Introduction: Epidermal Growth Factor (rhEGF) is a promising skin antiaging agent that successfully promotes skin wound repair, and it has been investigated in the past decade for these purposes. However, there are no updated systematic reviews, in English or English, that support the efficacy of rhEGF as a regenerative skin treatment or systematic reviews that compile the uses of rhEGF as facial aesthetic therapy and regenerative medicine. Aim: To describe the current state of facial aesthetic and regenerative medicine treatments in which rhEGF has been effectively used. Materials and Methods: An exhaustive search was carried out in “Medline” (via “PubMed”), “Cochrane,” “Bireme” through the Virtual Health Library (VHL), “Elsevier” via “Science Direct,” “Springer,” “SciELo,” “ResearchGate,” and Google Scholar. Studies related to the use of rhEGF in addressing skin disorders or skin aging are included. Results: Overall, 49 articles were found, which described the use of rhEGF for skin regeneration and restructuring. Efficacy in the regeneration of skin wounds was verified through the intradermal and topical application of formulations with rhEGF. Most clinical trials in aesthetics point to an effective inversion of skin aging. However, uncontrolled or randomized trials abound, so that does not represent enough evidence to establish its efficiency. There are transient adverse effects for both cases. Conclusion: The rhEGF considers an effective therapeutic alternative for patients with recalcitrant skin wounds and skin aging, as it is a potent and specific mitogenic factor for the skin.

The aim of combining different minimally invasive techniques is to achieve the most harmonious and most natural-looking facial rejuvenation as effectively and as safely as possible. Due to their safety and versatility, botulinum toxin and soft tissue fillers have become the most sought-after modalities for correcting the signs of facial aging. Recently, bioabsorbable threads used for repositioning ptotic facial tissue have been added into the picture. More practitioners are also combining threads with fillers and botulinum toxin to achieve longer-lasting and natural-looking results. Our aim is to provide guidance on basic anatomical landmarks and areas where botulinum toxin injections, subcutaneous filler injections, and bioabsorbable suspension threads are placed on the face. We would also like to share our best practices on the best combination, spacing the appropriate time intervals in between each procedure to allow for the shortest possible recovery time, as well as periprocedural advice for an integrated treatment approach.

Background: Melasma is a commonly acquired, chronic, and relapsing disorder that results in symmetrical, brownish facial pigmentation. It is more common in women than in men, which generally starts between 20 and 40 years of age, and it can lead to considerable embarrassment and distress. Managing melasma is a difficult challenge that requires long-term treatment with a number of topical agents. Microneedling has been described as a new technique to enhance the drug’s transdermal penetration, and has also been reported to result in sustained long-term improvement of recalcitrant melasma. Aim: The aim of this article was to compare the therapeutic efficacy and safety of combined treatment of skin microneedling and depigmenting cream versus depigmenting cream alone in the treatment of melasma. Materials and Methods: A prospective study was conducted with a sample size of 40 patients, with twenty in each of the treatment arms; 20 patients were treated with combined skin needling and depigmenting cream and 20 with depigmenting cream alone. The outcome was evaluated periodically for up to 2 months using the modified Melasma Area and Severity Index (MASI) score. Results: Significant reduction was observed in modified MASI score in the combined treatment, with P value <0.05. Conclusion: Combining microneedling with Kligman’s regimen gives better results in melasma treatment compared to topical treatment alone.

Background: Nonhealing ulcers can occur due to a variety of causes and are associated with high morbidity, expensive, and prolonged treatment. We conducted this study to determine the efficacy of autologous platelet-rich fibrin (PRF) in nonhealing ulcers in various disorders, which is a very cost-effective and safe treatment option. Materials and Methods: Eighteen patients with nonhealing leg ulcers were included. The ulcers were treated with PRF at weekly intervals. The response to treatment was recorded by calculating the area of ulcer at baseline and at every subsequent visit till the ulcers healed. Results: The study included 18 patients of nonhealing leg ulcers due to leprosy (n = 6), neuropathic ulcer (n = 4), venous ulcer (n = 3), diabetic foot ulcer (n = 2), post-traumatic ulcer (n = 2), and post-full-thickness skin graft ulcer (n = 1). The mean size of the ulcers was 8.44 cm² and mean duration was 5.55 months. The mean age of the patients was 40.5 years. The minimum and the maximum sittings required were three and nine, respectively (mean 5). No adverse events were noted. Conclusion: The treatment of nonhealing ulcer with PRF is an easy, safe, simple, and cost-effective method.

