Daily Cosmetic Research Analysis
Across cosmetic dermatology and oncologic aesthetics, three studies stood out: a systematic review supports 5% imiquimod as a tissue-sparing option for periocular basal cell carcinoma; a preclinical study shows a polynucleotide mixture attenuates UVB-induced melanogenesis via oxidative stress and NLRP3 suppression; and a real-world cohort suggests hypofractionated whole-breast radiotherapy with simultaneous integrated boost is feasible with favorable cosmetic and dosimetric profiles.
Summary
Across cosmetic dermatology and oncologic aesthetics, three studies stood out: a systematic review supports 5% imiquimod as a tissue-sparing option for periocular basal cell carcinoma; a preclinical study shows a polynucleotide mixture attenuates UVB-induced melanogenesis via oxidative stress and NLRP3 suppression; and a real-world cohort suggests hypofractionated whole-breast radiotherapy with simultaneous integrated boost is feasible with favorable cosmetic and dosimetric profiles.
Research Themes
- Tissue-sparing oncologic treatments and cosmetic outcomes
- Photoprotection and pigmentation modulation via immuno-oxidative pathways
- Hypofractionated radiotherapy strategies with simultaneous integrated boost
Selected Articles
1. Topical 5% Imiquimod for the Treatment of Superficial and Nodular Periocular Basal Cell Carcinoma: A Systematic Review of Clinical Outcomes, Safety, and Treatment Strategies.
This systematic review indicates that 5% imiquimod can clear selected periocular superficial and nodular BCCs with favorable cosmetic outcomes, offering a tissue-sparing alternative when surgery is contraindicated. Clearances appear slightly below Mohs surgery but comparable to radiotherapy, with risk-of-bias and certainty assessed via RoB2/ROBINS-I and GRADE.
Impact: Addresses a cosmetically and functionally sensitive site where tissue preservation is critical, synthesizing evidence across designs with formal bias and certainty assessments.
Clinical Implications: Imiquimod 5% can be considered for superficial/nodular periocular BCC when surgery is risky or cosmetically unfavorable, with shared decision-making and close histologic/clinical follow-up.
Key Findings
- 5% imiquimod achieved clinical/histologic clearance in selected superficial and nodular periocular BCCs with favorable cosmetic outcomes.
- Overall clearance was slightly lower than Mohs micrographic surgery but comparable to radiotherapy.
- Risk of bias was assessed (RoB 2/ROBINS-I) and certainty graded with GRADE; larger standardized RCTs with ≥3-year follow-up are needed.
Methodological Strengths
- Systematic search with predefined eligibility including multiple study designs
- Formal risk-of-bias (RoB2/ROBINS-I) and GRADE certainty assessments
Limitations
- Heterogeneity across studies and dosing schedules; limited randomized data
- Durability and long-term recurrence data (≥3 years) remain insufficient
Future Directions: Conduct multicenter RCTs with standardized dosing regimens, ≥3-year follow-up, histologic endpoints, and validated patient-reported cosmetic outcomes.
BACKGROUND/OBJECTIVES: To evaluate the clinical and histological efficacy, safety, and cosmetic outcomes of 5% imiquimod (IMQ) cream, used in monotherapy or in combination, for periocular superficial and nodular basal cell carcinoma (BCC). METHODS: A systematic search of MEDLINE, PubMed, and Google Scholar (inception-12 June 2025) identified studies reporting IMQ treatment of eyelid/periocular BCC. Randomized, nonrandomized and observational designs were eligible. Risk of bias was assessed with Cochrane RoB 2 or ROBINS-I, and certainty of evidence graded with GRADE. RESULTS: Seven studies ( CONCLUSIONS: IMQ 5% is a useful, tissue-sparing option for selected (superficial and nodular subtypes) periocular BCCs where surgery is contraindicated or cosmesis is paramount. Overall clearance is slightly lower than Mohs surgery but comparable to radiotherapy, and cosmetic outcomes are favorable. Larger, standardized RCTs with ≥3-year follow-up are needed to confirm durability, optimize dosing schedules, and validate patient-reported outcome measures.
2. Polynucleotide Mixture Attenuates Ultraviolet B-Induced Skin Pigmentation.
In UVB-irradiated keratinocytes and animal skin, both polynucleotides and a polynucleotide mixture reduced oxidative stress markers, suppressed NF-κB/NLRP3 inflammasome components, and downregulated melanogenesis signals, increasing skin lightness. The PN mixture outperformed PN alone, suggesting synergistic antioxidant effects.
Impact: Elucidates a mechanistic pathway (oxidative stress–NF-κB–NLRP3) linking UVB exposure to melanogenesis and demonstrates a formulation that outperforms PN alone.
Clinical Implications: Provides a mechanistic rationale for developing PN-based cosmeceuticals targeting UV-induced hyperpigmentation and photoaging, pending clinical safety/efficacy trials.
Key Findings
- PN and PN mixture reduced oxidative stress (NOX1/2/4 expression, improved GSH:GSSG, decreased 8-OHdG) in UVB-irradiated keratinocytes.
- Both interventions suppressed NLRP3 inflammasome components (NLRP3, ASC, pro-caspase-1) and IL-18.
- Conditioned media from PN/PNM reduced melanogenesis signals (MITF, tyrosinase, TRP1/2) and decreased melanin with increased skin lightness in vivo; PNM showed greater anti-melanogenic effects than PN.
Methodological Strengths
- Combined in vitro keratinocyte assays with in vivo skin validation
- Multi-axis mechanistic profiling (oxidative stress, NF-κB/NLRP3 inflammasome, melanogenesis markers)
Limitations
- Preclinical study; human clinical efficacy and safety not established
- Exact composition and dosing optimization of the PN mixture require standardization
Future Directions: Early-phase clinical trials to test PN/PNM topical formulations against UV-induced hyperpigmentation, with dose-finding, safety, and biomarker endpoints.
