Publications by authors named "Carmen Salavastru"

36 Publications

Laser in surgical scar clearance: An update review.

J Cosmet Dermatol 2021 Jul 2. Epub 2021 Jul 2.

Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.

Scar formation is a consequence of wound healing that developed from damaged tissue either from physical injury or surgical incision. A hypertrophic scar develops due to an abnormal healing response to trauma. It might lead to serious functional and cosmetic disability. There are numerous methods mentioned in the literature to treat such scars but to date, no single method has been known to cure them. In this review, we focused on differences between various types of nonsurgical management of hypertrophic scar focusing on the indication, mechanism of action, and efficacy of the pulsed dye laser (PDL), fractional carbon dioxide laser (fCO2), Er-YAG laser, and intense pulse light (IPL). The literature research included peer-reviewed articles (clinical trials or scientific reviews) which were identified by searching electronic databases like PubMed till January 2021 and reference lists of respective articles. Only articles published in the English language were included.
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http://dx.doi.org/10.1111/jocd.14325DOI Listing
July 2021

Tophaceous Gout - When the Skin Comes First.

Acta Dermatovenerol Croat 2020 Dec;28(7):223-227

Professor Carmen Salavastru, MD, PhD, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania;

Gout represents a metabolic disorder with systemic echo, in which needle-like crystals of monosodium urate are deposited in various tissular structures. Crystals accumulation in the connective tissue (tophi) represents the late, chronic stage of this disease, usually emerging after an average of 10 years after disease onset. Herein we report three cases of patients aged 70, 33, and 53 who presented with painful subcutaneous nodules located on various body areas. All of them had hyperuricemia. Several conditions had to be investigated in order to establish the etiology of uric acid metabolism alterations. Laboratory and pathology findings established the diagnosis of gout, with tophi as the first symptom of the disease. Following patient education, diet and lifestyle changes, and medication, the outcome in all patients was favorable, with alleviation of the symptoms. Tophaceous gout as a first presentation of this disease is currently uncommon, but dermatologist should be aware of this rare finding for proper management of such cases and to prevent the resultant significant functional and quality of life impairment if not recognized early.
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December 2020

Prevention of Hand Eczema among Nurse Apprentice (PREVEDERM): An Interventional Study.

Ann Work Expo Health 2021 03;65(2):167-175

Carol Davila University of Medicine and Pharmacy, Eroii Sanitari, Bucharest, Romania.

Background: Workers in the healthcare sector are at high risk of developing occupational hand eczema mainly due to frequent exposure to irritants and/or allergens. Amongst workers in healthcare, nurses are at higher risk of developing hand dermatitis.

Objectives: To evaluate the effectiveness of a short educational intervention program in preventing occupational hand eczema in nurse apprentices, using two objective tools, namely TEWL and EH, and the HECSI score.

Methods: Data regarding professions, wet work exposure, activities performed during working hours, self-reported eczema were collected from 230 nurse students, divided in two study groups: the intervention and the control group (CG). The intervention group (IG) was given education about risks and proper skin care and was provided with cosmeceuticals to be used for skin care during hospital activity. The evaluation of skin properties was performed using questionnaires, HECSI score, measurement of transepidermal water loss (TEWL) and epidermal hydration (EH).

Results: A number of 139 apprentice nurses completed the study. Of those participants who completed the study, 19.1% from CG and 19.6% from IG reported, at T1, hand eczema in the last 3 months, while at T2 (3 months later), 59.52 % of the CG and only 11.34 % from the IG stated having eczema in the last 3 months. In the IG, results showed an improvement of CM with 17% and of TEWL with 16%, with only a 0.5% improvement of CM in CG and a marked impairment of TEWL by 33%.

Conclusion: Hand eczema is a common occupational dermatosis affecting the medical staff, even during apprenticeship. Early preventive training programs are effective in reducing the burden of occupational contact dermatitis.
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http://dx.doi.org/10.1093/annweh/wxaa122DOI Listing
March 2021

[Curative treatment with lasers can improve skin pigmentation disorders].

Hautarzt 2020 Dec;71(12):919

Abteilung für pädiatrische Dermatologie, Colentina-Krankenhaus , 19-21 Stefan cel Mare Av., Bukarest, Rumänien.

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http://dx.doi.org/10.1007/s00105-020-04718-9DOI Listing
December 2020

[Treatment of pigmentation disorders in association with systemic diseases].

Hautarzt 2020 Dec;71(12):932-943

Carol-Davila-Universität für Medizin und Pharmazie, Bukarest, Rumänien.

