Peer PreSs Review
Dr Rohit Kotnis surveys academic and association journals to report on advances in research in medical aesthetics and related fields
Botulinum Toxin A Treatment of Raynaud’s Phenomenon: A Review
Iorio ML, Masden DL, Higgins JP. Semin Arthritis Rheum. 2011 Aug 23.
Botulinum toxin A has conventionally been used in the upper extremity to treat spasticity resulting from stroke, paraplegia and dystonia.
In this study, an Ovid MEDLINE search from 1950 to September 2010 was performed to identify reports on the use of botulinum toxin in the treatment of Raynaud’s disease or associated vasoconstrictive disorders.
Since 2004, there have been five studies that have evaluated the use of botulinum toxin A for the treatment of Raynaud’s. In each study, patients received a range of botulinum toxin injections (10-100 units) in their fingers and hands. The studies have many limitations, such as lack of controls, variable severity of disease and variability of dosing, but all report favourable clinical results. All showed improvement in patient pain and a reduction in soft tissue ulceration.
Initial reports on the use of botulinum toxin A for Raynaud’s phenomenon are promising. Larger controlled trials with improved study design are warranted.
Botulinum toxin treatment in upper limb spasticity: Treatment consistency
Papavasiliou AS, Nikaina I, Bouros P, Rizou I, Filiopoulos C. Eur J Paediatr Neurol. 2011 Aug 19.
The study assessed treatment consistency of botulinum toxin administration in spastic upper limbs through stability of dosages and between injections intervals. Over eight years, 153 children (81 with bilateral spastic cerebral palsy, 72 with unilateral) were treated according to accepted, experience-based guidelines with Botox and Dysport.
Treatment response was based on assessment of spasticity and attainment of pre-determined goals at three, six and 12 months post treatment.
Mean age at treatment onset was six years four months and median follow-up was 2.5 years. The number of injection sessions ranged between 1–10 and few had more than six sessions. In 106 children, more than one anatomic region of the limb was injected. Most (56.2%), had at least two injection sessions with a median time interval between the sessions of nine months.
Children over four years old at the first treatment had longer intervals between sessions (25.8%) compared to younger ones.
The mixed effects models demonstrated that botulinum toxin dosage was stable over subsequent visits and that intermediate intervals for subsequent visits were similar to the first one.
This is a useful article illustrating a common application for botulinum toxin in conventional medical circles. Patients enquire about the safety of the treatments cosmetically—this study can give the practitioner information on the use of the product in children which can be explained to a new client.
Extensive necrosis after injection of hyaluronic acid filler: case report and review of the literature.
Kassir R, Kolluru A, Kassir M. J Cosmet Dermatol. 2011 Sep;10(3):224-31.
The use of dermal fillers for soft tissue augmentation has become an integral part of aesthetic practices. Dermal fillers temporarily remove the appearance of rhytids and reduce the depth of skin folds. But even with the most experienced of injectors, adverse effects can occur, ranging from mild bruising to severe injection necrosis.
Physicians should be able to treat the severe complication of vascular necrosis and detect impending necrosis after injection of a dermal filler, especially with hyaluronic acid fillers.
This case report followed a patient for six months from time of hyaluronic acid injection to complete healing of the wound.
Complete wound healing was achieved with early recognition and institution of treatment. The study concludes that early recognition of vascular necrosis with specific protocol for treatment after injection necrosis with hyaluronic acid fillers improves the outcome of wound healing.
Cosmetic procedures in children
Curr Opin Pediatr. 2011 Aug;23(4):395-8
Many cosmetic procedures are being performed on children for aesthetic reasons and for the management of dermatological conditions such as psoriasis and vitiligo.
Recent developments in laser technology have improved our ability to treat paediatric cutaneous disorders. Most of these technologies were first developed for aesthetic dermatology in adults. Collagen-stimulatory agents such as poly-L-lactic acid were first approved for lipoatrophy associated with human immunodeficiency virus.
Poly-L-lactic acid and dermal fillers have potential therapeutic applications in children with atrophic disorders such as lipoatrophy and morphea. Injection of botulinum toxin is very successful in the treatment of hyperhidrosis in adults and can improve quality of life in children with the condition.
The field of cosmetic dermatology is evolving quickly, with limited safety and efficacy studies in the paediatric age group. Children may benefit from thoughtful application of these technologies.
Tissue engineering, regenerative medicine, and rejuvenation in 2010: the role of adipose-derived stem cells
Beeson W, Woods E, Agha R. Facial Plast Surg. 2011 Aug;27(4):378-87. Epub 2011 Jul 26.
There is a wide variety of dermal fillers for facial rejuvenation and many more are in development. Over the past few years, the study of adult-derived stem cells has become an active area of research. Adult stem cells are an attractive option for volume restoration and facial rejuvenation.
Adult stem cells are isolated from adipose tissue-adipose derived stem cells and have mesodermal, ectodermal, and endodermal potentials. Adipose-derived stem cells could conceivably be an alternative to pluripotent embryonic stem cells and could play a critical role in the rapidly expanding fields of tissue engineering and regenerative medicine.
This article reviews the history of soft tissue augmentation using adipose tissue grafting and the advent of adipose-derived stem cells. State-of-the-art stem cell isolation techniques as well as anticipated future therapeutic indications are also addressed.
Reviewing the peer press is Rohit Kotnis (Lon), Dip SEM (Ed). Rohit is an advanced tutor at Dermis Deep, Birmingham and a member of the Body Language editorial panel
