P3406Adjunctive measures to reduce discomfort of Botox Cosmetic

Anita Sethna, MD, Virginia Commonwealth University, Richmond, VA, UnitedStates; Michael Godin, MD, Virginia Commonwealth University, Richmond, VA,United States

Objectives: To assess the efficacy of several adjunctive measures designed todecrease the level of discomfort associated with Botox Cosmetic (Allergan; Irvine,California).

Methods: Eighty consecutive return patients receiving Botox for cosmetic purposescompleted surveys regarding several aspects of their treatment. Questions includedlength of treatment, frequency of administration, and severity of discomfort in threetreatment areas (glabella, forehead and orbicularis oculi). Following this, severaladjunctive methods to decrease discomfort were used on one side of the face,leaving the other side as the control. Adjunctive methods included ice-packplacement to the area of treatment before injection, topical placebo (AquaphorOintment; Biersdorf, CT), topical anesthetic (23% lidocaine/7% tetracaine) or apersonal massaging device applied to the area adjacent to the treatment sites. Oncethe treatment was complete, patients were asked to grade the severity of discomforton each side on a scale of 0 to 5, with 0 ¼ no pain and 5 ¼ severe pain.

Results: On average, patients in our practice receive Botox every 5.75 months. Theaverage level of discomfort associated with treatment was 2.5 out of 5, with no onearea being significantly more painful than the others. Most patients (54%) had beenreceiving Botox treatments for 1 to 5 years, 39% for more than 5 years. Six percenthad received Botox for less than 1 year. Using a paired sample t test, the averagediscomfort on the control side was found to be significantly more than the averagediscomfort on the treatment side (2.5 vs 1.9). In addition, a significant decrease indiscomfort (P # .05) was found for each of the four adjunctive measures whencompared to the control side. The massage device reduced the level of discomfortmore than other adjunctive measures (1.8 vs 3.0).

Conclusion: Botulinum toxin has been extensively studied for the purposes of facialrejuvenation since the early 1990s. Very little, however, has been written regardingthe discomfort associated with cosmetic administration. Our study revealed asignificant decrease in discomfort between sides treated with adjunctive measuresof any type, including placebo, compared to no adjuncts at all. In addition,application of a massage device to the area adjacent to injection seemed to provemost beneficial to our patients.

AB166

cial support: None identified.

Commer

P3407Safety and efficacy evaluation of a novel technology in transdermaldelivery of glycolic acid as skin conditioning agent

Michael Gold, MD, Tennessee Clinical Research Center, Gold Skin Care Center,Nashville, Tennessee, United States; Julie Biron, Tennessee Clinical ResearchCenter, Nashville, Tennessee, United States; Rhonda Page, RN, Tennessee ClinicalResearch Center, Nashville, Tennessee, United States

Background: For many years, patients have been treating photodamaged skin, acne,pigmentation, wrinkles, and facial rhytids by mechanical means such as dermabra-sion devices, chemical peels, or laser. The investigated device technology providesaccess to skin layers and allowing transcunteneous delivery of water basedsubstances.

Objective: Evaluate the relationship between treatments a novel device usingunique technology providing high velocity supersonic delivery system and cosmeticperformance of glycolic acid. Cosmetic performance was assessed by investigatorsrating of overall improvement and subjects self assessment of overall improvementand cosmetic acceptability.

Methods: Sixteen subjects who wished to improve photodamage and fine wrinkleswere enrolled into this open label, IRB approved trial using this novel device fordelivery of glycolic acid.

Results: A total of 16 subjects (mean age, 49.38 years completed the therapy.Fitzpatrick skin type scale distribution is as follow: type I, 12.50%; type II, 56.25%;type III, 25.0%; and type IV, 6.25%. No unexpected redness, swelling, burning,itching, and significant bruising were noted. Participants and investigator efficacyoutcome (satisfaction) were obtained (very much improved to improved) N ¼ 80%.

Conclusion: Delivering glycolic acid using this unique technology of high velocitysupersonic delivery may improve cosmetic appearance. Treatments were found tobe efficacious, safe, and provided a significant patient satisfaction.

cial support: 100% sponsored by TavTech.

