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Ножницы Ellis Cosmetic RN 023

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Ножницы Ellis Cosmetic RN 023

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NDA 21-083/S-022, S-023 NDAS-031 Wyeth Pharmaceuticals, Inc.

Day in the life of an Aesthetic

Attention: David K. Ellis, Ph.D.

Ножницы Ellis Cosmetic RN 023

Senior Director Worldwide Affairs Box 8299 Philadelphia, PA 19101-8299 Dear Dr. Ellis: Please refer to your supplemental new drug applications submitted section 505(b) of the Federal Food, Drug, and Cosmetic Act for: NDA

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Since the US Food and Drug Administration approval of BotulinumtoxinA (BoNT-A) for aesthetic uses in 2002, the products have become well established in this and are widely approved for correcting wrinkles in the and eye areas.

Ножницы Ellis Cosmetic RN 023

1,2 The currently approved commercial BoNT-A formulations—AbobotulinumtoxinA (ABO), incobotulinumtoxinA (INCO), and onabotulinumtoxinA.

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Второй пост данной темы является Публичной офертой, в которой содержатся все существенные условия Агентского договора об организации Совместной закупки в соответствии с п. 2 ст. 437 ГК РФ. We use cookies to enhance your experience on our website.
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Corresponding Author: Dr Joel Schlessinger, Skin Specialists, Смотрите подробнее, 2802 Oak View Drive, Suite 100, Omaha NE 68144, USA.
E-mail: Citation Joel Schlessinger, Erin Gilbert, Joel L.
The number of aesthetic procedures continues to increase as the patient population becomes more diverse, in particular with increasing numbers of people of color and men.
Further developments in treatment may continue to expand the audience for BoNT-A by making procedures more comfortable and by delivering a more natural, less static appearance.
Beyond amelioration of facial lines, encouraging results have been seen with the use of BoNT-A to improve the appearance of hypertrophic and keloid scars and even to prevent them.
Studies have been conducted with scars in various parts of the body and further research is ongoing.
Dermatological and other medical Японская гравюра Утагава - 100 Эдо, 67.

Переправа Сакасаи, см, на холсте, уз for BoNT-A are also active areas of research.
Injections of BoNT-A have been shown to reduce signs and symptoms of acne, rosacea, and psoriasis, to reduce neuromuscular pain, and to bring about significant improvements in a number of rare diseases that are caused or exacerbated by hyperhidrosis.
This paper reviews these new uses for BoNT-A, looking at the rationale for their use and discussing the results of перейти на источник case studies and clinical trials.
These areas have shown great promise to date, but more and larger clinical studies will be required before these treatments become a clinical reality.
To this end details are also provided of clinical trials currently listed in the main clinical trials database to highlight research areas of particular interest.
Since the US Food and Drug Administration approval of therapeutic BotulinumtoxinA BoNT-A for aesthetic uses in 2002, the products have become well established in this field and are widely approved for correcting wrinkles in the glabella and eye areas.
Details of the mechanism of action of BoNT-A are discussed in detail elsewhere in this supplement.
The main mechanism important to ссылка на страницу involves neuromuscular paralysis through Bullet VB3-BYR 11гр Fox Блесна Blue href="https://realgost.ru/100/gastar-895-yg-b.html">детальнее на этой странице process of chemical denervation.
Following injection into a muscle, BoNT-A travels to the neuromuscular junction NMJbinding first to a high-affinity presynaptic receptor, which permits entry into the presynaptic nerve terminal through receptor-mediated endocytosis into an endosome.
The component heavy and light chains dissociate by disulfide bond breakage, and the zinc-dependent endoprotease—the light chain—is released into the nerve ending.
In the nerve terminus, this cleaves synaptosomal-associated protein 25 SNAP-25which plays a key role in acetylcholine release during nerve stimulation.
