During the last 10 to 15 years, complementary and alternative medicine (CAM) has become increasingly popular in the
US. Within this realm of health care, oral and topical herbal supplements have become some of the most frequently used
alternative therapies. Most herbal supplements are based on, or include, several botanical ingredients with long histories
of traditional or folk medicine usage. Among the numerous botanical ingredients available on the market today, several
are believed to confer dermatologic benefits. This article will focus on a select group of botanical compounds, many of
which have long traditions in Asian medicine, with potential or exhibited dermatologic applications, including curcumin,
Ginkgo biloba, ginseng, silymarin, soy, and tea tree oil. Other botanical agents, such as arnica, bromelain, chamomile, pomegranate,
caffeine, green tea, licorice, and resveratrol, are also briefly considered. Some of these ingredients have been incorporated
into topical formulations.
Gary D. Monheit MD, Chad L. Prather MD
Over the past decade, the use of nonsurgical products and devices to correct facial contour defects and signs of skin aging
has exploded with new lasers, toxins for muscle relaxation, and dermal fillers revolutionizing aesthetic medicine. Of all
the nonsurgical modalities employed during this period, the dermal filler industry has seen the most growth in demand.
In 2006, the worldwide market for dermal fillers increased by 19%; and the US market is expected to increase a further
20% to 25%.1 This is due in large part to new products, particularly the hyaluronic acids such as Juvéderm™, which now
promise greater longevity, fewer side effects, a more natural appearance, and easier administration.
Macrene Alexiades-Armenakas MD PhD
A near-infrared laser with the ability to target different depths within skin has been developed and evaluated for the application
of facial and neck skin tightening in a pilot clinical study. The device consists of a combination of a 1310-nm
wavelength and sapphire contact cooling. Cooling temperature and laser pulse duration were varied to target different
dermal depths in various subgroups of the subject population. Quantitative changes in various categories characterizing
the aging skin employing a comprehensive grading scale as well as subject satisfaction were calculated. A mean improvement
of 7.9% (95% CI [confidence interval] 3.6-12.3) in laxity and 10.6% (95% CI 5.8-15.4) in rhytides was determined
by quantitative grading at one month after the treatment regimen. These values were 11.0% (5.5-16.5) and 11.7%
(5.8-17.7) at 3 months after the treatment regimen. The percent of patients reporting mild or better improvement in laxity
of the face and neck was 78% and 61% at one month, and 63% and 61% at 3 months, respectively. The discomfort
was minimal. Side effects were limited to short-term erythema and edema. In summary, a variable depth heating laser can
achieve skin tightening and wrinkle reduction with high subject satisfaction.
Divya Railan MD, Tina S. Alster MD
Topical anesthetic agents are frequently used by dermatologists to decrease the pain associated with a variety of cutaneous
procedures, including laser surgery, soft tissue augmentation, and other cosmetic surgical treatments. These lidocaine-containing
creams play an integral role in the cosmetic dermatology office by providing patient comfort with minimal side
effects. This review of topical lidocaine preparations should aid practitioners in the selection of an appropriate topical
anesthetic, taking into consideration its onset and duration of action and potential side effects.
Melissa A. Bogle MD, Kenneth A. Arndt MD, Jeffrey S. Dover MD FRCPC
Plasma skin regeneration is a novel type of skin rejuvenation technology developed over the last 3 years. Plasma is the
fourth state of matter in which electrons are stripped from atoms to form an ionized gas. Although high temperature plasmas
have been used in surgery for over a decade, plasma had previously been used as a conduction medium for electric
current. Unlike lasers which rely on the principle of selective photothermolysis to deliver heat to specific targets in the
skin, plasma technology delivers heat energy directly to tissue upon contact without reliance on skin chromophores. The
plasma itself produces controlled thermal damage to the skin surface to elicit changes such as new collagen formation and
improvement in photodamaged skin. The technology can be used at varying energies for different depths of effect, from
superficial epidermal effects to deeper dermal heating.
