Richard W. McClain BS, Brad A. Yentzer MD, Steven R. Feldman MD PhD
Background: Topical corticosteroids are often considered to have greater safety and poorer efficacy than oral corticosteroids in
treating psoriasis and atopic dermatitis. There are limited data for assessing relative efficacy of topical and systemic corticosteroids,
however. The concentration of corticosteroid in skin, adjusted for the relative potency of the active compound, may be a predictor of
clinical efficacy and can be estimated for both topical and oral administration.
Purpose: To analyze the assumption that oral corticosteroid therapy should be more potent than topical therapy by comparing relative
corticosteroid concentrations in the skin expected with topical versus systemic administration.
Methods: The estimated skin concentration of prednisone following oral dosing was calculated based on data showing 70–100%
bioavailability and an even tissue distribution. Data on the concentration of corticosteroids found in skin after topical application were
obtained from the literature. The relative potencies of corticosteroid molecules were then used to compare skin concentrations of
corticosteroid following topical versus oral treatment.
Results: Data derived from the existing literature demonstrated that hydrocortisone 2.5% ointment, triamcinolone 0.1% ointment,
and clobetasol 0.05% foam achieved effective skin concentrations greater than the effective concentration achieved by oral prednisone.
Betamethasone 0.1% cream achieved effective concentrations in skin within the range created by oral prednisone.
Limitations: This analysis was limited by the paucity of data regarding cutaneous concentrations of corticosteroids after topical application,
and by the differing experimental designs utilized in the available studies.
Conclusion: Most topical corticosteroids have the potential to achieve greater effective drug levels in the superficial layers of skin
than those achieved with standard doses of oral prednisone. The apparently greater efficacy of oral corticosteroid therapy may be
attributable, in part, to poor patient compliance with topical therapy. Systemic alterations in immune function following oral, but not
topical, corticosteroid use may also play a role.
Richard Fried MD PhD and Marge Nighland BS
Patient satisfaction and quality of life are important considerations when assessing products used to treat acne vulgaris, as these
factors may affect treatment adherence and subsequent treatment outcomes. The objective of this analysis was to determine patient
satisfaction and improvement in quality of life after treatment with tretinoin gel microsphere (TGM) in a pump dispenser. Assessments
were made during a phase IV, prospective, 12-week, open-label, community-based trial in which 544 patients who were dissatisfied
with their current acne treatments received TGM 0.04% or 0.1% in addition to ≤ 2 concurrent non-retinoid acne therapies.
At week 12, significant improvement was reported in both patient acne therapy satisfaction and in the overall mean Acne Quality
of Life Index scale15 (P<0.0001 versus baseline for both measures). The majority of patients (82.3%) rated the pump dispenser as
an “excellent” or “very good” means of dispensing medication, and 86.0% rated their overall satisfaction with the pump treatment
application as “very satisfied” or “extremely satisfied.” The results of this study indicate that the use of TGM in a pump dispenser in
patients with acne vulgaris is associated with significant increases in both quality of life and patient satisfaction.
Kenneth Beer MD PA and Nowell Solish MD
Hyaluronic acid (HA) fillers are long chains of sugar molecules. Depending on various physical properties, such as chain length and
cross-linking, they can have different textures and durations. Injections of hyaluronic acids for soft-tissue augmentation is one of the
most popular procedures performed in the U.S., Europe, Asia and Canada. With the development of newer HA molecules, it is likely
that this trend will continue. Choosing the right HA for a particular patient depends on various factors, including the area to be treated,
skin thickness and patients’ risk tolerance. Understanding the various molecules, and how they interact, is essential for ensuring
optimal patient outcomes.
Sujatha Tadicherla MD, Kate Ross BS, Philip D. Shenefelt MD, Neil A. Fenske MD
Topical corticosteroids are the most commonly prescribed agents in the treatment of dermatologic conditions. They are used primarily
as monotherapy or in combination with other agents for enhanced efficacy. Several stronger preparations are now available since
their first introduction. They are also available in various vehicles altering the potency and giving the option of tailoring them for use
based on specific anatomic locations, area of involvement, age of the patient, and most importantly, severity of the condition. Several
local and systemic side effects have been associated with their inadvertent use. Allergic contact dermatitis to most of the preparations
has also been noticed. Judicious use with reinforced patient education lowers such risk for side effects, and can be of great
use in treating dermatologic conditions.
Jeffrey L. Sugarman MD PhD and Lawrence Charles Parish MD
Objectives: The authors assessed the efficacy of a ceramide-dominant, triple-lipid barrier repair formulation (EpiCeram®), which designed
to correct the lipid-biochemical abnormalities in atopic dermatitis (AD) in comparison to fluticasone propionate cream.
Methods: In a five-center, investigator-blinded, randomized trial, EpiCeram was compared to fluticasone (Cutivate®) cream in 121
patients with moderate-to-severe AD. Primary outcome measures were: 1) reduction in disease severity, assessed as SCORAD (Severity
Scoring for Atopic Dermatitis) scores; 2) improvement in pruritus; and 3) improvements in sleep habits.
Results: EpiCeram reduced clinical disease severity, decreased pruritus and improved sleep habits both 14 and 28 days after initiation
of therapy. Although the fluticasone-treated group showed significantly greater improvement at 14 days, SCORAD, pruritus and sleep
habit scores for EpiCeram did not differ significantly from the fluticasone-treated group by 28 days.
Conclusion: The ceramide-dominant, physiological-lipid based formulation could represent an effective stand-alone or ancillary therapy
for many pediatric patients with AD.
Mitchel P. Goldman MD, Gregory R. Skover PhD, Gregory S. Payonk PhD
Demand for facial volume augmentation procedures is increasing, along with a growing appreciation for the importance of objective,
quantitative measures of treatment success. This article reviews currently available three-dimensional (3D) imaging techniques and
discusses their practical applications for cosmetic dermatology. X-ray–based imaging techniques can be costly, time-consuming and
expose patients to the potential health risks of ionizing radiation. Conventional photographic techniques vary widely in quality.
Standardized equipment, with controlled lighting, short exposure times, and high-resolution digital formats, provides high-quality,
two-dimensional photographic images allowing accurate assessment of changes in facial features. These images can be reconstructed
into 3D surfaces using stereophotogrammetric techniques, offering a major advance in measurement of changes. Although
no system is ideal for use in routine clinical practice, stereophotogrammetry-based optical profilers provide acceptable surface quality
and image overlays suitable for measurement and visual inspection. For research purposes, fringe projectors yield acceptable image
overlays for quantitation of facial volume changes.
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