Peer PreSs Review
Dr Rohit Kotnis surveys academic and association journals to report on advances in research in medical aesthetics and related fields
Efficacy of intra-articular botulinum toxin type A in painful knee osteoarthritis: a pilot study
Boon AJ et al. PM&R. 2010 Apr;2(4):268-76.
This study evaluated the efficacy and safety of botulinum toxin type A (BoNT-A) injected intra-articularly in subjects with moderate pain and functional impairment secondary to knee osteoarthritis.
The study comprised a double-blind, randomised, single tertiary care academic medical centre trial with a six-month follow-up. Sixty patients aged 40 years or older took part, each with painful osteoarthritis of the knee, which had failed physical therapy, medications and/or injection therapy. All patients completed an eight-week follow-up but only 32 patients did the 26-week follow-up.
Subjects were randomised to receive a single injection of corticosteroid, low-dose BoNT-A (100 units), or high-dose BoNT-A (200 units). Outcome measures were compared at baseline, four, eight, 12, and 26 weeks after injection.
The primary outcome measure was pain visual analogue scale (VAS) at eight weeks. Secondary outcome measures included Western Ontario McMaster Arthritis Index, Short Form-36 scores, patient global assessment, 40-metre timed walk and adverse effects.
The primary end point was pain VAS score at eight weeks, which decreased within each group but only reached statistical significance in the low-dose BoNT-A group. In the intra-articular corticosteroid group, VAS decreased from 6.4 +/- 1.8 to 5.4 +/- 2.3 (P = .15); for low-dose BoNT-A, from 6.6. +/- 1.9 to 4.5 +/- 2.2 (P = .01); and for high-dose BoNT-A, from 6.6 +/- 1.4 to 5.9 +/- 2.4 (P = .15).
This pilot study supports a possible role for BoNT-A as a treatment option for symptomatic knee osteoarthritis, but larger double-blind randomised studies are needed. This paper presents another potential use of botulinum toxin A and one which practitioners with an interest in sports medicine may wish to follow up on.
Use of botulinum toxin type A for chronic cough: a neuropathic model
Chu MW, Lieser JD, Sinacori JT. Arch Otolaryngol Head Neck Surg. 2010 May;136(5):447-52
The objective of this retrospective case series was to review the experience and outcomes of botulinum toxin type A in the treatment of chronic cough.
A total of 438 patients diagnosed with laryngeal spasm and chronic cough were given electromyography-guided injections in the thyroarytenoid muscles. Patient demographics (age and sex), voice-related quality-of-life scores, post-procedure complications, number of units used, number and length of treatments and voice outcomes were reviewed.
The mean patient age was 55.6 years. All patients had significant relief of cough after injection, with complete resolution after a median of seven injections using a mean dose of 4.0U per treatment session for a mean duration of 25.7 months.
This is the first reported series of the use of botulinum toxin type A in the treatment of chronic cough in adults. Further research and long-term follow-up are needed, but botulinum toxin type A is effective in directly decreasing laryngeal hypertonicity and possibly reducing neurogenic inflammation and neuropeptide-mediated cough.
This is another novel use of botulinum toxin A which may be used by specialists when other pathological causes have been excluded.
Calcium hydroxylapatite (Radiesse) for treatment of nasolabial folds: long-term safety and efficacy results
Bass LS, Smith S, Busso M, McClaren M. Aesthet Surg J. 2010 Mar;30(2):235-8
The authors of this study assess the long-term safety and effectiveness of calcium hydroxylapatite (Radiesse) for the treatment of nasolabial folds (NLF). Post-approval three year results are presented.
The study reports an extension phase of a premarket study of 117 patients comparing Radiesse to collagen. During the initial study, patients were treated to optimal correction and then followed for 12 months.
Around 40% of the folds evaluated at least 30 months after the last Radiesse treatment were graded as “improved” or “better” on an approval scale.
The reported improvement was substantially less than at earlier points in the premarket study, indicating some moderate, sustained improvement in some patients. There were no long-term or delayed-onset adverse events in the 102 patients followed for three years, with no reports of nodules, granulomata or infections.
The results demonstrate the long-term safety and effectiveness of Radiesse. The durability and safety of Radiesse compare favourably with other injectable fillers.
During teaching sessions, delegates often enquire about Radiesse and this article will provide further information that may assist clinicians in deciding if and how this product will complement their practice.
Aging well—the role of minimally invasive aesthetic dermatological procedures in women over 65
Wollina U, Payne CR. J Cosmet Dermatol. 2010 Mar;9(1):50-8
Women over 65 represent a growing group of consumers of cosmetic procedures. This study reviewed minimally invasive procedures for facial rejuvenation in women over 65.
Drawing from literature and personal experience, the opportunities, modifications, and limitations of minimally invasive techniques for facial rejuvenation in older women are considered.
In this older age group, dermal fillers, chemical and laser peels, and nonablative photorejuvenation remain useful and can each be used as stand-alone treatments. In this age group, botulinum toxin injections are more often used in combination with other procedures.
More scientific investigation is necessary to better meet needs of these consumers. Available data suggest that aesthetic dermatology can make a major contribution to the complex matter of ageing well.
This is an interesting and relevant article that reflects the changes in the demographics of the population at large, their changing aspirations for their appearance and the work load of cosmetic practitioners.
Reviewing the peer press is Rohit Kotnis (Lon), Dip SEM (Ed). Rohit is an advanced tutor at Dermis Deep, Birmingham and a member of the Body Language editorial panel
