivitis between dupilumab and the included newly approved and in trial agents.

Conclusion: Patients need to be counseled about the inbcidence of conjunctivitis and its occurrence with these new agents.

The high incidence of conjunctivitis with the AD indication of these medications in contrast to the other indications of these drugs raise the possibility of an association related to AD itself.

Sources of limitation could be the presence of minimal heterogeneity and the inability to portray causal relation between conjunctivitis and biologic agents.

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Incidence of upper respiratory tract infections with biological therapies in moderate to severe atopic dermatitis: a systematic review and meta-analys

Objectives: This meta-analysis aims to estimate the pooled incidence of
URTIs associated with these treatments compared to topicals.

Introduction: Atopic dermatitis (AD) is a chronic inflammatory skin disorder.
Treatment for moderate-to-severe AD includes biologics like dupilumab, tralokinumab, lebrikizumab, and JAK inhibitors (abrocitinib, upadacitinib).
Upper respiratory tract infections (URTIs) are commonly reported adverse events for these therapies.

Materials / method: P: moderate to severe atopic dermatitis
I: biological therapies: Dupilumab, Tralokinumab, lebrikizumab, Abrocitinib, and Upadacitinib.
C: placebo drug
O: incidence of URTI
S: Randomized controlled trials

figure 1, views the systematic approach to identifying eligible studies per PICO criteria

A thorough search in Medline (Pubmed), Directory of Open Access Journals, and ClinicalTrials.gov was done through September 2022.

Data were meta-analyzed using the Mantel-Haenszel (MH) method, to account for sparse event data. The search strategy is provided in supplementary materials.

Results: Out of these 21 trials, 11 tested Dupilumab, Tralokinumab (n=4), Upadacitinib (n=3), Lebrikizumab (n = 2) and Abrocitinib (n= 1). There was minimal heterogeneity across the studies reporting this outcome (Q= 25.04, I2= 20.14%). Out of 5053 intervention recipients, 490 (9.70%) reported upper respiratory tract infections, as compared with 182 (8.03%) placebo recipients. This translated to a MH Odds ratio of 1.18 (95% CI: 0.98 to 1.42) (Figure 2).
There was no evidence of publication bias (p = 0.83) (Figure 2).
There were no significant subgroup differences between patients taking different b

Conclusion: Patients need to be counseled about the incidence of URTI and its occurrence with these new agents.

The high incidence of URTI with the AD indication of these medication in contrast to the other indications of these drugs raise the possibility of an association related to AD itself. Sources of limitation could be the presence of minimal heterogeneity and the inability to portray causal relation between URTI and biologic agents.

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Injectables in Maxillofacial surgery: Competitor or Complementary ally?

Objectives: To assess the evolving role of injectable treatments (botulinum toxin, dermal fillers) in maxillofacial practice and determine whether these techniques compete with or complement traditional surgical approaches. The abstract aims to highlight how incorporating injectables may enhance both functional and aesthetic patient outcomes.

Introduction: The demand for non-surgical aesthetic interventions has grown exponentially, transforming patient expectations and reshaping treatment planning across specialties. Maxillofacial surgeons, traditionally focused on structural correction through surgery, now face a paradigm shift where injectables are increasingly used in both cosmetic and reconstructive care. This transition prompts the question: are injectables replacing surgery, or do they offer synergistic value?

Materials / method: A narrative literature review was conducted on publications from 2015 to 2024 using PubMed and IMCAS educational materials, focused on the application of injectables in maxillofacial indications (aesthetic contouring, post-traumatic correction, scar modulation, TMJ dysfunction). Data reports from integrated surgical–injectable protocols were analyzed qualitatively to explore decision-making processes and patient satisfaction metrics.

Results: Literature and statistics reveal a growing consensus that injectables enhance surgical outcomes when integrated thoughtfully. Fillers provide contour refinement post-surgery and allow for non-surgical corrections in select cases. Botulinum toxin offers muscle rebalancing and pain relief in both aesthetic and functional cases. However, competition arises in younger demographics seeking less invasive, lower-cost alternatives for facial rejuvenation, sometimes delaying necessary structural interventions.