Pigmentation disorders are a frequent skin problem and incorporate a broad spectrum of diseases, caused by an abnormal melanin pigmentation or also non-melanin pigmentation of the skin. Both hypermelanosis and hypomelanosis can be hereditary or acquired. This article summarizes the treatment approaches that are used in the majority of acquired pigmentation disorders of the skin. The following forms of hypermelanosis are addressed: lentiginosis, hyperpigmentation due to endocrine disorders or other systemic diseases, drug-induced hyperpigmentation. Acquired hypomelanoses include postinflammatory hypomelanosis, chemical depigmentation, idiopathic guttate hypomelanosis and punctate leucoderma. With reference to non-melanin pigmentation, the exogenous pigmentation due to chemicals, metals and drug exposure are discussed. The treatment is primarily based on finding the cause of the alterations to the pigment. The affected area, age and ethnic origin are also important factors. The spectrum of therapeutic options is broad: topical agents, chemical peeling, systemic agents, laser and light-based treatment. As some of these treatment procedures can have side effects, the availability of a protocol that contains information on the drug concentration, dose, parameters for laser treatment and the number of sessions is important. For every disorder the specific dermatological treatment is presented even when some pigmentation alterations that occur in association with systemic diseases, are cured by the treatment of the primary disease. Most diseases are exacerbated by exposure to UV light. Therefore, sun protection is recommended and a cosmetic coverage is indicated.
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http://dx.doi.org/10.1007/s00105-020-04715-yDOI Listing
December 2020

[Laser treatment of pigmentation disorders].

Hautarzt 2020 Dec;71(12):920-925

Abteilung für pädiatrische Dermatologie, Colentina-Krankenhaus, Bukarest, Rumänien.

Pigmentation disorders are among the most common cutaneous changes and occur in up to 60% of all people. They can be genetic or acquired, functionally or cosmetically disturbing, or the expression of a medical disorder. The best treatment options for hyperpigmentation are usually lasers and intense pulsed light (IPL). However, they can also worsen some conditions and are occasionally associated with side effects. A correct diagnosis is therefore essential, taking into account the skin type, the type of pigmentation and how deep the pigmentation is located in the skin. The most common indications for which laser treatment is recommended include genetically predisposed nevi (Becker, Ota, Hora, Ito, acquired bilateral nevus of Ota-like macules [ABNOM]), pigmentation (e.g., lentigines, postinflammatory hyperpigmentation, ephelides, café au lait, nevus spilus, linear and whorled hypermelanosis [LWNH]), nevus cell nevi, exogenous pigments, tattoos and cosmetic pigments.
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http://dx.doi.org/10.1007/s00105-020-04716-xDOI Listing
December 2020

Treatment of psoriatic erythroderma using systemic corticosteroids: A timeless option?

Dermatol Ther 2020 11 22;33(6):e14222. Epub 2020 Sep 22.

Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.

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http://dx.doi.org/10.1111/dth.14222DOI Listing
November 2020

Initial validation of the epidermolysis bullosa-specific module of the Infants and Toddlers Dermatology Quality of Life questionnaire.

Dermatol Ther 2020 11 7;33(6):e14128. Epub 2020 Sep 7.

Clinical Epidemiology Unit, IDI-IRCCS, Rome, Italy.

Children with epidermolysis bullosa (EB) experienced the highest quality of life impact among several skin conditions and have problems which had not been reported by parents of children with other skin diseases. The EB-specific module of the Infants and Toddlers Dermatology Quality of Life (InToDermQoL) questionnaire was recently developed to measure the impact of disease-specific aspects in children from birth to the age of 4 years. The aim of this study was initial validation of the InToDermQoL-EB questionnaire. Parents of 44 children with EB from seven countries completed the InToDermQoL-EB questionnaire. Cronbach's alpha was .86, .89 and .91 for three age-specific versions. Differences between severity levels were all significant except for that between moderate and severe level in the version for 3- to 4-year-old children. All items of the three versions of the InToDermQoL-EB showed very high levels of relevance except "problems with defecation" in children younger than 1 year and "rejection by other children" in 3- to 4-year-old children. The three versions of the InToDermQoL-EB instrument showed good internal consistency and discriminated well between different severity levels. All InToDermQoL-EB items were confirmed as being of high relevance and the questionnaire may be used in practice and clinical trials.
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http://dx.doi.org/10.1111/dth.14128DOI Listing
November 2020

Emergency management in epidermolysis bullosa: consensus clinical recommendations from the European reference network for rare skin diseases.

Orphanet J Rare Dis 2020 06 6;15(1):142. Epub 2020 Jun 6.

Dermatology Department, reference Centre MAGEC, Necker- Enfants Malades Hospital, Paris-Centre University, Paris, France.

