William P. Werschler MD FAAD, Susan Weinkle MD FAAD
With the growing number of injectable products for soft-tissue augmentation, non-surgical total facial restoration is within
reach. Nevertheless, the ideal injectable product has yet to be developed; at present different approaches are required for different
soft-tissue deficits. Products have previously been categorized as either temporary (requiring frequent touch-up treatments)
or permanent (associated with possible long-term complications and results that do not co-exist harmoniously with the
aging face). Although this dichotomy remains, longer-lasting or “semi-permanent” products are beginning to emerge. There
has long been a void in the availability of products that can effectively rejuvenate the face for between 2 and 5 years. This time
period would allow the patient to correct the continuing signs of aging with re-treatment at intervals that are tolerable from
both a financial and time-management perspective
Elizabeth Gallup MD JD MBA, The Ciclopirox TS Investigators, Todd Plott MD
Ciclopirox is a broad-spectrum antifungal, antibacterial, and anti-inflammatory agent. This open-label study investigated the
safety and efficacy of ciclopirox topical suspension 0.77% in the treatment of diaper dermatitis due to Candida albicans (C. albicans).
Forty-four male and female subjects aged 6 to 29 months were included in the study. Study medication was applied
topically to the affected diaper area twice daily for 1 week. Subjects were clinically evaluated at baseline and days 3, 7, and
14 (7 days post-treatment). Safety and efficacy variables included adverse events, mycological culture studies, KOH tests,
Severity Scores, and Global Evaluation of Clinical Response. All adverse events were mild to moderate and considered not
related to the study medication. Treatment provided statistically significant improvement (P < .05) for both the rate of mycological
cure and reduction of Severity Score at each time point compared with baseline. Ciclopirox was safe and effective in
the treatment of diaper dermatitis due to C. albicans
Tina S. Alster MD, Elizabeth L. Tanzi MD, Esperanza C. Welsh, MD
Background: Photorejuvenation of facial skin has been reported after intense pulsed light (IPL) therapy alone and in conjunction
with topical 5-aminolevulinic acid (5-ALA), but no comparative studies between these regimens have been performed.
Objective: To evaluate the safety and effectiveness of combination topical 5-ALA and IPL compared to IPL treatment alone.
Methods: Ten patients with mild to moderate photodamage were randomly assigned treatment with 5-ALA + IPL on one facial
half and IPL alone on the contralateral side. Two treatments were delivered at 4-week intervals. Clinical improvement scores
were determined by masked evaluations of digital photographs obtained at baseline, prior to each treatment session, and at 1, 3,
and 6 months after the final treatment.
Results: Higher clinical improvement scores were noted on the combination 5-ALA + IPL treated areas. Mild edema, erythema,
and desquamation were observed on the facial halves where 5-ALA was applied. No scarring or unwanted pigmentary alteration
Conclusions: Photodynamic therapy with combination topical 5-ALA + IPL is safe and more effective for facial rejuvenation
than IPL treatment alone.
Background: Retinoids comprise a family of compounds with structures and mechanisms of action that resemble those of vitamin A
(retinol), an essential nutrient which plays a role in cell growth and differentiation. The retinoids, which interact with nuclear
receptors and affect gene transcription, have enormous therapeutic potential, particularly if they are receptor- and functionselective.
Tretinoin was the first topical retinoid employed for the treatment of acne. In recent years, other topical retinoids
for the treatment of acne have been designed from a disease-specific approach, with enhanced receptor and function selectivity,
which translates to improved therapeutic effects and more favorable tolerability. The properties that differentiate the
topical retinoids tretinoin, adapalene, and tazarotene have permitted clinicians to tailor acne treatment regimens for maximum
Tretinoin (all-trans-retinoic acid), considered a first-generation retinoid, acts by altering the milieu of the microcomedo and
influences desquamation of abnormal epithelium. Two receptor-selective synthetic retinoids, adapalene and tazarotene, may
be classified as third-generation retinoids. Adapalene, a derivative of naphthoic acid, has comedolytic, antiproliferative, and
anti-inflammatory properties. Tazarotene is a prodrug metabolized to tazarotenic acid that modulates cellular differentiation,
desquamation, and inflammation.
