Molluscum Dermatitis in a One-Year-Old Male Child - A Good Prognostic Sign of Self Resolution
Cryolipolysis for Fat Reduction: A Case Report
EXECUTIVE EDITOR & PUBLISHER
Dom Daniel CORPORATE OFFICE
22, Shreeji Bhavan, 275-279, Samuel Street, Masjid Bunder (W), Mumbai-4000 03, INDIA.
EMAIL: theaestheticiansjournalindia@gmail.com
Website: theaestheticiansjournal.com
TEL: +91 22 2345 1404 +91 22 2345 5844
Printed, Published, Edited and Owned by Dom Daniel
Printed at Swastik Printer, Gala No.9 & 10, Vishal Industrial Estate, Bhandup (West), Mumbai- 400078. Published at 22 Shreeji Bhavan, 275/279, Samuel Street, Masjid Bunder (West), Mumbai - 400003. India.
“The Aestheticians Journal” takes no responsibility for unsolicited photographs or material
ALL PHOTOGRAPHS, UNLESS OTHERWISE INDICATED, ARE USED FOR ILLUSTRATIVE PURPOSE ONLY.
Views expressed in this Journal are those of the contributors and not of the publisher. Reproduction in whole or in parts of texts or photography is prohibited. Manuscripts, Photographs and art are selected at the discretion of the publisher free of charge (advertising excluded). Whether published or not, no material will be returned and remains the property of the publishing house, which may make use of it as seen fit. This may include the withdrawal of publication rights to other publishing houses.
All rights reserved. Reproducing in any manner without prior written permission prohibited.
Published for the period of July -2024
The Growing Influence of Dermatology in Today's World
In the ever-evolving landscape of medical science, dermatology has emerged as a field experiencing significant growth and transformation. In recent years, the field of dermatology has seen a remarkable surge in interest and importance. The increasing prevalence of skin conditions, the growing awareness of skin health, and the advancements in dermatological treatments have collectively contributed to this trend. Today, more than ever, individuals are prioritizing their skin health. With increasing awareness of environmental factors, lifestyle choices, and the pursuit of youthful appearance, dermatologists play a pivotal role in guiding patients.
Technological advancements in dermatological treatments, including laser therapy, biologics, and minimally invasive procedures, have revolutionized patient care. These advancements not only enhance the efficacy of treatments but also reduce recovery times and improve patient outcomes. Cosmetic dermatology boom, the desire for aesthetic enhancement has driven the growth of cosmetic dermatology. Dermatologists play a pivotal role in educating the public about the dangers of excessive sun exposure and the importance of regular skin checks. Continuous research in dermatology has led to a deeper understanding of various skin conditions and the development of new treatments. The combination of increased awareness, technological innovation, and a broader acceptance of cosmetic procedures ensures that dermatology will continue to rise as a vital and dynamic field within medical science.
In this issue, we delve into various condition of dermatology like Acne Cosmetica, Microneedling RF for Acne Scar, Cryolipolysis for Fat Reduction and Molluscum Dermatitis We hope our readers gain valuable insights and a deeper appreciation for the critical role dermatology plays in today's world.
HOPE YOU HAVE A GREAT READ
Thanks & Cheers
- Dom Daniel
Executive Editor & Publisher
The A Rising Trend in Today's World– Acne Cosmetica
Dr. Raj Kirit E. P, DNB, DDVL (KMC) Chief Dermatologist
Dr. Saketha Ananthula, MBBS (OMC), MD, DVL (GMC)
Md Fida Hossain, Research Fellow
Microneedling RF for Acne Scar
Dr. Shraddha Sonanis, MBBS, DNB (Dermatology)
Molluscum Dermatitis in a One-Year-Old Male ChildA Good Prognostic Sign of Self Resolution
Dr. R. Rajesh, MD, DNB
Dr. V. Mohankumar, MD
Dr. Dr. K. Revathi, MD, DVL
Dr. K. G. Srinivasahan, DD, Senior Resident
Dr. B. R. Balamurugan, DDVL, Senior Resident
Dr. D. Devi, MD, DVL, 3rd Year Resident
Cryolipolysis for Fat Reduction: A Case Report
Dr. Rashmi Soni, MD, DDV, DNB
Editorial Board
Dr. Raj Kirit E . P.
DNB, DDVL (KMC)
Chief Dermatologist, Cosmetologist, Trichologist and Hair Transplant Surgeon, Celestee Skin, Laser and Hair Clinic, Filmnagar and Kokapet, Hyderabad
Dr. Saketha Ananthula
MBBS (OMC), MD, DVL (GMC)
Consultant Dermatologist, Cosmetologist and Trichologist, Celestee Skin, Laser and Hair Clinic, Filmnagar and Kokapet, Hyderabad
Dr. Shraddha Sonanis
MBBS, DNB (Dermatology)
Consultant Dermatologist
Revive Skin Clinic and Laser Centre Nashik, Maharashtra
Dr. R. Rajesh
MD, DNB
Department of Dermatology, Venereology, Leprology, Government Erode Medical College and Hospital, Perundurai Sanatorium, Erode, Tamil Nadu
Dr. Rashmi Soni
MD, DDV, DNB
Founder and Consultant Dermatologist, Cosmetologist and Dermatosurgeon Skinsure Clinic, Pune
Consultant Dermatologist, KEM Hospital, Pune
Dr. V. Mohankumar
MD
Associate Professor
Department of Dermatology, Venereology, Leprology, Government Erode Medical College and Hospital, Perundurai Sanatorium, Erode, Tamil Nadu
Dr. K. Revathi
MD, DVL
Assistant Professor Department of Dermatology, Venereology, Leprology, Government Erode Medical College and Hospital, Perundurai Sanatorium, Erode, Tamil Nadu
Dr. K. G. Srinivasahan
DD, Senior Resident Department of Dermatology, Venereology, Leprology, Government Erode Medical College and Hospital, Perundurai Sanatorium, Erode, Tamil Nadu
Dr. B. R. Balamurugan
DDVL, Senior Resident Department of Dermatology, Venereology, Leprology, Government Erode Medical College and Hospital, Perundurai Sanatorium, Erode, Tamil Nadu
Dr. D. Devi
MD, DVL, 3rd Year Resident Department of Dermatology, Venereology, Leprology, Government Erode Medical College and Hospital, Perundurai Sanatorium, Erode, Tamil Nadu
Md Fida Hossain
Research Fellow
Celestee Skin, Laser and Hair Clinic, Filmnagar and Kokapet, Hyderabad
Advisory Board
Dr. Arun Kumar
Dr. Shaymalendu Chakraboty
Dr. Satyabratha Tripathy
Dr. Malay Halder
Dr. Shibasankar Bhattacharya
Dr. Uttam Kumar Lenka
Dr. C H Neelima
Dr. Uzma Fathima
Dr. Prathyusha P.
Dr. Kiran Raju
Dr. Roopashree M.
Dr. KVT Gopal
Dr. Neetu Choudhary
Dr. Vinayak V.
Dr. D. Srinivas
Dr. P. Rambabu
Dr. Amruta Dinkar
Dr. Kavya K.
Dr. Mallesh U.
Dr. Ambresh Badad
Dr. Nagaraj E.
Dr. Manjunath Hulmani
Dr. P. Ranganath
Dr. Haritha M.
A Rising Trend in Today's World–Acne Cosmetica
Dr. Raj Kirit E . P
DNB, DDVL (KMC)
Chief Dermatologist, Cosmetologist, Trichologist and Hair Transplant Surgeon, Celestee Skin, Laser and Hair Clinic, Filmnagar and Kokapet, Hyderabad
Dr. Saketha Ananthula
MBBS (OMC), MD, DVL (GMC)
Consultant Dermatologist, Cosmetologist and Trichologist, Celestee Skin, Laser and Hair Clinic, Filmnagar and Kokapet, Hyderabad
Md Fida Hossain
Research Fellow
Celestee Skin, Laser and Hair Clinic, Filmnagar and Kokapet, Hyderabad
Abstract
Background: Acne vulgaris is the most common skin disease affecting late adolescents across the globe. The most common cause of acne vulgaris is an increase in sebum production or a change in sebum components which results in the clogging of pores. Acne cosmetica, a type of acne linked to cosmetic usage, is characterized by persistent mild breakouts and occurs due to the complex interplay between sebum and trapped comedogenic products in cosmetics. Recently there have been an increasing number of studies
linking cosmetic usage to the development of acne. Here we report two cases of the post-pubertal age group that have developed acne after using cosmetics for fairness and beauty.
Case Report 1: A 26-yearold male patient came with complaints of pimples on the cheek and forehead for five months that developed after using fairness serum for two months. On examination, multiple open and closed comedones with sparse papules and pustules were present over the cheek
and forehead. Based on the chronological history of cosmetic usage, and typical clinical findings of predominant comedones aided by dermoscopy, the diagnosis of Acne cosmetica was made.