Conclusion: Injectables should not be viewed as a threat to surgical practice but as a flexible extension of it. When used by anatomically trained specialists such as maxillofacial surgeons, they offer high precision, safety, and personalized results. A hybrid approach—combining surgery with minimally invasive techniques—represents the emerging standard in holistic facial care.

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Role of High-Frequency Ultrasound in Quantitative Assessment of Skin Aging

Objectives: To synthesize current literature on the utilization of HFUS in evaluating skin aging, focusing on key ultrasonographic biomarkers and their correlation with histological and clinical findings.

Introduction: High-frequency ultrasound (HFUS) has emerged as a pivotal non-invasive imaging modality in dermatology, offering detailed visualization of skin structures. Its application in assessing skin aging provides quantitative insights into morphological and structural changes associated with both intrinsic aging and photoaging.  

Materials / method: A comprehensive review of peer-reviewed articles was conducted, analyzing studies that employed HFUS to assess skin aging parameters such as dermal thickness, echogenicity, and the subepidermal low-echogenic band (SLEB). Emphasis was placed on studies that correlated HFUS findings with histological data and evaluated the efficacy of anti-aging interventions.  

Results: HFUS effectively detects age-related changes in the skin, including:  • Dermal Thinning: A consistent decrease in dermal thickness with advancing age, reflecting collagen degradation.  • Echogenicity Reduction: Lower echogenicity in aged skin, indicative of decreased collagen and elastin content.  • SLEB Presence: The emergence and thickening of the SLEB in photoaged skin, correlating with elastosis and glycosaminoglycan accumulation.  Furthermore, HFUS has been utilized to monitor the efficacy of anti-aging treatments, such as topical retinoids and energy-based devices,

Conclusion: HFUS serves as a valuable tool in the objective assessment of skin aging, providing quantifiable metrics that correlate with histological changes. Its application enhances the evaluation of therapeutic interventions and contributes to personalized dermatological care. Standardization of imaging protocols and further research are recommended to optimize its clinical utility.

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USE OF PICOSECOND LASER (755 NM) IN THE REMOVAL OF EYEBROW MICROPIGMENTATION: A REPORT OF THREE CASES

Objectives: Evaluate the efficacy, safety and patient satisfaction of 755 nm picosecond alexandrite laser for dark eyebrow micropigment removal in a case series of three women.

Introduction: Microneedling‑based eyebrow micropigmentation is highly sought for reshaping and defining brows by implanting metal‑oxide pigments within the papillary dermis. Because colour persists for years, many clients later dislike the shade or outline and seek reversal. The 755 nm picosecond alexandrite laser emits ultrashort pulses that shatter pigment via photoacoustic cavitation (laser‑induced optical breakdowns) with minimal thermal diffusion, preserving vascular and adnexal structures. Despite growing use, peer‑reviewed data on efficacy and safety remain scarce.

Materials / method: Three healthy women (26–36 y) dissatisfied with micropigmentation done 3–5 y earlier were enrolled. All had metal‑oxide pigments in brows. They received 2–3 sessions of 755 nm picosecond laser spaced ≈30 d. Pulse energy 0.7‑1.3 J, 2.5‑5 Hz, flat tips 0.5–0.8 mm; three passes/session. Topical or infiltrative lidocaine 2 % as needed. Post‑procedure barrier ointment was applied to hasten re‑epithelialisation and limit adverse effects.

Results: Patients B and C achieved complete pigment clearance after two sessions; patient A showed >75 % lightening with residual blur. No burns, scarring, dyschromia or alopecia occurred. Mild erythema and transient oedema resolved <48 h. Variability in outcomes correlated with initial pigment load and depth. All participants reported high satisfaction, aesthetic improvement and psychological benefit, rating pain as tolerable with anaesthesia adjustments.

Conclusion: The 755 nm picosecond alexandrite laser proved a safe, effective modality for removing dark eyebrow micropigmentation, offering rapid recovery and minimal complications. Two to three sessions sufficed for marked clearance; thicker, deeper deposits may need more passes. Use of topical barrier ointment aided healing. Larger, controlled studies should refine parameters and validate long‑term efficacy and safety.

