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Skin scars and wrinkles temporary camouflage in dermatology and oncoesthetics: focus on acetyl hexapeptide-8

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Abstract

Objective: The aim of study is to evaluate the aesthetic outcome of specific formulated cosmeceutical product to mask and reduce the appearance surgical scars or unappealing skin tags in chronic diseases, such as cancer Methods: In a spontaneous, anecdotal, retrospective study, 26 patients with skin disorders appealed to Second Opinion Medical Network (Modena, Italy), required masking and improving the skin appearance. To evaluate the aesthetic improvement of skin imperfections, a gelcream containing 10% of acetyl hexapeptide-8 (registered trademark Argireline®) was selected, that can be applied directly upon the lesion, followed by a light massage in the treated area for a few minutes Results: The skin quality parameters (hydration, elasticity, sebum), photographs and investigators clinical assessment have been performed before and after the treatment and demonstrated that this cream significantly improved the skin values and the self-image expectation of each patient. No allergic reactions were documented during the period treatment Conclusions: The topical administration of this cosmeceutical cream is a safe and effective alternative to the invasive procedures, to improve the quality of life in patients with some skin disorders such as cancer, surgical scars, hidradenitis, aging wrinkles
Skin scars and wrinkles temporary camouflage in dermatology and oncoesthetics: focus on acetyl hexapeptide-8
e539
Skin scars and wrinkles temporary camouflage in dermatology
and oncoesthetics: focus on acetyl hexapeptide-8
B. Palmieri1,2, A. Noviello3, V. Corazzari2*, A. Garelli4, M. Vadala2
1Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Surgical Clinic,
Modena, Italy; 2Second Opinion Medical Network, Modena, Italy; 3Oncology Training International Oncology Esthetics (OTI),
Milan, Italy; 4Plastic and reconstructive surgery, Roma, Italy
Research article Clin Ter 2020; 171 (6):e539-548. doi: 10.7417/CT.2020.2270
Copyright © Società Editrice Universo (SEU)
ISSN 1972-6007
Correspondence: Veronica Corazzari, Network del Secondo Parere, Via Saliceto Panaro 5, 41122 Modena, 0598303683.
E-mail: verocoraz@outlook.it
Introduction
Scar formation is the consequence of the deep dermis
reaction to skin traumas of various origin (1). The activation
of hemostasis is the very first step followed by inflammation,
cell proliferation and new matrix deposition (2). This allows
the reconstruction and remodeling of the tissue to restore the
mechanical and functional characteristics of the previously
intact skin. The scar healing is a multistep process, mobi-
lizes and activates different cells, such as endothelial cells,
integrins, fibroblasts at specific steps and involving local and
systemic endogenous and exogenous mechanisms (1, 2).
The wound repair is individually tailored and different scar
Abstract
Objective. The aim of study is to evaluate the aesthetic outcome
of specific formulated cosmeceutical product to mask and reduce the
appearance surgical scars or unappealing skin tags in chronic diseases,
such as cancer.
Methods. In a spontaneous, anecdotal, retrospective study, 26 pa-
tients with skin disorders appealed to Second Opinion Medical Network
(Modena, Italy), required masking and improving the skin appearance.
To evaluate the aesthetic improvement of skin imperfections, a gel-
cream containing 10% of acetyl hexapeptide-8 (registered trademark
Argireline®) was selected, that can be applied directly upon the lesion,
followed by a light massage in the treated area for a few minutes.
Results. The skin quality parameters (hydration, elasticity, sebum),
photographs and investigators clinical assessment have been perfor-
med before and after the treatment and demonstrated that this cream
significantly improved the skin values and the self-image expectation
of each patient. No allergic reactions were documented during the
period treatment.
Conclusions. The topical administration of this cosmeceutical
cream is a safe and effective alternative to the invasive procedures, to
improve the quality of life in patients with some skin disorders such
as cancer, surgical scars, hidradenitis, aging wrinkles. Clin Ter 2020;
171 (6):e539-548. doi: 10.7417/CT.2020.2270
Key words: scars, topical treatment, acetyl hexapeptide-8, cosme-
ceutical cream, oncological treatment, quality of life
types (e.g. atrophic, hypertrophic scar or keloid )(reported
in Tab. 1), confirm that the process depends by individual
genetics, age, anatomic topography of the lesions, ethnicity,
etiology, single or multiple causes of trauma, complications
along of the healing steps, etc (1). Some exogenous factors
are also involved, such as exposure to solar radiation, life-
style (smoking, alcohol, food, etc.) and professional activ-
ity (1). Because of the collagen strands synthesis bridging the
wound margins and promoting epidermal cells centripetal
shifting to fill the chronic skin gap, the scar is always vari-
ably visible and cannot totally be erased (3, 4).
