Daily Cosmetic Research Analysis
Analyzed 38 papers and selected 3 impactful papers.
Summary
A split-face randomized trial showed surgical excision decisively outperforms 70% trichloroacetic acid for localized xanthelasma palpebrarum with superior clearance and cosmetic outcomes. A PROSPERO-registered meta-analysis found combined fractional CO2 and pulsed dye laser therapy significantly improves scar metrics versus monotherapy. A 28-year retrospective cohort linked Turkey’s 2021 ban on formaldehyde and formaldehyde-releasers to a marked drop in allergic contact dermatitis and showed formaldehyde patch testing misses many releaser allergies.
Research Themes
- Comparative effectiveness in cosmetic dermatology
- Dual-laser strategies for pathological scar remodeling
- Cosmetic ingredient safety policy and contact dermatitis surveillance
Selected Articles
1. Efficacy and safety of surgical excision versus 70% tricholoroacetic acid (TCA) topical application in xanthelasma palpebrarum: a split face randomized trial.
In a single-center, split-face randomized trial of adults with bilateral xanthelasma palpebrarum, surgical excision achieved 100% complete clearance at 12 weeks versus 22.2% with 70% TCA, with superior cosmetic outcomes and fewer pigmentary changes. Older age predicted excellent cosmetic results after excision, whereas papulonodular morphology was linked to TCA failure.
Impact: This is the first head-to-head randomized comparison of two widely used treatments for xanthelasma palpebrarum, delivering decisive efficacy and safety data that can immediately inform first-line therapy selection.
Clinical Implications: For localized XP (≤1/3 palpebral area), offer surgical excision as first-line due to predictable single-session clearance and better cosmetic outcomes; counsel that TCA has higher dyschromia risk and lower clearance, particularly in papulonodular lesions. Consider age when discussing expected cosmetic results.
Key Findings
- Complete clearance at week 12: 100% (36/36) with excision vs 22.2% (8/36) with 70% TCA (P<0.001).
- Median percentage area reduction: 100% (excision) vs 69.2% (TCA) (P<0.001).
- Excellent cosmetic outcome in 58.3% of excised XPUs vs 12.5% of TCA-treated XPUs achieving complete remission.
- Dyschromia occurred more often after TCA (75.0%) than excision (41.7%); older age predicted excellent outcome after excision (ROC cutoff 51 years); papulonodular morphology predicted TCA failure.
Methodological Strengths
- Prospective, split-face, single-blinded randomized design with within-patient control.
- Predefined primary endpoint with appropriate paired statistical tests (McNemar, Wilcoxon) and validated cosmetic assessments.
Limitations
- Single-center study with 12-week follow-up; durability beyond 3 months is unknown.
- TCA limited to up to three sessions; findings may not generalize to other concentrations or adjunctive regimens.
Future Directions: Conduct multicenter RCTs with longer follow-up to assess recurrence, optimize TCA protocols (concentration, sessions), and evaluate adjuncts or energy-based alternatives for specific morphologies.
