Daily Cosmetic Research Analysis
A large three-armed RCT showed that 5% potassium hydroxide solution achieved higher complete clearance and faster onset than diclofenac 3% gel and placebo for actinic keratosis. A meta-analysis found that transoral endoscopic thyroidectomy (TOETVA) offers better cosmetic satisfaction and higher central lymph node yield than the areola approach with similar safety, albeit with longer operative time. A randomized blinded trial in Chinese participants demonstrated non-inferiority and sustained effe
Summary
A large three-armed RCT showed that 5% potassium hydroxide solution achieved higher complete clearance and faster onset than diclofenac 3% gel and placebo for actinic keratosis. A meta-analysis found that transoral endoscopic thyroidectomy (TOETVA) offers better cosmetic satisfaction and higher central lymph node yield than the areola approach with similar safety, albeit with longer operative time. A randomized blinded trial in Chinese participants demonstrated non-inferiority and sustained effectiveness of a cross-linked hyaluronic acid plus mannitol filler versus Restylane for nasolabial folds.
Research Themes
- Lesion-directed therapy for actinic keratosis
- Scarless endoscopic thyroidectomy outcomes and cosmesis
- Comparative effectiveness and safety of hyaluronic acid fillers
Selected Articles
1. KOH 5% solution versus diclofenac 3% for the treatment of actinic keratosis - Results from a three-armed RCT.
In a three-armed RCT (n=631), 5% KOH solution achieved higher patient-level complete clearance than diclofenac 3% gel and placebo, with faster onset and similar tolerability. Individual-lesion clearance was also superior with KOH, and safety events were mostly mild and localized.
Impact: This large, registered RCT provides high-level evidence supporting a simple, lesion-directed topical therapy that outperforms a commonly used standard for early-stage actinic keratosis.
Clinical Implications: KOH 5% can be considered a first-line, lesion-directed option for mild-to-moderate AK (actinic keratosis) in primary care, offering faster onset and comparable tolerability to diclofenac.
Key Findings
- Treatment success (patient-level complete clearance) was 45.2% with KOH vs 23.8% with diclofenac and 22.9% with placebo.
- Individual-lesion complete remission was higher with KOH (65.0%) than diclofenac (45.9%) or placebo (39.9%).
- Faster onset: 1-month complete clearance 16.0% (KOH) vs 9.2% (diclofenac); safety was mostly mild localized reactions with similar tolerability.
Methodological Strengths
- Randomized, three-armed design with double-blinding for KOH/placebo and investigator blinding for diclofenac
- Registered trial (NCT04552327) with a large sample (n=631) and clinically meaningful endpoints
Limitations
- Diclofenac arm was investigator-blinded rather than fully double-blinded
- Study focused on mild-to-moderate AK; longer-term outcomes beyond 6 months were not fully characterized
Future Directions: Head-to-head comparisons with other field therapies, cost-effectiveness analyses, and durability of clearance beyond 12 months are warranted.
2. Outcomes of transoral endoscopic thyroidectomy vestibular approach versus endoscopic thyroidectomy via areola approach in the treatment of thyroid carcinoma: a meta-analysis.
Across 15 studies (n=1,961), TOETVA achieved higher cosmetic satisfaction and a greater number of central lymph node dissections than ETAA, with marginally lower intraoperative blood loss but longer operative time. Complication rates, RLN injury, hypocalcemia, and hospital stay did not differ significantly, supporting TOETVA as a safe scarless option.
Impact: This synthesis informs surgical decision-making for patients prioritizing scarless outcomes without compromising oncologic metrics such as central nodal yield.
Clinical Implications: TOETVA (transoral vestibular approach) can be preferentially offered to thyroid carcinoma patients seeking scarless surgery, with counseling on longer operative time and equivalent safety profiles to ETAA.
Key Findings
- Higher cosmetic satisfaction with TOETVA (WMD 0.93; 95% CI 0.42–1.43; p=0.0004) compared with ETAA.
- Greater central lymph node dissections with TOETVA (WMD 1.4; 95% CI 0.3–2.3; p=0.02).
- Longer operative time with TOETVA (WMD +17 min; 95% CI 8–26; p=0.0002) but similar complications, RLN injury, hypocalcemia, and length of stay.
Methodological Strengths
- Comprehensive multi-database search and PROSPERO registration
- Broad assessment of operative, oncologic, safety, and patient-reported cosmetic outcomes
Limitations
- Included studies were predominantly nonrandomized with potential selection bias and heterogeneity
- Cosmetic satisfaction measurement tools and follow-up durations varied across studies
Future Directions: Prospective RCTs comparing TOETVA vs ETAA with standardized cosmetic and functional outcomes, and long-term oncologic follow-up are needed.
3. Effectiveness and Safety of a Cross-Linked Hyaluronic Acid Plus Mannitol Filler for the Correction of Nasolabial Folds in Chinese Subjects: A Randomized, Blinded, Controlled Study.
In a 12-month, randomized, subject- and evaluator-blinded non-inferiority trial (~390 participants), STYLAGE L achieved non-inferiority to Restylane for nasolabial folds and showed higher WSRS responder rates at 6, 9, and 12 months. GAIS responses, satisfaction, and tolerability were high in both arms.
Impact: Provides high-quality comparative data in an Asian population, guiding filler selection with evidence on durability and safety over 12 months.
Clinical Implications: Clinicians can consider STYLAGE L as a non-inferior, potentially more durable option for nasolabial fold correction in Chinese/Asian patients, while accounting for product rheology that may affect injection technique.
Key Findings
- Non-inferiority achieved vs Restylane with a responder difference of 9.33% (95% CI 2.10%–16.56%).
- Higher WSRS responder rates with STYLAGE L at 6 months (difference 9.19%, p=0.0157), 9 months (19.75%, p<0.0001), and 12 months (11.36%, p=0.0116).
- High GAIS responder rates (>73%) and good tolerability in both groups; device performance indicated a 'harder' profile for the investigational filler.
Methodological Strengths
- Randomized, subject- and evaluator-blinded, multicenter non-inferiority design
- 12-month follow-up with multiple validated aesthetic endpoints (WSRS, GAIS, satisfaction)
Limitations
- Comparison limited to a single active comparator and one facial indication (nasolabial folds)
- Generalizability outside Chinese populations and across other facial regions remains to be established
Future Directions: Head-to-head trials across different facial regions and patient phenotypes, with standardized rheological profiling and cost-effectiveness analyses.