Ultraviolet (UV) radiation stimulates melanogenesis, leading to various esthetic problems. UV increases oxidative stress and nuclear factor-kappa B (NF-κB), which increase the nucleotide-binding oligomerization domain (NOD) or leucine-rich repeat and pyrin do-main containing 3 (NLRP3) inflammasome. Given that polydeoxyribonucleotides reduce melanogenesis and polynucleotide (PN) has molecular similarity to polydeoxyribonucleotides, we hypothesized that PN can decrease melanogenesis. We compared the anti-melanogenic effect of PN with that of a PN mixture (PNM) that contained other antioxidants, such as glutathione and hyaluronic acid, in UVB-irradiated keratinocytes and animal skin. PN and PNM both decreased oxidative stress, which was evaluated according to the expression of NADPH oxidase (NOX) 1/2/4, the glutathione (GSH):oxidized glutathione (GSSG) ratio, and 8-hydroxy-2'-deoxyguanosine (8-OHdG) in UVB-irradiated keratinocytes. The expression of NLRP3 inflammasome components (NLRP3, ASC, and pro-caspase-1) and IL-18 was increased by UVB radiation and reduced by PN and PNM. When conditioned media from PN or PNM were administered to UVB-radiated keratinocytes, melanogenesis-related signals (MITF, tyrosinase, and tyrosinase-related protein1/2) were decreased. These effects were similar in the UVB-irradiated animal skin. Both PN and PNM decreased melanin accumulation and increased skin lightness in UVB-irradiated skin. The anti-melanogenic effect of PNM was greater than that of PN. In conclusion, PN and PNM decreased melanogenesis by decreasing oxidative stress, NF-κB, and NLRP3 inflammasome activation.
3. Hypofractionated whole-breast radiation therapy with simultaneous integrated boost after breast-conserving surgery: preliminary real-life experience of the Radiation Therapy Oncology Group 1005 trial.
In 170 post-lumpectomy patients, hypofractionated WBRT with SIB delivered via IMRT/VMAT achieved excellent early control (1-year local/locoregional/distant/OS all 100%) with low heart doses, acceptable lung volumes, and mostly grade 1 skin toxicity. Feasibility and cosmetic profiles appear favorable, warranting longer follow-up.
Impact: Provides real-world dosimetric, toxicity, and early control data supporting SIB adoption with hypofractionation, potentially shortening treatment while preserving cosmesis.
Clinical Implications: Clinicians may consider hypofractionated WBRT with SIB using IMRT/VMAT after breast-conserving surgery, balancing dosimetry and cosmesis; continued monitoring is essential.
Key Findings
- 170 patients received WBRT 40 Gy/15 fractions with SIB 48 Gy via IMRT (79.4%) or VMAT (20.6%).
- Dosimetry: median mean heart dose 0.9 Gy; ipsilateral lung V16 12.8% and V8 19.1%.
- Toxicity and control: grade 1/2 radiodermatitis 58.8%/4.7%, edema 3.5%/0.6%; 1-year local/locoregional/distant control and overall survival were all 100%.
Methodological Strengths
- Consistent protocol aligned with RTOG 1005 experimental arm
- Detailed dosimetric reporting with contemporary techniques (IMRT/VMAT)
Limitations
- Single-center retrospective design with short median follow-up (14 months)
- No control arm; cosmetic outcomes not systematically quantified
Future Directions: Prospective multicenter studies with longer follow-up, standardized cosmetic assessments, and comparative arms versus sequential boost or conventional fractionation.
OBJECTIVES: This study aimed to report cosmetic and oncological outcomes for patients who underwent adjuvant hypofractionated whole-breast radiation therapy (WBRT) (40 Gy in 15 fractions) with simultaneous integrated boost (SIB) (48 Gy) using IMRT (intensity modulated radiation therapy) or VMAT (volumetric modulated arc therapy) after breast-conserving surgery at our institution as per the experimental arm of the Radiation Therapy Oncology Group (RTOG) 1005 trial. METHODS: One hundred and seventypatients who underwent adjuvant moderate hypofractionated WBRT with SIB after breast-conserving surgery were identified between 29 July 2019 and 22 September 2024. RESULTS: The median age was 57 (range: 33-84). The pTstage distribution was as follows: Tis: 18.2%, T0: 9.4%, T1: 57.1%, T2: 14.1% and T3: 1.2%. pN0: 82.9% and pN1mic: 17.1%. Neoadjuvant/adjuvant chemotherapy and adjuvant endocrine therapy were administered in 17.6%, 26.5% and 58.2% of cases, respectively. IMRT and VMAT techniques were used in 79.4% and 20.6% of cases, respectively. The median mean heart dose was 0.9 Gy (0.2-4.7). The median V16 and V8 of the ipsilateral lung were 12.8% (0-60.5) and 19.1% (0-63), respectively. Grade 1 and grade 2 radiodermitis and oedema were reported in 58.8%, 4.7%, 3.5%, and 0.6% of cases, respectively. With a median follow-up of 14 months (0-55), the 1-year local relapse-free survival, the locoregional relapse-free survival, the metastases recurrence-free survival, and overall survival were all 100%. CONCLUSIONS: Our preliminary data suggest that routine use of SIB with WBRT using IMRT or VMAT was feasible with a favourable risk-benefit ratio. Longer follow-up can confirm the safety of this approach. ADVANCES IN KNOWLEDGE: Preliminary data from our department showed that combining whole-breast irradiation with SIB and IMRT or VMAT was feasible for early-stage breast cancer.