Journal Of Cosmetic Dermatology[JOURNAL]
Sun
200 papers
Impulsivity, Psychological Distress, and Quality of Life Among the Patients With Acne Vulgaris: Factors Related to Acne Scars.
Yanik Hİ, Acer E, Karaman İGY … +4 more , Ağaoğlu E, Erdoğan HK, Bilgin M, Saraçoğlu ZN
J Cosmet Dermatol · 2026 Apr · PMID 41928073 · Full text
BACKGROUND: Acne scars affect up to 95% of acne vulgaris (AV) patients. However, there is little clinical data to predict which patients are more prone to create scars. OBJECTIVE: In this study, we aimed to evaluate the...
BACKGROUND: Acne scars affect up to 95% of acne vulgaris (AV) patients. However, there is little clinical data to predict which patients are more prone to create scars. OBJECTIVE: In this study, we aimed to evaluate the impulsivity, psychological distress, and quality of life in acne patients and factors related to acne scars. METHODS: This study included 403 AV patients aged 18 years and older. The Global Evaluation Acne (GEA) Scale and the Global Scale for Acne Scar Severity (SCAR-S) were used to assess acne and scar severity. The patients completed a form that included epidemiologic data, such as smoking habits, alcohol consumption, acne characteristics, the Acne Quality of Life Instrument (AQLI), the Barratt Impulsivity Scale-11 Short Form (BIS-11-SF), and the Depression Anxiety Stress Scale-21 (DASS-21). RESULTS: Of the 403 acne patients, 56% (n = 226) had scars. The male sex, mean disease duration, and severity of acne were higher, and the age of acne onset was lower in the group with acne scars (p < 0.001, p = 0.030, p < 0.001, p < 0.001). Oily skin type was more frequent in patients with acne scars (p < 0.001), and Fitzpatrick skin types 3 and 4 were more frequent in patients with acne scars (p < 0.001, p < 0.001). Pruritus and postinflammatory hyperpigmentation were more frequent in the group with acne scars (p < 0.001, p < 0.001). The time from the first acne lesion to the beginning of treatment was longer in the group with acne scars (p < 0.001). The history of systemic drug, topical drug, and dermo-cosmetic product use for acne treatment was lower in the group with acne scars (p = 0.010, p < 0.001, p < 0.001, p < 0.001). The mean AQLI, BIS-11-SF, total DASS-21, depression subscale, and stress subscale scores were higher in the group with acne scars (p < 0.001, p < 0.001, p = 0.002, p = 0.007, p = 0.002). There was a negative correlation between scar severity score and the age of acne onset and a positive correlation between scar severity score and disease duration (p < 0.001, r = 0.16, p < 0.001, r = -0.3, respectively). There was a positive correlation between scar severity score and the mean AQLI, BIS-11-SF, total DASS-21, depression subscale, and stress subscale (p < 0.001, r = 0.2, p < 0.001, r = 0.16, p < 0.001, r = 0.16; p < 0.001, r = 0.17, p = 0.003, r = 0.15, respectively). CONCLUSION: Male sex, early onset of acne, prolonged acne duration, severe acne, delayed treatment, oily skin type, darker skin type, presence of pruritus, and higher impulsivity were associated with acne scars. The presence of scars had adverse effects on quality of life and psychoemotional status, such as depression and stress.
Dexamethasone Admixture for Hypersensitivity Prevention in Botulinum Toxin Type A Treatment: A Case Report.
Jia X, Liang Y, Chen Q … +1 more , Hu J
J Cosmet Dermatol · 2026 Apr · PMID 41925068 · Full text
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Adhesion and Formation of Bacterial Biofilm on Polydioxanone (PDO) Thread Cannulas: An In Vitro Evaluation.
de Oliveira Rabelo H, de Andrade Cunha L, Pereira HMD … +5 more , da Silva Ryal EPF, Wada LGTT, Ferreira EB, Gimenes F, Tognim MCB
J Cosmet Dermatol · 2026 Apr · PMID 41923298 · Full text
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Persistent Trigeminal Neuralgia-Like Pain Following Isolated Hyaluronic Acid Lip Augmentation: A Case Report.
Calabrò RS, Bonavita P
J Cosmet Dermatol · 2026 Apr · PMID 41923295 · Full text
BACKGROUND: Hyaluronic acid (HA) fillers are widely used for lip augmentation and are generally associated with a favorable safety profile. While vascular complications are well recognized, non-vascular neurological adve...