Case Report 2: A 31-yearold female came with complaints of bumps over the forehead for three months that developed following the usage of cosmetic cream for five months. On examination, there are multiple comedones over the forehead. Based on the chronological history and typical clinical findings, the diagnosis of Acne cosmetica was made.
Discussion: Acne is a chronic inflammatory skin disorder of the sebaceous glands of the hair follicle. Acne cosmetica is a variant of acne associated with chronic usage of cosmetics containing potentially comedogenic substances and their complex interplay with sebum. The term comedogenicity refers to the potential of various agents to promote abnormal keratinization (hyperkeratinization) and desquamation of follicular epithelium. The comedogenic ingredients in cosmetics include D&C Pigments, Benzaldehyde, Isopropyl isostearate, Lanolin, Isopropyl Myristate, cetyl alcohol, stearic acid, etc.
Conclusion: As we see the increasing prevalence rates of acne cosmetica, the need of the hour here on dermatologists and patients
is to understand and select appropriate, well-tolerated, and non-comedogenic cosmetics containing active ingredients that help to eradicate acne.
Acne vulgaris is the most common skin disease affecting late adolescents across the globe. It is multifactorial in its causation, the most common cause is an increase in sebum production and secretion or a change in sebum components, which results in the clogging of pores.1 Given the rise of acne diagnosis, not only in teenagers but also across multiple nationalities and races, dermatologists need to understand the basic pathogenesis and most importantly investigate new exacerbating factors that may not have been previously associated with acne epidemiology.
For many years, it has been speculated that cosmetic products are implicated in the pathogenesis of acne. Acne cosmetica is a type of acne that occurs after the usage of cosmetics and is characterized by persistent mild breakouts. It occurs due to the complex interaction between sebum and trapped comedogenic products in cosmetics. Of late, there have been an increasing number of studies linking cosmetic usage to the development of acne. However, this association is difficult to
establish, as both the incidence of acne and the use of cosmetics have steadily increased over time.
Currently, we are witnessing a new spurt in skincare trends and it has become a routine for all classes of individuals. While cosmetics can damage the skin when used regularly and aggressively, noncomedogenic products applied with caution and in moderate amounts may conceal scars and blemishes, helping to increase the selfesteem of adolescents struggling with skin problems.2 There is a pressing need for dermatologists and patients to select appropriate, well-tolerated, and noncomedogenic cosmetic products containing active ingredients that help to eradicate acne.
Here we report two cases of the post-pubertal age group who have developed acne after using cosmetics for fairness and beauty.
Case Reports:
Case 1. A 26-year-old male patient came with complaints of pimples on the cheeks and forehead for five months. There is a history of application of a fairness serum containing aloe vera extract which was procured online for two months, before the onset of these lesions. The aggravation of pimples was noticed in the continuation of the serum. He had a history of acne during his adolescence which has not erupted for the past five years. On examination, there are multiple open and
closed comedones, with few papules and pustules, scars from previous acne distributed predominantly over his forehead and cheeks (figure 1). The dermoscopic examination confirmed the presence of comedones (figure 2). Based on the chronological history of cosmetic usage before the onset of lesions and typical clinical findings of predominant comedones that have not erupted for the past 5 years, the diagnosis of Acne cosmetica was made.
1: Multiple comedones and few papules over the cheeks and forehead of 26-year-old male
2
Case 2. A 31-year-old female patient came with complaints of small bumps over the forehead for three months (figure 3). There is a history of application of a cosmetic cream containing cetyl alcohol for the past five months. Her history revealed that she never had any similar eruption during her adolescence. On examination, there are multiple comedones over the forehead. Based on the chronological history and typical clinical findings of comedones, the diagnosis of Acne cosmetica was made.
3: Multiple
Discussion
Acne is the term derived from the Greek word “ACME” meaning “the prime of life”. Acne vulgaris is the most common skin disease affecting teenagers. According to the global burden of disease study approximately 85% of young adults between the age of 12 to 25 are afflicted by acne vulgaris. The prevalence of adolescent acne has been reported to range between 81% to 95% in males and 79% to 82% in females.
Acne is a chronic inflammatory disorder of
the sebaceous glands of the hair follicle. It is caused by a cascade of different events, subsequently leading to the formation of micro comedones and eventually papulopustular eruption. The most common cause of acne vulgaris is an increase in sebum production and secretion or a change in sebum components. Excessive sebum secretion is caused by the enlargement of sebaceous glands due to an increase in levels of androgens (DHEAs) during the prepubertal period. This makes the skin appear shiny and eventually leads to the formation of a hardened plug or comedone.3 Acne can also be triggered by the change in sebum composition i.e. when there is an imbalance between the ratio of monounsaturated fatty acids to total fatty acids. The ratio of triglyceride to wax esters is notably higher in the sebum of individuals with acne. Hormonal imbalance triggers the excessive production of sebum which when combined with dead skin cells promotes the development of acne. Propionibacterium acnes, a skin colonizing bacterium, is highly responsible for inducing inflammatory acne by increasing the secretion of sebum leading to a mounted immune response via the production of proinflammatory mediators like interleukins.
Acne vulgaris can be further divided into non-inflammatory and inflammatory acne. Non-inflammatory acne is composed of white
Figure
Figure
: Multiple comedones seen in dermoscopic picture of 26-year-old male
Figure
comedones over the forehead of a 31-year-old female
heads (open comedones) and blackheads (closed comedones) subsequently followed by inflammatory acne composed of painful red elevated lesions (papules), pus-filled lesions (pustules), and at times with painful red cystic lesions (nodulocystic acne) that often cause scarring over time.
Acne cosmetica is a variant of acne associated with chronic usage of cosmetics containing potentially comedogenic substances. It occurs due to the complex interaction between sebum and trapped comedogenic products in cosmetics. While acne vulgaris usually disappears in adulthood, acne cosmetica may appear at any age. The eruption of acne cosmetica is characterized by persistent mild breakouts comprising comedones along the forehead, neck, and scalp. Occasionally papules and pustules may be seen but they are far less common.
Dermatological products refer to topical prescriptions, overthe-counter medications, or cosmetic products applied to the human body for treating, cleansing, beautifying, promoting attractiveness, or altering the appearance without affecting body structure or functions. However, they can be the cause of skin disorders of varying severity, namely irritation, folliculitis, contact dermatitis, photosensitization, and comedone formation.
Traditionally dermatologists have advised individuals with oily skin to refrain from using
moisturizers, foundations, and other personal care items containing comedogenic oil-based products which are thick and creamy in consistency as they may clog the pores.
The term comedogenicity refers to the potential of various agents to promote abnormal keratinization (hyperkeratinization) and desquamation of follicular epithelium.4 These abnormalities lead to a partial (open comedones or blackheads) or complete (closed comedones or whiteheads) i.e. obstruction of the pilosebaceous unit and accumulation of sebum. The comedogenic potential of dermatological products has been documented since 1972 by Kligman AM and Mills OH.4
Below is a list of comedogenic ingredients in dermatological products:
1. D&C fluorescein-based dyes add colour to cosmetics especially found in blushes and bronzers, which explains the predominance of cosmetic acne in the cheekbone area
2. Algae extract found in some concealers and moisturizers
3. Benzaldehyde is an added fragrance in cosmetics and skin care products
4. Numerous silicone variations create a silkysmooth feel and are found in beauty products, especially sunscreens, deodorants, primers, and leave-in hair styling products
5. Isopropyl Isostearate is an emollient found in many lotions and skin care products
6. Isopropyl Myristate
7. Lanolin
8. Cetyl alcohol
9. Stearic acid etc.
Below is a list of ingredients used in alleviating as well as preventing acne:
1. Salicylic acid exfoliates the stratum corneum and has comedolytic properties that make it a useful peeling agent for acne. It also disrupts cellular junctions without lysing intercellular keratin filaments.5
2. Hyaluronic acid (HA), a glycosaminoglycan is known for its tendency to keep skin plump and supple due to its humectant capabilities, while preventing acne breakouts.
3. Retinol has a molecular structure small enough to penetrate the skin into the deep layers to interact with collagen and elastin. It also binds to specific proteins in the nucleus of skin which allows it to influence the transcription of many genes.6 The overall effect of retinol includes, but is not limited to correction of skin pigmentation, a decrease in the appearance of fine lines and wrinkles due to increased collagen synthesis, and reduction of sun damage and inflammation. It can also be used for the treatment of hyperpigmentation resulting from acne.
4. L-ascorbic acid interacts with copper ions at the
tyrosinase active site and inhibits the action of the enzyme tyrosinase, thereby decreasing melanin formation and resulting in decreased hyperpigmentation. Vitamin C has been known to stimulate the synthesis of collagen by stimulating lipid peroxidation. The byproduct of this stimulation, malondialdehyde, in turn, stimulates collagen gene expression. Vitamin C also activates the transcription of collagen synthesis.
