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TFOS Lifestyle: Impact of cosmetics on the ocular surface
Abstract
In this report the use of eye cosmetic products and procedures and how this represents a lifestyle challenge that may exacerbate or promote the development of ocular surface and adnexal disease is discussed. Multiple aspects of eye cosmetics are addressed, including their history and market value, psychological and social impacts, possible problems associated with cosmetic ingredients, products, and procedures, and regulations for eye cosmetic use. In addition, a systematic review that critically appraises randomized controlled trial evidence concerning the ocular effects of eyelash growth products is included. The findings of this systematic review highlight the evidence gaps and indicate future directions for research to focus on ocular surface outcomes associated with eyelash growth products.
... Many cosmetic products contain ingredients that have prompted concern regarding ocular health and safety. 4,9,[16][17][18] Ingredients of particular concern include preservatives (eg, benzalkonium chloride, parabens), phthalates, prostaglandin analogues, and retinoids. 4,16,19 The Tear Film & Ocular Surface Society has published a comprehensive review of cosmetic ingredients that may have adverse effects (eg, allergic reaction, endocrine disruption, immunosuppression, irritation), including those that may damage the ocular surface and adnexa. ...
... 4,9,[16][17][18] Ingredients of particular concern include preservatives (eg, benzalkonium chloride, parabens), phthalates, prostaglandin analogues, and retinoids. 4,16,19 The Tear Film & Ocular Surface Society has published a comprehensive review of cosmetic ingredients that may have adverse effects (eg, allergic reaction, endocrine disruption, immunosuppression, irritation), including those that may damage the ocular surface and adnexa. 16 The products evaluated in the present studies were formulated without using ingredients known to be of concern ( Table 6). ...
... 4,16,19 The Tear Film & Ocular Surface Society has published a comprehensive review of cosmetic ingredients that may have adverse effects (eg, allergic reaction, endocrine disruption, immunosuppression, irritation), including those that may damage the ocular surface and adnexa. 16 The products evaluated in the present studies were formulated without using ingredients known to be of concern ( Table 6). The results of the safety and ...
Purpose
Cosmetic products applied to the periocular area can cause skin sensitivity reactions, and manufacturers routinely test the safety and tolerability of products in development. This research was sponsored by Bausch + Lomb to evaluate three Lumify Eye Illuminations products: a lash and brow serum, a hydra-gel eye cream, and a micellar water eye makeup remover.
Methods
A cumulative irritation test (CIT) study and a repeated insult patch test (RIPT) study enrolled adult males or females with no known sensitivities to cosmetic products. Three clinical safety studies enrolled adult females with self-reported characteristics targeted by each product, which was applied in a manner consistent with expected use for 8 or 12 weeks.
Results
In CIT (n=34) and RIPT (n=201) studies, faint/minimal erythema reactions were observed in 0% to 2.9% of participants; there were no moderate or severe reactions. No safety signals were observed in participants who completed clinical safety studies for lash and brow serum (n=66 enrolled, n=55 completed [83%]), eye cream (n=61 enrolled, n=52 completed [85%]), or eye makeup remover (n=80 enrolled, n=68 completed [85%]). No clinically relevant changes in visual acuity or ophthalmologic slit-lamp examination findings were noted. No participants reported ocular sensations of burning/stinging, foreign-body sensation, or soreness. At the final clinical safety study assessment, mild cutaneous erythema (as graded by the investigator) was reported for one participant (eye cream study); no other prespecified signs of cutaneous irritation (eg, edema, dryness) were observed. A treatment-related adverse event that led to study discontinuation was experienced by one participant in the eye makeup remover study (bilateral periorbital swelling).
Conclusion
Findings from rigorously conducted irritation testing and clinical safety studies indicated that these products were safe and well tolerated. Increased availability of data regarding ocular and cutaneous safety of cosmetic products can inform consumer decision-making and eye care provider recommendations.
... A number of modifiable lifestyle factors have been evaluated for their potential association with dry eye disease, including environmental exposure [132], digital screen use [133], sleep quality [74], diet [134], and periocular cosmetic application [135]. ...
... An association between periocular cosmetic product application and the development of dry eye disease has been recognised, with multiple accounts of tear film contamination during routine ocular surface examination [135,162,163]. Factors such as eye rubbing, misapplication, passive migration of cosmetic eye products, and accidental application directly to the interpalpebral ocular surface result in tear film contamination [164]. ...
... Factors such as eye rubbing, misapplication, passive migration of cosmetic eye products, and accidental application directly to the interpalpebral ocular surface result in tear film contamination [164]. In addition to benzalkonium chloride (as discussed in Section 5.4) [165], other ingredients found frequently in make-up that are toxic to the ocular surface integrity include chlorphenesin, formaldehyde-releasing compounds, parabens and phenoxyethanol [135,[166][167][168]. These ingredients are often found in creams, and eyelash glue. ...
Dry eye disease is a multifactorial condition characterised by tear film instability, hyperosmolarity and ocular surface inflammation. Understanding the epidemiology of dry eye disease and recognising both modifiable and non-modifiable risk factors can assist eye care practitioners in assessing, treating, and managing patients with the condition. This review considers current knowledge surrounding its incidence and prevalence, as well as associated demographic, systemic, ocular, and iatrogenic, and lifestyle-related modifiable risk factors. Population-based prevalence estimates vary according to the diagnostic criteria used to define dry eye disease, as well as severity and demographic characteristics of the population. Considering recent data and variable population demographics, conservative prevalence estimates suggest that 10–20% of the population over 40 years of age report moderate to severe symptoms and/or seek treatment for dry eye disease. Individuals with specific non-modifiable demographic risk factors may be at increased risk of developing dry eye disease. Advanced age, female sex and East Asian ethnicity have been identified as key non-modifiable demographic features predisposing individuals to dry eye disease. Systemic conditions that have been associated with an increased risk of dry eye disease include migraine, Sjögren syndrome, connective tissue disorders, mental health disorders, diabetes mellitus and androgen deficiency. Medications that may contribute to this risk include antidepressants, antihistamines, and hormone replacement therapy. Ocular and iatrogenic risk factors of dry eye disease include blepharitis, Demodex infestation, ocular surgery, blink completeness, contact lens wear, and topical ophthalmic medications. A range of modifiable lifestyle factors that can increase the risk of dry eye disease have also been identified, including low humidity environments, digital screen use, quality of sleep, diet, and eye cosmetic wear. Dry eye is a common disease affecting millions globally. Increasing knowledge regarding its associated risk factors can better prepare the eye care practitioner to successfully manage patients with this ocular surface disease.
... Furthermore, a number of these chemicals pose health complications, such as carcinogens, pesticides, reproductive toxins, endocrine disruptors, plasticizers, degreasers, and surfactants. While some chemical ingredients may only cause minor irritations or allergic reactions, others are associated with more severe health issues, such as cancer, hormonal disruptions, immunosuppressants, tumor promoters, and reproductive problems [60][61][62]. It is important to consider that in the process of manufacturing, in addition to the chemicals used, synthetic preservatives are also used, which can have negative effects on human health. ...
... Certain cosmetics are associated with provoking negative effects on one's overall health over time or through continuous exposure. This is because the toxic chemical ingredients in these products can accumulate in the bloodstream, disrupt hormones and cell functioning structures, and increase the risk of developing chronic diseases, such as cancer [62]. The repeated application of certain cosmetic products may result in irritation or complications. ...
... In the study conducted by Sullivan et al. [62], it was found that eye makeup can directly cause ocular surface and adnexal diseases, leading to various symptoms such as infections, inflammation, allergies, trauma, neoplasia, dysfunction, and degeneration. In a survey of 10 makeup cosmetics, prominent symptoms such as toxicity, cytotoxicity, allergens, irritants, immunosuppressants, carcinogens, endocrine disruptors, neurotoxins, meibomian gland dysfunction, and antibiotic resistance were identified. ...
The growing demand for natural and sustainable ingredients in cosmetic formulations has driven scientists to explore a wide range of botanical resources. Helinus integrifolius, a lesser-known botanical entity, has recently emerged as a formidable contender in this field. This review explores the possibility of incorporating Helinus integrifolius in the cosmetics industry, synthesizing data from the literature on pharmacological, botanical, and cosmetic research. Additionally, this highlights the versatility and multipurpose nature of this botanical resource in cosmetic applications. Furthermore, concerns regarding the safety of contemporary cosmetic products, formulation compatibility, and regulatory aspects are addressed to accelerate its integration into cosmetic products. Ultimately, this review highlights the untapped potential of Helinus integrifolius as a treasured resource for the cosmetics industry, emphasizing its ability to meet the growing consumer demand for eco-friendly, effective, and naturally inspired cosmetic solutions. Through thorough exploration and analysis, this paper aims to stimulate further research and development initiatives aimed at harnessing the cosmetic capabilities of Helinus integrifolius, thus contributing to the advancement of innovation in natural cosmetics.
... Eye cosmetics have been used for thousands of years in Egyptian, Greek, Roman, Chinese, Japanese, Phoenician, Indian, and Muslim civilizations (Zhou et al. 2022). The historical use of eye make-up was to take a model of Gods, seek divine favor, protect the eyelids from the glare of the sun, keep out flies, protect toward the Evil Eye, and serve as an important burial gift, to purify and allow entry to the afterlife (Crespi and Mattix 2000;Al-Ashban et al. 2004;Murube 2013;Sullivan et al. 2023). Today, glamorous lifestyles and social media are influencing the use of eye make-up. ...
... Eyeliner is available in two forms, liquid or solid (Al-Ashban et al. 2004;McMichael and Stoff 2018). Mascara has the same content as eyeliners but has a higher percentage of wax (Al-Ashban et al. 2004;McMichael and Stoff 2018;Sullivan et al. 2023). Most of them use coal or activated carbon as the black pigment. ...
... Previously, eye make-up used ingredients derived from plants, animals, and/or minerals (Sullivan et al. 2023). In Asia, Africa, and the Middle East, they often use Kajal, collyrium, surma, or kohl. ...
Biomass, as a renewable and abundant resource, holds significant potential for improving human lives across various sectors. One promising avenue is the utilization of biomass for the production of activated carbon, which has multi-benefit resources and demonstrated exceptional properties for numerous applications. This review focuses on exploring the potential biomass-derived activated carbon, especially in the context of cosmetic applications, and also be a significant reference for researchers to determine the future technological and application needs of activated carbon-based cosmetics. Activated carbon derived from biomass processes has several advantageous characteristics, including its high porosity, large surface area, and unique chemical composition. These attributes make it an excellent material for various applications, especially for cosmetics formulations and treatments, owing to its adsorption, purification, and detoxification capabilities. In cosmetic applications, activated carbon from biomass serves as a versatile ingredient with multiple benefits. Its adsorption properties allow it to effectively remove impurities, pollutants, and excess sebum from the skin, resulting in a deep cleansing and detoxifying effect. Additionally, activated carbon can aid in controlling oiliness, reducing the appearance of pores and improving overall skin texture. The potential applications of biomass-derived activated carbon extend beyond skin care. It can be utilized in hair care products to remove pollutants, excess oils, and chemical residues from the scalp, promoting a healthy environment for hair growth. Moreover, activated carbon has the ability to neutralize odors, making it suitable for use in deodorants and oral care products. In conclusion, biomass-derived activated carbon holds immense promise for enhancing human lives through its application in cosmetics. Its unique properties offer opportunities for deep cleansing, detoxification, and eco-friendly formulations. Embracing this sustainable and renewable resource can revolutionize the cosmetics industry, providing consumers with innovative, effective, and environmentally conscious beauty products.
... Ocular cosmetic use is increasingly widespread and consists of an extensive range of leave-on and wash-off products [108]. These products contain a myriad of cosmetic ingredients which function as abrasive, absorbent, buffer, colourant, pH adjuster, or surfactant [108]. ...
... Ocular cosmetic use is increasingly widespread and consists of an extensive range of leave-on and wash-off products [108]. These products contain a myriad of cosmetic ingredients which function as abrasive, absorbent, buffer, colourant, pH adjuster, or surfactant [108]. As reported comprehensively in the Tear Film and Ocular Surface (TFOS) Lifestyle report on the impact of cosmetics on the ocular surface [108], due to the thin eyelid and periorbital skin, compounds in eye makeup and skincare products such as retinoids [109] and tea tree oil [110] can easily penetrate and migrate onto the ocular surface, causing negative effects such as orifice obstruction of the meibomian glands, promoting ocular surface inflammation and damage, and worsening meibomian gland and dry eye disease [111][112][113][114]. ...