This cleavage blocks the release of acetylcholine into the synaptic cleft, preventing the stimulus from reaching the muscle until the function of the NMJ is restored 3-6 months.
The aesthetic indications of ABO and other forms of BoNT-A will continue to expand owing to the increased diversity of individuals requesting aesthetic procedures, in particular people of color and men.
A number of research groups are investigating the efficacy of BoNT-A in inflammatory skin diseases, including common conditions, such as acne, and also some rare diseases that currently have few treatment options.
Pain relief is another area of extensive research, with a number of ongoing clinical studies.
Use of BoNT-A for improving the appearance of surgical wounds is an emerging area of research.
Early results indicate promise in this area but larger trials are required before firm recommendations can be made.
This paper will consider the potential new uses of BoNT-A under 2 broad headings: aesthetic developments and medical developments.
Where appropriate, listings of current and imminent clinical studies registered within the main clinical trials database, ClinicalTrials.
AESTHETIC DEVELOPMENTS Wound Healing Wound healing is a complex and dynamic process that is dependent on the coordinated activities of multiple cell types in the epithelium, connective tissue, and vasculature.
The process consists of 3 overlapping phases.
The proliferative or mitotic second phase typically lasts for weeks and is characterized by the formation of granulation tissue.
Recruited fibroblasts synthesize a scaffold of extracellular matrix ECMwhich builds a structural framework on which to bridge the wound and allow vascular ingrowth.
Myofibroblasts help to initiate wound contraction.
The final phase in the process is maturation, which starts once wound is closed and typically lasts for 7 months.
During this phase, the scar begins to shrink and swelling diminishes.
The inflammatory cells gradually diminish in number, ECM is degraded, angiogenesis and fibroplasia cease, and immature type III collagen is modified into mature type I collagen.
This may be influenced by the location of the wound, prolonged inflammation, wound infections, and delayed epithelialization longer than 10 days.
Tension exerted perpendicular to a wound during the healing process can result in ongoing microtrauma to the lesion, which exacerbates inflammation, leading to overproduction of collagen and glycosaminoglycans, and delayed healing.
Chang et al found that, in contrast to other facial wounds, the incidence of hypertrophic scars HS affecting the upper lip is high, ranging between 12% and 27%.
Raised scars that stay within the bounds of the original wound are known as HS, whereas those that continue to expand beyond the boundaries of the original wound as a result of ongoing fibroblast activity are known as keloids.
These may represent successive stages of a fibroproliferative skin disorder differentiated by varying degrees of inflammation.
Facial HS and keloids are disfiguring and are often associated with clinical symptoms such as itching, pain, and restricted range of motion and contracture.
The precise mechanisms underlying the formation of HS and keloids are not fully understood, this makes their management difficult.
Facial scarring can have profound psychological effects on patients.
Conventional options for the management of HS and keloids include intralesional corticosteroid injections, surgery, cryotherapy, pressure therapy, radiotherapy, laser therapy, and application of silicone gel sheeting.
In vivo studies in animals and humans have demonstrated that, in addition to the known effects on acetylcholine at the NMJ, BoNT-A inhibits fibroblast proliferation and hence collagen production and downregulates expression of α-smooth muscle actin and myosin II proteins, which are found in fibroblasts, all in a dose-dependent fashion.
Further investigation indicated that, as a result of the inhibition of fibroblast proliferation, production of the inflammatory cytokine transforming growth factor TGF -β1 and connective tissue growth factor were also diminished.
This was associated with faster vascularization and reepithelialization of the wound and, ultimately, a smaller scar.
Vascular endothelial growth factor VEGF has been shown to promote angiogenesis in wound healing.
BoNT-A may increase expression of VEGF, although the exact mechanism for this is not known.
Results from studies investigating the effect of BoNT-A on the expression of VEGF in keloid scar healing are inconsistent: some appear to demonstrate benefit, but others show no effect.
A recent meta-analysis of randomized controlled trials RCTs evaluating BoNT-A in HS in the face and neck areas found that patients who received BoNT-A had better outcomes than those who did not receive BoNT-A.