The different approaches to treat scars include natu-
ral methods, drug therapies, para-surgical therapies and
surgery (3, 5-9). Despite the advanced medications and
advices adopted by surgeons, caregivers and patients during
the perioperative and postoperative periods to achieve the
best aesthetic outcome, further surgical, chemical or laser
revision is required to reach the optimal outcome (6).
In the context of oncological therapies, it is necessary
to consider the effects on wound healing of chemotherapy
and radiotherapy as well as surgical instruments used intra-
operatively including laser radiofrequencies ultrasounds,
cold knifes etc. (10). Postsurgical chemotherapy is always
a chemical prolonged trauma to the surgically injured tissues,
involving the skin and the skin’s appendages, such as hair
and nails. Depending on the drug type, the effect can be mild
swelling, local irritation, inflammation or even actual tissue
necrosis (10). Scars from skin cancer surgery, especially
the facial ones, can be prominent and not easily relieved by
make-up (11). The marks often show hypopigmentation,
hyperpigmentation, neovascularization or diminished pore
structures compared to the surrounding skin (11).
Olsson et al. (12) explored the extent to which scars af-
fect adolescents and adults post-cancer treatment. They
developed emailed a study-specific questionnaire with
items on psychosocial health, body image and sexuality,
fertility, education, work, and leisure, to teenage and young
adults cancer survivors and matched controls in Sweden (12).
The relative risk of feeling less attractive due to scars was
higher both for female and male cancer survivors compared
to controls. The feeling of attractiveness was negatively
e540 B. Palmieri et al.
related to the size of scars in both groups. However, further
research on care interventions is needed to reduce, if pos-
sible, the impact of scars (12).
Due to the doctor-patient communication gap, most of the
patients usually wander around the medical websites looking
for proper answers to their health problems. However, their
search often becomes compulsive and obsessive and often
ambiguous and frustrating (13). Palmieri et al. (14) describe
this behavior as the “Web Babel Syndrome” a psycho-
logical imbalance affecting young and elderly patients,
especially those with multiple synchronous diseases who
receive from their caregivers heterogeneous and misleading
information or advices, including confused, contradictory
statements and prescriptions (15). This spontaneous, anec-
dotal, retrospective study is based on the evaluation of the
therapeutic efficacy of a topical product, and its aim is to
improve the appearance of scars and skin imperfections,
since the camouflage of such imperfections resulting from
Description Predisposing
factors
Chronology Histology Treatments Therapeutic
effect
Hypertrophic
scar
In relief and red,
it can be ac-
companied from
itching and pain.
Generally, the
scar remains
within the
borders of the
original lesion
and develops in
depth.
Less genetic
predisposition
and less asso-
ciation with skin
pigmentation
It appears usu-
ally after surgery,
or trauma (linear
hypertrophic
scar) or a burn
(extended hyper-
trophic scar)
Scar appears with
absence of a tongue-like
advancing edge under-
neath normal-appearing
epidermis and papillary
dermis. No horizontal cel-
lular fibrous band in the
upper reticular dermis
and no prominent fascia-
like fibrous band.
There is the presence
of well-organized, wavy
collagen fibers, type
III collagen bundles
parallel to the surface of
the epidermis; nodules
containing myofibroblasts
and acid mucopolysac-
charide; increase of
connective tissue.
- Spontaneous
regression
- Corticosteroids
- Surgery
Overall prog-
nosis is better
than keloids, it
improves with
appropriate
surgery and
low recurrence
following surgi-
cal excision
Keloid Thick, irregular,
rounded, with a
red-brownish
and/or hard
colour. Formed
by scar tissue, it
extends beyond
the limits of the
original lesion.
It develops both
in depth and in
width.
More established
genetic predispo-
sition and more
association with
skin pigmenta-
tion.
Post trauma or it
appears sponta-
neously
Scar appears with a
presence of a tongue-like
advancing edge under-
neath normal-appearing
epidermis and papillary
dermis. Appearance of
horizontal cellular fibrous
band in the upper reticu-
lar dermis and prominent
fascia-like fibrous band.
The collagen fibers are
disorganized, large,
and hyalinized types I
and type III hypocellular
collagen bundles with
no nodules or excess
myofibroblasts. Finally,
there is poor vasculariza-
tion with widely scattered
dilated blood vessels and
increased of connective
tissue.
-Not spontaneous
regression
-Silicone based
creams
- Vitamin E imple-
mentation
- Massages to
make the skin
softer
Overall
prognosis is
worst, often by
surgery high
recurrence is
observed after
surgical exci-
sion
Atrofic scar Insufficient
amount of tis-
sue to cover the
entire wound.
Reduced
rounded and
depressed
formation with
respect to the
surrounding
skin.
Result of dis-
eases like acne
or chicken pox.
Alteration of the
tissue regenera-
tion and insuffi-
cient production
of new connec-
tive tissue fibers.