Context: Cutaneous warts can affect up to 7–12% of the general population. Usually diagnosed clinically, there may be diagnostic dilemmas in atypical presentations or immunocompromised patients. Radiofrequency ablation is a common method of treatment of warts, but recurrences occur due to incomplete removal. Dermoscopy has been used in the diagnosis of various infectious dermatoses including warts. Aims: The study aimed to assess dermoscopic features of various types of viral warts and its efficacy in monitoring the treatment response following radiofrequency ablation. Settings and Design: Prospective non-comparative descriptive study in a tertiary care centre. Subjects and Methods: A prospective study was conducted comprising 60 patients with clinically diagnosed, previously untreated warts, including common warts, plane warts, palmar and plantar warts. Dermoscopic features of a representative lesion were evaluated in terms of definition, background color, vascularity, surrounding halo, dermatoglyphics, and presence of hemorrhage or crust. It was done at baseline and immediately after radiofrequency ablation of the wart to observe for complete removal of wart. Results: Most common dermoscopic features observed were presence of papillae surrounding haloes (61.67%), vascularity (dots>globules>linear vessels>loops; 58.33%), interrupted skin lines (51.67%), and brown colored background (48.3%). Nine cases (15%) demonstrated incomplete removal of the wart that was not visible with the naked eye and picked up only on dermoscopy. On follow up, at 6 months there were four recurrences (6.67%). Conclusion: Dermoscopy shows consistent features in the examination of warts. This can be a quick clinical aid in distinguishing it from close differentials. It is also valuable in reviewing the lesion real time after any ablative procedure to check if it has been removed in its entirety.

Context: Keloids are fibroproliferative scars characterized by excessive collagen deposition beyond the margins of the original wound. Although many treatment modalities were described in the literature, no single first-line therapy is recommended, and its recurrence rate remains high. Aims: The aim of this study was to investigate the efficacy rate in treating auricle keloids after fillet flap excision combined with adjuvant intralesional steroid injections. Settings and Design: This was a retrospective study. Materials and Methods: Between 2012 and 2019, a total of 16 auricle keloids were treated at our center with fillet flap excision and adjuvant steroid injections. Intralesional steroid injections were given at the end of the first week and then administered at 4-week intervals until the lesions were soft and flat. Postoperative efficacy, complications, recurrence, and patient satisfaction were analyzed. Results: A high improvement of the keloid was observed in 13 (81.2%) lesions. No major complications and no recurrence of the keloid were detected during the follow-up period (mean, 35 months). Regarding patient satisfaction, nine (81.8%) considered their result as excellent. Conclusion: This study showed that this approach is effective regardless of the keloid location at the auricle.

Background: Acne scar is a distressing psychosocial problem, and it has a negative effect on the quality of life. Although variety of approaches are available, demand of less invasive and more effective ways for their treatment is needed. Objective: This study aimed to assess and compare the clinical safety, efficacy, and tolerability of fractional carbon dioxide (FCO₂) laser versus fractional microneedling radio frequency (MNRF) in the management of acne scars. Materials and Methods: This study was a prospective, observational, nonrandomized, open-labeled study of total 50 patients selected according to Goodman and Baron global qualitative acne scar grading, and they were divided into two groups of 25 each, having Fitzpatrick skin type III–V. A total of four sessions were given for both the groups at an interval of 2 months. The assessment was done by the treating physician as well as by the blinded physician. Both the subjective and the objective assessment was done at the last follow up given at second month of the fourth session. Results: The mean score of 25 patients in each group of FCO₂ and fractional MNRF, decreased from 29.24 to 10.7 (i.e., 63.41%) and from 33.24 to 13.04 (i.e., 60.72%), respectively, as calculated by Goodman and Baron quantitative grading assessed by the treating physician (P = 0.0001). Grade 4 (>75%) improvement was shown by four patients and Grade 3 improvement (51%–75%) was shown by 14 patients among FCO₂ group, and similarly Grade 4 (>75%) improvement was shown by three patients and Grade 3 improvement (51%–75%) was shown by 12 patients among MNRF group, as observed by a blinded physician (P = 0.689). Conclusion: Both modalities are equally effective in the treatment of acne scars; however, fractional MNRF having lesser down time and Post inflammatory hyperpigmentation (PIH) among darker skin shades, with good patient satisfaction score, makes it an efficient and safer treatment option as compared to FCO₂.