5. Sodium sulfacetamide 10% sulfur 5% (SSS) is an emollient in face wash and cleanser. It works by stopping the growth of certain bacteria on the skin including Propionibacterium acnes.7
Conclusion
Firstly, today’s changes in lifestyle like irregular diet, pollution, stress, and hormonal changes are directly affecting the skin. These cause many skin diseases and the most common among them is Acne. Secondly, the selfcare routine has become a norm for every individual to mask skin problems and beautify the skin. But a pressing concern here is that people follow the erratic, random suggestions driven by commercial intent or given by social influencers who have meager knowledge and expertise in dermatological problems and their treatments. These all factors have culminated and led to an increased prevalence of Acne cosmetica. Remarkably, the biggest skincare trend that has been in the spotlight and will be in the future is SKIN KINDNESS.
Hence, we conclude from this discussion, that the need of the hour here on dermatologists and patients is to understand and choose appropriate, well-tolerated, and non-comedogenic cosmetic products containing active ingredients that help to eradicate acne.
References
1. Li X, He Congfen, Chen Z, Zhou C, Gan Y, Jia Y. A review of the role of sebum in the mechanism of acne pathogenesis. Journal of Cosmetic Dermatology. 2017;16(2):168-173.
2. Murakami-Yoneda Y, Hata M, Shirahige Y, Nakai K, Kubota Y. Effects of Makeup Application on Diverting the Gaze of Others from Areas of Inflammatory Lesions in Patients with Acne Vulgaris. Journal of Cosmetics, Dermatological Sciences and Applications. 2015;5(2):134-141.
3. Zaenglein AL, Pathy AL, Schlosser BJ, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016; 74:945.
5. Arif T. Salicylic acid as a peeling agent: a comprehensive review. Clin Cosmet Investig Dermatol. 2015;455–461.
6. Rigopoulos D, Ioannides D, Kalogeromitros D, Katsambas AD. Comparison of topical retinoids in the treatment of acne. Clin Dermatol. 2004;22(5):408-411.
7. Del Rosso JQ. The use of sodium sulfacetamide 10%-sulfur 5% emollient foam in the treatment of acne vulgaris. J Clin Aesthet Dermatol. 2009;2(8):26–29.
Microneedling RF for Acne Scar
Dr. Shraddha Sonanis
MBBS, DNB (Dermatology)
Consultant Dermatologist
Revive Skin Clinic and Laser Centre
Nashik, Maharashtra
Introduction
Acne is a common skin condition characterized by the appearance of pimples, blackheads and whiteheads on the face, neck, chest and back, caused by the overproduction of oil in the skin and the buildup of bacteria. Acne scarring is the most common concern for many people with acne, which can take several forms, such as ice pick scars (deep, narrow, resembling the shape of an ice pick), boxcar scars (round or oval, with sharp edges), keloid scars (raised scars extending beyond the original wound) and rolling scars (wave-like appearance, caused by bands of scar tissue under the skin). The type of scarring will depend on the severity and duration of the acne, as well as the individual's skin type. In some cases, hyperpigmentation, discoloration of the skin can occur due to increase in melanin production. Microneedling fractional radiofrequency (MFR) is a promising technique for the management of atrophic acne scars which works by creating controlled thermal zones in the deeper layers of the skin
without directly injuring the epidermis, unlike ablative lasers that can cause damage to the epidermis. The MFR device used for this purpose delivers radiofrequency energy through insulated microneedles, that penetrate the skin and create microscopic channels to induce a controlled injury in the reticular dermis, triggering a wound healing response. The thermal energy delivered stimulates the production of new collagen and elastin fibers, leading to dermal thickening and remodeling over time. The long-term dermal remodeling process, including neoelastogenesis (production of new elastin) and neocollagenogenesis (production of new collagen), helps to improve the appearance of atrophic acne scars. By stimulating the synthesis of these structural proteins, MFR promotes skin regeneration and helps fill in the depressions caused by the scars.1,2,3
Case report
A 27-year-old female patient with a history of moderate to severe acne presented
with atrophic scars on both cheeks. The scars were characterized by irregular texture and depressions. The patient had previously tried topical treatments with limited success. The acne scars on her cheeks, which significantly impacted her self-esteem. She visited our department because the acne lesions on her cheeks did not improve. A series of microneedling RF sessions were performed and the outcomes were assessed in terms of scar improvement and patient satisfaction. The patient underwent a series of six microneedling RF sessions, each spaced four weeks apart. A specialized device delivering controlled RF energy through microneedles was used. Topical anesthesia was applied to minimize discomfort during the procedure. Objective assessment included standardized photographs and subjective evaluation was based on the patient's selfreported satisfaction. After the completion of the treatment series, the patient exhibited a noticeable improvement in scar texture and depth. Objective measurements also revealed a reduction in scar severity. The patient was followed up for three months post-treatment. No significant adverse effects were reported. The patient expressed a high level of satisfaction with the outcomes, reporting improved confidence and quality of life. Microneedling RF appears to be a valuable intervention for atrophic acne scars, as demonstrated in this case. Informed consent
was obtained from the patient for reproduction of the clinical findings for publication.
Before treatment
Figure 1: Acne scars on cheeks
After treatment
Diagnosis
Diagnosing acne scars is typically done through a visual examination by a dermatologist or a healthcare professional. Here are some common types of acne scars that may be diagnosed:
1. Ice Pick Scars: These are deep, narrow scars that extend into the dermis. They resemble small, V-shaped pits.
2. Boxcar Scars: Boxcar scars are broad, rectangular depressions with sharply defined edges. They give the skin a pitted appearance.
3. Rolling Scars: Rolling scars create a wave-like texture on the skin. They are usually shallow and have sloping edges.
4. Hypertrophic Scars: Unlike most acne scars that result from a loss of tissue, hypertrophic scars are raised and result from an excess of collagen during the healing process.
5. Keloid Scars: Keloid scars are thick, raised scars that extend beyond the boundaries of the original acne lesion. They result from an overproduction of collagen.
To determine the best treatment approach, a dermatologist will assess the type and severity of the scars. Additionally, they may consider factors such as skin type, overall health and any previous treatments that have been attempted. Some common diagnostic methods and tools include:
1. Visual Examination: Dermatologists will carefully examine the skin to identify the type and extent of acne scarring.
2. Photography: Photographs may be taken to document the appearance of the scars and to track changes over time.
Microneedling
3. Skin Biopsy:
In some cases, a skin biopsy may be performed to analyze the skin tissue and help confirm the diagnosis.4,5,6
Treatment
Treatment options for acne scars include application of over-the-counter topical creams containing retinoids, alpha hydroxy acids or hydroquinone can help to reduce the appearance of acne scars by promoting collagen production and encouraging new skin cell growth. Chemical peels uses an acid solution to remove the top layers of skin, revealing smoother, clearer skin underneath. Dermabrasion (uses a rotating wire brush), laser resurfacing (uses laser beam) helps to remove the top layers of skin, promoting the growth of new collagen and improving the appearance of scars. Punch techniques, removes the scar tissue and then stitches the skin closed. Dermal fillers can be used to fill in indented scars and improve their appearance. In some cases, a combination of treatments can be used for best results. Scarring can be permanent and some treatments may require multiple sessions to see the desired improvement and results may vary from person to person. Microneedling with RF also known as collagen induction therapy uses tiny needles to create controlled micro-injuries in the skin, which triggers the body's natural healing response, resulting in the production of collagen and elastin. When RF energy is added to microneedling,
it heats the deeper layers of the skin, which can further stimulate collagen production and improve the appearance of acne scars. The procedure is typically performed using a device called a dermaroller, which has multiple needles of varying lengths. The needles create small channels in the skin that allow for the absorption of topical products, such as growth factors and antioxidants, which can enhance the healing process. It also helps to reduce the appearance of fine lines and wrinkles, hyperpigmentation and sun damage. The treatment typically requires multiple sessions to achieve the desired results and may cause some redness and swelling in the treated area. Microneedling with RF is generally considered safe and has few side effects. Additionally, some people may experience an allergic reaction to the RF energy, so it's important to consult with a qualified healthcare provider before undergoing this treatment. One of the innovative approaches is the use of fractional microneedling radiofrequency (FMRF) which delivers RF energy through a fraction of the needles, allowing for a more targeted and precise treatment of acne scars causing less damage to the surrounding skin and result in less downtime compared to traditional microneedling with RF. Another innovative approach is the use of a combination therapy of microneedling with RF and platelet-rich plasma (PRP). PRP is derived from a patient's own blood and
is rich in growth factors that can enhance the healing process. This approach can improve the overall results of the treatment and help to reduce the appearance of acne scars. Moreover, there are also new devices that are using the combination of microneedling and RF with other technologies like ultrasound and LED light which can enhance the results of the treatment and decrease the downtime of the procedure.7,8,9,10