However, the number of studies eligible for the analysis was small 9 and only 3 were unbiased in all assessment domains.
Clinical studies that have evaluated the efficacy of early injection of BoNT-A to ameliorate surgical HS are outlined in.
In subjective assessment, 75% of patients rated improvement as marked, 15% significant, and 10% as unchanged.
In subjective assessment, 75% of patients rated improvement as marked, 15% as significant, and 10% as unchanged.
BoNT-A, Botulinum toxin-A; ONA, onabotulinumtoxinA; RCT, randomized controlled trial; VAS, visual analog scale; VSS, Vancouver Scar Scale.
In subjective assessment, 75% of patients rated improvement as marked, 15% as significant, and 10% as unchanged.
In по этому сообщению assessment, 75% of patients rated improvement as marked, 15% as significant, and 10% as unchanged.
BoNT-A, Botulinum toxin-A; ONA, onabotulinumtoxinA; RCT, randomized controlled trial; VAS, visual analog scale; VSS, Vancouver Scar Scale.
The positive effects of BoNT in wound healing have also been demonstrated in patients undergoing surgical reconstruction following Mohs micrographic surgery for skin cancer.
It was suggested that the temporary muscle relaxation associated with BoNT enabled a more effective healing process through immobilization of the target area.
BoNT-A and -B were shown to result in equally effective outcomes.
Ongoing Clinical Studies Three early phase clinical studies to investigate the effect of BoNT-A on HS were listed on ClinicalTrials.
The first results should be available late 2016- early 2017.
In a cohort of 12 patients, repeated injections of BoNT-A 20-100 units at each session, depending on the size and location of the scar were used to treat long-term keloids that had failed to respond to conventional treatments.
On average, patients were treated for 11 months.
The authors reported good success, with only 2 patients experiencing recurrences.
ADD-IPNext190-100 IP-АТС IPNext190, до 100 абонентов, 4 слота расширения another study, patients with long-term keloids were randomized to receive a course of intralesional BoNT-A injections or intralesional steroid injections.
Both treatments contributed to significant improvements in the keloids, but the authors judged that treatment with BoNT-A was marginally more effective.
However, another group has reported that a 6-month course of BoNT-A injections failed to improve keloid appearance.
In vitro investigations with fibroblasts isolated from keloids have not found evidence of reduced proliferation or cytokine production.
In all these studies, no dose-ranging investigations have yet been carried out on an individual basis.
In summary, the evidence for using BoNT-A to ameliorate facial HS is promising, although large, randomized trials are required before firm recommendations can be made.
The evidence for efficacy in the treatment of already formed keloids is much less convincing and more investigative work is required.
Perhaps the time to intervene is prior to formation of the keloid, but future studies will need to be done to confirm this.
Combination Therapies The aging face is characterized by a loss of firmness, smoothness, complexion radiance, and changes skin color and homogeneity, which must all be addressed to achieve natural-looking rejuvenation of the whole face.
In addition, the relaxation effect of BoNT-A may assist the dermal filler to achieve better wrinkle smoothing effects.
In a split-face study comparing ABO plus HA with ABO alone, there was a suggestion that the filler and toxin act synergistically to improve overall cosmesis when they are both at peak effectiveness.
In this study, blinded assessors found that the combination gave statistically significantly greater improvement in both dynamic and static lines in the glabella, and dynamic lines on the forehead, at 24 weeks after treatment.
There was a nominal but not statistically significant improvement at 2, 6, and 12 weeks.
Carruthers and Carruthers suggest that the effect of BoNT-A on the presynaptic network and the vascular system ie, through inhibition of the release of vasodilating neuropeptides and other autonomic systems may explain the enhanced effect on signs of aging—such as fine lines, wrinkles, telangiectasia, and erythema—seen with BoNT-A and IPL.
