Evaluating Poly-D,L-lactic acid for lower eyelid rejuvenation in Korean women
Today’s report also covers research into the efficacy and safety of cysteamine for melasma, pain perception of aesthetic procedures depending on the menstrual cycle, and more (1,530 words, 7 minutes)
Good morning, and welcome to the Women in Dermatology e-newsletter from Chronicle Companies. We’re pleased to have you join us. This biweekly bulletin will update you on new findings regarding dermatologic issues that affect women and the female dermatologists who care for them. We welcome your feedback and opinions, so let us know if you have any comments, observations, or suggestions. You can email them to us at health@chronicle.org
New injectable filler products, including poly-D,L-lactic acid (PDLLA), are being explored as a novel approach to lower eyelid rejuvenation, addressing concerns such as tear trough deformities and infraorbital hollows. A study in the Journal of Cosmetic Dermatology (Feb. 28, 2025; 24(3):e70058) evaluated the efficacy and safety of poly-D,L-lactic acid for lower eyelid rejuvenation in Korean women. The researchers found that PDLLA is an effective and safe treatment for periorbital rejuvenation, with patients showing significant reductions in hollowness and sustained aesthetic benefits.
The study included patients with under-eye hollows, dark circles, and mild eye bags. Those with mid-facial volume loss were pre-treated with hyaluronic acid filler one week before the PDLLA injection. The tear trough deformities were classified using Hirmand’s classification system, which delineates volume loss into three classes. Follow-up assessments were conducted one week, one month, and six months after treatment.
Before the treatment, patients underwent a standardized pre-injection protocol, including facial cleansing, topical anesthesia, and photographic documentation. The injectable PDLLA was mixed with sterile water according to the volume needed. A 23G cannula was inserted 10 mm below the outer corner of the eye, and PDLLA was injected in small droplets using a fanning technique, with a maximum of 1 mL per side. Patients were advised not to massage the area at home to avoid complications. Patient satisfaction was measured using a visual analog scale, and clinicians performed independent, blinded evaluations to assess the improvement in tear trough deformities.
The authors presented four case studies, each involving Korean women with Fitzpatrick skin type 3 and varying degrees of tear-trough deformities. In each case, 1 mL of PDLLA was administered per side in a single session. In the first case, a 41-year-old woman with a Class II deformity showed complete resolution of tear trough hollowness after a single treatment session, with sustained results at six months. In the second case, a 36-year-old with a Class I deformity achieved full correction with high satisfaction and minimal side effects.
The third case, a 54-year-old patient with a severe Class III deformity, showed significant improvement. However, her condition remained at Class II at the six-month follow-up. Lastly, a 38-year-old woman with a Class II deformity improved to Class I post-treatment, maintaining the results over time. Across all cases, PDLLA demonstrated durable and effective outcomes. Furthermore, patients reported high satisfaction, and minimal bruising or swelling was observed, resolving within 48 hours. No serious adverse effects were reported during the follow-up period.
The study suggests that PDLLA is a promising option for lower eyelid rejuvenation. The treatment effectively addressed various severity levels of tear trough deformities, and the six-month follow-up indicated consistent improvements without complications. Although mild swelling and bruising were observed in some patients, these effects resolved quickly, and no serious adverse reactions were reported. The authors note that collagen-stimulating properties of PDLLA contributed to gradual and natural-looking enhancements.
The Takeaway: The study found that PDLLA is an effective and safe treatment for lower eyelid rejuvenation, reducing hollowness and providing lasting results. Mild swelling and bruising were the most common side effects, but they resolved within 48 hours with no serious adverse effects. Patient satisfaction was high, with most experiencing substantial improvements in under-eye appeance and minimal side effects. PDLLA’s collagen-stimulating properties contributed to gradual, natural-looking results.
A functional skincare formulation mixed with retinyl propionate, hydroxypinacolone retinoate, and vitamin C for antiaging and whitening
A study in the Journal of Cosmetic Dermatology examined the antiaging and whitening effects of a combination of hydroxypinacolone retinoate, retinol propionate, and vitamin C. The authors aimed to determine the optimal ratio of these compounds for maximum efficacy with minimal irritation. They found that a combination of vitamin C and hydroxypinacolone retinoate/retinol propionate at a weight ratio of 40:3 achieved the optimal and safe antiaging performance in vitro. Furthermore, the compound significantly reduced wrinkles, boosted collagen production, and improved skin brightness.