- Chemical peels
- Laser therapy
- Exfoliating treat-
ments
- Drugs: Benzoyl
peroxide, topical
retinoids, azelaic
acid, isotretinoin
Table 1. Synoptic table of scars types
Skin scars and wrinkles temporary camouflage in dermatology and oncoesthetics: focus on acetyl hexapeptide-8
e541
surgery or acne can have a long-term aesthetic benefits
and improve the quality of life of patients, including their
psycho-social state.
Materials and methods
Sample Population
26 volunteers (females) between 23 and 63 years of age
(Tab. 2) appealed to our “Second Opinion Medical Consul-
ting Network”, Medical Centre (Modena, Italy), because
of cutaneous and/or surgical scars/blemishes from chronic
diseases such as cancer, hidradenitis, etc.
Second Opinion Network
The Second Opinion Medical Network is a consultation
referral web and Medical Office System recruiting suddenly
a wide panel of real-time available specialists, to whom
any patient affected by any disease or syndrome and not
adequately satisfied by the diagnosis or therapy can apply
for an individual clinical audit (16). To help patients dis-
contented with their psycho-physical condition, the Second
Opinion Network aims to be a useful “problem-solving”
support revisiting each diagnostic and therapeutic step and
properly re-addressing tailored treatments and prognoses, as
well as preventing unnecessary investigational procedures
and unhelpful and expensive medical and surgical interven-
tions (17).
Process of application of the product
All the patients were visited and informed during a
personal interview, gave their permission, and signed an
informed consent. We selected, as topical treatment, a cos-
meceutical gel product, Instant Ageback (Vitayes®, Frank-
furt, Germany). It combined with several active ingredients,
including water, magnesium aluminum silicate, propylene
glycol, sodium silicate, acetyl hexapeptide-8 (reported in
Fig. 1), phenoxyethanol, ethylhexylglycerin, caprylyl glycol,
CI 16035, each with specific action (Tab. 3).
The product is simple to use with immediate and long-
term aesthetic effect: the healthcare professional applies a
small amount (rice grain) by dabbing lightly on the desired
area to treat. The patient waits for the effect while keeping
the face muscles relaxed and after only five minutes, skin
blemishes appear visually lessened. It is advisable to ap-
ply a moisturizer before proceeding with Vitayes® Instant
Ageback.
N. Patients Gender Disease Therapy
12 Female Adenoid cystic carcinoma Surgery
1 Hidradenitis Incision and topical creams
10 Moles lesions Surgery
3 Aging Topical creams
Table 2. Clinical cases characteristics.
Table 3. Functions of raw materials that constitute the topical product.
ACTIVE INGREDIENTS FUNCTION
Water Solubilizer
Magnesium Aluminum silicate + Sodium silicate Instant firming effect
Propylene glycol Humectant, skin conditioning
Acetyl hexapeptide-8 Long-term anti-aging effect
Phenoxyethanol + Ethylhexylglycerin Preservative
Caprylyl Glycol Conditioning of the skin
CI 16035 Dye
Fig.1. Chemical structure of acetyl hexapeptide-8
e542 B. Palmieri et al.
10 patients reported scars on the left side of the face and
neck, 10 other patients on the right area, while 6 patients on
the forehead and chin. The following skin evaluations have
been performed:
a) Hydration at baseline and after treatment by means of
point of care (POCT) DermaLabR USB instrument
(Cortex Technologies, Hadsund, Denmark). It has a
hydration probe, that is pressed upon the skin and due
to the conductance principle, measures the water binding
capacity of the stratum corneum (18).
b) Elasticity assessment by means of ElastiMeter R (Delfin
Technologies, Kuopio, Finland), it measures a stiffness,
a physical measure of an object’s resistance to change in
shape under an external force in N/m. The device consists
of a 1 mm length indenter, a reference plate and built-in
force sensors. The probe head is quickly pressed against
the skin surface with a recommended standard pressure
that is displayed on the screen. The indenter induces a
constant deformation when the reference plate is in full
contact with the skin, and the elasticity is determined by
the skin resistance to this deformation (19).
c) Skin sebum levels by means of Sebumeter SM 815
(Courage & Khazaka electronic), which in pathological
conditions tend to increase.
d) Photographic assessment at baseline and after cream
application.
Skin parameters were measured on six selected areas:
chin, left and right neck, forehead, right and left malar area.
The value of hydration ((expressed in microSiemens units
(μS)), elasticity (expressed in μS), and sebum (expressed in
Sebumeter® units from 0-350, approximated to μg/cm2 in
a certain range) is the arithmetic mean of 3-5 repetitive
measures in the same area.
The quality of life (QoL) of each patient was evaluated
at baseline and after treament using the abbreviated form of
the medical outcome health survey questionnaire (SF-36). It
measures health-related QoL in eight dimensions: vitality,
general health perceptions, physical functioning, physical
role functioning, emotional role functioning, social role
functioning, bodily pain and mental health. Each scale is
scored using norm-based methods, with percentage scores
ranging from 0% (lowest or worst response) to 100% (high-
est or best possible response) (20).