Epidermolysis bullosa (EB) comprises a group of genetic disorders with the hallmark of fragility of the skin and mucosal surfaces. The severity of different types of EB varies markedly as does the occurrence of extra-cutaneous involvement and complications. A number of emergency situations may occur in the context of EB including obstruction to oral intake from oral or esophageal blisters or scarring, acute airway obstruction, acute urinary retention, sepsis and corneal erosions. Whilst general management principles apply in each of these settings, specific considerations are essential in managing EB to avoid undue trauma or damage to delicate tissues. These recommendations have been developed from a literature review and consensus from experts of the European Network for Rare Skin Disorders (ERN-Skin) to aid decision-making and optimize clinical care by non-EB expert health professionals encountering emergency situations in babies, children and adults with EB.
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http://dx.doi.org/10.1186/s13023-020-01403-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7276067PMC
June 2020

The efficacy and safety of a 577-nm high-power optically pumped semiconductor laser in the treatment of postacne erythema.

J Cosmet Dermatol 2020 Jul 10;19(7):1642-1647. Epub 2020 Jun 10.

Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.

Background: Postacne erythema (PAE) is a common sequela of inflammatory acne vulgaris, treatment of which has been challenging due to limited options available and the variability of results for each modality. Recently, a 577-nm high-power optically pumped semiconductor laser (HOPSL) initially developed for vascular lesions has shown promising results for the treatment of PAE.

Aims: To evaluate the efficacy and safety of 577-nm HOPSL in the treatment of postacne erythema.

Methods: This was a split-face, randomized controlled trial pilot study. Twenty-one patients with PAE on both sides of their face were enrolled. Each subject's face sides were randomly assigned to either receive 577-nm HOPSL treatment (QuadroStar PRO™, Asclepion Laser Technologies) using the scanner handpiece, 1mm spot size, 80% coverage, 12-15 J/cm , 30 ms, 2 passes for 3 sessions at 1-month intervals, or no treatment at all. Outcome measures such as overall improvement, the Erythema Index (EI), and Melanin Index (MI) from 3 different areas on both treatment and control sides were assessed at baseline, and 1-month follow-up after each treatment session. Side effects including pain, erythema, swelling, and crusting were also recorded.

Results: Upon completion of the treatment period, the mean EI was significantly decreased in both treated and nontreated sides of the face (P < .001 and P = .001, respectively). The laser-treated sides already demonstrated significant reduction in the mean EI compared with nontreated sides at 1 month after the 2nd treatment (P = .007). The mean MI of both sides, however, did not show any statistically significant differences from baseline, and likewise when comparing between sides. Patients reported more improvement on laser-treated sides compared with nontreated sides. Reported side effects were limited to mild discomfort during treatment and transient facial erythema lasting approximately 30 minutes.

Conclusion: Patients who received treatment with the 577-nm HOPSL had better outcomes with minimal side effects at 1 month after 2 treatments as compared to those who did not receive any treatment. Therefore, the 577-nm HOPSL may be considered as an effective adjuvant treatment for PAE and early erythematous atrophic scars.
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http://dx.doi.org/10.1111/jocd.13474DOI Listing
July 2020

S3 guideline for actinic keratosis and cutaneous squamous cell carcinoma (cSCC) - short version, part 2: epidemiology, surgical and systemic treatment of cSCC, follow-up, prevention and occupational disease.

J Dtsch Dermatol Ges 2020 Apr 4;18(4):400-413. Epub 2020 Apr 4.

Department of Dermatology, Knappschaftskrankenhaus Recklinghausen, Recklinghausen, Germany.

Actinic keratoses (AKs) are common lesions in light-skinned individuals that can potentially progress to cutaneous squamous cell carcinoma (cSCC). Both conditions may be associated with significant morbidity and constitute a major disease burden, especially among the elderly. To establish an evidence-based framework for clinical decision making, the guidelines for actinic keratosis and cutaneous squamous cell carcinoma were developed using the highest level of methodology (S3) according to regulations issued by the Association of Scientific Medical Societies in Germany (AWMF). The guidelines are aimed at dermatologists, general practitioners, ENT specialists, surgeons, oncologists, radiologists and radiation oncologists in hospitals and office-based settings as well as other medical specialties involved in the diagnosis and treatment of patients with AKs and cSCC. The guidelines are also aimed at affected patients, their relatives, policy makers and insurance funds. In the second part, we will address aspects relating to epidemiology, etiology, surgical and systemic treatment of cSCC, follow-up and disease prevention, and discuss AKs and cSCC in the context of occupational disease regulations.
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http://dx.doi.org/10.1111/ddg.14072DOI Listing
April 2020

S3 guideline for actinic keratosis and cutaneous squamous cell carcinoma - short version, part 1: diagnosis, interventions for actinic keratoses, care structures and quality-of-care indicators.

J Dtsch Dermatol Ges 2020 Mar;18(3):275-294

Department of Dermatology, Knappschaftskrankenhaus Recklinghausen, Recklinghausen, Germany.