Background: Platelet-rich plasma (PRP) is a simple and safe procedure, which has been used for soft tissue and wound healing. PRP has been used in dermatology for skin rejuvenation and alopecia. Objective: The objective of our study was to study efficacy of PRP with microneedling in patients with androgenetic alopecia (AGA) and to assess number of sessions required for a patient. Materials and Methods: Sixty patients diagnosed with AGA were studied between August 2016 and October 2018 who did not respond to minoxidil and finasteride. PRP was prepared by centrifugation of patients’ blood. PRP with microneedling was done for all patients under aseptic conditions. Four to six sessions were done at an interval of 4 weeks. Subjective and objective scores were assessed based on a visual analog global score. Assessment was done at the first session, every next sitting, and 4 weeks after the last sitting. Follow-up was done at 3rd and 6th month after the last sitting. Results: According to subjective scores, two patients (3.33%) had excellent results, 24 (40%) very good, 22 (36.6%) good, 6 (10%) fair results, and 6 (10%) did not have any response. Objective assessment scores showed that two patients (3.33%) had excellent results, 26 (43.3%) very good, 21 (35%) good, 7 (11.6%) had fair results, and 4 (6.7%) did not have any response. Fifty patients underwent four sessions out of which 40 (i.e. 66%) patients had very good results. Only 10 patients required more than four sessions to achieve good results. Patients were happy with four sessions. There were no side effects noted either during or after the treatment. Conclusion: This study shows PRP with microneedling as an efficacious treatment for AGA and augments the effects of conventional treatment. This study sets example for assessing the number of PRP sessions. A minimum of four sessions is required to achieve very good results.

Introduction: Microneedling radiofrequency (MNRF) using insulated microneedles offers a great advantage to overcome the limitations of fractional lasers such as achieving greater depth, long downtime, and high risk of postinflammatory hyperpigmentation (PIH). Aims: The aim of this study was to assess the efficacy and safety of a novel multiple depth bipolar rotational stamping and monopolar criss-cross method (Wosyet vital technique) with MNRF using insulated needles for the improvement of facial acne scars in Asians. Materials and Methods: Thirty-two patients (20 females, 12 males, average age 30.3 years) with facial atrophic acne scars were treated with insulated MNRF by applying Wosyet vital technique. Most of the patients started noticing improvement in 4–6 weeks after the first session. All patients underwent four sessions at 1-month interval. Outcome assessments included subjective and physician evaluation of acne scars, pores, smoothness, tightness, and overall appearance. Objective assessment was determined by Goodman and Baron’s quantitative and qualitative analysis of the acne scars. Results: All subjects noticed at least 30%–90% (mean––62.50%) improvement in acne scars, whereas unbiased physicians graded 40%–80% (mean––58.44%) at a 6-month follow-up visit. The mean Goodman and Baron’s score decreased significantly from pre- to posttreatment. All patients reported 30%–90% (mean––61.88%) improvement in facial contour and skin tightening. Many patients observe improvement in the open pores as well. Conclusion: The possible explanation of improvement in the global appearance of skin and acne scars is the application of both monopolar and bipolar RF in the dermis through insulated microneedles. We did not find PIH after this technique in Asian patients despite of more aggressive treatment parameters and several treatment sessions. Statistical Analysis Used: The results were analyzed using chi-square test, Wilcoxon sign rank test, Pearson’s correlation test, Spearman’s correlation test, and paired t test.

Introduction: Lip pigmentation is frequently encountered in the Dermatology outpatient department. No effective treatment is available so far. Topical treatment requires longer time and is often unsatisfactory. Aim: The aim of this work was to study the efficacy of 532-nm Q-switched Nd:YAG laser in the treatment of lip melanosis. Settings and Design: This was a prospective interventional study. Materials and Methods: Twenty patients in the age group 27–53 years were included in the study. Eight patients had diffuse pigmentation and twelve patients had focal pigmentation. Test spot was done. After topical anesthesia, Q-switched Nd:YAG laser was used. Treatment interval was 4 weeks. Follow-up was done at 1 week and then monthly. Statistical Analysis Used: Wilcoxon signed ranks test and P value. Results: Seven patients (35%) showed an excellent response with more than 75% of pigment clearance. Seven patients (35%) showed a good response, two patients (10%) moderate response, and two patients (10%) had a mild response. Two patients had recurrence after 3 months follow-up. The average number of sessions required for clearance of pigmentation was 2.5. No scarring was seen. Conclusion: 532-nm Q-switched Nd:YAG laser is safe and effective in the management of lip pigmentation and gives rapid results.

