Introduction Intradermal injection of botulinum toxin type A (BoNT/A) has been used off-label by many clinicians for face-lifting. Previous studies on abobotulinumtoxinA (ABO) (Dysport®; Ipsen Biopharm Ltd.) have demonstrated clinical efficacy in face-lifting when compared to normal saline solution (NSS). However, few clinical studies have evaluated ABO in terms of duration of sustained effects for face-lifting. Methods Thirty subjects were enrolled, and their face was injected with ABO at a dilution of 1 vial:7 mL (500 U in 7 mL of NSS) using an intradermal injection technique. Standardized photographic documentation was obtained using a two-, and three-dimensional imaging system (Vectra H1, Canfield Scientific, Inc, Fairfield, NJ) at baseline, immediately after injection, 2 weeks after injection and at 1 , 2 , 3 , 4 , 5 and 6 months of follow-up after treatment. The face-lifting effects were graded by both the subjects and two blinded dermatologists who compared photographs taken at the different time points. Side effects were also recorded at the end of the study. Results Of the 30 subjects, 28 completed treatment and attended every follow-up visit. All subjects were female with Fitzpatrick skin type II to IV. The average age of the subjects was 27.6 ± 3.4 (range 22–34) years. The total number of ABO units used varied for each subject (range 200–250 U), with the average (± standard deviation) dose being 237 ± 19 units. Most of the subjects reported significant face-lifting up to 3 months post-procedure. However, face-lifting assessed by blinded dermatologists was notably lower than that of each patient’s evaluation. The difference in the facial contouring volume of the nasolabial fold and jawline, as measured by the Vectra H1 imaging system, was statistically significant from baseline up until 3 months after injection ( p = 0.001 and p = 0.001, respectively). The only side effect found in this study was minimal bruising, which was seen in 13.8% of subjects. None of the subjects reported facial asymmetry, either at rest or during facial expression. Conclusion The results of this study demonstrate the face-lifting effect of ABO intradermal injection. The results show sustained effects up to 3 months after injection.

Background Enlarged facial pores are one of the common skin signs of photoaging that patients seek treatment for. However, objective data and long‐term assessment on the efficacy and safety of therapeutic procedures for this condition are limited. Objective To objectively evaluate the efficacy and safety of a 1064‐nm picosecond laser with microlens array (MLA) for pore tightening. Methods Twenty‐five patients with enlarged pores received three treatments with a 1064‐nm picosecond laser coupled with MLA at 4‐week intervals. Patients were evaluated using objective (measurement of pore volume using three‐dimensional photography) and subjective (clinical evaluation by two blinded dermatologists) assessments at baseline and at the 1‐, 3‐, and 6‐month follow‐ups. Adverse effects were also recorded during each visit. Results After three treatments, there was a significant reduction of pore size from baseline (p < 0.001). The improvement in pore size appearance significantly continued from the 1‐month to the 6‐month follow‐up visits (p = 0.013). The total average pore size was 1.15652 ± 0.614322 and 0.8087 ± 0.50515 at baseline and at 6 months after the final treatment, respectively, resulting in an average of 30% reduction in pore size. No cases of dyspigmentation, textural alteration, or scarring were documented. Conclusion Fractional 1064‐nm picosecond laser appears to be effective and safe for reducing pore size in Asians with minimal transient side effects.

