Wendy E. Roberts MD FAAD
Worldwide air pollution is a major health concern. There is accumulating scientific evidence that air pollution plays an important role
in extrinsic aging. This article invites the reader to consider pollution as a possible emerging etiologic agent for the development of
melasma. Pollution may be a risk factor for melasma and other facial pigmentary dyschromias. Air pollution in the form of airborne
particulate matter (PM) and Polycyclic aromatic hydrocarbons (PAHs) enter the skin via nanoparticles and generate quinones, which are
redox-cycling chemicals that produce reactive oxygen species (ROS). The PM increases the amount of ROS that triggers the increase
of metalloproteinases that leads to extrinsic aging, which includes skin pigmentation. The incidence of disorders of facial hyperpigmentation
specifically, melasma, is increased in persons of skin type III-VI living in India and South East Asia. Interestingly, these are also
geographic regions with very heavy pollution. India, South East Asia, China, and United States lead the world in air pollution.
J Drugs Dermatol. 2015;14(4):337-341.
Wallace Nozile MS, Cheri N. Adgerson MD, and George F. Cohen MD
Cutaneous Lupus Erythematosus (CLE) is a common manifestation in patients with Systemic Lupus Erythematosus. In a significant
population of patients, CLE is the predominant feature and, in some cases, patients suffer from cutaneous disease alone. Chronic
Cutaneous Lupus Erythematosus (CCLE) is a scarring subtype, more prevalent in blacks. Patients with skin of color may pose a
challenge to physicians due to exaggerated cutaneous findings and increased risk of post-inflammatory hyperpigmentation and
hypertrophic scarring. With the demographics of the United States rapidly shifting towards a greater population of non-Caucasian
racial and ethnic groups, it is imperative that we expand on the limited research into molecular variation, clinical presentation, and
therapeutic efficacy in CLE. The purpose of this review is to bring attention to the unique and severe aspects of CLE in persons of
color, which calls for early and aggressive treatment.
J Drugs Dermatol. 2015;14(4):343-349.
Brooke A. Jackson MDa and Mark R. Vogel MAb
BACKGROUND: Despite the frequent use of botulinumtoxin A (BoNTA) in non-Caucasian patients, safety and efficacy has not been well
characterized in persons with darker skin.
OBJECTIVE: To investigate the efficacy and safety of incobotulinumtoxin A [Xeomin® (XEO)] for the correction of glabellar lines among
non-Caucasian patients with Fitzpatrick skin types IV to VI.
METHODS: This open-label, single-center, post-marketing study treated 29 patients with Fitzpatrick skin types IV to VI with moderate
to severe glabellar frown lines. Evaluation at day 0 included standardized photographs and patient and investigator assessments. Post
evaluation, XEO was administered at 5 intramuscular injection sites with equal aliquots of 4 units per 0.1 mL. Photographs and assessments
were repeated at days 30 and 90.
RESULTS: Response to treatment was defined as a 1 or more point improvement in patient and investigator assessments. At day 30,
100% (n = 29; 95 C.I. 0.87, 1.00; P< .001) responded to treatment. At day 90, 69% (n=20; 95% C.I. 0.52, 0.83; P= .42) responded to
treatment. The safety profile was similar to previously reported trials with BoNTA.
CONCLUSION: The efficacy and safety of XEO among patients with skin types IV to VI is similar to that among persons with fairer skin.
J Drugs Dermatol. 2015;14(4):350-353.
Anshika Kaushik BA,a Anne Laumann MBChB MRCP (UK),b Steven Nwe DO,c
Mary J. Kwasny ScD,d Dennis P. West PhD,b and Roopal V. Kundu MDb
BACKGROUND: Photosensitivity (PS) in cutaneous lupus erythematosus (CLE) contributes to decreased quality of life (QoL).
AIMS: We aimed to assess baseline knowledge about sun protection in persons with CLE and identify knowledge differences by
race. Additionally, we aimed to determine the impact of a verbal educational intervention on photoprotection and CLE.
