- Email: [email protected]
Diffusion, dispersion, or action halos of botulinum toxins? A pilot study comparing two commercial preparations of type a botulinum toxins
Ab# 153-03
Ab# 153-05
THE ACCURACY OF SERIAL TRANSVERSE CROSS-SECTIONS IN DETECTING RESIDUAL BASAL CELL CARCINOMA AT THE SURGICAL MARGINS OF AN ELLIPTICAL EXCISION SPECIMEN Arash Kimyai-Asadi, MD, Leonard Goldberg, MD, Ming Jih, MD, PhD, DermSurgery Associates Background: There has been no study estimating the proportion of positive surgical margins that is missed when serial transverse cross-sectioning (bread-loafing) is used to histologically sample the margins of elliptical excision specimens. Objective: To estimate the accuracy of bread-loafing at 4 mm intervals in detecting the presence of residual tumor at the margins of well-defined facial basal cell carcinomas excised as an ellipse with 2 mm surgical margins.
TREATMENT OF LIPODYSTROPHIC FACIAL AGING WITH THE USE OF INJECTABLE POLY-L-LACTIC ACID Douglas Key, MD, Associate Clinical Professor, Oregon Health & Science University, Portland, OR, United States
Methods: Forty-two small, well-defined, primary, non-morpheic facial basal cell carcinomas that had been excised as an ellipse with 2 mm margins and that had positive surgical margins utilizing en-face Mohs sections were included. After longitudinal bisection of each ellipse, frozen sections were prepared encompassing the entire surgical margin. Transparencies with parallel lines spaced at 4 mm intervals were superimposed on the histologic slides with the lines perpendicular to the epidermal surface. Areas in which the lines intersected tumor at the surgical margin were noted. Results: The 42 tumors had a total of 50 positive surgical margins. Overall, the crosssectional lines intersected tumor 44% of the time (95% confidence interval; range 3751%). Only 5 (10%) of the residual tumors at the surgical margins exceeded 4 mm in their longitudinal dimension. Conclusions: Bread-loafing at 4 mm intervals of excisional specimens from facial basal cell carcinomas excised with 2 mm surgical margins is only 44% sensitive in detecting residual tumor at the surgical margins. We recommend complete histologic margin control using en-face tissue orientation to identify residual tumor and reduce the risk of tumor recurrence. Nothing to disclose.
Background: There are 3 recognized forms of facial lipoatrophic changes: (1) the rare occurrences of facial partial lipodystrophy, (2) the uncommon changes of lipoatrophy associated with anti-retrovirals, and (3) the almost universal changes of intrinsic lipoatrophy associated the natural changes of facial aging. Of all of the changes of facial aging, the most important are the visual changes which are seen with the loss of facial subcutaneous volume. Effective treatment of facial lipoatrophic changes has been difficult, being limited to facial lipograting, with difficulty in many patients in obtaining sufficient donor lipograft tissue to effectively restore needed facial fullness, as well as variability in duration of lipografted tissue, even with the use of micro graft techniques of lipografting. Injectable Poly-L-lactic acid is a recently introduced injectable subcutaneous filler, indicated for the correction of lipoatrophy associated with anti-retroviral usage. This present study will illustrate the use of injectable poly-L-lactic acid in the treatment of intrinsic lipoatrophic facial aging in select patients who otherwise would not be ideal candidates for fat lipografting. Methods: Patients were selected for correction of mid-cheek and adjacent perioral intrinsic involutional loss of subcutaneous volume. These candidates for treatment were not ideal candidates for fat auto grafting correction, either by reason of limited donor adipose tissue availability or by reason of only limited sustained correction using prior fat auto grafting. The method of poly-L-lactic acid injection was similar to the deeper subcutaneous micro graft techniques of both Coleman and Amar fat auto grafting. A Canfield photographic fixed plan system was used to document and compare the pre and post procedure results. All patients treated with poly-L-lactic acid treatment will be followed for 2 years posttreatment. Results: Poly-L-lactic acid injectable treatment can, in selected patients, achieve correction of one of the most important aspects of facial aging, facial intrinsic lipoatrophy. The results of this study are early observations of correction as observed over 4 months post initial correction with a planned time of observation of over 2 years. Conclusions: One of the most prevalent and important aspects of facial aging, is facial lipoatrophy, the intrinsic loss of facial fatty tissue. These changes of lipoatrophy intrinic to facial aging may be effectively corrected, with a restoring of natural facial contour and form, in selected patients with subcutaneous injection treatment with poly-L-lactic acid. Nothing to disclose.
