Hilary E. Baldwin MD,a Neal D. Bhatia MD,b Adam Friedman MD,c Richard Martin Eng,d and Sophie Seité PhD e
The skin is constantly exposed to various endogenous and exogenous factors that may impact its barrier function at the physical, mechanical, immunological, and microbial levels. These factors have the potential to initiate or exacerbate a variety of inflammatory skin conditions, especially those associated with barrier dysfunction. The barrier function of the skin depends upon a symbiotic relationship between resident microbial communities and host tissue. This symbiosis results from complex signals involved in both the innate and adaptive immune responses. Recent research indicates that both bacterial diversity and the relative abundance of different microbes present on and in the skin, may contribute to skin barrier stability or dysfunction. The objectives of this review are to discuss the relationship between the skin microbiota and skin barrier function and to consider mechanisms that may help its preservation.
J Drugs Dermatol. 2017;16(1):12-18.
Suzanne Bruce MDa and Sylvia Barkovic BAb
BACKGROUND: Photodamage to the skin occurs with exposure to sunlight (UVA or UVB) either intentionally or unintentionally, and can present in a variety of ways. It typically occurs on areas of chronic UV exposure, including the face, ears, and neck.
METHODS: We evaluated the effects of a 3-product, 2-step retinol-rejuvenation system containing an exfoliating cleanser, a 0.5% retinol emollient cream, and SPF 30 moisturizing sunscreen used daily for 3 months on the appearance of mild-to-moderate facial photodamage in female subjects.
RESULTS: Significant improvements in facial appearance could be observed as early as 2 weeks, with continued improvement over the duration of the study. There were no adverse events reported that were related to study product and reports of cutaneous tolerability issues were rare.
CONCLUSIONS: A 3-product, 2-step retinol-rejuvenation system provides significant improvements in signs of photodamage and overall skin appearance, and is well-tolerated.
J Drugs Dermatol. 2017;16(1):23-28.
Zoe Diana Draelos MD,a Jwala Karnik MD,b and Gail Naughton PhDc
Growth factors are a new category of ingredient found in modern cosmeceutical formulations. One novel method of obtaining cosmeceutical growth factors is the use of a bioreactor to culture neonatal broblasts on dextran microcarrier beads for 8 weeks under low oxygen tension (1-5%) mimicking embryonic conditions and eliminating the need for fetal bovine serum constituents in the final cosmetic material. This research evaluated the ingredient in a moisturizing vehicle on 40 females to determine its efficacy in improving overall facial skin appearance, as well as skin brightness, evenness, firmness, pore size, radiance, fine lines, coarse wrinkles, and blotchiness/ dispigmentation. Statistically significant improvement was seen in 90 days in skin hydration through corneometry, as well in global investigator and subject assessments.
J Drugs Dermatol. 2017;16(1):30-34.
Elizabeth T. Makino BS CCRA MBA,a Shoichiro Yano MD,b Tsing Cheng PhD,a Rahul C. Mehta PhDa
OBJECTIVE: Due to innate differences in the biochemical processes of melanogenesis between people of different ethnic origins, the clinical efficacy and tolerability of a novel comprehensive hydroquinone-free and retinol-free serum for pigmentation control was assessed in Japanese subjects.
METHODS: A double-blind, placebo-regimen controlled clinical study was conducted to assess the efficacy and tolerability of a novel comprehensive hydroquinone-free and retinol-free serum (LYT2) in Japanese subjects presenting with moderate to severe facial hyper- pigmentation. Subjects were randomized to receive LYT2 plus a sunscreen placebo regimen or only the sunscreen placebo regimen. Clinical assessments for overall hyperpigmentation and skin tone evenness by the blinded investigator and standardized digital photography were conducted at all visits (baseline and weeks 4, 8, and 12).
