Peer PreSs Review
Dr Rohit Kotnis surveys academic and association journals to report on advances in research in medical aesthetics and related fields
Clinical relevance of botulinum toxin immunogenicity.
Benecke R. BioDrugs. 2012 Apr 1;26(2).
The reported prevalence of immunoresistance varies greatly, depending on factors such as study design and treated indication. This review presents what is known about the immunogenicity of botulinum toxin and how this impacts upon patient non-response to treatment.
The role of neutralising and non-neutralizing antibodies in the response to botulinum toxin is discussed, with an assessment of neutralising antibody measurement techniques.
Different botulinum toxins have been developed. The new preparations of botulinum toxin aim to minimise the risk of immunoresistance in patients being treated for chronic clinical conditions.
This article provides background information to explain immunoresistance. A concept that has been known about for some time with botulinum toxin and may have clinical implications.
Facing depression with botulinum toxin: A randomized controlled trial.
Wollmer MA et al. J Psychiatr Res 23 Feb. 2012 [Epub ahead of print].
Positive effects on mood have been observed in subjects who underwent treatment of glabellar frown lines with botulinum toxin and, in an open case series, depression remitted or improved after such treatment.
Using a randomised double-blind placebo-controlled trial design, the authors assessed botulinum toxin injection to the glabellar region as an adjunctive treatment of major depression.
Thirty patients were randomly assigned to a verum (onabotulinumtoxinA, n=15) or placebo (saline, n=15) group. The primary end point was change in the 17-item version of the Hamilton Depression Rating Scale six weeks after treatment compared to baseline.
The verum and the placebo groups did not differ significantly in the collected baseline characteristics. Throughout the 16-week follow-up, there was a significant improvement in depressive symptoms in the verum group compared with the placebo group as measured by the Hamilton Depression Rating Scale. The effect size was even larger at the end of the study (d=1.80).
Treatment-dependent clinical improvement was reflected in the Beck Depression Inventory, and in the Clinical Global Impressions Scale.
This study shows that a single treatment of the glabellar region with botulinum toxin may shortly accomplish a strong and sustained alleviation of depression in patients who did not improve sufficiently on previous medication. It supports the concept that the facial musculature not only expresses but also regulates mood states.
Blindness Following Cosmetic Injections of the Face.
Lazzeri D, Agostini T, Figus M, Nardi M, Pantaloni M, Lazzeri S. Plast Reconstr Surg 2012 Apr;129(4):995-1012.
Complications following facial cosmetic injections have heightened awareness of the possibility of iatrogenic blindness. The authors conducted a systematic review of the available literature to provide the best evidence for the prevention and treatment of this serious eye injury.
The authors included in the study only the cases in which blindness was a direct consequence of a cosmetic injection procedure of the face. Twenty-nine articles describing 32 patients were identified.
In 15 patients, blindness occurred after injections of adipose tissue; in the other 17, it followed injections of various materials, including corticosteroids, paraffin, silicone oil, bovine collagen, polymethylmethacrylate, hyaluronic acid, and calcium hydroxyapatite.
Some precautions may minimise the risk of embolisation of filler into the ophthalmic artery following facial cosmetic injections. Intravascular placement of the needle or cannula should be demonstrated by aspiration before injection and should be further prevented by application of local vasoconstrictor.
Needles, syringes, and cannulas of small size should be preferred to larger ones and be replaced with blunt flexible needles and microcannulas.
Low-pressure injections with the release of the least amount of substance possible should be considered safer than bolus injections. The total volume of filler injected during the entire treatment session should be limited, and injections into pre-traumatised tissues should be avoided.
Actually, no safe, feasible, and reliable treatment exists for iatrogenic retinal embolism. Nonetheless, therapy should theoretically be directed to lowering intraocular pressure to dislodge the embolus into more peripheral vessels of the retinal circulation, increasing retinal perfusion and oxygen delivery to hypoxic tissues.
A useful review article highlighting the potential dangers of filler injections and giving practical advice and guidance to minimise such significant complications.
Combination of microneedling and glycolic acid peels for the treatment of acne scars in dark skin.
Sharad J. J Cosmet Dermatol 2011 Dec;10(4):317-23
Acne scars can cause emotional and psychosocial disturbance to the patient. Various modalities have been used for the treatment of acne scars, such as punch excision, subcision, peels, microdermabrasion, unfractionated and fractioned lasers. The latest in the treatment armamentarium is microneedling.
Acne scars commonly coexist with postinflammatory hyperpigmentation. A combination of microneedling and glycolic acid (GA) peels was found to give excellent results in the treatment of such scars.
The aim was to study the efficacy of a combination of microneedling with glycolic peel for the treatment of acne scars in pigmented skin.
Thirty patients in the age group of 20–40, with rolling scars with postinflammatory hyperpigmentation were chosen for the study. Two groups were made. The first group comprised 30 patients in whom only microneedling was performed once in six weeks for five sessions.
In the second group of 30 patients, a combination of microneedling and 35% GA peels was carried out.
Based on the objective scoring and its statistical analysis, there was significant improvement in superficial and moderately deep scars (grade 1–3). There was improvement in skin texture and reduction in postacne pigmentation in the second group.
Microneedling is a simple, inexpensive office procedure with no downtime. It is safe in darker skin (skin types III-IV). The combined sequential treatment with GA peel caused a significant improvement in the acne scars without increasing morbidity.
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