Actinic keratoses (AK) are common lesions in light-skinned individuals that can potentially progress to cutaneous squamous cell carcinoma (cSCC). Both conditions may be associated with significant morbidity and constitute a major disease burden, especially among the elderly. To establish an evidence-based framework for clinical decision making, the guideline "actinic keratosis and cutaneous squamous cell carcinoma" was developed using the highest level of methodology (S3) according to regulations issued by the Association of Scientific Medical Societies in Germany (AWMF). The guideline is aimed at dermatologists, general practitioners, ENT specialists, surgeons, oncologists, radiologists and radiation oncologists in hospitals and office-based settings as well as other medical specialties involved in the diagnosis and treatment of patients with AK and cSCC. The guideline is also aimed at affected patients, their relatives, policy makers and insurance funds. In the first part, we will address aspects relating to diagnosis, interventions for AK, care structures and quality-of-care indicators.
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http://dx.doi.org/10.1111/ddg.14048DOI Listing
March 2020

Exposure to solar UV radiation in outdoor construction workers using personal dosimetry.

Environ Res 2020 02 27;181:108967. Epub 2019 Nov 27.

'Carol Davila' University of Medicine and Pharmacy, Department of Dermatology 2, "Colentina" Clinical Hospital, Bucharest, Romania.

Occupational exposure to solar UV radiation (SUVR), a Group 1 carcinogen according to the IARC classification is at high exposure levels in outdoor construction workers, usually above the suggested occupational limits. Furthermore, there are no regulations related to this exposure in the EU, except for the artificial UVR. Also, the use of the ICNIRP exposure guideline in an outdoor setting poses problems of adequate dose assessment. In this context, the main purpose of the study was to perform direct measurements of the SUVR dose in outdoor workers from the construction sector, using individual SUVR dosimeters (GENESIS-UV system), for a period of 7 months, from April to October, in a prospective, observational study in two groups of 10 outdoor workers in Romania, located at two different geographic sites. In term of cumulative standard erythema dose (SED), our study population of outdoor construction workers received high levels of solar UV radiation, ranging from 165 SED to 453 SED during 7 months of occupational activity, from April to October. Our results, ranging from 1.28 SED (standard erythema dose) per day to 6.4 SED per day pose an alarm signal to the national and European health authorities to take preventive action for outdoor workers, as the ICNIRP suggested limit value of 1.33 SED for mean daily erythemal UV exposure is vastly exceeded. We suggest that personal dosimetry for SUVR, from simple devices to complex systems as GENESIS-UV should be regularly and mandatory used in outdoor workers, similarly to the usage of personal dosimetry in occupational exposure to ionizing radiations, which could be included in European and national legislation to reduce both, the level of exposure and the detrimental effects on outdoor workers' health.
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http://dx.doi.org/10.1016/j.envres.2019.108967DOI Listing
February 2020

A challenging case of jaundice and febrile uncommon rash in an immunocompetent male patient.

Turk J Gastroenterol 2019 May;30(5):485-488

Carol Davila Central Military University Emergency Hospital, Bucharest, Romania.; Titu Maiorescu University School of Medicine, Bucharest, Romania.

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http://dx.doi.org/10.5152/tjg.2018.18465DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6505654PMC
May 2019

Reduction of abdominal skin laxity in women postvaginal delivery using the synergistic emission of radiofrequency and targeted pressure energies.

J Cosmet Dermatol 2018 Oct 26;17(5):766-769. Epub 2018 Aug 26.

Dermaplus Dermatology Laser and Aesthetic Medical Clinic, Plovdiv, Bulgaria.

Objective: This study evaluates clinical efficacy of a novel device which uses combined emission of radiofrequency and targeted pressure energy, for reduction of abdominal skin laxity.

Methods: This was a multicentric, randomized, parallel group-controlled prospective study. Forty-six women 6-36 months after delivery with abdominal skin laxity were randomly assigned to Group A or Group B. Group A received four treatments with BTL UNISON device (BTL Industries Inc, Boston, MA, USA); and, Group B didn't receive any treatments. Skin viscoelasticity was measured using a skin analyzer at baseline and 3 months posttreatments. Standardized digital photographs were evaluated for the severity of skin laxity. Patient comfort and satisfaction were evaluated by standardized questionnaires.

Results: Subjects' weight remained stable. In 95% of treated patients the umbilical circumference decreased (average - 1.43 cm, P < 0.0001). The average of skin viscoelasticity changes in individual patients totaled + 37.6%/3.29 Mpa (retraction time - 62.6 ms/-22.5%; suction pressure + 1.21 Mpa/+13.9%) (all P < 0.0001). The overall elasticity improved in 90.9% of patients. The control group changes were insignificant. Based on independent photo assessment there was an improvement in the degree of skin laxity in 86% of treated patients. The average laxity score across all treated patients decreased from 1.79 (moderate laxity) at baseline to 1.1 (mild laxity) 3 months posttreatments. Ninety percent of treated patients expressed satisfaction with achieved results. Therapy didn't cause any pain.