Statistical Analysis
Statistical analysis was performed using GraphPad
Prism 7 (GraphPad Software Inc., San Diego, CA, USA).
Data were analyzed using an unpaired t-test with Welch’s
correction. p < 0.05 was considered significant.
Results
The evaluated skin parameters significantly decreased
in all the patients. 10 patients reported scars on the left side
of the face and neck, 10 other patients on the right area,
while 6 patients on the forehead and chin. The parameters of
hydration, elasticity and sebum levels of the scars of these 3
areas have been measured respect to unaffected skin.
The cosmeceutical gel determined a lifting effect, due to
a slight decrease in the hydration levels of the affected area
than the surrounding skin. In fact, the hydration of scars (p<
0.01) in the left area of the neck and malar area changes from
65,5% to 57%; (respectively pre and post treatment), in right
neck and right malar area from 65% to 56% (respectively pre
and post treatment); in forehead and chin area from 56% to
52% (respectively pre and post treatment) (Fig.2).
Regard the elasticity, it has been observed a significant
(p < 0.001) elasticity level of the affected area than the
surrounding skin. In fact, elasticity of scars improved from
Fig. 2. Scars hydration levels (%)
measured before and after treat-
ment in the affected areas
Skin scars and wrinkles temporary camouflage in dermatology and oncoesthetics: focus on acetyl hexapeptide-8
e543
33,5% to 40,5% (respectively pre and post treatment) in left
lateral-medial area of the neck and malar area; from 24% to
31,5% (respectively pre and post treatment) in right lateral-
medial area of the neck and malar area; and from 25,5% to
38% (respectively pre and post treatment) in forehead and
chin area (Fig.3).
In addition, the measured skin sebum levels of the scars
evidenced a significant reduction (p<0.002) in all examined
skin areas. In the specific, it has been observed a reduced
sebum in scars of left neck and in left malar area from 58,
5% to 41% (respectively pre and post treatment); in right
neck and in right malar area from 65% to 51% (respectively
pre and post treatment); in forehead and chin from 90% to
76,5% (respectively pre and post treatment)(Fig.4).
Unretouched photos taken before and after treatment
showed a significant improvement of major signs of cancer
cutaneous blemishes and scars due a cyst or mole removal
surgery (Fig. 5-10). No worsening was reported, only one
patient expressed skin hypersensitivity and redness of the
affected area within 24 hours after gel application (Fig.6).
It has also been observed that topical treatment instantly
reduces wrinkles, bags, dark circles, enlarged pores and
scars by up to 85%. Furthermore, it firms, drains, refines
pores, and ensures flawless skin, showing a lifting effect
on atonic skin.
Regard the QoL of patients, the SF-36 questionnaire
administered before and after several applications of the
cosmeceutical cream, highlighted a significant score in the
Fig.3. Scar elasticity levels (%) mea-
sured before and after treatment in the
affected areas
Fig.4. Scar sebum levels (%) measured
before and after treatment in the af-
fected areas
e544 B. Palmieri et al.
Fig.5. Female, 63 years old, affected by adenoid cystic carcinoma
Fig.6. Female, 29 years
old, affected by Hidra-
denitis
Fig.7. Female, 45 years old, affected
by mole removed surgically
Skin scars and wrinkles temporary camouflage in dermatology and oncoesthetics: focus on acetyl hexapeptide-8
e545
Fig.8. Female, 40 years old, affected
by mole removed surgically
Fig.9. Female, 50 years old, affected
by imperfections of aging
Fig.10. Female, 23 years old, affected
by mole removed surgically
e546 B. Palmieri et al.
psychosocial sphere. The main efficacy endpoints were in
vitality (P < 0.03), in social role functioning (P < 0.02) and
in mood improvement (P < 0.03).
Discussion
Among the different approaches to treat scars, we can
mention the complementary therapies, including essential
oils (Tea tree oil, lavender etc.) for antibacterial action; Aloe
or centella asiatica extract, as anti-inflammatory; allantoin
and anthocyanins as antioxidants; Allium Coepa (onion
extract) for the kerato-modulating action that reshapes ke-
loids by compression; mineral complexes (petrolatum and
silicone) with dermoprotective effect, etc (5, 21-24). Also
topical administration of CBD ointment, without any THC,
is a safe and effective non-invasive alternative for improve
severe skin chronic diseases and/or outcome scars, especially
on inflammatory background (25).
In the medical practice Silicone-based products (she-
ets, gel or creams), intralesional corticosteroid injections,
5-fluorouracil, bleomycin, interferon, and verapamil are non-
invasive methods that modulate the scar appearance (3, 6,
7, 26). Specifically, silicone-based products are particularly
used: silicone with its long chain polymers (polysiloxanes),
silicon dioxide and volatile components are effective in redu-
cing redness and thickness of the scars. The silicone sheets
are effective essentially because they increase the hydration
of the stratum corneum, molding a softer and flatter scar;
protecting the scar tissue from bacterial contamination and
inducing phlogosis and collagen production, modulating the
expression of tissue growth factors, balancing the stroma
density and collagen strands breakdown (8).