Efficacy of Microneedling with Radiofrequency for acne scar
MRF may cause some side effects, such as redness, swelling and itching which subsides within a few days of the treatment. Several studies have reported positive results when using microneedling with RF for acne scars. A study published in the Journal of Clinical and Aesthetic Dermatology in 2018, carried out in 20 patients found that a series of microneedling with RF treatments led to significant improvement in the appearance of acne scars, including a reduction in scar depth and width, erythema, and improvement in skin texture and tone. A similar study was published in the Journal of Cosmetic and Laser Therapy in 2016, evaluating safety and efficacy of MFR device in treating acne scars in 40 patients. The study found that the treatment was safe and welltolerated, and resulted in significant improvement in the appearance of acne scars, with a reduction in scar depth
and width, and improvement in skin texture and tone. However, it is important to note that the results may vary depending on the type and severity of the scarring. It has to be noted that results may vary from person to person, and multiple sessions may be needed for optimal results. Additionally, combination therapy with other modalities may be more effective. It is always best to consult with a board-certified dermatologist or plastic surgeon before undergoing any treatment, as they can recommend the best treatment plan for you based on the type and severity of scars.11,12,13
Discussion
Microneedling RF (radiofrequency) is a cosmetic procedure that uses a device with fine needles to create tiny punctures in the skin. These punctures trigger the body's natural healing process, which leads to the production of collagen and elastin. At the same time, the device uses radiofrequency energy to heat the deeper layers of the skin, which can further improve skin tone and texture. The procedure is often used to treat fine lines and wrinkles, acne scars, hyperpigmentation, age spots, loose and damaged skin, sun damage, uneven skin tone and other skin imperfections. It is generally considered safe and effective, but as with any cosmetic procedure, there is a risk of side effects, such as redness and swelling. It is not recommended for individuals with certain skin conditions or are on certain
medications or for people with dark skin, as it can cause hyperpigmentation. The procedure is well-tolerated by most people and has minimal risk of complications. A study published in the Journal of Cutaneous and Aesthetic Surgery found that microneedling RF was effective in improving the appearance of acne scars, with a significant improvement in the overall appearance of the skin. Multiple sessions may be required to achieve the desired results and results may vary from person to person hence it is always recommended to consult with a licensed aesthetician or dermatologist to discuss if microneedling RF is the right treatment for acne. While ablative and non-ablative laser skin resurfacing have improved the treatment of atrophic acne scars, they are not without disadvantages. Ablative lasers, such as CO2 and Er:YAG lasers, have demonstrated efficacy in treating acne scars, but they can be associated with prolonged erythema (redness) for more than 3 months, dyspigmentation (changes in skin pigmentation) and scarring. Non-ablative lasers, such as 1064 nm Nd YAG and 1450 nm diode lasers, have shown efficacy of around 40-50% after a series of treatments. However, their effects are primarily observed on shallow box scars, with limited improvement in the epidermal layer of the skin. In contrast to ablative and nonablative lasers, microneedling fractional radiofrequency (MFR) treatment offers a
level of control by allowing adjustment of the needle depth. This allows for targeted treatment at specific depths of the skin, addressing the different types of atrophic acne scars. The advantage of MFR is that the treatment depth can be adjusted based on the specific type and severity of the acne scars. This allows for a customized approach, targeting different layers of the skin where the scars are located. It offers a safe and effective treatment option with minimal risk of post-inflammatory hyperpigmentation and scarring compared to ablative lasers. However, the efficacy of MFR for grade 3 acne scars with erythema may vary depending on individual factors and the specific characteristics of the scars and provide personalized recommendations for the best treatment plan.3,14
Conclusion
MRF is a safe and effective treatment for acne scars that works by creating small punctures in the skin, which triggers the body's natural healing process and leads to the production of collagen and elastin. At the same time, the radiofrequency energy heats the deeper layers of the skin, which can further improve skin tone and texture. A number of studies have shown that microneedling RF is effective in improving the appearance of acne scars, with a significant improvement in the overall appearance of the skin. However, it's important to note that the procedure may require multiple sessions
Microneedling RF for Acne Scar
to achieve the desired results and results may vary from person to person. One of the advantages of MFR is its ability to target the deeper layers of the skin without causing significant damage to the epidermis. This results in shorter recovery times and a lower risk of post-inflammatory hyperpigmentation compared to ablative lasers. The efficacy of MFR for acne scars may vary depending on factors such as the severity of the scars, individual skin response and the skill of the practitioner performing the procedure. Multiple treatment sessions are usually required to achieve optimal results and the treatments are typically spaced several weeks apart to allow for proper healing and collagen remodeling. Consultancy with a qualified dermatologist or aesthetic specialist to assess specific condition and determine if MFR is suitable for is essential.
to Improve Outcomes in Acne.” J Am Acad Dermatol 2018;78:S1-23.
5. Zaenglein AL, Pathy AL, et al. “Guidelines of care for the management of acne vulgaris.” J Am Acad Dermatol. 2016;74:94573.
7. Renzi M, McLarney M, et al. “Procedural and surgical treatment modalities for acne scarring – Part 2.” J Am Acad Dermatol (2022), [journal pre-press].
8. Salameh F, Shumaker PR, et al. “Energy-based devices for the treatment of acne scars: 2022. International consensus recommendations.” Lasers Surg Med. 2022 Jan;54(1):10-26.
9. Gozali, Maya Valeska, and Bingrong Zhou. “Effective treatments of atrophic acne scars.” The Journal of clinical and aesthetic dermatology vol. 8,5 (2015): 33-40.
Balasubramaniyan. (2023). Efficacy of microneedling radiofrequency for acne scars. International Journal of Dermatology, Venereology and Leprosy Sciences. 6. 1216. 10.33545/26649411.2023. v6.i2a.148.
14. Kornstein, Andrew N. “Intramuscular Insertion of a Radiofrequency Microneedling Device for Facial Rejuvenation: A New Technique and Case Reports.” Aesthetic surgery journal. Open forum vol. 2,1 ojz035. 11 Feb. 2020, doi:10.1093/asjof/ojz035 Microneedling
References
1. Alster TS, Graham PM. “Microneedling: A review and practical guide.” Dermatol Surg. 2018 Mar;44(3):397-404.
2. El-Domyati, Moetaz et al. “Microneedling Therapy for Atrophic Acne Scars: An Objective Evaluation.” The Journal of clinical and aesthetic dermatology vol. 8,7 (2015): 36-42.
3. Singh, Aashim, and Savita Yadav. “Microneedling: Advances and widening horizons.” Indian dermatology online journal vol. 7,4 (2016): 244-54. doi:10.4103/22295178.185468
4. Thiboutot DM, Dréno B, et al. “Practical management of acne for clinicians: An international consensus from the Global Alliance
10. Chandrashekar, B S et al. “Retinoic acid and glycolic acid combination in the treatment of acne scars.” Indian dermatology online journal vol. 6,2 (2015): 84-8. doi:10.4103/2229-5178.153007
11. Chandrashekar, Byalekere Shivanna et al. “Evaluation of microneedling fractional radiofrequency device for treatment of acne scars.” Journal of cutaneous and aesthetic surgery vol. 7,2 (2014): 93-7. doi:10.4103/09742077.138328
12. Tan MG, Jo CE, Chapas A, Khetarpal S, Dover JS. Radiofrequency Microneedling: A Comprehensive and Critical Review. Dermatol Surg. 2021;47(6):755-761. doi:10.1097/ DSS.0000000000002972
13. T, Dhanalakshmi & Pk, Kaviarasan & Poorana,
Omalizumab for Food Allergies: What Primary Care Physicians Should Know
Omalizumab, recently approved by the US Food and Drug Administration as monotherapy for the treatment of food allergies, may now bring peace of mind to these patients and their families by reducing their risk of dangerous allergic reactions to accidental exposure. While the drug does not cure food allergies, a phase 3, placebo-controlled trial found that after 16 weeks of treatment, two thirds of participants were able to tolerate at least 600 mg of peanut protein — equal to about 2.5 peanuts — without experiencing moderate to severe reactions. An open-label extension trial also found the monoclonal antibody reduced the likelihood of serious reactions to eggs by 67%, milk by 66%, and cashews by 42%. The treatment is approved for children as young as the age of 1 year and is the only treatment approved for multiple food allergies. It does not treat anaphylaxis or other emergency situations.
“Most important for family doctors prior to prescribing the medication will be to be sure that the diagnosis is correct,” researcher said. We know that allergy blood and skin testing is good but not perfect, and false positive results can occur. Even for patients with confirmed IgE-mediated allergies, researcher said selecting patients who are good candidates for the therapy has “nuances.” Patients must be willing and able to commit to injections every 2-4 weeks. Dosing depends on body weight and the total IgE levels of each patient. Patients with IgE levels > 1850 UI/mL likely will be disqualified from treatment since the clinical trial did not enroll patients with total IgE above this level and the appropriate dose in those patients is unknown.
