Mesotherapy for rejuvenation of photoaged skin: Ultrasound
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Mesotherapy for rejuvenation of photoaged skin: Ultrasound
Presented at American Academy of Dermatology: 66th Annual Meeting February 1-5, 2008 San Antonio, Texas *Dermatology Clinic, University of Catania, Catania, Italy **Nordstrom Hospital, Helsinki, Finland Giuseppe Micali, MD*, Francesco Lacarrubba, MD*, Aurora Tedeschi, MD*, Rolf Nordstrom, MD** Mesotherapy for rejuvenation of photoaged skin: Ultrasound evaluation Mesotherapy for rejuvenation of photoaged skin: Ultrasound evaluation Giuseppe Micali, MD, Dermatology Clinic, University of Catania, Catania Italy Francesco Lacarrubba, MD, Dermatology Clinic, University of Catania, Catania Italy Aurora Tedeschi, MD, Dermatology Clinic, University of Catania, Catania Italy Rolf Nordstrom, MD, Nordstrom Hospital, Helsinki, Finland Mesotherapy (M) is a treatment used in cosmetic dermatology. It is a minimally invasive technique, not a tissue augmentation, that consists in the injection, through dermal multipunctures, of bioactive substances, such as hyaluronic acid (HA). M is supposed to promote skin “rejuvenation” by increasing hydration and recreating a favorable environment to facilitate fibroblast activation and exchanges and interactions between cells of extracellular matrix. Ultrasound of the skin has been extensively used to visualize and quantify age related dermal changes. The so-called Subepidermal Low Echogenic Band (SLEB), located immediately below the epidermal entrance echo, is considered a marker of photoaging and is strictly related to dermal elastosis, basophilic degradation of collagen, and accumulation of glycosaminoglycans and water in the papillary dermis, as confirmed by numerous studies. The effect of M with HA on photoaged skin have been evaluated using a 20-MHz B-mode ultrasound equipment. Five females (mean age, 61 yrs; range, 56-67 yrs) with moderate signs of skin photoaging on the back of the hand, consisting of fine wrinkles and skin thinning and laxity, were treated with dermal injections on target areas on the back of the hand of non animal, stabilized HA, at concentration of 20 mg/ml, at 0.2, and 4 weeks. Ultrasound evaluation was performed at each treatment and 7 days after the end of treatment. At baseline, ultrasound evaluation showed in all patients the presence of SLEB. After 5 week, in all cases a remarkable improvement of SLEB, consisting in increased echogenicity, likely related to an increased density of dermal collagen fibers resulting from treatment, was evident. Clinically, an improvement of skin texture following therapy was reported by all patients. Our preliminary results have demonstrated that M with HA may be an effective treatment for photoaged skin, as confirmed by ultrasound results. Future applications of ultrasound could be represented by follow-up evaluation of skin changes after therapy discontinuation. LA MESOTERAPIA PER IL RINGIOVANIMENTO della cute fotoinvecchiata: VALUTAZIONE ECOGRAFICA La mesoterapia è una tecnica utilizzata in dermatologia cosmetologica. Consiste nell’iniezione intradermica di sostanze bioattive, quali l’acido ialuronico (AI), in grado di promuovere il rinnovamento cutaneo tramite la creazione di un terreno favorevole: • all’attivazione dei fibroblasti • a scambi e interazioni tra cellule e matrice extracellulare. L’ecografia cutanea, tra le sue varie applicazioni, è utilizzata per visualizzare e quantificare i cambiamenti del derma indotti dall’età. La cosiddetta Subepidermal Low Echogenic Band (SLEB), banda ipoecogena del derma legata a elastosi, degradazione del collagene, accumulo di glicosamminoglicani e acqua, è considerata un marker del fotoinvecchiamento cutaneo. Cinque donne (range 56-67 anni), con segni di invecchiamento cutaneo al dorso della mano e al viso, sono state trattate con iniezioni multiple di AI non animale stabilizzato, alla concentrazione di 20 mg/ml, a 0, 2 e 4 settimane. La valutazione ecografica è stata effettuata a ogni trattamento e 7 giorni dopo l’ultimo. In tutte le pazienti trattate si è osservato un miglioramento dello SLEB (figg. casi 1-3), determinato da un incremento della sua ecogenicità verosimilmente legato a un aumento della densità del collagene dermico. Tutte le donne hanno presentato un miglioramento evidente della texture della cute, nonché un apprezzabile miglioramento delle rughe superficiali (figg. casi 1-3). La mesoterapia con AI può essere considerata un trattamento efficace contro il fotoinvecchiamento della cute, come confermato dalla valutazione ecografica. lo studio è stato condotto con il prodotto Mesotherapy for rejuvenation of photoaged skin: Ultrasound evaluation Case 1 Case 2 Case 3 Clinical evaluation Clinical evaluation Clinical evaluation Before treatment Before treatment Before treatment After treatment After treatment After treatment Case 1 Case 2 Case 3 Ultrasound evaluation Ultrasound evaluation Ultrasound evaluation Baseline Baseline Baseline After 35 days After 35 days After 35 days Increased SLEB (subepidermal low-echogenic band) ecogenicity: Increased SLEB (subepidermal low-echogenic band) ecogenicity: Increased SLEB (subepidermal low-echogenic band) ecogenicity: +41.2% +50.2% +22.1%