METHODS: 31 adults with CLE were recruited from an academic-based dermatology clinic and completed a 17-item questionnaire
about CLE and sun protection at three time points: pre- intervention (PR-I), post-intervention (PO-I), and 3-month phone follow
up (3MF). An educational intervention using American Academy of Dermatology CLE and sun protection education materials was
delivered between PR-I and PO-I.
RESULTS: 31 subjects participated at PR-I and PO-I, and 25 subjects (81%) at 3MF. Baseline CLE-related PS and photoprotection
knowledge differed significantly by race, with non-Caucasians demonstrating less knowledge (P= 0.049). Knowledge about sun
exposure being linked to lupus increased from 81% to 97% (P=0.25) between PR-I and PO-I. At PR-I, 19% agreed that smoking
was linked to lupus compared to 90% PO-I (P<0.001). There was increased knowledge of lupus risk for non-Caucasians, UV exposure
indoors, and photo-avoidance during peak daytime (P<0.001).
CONCLUSION: There is a baseline disparity in knowledge related to PS and photo protection in CLE by race. A short educational
intervention successfully improved immediate lupus-related PS and sun exposure knowledge, but knowledge was not retained
long-term. It appears educational materials must be improved.
J Drugs Dermatol. 2015;14(4):355-358.
Hussein M. Hassab El Naby MD,a Mohamed R. Alnaggar MD,a Mahmoud F. Abdelhamid MD,b
Khadiga Alsaid MD,c Eslam M. Al Shawadfy MD,b and Mohamed L. Elsaie MD MBAb
Human leukocyte antigen (HLA) antigens vary considerably in different racial groups, and an analysis of results from several geographical
locations suggests that vitiligo appears to be associated with different HLA antigens in different groups. The aim of this
work was to assess the association of HLA-Cw with vitiligo in the Egyptian population. Forty unrelated patients with nonsegmental
vitiligo and 20 matched controls were selected. A polymerase chain reaction sequence specific primer (PCR-SSP) method was
used to determine HLA DNA typing. There was a statistically significant difference in the association of HLA-Cw6 with vitiligo in
the 2 studied groups. A comparatively increased number of patients showed HLA-Cw2 and HLA-Cw7 (13.64%). However, there
were no statistically significant differences. To the best of our knowledge, this is the first molecular study of HLA typing in Egyptian
patients with vitiligo. Our findings are in agreement with earlier studies that reported statistically increased frequencies for
allele of HLA-Cw6 in Northern Italian, Kuwaiti, Chinese Han, and Saudi populations (45.45%, P<.05).
J Drugs Dermatol. 2015;14(4):359-364.
Steven H. Dayan MD FACS,a,b,c Katherine Cho MPH,a,c Mary Siracusa BS,a,c and Selika Gutierrez-Borst MS RNa,c
INTRODUCTION: First impressions are lasting, consequential and defined as the immediate judgment made of another from zero acquaintance.
Multiple studies have reported the benefits of cosmetic make-up. We set out to investigate the psychosocial and aesthetic
effects of cosmetic make-up in order to better understand why women wear it.
MATERIALS AND METHODS: Twenty-seven women were recruited in order to examine the effects of cosmetic make-up on first impressions.
The photographs of individual subjects wearing the control cosmetics, their own make-up, and no make-up were randomly assigned
to three binders (A, B, and C). Three hundred evaluators participated (100 evaluators per book) and completed a 10-point First
Impression Scale for each of the 27 photos in their binder.
RESULTS: Statistical analysis of the collected data was conducted in SPSS using two-tailed t-tests to determine the statistical significance
of the differences between first impressions of Own Make-up vs No Make-up, No Make-up vs Control Make-up, and Own Makeup
vs Control Make-up. There was a significant difference in improvement in all pairings across all 8 categories in the First Impressions
questionnaire particularly in perceived age between own make-up, no make-up, control make-up (41, 42, 38; P<0.001).
DISCUSSION: Our study evaluated the first impressions, age perception, self-esteem, and the quality of life impact that cosmetic makeup
has on women’s appearance and confidence. Subjects wearing cosmetic make-up appeared 4 years younger than those wearing
no make-up. And the control cosmetic make-up subjects on average projected a 37% better first impression than subjects wearing no
make-up. We objectively quantified and qualified the benefits of applying cosmetic make-up. Make-up can reduce the perceived age,
improve the first impression projected and increase the self-esteem of those who apply it.