BACKGROUND: Hyaluronic acid (HA) fillers are widely used for lip augmentation and are generally associated with a favorable safety profile. While vascular complications are well recognized, non-vascular neurological adverse events, including trigeminal neuropathic pain, remain underreported, particularly following procedures in anatomically lower-risk areas such as the lips. OBJECTIVE: To report a rare case of persistent trigeminal neuralgia-like pain following HA lip augmentation and to highlight diagnostic and therapeutic considerations. METHODS: A 49-year-old woman developed persistent facial pain 10 days after HA lip augmentation. Clinical evaluation included dental assessment, imaging studies, and high-resolution ultrasound of the perioral region. Initial management with hyaluronidase, corticosteroids, and non-steroidal anti-inflammatory drugs was performed. Due to persistent symptoms, a neuropathic pain-oriented treatment with pregabalin and palmitoylethanolamide (PEA) was initiated. Pain severity was assessed using a visual analog scale (VAS), and follow-up was conducted over 3 months. RESULTS: The patient presented with severe bilateral facial pain and paresthesia (VAS 7), refractory to conventional anti-inflammatory treatment. Imaging excluded dental pathology and vascular complications, while ultrasound revealed localized post-procedural tissue changes. Following initiation of pregabalin and PEA, a significant and sustained reduction in pain was observed (VAS 2 at 1 month; VAS 1 at 3 months). CONCLUSION: Persistent trigeminal neuralgia-like pain represents a rare but clinically relevant complication of HA lip augmentation. This case supports a neuropathic and neuroinflammatory mechanism and underscores the importance of early recognition and targeted treatment. Awareness of this complication may improve clinical outcomes and guide management strategies in aesthetic practice.
The ARTIST Post-Market Study: Evaluating a High G' Hyaluronic Acid (HA) Injectable for Chin Combined With Midface HA Filler Treatments.
Nikolis A, Rivers JK, Rosen N … +3 more , Weinberg F, Prygova I, Bromée T
J Cosmet Dermatol · 2026 Apr · PMID 41919754 · Full text
BACKGROUND: A novel hyaluronic acid (HA) injectable (Restylane Shaype, HA) with high strength/firmness and enhanced HA concentration, optimized for lower face shaping has been developed. AIMS: This prospective, 8-week, m...
BACKGROUND: A novel hyaluronic acid (HA) injectable (Restylane Shaype, HA) with high strength/firmness and enhanced HA concentration, optimized for lower face shaping has been developed. AIMS: This prospective, 8-week, multicenter, post-market study evaluated three treatment algorithms, i.e., the Shayping Technique, for subjects with multiple aesthetic needs, including HA for chin augmentation alone/in combination with treatments for the lower face and midface with HA (Restylane Defyne) and HA (Restylane Lyft Lidocaine). PATIENTS/METHODS: Subjects ≥ 18 years were assigned to one of the following treatments: Group 1: HA (chin); Group 2: HA (chin) and HA (marionette line areas laterally to the chin); Group 3: HA (chin), HA (marionette line areas laterally to the chin), and HA (midface and/or nasolabial fold [NLF, piriform fossa] and/or jawline). Assessments included Global Aesthetic Improvement Scale (GAIS), subject and investigator satisfaction, and collection of adverse events (AEs). RESULTS: The GAIS responder rate ("improved," "much improved," or "very much improved") was 100% in all groups at Week 8 (primary endpoint) and Week 4 as assessed by the investigator and by subject self-assessment at Weeks 4 and 8. Overall subject and investigator satisfaction with treatment was high, and the safety profile for all product combinations was favorable, with no unexpected AEs. CONCLUSIONS: Treatment with HA for chin augmentation alone/in combination with HA and HA for comprehensive lower face and midface lift was safe and effective, with 100% aesthetic improvement at 8 weeks post-injection. The Shayping Technique provides standardized guidance for practitioners to perform safe injections and achieve optimal aesthetic outcomes.
Liposomal Delivery Enhances the Effects of a Collagen Tripeptide-Containing Formulation on Dermal Structure and Optical Skin Parameters: A Randomized, Double-Blind, Placebo-Controlled Trial.
Lin YK, Liang CH, Huang BC … +5 more , Lim SH, Lin YH, Chan ST, Chiang CF, Mao YW
J Cosmet Dermatol · 2026 Apr · PMID 41918155 · Full text
OBJECTIVE: This study aimed to determine whether liposomal delivery enhances the effects of a collagen tripeptide-containing formulation on dermal structural and biomechanical parameters, as well as appearance-related sk...