Background The Vitiligo Extent Score (VES) and Self-Assessment Vitiligo Extent Score (SA-VES) have not been formally validated in Thai population. Objective To evaluate reliability, validity and feasibility of the VES and SA-VES in Thai vitiligo patients. Methods Vitiligo lesions from 100 patients were evaluated by 2 independent dermatologists using VES and Vitiligo Area Scoring Index (VASI). Reliability was assessed by comparing VES scores between physicians. Validity was determined by comparison among the VES, VASI, and SA-VES instruments. Patients scored their vitiligo severity using the SA-VES. Results The reliability of the VES was excellent (inter-rater reliability: 0.997, 95% confidence interval: 0.995–0.998). There was very strong correlation between the VES and VASI ( r =0.976, p <0.001), and strong correlation between the VES and SA-VES ( r =0.890, p <0.001), and between the VASI and SA-VES ( r =0.866, p <0.001). Moderate correlation among the VES, VASI, and SA-VES was observed in patients with segmental or <1% body surface area (BSA) vitiligo. Ninety-five percent of patients rated the SA-VES as easy to moderately easy. Conclusion The VES has reliability and validity comparable to that of the VASI. The SA-VES is an user-friendly instrument that correlated well with physicians’ scoring methods in patients with non-segmental or >1% BSA vitiligo.

Bimatoprost ophthalmic solution 0.03% (PGF2α analogues) combined with narrowband ultraviolet B (NB-UVB) was reported to be an effective treatment for vitiligo. To investigate the efficacy and safety of treatment for non-segmental/segmental vitiligo compared among bimatoprost ophthalmic solution 0.01% combined with NB-UVB phototherapy, bimatoprost monotherapy, and placebo. This single-blind randomized controlled study enrolled stable Thai vitiligo patients with at least three similarly sized lesions in the same anatomical area. The treatment duration was 6 months with 1- and 2-month post-treatment follow-ups. The 3 selected lesions on each patient were randomized to receive combination therapy, monotherapy, or placebo. The Vitiligo Area Scoring Index (VASI) was used to evaluate lesion response. Of the 25 initially enrolled subjects, 19 patients were analyzed. There were 13 and 6 non-segmental and segmental vitiligo cases, respectively. Eight and 11 cases had face/neck and non-face/neck lesions, respectively. Non-segmental vitiligo and non-face/neck vitiligo patients in the combination group had significant improvement in VASI score at 3 months, 6 months, and at the 2-month follow-up. No side effects were observed/reported. Bimatoprost combination therapy was shown to be safe and effective for treating Thai patients with non-segmental vitiligo in non-face/neck areas of the body.

Objective: This research aim to compare (1) the sensitivities and specificities of Tzanck smears and indirect immunofluorescence assays (IFA) for cutaneous HSV and VZV infections in real-life settings; and (2) the detection rates of the tests for various patient types and lesion morphologies.Materials and Methods: This retrospective study reviewed 440 and 172 samples from patients with clinically suspicious cutaneous HSV and VZV infections, respectively. All patients underwent a Tzanck smear and IFA. The gold standard for the study was agreement of pre- and post-diagnostic coding (determined by a dermatologist) for cutaneous HSV and VZV infections.Results: For HSV infections, the respective sensitivity and specificity of Tzanck smears were 32.8% and 96.6%, whereas those for IFA were 60.7% and 100%. As to VZV infections, the sensitivity and specificity of Tzanck smears were 54.3% and 97.8%, respectively, while the corresponding IFA values were 71.7% and 100%. According to disease characteristics and lesion morphologies, the detection ability of cutaneous HSV by IFA was substantially higher than Tzanck smear especially in immunosuppressed condition.  Tzanck smears and IFA demonstrated no statistical difference for early-onset ( 3 days) VZV infections.Conclusion: Tzanck smears and IFA had higher sensitivities for detecting VZV than HSV infections. IFA testing in suspected cutaneous HSV patients with immunosuppressed conditions should be recommended. Despite the overall sensitivity and specificity of IFA being greater than those for Tzanck smears especially in HSV infections, the latter test is a comparable option for early-onset VZV infections.