Ab# 153-04 IMPROVEMENT OF FACIAL RHYTIDS THROUGH A NOVEL TRANSDERMAL DRUG DELIVERY SYSTEM Jaggi Rao, MD, Division of Dermatology, University of Alberta, Edmonton, Alberta, Canada; Mitchel P. Goldman, MD, Dermatology/Cosmetic Laser Associates of La Jolla, Inc., La Jolla, CA, United States Background: Until recently, the only drugs that could enter the skin transdermally were those possessing a very limited and specific combination of structural and chemical properties. Recent advances in bioengineering have led to enhancement technologies designed to transiently overcome the barrier function of the stratum corneum and facilitate drug delivery. In particular, iontophoresis and electroporation have the potential to greatly expand the range of drugs that can be delivered across the skin surface. Purpose: To evaluate the safety, tolerability, and efficacy of transdermal type I collagen delivery using a drug delivery system combining iontophoresis and electroporation, for the treatment of facial rhytids. Materials and methods: Ten healthy adult females with symmetrical facial rhytids were randomized to receive treatment on only one half of the face. The contralateral side served as an internal control. Subjects received 2 transdermal treatments given 2 weeks apart, of soluble collagen type I using an iontophoresis and electroporation device. Prior to first treatment and at follow-up, facial rhytids were evaluated by a blinded dermatologist reviewer. High-quality photographs were examined by 4 independent, blinded observers to assess improvement. Punch biopsies from treated and non-treated preauricular skin were performed and analyzed. Subjects completed questionnaires to document tolerability and efficacy. Results: All subjects tolerated the treatments well with only minimal, local, and transient side effects seen. The majority of subjects reported an improvement of facial contour and rhytids on the treated side. Evaluations by both physician and independent, blinded observers showed that all treatment sites demonstrated considerable improvement over control. Histologic sections of treated areas showed retention of exogenous collagen within both the papillary dermis and areas of the reticular dermis. Conclusion: This study demonstrates that through iontophoresis and electroporation, transdermal delivery of macromolecules is not only possible, but is also safe, tolerable, and effective. In addition, this technology may enhance the efficiency of topical therapies, such as anesthetics, antibiotics, anti-inflammatories, or photodynamic drugs by several orders of magnitude. Many exciting studies are in progress to further examine this breakthrough in drug admininstration.
Ab# 153-06 DIFFUSION, DISPERSION, OR ACTION HALOS OF BOTULINUM TOXINS? A PILOT STUDY COMPARING TWO COMMERCIAL PREPARATIONS OF TYPE A BOTULINUM TOXINS Doris Hexsel, MD, Doris Hexsel Dermatologic Clinic, Porto Alegre, RS, Brazil; Taciana Dal, MD, Forno Dini, MD, Doris Hexsel Dermatologic Clinic and Federal University of Rio Grande do Sul, Porto Alegre RS, Brazil; Debora Zechmeister do Prado, Doris Hexsel Dermatologic Clinic, Porto Alegre, RS, Brazil; Camile Hexsel, MD, University of Passo Fundo, Passo Fundo, RS, Brazil; University of Miami, FL, United States Diffusion of BT is crucial to determine the extension of the action area from the injection point. Differences between halos of action can determine different results, not merely affecting the efficacy of the procedure but also the results, which may be the cause of local side effects. Some factors can affect the diffusion or the action halos, such as the injected amount, the angle of the injection, and the bleeding caused by the injections.1 The largest radius of action from one commercial preparation can be useful to cover a bigger area of one or more muscles from a single point of injection, as well as cause side effects in adjacent muscles. Knowledge of the radius of action of the two most used commercial preparations of BT is very important, because it can increase the safety of the procedure. In order to determine and compare the radius of action of BOTOX and Dysport, we performed a randomized blind pilot study in 18 patients, injecting one point of each preparation, diluted 1: 2.5, BOTOX to Dysport, in each side of the upper part of the frontal muscles and lateral part of the periorbital muscles. The results showed that there are no significant differences between these two preparations, in the doses and muscles studied.
Reference 1. Le Louarn C. Toxine botulinique et rides faciales: Une nouvelle proce´dure d9 injection. Chir Plast Esthet 1998;43:526-33.