Commer

J AM ACAD DERMATOL

SURGERY—DERMATOLOGIC

P3500Preoperative assessment of extramammary Paget disease using conven-tional fluorescence diagnosis

Miaojian Wan, MD, The Third Affiliated Hospital of Sun Yat-San University,Department of Dermatology, Guangzhou, Guangdong, China; Han Ma, MD, TheThird Affiliated Hospital of Sun Yat-San University, Department of Dermatology,Gzhouzhou, Guangdong, China; Jiahui Dong, MD, The Third Affiliated Hospitalof Sun Yat-San University, Department of Dermatology, Gzhouzhou, Guangdong,China; Wei Lai, MD, The Third Affiliated Hospital of Sun Yat-San University,Department of Dermatology, Guangzhou, Guangdong, China

Extramammary Paget disease (EMPD) frequently extends subclinically, resulting inhigh recurrence rates after surgical excision. Mohs micrographic surgery (MMS)improves cure rates but requires time-consuming reexcision of subclinical exten-tion. A mechanism to estimate the location and extent of subclinical extensionwould be helpful. Fluorescence diagnosis (FD) seems to be a promising method forthe noninvasive detection of tumor boundaries. We aimed to investigate thediagnostic performance of conventional FD of EMPD. Three male patients whohad been diagnosed by histopathology were included in this study when they had askin lesion on the genitals or scrotum and the margins was not clear. FD wasperformed using a 20% aminolaevulinic acid (ALA) cream. The FD tumor area wasdetermined 3.5 hours after the ALA application using a Wood lamp. The tumormargins were marked on the basis of FD. Mapping biopsies were performed atseveral select points in accordance with FD. These results showed one patient werefound tumor cells according the FD-definedmargin. The lesionwere then excised byMMS, the margin depend the mapping biopsies and FD results. If the tumor cellscould not be found, themargin was 2mm; otherwise it was 5mm.Only two sites of apatient were incompletely excised in primary surgery. FD seems to be substantiallysuperior to simple clinical assessment of EMPD margins and can be a beneficaladjuvant technique before MMS for EMPD.

cial support: None identified.

Commer

P3501Compared therapeutic efficacy between melamine foam sponge andcotton wool bud in the cryotherapy of viral warts: A comparativesplit-lesion study

In Guk Song, Chosun University Hospital, Gwangju, South Korea; Bongseok Shin,Chosun University Hospital, Gwangju, South Korea; Chan Ho Na, ChosunUniversity Hospital, Gwangju, South Korea; Minsung Kim, Chosun UniversityHospital, Gwangju, South Korea

Background: Various therapeutic measures have been used to treat viral warts, butthe majority of these modalities are associated with suboptimal outcome. The aim isthat comparing the efficacy of the cotton tip and melamine foam as the applicator inthe treatment of viral warts with liquid nitrogen.

Methods: A split-lesion studywas conducted in 28 patientswithmore than two sameclinical type of viral wart on equal anatomic location who had been treated withcryotherapy in Chosun University Hospital between January and October 2009.Same clinical type lesions were allocated to have liquid nitrogen applied with eithera cotton wool bud or a melamine foam sponge. Using either technique, treatmentwas done at 2- or 3-week intervals with a double freeze-thaw cycle. Investigatormeasured the number and size of warts, the strength of pain, and complications ateach visit before treatment.

Results: Twenty-eight patients were enrolled, with a mean age of 14 years; 17 malesand 11 females. According to the clinical type, the number of warts was 55palmoplantar, 44 periungual, and 19 common warts. The average size reductionafter first treatment were 31% in the cotton wool bud group and 59% in themelamine foam sponge group. Averages number of total treatment were 3.0 in thecotton wool bud group and 2.3 in the melamine foam sponge group (P\.05). Inpalmoplantar warts, averages of the size reduction after first treatment and thenumber of total treatment were 29%, 3.4 in the cotton wool bud group and 53%, 2.5in the melamine foam sponge group (P \ .05). In periungual warts, the sizereduction and treatment number were 36%, 2.8 in the cotton wool bud group and59%, 2.3 in the melamine foam sponge group (P\.05). Also in common warts, thesize reduction and treatment number were 37%, 3.1 in the cotton wool bud groupand 73%, 1.8 in the melamine foam sponge group (P\.05). The average degrees ofpain were 6.7 in cotton wool bud group and 7.3 in melamine foam sponge group(P\.05).

Conclusion: When compared with the conventional cryotherapy with cotton woolbud, using melamine foam was superior in remedial value and duration. Also it hadmany advantages—easy and speedy treatment fit for each wart sizes, relatively lowcost, and use without difficulty about smaller lesions.

cial support: None identified.

Commer

FEBRUARY 2011