Instead, the para-surgical treatments include cryo-
therapy, dermabrasion, peeling, filler, laser, radiofrequency
(7, 26, 27). Cryotherapy is the rapid delivery of a cryogenic
substance but is limited to small scars (since dyschromic
outcomes are frequent); dermabrasion is a mechanical
smoothing of the skin, usually administered in the intermedi-
ate phase together with compression treatments; and lastly
peeling is applied with different acid compounds provided of
desquamating and kerato-modulating activity (to resist rapid
degradation). Fillers are chemically crosslinked mucopoly-
saccharides based on hyaluronic acid and chondroitin, with
bio-stimulating and bio-restructuring properties for the scar,
because moisturize mesenchymal tissues (28, 29). Lipofill-
ing is another method currently used, that follows the action
mechanism of common fillers: lipofilling requires availabil-
ity of autologous adipose tissue with or without stem cells
supplement to improve scar quality (30) while filler uses
mainly cross linked hyaluronic acid.
Several studies reported also pulsed dye laser treatment,
non-ablative fractional laser resurfacing, ablative fractional
laser resurfacing, microneedling and fractional needle ra-
diofrequency, as skin treatment, either in monotherapy or
in combination (6, 27, 31-36). The laser therapy is mainly
used in the oncological surgical scars, acne scars and skin-
aging (27, 31, 36, 37). The results vary according to the dif-
ferent laser wavelengths, power and administration protocol
and standardization are quite difficult (31).
In a study of 2016, Svolacchia et al. (26) investigated the
effectiveness of dermal autologous micrografts to improve
pathological scars. He used a new clinical practice called
Rigenera Protocol to obtain autologous micrografts which
were in turn injectable in the patients. These micrografts
were composed of mesenchymal stem cells and verified
restoration of the structural layers immediately below the
epidermis and a horizontal realignment of collagen fibers
in the papillary dermis (26).
Other skin method is the surgery, with total or partial
scar excision, that can be used to change the position, width
or shape of the scar and to decrease the tension of a scar,
improving the functionality of the affected area (4).
In this anecdotical, spontaneous, observational study, was
found a slight decrease in skin hydration levels and a clear
reduction in sebum levels while was recorded an increase
in skin elasticity levels. As a result, wrinkles and scars are
attenuated in the affected area, improving the psychological
frustrations and discomfort of the patients. These effects are
due to synthetic acetyl hexapeptide-8 that is the main active
substance contained in Vitayes® Instant Ageback (Fig.1). It
is a molecular weight of 889 Dalton patterned after the
N-terminal end of the protein Synaptosomal-associated
protein 25 (SNAP-25), that is part of the synaptosome, or
the structure responsible for the release of acetylcholine (38,
39). Acetyl hexapeptide-8 competes with SNAP-25 bin-
ding to it as agonist of the vesicle-associated membrane
protein (VAMP) with subsequent inhibition of neuronal
exocytosis preventing the attachment protein of receptor
(SNARE) complex (39). As a result, acetylcholine (40) is
not secreted into the vesicles, and the absence of choliner-
gic effect upon striated muscles in example of the facial
expression induces relaxation with an action mechanism
similar to botulinum toxin, but without any risk of toxici-
ty, and very low transdermal diffusion after epicutaneous
administration (39, 40). Only 0.22% of the total amount
is permeated through the skin and retained within stratum
corneum, and only the 0.01% of the peptide is through in the
epidermis (41). To overcome the problem, several research
groups have attempted to enhance transdermal delivery of
acetyl hexapeptide-8 by optimizing the formulations. For in-
stance, Hoppel et al. (42) showed a clear superiority of water-
rich water-in-oil-in-water (W/O/W) and oil-in-water (O/W)
emulsions over oil-rich water-in-oil emulsion (W/O) emul-
sions, due to increased absorption of water-rich emulsions
into the skin (39, 42). Vitayes® Instant Ageback is combined
with water, magnesium aluminum silicate, propylene glycol,
sodium silicate, acetyl hexapeptide-8, phenoxyethanol, eth-
ylhexylglycerin, caprylyl glycol, CI 16035. Therefore this
molecular combination achieves contemporarily a double
effect: relaxation of the skin surface due to mimic muscles
block; epidermal fluid embedding (interstitial water uptake
and temporary sequestration) with increased smoothness of
the surface and reduced appearance of scars or skin irregu-
larities (pores, granuloma nodules etc.).
Strenghts and limitations of the study
This study can be considered an innovative contribution
in the field of dermatological cosmetics. The product can
Skin scars and wrinkles temporary camouflage in dermatology and oncoesthetics: focus on acetyl hexapeptide-8
e547
be useful for patients with different problems: from surgical
scars to imperfections, due to aging or skin disorders such
as acne and hydrosadenitis. Furthermore, the application
of this topical active principle did not show any particular
adverse effects.