Nothing to disclose.
AB2
J AM ACAD DERMATOL
MARCH 2005
Ab# 153-05
THE ACCURACY OF SERIAL TRANSVERSE CROSS-SECTIONS IN DETECTING RESIDUAL BASAL CELL CARCINOMA AT THE SURGICAL MARGINS OF AN ELLIPTICAL EXCISION SPECIMEN Arash Kimyai-Asadi, MD, Leonard Goldberg, MD, Ming Jih, MD, PhD, DermSurgery Associates Background: There has been no study estimating the proportion of positive surgical margins that is missed when serial transverse cross-sectioning (bread-loafing) is used to histologically sample the margins of elliptical excision specimens. Objective: To estimate the accuracy of bread-loafing at 4 mm intervals in detecting the presence of residual tumor at the margins of well-defined facial basal cell carcinomas excised as an ellipse with 2 mm surgical margins.
TREATMENT OF LIPODYSTROPHIC FACIAL AGING WITH THE USE OF INJECTABLE POLY-L-LACTIC ACID Douglas Key, MD, Associate Clinical Professor, Oregon Health & Science University, Portland, OR, United States
Methods: Forty-two small, well-defined, primary, non-morpheic facial basal cell carcinomas that had been excised as an ellipse with 2 mm margins and that had positive surgical margins utilizing en-face Mohs sections were included. After longitudinal bisection of each ellipse, frozen sections were prepared encompassing the entire surgical margin. Transparencies with parallel lines spaced at 4 mm intervals were superimposed on the histologic slides with the lines perpendicular to the epidermal surface. Areas in which the lines intersected tumor at the surgical margin were noted. Results: The 42 tumors had a total of 50 positive surgical margins. Overall, the crosssectional lines intersected tumor 44% of the time (95% confidence interval; range 3751%). Only 5 (10%) of the residual tumors at the surgical margins exceeded 4 mm in their longitudinal dimension. Conclusions: Bread-loafing at 4 mm intervals of excisional specimens from facial basal cell carcinomas excised with 2 mm surgical margins is only 44% sensitive in detecting residual tumor at the surgical margins. We recommend complete histologic margin control using en-face tissue orientation to identify residual tumor and reduce the risk of tumor recurrence. Nothing to disclose.
Background: There are 3 recognized forms of facial lipoatrophic changes: (1) the rare occurrences of facial partial lipodystrophy, (2) the uncommon changes of lipoatrophy associated with anti-retrovirals, and (3) the almost universal changes of intrinsic lipoatrophy associated the natural changes of facial aging. Of all of the changes of facial aging, the most important are the visual changes which are seen with the loss of facial subcutaneous volume. Effective treatment of facial lipoatrophic changes has been difficult, being limited to facial lipograting, with difficulty in many patients in obtaining sufficient donor lipograft tissue to effectively restore needed facial fullness, as well as variability in duration of lipografted tissue, even with the use of micro graft techniques of lipografting. Injectable Poly-L-lactic acid is a recently introduced injectable subcutaneous filler, indicated for the correction of lipoatrophy associated with anti-retroviral usage. This present study will illustrate the use of injectable poly-L-lactic acid in the treatment of intrinsic lipoatrophic facial aging in select patients who otherwise would not be ideal candidates for fat lipografting. Methods: Patients were selected for correction of mid-cheek and adjacent perioral intrinsic involutional loss of subcutaneous volume. These candidates for treatment were not ideal candidates for fat auto grafting correction, either by reason of limited donor adipose tissue availability or by reason of only limited sustained correction using prior fat auto grafting. The method of poly-L-lactic acid injection was similar to the deeper subcutaneous micro graft techniques of both Coleman and Amar fat auto grafting. A Canfield photographic fixed plan system was used to document and compare the pre and post procedure results. All patients treated with poly-L-lactic acid treatment will be followed for 2 years posttreatment. Results: Poly-L-lactic acid injectable treatment can, in selected patients, achieve correction of one of the most important aspects of facial aging, facial intrinsic lipoatrophy. The results of this study are early observations of correction as observed over 4 months post initial correction with a planned time of observation of over 2 years. Conclusions: One of the most prevalent and important aspects of facial aging, is facial lipoatrophy, the intrinsic loss of facial fatty tissue. These changes of lipoatrophy intrinic to facial aging may be effectively corrected, with a restoring of natural facial contour and form, in selected patients with subcutaneous injection treatment with poly-L-lactic acid. Nothing to disclose.