Alan Shalita MD, Judith A. Myers, Lincoln Krochmak MD, Alex Yaroshinsky PhD
Clindamycin phosphate is the most widely used topical antibacterial agent for acne treatment. Treatment of patients with mild
to moderate acne vulgaris with a new foam formulation (clindamycin foam, CF) for 12 weeks was at least as effective as clindamycin
gel (CG) based on the Investigator’s Static Global Assessment (ISGA) score. CF was superior to CG based on the
reduction from baseline in total (P = .0014), inflammatory (P = .0478), and noninflammatory (P = .0037) acne lesion counts.
Additionally, CF achieved efficacy that was superior to that of vehicle foam based on ISGA score (P = .0025) and all 3 lesion
counts (all P < .05). Adverse experiences in the active treatment groups were mild or moderate and transient in nature. Thus
the foam formulation of clindamycin is a safe and effective acne treatment; the unique foam delivery vehicle may offer cosmetic
benefits to the patient and thus increase compliance
Ronald B. Vender MD FRCPC, Orli Goldberg MD
Imiquimod (Aldara,™ 3M Pharmaceuticals) is a potent stimulator of the innate and adaptive arms of the immune system
through induction, synthesis, and release of cytokines and chemokines. An extensive review of clinical trials, case reports, and
letters published in peer-reviewed journals was performed regarding imiquimod use in skin disorders. A reference module was
developed for physicians to consult as a guide. Studies have validated the benefit of imiquimod in treating external genital and
perianal warts, superficial basal cell carcinomas, and actinic keratoses. This new topical therapeutic agent has shown to be of
benefit in other various skin disorders through its broad immunomodulatory properties. Since many skin conditions are
immunologically influenced, it is reasonable to expect several diseases to respond to imiquimod. Our research consolidates the
therapeutic trials and reports on the innovative uses of imiquimod, thereby serving as a useful resource to benefit dermatologists
treating patients with refractory or recalcitrant skin diseases.
Michael H. Gold MD, Jaggi Rao MD, Mitchel P. Goldman MD, Tancy M. Bridges NP, Virginia L. Bradshaw NP, Molly M. Boring NP, April N Guilder RN
Background: Blue light sources have been shown to be effective in the treatment of mild to moderate inflammatory acne vulgaris
Objective: We evaluated the safety and efficacy of a new blue light source in the treatment of mild to moderate inflammatory
acne vulgaris in comparison to topical 1% clindamycin solution.
Results: Blue light therapy reduced inflammatory acne vulgaris lesions by an average of 34%, as compared to 14% for topical
1% clindamycin solution.
Conclusions: The blue light source presented in this report is a safe and effective treatment option available to our patients
with mild to moderate inflammatory acne lesions.
Alireza Firooz MD, Alireza Khatami MD, Ali Khamesipour PhD, Mansour Nassiri-Kashani MD, Fereydoun Behnia MD, Mohammadali Nilforoushzadeh MD, Hamidreza Pazoki-Touroudi PhD, Yahya Dowlati MD PhD
Several in vitro and in vivo studies have shown inhibitory effects of zinc sulfate (ZnSO4) on Leishmania parasites. The objective
of this study was to compare the efficacy of intralesional injections of 2% ZnSO4 solution with meglumine antimonate
(Glucantime) in the treatment of acute Old World cutaneous leishmaniasis (CL). Seventy-two patients with CL lesions less
than 8 weeks were recruited in a randomized, double-blind, clinical trial in an area endemic for Leishmania major after giving
written informed consent. They were treated with 6 weekly intralesional injections of either drug. Among 36 patients with 53
lesions treated with ZnSO4 and 36 patients with 53 lesions treated with Glucantime, 13 patients with 19 lesions and 22 patients
with 31 lesions completed the trial, respectively. Inadequacy of treatment was the main reason for drop-out in 12 (33.3%) and
2 (5.5%) patients in ZnSO4 and Glucantime groups, respectively (P < .05). Complete re-epithelialization was observed in 2
(10.5%) and 19 (61.3%) lesions 1 week after the end of treatment in the ZnSO4 and Glucantime groups, respectively (P <
.05). In conclusion a 6-week course of weekly intralesional injections of 2% ZnSO4 solution was less effective than Glucantime
in the treatment of acute Old World CL.