OBJECTIVE: This study aimed to determine whether liposomal delivery enhances the effects of a collagen tripeptide-containing formulation on dermal structural and biomechanical parameters, as well as appearance-related skin properties, compared with a nonliposomal formulation and placebo. METHODS: In a randomized, double-blind, placebo-controlled trial, 75 healthy adults aged 25-65 years were assigned to receive placebo, a nonliposomal formulation containing collagen tripeptides, or a liposomal formulation containing collagen tripeptides (50 mL/day) for 8 weeks. Objective assessments of dermal collagen density, skin hydration, elasticity, wrinkle area, skin luminance, and tone evenness were performed at baseline and Weeks 2, 4, and 8 using standardized instrumental measurements. RESULTS: Both collagen tripeptide-containing formulation groups showed significant improvements in dermal collagen density, hydration, and elasticity compared with placebo (p < 0.05). The liposomal formulation demonstrated an earlier onset and a greater magnitude of improvement across multiple parameters, with a statistically significant advantage in skin elasticity at Week 8 compared with the nonliposomal formulation (p < 0.05). Notably, only the liposomal collagen tripeptide-containing formulation group exhibited a significant reduction in wrinkle area at Week 8 relative to placebo (p < 0.05). Both collagen tripeptide formulation groups also showed significant increases in skin luminance and tone evenness. CONCLUSION: Liposomal delivery significantly enhances the functional effects of a collagen tripeptide-containing formulation on dermal structure and biomechanical performance, particularly dermal collagen density and skin elasticity, as well as optical skin properties including luminance and tone evenness. These findings support the application of liposomal formulations containing collagen tripeptides as an effective oral nutricosmetic strategy for improving visible signs of skin aging. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT06771388.
A Dual-Phase Approach to Facial Rejuvenation Integrating Contouring and Ligamentous (CL Code) Anchoring With a Polycaprolactone-Based Collagen Stimulator.
Hong GW, Wong IKJ, Wan J … +3 more , Park SY, Lee S, Yi KH
J Cosmet Dermatol · 2026 Apr · PMID 41918150 · Full text
BACKGROUND: Facial aging reflects concurrent skeletal remodeling, fat redistribution, and attenuation of retaining ligaments. Volume-oriented fillers may restore contours but often underaddress structural support. OBJECT...
BACKGROUND: Facial aging reflects concurrent skeletal remodeling, fat redistribution, and attenuation of retaining ligaments. Volume-oriented fillers may restore contours but often underaddress structural support. OBJECTIVE: To describe the CL Code, a dual-phase injectable protocol combining Contouring (C) and Ligamentous anchoring (L), using a polycaprolactone (PCL) collagen stimulator to integrate immediate volumization with delayed neocollagenesis. METHODS: The protocol aligned the biphasic kinetics of PCL with facial anatomy. The C-phase targeted seven contouring zones using small aliquots to restore volume, while the L-phase reinforced eight retaining ligament support points at the supraperiosteal or subsuperficial musculoaponeurotic plane using 27-gauge needles. A 49-year-old woman with pan-facial volume loss underwent treatment with a total volume of 2.9 mL (0.3 mL per C site and 0.1 mL per L point). Outcomes at 6 months included Global Aesthetic Improvement Scale (GAIS) ratings and patient-reported FACE-Q scores. FACE-Q was administered pretreatment and at 6 months using the Satisfaction with Facial Appearance module. GAIS was assessed by two independent dermatologists blinded to treatment details using standardized photographs. RESULTS: In this single patient, standardized photography demonstrated improved jawline definition, reduced jowling, and softening of nasolabial folds. GAIS was rated as "Very Much Improved," and FACE-Q scores increased from 58 to 86 (out of 100), indicating high patient satisfaction. CONCLUSIONS: Aligning the temporal behavior of PCL with anatomically targeted injection planes may couple immediate contour restoration with progressive ligamentous support. The CL Code achieved meaningful esthetic improvement using conservative volumes. Controlled comparative studies with longer follow-up are warranted.
The Value of High-Frequency Ultrasound and Color Doppler Flow Imaging in Assessing the Efficacy of Moderate-to-Severe Acne Vulgaris: A Prospective Single-Arm Study.
Zheng L, Fu X, Qiu X … +5 more , Gao S, Jiang Y, Wang X, Ali K, Chen F
J Cosmet Dermatol · 2026 Apr · PMID 41918149 · Full text
OBJECTIVE: This study aimed to investigate the value of non-invasive skin detection techniques for the therapeutic assessment of moderate-to-severe acne vulgaris. METHODS: In this study, we collected patients with modera...
OBJECTIVE: This study aimed to investigate the value of non-invasive skin detection techniques for the therapeutic assessment of moderate-to-severe acne vulgaris. METHODS: In this study, we collected patients with moderate-to-severe acne vulgaris who attended the Department of Dermatology at the First Affiliated Hospital of Guilin Medical University between October 2021 and December 2022, and analyzed their high-frequency ultrasound (HFUS) and color Doppler flow imaging (CDFI) characteristics at the Weekend 0 (T0), Weekend 4 (T1), and Weekend 12 (T2) of their treatment. RESULTS: A total of 30 patients with moderate-to-severe acne vulgaris [mean age 21.1 ± 3.4 years; 14 males (46.7%), 16 females (53.3%)] were enrolled. HFUS assessment revealed improvements (p < 0.05) in multiple parameters following treatment. Prior to treatment, there was perfect agreement (κ = 1.0) between the Pillsbury clinical grading and the SSSA ultrasound grading in all 30 patients (100%). Among the 30 patients who completed the 12-week follow-up, post-treatment ultrasound grading was higher than the clinical Pillsbury grading in 17 cases (56.7%). Agreement between the two grading methods post-treatment was poor (κ = 0.3, p = 0.645, 95% CI: -0.17, 0.77), though statistical significance was limited by sample size. CONCLUSION: HFUS effectively visualizes deep acne lesions (nodules/cysts). Although ultrasound grading demonstrates slower severity reduction than clinical assessment, it provides more objective severity evaluation. CDFI enhances hemodynamic analysis through real-time flow visualization. Combined HFUS/CDFI enables enhanced severity and prognostic assessment in moderate-to-severe acne vulgaris.