... These products contain a myriad of cosmetic ingredients which function as abrasive, absorbent, buffer, colourant, pH adjuster, or surfactant [108]. As reported comprehensively in the Tear Film and Ocular Surface (TFOS) Lifestyle report on the impact of cosmetics on the ocular surface [108], due to the thin eyelid and periorbital skin, compounds in eye makeup and skincare products such as retinoids [109] and tea tree oil [110] can easily penetrate and migrate onto the ocular surface, causing negative effects such as orifice obstruction of the meibomian glands, promoting ocular surface inflammation and damage, and worsening meibomian gland and dry eye disease [111][112][113][114]. In addition, numerous substances in products such as eyeshadows, mascara, eyeliner, and eye creams, for instance, benzalkonium chloride [115], parabens, phenoxyethanol [116], shellac, and 1,3-butylene glycol, have been shown to be toxic to the ocular surface and cause MGD and eyelid contact dermatitis [117][118][119]. ...
Ocular surface diseases (OSDs) are significant causes of ocular morbidity, and are often associated with chronic inflammation, redness, irritation, discomfort, and pain. In severe OSDs, loss of vision can result from ocular surface failure, characterised by limbal stem cell deficiencies, corneal vascularisation, corneal opacification, and surface keratinisation. External and internal exposomes are measures of environmental factors that individuals are exposed to, and have been increasingly studied for their impact on ocular surface diseases. External exposomes consist of external environmental factors such as dust, pollution, and stress; internal exposomes consist of the surface microbiome, gut microflora, and oxidative stress. Concerning internal exposomes, alterations in the commensal ocular surface microbiome of patients with OSDs are increasingly reported due to advancements in metagenomics using next-generation sequencing. Changes in the microbiome may be a consequence of the underlying disease processes or may have a role in the pathogenesis of OSDs. Understanding the changes in the ocular surface microbiome and the impact of various other exposomes may also help to establish the causative factors underlying ocular surface inflammation and scarring, the hallmarks of OSDs. This review provides a summary of the current evidence on exposomes in various OSDs.
... The direct impact of certain individual lifestyle factors in ocular surface diseases, including nutrition [3], cosmetics [4], elective medicine [5], lifestyle challenges [6], environment factors [7] and digital device use [8], is explored in detail in the respective Reports from the TFOS Lifestyle Workshop. The Societal Challenges Report will predominantly focus on how those factors contribute to societal norms that in turn influence presentation, outcome and management of ocular surface diseases and will refer to the relevant sub-committee reports for their direct effects. ...
... Castor oil is derived from the Ricinus communis plant and is used in cosmetics as an emollient (See TFOS Cosmetics Subcommittee Report [4]). It has been used as a wound dressing and a drug delivery system [326]. ...
... Indoor suntanning is a popular way of enhancing skin tones for people with light skin color (See TFOS Cosmetics Subcommittee Report [4]). Because of a lack of universally adopted laws or guidelines, eye protection during indoor suntanning is not obligatory. ...
Societal factors associated with ocular surface diseases were mapped using a framework to characterize the relationship between the individual, their health and environment. The impact of the COVID-19 pandemic and mitigating factors on ocular surface diseases were considered in a systematic review. Age and sex effects were generally well-characterized for inflammatory, infectious, autoimmune and trauma-related conditions. Sex and gender, through biological, socio-economic, and cultural factors impact the prevalence and severity of disease, access to, and use of, care. Genetic factors, race, smoking and co-morbidities are generally well characterized, with interdependencies with geographical, employment and socioeconomic factors. Living and working conditions include employment, education, water and sanitation, poverty and socioeconomic class. Employment type and hobbies are associated with eye trauma and burns. Regional, global socio-economic, cultural and environmental conditions, include remoteness, geography, seasonality, availability of and access to services. Violence associated with war, acid attacks and domestic violence are associated with traumatic injuries. The impacts of conflict, pandemic and climate are exacerbated by decreased food security, access to health services and workers. Digital technology can impact diseases through physical and mental health effects and access to health information and services. The COVID-19 pandemic and related mitigating strategies are mostly associated with an increased risk of developing new or worsening existing ocular surface diseases. Societal factors impact the type and severity of ocular surface diseases, although there is considerable interdependence between factors. The overlay of the digital environment, natural disasters, conflict and the pandemic have modified access to services in some regions.
... An evidence-based approach might be limited to lower level evidence (such as case series) if this is all that is available in the literature. For example, many of the associations between cosmetic use and ocular surface adverse events derive from case series (Level IV etiology studies) [23]. In the absence of higher level evidence, these findings may constitute the 'best' current evidence, but should be viewed with less certainty than if they were reported from well-conducted prospective cohort studies (as the optimal primary study design to answer etiological clinical questions). ...
... To facilitate potential incorporation into the narrative review, each systematic review was also classified into one of four categories (Table 5) to indicate its reliability and relevance to the topic area. The total number of systematic review articles in each topic area database ranged from 106 (Cosmetics [23]) to 434 (Elective Medications and Procedures [61]). ...
... The Evidence Quality Subcommittee sought to apply consistent, best practice methods across all of the systematic reviews [58]. Table 7 summarizes the key methodological features implemented across the reports, which meet all of the reliability criteria defined in Table 4. Five of the eight systematic reviews (Cosmetics [23], Digital environment [66], Lifestyle challenges [67], Contact Lenses [65] and Nutrition [24]) incorporated meta-analyses. For the other topic areas there was insufficient data and/or the data were deemed too heterogeneous for meta-analyses to be meaningful; in these cases, tabulated and narrative summaries of the evidence were provided. ...
Evidence-based practice is a dominant paradigm in healthcare that emphasizes the importance of ensuring the translation of the best available, relevant, research evidence into practice. An Evidence Quality Subcommittee was established to provide specialized methodological support and expertise to promote rigorous and evidence-based approaches for the Tear Film and Ocular Surface Society (TFOS) Lifestyle Epidemic reports. The present report describes the purpose, scope, and activity of the Evidence Quality Subcommittee in the undertaking of high-quality narrative-style literature reviews, and leading prospectively-registered, reliable systematic reviews of high priority research questions, using standardized methods for each topic area report. Identification of predominantly low or very low certainty evidence across the eight systematic reviews highlights a need for further research to define the efficacy and/or safety of specific lifestyle interventions on the ocular surface, and to clarify relationships between certain lifestyle factors and ocular surface disease. To support the citation of reliable systematic review evidence in the narrative review sections of each report, the Evidence Quality Subcommittee curated topic-specific systematic review databases and relevant systematic reviews underwent standardised reliability assessment. Inconsistent methodological rigor was noted, emphasizing the importance of internal validity assessment. Based on considerations and challenges associated with implementing the Evidence Quality Subcommittee, this report makes suggestions for incorporation of such initiatives in future international taskforces and working groups. Content areas broadly relevant to the activity of the Evidence Quality Subcommittee, including the critical appraisal of research, clinical evidence hierarchies (levels of evidence), and risk of bias assessment, are also outlined.
... Improper use or exposure to certain chemicals in cosmetics can lead to significant health concerns, including ocular irritation, allergic reactions, and even long-term visual impairment. A 2023 study by Sullivan et al. confirmed similar severe complications, demonstrating the negative impact of cosmetic procedures on the visual system (5). ...
INTRODUCTION: The cosmetic industry has seen significant growth, with an increasing number
of men utilizing procedures and rejuvenation therapies. This shift has expanded the consumption of
cosmetic services but also raised concerns about risks affecting eye health. Cosmetic products and
procedures can cause irritation, allergies, and infections, posing serious health risks. AIMS: This
study analyzes trends in the use of cosmetic products and facial procedures, aiming to assess their
potential risks to eye health. METHODS: A documentary method was applied, involving a
systematic review of literature from electronic databases such as PubMed, Scopus, Web of Science,
and Research Gate using specialized software. The analysis focused on existing trends and risks
related to cosmetic procedures, with keywords including "dry eye," "eye cosmetics," "safety,"
"cosmeticians," and "opticians." A sociological method was also employed through a survey
conducted in November 2024 among students (n=53) and faculty members (n=5). RESULTS:
Survey data indicated that 55.2% (n=32) of participants experienced burning or irritation in their
eyes after procedures such as chemical peels and micropigmentation. More severe reactions, such
as allergies or burns, were reported by 10.3% (n=6) of respondents. The findings highlight the need
for educational campaigns to promote safe cosmetic practices. CONCLUSION: Improved health
awareness among medical professionals and consumers about the risks of cosmetic procedures is
essential. Educational campaigns targeting both consumers and professionals are recommended.
Systematic information on the safety of these procedures is needed.
... Докладът на TFOS DEWS II "Епиемия от начина на живот: заболяване на очната повърхност" разглежда как използването на козметични продукти и процедури за очи е предизвикателство за начина на живот, което може да влоши или да предизвика развитие на заболяване на очната повърхност и аднексите. Така например много съставки на гримовете за очи могат да действат като алергени, канцерогенни и ендокринни разрушители, имуносупресивни агенти, мутагени, токсини и/или туморни стимулатори (10). Козметичните продукти и процедури могат да предизвикат негативни ефекти върху очната повърхност, вариращи от лек дискомфорт до състояния, застрашаващи зрението. ...
Introduction: Women have traditionally used cosmetics for the eye area and facial treatments, but recently, more men are also opting for beauty procedures such as eyebrow coloring, peeling, and facial massages. In her book "55 Reasons to Love Eyes," Prof. Grupcheva highlights that in ophthalmology, factors such as age, gender, or social status are irrelevant. Medical professionals concerned with eye health must stay updated on the latest fashion trends to provide appropriate care while considering potential risks and complications. This study explores the relationship between decorative cosmetics and the anterior ocular surface, with a focus on procedures and facial products linked to ophthalmic complications. Aim: This study aims to systematize and analyze trends and preferences in the use of decorative eye cosmetics and to gather data on the experience, awareness, and health literacy of medical and non-medical professionals. Materials and Methods: This educational study consists of two surveys: (a) face-to-face interviews with the staff of the University Eye Hospital in Varna and (b) a questionnaire distributed to students and faculty from the "Medical Cosmetician" program at the Medical College – Varna. Results: The findings reveal a high frequency of weekly decorative eye cosmetic use, age-specific preferences for cosmetic product groups, confirmed complications from cosmetic products and procedures, and satisfactory health awareness among participants. Conclusion: The study highlights the need to improve health literacy and awareness regarding the visual system among medical and non-medical personnel, as well as among women and adolescents, through targeted informational campaigns.
... Table 3 Because many studies about dry eye have already shown that dry eye is a multifactorial disease and all KDES members already accept this as a matter of course, we did not used this term for concise expression. [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] Previously, ocular surface staining was considered an essential part of diagnosis. [1,2] However, ocular surface staining is not required for the definitive diagnosis of dry eye. ...
New Korean guidelines for the diagnosis and management of dry eye disease were developed based on literature reviews by the Korean Dry Eye Guideline Establishment Committee, a previous dry eye guideline by Korean Corneal Disease Study Group, a survey of Korean Dry Eye Society (KDES) members, and KDES consensus meetings. The new definition of dry eye was also proposed by KDES regular members. The new definition by the regular members of the KDES is as follows: “Dry eye is a disease of the ocular surface characterized by tear film abnormalities and ocular symptoms.” The combination of ocular symptoms and an unstable tear film (tear breakup time <7 seconds) was considered as essential components for the diagnosis of dry eye. Schirmer test and ocular surface staining were considered adjunctive diagnostic criteria. The treatment guidelines consisted of a simplified stepwise approach according to aqueous deficiency dominant, evaporation dominant, and altered tear distribution subtypes. New Korean guidelines can be used as a simple, valid, and accessible tool for the diagnosis and management of dry eye disease in clinical practice.
... Although the outer layer of the skin has limited permeability, small amounts of chemicals in cosmetics are capable of reaching the circulatory system [15]. In particular, as an organ that contacts cosmetics directly besides the skin, the ocular surface and its appendages are susceptible to impairments associated with numerous cosmetic ingredients that can act as irritants, allergens, endocrine disruptors, immunosuppressive agents, and carcinogens [16]. A recent study demonstrated that avobenzone, a typical ingredient in cosmetics, had a significant inhibitory effect on the motor activity of zebrafish larvae, which was associated with altered retinal developmental function and disturbances in the neurotransmitter and antioxidant systems [17]. ...
The increasing use of cosmetics has raised widespread concerns regarding their ingredients. Cysteamine hydrochloride (CSH) is a newly identified allergenic component in cosmetics, and therefore its potential toxicity needs further elucidation. Here, we investigated the in vivo toxicity of CSH during ocular development utilizing a zebrafish model. CSH exposure was linked to smaller eyes, increased vasculature of the fundus and decreased vessel diameter in zebrafish larvae. Moreover, CSH exposure accelerated the process of vascular sprouting and enhanced the proliferation of ocular vascular endothelial cells. Diminished behavior in response to visual stimuli and ocular structural damage in zebrafish larvae after CSH treatment were confirmed by analysis of the photo-visual motor response and pathological examination, respectively. Through transcriptional assays, transgenic fluorescence photography and molecular docking analysis, we determined that CSH inhibited Notch receptor transcription, leading to an aberrant proliferation of ocular vascular endothelial cells mediated by Vegf signaling activation. This process disrupted ocular homeostasis, and induced an inflammatory response with neutrophil accumulation, in addition to the generation of high levels of reactive oxygen species, which in turn promoted the occurrence of apoptotic cells in the eye and ultimately impaired ocular structure and visual function during zebrafish development.