J Drugs Dermatol. 2015;14(4):366-374.
Lawrence F. Eichenfield MD and Andrew C. Krakowski MD
The iPLEDGE protocol for isotretinoin treatment requires multiple steps to be completed within strict timing windows, resulting
in many interruptions or discontinuations of treatment. The US Food and Drug Administration has indicated that approximately
40% of isotretinoin prescriptions written over the course of one year of the iPLEDGE program were denied due to failure to
comply with iPLEDGE. Insurance restrictions add to the likelihood of prescriptions not being filled. Here, we describe a novel
program implemented specifically to assist patients and providers with improving isotretinoin therapy adherence. This innovative
isotretinoin support program provides assistance with insurance questions and hurdles, an uninterrupted treatment supply, educational
support, reminder communications, and an indigent patient assistance program. Proof-of-concept analysis shows that 17
months after implementation of the program, 93% of prescriptions received have been filled. Utilization of the program appears
to improve adherence to an isotretinoin treatment regimen, with fewer interruptions due directly to unfilled prescriptions.
J Drugs Dermatol. 2015;14(4):375-379.
OBJECTIVE: To investigate whether treatment differences exist in male and female patients with moderate to severe acne treated with
clindamycin phosphate 1.2%/BP 3.75% gel or vehicle as monotherapy.
METHODS: A post hoc analysis comparing the efficacy and cutaneous tolerability in 498 male and female patients with moderate to
severe acne receiving clindamycin phosphate 1.2%/BP 3.75% gel, or vehicle for 12 weeks.
RESULTS: The efficacy of clindamycin phosphate 1.2%/BP 3.75% gel was greater than vehicle (P>.001) in both genders. Within the clindamycin
phosphate 1.2%/BP 3.75% gel group, the mean percent change from baseline in inflammatory and noninflammatory lesion counts
was greater among females than males, as was the percentage of subjects who achieved a 2-grade reduction in the EGSS (P=.049).
LIMITATIONS: It is not possible to determine the contributions of the individual active ingredients.
CONCLUSIONS: Clindamycin phosphate 1.2%/BP 3.75% gel provides statistically significant greater efficacy than vehicle with a favorable
safety and tolerability profile. It appears to be more effective in female patients.
J Drugs Dermatol. 2015;14(4):381-384.
Zoe Diana Draelos MD,a Susana Raab BS,b Margarita Yatskayer MS,b Nannan Chen PhD,b
Yevgeniy Krol BS,c and Christian Oresajo PhDb
Facial dyspigmentation treatment is an unmet need in dermatology with increasing challenges due to the questionable safety of
hydroquinone. This research examined a new OTC formulation containing hydroxyphenoxy propionic acid, ellagic acid, yeast extract,
and salicylic acid on subjects who previously completed 12 weeks of treatment with 4% hydroquinone and 0.025% retinoic acid. The
goal of this study was to evaluate the skin lightening and tolerability profile of a 20-week maintanence therapy with a cosmeceutical
formulation during the summer months. 33 healthy subjects ages 25-60 years with moderate facial dyspigmentation defined as a
score of 3 on a 5-point scale were enrolled. There was statistically significant improvement at week 20 in terms of even skin tone
(P<0.001), spot intensity (P<0.001), spot size (P<0.05) and overall hyperpigmentation (P=0.002).
J Drugs Dermatol. 2015;14(4):386-390.
Hilary C. Reich MD,a Irmina Wallander BA,b Lacie Schulte BA,b Hilary Frickman BA,b
and Suzanne Flickenger BA,b Brian Zelickson MDb
The home beauty device market is rapidly growing, having more than tripled in the last four years. This study evaluates several
specific attachment heads using a novel home skincare platform (HSP). By incorporating multiple treatment heads for cleansing,
skin smoothing, and skin infusion, this device has the potential to address many potential treatment goals. The first subset of this
study is a blinded, randomized split-face study evaluating the efficacy of the HSP device with a standard brush head for make-up
removal and compares the HSP device to a currently marketed home cleansing device. The results show that the HSP cleansing
head was comparable to the leading home skin cleansing device on the market. The HSP’s skin smoothing head showed statistically
significant improvement in erythema and dryness over baseline levels with significant histologic changes including normalization
of epidermal thickness in only 10 days of use. This is comparable to and exceeds many well-studied antiaging treatments
after weeks and months of therapy. Finally, the infusion head demonstrated improvement in skin hydration over baseline levels.