Ab# 153-04 IMPROVEMENT OF FACIAL RHYTIDS THROUGH A NOVEL TRANSDERMAL DRUG DELIVERY SYSTEM Jaggi Rao, MD, Division of Dermatology, University of Alberta, Edmonton, Alberta, Canada; Mitchel P. Goldman, MD, Dermatology/Cosmetic Laser Associates of La Jolla, Inc., La Jolla, CA, United States Background: Until recently, the only drugs that could enter the skin transdermally were those possessing a very limited and specific combination of structural and chemical properties. Recent advances in bioengineering have led to enhancement technologies designed to transiently overcome the barrier function of the stratum corneum and facilitate drug delivery. In particular, iontophoresis and electroporation have the potential to greatly expand the range of drugs that can be delivered across the skin surface. Purpose: To evaluate the safety, tolerability, and efficacy of transdermal type I collagen delivery using a drug delivery system combining iontophoresis and electroporation, for the treatment of facial rhytids. Materials and methods: Ten healthy adult females with symmetrical facial rhytids were randomized to receive treatment on only one half of the face. The contralateral side served as an internal control. Subjects received 2 transdermal treatments given 2 weeks apart, of soluble collagen type I using an iontophoresis and electroporation device. Prior to first treatment and at follow-up, facial rhytids were evaluated by a blinded dermatologist reviewer. High-quality photographs were examined by 4 independent, blinded observers to assess improvement. Punch biopsies from treated and non-treated preauricular skin were performed and analyzed. Subjects completed questionnaires to document tolerability and efficacy. Results: All subjects tolerated the treatments well with only minimal, local, and transient side effects seen. The majority of subjects reported an improvement of facial contour and rhytids on the treated side. Evaluations by both physician and independent, blinded observers showed that all treatment sites demonstrated considerable improvement over control. Histologic sections of treated areas showed retention of exogenous collagen within both the papillary dermis and areas of the reticular dermis. Conclusion: This study demonstrates that through iontophoresis and electroporation, transdermal delivery of macromolecules is not only possible, but is also safe, tolerable, and effective. In addition, this technology may enhance the efficiency of topical therapies, such as anesthetics, antibiotics, anti-inflammatories, or photodynamic drugs by several orders of magnitude. Many exciting studies are in progress to further examine this breakthrough in drug admininstration.
Ab# 153-06 DIFFUSION, DISPERSION, OR ACTION HALOS OF BOTULINUM TOXINS? A PILOT STUDY COMPARING TWO COMMERCIAL PREPARATIONS OF TYPE A BOTULINUM TOXINS Doris Hexsel, MD, Doris Hexsel Dermatologic Clinic, Porto Alegre, RS, Brazil; Taciana Dal, MD, Forno Dini, MD, Doris Hexsel Dermatologic Clinic and Federal University of Rio Grande do Sul, Porto Alegre RS, Brazil; Debora Zechmeister do Prado, Doris Hexsel Dermatologic Clinic, Porto Alegre, RS, Brazil; Camile Hexsel, MD, University of Passo Fundo, Passo Fundo, RS, Brazil; University of Miami, FL, United States Diffusion of BT is crucial to determine the extension of the action area from the injection point. Differences between halos of action can determine different results, not merely affecting the efficacy of the procedure but also the results, which may be the cause of local side effects. Some factors can affect the diffusion or the action halos, such as the injected amount, the angle of the injection, and the bleeding caused by the injections.1 The largest radius of action from one commercial preparation can be useful to cover a bigger area of one or more muscles from a single point of injection, as well as cause side effects in adjacent muscles. Knowledge of the radius of action of the two most used commercial preparations of BT is very important, because it can increase the safety of the procedure. In order to determine and compare the radius of action of BOTOX and Dysport, we performed a randomized blind pilot study in 18 patients, injecting one point of each preparation, diluted 1: 2.5, BOTOX to Dysport, in each side of the upper part of the frontal muscles and lateral part of the periorbital muscles. The results showed that there are no significant differences between these two preparations, in the doses and muscles studied.
Reference 1. Le Louarn C. Toxine botulinique et rides faciales: Une nouvelle proce´dure d9 injection. Chir Plast Esthet 1998;43:526-33.
Nothing to disclose.
AB2
J AM ACAD DERMATOL
MARCH 2005