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ACADEMIA DA BELEZA®: THE BODY FROM A HOLISTIC PERSPECTIVE

Objectives: To present a case report illustrating the holistic protocol adopted by Academia da Beleza®, which is based on three therapeutic pillars: Skincare, Innercare, and Dermacare.

Introduction: The term holistic was coined by Jan Christian Smuts in 1926 to describe the idea that the whole is greater than the sum of its parts. In dermatology, a holistic vision involves understanding the patient beyond their skin, integrating physical, emotional, and systemic aspects¹. Geisa Costa emphasizes that modern dermatology has evolved to encompass beauty, health, and well-being—improving not only the skin but also self-esteem². Psychological support has become increasingly important in cosmetic dermatology³.

Materials / method: A 46-year-old female post-bariatric patient (2018), with residual fat and comorbidities (Hashimoto’s thyroiditis, Sjögren’s syndrome, celiac disease), was enrolled in a holistic protocol based on skincare, dermacare, and innercare. Lab tests and bone densitometry were performed. Skincare included daily cleansing, hydration, actives, and photoprotection. Innercare involved nutrition guidance, probiotics/postbiotics, and mental health support with SSRI. Dermacare included 3D-guided cryolipolysis (debulking, sculpting, refining), ultrasound, biostimulators, RF microneedling, and HI-EMT.

Results: The patient showed measurable reduction in body circumferences, enhanced muscle definition, and visible skin firmness (Figure 2). Patient satisfaction was rated 7–8 on a 0–10 scale. The integrated care approach improved not only physical outcomes but also psychological well-being and treatment adherence.

Conclusion: Each human being is unique, shaped by different cultures, environments, and life experiences. Modern dermatology has evolved from surface-level care into a multidisciplinary science, integrating knowledge from various fields to treat patients holistically. With the advancement of artificial intelligence, non-invasive procedures, and regenerative therapies, the future of dermatology points toward more personalized, effective, and ethical care—demanding greater responsibility from healthcare professionals.

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Clinical Outcomes of Cryolipolysis in Multiple Body Areas: A Retrospective Multicenter Case Series

Objectives: This multicenter study aims to evaluate the effect of cryolipolysis in different body areas, using three-dimensional photographic analysis, adipometry, and dual-energy X-ray absorptiometry (DEXA) as standardized assessment methods in diverse populations.

Introduction: Body contouring has become increasingly sought after, driven by constant exposure to aesthetic standards intensified by social media. In dermatology, cryolipolysis represents a non-invasive alternative to liposuction, which is associated with a serious complication rate of approximately 0.7%¹. Cryolipolysis is based on the induction of selective cold panniculitis, promoting adipocyte apoptosis, with subsequent gradual reabsorption by the body²³. Among the commonly treated areas, the abdomen and flanks/hips are the most targeted⁴.

Materials / method: This retrospective clinical study included 32 participants (21 women and 11 men), aged 24 to 60 years, who underwent cryolipolysis between September 2024 and May 2025. Treated areas included the abdomen, flanks, hips, back, thighs, submental region, breasts, and infragluteal fold (“banana roll”), using anatomically shaped applicators as indicated by the manufacturer.

Results: A total of 262 cryolipolysis sessions were performed. The most treated areas were the abdomen, flanks, and hips. Adipometry showed an average fat thickness reduction of 7.4 mm, and 3D imaging revealed a mean volume loss of 48.3 mL. DEXA indicated consistent fat reduction, especially in abdominal and lateral areas. One patient showed a 1.7 kg fat loss and 406 g lean mass gain. Regional, consecutive sessions showed better and more sustained outcomes.

Conclusion: Cryolipolysis appears to offer a potentially favorable approach for addressing localized adiposity across different anatomical areas. Findings from this study suggest adequate tolerability and underscore the need for further investigations. The data contribute to a broader understanding of its clinical potential and reinforce the relevance of standardized parameters for assessing therapeutic response in future research.

