Daily Cosmetic Research Analysis
Today's most impactful studies span value-based dermatologic care, evidence-based wound closure, and de-implementation of low-value perioperative additives. A trial-based economic evaluation supports 5% 5-fluorouracil cream as a cost-effective first-line option for Bowen's disease, a systematic review maps cosmetic outcomes of secondary intention healing by anatomic site, and a randomized trial shows adding antimicrobials to NSAID oral sprays does not reduce postoperative sore throat severity.
Summary
Today's most impactful studies span value-based dermatologic care, evidence-based wound closure, and de-implementation of low-value perioperative additives. A trial-based economic evaluation supports 5% 5-fluorouracil cream as a cost-effective first-line option for Bowen's disease, a systematic review maps cosmetic outcomes of secondary intention healing by anatomic site, and a randomized trial shows adding antimicrobials to NSAID oral sprays does not reduce postoperative sore throat severity.
Research Themes
- Value-based dermatologic oncology and care
- Evidence-based wound closure and cosmesis
- De-implementation of low-value perioperative additives
Selected Articles
1. Cost-Effectiveness of Photodynamic Therapy and 5-Fluorouracil Cream versus Surgical Excision in Treatment of Bowen's Disease: A Trial-Based Economic Evaluation.
In a trial-based economic evaluation alongside a randomized non-inferiority study (n=250), 5% 5-fluorouracil cream had lower 12-month healthcare costs than surgical excision (€311 less) while remaining within the 22% non-inferiority margin for effectiveness; MAL-PDT had similar or slightly higher costs and was not non-inferior. At willingness-to-accept thresholds ≤ €2,500, 5-FU had the highest probability of being cost-effective.
Impact: Provides robust, trial-based cost-effectiveness evidence that can shift first-line management of Bowen's disease toward topical 5-FU under realistic budget thresholds.
Clinical Implications: Topical 5-FU can be prioritized over excision and MAL-PDT for Bowen’s disease when cost-effectiveness and acceptable non-inferiority are valued; clinicians should also consider prior evidence of superior cosmetic outcomes with 5-FU.
Key Findings
- At 12 months, 5-FU incurred €311 lower healthcare costs versus excision; MAL-PDT costs were €3 higher.
- 5-FU effectiveness was within a 22% non-inferiority margin compared with excision, whereas MAL-PDT was not non-inferior.
- 5-FU had the highest probability of cost-effectiveness at willingness-to-accept thresholds ≤ €2,500.
Methodological Strengths
- Trial-based economic evaluation alongside a randomized controlled study (n=250) with registered protocol (NCT03909646).
- Use of bootstrap and sensitivity analyses to address uncertainty in cost-effectiveness estimates.
Limitations
- 12-month analytic horizon may miss longer-term recurrences and costs.
- Healthcare payer perspective and Dutch cost structure limit generalizability to other systems.
Future Directions: Evaluate longer-term cost-effectiveness, incorporate patient-reported outcomes and cosmetic metrics, and validate across diverse healthcare systems.
2. Cosmetic and functional outcomes of excisional surgical wounds healed by secondary intention: A systematic review.
This PRISMA-compliant review of 35 studies (1655 wounds) found that secondary intention healing yields good-to-excellent cosmetic outcomes in selected sites (forehead, medial canthus, lower eyelid, nasal ala, cheeks, lips, postauricular area, feet), whereas scalp and several nasal subunits and the chin fare less well. Findings guide site-specific expectations and highlight the need for prospective, standardized studies.
Impact: Aggregates decades of evidence to clarify when secondary intention healing is cosmetically acceptable, informing reconstructive choices after skin cancer excision and other defects.
Clinical Implications: Consider SIH for defects on the forehead, medial canthus, lower eyelid, nasal ala, cheeks, lips, postauricular area, and feet; be cautious on the scalp, nasal dorsum/tip/sidewall, and chin where cosmesis may be suboptimal.
Key Findings
- Included 35 studies with 1655 wounds; 1518 (91.7%) healed by secondary intention.
- Best cosmetic outcomes observed in forehead, medial canthus, lower eyelid, nasal ala, cheeks, lips, postauricular area, and feet.
- Less acceptable outcomes on the scalp, nasal dorsum/tip/sidewall, and chin; underscores need for prospective, standardized assessments.
Methodological Strengths
- PRISMA-compliant systematic search across six decades with explicit inclusion criteria.
- Large aggregate sample enabling site-specific comparisons of cosmetic outcomes.
Limitations
- Heterogeneous study designs and outcome measures limit meta-analysis and causal inference.
- Baseline cosmetic variability of primarily closed wounds complicates comparative interpretation.
Future Directions: Prospective, site-stratified studies with standardized cosmetic and functional outcome measures to refine SIH indications.
3. Addition of antimicrobials to oral sprays containing nonsteroidal antiinflammatory drugs does not reduce the severity of postoperative sore throat: a prospective, randomized, placebo-controlled trial.
In a randomized, placebo-controlled trial of 105 patients undergoing ear surgery, both NSAID-based oral sprays reduced postoperative sore throat versus placebo, but adding antimicrobials (chlorhexidine/cetylpyridinium/benzydamine) conferred no additional analgesic benefit. Findings support use of simpler, cost-effective NSAID formulations without antimicrobial additives.
Impact: A negative RCT clarifies that antimicrobial additives do not improve analgesia for postoperative sore throat, informing de-implementation and antimicrobial stewardship.
Clinical Implications: Prefer NSAID-only oral sprays for POST prevention; avoid adding antimicrobials for analgesic purposes, reducing cost and potential exposure to antiseptics.
Key Findings
- Both NSAID-based sprays significantly reduced VAS scores versus placebo at early time points.
- No significant difference between flurbiprofen-only spray and the antimicrobial combination spray.
- Subgroup effects by surgery duration were observed early (1–6 h), but antimicrobial additives did not enhance analgesia.
Methodological Strengths
- Prospective, randomized, placebo-controlled design with standardized timing of administration.
- Multiple postoperative assessments (1 h, 6 h, 24 h, 1 week) enabling temporal evaluation.
Limitations
- Single surgical category (elective ear surgery) limits generalizability.
- Modest sample size and evaluation of only specific NSAID/antimicrobial formulations.
Future Directions: Larger, multi-center RCTs across surgical types, dose-optimization studies, and comparative effectiveness of alternative analgesic strategies.