... They can be used across an individual's lifespan and can contribute to esteem, be used to display personality and have cultural or religious significance [13]. The TFOS Lifestyle: Impact of cosmetics on the ocular surface report [14] addresses multiple aspects of eye cosmetics, including their history and market value, psychological and social impacts, and potential problems associated with numerous cosmetic ingredients that may act as allergens, carcinogens, endocrine disruptors, immunosuppressants, irritants, mutagens, toxins and/or tumor promoters, and may damage the ocular surface and adnexa. The report also addresses possible adverse effects associated with cosmetic products (such as concealers, conditioners, creams, extensions, eyeliners, foundations, glues, mascaras, primers, removers, serums, shadows, and toners) and procedures (including eyelash curling, dyeing, tinting, and perming, botulinum toxin, filler and platelet-rich plasma injections, chemical peels, conjunctival tattooing, eyelid piercing and tattooing, microdermabrasion, microneedling, and skin resurfacing and tightening), and reviews regulations for eye cosmetic use. ...
The objective of this study was to investigate whether eyeliner use is associated with an increase in dry eye symptoms. A survey was conducted to collect data on cosmetic usage and Ocular Surface Disease Index (OSDI) scores from a diverse public sample. Additionally, eyecare professionals were queried regarding their practice of inquiring about cosmetic use during patient consultations. The survey included specific questions about eyeliner application and the calculation of OSDI scores, with a score of 13 or higher indicating the presence of dry eye symptoms. Individuals who reported using eyeliner had a significantly higher rate of OSDI scores above 13 compared to non-users (42.93% vs. 33.38%, p < 0.001). Notably, subjects who applied eyeliner to the lid margins exhibited an even more pronounced increase in high OSDI scores (48.17%, p < 0.001). Furthermore, a significant proportion of patients (23.37%) expressed reluctance to discontinue cosmetic use when advised in medical contexts, while only 48.19% of healthcare providers routinely inquired about cosmetic use during patient consultations. The usage of eyeliner is associated with higher OSDI scores, underscoring the need for both eyecare practitioners and eyeliner users to be more cognizant of the potential impact of eyeliner on the ocular surface.
Consumers often use cosmetics long after their expiry date, despite the health risk. This paper aims to understand why and to suggest policy changes that can promote safer practices in cosmetics use. This is the first study to investigate risk perception in relation to expired cosmetics. Thirty‐three semistructured interviews with both cosmetics users and employees of cosmetics companies were conducted in the United Kingdom and China. Perceived risk theory was found to be a useful analytical lens. Eight risk factors emerged from the data, including two not previously identified. Combinations of risk were also found to be valuable in explaining consumer attitudes to cosmetic expiry dates, which suggests that perceived risk factors interact with each other to create an emergent perception of risk, requiring an integrated understanding. While physical, performance and self‐brand connection risk can promote adherence to an expiry date, other risk factors such as financial and social risk can override such concerns, leading to the expiry date being ignored. Implications for suppliers’ and regulators’ policies and risk‐communication strategies are identified that may help reduce the risks being taken by cosmetics users.
Objetivo: analizar la queratitis secundaria por el uso del maquillaje. Método: Descriptiva documental. Conclusión: El maquillaje afecta gravemente a los ojos, se puede observar patologías como la queratitis y secundario a esta un ojo seco por tres factores el primero es la migración de partículas de maquillaje desde parpado hacia superficie ocular y película lagrimal, los preservantes y conservantes, todos estos en conjunto son responsables de una alteración del film lagrimal y deficiencia de glándulas de meibomio lo que conduce a un ojo seco y una queratitis inflamatoria.
The third in the series of online education events was delivered by Dr Sònia Travé Huarte. The focus of this webinar was to discuss dry eye and ocular health and how assessments can be implemented seamlessly into the normal routine to help practitioners diagnose and manage dry eye disease. (C106327, suitable for one distance learning CPD point for optometrists, contact lens opticians and dispensing opticians)
The widespread adoption of double eyelid tapes (DET) to achieve the desired double eyelid aesthetic has prompted investigations into their long-term effects. Given the delicate and complex anatomy of the eyelid, concerns have emerged about the impact of DETs on eyelid structure and the outcomes of subsequent surgical procedures.
A cohort of 267 outpatients from our department was recruited between January 2022 and January 2024 to participate in a survey assessing the usage of double eyelid tape (DET). Eyelid laxity was subsequently tested in all outpatients using the Vertical Lid Pull and Parallel Lid Pull methods. Among all participants, 33 underwent double eyelid surgery, with 22 having a history of excessive DET usage and 11 with no DET usage. Post-operative outcomes, including operation duration, satisfaction levels, and complications were recorded. Additionally excised eyelid skin tissues during surgery underwent Masson’s staining and EVG staining to analyze collagen and elastic fibers.
Among surveyed outpatients (mean age: 23.79 ± 3.71 years, 99.63% female, mean BMI: 21.56 ± 1.75 kg/m2), 56.55% had oculopathy with ametropia being predominant (53.93%). Hooded eyelids were the most prevalent congenital condition (62.54%). Nearly half (49.44%) used Double Eyelid Tapes (DET) for 1–2 years, with 70.04% experiencing discomfort and 70.79% reporting permanent eyelid shape change. Lid pull measurements showed no significant difference in vertical pulls between DET users and non-users, but parallel pulls varied significantly (p<0.05). Complications like asymmetry, numbness, and hypertrophic scars were exclusive to DET users. Physician evaluations favored non-DET users significantly (p<0.05). Histological analysis revealed an interesting finding that individuals using DET have higher collagen levels and notable changes in skin structure when compared to non-users.
Prolonged use of double eyelid tape (DET) may result in eyelid laxity, impacting ocular health and complicating blepharoplasty procedures.
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Background: Eyelash extensions (EEs) are among the most popular cosmetic procedures today. There is no prospective study demonstrating how this procedure affects the ocular surface and eye dryness in particular. The goal of this study is to evaluate the effect of EEs removal on dry eye symptoms and signs. Materials and Methods: The subjects were prospectively recruited from routine clinical examinations for dry eye complaints. Only subjects with an OSDI score above 31 were included in the study. The subjects also planned to have the EEs removed and agreed to abstain from makeup use and new cosmetic procedures for 4 weeks. The presence of dry eye was evaluated by an OSDI questionnaire, and objectively by tear breakup time (TBUT), staining (Oxford scale) and blinking intervals. All tests for dry eye were performed at baseline and 4 weeks after EEs removal. Results: The mean age of our patients, all female, was 28 years. The size and type of EEs was diverse. The decision process was mainly based on appearance and models. None of the subjects had any health conditions. The mean result from the score from the OSDI questionnaire at the baseline was 33.4 and improved to 26.7 points 4 weeks after EEs removal. Objectively, the mean TBUT increased from 11.25 to 13.96 s. For the same period, the blinks increased by two per minute, and the staining was reduced by 1.0 grade. Conclusions: Removal of EEs improves the symptoms and the objective signs of dry eye. The most popular beauty procedure regarding eyelashes might not be innocuous to eye health.
The Tear Film & Ocular Surface Society (TFOS) Workshop entitled 'A Lifestyle Epidemic: Ocular Surface Disease' was a global initiative undertaken to establish the direct and indirect impacts of everyday lifestyle choices and challenges on ocular surface health. This article presents an Executive Summary of the evidence-based conclusions and recommendations of the 10-chapter TFOS Lifestyle Workshop report. Lifestyle factors described within the report include contact lenses, cosmetics, digital environment, elective medications and procedures, environmental conditions, lifestyle challenges, nutrition, and societal challenges. Each topic area chapter comprises a narrative-style review of the current literature and seeks to answer a key topic-specific question using systematic review methodology. The TFOS Lifestyle Workshop report was published in its entirety in the April 2023 and July 2023 issues of The Ocular Surface. Links to downloadable versions of the document and supplementary material, including report translations, are available on the TFOS website: www.TearFilm.org.
The global healthcare sector, responsible for 4 to 6% of CO2 emissions, faces a pressing need to embrace sustainability, particularly in ophthalmology, given its substantial volume of consultations and procedures. Dry-eye disease (DED), ranking as the third-most common reason for ophthalmology visits after refractive error and cataracts, affects approximately one in 11 people worldwide, with prevalence increasing with age and among women and certain populations. The incidence of DED is expected to rise following the aging population and environmental factors like pollution and low humidity related to climate change. Additionally, digital eye strain is becoming more prevalent in our daily lives. Despite its widespread occurrence, DED remains underdiagnosed and underreported, with significant economic costs attributed to reduced productivity. The treatment of DED primarily involves lubricating eye drops, which contribute to plastic waste, with recycling rates remaining disappointingly low. This environmental impact translates to an estimated 7 kg of CO2 emissions per person annually. Multidose treatment generates more waste and it is recommended to use single-dose, preservative-free eye drops. Beyond eye drops, anti-inflammatory drugs and eyelid hygiene measures also generate plastic waste. Digital eye strain can be mitigated by limiting screen time and employing blinking exercises and digital solutions. To address these challenges, the ophthalmological community must prioritize research and evidence-based sustainable practices. In conclusion, DED poses economic and environmental sustainability challenges due to its high patient volume and resource-intensive treatments, making adopting eco-friendly practices imperative for the future of eye care.
Recently, the rising demand of the industry for natural phenolic antioxidant compounds has turned to the study of microalgae as potential sources. Yet, more economic substrates for microalgal cultivation are sought to lower production costs. To this end, the present work deals with the utilization of rice hull hydrolysate (RHH) as substrate for microalgae B. braunii through a novel two-stage cultivation system. Initially, RHH was optimized to maximize the contained nutrients while minimizing its inhibitors content. The optimum point was reached under 121 °C, 60 min, 2% (v/v) H2SO4, 30% (w/v) loading. Next, B. braunii was successfully grown first heterotrophically in RHH (25%, v/v), obtaining high biomass production (6.67 g L-1) and then autotrophically to enhance phenolics accumulation. At the end, a high phenolic content of 7.44 ± 0.60 mg Gallic Acid Equivalents g-1 DW was achieved from the produced biomass, thus highlighting the potential of this novel biotechnological method.
Glaucoma is a common disease with an increasing prevalence [1]. Ocular surface disease (OSD) is also common, and its prevalence is increasing [2,3], due in part to the adverse effects of topical glaucoma medications [4,5]. Given this glaucoma/OSD association, David A. Sullivan, MS, PhD (Boston, MA, USA) and Amy Gallant Sullivan (Paris, France) on behalf of the Tear Film & Ocular Surface Society (TFOS), and in collaboration with Miriam Kolko, MD, PhD (Copenhagen University Hospital & University of Copenhagen, Denmark), organized a one-day meeting which was held on Saturday, October 22, in Cernobbio, Italy. This meeting focused on the impact of glaucoma medications on the ocular surface, and how OSD can influence glaucoma treatment. The term "ocular surface" encompasses the surface (cornea and conjunctiva), tear film, and adnexa (lacrimal and meibomian glands). The speakers included internationally renowned glaucoma and OSD experts. The evidence-based proceedings of this meeting are presented in this TFOS Experts' Meeting report.
Several lifestyle choices made by contact lens wearers can have adverse consequences on ocular health. These include being non-adherent to contact lens care, sleeping in lenses, ill-advised purchasing options, not seeing an eyecare professional for regular aftercare visits, wearing lenses when feeling unwell, wearing lenses too soon after various forms of ophthalmic surgery, and wearing lenses when engaged in risky behaviours (e.g., using tobacco, alcohol or recreational drugs). Those with a pre-existing compromised ocular surface may find that contact lens wear exacerbates ocular disease morbidity. Conversely, contact lenses may have various therapeutic benefits. The coronavirus disease-2019 (COVID-19) pandemic has impinged upon the lifestyle of contact lens wearers, introducing challenges such as mask-associated dry eye, contact lens discomfort with increased use of digital devices, inadvertent exposure to hand sanitizers, and reduced use of lenses. Wearing contact lenses in challenging environments, such as in the presence of dust and noxious chemicals, or where there is the possibility of ocular trauma (e.g., sport or working with tools) can be problematic, although in some instances lenses can be protective. Contact lenses can be worn for sport, theatre, at high altitude, driving at night, in the military and in space, and special considerations are required when prescribing in such situations to ensure successful outcomes. A systematic review and meta-analysis, incorporated within the review, identified that the influence of lifestyle factors on soft contact lens dropout remains poorly understood, and is an area in need of further research. Overall, this report investigated lifestyle-related choices made by clinicians and contact lens wearers and discovered that when appropriate lifestyle choices are made, contact lens wear can enhance the quality of life of wearers.