On the other hand, the major limitation of the present
study was a small number of clinical cases. Further research,
also in male gender, with the aim to evaluate any differen-
ces with the female gender in terms of skin responses and
psychosocial impact, are needed.
Conclusions
The clinical results suppose that the active principle of
Vitayes®Instant Ageback, acetyl hexapeptide-8, modifies
the surface appearance of the skin not only reducing the
wrinkles and minor skin folds holes and irregularities, but
masking also the surgical scars with temporal smoothing
and lightening epidermal surface and mimicking the effect
of botulinum toxin.
The treatment is quite safe and comfortable except some
perceived slight dryness of the surrounding skin. The mecha-
nism of this effect is well explained by the skin parameters
measured on our treated patients: a slight reduction of skin
hydration reduces the scar prominence and visibility; on the
other hand the increase in elastic skin response amplifies
the Acetyl hexapeptide-8 induced skin relaxation, produ-
cing a smoother and brighter appearance of the whole face
surface and great patient satisfaction even if aware that the
improvement will be lasting 4-8 hours.
Finally, the need to carry out a future clinical trial is
underlined, with a blind application of the product in two
different groups. Next Acetyl hexapeptide-8 administration
study can also give adequate information about the long-
term benefits of the treatment, namely the putative steady
improvement of the skin textures and of the scar definite
camouflaging effect.
Actually, the use of Vitayes Instant Ageback is re-
commended in the short term because of the high patient
compliance, the absence of side effects and the optimal
tolerability also when administered over very sensitive skin
surfaces. Intolerance to the product in fact has been rarely
observed in cancer patients with visible scarrings after
radio/chemo therapy, and also in young girls affected by
acne eruptions and scars.
In all these patients, the camouflage was very effective
and socially appreciated.
Declarations
Acknowledgement: None
Financial Disclosure or Funding: Not applicable.
Conflict of Interest: None declared.
Institutional Review Board Approval: Second Opinion
Medical Network, Modena, Italy.
Data Availability: The authors declare that data suppor-
ting the findings of this study are available.
All procedures performed were in accordance with
the 1964 Helsinki declaration and its later amendments or
comparable ethical standards.
References
1. Gauglitz GG, Potschke , M.T. Clementoni, (Therapy of scars
with lasers). Hautarzt, 2018; 69(1):17-26
2. Wolfram D, et al. Hypertrophic scars and keloids--a review
of their pathophysiology, risk factors, and therapeutic mana-
gement. Dermatol Surg, 2009;35(2):171-81
3. Ghazawi FM, et al. Insights into the Pathophysiology of
Hypertrophic Scars and Keloids: How Do They Differ? Adv
Skin Wound Care, 2018; 31(1):582-595
4. Garg S, Dahiya N, Gupta S, Surgical scar revision: an over-
view. Journal of cutaneous and aesthetic surgery, 2014; 7(1):
3-13
5. Fang QQ, et al. The Effectiveness of Topical Anti-scarring
Agents and a Novel Combined Process on Cutaneous Scar
Management. Curr Pharm Des, 2017;23(15):2268-2275
6. Eilers RE, Jr, et al. A Combination Approach to Surgical
Scars. Dermatol Surg, 2016; 42 Suppl 2:S150-6
7. Gauglitz GG, et al. Hypertrophic scarring and keloids:
pathomechanisms and current and emerging treatment stra-
tegies. Mol Med, 2011;17(1-2):113-25
8. Mustoe TA, et al. International clinical recommendations on
scar management. Plast Reconstr Surg, 2002; 110(2):560-
71
9. Leventhal D, Furr M, Reiter D. Treatment of keloids and
hypertrophic scars: a meta-analysis and review of the litera-
ture. Arch Facial Plast Surg, 2006; 8(6):362-8
10. DeHaven C. Chemotherapy and radiotherapy effects on the
skin. Plast Surg Nurs, 2014; 34(4):192-5
11. Cohen JL. Minimizing skin cancer surgical scars using abla-
tive fractional Er:YAG laser treatment. J Drugs Dermatol,
2013; 12(10):1171-3
12. Olsson M, et al. Self-Perceived Physical Attractiveness in
Relation to Scars Among Adolescent and Young Adult Cancer
Survivors: A Population-Based Study. J Adolesc Young Adult
Oncol, 2018; 7(3):358-366
13. Palmieri BLC, Vadalà M, The “Second Opinion Medical
Network”. Int J Pathol Clin Res 2017; 3:056
14. Palmieri B, et al. (Second opinion clinic: is the Web Babel
Syndrome treatable?). Clin Ter 2011; 162(6):575-83
15. Palmieri B, Iannitti T. The Web Babel syndrome. Patient Educ
Couns, 2011; 85(2):331-3
16. Wunsch A, Palmieri B. The rôle of second opinion in oncol-
ogy: an update. European Journal of Oncology, 2014; 18(3):
117-120
17. Di Cerbo A, Palmieri B. The economic impact of second
opinion in pathology. Saudi Med J, 2012; 33(10):1051-2
18. Laurino C, Palmieri B, Coacci A. Efficacy, Safety, and Toler-
ance of a New Injection Technique for High- and Low-Mo-
lecular-Weight Hyaluronic Acid Hybrid Complexes. Eplasty,
2015; 15:e46
19. Iivarinen JT, Korhonen RK, Jurvelin JS. Experimental and
numerical analysis of soft tissue stiffness measurement
using manual indentation device--significance of indenta-
tion geometry and soft tissue thickness. Skin Res Technol,
2014; 20(3):347-54
20. Palmieri B, Laurino C, Vadalà M. Spontaneous, anecdotal,
retrospective, open-label study on the efficacy, safety and
e548 B. Palmieri et al.
