BACKGROUND Striae distensae have notoriously been difficult to treat due to their extensive involvement of nonfacial skin. Microneedling with its lack of thermal injury during microneedling treatment renders it a viable treatment option in darker skin tones and nonfacial regions due to the reduced risk of postinflammatory hyperpigmentation. OBJECTIVE To describe the clinical results and side effects of microneedling in a series of 25 individuals with striae distensae. MATERIALS AND METHODS Twenty-five consecutive adults (SPT I–V) with striae distensae involving the trunk and extremities were treated using a microneedling device. No additional treatments (topical or intralesional) were applied. Two assessors blinded to treatment protocol rated clinical improvement of striae on a 5-point scale. Side effects were monitored and tabulated. RESULTS Patients received 1 to 3 consecutive monthly treatments. All striae improved at least 50% after an average of 1.8 treatments, and 28% of patients demonstrated more than 75% clinical improvement. Striae in thicker skin regions (e.g., buttocks/thighs) showed comparable clinical improvement than those in thinner skin areas (e.g., breasts) and did not require additional treatment sessions. Side effects were limited to transient erythema in all skin phototypes. No infections or dyspigmentation were observed. CONCLUSION The clinical results obtained in this study support the safe and effective treatment of striae distensae with microneedling in light and dark skin tones in various body locations. Standardization of treatment protocols are anticipated with further (ongoing) studies.

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Our experience provides further evidence to support the safety and effectiveness of the 1064-nm Nd:YAG laser in the management of large and surgically challenging GVMs.

BACKGROUND Beyond submental fat reduction, injectable deoxycholic acid (DCA) has gained popularity in recent years for various minimally invasive lipolysis applications. OBJECTIVE To summarize and evaluate the evidence of off-label uses of injectable DCA. METHODS MEDLINE, Embase, CINAHL, Web of Science, and CENTRAL were searched. The outcomes measured included applications of DCA, treatment regimen, and its efficacy. An overall success rate for each condition was calculated based on the improvement defined in the included studies. RESULTS Eleven studies evaluated the cosmetic use of DCA for excess adipose tissue on various anatomical locations. The outcomes were evaluated at time points ranging from 1 to 21 months post-treatment, with overall success rates over 85%. Eight case reports and series reported the success of using DCA treating lipomas, xanthelasmas, paradoxical adipose hyperplasia, fibrofatty residue of infantile hemangioma, piezogenic pedal papules, and HIV-associated lipohypertrophy. Although the preliminary efficacies were high, the overall recommendations for off-label uses are weak because of the lack of high-level studies. CONCLUSION The review emphasizes the diversity of injectable DCA as a minimally invasive technique for lipolysis. Further high-level studies demonstrating consistent treatment regimens and methods of evaluation are warranted to make more definitive recommendations regarding off-label DCA use.

We thank Cohen and Ross for their letter "Laser-Induced Chrysiasis: A Unique Adverse Event Associated with Q-Switched Lasers" [1]. While uncommon, this additional complication is worthy of inclusion as a possible undesirable outcome of Q-switched (or other short-pulsed) laser treatments. Chrysiasis is characterized by skin pigmentation due to deposition of gold pigment following long-term chrysotherapy [2]. Certainly, prevention of the phenomenon would be accomplished by obtaining a comprehensive medical history including any lifetime exposure to gold [3]. It is believed that cutaneous pigmentation appears immediately after Q-switched laser therapy due to reduction of the gold particle size [4]. Regrettably, management strategies for this phenomenon are case-based, making its avoidance of paramount importance [3, 5]. We appreciate the authors highlighting this potential untoward outcome and supplementing our collective knowledge of safe laser practices. Declarations Funding No funding was received for the preparation of this letter.