BACKGROUND Physiologic lip hyperpigmentation is a common aesthetic concern, especially in Southeast Asia. There is limited data on the application of the picosecond laser for this condition. OBJECTIVE To evaluate the efficacy and safety of using a 755-nm picosecond laser in the treatment of physiologic lip hyperpigmentation. METHODS Twenty healthy patients with physiologic lip hyperpigmentation received 5 bi-weekly treatments with a 755nm picosecond laser using a 6-mm spot size, fluence of 0.71 J/cm 2 at 5 Hz. Subjective and objective evaluation on the improvement of lip hyperpigmentation were obtained at baseline, 2 weeks after each treatment and at 1, 3, and 6 months after the final treatment. Patient self-assessment, pain score, and adverse reactions were also recorded. RESULTS All patients completed the study and attended all follow-ups. Most (52.6%) patients presented with moderate clinical improvement at 6-month follow-up. The average melanin index decreased significantly after the fourth treatment (p 5 .048) and at 1-month follow-up (p 5 .026). More than half the patients (70%) reported moderate-to-marked improvement at 6-month follow-up. Only 1 patient presented with a transient adverse reaction of lip edema. CONCLUSION The 755-nm picosecond laser is safe and effective for the treatment of physiologic lip hyperpigmentation in Thai patients.

Background: Taking the perspectives of patients into consideration is of the utmost importance when defining treatment goals for psoriasis. The patientacceptable symptom state (PASS) is a dichotomised question that captures patients' perceptions of their overall health state.Objectives: To evaluate PASS and determine the factors associated with a satisfactory PASS for psoriatic patients.Methods: Three questions were asked: (Q1) Considering the ways that your skin symptoms affect your functioning, is your current skin psoriasis satisfactory? (Current PASS), (Q2) Considering the ways that your psoriasis is affecting you, if you were to remain in this state for the next few months, would this be satisfactory? (Future PASS) and (Q3) If you were to remain for the rest of your life as you were during the last 48 hours, would this be satisfactory? (Lifelong PASS). Disease severity, symptoms and health-related quality of life (HRQoL) were collected.Results: Of 140 patients, 74.3%, 70.0% and 85.7% expressed satisfaction with their current, future and lifelong skin psoriasis conditions respectively. A satisfactory PASS was significantly associated with older and married patients; lower disease severity; fewer skin symptoms; and a higher HRQoL. A multivariate analysis revealed that the independent factors associated with a satisfactory PASS were being older than 40 years, being married, practising meditation, not having extensive lesions at sensitive areas and having a high HRQoL.Conclusions: PASS is a simple and easily administered questionnaire that reflects both disease severity and HRQoL. Understanding patients' needs and satisfaction levels will result in better care for psoriatic patients than otherwise.

Background: Submental fat is a noticeable fat in the submental region that is of great concern aesthetically, especially to female patients. A 1060-nm diode laser is a clinically proven device for the laser lipolysis of subcutaneous fat cells. This study aimed to evaluate the safety and efficacy of a 1060-nm diode laser for submental fat reduction. Methods: Twenty subjects with unwanted localized submental fat were treated with a single session of a 1060-nm diode laser with an energy setting between 0.95 and 1.40 W/cm 2 , depending on each patient's tolerance. Submental fat thickness measurements were documented at baseline, and 1, 3, and 6 months after treatment. Clinical photographs, ultrasound images, and adverse events were evaluated at each follow-up visit. Subjects responded to a satisfaction questionnaire at the end of the study. Results:The subjects had a mean age of 34.55 ± 6.19 years, a mean body weight of 70.66 ± 10.55 kilograms, and most (95%) were women. The average energy setting was 0.95-1.40 W/cm 2 , with a pain score of 3.90 ± 1.30 on a 0-to-10 scale. A significant reduction in submental fat thickness measured by ultrasound was noted at post-treatment month 3 (falling to 0.46 ± 0.13; P = 0.013). However, there was a slight increase in the submental fat thickness at the 6-month follow-up (to 0.48 ± 0.12); the change in the thickness relative to the baseline was nonsignificant (P = 0.121). Most subjects reported an improvement 6 months after the treatment. No severe adverse events were observed throughout the study period. Conclusion:Our study demonstrated the potential role of 1060-nm Diode laser for the treatment of localized submental subcutaneous adiposities. It is a promising alternative treatment modality for patients seeking an in-office, nonsurgical procedure for fat reduction without severe complications.