BACKGROUND: Despite its frequency, there is lack of comparative evidence evaluating available treatment modalities for xanthelasma palpebrarum (XP). Although surgical excision and trichloroacetic acid (TCA) are commonly used interventions for XP, no study has compared these two modalities. OBJECTIVE: To compare the efficacy and safety of surgical excision versus 70% trichloroacetic acid (TCA) in the management of limited XP. METHODS: Prospective, split-face, single-blinded single-centre randomized clinical trial conducted from November 2024 to August 2025 with 12-week follow-up. Adults aged ≥18 years with bilateral XP limited to ≤1/3 of the palpebral area were included. Key exclusion criteria were lesions larger than one-third of eyelid height or area and lesions within 2 mm of the canthi. These criteria ensured safe and comparable use of both treatments. Each participant contributed two XP units (XPUs-- defined as all XP lesions in one eye). One eye XPU in each patient was randomized to surgical excision and the contralateral eye XPU to TCA application (up to three sessions, 4 weeks apart). The primary outcome was complete clearance (100% reduction in XPU surface area) at week 12. Secondary outcomes included cosmetic outcome, patient satisfaction, percentage reduction in size, and adverse effects. RESULTS: All excision-treated XPUs (36/36; 100%) achieved complete clearance compared with 8/36 XPUs (22.2%) treated with TCA (McNemar test, P< 0.001). Median percentage reduction was 100% for excision and 69.2% for TCA (P< 0.001,Wilcoxon signed-rank test). Excellent cosmetic outcomes occurred in 21/36 (58.3%) excised XPUs versus 1/8 (12.5%) TCA-treated XPUs who achieved complete remission. Dyschromia was more common after TCA (27/36, 75.0%) than excision (15/36, 41.7%). Older age independently predicted excellent cosmetic outcomes after surgical excision with ROC analysis identifying 51 years as the optimal cutoff. Papulonodular morphology was associated with TCA treatment failure. CONCLUSION: Surgical excision was more effective than 70% TCA for limited XP, providing predictable single-session clearance, superior cosmetic outcomes, fewer pigmentary changes and higher patient satisfaction. Excision can be considered the preferred first-line therapy for localized XP.
2. Combined Fractional CO
This PRISMA-compliant, PROSPERO-registered meta-analysis of nine studies (N=247) found that combining fractional CO2 and pulsed dye lasers significantly improves scar severity across POSAS (MD −18.09), OSAS (MD −19.44), and VSS (MD −3.80), with a favorable safety profile. Findings support the superiority of dual-laser strategies over monotherapy for pathological scars.
Impact: It consolidates multi-study evidence for a dual-laser regimen, informing standardized protocols and patient selection to optimize both functional and aesthetic scar outcomes.
Clinical Implications: Consider integrating fractional CO2 plus PDL for hypertrophic/keloid and mixed-etiology scars to improve vascularity, thickness, pliability, and pigmentation versus monotherapy. Protocol standardization (fluence, density, pulse parameters, intervals) and long-term outcome monitoring are needed.
Key Findings
- Nine studies with 247 patients showed significant scar severity reductions with combined CO2+PDL: POSAS MD −18.09, OSAS MD −19.44, VSS MD −3.80.
- Benefits spanned multiple dimensions (thickness, vascularity, pliability, pigmentation) using validated scales.
- Safety profile was favorable compared with monotherapy across included studies.
Methodological Strengths
- PRISMA adherence with PROSPERO registration (CRD42024619973).
- Use of validated scar scales and random-effects meta-analysis across multiple databases.
Limitations
- Only nine studies with heterogeneous protocols and devices; limited sample size may constrain subgroup analyses.
- Long-term durability and optimal parameter combinations remain insufficiently defined.
Future Directions: Prospective, comparative trials to standardize protocols (energy, density, pulse duration), define sequencing with adjunctive therapies, and document long-term outcomes and recurrence.
BACKGROUND: Pathological scars, particularly hypertrophic and keloid types, often pose significant cosmetic and functional challenges. Although fractional CO₂ lasers and pulsed dye lasers have individually shown promise in scar treatment, their combined efficacy remains underexplored. METHODS: Following preferred reporting items for systematic reviews and meta-analyses guidelines and registered in PROSPERO (CRD42024619973), a comprehensive search across 6 databases identified studies involving patients treated with combined fractional CO₂ laser and pulsed dye laser for scars of various etiologies. Inclusion criteria focused on clinical outcomes such as scar thickness, vascularity, pliability, and pigmentation, assessed via validated tools such as the Vancouver Scar Scale, Patient and Observer Scar Assessment Scale, and Observer Scar Assessment Scale. Nine studies, involving a total of 247 patients, were included. Meta-analyses were performed using a random-effects model. RESULTS: The combination therapy significantly improved scar appearance across multiple scales. The pooled mean differences were -18.09 for the Patient and Observer Scar Assessment Scale, -19.44 for the Observer Scar Assessment Scale, and -3.80 for the Vancouver Scar Scale, all of which were statistically significant ( CONCLUSIONS: Combining fractional CO₂ and pulsed dye lasers offers superior outcomes in scar remodeling compared with monotherapy, improving both functional and aesthetic aspects with a favorable safety profile. Future studies should focus on standardizing treatment protocols and exploring long-term outcomes to optimize clinical use.
