University of Camerino and Torino, Italy
Introduction: Recent studies have shown autologous collagen regeneration, efficacy on face and neck lifting and safety of transcutaneous micro-focused ultrasound procedures. Despite this, guidelines on clinical indications and technical aspects such as the proper number of energy spots to be delivered to the patients are lacking.
Materials and methods: We reviewed 925 women with a mean age of 51, 3 years (range 33 – 64 years), with soft to severe skin ptosis of the face according to APSS (Araco Ptosis Scale System),which received an average of 1.060 spots of micro-focused ultrasound as sole treatment.
The first statistical analysis was conducted on the differences in the number of spots delivered in different homogeneous groups. The first group of 56 patients received an average of 486 lines; the second group of 73 patients received an average of 1.126 lines and the third group of 66 patients received an average of 1460 lines.
The second analysis was conducted on the differences in clinical indication according to APSS in three different homogeneous groups. The first group of 175 patients was on APSS 2; the second group of 193 patients on APSS 3 and the third group of 184 patients on APSS 3.
Standardised digital photographs and 3d reconstructions with VectraH2, before and 6 months after treatment were assessed by two blinded independent doctors (F.A.; M.A.) which scored photographs from 1 to 20 according to the SASS (Surgeon Assessment Scoring System). The reduction of at least 4 set points was considered a significant difference.
A patient satisfaction questionnaire (PSQ) were given to patients that scored the results from 0 to 10. The reduction of at least 2 set points was considered a significant difference.
Result: All patients completed the follow-up after 6 months and no major side effects were reported.
Result on energy lines delivered: Only groups 2 and 3 reached the statistical significant difference according to SASS and PSQ.
Result on face ptosis groups: Only groups 1 and 2 reached the statistical significant difference according to SASS and PSQ.
Conclusion: Our retrospective study showed that in order to stimulate collagen regeneration and tissue contraction (lifting effect), itʼs necessary to deliver a significant number of energy micro-focused ultrasound lines and choose the right patient indication.
Dr. Antonino Araco is a Consultant Aesthetic Surgeon and Medical Director at Jenevì Medical since 2010. He is a Contracted Professor at University of Camerino and Torino. He is also an International Speaker and Scientific Researcher (over 60 articles in peer reviewed Journal). During 2003-2010 he was a consultant surgeon at Dolan Park Hospital, Birmingham (UK).
Dermapremier Skin Clinic, Egypt
As we age, our bodies produce less Collagen and Elastin. This causes our skin to lose elasticity and firmness, resulting in sagging skin. The skin around your eyes is thin and more sensitive than the skin elsewhere on our body. Itʼs more prone to wrinkles, sagging and fine lines.
In the past, they considered the upper lid Blepharoplasty to be in the domain of a surgeon after all, and that we can only slightly help in lifting the eyelids with Botox. Plasma based energy device (Purisma) developed to treat this delicate area safely and perfectly where lasers and radio surgical units cannot. During the treatment itself, the skin of the upper and lower lids is lifted and the excess skin disappears without surgery and without long recovery time.
It works according to the principle of fractional plasma and is extremely precise and creating a series of minute dots on the skin, which trigger an instant contraction, and tightening of the skin, to create a lifting, remodeling and rejuvenating effect of the treated area.
Dr. Belkais Marwan graduated from Al Minia University in 1994 (Egypt), she obtained her Masters Degree in Dermatology in 1999. Dr. Belkais worked as an Assistant Lecturer from 2000 till end of 2012 at Al Minia University, Egypt, then for two and half years at Medcare Hospital (Dubai-UAE) from 2009 till 2011. She worked in a private clinic from April 2011 till December 2014 then, she moved to her Clinic (Dermapremier Skin Clinic) on January 2015 till now.
• MD research topic about: A thesis submitted for partial fulfillment of Doctoral- (M.D.) degree in Dermatology, STDs and Andrology Titled: Comparative study between Botulinum Toxin A injection and Laser resurfacing for facial wrinkles.
