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Presented at American Academy of Dermatology:

66th Annual Meeting


February 1-5, 2008
San Antonio, Texas
*Dermatology Clinic, University of Catania, Catania, Italy
**Nordstrom Hospital, Helsinki, Finland

Giuseppe Micali, MD*, Francesco Lacarrubba, MD*, Aurora Tedeschi, MD*, Rolf Nordstrom, MD**

Mesotherapy for rejuvenation of photoaged skin: Ultrasound evaluation


Mesotherapy for rejuvenation of photoaged skin: Ultrasound evaluation
Giuseppe Micali, MD, Dermatology Clinic, University of Catania, Catania Italy
Francesco Lacarrubba, MD, Dermatology Clinic, University of Catania, Catania Italy
Aurora Tedeschi, MD, Dermatology Clinic, University of Catania, Catania Italy
Rolf Nordstrom, MD, Nordstrom Hospital, Helsinki, Finland

Mesotherapy (M) is a treatment used in cosmetic dermatology. It is a minimally


invasive technique, not a tissue augmentation, that consists in the injection,
through dermal multipunctures, of bioactive substances, such as hyaluronic
acid (HA). M is supposed to promote skin rejuvenation by increasing
hydration and recreating a favorable environment to facilitate fibroblast
activation and exchanges and interactions between cells of extracellular matrix.
Ultrasound of the skin has been extensively used to visualize and quantify age
related dermal changes. The so-called Subepidermal Low Echogenic Band
(SLEB), located immediately below the epidermal entrance echo,
is considered a marker of photoaging and is strictly related to
dermal elastosis, basophilic degradation of collagen, and accumulation of
glycosaminoglycans and water in the papillary dermis, as confirmed by
numerous studies. The effect of M with HA on photoaged skin have been
evaluated using a 20-MHz B-mode ultrasound equipment. Five females (mean
age, 61 yrs; range, 56-67 yrs) with moderate signs of skin photoaging on the
back of the hand, consisting of fine wrinkles and skin thinning and laxity, were
treated with dermal injections on target areas on the back of the hand of non
animal, stabilized HA, at concentration of 20 mg/ml, at 0.2, and 4 weeks.
Ultrasound evaluation was performed at each treatment and 7 days after the
end of treatment. At baseline, ultrasound evaluation showed in all patients the
presence of SLEB. After 5 week, in all cases a remarkable improvement of
SLEB, consisting in increased echogenicity, likely related to an increased
density of dermal collagen fibers resulting from treatment, was evident.
Clinically, an improvement of skin texture following therapy was reported by all
patients. Our preliminary results have demonstrated that M with HA may be
an effective treatment for photoaged skin, as confirmed by ultrasound results.
Future applications of ultrasound could be represented by follow-up evaluation
of skin changes after therapy discontinuation.

LA MESOTERAPIA PER IL RINGIOVANIMENTO della cute fotoinvecchiata:


VALUTAZIONE ECOGRAFICA
La mesoterapia una tecnica utilizzata in dermatologia cosmetologica.
Consiste nelliniezione intradermica di sostanze bioattive, quali lacido
ialuronico (AI), in grado di promuovere il rinnovamento cutaneo tramite
la creazione di un terreno favorevole:
allattivazione dei fibroblasti
a scambi e interazioni tra cellule e matrice extracellulare.
Lecografia cutanea, tra le sue varie applicazioni, utilizzata per visualizzare e
quantificare i cambiamenti del derma indotti dallet.
La cosiddetta Subepidermal Low Echogenic Band (SLEB),
banda ipoecogena del derma legata a elastosi, degradazione del collagene,
accumulo di glicosamminoglicani e acqua, considerata un marker
del fotoinvecchiamento cutaneo.
Cinque donne (range 56-67 anni), con segni di invecchiamento cutaneo
al dorso della mano e al viso, sono state trattate con iniezioni multiple
di AI non animale stabilizzato, alla concentrazione di 20 mg/ml,
a 0, 2 e 4 settimane.
La valutazione ecografica stata effettuata a ogni trattamento
e 7 giorni dopo lultimo.
In tutte le pazienti trattate si osservato un miglioramento dello SLEB (figg.
casi 1-3), determinato da un incremento della sua ecogenicit verosimilmente
legato a un aumento della densit del collagene dermico.
Tutte le donne hanno presentato un miglioramento evidente
della texture della cute, nonch un apprezzabile miglioramento delle rughe
superficiali (figg. casi 1-3).
La mesoterapia con AI pu essere considerata
un trattamento efficace contro il fotoinvecchiamento della cute,
come confermato dalla valutazione ecografica.

lo studio stato condotto con il prodotto

Mesotherapy for rejuvenation of photoaged skin: Ultrasound evaluation


Case 1

Case 2

Case 3

Clinical evaluation

Clinical evaluation

Clinical evaluation

Before treatment

Before treatment

Before treatment

After treatment

After treatment

After treatment

Case 1

Case 2

Case 3

Ultrasound evaluation

Ultrasound evaluation

Ultrasound evaluation

Baseline

Baseline

Baseline

After 35 days

After 35 days

After 35 days

Increased SLEB
(subepidermal low-echogenic band) ecogenicity:

Increased SLEB
(subepidermal low-echogenic band) ecogenicity:

Increased SLEB
(subepidermal low-echogenic band) ecogenicity:

+41.2%

+50.2%

+22.1%