3. Marked Impact of Regulatory Bans on Formaldehyde and Formaldehyde-Releaser-Induced Allergic Contact Dermatitis: A Retrospective Cohort Study (1996-2024) From Turkey.
In a 2,592-patient retrospective cohort spanning 1996–2024, FA/FR sensitization prevalence was 1.9%, predominantly in those over 40. After Turkey’s 2021 cosmetic ban, no FA/FR-related cases were observed, and FA 1–2% patch testing missed 31.9% of FR allergies, underscoring the need for continued testing of individual releasers.
Impact: This long-term cohort provides real-world evidence that regulatory bans can reduce cosmetic preservative-related ACD and clarifies that FA is an insufficient screening proxy for FR allergy, informing both policy and clinical patch-testing panels.
Clinical Implications: Maintain dedicated FR allergens (e.g., Quaternium-15, hexahydro-1,3,5-tris-(2-hydroxyethyl)triazine, bronopol, DMDM-hydantoin) in patch-testing series even when FA is negative. Counsel patients about non-occupational rinse-off cosmetics as key exposures; support ongoing surveillance post-ban to detect shifts to alternative preservatives.
Key Findings
- Overall FA/FR sensitization prevalence was 1.9% (48/2592), mostly in patients >40 years.
- After the 2021 national ban, no FA/FR-related ACD cases were detected in the cohort.
- FA 1–2% aqueous patch testing failed to detect 31.9% of FR sensitizations; bronopol and DMDM-hydantoin induced ACD without FA co-reactivity.
- ACD occurred in 37.5% of sensitized patients, mainly hand eczema from non-occupational rinse-off cosmetics; 16.7% were occupational cases.
Methodological Strengths
- Large, 28-year single-center cohort with standardized patch testing to multiple FRs.
- Pre/post regulatory comparison enabling policy impact assessment.
Limitations
- Single-center retrospective design limits generalizability; potential changes in testing panels over decades.
- Causality cannot be definitively established; exposure data may be incomplete.
Future Directions: Establish multicenter surveillance with harmonized FR panels, evaluate substitute preservatives’ sensitization potential post-ban, and refine baseline patch series to improve sensitivity without excessive burden.
BACKGROUND: Formaldehyde (FA) and formaldehyde-releasers (FRs) are well-known causes of allergic contact dermatitis (ACD). Following the 2019 EU ban on FA and Quaternium-15 in cosmetics, stable or slightly decreasing sensitisation rates have been reported. In Turkey, both were banned in 2021. OBJECTIVES: To assess FA/FR sensitisation and ACD rates before and after the ban, and evaluate the role of FA as a marker for FR allergy. METHODS: A single-centre retrospective cohort of 2592 patients patch tested with FA 1% or 2% aq. and at least one FR between 1996 and 2024. RESULTS: FA/FRs sensitisation prevalence was 1.9% (48/2592), mostly in patients > 40 years old. The most frequent sensitisers were hexahydro-1,3,5-tris-(2-hydroxyethyl)triazine (0.7%) and Quaternium-15 (0.6%). ACD occurred in 37.5% (18/48), mainly as hand eczema from non-occupational rinse-off cosmetics, while 16.7% were occupational (hairdressers/barbers/metalworkers). FA 1%-2% aq. failed to detect FR sensitisation in 31.9% (n = 15/47) of patients, including nine missed with FA 1% aq. and six with FA 2% aq. No cases occurred after the 2021 ban. 2-bromo-2-nitropropane-1,3-diol and DMDM-hydantoin showed no co-reactivity with FA, but were important inducers of FR-related ACD. CONCLUSIONS: The 2021 ban in Turkey appears to have reduced ACD due to FA and FRs. Continued FR testing remains essential, as FA 2% aq. is complementary but not a fully reliable marker.