• M.sc in Dermatology and Andrology, Al Minia University, Egypt 2000.
• Diploma in Aesthetic Medicine from AAAM, 2011.
• B.sc. in Medicine and Surgery, Al Minia University, Egypt 1994
Hong Kong Academy of Medicine, China
Sensitive skin, Rosacea and Chronic Atopic Dermatitis (AD) are prevalent skin conditions which are difficult to manage and have a significant impact to personʼs quality of life and diseases burden to the community. On the surface, they look as belong to different disease category, they share similar underlying pathogenetic mechanisms. Particularly worth discussion is the association of these diseases with the widely distributed Transient Potential Receptors (TRP) channels and its associated protein interactors G Protein C Receptor (GPCR) and signalling pathways. TRP not only transduce environmental noxious signals like allergens, microbiomes, pH variations, temperature change and reactive chemicals through the defective skin barrier resulting neurogenic and non-specific inflammation but also involve in the multi-faceted manifestations of these diseases especially cognitive impairments of the Central Nervous System resulting in emotional disturbances, sleep deprivation, unhappiness and depression. This skin – cognitive pathway is well illustrated by the recalcitrant itch – scratch – cycle in chronic AD and the psychiatric co-morbidities in Rosacea with its cardiovascular and metabolic complications. Interestingly, the gut is also shown to be linked to this axis immunologically. In the lecture, the recent scientific evidences of this gut – brain – skin – motor and non-motor functional axis will be discussed with reference to the above skin conditions and Parkinsonʼs Disease (PD).
Keywords: Sensitive skin, Rosacea and AD, TRP channels, Gut – Brain – Skin – Movement Axis, Parkinsonʼs disease.
Dr. Chan Kam Tim Michael is a practicing private Dermatologist in Hong Kong. He received his Fellowship from Hong Kong Academy of Medicine (FHKAM) (Medicine) as a registered Dermatologist since 1998. He received his post- doctoral training in University of California, Los Angeles (UCLA) in 1997. He is now the Vice President of the Association of Integrative Aesthetic Medicine (AIAM) in Hong Kong. In 2017, he was invited and served as editorial board member of the following International Journals: Journal of Anatomy and Physiological Studies; the Cognitive Neuroscience Journal; Research Journal of Nervous System; Medical Reports and Case Studies; Advances in Neurology and Neuroscience. He has been the Editor of Hong Kong Journal of Dermatology and Venereology from 2002 to 2007. Honorary Clinical Assistant Professor of the Faculty of Medicine in The University of Hong Kong from July 2007 to June 2009.He also fulfilled his part time lectureship in the Baptist University of Hong Kong in teaching a Master Course on Public Health and Common Goods for the Public since 2013.
Hong Kong Academy of Medicine, China
Scratching is a distinguishing feature of many resistant dermatosis like Chronic Atopic Dermatitis. Recently, discovery in neuroendocrinology, immunology and MRI studies suggest itch – scratch cycle may be an addictive neuroendocrine mediated pathological movement pathway with an aberrant and imbalance of neurotransmitters in Central Nervous system (CNS).