RESULTS: Thirty-five female and male subjects aged 37-67 years completed the twelve-week study. Subjects treated with LYT2 showed early signi cant reductions in both mean overall hyperpigmentation and skin tone evenness scores at week 4, with continuing significant reductions through week 12. LYT2 showed significantly greater improvements in skin tone evenness scores compared to the sunscreen placebo regimen at weeks 4 and 12. Standardized digital photographs support the overall improvements observed by the investigator. Both treatments were well-tolerated with mean tolerability scores remaining mild or below throughout the study duration. DISCUSSION: LYT2 combines multiple ingredients that modulate several key biochemical pathways in melanogenesis to work on multiple types of pigmentary conditions in people of various ethnic origins. In a previous multi-ethnic study, LYT2 showed clinical efficacy in African American, Hispanic, and Caucasian sub-groups. The present study supports the efficacy and tolerability of LYT2 in improving the appearance of facial hyperpigmentation in Japanese subjects.
J Drugs Dermatol. 2017;16(1):36-40.
Jonathan M. Sykes MD,a Amir Allak MD MBA,a and Brian Klink MDb
Deoxycholic acid (KybellaTM, Allergan Pharmaceuticals, Irvine, CA) is a novel injectable treatment used for the cosmetic reduction of redundant submental fat. By inducing adipose cell lysis, the soft tissue alteration induces subsequent contour change and sharpening of the cervicomental angle.The safety and efficacy have been well established in several prospective clinical trials and subsequent FDA approval for this purpose. This has provided an effective and less invasive alternative to surgical liposuction with virtually no recovery time and less overall discomfort. Given its success for use in this context, a logical step would be to extrapolate to other regions of the body where cosmetic deformity is caused by excessive adipose tissue. In the current article, the authors propose potential options for further use in various targeted areas where subcutaneous fat may be amenable to reduction with deoxycholic acid injection, understanding that such uses would be off-label and require an understanding of the regional anatomy and possible complications.
J Drugs Dermatol. 2017;16(1):43-46.
Laura Schilling MD,a Nazanin Saedi MD,a and Robert Weiss MDb
Non-invasive body contouring is becoming increasingly popular in the United States. Using the 1060 nm diode laser to achieve hyperthermic temperatures within the adipose tissue with subsequent lipolysis is one of the most recent advancements in this field and is the first of its kind. This wavelength was carefully chosen to effectively target the unwanted adipocytes while sparing the overlying skin and adnexae. Appreciable results are achieved after a single treatment, and these results are comparable to other non-invasive technologies. The 25-minute procedure is well tolerated among patients, with no downtime required. This versatile system allows for treatment of multiple body sites, which can be customized for a particular patient’s needs. Herein, we discuss in detail the mechanism of action, efficacy, and safety of 1060 nm diode hyperthermic laser lipolysis. Amongst the various body contouring modalities available today, the 1060 nm diode hyperthermic laser is a worthy addition providing a safe, quick, and effective non-invasive fat reduction option for patients.
J Drugs Dermatol. 2017;16(1):48-52.
W.Walsh Thomas MDa and Jason D. Bloom MDb
There have been many recent and significant innovations to the cosmetic physician’s repertoire for addressing excess submental fat and improving patients’ neck contour. These new techniques include submental cryolipolysis, injectable chemical lipolysis, percutaneous radiofrequency, laser techniques, and liposuction with or without laser or power assistance. These modalities range from completely non-invasive to surgical procedures. Each technique has its own unique advantages, and limitations and as such, aesthetic practitioners should be familiar with the various indications to use each technique. Additionally, cost to the practice and patient are similarly varied across the different techniques. By increasing familiarity with the new procedures addressed herein, practices can better present a diverse range of treatment options for excess submental fat and neck fullness to the cosmetic patient.
J Drugs Dermatol. 2017;16(1):54-57.
Mitalee P. Christman MD,a Daniel Belkin MD,b Roy G. Geronemus MD, a,band Jeremy A. Brauer MDa,b
Cellulite is the common rippling or dimpling of skin of the thighs and buttocks of women, formed from a confluence of skin laxity, tethering fibrous septa, and fat herniation. We describe an anatomical approach to evaluating the cellulite patient and selecting the best treatment from among available non-invasive, minimally invasive, and invasive therapies. It is crucial to consider the anatomy of the patient and the morphology of cellulite while choosing a treatment. Diffuse rippling represents increased adiposity and/or increased skin laxity which may stand to benefit from lipolytic and skin tightening modalities. Dimpling represents tethering by fibrous septa which may stand to improve from subcision by minimally invasive devices such as Cell na. Patients with both morphologies may be treated with a combination of treatments or Cellulaze. Careful evaluation of the patient can help identify the best therapeutic strategy.