BoNT-A Plus Skincare Photoaging reduces the production of collagen in fibroblasts and, at the same time, increases the secretion of matrix metalloproteinases MMPswhich break down existing collagen leading to loss of volume and elasticity.
Bonaparte and Ellis used a Cutometer Courage+Khazaka electronic GmbH, Cologne, Germany instrument to measure skin pliability and elastic recoil—measures of elasticity—before and after treatment with ONA at the glabellar, supraorbital, and lateral orbital sites.
They found that in addition to the neuromuscular effects of BoNT-A, there is clear evidence of biomechanical changes in the skin.
The authors hypothesized that BoNT-A may result in increased organization of the dermal network of collagen, and that this—along with increased production of procollagen, collagen, and elastin—effectively reverses the loss of elastic recoil caused by aging.
Collagen synthesis can be increased simply by pricking the skin, but Permatasari et al have confirmed that BoNT-A promotes the synthesis of collagen and inhibits the secretion of MMPs.
Skincare regimens designed to rejuvenate the skin can enhance the effects of BoNT-A used alone.
Used daily, topical retinoids reverse photoaging by preventing destruction of the dermal matrix and promoting collagen formation, while creams, serums, and gels containing HA can improve skin hydration and elasticity.
Other components of skincare regimens used in combination with BoNT-A include hydroquinone for skin lightening, and adenosine, which has been proposed to act by a number of mechanisms to reduce wrinkles and improve skin tone and texture.
Use of such a skin care regimen by individuals who have had BoNT-A injections has been demonstrated to have a beneficial effect on the mean volume and depth of lines, hyperpigmentation, smoothness of skin, and evenness of skin tone and color compared with BoNT-A injections alone.
The microbotox method also known as meso-Botox developed by Wu in 2000, aimed to provide more natural-looking effects for patients.
The method involves the systematic injection of multiple tiny blebs of highly diluted BoNT-A mainly ONA at 0.
It is proposed that the microinjections smooth and tighten the skin by inducing bulk atrophy of the sweat and sebaceous glands, and by weakening the superficial muscle fibers that insert into the skin, thus reducing the pulling and tethering effects of the facial muscles that result in fine lines and wrinkles.
An additional advantage is that decreased sweat and sebaceous gland activity improves the appearance quality of the skin especially the forehead.
Practitioners must receive training in how to deliver the microdroplet technique consistently and superficially in order to avoid inadvertently paralyzing deeper muscle groups in the treated area.
The effects of treatment typically last for 3 to 4 months but may last for up to 6 months.
Although originally developed for ONA, the technique has also been successfully used with ABO.
The author reports results with ABO have been less reliable, possibly due to the lack of a fixed dose ratio between ABO and ONA and the need to perform dose-ranging studies with the technique.
Treatment is challenging, due to the shallowness and length of the lines.
The technique developed Môle et al employs superficial injections 25-30 of highly diluted BoNT-A and noncross-linked HA.
While the effects of the toxin on the muscles are clearly expected, the effects on the midcheek areas are surprising.
The effects may be explained by diffusion of toxin into dermal cells facilitated by the high dilution where the BoNT-A can alter rates of biosynthesis of collagen and production of inflammatory cytokines.
Only a limited number of patients have undergone the procedure to date.
The investigator recommends a maximum of 40 units of ABO per side.
Some patients and physicians may find the large number of required injections unacceptable.
This may be overcome by use of microcannulae inserted at 4 points 2 in the temporomandibular area and 2 in the jugular areaalthough this is less accurate.
The present authors have found the Aquagold Fine Touch microneedling device Aquavit Pharmaceuticals, New York, NYwhich can also be used to deliver combinations of BoNT-A and fillers, to be effective.
Ongoing Clinical Studies Two Phase IV studies investigating ABO in combination with fillers were registered on ClinicalTrials.
The first results should be available late 2016- early 2017.
Moreover, some patients are quite simply frightened of needles.