TriHex Technology and Reversal of Solar Elastosis: Dispelling Some Myths.
Widgerow AD, Napekoski K, Shafiq F … +1 more , Robison T
J Cosmet Dermatol · 2026 Apr · PMID 41918136 · Full text
BACKGROUND: Solar elastosis (SE) is the end result of long-term sun damage, characterized by a buildup of dystrophic material in the extracellular matrix (ECM) surrounded by fragmented collagen and dysfunctional, aggrega...
BACKGROUND: Solar elastosis (SE) is the end result of long-term sun damage, characterized by a buildup of dystrophic material in the extracellular matrix (ECM) surrounded by fragmented collagen and dysfunctional, aggregated elastin. This degenerative process was once thought to be irreversible but is now recognized as dynamic, with the potential for regenerative change through appropriate interventions. New stains also enable the detection of newly formed elastin and collagen as part of this reversal process. MATERIALS AND METHODS: A retrospective analysis of multiple clinical studies (624 patients, 80 biopsies, 31 reported solar elastosis) was conducted, focusing on the use of TriHex and TriHex+ peptide-based technology (Alastin Skincare Inc., Carlsbad, CA). Biopsies were evaluated using novel histologic stains, including Herovici and Movat, alongside conventional Hematoxylin & Eosin (H&E) and CD44. Markers such as Collagen IV and Laminin at the dermo-epidermal junction (DEJ) were also assessed to identify evidence of regenerative reversal of solar elastosis, ECM remodeling, and new elastin formation. RESULTS: The regenerative reversal of solar elastosis was observed across multiple clinical trials. The TriHex formulations consistently produced significant improvements in ECM structure. Reported histology in 74% of cases showed clear removal of amorphous elastotic deposits and restoration of the ECM, including new elastin fiber formation, strengthening of the DEJ with increased Collagen IV and Laminin, new rete ridge architecture, and positive hydration effects evidenced by increased CD44 staining. CONCLUSION: This review positively challenges a long-standing myth and clearly establishes a new perspective: solar elastosis is reversible. The peptide-based TriHex Technology can remove the elastotic amorphous material from the ECM and rebuild it with new elastin and collagen fibers. Clinically and histologically, this shows that chronic sun damage can be repaired in the dermis, supporting a shift from superficial treatments to a more targeted regenerative approach focused on restoring the structural integrity of the skin.
Beyond Isotretinoin: A Narrative Review of Emerging Systemic Therapies for Moderate-to-Severe Acne.
Tommasino N, Annunziata MC, Potestio L … +1 more , Napolitano M
J Cosmet Dermatol · 2026 Apr · PMID 41914642 · Full text
BACKGROUND: Acne vulgaris is a common inflammatory skin disorder with significant psychosocial impact. While isotretinoin remains the gold standard for moderate-to-severe cases, its adverse effects and teratogenicity und...
BACKGROUND: Acne vulgaris is a common inflammatory skin disorder with significant psychosocial impact. While isotretinoin remains the gold standard for moderate-to-severe cases, its adverse effects and teratogenicity underscore the need for alternative systemic therapies. OBJECTIVE: To review emerging systemic treatments for acne beyond isotretinoin, evaluating their efficacy, safety, and potential clinical applications. METHODS: A narrative review was conducted through PubMed, Scopus, and Web of Science, including studies from January 2015 to June 2025. Eligible publications focused on systemic treatments for moderate-to-severe acne, excluding topical-only and non-peer-reviewed studies. RESULTS: Promising alternatives include the narrow-spectrum antibiotic sarecycline, hormonal agents such as spironolactone and combined oral contraceptives, and metformin in patients with polycystic ovary syndrome. Biologic therapies, phosphodiesterase-4 inhibitors, oral probiotics, and novel agents like montelukast and CAMP factor vaccines are also under investigation. These treatments show varying degrees of efficacy and improved safety profiles, but most lack head-to-head comparisons with isotretinoin. CONCLUSION: Several systemic options beyond isotretinoin have emerged, showing potential in specific subgroups or as adjunctive therapies. However, further large-scale comparative studies are needed to define their roles within evidence-based acne management algorithms.
Predictors and Characteristics of Hair Loss Among Users of GLP-1 Receptor Agonists: A Cross-Sectional Analysis.
