Thu Minh Truong

Chemical peeling is a popular cutaneous resurfacing procedure for photoaging, fine lines, scarring, pigmentary disorders, wrinkles, and inflammatory dermatoses. We conducted a clinical pilot study with 18 subjects, involving initial screening, two peeling sessions, and a postpeel assessment. We used a combination peel containing 10% TCA and 24% lactic acid, with a pH ranging from 0.15 to 1.15. Subjects underwent clinic visits for cheek swabbing for microbial analysis, dermatologist assessment, VISIA imaging, and confocal microscopy at 4‐week intervals. Results: The score for global appearance, abnormal pigmentation, and fine and coarse wrinkling were assessed on a scale ranging from 0 ( absent ) to 9 ( severe ), with the following subscales: 1–3: mild, 4–6: moderate, and 7–9: severe. The average score for global appearance improved from 5 to 3.5, wrinkles from 4.5 to 3.5, and uneven pigmentation from 4.75 to 3.5. VISIA analysis showed an improvement in spots, brown spots, texture, pores, and red areas. Confocal microscopy showed a decrease in melanin and an increase in collagen. Microbial analysis indicated no imbalance in the microflora of the facial skin; counterintuitively, there was a trend showing an increase in species diversity after each peeling session as seen in Shannon diversity, Hill1 diversity, and observed taxonomic units. The facial peel was well tolerated and was effective in improving overall global appearance, uneven pigmentation, and wrinkles.

Background/Objectives: Adapalene is a synthetic retinoid used as a treatment for acne vulgaris. In this study, we attempted to evaluate the dermal pharmacokinetics of adapalene utilizing experimental and in silico tools. Methods: We utilized three over the counter (OTC) adapalene gels to evaluate local dermal pharmacokinetics. A data-driven, robust, mechanistic dermal physiologically based pharmacokinetic (PBPK) model was developed by integrating the physicochemical properties of adapalene, the formulation attributes of the gels, and the biophysical aspects of dermal absorption. The dermal PBPK model was validated against experimental data using in vitro release studies and in vitro permeation studies with human cadaver skin. A clinical study was performed to evaluate the effects of adapalene from the three gel formulations. The impact of adapalene delivery from three gels on the stratum corneum (SC) thickness, pilosebaceous unit area, keratinocyte number, and epidermal thickness was captured using a non-invasive technique, line-field confocal optical coherence tomography (LC–OCT). These responses were evaluated using an Emax model. Results: The dermal PBPK model has successfully predicted adapalene penetration profiles across different gel formulations. The model accuracy, in predicting drug release and permeation characteristics, was confirmed using the experimental data. Clinical evaluation revealed formulation-dependent differences in adapalene’s effects on measured skin parameters, with distinct pharmacodynamic profiles observed for each gel formulation. Conclusions: The overall study gave us a detailed insight into potential effects of formulation on the dermal pharmacokinetics and pharmacodynamics of adapalene using three marketed gels.

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Pemphigus represents a spectrum of autoimmune-mediated blistering diseases associated with high morbidity, mortality and reduced quality of life (QoL). Despite an increase in pemphigus clinical trials, the varied instrument measurements of disease severity and QoL outcomes make comparisons between studies challenging. This study aimed to evaluate trends in the use of disease severity and QoL outcome measurements in pemphigus clinical trials. A review of pemphigus clinical trials was conducted using the PubMed, Embase, Cochrane Reviews and ClinicalTrials.gov databases up until September 2023. Only pemphigus randomized clinical trials that assessed at least one disease severity and/or QoL outcome were included. Overall, 53 clinical trials were eligible for this review. All clinical trials evaluated a disease severity outcome, with the Pemphigus Disease Area Index being the most used validated questionnaire (28.3% of trials) and more popular after 2015 (47.8% of trials since). The autoimmune bullous skin disorder intensity score (7.6%) and visual analogue measurements (7.6%) have fallen out of favour. Most studies now include lab parameters (56.5% of trials after 2015), with anti-desmoglein 1 and 3 antibody levels (30.2%), immunoglobulins (IgG and/or IgM and IgA) (11.3%), and anti-drug antibody levels (7.6%) being frequently evaluated. A small portion of trials evaluated QoL (26.5% of studies), with the autoimmune bullous quality of life being the most common (15.1%), however QoL utilization as an outcome measure has been increasing since 2015 (61.1% of trials since). Standardising the use of validated outcome measurements allows for better data interpretation, comparability and clinical application of results.

