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.
INTRODUCTION: Given the increasing incidence of Bowen's disease, treatment leads to a substantial economic burden for healthcare services. There are several treatment options for Bowen's disease, of which surgical excision, 5-fluorouracil (5-FU) and methyl aminolevulinate photodynamic therapy (MAL-PDT) are the most commonly used. Recently, results from a randomized controlled non-inferiority trial showed that 5-FU was non-inferior to excision and was associated with a better cosmetic outcome. MAL-PDT was not shown to be non-inferior to excision. Although 5-FU and MAL-PDT were expected to be cheaper than excision, it remains to be determined whether the potential cost savings compensate for the loss of effectiveness. The aim of this study was to determine the most cost-effective treatment for Bowen's disease when comparing surgical excision, MAL-PDT, and 5% 5-FU cream from a healthcare perspective.
METHODS: Data were collected alongside a randomized controlled trial with 250 patients in the Netherlands. Valuation of treatment costs was based on documented resource use and Dutch cost prices. A cost-effectiveness analysis was performed from a healthcare perspective. The primary outcome was the decremental cost-effectiveness ratio (DCER), expressed as the cost-savings per additional recurrence or residual Bowen's disease. Bootstrap analysis and sensitivity analysis were performed to address uncertainty. This trial is registered with
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.
BACKGROUND: Data regarding short-term and long-term cosmesis and functional outcomes of excisional surgical wounds healed by secondary intention healing (SIH) are limited. OBJECTIVE: To conduct a systematic review and assess the cosmetic and functional acceptability of SIH for acute excisional surgical wounds. METHODS: Full-text articles queried from PubMed and Embase databases between January 1964 and April 2024 with cosmetic outcome data of human subjects with acute surgical wounds healed by SIH were included. Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines were followed. RESULTS: A total of 1655 surgical wounds, of which 1518 (91.7%) healed by SIH, from 35 studies, were included in this review. The most frequent indication for SIH was a defect resulting from excision of nonmelanoma skin cancer (keratinocyte carcinoma), which was identified in 1439 (86%) of patients. Common sites for SIH included the nose (23.3%), periocular region (15.46%), and forehead (13.5%). The majority of wounds on the forehead, medial canthus, lower eyelid, nasal ala, cheeks, lips, postauricular area, and feet resulted in good to excellent cosmetic results, whereas those on the scalp, nasal dorsum, nasal tip, nasal sidewall, and chin yielded less acceptable cosmetic results. Given the baseline variability in cosmesis of primarily closed wounds in some anatomic locations, however, these data suggest the need for future prospective studies. SUMMARY: SIH may produce an acceptable cosmetic and functional outcome for selected defects and may be of clinical benefit in the appropriate setting. This must be weighed against the potentially improved cosmesis and more rapid healing seen with primarily closed defects.
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.
BACKGROUND/AIM: Postoperative sore throat (POST) is a common complication following general anesthesia that significantly affects patient satisfaction, prolongs recovery, and increases treatment costs. This study aimed to evaluate whether the addition of antimicrobial agents to NSAID-based oral sprays could enhance the preventive efficacy against POST. MATERIALS AND METHODS: In this prospective, randomized, placebo-controlled trial, 105 patients (ASA I-II; age 18-65 years) scheduled for elective ear surgery under general orotracheal anesthesia were enrolled. Patients were randomly allocated into three groups: a placebo group; a flurbiprofen oral spray group; and a group receiving an oral spray containing benzydamine hydrochloride, chlorhexidine digluconate, and cetylpyridinium chloride. The sprays were administered under direct laryngoscopy before intubation and after the final oropharyngeal aspiration. POST severity was assessed using a 10mm Visual Analog Scale (VAS) at 1 h, 6 h, 24 h, and 1 week postoperatively. Patients were also subgrouped based on surgical duration (<120 min vs. ≥120 min). RESULTS: Both NSAIDbased treatments significantly reduced VAS scores at early postoperative time points compared to the placebo. In subgroup analysis, patients undergoing surgeries lasting less than 120 min exhibited lower VAS scores with both active treatments, while in those with surgeries ≥120 min, significant differences were noted at 1 and 6 h. No significant difference was found between the flurbiprofen spray and the combination spray. CONCLUSION: NSAIDcontaining oral sprays effectively reduce the severity of postoperative sore throat. However, the addition of antimicrobial agents does not provide extra analgesic benefit, suggesting that simpler, costeffective NSAID formulations may be preferable in clinical practice.