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Background: Facial dyspigmentation is a challenging concern which cannot easily be corrected. Although the application of topical exosomes has shown some efficacy, there is still scarce data addressing the role of plant-derived exosomes for skin hyperpigmentation. Objectives: This study using rose stem-cell-derived exosomes (RSCE) was performed as a proof-of-concept case series to evaluate the efficacy and safety of microneedling and topical RSCE, for the reduction of pigmentation and photoaging in adult volunteers. Methods: Twelve female volunteers were recruited, with a mean age of 46.64 years and a moderate-to-severe facial pigmentation, due to solar lentigines, melasma, postinflammatory hyperpigmentation, and periorbital hyperpigmentation. Three treatments were performed at 3 weeks intervals. These consisted of the topical application of RSCE with microneedling and a 20 min LED light with an RSCE-infused mask. A 3D facial analyzer was used to quantify improvement in superficial, deep pigmentation, skin redness, and wrinkles at baseline, Weeks 3, 6, and 12. Global Aesthetic Improvement Scale (GAIS), Dermatology Life and Quality Index (DLQI), and Melasma Quality of Life Scale (MELASQoL) scores were noted at the same time points. Results: GAIS scores improved by at least 1 scale point. Superficial pigmentation and spots decreased by 12.95% and deep pigmentation improved by 15.9%, by Week 12. Skin redness was reduced by 7.34% at the same time point. The measured wrinkle reduction was 6.34%. DLQI scores were reduced by 10 points, and MELASQoL scores had a mean reduction of 30 points at Week 12. Conclusions: Improvement of facial pigmentation is possible when combining nonthermal microneedling and the use of topical RSCE.

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Regenerative aesthetics aims to restore the structure and function of aging skin. Two products, Radiesse (CaHA) and NCTF 135 HA (micronutrient mesotherapy) have been established as minimally invasive treatments that restore the structure and function of various skin components. It has been anecdotally observed by the authors, however, that some patients respond suboptimally to regenerative treatments without a clear indication as to why. It was hypothesized that micronutrient deficiencies in some patients may contribute to their lack of responsiveness and that a concurrent delivery of amino acids and co-enzymes may create a nutritional reservoir necessary for optimal protein synthesis. Noting that CaHA is known to drive the regeneration of extracellular matrix proteins, the aim of this case series was to investigate if “priming” the skin with NCTF 135 HA could lead to enhanced clinical effects of CaHA. The combination treatment resulted in improvements in panfacial aesthetics, skin laxity, wrinkle severity, skin luminosity, hyperpigmentation, and in skin and subcutis thicknesses in 100% of patients following a single treatment. This study is the first to introduce skin priming via diluting a regenerative biostimulator treatment with an amino acid-based diluent.  Citation: Theodorakopoulou  E, McCarthy A, Perico V, et al. Optimizing skin regenerative response to calcium hydroxylapatite microspheres via poly-micronutrient priming. J Drugs Dermatol. 2023;22(9):925-934. doi:10.36849/JDD.7405.

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The authors present a rare case of Birt-Hogg-Dubé (BHD) syndrome that presented primarily as an aesthetic case. Previous providers failed to accurately diagnose BHD, despite the patient's history of pneumothoraces. This female patient complained of numerous recurrent, small skin-colored growths on the face and neck and patchy hypopigmentation from the multiple treatments she had to undergo for her "bumpy skin." She also suffered 4 spontaneous pneumothoraces. Following histopathologic and genetic testing, the patient was diagnosed with BHD. Computed tomography and ultrasound scans revealed multiple cysts in both lungs and an angiomyolipoma in both kidneys. This patient had undergone a variety of treatments to aesthetically remove and heal her skin bumps from several healthcare providers, all of whom had misdiagnosed her condition.

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Psoriasis (Pso) and psoriatic arthritis (PsA) are chronic and debilitating diseases which often develop in the same patient and are linked to a wide range of comorbid conditions. Dermatologists and rheumatologists need to cooperate in combined clinics, especially when they deal with severe, recalcitrant disease, and multiple comorbidities. The clinical and research benefits of this collaboration have been previously described to contribute to a better and more sustainable health care system. To apply a more holistic approach of patients with Pso and PsA, we established the first dual care clinic in Greece, for Pso and PsA patients, based at Attikon General University Hospital. Hereby, we describe the infrastructure and operation of a combined Pso and PsA clinic (PPAC), in the national health care system of Greece, and its impact on the management of Pso and PsA. The PPAC is a single-day joint clinic, held once a week, which consists of three dermatologists and three rheumatologists. We present the results of 185 newly diagnosed patients between December 2018 and January 2019. Mean age of onset of Pso was 34 ± 16 years old and 47 ± 12 years old for PsA. Most patients suffered from severe plaque Pso (144/185, 78%) and asymmetric oligoarticular arthritis (59/185, 32%), for which they were receiving treatment with biologic agents (105/185, 57%). Many required monitoring for hypertension (74/185, 40%), dyslipidemia (69/185, 37%), diabetes (17/185, 9%), and depression (20/185, 11%). Patients reported high levels of care satisfaction (visual analogue scale: 86 ± 11.5), using the PPAC facility, compared to different referrals between specialties. This is the first joint dermatology-rheumatology clinic in Greece, providing comprehensive care in patients with Pso and PsA. Our results support the concept of combined clinics delivering better integrated care for such patients.

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