Argobi Y, Jadaan NS, Alshalhoob HB … +4 more , Alyousef MS, Alotaibi GM, Alwesaibie HS, Alshehri ISM
J Cosmet Dermatol · 2026 Apr · PMID 41914454 · Full text
BACKGROUND: The increasing use of GLP-1 receptor agonists for weight loss and metabolic improvements has led to the recognition of various side effects. One potential, yet underexplored, adverse effect is hair loss. This...
BACKGROUND: The increasing use of GLP-1 receptor agonists for weight loss and metabolic improvements has led to the recognition of various side effects. One potential, yet underexplored, adverse effect is hair loss. This study aims to investigate the frequency, characteristics, and predictors of hair loss in patients using GLP-1RAs. METHODS: This cross-sectional study, conducted uniquely in Saudi Arabia from January to June 2025, involved 254 participants who had used GLP-1RAs (Mounjaro, Ozempic, Saxenda, or Victoza) for weight loss purposes. Data were collected through structured questionnaires, ensuring comprehensive coverage of demographic information, clinical characteristics, and details of hair loss, including timing, severity, and progression. The data analysis was conducted using SPSS v29. RESULTS: A total of 254 participants were included in the study, with the majority being female (71.3%) and an average age of 33.28 ± 9.73 years. Hair loss characteristics by injection type revealed no significant differences in prevalence (p = 0.116). However, severe hair loss was significantly more common in Mounjaro (43.4%) and Saxenda (42.9%) users compared to other groups (p < 0.001). Multivariable logistic regression analysis identified gender, marital status, and injection type as significant predictors of hair loss. Males were less likely to report hair loss compared to females (adjusted OR = 0.36, p = 0.003). Married participants had the highest odds of experiencing hair loss (adjusted odds ratio = 9.94, p = 0.004), and Mounjaro users had significantly higher odds of hair loss compared to the users of other injection types (adjusted odds ratio = 3.02, p = 0.009). The duration of injection use did not significantly predict hair loss, although a trend toward higher odds was noted for those using injections for 6-12 months (adjusted odds ratio = 3.50, p = 0.053). CONCLUSION: Our study highlights the significant side effects of hair loss associated with GLP-1RA therapy, particularly in female patients and those using Mounjaro. Although this type of hair loss is typically non-scarring and reversible, it can lead to psychological distress and affect treatment adherence. These conclusions highlight the need for clinicians to be aware of this potential side effect and to provide appropriate support and guidance to their patients.
A Retrospective Case Series Reporting the Safety of a Polyvinyl Alcohol (PVA) Composite Filler for Facial Augmentation.
Wang WT, Ya ZM, Pu CL … +10 more , Yang F, Yang W, Tao Y, Han C, Zhang XM, Wang SW, Zou MY, Gou LN, Ding BF, Lou X
J Cosmet Dermatol · 2026 Apr · PMID 41913323 · Full text
BACKGROUND: A novel polyvinyl alcohol (PVA)-based filler has been developed for durable facial augmentation. Despite its clinical application, long-term real-world data regarding its safety profile remain limited. OBJECT...
BACKGROUND: A novel polyvinyl alcohol (PVA)-based filler has been developed for durable facial augmentation. Despite its clinical application, long-term real-world data regarding its safety profile remain limited. OBJECTIVE: This study aimed to retrospectively assess the long-term safety profile and clinical outcomes of this PVA-based filler for facial augmentation. METHODS: A multi-center, retrospective case series was conducted across eight aesthetic clinics in China. Medical records of patients who received the PVA-based filler for facial augmentation between January 2022 and January 2025 with a follow-up of at least 18 months were reviewed. Adverse events (AEs) were extracted from the original medical charts and follow-up logs and were classified by time of onset, type, and severity. A post hoc descriptive efficacy assessment using the Global Aesthetic Improvement Scale (GAIS) and FACE-Q was performed on a sub-cohort with complete photographic documentation exceeding 12 months. RESULTS: A total of 279 patient charts were included, with a mean follow-up period of 24.5 ± 7.2 months. Three patients (1.07%) reported at least one AE (totaling 4 events), all of which were early-onset, transient, and mild injection site reactions that resolved spontaneously. No late-onset adverse events were reported in this cohort. The descriptive efficacy analysis (n = 18) demonstrated sustained corrective effects, with a 72.2% improvement rate on GAIS and high patient satisfaction scores on FACE-Q. CONCLUSION: In this retrospective cohort, the PVA-based composite filler demonstrated a low incidence of adverse events, with absence of documented late-onset complications in 279 patients. Descriptive observations of long-term efficacy are encouraging; further prospective, controlled studies are warranted to objectively substantiate its durability and performance.
Trichoscopic Evaluation of the Effectiveness of Topical Stemoxydine for Hair Restoration in Androgenetic Alopecia: A Prospective Pre-Post Single-Arm Exploratory Study.