tolerability of cannabis galenical preparation (Bedrocan). Int J
Pharm Pract. 2019; 27(3):264-270. doi:10.1111/ijpp.12514
21. Bylka W, et al. Centella asiatica in dermatology: an over-
view. Phytother Res, 2014; 28(8):1117-24
22. Feily A, Namazi MR. Aloe vera in dermatology: a brief
review. G Ital Dermatol Venereol, 2009; 144(1):85-91
23. Prager W, Gauglitz GG. Effectiveness and Safety of an Over-
night Patch Containing Allium cepa Extract and Allantoin
for Post-Dermatologic Surgery Scars. Aesthetic Plast Surg,
2018; 42(4):1144-1150
24. Yeh LC, Gonzalez N, Goldberg DJ. Comparison of a novel
wound dressing vs current clinical practice after laser resur-
facing. J Cosmet Dermatol, 2019; 18(4):1020-1024
25. Palmieri B, Laurino C, Vadalà M. A therapeutic effect of
cbd-enriched ointment in inflammatory skin diseases and
cutaneous scars. Clin Ter. 2019 Mar-Apr;170(2):e93-e99.
doi: 10.7417/CT.2019.2116. PMID: 30993303
26. Svolacchia F, et al. An innovative regenerative treatment
of scars with dermal micrografts. J Cosmet Dermatol,
2016; 15(3):245-53
27. Sadick NS, Cardona A. Laser treatment for facial acne scars:
A review. J Cosmet Laser Ther, 2018; 20(7-8):424-435
28. Ramos-E-Silva M, et al. STYLAGE®: a range of hyaluronic
acid dermal fillers containing mannitol. Physical properties
and review of the literature. Clinical, cosmetic and investi-
gational dermatology, 2013; 6:257-261
29. Khunmanee S, Jeong Y, Park H. Crosslinking method of hya-
luronic-based hydrogel for biomedical applications. Journal
of tissue engineering, 2017; 8:2041731417726464-
2041731417726464
30. Gotland N, et al. (Treating scars with lipofilling). Ugeskr
Laeger, 2018; 180(26)
31. Magnani LR, Schweiger ES. Fractional CO2 lasers for the
treatment of atrophic acne scars: a review of the literature. J
Cosmet Laser Ther, 2014; 16(2):48-56
32. Togsverd-Bo K. Early laser intervention for improved appe-
arance of surgical scars. Br J Dermatol, 2019; 180(1):25
33. Lee Y, Kim W. Combination laser treatment for immediate
post-surgical scars: a retrospective analysis of 33 immature
scars. Lasers Med Sci, 2017; 32(5):1111-1119
34. Karmisholt KE, et al. Laser treatments in early wound healing
improve scar appearance: a randomized split-wound trial
with nonablative fractional laser exposures vs. untreated
controls. Br J Dermatol, 2018; 179(6):1307-1314
35. Orringer JS, et al. Molecular mechanisms of nonablative
fractionated laser resurfacing. Br J Dermatol, 2010; 163(4):
757-68
36. Ansari F, Sadeghi-Ghyassi F, Yaaghoobian B. The clinical
effectiveness and cost-effectiveness of fractional CO2 laser
in acne scars and skin rejuvenation: A meta-analysis and
economic evaluation. J Cosmet Laser Ther, 2018; 20(4):
248-251
37. Qian H, et al. Treatment of acne scarring with fractional CO2
laser. J Cosmet Laser Ther, 2012; 14(4):162-5
38. Wang Y, et al. The anti-wrinkle efficacy of acetyl hexa-
peptide-8, a synthetic hexapeptide, in Chinese subjects: a
randomized, placebo-controlled study. Am J Clin Dermatol,
2013; 14(2): 147-53
39. Lim SH, et al. Enhanced Skin Permeation of Anti-wrinkle
Peptides via Molecular Modification. Sci Rep, 2018; 8(1):
1596
40. Blanes-Mira C, et al. A synthetic hexapeptide (Acetyl
hexapeptide-8) with antiwrinkle activity. Int J Cosmet Sci,
2002; 24(5):303-10
41. Kraeling ME, et al. In vitro skin penetration of acetyl hexa-
peptide-8 from a cosmetic formulation. Cutan Ocul Toxicol,
2015; 34(1):46-52
42. Hoppel M, et al. Topical delivery of acetyl hexapeptide-8 from
different emulsions: influence of emulsion composition and
internal structure. Eur J Pharm Sci, 2015; 68:27-35
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Background Within recent years, various lasers have increasingly been applied during wound healing to minimize scar formation. However, no consensus regarding treatment procedures exists. The aim of this study is to clinically assess scar formation after three non‐ablative fractional laser (NAFL)‐exposures, targeting inflammation‐, proliferation‐ and remodeling wound healing phases versus untreated controls. Methods A randomized, controlled trial was performed using a split‐wound design to assess excisional wound‐halves treated with 1540 nm NAFL versus no laser treatment. Three NAFL‐exposures were provided respectively: immediately before surgery, at suture removal and six weeks after surgery. NAFL‐exposures were applied using two hand‐pieces, sequentially distributing energy deeply and