IMPORTANCE Reticular veins are subdermal veins located in the lower limbs and are mainly associated with aesthetic complaints. Although sclerotherapy is the treatment of choice for reticular veins in the lower limbs, no consensus has been reached regarding to the optimal sclerosant.OBJECTIVE To compare the efficacy and safety of 2 sclerosants used to treat reticular veins: 0.2% polidocanol diluted in 70% hypertonic glucose (HG) (group 1) vs 75% HG alone (group 2). DESIGN, SETTING, AND PARTICIPANTS Prospective, randomized, triple-blind, controlled, parallel-group clinical trial with patients randomly assigned in a 1:1 ratio between the 2 treatment groups from March through December 2014, with 2 months' follow-up. The study was conducted in a single academic medical center. Eligible participants were all women, aged 18 to 69 years, who had at least 1 reticular vein with a minimum length of 10 cm in 1 of their lower limbs. INTERVENTIONSThe patients underwent sclerotherapy in a single intervention with either 0.2% polidocanol plus 70% HG or 75% HG alone to eliminate reticular veins. MAIN OUTCOMES AND MEASURESThe primary efficacy end point was the disappearance of the reticular veins within 60 days after treatment with sclerotherapy. The reticular veins were measured on images obtained before treatment and after treatment using ImageJ software. Safety outcomes were analyzed immediately after treatment and 7 days and 60 days after treatment and included serious adverse events (eg, deep vein thrombosis and systemic complications) and minor adverse events (eg, pigmentation, edema, telangiectatic matting, and hematomas).RESULTS Ninety-three women completed the study, median (interquartile range) age 43.0 (24.0-61.0) years for group 1 and 41.0 (27.0-62.0) years for group 2. Sclerotherapy with 0.2% polidocanol plus 70% HG was significantly more effective than with 75% HG alone in eliminating reticular veins from the treated area (95.17% vs 85.40%; P < .001). No serious adverse events occurred in either group. Pigmentation was the most common minor adverse event, with a 3.53% treated-vein pigmentation length for group 1 and 7.09% for group 2, with no significant difference between the groups (P = .09).CONCLUSIONS AND RELEVANCE Sclerotherapy with 0.2% polidocanol diluted in 70% HG was superior to 75% HG alone in sclerosing reticular veins, with no statistical difference for complications. Pigmentation occurred in both groups, with no statistical difference between them. No serious adverse events occurred in either group. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02054325
Background The independent role of solar radiation in the differential melanogenesis between melasma and adjacent skin is unknown. Objectives To assess the melanogenic responses of skin with facial melasma and of the adjacent skin to UVB, UVA, and visible light, in an ex vivo model. Methods This was a quasi-experimental study involving 22 patients with melasma. Facial melasma and adjacent skin samples were collected and stored in DMEM medium, at room temperature. One fragment was placed under the protection from light, while another was exposed to UVB, UVA, and visible light (blue-violet component): 166 mJ/cm 2 , 1.524 J/cm 2 , and 40 J/cm 2 , respectively. Subsequently, all samples were kept for 72 hours in a dark environment and stained by Fontana-Masson to assess basal layer pigmentation, dendrites, and melanin granulation. Results Effective melanogenesis was observed in the basal layer in melasma and in the normal adjacent skin after all irradiations ( p < 0.01), with the following median increment: UVB (4.7% vs . 8.5%), UVA (9.5% vs . 9.9%), and visible light (6.8% vs . 11.7%), with no significant difference between anatomical sites. An increase in melanin granulation (coarser melanosomes) was observed only after irradiation with UVA and only in the skin with melasma ( p = 0.05). An increase in the melanocyte dendrite count induced by UVB radiation was observed in both anatomical sites ( p ≤ 0.05). Study limitations Use of an ex vivo model, with independent irradiation regimes for UVB, UVA, and visible light. Conclusions Melanogenesis induced by UVB, UVA, and visible light was observed both in melasma and in the adjacent skin. The morphological patterns suggest that different irradiations promote individualized responses on the skin with melasma.
Early-onset effluvium secondary to COVID-19: Clinical and histologic characterizationTo the Editor: As telogen effluvium (TE) is the most common manifestation of postacute COVID-19 syndrome, we read with keen interest the publication by Abrantes et al 1 reporting the clinical characteristics of 30 patients with post-COVIDe19 acute TE. We would like to commend the authors and bring some other elements to this relevant discussion.TE is a heterogeneous condition that can be elicited by multiple stimuli. 2 Headington 3 proposed 5 functional types of TE based on alternations in particular phases of the follicular cycle. Infections are thought to induce TE through the mechanism of immediate anagen release. According to this model, an acute inflammatory state converts the follicles from anagen to catagen, leading to the shedding of telogen hairs around 90 days after the infection. Interestingly, the median time for the onset of hair shedding observed by Abrantes et al 1 was 45 days after infection; in the most precocious case, it started 18 days after COVID-19.This early onset was also observed in 2 multicentric studies. Moreno-Arrones et al 4 evaluated 214 cases of acute TE after COVID-19 and noted the onset of hair shedding, on average, 57.1 days after the infection. Starace et al 5 observed early onset especially when TE was associated with trichodynia. In these cases, the latency from the infection to hair shedding occurred at an average of 3 (range, 2-7.5) weeks. 5 We recently assessed 203 hospitalized patients with confirmed COVID-19, of whom 11 (5.4%) reported hair loss with onset early during hospitalization, \30 days after the infection. Seven of them were assessed using trichoscopy, a trichogram, and a histologic evaluation. The detailed information of these cases is presented in Supplementary Table I (available via Mendeley at https://data.mendeley.com/datasets/p254jbh356/1).Clinically, all the cases presented a positive pull test result. Trichoscopy did not reveal broken hairs, anisotrichosis, or yellow dots, but it did reveal some empty follicles. The trichogram obtained from the vertex revealed[10% dystrophic anagen hairs (Fig 1) and [20% telogen hairs in all the cases. Histologically, there was predominance of anagen terminal follicles, no relevant miniaturization ([10%), and no cases showing [25% telogen follicles. No
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