J Drugs Dermatol. 2017;16(1):58-61.
Derek Ho BSa,b and Jared Jagdeo MD MSa,b,c
BACKGROUND: Body sculpting, or body contouring, is among the fastest growing areas in cosmetic dermatology. Cryolipolysis, or “fat freezing,” was FDA-cleared (CoolSculpting System, ZELTIQ Aesthetics, Pleasanton, CA) initially in 2010 for fat removal of the anks, and subsequently received FDA-clearance for other anatomical locations. Over the past several years, there have been increasing published reports and physician discussion regarding paradoxical adipose hyperplasia (PAH) post-cryolipolysis, previously identified as a “rare” adverse effect.
OBJECTIVE: To review published reports of PAH post-cryolipolysis, expand on previously proposed hypothesis of PAH, and provide rec- ommendations for prevention and treatment of PAH.
METHODS AND MATERIALS: On July 26, 2016, we systematically searched the computerized medical bibliographic databases PubMed, EMBASE, Web of Science, and CINAHL with the search term “cryolipolysis.”
RESULTS: A total of 314 records were returned from our search terms and 10 records were found to be suitable for our review. We identi- ed a total of 16 cases of PAH post-cryolipolysis in the published literature.
CONCLUSIONS: Based upon the published literature, we identi ed that the current incidence of PAH may be higher than previously re- ported. Although the pathoetiology of PAH is currently unknown, we hypothesize that some adipocytes may be “naturally selected” for survival due to their inherent tolerance to cryolipolysis. We believe that while cryolipolysis is an effective non-invasive treatment option for body contouring, physicians and patients should be aware of PAH as a potential adverse effect and treatment options.
J Drugs Dermatol. 2017;16(1):62-67.
Yana Alexandrovna Yutskovskaya MD PhDa and Evgeniya Alexandrovna Kogan MD PhDb
BACKGROUND: Calcium hydroxylapatite (CaHA; Radiesse (R)) provides safe and effective correction of moderate-to-deep lines, volume replacement, lift and contour, and induction of neocollagenesis and neoelastogenesis for improved skin quality. CaHA hyperdilution takes advantage of its skin-tightening properties without a volumizing effect.
OBJECTIVE: To evaluate the collagen- and elastin-stimulating effects of diluted CaHA in subjects with skin laxity in the neck and décolletage. Methods: Twenty subjects with skin laxity in the neck and décolletage received multiple, linear, subdermal injections of CaHA diluted with preserved saline at baseline and 4 months: 1:2 dilution (normal skin), 1:4 dilution (thin skin), and 1:6 dilution (atrophic skin). Subjects also received deep subdermal injection of CaHA (~0.1 ml) of the same dilution in the peri-auricular area for skin biopsy. Biopsy tissue was obtained at baseline, 4 months, and 7 months for immunohistochemical evaluation of neocollagenesis. Changes to skin mechanical properties were measured by ultrasound scanning and cutometry. Subject and investigator satisfaction was evaluated using the Global Aesthetic Improvement Scale.
RESULTS: Immunohistochemical analysis of biopsy tissue demonstrated signi cant increases in collagen I expression at 4 months (P less than 0.05) and 7 months (P less than 0.00001) compared with baseline. Increases in collagen III levels were also significant at 4 months (P less than 0.00001); they declined by 7 months but remained above baseline. Staining for elastin and angiogenesis signi cantly increased at 4 months (P less than 0.05 and P less than 0.01, respectively) and 7 months (P less than 0.00001 for both) compared with baseline. Immunohistochemical data correlated with improvements in skin elasticity and pliability evaluated by cutometry, and with ultrasound-assessed increases in dermal thickness. Subject and investigator satisfaction was high, and the procedure was well tolerated.
CONCLUSIONS: Injection of diluted CaHA is very effective for skin tightening of the neck and décolletage.
J Drugs Dermatol. 2017;16(1):68-74.