“Researcher recommendation for family physicians who are counseling food-allergic patients interested in omalizumab treatment is to partner with an allergist-immunologist, if at all possible.” Researcher added that patients should have a comprehensive workup before beginning treatment because starting omalizumab would reduce reactivity and alter the outcome a diagnostic oral food challenge. Two populations researcher thinks might particularly benefit from the therapy are college students and preschoolers, who may be unable to completely avoid allergens because of poor impulse control and food sharing in group settings. “The concerns we have about this age group are whether or not there might be other factors involved that may impede their ability to make good decisions
Consensus Statement Aims to Guide Use of Low-Dose Oral Minoxidil for Hair Loss
Topical minoxidil is safe, effective, over-the-counter, and FDA-approved to treat the most common form of hair loss, androgenetic alopecia. It is often used off label for other types of hair loss, yet clinicians who treat hair loss know that patient compliance with topical minoxidil can be poor for a variety of reasons. Patients report that it can be difficult to apply and complicate hair styling. For many patients, topical minoxidil can be drying or cause irritant or allergic contact reactions. Compared with the use of topical minoxidil for hair loss, the used of low-dose oral minoxidil (LDOM) can be considered when topical minoxidil is more expensive or logistically challenging, has plateaued in efficacy, leaves unwanted product residue, causes skin irritation, or exacerbates the inflammatory process. Those are among the key recommendations that resulted from a modified eDelphi consensus of experts who convened to develop guidelines for LDOM prescribing and monitoring.
Our goal was to provide clinicians who treat hair loss patients a road map for using LDOM effectively, maximizing hair growth, and minimizing potential cardiovascular adverse effects. The process involved 43 hair loss specialists from 12 countries with an average of 6.29 years of experience with LDOM for hair loss, who participated in a multi-round modified Delphi process. They considered questions that addressed LDOM safety, efficacy, dosing, and monitoring for hair loss, and consensus was reached if at least 70% of participants indicated “agree” or “strongly agree” on a five-point Likert scale. Round 1 consisted of 180 open-ended, multiple-choice, or Likert-scale questions, while round 2 involved 121 Likert-scale questions, round 3 consisted of 16 Likert-scale questions, and round 4 included 11 Likert-scale questions. In all, 94 items achieved Likert-scale consensus. Specifically, experts on the panel found a direct benefit of LDOM for androgenetic alopecia, age-related patterned thinning, alopecia areata, telogen effluvium, traction alopecia, persistent chemotherapy-induced alopecia, and endocrine therapy-induced alopecia. They found a supportive benefit of LDOM for lichen planopilaris, frontal fibrosing alopecia, central centrifugal alopecia, and fibrosing alopecia in a patterned distribution.
Researchers team noted that the earliest time point at which LDOM should be expected to demonstrate efficacy is 3-6 months. “Baseline testing is not routine but may be considered in case of identified precautions,” they wrote. They also noted that LDOM can possibly be co-administered with beta-blockers with a specialty consultation, and with spironolactone in biologic female or transgender female patients with hirsutism, acne, polycystic ovary syndrome (PCOS), and with lower extremity and facial edema.
According to the consensus statement, the most frequently prescribed LDOM dosing regimen in adult females aged 18 years and older includes a starting dose of 1.25 mg daily, with a dosing range between 0.625 mg and 5 mg daily. For adult males, the most frequently prescribed dosing regimen is a starting dose of 2.5 daily, with a dosing range between 1.25 mg and 5 mg daily. The most frequently prescribed LDOM dosing regimen in adolescent females aged 12-17 years is a starting dose of 0.625 mg daily, with a dosing range of 0.625 to 2.5 mg daily. For adolescent males, the recommended regimen is a starting dose of 1.25 mg daily, with a dosing range of 1.25 mg to 5 mg daily.
The advantages of the study are the standardized methods used, and the experience of the panel . Study limitations include the response rate, which was less than 60%, and the risk of potential side effects are not stratified by age, sex, or comorbidities.
Old Male Child - A Good Prognostic Sign of Self Resolution
Dr. R. Rajesh
MD, DNB
Professor & HOD
Dr. K. G. Srinivasahan
DD
Senior Resident
Dr. V. Mohankumar
MD
Associate Professor
Dr. B. R. Balamurugan
DDVL
Senior Resident
Dr. K. Revathi
MD, DVL
Assistant Professor
Dr. D. Devi
MD, DVL
3rd Year Resident
Department of Dermatology, Venereology, Leprology, Government Erode Medical College and Hospital, Perundurai Sanatorium, Erode, Tamil Nadu
Abstract
Molluscum contagiosum (MC) is a common viral skin infection primarily affecting children. It causes localized clustering of pearly white umbilicated papules in the epidermis. Here, we present a case of MC in a one-yearold male child with multiple lesions predominantly located on the trunk, left side paraumbilical region, and left axilla. MC frequently induces inflammation around them, leading to molluscum dermatitis with the affected area of the skin becomes pink, dry, and pruritic. As the papules resolve, they may
become inflamed, crusted, or scabby for a week or two. The case highlights the occurrence of molluscum dermatitis as a complication of MC in pediatric patients carrying a good prognosis of early remission otherwise spontaneous clearance takes several months to a few years.
Molluscum contagiosum is a viral skin infection caused by the Molluscum contagiosum
virus (MCV) of the Poxviridae family.(1) It spreads through direct physical contact, autoinoculation, and fomite sharing. MC typically presents as discrete, flesh-colored, dome-shaped, shiny papules, containing cheesy material. Complications such as molluscum dermatitis can occur, especially in children with a history of atopic dermatitis. This inflammatory response varies from a mild reaction extending 5 mm around a discrete lesion to 10 cm areas of acute dermatitis. Symptoms include moderate pruritus. The surrounding inflammation may be severe enough that small molluscas are difficult to view clinically. The non-inflamed molluscum lesions can precede the dermatitis. Not all MC papules will develop a dermatitis. The molluscum lesions precede the dermatitis from 1 to 15 months.
Case Presentation
A one-year-old male child presented to our outpatient department with multiple flesh-colored, dome-shaped, shiny, papules on the trunk, left side of the abdomen, and left axilla for four months. The lesions were asymptomatic and had been progressively increasing in number over the past two months. No history of fever or other constitutional symptoms. The child did not have any symptoms suggestive of atopic dermatitis. Contact history was negative. On examination, the lesions were multiple firm, non-tender, discrete, dome-shaped, shiny papules ranging in size from 2
to 5 mm with central umbilication. Surrounding the big lesion, multiple new pinpoint papules about 2 mm with surrounding erythema were observed in the paraumbilical region, clinically consistent with molluscum dermatitis. The lesions on the left side paraumbilical region exhibited erythema and small satellite lesions around the big papule show a BOTE sign (figure no 1&2). A clinical diagnosis of molluscum contagiosum / Molluscum dermatitis was made based on the characteristic appearance of the lesions. Given the benign nature of the lesions and the child's young age, conservative management was given. Topical 10% KOH was prescribed. Emphasis was placed on counseling and the parents were assured regarding the self-limiting nature of the condition and the importance of avoiding scratching to prevent secondary bacterial infections. The child is now under follow-up.
1
2
Figure 1 & 2: Shows multiple, discrete dome shaped , skin coloured, shiny, papules with central umblication, seen over left shoulder, paraumblical region left flank and iliac region and signs of Beginning Of The End or BOTE sign seen over paraumblical region.
Discussion
Molluscum contagiosum (MC) or water warts is a viral skin infection caused by a double-stranded DNA virus belonging to the Poxviridae family.(1) It is primarily spread through physical contact, autoinoculation, and fomite sharing. Transmission can occur via direct contact with infected individuals or indirectly through contaminated surfaces such as bath towels and swimming pools. Additionally, shaving and sexual contact in the reproductive age group are also recognized modes of transmission. The causative agent, Molluscum contagiosum virus (MCV), exists in four types: MCV1, MCV2, MCV3, and MCV4.(1) MCV1 is the most common type, typically affecting children, while MCV2 is often found in immunocompromised individuals. MCV3 and MCV4 are more prevalent in regions like Asia and Australia. Pathogenesis of MC involves viral infection of keratinocytes in the epidermis, with subsequent viral replication occurring in the cytoplasm of these cells.
