All Articles

Andreas Nikolis^1,2*, Kaitlyn M. Enright²

¹Associate professor of Plastic Surgery, Division of Plastic Surgery, McGill University, Montreal, Quebec, Canada

²Erevna Innovations Clinical Research Unit, Westmount, Quebec, Canada

Hyaluronic acid (HA) substrates in facial rejuvenation have been a long-standing staple in the aesthetic injector’s offerings. The development of different technologies, variability in the concentration of HA within the gels and different types of cross-linking methodologies have led to the development of many skews across multiple companies. When addressing micro-droplet techniques whereby small aliquots of HA are deposited in the dermis, few have developed a safety and efficacy profile that supports claims of improved skin quality. The concept of adding HA into the dermis is inherently a correct one, as this glycosaminoglycan is able to bind and retain water in a significant fashion. Successful management of skin quality requires specific quantities of HA to be precisely placed at the appropriate depth using a reproducible volume. These aforementioned factors all contribute to successful skin quality improvements. We present a clinical summary of pearls and pitfalls in managing skin quality with micro-droplet HA that we have identified over the last 4 years.

Flora Canzona¹, Mammucari Massimo²*, Arianna Tuzi³, Enrica Maggiori², Maria Gabriella Grosso⁴, Luciano Antonaci², Stefania Santini³, Anna Rosa Catizzone³, Fiammetta Troili³, Alessandra Gallo³, Teresa Paolucci³, Piergiovanni Rocchi³, Costanza Guglielmo³, Domenico Russo⁵, Chiara Giorgio⁶, Dario Dorato³, Raffaele Di Marzo³, Giovanna Viglione³, Anna G Fiorentini³, Manuela Giardini³, Silvia Natoli⁷

¹Istituto Dermopatico dell'Immacolata, IRCCS Foundation, Rome, Italy

²Primary Care Unit ASL RM 1, Rome, Italy

³Member of the Italian Society of Mesotherapy, Rome, Italy

⁴Ospedale Israelitico, Rome Italy

⁵San Marco Hospice and Palliative Care, Latina, Italy

⁶Rehabilitation Unit, F Pirinei Hospital, Altamura (BA), Italy

⁷Department of Clinical Science and Translational Medicine, Tor Vergata University, Rome, Italy

Mesotherapy consists of a series of micro injections in the superficial layer of the skin of active ingredients that slowly diffuse into the underlying tissues. This technique is applied in different clinical conditions and also in dermatology it could play a useful role in the treatment path of many patients. However, further clinical studies are needed to standardize its application in various dermatological pathologies. The recommendations of the Italian Mesotherapy Society aim at personalized therapy based on evidence, efficacy and safety.

Rebecca Liu¹, Braden M. Candela², Joseph C English III²*

¹University of Pittsburgh School of Medicine

²Department of Dermatology, University of Pittsburgh, Pittsburgh, PA

Psoriatic arthritis (PsA) may affect up to a third of patients with psoriasis. It is characterized by diverse clinical phenotypes and as such, is often underdiagnosed, leading to disease progression and poor outcomes. Nail psoriasis (NP) has been identified as a risk factor for PsA, given the anatomical connection between the extensor tendon and nail matrix. Therefore, it is important for dermatologists to screen patients exhibiting symptoms of NP for joint manifestations. On physical exam, physicians should be evaluating for concurrent skin and nail involvement, enthesitis, dactylitis, and spondyloarthropathy. Imaging modalities, including radiographs and ultrasound, may also be helpful in diagnosis of both nail and joint pathology. Physicians should refer to Rheumatology when appropriate. Numerous systemic therapies are effective at addressing both NP and PsA including DMARDs, biologics, and small molecule inhibitors. These treatments ultimately can inhibit the progression of inflammatory disease and control symptoms, thereby improving quality of life for patients.

Nicholas X. Williams¹, Aaron D. Franklin^1,2*

¹Department of Electrical and Computer Engineering, Duke University, Durham NC 27708, USA

²Department of Chemistry, Duke University, Durham NC 27708, USA

Real-time monitoring of relevant biological signals, in combination with the timely delivery of target drugs, would be ideal for treating most medical conditions. However, access to biological fluids without a bulky, costly, and cumbersome apparatus remains challenging, as does the ability to deliver drugs of controlled dosage in a similarly unobtrusive fashion. The skin provides a promising medium for access and dosing using biomedical electronics, colloquially dubbed electronic tattoos. Recent developments in biologically compatible, flexible materials and devices have brought electronic tattoos closer to reality for sensing biomarkers extracted from the skin and delivering target drugs through the dermis. In this review, the materials and engineering requirements, fabrication developments, and sensing and therapeutic advancements of electronic tattoos are presented. Three components are required for a complete theragnostic electronic tattoo system: 1) supporting electronics for control and data transmission; 2) diagnostic sensors, categorized as mechanical (measure an internal stimulus) and chemical (measure a chemical change); and 3) therapeutics for drug delivery. The leading approaches for fabrication are summarized, including the transfer of flexible devices to the skin and the direct printing of devices onto the epidermis. Altogether, while significant obstacles remain, the advancements in this field show great promise for realizing electronic tattoo theragnostics to revolutionize point-of-care medicine.