Formulations and delivery mechanisms that avoid these problems are therefore desirable.
There is also scope for improved convenience for physicians with new formulations that avoid the need to reconstitute the toxin from the powder form—all of the main toxin products that are currently available worldwide are provided as either freeze-dried or vacuum-dried powders that require reconstitution before use.
Advances in Formulations As a result of the large molecular size, BoNT-A has negligible cutaneous bioavailability—simply applying solutions of toxin to intact skin is not effective.
Two studies have used a fractional ablative laser to create microscopic columns in the epidermis and dermis with the expectation that this would permit molecules of ABO to reach the superficial orbicularis oculi in the lower dermis.
ABO 100 U in saline solution was then applied to one side of the face, and saline solution only to the other side.
There were no differences in pain and swelling on either side, but patient satisfaction was much greater with BoNT-A treatment.
Although the combination treatment was successful, the investigators point out that the procedure is more complicated and more expensive than injections.
In this formulation, BoNT-A is complexed with a novel peptide-based drug delivery system TransMTS; Revance, Newark, CA.
By varying the length of the carrier peptides, the toxin can be delivered to a defined depth or target site.
No patient in the placebo arm met this endpoint.
In view of these results, Revance Therapeutics, Inc.
A ready-to-use sterile liquid formulation of a novel BoNT-A, MT10109L, developed by MedyTox, Inc.
Cheongju, South Koreadoes not require dilution use and contains no albumin or animal-derived proteins.
The molecular weight and diffusion capacity of MT10109L are reported to be similar to those of ONA.
In a study to compare MT10109L with ONA in the treatment of glabellar lines, participants were randomized to receive 20 U of BoNT-A—4 units at 5 injection points.
Both groups showed significant improvement of glabellar lines from baseline to week 4 investigator ratingwhich persisted until week 16.
Self-assessment of improvement of glabellar lines and satisfaction yielded comparable results for the 2 groups.
Similarly, rates of adverse events were similar in each group.
The differences in efficacy are readily explained by the fact that the potency units of botulinum products https://realgost.ru/100/salfetki-dlya-zhk-ekranov-v-banke-konoos-kbf-100-100-sht.html specific to each product family and are not interchangeable.
Advances in Delivery Methods Many patients experience notable продолжение здесь when receiving BoNT-A injections.
Evidence from dentistry and therapeutic dermatology procedures suggests that vibration anesthesia may help to reduce injection pain.
It is hypothesized that vibration anesthesia works by dampening pain sensation by costimulation of the nerve fibers with waves of vibrations.
Tailored Treatments Each patient who presents for aesthetic treatment is different in terms of physical attributes, the way that they feel about their appearance, and what they would like to change.
In recent years, a number of groups have proposed that fixed injection patterns should be replaced by protocols that tailor the number of injections Автомобиль JЕ1288 dose of toxin to individual patient characteristics.
This strategy has the potential to optimize the outcome for the individual, and to reduce dosages and numbers of injections.
Two groups have developed protocols based on the classification of muscles, while a third has developed an assessment protocol that should be used before a patient is injected in order to determine the size of the dose and the number of injections.
They found that an upper fan pattern was uncommon found in only 5% of patientslower fan patterns were more common in males, and the frequency of full fan patterns increased with age.
Full fan and lower fan patterns were also associated with more severe wrinkles.
Xie et al used a combination of clinical palpation and ultrasound examination to classify masseter muscles in healthy volunteers and prospective patients according to bulging type on clenching and muscle thickness.
They used this information, in addition to an understanding of masseter anatomy from dissection studies, to develop a tailored treatment protocol for masseter hypertrophy an unlicensed indication.
Palpation identified 5 classes of bulging type in masseter muscles: minimal, mono-bulging, double-bulging, triple-bulging, and excessive bulging.
Ultrasound examination gave rise to 3 classes based on muscle thickness, ranging from mild 14 mm.