Background: Theclinical presentation of atopic dermatitis (AD) varies in different skin phototypes and has been evaluated previously using reflectance confocal microscopy (RCM). Line‐field confocal optical coherence tomography (LC‐OCT) is a new noninvasive imaging modality with additional capabilities.Objectives: This prospective cohort study aimed to assess the capabilities of LC‐OCT and RCM in visualizing and quantifying microscopic features of AD lesions.Methods: Ten patients with clinically diagnosed AD and visible active lesions were included in the study. LC‐OCT and RCM imaging were performed on lesional and perilesional skin during routine dermatology visits. Image analysis included quantitative measurements of living and total epidermal thickness and dermo‐epidermal junction (DEJ) undulation using LC‐OCT, as well as visual assessment of characteristic features such as spongiosis, exocytosis, perivascular inflammation, and atypical blood vessels using both LC‐OCT and RCM.Results: LC‐OCT provided precise measurements of epidermal landmarks and shared similar microscopic features compared to RCM. AD lesions exhibited increased stratum corneum thickness, living epidermis thickness, total epidermis thickness, and DEJ undulation compared to clinically normal skin. Spongiosis, exocytosis, perivascular inflammation, blood vessel proliferation, and dilation were prominent features observed in AD lesions on both LC‐OCT and RCM images. Interestingly, some inflammatory features were also detected in the visually normal skin of AD patients.Conclusions: LC‐OCT showed potential as a fast and noninvasive imaging tool for assessing inflammatory skin pathologies, including AD. Its ability to visualize microscopic features and quantify epidermal changes may aid in diagnosis and treatment monitoring. These findings suggest that LC‐OCT could provide valuable insights, particularly for patients with darker skin types where clinical severity assessment may be challenging. Further studies are warranted to explore the full potential of LC‐OCT and its integration into clinical practice.

Background: Hydradermabrasion, also known as “HydraFacial,” is an exfoliative cosmetic procedure for skin rejuvenation that has gained popularity. Despite its increasing popularity, clinical studies validating its efficacy with non‐invasive assessment of histological changes to the skin, are scarce. In this study, we used Line‐Field Confocal Optical Coherence Tomography (LC‐OCT), an optical imaging device, to non‐invasively visualize microscopic changes to skin anatomy after hydradermabrasion treatment. Materials/Methods: Eight volunteers (Fitzpatrick skin types II–V) were recruited for this study. Images, using LC‐OCT (DeepLive, DAMAE medical) were obtained before and after hydradermabrasion and at 2 weeks post‐treatment. A commercially available hydradermabrasion device was utilized to perform the dermabrasion. Results: In the epidermis, initially, a decrease in the average thickness of the stratum corneum, from 9.42 to 6.67 µm was visualized in LC‐OCT images after hydradermabrasion. However, at 2 weeks of follow‐up, the average stratum corneum thickness was 9.75 µm, resulting in an overall increase in the average thickness after treatment. Improved homogenization of the stratum corneum and decreased number of undulations in the epidermis post‐treatment were also visualized. In all the subjects, the superficial dermis appeared stretched, which returned to baseline by the 2‐week follow‐up. At the 2‐week follow‐up, there were no visible differences in the quality and quantity of collagen fibers in the dermis. Conclusion: In our study, LC‐OCT images of the epidermis and dermis demonstrated microscopic features of skin rejuvenation when treated with hydradermabrasion. Thus, not only highlighting the efficacy of hydradermabrasion but also the potential of LC‐OCT to serve as a tool for visualizing the microscopic effects of cosmetic procedures on skin anatomy.

Artificial intelligence (AI) uses algorithms and large language models in computers to simulate human‐like problem‐solving and decision‐making. AI programs have recently acquired widespread popularity in the field of dermatology through the application of online tools in the assessment, diagnosis, and treatment of skin conditions. A literature review was conducted using PubMed and Google Scholar analyzing recent literature (from the last 10 years through October 2023) to evaluate current AI programs in use for dermatologic purposes, identifying challenges in this technology when applied to skin of color (SOC), and proposing future steps to enhance the role of AI in dermatologic practice. Challenges surrounding AI and its application to SOC stem from the underrepresentation of SOC in datasets and issues with image quality and standardization. With these existing issues, current AI programs inevitably do worse at identifying lesions in SOC. Additionally, only 30% of the programs identified in this review had data reported on their use in dermatology, specifically in SOC. Significant development of these applications is required for the accurate depiction of darker skin tone images in datasets. More research is warranted in the future to better understand the efficacy of AI in aiding diagnosis and treatment options for SOC patients.

Introduction: Exosomes are extracellular vesicles that transport bioactive substances during normal and abnormal cellular physiological processes. The unique properties of exosomes can be exploited for use as biomarkers and targeted drug delivery vehicles, and are, for this reason, gaining increasing attention in the field of dermatology. This review aims to synthesise the existing evidence supporting exosomes in regenerative and cosmetic dermatology. Method: A comprehensive PubMed search for the period of 2010–2023 was performed using the MeSH terms "exosome" and "skin.” The initial search yielded 246 studies, which were then refined to 178 studies following title and abstract screening. Studies were confined to human or animal studies published in English that evaluated the use of exosomes in medical/cosmetic dermatology. A subsequent full-text review based on these criteria yielded 34 studies, which were then reviewed. Results: Exosomes can be derived from a variety of biological sources and show potential application in wound healing, scar prophylaxis, photodamage prevention, skin regeneration, improved grafting success, hair loss mitigation, and as biomarkers and drug carriers. Conclusion: Exosomes are gaining traction in regenerative and cosmetic dermatology. However, their widespread clinical application is hindered by cost, a complex isolation process, lack of uniform protocols, limited assessment of infective potential, and a paucity of clinical evidence. Further research in this area is needed, especially by way of clinical studies evaluating the efficacy of exosome-based treatments on human skin.