Claudia McGloin
Management of granulomatous foreign body reaction to fillers with methotrexate
Almost every injectable treatment with dermal filler has reported granulomatous foreign body reactions (GFBR). Such granulomatosis is uncommon; however, when they occur, they can cause substantial discomfort and repercussions to both the aesthetic practitioner and the patient.
A recent study on platelet-rich plasma reported positive results from the treatment despite a lack of randomsed controlled trials
The aim of this study was to look at whether immunomodulation alongside low doses of methotrexate was effective in treating GFBR to filler material. The study took the clinical cases of four patients with severe GFBR to non-biodegradable fillers that was resistant to treatment. They were successfully treated with 10–15 mg of either oral or subcutaneous methotrexate once per week for 6 months. For the first month, adverse occurrences were monitored throughout the treatment once a week, and then once a month for the last 5 months.
Four women with nodularity of the face were part of the study and were treated for 6 months. Following injection of the filler, the delay ranged from 17 to 30 years. The results showed that one patient's inflammatory lesions were followed by dental care, and, following 10–15 mg of methotrexate once per week for 6 months, all patients were cleared.
In conclusion to this study, low doses of methotrexate seem to offer a low-risk therapeutic alternative in severe GFBR to fillers. The authors have also stated that a future study with long-term follow-up is necessary to confirm these initial observations.
The physician's guide to platelet-rich plasma in dermatologic surgery part I: definitions, mechanisms of action, and technical specifications
Platelet-rich plasma (PRP) is fast becoming a hugely popular treatment within aesthetics but there are limits in both the clinical knowledge and literature.
The aim of this study was to closely analyse PRP in dermatology by reviewing all available data on its use for hair restoration, soft tissue remodelling, resurfacing, and rejuvenation. The study also aimed to identify any gaps and controversies, including making suggestions for future research that could help dermatologists lead the way forward in regenerative medicine.
To carry out this study, a two-part systematic review was carried out, as well as an expert investigation of work published before October 2018.
It was found that the majority of studies on PRP reported positive outcomes, with the highest level of evidence available for androgenetic alopecia treatment. The study also found that there was a lack of randomised controlled trials and a lack of specific protocols, which the authors conclude may have an influence on the clinical outcomes.
Death caused by vaginal injection of hyaluronic acid and collagen: a case report
The use of hyaluronic acid (HA) and collagen in aesthetic medicine is increasing, and any complications arising cause great concern. Recently, a fatality was caused by a poorly regulated procedure of vaginal injection with HA and collagen.
The report shows that a 33-year-old lady was admitted to the emergency department 3 hours after the procedure, mainly complaining of dyspnea. Her blood pressure remained low and fluid replacement was used.
A computed tomography (CT) of her chest was performed and showed local exudation in the lower lobe of the patient's left lung, an enlargement of the right atrium and ventricle and unequal development of the bilateral inferior lobar artery with filling defects. Continuous interruption of pulmonary artery branches of the posterior basal segment of the right lower lobe was shown through pulmonary computed tomography angiography and three-dimensional reconstruction.
Sadly, the report also shows that the symptoms caused by vaginal injection increased dramatically and the patient died 9 hours after the injection.
This case highlights that anyone performing vaginal rejuvenation procedures must be aware of the risks associated with these two popular injectable fillers, including serious pulmonary complications and even death.
Therapeutic options in vitiligo with special emphasis on immunomodulators: a comprehensive update with review of literature
Vitiligo is a common skin disorder that is characterised by depigmented skin.
Even though there are many treatment options available, none of them can cure the condition.
The authors of this study conducted an in-depth review of all literature available from various databases (e.g. PubMed, MEDLINE and Cochrane) using individual and combination keywords, such as ‘vitiligo’ and ‘treatment’ to find relevant literature. The articles that were used were ones that conducted randomised controlled trials. The authors scanned all the applicable articles and summarised them to acquire up-to-date information about treating vitiligo.
Young people's perceptions of acne and acne treatments: secondary analysis of qualitative interview data
A common skin condition, approximately 95% of young people will suffer with some form or severity of acne vulgaris.
Topical preparations are first-line treatments for acne, but nonadherence is a common issue. Furthermore, a large number of patients take long courses of oral antibiotics, which are associated with antibiotic resistance.
The aim of this study was to look at young people's views and experiences of acne and its treatments. The authors looked at information and data that was collected by researchers in the Health Experiences Research Group (HERG) at the University of Oxford, UK. This included a total of 25 transcripts from young people with acne aged 13–24.
It was found that, often, acne can be viewed as a short-term skin condition and part of adolescence, and this can have an effect on seeking treatment or advice.
The participants in this study had a general view that topical treatments were ineffective and were of the opinion that they had tried all available topical treatments; however, they were unsure of the ingredients in the treatments or were unaware of the differences between cosmetic and pharmaceutical treatments. Furthermore, participants were apprehensive of how to effectively use topical treatments, as well as being unsure of how potential side effects can be avoided. Participants were also concerned about the requirement or potential side effects of oral treatments, although few seemed aware of antibiotic resistance.
In conclusion, the authors state that anyone suffering with acne will need adequate support to effectively manage their condition, as well as better understand various topical treatments, how to use them and how side effects can be avoided. Most importantly, directing patients towards accessible evidence-based information is a necessity.