In their treatment protocol, the dose of BoNT-A was determined by masseter thickness ranging from ONA 20 U for mild hypertrophy to 40 U for severe hypertrophy.
Bulging type was used to determine the number of injections and the injection sites.
Tailored Botulinum Toxin Type A Injection Protocol, a Republished with permission of Plastic and Reconstructive Surgery62; permission conveyed through Copyright Clearance Center, Inc.
Tailored Botulinum Toxin Type A Injection Protocol, a Republished with permission of Plastic and Reconstructive Surgery62; permission conveyed through Copyright Clearance Center, Inc.
The investigators report that more studies are planned to refine the protocol.
The objective-muscle-identification technique OMIT requires the surface area of the Смартфон A316i muscle to be mapped before treatment.
Mapping the surface area of the muscle to be injected allows an individual dose to be calculated and the injection sites to be pinpointed.
Careful targeting of the injection point reduces the risk of puncturing the supraorbital nerve and blood vessels, and delivers the toxin to the medial portion of the muscle, from where it can be encouraged to diffuse through to the internal and lateral portion of the muscle by applying gentle finger pressure to the wheal created by the injection.
This individualized approach is particularly helpful in patients with asymmetric muscle hypertrophy.
The OMIT technique has been compared directly with a fixed point technique based on a general consensus for treating the glabellar area.
A total of 31 patients in the fixed point arm received 4 injections of ONA 4 U at distances of 0.
They received a total dose of 16 U in ~0.
The majority of the 31 patients in the OMIT arm received only 2 injections into each corrugator muscle, with a mean total dose of approximately 12 U in approximately 0.
Further studies are necessary to confirm that OMIT may be generalized to other types of BoNT-A.
MEDICAL DEVELOPMENTS Intradermal uses for botulinum toxin represent a new and exciting area of research with BoNT-A.
The inhibition of inflammatory processes observed by researchers investigating the mechanism of правы.

Трусы LUI et ELLE Нам of BoNT-A in wound healing as described above and in Wang and Tsai may also be exploited in the treatment of these conditions.
The mode of action of BoNT-A страница inflammatory diseases remains to be fully elucidated and, although there some evidence читать больше suggest efficacy, results in clinical studies conducted to date have not been conclusive.
However, research is at a very early stage and more clinical studies are ongoing.
Interestingly, BoNT-A has demonstrated efficacy in a number of rare skin diseases for which there are few therapeutic options.
Acne and Rosacea No single factor is entirely responsible for the development of acne, but changes in sebaceous gland functions, including increased production of sebum, are important.
BoNT-A has been shown to decrease sebum production and reduce pore size in individuals with oily skin, probably by blocking the activity of acetylcholine in sebocytes.
BoNT may also exert its effects via its action on the sebaceous gland.
These effects may be due to the inhibition by BoNT-A of acetylcholine and vasoactive intestinal polypeptide, and BoNT-A might therefore be an effective treatment for acne and rosacea.
The total dose was 10 to 11 units.
Patients reported an improvement in symptoms within 2 weeks of treatment, and the effects lasted for up to 4 months.
Two Korean patients underwent 2 treatment sessions with intradermal ONA at 1-week intervals.
The total dose of ONA was 50 units across the 2 sessions for the first patient and 40 units across 2 sessions for the second.
The cheeks, chin, and supra-eyebrow were injected at each session.
Improvements in rosacea flushing were evident 1 week after the second treatment and lasted for 3 months.
A proof-of-concept study investigated ABO in 15 patients with facial erythema of erythematotelangiectatic rosacea.
Initially patients received intradermal injections to the nasal tip, nasal bridge, and nasal alae, but the protocol was altered to also include the cheeks, forehead, and chin.
The mean dose was 25 units range 15-45 units.
There is no evidence to support greater diffusion of ABO from any study to date, only that the doses of ABO used in comparative studies are generally higher than those for other products, giving a larger ABO field of effect.
Photographic evidence confirmed these findings.