Molluscum
Figure
Figure
This process leads to the loss of S100 protein-positive dendritic cells in the mid and upper layers of the epidermis, resulting in local modulation of cytokines and a reduction in the number of Langerhans cells. Clinically, MC presents as few or multiple flesh-colored dome-shaped shiny papules, typically 2 to 3 mm in size, containing cheesy material when expressed. Common sites of involvement include the axilla, antecubital fold, popliteal fossa, and crural fold. The BOTE sign ((beginning of the end sign) refers to the spontaneous resolution of the primary lesion(s) of molluscum contagiosum due to an inflammatory response. This inflammatory response is thought to be triggered by the body's immune system reacting to the virus. As a result, the changes in the primary lesions such as redness, swelling, and sometimes ulceration are signify the beginning of the resolution. (1,2) Molluscum dermatitis, a common complication occurring in up to 39% of MC cases, is characterized by eczematous patches and plaques surrounding MC lesions. Children with a history of atopic dermatitis are particularly prone to developing molluscum dermatitis. Furthermore, approximately 5% of MC lesions may lead to Gianotti-Crosti syndromelike reactions, attributed to immune reactions to MCV. (1,2,3,)
It is crucial to differentiate MC from other dermatological conditions, including
syringoma, warts, epidermal cysts, pyoderma, folliculitis, varicella, and in immunocompromised individuals, keratoacanthoma, cryptococcosis ..............., histoplasmosis, and foreign body granuloma.(1) Untreated MC can lead to secondary infections, local reactions, eczema, scarring, anxiety, and social separation.(4) For atypical presentation skin biopsy can be done. Classical Henderson Paterson bodies (HP bodies) can be demonstrated histologically.(1)
Treatment options for MC include topical application of 10% potassium hydroxide (KOH), 5% imiquimod cream, 0.5% podophyllotoxin, trichloroacetic acid (TCA), intralesional interferons, 1.3% cidofovir, 0.1% tretinoin, cantharidin 0.7% solution (extraction from blister beetles), a newer drug, Berdazimer topical gel 10.3%, it is a nitric oxide-releasing topical, it reduces pox virus replication and has shown promise for use in children aged one year and older, cryotherapy, and curettage. (5,6,7,8)
This case illustrates the typical presentation of molluscum contagiosum in a pediatric patient, with multiple lesions predominantly located on the trunk and characteristic BOTE sign observed in the paraumbilical region. Additionally, the occurrence of molluscum dermatitis highlights the importance of considering complications associated with MC, especially in children with underlying atopic dermatitis.
Conclusion
Molluscum contagiosum is a common viral skin infection in children. Awareness of characteristic clinical features such as the BOTE SIGN shows good prognostic sign and complications like molluscum dermatitis aid in accurate diagnosis and management.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil
Conflicts of interest
No conflicts of interest.
Acknowledgments
We would like to thank the patient's parents for their cooperation and consent to the image publication of this case report. We thank the institutional ethical committee for granting and allowing us to publish the case.
References
1. Meza-Romero, R., NavarreteDechent, C., & Downey, C. (2019). Molluscum contagiosum: an update and review of new perspectives in etiology, diagnosis, and treatment. Clinical, Cosmetic and
2. Sil, A., Bhanja, D. B., Chandra, A., & Biswas, S. K. (2020). BOTE sign in molluscum contagiosum. BMJ Case Reports, 13(9). https:// doi.org/10.1136/bcr-2020-239142
3. Jicha, K. I., Nieman, E. L., & Morrell, D. S. (2023). Granuloma Annulare-Like Id Reaction to Inflamed Molluscum Contagiosum: A Case Report. Clinical Medicine Insights: Pediatrics. https://doi. org/10.1177/11795565231194819
4. Bhatia, N., Hebert, A. A., & Del Rosso, J. Q. (2023). Comprehensive Management of Molluscum Contagiosum: Assessment of Clinical Associations, Comorbidities, and Management Principles. The Journal of Clinical and Aesthetic Dermatology, 16(8 Suppl 1), S12. https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC10453397/
5. Maeda-Chubachi, T., Hebert, D., Messersmith, E., & Siegfried, E. C. (2021). SB206, a Nitric Oxide–Releasing Topical Medication, Induces the Beginning of the End Sign and Molluscum Clearance. JID Innovations, 1(3), 100019. zttps://doi.org/10.1016/j. xjidi.2021.100019
6. Peter J. Chapa, Daudi R. Mavura, Rune Philemon, Lulyritha Kini, Elisante J. Masenga, "Contributing Factors and Outcome after Cryotherapy of Molluscum Contagiosum among Patients Attending Tertiary Hospital, Northern Tanzania: A Descriptive Prospective Cohort Study", Dermatology Research and Practice, vol. 2021, Article ID 9653651, 4 pages, 2021. https:// doi.org/10.1155/2021/9653651
7. Paller, A. S., Green, L. J., Silverberg, N., Stripling, S., Cartwright, M., Enloe, C., Wells, N., Kowalewski, E. K., & MaedaChubachi, T. Berdazimer gel
for molluscum contagiosum in patients with atopic dermatitis. Pediatric Dermatology. https://doi. org/10.1111/pde.15575
8. Hebert, A. A., Siegfried, E. C., Durham, T., De León, E. N., Reams, T., Messersmith, E., & MaedaChubachi, T. (2020). Efficacy and tolerability of an investigational nitric oxide-releasing topical gel in patients with molluscum contagiosum: A randomized clinical trial. Journal of the American Academy of Dermatology, 82(4), 887-894. https://doi.org/10.1016/j. jaad.2019.09.064
Molluscum Dermatitis
Cryolipolysis for Fat Reduction: A Case Report
Dr. Rashmi Soni
MD, DDV, DNB
Founder and Consultant Dermatologist, Cosmetologist and Dermatosurgeon
Skinsure Clinic, Pune
Consultant Dermatologist, KEM Hospital, Pune
Introduction
In the pursuit of achieving their desired physique, many individuals encounter persistent pockets of fat that resist traditional methods of diet and exercise. Liposuction, the traditional method for fat reduction, carries risks like infection and long recovery times. Its invasive nature can deter those averse to surgery. Non-surgical options like creams and massages offer modest results but require frequent sessions for upkeep, making them less appealing to those wanting quick, noticeable changes. For those seeking a non-invasive solution, cryolipolysis, also known as "fat freezing" or "Cool sculpting," has emerged as a promising option. This innovative procedure offers a safe, effective, and convenient alternative to surgical interventions like liposuction, providing individuals with a means to sculpt and refine their body contours without the associated risks and downtime.1,2 By precisely cooling targeted areas of the body to sub-zero temperature, cryolipolysis
induces apoptosis, or programmed cell death, in adipocytes (fat cells), while sparing surrounding tissues.3 over time, the body naturally eliminates these damaged fat cells through its lymphatic system, resulting in a gradual reduction in fat volume and improved body contours.1
Cryolipolysis addresses the shortcomings of traditional fat reduction methods by offering a non-invasive, safe, and effective alternative, devoid of the need for surgical incisions, anesthesia, or post-operative recovery time. This allows patients to promptly resume their daily routines following the procedure. Furthermore, the gradual nature of fat reduction ensures naturallooking results, avoiding the abrupt changes associated with surgical procedures. Cryolipolysis constitutes a notable progression in aesthetic medicine, furnishing patients with a practical remedy for localized adipose deposition. By leveraging controlled cooling, cryolipolysis presents a
non-invasive avenue for contouring and enhancing body morphology, thereby enabling patients to realize their aesthetic objectives with assurance and limited interference to their daily routines. Additional research is warranted to comprehensively elucidate the underlying mechanism of cryolipolysis and its effectiveness across various anatomical treatment sites.4
Before conducting a clinical examination for cryolipolysis, ensure that the patient's medical history, including any previous treatments or surgeries, allergies, and current medications, is reviewed. Obtain informed consent and explain the procedure to the patient, including potential risks and benefits. By conducting a comprehensive anamnesis and physical examination, clinicians can gather essential information to guide treatment planning and optimize outcomes for patients undergoing cryolipolysis. This detailed assessment helps to identify individualized treatment goals, tailor treatment approaches, and monitor progress over time.2,5 Cryolipolysis is an effective and well-tolerated procedure for reducing localized fat deposits and enhancing body contour. Understanding the clinical presentation, including expected symptoms, timeline of recovery, and potential complications, is crucial for both patients and healthcare providers involved in the management of individuals undergoing this cosmetic treatment.2,4
Case Report
A 39 -year-old female patient presented with unwanted fat deposits on her abdomen and flanks. Despite efforts through diet and exercise, these fat deposits remained stubborn and resistant to reduction. After discussing various options for fat reduction with the patient, including surgical and non-invasive approaches, cryolipolysis was chosen as the preferred method. The patient underwent cryolipolysis treatment targeting the abdominal area and flanks. Specialized applicators were applied to these areas, delivering controlled cooling to induce fat cell apoptosis (cell death). Following the cryolipolysis procedure, the patient was advised to monitor for any side effects such as redness, swelling, or discomfort. She was also instructed to maintain a healthy lifestyle with regular exercise and balanced nutrition to optimize results. A visible reduction in fat thickness and improvement in body contour became evident, contributing to a more sculpted appearance in the abdominal and flank regions. Before
Treatment 6,7,8
Adipocytes store triacylglycerols as an energy reserve, leading to an expansion of adipose tissue volume. Weight gain can be prevented by damaging adipocyte structure or increasing the body's metabolic rate. Several methods, such as injection lipolysis, cryolipolysis, ultrasonic lipolysis, radiofrequency lipolysis, laser lipolysis, carboxytherapy, and lipolysis using
Figure 1: Unwanted fat deposition on abdomen
Figure 2: Unwanted fat deposition on flanks
Cryolipolysis for Fat Reduction: A Case Report
an electromagnetic field, are commonly used to disrupt adipocyte membranes. These methods are minimally invasive and effective. However, ongoing medical research and individuals' desire for aesthetic improvement have spurred investigations into additional fat reduction strategies. Beige adipocytes, capable of thermogenesis, hold promise for fat reduction. They can be recruited from white adipocytes or synthesized de novo, often stimulated by cold exposure and B3adrenergic activation. Innovative approaches like cooling clothing capitalize on this discovery. Substances like curcumin and natural anthocyanins have shown efficacy in treating obesity and diabetes by promoting glucagon-like peptide-1 secretion and beige adipocyte formation. Interleukin-6, elevated during exercise, indirectly influences white adipose tissue conversion. Other potential interventions include adenosine analogs, fenoldopam, rhubarb, Ephedra sinica Stapf extract, electroacupuncture simulation, and CBL-514. Despite extensive knowledge and experimentation, an ideal method for rapid, noticeable, safe, and non-invasive fat reduction remains elusive. Ongoing research offers hope for a breakthrough in combating overweight and obesity.6
Currently, some prominent non-invasive or minimally invasive techniques are employed for fat reduction:
Cryolipolysis, laser lipolysis, injection lipolysism, ultrasonic lipolysis, radiofrequency lipolysis, low-level laser therapy, carboxytherapy, high-intensity focused electromagnetic field and pharmacological methods.