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Use of High-Intensity Focused Electromagnetic Field (HIFEM) in Rectus Abdominis Diastasis and Postpartum Muscle Tone: Clinical Study

Objectives: To evaluate the efficacy of high-intensity focused electromagnetic (HIFEM) field in reducing rectus abdominis diastasis and improving muscle tone in postpartum patients, through clinical measurements, and participants' subjective perception.

Introduction: Rectus abdominis diastasis is common in the postpartum period and is associated with abdominal wall weakness, postural changes, and aesthetic dissatisfaction¹. Spontaneous recovery is often incomplete. High-intensity focused electromagnetic (HIFEM) fields induce supramaximal muscle contractions, promoting hypertrophy and hyperplasia². This technology has emerged as a promising non-invasive alternative for muscle strengthening and functional improvement of abdominal diastasis³.

Materials / method: Case study of a 43-year-old female patient with localized abdominal fat and mild rectus abdominis diastasis. She reported dissatisfaction with previous treatments, including cryolipolysis and enzymatic applications, and practiced Pilates twice a week. A protocol of eight HIFEM sessions was proposed, 30 minutes on alternate days, with progressive intensity above 80%. Assessments were done at baseline and after 30 days, including abdominal circumference, 3D photographic analysis, and subjective perception using a Likert scale. Oral supplementation was used; injectable procedures were excluded.

Results: An average reduction of 1.6 cm was observed in the diastasis distance, along with visible improvement in muscle definition in clinical images and an increase in strength reported by the patient (Image 1.2). No relevant adverse events were reported. The average reduction in abdominal circumference was 2.2 cm, abdominal strength perception improved by 72%, and the overall satisfaction rate was 91.6%.

Conclusion: The use of HIFEM technology proved to be effective, safe, and well tolerated in the treatment of mild to moderate abdominal diastasis in the postpartum period. In addition to functional and aesthetic improvements, it promoted increased perception of muscle strength and body satisfaction, and may be incorporated as part of the aesthetic and physical rehabilitation plan for postpartum patients.

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Evaluation of the Efficacy and Treatment-emergent Adverse Events of Deuruxoltinib for Moderate to Severe Alopecia Areata: Meta-analysis

Objectives: To review the literature, identify all relevant papers, and conduct a meta-analysis to assess and evaluate the efficacy and treatment-emergent adverse events of Deuruxoltinib for moderate to severe Alopecia Areata.

Introduction: Alopecia areata (AA) is an immune disease characterized by non-scarring hair loss. With the increasing use of janus kinase (JAK) inhibitors in immune-related conditions, their potential role in AA treatment is gaining attention. This systematic review and meta-analysis aim to assess the efficacy of Deuruxoltinib in moderate to severe AA.

Materials / method: We systematically searched CENTRAL, Medline, and ClinicalTrials.gov for relevant data. Deuruxoltinib vs placebo was evaluated, and efficacy was measured using Severity of Alopecia Tool (SALT) and Hair Satisfaction Participants Reported Outcome (SPRO). Treatment-emergent adverse events such as increased creatinine kinase (CPK), acne, and headache were specifically assessed. Effect sizes were presented using mean difference (MD) or risk ratio (RR). Statistical heterogeneity was measured by I2, with a 95% confidence interval (CI) and P-value <0.05 considered significant.

Results: Three randomized controlled trials involving 1372 patients were included. Deuruxoltinib demonstrated a significant improvement in SALT score change from baseline with a significant number of patients achieving 75% and 90% improvement from baseline. Patients randomized to Deuruxoltinib reported a significant improvement in SPRO with many experiencing more than two points of improvement. However, safety concerns arose due to increased CPK levels, headaches, and acne (significant in the 12mg dose only)

Conclusion: In conclusion, Deuruxoltinib shows promising efficacy in treating moderate to severe alopecia areata, leading to significant improvements in hair regrowth and patient-reported satisfaction. However, the occurrence of treatment-emergent adverse events, particularly increased CPK levels, headaches, and acne (especially at the 12mg dose), warrants cautious consideration. Further research and vigilant monitoring of side effects are necessary before widespread adoption of Deuruxoltinib for alopecia areata treatment.