Alexander L. Berlin MD, Mussarrat Hussain MD, Robert Phelps MD, David J. Goldberg MD
Background and Objective: Studies documenting improvement following combined laser and light-based devices are
needed. The objective of this study was to evaluate clinical, histological, and ultrastructural changes in photodamaged
facial skin following sequential treatment with ablative superficial erbium:YAG (Er:YAG) laser peels and nonablative
intense pulsed light, or broadband light (BBL), treatments.
Study Design/Materials and Methods: Fifteen subjects with photodamaged facial skin and Fitzpatrick skin types I to III
underwent 3 monthly treatments with the Profile™ system (Sciton, Inc, Palo Alto, CA) utilizing very superficial
MicroLaserPeel™ settings of 2.5 to 5.0 J/cm2 and BBL™ settings of 515-, 560-, or 590-nm filters, 10-msec pulse duration,
and fluences of 12 J/cm2. Five subjects underwent pre- and post-treatment postauricular skin biopsies for evaluation of
treatment-induced light and electron microscopic changes.
Results: Twelve subjects completed the study. Both blinded evaluator and subject assessment of clinical changes documented
significant improvement in photodamaged skin, with the greatest improvement achieved in overall appearance
and epidermal dyspigmentation. These results were largely maintained at 3 months following the last treatment. Light
microscopy showed changes in the epidermis, collagen, and elastic fibers consistent with a wound repair mechanism to
the depth of 250 to 350 microns. Electron microscopy revealed a slight decrease in the average collagen fiber thickness,
pointing to an increase in type III collagen.
Conclusion: A protocol utilizing multiple combined superficial Er:YAG ablative treatments and nonablative BBL treatments
lead to a significant improvement in the clinical signs of photodamaged skin, with histological and ultrastructural
evidence of new collagen formation.
Fractional resurfacing or laser therapy (FLT) represents a technology that seeks to address the limitations of both ablative
resurfacing and nonablative treatments. Many companies now offer versions of fractionated erbium or carbon dioxide
lasers. The purpose of this paper is to examine FLT for difficult to treat applications such as melasma, acne scarring,
atrophic scarring, striae distensae, and deep rhytides. Fractional laser therapy is a truly novel approach to many conditions,
especially those with dermal pathology. Although published peer review data is limited, the ability to effectively
and safely treat these conditions in all skin types appears to have been significantly enhanced with this new modality.
We are early in our scientific explorations of what is possible with FLT.
The use of photodynamic therapy (PDT) in the US has shown record growth in 2007 with more clinicians utilizing PDT
for more clinical entities than ever before. Research endeavors utilizing PDT in published clinical manuscripts have been
slow in 2007 and yet the use continues to rise significantly. This manuscript will highlight the state of PDT in the US
as 2007 comes to a close and focus on the future of PDT as we move toward 2008.
Jessica Hsu BA, Greg Skover PhD, Mitchel P. Goldman MD
This study evaluates the efficacy and tolerability of an investigational study cream composed of 3 ingredients (green and
white teas, mangosteen, and pomegranate extract), Vitaphenol™ Skin Cream (La Jolla Spa MD, La Jolla CA), as compared
to a placebo cream in rejuvenating facial skin. Twenty healthy females between the ages of 35 and 65 with demonstrable
facial wrinkling, achieving a Rao-Goldman wrinkle scale score of 2 or above, applied either Vitaphenol Skin Cream or
placebo cream to a randomized half of their face twice daily for 60 days and returned for follow-up after 2 weeks. Twice as
many subjects indicated an enhancement of skin texture (eg, reduction in pore size, roughness, and touch) with the usage
of Vitaphenol versus placebo. In all, 41% of the study subjects preferred the half of their face that had been receiving
Vitaphenol, while only 0.06% of the subjects favored the placebo side. PRIMOS images from periorbital skin treated with
Vitaphenol demonstrated an average improvement in skin smoothness of 1 mm3, whereas skin treated with placebo showed
an average decrease in smoothness or an increase in skin roughness of 0.9 mm3. The addition of 3 antioxidants, green and
white teas, mangosteen, and pomegranate, have an additive effect to enhance the improvement of age-related changes in