Conclusions: We conclude the investigated device can significantly reduce signs of early postpartum laxity in abdominal area. As such, it is a promising alternative to surgical procedures.
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http://dx.doi.org/10.1111/jocd.12741DOI Listing
October 2018

Traditional and ethnobotanical dermatology practices in Romania and other Eastern European countries.

Clin Dermatol 2018 May - Jun;36(3):338-352. Epub 2018 Mar 10.

Dermatology Department, Pediatric Dermatology Unit, Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.

The geographic and ecologic specificity of Romania and other Eastern European countries has resulted in the development of an exceptional diversity of medicinal plants. The purpose of this study was to provide an overview of the ethnobotanical dermatology practices based on the use of medicinal plants in this region. The indications, ethnopharmacologic activities, parts used, and administration of 106 medicinal plants are provided. We also discuss the relative importance of these species, using two modified indices of quantitative ethnobotany: Use Value Index and Relative Dermatologic Importance, which were calculated on the basis of etic constructions (indications and ethnopharmacologic activities). The species identified to have the highest dermatologic importance (on a scale of 100) were Brassica oleracea L. (100), Matricaria chamomilla L. (79.17), Arctium lappa L. (74.82), Daucus carota L. (72.28), Equisetum arvense L. (70.47), Juglans regia L. (69.93), Populous nigra L. (65.94), Symphytum officinale L. (63.59), Chelidonium majus L. (57.78), Calendula officinalis L. (57.78), Achillea millefolium L. (57.43), Melilotus officinalis L. (55.25), Allium cepa L. (51.45), Quercus robur L. (51.08), and Betula spp. (50.91). This preliminary study on ethnobotanical dermatology practices indicates that Eastern European traditional medical knowledge represents an important heritage that is currently underexploited.
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http://dx.doi.org/10.1016/j.clindermatol.2018.03.008DOI Listing
November 2018

Clinical evaluation of simultaneously applied monopolar radiofrequency and targeted pressure energy as a new method for noninvasive treatment of cellulite in postpubertal women.

J Cosmet Dermatol 2018 Jun 9;17(3):361-364. Epub 2018 Mar 9.

Dermaplus Dermatology Laser & Aesthetic Medical Clinic, Plovdiv, Bulgaria.

Introduction: This study investigates noninvasive cellulite treatments based on simultaneous application of monopolar radiofrequency (RF) and targeted pressure energy to evaluate efficacy and safety and to see whether simultaneous application has any benefits in noninvasive cellulite treatments.

Methods: Thirty women with cellulite (fibrous/adipose/aqueous types) received 4 gluteofemoral treatments (~24 minutes; ~1000 cm ) using a simultaneous application of RF and targeted pressure energy. Clinical improvement was assessed using a pentile grading scale and satisfaction questionnaires. Hip/thigh circumference was measured. Ultrasonography and thermography observed changes in dermal/subcutaneous tissue composition and in gluteofemoral thermal profile. Evaluation at 3 months posttreatment was compared against the baseline.

Results: The clinical improvement averaged 2.17 ± 0.95 (54% improvement). Cellulite was reduced in 93% of cases, while 73% of patients showed good/very good/excellent improvement, with most significant improvement seen in patients with moderately severe cellulite. Hips and thigh circumference decreased on average by 2.31 cm and 2.13 cm, respectively (P < .001). Patient satisfaction was very high, averaging 4.47 ± 0.57 points (1-5 scale). Ultrasonography revealed smoothing and thickening (+0.28 ± 0.15 mm) of the dermis and an average reduction of 1.96 ± 1.60 mm in fat thickness (P < .05). Subjects with significant cellulite reduction had a more homogenous thermal profile at follow-up as a result of therapy-induced diminution of topographic skin defects. No adverse events were recorded.

Conclusion: The application is effective and safe for treating cellulite. The level of clinical improvement after 4 sessions is comparable to results reported after 6-20 sessions in studies on stand-alone RF/laser/targeted pressure energy devices. The technology is promising and deserves further attention and research.
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http://dx.doi.org/10.1111/jocd.12525DOI Listing
June 2018

Long-term follow-up on patients treated for abdominal fat using a selective contactless radiofrequency device.

J Cosmet Dermatol 2017 Dec 22;16(4):471-475. Epub 2017 Sep 22.

Carol Davila University, Bucharest, Romania.

Background And Objective: The aim of this study was to evaluate how abdominal circumferential reduction achieved after using a noninvasive radiofrequency device (BTL Vanquish, BTL Industries Inc., Boston, MA) evolves over a 4-year period.