For this study, 120 healthy Han women were randomly divided into four groups to evaluate the antiaging and whitening effects of different skincare serums over 28 days. Skin parameters were assessed using imaging devices at the start and after 14 and 28 days. In vitro, experiments were conducted on human skin fibroblasts to evaluate cell viability and gene expression after treatment with vitamin C and a combination of retinol and hydroxypinacolone retinoate. The results showed that a combination of hydroxypinacolone retinoate, retinol propionate, and vitamin C is effective in postponing skin aging and improving skin whitening.
Efficacy and safety of cysteamine in melasma in patients of skin of colour
A study published in the International Indian Dermatology Online Journal evaluated cysteamine cream as a treatment for melasma in women with skin of colour. The researchers found that cysteamine cream significantly reduced melasma severity, with all participants experiencing noticeable improvement and a 29.72% reduction in pigmentation.
For this study, the authors examined 10 Indian women with Fitzpatrick skin types III to V diagnosed with epidermal melasma. Participants applied 5% cysteamine cream daily for six weeks, following a four-week washout period where only sunscreen was used. Statistical analysis confirmed significant improvement, supporting cysteamine cream as a promising first-line treatment option for melasma. Patient satisfaction was generally positive, and side effects were minimal, including mild stinging and lightening of surrounding skin in a few cases.
Sodium-glucose cotransporter 2 inhibitors and the risk of new-onset atopic dermatitis in diabetic patients
A comprehensive study in the International British Journal of Dermatology evaluated the association between sodium-glucose cotransporter-2 inhibitors (SGLT2i) use and the risk of atopic dermatitis (AD) in diabetic patients. The researchers found that female SGLT2i users exhibited a higher risk of developing AD than male users.
For this study, the researchers used data from the Taiwan National Health Insurance Database to examine the link between SGLT2i use and AD risk in diabetic patients. They compared 148,354 SGLT2i users with 322,703 DPP4i users. They also conducted various sensitivity and subgroup analyses. The results showed that SGLT2i use is associated with a significantly lower risk of developing atopic dermatitis in diabetic patients compared to DPP4i use. Furthermore, different SGLT2i types also showed a consistent protective effect for AD. Notably, the highest SGLT2i dosage was associated with the lowest AD risk.
Assessment of pain perception of aesthetic procedures during menstrual period in comparison to non-menstrual period days
A study published in the International Journal of Women’s Health examined pain perception during non-surgical aesthetic procedures across different menstrual phases. The researchers found that pain perception during non-surgical aesthetic procedures was higher before and around menstruation, with premenstrual symptoms such as cramps and headaches intensifying the perception of pain. They also found that laser hair removal was the most painful treatment.
The authors conducted a questionnaire-based cross-sectional study at dermatology clinics in Saudi Arabia from Feb. to Mar. 2024. Participants were asked about demographic factors, aesthetic procedures, menstrual status, premenstrual symptoms, and pain severity. They analyzed 383 responses from female patients undergoing procedures such as laser hair removal, injectables, fractional laser, microneedling radiofrequency, and ultrasound therapy. The participants reported that laser hair removal induced the highest pain perception across all menstrual phases, while ultrasound therapy caused the least pain. The results revealed a significant correlation between premenstrual symptom severity and increased pain perception in laser hair removal and injectables. The study also highlighted that age had a negative association with pain perception in laser hair removal, suggesting that older participants experienced less pain.
Toronto-based dermatologist Dr. Janiene Luke shares her perspective on proper skin care, dermatology education for all skin tones, and the importance of forming strong connections with patients.
A case of labial adhesions due to vulvovaginal lichen planus
A case study in IJU Case Reports described a 78-year-old woman who presented with vulvar pain, itching, and decreased urinary output lasting more than five years. Despite prior treatment with a steroid ointment, her symptoms persisted. A physical examination revealed labial adhesions, erythema, and mucosal erosion. A skin biopsy confirmed a diagnosis of vulvovaginal lichen planus. After labia detachment surgery, the patient was prescribed clobetasol propionate ointment and her urinary symptoms improved, but vulvar itching and pain persisted. Eventually, labial adhesions recurred. She was taking candesartan cilexetil for hypertension, and the doctors suspected it could be causing the lichen planus. Candesartan cilexetil cessation led to improvement within a week, and no recurrence of adhesions was observed in the following months.
“Pursue your passion for science and helping others and never stop learning. Dermatology is an ever-evolving field, so staying informed about the latest research and advancements is crucial. Develop strong communication skills, as educating patients is just as important as diagnosing and treating skin conditions. Most importantly, have confidence in yourself and don’t be afraid to forge your own path. Diversity and representation are vital in this industry, and your unique perspective can make a meaningful impact.”
— Dr. Lee-Mei Yap, a Victoria, Australia-based dermatologist in an interview with Missing Perspectives.
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