Elattar YA, Doghem NN, Amin MT … +1 more , Hawwam SA
J Cosmet Dermatol · 2026 Apr · PMID 41909969 · Full text
BACKGROUND: Androgenetic Alopecia (AGA) is a prevalent hereditary disorder leading to hair loss. Stemoxydine, a competitive (Prolyl 4-hydroxylase) inhibitor, may activate Hypoxia-Inducible Factor 1-alpha signaling and sh...
BACKGROUND: Androgenetic Alopecia (AGA) is a prevalent hereditary disorder leading to hair loss. Stemoxydine, a competitive (Prolyl 4-hydroxylase) inhibitor, may activate Hypoxia-Inducible Factor 1-alpha signaling and shorten the hair kenogen phase, potentially increasing hair density as a proposed treatment for AGA. AIMS: This study aimed to evaluate the effectiveness of topical Stemoxydine in the treatment of AGA. PATIENTS AND METHODS: The study included 35 patients with AGA treated with a topical solution of Stemoxydine twice daily for 3 months. Clinical outcomes were evaluated at 6 and 12 weeks using clinical photography, dermoscopy, and digital dermoscopy. The primary endpoint was the percentage of clinical improvement after 12 weeks of treatment application. Dermoscopy and digital image analysis were performed to assess hair growth, density, and diameter. Subgroup analysis compared outcomes between males and females. Adverse events were recorded and evaluated for severity and tolerability. RESULTS: A total of 35 participants (23 females, 12 males) aged 19-45 years (mean ± SD: 29.2 ± 6.98) were enrolled. The mean age was 31.1 ± 7.28 years for females and 25.7 ± 4.87 years for males. A positive family history of alopecia was reported in 62.9% of participants. Baseline alopecia severity included Grade 2 in 25.7%, Grade 3 in 45.7%, and Grade 4 in 28.6% of cases. After 3 months of treatment application, we observed a median clinical improvement of 80% (range: 35%-100%). As per the Quartile Grading Scale, 57.1% of patients demonstrated significant improvement, while 34.3% showed moderate improvement. Statistically significant improvements in AGA grades were observed post-treatment. The dermoscopic evaluation revealed new hair growth in 97.1% of patients by 1.5 months, with digital analysis demonstrating significant increases in both hair density (p < 0.001) and diameter (p < 0.001). Subgroup analysis indicated males achieved significantly more significant clinical improvement (p < 0.001), increased hair density (p < 0.001), and larger diameter (p = 0.02) compared to females. Adverse events were mild and well-tolerated, with the most common being redness (22.9%). CONCLUSION: In conclusion, topical Stemoxydine demonstrated significant clinical benefits in treating AGA, enhancing hair density with minimal adverse effects.
Development and Validation of the Cheek Smoothness Scale: A Photonumeric Assessment Tool for Cheek Skin Texture.
Han HS, Kim BJ
J Cosmet Dermatol · 2026 Apr · PMID 41891283 · Full text
BACKGROUND: Changes in cheek skin texture and surface smoothness are prominent features of facial aging and increasingly targeted by modern aesthetic interventions. However, despite rising demand for minimally invasive a...
BACKGROUND: Changes in cheek skin texture and surface smoothness are prominent features of facial aging and increasingly targeted by modern aesthetic interventions. However, despite rising demand for minimally invasive aesthetic procedures to improve cheek skin quality, validated site-specific photonumeric assessment tools remain limited. AIMS: To develop and validate a novel photonumeric assessment tool, the Cheek Smoothness Scale (CSS), for evaluating cheek skin smoothness and surface texture. METHODS: The CSS was developed as a five-grade photonumeric scale using standardized clinical photographs. Inter- and intra-rater reliability were assessed using Fleiss' and Cohen's kappa statistics based on single-angle (45°) and multi-angle image assessments by five board-certified dermatologists. Construct validity was further examined by objective skin surface roughness measurements (Ra values) obtained using the PRIMOS CR three-dimensional imaging system. RESULTS: The CSS demonstrated excellent inter- and intra-rater reliability, with kappa values consistently in the good-to-very good range. Complete agreement between single- and multi-angle assessments supported the use of the 45° oblique view as a representative angle for evaluating cheek skin texture. CSS grades also showed a progressive increase in PRIMOS-derived Ra values, indicating strong concordance between visually assessed skin smoothness and objectively measured surface roughness. CONCLUSIONS: The CSS is a reliable, reproducible, and clinically meaningful photonumeric scale for assessing cheek skin smoothness and surface texture. By integrating visual assessment with objective validation of surface smoothness, the CSS provides a valuable outcome measure for clinical research and real-world aesthetic practice.
Is Ready-To-Use AbobotulinumtoxinA More Effective Than OnabotulinumtoxinA for Glabellar Lines? A Randomized, Controlled, Triple-Blinded Clinical Trial.