Mas-related G protein-coupled receptor A3 (MrgprA3) and MrgprC11 expressed afferent neurons penetrated in the epidermis together with Transient Receptor Potential (TRP) receptors like TRPV (vanilloid) 1, TRPV 3, TRPV4, TRPA (ankyrin) 1 together with Serotonin receptors relay itch signals from the periphery synapses to the dorsal horn of spinal cord. Pruritogenic signals via the afferent neurones synapse with Gastrin -Releasing Peptide Receptors(GRPR) in the spinal cord. GRPR activation released substance P, Calcitonin G Releasing Peptide, Vasoactive Intestinal Peptide including Pituitary adenylate cyclase activating peptides which was distributed in the CNS. Endothelin-1, tachykinin through neurogenic inflammation increased levels of Th2 cytokines and interleukin – 31 also mediate itch. The central station of itch transmission in our brain is the Thalamus. Hedonic scratch activated the primary somatosensory S1 areas gave the perception of comfort in the cingulate cortex decided the planned motor response of scratching. The midbrain, striatum, ventral tegmental area, caudate nucleus and ventromedial prefrontal cortex as shown by MRI studies are activated in this pleasant circuitry. If this endogenous neuroendocrine circuitry become uncontrolled, harmful cravings behaviour superseded. Insula cortex and Claustrum of the brain play a prominent role in interoception including addiction. They are highly activated when itch is intensified. The adverse pruritic experience is represented in amygdala, subcallosal gray matter and nucleus accumbens. The miswiring and imbalance of 5 Hydroxytryptamine and its multiple receptors are involved.
Besides pharmacological intervention, cognitive behavioural therapy including education, refocusing attention strategy; virtual reality immersion; audio visual distraction techniques; habit reversal training; arousal reduction and cognitive restructuring are helpful.
Chan Kam Tim Michael is a practicing private Dermatologist in Hong Kong. He received Dermatology Specialist Fellowship in Hong Kong Academy of Medicine in 1998. In the same year, he was granted a Government of Hong Kong scholarship for post graduate training in UCLA, USA. He is now the Vice President of the Association of Integrative Aesthetic Medicine in Hong Kong. He was editor of the Hong Kong Journal of Dermatology and Venerology from 2002 to 2007. He acts as Editorial Board Members of the following international journals since 2017: Research Journal of Nervous System; The Cognitive Neuroscience Journal, Medical Reports and Case Studies and Advances in Neurology and Neuroscience. He has been working in the University of Hong Kong as Honorary Clinical Assistant Professor from 2007 to 2009. He is now a part time lecturer in the Baptist University of Hong Kong for teaching Master Course in Public Health.
1East Tennessee State University, USA
2University of Rochester Medical School and Dentistry, USA
The Spitz lesions are rare and challenging Melanocytic lesions that are primarily recognized during childhood. These lesions include the conventional Spitz nevus, atypical Spitz tumor and Spitzoid Melanoma. Clinically, Spitz lesions can be anywhere from pink or flesh-colored, to brown, to a black lesion that may grow and ulcerate. In addition, these lesions may affect any site, however, they predominantly present at the face or the head and neck region of a child or a young individual. Histologically, Spitz nevus is recognized as a proliferation of predominantly uniform Melanocytes in a raining-down pattern. Atypia, as well as mitoses, are not uncommon. Atypical Spitz tumor is characterized by melanocytic proliferation with significant Atypia, increased mitoses, and loss of the raining-down pattern with an extension to the subcutaneous adipose tissue resembling Spitzoid Melanoma. The latter is predominantly a dermal-based lesion with striking atypia, frequent dermal mitoses, and subcutaneous tissue invasion with significant tumor-infiltrating lymphocytes. The Spitz lesions may overlap clinically and histologically which make the lesion problematic to diagnose. In Spitz nevi and tumors, molecular studies with CGH and FISH revealed an increased chromosome 11p copy number and RAS mutation, respectively, whereas the mutation in Spitzoid Melanoma is BRAF with no increase in 11p copies. Treatment includes clinical follow-up of Spitz nevus while a complete excision with negative margins is recommended in atypical Spitz tumor and indicated in Spitzoid Melanoma.
In summary, the Spitz lesions are best described as a continuum of an evolving melanocytic lesions with significant clinical and histological overlap. Immunohistochemical staining with melanocytic markers have a limited use in these lesions. In problematic cases, molecular studies are used routinely for accurate diagnosis and proper treatment.