1. Cryolipolysis
Cryolipolysis involves using cold temperatures to freeze targeted fat cells, which are then naturally eliminated from the body. This process induces apoptosis in the adipocytes, leading to their gradual absorption and removal. Patients undergoing cryolipolysis may experience sensations of skin pulling and pinching during the procedure, although immediate effects are not typically noticeable. The underlying principle of cryolipolysis is based on the differential susceptibility of adipocytes to cold compared to other skin cells. When cooled to around −1 °C, adipocytes undergo apoptosis. Following this, an inflammatory response is triggered, with inflammatory cells infiltrating the treated area within two weeks. Over the next month, macrophages surrounding the adipose tissue metabolize the lipid cells, leading to a reduction in inflammation and adipocyte volume. Histological analysis conducted 2–3 months post-cryolipolysis reveals a significant decrease in the distance between adipose tissue septa, with no alterations in the lipid profile. Even a single session of cryolipolysis can result in a reduction in body fat thickness of up to 20%, with
noticeable effects typically appearing after 3–4 months. Cryolipolysis is well-regarded for its efficacy and safety, with reported side effects being minimal.6
2. Laser Lipolysis
Laser lipolysis has been a widely used method for reducing body fat since 2006. This technique employs a laser beam, which can have wavelengths of 924, 968, and 980 nm for diode lasers, and 1064, 1319, 1320, and 1440 nm for Nd (neodymiumYAG) lasers. When the laser penetrates the tissue, it undergoes scattering, reflection, and absorption. The efficacy of laser fat reduction is influenced by the wavelength and energy of the laser. This noninvasive method operates by heating adipocytes (fat cells) to a temperature range that induces cell death, specifically 42-47 °C, with complete decomposition occurring at 50-65 °C. As heat accumulates, adipocytes are irreversibly damaged due to the formation of transient micropores in their membranes, which leads to the release of intracellular lipids. Similar to cryolipolysis, the subsequent inflammation facilitates the removal of the dead cells.6
Innovative laser lipolysis devices are often equipped with cooling systems or supported by cryogenic sprays to mitigate the side effects of laser photothermolysis and enhance the overall therapeutic effect. Laser therapy has been shown to effectively reduce the circumference of
the waist, hips, and thighs; close small vessels; remove skin imperfections such as rosacea and erythema; and address signs of skin aging like loss of firmness, tissue flabbiness, wrinkles, and folds. Additionally, it has been found to lower cholesterol and leptin levels, all while remaining a non-invasive and safe method.6
3. Injection Lipolysis
Injection lipolysis is often mistaken for mesotherapy, though it encompasses a broader range of techniques. Lipolysis refers to the hydrolysis or degradation of lipids into their constituent fatty acids and glycerol esters, a process regulated by lipases and occurring in the adipocytes and vascular spaces of muscle or adipose tissue. In treatments targeting body fat reduction, mesotherapy involves multiple intradermal injections of small doses of a specific drug into selected body areas. In contrast, injection lipolysis typically involves fewer punctures, such as the 1-2 punctures seen in intralipotherapy, performed in cycles of 2-5 sessions at intervals of 4-6 weeks. The active substances used in injection lipolysis are most commonly phosphatidylcholine (PPC) or sodium deoxycholate (DC). PPC is a primary phospholipid component of cell membranes and a precursor to acetylcholine. When PPC is injected subcutaneously into adipose tissue, it causes adipocytes to burst and increases the secretion of triglyceride-rich
lipoproteins. DC, a component of human bile acid, aids in the emulsification and digestion of fats in the intestines. When administered externally, DC damages the cell membranes of adipocytes, leading to their destruction. Notable combinations of PPC and DC in injection lipolysis include Lipostabil PPC (50 mg/mL), which contains DC, sodium hydroxide, sodium chloride, tocopherol, benzyl alcohol, and ethanol; Kybella, which contains DC (10 mg/mL); and GeoLysis, which also contains DC (10 mg/mL). The destruction of adipocytes triggers an inflammatory response, leading to the migration and stimulation of fibroblasts and the eventual accumulation of collagen.6
4. Ultrasonic Lipolysis
Ultrasonic lipolysis, particularly high-intensity focused ultrasound (HIFU) lipolysis, targets adipose tissue through two primary mechanisms. First, it generates negative acoustic pressure that disrupts cell membranes by inducing cavitation bubbles. This process releases heat energy, raising the temperature and causing protein denaturation and coagulation. The cavitation effect liquefies the adipose tissue, which is then naturally excreted through urine. The elevated temperature is achieved via ultrasonic vibrations, leading to the destruction of adipocytes and the release of lipids. These lipids are subsequently transported to the hepatobiliary system via lymphatic drainage. The
overall result is a reduction in the local volume of adipose tissue. This method is entirely non-invasive and painless.6
5. Radiofrequency Lipolysis
Radiofrequency lipolysis employs radio waves to emit heat, which is selectively directed at collagen-rich tissue. This process causes the collagen fibers to shrink and denature while stimulating fibroblasts. Primarily used for skin firming and gentle body fat reduction, this method induces the thermal apoptosis of adipocytes. Radiofrequency lipolysis is most effective as a supplementary therapy to other fat-removal procedures.6
6. Low-Level Laser Therapy
Low-level laser therapy (LLLT), which emits waves between 630–640 nm, can be used to supplement lipoplasty. The EML laser, emitting 14 mW of light at a wavelength of 635 nm, is applied to the skin's surface before the liposuction procedure. This application emulsifies the fat and softens the targeted body area prior to suction. LLLT shortens the procedure time, increases the volume of fat removed, and accelerates the patient's recovery. Additionally, this therapy exhibits biostimulating properties associated with the specific wavelength used.6
7. Carboxytherapy
Carboxytherapy involves the transdermal administration of carbon dioxide for therapeutic purposes. The amount of CO2 infused varies depending on the body area: 50–100 mL for
the chin and arm, 200–300 mL for the thigh, and 300–600 mL for the abdomen. The role of carboxytherapy in lipolysis remains controversial. Locally applied CO2 can enhance peripheral circulation, improve tissue perfusion, increase oxygen partial pressure through reflex vasodilation, and stimulate neoangiogenesis. One aspect supporting its effectiveness in obesity treatment is the noticeable shrinkage of adipocytes and decreased density in the treated area. Brandi et al. observed histological changes following local CO2 application, noting fat cell damage and the subsequent release of triglycerides into the intracellular spaces, which could be pivotal in developing this therapy.6
8. High-Intensity Focused Electromagnetic Field
High-Intensity Focused Electromagnetic Field (HIFEM) is a non-invasive technique used to reduce body fat and assist in muscle repair. The device generates an electromagnetic field that induces electrical currents in neuromuscular tissue, leading to muscle contractions. This significant energy demand forces the muscles to utilize the energy stored in adipocytes, specifically free fatty acids, thereby reducing the size and, under extreme muscle strain, the number of fat cells. Studies have reported an average reduction in abdominal circumference of 4.37 cm. HIFEM can also be combined with radiofrequency (RF) for enhanced effects.