Nutrients, required by human bodies to perform life-sustaining functions, are obtained from the diet. They are broadly classified into: macronutrients (carbohydrates, lipids, and proteins), micronutrients (vitamins and minerals) and water. All nutrients serve as a source of energy, provide structural support to the body and/or regulate the chemical processes of the body. Food and drinks also consist of non-nutrients that may be beneficial (e.g., antioxidants) or harmful (e.g., dyes or preservatives added to processed foods) to the body and the ocular surface. There is also a complex interplay between systemic disorders and an individual's nutritional status. Changes in the gut microbiome may lead to alterations at the ocular surface. Poor nutrition may exacerbate select systemic conditions. Similarly, certain systemic conditions may affect the uptake, processing and distribution of nutrients by the body. These disorders may lead to deficiencies of micro- and macro-nutrients that are important in maintaining ocular surface health. Medications used to treat these conditions may also cause ocular surface changes. The prevalence of nutrition-related chronic diseases is climbing worldwide. This report sought to review the evidence supporting the impact of nutrition on the ocular surface, either directly or as a consequence of the chronic diseases that result. To address a key question, a systematic review investigated the effects of intentional food restriction on ocular surface health; of the 25 included studies, most investigated Ramadan fasting (56%), followed by bariatric surgery (16%), anorexia nervosa (16%), but none were judged to be of high quality, with no randomized-controlled trials.
The word "elective" refers to medications and procedures undertaken by choice or with a lower grade of prioritization. Patients usually use elective medications or undergo elective procedures to treat pathologic conditions or for cosmetic enhancement, impacting their lifestyle positively and, thus, improving their quality of life. However, those interventions can affect the homeostasis of the tear film and ocular surface. Consequently, they generate signs and symptoms that could impair the patient's quality of life. This report describes the impact of elective topical and systemic medications and procedures on the ocular surface and the underlying mechanisms. Moreover, elective procedures performed for ocular diseases, cosmetic enhancement, and non-ophthalmic interventions, such as radiotherapy and bariatric surgery, are discussed. The report also evaluates significant anatomical and biological consequences of non-urgent interventions to the ocular surface, such as neuropathic and neurotrophic keratopathies. Besides that, it provides an overview of the prophylaxis and management of pathological conditions resulting from the studied interventions and suggests areas for future research. The report also contains a systematic review investigating the quality of life among people who have undergone small incision lenticule extraction (SMILE). Overall, SMILE seems to cause more vision disturbances than LASIK in the first month post-surgery, but less dry eye symptoms in long-term follow up.
Eye strain when performing tasks reliant on a digital environment can cause discomfort, affecting productivity and quality of life. Digital eye strain (the preferred terminology) was defined as "the development or exacerbation of recurrent ocular symptoms and/or signs related specifically to digital device screen viewing". Digital eye strain prevalence of up to 97% has, due to no previously agreed definition/diagnostic criteria and limitations of current questionnaires, failed to differentiate such symptoms from those arising from non-digital tasks. Objective signs such as blink rate or critical flicker frequency changes are not 'diagnostic' of digital eye strain nor validated as sensitive. The mechanisms attributed to ocular surface disease exacerbation are mainly reduced blink rate and completeness, partial/uncorrected refractive error and/or underlying binocular vision anomalies, together with the cognitive demand of the task and differences in position, size, brightness and glare compared to an equivalent non-digital task. In general, interventions are not well established; patients experiencing digital eye strain should be provided with a full refractive correction for the appropriate working distances. Improving blinking, optimizing the work environment and encouraging regular breaks may help. Based on current, best evidence, blue-light blocking interventions do not appear to be an effective management strategy. More and larger clinical trials are needed to assess artificial tear effectiveness for relieving digital eye strain, particularly comparing different constituents; a systematic review within the report identified use of secretagogues and warm compress/humidity goggles/ambient humidifiers as promising strategies, along with nutritional supplementation (such as omega-3 fatty acid supplementation and berry extracts).
There is increasing recognition that environmental exposure to chemicals, such as endocrine-disruptive chemicals (EDCs), contributes to the development of breast cancer. Parabens are a group of EDCs commonly found in personal care products, foods, and pharmaceuticals. Systemic exposure to parabens has been confirmed by the ubiquitous detection of parabens in human blood and urine samples. Although evidence from in vivo and epidemiological studies linking parabens exposure to breast cancer is limited, the current evidence suggests that parabens may negatively interfere with some endocrine and intracrine targets relevant to breast carcinogenesis. So far, most studies have focused on a single paraben's effects and the direct modulating effects on estrogen receptors or the androgen receptor in vitro. Recent studies have revealed that parabens can modulate local estrogen-converting enzymes, 17β-hydroxysteroid dehydrogenase 1 and 2 and increase local estrogen levels. Also, parabens can crosstalk with the human epidermal growth factor receptor 2 (HER2) pathway and work with ER signaling to increase pro-oncogenic c-Myc expression in ER+/HER2+ breast cancer cells. Future studies investigating paraben mixtures and their crosstalk with other EDCs or signaling pathways both in vitro and in vivo in the context of breast cancer development are warranted.
Skin aging inevitably begins from the very early days of life. The lasers used in skin rejuvenation are mainly of two types: ablative and non-ablative. This meta-analysis aimed at comparing ablative with non-ablative lasers in terms of their efficacy and safety in skin rejuvenation. Articles published by March 15, 2020 in Embase, Medline (PubMed), Scopus, Cochrane, and clinicalTrials.gov were searched. The inclusion criteria included randomized controlled clinical trials (RCTs) in English using ablative and non-ablative lasers and comparing their safety and efficiency in wrinkle improvement and photoaging therapy. Out of 1353 extracted articles, 11 were selected for qualitative synthesis and of these, 4 were quantitatively analyzed. Different modes of various lasers were implemented; the ablative lasers included Erbium: yttrium–aluminium-garnet (Er:YAG) and CO2, besides the non-ablative lasers, comprised Ytterbium/Erbium, Erbium: Glass, neodymium: yttrium–aluminum-garnet (Nd:YAG), and alexandrite. Pooled analyses on 124 participants showed insignificant differences between ablative and non-ablative lasers in the likelihood of excellent improvement with an odds ratio of 0.83 (95% CI: 0.24, 2.83). The analyses also showed good improvement with an odds ratio of 0.88 (95% CI: 0.44, 1.78), fair improvement with an odds ratio of 1.13 (95% CI: 0.56, 2.26) and side effects with an odds ratio of 0.82 (95% CI: 0.43, 1.56). The efficacy and safety of ablative laser were not higher than those of non-ablative laser in skin rejuvenation. Given the small samples of the included articles, it is recommended that further high-quality RCTs be conducted using larger samples to confirm this conclusion.
Background
Infraorbital hollows can give a fatigued or aged appearance which can be treated by volumizing the segmented transition from the tear trough to the cheek with hyaluronic acid filler. Due to thin skin and the complex anatomy of the infraorbital area, both short- and long-term side effects from this treatment are very common. While some patients are clear surgical candidates vs. filler candidates, in real-world practice, many, if not most patients are on a continuum where either procedure is appropriate, and the treatment decision is individualized based on each person’s risk vs. benefit profile.
Objectives
Common aesthetic side effects from hyaluronic acid filler treatment in the infraorbital area will be reviewed, including their etiology, prevention, detection, and treatment.
Method
The authors’ experience from injecting the infraorbital areas of more than 800 patients in private clinical practice and observations from both short and long-term follow ups over eight years is leveraged to provide detailed guidance.
Results
Recommendations on injection techniques, patient selection, and patient education are presented along with algorithms for the prevention and management of bruising, short- and long-term swelling, bumps, and blue discoloration (which is usually secondary to swelling from the filler rather than just the filler alone placed or migrating too superficially).
Conclusion
For nearly all patients, complete dissolution of filler with hyaluronidase is not required to address the issue, and the guidelines provided here will assist clinicians in management of side effects to increase patient satisfaction with their treatment and aesthetic outcome.
Background
The use of social media and photo-editing practice has grown enormously over the past decades. Photo editing can alter a person’s desire to look better in photographs posted on social media platforms.
Objective
To assess the cosmetic dermatology seeking behavior of social media users and those who edit photographs before posting them on social media platforms.
Methods
A validated self-administered structured questionnaire via Google form was sent to 550 social media users in Nepal. It included 5 sub-headings: use of social networking sites, photo-editing practices, awareness and motivation about cosmetic dermatology care, cosmetic dermatology care seeking behavior and self-esteem.
Results
Facebook and Instagram were the preferred social networking sites for posting photographs. One-fourth of the participants edited >40% of the total photos posted in social media. Hiding skin lesions was the most common reason (36.3%) for photograph editing. Fifty percent of the respondents felt the need to look better; repair skin damage; be able to look good without make up; look younger; feel happier and improve total quality of life as a “lot and top” motivation for using the cosmetic dermatological procedures. A majority preferred to seek cosmetic dermatology care from non-dermatologists because they felt dermatologist visit was not needed, the services were costly and they could not visit due to their busy schedule. On multivariate analysis, respondents who were aware of skin care favored seeking cosmetic dermatology care from dermatologists.
Conclusion
Higher investment in social media and photo-editing practices might be associated with increased non-dermatologist seeking behavior.
Background:
tattooing and piercing are increasingly common, especially among youths. However, several health complications may be associated with these practices if basic hygiene rules are not respected. This multicenter study was aimed at exploring tattoo and piercing experiences reported by a large sample of Italian undergraduate students through a public health perspective.
Methods:
tattooed and/or pierced students attending 12 Italian universities were asked to complete a web-based questionnaire regarding their body art experience.
Results:
out of 1472 respondents, 833 (56.6%) were tattooed and 1009 (68.5%) were pierced. The greatest proportion of tattooed students (93.9%) got her/his first tattoo in a tattoo studio, while most of the pierced were serviced in a jewelry store (48.0%). The pierced ones were less informed on health issues related to the procedure (56.0% versus 77.8% of tattooed p < 0.001), and tattooists were reportedly more attentive to hygiene rules (instrument sterilization 91.5% versus 79.1% of piercers, p < 0.001; use of disposable gloves 98.2% versus 71% of piercers, p < 0.001).
Conclusions:
educational interventions for both professionals and communities are needed to improve the awareness and the control of health risks related to body art throughout the Italian territory.
Per- and poly-fluoroalkyl substances (PFAS) are widespread environmental contaminants frequently detected in drinking water supplies worldwide that have been linked to a variety of adverse reproductive health outcomes in women. Compared to men, reproductive health effects in women are generally understudied while global trends in female reproduction rates are declining. Many factors may contribute to the observed decline in female reproduction, one of which is environmental contaminant exposure. PFAS have been used in home, food storage, personal care and industrial products for decades. Despite the phase-out of some legacy PFAS due to their environmental persistence and adverse health effects, alternative, short-chain and legacy PFAS mixtures will continue to pollute water and air and adversely influence women’s health. Studies have shown that both long- and short-chain PFAS disrupt normal reproductive function in women through altering hormone secretion, menstrual cyclicity, and fertility. Here, we summarize the role of a variety of PFAS and PFAS mixtures in female reproductive tract dysfunction and disease. Since these chemicals may affect reproductive tissues directly or indirectly through endocrine disruption, the role of PFAS in breast, thyroid, and hypothalamic-pituitary-gonadal axis function are also discussed as the interplay between these tissues may be critical in understanding the long-term reproductive health effects of PFAS in women. A major research gap is the need for mechanism of action data – the targets for PFAS in the female reproductive and endocrine systems are not evident, but the effects are many. Given the global decline in female fecundity and the ability of PFAS to negatively impact female reproductive health, further studies are needed to examine effects on endocrine target tissues involved in the onset of reproductive disorders of women.
Background:
Androgenetic alopecia (AGA) leads to thinning of scalp hair and affects 60%~70% of the adult population worldwide. Developing more effective treatments and studying its mechanism are of great significance. Previous clinical studies have revealed that hair growth is stimulated by 650-nm red light.
Objective:
This study aimed to explore the effect and mechanism of 650-nm red light on the treatment of AGA by using ex vivo hair follicle culture.
Methods:
Human hair follicles were obtained from hair transplant patients with AGA. Hair follicles were cultured in Williams E medium and treated with or without 650-nm red light. Real-time RT-PCR and immunofluorescence staining were used to detect the expression level of genes and proteins in hair follicles, respectively. RNA-sequencing analysis was carried out to reveal the distinct gene signatures upon 650 nm treatment.
