Alopecia areata (AA) is an autoimmune condition that affects up to 2% of the general population. Currently available treatment options for AA are of limited efficacy and can be associated with ...adverse effects. The advancement in understanding of the genetic and molecular mechanisms of AA has led to the development of novel treatment options, with the Janus kinase (JAK) inhibitor class of drugs at the forefront of ongoing clinical trials. Platelet-rich plasma, fecal transplants, and cytokine-targeted therapy with ustekinumab and dupilumab have also been shown to regrow hair in patients with AA in individual case reports or small studies. Several other novel therapies have preliminary data or are being tested in clinical trials.
Background
Surgical reconstructions following Mohs micrographic surgery and standard surgical excisions are often closed with two layers of sutures: a deep subcuticular layer and a superficial ...cuticular layer. Some surgeons feel the need to place many deep sutures in order to reduce tension on cuticular sutures, as they believe this may decrease incidence of track marks and dehiscence, and lead to better cosmetic outcomes. However, others feel that a higher number of subcuticular sutures increases the risk of a suture reaction, which leads to patient anxiety and poorer wound cosmesis. To our knowledge, there are no studies published on the effect of subcuticular suture spacing on wound cosmesis.
Objectives
To determine whether suturing with 1‐cm interval subcuticular sutures results in better cosmetic outcomes than suturing with 2‐cm interval subcuticular sutures.
Methods
Fifty patients were enrolled in a randomized clinical trial using a split‐wound model, where half of the wound was repaired with sutures spaced 2 cm apart and the other half was repaired with sutures spaced 1 cm apart (ClinicalTrials.gov identifier NCT03327922). Both the evaluators and patients were blinded as to which side received which treatment. The scar was evaluated 3 months post‐surgery by two blinded observers and the patients themselves using the Patient and Observer Scar Assessment Scale (POSAS), a validated scar assessment instrument.
Results
The total mean POSAS score for observers for the sides that received 1‐cm interval subcuticular sutures and the sides that received 2‐cm interval subcuticular sutures did not differ significantly at 3 months (P = 0·34). There was also no significant difference in the patient assessment scale score between the two sides at 3 months (P = 0·084).
Conclusions
We found that 1‐cm suture spacing was not significantly associated with improved overall cosmetic outcome compared with 2‐cm suture spacing when evaluated by blinded observers or the patients themselves. Our results support the use of either interval.
What is already known about this topic?
Surgeons have differing opinions on the ideal frequency of subcuticular sutures for optimizing cosmetic outcomes and minimizing suture reactions.
The effect of subcuticular suture spacing on wound cosmesis has not been previously explored in the literature.
What does this study add?
There was no significant difference in cosmetic outcome between 1‐cm suture spacing and 2‐cm suture spacing when evaluated by blinded observers and patients.
Dermatology surgeons can use 2‐cm suture spacing for increased efficiency, without significantly different cosmetic outcomes, detected by blinded observers and patients.
Surgeons have varying opinions on the ideal interval of subcuticular sutures for optimizing cosmetic outcomes and minimizing suture reactions. We found that 1 cm suture spacing was not significantly associated with improved overall cosmetic outcome compared with 2 cm suture spacing when evaluated by blinded observers or the patients themselves. Our results support the use of either interval.
The vitiligo area scoring index (VASI) is a validated, reliable clinician-reported outcome measure widely used to assess the extent of skin depigmentation seen in patients with vitiligo and to ...measure patient responses to therapies for vitiligo in clinical trials. However, its implementation in studies is inconsistent and makes comparing results across different studies difficult. The aim of this scoping review is to summarize interventional clinical studies that applied the VASI to measure vitiligo and identify variability in VASI implementation. A systematic search of Ovid Medline, Embase, Web of Science, Cochrane, and ClinicalTrials.gov was performed. Interventional studies published between January 1946 and October 2020 that used the VASI as an outcome measure for assessing vitiligo response were reviewed for methodological approach. Great heterogeneity was found within the 55 included interventional studies that used VASI as an outcome measure. A total of 9 VASI subtypes were described by the authors within 10 intervention categories. VASI determined study eligibility in one study. Body surface area was most frequently established using inconsistent methods. We found unclear or ambiguously scaled assessments of depigmentation. Most VASI outcomes were reported as mean absolute difference, percentage VASI improvement, and percentage of patients who achieved the VASI endpoint. The VASI score was over 100 in one study. Our scoping review revealed many VASI methodology variations in interventional clinical studies of vitiligo. While VASI is a standard method to measure vitiligo changes, substantial heterogeneity in methodology limits reliable comparison and interpretation of findings from different clinical trials. Our findings may be used as a foundation to standardize the VASI outcome measure methodology, allowing for improved clinician training and rigorous data analysis across vitiligo research groups worldwide.
The figure presented here illuminates the large number of variables that are necessary to adequately describe phototesting protocols. Each of these characteristics can be critical in understanding ...results presented in the photomedicine community as well as the broader photobiology and photochemistry communities. The inclusion of all of these variables within each phototesting publication will aid in discourse and further scientific discovery within our field.
