Background
Masseter muscle hypertrophy (MMH) usually presents with cosmetic concerns as it may lead to widening of the lower face. Apart from the traditional surgical approaches, botulinum toxin type A (BTA) injection is a non‐invasive treatment option available. There are no standard guidelines for this procedure.
Objectives
To study the efficacy of botulinumtoxin A in MMH for lower face contouring.
Methodology
The Cochrane Library, PubMed/MEDLINE, Google‐scholar, Science‐Direct database, and ResearchGate from inception until September 2021 were searched using the keywords “botulinumtoxin type A,” “masseter muscle hypertrophy,” “lower face contouring,” and “masseter botox.” All available retrospective and prospective studies, case‐series, case‐reports, and expert reviews were included with an emphasis on efficacy of BTA in MMH and units injected into the muscle, points of placement, adverse events, and the duration of its effect. Reference lists of the resultant articles, as well as relevant reviews, were also searched.
Result
40 articles were shortlisted for the review, of which 14 studies with sample‐size ≥10 in accordance with the study requirements were summarized in a tabular form for analysis and easy comparison and reference.
Conclusion
BTA injection is a non‐invasive, safe, and effective treatment for MMH. The optimum number of BTA units could not be ascertained due to wide variability in the studies as well as ethnicity of patients and extent or some measurement of MMH. The points of placement of injection should be well within the boundaries of the masseter muscle. The maximum effect of BTA after a single injection session is usually seen in ~3 months, and the duration may last for 6–12 months. Multiple injection sessions may be required to maintain a long‐term effect. Injection technique and total number of injection units of neuromodulator must be individualized for each patient.
Poikilodermatous mycosis fungoides (PMF) is a rare clinical variant of early-stage mycosis fungoides with peculiar histological features and with low risk of disease progression. Since poikiloderma can coexist with classical mycosis fungoides lesions, PMF can only be considered when poikilodermatous lesions are predominant (>50% of lesions). We here report one such rare case of PMF with poikilodermatous lesions covering almost 70% of the body surface and with characteristic clinical, histopathological, dermoscopic, and immunohistochemical findings.
DEAR EDITOR, A 42-year-old woman developed erythematous pruritic symmetrical acral plaques 4 weeks after SARS-Cov-2 infection (reverse transcription polymerase chain reaction positive) that resolved in 2 months with topical medications. Three months after full recovery from the infection, she was administered a first dose of recombinant monovalent vaccine (Covishield). A week later, there was aggravation of erythema, oozing and scaling over the previously healed lesions. Examination showed hyperkeratotic erythematous acral plaques with a sharp cutoff from palms and soles. Patches of hypopigmentation over the dorsum of the hands were also noted (previously healed lesions) (a, b). Skin biopsy from the left leg a week later showed psoriasiform hyperplasia with keratinocyte necrosis (c, d). The patient was treated for necrolytic acral erythema 1,2 with oral zinc supplementation (low serum zinc level) and topicals, with gradual response.
This case report describes multiple coalescing brownish black macules with irregular borders over the left palm and palmar aspect of the digits, with black pigmentary accentuation over the creases.
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