Results:
Low-level 650 nm red light promoted the proliferation of human hair follicles in the experimental cultured-tissue model. Consistently, 650 nm red light significantly delayed the transition of hair cycle from anagen to catagen in vitro. RNA-seq analysis and gene clustering for the differentially expressed genes suggests that leukocyte transendothelial migration, metabolism, adherens junction and other biological process maybe involved in stimulation of hair follicles by 650-nm red light treatment.
Conclusion:
The effect of 650-nm red light on ex vivo hair follicles and the transcriptome set which implicates the role of red light in promoting hair growth and reversing of miniaturization process of AGA were identified.
Background:. The coronavirus disease 2019 (COVID-19) pandemic has led to an unforeseen surge in demand for facial plastic surgery (FPS). The objective of this study was to survey patients who pursued cosmetic FPS during COVID-19 to better understand how changes in lifestyle, digital media usage, and their facial self-image influenced their decision to pursue surgery.
Methods:. A web-based survey was sent to 150 patients who had undergone FPS at an outpatient clinic between May 1 and July 30, 2020. Questions included changes in patients’ lifestyle habits, use of video conferencing and social media, Likert scale ratings of motivational factors to pursue FPS, and changes in perception of their own facial aesthetics during COVID-19.
Results:. The survey response rate was 41%. Overall increases in video conferencing for social (79% of respondents) and occupational (73%) purposes, and social media usage (82%) were noted. The most commonly cited motivating factors to pursue FPS during COVID-19 were having ample privacy from family, friends, and co-workers (77%) and not requiring extended leave of absence from work (69%) during the postoperative recovery period. Patients were more aware of their nose than any other facial feature during COVID-19 compared to prior.
Conclusions:. The popularity of FPS during COVID-19 can be partially attributed to increased usage of video conferencing and social media, digital applications which often accentuate personal and idealized facial aesthetics. As surgeons adjust to increased demand for FPS, a better understanding of patient perspectives and motivations can help optimize doctor–patient relations and the delivery of care.
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is mainly transmitted by airborne droplets generated by infected individuals. Since this and many other pathogens are able to remain viable on inert surfaces for extended periods of time, contaminated surfaces play an important role in SARS-CoV-2 fomite transmission. Cosmetic products are destined to be applied on infection-sensitive sites, such as the lips and eyelids. Therefore, special biosafety precautions should be incorporated into the routine procedures of beauty parlors and shops. Indeed, innovative cosmetics companies are currently searching for disinfection protocols that ensure the customers’ safety in makeup testing. Here, we propose an ultraviolet germicidal irradiation (UVGI) strategy that can be used to reduce the odds of COVID-19 fomite transmission by makeup testers. It is well-known that UVGI effectively inactivates pathogens on flat surfaces and clear fluids. However, ultraviolet-C (UVC) radiation at 254 nm penetrates poorly in turbid and porous materials, such as makeup and lipstick formulations. Thus, we investigated the virucidal effect of UVGI against SARS-CoV-2 deposited on such substrates and compared their performance to that of flat polystyrene surfaces, used as controls. Concentrated infectious SARS-CoV-2 inoculum (106 PFU/mL) deposited on lipstick and makeup powder was completely inactivated (>5log10 reduction) following UVC exposures at 1,260 mJ/cm2, while flat plastic surfaces required 10 times less exposure (126 mJ/cm2) to reach the same microbicidal performance. We conclude that UVGI comprises an effective disinfection strategy to promote biosafety for cosmetics testers. However, appropriate UVC dosimetry must be implemented to overcome inefficiencies caused by the optical properties of turbid materials in lipsticks and makeup powders.
Purpose/Aim of the study
To evaluate the improvement of ocular signs and symptoms in patients suffering from Demodex blepharitis using a combined treatment approach: use of eyelid wipes impregnated with 2.5% terpinen-4-ol (T4O) and 0.2% hyaluronic acid (HA) in the initial treatment period and investigation of maintenance of the treatment effect with the use of eyelid cleansing wipes.
Materials and Methods
Fifty patients with Demodex blepharitis were treated in the initial treatment period with sterile eyelid T4O impregnated wipes for 28 days. In the following four-week maintenance period, 82% patients received sterile eyelid maintenance wipes, while 16% continued treatment with T4O impregnated wipes. Global ocular discomfort, adapted TOSS, SANDE score, and individual blepharitis symptoms were assessed by patients at day 28 and day 56. Ocular signs were evaluated by the investigator at the study visits. Investigator’s assessment of the overall treatment performance, patient’s assessment of treatment satisfaction, and tolerability were evaluated with questionnaires.
Results
All global ocular discomfort symptoms and disease specific symptoms assessed by patients as well as all parameters evaluated by the investigators significantly improved in the initial treatment period with the application of eyelid wipes impregnated with 2.5% terpinen-4-ol until day 28. The therapeutic effect was maintained or even improved during the maintenance period under administration of mainly eyelid maintenance wipes until day 56. Both products were well tolerated. No adverse events and no clinically relevant changes in visual acuity were observed during both periods.
Conclusions
Once daily treatment with T4O impregnated eyelid wipes in the initial treatment period significantly improved the ocular symptoms and signs and reduced the mite count in patients with Demodex blepharitis within four-weeks administration. Subsequent maintenance treatment with maintenance wipes for another 4 weeks preserved or further intensified the treatment success. The products were well tolerated and were convenient to use.
Background
Plasma medicine is an innovative research field focused on the application of atmospheric-pressure low-temperature plasmas (ALTP) for therapeutic purposes. Considering the potentials of plasma in ophthalmology, in this study, we evaluated the safety of plasma on the conjunctival tissue in animal models for 6 months.
Methods
Twelve adult male New Zealand albino rabbits were divided into four groups. The right eye of each rabbit was chosen for the test and the left eye was considered as the control. Experiments were performed using the Plexr device (GMV, Rocca Priora, RM, Italy). Four plasma spots were applied on the superior part of the conjunctiva (from 10 to 2 o’clock positions) using the continuous mode and a low power level (white handpiece) of the Plexr. For evaluation of the plasma safety, the histopathological changes were assessed 1 week (A), 1 month (B), 3 months (C), and 6 months (D) after the intervention.
Results
According to the histopathological findings, a mild decrease in blood vessels and severe stromal edema, as well as a superficial epithelium loss, were observed in group A. No chronic inflammation, scar tissue, deposition, and hemorrhage were found in group B. Epithelialization was confirmed by the histological examinations after 1 month. There was no evidence of atypia or dysplasia after 3 and 6 months.
Conclusion
In conclusion, there were no persistent histopathological changes on conjunctival tissue after plasma exposure. Then, plasma can be considered as a minimally invasive alternative method for treating some ocular surface disorders.
Given that nonadherence is related to subject characteristics and drug tolerance and preserved eye drops tend to be more intolerable than preservative-free ones, we conducted a phase 4, parallel-grouped, investigator-blind, active-control, randomized, multicenter study. A total of 51 patients with intraocular pressure (IOP) ≥ 15 mmHg diagnosed with open-angle glaucoma or ocular hypertension were randomly assigned to the preserved latanoprost group (n = 26) and the preservative-free latanoprost group (n = 25). The efficacy variables were corneal/conjunctival staining grade, Ocular Surface Disease Index (OSDI), adherence at 12 weeks after the first administration; corneal/conjunctival staining grade at 4 weeks; and IOP, tear break-up time (TBUT), and hyperemia score at 4 and 12 weeks. The safety variables included visual acuity and drug tolerance questionnaire results. There was no statistically significant difference in corneal/conjunctival staining grade, OSDI, or TBUT between the groups at 4 and 12 weeks. However, the adherence rate was higher and the hyperemia score was lower in the preservative-free group than in the preserved group. The severity and duration of stinging/burning sensation were lower in the preservative-free group than in the preserved group. Overall, preservative-free latanoprost showed better ocular tolerance assessed by hyperemia scores and stinging/burning symptoms following higher adherence than preserved latanoprost.
Retinoids are defined as molecules that bind to and activate retinoic acid receptors to influence the proliferation and differentiation of cells. Topical retinoids have evolved over the past several decades, being used in multiple dermatological conditions. This review aims to differentiate between synthetic and natural retinoids, discuss the pharmacology behind topical retinoids, highlight clinical applications, and categorize all the commercially available agents, including combination products. Understanding retinoid affinities for unique receptor subtypes can impact clinical decisions, resulting in optimizing treatment and enhancing patient adherence.
Objective:
To compare and analyze the effects of Er:YAG laser treatment in the microlaser peeling, fractional ablative laser, or combined modes for the treatment of concave acne scars.
Method:
Ninety patients of concavity acne scar were randomly assigned to three different groups:microlaserpeeling mode group (MM group), fractional ablative mode group (FM group) and combined mode group (CM group). MM group received microlaserpeeling mode with depth of 60 μm and a repetition rate of 20%, FM group received fractional ablative mode with depth of 300 μm and a fractional density of 8%, and CM group received a fractional depth of 200 μm, density of 8%, and a peeling depth of 30 μm, repetition rate of 20%. All patients were evaluated for their treatment effects and side effects 30 days after treatment, including the treatment satisfaction, the ECCA grading scale, pain score and pigmentation level.
Results:
According to the effect satisfaction of patients' self-assessment, the difference among the three groups was statistically significant (P < .05), the CM group was better than the other two groups, but there was no significant difference between the FM group and the MM group (P > .05). About the ECCA grading scale 30 days after treatment, the statistical result among the three groups was significant (P < .05), the CM group is much lower than the FM group which is approximately equal to the MM group. There was statistical difference in pain score among the three groups and every two groups (P < .05), the CM group had the highest pain score, while FM group had the lowest. About the pigmentation level, there was statistical difference among the three groups (P < .05), FM group had the lightest pigmentation, while the CM group had the heaviest.
Conclusions:
Three treatment modes are all effective in treating the concavity acne scar. Among the three modes, CM group is best effective, also accompanied with the most severe side effect; FM group achieves the best balance between treatment effect and side effect. The treatment practices indicate that when the Er:YAG laser with a wavelength of 2940 nm is used to treat concavity acne scars, the right treatment mode should be subject to the severity of the scar.
In recent years, variable rejuvenation techniques, such as hyaluronic acid (HA) fillers and radiofrequency (RF) devices, have become popular. We evaluated the RF hydro-injector (RFHI) device that simultaneously delivers both a microneedle intradermal RF treatment and a HA filler injection to overcome the disadvantages of HA filler and RF devices alone. This study aimed to assess the efficacy and safety of the RFHI device for the rejuvenation of the periorbital area, including the lateral canthal lines (LCLs) and the infraorbital area. A total of 24 subjects were enrolled in this study and underwent 2 to 3 treatments using the RFHI device. The investigator’s global assessment of the lateral canthal line (IGA-LCL) and the global esthetic improvement scale (GAIS) were used to evaluate the improvement in the LCL. Cutometer® was used to evaluate the skin’s elasticity, and the Antera 3D image capture system® was used to evaluate the degree of wrinkles, roughness, and pore volume. At the 8 week follow-up after the first treatment session, both the IGA-LCL and GAIS showed significant improvement. The improvement in the wrinkles, roughness, and pore volume, measured by the Antera 3D image capture system®, was statistically significant. No serious adverse event was reported. This RFHI device, which delivers both microneedle intradermal RF treatment and HA filler injection, is effective and safe for periorbital rejuvenation.
Different studies highlight photo-receptors’ presence on the hair follicle that seems to be capable of eliciting hair growth. This study aims to demonstrate blue light’s effectiveness on hair growth in patients affected by androgenetic alopecia. Twenty patients enrolled at Magna Graecia University Unit of Dermatology, affected by androgenetic alopecia, were treated with a blue LED light device at 417 ± 10 nm, fluence of 120 J/cm2, and power intensity of 60 mW/cm2 ± 20%. The treatments were performed twice a week for ten consecutive weeks. Patients were evaluated before and 1 month after the end of therapy clinically using standardized global photographs and dermoscopically estimating hair density and hair shaft width. An increase in hair density and hair shaft width was recorded in 90% of patients after 10 weeks. Photographic improvement was noted in 80% of the patients. No serious adverse events have been reported. The only side effect consisted in a darkening of the hair, perhaps due to melanic stimulation due to blue light in 2 patients. Blue light therapy is a promising therapy for patients affected by androgenetic alopecia and other diseases characterized by hair loss. Further studies will be necessary to confirm the findings of this preliminary study.
The art of tattooing is a popular decorative approach for body decoration and has a corrective value for the face. The tattooing procedure is characterized by placing exogenous pigments into the dermis with a number of needles. The process of creating traditional and cosmetic tattoos is the same. Colorants are deposited in the dermis by piercing the skin with needles of specific shape and thickness, which are moistened with the colorant. Colorants (pigments or dyes) most of the time include impurities which may cause adverse reactions. It is commonly known that tattoo inks remain in the skin for lifetime. It is also a fact that the chemicals that are used in permanent makeup (PMU) colorants may stay in the body for a long time so there is a significant long-term risk for harmful ingredients being placed in the body. Tattoo and PMU colorants contain various substances and their main ingredients and decomposition components may cause health risks and unwanted side effects to skin.