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Use of intradermal Incobotulinum Toxin Type A (iBoNT-A) for improving pore size and appearance.

Objectives: 1. Apply botulinum toxin to manage pore size in Latin American patients
2. Evaluate objective and subjective pore size improvement
3. Report adverse effects

Introduction: In Dermatology clinical practice, there has been and increased use of botulinum toxin over the years, for diverse aesthetic procedures such as treatment of dynamic facial lines or hyperhidrosis. More recently it has been used for improving pore size with intradermal micro-droplet injections based on its capacity to reduce sebum production and by a direct effect on the arrector pili muscle to improve overall pore appearance. The objective of this study is to gather data of the results of this procedure in Mexican patients.

Materials / method: Eligibility criteria for participants included: patients with a chief concern of pore appearance, over 18 years old, with no known allergic reactions to iBoNT-A and a signed informed consent form.
The study consisted of an initial evaluation of the patient that included an automatized skin analysis software (Opatra Dome Analyzer) and a patient self-assessment questionnaire.
iBoNT-A 100 UI were diluted with 5 ml of normal saline solution and was later applied intradermally with a 31 G needle in both cheeks, a total of ten points per cheek (figure 1), applying 0.5 UI per point.
Two weeks after

Results: A total of 15 participants were included, with the following demographic characteristics: Fitzpatrick types ranging from I to V, ages from 18-64 and a predominance (66%) of female patients.
All participants described an improvement from baseline at two weeks. Subjective appearance as described by participants had an overall reduction of 30% (figure 2), subjective discomfort had an overall reduction of 34%, and percentage of larger pores had an overall reduction of 14% (as determined by skin analysis software) (figure 3,4).
During the application pain was reported by 100% with a numerical ana

Conclusion: Intradermal application of iBoNT-A, improves skin appearance reducing the pore size, giving special importance in this study to the positive impact the procedure had on participant patients’ self-assessment questionnaire. iBoNT-A is a safe and effective procedure for patients looking for a quick solution to improving pore appearance.
Although these results contribute to filling the gap from the Latin-American perspective, further research and larger studies are needed.

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Shedding a new light on dermatosurgical wound healing, using a formula of modified silicone gel

Objectives: Healing a dermatologic surgical wound is a highly intricate process. Any disturbance at any stage can cause delayed closure, prolonged hospitalization, increased costs, and negative impacts on patients' daily lives. Based on all the above, a case series study was conducted to evaluate the results of postoperative interventions using a modified silicone gel formula in dermatologic surgery trauma.

Introduction: Cutaneous wound healing is a fascinating mechanism that is extremely important due to the skin's function as a physical, chemical, and bacterial barrier. The process involves complex chemical and cellular interactions aimed at the reconstruction of injured tissues, restoration of the skin surface, and total restoration of both skin integrity and resistance.

Materials / method: Εvaluation of postoperative course of 12 patients who received treatment twice daily with the formula of hyaluronic acid, zinc and manganese, madecassonide, glycerin, specific thermal water, panthenol, vitamin B5 and silicones on the skin when stiches removed. The postoperative would healing process was evaluated by clinical examination, digital photography, Manchester scale score and dermatology life quality index. The patients were followed up when stiches were removed and gel was used on the 15th, 30th day.

Results: In our case series study, we found that administering the modified silicone gel formula twice daily after suture removal led to faster healing without complications.

Conclusion: Postoperative therapy employing a combined formulation of hyaluronic acid, zinc, manganese, madecassoside, glycerin, specific thermal water, panthenol, silicones, and vitamin B5 demonstrates enhanced and expedited healing following surgical procedures. This approach significantly reduces the risk of complications and facilitates a prompt return to routine activities. The aforementioned formulation promotes optimal epidermal recovery through the soothing and anti-inflammatory effects of madecassoside, the barrier-repairing action of panthenol, and the hydrating properties attributed to silicone

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