Haider A. Mejbel is a chief resident in Pathology at ETSU with a background experience in diagnosis as well as translational research in Skin Pathology. Following graduation from medical school, Dr. Mejbel had a formal research training in skin cancer biology under the tutelage of Dr. Thuy L. Phung. Dr. Mejbel developed his experience in Dermatopathology from Dr. Thuy L. Phung and enhanced his skills under the mentorship of Dr. Bruce R. Smoller. Dr. Mejbel and Dr. Smoller are awarded from The American Society of Dermatopathology for their current investigative research study of the Adnexal Skin Neoplasms. Dr. Mejbel recent publication includes co-authoring chapters in Phung, Wright, Pourciau, and Smoller “Pediatric Dermatopathology” textbook, and his research interest includes Primary Cutaneous Lymphoma, Pathology of the Skin Appendages, Childhood Melanoma and Pediatric Dermatopathology.
Nanorx Inc., USA
The skin is the largest organ of the body that fulfills multiple essential tasks. It forms the boundary between the inside and outside. It protects against mechanical and chemical threats, it provides innate and adaptive immune defenses, it enables thermoregulation and vitamin D production, and it acts as the sensory organ of touch. Skin diseases are a significant cause of global disease burden, affecting millions of people worldwide. There are more than 3000 known diseases of the skin. Aging, environmental and genetic factors, and trauma can result in the development of a diverse set of skin diseases.
Metadichol a nano formulation of long-chain lipid alcohols derived from food. It is a inverse agonist of Vitamin D Receptor (VDR), Aryl Hydrocarbon Receptor (AHR), and Ror game (RORC) that could have beneficial effects on skin diseases. We now present case studies of patients with various skin disease show Metadichol is an inverse agonist of these named nuclear receptors thus modulating Th1 pathway towards a TH2 and Th 17 and IL 17 and IL22 and also being a TNF alpha inhibitor can modulate IL23 thus blocking the major pathways that exacerbate many skin diseases.
Metadichol is the first molecule to successfully navigate around the problems involved with promiscuous ligands and targets. It fulfills the goals of the emerging field of Polypharmacology, i.e., a single drug is able to bind to multiple targets beyond the “one drug, one target” philosophy. We show how Metadichol is an innovative treatment or treating multiple skin diseases like eczema, acne, diabetic wounds, viral and bacterial infection and also improving skin texture. Metadichol ® is a safe non toxic low cost solution and is an alternative to numerous clinical candidates in combating over 3000 skin diseases.
P.R. Raghavan is a CEO of Nanorx INC has a Ph.D. in Organic Chemistry from Oregon State University (1979) and an M.S in Chemistry(1972) from I.I.T Mumbai, India. He has worked on drug discovery for over 25 years at Columbia University, Max-Planck Institute, Germany, Ciba-Geigy (now Novartis) and Boehringer Ingelheim. He has over 15 US and International patents and another 15 pending patent applications.
International Society of Aesthetic Genital Surgery and Sexology, Turkey
Aesthetic- Plastic genital operations and energy based genital cosmetic managements are the fastest growing segment within all of the aesthetic surgeries.
These operations are being done for aesthetic, functional, hygienic, medical and also for sexual purposes. Labiaplasty, vaginal tightening and perineoplasty operations are the most globally demanded operations by the patients. On the other hand genital laser, radiofrequency and PRP (Platelet Rich Plasma) are the non-invasive methods which can be applied for functional and cosmetic reasons as well. The patientʼs needs, expectancy and tissue anatomy should be very well evaluated before the surgery to get best results. And the surgeon should have training before starting these kind of operations.
Dr. Eserdag trained at Zekai Tahir Burak Womenʼs Health and Educational Hospital, the largest maternity hospital in Turkey. He acquired unique training experiences from some of the worldʼs most renowned experts when aesthetic genital surgery was in its infancy. He established his renowned clinic in three big cities of Turkey as ‘Hera Clinicsʼ, which attracts thousands of patients every year from countries all over the region. With his professional team since 2002, heʼs treated more than 6000 patients of sexual dysfunctions involving mostly vaginismus and dyspareunia, and also sexual desire, arousement, orgasmic problems.