more superficially in the skin (40‐50mJ/microbeam). Evaluated at 3 months follow‐up, primary outcome was blinded, on‐site evaluation on Patient‐Observer‐Scar‐Assessment‐Scale (POSAS‐total, range 6=normal skin to 60=worst imaginable scar). Secondary outcomes comprised blinded evaluation on Vancouver‐Scar‐Scale (VSS) and standardized assessment comparing scar sides, carried out by blinded on‐site‐, photo‐, and patients‐assessments. Results Thirty of 32 patients completed the trial. At three months follow‐up, NAFL‐treated scar halves showed improvement compared to untreated control halves on POSAS‐total (NAFL‐treated median 11[9‐12] vs control median 12[10‐16], P=.001). POSAS‐subitems showed that NAFL‐treated halves were significantly less red, more pliable, and presented with smoother relief compared to untreated controls. VSS‐total correspondingly revealed enhanced appearance in NAFL‐treated halves (median 2[1‐2.5] vs control median 2[1.75‐3], P=.007). The standardized assessment comparing appearance of scar halves, demonstrated a low degree of correspondence between on‐site‐, photo‐ and patient‐assessments. NAFL‐treated scars were rated superior to untreated by 21/29 patients themselves. Conclusions NAFL‐treated scars showed subtle improvement when compared to untreated control scars. This article is protected by copyright. All rights reserved.
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Introduction: Fractional CO2 has many indications in medicine including in treatment of acne scars and rejuvenation. The aim of this study was to evaluate the safety, efficacy, and cost-effectiveness of Fractional CO2 Laser in comparison with other methods of rejuvenation and acne scar treatment. Materials and methods: Several databases including Medline, OVID, EMBASE, CINHAL, SCOPUS, Web of science, CRD, and Cochrane were searched. After conducting the search and evaluation of selected publications, critical appraisal was done and eligible studies were accepted for inclusion in the systematic review. Results and discussion: From 2667 identified publications two of the trials were eligible. The effectiveness and complications of Fractional CO2 laser were comparable with Er:YAG but Fractional CO2 laser was 14.7% (p = 0.01) more effective than Q-Switched ND:YAG laser. Cost affectivity of this method was the same as other alternative lasers. In conclusion Fractional CO2 laser is an effective and safe method for curing of several kinds of skin diseases. Nevertheless there was not sufficient evidence to support its advantage. This device has equal or lower price in comparison to competent technologies except for the non- fractional ablative CO2 laser that has the same or lower price and comparable effects.
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Objective: Cancer treatment may result in various effects that last long after treatment has been concluded. The purpose of this study was to explore to what extent scars affect adolescents and young adults postcancer treatment. Methods: In this population-based study, a study-specific questionnaire was developed by a method used in several previous investigations carried out by our research group, Clinical Cancer Epidemiology. Question development involved expert validation by professionals from oncology units, midwives, epidemiologists, and statisticians. The questionnaire was developed in collaboration with adolescent and young adult cancer survivors. The topics covered in the questionnaire were as follows: psychosocial health, body image and sexuality, fertility, education, work, and leisure. The web-based questionnaire was sent to teenage and young adult cancer survivors and matched controls in Sweden. Results: In this study, the relative risk of feeling less attractive due to scars was higher both for female cancer survivors RR 1.48, CI 1.05-2.08 and male cancer survivors RR 1.90, CI 1.15-3.13 compared to controls. The feeling of attractiveness was negatively related to the size of scars in both cancer and control groups. In a logistic regression analysis, significant associations were found between age, education, exercise, depression, and the feeling of low attractiveness due to scars. Conclusions: The results of this study provide a basis for care interventions for teenage and young adult cancer patients during and after cancer treatment. Further research is needed on care interventions to reduce, if possible, the impact of scars.