Abstract The world of medical science literature is ever increasingly accessible via the Internet. Open access online medical journals, in particular, offer access to a wide variety of useful ...information at no cost. In addition, they provide avenues for publishing that are available to health care providers of all levels of training and practice. Whereas costs are less with the publishing of online open access journals, fewer resources for funding and technical support also exist. A recent rise in predatory journals, which solicit authors but charge high fees per paper published and provide low oversight, pose other challenges to ensuring the credibility of accessible scientific literature. Recognizing the value and efforts of legitimate open access online medical journals can help the reader navigate the over 11,000 open access journals that are available to date.
Undermining is thought to improve wound outcomes; however, randomized controlled data regarding its efficacy are lacking in humans. The objective of this randomized clinical trial was to determine ...whether undermining low to moderate tension wounds improves scar cosmesis compared to wound closure without undermining. Fifty-four patients, 18 years or older, undergoing primary linear closure of a cutaneous defect with predicted postoperative closure length of ≥ 3 cm on any anatomic site were screened. Four patients were excluded, 50 patients were enrolled, and 48 patients were seen in follow-up. Wounds were divided in half and one side was randomized to receive either no undermining or 2 cm of undermining. The other side received the unselected intervention. Three months, patients and 2 masked observers evaluated each scar using the Patient and Observer Scar Assessment Scale (POSAS). A total of 50 patients mean (SD) age, 67.6 (11.5) years; 31 (64.6%) male; 48 (100%) white were enrolled in the study. The mean (SD) sum of the POSAS observer component scores was 12.0 (6.05) for the undermined side and 11.1 (4.68) for the non-undermined side (
P
= .60). No statistically significant difference was found in the mean (SD) sum of the patient component for the POSAS score between the undermined side 15.9 (9.07) and the non-undermined side 13.33 (6.20) at 3 months. For wounds under low to moderate perceived tension, no statistically significant differences in scar outcome or total complications were noted between undermined wound halves and non-undermined halves.
Trail Registry
: Clinical trials.gov Identifier NCT02289859.
https://clinicaltrials.gov/ct2/show/NCT02289859
.
Objective
Acetyl zingerone (AZ), a derivative of the phytochemical zingerone from Zingiber officinale (ginger), is a novel compound that is purported to have antiaging properties. The objective of ...this clinical study was to assess the role of acetyl zingerone in its ability to improve the appearance of facial skin wrinkles, redness, pigmentation, and photoaging was assessed.
Methods
Thirty‐one healthy participants (age 44 ± 7 years) were randomized in blinded fashion to apply either 1% AZ or placebo, consisting of the vehicle base cream, to the full face twice daily for 8 weeks with a total of 3 visits. Signs of photoaging, including wrinkles, dyspigmentation, and redness were assessed with facial image analysis photography and software.
Results
There was a significant decrease in average wrinkle severity (P = .019; Mean=−25.7% change), total wrinkle volume (P = .003; Mean=−30.1% change), pigment intensity (P = .021; Mean=−25.6% change), and redness intensity (P = .035; Mean=−20.7% change) in the AZ group by 8 weeks compared with the placebo. No significant itching, burning, or stinging was noted by study participants. There was also no significant difference between both groups in the clinical assessment of scaling, erythema, hypopigmentation, or hyperpigmentation.
Conclusions and Relevance
Topical AZ improves photodamage and decreases the appearance of wrinkles, dyspigmentation, and redness intensity when compared to placebo (vehicle) formulation. Acetyl zingerone is well tolerated with daily use.
Probiotic supplementation has been shown to modulate the gut-skin axis. The goal of this study was to investigate whether oral spore-based probiotic ingestion modulates the gut microbiome, plasma ...short-chain fatty acids (SCFAs), and skin biophysical properties. This was a single-blinded, 8-week study (NCT03605108) in which 25 participants, 7 with noncystic acne, were assigned to take placebo capsules for the first 4 weeks, followed by 4 weeks of probiotic supplementation. Blood and stool collection, facial photography, sebum production, transepidermal water loss (TEWL), skin hydration measurements, and acne assessments were performed at baseline, 4, and 8 weeks. Probiotic supplementation resulted in a decreasing trend for the facial sebum excretion rate and increased TEWL overall. Subanalysis of the participants with acne showed improvement in total, noninflammatory, and inflammatory lesion counts, along with improvements in markers of gut permeability. The gut microbiome of the nonacne population had an increase in the relative abundance of
, while the subpopulation of those with acne had an increase in the relative abundance of
and
. Probiotic supplementation augmented the circulating acetate/propionate ratio. There is preliminary evidence for the use of spore-based probiotic supplementation to shift the gut microbiome and augment short-chain fatty acids in those with and without acne. Further spore-based supplementation studies in those with noncystic acne are warranted.
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