Dillon D Clarey, Adam V Sutton, Ryan M Trowbridge*

University of Nebraska Medical Center, Department of Dermatology, Omaha, NE

Cryptococcal cellulitis is a rare dermatologic diagnosis most often seen in immunocompromised patients. We present a case of disseminated Cryptococcus presenting as cellulitis in a patient with decompensated cirrhosis. We discuss various presentations of Cryptococcus in the skin, both as primary and disseminated disease.

Rattan L. Mittal*

Emeritus Professor, Orthopaedic Department, GOMCO, Patiala, India

Introduction: Congenital clubfoot, the commonest orthopaedic defect and with very high prevalence rate in LMICs with tremendous GBD (80% global population), still remains unsolved, with 95% relapses/ under-corrections, in extreme deformities (Mittal¹), besides the umpteen uncorrected deformities. Author has researched this unexplored area for over fifty years, still continuing. AIM: Cosmetology/ Plastic surgery are the deep routed foundations of this high rise, evidence based, research. Being need based, it was destined to happen in three phases. This is, FIRST EVER, successful use of the four popular plastic procedures in a single incision¹ (Rotation, Z-plasty, vY-plasty and Fillet flaps), nicknamed as FUSION 4-in1, by any surgeon (including plastic and orthopaedic surgeons) on any part of HUMAN BODY, leave aside CLUBFOOT. This is A LOUD AWARENESS CALL for improving looks, function and avoiding complications.

Methods: These were need based, 3 phased, persistent, sequential endeavors: PHASE 1, the anatomical dissections² and years of clinical observations, leading to discovery of heterogeneous 3D skin contractures (foot being a 3D organ) as the reason for all failures. Rotation flap was used for the first time in CLUBFOOT for correcting grade 1 of this deformity with an authentic publication of a series of one hundred cases documented in SICOT JOURNAL (Mittal)³. With a thumbs-up start, it progressed to higher evolutionary stage of PHASE 2, in more extreme deformities: combining Z- plasties (1, 2 or even 3 Zs) with rotation flap as 2-in-1 incision and then to PHASE 3 for even more rigid deformities, adding VY-plasty also with rotation + Z-plasty, as 3-in-1 incision and even adding fillet flap as 4-in-1 in a lone OCTOPUS CLUBFOOT, World’s first case. RESULTS and CONCLUSIONS: The Triple or even Tetra skin expanding incision gave consistently gratifying results with longer, flexible, better functioning and pleasing looking feet, with long term follow up as reported and published in a Landmark SICOT publication of 1080 cases over a 40 years period with a long term follow up averaging 12½ years (Mittal)¹.

Cosmetology and plastic surgery, in this evidence based, cutting edge research, achieved the distinction of, FIRST EVER use of the 4 procedures in a single incision transforming “CROOKED TO ROZY FEET”. ROZY is an acronym and stands for ROtation, Z-plasty and vY-plasty (Mittal)⁴. This is also a LOUD Awakening Call to disseminate this surgical concept for correcting the more rigid and severe deformities, with relapses and under-corrections at any age, including the uncorrected ones for the Global clubfoot community.

Katarzyna Smejda¹, Agnieszka Brzozowska¹, Daniela Podleck¹, Kinga Polanska², Joanna Jerzynsk¹*

¹Department of Pediatrics and Allergy, Medical University of Lodz, Copernicus Memorial Hospital in Lodz, Poland

²Department of Environmental Epidemiology, Nofer Institute of Occupational Medicine, Lodz, Poland

During pregnancy, women are more prone to stress and at risk of distress due to deep hormonal and physiological changes. The aim of this systematic review was to examine whether maternal stress during pregnancy increases the risk of atopic diseases in the children.

A review of the literature was performed using three databases: PubMed, Web of Science, EBSCO. We limited the results to human-subject studies published in English between January 2010 and September 2019. This systematic review suggests a relationship between maternal stress during pregnancy and allergic diseases in the child. The findings highlight the importance of the implementation of stress reduction programs for pregnant women and those in their postpartum period within communities in order to enable these individuals to relieve stress effectively.