Context:
Though many treatment options are available for treating post-acne scars, optimized treatment still does not exist. Till date, comparative split-face studies, analyzing the efficacy of combined treatment modalities for acne scars with adequate sample size and with statistically significant results, are still lacking.
Aim:
The aim of this study was to compare the effectiveness of the combined use of platelet-rich plasma (PRP) and fractional ablative CO2 laser (FACL) versus FACL in the management of acne scars and to study the safety of autologous PRP and FACL in the treatment of post-acne scars.
Settings and design:
This was a randomized split-face trial study.
Materials and methods:
This study was conducted in 30 patients having Goodman and Baron's grade 3 and 4 acne scars. The efficacy of PRP in combination with FACL was compared to FACL alone in the treatment of post-acne scars. Right half of the patient's face was taken as the study side where FACL was performed followed by PRP injections. The left half of the same patient's face was taken as the control side where FACL was performed followed by normal saline injections.
Statistical analysis:
Results were analyzed using Statistical Package for the Social Sciences (SPSS, Chicago).
Results:
At the time of enrollment, mean Goodman and Baron Acne Qualitative Grading Scale on study and control side was 3.80 with standard deviation (SD) of 0.40 at baseline. After completion of four treatment sessions, it was reduced to 2.43 (SD = 0.76) and 2.76 (SD = 0.49) on the study and control side, respectively. Improvement on both sides was statistically significant (P = 0.000).
Conclusion:
There is no single proven modality for the effective treatment of post-acne scars. Combination of FACL with newer adjuvants such as PRP has definitive role in managing post-acne scars with better safety profile than FACL alone.
The desire for an even skin tone pervades all cultures and regions of the world. Uniform skin color is considered a sign of beauty and youth. Pigmentation abnormalities can arise idiopathically with genetic predetermination, with injury and environmental exposures, and with advancing age, and can, therefore, be distressing to patients, leading them to seek a variety of treatments with professional assistance. In this short report, we describe the trends in the use of prescription lightening creams, particularly in patients with darker skin types residing in the US. Amongst 404 participants, skin hyperpigmentation had a moderate effect on patients’ quality of life, and the most common diagnosis associated with the use of a prescription product was melasma (60.8%). The most common agent prescribed was hydroquinone (62.9%), followed by triple combination cream (31.4%). It is the dermatologist’s duty to gauge the effect of the pigmentation disease on patients’ life in order to counsel, tailor, and decide on the most appropriate treatment option.
A 35-year-old woman underwent left external dacryocystorhinostomy (DCR) following a recent bout of left acute dacryocystitis. She had a right DCR 14 years earlier. Her relatively young age of presentation prompted suspicion of secondary nasolacrimal duct obstruction and, although the left lacrimal sac appeared macroscopically normal peroperatively, a lacrimal sac biopsy was taken. Histopathology revealed florid chronic inflammation, with abundant granular brown pigment and polarisable crystals suggestive of an exogenous material in the lacrimal sac mucosa compatible with mascara. After initial improvement, her epiphora has recurred 1-year postoperatively, but her ocular discharge has resolved. Mascara-induced conjunctival pigmentation is well established. However, there are very few published reports of nasolacrimal duct obstruction due to mascara. Since cosmetic application of mascara and kohl eyeliner is widespread, patients and practitioners should be aware of their potential to migrate into the lacrimal apparatus and cause chronic inflammation with secondary nasolacrimal duct obstruction.
People are constantly exposed to phthalates, due to their common use in the production of plastics, pharmaceuticals, cosmetics and skin care products. The ability of phthalates to disrupt endocrine signaling, leading to developmental, reproductive and metabolic defects, has been studied, yet how phthalates interfere with these biological functions is still unclear. To uncover DBP interacting molecular pathways, we raised Drosophila melanogaster on food containing dibutyl phthalate (DBP) at various concentrations. Whole transcriptome analysis of adult Drosophila reveals that DBP exposure throughout development disrupts the expression of genes central to circadian rhythm regulation, including increased expression of vrille (vri, human NFIL3), timeless (tim, human TIMELESS) and period (per, human PER3), with decreased expression of Pigment-dispersing factor (Pdf). DBP exposure also alters the expression of the evolutionarily conserved nuclear receptor Hormone receptor-like in 38 (Hr38, human NR4A2), which is known to regulate Pdf expression. Furthermore, behavioral assays determined that exposing Drosophila to DBP throughout development modifies the circadian rhythm of adults. Although DBP inhibits the expression of signaling systems regulating vision, including Rh5 and Rh6, two light-sensing G-protein coupled receptors involved in the daily resetting of circadian rhythm, it does not influence eye development. Circadian rhythm genes are well conserved from flies to humans; therefore, we tested the effect of DBP exposure on human breast cells (MCF10A) and demonstrate that, similar to the fruit fly model, this exposure disrupts circadian rhythm (BMAL1 expression) at doses that promote the proliferation and migration ability of MCF10A cells. Our results are the first to provide comprehensive evidence that DBP interferes with circadian rhythm in both adult Drosophila and human cells, which may help to explain the broad physiological action of phthalates.
Purpose
To evaluate the ocular surface at the microstructural level of adults who habitually undertake indoor-suntanning utilising in vivo confocal microscopy.
Methods
Participants were prospectively recruited and enrolled into either а study group (n = 75) with a history UV indoor tanning, or a control group (n = 75) with no prior history of artificial tanning. The study group participated in voluntary tanning sessions performed with standard equipment and maintained their usual routine for eye protection. Slit lamp biomicroscopy and in vivo confocal microscopy were performed at baseline before undertaking a series of suntanning sessions (10 sessions of 10 min duration over a 15 day period), within three days after the last session, and four weeks after the last session. Control group participants were examined at baseline and 8 weeks later and did not participate in tanning sessions.
Results
All participants were female with a mean age of 25 ± 4 years and 24 ± 4 years in the study and control groups, respectively. No clinically significant changes were observed in either group over time using slit lamp biomicroscopy (all p ≥ 0.05), however, statistically significant differences were observed between the study and the control group for all corneal layers imaged using confocal microscopy (all p ≤ 0.03). Characteristic cystic conjunctival lesions with dark centres and bright borders were observed in 95% of the study group before and in 100% after the suntanning sessions.
Conclusion
Indoor suntanning resulted in statistically significant microstructural changes in the cornea and the bulbar conjunctiva that are undetectable with slit lamp biomicroscopy.
Background
Efficacy and safety of ablative fractional laser used for treatment of acne scars has been described in several studies. Recently, Microneedling Radiofrequency treatment has been showing promising results with low risk of side effects and rapid healing time.
Objective
To study efficacy and safety of ablative fractional Er:YAG laser 2940 nm and Microneedling Radiofrequency for facial atrophic acne scar .
Methods
21 Patients with atrophic post acne scars were randomized to MRF for one half of the face and laser for the other half. Four sessions were performed monthly. For evaluation, the validated scale “Quantitative Global Grading System for Postacne Scarring” and patient’s satisfaction were used before and 3 months after treatment . Optical coherence tomography. imaging of the skin was used as an objective tool for assessment.
Results
Both sides showed significant improvement on clinical evaluation with no significant difference. Optical coherence tomography assessment showed significant increase of both epidermal and dermal thickness compared to baseline.
Conclusion
Both MRF and ablative fractional Er. YAG laser 2940 nm are effective in the treatment of post acne scars. Microneedling Radiofrequency is better tolerated, with lower down time and fewer side effects .
Background:
The FDA approved bimatoprost ophthalmic solution 0.03% for treatment of eyelash hypotrichosis in 2008. Consumer concern persists regarding potential side effects of this product.
Objective:
To identify gaps in the safety information associated with the use of prostaglandin eyelash growth products.
Materials and methods:
Literature searches were performed using PubMed, Embase, and Nexis Uni databases without restriction to publication date, language, or study setting.
Results:
The literature pertaining to bimatoprost for treatment of eyelash hypotrichosis is dominated by industry-sponsored clinical trials. Study design choices create gaps in our understanding of the clinical safety of these products.
Conclusion:
Because of study design choice, clinical trials of bimatoprost for eyelash growth may have systematically underreported the incidence of drug application discomfort and prostaglandin-associated periorbitopathy. The risk of increased iris pigmentation remains inadequately investigated. Consequently, there is an ongoing need to educate and monitor patients who choose to use these products.
The safety assessment of cosmetic products is based on the safety of the ingredients, which requires information on chemical structures, toxicological profiles, and exposure data. Approximately 6% of the population is sensitized to cosmetic ingredients, especially preservatives and fragrances. In this context, the aim of this study was to perform a hazard assessment and risk characterization of benzalkonium chloride (BAC), benzyl alcohol (BA), caprylyl glycol (CG), ethylhexylglycerin (EG), chlorphenesin (CP), dehydroacetic acid (DHA), sodium dehydroacetate (SDH), iodopropynyl butylcarbamate (IPBC), methylchloroisothiazolinone and methylisothiazolinone (MCI/MIT), methylisothiazolinone (MIT), phenoxyethanol (PE), potassium sorbate (PS), and sodium benzoate (SB). Considering the integrated approaches to testing and assessment (IATA) and weight of evidence (WoE) as a decision tree, based on published safety reports. The hazard assessment was composed of a toxicological matrix correlating the toxicity level, defined as low (L), moderate (M), or high (H) and local or systemic exposure, considering the endpoints of skin sensitization, skin irritation, eye irritation, phototoxicity, acute oral toxicity, carcinogenicity, mutagenicity/genotoxicity, and endocrine activity. In a risk assessment approach, most preservatives had a margin of safety (MoS) above 100, except for DHA, SDH, and EG, considering the worst‐case scenario (100% dermal absorption). However, isolated data do not set up a safety assessment. It is necessary to carry out a rational risk characterization considering hazard and exposure assessment to estimate the level of risk of an adverse health outcome, based on the concentration in a product, frequency of use, type of product, route of exposure, body surface location, and target population.
Background
Axillary hyperpigmentation (AH) is a condition in which axillary skin is darker than the adjacent areas. To date, there is no standard treatment for AH. The Q‐switched neodymium‐doped yttrium aluminum garnet 1064‐nm(QS) laser and intense pulsed light (IPL) are two effective modalities for the treatment of pigmentary disorders; however, the efficacy and safety levels of both treatments for AH have not yet been compared in a controlled study.
Objectives
To evaluate and compare the efficacy and safety of the QS laser and IPL in the treatment of AH.
Methods
A randomized, split‐side study was conducted on 22 subjects; all subjects received a total of five split‐side treatments every 2 weeks. The efficacy was determined using the melanin index (MI), color chart level using the Pantone Skintone™ Guide, improvement grading scale (IGS), and patient satisfaction scores at weeks 2, 4, 6, 8, and 10.
Results
The results showed that there was no significant difference in MI, color chart level, IGS, and patient satisfaction scores between the two treatments. Both treatments significantly improved AH after three sessions. However, the pain score was lower for IPL treatment. The adverse effects were transient and were found after IPL treatment in one participant (4.45%) who developed hyperpigmentation and another participant (4.45%) who developed erythema.
Conclusions
IPL therapy is safe and effective for the treatment of AH, with no significant difference in the outcome compared with QS laser treatment.
Purpose
Scleral tattooing, also known as episcleral, subconjunctival, or simply eyeball tattooing, is a relatively new form of extreme body modification that first emerged in 2007. There are few reports of the management of these tattoos in the medical literature, and we aim to increase the body of knowledge surrounding this rare and potentially dangerous practice.
Observations
We present two new cases of improvised scleral tattooing, both performed in prison using pen ink and insulin needles, and both with minimal complications and managed with topical medications. A brief review of the literature is included which details the dangers of scleral tattooing.
Conclusions and importance
We discuss management of complications for this new, previously unreported method of scleral tattooing using pen ink. Ophthalmologists should be aware of the presentation, possible complications, and management of these cases.
Purpose
The aim of the study was to examine Demodex survival in makeup cosmetics, i.e., powder cream, mascara, and lipstick, and to determine whether cosmetics shared with others can be a source of D. folliculorum infection.
Methods
Live D. folliculorum adults were placed in cosmetic samples and their motility was observed under a microscope. The mites were fully or partially immersed in the powder cream and lipstick, and only partially immersed in the mascara. Partial immersion means that only the opisthosoma was covered by the cosmetic, whereas the gnathosoma and podosoma had no contact with the cosmetic. Cessation of motility was regarded as a sign of death.
Results
In the control (mites placed on a microscope slide with no cosmetics), the survival time was 41.2 h. D. folliculorum that were immersed fully or partially in the lipstick substrate were viable for 38.5 h and 148 h, respectively. The survival time of the mites at full and partial immersion in the powder cream was 0.78 h and 2.16 h, respectively. The average survival time in the mascara was 21 h.