Synchronized RF generates electromagnetic energy that can be precisely regulated to focus on adipose tissue, selectively heating adipocytes to a temperature range of 42 °C to 45 °C, which induces apoptosis. Patients treated with this combined HIFEM+RF approach show an average reduction of 30% in body fat and a 25% increase in muscle mass.6
9.Pharmacological Methods
In addition to non-invasive methods for reducing body fat, numerous pharmaceuticals can also accelerate weight loss. Some notable examples of drugs affecting human metabolism include liraglutide and semaglutide, both of which are glucagon-like peptide-1 (GLP-1) receptor agonists used in the treatment of type 2 diabetes and obesity. These drugs regulate the pancreatic secretion of insulin and glucagon based on blood glucose levels, increasing satiety and reducing hunger, which leads to decreased food intake and weight loss. GLP-1 is an incretin hormone secreted by the intestines in response to food intake, which lowers postprandial glucose levels by stimulating insulin secretion and reducing glucagon secretion. It also suppresses appetite, slows gastric emptying, and reduces overall food intake, positively affecting weight loss and decreasing the incidence of cardiovascular events. Biochemically modified analogs of GLP-1 increase its half-life and potency. GLP-1 receptors are present
in various organs, including the brain, particularly in the hypothalamus, brainstem, and septal nucleus. Studies have shown that both liraglutide and semaglutide affect these brain receptors, reducing caloric intake, with semaglutide demonstrating superior.6
Discussion
Recently, a wave of novel, non-invasive, energy-based techniques has emerged in the market, signaling a potential paradigm shift in fat reduction and body contouring practices. The primary goal of these new therapies is tissue volume reduction, ultimately leading to non-invasive body contouring. With over 450,000 procedures performed to date, cryolipolysis has become one of the most popular alternatives to liposuction for targeted adipose tissue reduction. Due to its ease of use and minimal adverse effects, this procedure is now the leading technology in noninvasive techniques.1,9
Although the mechanism of cryolipolysis is not fully understood, it is believed that vacuum suction combined with controlled cooling impedes blood flow and induces crystallization of the targeted adipose tissue. The temperatures used in cryolipolysis do not permanently affect the dermis and epidermis. However, the cold ischemic injury may cause cellular damage in adipose tissue through mechanisms such as cellular edema, reduced Na-KATPase activity, decreased ATP levels, elevated lactic
acid, and mitochondrial free radical release. Another proposed mechanism is that the initial crystallization and cold ischemic injury are compounded by ischemiareperfusion injury, leading to reactive oxygen species generation, increased cytosolic calcium, and activation of apoptotic pathways. Ultimately, these processes induce apoptosis of the adipocytes, followed by a significant inflammatory response and their removal from the treatment site over several weeks.
Histological studies show that macrophages primarily clear the damaged cells and debris within three months. There have been concerns that cryolipolysis might elevate blood lipid levels and liver enzymes, posing additional cardiovascular risks. However, multiple studies have demonstrated that levels of cholesterol, triglycerides, LDL, HDL, AST/ ALT, total bilirubin, albumin, and glucose remain within normal limits during and after cryolipolysis. 1,9
Despite its relatively recent introduction, many factors about cryolipolysis still need further investigation, including identifying the ideal patient profile. Ferraro et al. suggest that patients needing only small to moderate amounts of adipose tissue and cellulite removal benefit most from cryolipolysis. Contraindications include cold-induced conditions such as cryoglobulinemia, cold urticaria, and paroxysmal cold hemoglobinuria. Cryolipolysis
should also be avoided in areas with severe varicose veins, dermatitis, or other cutaneous lesions. Although all studies reviewed showed fat reduction in every treated area, it is still unclear which areas are most responsive to cryolipolysis. Factors such as the vascularity, local cytoarchitecture, and metabolic activity of specific fat depots may influence the degree of fat reduction. Due to the limited size and number of studies, it is uncertain which treatment sites are most amenable to cryolipolysis. Future studies should be adequately powered to determine the most suitable treatment sites. 1,9
Treatment protocols for cryolipolysis are still being optimized. Recent studies have shown enhanced efficacy with multiple treatments in the same area, with a second treatment leading to further fat reduction, although the improvement is not as significant as the first. One study found that a second treatment enhanced fat layer reduction in the abdomen but not the love handles. Hypotheses for the diminished effect of the second treatment include closer proximity of fat to the muscle layer, impeding heat extraction efficiency, and increased cold tolerance of adipocytes surviving the first treatment. 1,9
Boey and Wasilenchuk examined whether a posttreatment manual massage enhanced the efficacy of cryolipolysis. They found that a 2-minute massage immediately after treatment
statistically significantly improved results at two months, although the difference was not significant at four months. Another study demonstrated excellent outcomes with a 5-minute post-treatment mechanical massage using the device applicator.1,9,10
Cryolipolysis's low profile of adverse effects is a major advantage compared to more invasive measures. Mild, short-term side effects like erythema, bruising, changes in sensation, and pain were reported. Erythema typically subsided within a week, while swelling and bruising were less common but resolved quickly. Changes in sensation were temporary, with normal sensation returning within about 3.6 weeks. Pain during the procedure was generally nonexistent or tolerable in 96% of cases. Rare side effects include vasovagal reactions and paradoxical adipose hyperplasia (PAH), with an incidence of approximately 0.0051%. PAH involves the development of a large, tender fat mass at the treatment site months after the procedure. Despite this, cryolipolysis poses a minor threat compared to traditional liposuction. Various methods have been used to measure fat reduction after cryolipolysis, including caliper, ultrasound, three-dimensional imaging, and manual tape measurements. 1,9
Conclusion
In conclusion, cryolipolysis is a nonsurgical technique for localized fat reduction. Given the higher risk of
complications associated with invasive methods like liposuction, cryolipolysis offers a promising alternative for nonsurgical body contouring. Its ability to selectively target adipose tissue with controlled cooling offers patients a safe and effective means of achieving desired body contouring outcomes. Despite its advantages of non-invasiveness, precise targeting, and natural-looking results, careful consideration of contraindications and treatment duration is paramount to ensure patient safety and optimize treatment efficacy. By adhering to proper patient selection criteria and utilizing confirmatory methods for fat deposition assessment, cryolipolysis can offer patients a reliable path towards achieving their aesthetic goals. With continued advancements in technology and further research, cryolipolysis is poised to remain a valuable tool in the realm of noninvasive body sculpting.
References
1. Krueger N, Mai SV, Luebberding S, Sadick NS. Cryolipolysis for noninvasive body contouring: clinical efficacy and patient satisfaction. ClinCosmetInvestig Dermatol. 2014;7:201-205. Published 2014 Jun 26. doi:10.2147/CCID. S44371
2. Kania B, Goldberg DJ. Cryolipolysis: A promising nonsurgical technique for localized fat reduction. J CosmetDermatol. 2023;22Suppl 3:1-7. doi:10.1111/jocd.16039
3. Choi SY, Park JW, Koh YG, et al. Cryolipolysis for abdominal subcutaneous fat reduction: A prospective, multicenter, single arm, clinical study. DermatolTher. 2022;35(9):e15717. doi:10.1111/ dth.15717
4. Meyer PF, Davi Costa E Silva J, Santos de Vasconcellos L, deMoraisCarreiro E, Valentim da Silva RM. Cryolipolysis: patient selection and special considerations. Clin CosmetInvestig Dermatol. 2018;11:499-503. Published 2018 Oct 16. doi:10.2147/CCID. S146258
5. Few J, Saltz R, Beaty M, et al. Cryolipolysis: Clinical Best Practices and Other Nonclinical Considerations. AesthetSurg J Open Forum. 2020;2(2):ojaa010. Published 2020 Mar 17. doi:10.1093/asjof/ojaa010
6. Piłat P, Szpila G, Stojko M, Noco J, Smolarczyk J, mudka K, Moll M, Hawranek M. Modern and Non-Invasive Methods of Fat Removal. Medicina (Kaunas). 2023 Jul 28;59(8):1378. doi: 10.3390/medicina59081378. PMID: 37629668; PMCID: PMC10456392.
7. Mazzoni D, Lin MJ, Dubin DP, Khorasani H. Review of non-invasive body contouring devices for fat reduction, skin tightening and muscle definition. The Australasian Journal of Dermatology. 2019 Nov;60(4):278283. DOI: 10.1111/ajd.13090. PMID: 31168833.
8. Jewell ML, Solish NJ, Desilets CS. Noninvasive body sculpting technologies with an emphasis on highintensity focused ultrasound. Aesthetic Plastic Surgery. 2011 Oct;35(5):901912. DOI: 10.1007/s00266-011-97005. PMID: 21461627.
9. Ingargiola MJ, Motakef S, Chung MT, Vasconez HC, Sasaki GH. Cryolipolysis for fat reduction and body contouring: safety and efficacy of current treatment paradigms. Plast Reconstr Surg. 2015 Jun;135(6):1581-1590. doi: 10.1097/ PRS.0000000000001236. PMID: 26017594; PMCID: PMC4444424.
10. Boey GE, Wasilenchuk JL. Enhanced clinical outcome with manual massage following cryolipolysis treatment: a 4-month study of safety and efficacy. Lasers Surg Med. 2014 Jan;46(1):206. doi: 10.1002/lsm.22209. Epub 2013 Dec 11. PMID: 24338439; PMCID: PMC4265298.
Dapsone Gel 5%
O.M.C, Mineral Oil,Vitmin E, Benzophenone-3 Squalene, Kokum Butter & Shea Butter Butter