Methods: This is a follow-up on patients who were treated in our practice for abdominal fat in an earlier published multicenter prospective study. Patients were recalled for biometric data collection 4 years (±60 days) after the last treatment. Body and weight measurements were compared to the historical data. Digital images of the treated area were taken. Independent panelists were asked to recognize the original baseline images from the 4-year follow-up images.

Results: The evaluation encompasses 13 subjects. In the original study, these patients lost on average 5.88 ± 4.14 cm of waist circumference (P < .001) while losing on average 1.29 kg. After 4 years, the same subjects had an average reduction of 4.42 ± 2.85 cm (P < .001) compared to the baseline, while gaining on average 0.50 kg. In both cases, the waist change was statistically independent of the weight change (P < .01). The patients preserved on average 75.2% of the original body contouring effect after 4 years as measured by circumference. None of the patients grew in circumference when compared to the baseline. Reviewers recognized the baseline patient images from the follow-up patient images in 82.1% cases. No long-term side effects were observed that would relate to the treatments.

Conclusions: In the study group, patients with ordinary weight changes preserved most of the original waist reduction after 4 years.
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http://dx.doi.org/10.1111/jocd.12429DOI Listing
December 2017

Ways of Noninvasive Facial Skin Tightening and Fat Reduction.

Facial Plast Surg 2016 Jun 1;32(3):276-82. Epub 2016 Jun 1.

Department of Paediatric Dermatology, Colentina Clinica Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.

For skin tightening, ablative and nonablative lasers have been used with various parameters full or fractionated. Currently, other energy-based technologies have been developed such as radiofrequency (RF) from mono- to multipolar, microneedling RF, and high-intensity focused ultrasound. They heat up the tissue to a clinical endpoint. Temperatures above 42°C stimulate fibroblasts to produce more collagen and some technologies produce small coagulation points that allow to shrink and to tighten the tissue with less downtime or side effects. Alternative treatments not based on heat can be chemical peels from light to deep and microneedling without RF.
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http://dx.doi.org/10.1055/s-0036-1584214DOI Listing
June 2016

A novel selective RF applicator for reducing thigh circumference: a clinical evaluation.

Dermatol Ther 2016 Mar-Apr;29(2):92-5. Epub 2015 Nov 2.

Lasercenter s.r.o, Nitra, Slovak Republic.

The demand for noninvasive body contouring procedures continues to drive the development of new technology to treat areas on the body that are more resistant to diet and exercise. This study assesses the safety and efficacy of a novel selective RF applicator as a noninvasive, contactless method for reducing thigh circumference using a radiofrequency electric field (Vanquish Flex Applicator, BTL Industries Inc., Boston, MA). Forty-two female subjects were enrolled to undergo a treatment of their bilateral inner and outer thighs (saddle bags) once weekly for 4 weeks. Thigh circumference was measured at the baseline and 2 weeks after the fourth treatment. The primary objective was the evaluation of clinical outcomes of 40 treated subjects. Safety of the device was assessed based on adverse events reports during the course of the study. Forty subjects completed the study. After four treatments, the therapy group showed a statistically significant (p < 0.001) reduction in thigh circumference of 2.43 cm compared with an untreated control group of 10 patients, where no change was seen (p = 0.297). No treatment associated pain or discomfort was reported by the subjects. There were also no reports of adverse events. This study demonstrates that the contactless RF Applicator is safe, painless and effective for the circumferential reduction of the thighs.
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http://dx.doi.org/10.1111/dth.12304DOI Listing
January 2017

Adverse reactions of biological therapy for psoriasis.

Rev Med Chir Soc Med Nat Iasi 2015 Jan-Mar;119(1):38-44

Aim: To detect in patients with psoriasis the adverse effects during TNF-a inhibitor therapy.

Material And Methods: Fifty-seven patients with psoriasis, aged between 12 and 75 years were analyzed. They were treated with different TNF-α antagonists, the maximum treatment duration being 59 months. All patients were followed monthly after the initiation of therapy by clinical checkup, then every 3 months during the first 6 months of treatment by laboratory screening, and then every 6 month. Chest x-ray and tuberculin intradermal skin test were performed annually or as needed. All symptoms reported by patients were recorded, the treating doctor deciding the need for additional investigations or specialist consult.

Results: Of the total of 57 patients with psoriasis on biological therapy, 9 patients developed diseases requiring temporary or permanent discontinuation of therapy. The recorded adverse reactions were: infectious (pulmonary tuberculosis, pulmonary empyema), oncologic (rectal cancer, renal cancer), dermatologic (vesiculobullous erythema multiforme major, nodular hypodermtis, secondary erythroderma, and hives) disorders.

Conclusions: Despite its adverse reactions, biological therapy is safe and is a necessary tool in the treatment of moderate and severe forms of psoriasis unresponsive to other treatments.
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June 2015

Epidemiological aspects of genital warts in romania - a 2012 retrospective survey.