J Drugs Dermatol. 2015;14(4):391-399.
Monya L. Sigler PhD, and Thomas J. Stephens PhD
BACKGROUND: Chronic exposure to the sun causes the skin to prematurely age. Photodamaged skin is characterized by progressive
damage to the dermal extracellular matrix with loss of collagen and degradation of elastin. Clinical manifestations of such photoaged
or photodamaged skin include wrinkles and irregular pigmentation. Various cosmetic treatments including topical retinoids, growth
factors, and skin lighteners have shown some benefit. Salts of copper chlorophyllin complex are semi-synthetic naturally derived compounds
with anti-oxidant and wound healing activity that has not been previously tested in photodamaged skin.
OBJECTIVES: This single-center pilot study was conducted to assess the efficacy and safety of a liposomal dispersion of topically applied
sodium copper chlorophyllin complex in women with mild-moderate fine lines and wrinkles in the periocular areas and facial solar
lentigenes over a course of 8 weeks.
METHODS: Subjects were supplied with the test product, a topical gel containing chlorophyllin complex salts (0.066%), with directions to
apply a pea-sized amount to the periocular areas, cheeks and nose every morning and evening. Clinical assessments were performed at
screening/baseline and at week 8. Standardized digital photographs were taken and self-assessment questionnaires were conducted.
RESULTS: Ten subjects completed the 8-week study. All clinical efficacy parameters showed statistically significant improvements over
baseline at week 8. The study product was well tolerated. Subject questionnaires showed the test product was highly rated.
CONCLUSIONS: In this pilot study, a topical formulation containing a liposomal dispersion of sodium copper chlorophyllin complex was shown
to be clinically effective and well tolerated for the treatment of mild-moderate photodamage and solar lentigenes when used for 8 weeks.
J Drugs Dermatol. 2015;14(4):401-404.
Rachel Seidel BAa and Ronald L. Moy MD FAADa,b
BACKGROUND: Under-eye bags are a common manifestation of age and a frequent complaint among patients who no longer feel youthful.
Non-invasive topical agents are largely ineffective at reducing their appearance.
OBJECTIVE: We studied the ability of a topical serum containing epidermal growth factor (EGF) to minimize the appearance of
METHODS: A single-center clinical trial was performed on eighteen volunteer male and female patients with under-eye bags. Subjects
applied EGF serum to the infraorbital area twice daily for 12 weeks. At each visit, subjects were evaluated using clinical photography
and written self-assessment. A grade on the Merz Infraorbital Hollowness Scale was also given and two independent, blind investigators
assigned an Investigator’s Global Assessment (IGA) score. At the trial’s end, patients shared their final evaluation and perception
of results with a questionnaire.
RESULTS: Sixteen subjects completed the trial. The final average Merz grade was 1.63 (SEM = .273), statistically significantly lower
than the mean baseline average of 2.06 (SEM = .232) (P = .0019). A reduction in average IGA score was also significant (P < .0001).
Average initial IGA was 2.75 (SEM = .270) and average final IGA was 2.00 (SEM = .310). All but two subjects reported improvement
at the final visit. Improvement was quantified as 76-100% by two subjects, 50-75% by three subjects, and 25-49% by nine subjects.
Eleven subjects classified their under-eye bags as milder at the end of the trial compared to the first visit. Seven subjects reported
greater satisfaction with their overall facial appearance. Of the subjects who had used other topical treatments in the past, two
reported the serum to be “significantly better” and four said it was “better” in treating their under-eye bags.
CONCLUSION: Our results offer evidence that topical EGF can reduce the appearance of under-eye bags.
J Drugs Dermatol. 2015;14(4):405-410.