Conclusions
Makeup cosmetics used by different individuals at short intervals (from several hours to several days) can be a source of transmission of Demodex sp. mites.
The word "elective" refers to medications and procedures undertaken by choice or with a lower grade of prioritization. Patients usually use elective medications or undergo elective procedures to treat pathologic conditions or for cosmetic enhancement, impacting their lifestyle positively and, thus, improving their quality of life. However, those interventions can affect the homeostasis of the tear film and ocular surface. Consequently, they generate signs and symptoms that could impair the patient's quality of life. This report describes the impact of elective topical and systemic medications and procedures on the ocular surface and the underlying mechanisms. Moreover, elective procedures performed for ocular diseases, cosmetic enhancement, and non-ophthalmic interventions, such as radiotherapy and bariatric surgery, are discussed. The report also evaluates significant anatomical and biological consequences of non-urgent interventions to the ocular surface, such as neuropathic and neurotrophic keratopathies. Besides that, it provides an overview of the prophylaxis and management of pathological conditions resulting from the studied interventions and suggests areas for future research. The report also contains a systematic review investigating the quality of life among people who have undergone small incision lenticule extraction (SMILE). Overall, SMILE seems to cause more vision disturbances than LASIK in the first month post-surgery, but less dry eye symptoms in long-term follow up.
Societal factors associated with ocular surface diseases were mapped using a framework to characterize the relationship between the individual, their health and environment. The impact of the COVID-19 pandemic and mitigating factors on ocular surface diseases were considered in a systematic review. Age and sex effects were generally well-characterized for inflammatory, infectious, autoimmune and trauma-related conditions. Sex and gender, through biological, socio-economic, and cultural factors impact the prevalence and severity of disease, access to, and use of, care. Genetic factors, race, smoking and co-morbidities are generally well characterized, with interdependencies with geographical, employment and socioeconomic factors. Living and working conditions include employment, education, water and sanitation, poverty and socioeconomic class. Employment type and hobbies are associated with eye trauma and burns. Regional, global socio-economic, cultural and environmental conditions, include remoteness, geography, seasonality, availability of and access to services. Violence associated with war, acid attacks and domestic violence are associated with traumatic injuries. The impacts of conflict, pandemic and climate are exacerbated by decreased food security, access to health services and workers. Digital technology can impact diseases through physical and mental health effects and access to health information and services. The COVID-19 pandemic and related mitigating strategies are mostly associated with an increased risk of developing new or worsening existing ocular surface diseases. Societal factors impact the type and severity of ocular surface diseases, although there is considerable interdependence between factors. The overlay of the digital environment, natural disasters, conflict and the pandemic have modified access to services in some regions.
Evidence-based practice is a dominant paradigm in healthcare that emphasizes the importance of ensuring the translation of the best available, relevant, research evidence into practice. An Evidence Quality Subcommittee was established to provide specialized methodological support and expertise to promote rigorous and evidence-based approaches for the Tear Film and Ocular Surface Society (TFOS) Lifestyle Epidemic reports. The present report describes the purpose, scope, and activity of the Evidence Quality Subcommittee in the undertaking of high-quality narrative-style literature reviews, and leading prospectively-registered, reliable systematic reviews of high priority research questions, using standardized methods for each topic area report. Identification of predominantly low or very low certainty evidence across the eight systematic reviews highlights a need for further research to define the efficacy and/or safety of specific lifestyle interventions on the ocular surface, and to clarify relationships between certain lifestyle factors and ocular surface disease. To support the citation of reliable systematic review evidence in the narrative review sections of each report, the Evidence Quality Subcommittee curated topic-specific systematic review databases and relevant systematic reviews underwent standardised reliability assessment. Inconsistent methodological rigor was noted, emphasizing the importance of internal validity assessment. Based on considerations and challenges associated with implementing the Evidence Quality Subcommittee, this report makes suggestions for incorporation of such initiatives in future international taskforces and working groups. Content areas broadly relevant to the activity of the Evidence Quality Subcommittee, including the critical appraisal of research, clinical evidence hierarchies (levels of evidence), and risk of bias assessment, are also outlined.
Background
Prostaglandin analogues (PGAs; a first-line anti-glaucoma treatment) have been re-marketed as popular eyelash lengthening serums due to their lash lengthening and thickening side-effects. Periorbital volume loss is now a well-established side-effect of topical PGAs used to treated glaucoma (prostaglandin-associated periorbitopathy [PAP]) but has not, to date, been listed as a potential side-effect of lash lengthening serums containing PGA.
Objectives
To identify whether periorbital fat/volume loss is seen in users of prostaglandin analogue lash lengtheners.
Methods
A case report and informal randomised controlled study comparing “before-and-after” colour photos displayed on the websites of PGA-containing lash lengtheners (PGALL) (i.e., containing bimatoprost, norbimatoprost, isopropyl cloprostenate, dechloro-dihydroxy-difluoro-ethylcloprostenolamide, or methylamido-dihydro-noralfaprostal), compared with two control groups: non-PGALL (NPGALL); false eyelashes (FL). Expert and layperson blinded graders used a purpose-designed grading system to identify subtle signs of periorbital fat/volume loss over time.
Results
A 35-year-old female developed thin, wrinkled, darker skin and periorbital hollowing within 10-months of using Lash Boost (Rodan & Fields, San Francisco, CA), containing isopropyl cloprostenate, which reversed six months after discontinuation. Fifteen “before-and-after” image pairs (PGALL, n=10; NPGALL, n=3; FL, n=2) were graded by five graders (three expert, two layperson). Mean grading score was 8.2 (of 19) in the PGALL group: NPGALL, 2.3; FL, 3.2. PGALL scores were significantly higher than NPGALL (p<0.001) and FL (p=0.017) groups.
Conclusions
Review of commercial “before-and-after” photos suggests PGALL users develop changes compatible with PAP. Consumers must be aware of the possibility of periorbital volume loss prior to commencing PGALLs. Often the customer-facing product ingredient list contains no mention of PGA
Fractional laser (FL) resurfacing has proved its effectiveness in acne scars treatments. To evaluate the efficacy of Fractional laser systems for treatment of acne scars as a monotherapy, and as adjunctive therapy with other treatment types. A systematic literature review was performed by searching the electronic databases PubMed, Google Scholar, and Embase. Fractional laser has proven therapeutic efficacy of over 26% in treating acne scars, with minor and transient side effects, and well-tolerant pain. The application of PRP not only accelerated recovery and reduced adverse events, but also enhanced localized collagen neogenesis and redistribution. The addition of surgical treatments to Fractional Laser Systemes (FLS) therapy delivers the best treatment results for Icepick scars. Fractional laser is an effective tool for treating acne scars. The degree of effectiveness varies according to the laser parameters, the number of treatment sessions, skin photo type, the severity and the type of scars. The application of Platelet-Rich Plasma (PRP) and Fractional Radiofrequency Microneedle (FRM) in addition to the FL treatment improves the therapeutic efficacy and reduces the appearance of Post Inflammatory Hyper-Pigmentation (PIH), and is the ideal treatment for dark-skinned patients. FL therapy along with surgical methods such as subsicion and punch techniques provided the best improvements for deep scars.
Significance:
Tattoo granuloma and uveitis or "tattoo-associated uveitis" is a description of simultaneous tattoo inflammation and uveitis. Multiple cases exist in the literature in the setting of systemic sarcoidosis or a delayed-type hypersensitivity reaction; however, there is no agreed-upon consensus on etiology. The authors of this article propose that questions regarding tattoos be asked to all patients presenting with a new uveitis.
Purpose:
In this retrospective review case series, two African American males with simultaneous tattoo inflammation and bilateral anterior uveitis were examined. Systemic sarcoidosis was suspected as the leading differential in both cases, however, laboratory evidence and imaging did not confirm a sarcoidosis diagnosis. Both patients were therefore suspected to have tattoo-associated uveitis.
Case reports:
Acute anterior uveitis was diagnosed in 24 and 42-year-old African American males who presented with bilateral uveitis and inflammation of tattoos received greater than one year prior to the onset of symptoms. One patient presented with granulomatous ocular signs while the other did not. Both patients received skin biopsies of their tattoos confirming noncaseating granulomas. Both patients had unremarkable radiological chest scans and were treated with topical and oral corticosteroids, but only had complete inflammatory resolution after removal of their tattoos. After tattoo removal, neither patient experienced recurrent inflammation.
Conclusions:
Simultaneous tattoo granuloma and uveitis is well-supported by literature evidence. It is suspected that both patients either had a localized sarcoidosis reaction or had tattoo-associated uveitis due to a delayed-type hypersensitivity reaction caused by an unknown antigen in the tattoo ink.
Skin bleaching, also known as skin lightening, is the deliberate lightening of an individual’s skin tone outside of medical supervision. The causes are complex, multifactorial and often intertwined although the unifying themes centre around a belief that lighter skin denotes an individual of higher status, be that economic or physical beauty, than their darker skinned counterpart. Skin lightening is achieved using agents that block the production of melanin and often contain drugs such as Hydroquinone, super potent topical steroid and Mercury. These drugs can cause serious local and systemic complication. Skin lightening compounds are illegal in most countries throughout the world however the industry is worth billions of dollars annually and the agents can be easily obtained by individuals seeking to lightening their skin. Dermatologists are in a unique position to identify those at risk of using skin bleaching agents, manage complications and give advice on how to avoid using skin lightening agents to treat dermatological conditions and physiological variation in pigmentation. In order to manage the belief that lighter skin is better, societal level change is required in order to ensure that people of all skin tones are represented in the media.
Background
Periorbital fractional CO2 laser resurfacing has been used for facial rejuvenation purposes. However, to the best of our knowledge, no study objectively assessed periorbital neoformation and remodeling of local cutaneous collagen, in a split-face model, from skin samples obtained during upper blepharoplasty.
Objectives
To objectively evaluate neoformation and remodeling of local cutaneous collagen after periorbital skin fractional CO2 laser resurfacing.
Methods
Prospective and comparative study in which 16 female subjects presenting with dermatochalasis and periorbital rhytids were evaluated. All subjects underwent unilateral periorbital fractional CO2 laser resurfacing 30 days prior to upper blepharoplasty. Quantification of types I and III collagen from laser treated and untreated eyelid skin samples obtained during upper blepharoplasty was assessed with histochemical analysis (Picrosirius Red staining). Laser resurfacing treatment was applied to the untreated side immediately after the upper blepharoplasty. Two blinded, independent physicians evaluated clinical improvement in pretreatment, 1 and 6-month post-treatment digital images.
Results
Histochemical analysis showed significant higher intensity in collagen types I (treated: 158.7 ± 5.3, untreated: 139.2 ± 5.0; p<0.0001) and III (treated: 105.1 ± 7.7, untreated: 104.1 ± 7.1; p< 0.0001) in the samples submitted to fractional CO2 laser treatment; a greater difference was detected in collagen type I. A significant improvement in periorbital rhytidosis was observed one month after laser resurfacing (23%); a greater improvement in the periorbital region was observed 6 months after laser resurfacing and upper blepharoplasty (43.67%).
Conclusions
Periorbital fractional CO2 laser resurfacing demonstrated to be an effective method to improve palpebral skin, with histochemical evidence of increase in collagen types I and III.
Objectives
This study aimed to report a case of laser-induced macular neovascularization (MVN) following accidental exposure to Alexandrite laser.
Methods
A young female presented with a painless visual blurring of the right eye 25 days after direct inadvertent exposure to a single discharge from a 750-nm Alexandrite hair removal procedure. The best-corrected visual acuity (BCVA) of the right eye was finger count 3 m (M). Ophthalmoscopic findings, spectral-domain optical coherence tomography (SD-OCT), fluorescein angiography, and optical coherence tomography angiography were evaluated.
Results
Fundus examination of the right eye revealed intraretinal hemorrhage and a round yellow-grayish subretinal lesion just beneath the fovea. SD-OCT of the right eye showed retinal thickening, subretinal hyperreflective lesion, subretinal and mild intraretinal fluid, and a small retinal pigment epithelium defect beneath the fovea. Optical coherence tomography angiography demonstrated MNV type 2. After the administration of intravitreal injection of three monthly anti-vascular endothelial growth factor, BCVA improved to 20/20.
PurposeIn the current study, the authors attempt to thoroughly investigate the concept of beauty from different perspectives in different historical periods and offer their personal thoughts about it.Methods
The authors performed a comprehensive and across-the-board literature review about ‘beauty’, including beauty from a philosophical perspective, beauty perception by human mind, beauty from a biopsychological perspective, beauty of the face, body and breast, models of beauty and beauty in cosmetic surgery.ResultsFrom Plato to modern neuro-psychological studies, the concept of beauty has always been a theme for adamant debates and passionate thoughts. Different aspects of beauty, from intellectual to pure physical, have received a tremendous amount of attention. The true definition of the concept of beauty is still ambiguous, and there is not a unanimous explanation for it. It seems that the definition of beauty differs in every individual’s mind and over the history of humankind.Conclusion
Although beauty is a very important concept and the seek for achieving it is a very natural behavior, one must remember that the importance of beauty should not overshadow the fact that every human being is made up of similar internal organs. We strongly encourage the reader to look beyond the hedge, to be aware that each of us is made up of internal organs, beyond the external appearance.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266.