Maedica (Bucur) 2014 Jun;9(2):144-50

Department of Dermatology 2, Colentina Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.

Objectives: Genital infection with human papillomavirus (HPV) has become one of the most frequently viral sexually transmitted diseases. The infection may remain asymptomatic, may take the form of external genital warts and may give raise to cervical cancers. The aim of this study was to assess the frequency of the patients with genital warts addressing to five tertiary referral dermato-venereological units in Romania (where patients from several counties are referred) and to compare the results with the out-patient data reported by all Romanian hospitals.

Material And Methods: Data regarding patients with external genital warts who addressed to the hospital emergency rooms, in five tertiary referral dermato-venerological units in Romania (Bucharest, Timisoara, Craiova, Constanta, Târgu-Mures) were collected for the year 2012. For comparison there have been used data collected by the National School of Public Health, Management and Professional Development, during the same year.

Outcomes: Data reported at national level in 2012 included 952 patients (731 women and 221 men) with 26 males under 20 years of age and 251 female patients in the age group 0-20 years. In the overall population (males and females combined) the total number of genital warts cases registered at the hospital emergency rooms in the five centers, in the year 2012, was 266 patients (119 men and 147 women) with 4 girls under 14 years of age and 6 male patients in the age group 0-14 years.

Conclusions: The high prevalence of the infection with HPV, the costs of treatment and the psychological impact prove that prevention of the disease is the most important step for decreasing the incidence of this disease. General measures for patients awareness regarding the disease and its complications need to be completed with the recommendation for vaccination. A closer monitoring of patients would provide information for a strategic national approach leading to a better outcome.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4296756PMC
June 2014

Napkin psoriasis--case report.

Rev Med Chir Soc Med Nat Iasi 2014 Oct-Dec;118(4):1008-12

University of Medicine and Pharmacy Grigore T. Popa - Iaşi, Department of Medical Specialties (II).

Psoriasis is a chronic inflammatory disease that can affect up to 1% of children. Genetic (family history of psoriasis) and environmental factors (bacterial or viral infections, stress, and trauma) are frequently involved in its occurrence. Napkin psoriasis is a particular form of psoriasis affecting mainly children younger than 2 years of age and can be classified together with other diseases under diaper rash. We present the case of a 4-month-old infant, born at term, naturally, weight and height within the normal range, who was brought to the Dermatology Clinic for the occurrence of erythematosquamous lesions in the anogenital area, buttocks and upper third of the thighs, with subsequent dissemination of lesions. The onset of symptoms began a few days after a respiratory tract infection. Initially he received treatment with systemic antibiotic and topical corticosteroid and antibiotic with unfavorable outcome. Laboratory tests revealed iron-deficiency anemia, leukocytosis, thrombocytosis, accelerated ESR, marked hepatic cytolysis, hyperphosphatemia and nasal carriage of Staphylococcus aureus. A systemic antihistamine and nonspecific desensitization treatment was administered. Topical treatment consisted in the removal of predisposing factors and irritants (diaper, urine) by rigorous hygiene, application of topical non-fluorinated cortico-steroid and use of emollients, with favorable course of the lesions. The peculiarity of the case is that the diagnosis of psoriasis was based on history, physical examination and laboratory tests, in the absence of a pathology examination to confirm the diagnosis. Pathology examination could not be performed due to patient's age as biopsy required general anesthesia.
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March 2015

Birth weight and atopic dermatitis: systematic review and meta-analyis.

Acta Dermatovenerol Croat 2014 ;22(2):91-6

Prof. Carmen Salavastru, MD, PhD 2nd Dermatology Clinic - Colentina Clinical Hospital Sos. Stefan cel Mare nr. 19-21, Bucharest, Romania;

Several studies examined the relationship between birth weight and atopic diseases, but no consensus has yet been reached regarding the results. The purpose of this paper was to perform a meta-analysis of the existing studies regarding the role of birth weight in the occurrence of atopic dermatitis. We carried out an extensive search in the international databases (Pubmed, Cochrane Library, and Web of Knowledge). We selected the cross-sectional, case-control, and cohort studies which analyzed the role of birth weight in the occurrence of atopic dermatitis. We performed a meta-analysis of the selected studies, and calculated the odds ratio (OR) and corresponding 95% confidence intervals (95% CI). We included 10 studies in the final meta-analysis, which comprised 110974 patients. Weight classification was in compliance with Pediatric Nutrition Surveillance System (PedNSS) Health Indicators. In the first meta-analysis, we selected patients with low weight (below 2500 g) and atopic dermatitis and compared them with those with normal weight (2500 - 4000 g) and atopic dermatitis. The analysis showed that low birth weight represents a protective factor in the occurrence of atopic dermatitis (OR = 0.68, CI: 0.63 - 0.75, P<0.0001). In the second meta-analysis, we compared patients with high weight (over 4000 g) and atopic dermatitis with those with normal weight and atopic dermatitis. The results indicated that increased birth weight represents a risk factor for atopic dermatitis (OR = 1.1; CI: 1.02 - 1.17; P = 0.01) Thus, low birth weight represents a protective factor for the occurrence of atopic dermatitis and high birth weight represents a risk factor for the occurrence of this disease.
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July 2016

A burst in the incidence of viral exanthems.