Again, the only adverse event reported was mild pain from the injection.
The results of these small, but important, pilot studies suggest that intradermal BoNT-A injections are safe and efficacious for reducing erythema and flushing in rosacea.
Larger, controlled, randomized studies are warranted to determine optimum dosing and duration of activity.
More research is also required to elucidate the mechanism of action of BoNT-A in rosacea.
Psoriasis Inverse or intertriginous psoriasis results from sweating and friction in skin folds.
In 2008, Zanchi et al used ONA 50-100 units, depending on the extent and severity of the psoriasis to reduce sweating and inflammation in 15 patients with inverse psoriasis.
Photographic evidence and subjective patient assessment of pain and itch indicated that treatment had been successful in 87% of cases.
Other researchers have provided evidence that supports a role for the nervous system in psoriasis pathogenesis.
Ward et al demonstrated that ABO could induce remission of psoriasis in the keratinocyte-Tie2 KC-Tie2 transgenic mouse model of psoriasis.
продолжить, the same group demonstrated local clearance of plaque psoriasis following an off-label intradermal injection of ABO in a single patient with recalcitrant disease.
The duration of effect, showing complete clearance of plaques, was 7 Комбинезон-трансформер Oldos Юна OAW192T1OV45 пробовали, with recurrence starting by month 8.
Based on current findings, BoNT-A may not be a practical approach for patients with extensive psoriasis.
This is due to the number of injections needed and thus the treatment cost, as well as the risk of inducing muscle weakness with extensive dosing.
However, BoNT-A may be a useful and long-lasting treatment for patients with focal lesions that are recalcitrant to standard therapy.
Fox-Fordyce disease FFD is a rare inflammatory disease of the apocrine glands characterized by the presence of discrete, dome-shaped, skin-colored, pruritic follicular papules in apocrine-rich areas of the skin ie, the axillary, anogenital, and periareolar skin.
The etiology of FFD has not been fully determined, but the condition is exacerbated благодарю!

Каминная вытяжка GERMES Alt sensor 60 white вопрос emotional, physical, and pharmacological stimulation that induces increased sweating.
The primary aim of therapy is to reduce pruritus.
For this reason, the agents of choice are usually topical and intralesional corticosteroids; however, antiperspirants, calcineurin inhibitors, tretinoin, isotretinoin, clindamycin, and contraceptives have all shown some benefit in case studies.
When pharmacotherapy fails, removal of the apocrine glands via liposuction-assisted curettage, electrocautery, or surgical excision is an option.
In a case study, a patient with refractory FFD was treated with intradermal injections of ONA.
Both axillae were treated with a total of 50 injections of 2 units посетить страницу, spaced 2 cm apart.
Pruritus resolved after 15 days, and a marked reduction in the number and appearance of papules was also observed.
The response was sustained for a period of at least 8 months.
The authors recommended that BoNT-A injections should be considered for patients with highly pruritic or recalcitrant FFD, but noted that clinical trials are needed to evaluate optimal treatment modalities and to further investigate how BoNT-A is exerting its effect in FFD.
Hailey—Hailey disease familial benign chronic pemphigus is a rare, inherited, bullous disease in which red scaly areas that can be itchy and sore can lead to superficial blisters and eroded areas of the skin folds of the groin, armpits, neck, and under the breasts.
ONA and ABO, alone or in combination with other anti-inflammatory treatments, have demonstrated efficacy in patients with Hailey—Hailey disease in a range of case studies.
Individual conditions affect different areas of the body, but in most cases the blistering can be extensive.
Treatment typically includes corticosteroids and other immunosuppressive agents.
One case study documented treatment of linear immunoglobulin A bullous dermatosis with BoNT-A.
The disease was mostly controlled by immunosuppressive drugs, but sweating caused flares of symptoms.
Multiple injections of BoNT-A into the axillae not only reduced blistering for up to 6 months, but also improved patient quality of life scores.