Background: Although fat grafting has become an attractive method of correction of soft tissue deficiencies, variability in results exists. As the understanding of mechanism of survival of graft improves, the concepts regarding fat grafting change. There are many ways to process the aspirated fat with no clear method superior. Aim: The aim of this study was to evaluate the role of processing during autologous fat transfer. Materials and Methods: The patients were serially divided into two groups, namely, A and B. Harvesting of lipoaspirate and injection of fat were same in both the groups. In group A, no processing was done. In group B, the fat was processed by sedimentation and injected. Patient satisfaction was assessed following the procedure and statistical analysis was done using the Mann–Whitney U-test. Results: Young females between 21 and 30 years formed the majority of patients who opted for fat grafting procedure. Most of the procedures were performed for defects in the face (93.3%). The most common indication of fat grafting was contour deformities, with abdomen being the most preferred donor site. The mean patients’ satisfaction following fat grafting without processing is 2.2 ± 0.68. The mean patients’ satisfaction following fat grafting with processing is 2.53 ± 0.99. Conclusion: There was not a statistically significant difference in patient outcomes following fat grafting, with or without processing, in terms of patient satisfaction. Autologous fat grafting was found to be a safe procedure with no significant complications.

The aim of this report was to study the effectiveness of nonabsorbable (polyamide black) subcutaneous buried suture (6-0) in elliptical excision of various indications for better outcome of the scar. Clinical data of 155 patients, who underwent nonabsorbable buried subcutaneous closure in elliptical excision for different indications, were collected randomly and analyzed retrospectively. By using a modified Vancouver Scar Scale, which includes an assessment of pliability, the height of scar, vascularity, and pigmentation, all postoperative scars were classified into five categories: excellent, good, moderate, hypertrophic scar, or keloid. A total of 155 patients of elliptical excision with different indications were included in the study. In this study, the male-to-female ratio was 1:2, and patients in the age-group between 10 and 70 years were involved. Of 155 patients, 72% of patients had excellent cosmetic outcome (0 score), 21.29% had good cosmetic outcome (1 score), and 2.58% had a moderate cosmetic outcome (2 score) without any hypertrophic scar or keloid by using a modified Vancouver Scar Scale. No complaints were reported during the study. Scar closure by nonabsorbable buried subcutaneous suture will reduce cutaneous tension, so there will be a better approximation of wound edges and thus better outcome of the scar.

Dermabrasion is important step in any vitiligo surgery. Unfortunately, it is not possible to derma abrade very small area with conventional burs available. The present paper highlights the use of dental burrs in such situations.

Background: Stretch marks (SM) are nowadays the most common aesthetic pathology of the body; in the XX century, it mainly affected pregnant women, while today it also affects teenagers during puberty, boys and girls without distinction. The aim of this study was to evaluate possible variations in the histological structure of the skin—in terms of quality/quantity of the extracellular matrix and of the collagen and elastic fibers—following the electromagnetic fields and negative pressure (V-EMF) treatment as regards hypotonia and SMs. Materials and Methods: For the current study, 60 women, aged between 25 and 45, were examined. All of them presented deep, white or pearly white colored SMs having had them for between 12 and 25 years. These were documented, asking patients their level of satisfaction, through pictures and biopsies. All patients underwent a cycle of 6 or 8 weekly sessions; everyone was highly satisfied with the results obtained. Results: Biopsies proved that the tissue was reorganized and restored to the original volume, characterized by the production of new, high-quality collagen and elastin molecules, by the reorganization of the basement membrane and by the correct positioning of the melanocytes. No side effects were observed during the treatments. This synergy stands as the most suitable treatment of striae rubra and alba. Conclusion: V-EMF enhances the keratinocyte migration base, melanocytes, and promotes neoangiogenesis with the result of improvement in the SM.

Skin grafting is the transplantation of skin, a routinely performed procedure to cover the loss of skin. Skin is the largest organ of the body, which falls short of availability in extensive injuries, especially burns. In such a situation, pixel grafting, a novel expansion technique helps to cover a large area with less skin harvest. The objective of the study was to test fast, minimally invasive, easy to use minced split-thickness skin graft to cover large wounds and to reflect on the advantages of pixel graft. It is a pilot study of patients admitted with severe burns. We conclude that with this technique of pixel or minced grafting, large areas can be grafted with minimal donor-site requirement, and the techniques of preparation provide adequate size graft for pixel grafting.