Gonçalves JR, Valesan LF, Shishido ACLN … +4 more , Sanchez-Ayala A, Carbone AC, Câmara-Souza MB, De la Torre Canales G
J Cosmet Dermatol · 2026 Apr · PMID 41889091 · Full text
BACKGROUND: Most commercially available botulinum toxin A (BoNT-A) formulations are lyophilized or vacuum-dried powders requiring reconstitution. Recently a ready-to-use formulation (RTUaboBoNT-A) has been introduced. Al...
BACKGROUND: Most commercially available botulinum toxin A (BoNT-A) formulations are lyophilized or vacuum-dried powders requiring reconstitution. Recently a ready-to-use formulation (RTUaboBoNT-A) has been introduced. Although its efficacy in reducing glabellar lines has been reported, comparative data with powder onabotulinumtoxinA (OnaBoNT-A) remain limited. AIMS: To evaluate the efficacy, durability, and safety of RTUaboBoNT-A compared with OnaBoNT-A for moderate to severe glabellar wrinkles: METHODS: Forty women (25-50 years) were randomly allocated to receive either OnaBoNT-A (n = 20) or RTUaboBoNT-A (n = 20) at equivalent doses in the procerus and corrugator muscles. Outcomes included Electromyography activity (EMG), Merz 5-point glabellar lines scale, FACE-Q satisfaction scores, perceived age and pain intensity (VAS). Assessments were performed at baseline and 1, 2-, 3-, 4- and 5-months post-injection. Statistical analysis included two-way repeated-measures ANOVA with Bonferroni's post hoc, chi-squared tests and independent Student's t-tests. RESULTS: No significant intergroup differences were observed in EMG activity of the assessed muscles across follow-ups (p > 0.05). Glabellar lines severity was comparable between groups at rest and maximum contraction throughout the study (p > 0.05). Higher satisfaction scores were observed at 2-months in the OnaBoNT-A group (p = 0.01). Pain during injection was greater with RTUaboBoNT-A (p = 0.02). No intergroup differences were found in perceived age (p > 0.05). CONCLUSION: The RTUaboBoNT-A demonstrated similar efficacy, durability, and safety profile to OnaBoNT-A for the treatment of glabellar lines. With minor differences in satisfaction and injection disconfort.
Comment on "Efficacy and Safety of Combined Platelet-Rich Plasma With Fractional Laser for Adult Patients With Vitiligo: A Systematic Review and Meta-Analysis of Randomized Controlled Trials".
Pavlović MD
J Cosmet Dermatol · 2026 Apr · PMID 41884884 · Full text
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Multimodal Approach for Recalcitrant Melasma Using Picosecond Laser and Topical JAK Inhibition: A Case Report.
Ashkanani H, AlZaabi M, AlRasheed A … +1 more , AlDaraji W
J Cosmet Dermatol · 2026 Apr · PMID 41883035 · Full text
BACKGROUND: Melasma is a chronic hyperpigmentation disorder with high relapse rates, particularly in Fitzpatrick skin types III-V. Increasing evidence implicates cytokine-driven inflammation and visible light-induced mel...
BACKGROUND: Melasma is a chronic hyperpigmentation disorder with high relapse rates, particularly in Fitzpatrick skin types III-V. Increasing evidence implicates cytokine-driven inflammation and visible light-induced melanogenesis as key contributors to disease persistence. These mechanisms support the rationale for exploring a multimodal therapeutic approach. CASE PRESENTATION: A woman in her early 30s with phototype IV presented with a 5-year history of recalcitrant centrofacial melasma. Previous treatments-including hydroquinone, oral tranexamic acid, and superficial chemical peels-produced only transient and incomplete improvement. Baseline Melasma Severity Index (MSI) score was 7.9, consistent with moderate-to-severe disease. INTERVENTION: Treatment consisted of low-fluence picosecond 755 nm alexandrite laser, short-term topical corticosteroid post-procedure, initiation of topical tofacitinib 2% cream twice daily for 11 months, and continuous iron oxide-based visible light-blocking photoprotection. Laboratory monitoring during therapy remained normal. OUTCOME: At 11 months, the patient achieved near-total clearance with an MSI reduction from 7.9 to 0.10 (98.7% improvement). No adverse events, post-inflammatory hyperpigmentation, or relapse were observed, including 3 months after treatment cessation. CONCLUSION: This case illustrates the potential clinical value of combining pigment-targeted picosecond laser therapy with topical JAK inhibition and visible light-specific photoprotection for recalcitrant melasma. The durable remission achieved supports further investigation into anti-inflammatory and photoreactive pathway modulation as adjunctive strategies in melasma management.
BIO3 Protocol: Clinical and In Vitro Evidence of Triple Biostimulation With CaHA and P (LA/CL) Threads.