The popularity and variety of temporary and permanent periocular aesthetic treatments has increased over the past decade. Patients frequently present to eye clinics with ocular complications and side effects following these treatments, their severity ranging from ocular irritation from dry eyes to visual loss from vascular occlusion. A careful, thorough history is essential, as many patients may not associate aesthetic procedures with ocular complications, and some may be embarrassed to disclose this information. All ophthalmologists should understand the potential ocular sequelae of these treatments and be able to initiate treatment in sight-threatening cases. Wesummarises the current literature on ophthalmic complications of the most common periocular aesthetic treatments.
The way in which communication takes place has undergone significant change over the last year leading to alterations regarding the way we perceive our own personal image. Indeed, the increase in remote video interaction seems to have led to an increase in the number of requests for teleconsultations with plastic surgeons in private practice (70% in the UK and 64% in the USA), the so-called Zoom Boom. The reasons connected to this increase are still under investigation, but it is likely that patients’ greater exposure to seeing their own image in online video communication for prolonged periods has highlighted what patients perceive as flaws and/or their self-image does not correspond to the same image that they see in the mirror. However, the motivations for seeking cosmetic surgery cannot be solely attributed to seeing ourselves online more frequently; the psychological impact of the pandemic (lower moods, isolation and greater concerns) may also be to blame. Therefore, the reasons patients hope to touch-up, rejuvenate, re-do or revise their “lockdown faces” need careful attention with a view to understand the extent of which the online distortion of one’s own body image may be the underlying cause.Level of Evidence V “This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.”
Background:
Although pulsed-dye laser (PDL) 595 nm is known as the gold standard for treatment of port-wine stains (PWS), complete clearance of lesions occurs in a minority of cases.
Objective:
To compare the efficacy and safety of double-pass pulsed-dye laser (DPL), long pulse duration (20 m/s) followed by short pulse duration (1.5 m/s) within 20 minutes interval, with single-pass pulsed-dye laser (SPL) for (1.5 m/s) in the treatment of PWS.
Methods:
Twenty-four patients with PWS underwent 3 sessions of PDL. Each lesion was randomly divided into 2 portions to receive DPL or SPL. Colorimetric and dermoscopic evaluations were used to determine the response objectively. In addition, improvement was scored subjectively using the visual analog scale (VAS).
Results:
According to colorimetric analysis, the mean blanching rates for DPL and SPL treated sites were 48% (SD = 0.215) and 37% (SD = 0.213), respectively (p = .001). With VAS, 3.79 (SD = 0.93) and 3.33 (SD = 0.91) improvement scores were reported in the DPL and SPL treated areas, respectively (p = .008). Dermoscopic images showed that larger deep vessels were the most common remnant vessels in both treatment areas.
Conclusion:
Compared with SPL, DPL with 20 minutes interval seems to be a more effective and safe method for the treatment of PWS.
Dry eye disease is one of the most common, chief-complaints presenting in clinical practice, with a prevalence of up to 50%. Evaporative dry eye, as a result of meibomian gland dysfunction, is thought to be the biggest component factor. Treatments for meibomian gland dysfunction aim to restore tear film homoeostasis and include warm compress therapy, eyelid hygiene, in-office meibomian gland expression and lipid-containing, artificial tears. A recent introduction to the in-office treatments available for meibomian gland dysfunction has been low-level light therapy, also known as photobiomodulation. The technique involves applying red, or near infra-red, radiation using low-power light sources and is suggested to promote tissue repair, decrease inflammation, and relieve pain. This work aims to review the available literature on the efficacy and safety of photobiomodulation in meibomian gland dysfunction and dry eye disease, as well as what is currently known about its mechanism of action.
Purpose:
To describe postoperative management following ablative carbon dioxide laser resurfacing of the lower eyelids.
Methods:
A retrospective review of patients who consecutively underwent bilateral lower eyelid ablative carbon dioxide laser resurfacing by a single experienced oculoplastic surgeon over a 6-year period was conducted. Patient satisfaction, aesthetic outcomes, and postoperative complications were evaluated as adjunctive or monotherapy.
Results:
Among 424 patients included in the study, most were female (n = 356, 84.0%) and Caucasian (n = 404, 95.3%), with Fitzpatrick skin types II-III (n = 381, 89.9%). Mean age was 62.8 years (standard deviation: 9.7 years). Most (n = 324, 76.4%) underwent fractional ablative carbon dioxide laser resurfacing of the lower eyelids, whereas 91 (21.5%) received traditional laser resurfacing and 9 (2.1%) had both fractional and traditional laser resurfacing during the same session. At the time of lower eyelid laser resurfacing, most patients also underwent concurrent procedures, including upper (n = 321, 75.7%) and lower blepharoplasty (n = 348, 82.1%); a small proportion of patients (n = 39, 9.2%) did not undergo any concurrent surgical procedure. In addition to ablative laser resurfacing of the lower eyelids, 25 (5.9%) had upper eyelid laser resurfacing, 60 (14.2%) had full-face laser resurfacing, 55 (13.0%) had neck laser resurfacing, and 42 (9.9%) had additional treatment of solar lentigines or dyschromias on the face. Median follow-up duration was 3.9 months (interquartile range: 2.0-11.0 months). In the immediate postoperative period, 22 patients (5.2%) developed contact dermatitis from topical antibiotic eye drops and/or ointment prescribed postblepharoplasty. Postinflammatory hyperpigmentation was observed in 40 patients (9.4%) despite topical prophylaxis; all were eventually successfully treated with a combination of topical nonprescription and prescription creams and/or oral tranexamic acid. A localized herpetic outbreak occurred in 3 (0.7%) who underwent full-face laser resurfacing and 1 (0.2%) who underwent periocular laser resurfacing only; all were successfully treated with oral antiviral therapy. Two (0.5%) developed culture-proven atypical mycobacterial infection of the resurfaced lower eyelid skin and were treated with combination antibiotic therapy for several months until resolution. A small scar was noted in 4 patients (0.9%), which resolved after local corticosteroid injections. No patient developed persistent scarring or ectropion. Patient satisfaction was overall high, with 363 (85.6%) very satisfied and 48 (11.3%) satisfied with the aesthetic outcome of lower eyelid laser resurfacing.
Conclusions:
Ablative carbon dioxide laser resurfacing of the lower eyelids can be a useful tool in the armamentarium of the experienced oculoplastic surgeon, with excellent aesthetic results, high patient satisfaction, and low complication rates as adjunctive or monotherapy. Proper and timely management of postoperative complications is essential to maximizing successful cosmetic outcomes.
Background
Low level light therapy is a recent aaddition to the pantheon of light-based therapeutic interventions. Termed “photobiomodulation”, the absorption of red/near infrared light energy induces enhancement of mitochondrial ATP production, cell signaling and growth factor synthesis and attenuates oxidative stress. Photobiomodulation is highly commercialized with devices marketed directly to the consumer. In the grey area between the commercial and therapeutic sectors, harnessing the clinical potential in reproducible and scientifically measurable ways remains challenging.
Objectives
This article presents a summary of the clinical evidence for photobiomodulation and discusses the regulatory framework for low level light therapy
Methods
A review of the clinical literature pertaining to the use of low level light therapy for skin rejuvenation (facial rhytids and dyschromias), acne vulgaris, wound healing, body contouring and androgenic alopecia was performed.
Results
A reasonable body of clinical trial evidence exists in support of the role of low energy red/near infrared light as a safe and effective method of skin rejuvenation, treatment of acne vulgaris, alopecia and, especially, body contouring. Methodological flaws, small patient cohorts and industry funding mean there is ample scope to improve the quality of evidence. It remains unclear if LED-based light sources induces physiologic effects of the nature and magnitude of laser-based systems which were used in most of the higher quality studies.
Conclusions
Low level light therapy is here to stay. However, its ubiquity and commercial success has outpaced the empirical approach on which solid clinical evidence is established. Thus, the challenge is to prove its therapeutic utility in retrospect. Well-designed, adequately powered, independent clinical trials will help us answer some of the unresolved questions and enable the potential of this therapy to be realized.
Objective:
This randomized controlled trial aims to verify the efficacy of a combined fractional CO2 laser and rhodamine-intense pulsed-light (r-IPL) protocol in the photoaging therapy.
Background:
Skin aging is related to multiple environmental and genetic factors that give rise to different manifestations. In recent years many techniques have been proposed for the rejuvenation of the skin of the face such as ablative and nonablative procedures. Combination of laser or light sources with different wavelengths represents a safe and effective treatment method. r-IPL is a new pulsed-light technique capable to generate wavelengths varying from 550 to 650 nm proposed in nonablative photorejuvenation with a good efficacy and safety profile.
Methods:
Twenty-two patients (skin phototypes II-III, aged 46-67 years) were randomly allocated into two groups: group A was treated only with a therapeutic standard dose of the fractional CO2 laser, whereas group B was treated with a combined therapy of r-IPL and fractional CO2 laser. All patients were treated up to three times at a 2-month interval. Efficacy of the procedures was assessed thanks to the Fitzpatrick Wrinkle Severity Scale (scores 1-9) before treatment and at a 4-month follow-up from the last treatment.
Results:
Patients treated with the combination of r-IPL and fractional CO2 laser showed better results in terms of wrinkle reduction according to the Fitzpatrick Wrinkle Severity score (2.82 ± 0.87 vs. 3.09 ± 1.14), with a statistically significant reduction in healing times (7.82 ± 0.75 vs. 13.82 ± 1.94 days, p ≤ 0.001) and duration of post-treatment erythema (3.55 ± 0.93 vs. 8.18 ± 1.47 days, p ≤ 0.001). Patient satisfaction was higher after combined fractional CO2 laser and r-IPL treatment.
Conclusions:
Our data suggest that combined use of fractional CO2 laser and r-IPL may lead to excellent results in terms of skin rejuvenation with a simple post-treatment management and an optimal tolerability.
Objective:
To evaluate the effectiveness and safety of a 675 nm laser device in the treatment of facial aging.
Background:
Wrinkles represent a major sign of aging skin and are considered a major topic in cosmetic dermatology, representing a common problem that negatively impacts patients' quality of life. Different types of treatments are currently available. The aim of this study was to assess the efficacy and safety of a new 675 nm laser source system on facial wrinkles.
Methods:
A total of 22 consecutive female (age 49.36 ± 8.72) patients, with Fitzpatrick skin types II-IV and facial wrinkles, were treated with three sessions of a 675 nm laser system. Efficacy of treatment was assessed using the Modified Fitzpatrick Wrinkles Scale pre and postoperatively before 3 months.
Results:
All 22 patients treated with the 675 nm laser had a significant improvement of facial wrinkles according to the FWS (from 1.59 ± 0.80 to 1 ± 0.64; p ≤ 0.001). No side effects occurred except a mild erythematous rash in two patients.
Conclusions:
This novel 675 nm laser system can be considered a promising and effective tool in patients with facial wrinkles, and it involves a simple post-treatment management.
Background:
Ophthalmic products are a common but often overlooked contributor to allergic contact dermatitis. Frequency of allergenic ingredients in over-the-counter ophthalmic products has not been well characterized.
Objective:
The purpose of this study was to determine the prevalence of allergenic ingredients in most commonly bought eye lubricants and contact lens solutions.
Methods:
A product list of Amazon.com's best-selling ophthalmic products was curated by searching for "Best Sellers in Eye Drops, Lubricants & Washes" and "Best Sellers in Contact Lens Care Products." For exploratory analysis, indication, price, consumer ratings, number of reviews, and US Food and Drug Administration approval status were recorded. The products' ingredients were compiled using NLM DailyMed, and products that had 1 or more allergens or relevant cross-reactors on either the 2018 American Contact Dermatitis Society Core Allergen Series or the 2015-2016 North American Contact Dermatitis Group Standard Allergen Series were noted.
Results:
Forty-eight percent (n = 49) of the total products, (57.8% [n = 37] of eye lubricants, and 31.6% [n = 12] of contact lens solutions) had 1 or more allergens or associated cross-reactors. Identified allergens were benzalkonium chloride, propylene glycol, sorbic acid, amidoamine, sorbitan sesquioleate, chlorhexidine digluconate, lanolin alcohol, parabens, benzyl alcohol, and butylated hydroxytoluene.
Conclusions:
Awareness of potential allergens is crucial to diagnosing allergic contact dermatitis to ophthalmic products and helping patients navigate online pharmacological chaos.