Cicatricial lower lid ectropion is characterized by vertical shortening and/or scarring of the anterior lamella of eyelid and can be the result of thermal or chemical burns, mechanical or surgical trauma/scars, medications, sun damage, chronic inflammation, and involutional changes.Ectropion repair presents a challenge to the surgeon. The surgical management of cicatricial ectropion depends on the situation after the release of the scar traction in the lower lid area. Various techniques have been described for correcting cicatricial ectropion by lengthening the anterior lamella with transposition flaps or with full-thickness free skin grafts.We would like to describe two cases of lower lid cicatrical ectropion with two different causes, which were managed in two different ways.

Eccrine acrospiroma is a benign skin tumor that arises from the ducts of sweat glands, presents as small solid or cystic lesions that rarely can undergo malignant transformation, and leads to a diagnostic dilemma. We report a 32-year-old woman who presented with a large pedunculated tumor of the scalp that was excised and histopathologically proven to be a giant eccrine acrospiroma. This case is being presented because of its infrequent occurrence and the unusual large size of the lesion on the scalp that has been not reported in the literature so far.

Seborrhoeic dermatitis (SD) is a chronic, relapsing, papulosquamous inflammatory itchy dermatoses. It manifests as erythematous papules, macules, or ill-defined flat plaques with varying levels of scaling and pruritus. The exact pathogenesis of this condition is not known but Malassezia yeasts, hormones (androgens), amount of sebum produced, and deranged immune response are known to play important roles in its development. There is a wide range of therapeutic options to treat SD but some patients do not respond to any of the treatments. Here, we report three patients with treatment-resistant facial SD, successfully treated with light-emitting diode light therapy (LED-LT).

Cryotherapy using liquid nitrogen as cryogen is a well-established therapeutic modality in dermatology. In recent times, there have been many innovations and improvisation of cryotherapy for various dermatological disorders. In this article, we present a short comprehensive collation of practically useful points of cryotherapy covering the various aspects of procedure-planning, patient selection, storage and delivery techniques, and challenging clinical scenarios which can enhance the utility of this efficacious and economic treatment option.

Background: Lipofilling is currently a fundamental component of rhytidoplasty and fat harvesting has become a common procedure. Tonnard introduced the concept of nanofat grafting, a revolutionary milestone, in which adipocytes are mechanically separated from the stromal vascular fraction and the latter is injected, adding the possibility of cellular therapies to the surgical field. Later, Verpaele et al. published a report using a new device to apply this nanofat in a uniform manner, which they termed nanofat needling. The device has 24 microneedles of 1.5 mm length and is applied as a stamp, in a tapping motion. The same manufacturer offers a similar model with 64 microneedles, 1.0 mm length, and available as a roller. Objectives: We sought to evaluate the combination of the above-mentioned microneedling devices to achieve faster nanofat delivery. Materials and Methods: A prospective evaluation of patients undergoing a combined nanofat microneedling approach for skin rejuvenation and scar revision, using both a stamp device as well as a roller, was performed in a private practice setting, from January 2019 to January 2020. Patient satisfaction, complications, and surgical time were evaluated. Results: We applied this combination treatment to over 100 treatment areas in 86 patients over a 12-month period, with a short operative time, no increase in complications, consistent results, and good patient satisfaction. Conclusions: We recommend the use of this new device in association with the original one, in order to decrease the procedure time. We designate this strategy “fast nanofat microneedling.”

Acne keloidalis nuchae (AKN) correctly termed “folliculitis keloidalis”, is an unusual form of chronic folliculitis and cicatricial alopecia that affects nape of neck. AKN can lead to significant scarring with tumor like masses and alopecia. Treatment in chronic cases is challenging with recurrence being common. Several modalities are being tried with variable success. We aim to report our experience with multimodality surgical approach. Five patients of chronic AKN refractory to intralesional steroids were treated between 2015 - 2018 with (1) excision and primary closure or (2) punch excision followed by healing with secondary intention or (3) intralesional cryotherapy, based on lesion morphology, site and extent . All patients also underwent long-pulsed (LP) neodymium-doped yttrium aluminum garnet (Nd:YAG)laser hair removal for the affected part with an aim to prevent new lesions from developing in the surrounding area. Patients were followed at regular intervals till 6 months. 100% patients were satisfied with the treatment outcome. They showed 80%–90% overall reduction in lesions with satisfactory cosmetic outcome. Complete removal of follicles leads to least chance of local recurrence. Surgical excision remains the most effective modality of management. In case of lesions <5 mm, punch excision can be gratifying. Cryotherapy is useful where excision and primary closure is not feasible. Hair removal lasers can prevent new lesions in the sorrounding area. Combined multimodality approach tailored to the type of lesions gives maximal result with a better cosmetic outcome.