Tonon L, Alves MO, Viana R
J Cosmet Dermatol · 2026 Apr · PMID 41881670 · Full text
BACKGROUND: Facial aging involves progressive deterioration of the extracellular matrix (ECM), volume loss, and structural sagging. Minimally invasive strategies like absorbable threads provide mechanical support and bio...
BACKGROUND: Facial aging involves progressive deterioration of the extracellular matrix (ECM), volume loss, and structural sagging. Minimally invasive strategies like absorbable threads provide mechanical support and biostimulation, but their efficacy may be compromised in patients with poor dermal quality. Calcium Hydroxyapatite (CaHA) is a well-documented biostimulator that enhances collagen and elastin synthesis. This study explored whether combining CaHA with P (LA/CL)-based absorbable threads could synergistically improve ECM remodeling and clinical outcomes. AIMS: To evaluate the biological and clinical effects of the BIO3 protocol-sequential biostimulation with CaHA and P (LA/CL) threads-by integrating in vitro gene expression analysis and retrospectively collected clinical outcomes. PATIENTS/METHODS: An in vitro model of full-thickness human skin was used to assess COL1A1, COL3A1, and ELN expression after treatment with CaHA, P (LA/CL) threads, or both. A retrospective clinical study was also conducted with 11 female patients aged 35-65 undergoing facial rejuvenation with threads alone (n = 6) or preceded by CaHA (n = 5). Clinical outcomes were assessed using GAIS, WSRS, facial laxity scores, ultrasound imaging, and satisfaction questionnaires at multiple timepoints. RESULTS: Combined in vitro treatment resulted in significantly higher upregulation of ECM-related genes compared to monotherapies. Clinically, all patients showed aesthetic improvement. The CaHA/P (LA/CL) group demonstrated greater dermal and subcutaneous thickening and higher GAIS ratings at D120. Patient satisfaction reached 100% in both groups by D30 and remained stable. No adverse events were reported. CONCLUSIONS: The BIO3 protocol-combining CaHA and P (LA/CL) threads-showed promising synergistic effects on ECM remodeling and aesthetic outcomes. These findings support the rationale for layered and sequential biostimulation strategies in clinical practice.
Treatment of Melasma Targeting Dermal-Epidermal Interactions Utilizing High-Intensity, High-Frequency Parallel Ultrasound Beam in Asian Skin.
Oku K
J Cosmet Dermatol · 2026 Apr · PMID 41881668 · Full text
BACKGROUND: Melasma is a multifactorial disorder, and while treatments aimed at suppressing melanin production and removing excess melanin have demonstrated some efficacy, no definitive therapy has yet been established....
BACKGROUND: Melasma is a multifactorial disorder, and while treatments aimed at suppressing melanin production and removing excess melanin have demonstrated some efficacy, no definitive therapy has yet been established. Dermal aging is widely recognized as a contributing factor in melasma, and previous studies have demonstrated that the presence of senescent fibroblasts reduces the efficacy of melasma treatments. Therefore, treatment strategies focused on reactivating fibroblast activity are anticipated to be effective against melasma. OBJECTIVE: The objective of this study is to investigate the safety and efficacy of the Thermal-Thread Technique, which utilizes high-intensity, high-frequency parallel ultrasound beams for the treatment of melasma among Asian subjects. STUDY DESIGN/METHODS: Patients diagnosed with melasma, regardless of disease type, duration, or Fitzpatrick skin type, underwent a single treatment session covering the entire face utilizing a high-intensity, high-frequency parallel ultrasound beam with Thermal-Thread Technique. High-resolution skin images were captured using a skin analyzer before treatment and six months after the treatment. Two independent evaluators assessed these images using the modified Melasma Area and Severity Index (mMASI) scoring system to objectively evaluate treatment efficacy. Statistical analyses of the mMASI scores were performed using paired t-tests. All potential side effects were carefully monitored both during and after the procedure. RESULTS: All patients (n = 20, female, mean age: 50.5 ± 5.7) completed the study. The distribution of Fitzpatrick skin types among participants was as follows: type II (n = 7), type III (n = 11), and type IV (n = 2). The mean mMASI score significantly decreased from 4.63 ± 1.66 at baseline to 1.69 ± 0.90 six months post-treatment (p = 1.53e-9; p < 0.001). No statistically significant difference was observed among FST groups (F(2,17) = 1.68, p = 0.216). No side effects were observed or reported during or after the treatment period. CONCLUSION: The improvement in mMASI scores observed with the Thermal-Thread Technique, utilizing a high-intensity, high-frequency parallel ultrasound beam, demonstrates its potential as an effective treatment for melasma. Further research is necessary to evaluate its efficacy in more severe cases, extend the observational period, and investigate the potential benefits associated with multiple treatment sessions.
Dissolving Hyaluronic Acid Filler: The Diffusion Barrier to Hyaluronidase Efficacy.
Murray G, Khoshnaw S, Velthuis P
J Cosmet Dermatol · 2026 Apr · PMID 41877604 · Full text
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