Pachyonychia congenita is a genodermatosis, which may be associated with painful hyperkeratotic lesions on the soles of the feet that blister when the feet become hot and start to sweat.
A series of 3 case studies using ABO and a small retrospective study with ONA have shown that BoNT-A 121, Вт SN Сонекс E27, 100 after local anesthetic reduced sweating and provided pain relief that lasted for 3 to 6 months.
Importantly for this chronic condition, repeated treatments did not result in loss of efficacy.
Relief of pain is an important aspect of some of the currently approved indications for ONA, notably in chronic migraine, chronic headache, and cervical dystonia.
Clinical studies that focus on these conditions are not included in.
Additional sources of pain in which BoNT-A has been shown to be useful are diabetic polyneuropathy, trigeminal neuralgia, chronic back and shoulder pain, myofascial pain, temporomandibular joint disorders, and pain due to arthritis and multiple sclerosis.
There is some speculation about the mechanism for pain relief with BoNT-A.
Hypotheses involving both the peripheral and central nervous systems have been proposed.
Clearly, the effect of BoNT-A on neurotransmission at the NMJ must https://realgost.ru/100/ortomaks-sale-hard-21-s1000-100-h-195-sm-1000-h-1950-mm.html a role in relieving muscular pain, such as that associated with spasm and cramping.
Some chronic diseases cause the wide dynamic range neurons of the central nervous system CNS to perceive nonpainful stimuli as causing pain, and this sense of pain can increase as the disease state persists.
BoNT-A attenuates this condition by diminishing nonnociceptive stimuli, altering postganglionic cholinergic nerve fibers with blood vessels, and interfering with peripheral glutamatergic pain modulation, hence effecting changes in neuroplastic mechanisms within the CNS that lead to a reduction in chronic pain.
Inhibition of acetylcholine signaling in the NMJ is also known to inhibit the release of neurotransmitters such as substance P, glutamate, and calcitonin gene-related peptide, which also serves to dull the sensation of pain.
There is accumulating evidence from animal models and completed clinical studies that BoNT-A shows promise for the relief of chronic pain.
However, larger and better-designed studies are still required to confirm these important effects.
CONCLUSIONS ABO is well established around the world for the treatment of wrinkles in the upper face, and is frequently used off-label to treat other regions of the face and neck.
Ongoing research is identifying new ways of using BoNT-A including ABO to treat facial lines, which have the potential to increase its efficacy, make procedures more comfortable, and give an overall more pleasing effect for patients.
In addition, recent and ongoing research suggests that use of ABO could be extended to other aesthetic and medical uses—in particular intralesional and intradermal therapy for the treatment of HS and inflammatory diseases, respectively, and the relief of musculoskeletal and neuropathic pain.
These areas have shown great на этой странице to date, but more and larger clinical studies, beyond those already in progress or about to start, will be required before these treatments become a clinical reality.
Dr Kaufman has received research funding from Allergan, grants and research funding from Merz, personal fees and honoraria from Galderma, and research funding from Revance.
Dr Gilbert declared no potential conflicts of приведенная ссылка with respect to the research, authorship, and publication of this article.
Funding This publication was supported by Galderma Laboratories, LP Fort Worth, TXwho funded the development of this supplement.
ссылка assistance was funded by Galderma Laboratories, LP, and provided по этому адресу Jane Tricker and MedSense, Ltd.
The authors did not receive compensation for writing the https://realgost.ru/100/ventilyatsionnaya-reshetka-kaminnaya-reguliruemaya-europlast-mrk3015ra.html />Acknowledgment The authors would like to acknowledge the support of Jane Tricker, freelance writer, who assisted in the writing of this paper, and MedSense, Ltd.
High Wycombe, UK for editorial support, both funded by Galderma.
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Corresponding Author: Dr Joel Schlessinger, Skin Specialists, PC, 2802 Oak View Drive, Suite 100, Omaha NE 68144, USA.
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