Indian Dermatol Online J 2014 Apr;5(2):144-7

Dermatology Clinic 2, Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.

Background: Vaccines have a major role in eradication programs of viral diseases. Vaccines against measles, rubella, and varicella are included in the vaccination schedules for children in most countries.

Objective: A comparative analysis between 2011 and 2012 was performed to investigate if the number of patients with viral exanthemas reported to our clinic in 2012 was increased.

Materials And Methods: PATIENTS WERE GROUPED IN FOUR CATEGORIES: rubella, measles, varicella and other viral exanthemas.

Results: Between January and April 2011, there were registered 37 cases with viral exanthemas: 69.5% presented with varicella and 30.5% with other viral exanthemas. Between January and April 2012, there were 178 cases registered with viral eruption, of which 37% were of other viral exanthemas, 35.4% rubella, 19.7% measles and 7.9% varicella. The highest incidence was seen in patients aged between 20 and 29 years (52.2%), with 21% having measles, 32.2% rubella, 9% varicella and 37.6% having other exanthemas. In 2012, the number of cases of viral exanthemas increased 5 times, with important outbreaks of new cases of measles and rubella.

Conclusions: Although vaccines against measles and rubella were being used since 1979 and 1998 respectively, it was only in 2004, that these vaccines became part of the mandatory vaccination schedule. Although persons under 32 years should be protected against measles infection if they are previously vaccinated, more than 90% of the registered cases of measles occurred in such patients. The patients registered between January and April 2011 were mostly pediatric. Adults also were much more affected with measles, rubella, or varicella viruses in 2012 than in 2011.
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http://dx.doi.org/10.4103/2229-5178.131083DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4030339PMC
April 2014

Laser-induced fluorescence made simple: implications for the diagnosis and follow-up monitoring of basal cell carcinoma.

J Biomed Opt 2014 Mar;19(3):30901

University of Athens, Andreas Syggros Hospital, Department of Dermatology, Photobiology Unit, 5 Dragoumi Street, 16121 Athens, Greece.

Noninvasive treatments are increasingly being used for the management of basal cell carcinoma (BCC), the predominant type of nonmelanoma skin cancer, making the development of noninvasive diagnostic technologies highly relevant for clinical practice. Laser-induced fluorescence (LIF) spectroscopy emerges as an attractive diagnostic technique for the diagnosis and demarcation of BCC due to its noninvasiveness, high sensitivity, real-time measurements, and user-friendly methodology. LIF relies on the principle of differential fluorescence emission between abnormal and normal skin tissues (ex vivo and in vivo) in response to excitation by a specific wavelength of light. Fluorescence originates either from endogenous fluorophores (autofluorescence) or from exogenously administered fluorophores (photosensitizers). The measured optical properties and fluorophore contributions of normal skin and BCC are significantly different from each other and correlate well with tissue histology. Photodynamic diagnosis (PDD) is based on the visualization of a fluorophore, with the ability to accumulate in tumor tissue, by the use of fluorescence imaging. PDD may be used for detecting subclinical disease, determining surgical margins, and following-up patients for residual tumor or BCC relapse. In this review, we will present the basic principles of LIF and discuss its uses for the diagnosis, management, and follow-up of BCC.
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http://dx.doi.org/10.1117/1.JBO.19.3.030901DOI Listing
March 2014

Recommended strategies for epidermolysis bullosa management in romania.

Maedica (Bucur) 2013 Jun;8(2):200-5

Colentina Dermatology Clinic 2, "Carol Davila" University of Medicine and Pharmacy Bucharest, Romania.

Abstract:

Background: There are 72 families with epidermolysis bullosa (EB) in Romania. Since 2012 a National Program for the treatment of these patients is run by the Ministry of Health.The objectives of the strategies for EB patients are to optimize the management (diagnosis, treatment, monitoring) and to provide actual information on classification and patho-physiology which dictate the course of the disease.

Methods: An international expert panel of specialists produced by consensus the recommendations for the management of EB cases in Romania taking into account the local possibilities. Patient association proposals were included. A review of the literature was performed to up-date the information.

Outcomes: A strategy for diagnosis, treatment and follow-up of the patients with EB was elaborated in clear steps. Pharmacological treatments and wound care indications are provided together with a useful score for patient evaluation.

Conclusion: These recommended strategies are allowing dermatologists to generate an individualized care plan for patients with EB.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3865131PMC
June 2013